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[SciELO Preprints] - Guidelines on the Diagnosis and Treatment of Hypertrophic Cardiomyopathy – 2024
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Fernandes, Fabio Simões, Marcus V. Correia, Edileide de Barros Marcondes-Braga, Fabiana G. Coelho-Filho, Otavio Rizzi Mesquita, Cláudio Tinoco Mathias-Junior, Wilson Rochitte, Carlos Eduardo Ramires, Felix José Alvarez Alves, Silvia Marinho Martins Montera, Marcelo Westerlund Lopes, Renato Delascio Oliveira-Junior, Mucio Tavares Scolari, Fernando L. Avila, Walkiria Samuel Canesin, Manoel Fernandes Bacal, Fernando Bocchi, Edimar Alcides Moura, Lídia Ana Zytynski Saad, Eduardo Benchimol Scanavacca, Mauricio I. Valdigem, Bruno Pereira Cano , Manuel Nicolas Abizaid , Alexandre Ribeiro, Henrique Barbosa Lemos-Neto, Pedro Alves Ribeiro, Gustavo Calado de Aguiar Jatene, Fabio Biscegli Dias, Ricardo Ribeiro Beck-da-Silva, Luis Rohde, Luis Eduardo P. Bittencourt, Marcelo Imbroinise Pereira, Alexandre Krieger, José Eduardo Villacorta, Humberto Martins, Wolney de Andrade Figueiredo-Neto, José Albuquerque de Cardoso , Juliano Novaes Pastore, Carlos Alberto Jatene, Ieda Biscegli Tanaka, Ana Cristina Sayuri Hotta, Viviane Tiemi Romano, Minna Moreira Dias Albuquerque, Denilson Campos de Mourilhe-Rocha, Ricardo Hajjar, Ludhmila Abrahão Brito, Fabio Sandoli de Caramelli , Bruno Calderaro, Daniela Farsky, Pedro Silvio Colafranceschi , Alexandre Siciliano Pinto, Ibraim Masciarelli Vieira , Marcelo Luiz Campos Danzmann, Luiz Claudio Barberato , Silvio Henrique Mady, Charles Martinelli-Filho, Martino Torbey , Ana Flavia Malheiros Schwartzmann, Pedro Vellosa Macedo, Ariane Vieira Scarlatelli Ferreira , Silvia Moreira Ayub Schmidt, Andre Melo , Marcelo Dantas Tavares de Lima-Filho, Moysés Oliveira Sposito, Andrei C. Brito, Flavio de Souza Biolo, Andreia Madrini-Junior, Vagner Rizk, Stéphanie Itala Mesquita, Evandro Tinoco

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Publication date: 2024-04-08

Abstract: Pt Es En

A cardiomiopatia hipertrófica (CMH) é uma forma de doença do músculo cardíaco de causa genética, caracterizada pela hipertrofia das paredes ventriculares. O diagnóstico requer detecção por métodos de imagem (Ecocardiograma ou Ressonância Magnética Cardíaca) de qualquer segmento da parede do ventrículo esquerdo com espessura > 15 mm, sem outra causa provável. A análise genética permite identificar mutações de genes codificantes de diferentes estruturas do sarcômero responsáveis pelo desenvolvimento da CMH em cerca de 60% dos casos, permitindo o rastreio de familiares e aconselhamento genético, como parte importante do manejo dos pacientes e familiares. Vários conceitos sobre a CMH foram recentemente revistos, incluindo sua prevalência de 1 em 250 indivíduos, não sendo, portanto, uma doença rara, mas subdiagnosticada. A vasta maioria dos pacientes é assintomática. Naqueles sintomáticos, a obstrução do trato de saída do ventrículo esquerdo (OTSVE) é o principal distúrbio responsável pelos sintomas, devendo-se investigar a sua presença em todos os casos. Naqueles em que o ecocardiograma em repouso ou com Manobra de Valsalva não detecta gradiente intraventricular significativo (> 30 mmHg), devem ser submetidos à ecocardiografia com esforço físico para detecção da OTSVE.   Pacientes com sintomas limitantes e grave OTSVE, refratários ao uso de betabloqueadores e verapamil, devem receber terapias de redução septal ou uso de novas drogas inibidoras da miosina cardíaca. Por fim, os pacientes adequadamente identificados com risco aumentado de morta súbita podem receber medida profilática com implante de cardiodesfibrilador implantável (CDI).

