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Autologous blood salvage in cardiac surgery: clinical evaluation, efficacy and levels of residual heparin
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Vieira, Sérgio Domingos

; Perini, Fernanda da Cunha Vieira

; Sousa, Luiz Carlos Bento de

; Buffolo, Enio

; Chaccur, Paulo

; Arrais, Magaly

; Jatene, Fábio Biscegli

Hematology, Transfusion and Cell Therapy

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mar 2021, Volume 43 N. 1 Pages 1 - 8

Abstract: En | Text: En | PDF: En

ABSTRACT Objective: Intraoperative blood salvage (cell saver technique) in cardiac surgery is universally used in surgical procedures with a marked risk of blood loss. The primary objectives of this study were to determine the concentration of residual heparin in the final product that is reinfused into the patient in the operating room and to evaluate the efficacy and safety of the cell saver technique. Method: Twelve patients undergoing elective cardiac surgery were enrolled in this study. Using the XTRA Autotransfusion System, blood samples were collected from the cardiotomy reservoir, both prior to blood processing (pre-sample) and after it, directly from the bag with processed product (post-sample). Hematocrit and hemoglobin levels, the protein, albumin and residual heparin concentrations, hemolysis index, and the platelet, erythrocyte and leukocyte counts were measured. Results: Hematocrit and hemoglobin levels and red blood cell counts were higher in post-processing samples, with a mean variation of 54.78%, 19.81 g/dl and 6.84 × 106/mm3, respectively (p < 0.001). The mean hematocrit of the processed bag was 63.49 g/dl (range: 57.2-67.5). The residual heparin levels were ≤0.1 IU/ml in all post-treatment analyses (p = 0.003). No related adverse events were observed. Conclusion: The reduced residual heparin values (≤0.1 IU/ml) in processed blood found in this study are extremely important, as they are consistent with the American Association of Blood Banks guidelines, which establish target values below 0.5 IU/ml. The procedure was effective, safe and compliant with legal requirements and the available international literature.

https://doi.org/10.1016/j.htct.2019.08.005 164 downloads

Brazilian Academy of Cardiovascular Surgery: From Idea to Reality
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Wanderley Neto, José

; Buffolo, Enio

; Mendonça, José Teles de

Brazilian Journal of Cardiovascular Surgery

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dec 2020, Volume 35 N. 6 Pages IV - VI

Abstract: En | Text: En | PDF: En

https://doi.org/10.21470/1678-9741-1-2020-0631 225 downloads

Domingo Marcolino Braile (1938-2020) Surgeon - Scientist - Professor - Businessman - Aviator The last flight of a great man
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Buffolo, Enio

; Wanderley Neto, José

; Mendonça, José Teles de

; Lima, Ricardo C.

; Brofman, Paulo Roberto

; Lucchese, Fernando A

; Jatene, Fabio B

Brazilian Journal of Cardiovascular Surgery

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jun 2020, Volume 35 N. 3 Pages VII - IX

Abstract: En | Text: En | PDF: En

https://doi.org/10.21470/1678-9741-1-2020-0605 167 downloads

Comment on the study Coronary Artery Bypass Surgery in Brazil: Analysis of the National Reality Through the Bypass Registry that was presented at the 46th Congress of the Brazilian Society of Cardiovascular Surgery, Nova Lima, BH, Brazil, April 5 and 6, 2019
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Dallan, Luís Alberto O.

; Paez, Rodrigo Pereira

; Hossne Junior, Nelson Américo

; Santo, José Amalth do Espírito

; Berwanger, Otavio

; Santos, Renato Hideo Nakagawa

; Kalil, Renato Abdala Karam

; Jatene, Fabio B.

