Cardiovascular Surgical Procedures – ABC CARDIOL

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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Editorial

Nothing about Women without Women is for Women

Camila Perez de Souza Arthur et al. Omar Asdrúbal Vilca Mejia

Adjusted analyses show that women have higher mortality rates than men after coronary artery bypass grafting (CABG), in addition to receiving a lower-quality surgical technique.^, Current strategies focus on preoperative optimization and standardization of intra- and postoperative care, as well as including more women in research. Currently, women are underrepresented, reaching up to 16% of the sample in some trials. This reinforces the call for greater equity and greater inclusion of women in research projects, or, on the contrary, for specific studies on women. I believe that we have been slow to reflect on this reality, since female gender has been considered a predictor of mortality in CABG since the publication of CASS in 1981 and has remained constant, including in our setting as part of InsCor. This was once again recognized in this important article by Goncharov et al. Identifying female sex as a predictor of mortality in a single-center and retrospective study with 9,845 patients, where less than 20% were women. However, unlike other studies, the difference in mortality between women and men was lost after pairing.

The propensity score adjusts an analysis based on the observed variables, while randomized studies balance both known and unknown variables. Bias arises when differences in results may be a consequence of secondary characteristics of the patients, and this can be noticeable in a sample spanning almost 3 decades. Within this, perhaps the variable that may have most influenced these results was the inclusion of surgeries combined with CABG and not just CABG alone. Women in general are operated on with more comorbidities and arrive at a more advanced stage for surgery.

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ABC

Original Article

Is Female Gender Associated with Mortality in Coronary Artery Bypass Grafting?

Maxim Goncharov et al. Erlon Oliveira de Abreu Silva Pedro Gabriel Melo de Barros e Silva Fabiane Letícia de Freitas … Adriana Costa Moreira Lucas Tramujas Alexandre Biasi Cavalcanti Ieda Maria Liguori Fabio Biscegli Jatene Ieda Biscegli Jatene Claudia Maria Rodrigues Alves

Abstract

Background

Women undergoing coronary artery bypass grafting (CABG) tend to have worse in-hospital outcomes, but it is unclear whether these differences are due to gender or to clinical factors.

Objective

To compare in-hospital outcomes between women and men undergoing CABG.

Methods

This was a single-center, retrospective observational study analyzing data from 9,845 patients who underwent CABG between 1995 and 2022, of whom 1,947 (19.8%) were women. To evaluate female gender as a prognostic factor for in-hospital mortality, we used descriptive statistics, univariate and multivariate logistic regression, and propensity score matching. The significance level was set at 5%.

Results

Women were older (66.7 vs 62.19 years, p<0.001), had lower body mass index (26.91 vs 27.64, p<0.001), and had a higher prevalence of diabetes mellitus (34.0% vs 31.6%, p=0.045). They also had longer hospital stays (14.84 vs 13.13 days, p<0.001) and higher operative mortality (4.8% vs 2.4%, p<0.001). In logistic regression, female gender was associated with higher mortality (OR=1.51; 95% CI: 1.15-1.99; p=0.003). After matching, there was no significant difference in mortality (OR=1.20; 95% CI: 0.88-1.64; p=0.241), but length of hospital stay remained longer in women.

Conclusion

When clinical factors were matched between men and women, the mortality difference disappeared. This suggests that targeted interventions to reduce disparities may help improve mortality outcomes in women undergoing CABG.

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ABC

Research Letter

Elements for Implementing Perioperative Optimization in Cardiac Surgery Based on Enhanced Recovery after Surgery

Marcelo Jamus Rodrigues et al. Andréa de Fátima Cristino Bastos Crespo Gabrielle Barbosa Borgomoni Fábio Antônio Serra de Lima Júnior … Paola Keese Montanhesi Luiz Fernando Falcão Valter Furlan Omar Asdrúbal Vilca Mejia

Introduction

The optimization of recovery after surgery, as proposed by the Enhanced Recovery After Surgery (ERAS) concept, involves perioperative care aimed at minimizing emotional and physiological stress while accelerating patients’ functional recovery.

