Volume 40 - Número 1
EDITORIAL
The Bioartificial Heart: Our Mission to Mars
Braz J Cardiovasc Surg 40;
e20250044
Publish in: 8/2/2025
EXPERT OPINION
Multisociety endorsement of the 2024 European guideline recommendations on coronary revascularization
Braz J Cardiovasc Surg 40;
e20250900
Publish in: 8/2/2025
ORIGINAL ARTICLE
Prolonged Mechanical Ventilation and Extubation Failure in Children and Adolescents Undergoing Cardiac Surgery
Braz J Cardiovasc Surg 40;
e20230281
Publish in: 8/2/2025
Introduction: Mechanical ventilation (MV) is one of the factors that may be associated with
postoperative complications of cardiac surgeries. This study aimed to verify
the clinical and biological factors related to prolonged MV and extubation
failure in children and adolescents submitted to cardiac surgeries.
Method: This retrospective cohort included all patients aged between 0 and 15 years at the Unidade de Recuperação Cardio-Torácica Pediátrica who were submitted to the first extubation after cardiac surgery. Those tracheostomized and under MV before the surgery or who suffered accidental extubation were excluded. The following data was collected — age, weight, and sex; body mass index (BMI); heart disease; surgical severity (Risk Adjustment for Congenital Heart Surgery-1); hospitalization period and length of stay at intensive care unit; MV, cardiopulmonary bypass, and anoxia duration; use of continuous sedation (midazolam and/or fentanyl); pulmonary hypertension; nitric oxide use; Down syndrome, extubation site, and failure. The outcomes were prolonged MV and extubation failure.
Results: A total of 233 patients were included — 79 (33.9%) aged below 12 months, 47 (20.2%) had Down syndrome, and 215 (92.3%) presented low BMI. Down syndrome patients and those under continuous sedation in the immediate postoperative period presented a higher risk of prolonged MV (P<0.001). Moreover, patients aged below 12 months (P=0.048) and those under prolonged MV (P=0.006) presented the highest risk of extubation failure.
Conclusion: Patients with continuous sedation or Down syndrome required longer MV. In addition, children younger than 12 months or under prolonged MV presented a high extubation failure rate.
Keywords: Mechanical Ventilation; Pediatric Cardiac Surgery; Extubation; Children
Method: This retrospective cohort included all patients aged between 0 and 15 years at the Unidade de Recuperação Cardio-Torácica Pediátrica who were submitted to the first extubation after cardiac surgery. Those tracheostomized and under MV before the surgery or who suffered accidental extubation were excluded. The following data was collected — age, weight, and sex; body mass index (BMI); heart disease; surgical severity (Risk Adjustment for Congenital Heart Surgery-1); hospitalization period and length of stay at intensive care unit; MV, cardiopulmonary bypass, and anoxia duration; use of continuous sedation (midazolam and/or fentanyl); pulmonary hypertension; nitric oxide use; Down syndrome, extubation site, and failure. The outcomes were prolonged MV and extubation failure.
Results: A total of 233 patients were included — 79 (33.9%) aged below 12 months, 47 (20.2%) had Down syndrome, and 215 (92.3%) presented low BMI. Down syndrome patients and those under continuous sedation in the immediate postoperative period presented a higher risk of prolonged MV (P<0.001). Moreover, patients aged below 12 months (P=0.048) and those under prolonged MV (P=0.006) presented the highest risk of extubation failure.
Conclusion: Patients with continuous sedation or Down syndrome required longer MV. In addition, children younger than 12 months or under prolonged MV presented a high extubation failure rate.
Keywords: Mechanical Ventilation; Pediatric Cardiac Surgery; Extubation; Children
Biopsychosocial Prognosis Scale for Coronary Artery Bypass Grafting – Brazilian Version: Adaptation and Content Validity
Braz J Cardiovasc Surg 40;
e20230371
Publish in: 8/2/2025
Introduction: The Biopsychosocial Prognosis Scale for Coronary Artery Bypass Grafting (BIPROSCAB) assesses biophysical symptoms and psychosocial experiences following coronary artery bypass grafting (CABG), thereby enabling the targeting of interventions to improve post-procedure biopsychosocial prognosis. The aim of this study was to adapt the BIPROSCAB for use in Brazil and assess the content validity of the adapted version.
Methods: For the cross-cultural adaptation, English-Portuguese translations, synthesis of translations, back-translations, assessment of back-translations for conceptual consistency by the authors of the original instrument, and evaluation of semantic, idiomatic, cultural, and conceptual equivalences by 11 expert judges were performed. Modifications were made based on suggestions until consensus > 80% was achieved. For the content validity assessment, experts assessed the clarity, theoretical relevance, and practical pertinence of the items, which were considered adequate when the content validity ratio (CVR) > 0.635. Post-CABG patients completed the questionnaire and evaluated understandability of the items.
