ABSTRACT Advances in treatment of structural heart disease have been disruptive to cardiovascular surgery, and there have been discussions about how to incorporate these technologies into the surgeons’ therapeutic arsenal. Transcatheter procedures, complex redo interventions, and endovascular aortic approaches are already practiced by cardiovascular surgeons in Brazil. The expansion of these techniques, coupled with recent changes in the country’s medical residency program in cardiovascular surgery, has led to an urgent need to acquire catheter-based skills. In this article, we discuss these aspects in the light of the reality of cardiovascular surgery training in Brazil. arsenal procedures interventions Brazil techniques countrys country s catheterbased catheter based skills article

ABSTRACT Introduction: Atrial fibrillation is the main complication in the postoperative period of cardiovascular surgery. Its genesis is multifactorial, so its rapid identification to mitigate the associated risks is essential. Objective: To evaluate the incidence of atrial fibrillation in patients undergoing coronary artery bypass grafting (CABG) and its relationship with other complications in our setting. Methods: This is a multicenter, observational study involving patients undergoing isolated CABG between 2017 and 2019 with data from the Registro Paulista de Cirurgia Cardiovascular (or REPLICCAR II). Variables were prospectively collected in REDCap following the definitions given by version 2.73 of the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Data were collected with prior authorization from the local ethics committee and analyses performed in R software. Results: A total of 3,803 patients were included, of these 605 had postoperative atrial fibrillation (POAF). In order to adjust the groups, propensity score matching was used. Such analyses resulted in 605 patients in each group (without POAF vs. with POAF). Among patients with POAF, the mean age was 67.56 years, with a prevalence of males (73.6%, 445 patients). Patients belonging to the group with POAF had a mortality rate of 9.26% (P=0.007), longer ventilation time (P<0.001), pneumonia (P<0.001), and sepsis (P<0.001). In multiple analysis, acute renal dysfunction (P=0.032) and longer intensive care unit stay (P<0,001) were associated with the presence of POAF. Conclusion: POAF in CABG is associated with longer intensive care unit and hospital stay, as well as renal dysfunction, pneumonia, and in-hospital mortality. Introduction surgery multifactorial essential Objective (CABG setting Methods multicenter 201 or II. II . II) 273 2 73 2.7 Database software Results 3803 3 803 3,80 included 60 (POAF) groups used without vs POAF) 6756 67 56 67.5 years 73.6%, 736 6 (73.6% 44 patients. patients) 926 9 26 9.26 P=0.007, P0007 P P=0.007 , 0 007 (P=0.007) P<0.001, P0001 P<0.001 001 (P<0.001) P<0.001. analysis P=0.032 P0032 032 (P=0.032 P<0,001 (P<0,001 Conclusion inhospital 20 27 7 2. 380 80 3,8 (POAF 675 5 67. 73.6% (73.6 4 92 9.2 P000 P=0.00 00 (P=0.007 P<0.00 (P<0.001 P=0.03 P003 03 (P=0.03 P<0,00 (P<0,00 38 8 3, 73.6 (73. 9. P00 P=0.0 (P=0.00 P<0.0 (P<0.00 (P=0.0 P<0,0 (P<0,0 73. (73 P0 P=0. P<0. (P<0.0 (P=0. P<0, (P<0, (7 P=0 P<0 (P<0. (P=0 (P<0 ( P= P< (P= (P< (P

