Volume 33 - Número 3
EDITORIAL
Even Considering the Existing High Technology, Do Not Forget That the Old Stethoscope Is Still a Useful Tool for the Heart Team
Braz J Cardiovasc Surg 33;
Publish in: 8/2/2025
Operating with Data - Statistics for the Cardiovascular Surgeon: Part I. Fundamentals of Biostatistics
Braz J Cardiovasc Surg 33;
Publish in: 8/2/2025
ORIGINAL ARTICLE
Lidocaine and Pinacidil Added to Blood versus Crystalloid Cardioplegic Solutions: Study in Isolated Hearts
Braz J Cardiovasc Surg 33;
Publish in: 8/2/2025
Objective: The present study aimed the functional recovery evaluation after long term of
cardiac arrest induced by Custodiol (crystalloid-based)
versus del Nido (blood-based) solutions, both added
lidocaine and pinacidil as cardioplegic agents. Experiments were performed
in isolated rat heart perfusion models.
Methods: Male rat heart perfusions, according to Langendorff technique, were induced to cause 3 hours of cardiac arrest with a single dose. The hearts were assigned to one of the following three groups: (I) control; (II) Custodiol-LP; and (III) del Nido-LP. They were evaluated after ischemia throughout 90 minutes of reperfusion. Left ventricular contractility function was reported as percentage of recovery, expressed by developed pressure, maximum dP/dt, minimum dP/dt, and rate pressure product variables. In addition, coronary resistance and myocardial injury marker by alpha-fodrin degradation were also evaluated.
Results: At 90 minutes of reperfusion, both solutions had superior left ventricular contractile recovery function than the control group. Del Nido-LP was superior to Custodiol-LP in maximum dP/dt (46%±8 vs. 67%±7, P<0.05) and minimum dP/dt (31%±4 vs. 51%±9, P<0.05) variables. Coronary resistance was lower in del Nido-LP group than in Custodiol-LP (395%±50 vs. 307%±13, P<0.05), as well as alpha-fodrin degradation, with lower levels in del Nido-LP group (P<0.05).
Conclusion: Del Nido-LP cardioplegia showed higher functional recovery after 3 hours of ischemia. The analysis of alpha-fodrin degradation showed del Nido-LP solution provided greater protection against myocardial ischemia and reperfusion (IR) in this experimental model. Keywords: Cardioplegic solutions; Myocardial reperfusion injury; Models, animal; Heart arrest, induced/methods
Methods: Male rat heart perfusions, according to Langendorff technique, were induced to cause 3 hours of cardiac arrest with a single dose. The hearts were assigned to one of the following three groups: (I) control; (II) Custodiol-LP; and (III) del Nido-LP. They were evaluated after ischemia throughout 90 minutes of reperfusion. Left ventricular contractility function was reported as percentage of recovery, expressed by developed pressure, maximum dP/dt, minimum dP/dt, and rate pressure product variables. In addition, coronary resistance and myocardial injury marker by alpha-fodrin degradation were also evaluated.
Results: At 90 minutes of reperfusion, both solutions had superior left ventricular contractile recovery function than the control group. Del Nido-LP was superior to Custodiol-LP in maximum dP/dt (46%±8 vs. 67%±7, P<0.05) and minimum dP/dt (31%±4 vs. 51%±9, P<0.05) variables. Coronary resistance was lower in del Nido-LP group than in Custodiol-LP (395%±50 vs. 307%±13, P<0.05), as well as alpha-fodrin degradation, with lower levels in del Nido-LP group (P<0.05).
Conclusion: Del Nido-LP cardioplegia showed higher functional recovery after 3 hours of ischemia. The analysis of alpha-fodrin degradation showed del Nido-LP solution provided greater protection against myocardial ischemia and reperfusion (IR) in this experimental model. Keywords: Cardioplegic solutions; Myocardial reperfusion injury; Models, animal; Heart arrest, induced/methods
Effect of Plasma Level of Vitamin D on Postoperative Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting
Braz J Cardiovasc Surg 33;
Publish in: 8/2/2025
Objective: Postoperative atrial fibrillation (PoAF) is a common complication after
coronary artery bypass grafting (CABG). The aim of the present study was to
evaluate the association between development of PoAF and vitamin D levels in
patients undergoing isolated CABG.