Results: Three rounds were required to achieve the desired agreement in the cross-cultural adaptation process. In the content evaluation by experts, only one round was needed, with CVR > 0.635. Following content evaluation by patients, it was decided to reverse the order of the response scale to an ascending order.
Conclusion: The Brazilian version, BIPROSCAB-Br, is equivalent to the original instrument and has satisfactory evidence of content validity. Additional psychometric assessments are needed for use in Brazil.
Keywords: Cross-Cultural Comparasion; Prognosis; Psychometry; Coronary artery bypass; Consensus
Methods: For the cross-cultural adaptation, English-Portuguese translations, synthesis of translations, back-translations, assessment of back-translations for conceptual consistency by the authors of the original instrument, and evaluation of semantic, idiomatic, cultural, and conceptual equivalences by 11 expert judges were performed. Modifications were made based on suggestions until consensus > 80% was achieved. For the content validity assessment, experts assessed the clarity, theoretical relevance, and practical pertinence of the items, which were considered adequate when the content validity ratio (CVR) > 0.635. Post-CABG patients completed the questionnaire and evaluated understandability of the items.
Results: Three rounds were required to achieve the desired agreement in the cross-cultural adaptation process. In the content evaluation by experts, only one round was needed, with CVR > 0.635. Following content evaluation by patients, it was decided to reverse the order of the response scale to an ascending order.
Conclusion: The Brazilian version, BIPROSCAB-Br, is equivalent to the original instrument and has satisfactory evidence of content validity. Additional psychometric assessments are needed for use in Brazil.
Keywords: Cross-Cultural Comparasion; Prognosis; Psychometry; Coronary artery bypass; Consensus
Papillary Fibroelastomas: 16-Year Single-Center Experience
Braz J Cardiovasc Surg 40;
e20230431
Publish in: 8/2/2025
Introduction: Papillary fibroelastoma is a rare primary benign cardiac tumor. The majority
of patients are asymptomatic. Complications may result in embolic events,
syncope, ventricular arrhythmias, and sudden death. In this study, we report
on a series of papillary fibroelastomas documented in our institution.
Methods: Medical history records from period between 2007 and 2022 were reviewed for all the patients diagnosed with cardiac papillary fibroelastomas treated surgically and confirmed histologically. Clinical, tumor, and demographic characteristics, echocardiography findings, and treatment modalities were analyzed.
Results: In a sixteen-year period, 12 cases of papillary fibroelastomas were documented. The percentage of female patients was 83.3%. The average age was 59.0 ± 11.2 years. Average diameter of tumor was 1.2 cm. The aortic valve was the most common origin site, with six cases (50%). In two cases (17%), the mitral valve was involved. There were single cases of tumor (8% each) found on the tricuspid valve, in the left atrium, in the left ventricle, and in the right ventricle. All patients were treated successfully by complete resection.
Conclusion: PFEs are generally small and single tumors. Complete surgical resection of the tumor has a good prognosis and is a safe, efficient, and definitive treatment.
Keywords: Heart Ventricules; Cardiac Papillary Fibroelastoma; Aortic valve; Tricuspid Valve; Mitral Valve; Sudden Death; Echocardiography
Methods: Medical history records from period between 2007 and 2022 were reviewed for all the patients diagnosed with cardiac papillary fibroelastomas treated surgically and confirmed histologically. Clinical, tumor, and demographic characteristics, echocardiography findings, and treatment modalities were analyzed.
Results: In a sixteen-year period, 12 cases of papillary fibroelastomas were documented. The percentage of female patients was 83.3%. The average age was 59.0 ± 11.2 years. Average diameter of tumor was 1.2 cm. The aortic valve was the most common origin site, with six cases (50%). In two cases (17%), the mitral valve was involved. There were single cases of tumor (8% each) found on the tricuspid valve, in the left atrium, in the left ventricle, and in the right ventricle. All patients were treated successfully by complete resection.
Conclusion: PFEs are generally small and single tumors. Complete surgical resection of the tumor has a good prognosis and is a safe, efficient, and definitive treatment.
Keywords: Heart Ventricules; Cardiac Papillary Fibroelastoma; Aortic valve; Tricuspid Valve; Mitral Valve; Sudden Death; Echocardiography
The Role of Preoperative Chronic Hypertension in Neurocognitive Decline after Cardiac Surgery: A Retrospective Cohort Study
Braz J Cardiovasc Surg 40;
e20230470
Publish in: 8/2/2025
Introduction: Patients frequently experience transient postoperative neurocognitive decline
(NCD) after cardiac surgery with cardiopulmonary bypass. The goal of this
study is to describe preoperative high blood pressure as a risk factor for
NCD and use genomic expression to uncover its contribution to the
pathophysiology of NCD.