La miocardiopatía hipertrófica (MCH) es una forma de enfermedad cardíaca de origen genético, caracterizada por el engrosamiento de las paredes ventriculares. El diagnóstico requiere la detección mediante métodos de imagen (Ecocardiograma o Resonancia Magnética Cardíaca) que muestren algún segmento de la pared ventricular izquierda con un grosor > 15 mm, sin otra causa probable. El análisis genético permite identificar mutaciones en genes que codifican diferentes estructuras del sarcómero responsables del desarrollo de la MCH en aproximadamente el 60% de los casos, lo que permite el tamizaje de familiares y el asesoramiento genético, como parte importante del manejo de pacientes y familiares. Varios conceptos sobre la MCH han sido revisados recientemente, incluida su prevalencia de 1 entre 250 individuos, por lo tanto, no es una enfermedad rara, sino subdiagnosticada. La gran mayoría de los pacientes son asintomáticos. En los casos sintomáticos, la obstrucción del tracto de salida ventricular izquierdo (TSVI) es el trastorno principal responsable de los síntomas, y su presencia debe investigarse en todos los casos. En aquellos en los que el ecocardiograma en reposo o la maniobra de Valsalva no detecta un gradiente intraventricular significativo (> 30 mmHg), deben someterse a ecocardiografía de esfuerzo para detectar la obstrucción del TSVI. Los pacientes con síntomas limitantes y obstrucción grave del TSVI, refractarios al uso de betabloqueantes y verapamilo, deben recibir terapias de reducción septal o usar nuevos medicamentos inhibidores de la miosina cardíaca. Finalmente, los pacientes adecuadamente identificados con un riesgo aumentado de muerte súbita pueden recibir medidas profilácticas con el implante de un cardioversor-desfibrilador implantable (CDI).

Hypertrophic cardiomyopathy (HCM) is a form of genetically caused heart muscle disease, characterized by the thickening of the ventricular walls. Diagnosis requires detection through imaging methods (Echocardiogram or Cardiac Magnetic Resonance) showing any segment of the left ventricular wall with a thickness > 15 mm, without any other probable cause. Genetic analysis allows the identification of mutations in genes encoding different structures of the sarcomere responsible for the development of HCM in about 60% of cases, enabling screening of family members and genetic counseling, as an important part of patient and family management. Several concepts about HCM have recently been reviewed, including its prevalence of 1 in 250 individuals, hence not a rare but rather underdiagnosed disease. The vast majority of patients are asymptomatic. In symptomatic cases, obstruction of the left ventricular outflow tract (LVOT) is the primary disorder responsible for symptoms, and its presence should be investigated in all cases. In those where resting echocardiogram or Valsalva maneuver does not detect significant intraventricular gradient (> 30 mmHg), they should undergo stress echocardiography to detect LVOT obstruction. Patients with limiting symptoms and severe LVOT obstruction, refractory to beta-blockers and verapamil, should receive septal reduction therapies or use new drugs inhibiting cardiac myosin. Finally, appropriately identified patients at increased risk of sudden death may receive prophylactic measure with implantable cardioverter-defibrillator (ICD) implantation.

https://doi.org/10.1590/SciELOPreprints.8394

Performance Evaluation of Geometrically Different Pediatric Arterial Cannulae in a Pediatric Cardiopulmonary Bypass Model
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Carvalho, Gabriela B. de O.

; Caneo, Luiz Fernando

; Matte, Gregory

; Cruz, Caio Henrique de A.

