Brazilian journal of cardiovascular surgery最新文献

{"title":"Resolution of Acute Respiratory Distress Syndrome-Induced Takotsubo Cardiomyopathy with Venovenous Extracorporeal Membrane Oxygenation.","authors":"Ishaq J Wadiwala, Pankaj Garg, Wesley L Allen, Si M Pham, Mathew Thomas","doi":"10.21470/1678-9741-2023-0117","DOIUrl":"10.21470/1678-9741-2023-0117","url":null,"abstract":"<p><strong>Introduction: </strong>Takotsubo cardiomyopathy (TTCM) can occur in acute respiratory distress syndrome (ARDS) and a few cases in literature were reported to be associated with hemodynamic instability. All these patients were managed with venoarterial extracorporeal membrane oxygenation (VA-ECMO).Case presentation: We present two patients with ARDS-induced TTCM who were managed successfully with venovenous ECMO (VV-ECMO).</p><p><strong>Conclusion: </strong>Ventricular function in both patients fully recovered three days after ECMO initiation, and they were subsequently weaned from ECMO once pulmonary function improved.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"e20230117 e20230117","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11497616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482244","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":"Role of Preservation Solution in Human Aneurysmatic Aorta Harvest and Transport: A Comparative Analysis of Different Solutions for Tissue Injury Protection.","authors":"Carlos Alexandre Curylofo Corsi, Maria Cecília Jordani, Jéssyca Michelon-Barbosa, Vinicius Flora Dugaich, Fabiola Mestriner, Cláudia Tarcila Gomes Sares, Rodolfo Borges Dos Reis, Paulo Roberto Evora, Mauricio Serra Ribeiro, Christiane Becari","doi":"10.21470/1678-9741-2023-0434","DOIUrl":"10.21470/1678-9741-2023-0434","url":null,"abstract":"<p><strong>Introduction: </strong>Human aortic tissues in vitro are tools to clarify the pathophysiological mechanisms of the cardiovascular system, cell culture, and transplants. Therefore, this study aims to analyze and compare the preservation of human aneurysmatic aortic tissues in three different solutions.</p><p><strong>Methods: </strong>Six human abdominal aortic aneurysms were obtained from patients after surgical ablation. The aorta samples were incubated in different solutions - 0.9% normal physiological saline solution, Ringer's lactate solution, and histidine-tryptophan-ketoglutarate solution (Custodiol®). Segments were collected at 0, 6, 24, and 48 hours. Creatine kinase and nitrate/nitrite were quantified for each incubation time. The tissue's alpha-smooth muscle actin was analyzed by immunofluorescence.</p><p><strong>Results: </strong>There was a significant increase in creatine kinase formation in the normal saline group at 0 and 48 hours and in the Ringer's lactate group at 0 and 48 hours (P=0.018 and P=0.028). The lower levels of creatine kinase and nitrate/nitrite and the aortic tissues' morphological integrity show that histidine-tryptophan-ketoglutarate has better tissue protection. These data suggest that histidine-tryptophan-ketoglutarate induces a protective effect on smooth muscle cells, with less tissue depletion in the aortic aneurysm.</p><p><strong>Conclusion: </strong>This study compared three preservation solutions with the potential for human abdominal aortic aneurysm tissue preservation. The histidine-tryptophan-ketoglutarate solution reduced tissue injury and improved tissue preservation in human abdominal aortic aneurysm tissue samples.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"e20230434 e20230434","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482247","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":"Early Mortality in Cardiac Surgery - Is Lactate Significant?","authors":"Mohammad Zeeshan Hakim, Vivek Tewarson, Sarvesh Kumar, Kumar Rahul, Rati Prabha, Sushil Kumar Singh","doi":"10.21470/1678-9741-2023-0245","DOIUrl":"10.21470/1678-9741-2023-0245","url":null,"abstract":"<p><strong>Introduction: </strong>Serum lactate is a consequence of tissue hypoperfusion and has been used routinely for patient management following cardiac surgery. This study aims to determine the association of lactate with early mortality and postoperative morbidity.</p><p><strong>Methods: </strong>This is a prospective cohort study carried out in the Department of Cardiovascular and Thoracic Surgery, King George's Medical University (India), from January 2020 to December 2022. A total of 270 patients were included in this study. Serum lactate levels were measured preoperatively, intraoperatively on-pump, coming off-pump, and at six, 12, 24, and 48 hours postoperatively.