Volume 21 - Número 1
EDITORIAL
Stem cell fraud is a warning for scientific journals
Braz J Cardiovasc Surg 21;
Publish in: 8/1/2025
Evidenced based medicine
Braz J Cardiovasc Surg 21;
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Ich Weiss Nicht Was Soll Es Bedeuten: Language Matters in Medicine
Braz J Cardiovasc Surg 21;
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SUS and the High Complexity Assistance in Natal, RN
Braz J Cardiovasc Surg 21;
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SPECIAL ARTICLE
Guidelines for Surgery of Aortic Diseases from Brazilian Society of Cardiovascular Surgery
Braz J Cardiovasc Surg 21;
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Publication of scientific journals on the Internet
Braz J Cardiovasc Surg 21;
Publish in: 8/1/2025
ORIGINAL ARTICLE
Assessment of the EuroSCORE as a predictor for mortality in myocardial revascularization surgery at the Heart Institute of Pernambuco
Braz J Cardiovasc Surg 21;
Publish in: 8/1/2025
Objective: To assess the applicability of the European Risk System in Cardiac Operations (EuroSCORE) in patients undergoing myocardial revascularization at the Heart Institute of Pernambuco.
Method: During 2003 and 2004, 759 patients underwent myocardial revascularization. Of these, seven were excluded owing to the lack of information on one aspect or another involved in obtaining a EuroSCORE. In order to assess the applicability of the EuroSCORE, an adjustment was made using a logistic regression model of operative mortality (response variable) on the EuroSCORE (explanatory variable). The calibration of the model was measured by comparing the morbidity observed with that expected, using the Hosmer-Lemeshow Test of Goodness of Fit. The accuracy of the model was evaluated by means of Statistic-c.
Results: The accuracy of the model, estimated at 69.9%, and the calibration (Hosmer-Lemeshow test, p=0.663) were satisfactory. The total predicted mortality was practically identical to that observed - 1.7%. The low-risk group (EuroSCORE: 0-2) comprised 231 patients and two (0.87%) deaths occurred. The medium-risk group (EuroSCORE: 3-5) comprised 268 patients and one (0.37%) death occurred. The high-risk group (EuroSCORE: >6) comprised 253 patients and ten (3.95%) deaths occurred. The discrepancies between the percentages of deaths observed in these groups and those predicted by the model were not statistically significant on the basis of the result of the chi-square test (p=0.624).
Conclusion: The EuroSCORE, a simple and objective index, proved to be a satisfactory predictor of operative mortality in patients submitted to myocardial revascularization in the Heart Institute of Pernambuco.
Keywords: Myocardial revascularization; Epidemiologic methods; Severity of illness index; Risk assessment, methods; Survival analysis; Mortality
Comparative randomized study of the immediate outcomes of patients with radial arteries proximally anastomosed to the aorta or as a composite graft
Braz J Cardiovasc Surg 21;
Publish in: 8/1/2025
Objective: The clinical results of the radial artery when proximally anastomosed to the aorta or to the left internal thoracic artery (LITA) as a composite Y-graft were comparatively evaluated.
Methods: From November 1999 to March 2001, 100 patients who underwent coronary artery bypass grafting using the RA, the LITA and, when required, the saphenous vein, were divided in two groups with 50 patients each in a prospective randomized study. Group I (GI) with radial artery proximally anastomosed to the aorta and Group II (GII) as a composite graft (Y-graft) with the LITA.
Results: Early mortality was 1.0 % (GI 2.0% and GII 0.0%) (p=1.00). A mean of 3.0+0.12 (GI) versus 2.82+0.12 (GII) (p=0.29) coronary vessels were grafted per patient. Patients in composite Y-graft group had shorter bypass time (p=0.0001). There were no differences in terms of perioperative outcomes.
Conclusions: The RA provides similar clinical results as aorto-coronary grafts and ascomposite Y-grafts with the LITA, except in respect to the bypass time.
Keywords: Myocardial revascularization; Radial artery; Anastomosis, surgical, methods
Conventional ultrafiltration with technical modification in congenital heart defect surgery
Braz J Cardiovasc Surg 21;
Publish in: 8/1/2025
Objective: To compare patients submitted to the conventional ultrafiltration (CUF) with and without a technical modification that allows use of residual blood from the circuit tubes and oxygenator.
