Brazilian journal of cardiovascular surgery最新文献

{"title":"Clinical Impact of New-Onset Left Bundle Branch Block After Transcatheter Aortic Valve Replacement: Data from a Single-Center Retrospective Registry.","authors":"Aleksey A Baranov, Aram G Badoian, Dmitrii A Khelimskii, Aryuna Yu Tsydenova, Ivan S Peregudov, Vladimir V Beloborodov, Aleksey G Filippenko, Toyche U Khalkhozhaev, Oleg V Krestyaninov","doi":"10.21470/1678-9741-2024-0187","DOIUrl":"10.21470/1678-9741-2024-0187","url":null,"abstract":"<p><strong>Introduction: </strong>The clinical significance of new-onset left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) remains controversial. In the presented study, we aimed to assess the impact of new LBBB on clinical outcomes after TAVR.</p><p><strong>Methods: </strong>A total of 473 patients underwent TAVR for severe aortic stenosis between 2015 and 2023. According to the exclusion criteria, the study cohort comprised of 322 patients for analysis. The primary endpoint was cardiovascular death, with secondary endpoints including all-cause mortality and permanent pacemaker implantation (PPI) during follow-up.</p><p><strong>Results: </strong>Patients with new LBBB had a significantly smaller indexed aortic valve area (0.3 ± 0.1 vs. 0.4 ± 0.1, P < 0.01) and interventricular membranous septum length (6.2 ± 1.6 vs. 6.9 ± 1.8, P < 0.01). By multivariable analysis, new LBBB remained an independent predictor of cardiovascular death (hazard ratio [HR] 7.09, 95% confidence interval [CI] 1.16 - 43.50, P = 0.03) during the 2.9-year follow-up period. There were no significant differences in the incidence of all-cause mortality (HR 0.48, 95% CI 0.17 - 1.37, P = 0.16) and PPI (HR 2.61, 95% CI 0.85 - 0.80, P = 0.08) between patients with new LBBB compared to those without it.</p><p><strong>Conclusion: </strong>New LBBB after TAVR procedure is associated with an increased risk of death from cardiovascular causes, but it did not increase the risk of all-cause mortality and PPI over the long-term period.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 3","pages":"e20240187"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12124747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188569","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":"Evaluation of Intraoperative and Postoperative Blood Cell Salvage Use in Cardiac Surgery with Cardiopulmonary Bypass.","authors":"Marco Antonio Araújo de Mello, Laís da Silva Pereira-Rufino, Antonio Alceu Dos Santos, Nelson Americo Hossne, Carlos Eduardo Panfilio, Albert Schiaveto de Souza, Isabel Cristina Céspedes","doi":"10.21470/1678-9741-2024-0244","DOIUrl":"10.21470/1678-9741-2024-0244","url":null,"abstract":"<p><strong>Introduction: </strong>Blood transfusion is associated with adverse clinical and surgical outcomes. Strategies like the Patient Blood Management program, which includes blood cell salvage, contribute to reducing the use of blood components. Blood cell salvage is very useful in heart surgeries where the patient's blood loss can be massive.</p><p><strong>Objective: </strong>The present study aimed to evaluate the impact of using the blood cell salvage in the intraoperative and postoperative periods (up to 24 hours) on the hemoglobin and hematocrit values, transfusion of red blood cells, infection rates, and postoperative length of stay in patients undergoing cardiac surgery with cardiopulmonary bypass.</p><p><strong>Methods: </strong>Forty-one patients who underwent cardiac surgery with cardiopulmonary bypass according to the inclusion criteria were selected in an observational study and separated into two groups: with the use of the blood cell salvage group (BCS, n = 21) and without the use of the blood cell salvage (WBCS, n = 20).</p><p><strong>Results: </strong>Patients in the group using blood cell salvage had higher postoperative hemoglobin (P = 0.018) and postoperative hematocrit levels (P = 0.009), lower consumption of red blood cells in the postoperative period and hospital discharge (P < 0.001), shorter postoperative length of stay (P = 0.020), and lower infection rates (P = 0.009).</p><p><strong>Conclusion: </strong>Patient Blood Management strategies, particularly the use of blood cell salvage in the intraoperative and immediate postoperative periods of patients undergoing cardiac surgery with cardiopulmonary bypass, are associated with less use of blood components and consequently better clinical outcomes.