Brazilian journal of cardiovascular surgery最新文献

Introduction: Saphenous vein grafts are frequently used for coronary artery revascularization. However, harvesting veins is associated with infected surgical sites and other complications. The no-touch technique that includes harvesting saphenous vein grafts along with surrounding tissues improves graft patency but increases the frequency of wound complications. We harvested saphenous vein grafts using the no-touch technique and devised other options for sites and incision methods to prevent wound complications. This study aimed to determine the clinical outcomes of no-touch saphenous vein grafts as well as associations between harvesting methods and wound complications.

Methods: We enrolled 132 patients who underwent isolated coronary artery bypass surgery with saphenous vein grafts harvested using the no-touch technique. Wound condition, general status, and graft patency were assessed during clinical follow-up.

Results: We harvested 180 veins (lower legs, n = 69 veins; upper legs, n = 111) using longitudinal and skip incisions at 100 and 80 sites, respectively. Wound complications occurred at 35 sites. The frequency of complications was significantly lower in the upper, than in the lower legs (14.4% vs. 27.5%). Furthermore, wound complications were reduced more by skip, than by longitudinal skin incisions (16.3% vs. 20.0%).

Conclusion: We devised a method to harvest no-touch saphenous vein grafts and determined the clinical outcomes of saphenous vein grafts and harvesting sites. Harvesting from the upper leg and via skip incisions reduced the frequency of wound complications.

Introduction: The preferred treatment for aortic coarctation is direct repair during childhood. However, some patients reach adulthood without being diagnosed. For these patients, an extra-anatomic bypass offers an alternative solution.

Objective: To evaluate the surgical outcomes of adult patients with aortic coarctation treated with an extra-anatomic aorto-aortic bypass.

Methods: This retrospective study includes adult patients who underwent an intrapericardial extra-anatomic bypass using a Dacron® tube from 2013 to 2021 (n=8). Clinical characteristics, surgical outcomes, survival rates, and the need for reinterventions were assessed up to March 31, 2024.

Results: All patients were male, with an average age of 39.9 ± 10.8 years (range 23-51). All were hypertensive. Four patients had associated aortic valve disease, and one had coronary artery disease. The operative risk, calculated using the European System for Cardiac Operative Risk Evaluation II score, was 1.65%. Four patients underwent concurrent valve surgeries (two valve replacements, one David procedure, and one Bentall procedure), and one had coronary artery surgery. The average pump time was 119 minutes, with longer times for those undergoing additional procedures (157 vs. 82.5 minutes). There was no operative mortality. The mean follow-up period was 107.1 ± 32 months, during which all patients survived. One patient required reintervention on the 118th postoperative month due to aortic stenosis, necessitating valve replacement with a biological prosthesis.

Conclusion: Intrapericardial extra-anatomic bypass is a viable option for treating aortic coarctation in adults, demonstrating excellent shortand long-term outcomes. It can be effectively combined with other surgical procedures.

Introduction: Previous studies found that patients with a history of cancer either have similar outcomes or face an increased risk of early morbidity following cardiac surgery. However, the applicability of these findings to clinical practice may be constrained by the heterogeneity of cancer patients. To refine our understanding, this study focuses specifically on the in-hospital outcomes of patients with non-metastatic malignant solid tumors (NMST) undergoing coronary artery bypass grafting (CABG).

Methods: Patients who underwent CABG were identified in National/Nationwide Inpatient Sample from Q4 2015-2020. Exclusion criteria included age < 18 years, concomitant procedures, and other malignancies. A 1:3 propensity-score matching was employed to address differences in demographics, socioeconomic status, primary payer status, hospital characteristics, comorbidities, and admission status between patients with and without NMST. In-hospital outcomes after CABG were evaluated.

Results: There were 2,139 patients with NMST who underwent CABG and who were matched to 6,580 out of 164,351 patients without NMST. Patients with and without NMST had comparable mortality (2.25% vs. 2.16%, P=0.80). However, NMST patients have a higher risk of hemorrhage/hematoma (63.48% vs. 58.27%, P<0.01) and a higher rate of transfer out (28.75% vs. 25.36%, P<0.01). In addition, patients with NMST had longer time from admission to operation (P<0.01), a longer length of stay (P<0.01), and higher hospital charges (P<0.01).

Conclusion: Patients with NMST have comparable short-term outcomes after CABG, except for a higher risk of postoperative bleeding. Thus, CABG could be performed safely for NMST patients, despite long-term prognosis of these patients may require further investigation.

Minimally invasive direct coronary artery bypass grafting (MIDCAB) has considerable benefits over the conventional coronary artery bypass grafting procedure. This case report presents the MIDCAB procedure in a multivessel coronary disease using triple arterial grafts and four arterial anastomoses. The initial anastomosis was made between the left intrathoracic mammary artery (LIMA) and the radial artery (RA), as an end-to-side "T" graft. Next, the RIMA was used to left anterior descending anastomosis. The first obtuse marginal (OM1) branch was grafted to allow LIMA-OM1 side-to-side anastomosis. Then, with the diagonal branch (Dg) opened, the formation of a "jumping" anastomosis was made using LIMA-OM1-Dg. The posterior descending artery (PDA) was used to create a LIMA-RA-PDA.

Introduction: The clinical significance of new-onset left bundle branch block (LBBB) after transcatheter aortic valve replacement (TAVR) remains controversial. In the presented study, we aimed to assess the impact of new LBBB on clinical outcomes after TAVR.

