Volume 14 - Número 2
EDITORIAL
A arbitragem e a RBCCV
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
Keywords:
ORIGINAL ARTICLE
Left ventricular geometric repair using semi-rigid bovine pericardial prosthesis: 11-year experience
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
The present study is aimed at showing the survival curve throughout eleven years of follow-up, after surgical treatment using semi-rigid bovine pericardial prosthesis in left ventricular aneurysm. From July, 1988 to November, 1998, 56 standardized left ventricular repair surgeries using semi-rigid bovine pericardial prostheses were carried out, and the prostheses were chosen according to established measurements. The diameter ranged from 23 to 31 mm, and a measurer specific for surgical procedures was used. There were 39 men and 17 women, ranging in age from 35 to 73 years (mean 56.57). Ejection fraction was evaluated by Dodge/Kennedy's paired test and segmental contractility by the "definition of the 100 shortening cords" by ventriculography. All of the patients were followed up for a period of up to 11 years. There were two deaths, one (0.55%) hospitalized patient and 1 (0.55%) late death. Mean ejection fraction increased from 0.37 to 0.57 and the anteroapical segment (subgroup of patients) had the most significant improvement. Death-free survival rate at the end of the follow-up period was 95.47% (confidence interval 95%: 92.27% to 98.67%). In face of the results obtained, we believe the use of semi-rigid bovine pericardial prosthesis for left ventricular geometric repair improves ventricular function and long-term survival.
Keywords: Heart ventricle, surgery; Heart ventricle, pathology; Prostheses and implants; Coronary aneurysm, surgery; Pericardium, cattle; Follow-up studies
Three years of partial left ventriculectomy: overall and late results in 41 patients
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
Background: Batista Partial Left Ventriculectomy has been used as a surgical alternative in the treatment of end-stage heart failure. However as a novel procedure it ensues many questions and answers.
Objectives: To evaluate surgical indication, survival, quality of life and the incidence of lifethreatening or fatal arrhythmias after partial left ventriculectomy and report its availability as a biological bridge to transplantation.
Material and Methods: Forty-one patients were operated on from December 1994 to December 1997, ages ranging from 32 to 70 years, in whom a diagnosis of dilated cardiomyopathy was established. NYHA functional class IV (92.6%) and III (7.3%), contraindication to heart transplantation and poor quality of life were part of the inclusion criteria. Echocardiograms and electrophysiologic studies (EPS) were performed. They were clinically grouped according to their NYHA functional class and categorized concerning our own quality of life protocol.
Results: A group of 15 patients showed sustained decrease in heart dimensions and functional parameters at 30 and 90 postoperative days, as follows:
where FE = fractional shortening, EF = ejection fraction, LVED = left ventricular end-dimensions both diastolic and systolic. Survival was 66%, 53%, 40% and 36.6% at 3, 6, 12 and 24 months of follow-up, respectively. At the conclusion of this 3 year period the immediate and late mortalities are 21.5 % and 42.1 %, with an overall mortality of 63.6%. EPSs probably can predict less mortality rate due to ventricular arrhythmias when those are not induced postoperatively. Quality of life was better postoperatively (72.7 % in NYHA classes I and II and 81.8% in QOL I and II) and two patients were transplanted after primary PLVs.
Conclusions: Cardiac dynamics, Quality of Life and NYHA functional classes improved in all survivors. EPSs can provide useful information concerning the probability of fatal ventricular arrhythmias and the need for implantable cardioverter-defibrillators. Survival is encouraging if we keep in mind the seriousness of this cohort of patients. Patient selection is still controversial.
Keywords: Heart ventricle, surgery; Cardiomyopathy, congestive, surgery; Treatment outcome
where FE = fractional shortening, EF = ejection fraction, LVED = left ventricular end-dimensions both diastolic and systolic. Survival was 66%, 53%, 40% and 36.6% at 3, 6, 12 and 24 months of follow-up, respectively. At the conclusion of this 3 year period the immediate and late mortalities are 21.5 % and 42.1 %, with an overall mortality of 63.6%. EPSs probably can predict less mortality rate due to ventricular arrhythmias when those are not induced postoperatively. Quality of life was better postoperatively (72.7 % in NYHA classes I and II and 81.8% in QOL I and II) and two patients were transplanted after primary PLVs.
Conclusions: Cardiac dynamics, Quality of Life and NYHA functional classes improved in all survivors. EPSs can provide useful information concerning the probability of fatal ventricular arrhythmias and the need for implantable cardioverter-defibrillators. Survival is encouraging if we keep in mind the seriousness of this cohort of patients. Patient selection is still controversial.
