Pesquisa | SciELO

ABSTRACT Objective: To investigate the association between body mass index (BMI), obesity, clinical outcomes, and mortality following coronary artery bypass grafting (CABG) in Brazil using a large sample with one year of follow-up from the Brazilian Registry of Cardiovascular Surgeries in Adults (or BYPASS) Registry database. Methods: A multicenter cohort-study enrolled 2,589 patients submitted to isolated CABG and divided them into normal weight (BMI 20.0-24.9 kg/m2), overweight (BMI 25.0-29.9 kg/m2), and obesity (BMI > 30.0 kg/m2) groups. Inpatient postoperative outcomes included the most frequently described complications and events. Collected post-discharge outcomes included rehospitalization and mortality rates within 30 days, six months, and one year of follow-up. Results: Sternal wound infections (SWI) rate was higher in obese compared to normal-weight patients (relative risk [RR]=5.89, 95% confidence interval [CI]=2.37-17.82; P=0.001). Rehospitalization rates in six months after discharge were higher in obesity and overweight groups than in normal weight group (χ2=6.03, P=0.049); obese patients presented a 2.2-fold increase in the risk for rehospitalization within six months compared to normal-weight patients (RR=2.16, 95% CI=1.17-4.09; P=0.045). Postoperative complications and mortality rates did not differ among groups during time periods. Conclusion: Obesity increased the risk for SWI, leading to higher rehospitalization rates and need for surgical interventions within six months following CABG. Age, female sex, and diabetes were associated with a higher risk of mortality. The obesity paradox remains controversial since BMI may not be sufficient to assess postoperative risk in light of more complex and dynamic evaluations of body composition and physical fitness.

https://doi.org/10.21470/1678-9741-2023-0133

Official Scientific Statement from the Brazilian Society of Cardiovascular Surgery - The 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization and the 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for Chronic Coronary Disease
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Hossne Jr, Nelson A.

; Dallan, Luís Roberto Palma

; Lisboa, Luiz Augusto Ferreira

; Murad, Henrique

; Gomes, Walter José

Brazilian Journal of Cardiovascular Surgery

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2024, Volume 39 Nº 2 elocation e20240990

Resumo: En | Texto: En | PDF: En

https://doi.org/10.21470/1678-9741-2024-0990

Enxerto Multiarterial na Cirurgia de Revascularização Coronária. A Busca Renovada por Resultados Aprimorados
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Gomes, Walter J.

Arquivos Brasileiros de Cardiologia

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2023, Volume 120 Nº 3 elocation e20230094

Resumo: Pt | Texto: Pt | PDF: Pt

https://doi.org/10.36660/abc.20230094

Early Six-Minute Walk Test May Predict Midterm Outcomes Following Coronary Artery Bypass Grafting
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Pauletti, Hayanne O.

; Gomes, Walter José

; Rocco, Isadora S.

; Viceconte, Marcela

; Garcia, Bruna Caroline Matos

; Marcondi, Natasha O.

; Bublitz, Caroline B.

; Costa, Ariele dos Santos

; Paiva, Thâmara Pequeno de

; Spina, Giovanna Domingues

; Begot, Isis

; Silva, Célia Camelo

; Moreira, Rita Simone L.

; Branco, João Nelson Rodrigues

; Vargas, Guilherme Flora

; Hossne Jr., Nelson A.

; Arena, Ross

; Guizilini, Solange

Brazilian Journal of Cardiovascular Surgery

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2023, Volume 38 Nº 4 elocation e20220459

