Pub Date : 2023-10-27DOI: 10.21470/1678-9741-2022-0179
Dmitri Panfilov, Victor Saushkin, Svetlana Sazonova, Boris Kozlov
Introduction: According to recent data, thoracic aortic surgery has reduced morbidity and mortality including ascending aortic aneurysm treatment; however, women are at increased postoperative risk of adverse outcomes.
Objective: Our aim was to evaluate early and late outcomes in male and female patients who underwent pre-emptive ascending aortic replacement (AAR).
Methods: From January 2013 to September 2021, 91 patients (56 [61.5%] men and 35 [38.5%] women) underwent AAR for small (ranged from 5.0 to 5.5 cm) non-syndromic aneurysms. A propensity score-based adjustment of the groups was performed. We compared clinical outcomes between males and females.
Results: Preoperative normalized aortic diameters were significantly larger in females (2.9 [2.7; 3.2] cm/m2) than in males (2.5 [2.3; 2.6] cm/m2, P<0.001), without differences in absolute values (51 [49; 53] mm vs. 52 [50; 53] mm, P=0.356). There were no significant differences in neurological, cardiac, pulmonary, and renal complications in both groups before and after matching. In-hospital mortality was 1 (1.8%) and 2 (5.7%) (P=0.307) in male and female patients in unmatched groups and 1 (2.9%) and 2 (5.7%) (P=0.553) in matched groups, respectively. Univariate logistic regression analysis revealed that the only risk factor for in-hospital mortality was age (odds ratio 1.117, 95% confidence interval 1.003-1.244; P=0.04). The overall survival rate was 83.5±0.06% in men and 94.3±0.04% in women at 36 months (P=0.404).
Conclusion: Ascending aortic surgery for aneurysms ranged from 5.0 to 5.5 cm seems to have tolerable early and late outcomes in men and women.
{"title":"Ascending Aortic Surgery for Small Aneurysms in Men and Women.","authors":"Dmitri Panfilov, Victor Saushkin, Svetlana Sazonova, Boris Kozlov","doi":"10.21470/1678-9741-2022-0179","DOIUrl":"10.21470/1678-9741-2022-0179","url":null,"abstract":"<p><strong>Introduction: </strong>According to recent data, thoracic aortic surgery has reduced morbidity and mortality including ascending aortic aneurysm treatment; however, women are at increased postoperative risk of adverse outcomes.</p><p><strong>Objective: </strong>Our aim was to evaluate early and late outcomes in male and female patients who underwent pre-emptive ascending aortic replacement (AAR).</p><p><strong>Methods: </strong>From January 2013 to September 2021, 91 patients (56 [61.5%] men and 35 [38.5%] women) underwent AAR for small (ranged from 5.0 to 5.5 cm) non-syndromic aneurysms. A propensity score-based adjustment of the groups was performed. We compared clinical outcomes between males and females.</p><p><strong>Results: </strong>Preoperative normalized aortic diameters were significantly larger in females (2.9 [2.7; 3.2] cm/m2) than in males (2.5 [2.3; 2.6] cm/m2, P<0.001), without differences in absolute values (51 [49; 53] mm vs. 52 [50; 53] mm, P=0.356). There were no significant differences in neurological, cardiac, pulmonary, and renal complications in both groups before and after matching. In-hospital mortality was 1 (1.8%) and 2 (5.7%) (P=0.307) in male and female patients in unmatched groups and 1 (2.9%) and 2 (5.7%) (P=0.553) in matched groups, respectively. Univariate logistic regression analysis revealed that the only risk factor for in-hospital mortality was age (odds ratio 1.117, 95% confidence interval 1.003-1.244; P=0.04). The overall survival rate was 83.5±0.06% in men and 94.3±0.04% in women at 36 months (P=0.404).</p><p><strong>Conclusion: </strong>Ascending aortic surgery for aneurysms ranged from 5.0 to 5.5 cm seems to have tolerable early and late outcomes in men and women.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10610907/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54232682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-27DOI: 10.21470/1678-9741-2023-0111
Jenny Lourdes Rivas de Oliveira, Magaly Arrais Dos Santos, Ari Timerman
Introduction: Systemic inflammatory response syndrome (SIRS) is related to increased circulating endothelial microparticles (EMP).
