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COVID-19 has placed a tremendous burden on physicians worldwide, especially women physicians, affected by increased workload and loss of quality of life.To assess the effects of the COVID-19 pandemic on the quality of life, burnout and spirituality of Brazilian women physicians directly or indirectly providing care to COVID-19 patients.Prospective, observational study performed from July 28 to September 27, 2020, in Brazil, with women physicians from 47 specialities, the most frequent being cardiology (22.8%), with no age restriction. They voluntarily answered an online survey with questions on demographic and socioeconomic characteristics, quality of life (WHOQOL-brief), spirituality (WHOQOL-SRPB), and statements from the Oldenburg Burnout Inventory. Statistical analysis used the R software, beta regression, classification trees, and polychoric correlation matrix, with a 5% of significance level.Of the 769 respondents, 61.6% reported signs of burnout. About 64% reported wage loss of up to 50% during the pandemic. Some reported lack of energy for daily tasks, frequent negative feelings, dissatisfaction with capability for work, and caring for others not adding meaning to their lives. Negative feelings correlated negatively with satisfaction with sexual life and personal relations, and energy for daily tasks. The inability to remain optimistic in times of uncertainty correlated positively with feeling unsafe daily and not acknowledging that caring for others brings meaning to life.This study showed a high frequency of burnout among Brazilian women physicians who answered the survey during the COVID-19 pandemic. Nevertheless, they presented with a relatively good quality of life and believed that spirituality comforted and reassured them in hard times.A COVID-19 adicionou um fardo enorme sobre os médicos ao redor do mundo, especialmente as mulheres médicas, que são afetadas pelo aumento da carga de trabalho e pela perda da qualidade de vida.Avaliar os efeitos da pandemia de COVID-19 na qualidade de vida, burnout e espiritualidade de médicas brasileiras que atendem pacientes com COVID-19 direta ou indiretamente.Estudo prospectivo, observacional realizado de 28 de julho a 27 de setembro de 2020, no Brasil, com mulheres médicas de 47 especialidades, a mais frequente sendo a cardiologia (22,8%), sem restrição de idade. Elas responderam voluntariamente um questionário online com questões sobre características demográficas e socioeconômicas, qualidade de vida (WHOQOL-brief) e espiritualidade (WHOQOL-SRPB) e enunciados do Oldenburg Burnout Inventory. A análise estatística utilizou o software R, regressão beta, árvores de classificação e matriz de correlação policórica, com nível de significância de 5%.Das 769 respondentes, 61,6% relataram sinais de burnout. Cerca de 64% relataram perda salarial de até 50% durante a pandemia. Algumas relataram falta de energia para as tarefas diárias, sentimentos negativos frequentes, insatisfação com a capacidade para o trabalho, e que cuidar de outras pessoas não agregava sentido às suas vidas. Os sentimentos negativos correlacionaram-se negativamente com a satisfação com a vida sexual, a satisfação com as relações pessoais e a energia para as tarefas diárias. A incapacidade de permanecer otimista em tempos de incerteza correlacionou-se positivamente com a sensação de insegurança no dia a dia e com o não reconhecimento de que cuidar de outras pessoas trouxesse sentido à vida.O presente estudo mostrou uma alta frequência de burnout entre as médicas brasileiras que responderam ao questionário durante a pandemia de COVID-19. Apesar disso, apresentavam uma qualidade de vida relativamente boa e acreditavam que a espiritualidade trazia-lhes conforto e segurança nos momentos difíceis.

Background The objectives of this study are to validate the Quality of Life in Cardiovascular Surgery (QLCS) questionnaire and to observe the evolution of quality of life in the first year of postoperative follow-up of patients who underwent coronary artery bypass grafting (CABG). Methods This was a prospective observational study of patients undergoing CABG from July 2016 to June 2017 who survived and answered the QLCS with 1, 6, and 12 months of follow-up. Validation was evaluated for internal consistency by Cronbach’s alpha, test–retest reproducibility by correlation coefficient of concordance, and accuracy for interrater reliability by the kappa statistic. The nonparametric analysis of variance test was used for analysis of repeated measures, during follow-up, of the QLCS was considered significant at p Results Included were 360 patients, with a mean age of 63 years; 72% were men. Cronbach's alpha was 0.82, demonstrating adequate internal consistency. The correlation coefficient of concordance was 0.93 and accuracy 0.99, showing good precision and accuracy. The kappa statistic for questions ranged from 0.58 to 0.78, which ensures a moderate reproducibility. Scores of the QLCS in patients undergoing CABG of 17.69, 18.82, and 19.52 were found at 1, 6, and 12 months, respectively. Thus there was a progressive improvement in quality of life over the first year of follow-up (p Conclusions The QLCS proved to be a good questionnaire in this population, with adequate internal consistency and moderate reproducibility. Its use revealed a progressive and significant improvement in the quality of life of patients undergoing CABG.

Choosing a surgical specialty can be a hard decision for a medical student. Several studies present data showing that most medical students fear the surgical field and end up switching to another specialty. For cardiovascular surgery, the scenario is very similar. In the last decades, the interest in cardiovascular surgery has been decreasing worldwide and the cardiothoracic surgical societies across the globe have been trying to understand the factors that push away medical students and general surgical residents from the specialty. In this regard, our work aims to focus on describe the access of students to cardiovascular surgery, especially during medical school, as well as to provide a brief report of our current data regarding the specialty.

