Brazilian journal of cardiovascular surgery最新文献

{"title":"Survival and Mid-Term Outcomes of On Pump vs. Off Pump Coronary Artery Bypass Grafting: A Propensity Score-Matched Analysis in A First Peruvian Registry.","authors":"W Samir Cubas, Wildor Dongo-Minaya, Franco Albán-Sánchez, Jose Torres-Neyra, Anna Paredes-Temoche, Katherine Inga-Moya, Hector Bedoya-Copello, Wilfredo Luna-Victoria, Enrique Velarde-Revilla","doi":"10.21470/1678-9741-2023-0242","DOIUrl":"10.21470/1678-9741-2023-0242","url":null,"abstract":"<p><strong>Introduction: </strong>The efficacy and outcomes of on-pump and off-pump coronary artery bypass grafting (CABG) remain uncertain, especially in Latin America. Our study aims to explore survival and shortand mid-term outcomes in the first reported Peruvian registry of patients treated with both techniques.</p><p><strong>Methods: </strong>This is an observational, analytical, and longitudinal study using a propensity score-matched (PSM) analysis in a single-center retrospective registry of 2280 patients during 2000-2019; 846 patients were analyzed after PSM (on-pump = 423 vs. off-pump = 423). Baseline variables, comorbidities, and major outcomes were studied in the short term (≤ 30 days) and in midterm (30 days-36 months) with major adverse cardiac and cerebrovascular events. The matched groups were compared by descriptive, multivariate, and Kaplan-Meier survival analyses.</p><p><strong>Results: </strong>Before PSM, previous myocardial infarction < 7 days (27.03%) and ejection fraction ≥ 50% (45.72%) were higher in off-pump CABG (P<0.05). After PSM, pre-surgery percutaneous coronary intervention (27.18% vs. 26.71%, P=0.049) and Society of Thoracic Surgeons risk score (1.98% vs. 1.90%, P=0.047) were higher in off-pump CABG. In the short term, there was higher mortality (2.12% vs. 0.47%, P=0.048), blood transfusion > 500 ml (57.91% vs. 7.56%, P=0.049), reintervention (7.32% vs. 2.12%, P=0.045), hospital stay (nine vs. four days, P=0.048), arrhythmia (9.92% vs. 4.96%, P=0.049), and renal failure (20.09% vs. 5.91%, P=0.009) in on-pump CABG. Long-term mortality (4.25% vs. 1.65%, P=0.044), myocardial infarction (17.02% vs. 7.32%, P=0.046), and repeat revascularization (17.49% vs. 8.26%, P=0.045) predominated in on-pump CABG. There was a higher 36-month adjusted survival for off-pump over on-pump CABG (97.88% vs. 93.63%, P=0.046).</p><p><strong>Conclusion: </strong>This first reported Peruvian registry of patients treated with CABG has demonstrated that off-pump CABG is associated with lower shortand mid-term morbidity and mortality rates and better-adjusted survival rates compared to on-pump CABG; however, further multicenter studies in Latin America are needed to elucidate its benefits over classic on-pump CABG.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"e20230242 e20230242","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752582","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":"Effects of Concomitant Intra-Aortic Balloon Pump Usage and Different Cannulation Techniques on Venoarterial Extracorporeal Membrane Oxygenation Support in Terms of Organ Perfusion.","authors":"Mustafa Mert Özgür, Tanıl Özer, Mehmet Aksüt, Mehmet Dedemoğlu, Ekin Can Çelik, İbrahim Çağrı Kaya, Murat Bülent Rabuş","doi":"10.21470/1678-9741-2023-0241","DOIUrl":"10.21470/1678-9741-2023-0241","url":null,"abstract":"<p><strong>Introduction: </strong>Various cannulation strategies for venoarterial extracorporeal membrane oxygenation (V-A ECMO) support are currently in use according to the clinical urgency and experience of the rescuing team. Although central V-A ECMO is considered more effective than a peripheral approach, the superiority of one cannulation configuration instead of another remains a controversial subject. This study mainly aims to compare the contribution of V-A ECMO circulatory support modalities to patients' improvement according to various cannulation site strategies and additional usage of intra-aortic balloon pump (IABP).</p><p><strong>Methods: </strong>The study design involved the categorization of all patients into two groups: isolated V-A ECMO support and V-A ECMO plus IABP support. Secondly, we divided the patients into four groups considering V-A ECMO cannulation sites, such as central (aorto-atrial), axillo-femoral, femoro-femoral, and jugulo-femoral. We analyzed the parameters regarding the outcome for each group.