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Mejia OAV, Souza RC, Meneghini B, Santos AS, Lisboa LAF, Dallan LAO, Cunha-Neto E, Ferreira LRP, Jatene FB. Circulating miRNA-770-5p and miRNA-30d-5p as potential biomarkers in vasoplegic syndrome after on-pump coronary artery bypass surgery – PREVENT trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Vasoplegic syndrome (VS) is one of the most common unexpected complications following cardiothoracic surgery, approaching a 25% mortality rate. No standardized methods for diagnosing VS are available. A biomarker is a valuable tool in all fields of medicine, especially in cardiovascular disease when the patient has to undergo invasive surgery as on-pump CABG. MicroRNAs (miRNAs) have been studied and employed as biomarkers for numerous diseases, however, there are no studies regarding their expression in VS.
Purpose
To discover a new predictor of VS by comparing the miRNA profiles from patients who evolved to VS versus those who did not evolve after following Coronary artery bypass graft surgery (CABG).
Methods
A nested case-control study had an exploratory nature and involved an initial cohort of 87 patients who underwent on-pump CABG in elective or urgency procedures,considering the low surgical risk (STS score <2%). For this analysis, we compared 30 patients, divided into two groups: patients who evolved VS (VASO group, n=15) and who did not evolve VS (NONVASO group, n=15) after surgery. To perform the miRNA profiling, the target prediction, and identify the putative targets of the dysregulated miRNAs, the whole blood samples were collected after anesthetic induction and before incision in the chest (Figure 1A).
Results
We identified among the 754 screened miRNAs, eight differentially circulating miRNAs in the whole blood of VASO versus NONVASO groups (Figure 1B). Six miRNAs were increased (hsa-miR-548c-3p, hsa-miR-30d-5p, hsa-miR8 199b-5p, hsa-miR-183-3p, hsa-miR-571, hsa-miR-383-5p) and two were decreased (hsa-miR-1236-3p, hsa-miR-770-5p) and hsa-miR-1236-3p was not statistically significant (Figure 1C). The ROC curves for each single miRNAs yielded the top 2 highest AUC values of 0.8333 and 0.8178 for hsa-miR-770-5p and hsa-miR-30d-5p, respectively. The combination of these two miRNAs yielded an AUC value of 0.9615 with 84.6% sensitivity and 91.67% specificity in distinguishing patients from VASO from NONVASO groups showed a superior diagnostic power to that of a single miRNA (Figure 2). Computational analyses identified as the top enriched pathway the “Apelin Liver Signaling Pathway” with 14 out of 26 molecules within the pathway (53,8%) containing the higher number of targets of the dysregulated miRNAs. There was no statistical difference in preoperative, postoperative, EuroSCORE II, and variables comparing both groups.
Conclusion(s)
We showed that miRNA-770-5p and miRNA-30d-5p could be employed as potential biomarkers of VS, a new strategy to VS diagnosis since miRNAs expression could distinguish patients who could and could not evolve the disease. The capability of predicting VS with high accuracy would drastically change the clinical management and patient's referral to cardiac surgery by helping in decision-making once the clinical score risks proved to be unable to predict VS in low-risk patients.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Fundação de Amparo a Pesquisa de São Paulo - FAPESP
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Affiliation(s)
- O A V Mejia
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - R C Souza
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - B Meneghini
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - A S Santos
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - L A F Lisboa
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - L A O Dallan
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - E Cunha-Neto
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
| | - L R P Ferreira
- Federal University of Minas Gerais , Belo Horizonte , Brazil
| | - F B Jatene
- Heart Institute of the University of Sao Paulo (InCor) , Sao Paulo , Brazil
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Dallan LAP, Dae M, Giannetti NS, Polastri TF, Lima MKF, Rochitte CE, Hajjar LA, San Martin CYB, Lima FG, Nicolau JC, de Oliveira Jr MT, Dallan LAO, Ribeiro da Silva EE, Kalil Filho R, Abizaid A, Lemos Neto PA, Timerman S. Endovascular therapeutic hypothermia adjunctive to percutaneous coronary intervention in acute myocardial infarction: realistic simulation as a game changer. Rev Cardiovasc Med 2022; 23:104. [DOI: 10.31083/j.rcm2303104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/29/2021] [Accepted: 01/10/2022] [Indexed: 11/06/2022] Open
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Dallan LRP, Dallan LAO, Mejía OV, Dallan LAP, Lisboa LAF, Jatene FB. Pericardial-Peritoneal Window as an Alternative Treatment for Large and Recurrent Pericardial Effusion Post-Pericardiotomy. Braz J Cardiovasc Surg 2021; 36:581-583. [PMID: 33656833 PMCID: PMC8522315 DOI: 10.21470/1678-9741-2020-0355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The presence of mild to moderate pericardial effusion after cardiac surgery is common and oral medical therapy is usually able to treat it. Larger effusions are less frequent and surgical intervention is usually necessary. However, there are some rare cases of large effusions that are recurrent even after intervention and become challenging to treat. METHODS We describe the case of a patient submitted to coronary artery bypass grafting (CABG) without any intraoperative complications, who was regularly discharged from the hospital. She was referred to our emergency department twice after surgery with large pericardial effusion that was drained. Even after those two interventions and with adequate oral medication, the large effusion recurred. RESULTS During follow-up, the patient had her symptoms resolved, with no need for further hospital admission. Her echocardiograms after the last intervention showed no pericardial effusion. The present surgical technique demonstrated to be easy to perform, thus it should be considered as a treatment option for these rare cases of large and repetitive effusions, which do not respond to the traditional methods. CONCLUSIONS In challenging cases of recurrent and large pericardial effusions, the pericardial-peritoneal window is an alternative surgical technique that brings clinical improvement and diminishes the risk of cardiac tamponade.
