Many elderly undergo cardiac surgery. The prevalence of malnutrition in elderly is high and increases with comorbidity. This thesis aims to clarify some aspects on performing surgery in elderly concerning nutritional status, nutritional treatment and age-related physiology. Study I: 886 patients were assessed preoperatively by body mass index (BMI) and S-albumin and postoperatively for mortality and morbidity.. Low BMI increased the relative hazard for death and low S-albumin increased the risk for infection. BMI and S-albumin are useful in preoperative evaluations Study II: we followed energy intake in 31 patients for five postoperative days. Scheduled and unscheduled surgery did not differ in preoperative resting energy expenditure (REE). REE increased by 10-12% postoperatively, more in unscheduled CABG. Nutritional supplementation increased total energy intake. All patients exhibited postoperative energy deficits, less prominent in the supplemented group. There were no differences in protein synthesis or muscle degradation. Study III: in 16 patients, .we measured stress hormones and insulin resistance before surgery and for five postoperative days Patients were insulin resistant on the first two days. We saw no clearly adverse or beneficial effects of oral carbohydrate on insulin resistance or stress hormone response. Study IV: 73 patients, with early enteral nutrition (EN), were observed until discharge or resumed oral nutrition. EN started within three days in most patients. In a minority, problems occurred (gastric residual volumes, tube dislocation, vomiting, diarrhoea, aspiration pneumonia). In the cardiothoracic ICU individually adjusted early EN is feasible. Study V: in 16 patients, splanchnic blood flow (SBF) enhancing treatments (dopexamine (Dpx) or EN) were compared. Dpx increased systemic blood flow, but had only a transient effect on SBF. EN had no effect on systemic blood flow or SBF. Neither Dpx, EN or the combined treatment, exhibited any difference between groups on systemic or splanchnic VO2 or oxygen extraction ratio.

Background: Despite the successful development in cardiac surgery, cerebrovascular accidents (CVA) remain a devastating complication. Aortic atherosclerosis has been identified as a major risk factor for CVA. The present thesis addresses this question in relation to aortic manipulation during cardiac surgery, being divided into a clinical (I-II) and an experimental part (III-V). Material and methods: Consecutive cardiac surgery cases (n=2641) were analyzed. Patients with CVA were extracted from a database designed to monitor clinical symptoms. Patient records were used to confirm clinical data and diagnosis. Subdivision was made into three groups: control subjects, immediate, and delayed CVA, being analyzed for neurological symptoms (I). Patients with CVA who also had been investigated with computer tomography (CT) (n=77) were further evaluated in terms of hemispheric and vascular distribution of lesions. The CT-findings were compared with CVA symptoms (II). An aortic perfusion model was developed using cadaver aorta onto which multiple cross-clamp manipulations were applied (III). Washout samples of perfusate were analyzed by computerized image processing and with subdivision into different particle spectra. The model was further developed with the introduction of intraluminal manipulation from cannula and intra-aortic filter (IV). A technique for macro-anatomic mapping of plaque distribution of cadaver thoracic aorta was developed (V). Variation in plaque density was analyzed in different anatomical segments, monitored by digital image analysis. Hazards associated with surgical manipulation were studied by superimposing cannulation and cross-clamp sites onto the aortic maps in a blinded fashion. Results: The incidence of immediate and delayed CVA was 3.0% and 0.9%, respectively. Aortic quality was a strongly associated with immediate but not delayed CVA. Left-sided symptoms of immediate CVA were significantly more frequent than of the contra-lateral side. Positive signs on CT were seen in 66% of the CVA patients. Right-hemispheric lesions were more frequent compared with the contra-lateral side and the middle-cerebral artery territory dominated. Aortic cross-clamping produced a substantial output of particulate matter. Manipulation by intra-aortic filter produced a significant washout of embolic particles that escaped the filter, although some particles were captured. Cannulation was an additional source of embolic material. In terms of plaque distribution was the anterior wall of the ascending part and arch of the aorta more affected than its posterior side. However, observing a plaque in the anterior wall of this aortic segment predicted to 83% a concomitant plaque in the posterior wall. Increased age correlated positively with plaque density. The theoretical chance of interfering with a plaque during cannulation and/or clamp positioning was 45.8%. Conclusions: Both CT scans and clinical symptoms confirmed that CVA after cardiac surgery had a right-hemispheric predominance. The perfusion model resulted in a profound output of material during cross-clamp maneuvers. The intra-aortic filter successfully collected particles but also generated embolic debris on its own. Aortic cannulation was an additional source of embolic debris. Plaques were frequently found in the cadaveric aorta, and there was a high risk of plaque interference during surgical manipulation. As expected, plaque density was age-dependent.