Methods: This is a retrospective analysis of cohort study at a single academic center. Patients undergoing cardiac surgery with the use of cardiopulmonary bypass were administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) preoperatively, at postoperative day four, and four weeks postoperatively. Electronic medical records were reviewed for all recorded blood pressure from the year preceding surgery and intraoperative blood pressures. Blood samples were collected six hours preoperatively and six hours postoperatively to assess messenger ribonucleic acid expression.
Results: Eighty-seven patients completed postoperative day four testing, of whom thirty-seven experienced NCD (42.5%). Chronically elevated systolic blood pressure over the year preceding surgery was correlated with greater negative change in RBANS score at postoperative day four (P=0.03). Upon genomic analysis, macrophage markers were upregulated preoperatively, and anti-inflammatory and neuroprotective genes were downregulated postoperatively among patients who had a mean systolic blood pressure ≥ 130 mmHg.
Conclusion: Chronic exposure to elevated preoperative systolic blood pressure may increase the risk of NCD. The contributing role of preoperative hypertension in NCD may be partly explained by reduced attenuation of oxidative stress, increased inflammation, and reduced neuroprotection and heme metabolism postoperatively. This must be considered when assessing patient risks for cardiac surgery.
Keywords: Cardiac surgery; Neurocognitive Decline; Cognitive Dysfunction; Postoperative Cognitive Complications; Neuropsychological Tests
Methods: This is a retrospective analysis of cohort study at a single academic center. Patients undergoing cardiac surgery with the use of cardiopulmonary bypass were administered the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) preoperatively, at postoperative day four, and four weeks postoperatively. Electronic medical records were reviewed for all recorded blood pressure from the year preceding surgery and intraoperative blood pressures. Blood samples were collected six hours preoperatively and six hours postoperatively to assess messenger ribonucleic acid expression.
Results: Eighty-seven patients completed postoperative day four testing, of whom thirty-seven experienced NCD (42.5%). Chronically elevated systolic blood pressure over the year preceding surgery was correlated with greater negative change in RBANS score at postoperative day four (P=0.03). Upon genomic analysis, macrophage markers were upregulated preoperatively, and anti-inflammatory and neuroprotective genes were downregulated postoperatively among patients who had a mean systolic blood pressure ≥ 130 mmHg.
Conclusion: Chronic exposure to elevated preoperative systolic blood pressure may increase the risk of NCD. The contributing role of preoperative hypertension in NCD may be partly explained by reduced attenuation of oxidative stress, increased inflammation, and reduced neuroprotection and heme metabolism postoperatively. This must be considered when assessing patient risks for cardiac surgery.
Keywords: Cardiac surgery; Neurocognitive Decline; Cognitive Dysfunction; Postoperative Cognitive Complications; Neuropsychological Tests
Identification of TGFBR1 Gene Variants in Two Chinese Pedigrees with Loeys-Dietz Syndrome
Braz J Cardiovasc Surg 40;
e20230495
Publish in: 8/2/2025
Objective: To investigate a precise treatment and related gene variants in some Loeys-Dietz syndrome (LDS) patients with vascular disease.
Methods: Two probands (JX001-II1 and JX002-II1) diagnosed with LDS and their families were recruited. Routine blood test, antiphospholipid antibodies, immune globulins, nuclear antibodies (ANAs) and biochemical tests, and computed tomography angiography (CTA) were performed for probands. Deoxyribonucleic acid was collected from the two families and was sequenced by the next-generation sequencing employing the Ion Torrent platform (Life Technologies); the variants were confirmed by Sanger sequencing.
Results: Two probands’ antiphospholipid antibodies, immune globulins, and ANAs were near normal. CTA showed that both probands had an LDS patient typical arterial change: aortic aneurysm. Genetic testing of the 10 LDS-associated genes in the two probands showed that c.605C>T (JX001-II1) and c.679G>A (JX002-II1) variants were both positioned in exon 1 of TGFBR1 and it results in the substitution of highly conserved 202 alanine (Ala) for valine (Val) ( P. Ala 202Val, JX001-II1) and 227 glutamic acids (Glu) for lysine (Lys) ( P. Glu 227Lys, JX002-II1). However, the parents of both patients did not have similar symptoms and did not carry such gene variants. Proband 1 (JX001-II1) died unexpectedly during the operation preparations, whereas proband 2 (JX002-II1) underwent two operations, and the patient is currently in excellent health.
