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1.
Gomes, Walter J.; Rocco, Isadora; Pimentel, Wallace S.; Pinheiro, Aislan H. B.; Souza, Paulo M. S.; Costa, Luiz A. A.; Teixeira, Marjory M. P.; Ohashi, Leonardo P.; Bublitz, Caroline; Begot, Isis; Moreira, Rita Simone L; Hossne Jr, Nelson A.; Vargas, Guilherme F.; Branco, João Nelson R.; Teles, Carlos A.; Medeiros, Eduardo A. S.; Sáfadi, Camila; Rampinelli, Amândio; Moratelli Neto, Leopoldo; Rosado, Anderson Rosa; Mesacasa, Franciele Kuhn; Capriata, Ismael Escobar; Segalote, Rodrigo Coelho; Palmieri, Deborah Louize da Rocha Vianna; Jardim, Amanda Cristina Mendes; Vianna, Diego Sarty; Coutinho, Joaquim Henrique de Souza Aguiar; Jazbik, João Carlos; Coutinho, Henrique Madureira da Rocha; Kikuta, Gustavo; Almeida, Zely SantAnna Marotti de; Feguri, Gibran Roder; Lima, Paulo Ruiz Lucio de; Franco, Anna Carolina; Borges, Danilo de Cerqueira; Cruz, Felipe Ramos Honorato De La; Croti, Ulisses Alexandre; Borim, Bruna Cury; Marchi, Carlos Henrique De; Goraieb, Lilian; Postigo, Karolyne Barroca Sanches; Jucá, Fabiano Gonçalves; Oliveira, Fátima Rosane de Almeida; Souza, Rafael Bezerra de; Zilli, Alexandre Cabral; Mas, Raul Gaston Sanchez; Bettiati Junior, Luiz Carlos; Tranchesi, Ricardo; Bertini Jr, Ayrton; Franco, Leandro Vieira; Fernandes, Priscila; Oliveira, Fabiana; Moraes Jr, Roberto; Araújo, Thiago Cavalcanti Vila Nova de; Braga, Otávio Penna; Pedrosa Sobrinho, Antônio Cavalcanti; Teixeira, Roberta Tavares Barreto; Camboim, Irla Lavor Lucena; Gomes, Eduardo Nascimento; Reis, Pedro Horigushi; Garcia, Luara Piovan; Scorsioni, Nelson Henrique Goes; Lago, Roberto; Guizilini, Solange.
Rev. bras. cir. cardiovasc ; 36(6): 725-735, Nov.-Dec. 2021. tab, graf
Article in English | LILACS | ID: biblio-1351666

ABSTRACT

Abstract Introduction: We investigated the clinical course and outcomes of patients submitted to cardiovascular surgery in Brazil and who had developed symptoms/signs of coronavirus disease 2019 (COVID-19) in the perioperative period. Methods: A retrospective multicenter study including 104 patients who were allocated in three groups according to time of positive real time reverse transcriptase-polymerase chain reaction (RT-PCR) for the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2): group 1, patients who underwent cardiac surgery > 10 days after positive RT-PCR; group 2, patients with a positive RT-PCR within 10 days before or after surgery; group 3, patients who presented positive RT-PCR > 10 days after surgery. The primary outcome was mortality and secondary outcomes were postoperative complications, intensive care unit (ICU) length of stay, and postoperative days of hospitalization. Results: The three groups were similar with respect to age, the European System of Cardiac Operative Risk Evaluation score, and comorbidities, except hypertension. Postoperative complications and death were significantly higher in groups 2 and 3 than in group 1, and no significant difference between groups 2 and 3 was seen. Group 2 showed a high prevalence of surgery performed as an urgent procedure. Although no significant differences were observed in ICU length of stay, total postoperative hospitalization time was significantly higher in group 3 than in groups 1 and 2. Conclusion: COVID-19 affecting the postoperative period of patients who underwent cardiovascular surgery is associated with a higher rate of morbidity and mortality. Delaying procedures in RT-PCR-positive patients may help reduce risks of perioperative complications and death.


Subject(s)
Humans , COVID-19 , Brazil , Retrospective Studies , Perioperative Period , SARS-CoV-2
2.
Rev. bras. cir. cardiovasc ; 36(3): 397-405, May-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1288234

ABSTRACT

Abstract Coronary artery bypass grafting (CABG) has consolidated its role as the most effective procedure for treating patients with advanced atherosclerotic coronary artery disease, reducing the long-term risk of myocardial infarction and death compared to other therapies and relieving angina. Despite the recognized benefits afforded by surgical myocardial revascularization, a subset of higher-risk patients bears a more elevated risk of perioperative stroke. Stroke remains the drawback of conventional CABG and has been strongly linked to aortic manipulation (cannulation, cross‐clamping, and side-biting clamping for the performance of proximal aortic anastomoses) and the use of cardiopulmonary bypass. Adoption of off-pump CABG (OPCAB) is demonstrated to lower the risk of perioperative stroke, as well as reducing the risk of short-term mortality, renal failure, atrial fibrillation, bleeding, and length of intensive care unit stay. However, increased risk persists owing to the need for the tangential ascending aorta clamping to construct the proximal anastomosis. The concept of anaortic (aorta no-touch) OPCAB (anOPCAB) stems from eliminating ascending aorta manipulation, virtually abolishing the risk of embolism caused by aortic wall debris into the brain circulation. The adoption of anOPCAB has been shown to further decrease the risk of postoperative stroke, especially in higher-risk patients, entailing a step forward and a refinement of outcomes provided by the primeval OPCAB technique. Therefore, anOPCAB has been the recommended technique in patients with cerebrovascular disease and/or calcification or atheromatous plaque in the ascending aorta and should be preferred in patients with high-risk factors for neurological damage and stroke.


Subject(s)
Humans , Coronary Artery Disease/surgery , Stroke/etiology , Stroke/prevention & control , Coronary Artery Bypass, Off-Pump , Mammary Arteries , Coronary Artery Bypass
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