Adaptation And Use of the Papworth Haemostasis Checklist - Clinical Outcomes Analysis at Hospital Estadual Mário Covas.

INTRODUCTION: Postoperative bleeding is one of the main causes of complications in cardiovascular surgery, which highlights the importance of ensuring adequate intraoperative hemostasis, providing a better patient outcome. This study aimed to improve the prevention of postoperative bleeding in the Cardiovascular Surgery Department of the Hospital Estadual Mário Covas (Santo André, Brazil) using an adapted version of the Papworth Haemostasis Checklist to assess the impact of this standardization on bleeding rate, postoperative complications, reoperation, and mortality. METHODS: This is a non-randomized controlled clinical trial, whose non-probabilistic sample consisted of patients undergoing cardiac surgery in the abovementioned service within a two-year interval. The Papworth Haemostasis Checklist was adapted to the Brazilian laboratory parameters and the questions were translated into Portuguese. This checklist was used before the surgeon started the chest wall closure. Patients were followed up until 30 days after surgery. A P-value < 0.05 was considered statistically relevant. RESULTS: This study included 200 patients. After the checklist, a reduction in 24-hour drain output, postoperative complications, and reoperation was observed, although statistical significance was not reached. Finally, there was a significant reduction in the number of deaths (8 vs. 2; P=0.05). CONCLUSION: The use of the adapted checklist in our hospital proved to be an effective intervention to improve the prevention of postoperative bleeding, with a direct impact in the number of deaths in the study period. The reduction in deaths was possible thanks to the reduction in the bleeding rate, postoperative complications, and reoperations for bleeding.

Adaptation And Use of the Papworth Haemostasis Checklist - Clinical Outcomes Analysis at Hospital Estadual Mário Covas

ABSTRACT Introduction: Postoperative bleeding is one of the main causes of complications in cardiovascular surgery, which highlights the importance of ensuring adequate intraoperative hemostasis, providing a better patient outcome. This study aimed to improve the prevention of postoperative bleeding in the Cardiovascular Surgery Department of the Hospital Estadual Mário Covas (Santo André, Brazil) using an adapted version of the Papworth Haemostasis Checklist to assess the impact of this standardization on bleeding rate, postoperative complications, reoperation, and mortality. Methods: This is a non-randomized controlled clinical trial, whose non-probabilistic sample consisted of patients undergoing cardiac surgery in the abovementioned service within a two-year interval. The Papworth Haemostasis Checklist was adapted to the Brazilian laboratory parameters and the questions were translated into Portuguese. This checklist was used before the surgeon started the chest wall closure. Patients were followed up until 30 days after surgery. A P-value < 0.05 was considered statistically relevant. Results: This study included 200 patients. After the checklist, a reduction in 24-hour drain output, postoperative complications, and reoperation was observed, although statistical significance was not reached. Finally, there was a significant reduction in the number of deaths (8 vs. 2; P=0.05). Conclusion: The use of the adapted checklist in our hospital proved to be an effective intervention to improve the prevention of postoperative bleeding, with a direct impact in the number of deaths in the study period. The reduction in deaths was possible thanks to the reduction in the bleeding rate, postoperative complications, and reoperations for bleeding.

A randomized trial of the topical effect of antifibrinolytic epsilon aminocaproic Acid on coronary artery bypass surgery without cardiopulmonary bypass.

We assessed the effect of the topical application of epsilon-aminocaproic antifibrinolytic acid (EACA) on the pericardium of patients submitted to coronary artery bypass graft (CABG) without the use of cardiopulmonary bypass (CPB). This is a prospective, randomized, and double-blind study. We evaluated 26 patients with chronic coronary heart disease indicated for CABG without CPB (EACA and placebo groups). The analysis of the postoperative hematological results showed no difference between groups in hemoglobin and hematocrit. There was no difference between the groups regarding the postoperative bleeding through the drains in the first 24 hours, 48 hours, and accumulated loss until removal of drains. The use of EACA in patients undergoing CABG without CPB presented no difference in the reduction of the amount of bleeding and the need for blood transfusions.