; Silva, Everton Neri da

; Carletto, Luciana P.

; Castro, Ana Vitória C. X. de

; Silva, Betina G. Madueño

; Policarpo, Valéria C.

; Cestari, Idágene A.

; Jatene, Fabio B

; Jatene, Marcelo Biscegli

Brazilian Journal of Cardiovascular Surgery

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2024, Volume 39 N. 1 elocation e20230110

Abstract: En | Text: En | PDF: En

ABSTRACT Objective: To define a reference chart comparing pressure drop vs. flow generated by a set of arterial cannulae currently utilized in cardiopulmonary bypass conditions in pediatric surgery. Methods: Cannulae from two manufacturers were selected considering their design and outer and inner diameters. Cannula performance was evaluated in terms of pressure drop vs. flow during simulated cardiopulmonary bypass conditions. The experimental circuits consisted of a Jostra HL-20 roller pump, a Quadrox-i pediatric oxygenator (Maquet Cardiopulmonary AG, Rastatt, Germany), and a custom pediatric tubing set. The circuit was primed with lactated Ringer’s solution only (first condition) and with human packed red blood cells added (second condition) to achieve a hematocrit of 30%. Cannula sizes 8 to 16 Fr were inserted into the cardiopulmonary bypass circuit with a “Y” connector. The flow was adjusted in 100 ml/min increments within typical flow ranges for each cannula. Pre-cannula and post-cannula pressures were measured to calculate the pressure drop. Results: Utilizing a pressure drop limit of 100 mmHg, our results suggest a recommended flow limit of 500, 900, 1400, 2600, and 3100 mL/min for Braile arterial cannulae sizes 8, 10, 12, 14, and 16 Fr, respectively. For Medtronic DLP arterial cannulae sizes 8, 10, 12, 14, and 16 Fr, the recommended flow limit is 600, 1100, 1700, 2700, and 3300 mL/min, respectively. Conclusion: This study reinforces discrepancies in pressure drop between cannulae of the same diameter supplied by different manufacturers and the importance of independent translational research to evaluate components’ performance.

https://doi.org/10.21470/1678-9741-2023-0110

Do Volume para a Geração de Valor em Cirurgia Cardíaca: O que Falta para Dar a Largada no Brasil? Cardíaca Brasil
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Mejia, Omar Asdrúbal Vilca

; Jatene, Fabio Biscegli

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 2 elocation e20230036

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

https://doi.org/10.36660/abc.20230036

Cardiopatia Carcinoide: Relato de Caso e Revisão da Literatura Carcinoide
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Costa, Isabela Bispo Santos da Silva

; Melo, Edielle de Sant`Anna

; Furtado, Armando

; Sobral-Alves, Juliana Barbosa

; Rizk, Stephanie Itala

; Benvenuti, Luiz Alberto

; Rochitte, Carlos E.

; Brandão, Carlos Manuel de Almeida

; Pomarentzeff, Pablo Maria

; Bittar, Cristina Salvadori

; Galas, Filomena Regina Barbosa Gomes

; Auler Junior, José Otavio Costa

; Hoff, Paulo Marcelo Gehm

; Kalil Filho, Roberto

; Jatene, Fabio Biscegli

; Hajjar, Ludhmila Abrahão

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 N. 6 elocation e20220245

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

https://doi.org/10.36660/abc.20220245

Early reduction of pulmonary arterial hypertension in patients using a long-term mechanical ventricular assistance device: a cross-sectional study
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Rangel, Bruno Soares da Silva

; Biselli, Bruno

; Quintanilha, Nádia Romanelli

; Avila, Mônica Samuel

; Pêgo-Fernandes, Paulo Manuel

; Jatene, Fabio Biscegli

; Kalil Filho, Roberto

; Ferreira, Silvia Moreira Ayub

Sao Paulo Medical Journal

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jun 2022, Volume 140 N. 3 Pages 505 - 508