La thymectomie est un geste chirurgical fréquemment nécessaire lors des interventions cardiaques en période néonatale. Il est connu que la résection du thymus entraîne une lymphopénie ne semblant pas avoir de conséquences cliniques graves. La lymphopénie constatée serait plus importante chez les patients ayant eu une chirurgie cardiaque de type Fontan. Toutefois, on ignore si la lymphopénie est uniquement secondaire à la thymectomie ou si elle est liée à ce type particulier de chirurgie cardiaque. La présente recherche porte sur 19 patients opérés selon l'approche Fontan; ils ont été comparés à 6 patients "contrôle" ayant eu une thymectomie au cours d'une chirurgie cardiaque d'un autre type. Les résultats indiquent que les patients de type Fontan accusent une diminution du nombre de cellules naïves CD4+ et CD8+ et plus particulièrement une baisse de leurs émigrants thymiques (CD45RA+CD31+/CD4+). On note en contrepartie une expansion du répertoire mémoire (CD45RO+). Ces altérations lymphocytaires sont comparables aux contrôles. Il semble donc que les anomalies lymphocytaires relevées soient reliées principalement à la thymectomie et non pas au type de chirurgie. Les infections plus importantes chez les Fontan, quant à elles, pourraient s'expliquer par une évolution post-opératoire défavorable. / The thymectomy is a surgical procedure often done during cardiac surgery. It is well known that the resection of the thymus can cause alterations of lymphocyte subpopulations without major clinical consequences. This lymphopenia could be more pronounced in patients who undergone a cardiac surgery named "Fontan". Nevertheless, it is not known if these alterations are due to the thymectomy or this specific type of cardiac surgery. We recruited 19 patients with Fontan surgery and compared them to 6 patients who had a cardiac surgery of another type. Our results show decreased CD4+ and CD8+ naive T cells populations and more specifically, low numbers of thymic emigrants (CD45RA+CD31+/CD4+). Expansion of memory repertoire (CD45RO+) is also noted. These findings are also found in the control group. Thus, perturbations of T cells populations seem to be related to the thymectomy rather than the type of cardiac surgery. Infections were more severe in the Fontan group but they can be explained by an unfavourable post-operative evolution in this group of patients.

The aim of present study was to investigate the prognostic value of plasma and atrial tissue expression of prothrombotic, proinflammatory and extracellular matrix turnover indices for the development of atrial fibrillation (AF) after on-pump coronary artery bypass grafting (CABG) surgery and to describe atrial ultrastructural changes in patients suffering from severe coronary artery disease. Methods: Blood samples were obtained from peripheral vein (PV) and from intracardiac chambers (right atrium (RA), right atrial appendage (RAA), left atrium (LA) and left atrial appendage (LAA)) amongst 100 consecutive patients undergoing elective on-pump CABG. Biomarker (high sensitivity C reactive protein (hs-CRP), interleukin 6 (IL-6), von Willebrand factor (vWF), tissue factor (TF), matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of matrix metalloproteinase 1 (TIMP-1)) concentrations were related to incident AF (in 30 days after CABG). The RAA and LAA tissues were tested for expression of vWF, TF, IL-6, MMP-9 and TIMP-1 using immunohistochemistry. The ultrastructure of the RAA and LAA in 20 patients was examined by electron microscopy. Results: Levels of plasma vWF, TF, hs-CRP, MMP-9 and TIMP-1 differ in-between various intracardiac