Objective: The aim of this study was to compare the plasma concentration of EMP between patients undergoing aortic valve replacement with conventional bioprosthesis implantation and Perceval™ S (LivaNova) and to evaluate its impact on the inflammatory response in the short-term follow-up.
Methods: This is a randomized clinical trial with 24 patients submitted to isolated aortic valve replacement divided into two groups: Perceval™ S (Group P) and conventional bioprostheses (Group C). Incidence of severe SIRS (three or more criteria) in the first 48 hours postoperatively, EMP release profile, interleukins (IL) 6 and 8, C-reactive protein, and procalcitonin were analyzed preand postoperatively at 24 hours and three months.
Results: There were 24 patients (12 in each group), mean age was 69.92±5.17 years, 83.33% were female, the incidence of severe SIRS was 66.7% and 50% in groups C and P, respectively (P=0.68), and EMP showed a significant increase in the 24-hour postoperative period (P≤0.001) and subsequent decrease in the three-month postoperative period (P≤0.001), returning to baseline levels. For IL-6 and IL-8, there was a greater increase in group C at 24 hours postoperatively (P=.0.02 and P<0.001).
Conclusion: The incidence of severe SIRS was similar in both groups, with significantly higher levels of IL-6 and IL-8, at the 24-hour postoperative period, in group C, however with higher levels of EMP in group P, and subsequent return to baseline levels at the three-month postoperative period in both groups.
{"title":"Endothelial Microparticles: Markers of Inflammatory Response After Sutureless Valve Implantation.","authors":"Jenny Lourdes Rivas de Oliveira, Magaly Arrais Dos Santos, Ari Timerman","doi":"10.21470/1678-9741-2023-0111","DOIUrl":"10.21470/1678-9741-2023-0111","url":null,"abstract":"<p><strong>Introduction: </strong>Systemic inflammatory response syndrome (SIRS) is related to increased circulating endothelial microparticles (EMP).</p><p><strong>Objective: </strong>The aim of this study was to compare the plasma concentration of EMP between patients undergoing aortic valve replacement with conventional bioprosthesis implantation and Perceval™ S (LivaNova) and to evaluate its impact on the inflammatory response in the short-term follow-up.</p><p><strong>Methods: </strong>This is a randomized clinical trial with 24 patients submitted to isolated aortic valve replacement divided into two groups: Perceval™ S (Group P) and conventional bioprostheses (Group C). Incidence of severe SIRS (three or more criteria) in the first 48 hours postoperatively, EMP release profile, interleukins (IL) 6 and 8, C-reactive protein, and procalcitonin were analyzed preand postoperatively at 24 hours and three months.</p><p><strong>Results: </strong>There were 24 patients (12 in each group), mean age was 69.92±5.17 years, 83.33% were female, the incidence of severe SIRS was 66.7% and 50% in groups C and P, respectively (P=0.68), and EMP showed a significant increase in the 24-hour postoperative period (P≤0.001) and subsequent decrease in the three-month postoperative period (P≤0.001), returning to baseline levels. For IL-6 and IL-8, there was a greater increase in group C at 24 hours postoperatively (P=.0.02 and P<0.001).</p><p><strong>Conclusion: </strong>The incidence of severe SIRS was similar in both groups, with significantly higher levels of IL-6 and IL-8, at the 24-hour postoperative period, in group C, however with higher levels of EMP in group P, and subsequent return to baseline levels at the three-month postoperative period in both groups.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10610908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54232683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-27DOI: 10.21470/1678-9741-2022-0344
Pablo Salazar Elizalde, German J Chaud, Joaquín Gundelach, Barbara Gaete, Marcos Durand, Ignacio Cuadra, Sinthya Provoste, Enrique Yanten, Marcelo Tiznado, Cristóbal Alvarado
Introduction: Extracorporeal membrane oxygenation (ECMO) is the first-line therapy for temporary mechanical circulatory support allowing cardiac and pulmonary recovery or as a bridge to further therapeutic alternatives. The aim of this study was to report clinical outcomes in adult patients with refractory cardiac failure after open-heart surgery undergoing ECMO in a single center with an ECMO unit in Chile.
Methods: We retrospectively analyzed adults with refractory cardiac failure after open-heart surgery who required a venoarterial (VA) ECMO between 2016 and 2021.
