Brazilian journal of cardiovascular surgery最新文献

{"title":"Fontan Surgical Planning: Numerical Simulations Reveal Efficient Geometries Predicting Post-Surgical Outcomes.","authors":"Paulo Cesar Duarte, Alexandre Noboru Murakami, Rudolf Huebner, Hemerson Donizete Pinheiro","doi":"10.21470/1678-9741-2024-0217","DOIUrl":"10.21470/1678-9741-2024-0217","url":null,"abstract":"<p><strong>Introduction: </strong>Computational fluid dynamics has the potential to assist cardiovascular surgeons in making more accurate decisions, allowing the prediction of post-surgical outcomes, provided that pre-surgical conditions are well established. However, the application of current techniques, which are based on volume methods, is still limited to a few specialized centers. Lack of knowledge, coupled with the need for advanced computational resources, can serve as obstacles to implementation. Objective: This study aimed to develop a replicable surgical planning procedure for a simplified and clinically feasible total cavopulmonary geometry.</p><p><strong>Methods: </strong>The finite volume method was used to simulate different configurations of cavopulmonary anastomosis under continuous and pulsatile flow and thus gain a better understanding of blood behavior, energy efficiency, and shear stress in the studied regions.</p><p><strong>Results: </strong>Two geometries were found to be efficient in distributing blood flow in a physiological manner, with adequate shear stress and energy loss. In addition to the correct placement of the anastomosis, the results underscored the need for attention regarding potential stenoses in pulmonary arteries to obtain adequate geometries.</p><p><strong>Conclusion: </strong>The developed method proved to be effective for early visualization of post-surgical results, particularly in complex clinical cases. Furthermore, the method contributes to a comprehensive understanding of hemodynamics in the studied area, improving the accuracy of cardiovascular surgical planning.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 2","pages":"e20240217"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925220/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659816","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":"Frailty Assessment to Improve Risk Stratification in Elderly Patients Undergoing Elective Cardiac Surgery.","authors":"Kamile Ozeren, Ahmet Can Topcu, Ilyas Kayacioglu","doi":"10.21470/1678-9741-2023-0182","DOIUrl":"10.21470/1678-9741-2023-0182","url":null,"abstract":"<p><strong>Introduction: </strong>Frailty is a biological syndrome of the elderly characterized by decreased physiological reserve and weakened response to stressors. Most cardiac surgical risk models incorporate chronologic age as a risk parameter, but not frailty. We aimed to identify the frailty assessment tool with the highest prognostic value to predict postoperative adverse outcomes in elderly patients undergoing cardiac surgery and to investigate whether addition of a frailty parameter to cardiac surgical risk models would increase predictive power.</p><p><strong>Methods: </strong>This is a single-center, prospective, observational study. Consecutive adults, undergoing elective cardiac surgery between January and May 2020, were included. The European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) and Society of Thoracic Surgeons risk scores were calculated. Fried Scale, Short Physical Performance Battery, Clinical Frailty Scale, and serum albumin were used for frailty assessment. Patients were followed-up for 30 days postoperatively or until discharge. Primary endpoint was a composite of mortality and major morbidity.</p><p><strong>Results: </strong>One hundred sixty-four patients were included (34.76% women, median age 70 years [interquartile range, 67-74]. EuroSCORE II and albumin were the only tools significantly associated with the primary endpoint (P=0.045 and P=0.031, respectively). Model created by combination of EuroSCORE II and albumin was not associated with the primary outcome (P=0.571), however EuroSCORE II's R-squared value increased from 0.07 to 0.144 after addition of albumin.</p><p><strong>Conclusion: </strong>Addition of albumin measurement as a frailty marker to EuroSCORE II has the potential to improve EuroSCORE II's ability to predict early postoperative mortality/morbidity in elderly patients undergoing cardiac surgery.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 2","pages":"e20230182"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11922485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659819","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":"Dacron® Graft Kinking Following Ascending Aorta Replacement Is Not Only a Cosmetic Issue.","authors":"Ermal Likaj, Alfred Ibrahimi, Saimir Kuci, Jacob Zeitani","doi":"10.21470/1678-9741-2022-0468","DOIUrl":"10.21470/1678-9741-2022-0468","url":null,"abstract":"<p><p>A 58-year-old man, who has undergone ascending aorta replacement, started to complain of pain in the lower limbs, shortness of breath, and progressive fatigue a few months after surgery. Transthoracic and transesophageal Doppler echocardiographies revealed a diseased bicuspid aortic valve and a subocclusive mass in the ascending aorta. Thoracic computed tomography angiography confirmed the presence of a subocclusive mass, pseudoaneurysm formation, and a distorted shape of the Dacron® graft. The patient underwent urgent surgery to remove the mass, which appeared to be a thrombus, and aortic valve and ascending aorta replacement. Kinking of vascular graft has been reported including surgical techniques to correct the excessive length to avoid gradients and guarantee laminar flow. When kinking is severe, high gradients and hemolysis can be detected. However, thrombus formation in the ascending aorta segment is less likely, due to the high blood velocity flow. Therefore, several concurrent causes should be considered. In this case, the most probable explanation for thrombus formation was kinking of a too long Dacron® graft, combined with extrinsic compression effect of the graft by the pseudoaneurysm at the anastomosis site and anomalous flow directed from the diseased bicuspid aortic valve. Various grades of Dacron® graft kinking might occur following ascending aorta replacement and undiagnosed at follow-up especially if resulting in mild symptoms, thus, careful visual and echocardiography evaluation should be done at the end of surgery. Finally, distorted Dacron® graft might trigger thrombus formation when inflammation and coagulation processes are set off during bacteria or viral infection.