Abstract Background Although cardiovascular disease is the leading cause of death in women, few data exist on risk factors and treatment of these diseases in women. This leads to a delay in the institution of appropriate therapies and worse outcomes in this population. Objective We aimed to identify predictors of morbidity and mortality in women undergoing isolated mitral valve replacement. Methods This was a retrospective cohort study with 104 women who underwent isolated mitral valve replacement at a referral hospital for treatment of cardiovascular diseases, performed from January 2011 to December 2016. Data were obtained from medical records. Statistical analysis was performed to calculate odds ratio, unpaired Student's t-test, and binary logistic regression. P values <0.05 were considered statistically significant. Results Mean age of patients was 43.73 (±13.85) years. Most patients had a diagnosis of rheumatic disease prior to surgery (76%; N=79). Mortality rate was 4.9% (N = 5). There was a statistically higher risk of death among patients with reduced ejection fraction (EF) (<50%) (OR = 14.833, 95% CI 2.183 - 100.778, P=0.001) and older age (P = 0.009). There was an inverse association between a previous diagnosis of rheumatic disease and death (OR = 0.064, 95% CI 0.007 - 0.606, P=0.002). Logistic regression showed reduced EF at preoperative evaluation as a predictor of death and a diagnosis of rheumatic disease as a protective factor. Conclusion Older age and reduced EF were associated with postoperative mortality. Reduced EF was a predictor of death, and rheumatic disease was associated with better surgical outcomes.

Abstract Introduction: We aimed to identify predictors of morbidity and mortality in patients undergoing isolated mitral valve replacement. Methods: This is a retrospective cohort study with 164 patients who underwent isolated mitral valve replacement at a referral hospital for cardiovascular diseases, which were performed from January 2011 to December 2016. Data were obtained from medical records, including preoperative, intraoperative, and postoperative information. Statistical analysis was performed to calculate odds ratio (OR), unpaired Student's t-test, and binary logistic regression. P-values < 0.05 were considered significant. Results: A total of 69.5% (n=114) of the patients had a diagnosis of rheumatic disease prior to surgery. Mortality rate was 6.7% (n=11). The most observed complication was the occurrence of postoperative arrhythmias (19.5%). On average, patients remained 5.34 days in the intensive care unit. There was a statistically significant enhanced risk of death among patients with previous diagnosis of endocarditis (OR 5.22, 95% confidence interval [CI] 1,368-19,915; P=0.008), reduced ejection fraction (EF) (< 50%) (OR 9.46, 95% CI 2,61-34,35; P<0.001), and mitral regurgitation (MR) (OR 7.7, 95% CI 1.576-37.545; P=0.004). Patients who died were older than those who survived surgery (P<0.001) and had lower preoperative serum hemoglobin levels (P=0.018). Logistic regression showed age and reduced EF at preoperative evaluation as predictors of death. Conclusion: Older age, reduced serum hemoglobin levels, preoperative diagnosis of endocarditis, reduced EF, and MR were associated with postoperative mortality. Age and reduced EF were predictors of death.

INTRODUÇÃO: A cirurgia valvar mitral pode ser realizada com o coração com atividade elétrica, vazio e normotérmico com pinçamento aórtico, perfusão sanguínea no seio coronário, simulando um estado fisiológico. OBJETIVOS: Comparar as manifestações clínicas e ultramicroscópicas do miocárdio, na cirurgia valvar mitral, com o coração com atividade elétrica versus sem atividade elétrica. MÉTODOS: Estudo randomizado constituído de 34 pacientes: grupo A (batendo) e grupo B (parado). Os parâmetros foram: hematológico, bioquímico, ecocardiográfico, lactato. Foram realizadas 102 biopsias da parede anterior do ventrículo esquerdo preparadas para análise ultraestrutural: antes da circulação extracorpórea, antes do despinçamento aórtico e 10 minutos após a interrupção da circulação extracorpórea. RESULTADOS: Verificou-se elevação do lactato 3 horas após o início do procedimento, que foi maior no grupo A (P=0,06), todavia semelhantes no final da cirurgia. A cardioversão foi necessária em (A) 5/17 vs. (B) 13/17, P=0,07. A temperatura intraoperatória média foi significativamente menor no grupo B em relação ao grupo A (32oC vs. 36oC), P<0,001. A análise ultramicroscópica das amostras das biopsias do coração antes da circulação extracorpórea, ao término do pinçamento aórtico e após a saída da circulação extracorpórea, revelou anormalidades transitórias semelhantes no citoplasma, núcleos e mitocôndrias em ambos os grupos, independentemente do momento das biopsias. CONCLUSÃO: A proteção miocárdica na cirurgia valvar mitral apresentou aspectos semelhantes na preservação da integridade ultraestrutural dos cardiomiócitos quando realizada com o coração com ou sem atividade elétrica.

