Comparison of two technics of cardiopulmonary bypass (conventional and mini CPB) in the trans-and postoperative periods of cardiac surgery / Comparação de duas técnicas de circulação extracorpórea (convencional e mini CEC), nos períodos trans e pós-operatório de cirurgia cardíaca

AbstractObjective:This study aimed to compare the effects of two different perfusion techniques: conventional cardiopulmonary bypass and miniature cardiopulmonary bypass in patients undergoing cardiac surgery at the University Hospital of Santa Maria - RS.Methods:We perform a retrospective, cross-sectional study, based on data collected from the patients operated between 2010 and 2013. We analyzed the records of 242 patients divided into two groups: Group I: 149 patients undergoing cardiopulmonary bypass and Group II - 93 patients undergoing the miniature cardiopulmonary bypass.Results:The clinical profile of patients in the preoperative period was similar in the cardiopulmonary bypass and miniature cardiopulmonary bypass groups without significant differences, except in age, which was greater in the miniature cardiopulmonary bypass group. The perioperative data were significant of blood collected for autotransfusion, which were higher in the group with miniature cardiopulmonary bypass than the cardiopulmonary bypass and in transfusion of packed red blood cells, which was higher in cardiopulmonary bypass than in miniature cardiopulmonary bypass. In the immediate, first and second postoperative period the values of hematocrit and hemoglobin were higher and significant in miniature cardiopulmonary bypass than in the cardiopulmonary bypass, although the bleeding in the first and second postoperative days was higher and significant in miniature cardiopulmonary bypass than in the cardiopulmonary bypass.Conclusion:The present results suggest that the miniature cardiopulmonary bypass was beneficial in reducing the red blood cell transfusion during surgery and showed slight but significant increase in hematocrit and hemoglobin in the postoperative period.

ResumoObjetivo:Este estudo teve como objetivo comparar os efeitos de duas técnicas de perfusão diferentes: convencional (CEC) e mini (MCEC) em pacientes submetidos à cirurgia cardíaca no Hospital Universitário de Santa Maria - RS.Métodos:Foi realizado um estudo retrospectivo, transversal, baseado em dados coletados dos pacientes operados entre 2010 e 2013. Foram analisados ​​os registros de 242 pacientes divididos em dois grupos: Grupo I - 149 pacientes submetidos à circulação extracorpórea e Grupo II - 93 pacientes submetidos à minicirculação extracorpórea.Resultados:O perfil clínico dos pacientes no pré-operatório foi semelhante nos grupos circulação extracorpórea e minicirculação extracorpórea sem diferenças significativas, exceto na idade, maior no grupo minicirculação extracorpórea. Os dados perioperatórios foram significativos de sangue coletadas para autotransfusão, que foram maiores no grupo com minicirculação extracorpórea do que a circulação extracorpórea e na transfusão de concentrado de hemácias, superior em circulação extracorpórea do que em minicirculação extracorpórea. Nos valores pós-operatório imediato, primeiro e segundo, os níveis de hematócrito e da hemoglobina foram maiores e significativos na minicirculação extracorpórea que no circulação extracorpórea, embora o sangramento no primeiro e segundo dias pós-operatórios tenha sido maior e significativo no minicirculação extracorpórea que no circulação extracorpórea.Conclusão:Os resultados sugerem que a minicirculação extracorpórea foi benéfica em reduzir a transfusão de células vermelhas do sangue durante a cirurgia e houve discreta, mas significativa, elevação do hematócrito e hemoglobina no pós-operatório.

Comparison of two technics of cardiopulmonary bypass (conventional and mini CPB) in the trans-and postoperative periods of cardiac surgery.

OBJECTIVE: This study aimed to compare the effects of two different perfusion techniques: conventional cardiopulmonary bypass and miniature cardiopulmonary bypass in patients undergoing cardiac surgery at the University Hospital of Santa Maria--RS. METHODS: We perform a retrospective, cross-sectional study, based on data collected from the patients operated between 2010 and 2013. We analyzed the records of 242 patients divided into two groups: Group I: 149 patients undergoing cardiopulmonary bypass and Group II - 93 patients undergoing the miniature cardiopulmonary bypass. RESULTS: The clinical profile of patients in the preoperative period was similar in the cardiopulmonary bypass and miniature cardiopulmonary bypass groups without significant differences, except in age, which was greater in the miniature cardiopulmonary bypass group. The perioperative data were significant of blood collected for autotransfusion, which were higher in the group with miniature cardiopulmonary bypass than the cardiopulmonary bypass and in transfusion of packed red blood cells, which was higher in cardiopulmonary bypass than in miniature cardiopulmonary bypass. In the immediate, first and second postoperative period the values of hematocrit and hemoglobin were higher and significant in miniature cardiopulmonary bypass than in the cardiopulmonary bypass, although the bleeding in the first and second postoperative days was higher and significant in miniature cardiopulmonary bypass than in the cardiopulmonary bypass. CONCLUSION: The present results suggest that the miniature cardiopulmonary bypass was beneficial in reducing the red blood cell transfusion during surgery and showed slight but significant increase in hematocrit and hemoglobin in the postoperative period.