Results: Of 16 patients with VA ECMO, 60% were men (n=10), 90% had hypertension (n=14), 69% had < 30% of left ventricular ejection fraction (n=11), and the mean European System for Cardiac Operative Risk Evaluation II score was 12 ± 11%. ECMO support with central cannulation accounts for 81% (n=13), and an intra-aortic balloon pump was used in nine patients (56%). The mean time of support was 4.7 ± 2.6 days (1.5 - 12 days). ECMO weaning was achieved in 88% of patients, and in-hospital mortality was 44% (n=7) after discharge. The freedom from all-cause mortality at one year of follow-up of the entire cohort was 38% (n=6).
Conclusion: VA ECMO is now a well-known life-saving therapeutic option, but mortality and morbidity remain high. Implementation of an ECMO program with educational training is mandatory in order to find the proper balance between patient benefits, ethical considerations, and public health financial input in South America.
{"title":"Extracorporeal Membrane Oxygenation Uses in Refractory Cardiogenic Shock After Open-Heart Surgery.","authors":"Pablo Salazar Elizalde, German J Chaud, Joaquín Gundelach, Barbara Gaete, Marcos Durand, Ignacio Cuadra, Sinthya Provoste, Enrique Yanten, Marcelo Tiznado, Cristóbal Alvarado","doi":"10.21470/1678-9741-2022-0344","DOIUrl":"10.21470/1678-9741-2022-0344","url":null,"abstract":"<p><strong>Introduction: </strong>Extracorporeal membrane oxygenation (ECMO) is the first-line therapy for temporary mechanical circulatory support allowing cardiac and pulmonary recovery or as a bridge to further therapeutic alternatives. The aim of this study was to report clinical outcomes in adult patients with refractory cardiac failure after open-heart surgery undergoing ECMO in a single center with an ECMO unit in Chile.</p><p><strong>Methods: </strong>We retrospectively analyzed adults with refractory cardiac failure after open-heart surgery who required a venoarterial (VA) ECMO between 2016 and 2021.</p><p><strong>Results: </strong>Of 16 patients with VA ECMO, 60% were men (n=10), 90% had hypertension (n=14), 69% had < 30% of left ventricular ejection fraction (n=11), and the mean European System for Cardiac Operative Risk Evaluation II score was 12 ± 11%. ECMO support with central cannulation accounts for 81% (n=13), and an intra-aortic balloon pump was used in nine patients (56%). The mean time of support was 4.7 ± 2.6 days (1.5 - 12 days). ECMO weaning was achieved in 88% of patients, and in-hospital mortality was 44% (n=7) after discharge. The freedom from all-cause mortality at one year of follow-up of the entire cohort was 38% (n=6).</p><p><strong>Conclusion: </strong>VA ECMO is now a well-known life-saving therapeutic option, but mortality and morbidity remain high. Implementation of an ECMO program with educational training is mandatory in order to find the proper balance between patient benefits, ethical considerations, and public health financial input in South America.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10611424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54232693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-27DOI: 10.21470/1678-9741-2023-0012
Tomasz Stankowski, Sleiman Sebastian Aboul-Hassan, Mohammed Salem, Kristin Rochor, Soeren Schenk, Temirlan Erkenov, Farzaneh Seifi Zinab, Anja Muehle, Volker Herwig, Axel Harnath, Michel Pompeu Sá, Basel Ramlawi, Dirk Fritzsche, Bartłomiej Perek
Introduction: The impact of mitral regurgitation (MR) on valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) in patients with failed bioprostheses remains unclear. The purpose of this study was to assess the prognostic impact of residual moderate MR following VIV-TAVI.
Methods: We retrospectively analyzed 127 patients who underwent VIV-TAVI between March 2010 and November 2021. At least moderate MR was observed in 51.2% of patients before the procedure, and MR improved in 42.1% of all patients. Patients with postoperative severe MR, previous mitral valve intervention, and patients who died before postoperative echocardiography were excluded from further analyses. The remaining 114 subjects were divided into two groups according to the degree of postprocedural MR: none-mild MR (73.7%) or moderate MR (26.3%). Propensity score matching yielded 23 pairs for final comparison.
Results: No significant differences were found between groups before and after matching in early results. In the matched cohort, survival probabilities at one, three, and five years were 95.7% vs. 87.0%, 85.0% vs. 64.5%, and 85.0% vs. 29.0% in the none-mild MR group vs. moderate MR-group, respectively (log-rank P=0.035). Among survivors, patients with moderate MR had worse functional status according to New York Heart Association (NYHA) class at follow-up (P=0.006).