Objective: To investigate whether hybrid repair has supremacy over conventional open repair in aortic arch diseases. Methods: A comprehensive search was undertaken in two major databases (PubMed and MEDLINE) to identify all studies comparing the two surgical techniques in five years, up to December 2018, that met the established criteria in this study. The search returned 310 papers, and 305 were selected after removing duplicates. The abstracts of the remaining articles were assessed, resulting in 15 studies that went to full-text analysis. After application of the inclusion and exclusion criteria, 8 papers remained for the final revision. Results: Eight studies met the criteria, with the inclusion of 1,837 patients. From a short-term perspective, hybrid repair and conventional open repair had similar outcomes in terms of postoperative mortality and acute neurological events. Hybrid repair was associated with less respiratory complications and risk of new intervention, as well as reduced hospital length of stay. Conventional open repair showed better mid- and long-term outcomes. Conclusion: Hybrid repair should be used in selected patients, with a high risk or very high-risk profile for conventional surgery. Finally, since most of the current data were obtained from limited to large samples, with narrow follow-up and had great heterogeneity, the best approach to the aortic arch is still variable. Therefore, the decision of the approach should be individualized and evaluated by the whole Heart Team, considering the expertise of the surgical team.

To observe the impact of the use of capnography system adapted to cardiopulmonary bypass (CPB). To measure the concordance between values obtained from continuous monitoring of partial pressure of carbon dioxide in membrane oxygenator exhaustion (PeCO2) and the results observed on arterial blood gas test.Participated in this study 40 patients submitted to elective cardiovascular surgery with CPB. They were divided into two groups: Group 1, with 20 patients submitted to the surgical procedure using blood gas analysis at intermittent intervals (20 - 30 minutes); Group 2, with 20 patients operated with a capnography system adapted applied to membrane oxygenator exhaustion and blood gas test. A test was used to compare arterial partial pressure of carbon dioxide (PaCO2) from group 1 and group 2. In group 2, the strength of the correlation between PeCO2 and PaCO2 was evaluated by a linear regression test. The Bland-Altman method was used to determine the degree of agreement between the two variables.Average and standard deviation of Group 1's PaCO2 (34.6 ± 7.44) and Group 2's PaCO2 / PeCO2 (36.5 ± 4.42) / (39.9 ± 3.98). There was no statistically significant difference in PaCO2 between the groups (P = 0.21). In group 2, PeCO2 and PaCO2 analyzed corrected for esophageal temperature obtained a positive linear correlation (r = 0.79, P0.001), the degree of agreement presented an average 3.47 ± 2.70 mmHg.The continuous PeCO2 monitoring from cardiopulmonary bypass circuit has a positive impact on the result of PaCO2. This instrument confirms and maintains the carbon dioxide (CO2) values into reference parameters.

Objetivo O objetivo primordial desse documento e estimular a melhoria das condicoes de saude das mulheres brasileiras, com foco na doenca cardiovascular (DCV). A DCV e responsavel por 17,5 milhoes de mortes prematuras/ano no mundo, com previsao de aumento para 23 milhoes em 2030. As DCV sao responsaveis por um terco de todas as mortes no Brasil, com semelhanca entre homens e mulheres apos a menopausa. Esses dados revestem-se de maior importância quando consideramos que 80% das mortes prematuras poderiam [...]

Objective: Elaboration and internal validation of the Quality of Life in Cardiovascular Surgery (QLCS) questionnaire adapted to the reality of Brazilian cardiovascular surgery. Methods: Cross-sectional pilot study of a prospective cohort included in the Documentation and Surgical Registry Center (CEDREC) for internal validation of the QLCS questionnaire. Four hundred forty-five patients submitted to cardiovascular surgery and who answered a QLCS questionnaire 30 days after hospital discharge were included. It was applied via telephone. To verify the questions' internal consistency, Cronbach's alpha was used. The total QLCS score was calculated as the sum of 5 questions, ranging from 5 to 25 points. Mann-U-Whitney test was used to relate the symptoms with the quality of life (QoL). Level of significance was 5%. Results: After 30 days of surgery, about 95% of the patients had already returned to normal routine and 19% of them were already performing physical activity. In the evaluation of the QLCS's internal consistency, a Cronbach's alpha of 0.74 was found, suggesting that this was probably an adequate questionnaire to evaluate QoL in this population. In the comparison between the presence and absence of symptoms and the median of QoL, the presence of pain at the incision (P=0.002), chest pain (P