Long-term cardiac changes in patients with systemic lupus erythematosus.

BACKGROUND: The aim of this study was evaluate the late-onset repercussions of heart alterations of patients with systemic lupus erythematosus (SLE) after a 13-year follow up. METHODS: A historical prospective study was carried out involving the analysis of data from the charts of patients with a confirmed diagnosis of lupus in follow up since 1998. The 13-year evolution was systematically reviewed and tabulated to facilitate the interpretation of the data. RESULTS: Forty-eight patient charts were analyzed. Mean patient age was 34.5 ± 10.8 years at the time of diagnosis and 41.0 ± 10.3 years at the time of the study (45 women and 3 men). Eight deaths occurred in the follow-up period (two due to heart problems). Among the alterations found on the complementary exams, 46.2% of cases demonstrated worsening at reevaluation and four patients required a heart catheterization. In these cases, coronary angioplasty was performed due to the severity of the obstructions and one case required a further catheterization, culminating in the need for surgical myocardial revascularization. CONCLUSION: The analysis demonstrated progressive heart impairment, with high rates of alterations on conventional complementary exams, including the need for angioplasty or revascularization surgery in four patients. These findings indicate the need for rigorous cardiac follow up in patients with systemic lupus erythematosus.

[Transhiatal esophagectomiy using partial sternotomy]. / Esofagectomia trans-hiatal com esternotomia parcial.

Transhiatal Esophagectomy offers the advantage of not requiring thoracotomy or thoracoscopy. Nevertheless, it has the disadvantage of having to be performed, at least in part, with blind, blunt dissection, with high frequency of pleural lesions, increased bleeding, among other complications. The association of median diaphragm transection with partial sternotomy allows the isolation of the esophagus completely under direct vision. The authors present the technique of transhiatal esophagectomy with partial sternotomy.

Adiponectin expression in epicardial adipose tissue after percutaneous coronary intervention with bare-metal stent.

BACKGROUND: The classical view of adipose tissue as a passive reservoir for energy storage is no longer valid. In the past decade, adipose tissue has been shown to have endocrine functions and the most abundant peptide secreted by adipocytes is adiponectin. Pericardial adipose tissue (PAT) is distributed around coronary arteries and endovascular injury, caused by the presence of intracoronary bare-metal stent (BMS), could promote inflammatory changes in the periadvential fat, contributing to vascular restenosis. OBJECTIVE: We sought to determine gene expression of inflammatory mediator in pericardial adipose tissue after bare-metal stent implantation and vascular restenosis that had been referred to operative treatment. METHODS: Paired samples of PAT were harvested at the time of elective coronary artery bypass surgery (CABG) in 11 patients (n = 22), one sample was obtained of the tissue around BMS area and another sample around coronary artery without stent. Local expression of adiponectin was determined by real-time polymerase chain reaction (RT-PCR) using Taq DNA polymerase. RESULTS: In two samples, there was no gene expression of adiponectin. We are able to identify adiponectin in 20 samples, however, the pattern of gene expression were heterogeneous.We did not notice specificity when we compared PAT obtained near BMS area or far from BMS area. CONCLUSION: There were no correlation between adiponectin gene expression and presence of BMS.

Comparison of uniatrial and biatrial radiofrequency ablation procedures in atrial fibrillation: initial results.