Methods: This prospective randomized clinical trial was conducted on the patients with isolated CABG. The study was terminated when 50 patients in both PoAF(+) group and PoAF(-) group were reached. Development of AF until discharge period was assessed. Vitamin D level was measured immediately after AF; it was measured on the discharge day for the patients without PoAF. Predictive values of the independent variables were measured for the development of PoAF.
Results: The groups were separated as PoAF(-) group (66% male, mean age 58.18±10.98 years) and PoAF(+) group (74% male, mean age 61.94±10.88 years). 25(OH) vitamin D level (OR=0.855, 95% CI: 0.780-0.938, P=0.001) and > 65 years (OR=3.525, 95% CI: 1.310-9.483, P=0.013) were identified as an independent predictor of postoperative AF after CABG surgery in multivariate analysis. The cut-off level for 25(OH) vitamin D level in receiver-operating characteristic curve analysis was determined as 7.65 with sensitivity of 60% and specificity of 64% for predicting PoAF (area under the curve: 0.679, P=0.002).
Conclusion: Vitamin D level is considered an independent predictor for development of PoAF. Lower vitamin D levels may be one of the reasons for PoAF. Keywords: Vitamin D; Atrial fibrillation; Coronary artery bypass; Postoperative period
Methods: This prospective randomized clinical trial was conducted on the patients with isolated CABG. The study was terminated when 50 patients in both PoAF(+) group and PoAF(-) group were reached. Development of AF until discharge period was assessed. Vitamin D level was measured immediately after AF; it was measured on the discharge day for the patients without PoAF. Predictive values of the independent variables were measured for the development of PoAF.
Results: The groups were separated as PoAF(-) group (66% male, mean age 58.18±10.98 years) and PoAF(+) group (74% male, mean age 61.94±10.88 years). 25(OH) vitamin D level (OR=0.855, 95% CI: 0.780-0.938, P=0.001) and > 65 years (OR=3.525, 95% CI: 1.310-9.483, P=0.013) were identified as an independent predictor of postoperative AF after CABG surgery in multivariate analysis. The cut-off level for 25(OH) vitamin D level in receiver-operating characteristic curve analysis was determined as 7.65 with sensitivity of 60% and specificity of 64% for predicting PoAF (area under the curve: 0.679, P=0.002).
Conclusion: Vitamin D level is considered an independent predictor for development of PoAF. Lower vitamin D levels may be one of the reasons for PoAF. Keywords: Vitamin D; Atrial fibrillation; Coronary artery bypass; Postoperative period
Functional Performance of Different Venous Limb Options in Simulated Neonatal/Pediatric Cardiopulmonary Bypass Circuits
Braz J Cardiovasc Surg 33;
Publish in: 8/2/2025
Objective: Hemodilution is a concern in cardiopulmonary bypass (CPB). Using a smaller
dual tubing rather than a single larger inner diameter (ID) tubing in the
venous limb to decrease prime volume has been a standard practice. The
purpose of this study is to evaluate these tubing options.
Methods: Four different CPB circuits primed with blood (hematocrit 30%) were investigated. Two setups were used with two circuits for each one. In Setup I, a neonatal oxygenator was connected to dual 3/16" ID venous limbs (Circuit A) or to a single 1/4" ID venous limb (Circuit B); and in Setup II, a pediatric oxygenator was connected to dual 1/4" ID venous limbs (Circuit C) or a single 3/8" ID venous limb (Circuit D). Trials were conducted at arterial flow rates of 500 ml/min up to 1500 ml/min (Setup I) and up to 3000 ml/min (Setup II), at 36°C and 28°C.
Results: Circuit B exhibited a higher venous flow rate than Circuit A, and Circuit D exhibited a higher venous flow rate than Circuit C, at both temperatures. Flow resistance was significantly higher in Circuits A and C than in Circuits B (P<0.001) and D (P<0.001), respectively.
Conclusion: A single 1/4" venous limb is better than dual 3/16" venous limbs at all flow rates, up to 1500 ml/min. Moreover, a single 3/8" venous limb is better than dual 1/4" venous limbs, up to 3000 ml/min. Our findings strongly suggest a revision of perfusion practice to include single venous limb circuits for CPB. Keywords: Pediatrics; Oxygenators; Membranes; Cardiopulmonary bypass
Methods: Four different CPB circuits primed with blood (hematocrit 30%) were investigated. Two setups were used with two circuits for each one. In Setup I, a neonatal oxygenator was connected to dual 3/16" ID venous limbs (Circuit A) or to a single 1/4" ID venous limb (Circuit B); and in Setup II, a pediatric oxygenator was connected to dual 1/4" ID venous limbs (Circuit C) or a single 3/8" ID venous limb (Circuit D). Trials were conducted at arterial flow rates of 500 ml/min up to 1500 ml/min (Setup I) and up to 3000 ml/min (Setup II), at 36°C and 28°C.
