Pesquisa | SciELO

ABSTRACT Objective: To define a reference chart comparing pressure drop vs. flow generated by a set of arterial cannulae currently utilized in cardiopulmonary bypass conditions in pediatric surgery. Methods: Cannulae from two manufacturers were selected considering their design and outer and inner diameters. Cannula performance was evaluated in terms of pressure drop vs. flow during simulated cardiopulmonary bypass conditions. The experimental circuits consisted of a Jostra HL-20 roller pump, a Quadrox-i pediatric oxygenator (Maquet Cardiopulmonary AG, Rastatt, Germany), and a custom pediatric tubing set. The circuit was primed with lactated Ringer’s solution only (first condition) and with human packed red blood cells added (second condition) to achieve a hematocrit of 30%. Cannula sizes 8 to 16 Fr were inserted into the cardiopulmonary bypass circuit with a “Y” connector. The flow was adjusted in 100 ml/min increments within typical flow ranges for each cannula. Pre-cannula and post-cannula pressures were measured to calculate the pressure drop. Results: Utilizing a pressure drop limit of 100 mmHg, our results suggest a recommended flow limit of 500, 900, 1400, 2600, and 3100 mL/min for Braile arterial cannulae sizes 8, 10, 12, 14, and 16 Fr, respectively. For Medtronic DLP arterial cannulae sizes 8, 10, 12, 14, and 16 Fr, the recommended flow limit is 600, 1100, 1700, 2700, and 3300 mL/min, respectively. Conclusion: This study reinforces discrepancies in pressure drop between cannulae of the same diameter supplied by different manufacturers and the importance of independent translational research to evaluate components’ performance.

https://doi.org/10.21470/1678-9741-2023-0110

A New Dawn for Brazilian Pediatric Cardiac Surgery Is on the Way - Issues Around and Outside the Operating Room
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Caneo, Luiz Fernando

; Miana, Leonardo Augusto

; Garros, Daniel

; Neirotti, Rodolfo

Brazilian Journal of Cardiovascular Surgery

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Ago 2022, Volume 37 Nº 4 Páginas 566 - 574

Resumo: En | Texto: En | PDF: En

ABSTRACT In some developing countries, congenital heart disease still stands out among the leading causes of death in the first year of life. Therefore, there is a great need to develop programs designed to improve outcomes in the diagnosis and surgical treatment of congenital heart disease in these nations, where children have always been and still are severely underserved. The Brazilian Public Health Care System demands universal access to treatment as a constitutional right. Therefore, an underfunded Pediatric Cardiac Surgery program is unacceptable since it will cost lives and increase the infant mortality rate. Additionally, poor funding decreases providers’ interest, impedes technological advances and multidisciplinary engagement, and reduces access to comprehensive care. Unfortunately, in most developing countries, Pediatric Cardiac Surgery progress is still the result of isolated personal efforts, dedication, and individual resilience. This article aims to present the current state of Brazilian pediatric cardiac surgery and discuss the structural and human limitations in developing a quality care system for children with congenital heart disease. Considering such constraints, quality improvement programs via International collaboration with centers of excellence, based on proper data collection and outcomes analysis, have been introduced in the country. Such initiatives should bring a new dawn to Brazilian Pediatric Cardiac Surgery.

https://doi.org/10.21470/1678-9741-2022-0141

Adherence to the cardiac surgery checklist decreased mortality at a teaching hospital: A retrospective cohort study
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Mejia, Omar Asdrúbal Vilca

; Mendonça, Frederico Carlos Cordeiro de

; Sampaio, Lucimar Aparecida Barrense Nogueira

; Galas, Filomena Regina Barbosa Gomes

; Pontes, Mauricio Franklin

; Caneo, Luiz Fernando

; Dallan, Luís Roberto Palma

; Lisboa, Luiz Augusto Ferreira

; Ferreira, João Fernando Monteiro

; Dallan, Luís Alberto de Oliveira

; Jatene, Fabio Biscegli

Clinics

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2022, Volume 77 elocation 100048