Abstract Background The COVID-19 pandemic has been a worldwide challenge. In patients with coronary artery disease (CAD), previously submitted to coronary artery bypass graft surgery (CABG), such impact should be analyzed. Objectives Evaluate the impact on quality of life of COVID-19 infection in patients with prior CABG. Methods Patients undergoing isolated CABG between July 2016 and July 2017 were enrolled. This is an observational, cross-sectional, prospective study. Patients were divided into two groups: Group (COVID-19) and Group (No-COVID), for analysis of variables. The World Health Organization’s (WHO) definitions of confirmed cases were used to define the diagnosis of COVID-19 infection. Quality of life was assessed using the Quality of Life in Cardiovascular Surgery (QLCS) questionnaire, applied 30 days, 6 months, 1 year, and 4 years after surgery. The primary endpoint was improvement in quality of life at 4 years after CABG. The local ethics committee approved the study. Continuous variables were described by their means and standard deviations (SD). Categorical variables were described using absolute or relative frequencies. The items that make up the quality of life questionnaire were added together to calculate the score. A linear mixed model was used to assess the effect of time on the score. The significance level adopted was 5%. The analyses were carried out using R software, version 4.2.1. Results The total sample consisted of 434 patients who underwent isolated CABG; the mean age was 63 years, with a prevalence of males (71%). Among the patients followed up at the 4-year follow-up (115), 60 (52%) were positive according to the WHO’s definitions. After multiple comparisons, there was a statistical difference in quality of life in all periods (P<0.001). Between patients with and without COVID-19, a statistical difference was observed at 1 and 4 years (p = 0.0039). Conclusion Patients who underwent CABG and had a history of COVID-19 infection experienced worsening quality of life within 4 years. There was no difference between groups regarding new acute myocardial infarction (AMI), stroke, or hospitalization. COVID19 COVID 19 COVID-1 challenge CAD, CAD , (CAD) CABG, (CABG) analyzed 201 enrolled observational crosssectional, crosssectional cross sectional, sectional cross-sectional study (COVID-19 NoCOVID, NoCOVID No (No-COVID) Organizations Organization s WHO (WHO QLCS (QLCS 3 days months year SD. SD . (SD) frequencies score 5 5% software 421 2 4.2.1 43 71%. 71 71% (71%) 4year followup follow 115, 115 (115) 52% 52 (52% WHOs comparisons P<0.001. P0001 P P<0.001 0 001 (P<0.001) COVID19, 19, p 0.0039. 00039 0.0039 0039 0.0039) AMI, AMI (AMI) stroke hospitalization COVID1 COVID- (CAD (CABG 20 (COVID-1 (No-COVID (SD 42 4.2. 7 (71% 11 (115 (52 P000 P<0.00 00 (P<0.001 0003 0.003 003 (AMI (COVID- 4.2 (71 (11 (5 P00 P<0.0 (P<0.00 000 0.00 (COVID 4. (7 (1 ( P0 P<0. (P<0.0 0.0 P<0 (P<0. 0. P< (P<0 (P< (P

Resumo Fundamento: A análise de indicadores como taxa de readmissão hospitalar é crucial para aprimorar a qualidade dos serviços e gestão em processos hospitalares. Objetivo: Identificar as variáveis correlacionadas a readmissão hospitalar até 30 dias após cirurgia de revascularização miocárdica (CRM). Métodos: Estudo de coorte transversal no banco de dados Registro Paulista de Cirurgia Cardiovascular II (REPLICCAR II)(N=3.392), de junho de 2017 a junho de 2019. Avaliaram-se retrospectivamente 150 pacientes para identificar os fatores correlacionados a readmissão hospitalar até 30 dias após-CRM via regressão logística univariada e multivariada. As análises foram realizadas no software R, com significância de 0,05 e intervalos de confiança de 95%. Resultados: Cento e cinquenta pacientes foram readmitidos até 30 dias após a alta hospitalar de CRM (150/3.392, 4,42%) principalmente por infecções (mediastinite, ferida operatória e sepse) totalizando 52 casos (52/150, 34,66%), outras causas foram: complicações cirúrgicas (14/150, 9,33%) e pneumonia (13/150, 8,66%). Os preditores de readmissão identificados foram: O modelo de regressão multivariada apontou intercepto (OR: 1,098, p<0,00001), apneia do sono (OR: 1,117, p=0,0165), arritmia cardíaca (OR: 1,040, p=0,0712) e uso de balão intra-aórtico (OR: 1,068, p=0,0021) como preditores do desfecho, com uma AUC de 0,70. Conclusão: 4,42% dos pacientes foram readmitidos pós-CRM, principalmente por infecções. Fatores como apneia do sono (OR: 1,117, p=0,0165), arritmia cardíaca (OR: 1,040, p=0,0712) e uso de balão intra-aórtico (OR: 1,068, p=0,0021) foram preditores de readmissão, com uma discriminação de risco moderada (AUC: 0,70). Fundamento hospitalares Objetivo 3 CRM. . (CRM) Métodos REPLICCAR IIN=3.392, IIN3392 IIN N=3.392 , N 392 II)(N=3.392) 201 2019 Avaliaramse Avaliaram se 15 apósCRM R 005 0 05 0,0 95 95% Resultados 150/3.392, 1503392 (150/3.392 442 4 42 mediastinite, mediastinite (mediastinite sepse 5 52/150, 52150 (52/150 34,66%, 3466 34,66% 34 66 34,66%) 14/150, 14150 14 (14/150 9,33% 933 9 33 13/150, 13150 13 (13/150 8,66%. 866 8,66% 8 8,66%) OR (OR 1098 1 098 1,098 p<0,00001, p000001 p p<0,00001 00001 p<0,00001) 1117 117 1,117 p=0,0165, p00165 p=0,0165 0165 p=0,0165) 1040 040 1,040 p=0,0712 p00712 0712 intraaórtico intra aórtico 1068 068 1,068 p=0,0021 p00021 0021 desfecho 070 70 0,70 Conclusão 4,42 pósCRM, pósCRM pós CRM, pós-CRM (AUC 0,70) (CRM IIN=3.392 IIN339 N3392 N=3.39 39 II)(N=3.392 20 00 0, 150/3.392 150339 (150/3.39 44 52/150 5215 (52/15 346 34,66 6 14/150 1415 (14/15 9,33 93 13/150 1315 (13/15 86 8,66 109 09 1,09 p00000 p<0,0000 0000 111 11 1,11 p0016 p=0,016 016 104 04 1,04 p=0,071 p0071 071 106 06 1,06 p=0,002 p0002 002 07 7 0,7 4,4 IIN=3.39 IIN33 N339 N=3.3 II)(N=3.39 2 150/3.39 15033 (150/3.3 52/15 521 (52/1 34,6 14/15 141 (14/1 9,3 13/15 131 (13/1 8,6 10 1,0 p0000 p<0,000 000 1,1 p001 p=0,01 01 p=0,07 p007 p=0,00 p000 4, IIN=3.3 IIN3 N33 N=3. II)(N=3.3 150/3.3 1503 (150/3. 52/1 (52/ 34, 14/1 (14/ 9, 13/1 (13/ 8, 1, p<0,00 p00 p=0,0 IIN=3. N3 N=3 II)(N=3. 150/3. (150/3 52/ (52 14/ (14 13/ (13 p<0,0 p0 p=0, IIN=3 N= II)(N=3 150/3 (150/ (5 (1 p<0, p=0 IIN= II)(N= 150/ (150 ( p<0 p= II)(N (15 p<