Introduction: The great saphenous vein is widely used as a graft in coronary artery bypass grafting surgery. Complications due to saphenous vein harvesting can be minimized when using ultrasonography mapping and marking. Objective: To analyze by clinical trial the use of vascular ultrasonography to map the saphenous vein in coronary artery bypass grafting to determine viability and dissection site. Methods: A total of 151 consecutive patients submitted to coronary artery bypass surgery with the use of the great saphenous vein as a graft were selected for this prospective study. They were divided into two groups: Group 1 - 84 patients were submitted to ultrasonographic mapping and marking of the saphenous vein; Group 2 - 67 patients had saphenous vein harvested without any previous study. Both groups were coupled with follow-up on the 1st, 5th and 30th postoperative days. Primary endpoints were need for incision of the contralateral leg and wound complications within 30 days. Results: Both legs had to be incised in 6 (8.95%) patients from Group 2 (P=0.0067). Wound complications occurred in 33 (23.4%) patients within 30 days, 21 (35%) from Group 2 e 12 (14.8%) from Group 1 (OR 3.095, 1.375-6.944, CI 95%, P=0.008). Within 30 days there were 4 (2.8%) deaths, all in Group 2 (P=0.036). Conclusion: The use of vascular ultrasonography for mapping of the great saphenous vein in coronary artery bypass surgery has properly identified and evaluated the saphenous vein, significantly reducing wound complications and unnecessary incisions. It would be advisable to use this noninvasive and easy to use method routinely in coronary artery bypass surgery.

Introduction: Active infective endocarditis is associated with high morbidity and mortality. Surgery is indicated in high-risk conditions, and the main determinants of mortality in surgical treatment should be evaluated. Objective: To identify mortality predictors in the surgical treatment of active infective endocarditis in a long-term follow-up. Methods: This prospective observational study involved 88 consecutive patients diagnosed with active infective endocarditis, who underwent surgery between January 2005 and December 2015. Fifty-eight (65.9%) patients were male, the mean age was 50.87±16.15 years. A total of 31 (35.2%) patients had a history of rheumatic fever; 48 (54.5%) had had heart surgery with prosthetic valve implantation; 45 (93.8%) had biological prosthetic valve endocarditis and 3 (6.3%) mechanical prosthetic valve; 40 (45.5%) patients had the disease in their native valve. The mean EuroSCORE II was 8.9±6.5%, and the main surgical indication was refractory heart failure in 38 (43.2%) patients. A total of 68 bioprosthesis (36 aortic, 32 mitral) and 29 mechanical prostheses (12 aortic, 17 mitral) were implanted and three mitral valve plasties performed. A total of 25 (28.4%) patients underwent double or triple valve procedures. Aortic annulus reconstruction by abscess was performed in 18 (20.5%) and six (6.81%) patients had combined procedure. The mean surgery time was 359±97.6 minutes. Results: The overall survival in up to a 10-year follow-up period was 79.5%. In the univariate analysis, the main mortality predictors were positive blood cultures (P=0.003), presence of typical microorganisms (P=0.008), most frequently Streptococcus viridans (12 cases; 25%); C-reactive protein (hazard ratio [HR] 1.034, 95% confidence interval [CI] 1.000 to 1.070, P=0.04); creatinine clearance (HR 0.977, 95% CI 0.962 to 0.993, P=0.005); length of surgery: every five minutes multiplies the chance of death 1.005-fold (HR 1.005, 95% CI 1.001 to 1.009, P=0.0307); age (HR 1.060, 95% CI 1.026 to 1.096, P=0.001); and EuroSCORE II (HR 1.089, 95% CI 1.030 to 1.151, P=0.003). Conclusion: A positive blood culture with typical microorganism, C-reactive protein, age, EuroSCORE II, total surgical time and the presence of postoperative complications were the major predictors of mortality and significantly impacted survival in up to a 10-year follow-up period.

OBJECTIVE:The purpose of this study was to describe a new technique for closure of patent ductus arteriosus (PDA) by minithoracotomy (2.5 a 3.0 cm) and clipping the PDA with titanium clips. MATERIAL AND METHODS: From November 1996 to December 1997, 15 children with PDA underwent surgical closure. The mean age at the time of operation was 2.7 years, mean weight was 13.9 kg. The procedure was through a left minithoracotomy at the 4o intercostal space. The ductus was identified, dissected and isolated. Interruption of ductal flow was performed by direct clipping with two clips. The chest was closed without a chest drain. Unless the patient was ventilator dependent before the closure, the child usually was extubated in the operating room. RESULTS: Color doppler echocardiography demonstrated total occlusion of the ductus in all patients. All 15 patients were discharged from the hospital on the 4o postoperative day (mean). CONCLUSION: We conclude that surgical closure of patent ductus arteriosus with minitoracotomy, without chest tube drainage can be accomplished safely and with low incidence of complications.

