Endothelial Microparticles: Markers of Inflammatory Response After Sutureless Valve Implantation

ABSTRACT Introduction: Systemic inflammatory response syndrome (SIRS) is related to increased circulating endothelial microparticles (EMP). Objective: The aim of this study was to compare the plasma concentration of EMP between patients undergoing aortic valve replacement with conventional bioprosthesis implantation and Perceval™ S (LivaNova) and to evaluate its impact on the inflammatory response in the short-term follow-up. Methods: This is a randomized clinical trial with 24 patients submitted to isolated aortic valve replacement divided into two groups: Perceval™ S (Group P) and conventional bioprostheses (Group C). Incidence of severe SIRS (three or more criteria) in the first 48 hours postoperatively, EMP release profile, interleukins (IL) 6 and 8, C-reactive protein, and procalcitonin were analyzed preand postoperatively at 24 hours and three months. Results: There were 24 patients (12 in each group), mean age was 69.92±5.17 years, 83.33% were female, the incidence of severe SIRS was 66.7% and 50% in groups C and P, respectively (P=0.68), and EMP showed a significant increase in the 24-hour postoperative period (P≤0.001) and subsequent decrease in the three-month postoperative period (P≤0.001), returning to baseline levels. For IL-6 and IL-8, there was a greater increase in group C at 24 hours postoperatively (P=.0.02 and P<0.001). Conclusion: The incidence of severe SIRS was similar in both groups, with significantly higher levels of IL-6 and IL-8, at the 24-hour postoperative period, in group C, however with higher levels of EMP in group P, and subsequent return to baseline levels at the three-month postoperative period in both groups.

Endothelial Microparticles: Markers of Inflammatory Response After Sutureless Valve Implantation.

INTRODUCTION: Systemic inflammatory response syndrome (SIRS) is related to increased circulating endothelial microparticles (EMP). OBJECTIVE: The aim of this study was to compare the plasma concentration of EMP between patients undergoing aortic valve replacement with conventional bioprosthesis implantation and Perceval™ S (LivaNova) and to evaluate its impact on the inflammatory response in the short-term follow-up. METHODS: This is a randomized clinical trial with 24 patients submitted to isolated aortic valve replacement divided into two groups: Perceval™ S (Group P) and conventional bioprostheses (Group C). Incidence of severe SIRS (three or more criteria) in the first 48 hours postoperatively, EMP release profile, interleukins (IL) 6 and 8, C-reactive protein, and procalcitonin were analyzed preand postoperatively at 24 hours and three months. RESULTS: There were 24 patients (12 in each group), mean age was 69.92±5.17 years, 83.33% were female, the incidence of severe SIRS was 66.7% and 50% in groups C and P, respectively (P=0.68), and EMP showed a significant increase in the 24-hour postoperative period (P≤0.001) and subsequent decrease in the three-month postoperative period (P≤0.001), returning to baseline levels. For IL-6 and IL-8, there was a greater increase in group C at 24 hours postoperatively (P=.0.02 and P<0.001). CONCLUSION: The incidence of severe SIRS was similar in both groups, with significantly higher levels of IL-6 and IL-8, at the 24-hour postoperative period, in group C, however with higher levels of EMP in group P, and subsequent return to baseline levels at the three-month postoperative period in both groups.

Degenerative Aortic Stenosis in Women: Challenges and Perspectives

Abstract Degenerative aortic stenosis is currently a public health problem. Affecting the elderly population, this pathology has been showing an increasing prevalence as a direct result of the population aging. In this context, women have a greater life expectancy, corresponding to most of the population with degenerative aortic stenosis. Specific characteristics of this pathology in females are present in the diagnosis, pathophysiology, anatomical aspects, imaging and in therapeutic approach. Women present a more severe disease with less valve calcification than men, more concentric ventricular remodeling, higher transvalvular gradients, and less myocardial fibrosis. Less evident symptoms mean that these patients are referred later for surgical or percutaneous therapeutic treatment. The greater comorbidity presented by females and possibly due to the smaller body surface, bring specific aspects that affect the surgery results, leading to higher mortality rates and, more often, the prosthesis-patient mismatch. Percutaneous valve implantation is a good alternative, with better results in females, when compared to surgery, both in the treatment of native valves and in the treatment of a previously implanted bioprosthesis' dysfunction. The challenges encountered for the treatment of aortic stenosis in women and their possible solutions are described in this article, focusing on the observed difference of aortic stenosis in females and their possible solutions.

