Volume 23 - Número 3
EDITORIAL
Technology in service of science
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
The future of saphenous vein graft for coronary artery bypass surgery
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
A brief history of the journal Acta Cirúrgica Brasileira
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
What is the best treatment for cardiac disease?
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
MEMORIAL
José Carlos de Andrade (28/5/1942 - 11/6/2008)
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
ORIGINAL ARTICLE
The risk factors affecting the complications of saphenous vein graft harvesting in aortocoronary bypass surgery
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: Problem of wound healing is commonly observed after coronary artery bypass graft procedures. Our aim is to determine the prevalence and the predictors of saphenous vein harvesting complication after coronary revascularization procedures. Methods: After institutional ethical committee review and approval, a retrospective review was undertaken of 4029 bypass procedures with saphenous vein graft performed over a period of six years is conducted. Thirteen risk factors for those who developed major leg wound complications were analyzed and compared with the entire cohort of patients, undergoing similar bypass procedures during the same period. Results: Lower extremity wound complications occurred in 68 patients (1.7%), 43 of them required additional surgical interventions. There were 17 wound debridements, nine skin grafts, one angioplasty, 11 fasciotomies, three vascular procedures, and two free tissue transfers. Of 13 variables evaluated by multivariate analysis, female gender, BMI, use of internal thoracic artery graft, peripheral vascular disease, the use of postoperative intraaortic balloon pump and preexisting hyperlipidemia were identified as significant independent predictors of major leg wound complications (p<0.05). Conclusions: The causes of major leg wound complications after saphenous vein harvest for coronary artery bypass graft procedures are multifactorial. To minimize these complications, we recommend vascular evaluations before saphenous vein harvest, attention to proper surgical technique, and careful harvest site section.
Keywords: Myocardial Revascularization; Saphenous vein; Coronary artery bypass; Leg; Postoperative complications/etiology
Microscopic and ultrastructural evaluation of the saphenous vein endothelium for CABG prepared by the no touch technique
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: Saphenous vein grafts (SV) used in coronary artery bypass grafting have a limited life and vein occlusion may be the final adverse effect. Efforts to develop new techniques to harvest the saphenous vein may improve the viability of the graft. Methods: Twenty patients were randomly divided into two groups with the objective of evaluating the vascular endothelium. The No Touch (NT) technique consists in removing the saphenous vein with perivascular tissue. The conventional technique consists in harvesting with "in situ" removal of the perivascular tissue. The standard saphenous vein harvesting procedure used bridged incisions. Characteristics of the vein were considered. Evaluation of the endothelium was achieved by electron microscopy and histologic analysis using hematoxylin eosin staining. The Picrosirius and Masson Trichrome methods were used to analyze subendothelial collagen. Results: Electron microscopy demonstrated that the NT Group had larger non-denudated endothelial areas as well as a smaller number of degraded cells. Histological analysis showed the form and integrity of the saphenous vein layers. A larger amount of collagen fibers were identified in the NT Group. Conclusions: The NT technique better preserves the saphenous vein endothelium suggesting a more viable graft in the long term.
Keywords: Saphenous vein; Myocardial revascularization; Endothelium, vascular; Coronary artery bypass
Technical modification for correction of aortic coarctation using hypoplastic arch
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objectives: To study technical feasibility and early results of the technical modification suggested by Caliani et al. for correction of aortic coarctation and aortic arc. Methods: Between January 2005 and July 2006, nine newborn patients with aortic coarctation and significant aortic hypoplasia were selected, and underwent a new surgical approach in order to correct this aortic defect. The definition of aortic arch hypoplasia according to Moulaert's criteria is an aortic arch with a diameter that is less than 50% of the diameter of the ascending aorta. In this study, only patients with proximal and distal aortic hypoplasia were selected. Many techniques were previously used, but significant residual gradients were observed, as well as the incovenience of definitive occlusion of the left subclavian artery. The aim of this study is to describe a new surgical technique that includes left posterolateral thoracotomy, wide mobilization of descending aorta with occlusion of the first two intercostal branches, transection of the left subclavian artery at its base, wide resection of the hypoplastic area and the surronding regions of the ductus arteriosus; end-to-end anastomosis between the aortic arch and descending aorta, with 7-0 PDS thread and reimplantation of the subclavian artery into the left carotid artery with side-to-end anastomosis. Results: There were no perioperative or late deaths. The mean residual gradient was 5 mmHg. Up to now, there were no cases of recoarctation or medullary neurological lesions. Conclusion: Despite the small number of cases and the short follow-up, this technique modification may be an excellent option for the treatment of this complex situation.