</p><p><strong>Results: </strong>When comparing cannulation sites in relation to laboratory parameters for assessing organ perfusion, no statistically significant differences were observed among the groups. We found no statistically significant result within the groups affecting organ perfusion. The complication rates were higher in patients with concomitant IABP support, but the difference was not statistically significant likewise.</p><p><strong>Conclusion: </strong>V-A ECMO provides effective perfusion, no matter which cannulation site is preferred during the decision-making process, and the utilization of IABP support has no additional contribution to the outcomes. We believe that the most suitable strategy should be a tailor-made decision according to the clinical status of patients, the pathology, urgency, and cost-effectiveness.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"e20230241 e20230241","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11604208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752581","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 Effect of Silymarin on the Prevention of Atrial Fibrillation After Coronary Artery Bypass Grafting.","authors":"Bogdan Okiljevic, Ranko Zdravkovic, Andrej Preveden, Mihaela Preveden, Nikola Mladenovic, Stamenko Susak","doi":"10.21470/1678-9741-2023-0422","DOIUrl":"10.21470/1678-9741-2023-0422","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative atrial fibrillation is a frequent complication after coronary artery bypass grafting and is associated with increased mortality. The effects of various drugs on the occurrence of postoperative atrial fibrillation have been studied, but no one has looked into the effect of silymarin on the occurrence of postoperative atrial fibrillation.</p><p><strong>Methods: </strong>This prospective experimental study included 160 patients undergoing coronary artery bypass grafting. The experimental group received 400 mg of silymarin orally three days before the surgery, while the control group did not. The occurrence of postoperative atrial fibrillation was monitored. Patients' clinical data and postoperative characteristics were investigated to elucidate their impact on postoperative atrial fibrillation.</p><p><strong>Results: </strong>Postoperative atrial fibrillation occurred in significantly fewer patients in the experimental group (14 vs. 30, P=0.008). There were also lower mean values of postoperatively measured C-reactive protein (P<0.0005) and aspartate aminotransferase (P=0.001) in the experimental group. Within the multivariate regression model, a non-silymarin group (odds ratio 0.296 [0.109-0.807], P=0.005), postoperative red blood cell transfusion (odds ratio 5.218 [1.930-14.107], P=0.001), left atrial diameter (odds ratio 7.800 [2.122-28.672], P=0.002), postoperative C-reactive protein (odds ratio 1.020 [1.008-1.032], P=0.001), and CHA₂DS₂-VASc score (standing for congestive heart failure, hypertension, age ≥ 75 years [doubled], diabetes, stroke [doubled], vascular disease, age 65 to 74 years, and sex category [female]) (odds ratio 1.873 [1.279-2.743], P=0.001) proved to be independently associated with the development of postoperative atrial fibrillation.</p><p><strong>Conclusion: </strong>This study showed that preoperative administration of silymarin significantly reduces the development of atrial fibrillation after coronary artery bypass grafting.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"e20230422 e20230422","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11606346/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752584","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":"Patient Blood Management in Cardiovascular Surgery.","authors":"Isabel Cristina Céspedes, Maria Stella Figueiredo, Antonio Alceu Dos Santos, Nelson Americo Hossne","doi":"10.21470/1678-9741-2024-0994","DOIUrl":"https://doi.org/10.21470/1678-9741-2024-0994","url":null,"abstract":"","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"e20240994 e20240994","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11500607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549281","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":"Is It Safe to Use Arterial Grafts in Patients with Acute Myocardial Infarction? Short-Mid-Term Propensity Analysis.","authors":"Leonardo Lacava, Gabrielle Barbosa Borgomoni, Leticia de Mendonça Lopes, Leonardo Passaglia de Freitas, Fabiane Leticia Freitas, Luís Roberto Palma Dallan, Luiz Augusto Ferreira Lisboa, José Carlos Nicolau, Fabio B Jatene, Omar Asdrúbal Vilca Mejia","doi":"10.21470/1678-9741-2023-0384","DOIUrl":"10.21470/1678-9741-2023-0384","url":null,"abstract":"<p><strong>Introduction: </strong>The use of multiple arterial grafts (MAGs) has an impact on patient survival; however, preference for its use in the acute phase of myocardial infarction (AMI) has not yet been established. This study aimed to compare the short-mid-term clinical results of AMI patients undergoing coronary artery bypass grafting (CABG) with a single arterial graft (SAG) vs. MAGs.