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MÉTODO: No período de agosto de 1997 a maio de 2001, 250 pacientes multiarteriais, consecutivos, foram submetidos à cirurgia de revascularização do miocárdio sem circulação extracorpórea. A faixa etária dos pacientes variou de 38 a 83 anos (média de 59,9 anos), dos quais 62% eram do sexo masculino. A principal indicação cirúrgica foi a insuficiência coronariana crônica (82%). Todos os pacientes foram operados por esternotomia mediana. RESULTADOS: Três (1,2%) pacientes necessitaram de instalação de circulação extracorpórea. Nos demais 247 pacientes, realizou-se 592 anastomoses, com uma média de 2,4 pontes/paciente. A artéria torácica interna esquerda foi utilizada em 198 (80,1%) pacientes, a artéria torácica interna direita em 5 (2%) pacientes e a veia safena em 247 (100%) pacientes. As artérias coronárias mais revascularizadas foram o ramo interventricular anterior (89%) e o ramo marginal esquerdo (53%). A mortalidade hospitalar global foi de 4%, sendo a principal causa o infarto pós-operatório (1,2%). Morbidade pós-operatória foi constatada em 23 (9,3%) pacientes. O tempo médio de permanência hospitalar foi de 7,7 dias. CONCLUSÃO: Conclui-se da presente investigação, que a revascularização do miocárdio sem circulação extracorpórea em pacientes multiarteriais é factível, reprodutível e com baixo índice de complicações pós-operatórias.
METHODS: From August 1997 to May 2001, off-pump coronary artery bypass grafting (OPCAB) was performed in 250 consecutive patients with multivessel disease. Ages ranged from 38 to 83 years (mean-age 59.9 years) and 62% of the patients were males. The main surgical indication was chronic coronary insufficiency (82%). The surgical approach was through median sternotomy in all patients. RESULTS: Three (1.2%) patients needed cardiopulmonary bypass support. In the 247 remaining patients, we performed 592 grafts (mean 2.4 grafts/patient). The left internal thoracic artery was used in 198 (80.1%) patients, the right internal thoracic artery in 5 (2%) patients and the saphenous vein in all patients (100%). The most frequently revascularized coronary arteries were the anterior interventricular branch (89%) and the obtuse marginal (53%). The mortality rate was 4% and the main primary cause of death was myocardial infarction (1.2%). Twenty-three (9.3%) patients had major complications in the postoperative period. The mean hospital stay was 7.7 days. CONCLUSION: In conclusion, OPCAB can be safely performed in patients with multivessel disease, with low rates of postoperative complications

IntroductionOptimal surgical management for acute type A aortic dissection (AAAD) remains unclear. The in-hospital mortality rate is still high (15%), and the intraoperative bleeding is an independent risk factor for hospital mortality.ObjectiveThe aim of our study was describe a new method for aortic anastomosis in the repair of AAAD and report the hospital mortality and bleeding complications.MethodsBetween January 2008 and November 2014, 24 patients, 16 male, median age 62 years, underwent surgical treatment of AAAD. The surgical technique consisted of intussusception of a Dacron tube in the dissected aorta, which is anastomosed with a first line of 2-0 polyester everting mattress suture and a second line of 3-0 polypropylene running suture placed at the outermost side. Open distal anastomosis was performed with bilateral selective antegrade cerebral perfusion in 13 (54.1%) patients.ResultsCardiopulmonary bypass and aortic clamping time ranged from 75 to 135 min (mean=85 min) and 60 to 100 min (mean=67 min), respectively. The systemic circulatory arrest ranged from 29 to 60 min (mean=44.5 min). One (4.1%) patient required reoperation for bleeding, due to the use of preoperative clopidogrel. The postoperative bleeding was 382-1270 ml (mean=654 ml). We used an average of 4.2 units of red blood cells/patient. There were two (8.3%) hospital deaths, one due to intraoperative bleeding and another due to mesenteric ischemia. The average length of stay in the intensive care unit and hospital was 44 hours and 6.7 days, respectively.ConclusionThis new method for surgical correction of AAAD was reproducible and resulted in satisfactory clinical outcomes.

