GOMES, WJ ET AL -Coronary artery and myocardial inflammatory reaction induced by intracoronary stentRev Bras Cir Cardiovasc 2002; 17(4): 293-298 Alterações inflamatórias das artérias coronárias e do miocárdio induzidas por stents coronários Coronary artery and myocardial inflammatory reaction induced by intracoronary stent Resumo: Objetivo: Stents intracoronários têm sido extensivamente utilizados na revascularização coronária percutânea. Entretanto, apesar dos avanços e desenvolvimento nessa área, novas complicação tem emergido obrigando o cirurgião cardíaco a enfrentar esta nova situação. A presença do stent poderia induzir reação inflamatória tipo corpo-estranho com repercussão funcional na artéria coronária e no músculo cardíaco.Casuística e Método: Pacientes portadores de stents intracoronários e submetidos a cirurgia de revascularização miocárdica foram submetidos a biopsia da artéria coronária no local imediatamente distal ao stent e do músculo adjacente. Os materiais foram processados e estudados histologicamente.Resultados: Os estudos histológicos mostraram intenso processo inflamatório agudo, com predomínio de leucócitos polimorfonucleares na íntima das artérias coronárias, mesmo em pacientes no seguimento tardio, evidenciando um processo inflamatório continuado. A análise do miocárdio adjacente ao local de implante exibiu também processo infiltrativo inflamatório, compatível com miocardite.Conclusão: O uso de stents intracoronários desencadeia um processo inflamatório crônico que pode ser reagudizado, com envolvimento miocárdico e dos segmentos distais da artéria coronária. Estudos adicionais são necessários para avaliar a extensão do processo inflamatório e suas conseqüências.Descritores: stent, cirurgia de revascularização miocárdica, inflamação.

ObjectiveTo report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients.MethodsData collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8), Northeast (5), South (3), and Center-West (1). The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG), mitral valve, aortic valve (either conventional or transcatheter), surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults.Results83.1% of patients came from the public health system (SUS), 9.6% from the supplemental (private insurance) healthcare systems; and 7.3% from private (out-of -pocket) clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%; for CABG was 2.6%, and for valve operations, 4.4%.ConclusionThis first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.

Introduction Coronary artery bypass grafting (CABG) is the most frequently performed heart surgery in Brazil. Recent international guidelines recommend that national societies establish a database on the practice and results of CABG. In anticipation of the recommendation, the BYPASS Registry was introduced in 2015. Objective To analyze the profile, risk factors and outcomes of patients undergoing CABG in Brazil, as well as to examine the predominant surgical strategy, based on the data included in the BYPASS Registry. Methods A cross-sectional study of 2292 patients undergoing CABG surgery and cataloged in the BYPASS Registry up to November 2018. Demographic data, clinical presentation, operative variables, and postoperative hospital outcomes were analyzed. Results Patients referred to CABG in Brazil are predominantly male (71%), with prior myocardial infarction in 41.1% of cases, diabetes in 42.5%, and ejection fraction lower than 40% in 9.7%. The Heart Team indicated surgery in 32.9% of the cases. Most of the patients underwent cardiopulmonary bypass (87%), and cardioplegia was the strategy of myocardial protection chosen in 95.2% of the cases. The left internal thoracic artery was used as a graft in 91% of the cases; the right internal thoracic artery, in 5.6%; and the radial artery in 1.1%. The saphenous vein graft was used in 84.1% of the patients, being the only graft employed in 7.7% of the patients. The median number of coronary vessels treated was 3. Operative mortality was 2.8%, and the incidence of cerebrovascular accident was 1.2%. Conclusion CABG data in Brazil provided by the BYPASS Registry analysis are representative of our national reality and practice. This database constitutes an important reference for indications and comparisons of therapeutic procedures, as well as to propose subsequent models to improve patient safety and the quality of surgical practice in the country.