Keywords: Aortic coarctation/surgery; Heart defects, congenital; Cardiac surgical procedures/methods; Infant, newborn
Applicability of Ambler's risk score to patients who have undergone valve replacement with bovine pericardial bioprosthesis
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objetives: This study aims to verify the applicability of Ambler's risk score to patients who have undergone implantation of bovine pericardial bioprosthesis at the Instituto de Cardiologia do RGS/FCU. This study also aims to quantify the risk factors. Methods: Retrospective study with 703 patients who had undergone implantation of bovine pericardial bioprosthesis between 1991 and 2005 at the Instituto de Cardiologia do RS. Aortic implant occurred in 392 patients, mitral in 250 and combined in 61. Primary outcome was hospital mortality. Characteristics used to estimate risk were: gender, age, body mass index (BMI), NYHA functional class, left ventricular ejection fraction, valvular lesions, systemic arterial hypertension, diabetes mellitus, renal function, cardiac rhythm, previous cardiac operations, and surgical priority. Univariate and multivariate logistic regression was used to quantify preponderant risk factors by the odds-ratio (OR). Results: The mortality rate was 14.3%, which was higher than the estimated mortality rate (3%, according to Ambler's mean score of 6, (p<0.01)). Patients who died presented a mean score of 8.26, which was higher than the survivors' average score of 5.68. Characteristics of increased risk were emergency surgery (OR=10.87), dialysis (OR=6.10), and age higher than 80 years (OR=6.10). Our sample indicates an area under the ROC curve of 72.9% (accepted value > 70%). Conclusion: The mortality predicted in Ambler's score was not reproduced in the observed results. However, the ROC curve provides evidence that this model is applicable. Preponderant risk factors were individualizated.
Keywords: Heart valve prosthesis implantation/mortality; Heart valve prosthesis implantation/adverse effects; Bioprosthesis; Heart valves/surgery; Hospital mortality; Cardiac surgical procedures/mortality; Prognosis; Risk assessment/methods; Risk factors
Benefits of non-invasive ventilation after extubation in the postoperative period of heart surgery
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: to show the benefits of the use of non-invasive positive pressure ventilation (NPPV) in the process of weaning from mechanical ventilation in the immediate postoperative period of heart surgery. Methods: A prospective, randomized and controlled study was performed involving 100 consecutive patients submitted to coronary artery bypass grafting or valve surgery. The subjects were admitted into the Intensive Care Unit (ICU) under mechanical ventilation and randomized in a study group (n=50), which used NPPV with bilevel pressure for 30 minutes after extubation, and a control group (n=50) which only used a nasal O2 catheter. Anthropometric variables and the times of the intra-operative periods corresponding to anesthesia, surgery and cardiopulmonary bypass, as well as the time required for weaning from invasive mechanical ventilation were analysed. The arterial blood gases and hemodynamic variables were also assessed before and after extubation. Results: The evolution was similar for the control and study groups without statistically significant differences of the variables analyzed except for the PaO2. On comparing the groups, the PaO2 improved significantly (p = 0.0009) with the use of NPPV for 30 minutes after extubation, but there was no statistically significant difference in the PaCO2 (p = 0.557). Conclusion: The use of NPPV for 30 minutes after extubation improved oxygenation in the immediate postoperative period of heart surgery.
Keywords: Cardiac surgical procedures; Intensive care units; Respiration, artificial; Ventilator weaning; Intermittent positive-pressure ventilation
Double skeletonized internal thoracic artery vs. double conventional internal thoracic artery in diabetic patients submitted to OPCAB
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To evaluate the influence of the technique used in the dissection of thoracic arteries in the evolution of diabetic patients submitted to OPCAB. Methods: Seventy diabetic patients submitted to OPCAB using bilateral thoracic arteries were evaluated. In Group A, thoracic arteries were dissected as a pedicle, while in Group B they were skeletonized. Results: The mean age of patients in Group A was 52.14 ± 7.35 years old versus 55.71 ± 8.1 years for Group B (p=0.057). In Group A, six patients (17.1%) were insulin dependent against nine (25.7%) in Group B (p = 0.561). The EUROSCORE was 3.97 ± 2.49 for Group A opposed to 4.14 ± 3.06 for Group B (p = 0.879). The number of distal anastomoses in Group A was 3 ± 0.77 versus 3.03 ± 0.89 in Group B (p = 0.981). Three patients (8.57%) from Group A presented with mediastinitis. Insulin dependence was the only significant risk factor (p=0.008) for mediastinitis. In this group the use of skeletonized internal thoracic arteries significantly decreased the incidence of mediastinitis (p = 0.044). Conclusion: The incidence of mediastinitis was lower in the group for which mammary arteries were dissected using skeletonization. Among insulin-dependent diabetics, 50% of the patients from the group in which the pedicled internal thoracic artery was utilized presented with mediastinitis; the utilization of skeletonized internal thoracic arteries significantly decreases the incidence of mediastinitis.