Com o objetivo de evitar complicações de reestenose da aorta na evolução tardia dos pacientes submetidos ao tratamento cirúrgico da estenose supravalvar aórtica localizada, provocada por calcificação e enrijecimento de material protético utilizado para ampliação de um ou mais seios de Valsalva, com ou sem secção transversal da aorta, desenvolvemos, de outubro de 1991 a dezembro de 1995, uma modificação técnica, que, sem utilização de enxertos artificiais, apenas com tecido sadio da aorta ascendente, permite ampliação adequada da porção inicial da aorta. Neste período, foram operados 10 pacientes, com diagnóstico clínico e hemodinâmico de estenose supravalvar aórtica localizada. As idades variaram de 11 meses a 38 anos (m = 13,2 anos), o peso variou de 7,500 kg a 56 kg (m = 29,1 kg) e a altura variou de 72 cm a 1,68 m (m = 1,5 m). Seis pacientes eram do sexo masculino. Três eram assintomáticos, 4 tinham dispnéia, 2 cansaço aos esforços, 2 palpitações, 1 parestesia de membros inferiores e 1 cianose ao choro. Seis pacientes eram portadores de síndrome de Williams. O gradiente sistólico entre a cavidade livre do ventrículo esquerdo e aorta variou de 50 mmHg a 100 mmHg (m = 73,5). Os pacientes foram operados com auxílio de circulação extracorpórea, hipotermia moderada, cardioplegia cristalóide, nos 7 primeiros casos, e cardioplegia sangüínea nos 3 últimos. A aorta ascendente foi amplamente dissecada até os vasos da base. Após a transecção total da aorta e ressecção do tecido fibrótico estenosante, realizamos incisões longitudinais do bordo da porção proximal da aorta até o fundo dos seios de Valsalva; a seguir, foram feitas incisões longitudinais na porção distai, nas regiões correspondentes aos postes comissurais, de maneira que cada prolongamento da aorta distai ampliasse um fundo de seio de Valsalva, obtendo uma aorta inicial de aspecto anatômico e dimensões normais.Atualmente, com um período pós-operatório de 3 meses a 4 anos e 5 meses, não houve óbito; todos os pacientes estão assintomáticos, evoluindo satisfatoriamente, sem gradiente entre a cavidade livre do ventrículo esquerdo e aorta ascendente, conforme ecocardiograma, Doppler, ressonância nuclear magnética e estudo hemodinâmico. Estes resultados nos permitem concluir ser esta técnica adequada para a correção cirúrgica da estenose supravalvar aórtica localizada, por não utilizar enxertos artificiais e realizar a sutura da aorta em uma linha sinusoidal, evitando, assim, reestenose.

A abordagem cirúrgica da doença coronária sofreu grandes modificações nos últimos anos. Devido à possibilidade de angioplastia, os doentes encaminhados para cirurgia são aqueles com doença ateromatosa difusa grave e/ou com artérias ocluídas, geralmente responsável por uma área de músculo viável. Assim sendo, a endarterectomia de coronária é um recurso técnico que viabiliza a abordagem destes vasos. Em nosso Serviço, no Hospital do Coração, foram submetidos para cirurgia de revascularização do miocárdio (RM) com endarterectomia, no período de janeiro de 88 a dezembro de 92,110 pacientes(pts.). O sexo masculino predominou, com 99 (90%) pts. Encontramos com função ventricular normal 33 (30%), déficit moderado 71 (64,5%) e severo 6 (5,4%). Doze (10,9%) pts. eram reintervenção para nova RM. Dividimos em 2 grupos quanto ao número de endarterectomias realizadas. Grupo A com uma endarterectomia 104 (94,5%) pts. e Grupo B com mais de uma endarterectomia 6 (5,4%) pts. No Grupo A a coronária esquerda (CE) foi abordada em 38 (36,5%) pts. e a coronária direita (CD) 66 (63,4%) pts. No Grupo B com mais de uma endarterectomia a CE foi abordada 8 vezes e a CD outras 4. Em todos os casos o cirurgião removeu a endoartéria com a placa ateromatosa, com sucesso. A ocorrência de infarto trans-operatório na região da artéria endarterectomizada foi de 7 (6,3%) pts. e em regiões não relacionadas com as artérias manipuladas foi de 3 (2,7) pts. Em 9 (8,1 %) pts. foi realizado procedimento associado, como: aneurismectomia do ventrículo esquerdo 5 (4,5%) pts., troca de valva aórtica 1 (0,9%) e ventrículotomia para retirada de trombo em 3 (2,7%). As complicações mais freqüentes foram: arritmias 26 (23,6%) pts., insuficiência renal aguda 10 (9%) pts., síndrome de baixo débito (SBD) 4 (3,6%) pts. Ocorreram 5 (4,5%) óbitos, tendo como causa mais freqüente a SBD. Quatro (3,8%) pts., do Grupo A e 1 (16,6%) do Grupo B. Com esses resultados, verificamos que a endarterectomia é um procedimento que, utilizado criteriosamente, possibilita uma RM completa e com resultados consistentes. The surgical approach to coronary artery disease has improved a lot during the past two decades. With the widespread use of balloon angioplasty, a growing percentage of surgical patients, have complex coronary pathology. In properly selected patients, coronary endarterectomy has been a valuable adjunt to bypass techiniques by removing obstructing lesions and preparing the distal artery for bypass grafting. Over a 5 years period (1988 to 1993), 2781 patients underwent surgical revascularization at our Instituition (Hospital do Coração). Coronary artery bypass combined with coronary endarterectomy was done in 110 patients. There were 99 men (90%) and 11 women, mean age 58.9 years. For comparation patients were placed into two groups: Group A, patients undergoing endarterectomy to one artery, 104 patients - 94.5%. Group B, patients with more than one endarterectomy - 6 patients 5.4%. Perioperative myocardial infarction envolving the area supplied by the endarterectomized artery occurred in 6.3%, (7 patients). In 3 (2.7%) the infarction was not related with the endarterectomized artery. Complications during the post-operative period were: arrhythmia in 26 patients (23.6%), return to the operation room for control of bleeding in 12 (10.9%), acute renal failure in 10 (9%), and low cardiac output in 4 (3.6%) patients. Operative mortality rate was 4.5% (5/110), due to low cardiac output and multiple organs failure; 4 (3.8%) patients belonged to Group A and 1 to Group B (16.6%). This study demostrates that multiple bypass grafting and adjunt coronary endarterectomy, can yeld good clinical results in patients with difuse coronary artery disease, many of whom would otherwise be inoperable.