Mulheres Médicas: Burnout durante a Pandemia de COVID-19 no Brasil / Women Physicians: Burnout during the COVID-19 Pandemic in Brazil

Resumo Fundamento A COVID-19 adicionou um fardo enorme sobre os médicos ao redor do mundo, especialmente as mulheres médicas, que são afetadas pelo aumento da carga de trabalho e pela perda da qualidade de vida. Objetivo Avaliar os efeitos da pandemia de COVID-19 na qualidade de vida, burnout e espiritualidade de médicas brasileiras que atendem pacientes com COVID-19 direta ou indiretamente. Método Estudo prospectivo, observacional realizado de 28 de julho a 27 de setembro de 2020, no Brasil, com mulheres médicas de 47 especialidades, a mais frequente sendo a cardiologia (22,8%), sem restrição de idade. Elas responderam voluntariamente um questionário online com questões sobre características demográficas e socioeconômicas, qualidade de vida (WHOQOL-brief) e espiritualidade (WHOQOL-SRPB) e enunciados do Oldenburg Burnout Inventory. A análise estatística utilizou o software R, regressão beta, árvores de classificação e matriz de correlação policórica, com nível de significância de 5%. Resultados Das 769 respondentes, 61,6% relataram sinais de burnout. Cerca de 64% relataram perda salarial de até 50% durante a pandemia. Algumas relataram falta de energia para as tarefas diárias, sentimentos negativos frequentes, insatisfação com a capacidade para o trabalho, e que cuidar de outras pessoas não agregava sentido às suas vidas. Os sentimentos negativos correlacionaram-se negativamente com a satisfação com a vida sexual, a satisfação com as relações pessoais e a energia para as tarefas diárias. A incapacidade de permanecer otimista em tempos de incerteza correlacionou-se positivamente com a sensação de insegurança no dia a dia e com o não reconhecimento de que cuidar de outras pessoas trouxesse sentido à vida. Conclusão O presente estudo mostrou uma alta frequência de burnout entre as médicas brasileiras que responderam ao questionário durante a pandemia de COVID-19. Apesar disso, apresentavam uma qualidade de vida relativamente boa e acreditavam que a espiritualidade trazia-lhes conforto e segurança nos momentos difíceis.

Abstract Background COVID-19 has placed a tremendous burden on physicians worldwide, especially women physicians, affected by increased workload and loss of quality of life. Objective To assess the effects of the COVID-19 pandemic on the quality of life, burnout and spirituality of Brazilian women physicians directly or indirectly providing care to COVID-19 patients. Methods Prospective, observational study performed from July 28 to September 27, 2020, in Brazil, with women physicians from 47 specialities, the most frequent being cardiology (22.8%), with no age restriction. They voluntarily answered an online survey with questions on demographic and socioeconomic characteristics, quality of life (WHOQOL-brief), spirituality (WHOQOL-SRPB), and statements from the Oldenburg Burnout Inventory. Statistical analysis used the R software, beta regression, classification trees, and polychoric correlation matrix, with a 5% of significance level. Results Of the 769 respondents, 61.6% reported signs of burnout. About 64% reported wage loss of up to 50% during the pandemic. Some reported lack of energy for daily tasks, frequent negative feelings, dissatisfaction with capability for work, and caring for others not adding meaning to their lives. Negative feelings correlated negatively with satisfaction with sexual life and personal relations, and energy for daily tasks. The inability to remain optimistic in times of uncertainty correlated positively with feeling unsafe daily and not acknowledging that caring for others brings meaning to life. Conclusion This study showed a high frequency of burnout among Brazilian women physicians who answered the survey during the COVID-19 pandemic. Nevertheless, they presented with a relatively good quality of life and believed that spirituality comforted and reassured them in hard times.

Women Physicians: Burnout during the COVID-19 Pandemic in Brazil. / Mulheres Médicas: Burnout durante a Pandemia de COVID-19 no Brasil.