Keywords: Myocardial revascularization; Mammary arteries; Diabetes mellitus
Evaluation of infant membrane oxygenator in sheep
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To analyze the security and efficacy of a new membrane oxygenator, the so-called OXM - 1500. Methods: From May 2005 to September 2006, six sheep of Santa Inês breed (five male and one female, respectively) were studied. The average body weight was 14.1 (±5) kg, body surface 0.6 (±0.2) m2 and a mean age 3.8 (±1.5) months. All of them were submitted to extracorporeal circulation (CEC) with evaluation at 10, 30, 60, 120, 180 and 240 minutes. The following values were obtained: values of oxygen transference (TTO2) and carbon dioxide transference (TTCO2), haemoglobin (HBS) and free haemoglobin (HBL), the score of platelets and of leucocytes, and heat transference rate. Results: TTO2 and TTCO2 were adequate. Lesion of the majority formed blood elements was insignificant; there no modifications in HBS, HBL levels; platelets and leucocytes decreased over time. Heat exchange was effective (p < 0.05). Conclusions: The membrane OXM - 1500 infant oxygenator, tested in sheep, showed adequate oxygenation capacity, CO2 removal capacity, and small alteration of haemoglobin and platelets without significant decrease of leucocytes, as expected. Heat exchanger connected to the oxygenator was efficient in temperature changes.
Keywords: Extracorporeal membrane oxygenation; Extracorporeal circulation; Sheep
Surgical treatment of chronic atrial fibrillation with conventional electrocautery in mitral valve surgery
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To evaluate the results of the surgical treatment of atrial fibrillation for ablation of the posterior left atrial wall using electrocautery in mitral valve surgery. Methods: From May 2004 to December 2006, 23 patients underwent surgical correction of mitral valve disease and treatment of atrial fibrillation using the conventional electrocautery for the accomplishment of lines of endocardial ablation in the left atrium. The mean age of the patients was 59 years, and 60.8% were female. The left atrium mean diameter was 50.3 ± 5.09 mm and the left ventricular ejection fraction was 53.6 ± 11.03%. Results: The mean time of extracorporeal circulation was 52.5 ± 13.3 min; aortic clamping, 35.6 ± 12.9 min; atrial ablation, 3.05 ± 0.16 min. All the patients were free of atrial fibrillation after the procedure; on hospital discharge, 69.5%; at 6 months, 91.3%; at 12 months, 76.4%; at 18 months, and at 24 months, 68.4%. At 12 months, left atrium mean diameter was 42.1 ± 3.5 mm; left ventricular ejection fraction was 59.2 ± 3.48%; In addition, left atrial contraction was present in 68.8% of the patients. Conclusion: The surgical treatment of the atrial fibrillation with electrocautery in mitral valve surgery was capable to determine the reversion of this arrhythmia in a significant number of patients during short- and middle-term clinical follow-up without mortality and fewer complications.