Results: Circuit B exhibited a higher venous flow rate than Circuit A, and Circuit D exhibited a higher venous flow rate than Circuit C, at both temperatures. Flow resistance was significantly higher in Circuits A and C than in Circuits B (P<0.001) and D (P<0.001), respectively.
Conclusion: A single 1/4" venous limb is better than dual 3/16" venous limbs at all flow rates, up to 1500 ml/min. Moreover, a single 3/8" venous limb is better than dual 1/4" venous limbs, up to 3000 ml/min. Our findings strongly suggest a revision of perfusion practice to include single venous limb circuits for CPB. Keywords: Pediatrics; Oxygenators; Membranes; Cardiopulmonary bypass
Are Pre and Postoperative Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio Associated with Early Postoperative AKI Following CABG?
Braz J Cardiovasc Surg 33;
Publish in: 8/2/2025
Objective: In this study, we investigated the role of two of the recent biomarkers of
inflammation on the development of acute kidney injury in the early
postoperative period of isolated coronary artery bypass grafting.
Methods: Three hundred and eleven patients, who underwent isolated coronary artery bypass grafting with cardiopulmonary bypass by the same surgery team in our clinic between May 2010 and October 2014, who had a preoperative serum creatinine level lower than 1.5 mg/dl were included in the study. These patients' records were reviewed retrospectively. The diagnosis of acute kidney injury was performed according to the Kidney Disease Improving Global Outcomes 2012 Acute Kidney Injury Guideline criteria. Patients who developed acute kidney injury in the early postoperative period were classified as Group-1 (n=62) and the patients with normal postoperative renal functions were classified as Group-2 (n=249). The demographic data, body mass index, comorbidities, hematologic/biochemical profiles, preoperative ejection fraction, blood transfusion history, and operative data of the groups were compared. Univariate analyses were performed to determine significant clinical factors, and multiple logistic regression analyses were subsequently done to determine independent predictors of acute kidney injury.
Results: Sixty-two (19.9%) patients developed acute kidney injury during the first 72 hours postoperatively. Multivariate logistic regression analyses revealed preoperative increased creatinine (P=0.0001), C-reactive protein (P=0.02), neutrophil-lymphocyte ratio (P=0.04) and platelet-lymphocyte ratio (P=0.002); increased postoperative first day leukocyte count (P=0.03), C-reactive protein levels (P=0.02), neutrophil-lymphocyte ratio (P=0.002), platelet-lymphocyte ratio (P=0.01) and increased intubation time (P=0.006) as independent predictors of early postoperative acute kidney injury in patients who underwent isolated coronary artery bypass grafting.
Conclusion: The preoperative and postoperative increased levels of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio which can be calculated by simple methods from routine blood analysis showed us that these parameters are independent biomarkers directly related to development of acute kidney injury in the early postoperative period. Keywords: Acute kidney injury; Biomarkers; Inflammation; Coronary artery bypass
Methods: Three hundred and eleven patients, who underwent isolated coronary artery bypass grafting with cardiopulmonary bypass by the same surgery team in our clinic between May 2010 and October 2014, who had a preoperative serum creatinine level lower than 1.5 mg/dl were included in the study. These patients' records were reviewed retrospectively. The diagnosis of acute kidney injury was performed according to the Kidney Disease Improving Global Outcomes 2012 Acute Kidney Injury Guideline criteria. Patients who developed acute kidney injury in the early postoperative period were classified as Group-1 (n=62) and the patients with normal postoperative renal functions were classified as Group-2 (n=249). The demographic data, body mass index, comorbidities, hematologic/biochemical profiles, preoperative ejection fraction, blood transfusion history, and operative data of the groups were compared. Univariate analyses were performed to determine significant clinical factors, and multiple logistic regression analyses were subsequently done to determine independent predictors of acute kidney injury.