Abstract: En | Text: En | PDF: En

ABSTRACT BACKGROUND: Severe pulmonary arterial hypertension (PAH) is a contraindication for heart transplantation (HT). It has been correlated with increased early and late mortality, mainly associated with right ventricular failure. Ventricular assistance devices (VADs) can promote reduction of intracardiac pressures and consequent reduction of PAH over the medium and long terms, thus enabling future candidature for HT. The diminution of early pulmonary pressure within this scenario remains unclear. OBJECTIVE: To evaluate the reduction of PAH and correlate data from right catheterization with the earliness of this reduction. DESIGN AND SETTING: Cross-sectional study in a general hospital in São Paulo, Brazil. METHODS: This was a retrospective analysis on the medical records of patients undergoing VAD implantation in a single hospital. Patients for whom VAD had been indicated as a bridge to candidature for HT due to their condition of constant PAH were selected. RESULTS: Four patients with VADs had constantly severe PAH. Their mean pulmonary artery systolic pressure (PASP) before VAD implantation was 66 mmHg. Over the 30-day period after the procedure, all the patients evolved with a drop in PASP to below 60 mmHg. Their new average was 36 mmHg, which was a drop of close to 50% from baseline values. The one-year survival of this sample was 100%. CONCLUSION: VAD implantation can reduce PAH levels. Early reduction occurred in all patients. Thus, use of VAD is an important bridge tool for enabling candidature for HT among patients with constantly severe PAH.

https://doi.org/10.1590/1516-3180.2021.0944.r2.18032022

Impacto da Primeira Onda da Pandemia de COVID-19 na Cirurgia Cardiovascular no Brasil: Análise de um Centro Terciário de Referência
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Lisboa, Luiz Augusto

; Mejia, Omar Asdrúbal Vilca

; Arita, Elisandra Trevisan

; Guerreiro, Gustavo Pampolha

; Silveira, Lucas Molinari Veloso da

; Brandão, Carlos Manuel de Almeida

; Dias, Ricardo Ribeiro

; Dallan, Luís Roberto Palma

; Miana, Leonardo

; Caneo, Luiz F.

; Jatene, Marcelo Biscegli

; Dallan, Luís Alberto Oliveira

; Jatene, Fabio Biscegli

Arquivos Brasileiros de Cardiologia

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mar 2022, Volume 118 N. 3 Pages 663 - 666

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

https://doi.org/10.36660/abc.20210235

Are we preparing for the digital healthcare era?
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Rabello, Guilherme Machado

; Pêgo-Fernandes, Paulo Manuel

; Jatene, Fabio Biscegli

Sao Paulo Medical Journal

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feb 2022, Volume 140 N. 2 Pages 161 - 162

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/1516-3180.2022.140225112021

Preparando Pacientes e Otimizando Processos no Perioperatório das Cirurgias Cardíacas: Como Redesenhar os Fluxos de Assistência após a COVID-19
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Mejia, Omar Asdrúbal Vilca

; Mioto, Bruno Mahler

; Borgomoni, Gabrielle Barbosa

; Camilo, Juliana Mendanha

; Watanabe, Danielle Misumi

; Nunes, Sirlei Pereira

; Sallai, Vanessa Santos

; Lima, Maraina Pegorini Libório de

; Palomo, Jurema da Silva Herbas

; Costa, Helenice Moreira da

; Arita, Elisandra Trevisan

; Feltrim, Maria Ignêz Zanetti

; Coimbra, Vera

; Dias, Roger Daglius

; Galas, Filomena Regina Barbosa Gomes

; Auler Junior, José Otávio Costa

; Jatene, Fabio Biscegli

Arquivos Brasileiros de Cardiologia

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jan 2022, Volume 118 N. 1 Pages 110 - 114

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

https://doi.org/10.36660/abc.20210484

Adherence to the cardiac surgery checklist decreased mortality at a teaching hospital: A retrospective cohort study
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Mejia, Omar Asdrúbal Vilca