Keywords: Atrial fibrillation/surgery; Arrhythmia/surgery; Mitral valve/surgery; Heart valve diseases/surgery; Cardiac surgical procedures; Electrophysiology; Diathermy
Mitral valve replacement with crossed papillopexy and annular constriction in heart failure patients
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To analyze the short-term and mid-term follow-ups of patients with heart failure and moderate to severe mitral valve insufficiency and who have undergone mitral valve replacement with crossed papillopexy and annular constriction. Methods: Thirteen patients in NYHA functional class III or IV, with a mean age of 54.1 years and with idiopathic etiology, underwent mitral valve replacement with ring constriction and crossed papillopexy. Echocardiograph parameters, functional class and survival actuarial curve were analyzed. Results: There were no deaths during surgery or in the postoperative period. The mean left ventricular diastolic diameter was reduced from 71 ± 8.6 mm to 65.3 ± 8.6 mm (p=0.049) and the mean left ventricular systolic diameter was reduced from .1 ± 8.5 mm to 50.4 ± 11.1 mm (p=0.002). The atrial diameters varied from 49.4 ± 6.4 mm to 44 ± 5.9 mm (p=0.017); the percentage of the left ventricular shortening was 17 ± 4 % to 24 ± 8.3% (p=0.014); the ejection fraction varied statistically and significantly from 34 ± 9% to 45 ± 14% (p=0.008). Eleven (84.6%) patients were in FC I and II. At 1, 6 and 12 months after follow-up surgery, the survival rate was 100%, 82.6%, 71.6%, respectively. This rate was maintained at 7.6% for more than 36 months. Conclusion: The results obtained from patients with heart failure and moderate to severe mitral valve insufficiency and who underwent mitral valve replacement with crossed papillopexy and annular constriction presented evidence of improved heart remodeling and significant improvement in left ventricular performance.
Keywords: Cardiomyopathy, dilated/surgery; Mitral valve insufficiency/surgery; Papillary muscles/surgery
Evaluation of serum cardiac troponin I values in children less than 1 year of age
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: The objective is to verify the cardiac troponin I values in children less than 1 year of age without clinical cardiac dysfunction. Methods: The cardiac troponin I values were determined in 99 children less than 1 year of age, including term infants without diseases related to cardiac dysfunction using the specific kit Opus T Troponin I (cTn) (Dade Behring Inc. - Newalk, DE 19714, USA). Results: All children have values of cardiac troponin I less than 0.1 ng/ml. Conclusion: We verified that the cardiac troponin I value is less than 0.1 ng/ml in children less than 1 year, including term infants without cardiac dysfunction, when analized by the kit Opus T Troponin I (cTn) test modules.
Keywords: Child; Troponin I/blood; Reference values
Preoperative physiotherapy in prevention of pulmonary complications in pediatric cardiac surgery
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: To evaluate the occurrence and risk of pulmonary complications in children who underwent pre- and postoperative physiotherapeutic intervention in cardiac surgeries, as well as to compare these patients to those who underwent only postoperative physiotherapeutic intervention. Methods: A randomized controlled trial was performed with 135 patients from 6 years of age and younger with congenital heart disease who had undergone cardiac surgery. Patients were randomly assigned to the intervention group (G1) in which they underwent pre- and postoperative physiotherapy or to the control group (G2) in which they underwent only postoperative physiotherapy. Mann-Whitney and the Chi-square tests were used to compare the variables between the groups. The magnitude of the absolute risk was calculated by the number of patients needed to treat. Statistical significance was set at 5% (P<0.05). Results: 17 patients (25%) in G1, and 29 patients (43.3%) in G2 presented pulmonary complications (P= 0.025), pneumonia was the most frequent complication, and among the 17 patients in G1, seven (10.3%) developed pneumonia, six (8.8%) developed atelectasis, and four (5.9%) presented complications due to both complications. In G2, 13 patients (19.4%) developed pneumonia, eight (11.9%) developed atelectasis, and eight (11.9%) developed pneumonia associated with atelectasis. Absolute risk reduction for the primary outcome was of 18.3% and the number of needed to treat was 5.5. Conclusion: Preoperative respiratory physiotherapy significantly reduced the risk of pulmonary complications in postoperative pediatric cardiac surgery.
Keywords: Physical therapy modalities; Cardiac surgical procedures; Child; Randomized Controlled Trial
Ultrastructural study of the myocardium using cardioplegic crystalloid solution with and without procaine in patients undergoing aortic valve replacement
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: The aim of this study was to assess whether the presence of procaine in crystalloid cardioplegic solution increases myocardial protection at the ultra structural level. Methods: Eighteen patients that underwent aortic valve replacement in the Hospital de Clínicas de Porto Alegre over a 10-month period were studied. They were randomly allocated into two groups: group A - eight patients receiving cardioplegia without procaine; group B - ten patients receiving cardioplegia with procaine. Myocardial biopsies were performed in three different periods: 1st - before ischemic arrest, 2nd - at the end of ischemic arrest, and 3rd - 15 minutes after reperfusion. Results: The ultra structural analysis comparing the groups in the three moments did not show any statistically significant difference. The mean score in group A at moment I, II and III was 0.1 ± 0.2; 0.4 ± 0.3; 0.4 ± 0.4, and group B 0.2 ± 0.2; 0.4 ± 0.3; 0.7 ± 0.2. Comparative analysis of CK-MB was similar. The spontaneous return to sinus rhythm after aortic declamping in group B occurred in 70% and in group A 12.5% (p=0.024). Conclusion: Both cardioplegic solutions tested were equally effective in myocardial preservation, and we could not demonstrate at the ultrastructural level any benefit when procaine was added. The spontaneous return to sinus rhythm after aortic declamping was significantly greater when procaine was added.
