Brazilian journal of cardiovascular surgery最新文献

{"title":"Study Design Update of the Off-pump versus On-pump Coronary Artery Bypass Grafting in Frail Patients: FRAGILE Trial.","authors":"Omar Asdrubal Vilca Mejia, Fabiane Letícia de Freitas, Bianca Meneghini, Maurilio Onofre Deininger, Rodrigo Segalote, Felipe Consentino, Mauricio Guerrieri, Alexandre Ciappina Hueb, Fernando Ribas, Rodrigo Moreira Castro, Luís Roberto Palma Dallan, Pedro Gm de Barros E Silva, Renato D Lopes, Luiz Augusto Ferreira Lisboa, John Puskas, Fabio B Jatene","doi":"10.21470/1678-9741-2025-0199","DOIUrl":"10.21470/1678-9741-2025-0199","url":null,"abstract":"<p><p>The Off-pump versus On-pump Coronary Artery Bypass Grafting in Frail Patients (FRAGILE Trial) is a multicenter, randomized controlled trial comparing off-pump and on-pump coronary artery bypass grafting in frail or pre-frail patients undergoing coronary artery bypass grafting. This manuscript presents an update to the FRAGILE Trial study design, detailing protocol modifications made in response to the time gap between the study's conception and its actual implementation. These changes were implemented early in the trial and were formally approved by the Ethics Committee, ensuring the scientific and ethical integrity of the study and reinforcing its relevance to address a gap in a vulnerable patient population.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 5","pages":"e20250199"},"PeriodicalIF":1.2,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144746320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging Gaps, Building Legacy: The Role of BJCVS in Latin American Science.","authors":"Andrea Cristina Oliveira Freitas, Henrique Murad","doi":"10.21470/1678-9741-2025-0904","DOIUrl":"https://doi.org/10.21470/1678-9741-2025-0904","url":null,"abstract":"","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 4","pages":"e20250904"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Neurocognitive Disorder After Cardiac Surgery - A Narrative Study of a Retrospective Casuistic.","authors":"Pedro Oliveira Dias Martins, Suely Pereira Zeferino, Filomena Regina Barbosa Gomes Galas, Denise Aya Otsuki, Jose Otavio Costa Auler","doi":"10.21470/1678-9741-2024-0216","DOIUrl":"https://doi.org/10.21470/1678-9741-2024-0216","url":null,"abstract":"<p><strong>Introduction: </strong>Delirium is one of the most serious and common neuropsychological complications in the immediate postoperative period of cardiac surgery, always resulting in negative consequences, prolonged hospitalization, and increased early and late morbidity and mortality.</p><p><strong>Methods: </strong>An active search for acute cognitive dysfunction was performed in the electronic medical records written by the multidisciplinary team about the immediate postoperative period of 262 consecutive adult patients undergoing cardiac surgery with cardiopulmonary bypass operated on in 2019 at the Instituto do Coração of Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo. To maintain randomness, data were collected from 25 patients per month for a total of 10 months.</p><p><strong>Results: </strong>Seventy-three patients (27.9%) presented symptoms of delirium or perioperative neurocognitive disorder in the postoperative period, with a median time of four days. The most frequent symptoms were changes in cognition (25.6%), attention (25.2%), and agitation (24.8%). Patients with delirium had a longer intensive care unit stay (median seven days vs. three days, P < 0.001), longer mechanical ventilation (median 977 vs. 535, P < 0.001), longer hospital stay (median 20 days vs. 13 days, P < 0.001), and higher incidence of hospital death (22.2% vs. 3.2%, P < 0.001).</p><p><strong>Conclusion: </strong>The incidence of delirium immediately after cardiac surgery was high, around 27.9%, which is consistent with values found in the literature. The occurrence of delirium was highly associated with worse outcomes, such as longer hospital stays and mortality.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 4","pages":"e20240216"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Suicide Donors and Outcomes in Heart Transplantation: A Retrospective Cohort Study.","authors":"Álvaro Perazzo, Samuel Padovani Steffen, Aichah Ahmad El Orra, Shirlyne Fabianni Dias Gaspar, Daniele Ronco, Ronaldo Honorato Barros Santos, Domingos Dias Lourenço, Luis Fernando Bernal da Costa Seguro, Monica Samuel Avila, Fabiana Goulart Marcondes-Braga, Claudio Francesco Russo, Fernando Bacal, Roberto Lorusso, Fabio Antonio Gaiotto, Fabio B Jatene","doi":"10.21470/1678-9741-2024-0299","DOIUrl":"https://doi.org/10.21470/1678-9741-2024-0299","url":null,"abstract":"<p><strong>Introduction: </strong>The use of organs from suicide donors in heart transplantation is controversial due to potential concerns about graft function and recipient outcomes. This study investigates the association between heart transplantation using suicide donors related with the incidence of primary graft dysfunction (PGD) and mortality within 30 days after transplant.