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 3","pages":"e20240244"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12124749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188597","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 Ticking Clock of Aortic Root Replacement - Single-Center Experience After Urgent and Emergent Aortic Root Replacement Using the BioIntegral and Freestyle™ Bioconduits.","authors":"Konstantina Spetsotaki, Jingjing Shi, Ajay Moza, Matthias Menne, Ali Aljalloud","doi":"10.21470/1678-9741-2024-0307","DOIUrl":"10.21470/1678-9741-2024-0307","url":null,"abstract":"<p><strong>Introduction: </strong>Aortic root pathologies needing full aortic root replacement are challenging entities correlated to high morbidity and mortality due to their complexity and mostly refer to high-risk patients. In this retrospective study, we report our surgical experience and clinical results of patients undergoing a Bentall procedure as primary or reoperative surgery with the application of aortic bioconduits.</p><p><strong>Methods: </strong>Patients who underwent full aortic root replacement utilizing either BioIntegral (BI) or Medtronic Freestyle™ (FS) bioconduit in the Cardiothoracic Surgery Department of the University Hospital Aachen RWTH from January 2015 until September 2020, in an urgent or emergency setting, were analyzed and followed up until December 2023.</p><p><strong>Results: </strong>Twenty-six patients underwent aortic root replacement with bioconduits (N=11 with BI, N=15 with FS) in our center. Twenty-three cases were of infective cause, and three were of noninfective cause; 30.76% were urgent, and 69.23% were emergency cases. Two (7.70%) patients died during operation due to irreversible aortic root damage. In-hospital and 30-day mortality rates were four out 26 (15.4%) patients. The mean follow-up time for all the patients was 52.01 ± 39.41 months. Patients who received a primary aortic root replacement had significantly higher survival than redo cases. BI surgery needed longer cardiopulmonary bypass times.</p><p><strong>Conclusion: </strong>Clinical outcome was equal for both bioconduits. Further studies with larger cohorts are needed for deeper insights into this complex entity.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 3","pages":"e20240307"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12124750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188601","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":"Del Nido vs. Blood Cardioplegia: A Comparative Analysis of Postoperative Atrial Fibrillation in Coronary Artery Bypass Grafting Patients.","authors":"Hasan Toz, Ali Aycan Kavala, Saygın Türkyılmaz, Yusuf Kuserli, Gülsüm Türkyılmaz, Mehmet Ali Yesiltas, Necdet Kılıçaslan","doi":"10.21470/1678-9741-2024-0071","DOIUrl":"10.21470/1678-9741-2024-0071","url":null,"abstract":"<p><strong>Introduction: </strong>Cardioplegia solution, also called the del Nido solution, has been widely used in pediatric cardiac surgeries, and has recently started to be used in adult cardiac surgeries. In this context, this study aimed to investigate the relationship between the use of del Nido and blood cardioplegia solutions and postoperative atrial fibrillation rates in our clinic.</p><p><strong>Methods: </strong>The study sample comprised 140 patients who underwent coronary artery bypass grafting. The del Nido and blood cardioplegia solutions were used in 70 (50%) patients. The postoperative atrial fibrillation rates of both groups were compared. Additionally, patients' preoperative, intraoperative, and postoperative data were evaluated.</p><p><strong>Results: </strong>The cardiopulmonary bypass duration and defibrillation rate were lower in the del Nido cardioplegia group than in the blood cardioplegia group (P < 0.001). Atrial fibrillation rates on postoperative days one, five, and 30 were significantly lower in the del Nido cardioplegia group than in the blood cardioplegia group (P < 0.001, P < 0.001, and P = 0.007, respectively).</p><p><strong>Conclusion: </strong>The postoperative atrial fibrillation rate was significantly lower in the del Nido cardioplegia group than in the blood cardioplegia group. In addition, the del Nido cardioplegia solution did not interrupt the surgical flow, thus resulting in less total perfusion, shorter cross-clamping durations, and fewer defibrillation needs. In conclusion, the del Nido cardioplegia solution can be used safely and effectively in coronary artery bypass grafting surgeries.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 3","pages":"e20240071"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188595","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":"Left Anterior Mini-Thoracotomy vs. Conventional Sternotomy in On-Pump Multivessel Coronary Revascularization.","authors":"Hüseyin Sicim, Ali Fedakar","doi":"10.21470/1678-9741-2023-0299","DOIUrl":"10.21470/1678-9741-2023-0299","url":null,"abstract":"<p><strong>Objective: </strong>In this study, we aimed to compare the outcomes of left anterior mini-thoracotomy and conventional sternotomy in on-pump multivessel coronary revascularization.