Volume 34 - Número 4
EDITORIAL
Importance of Research in the Training of Thoracic Surgeons
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Reflections on the Cardiac Surgery Practiced in the1970s when Compared with the Current Practice
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
On- or Off-pump Coronary Artery Bypass Surgery. Is the Debate Settling Down?
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Robotic Cardiac Surgery: The Future Gold Standard or An Unnecessary Extravagance?
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
ORIGINAL ARTICLE
Evaluation of Depression and Anxiety in Coronary Artery Bypass Surgery Patients: A Prospective Clinical Study
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Objective: The aim of this clinical study is to determine the
depression and anxiety levels in coronary artery bypass graft
(CABG) surgery patients in the pre and postoperative periods.
Methods: This clinical prospective study was done with 65 patients. Beck’s Depression Inventory (BDI) and Beck’s Anxiety Inventory (BAI) tests were performed in patients who had a diagnosis of coronary artery disease and were awaiting CABG surgery. These patients presented characteristic symptoms of anxiety and depression and BDI and BAI tests are important to assess these symptoms.
Results: We found out that depression and anxiety levels were higher in the postoperative than in the preoperative period (P<0.001). Both anxiety and depression levels were increased significantly following CABG operation when compared with preoperative levels in all patients. Statistical correlation of depression and anxiety in different ages, genders, and professions were evaluated too, but we did not found a correlation between them (P>0.05).
Conclusion: We suggest that good management of the psychological condition of cardiac surgery candidates, as well as post-bypass patients, will improve quality of life and cardiovascular outcomes in these patients. Keywords: Depressive Disorder; Anxiety Disorders; Coronary artery bypass; Coronary Artery Diseases; Quality of Life
Methods: This clinical prospective study was done with 65 patients. Beck’s Depression Inventory (BDI) and Beck’s Anxiety Inventory (BAI) tests were performed in patients who had a diagnosis of coronary artery disease and were awaiting CABG surgery. These patients presented characteristic symptoms of anxiety and depression and BDI and BAI tests are important to assess these symptoms.
Results: We found out that depression and anxiety levels were higher in the postoperative than in the preoperative period (P<0.001). Both anxiety and depression levels were increased significantly following CABG operation when compared with preoperative levels in all patients. Statistical correlation of depression and anxiety in different ages, genders, and professions were evaluated too, but we did not found a correlation between them (P>0.05).
Conclusion: We suggest that good management of the psychological condition of cardiac surgery candidates, as well as post-bypass patients, will improve quality of life and cardiovascular outcomes in these patients. Keywords: Depressive Disorder; Anxiety Disorders; Coronary artery bypass; Coronary Artery Diseases; Quality of Life
Coronary Artery Bypass Graft Surgery Improves Survival Without Increasing the Risk of Stroke in Patients with Ischemic Heart Failure in Comparison to Percutaneous Coronary Intervention: A Meta-Analysis With 54,173 Patients
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Objective: To evaluate whether there is any difference on the results of patients
treated with coronary artery bypass grafting (CABG) or percutaneous coronary
intervention (PCI) in the setting of ischemic heart failure (HF).
Methods: Databases (MEDLINE, Embase, Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Literatura Latino-americana e do Caribe em Ciências da Saúde [LILACS], and Google Scholar) were searched for studies published until February 2019. Main outcomes of interest were mortality, myocardial infarction, repeat revascularization, and stroke.
Results: The search yielded 5,775 studies for inclusion. Of these, 20 articles were analyzed, and their data were extracted. The total number of patients included was 54,173, and those underwent CABG (N=29,075) or PCI (N=25098). The hazard ratios (HRs) for mortality (HR 0.763; 95% confidence interval [CI] 0.678-0.859; P<0.001), myocardial infarction (HR 0.481; 95% CI 0.365-0.633; P<0.001), and repeat revascularization (HR 0.321; 95% CI 0.241-0.428; P<0.001) were lower in the CABG group than in the PCI group. The HR for stroke showed no statistically significant difference between the groups (random effect model: HR 0.879; 95% CI 0.625-1.237; P=0.459).
Conclusion: This meta-analysis found that CABG surgery remains the best option for patients with ischemic HF, without increase in the risk of stroke. Keywords: Meta-analysis; Coronary artery bypass; Stents; Percutaneous Coronary Intervention; Heart failure
Methods: Databases (MEDLINE, Embase, Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Literatura Latino-americana e do Caribe em Ciências da Saúde [LILACS], and Google Scholar) were searched for studies published until February 2019. Main outcomes of interest were mortality, myocardial infarction, repeat revascularization, and stroke.