BACKGROUND: COVID-19 has placed a tremendous burden on physicians worldwide, especially women physicians, affected by increased workload and loss of quality of life. OBJECTIVE: To assess the effects of the COVID-19 pandemic on the quality of life, burnout and spirituality of Brazilian women physicians directly or indirectly providing care to COVID-19 patients. METHODS: Prospective, observational study performed from July 28 to September 27, 2020, in Brazil, with women physicians from 47 specialities, the most frequent being cardiology (22.8%), with no age restriction. They voluntarily answered an online survey with questions on demographic and socioeconomic characteristics, quality of life (WHOQOL-brief), spirituality (WHOQOL-SRPB), and statements from the Oldenburg Burnout Inventory. Statistical analysis used the R software, beta regression, classification trees, and polychoric correlation matrix, with a 5% of significance level. RESULTS: Of the 769 respondents, 61.6% reported signs of burnout. About 64% reported wage loss of up to 50% during the pandemic. Some reported lack of energy for daily tasks, frequent negative feelings, dissatisfaction with capability for work, and caring for others not adding meaning to their lives. Negative feelings correlated negatively with satisfaction with sexual life and personal relations, and energy for daily tasks. The inability to remain optimistic in times of uncertainty correlated positively with feeling unsafe daily and not acknowledging that caring for others brings meaning to life. CONCLUSION: This study showed a high frequency of burnout among Brazilian women physicians who answered the survey during the COVID-19 pandemic. Nevertheless, they presented with a relatively good quality of life and believed that spirituality comforted and reassured them in hard times.

FUNDAMENTO: A COVID-19 adicionou um fardo enorme sobre os médicos ao redor do mundo, especialmente as mulheres médicas, que são afetadas pelo aumento da carga de trabalho e pela perda da qualidade de vida. OBJETIVO: Avaliar os efeitos da pandemia de COVID-19 na qualidade de vida, burnout e espiritualidade de médicas brasileiras que atendem pacientes com COVID-19 direta ou indiretamente. MÉTODO: Estudo prospectivo, observacional realizado de 28 de julho a 27 de setembro de 2020, no Brasil, com mulheres médicas de 47 especialidades, a mais frequente sendo a cardiologia (22,8%), sem restrição de idade. Elas responderam voluntariamente um questionário online com questões sobre características demográficas e socioeconômicas, qualidade de vida (WHOQOL-brief) e espiritualidade (WHOQOL-SRPB) e enunciados do Oldenburg Burnout Inventory. A análise estatística utilizou o software R, regressão beta, árvores de classificação e matriz de correlação policórica, com nível de significância de 5%. RESULTADOS: Das 769 respondentes, 61,6% relataram sinais de burnout. Cerca de 64% relataram perda salarial de até 50% durante a pandemia. Algumas relataram falta de energia para as tarefas diárias, sentimentos negativos frequentes, insatisfação com a capacidade para o trabalho, e que cuidar de outras pessoas não agregava sentido às suas vidas. Os sentimentos negativos correlacionaram-se negativamente com a satisfação com a vida sexual, a satisfação com as relações pessoais e a energia para as tarefas diárias. A incapacidade de permanecer otimista em tempos de incerteza correlacionou-se positivamente com a sensação de insegurança no dia a dia e com o não reconhecimento de que cuidar de outras pessoas trouxesse sentido à vida. CONCLUSÃO: O presente estudo mostrou uma alta frequência de burnout entre as médicas brasileiras que responderam ao questionário durante a pandemia de COVID-19. Apesar disso, apresentavam uma qualidade de vida relativamente boa e acreditavam que a espiritualidade trazia-lhes conforto e segurança nos momentos difíceis.

Medical School, Cardiovascular Surgery, and Education: how we do it in Brazil's scenario?

Abstract Choosing a surgical specialty can be a hard decision for a medical student. Several studies present data showing that most medical students fear the surgical field and end up switching to another specialty. For cardiovascular surgery, the scenario is very similar. In the last decades, the interest in cardiovascular surgery has been decreasing worldwide and the cardiothoracic surgical societies across the globe have been trying to understand the factors that push away medical students and general surgical residents from the specialty. In this regard, our work aims to focus on describe the access of students to cardiovascular surgery, especially during medical school, as well as to provide a brief report of our current data regarding the specialty.

