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Silva HVC, Lunardi AC, Pinto ACPN, de Macedo JRFF, dos Santos EDC. Is Incentive Spirometry Superior to Standard Care in Postoperative Cardiac Surgery on Clinical Outcomes and Length of Hospital and Intensive Care Unit Stay? A Systematic Review with Meta-Analysis. Braz J Cardiovasc Surg 2024; 39:e20220319. [PMID: 38629953 PMCID: PMC11020284 DOI: 10.21470/1678-9741-2022-0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/16/2023] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Cardiac surgery is a frequent surgical procedure and may present a high risk of complications. Among the prophylactic strategies studied to decrease the rates of negative outcomes, respiratory care seems to reduce pulmonary complications. Incentive spirometry (IS) is a low-cost, respiratory exercise technique, used for the prevention and treatment of postoperative pulmonary complications (PPC). The aim of this review was to evaluate whether IS is superior to respiratory care, mobilization exercises, and noninvasive ventilation on PPC, and clinical outcomes. METHODS Systematic review. Medical Literature Analysis and Retrieval System Online (or MEDLINE®), Embase®, Cochrane Central Register of Controlled Trials (or CENTRAL), Physiotherapy Evidence Database (or PEDro), Cumulative Index of Nursing and Allied Health (or CINAHL®), Latin American and Caribbean Health Sciences Literature (or LILACS), Scientific Electronic Library Online (or SciELO), Allied, Scopus®, and OpenGrey databases, clinical trial registration sites, conferences, congresses, and symposiums were searched. RESULTS Twenty-one randomized trials and one quasi-randomized trial (1,677 participants) were included. For partial pressure of oxygen (PaO2), IS was inferior to respiratory care (mean difference [MD] -4.48; 95% confidence interval [CI] -8.32 to -0.63). Flow-oriented IS was inferior to respiratory care on PaO2 (MD -4.53; 95% CI -8.88 to -0.18). However, compared to respiratory care, flow-oriented IS was superior on recovery vital capacity. CONCLUSIONS This meta-analysis revealed that IS was not superior to standard respiratory care for PPCs and clinical outcomes, therefore its use should not be widely recommended until further studies with high quality be performed to ensure this clinical guidance.
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Affiliation(s)
| | - Adriana Claudia Lunardi
- Programa de Pós-Graduação Stricto Sensu em
Fisioterapia, Universidade Cidade de São Paulo, São Paulo, São
Paulo, Brazil
- Department of Physical Therapy, Escola de Medicina, Universidade de
São Paulo, São Paulo, São Paulo, Brazil
| | - Ana Carolina Pereira Nunes Pinto
- Department of Biological and Health Sciences, Universidade Federal
do Amapá, Macapá, Amapá, Brazil
- Department of Physical Therapy, University of Pittsburgh,
Pennsylvania, United States of America
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Ramos RS, Rocco IS, Viceconte M, Santo JADE, Berwanger O, Santos RHN, Kalil RAK, Jatene FB, Cavalcanti AB, Zilli AC, Pimentel WDS, Hossne Junior NA, Branco JNR, Trimer R, Evora PRB, Gomes WJ, Guizilin S. Association Between Body Mass Index, Obesity, and Clinical Outcomes Following Coronary Artery Bypass Grafting in Brazil: An Analysis of One Year of Follow-up of BYPASS Registry Patients. Braz J Cardiovasc Surg 2024; 39:e20230133. [PMID: 38569010 PMCID: PMC10987126 DOI: 10.21470/1678-9741-2023-0133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/05/2024] Open
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 (χ=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.