ERAS utilizes intervention bundles that, collectively, decrease hospitalization time,^– opioid use, postoperative complications,^, and healthcare expenses.^,

[…]

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ABCIC

Case Report

Percutaneous Closure of the Aortopulmonary Window in an Infant Using an Amplatzer Duct Occluder II Prosthesis

Edmundo Clarindo Oliveira et al. José Augusto Almeida Barbosa Marco Antonio Gonçalves Moura Marcelo Frederigue de Castro … Renata Fonseca Mendoza Maria Carmo Pereira Nunes

Introduction

The Aortopulmonary Window (APW) is a rare congenital malformation, representing approximately 0.2% of all congenital heart diseases. It is typically nonrestrictive and requires early surgical intervention to prevent complications such as pulmonary congestion, respiratory infections, and obstructive pulmonary vascular disease. In cases like ours, where the surgical risk is exceedingly high, percutaneous closure may present a viable alternative.

[…]

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ABCIC

Case Report

Atrial Myxoma in Male Young Adult Patient: A Case Report and Literature Review

Monize Aparecida Gonçalves do Nascimento et al. Eliseu Henrique Bispo Pereira Giovanna Karine Leal Magalhães Laura Souza Mariano … Luana Mireli Carbonera Rodrigues Leonardo Alves Batista Rogério de Paula Garcia Caravante Ayná Emanuelli Alves Barreto

Introduction

Cardiac tumors are found in 0.001% to 0.3% of autopsies, where myxoma is the most common cardiac neoplasia. Approximately 70% appear in the left atrium next to the foramen ovale and are pedunculated. Its pedunculus can be short, limiting its movement, or can be long, allowing tumor movement inside and outside the atrium during the cardiac cycle.^,

Clinical conditions depend on the size, mobility, and location of the tumor. Classic symptoms are related to Goodwin’s triad, which includes unspecific systemic symptoms, embolism and intracardiac obstruction. Among systemic symptoms are dyspnea, orthopnea, paroxysmal nocturnal dyspnea, pulmonary edema, cough, hemoptysis, edema, and fatigue due to obstructive features of neoplasia.^,

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ABC

Original Article

More Hospital Complications in Women after Cabg Even for Reduced Surgical Times: Call to Action for Equity in Quality Improvement

Leonardo Lacava et al. Fabiane Letícia de Freitas Gabrielle Barbosa Borgomoni Pedro Gabriel Melo de Barros e Silva … Marcelo Arruda Nakazone Valquiria Pelisser Campagnucci Marcos Gradim Tiveron Luiz Augusto Lisboa Fabio Biscegli Jatene Omar Asdrúbal Vilca Mejia

Abstract

Background

Analyses of extensive registries indicate adverse outcomes for women undergoing coronary artery bypass grafting (CABG) surgery, while randomized studies often lack representativeness.

Objective

To compare adjusted hospital outcomes between men and women undergoing CABG.

Methods

From July 2017 to June 2019, 3991 patients underwent primary isolated CABG, both electively and urgently, in 5 hospitals in the state of São Paulo, Brazil. To mitigate demographic differences between men and women, populations were adjusted using propensity score matching (PSM). The outcomes considered for analysis were those used by the STS Adult Database. The analyses were performed using R software, with a significance set at p<0.05.

Results

After PSM (1:1), each group included 1089 patients. Regarding intraoperative variables, men exhibited longer cardiopulmonary bypass (CPB) time (p<0.001), surgical time (p<0.001), a higher number of distal anastomoses (p<0.001), and increased use of arterial grafts. Regarding outcomes, women had a higher incidence of deep sternal wound infection (p=0.006), prolonged Intensive Care Unit stay (p=0.002), increased need for an intra-aortic balloon pump (p=0.04), higher blood transfusion rates (p<0.001), higher 30-day hospital readmission rates after surgery (p=0.002) and higher mortality rate (p=0.03).

Conclusions

Although men had longer CPB times, a greater number of arterial grafts, and a greater number of distal anastomoses, immediate results after CABG were poorer in women.

