Brazilian journal of cardiovascular surgery最新文献

Introduction: Postoperative atrial fibrillation (POAF), the pathophysiology that includes inflammation and oxidative stress, is associated with increased hospital length of stay, mortality, and complications. The uric acid-to-albumin ratio reflects the inflammatory status of the body. We sought to evaluate whether there is an association between POAF and uric acid-to-albumin ratio in patients undergoing cardiac surgery.

Methods: Five hundred forty-three patients who developed POAF and 166 patients who did not formed our control and study groups, respectively. Patients who had an episode of atrial fibrillation lasting > 30 seconds were considered to have POAF. The uric acid-to-albumin ratio was calculated for each patient.

Results: Patients who developed POAF were older; had higher rates of hypertension, carotid artery disease, left atrial diameter, urea, creatinine, uric acid, and C-reactive protein levels; and had lower hemoglobin and albumin levels. The uric acid-to-albumin ratio of patients with and without POAF was 1.65 ± 0.63 and 1.26 ± 0.39, respectively (P < 0.001). Compared with uric acid and albumin, uric acid-to-albumin ratio had the highest area under the curve for predicting POAF (0.681, 0.449, and 0.702, respectively). Age and hemoglobin concentration were predictors of POAF. Although uric acid and albumin did not reach statistical significance for predicting POAF, the uric acid-to-albumin ratio had predictive value for the development of POAF.

Conclusion: The ability of the uric acid-to-albumin ratio to predict POAF in cardiac surgery patients and its nonnegligible benefits justify its use in clinical practice.

Objective: In this study, we aimed to compare the levels of serum atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) with ligation and primary repair of right atrial appendage after venous decannulation procedure in isolated coronary artery bypass grafting (CABG) and their relationship with postoperative atrial fibrillation (POAF).

Methods: In this prospective randomized study, 38 patients who underwent isolated CABG in Haydarpasa Training Hospital between March 2015 and November 2015 were included. Patients were divided into two groups whose atrial appendage were ligated (group A) or primary repaired (group B) after right atrial appendage decannulation. Both groups were evaluated in terms of perioperative serum ANP/BNP levels and POAF incidence. ANP/BNP levels were measured by taking blood samples through the central venous catheter on the preoperative day and postoperative days 1 and 3.

Results: While six POAF incidents were observed in group A, there were none in group B. There was no statistical difference between the groups (P > 0.05) in the evaluation of ANP/BNP levels. POAF rate in group A was statistically significantly higher than in group B (P < 0.05).

Conclusion: No significant difference in perioperative ANP/BNP levels was observed between the two groups. Also, no correlation between ANP/BNP levels and POAF were detected. Development of POAF significantly increased in group A. Therefore, we advocate that the prevalence of atrial fibrillation might be reduced in patients who had undergone right atrial repair with primary repair method.

Introduction: The rapid advancement of medical technology has enabled the application of single-lumen endotracheal tube (SLET) incubation anesthesia in thoracoscopic surgeries for thoracic diseases, demonstrating promising results. This study aims to explore the application of extracorporeal circulation (ECC) and combined intravenous-inhalation anesthesia (CIIA) with SLET intubation in totally thoracoscopic cardiac surgery (TTCS).

Methods: In this single-center, double-blind, randomized controlled trial, we assessed primary outcomes, including intraoperative metrics and postoperative conditions. Secondary outcomes included the number of patients achieving spontaneous resuscitation and those requiring extracorporeal defibrillation after opening the ascending aorta, alertness/sedation scores five minutes post-extubation, and incidence of postoperative complications.

Results: The observation group showed shorter durations in the anesthesia recovery room, intensive care unit retention, extubation, eye-opening time, and postoperative hospital stay compared to the control group (t = 5.913, 8.820, 7.792, 6.904, 11.140; all P < 0.001) and had higher proportion of patients with an alertness/sedation score of five (43/109, 39.45%) and rate of spontaneous resuscitation after opening the ascending aorta (97/109, 88.99%) compared to the control group ([8/109, 34%], [84/109, 77.06%]). In contrast, the rate of external electrical defibrillation (12/109, 11.01%) and the incidence of postoperative complications (2/109, 1.83%) were lower than in the control group ([25/109, 22.94%], [10/109, 9.17%]) (χ = 31.350, 5.501, 5.644; all P < 0.05).