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Affiliation(s)
- Luis Roberto Palma Dallan
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Luis Alberto Oliveira Dallan
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Omar Vilca Mejía
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Luis Augusto Palma Dallan
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Luiz Augusto Ferreira Lisboa
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
| | - Fabio B Jatene
- Department of Cardiovascular Surgery, Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina do Estado de São Paulo (InCor), São Paulo, São Paulo, Brazil
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Dourado LOC, Pereira AC, Poppi NT, Cavalcante R, Gaiotto F, Dallan LAO, Bittencourt MS, Cesar LAM, Gowdak LHW. The Role of the Heart Team in Patients with Diffuse Coronary Artery Disease Undergoing Coronary Artery Bypass Grafting. Thorac Cardiovasc Surg 2020; 69:584-591. [PMID: 33225435 DOI: 10.1055/s-0040-1718936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND In patients eligible for coronary artery bypass grafting, no data assess the importance of the Heart Team in programming the best surgical strategy for patients with diffuse coronary artery disease (CAD). This study aims to determine the contribution of the Heart Team in predicting the feasibility of coronary artery bypass graft and angiographic surgical success in these patients based on visual angiographic analysis. METHODS Patients with diffuse and severe CAD undergoing incomplete coronary artery bypass graft surgery were prospectively included. One-year postoperative coronary angiograms were obtained to evaluate graft occlusion. Two clinical cardiologists, two cardiovascular surgeons, and one interventional cardiologist retrospectively analyzed preoperative angiograms. A subjective scale was applied at a single moment to quantify the chance of successful coronary artery bypass grafting for each coronary territory with anatomical indication for revascularization. Based on individual scores, the Heart Team's and the specialists' scores were calculated and compared. RESULTS The examiners evaluated 154 coronary territories, of which 85 (55.2%) were protected. The Heart Team's accuracy for predicting the angiographic success of the surgery was 74.9%, almost equal to that of the surgeons alone (73.2%). Only the interventional cardiologist predicted left anterior descending territory grafting success. The Heart Team had good specificity and reasonable sensitivity, and the surgeons had high sensitivity and low specificity in predicting angiographic success. CONCLUSION The multispecialty Heart Team achieved good accuracy in predicting the angiographic coronary artery bypass graft success in patients with diffuse CAD, with a high specificity and reasonable sensitivity.