BACKGROUND: Atrial fibrillation (AF) is the most commonly sustained cardiac rhythm disturbance. Surgical ablation techniques were developed involving the left atrium only and modifications of the maze procedure in ablating both atria. OBJECTIVE: The aim of this study was to compare, in patients with permanent AF, the efficacy of uniatrial versus biatrial radiofrequency ablation procedure in the treatment of chronic atrial fibrillation in patients with associated cardiac disease. METHOD: Between September 2003 and May 2009, 30 patients were submitted to the radiofrequency ablation procedure for AF associated with concomitant cardiac surgery; 15 patients underwent a uniatrial procedure, and 15 patients underwent biatrial ablation. The mean age was 47.73 ± 9.85 years, and 53.4% were men. The average followup time was 12.16 ± 10.89 months for the uniatrial group and 7.0 ± 4.0 months for the biatrial group. RESULTS: Neither hospital mortality nor complications related to radiofrequency ablation were was registered. At the time of hospital discharge, 9 patients (60%) were in a state of sinus rhythm in both groups. However, patients undergoing biatrial ablation (range 73.3% versus 46.7%) demonstrated complete freedom from atrial fibrillation at all times. CONCLUSION: Biatrial ablation surgical procedures were more effective in controlling atrial fibrillation than procedures limited to the left atrium.

Expressão gênica de adiponectina no tecido adiposo epicárdico após intervenção coronária percutânea com implante de stent metálico / Adiponectin expression in epicardial adipose tissue after percutaneous coronary intervention with bare-metal stent

INTRODUÇÃO: A visão clássica de tecido adiposo como um reservatório passivo para o armazenamento de energia não é mais válido. Na última década, o tecido adiposo tem demonstrado funções endócrinas, sendo o peptídeo mais abundante secretado pelos adipócitos a adiponectina. O tecido adiposo epicárdico (TAE) é distribuído em torno das artérias coronárias e, a lesão endovascular causada pela presença de stent metálico intracoronário, poderia promover alterações inflamatórias na gordura periadventicial, contribuindo para reestenose. OBJETIVO: Determinar a expressão gênica de mediadores inflamatórios no tecido adiposo epicárdico após implante de stent metálico com reestenose que haviam sido encaminhados para tratamento cirúrgico. MÉTODOS: Amostras pareadas de TAE foram colhidas no momento da cirurgia de revascularização miocárdica (CRM) em 11 pacientes (n = 22), uma amostra foi obtida do tecido em torno da area com stent e outra amostra em torno da artéria coronária sem stent. Expressão local de adiponectina foi determinada por reação em cadeia de polymerase em tempo real utilizando Taq DNA polimerase. RESULTADOS: Em duas amostras, não houve expressão do gene da adiponectina. Fomos capazes de identificar adiponectina em 20 amostras, no entanto, o padrão de expressão gênica foi heterogêneo. Não percebemos especificidade quando comparamos TAE obtido próximo à área de stent ou distante da área de stent. CONCLUSÃO: Não houve correlação entre a expressão do gene de adiponectina e a presença de stent intracoronário.

BACKGROUND: The classical view of adipose tissue as a passive reservoir for energy storage is no longer valid. In the past decade, adipose tissue has been shown to have endocrine functions and the most abundant peptide secreted by adipocytes is adiponectin. Pericardial adipose tissue (PAT) is distributed around coronary arteries and endovascular injury, caused by the presence of intracoronary bare-metal stent (BMS), could promote inflammatory changes in the periadvential fat, contributing to vascular restenosis. OBJECTIVE: We sought to determine gene expression of inflammatory mediator in pericardial adipose tissue after bare-metal stent implantation and vascular restenosis that had been referred to operative treatment. METHODS: Paired samples of PAT were harvested at the time of elective coronary artery bypass surgery (CABG) in 11 patients (n=22), one sample was obtained of the tissue around BMS area and another sample around coronary artery without stent. Local expression of adiponectin was determined by real-time polymerase chain reaction (RT-PCR) using Taq DNA polymerase. RESULTS: In two samples, there was no gene expression of adiponectin. We are able to identify adiponectin in 20 samples, however, the pattern of gene expression were heterogeneous.We did not notice specificity when we compared PAT obtained near BMS area or far from BMS area. CONCLUSION: There were no correlation between adiponectin gene expression and presence of BMS.

Surgical biatrial ablation of atrial fibrillation: initial results.