</p><p><strong>Methods: </strong>Two hundred sixty-two patients who underwent minimally invasive coronary artery bypass grafting through the left anterior mini-thoracotomy and conventional coronary artery bypass grafting with full sternotomy were included. All patients were divided into two groups - 132 patients who underwent minimally invasive multivessel coronary artery bypass grafting in Group I, and 130 patients with full sternotomy in Group II. Intraoperative variables (cross-clamping time, cardiopulmonary bypass time, etc.), postoperative parameters (drainage amount, revision, intensive care and hospital stay times, etc.), and mortality were analyzed retrospectively.</p><p><strong>Results: </strong>Cardiopulmonary bypass time (152.24 ± 36.4 minutes) was significantly longer in Group I than in Group II (102.24 ± 19.4 minutes) (P<0.001). Cross-clamping time (86 ± 13.2 minutes) was significantly longer in Group I than in Group II (62 ± 21.4 minutes) (P<0.001). And intensive care stay time (P=0.005) and hospital stay time (P=0.004) were significantly shorter in Group I. In the postoperative period, six patients in Group I and seven patients in Group II were revised due to bleeding. Total perioperative mortality was one patient in both groups (P=0.82).</p><p><strong>Conclusion: </strong>Multivessel coronary artery bypass grafting through the left anterior mini-thoracotomy is an effective, reliable, and successful method, due to less drainage amount and less blood transfusion need, shorter intensive care and hospital stays, faster return to daily life, and better cosmetic results compared to conventional methods.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 3","pages":"e20230299"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12131425/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188599","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":"Mini-Sternotomy for Aortic Valve Replacement with Concomitant Ablation of the Pulmonary Vein and Persistent Left Superior Vena Cava: A Case Report.","authors":"Kensuke Kobayashi, Yusuke Mizuno, Takayuki Kai","doi":"10.21470/1678-9741-2024-0053","DOIUrl":"https://doi.org/10.21470/1678-9741-2024-0053","url":null,"abstract":"<p><p>A 79-year-old man with severe aortic valve stenosis and atrial fibrillation was referred to our department for surgery. Computed tomography revealed persistent left superior vena cava. Lower mini-sternotomy was performed. The left atrial appendage was amputated before ablation of the persistent left superior vena cava. The jaw of the ablation device was passed behind the pulmonary veins using a tip-lighted articulating dissector. Finally, aortic valve replacement was completed. Aortic valve replacement with concomitant pulmonary vein and persistent left superior vena cava ablation via lower mini-sternotomy is a safe and less invasive alternative.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 4","pages":"e20240053"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058399","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":"Fate of Residual Aorta After Surgery for Type A Aortic Dissection.","authors":"Apeksha Mittal, Pankaj Aggarwal, Harkant Singh, Manphool Singhal, Arun Sharma, Mohamed M R Irshad, Nishit Santoki, Nitish Kumar, Dollphy Garg, Chandra Shekhar Singh Aswal, Richa Soni, A Arun George","doi":"10.21470/1678-9741-2024-0243","DOIUrl":"https://doi.org/10.21470/1678-9741-2024-0243","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical treatment of type A aortic dissection is essentially palliative. Many patients who undergo the procedure still have a dissection flap in the residual aorta, with a persistent patent or partially thrombosed false lumen leaving them susceptible to the dilatation of distal aorta and aneurysm formation.</p><p><strong>Methods: </strong>Patients who had undergone surgery for type A aortic dissection from January 2015 till December 2022 were recruited into the study. Two follow-up computed tomography scans were performed at least six months apart, the first one at least one month after the surgery.</p><p><strong>Results: </strong>A persistent dissection flap was found in 34 (68%) patients. All segments of residual distal aorta showed dilatation with time. Growth rate was maximum for abdominal aorta - 3.1 (1.6 - 5.4) mm/year. Patency of false lumen was the only significant factor associated with growth of lower descending thoracic aorta and abdominal aorta (P<0.05). Maximum growth was seen in the patients with partial thrombosis of the false lumen, followed by those with patent false lumen. Two patients with partially thrombosed false lumens required reintervention in the form of endovascular stenting.