Revista Brasileira De Cirurgia Cardiovascular最新文献

{"title":"Evaluation of Cardiac Autonomic Modulation Using Symbolic Dynamics After Cardiac Transplantation","authors":"Sílvia Cristina Garcia de Moura-Tonello, V. O. Carvalho, M. D. de Godoy, A. Porta, Â. M. Leal, E. Bocchi, A. Catai","doi":"10.21470/1678-9741-2019-0236","DOIUrl":"https://doi.org/10.21470/1678-9741-2019-0236","url":null,"abstract":"Objective To characterize the behavior of cardiac autonomic modulation in individuals with different times after orthotopic heart transplantation (HTx) using symbolic dynamics analysis. Methods Sixty patients were evaluated after HTx. We recorded their instantaneous R-R intervals (RRi) by cardiac monitor Polar® RS800CX™ (Polar Electro Oy, Kempele, Finland) for 10 minutes. The same sequence of RRi with 256 consecutive beats was used to perform spectral analysis and symbolic dynamics analysis. We used hierarchical clustering to form groups. One-way analysis of variance (ANOVA) (with Holm-Sidak method) or one-way Kruskal-Wallis test (with Dunn´s post-hoc test) was used to analyze the difference between groups. Linear correlation analysis between variables was performed using Pearson’s or Spearman’s tests. P-value < 0.05 was considered statistically significant. Results The 0V% index increased, the 2UV% index and the normalized complexity index decreased with an increase of HTx postoperative time. There were a negative correlation between complexity indexes and 0V% and a positive correlation between complexity indexes and 2UV%. Conclusion Symbolic dynamics indexes were able to show a specific cardiac autonomic modulation pattern for HTx recipients with different postoperative times.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"34 1","pages":"572 - 580"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68503636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aortic Valve Neocuspidization with Glutaraldehyde-Treated Autologous Pericardium (Ozaki Procedure) - A Promising Surgical Technique","authors":"M. Sá, Álvaro M. Perazzo, K. Zhigalov, R. Komarov, B. Kadyraliev, Soslan T. Enginoev, J. Ennker, A. Popov, C. Quarto, A. Weymann, R. Lima","doi":"10.21470/1678-9741-2019-0304","DOIUrl":"https://doi.org/10.21470/1678-9741-2019-0304","url":null,"abstract":"In cases of aortic valve disease, prosthetic valves have been increasingly used for valve replacement, however, there are inherent problems with prostheses, and their quality in the so-called Third World countries is lower in comparison to new-generation models, which leads to shorter durability. Recently, transcatheter aortic valve replacement has been explored as a less invasive option for patients with high-risk surgical profile. In this scenario, aortic valve neocuspidization (AVNeo) has emerged as another option, which can be applied to a wide spectrum of aortic valve diseases. Despite the promising results, this procedure is not widely spread among cardiac surgeons yet. Spurred on by the last publications, we went on to write an overview of the current practice of state-of-the-art AVNeo and its results.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"34 1","pages":"610 - 614"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43309464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Russian Conduit - Combining Bentall and Ozaki Procedures for Concomitant Ascending Aorta Replacement and Aortic Valve Neocuspidization","authors":"R. Komarov, I. Chernov, Soslan T. Enginoev, M. Sá, D. Tarasov","doi":"10.21470/1678-9741-2019-0329","DOIUrl":"https://doi.org/10.21470/1678-9741-2019-0329","url":null,"abstract":"In aortic valve disease cases, prosthetic valves have been used for valve replacement, however, these prostheses have inherent problems, and their quality in some countries is lower comparing to new-generation models, causing shorter durability. Aortic valve neocuspidization (AVNeo) has emerged as an option, which can be applied to a wide spectrum of these diseases. Despite the promising results, this procedure is not widely spread among cardiac surgeons yet. We developed a surgical technique combining Bentall and Ozaki procedures to treat patients with concomitant ascending aorta replacement and AVNeo and we describe it in this paper. The Russian conduit – combination of Bentall and Ozaki procedures.