Results: Sixty-two (19.9%) patients developed acute kidney injury during the first 72 hours postoperatively. Multivariate logistic regression analyses revealed preoperative increased creatinine (P=0.0001), C-reactive protein (P=0.02), neutrophil-lymphocyte ratio (P=0.04) and platelet-lymphocyte ratio (P=0.002); increased postoperative first day leukocyte count (P=0.03), C-reactive protein levels (P=0.02), neutrophil-lymphocyte ratio (P=0.002), platelet-lymphocyte ratio (P=0.01) and increased intubation time (P=0.006) as independent predictors of early postoperative acute kidney injury in patients who underwent isolated coronary artery bypass grafting.
Conclusion: The preoperative and postoperative increased levels of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio which can be calculated by simple methods from routine blood analysis showed us that these parameters are independent biomarkers directly related to development of acute kidney injury in the early postoperative period. Keywords: Acute kidney injury; Biomarkers; Inflammation; Coronary artery bypass
Rational Use of Mechanical Circulatory Support as a Bridge to Pediatric and Congenital Heart Transplantation
Braz J Cardiovasc Surg 33;
Publish in: 8/2/2025
Introduction: Donor shortage and organ allocation is the main problem in pediatric heart
transplant. Mechanical circulatory support is known to increase waiting list
survival, but it is not routinely used in pediatric programs in Latin
America.
Methods: All patients listed for heart transplant and supported by a mechanical circulatory support between January 2012 and March 2016 were included in this retrospective single-center study. The endpoints were mechanical circulatory support time, complications, heart transplant survival and discharge from the hospital.
Results: Twenty-nine patients from our waiting list were assessed. Twelve (45%) patients were initially supported by extracorporeal membrane oxygenation (ECMO) and a centrifugal pump was implanted in 17 (55%) patients. Five patients initially supported by ECMO were bridged to another device. One was bridged to a centrifugal pump and four were bridged to Berlin Heart Excor®. Among the 29 supported patients, 18 (62%) managed to have a heart transplant. Thirty-day survival period after heart transplant was 56% (10 patients). Median support duration was 12 days (interquartile range [IQR] 4 - 26 days) per run and the waiting time for heart transplant was 9.5 days (IQR 2.5-25 days). Acute kidney injury was identified as a mortality predictor (OR=22.6 [CI=1.04-494.6]; P=0.04).
Conclusion: Mechanical circulatory support was able to bridge most INTERMACS 1 and 2 pediatric patients to transplant with an acceptable complication rate. Acute renal failure increased mortality after mechanical circulatory support in our experience. Keywords: Heart transplantation; Heart-assist devices; Heart Failure/Therapy; Heart Defects, Congenital
Methods: All patients listed for heart transplant and supported by a mechanical circulatory support between January 2012 and March 2016 were included in this retrospective single-center study. The endpoints were mechanical circulatory support time, complications, heart transplant survival and discharge from the hospital.
Results: Twenty-nine patients from our waiting list were assessed. Twelve (45%) patients were initially supported by extracorporeal membrane oxygenation (ECMO) and a centrifugal pump was implanted in 17 (55%) patients. Five patients initially supported by ECMO were bridged to another device. One was bridged to a centrifugal pump and four were bridged to Berlin Heart Excor®. Among the 29 supported patients, 18 (62%) managed to have a heart transplant. Thirty-day survival period after heart transplant was 56% (10 patients). Median support duration was 12 days (interquartile range [IQR] 4 - 26 days) per run and the waiting time for heart transplant was 9.5 days (IQR 2.5-25 days). Acute kidney injury was identified as a mortality predictor (OR=22.6 [CI=1.04-494.6]; P=0.04).
Conclusion: Mechanical circulatory support was able to bridge most INTERMACS 1 and 2 pediatric patients to transplant with an acceptable complication rate. Acute renal failure increased mortality after mechanical circulatory support in our experience. Keywords: Heart transplantation; Heart-assist devices; Heart Failure/Therapy; Heart Defects, Congenital
Extended-time of Noninvasive Positive Pressure Ventilation Improves Tissue Perfusion after Coronary Artery Bypass Surgery: a Randomized Clinical Trial
Braz J Cardiovasc Surg 33;
Publish in: 8/2/2025
Objective: To compare the effects of extended- versus short-time
noninvasive positive pressure ventilation on pulmonary function, tissue
perfusion, and clinical outcomes in the early postoperative period following
coronary artery bypass surgery in patients with preserved left ventricular
function.