Method: From March 2002 to January 2005, 301 patients undergoing to congenital heart defects surgery with cardiopulmonary bypass (CPB) were retrospectively analyzed and divided in two groups: Group A - 130 submitted to CUF and Group B, 171 patients submitted to CUF with a technical modification that uses residual blood. Demographic data, diagnosis, surgical treatment, intra-operative and postoperative data, the need and amount of blood transfusions, laboratorial results and length of hospital stay were compared between the groups.
Results: There was no differences in the initial hematocrit before CPB (p = 0.06), but in the Group B, the values after ultrafiltration were higher (p <0.0001). Group B patients received more transfusions in the first 48 hours of the postoperative period (p <0.0001). There was no signicant difference in the time of mechanical ventilation (p = 0.34), but the inotropic support (p <0.0001), antibiotic therapy (p = 0.0006), length of stay in the intensive care unit (p <0.0001) and length of hospital stay (p <0.0001) were greater for Group B.
Conclusions: CUF with the technical modification was not better than conventional CUF, because in spite of elevating the hematocrit after the CBP, it caused greater postoperative bleeding with a greater need of blood transfusions and longer hospitalar stays.
Keywords: Ultrafiltration; Extracorporeal circulation; Heart defects, congenital
Evaluation of extracorporeal circulation effects on gallstone formation
Braz J Cardiovasc Surg 21;
Publish in: 8/1/2025
Objective: The objective of the present study was to clarify the relationship between cardiopulmonary bypass with the use of a heart-lung machine and gallstones in a short-term follow-up.
Method: A total of 135 patients with ischaemic heart disease were included in this study. All were followed up by the Cardiology Department of Hospital São Paulo, Federal University of São Paulo. They were divided into three groups: Group 1 - 51 patients who were treated clinically; Group 2 - 43 patients who underwent coronary artery grafting bypass without cardiopulmonary bypass; and Group 3 - 41 patients who underwent coronary artery grafting bypass with cardiopulmonary bypass and the use of a heart-lung machine. There were no statistically significant differences between the groups in relation to gender, age, body mass index or associated diseases (p<0.05). All the patients underwent ultrasound examination 12 months after beginning their cardiological treatment (clinical treatment alone or surgical plus follow-up).
Results: The prevalence of gallstones in the groups was: Group 1 - 7.84%, Group 2 - 11.62%, and Group 3 - 19.51%. There was no statistically significant differences between the groups (p = 0.248).
Conclusion: It was concluded that cardiopulmonary bypass does not appear to have a close relationship with gallstone formation one year after coronary artery bypass grafting. However, long-term follow-up is advisable.
Keywords: Coronary disease; Extracorporeal circulation; Heart-lung machine; Gallstones; Cholelithiasis; Cross-sectional studies
Left ventricular aneurysmectomy with continuous beating heart: early results
Braz J Cardiovasc Surg 21;
Publish in: 8/1/2025
Objective: Operative mortality after left ventricular aneurysmectomy is close to 15%. Specifically for this procedure, forms of myocardial protection have been little discussed. The purpose of this study was to evaluate immediate results of left anterior ventricular aneurysmectomy using the beating heart approach.
Method: We performed a retrospective analysis of 34 patients who underwent a left anterior ventricular aneurysmectomy, both with and without revascularization, from January 1997 to May 2005. The series consisted of 20 males and 14 females with a mean age of 52 years-old (range: 28 to 76). All of them were operated on cardiopulmonary bypass with normothermia, aortic cross-clamping was used but the open-beating heart was. We evaluated the perioperative mortality, thromboembolic events, duration of cardiopulmonary bypass, the length of stay in intensive care unit and the use of invasive ventilatory assistance.
Results: There were no perioperative mortalities or thromboembolic events. The cardiopulmonary bypass time was 85 minutes (range: 25-150 minutes). Invasive ventilatory assistance was used on average for 18 hours (range: 8-96 hours) and the mean stay in intensive unit care was 3.1 days (range: 2-14 days).
