Volume 34 - Número 2
EDITORIAL
Considerations about the Bibliometric Impact Factor. The BJCVS is on the Right Track
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
The SBCCV/SBCEC Standards and Guidelines for Perfusion Practice: A Landmark for Cardiopulmonary Bypass in Brazil
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Postoperative Metabolic, Inflammation, and Atrial Fibrillation Control: a Relentless Battle
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
ORIGINAL ARTICLE
Benefits of Fasting Abbreviation with Carbohydrates and Omega-3 Infusion During CABG: a Double-Blind Controlled Randomized Trial
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Objective: To assess postoperative clinical data considering the association of
preoperative fasting with carbohydrate (CHO) loading and intraoperative
infusion of omega-3 polyunsaturated fatty acids (?-3 PUFA).
Methods: 57 patients undergoing coronary artery bypass grafting (CABG) were randomly assigned to receive 12.5% maltodextrin (200 mL, 2 h before anesthesia), (CHO, n=14); water (200 mL, 2 h before anesthesia), (control, n=14); 12.5% maltodextrin (200 mL, 2 h before anesthesia) plus intraoperative infusion of ?-3 PUFA (0.2 g/kg), (CHO+W3, n=15); or water (200 mL, 2 h before anesthesia) plus intraoperative infusion of ?-3 PUFA (0.2 g/kg), (W3, n=14). The need for vasoactive drugs was analyzed, in addition to postoperative inflammation and metabolic control.
Results: There were two deaths (3.5%). Patients in CHO groups presented a lower incidence of hospital infection (RR=0.29, 95% CI 0.09-0.94; P=0.023), needed fewer vasoactive drugs during surgery and ICU stay (P<0.05); and had better blood glucose levels in the first six hours of recovery (P=0.015), requiring less exogenous insulin (P=0.018). Incidence of postoperative atrial fibrillation (POAF) varied significantly among groups (P=0.009). Subjects who receive ?-3 PUFA groups had fewer occurrences of POAF (RR=4.83, 95% CI 1.56-15.02; P=0.001). Patients in the W3 group had lower ultrasensitive-CRP levels at 36 h postoperatively (P=0.008). Interleukin-10 levels varied among groups (P=0.013), with the highest levels observed in the postoperative of patients who received intraoperative infusion of ?-3 PUFA (P=0.049).
Conclusion: Fasting abbreviation with carbohydrate loading and intraoperative infusion of ?-3 PUFA is safe and supports faster postoperative recovery in patients undergoing on-pump CABG. Keywords: Myocardial Revascularization; Atrial fibrillation; Perioperative care; Inflammation; Hyperglycemia
Methods: 57 patients undergoing coronary artery bypass grafting (CABG) were randomly assigned to receive 12.5% maltodextrin (200 mL, 2 h before anesthesia), (CHO, n=14); water (200 mL, 2 h before anesthesia), (control, n=14); 12.5% maltodextrin (200 mL, 2 h before anesthesia) plus intraoperative infusion of ?-3 PUFA (0.2 g/kg), (CHO+W3, n=15); or water (200 mL, 2 h before anesthesia) plus intraoperative infusion of ?-3 PUFA (0.2 g/kg), (W3, n=14). The need for vasoactive drugs was analyzed, in addition to postoperative inflammation and metabolic control.
Results: There were two deaths (3.5%). Patients in CHO groups presented a lower incidence of hospital infection (RR=0.29, 95% CI 0.09-0.94; P=0.023), needed fewer vasoactive drugs during surgery and ICU stay (P<0.05); and had better blood glucose levels in the first six hours of recovery (P=0.015), requiring less exogenous insulin (P=0.018). Incidence of postoperative atrial fibrillation (POAF) varied significantly among groups (P=0.009). Subjects who receive ?-3 PUFA groups had fewer occurrences of POAF (RR=4.83, 95% CI 1.56-15.02; P=0.001). Patients in the W3 group had lower ultrasensitive-CRP levels at 36 h postoperatively (P=0.008). Interleukin-10 levels varied among groups (P=0.013), with the highest levels observed in the postoperative of patients who received intraoperative infusion of ?-3 PUFA (P=0.049).
Conclusion: Fasting abbreviation with carbohydrate loading and intraoperative infusion of ?-3 PUFA is safe and supports faster postoperative recovery in patients undergoing on-pump CABG. Keywords: Myocardial Revascularization; Atrial fibrillation; Perioperative care; Inflammation; Hyperglycemia
Relationship of Inter-Arm Systolic Blood Pressure Difference with Subclavian Artery Stenosis and Vertebral Artery Stenosis in Patients Undergoing Carotid Endarterectomy
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Introduction: The aim of this study was to examine the association of inter-arm systolic
blood pressure difference (IASBPD) with carotid artery stenosis, subclavian
artery stenosis and vertebral artery stenosis in patients who underwent
carotid endarterectomy.