Resumo: En | Texto: En | PDF: En

ABSTRACT Objective: This study aims to investigate the ability of the six-minute walk distance (6MWD) as a prognostic marker for midterm clinical outcomes three months after coronary artery bypass grafting (CABG), to identify possible predictors of fall in 6MWD in the early postoperative period, and to establish the percentage fall in early postoperative 6MWD, considering the preoperative baseline as 100%. Methods: A prospective cohort of patients undergoing elective CABG were included. The percentage fall in 6MWD was assessed by the difference between preoperative and postoperative day (POD) five. Clinical outcomes were evaluated three months after hospital discharge. Results: There was a significant decrease in 6MWD on POD5 compared with preoperative baseline values (percentage fall of 32.5±16.5%, P<0.0001). Linear regression analysis showed an independent association of the percentage fall of 6MWD with cardiopulmonary bypass (CPB) and preoperative inspiratory muscle strength. Receiver operating characteristic curve analysis revealed that the best cutoff value of percentage fall in 6MWD to predict poorer clinical outcomes at three months was 34.6% (area under the curve = 0.82, sensitivity = 78.95%, specificity = 76.19%, P=0.0001). Conclusion: This study indicates that a cutoff value of 34.6% in percentage fall of 6MWD on POD5 was able to predict poorer clinical outcomes at three months of follow-up after CABG. Use of CPB and preoperative inspiratory muscle strength were independent predictors of percentage fall of 6MWD in the postoperative period. These findings further support the clinical application of 6MWD and propose an inpatient preventive strategy to guide clinical management over time.

https://doi.org/10.21470/1678-9741-2022-0459

PERFIL NEUROPSICOLÓGICO DE LOS USUARIOS DE ALCOHOL Y CANNABIS: UN ESTUDIO EXPLORATORIO EN BRASIL
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Azevedo-Gomes, Walter-Bruno

Cuadernos de neuropsicología

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Abr 2022, Volume 16 Nº 1 Páginas 71 - 84

Resumo: En Pt Es | Texto: En Pt Es | PDF: En | PDF: Pt | PDF: Es

ABSTRACT This article aims to carry out exploratory research on the neuropsychological profile of users of illicit (cannabis) and legal (alcohol) drugs based on knowledge of how drugs (marijuana and alcohol) work in the Central Nervous System (CNS). Using standardized instruments, cognitive functions will be evaluated - memory, reasoning, inhibitory control, and executive control. The individuals were selected according to the inclusion criteria: adults, age group from 20 to 35 years old, of both sexes, with a minimum education of complete high school, residents of Belo Horizonte and the metropolitan region, marijuana users, alcohol users alone or simultaneously. Then, a frequency analysis was performed based on the users' profile based on the average of their test results. Preliminary results show the challenges of studying the effects of drugs. and raising hypotheses for future studies on the neuropsychological profile of drug users and their relationship with cognitive impairment.

RESUMO Esse artigo objetiva realizar uma pesquisa exploratória sobre perfil neuropsicológico de usuários de drogas ilícitas (cannabis) e lícitas (álcool) a partir de conhecimento do funcionamento das drogas (maconha e álcool) no Sistema Nervoso Central (SNC). A partir de instrumentos padronizados, serão avaliadas as funções cognitivas - memória, raciocínio, controle inibitório e controle executivo. Os indivíduos foram selecionados seguindo os critérios de inclusão: adultos, faixa etária de 20 a 35 anos, de ambos os sexos, com escolaridade mínima de ensino médio completo, moradores de Belo Horizonte e região metropolitana, usuários de maconha, álcool isoladamente ou simultaneamente. Em seguida foi realizada uma análise de frequência a partir do perfil dos usuários baseado na média de seus resultados nos testes. Os resultados preliminares mostram os desafios de estudar o efeito das drogas. e o levantamento de hipóteses para futuros estudos sobre o perfil neuropsicológico de usuários de drogas e sua relação com alteração cognitiva

RESUMEN Este artículo tiene como objetivo realizar una investigación exploratoria sobre el perfil neuropsicológico de los usuarios de drogas ilícitas (cannabis) y legales (alcohol) a partir del conocimiento del funcionamiento de las drogas (marihuana y alcohol) en el Sistema Nervioso Central (SNC). Utilizando instrumentos estandarizados, se evaluarán las funciones cognitivas: memoria, razonamiento, control inhibitorio y control ejecutivo. Los individuos fueron seleccionados según los criterios de inclusión: adultos, grupo etario de 20 a 35 años, de ambos sexos, con educación mínima de bachillerato completo, residentes de Belo Horizonte y la región metropolitana, consumidores de marihuana, consumidores de alcohol solos o simultáneamente. Luego, se realizó un análisis de frecuencia basado en el perfil de los usuarios basado en el promedio de sus resultados de prueba. Los resultados preliminares muestran los desafíos de estudiar los efectos de las drogas. y plantear hipótesis para futuros estudios sobre el perfil neuropsicológico de los consumidores de drogas y su relación con el deterioro cognitivo.

https://doi.org/10.7714/cnps/16.1.204

The No-touch Saphenous Vein Graft in Coronary Artery Bypass Surgery. Towards a New Standard?
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Gomes, Walter J.