sampling sites. Higher plasma hs-CRP levels in the PV, RAA and LA, higher plasma IL-6 levels in the RAA, LA and LAA and higher plasma MMP-9 levels in the LAA are associated with postoperative AF. An increased expression of vWF by the LAA is a risk... [to full text] / Tyrimo tikslas – išaiškinti prognostinę kraujo plazmoje ir prieširdžių audinyje nustatomų prokoaguliacinių, prouždegiminių citokinų ir ekstraląstelinio matrikso degradacijos žymenų vertę pooperacinio prieširdžių virpėjimo (PV) išsivystymui pacientams, kuriems atliekama izoliuota AVJO su dirbtine kraujo apytaka (DKA) bei aprašyti šių pacientų prieširdžių audinio ultrastruktūros pakitimus. Metodai: Kraujo mėginiai paimti iš 5 skirtingų 100 pacientų, kuriems buvo atliekama izoliuota AVJO su DKA, vietų: periferinio kraujo (PK), dešiniojo prieširdžio (DP), dešiniojo prieširdžio ausytės (DPA), kairiojo prieširdžio (KP), kairiojo prieširdžio ausytės (KPA). Kraujo plazmos citokinai (von Willebrand faktorius (vWF), audinių faktorius (AF), didelio jautrumo C reaktyvus baltymas (dj-CRB), interleukinas 6 (IL-6), matrikso metaloproteinazė 9 (MMP-9) bei matrikso metaloproteinazių audinių inhibitorius 1 (TIMP-1)) tirti imunofermentiniais metodais. DPA ir KPA biopsijos tirtos imunohistocheminiais metodais dėl vWF, AF, IL-6, MMP-9 bei TIMP-1 ekspresijos. DPA ir KPA ultrastruktūros pakitimai ištirti 20-iai pacientų elektroninės mikroskopijos būdu. Rezultatai: Nustatėme, kad plazmos vWF, AF, MMP-9, TIMP-1 ir dj-CRB koncentracijos skiriasi įvairiose prieširdžių vietose. Didesnės plazmos dj-CRB koncentracijos PK, DPA ir KP, taip pat plazmos IL-6 koncentracijos DPA, KP ir KPA bei plazmos MMP-9 koncentracija KPA buvo susiję su pooperacinio PV kilimu. vWF žymesnė ekspresija KPA buvo susijusi su PV... [toliau žr. visą tekstą]

Tyrimo tikslas – išaiškinti prognostinę kraujo plazmoje ir prieširdžių audinyje nustatomų prokoaguliacinių, prouždegiminių citokinų ir ekstraląstelinio matrikso degradacijos žymenų vertę pooperacinio prieširdžių virpėjimo (PV) išsivystymui pacientams, kuriems atliekama izoliuota AVJO su dirbtine kraujo apytaka (DKA) bei aprašyti šių pacientų prieširdžių audinio ultrastruktūros pakitimus. Metodai: Kraujo mėginiai paimti iš 5 skirtingų 100 pacientų, kuriems buvo atliekama izoliuota AVJO su DKA, vietų: periferinio kraujo (PK), dešiniojo prieširdžio (DP), dešiniojo prieširdžio ausytės (DPA), kairiojo prieširdžio (KP), kairiojo prieširdžio ausytės (KPA). Kraujo plazmos citokinai (von Willebrand faktorius (vWF), audinių faktorius (AF), didelio jautrumo C reaktyvus baltymas (dj-CRB), interleukinas 6 (IL-6), matrikso metaloproteinazė 9 (MMP-9) bei matrikso metaloproteinazių audinių inhibitorius 1 (TIMP-1)) tirti imunofermentiniais metodais. DPA ir KPA biopsijos tirtos imunohistocheminiais metodais dėl vWF, AF, IL-6, MMP-9 bei TIMP-1 ekspresijos. DPA ir KPA ultrastruktūros pakitimai ištirti 20-iai pacientų elektroninės mikroskopijos būdu. Rezultatai: Nustatėme, kad plazmos vWF, AF, MMP-9, TIMP-1 ir dj-CRB koncentracijos skiriasi įvairiose prieširdžių vietose. Didesnės plazmos dj-CRB koncentracijos PK, DPA ir KP, taip pat plazmos IL-6 koncentracijos DPA, KP ir KPA bei plazmos MMP-9 koncentracija KPA buvo susiję su pooperacinio PV kilimu. vWF žymesnė ekspresija KPA buvo susijusi su PV... [toliau žr. visą tekstą] / The aim of present study was to investigate the prognostic value of plasma and atrial tissue expression of prothrombotic, proinflammatory and extracellular matrix turnover indices for the development of atrial fibrillation (AF) after on-pump coronary artery bypass grafting (CABG) surgery and to describe