Resumo: En | Texto: En | PDF: En

Abstract Objectives To evaluate the impact of adherence to the cardiac surgical checklist on mortality at the teaching hospital. Methods A retrospective cohort study after the implementation of the cardiac surgical safety checklist in a reference hospital in Latin America. All patients undergoing coronary artery bypass surgery and/or heart valve surgery from 2013 to 2019 were analyzed. After the implementation of the project InCor-Checklist “Five steps to safe cardiac surgery” in 2015, the correlation between adherence and completeness of this instrument with surgical mortality was assessed. The EuroSCORE II was used as a reference to assess the risk of expected mortality for patients. Cross-sectional questionnaires were during the implementation of the InCor-Checklist. To perform the correlation, Pearson’s coefficient was calculated using R software. Results Since 2013, data from 8139 patients have been analyzed. The average annual mortality was 5.98%. In 2015, the instrument was used in only 58% of patients; in contrast, it was used in 100% of patients in 2019. There was a decrease in surgical mortality from 8.22% to 3.13% for the same group of procedures. The results indicate that the greater the checklist use, the lower the surgical mortality (r = 88.9%). In addition, the greater the InCor-Checklist completeness, the lower the surgical mortality (r = 94.1%). Conclusion In the formation of the surgical patient safety culture, the implementation and adherence to the InCor-Checklist “Five steps to safe cardiac surgery” was associated with decreased mortality after cardiac surgery. HIGHLIGHTS Checklists avoid human errors and are commonly used in high-reliability industries. The “InCor Checklist” was associated with decreased mortality over time. Adherence, completeness, and sustainability within public policies are necessary.

https://doi.org/10.1016/j.clinsp.2022.100048

Preoperative Neutrophil-Lymphocyte Ratio Can Predict Outcomes for Patients Undergoing Tetralogy of Fallot Repair
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Manuel, Valdano

; Miana, Leonardo A.

; Guerreiro, Gustavo Pampolha

; Turquetto, Aida

; Santos, Rômullo Medeiros

; Fernandes, Natália

; Tenório, Davi Freitas

; Caneo, Luiz Fernando

; Jatene, Fabio B.

; Jatene, Marcelo Biscegli

Brazilian Journal of Cardiovascular Surgery

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Out 2021, Volume 36 Nº 5 Páginas 607 - 613

Resumo: En | Texto: En | PDF: En

Abstract Introduction: Elevated neutrophil-lymphocyte ratio (NLR) has been associated with poorer outcomes in cyanotic patients undergoing single ventricle palliation. Little is known about this biomarker on patients with tetralogy of Fallot (TOF), the most common cyanotic congenital heart disease. Our objective is to study the impact of preoperative NLR on outcomes of TOF patients undergoing total repair. Methods: This retrospective study included 116 consecutive patients between January 2014 and December 2018. Preoperative NLR was measured from the last complete blood count test before the surgery. Using the cutoff value of 0.80, according to the receiver-operating characteristic (ROC) curve, the sample was divided into two groups (NLR < 0.80 and ≥ 0.80). The primary endpoint was hospital length of stay (LOS). Results: ROC curves showed that higher preoperative NLR was associated with longer hospital LOS, with an area under the curve of 0.801±0.040 (95% confidence interval 0.722 - 0.879; P<0.001). High preoperative NLR was also associated with long intensive care unit (ICU) LOS (P=0.035). Preoperative NLR predicted longer hospital LOS with a sensitivity of 63% and a specificity of 81.4%. Conclusion: Higher preoperative NLR was associated with long ICU and hospital LOS in patients undergoing TOF repair.

https://doi.org/10.21470/1678-9741-2020-0408

Impact of COVID-19 Pandemic in a Pediatric and Congenital Cardiovascular Surgery Program in Brazil
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Miana, Leonardo A.

; Manuel, Valdano

; Caneo, Luiz Fernando

; Strabelli, Tânia Mara Varejão

; Arita, Elisandra Trevisan

; Monteiro, Rosângela

; Jatene, Marcelo Biscegli

; Jatene, Fabio B.

Brazilian Journal of Cardiovascular Surgery

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Jun 2021, Volume 36 Nº 3 Páginas 289 - 294

Resumo: En | Texto: En | PDF: En

Abstract Introduction: The coronavirus disease 2019 (COVID-19) has negatively impacted healthcare services worldwide. We hypothesized that the pandemic would affect our case mix and mortality. Our objective was to study this impact. Methods: We retrospectively studied all patients who underwent congenital heart surgeries from March 21st to August 21st in 2019 and 2020 using the institutional electronic database. We compared demographic data, preoperative and postoperative length of stay (LOS), risk stratification using Risk Adjustment for Congenital Heart Surgery (RACHS) classification and outcomes in both periods. Results: We observed a 66.7% decrease in our surgical volume (285 × 95 patients). Patients operated in the pre-pandemic period were older (911.3 [174.8 - 5953.8] days-old) compared to the pandemic period (275 days-old; P<0.05). When the case mix was compared between periods, the percentage of neonatal surgery was increased in the pandemic era (8% × 21.1%; P<0.05), and the number of RACHS 1-2 surgeries decreased significantly (60.7 × 27.4%; P<0.05). Preoperative LOS was increased in the pandemic period (1.2 × 7 days; P=0.001). There was no significant increment in mortality (P=0.1). Two patients tested positive for COVID-19 in the postoperative period and both died. Conclusion: Our program observed a sudden decrease in surgical volume and a consequent increase in surgical complexity. There was a non-significant increment in mortality.