Keywords: Heart ventricle, surgery; Cardiomyopathy, congestive, surgery; Treatment outcome
Revascularization surgery of the myocardium in the elderly patients: descriptive study in 144 patients
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
A retrospective analysis involving seventy-year-old patients as well as those over seventy who have undergone CABG as a single procedure, during Jannuary 1992 to December 1997, was carried out with the purpose of assessing their morbidity with mortality. Of the 144 patients, 92 (63.9%) were males, aged 70 to 84 (average age 73.51 and standard deviation 2.82). Most of those, 114 (79.16%), suffered from angina belonging to the functional class III or IV. The occurrence in the pre-operative period of obesity (p = 0.004), heart failure (III/IV class - p = 0.03) and/or acute myocardial infection (less than 21 days - p = 0.01) demonstrated a definite relationship with mortality. There were 120 (83.34%) patients with lesions in three or more vessels (average 3.48 anastomoses/patients).The pediculate internal mammary artery was employed in 126 patients (87.5%) and that rate increased to 98.9% in the last two years. The main complications in the post-operation period leading to death were either infections (p < 0.0001), prolonged ventilatory support (p < 0.0001), renal failure with dialysis (p < 0.0001) and/or low cardiac output (p = 0.003). As to statistical analysis the Student T test, the Chi-square test and Fisher's exact test were used. Surgical mortality totalling 5.5% (8/144) in the first thirty post-operative days decreased to 1.53% (1/65) in the last two years. Coronary artery bypass graft in the elderly can be a procedure with low morbidity and mortality if their body systems are carefully evaluated.
Keywords: Myocardial revascularization; Myocardial revascularization, aged; Myocardial revascularization, mortality; Retrospective studies
Aortic valve surgery: a prospective and randomized study of ministernotomy versus conventional surgery
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
Objective: Minimally Invasive Surgery aims to provide a more rapid recovery, less time in hospital and intensive care unit (ICU), as well as less pain and cost, as a result of less surgical trauma to the patient. This clinical prospective and randomized study aims to evaluate the advantages of minimally invasive surgery of the aortic valve over the conventional one.
Material and Methods: Forty consecutive patients were studied. All had Aortic Valve Disease, age of less than 80 years old and had not been submitted to previous surgery. The evaluation was made prospectively and randomized by computer into two groups (an inverted "L" ministernotomy and a conventional surgery group), during the period between June 1997 to August 1998. All patients were operated on according to pre-established surgical protocols. Both groups were clinically similar. The following variables were analyzed: incision size, ischemia, cardiopulmonary bypass (CPB) and surgical time, hospitalization and ICU time, time of extubation, bleeding, pain and mortality. The data were submitted to statistical analysis using the Student t Test, Mann Whitney Test and the Exact Fisher Test.
Results: The group submitted to minimally invasive aortic valve replacement showed significantly increased time for ischemia and CPB than the conventional surgery group (p=0.006 and p=0.041, respectively) as well as a significantly smaller incision size (p<0.001). The other variables studied did not present any statistically significant differences.
Conclusion: Better cosmetic effect through the minimally invasive surgery. Increased ischemia and CPB time were obtained in the ministernotomy group. The other results obtained for the two groups were similar.
Keywords: Aortic valve, surgery; Surgical procedures, minimally invasive; Prospective studies
Midterm results of annuloplasty repair with bovine pericardial orthesis in rheumatic mitral insufficiency
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
Objectives: Mitral valve repair presents many advantages over valve replacement but the mid-term outcome depends on the technique applied and the underlying disease. The authors have evaluated the results of mid-term mitral valve repair both clinical and echocardiographic variables in rheumatic mitral insufficiency.
Patients and Methods: From January 1995 to February 1997, 23 patients with rheumatic valve disease underwent mitral valve repair. There were 17 females (73.9%) and 6 males (26.1%), all patients with mitral insufficiency or double mitral dysfunction. All of them had no rheumatic activity at time of surgery. Eleven patients (47.8%) were in NYHA class III or IV. All patients underwent annuloplasty with bovine pericardial ring, and were evaluated with trans-thoracic echocardiography before surgery and at each six months after sugery.
Results: There were no peri-operative deaths. Follow-up time was 25.8 ± 7.8 months, 83.9% patients were free from reoperation in 36.09 ± 1.2 months (confidence interval 33.7 to 38.48 months). Statistically, an improvement occurred in left ventricle and diastolic volume (from 58.52 ± 12.87 to 53 ± 12.15 mm) (p = 0.001), and functional class (p = 0.0001). Ejection fraction and left ventricle systolic volume showed no significant improvement. Two patients were reoperated at 22.7 and 28.5 months of follow-up. One patient presented moderate mitral insufficiency and all others showed satisfactory results (mild insufficiency or none).
Conclusions: We conclude that mitral valve annuloplasty repair presents good results at mid-term, with improvement of clinical and echocardiographic variables. Reoperation incidence was very low.
