Portuguese journal of cardiac thoracic and vascular surgery最新文献

{"title":"Evar Fast-Track, The Implementation Of A Safe And Cost-Effective Protocol.","authors":"Rita Calviño López-Villalta, Nilo Javier Mosquera Arochena","doi":"10.48729/pjctvs.568","DOIUrl":"https://doi.org/10.48729/pjctvs.568","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate and confirm the cost effectiveness and safety of a fast-track protocol discharge of patients after elective EVAR.</p><p><strong>Material and methods: </strong>A total of 83 patients admitted for elective EVAR procedure were collected in a database. The experimental group included 40 patients treated after the establishment of a fast-track EVAR protocol (from April 2020 to April 2023) in our hospital. The control group included 43 patients, standard admission, treated before 2020 (from January 2017 to December 2019). We collected data on the length of hospital stay and the costs derived from it, the need for re-intervention and the occurrence of major adverse events. We did a follow-up after 30 days and six months after the intervention.</p><p><strong>Results: </strong>No differences were found in main demographic and clinical characteristics in both groups. There were no changes in clinical indication or surgical procedures between both groups. We observed a shorter hospital stay (2.3 vs 3.7 days p< 0.001), less need for monitoring in the resuscitation unit (0.2 vs 1.1 days p< 0.001) and lower rate of secondary intervention in the experimental group (fast-track group). In postoperative follow-up, the fast-track group also presented lower readmission rate for any reason (12.5% vs. 23.3%). The total cost per patient for the health system during the hospital admission was 1403.29 ± 820.3 euros in the experimental group and 3339.34 ± 2513.1 euros in the control group, resulting in a total saving per patient of 1936.05 euros (95% CI 2748.12 - 1123.97) in the fast-track group.</p><p><strong>Conclusions: </strong>The implementation of a fast-track protocol for patients undergoing elective EVAR, results in a shorter hospital stay lowering perioperative costs, without increasing adverse events or readmission rate following discharge. Therefore, its practice should be considered as standard of care in patients admitted for EVAR procedure.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 4","pages":"19-24"},"PeriodicalIF":0.0,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146260355","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":"Intravascular Lithotripsy For Severe Peripheral Artery Calcification - A 3-Year Single Centre Experience.","authors":"Inês Gueifão, Ricardo Correia, Anita Quintas, Tiago Ribeiro, Joana Cardoso, Helena Fidalgo, Adriana Figueiredo, Maria Emília Ferreira","doi":"10.48729/pjctvs.528","DOIUrl":"https://doi.org/10.48729/pjctvs.528","url":null,"abstract":"<p><strong>Introduction: </strong>Severe arterial calcification is a challenging limitation in endovascular procedures leading to worse success rates and outcomes. Conventional balloon angioplasty may provide limited luminal gain, calling for adjunctive strategies of plaque modification, such as intravascular lithotripsy (IVL). The aim of this study is to describe our institutional experience with IVL in the treatment of peripheral artery disease (PAD).</p><p><strong>Materials and methods: </strong>A prospectively maintained database from a tertiary academic medical centre was retrospectively enquired from October 2021 to September 2024. The study included all patients who underwent IVL (Shockwave Medical, Inc., California, USA) for vessel preparation during endovascular treatment of PAD.</p><p><strong>Results: </strong>19 patients were included (79% male, median age 76 years) with a median follow-up period of 6 and total of 35 months. Most common risk factors were hypertension (90%), diabetes (68%), dislipidemia (63%) and ischaemic heart disease (63%). Clinical presentation was mostly chronic limb-threatening ischemia (Fontaine grade IV in 74% and Fontaine grade III in 10%). The target lesion undergoing IVL was most often femoropopliteal (68%). Intraprocedural lesion crossing was almost equally subintimal and intraluminal (53% vs. 47%) and definitive treatment was mostly performed with stenting (79%). Additionally, 3 patients (16%) underwent a hybrid procedure with femoral endarterectomy (11%) or femoro-femoral bypass (5%). There were no identified procedural complications. Major adverse limb events (MALE) included no reinterventions and 1 major amputation (5%), and the all-cause mortality rate was 16%. Regarding the 14 patients in Fontaine grade IV, the wound healing rate was 57%.</p><p><strong>Discussion/conclusion: </strong>IVL is a safe and effective adjunctive in vessel preparation during endovascular revascularisation procedures, particularly in the femoropopliteal sector. Procedure and/or device-related complications, MALE and mortality are infrequent. Further research is needed concerning aortoiliac and infrapopliteal sectors and comparison with other supplementary treatment alternatives.