Surgical risk for patients with Chagasic achalasia and its correlation with the degree of esophageal dilation

Table 1 Patients according to the grade of esophageal dilatation and surgical treatment adopted

Esophageal Dilatation	Surgical Technique	Patients (%)
Group II		53
	Cardiomyectomy with fundoplication (Pinotti’s technique)	53
Group III		37
	Cardiomyectomy with fundoplication	32
	Grondahl cardioplasty with hemigastrectomy and Roux-en-Y diversion (Serras Doria operation)	5
Group IV		34
	Grondahl cardioplasty with hemigastrectomy and Roux-en-Y diversion	26
	Mucosectomy	4
	Merendino’s operation	2
	Gastrostomy	2

Table 2 Postoperative complications according to the functional class classification

Results	Functional class/number of patients
	I (n = 67)bd		II (n = 46)1		III (n = 11)
	n	%	n	%	n	%
No complications	39	58.21	11	23.91	-	0
With complications	28	41.79	35	76.09	11	100
Heart failure/shock	0	0	4	11.43	7	63.64
Death	1	3.57	2	5.71	1	9.09
Others	27	96.43	29	82.86	3	27.27

^bP<0.001 FCI vs FCII;

^dP<0.001 FCI vs FCIII;

¹P=0.072 FCII vs FCIII.

Table 3 Preoperative ECG results in patients with Chagasic esophageal achalasia

ECG results	Patients (n)	%
Normal ECG	44	35.48
Isolated ventricular extrasystoles	58	37.09
Complete right bundle branch block	35	28.22
Primary change in ventricular repolarization	12	9.67
First-degree atrioventricular block (1st degree AVB)	16	12.9
Second-degree atrioventricular block (2nd degree AVB)	2	1.61
Mobitz I
Second-degree atrioventricular block (2nd degree AVB)	3	2.41
Mobitz II
Complete atrioventricular block (CAVB)	8	6.4
Upper anterior divisional block (DB)	11	8.87
Complete left bundle branch block (CLBBB)	3	2.41
Paired ventricular extrasystoles	9	7.25
Supraventricular extrasystoles	6	4.83
Atrial fibrillation (AF)	4	3.22

Table 4 Correlation between postoperative complications and ECG changes

Results	ECG results
	Normal (n = 44)		With abnormalities (n = 80)
	n	%	n	%
No complications	27	61.4	23	28.8
With complications
CHF/shock	2	11.8	8	14
Death	1	5.9	3	5.3
Others	14	82.4	46	80.7

χ²= 12.548; P < 0.001.

Table 5 Postoperative complications according to the degree of dilation of the Chagasic achalasia

Complications	Achalasia groups
	II (n = 53)b,d		III (n = 37)1		IV (n = 34)
	n	%	n	%	n	%
No complications	33	62.26	13	35.14	4	11.76
With complications	20	37.74	32	64.86	38	88.24
CHF/shock	-	0	6	18.75	7	18.42
Death	-	0	2	6.25	2	5.26
Others	20	100	24	75	29	76.32

^bP<0.001 GII vs GIII; dP<0.001 GII vs GIV 1P=0.017 GIII vs GIV.

Table 6 Postoperative cardiovascular complications after surgical treatment of Chagasic esophageal achalasia

Complications	Patients (%)
Decompensated congestive heart failure	12 (9.67)
Cardiogenic shock	03 (2.41)
Ventricular extrasystole	58 (46.77)
Sinus bradycardia	22 (17.74)
Non-sustained ventricular tachycardia	12 (9.67)
Sustained ventricular tachycardia	01 (0.80)
Acute atrial fibrillation	05 (4.03)
Supraventricular tachycardia	03 (2.41)
Temporary complete atrioventricular block	01 (0.80)
Acute arterial occlusion	04 (3.22)
Stroke	03 (2.41)
Pulmonary embolism	02 (1.67)
Acute renal failure	02 (1.67)

Table 7 Risk index for Chagasic achalasia

(a) Points
Achalasia	Points
Grade II	9
Grade III	13
Grade IV	17
Primary changes in ventricular repolarization	Points
Yes	15
No	0
Arrhythmias	Points
Yes	12
No	0
Functional class	Points
1	6
2	12
3	24
(b) Final index
Points	Risk level
Up to 21	Mild
From 22 to 34	Moderate
Above 34	High
(c) Probability of accuracy of the risk level
Risk levels	Probability (%)
Mild	82.4
High	94.6