Brazilian journal of cardiovascular surgery最新文献

Introduction: The Charlson Comorbidity Index (CCI) is used for assessing comorbidities and estimating risk of adverse outcomes in surgical patients. In cardiac surgery, the burden of comorbidities can significantly influence incidence of postoperative complications and mortality. This study evaluates the utility of CCI in predicting perioperative complications in patients undergoing cardiac surgery.

Methods: Observational cross-sectional study with retrospective data including 483 adult patients who underwent cardiac surgery with cardiopulmonary bypass at the Instituto Nacional de Cardiología Ignacio Chávez from June 2022 to December 2023. Patients were grouped by preoperative CCI: mild (0 - 1), moderate (2), and severe (≥ 3). Statistical analyses (chi-square, Mann-Whitney U, logistic regression) assessed the association between CCI and postoperative complications, adjusting for age and sex.

Results: Patients with severe comorbidity had higher rates of postoperative complications, including delirium (27.3% vs. 9.4%, P = 0.00), stroke (P = 0.03), transfusion (69.7% vs. 47.2%, P = 0.04), and renal replacement therapy (18.2% vs. 5.3%, P = 0.02). Median Sequential Organ Failure Assessment scores at 24 hours were significantly higher (P = 0.00). Logistic regression adjusted for age, sex, and coronary artery bypass grafting identified delirium (odds ratio [OR]: 3.13), nosocomial pneumonia (OR: 3.10), acute kidney injury (OR: 2.28), and renal replacement therapy (OR: 4.10) as independent predictors of severe comorbidity.

Conclusions: The CCI is a valuable tool for predicting postoperative complications in patients undergoing cardiac surgery. Early identification of comorbidities is essential for perioperative planning and optimizing clinical outcomes. Integrating the CCI into routine clinical practice is recommended to enhance patient management.

Introduction: Postoperative bleeding increases morbidity and mortality. We aimed to review the scoring systems used to predict massive bleeding after isolated coronary artery bypass grafting in diabetic patients and determine the parameters of the new scoring system - the Optimum Risk Score for Bleeding (ORS).

Methods: Two hundred ninety-seven diabetic patients who underwent isolated coronary artery bypass operation between 2017 and 2019 were reviewed. The patients were grouped according to amount of drainage (> 850 mL/day) and the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) bleeding severity grade. Previously identified risk factors and scoring systems (Papworth, WILL-BLEED, Association of Cardiothoracic Anesthetists perioperative risk of blood transfusion [ACTA-PORT], Transfusion Risk and Clinical Knowledge [TRACK], and Transfusion Risk Understanding Scoring Tool [TRUST]) were analyzed.

Results: Papworth was better predictive for E-CABG bleeding grades 2 - 3. WILL-BLEED, ACTA-PORT, TRACK, and TRUST had no discriminatory value in terms of E-CABG bleeding grades 2 - 3. Among the parameters in the scoring systems, gender, preoperative hemoglobin (or hematocrit) value, preoperative platelet count, use of antiplatelets until less than five days prior to the operation, and preoperative creatinine (or estimated glomerular filtration rate) values should be included in the scoring system we aim to establish in the future, the ORS.

Conclusion: The current scoring systems do not provide satisfactory results in predicting postoperative bleeding. Female gender, lower body mass index, and preoperative platelet count were associated with increased postoperative bleeding. There is a need for an ORS which gives more precise results in predicting postoperative bleeding.

Introduction: Heart transplantation is a crucial therapeutic modality for patients with advanced heart failure. For satisfactory results, acceptable ischemic times are essential. This study aims to investigate the relationship between cold ischemic time > 4 hours and mortality in the first month after heart transplantation.

Methods: Retrospective and observational analysis of medical records of patients who underwent heart transplantation between January 2019 and December 2023. The inclusion criteria were patients who underwent heart transplantation using the histidine-tryptophan-ketoglutarate preservation solution during organ retrieval and immediately before organ implantation. Recipient variables, etiology of heart failure, procedural variables, and 30-day mortality were studied.

Results: During the study period, 62 patients underwent heart transplantation. There were a predominance of males (79%) and an average age of 51 years. Seven patients had a cold ischemic time ≥ 4 hours, with three dying (43%) before 30 days. Among the 55 patients with cold ischemic times < 4 hours, 17 died (31%) before 30 days. Statistical analysis using the chi-square test revealed no statistically significant association between cold ischemia and mortality in the first 30 days after transplantation (P = 0.835).

Conclusion: The study found no difference in 30-day mortality between patients who underwent heart transplantation with cold ischemic times > 4 hours and those with cold ischemic times < 4 hours. Thus, there may be new strategies to increase the number of donors with a safe rebalance of the relationship between the number of available allografts and patients on the waiting list.

Introduction: Choosing a surgical technique in patients with acute type A aortic dissection is still a debatable issue. In patients with massive aortic root destruction, the Bentall procedure is a gold standard. Aortic valve reimplantation is a reliable alternative, especially in patients with the preserved anatomy of aortic valve leaflets.

Objective: To compare the results of modified valve sparing procedure and composite root replacement in patients with acute type A aortic dissection.

Methods: In total, 62 patients were included in this study. Of those, 27 patients underwent aortic valve reimplantation, and 35 had the Bentall procedure with the Kouchoukos modification.