OBJECTIVE: To evaluate the results of intraoperative radiofrequency ablation with biatrial procedure in the treatment of chronic atrial fibrillation in patients with associated cardiac disease. METHODS: Between February 2008 and May 2009, 15 consecutive patients were underwent mitral valve procedure plus modified radiofrequency biatrial ablation of chronic atrial fibrillation. The mean age was 47.73 +/- 9.85 years and 60% were male. The mean left atrial diameter was 55.06 +/- 7.56 mm. RESULTS: There were no hospital mortality or complications related to radiofrequency ablation. The mean follow-up period was 7 +/- 4 months. At the time of hospital discharge nine (60%) patients were in sinus rhythm. After a mean follow-up period 11 (73.3%) were in sinus rhythm. CONCLUSION: Intraoperative biatrial radiofrequency ablation is a safe and effective technique for the treatment of chronic atrial fibrillation, with satisfactory midterms outcomes in terms of conversion to sinus rhythm.

[Transdiaphragmatic intercostal hernia after spontaneous rib fractures secondary to coughing fit]. / Hérnia intercostal transdiafragmática após fratura espontânea de costelas secundária à crise de tosse.

One case of transdiafragmatic intercostal hernia after intense coughing fit followed by rib fractures in patient with history of pneumonia is presented. He had a severe coughing fit, developed a right toracoabdominal hematoma and then a tumor that was gradually enlarging. Image exams confirmed the diagnosis. Treatment consisted of surgical repair with the use of a polypropylene prosthetic mesh. It is a rare type of hernia. Only four cases were found in literature. The sooner the disease is diagnosed and treated the better the prognoses will be since it will prevent hernia from strangulation and incarceration.

Avaliação inicial da ablação operatória biatrial por radiofrequência de fibrilação atrial / Surgical biatrial ablation of atrial fibrillation: initial results

OBJETIVO: Apresentar o resultado inicial da ablação operatória de fibrilação atrial (FA) por radiofrequência irrigada, aplicada em ambos os átrios, para reversão e manutenção do ritmo sinusal, a curto e médio prazo, nos pacientes submetidos à operação cardíaca concomitante da valva mitral. MÉTODOS: Entre fevereiro de 2008 e maio de 2009, 15 pacientes consecutivos portadores de FA permanente foram submetidos à ablação intraoperatória da taquiarritmia por radiofrequência irrigada, aplicada de forma biatrial, com operação cardíaca concomitante (plastia ou troca valvar mitral). O grupo era constituído de nove (60 por cento) pacientes do sexo masculino, com idades variando de 25 a 59 anos (média de 47,73 ± 9,85 anos). O diâmetro do átrio esquerdo variou de 44 a 70 mm (média de 55,06 ± 7,56 mm). RESULTADOS: Não houve mortalidade hospitalar ou complicações relacionadas à radiofrequência. Na alta hospitalar, 9 (60 por cento) pacientes estavam em ritmo sinusal. No tempo médio de seguimento de 7 ± 4 meses, 11 (73,3 por cento) pacientes estavam em ritmo sinusal. CONCLUSÕES: A ablação operatória por radiofrequência irrigada da fibrilação atrial crônica, aplicada em ambos os átrios, é efetiva na reversão e manutenção do ritmo sinusal, no seguimento a curto e médio prazo. A inclusão de maior número de pacientes e a continuidade do seguimento pós-operatório são necessárias para confirmar a efetividade da técnica empregada.

OBJECTIVE: To evaluate the results of intraoperative radiofrequency ablation with biatrial procedure in the treatment of chronic atrial fibrillation in patients with associated cardiac disease. METHODS: Between February 2008 and May 2009, 15 consecutive patients were underwent mitral valve procedure plus modified radiofrequency biatrial ablation of chronic atrial fibrillation. The mean age was 47.73 ± 9.85 years and 60 percent were male. The mean left atrial diameter was 55.06 ± 7.56 mm. RESULTS: There were no hospital mortality or complications related to radiofrequency ablation. The mean follow-up period was 7 ± 4 months. At the time of hospital discharge nine (60 percent) patients were in sinus rhythm. After a mean follow-up period 11 (73.3 percent) were in sinus rhythm. CONCLUSION: Intraoperative biatrial radiofrequency ablation is a safe and effective technique for the treatment of chronic atrial fibrillation, with satisfactory midterms outcomes in terms of conversion to sinus rhythm.