Keywords: Mitral valve insufficiency, surgery; Pericardium; Prostheses and implants; Mitral valve insufficiency, etiology; Rheumatic diseases complications; Ortheses and implants
Surgical treatment of endocarditis in tricuspid valve by valvar resection
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
The surgical treatment of endocarditis in the tricuspid valve is controversial. Arbulu et al. indicate simple exeresis of the tricuspid valve, so that one can opt for the implantation of a prosthesis in a second procedure. Other authors, such as Frater, indicate change of the valve during the same procedure; Evora et al. suggest vegectomy with valvuloplasty. The purpose of this report is to show the follow-up of three patients subjected to surgery from September 1990 to April 1998. Endocarditis was isolated from the tricuspid valve using the technique of valve change. No patient was using IV drugs nor underwent surgery in sepsis. One patient died of septic shock due to his severe condition and the other ones are progressing in class I and II of NYHA.
Keywords: Endocarditis, surgery; Heart valve diseases, surgery; Tricuspid valve, surgery
Ross procedure in children
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
Current prosthetic replacement for aortic valve disease are far from the ideal. The pulmonary autograft replacement of the aortic valve, associated with a homograft in pulmonary position (Ross' procedure), offers an attractive option in younger patients, with growth potential and long-term survival. In our Institution, between January 1997 and December 1998, 12 patients have undergone this procedure. Aortic regurgitation was the main lesion in 5 cases - associated with significant mitral regurgitation, requiring intervention, in three, Aortic regurgitation associated with sub-aortic membrane - 2 cases, Aortic stenosis - 1 case. Reoperation due to failure of aortic valve reconstruction - 1 case. The ethiology was rheumatic in 83.3% of the patients. The mean age was 12.17 years (± 2.04) (range, 8 to 15 years). 41.66% (5 patients ) were in NYHA Class II and the remaining in NYHA Class III. Echocardiogram was performed for pre-op and post-op evaluation in all cases, as well as post-op cardiac catheterization. The homografts used in this series were preserved in antibiotic solution and used before three weeks. Post-op fever was present in 9 (75%) patients, congestive heart failure in 3 (25%), systemic hypertension in 4 (33.3%), excessive pulmonary secretion in 1 (8.33%) and myocardial ischemia 1 case (8.33%). Post-op cardiac catheterization, one month after surgery, showed absence of aortic or pulmonary regurgitation. All patients but 1 (8.33%) are in NYHA Class I, with no medication. In conclusion, the techniques is effective and adequate for children, but some long-term follow up is necessary for better evaluation of the grafts.
Keywords: Aortic valve, surgery; Pulmonary valve, surgery; Cardiovascular surgical procedures, methods; Heart valve diseases, surgery; Transplantation, homologous
Initial evaluation of homografts in pulmonary position in infants and adolescents
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
Objective: Heart valve homografts - fresh or cryopreserved - are a good valvular substitute in infants and teenagers as they need no anticoagulation, have a higher resistance to infection and present a good hemodynamic performance. The objective of this report was to evaluate the initial postoperative results on pediatric subjects after homograft implant in pulmonary position.
Methods: Fourteen homografts were implanted in pulmonary position from September, 1995 to December, 1997. Four of them were fresh (28.6%) and ten were cryopreserved (71.4%). Subjects ranged in age from 10 months to 17 years with 9 (64%) males and 5 (36%) females . The subjects were divided into two groups, as follows: A - aortic valve disease (Ross operation) and B - congenital heart disease. The diameter of the homografts ranged from 16 to 26 mm. The cardiopulmonary-bypass time ranged from 74 to 303 minutes and the aortic-occlusion time between 49 to 160 minutos.
Results: A hospital death occurred. All the survivors were clinically, radiologically, electrocardiographycally and echocardiographycally monitored. There were 13 NYHA I patients and one NYHA II patients. The most common complications were low output syndrome, pericardial effusion and EKG abnormalities. All these ocurred in two patient but with a favorable outcome. Stenosis of the right ventricular outflow track was observed early on in two subjects with gradients of 44 and 23 mmHg. One of the pulmonary homografts was submitted to a successful balloon valvuloplasty due to a severe stenosis. The rheumatic patients are still receiving antibiotic therapy and without recurrence of the disease.
Conclusion: Evaluation of the hemodynamics of the homografts, in pulmonary position, was satisfactory. One of the subjects has presented marked stenosis but, after a balloon valvuloplasty, his gradient decreased. Another patient has kept his preoperative NYHA classification. We believe was not correlated with the homograft (coagulation disorder). It's our belief that fresh and cryopreserved homografts are a satisfactory solution for the correction of congenital or acquired valve disease in infants and adolescents.