Abstract Background: The analysis of indicators such as hospital readmission rates is crucial for improving the quality of services and management of hospital processes. Objectives: To identify the variables correlated with hospital readmission up to 30 days following coronary artery bypass grafting (CABG). Methods: Cross-sectional cohort study by REPLICCAR II database (N=3,392) from June 2017 to June 2019. Retrospectively, 150 patients were analyzed to identify factors associated with hospital readmission within 30 days post-CABG using univariate and multivariate logistic regression. Analysis was conducted using software R, with a significance level of 0.05 and 95% confidence intervals. Results: Out of 3,392 patients, 150 (4,42%0 were readmitted within 30 days post-discharge from CABG primarily due to infections (mediastinitis, surgical wounds, and sepsis) accounting for 52 cases (34.66%). Other causes included surgical complications (14/150, 9.33%) and pneumonia (13/150, 8.66%). The multivariate regression model identified an intercept (OR: 1.098, p<0.00001), sleep apnea (OR: 1.117, p=0.0165), cardiac arrhythmia (OR: 1.040, p=0.0712), and intra-aortic balloon pump use (OR: 1.068, p=0.0021) as predictors of the outcome, with an AUC of 0.70. Conclusion: 4.42% of patients were readmitted post-CABG, mainly due to infections. Factors such as sleep apnea (OR: 1.117, p=0.0165), cardiac arrhythmia (OR: 1.040, p=0.0712), and intra-aortic balloon pump use (OR: 1.068, p=0.0021) were predictors of readmission, with moderate risk discrimination (AUC: 0.70). Background processes Objectives 3 CABG. . (CABG) Methods Crosssectional Cross sectional N=3,392 N3392 N 392 (N=3,392 201 2019 Retrospectively 15 postCABG post R 005 0 05 0.0 95 intervals Results 3392 3,39 4,42%0 4420 4 42 (4,42% postdischarge discharge mediastinitis, mediastinitis (mediastinitis wounds sepsis 5 34.66%. 3466 34.66% 34 66 (34.66%) 14/150, 14150 14 (14/150 9.33% 933 9 33 13/150, 13150 13 (13/150 8.66%. 866 8.66% 8 8.66%) OR (OR 1098 1 098 1.098 p<0.00001, p000001 p p<0.00001 , 00001 p<0.00001) 1117 117 1.117 p=0.0165, p00165 p=0.0165 0165 p=0.0165) 1040 040 1.040 p=0.0712, p00712 p=0.0712 0712 p=0.0712) intraaortic intra aortic 1068 068 1.068 p=0.0021 p00021 0021 outcome 070 70 0.70 Conclusion 442 4.42 postCABG, CABG, (AUC 0.70) (CABG N=3,39 N339 39 (N=3,39 20 00 0. 339 3,3 4,42% (4,42 346 34.66 6 (34.66% 14/150 1415 (14/15 9.33 93 13/150 1315 (13/15 86 8.66 109 09 1.09 p00000 p<0.0000 0000 111 11 1.11 p0016 p=0.016 016 104 04 1.04 p0071 p=0.071 071 106 06 1.06 p=0.002 p0002 002 07 7 0.7 44 4.4 N=3,3 N33 (N=3,3 2 3, 4,42 (4,4 34.6 (34.66 14/15 141 (14/1 9.3 13/15 131 (13/1 8.6 10 1.0 p0000 p<0.000 000 1.1 p001 p=0.01 01 p007 p=0.07 p=0.00 p000 4. N=3, N3 (N=3, 4,4 (4, 34. (34.6 14/1 (14/ 9. 13/1 (13/ 8. 1. p<0.00 p00 p=0.0 N=3 (N=3 4, (4 (34. 14/ (14 13/ (13 p<0.0 p0 p=0. N= (N= ( (34 (1 p<0. p=0 (N (3 p<0 p= p<