Hérnia intercostal transdiafragmática após fratura espontânea de costelas secundária à crise de tosse / Transdiaphragmatic intercostal hernia after spontaneous rib fractures secondary to coughing fit

One case of transdiafragmatic intercostal hernia after intense coughing fit followed by rib fractures in patient with history of pneumonia is presented. He had a severe coughing fit, developed a right toracoabdominal hematoma and then a tumor that was gradually enlarging. Image exams confirmed the diagnosis. Treatment consisted of surgical repair with the use of a polypropylene prosthetic mesh. It is a rare type of hernia. Only four cases were found in literature. The sooner the disease is diagnosed and treated the better the prognoses will be since it will prevent hernia from strangulation and incarceration.

Topical use of antifibrinolytic agent to reduce postoperative bleeding after coronary artery bypass surgery.

OBJECTIVE: Antifibrinolytic agents reduce bleeding after cardiac surgery, but there are adverse effects after their systemic use. These effects are avoided by topical application of antifibrinolytic agents in pericardial cavity. We compared the effects of topically applied epsilon-aminocaproic acid (EACA) and placebo on postoperative bleeding and transfusion requirements after coronary artery bypass surgery. METHODS: In this single center prospective, randomized, double-blind trial, 53 patients were randomized into two groups to receive EACA (24 g in 250 ml of saline solution) or placebo (250 ml of saline solution) before sternal closure. Groups were comparable with respect to all preoperative and intraoperative variables. Postoperative bleeding, transfusion requirements and hematologic parameters were evaluated. RESULTS: Postoperative bleeding within first 24 hours (h) period (EACA group 154.66+/-74.64 x Placebo group 220.21+/-136.42 ml; P=0.031) showed statistically significant inter-group difference, within 48 h (EACA group 259.14+/-420.07 x Placebo group 141.67+/-142.58 ml; P=0.614), as well as cumulative blood loss (EACA group 832.07+/-576.86 x Placebo group 827.50+/-434.12 ml; P=0.975), not showed statistically inter-group differences. Inter-group difference of blood product requirements was statistically significant (EACA group 185.90+/-342.07 x Placebo group 439.42+/-349.07 ml; P=0.016). Laboratory analyses showed no differences between the two groups postoperative (hematologic characteristics: hemoglobin (g/dl)- EACA group 9.18+/-0.92 x Placebo group 8.85+/-1.48 g/dL; P=0.11; hematocrit (%)-EACA group 28.15+/-3.35 x Placebo group 26.67+/-4.15%; P=0.06). CONCLUSION: Topical use of epsilon aminocaproic acid reduces postoperative bleeding in the first 24 hours and requirements of blood transfusion after coronary artery bypass graft surgery.

Right coronary bypass grafting with coronary-coronary venous bypass graft.

OBJECTIVE: The following report describes the experience of the Cardiovascular Surgery Team of the ABC Medical School with coronary-coronary bypass grafting. METHODS: Four patients undergone off-pump coronary artery bypass grafting, with coronary-coronary bypass of the right coronary artery, by using great saphenous vein graft. RESULTS: The follow-up period was 3 to 5 years without any intra- or postoperative recurrence. One patient presented anginal symptoms four years after the surgery and underwent cinecoronariography that revealed patent anastomosis. CONCLUSION: The coronary-coronary bypass is a good option for patients undergone coronary artery bypass grafting.