Conclusion: The two TGFBR1 gene variants may be a primary genetic cause of LDS. The results expand the TGFBR1 variant spectrum. Endovascular surgery can be a feasible option for LDS patients.
Keywords: Loeys-Dietz Syndrome; Transforming Growth Factor-beta Type 1; Lysine; Computed Tomography Angiography; Exons; Genetic Testing; High-Throughput Nucleotide Sequencing; DNA
Methods: Two probands (JX001-II1 and JX002-II1) diagnosed with LDS and their families were recruited. Routine blood test, antiphospholipid antibodies, immune globulins, nuclear antibodies (ANAs) and biochemical tests, and computed tomography angiography (CTA) were performed for probands. Deoxyribonucleic acid was collected from the two families and was sequenced by the next-generation sequencing employing the Ion Torrent platform (Life Technologies); the variants were confirmed by Sanger sequencing.
Results: Two probands’ antiphospholipid antibodies, immune globulins, and ANAs were near normal. CTA showed that both probands had an LDS patient typical arterial change: aortic aneurysm. Genetic testing of the 10 LDS-associated genes in the two probands showed that c.605C>T (JX001-II1) and c.679G>A (JX002-II1) variants were both positioned in exon 1 of TGFBR1 and it results in the substitution of highly conserved 202 alanine (Ala) for valine (Val) ( P. Ala 202Val, JX001-II1) and 227 glutamic acids (Glu) for lysine (Lys) ( P. Glu 227Lys, JX002-II1). However, the parents of both patients did not have similar symptoms and did not carry such gene variants. Proband 1 (JX001-II1) died unexpectedly during the operation preparations, whereas proband 2 (JX002-II1) underwent two operations, and the patient is currently in excellent health.
Conclusion: The two TGFBR1 gene variants may be a primary genetic cause of LDS. The results expand the TGFBR1 variant spectrum. Endovascular surgery can be a feasible option for LDS patients.
Keywords: Loeys-Dietz Syndrome; Transforming Growth Factor-beta Type 1; Lysine; Computed Tomography Angiography; Exons; Genetic Testing; High-Throughput Nucleotide Sequencing; DNA
The Konno-Rastan Procedure in the Current Era: Still A Feasible Option?
Braz J Cardiovasc Surg 40;
e20240002
Publish in: 8/2/2025
Introduction: The Konno-Rastan procedure is a commonly used surgical technique to address complicated subaortic stenosis and to enlarge the aorta via an anterior route. The objective of this report is to describe the experience of our unit with this procedure.
Methods: Between 2002 and 2022, we identified pediatric patients who underwent the Konno-Rastan procedure. Relevant information was retrospectively collected.
Results: There were 16 patients who underwent the Konno-Rastan procedure. The median follow-up was nine years (4 - 16 years), and there was no operative mortality. All patients had a straightforward recovery, and five patients required reoperation at follow-up, none of which was related to the left ventricular outflow tract. The median echocardiographic indices at the most recent follow-up were not significantly different from the preoperative values, with a median peak gradient across the left ventricular outflow tract of 25 mmHg. In their most recent follow-up, 81% of the patients were New York Heart Association class 1. No bleeding, thromboembolic, or infective complications were encountered.
Conclusion: We concluded that the Konno-Rastan procedure can be regarded as a definitive alternative to other surgical interventions for left ventricular outflow tract obstructions. Although reoperations are still necessary, particularly in patients with additional mitral valve disease, the Konno-Rastan procedure is still a viable option in patients with complex left ventricular disease.
Keywords: Mitral Valve; Left Ventricular Outflow Obstruction; Pathologic Constriction; Hear Valve Diseases; Subvalvular Aortic Stenosis; Hypertrophic Cardiomyopathy
Methods: Between 2002 and 2022, we identified pediatric patients who underwent the Konno-Rastan procedure. Relevant information was retrospectively collected.
Results: There were 16 patients who underwent the Konno-Rastan procedure. The median follow-up was nine years (4 - 16 years), and there was no operative mortality. All patients had a straightforward recovery, and five patients required reoperation at follow-up, none of which was related to the left ventricular outflow tract. The median echocardiographic indices at the most recent follow-up were not significantly different from the preoperative values, with a median peak gradient across the left ventricular outflow tract of 25 mmHg. In their most recent follow-up, 81% of the patients were New York Heart Association class 1. No bleeding, thromboembolic, or infective complications were encountered.
Conclusion: We concluded that the Konno-Rastan procedure can be regarded as a definitive alternative to other surgical interventions for left ventricular outflow tract obstructions. Although reoperations are still necessary, particularly in patients with additional mitral valve disease, the Konno-Rastan procedure is still a viable option in patients with complex left ventricular disease.