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 3","pages":"33-37"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515077","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":"Ten-Year Experience of a Tertiary Center with Giant Abdominal Aortic Aneurysms: A Retrospective Analysis.","authors":"Francisco Basílio, Andreia Coelho, João Peixoto, Luís Fernandes, Roberto Boal, Marta Machado, Patrícia Carvalho, Beatriz Guimarães","doi":"10.48729/pjctvs.529","DOIUrl":"https://doi.org/10.48729/pjctvs.529","url":null,"abstract":"<p><strong>Introduction: </strong>The risk of rupture for abdominal aortic aneurysms (AAAs) is primarily influenced by their diameter with the likelihood of rupture increasing exponentially as the aneurysm enlarges. Nowadays, giant AAAs are relatively rare in clinical practice due to earlier diagnosis and treatment. This study aimed to analyze the treatment and prognosis of giant aneurysms comparing with non-giant AAAs within our center´s prospective registry.</p><p><strong>Methods: </strong>We identified all AAAs treated at our center exceeding 9 cm in diameter from surgical records between January 1, 2013, and September 10, 2024. Demographic data, risk factors, anatomical characteristics, treatments, and outcomes were recorded. Furthermore, we analyzed and compared the anatomical features and outcomes of giant aneurysms with non-giant AAAs treated in our department (non-giant AAAs) from 2019 and 2023.</p><p><strong>Results: </strong>A total of 24 patients with giant AAAs were identified, with a mean age of 77 .46±9.03 years, and the majority were male (95.8%). Rupture was significantly more frequent in the giant AAAs cohort (54.2% vs. 9.6%, p<0.001). Additionally, Giant AAAs were significantly less likely to undergo endovascular aneurysm repair (EVAR) (33.33% vs. 75.53%, p < 0.001), but with a higher risk of reintervention due to complications at 30 days (18.18% vs. 1.18%, p < 0.001) and 1 year (18.18% vs. 3.53%, p < 0.001) in non-ruptured sub-group.</p><p><strong>Conclusion: </strong>Giant AAAs are predominantly ruptured at presentation and primarily managed with open surgical repair. When treated with EVAR, there was a higher risk of reintervention compared to non-giant AAAs.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 3","pages":"7-13"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515199","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":"Managing The Mitral Valve In HCM Surgery: Tips And Tricks.","authors":"Sara Ranchordás, Miguel Abecasis, Eduard Quintana","doi":"10.48729/pjctvs.574","DOIUrl":"https://doi.org/10.48729/pjctvs.574","url":null,"abstract":"<p><p>Mitral regurgitation (MR) in hypertrophic cardiomyopathy (HCM) patients is mainly due to systolic anterior motion (SAM) of the mitral valve (MV). However, other mechanisms contributing to mitral regurgitation may coexist as a result of further structural abnormalities. SAM might occur because of the increased septal thickness alone or due to simultaneous MV or subvalvular apparatus anomalies, such as mitral leaflet elongation, papillary muscle body anomalies, accessory papillary muscles or additional papillary muscle heads. Additionally, anomalous mitral chordae or the recently described mitral-aortic discontinuity (leading to a longer anterior mitral leaflet (AML)) can contribute to abnormal physiology. A closed aortomitral angle may also contribute. During intraoperative echocardiographic assessment, it is important to thoroughly evaluate the MV and the regurgitant jet to understand the mechanism(s) that cause MR in HCM patients. Although myectomy alone is frequently enough to correct SAM, concomitant MV procedures may be needed, especially when the septum is thin (<16-18 mm) and/or there is intrinsic MV disease. Detection of concomitant regurgitation mechanisms beyond SAM can eventually be identified preoperatively, either by direct structural detection (valve prolapse), by pharmacological palliation of SAM with vasopressors and negative inotropic agents or suspected by identification of anteriorly and centrally directed regurgitant mitral jets. Surgical techniques that can be employed to contribute to SAM elimination include plication/extension/retention plasty of the AML, resection/release/reorientation of papillary muscles, division of anomalous chordae, edge-to-edge repair, or, at times, prosthetic MV replacement. If there is structural MV disease concomitant to HCM, appropriately tailored techniques to address the MV may be used. Transoesophageal echocardiography at the end of the procedure should demonstrate elimination of SAM, resolution of LVOT obstruction, and appropriate coaptation of the MV leaflets and nearly resolution of MR. Provocation with inotropes can be used to ensure no latent obstruction persists.