Revascularização da artéria coronária direita com enxerto venoso coronária-coronária / Right coronary bypass grafting with coronary-coronary venous bypass graft

OBJETIVO: Descrever a experiência do Serviço de Cirurgia Cardiovascular da Faculdade de Medicina da Fundação do ABC com a revascularização do miocárdio com ponte coronária-coronária. MÉTODOS: Foram analisados quatro pacientes submetidos a operação com ponte coronária-coronária, todos sem circulação extracorpórea. Em todos os casos, foi realizada ponte coronária-coronária na artéria coronária direita exclusivamente, utilizando segmento da veia safena magna. RESULTADOS: Não houve nenhuma intercorrência intra ou pós-operatória. O tempo de seguimento variou de 3 a 5 anos. Apenas um dos pacientes apresentou angina após quatro anos da operação, sendo submetido a cinecoronariografia, que demonstrou ponte coronária-coronária livre de lesões. CONCLUSÃO: A ponte coronária-coronária constitui opção viável e satisfatória para pacientes submetidos à revascularização do miocárdio

OBJECTIVE: The following report describes the experience of the Cardiovascular Surgery Team of the ABC Medical School with coronary-coronary bypass grafting. METHODS: Four patients undergone off-pump coronary artery bypass grafting, with coronary-coronary bypass of the right coronary artery, by using great saphenous vein graft. RESULTS: The follow-up period was 3 to 5 years without any intra- or postoperative recurrence. One patient presented anginal symptoms four years after the surgery and underwent cinecoronariography that revealed patent anastomosis. CONCLUSION: The coronary-coronary bypass is a good option for patients undergone coronary artery bypass grafting

Uso tópico de agente antifibrinolítico na redução do sangramento após revascularização cirúrgica do miocárdio / Topical use of antifibrinolytic agent to reduce postoperative bleeding after coronary artery bypass surgery

OBJETIVO: Verificar o efeito do uso tópico do ácido epsilon-aminocapróico (AEAC), aplicado na cavidade pericárdica, na redução do sangramento e necessidade de transfusão sanguínea no pós-operatório de revascularização cirúrgica do miocárdio. MÉTODOS: Entre outubro de 2007 e outubro de 2008, 53 pacientes da mesma instituição foram alocados em um estudo prospectivo, randomizado e duplo-cego. Foram selecionados portadores de insuficiência coronariana crônica com indicação para revascularização cirúrgica do miocárdio. Os pacientes foram divididos em dois grupos: grupo AEAC e grupo Placebo, comparados de acordo com as características clínicas, demográficas e variáveis operatórias. Foram avaliados o volume de sangramento pelos drenos, a necessidade de transfusão e os níveis de hemoglobina e hematócrito de pós-operatório. RESULTADOS: O sangramento pós-operatório pelos drenos nas primeiras 24 horas (grupo AEAC 154,66±74,64 x grupo placebo 220,21±136,42 ml; P=0,031) foi menor no grupo AEAC, porém, em 48 horas (grupo AEAC 259,14±420,07 x grupo placebo 141,67±142,58 ml; P=0,197) e a perda acumulada até a retirada dos drenos (grupo AEAC 832,07±576,86 x grupo placebo 827,50±434,12 ml; P=0,975) não apresentou diferença estatística significante. Houve menor necessidade de transfusão no grupo AEAC, com diferença estatística significante (grupo AEAC 185,90±342,07 x grupo placebo 439,42±349,07 ml; P=0,016). Os valores de hemoglobina (grupo AEAC 9,18±0,92 x grupo placebo 8,85±1,48 g/dL; P=0,331) e hematócrito (grupo AEAC 28,15±3,35 x grupo placebo 26,67±4,15 por cento; P=0,162) não mostraram diferença estatística significante na comparação entre os grupos. CONCLUSÕES: O uso tópico do ácido epsilon-aminocapróico apresentou efeito favorável na redução do sangramento nas primeiras 24 horas de pós-operatório e na necessidade de transfusão sanguínea após revascularização cirúrgica do miocárdio. Trabalhos adicionais com maior número de pacientes serão necessários ...

