Volume 40 - Número 5

Introduction: The use of organs from suicide donors in heart transplantation is controversial due to potential concerns about graft function and recipient outcomes. This study investigates the association between heart transplantation using suicide donors related with the incidence of primary graft dysfunction (PGD) and mortality within 30 days after transplant.
Methods: A retrospective analysis was conducted on 97 adult heart transplant recipients at the Instituto do Coração of São Paulo between 2020 and 2021. Data on donor characteristics (age, sex, mechanism of brain death), recipient preoperative status (age, sex, cardiomyopathy etiology, body mass index, comorbidities, use of intra-aortic balloon pump, extracorporeal membrane oxygenation [ECMO]), intraoperative variables (ischemia time, cardiopulmonary bypass time, implantation time), and postoperative outcomes (use of ECMO, mortality) were analyzed.
Results: Of the 97 transplants analyzed, six were from suicide donors (6.2%). Recipients of hearts from suicide donors had a significantly higher need for ECMO (33.3% vs. 4.4%, P = 0.036), increased PGD (66.7% vs. 19.8%, P < 0.05), and higher 30-day mortality (50% vs. 3.3%, P < 0.05) compared to non-suicide donors. No significant intraoperative time differences were found between the groups.
Conclusion: This study is the first to identify a significant association between heart transplantation from suicide donors and adverse outcomes, including higher rates of PGD and early mortality. These findings suggest possible psychological and biological influences on organ quality and transplantation outcomes. Further research is needed to clarify these associations and inform donor selection criteria.
Keywords: Heart transplantation; Donors; Primary Graft Dysfunction; Organ preservation; Inflammatory Markers;

The Off-pump versus On-pump Coronary Artery Bypass Grafting in Frail Patients (FRAGILE Trial) is a multicenter, randomized controlled trial comparing off-pump and on-pump coronary artery bypass grafting in frail or pre-frail patients undergoing coronary artery bypass grafting. This manuscript presents an update to the FRAGILE Trial study design, detailing protocol modifications made in response to the time gap between the study’s conception and its actual implementation. These changes were implemented early in the trial and were formally approved by the Ethics Committee, ensuring the scientific and ethical integrity of the study and reinforcing its relevance to address a gap in a vulnerable patient population.

Keywords: Coronary Artery Bypass Grafts; CABG; Frailty Syndrome; Outcomes; Coronary Artery Disease

Post-myocardial infarction ventricular septal defect is an infrequent complication associated with low survival rates in the absence of surgical management. An 80-year-old woman presents to the emergency department with an inferior wall ST-segment elevation myocardial infarction with complete occlusion of the right coronary artery and a rupture of the interventricular septum with rapid deterioration to cardiogenic shock. Advanced age, female sex, and cardiogenic shock are associated with high mortality. The use of intra-aortic balloon pump improves hemodynamic status, allowing stabilization in the preoperative period.

Keywords: Heart Septal Defects. Ventricular. Myocardial infarction. Cardiogenic shock. Hospital Emergency Service. Preoperative Period.

Ventricular assist devices have been widely accepted as an alternative treatment for advanced heart failure, while heart transplantation is a limited procedure because of the shortage of donors. In face of a scarce availability of these devices, many centers around the world have developed their own technologies. We describe historical and general features of the main ventricular assist devices developed at the Instituto Dante Pazzanese de Cardiologia. The auxiliary total artificial heart is an electromechanical pulsatile blood pump with left and right chambers, being originally designed to work as a heterotopic artificial heart. The spiral pump is a disposable device and currently available for clinical use in cardiopulmonary bypass. It works through a combination of centrifugal and axial pumping principles coming from a conically shaped impeller. The implantable centrifugal blood pump was conceived for long-term circulatory assistance with a unique impeller design concept producing a mixed flow. The apico-aortic blood pump consists of a miniaturized centrifugal pump originally conceived for bridge to transplantation strategy. The temporary circulatory support device is a new centrifugal blood pump for temporary ventricular assistance developed with the purpose of bridge-to-decision or recovery strategies. Additionally, the hybrid cardiovascular simulator was developed as a tool to test blood pumps as they minimize the need for animal experiments. Brazil represents an important reference with a few academic groups with a considerable output in ventricular assist devices research and development. Notable devices produced at Instituto Dante Pazzanese de Cardiologia have demonstrated excellent results for clinical application.

Keywords: Engineering; Heart-assist devices; Cardiopulmonary bypass; Animal experimentation; Heart failure; Heart transplantation; Artificial Heart;

Minimally invasive direct coronary artery bypass grafting (MIDCAB) has considerable benefits over the conventional coronary artery bypass grafting procedure. This case report presents the MIDCAB procedure in a multivessel coronary disease using triple arterial grafts and four arterial anastomoses. The initial anastomosis was made between the left intrathoracic mammary artery (LIMA) and the radial artery (RA), as an end-to-side "T" graft. Next, the RIMA was used to left anterior descending anastomosis. The first obtuse marginal (OM1) branch was grafted to allow LIMA-OM1 side-to-side anastomosis. Then, with the diagonal branch (Dg) opened, the formation of a "jumping" anastomosis was made using LIMA-OM1-Dg. The posterior descending artery (PDA) was used to create a LIMA-RA-PDA.

Keywords: Coronary artery bypass; Coronary Artery Disease; Surgical Anastomosis; Mammary arteries; Radial artery

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