</p><p><strong>Results: </strong>Early mortality was noted in 17 cases (6.3%). While both lactate and lactate clearance correlated with duration of mechanical ventilation, vasopressor duration, and intensive care unit and hospital stay, correlation with early mortality was noted only with lactate at 24 hours. Logistic regression analysis demonstrated that lactate levels at preoperative period (adjusted odds ratio [OR] 4.76 [1.67-13.59], P=0.004) and at 24 hours after bypass (OR 1.21 [1.00-1.47], P=0.046) and vasopressor duration (OR 1.11 [1.04-1.19], P=0.002) are independent predictors of mortality. Receiver operating characteristic curve analysis showed that arterial lactate on-pump, off-pump, and at six, 12, and 24 hours after surgery had significant area under the curve for predicting mortality.</p><p><strong>Conclusion: </strong>Arterial lactate and lactate clearance show good correlation with duration of mechanical ventilation, vasopressor support, and intensive care unit and hospital stay and can serve as a good indicator to guide therapeutic decisions in postoperative period. However, it fails to be a sensitive predictor of mortality.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"e20230245 e20230245","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482245","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":"Right Ventricular Perforation by Fractured Sternal Wires: A Narrative Review.","authors":"Carlos Gallego-Navarro, Omar Latif, Sorin V Pislaru, Lawrence J Sinak, Kevin L Greason, John M Stulak, Arman Arghami","doi":"10.21470/1678-9741-2023-0461","DOIUrl":"10.21470/1678-9741-2023-0461","url":null,"abstract":"<p><strong>Introduction: </strong>Migration of a fragmented sternal wire is an unusual and rare phenomenon following cardiovascular surgery. It can present with variable clinical presentations, ranging from incidental findings to hemodynamic instability. Here, we described two cases of fragmented sternal wire migration to the right ventricle.</p><p><strong>Methods: </strong>Retrospective review of the clinical course of two patients presenting with a fragmented sternal wire embedded in the right ventricle after sternotomy for cardiovascular surgery. We also conducted a literature review to identify similar cases, compared them based on reported clinical variables, and discussed the role of diagnostic imaging and management.</p><p><strong>Results: </strong>We identified 13 patients (11 from the literature), of which 85% were men, and the median age was 64 years; 46% presented with hemorrhagic shock, another 46% had other cardiovascular symptoms, and 8% were asymptomatic. The presentation was bimodal, 54% presented within three weeks of the original sternotomy, while 46% had sternotomy more than a year before. Sternal dehiscence/instability was observed in 61% of cases. Computed tomography scan was the most common diagnostic modality (54%). Two patients did not undergo surgery, and two others died after surgery, while others had a successful surgical repair.</p><p><strong>Conclusion: </strong>Migration of a fragmented sternal wire is a phenomenon presented on a dehisced and unstable sternum that can occur days or years after sternotomy. These findings and the associated cardiac injury can be easily missed on computed tomography scan reporting if one is not looking for it. After diagnosis, treatment should be individualized according to the patient's needs.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"e20230461 e20230461","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482248","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":"COAPT Trial at 5 Years: Same Doubts Remain About the Efficacy of Transcatheter Edge-to-Edge in Functional Mitral Regurgitation.","authors":"Ovidio A García-Villarreal, Du Chunming","doi":"10.21470/1678-9741-2023-0360","DOIUrl":"https://doi.org/10.21470/1678-9741-2023-0360","url":null,"abstract":"","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"39 4","pages":"e20230360"},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11484088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482243","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":"Bypass and Ligation of Right Subclavian Artery Aneurysm in a Patient with Marfan's Syndrome via Reoperative Partial Upper Median Sternotomy.","authors":"Kevin R An, Lamia Harik, Talal Alzghari, Roberto Perezgrovas-Olaria, Giovanni Jr Soletti, Arnaldo Dimagli, Gianmarco Cancelli, Mario F L Gaudino, Sharif H Ellozy, Christopher Lau","doi":"10.21470/1678-9741-2023-0300","DOIUrl":"10.21470/1678-9741-2023-0300","url":null,"abstract":"<p><p>Subclavian artery aneurysms are rare and can result in thromboembolism or rupture. We present the case of a 41-year-old man with a history of Marfan's syndrome and multiple previous operations, who presented with an enlarging asymptomatic 5.2 cm right subclavian artery aneurysm and was successfully treated with a hybrid surgical operation.