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.

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.

Comparação dos resultados iniciais entre cirurgias de revascularização do miocárdio com e sem circulação extracorpórea / Early clinical outcomes after on-pump versus off-pump coronary-artery bypass

Introdução: A cirurgia de revascularização do miocárdio (CRM) sem a parada cardíaca e sem o uso de circulação extracorpórea (CEC), pode reduzir o número de complicações relacionadas à técnica tradicionalmente executada, utilizando a CEC. Objetivo: Comparar os resultados iniciais em grupos de pacientes submetidos à cirurgia de revascularização do miocárdio com e sem circulação extracorpórea. Método: Estudo observacional transversal retrospectivo, com 183 pacientes submetidos à CRM com CEC e sem CEC, operados entre janeiro de 2009 e janeiro de 2013. As variáveis qualitativas foram descritas em frequências absolutas e relativas, enquanto as variáveis quantitativas, em médias e desvios-padrão. Os testes qui-quadrado ou prova exata de Fischer foram utilizados para testar a homogeneidade de proporções. Resultados: A idade média foi de 61,13 ± 8,45 anos no grupo com CEC e 61,41 ± 9,49 anos no grupo sem CEC. A maior parte dos procedimentos foi realizada em pacientes sexo masculino (64,44% e 74,19% nos grupos com CEC e sem CEC, respectivamente). Houve predomínio no grupo sem CEC na história de intervenção coronariana percutânea (p=0,029), uso prévio de antiagregantes (p=0,006) no grupo com CEC, e número de artérias acometidas com predomínio monoarterial no grupo sem CEC (p<0,001) e triarterial no grupo com CEC (p<0,001). Não houve diferença significativa entre os grupos no tempo de internação em UTI, internação hospitalar, complicações intra-hospitalares e número de óbitos. Conclusão: A cirurgia de revascularização sem CEC não demonstrou resultados superiores de morbi-mortalidade inicial em relação aos pacientes submetidos à cirurgia com CEC, indicando que ambas as técnicas são igualmente eficientes e seguras.

Coronary-artery bypass grafting (CABG) performed without cardiopulmonary bypass (off-pump CABG), might reduce the number of complications as compared with CABG performed with the use of cardiopulmonary bypass (on-pump CABG). Objective: To compare the early clinical outcomes in patients scheduled for elective CABG of either on-pump or off-pump procedures. Methods: We selected 183 patients in a observational transversal retrospective study, from January 2009 through to January 2013. Qualitative variables were described as absolute and relative frequencies, while quantitative variables as means and standard deviations. The chi-square or Fischer exact test were used to test the homogeneity of proportions. Results: The mean age was 61.13±8.45 years for on-pump group and 61.41±9.49 years for off-pump group. There was dominance for male patients (64.44% and 74.19% for on-pump and off-pump procedures, respectively). There was significant difference in previous percutaneous coronary intervention (p=0.029) in Control group, use of antiplatelet agent before surgery (p=0.006) on Case group and number of diseased vessels, one-vessel for Control group (p<0.001) and three-vessels for Case group (p<0.001). Conclusions: Coronary-artery bypass grafting performed without cardiopulmonary bypass did not show superior results of initial morbidity and mortality compared to patients undergoing cardiopulmonary bypass, indicating that both techniques are equally efficient and safe.

Trombocitopenia adquirida e cirurgia cardíaca: relato de caso / Acquired thrombocytopenia and cardiac surgery: case report

Trombocïtopenia é um grande problema hemostático em pacientes submetidos à cirurgia cardíaca. Relataremos dois casos de pacientes com diminuição adquirida das plaquetas: um devido a uremia e outro por disfunção valvar (disfunção de prótese em posição mitral). Estes pacientes tiveram períodos de transoperatório e pós-operatório imediato sem intercorrência. A perda sangüínea não foi maior do que a esperada. A transfusão de plaquetas realizada durante a operação pode prevenir futuras complicações na recuperação do paciente

Tratamento endovascular do aneurisma da aorta abdominal: estudo experimental / Handling to endovascular of the aneurism of aorta abdominal: experimental study

O objetivo deste estudo é avaliar a viabilidade e a eficácia do tratamento endovascular das aneurismas de aorta abdominal através de um modelo experimental em cäes. Foi realizado um estudo experimetal onde foram estudados 10 cäes sem raça definida, "portadores" de aneurisma de aorta abdominal construído cirúrgicamente com a implantaçäo de um remendo de Dacron. Após a criaçäo do aneurisma e realizaçäo de aortografia diagnóstica, todos os cäes foram submetidos ao tratamento endovascular mediante a implantaçäo de uma endoprótese autoexpansível reta...

Critérios e tempo ideal na cirurgia da valvopatia aórtica / Criteria and ideal time in aortic valve surgery

Antes de considerarmos os vários parâmetros que säo necessários para indicarmos uma correçäo cirúrgica de uma patologia cardiovascular é importante sabermos o que podemos esperar da mesma. Nas cirurgias valvares, a melhoria do padräo de vida dos operados ficou evidenciada na análise dos primeiros resultados e foi confirmada em todas as revisöes. Entretanto, essa substituiçäo por válvulas artificiais ocasionou o aparecimento de novos quadros clínicos, com os quais tivemos de aprender a lidar. Patologia esta com repercussäo hemodinâmica bem menor, mas mesmo assim uma patologia "iatrogênica" e repleta de novidades clínicas. Como até o momento, a média de durabilidade das próteses valvares oscila entre 8 e 10 anos, a cada momento novos avanços técnicos acrescentam inovaçöes na reconstruçäo das válvulas como nos desenhos das próteses artificiais e válvulas biológicas, com o aperfeiçoamento das já existentes, provendo para um futuro próximo senäo uma prótese ideal, ao menos um modelo aproximado. Essa constataçäo tem dificultado a definiçäo do tempo ideal para indicaçäo da cirurgia valvar