; Cavalcanti, Alexandre Biasi

; Zilli, Alexandre Cabral

; Bettiati Jr, Luiz Carlos

; Figueira, Fernando Augusto Marinho dos Santos

; D’Azevedo, Stephanie Steremberg Pires

; Soares, Marcelo José Ferreira

; Fernandes, Marcio Pimentel

; Ardito, Roberto Vito

; Bogdan, Renata Andrea Barberio

; Campagnucci, Valquíria Pelisser

; Nakasako, Diana

; Rodrigues, Clarissa Garcia

; Rodrigues Junior, Anilton Bezerra

; Cascudo, Marcelo Matos

; Atik, Fernando Antibas

; Lima, Elson Borges

; Nina, Vinicius José da Silva

; Heluy, Renato Albuquerque

; Azeredo, Lisandro Gonçalves

; Henrique Junior, Odilon Silva

; Mendonça, José Teles de

; Silva, Katharina Kelly de Oliveira Gama

; Pandolfo, Marcelo

; Lima Júnior, José Dantas de

; Faria, Renato Max

; Santos, Jonas Gonçalves dos

; Coelho, Guilherme Henrique Biachi

; Pereira, Sergio Nunes

; Senger, Roberta

; Buffolo, Enio

; Caputi, Guido Marco

; Oliveira, Juliana Aparecida Borges de

; Gomes, Walter J.

Brazilian Journal of Cardiovascular Surgery

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aug 2019, Volume 34 N. 4 Pages 504 - 506

Abstract: En | Text: En | PDF: En

https://doi.org/10.21470/1678-9741-2019-0606 335 downloads

Coronary Artery Bypass Surgery in Brazil: Analysis of the National Reality Through the BYPASS Registry
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Paez, Rodrigo Pereira

; Hossne Junior, Nelson Américo

; Santo, José Amalth do Espírito

; Berwanger, Otavio

; Santos, Renato Hideo Nakagawa

; Kalil, Renato Abdala Karam

; Jatene, Fabio B.

; Cavalcanti, Alexandre Biasi

; Zilli, Alexandre Cabral

; Bettiati Jr, Luiz Carlos

; Figueira, Fernando Augusto Marinho dos Santos

; D'Azevedo, Stephanie Steremberg Pires

; Soares, Marcelo José Ferreira

; Fernandes, Marcio Pimentel

; Ardito, Roberto Vito

; Bogdan, Renata Andrea Barberio

; Campagnucci, Valquíria Pelisser

; Nakasako, Diana

; Rodrigues, Clarissa Garcia

; Rodrigues Junior, Anilton Bezerra

; Cascudo, Marcelo Matos

; Atik, Fernando Antibas

; Lima, Elson Borges

; Nina, Vinicius José da Silva

; Heluy, Renato Albuquerque

; Azeredo, Lisandro Gonçalves

; Henrique Junior, Odilon Silva

; Mendonça, José Teles de

; Silva, Katharina Kelly de Oliveira Gama

; Pandolfo, Marcelo

; Lima Júnior, José Dantas de

; Faria, Renato Max

; Santos, Jonas Gonçalves dos

; Coelho, Guilherme Henrique Biachi

; Pereira, Sergio Nunes

; Senger, Roberta

; Buffolo, Enio

; Caputi, Guido Marco

; Oliveira, Juliana Aparecida Borges de

; Gomes, Walter J.

Brazilian Journal of Cardiovascular Surgery

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apr 2019, Volume 34 N. 2 Pages 142 - 148

Abstract: En | Text: En | PDF: En

Abstract Introduction: Coronary artery bypass grafting (CABG) is the most frequently performed heart surgery in Brazil. Recent international guidelines recommend that national societies establish a database on the practice and results of CABG. In anticipation of the recommendation, the BYPASS Registry was introduced in 2015. Objective: To analyze the profile, risk factors and outcomes of patients undergoing CABG in Brazil, as well as to examine the predominant surgical strategy, based on the data included in the BYPASS Registry. Methods: A cross-sectional study of 2292 patients undergoing CABG surgery and cataloged in the BYPASS Registry up to November 2018. Demographic data, clinical presentation, operative variables, and postoperative hospital outcomes were analyzed. Results: Patients referred to CABG in Brazil are predominantly male (71%), with prior myocardial infarction in 41.1% of cases, diabetes in 42.5%, and ejection fraction lower than 40% in 9.7%. The Heart Team indicated surgery in 32.9% of the cases. Most of the patients underwent cardiopulmonary bypass (87%), and cardioplegia was the strategy of myocardial protection chosen in 95.2% of the cases. The left internal thoracic artery was used as a graft in 91% of the cases; the right internal thoracic artery, in 5.6%; and the radial artery in 1.1%. The saphenous vein graft was used in 84.1% of the patients, being the only graft employed in 7.7% of the patients. The median number of coronary vessels treated was 3. Operative mortality was 2.8%, and the incidence of cerebrovascular accident was 1.2%. Conclusion: CABG data in Brazil provided by the BYPASS Registry analysis are representative of our national reality and practice. This database constitutes an important reference for indications and comparisons of therapeutic procedures, as well as to propose subsequent models to improve patient safety and the quality of surgical practice in the country.