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"e20230300 e20230300","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482246","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":"The Usefulness of Microcirculatory Assessment After Cardiac Surgery: Illustrative Case Report.","authors":"Marcos Fernandes, Andrea De Lorenzo, Eduardo Tibiriçá","doi":"10.21470/1678-9741-2023-0383","DOIUrl":"10.21470/1678-9741-2023-0383","url":null,"abstract":"<p><p>Cardiac surgery causes a series of disturbances in human physiology. The correction of systemic hemodynamic variables is frequently ineffective in improving microcirculatory perfusion and delivering oxygen to the tissues. We present the case of a 52-year-old male submitted to mitral valve replacement (metallic valve) and subaortic membrane resection. Sublingual microcirculatory density and perfusion were evaluated using a handheld CytoCam camera before surgery and in the early postoperative period. In this case, systemic hemodynamic variables were compromised despite an actual improvement in the microcirculatory parameters in comparison to the preoperative evaluation, possibly due to the correction of the structural cardiac defects.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"39 6","pages":"e20230383"},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11382545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156808","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":"Risk Model for Laryngeal Complications Prediction in Chinese PatientGBVs After Coronary Artery Bypass Grafting.","authors":"Jiangyun Peng,Yinghong Zhang,Xuan Liu,Xue Feng,Zijun Yin,Yanhong Hu,Wen Zhang,Jing Zhang,Jingping Li","doi":"10.21470/1678-9741-2023-0424","DOIUrl":"https://doi.org/10.21470/1678-9741-2023-0424","url":null,"abstract":"INTRODUCTIONThe aim of this study was to identify perioperative risk factors of laryngeal symptoms and to develop an implementable risk prediction model for Chinese hospitalized patients undergoing coronary artery bypass grafting (CABG).METHODSA total of 1476 Chinese CABG patients admitted to Wuhan Asian Heart Hospital from January 2020 to June 2022 were included and then divided into a modeling cohort and a verification cohort. Univariate analysis was used to identify laryngeal symptoms risk factors, and multivariate logistic regression was applied to construct a prediction model for laryngeal symptoms after CABG. Discrimination and calibration of this model were validated based on the area under the receiver operating characteristic (ROC) curve and the Hosmer-Lemeshow (H-L) test, respectively.RESULTSThe incidence of laryngeal symptoms in patients who underwent CABG was 6.48%. Four independent risk factors were included in the model, and the established aryngeal complications risk calculation formula was Logit (P) = -4.525 + 0.824 × female + 2.09 × body mass index < 18.5 Kg/m2 + 0.793 × transesophageal echocardiogram + 1.218 × intensive care unit intubation time. For laryngeal symptoms, the area under the ROC curve was 0.769 in the derivation cohort (95% confidence interval [CI]: 0.698-0.840) and 0.811 in the validation cohort (95% CI: 0.742-0.879). According to the H-L test, the P-values in the modeling group and the verification group were 0.659 and 0.838, respectively.CONCLUSIONThe prediction model developed in this study can be used to identify high-risk patients for laryngealsymptoms undergoing CABG, and help clinicians implement the follow-up treatment.","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"183 1","pages":"e20230424"},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142196094","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":"Comparison of the Effect of Pump Flow Type (Pulsatile or Non-Pulsatile) on Postoperative Neurocognitive Functions in Coronary Artery Surgery.","authors":"Ferhat Borulu, Bilgehan Erkut","doi":"10.21470/1678-9741-2023-0345","DOIUrl":"10.21470/1678-9741-2023-0345","url":null,"abstract":"<p><strong>Introduction: </strong>The effect of pump flow type on perfusion in coronary surgery using cardiopulmonary bypass (CPB) is discussed. We aimed to evaluate the effect of pump flow type on cognitive functions with neurocognitive function tests.