Hybrid Repair versus Conventional Open Repair Approaches for Aortic Arch Disease: a Comprehensive Review

Abstract Objective: To investigate whether hybrid repair has supremacy over conventional open repair in aortic arch diseases. Methods: A comprehensive search was undertaken in two major databases (PubMed and MEDLINE) to identify all studies comparing the two surgical techniques in five years, up to December 2018, that met the established criteria in this study. The search returned 310 papers, and 305 were selected after removing duplicates. The abstracts of the remaining articles were assessed, resulting in 15 studies that went to full-text analysis. After application of the inclusion and exclusion criteria, 8 papers remained for the final revision. Results: Eight studies met the criteria, with the inclusion of 1,837 patients. From a short-term perspective, hybrid repair and conventional open repair had similar outcomes in terms of postoperative mortality and acute neurological events. Hybrid repair was associated with less respiratory complications and risk of new intervention, as well as reduced hospital length of stay. Conventional open repair showed better mid- and long-term outcomes. Conclusion: Hybrid repair should be used in selected patients, with a high risk or very high-risk profile for conventional surgery. Finally, since most of the current data were obtained from limited to large samples, with narrow follow-up and had great heterogeneity, the best approach to the aortic arch is still variable. Therefore, the decision of the approach should be individualized and evaluated by the whole Heart Team, considering the expertise of the surgical team.

Tendências em cirurgia de revascularização miocárdica isolada ­ análise de 19 anos em centro de referência / Trends in isolated myocardial revascularization surgery - 19-year analysis in a reference center

INTRODUÇÃO: Com a evolução das técnicas operatórias, melhoria da terapêutica medicamentosa assim como da abordagem percutânea, o perfil de pacientes submetidos a cirurgia de revascularização miocárdica isolada (CRM) tem se modificado ao longo dos anos. A avaliação desta mudança pode resultar em compreensão dos atuais resultados de morbidade e mortalidade hospitalar. MÉTODOS: Estudo observacional, transversal e retrospectivo. Foram avaliados pacientes (p) submetidos à CRM entre 1999 e 2017 sendo divididos em três grupos temporais, 1999-2005 (3627p), 2006-2011 (3426 p) e 2012-2017 (2773p) a fim de comparar o perfil epidemiológico, evolução clínica e complicações associadas ao procedimento cirúrgico. RESULTADOS: No período analisado, 9826 p foram submetidos CRM; nos três períodos a idade média pouco se modificou, 62,1 vs 62,4 vs 62,8 anos (a), porém observou-se queda significativa no percentual de p jovens, idade < 50 a, 13,8% vs 11% vs 9,5%, e discreta diminuição de p acima de 70 a, 25,1% vs, 24,3% e 24,8% (p< 0,001) e diabetes melito, 36,6% vs 43,8% vs 47,9% (p < 0,001). Elevou-se o percentual de não tabagistas, 45% vs 47,3% vs 48,5% (p=0,004). Entre os vasos acometidos, houve diminuição importante no percentual de uniarteriais, 7,3% vs 5,3% e 3,1% e biarteriais, 22,9% vs 21,8% vs 18,1%, com aumento de triarteriais, 49,4% vs 51,4% vs 55,1%, assim como de lesões de tronco de coronária esquerda, 20,2% vs 21,4% vs 23%(p<0,001). Não houve aumento significativo no percentual de p com disfunção ventricular grave, 10,3% vs 10% vs 9,5%. O uso de enxertos com artéria torácica interna (ATI) esquerda foi crescente,86,8% vs 94,7% vs 96,2%, assim como a utilização de enxertos com ATI direita e esquerda, 4,3% vs 7,9% vs 9%, p<0,001. Entre as complicações pós operatórias observou-se diminuição da necessidade ventilação mecânica prolongada (> 48h), 4,9% vs 5,9% vs 3,8% (p<0,001). A mortalidade hospitalar foi 4,5% vs 5,6% vs 4,8% (p=0,07). CONCLUSÃO: Na presente análise foi possível observar aumento na gravidade do perfil dos pacientes submetidos a CRM, com maior número de pacientes hipertensos, diabéticos, triarteriais e com lesão de tronco de coronária. Enxertos com ATIE e dupla artéria torácica foram progressivamente mais utilizados. A taxa de mortalidade não se modificou significantemente no período analisado.