Results: The search yielded 5,775 studies for inclusion. Of these, 20 articles were analyzed, and their data were extracted. The total number of patients included was 54,173, and those underwent CABG (N=29,075) or PCI (N=25098). The hazard ratios (HRs) for mortality (HR 0.763; 95% confidence interval [CI] 0.678-0.859; P<0.001), myocardial infarction (HR 0.481; 95% CI 0.365-0.633; P<0.001), and repeat revascularization (HR 0.321; 95% CI 0.241-0.428; P<0.001) were lower in the CABG group than in the PCI group. The HR for stroke showed no statistically significant difference between the groups (random effect model: HR 0.879; 95% CI 0.625-1.237; P=0.459).
Conclusion: This meta-analysis found that CABG surgery remains the best option for patients with ischemic HF, without increase in the risk of stroke. Keywords: Meta-analysis; Coronary artery bypass; Stents; Percutaneous Coronary Intervention; Heart failure
A Simple Modification of the Conventional Figure-of-Eight Sternal Closure Technique
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Objective: To describe a new technique of sternal closure, modified from the
conventional figure-of-eight approach, which can provide a secure closure
and prevent sternal complications.
Methods: The modified technique is based on the intercalation of the caudal portion of each steel wire passed along the sternum. This is a retrospective analysis of patients operated with this modified technique at our institution between January 2014 and December 2016.
Results: One hundred and forty-three patients underwent sternal closure with the modified technique. In-hospital mortality rate was 1.4% (n=2). No sternal instability was observed at 30 days postoperatively. Two patients developed mediastinitis that required extraction of the wires.
Conclusion: Short-term results have shown that the modified sternal closure technique can be used safely and effectively, with complications rates being consistent with worldwide experience. Keywords: Sternum - Surgery; Mediastinitis; Steel; Bone wires; Hospital mortality; Wound Closure Techniques
Methods: The modified technique is based on the intercalation of the caudal portion of each steel wire passed along the sternum. This is a retrospective analysis of patients operated with this modified technique at our institution between January 2014 and December 2016.
Results: One hundred and forty-three patients underwent sternal closure with the modified technique. In-hospital mortality rate was 1.4% (n=2). No sternal instability was observed at 30 days postoperatively. Two patients developed mediastinitis that required extraction of the wires.
Conclusion: Short-term results have shown that the modified sternal closure technique can be used safely and effectively, with complications rates being consistent with worldwide experience. Keywords: Sternum - Surgery; Mediastinitis; Steel; Bone wires; Hospital mortality; Wound Closure Techniques
Early Outcomes of Low Postoperative Bleeding after Off-Pump Coronary Artery Bypass Grafting
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Objective: To investigate whether low bleeding influences the early outcomes after
off-pump coronary artery bypass grafting (CABG).
Methods: Retrospective analysis of ischemic heart disease patients who underwent off-pump CABG from January 2013 to December 2017. Patients were divided into low-bleeding group (n=659) and bleeding group (n=270), according to total drainage from chest tube during the first postoperative 12 hours. Clinical material and early outcomes were compared between the groups.
Results: Baseline was similar in the two groups. Operation time was 270±51 min in the low-bleeding group and 235±46 min in the bleeding group (P<0.0001). The low-bleeding group presented smaller drainage during the first 12 h (237±47 ml) and shorter mechanical ventilation time (6.86±3.78 h) than the bleeding group (557±169 ml and 10.66±5.19 h, respectively) (P<0.0001). Hemodynamic status was more stable in the low-bleeding group (P<0.0001) and usage rate of more than two vasoactive agents in this group was lower than in the bleeding group (P<0.0001). Number of distal anastomosis, reoperation for bleeding, suddenly increase in chest tube output, intensive care unit (ICU) stay, hospital stay, and other early outcomes had no statistical significance between the groups (P>0.05).
Conclusion: Postoperative bleeding < 300 ml/12 h in off-pump CABG patients did not require blood product transfusion and reoperation and that would contribute to reduction in mechanical ventilation time and maintaining hemodynamic stability. Bleeding < 800 ml during the first postoperative 12 h did not increase infection rates and ICU length of stay. Keywords: Off-Pump Coronary Artery Bypass; Respiration, artificial; Coronary Artery Disease; Reoperation; Hemodynamics
Methods: Retrospective analysis of ischemic heart disease patients who underwent off-pump CABG from January 2013 to December 2017. Patients were divided into low-bleeding group (n=659) and bleeding group (n=270), according to total drainage from chest tube during the first postoperative 12 hours. Clinical material and early outcomes were compared between the groups.