; Mendonça, Frederico Carlos Cordeiro de

; Sampaio, Lucimar Aparecida Barrense Nogueira

; Galas, Filomena Regina Barbosa Gomes

; Pontes, Mauricio Franklin

; Caneo, Luiz Fernando

; Dallan, Luís Roberto Palma

; Lisboa, Luiz Augusto Ferreira

; Ferreira, João Fernando Monteiro

; Dallan, Luís Alberto de Oliveira

; Jatene, Fabio Biscegli

Clinics

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2022, Volume 77 elocation 100048

Abstract: En | Text: En | PDF: En

Abstract Objectives To evaluate the impact of adherence to the cardiac surgical checklist on mortality at the teaching hospital. Methods A retrospective cohort study after the implementation of the cardiac surgical safety checklist in a reference hospital in Latin America. All patients undergoing coronary artery bypass surgery and/or heart valve surgery from 2013 to 2019 were analyzed. After the implementation of the project InCor-Checklist “Five steps to safe cardiac surgery” in 2015, the correlation between adherence and completeness of this instrument with surgical mortality was assessed. The EuroSCORE II was used as a reference to assess the risk of expected mortality for patients. Cross-sectional questionnaires were during the implementation of the InCor-Checklist. To perform the correlation, Pearson’s coefficient was calculated using R software. Results Since 2013, data from 8139 patients have been analyzed. The average annual mortality was 5.98%. In 2015, the instrument was used in only 58% of patients; in contrast, it was used in 100% of patients in 2019. There was a decrease in surgical mortality from 8.22% to 3.13% for the same group of procedures. The results indicate that the greater the checklist use, the lower the surgical mortality (r = 88.9%). In addition, the greater the InCor-Checklist completeness, the lower the surgical mortality (r = 94.1%). Conclusion In the formation of the surgical patient safety culture, the implementation and adherence to the InCor-Checklist “Five steps to safe cardiac surgery” was associated with decreased mortality after cardiac surgery. HIGHLIGHTS Checklists avoid human errors and are commonly used in high-reliability industries. The “InCor Checklist” was associated with decreased mortality over time. Adherence, completeness, and sustainability within public policies are necessary.

https://doi.org/10.1016/j.clinsp.2022.100048

10.

Impacto da Pandemia por COVID-19 nos Procedimentos Cirúrgicos de Dispositivos Cardíacos Eletrônicos Implantáveis em um Centro de Referência Terciário
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Costa, Roberto

; Silva, Katia Regina da

; Saucedo, Sarah Caroline Martins

; Silva, Laisa Arruda

; Crevelari, Elizabeth Sartori

; Nascimento, Wagner Tadeu Jurevicius

; Silveira, Thiago Gonçalves

; Fiorelli, Alfredo

; Martinelli Filho, Martino

; Jatene, Fabio Biscegli

Arquivos Brasileiros de Cardiologia

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oct 2021, Volume 117 N. 4 Pages 765 - 769

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

https://doi.org/10.36660/abc.20201378 32 downloads

11.

Translation and Validation of the Boston Technical Performance Score in a Developing Country
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Miana, Leonardo A.

; Nathan, Meena

; Tenório, Davi Freitas

; Manuel, Valdano

; Guerreiro, Gustavo

; Fernandes, Natália

; Campos, Carolina Vieira de

; Gaiolla, Paula V.

; Cassar, Renata Sá

; Turquetto, Aida

; Amato, Luciana

; Canêo, Luiz Fernando

; Daroda, Larissa Leitão

; Jatene, Marcelo Biscegli

; Jatene, Fabio B.