Aortoplastia redutora com contenção externa associada à troca valvar aórtica em pacientes de alto riscoReduction aortoplasty with external wrapping associated with aortic valve replacement in highrisk patients Abstract Objective: To assess the midterm follow-up of reduction aortoplasty with external wrapping associated with aortic valve replacement in high risk patients.Methods: Six patients with ascending aortic aneurysm and aortic valve disease were included in this study. Four of them were male. The age ranged from 61 to 70 years (mean 65.7 years). One patient presented severe mitral valve insufficiency. All patients underwent aortic valve replacement (83.3% with aortic insufficiency and 16.7% with aortic stenosis). The inclusion criteria were: surgical aortic valve disease, ascending aortic aneurysm > 5.5 cm, EuroSCORE > 6 and age above 60 years. The ascending aortic diameter ranged from 57 to 68 mm (mean 63.7 mm). Data were analyzed by paired T test for comparison between the studied variables and P < 0.05 was considered significant.Results: All patients underwent reduction aortoplasty with external wrapping associated with aortic valve replacement. The postoperative hospital mortality and morbidity was 0% and 16.7% (atrial fibrillation), respectively. The mean ascending aortic diameter was 37.0 + 4.5mm after 6 months of follow-up (P < 0.0001, compared with the preoperative period). The actuarial survival curve after 28 months of follow-up was 100%.

Objective: Evaluate the efficacy of the extended vertical transseptal approach in mitral valve reoperation with a small left atrium. Method: From January 2001 to December 2002, 15 patients with previous mitral operation, small left atrium and atrial fibrillation underwent mitral valve surgery through an extended vertical transseptal incision. There were nine women and six men. Their ages ranged from 22 to 48 years. The main surgical indication was mitral prosthetic dysfunction in six patients, pure mitral regurgitation in five and mitral stenosis with regurgitation in four. Three patients had associated aortic regurgitation and one patient had associated tricuspid regurgitation. Nine patients (60%) were in congestive heart failure function class III (NYHA) and 6 patients (40%) in function class IV. Results: In all patients this approach provided excellent exposure. The cardiopulmonary bypass time ranged from 65 to 150 minutes (mean = 95 min). The mitral valve was replaced in 15 patients, the aortic valve in three and the tricuspid valve in one. One patient died secondary to cardiogenic shock and multiple organ failure (hospital mortality 6.6%). Another patient had pneumonia in the postoperative period (morbidity 7.1%). Ten patients remained in atrial fibrillation, three regained sinus rhythm and one was in nodal rhythm. The mean hospital stay was 8.2 days. Twelve patients (85%) have been in NYHA functional class I and two patients (15%) in functional class II. Actuarial survival rate at 22 months is 92.5%. Conclusion: The extended vertical transseptal approach provides excellent mitral valve exposure without inherent complications.

Resumo Objetivo?A s?ndrome de Terson (ST) (hemorragia v?trea) tem sido relatada em pacientes com hemorragia subaracn?idea por ruptura de aneurisma. O presente estudo tem por objetivo avaliar a presen?a de hemorragia ocular em tais pacientes, visando identificar os que se beneficiariam com o tratamento espec?fico para recupera??o do d?ficit visual. M?todos?Foram estudados, prospectivamente, 53 pacientes com hemorragia subaracn?idea espont?nea por ruptura de aneurisma, em rela??o ? presen?a de hemorragia v?trea, atrav?s de fundoscopia indireta, com seguimento de 6 a 12 meses. Resultados?As idades variaram de 17 a 79 anos (m?dia?=?45,9???11,7), sendo que 39 pacientes (73%) eram mulheres, e 14, homens (27%). Observou-se que seis pacientes (11%) apresentavam ST, sendo que 83,3% tiveram perda de consci?ncia transit?ria durante o ?ctus. Conclus?o?A avalia??o oftalmol?gica deve ser realizada rotineiramente nos pacientes portadores de HSAE, especialmente naqueles com pior grau neurol?gico. Al?m disso, os pacientes portadores da ST apresentaram pior progn?stico.

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