Keywords: Heart ventricle, surgery; Aortic valve; Pulmonary valve; Heart valve diseases, surgery; Heart defects, congenital, surgery; Transplantation, homologous
In vitro and in vivo tests with the Auxiliary Total Artificial Heart (ATAH): a new device of a totally implantable and heterotopic artificial heart
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
A miniaturized artificial heart is being developed in the authors laboratories, the Auxiliary Total Artificial Heart (ATAH). This device is an electromechanically driven ATAH using a brushless direct current (DC) motor fixed in a center aluminum piece. This pusher plate type ATAH is controlled based on Frank-Starling's law. The beating frequency is regulated through the change of the left preload, assisting the natural heart in obtaining adequate blood flow. With the miniaturization of this pump, the average sized patient can have the surgical procedure of implantation in the right thoracic cavity performed without removal of the natural heart. The left and right stroke volumes are 35 ml and 32 ml, respectively. In vitro tests were made and the performance curves demonstrated that the ATAH produces 5L/min of cardiac output at 180 bpm (10 mmHg of left inlet mean pressure and 100 mmHg of left outlet mean pressure). Preliminary acute In vivo tests were performed in two sheeps with 50 ± 5 kg, during 5 hours. The ATAH performance is satisfactory for helping the natural heart to obtain the required blood flow and arterial pressure. With the ATAH and the natural heart working simultaneously the ATAH control system is simpler, also the risks of a fatal misoperation is minor compared to a total artificial heart, for patients that still present some cardiac function.
Keywords: Heart-assist devices; Heart, artificial; Transplantation, heterotopic
Assisted venous drainage using an adjustable vacuum system: a clinical study
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
The use of small cannulae improves surgical field visualization in minimally invasive cardiac surgery, but may compromise the venous drainage. Vacuum assisted venous drainage is a simple and nonexpensive solution to this problem. We report our clinical experience using a device consisting of a negative pressure regulator, a vacuum line filter and an electronic manometer. The safety and efficacy of this CPB system was first tested in vitro, applying a negative pressure of 250 mmHg to the venous blood reservoir of a membrane oxigenator, at 40°C. Such a system was used in 11 patients who underwent CABG through standard sternotomy. Later, 9 patients underwenf aortic valve surgery (5 patients) or ASD closure (4 patients) through partial sternotomy ("J" incision), using this system. This device allowed the use of 24 to 28 Fr cannulae, using negative pressure of 40 to 70 mmHg, with adequate arterial flow, venous drainage and no evidence of hemolysis.
Keywords: Myocardial revascularization, instrumentation; Vacuum; Catheters, indwelling; Oxigenators; Drainage
Implantable cardioverter defibrillator: initial experience
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
The implantable cardioverter-defibrillator (ICD) is gaining increasing significance in therapy of life-threatening ventricular arrhythmias. Mirowski started to develop experimental automatic implantable defibrillators in the seventies. In 1980, the first human implant of an automatic implantable defibrillator was done by the team of Mirowski in Baltimore, USA. The purpose of this report is to examine 15 implantation at our Institution. Adequate defibrillation thresholds with were obrtained mean 8.0 Joules, slew rate 1.25 V/s and impedance of 620 Ohms. All implants were performed with non-thoracotomy lead, two abdominal implantations and three left pectoral implantations. Implantation time was 164 minutes. During a mean follow-up of 18.79 months, nine patients received therapy. An inappropriate shock was delivered in one case because there was a sensing problem. No mortality, morbidity, or surgical complications were observed. These findings suggest the ICDs with endocardial leads are a feasible and effective therapy for prevention of sudden cardiac death.
Keywords: Defibrillators, implantable; Arrhythmia, therapy; Follow-up studies
Guidelines to decision - making in congenital heart disease on the WEB interface: Tricuspid Atresia model
Braz J Cardiovasc Surg 14;
Publish in: 8/2/2025
Stimulated by the challenge of updating and organizing all the information acquired in the health field, computer medicine has developed on a wide global scale. The recent success of the Internet for distribution of information has created a need for the production and distribution of medical programs for use via this network. The creation of a decision-making program through the World Wide Web for congenital heart diseases could provide updated information for cardiac surgeons, pediatricians and cardiologists involved in patient management.
The objectives of this project were the following:
- to create a of decision-making model in pediatric cardiac surgery using Tricuspid Atresia, a complex congenital heart disease, as an example;
- to evaluate the complexity of the creation of this model and the benefits of using the computer and the Web Interface;
- to test its validity in 16 cases treated at the "Universidade Federal de São Paulo" (UNIFESP) between 1980 and March 1997.
Using suitable hardware and HTML program language, this program was developed using a group of the texts; 7 pictures and 37 images. During creation of this program, the possibility of its easy development and rapid updating was demonstrated. The validation analysis showed a significant agreement (91.7%) with the surgical indication performed by specialists at the UNIFESP.
Keywords: Heart defects, congenital; Tricuspid atresia; Decision making, computer assisted; Internet
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