</p><p><strong>Methods: </strong>This is a cross-sectional cohort study of 4,053 patients from the Registro Paulista de Cirurgia Cardiovascular II (REPLICCAR II). CABG in the AMI was considered when performed between one and seven days after diagnosis (n=238). Thirty-five patients underwent surgery with ≥ 2 arterial grafts (MAG group), population adjustment in SAG group was performed using the propensity score matching (PSM). Clinical follow-up was performed by telephone to assess need for readmission, new AMI, reoperation, and death.</p><p><strong>Results: </strong>After PSM, 70 patients were evaluated. During hospitalization, a significant statistical difference was observed in the surgery duration: the MAG group had a median of 4.78 hours while the SAG group had 4.11 hours (P=0.040). Within the MAG group, there was a predominance use of bilateral internal thoracic artery (62.86%), followed by radial graft associated with the use of left internal thoracic artery (28.57%) and the combination of the three grafts (8.57%). There were no significant differences between the groups in terms of outcomes up to 30 days after CABG or up to five years after CABG.</p><p><strong>Conclusion: </strong>In REPLICCAR II, usage of MAGs in the AMI was not associated with clinical worsening of patients until the mid-term follow-up.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"e20230384 e20230384","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11497619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549280","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":"Thromboelastography with Platelet Mapping to Optimize Surgical Timing in Coronary Artery Bypass Grafting Patients on P2Y12 Receptor Blockers Therapy.","authors":"Pierpaolo Dambruoso, Pasquale Raimondo, Fabrizia Massaro, Margherita D'Aniello, Giuseppe Di","doi":"10.21470/1678-9741-2023-0292","DOIUrl":"10.21470/1678-9741-2023-0292","url":null,"abstract":"<p><strong>Introduction: </strong>An increasing number of patients attending coronary artery bypass grafting (CABG) receive preoperative antiplatelet drugs (acetylsalicylic acid, clopidogrel, prasugrel, ticagrelor). The optimal assessment of preoperative platelet function is the aim of this study for a shorter surgical timing in patients undergoing elective coronary artery bypass grafting.</p><p><strong>Methods: </strong>This study was performed on patients presenting for first-time isolated CABG on therapy with an P2Y12 receptor blockers loading dose (clopidogrel [300 mg] or prasugrel [60 mg] or ticagrelor [180 mg]) or P2Y12 receptor blockers maintenance therapy at least for five days (clopidogrel [75 mg once daily], prasugrel [10 mg once daily], ticagrelor [90 mg twice daily]). All patients received simultaneously acetylsalicylate acid (100 mg daily). Exclusion criterion was emergency CABG regardless of preoperative antiplatelet and anticoagulant therapy. All patients' data were recorded in an Excel® file and analyzed using RStudio® software.</p><p><strong>Results: </strong>Forty-eight consecutive adult patients presenting for CABG were enrolled. Preoperative thromboelastography-platelet mapping showed platelet resistance to P2Y12 blockers receptor - 25% for clopidogrel (6/24), 33% for ticagrelor (6/18), 33% for prasugrel (2/6), and this data was useful to obtain a shorter CABG waiting time in comparison with current guidelines (2.7 vs. five days for clopidogrel, 2.5 vs. five days for ticagrelor, 3.3 vs. seven days for prasugrel).</p><p><strong>Conclusion: </strong>Preoperative thromboelastography-platelet mapping is helpful to detect harmful P2Y12 receptor blockers resistance and to minimize CABG waiting time avoiding unnecessary and life-threatening delays.