INTRODUCTION: Beating heart surgery on normothermic bypass simulates physiologic cardiac status. OBJECTIVES: This study compared clinical and transmission electron microscopic aspects of myocardial protection during mitral valve replacement using warm retrograde perfusion in empty beating versus arrested heart with cold blood anterograde cardioplegia. METHODS: Randomized study to evaluate myocardial cellular ischemia-reperfusion of both techniques to replace the mitral valve. Thirty-four patients were randomly assigned into group A (beating heart) and group B (arrested heart). The following parameters were assessed: echocardiography, blood chemistry, hemoglobin, lactate. During the surgical procedure a total of 102 myocardial biopsies were performed for ultrastructural analysis from anterior left ventricular wall: before cardiopulmonary bypass, before aortic desclamping and 10 minutes after reperfusion. RESULTS: Elevation of lactate at 3 hours during the procedure was higher in group A, but similar at the end of surgery (P=0.06). Cardioversion was necessary in 5/17 (A) vs. 13/17 (B) P=0.07. Median intraoperative systemic temperature was significantly lower in the group B compared to A (32oC vs. 36oC), P<0.001. There was no significant difference of the ultramicroscopic aspects of the heart biopsies before, during and after surgery in both groups. Cellular and mitochondrial transient abnormalities such as mitochondrial swelling, glycogen loss and cytosol swelling were detected independently of the moment of the biopsies. CONCLUSION: Myocardial protection and ultrastructural abnormalities were similar for both types of mitral valve replacement beating or arrested heart techniques.

INTRODUÇÃO: O tratamento cirúrgico da cardiopatia congênita em adultos apresentou importante crescimento nos últimos anos. Contudo, ainda assim, o número de pacientes que atingem a idade adulta sem tratamento cirúrgico adequado permanece elevado. OBJETIVO: Avaliar os resultados hospitalares e diagnósticos dos pacientes adultos com cardiopatia congênita submetidos à primeira operação. MÉTODOS: Estudo retrospectivo, que analisou prontuários de pacientes operados para correção de cardiopatia congênita com idade maior ou igual a 18 anos. O critério de exclusão foi cirurgia para reoperação. Foi analisado o período entre dezembro de 2007 e dezembro de 2010, com inclusão de 79 pacientes. RESULTADOS: Os defeitos do septo atrial foram os mais prevalentes (53,1%), seguidos de comunicação interventricular (15,2%), coarctação da aorta (6,3%) e canal atrioventricular parcial (6,3%). Treze (16,4%) pacientes apresentavam doença associada adquirida e 14 pacientes (17,7%), congênita. Trinta e três (41,8%) pacientes apresentavam hipertensão pulmonar. O tempo médio de internamento em UTI e hospitalar foi de 3,9 e 14,5 dias, respectivamente. Complicações ocorreram em 18 (22,8%) pacientes, sendo as infecciosas as mais comuns. A mortalidade hospitalar foi de dois (2,5%) pacientes. CONCLUSÃO: O tratamento da cardiopatia congênita em adultos como primeira cirurgia apresentou resultado bastante favorável. Contudo, em nossa série, houve maior tempo de internamento em UTI e hospitalar.

INTRODUCTION: Surgical treatment of congenital heart disease in adults showed a significant growth in recent years. But even so, the number of patients who reach adulthood without adequate surgical treatment remains high. OBJECTIVE: To demonstrate the results and hospital diagnoses of adult patients with congenital heart disease underwent the first surgery. METHODS: A retrospective analysis of records of patients operated for correction of congenital heart disease and age greater than or equal to 18 years. The exclusion criterium was surgery for reoperation. Period analyzed was from December 2007 to December 2010 with inclusion of 79 patients. RESULTS: The atrial septal defects were the most prevalent (53.1%), followed by VSD (15.2%), the coarctation (6.3%) and partial atrioventricular canal (6.3%). Thirteen (16.4%) patients had associated disease acquired and 14 (17.7%) congenital disease. Complications occurred in 18 (22.8%) patients, with infections being the most common. The average hospital stay in ICU and hospital were 3.9 and 14.5 days, respectively. Thirty-three (41.8%) patients had pulmonary hypertension. The hospital mortality was two (2.5%) patients. CONCLUSION: The treatment of congenital heart disease in adults as first surgery has very favorable results. However, in our series, there was an increased length of stay in ICU and hospital.