https://doi.org/10.21470/1678-9741-2020-0657 91 downloads

Analysis of >100,000 Cardiovascular Surgeries Performed at the Heart Institute and a New Era of Outcomes
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Mejia, Omar A.V.

; Lisboa, Luiz Augusto Ferreira

; Caneo, Luiz Fernando

; Arita, Elisandra Trevisan

; Brandão, Carlos Manuel de Almeida

; Dias, Ricardo Ribeiro

; Costa, Roberto

; Jatene, Marcelo Biscegli

; Pomerantzeff, Pablo Maria Alberto

; Dallan, Luís Alberto Oliveira

; Jatene, Fabio Biscegli

Arquivos Brasileiros de Cardiologia

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Abr 2020, Volume 114 Nº 4 Páginas 603 - 612

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Fundamento: O desafio atual da cirurgia cardiovascular (CCV) é melhorar resultados em pacientes cada vez mais graves. Nesse sentido, Programas de Melhoria Contínua da Qualidade (PMCQ) tem impactado os resultados. Objetivo: Avaliar a evolução da incidência e mortalidade das CCV, assim como os resultados atuais do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor). Métodos: Análise dos resultados das CCV realizadas no InCor entre jan-1984 e jun-2019. Foram observadas as tendências dos volumes cirúrgicos e da mortalidade em 5 períodos 1º (1984-1989), 2º (1990-1999), 3º (2000-2007), 4º (2008-2015) e 5º (2016-2019). O PMCQ foi estabelecido entre 2015-2016. A análise incluiu o total de cirurgias e a evolução dos procedimentos mais frequentes. Resultados: Foram realizadas 105.599 CCV, com uma média anual de 2.964 procedimentos e mortalidade de 5,63%. Comparando o 4º com o 5º período, o volume global médio de cirurgias foi de 2.943 para 3.139 (p = 0,368), cirurgias de revascularização miocárdica (CRM) de 638 para 597 (p = 0,214), valvas cardíacas de 372 para 465 (p = 0,201) e cardiopatias congênitas de 530 para 615 (p = 0,125). A mortalidade média global passou de 7,8% para 5% (p < 0,0001), nas cirurgias de revascularização miocárdica de 5,8% para 3,1% (p < 0,0001), nas cirurgias valvares de 14% para 7,5% (p < 0,0001) e nas cirurgias de cardiopatias congênitas de 12,1% para 9,6% (p < 0,0001). Conclusão: Embora haja uma tendência recente ao aumento dos volumes cirúrgicos, houve uma diminuição significativa da mortalidade cirúrgica nos grupos analisados. Após o estabelecimento do PMCQ, as taxas de mortalidade se aproximaram a dos padrões internacionais.

Abstract Background: The current challenge of cardiovascular surgery (CVS) is to improve the outcomes in increasingly severe patients. In this respect, continuous quality improvement (CQI) programs have had an impact on outcomes. Objective: To assess the evolution of the incidence and mortality due to CVS, as well as the current outcomes of the Hospital das Clínicas Heart Institute of the University of São Paulo Medical School (InCor-HCFMUSP). Methods: An outcome analysis of CVSs performed at the InCor, between January 1984 and June 2019. We observed the surgical volume and mortality rates in 5 time periods: 1st (1984-1989), 2nd (1990-1999), 3rd (2000-2007), 4th (2008-2015) and 5th (2016-2019). The CQI program was implemented between 2015 and 2016. The analysis included the total number of surgeries and the evolution of the most frequent procedures. Results: A total of 105,599 CCVs were performed, with an annual mean of 2,964 procedures and mortality of 5,63%. When comparing the 4th and the 5th periods, the average global volume of surgeries was increased from 2,943 to 3,139 (p = 0.368), bypass graft (CABG), from 638 to 597 (p = 0.214), heart valve surgery, from 372 to 465 (p = 0.201), and congenital heart disease surgery, from 530 to 615 (p = 0.125). The average global mortality went from 7.8% to 5% (p < 0.0001); in CABG surgery, from 5.8% to 3.1% (p < 0.0001); in heart valve surgery, from 14% to 7.5% (p < 0.0001) and in congenital heart disease surgery, from 12.1% to 9.6% (p < 0.0001). Conclusion: In spite of a recent trend towards increased surgical volume, there was a significant decrease in operative mortality in the groups studied. After the implementation of the CQI program, the mortality rates were closer to international standards.