GOMES, WJ ET AL -Coronary artery and myocardial inflammatory reaction induced by intracoronary stentRev Bras Cir Cardiovasc 2002; 17(4): 293-298 Alterações inflamatórias das artérias coronárias e do miocárdio induzidas por stents coronários Coronary artery and myocardial inflammatory reaction induced by intracoronary stent Resumo: Objetivo: Stents intracoronários têm sido extensivamente utilizados na revascularização coronária percutânea. Entretanto, apesar dos avanços e desenvolvimento nessa área, novas complicação tem emergido obrigando o cirurgião cardíaco a enfrentar esta nova situação. A presença do stent poderia induzir reação inflamatória tipo corpo-estranho com repercussão funcional na artéria coronária e no músculo cardíaco.Casuística e Método: Pacientes portadores de stents intracoronários e submetidos a cirurgia de revascularização miocárdica foram submetidos a biopsia da artéria coronária no local imediatamente distal ao stent e do músculo adjacente. Os materiais foram processados e estudados histologicamente.Resultados: Os estudos histológicos mostraram intenso processo inflamatório agudo, com predomínio de leucócitos polimorfonucleares na íntima das artérias coronárias, mesmo em pacientes no seguimento tardio, evidenciando um processo inflamatório continuado. A análise do miocárdio adjacente ao local de implante exibiu também processo infiltrativo inflamatório, compatível com miocardite.Conclusão: O uso de stents intracoronários desencadeia um processo inflamatório crônico que pode ser reagudizado, com envolvimento miocárdico e dos segmentos distais da artéria coronária. Estudos adicionais são necessários para avaliar a extensão do processo inflamatório e suas conseqüências.Descritores: stent, cirurgia de revascularização miocárdica, inflamação.

No abstract

The combination of these technical advances in surgical myocardial revascularization proved efficient and able to contribute to improved benefits in the long term.

Malignant neoplasms are relatively common in the population studied. Skin cancer was the most common type compared to the other types of neoplasms. Solid tumors were more frequently diagnosed than the lymphoproliferative diseases in the population examined.

The use of a female donor for a male recipient is known to have a greater early mortality (OR=1.11, P=0.3), similarly to that of a recipient using vasoactive drugs and waiting in the intensive care unit (OR=2.51, P<0.0001) [13][14][15] .We report the case of a patient undergoing orthotopic cardiac transplantation, who experienced cardiogenic shock due to right ventricular dysfunction secondary to pulmonary hypertension associated with vasoplegia. Because the recipient's clinical condition was critical, a marginal donor was used.In the national literature, we did not find reports of the use of sildenafil for pulmonary hypertension in the postoperative period. The objective of this report is to propose a new and safe manner to treat right ventricular failure secondary to pulmonary hypertension in the postoperative period of cardiac transplantation. Case ReportThe patient was a 33-year-old man with idiopathic dilated cardiomyopathy, who had been in NYHA functional class IV for the preceding 2 years and was hospitalized with low cardiac output and was using catecholamines (dobutamine, 6.6 mcg/kg/min, and dopamine, 8 mcg/kg/min). The patient was hypotensive (blood pressure of 70x40 mmHg), slightly dyspneic at rest, and had hepatomegaly and pulmonary congestion (basal rales in both bases).The patient underwent orthotopic cardiac transplantation on 08/02/2003. Due to his rapid clinical worsening, a marginal organ was used. The marginal donor was a 60-kg female, who had experienced cardiac arrest for 15 minutes 3 days before, was using 12 mcg/kg/min of dopamine, and, on the echocardiogram, had diffuse, mild hypokinesia and preserved overall function.The transplantation was performed according to the bicaval technique with 165 minutes of extracorporeal circulation and 117 minutes of anoxia, under mild hypothermia (32 o C) and use of intermittent anterograde blood cardioplegia. The patient was removed from the extracorporeal circulation after the third attempt and sent to the ICU receiving 0.11 mcg/kg/min of isoproterenol, 0.75 mcg/ kg/min milrinone, and 20mcg/kg/min of dobutamine. His mean blood pressure was 40 mmHg and mean pulmonary arterial pressure was 45 mmHg. His right ventricular contractility was very poor, and he received adrenaline in bolus during transportation and in the first hours at the ICU. Twelve hours after transplantation, the patient was receiving 10mcg/kg/min of dobutamine, 0.96 mcg/kg/min of adrenaline, 0.13 mcg/kg/min of isoproterenol, and 0.41 mcg/kg/ The use of inhaled nitric oxide reduces pulmonary artery pressure, increasing the production of guanosine 3',5'-cyclic monophosphate (GMPc) in the smooth muscle cells of the lung 1 . Specific inhibitors of GMPc phosphodiesterase (PDE5), which hydrolyzes GMPc in vascular smooth muscle, cause pulmonary vasodilation 2-4 .Sildenafil is a specific inhibitor of PDE5 that increases the pulmonary vasodilating effect of inhaled nitric oxide 5-8 , prevents pulmonary hypertensive crises after weaning of nitric oxide in patients with severe pulmonary hypertensio...