Brazilian journal of cardiovascular surgery最新文献

Objective: In this study, we aimed to compare the outcomes of left anterior mini-thoracotomy and conventional sternotomy in on-pump multivessel coronary revascularization.

Methods: Two hundred sixty-two patients who underwent minimally invasive coronary artery bypass grafting through the left anterior mini-thoracotomy and conventional coronary artery bypass grafting with full sternotomy were included. All patients were divided into two groups - 132 patients who underwent minimally invasive multivessel coronary artery bypass grafting in Group I, and 130 patients with full sternotomy in Group II. Intraoperative variables (cross-clamping time, cardiopulmonary bypass time, etc.), postoperative parameters (drainage amount, revision, intensive care and hospital stay times, etc.), and mortality were analyzed retrospectively.

Results: Cardiopulmonary bypass time (152.24 ± 36.4 minutes) was significantly longer in Group I than in Group II (102.24 ± 19.4 minutes) (P<0.001). Cross-clamping time (86 ± 13.2 minutes) was significantly longer in Group I than in Group II (62 ± 21.4 minutes) (P<0.001). And intensive care stay time (P=0.005) and hospital stay time (P=0.004) were significantly shorter in Group I. In the postoperative period, six patients in Group I and seven patients in Group II were revised due to bleeding. Total perioperative mortality was one patient in both groups (P=0.82).

Conclusion: Multivessel coronary artery bypass grafting through the left anterior mini-thoracotomy is an effective, reliable, and successful method, due to less drainage amount and less blood transfusion need, shorter intensive care and hospital stays, faster return to daily life, and better cosmetic results compared to conventional methods.

A 79-year-old man with severe aortic valve stenosis and atrial fibrillation was referred to our department for surgery. Computed tomography revealed persistent left superior vena cava. Lower mini-sternotomy was performed. The left atrial appendage was amputated before ablation of the persistent left superior vena cava. The jaw of the ablation device was passed behind the pulmonary veins using a tip-lighted articulating dissector. Finally, aortic valve replacement was completed. Aortic valve replacement with concomitant pulmonary vein and persistent left superior vena cava ablation via lower mini-sternotomy is a safe and less invasive alternative.

Introduction: Surgical treatment of type A aortic dissection is essentially palliative. Many patients who undergo the procedure still have a dissection flap in the residual aorta, with a persistent patent or partially thrombosed false lumen leaving them susceptible to the dilatation of distal aorta and aneurysm formation.

Methods: Patients who had undergone surgery for type A aortic dissection from January 2015 till December 2022 were recruited into the study. Two follow-up computed tomography scans were performed at least six months apart, the first one at least one month after the surgery.

Results: A persistent dissection flap was found in 34 (68%) patients. All segments of residual distal aorta showed dilatation with time. Growth rate was maximum for abdominal aorta - 3.1 (1.6 - 5.4) mm/year. Patency of false lumen was the only significant factor associated with growth of lower descending thoracic aorta and abdominal aorta (P<0.05). Maximum growth was seen in the patients with partial thrombosis of the false lumen, followed by those with patent false lumen. Two patients with partially thrombosed false lumens required reintervention in the form of endovascular stenting.

Conclusion: Patients after surgery for type A aortic dissection with partially thrombosed false lumens are more prone to aortic dilatation. Regular follow-up of these patients with computed tomography aortogram can lead to timely detection of these sequalae and intervention as needed.

Objective: To assess how efficient the local team attained skills are after several visits made by international missions in respect to number of coronary artery bypass grafting surgery performed and the overall patient outcome.

Methods: This was a retrospective study that included all patients who were operated on at the center after being diagnosed with chronic coronary artery disease from May 2016 to December 2023. Patients' demographic data were retrieved from patients' files coupled with theatre record file, entered into a structured questionnaire, and then, in a statistical program.

Results: A total of 290 patients underwent coronary artery bypass grafting at the center. The international missions performed a total of 159 (54.8%) operations, while the local team operated a total of 131 (45.2%) patients. The study showed significant statistical difference in terms of total operation time (95% confidence interval [CI] = 5.67, 6.01 vs. 95% CI = 6.32, 6.66), aortic cross-clamping time (95% CI = 75.92, 90.00 vs. 95% CI = 111.19, 126.65), and total cardiopulmonary bypass time (95% CI = 115.9, 134.75 vs. 95% CI = 174.52, 201.27) between the international missions and local surgical team, respectively. The mortality rate was higher in patients operated on by the local team (13.7%) than by international missions (8.8%), however there was no statistical difference.

Conclusion: This study has shown the beneficial advantage of international surgical missions to newly established open-heart centers with advanced facilities and skill-deprived team. International surgical missions have greatly contributed to the progression of the center as they oversee and support the programs.

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.