Methods: A total of 141 patients (29 females, 112 males; mean age 71.2±10.4 years; range 47 to 92 years) who underwent carotid endarterectomy between September 2010 and December 2017 were retrospectively evaluated. We classified patients into four groups according to the IASBPD ? 10 mmHg, = 10 mm Hg, = 20 mmHg and = 30 mmHg. The stenosis of both subclavian and vertebral arteries was considered as = 50%.
Results: Of the 141 patients, 44 (31.2%) had = 10 mmHg, 29 (20.5%) had = 20 mmHg and 4 (2.8%) had = 30 mmHg of IASBPD. 26 patients (18.4%) were diagnosed with significant subclavian artery stenosis and 18 (69.2%) of them had more than 20 mmHg of IASBPD. Of the 29 patients with IASBPD = 20 mmHg, 19 patients (65.5%) had a significant subclavian artery stenosis. We found a significant correlation between preoperative symptoms and subclavian artery stenosis (P=0.018) and overall perioperative stroke was seen more frequently in patients with subclavian artery stenosis (P=0.041). A significant positive correlation was observed between vertebral artery stenosis and subclavian artery stenosis (P=0.01).
Conclusion: Patients who were diagnosed with both subclavian artery stenosis and IASBPD (= 20 mmHg) had a higher risk of postoperative stroke and death, had higher total cholesterol, LDL-C, blood creatinine level, and were more symptomatic. Keywords: Subclavian Steal Syndrome; Carotid stenosis; Blood Pressure Determination/Methods; Carotid Endarterectomy; Systole
Methods: A total of 141 patients (29 females, 112 males; mean age 71.2±10.4 years; range 47 to 92 years) who underwent carotid endarterectomy between September 2010 and December 2017 were retrospectively evaluated. We classified patients into four groups according to the IASBPD ? 10 mmHg, = 10 mm Hg, = 20 mmHg and = 30 mmHg. The stenosis of both subclavian and vertebral arteries was considered as = 50%.
Results: Of the 141 patients, 44 (31.2%) had = 10 mmHg, 29 (20.5%) had = 20 mmHg and 4 (2.8%) had = 30 mmHg of IASBPD. 26 patients (18.4%) were diagnosed with significant subclavian artery stenosis and 18 (69.2%) of them had more than 20 mmHg of IASBPD. Of the 29 patients with IASBPD = 20 mmHg, 19 patients (65.5%) had a significant subclavian artery stenosis. We found a significant correlation between preoperative symptoms and subclavian artery stenosis (P=0.018) and overall perioperative stroke was seen more frequently in patients with subclavian artery stenosis (P=0.041). A significant positive correlation was observed between vertebral artery stenosis and subclavian artery stenosis (P=0.01).
Conclusion: Patients who were diagnosed with both subclavian artery stenosis and IASBPD (= 20 mmHg) had a higher risk of postoperative stroke and death, had higher total cholesterol, LDL-C, blood creatinine level, and were more symptomatic. Keywords: Subclavian Steal Syndrome; Carotid stenosis; Blood Pressure Determination/Methods; Carotid Endarterectomy; Systole
Coronary Artery Bypass Surgery in Brazil: Analysis of the National Reality Through the BYPASS Registry
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Introduction: Coronary artery bypass grafting (CABG) is the most frequently performed heart
surgery in Brazil. Recent international guidelines recommend that national
societies establish a database on the practice and results of CABG. In
anticipation of the recommendation, the BYPASS Registry was introduced in
2015.
Objective: To analyze the profile, risk factors and outcomes of patients undergoing CABG in Brazil, as well as to examine the predominant surgical strategy, based on the data included in the BYPASS Registry.
Methods: A cross-sectional study of 2292 patients undergoing CABG surgery and cataloged in the BYPASS Registry up to November 2018. Demographic data, clinical presentation, operative variables, and postoperative hospital outcomes were analyzed.
Results: Patients referred to CABG in Brazil are predominantly male (71%), with prior myocardial infarction in 41.1% of cases, diabetes in 42.5%, and ejection fraction lower than 40% in 9.7%. The Heart Team indicated surgery in 32.9% of the cases. Most of the patients underwent cardiopulmonary bypass (87%), and cardioplegia was the strategy of myocardial protection chosen in 95.2% of the cases. The left internal thoracic artery was used as a graft in 91% of the cases; the right internal thoracic artery, in 5.6%; and the radial artery in 1.1%. The saphenous vein graft was used in 84.1% of the patients, being the only graft employed in 7.7% of the patients. The median number of coronary vessels treated was 3. Operative mortality was 2.8%, and the incidence of cerebrovascular accident was 1.2%.
Conclusion: CABG data in Brazil provided by the BYPASS Registry analysis are representative of our national reality and practice. This database constitutes an important reference for indications and comparisons of therapeutic procedures, as well as to propose subsequent models to improve patient safety and the quality of surgical practice in the country. Keywords: Registries; Myocardial Revascularization; Database, Cardiovascular Surgical Procedures; Coronary Artery Bypass Grafts; Cardiac surgical procedures
Objective: To analyze the profile, risk factors and outcomes of patients undergoing CABG in Brazil, as well as to examine the predominant surgical strategy, based on the data included in the BYPASS Registry.