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 97 adult heart transplant recipients at the Instituto do Coração of São Paulo between 2020 and 2021. Data on donor characteristics (age, sex, mechanism of brain death), recipient preoperative status (age, sex, cardiomyopathy etiology, body mass index, comorbidities, use of intra-aortic balloon pump, extracorporeal membrane oxygenation [ECMO]), intraoperative variables (ischemia time, cardiopulmonary bypass time, implantation time), and postoperative outcomes (use of ECMO, mortality) were analyzed.</p><p><strong>Results: </strong>Of the 97 transplants analyzed, six were from suicide donors (6.2%). Recipients of hearts from suicide donors had a significantly higher need for ECMO (33.3% vs. 4.4%, P = 0.036), increased PGD (66.7% vs. 19.8%, P < 0.05), and higher 30-day mortality (50% vs. 3.3%, P < 0.05) compared to non-suicide donors. No significant intraoperative time differences were found between the groups.</p><p><strong>Conclusion: </strong>This study is the first to identify a significant association between heart transplantation from suicide donors and adverse outcomes, including higher rates of PGD and early mortality. These findings suggest possible psychological and biological influences on organ quality and transplantation outcomes. Further research is needed to clarify these associations and inform donor selection criteria.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research and Development of Ventricular Assist Devices: Experiences from the Instituto Dante Pazzanese de Cardiologia.","authors":"Carlos J T Karigyo, José F Biscegli, Eduardo G P Bock, Jeison W G Fonseca, Juliana Leme, Bruno U Silva, Aron J P Andrade","doi":"10.21470/1678-9741-2024-0209","DOIUrl":"https://doi.org/10.21470/1678-9741-2024-0209","url":null,"abstract":"<p><p>Ventricular assist devices have been widely accepted as an alternative treatment for advanced heart failure, while heart transplantation is a limited procedure because of the shortage of donors. In face of a scarce availability of these devices, many centers around the world have developed their own technologies. We describe historical and general features of the main ventricular assist devices developed at the Instituto Dante Pazzanese de Cardiologia. The auxiliary total artificial heart is an electromechanical pulsatile blood pump with left and right chambers, being originally designed to work as a heterotopic artificial heart. The spiral pump is a disposable device and currently available for clinical use in cardiopulmonary bypass. It works through a combination of centrifugal and axial pumping principles coming from a conically shaped impeller. The implantable centrifugal blood pump was conceived for long-term circulatory assistance with a unique impeller design concept producing a mixed flow. The apico-aortic blood pump consists of a miniaturized centrifugal pump originally conceived for bridge to transplantation strategy. The temporary circulatory support device is a new centrifugal blood pump for temporary ventricular assistance developed with the purpose of bridge-to-decision or recovery strategies. Additionally, the hybrid cardiovascular simulator was developed as a tool to test blood pumps as they minimize the need for animal experiments. Brazil represents an important reference with a few academic groups with a considerable output in ventricular assist devices research and development. Notable devices produced at Instituto Dante Pazzanese de Cardiologia have demonstrated excellent results for clinical application.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 5","pages":"e20240209"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Right Coronary Artery Bypass Grafting on Development of Atrial Fibrillation in Coronary Artery Bypass Grafting Surgery: A Retrospective Study.","authors":"Seyhan Yilmaz, Ertan Aydin, Sabür Zengin, Elvan Tekir Yılmaz, Abdullah Çelik","doi":"10.21470/1678-9741-2024-0325","DOIUrl":"https://doi.org/10.21470/1678-9741-2024-0325","url":null,"abstract":"<p><strong>Introduction: </strong>Previous studies suggest that the location of coronary artery disease cannot independently predict atrial fibrillation after coronary artery bypass grafting, but with little information, it has also been thought that simultaneous right coronary endarterectomy may cause this rhythm problem.