Conclusion: The beating heart approach constitutes a safe and efficient cardioprotective method for anterior left ventricular aneurysmectomy procedures.
Keywords: Heart aneurysm; Heart arrest, induced; Myocardial ischemia; Treatment outcome
Carotid endarterectomy in conscious patient
Braz J Cardiovasc Surg 21;
Publish in: 8/1/2025
Objective: To evaluate morbidity and mortality of carotid endarterectomy performed under regional cervical block, taking into account duration of surgery, use of shunt, conversion to general anesthesia, surgical complications, stay of patients inthe intensive care unit (ICU) and in the hospital, and patients' evolution over one year.
Methods: From June 1998 to January 2004, 67 operations were performed in 61 patients, with 70% or greater internal carotid stenosis, diagnosed by Doppler and confirmed by carotid angiography. Neurologic monitoring consisted of continuous assessment of alertness and motor activity of patients during the operation. The mean age was 69.7 years old. Regarding concomitant pathologies, 45 (47%) had hipertension; 21 (22%), coronary artery disease; 17 (18%), diabetes; 12 (13%), pneumopathy.
Results: There were three (4.48%) cases of bilateral carotid disease, for which surgery was performed at different times. The mean duration of surgery was 120 minutes. The use of a shunt was necessary in six (8.95%) cases and to convert to general anesthesia in two (2.98%). Two (2.98%) patients evolved with mental confusion after surgery and one (1.49%) presented infection of surgical site. Restenosis occurred in three (4.48%) cases. The mean times of stay in the ICU and hospital were 1.34 and 4.20 days, respectively. There were no deaths, strokes or acute myocardial infarctions.
Conclusion: Carotid endarterectomy with conscious patient is a good alternative for selected patients at high surgical risk for general anesthesia.
Keywords: Carotid stenosis, surgery; Endarterectomy, carotid; Cervical plexus; Nerve block
Depression as a risk factor for early and late morbidity after coronary artery bypass surgery
Braz J Cardiovasc Surg 21;
Publish in: 8/1/2025
Objective: To assess presence of symptoms of depression in the in the preoperative period, immediate postoperative period (IPP) and in the late postoperative period (LPP) in patients with coronary artery disease undergoing bypass surgery and its impact on early and late postoperative morbidity.
Method: Fifty-eight inpatients waiting to undergo an elective bypass surgery completed the Beck Depression Inventory (BDI) before surgery (Period I), after surgery just before hospital discharge (Period II) and three months later (Period III). Patients mean age was 61.2 (34 to 78 years; SD: 10.1), 34 (58.6%) were male, 31 (55.4%) had a history of infarction, 35 (62.5%) had ejection fraction >40% and 19 (33.0%) had diabetes.
Results: Depression symptoms were identified in 12 (20.7%) patients in Period I, 13 (23.6%) in Period II and four (9.8%) in Period III. Eighteen (31.0%) patients had complications in the IPP, 17 (34.0%) in the LPP. IPP complications were more frequent for older patients (more than 65 years; p=0.003), with at least three grafts (p=0.001) and depression in Period I (p=0.011). When those variables were associated with complications on the LPP, there was a significant difference for females (p=0.006) and depression in Period II (p=0.008). Female patients had more depression symptoms while staying in hospital (p=0.04).
Conclusion: More than 65 years, females, three or more grafts and depression symptoms in the postoperative period were associated with more complications after bypass surgery. Patients undergoing bypass surgery should be carefully monitored for depression and treated if necessary since it may be associated with complications after surgery.
Keywords: Coronary disease; Depression; Myocardial revascularization
Evaluation of the interference of oral tolerance in the rejection of avascular allogeneic heart grafts to mouse ears
Braz J Cardiovasc Surg 21;
Publish in: 8/1/2025
Objective: Although the development of surgical techniques and the discovery of immune-suppressors permitted heart transplantation to be accepted as a widespread treatment for terminally ill patients, rejection, complications due to these drugs and the chronic vasculopathies continue to be majority problems. The search for alternatives to supplant these impediments by performing avascular allogeneic heart transplants from newborn BALB/C mice (24h old) to the subcutaneous tissue of the ears of adult male C57BI/6J and C3H/HEJ mice to evaluate the interference of systemic oral tolerance on the rejection mechanisms are our main goal.
