RBCCV Brazilian Journal of Cardiovascular Surgery Revista Brasileira de Cirurgia Cardiovascular

Plasma catecholamine levels were measured in 20 infants (mean age 6.0 ± 5.86 months; mean weigh 5.3 ± 1.82 Kg), undergoing correction of congenital heart defects using surface cooling (26ºC), limited cardiopulmonary bypass and circulatory arrest (15ºC). Plasma adrenaline and noradrenaline were assayed in serial arterial blood samples using cromatography and electrochemical techniques. Surface cooling produced a significant rise in adrenaline and noradrenaline: the levels of both catecholamines fell, however, during core-cooling on cardiopulmonary bypass. Following the period of circulatory arrest (23/64 min, mean 41.3 min), there was a further increase in plasma catecholamines, which persisted during rewarming. Following rewarming, plasma catecholamines remained elevated untill the end of the surgical procedure. Our data show the technique of surface cooling, limited cardiopulmonary bypass and circulatory arrest produces a major sympathoadrenal response. The biological significance of high levels of circulating catecholamines under hypothermic conditions is uncertain.

Keywords: simpathoadrenal function, children, surgery. surface cooling, children. cardiopulmonary bypass, children. circulatory arrest, children.

Myocardial revascularization surgery without the use of cardiopulmonary bypass was performed by Trapp and Ankeney in the 1970's. However it fell to Buffolo in Brazil and Benetti in Argentina to introduce its systematic use, standardization and recommendation as a valid and safe alternative modality of treatment. With the aim of evaluating the technique's reproducibility, morbidity and mortality, its technical difficulties and the possibilities of incorporating it into routine practice, the authors present the results obtained in 182 patients submitted to myocardial revascularization with saphenous and/or thoracic internal bypass without the use of cardiopulmonary bypass. One hundred and eighty-two patients were operated on using this technique: 128 (70.3%) males and 54 (29.7%) females, whose ages ranged from 40 to 79 years (mean = 58.8 years), with lesions of coronary arteries: interventricular anterior (IA); right coronary (RD); diagonal artery (DI) and marginal artery (MG). Two hundred and seventy-seven arteries were revasculahsed: 159/277 IA's (57.4%), 62/277 CD's (22.4%), 44/277 DI's (15.9%) and 12/277 MG's (4.3%). The left thoracic internal artery was used on 60/277 (21.7%) occasions and the saphenous vein on 217/277 (78.3%). The duration of the ischemia ranged from 5 to 33 minutes with a mean of 14 minutes. The following conditions were noted in the study as complications: coronary spasm in 6/182 cases (3.3%), acute myocardial infarct in 3/182 (0.6%), bleeding in 2/182 (1.1%), pulmonary embolism in 1/182 (0.6%) and mediastinitis in 1/182 (0.6%). Five/182 patients (2.7%) died in the immediate postoperative period from causes unrelated to the technique employed. The authors conclude that the technique may be safely carried out by most surgeons in selected cases with good results. The technique reduces the costs of surgery and in some subgroups, such as the elderly and those suffering from systemic disease, it may be the best alternative.

Keywords: myocardial revascularization, surgery without extracorporeal circulation.

Truly Cordis Ectopy is a rare congenital heart disease, which is caracterized by the presence of the heart out of the thoracic box, having as the main feature the absence of tissues which cover it. In the great majorly of patients with Truly Cordis Ectopy there is an association of complex intra-cardiac defects. In the present work, the authors show their experience with 2 cases who had undergone to surgery, at the Unidade de Tratamento Cardiotorácico - UNITÓRAX - in Real Hospital Português do Recife, and discuss the surgical management as well was a literature revision.

Keywords: ectopia cordis, surgery.

OBJECTIVE: To present a number of modifications to the conventional heart implant technique in orthotopic cardiac transplants. METHODS: The proposed modifications consist basically of the following: 1) resecting as much of the disease heart as possible during the cardiectomy, leaving only sufficient tissue to enable the new heart to be sutured during the implant; 2) opening the right atrium of the donor heart from the inferior vena cava, close and parallel to the interatrial septum as far as the highest part, where the incision should be sharply directed towards the right atrial apendix; 3) initiating the implant through the pulmonary artery, and 4) suturing the atria simultaneously, in a single plane, atthe level of the septum. These technical modifications have been utilized in all patients undergoing transplants in the three Institutions. REMARKS: The technical changes present the following advantages: 1) a perfect alignment of the pulmonary artery, thereby avoiding bending and torsion and 2) smaller atrial cavities with no sutures protouding into the atria and, consequently, less likelihood of tromboembolic phenomenon or asynchronous contractions of the atria (donor-receiver) which, in addition to facilitating the formation of thrombi, may impair the functioning of the atrioventricular valves. CONCLUSIONS: The method is easily reproducible and can be recommended for orthotopic heart transplants.