Brazilian Journal of Cardiovascular Surgery

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oct 2021, Volume 36 N. 5 Pages 589 - 598

Abstract: En | Text: En | PDF: En

Abstract Introduction: The Technical Performance Score (TPS) was developed and subsequently refined at the Boston Children's Hospital. Our objective was to translate and validate its application in a developing country. Methods: The score was translated into the Portuguese language and approved by the TPS authors. Subsequently, we studied 1,030 surgeries from June 2018 to October 2020. TPS could not be assigned in 58 surgeries, and these were excluded. Surgical risk score was evaluated using Risk Adjustment in Congenital Heart Surgery (or RACHS-1). The impact of TPS on outcomes was studied using multivariable linear and logistic regression adjusting for important perioperative covariates. Results: Median age and weight were 2.2 (interquartile range [IQR] = 0.5-13) years and 10.8 (IQR = 5.6-40) kilograms, respectively. In-hospital mortality was 6.58% (n=64), and postoperative complications occurred in 19.7% (n=192) of the cases. TPS was categorized as 1 in 359 cases (37%), 2 in 464 (47.7%), and 3 in 149 (15.3%). Multivariable analysis identified TPS class 3 as a predictor of longer hospital stay (coefficient: 6.6; standard error: 2.2; P=0.003), higher number of complications (odds ratio [OR]: 1.84; 95% confidence interval [CI]: 1.1-3; P=0.01), and higher mortality (OR: 3.2; 95% CI: 1.4-7; P=0.004). Conclusion: TPS translated into the Portuguese language was validated and showed to be able to predict higher mortality, complication rate, and prolonged postoperative hospital stay in a high-volume Latin-American congenital heart surgery program. TPS is generalizable and can be used as an outcome assessment tool in resource diverse settings.

https://doi.org/10.21470/1678-9741-2021-0485

12.

Preoperative Neutrophil-Lymphocyte Ratio Can Predict Outcomes for Patients Undergoing Tetralogy of Fallot Repair
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Manuel, Valdano

; Miana, Leonardo A.

; Guerreiro, Gustavo Pampolha

; Turquetto, Aida

; Santos, Rômullo Medeiros

; Fernandes, Natália

; Tenório, Davi Freitas

; Caneo, Luiz Fernando

; Jatene, Fabio B.

; Jatene, Marcelo Biscegli

Brazilian Journal of Cardiovascular Surgery

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oct 2021, Volume 36 N. 5 Pages 607 - 613

Abstract: En | Text: En | PDF: En

Abstract Introduction: Elevated neutrophil-lymphocyte ratio (NLR) has been associated with poorer outcomes in cyanotic patients undergoing single ventricle palliation. Little is known about this biomarker on patients with tetralogy of Fallot (TOF), the most common cyanotic congenital heart disease. Our objective is to study the impact of preoperative NLR on outcomes of TOF patients undergoing total repair. Methods: This retrospective study included 116 consecutive patients between January 2014 and December 2018. Preoperative NLR was measured from the last complete blood count test before the surgery. Using the cutoff value of 0.80, according to the receiver-operating characteristic (ROC) curve, the sample was divided into two groups (NLR < 0.80 and ≥ 0.80). The primary endpoint was hospital length of stay (LOS). Results: ROC curves showed that higher preoperative NLR was associated with longer hospital LOS, with an area under the curve of 0.801±0.040 (95% confidence interval 0.722 - 0.879; P<0.001). High preoperative NLR was also associated with long intensive care unit (ICU) LOS (P=0.035). Preoperative NLR predicted longer hospital LOS with a sensitivity of 63% and a specificity of 81.4%. Conclusion: Higher preoperative NLR was associated with long ICU and hospital LOS in patients undergoing TOF repair.

https://doi.org/10.21470/1678-9741-2020-0408

13.

A Técnica de Duplicação de Orifício na Plastia Valvar Mitral: 35 Anos de História
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Pomerantzeff, Pablo Maria Alberto

; Brandão, Carlos Manuel de Almeida

; Riso, Arlindo

; Jatene, Fabio Biscegli

Arquivos Brasileiros de Cardiologia

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sep 2021, Volume 117 N. 3 Pages 424 - 425

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

https://doi.org/10.36660/abc.20210067 39 downloads

14.