https://doi.org/10.36660/abc.20190736 938 downloads

Impact of Vacuum-Assisted Venous Drainage on Forward Flow in Simulated Pediatric Cardiopulmonary Bypass Circuits Utilizing a Centrifugal Arterial Pump Head
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Guimarães, Daniel Peres

; Caneo, Luiz Fernando

; Matte, Gregory

; Carletto, Luciana P.

; Policarpo, Valéria Camargo

; Castro, Ana Vitória C. X.

; Miranda, Matheus H. C.

; Costa, Priscila S.

; Jatene, Marcelo B.

; Cestari, Idagene

; Jatene, Fabio B.

Brazilian Journal of Cardiovascular Surgery

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Abr 2020, Volume 35 Nº 2 Páginas 134 - 140

Resumo: En | Texto: En | PDF: En

Abstract Objective: To analyze the impact of vacuum-assisted venous drainage (VAVD) on arterial pump flow in a simulated pediatric cardiopulmonary bypass circuit utilizing a centrifugal pump (CP) with an external arterial filter. Methods: The simulation circuit consisted of a Quadrox-I Pediatric oxygenator, a Rotaflow CP (Maquet Cardiopulmonary AG, Rastatt, Germany), and a custom pediatric tubing set primed with Lactated Ringer's solution and packed red blood cells. Venous line pressure, reservoir pressure, and arterial flow were measured with VAVD turned off to record baseline values. Four other conditions were tested with progressively higher vacuum pressures (-20, -40, -60, and -80 mmHg) applied to the baseline cardiotomy pressure. An arterial filter was placed into the circuit and arterial flow was measured with the purge line in both open and closed positions. These trials were repeated at set arterial flow rates of 1500, 2000, and 2500 mL/min. Results: The use of progressively higher vacuum caused a reduction in effective arterial flow from 1490±0.00 to 590±0.00, from 2020±0.01 to 1220±0.00, and from 2490±0.0 to 1830±0.01 mL/min. Effective forward flow decreased with increased levels of VAVD. Conclusion: The use of VAVD reduces arterial flow when a CP is used as the main arterial pump. The reduction in the forward arterial flow increases as the vacuum level increases. The loss of forward flow is further reduced when the arterial filter purge line is kept in the recommended open position. An independent flow probe is essential to monitor pump flow during cardiopulmonary bypass.

https://doi.org/10.21470/1678-9741-2019-0311 402 downloads

Early and Long-Term Outcomes of Surgical Treatment of Ebstein’s Anomaly
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Silva, Guilherme Viotto Rodrigues da

; Miana, Leonardo Augusto

; Caneo, Luiz Fernando

; Turquetto, Aída Luiza Ribeiro

; Tanamati, Carla

; Penha, Juliano G.

; Jatene, Fabio B

; Jatene, Marcelo B

Brazilian Journal of Cardiovascular Surgery

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Out 2019, Volume 34 Nº 5 Páginas 511 - 516

Resumo: En | Texto: En | PDF: En

Abstract Objective: This study aimed to evaluate Ebstein’s anomaly surgical correction and its early and long-term outcomes. Methods: A retrospective analysis of 62 consecutive patients who underwent surgical repair of Ebstein’s anomaly in our institution from January 2000 to July 2016. The following long-term outcomes were evaluated: survival, reoperations, tricuspid regurgitation, and postoperative right ventricular dysfunction. Results: Valve repair was performed in 46 (74.2%) patients - 12 of them using the Da Silva cone reconstruction; tricuspid valve replacement was performed in 11 (17.7%) patients; univentricular palliation in one (1.6%) patient; and the one and a half ventricle repair in four (6.5%) patients. The patients’ mean age at the time of surgery was 20.5±14.9 years, and 46.8% of them were male. The mean follow-up time was 8.8±6 years. The 30-day mortality rate was 8.06% and the one and 10-year survival rates were 91.9% both. Eleven (17.7%) of the 62 patients required late reoperation due to tricuspid regurgitation, in an average time of 7.1±4.9 years after the first procedure. Conclusion: In our experience, the long-term results of the surgical treatment of Ebstein's anomaly demonstrate an acceptable survival rate and a low incidence of reinterventions.