</p><p><strong>Objective: </strong>In this study, we aimed to evaluate the effect of right coronary artery bypass grafting on early postoperative atrial fibrillation.</p><p><strong>Methods: </strong>Patients who underwent elective on-pump coronary artery bypass grafting operations in our hospital were included in the study, and patients who underwent a different open-heart surgery or those who had previously undergone open-heart surgery were not included. Patients included in the study were divided into Group 1 (patients who developed postoperative atrial fibrillation) and Group 2 (patients who did not develop postoperative atrial fibrillation) and compared in terms of right coronary artery bypass grafting and other follow-up parameters.</p><p><strong>Results: </strong>The mean age of a total of 158 patients included in the study was determined as 63.25 ± 10.07 years (range 44 - 85 years), 120 were male, and 96% of them had hypertension. Postoperative atrial fibrillation developed in 43 patients, and right coronary artery bypass grafting was performed in 123 patients.</p><p><strong>Conclusion: </strong>We think that the frequency of postoperative atrial fibrillation development may be higher in cases where right coronary artery bypass grafting is performed, as it may play a role in processes related to the conduction system and right ventricular dysfunction, and multicenter studies with a large number of patients would be beneficial on this subject.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 4","pages":"e20240325"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of Hemodialysis Patients and Renal Transplant Recipients Undergoing Cardiovascular Intervention: Is It Possible to Predict Cardiac Risk?","authors":"Dilek Aslan Kutsal, Fatih Kizilyel, Rafet Gunay, Bulend Ketenci","doi":"10.21470/1678-9741-2024-0291","DOIUrl":"https://doi.org/10.21470/1678-9741-2024-0291","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiovascular problems are one of the major causes of morbidity and mortality among renal transplant and hemodialysis patients. This study evaluates the preoperative risk factors and postoperative outcomes in patients undergoing heart surgery.</p><p><strong>Methods: </strong>A total of 83 patients (47 post-renal transplant recipients and 36 on hemodialysis) who underwent cardiac surgery and percutaneous coronary artery procedures at Dr. Siyami Ersek Heart Hospital between 2015 and 2022 were retrospectively analyzed using hospital electronic records without selection bias. Demographic information, such as age, sex, height, weight, and body mass index, cardiac surgery type, and preoperative laboratory findings were recorded.</p><p><strong>Results: </strong>Renal transplant recipients and hemodialysis patients undergoing heart surgery showed no significant differences in age, sex, or comorbidities (P > 0.05). Both groups had a high percentage of patients with elevated fasting blood glucose, triglycerides, and low-density lipoprotein levels. Additionally, body mass index and the triglyceride-glucose index were elevated, indicating insulin resistance. Renal transplant recipients with low preoperative glomerular filtration rate and hemoglobin levels < 10 g/dL had a higher risk of developing acute kidney injury. Four patients (9%) experienced graft loss after acute kidney injury, requiring hemodialysis. Mortality rates did not differ significantly between the groups (P > 0.56).</p><p><strong>Conclusion: </strong>Cardiovascular surgery can be safely performed in both renal transplant recipients with functional allografts and end-stage kidney disease patients on hemodialysis. Identifying and managing risk factors in these patients, who frequently experience cardiovascular complications, will lead to better outcomes.