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 3","pages":"49-56"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515128","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":"Cerebral Embolism: A Challenging Complication In Libman-Sacks Endocarditis.","authors":"Souhayla Souaf Khalafi, Jhonny Javier Montesino Villafranca, Jose Andrés Donoso Mera, Angel Luis Fernández González","doi":"10.48729/pjctvs.497","DOIUrl":"https://doi.org/10.48729/pjctvs.497","url":null,"abstract":"<p><p>Libman-Sacks endocarditis is an uncommon disorder that can be a risk factor for neurocognitive dysfunction, and brain lesions, either separately or in a combination. We report 57-year-old woman from Colombia who presented with a history of dyspnea, associated with general malaise and arthralgia of small joints. On examination, she had signs of chronic arthropathy and purpuric plantar lesions. Her cardiac exam revealed a pan-systolic murmur of mitral regurgitation, harsh, grade 5/6, best heard at the apex, and a diastolic murmur in the aortic focus. Her echocardiography revealed severe mitral regurgitation and moderate aortic regurgitation with nodular thickening of both valves, consistent with a diagnosis of LSE. Blood cultures and serologic tests were negative. After starting anticoagulant treatment, the patient suffered a stroke, and it was finally decided that she would undergo surgery. She suffered a second stroke with status epilepticus in the immediate postoperative period. She eventually recovered without serious neurological sequelae.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 3","pages":"57-61"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515112","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":"3d Model For Chest Wall Reconstruction - Utility Survey.","authors":"Luís Lourenço Graça, Filipe Leite, Gonçalo Paupério","doi":"10.48729/pjctvs.521","DOIUrl":"https://doi.org/10.48729/pjctvs.521","url":null,"abstract":"<p><strong>Introduction: </strong>Three-dimensional (3D) models contributed to many improvements in surgical planning, presenting irrefutable advantages in many fields and may play a relevant role in chest wall surgeries. This study aims to evaluate their usefulness for chest wall reconstruction surgeries.</p><p><strong>Materials and methods: </strong>All thoracic surgeons and residents practicing in the Iberian Peninsula and Latin America were asked to complete an online survey questionnaire, distributed through their respective national scientific societies. Results were analyzed using descriptive statistics and Mann-Whitney U test to access differences among surgeons with experience with 3D models and those without experience.</p><p><strong>Results: </strong>A total of 145 answers were gathered from 15 countries. Most respondents had never performed thoracic wall reconstruction surgeries using rigid prosthesis with 3D patient-specific modeling. Most consensus was obtained regarding the positive contribution of a 3D model for preoperative communication with the patient, improvement in preoperative planning, and its positive role in training of less experienced surgeons. A tendency for neutral opinion was observed regarding its impact in avoidance of perioperative complications. Regarding 3D printing of a physical model, 74.8% agreed or strongly agreed that it is advantageous in comparison with a digital model, and 72.8% agreed or strongly agreed that it is advantageous for all candidates considered for chest wall reconstruction with rigid prothesis. Surgeons without experience with 3D models value significantly more than those with experience their contribution for a more precise preoperative planning (p=0.036), planning of surgery duration (p=0.008), and consider 3D printed models to be advantageous for all candidates to chest wall reconstruction surgery (p=0.028).</p><p><strong>Conclusion: </strong>3D patient-specific models are not accessible to most surgeons but the overall opinion on their usefulness is very positive. Printed models seem to be advantageous over digital ones, and beneficial for all patients undergoing chest wall reconstruction surgery.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 3","pages":"25-31"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515041","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 Prognostic Factors In Patients With Lung Cancer Operated After Neoadjuvant Treatment.","authors":"Dilvin Ozkan, Muhammet Sayan, Sevki Mustafa Demiroz, Olgun Kadir Aribas, Ismail Cuneyt Kurul, Ali Celik, Abdullah Irfan Tastepe","doi":"10.48729/pjctvs.534","DOIUrl":"https://doi.org/10.48729/pjctvs.534","url":null,"abstract":"<p><strong>Aim: </strong>Lung cancer is the leading cause of cancer-related deaths worldwide. The most favorable treatment option for early-stage non-small cell lung cancer is surgical resection. In locally advanced lung cancer, surgery can be performed as part of multimodal treatment regimens. In this study, we aimed to investigate the survival outcomes and prognostic factors of non-small cell lung cancers operated on after neoadjuvant treatment.</p><p><strong>Methods: </strong>The data of patients who were operated on after neoadjuvant treatment in our clinic between 2012 and 2022 were collected. Data were analyzed according to age, gender, complete resection, applied treatment regimen, operation type, presence of viable tumor, histopathology, N status, tumor diameter, and presence of progression.