Use of CentriMag for refractory cardiogenic shock in a puerperal woman: case report
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Pêgo-Fernandes, Paulo Manuel

; Scalabrini Neto, Augusto

; Hajjar, Ludhmila Abrahão

; Costa, Priscila Berenice da

; Kalil Filho, Roberto

; Jatene, Fabio Biscegli

Sao Paulo Medical Journal

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aug 2021, Volume 139 N. 4 Pages 412 - 415

Abstract: En | Text: En | PDF: En

ABSTRACT CONTEXT: Heart failure in Brazil is a major public health problem and, even with advances in treatment, it still presents high morbidity and mortality. As a treatment option, mechanical circulatory assist devices (MCADs) have greatly increased in importance over the last decade. CASE REPORT: This report concerns a case of refractory cardiogenic shock due to acute myocarditis in a 35-year-old puerperal female patient who presented with retrosternal pain, fatigue and dyspnea. At the hospital, she was diagnosed with myocarditis. There was no improvement in perfusion even after receiving dobutamine, intra-aortic balloon passage (IAB) and venoarterial extracorporeal membrane oxygenation (VA-ECMO). Therefore, it was decided to implant a MCAD (CentriMag). During hospitalization, recovery from the bi-ventricular dysfunction was achieved. The CentriMag device was removed 10 days after it had been implanted, and the patient was discharged after another 8 days. The myocarditis was proven to be due to the Coxsackie virus. CONCLUSIONS: The decision to implant a MCAD should be individualized, as patient profiles do not always match the indications in the guidelines and protocols. In this study, clinical discussion of the case among the medical and multi-professional teams was essential in order to be able to successfully reverse the patient’s severe clinical condition without sequelae, through using a CentriMag implant.

https://doi.org/10.1590/1516-3180.2020.0775.18022021 4 downloads

15.

Impact of COVID-19 Pandemic in a Pediatric and Congenital Cardiovascular Surgery Program in Brazil
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Miana, Leonardo A.

; Manuel, Valdano

; Caneo, Luiz Fernando

; Strabelli, Tânia Mara Varejão

; Arita, Elisandra Trevisan

; Monteiro, Rosângela

; Jatene, Marcelo Biscegli

; Jatene, Fabio B.

Brazilian Journal of Cardiovascular Surgery

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jun 2021, Volume 36 N. 3 Pages 289 - 294

Abstract: En | Text: En | PDF: En

Abstract Introduction: The coronavirus disease 2019 (COVID-19) has negatively impacted healthcare services worldwide. We hypothesized that the pandemic would affect our case mix and mortality. Our objective was to study this impact. Methods: We retrospectively studied all patients who underwent congenital heart surgeries from March 21st to August 21st in 2019 and 2020 using the institutional electronic database. We compared demographic data, preoperative and postoperative length of stay (LOS), risk stratification using Risk Adjustment for Congenital Heart Surgery (RACHS) classification and outcomes in both periods. Results: We observed a 66.7% decrease in our surgical volume (285 × 95 patients). Patients operated in the pre-pandemic period were older (911.3 [174.8 - 5953.8] days-old) compared to the pandemic period (275 days-old; P<0.05). When the case mix was compared between periods, the percentage of neonatal surgery was increased in the pandemic era (8% × 21.1%; P<0.05), and the number of RACHS 1-2 surgeries decreased significantly (60.7 × 27.4%; P<0.05). Preoperative LOS was increased in the pandemic period (1.2 × 7 days; P=0.001). There was no significant increment in mortality (P=0.1). Two patients tested positive for COVID-19 in the postoperative period and both died. Conclusion: Our program observed a sudden decrease in surgical volume and a consequent increase in surgical complexity. There was a non-significant increment in mortality.

https://doi.org/10.21470/1678-9741-2020-0657 91 downloads

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