Results: Baseline was similar in the two groups. Operation time was 270±51 min in the low-bleeding group and 235±46 min in the bleeding group (P<0.0001). The low-bleeding group presented smaller drainage during the first 12 h (237±47 ml) and shorter mechanical ventilation time (6.86±3.78 h) than the bleeding group (557±169 ml and 10.66±5.19 h, respectively) (P<0.0001). Hemodynamic status was more stable in the low-bleeding group (P<0.0001) and usage rate of more than two vasoactive agents in this group was lower than in the bleeding group (P<0.0001). Number of distal anastomosis, reoperation for bleeding, suddenly increase in chest tube output, intensive care unit (ICU) stay, hospital stay, and other early outcomes had no statistical significance between the groups (P>0.05).
Conclusion: Postoperative bleeding < 300 ml/12 h in off-pump CABG patients did not require blood product transfusion and reoperation and that would contribute to reduction in mechanical ventilation time and maintaining hemodynamic stability. Bleeding < 800 ml during the first postoperative 12 h did not increase infection rates and ICU length of stay. Keywords: Off-Pump Coronary Artery Bypass; Respiration, artificial; Coronary Artery Disease; Reoperation; Hemodynamics
Patency of Individual and Sequential Coronary Artery Bypass in Patients with Ischemic Heart Disease: A Meta-analysis
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Objective: To evaluate the patency of individual and sequential coronary artery bypass
in patients with ischemic heart disease.
Methods: We searched PubMed, Cochrane Library, Excerpta Medica Database, and ClinicalTrials.gov databases for controlled trials. Endpoints included graft patency, anastomosis patency, occluded rates in left anterior descending (LAD) system and right coronary artery (RCA) system, in-hospital mortality, and follow-up mortality. Pooled risk ratios (RRs) and standardized mean difference (SMD) were used to assess the relative data.
Results: Nine cohorts, including 7100 patients and 1440 grafts under individual or sequential coronary artery bypass. There were no significant differences between individual and sequential coronary artery bypass in the graft patency (RR=0.96; 95% CI=0.91-1.02; P=0.16; I2=87%), anastomosis patency (RR=0.95; 95% CI=0.91-1.00; P=0.05; I2=70%), occluded rate in LAD system (RR=1.03; 95% CI=0.92-1.16; P=0.58; I2=37%), occluded rate in RCA system (RR=1.36; 95% CI=0.72-2.57; P=0.35; I2=95%), in-hospital mortality (RR=1.57; 95% CI=0.92-2.69; P=0.10; I2=0%), and follow-up mortality (RR=0.96; 95% CI=0.36-2.53; P=0.93; I2=0%).
Conclusion: No significant differences on clinical data were observed regarding anastomosis patency, occluded rate in LAD system, occluded rate in RCA system, in-hospital mortality, and follow-up mortality, indicating that the patency of individual and the patency of sequential coronary artery bypass are similar to each other. Keywords: Coronary artery bypass; Coronary Artery Disease; Myocardial ischemia; Hospital mortality; Meta-Analysis as Topic
Methods: We searched PubMed, Cochrane Library, Excerpta Medica Database, and ClinicalTrials.gov databases for controlled trials. Endpoints included graft patency, anastomosis patency, occluded rates in left anterior descending (LAD) system and right coronary artery (RCA) system, in-hospital mortality, and follow-up mortality. Pooled risk ratios (RRs) and standardized mean difference (SMD) were used to assess the relative data.
Results: Nine cohorts, including 7100 patients and 1440 grafts under individual or sequential coronary artery bypass. There were no significant differences between individual and sequential coronary artery bypass in the graft patency (RR=0.96; 95% CI=0.91-1.02; P=0.16; I2=87%), anastomosis patency (RR=0.95; 95% CI=0.91-1.00; P=0.05; I2=70%), occluded rate in LAD system (RR=1.03; 95% CI=0.92-1.16; P=0.58; I2=37%), occluded rate in RCA system (RR=1.36; 95% CI=0.72-2.57; P=0.35; I2=95%), in-hospital mortality (RR=1.57; 95% CI=0.92-2.69; P=0.10; I2=0%), and follow-up mortality (RR=0.96; 95% CI=0.36-2.53; P=0.93; I2=0%).
Conclusion: No significant differences on clinical data were observed regarding anastomosis patency, occluded rate in LAD system, occluded rate in RCA system, in-hospital mortality, and follow-up mortality, indicating that the patency of individual and the patency of sequential coronary artery bypass are similar to each other. Keywords: Coronary artery bypass; Coronary Artery Disease; Myocardial ischemia; Hospital mortality; Meta-Analysis as Topic
Minimally Invasive Video-assisted Mitral Valve Replacement with a Right Chest Small Incision in Patients Aged Over 65 Years
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Objective: To analyze and summarize the clinical safety and feasibility of minimally
invasive video-assisted mitral valve replacement via a right thoracic
minimal incision in patients aged over 65 years.