Conclusion: MR is common in patients with failed aortic bioprostheses, and improvement in MR-status was observed in over 40% of patients following VIV-TAVI. Residual moderate MR after VIV-TAVI is not associated with worse early outcomes, however, it was associated with increased mortality at five years of follow-up and worse NYHA class among survivors.
{"title":"Prognostic Impact of Residual Moderate Mitral Regurgitation Following Valve-in-Valve Transcatheter Aortic Valve Implantation.","authors":"Tomasz Stankowski, Sleiman Sebastian Aboul-Hassan, Mohammed Salem, Kristin Rochor, Soeren Schenk, Temirlan Erkenov, Farzaneh Seifi Zinab, Anja Muehle, Volker Herwig, Axel Harnath, Michel Pompeu Sá, Basel Ramlawi, Dirk Fritzsche, Bartłomiej Perek","doi":"10.21470/1678-9741-2023-0012","DOIUrl":"10.21470/1678-9741-2023-0012","url":null,"abstract":"<p><strong>Introduction: </strong>The impact of mitral regurgitation (MR) on valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) in patients with failed bioprostheses remains unclear. The purpose of this study was to assess the prognostic impact of residual moderate MR following VIV-TAVI.</p><p><strong>Methods: </strong>We retrospectively analyzed 127 patients who underwent VIV-TAVI between March 2010 and November 2021. At least moderate MR was observed in 51.2% of patients before the procedure, and MR improved in 42.1% of all patients. Patients with postoperative severe MR, previous mitral valve intervention, and patients who died before postoperative echocardiography were excluded from further analyses. The remaining 114 subjects were divided into two groups according to the degree of postprocedural MR: none-mild MR (73.7%) or moderate MR (26.3%). Propensity score matching yielded 23 pairs for final comparison.</p><p><strong>Results: </strong>No significant differences were found between groups before and after matching in early results. In the matched cohort, survival probabilities at one, three, and five years were 95.7% vs. 87.0%, 85.0% vs. 64.5%, and 85.0% vs. 29.0% in the none-mild MR group vs. moderate MR-group, respectively (log-rank P=0.035). Among survivors, patients with moderate MR had worse functional status according to New York Heart Association (NYHA) class at follow-up (P=0.006).</p><p><strong>Conclusion: </strong>MR is common in patients with failed aortic bioprostheses, and improvement in MR-status was observed in over 40% of patients following VIV-TAVI. Residual moderate MR after VIV-TAVI is not associated with worse early outcomes, however, it was associated with increased mortality at five years of follow-up and worse NYHA class among survivors.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10610905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54232695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-27DOI: 10.21470/1678-9741-2022-0461
Akram Abawi, Anders Magnuson, Ole Fröbert, Ninos Samano
Introduction: There is no consensus on the impact of coronary artery disease in patients undergoing transcatheter aortic valve implantation. Therefore, the objective of this study was, in a single-center setting, to evaluate the five-year outcome of transcatheter aortic valve implantation patients with or without coronary artery disease.
Methods: All transcatheter aortic valve implantation patients between 2009 and 2019 were included and grouped according to the presence or absence of coronary artery disease. The primary endpoint, five-year all-cause mortality, was evaluated using Cox regression adjusted for age, sex, procedure years, and comorbidities. Comorbidities interacting with coronary artery disease were evaluated with interaction tests. In-hospital complications was the secondary endpoint.
Results: In total, 176 patients had aortic stenosis and concomitant coronary artery disease, while 170 patients had aortic stenosis only. Mean follow-up was 2.2±1.6 years. There was no difference in the adjusted five-year all-cause mortality between transcatheter aortic valve implantation patients with and without coronary artery disease (hazard ratio 1.00, 95% confidence interval 0.59-1.70, P=0.99). In coronary artery disease patients, impaired renal function, peripheral arterial disease, or ejection fraction < 50% showed a significant interaction effect with higher five-year all-cause mortality. No significant differences in complications between the groups were found.
Conclusion: Five-year mortality did not differ between transcatheter aortic valve implantation patients with or without coronary artery disease. However, in patients with coronary artery disease and impaired renal function, peripheral arterial disease, or ejection fraction < 50%, we found significantly higher five-year all-cause mortality.