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ABCIC

Case Report

Cardiac Lipoma as an Incidental Finding in Cardiovascular Imaging Exam

Fábio P. Taniguchi et al. Marcelo G. Silas Patrícia M. Oliveira

Introduction

The advent of cardiac imaging has ushered in an era where incidental findings can be detected using less invasive methods, even in asymptomatic patients. The clinical presentation of cardiac masses, characterized by their varying growth rates and diverse locations within the heart, poses a formidable challenge to cardiologists. Therefore, paramount importance lies in reducing the clinical burden and costs, considering the potential of cardiac imaging to optimize the clinical pathway. The most common cardiac masses in the right atrium include thrombi, vegetations, and neoplasia. Approximately 75% of primary tumors are benign, with myxomas comprising 50% of benign cases. Other benign tumors that usually may arise in the right atrium are rhabdomyomas, fibromas, fibroelastomas, and lipomas. Cardiac lipomas are rare, accounting for 2.9% to 8% of all benign cardiac tumors. They rank third in frequency after myxomas and papillary fibroelastomas. The literature suggests that 25% of cardiac lipomas are intramyocardial; 25% are extracavitary of epicardial origin, and 50% are intracavitary of subendocardial origin. Lipomas are well-encapsulated and homogeneous masses composed of mature fat. Although the etiology of cardiac lipomas is unknown, they can originate from any of the three cardiac tissues: subendocardial (the most common), pericardial, or myocardial.

The aim of this report is to present a case of an asymptomatic right atrial lipoma and to discuss the etiology, natural history, and optimal management strategies for right atrial lipomas.

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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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ABC

Original Article

Infective Endocarditis Surgery. Insights from 328 Patients Operated in a University Tertiary Hospital

Marcelo Serafim Jorge et al. Alfredo J. Rodrigues Walter Vilella A. Vicente Paulo Roberto B. Evora

Abstract

Background

Infectious endocarditis (IE) refers to infection of the endocardial surface of the heart and usually occurs in native or prosthetic valves.

Objective

This study aimed to raise IE data reflecting the surgical therapy in a University Hospital in the interior of the State of Sao Paulo–Brazil.

Method

Retrospective and observational approach of 328 patients with IE who underwent surgery between 1982 and 2020

Results

The main data (n=121/37%), congestive heart failure (n=114/35%), valve disease (n=92/28%), diabetes mellitus (n=85/26%), chronic kidney disease (n=59/18%), and rheumatic fever (49/15%). Renal failure is one of the main and most relevant pre-surgical risk factors for a poor prognosis.

Conclusion

For a better clinical and surgical outcome, an early syndromic and etiological diagnosis of IE is necessary, especially in patients with multiple comorbidities.

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ABC

Research Letter

Preparing Patients And Optimizing Processes In The Perioperative Period Of Cardiac Surgery: How To Redesign The Flow Of Care After COVID-19

Omar Asdrúbal Vilca Mejia et al. Bruno Mahler Mioto Gabrielle Barbosa Borgomoni Juliana Mendanha Camilo … Danielle Misumi Watanabe Sirlei Pereira Nunes Vanessa Santos Sallai Maraina Pegorini Libório de Lima Jurema da Silva Herbas Palomo Helenice Moreira da Costa Elisandra Trevisan Arita Maria Ignêz Zanetti Feltrim Vera Coimbra Roger Daglius Dias Filomena Regina Barbosa Gomes Galas José Otávio Costa Auler Junior Fabio Biscegli Jatene

Introduction

The lack of proactive care strategies influences the fragmentation of care, deparametrization of processes and extension of hospital times, while evidence has shown that multidisciplinary protocols based on evidence executed by synchronized teams, with standardized processes, proactivity and patient-centered care decrease complications, hospital times and hospital costs.^, In this context, care based on the Enhanced Recovery After Surgery (ERAS) concept revolutionizes traditional flows. Guidelines for cardiac surgery were recently published, producing encouraging results.^,

This approach showed efficiency and safety in hospital discharge within three days after cardiac surgery,^, which is promising in the COVID-19 era, in which surgical queues have grown due to procedural delays, enabling a greater number of visits in less time, reducing the risk of contamination and hospital costs.

[…]

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ABC

Original Article

Clinical Profile and Outcome of Patients with Cardiac Implantable Electronic Device-Related Infection

Alessandra de Souza Maciel et al. Rose Mary Ferreira Lisboa da Silva

Abstract

Background

In recent years, the incidence of infections related to cardiac implantable electronic devices (CIED) has increased sharply, impacting mortality.