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Affiliation(s)
| | - Alexandre C Pereira
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Nilson Tavares Poppi
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Rafael Cavalcante
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Fabio Gaiotto
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Marcio Sommer Bittencourt
- Division of Internal Medicine, Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, Sao Paulo, Brazil
| | - Luiz Antonio M Cesar
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
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Rezende PC, Hueb W, Bocchi EA, Farkouh M, Junior CVS, Lima EG, Silva EER, Dallan LAO, Gaiotto FA, Garzillo CL, Rochitte CE, Nomura CH, Scudeler TL, Soares PR, Jatene FB, Ramires JAF, Filho RK. Hypotheses, rationale, design, and methods for prognostic evaluation of a randomized comparison between patients with coronary artery disease associated with ischemic cardiomyopathy who undergo medical or surgical treatment: MASS-VI (HF). Trials 2020; 21:337. [PMID: 32299458 PMCID: PMC7164251 DOI: 10.1186/s13063-020-04270-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/20/2020] [Indexed: 12/03/2022] Open
Abstract
Background Ischemic cardiomyopathy and severe left ventricular dysfunction are well established to represent the main determinants of poor survival and premature death compared with preserved ventricular function. However, the role of myocardial revascularization as a therapeutic alternative is not known to improve the long-term prognosis in this group of patients. This study will investigate whether myocardial revascularization contributes to a better prognosis for patients compared with those treated with drugs alone and followed over the long term. Methods The study will include 600 patients with coronary artery disease associated with ischemic cardiomyopathy. The surgical or drug therapy option will be randomized, and the events considered for analysis will be all-cause mortality, nonfatal infarction, unstable angina requiring additional revascularization, and stroke. The events will be analyzed according to the intent-to-treat principle. Patients with multivessel coronary disease and left ventricular ejection fraction measurements of less than 35% will be included. In addition, myocardial ischemia will be documented by myocardial scintigraphy. Markers of myocardial necrosis will be checked at admission and after the procedure. Discussion The role of myocardial revascularization (CABG) in the treatment of patients with coronary artery disease and heart failure is not clearly established. The surgical option of revascularizing the myocardium is a procedure designed to reduce the load of myocardial hibernation in patients with heart failure caused by coronary artery disease. On the other hand, the assessment of myocardial viability is frequently used to identify patients with left ventricular ischemic dysfunction in which CABG may add survival benefit. However, the effectiveness of this option is uncertain. The great difficulty in establishing the efficacy of surgical intervention is based on the understanding of viability without ischemia. Thus, this study will include only patients with viable and truly ischemic myocardium to correct this anomaly. Trial registration Evaluation of a randomized comparison between patients with coronary artery disease associated with ischemic cardiomyopathy submitted to medical or surgical treatment: MASS-VI (HF), ISRCTN77449548, Oct 10th, 2019 (retrospectively registered).
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Affiliation(s)
- Paulo Cury Rezende
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Whady Hueb
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil.
| | - Edimar Alcides Bocchi
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Michael Farkouh
- Toronto General Hospital Research Institute (TGHRI), Toronto, Ontario, Canada
| | - Carlos Vicente Serrano Junior
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Eduardo Gomes Lima
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Expedito Eustáquio Ribeiro Silva
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Luis Alberto Oliveira Dallan
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Fabio Antonio Gaiotto
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Cibele Larrosa Garzillo
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Carlos Eduardo Rochitte
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Cesar Higa Nomura
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Thiago Luis Scudeler
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Paulo Rogério Soares
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Fabio Biscegli Jatene
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - José Antonio Franchini Ramires
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
| | - Roberto Kalil Filho
- Instituto do Coraçao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Eneas de Carvalho Aguiar 44, AB, Sala 114, Cerqueira César, São Paulo, SP, 05403-000, Brazil
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Nakashima CAK, Dallan LAO, Lisboa LAF, Hajjar LA, Soeiro AM, Silva BA, Costa MSS, Dornas CJCB, Dalcoquio TF, Furtado RHM, Baracioli LM, Fukushima JT, Gurbel PA, Giugliano RP, Nicolau JC. P1839Platelet aggregability evaluation in patients with acute coronary syndromes scheduled for coronary artery bypass graft. The PLAT-CABG study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Dual antiplatelet therapy is recommended for patients (pts) with acute coronary syndromes (ACS). However, 10–15% of pts have indication of coronary artery bypass graft (CABG) for the index event and current guidelines recommend stopping clopidogrel at least 5 days prior to CABG. This waiting time could increase hospital length of stay, thus having negative impacts on costs and clinical complications.
Purpose
To evaluate if release to CABG based on platelet aggregability by Multiplate AnalyzerTM would be non-inferior in comparison with common practice (5 days) in terms of 24-hours post-CABG bleeding.
Methods
The PLAT-CABG (NCT 02516267) is a randomized, open label, non-inferiority trial (boundary 25%) testing a strategy of platelet aggregability-guided release to CABG versus standard-of-care on the primary endpoint of chest tube drainage in the first 24 hours post CABG. A total of 190 pts admitted with ACS, treated with aspirin + clopidogrel and with indication for CABG, were assigned to clopidogrel discontinued 5 days prior to CABG (control group) vs. daily measurements of platelet aggregability to ADP using Multiplate AnalyzerTM (intervention group) with CABG occurring after recovering from platelet inhibition (pre-defined as a threshold of 46 AU).
Results
The main results are depicted in the table
Main results of PLAT-CABG study Variables Control Group (n=95) Intervention Group (n=95) P-value for superiority P-value for non-inferiority Chest tube drainage (mL), Median (25th–75th) 350 (250–500) 350 (250–500) 0.680 0.001 Time symptom to CABG (hours), Median (25th–75th) 191 (150–281) 166 (119–225) <0.001 NA Time surgery indication to CABG (hours), Median (25th–75th) 136 (112–161) 112 (66–142) <0.001 NA CABG = coronary artery bypass graft.
Conclusion
Platelet-aggregability guided release to CABG is non-inferior to standard of care in ACS patients awaiting CABG in terms of peri-operative bleeding and significantly shortens the time to CABG.