ABSTRACT Introduction: Cardiovascular surgery has undergone numerous changes over the last decades. Transcatheter technologies, endovascular procedures, hybrids, and minimally invasive surgery have undoubtedly advanced as a therapy for patients. Thus, the discussion about the training of residents in the face of new technologies in the specialty is in check. In this article, it is proposed a review to discuss the challenges in this scenario as well as the current training in cardiovascular surgery in Brazil. Methods: A comprehensive review was performed in the Brazilian Journal of Cardiovascular Surgery. All editions from 1986 to 2022 were included. The research was carried out using the search engine on the journal’s website (https://www.bjcvs.org) and an individual analysis of the titles and abstracts of each article published. Results: All the studies are summarized in the appropriate table with a discussion along this review. Conclusion: Most articles that discuss training in cardiovascular surgery in the national context are editorials and expert points of view with no observational studies evaluating the residency programs. Introduction decades procedures hybrids patients Thus check Brazil Methods Surgery 198 202 included journals journal s https//www.bjcvs.org httpswwwbjcvsorg https //www.bjcvs.org www bjcvs org (https://www.bjcvs.org published Results Conclusion programs 19 20 wwwbjcvsorg 1 2

Abstract We present the case of a 55-year-old patient who underwent the Bentall-De Bono procedure with mechanical prosthesis in 2005 and was admitted to the emergency department in July 2020 with mixed shock. Complementary exams showed an abscess involving the prosthetic tube, two thirds of the aortic valve circumference and the left ventricle, with a neocavity of about 45 mm in diameter from the aortic sinus to the ascending aorta. The patient underwent surgical repair, with a new procedure using the Bentall-De Bono technique, now associated with coronary artery bypass grafting with a great saphenous vein graft between the aorta and the anterior descending artery. Culture of samples collected intraoperatively showed Staphylococcus epidermidis. The patient received antibiotic therapy for 30 days, evolving favorably, and is under regular outpatient follow-up. 55yearold yearold 55 year old BentallDe Bentall De 200 202 shock tube ventricle 4 repair technique epidermidis 3 days favorably followup. followup follow up. up follow-up 5 20 2

Abstract Case Presentation: A case of a 49-year-old patient, male, victim of stab wound, developing belatedly cardiac tamponade and hemodynamic stability was reported. The patient underwent a pericardial window with drainage of pericardial effusion of blackened aspect; however, without visualization of the cardiac lesion, enlargement of the incision by median sternotomy was opted for. A hematoma was spotted at the left ventricle with epicardial lesion and a patch of pericardium was made with 3-0 polypropylene. The patient developed acute pulmonary edema and atrial fibrillation, which improved after the intensive care unit clinical management, with hospital discharge in the 7th postoperative day.