Methods: Patients were randomized into two groups according to noninvasive positive pressure ventilation intensity: short-time noninvasive positive pressure ventilation n=20 (S-NPPV) and extended-time noninvasive positive pressure ventilation n=21 (E-NPPV). S-NPPV was applied for 60 minutes during immediate postoperative period and 10 minutes, twice daily, from postoperative days 1-5. E-NPPV was performed for at least six hours during immediate postoperative period and 60 minutes, twice daily, from postoperative days 1-5. As a primary outcome, tissue perfusion was determined by central venous oxygen saturation and blood lactate level measured after anesthetic induction, immediately after extubation and following noninvasive positive pressure ventilation protocols. As a secondary outcome, pulmonary function tests were performed preoperatively and in the postoperative days 1, 3, and 5; clinical outcomes were recorded.
Results: Significant drop in blood lactate levels and an improvement in central venous oxygen saturation values in the E-NPPV group were observed when compared with S-NPPV group after study protocol (P<0.01). The E-NPPV group presented higher preservation of postoperative pulmonary function as well as lower incidence of respiratory events and shorter postoperative hospital stay (P<0.05).
Conclusion: Prophylactic E-NPPV administered in the early postoperative period of coronary artery bypass surgery resulted in greater improvements in tissue perfusion, pulmonary function and clinical outcomes than S-NPPV, in patients with preserved left ventricular function.
Trial Registration: Brazilian Registry of Clinical trial - RBR7sqj78 - http://www.ensaiosclinicos.gov.br Keywords: Lactic Acid/Blood; Lung/Physiology; Coronary artery bypass; Forced Expiratory Volume; Positive-Pressure Respiration;
Methods: Patients were randomized into two groups according to noninvasive positive pressure ventilation intensity: short-time noninvasive positive pressure ventilation n=20 (S-NPPV) and extended-time noninvasive positive pressure ventilation n=21 (E-NPPV). S-NPPV was applied for 60 minutes during immediate postoperative period and 10 minutes, twice daily, from postoperative days 1-5. E-NPPV was performed for at least six hours during immediate postoperative period and 60 minutes, twice daily, from postoperative days 1-5. As a primary outcome, tissue perfusion was determined by central venous oxygen saturation and blood lactate level measured after anesthetic induction, immediately after extubation and following noninvasive positive pressure ventilation protocols. As a secondary outcome, pulmonary function tests were performed preoperatively and in the postoperative days 1, 3, and 5; clinical outcomes were recorded.
Results: Significant drop in blood lactate levels and an improvement in central venous oxygen saturation values in the E-NPPV group were observed when compared with S-NPPV group after study protocol (P<0.01). The E-NPPV group presented higher preservation of postoperative pulmonary function as well as lower incidence of respiratory events and shorter postoperative hospital stay (P<0.05).
Conclusion: Prophylactic E-NPPV administered in the early postoperative period of coronary artery bypass surgery resulted in greater improvements in tissue perfusion, pulmonary function and clinical outcomes than S-NPPV, in patients with preserved left ventricular function.
Trial Registration: Brazilian Registry of Clinical trial - RBR7sqj78 - http://www.ensaiosclinicos.gov.br Keywords: Lactic Acid/Blood; Lung/Physiology; Coronary artery bypass; Forced Expiratory Volume; Positive-Pressure Respiration;
Acetaminophen Mitigates Myocardial Injury Induced by Lower Extremity Ischemia-Reperfusion in Rat Model
Braz J Cardiovasc Surg 33;
Publish in: 8/2/2025
Objective: The injury-reducing effect of acetaminophen, an effective analgesic and
antipyretic on ischemia-reperfusion continues to attract great attention.
This study analyzed the protective effect of acetaminophen on myocardial
injury induced by ischemia-reperfusion in an experimental animal model from
lower extremity ischemia-reperfusion.
Methods: Twenty-four Sprague-Dawley female rats were randomized into three groups (n=8) as (i) control group (only laparotomy), (ii) aortic ischemia-reperfusion group (60 min of ischemia and 120 min of reperfusion) and (iii) ischemia-reperfusion + acetaminophen group (15 mg/kg/h intravenous acetaminophen infusion starting 15 minutes before the end of the ischemic period and lasting till the end of the reperfusion period). Sternotomy was performed in all groups at the end of the reperfusion period and the heart was removed for histopathological examination. The removed hearts were histopathologically investigated for myocytolysis, polymorphonuclear leukocyte (PMNL) infiltration, myofibrillar edema and focal hemorrhage.