https://doi.org/10.21470/1678-9741-2018-0313 1270 downloads

The Brazilian Registry of Adult Patient Undergoing Cardiovascular Surgery, the BYPASS Project: Results of the First 1,722 Patients
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Gomes, Walter J.

; Moreira, Rita Simone

; Zilli, Alexandre Cabral

; Bettiati Jr, Luiz Carlos

; Figueira, Fernando Augusto Marinho dos Santos

; D' Azevedo, Stephanie Steremberg Pires

; Soares, Marcelo José Ferreira

; Fernandes, Marcio Pimentel

; Ardito, Roberto Vito

; Bogdan, Renata Andrea Barberio

; Campagnucci, Valquíria Pelisser

; Nakasako, Diana

; Kalil, Renato Abdala Karam

; Rodrigues, Clarissa Garcia

; Rodrigues Junior, Anilton Bezerra

; Cascudo, Marcelo Matos

; Atik, Fernando Antibas

; Lima, Elson Borges

; Nina, Vinicius José da Silva

; Heluy, Renato Albuquerque

; Azeredo, Lisandro Gonçalves

; Henrique Junior, Odilon Silva

; Mendonça, José Teles de

; Silva, Katharina Kelly de Oliveira Gama

; Pandolfo, Marcelo

; Lima Júnior, José Dantas de

; Faria, Renato Max

; Santos, Jonas Gonçalves dos

; Paez, Rodrigo Pereira

; Coelho, Guilherme Henrique Biachi

; Pereira, Sergio Nunes

; Senger, Roberta

; Buffolo, Enio

; Caputi, Guido Marco

; Santo, José Amalth do Espírito

; Oliveira, Juliana Aparecida Borges de

; Berwanger, Otavio

; Cavalcanti, Alexandre Biasi

; Jatene, Fabio B.

Brazilian Journal of Cardiovascular Surgery

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apr 2017, Volume 32 N. 2 Pages 71 - 76

Abstract: En | Text: En | PDF: En

Abstract Objective: To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Methods: Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8), Northeast (5), South (3), and Center-West (1). The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG), mitral valve, aortic valve (either conventional or transcatheter), surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults. Results: 83.1% of patients came from the public health system (SUS), 9.6% from the supplemental (private insurance) healthcare systems; and 7.3% from private (out-of -pocket) clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%; for CABG was 2.6%, and for valve operations, 4.4%. Conclusion: This first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.

https://doi.org/10.21470/1678-9741-2017-0053 1883 downloads

Analysis of the Use of Extracorporeal Circulation on the In-Hospital Outcomes of Dialytic Patients Who Underwent Myocardial Revascularization Surgery
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Miranda, Matheus

; Branco, João Nelson Rodrigues

; Vargas, Guilherme Flora

; Hossne Jr., Nelson Americo

; Yoshimoto, Michele Costa

; Fonseca, José Honorio de Almeida Palma da

; Pestana, José Osmar Medina de Abreu

; Buffolo, Enio

Arquivos Brasileiros de Cardiologia

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dec 2016, Volume 107 N. 6 Pages 518 - 522