Acknowledgement/Funding
Roche Diagnostica Brazil
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Affiliation(s)
- C A K Nakashima
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - L A O Dallan
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - L A F Lisboa
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - L A Hajjar
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - A M Soeiro
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - B A Silva
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - M S S Costa
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | | | - T F Dalcoquio
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - R H M Furtado
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - L M Baracioli
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - J T Fukushima
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
| | - P A Gurbel
- Duke University Medical Center, Durham, United States of America
| | - R P Giugliano
- Brigham and Womens Hospital, Boston, United States of America
| | - J C Nicolau
- Heart Institute of the University of Sao Paulo (InCor), Sao Paulo, Brazil
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Titinger DP, Lisboa LAF, Matrangolo BLR, Dallan LRP, Dallan LAO, Trindade EM, Eckl I, Kalil Filho R, Mejía OAV, Jatene FB. Cardiac surgery costs according to the preoperative risk in the Brazilian public health system. Arq Bras Cardiol 2015; 105:130-8. [PMID: 26107813 PMCID: PMC4559121 DOI: 10.5935/abc.20150068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Heart surgery has developed with increasing patient complexity. OBJECTIVE To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS). METHOD All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups. RESULTS Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001), as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata. CONCLUSION Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.
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Affiliation(s)
| | | | | | | | | | | | - Ivone Eckl
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | - Roberto Kalil Filho
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
| | | | - Fabio Biscegli Jatene
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR
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Nicolau JC, Timerman A, Marin-Neto JA, Piegas LS, Barbosa CJDG, Franci A, Avezum A, Carvalho ACC, Markman Filho B, Polanczyk CA, Rochitte CE, Serrano Júnior CV, Precoma DB, Silva Junior DG, Albuquerque DC, Stefanini E, Knobel E, Jatene FB, Feres F, Morcerf FAP, Ganem F, Lima Filho FA, Feitosa Filho GS, Ferreira JFM, Meneghetti JC, Saraiva JFK, Silva LS, Maia LN, Baracioli LM, Lisboa LAF, Dallan LAO, Bodanese LC, Andrade MD, Oliveira Júnior M, Dutra OP, Coelho OR, Leães PE, Albuquerque PF, Lemos P, Kalil R, Costa RVC, Esporcate R, Marino RL, Botellho RV, Meneghelo RS, Sprovieri SR, Timerman S, Mathias Júnior W. [Guidelines of Sociedade Brasileira de Cardiologia for Unstable Angina and Non-ST-Segment Elevation Myocardial Infarction (II Edition, 2007) 2013-2014 Update]. Arq Bras Cardiol 2014; 102:1-61. [PMID: 24862929 DOI: 10.5935/abc.2014s001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Girão-Silva T, Bassaneze V, Campos LCG, Barauna VG, Dallan LAO, Krieger JE, Miyakawa AA. Short-term mechanical stretch fails to differentiate human adipose-derived stem cells into cardiovascular cell phenotypes. Biomed Eng Online 2014; 13:54. [PMID: 24885410 PMCID: PMC4012171 DOI: 10.1186/1475-925x-13-54] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/22/2014] [Indexed: 12/31/2022] Open
Abstract
Background We and others have previously demonstrated that adipose-derived stem cells (ASCs) transplantation improve cardiac dysfunction post-myocardium infarction (MI) under hemodynamic stress in rats. The beneficial effects appear to be associated with pleiotropic factors due to a complex interplay between the transplanted ASCs and the microenvironment in the absence of cell transdifferentiation. In the present work, we tested the hypothesis that mechanical stretch per se could change human ASCs (hASCs) into cardiovascular cell phenotypes that might influence post-MI outcomes. Methods Human ASCs were obtained from patients undergoing liposuction procedures. These cells were stretched 12%, 1Hz up to 96 hours by using Flexercell 4000 system. Protein and gene expression were evaluated to identify cardiovascular cell markers. Culture medium was analyzed to determine cell releasing factors, and contraction potential was also evaluated. Results Mechanical stretch, which is associated with extracellular signal-regulated kinase (ERK) phosphorylation, failed to induce the expression of cardiovascular cell markers in human ASCs, and mesenchymal cell surface markers (CD29; CD90) remained unchanged. hASCs and smooth muscle cells (SMCs) displayed comparable contraction ability. In addition, these cells demonstrated a profound ability to secrete an array of cytokines. These two properties of human ASCs were not influenced by mechanical stretch. Conclusions Altogether, our findings demonstrate that hASCs secrete an array of cytokines and display contraction ability even in the absence of induction of cardiovascular cell markers or the loss of mesenchymal surface markers when exposed to mechanical stretch. These properties may contribute to beneficial post-MI cardiovascular outcomes and deserve to be further explored under the controlled influence of other microenvironment components associated with myocardial infarction, such as tissue hypoxia.