; Kim, Ki-Bong

; Pinheiro, Bruno Botelho

; Souza, Domingos S. R.

Brazilian Journal of Cardiovascular Surgery

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2022, Volume 37 Nº spe1 Páginas I - II

Resumo: En | Texto: En | PDF: En

https://doi.org/10.21470/1678-9741-2022-0955

COVID-19 in the Perioperative Period of Cardiovascular Surgery: the Brazilian Experience
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Gomes, Walter J.

; Rocco, Isadora

; Pimentel, Wallace S.

; Pinheiro, Aislan H. B.

; Souza, Paulo M. S.

; Costa, Luiz A. A.

; Teixeira, Marjory M. P.

; Ohashi, Leonardo P.

; Bublitz, Caroline

; Begot, Isis

; Moreira, Rita Simone L

; Hossne Jr, Nelson A.

; Vargas, Guilherme F.

; Branco, João Nelson R.

; Teles, Carlos A.

; Medeiros, Eduardo A. S.

; Sáfadi, Camila

; Rampinelli, Amândio

; Moratelli Neto, Leopoldo

; Rosado, Anderson Rosa

; Mesacasa, Franciele Kuhn

; Capriata, Ismael Escobar

; Segalote, Rodrigo Coelho

; Palmieri, Deborah Louize da Rocha Vianna

; Jardim, Amanda Cristina Mendes

; Vianna, Diego Sarty

; Coutinho, Joaquim Henrique de Souza Aguiar

; Jazbik, João Carlos

; Coutinho, Henrique Madureira da Rocha

; Kikuta, Gustavo

; Almeida, Zely Sant'Anna Marotti de

; Feguri, Gibran Roder

; Lima, Paulo Ruiz Lucio de

; Franco, Anna Carolina

; Borges, Danilo de Cerqueira

; Cruz, Felipe Ramos Honorato De La

; Croti, Ulisses Alexandre

; Borim, Bruna Cury

; Marchi, Carlos Henrique De

; Goraieb, Lilian

; Postigo, Karolyne Barroca Sanches

; Jucá, Fabiano Gonçalves

; Oliveira, Fátima Rosane de Almeida

; Souza, Rafael Bezerra de

; Zilli, Alexandre Cabral

; Mas, Raul Gaston Sanchez

; Bettiati Junior, Luiz Carlos

; Tranchesi, Ricardo

; Bertini Jr, Ayrton

; Franco, Leandro Vieira

; Fernandes, Priscila

; Oliveira, Fabiana

; Moraes Jr, Roberto

; Araújo, Thiago Cavalcanti Vila Nova de

; Braga, Otávio Penna

; Pedrosa Sobrinho, Antônio Cavalcanti

; Teixeira, Roberta Tavares Barreto

; Camboim, Irla Lavor Lucena

; Gomes, Eduardo Nascimento

; Reis, Pedro Horigushi

; Garcia, Luara Piovan

; Scorsioni, Nelson Henrique Goes

; Lago, Roberto

; Guizilini, Solange

Brazilian Journal of Cardiovascular Surgery

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Dez 2021, Volume 36 Nº 6 Páginas 725 - 735