Method: Adult, male C57BI/6 e C3H/HEJ were divided in two groups. The tolerant group received peanuts ad libitum for one week in the diet while the immune group continued to eat mouse chow. Both groups were immunized sc with 100mg of peanut extract. The transplanted newborn BALB/C hearts were deposited of into the subcutaneous tissue of the ears of tolerant and immune mice in the presence or not of concomitant immunization to peanut protein.
Results: We demonstrated that feeding proteins induces systemic tolerance since animals of both strains that ate the seeds before being immunized had lower systemic antibodies than immune animals. Tolerant C3H/HEJ mice with concomitant administration of the tolerogenic antigen presented a more preserved transplanted heart than all other groups.
Conclusion: Although not homegeneously, the immunoregulatory mecanisms of oral tolerance modified the rejection process of alogenic avascular heart transplant to the ear of adult mice. As these mecanisms are not yet well understood more work needs to be done in this field.
Keywords: Immune tolerance; Transplantation, heart; Graft rejection; Mice
REVIEW ARTICLE
Treatment with implantable defibrillators and cardiac resynchronization: isolated or in association?
Braz J Cardiovasc Surg 21;
Publish in: 8/1/2025
CASE REPORT
Post-infarct sub-acute left ventricular free wall rupture: case report and review of the literature
Braz J Cardiovasc Surg 21;
Publish in: 8/1/2025
Post-infarction left ventricular free wall rupture is life threatening and not uncommon. Surgical experience is largely anecdotal with different techniques being used since the first successful surgical treatment was described. Here we present two patients with subacute left ventricular rupture that were managed using different perioperative strategies. Although the aim of surgical intervention is first and foremost to remove the threat to life by relieving of tamponade and closure of the ventricular defect, longer-term goals were those of conventional coronary operations, i.e., to prevent or limit the development of angina postoperatively and to improve the prognosis. These latter goals are controversial, and are discussed. The small number of patients involved prevent us to determine which approach is best but some surgeons, like us, advocate the concomitant procedure, whenever feasible, which achieves revascularization early and avoids the risk of repeat infarctions in the early postoperative period and the difficulties of early pericardial adhesions at reoperation. Combining the epicardial patch repair and complete myocardial revascularization appears to be the most attractive option for some patients that present with subacute left ventricular free wall rupture.
Keywords: Heart rupture, post-infarction, surgery; Myocardial infarction; Shock, cardiogenic
Left ventricular aneurysm in a patient with systemic lupus erythematosus: case report
Braz J Cardiovasc Surg 21;
Publish in: 8/1/2025
We describe the case of a 36-year-old woman with systemic lupus erythematosus, who suffered myocardial infarction and, subsequently, developed a huge inferior left ventricular aneurysm and heart failure. The patient was surgically treated with good results. The rarity of this condition is emphasized.
Keywords: Heart aneurysm, surgery; Lupus erythematosus, systemic; Cardiac surgical procedures
Left atrial myxosarcoma: case report
Braz J Cardiovasc Surg 21;
Publish in: 8/1/2025
Primary cardiac myxosarcoma is a very rare disease and is difficult to differentiate from myxoma, both clinically and pathologically. In this study, the authors report the first case of surgical excision of left atrial myxosarcoma in Brazil, in a 36-year-old woman. The operation was sucessful, and the patient remains asymptomatic for more than 180 postoperative days (Functional Class I - NYHA), with no signs of relapse of the tumor.
Keywords: Myxosarcoma; Myxoma; Sarcoma; Heart
CLINICAL-SURGICAL CORRELATION
Juxtaposition of the atrial appendages in tetralogy of Fallot - Case 1/2006
Braz J Cardiovasc Surg 21;
Publish in: 8/1/2025
Endoarteritis in adult with tetralogy of Fallot - Case 2/2006
Braz J Cardiovasc Surg 21;
Publish in: 8/1/2025
MEMORIAL
NORMAN SHUMWAY
Braz J Cardiovasc Surg 21;
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LETTERS TO THE EDITOR
Letters to the Editor
Braz J Cardiovasc Surg 21;
Publish in: 8/1/2025