https://doi.org/10.21470/1678-9741-2018-0333 473 downloads

Atualização da Diretriz de Ressuscitação Cardiopulmonar e Cuidados Cardiovasculares de Emergência da Sociedade Brasileira de Cardiologia - 2019
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Bernoche, Claudia

; Timerman, Sergio

; Polastri, Thatiane Facholi

; Giannetti, Natali Schiavo

; Siqueira, Adailson Wagner da Silva

; Piscopo, Agnaldo

; Soeiro, Alexandre de Matos

; Reis, Amélia Gorete Afonso da Costa

; Tanaka, Ana Cristina Sayuri

; Thomaz, Ana Maria

; Quilici, Ana Paula

; Catarino, Andrei Hilário

; Ribeiro, Anna Christina de Lima

; Barreto, Antonio Carlos Pereira

; Azevedo Filho, Antonio Fernando Barros de

; Pazin Filho, Antonio

; Timerman, Ari

; Scarpa, Bruna Romanelli

; Timerman, Bruno

; Tavares, Caio de Assis Moura

; Martins, Cantidio Soares Lemos

; Serrano Junior, Carlos Vicente

; Malaque, Ceila Maria Sant’Ana

; Pisani, Cristiano Faria

; Batista, Daniel Valente

; Leandro, Daniela Luana Fernandes

; Szpilman, David

; Gonçalves, Diego Manoel

; Paiva, Edison Ferreira de

; Osawa, Eduardo Atsushi

; Lima, Eduardo Gomes

; Adam, Eduardo Leal

; Peixoto, Elaine

; Evaristo, Eli Faria

; Azeka, Estela

; Silva, Fabio Bruno da

; Wen, Fan Hui

; Ferreira, Fatima Gil

; Lima, Felipe Gallego

; Fernandes, Felipe Lourenço

; Ganem, Fernando

; Galas, Filomena Regina Barbosa Gomes

; Tarasoutchi, Flavio

; Souza, Germano Emilio Conceição

; Feitosa Filho, Gilson Soares

; Foronda, Gustavo

; Guimarães, Helio Penna

; Abud, Isabela Cristina Kirnew

; Leite, Ivanhoé Stuart Lima

; Linhares Filho, Jaime Paula Pessoa

; Moraes Junior, João Batista de Moura Xavier

; Falcão, João Luiz Alencar de Araripe

; Ramires, Jose Antônio Franchini

; Cavalini, José Fernando

; Saraiva, José Francisco Kerr

; Abrão, Karen Cristine

; Pinto, Lecio Figueira

; Bianchi, Leonardo Luís Torres

; Lopes, Leonardo Nícolau Geisler Daud

; Piegas, Leopoldo Soares

; Kopel, Liliane

; Godoy, Lucas Colombo

; Tobase, Lucia

; Hajjar, Ludhmila Abrahão

; Dallan, Luís Augusto Palma

; Caneo, Luiz Fernando

; Cardoso, Luiz Francisco

; Canesin, Manoel Fernandes

; Park, Marcelo

; Rabelo, Marcia Maria Noya

; Malachias, Marcus Vinícius Bolívar

; Gonçalves, Maria Aparecida Batistão

; Almeida, Maria Fernanda Branco de

; Souza, Maria Francilene Silva

; Favarato, Maria Helena Sampaio

; Carrion, Maria Julia Machline

; Gonzalez, Maria Margarita

; Bortolotto, Maria Rita de Figueiredo Lemos

; Macatrão-Costa, Milena Frota

; Shimoda, Mônica Satsuki

; Oliveira-Junior, Mucio Tavares de

; Ikari, Nana Miura

; Dutra, Oscar Pereira

; Berwanger, Otávio

; Pinheiro, Patricia Ana Paiva Corrêa

; Reis, Patrícia Feitosa Frota dos

; Cellia, Pedro Henrique Moraes

; Santos Filho, Raul Dias dos

; Gianotto-Oliveira, Renan

; Kalil Filho, Roberto

; Guinsburg, Ruth

; Managini, Sandrigo

; Lage, Silvia Helena Gelas

; Yeu, So Pei

; Franchi, Sonia Meiken

; Shimoda-Sakano, Tania

; Accorsi, Tarso Duenhas

; Leal, Tatiana de Carvalho Andreucci

; Guimarães, Vanessa

; Sallai, Vanessa Santos

; Ávila, Walkiria Samuel

; Sako, Yara Kimiko

Arquivos Brasileiros de Cardiologia

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Set 2019, Volume 113 Nº 3 Páginas 449 - 663

Resumo: Pt | Texto: Pt | PDF: Pt

https://doi.org/10.5935/abc.20190203 54793 downloads

10.