Methods: The clinical data of 45 patients over 65 years old who had mitral valve disease were analyzed retrospectively from January 2014 to January 2017 at Union Hospital, Fujian Medical University. The patients were divided into two groups; 20 patients in group A, who underwent minimally invasive video-assisted mitral valve replacement via a right thoracic minimal incision, and 25 patients in group B, who underwent conventional mitral valve replacement. We collected and analyzed their relevant clinical data.
Results: The operation was completed successfully in both groups. Compared with group B, group A was clearly superior for postoperative analgesia time, postoperative hospital length of stay, thoracic drainage liquid, blood transfusion, and length of incision. There were no differences between the two groups in postoperative severe complications and mortality. More patients in group B had pulmonary infections and poor incision healing, while more patients in group A had postoperative pneumothorax and subcutaneous emphysema.
Conclusion: In patients aged over 65 years, minimally invasive video-assisted mitral valve replacement with a small incision in the right chest had the same clinical safety and efficacy as the conventional method. Keywords: Mitral Valve; Pneumothorax; Heart valve diseases; Thoracotomy; Subcutaneous Emphysema; Length of stay
Methods: The clinical data of 45 patients over 65 years old who had mitral valve disease were analyzed retrospectively from January 2014 to January 2017 at Union Hospital, Fujian Medical University. The patients were divided into two groups; 20 patients in group A, who underwent minimally invasive video-assisted mitral valve replacement via a right thoracic minimal incision, and 25 patients in group B, who underwent conventional mitral valve replacement. We collected and analyzed their relevant clinical data.
Results: The operation was completed successfully in both groups. Compared with group B, group A was clearly superior for postoperative analgesia time, postoperative hospital length of stay, thoracic drainage liquid, blood transfusion, and length of incision. There were no differences between the two groups in postoperative severe complications and mortality. More patients in group B had pulmonary infections and poor incision healing, while more patients in group A had postoperative pneumothorax and subcutaneous emphysema.
Conclusion: In patients aged over 65 years, minimally invasive video-assisted mitral valve replacement with a small incision in the right chest had the same clinical safety and efficacy as the conventional method. Keywords: Mitral Valve; Pneumothorax; Heart valve diseases; Thoracotomy; Subcutaneous Emphysema; Length of stay
The Effect of Continuous Ventilation on Thiol-Disulphide Homeostasis and Albumin-Adjusted Ischemia-Modified Albumin During Cardiopulmonary Bypass
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Objective: To investigate the effect of continuous lung ventilation with low tidal
volume on oxidation parameters, such as thiol/disulphide homeostasis and
albumin-adjusted ischemia-modified albumin (AAIMA), during cardiopulmonary
bypass (CBP) in coronary artery bypass grafting (CABG).
Methods: Seventy-four patients who underwent elective CABG with CPB were included in the study. Blood samples were taken in the preoperative period, 10 minutes after CPB, and six and 24 hours postoperatively. Patients were assigned to the continuous ventilation group (Group 1, n=37) and the non-ventilated group (Group 2, n=37). The clinical characteristics, thiol/disulphide homeostasis, ischemia-modified albumin (IMA), and AAIMA levels of the patients were compared.
Results: A significant difference was found between the groups regarding native thiol, total thiol, and IMA levels at the postoperative 24th hour (P=0.030, P=0.031, and P=0.004, respectively). There was no difference between the groups in terms of AAIMA. AAIMA levels returned to preoperative levels in Groups 1 and 2, at the 6th and 24th postoperative hours, respectively. Length of hospital stay was significantly shorter in Group 1 (P<0.001) than in Group 2.
Conclusion: Continuous ventilation during CPB caused an increase in native and total thiol levels, an earlier return of AAIMA levels, and shorter hospital stay. Continuous ventilation may reduce the negative effects of CPB on myocardium (Table 2, Figure 1, and Reference 31). Keywords: Coronary artery bypass; Mechanical Ventilation; Ischemia-Modified Albumin; Disulfides; Sulfhydryl Compounds; Biomarkers
Methods: Seventy-four patients who underwent elective CABG with CPB were included in the study. Blood samples were taken in the preoperative period, 10 minutes after CPB, and six and 24 hours postoperatively. Patients were assigned to the continuous ventilation group (Group 1, n=37) and the non-ventilated group (Group 2, n=37). The clinical characteristics, thiol/disulphide homeostasis, ischemia-modified albumin (IMA), and AAIMA levels of the patients were compared.
Results: A significant difference was found between the groups regarding native thiol, total thiol, and IMA levels at the postoperative 24th hour (P=0.030, P=0.031, and P=0.004, respectively). There was no difference between the groups in terms of AAIMA. AAIMA levels returned to preoperative levels in Groups 1 and 2, at the 6th and 24th postoperative hours, respectively. Length of hospital stay was significantly shorter in Group 1 (P<0.001) than in Group 2.