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento: A revascularização cirúrgica do miocárdio é o melhor tratamento para o paciente dialítico com doença coronariana multiarterial. Contudo, o procedimento ainda apresenta elevada morbimortalidade. O uso da circulação extracorpórea (CEC) pode impactar de maneira negativa na evolução intra-hospitalar desses pacientes. Objetivos: Avaliar a diferença entre as técnicas com ou sem CEC na evolução intra-hospitalar de pacientes dialíticos submetidos a cirurgia de revascularização do miocárdio. Métodos: Estudo unicêntrico de 102 pacientes dialíticos consecutivos e não selecionados, submetidos à revascularização cirúrgica do miocárdio em um hospital terciário universitário no período de 2007 a 2014. Resultados: 63 pacientes foram operados com CEC e 39 sem o uso de CEC. Foi observada alta prevalência de fatores de risco cardiovascular em ambos grupos, porém sem diferença estatisticamente significante entre eles. O grupo "com CEC" apresentou maior número de coronárias revascularizadas (2,4 vs 1,7; p <0,0001), maior necessidade de hemocomponentes (77,7% vs 25,6%; p <0,0001) e apoio inotrópico (82,5% vs 35,8%; p <0,0001). Na evolução pós-operatória, o grupo "sem CEC" apresentou menor necessidade de drogas vasoativas (61,5% vs 82,5%; p = 0,0340), maior taxa de extubação em sala cirúrgica (58,9% vs 23,8%, p = 0,0006), menor tempo de ventilação mecânica (13,0 horas vs 36,3 horas, p = 0,0217), menor taxa de infecções (7,6% vs 28,5%; p = 0,0120) e menor tempo de internação em UTI (5,2 dias vs 8,1 dias; p = 0,0054) em comparação ao grupo "com CEC". Não houve diferença de mortalidade entre os grupos. Conclusão: O uso da CEC na revascularização do miocárdio em pacientes dialíticos resultou em maior morbidade no período perioperatório em comparação ao procedimento realizado sem CEC, contudo, sem diferença de mortalidade.

Abstract Background: Myocardial revascularization surgery is the best treatment for dyalitic patients with multivessel coronary disease. However, the procedure still has high morbidity and mortality. The use of extracorporeal circulation (ECC) can have a negative impact on the in-hospital outcomes of these patients. Objectives: To evaluate the differences between the techniques with ECC and without ECC during the in-hospital course of dialytic patients who underwent surgical myocardial revascularization. Methods: Unicentric study on 102 consecutive, unselected dialytic patients, who underwent myocardial revascularization surgery in a tertiary university hospital from 2007 to 2014. Results: Sixty-three patients underwent surgery with ECC and 39 without ECC. A high prevalence of cardiovascular risk factors was found in both groups, without statistically significant difference between them. The group "without ECC" had greater number of revascularizations (2.4 vs. 1.7; p <0.0001) and increased need for blood components (77.7% vs. 25.6%; p <0.0001) and inotropic support (82.5% vs 35.8%; p <0.0001). In the postoperative course, the group "without ECC" required less vasoactive drugs, (61.5% vs. 82.5%; p = 0.0340) and shorter time of mechanical ventilation (13.0 hours vs. 36,3 hours, p = 0.0217), had higher extubation rates in the operating room (58.9% vs. 23.8%, p = 0.0006), lower infection rates (7.6% vs. 28.5%; p = 0.0120), and shorter ICU stay (5.2 days vs. 8.1 days; p = 0.0054) as compared with the group with ECC surgery. No difference in mortality was found between the groups. Conclusion: Myocardial revascularization with ECC in patients on dialysis resulted in higher morbidity in the perioperative period in comparison with the procedure without ECC, with no difference in mortality though.

https://doi.org/10.5935/abc.20160180 2085 downloads

Adib Jatene: 4 de junho de 1929 14 de novembro de 2014
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Braile, Domingo M.

; Buffolo, Enio

Brazilian Journal of Cardiovascular Surgery

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dec 2014, Volume 29 N. 4 Pages 473 - 477

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.5935/1678-9741.20140124 3959 downloads

Impact of Intensive Physiotherapy on Cognitive Function after Coronary Artery Bypass Graft Surgery
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Cavalcante, Elder dos Santos

; Magario, Rosmeiri

; Conforti, César Augusto

; Cipriano Júnior, Gerson

; Arena, Ross

; Carvalho, Antonio Carlos C.

