Cardiovascular Surgical Procedures

IJCS

Original Article

Impact of Updated Guidelines on TAVI Outcomes in a Health Maintenance Organization in Brazil: A Decade-Long Retrospective Study

Maria da Gloria Cruvinel Horta et al. Marcus Carvalho Borin Julia Teixeira Tupinambas Luciano Rios Scherrer … Mateus Goncalves Souza Matheus del-Valle Carina Rejane Martins Daniel Pitchon dos Reis Geraldo Jose Coelho Ribeiro Karina de Castro Zocrato Lelia Maria de Almeida Carvalho Marcela Pinto Freitas Mariana Michel Barbosa Mariza Cristina Torres Talim Fernando Biscione Martin Silvana Marcia Bruschi Kelles

Abstract

Background

Aortic stenosis is a progressive condition that leads to significant morbidity and mortality if untreated. Transcatheter aortic valve implantation (TAVI) provides a less invasive alternative to surgical aortic valve replacement (SAVR), particularly for high-risk patients.

Objectives

This study evaluates the outcomes of TAVI procedures performed in a Health Maintenance Organization (HMO) in Brazil from 2013 to 2023, focusing on the impact of clinical guidelines updated in 2018.

Methods

A retrospective cohort study included 325 patients diagnosed with severe symptomatic aortic stenosis who underwent TAVI. Patients were divided into two groups: those treated before January 2019 (n=56) and those treated from January 2019 onwards (n=269). The primary outcomes included all-cause mortality and major complications, while the secondary outcomes encompassed procedural success rates and specific complication rates. Continuous variables were analyzed using the Mann-Whitney test, and categorical variables were analyzed using the chi-square test or Fisher’s exact test. Statistical significance was defined as p < 0.05.

Results

After January 2019, the shift to self-expanding valves was associated with a statistically significant reduction in pacemaker implantation rates (from 28.6% to 18.2%, p=0.03), whereas other outcomes did not reach statistical significance.

Conclusions

The implementation of updated protocols was associated with improved TAVI outcomes, especially a reduced need for pacemaker implantation, supporting its expanded use in intermediate-risk patients.

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IJCS

Original Article

Impact of the COVID-19 Outbreak on Coronary Artery Bypass Grafting in Brazil

Felipy de Almeida Machado et al. Rui M. S. Almeida

Abstract

Background

The COVID-19 pandemic has disrupted the routine of emergency centers around the world, including in Brazil, where the crisis has affected the volume of major cardiac surgeries such as coronary artery bypass grafting.

Objective

To analyze the impact of the COVID-19 pandemic on the number of surgical procedures for coronary artery bypass grafting in Brazil.

Methods

An ecological, cross-sectional, quantitative, and descriptive study was conducted. Data for the period from July 2018 to June 2019 and from July 2020 to June 2021 were collected from SIHSUS using DATASUS/Tabwin.

Results

A global reduction of 26.58% was observed in the analyzed population, with on-pump coronary artery bypass grafting decreasing by 28.10%, and off-pump coronary artery bypass grafting reduced by only 10.31%.

Conclusion

During the pandemic, there was a 26.58% reduction in the number of surgical procedures for myocardial revascularization in Brazil.

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IJCS

Editorial

Pain after Cardiac Surgery

Tirone E. David

Most cardiac operations are performed via median sternotomy and cardiopulmonary bypass. Both thoracic incision and cardiopulmonary bypass cause major disturbances in the homeostasis of the patient. Disruption of the tissues by the incision initiates an immediate neurological reaction perceived as pain and an intense biochemical and cellular response to repair the wound. Cardiopulmonary bypass causes far more serious systemic changes in homeostasis than pain, and that is probably the main reason why cardiac surgery is behind other surgical specialties in the development of minimally invasive procedures. Pain associated with surgical incision is largely self-limited and resolves with time and, luckily, so do the changes caused by cardiopulmonary bypass. Obviously, surgical incisions that cause less tissue damage are associated with lower degrees of pain and metabolic disturbance than larger and more traumatic incisions.