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 2","pages":"e20220468"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921935/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659805","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":"Penetrating Cardiac Injury: A 20-Year Retrospective Analysis at a High-Complexity University Center.","authors":"Li Siyuan Wada, Paulo Roberto Barbosa Évora, Giovane Okarenski, Adilson Scorzoni, Mauricio Godinho, Sandro Scarpelini, Gabriel Bianco Giuliani, Danilo Tadao Wada, Fabio Luis-Silva, Alfredo José Rodrigues","doi":"10.21470/1678-9741-2024-0049","DOIUrl":"10.21470/1678-9741-2024-0049","url":null,"abstract":"<p><strong>Introduction: </strong>Penetrating cardiac injury, though infrequent, is associated with substantial mortality. In 2005, our research team conducted a comprehensive retrospective analysis of penetrating cardiac injuries managed at our facility from 1990 to 2003. Now, two decades later, we conducted the present study on penetrating cardiac injuries attended in our hospital over the last 20 years.</p><p><strong>Methods: </strong>This is a retrospective analysis of medical records and trauma database data, with a focus on survivors of penetrating cardiac trauma, excluding those deceased upon arrival.</p><p><strong>Results: </strong>Out of 1,093 cases, 25 had penetrating cardiac injuries with an overall mortality rate of 36%. Hemorrhage was the leading cause of death, and survival was correlated with higher systolic blood pressure upon admission and the level of consciousness.</p><p><strong>Conclusion: </strong>The study highlights the need for rapid intervention and emphasizes the importance of managing bleeding and supporting hemodynamics. It also points to areas for improvement in emergency care and the benefits of interdisciplinary collaboration.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 2","pages":"e20240049"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11924954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659822","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":"Post-Cardiotomy Blood Parameters as a Prognostic Marker in Acute Aortic Dissection Surgery.","authors":"Mesut Engin, Umut Serhat Sanrı, Ufuk Aydın, Yusuf Ata, Senol Yavuz","doi":"10.21470/1678-9741-2024-0087","DOIUrl":"10.21470/1678-9741-2024-0087","url":null,"abstract":"","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 2","pages":"e20240087"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659824","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":"Cardiopulmonary Bypass and Cross-Clamping Times in Aortic Valve Replacement Surgery by Ministernotomy with Sutureless Prosthesis Implantation Compared to Conventional Prosthesis: A Cross-Sectional Study.","authors":"Álvaro Perazzo, Silvia Mariani, Gabriela Lucena Montenegro, Luca Conci, Diana Patrícia Lamprea Sepúlveda, Samuel Padovani Steffen, Fabio Antonio Gaiotto, Roberto Lorusso, Silvio Caldas, Esdras Marques Lins, João Carlos Ferreira Leal, Fernando Ribeiro de Moraes","doi":"10.21470/1678-9741-2024-0290","DOIUrl":"10.21470/1678-9741-2024-0290","url":null,"abstract":"<p><strong>Introduction: </strong>Valve replacement is one of the effective treatments for aortic valve disease. This study aims to compare cardiopulmonary bypass and ischemia times in aortic valve replacement surgeries using stented biological and sutureless prostheses (PERCEVAL®) through a minimally invasive ministernotomy approach. Methods: This single-center cross-sectional study, conducted from February 2015 to February 2021, assessed clinical and epidemiological characteristics in aortic valve replacement patients. It analyzed factors including hospital stay, early outcomes, valve etiology, intraoperative diagnosis, systolic gradients, left ventricular ejection fraction, and left ventricular mass. Two groups were studied: 12 patients with PERCEVAL® prostheses and 81 with conventional bioprostheses.</p><p><strong>Results: </strong>This study included 93 patients (age: 59 ± 16 years), 61.3% were male, and 80.2% had hypertension; dyslipidemias were present in 34.1% and 25.3% were diabetic. Cardiopulmonary bypass and cross-clamping times were 61 minutes and 41 minutes in the conventional bioprostheses group and 59.5 minutes and 39.5 minutes in the PERCEVAL® group (P=0.143 and P=0.058, respectively). Intensive care unit and overall hospital stays were statistically comparable between both groups (P=0.662 and P=0.599, respectively). All participants survived the 30-day postoperative period, with minimal complications, no significant differences in echocardiographic parameters were observed, yet higher values for certain cardiac function indicators were noted in the conventional bioprostheses group.</p><p><strong>Conclusion: </strong>The groups with conventional bioprostheses and sutureless prostheses (PERCEVAL®) didn't display significant differences in the analyzed variables for ministernotomy aortic valve replacement surgery. They exhibited similar results in terms of hospital stay duration, 30-day outcomes, and cardiac function values.