Conclusion: Maintaining oxygen saturation in thoracoscopic surgery requires effective cooperation of anesthesia and ECC. The combined use of ECC and CIIA with SLET intubation in TTCS is a safe, effective approach that warrants broader clinical application.

Introduction: Conventional surgical approaches for aortic root aneurysms, including valved grafts and valve-sparing techniques, present inherent limitations such as the requirement for anticoagulation and the potential for late reoperation. Personalized External Aortic Root Support (PEARS), utilizing the ExoVasc® implant, represents a novel approach that aims to overcome these limitations.

Methods: This report presents the initial clinical experience with the ExoVasc® PEARS implant in the Americas, encompassing 10 patients (six males, age range 30 - 52 years, mean age 37.8 years) diagnosed with aortic root aneurysms. Indications for PEARS included Marfan syndrome (eight patients, including one reoperation), bicuspid aortic valve (two patients, including one with anomalous coronary artery), and associated valvular dysfunction. Cardiopulmonary bypass was utilized in four cases.

Results: No major adverse postoperative events were observed. Postoperative recovery was generally uneventful, with minor complications, including pericarditis and atrial fibrillation, successfully managed with medical therapy. Aortic dimensions remained stable at 30-day and one-year follow-ups.

Conclusion: This initial experience demonstrates the feasibility, safety, and efficacy of the PEARS technique for the treatment of aortic root aneurysms. Potential advantages over traditional approaches include the possibility for off-pump procedures, reduced risk of aortic valve dysfunction, shorter hospital stays, and elimination of the need for long-term anticoagulation therapy. Further investigation is warranted to evaluate the long-term durability and clinical outcomes of this innovative approach.

Introduction: The use of organs from suicide donors in heart transplantation is controversial due to potential concerns about graft function and recipient outcomes. This study investigates the association between heart transplantation using suicide donors related with the incidence of primary graft dysfunction (PGD) and mortality within 30 days after transplant.

Methods: A retrospective analysis was conducted on 97 adult heart transplant recipients at the Instituto do Coração of São Paulo between 2020 and 2021. Data on donor characteristics (age, sex, mechanism of brain death), recipient preoperative status (age, sex, cardiomyopathy etiology, body mass index, comorbidities, use of intra-aortic balloon pump, extracorporeal membrane oxygenation [ECMO]), intraoperative variables (ischemia time, cardiopulmonary bypass time, implantation time), and postoperative outcomes (use of ECMO, mortality) were analyzed.

Results: Of the 97 transplants analyzed, six were from suicide donors (6.2%). Recipients of hearts from suicide donors had a significantly higher need for ECMO (33.3% vs. 4.4%, P = 0.036), increased PGD (66.7% vs. 19.8%, P < 0.05), and higher 30-day mortality (50% vs. 3.3%, P < 0.05) compared to non-suicide donors. No significant intraoperative time differences were found between the groups.

Conclusion: This study is the first to identify a significant association between heart transplantation from suicide donors and adverse outcomes, including higher rates of PGD and early mortality. These findings suggest possible psychological and biological influences on organ quality and transplantation outcomes. Further research is needed to clarify these associations and inform donor selection criteria.

Introduction: Prolonged aortic cross-clamping may intensify systemic inflammation after cardiac surgery. This study aimed to evaluate the effect of cross-clamp duration on systemic inflammatory response index (SIRI) and systemic immune inflammation index (SIII) in isolated coronary artery bypass grafting (CABG).

Method: This retrospective study included 155 patients who underwent first-time isolated CABG between January 2021 and June 2024. Patients were divided into two groups based on median cross-clamping time: Group I (≤ 64 minutes, n = 83) and Group II (> 64 minutes, n = 72). Demographic, hematologic, and biochemical data were collected. SIII was calculated as platelet × neutrophil/lymphocyte; SIRI as neutrophil × monocyte/lymphocyte.

