28SÁ, MPBO ET AL -Risk factors for mediastinitis after coronary artery bypass grafting surgery Bras Cir Cardiovasc 2011; 26.1: 27-35 Rev

We found evidence that argues against any superiority in terms of hard outcomes between blood or crystalloid cardioplegia for myocardial protection during cardiac surgery.

Results: On average, complication occurred within 13 days after operation; in a total of 25 lethal cases (2.4%), deaths occurred in eight (32%). Several risk factors for mediastinitis were identified as follows: 56% diabetes, 56% smoking, 20% obesity, 16% chronic obstructive pulmonary disease, and 8% end-stage renal disease. Mediastinitis was reported in 21 (84%) patients submitted to coronary artery bypass grafting and it was related to a major risk for development of infection (IC 3.44-8.30, P=0.0001). High rates of complications were observed: respiratory failure (44%), stroke (16%), cardiogenic shock (12%), acute renal failure (28%), pulmonary infection (36%), multiple organs failure (16%), and sternal dehiscence (48%). Bacterial cultures of exudates were positive in 84% of patients; Staphylococcus aureus was the most frequently pathogen (28.8%) detected.Conclusion: Mediastinitis remains as a severe surgical complication and difficult to manage in postoperative cardiovascular surgery. The disease has low incidence rate but high lethality. Coronary bypass was associated to a major risk for development of infection.Descriptors: Infection. Mediastinitis. Cardiac surgical procedures.

No abstract

Background: Mediastinitis is a serious complication of median sternotomy and is associated to significant morbidity and mortality. Diabetes is a feared risk factor for mediastinitis and viewed with caution by cardiovascular surgeons.Objective SÁ, MPBO ET AL -Skeletonized left internal thoracic artery is associated with lower rates of mediastinitis in diabetic patientsRev Bras Cir Cardiovasc 2011;26(2):183-9

Estudo comparativo entre cirurgia de revascularização miocárdica com e sem circulação extracorpórea em mulheresComparative study between on-pump and off-pump coronary artery bypass graft in women of Abstract Background: It has been well documented that women have higher morbidity and mortality rates than men following coronary artery bypass graft (CABG) surgery. In view of this evidence, it is necessary to know if there is benefit to off-pump CABG surgery in women in comparison to on-pump CABG.Objectives: Compare outcomes between off-pump CABG and on-pump CABG in women.Methods: Retrospective study. Our investigation analyzes comparatively clinical profile, thirteen procedure complications and mortality of a population of 941 consecutive women undergoing CABG surgery (549 off-pump and 392 on-pump) at two hospitals for the period January 2000 to December 2005.Results: Mortality rate for women undergoing off-pump CABG surgery is lower than for women undergoing on-pump surgery, however, not statistically significant (3.1% vs 5.3%; P=0.134). The complication rates analyzed (hemorrhagic shock, neurologic, respiratory, acute renal failure, adult respiratory distress syndrome, septicemia, pneumonia, atrial fibrillation) were lower (significant statistically difference) for women off-pump than women on-pump, with the exception of low cardiac output and wound infection.Conclusions: Evidence suggests that off-pump CABG surgery may be better for women than on-pump CABG 239 SÁ, MPBO ET AL -Comparative study between on-pump and off-pump coronary artery bypass graft in women Bras Cir Cardiovasc 2010; 25(2): 238-244 in outcomes in female patients undergoing on-pump CABG compared with those undergoing OPCAB, tracing the preoperative clinical profile and analyzing the differences in rates of complications and possible differences in mortality rates. Rev METHODSWe studied 941 female patients undergoing CABG with two centers:

When it comes to neurological outcomes in patients undergoing thoracic aortic surgery, there was no evidence that argues in favor of any choice of arterial cannulation site, which makes us reject any superiority of one approach over the other in this regard.

Perfil clínico-cirúrgico de pacientes operados por ruptura do septo interventricular pós-infarto do miocárdioClinical and surgical profile of patients operated for postinfarction ventricular septal rupture .9% (n = 13) were male. Rupture occurred on average 4.8 days after infarction. Cardiogenic shock was observed in 57.1% (n = 12), being risk factor for death (100% with shock vs 22,2% without shock; P<0.001). Survivors had a higher mean ejection fraction compared to deaths (66.29% ± 4.61% versus 42.71% ± 4.79%, P <0.001). All were classified as high risk by the EuroSCORE, and the survivors had lower mean score compared to deaths (6.57 ± 0.53 versus 10.93 ± 2.23; p <0.001). The majority (76.2%, n = 16) needed to use vasoactive drugs and 57.1% (n = 12) considered hemodynamically unstable. The need for vasoactive drugs was a risk factor for death (81.3% in the vasoactive drugs group versus 20% without vasoactive drugs group, P = 0.025). Hemodynamic instability was also a risk factor for death (100% in the unstable group versus 22.2% in the stable group; P <0.001). The rate of in-hospital mortality was 66.7% (n = 14).Conclusions: The need for vasoactive drugs, hemodynamic instability and cardiogenic shock were associated with higher rates of mortality. Patients who had adverse outcomes had less ventricular function and higher score in the EuroSCORE. Mortality rate remains high.Descriptors: Heart Septal Defects. Heart Rupture, PostInfarction. Myocardial Infarction. 342SÁ, MPBO ET AL -Clinical and surgical profile of patients operated for postinfarction ventricular septal rupture Bras Cir Cardiovasc 2010; 25(3): 341-349 Rev