Objective

To verify the proportion of patients with CIED infection; to analyze their clinical profile and the variables related to the infection and its progression.

Methods

Retrospective and longitudinal observational study including 123 patients with CIED infection among 6406 procedures. Parametric tests and a level of significance of 5% were used in the statistical analyses

Results

The mean age of patients was 60.1 years and mean length of stay in hospital was 35.3 days; most (71) patients were male, and the system was completely removed in 105 cases. Infectious endocarditis (IE) and sepsis were observed in 71 and 23 patients, respectively. Intra-hospital mortality was 19.5%. IE was associated with extrusion of the generator (17.0% vs 19.5% with and without IE, respectively, p = 0.04, inverse association) and sepsis (15.4% vs 3.2%, p = 0.01). Intra-hospital death was associated with IE (83.3% vs 52.0% with and without intra-hospital death, respectively, p = 0.005) and sepsis (62.5% vs 8.1%, p < 0.0001). Ninety-nine patients were discharged. During a mean follow-up of 43.8 months, mortality rate was 43%; among patients with sepsis, it was 65.2% (p < 0.0001). By applying a Kaplan-Meier survival curve, we did not indicate significant associations with sex, etiologic agent, ejection fraction, IE, or treatment modality. The death rate was 32.8% for patients subjected to endocardial electrode reimplantation and 52.2% for epicardial reimplantation (p = 0.04). Chagasic etiology (44.7% of the baseline heart diseases) did not influence clinical and laboratory variables or disease progression.

Conclusion

The infection rate was 1.9%, mostly in men. We observed an association of intra-hospital mortality with IE and sepsis. After discharge, the annual mortality rate was 11.8%, influenced by sepsis during hospitalization and epicardial implantation. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)

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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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Case Report

Surgical Epicardial CRT-D Implantation in a Patient with Complete Obstruction of the Superior Vena Cava

Gustavo Lima da Silva et al. Nuno Cortez-Dias João de Sousa Ângelo Nobre Fausto J. Pinto

Introduction

Current guidelines clearly define the subset of heart failure patients who benefit from device implantation. Although first-time trans-venous device implantation has a high success rate, some patients present complex and challenging technical problems.

[…]

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ABC

Original Article

First results of the Brazilian Registry of Percutaneous Left Atrial Appendage Closure

Ênio Eduardo Guérios et al. Francisco Chamié Márcio Montenegro Eduardo Benchimol Saad … Fabio Sandoli de Brito Junior Paulo Avancini Caramori Luiz Carlos Simões Flávio Roberto Azevedo de Oliveira Luiz Carlos Giuliano Cláudio Munhoz da Fontoura Tavares

Abstract

Background:

Left atrial appendage closure (LAAC) is an effective alternative to oral anticoagulation (OA) for the prevention of stroke in patients with non-valvular atrial fibrillation (NVAF).

Objective:

To present the immediate results and late outcomes of patients submitted to LAAC and included in the Brazilian Registry of Percutaneous Left Atrial Appendage Closure.

Methods:

91 patients with NVAF, high stroke risk (CHA₂DS₂VASc score = 4.5 ± 1.5) and restrictions to OAC (HAS-BLED score = 3.6 ± 1.0) underwent 92 LAAC procedures using either the Amplatzer cardiac plug or the Watchman device in 11 centers in Brazil, between late 2010 and mid 2016.

Results:

Ninety-six devices were used (1.04 device/procedure, including an additional non-dedicated device), with a procedural success rate of 97.8%. Associated procedures were performed in 8.7% of the patients. Complete LAAC was obtained in 93.3% of the successful cases. In cases of incomplete closure, no residual leak was larger than 2.5 mm. One patient needed simultaneous implantation of 2 devices. There were 7 periprocedural major (5 pericardial effusions requiring pericardiocentesis, 1 non-dedicated device embolization and 1 coronary air embolism without sequelae) and 4 minor complications. After 128.6 patient-years of follow-up there were 3 deaths unrelated to the procedure, 2 major bleedings (one of them in a patient with an unsuccessful LAAC), thrombus formation over the device in 2 cases (both resolved after resuming OAC for 3 months) and 2 strokes (2.2%).