Impacto da pandemia por COVID-19 em centro de referência em cirurgia cardiovascular / Impact of the COVID-19 pandemic in a cardiovascular surgery referral center

INTRODUÇÃO: O primeiro caso de infecção causado pela COVID-19 foi primeiramente reportado em Wuhan, China, em meados de dezembro 2019. Desde então, a infecção tomou proporções globais, afetando mais de 200 países. A presença de doença cardiovascular é fator de risco frequentemente observado nos pacientes acometidos pela COVID-19 associado a altas taxas de mortalidade e morbidade. MÉTODOS: Trata-se de um estudo observacional, transversal, retrospectivo, a fim de avaliar o impacto no número de procedimentos cirúrgicos em centro de referência nacional em cirurgia cardiovascular. Foram comparados os números absolutos de cirurgia de revascularização miocárdica, troca ou plastia valvar, correção de aneurismas de aorta, transplante cardíaco e cirurgias para correção de patologias congênitas entre 2019 (Janeiro ­ Dezembro) e 2020 (Janeiro ­ Dezembro). RESULTADOS: Em 2019, foram realizados 1383 procedimentos, dentre os quais, 591 cirurgias de revascularização miocárdica isolada e associadas à aneurismectomia, correção de comunicação interventricular e troca valvar, 359 plastia ou trocas valvares múltiplas ou isoladas. Por outro lado, em 2020, foram realizados 966 procedimentos cirúrgicos, entre os quais, 414 coronarianos, 225 valvares, 241 congênitos, 75 correções de aneurisma ou dissecção de aorta e 11 transplantes cardíacos. Houve uma redução global de 30,1%, na análise exclusiva da cirurgia de revascularização miocárdica, a redução foi de aproximadamente 29,9%. CONCLUSÃO: Muitos questionamentos ainda permanecem no cenário pós-pandemia, a adaptação dos serviços cirúrgicos à abordagem destes pacientes assim como as complicações inerentes da infecção por COVID-19 em consonância àquelas da doença cardiovascular demandarão mais estudos a fim de esclarecer tantos pontos.

Medical School, Cardiovascular Surgery, and Education: how we do it in Brazil's scenario?

Choosing a surgical specialty can be a hard decision for a medical student. Several studies present data showing that most medical students fear the surgical field and end up switching to another specialty. For cardiovascular surgery, the scenario is very similar. In the last decades, the interest in cardiovascular surgery has been decreasing worldwide and the cardiothoracic surgical societies across the globe have been trying to understand the factors that push away medical students and general surgical residents from the specialty. In this regard, our work aims to focus on describe the access of students to cardiovascular surgery, especially during medical school, as well as to provide a brief report of our current data regarding the specialty.

Hybrid Repair versus Conventional Open Repair Approaches for Aortic Arch Disease: a Comprehensive Review.

OBJECTIVE: To investigate whether hybrid repair has supremacy over conventional open repair in aortic arch diseases. METHODS: A comprehensive search was undertaken in two major databases (PubMed and MEDLINE) to identify all studies comparing the two surgical techniques in five years, up to December 2018, that met the established criteria in this study. The search returned 310 papers, and 305 were selected after removing duplicates. The abstracts of the remaining articles were assessed, resulting in 15 studies that went to full-text analysis. After application of the inclusion and exclusion criteria, 8 papers remained for the final revision. RESULTS: Eight studies met the criteria, with the inclusion of 1,837 patients. From a short-term perspective, hybrid repair and conventional open repair had similar outcomes in terms of postoperative mortality and acute neurological events. Hybrid repair was associated with less respiratory complications and risk of new intervention, as well as reduced hospital length of stay. Conventional open repair showed better mid- and long-term outcomes. CONCLUSION: Hybrid repair should be used in selected patients, with a high risk or very high-risk profile for conventional surgery. Finally, since most of the current data were obtained from limited to large samples, with narrow follow-up and had great heterogeneity, the best approach to the aortic arch is still variable. Therefore, the decision of the approach should be individualized and evaluated by the whole Heart Team, considering the expertise of the surgical team.

Medical School, Cardiovascular Surgery, and Education: how we do it in Brazil's scenario?