atrial ultrastructural changes in patients suffering from severe coronary artery disease. Methods: Blood samples were obtained from peripheral vein (PV) and from intracardiac chambers (right atrium (RA), right atrial appendage (RAA), left atrium (LA) and left atrial appendage (LAA)) amongst 100 consecutive patients undergoing elective on-pump CABG. Biomarker (high sensitivity C reactive protein (hs-CRP), interleukin 6 (IL-6), von Willebrand factor (vWF), tissue factor (TF), matrix metalloproteinase 9 (MMP-9) and tissue inhibitor of matrix metalloproteinase 1 (TIMP-1)) concentrations were related to incident AF (in 30 days after CABG). The RAA and LAA tissues were tested for expression of vWF, TF, IL-6, MMP-9 and TIMP-1 using immunohistochemistry. The ultrastructure of the RAA and LAA in 20 patients was examined by electron microscopy. Results: Levels of plasma vWF, TF, hs-CRP, MMP-9 and TIMP-1 differ in-between various intracardiac sampling sites. Higher plasma hs-CRP levels in the PV, RAA and LA, higher plasma IL-6 levels in the RAA, LA and LAA and higher plasma MMP-9 levels in the LAA are associated with postoperative AF. An increased expression of vWF by the LAA is a risk... [to full text]

Background: Coronary artery disease is a common cause of morbidity and mortality in the UK. Interventional revascularisation procedures for addressing the disease include percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), which respectively seek to open up or bypass blocked arteries to restore blood flow to heart muscle. Rates at which these procedures are carried out have changed in recent years, as have clinical indications for referral. PCI is delivered by interventional cardiologists, while CABG is carried out by cardiothoracic surgeons, necessitating multi-disciplinary decision making. There is both within- and cross-speciality debate as to the optimal treatment strategy in some case types. Evaluation of the care provided is of clinical and political importance, and requires information about how post-procedure event rates per operator and hospital compare with those expected given the composition of patient populations. Methods: Two UK-wide audit databases of PCI and CABG procedures were used to explore a range of clinical outcome questions. The patient populations contained within each database were compared to see how they differed, and also how each had changed in recent years. In CABG patients, comparative effectiveness of two different surgical techniques (single vs bilateral mammary artery grafting) was assessed with respect to both short-term and long-term mortality outcomes. In PCI patients, a risk model to predict 30-day mortality was developed for use in clinical appraisal. Results: In both patient populations there had been changes to the relative frequencies of many characteristics over time. In the CABG population, multivariable analysis showed that patients undergoing single mammary artery grafting had lower odds of all-cause mortality within 30 days of procedure than those receiving bilateral mammary artery grafting, but had worse overall survival in the long term. In the PCI population, the developed risk model demonstrated good calibration and discrimination at predicting 30-day all-cause mortality. Discussion: The studies described above demonstrate that large-scale routinely collected data can be used to gain insights into clinical care quality and delivery. These resources are under-utilised at present; correcting this requires an understanding of the limitations of the data and how the information contained therein relates to actual clinical care.

