Luis Ernesto Avanci

Risk stratification with troponin I in patients undergoing myocardial revascularization surgery.

OBJECTIVE To determine the immediate behavior and the prognostic value in terms of late survival of serum troponin I measurement in patients undergoing myocardial revascularization surgery with extracorporeal circulation. METHODS We studied 88 random patients, 65 (73.8%) of the male sex, who underwent myocardial revascularization surgery with extracorporeal circulation. Troponin measurements were performed as follows: in the preoperative period, right after intensive care unit admission, and on the first and second postoperative days. Values below 0.1 nanogram per milliliter (ng/mL) were considered normal. The cut points for late prognostic assessment were 0.5 ng/mL; 1 ng/mL; 2.5 ng/mL; and 5 ng/mL. RESULTS The serum troponin I levels were elevated on the first postoperative day, suggesting the occurrence of specific myocardial damage. Patients with a poor prognosis could be identified, because the serum levels above 2.5 ng/mL and 5 ng/mL in the postoperative period resulted, respectively, in mortality rates of 33% and 50% in a maximum 6-month follow-up. CONCLUSION Troponin I values around 2.5 ng/mL in the postoperative period should call attention to the need for more aggressive diagnostic or therapeutical measures.

Revascularização do miocárdio com cirurgia minimamente invasiva (MIDCAB): resultados em 46 pacientes

Objective: To present the experience with myocardial revascularization by Minimally Invasive Direct Coronary Artery Bypass Graft via left anterior minithoracotomy without extracorporeal circulation (MIDCAB). Material and Methods: 46 patients were submitted to MIDCAB from February 1997 to January 1998. Everyone has obstructive disease in the proximal portion of the interventricular descending artery (IDA). The technique consisted of a small transverse incision, of about 8.0 cm, traverse, in the left infra-mammary area, allowing good visibility and easy access for dissection of the thoracic internal artery (TIA) and anastomosis with IDA. The evaluation of the results was made by clinical, laboratory and angiographic control. Results: The mean duration of operation was 2 hours with about 18 hours of permanence in ICU and 5 days of maximum hospital stay. There were no intra-operative deaths. There was a case of sudden death after discharge (15o post-operative day). The patients followed did not refer anginal pain. Four cases of TIA occlusion and 2 AIA stenoses were documented, probably secondary to vessel banding during the procedure. There was no correlation between troponin-I blood levels and occlusion of the graft. It was verified that the levels of troponin-I in patients submitted to MIDCAB were significantly lower than in the conventional procedure. There was no significant clinical complication. Conclusions: MIDCAB has proved to be a useful procedure with low morbidity and mortality, with the possibility of shorter hospital stay and consequent lower cost. The low Troponin-I blood levels indicate reduced myocardial injury during the procedure.

O tratamento operatório da dissecção aórtica crônica tipo A em pacientes submetidos à revascularização cirúrgica do miocárdio

Surgical treatment of aortic dissection is a challenge for the cardiac surgeon, especially in patients undergoing cardiac operations. Our objective in this case report is to demonstrate how we treat the chronic type A aortic dissection in patients revascularized using percutaneous arterial and venous cannulae.Surgical treatment of aortic dissection is a challenge for the cardiac surgeon, especially in patients undergoing cardiac operations. Our objective in this case report is to demonstrate how we treat the chronic type A aortic dissection in patients revascularized using percutaneous arterial and venous cannulae.

Implantation of transcatheter aortic valve prosthesis through the ascending aorta concomitant with coronary artery bypass grafting without cardiopulmonary bypass

Introdution The transcatheter aortic valve implantation in the treatment of high-risk symptomatic aortic stenosis has increased the number of implants every year. The learning curve for transcatheter aortic valve implantation has improved since the last 12 years, allowing access alternatives. Objective The aim of this study is to approach the implantation of transcatheter aortic valve through transaortic via associated with off-pump cardiopulmonary bypass surgery in a 67-year-old man, with chronic obstructive pulmonary disease, arterial hypertension and kidney transplant. Methods Off-pump coronary artery bypass surgery was performed and the valve in the aortic position was released successfully. Results There were no complications in the intraoperative and postoperative period. Gradient reduction, effective orifice increasing of the prosthesis and absence of valvular regurgitation after implantation were observed by transesophageal echocardiography. Conclusion Procedural success demonstrates that implantation of transcatheter aortic valve through the ascending aorta associated with coronary artery bypass surgery without CPB is a new option for these patients.