Conclusions:

In this multicenter, real world registry, that included patients with NVAF and high thromboembolic and bleeding risks, LAAC effectively prevented stroke and bleeding when compared to the expected rates based on CHA₂DS₂VASc and HASBLED scores for this population. Complications rate of the procedure was acceptable considering the beginning of the learning curve of most of the involved operators.

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Artigo Original

Evolution of cardiovascular surgery at the Instituto do Coração: analysis of 71,305 surgeries

Luiz Augusto F. Lisboa et al. Luiz Felipe P. Moreira Omar Vilca Mejia Luís Alberto O. Dallan … Pablo M. A. Pomerantzeff Roberto Costa Luiz B. Puig Fabio B. Jatene Miguel Barbero Marcial Noedir A. G. Stolf

BACKGROUND: Cardiovascular surgery has been undergoing transformations due to the advancement of percutaneous techniques, clinical treatment and primary prevention. OBJECTIVE: Evaluation of incidence and mortality of heart surgeries performed at the Instituto do Coração (InCor-HCFMUSP). METHODS: Using database from the Instituto do Coração, analysis was carried out on cardiovascular surgeries performed between 1984 and 2007, taking into consideration trends of main procedures and of mortality rates. RESULTS: In 24 years, 71,305 heart surgeries were performed, with an annual average of 2971 procedures. The number of coronary artery bypass graft surgeries, which in the 1980s had an average of 856/year, is currently around 1.106/year. Heart valve procedures increased from 400 to 597 surgeries per year, growing 36.7%, when compared to the 1990s. Repair of congenital heart disease also had a significant increase of 50.8% in relation to the last decade. Global mortality average rate, which at baseline was 7.5%, is currently at 7.0% and 4.9% among elective procedures. In coronary artery bypass graft surgery, current average mortality rate is 4.8% and 8.5% in valve surgery. Repair of congenital heart disease accounts for 5.3%. CONCLUSION: Cardiovascular surgery continues increasing. The coronary artery bypass graft is still the most commonly performed surgery. However, profile of procedures has been undergoing changes with the largest increase of approach to cardiac valves and congenital heart disease. Mortality rates are higher when compared to international rates, reflecting the high complexity presented in tertiary service of national reference.

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Artigo Original

Use of centrifugal pump and extracorporeal membrane oxygenation as cardiopulmonary support in pediatric cardiovascular surgery

Fernando A. Atik et al. Rodrigo Santos de Castro Fabiana Moreira Passos Succi Maria Regina Barros … Cristina Afiune Guilherme de Menezes Succi Ricardo B. Corso Cristiano N. Faber Jorge Y. Afiune Luiz Fernando Caneo

BACKGROUND: Extracorporeal membrane oxygenation is a well-documented resuscitation method in patients with severe hemodynamic and/or respiratory impairment. OBJECTIVE: To describe several aspects related to the use of extracorporeal membrane oxygenation in a pediatric heart center and determine its immediate and late outcomes. METHODS: Between October 2005 and January 2007, 10 patients who were submitted to pediatric cardiac surgery underwent extracorporeal membrane oxygenation implant. Median age was 58.5 days (40% neonates) and median body weight was 3.9 kg. Circulatory assistance was initiated aiming at the recovery and the weaning protocols followed daily clinical and echocardiographic criteria. Support was discontinued when transplant was contraindicated, when the patient was unable to recover or when survival was considered to be limited by a multidisciplinary team. RESULTS: Extracorporeal membrane oxygenation was employed after corrective or palliative heart surgery in 80% and preoperatively in the remaining ones. It was most often indicated for irresponsive hemodynamic instability (40%), post-cardiotomy shock (20%) and post-cardiac arrest (20%). The mean duration on support was 58 ± 37 hours. Weaning was successfully in 50% of the cases and 30% were discharged home. Actuarial survival was 40%, 30% and 20% at 30 days, 3 months and 24 months, respectively. CONCLUSION: Extracorporeal membrane oxygenation is an effective and useful tool for the resuscitation of patients presenting severe hemodynamic and/or respiratory failure in the perioperative period of pediatric cardiovascular surgery.

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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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