Results: The results of histopathological examination showed that acetaminophen was detected to particularly diminish focal hemorrhage and myofibrillar edema in the ischemia-reperfusion + acetaminophen group (P<0.001, P=0.011), while there were no effects on myocytolysis and PMNL infiltration between the groups (P=1.000, P=0.124).
Conclusion: Acetaminophen is considered to have cardioprotective effect in rats, by reducing myocardial injury induced by abdominal aortic ischemia-reperfusion. Keywords: Acetaminophen; Reperfusion injury; Aorta, abdominal
Methods: Twenty-four Sprague-Dawley female rats were randomized into three groups (n=8) as (i) control group (only laparotomy), (ii) aortic ischemia-reperfusion group (60 min of ischemia and 120 min of reperfusion) and (iii) ischemia-reperfusion + acetaminophen group (15 mg/kg/h intravenous acetaminophen infusion starting 15 minutes before the end of the ischemic period and lasting till the end of the reperfusion period). Sternotomy was performed in all groups at the end of the reperfusion period and the heart was removed for histopathological examination. The removed hearts were histopathologically investigated for myocytolysis, polymorphonuclear leukocyte (PMNL) infiltration, myofibrillar edema and focal hemorrhage.
Results: The results of histopathological examination showed that acetaminophen was detected to particularly diminish focal hemorrhage and myofibrillar edema in the ischemia-reperfusion + acetaminophen group (P<0.001, P=0.011), while there were no effects on myocytolysis and PMNL infiltration between the groups (P=1.000, P=0.124).
Conclusion: Acetaminophen is considered to have cardioprotective effect in rats, by reducing myocardial injury induced by abdominal aortic ischemia-reperfusion. Keywords: Acetaminophen; Reperfusion injury; Aorta, abdominal
Quality of Life After Open Surgical
Braz J Cardiovasc Surg 33;
Publish in: 8/2/2025
Objective: This study aims to compare open surgical and endovascular aneurysm repair
(EVAR) of abdominal aortic aneurysms in terms of their effects on quality of
life, using Short Form-36 (SF-36).
Methods: A total of 133 consecutive patients who underwent EVAR or open surgical repair for infra-renal abdominal aorta aneurysm between January 2009 and June 2014 were included in the study. Twenty-six (19.5%) patients died during follow-up and were excluded from the analysis. Overall, 107 patients, 39 (36.4%) in the open repair group, and 68 (63.6%) in the EVAR group, completed all follow-up visits and study assessments. Quality of life assessments using SF-36 were performed before surgery and at post-operative months 1, 6, and 12.
Results: The mean duration of follow-up was 29.55±19.95 months. At one month, both physical and mental domains of the quality of life assessments favored EVAR, while the two surgical approaches did not differ significantly at or after six months postoperatively.
Conclusion: Despite anatomical advantages and acceptable mid-phase mortality in patients with high- or medium-risk for open surgery, EVAR did not exhibit a quality of life superiority over open surgery in terms of physical function and patient comfort at or after postoperative six months.
Keywords: Endovascular procedures; Aortic aneurysm, abdominal; Quality of Life
Methods: A total of 133 consecutive patients who underwent EVAR or open surgical repair for infra-renal abdominal aorta aneurysm between January 2009 and June 2014 were included in the study. Twenty-six (19.5%) patients died during follow-up and were excluded from the analysis. Overall, 107 patients, 39 (36.4%) in the open repair group, and 68 (63.6%) in the EVAR group, completed all follow-up visits and study assessments. Quality of life assessments using SF-36 were performed before surgery and at post-operative months 1, 6, and 12.
Results: The mean duration of follow-up was 29.55±19.95 months. At one month, both physical and mental domains of the quality of life assessments favored EVAR, while the two surgical approaches did not differ significantly at or after six months postoperatively.
Conclusion: Despite anatomical advantages and acceptable mid-phase mortality in patients with high- or medium-risk for open surgery, EVAR did not exhibit a quality of life superiority over open surgery in terms of physical function and patient comfort at or after postoperative six months.
Keywords: Endovascular procedures; Aortic aneurysm, abdominal; Quality of Life
Late Follow-up of Patients Submitted to Total Cavopulmonary Derivation: Clinical Aspects, Reinterventions, and Complications Interfering in Morbidity and Mortality
Braz J Cardiovasc Surg 33;
Publish in: 8/2/2025
Objective: To identify main complications in outpatient follow-up, as well as factors
before or during operation that may interfere in patient's evolution.