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Affiliation(s)
- Rodrigo Santin Ramos
- Cardiology Postgraduate Program, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Isadora Salvador Rocco
- Cardiology Postgraduate Program, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Marcela Viceconte
- Cardiology Postgraduate Program, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Otavio Berwanger
- Instituto de Pesquisa - IP, Hospital do Coração -
HCor, São Paulo, São Paulo, Brazil
| | | | - Renato Abdala Karam Kalil
- Instituto de Cardiologia do Rio Grande do Sul,
Fundação Universitária de Cardiologia, Porto Alegre, Rio Grande
do Sul, Brazil
| | - Fabio B. Jatene
- Instituto de Pesquisa - IP, Hospital do Coração -
HCor, São Paulo, São Paulo, Brazil
- Cardiovascular Surgery Division, Instituto do Coração
- InCor, Hospital das Clínicas da Faculdade de Medicina da Universidade de
São Paulo - HCFMUSP, São Paulo, São Paulo, Brazil
| | | | - Alexandre Cabral Zilli
- Cardiology Postgraduate Program, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Walace de Souza Pimentel
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Nelson Américo Hossne Junior
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - João Nelson Rodrigues Branco
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Renata Trimer
- Department of Physical Therapy, Universidade Federal de São
Carlos, São Carlos, São Paulo, Brazil
| | - Paulo Roberto Barbora Evora
- Department of Surgery and Anatomy, Escola de Medicina de
Riberão Preto, Universidade de São Paulo, Ribeirão Preto,
São Paulo, Brazil
| | - Walter J. Gomes
- Cardiology Postgraduate Program, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Solange Guizilin
- Cardiology Postgraduate Program, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Cardiovascular Surgery Discipline, Escola Paulista de Medicina,
Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
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Polo-Gutierrez G, Silva-Tejada HA, Martinez-Ninanqui FW, Robles-Velarde V, Ríos-Ortega J. [Analysis of cardiac surgeries and operative mortality at the National Cardiovascular Institute during 2022]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:55-61. [PMID: 37780951 PMCID: PMC10538925 DOI: 10.47487/apcyccv.v4i2.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/17/2023] [Indexed: 10/03/2023]
Abstract
Objective To describe cardiac surgeries, their approaches, and determine operative mortality according to the type of surgery and the main complications recorded within 30 days postoperatively, performed at the National Cardiovascular Institute of Peru. Materials and methods A descriptive study was conducted on all patients over 18 years of age who underwent cardiovascular surgery at the National Cardiovascular Institute "Carlos Alberto Peschiera Carrillo". Results During the year 2022, a total of 503 cardiac surgeries were performed. Of the patients undergoing surgery, 63.6% (320) were males. Isolated valvular surgery, primarily aortic or mitral valve replacement, was the most frequent surgical procedure, with 136 surgeries (27.0%). This was followed by myocardial revascularization surgery with 110 procedures (21.9%). Throughout the year, there were 23 deaths, resulting in an overall mortality rate of 4.5%. The mortality rate for elective surgeries was 2.8%, while for emergency surgeries, it was 14.3%. The most common complication was paroxysmal atrial fibrillation (14.0%), followed by surgical site infection with 52 cases (10.3%). Conclusions Valvular surgery, whether isolated or combined with other procedures, was the most frequently performed. The obtained mortality rate is considered acceptable for a reference center.
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Affiliation(s)
- Gerber Polo-Gutierrez
- Instituto Nacional Cardiovascular. Lima, Perú Instituto Nacional Cardiovascular Lima Perú
| | | | | | - Victor Robles-Velarde
- Instituto Nacional Cardiovascular. Lima, Perú Instituto Nacional Cardiovascular Lima Perú
| | - Josías Ríos-Ortega
- Instituto Nacional Cardiovascular. Lima, Perú Instituto Nacional Cardiovascular Lima Perú
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The effect of the relationship between post-cardiotomy neutrophil/lymphocyte ratio and platelet counts on early major adverse events after isolated coronary artery bypass grafting. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:36-44. [PMID: 33768979 PMCID: PMC7970088 DOI: 10.5606/tgkdc.dergisi.2021.20873] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/23/2020] [Indexed: 11/24/2022]
Abstract
Background
In this study, we aimed to investigate the role of postcardiotomy neutrophil, lymphocyte, and platelet counts in predicting major adverse events after coronary artery bypass grafting.
Methods
A total of 373 patients (257 males, 116 females; median age 63, range 33 to 85 years) who underwent isolated coronary artery bypass grafting under cardiopulmonary bypass between January 2015 and January 2020 were retrospectively analyzed. The patients who did not develop any postoperative major adverse event were included in Group 1, while those who did constituted Group 2. Preoperative neutrophil-to-lymphocyte ratio, postcardiotomy neutrophil-to-lymphocyte ratio, postoperative Day 1 neutrophil-to-lymphocyte ratio, and neutrophil-to-lymphocyte x platelet ratio were calculated.