</p><p><strong>Results: </strong>A total of 96 patients were included in the study. There were 9 female (9.4%) and 87 male (90.6%) patients. The mean age was 65.2 ± 8.3. Median overall survival was 41 months (15.7-66.2), and 5-year overall survival was 42.4%. Poor prognostic factors for overall survival in our study are being older than 65 years (p=0.02), tumor progressing despite treatment (p=0.008), tumor diameter greater than 2.65 cm (p=0.01), incomplete resection (p=0.002), and tumor stage higher than stage I according to TNM classification 8th edition (p=0.02). There was no significant correlation between survival and gender, tumor histopathology, neoadjuvant treatment protocol, presence of viable tumor, presence of persistent N2, and type of surgery performed (p>0.05) Conclusion: When planning surgery after neoadjuvant treatment in locally advanced lung cancer, there are some parameters to take into consideration which are age, tumor diameter after treatment, complete resectability, and the presence of diameter progression despite treatment.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 3","pages":"39-47"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515069","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":"Systemic Arterial Supply to a Congenital Pulmonary Airway Malformation: Imaging of a rare Hybrid BPS/CPAM Lesion.","authors":"Mário Rui Correia, Filipa Coelho, Fátima Carvalho, Gonçalo Paupério","doi":"10.48729/pjctvs.539","DOIUrl":"https://doi.org/10.48729/pjctvs.539","url":null,"abstract":"","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 3","pages":"63"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515186","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":"Blood Prime Of The Cardiopulmonary Bypass Circuit In Congenital Heart Surgery.","authors":"Valdir Assis Dos Reis Filho, José Cícero Stocco Guilhen, Mariana Leticia Matias, Karina Aparecida Antonelli Novello, Diego Gamarra Moreira, Jesus Antonio Gutierrez Saurith, Omar Alonzo Pozo Ibanez, Luiz Antonio Rivetti","doi":"10.48729/pjctvs.557","DOIUrl":"https://doi.org/10.48729/pjctvs.557","url":null,"abstract":"<p><strong>Introduction: </strong>The use of cardiopulmonary bypass (CPB) is necessary during the repair of most congenital heart disease (CHD). The surface area of the CPB circuit and the volume of the filling prime are relatively large concerning the volume of neonatal and pediatric patients. Consequently, blood is often required to maintain an adequate hematocrit (HCT) level throughout the procedure.</p><p><strong>Objective: </strong>To evaluate the effects of ultrafiltration (UF) of the blood prime from the cardiopulmonary bypass circuit in children undergoing surgical procedures to correct heart disease.</p><p><strong>Methods: </strong>This is a prospective interventional study with convenience sampling of fifty-five children undergoing elective one of two groups as follows: control group (group 1) not using ultrafiltration of blood prime and experimental group (group 2) with UF of the prime before CPB. Blood samples were obtained for analysis of CPB circuit prime, during the intraoperative and after surgery in immediate postoperative period (IPO). The duration of mechanical ventilation (MV), intensive care unit (ICU) stay, and length of postoperative hospital stay were compared between the 2 groups.</p><p><strong>Results: </strong>Levels of glucose, potassium and lactate values demonstrated a significant decrease after prime ultrafiltration in group 2, however an increase in sodium values was revealed (p= <0,001). In the present study, to postoperative clinical outcomes, there was not difference between groups in the duration of mechanical ventilation and ICU stay. However , length of postoperative hospital stay, group 1 demonstrated longer time in comparison with the group 2 [13 (6 - 35) vs 9 (6 - 34); Median (interquartile range) and p= 0.032]. Group 2 demonstrated lower lactate values in intraoperative and in the immediate postoperative period (p= 0.008). It was observed in the first postoperative 24 hours, stability in lactate levels between the groups.</p><p><strong>Conclusion: </strong>Analysis of intraoperative and postoperative laboratory outcomes showed overall stability in blood parameters, with some specific variations in potassium and lactate levels. The observation of a shorter hospital stay in the group that had the prime ultrafiltration, it is suggested that this technique may help shorten the hospitalization period.</p>","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 3","pages":"15-23"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515038","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":"Pulsatile Danger: Anterior Tibial Artery Pseudoaneurysm After Orthopaedic Intervention.","authors":"Samuel Cardoso, Duarte Rego","doi":"10.48729/pjctvs.591","DOIUrl":"https://doi.org/10.48729/pjctvs.591","url":null,"abstract":"","PeriodicalId":74480,"journal":{"name":"Portuguese journal of cardiac thoracic and vascular surgery","volume":"32 3","pages":"65"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515193","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}