OBJETIVO: Avaliar o comportamento mecânico e os efeitos no processo de calcificação pós-implante do pericárdio bovino tratado com glutaraldeído submetido a várias doses de radiação gama. MÉTODO: Pericárdios bovinos fixados com glutaraldeído foram submetidos a radiação gama, nas doses de 0 a 10000 Gy. Seis amostras de cada grupo foram avaliadas pela microscopia óptica, determinação da temperatura de desnaturação do colágeno e ensaio mecânico de tração e implantadas subcutaneamente em ratos. Após quatro meses do implante, as amostras foram explantadas e o conteúdo de Ca2+ determinado pela espectrometria de absorção atômica. RESULTADOS: Níveis de Ca2+ (em µg/mg): 0 Gy (controle) - 194,45; 50 Gy - 154,64; 100 Gy - 169,37; 200 Gy - 163,64; 500 Gy - 199,89; 1000 Gy - 184,02; 2000 Gy - 198,95; 5000 Gy - 227,95 e 10000 Gy - 362,62. Houve alteração significativa no comportamento mecânico do tecido irradiado, quando comparado ao grupo controle, mesmo com o emprego de baixas doses de radiação. CONCLUSÃO: O emprego da radiação gama no pericárdio bovino tratado com glutaraldeído não reduziu os níveis de Ca2+ em implantes subcutâneos em ratos por quatro meses e promoveu alteração significativa no comportamento mecânico do tecido, com redução na sua resistência, quando comparados ao grupo controle.

OBJECTIVE: To evaluate the effect of gamma irradiation on glutaraldehyde-fixed bovine pericardium. METHOD: Glutaraldehyde-fixed bovine pericardium was exposed to gamma radiation (doses from 0 to 10000 Gy). Six samples from each of nine groups were evaluated by optic microscopy, and shrinking and mechanical tests and the denaturation temperature was determined. Additionally, they were subcutaneously implanted in rats and after four months they were explanted and Ca2+ levels measured by atomic absorption spectroscopy. RESULTS: The Ca2+ levels were (in µg/mg): control (0 Gy) - 194.45; 50 Gy - 154.64; 100 Gy - 169.37; 200 Gy - 163.64; 500 Gy - 199.89; 1000 Gy - 184.02; 2000 Gy - 198.95; 5000 Gy - 227.95; 10000 Gy - 362.62. Gamma irradiation caused a significant effect on the biomechanical properties of the tissue. CONCLUSION: e-fixed bovine pericardium.

OBJETIVO: Avaliar possível efeito sinérgico dos agentes anticalcificantes mais promissores investigados na literatura, por meio de tratamento seqüencial. MÉTODO: Pericárdios bovinos fixados com glutaraldeído foram tratados com: aquecimento a 50ºC, éter dietílico 80%, quitosana 0,125%, heparina, NaBH4 e formaldeído 4%. Amostras foram avaliadas pela microscopia óptica, determinação da temperatura de desnaturação do colágeno e ensaio mecânico de tração e implantadas subcutaneamente em ratos. Após quatro meses do implante, as amostras foram explantadas e o conteúdo de Ca2+ determinado pela espectrometria de absorção atômica. RESULTADOS: Níveis de Ca2+ (em µg/mg): Controle -194,45; aquecimento a 50ºC - 6,87; éter dietílico - 3,69; quitosana - 68,89; quitosana+heparina - 6,81; formaldeído - 107,34; tratamento seqüencial - 0,17. O comportamento mecânico variou de acordo com os tratamentos empregados. CONCLUSÃO: O tratamento seqüencial foi efetivo na inibição da calcificação e o tecido apresentou comportamento mecânico adequado à confecção de biopróteses.

