Intraoperative Care – ABC CARDIOL

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Editorial

Myocardial Protection in Cardiac Surgery – What is the Ideal Method?

The study of myocardial protection has improved together with cardiac surgery, aiming to prevent intraoperative myocardial injury, which can lead to ventricular dysfunction, arrhythmias, low cardiac output and other complications, often irreversible ones.

Since the first cardiac surgeries with cardiopulmonary bypass (CPB) in 1953 performed by Dr. Gibbon at Massachusetts General Hospital, several methods of myocardial protection have been studied, allowing more extensive cardiac surgeries to be performed, with longer aortic clamping time. In the first surgeries, hypothermia was the method used for myocardial protection, but it showed to be insufficient for longer periods of ischemia.

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Original Article

Factors Associated with Inadequate Management of Antiplatelet Agents in Perioperative Period of Non-Cardiac Surgeries

Juliana Maria Dantas Mendonça Borges et al. Pamella de Assis Almeida Mariana Martins Gonzaga do Nascimento José Augusto Soares Barreto Filho … Mario Borges Rosa Antonio Carlos Sobral Sousa

Abstract

Background:

The current guidelines dispose recommendations to manage antiplatelet agents in the perioperative period; however, the daily medical practices lack standardization.

Objectives:

To asses factors associated with inadequate management of antiplatelet agents in the perioperative period of non-cardiac surgeries.

Methods:

Cross-sectional Study conducted in hospital from October 2014 to October 2016. The study dependent variable was a therapy that did not comply with the recommendations in the Brazilian Association of Cardiology (SBC) guidelines. The independent variables included some characteristics, the people in charge of the management and causes of lack of adherence to those guidelines. Variables were included in the multivariate model. Analysis was based on the odds ratio (OR) value and its respective 95% confidence interval (CI) estimated by means of logistic regression with 5% significance level.

Results:

The sample was composed of adult patients submitted to non-cardiac surgeries and who would use acetylsalicylic acid (aspirin) or clopidogrel (n = 161). The management failed to comply with the recommendations in the guidelines in 80.75% of the sample. Surgeons had the highest number of noncomplying orientations (n = 63). After multivariate analysis it was observed that patients with a higher level of schooling (OR = 0.24; CI95% 0.07-0.78) and those with a previous episode of acute myocardial infarction (AMI) (OR = 0.18; CI95% 0.04-0.95) had a higher probability of using a therapy complying with the guidelines.

Conclusion:

Positive association between patients’ schooling level, or those with a history of previous AMI, with management of the use of aspirin and clopidogrel in the perioperative period of non-cardiac surgeries. However, diverging conducts stress the need of having internal protocol defined.

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Case Report

Intraoperative evaluation and surgical planning in the hypertrophic cardiomyopathy

Maria Fernanda Maretti A Garcia et al. Maria Estefânia B Otto Núbia Welerson Vieira Linda Maria B. C Santos … Juliana Ascensão de Souza Fernando Antibas Atik

A male, 45 year old patient, with diagnosis of septum hypertrophic cardiomyopathy, having undergone a cardiofibrilator implant in the past. Despite the optimized clinical treatment, he evolved to a progressive clinical deterioration that led to invasive treatment. However, there was not an important gradient in the exit pathway of the left ventricle (EPLV) at the echocardiogram in rest and the challenging test with dobutamine was non conclusive because it did not reach the preconized cardiac frequency. The intraoperative evaluation with a transesophageal echocardiogram using isoproterenol was fundamental for the diagnosis of the EPLV obstruction. The septum myectomy was performed successfully and the patient presented good post-operative evolution.

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Myocardial Protection in Cardiac Surgery – What is the Ideal Method?

Factors Associated with Inadequate Management of Antiplatelet Agents in Perioperative Period of Non-Cardiac Surgeries

Abstract

Background:

Objectives:

Methods:

Results:

Conclusion:

Intraoperative evaluation and surgical planning in the hypertrophic cardiomyopathy

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Electronic Document Format (ABNT)

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Electronic Document Format (Vancouver)

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Electronic Document Format (APA)

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