Keywords: heart transplantation, orthotopic.

Between October 1995 and February 1996, sixteen patients were selected to undergo to surgical myocardial revascularization through left anterolateral minithoracotomy. The left internal thoracic artery was dissected in all patients, for consecutive anastomosis with interventricular anterior artery, without using extracorporeal circulation. Patients age ranged from 43 to 77, average 60 years. Sixty-two percent of them were men. There were no complications such as: acute myocardial infarction, mediastinitis, acute renal failure, hemorrhagy or stroke. There were no deaths. Four (25%) patients were submitted to cardiac catheterization that showed patency of grafts and grafted native arteries. Due to excellent initial results, the authors believe that this technique can be employed with greater frequency and that its use can be extended to the treatment of diagonal branches of the interventricular anterior artery and marginal branches of the circunflex, as soon as the surgical teams become more familiarized with it.

Keywords: Myocardial revascularization, methods. Thoracotomy, methods. Thoracic arteries, surgery.

The authors report a case of a 16-year-old man who presented progressive dyspnea. At that time the diagnosis of rheumatic fever with mitral valve involvement was performed. The bidimensional echocardiogram showed presence of mobile mass inside the left atrium. The tumor presented lobules, projecting into the left ventricle during the diastole and provoking turbulence. The patient underwent surgical resection with postoperative course needing re-operation for mitral valve replacement. Histopathology has proven that such tumor was a primary cardiac rhabdomyosarcoma and the early clinical diagnosis of rheumatic mitral valve disease was very difficult.

Keywords: Neoplasms. Heart valves. Mitral valve.

OBJECTIVE: To report the incidence of mediastinitis in cardiovascular surgery postoperation. METHODS: The records of all 1038 patients who underwent cardiovascular surgical procedures between May/2007 and June/2009 were reviewed. All operations were performed in Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. RESULTS: The complication occurred within, on average, 13 days after operation, in total of 25 (2.4%), eight (32%) deaths occurred. Several risk factors mediastinitis were identified: 56% diabetes, 56% smokers, 20% obeses, 16% with chronic obstructive pulmonary disease and 8% of chronic renal failure. Mediastinitis were reported in 21 (84%) cases of patients submitted to coronary artery bypass grafting, being associated to major risk of infection development (IC 3.448.30, P=0.0001). High rates of complications were observed: respiratory insufficiency (44%), stroke (16%), cardiogenic shock (12%), acute renal failure (28%), pulmonary infection (36%), multiple organs failure (16%) and esternal deiscence (48%). Bacterial cultures of exudates were positive in 84% of patients; Staphylococcus aureus was the most responsible pathogen (28.8%). CONCLUSION: Mediastinitis stays a serious surgical complication and difficult management in cardiovascular surgery postoperation. The disease stays with low incidence, but still with high lethality. Coronary bypass was associated to major risk of infection development

Keywords: Infection. Mediastinitis. Cardiac surgical procedures.

BACKGROUND: It has been well documented that women have higher morbidity and mortality rates than men following coronary artery bypass graft (CABG) surgery. In view of this evidence, it is necessary to know if there is benefit to off-pump CABG surgery in women in comparison to on-pump CABG. OBJECTIVES: Compare outcomes between off-pump CABG and on-pump CABG in women. METHODS: Retrospective study. Our investigation analyzes comparatively clinical profile, thirteen procedure complications and mortality of a population of 941 consecutive women undergoing CABG surgery (549 off-pump and 392 on-pump) at two hospitals for the period January 2000 to December 2005. RESULTS: Mortality rate for women undergoing off-pump CABG surgery is lower than for women undergoing on-pump surgery, however, not statistically significant (3.1% vs 5.3%; P=0.134). The complication rates analyzed (hemorrhagic shock, neurologic, respiratory, acute renal failure, adult respiratory distress syndrome, septicemia, pneumonia, atrial fibrillation) were lower (significant statistically difference) for women off-pump than women on-pump, with the exception of low cardiac output and wound infection. CONCLUSIONS: Evidence suggests that off-pump CABG surgery may be better for women than on-pump CABG surgery because it appears to reduce morbimortality rates. Ten of 13 complications investigated demonstrated an advantage for women undergoing off-pump surgery relative to those receiving on-pump surgery.