Results: The mean aortic cross-clamping time of Group I was 53 minutes (interquartile range 44 - 60 minutes) and of Group II it was 78 minutes (interquartile range 71 - 87 minutes) (P < 0.001). An increase in systemic immune inflammation index and systemic inflammatory response index values was observed in both groups at the 24th postoperative hour. Postoperative systemic immune inflammation index and systemic inflammatory response index levels were significantly higher in Group II (P < 0.05). There was a weak but significant positive correlation between aortic cross-clamping time and postoperative systemic inflammation response index (r = 0.220; P = 0.006).

Conclusion: Prolonged aortic cross-clamping time is associated with an increased postoperative inflammatory response. These indices may serve as biomarkers for evaluating systemic inflammation following coronary artery bypass grafting.

Objective: To evaluate the long-term performance of a bovine pericardium valve prosthesis in individuals who required valve replacement in the Brazilian public health system.

Methods: Medical records of patients having mitral or aortic valve replacement with bovine pericardium valve prostheses between 1978 and 1994 at a Brazilian hospital were reviewed in this retrospective study. Safety was assessed through the complications and serious adverse events rates in the early and long terms. Successful valve replacement was defined by absence of complications and serious adverse events up to 30 days after surgery.

Results: A total of 439 surgeries were performed in 382 patients with a mean age of 46.45 ± 13.93 years. Mean follow-up time was 6.26 years (up to 26.13 years). Rheumatic etiology was present in 83.5% of the cases. Mitral valve replacement was the most performed surgery. Five complications in five patients were recorded up to 30 days after surgery, and the rate of serious adverse events for the same period was 10.3%. Successful valve replacement rate was 90.7%. Postoperative complications were reported during the follow-up period in 29.6% of the procedures, being calcification the most common with 17.3%.

Conclusions: Despite the young age of the patients, safety outcomes were in accordance with what is reported in the literature for bioprostheses, with acceptable complication, serious adverse events, and freedom from reintervention rates.

Introduction: This study aimed to clarify whether pulmonary hypertension is a risk factor for postoperative new-onset atrial fibrillation (NOAF) following isolated coronary artery bypass grafting (CABG).

Methods: Data of 4,782 patients were retrospectively examined from clinical database, and data of isolated CABG performed patients (n = 854) with preoperative echocardiography including pulmonary artery pressure (PAP) measurement were enrolled in study. While 115 patients had post-CABG NOAF (atrial fibrillation [AF] group), 739 did not have AF (non-AF group). Demographic, clinical, and treatment-related parameters were compared between groups, and independent clinical predictors of NOAF were identified by multivariate analysis.

Results: Patients of AF group were significantly older and had higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) points, significantly elevated mean systolic PAP, and more pulmonary hypertension. Multivariate regression analysis revealed that mean systolic PAP (odds ratio [OR]: 1.027, 95% confidence interval [CI]: 1.006 - 1.048) and pulmonary hypertension (≥ 30 mmHg; OR: 1.659, 95% CI: 1.093 - 2.518) were independent risk factors for post-CABG NOAF. Chronic obstructive pulmonary disease (COPD) (OR: 2.033, 95% CI: 1.265 - 3.268) and mean duration of ventilation support (OR: 1.059, 95% CI: 1.017 - 1.104) were additionally determined as risk factors for post-CABG NOAF.

Conclusion: This study identified patients' age, high EuroSCORE points, presence of COPD, prolonged ventilation support, and increased PAP as predictors of post-CABG NOAF. Understanding the risk factors will provide better guidance in preventing this complication and its potential consequences. Prospective randomized controlled trials are required to further validate these findings and provide more robust evidence.

Implanting sutureless aortic valves enables a reduction in surgical times and related complications. Nonetheless, their application has been limited in cases involving aortic aneurysms due to anchor system concerns. We present a case of aortic valve replacement using a Perceval™ sutureless aortic valve in a patient with stage IV chronic kidney disease, an ascending aortic aneurysm, and a porcelain aorta. The procedure was performed concomitantly with coronary artery bypass grafting involving two grafts, as well as ascending aorta and hemiarch replacement. This case underscores the critical importance of time efficiency, technical modifications for valve implantation, and strategic surgical planning to mitigate potential intraoperative and postoperative complications.