; Buffolo, Enio

; Luna Filho, Bráulio

Arquivos Brasileiros de Cardiologia

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nov 2014, Volume 103 N. 5 Pages 391 - 397

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Background: Coronary artery bypass graft (CABG) is a standard surgical option for patients with diffuse and significant arterial plaque. This procedure, however, is not free of postoperative complications, especially pulmonary and cognitive disorders. Objective: This study aimed at comparing the impact of two different physiotherapy treatment approaches on pulmonary and cognitive function of patients undergoing CABG. Methods: Neuropsychological and pulmonary function tests were applied, prior to and following CABG, to 39 patients randomized into two groups as follows: Group 1 (control) - 20 patients underwent one physiotherapy session daily; and Group 2 (intensive physiotherapy) - 19 patients underwent three physiotherapy sessions daily during the recovery phase at the hospital. Non-paired and paired Student t tests were used to compare continuous variables. Variables without normal distribution were compared between groups by using Mann-Whitney test, and, within the same group at different times, by using Wilcoxon test. The chi-square test assessed differences of categorical variables. Statistical tests with a p value ≤ 0.05 were considered significant. Results: Changes in pulmonary function were not significantly different between the groups. However, while Group 2 patients showed no decline in their neurocognitive function, Group 1 patients showed a decline in their cognitive functions (P ≤ 0.01). Conclusion: Those results highlight the importance of physiotherapy after CABG and support the implementation of multiple sessions per day, providing patients with better psychosocial conditions and less morbidity.

https://doi.org/10.5935/abc.20140161 4134 downloads

10.

Estudo da Fase Intra-hospitalar da Revascularizacao Cirurgica do Miocardio em Pacientes Dialiticos
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Miranda, Matheus

; Hossne Jr., Nelson Americo

; Branco, Joao Nelson Rodrigues

; Vargas, Guilherme Flora

; Fonseca, Jose Honorio de Almeida Palma da

; Pestana, Jose Osmar Medina de Abreu

; Juliano, Yara

; Buffolo, Enio

Arquivos Brasileiros de Cardiologia

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mar 2014, Volume 102 N. 2 Pages 128 - 133

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Fundamentos: Atualmente, a revascularização cirúrgica do miocárdio é o melhor tratamento para o paciente dialítico com lesão coronariana multiarterial, contudo a mortalidade e a morbidade hospitalar do procedimento ainda permanecem altas. Objetivos: Avaliar os resultados e a evolução intra-hospitalar da revascularização cirúrgica do miocárdio isolada em pacientes dialíticos. Métodos: Estudo retrospectivo unicêntrico de 50 pacientes dialíticos consecutivos e não selecionados, submetidos à revascularização cirúrgica do miocárdio em um hospital terciário universitário no período de 2007 a 2012. Resultados: A casuística apresentou alta prevalência de fatores de risco cardiovasculares (100% hipertensos, 68% diabéticos e 40% dislipidêmicos). Não houve óbito intraoperatório, e 60% dos procedimentos foram feitos sem circulação extracorpórea. Houve sete (14%) óbitos intra-hospitalares. Infecção pós-operatória, insuficiência cardíaca prévia, uso de circulação extracorpórea, função ventricular anormal e reexploração cirúrgica foram os fatores associados a maior mortalidade. Conclusão: A revascularização cirúrgica do miocárdio é um procedimento factível para essa classe de pacientes, contudo com alta morbidade e mortalidade intra-hospitalar. É necessário melhor entendimento das particularidades metabólicas desses pacientes para o planejamento adequado das condutas.

Background: Coronary artery bypass grafting currently is the best treatment for dialytic patients with multivessel coronary disease, but hospital morbidity and mortality related to procedure is still high. Objective: Evaluate results and in-hospital outcomes of coronary artery bypass grafting in dialytic patients. Methods: Retrospective unicentric study including 50 consecutive and not selected dialytic patients, who underwent coronary artery bypass grafting in a tertiary university hospital from 2007 to 2012. Results: High prevalence of cardiovascular risk factors was observed (100% hypertensive, 68% diabetic and 40% dyslipidemic). There was no intra-operative death and 60% of the procedures were performed off-pump. There were seven (14%) in-hospital deaths. Postoperative infection, previous heart failure, cardiopulmonary bypass, abnormal ventricular function and surgical re-exploration were associated with increased mortality. Conclusion: Coronary artery bypass grafting is feasible to dialytic patients although high in-hospital morbidity and mortality. It is necessary better understanding about metabolic aspects to plan adequate interventions.

https://doi.org/10.5935/abc.20130231 3307 downloads

11.