Keywords: Mitral Valve; Left Ventricular Outflow Obstruction; Pathologic Constriction; Hear Valve Diseases; Subvalvular Aortic Stenosis; Hypertrophic Cardiomyopathy
Optimal Concentration of Papaverine for the Inhibition of Internal Thoracic Artery Vasospasm during Coronary Artery Bypass Graft Surgery
Braz J Cardiovasc Surg 40;
e20240058
Publish in: 8/2/2025
Introduction: The internal thoracic artery is commonly used as a graft in coronary artery bypass grafting. In this study, we aimed to investigate whether papaverine prevents vasoconstriction caused by various vasospasm inducers, including 5-hydroxytriptamine or serotonin, in endothelium-denuded internal thoracic artery at concentrations as low as 1.25 mM used for radial arteries.
Methods: Human internal thoracic artery tissue was obtained from patients (n=6) undergoing coronary artery bypass grafting. The organ bath technique was used to determine the inhibitory effects of papaverine on vasoconstriction induced by ergonovine, adenosine diphosphate, 5-hydroxytriptamine, noradrenaline, and angiotensin II in isolated endothelium-denuded internal thoracic artery. Moreover, the inhibitory effect of papaverine on collagen-stimulated human platelet aggregation was examined at the same concentration.
Results: Papaverine inhibited ergonovine-induced vasoconstriction in a concentration-dependent manner. Papaverine at concentrations > 30 μM not only blocked ergonovine-induced vasoconstriction but also induced vasodilation. Papaverine at 30 μM significantly suppressed the vasoconstriction induced by 5-hydroxytriptamine or noradrenaline and completely blocked that induced by adenosine diphosphate or angiotensin II. However, 100 μM papaverine completely blocked the vasoconstriction induced by adenosine diphosphate, 5-hydroxytriptamine, noradrenaline, and angiotensin II. Additionally, papaverine significantly inhibited collagen-stimulated human platelet aggregation in a concentration-dependent manner.
Conclusion: Overall, 100 μM papaverine prevented vasoconstriction by various vasospasm inducers, such as 5-hydroxytriptamine, and significantly suppressed collagen-stimulated platelet aggregation. These results suggest that papaverine at 100 μM, which is 1/10th the concentration used for radial artery, is sufficient to prevent vasospasm in internal thoracic artery during coronary artery bypass grafting.
Keywords: Coronary artery bypass; Thoracic Artery; Papaverine; Vasoconstriction
Methods: Human internal thoracic artery tissue was obtained from patients (n=6) undergoing coronary artery bypass grafting. The organ bath technique was used to determine the inhibitory effects of papaverine on vasoconstriction induced by ergonovine, adenosine diphosphate, 5-hydroxytriptamine, noradrenaline, and angiotensin II in isolated endothelium-denuded internal thoracic artery. Moreover, the inhibitory effect of papaverine on collagen-stimulated human platelet aggregation was examined at the same concentration.
Results: Papaverine inhibited ergonovine-induced vasoconstriction in a concentration-dependent manner. Papaverine at concentrations > 30 μM not only blocked ergonovine-induced vasoconstriction but also induced vasodilation. Papaverine at 30 μM significantly suppressed the vasoconstriction induced by 5-hydroxytriptamine or noradrenaline and completely blocked that induced by adenosine diphosphate or angiotensin II. However, 100 μM papaverine completely blocked the vasoconstriction induced by adenosine diphosphate, 5-hydroxytriptamine, noradrenaline, and angiotensin II. Additionally, papaverine significantly inhibited collagen-stimulated human platelet aggregation in a concentration-dependent manner.
Conclusion: Overall, 100 μM papaverine prevented vasoconstriction by various vasospasm inducers, such as 5-hydroxytriptamine, and significantly suppressed collagen-stimulated platelet aggregation. These results suggest that papaverine at 100 μM, which is 1/10th the concentration used for radial artery, is sufficient to prevent vasospasm in internal thoracic artery during coronary artery bypass grafting.
Keywords: Coronary artery bypass; Thoracic Artery; Papaverine; Vasoconstriction
Comparison of Two Coronary Anastomosis Techniques in Terms of Flow Rate in Porcine Hearts
Braz J Cardiovasc Surg 40;
e20240073
Publish in: 8/2/2025
Introduction: The quality of coronary anastomoses is one of the important parameters that may affect graft patency in coronary artery bypass grafting patients. Therefore, we compared two different anastomotic techniques to improve graft flow and patency rates.