Keywords: Cardioplegic solutions; Procaine; Myocardium/ultrastructure; Heart valve prosthesis; Aortic valve/surgery; Microscopy, electron
SPECIAL ARTICLE
Critical reading of the statistical data in scientific studies
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objectives: Statistics are a valuable tool that validates the conclusions of scientific works. The objective of this review was to present some concepts related to statistic calculations that are fundamental for the critical reading and analysis of medical literature. Contents: In general, authors present the results of their studies as charts, boxes, and tables with quantitative data, along with descriptive statistics (means, standard deviations, medians), and almost always mention the statistic tests used. After reviewing several studies, it was difficult to find the value attributed to the statistical test. Thus, it is up to the reader to evaluate the adequacy of the information, and to search for evidence that contradict possible mistakes that could threaten the validity of their conclusion. Conclusions: Examining the design of the studies one observes that, in many of them, excessive importance is given to statistical calculations as definitive factors, irrefutable evidence of arguable, or equivocal, conclusions.
Keywords: Statistical analysis; Data interpretation, statistical; Statistical methods and procedures; Research design/statistics & numerical data
REVIEW ARTICLE WITH PRACTICAL APPLICATION
Pre-and postoperative care in cardiothoracic surgery: a physiotherapeutic approach
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
It is well known that anesthesia and certain surgeries predispose patients to changes in respiratory function, pulmonary volumes, and gas exchange. Cardiac surgery, which is considered a major surgery, may trigger respiratory complications in the postoperative period. These complications have various causes, such as heart and lung functions in the pre-operative, the use of cardiopulmonary bypass (CPB), and the level of sedation. In these extensive thoracic procedures, respiratory dysfunction may be significant, persisting in the postoperative period. Physiotherapy is offered to patients in the ICU as part of a multidisciplinary treatment plan. It is a time-consuming treatment, and is possible at various times during the patient's stay in the ICU. However, it is particularly valuable in postoperative recovery in order to avoid respiratory and motor complications. Thus, a literature review was performed, aiming to arrange current and relevant information on available resources for respiratory monitoring, as well as its importance in evaluating and treating lung function impairment, as this complication is a frequent cause of death in surgical patients.
Keywords: Thoracic surgery; Cardiac surgical procedures; Physical therapy; Postoperative care
CASE REPORT
Totally endoscopic mitral valve repair: a case report
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Minimum incision techniques in cardiac surgery have been on the rise after their inclusion in videothoracoscopy. Video-assisted minimally invasive cardiac surgery is considered by many centers in the world to be the approach of choice for treatment of mitral and aortic valve diseases. The aim of this is study is to report a case of valve repair in a patient with mitral restenosis after surgical repair 12 years before. Through a minimally invasive and totally endoscopic procedure, it was possible to successfully perform a mitral commissurotomy with only videoscopic support, and without any incisions larger than those needed to introduce the trocars for instrumentation.
Keywords: Video-assist surgery; Cardiac surgical procedures/methods; Thoracic surgery, video-assisted/methods; Mitral valve/surgery; Reoperation
Aortic complications after bariatric surgery
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Obesity and its correlated comorbidities are nowadays considered a public health concern. In the last few years, a myriad of strategies searched an effective procedure to reduce weight and decreases related comorbidities. Among these strategies, the bariatric procedures have been achieved a significantly increase, being able to promote an expressive and lasting weight reduction. Diverse early and late complications are described and related to restrictive and malabsortive bariatric procedures. In this report we describe two cases of cardiovascular complications (aortic dissection and aneurysm) in the late postoperative period of the bariatric procedures.
