Brazilian journal of cardiovascular surgery最新文献

We report the case of a surgical treatment after transcatheter edge-to-edge mitral valve repair failure in a 79-year-old patient who had undergone cardiac surgery 30 years earlier. The transcatheter procedure of mitral valve got complicated by single leaflet device attachment leading to recurrent severe regurgitation. Despite the extremely high surgical risk and a porcelain aorta, we deemed the patient operable thanks to his performant physical and cognitive status. He underwent mitral valve replacement with a bioprosthesis in deep hypothermic circulatory arrest and retrograde cerebral perfusion. The postoperative course was regular, and he is in good functional class at one-year follow-up.

We present a case of left atrial thrombus mimicking myxoma after orthotopic heart transplantation. Multimodality imaging established the diagnosis of atrial myxoma, and the patient was treated accordingly, but the definite diagnosis after surgical excision and histology showed left atrial thrombus. This report demonstrates the limitations of multimodality diagnosis in tumors with features highly suggestive of an atrial myxoma.

Introduction: Chronic pericardial effusion is a common pericardial syndrome associated with multiple etiologies. Most studies report good outcomes and success rate after pericardial window, although mortality varies. This study aimed to identify risk predictors for mortality in addition to determining factors associated with in-hospital mortality over a 30-day period in patients who underwent surgical pericardial window.

Methods: We retrospectively reviewed case files from patients who underwent pericardial window for the treatment of pericardial effusion from 2007 to 2023.

Results: One hundred and two patients were included in our analysis, with an overall hospitalized mortality after pericardial window of 28% (n = 29). When assessing etiology, mortality was similar between all causes of effusion (P = 0.359). In echocardiography, there was a significantly lower left ventricular ejection fraction (P = 0.016) in patients who died after the surgical procedure. Similarly, the presence of cardiac cavity collapse before the procedure was significant for an increase in mortality (P ≤ 0.0001). Logistic and Cox regression analysis showed that cardiac cavity collapse, complications, and lung cancer were associated with increased postoperative mortality following pericardial window.

Conclusion: Although surgical pericardial window offers feasible treatment with good success rates, in-hospital mortality is elevated, particularly in patients with cardiac cavity collapse and complications.

At this moment, many modifications of the Bentall-De Bono procedure have been introduced. The authors of most of the existing modifications aim to solve the problems of bleeding from the proximal anastomosis and the reimplantation of coronary arteries into the conduit. Both problems are among the most important reasons for unsatisfactory results of the Bentall-De Bono procedure. The new technique of proximal anastomosis formation presented in this work aims to solve the problems of bleeding from the zone of proximal anastomosis and reimplantation of low-positioned coronary artery orifices.

Introduction: Various dosing regimens of tranexamic acid have been reported to exhibit varying efficacy and safety profiles. Herein, we conducted a meta-analysis to evaluate the efficacy and safety of low-dose regimens in open-heart surgery.

Methods: Three databases were systematically searched for randomized trials examining the bleeding reduction effect of tranexamic acid in open-heart surgery. The pooled data of the low-dose group was then compared with the control, high-dose, and epsilon aminocaproic acid groups. The boundary between the lowand high-dose groups was a bolus of 30 mg/kg followed by 16 mg/kg/hour.

Results: The meta-analysis included 81 studies. The low-dose tranexamic acid regimen was associated with a decreased incidence of reoperation (risk ratio: 0.52; 95% confidence interval: 0.39-0.69; high quality of evidence), perioperative myocardial infarction (risk ratio: 0.64; 95% confidence interval: 0.43-0.95; high quality of evidence), the amount of postoperative bleeding in 24 hours, and the need for transfusion of packed red cells compared to control, without increasing the rates of mortality, venous thromboembolism, or stroke. Compared with the high-dose group, the low-dose group had a lower incidence of seizures and stroke. The low-dose of tranexamic acid group also showed significantly reduced postoperative bleeding; however, the cost of an increased risk of seizure events was higher in the low-dose group than in the epsilon aminocaproic acid group.

Conclusion: Low-dose tranexamic acid effectively reduced bleeding, the risk of reoperation, and myocardial infarction without increasing the risk of adverse events.