</p><p><strong>Methods: </strong>One hundred patients who underwent isolated coronary artery bypass surgery between November 2020 and July 2021 were divided into two equa groups. Groups were formed according to pump flow type pulsatile (Group 1) and non-pulsatile (Group 2). Clock drawing test (CDT) and standardized mini mental test (SMMT) were performed on the patients in both groups in the preoperative period, on the 1st preoperative day, and on the day before discharge. Neurocognitive effects were compared with all follow-up parameters.</p><p><strong>Results: </strong>There was no difference between the groups in terms of demographic data and in terms of neurocognitive tests performed before the operation. SMMT on postoperative day 1 (Group I: 27.64 ± 1.05; Group II: 24.44 ± 1.64; P=0.001) and CDT (Group I: 5.4 ± 0.54; Group II: 4 .66 ± 0.52; P=0.001), and SMMT on the day before discharge (Group I: 27.92 ± 1.16; Group II: 24.66 ± 1.22; P=0.001) and CDT (Group I: 5 It was calculated as .66 ± 0.48; Group II: 5.44 ± 0.5; P=0.001). The duration of intensive care and hospitalization were higher in the non-pulsatile group.</p><p><strong>Conclusion: </strong>We think that the type of pump flow used in coronary artery bypass surgery using CPB is effective in terms of neurocognitive functions and that pulsatile flow makes positive contributions to this issue.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"39 5","pages":"e20230345"},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11379152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143487","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":"Construction and Surgical Training of Coronary Anastomosis on a Low-Cost Portable Simulator: Experience in a Peruvian Multicenter Study.","authors":"W Samir Cubas, Anna Paredes-Temoche, Wildor R Dongo, Katherine E Inga, Wilfredo Luna-Victoria, Enrique Velarde-Revilla","doi":"10.21470/1678-9741-2023-0479","DOIUrl":"10.21470/1678-9741-2023-0479","url":null,"abstract":"<p><strong>Introduction: </strong>The operating room is no longer the ideal place for early surgica training of cardiothoracic surgery residents, forcing the search for simulation-based learning options. The study's aim was the construction and surgicaltraining of coronary anastomosis in a portable, low-cost, homemade simulator.</p><p><strong>Methods: </strong>This is an observational, analytical, and multicenter study. The simulator was built with common materials and was evaluated with the Objective Structured Assessment ofTechnical Skills (or OSATS) Modified. All junior and senior residents from nine national cardiothoracic surgery centers were considered for 90 days. Operative skill acquisition and time in the creation of side-to-side (S-T-S), end-to-side (E-T-S), and end-to-end (E-T-E) coronary anastomoses were evaluated. All sessions were recorded and evaluated by a single senior cardiothoracic surgeon during two time periods.</p><p><strong>Results: </strong>One hundred and forty residents were assessed in 270 sessions. In junior residents, a significant improvement in final scores was identified in S-T-S (use of Castroviejo needle holder, needle angles, and needle transfer) (P<0.05). In seniors, a significant improvement was identified in S-T-S (graft orientation, appropriate spacing, use of forceps, angles, and needle transfer) anastomoses (P<0.05). A significant improvement in the final anastomosis time of senior residents over junior residents was identified in S-T-S (8.11 vs. 11.22 minutes), E-T-S (7.93 vs. 10.10 minutes), and E-T-E (6.56 vs. 9.68 minutes) (P=0.039).</p><p><strong>Conclusion: </strong>Our portable and low-cost coronary anastomosis simulator is effective in improving operative skills in cardiothoracic surgery residents; therefore, skills acquired through simulation-based training transfer have a positive impact on the surgical environment.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"39 5","pages":"e20230479"},"PeriodicalIF":0.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11379378/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143488","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}