Conclusion: Continuous ventilation during CPB caused an increase in native and total thiol levels, an earlier return of AAIMA levels, and shorter hospital stay. Continuous ventilation may reduce the negative effects of CPB on myocardium (Table 2, Figure 1, and Reference 31). Keywords: Coronary artery bypass; Mechanical Ventilation; Ischemia-Modified Albumin; Disulfides; Sulfhydryl Compounds; Biomarkers
Effect of Opium Addiction on Postoperative Arrhythmia Among Patients Undergoing CABG operation on Cardiopulmonary Bypass
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Objectives: Postoperative arrhythmia is an important complication of coronary artery
bypass grafting (CABG) surgeries among patients. It seems that opioid usage
is implicated in the pathogenesis of this condition due to its impacts on
different organ systems, such as the autonomic nervous system. The present
study was performed to investigate the effect of opium use on postoperative
arrhythmia in patients undergoing CABG surgery.
Methods: Study participants were selected via convenience sampling from patients undergoing CABG surgery in a referral hospital. Study variables, including use of inotropic drugs, vital signs monitoring parameters and postoperative arrhythmia were observed and recorded at baseline and at follow-up time after surgery.
Results: Sixty-five (14.8%) patients had postoperative arrhythmia, and 104 participants were addicted. Prevalence of postoperative arrhythmia was the same among addict and non-addict patients. According to the regression analysis model, only serum level of epinephrine in operating room, heart rate and central venous pressure at baseline and 48 hours after operation are known as independent predictors of postoperative arrhythmia among study population.
Conclusion: This study showed that although opium addiction increased postoperative arrhythmia among patients undergoing CABG surgery, this difference was not significant, and this association is probably mediated by other study variables. Keywords: Coronary artery bypass; Arrhythmias, cardiac; Opium Dependence; Central venous pressure; Epinephrine; Postoperative period
Methods: Study participants were selected via convenience sampling from patients undergoing CABG surgery in a referral hospital. Study variables, including use of inotropic drugs, vital signs monitoring parameters and postoperative arrhythmia were observed and recorded at baseline and at follow-up time after surgery.
Results: Sixty-five (14.8%) patients had postoperative arrhythmia, and 104 participants were addicted. Prevalence of postoperative arrhythmia was the same among addict and non-addict patients. According to the regression analysis model, only serum level of epinephrine in operating room, heart rate and central venous pressure at baseline and 48 hours after operation are known as independent predictors of postoperative arrhythmia among study population.
Conclusion: This study showed that although opium addiction increased postoperative arrhythmia among patients undergoing CABG surgery, this difference was not significant, and this association is probably mediated by other study variables. Keywords: Coronary artery bypass; Arrhythmias, cardiac; Opium Dependence; Central venous pressure; Epinephrine; Postoperative period
Functional Magnetic Resonance Imaging in the Evaluation of the Elastic Properties of Ascending Aortic Aneurysm
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Objective: To evaluate the aortic wall elasticity using the maximal rate of systolic
distension (MRSD) and maximal rate of diastolic recoil (MRDR) and their
correlation with the aortic size index (ASI).
Methods: Forty-eight patients with thoracic aortic aneurysm were enrolled in this study. A standard magnetic resonance imaging (MRI) protocol was used to calculate MRSD and MRDR. Both MRSD and MRDR were expressed as percentile of maximal area/10-3 sec. ASI (maximal aortic diameter/body surface area) was calculated. A correlation between MRSD, MRDR, ASI, and the patient’s age was performed using regression plot.
Results: A significant correlation between MRSD (t=-4,36; r2=0.29; P≤0.0001), MRDR (t=3.92; r2=0.25; P=0.0003), and ASI (25±4.33 mm/m2; range 15,48-35,14 mm/m2) is observed. As ASI increases, aortic MRSD and MRDR decrease. Such inverse correlation between MRSD, MRDR, and ASI indicates increased stiffness of the ascending aorta. A significant correlation between the patient’s age and the decrease in MRSD and MRDR is observed.
Conclusion: MRSD and MRDR are significantly correlated with ASI and the patient’s age. They seem to describe properly the increasing stiffness of aortas. These two new indexes provide a promising, accessible, and reproducible approach to evaluate the biomechanical property of the aorta. Keywords: Aortic aneurysm, thoracic; Systole; Diastole; Elastic; Dilatation, Pathology; Magnetic Resonance Imaging
Methods: Forty-eight patients with thoracic aortic aneurysm were enrolled in this study. A standard magnetic resonance imaging (MRI) protocol was used to calculate MRSD and MRDR. Both MRSD and MRDR were expressed as percentile of maximal area/10-3 sec. ASI (maximal aortic diameter/body surface area) was calculated. A correlation between MRSD, MRDR, ASI, and the patient’s age was performed using regression plot.