Results
Preoperative neutrophil counts, C-reactive protein values, neutrophilto- lymphocyte ratio, total perfusion time, and length of intensive care unit and hospital stay were significantly higher in Group 2 (p=0.019, p=0.028, p<0.001, p=0.027, p<0.001, and p<0.001, respectively). Post-cardiotomy neutrophil, neutrophil-to-lymphocyte ratio, and neutrophil-to-lymphocyte x platelet ratio, along with the postoperative first day white blood cell count, neutrophil, C-reactive protein, neutrophil-to-lymphocyte ratio, and neutrophil-to-lymphocyte x platelet ratio were significantly higher in Group 2 (p=0.004, p<0.001, p<0.001, p=0.019, p=0.003, p=0.001, p<0.001, and p=0.041, respectively). The post-cardiotomy platelet and lymphocyte counts and postoperative first day lymphocyte counts were significantly lower in Group 2 (p<0.001, p=0.007, and p=0.009, respectively).
Conclusion
Post-cardiotomy neutrophil-to-lymphocyte ratio and neutrophilto- lymphocyte x platelet ratio can be easily accessible, inexpensive complete blood count parameters and may be more valuable in predicting major adverse events in patients undergoing coronary artery bypass grafting.
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Chiorino CDRN, Santos VB, Lopes JDL, Lopes CT. Predictors of Hospital Readmission within 30 Days after Coronary Artery Bypass Grafting: Data Analysis of 2,272 Brazilian Patients. Braz J Cardiovasc Surg 2020; 35:884-890. [PMID: 33306313 PMCID: PMC7731841 DOI: 10.21470/1678-9741-2020-0266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction In order to reduce readmission rates after coronary artery bypass grafting (CABG), its predictors should be known in different contexts. The objective of this study was to identify predictive factors of hospital readmission within 30 days after CABG in a Brazilian center. Methods A secondary analysis of an electronic database of patients submitted to isolated CABG was performed. The relationship between readmission within 30 days and demographic, anthropometric, clinical, and surgery-related characteristics was investigated by univariate analyses. Predictors were identified by multiple logistic regression. Results Data from 2,272 patients were included, with an incidence of readmission of 8.6%. The predictors of readmission were brown skin color (Beta=1.613; 95% confidence interval [CI] 1.047-2.458; P=0.030), African-American ethnicity (Beta=0.136; 95% CI 0.019-0.988; P=0.049), chronic kidney disease (Beta=2.214; 95% CI 1.269-3.865; P=0.005), postoperative use of blood products (Beta=1.515; 95% CI 1.101-2.086; P=0.011), chronic obstructive pulmonary disease (Beta=2.095; 95% CI 1.284-3.419; P=0.003), and use of acetylsalicylic acid (Beta=1.418; 95% CI 1.000-2.011; P=0.05). Preoperative antibiotic prophylaxis (Beta=0.742; 95% CI 0.5471.007; P=0.055) was marginally significant. Conclusion The predictors identified may support a closer postoperative follow-up and individualized planning for a safe discharge.
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Affiliation(s)
- Camilla do Rosário Nicolino Chiorino
- Educação Corporativa da Associação Beneficência Portuguesa de São Paulo, São Paulo, Brazil.,Programa de Pós-Graduação em Enfermagem, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vinicius Batista Santos
- Departamento de Enfermagem Clínica e Cirúrgica, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Juliana de Lima Lopes
- Departamento de Enfermagem Clínica e Cirúrgica, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Camila Takao Lopes
- Programa de Pós-Graduação em Enfermagem, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil.,Departamento de Enfermagem Clínica e Cirúrgica, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil
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Zilli AC, Guizilini S, Rocco IS, Santo JADE, Berwanger O, Kalil RAK, Jatene FB, Cavalcanti AB, Santos RHN, Gomes WJ. Valve Heart Surgery in Brazil - The BYPASS Registry Analysis. Braz J Cardiovasc Surg 2020; 35:82-90. [PMID: 32270964 PMCID: PMC7089740 DOI: 10.21470/1678-9741-2019-0408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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.