Impact of autologous blood transfusion on the use of pack of red blood cells in coronary artery bypass grafting surgery.

OBJECTIVE: To evaluate the impact of Cell Saver autologous blood transfusion system (CS) on the use of packed red blood cells (pRBC) in coronary artery bypass grafting (CABG) surgery. METHODS: We carried out a retrospective cross-sectional study in 87 patients undergoing primary elective CABG with miniaturized cardiopulmonary bypass (miniCPB), divided in two groups: 44 without-CS and 43 with-CS. We investigated the necessity of absolute use and the volume of packed red blood cells (pRBC) in each group, as well as cardiovascular risk factors, presurgical variables and intraoperative surgical parameters. All data were collected from medical records and there was no randomization or intervention on group selection. Statistical analysis was performed with Student t-test, Mann-Whitney U-test and χ² test, with a 5% significance level. RESULTS: There were no significant differences between the two groups in terms of cardiovascular risk factors and pre and intraoperative variables. Evaluating the absolute use of pRBC during surgery, there was a statistically significant difference (P=0.00008) between the groups without-CS (21/44 cases; 47.7%) and with-CS (4/43 cases; 9.3%). There was also a statistically significant difference (P=0.000117) in the volumes of pRBC between the groups without-CS (198.651258.65 ml) and with-CS (35.061125.67 ml). On the other hand, in the early postoperative period (up to 24h) there was no difference regarding either the absolute use or the volumes of pRBC between both studied groups. CONCLUSION: Autologous erythrocyte transfusion with CS use reduces the use of intraoperative homologous pRBC in coronary artery bypass grafting surgeries associated with miniCPB.

Impact of autologous blood transfusion on the use of pack of red blood cells in coronary artery bypass grafting surgery / Impacto da transfusão autóloga no uso de concentrado de hemácias em cirurgias de revascularização do miocárdio

OBJECTIVE: To evaluate the impact of Cell Saver autologous blood transfusion system (CS) on the use of packed red blood cells (pRBC) in coronary artery bypass grafting (CABG) surgery. METHODS: We carried out a retrospective cross-sectional study in 87 patients undergoing primary elective CABG with miniaturized cardiopulmonary bypass (miniCPB), divided in two groups: 44 without-CS and 43 with-CS. We investigated the necessity of absolute use and the volume of packed red blood cells (pRBC) in each group, as well as cardiovascular risk factors, presurgical variables and intraoperative surgical parameters. All data were collected from medical records and there was no randomization or intervention on group selection. Statistical analysis was performed with Student t-test, Mann-Whitney U-test and χ² test, with a 5% significance level. RESULTS: There were no significant differences between the two groups in terms of cardiovascular risk factors and pre and intraoperative variables. Evaluating the absolute use of pRBC during surgery, there was a statistically significant difference (P=0.00008) between the groups without-CS (21/44 cases; 47.7%) and with-CS (4/43 cases; 9.3%). There was also a statistically significant difference (P=0.000117) in the volumes of pRBC between the groups without-CS (198.651258.65ml) and with-CS (35.061125.67ml). On the other hand, in the early postoperative period (up to 24h) there was no difference regarding either the absolute use or the volumes of pRBC between both studied groups. CONCLUSION: Autologous erythrocyte transfusion with CS use reduces the use of intraoperative homologous pRBC in coronary artery bypass grafting surgeries associated with miniCPB.

