Sonication fluid culture from the removed cardiac implants has the potential to improve the microbiological diagnosis of CIDAIs.

Objective: The aim of this study was to assess the performance of the European System of Cardiac Operation Risk Evaluation (EuroSCORE) model to predict mortality of patients undergoing coronary artery bypass surgery in the Cardiovascular Surgery Division of Santa Casa de São Paulo Medical School.Methods: From May 2005 to November 2006, 100 consecutive patients undergoing coronary artery bypass surgery were retrospectively analyzed. The records of these patients were reviewed in order to retrieve the variables included in the EuroSCORE method. The correlation of predicted and observed mortality was compared. Statistical analysis was performed using the chi-square test for univariate analysis and the Hosmer-Lemeshow test for logistic regression.Results: Hospital mortality was 5%. The EuroSCORE univariate analysis findings were as follows: score 0-2 predicted mortality 0.40%, observed 0.00%; score 3-5 predicted mortality 1.45%, observed 0.00%; score greater than 6 predicted mortality 3.15%, observed 7.94%. In spite of these differences the p-value was 0.213 demonstrating no statistical significance. The p-value for the HosmerLemeshow test was < 0.001 indicating poor calibration of the model for this sample.Conclusion: The EuroSCORE model is a simple, 263CAMPAGNUCCI, VP ET AL -EuroSCORE and the patients undergoing coronary bypass surgery at Santa Casa de São Paulo Aplicamos o teste do qui-quadrado para análise univariada e o teste de Hosmer-Lemeshow para ajuste do modelo de regressão logística.Resultados: A mortalidade hospitalar foi 5,0%. Na análise univariada, para escore 0-2 a mortalidade prevista pelo EuroSCORE foi de 0,40% e a encontrada 0%. Para o escore 3-5, a mortalidade prevista foi de 1,45% e a encontrada 0%. Para escore >6, a mortalidade prevista foi de 3,15% e a encontrada 7,94%. As discrepâncias entre as porcentagens observadas e previstas não foram estatisticamente significantes (p = 0,213

IntroductionChagas disease is a major cause of cardiomyopathy and sudden death in our country. It has a high mortality when their patients develop New York Heart Association (NYHA) class IV.ObjectiveThe objective of this study is to analyze the clinical outcome of patients with Chagas' cardiomyopathy with congestive heart failure with optimized pharmacological therapy, undergoing cardiac resynchronization therapy.MethodsBetween January 2004 and February 2009, 72 patients with Chagas' cardiomyopathy in NYHA class III and IV underwent cardiac resynchronization therapy and were monitored to assess their clinical evolution. We used the t test or the Wilcoxon test to compare the same variable in two different times. A P value < 0.05 was established as statistically significant.ResultsThe average clinical follow-up was 46.6 months (range 4-79 months). At the end of the evaluation, 87.4% of patients were in NYHA class I or II (P<0.001). There was response to therapy in 65.3% of patients (P<0.001), with an overall mortality of 34.7%.ConclusionIn patients with chronic Chagas cardiomyopathy undergoing cardiac resynchronization therapy, we found the following statistically significant changes: improvement in NYHA class and increase of left ventricle ejection fraction, a decrease of the systolic final diameter and systolic final left ventricle volume and improvement of patient survival.

The authors describe the operative technique approach and its post-operative course used in an adult patient with coarctation of aorta, in which it was not possible to perform the traditional correction with an end-to-end anastomosis with graft interposition. During the surgery it was necessary to make an extra-anatomic bypass: ascending-descending aorta with an enlarged left posterior-lateral thoracotomy approach. The authors also make a short review of several possible approaches used for extra-anatomic bypass as well as its advantages and drawbacks.