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Affiliation(s)
- Alexandre Cabral Zilli
- Universidade Federal de São Paulo Escola Paulista de Medicina Hospital São Paulo São Paulo SP Brazil Discipline of Cardiovascular Surgery, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM-UNIFESP, São Paulo, SP, Brazil
| | - Solange Guizilini
- Universidade Federal de São Paulo Escola Paulista de Medicina Hospital São Paulo São Paulo SP Brazil Discipline of Cardiovascular Surgery, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM-UNIFESP, São Paulo, SP, Brazil
| | - Isadora S Rocco
- Universidade Federal de São Paulo Escola Paulista de Medicina Hospital São Paulo São Paulo SP Brazil Discipline of Cardiovascular Surgery, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM-UNIFESP, São Paulo, SP, Brazil
| | - José Amalth do Espírito Santo
- Instituto de Pesquisa do Hospital do Coração São Paulo SP Brazil Instituto de Pesquisa do Hospital do Coração - IP-HCor, São Paulo, SP, Brazil
| | - Otavio Berwanger
- Instituto de Pesquisa do Hospital do Coração São Paulo SP Brazil Instituto de Pesquisa do Hospital do Coração - IP-HCor, São Paulo, SP, Brazil
| | - Renato Abdala Karam Kalil
- Fundação Universitária de Cardiologia Instituto de Cardiologia do Rio Grande do Sul Porto Alegre RS Brazil Instituto de Cardiologia do Rio Grande do Sul, Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
| | - Fabio Biscegli Jatene
- Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - InCor-HCFMUSP, São Paulo, SP, Brazil
| | - Alexandre Biasi Cavalcanti
- Instituto de Pesquisa do Hospital do Coração São Paulo SP Brazil Instituto de Pesquisa do Hospital do Coração - IP-HCor, São Paulo, SP, Brazil
| | - Renato Hideo Nakagawa Santos
- Instituto de Pesquisa do Hospital do Coração São Paulo SP Brazil Instituto de Pesquisa do Hospital do Coração - IP-HCor, São Paulo, SP, Brazil
| | - Walter J Gomes
- Universidade Federal de São Paulo Escola Paulista de Medicina Hospital São Paulo São Paulo SP Brazil Discipline of Cardiovascular Surgery, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo - EPM-UNIFESP, São Paulo, SP, Brazil
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Paez RP, Hossne Junior NA, Santo JADE, Berwanger O, Santos RHN, Kalil RAK, Jatene FB, Cavalcanti AB, Zilli AC, Bettiati LC, Figueira FAMDS, D'Azevedo SSP, Soares MJF, Fernandes MP, Ardito RV, Bogdan RAB, Campagnucci VP, Nakasako D, Rodrigues CG, Rodrigues Junior AB, Cascudo MM, Atik FA, Lima EB, Nina VJDS, Heluy RA, Azeredo LG, Henrique Junior OS, Mendonça JTD, Silva KKDOG, Pandolfo M, Lima Júnior JDD, Faria RM, Santos JGD, Coelho GHB, Pereira SN, Senger R, Buffolo E, Caputi GM, Oliveira JABD, Gomes WJ. Coronary Artery Bypass Surgery in Brazil: Analysis of the National Reality Through the BYPASS Registry. Braz J Cardiovasc Surg 2019; 34:142-148. [PMID: 30916123 PMCID: PMC6436784 DOI: 10.21470/1678-9741-2018-0313] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/27/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction Coronary artery bypass grafting (CABG) is the most frequently performed heart
surgery in Brazil. Recent international guidelines recommend that national
societies establish a database on the practice and results of CABG. In
anticipation of the recommendation, the BYPASS Registry was introduced in
2015. Objective To analyze the profile, risk factors and outcomes of patients undergoing CABG
in Brazil, as well as to examine the predominant surgical strategy, based on
the data included in the BYPASS Registry. Methods A cross-sectional study of 2292 patients undergoing CABG surgery and
cataloged in the BYPASS Registry up to November 2018. Demographic data,
clinical presentation, operative variables, and postoperative hospital
outcomes were analyzed. Results Patients referred to CABG in Brazil are predominantly male (71%), with prior
myocardial infarction in 41.1% of cases, diabetes in 42.5%, and ejection
fraction lower than 40% in 9.7%. The Heart Team indicated surgery in 32.9%
of the cases. Most of the patients underwent cardiopulmonary bypass (87%),
and cardioplegia was the strategy of myocardial protection chosen in 95.2%
of the cases. The left internal thoracic artery was used as a graft in 91%
of the cases; the right internal thoracic artery, in 5.6%; and the radial
artery in 1.1%. The saphenous vein graft was used in 84.1% of the patients,
being the only graft employed in 7.7% of the patients. The median number of
coronary vessels treated was 3. Operative mortality was 2.8%, and the
incidence of cerebrovascular accident was 1.2%. Conclusion CABG data in Brazil provided by the BYPASS Registry analysis are
representative of our national reality and practice. This database
constitutes an important reference for indications and comparisons of
therapeutic procedures, as well as to propose subsequent models to improve
patient safety and the quality of surgical practice in the country.