Results: A significant correlation between MRSD (t=-4,36; r2=0.29; P≤0.0001), MRDR (t=3.92; r2=0.25; P=0.0003), and ASI (25±4.33 mm/m2; range 15,48-35,14 mm/m2) is observed. As ASI increases, aortic MRSD and MRDR decrease. Such inverse correlation between MRSD, MRDR, and ASI indicates increased stiffness of the ascending aorta. A significant correlation between the patient’s age and the decrease in MRSD and MRDR is observed.
Conclusion: MRSD and MRDR are significantly correlated with ASI and the patient’s age. They seem to describe properly the increasing stiffness of aortas. These two new indexes provide a promising, accessible, and reproducible approach to evaluate the biomechanical property of the aorta. Keywords: Aortic aneurysm, thoracic; Systole; Diastole; Elastic; Dilatation, Pathology; Magnetic Resonance Imaging
Lead Removal Without Extraction Tools: A Single-Center Experience
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Introduction: Indications for cardiac devices have been increasing as well as the need for
lead extractions as a result of infections, failed leads and device recalls.
Powered laser sheaths, with a global trend towards the in-creasingly
technological tools, meant to improve the procedure’s outcome but have
economic implications.
Objective: The aim of this study is to demonstrate the experience of a Bra-zilian center that uses simple manual traction in most lead removals per-formed annually, questioning the real need for expensive and technically challenging new devices.
Methods: This retrospective observational study included 35 patients who had a transvenous lead extraction in the period of a year between January 1998 and October 2014 at Hospital de Messejana Dr. Carlos Alberto Studart Gomes, in Fortaleza, CE, Brazil. Data were collected through a records review. They were evaluated based on age, type of device, dwelling time, indication for removal, technique used and immediate outcomes.
Results: The median dwelling time of the devices was 46.22 months. Infec-tion, lead fracture and device malfunction were the most common indica-tions. Simple traction was the method of choice, used in 88.9% of the pro-cedures. Manual traction presented high success rates, resulting in com-plete removal without complications in 90% of the cases.
Conclusion: This article suggests that lead extraction by simple manual traction can still be performed effectively in countries with economic diffi-culties as a first attempt, leaving auxiliary tools for a second attempt in case of failure or contraindications to the simple manual traction technique. Keywords: Pacemaker, artificial; Lasers; Traction; Retrospective studies
Objective: The aim of this study is to demonstrate the experience of a Bra-zilian center that uses simple manual traction in most lead removals per-formed annually, questioning the real need for expensive and technically challenging new devices.
Methods: This retrospective observational study included 35 patients who had a transvenous lead extraction in the period of a year between January 1998 and October 2014 at Hospital de Messejana Dr. Carlos Alberto Studart Gomes, in Fortaleza, CE, Brazil. Data were collected through a records review. They were evaluated based on age, type of device, dwelling time, indication for removal, technique used and immediate outcomes.
Results: The median dwelling time of the devices was 46.22 months. Infec-tion, lead fracture and device malfunction were the most common indica-tions. Simple traction was the method of choice, used in 88.9% of the pro-cedures. Manual traction presented high success rates, resulting in com-plete removal without complications in 90% of the cases.
Conclusion: This article suggests that lead extraction by simple manual traction can still be performed effectively in countries with economic diffi-culties as a first attempt, leaving auxiliary tools for a second attempt in case of failure or contraindications to the simple manual traction technique. Keywords: Pacemaker, artificial; Lasers; Traction; Retrospective studies
REVIEW ARTICLE
Could Cerebrospinal Fluid Biomarkers Offer Better Predictive Value for Spinal Cord Ischaemia Than Current Neuromonitoring Techniques During Thoracoabdominal Aortic Aneurysm Repair - A Systematic Review
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Objective: Cerebrospinal fluid (CSF) drainage is a technique that has significantly
reduced the incidence of spinal cord ischaemia (SCI). We present results of
a systematic review to assess the literature on this topic in relation to
thoracoabdominal aortic aneurysm repair (TAAR).
Methods: Major medical databases were searched to identify papers related to CSF biomarkers measured during TAAAR.
Results: Fifteen papers reported measurements of CSF biomarkers with 265 patients in total. CSF biomarkers measured included S-100ß, neuron-specific endolase (NSE), lactate, glial fibrillary acidic protein A (GFPa), Tau, heat shock protein 70 and 27 (HSP70, HSP27), and proinflammatory cytokines. Lactate and S-100ß were reported the most, but did not correlate with SCI, which was also the case with NSE and TAU. GFPa showed significant CSF level rises, both intra and postoperative in patients who suffered SCI and warrants further investigation, similar results were seen with HSP70, HSP27 and IL-8.