Foram analisados 305 casos operados entre janeiro de 1984 e dezembro de 1991, abrangendo os resultados imediatos e a evolução tardia, de 8 meses a 8,5 anos de pacientes operados de aneurisma do VE. A evolução clínica a longo prazo foi integral, isto é, todos os pacientes que receberam alta hospitalar foram acompanhados. A maioria (88,5%) era masculina, com idade entre 33 e 78 anos, sendo que 46% dos pacientes se situavam entre 51 e 60 anos. O sintoma mais freqüente foi dor precordial (73,3%), insuficiência cardíaca (45,9%) e arritmias (24,9%). Quanto à classe funcional (NYHA) 54% dos pacientes estavam na classe 1,52% na classe II, 12,7% na classe III e 28,7% na classe IV, respectivamente. O estudo hemodinâmico revelou aneurisma e deiscência em todos os casos e com lesão coronária obstrutiva em 1 vaso em 20,9% dos pacientes, 2 vasos em 45,9%, 3 vasos em 25,9% e, finalmente, 4 ou mais vasos em 7,2% dos casos. De acordo com a fração de ejeção das porções contrateis do VE foram divididos em Grupo Bom (Fe = 0,58) 34,7% pacientes, Grupo Regular (Fe = 0,35) 54,7% pacientes e Grupo Ruim (Fe = 0,22) 10,4% pacientes. A técnica cirúrgica empregada foi a de corrigir com auxílio da CEC, o aneurisma, com o coração batendo, de maneira a permitir avaliação funcional das áreas contrateis versus fibrose, reconstruir a anatomia contrátil da melhor forma possível e preservar o miocárdio em condições fisiológicas durante o procedimento. Em casos selecionados, logo após a abertura do aneurisma e remoção dos trombos intracavitários, eram revascularizadas as artérias coronárias interessadas através de pinçamentos intermitentes, da aorta (32ºC), deixando-se a reconstrução da cavidade para o final do procedimento. A aneurismectomia isolada foi o único procedimento em 21,3% dos casos, associados a RM em 77,3% e a outros procedimentos em 1,3%. A mortalidade hospitalar global foi de 6,2% sendo de 2,8% no Grupo Bom, 2,9% no Grupo Regular e de 34,3% no Grupo Ruim. Obtiveram alta hospitalar 286 (93,8%) pacientes, dos quais 44,3% se encontram assintomáticos (Grupo Bom 60%, Grupo Regular 40%, Grupo Ruim 57,1%). Ocorreram 7,6% óbitos tardios, distribuídos no Grupo Bom 4,8%, Grupo Regular 7,4% e Grupo Ruim 23,8%. Analisando as curvas atuariais numa evolução até 8,5 anos, os autores concluem que a expectativa de vida para os portadores de aneurisma, de VE que se submetem a tratamento cirúrgico, com ou sem procedimentos associados, é de 85,5% com Fe = 0,58; 87,7% com Fe = 0,35 e 59,3% com Fe = 0,22.

OBJETIVO: Descrever a utilização de ambas artérias mamárias internas (MIs) em pacientes submetidos à operação de revascularização do miocárdio (RM), que sejam portadores de diabetes mellitus (DM). MÉTODO: No período compreendido entre janeiro de 1995 e agosto de 2005, 4.569 pacientes foram submetidos a RM em nossa instituição, sendo que 1.298 eram portadores de DM. A média de idade era de 62 anos, e a mortalidade global foi de 2,18% (100 pacientes). Ambas MIs foram empregadas em 700 pacientes, que foram divididos em dois grupos, portadores de DM (grupo I, com 148 pacientes) e não portadores de DM (grupo II, 552 pacientes). A seleção de pacientes para utilizar estes enxertos foi baseada nas características angiográficas das artérias coronárias e qualidade do esterno quando de sua transsecção. Quando ambos fatores eram considerados favoráveis, foram dissecadas ambas MIs, independente de o paciente ser portador ou não de DM. Durante a dissecção dos enxertos arteriais, tomava-se o cuidado de procurar manter as cavidades pleurais fechadas. RESULTADOS: Houve pouca variação entre os grupos de pacientes no tocante a morbidade e mortalidade. CONCLUSÃO: Nossos dados sugerem que pacientes portadores de DM podem se beneficiar do uso de ambas artérias MIs, com pouco acréscimo de risco quando sua aplicação for adequadamente indicada. OBJECTIVE: We sought to describe the use of both internal mammary arteries (IMA) in patients with diabetes mellitus (DM) submitted to coronary artery bypass grafting (CABG). METHOD: Between January of 1995 to August of 2005, 4.569 patients received isolated CABG in our institution, of these, 1.298 had DM. Mean sample age was 62 years, and total mortality was 2.18% (100 patients). We have used both IMA's in 700 patients, that here are split in two groups, with DM (group I, 148 patients), and without DM (group II, 552 patients). Patient selection for double IMA grafting was based on coronary artery anatomy and sternal bone quality, the later was evaluated during sternal transsection. When these two factors were considered favorable, we harvested both IMA's, not mattering if the patient had or had not DM. During IMA's harvest, care was taken not to open the pleural spaces. RESULTS: There was small difference between the two groups in terms of morbidity and mortality. CONCLUSION: Our data suggest that patients with DM can benefit of double IMA's grafting, with little increase in risk for complications if its application is carefully indicated.