The Brazilian Society for Cardiovascular Surgery (SBCCV) and Brazilian Society for Extracorporeal Circulation (SBCEC) Standards and Guidelines for Perfusion Practice
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Caneo, Luiz Fernando

; Matte, Gregory

; Groom, Robert

; Neirotti, Rodolfo A.

; Pêgo-Fernandes, Paulo Manuel

; Mejia, Juan Alberto C.

; Figueira, Fernando Augusto Marinho dos Santos

; Carvalho Filho, Élio Barreto de

; Costa, Fábio Murilo da

; Chalegre, Sintya Tertuliano

; Kalil, Renato Abdala Karam

; Almeida, Rui M. S.

Brazilian Journal of Cardiovascular Surgery

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Abr 2019, Volume 34 Nº 2 Páginas 239 - 260

Resumo: En | Texto: En | PDF: En

https://doi.org/10.21470/1678-9741-2018-0347 1484 downloads

11.

Outcomes of the Conversion of the Fontan-Kreutzer Operation to a Total Cavopulmonary Connection for the Failing Univentricular Circulation
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Fernandes, Gabriel Carmona

; Silva, Guilherme Viotto Rodrigues da

; Caneo, Luiz Fernando

; Tanamati, Carla

; Turquetto, Aida Luiza Ribeiro

; Jatene, Marcelo Biscegli

Arquivos Brasileiros de Cardiologia

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Fev 2019, Volume 112 Nº 2 Páginas 130 - 135

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Fundamento: O procedimento de Fontan-Kreutzer (FK) foi amplamente realizado no passado, mas a longo prazo gerou muitas complicações, resultando em falha na circulação univentricular. A conversão para conexão cavopulmonar total (CCPT) é uma das opções de tratamento. Objetivo: Avaliar os resultados da conversão de FK para CCPT. Métodos: Revisão retrospectiva de prontuários de pacientes submetidos à conversão de FK para CCPT no período de 1985 a 2016. Significância p < 0,05. Resultados: Operações do tipo Fontan foram realizadas em 420 pacientes durante este período: CCPT foi realizada em 320, técnica de túnel lateral em 82 e FK em 18. Dez casos do grupo FK foram eleitos para conversão em CCPT. Todos os pacientes submetidos à conversão de Fontan foram incluídos neste estudo. Em nove pacientes, a indicação deveu-se a arritmia não controlada e em um devido à enteropatia perdedora de proteínas. A morte foi observada nos dois primeiros casos. O tempo médio de internação na unidade de terapia intensiva (UTI) foi de 13 dias e o tempo médio de internação hospitalar foi de 37 dias. Uma classe funcional pela melhora da New York Heart Association (NYHA) foi observada em 80% dos pacientes em NYHA I ou II. Cinquenta e sete por cento das conversões devido a arritmias tiveram melhora das arritmias; quatro casos foram curados. Conclusões: A conversão é um procedimento complexo e requer que um hospital terciário experiente seja realizado. A conversão melhorou a classe funcional da NYHA, apesar de uma resolução insatisfatória da arritmia.

Abstract Background: The Fontan-Kreutzer procedure (FK) was widely performed in the past, but in the long-term generated many complications resulting in univentricular circulation failure. The conversion to total cavopulmonary connection (TCPC) is one of the options for treatment. Objective: To evaluate the results of conversion from FK to TCPC. Methods: A retrospective review of medical records for patients who underwent the conversion of FK to TCPC in the period of 1985 to 2016. Significance p < 0,05. Results: Fontan-type operations were performed in 420 patients during this period: TCPC was performed in 320, lateral tunnel technique in 82, and FK in 18. Ten cases from the FK group were elected to conversion to TCPC. All patients submitted to Fontan Conversion were included in this study. In nine patients the indication was due to uncontrolled arrhythmia and in one, due to protein-losing enteropathy. Death was observed in the first two cases. The average intensive care unit (ICU) length of stay (LOS) was 13 days, and the average hospital LOS was 37 days. A functional class by New York Heart Association (NYHA) improvement was observed in 80% of the patients in NYHA I or II. Fifty-seven percent of conversions due to arrhythmias had improvement of arrhythmias; four cases are cured. Conclusions: The conversion is a complex procedure and requires an experienced tertiary hospital to be performed. The conversion has improved the NYHA functional class despite an unsatisfactory resolution of the arrhythmia.

https://doi.org/10.5935/abc.20180256 3772 downloads

12.