In this issue of the International Journal of Cardiovascular Sciences, Silva and colleagues, from the University of Fortaleza, Brazil, report a comparative study on postoperative pain following conventional median sternotomy and right mini-thoracotomy. The study has limitations because of the sample size (there were only 17 patients in each arm), the endpoint of the study was largely subjective, and patients were not randomized. However, as one would expect, both groups of patients complained of pain in the first three days but fewer patients with mini-thoracotomy complained of pain by the seventh postoperative day. In addition, mini-thoracotomy was associated with pain of lower intensity, fewer sites, and shorter duration than median sternotomy.

[…]

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IJCS

Original Article

Minimally Invasive Cardiac Surgery versus Sternotomy – Pain Investigation

Juliana Fernandes Silva et al. Marcela Paula Cavalcante Roger Benevides Montenegro Romulo Lira … Emanuel Carvalho Mel Josue Viana Castro

Abstract

Background:

Treatment of postoperative (PO) pain is essential after surgery, as it contributes to a faster rehabilitation. Assessment of PO pain after minimally invasive (MI) surgery has not been regularly addressed, especially when compared with median sternotomy (MS).

Objective:

This study aims to evaluate the intensity of thoracic pain in the PO period in patients subjected to MI surgery and MS.

Methods:

This study compared the intensity of thoracic pain in 34 patients subjected to minimally invasive (MI; n = 17) and median sternotomy (MS; n = 17) from June 2015 to June 2016. The intensity and sites of pain in the PO period, assessed using the visual numeric pain scale, and the need for pain medications were analyzed using the Student’s t-test and the z test, with confidence level of 95% (p < 0.05).

Results:

Almost all patients reported pain on the third PO day (MS = 94.1% and MI = 88.2%; p = 0.5410). On the seventh PO day, there were significantly more patients free of pain in the group of patients subjected to the MI procedure (MS = 94.1% and MI = 64.7%; p = 0.0341). also, these patients reported fewer pain sites (3^rd PO day: MS = 3.2 ± 1.5; MI = 1.5 ± 1.2; p = 0.001; 7^th PO day: MS = 3.1 ± 1.4; MI = 0.9 ± 0.9; p = 0.000). Patients undergoing MS reported higher pain intensity and longer lasting pain (3^rd PO: MS = 4.8 ± 2.2; MI = 3.0 ± 1.6; 7^th PO: MS = 5.3 ± 2.0; MI = 1.2 ± 1.3; p = 0.001), with no difference in pain intensity between the third and the seventh PO days (p = 0.4931). In addition, patients subjected to MI procedure had a significant decrease in pain intensity from the third to the seventh PO days (p = 0.001).

Conclusion:

According to these results, we concluded that a MI procedure leads to lower intensity of pain in the PO period (from the third PO day on) when compared to a MS; also, patients undergoing MI patients reported fewer pain sites.

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ABC

Original Article

Surgical treatment of partial atrioventricular septal defect: functional analysis of the mitral valve in the postoperative period

Josué Viana Castro Neto et al. Paulo Chaccur Cláudio Leo Gelape Eliseu de Sousa Santos … Hélio Carlos Falcão Mário Issa Antoninho Sanfins Arnoni Flávio Sanches Almeida Camilo Abdulmassih Neto Jarbas Jackson Dinkhuysen Luís Carlos Bento Souza Paulo Paredes Paulista

OBJECTIVE: To study mitral valve function in the postoperative period after correction of the partial form of atrioventricular septal defect. METHODS: Fifty patients underwent surgical correction of the partial form of atrioventricular septal defect. Their mean age was 11.8 years and 62% of the patients were males. Preoperative echocardiography showed moderate and severe mitral insufficiency in 44% of the patients. The mitral valve cleft was sutured in 45 (90%) patients (group II – GII). Echocardiographies were performed in the early postoperative period, and 6 and 12 months after hospital discharge. RESULTS: The patients who had some type of arrhythmia in the postoperative period had ostium primum atrial septal defect of a larger size (2.74 x 2.08 cm). All 5 patients in group I (GI), who did not undergo closure of the cleft, had a competent mitral valve or mild mitral insufficiency in the preoperative period. One of these patients began to have moderate mitral insufficiency in the postoperative period. On the other hand, in GII, 88.8% and 82.2% of the patients had competent mitral valve or mild mitral insufficiency in the early and late postoperative periods, respectively. CONCLUSION: The mitral valve cleft was repaired in 90% of cases. Echocardiography revealed competent mitral valve or mild mitral insufficiency in 88.8% and 82.2% of GII patients in the early and late postoperative periods, respectively.

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