Objective: To analyze the in-hospital outcome of elderly patients aged 70 years and older who were operated on, using the beating heart coronary artery bypass grafting with an intraluminal shunt, in urgent, emergent and elective coronary revascularizations. Methods: From July 1989 to July 2005, prospectively, we analyzed 87 patients aged 70 to 92 years old. In the whole group, 50 (57.5%) patients had unstable angina, with three (3.4%) acute myocardial infarction. Thirty-one (35.6%) patients underwent urgent and emergent surgery. Thirteen (14.9%) patients had myocardial infarction in less than 30 days and 34 (39.1%) in more than 30 days.Results: The main postoperative complications were: atrial fibrillation (32.2%), heart failure (12.6%), pneumonia (10.3%), septicemia (3.4%), acute myocardial infarction (2.3%), mediastinitis (1.1%) transient ischemic attack (1.1%) and pneumothorax (1.1%). The mean extubation time was 18.50±19.09 hours, the intensive care unit stay was 2.92±2.03 days, and hospital stay was 10.55±7.16 days. Nine (10.34%) patients received blood transfusion with no reoperation for bleeding. The in-hospital mortality was 4.6%.Conclusions: In 70 years old and over patients, elective and non-elective off-pump coronary artery bypass grafting with intracoronary shunt showed to be safe and effective, associated with low rates of postoperative complications and mortality in relation to the studied population. 41SILVA, AMRP ET AL -Off-pump myocardial revascularization in the elderly:analysis of morbidity and mortality Bras Cir Cardiovasc 2008; 23(1): 40-45 Rev

No abstract

Aneurismectomia de ventrículo esquerdo com o coração batendo ininterruptamente: resultados imediatosLeft ventricular aneurysmectomy with continuous beating heart: early results AbstractObjective: Operative mortality after left ventricle aneurysmectomy is close to 15%. Specifically for this procedure, forms of myocardial protection have been little discussed. The purpose of this study was to evaluate immediate results of left anterior ventricular aneurysmectomy using the beating heart approach.Method: We performed a retrospective analysis of 34 patients who underwent a left anterior ventricular aneurysmectomy, both with and without revascularization, from January 1997 to May 2005. The series consisted of 20 males and 14 females with a mean age of 52 years-old (range: 28 to 76). All of them were operated on using cardiopulmonary bypass and normothermia; aortic cross-clamping was not used but the open-beating heart technique was. We evaluated the perioperative mortality, thromboembolic events, duration of cardiopulmonary bypass, the length of stay in intensive care unit and the use of invasive ventilatory assistance.Results: There were no perioperative mortalities or thromboembolic events. The cardiopulmonary bypass time was 85 minutes (range: 25-150 minutes). Invasive ventilatory assistance was used on average for 18 hours (range: 8-96 hours) and the mean stay in the intensive unit care was 3.1 days (range: 2-14 days). Conclusion:The beating heart approach constitutes a safe and efficient cardioprotective method for anterior left ventricle aneurysmectomy procedures.Descriptors: Heart aneurysm. Heart arrest, induced. Myocardial ischemia. Treatment outcome. J Cardiovasc Surg 2006; 21(1): 55-61 56 CAMPAGNUCCI, VP ET AL -Left ventricular aneurysmectomy with continuous beating heart: early results Braz INTRODUCTIONIntervention in the acute phase of myocardial infarctions with precocious reperfusion by thromboembolic therapy or angioplasty enables a reduction in mortality due to acute coronary insufficiency. Consequently, there is an increase of patients who present with complications with the evolution of chronic myocardial ischemia [1,2]. These events mainly emerge due to congestive heart failure (CHF) and arrhythmias. There is risk of sudden death in the complex forms of ventricular arrhythmia, but there is a high morbidity seen in patients with CHF. The quality of life of these patients is compromised with limitations and even the inability to do productive activities with frequent hospitalization.Coronary artery bypass grafting or percutaneous surgery to treat ischemic CHF must always be considered and used for patients with coronary injuries who can not be treated by other techniques. However, these alternatives are not always adequate and it is necessary to consider other kinds of intervention, specifically in patients who are refractive to pharmacologic treatment. Heart transplantation is the radical alternative for the most severe forms of CHF; it is not used in a scale proportional to the incidence of the ...

No abstract