COVID-19 in the Perioperative Period of Cardiovascular Surgery: the Brazilian Experience.

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.

Benefits of Fasting Abbreviation with Carbohydrates and Omega-3 Infusion During CABG: a Double-Blind Controlled Randomized Trial.

OBJECTIVE: To assess postoperative clinical data considering the association of preoperative fasting with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA). METHODS: 57 patients undergoing coronary artery bypass grafting (CABG) were randomly assigned to receive 12.5% maltodextrin (200 mL, 2 h before anesthesia), (CHO, n=14); water (200 mL, 2 h before anesthesia), (control, n=14); 12.5% maltodextrin (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (CHO+W3, n=15); or water (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (W3, n=14). The need for vasoactive drugs was analyzed, in addition to postoperative inflammation and metabolic control. RESULTS: There were two deaths (3.5%). Patients in CHO groups presented a lower incidence of hospital infection (RR=0.29, 95% CI 0.09-0.94; P=0.023), needed fewer vasoactive drugs during surgery and ICU stay (P<0.05); and had better blood glucose levels in the first six hours of recovery (P=0.015), requiring less exogenous insulin (P=0.018). Incidence of postoperative atrial fibrillation (POAF) varied significantly among groups (P=0.009). Subjects who receive ω-3 PUFA groups had fewer occurrences of POAF (RR=4.83, 95% CI 1.56-15.02; P=0.001). Patients in the W3 group had lower ultrasensitive-CRP levels at 36 h postoperatively (P=0.008). Interleukin-10 levels varied among groups (P=0.013), with the highest levels observed in the postoperative of patients who received intraoperative infusion of ω-3 PUFA (P=0.049). CONCLUSION: Fasting abbreviation with carbohydrate loading and intraoperative infusion of ω-3 PUFA is safe and supports faster postoperative recovery in patients undergoing on-pump CABG.

COVID-19 in the perioperative period of cardiovascular surgery: the brazilian experience

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.

Benefits of fasting abbreviation with carbohydrates and omega-3 infusion during cabg: a double-blind controlled randomized trial

Abstract Objective: To assess postoperative clinical data considering the association of preoperative fasting with carbohydrate (CHO) loading and intraoperative infusion of omega-3 polyunsaturated fatty acids (ω-3 PUFA). Methods: 57 patients undergoing coronary artery bypass grafting (CABG) were randomly assigned to receive 12.5% maltodextrin (200 mL, 2 h before anesthesia), (CHO, n=14); water (200 mL, 2 h before anesthesia), (control, n=14); 12.5% maltodextrin (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (CHO+W3, n=15); or water (200 mL, 2 h before anesthesia) plus intraoperative infusion of ω-3 PUFA (0.2 g/kg), (W3, n=14). The need for vasoactive drugs was analyzed, in addition to postoperative inflammation and metabolic control. Results: There were two deaths (3.5%). Patients in CHO groups presented a lower incidence of hospital infection (RR=0.29, 95% CI 0.09-0.94; P=0.023), needed fewer vasoactive drugs during surgery and ICU stay (P<0.05); and had better blood glucose levels in the first six hours of recovery (P=0.015), requiring less exogenous insulin (P=0.018). Incidence of postoperative atrial fibrillation (POAF) varied significantly among groups (P=0.009). Subjects who receive ω-3 PUFA groups had fewer occurrences of POAF (RR=4.83, 95% CI 1.56-15.02; P=0.001). Patients in the W3 group had lower ultrasensitive-CRP levels at 36 h postoperatively (P=0.008). Interleukin-10 levels varied among groups (P=0.013), with the highest levels observed in the postoperative of patients who received intraoperative infusion of ω-3 PUFA (P=0.049). Conclusion: Fasting abbreviation with carbohydrate loading and intraoperative infusion of ω-3 PUFA is safe and supports faster postoperative recovery in patients undergoing on-pump CABG.