Conclusions: Although there is significant interest in this topic, there still remains a significant lack of high-quality studies investigating CSF biomarkers during TAAR to detect SCI. A large and multicentre study is required to identify the significant role of each biomarker. Keywords: Spinal Cord Ischemia; Thoracic aortic aneurysm; Lactic acid; Cytokines; Biomarkers
Methods: Major medical databases were searched to identify papers related to CSF biomarkers measured during TAAAR.
Results: Fifteen papers reported measurements of CSF biomarkers with 265 patients in total. CSF biomarkers measured included S-100ß, neuron-specific endolase (NSE), lactate, glial fibrillary acidic protein A (GFPa), Tau, heat shock protein 70 and 27 (HSP70, HSP27), and proinflammatory cytokines. Lactate and S-100ß were reported the most, but did not correlate with SCI, which was also the case with NSE and TAU. GFPa showed significant CSF level rises, both intra and postoperative in patients who suffered SCI and warrants further investigation, similar results were seen with HSP70, HSP27 and IL-8.
Conclusions: Although there is significant interest in this topic, there still remains a significant lack of high-quality studies investigating CSF biomarkers during TAAR to detect SCI. A large and multicentre study is required to identify the significant role of each biomarker. Keywords: Spinal Cord Ischemia; Thoracic aortic aneurysm; Lactic acid; Cytokines; Biomarkers
Annuloaortic Ectasia and Arteritis: Clinical Features, Treatments of Choice, and Causative Relations
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
The roles that aortitis plays in the development of
annuloaortic ectasia (AAE) remain uncertain, while clinical
features of AAE in arteritis are largely unknown. This study was
designed to highlight the clinical features of AAE, the treatments
of choice, and the causative relations between aortitis and AAE.
The morphology of the aortic valve leaflets was normal in half
of the patients, while the valves were thin and overstretched in
the other half. Most patients had an aortic aneurysm. Half of the
patients had severe aortic valve insufficiency, and one-quarter of
them had dilation of the sinuses of Valsalva. Takayasu arteritis
was prone to develop coronary artery lesions, whereas giant
cell arteritis were not. Aortic branch lesions in Takayasu arteritis
were stenotic or occlusive in 92.9% of the patients, while in giant
cell arteritis, they were all dilated lesions. Most patients (94.7%)
required surgical treatment with steroid therapy. However, longterm
follow-up results showed a higher anastomotic dehiscence
rate, particularly in patients with Takayasu arteritis. Further
morphometric and pathological research on AAE in arteritis
should be undertaken, and more feasible measures should be
warranted for preventing postoperative anastomotic dehiscence.
Keywords: Aortic aneurysm; Arteritis; Giant Cell Arteritis; Takayasu Arteritis
SPECIAL ARTICLE
Why Use the Radial Artery? The Saphenous Vein is the Second Graft of Choice for CABG in Brazil
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
The saphenous vein (SV) is the most commonly used conduit
for coronary artery bypass surgery (CABG) and the second conduit
of choice in Brazil and many other countries. The radial artery
(RA) is suggested, by some, to be superior to SV grafts, although
its use in the USA declined over a 10 year period. The patency
of SV grafts (SVG) is improved when the vein is harvested with
minimal trauma using the no-touch (NT) technique. This improved
performance is due to the preservation of the outer pedicle
surrounding the SV and reduction in vascular damage that occurs
when using conventional techniques (CT) of harvesting. While
the patency of NT SVGs has been shown superior to the RA at 36
months in one study, data from the RADIAL trial suggests the RA
to be the superior conduit. When additional data using NT SVG
is included in this trial the difference in risk of graft occlusion
between the RA and SV grafts dissipates with there no longer
being a significant difference in patency between conduits. The
importance of preserving SV structure and the impact of NT
harvesting on conduit choice for CABG patients are discussed in
this short review.
Keywords: Humans; Saphenous vein; Radial artery; Coronary artery bypass
HOW TO DO IT
A Dedicated Stitch to Allow Early Safe Mobilization Avoiding Drain-Induced Heart Injury
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Placement of a mediastinal drain is a routine procedure
following heart surgery. Postoperative bed rest is often
imposed due to the fear of potential risk of drain displacement
and cardiac injury. We developed an encapsulating stitch as
a feasible, effective and low-cost technique, which does not
require advanced surgical skills for placement. This simple, novel
approach compartmentalizes the drain allowing for safe early
mobilization following cardiac surgery.
Keywords: Coronary Artery Bypass Grafts; Arterial Grafts; Off-Pump Surgery; Drainage; Heart Injury
CASE REPORT
Off-Pump Coronary Revascularization Using Bilateral Internal Thoracic Arteries in A Patient with Paroxysmal Nocturnal Hemoglobinuria: A Case Report
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Paroxysmal nocturnal hemoglobinuria (PNH) is an ultraorphan
disease. We report the first case in the literature of Off-
Pump Coronary Revascularization Using Bilateral Internal Thoracic
Arteries in a patient with paroxysmal nocturnal hemoglobinuria.