Methods: A cross-sectional study of 2292 patients undergoing CABG surgery and cataloged in the BYPASS Registry up to November 2018. Demographic data, clinical presentation, operative variables, and postoperative hospital outcomes were analyzed.
Results: Patients referred to CABG in Brazil are predominantly male (71%), with prior myocardial infarction in 41.1% of cases, diabetes in 42.5%, and ejection fraction lower than 40% in 9.7%. The Heart Team indicated surgery in 32.9% of the cases. Most of the patients underwent cardiopulmonary bypass (87%), and cardioplegia was the strategy of myocardial protection chosen in 95.2% of the cases. The left internal thoracic artery was used as a graft in 91% of the cases; the right internal thoracic artery, in 5.6%; and the radial artery in 1.1%. The saphenous vein graft was used in 84.1% of the patients, being the only graft employed in 7.7% of the patients. The median number of coronary vessels treated was 3. Operative mortality was 2.8%, and the incidence of cerebrovascular accident was 1.2%.
Conclusion: CABG data in Brazil provided by the BYPASS Registry analysis are representative of our national reality and practice. This database constitutes an important reference for indications and comparisons of therapeutic procedures, as well as to propose subsequent models to improve patient safety and the quality of surgical practice in the country. Keywords: Registries; Myocardial Revascularization; Database, Cardiovascular Surgical Procedures; Coronary Artery Bypass Grafts; Cardiac surgical procedures
Effect of Preoperative Creatinine Levels on Mortality after Coronary Artery Bypass Grafting Surgery: an Observational Study
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Introduction: Renal function is an independent risk factor for mortality among on-pump
coronary bypass grafting (ONCABG) patients. This association is well known
in the international literature, but there is a lack of knowledge of how
admission creatinine (AC) levels modulate each cardiovascular risk
factor.
Objective: The aim of this paper was to assess the effect of different AC levels on mortality among ONCABG patients.
Methods: 1,599 patients who underwent ONCABG between December 1999 and February 2006 at Hospital de Base in São José do Rio Preto/SP-Brazil were included. They were divided into quartiles according to their AC levels (QI: 0.2 =AC < 1.0 mg/dL; QII: 1.0 = AC < 1.2 mg/dL; QIII: 1.2 = AC < 1.4 mg/dL; and QIV: 1.4 = AC = 2.6 mg/dL). Seven risk factors were then evaluated in each stratum.
Results: Mortality was higher in the QIV group than QI or QII groups. Factors such as age (= 65 years) and cardiopulmonary bypass (CPB) time (= 115 minutes) in QIV, as well preoperative hospital stay (= 5 days) in QIII, were associated with higher mortality rates. Creatinine variation greater than or equal to 0.4 mg/dL increased mortality rates in all groups. The use of intra-aortic balloon pump and dialysis increased mortality rates in all groups except for QII. Type I neurological dysfunction increased the mortality rate in the QII and III groups.
Conclusion: Creatinine levels play an important role in ONCABG mortality. The combination of selected risk factors and higher AC values leads to a worse prognosis. On the other hand, lower AC values were associated with a protective effect, even among elderly patients and those with a high CPB time. Keywords: Kidney - Physiopathology; Coronary artery bypass; Risk Factors; Creatinine - Blood, Treatment Outcome
Objective: The aim of this paper was to assess the effect of different AC levels on mortality among ONCABG patients.
Methods: 1,599 patients who underwent ONCABG between December 1999 and February 2006 at Hospital de Base in São José do Rio Preto/SP-Brazil were included. They were divided into quartiles according to their AC levels (QI: 0.2 =AC < 1.0 mg/dL; QII: 1.0 = AC < 1.2 mg/dL; QIII: 1.2 = AC < 1.4 mg/dL; and QIV: 1.4 = AC = 2.6 mg/dL). Seven risk factors were then evaluated in each stratum.
Results: Mortality was higher in the QIV group than QI or QII groups. Factors such as age (= 65 years) and cardiopulmonary bypass (CPB) time (= 115 minutes) in QIV, as well preoperative hospital stay (= 5 days) in QIII, were associated with higher mortality rates. Creatinine variation greater than or equal to 0.4 mg/dL increased mortality rates in all groups. The use of intra-aortic balloon pump and dialysis increased mortality rates in all groups except for QII. Type I neurological dysfunction increased the mortality rate in the QII and III groups.
Conclusion: Creatinine levels play an important role in ONCABG mortality. The combination of selected risk factors and higher AC values leads to a worse prognosis. On the other hand, lower AC values were associated with a protective effect, even among elderly patients and those with a high CPB time. Keywords: Kidney - Physiopathology; Coronary artery bypass; Risk Factors; Creatinine - Blood, Treatment Outcome
The Expression of and Preoperative Correlation between Heat-Shock Protein 70, EuroSCORE, and Lactate in Patients undergoing CABG with Cardiopulmonary Bypass
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Objetive: Coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB)
improved symptoms and increased survival and quality of life in patients
with coronary artery disease. However, it should be the main cause of a
complex organic systemic inflammatory response that greatly contributes to
several postoperative adverse effects.