Results: Preoperative demographics and clinical characteristics were analyzed in both groups. Similar indicators of preoperative malperfusion were observed in both. Cardiopulmonary bypass time (P = 0.125) and aortic clamping time (P = 0.001) were longer (≈ 30 minutes) in the reimplantation group while the time of circulatory arrest was longer in the Bentall group (P = 0.290). Hospital mortality rates were 8.3% in the reimplantation group and 22.9% in the Bentall group. During the long-term follow-up period, there were six (25%) deaths in the reimplantation group and 10 (28.6%) deaths in the Bentall group. The aortic regurgitation degree was stable in all cases up to the moment of last contact with the patients.

Conclusion: Modified aortic valve reimplantation shows good immediate and long-term outcomes in patients with acute type A aortic dissection.

Left ventricular aneurysm is an important mechanical complication of myocardial infarction, and its reported incidence after myocardial infarction varies between 10 and 35%. Left ventricular aneurysms in patients with angina pectoris, congestive heart failure, malignant ventricular arrhythmias, and systemic embolization should be surgically repaired. In this paper, we present a novel modified off-pump linear closure technique performed by using a simple Foley catheter for hemostasis on beating heart without cardiopulmonary bypass for the surgical treatment of left ventricular aneurysm. To the best of our knowledge, this is the first reported case of such an approach in the literature.

Objective: This study aimed to investigate the frequency of persistent left superior vena cava (PLSVC) and its impact on outcomes in children undergoing congenital heart surgery.

Methods: The study was conducted retrospectively in cases diagnosed with congenital heart disease who were operated on under the age of 16 years between October 1st, 2021, and October 1st, 2024, at two major tertiary centers. The frequency of PLSVC and its possible impact on surgical outcomes were evaluated in these cases. The results were analyzed statistically.

Results: There were 4,000 cases during the study period, with 52% being male. The median weight was 5.2 kg (interquartile range 4.5 - 6 kg). PLSVC was detected in a total of 260 cases (6.5%). Of these cases, 92.3% (240/260) drained into the coronary sinus, while 7.7% (20/260) drained directly into the left atrium. In 251 (96.5%) of the patients with PLSVC, there was a right SVC, while nine (3.5%) did not have a right SVC. Of the 251 patients with double SVC, 105 (42%) had a normal innominate vein. PLSVC was primarily associated with heterotaxy syndrome, atrioventricular septal defect, and vascular ring defects.

Conclusion: There is an increased frequency of PLSVC among certain congenital heart disease groups, and raising awareness during echocardiographic examination can facilitate the diagnosis of PLSVC. Preoperative diagnosis of PLSVC can help in managing complications more effectively.

Introduction: Frailty syndrome is a significant risk factor for elderly patients undergoing cardiovascular surgery. However, there is no consensus on which criteria are most effective for assessing frailty in this context.

Objective: This study aimed to evaluate the relationship between different widely cited frailty syndrome criteria and postoperative morbidity and mortality.

Methods: Patients aged ≥ 60 years scheduled for coronary artery bypass graft, valve, and/or ascending aortic surgery were assessed for frailty preoperatively. Frailty was defined by Clinical Frailty Scale (CFS) ≥ 4, Katz Index ≥ 1, Short Physical Performance Battery (SPPB) ≤ 6, Fried Frailty Phenotype (FFP) ≥ 3 or abnormal values in 15-feet gait speed (GS) test, or hand grip strength. Clinical outcomes, including mortality and major adverse cardiovascular and cerebral events (MACCE), were assessed 30 days post-surgery.

Results: Among 137 patients (70.1% male, mean age 69.43 ± 5.98 years), frailty prevalence ranged from 13.1% to 43.1%, depending on criterion, with no significant differences by age strata or surgery type. At 30-day follow-up, mortality was 5.1% (n = 7), and a total of 29 MACCE (21.1%) were recorded. Patients identified as frail by the FFP, CFS, SPPB, and GS criteria showed a significant association with mortality and MACCE. Multivariate analysis indicated FFP and CFS as independent risk factors for MACCE with equivalent prognostic prediction.

Conclusion: Frailty is a prevalent condition among elderly patients undergoing cardiovascular surgery and is associated with mortality and morbidity. Frailty defined by FFP and CFS criteria was independently associated with higher MACCE rates.

Introduction: Reoperative cardiac surgery is associated with a higher risk of complications due to technical difficulties compared to the first-time surgery. This study aims to compare the early outcomes of median sternotomy (MS) and lateral thoracotomy (LT) procedures in patients with a history of previous open-heart surgery who underwent left ventricular assist device (LVAD) implantation with cardiopulmonary bypass (CPB).

Methods: A retrospective analysis was conducted on 36 patients who received LVAD implants for end-stage heart failure between November 2012 and June 2015. The patients were divided into Group 1 (MS, n = 18) and Group 2 (LT, n = 18).

Results: The mean age of the patients was 57.2 ± 9.4 years (range: 24 - 70 years), and only 8.3% were female. Demographic data, preoperative characteristics, use of blood products, anesthetic drugs, and complications were similar in both groups (P > 0.05). The MS group had significantly longer operation duration (101 ± 46 minutes vs. 70 ± 20 minutes, P = 0.038) and CPB time (328 ± 79 minutes vs. 265 ± 47 minutes, P = 0.048) compared to the LT group. Postoperative analgesic consumption and pain scores were similar between the two groups (P > 0.05).

Conclusion: In patients with a history of previous cardiac surgery, LVAD implantation with LT through CPB demonstrated favorable outcomes regarding reduced operation duration and CPB time. However, it did not positively impact the duration of stay in the intensive care unit, hospital stay, use of blood products, and complications.