Objetivo: Verificar a eficácia da fisioterapia respiratória precoce, através da hiperinsuflação manual (HM) associada à pressão expiratória positiva final (PEEP) no pós-operatório de pacientes submetidos à cirurgia de revascularização do miocárdio (CRM). Método: Ensaio clínico randomizado. Participantes: Cinqüenta e cinco pacientes foram incluídos no estudo, onde o grupo intervenção foi submetido à técnica fisioterapêutica logo no pósoperatório imediato e o grupo controle recebeu a rotina assistencial do serviço. Foram avaliados parâmetros de oxigenação, através da gasometria arterial, tempo de extubação, complacência pulmonar e presença de complicações respiratórias pós-operatórias. Resultados: Houve melhora significativa no grupo intervenção quando comparado ao controle nos seguintes parâmetros: oxigenação (PaO2 93,4±5,51mmHg x 81,7±2,25mmHg – p<0,001), tempo de extubação (295,4±41,7min x 371,5±130,1min – p=0,005) e complacência estática (60,3±4,43ml/cmH2O x 51,8±3,22ml/cmH2O – p<0,001). Conclusão: O grupo que foi submetido à fisioterapia precoce com hiperinsuflação manual apresentou melhora significativa em termos de oxigenação, complacência estática e redução do tempo de permanência em ventilação mecânica, quando comparado ao grupo controle. A incidência de complicações respiratórias pós-operatórias foi similar nos dois grupos. / Question: How does immediate postoperative respiratory physiotherapy affect clinical parameters, oxygenation and static compliance after myocardial revascularization (MR), and what impact does it have on clinical outcome, pulmonary complications and intubation time? Design: Randomized clinical trial. Participants: Fifty-five patients scheduled for elective myocardial revascularization. Intervention: A physiotherapy technique was used for the intervention group immediately after surgery; the control group received the service’s routine care. Outcome measures: Oxygenation parameters were evaluated by means of arterial blood gases, extubation time, lung compliance and postoperative respiratory complications. Results: Improvement in the intervention group was significantly greater than in the control group according to the following parameters: oxygenation (PaO2 93.4±5.51 mmHg x 81.7±2.25 mmHg; p<0.001), extubation time (295.4±41.7 min x 371.5±130.1min; p=0.005) and static compliance (60.3±4.43 ml/cmH2O x 51.8±3.22 ml/cmH2O; p<0.001). Conclusion: The group that received early manual hyperinflation physiotherapy had significantly better oxygenation and static compliance and shorter mechanical ventilation times than the control group. The incidence of postoperative respiratory complications was similar in the two groups.

Objetivo: Verificar a eficácia da fisioterapia respiratória precoce, através da hiperinsuflação manual (HM) associada à pressão expiratória positiva final (PEEP) no pós-operatório de pacientes submetidos à cirurgia de revascularização do miocárdio (CRM). Método: Ensaio clínico randomizado. Participantes: Cinqüenta e cinco pacientes foram incluídos no estudo, onde o grupo intervenção foi submetido à técnica fisioterapêutica logo no pósoperatório imediato e o grupo controle recebeu a rotina assistencial do serviço. Foram avaliados parâmetros de oxigenação, através da gasometria arterial, tempo de extubação, complacência pulmonar e presença de complicações respiratórias pós-operatórias. Resultados: Houve melhora significativa no grupo intervenção quando comparado ao controle nos seguintes parâmetros: oxigenação (PaO2 93,4±5,51mmHg x 81,7±2,25mmHg – p<0,001), tempo de extubação (295,4±41,7min x 371,5±130,1min – p=0,005) e complacência estática (60,3±4,43ml/cmH2O x 51,8±3,22ml/cmH2O – p<0,001). Conclusão: O grupo que foi submetido à fisioterapia precoce com hiperinsuflação manual apresentou melhora significativa em termos de oxigenação, complacência estática e redução do tempo de permanência em ventilação mecânica, quando comparado ao grupo controle. A incidência de complicações respiratórias pós-operatórias foi similar nos dois grupos. / Question: How does immediate postoperative respiratory physiotherapy affect clinical parameters, oxygenation and static compliance after myocardial revascularization (MR), and what impact does it have on clinical outcome, pulmonary complications and intubation time? Design: Randomized clinical trial. Participants: Fifty-five patients scheduled for elective myocardial revascularization. Intervention: A physiotherapy technique was used for the intervention group immediately after surgery; the control group received the service’s routine care. Outcome measures: Oxygenation parameters were evaluated by means of arterial blood gases, extubation time, lung compliance and postoperative respiratory complications. Results: Improvement in the intervention group was significantly greater than in the control group according to the following parameters: oxygenation (PaO2 93.4±5.51 mmHg x 81.7±2.25 mmHg; p<0.001), extubation time (295.4±41.7 min x 371.5±130.1min; p=0.005) and static compliance (60.3±4.43 ml/cmH2O x 51.8±3.22 ml/cmH2O; p<0.001). Conclusion: The group that received early manual hyperinflation physiotherapy had significantly better oxygenation and static compliance and shorter mechanical ventilation times than the control group. The incidence of postoperative respiratory complications was similar in the two groups.