OBJECTIVE: Antifibrinolytic agents reduce bleeding after cardiac surgery, but there are adverse effects after their systemic use. These effects are avoided by topical application of antifibrinolytic agents in pericardial cavity. We compared the effects of topically applied epsilon-aminocaproic acid (EACA) and placebo on postoperative bleeding and transfusion requirements after coronary artery bypass surgery. METHODS: In this single center prospective, randomized, double-blind trial, 53 patients were randomized into two groups to receive EACA (24 g in 250 ml of saline solution) or placebo (250 ml of saline solution) before sternal closure. Groups were comparable with respect to all preoperative and intraoperative variables. Postoperative bleeding, transfusion requirements and hematologic parameters were evaluated. RESULTS: Postoperative bleeding within first 24 hours (h) period (EACA group 154.66±74.64 x Placebo group 220.21±136.42 ml; P=0.031) showed statistically significant inter-group difference, within 48 h (EACA group 259.14±420.07 x Placebo group 141.67±142.58 ml; P=0.614), as well as cumulative blood loss (EACA group 832.07±576.86 x Placebo group 827.50±434.12 ml; P=0.975), not showed statistically inter-group differences. Inter-group difference of blood product requirements was statistically significant (EACA group 185.90±342.07 x Placebo group 439.42±349.07 ml; P=0.016). Laboratory analyses showed no differences between the two groups postoperative (hematologic characteristics: hemoglobin (g/dl)- EACA group 9.18±0.92 x Placebo group 8.85±1.48 g/dL; P=0.11; hematocrit ( percent)-EACA group 28.15±3.35 x Placebo group 26.67±4.15 percent; P=0.06). CONCLUSION: Topical use of epsilon aminocaproic acid reduces postoperative bleeding in the first 24 hours and requirements of blood transfusion after coronary artery bypass graft surgery

Effect of ventral cardiac denervation in the incidence of atrial fibrillation after coronary artery bypass graft surgery.

OBJECTIVE: To evaluate the effect of ventral cardiac denervation in the incidence of atrial fibrillation after coronary artery bypass surgery. METHODS: Between September and November, 50 patients without history or previous diagnosis of atrial arrhythmia from the same institution presenting coronary heart disease with indication for coronary artery graft bypass surgery were enrolled in a prospective and randomized study. The exclusion criteria were: patients older than 75 years of age, previous history of atrial arrhythmia and associated heart surgeries. Denervation was performed before cardiopulmonary bypass and it was achieved by removing the adipose tissues around the superior vena cava, aorta and pulmonary artery. The groups were compared regarding demographic, clinical and operative variables. RESULTS: There were no hospital mortalities. The additional time for the denervation was 7.64+/-2.33 minutes, and there were no associated complications. Postoperative atrial fibrillation was present in two (8%) patients of the Control Group and in three (12%) patients who underwent ventral cardiac denervation. The risk of postoperative atrial fibrillation in patients undergoing ventral cardiac denervation was 22% higher than in the Control Group (0.56-2.66,confidence interval); however, this outcome was not statistically significant (p=0.64). CONCLUSION: Ventral cardiac denervation, despite being a fast and low-risk procedure, does not significantly reduce the incidence of atrial fibrillation after coronary artery bypass graft surgery.

Operative treatment after iatrogenic left main dissection.

Coronary dissection has a significant morbidity and mortality. The ideal management of acute coronary occlusion is the prompt restoration of the vessel patency to limit the extent and duration of ischemia. In the setting of dissection during percutaneous procedure, the usual approach has been emergency aortocoronary bypass surgery. The authors present a case of a patient with left main dissection during percutaneous transluminal coronary angioplasty. This problem was successfully managed with emergent aortocoronary bypass surgery.

[Surgical ablation of atrial fibrillation using radiofrequency]. / Ablação operatória da fibrilação atrial por radiofreqüência.