Abstract: Choosing a surgical specialty can be a hard decision for a medical student. Several studies present data showing that most medical students fear the surgical field and end up switching to another specialty. For cardiovascular surgery, the scenario is very similar. In the last decades, the interest in cardiovascular surgery has been decreasing worldwide and the cardiothoracic surgical societies across the globe have been trying to understand the factors that push away medical students and general surgical residents from the specialty. In this regard, our work aims to focus on describe the access of students to cardiovascular surgery, especially during medical school, as well as to provide a brief report of our current data regarding the specialty. Keywords: Medical School. Students, Medical. Cardiac Surgery. Internship and Residency. Specialties, Surgical. Medicine.

REPLICCAR II Study: data quality audit in the paulista cardiovascular surgery registry

The quality of data in electronic healthcare databases is a critical component when used for research and health practice. The aim of the present study was to assess the data quality in the Paulista Cardiovascular Surgery Registry II (REPLICCAR II) using two different audit methods, direct and indirect. The REPLICCAR II database contains data from 9 hospitals in São Paulo State with over 700 variables for 2229 surgical patients. The data collection was performed in REDCap platform using trained data managers to abstract information. We directly audited a random sample (n = 107) of the data collected after 6 months and indirectly audited the entire sample after 1 year of data collection. The indirect audit was performed using the data management tools in REDCap platform. We computed a modified Aggregate Data Quality Score (ADQ) previously reported by Salati et al. (2015). The agreement between data elements was good for categorical data (Cohen κ = 0.7, 95%CI = 0.59-0.83). For continuous data, the intraclass coefficient (ICC) for only 2 out of 15 continuous variables had an ICC < 0.9. In the indirect audit, 77% of the selected variables (n = 23) had a good ADQ score for completeness and accuracy. Data entry in the REPLICCAR II database proved to be satisfactory and showed competence and reliable data for research in cardiovascular surgery in Brazil.

Benefits of Continuous Monitoring of PCO2 Obtained from a System Applied to Membrane Oxygenator Exhaustion of the Cardiopulmonary Bypass Circuit.

OBJECTIVE: To observe the impact of the use of capnography system adapted to cardiopulmonary bypass (CPB). To measure the concordance between values obtained from continuous monitoring of partial pressure of carbon dioxide in membrane oxygenator exhaustion (PeCO2) and the results observed on arterial blood gas test. METHODS: Participated in this study 40 patients submitted to elective cardiovascular surgery with CPB. They were divided into two groups: Group 1, with 20 patients submitted to the surgical procedure using blood gas analysis at intermittent intervals (20 - 30 minutes); Group 2, with 20 patients operated with a capnography system adapted applied to membrane oxygenator exhaustion and blood gas test. A test was used to compare arterial partial pressure of carbon dioxide (PaCO2) from group 1 and group 2. In group 2, the strength of the correlation between PeCO2 and PaCO2 was evaluated by a linear regression test. The Bland-Altman method was used to determine the degree of agreement between the two variables. RESULTS: Average and standard deviation of Group 1's PaCO2 (34.6 ± 7.44) and Group 2's PaCO2 / PeCO2 (36.5 ± 4.42) / (39.9 ± 3.98). There was no statistically significant difference in PaCO2 between the groups (P = 0.21). In group 2, PeCO2 and PaCO2 analyzed corrected for esophageal temperature obtained a positive linear correlation (r = 0.79, P < 0.001), the degree of agreement presented an average 3.47 ± 2.70 mmHg. CONCLUSION: The continuous PeCO2 monitoring from cardiopulmonary bypass circuit has a positive impact on the result of PaCO2. This instrument confirms and maintains the carbon dioxide (CO2) values into reference parameters.

Impacto na qualidade de vida da fibrilação atrial de início no pós-operatório em pacientes submetidos à cirurgia de revascularização miocárdica / Impact on quality of life of postoperative onset atrial fibrillation in patients undergoing myocardial revascularization surgery