Les pentasaccharides sont des inhibiteurs indirects du facteur Xa ayant des profils pharmacocinétiques très prédictibles. En raison de la liaison de forte affinité des pentasaccharides à l'antithrombine, cette pharmacocinétique peut être prédite mais aussi transférée à d'autres molécules qui leur sont liées de manière covalente. L'EP42675 combine dans une seule molécule, une antithrombine directe réversible peptidomimétique (analogue de l'α-NAPAP), et un pentasaccharide inhibiteur indirect du facteur Xa antithrombine dépendant (analogue du fondaparinux). L'EP217609 est le dérivé biotinylé de l'EP42675. Son action anticoagulante peut être neutralisée par l'avidine qui se lie avec une grande affinité et spécificité à la fraction biotine de l'EP217609. La première indication cible de l'EP217609 et de son antidote l'avidine est la chirurgie cardiaque nécessitant une circulation extracorporelle. La deuxième indication cible est le traitement des syndromes coronariens aigus nécessitant ou non une intervention coronarienne percutanée. Les études précliniques et cliniques de phase I et phase IIa résumées ici démontrent l'intérêt d'un tel concept de couplage avec un pentasaccharide : absence de dissociation entre les deux entités, faible variabilité intra et interindividuelle des paramètres pharmacocinétiques et pharmacodynamiques, et une neutralisation de l'activité anticoagulante de l'EP21609 quasi complète et sans effet rebond. / Pentasaccharides are indirect inhibitors of factor Xa with highly predictable pharmacokinetic profiles. Because of the high affinity binding of pentasaccharides to antithrombin, this pharmacokinetics can be predicted but also transferred to other molecules covalently bound to them. EP42675 combines in a single molecule, a reversible direct antithrombin (α-NAPAP peptidomimetic analog), and a pentasaccharide similar to fondaparinux with an indirect anti-factor Xa activity. EP217609 is the biotinylated derivative of EP42675 whose anticoagulant activity can be neutralized by avidin which binds with high affinity and specificity to the biotin moiety of EP217609.The first target indication of EP217609 and its antidote avidin is cardiac surgery requiring extracorporeal circulation. The second target indication is the treatment of acute coronary syndromes requiring or not a percutaneous coronary intervention.The preclinical and clinical Phase I and IIa studies summarized here demonstrate the value of such a coupling concept to the pentasaccharide: absence of dissociation between the two entities, low intra- and interindividual variability of the pharmacokinetic and pharmacodynamic parameters, and an almost complete neutralization of the EP217609 anticoagulant activity with no rebound effect.

