Brazilian journal of cardiovascular surgery最新文献

The incidence of sternal wound complications, such as dehiscences, infections, and sternocutaneous fistulas, can reach 10%. Sternocutaneous fistulas are extremely rare, and the only definite therapy is surgical repair. Our experience taught us that combining a traditional approach with an extracellular matrix patch might be a step forward in therapy. We described three examples of surgically reconstructing sternocutaneous fistulas with an extracellular matrix patch (ProxiCor®).

Introduction: Randomized controlled trials (RCTs) provide evidence of efficacy, while real-world data (RWD) demonstrate effectiveness in real-world practice. We designed a systematic review and meta-analysis of reconstructed time-to-event (RTE) data from propensity score matching studies comparing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) to compare their effectiveness and evaluate the generalizability of TAVI indications.

Methods: Systematic review of literature between 2007 and 2023 including propensity score matching studies comparing TAVI or SAVR that reported at least one-year Kaplan-Meier curves of endpoints.

Results: Twenty-one studies were included (39538 participants). TAVI shows a higher all-cause mortality (hazard ratio [HR] 1.41; 95% confidence interval [CI] 1.34-1.47, P-value < 0.001), with a significant heterogeneity. The analysis of HR trend over time shows that TAVI superiority is limited to the first month with a steep reversal afterwards, when SAVR becomes clearly superior. All-cause mortality is significantly higher in TAVI in low-risk (HR 1.35; 95% CI 1.08-1.69, P-value < 0.001) as well as in intermediate (HR 1.73; 95% CI 1.35-2.22, P-value < 0.001) and high-risk (HR 1.61; 95% CI 1.38-1.88, P-value < 0.001) patients. The HR trend in the subgroups of risk confirms the data from the whole mixed population.

Conclusion: In a real-word setting, TAVI is associated with higher incidence of all-cause death and maintains a survival benefit only in the first month after implantation. These results show that TAVI effectiveness may not reflect the efficacy demonstrated by RCTs and pose a threat to their external validity.

Various techniques of conduit repair have been employed during valve reconstruction. While Ozaki conduits have streamlined the procedure, their limited availability poses concerns. This case report presents 14-year-old patient with pulmonary atresia and an anomalous left anterior descending artery arising from the right sinus. A right ventricle-to-pulmonary artery conduit was created using Dacron® graft and a trileaflet valve employing Duran's technique of pericardial valve reconstruction, elucidating surgical methodology. In developing countries, the implementation of Duran's technique presents noteworthy advantage allowing for utilization of autologous tissue, addressing challenges associated with PTFE conduits. Unlike PTFE conduits, the results of Duran's technique at the pulmonary position needs to be followed up in a large number of cases.

Persistent left superior vena cava (PLSVC) is a common congenital venous anomaly, usually associated with other congenital heart diseases (12%). Its incidence in the general population is 0.5%. In cardiac surgery patients, it is suspected when using the left subclavian vein or left internal jugular vein for central venous catheter or hemodialysis catheter placement. Transthoracic ultrasound exam is useful in confirming the position of catheters in the venous system by injecting a 5% glucose solution that can be visualized in the right atrium after administration through the catheter. Hemodialysis catheters can be inserted in the PLSVC with good catheter function and no major risk in increase of complications.

Introduction: Pediatric cardiac surgery patients need close post-extubation monitoring for ventilation. Non-invasive transcutaneous partial pressure of oxygen (TcPO2) and transcutaneous partial pressure of carbon dioxide (TcPCO2) offer continuous insights and in improving care.

Objective: To investigate the correlation of transcutaneous blood gases (TcPO2, TcPCO2) with arterial blood gases i.e. arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2).

Methods: We conducted a study on 30 pediatric post-cardiac surgery patients (four months to three years old) who were extubated and exhibited stable hemodynamics (inotropic score ≤ 5), normal sinus rhythm, and no respiratory or heart failure signs. Continuous transcutaneous and intermittent arterial blood gas monitoring started one hour after extubation, with recordings every 30 minutes for four hours. A single observer conducted probe calibration and data recording to minimize variability, while analysis of 240 paired samples included correlation coefficient, linear regression, Bland-Altman analysis, and Mountain plot.

Results: The r-value between PaCO2 and TcPCO2 was 0.95, r2-value of 0.9060 (P<0.001). Bland-Altman showed a bias of 2.579, and 95% limits of agreement were -6.4 to 1.3. The r-value between PaO2 and TcPO2 was 0.8942, r2-value of 0.7996 (P<0.001); bias of 20.171 and 95% limit of agreement of -0.5 to 40.9. The Mountain plot revealed a median of 2.57 for PaCO2 vs. TcPCO2 and 20.17 for PaO2 vs. TcPO2.

Conclusion: Transcutaneous carbon dioxide values are interchangeable with arterial PaCO2 in our population study, acting as a surrogate in postoperative pediatric cardiac surgery. Confirmation with arterial blood gases is needed if discrepancies occur.

Objective: To evaluate pulmonary vascular development and outcomes of complete correction following palliative treatment in infants with critical tetralogy of Fallot.

Methods: This prospective, randomized, two-center study included infants with tetralogy of Fallot who underwent surgery between June 2018 and 2022. The patients were divided into two groups - those who underwent stenting of the right ventricular outflow tract (stent group, n=21) and those who underwent modified Blalock-Taussig shunt placement (shunt group, n=21).

Results: In the stent group, a significantly greater increase in Nakata index was observed, with mean values rising from 104.2 to 208.6 mm2/m2, compared to an increase from 107.3 to 169.4 mm2/m2 in the shunt group (P<0.01). According to the mixed model analysis, the rate of growth of the right pulmonary artery in the stent group was 2.05*10-2 z score/day, which was 3.01 times greater than that in the shunt group (P<0.01). The rate of growth of the left pulmonary artery in the stent group was 2.3*10-2 z score/day, which was 1.47 times greater than that in the shunt group (P<0.01). In one patient (4.8%), after 76 days following the stenting of the RVOT, a severe infectious process with sepsis occurred, leading to a fatal outcome. Complete correction in the stent group involved transannular patch repair of the right ventricular outflow tract to the pulmonary artery in 12 patients (60%), while the same procedure was performed in 15 patients (71.4%) in the shunt group (P=0.52).

Conclusion: Stenting of the right ventricular outflow tract provides hemodynamic stabilization and symmetric growth of the pulmonary vascular bed compared to the formation of a modified Blalock-Taussig shunt.