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"34 1","pages":"618 - 623"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41942639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Treatment of the Ascending Aorta: is this the Last Frontier in Aortic Surgery?","authors":"E. Saadi, A. Tagliari, R. Almeida","doi":"10.21470/1678-9741-2019-0317","DOIUrl":"https://doi.org/10.21470/1678-9741-2019-0317","url":null,"abstract":"Regardless the successful treatment of the descending aorta with endovascular prosthesis, for the ascending aorta segment, because of several anatomic and physiologic issues, this technique has been considered an alternative only for high-risk or inoperable patients. Despite restricted indications, hundreds of treatments have been performed worldwide, demonstrating its safety and reproducibility if it is done in high-quality centers. Therefore, understanding patients’ selection criteria and technique limitations are critical to its application.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"34 1","pages":"759 - 764"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46534520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Sharp Dissection, Electrocautery, and Ultrasonic Activated Scalpel with Regard to Endothelial Damage, Preparation Time, and Postoperative Bleeding During Radial Artery Harvesting","authors":"Dinçer Uysal, Ş. Gülmen, Hayrettin Özkan, Ulaş Sağlam, M. Etli, S. Bircan, R. Sütçü, T. Yavuz, Hakan Öntaş, F. Aksoy","doi":"10.21470/1678-9741-2018-0311","DOIUrl":"https://doi.org/10.21470/1678-9741-2018-0311","url":null,"abstract":"Objective To examine the effects of classical technique, electrocautery, and ultrasonic dissection on endothelial integrity, function, and preparation time for harvesting the radial artery (RA) during coronary artery bypass grafting (CABG). Methods Forty-five patients who underwent isolated CABG and whose RA was suitable for use were studied and divided into three groups: Group 1, classical method (using sharp dissection); Group 2, electrocautery; and Group 3, ultrasonic cautery. Levels of prostacyclin and nitric oxide derivatives were examined biochemically; vascular cell adhesion molecule 1 (VCAM-1) and endothelial nitric oxide synthetase (eNOS) values were assessed using immunohistochemical staining. RA preparation time, RA length/harvesting time ratio, and drainage amounts at the site of RA removal were compared. Results Differences in RA preparation time (Group 1: 25±6 min, Group 2: 18±3 min, Group 3: 16±3 min, P<0.001) and length/harvesting time ratio (Group 1: 0.76±0.19 cm/min, Group 2: 0.98±0.16 cm/min, Group 3: 1.13±0.09 cm/min, P<0.001) were statistically significant among the groups. Levels of prostacyclin and nitric oxide derivatives were not statistically significant different, VCAM-1 and eNOS expressions were observed to be similar among the groups, and endothelial damage was detected in only one patient per group. Conclusion Use of ultrasonic cautery during RA preparation considerably reduces the preparation time and postoperative drainage amount. However, the superiority of one method over the others could not be demonstrated when the presence of endothelial damage with both biochemical and histopathological evaluations was considered.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"34 1","pages":"667 - 673"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47023150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of Platelet to Lymphocyte and Neutrophil to Lymphocyte Ratios with In-Hospital Mortality in Patients with Type A Acute Aortic Dissection","authors":"C. Bedel, F. Selvi","doi":"10.21470/1678-9741-2018-0343","DOIUrl":"https://doi.org/10.21470/1678-9741-2018-0343","url":null,"abstract":"Objective To evaluate the relationship between neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) with in-hospital mortality in type A acute aortic dissection (AAD). Methods A total of 96 patients who presented to the emergency department between January 2013 and June 2018 with a diagnosis of type A AAD were enrolled in this study. White blood cell count subtypes such as NLR and PLR were calculated at the time of admission. The end point was in-hospital mortality. Results Of the 96 type A AAD patients included in this analysis, 17 patients (17.7%) died during hospitalization. NLR and PLR were significantly elevated in patients with type A AAD (P<0.001 and <0.001, respectively). Based on the receiver operating characteristic curve, the best NLR cut-off value to predict in-hospital mortality was 9.74, with 70.6% sensitivity and 76.8% specificity, whereas the best PLR cut-off value was 195.8, with 76.5% sensitivity and 78.1% specificity. Conclusion Admission NLR and PLR levels were important risk factors and independently associated with in-hospital mortality of type A AAD patients.