Estudio SYNTAX de la evidencia a la desobediencia
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Buffolo, Enio

; Stein, Alberto Juffe

Brazilian Journal of Cardiovascular Surgery

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jun 2013, Volume 28 N. 2 Pages III - V

Abstract: Es | Text: Es | PDF: Es

https://doi.org/10.5935/1678-9741.20130023 4067 downloads Cited 2 times in SciELO

12.

Stent aórtico pulsátil: uma nova alternativa na assistência ventricular crônica
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Palma, José Honório

; Gaia, Diego Felipe

; Caputi, Guido

; Agreli, Guilherme

; Breda, João Roberto

; Braile, Domingo M.

; Buffolo, Enio

Brazilian Journal of Cardiovascular Surgery

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jun 2013, Volume 28 N. 2 Pages 217 - 223

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: A insuficiência cardíaca é uma das causas mais comuns de internação. Dispositivos para assistência circulatória crônica foram testados e, em sua maioria, são de alta complexidade. O objetivo deste estudo é a descrição de uma endoprótese contrátil com capacidade de pulsação crônica no interior da aorta descendente, de maneira semelhante à produzida pelo balão intra-aórtico. MÉTODOS: Endopróteses pulsáteis compostas de níquel-titânio foram posicionadas de forma a envolver tubos de látex, simulando a aorta. Diferentes correntes elétricas foram aplicadas a unidades ligadas em série, de modo a causar contração da estrutura e deslocamento de uma coluna líquida. Foram realizadas duas sequências de testes: a primeira com duas gaiolas metálicas e a segunda com cinco gaiolas. Na primeira sequência de testes, aplicou-se tensão de 16,3 volts e corrente de 5 amperes e, na segunda sequência, tensão de 15 volts e corrente de 7 amperes. RESULTADOS: Na primeira sequência de testes, obteve-se o efeito pulsátil dos 2 stents, havendo contração do tubo e deslocamento da coluna d'água suficientes para validar o efeito pulsátil da endoprótese. As duas estruturas ejetaram um volume de 2,6 mL por ciclo, com uma variação de 29 mm na altura da coluna de água, equivalente a 8% de contração durante a pulsação. Na segunda sequência, conseguiu-se uma variação de 7,4 mL por ciclo. CONCLUSÃO: Os resultados obtidos comprovam a contratilidade da endoprótese pulsátil ativada pela aplicação de corrente elétrica. Continuidade do estudo e aperfeiçoamento do material se fazem necessários para obtenção de modelo mais eficiente do ponto de vista energético e com maior pulsação, para permitir volumes de ejeção comparáveis aos de balões intra-aórticos.

OBJECTIVE: Heart failure is currently one of the most common hospitalization causes. Several chronic circulatory assist devices have been tested and are highly complex. The objective is the description of a pulsatile endoprosthesis capable of applying a chronic pulse within the descending aorta, similar to that produced by intra-aortic balloon. METHODS: Pulsatile stents composed of nickel-titanium were built and positioned to engage latex tubes simulating the aorta. Different electric currents were applied to units connected in series in order to cause structure contraction and displacement of a liquid column. There were two sequence tests: first composed of two metallic cages and the second composed of five cages. At first sequence tests was applied a voltage of 16.3 volts and a current of 5 amperes. In the second, voltage of 15 volts and current of 07 amperes. RESULTS: In the first sequence was obtained the pulsatile effect of stent, with contraction of the tube and displacement of the water column sufficient to validate the pulsating effect of the endoprosthesis. The two structures ejected a volume of 2.6 ml per cycle, with a range of 29 mm in height of the column of water equivalent to 8% shrinkage during the pulse. In the second sequence, it reachead a variation of 7.4 mL per cycle. CONCLUSION: The results obtained confirm the stent pulsatile contractility activated by electrical current. The continuity of the study and material improvement are necessary to obtain more efficient model from the point of view of energy and pulse, to allow ejection volumes comparable with the intra-aortic balloons

https://doi.org/10.5935/1678-9741.20130031 2920 downloads

13.