OBJECTIVE: To evaluate a possible synergic effect of the most promising anti-calcifying agents investigated in literature by sequential treatment. METHOD: Glutaraldehyde-fixed bovine pericardium was treated by: heating to 50ºC, 80% ether, 0.125% chitosan, heparin, NaBH4 and 4% formaldehyde. Samples were evaluated by optic microscopy, shrinking and mechanical tests and implanted subcutaneously in rats. Four months later the samples were explanted and Ca2+ levels measured by atomic absorption spectroscopy. RESULTS: Ca2+ levels were (in µg/mg): control - 194.45; heating at 50ºC - 6.87; ether - 3.69; chitosan - 68.89; heparin - 6.81; formaldehyde - 107.34; sequential treatment - 0.17. The mechanical characteristics changed according to the treatments employed. CONCLUSION: Sequential treatment was effective to inhibit calcification and the tissue showed an adequate mechanical structure for the manufacture of bioprosthesis.

Objetivo: Apresentar uma modificação técnica para a correção cirúrgica biventricular da dupla via de saída de ventrículo direito com comunicação interventricular não relacionada. Métodos: No período de abril de 1987 a fevereiro de 1996, 15 pacientes portadores desta anomalia foram submetidos à técnica de reconstrução biventricular com "tunelização" do ventrículo esquerdo para a aorta utilizando-se 2 ou mais retalhos de pericárdio bovino. A idade variou entre 2 a 13 anos (média = 4,8 anos; média = 5 anos). Treze pacientes apresentavam situs solitus e levocardia, 1 paciente situs inversus e dextrocardia e 1 paciente situs solitus e dextrocardia. A construção do túnel inicia-se no átrio direito. Sendo a CIV pequena ou restritiva, é feita a ampliação em sentido anterior e o primeiro retalho é suturado na borda póstero-inferior do defeito direcionando-o para o septo, em posição anterior e superior. A seguir, através de ventriculotomia direita o segundo, terceiro e, por vezes, o quarto retalhos são suturados direcionando o túnel para o anel aórtico. Resultados: Houve 3 óbitos (mortalidade de 20%), 2 hospitalares, 1 tardio e os 12 pacientes restantes foram seguidos por um período variável de 10 meses a 9 anos (média 33 meses) encontrando-se todos em classe funcional I (NYHA). Comunicação interventricular residual, mínima, foi observada em 1 paciente, estenose pulmonar residual em 2 pacientes e insuficiência pulmonar em 1 paciente. Em nenhum dos pacientes demonstrou-se obstrução do túnel ventrículo esquerdo - aorta. Conclusão: Baseados nestes resultados, concluímos que esta técnica para reparo biventricular permite a construção de um túnel com diâmetro interno adequado, respeitando as mudanças de direção existentes entre a comunicação interventricular e a aorta. O túnel de pericárdio bovino ocupa menor espaço intraventricular causando, portanto, menor risco de obstrução da via de saída de ventrículo direito.

Objetive: To introduce a new surgical technique for biventricular correction of the double-outlet right ventricle with non-commited ventricular septal defect. Methods: In the period from April 1987 to February 1996, 15 patients with this anomaly were operated on with a new technique for biventricular repair, using multiple patches of bovine pericardium in order to create a tunnel between the left ventricle and the aorta. Ages ranged from 2 months to 13 years (mean-age 4.8 years). Thirteen patients had situs solitus and levocardia, 1 patient situs inversus and dextrocardia, and 1 patient situs solitus and dextrocardia. Construction of the tunnel begins at the right atrium. The ventricular septal defect (VSD) is enlarged anteriorly, if restrictive or small, and the first patch is sutured in the infero-posterior edge of the VSD. The second, third and sometimes the fourth patche are sutured in sequence, through the right ventriculotomy, directing the tunnel to the aortic annulus. Results: Overall mortality was 20%, 2 early and 1 late death. The surviving patients were followed-up for a period ranging from 10 months to 9 years (mean 33 months), and all are in functional class I (NYHA). A minimal residual ventricular septal defect was diagnosed by echocardiography in 1 patient, pulmonary residual stenosis in 2 patients and moderate degree of pulmonary insufficiency in 1. There is no any degree of obstruction of the intraventricular tunnel between the LV and the aorta. Conclusion: Based on these data, we conclude that this technical modification for the biventricular repair of the double-outlet right ventricle with non-committed VSD permits the construction of the tunnel with adequate internal diameter, respecting the spatial changes existing between the VSD and aorta. Besides this, the intraventricular bovine pericardial tunnel occupies less space, reducing the incidence of the outflow right ventricle obstruction.