{"title":"Five-Year Follow-Up After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis and Concomitant Coronary Artery Disease: A Single-Center Experience.","authors":"Akram Abawi, Anders Magnuson, Ole Fröbert, Ninos Samano","doi":"10.21470/1678-9741-2022-0461","DOIUrl":"10.21470/1678-9741-2022-0461","url":null,"abstract":"<p><strong>Introduction: </strong>There is no consensus on the impact of coronary artery disease in patients undergoing transcatheter aortic valve implantation. Therefore, the objective of this study was, in a single-center setting, to evaluate the five-year outcome of transcatheter aortic valve implantation patients with or without coronary artery disease.</p><p><strong>Methods: </strong>All transcatheter aortic valve implantation patients between 2009 and 2019 were included and grouped according to the presence or absence of coronary artery disease. The primary endpoint, five-year all-cause mortality, was evaluated using Cox regression adjusted for age, sex, procedure years, and comorbidities. Comorbidities interacting with coronary artery disease were evaluated with interaction tests. In-hospital complications was the secondary endpoint.</p><p><strong>Results: </strong>In total, 176 patients had aortic stenosis and concomitant coronary artery disease, while 170 patients had aortic stenosis only. Mean follow-up was 2.2±1.6 years. There was no difference in the adjusted five-year all-cause mortality between transcatheter aortic valve implantation patients with and without coronary artery disease (hazard ratio 1.00, 95% confidence interval 0.59-1.70, P=0.99). In coronary artery disease patients, impaired renal function, peripheral arterial disease, or ejection fraction < 50% showed a significant interaction effect with higher five-year all-cause mortality. No significant differences in complications between the groups were found.</p><p><strong>Conclusion: </strong>Five-year mortality did not differ between transcatheter aortic valve implantation patients with or without coronary artery disease. However, in patients with coronary artery disease and impaired renal function, peripheral arterial disease, or ejection fraction < 50%, we found significantly higher five-year all-cause mortality.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10610330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"54232694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-23DOI: 10.21470/1678-9741-2023-0145
Cem Atik, Derya Atik
Introduction: In this study, it was aimed to compare the clinical results and complications of rigid titanium plate reinforcement and only conventional wire methods for sternum fixation in morbidly obese patients who underwent sternotomy for open-heart surgery.
Methods: The study was planned as a retrospective case-control study. Morbidly obese patients who underwent open-heart surgery with median sternotomy between 2011 and 2021 were analyzed retrospectively.
Results: There was no statistically significant difference between the two groups in terms of characteristics of the patients (P≥0.05). Sternal dehiscence, sternum revision, wound drainage, and mediastinitis were significantly less common in the titanium plate group (P≤0.05). There was no statistically significant difference between the groups in terms of 30-day mortality (P≥0.05).
Conclusion: Rigid titanium plate reinforcement application produced more positive clinical results than only conventional wire application. In addition, it was determined that although the rigid titanium plate application prolonged the operation time, it did not make a significant difference in terms of mortality and morbidity compared to the conventional wire applied group.
{"title":"The Results of Rigid Titanium Plate Reinforcement and Only Conventional Wire Methods in Sternal Fixation in Morbidly Obese Patients.","authors":"Cem Atik, Derya Atik","doi":"10.21470/1678-9741-2023-0145","DOIUrl":"10.21470/1678-9741-2023-0145","url":null,"abstract":"<p><strong>Introduction: </strong>In this study, it was aimed to compare the clinical results and complications of rigid titanium plate reinforcement and only conventional wire methods for sternum fixation in morbidly obese patients who underwent sternotomy for open-heart surgery.</p><p><strong>Methods: </strong>The study was planned as a retrospective case-control study. Morbidly obese patients who underwent open-heart surgery with median sternotomy between 2011 and 2021 were analyzed retrospectively.</p><p><strong>Results: </strong>There was no statistically significant difference between the two groups in terms of characteristics of the patients (P≥0.05). Sternal dehiscence, sternum revision, wound drainage, and mediastinitis were significantly less common in the titanium plate group (P≤0.05). There was no statistically significant difference between the groups in terms of 30-day mortality (P≥0.05).</p><p><strong>Conclusion: </strong>Rigid titanium plate reinforcement application produced more positive clinical results than only conventional wire application. In addition, it was determined that although the rigid titanium plate application prolonged the operation time, it did not make a significant difference in terms of mortality and morbidity compared to the conventional wire applied group.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10594697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49694779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-23DOI: 10.21470/1678-9741-2023-0144
Lishuang Ji, Le Wang, Xuecheng Song, Mei Wei, Min Li, Mingqi Zheng, Gang Liu
Objective: To investigate the risk factors for predicting atrial high-rate episodes (AHREs) detected by cardiac implantable electronic devices (CIEDs).