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"34 1","pages":"694 - 698"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43976573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stem Cells for Cardiovascular Diseases Revisited in 2019","authors":"R. Kalil, N. Nardi","doi":"10.21470/1678-9741-2019-0316","DOIUrl":"https://doi.org/10.21470/1678-9741-2019-0316","url":null,"abstract":"cardiovascular diseases, such as refractory angina and myocardial failure, caused a frenzy in clinical research in the late 1990’s and early 2000’s. Experimental reports have shown marked improvements in myocardial contractility in heart failure models, and increased myocardial perfusion or even myocardial replacement after necrosis in ischemic models. More than 200 clinical trials were produced, but the experimental effects could not be reproduced. Indeed, an improvement in cardiac function as well as some angiogenic reperfusion have been observed at the clinical level, but those effects were light and temporary, not sufficient to represent a usable therapeutic tool. The reasons for that are an actual challenge to researchers. There are many hypotheses for stem cell therapy failure in clinical therapy. Animal experiments are done in young individuals and outcomes are evaluated invariably at short term. Cardiac diseases are present in older patients, in whom stem cells are also old and submitted to pharmacological effects of therapeutic drugs. Potent and prolonged improvements are necessary to influence clinical outcomes, differently from what can be achieved in animal research. Those could be some of several explanations. The mechanism of action of stem cell therapy is also under exploration. The elements responsible for the effects need to be better understood. Cellular proliferation, paracrine effects, and delivery of cell elements or components are theories to be studied. Proliferation has been demonstrated as not feasible in clinical level. Some considerations should be brought to mind. There are two main types of stem cells. Pluripotent stem cells, capable of differentiating in any type of mature cells, of EDITORIAL","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"34 1","pages":"IV - V"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47741656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative Carotid Duplex Scanning in Patients Undergoing Coronary Artery Bypass Grafting","authors":"H. Kara","doi":"10.21470/1678-9741-2019-0131","DOIUrl":"https://doi.org/10.21470/1678-9741-2019-0131","url":null,"abstract":"Objective The aim of this study was to determine the prevalence and risk factors of carotid artery stenosis (CAS) using carotid duplex ultrasound in patients undergoing coronary artery bypass grafting (CABG). Methods This retrospective study was conducted between January 2017 and January 2018 and included 166 consecutive patients [130 males (78.31%), 36 females (21.69%); mean age: 64.25±9.78 years] who underwent elective and isolated CABG. Patients who had significant CAS (≥50% stenosis) were compared with patients who had non-significant CAS (<50% stenosis). Logistic regression analysis was applied across the selected parameters to identify risk factors for significant CAS. Results Of all patients, 36 (21.68%) had CAS ≥50% and 8 (4.81%) had unilateral carotid stenosis ≥70%. Carotid endarterectomy/CABG was performed simultaneously in five (3.01%) patients. None of these patients had cardiac and neurological problems during the postoperative period. The overall incidence of cerebrovascular accident (CVA) after CABG was 1.20% (n=2). Age (P=0.011) and history of CVA (P=0.035) were significantly higher in the CAS ≥50 group than in the CAS <50 group. Significant CAS was identified as a risk factor for postoperative CVA (P=0.013). Conclusion Age and history of CVA were identified as risk factors for significant CAS. Furthermore, significant CAS was identified as a risk factor for postoperative CVA. For this reason, carotid screening is recommended for patients undergoing CABG even in the absence of associated risk factors.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"34 1","pages":"581 - 587"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47920223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular disease: The Brazilian research contribution","authors":"E. Krauskopf","doi":"10.21470/1678-9741-2019-0285","DOIUrl":"https://doi.org/10.21470/1678-9741-2019-0285","url":null,"abstract":"Cardiovascular disease is the leading cause of death around the world. According to a study from the World Economic Forum, the economic burden of this disease to society reached US$ 863 billion in 2010, with an estimation to rise by 22% to US$ 1,044 in 2030[1]. Likewise, recent studies have shown that in Brazil ischemic heart disease and stroke have been the main cause of death since