INTRODUÇÃO: Trabalhos recentes evidenciaram que fibrilação atrial de início no pós-operatório (FAPO) de cirurgia cardíaca está associada a um aumento de complicações, tempo de internação, mortalidade e, dessa forma, podendo influenciar na qualidade de vida (QV). Objetivos: Identificar a ocorrência de FAPO e seu impacto na QV após cirurgia de revascularização miocárdica (CRM) isolada. MÉTODOS: Coorte observacional, com avaliação de um banco de dados de um centro terciário de cardiologia. Foram selecionados pacientes submetidos à CRM isolada durante o período de julho de 2016 a julho de 2017, divididos em dois grupos: com e sem FAPO. Foi avaliada a QV por meio do questionário Quality of Life in Cardiovascular Surgery (QLCS), desenvolvido e validado no Brasil, direcionado para pacientes submetidos à cirurgia cardiovascular e aplicado por telefone, possui 21 questões, sendo cinco sobre qualidade de vida que recebem uma pontuação de 1 a 5. A pontuação final da QV foi calculada com a soma de pontos dessas 5 questões, variando de 5 a 25 pontos, quanto maior o valor, melhor a QV (figura 1). As demais questões envolvem perguntas sobre medicamentos, sintomas, procedimentos e internações. A análise estatística foi realizada por meio do teste ANOVA não-paramétrico para medidas repetidas. RESULTADOS: Foram 418 pacientes submetidos à CRM, 341 (81,6%) sem FAPO e 77 (18,4%) com FAPO, homens representavam 69,8% (n=238) do grupo sem FAPO e 75,3% (n=58) do grupo com FAPO. Dentre esses, 346 responderam o questionário em todos os períodos avaliados, 283 (81,8%) no grupo sem FAPO e 63 (18,2%) com FAPO. A média de idade foi de 62,16 (±9,063) e 66,04 (±7,349) anos nos grupos sem e com FAPO, respectivamente. O questionário de QV foi aplicado 01 mês, 06 e 12 meses após a cirurgia. Houve aumento da pontuação do questionário em ambos os grupos ao longo do tempo, porém sem diferença estatística de QV entre os dois grupos, com p-valor 0,208 (figura 2). CONCLUSÃO: Apesar de FAPO está associada a um aumento de complicações, podendo influenciar na presença de sintomas e na QV, este estudo não evidenciou diferença na QV entre pacientes com e sem FAPO após CRM no acompanhamento de 01 ano. Palavras-chave: Fibrilação Atrial. Revascularização Miocárdica. Qualidade de Vida. (AU)

Benefits of continuous monitoring of PCO2 obtained from a system applied to membrane oxygenator exhaustion of the cardiopulmonary bypass circuit

OBJECTIVE: To observe the impact of the use of capnography system adapted to cardiopulmonary bypass (CPB). To measure the concordance between values obtained from continuous monitoring of partial pressure of carbon dioxide in membrane oxygenator exhaustion (PeCO2) and the results observed on arterial blood gas test. METHODS: Participated in this study 40 patients submitted to elective cardiovascular surgery with CPB. They were divided into two groups: Group 1, with 20 patients submitted to the surgical procedure using blood gas analysis at intermittent intervals (20 - 30 minutes); Group 2, with 20 patients operated with a capnography system adapted applied to membrane oxygenator exhaustion and blood gas test. A test was used to compare arterial partial pressure of carbon dioxide (PaCO2 ) from group 1 and group 2. In group 2, the strength of the correlation between PeCO2 and PaCO2 was evaluated by a linear regression test. The Bland-Altman method was used to determine the degree of agreement between the two variables. RESULTS: Average and standard deviation of Group 1's PaCO2 (34.6 ± 7.44) and Group 2's PaCO2 / PeCO2 (36.5 ± 4.42) / (39.9 ± 3.98). There was no statistically significant difference in PaCO2 between the groups (P = 0.21). In group 2, PeCO2 and PaCO2 analyzed corrected for esophageal temperature obtained a positive linear correlation (r = 0.79, P < 0.001), the degree of agreement presented an average 3.47 ± 2.70 mmHg. CONCLUSION: The continuous PeCO2 monitoring from cardiopulmonary bypass circuit has a positive impact on the result of PaCO2. This instrument confirms and maintains the carbon dioxide (CO2) values into reference parameters.

Sociedade brasileira de cardiologia a carta das mulheres / Brazilian society of cardiology the women's letter

O objetivo primordial desse documento é estimular a melhoria das condições de saúde das mulheres brasileiras, com foco na doença cardiovascular (DCV). A DCV é responsável por 17,5 milhões de mortes prematuras/ano no mundo, com previsão de aumento para 23 milhões em 2030. As DCV são responsáveis por um terço de todas as mortes no Brasil, com semelhança entre homens e mulheres após a menopausa. Esses dados revestem-se de maior importância quando consideramos que 80% das mortes prematura. (AU)