OBJECTIVE: To evaluate the effectiveness of intraoperative atrial fibrillation ablation using radiofrequency during mitral valve procedure. This report describes the early and midterms results. METHODS: Between September 2003 and September 2005, 15 patients with mitral disease were operated. All patients were in chronic atrial fibrillation and with congestive symptoms despite full medication. The patients were analysed according to clinical criteria, electrical and echocardiographic findings. RESULTS: There were no hospital mortality or complications related to radiofrequency ablation. The mean follow-up period was 12.16 +/- 10.29 months. All patients left operating room in sinus rhythm, however, before hospital discharge, only nine (60%) were in regular cardiac rhythm. During follow-up, two patients presented atrial fibrillation recurrence and currently seven (46.7%) keep sinus rhythm. CONCLUSION: Despite low morbimortality related to the procedure, initial results in this report showed a less effectiveness of this technique when compared with other papers.

Efeito da denervação cardíaca ventral na incidência de fibrilação atrial após revascularização cirúrgica do miocárdio / Effect of ventral cardiac denervation in the incidence of atrial fibrilation after coronary artery bypass graft surgery

OBJETIVO: Verificar o efeito da denervação cardíaca ventral na incidência de fibrilação atrial no pós-operatório de revascularização cirúrgica do miocárdio. MÉTODOS: Entre setembro e novembro de 2005, 50 pacientes consecutivos da mesma instituição foram alocados neste estudo prospectivo e randomizado. Foram selecionados pacientes portadores de insuficiência coronariana com indicação de revascularização cirúrgica do miocárdio, sem história ou diagnóstico prévio de arritmia atrial. Os critérios de exclusão foram: idade acima de 75 anos, história prévia de arritmia atrial e operações cardíacas associadas. A denervação era realizada antes do início da circulação extracorpórea pela remoção do tecido gorduroso ao redor da veia cava superior, aorta e artéria pulmonar. Os grupos foram comparados de acordo com as características clínicas, demográficas e variáveis operatórias. RESULTADOS: Não houve mortalidade hospitalar em ambos os grupos. O tempo médio adicional para realização da denervação foi de 7,64 + 2,33 minutos e não houve complicações associadas ao procedimento. Cinco pacientes apresentaram fibrilação atrial no pós-operatório, sendo dois (8 por cento) no grupo controle e três (12 por cento) no grupo denervação. O risco dos pacientes do grupo denervação apresentarem fibrilação atrial foi 22 por cento maior do que no grupo controle (intervalo de confiança, 0,56-2,66), porém, este resultado não foi estatisticamente significativo (p=0,64). CONCLUSÕES: A denervação cardíaca ventral, apesar de rápida execução e de baixo risco, não apresentou efeito na redução da incidência de fibrilação atrial no pós-operatório de revascularização cirúrgica do miocárdio.

OBJECTIVE: To evaluate the effect of ventral cardiac denervation in the incidence of atrial fibrillation after coronary artery bypass surgery. METHODS: Between September and November, 50 patients without history or previous diagnosis of atrial arrhythmia from the same institution presenting coronary heart disease with indication for coronary artery graft bypass surgery were enrolled in a prospective and randomized study. The exclusion criteria were: patients older than 75 years of age, previous history of atrial arrhythmia and associated heart surgeries. Denervation was performed before cardiopulmonary bypass and it was achieved by removing the adipose tissues around the superior vena cava, aorta and pulmonary artery. The groups were compared regarding demographic, clinical and operative variables. RESULTS: There were no hospital mortalities. The additional time for the denervation was 7.64±2.33 minutes, and there were no associated complications. Postoperative atrial fibrillation was present in two (8 percent) patients of the Control Group and in three (12 percent) patients who underwent ventral cardiac denervation. The risk of postoperative atrial fibrillation in patients undergoing ventral cardiac denervation was 22 percent higher than in the Control Group (0.56-2.66,confidence interval); however, this outcome was not statistically significant (p=0.64). CONCLUSION: Ventral cardiac denervation, despite being a fast and low-risk procedure, does not significantly reduce the incidence of atrial fibrillation after coronary artery bypass graft surgery.