Methods: Retrospective study of patients submitted to total cavopulmonary shunt with extracardiac conduit from 2000 to 2014 at the Hospital do Coração (São Paulo, Brazil) and who underwent clinical follow-up at this institution.
Results: One hundred and fifty surgeries were performed and 59 patients maintained outpatient follow-up. The mean age of these patients at the time of surgery was 4.45 years (median of 45 months) and 70.2% of them were males. Among the patients undergoing outpatient follow-up, postoperative time at evaluation ranged from 10 days to 145 months; 30 (50.8%) patients had single left ventricle and 29 (49.2%) had single right ventricle (48.2% of these presented with hypoplastic left heart syndrome [HLHS]). Patients with single left ventricle had a higher percentage of reintervention-free survival, but without statistically significant difference. 40% of the patients had no complications and 35% of them presented with thrombosis at some point in the follow-up period, with ventricular dysfunction being the second most frequently found complication (15% of cases), mainly among patients with single right ventricle morphology (P=0.04). Between the patients currently under follow-up, 20 (35%) of them had been evaluated by ultrasonography and had some degree of hepatic congestion and/or hepatomegaly. 16.7% of the patients with such alteration had HLHS (P=0.057).
Conclusion: Except for the right ventricular morphology, no other factor has been shown to interfere in late evolution after total cavopulmonary shunt. Keywords: Fontan procedure; Treatment outcome; Heart ventricles/pathology; Heart Defects, Congenital
Methods: Retrospective study of patients submitted to total cavopulmonary shunt with extracardiac conduit from 2000 to 2014 at the Hospital do Coração (São Paulo, Brazil) and who underwent clinical follow-up at this institution.
Results: One hundred and fifty surgeries were performed and 59 patients maintained outpatient follow-up. The mean age of these patients at the time of surgery was 4.45 years (median of 45 months) and 70.2% of them were males. Among the patients undergoing outpatient follow-up, postoperative time at evaluation ranged from 10 days to 145 months; 30 (50.8%) patients had single left ventricle and 29 (49.2%) had single right ventricle (48.2% of these presented with hypoplastic left heart syndrome [HLHS]). Patients with single left ventricle had a higher percentage of reintervention-free survival, but without statistically significant difference. 40% of the patients had no complications and 35% of them presented with thrombosis at some point in the follow-up period, with ventricular dysfunction being the second most frequently found complication (15% of cases), mainly among patients with single right ventricle morphology (P=0.04). Between the patients currently under follow-up, 20 (35%) of them had been evaluated by ultrasonography and had some degree of hepatic congestion and/or hepatomegaly. 16.7% of the patients with such alteration had HLHS (P=0.057).
Conclusion: Except for the right ventricular morphology, no other factor has been shown to interfere in late evolution after total cavopulmonary shunt. Keywords: Fontan procedure; Treatment outcome; Heart ventricles/pathology; Heart Defects, Congenital
Survival and Risk Factors Among Dialytic Acute Kidney Injury Patients After Cardiovascular Surgery
Braz J Cardiovasc Surg 33;
Publish in: 8/2/2025
Objective: Acute kidney injury (AKI) is a frequent postoperative complication after
cardiovascular surgery. It has been described as a predictor of decreased
survival rates, but how dialysis decreases survival when initiated on the
postoperative period has yet to be determined. To analyze the survival of
patients who presented postoperative AKI requiring dialysis up to 30 days
after cardiovascular surgery and its risk factors is the aim of this study.
Methods: Of the 5,189 cardiovascular surgeries performed in a 4-year period, 157 patients developed AKI requiring dialysis in the postoperative period. The Kaplan-Meier survival curve and log-rank test were used in the statistical analysis to compare the curves of categorical variables. P-value< 0.05 was considered significant.
Results: Patient average survival was 546 days and mortality was 70.7%. The need for dialysis on the postoperative period decreased late survival. Risk factors for decreased survival included age (P<0.001) and postoperative complications (P<0.0003).
Conclusion: The average survival was approximately one year among dialytic patients. Age and postoperative complications were risk factors that determined decreased survival. Keywords: Survival analysis; Cardiovascular surgical procedures; Renal Dialysis;; Renal insufficiency
Methods: Of the 5,189 cardiovascular surgeries performed in a 4-year period, 157 patients developed AKI requiring dialysis in the postoperative period. The Kaplan-Meier survival curve and log-rank test were used in the statistical analysis to compare the curves of categorical variables. P-value< 0.05 was considered significant.