We sought to describe the use of both internal mammary arteries (IMA) in patients with diabetes mellitus (DM) submitted to coronary artery bypass grafting (CABG).Between January of 1995 to August of 2005, 4.569 patients received isolated CABG in our institution, of these, 1.298 had DM. Mean sample age was 62 years, and total mortality was 2.18% (100 patients). We have used both IMA's in 700 patients, that here are split in two groups, with DM (group I, 148 patients), and without DM (group II, 552 patients). Patient selection for double IMA grafting was based on coronary artery anatomy and sternal bone quality, the later was evaluated during sternal transsection. When these two factors were considered favorable, we harvested both IMA's, not mattering if the patient had or had not DM. During IMA's harvest, care was taken not to open the pleural spaces.There was small difference between the two groups in terms of morbidity and mortality.Our data suggest that patients with DM can benefit of double IMA's grafting, with little increase in risk for complications if its application is carefully indicated.

Introduction: Replacement of the aortic valve in patients with a small aortic annulus is associated with increased morbidity and mortality. A prosthesis-patient mismatch is one of the main problems associated with failed valves in this patient population. Objective: To evaluate the long-term mortality predictors in patients with a small aortic annulus undergoing aortic valve replacement with a bioprosthesis. Methods: In this retrospective observational study, a total of 101 patients undergoing aortic valve replacement from January 2000 to December 2010 were studied. There were 81 (80.19%) women with a mean age of 52.81±18.4 years. Severe aortic stenosis was the main indication for surgery in 54 (53.4%) patients. Posterior annulus enlargement was performed in 16 (15.8%) patients. Overall, 54 (53.41%) patients underwent concomitant surgery: 28 (27.5%) underwent mitral valve replacement, and 13 (12.7%) underwent coronary artery bypass graft surgery. Results: Mean valve index was 0.82±0.08 cm2/m2. Overall, 17 (16.83%) patients had a valve index lower than 0.75 cm2/m2, without statistical significance for mortality (P=0.12). The overall 10-year survival rate was 83.17%. The rate for patients who underwent isolated aortic valve replacement was 91.3% and 73.1% (P=0.02) for patients who underwent concomitant surgery. In the univariate analysis, the main predictors of mortality were preoperative ejection fraction (P=0.02; HR 0.01) and EuroSCORE II results (P=0.00000042; HR 1.13). In the multivariate analysis, the main predictors of mortality were age (P=0.01, HR 1.04) and concomitant surgery (P=0.01, HR 5.04). Those relationships were statistically significant. Conclusion: A valve index of < 0.75 cm2/m2 did not affect 10-year survival. However, concomitant surgery and age significantly affected mortality.

Introduction: Advances in modern medicine have led to people living longer and healthier lives. Frailty is an emerging concept in medicine yet to be explored as a risk factor in cardiac surgery. When it comes to CABG surgery, randomized controlled clinical trials have primarily focused on low-risk (ROOBY, CORONARY), elevated-risk (GOPCABE) or high-risk patients (BBS), but not on frail patients. Therefore, we believe that off-pump CABG could be an important technique in patients with limited functional capacity to respond to surgical stress. In this study, the authors introduce the new national, multicenter, randomized, controlled trial "FRAGILE", to be developed in the main cardiac surgery centers of Brazil, to clarify the potential benefit of off-pump CABG in frail patients. Methods: FRAGILE is a two-arm, parallel-group, multicentre, individually randomized (1:1) controlled trial which will enroll 630 patients with blinded outcome assessment (at 30 days, 6 months, 1 year, 2 years and 3 years), which aims to compare adverse cardiac and cerebrovascular events after off-pump versus on-pump CABG in pre-frail and frail patients. Primary outcomes will be all-cause mortality, acute myocardial infarction, cardiac arrest with successful resuscitation, low cardiac output syndrome/cardiogenic shock, stroke, and coronary reintervention. Secondary outcomes will be major adverse cardiac and cerebrovascular events, operative time, mechanical ventilation time, hyperdynamic shock, new onset of atrial fibrillation, renal replacement therapy, reoperation for bleeding, pneumonia, length of stay in intensive care unit, length of stay in hospital, number of units of blood transfused, graft patency, rate of complete revascularization, neurobehavioral outcomes after cardiac surgery, quality of life after cardiac surgery and costs. Discussion: FRAGILE trial will determine whether off-pump CABG is superior to conventional on-pump CABG in the surgical treatment of pre-frail and frail patients. Trial registration: ClinicalTrials.gov, ID: NCT02338947. Registered on August 29th 2014; last updated on March 21st 2016.