Methods: We aimed to evaluate heat-shock protein 70 (HSP 70) expression as a morbimortality predictor in patients with preserved ventricular function undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) and to determine their association with the lactate as a marker of tissue hypoperfusion and the EuroSCORE risk score. This is a prospective, observational study including 46 patients and occurring between May and July 2016. Patients without ventricular dysfunction undergoing myocardial revascularization with extracorporeal circulation were included. They were divided into (1) complicated and (2) uncomplicated postoperative evolution groups. EuroSCORE, lactate levels, and HSP 70 expression and their correlations were determined.
Results: Statistical analysis showed that the group with complicated evolution had higher EuroSCORE values than the other group. HSP 70 protein levels were significantly increased in the group with uncomplicated evolution and showed similar results. According to our results, HSP family proteins may be independent predictors of uncomplicated evolution in patients without ventricular dysfunction undergoing CABG with CPB.
Conclusion: HSP 70 should be a good discriminator and protection marker for complications in cardiac surgery. Keywords: HSP 70 Heat-Shock Proteins/Blood; Heat-Shock Proteins; Coronary artery bypass; Cardiopulmonary bypass
Methods: We aimed to evaluate heat-shock protein 70 (HSP 70) expression as a morbimortality predictor in patients with preserved ventricular function undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (CPB) and to determine their association with the lactate as a marker of tissue hypoperfusion and the EuroSCORE risk score. This is a prospective, observational study including 46 patients and occurring between May and July 2016. Patients without ventricular dysfunction undergoing myocardial revascularization with extracorporeal circulation were included. They were divided into (1) complicated and (2) uncomplicated postoperative evolution groups. EuroSCORE, lactate levels, and HSP 70 expression and their correlations were determined.
Results: Statistical analysis showed that the group with complicated evolution had higher EuroSCORE values than the other group. HSP 70 protein levels were significantly increased in the group with uncomplicated evolution and showed similar results. According to our results, HSP family proteins may be independent predictors of uncomplicated evolution in patients without ventricular dysfunction undergoing CABG with CPB.
Conclusion: HSP 70 should be a good discriminator and protection marker for complications in cardiac surgery. Keywords: HSP 70 Heat-Shock Proteins/Blood; Heat-Shock Proteins; Coronary artery bypass; Cardiopulmonary bypass
Diagnostic Performance of QFR for the Evaluation of Intermediate Coronary Artery Stenosis Confirmed by Fractional Flow Reserve
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Introduction: Quantitative flow ratio (QFR) is a novel method enabling efficient
computation of FFR from three-dimensional quantitative coronary angiography
(3D QCA) and thrombolysis in myocardial infarction (TIMI) frame counting. We
decided to perform a systematic review and quantitative meta-analysis of the
literature to determine the correlation between the diagnosis of
functionally significant stenosis obtained by QFR versus FFR and to
determine the diagnostic accuracy of QFR for intermediate coronary artery
stenosis.
Methods: We searched PubMed, Embase, and Web of Science for studies concerning the diagnostic performance of QFR. Our meta-analysis was performed using the DerSimonian and Laird random effects model to determine sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR). The sROC was used to determine diagnostic test accuracy.
Results: Nine studies consisting of 1175 vessels in 1047 patients were included in our study. The pooled sensitivity, specificity, LR+, LR-, and DOR for QFR were 0.89 (95% CI: 0.86-0.92), 0.88 (95% CI: 0.86-0.91), 6.86 (95% CI,: 5.22-9.02), 0.14 (95% CI: 0.10-0.21), and 53.05 (95% CI: 29.75-94.58), respectively. The area under the summary receiver operating characteristic (sROC) curve for QFR was 0.94.
Conclusion: QFR is a simple, useful, and noninvasive modality for diagnosis of functional significance of intermediate coronary artery stenosis. Keywords: Myocardial Fractional Flow Reserve; Coronary Artery Disease; Quantitative Flow Ratio; Sensitivity and Specificity; Meta-Analysis [Publication Type]
Methods: We searched PubMed, Embase, and Web of Science for studies concerning the diagnostic performance of QFR. Our meta-analysis was performed using the DerSimonian and Laird random effects model to determine sensitivity, specificity, positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR). The sROC was used to determine diagnostic test accuracy.
Results: Nine studies consisting of 1175 vessels in 1047 patients were included in our study. The pooled sensitivity, specificity, LR+, LR-, and DOR for QFR were 0.89 (95% CI: 0.86-0.92), 0.88 (95% CI: 0.86-0.91), 6.86 (95% CI,: 5.22-9.02), 0.14 (95% CI: 0.10-0.21), and 53.05 (95% CI: 29.75-94.58), respectively. The area under the summary receiver operating characteristic (sROC) curve for QFR was 0.94.