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"e20230292 e20230292","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495379/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549278","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 Minithoracotomy for Pulmonary Valve Replacement in Adults.","authors":"Alisson Parrilha Toschi, Rodolfo F Gomes, Renato B Pope, Mateus B Bueno, Cézar Suchard, Isaias Cidral, Robinson Poffo","doi":"10.21470/1678-9741-2023-0324","DOIUrl":"10.21470/1678-9741-2023-0324","url":null,"abstract":"<p><p>Surgical interventions on the pulmonary valve in adults have been increasing over the years, as patients with congenital heart diseases are experiencing extended lifespans. Reoperations involving multiple sternotomies exhibit elevated morbidity and mortality rates. With nearly two decades of experience in minimally invasive video-assisted mitral valve surgery, we have chosen the left anterior minithoracotomy approach for addressing the pulmonary valve and right ventricular outflow tract in adult patients. The technique demonstrates safety based on initial outcomes, minimizing potential complications from multiple cardiac reapproaches. Our series of five patients demonstrated an absence of postoperative complications or mortality.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"e20230324 e20230324","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11495225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142549279","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":"DO₂/VCO₂ Ratio Improvement on Cardiopulmonary Bypass During Minimally Invasive Mitral Valve Repair.","authors":"Ignazio Condello, Giuseppe Speziale","doi":"10.21470/1678-9741-2023-0464","DOIUrl":"https://doi.org/10.21470/1678-9741-2023-0464","url":null,"abstract":"","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"e20230464 e20230464","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488388/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482249","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":"Life & Advice from the Giants in Cardiac Surgery: Giving & Receiving; Leading & Following.","authors":"Teresa M Kieser","doi":"10.21470/1678-9741-2024-0995","DOIUrl":"https://doi.org/10.21470/1678-9741-2024-0995","url":null,"abstract":"","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"e20240995 e20240995","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482251","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":"Methylene Blue and Blood Transfusion in Hemorrhagic Shock Resuscitation: An Experimental Porcine Study.","authors":"André Luppi, Agnes Afrodite S Albuquerque, Marelaine Prandi, Jessyca M Barbosa, Maria Cecília Jordani, Suely Fazio Ferraciolli, Sergio Wechsler, Paulo Roberto B Evora","doi":"10.21470/1678-9741-2023-0480","DOIUrl":"10.21470/1678-9741-2023-0480","url":null,"abstract":"<p><strong>Introduction: </strong>Hemorrhagic shock requires immediate treatment to prevent mortality and organ dysfunction. This study evaluates the efficacy of methylene blue (MB) with blood transfusion (BT) as a potential rescue therapy in acute severe bleeding in pigs.</p><p><strong>Methods: </strong>Thirty animals were randomly assigned to one of six groups following the induction of fixed-pressure hemorrhagic shock, after reaching a mean arterial pressure (MAP) of 55 mmHg - Group 1 (60 BT: BT after 60 minutes), Group 2 (60 MB: MB infusion after 60 minutes), Group 3 (60 MB + BT: MB and BT after 60 minutes), Group 4 (15 MB + BT: MB and BT after 15 minutes), Group 5 (15 BT + 60 MB: BT after 15 minutes and MB infusion after 60 minutes), and Group 6 (15 MB + 60 BT: MB infusion after 15 minutes and BT after 60 minutes). Hemodynamic and blood gas parameters were meticulously recorded, reversal of the shock was considered when MAP reached 90% of the baseline MAP.</p><p><strong>Results: </strong>Except for Group 2, all groups reverted from the shock. However, groups that received MB in combination with BT, specifically Groups 3 and 4, exhibited statistically significant higher ratios of maximum MAP to baseline MAP.</p><p><strong>Conclusion: </strong>Using MB concomitant with BT allowed the reversal of hemorrhagic shock with higher median arterial pressure levels compared to BT alone or applying MB separately from BT. This suggests that simultaneous application of MB and BT could be a more effective strategy for reversing the effects of severe acute bleeding.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":"e20230480 e20230480","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142482250","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}