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Affiliation(s)
| | | | | | | | | | - Jose Eduardo Krieger
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor) - University of São Paulo School of Medicine, Avenue Dr, Eneas de Carvalho Aguiar, 44, São Paulo, SP 05403-000, Brazil.
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Mejía OAV, Lisboa LAF, Dallan LAO, Pomerantzeff PMA, Trindade EM, Jatene FB, Kalil Filho R. Heart surgery programs innovation using surgical risk stratification at the São Paulo State Public Healthcare System: SP-SCORE-SUS study. Braz J Cardiovasc Surg 2014; 28:263-9. [PMID: 23939324 DOI: 10.5935/1678-9741.20130037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 05/17/2013] [Indexed: 11/20/2022] Open
Abstract
Cardiovascular diseases represent the greatest burden of morbidity and mortality for the health system and cardiac surgery has an important impact on their resolutivity. The association and correlation of patients' demographic and clinical relevant information with the resources required for each stratum represent the possibility to adapt, improve and innovate into the healthcare programs. This project aims to remodel the "InsCor" risk score for the formulation of the SP-SCORE (Sao Paulo System for Cardiac Operative Risk Evaluation) in order to better reflects the complexity of cardiac surgical care. The participating hospitals include the Health Technology Assessment Centers in of the Health Secretariat' HTA Network of São Paulo State (HTA-NATSs / SES-SP). The SP-SCORE will use 10 variables of the InsCor model and others 8 variables with presumed influence in Brazil. The primary endpoints are morbidity and mortality. Bootstrap technique besides automated selection of variables (stepwise) will be used to develop a parsimonious model by multiple logistic regression. This project will contribute for the SUS-SP regionalized health-care (RRAS) sustainability and financing of the CABG and/or heart valve surgery programs promoting equitable allocation, increasing access and effectiveness, as well as characterizing the magnitude of available resources and its impact.
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Affiliation(s)
- Omar Asdrúbal Vilca Mejía
- University of São Paulo Medical School (FMUSP), Beneficência Portuguesa Hospital of São Paulo, São Paulo, SP, Brazil.
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Iglezias JCR, Chi A, Dallan LAO, Moreira LFP, Jatene FB. Surgical myocardial revascularization versus stents. Medical Express 2014. [DOI: 10.5935/medicalexpress.2014.06.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mola RD, Flório J, Pescioto VR, Lovatti DH, Dallan LAO, Rocha-e-Silva R, Figueiredo LPD. Safety and efficacy of hypertonic saline versus isotonic saline solution in off-pump coronary artery bypass grafting. Medical Express 2014. [DOI: 10.5935/medicalexpress.2014.01.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Mejía OAV, Lisboa LAF, Puig LB, Moreira LFP, Dallan LAO, Jatene FB. On-pump or off-pump? Impact of risk scores in coronary artery bypass surgery. Braz J Cardiovasc Surg 2013; 27:503-11. [PMID: 23515722 DOI: 10.5935/1678-9741.20120091] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 11/13/2012] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Remain controversies about the use of cardiopulmonary bypass (CPB) in coronary artery bypass grafting (CABG). The aim of this study was to evaluate the impact of the 2000 Bernstein Parsonnet (2000BP) and EuroSCORE (EU) for choice CPB in CABG. METHODS 1.551 consecutive patients underwent CABG. CPB was used in 1.121 (72.3%) patients. The performance of 2000BP and EU was assessed by calibration, discrimination and correlation tests. For both risk scores, increasing the value of the score and presence of CPB were directly related to a higher risk of death (P<0.05). Therefore with these two variables was constructed a logistic regression model for each risk score, in order to determine in which value of score the presence of CPB increases significantly the risk of death. RESULTS The calibration, like the area under the ROC curve for the group with CPB [2000BP=0.80; EU=0.78] and without CPB [2000BP=0.81; EU=0.85] were appropriate. The Spearman correlation for groups with and without CPB was 0.66 (P<0.001) and 0.62 (P<0.001), respectively. Using the 2000BP, for a value>17.75 the presence of CPB increased the chance of death to 7.4 [CI 95% (4.4-12.3), P<0.0001]. With the EU, for a value >4.5 the presence of CPB increased the chance of death to 5.4 [CI 95% (3.3-9), P<0.0001]. CONCLUSION In decision making, the 2000BP>17.75 or the EU>4.5 guide to identify patients who underwent CABG with CPB increases significantly the chance of death.