Made available in DSpace on 2016-12-06T17:07:21Z (GMT). No. of bitstreams: 1 JERUSA SCHNAIDER.pdf: 524187 bytes, checksum: a96a56d066b471f07ff2853d2a241700 (MD5) Previous issue date: 2009-07-27 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Surgical procedures may affect respiratory muscles through various mechanisms. Previous patient´s health conditions may also contribute to increase this dysfunction. The objective of this study was to verify if respiratory muscle strength in the preoperative phase could influence the outcomes after coronary artery bypass graft surgery (CABG). It was an descriptive and prospective, cohort-type study, conducted in the Instituto de Cardiologia de Santa Catarina (ICSC), located in the city of São José/SC. The cohort was composed of male adults of any age and post menopause women waiting for elective RM surgery, without previous history of cardiac surgery, or recent aneurism and unstable angina. 28 patients were consecutively evaluated between the months of August and November of 2008, and the final cohort was composed of 24 individuals: 18 male adults and 6 women. Due to the preoperative evaluation of Respiratory Muscle Strength (RMS) 2 groups were formed: G1, composed of individuals with standard RMS value (n=13); and G2 (n=11), with abnormal RMS results (inspiratory pressure, Pimax, lower than 70% of the predicted value). In inferential statistics, we decided to adopt the Fisher´s exact and Mann-Whitney tests, besides risk calculations for postoperative pulmonary complications (PPC), expressed by Relative Risk measurements (RR) Odds Ratio (OR) and with significance level of 5%. The results show that the groups were homogeneous, showing no significant difference in either the patients preoperative profile in both groups or in the surgical procedures conducted. There was a high prevalence of respiratory muscle dysfunction in preoperative: 46% of the patients had PImax < 70% of the predicted value, 20,83% also presented PEmax <70% of the predicted value and abnormal postoperative spirometry. There was a significant reduction of RMS from pre to postoperative in both groups, where PImax and PEmax were significantly lower in G2 also in post operative. Postoperative evolution data, like mechanical ventilation time, ICU time, postoperative hospitalization, time degree of PPC did not estatistically differ between the groups. It was found an increase in the risk for G2 patients to develop PPC in relation to G1, with RR of 2.36 (IC 95% between 0.7636 and 7.316) and OR of 4.00 (IC 95% between 0.6927 and 23.099), although without statistical confirmation, probably due to the small sample. / O procedimento cirúrgico pode afetar os músculos respiratórios por vários mecanismos, e ainda contribuem para o aumento dessa disfunção as condições prévias dos pacientes. O objetivo da pesquisa foi verificar se a força muscular respiratória na fase pré-operatória poderia influenciar nos desfechos após a cirurgia de revascularização do miocárdio (RM). O estudo foi descritivo e prospectivo, tipo coorte, realizado no Instituto de Cardiologia de Santa Catarina localizado no município de São José/SC. Foram incluídos homens adultos de qualquer idade e mulheres pós-menopausa, aguardando cirurgia de RM eletiva, sem história de cirurgia cardíaca anterior, ou aneurisma e angina instável recente. Avaliou-se 28 pacientes consecutivamente entre os meses de agosto e novembro de 2008, e a amostra final foi composta de 24 indivíduos: 18 adultos homens e 6 mulheres. Em decorrência da avaliação pré-operatória de força muscular respiratória (FMR), formaram-se 2 grupos: G1 constituído por indivíduos com FMR com valores considerados normais (n=13), e G2 (n=11) com resultados anormais de FMR (pressão inspiratória - PImax - menor que 70% do previsto). Na estatística inferencial optou-se pelos testes exato de Fisher e Mann-Whitney, além do cálculo de risco para complicações pulmonares pós-operatórias (CPP), expresso pelas medidas de Risco Relativo (RR) e Odds Ratio (OR), com nível de significância de 5%. Os resultados mostram que os grupos eram homogêneos não havendo diferença significativa nem no perfil pré-operatório dos participantes dos dois grupos, nem quanto aos procedimentos cirúrgicos realizados. Houve alta prevalência de disfunção muscular respiratória no pré-operatório: 46% dos indivíduos tinham PImax < 70% do previsto, 20,83% apresentavam também PEmax <70% do previsto e espirometria pré-operatória anormal. Houve uma redução significativa da FMR do pré para o pós-operatório em ambos os grupos, sendo que PImax e PEmax foram significativamente menores no G2 também no pós-operatório. Dados da evolução pós-operatória como tempo de ventilação mecânica, tempo de internação em UTI, tempo de internação pós-operatória, grau de CPP, não diferiram estatisticamente entre os grupos. Foi encontrado um aumento do risco para os pacientes do G2 desenvolverem CPP em relação ao G1, com RR de 2,364 (IC 95% entre 0,7636 e 7,316) e OR de 4,00 (IC 95% entre 0,6927 e 23,099), porém sem confirmação estatística provavelmente devido a amostra reduzida.