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 2","pages":"e20240290"},"PeriodicalIF":0.0,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925287/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659799","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":"Thiol/Disulfide Homeostasis in Pericardial Fluid and Plasma of Patients Undergoing Coronary Artery Bypass Surgery.","authors":"Reşat Dikme, Abdullah Taşkin","doi":"10.21470/1678-9741-2022-0367","DOIUrl":"10.21470/1678-9741-2022-0367","url":null,"abstract":"<p><strong>Introduction: </strong>On-pump coronary artery bypass grafting (CABG) method affect almost allbiochemicalreactions by disrupting the patient's redox homeostasis. Detection of systemic redox hemostasis in the patient is critical for the CABG method's success and the prognosis of the disease. In this study, thiol/disulfide parameters, which are indicators of redox homeostasis, and ischemia-modified albumin levels in the plasma and pericardial fluid of patients who underwent CABG were investigated.</p><p><strong>Methods: </strong>Sixty patients who underwent an on-pump CABG operation with the cardiopulmonary bypass method were included in this study. Blood samples were taken from the patients before and after cardiopulmonary bypass. Pericardia fluid samples were taken before cardiopulmonary bypass. Then, thiol/disulfide homeostasis, albumin, and ischemia-modified albumin levels in the pericardial fluid and the patients' plasma levels were compared.</p><p><strong>Results: </strong>Albumin and ischemia-modified albumin levels were significantly higher in the postoperative period compared to the preoperative one (P<0.001). Thiol/disulfide parameters were higher and statistically significant in preoperative than in postoperative examinations (P<0.001). A negative correlation was found between pericardial fluid ischemia-modified albumin and thiol-disulfide parameters (P<0.001).</p><p><strong>Conclusion: </strong>Changes in thiol/disulfide homeostasis, albumin, and ischemia-modified albumin levels at different times during the on-pump CABG may be caused by foreign non-endothelial surfaces, filters, the reperfusion process, and pharmacological effects in the extracorporeal circulation. Thiol/disulfide homeostasis, albumin, and ischemia-modified albumin levels should be monitored during the on-pump CABG and should be intervened with appropriate therapeutic strategies. In this way, secondary pathologies can be avoided by preventing cellular damage and excessive inflammatory responses.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 1","pages":"e20220367"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844310/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494885","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":"Body Perfusion Management in Aortic Arch Surgery.","authors":"Mesut Engin, Mustafa Abanoz, Ufuk Aydın, Yusuf Ata, Şenol Yavuz","doi":"10.21470/1678-9741-2024-0054","DOIUrl":"10.21470/1678-9741-2024-0054","url":null,"abstract":"","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 3","pages":"e20240054"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11844828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494936","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":"Robotic-Assisted Minimally Invasive Direct Coronary Artery Bypass Grafting with Concomitant Left Atrial Appendage Exclusion.","authors":"Gregory Fishberger, Blake Bulard, Leonardo Paim N da Costa, Lucian Lozonschi","doi":"10.21470/1678-9741-2024-0198","DOIUrl":"10.21470/1678-9741-2024-0198","url":null,"abstract":"<p><p>Off-pump robotic-assisted minimally invasive direct coronary artery bypass (MIDCAB) achieves revascularization without conventional sternotomy and provides benefit to patients that otherwise may not be ideal surgical candidates. For patients with comorbid atrial fibrillation, left atrial appendage exclusion may reduce stroke risk and is achievable via mini thoracotomy during concomitant MIDCAB. Here, we report four patients who underwent off-pump robotic-assisted MIDCAB and concurrent epicardial left atrial appendage exclusion. Intraoperative transesophageal echocardiography confirmed complete left atrial appendage exclusion in all cases. The concomitant robotic approach proved to be feasible, efficacious, and safe, with no postoperative mortality or stroke events during follow-up.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 3","pages":"e20240198"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11845091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494938","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":"Reentry to the Mediastinum When the Ascending Aorta Is Adherent to the Sternum: A Two-Stage Sternotomy Approach.","authors":"Saimir Kuci, Ermal Likaj, Alfred Ibrahimi, Marsela Goga, Romina Teliti, Jacob Zeitani","doi":"10.21470/1678-9741-2023-0310","DOIUrl":"10.21470/1678-9741-2023-0310","url":null,"abstract":"<p><p>Reentry to the mediastinum when the ascending aorta aneurysm is adherent to the sternum is characterized by high risk of aneurysm rupture during sternum opening. In such cases, often cardiopulmonary bypass via peripheral vessels is instituted, and reentry done in deep hypothermia and circulatory arrest. To reduce both risks of aneurysm rupture during resternotomy and those related to prolonged cardiopulmonary bypass time, we present a surgical approach consisting of a two-stage sternotomy to avoid the risky zone and extra-anatomic epiaortic vessels anastomoses.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"40 3","pages":"e20230310"},"PeriodicalIF":0.0,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11873817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494937","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}