Keywords: Coronary Artery Bypass, Off-Pump. Women. Surgery.

Objective: This study aims to evaluate the surgical treatment of atrial fibrillation with ultrasound ablation concomitant to mitral surgery in PROCAPE's patients with permanent atrial fibrillation. Methods: From March 2008 through January 2009 a prospective study was performed at the Pernambuco Cardiology Emergency Facility on 44 consecutive patients with a permanent atrial fibrillation and concomitant cardiac valvular surgery indication, from March 2008 through January 2009 at Pernambuco Cardiology Emergency Facility Twenty two patients underwent epicardial ultrasonic ablation on the right atrium and had ultrasonic ablation performed in the left atrium endocardial concomitant with the valve procedure. The other 22 patients, the concurrent controls were submitted to valve procedure without ultrasonic ablation. Patients with serious diseases such as coronary and others were excluded of the research. Results: It was observed 90% restoration to sinus rhythm immediately after surgery in patients submitted to treatment of atrial fibrillation with ultrasound ablation simultaneous a mitral surgery. The evolution in late post operation showed that the maintenance of sinus rhythm drops although it was still 27% higher in the group which received ablation compared with the control group. 86.40% of the patients who received ablation had improved in functional class; they also have fewer complications than patients in the control group. Conclusion: The results showed that the patients who received treatment for atrial fibrillation simultaneously with valvar surgery had advantages related to the control group.

Keywords: Atrial fibrillation. Ablation techniques. Mitral valve. Arrhythmias, cardiac.

Objectives: To study clinical features, complications and in-hospital outcomes of patients operated for postinfarction ventricular septal rupture. Methods: A retrospective study involving 21 patients between January/1996 and June/2009. All operations were performed at the Division of Cardiovascular Surgery of Complexo Hospitalar HUOC/PROCAPE. Results: Mean age of patients was 62.81 years (±8.21), 61.9% (n=13) were male. Rupture occurred on average 4.8 days after infarction. Cardiogenic shock was observed in 57.1% (n=12), being risk factor for death (100% with shock vs. 22.2% without shock; P<0.001). Survivors had a higher mean ejection fraction compared to deaths (66.29%±4.61% versus 42.71%±4.79%, P <0.001). All were classified as high risk by the EuroSCORE, and the survivors had lower average score compared to deaths (6.57±0.53 versus 10.93±2.23; P<0.001). The majority (76.2%, n=16) of the patients needed to use vasoactive drugs and 57.1% (n=12) considered hemodynamically unstable. Need for vasoactive drugs was a risk factor for death (81.3% with vasoactive drugs versus 20% without vasoactive drugs, P=0.025). Hemodynamic instability was also a risk factor for death (100% in the unstable group versus 22.2% in the stable group; P<0.001). The rate of in-hospital mortality was 66.7% (n=14). Conclusions: The need for vasoactive drugs, hemodynamic instability and cardiogenic shock were associated with higher rates of mortality. Patients who had adverse outcomes had less ventricular function and higher score in the EuroSCORE. Mortality remains high.

Keywords: Heart septal defects, ventricular. Heart rupture, post-infarction. Myocardial infarction.

Objective: The aim of this study is to evaluate the applicability of EuroSCORE in patients undergoing coronary artery bypass graft (CABG) surgery at the Division of Cardiovascular Surgery of Pernambuco Cardiologic Emergency Medical Services - PROCAPE. Methods: A retrospective study involving 500 patients operated between May 2007 and April 2010. The registers contained all the information used to calculate the EuroSCORE. The outcome of interest was death. Univariate analysis and multivariate analysis by backward logistic regression were applied to assess the association between each variable in the EuroSCORE and deaths. The following parameters were calculated: sensitivity, specificity, positive predictive value, and negative predictive value. The power of concordance between the predicted mortality by the EuroSCORE and the observed mortality was measured using the Kappa coefficient. The accuracy of the model was evaluated by the ROC (receiver operating characteristic) curve. Results: The incidence of death was 13%. In multivariate analysis, nine variables remained independent predictors of death: chronic obstructive pulmonary disease, creatinine >2,3mg/dL, active endocarditis, preoperative critical state, unstable angina, ejection fraction 30% to 50%, acute myocardial infarction < 90 days, emergency surgery and additional surgery. The score had a sensitivity of 88.4%, specificity of 79.3%, positive predictive value of 40.7%, negative predictive value of 97.7% and 80.6% concordance. The accuracy measured by the area under the ROC curve was 0.892 (95% CI 0.862-0.922). Conclusions: The EuroSCORE proved to be a simple and objective index, revealing a satisfactory discriminator of postoperative evolution in patients undergoing CABG surgery at our institution.