Implantation of transcateter aortic valve prosthesis through ascending aorta concomitant with myocardial revascularization without cardiopulmonary bypass

Introdution The transcatheter aortic valve implantation in the treatment of high-risk symptomatic aortic stenosis has increased the number of implants every year. The learning curve for transcatheter aortic valve implantation has improved since the last 12 years, allowing access alternatives. Objective The aim of this study is to approach the implantation of transcatheter aortic valve through transaortic via associated with off-pump cardiopulmonary bypass surgery in a 67-year-old man, with chronic obstructive pulmonary disease, arterial hypertension and kidney transplant. Methods Off-pump coronary artery bypass surgery was performed and the valve in the aortic position was released successfully. Results There were no complications in the intraoperative and postoperative period. Gradient reduction, effective orifice increasing of the prosthesis and absence of valvular regurgitation after implantation were observed by transesophageal echocardiography. Conclusion Procedural success demonstrates that implantation of transcatheter aortic valve through the ascending aorta associated with coronary artery bypass surgery without CPB is a new option for these patients.

Hybrid treatment for correction of pseudoaneurysm after surgical treatment of aortic coarctation.

The need for a new surgical procedure for correction of postoperative pseudoaneurysm of aortic coarctation makes the procedure especially challenging for the surgeon.ta abstract.

Cirurgia de revascularização miocárdica após infarto agudo do miocárdio causado por trombose de aneurisma coronariano

The morphology of coronary aneurysm sets a predisposing factor to thrombus formation. However, the blood stasis caused by the change in flow may not be enough to cause thromboembolic events.The morphology of coronary aneurysm sets a predisposing factor to thrombus formation. However, the blood stasis caused by the change in flow may not be enough to cause thromboembolic events.

Implantable cardioverter-defibrillator in pregnant women with hypertrophic cardiomyopathy

Surgical treatment of aortic dissection is a challenge for the cardiac surgeon, especially in patients undergoing cardiac operations. Our objective in this case report is to demonstrate how we treat the chronic type A aortic dissection in patients revascularized using percutaneous arterial and venous cannulae.Surgical treatment of aortic dissection is a challenge for the cardiac surgeon, especially in patients undergoing cardiac operations. Our objective in this case report is to demonstrate how we treat the chronic type A aortic dissection in patients revascularized using percutaneous arterial and venous cannulae.

Aplicabilidade conjunta da endoprótese em reoperação na dissecção de aorta

CLINICAL DATA We present the case of a 68-year-old male patient, who had been submitted to correction of aortic type-A correction 10 years previously. During outpatient follow up he presented with intense sharp thoracic pain irradiating to the dorsum. He was in a good general health, eupneic, afebrile in functional class I (NYHA). His thorax was symmetrical and the heart rhythm was regular with two clicks. The pulmonary auscultation was symmetrical without adventitious sounds. The abdomen was without change. The pulses were palpable in the four limbs with a slight reduction in the left upper limb and lower limbs.

Impact of serum troponin I in the long-term evolution of patients submitted to resynchronization with biventricular stimulation: follow-up of up to 59 months

OBJECTIVE: To analyze the evolution and prognostic influence of the cardiac troponin I serum levels in patients with congestive heart failure (CHF) submitted to interventricular resynchronization (VR) over a 59-month follow-up period. METHOD: Thirty-three patients with idiopathic dilated myocardiopathy in NYHA functional classes III and IV were submitted to VR. The pre- and post-operative quality of life (QV) was analyzed using the Minnesota Code and the left ventricle function was assessed by echocardiography. The cardiac troponin I levels were compared in 23 patients utilizing the Fisher exact test to analyze the correlation with death and the Kaplan-Meier curve was used to analyze the survival rate. RESULTS: The QV was better after VR with a median of 73 points in the pre-operative period and 36 in the postoperative period (p-value < 0.0001). The left ventricle diastolic diameter (LVDD) reduced from 65 mm in the preoperative period to 60 mm in the postoperative period (p-value = 0.0014) with an increase in the ejection fraction from 37 to 47% (p-value = 0.0004). In 15 patients with normal cardiac troponin I levels, no deaths occurred and of the 8 patients with high levels, six died (p-value = 0.0003). The actuarial survival curve showed a survival rate of 47.1 ± 13.3% at the end of 59 months. CONCLUSION: VR in patients with CHF improves the QV and echocardiographic parameters (ejection fraction and LVDD). It is a good alternative for functional class III and IV patients. The serum levels of cardiac troponin I are predictors of risk to life.