Conclusion: QFR is a simple, useful, and noninvasive modality for diagnosis of functional significance of intermediate coronary artery stenosis. Keywords: Myocardial Fractional Flow Reserve; Coronary Artery Disease; Quantitative Flow Ratio; Sensitivity and Specificity; Meta-Analysis [Publication Type]
Previous Cardiac Surgery: a Predictor of Mortality in Aortic Valve Replacement?
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Introduction: Previous cardiac surgery (PCS) is a risk factor for operative mortality in
pa-tients undergoing reoperative aortic valve replacement (AVR) and may be
influenced by the volume of patients in each center. The aim of this study
was to evaluate the results of AVR in patients with previous cardiac surgery
in a low volume cardiac center (400 cases per year).
Methods: Between January 2006 and December 2016, 854 patients underwent isolated AVR surgery at our institution. Of these, 70 had PCS. Propensity match (PM) was per-formed to balance basal covariates. Operative mortality and survival were the primary outcomes.
Results: The PCS and first-time surgery (FTS) groups had significant differences in base-line characteristics (PCS group were older, higher incidence of hypertension, endocarditis, NYHA III/IV, lower LVEF, higher creatinine and higher EuroSCORE). In the unmatched population, patients with PCS had higher operative mortality (17.1% vs. 4.6%, P=0.001). In the PM groups, this difference was not significant (12.5% and 3.6%, P=0.08). The only independent predictors for operative mortality found in the PCS group were age and fe-male gender. Age and diabetes were identified as the only independent predictors of sur-vival.
Conclusion: PCS was not a predictor for operative mortality nor long-term survival in pa-tients undergoing isolated aortic valve replacement. Keywords: Previous Cardiac Surgery; Aortic Valve Replacement; Mortality; Survival
Methods: Between January 2006 and December 2016, 854 patients underwent isolated AVR surgery at our institution. Of these, 70 had PCS. Propensity match (PM) was per-formed to balance basal covariates. Operative mortality and survival were the primary outcomes.
Results: The PCS and first-time surgery (FTS) groups had significant differences in base-line characteristics (PCS group were older, higher incidence of hypertension, endocarditis, NYHA III/IV, lower LVEF, higher creatinine and higher EuroSCORE). In the unmatched population, patients with PCS had higher operative mortality (17.1% vs. 4.6%, P=0.001). In the PM groups, this difference was not significant (12.5% and 3.6%, P=0.08). The only independent predictors for operative mortality found in the PCS group were age and fe-male gender. Age and diabetes were identified as the only independent predictors of sur-vival.
Conclusion: PCS was not a predictor for operative mortality nor long-term survival in pa-tients undergoing isolated aortic valve replacement. Keywords: Previous Cardiac Surgery; Aortic Valve Replacement; Mortality; Survival
Postoperative Atrial Fibrillation: Evaluation of its Economic Impact on the Costs of Cardiac Surgery
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Objective: The objective of this study was to calculate the direct costs of
postoperative atrial fibrillation (POAF) in a high-complexity cardiovascular
hospital.
Methods: We performed a cost analysis with a pairwise-matched design. Twenty-two patients with POAF and 22 patients without this complication were included. Pair-matching was performed (1:1) based on the following criteria: identical type of surgery, similar EuroSCORE II values, and absence of any other postoperative complication.
Results: The total hospital cost was significantly higher in the POAF group than in the non-POAF group (US$ 10,880 [± 2,688] vs. US$ 8,856 [± 1,782], respectively, for each patient; P=0.005). This difference was attributable to postoperative costs (US$ 3,103 [± 1,552] vs. US$ 1,238 [± 429]; P=0.0001) for patients with or without POAF, respectively. The median postoperative lengths of stay were 9 (range 5-17) and 5 (3-9) days for patients with and without POAF (P=0.032), respectively. Preoperatively, no differences were found in the EuroSCORE II values (median 1.7 vs. 1.6, respectively; P=0.91) or direct costs (US$ 1,127 vs. US$ 1,063, respectively; P=0.56) between POAF and non-POAF groups.
Conclusion: POAF generates a high economic burden in the overall costs of cardiac surgery, and our results reveal the differential contribution of each of the evaluated factors. This information, which was previously unavailable in this setting, is essential for the development of more effective prevention strategies. Keywords: Atrial fibrillation; Postoperative care; Cost-of-Disease; Cardiac surgery
Methods: We performed a cost analysis with a pairwise-matched design. Twenty-two patients with POAF and 22 patients without this complication were included. Pair-matching was performed (1:1) based on the following criteria: identical type of surgery, similar EuroSCORE II values, and absence of any other postoperative complication.
Results: The total hospital cost was significantly higher in the POAF group than in the non-POAF group (US$ 10,880 [± 2,688] vs. US$ 8,856 [± 1,782], respectively, for each patient; P=0.005). This difference was attributable to postoperative costs (US$ 3,103 [± 1,552] vs. US$ 1,238 [± 429]; P=0.0001) for patients with or without POAF, respectively. The median postoperative lengths of stay were 9 (range 5-17) and 5 (3-9) days for patients with and without POAF (P=0.032), respectively. Preoperatively, no differences were found in the EuroSCORE II values (median 1.7 vs. 1.6, respectively; P=0.91) or direct costs (US$ 1,127 vs. US$ 1,063, respectively; P=0.56) between POAF and non-POAF groups.