Keywords: Myocardial revascularization. Risk. Mortality. Risk assessment/methods.

From January/95 to December/96 our surgical team (ICORP - Fortaleza - Ceará), has performed coronary artery surgery without cardiopulmonary bypass (CPB) as a routine. During this period, 385 operations were sequencially performed, 86 per cent of them (333) without CPB. The purpose of this study is to evaluate the results of these 333 patients regarding hospitalization time, age, gender, number of grafts, functional status and morbimortality. All patients were submitted to previous coronary arteriography. All coronaies were by-passed, including the circumflex marginal artery. The age of these patients ranged from 35 to 86 years with a mean age of 61. The average time of hospitalization was 7 days; 625 grafts were placed varying from 1 to 4 with an average of 1.9 by patient. The incidence of procedure related with complications was 2 per cent (7 patients). Ten patients died in the early postoperative course. Considering the data obtained herein we conclude that this procedure can be used in the great majority of patients that undergo coronary artery surgery.

Keywords: Myocardial revascularization, methods. Myocardial ischemia, surgery. Extracorporeal circulation. Surgery, minimally invasive.

OBJECTIVES: Over the past few years, great strides have been made in off-pump coronary surgery. This progress is due to a combination of the advances in surgical techniques and the development of instruments that make it possible to perform this procedure in the most varied situations. This is a retrospective study, the purpose of which is to assess our experience with this procedure over the last eleven and a half years. The authors underscore the rapid progress of the method in recent years and report on its indications, contraindications and results. METHODS: In the period from August 1991 to December 2003, 3,410 consecutively patients suffering from angina pectoris were submitted to off-pump coronary surgery. Ages ranged from 13 to 93 years, with a mean of 63 ± 12.0 years. Males accounted for 58% of the cases. The angina was rated according to the criteria of the Canadian Cardiovascular Society, 6.1% of the patients being in Class I, 6.8% in Class II, 46.3% in Class III and 40.8% in Class IV. RESULTS: Intraoperative mortality was low (0.4%). Hospital mortality (30 postoperative days) was 2.5%. Mortality and morbidity among the octogenarian patients were extremely low compared with patients operated on with cardiopulmonary bypass (CPB) (2.2% versus 12.6%) (p<0.001). Postoperative complications regarded as nonfatal occurred in 7.6%. In the final year no difference was observed between the number of conduits in the patients operated on with and without CPB [with CPB 2.8 ± 1.2 and without 2.8 ± 0.8 (NS)]. Acute myocardial infarction was the most frequent complication, occurring in 2.7% of the patients. The mean time in the intensive care unit was 22.3 hours. CONCLUSIONS: Off-pump coronary surgery, employed as a revascularization technique in patients requiring multiple grafts, is a reproducible procedure, the results of which are similar to those obtained from conventional surgery with CPB. In the present series it was possible to perform coronary artery bypass grafting without CPB in 95% of the patients, thus making all patients with indication for grafting potential candidates for the procedure without CPB.

Keywords: coronary disease, coronary artery bypass grafting. off-pump coronary surgery.

