Impact of COVID-19 Pandemic in a Brazilian High-Volume Aortic Center.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic brought an unprecedented lack of control of what was to come. The intent of this document is to provide a balance of how much was ceased to be done for patients with aortic disease, to assess the mortality of these patients, and to show what happened to those who became COVID-19 positive during their hospitalization. METHODS: From April 1st to July 31st 2020, the worst period of the pandemic in São Paulo, Brazil, the Institute's aortic surgical patients operated on were evaluated and those were compared with patients operated during the same period in 2019. RESULTS: In 2019, 88 surgeries were performed; most of them were elective (66 [75%]), 10 were urgent, and 12 were emergency surgeries. In 2020, during the COVID-19 pandemic, we operated on only 31 patients, being 74.2% non-elective surgeries (P<0,001). There was a higher mortality for patients operated on during the pandemic surge of COVID-19 (P<0,001), but it was not specifically related to infected patients. CONCLUSION: The COVID-19 pandemic had an impact on surgical volume and outcome of patients with aortic disease, although it did not directly increase mortality.

Impact of COVID-19 Pandemic in a Brazilian High-Volume Aortic Center

Abstract Introduction: The coronavirus disease 2019 (COVID-19) pandemic brought an unprecedented lack of control of what was to come. The intent of this document is to provide a balance of how much was ceased to be done for patients with aortic disease, to assess the mortality of these patients, and to show what happened to those who became COVID-19 positive during their hospitalization. Methods: From April 1st to July 31st 2020, the worst period of the pandemic in São Paulo, Brazil, the Institute's aortic surgical patients operated on were evaluated and those were compared with patients operated during the same period in 2019. Results: In 2019, 88 surgeries were performed; most of them were elective (66 [75%]), 10 were urgent, and 12 were emergency surgeries. In 2020, during the COVID-19 pandemic, we operated on only 31 patients, being 74.2% non-elective surgeries (P<0,001). There was a higher mortality for patients operated on during the pandemic surge of COVID-19 (P<0,001), but it was not specifically related to infected patients. Conclusion: The COVID-19 pandemic had an impact on surgical volume and outcome of patients with aortic disease, although it did not directly increase mortality.

Can tricuspid annuloplasty of the donor heart reduce valve insufficiency following cardiac transplantation with bicaval anastomosis?

BACKGROUND: The aim of this study was to evaluate the degree of tricuspid valve insufficiency after orthotopic cardiac transplantation with bicaval anastomosis and prophylactic donor heart annuloplasty. METHODS: At present, our cardiac transplantation experience includes 478 cases. After January 2002, we included 30 consecutive patients in this study who had undergone orthotopic cardiac transplantation and survived >6 months. The patients were divided into 2 groups: group I, 15 patients who underwent transplantation with prophylactic tricuspid annuloplasty on the donor heart with the De Vega technique; and group II, 15 patients who underwent transplantation without this procedure. Their preoperative clinical characteristics were the same. During the late postoperative follow-up, the degree of tricuspid insufficiency was evaluated by transthoracic Doppler echocardiography and assessed according to the Simpson scale: 0, absent; 1, mild; 2, moderate; and 3, severe. Hemodynamic parameters were evaluated invasively by means of a Swan-Ganz catheter during routine endomyocardial biopsies. RESULTS: The mean follow-up time was 26.9 +/- 5.4 months (range, 12-36 months). In group I, 1 patient (6.6%) died from infection in the 18th month after the operation; the death was not related to the annuloplasty. In group II, 1 death (6.6%) occurred after 10 months because of rejection (P > .05). After the 24-month follow-up, the mean degree of tricuspid insufficiency was 0.4 +/- 0.5 in group I and 1.7 +/- 0.9 in group II (P < .05). Similarly, the 2 groups were significantly different with respect to the right atrium pressure, which was higher in group II. CONCLUSIONS: Prophylactic tricuspid annuloplasty on the donor heart was able to reduce significantly the degree of valvular insufficiency, even in cardiac transplantation with bicaval anastomosis; however, it did not modify significantly the hemodynamic performance of the allograft during the investigation period. It is very important to extend the observation period and casuistics to verify other benefits that this technique may offer.

Aneurysmal dilation of the reimplant segment of the visceral vessels after thoracoabdominal aneurysm correction.

We present a case of aneurysmal dilation of the aortic residual segment, involving abdominal vessels in corrective surgeries for thoracoabdominal aortic aneurysm, through the identification of risk groups for recurrent dilation, aiming at using a specific operative technique with a branched graft, to prevent aneurysm relapse.

Dilataçäo aneurismática do segmento de reimplante dos vasos viscerais após correçäo de aneurisma toracoabdominal / Aneurysmal dilation of the reimplant segment of the visceral vessels after thoracoabdominal aneurysm correction

We present a case of aneurysmal dilation of the aortic residual segment, involving abdominal vessels in corrective surgeries for thoracoabdominal aortic aneurysm, through the identification of risk groups for recurrent dilation, aiming at using a specific operative technique with a branched graft, to prevent aneurysm relapse

Substituição da valva mitral nas cardiomiopatias dilatadas com insuficiência mitral secundária / Replacement of the mitral valve in dilated cardiomyopathy with secondary mitral regurgitation

A insuficiência mitral funcional nas cardiomiopatias dilatadas ocorre em razão das alterações da geometria do ventrículo esquerdo e dos aparelhos valvar e subvalvar. A sobrecarga de volume decorrente da insuficiência mitral resulta no aumento progressivo da cavidade ventricular e do anel mitral, agravando a disfunção ventricular. O objetivo deste trabalho é estudar o resultado da substituição valvar mitral associado ao remodelamento ventricular nesse grupo de pacientes. No período de julho de 2000 a fevereiro de 2003, 20 pacientes consecutivos portadores de insuficiência mitral funcional (classe funcional III e IV) e cardiomiopatia dilatada idiopática foram submetidos a troca da valva mitral associada ao remodelamento ventricular esquerdo. Foram avaliados segundo as alterações hemodinâmicas e ecocardiográficas e quanto à evolução clínica. A análise estatística foi obtida por meio do teste t de Student e a análise de sobrevida, pelo método de Kaplan-Meyer. A mortalidade hospitalar foi de 10 por cento e a curva atuarial demonstrou sobrevida de 74 por cento + 14,8 por cento aos 30 meses de seguimento; após seguimento médio de 11,2 meses, 82 por cento dos pacientes encontram-se em classe funcional I e II. A avaliação hemodinâmica apresentou melhora do débito e do índice cardíacos (p < 0,00001 para ambos). A avaliação ecocardiográfica demonstrou melhora da fração de ejeção (p = 0,01), redução dos diâmetros sistólico e diastólico final esquerdo (p = 0,0007 e p = 0,03) e redução do volume sistólico final esquerdo (p = 0,03). A troca valvar mitral associada ao remodelamento ventricular foi capaz de reduzir os sintomas, melhorar a qualidade de vida e prolongar a sobrevida desses pacientes.