Functional Performance of Different Venous Limb Options in Simulated Neonatal/Pediatric Cardiopulmonary Bypass Circuits
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Caneo, Luiz Fernando

; Matte, Gregory S.

; Guimarães, Daniel Peres

; Viotto, Guilherme

; Mazzeto, Marcelo

; Cestari, Idagene

; Neirotti, Rodolfo A.

; Jatene, Marcelo B.

; Wang, Shigang

; Ündar, Akif

; Chang Junior, João

; Jatene, Fabio B.

Brazilian Journal of Cardiovascular Surgery

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Jun 2018, Volume 33 Nº 3 Páginas 224 - 232

Resumo: En | Texto: En | PDF: En

Abstract Objective: Hemodilution is a concern in cardiopulmonary bypass (CPB). Using a smaller dual tubing rather than a single larger inner diameter (ID) tubing in the venous limb to decrease prime volume has been a standard practice. The purpose of this study is to evaluate these tubing options. Methods: Four different CPB circuits primed with blood (hematocrit 30%) were investigated. Two setups were used with two circuits for each one. In Setup I, a neonatal oxygenator was connected to dual 3/16" ID venous limbs (Circuit A) or to a single 1/4" ID venous limb (Circuit B); and in Setup II, a pediatric oxygenator was connected to dual 1/4" ID venous limbs (Circuit C) or a single 3/8" ID venous limb (Circuit D). Trials were conducted at arterial flow rates of 500 ml/min up to 1500 ml/min (Setup I) and up to 3000 ml/min (Setup II), at 36°C and 28°C. Results: Circuit B exhibited a higher venous flow rate than Circuit A, and Circuit D exhibited a higher venous flow rate than Circuit C, at both temperatures. Flow resistance was significantly higher in Circuits A and C than in Circuits B (P<0.001) and D (P<0.001), respectively. Conclusion: A single 1/4" venous limb is better than dual 3/16" venous limbs at all flow rates, up to 1500 ml/min. Moreover, a single 3/8" venous limb is better than dual 1/4" venous limbs, up to 3000 ml/min. Our findings strongly suggest a revision of perfusion practice to include single venous limb circuits for CPB.

https://doi.org/10.21470/1678-9741-2018-0074 784 downloads

13.

Rational Use of Mechanical Circulatory Support as a Bridge to Pediatric and Congenital Heart Transplantation
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Miana, Leonardo A.

; Silva, Guilherme Viotto Rodrigues da

; Caneo, Luiz Fernando

; Turquetto, Aida Luisa

; Tanamati, Carla

; Foronda, Gustavo

; Massoti, Maria Raquel

; Penha, Juliano G.

; Azeka, Estela

; Galas, Filomena R. B. G.

; Jatene, Fabio B.

; Jatene, Marcelo B.

Brazilian Journal of Cardiovascular Surgery

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Jun 2018, Volume 33 Nº 3 Páginas 242 - 249

Resumo: En | Texto: En | PDF: En

Abstract Introduction: Donor shortage and organ allocation is the main problem in pediatric heart transplant. Mechanical circulatory support is known to increase waiting list survival, but it is not routinely used in pediatric programs in Latin America. Methods: All patients listed for heart transplant and supported by a mechanical circulatory support between January 2012 and March 2016 were included in this retrospective single-center study. The endpoints were mechanical circulatory support time, complications, heart transplant survival and discharge from the hospital. Results: Twenty-nine patients from our waiting list were assessed. Twelve (45%) patients were initially supported by extracorporeal membrane oxygenation (ECMO) and a centrifugal pump was implanted in 17 (55%) patients. Five patients initially supported by ECMO were bridged to another device. One was bridged to a centrifugal pump and four were bridged to Berlin Heart Excor®. Among the 29 supported patients, 18 (62%) managed to have a heart transplant. Thirty-day survival period after heart transplant was 56% (10 patients). Median support duration was 12 days (interquartile range [IQR] 4 - 26 days) per run and the waiting time for heart transplant was 9.5 days (IQR 2.5-25 days). Acute kidney injury was identified as a mortality predictor (OR=22.6 [CI=1.04-494.6]; P=0.04). Conclusion: Mechanical circulatory support was able to bridge most INTERMACS 1 and 2 pediatric patients to transplant with an acceptable complication rate. Acute renal failure increased mortality after mechanical circulatory support in our experience.

https://doi.org/10.21470/1678-9741-2018-0081 696 downloads

14.