Conclusion: POAF generates a high economic burden in the overall costs of cardiac surgery, and our results reveal the differential contribution of each of the evaluated factors. This information, which was previously unavailable in this setting, is essential for the development of more effective prevention strategies. Keywords: Atrial fibrillation; Postoperative care; Cost-of-Disease; Cardiac surgery
Left Ventricular Aneurysm Repair: Off-pump Linear Plication versus On-pump Patch Plasty
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Objective: The study aimed to compare the clinical outcomes of simplified linear
plication and classic patch plasty in patients with left ventricular
aneurysm (LVA).
Methods: We retrospectively reviewed 282 patients undergoing LVA repair between 2006 and 2016. After propensity score matching, 45 pairs of patients receiving LVA surgery were divided into either a patch group (on-pump endoventricular patch plasty) or a plication group (off-pump linear plication). Then, their early surgical outcomes and long-term survival were compared in two matched groups.
Results: The heart function improvement at discharge was similar in the two matched groups, while patients in the patch group more commonly suffered from low cardiac output syndrome (P=0.042) with higher proportion of intra-aortic balloon pumping assistance (P=0.034) than patients in the plication group. Compared with patients in the patch group, the patients in the plication group had shorter recovery times, regarding to mechanical ventilation, intensive care unit stay, and hospital stay (P<0.001, P<0.001, and P=0.001, respectively). No significant difference was found in the long-term survival (P=0.62).
Conclusions: Off-pump linear plication presented acceptable results in terms of early outcomes and long-term survival. For high-risk patients, the simplified LVA repair technique may be an option. Keywords: Left Ventricular Aneurysm; Patch Plasty; Linear Plication Repair; Outcomes
Methods: We retrospectively reviewed 282 patients undergoing LVA repair between 2006 and 2016. After propensity score matching, 45 pairs of patients receiving LVA surgery were divided into either a patch group (on-pump endoventricular patch plasty) or a plication group (off-pump linear plication). Then, their early surgical outcomes and long-term survival were compared in two matched groups.
Results: The heart function improvement at discharge was similar in the two matched groups, while patients in the patch group more commonly suffered from low cardiac output syndrome (P=0.042) with higher proportion of intra-aortic balloon pumping assistance (P=0.034) than patients in the plication group. Compared with patients in the patch group, the patients in the plication group had shorter recovery times, regarding to mechanical ventilation, intensive care unit stay, and hospital stay (P<0.001, P<0.001, and P=0.001, respectively). No significant difference was found in the long-term survival (P=0.62).
Conclusions: Off-pump linear plication presented acceptable results in terms of early outcomes and long-term survival. For high-risk patients, the simplified LVA repair technique may be an option. Keywords: Left Ventricular Aneurysm; Patch Plasty; Linear Plication Repair; Outcomes
Treatment of Pericardial Effusion Through Subxiphoid Tube Pericardiostomy and Computerized Tomography- or Echocardiography - Guided Percutaneous Catheter Drainage Methods
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Objective: In this retrospective study, we aimed to observe the efficacy of pericardial
effusion (PE) treatments by a survey conducted at the Department of
Cardiovascular Surgery, Faculty of Medicine, Atatürk University.
Methods: In order to get comparable results, the patients with PE were divided into three groups - group A, 480 patients who underwent subxiphoid pericardiostomy; group B, 28 patients who underwent computerized tomography (CT)-guided percutaneous catheter drainage; and group C, 45 patients who underwent echocardiography (ECHO)-guided percutaneous catheter drainage.
Results: In the three groups of patients, the most important symptom and physical sign were dyspnea and tachycardia, respectively. The most common causes of PE were uremic pericarditis in patients who underwent tube pericardiostomy, postoperative PE in patients who underwent CT-guided percutaneous catheter drainage, and cancer-related PE in patients who underwent ECHO-guided percutaneous catheter drainage. In all the patients, relief of symptoms was achieved after surgical intervention. There was no treatment-related mortality in any group of patients. In patients with tuberculous pericarditis, the rates of recurrent PE and/or constrictive pericarditis progress were 2,9% and 2,2% after tube pericardiostomy and ECHO-guided percutaneous catheter drainage, respectively.
Conclusion: Currently, there are many methods to treat PE. The correct treatment method for each patient should be selected according to a very careful analysis of the patient's clinical condition as well as the prospective benefit of surgical intervention. Keywords: Pericardial effusion; Mediastinum; X-ray Computed Tomography; Echocardiography; Retrospective studies; Pericardium
Methods: In order to get comparable results, the patients with PE were divided into three groups - group A, 480 patients who underwent subxiphoid pericardiostomy; group B, 28 patients who underwent computerized tomography (CT)-guided percutaneous catheter drainage; and group C, 45 patients who underwent echocardiography (ECHO)-guided percutaneous catheter drainage.
