Long-Term Radial Artery Grafts with Previous Midterm Proven Patency

ABSTRACT Introduction: Left internal thoracic artery to left anterior descending artery (LITA-LADA) grafting has become a fundamental part of coronary artery bypass grafting (CABG). This grafting has led to an increased use of other arterial conduits, of which the radial artery (RA) is the most popular. Whether RA can have the same long-term patency as LITA is controversial. The objective of this study is to access the long-term clinical follow-up and, when available, the patency rate of RA grafts. Methods: Twenty-six patients from a previous study with critical stenosis in all target vessels underwent complete arterial CABG with LITA and RA grafts from 1996 to 2003. They all underwent midterm multidetector computed tomography after surgery with the association of at least one patent LITA and one patent RA graft. Results: Twelve patients (46%) are alive with no angina symptoms. Six patients underwent a second image exam 12 to 16 years (average of 14 years) after surgery, with a total of six LITA-LADA and 14 RA grafts with 100% patency rate. Clinical follow-up five to 23 years after surgery (average of 14 years) showed only one death 12 years after surgery related to coronary artery disease (CAD) (3,8%). Another 12 patients died of non-CAD. Conclusion: Patients with midterm associated LITA and RA patent grafts show similar optimal long-term patency rates of both types of grafts with excellent clinical outcome.

Aortic valve replacement: treatment by sternotomy versus minimally invasive approach

Abstract Objective: To compare the results of aortic valve replacement with access by sternotomy or minimally invasive approach. Methods: Retrospective analysis of medical records of 37 patients undergoing aortic valve replacement by sternotomy or minimally invasive approach, with emphasis on the comparison of time of cardiopulmonary bypass and aortic clamping, volume of surgical bleeding, time of mechanical ventilation, need for blood transfusion, incidence of atrial fibrillation, length of stay in intensive care unit, time of hospital discharge, short-term mortality and presence of surgical wound infection. Results: Sternotomy was used in 22 patients and minimally invasive surgery in 15 patients. The minimally invasive approach had significantly higher time values of cardiopulmonary bypass (114.3±23.9 versus 86.7±19.8min.; P=0.003), aortic clamping (87.4±19.2 versus 61.4±12.9 min.; P<0.001) and mechanical ventilation (287.3±138.9 versus 153.9±118.6 min.; P=0.003). No difference was found in outcomes surgical bleeding volume, need for blood transfusion, incidence of atrial fibrillation, length of stay in intensive care unit and time of hospital discharge. No cases of short-term mortality or surgical wound infection were documented. Conclusion: The less invasive approach presented with longer times of cardiopulmonary bypass, aortic clamping and mechanical ventilation than sternotomy, however without prejudice to the length of stay in intensive care unit, time of hospital discharge and morbidity.

Low cost simulator for heart surgery training

Abstract Objective: Introduce the low-cost and easy to purchase simulator without biological material so that any institution may promote extensive cardiovascular surgery training both in a hospital setting and at home without large budgets. Methods: A transparent plastic box is placed in a wooden frame, which is held by the edges using elastic bands, with the bottom turned upwards, where an oval opening is made, "simulating" a thoracotomy. For basic exercises in the aorta, the model presented by our service in the 2015 Brazilian Congress of Cardiovascular Surgery: a silicone ice tray, where one can train to make aortic purse-string suture, aortotomy, aortorrhaphy and proximal and distal anastomoses. Simulators for the training of valve replacement and valvoplasty, atrial septal defect repair and aortic diseases were added. These simulators are based on sewage pipes obtained in construction material stores and the silicone trays and ethyl vinyl acetate tissue were obtained in utility stores, all of them at a very low cost. Results: The models were manufactured using inert materials easily found in regular stores and do not present contamination risk. They may be used in any environment and maybe stored without any difficulties. This training enabled young surgeons to familiarize and train different surgical techniques, including procedures for aortic diseases. In a subjective assessment, these surgeons reported that the training period led to improved surgical techniques in the surgical field. Conclusion: The model described in this protocol is effective and low-cost when compared to existing simulators, enabling a large array of cardiovascular surgery training.

Cirurgia vídeo-assistida para fechamento de canal arterial persistente: estudo em carneiros e experiência clínica inicial / Video-assisted ligation of the patent ductus arteriosus: experimental and clinical initial experience

Objetivo - avaliar a factibilidade e a eficiência do fechamento da persistência do canal arterial (PCA) através da técnica da cirurgia vídeo-assistida (CVA). Métodos - A técnica foi inicialmente empregada em 6 carneiros neonatos (idade 7-15 dias). Foram utilizadas de 3 a 4 incisöes em cada animal entre 3 a 10mm cada, para introduçäo da óptica, do fastador pulmonar e das pinças cirúrgicas, sendo os procedimentos acompanhados através do monitor de vídeo. A dissecçäo foi realizada utilizando-se pequenos ganchos especiais. O fechamento da PCA foi feito por aplicaçäo de 2 clips de titânio. Ao final de 7 dias os animais foram sacrificados e realizado estudo anatomopatológico. Baseados nessa experiência em animais, usou-se a CVA para fechamento de PCA em crianças. Operamos 7 pacientes (idade 17 a 108 meses, 5 do sexo feminino e peso de 11 a 30kg) e em todos a dissecçäo foi feita com CVA, por uma única abertura de 3cm. Resultados - Nos carneiros, a maior dificuldade técnica foi o afastamento do pulmäo, tendo em vista a näo realizaçäo de intubaçäo seletiva. O fechamento do canal foi satisfatório pelo campo visual e comprovado pelo estudo anatomopatológico. A exposiçäo do PCA em crianças foi mais facilmente obtida pela ventilaçäo manual. A ligadura foi obtida em 4 dos 7 pacientes, naqueles onde havia compatibilidade entre o diâmetro do canal e o tamanho do clip, sem intercorrências, sendo a comprovaçäo do fechamento obtida por estudo ecocardiográfico e angiografia digital. Conclusäo - A técnica da CVA para fechamento de PCA mostrou-se viável com baixa morbidade e resultado satisfatório