Objective: The purpose of the present study is to compare and analyze the benefits of this operation with and without cardiopulmonary bypass in octogenarian patients. Method: Retrospective data of the patients aged eighty years or more from December 1995 to December 2003 were analyzed. During this period 73 patients were submitted to coronary artery bypass grafting (CABG), 26 (35.6%) on-pump and 47 (64.4%) off-pump. A comparison was made of the demographic data, preoperative risks, concurrent morbid conditions, types of angina, postoperative complications and surgical outcomes between the on-pump and off-pump groups. The Student t-test was used to compare the groups and the level of significance was set at p-value < 0.05. Results: Both groups showed a high preoperative risk, although the off-pump group presented less surgical mortality (11.5% vs 2.1%, p < 0.05). No strokes were observed in the patients operated on off-pump (11.5% vs 0.0%, p < 0.005). Atrial fibrillation (AF) in the immediate postoperative period was present less often in the off-pump group (30.8% vs 12.8%, p < 0.005). The postoperative mechanical ventilation time and the presence of respiratory failure were less in the off-pump group (p < 0.005). The presence of acute renal insufficiency (ARI) was 19.2% in the on-pump group and 0% in the off-pump group (p < 0.05). There was less need for transfusion of blood or blood derivatives in the off-pump group (69.2% vs 31.9%, p < 0.005). The mean sojourn in the intensive care unit (ICU) was shorter in the off-pump group (p < 0.05). The percentage of patients with no postoperative complications was higher in the off-pump group than in the on-pump group (89.4% vs 61.5%, p <0.001). Conclusions: The present study suggests that patients aged eighty years and over benefit when submitted to off-pump CABG and that this procedure is associated with low rates of postoperative complications such as stroke, AF, ARI and respiratory insufficiency, and with less time in the ICU, a shorter hospital sojourn, less use of blood derivatives and lower mortality. In octogenarian patients off-pump CABG surgery is a safe and effective technique, and may be the operation of choice when correctly indicated.

Keywords: Myocardial revascularization, aged. Extracorporeal circulation.

Objective: To describe the technique and evaluate the immediate results of using an ultrasonic scalpel in the skeletonization of the internal thoracic artery for coronary artery bypass grafting surgery. Methods: From January 2000 to October 2006, 188 patients were submitted to coronary artery bypass grafting with the internal thoracic artery skeletonized using an ultrasonic scalpel. Seventy-one patients (37.8%) were women. The patients' ages varied from 28 to 81 years old. The entire internal thoracic artery was exposed opening the endothoracic fascia using scissors as close as possible to the arterial adventitia. An ultrasonic scalpel was used to transect and coagulate all the intercostal branches, thereby minimizing the use of metallic clips. Results: The skeletonized internal thoracic arteries presented with excellent flow, obviating the need for intraluminal manipulation for vasodilatation. In the immediate postoperative period, two patients were found to have temporary left-sided diaphragmatic paralysis. There were no sternal wound infections in this series. The dissection can be performed in approximately 33 minutes however with more experience this time may be reduced. Conclusion: This technique facilitates and shortens the internal thoracic artery skeletonization procedure and does not cause arterial spasms. Cauterization of the collateral branches with an ultrasonic scalpel is efficient and the use of metallic clips is almost unnecessary. It is a procedure that is easy to reproduce and may be recommended as the first-choice technique for the dissection of the internal thoracic artery.

Keywords: Myocardial revascularization. Coronary artery bypass. Mammary arteries.

Objective: To make a 30-year review of the immediate results of coarctation of the aorta (CoAo) operation, between 1974 and 2004. All the patients underwent CoAo whether in isolation or associated with other congenital defects. Methods: The following data was investigated: age at the time of surgery, gender, associated lesions, type of surgical technique, and immediate surgical outcome, particularly focusing the presence of systemic arterial hypertension. Results: One hundred and four patients underwent CoAo. Of the 104 enrolled patients, 75 (72%) were pediatric patients and 29 (28%) adults patients. In the pediatric group, 23 (22%) were considered neonates, 17 (16%) infants, and 35 (34%) children. The associated defects were present in 66 (63.5%) patients, 54 (51.9%) in the pediatric group and 12 (11.3%) in the adult group. Seven (6.7%) deaths were observed in the immediate postoperative period. Among the various surgical techniques employed, aortoplasty was used in 80 patients (76.9%); end-to-end anastomosis in 15 (14.4%); Teles technique in seven (6.7%), Waldhausen technique in one (1%), and it was not possible to identify the technique in one patient (1%). Conclusions: Despite the limitations of the present study, it may be noted that the results were good with the corrective surgery being performed safely and with a low mortality rate. Medium- and long-term follow-up was impaired by the well-known structural deficiencies in Brazil.

Keywords: Aortic coarctation, surgery. Cardiac surgical procedures. Heart defects, congenital. Retrospective studies.