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 4","pages":"e20240291"},"PeriodicalIF":0.0,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Echocardiographic Anatomical Risk Factors for Permanent Pacemaker Implantation After Transcatheter Aortic Valve Replacement: A Retrospective Cohort Study.","authors":"Hugo Mantilla-Gutierrez, Jaime Cabrales, Víctor Herrera","doi":"10.21470/1678-9741-2024-0127","DOIUrl":"https://doi.org/10.21470/1678-9741-2024-0127","url":null,"abstract":"<p><strong>Introduction: </strong>Transcatheter aortic valve replacement (TAVR) has revolutionized the management of patients with aortic valve disease. However, the need for pacemaker implantation remains a frequent complication. The objectives of this study were to estimate the incidence of permanent pacemaker implantation and to determine the associated risk factors.</p><p><strong>Methods: </strong>This is a retrospective cohort study of adults who underwent TAVR, developed cardiac conduction disease, and required permanent pacemaker implantation during hospitalization. Groups were compared according to post procedure pacemaker implantation or not; and recognized preoperative and echocardiographically identified anatomic factors related to the procedure were evaluated. A predictive model was generated using multiple logistic regression.</p><p><strong>Results: </strong>A total of 234 patients were included. The pacemaker implantation rate was 14%, and risk factors associated with this procedure were age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.01 - 1.22), female sex (OR 0.11, 95% CI 0.01 - 0.61), body surface area > 1.51 m2 (OR 9.78, 95% CI 2.13 - 73.6), right bundle branch block (OR 22.5, 95% CI 2.62 - 242), first-degree atrioventricular block (OR 18.8, 95% CI 3.04 - 150), and implantation depth measured via echocardiography (OR 1.76, 95% CI 1.26 - 2.64). The model demonstrated good predictive capability with an area under the receiver operating characteristic curve of 0.934 (P < 0.001, 95% CI 0.878 - 0.988).</p><p><strong>Conclusion: </strong>A well-performing predictive model was developed with six independent risk factors for the need for pacemaker implantation after TAVR, based on factors related to anatomic echocardiographic measurements associated with classic risk factors.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 4","pages":"e20240127"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the Gap Between Research and Clinical Practice in Cardiac Tumors.","authors":"Basil Joy","doi":"10.21470/1678-9741-2024-0298","DOIUrl":"https://doi.org/10.21470/1678-9741-2024-0298","url":null,"abstract":"","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 5","pages":"e20240298"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Antibiotic Therapy and Circuit Management in Extracorporeal Membrane Oxygenation: A Comprehensive Narrative Review of Clinical Strategies and Evidence.","authors":"Ignazio Condello","doi":"10.21470/1678-9741-2024-0158","DOIUrl":"10.21470/1678-9741-2024-0158","url":null,"abstract":"<p><strong>Introduction: </strong>Extracorporeal membrane oxygenation (ECMO) has emerged as a life-saving therapy for patients with severe respiratory and cardiac failure. However, the management of infections and circuit sequestration remains a significant challenge in ECMO patients. This narrative review aims to provide a comprehensive overview of current strategies and evidence related to antibiotics therapy and circuit management in ECMO.</p><p><strong>Methods: </strong>A systematic search was conducted in medical databases including PubMed® and Google Scholar to identify relevant studies published up to January 2022. Keywords such as \"antibiotics therapy ECMO\", \"circuit sequestration ECMO\", and related terms were used to retrieve articles. Studies focusing on infections acquired during ECMO, antibiotic dosing, circuit optimization, and outcomes were included.</p><p><strong>Results: </strong>The search yielded a total of 20 relevant studies encompassing various aspects of antibiotics therapy and circuit sequestration in ECMO patients. Key findings include the epidemiology of infections acquired during ECMO, optimal antibiotic dosing strategies, risk factors for circuit-related complications, and the impact of circuit changes on patient outcomes. Effective management of infections and circuit sequestration is essential to improve outcomes in ECMO patients.</p><p><strong>Conclusion: </strong>This review highlights the importance of tailored antibiotic therapy, vigilant circuit monitoring, and evidence-based practices to mitigate complications and optimize patient care during ECMO support. Further research is needed to refine existing strategies and enhance the overall management of ECMO-associated infections and circuit issues.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 4","pages":"e20240158"},"PeriodicalIF":0.0,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}