Resumo: En | Texto: En | PDF: En

Abstract Introduction: We investigated the clinical course and outcomes of patients submitted to cardiovascular surgery in Brazil and who had developed symptoms/signs of coronavirus disease 2019 (COVID-19) in the perioperative period. Methods: A retrospective multicenter study including 104 patients who were allocated in three groups according to time of positive real time reverse transcriptase-polymerase chain reaction (RT-PCR) for the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2): group 1, patients who underwent cardiac surgery > 10 days after positive RT-PCR; group 2, patients with a positive RT-PCR within 10 days before or after surgery; group 3, patients who presented positive RT-PCR > 10 days after surgery. The primary outcome was mortality and secondary outcomes were postoperative complications, intensive care unit (ICU) length of stay, and postoperative days of hospitalization. Results: The three groups were similar with respect to age, the European System of Cardiac Operative Risk Evaluation score, and comorbidities, except hypertension. Postoperative complications and death were significantly higher in groups 2 and 3 than in group 1, and no significant difference between groups 2 and 3 was seen. Group 2 showed a high prevalence of surgery performed as an urgent procedure. Although no significant differences were observed in ICU length of stay, total postoperative hospitalization time was significantly higher in group 3 than in groups 1 and 2. Conclusion: COVID-19 affecting the postoperative period of patients who underwent cardiovascular surgery is associated with a higher rate of morbidity and mortality. Delaying procedures in RT-PCR-positive patients may help reduce risks of perioperative complications and death.

https://doi.org/10.21470/1678-9741-2021-0960

Inspiratory Muscle Weakness is Related to Poor Short-Term Outcomes for Heart Transplantation
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Begot, Isis

; Gomes, Walter J.

; Rocco, Isadora S.

; Bublitz, Caroline

; Gonzaga, Laion R. A.

; Bolzan, Douglas W.

; Santos, Vinicius Batista

; Moreira, Rita Simone Lopes

; Breda, João R.

; Almeida, Dirceu Rodrigues de

; Arena, Ross

; Guizilini, Solange

Brazilian Journal of Cardiovascular Surgery

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Jun 2021, Volume 36 Nº 3 Páginas 308 - 317

Resumo: En | Texto: En | PDF: En

Abstract Introduction: In heart transplantation (HT) recipients, several factors are critical to promptly adopting appropriate rehabilitation strategies and may be important to predict outcomes way after surgery. This study aimed to determine preoperative patient-related risk factors that could adversely affect the postoperative clinical course of patients undergoing HT. Methods: Twenty-one hospitalized patients with heart failure undergoing HT were evaluated according to respiratory muscle strength and functional capacity before HT. Mechanical ventilation (MV) time, reintubation rate, and intensive care unit (ICU) length of stay were recorded, and assessed postoperatively. Results: Inspiratory muscle strength as absolute and percentpredicted values were strongly correlated with MV time (r=-0.61 and r=-0.70, respectively, at P<0.001). Concerning ICU length of stay, only maximal inspiratory pressure (MIP) absolute and percent-predicted values were significantly associated. The absolute |MIP| was significantly negatively correlated with ICU length of stay (r=-0.58 at P=0.006) and the percent-predicted MIP was also significantly negatively correlated with ICU length of stay (r=-0.68 at P=0.0007). No associations were observed between preoperative functional capacity, age, sex, and clinical characteristics and MV time and ICU length of stay in the cohort included in this study. Patients with respiratory muscle weakness had a higher prevalence of prolonged MV, reintubation, and delayed ICU length of stay. Conclusion: An impairment of preoperative MIP was associated with poorer short-term outcomes following HT. As such, inspiratory muscle strength is an important clinical preoperative marker in patients undergoing HT.

https://doi.org/10.21470/1678-9741-2020-0344 14 downloads

Why Methylene Blue Is the Only Option for Blocking the cGMP/NO Pathway in The Treatment of Vasoplegic Shock? “Reasons That Reason Itself Does Not Know…”
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Evora, Paulo Roberto B.

; Gomes, Walter J

Brazilian Journal of Cardiovascular Surgery

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Jun 2021, Volume 36 Nº 3 Páginas I - II

Resumo: En | Texto: En | PDF: En

https://doi.org/10.21470/1678-9741-2021-0957 50 downloads

10.

The Anaortic Technique with Bilateral Internal Thoracic Artery Grafting - Filling the Gap in Coronary Artery Bypass Surgery
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Gomes, Walter J.