Escores de risco: Cirurgia de Revascularização Miocárdica com e sem CEC
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Buffolo, Enio

Brazilian Journal of Cardiovascular Surgery

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dec 2012, Volume 27 N. 4 Pages III - V

Abstract: Pt | Text: Pt | PDF: Pt

https://doi.org/10.5935/1678-9741.20120086 1514 downloads

14.

Substituição do tronco da artéria pulmonar em carneiros utilizando heteroenxerto tubular valvado com preservação não-aldeídica
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Souza, Helmgton José Brito de

; Palma, José Honório de Almeida

; Casagrande, Ivan Sérgio Joviano

; Christo, Sérgio Campos

; Alves-Silva, Luiz Sérgio

; Almeida, Marco Antônio Cardoso de

; Gaia, Diego Felipe

; Buffolo, Enio

Brazilian Journal of Cardiovascular Surgery

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sep 2012, Volume 27 N. 3 Pages 419 - 428

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: As biopróteses valvares cardíacas estão relacionadas a eventos tromboembólicos, infecciosos e degenerativos. Seu desgaste é atribuído principalmente à desnaturação do colágeno. O glutaraldeído, método predominante de preservação de biopróteses, favorece o processo de calcificação e limita sua durabilidade. Diversas técnicas tentam conter o processo degenerativo das biopróteses. OBJETIVO: Avaliar o processo de calcificação, in vivo, de heteroenxertos pulmonares valvados, preservados em meio não-aldeídico (L-Hydro®). MÉTODOS: Dezessete carneiros foram submetidos à substituição do tronco da artéria pulmonar por enxerto tubular valvado de pericárdio bovino. Os animais foram distribuídos em dois grupos: Grupo L-Hydro® (teste / n=14) e Grupo Glutaraldeído (controle /n=3). Cerca de 150 dias pós-implante os animais foram sacrificados, necropsiados e as próteses submetidas a estudo anatomopatológico, avaliação radiológica e dosagem do cálcio por espectrofotometria de absorção atômica. A análise estatística foi obtida por meio dos testes exato de Fisher, T de Student ou Mann-Whitney (significância: 5%). RESULTADOS: A avaliação radiológica, macroscopia, microscopia e dosagem de cálcio por espectrofotometria de absorção atômica demonstraram maior calcificação nas próteses do Grupo Glutaraldeído, quando comparadas às próteses do Grupo L-Hydro® (P=0,001). Sete animais do Grupo L-Hydro® (50%) apresentaram aderência das cúspides à parede do tubo (P=0,228). CONCLUSÕES: As próteses preservadas em L-Hydro® demonstraram-se mais resistentes à calcificação, quando comparadas às preservadas em glutaraldeído.

INTRODUCTION: The cardiac bioprostheses are related to thromboembolic events, infectious and degenerative diseases. Wear is mainly attributed to the denaturation of collagen. Glutaraldehyde, the predominant method of preservation of bioprostheses, favors the calcification process and limits their durability. Several techniques try to contain the degenerative process of bioprostheses. OBJECTIVES: To evaluate the process of calcification in vivo pulmonary valve heterografts preserved in non-aldehydic (L-Hydro®). METHODS: Seventeen sheep underwent replacement of the pulmonary artery valved tubular grafts of bovine pericardium. The animals were divided into two groups: Group L-Hydro® (test / n = 14) and Group Glutaraldehyde (control / n = 3). About 150 days after implantation the animals were sacrificed, necropsied and implants subjected to a pathological study, radiological evaluation and measurement of calcium by atomic absorption spectrophotometry. Statistical analysis was obtained through the Fisher's exact test, Student's t or Mann-Whitney test (significance: 5%). RESULTS: The radiological evaluation, the macroscopic and microscopic measurement of serum calcium by atomic absorption spectrophotometry showed increased calcification of the prosthetic group Glutaraldehyde, when compared to denture-HydroR Group L (P = 0.001). Seven animals in Group L-Hydro® (50%) had adherence of the leaflets to the wall of the tube (P = 0.228). CONCLUSIONS: Prostheses preserved in L-Hydro® were more resistant to calcification when compared with glutaraldehyde preserved.

https://doi.org/10.5935/1678-9741.20120071 2388 downloads

15.

