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- Pinheiro, Bruno Botelho, et al.
(author)
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Dacron Graft Intussusception Technique for Treatment of Type A Aortic Dissections : Technical Notes and Preliminary Results
- 2016
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In: Brazilian Journal of Cardiovascular Surgery. - : Sociedade Brasileira de Cirurgia Cardiovascular. - 0102-7638 .- 1678-9741. ; 31:2, s. 115-119
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Journal article (peer-reviewed)abstract
- Introduction: Optimal surgical management for acute type A aortic dissection (AAAD) remains unclear. The in-hospital mortality rate is still high (15%), and the intraoperative bleeding is an independent risk factor for hospital mortality.Objective: The aim of our study was describe a new method for aortic anastomosis in the repair of AAAD and report the hospital mortality and bleeding complications.Methods: Between January 2008 and November 2014, 24 patients, 16 male, median age 62 years, underwent surgical treatment of AAAD. The surgical technique consisted of intussusception of a Dacron tube in the dissected aorta, which is anastomosed with a first line of 2-0 polyester everting mattress suture and a second line of 3-0 polypropylene running suture placed at the outermost side. Open distal anastomosis was performed with bilateral selective antegrade cerebral perfusion in 13 (54.1%) patients.Results: Cardiopulmonary bypass and aortic clamping time ranged from 75 to 135 min (mean= 85 min) and 60 to 100 min (mean= 67 min), respectively. The systemic circulatory arrest ranged from 29 to 60 min (mean=44.5 min). One (4.1%) patient required reoperation for bleeding, due to the use of preoperative clopidogrel. The postoperative bleeding was 382-1270 ml (mean= 654 ml). We used an average of 4.2 units of red blood cells/patient. There were two (8.3%) hospital deaths, one due to intraoperative bleeding and another due to mesenteric ischemia. The average length of stay in the intensive care unit and hospital was 44 hours and 6.7 days, respectively.Conclusion: This new method for surgical correction of AAAD was reproducible and resulted in satisfactory clinical outcomes.
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| 2. |
- Abawi, Akram, et al.
(author)
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Five-Year Follow-Up After Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis and Concomitant Coronary Artery Disease : A Single-Center Experience
- 2023
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In: Brazilian Journal of Cardiovascular Surgery. - : Sociedade Brasileira de Cirurgia Cardiovascular. - 0102-7638 .- 1678-9741. ; 39:1
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Journal article (peer-reviewed)abstract
- INTRODUCTION: There is no consensus on the impact of coronary artery disease in patients undergoing transcatheter aortic valve implantation. Therefore, the objective of this study was, in a single-center setting, to evaluate the five-year outcome of transcatheter aortic valve implantation patients with or without coronary artery disease.METHODS: All transcatheter aortic valve implantation patients between 2009 and 2019 were included and grouped according to the presence or absence of coronary artery disease. The primary endpoint, five-year all-cause mortality, was evaluated using Cox regression adjusted for age, sex, procedure years, and comorbidities. Comorbidities interacting with coronary artery disease were evaluated with interaction tests. In-hospital complications was the secondary endpoint.RESULTS: In total, 176 patients had aortic stenosis and concomitant coronary artery disease, while 170 patients had aortic stenosis only. Mean follow-up was 2.2±1.6 years. There was no difference in the adjusted five-year all-cause mortality between transcatheter aortic valve implantation patients with and without coronary artery disease (hazard ratio 1.00, 95% confidence interval 0.59-1.70, P=0.99). In coronary artery disease patients, impaired renal function, peripheral arterial disease, or ejection fraction < 50% showed a significant interaction effect with higher five-year all-cause mortality. No significant differences in complications between the groups were found.CONCLUSION: Five-year mortality did not differ between transcatheter aortic valve implantation patients with or without coronary artery disease. However, in patients with coronary artery disease and impaired renal function, peripheral arterial disease, or ejection fraction < 50%, we found significantly higher five-year all-cause mortality.
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| 3. |
- Edin, Victor, et al.
(author)
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A Case of Using No-Touch Saphenous Vein Graft in Redo CABG after Multiple Failed Percutaneous Coronary Interventions
- 2022
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In: Brazilian Journal of Cardiovascular Surgery. - : Brazilian Society for Cardiovascular Surgery. - 0102-7638 .- 1678-9741. ; 37:1, s. 135-138
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Journal article (peer-reviewed)abstract
- The modality of repeat revascularization due to late graft failure is a debated topic. The latest available European guidelines recommend redo coronary artery bypass graft (CABG) for cases of extensively diseased and/or occluded grafts and those with diffuse native vessel disease. We present the case of a patient being relieved of recurrent unstable angina pectoris with redo CABG using no-touch saphenous vein grafts after repeated and unsuccessful attempts with percutaneous coronary intervention (PCI). This could be an alternative to PCI in patients with a complex medical history. Teamwork between cardiologists and surgeons is pivotal in deciding the best treatment modality.
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| 4. |
- Ferrari, Gabriele, 1984-, et al.