Methods: A total of 140 patients with CIED in our hospital from June 2013 to June 2018 were included and were followed up to observe whether they had AHREs. AHRE are defined as atrial rate ≥ 175 times/minute, lasting > 5 minutes, and reviewed by an experienced electrophysiologist with unclear clinical diagnosis. The patients fasted for 12 hours after implantation, and blood samples were collected for biochemical, lipid, and whole blood count detection. Follow-up was regular after discharge to record follow-up data of each patient and conduct statistical analysis.
Results: One hundred and forty patients were implanted with dual-chamber pacemakers, their median age was 70 years old, 44.29% were male, 27 patients had AHRE within one year, and AHRE incidence rate was 19.29%. The microcytic to hypochromic (M/H) ratio was calculated for all AHRE patients and compared with the patients without AHRE; the M/H value of AHRE patients was significantly higher. Throughout the entire follow-up period, a total of 44 patients developed AHRE; when adjusted by multivariate analysis, only M/H ratio ≥ 4.5 vs. < 4.5 had statistical significance, and the adjusted hazard ratio value was 4.313 (1.675-11.105).
Conclusion: As an indicator, M/H ratio may play an important role in the occurrence and development of atrial fibrillation and can be used as a predictor of AHRE in patients with CIED.
{"title":"Monocyte/High-Density Lipoprotein Ratio Is Associated with Atrial High-Rate Episodes within One Year Detected by Cardiac Implantable Electronic Devices.","authors":"Lishuang Ji, Le Wang, Xuecheng Song, Mei Wei, Min Li, Mingqi Zheng, Gang Liu","doi":"10.21470/1678-9741-2023-0144","DOIUrl":"10.21470/1678-9741-2023-0144","url":null,"abstract":"<p><strong>Objective: </strong>To investigate the risk factors for predicting atrial high-rate episodes (AHREs) detected by cardiac implantable electronic devices (CIEDs).</p><p><strong>Methods: </strong>A total of 140 patients with CIED in our hospital from June 2013 to June 2018 were included and were followed up to observe whether they had AHREs. AHRE are defined as atrial rate ≥ 175 times/minute, lasting > 5 minutes, and reviewed by an experienced electrophysiologist with unclear clinical diagnosis. The patients fasted for 12 hours after implantation, and blood samples were collected for biochemical, lipid, and whole blood count detection. Follow-up was regular after discharge to record follow-up data of each patient and conduct statistical analysis.</p><p><strong>Results: </strong>One hundred and forty patients were implanted with dual-chamber pacemakers, their median age was 70 years old, 44.29% were male, 27 patients had AHRE within one year, and AHRE incidence rate was 19.29%. The microcytic to hypochromic (M/H) ratio was calculated for all AHRE patients and compared with the patients without AHRE; the M/H value of AHRE patients was significantly higher. Throughout the entire follow-up period, a total of 44 patients developed AHRE; when adjusted by multivariate analysis, only M/H ratio ≥ 4.5 vs. < 4.5 had statistical significance, and the adjusted hazard ratio value was 4.313 (1.675-11.105).</p><p><strong>Conclusion: </strong>As an indicator, M/H ratio may play an important role in the occurrence and development of atrial fibrillation and can be used as a predictor of AHRE in patients with CIED.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10593409/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49694778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-06DOI: 10.21470/1678-9741-2022-0398
Jianwei Wang, Shengshu Wang, Yang Song, MingJun Huang, Wenzhe Cao, Shaohua Liu, Shimin Chen, Xuehang Li, Miao Liu, Yao He
Objective: To explore the factors affecting short-term prognosis of circulatory failure patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) treatment.
Methods: A total of 136 patients undergoing VA-ECMO were enrolled in this study and subsequently divided into the death group (n=35) and the survival group (n=101) based on whether death occurred during hospitalisation. Extracorporeal membrane oxygenation (ECMO) running time, length of intensive care unit stay, length of hospital stay, costs, and ECMO complications were then compared between the two groups.