Objectives: Mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. The aim of this study is to identify risk factors for mediastinitis in patients undergoing coronary artery bypass grafting (CABG), without the use of bilateral internal thoracic artery (ITA), at the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE. Methods: A retrospective study of 500 consecutive patients operated on between May 2007 and April 2010. Ten preoperative variables, seven intraoperative variables and seven postoperative variables possibly involved in the development of postoperative mediastinitis were evaluated. Univariate and multivariate logistic regression analyses were performed. Results: The incidence of mediastinitis was 5.6% (n=28), with a lethality rate of 32.1% (n=9). In multivariate analysis using logistic regression, five variables remained as independent risk factors: obesity (OR 2.60, 95% CI 1.11 to 6.68), diabetes (OR 2.71, 95% CI 1.18 to 6.65), smoking (OR 2.10, 95% CI 1.12 to 4.67), use of pedicled internal thoracic artery (OR 5.17, 95% CI 1.45 to 18.42) and on-pump CABG (OR 2.26, 95% CI 1.14 to 5.85). Conclusions: This study identified the following independent risk factors for mediastinitis after CABG: obesity, diabetes, smoking, use of pedicled ITA and on-pump CABG.

Keywords: Risk Factors. Mediastinitis. Myocardial Revascularization.

Objectives: To report the experience with the vacuum-assisted venous drainage (VAVD) technique in cardiopulmonary bypass (CPBP) and blood transfusion need. Methods: A retrospective study was made about data from 111 patients who were operated, using VAVD between October 2006 and February 2008, at the Esperança Hospital, Recife, Pernambuco. The necessity of blood transfusion was verified on the single group of patients who underwent VAVD, comparing with sex, age and weigh, before the beginning of the CPBP and during the surgery, using Chi-square test and t-student test. Results: Before the beginning of the CPBP only 10% of patients had need for blood transfusion and 12% during the surgery. It was observed that 17% of women received blood transfusion versus 4.7% of men before the beginning of CPBP (P=0.51), and 38% of women versus 9% of men during the surgery (P<0.001). The weight of patients who received blood transfusion were lower both before the beginning of the CPBP as during the surgery (P=0.049 e P=0.001, respectively). Conclusion: The VAVD technique has been used safely and satisfactorily, optimizing venous drainage during CPBP, in the hospital that conducted the study. However, prospective and comparative investigations between conventional drainage and VAVD are needed to better clarify this relation with blood transfusion.

Keywords: Extracorporeal Circulation. Vacuum. Blood Transfusion.

OBJECTIVE: The aim of this study is to evaluate the applicability of a new score for predicting mediastinitis - MagedanzSCORE - in patients undergoing coronary artery bypass graft (CABG) surgery in the Division of Cardiovascular Surgery of Pronto Socorro Cardiológico de Pernambuco - PROCAPE.
METHODS: Retrospective study involving 500 patients operated between May/2007 and April/2010. The registers contained all the information used to calculate the MagedanzSCORE. The outcome of interest was mediastinitis. We calculated sensitivity, specificity, positive predictive value, negative predictive value, concordance and accuracy. The accuracy of the model was evaluated by ROC (receiver operating characteristic) curve.
RESULTS: The incidence of mediastinitis was 5.6%, with a lethality rate of 32.1%. In univariate analysis, the five variables of the MagedanzSCORE were predictors of postoperative mediastinitis: chronic obstructive pulmonary disease (OR 6.42; 95.0% CI 2.76-14.96; P<0.001), obesity (OR 3.06; 95.0% CI 1.32-7.09; P=0.009), surgical reintervention (OR 82.40; 95.0% CI 30.40-223.30; P<0.001), multiple transfusion (OR 3.33; 95.0% CI 1.52-7.29; P=0.003) and stable angina class IV or unstable (OR 2.59; 95.0% CI 1.19-7.64; P=0.016) according to Canadian Cardiovascular Society. The score had a sensitivity of 96.4%, specificity of 90.0%, positive predictive value of 36.5%, negative predictive value of 99.8% and 90.4% concordance. The accuracy measured by the area under the ROC curve was 96.2% (95.0% CI 94.5%-97.9%).
CONCLUSIONS: The MagedanzSCORE proved to be a simple and objective index, revealing a satisfactory predictor of development of postoperative mediastinitis in patients undergoing CABG surgery at our institution

Keywords: Risk factors. Mediastinitis. Coronary artery bypass. Myocardial revascularization.