A 36-year-old man came to the emergency department with acute non-ST elevation myocardial infarction (NSTEMI). He presented paroxysmal nocturnal hemoglobinuria diagnosed in 2016. Coronary angiography revealed tripple vessel disease.
The conduits used for coronary revascularization were both internal thoracic arteries (left ITA–right ITA [LITA-RITA]).
We consider that off-pump coronary artery bypass grafting (OPCABG) using Bilateral Internal Thoracic Arteries (BITA) can be safely performed with low in-hospital mortality and complications rates, even in patient with PNH. Keywords: Off-Pump Coronary Revascularization; Bilateral Internal Thoracic Arteries; Paroxysmal Nocturnal Hemoglobinuria
A 36-year-old man came to the emergency department with acute non-ST elevation myocardial infarction (NSTEMI). He presented paroxysmal nocturnal hemoglobinuria diagnosed in 2016. Coronary angiography revealed tripple vessel disease.
The conduits used for coronary revascularization were both internal thoracic arteries (left ITA–right ITA [LITA-RITA]).
We consider that off-pump coronary artery bypass grafting (OPCABG) using Bilateral Internal Thoracic Arteries (BITA) can be safely performed with low in-hospital mortality and complications rates, even in patient with PNH. Keywords: Off-Pump Coronary Revascularization; Bilateral Internal Thoracic Arteries; Paroxysmal Nocturnal Hemoglobinuria
A Complete Occlusion of Right Coronary Artery Due to Stanford Type A Aortic Dissection - Successful Treatment with Extracorporeal Membrane Oxygenation (ECMO)
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
We present a patient diagnosed Stanford Type A aortic
dissection, who was misdiagnosed as acute myocardial infarction
for 5 days. In the surgery, the right coronary ostium was totally
occluded, and the right coronary artery (RCA) was bluish from
the trunk to branches. The true lumen couldn’t be found when
we opened the RCA. We had to give up coronary artery bypass
grafting (CABG). After a regular surgery of type A aortic dissection,
the patient was failed to wean from cardiopulmonary bypass due
to the right heart dysfunction. The Extracorporeal membrane
oxygenation (ECMO) was instituted. The right ventricular wall
motion was gradually improved during the post-operation
period. This is the first report of using ECMO to successfully treat
a complete occlusion of the right coronary artery due to a Type
A aortic dissection. This case demonstrates the value of ECMO in
assisting right heart function to ensure stable hemodynamics and
myocardial recovery in the type A aortic dissection with coronary
involvement.
Keywords: Stanford Type A Aortic Dissection; Coronary Involvement; Extracorporeal Membrane Oxygenation (ECMO)
Non-Fluoroscopic Radiofrequency Ablation of Left Atrial Appendage Tachycardia During Early Pregnancy
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Management of symptomatic atrial tachycardia (AT) during
pregnancy seems challenging, especially those originating from
left atrial appendage (LAA), which easily tend to be incessant
and mediate cardiomyopathy. It’s contradictory between therapy
and pregnancy. In this study, we report a case of a woman who
presented with persistent AT, which lead to heart failure, during
early pregnancy. She underwent successful catheter ablation
using CartoSound and electroanatomic mapping without
fluoroscopy. An electrophysiology (EP) study confirmed a focal
LAA tachycardia. Soon after, left ventricular function of her heart
normalized, and the patient successfully delivered a healthy child.
Keywords: Ectopic Atrial Tachycardia, Cardiovascular Pregnancy Complications; Catheter ablation; Cardiac Arrhythmias - Therapy; Atrium; Cardiac Electrophysiology - Methods
Symptomatic Aortic Valve Mass - Cardiac Work-Up Challenges and Role of Computed Tomography Angiography: A Case Report
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Cardiac papillary fibroelastoma are rare, benign cardiac
tumors that may lead to lethal complications from embolization
or valvular dysfunction if left untreated. When working up
symptomatic tumors with concomitant angina, traditional
diagnostic studies such as cardiac catheterization may predispose
the patient to embolic complications if the mass is located in the
path of the catheter. Newer, non-invasive diagnostic testing, such
as cardiac magnetic resonance imaging or dynamic computed
tomography angiography, may be considered in lieu of invasive
approaches to avoid potentially devastating complications.
We herein present a case report of a 77-year-old female with
a symptomatic aortic valve tumor and describe our diagnostic
strategy and management.
Keywords: Heart Neoplasms - Complications; Angina Pectoris - Etiology; X-ray Computed Tomography; Magnetic Resonance Imaging
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Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025