Implante valve-in-valve transcateter em posição aórtica: uma mudança de seleção?
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Gaia, Diego Felipe

; Couto, Aline

; Breda, João Roberto

; Ferreira, Carolina Baeta Neves Duarte

; Macedo, Murilo Teixeira

; Gimenes, Marcus Vinicius

; Buffolo, Enio

; Palma, José Honório

Brazilian Journal of Cardiovascular Surgery

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sep 2012, Volume 27 N. 3 Pages 355 - 361

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

INTRODUÇÃO: A reoperação para substituição de biopróteses aórticas com disfunção é procedimento que envolve considerável risco. Em alguns casos, a mortalidade é elevada e pode contraindicar o procedimento. O implante minimamente invasivo "valve-in-valve" transcateter de valva aórtica parece ser uma alternativa, reduzindo morbimortalidade. O objetivo deste estudo foi avaliar esses implantes utilizando a prótese Braile Inovare. MÉTODOS: A prótese Braile Inovare, transcateter, balão expansível foi utilizada em 14 casos. Euroscore médio foi de 42,9%. Todos os pacientes eram portadores de dupla disfunção de bioprótese aórtica. Os procedimentos foram realizados em ambiente cirúrgico híbrido, sob controle ecocardiográfico e fluoroscópico. Por meio de minitoracotomia esquerda, as próteses foram implantadas através do ápice ventricular, sob estimulação ventricular de alta frequência. Foram realizados controles clínicos e ecocardiográficos seriados. O seguimento variou de 1 a 30 meses. RESULTADOS: A correta liberação protética foi possível em todos os casos. Não ocorreu conversão. Não houve mortalidade operatória. A mortalidade em 30 dias foi de 14,3% (dois casos). A fração de ejeção apresentou aumento significativo após o 7º pós-operatório e o gradiente aórtico apresentou redução significativa. A insuficiência aórtica residual não esteve presente. Não ocorreu complicação vascular periférica ou bloqueio atrioventricular total. CONCLUSÕES: O implante "valve-in-valve" de valva aórtica transcateter em biopróteses com disfunção é um procedimento seguro e com morbimortalidade baixa. Essa possibilidade poderá alterar a indicação de seleção de prótese no procedimento inicial, favorecendo próteses biológicas.

OBJECTIVE: Aortic valve replacement for bioprosthesis dysfunction is a procedure involving considerable risk. In some cases, mortality is high and may contraindicate the procedure. Minimally invasive transcatheter aortic "valve-in-valve" implant appears to be an alternative, reducing morbidity and mortality. The objective is to evaluate aortic valve-in-valve procedure using Braile Inovare prosthesis. METHODS: The Braile Inovare prosthesis, transcatheter, expandable balloon, was used in 14 cases. Average EuroSCORE was 42.9%. All patients had double aortic bioprosthesis dysfunction. Procedures were performed in a surgical hybrid environment under echocardiographic and fluoroscopic guidance. Using left minithoracotomy prostheses were implanted through the ventricular apex under high-frequency ventricular pacing. Serial clinical and echocardiographic controls were performed. Follow-up ranged 1-30 months. RESULTS: Correct prosthetic deployment was obtained in all cases. There was no conversion. There was no operative mortality. The 30-day mortality was 14.3% (two cases). Ejection fraction increased significantly after the 7th postoperative day. Aortic gradient significantly reduced. The residual aortic regurgitation was not present. There were no vascular complications or complete atrioventricular block. CONCLUSION: The transcatheter "valve-in-valve" procedure for bioprosthesis dysfunction is safe with low morbidity. This possibility may change prosthesis choice during the first aortic valve replacement, favoring bioprostheses.

https://doi.org/10.5935/1678-9741.20120062 3756 downloads

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