Triple valve surgery: long-term follow-up from a single centre.

AIMS: The aims of this study were to analyze early and late outcomes of TVS and identify predictors of short and long- term poor prognosis. METHODS: Single centre retrospective study with 130 patients who underwent TVS between 2007 and 2020. Most of the patients were female (72.3%), mean age of 64.4 years; 61.1% were in New York Heart Association class III/IV, with a EuroSCORE II of 7.5%. Univariable and Multivariable analyses were undertaken to identify predictors of perioperative mortality and morbidity and long-term mortality. RESULTS: In-hospital mortality was 10.8%, of which 7.6% were due to a cardiac cause. Diabetes Mellitus was an in- dependent predictor of increased perioperative mortality. This group had 27.7% rate of major perioperative complications. Elevated systolic pulmonary pressure and obesity were predictors of early morbidity. All-cause mortality was 43.1% for 14 years. The survival at 1, 5 and 10 years was 83%, 60% and 43%, respectively. Diabetes Mellitus was a risk factor for long-term mortality. CONCLUSIONS: Patients undergoing TVS have a high surgical risk making TVS an operation associated with high mor- tality and morbidity. This research suggests Diabetes Mellitus, pulmonary hypertension and obesity as risk factors for mortality in TVS.

LUNG RESECTION FOR NON-SMALL-CELL LUNG CANCER - A NEW RISK SCORE TO PREDICT MAJOR PERIOPERATIVE COMPLICATIONS.

OBJECTIVES: Identify risk factors for major perioperative complications (MPC) after anatomical lung resection for NonSmall-Cell Lung Cancer (NSCLC) and establish a scoring system. METHODS: Single center retrospective study of all consecutive patients diagnosed with NSCLC submitted to anatomical lung resection from 2015 to 2019 (N=564). EXCLUSION CRITERIA: previous lung surgery, concomitant non-lung cancer related procedures, urgency surgery. STUDY POPULATION: 520 patients. PRIMARY END-POINT: MPC defined as a composite endpoint including at least one of the in-hospital complications. Univariable and Multivariable analyses were developed to identify predictors of perioperative complications and create a risk score. Discrimination was assessed using the C-statistic. Calibration was evaluated by Hosmer and Lemeshow test and internal validation was obtained by means of bootstrap replication. RESULTS: Mean age of 65 years and 327 (62.9%) were males. Mean hospital stay of 9 days after surgery. Overall MPC rate was 23.3%. Male gender, hypertension, FEV1<75%, thoracotomy, bilobectomy/pneumectomy and additional resection were independent predictors of MPC. A risk score based on the odds ratios was developed - Major Perioperative Complications of Lung Resection (MPCLR) scoring system - and ranged between 0 and 14 points. It was divided in 5 groups: 1-2 points (positive preditive value 15%); 3-4 (PPV 25%); 5-7 (PPV 35%); 8-9 (PPV 60%); >10 points (PPV 88%). The score showed rea- sonable discrimination (C-statistic=0.70), good calibration (P=.643) and it was internally validated (C-statistic=0,70 BCa95% CI,0.65-0.79). CONCLUSIONS: This study proposes a simple and daily-life risk score system that was able to predict the incidence of perioperative complications.

Complete surgical revascularization: Different definitions, same impact?

BACKGROUND: There are several different definitions of complete revascularization on coronary surgery across the literature. Despite the importance of this definition, there is no agreement on which one has the most impact. The aim of this study was to evaluate which definition of complete surgical revascularization correlates with early and late outcomes. METHODS: All consecutive patients submitted to isolated CABG from 2012 to 2016 with previous myocardial scintigraphy were evaluated. EXCLUSION CRITERIA: emergent procedures and previous cardiac surgery procedures. The population of 162 patients, follow-up complete in 100% patients; median 5.5; IQR: 4.4-6.9 years. Each and all of the 162 patients were classified as complying or not with the four different definitions: numerical, functional, anatomical conditional, and anatomical unconditional. Perioperative outcome: MACCE; long-term outcomes: survival and repeat revascularization. Univariable and multivariable analyses were developed to detect predictors of outcomes. RESULTS: Complete functional revascularization was a predictor of increased survival (HR: 0.47; CI 95: 0.226-0.969; p = .041). No other definitions showed effect on follow-up mortality. Age and cardiac dysfunction increased long-term mortality. The definition of complete revascularization did not have an impact on MACCE or the need for revascularization CONCLUSIONS: A uniformly accepted definition of complete coronary revascularization is lacking. This study raises awareness about the importance of viability guidance for CABG.

POSTOPERATIVE ATRIAL FIBRILLATION - VIDEO-ASSISTED THORACOSCOPIC SURGERY VERSUS OPEN SURGERY.

OBJECTIVES: Compare the incidence of Postoperative atrial fibrillation (PAF) after anatomical lung resection for Non- Small-Cell Lung Cancer (NSCLC) following open surgery versus VATS. METHODS: Single center retrospective study of all consecutive patients diagnosed with NSCLC submitted to anatomical lung resection from 2015 to 2019 (N=564). EXCLUSION CRITERIA: prior atrial fibrillation, previous lung surgery, concomitant procedures, pneumectomy, non-pulmonary resections, urgency surgery. Study population of 439 patients. PRIMARY END-POINT: incidence of PAF. Univariable analysis was used to compare the baseline characteristics of the 2 groups. Inverse probability of treatment weighting (IPTW) multivariable logistic regression was used including 23 clinical variables to analyze the effect of the approach. The balance was assessed by standardized mean differences. RESULTS: Thoracotomy was performed in 280 patients (63.8%) and 159 (36.2%) were submitted to VATS. Patients submitted to VATS were more likely to be females, had a lower prevalence of non-adenocarcinoma cancer, stage TNM IIIIV, Diabetes Mellitus, respiratory disease, and chronic heart failure. They were submitted less often to neoadjuvant therapy, bilobectomy and they presented higher levels of diffusing capacity for carbon monoxide. After IPTW adjustment, all clinical covariates were well balanced. PAF occurred in 8.6% of the patients undergoing thoracotomy and 3,8% of the patients after VATS. After IPTW adjustment, VATS was not associated with a lower incidence of PAF (OR 0.40; CI95%:0.140-1.171; p=0.095). CONCLUSION: In this study, minimally invasive non-rib spreading VATS did not decrease the incidence of PAF when compared with standard thoracotomy regarding anatomical lung resection for NSCLC.