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Affiliation(s)
- Rodrigo Pereira Paez
- Hospital São Paulo, Escola Paulista de Medicina da Universidade Federal de São Paulo, (EPM - UNIFESP), São Paulo, SP, Brazil
| | - Nelson Américo Hossne Junior
- Hospital São Paulo, Escola Paulista de Medicina da Universidade Federal de São Paulo, (EPM - UNIFESP), São Paulo, SP, Brazil
| | | | - Otavio Berwanger
- Instituto de Pesquisa do Hospital do Coração (IP - HCor), São Paulo, SP, Brazil
| | | | - Renato Abdala Karam Kalil
- Instituto de Cardiologia do Rio Grande do Sul - Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
| | - Fabio B Jatene
- Cardiovascular Surgery Division, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil
| | | | | | | | | | | | | | | | - Roberto Vito Ardito
- Instituto de Moléstias Cardiovasculares (IMC), São José do Rio Preto, SP, Brazil
| | | | - Valquíria Pelisser Campagnucci
- Irmandade da Santa Casa de São Paulo (INCT-HPV/Faculdade de Ciências Médicas da Santa Casa de São Paulo), São Paulo, SP, Brazil
| | - Diana Nakasako
- Irmandade da Santa Casa de São Paulo (INCT-HPV/Faculdade de Ciências Médicas da Santa Casa de São Paulo), São Paulo, SP, Brazil
| | - Clarissa Garcia Rodrigues
- Instituto de Cardiologia do Rio Grande do Sul - Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Marcelo Pandolfo
- Instituto de Cirurgia Cardiovascular (ICCV)/Hospital Nossa Senhora da Salete, Cascavel, PR, Brazil
| | | | | | | | | | | | - Roberta Senger
- Hospital Universitário de Santa Maria, Santa Maria, RS, Brazil
| | - Enio Buffolo
- Hospital do Coração (HCor), São Paulo, SP, Brazil
| | | | | | - Walter J Gomes
- Hospital São Paulo, Escola Paulista de Medicina da Universidade Federal de São Paulo, (EPM - UNIFESP), São Paulo, SP, Brazil
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Valdigem BP, Moreira DAR, Andalaft RB, Santana MVT, Sierra-Reyes CA, Mizzacci C. Successful Treatment of Ventricular Arrhythmia in Tetralogy of Fallot Repair Using Catheter Ablation. Braz J Cardiovasc Surg 2018; 33:418-423. [PMID: 30184040 PMCID: PMC6122762 DOI: 10.21470/1678-9741-2017-0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 02/03/2018] [Indexed: 11/04/2022] Open
Abstract
Tetralogy of Fallot (ToF) is one of the most prevalent congenital heart disease. Its surgical corrections may haemodinamically correct a disease, but the incisions may create scars that will originate ventricular arrhythmias. Even though life threatening arrhythmias are not common, some patients present unstable ventricular tachycardia (VT) of ectopic ventricular beats triggering heart failure and symptoms. We describe the treatment of a 16-years-old woman with late ToF repair and drug refractory Implantable cardioverter defibrillator (ICD) shocks. The patient underwent successful ablation of VT using X-ray and anatomic landmarks without the use of electroanatomical mapping. We were able to reduce drugs after one month of ablation and improve quality of life and symptoms. In this paper we describe the indications and perform a brief review of the key points for successful radiofrequency catheter ablation of VT in ToF patients.
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