Pre-validation Study of the Brazilian Version of the Disruptions in Surgery Index (DiSI) as a Safety Tool in Cardiothoracic Surgery
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Nina, Vinicius José da Silva

; Jatene, Fabio B.

; Sevdalis, Nick

; Mejía, Omar Asdrúbal Vilca

; Brandão, Carlos Manuel de Almeida

; Monteiro, Rosangela

; Caneo, Luiz Fernando

; Scudeller, Paula Gobi

; Mendes, Augusto Dimitry

; Mendes, Vinícius Giuliano

; Romano, Bellkiss Wilma

Brazilian Journal of Cardiovascular Surgery

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Dez 2017, Volume 32 Nº 6 Páginas 451 - 461

Resumo: En | Texto: En | PDF: En

Abstract Introduction: Most risk stratification scores used in surgery do not include external and non-technical factors as predictors of morbidity and mortality. Objective: The present study aimed to translate and adapt transculturally the Brazilian version of the Disruptions in Surgery Index (DiSI) questionnaire, which was developed to capture the self-perception of each member of the surgical team regarding the disruptions that may contribute to error and obstruction of safe surgical flow. Methods: A universalist approach was adopted to evaluate the conceptual equivalence of items and semantics, which included the following stages: (1) translation of the questionnaire into Portuguese; (2) back translation into English; (3) panel of experts to draft the preliminary version; and (4) pre-test for evaluation of verbal comprehension by the target population of 43 professionals working in cardiothoracic surgery. Results: The questionnaire was translated into Portuguese and its final version with 29 items obtained 89.6% approval from the panel of experts. The target population evaluated all items as easy to understand. The mean overall clarity and verbal comprehension observed in the pre-test reached 4.48 ± 0.16 out of the maximum value of 5 on the psychometric Likert scale. Conclusion: Based on the methodology used, the experts' analysis and the results of the pre-test, it is concluded that the essential stages of translation and cross-cultural adaptation of DiSI to the Portuguese language were satisfactorily fulfilled in this study.

https://doi.org/10.21470/1678-9741-2017-0141 621 downloads

15.

Collaborative Quality Improvement in the Congenital Heart Defects: Development of the ASSIST Consortium and a Preliminary Surgical Outcomes Report
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Carmona, Fabio

; Manso, Paulo Henrique

; Ferreira, Mariana Nicoletti

; Ikari, Nana Miura

; Jatene, Marcelo Biscegli

; Amato, Luciana

; Turquetto, Aida Luiza

; Caneo, Luiz Fernando

Brazilian Journal of Cardiovascular Surgery

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Ago 2017, Volume 32 Nº 4 Páginas 260 - 269

Resumo: En | Texto: En | PDF: En

Abstract Objective: ASSIST is the first Brazilian initiative in building a collaborative quality improvement program in pediatric cardiology and congenital heart disease. The purposes of this manuscript are: (a) to describe the development of the ASSIST project, including the historical, philosophical, organizational, and infrastructural components that will facilitate collaborative quality improvement in congenital heart disease care; (b) to report past and ongoing challenges faced; and (c) to report the first preliminary data analysis. Methods: A total of 614 operations were prospectively included in a comprehensive online database between September 2014 and December 2015 in two participating centers. Risk Adjustment for Congenital Heart Surgery (RACHS) 1 and Aristotle Basic Complexity (ABC) scores were obtained. Descriptive statistics were provided, and the predictive values of the two scores for mortality were calculated by multivariate logistic regression models. Results: Many barriers and challenges were faced and overcome. Overall mortality was 13.4%. Independent predictors of in-hospital death were: RACHS-1 categories (3, 4, and 5/6), ABC level 4, and age group (≤ 30 days, and 30 days - 1 year). Conclusion: The ASSIST project was successfully created over a solid base of collaborative work. The main challenges faced, and overcome, were lack of institutional support, funding, computational infrastructure, dedicated staff, and trust. RACHS-1 and ABC scores performed well in our case mix. Our preliminary outcome analysis shows opportunities for improvement.

https://doi.org/10.21470/1678-9741-2016-0074 827 downloads

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