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Affiliation(s)
- Omar Asdrúbal Vilca Mejía
- Heart Institute of the Clinical Hospital of the Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
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Mejía OAV, Lisboa LAF, Dallan LAO, Pomerantzeff PMA, Moreira LFP, Jatene FB, Stolf NAG. Validation of the 2000 Bernstein-Parsonnet and EuroSCORE at the Heart Institute - USP. Braz J Cardiovasc Surg 2013; 27:187-94. [PMID: 22996968 DOI: 10.5935/1678-9741.20120033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 05/02/2012] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To validate the 2000 Bernstein Parsonnet (2000BP) and additive EuroSCORE (ES) to predict mortality in patients who underwent coronary bypass surgery and/or heart valve surgery at the Heart Institute, University of São Paulo (InCor/HC-FMUSP). METHODS A prospective observational design. We analyzed 3000 consecutive patients who underwent coronary bypass surgery and/or heart valve surgery, between May 2007 and July 2009 at the InCor/HC-FMUSP. Mortality was calculated with the 2000BP and ES models. The correlation between estimated mortality and observed mortality was validated by calibration and discrimination tests. RESULTS There were significant differences in the prevalence of risk factors between the study population, 2000BP and ES. Patients were stratified into five groups for 2000BP and three for the ES. In the validation of models, the ES showed good calibration (P = 0.596), however, the 2000BP (P = 0.047) proved inadequate. In discrimination, the area under the ROC curve proved to be good for models, ES (0.79) and 2000BP (0.80). CONCLUSION In the validation, 2000BP proved questionable and ES appropriate to predict mortality in patients who underwent coronary bypass surgery and/or heart valve surgery at the InCor/HC-FMUSP.
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Mejía OAV, Lisboa LAF, Tiveron MG, Santiago JAD, Tineli RA, Dallan LAO, Jatene FB, Stolf NAG. Coronary artery bypass grafting in acute myocardial infarction: analysis of predictors of in-hospital mortality. Braz J Cardiovasc Surg 2012; 27:66-74. [PMID: 22729303 DOI: 10.5935/1678-9741.20120011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 02/06/2012] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE Coronary artery bypass grafting (CABG) during the acute phase of infarction (AMI) is associated with increased operative risk. The aim of this study was to determine predictors of in-hospital mortality in patients undergoing CABG in AMI. METHODS During three years, all patients undergoing CABG in AMI were retrospectively analyzed of the institutional database. Sixty variables per patient were evaluated: 49 preoperative variables from the 2000 Bernstein-Parsonnet and EuroSCORE models, 4 preoperative variables not considered in these models (time between AMI and CABG, maximum CKMB, Troponin maximum and ST-segment elevation) and 7 intraoperative variables [(cardiopulmonary bypass (CPB), CPB time, type of cardioplegia, endarterectomy, number of grafts, use of internal thoracic artery and complete revascularization]. Univariate and multivariate analysis for the outcome of in hospital mortality were performed. RESULTS The mean time between AMI and CABG was 3.8 ± 3 days. The overall mortality was 19%. In the multivariate analysis: age > 65 years OR [16.5 (CI 1.8 to 152), P= 0.013]; CPB > 108 minutes [OR 40 (CI 2.7 to 578), P= 0.007], creatinine> 2 mg/dl [OR 35.5 (CI 1.7 to 740), P= 0.021] and systolic pulmonary pressure > 60 mmHg [OR 31 (CI 1.6 to 591), P= 0.022] were predictors of in-hospital mortality. CONCLUSION Conventional preoperative variables such as age > 65 years, creatinine > 2 mg/dl and systolic pulmonary pressure > 60 mmHg were predictive of in-hospital mortality in patients underwent CABG in AMI.
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Affiliation(s)
- Omar Asdrúbal Vilca Mejía
- Heart Institution, Clinics Hospital of the Faculty of Medicine, University of São Paulo (InCor-HCFMUSP), São Paulo, SP, Brazil.