; Gomes, Eduardo N.

; Bertini Jr, Ayrton

; Reis, Pedro H.

; Hossne Jr, Nelson A.

Brazilian Journal of Cardiovascular Surgery

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Jun 2021, Volume 36 Nº 3 Páginas 397 - 405

Resumo: En | Texto: En | PDF: En

Abstract Coronary artery bypass grafting (CABG) has consolidated its role as the most effective procedure for treating patients with advanced atherosclerotic coronary artery disease, reducing the long-term risk of myocardial infarction and death compared to other therapies and relieving angina. Despite the recognized benefits afforded by surgical myocardial revascularization, a subset of higher-risk patients bears a more elevated risk of perioperative stroke. Stroke remains the drawback of conventional CABG and has been strongly linked to aortic manipulation (cannulation, cross‐clamping, and side-biting clamping for the performance of proximal aortic anastomoses) and the use of cardiopulmonary bypass. Adoption of off-pump CABG (OPCAB) is demonstrated to lower the risk of perioperative stroke, as well as reducing the risk of short-term mortality, renal failure, atrial fibrillation, bleeding, and length of intensive care unit stay. However, increased risk persists owing to the need for the tangential ascending aorta clamping to construct the proximal anastomosis. The concept of anaortic (aorta no-touch) OPCAB (anOPCAB) stems from eliminating ascending aorta manipulation, virtually abolishing the risk of embolism caused by aortic wall debris into the brain circulation. The adoption of anOPCAB has been shown to further decrease the risk of postoperative stroke, especially in higher-risk patients, entailing a step forward and a refinement of outcomes provided by the primeval OPCAB technique. Therefore, anOPCAB has been the recommended technique in patients with cerebrovascular disease and/or calciﬁcation or atheromatous plaque in the ascending aorta and should be preferred in patients with high-risk factors for neurological damage and stroke.

https://doi.org/10.21470/1678-9741-2020-0451 54 downloads

11.

The 2020 American College of Cardiology/American Heart Association (ACC/AHA) Guideline for the Management of Patients with Valvular Heart Disease. Should the World Jump In?
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Gomes, Walter J

; Almeida, Rui M S

; Petrucci, Orlando

; Antunes, Manuel J.

; Albuquerque, Luciano C.

Brazilian Journal of Cardiovascular Surgery

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Abr 2021, Volume 36 Nº 2 Páginas 278 - 288

Resumo: En | Texto: En | PDF: En

https://doi.org/10.21470/1678-9741-2021-0953 218 downloads

12.

New Revelations Ignite the EXCEL Affair and Expose the Distortion of Science
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Gomes, Walter J.

; Albuquerque, Luciano C.

; Almeida, Rui M.S.

Brazilian Journal of Cardiovascular Surgery

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Out 2020, Volume 35 Nº 5 Páginas I - III

Resumo: En | Texto: En | PDF: En

https://doi.org/10.21470/1678-9741-1-2020-0609 213 downloads

13.

Cardiovascular involvement in COVID-19: not to be missed
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Rocco, Isadora S.

; Gomes, Walter J.

; Viceconte, Marcela

; Bolzan, Douglas W.

; Moreira, Rita Simone L

; Arena, Ross

; Guizilini, Solange

Brazilian Journal of Cardiovascular Surgery

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Ago 2020, Volume 35 Nº 4 Páginas 530 - 538