Methods: This study was conducted by performing two different fashions of anastomosis with a human saphenous vein graft on 24 various coronary segments of five postmortem porcine hearts. Each arteriotomy was used for both anastomotic techniques. In the first method, epicardial fat tissue around the coronary artery was involved to the saphenous vein anastomosis line (coronary wall and epicardial fat tissue [CWE] technique). In the second method, the saphenous vein graft was sutured to the coronary wall only, without involving epicardial fat tissue (only coronary wall [OCW] technique).The time it tookfor 30 cc of 0.9% isotonic saline solution to pass through the anastomosis in a free-flow fashion by gravity was measured following each technique. Additionally, the anastomotic areas in mm2 were measured and compared between the two techniques.
Results: The mean flow time for the CWE technique was 77.5 ± 21.4 seconds, whereas for the OCW technique, it was 87.2 ± 19.5 seconds (P<0.001). The flow rates were 23.2 ml/min and 20.6 ml/min, respectively. The anastomotic area was 3.947 mm2 for the CWE technique and 1.430 mm2 for the OCW technique.
Conclusion: When the sutures penetrate both the epicardial fat tissue and the coronary artery wall simultaneously, a larger anastomosis area can be created. Consequently, potentially better graft flow and hemodynamic performance could be achieved.
Keywords: Coronary Anastomosis Technique; Hemodynamic Performance; Graft Flow; Coronary artery bypass; Graft Patency
Methods: This study was conducted by performing two different fashions of anastomosis with a human saphenous vein graft on 24 various coronary segments of five postmortem porcine hearts. Each arteriotomy was used for both anastomotic techniques. In the first method, epicardial fat tissue around the coronary artery was involved to the saphenous vein anastomosis line (coronary wall and epicardial fat tissue [CWE] technique). In the second method, the saphenous vein graft was sutured to the coronary wall only, without involving epicardial fat tissue (only coronary wall [OCW] technique).The time it tookfor 30 cc of 0.9% isotonic saline solution to pass through the anastomosis in a free-flow fashion by gravity was measured following each technique. Additionally, the anastomotic areas in mm2 were measured and compared between the two techniques.
Results: The mean flow time for the CWE technique was 77.5 ± 21.4 seconds, whereas for the OCW technique, it was 87.2 ± 19.5 seconds (P<0.001). The flow rates were 23.2 ml/min and 20.6 ml/min, respectively. The anastomotic area was 3.947 mm2 for the CWE technique and 1.430 mm2 for the OCW technique.
Conclusion: When the sutures penetrate both the epicardial fat tissue and the coronary artery wall simultaneously, a larger anastomosis area can be created. Consequently, potentially better graft flow and hemodynamic performance could be achieved.
Keywords: Coronary Anastomosis Technique; Hemodynamic Performance; Graft Flow; Coronary artery bypass; Graft Patency
Total Arch Replacement is Safe as Hemiarch Repair in Acute Type A Aortic Dissection in a Middle-Income Country Setting
Braz J Cardiovasc Surg 40;
e20240088
Publish in: 8/2/2025
Objectiver: The aim of this study was to determine the clinical outcomes of patients with
acute type A aortic dissection comparing proximal aortic repair
vs. total arch replacement.
Methods: This was a retrospective cohort study. We included all acute type A aortic dissection procedures from January 2002 to November 2022. Groups were defined according to the extent of aortic replacement (hemiarch repair vs. total arch replacement). We collected data from pre, intra, and postoperative variables. Our main endpoints were stroke rate, spinal cord injury, and in-hospital mortality. We performed a statistical analysis for between-group comparisons according to the nature and distribution of variables. Bivariate analyses were done using the Mann-Whitney U test and for categorical variables, the Chi-square test or Fisher’s exact test. Significance was established at alpha level of 0.05.
Results: We identified 107 acute type A aortic dissection procedures (69 hemiarch repairs vs. 38 total arch replacements). There were no differences in postoperative outcomes such as surgical site infection or acute kidney injury. Bleeding reoperation was more frequent in the hemiarch group (30% vs. 11 %). We did not find statistically significant differences in stroke rate, spinal cord injury, or in-hospital mortality.
Conclusion: Acute type A aortic dissection treatment is still a challenge. Total arch replacement does not increase the risk of major early postoperative complications in comparison to hemiarch repair. The extended repair seems to provide benefits such as a lower risk of reoperation. Total arch replacement should be performed in selected patients, as it may improve long-term outcomes
Keywords: Surgical wound infection; Reoperation; Hospital mortality; Aortic Dissection; Spinal Cord Injuries; Stroke; Acute kidney injury
Methods: This was a retrospective cohort study. We included all acute type A aortic dissection procedures from January 2002 to November 2022. Groups were defined according to the extent of aortic replacement (hemiarch repair vs. total arch replacement). We collected data from pre, intra, and postoperative variables. Our main endpoints were stroke rate, spinal cord injury, and in-hospital mortality. We performed a statistical analysis for between-group comparisons according to the nature and distribution of variables. Bivariate analyses were done using the Mann-Whitney U test and for categorical variables, the Chi-square test or Fisher’s exact test. Significance was established at alpha level of 0.05.