Results: Patient average survival was 546 days and mortality was 70.7%. The need for dialysis on the postoperative period decreased late survival. Risk factors for decreased survival included age (P<0.001) and postoperative complications (P<0.0003).
Conclusion: The average survival was approximately one year among dialytic patients. Age and postoperative complications were risk factors that determined decreased survival. Keywords: Survival analysis; Cardiovascular surgical procedures; Renal Dialysis;; Renal insufficiency
REVIEW ARTICLE
Update in Heart Rhythm Abnormalities and Indications for Pacemaker After Transcatheter Aortic Valve Implantation
Braz J Cardiovasc Surg 33;
Publish in: 8/2/2025
Objective: Rhythm abnormalities following transcatheter aortic valve implantation (TAVI)
and indications for permanent pacemaker implantation (PPI) were reviewed,
which aren't well established in the current guidelines. New left bundle
branch block and atrioventricular block are the most common
electrocardiographic changes after TAVI. PPI incidence ranges from 9-42% for
self-expandable and 2.5-11.5% for balloon expandable devices. Not only
anatomical variations in conduction system have an important role in
conduction disorders, but different valve characteristics and their
relationship with cardiac structures as well. Previous right bundle branch
block has been confirmed as one of the most significant predictors for
PPI.
Keywords: Aortic valve stenosis; Transcatheter Aortic Valve Implantation; Arrhythmias, cardiac; Pacemaker, artificial
Heat Shock Proteins: Protection and Potential Biomarkers for Ischemic Injury of Cardiomyocytes After Surgery
Braz J Cardiovasc Surg 33;
Publish in: 8/2/2025
The heat shock proteins are endogenous proteins with the ability
to act as molecular chaperones. Methods that provide cell protection
by way of some damage can positively influence the results of
surgery. The present review summarizes current knowledge
concerning the cardioprotective role of the heat shock proteins as
occurs in heart damage, including relevant information about the
stresses that regulate the expression of these proteins and their
potential role as biomarkers of heart disease.
Keywords: Heat-shock response; Cytoprotection; Biomarkers; Myocardium; Infarction
CASE REPORT
Heart Injury with Projectile Lodged Inside the Heart
Braz J Cardiovasc Surg 33;
Publish in: 8/2/2025
Penetrating heart injuries present high mortality rates. Increasing
rates of urban violence have contributed to a significant rise in the
number of heart injuries by firearm projectiles. Such injuries are
associated with the highest mortality rates among penetrating
cardiac injuries and may involve one or more cardiac chambers.
We present the case of a police officer who, in an approach to five
robbers, suffered a transfixed cardiac injury by firearm with the
projectile having been lodged inside the right ventricle. This patient
was successfully operated, 65 days after the injury, at our institution.
Keywords: Heart injuries; Wounds and Injuries; Wounds, gunshot; Cardiac surgical procedures
Left Atrial Giant Cell Myocarditis Presenting as a Tumor: First-in-Man Case Report
Braz J Cardiovasc Surg 33;
Publish in: 8/2/2025
Giant cell myocarditis is a rare and highly lethal disorder with
resultant cardiac insufficiency. It necessitates aggressive immune
suppression therapy, although the results are often fatal. When
it affects only the atria, the characteristics of the disease changes
completely. In this case report, we present atypical presentation
of atrial giant cell myocarditis with mass lesion, which completely
resolved after successful surgical resection without immuno
suppression therapy.
Keywords: Heart failure; Heart neoplasms; Myocarditis
Off-pump Coronary Artery Bypass Grafting in Moyamoya Disease: a Case Report
Braz J Cardiovasc Surg 33;
Publish in: 8/2/2025
Moyamoya disease is a rare, idiopathic, progressive, occlusive
disease of the internal carotid artery characterized by the
development of collateral vasculature in the brain base. In patients
with accompanying coronary artery disease, cardiopulmonary
bypass posses a potential risk for perioperative cerebral ischemic
complication. Herein, we report a 53-year-old male case of Moyamoya
disease and coronary artery disease who was treated with off-pump
coronary artery bypass grafting.
Keywords: Moyamoya Disease; Coronary artery bypass, off-pump; Coronary artery bypass; Coronary Stenosis/Complications/Surgery