Results: In the three groups of patients, the most important symptom and physical sign were dyspnea and tachycardia, respectively. The most common causes of PE were uremic pericarditis in patients who underwent tube pericardiostomy, postoperative PE in patients who underwent CT-guided percutaneous catheter drainage, and cancer-related PE in patients who underwent ECHO-guided percutaneous catheter drainage. In all the patients, relief of symptoms was achieved after surgical intervention. There was no treatment-related mortality in any group of patients. In patients with tuberculous pericarditis, the rates of recurrent PE and/or constrictive pericarditis progress were 2,9% and 2,2% after tube pericardiostomy and ECHO-guided percutaneous catheter drainage, respectively.
Conclusion: Currently, there are many methods to treat PE. The correct treatment method for each patient should be selected according to a very careful analysis of the patient's clinical condition as well as the prospective benefit of surgical intervention. Keywords: Pericardial effusion; Mediastinum; X-ray Computed Tomography; Echocardiography; Retrospective studies; Pericardium
Prosthesis-Patient Mismatch Negatively Affects Outcomes after Mitral Valve Replacement: Meta-Analysis of 10,239 Patients
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Objective: This study sought to evaluate the impact of prosthesis-patient mismatch on
the risk of perioperative and long-term mortality after mitral valve
replacement.
Methods: Databases were researched for studies published until December 2018. Main outcomes of interest were perioperative and 10-year mortality and echocardiographic parameters.
Results: The research yielded 2,985 studies for inclusion. Of these, 16 articles were analyzed, and their data extracted. The total number of patients included was 10,239, who underwent mitral valve replacement. The incidence of prosthesis-patient mismatch after mitral valve replacement was 53.7% (5,499 with prosthesis-patient mismatch and 4,740 without prosthesis-patient mismatch). Perioperative (OR 1.519; 95%CI 1.194-1.931, P<0.001) and 10-year (OR 1.515; 95%CI 1.280-1.795, P<0.001) mortality was increased in patients with prosthesis-patient mismatch. Patients with prosthesis-patient mismatch after mitral valve replacement had higher systolic pulmonary artery pressure and transprosthethic gradient and lower indexed effective orifice area and left ventricle ejection fraction.
Conclusion: Prosthesis-patient mismatch increases perioperative and long-term mortality. Prosthesis-patient mismatch is also associated with pulmonary hypertension and depressed left ventricle systolic function. The findings of this study support the implementation of surgical strategies to prevent prosthesis-patient mismatch in order to decrease mortality rates. Keywords: Heart valve prosthesis; Mitral valve/surgery; Meta-analysis; Prosthesis-Patient Mismatch
Methods: Databases were researched for studies published until December 2018. Main outcomes of interest were perioperative and 10-year mortality and echocardiographic parameters.
Results: The research yielded 2,985 studies for inclusion. Of these, 16 articles were analyzed, and their data extracted. The total number of patients included was 10,239, who underwent mitral valve replacement. The incidence of prosthesis-patient mismatch after mitral valve replacement was 53.7% (5,499 with prosthesis-patient mismatch and 4,740 without prosthesis-patient mismatch). Perioperative (OR 1.519; 95%CI 1.194-1.931, P<0.001) and 10-year (OR 1.515; 95%CI 1.280-1.795, P<0.001) mortality was increased in patients with prosthesis-patient mismatch. Patients with prosthesis-patient mismatch after mitral valve replacement had higher systolic pulmonary artery pressure and transprosthethic gradient and lower indexed effective orifice area and left ventricle ejection fraction.
Conclusion: Prosthesis-patient mismatch increases perioperative and long-term mortality. Prosthesis-patient mismatch is also associated with pulmonary hypertension and depressed left ventricle systolic function. The findings of this study support the implementation of surgical strategies to prevent prosthesis-patient mismatch in order to decrease mortality rates. Keywords: Heart valve prosthesis; Mitral valve/surgery; Meta-analysis; Prosthesis-Patient Mismatch
REVIEW ARTICLE
Innominate vs. Axillary Artery Cannulation in Aortic Surgery: a Systematic Review and Meta-Analysis
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Objective: To investigate whether axillary artery cannulation has supremacy over
innominate artery cannulation in thoracic aortic surgery.
Methods: A comprehensive search was undertaken among the four major databases (PubMed, Excerpta Medica dataBASE [EMBASE], Scopus, and Ovid) to identify all randomized and nonrandomized controlled trials comparing axillary to innominate artery cannulation in thoracic aortic surgery. Databases were evaluated and assessed up to March 2017.
Results: Only three studies fulfilled the criteria for this meta-analysis, including 534 patients. Cardiopulmonary bypass time was significantly shorter in the innominate group (P=0.004). However, the innominate group had significantly higher risk of prolonged intubation > 48 hours (P=0.04) than the axillary group. Further analysis revealed no significant difference between the innominate and axillary groups for deep hypothermic circulatory arrest time (P=0.06). The relative risks for temporary and permanent neurological deficits as well as in-hospital mortality were not significantly different for both groups (P=0.90, P=0.49, and P=0.55, respectively). Length of hospital stay was similar for both groups.