Results: The average age of all patients undergoing ECMO was 47.64±16.78 years (53.2±16.20 years in the death group and 45.713±16.62 years in the survival group) (P=0.022). Patients in the survival group exhibited a clear downward trend in lactic acid value following ECMO treatment compared to those in the death group. Total hospitalisation stay was longer in the survival group (35 days) than in the death group (15.5 days) (P<0.001). In the analysis of ECMO complications, the incidence of neurological complications, renal failure, limb complications, and infection were higher in the death group than in the survival group (P<0.05 for all). Specifically, as a risk factor for patient survival and discharge, the occurrence of infection will lead to increased hospitalisation stays and costs (P<0.05 for both).
Conclusion: Complications such as kidney failure and infection are associated with in-hospital death, and ECMO-related complications should be actively prevented to improve the survival rate of VA-ECMO treatment.
{"title":"Analysis of 24-hour Death Risk Factors in Circulatory Failure Patients Treated with Venoarterial Extracorporeal Membrane Oxygenation.","authors":"Jianwei Wang, Shengshu Wang, Yang Song, MingJun Huang, Wenzhe Cao, Shaohua Liu, Shimin Chen, Xuehang Li, Miao Liu, Yao He","doi":"10.21470/1678-9741-2022-0398","DOIUrl":"10.21470/1678-9741-2022-0398","url":null,"abstract":"<p><strong>Objective: </strong>To explore the factors affecting short-term prognosis of circulatory failure patients undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO) treatment.</p><p><strong>Methods: </strong>A total of 136 patients undergoing VA-ECMO were enrolled in this study and subsequently divided into the death group (n=35) and the survival group (n=101) based on whether death occurred during hospitalisation. Extracorporeal membrane oxygenation (ECMO) running time, length of intensive care unit stay, length of hospital stay, costs, and ECMO complications were then compared between the two groups.</p><p><strong>Results: </strong>The average age of all patients undergoing ECMO was 47.64±16.78 years (53.2±16.20 years in the death group and 45.713±16.62 years in the survival group) (P=0.022). Patients in the survival group exhibited a clear downward trend in lactic acid value following ECMO treatment compared to those in the death group. Total hospitalisation stay was longer in the survival group (35 days) than in the death group (15.5 days) (P<0.001). In the analysis of ECMO complications, the incidence of neurological complications, renal failure, limb complications, and infection were higher in the death group than in the survival group (P<0.05 for all). Specifically, as a risk factor for patient survival and discharge, the occurrence of infection will lead to increased hospitalisation stays and costs (P<0.05 for both).</p><p><strong>Conclusion: </strong>Complications such as kidney failure and infection are associated with in-hospital death, and ECMO-related complications should be actively prevented to improve the survival rate of VA-ECMO treatment.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10550103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41172097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-06DOI: 10.21470/1678-9741-2023-0074
Carlos J T Karigyo, Jeison W G Fonseca, André G Boscarato, Mônica M S Matsumoto, Aron J P Andrade
Heart transplantation (HTx) continues to be the gold standard therapy for advanced heart failure refractory to the conservative treatment. Nonetheless, HTx remains as a limited procedure in face of shortage of donors and poor medical conditions that many potential recipients carry or develop over the natural history of the disease. Because of these factors, several patients get their clinical status worsened at the transplant waiting list, and even though with a prioritization path, many of them deteriorate to an unfavorable scenario to receive a heart[1]. The application of mechanical circulatory support devices aims to maintain alive and stable the patients who develop severe clinical conditions that could disable them from receiving a heart in a short term, serving as a bridge therapeutic strategy (bridge-to-transplantation [BTT])[1]. Historically, artificial pumps were developed to support and provide adequate perfusion for patients with difficult weaning from cardiopulmonary bypass (CPB) after heart operations, becoming useful for giving hemodynamic support to bridge transplant candidates when HTx era started in the 1960s. Briefly, left ventricular assist devices (LVADs) were composed by pulsatile pumps, evolving to implantable continuous-flow axial pumps and posteriorly to continuous-flow centrifugal pumps. Currently, LVADs are an accepted therapy in many countries and commonly applied to a variety of heart diseases that lead to circulatory failure, serving not just for BTT strategy, but for bridgeto-decision, bridge-to-recovery, or for destination therapy[2]. 1Centro de Engenharia em Assistência Circulatória, Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil. 2Programa de Pós-graduação em Medicina/Tecnologia e Intervenção em Cardiologia, Universidade de São Paulo, São Paulo, São Paulo, Brazil. 3Programa de Pós-graduação em Ciência Animal com Ênfase em Produtos Bioativos, Universidade Paranaense, Umuarama, Paraná, Brazil. 4Clínica Cirúrgica de Grandes Animais, Hospital Veterinário, Universidade Paranaense, Umuarama, Paraná, Brazil. 5Medical Electrical Devices Laboratory, Electronics Engineering Division, Instituto Tecnológico de Aeronáutica, São José dos Campos, São Paulo, Brazil.