(author)
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Quality of Life After Percutaneous Coronary Intervention in No-Touch Saphenous Vein Grafts is Significantly Better Than in Conventional Vein Grafts
- 2022
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In: Brazilian Journal of Cardiovascular Surgery. - : Sociedade Brasileira de Cirurgia Cardiovascular. - 0102-7638 .- 1678-9741. ; 37:4, s. 430-438
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To compare health-related quality of life (HRQoL) of patients primarily treated with a no-touch saphenous vein graft with that of patients who received a conventional graft.METHODS: The study included all individuals treated with a percutaneous coronary intervention (PCI) on a saphenous vein graft (SVG) between January 2006 and June 2020. The RAND-36 health survey was used to assess HRQoL. The Mann-Whitney U test was used to test differences in HRQoL between the two groups. Effect size was estimated via Cohen's d. The average treatment effect between the groups was tested by propensity score matching (PSM).RESULTS: Of the 346 patients treated with a PCI in a stenosed or occluded SVG, 165 responded to RAND-36 (no-touch: n=48; conventional: n=117). Patients with a no-touch graft reported better mean values on seven of the eight health survey domains. Statistically significant differences were observed for four of the domains, all in favour of the no-touch group. The effect size estimates indicated a small difference for five domains, with the highest values (>0.40) seen for the general health and energy/fatigue domains. PSM confirmed a statistically significant difference for the physical functioning and general health domains.CONCLUSION: At a mean follow-up of 5.4 years, patients who received a PCI in no-touch vein grafts showed significantly better HRQoL than those who received a PCI in conventional vein grafts.
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| 7. |
- Samano, Ninos, 1972-, et al.
(author)
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Surgical Aspects of No-Touch Saphenous Vein Graft Harvesting in CABG : Clinical and Angiographic Follow-Up at 3 Months
- 2019
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In: Brazilian Journal of Cardiovascular Surgery. - : Sociedade Brasileira de Cirurgia Cardiovascular. - 0102-7638 .- 1678-9741. ; 34:1, s. 98-100
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Journal article (peer-reviewed)abstract
- With more than 800,000 coronary artery bypass grafting (CABG) operations annually worldwide and the saphenous vein being the most common conduit used, there is no question that improving saphenous vein graft patency is one of the most important tasks in CABG. This video describes the no-touch harvesting procedure of the saphenous vein on an 80-year old man with hypertension, hyperlipidemia and a previous myocardial infarction with percutaneous coronary intervention to the right coronary artery. He was complaining of exertional chest pain and was diagnosed with stable angina pectoris. The coronary angiography showed advanced three vessel disease with significant stenoses in the left anterior descending (LAD) artery, two marginal arteries (MAs) and the posterior descending artery (PDA), in addition to an occluded diagonal artery (DA). The patient received a triple sequential no-touch vein graft to the PDA and two MAs together with a double sequential no-touch vein graft to the DA and LAD. A vein graft was used to bypass the LAD due to the age of the patient and the low degree of stenosis in the LAD. The no-touch harvesting technique is described in detail in the film with complete narration. A follow-up of this patient was performed at three months both clinically and with a computed tomography angiography (CTA). No angina pectoris symptoms were reported by the patient and the wounds in the chest and lower limb were completely healed. The CTA showed patent no-touch saphenous vein grafts to all the distal anastomoses.
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| 8. |
- Samano, Ninos, 1972-, et al.
(author)
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Twenty-Five Years of No-Touch Saphenous Vein Harvesting for Coronary Artery Bypass Grafting : Structural Observations and Impact on Graft Performance
- 2020
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In: Brazilian Journal of Cardiovascular Surgery. - : Sociedade Brasileira de Cirurgia Cardiovascular. - 0102-7638 .- 1678-9741. ; 35:1, s. 91-99
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Research review (peer-reviewed)abstract
- The saphenous vein is the most common conduit used in coronary artery bypass grafting (CABG) yet its failure rate is higher compared to arterial grafts. An improvement in saphenous vein graft performance is therefore a major priority in CABG. No-touch harvesting of the saphenous vein is one of the few interventions that has shown improved patency rates, comparable to that of the left internal thoracic artery. After more than two decades of no-touch research, this technique is now recognized as a Class IIa recommendation in the 2018 European Society of Cardiology and the European Association for Cardio-Thoracic Surgery guidelines on myocardial revascularization. In this review, we describe the structural alterations that occur in conventional versus no-touch saphenous vein grafts and how these changes affect graft patency. In addition, we discuss various strategies aimed at repairing saphenous vein grafts prepared at conventional CABG.
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| 9. |
- Borges, Juliana Bassalobre Carvalho, et al.
(author)
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[Quality of service provided to heart surgery patients of the Unified Health System-SUS]
- 2010
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In: Brazilian Journal of Cardiovascular Surgery. - 0102-7638 .- 1678-9741. ; 25:2, s. 172-182
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Journal article (peer-reviewed)abstract
- OBJECTIVE:To evaluate the service quality provided to heart surgery patients during their hospital stay, identifying the patient's expectations and perceptions. To associate service quality with: gender, age and the use of extracorporeal circulation.METHODS:We studied 82 elective heart surgery patients (52.4% females and 47.6% males), operated by midsternal thoracotomy, age: 31 to 83 years (60.4 +/- 13.2 years); period: March to September 2006. Service quality was evaluated in two instances: the expectations at pre-operative and the perceptions of the service received on the 6th post-operative; through the application of the modified SERVQUAL scale (SERVQUAL-Card). The result was obtained by the difference of the sum of the scores on perception minus those of the expectations, and through statistical analysis.RESULTS:The SERVQUAL-Card scale was statistically validated, showing adequate level of internal consistency. We found a higher frequency of myocardial revascularization 55 (67.0%); first heart surgery 72 (87.8%) and the use of ECC 69 (84.1%). We noticed high mean values for expectations and perceptions with significant results (P<0.05). We observed a significant relationship between the quality of service with: gender, in empathy (P= 0.04) and age, in reliability (P = 0.02). There was no significant association between ECC and quality of service.CONCLUSION:Service quality was satisfactory. The patient demonstrated a high expectation to hospital medical service. Women present a higher perception of quality in empathy and younger people in reliability. The use of ECC is not related to service quality in this sample. The data obtained in this study suggest that the quality of this health service can be monitored through the periodical application of the SERVQUAL scale.
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