</p><p><strong>Conclusion: </strong>Patients after surgery for type A aortic dissection with partially thrombosed false lumens are more prone to aortic dilatation. Regular follow-up of these patients with computed tomography aortogram can lead to timely detection of these sequalae and intervention as needed.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 3","pages":"e20240243"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053897","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 Impact of International Missions in Provision of Cardiac Services and Skill Transfer in Respect to Coronary Artery Bypass Grafting at Jakaya Kikwete Cardiac Institute - Tanzania.","authors":"Evarist T M Nyawawa, Henry A Mayala, Peter R Kisenge, Moses Byomuganyizi, Alex B Joseph, Angela N Muhozya, Ramadhan Khamis, Evans E Nyawawa, Juma B Nyangasa, Adelphina Ncheye, Alex Loth, Aubyn Marath","doi":"10.21470/1678-9741-2024-0075","DOIUrl":"https://doi.org/10.21470/1678-9741-2024-0075","url":null,"abstract":"<p><strong>Objective: </strong>To assess how efficient the local team attained skills are after several visits made by international missions in respect to number of coronary artery bypass grafting surgery performed and the overall patient outcome.</p><p><strong>Methods: </strong>This was a retrospective study that included all patients who were operated on at the center after being diagnosed with chronic coronary artery disease from May 2016 to December 2023. Patients' demographic data were retrieved from patients' files coupled with theatre record file, entered into a structured questionnaire, and then, in a statistical program.</p><p><strong>Results: </strong>A total of 290 patients underwent coronary artery bypass grafting at the center. The international missions performed a total of 159 (54.8%) operations, while the local team operated a total of 131 (45.2%) patients. The study showed significant statistical difference in terms of total operation time (95% confidence interval [CI] = 5.67, 6.01 vs. 95% CI = 6.32, 6.66), aortic cross-clamping time (95% CI = 75.92, 90.00 vs. 95% CI = 111.19, 126.65), and total cardiopulmonary bypass time (95% CI = 115.9, 134.75 vs. 95% CI = 174.52, 201.27) between the international missions and local surgical team, respectively. The mortality rate was higher in patients operated on by the local team (13.7%) than by international missions (8.8%), however there was no statistical difference.</p><p><strong>Conclusion: </strong>This study has shown the beneficial advantage of international surgical missions to newly established open-heart centers with advanced facilities and skill-deprived team. International surgical missions have greatly contributed to the progression of the center as they oversee and support the programs.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 3","pages":"e20240075"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12053801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031496","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":"Treatment of Sternocutaneous Fistula Due to Cardiac Surgery Using Extracellular Matrix Patch.","authors":"Zoran Tabaković, Milana Marinković, Petar Milačić, Slobodan Mićović, Igor Živković","doi":"10.21470/1678-9741-2024-0137","DOIUrl":"https://doi.org/10.21470/1678-9741-2024-0137","url":null,"abstract":"<p><p>The incidence of sternal wound complications, such as dehiscences, infections, and sternocutaneous fistulas, can reach 10%. Sternocutaneous fistulas are extremely rare, and the only definite therapy is surgical repair. Our experience taught us that combining a traditional approach with an extracellular matrix patch might be a step forward in therapy. We described three examples of surgically reconstructing sternocutaneous fistulas with an extracellular matrix patch (ProxiCor®).</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 4","pages":"e20240137"},"PeriodicalIF":0.0,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12052251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047418","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":"ERRATUM.","authors":"","doi":"10.21470/1678-9741-2019-0206e","DOIUrl":"https://doi.org/10.21470/1678-9741-2019-0206e","url":null,"abstract":"","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 1","pages":"e20190206e"},"PeriodicalIF":0.0,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057407","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}