{"title":"Ventricular Assist Device Research and Development in Brazil: A Long and Promising Relationship Between Medicine and Engineering.","authors":"Carlos J T Karigyo, Jeison W G Fonseca, André G Boscarato, Mônica M S Matsumoto, Aron J P Andrade","doi":"10.21470/1678-9741-2023-0074","DOIUrl":"10.21470/1678-9741-2023-0074","url":null,"abstract":"Heart transplantation (HTx) continues to be the gold standard therapy for advanced heart failure refractory to the conservative treatment. Nonetheless, HTx remains as a limited procedure in face of shortage of donors and poor medical conditions that many potential recipients carry or develop over the natural history of the disease. Because of these factors, several patients get their clinical status worsened at the transplant waiting list, and even though with a prioritization path, many of them deteriorate to an unfavorable scenario to receive a heart[1]. The application of mechanical circulatory support devices aims to maintain alive and stable the patients who develop severe clinical conditions that could disable them from receiving a heart in a short term, serving as a bridge therapeutic strategy (bridge-to-transplantation [BTT])[1]. Historically, artificial pumps were developed to support and provide adequate perfusion for patients with difficult weaning from cardiopulmonary bypass (CPB) after heart operations, becoming useful for giving hemodynamic support to bridge transplant candidates when HTx era started in the 1960s. Briefly, left ventricular assist devices (LVADs) were composed by pulsatile pumps, evolving to implantable continuous-flow axial pumps and posteriorly to continuous-flow centrifugal pumps. Currently, LVADs are an accepted therapy in many countries and commonly applied to a variety of heart diseases that lead to circulatory failure, serving not just for BTT strategy, but for bridgeto-decision, bridge-to-recovery, or for destination therapy[2]. 1Centro de Engenharia em Assistência Circulatória, Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil. 2Programa de Pós-graduação em Medicina/Tecnologia e Intervenção em Cardiologia, Universidade de São Paulo, São Paulo, São Paulo, Brazil. 3Programa de Pós-graduação em Ciência Animal com Ênfase em Produtos Bioativos, Universidade Paranaense, Umuarama, Paraná, Brazil. 4Clínica Cirúrgica de Grandes Animais, Hospital Veterinário, Universidade Paranaense, Umuarama, Paraná, Brazil. 5Medical Electrical Devices Laboratory, Electronics Engineering Division, Instituto Tecnológico de Aeronáutica, São José dos Campos, São Paulo, Brazil.","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10550219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41159094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-06DOI: 10.21470/1678-9741-2021-0428
Nabil Dib, Raphael Martins, Erwan Flécher
Ventricular fibrillation (VF) is a deadly rhythm problem. With asystole, it represents one of the most extreme emergencies that may engage vital prognosis within only few minutes if appropriated treatment is not instituted. It is learned in all medical schools worldwide that VF is not compatible with consciousness and sustained life. Moreover, at 37°C, and without restauration of cardiac flow, VF may be responsible for severe and most often irreversible brain damage after 3 minutes.
{"title":"Ventricular Fibrillation Is a Sign of Life.","authors":"Nabil Dib, Raphael Martins, Erwan Flécher","doi":"10.21470/1678-9741-2021-0428","DOIUrl":"10.21470/1678-9741-2021-0428","url":null,"abstract":"<p><p>Ventricular fibrillation (VF) is a deadly rhythm problem. With asystole, it represents one of the most extreme emergencies that may engage vital prognosis within only few minutes if appropriated treatment is not instituted. It is learned in all medical schools worldwide that VF is not compatible with consciousness and sustained life. Moreover, at 37°C, and without restauration of cardiac flow, VF may be responsible for severe and most often irreversible brain damage after 3 minutes.</p>","PeriodicalId":72457,"journal":{"name":"Brazilian journal of cardiovascular surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10557982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41174742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}