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Mota FA, Marcolan JF, Pereira MHC, Milanez AMDM, Dallan LAO, Diccini S. Comparison study of two different patient-controlled anesthesia regiments after cardiac surgery. Braz J Cardiovasc Surg 2010; 25:38-44. [DOI: 10.1590/s0102-76382010000100011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Indexed: 11/22/2022] Open
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Colafranceschi AS, Monteiro AJDO, Botelho ESL, Canale LS, Rabischoffsky A, Costa IP, Cruz Filho FEDS, Sá RLMDS, Boechat AL, Dallan LAO. Cirurgia vídeo-assistida para a ablação da fibrilação atrial isolada por radiofrequência bipolar. Arq Bras Cardiol 2009; 93:334-42, 327-35. [DOI: 10.1590/s0066-782x2009001000005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2008] [Accepted: 09/11/2008] [Indexed: 11/22/2022] Open
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Iglezias JCR, Dallan LAO, Lourenção A, Celullare AL, Pereira R, Stolf NAG. Degree of risk related to procedures performed in conjunction with surgical myocardial revascularization in octogenarians. Clinics (Sao Paulo) 2009; 64:387-92. [PMID: 19488602 PMCID: PMC2694240 DOI: 10.1590/s1807-59322009000500003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2008] [Accepted: 02/03/2009] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION/OBJECTIVES We determined the degree of risk produced by the association of other surgical procedures with surgical myocardial revascularization in octogenarian patients and identified the risk factors that best explain hospital mortality. METHODS This study was an observational analytical historical cohort study involving octogenarians operated on at our institution between January 1, 2000 and January 1, 2005. We stratified the objective population as follows: Group 1 comprised octogenarians revascularized without associated procedures, and Group 2 comprised octogenarians revascularized with associated procedures. Statistical analyses included the t test for independent samples and multiple logistic regression analysis. Significance was accepted with an alpha error of 5%. RESULTS Univariate analyses revealed the following clinical and statistically significant variables: hospital mortality (P=0.002), diabetes mellitus (P=0.017), preoperative endocarditis (P=0.001), cardiogenic shock (P=0.019), use of an intra-aortic balloon pump (P=0.026), preoperative risk score (Parsonnet), P<0.001, procedure associated with revascularization (P<0.001), medium number of affected coronary arteries (P<0.001), use of extracorporeal circulation (P<0.001), time of extracorporeal circulation (P<0.001), number of distal anastomoses (P=0.002), graft type (P<0.001), postoperative breathing support (P<0.001), stroke (P<0.001), infection (P=0.002), creatinine level (P=0.018), and quality of life score (P=0.050). DISCUSSION/CONCLUSIONS In octogenarian patients, the need for a procedure associated with surgical myocardial revascularization produces an absolute increase in hospital mortality risk of 45%. The variables that contributed to hospital mortality were preoperative endocarditis, preoperative cardiogenic shock, the use of extracorporeal circulation, the length of time of extracorporeal circulation, postoperative creatinine level, and postoperative need for prolonged respiratory support.
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Daroz LRD, Lopes JB, Dallan LAO, Campana-Filho SP, Moreira LFP, Stolf NAG. Prevenção de aderências pericárdicas pós-operatórias com uso de carboximetilquitosana termoestéril. Braz J Cardiovasc Surg 2008; 23:480-7. [DOI: 10.1590/s0102-76382008000400005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Accepted: 10/13/2008] [Indexed: 11/21/2022] Open
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Abstract
INTRODUCTION Saphenous vein grafting is still widely used to revascularize ischemic myocardium. The effectiveness of this procedure is limited by neointima formation and accelerated atherosclerosis, which frequently leads to graft occlusion. A better understanding of this process is important to clarify the mechanisms of vein graft disease and to aid in the formulation of strategies for prevention and/or therapeutics. OBJECTIVE To develop an ex vivo flow system that allows for controlled hemodynamics in order to mimic arterial and venous conditions. METHODS Human saphenous veins were cultured either under venous (flow: 5 ml/min) or arterial hemodynamic conditions (flow: 50 ml/min, pressure: 80 mmHg) for 1-, 2- and 4-day periods. Cell viability, cell density and apoptosis were compared before and after these intervals using MTT, Hoeschst 33258 stain, and TUNEL assays, respectively. RESULTS Fresh excised tissue segments were well preserved prior to the study. Hoechst 33258 and MTT stains showed progressive losses in cell density and cell viability in veins cultured under arterial hemodynamic conditions from 1 to 4 days, while no alterations were observed in veins cultured under venous conditions. Although the cell density from 1-day cultured veins under arterial conditions was similar to that of freshly excised veins, the TUNEL assay indicated that most of these cells were undergoing apoptosis. CONCLUSION The results observed resemble the events taking place during early in vivo arterial-vein grafting and provide evidence that an ex vivo perfusion system may be useful for the identification of new therapeutic targets that ameliorate vein graft remodeling and increase graft patency over time.
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Affiliation(s)
- Ayumi Aurea Miyakawa
- Heart Institute (InCor) and Department of Medicine-LIM 13, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
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Lopes JB, Puig LB, Dallan LAO, Tossuniam CE, Gaiotto FA, Stolf NAG. Hybrid CABG: an alternative for perfusion time decrease. Braz J Cardiovasc Surg 2008; 23:240-4. [PMID: 18820788 DOI: 10.1590/s0102-76382008000200014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2008] [Accepted: 06/17/2008] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the decrease of CPB time and its related complications in CABG using a hybrid alternative method. METHODS Ninety patients were retrospectively analyzed between March 2000 and August 2006. All were treated with three or more grafts and divided into two groups: Group 1 was the hybrid group--45 patients who had been operated by the hybrid technique; Group 2 was the total group--45 patients operated in on-pump. RESULTS In the hybrid group, the CPB time varied from 20 min. to 81 min. In the total group, the CPB time varied from 60 min. to 210 min. (p<0.001). The aorta cross-clamping time varied in the first group from 7 min. to 70 min. In Group 2, from 34 to 100 min. (p<0.001). A statistically significant difference was found between these two groups in relation to the occurrence of postoperative atrium fibrillation and renal dysfunction. CONCLUSION Using the hybrid technique it is possible to reduce the CPB time, as well as the occurrence of some postoperative complications. Probably, this decreasing in atrial fibrillation and renal dysfunction incidences could be explained due to a less significant inflammatory activation, which is a consequence of a shorter CPB time.