Acute type A aortic dissection (AAD) is a life-threatening emergency with high mortality. Preoperative organ malperfusion significantly worsens surgical outcomes. Isolated renal malperfusion is common in acute type A aortic dissection, increasing the risk of postoperative renal ischemia and early mortality. This case involves a young patient with renal malperfusion due to left renal artery closure by an intimal flap and true lumen compression of the abdominal aorta affecting both renal arteries. Endovascular intervention was not feasible. The patient later underwent a successful kidney transplant and has been followed up for years without complications.

Introduction: Cardioplegias are routinely used in cardiac surgery to protect the heart from ischemia-reperfusion injury. The choice of cardioplegia depends on the surgeon's clinical expertise. No clear data demonstrate the redox-protective superiority of one cardioplegia over another. We aim to evaluate redox status and signaling assessments in coronary sinus blood samples for the different cardioplegias.

Methods: Our study included patients undergoing coronary artery bypass and isolated valve surgery. We compared blood and del Nido cardioplegia solutions. During the preoperative period, blood samples were collected from the coronary sinus both preand post-aortic cross-clamping. We also assessed redox system biomarkers and transcription factors related to the antioxidant system using spectrophotometric and immunochemical methods.

Results: In valve patient groups that received both cardioplegia solutions, post-cross-clamping protein carbonyl levels were significantly lower compared to pre-cross-clamping values. For the levels of antioxidant system parameters, except for catalase and superoxide dismutase, no significant difference was observed for del Nido cardioplegia. Increased antioxidant enzyme levels highlight the importance of these enzymes in eliminating the higher hydroperoxide load. Regulatory proteins involved in redox signaling did not show significant variations except for Kelch-like ECH-associated protein 1 and peroxisome proliferator-activated receptor-gamma coactivator-1 alpha for cardioplegias.

Conclusion: Current results indicate that del Nido cardioplegia effectively protects myocardial redox status. Given these findings, despite concerns regarding its use in clinical practice, particularly in valve surgery compared to coronary artery bypass surgery, del Nido cardioplegia may provide effective myocardial protection in both coronary artery bypass and heart valve surgeries.

Introduction: Coronary artery disease (CAD) is the main cause of death among cardiovascular diseases. Current guidelines aim to guide clinical practice in choosing the best treatment, based on the best scientific evidence. The SYnergy between percutaneous coronary intervention with TAXus and cardiac surgery (SYNTAX) score uses anatomical and clinical factors, helping to assess the complexity of coronary lesions.

Objective: To verify whether the treatment used in CAD complied with the recommendations set out in the guidelines and in the SYNTAX study.

Methods: Single-center, cross-sectional, observational, descriptive, and retrospective study, which analyzed medical records over a three-year period. Patients diagnosed with CAD who had obstructive disease in at least two vessels were selected. The exams were evaluated by a specialist who was unaware of the report and the treatment used for each patient. SYNTAX 1 and 2 scores were calculated, and the recommended treatment was compared to the established treatment.

Results: Two hundred and ten patients were distributed, according to SYNTAX Score 1, into the groups low (Group A), intermediate (Group B), and high risk (Group C). Of 155 patients in Groups B and C, 105 (67.7%) were treated with percutaneous coronary intervention (PCI), vs. 24 (15.5%) with CABG. When calculating the SYNTAX Score 2 of the 101 patients with recommended treatment for CABG, 71 (70.3%) received PCI, compared to 18 (17.8%) treated with CABG. All patients recommended for preferential treatment for PCI had the recommendation respected.

Conclusion: The treatment offered was not supported by current guidelines and recommendations. Expanding the sample size may determine the current situation of the treatment of CAD in Brazil.

This case study involves a 51-year-old woman with a complex cardiovascular condition, namely cor triatriatum dexter, accompanied by sick sinus syndrome. She presented with bradycardia, dizziness, and amaurosis, and was admitted to the emergency department due to right limb numbness. Diagnostic examinations, including computed tomography and cardiac color ultrasound screening, revealed the presence of cor triatriatum dexter with an enlarged left atrium and ventricle. Additional abnormalities, such as absent inferior vena cava and polysplenia syndrome, were also detected. Based on the findings, a double-chamber pacemaker surgery was recommended, supported by cardiac and thoracic-abdominal computed tomography angiography and three-dimensional vascular reconstruction.