Conclusion: There is no superiority of axillary over innominate artery cannulation in thoracic aortic surgery in terms of perioperative outcomes; however, as the studies were limited, larger scale comparative studies are required to provide a solid evidence base for choosing optimal arterial cannulation site. Keywords: Dissecting Aneurysm - Surgery; Thoracic Surgical Procedures; Axillary artery; Peripheral Catherization - Methods; Treatment Outcomes
Methods: A comprehensive search was undertaken among the four major databases (PubMed, Excerpta Medica dataBASE [EMBASE], Scopus, and Ovid) to identify all randomized and nonrandomized controlled trials comparing axillary to innominate artery cannulation in thoracic aortic surgery. Databases were evaluated and assessed up to March 2017.
Results: Only three studies fulfilled the criteria for this meta-analysis, including 534 patients. Cardiopulmonary bypass time was significantly shorter in the innominate group (P=0.004). However, the innominate group had significantly higher risk of prolonged intubation > 48 hours (P=0.04) than the axillary group. Further analysis revealed no significant difference between the innominate and axillary groups for deep hypothermic circulatory arrest time (P=0.06). The relative risks for temporary and permanent neurological deficits as well as in-hospital mortality were not significantly different for both groups (P=0.90, P=0.49, and P=0.55, respectively). Length of hospital stay was similar for both groups.
Conclusion: There is no superiority of axillary over innominate artery cannulation in thoracic aortic surgery in terms of perioperative outcomes; however, as the studies were limited, larger scale comparative studies are required to provide a solid evidence base for choosing optimal arterial cannulation site. Keywords: Dissecting Aneurysm - Surgery; Thoracic Surgical Procedures; Axillary artery; Peripheral Catherization - Methods; Treatment Outcomes
CASE REPORT
Mal-Positioning of Dialysis Catheter in Anomalous Left Superior Pulmonary Vein in a Patient with Acute Type A Dissection, a Case Report
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
The partial anomalous pulmonary vein drainage is a rare
congenital defect. The pulmonary vein drains in to a systemic vein
instead of draining in to the left atrium.
In this rare birth defect, the right sided pulmonary vein
involvement is more prevalent than the left sided pulmonary veins.
We present a case where the anomalous left superior
pulmonary vein was diagnosed when a renal dialysis catheter
(size = 12F x 16cm) was mal-positioned in to the Anomalous left
superior pulmonary vein, demonstrating confusing blood results.
We describe how a systematic multidisciplinary approach and use
of advanced imaging techniques can recognise and deal with this
rare clinical dilemma.
Endovascular Repair of a Penetrating Axillary Artery Injury
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
We report a 16-year-old boy who sustained a gunshot injury on his upper left side of the chest that resulted in an injury to the left axillary artery and was treated with endovascular repair. An endovascular repair has been increasingly accepted for the management of hemorrhage in critically ill trauma patients; using covered endovascular stents provides an alternative modality for both controlling hemorrhage and preserving flow.
Keywords: Case Reports; Gunshot Wounds; Axillary Artery - Injuries; Angioplasty; Vascular System InjuriesTransesophageal Echocardiography-Guided Thrombectomy of Level IV Renal Cell Carcinoma without Cardiopulmonary Bypass
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Advanced renal cell carcinoma accompanied by tumor thrombus in the venous system is present in up to 10% of cases. Extension of tumor thrombus above the diaphragm or into the right atrium represents level IV disease. Level IV tumors are typically treated with sterno-laparotomy approach with or without deep hypothermic circulatory arrest and veno-venous bypass. In this case report, the surgical technique for the resection of advanced RCC were described, with the concomitant use of transesophageal echocardiography for thrombus extraction without the venovenous or cardiopulmonary bypass.
Keywords: Renal Cell Carcinoma; Inferior Vena Cava; Transesophageal EchocardiogramLeft Ventricular Assist Device Implantation Combined with Bentall Procedure
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
Ventricular assist devices (VADs) are an important technological development for patients with end-stage heart failure, and approximately 50% of these patients require various additional cardiac procedures. Here we presente the case of a patient suffering from severe aortic insufficiency, aortic root dilatation, and an ascending aortic aneurysm with end-stage decompensated heart failure. We performed the Bentall procedure combined with a left VAD implantation during the same session. The postoperative period was uneventful for this patient, and he was discharged on the 32nd postoperative day. The heart failure symptoms of the patient are reasonable, and he is still on the heart transplantation waiting list.
Keywords: Treatment outcome; Case Reports; Heart-assist devices; Aortic Valve Insufficiency - Surgery
LETTER TO THE EDITOR
Mean Platelet Volume: is it an Emerging Marker or an Exaggeration?
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025
GUIDELINE
The Brazilian Society for Cardiovascular Surgery (SBCCV) and Brazilian Society for Extracorporeal Circulation (SBCEC) Standards and Guidelines for Perfusion Practice
Braz J Cardiovasc Surg 34;
Publish in: 8/2/2025