Keywords: Aorta/surgery; Bariatric surgery/adverse effects; Aortic aneurysm/etiology; Aneurysm, dissecting
Crossed papillopexy with graft in mitral valve replacement: case report
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
The aim of this study is to present the crossed papillopexy technique using bovine pericardial graft in mitral replacement caused by intense valvar and subvalvar fibrosis and calcification. This technique allows the functional preservation of the mitral subvalvar apparatus and was successfully applied, by the first time as far as we known, in a patient with calcified rheumatic mitral stenosis, who underwent mitral valve replacement surgery. The patient had an uneventful recovery and was discharged home on postoperative day 6. Echocardiography controls showed normal left ventricular function without any interference on the mitral prosthesis dynamics.
Keywords: Mitral valve/surgery; Papillary muscles/surgery; Heart valve prosthesis
Cardiac tamponade caused by central venous catheter in two newborns
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Cardiac tamponade secondary to the use of central venous catheter is a rare complication; however, it is potentially reversible when it is caught in time. We report two cases of cardiac tamponade that was diagnosed using a transthoracic echocardiography, followed by urgent pericardiocentesis and surgical pericardial drainage as a complication from umbilical venous catheterization. In one case, the tip of the catheter was properly placed, and in the other case, it was not. In both cases, a hyperosmolar solution was being injected. Although it may be an uncommon situation, it should be always considered as a possibility in a newborn who develops cardiogenic shock without an apparent cause.
Keywords: Cardiac tamponade; Infant, newborn; Umbilical veins; Catheterization, central venous/adverse effects; Catheterization/methods
Endovascular repair of an abdominal aortic aneurysm in patient with horseshoe kidney: a case report
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Horseshoe kidney is a rare congenital anomaly that may cause various technical problems during conventional repairs of abdominal aortic aneurysms. We report the case of a 68-year-old woman with a horseshoe kidney, symptomatic abdominal aortic aneurysm and mild renal failure. The patient underwent endovascular repair using a bifurcated endoprosthesis. The postoperative was uneventful. We describe the diagnosis and the endovascular technique and literature review.
Keywords: Aortic aneurysm; Aortic aneurysm, abdominal/surgery; Blood vessel prosthesis implantation/methods; Kidney diseases/surgery; Kidney/abnormalities; Stents
MULTIMEDIA
Total cavopulmonary with extracardiac conduit without cardiopulmonary bypass
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
BRIEF COMMUNICATION
Particulate emboli capture by an intra-aortic filter device during aortic valve replacement
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Objective: This study aims to analyze the embolic activity in patients with calcified aortic stenosis who underwent aortic valve replacement using intra-aortic filtration with an EMBOL-X® System device (Edwards Lifesciences Inc., Mountain View, CA, USA). Methods: From January 2007 to July 2007, 13 consecutive patients with calcified aortic stenosis, who underwent isolated aortic valve replacement using intra-aortic filtration by an EMBOL-X® System for 5 minutes after aortic clamp release, were evaluated. Mean patient age was 63.7 years (range 34 to 79 years) and 61.5% were female. The mean bypass time was 60.2 ± 7.5 minutes (range 45 to 72 minutes) and the mean cross-clamp time was 50 ± 7.5 minutes (range 35 to 63 minutes). Following removal, each filter was fixed in formalin and analyzed macroscopically with the captured fragments being counted. Histological examinations of the captured material were performed. Results: There were no strokes or gross neurological events. There were no cases of postoperative renal failure. No deaths were reported during hospitalization. Particulate emboli were found in five (38.5%) of the filters. On histological analysis of the particulate emboli captured, two (40%) contained fibrin, two (40%) presented conjunctive tissue, one (20%) contained red blood cells and in one it was not possible to determine the nature of the particulates captured. Conclusion: The EMBOL-X® System device was effective in particulate emboli capture in aortic valve replacement surgery of patients with calcified aortic stenosis.
Keywords: Aortic valve stenosis/surgery; Embolism/prevention & control; Stroke/prevention & control; Filtration/instrumentation; Heart valve prosthesis implantation
CLINICAL-SURGICAL CORRELATION
Enlargement of the ascending aorta with Brom technique in a patient with Williams-Beuren syndrome
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
Alternative to an extracardiac Fontan-type operation: direct anastomosis between pulmonary trunk and inferior vena cava
Braz J Cardiovasc Surg 23;
Publish in: 8/2/2025
LETTERS TO THE EDITOR
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