OBJETIVO: Avaliar o impacto do sistema de autotransfusão com hemoconcentração (SAH) no uso de concentrado de hemácias (CH) em cirurgias de revascularização do miocárdio (CRM). MÉTODOS: Foi desenvolvido um estudo transversal, que incluiu 87 pacientes submetidos a CRM eletiva primária com miniCEC, sendo 44 sem uso do SAH e 43 pacientes com uso do SAH. Foi investigada a necessidade de uso e o volume de CH em cada grupo, bem como fatores de risco cardiovascular, variáveis pré-operatórias e parâmetros cirúrgicos transoperatórios por meio de coleta de dados em prontuários. Não houve randomização ou intervenção na seleção dos grupos. Na análise estatística foram utilizados os testes t de Student, teste U de Mann-Whitney, teste do qui-quadrado, com um nível de significância de 5%. RESULTADOS: Em relação a fatores de risco cardiovascular e variáveis pré e transoperatórias, não houve diferença estatística significativa entre os dois grupos. Quando se avaliou o uso absoluto de CH no transoperatório, houve diferença estatística significativa (P=0,00008) entre os grupos sem-SAH (21/44 casos; 47,7%) e com-SAH (4/43 casos; 9,3%). Na análise dos volumes de CH utilizado no transoperatório, também houve diferença significativa (P=0,000117) entre os volumes utilizados no grupo sem-SAH (198,651258,65 ml) e com-SAH (35,061125,67 ml). Já no pós-operatório imediato (até 24 horas), não houve diferença tanto no uso absoluto como nos volumes de CH entre os grupos que usaram ou não o SAH. CONCLUSÃO: A autotransfusão de hemácias possibilitada pelo uso do SAH determina menor uso de CH homólogo no transoperatório de CRM com uso de miniCEC.

Fasceíte necrotizante do tórax em pós-operatório de cirurgia cardíaca / Postoperative necrotizing fasciitis of the thorax in cardiac surgery

Necrotizing fasciitis is a rare soft tissue infection and a life-threatening emergency, often fatal. Its incidence and management are described plentifully in the medical literature regarding the most common anatomical sites involved like the abdomen, lower and upper limbs, and perineum. However, available data and case reports of chest wall necrotizing fasciitis after thoracic procedures are scarce, mainly after major cardiac operations. We report and discuss a case of necrotizing fasciitis of the chest wall occurring in the immediate postoperative period of a cardiac procedure, and include a brief review of the concepts, pathophysiology, and treatment reported in the medical literature. We emphasize the need for early diagnosis and urgent and effective surgical debridement. Of importance is the fact that we have not found any references in the literature to cases similar or equal to the one we describe here, which occurred in the postoperative period of a cardiac procedure

Ventriculectomia parcial esquerda: ponte para transplante? / Partial left ventriculectomy: bridge to transplantation?

OBJETIVO: Analisar os resultados e a viabilidade da ventriculectomia parcial esquerda (VPE) como ponte para transplante cardíaco (TX). DELINEAMENTO: Estudo de coorte histórica e prospectivo. CASUISTICA E MÉTODOS: Cinquenta e três pacientes (pts) foram submetidos a VPE em um período de 5 anos. Destes, 7 pts com contra-indicação inicial ao TX, idades variando de 37 a 64 anos, 5 homens e 2 mulheres, com miocardiopatia dilatada, foram subseqüentemente relistados e transplantados. Foram analisados a fração de ejeção (FE), o diâmetro diastólico final do ventrículo esquerdo (DDFVE), a CF da NYHA, o consumo máximo de oxigênio (VO2 máx) e os escores de qualidade de vida (QV) antes da VPE, aos 3 e 6 meses, e pré-transplante...

Três anos de ventriculectomia parcial esquerda: resultados globais e tardios em 41 pacientes / Three years of partial left ventriculectomy: overall and late results in 41 patients

Objetivos: Avaliar a indicação, sobrevida, qualidade de vida e arritmias após Ventriculectomia Parcial Esquerda (VPE) e relatar seu uso como ponte para transplante. Casuística e Métodos: Quarenta e um pacientes (pt) operados no período de dezembro de 1994 a dezembro de 1997,com idades de 32 a 70 anos, com miocardiopatia dilatada, classe funcional IV-92,6 por cento e III-7,3 por cento com contra-indicação para transplante e má qualidade de vida. Ecocardiogramas e estudos eletrofisiológicos (EEF) pré e pós-operatórios foram realizados. Clinicamente, agrupados pela NYHA e pelo Protocolo de Qualidade de Vida (QV). Resultados: Em 15 pacientes examinados aos 30 e 90 dias de pós-operatório por ecocardiograma obtivemos os dados da tabela abaixo: Sobrevida de 66 por cento, 53 por cento, 40 por cento e 36,6 por cento aos 3, 6, 12 e 24 meses, respectivamente. Aos 3 anos a mortalidade imediata e tardia é de 21,5 por cento e 42,1 por cento, com total de 63,6 por cento. Menor mortalidade relacionada a arritmia quando não se conseguiu induzí-la no pós-operatório. A qualidade de vida melhorou (72,7 por cento em NYHA I e II e 81,8 por cento em QV I e II) e dois foram transplantados posteriormente. Conclusões: Melhoraram a dinâmica cardíaca, a QV e a classe funcional (NYHA). O EEF identificou pacientes com maior risco de arritmias pós-operatórias. A sobrevida de 36 por cento em 3 anos é encorajadora, levando-se em conta a gravidade dos casos. A seleção de pacientes não tem ainda critérios inequívocos.