Resumo: En | Texto: En | PDF: En

Abstract In December 2019, a striking appearance of new cases of viral pneumonia in Wuhan led to the detection of a novel coronavirus (SARS-CoV2). By analyzing patients with severe manifestations, it became apparent that 20 to 35% of patients who died had preexisting cardiovascular disease. This finding warrants the important need to discuss the influence of SARS-CoV2 infection on the cardiovascular system and hemodynamics in the context of clinical management, particularly during mechanical ventilation. The SARS-CoV2 enters human cells through the spike protein binding to angiotensin-converting enzyme 2 (ACE2), which is important to cardiovascular modulation and endothelial signaling. As ACE2 is highly expressed in lung tissue, patients have been progressing to acute respiratory injury at an alarming frequency during the Coronavirus Disease (COVID-19) pandemic. Moreover, COVID-19 leads to high D-dimer levels and prothrombin time, which indicates a substantial coagulation disorder. It seems that an overwhelming inflammatory and thrombogenic condition is responsible for a mismatching of ventilation and perfusion, with a somewhat near-normal static lung compliance, which describes two types of pulmonary conditions. As such, positive pressure during invasive mechanical ventilation (IMV) must be applied with caution. The authors of this review appeal to the necessity of paying closer attention to assess microhemodynamic repercussion, by monitoring central venous oxygen saturation during strategies of IMV. It is well known that a severe respiratory infection and a scattered inflammatory process can cause non-ischemic myocardial injury, including progression to myocarditis. Early strategies that guide clinical decisions can be lifesaving and prevent extended myocardial damage. Moreover, cardiopulmonary failure refractory to standard treatment may necessitate the use of extreme therapeutic strategies, such as extracorporeal membrane oxygenation.

https://doi.org/10.21470/1678-9741-2020-0224 659 downloads

14.

A Tribute to a Master: Professor Domingo M. Braile
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Gomes, Walter J.

; Leal, João Carlos F.

Brazilian Journal of Cardiovascular Surgery

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Jun 2020, Volume 35 Nº 3 Páginas I - VI

Resumo: En | Texto: En | PDF: En

https://doi.org/10.21470/1678-9741-1-2020-0606 174 downloads

15.

Valve Heart Surgery in Brazil - The BYPASS Registry Analysis
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Zilli, Alexandre Cabral

; Guizilini, Solange

; Rocco, Isadora S.

; Santo, José Amalth do Espírito

; Berwanger, Otavio

; Kalil, Renato Abdala Karam

; Jatene, Fabio Biscegli

; Cavalcanti, Alexandre Biasi

; Santos, Renato Hideo Nakagawa

; Gomes, Walter J.

Brazilian Journal of Cardiovascular Surgery

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Jan 2020, Volume 35 Nº 1 Páginas 82 - 90

Resumo: En | Texto: En | PDF: En

Abstract Objective: To analyze the profile and outcomes of patients who underwent valve heart surgery in Brazil, using information retrieved from the Brazilian Registry of Cardiovascular Surgeries in Adults (BYPASS Registry) database. Methods: This is a multicenter cohort study, evaluating 920 patients submitted to heart valve surgery. Demographics and postoperative clinical outcomes were assessed and compared to estimate mortality risk using the European System for Cardiac Operative Risk Evaluation (EuroSCORE). Results: Isolated aortic valve replacement was the most frequently performed surgery (34%), followed by isolated mitral valve replacement (24.9%). Valve repair was performed in 21% of mitral procedures. Minimally invasive access was performed in 1.6% and the most frequent postoperative complications were arrhythmias (22.6%), infections (5.7%), and low-output syndrome (5.1%). Operations covered by the public health system accounted for 80.8% and the hospital mortality rate was 7.3%. Conclusion: The most frequent isolated valve surgery in Brazil is the aortic valve replacement by conventional open access and the rheumatic disease is still the main etiology for valve surgery. The BYPASS Registry has a fundamental role to provide information on the profile of patients with valve heart disease in our country in order to delineate adequate strategies for health promotion and resource allocation for cardiac surgery.

https://doi.org/10.21470/1678-9741-2019-0408 311 downloads

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journal_title	título completo da revista (ex. Cadernos de Saúde Pública)
la	código do idioma da publicação (ex. pt - Português, es - Espanhol)
type	tipo do documento
pid	identificador da publicação
publication_year	ano de publicação do artigo
sponsor	financiador
aff_country	código do país de afiliação do autor
aff_institution	instituição de afiliação do autor
volume	volume do artigo
issue	número do artigo
elocation	elocation
doi	número DOI
issn	ISSN da revista
in	código da coleção SciELO (ex. scl - Brasil, col - Colômbia)
use_license	código da licença de uso do artigo

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