Results: We identified 107 acute type A aortic dissection procedures (69 hemiarch repairs vs. 38 total arch replacements). There were no differences in postoperative outcomes such as surgical site infection or acute kidney injury. Bleeding reoperation was more frequent in the hemiarch group (30% vs. 11 %). We did not find statistically significant differences in stroke rate, spinal cord injury, or in-hospital mortality.
Conclusion: Acute type A aortic dissection treatment is still a challenge. Total arch replacement does not increase the risk of major early postoperative complications in comparison to hemiarch repair. The extended repair seems to provide benefits such as a lower risk of reoperation. Total arch replacement should be performed in selected patients, as it may improve long-term outcomes
Keywords: Surgical wound infection; Reoperation; Hospital mortality; Aortic Dissection; Spinal Cord Injuries; Stroke; Acute kidney injury
Thiol/Disulfide Homeostasis in Pericardial Fluid and Plasma of Patients Undergoing Coronary Artery Bypass Surgery
Braz J Cardiovasc Surg 40;
e20220367
Publish in: 8/2/2025
Introduction: On-pump coronary artery bypass grafting (CABG) method affect almost
allbiochemicalreactions by disrupting the patient’s redox homeostasis.
Detection of systemic redox hemostasis in the patient is critical for the
CABG method’s success and the prognosis of the disease. In this study,
thiol/disulfide parameters, which are indicators of redox homeostasis, and
ischemia-modified albumin levels in the plasma and pericardial fluid of
patients who underwent CABG were investigated.
Methods: Sixty patients who underwent an on-pump CABG operation with the cardiopulmonary bypass method were included in this study. Blood samples were taken from the patients before and after cardiopulmonary bypass. Pericardia fluid samples were taken before cardiopulmonary bypass. Then, thiol/disulfide homeostasis, albumin, and ischemia-modified albumin levels in the pericardial fluid and the patients’ plasma levels were compared.
Results: Albumin and ischemia-modified albumin levels were significantly higher in the postoperative period compared to the preoperative one (P<0.001). Thiol/disulfide parameters were higher and statistically significant in preoperative than in postoperative examinations (P<0.001). A negative correlation was found between pericardial fluid ischemia-modified albumin and thiol-disulfide parameters (P<0.001).
Conclusion: Changes in thiol/disulfide homeostasis, albumin, and ischemia-modified albumin levels at different times during the on-pump CABG may be caused by foreign non-endothelial surfaces, filters, the reperfusion process, and pharmacological effects in the extracorporeal circulation. Thiol/disulfide homeostasis, albumin, and ischemia-modified albumin levels should be monitored during the on-pump CABG and should be intervened with appropriate therapeutic strategies. In this way, secondary pathologies can be avoided by preventing cellular damage and excessive inflammatory responses.
Keywords: Coronary artery bypass; Disulfides; Extracorporeal circulation; Pericardia Fluid; Homeostasis; Indicators and Reagents; Ischemia; Oxidation-Reduction; Reperfusion; Sulfhydryl Compounds
Methods: Sixty patients who underwent an on-pump CABG operation with the cardiopulmonary bypass method were included in this study. Blood samples were taken from the patients before and after cardiopulmonary bypass. Pericardia fluid samples were taken before cardiopulmonary bypass. Then, thiol/disulfide homeostasis, albumin, and ischemia-modified albumin levels in the pericardial fluid and the patients’ plasma levels were compared.
Results: Albumin and ischemia-modified albumin levels were significantly higher in the postoperative period compared to the preoperative one (P<0.001). Thiol/disulfide parameters were higher and statistically significant in preoperative than in postoperative examinations (P<0.001). A negative correlation was found between pericardial fluid ischemia-modified albumin and thiol-disulfide parameters (P<0.001).
Conclusion: Changes in thiol/disulfide homeostasis, albumin, and ischemia-modified albumin levels at different times during the on-pump CABG may be caused by foreign non-endothelial surfaces, filters, the reperfusion process, and pharmacological effects in the extracorporeal circulation. Thiol/disulfide homeostasis, albumin, and ischemia-modified albumin levels should be monitored during the on-pump CABG and should be intervened with appropriate therapeutic strategies. In this way, secondary pathologies can be avoided by preventing cellular damage and excessive inflammatory responses.