the end of the 1960s, costing a total of R$ 56.2 billion just in 2015[2,3]. Due to Brazil’s large size, its 27 states have developed unevenly, so states located in the south and southeast regions of the country are more developed and have the best infrastructure[2]. Hence, such differences ought to be considered when allocating resources efficiently to improve healthcare among the population. It is imperative to seek knowledge through locally-based research as its outcomes may be used as a tool to instruct policy makers, regional-level physicians, health professionals and the general population[4]. To establish the Brazilian contribution to cardiovascular disease research, the Scival platform (www.scival.com) was used, which analyzes data from several sources such as Scopus and ScienceDirect. In the case of patent article citations, data emanate from European Patent Office, Intellectual Property Office, Japan Patent Office, United States Patent and Trademark Office and the World Intellectual Property Organization. A query was made to retrieve data from Brazil which had been published within the most recent 5-year period (2014-2018) in the field of “Cardiology and Cardiovascular Medicine”. One of the key features of Scival is that it disaggregates each field into specific research topics. As approximately 96,000 specific research topics have been defined, topic clusters are formed by aggregating topics with similar research interest, creating a broader area of research[5]. It is important to note that a publication can belong to only one topic, consequently, to one topic cluster. The indicators used for this analysis were the following: • Scholarly output: The number of documents published within the 5-year period in the topic cluster. • Growth (%): This indicator represents the increase or decrease of published documents within the specific topic cluster in the 5-year period. • International collaboration (%): The proportion of published documents authored by researchers from Brazil and another countries. • Field-Weighted Citation Impact (FWCI): Indicator that refers to citations received in the year of publication plus the following 3 years. FWCI of 1.00 means that the publications have been cited at world average for similar publications. Thus, a score of 1.17 indicates that the outputs have been cited 17% more than expected. Contrarily, a FWCI of 0.77 means 23% less cited than the world average. • Patent-cited scholarly output: The count of scholarly outputs published by the country that have been cited in patents.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"34 1","pages":"VI - IX"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43762815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-Term Assessment of Left Ventricular Ejection Fraction and Mitral Regurgitation Following Takeuchi Repair","authors":"Gökmen Akkaya, Ç. Bilen, O. Tuncer, M. Ayık, Y. Atay","doi":"10.21470/1678-9741-2018-0376","DOIUrl":"https://doi.org/10.21470/1678-9741-2018-0376","url":null,"abstract":"Objective This study aimed to evaluate the early operative outcomes and to compare the left ventricle and mitral valve functions after initial Takeuchi repair in patients with anomalous left coronary arising from pulmonary artery (ALCAPA). Methods Fourteen patients (5 males, 9 females; mean age 4.3 years, ranging from 25 days to 34 years) who were operated for ALCAPA between 2007 and 2018 were included in this study. Data were evaluated retrospectively based on our medical records. Results Hospital mortality rate was 7.1% (n=1). Thirteen surviving patients were kept in follow-up mean 4.3±3.05 years. When compared to preoperative measurements, both left ventricular ejection fraction (LVEF), (P=0.007) and mitral regurgitation (MR) (P=0.001) significantly improved before discharge. Moreover, LVEF values were improved in the late follow-up, considering early postoperative outcomes, and this alteration was significant (P=0.014). Nevertheless, alteration in the degree of MR among patients did not differ in the long-term follow-up (P=0.180). There was no late-term mortality or need for reoperation among patients. Conclusion Although some centers prefer to direct implantation in ALCAPA, Takeuchi procedure can be accepted as a reliable method that provides satisfactory long-term results, considering that it aids to improve left ventricle ejection fraction and reduced mitral valve regurgitation.","PeriodicalId":54481,"journal":{"name":"Revista Brasileira De Cirurgia Cardiovascular","volume":"34 1","pages":"687 - 693"},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47404253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}