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Ladeira RT, Jatene FB, Monteiro R, Zucato SP, Baracioli LM, Hueb AC, Dallan LAO, Puig LB, Oliveira SA, Nicolau JC. Cirurgia de revascularização na fase aguda do infarto do miocárdio: análise dos fatores pré-operatórios preditores de mortalidade. Arq Bras Cardiol 2006; 87:254-9. [PMID: 17057923 DOI: 10.1590/s0066-782x2006001600005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2004] [Accepted: 08/12/2005] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess preoperative predictors of mortality in patients undergoing coronary artery bypass grafting (CABG) within the first 30 days of acute myocardial infarction (AMI). METHODS Between March 1998 and July 2002, 753 AMI patients were consecutively and prospectively entered into a database, 135 (17.9%) of whom underwent isolated CABG and were enrolled in this study. The following prognostic factors were assessed by multivariate analysis: age, gender, diabetes, history of previous AMI, CABG or coronary angioplasty (PTCA), anterior infarct location, Q-wave AMI, the use of fibrinolytics, elapsed time from AMI to the procedure, and presence of complications in the preoperative period. RESULTS Overall in-hospital mortality was 6.7%, ranging from 12.5% in patients with preoperative complications to 1.4% in those with no complications. Only history of previous angioplasty (p = 0.037) and cardiogenic shock (p = 0.002) showed a statistically significant correlation with postoperative mortality. The use of thrombolytics, on the other hand, in the initial management of AMI showed a negative correlation with mortality (p = 0.035). CONCLUSION CABG in the acute phase of MI is associated with distinct operative mortality, depending on the patients preoperative clinical condition. Among those factors analyzed, preoperative cardiogenic shock and history of previous angioplasty were predictive of worse prognosis in this group of patients.
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Rocha-E-Silva R, de Pádua Mansur A, Fabri Junior J, Ramos RB, Cunha Filho CEC, Dallan LAO, de Oliveira SA. Coronary revascularization with the left internal thoracic artery and radial artery: comparison of short-term clinical evolution between elective and emergency surgery. Clinics (Sao Paulo) 2005; 60:227-32. [PMID: 15962084 DOI: 10.1590/s1807-59322005000300008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Left internal thoracic artery-to left anterior descending artery grafting has become a fundamental part of coronary artery bypass grafting. This grafting has led to increased use of other arterial conduits, of which the radial artery is most popular. Whether radial grafting can be used in the emergency patient is not known. This study compares the short-term clinical evolution between elective vs emergency coronary artery bypass grafting surgery with left internal thoracic artery and radial artery. METHODS A retrospective study of 47 patients who underwent elective or emergency coronary artery bypass grafting from 1996 to 2003. All patients had coronary stenosis>70% in all target vessels. Only the left internal thoracic artery and radial artery were used as grafts. Patients were divided into elective group (23 patients) and emergency group (24 patients). Emergency criteria were unstable angina and/or critical coronary stenosis with high risk for acute myocardial infarction. Groups were similar for age and number of diseased vessels. RESULTS The mean number of left internal thoracic artery grafts per patient in the elective and emergency groups were respectively 1.17 and 1.38 (P=.17). The mean number of radial artery grafts per patient in the elective and emergency groups was respectively 2.26 and 2.08 (P=.48). The 30-day mortality was 0. There was no postoperative cardiogenic shock. The elective group had 1 acute myocardial infarction (4.4%) postoperatively, and emergency group had 5 (20.8%). A nonsignificant trend towards acute myocardial infarction was noted in the emergency group (P=.18). Intensive care unit and postoperative stay were similar in both groups. CONCLUSION Coronary artery bypass grafting using left internal thoracic artery and radial artery accomplishing complete revascularization can be performed in emergency patients with results similar to those for elective patients.
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Affiliation(s)
- Roberto Rocha-E-Silva
- Heart Institute, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Oliveira SAD, Dallan LAO, Lisboa LAF, Chavantes MC, Cesar LAM, Pardi MJ, Jatene AD. Transmyocardial laser revascularization. Early clinical experience. Arq Bras Cardiol 1999. [DOI: 10.1590/s0066-782x1999000400005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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