Keywords: Coronary artery bypass; Disulfides; Extracorporeal circulation; Pericardia Fluid; Homeostasis; Indicators and Reagents; Ischemia; Oxidation-Reduction; Reperfusion; Sulfhydryl Compounds
REVIEW ARTICLE
Prevalence of Hearing Loss After Open-Heart Surgery: A Systematic Review
Braz J Cardiovasc Surg 40;
e20230197
Publish in: 8/2/2025
Introduction: Today, due to the increase in the incidence of heart problems in people, we
see an increase in the number of heart surgeries worldwide. Hearing
disorders in the form of hearing loss have been reported as one of the side
effects of this kind of surgery in some studies. Considering the evidence of
the effect of open-heart surgery on patients’ hearing loss, this systematic
review study was conducted to determine the frequency of hearing loss after
open-heart surgery.
Methods: To carry out this systematic review, studies that investigated hearing loss after open-heart surgery in Iran and the rest of world, published in Persian or English, and various international electronic databases including PubMed®, Web of Science, Scopus®, and authentic Persian sources (e.g., Irandoc and Scientific Information Database) until the end of 2021 have been indexed.
Results: In the initial review, 46 of the 2230 initially searched articles had the conditions for further review. After checking the articles’ title and abstract and the working method of the studies and removing duplicates and incomplete articles, a total of 16 articles were included in the study. Then, their results were analyzed as the frequency of hearing loss after open-heart surgery by age and sex.
Conclusion: The review of various studies confirms the fact that after open-heart surgery, the existence of evidence of hearing changes is not far from expected.
Keywords: Hearing Loss; Deafness; Cardiac surgical procedures; Systematic Review Study
Methods: To carry out this systematic review, studies that investigated hearing loss after open-heart surgery in Iran and the rest of world, published in Persian or English, and various international electronic databases including PubMed®, Web of Science, Scopus®, and authentic Persian sources (e.g., Irandoc and Scientific Information Database) until the end of 2021 have been indexed.
Results: In the initial review, 46 of the 2230 initially searched articles had the conditions for further review. After checking the articles’ title and abstract and the working method of the studies and removing duplicates and incomplete articles, a total of 16 articles were included in the study. Then, their results were analyzed as the frequency of hearing loss after open-heart surgery by age and sex.
Conclusion: The review of various studies confirms the fact that after open-heart surgery, the existence of evidence of hearing changes is not far from expected.
Keywords: Hearing Loss; Deafness; Cardiac surgical procedures; Systematic Review Study
SPECIAL ARTICLE
Off-pump Myocardial Revascularization — From the Beginning Till Now
Braz J Cardiovasc Surg 40;
e20240993
Publish in: 8/2/2025
CASE REPORT
Repair of Left Ventricular Pseudoaneurysm Due to Systemic Lupus Erythematosus
Braz J Cardiovasc Surg 40;
e20240038
Publish in: 8/2/2025
Systemic lupus erythematosus is a clinically heterogeneous autoimmune disease that frequently affects young women. The risk of cardiovascular events is higher in patients with this disease than in the general population. In this study, we report a patient who developed a left ventricular pseudoaneurysm with no etiological factor other than systemic lupus erythematosus. Dor ventriculoplasty and mitral ring replacement were performed as surgical treatment. The case is shared because of the rarity of left ventricular pseudoaneurysm due to systemic lupus erythematosus and successful pseudoaneurysm repair.
Keywords: Left Ventricular Pseudo-Aneurysm; Systemic Lupus Erythematosus; Ventriculoplasty
EDUCATIONAL FORUM
Early Acute Aortic Dissection After Coronary Artery Bypass Grafting
Braz J Cardiovasc Surg 40;
e20230342
Publish in: 8/2/2025
Patients having Stanford type A acute dissection soon after cardiac surgery have a high risk of rupture and death. The presentation, management, and outcome of primary dissection of the ascending aorta (Stanford type A or De Bakey type I or II) are well described. However, patients with Stanford type A acute aortic dissection soon (3-4 weeks) after primary cardiac surgery have distinctly different presentation, management, and postoperative outcome. In this report, we describe the clinical and surgical findings of a patient with early Stanford type A acute aortic dissection four weeks after primary coronary artery bypass grafting.
Keywords: Coronary artery bypass; Aortic Dissection; Cardiac surgical procedures; Thoracic Aorta; Aortic Dissection
LETTER TO THE EDITOR
Coronary Artery Bypass Grafting in Patients with Reduced Ventricular Function: The Devil Is in The Details
Braz J Cardiovasc Surg 40;
e20240052
Publish in: 8/2/2025
The Ticking Surgical Clock: Outcome, Predictor, or a Bit of Both?
Braz J Cardiovasc Surg 40;
e20240084
Publish in: 8/2/2025
ERRATUM