Fibrilação atrial de início no pós-operatório (FAPO) de cirurgia cardíaca está associada a aumento de complicações, tempo de internação, mortalidade e, dessa forma, poderia influenciar na qualidade de vida (QV). Os objetivos deste trabalho foram avaliar o impacto na qualidade de vida da FAPO após cirurgia de revascularização miocárdica (CRM), bem como identificar fatores clínicos, ecocardiográficos e perioperatórios preditores de FAPO; avaliar desfechos relacionados à FAPO: tempo de internação, mortalidade hospitalar e após um ano de cirurgia. Quanto aos métodos, os pacientes foram submetidos à CRM isolada em um centro cardiológico terciário, durante o período de julho de 2016 a julho de 2017, divididos em dois grupos: com e sem FAPO. Esse trabalho foi realizado com informações obtidas de um banco de dados da instituição, assim, uma análise retrospectiva de um banco de dados que foi construído a partir de uma coorte prospectiva. A qualidade de vida foi avaliada por meio do questionário Quality of Life in Cardiovascular Surgery (QLCS), aplicado 01 mês, 06 e 12 meses após a cirurgia. Os resultados apontam uma amostra final de 418 pacientes, 341 (81,6%) sem FAPO e 77 (18,4%) com FAPO. A idade apresentou diferença estatisticamente significativa, com média de idade de 62,16 (DP ± 9,06) e 66,04 (DP ± 7,35) anos nos grupos sem e com FAPO, respectivamente (P < 0,001), sendo fator de risco independente para FAPO (OR 1,061; IC 95%: 1,026 1,097; P < 0,001). Doença arterial periférica (DAP) também foi um fator de risco independente para FAPO (OR 3,503; IC 95%: 1,236 9,931; P = 0,018). Houve aumento da pontuação do questionário de QV em ambos os grupos ao longo do tempo, porém sem diferença estatística da QV entre os dois grupos, médias do QLCS com 01, 06 e 12 meses no grupo sem FAPO 17,64(±3,77), 18,91(±3,36), 19,57(±3,28) e com FAPO 17,65(±4,16), 18,24(±3,45), 19,11(±3,81) (P interação = 0,208, P grupo = 0,440, P tempo < 0,001). O tempo total de internação foi maior no grupo FAPO, com diferença média de 3 dias (P < 0,001). Mortalidade hospitalar e com um ano não apresentaram diferença estatisticamente significante (P = 0,625; P = 0,758). Conclui-se que, idade e DAP foram fatores de risco independentes para FAPO. Pacientes com FAPO apresentaram maior tempo de internação. Este estudo não evidenciou diferença na QV entre pacientes com e sem FAPO após CRM, durante o acompanhamento de 01 mês, 6 e 12 meses, dessa forma os dois grupos se comportam de forma similar, com melhora da qualidade de vida ao longo do tempo. New onset postoperative atrial fibrillation (POAF) of cardiac surgery is associated with an increase in patients complications, length of hospital stay and mortality, therefore, POAF could influence quality of life (QoL). The aims of this study were to evaluate the impact on the quality of life of POAF after coronary artery bypass grafting (CABG), as well as to identify predictive clinical, echocardiographic and perioperative factors of POAF; to evaluate outcomes related to POAF, such as length of hospital stay, in-hospital mortality and one-year survival. As for the methods, pacients undergoing isolated CABG in a tertiary cardiology center, from July 2016 to July 2017, divided into two groups, with and without POAF. This study was performed with information obtained from a database of the institution, thus, a retrospective analysis of a database that was built from a prospective cohort. Quality of life assesment was made using the Quality of Life in Cardiovascular Surgery (QLCS) questionnaire, applied 01 month, 06 and 12 months after CABG. The results show a total of 418 patients, 341 (81.6%) without POAF and 77 (18.4%) with POAF. Patients with POAF were older than those without, mean age 62.16 (SD ± 9.06) and 66.04 (SD ± 7.35) years in the groups without and with POAF, respectively (P = 0.001), age was an independent risk factor for POAF (OR 1.061; 95% CI: 1.026 - 1.097; P = 0.001). Peripheral arterial disease (PAD) was also an independent risk factor for POAF (OR 3.50; 95% CI: 1.236 - 9.931; P = 0.018). There was an increase in QoL questionnaire scores in both groups over time, but with no statistical difference in QoL between the two groups, mean QLCS scores at 01, 06 and 12 months in the group without POAF 17.64 (± 3.77), 18.91 (± 3.36), 19.57 (± 3.28) and with POAF 17.65 (± 4.16), 18.24 (± 3.45), 19.11 (± 3 , 81) (P interaction = 0.208, P group = 0.440, P time