Methods: A total of 473 patients underwent TAVR for severe aortic stenosis between 2015 and 2023. According to the exclusion criteria, the study cohort comprised of 322 patients for analysis. The primary endpoint was cardiovascular death, with secondary endpoints including all-cause mortality and permanent pacemaker implantation (PPI) during follow-up.

Results: Patients with new LBBB had a significantly smaller indexed aortic valve area (0.3 ± 0.1 vs. 0.4 ± 0.1, P < 0.01) and interventricular membranous septum length (6.2 ± 1.6 vs. 6.9 ± 1.8, P < 0.01). By multivariable analysis, new LBBB remained an independent predictor of cardiovascular death (hazard ratio [HR] 7.09, 95% confidence interval [CI] 1.16 - 43.50, P = 0.03) during the 2.9-year follow-up period. There were no significant differences in the incidence of all-cause mortality (HR 0.48, 95% CI 0.17 - 1.37, P = 0.16) and PPI (HR 2.61, 95% CI 0.85 - 0.80, P = 0.08) between patients with new LBBB compared to those without it.

Conclusion: New LBBB after TAVR procedure is associated with an increased risk of death from cardiovascular causes, but it did not increase the risk of all-cause mortality and PPI over the long-term period.

Introduction: Blood transfusion is associated with adverse clinical and surgical outcomes. Strategies like the Patient Blood Management program, which includes blood cell salvage, contribute to reducing the use of blood components. Blood cell salvage is very useful in heart surgeries where the patient's blood loss can be massive.

Objective: The present study aimed to evaluate the impact of using the blood cell salvage in the intraoperative and postoperative periods (up to 24 hours) on the hemoglobin and hematocrit values, transfusion of red blood cells, infection rates, and postoperative length of stay in patients undergoing cardiac surgery with cardiopulmonary bypass.

Methods: Forty-one patients who underwent cardiac surgery with cardiopulmonary bypass according to the inclusion criteria were selected in an observational study and separated into two groups: with the use of the blood cell salvage group (BCS, n = 21) and without the use of the blood cell salvage (WBCS, n = 20).

Results: Patients in the group using blood cell salvage had higher postoperative hemoglobin (P = 0.018) and postoperative hematocrit levels (P = 0.009), lower consumption of red blood cells in the postoperative period and hospital discharge (P < 0.001), shorter postoperative length of stay (P = 0.020), and lower infection rates (P = 0.009).

Conclusion: Patient Blood Management strategies, particularly the use of blood cell salvage in the intraoperative and immediate postoperative periods of patients undergoing cardiac surgery with cardiopulmonary bypass, are associated with less use of blood components and consequently better clinical outcomes.

Introduction: Aortic root pathologies needing full aortic root replacement are challenging entities correlated to high morbidity and mortality due to their complexity and mostly refer to high-risk patients. In this retrospective study, we report our surgical experience and clinical results of patients undergoing a Bentall procedure as primary or reoperative surgery with the application of aortic bioconduits.

Methods: Patients who underwent full aortic root replacement utilizing either BioIntegral (BI) or Medtronic Freestyle™ (FS) bioconduit in the Cardiothoracic Surgery Department of the University Hospital Aachen RWTH from January 2015 until September 2020, in an urgent or emergency setting, were analyzed and followed up until December 2023.

Results: Twenty-six patients underwent aortic root replacement with bioconduits (N=11 with BI, N=15 with FS) in our center. Twenty-three cases were of infective cause, and three were of noninfective cause; 30.76% were urgent, and 69.23% were emergency cases. Two (7.70%) patients died during operation due to irreversible aortic root damage. In-hospital and 30-day mortality rates were four out 26 (15.4%) patients. The mean follow-up time for all the patients was 52.01 ± 39.41 months. Patients who received a primary aortic root replacement had significantly higher survival than redo cases. BI surgery needed longer cardiopulmonary bypass times.

Conclusion: Clinical outcome was equal for both bioconduits. Further studies with larger cohorts are needed for deeper insights into this complex entity.

Introduction: Cardioplegia solution, also called the del Nido solution, has been widely used in pediatric cardiac surgeries, and has recently started to be used in adult cardiac surgeries. In this context, this study aimed to investigate the relationship between the use of del Nido and blood cardioplegia solutions and postoperative atrial fibrillation rates in our clinic.

Methods: The study sample comprised 140 patients who underwent coronary artery bypass grafting. The del Nido and blood cardioplegia solutions were used in 70 (50%) patients. The postoperative atrial fibrillation rates of both groups were compared. Additionally, patients' preoperative, intraoperative, and postoperative data were evaluated.

Results: The cardiopulmonary bypass duration and defibrillation rate were lower in the del Nido cardioplegia group than in the blood cardioplegia group (P < 0.001). Atrial fibrillation rates on postoperative days one, five, and 30 were significantly lower in the del Nido cardioplegia group than in the blood cardioplegia group (P < 0.001, P < 0.001, and P = 0.007, respectively).

Conclusion: The postoperative atrial fibrillation rate was significantly lower in the del Nido cardioplegia group than in the blood cardioplegia group. In addition, the del Nido cardioplegia solution did not interrupt the surgical flow, thus resulting in less total perfusion, shorter cross-clamping durations, and fewer defibrillation needs. In conclusion, the del Nido cardioplegia solution can be used safely and effectively in coronary artery bypass grafting surgeries.