Tumores cardíacos malignos / Malignant cardiac tumours

Os tumores do sistema cardiovascular são afecções raras. Manifestam-se por sinais e sintomas inespecíficos, na maioria das vezes. O tratamento de alterações de ritmo cardíaco, das doenças que acarretam disfunção no sistema de condução Hiss-Purkinje e das síndromes que podem acometer o coração (isquêmica, particularmente) devem levar em consideração a possibilidade de neoplasias cardíacas. Os tumores do músculo cardíaco são os rabdomiossarcomas, que se desenvolvem com maior freqüência nas cavidades cardíacas esquerdas, principalmente no ventrículo esquerdo. Dentre os tumores endovasculares, o mais freqüente é o mixoma de átrio esquerdo e suas possíveis variantes. Os tumores metastáticos do coração, entre eles o melanoma maligno, são descritos com maior freqüência acometendo o ventrículo direito (parede anterior e septal, com invasão do ventrículo esquerdo), nas formas de doença não disseminada. O diagnóstico tardio implica em altas taxas de morbidade e mortalidade, associada ou não ao tratamento cirúrgico. Os autores descrevem caso de paciente com melanoma localizado no ventrículo direito, a abordagem diagnóstica e terapêutica realizada, comparando-as com os dados da literatura. A revisão da literatura é inconclusiva quanto ao tratamento de escolha dos tumores malignos do músculo cardíaco (primários ou metastáticos). Os autores sugerem a realização de estudos retrospectivos com metanálise na tentativa de estabelecer critérios diagnósticos e terapêuticos para os tumores malignos do coração, devido à pequena incidência desta doença.

Valor da oximetria de pulso na avaliaçäo da perfusäo da mäo para retirada da artéria radial. O teste de Allen é satisfatório? / The importance of pulse oxymetry in evaluation of hand's perfusion for harvesting the radial artery

Com o crescimento da utilizaçao da artéria radial como enxerto em operaçoes de revascularizaçao tornou-se importante a avaliaçao fidedigna da integridade da arcada palmar em cada paciente a fim de se prevenir complicaçoes vasculares da mao. Classicamente, utiliza-se para esta finalidade o teste de Allen, que é baseado em avaliaçao subjetiva da coloraçao da mao ao se comprimir os pulsos radial e ulnar e, portanto, mais sujeitos a erros de interpretaçao. Com a finalidade de avaliaçao objetiva, propusemos a realizaçao do teste, analisando-se a perfusao através da oximetria de pulso, método simples e facilmente disponível em centro cirúrgico. Objetivo: Os autores apresentam uma nova proposta para avaliaçao da perfusao e integridade da arcada palmar com a utilizaçao do oxímetro de pulso e comparam os dados obtidos por este método com os do teste de Allen. Método: Foram estudadas 50 artérias radiais, 50 artérias ulnares de 25 pacientes em decúbito dorsal, com idade igual ou superior a 45 anos, sendo 19 do sexo masculino e 6 do sexo feminino, em condiçoes cardio-respiratórias estáveis e sem alteraçoes vasculares periféricas conhecidas em membros superiores. O oxímetro utilizado foi o da marca Ohmeda, sendo o Doppler portátil de fluxo contínuo da Medical Eletronics. A principio colocou-se o dedal do oxímetro no dedo indicador de cada mao anotando-se a saturaçao que chamamos de inicial. Verificou-se ao Doppler os pulsos radial e ulnar. Foi realizado o teste de Allen em cada mao comprimindo-se digitalmente ambas as artérias, com o oxímetro no 2º dedo e observando-se o desaparecimento da onda de pulso. Após isso, descomprimiu-se a artéria ulnar retornando a onde de pulso e medindo-se a saturaçao final. Houve queda de 0 a 2 pontos, no valor da saturaçao, em 96 por cento dos casos. O Doppler foi utilizado distalmente à compressao da artéria radial mostrando nao haver fluxo nesta artéria. Resultado: O teste de Allen mostrou-se satisfatório em 35 (70 por cento) procedimentos; insatisfatórios em 15 (30 por cento); a oximetria resultou normal em 49 (98 por cento) procedimentos com queda importante de sua saturaçao em apenas 1 (2 por cento) caso, no qual o teste de Allen foi insatisfatório. Conclusoes: Observamos que houve diferença significativa entre resultados do teste de Allen e do oxímetro, levando-nos ao questionamento da validade do teste de Allen quanto à sua eficácia...