Introdução: É crescente o número de pacientes com doença arterial coronariana e angioplastia (ATC) prévia que realizam cirurgia de revascularização do miocárdio (CRM). Estudos demonstraram que a presença de stent aumenta os fatores inflamatórios locais, porém o impacto da ATC prévia nos resultados da CRM ainda é controverso. Objetivo: Primariamente, avaliar o impacto da ATC prévia na qualidade de vida (QV) dos pacientes submetidos à CRM. Secundariamente, avaliar esse impacto na morbimortalidade hospitalar e sobrevida em um ano. Métodos: Estudo prospectivo, longitudinal, com pacientes submetidos à CRM isolada de julho de 2016 a junho de 2017. Os pacientes foram divididos em dois grupos, com e sem ATC prévia. As características clínicas e cirúrgicas, os exames, e as intercorrências foram registradas. Foi realizada a avaliação da QV através do questionário Quality of Life in Cardiovascular Surgery (QLCS) com um, seis e doze meses após a cirurgia. Foi utilizado para análise estatística o teste de Mann Whitney para variáveis quantitativas, o teste Exato de Fisher para as qualitativas e o teste ANOVA não paramétrico para QLCS, curva de Kaplan-­Meier para sobrevivência, e modelo de Cox univariado, com seu hazard risk e intervalo de confiança de 95%. Em seguida, foi realizada análise com propensity matching score. Foi considerado significativo P < 0,05. Resultados: Dos 434 pacientes, 70 pacientes tiveram ATC prévia (16%). Nas características iniciais da amostra a presença de infarto agudo do miocárdio prévio (P = 0,02) e a classe de angina (CCS) (P = 0,04) foram significativas. Dos 394 sobreviventes, 362 completaram o seguimento (92%). A presença de ATC prévia não afetou a QV (P = 0,69), as médias encontradas em um, seis e doze meses no QLCS foram 17,8 (± 3,8), 18,8 (± 3,3), 19,5 (± 3,4) no grupo sem ATC prévia e 17,1 (± 4,1), 18,6 (± 3,6), 19,6 (± 3,6) no com ATC prévia. Os grupos se comportaram de maneira semelhante, com melhora progressiva da QV durante doze meses de seguimento (P < 0,0001). Os desfechos secundários, não apresentaram diferença estatística significativa entre os grupos para: infarto peri-­operatório (P = 0,08), acidente vascular cerebral (P = 1,0), ECCM (P = 0,36), e tempo de internação (P = 0,22), mortalidade intra-­hospitalar (P = 0,11), mortalidade no primeiro ano (P = 0,26), curva de sobrevivência em um ano (P = 0,29). O HR foi de 1,5 com IC (95%)=[0,69 - 3,33]. A mortalidade hospitalar foi de 11,4% no grupo com ATC prévia e 5,8% no grupo sem ATC prévia, aproximadamente o dobro. A incidência de infarto peri-­operatório foi maior no grupo com stent (7,2% vs. 2,8%). Resultados similares foram obtidos na análise com propensity matching score. Conclusão: Este estudo, o qual é o primeiro estudo na literatura mundial a avaliar o impacto da ATC prévia na QV dos pacientes submetidos à CRM, não demonstrou diferença significativa entre os grupos, porém, em comum a melhora progressiva na QV. Foram demonstradas maior taxa de mortalidade hospitalar e infarto peri­operatório no grupo com stent prévio. Introduction: The number of patients with previous coronary artery disease and percutaneous coronary intervention (PCI) who undergo coronary artery bypass grafting (CABG) is increasing. Studies have shown that the presence of stent increases local inflammatory factors, but the impact of previous PCI on CABG results is still controversial. Objective: To evaluate the impact of previous PCI on quality of life (QoL) of patients undergoing CABG. Secondarily, to evaluate this impact on hospital morbidity and mortality, and survival at one year. Methods: Prospective, longitudinal study with patients submitted to isolated CABG from July 2016 to June 2017. Patients were divided into two groups, with and without previous PCI. Clinical and surgical characteristics, examinations and intercurrences were recorded. The QoL was evaluated through the Quality of Life in Cardiovascular Surgery (QLCS) questionnaire at one, six and twelve months after surgery. It was used the Mann Whitney test for quantitative variables, Fisher\'s exact test for qualitative variables and the non-­parametric ANOVA test for QLCS, Kaplan-­Meier survival curve, and univariate Cox model with its hazard risk and interval confidence intervals of 95%. Subsequently, analysis with propensity matching score was performed. P < 0.05 was considered significant. Results: Of the 434 patients, 70 patients had previous PCI (16%). In the initial characteristics of the sample, the presence of previous acute myocardial infarction (P = 0.02) and angina class (CCS) (P = 0.04) were significant. Of the 394 survivors, 362 completed follow-­up (92%). The presence of previous PCI did not affect the QoL (P = 0.69), the means found at one, six and twelve months in the QLCS were 17.8 (± 3.8), 18.8 (± 3.3), 19.5 (± 3.4) in the group without previous PCI and 17.1 (± 4.1), 18.6 (± 3.6), 19.6 (± 3.6) in the previous PCI group. The groups behaved in a similar way, with progressive improvement of QoL for twelve months of follow-­up (P < 0.0001). Secondary outcomes did not present a significant statistical difference between the groups for perioperative infarction (P = 0.08), stroke (P = 1.0), MACCE (P = 0.36), and length of hospital stay (P = 0.22), in-­hospital mortality (P = 0.11), mortality in the first year (P = 0.26), survival curve at one year (P = 0.29). HR was 1.5 with CI (95%) = [0.69-­3.33]. Hospital mortality was 11.4% in the previous PCI group and 5.8% in the group without prior PCI, approximately the double. The incidence of perioperative infarction was higher in the stent group (7.2% vs. 2.8%). Similar results were obtained in the analysis with propensity matching score. Conclusion: This study, witch is the first study in the world literature to evaluate the impact of prior PCI on the QoL of patients submitted to CABG, did not show a significant difference between the groups, but with a progressive improvement in the QoL. There was a higher rate of hospital mortality and perioperative infarction in the group with previous stent.