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ABSTRACT: Complete revascularization is considered superior to incomplete revascularization (IR), with better long-term survival and a lower rate of reintervention. However, it has yet to be established whether this difference is due directly to IR as a surgical strategy or whether this approach is merely a marker of more severe coronary disease and more rapid progression. We believe that IR is a prognostic marker for a more complex coronary pathology, and adverse effects are probably due to the preoperative condition of the patient. In fact, although IR may negatively affect long-term outcomes, it may be, when wisely chosen, the ideal treatment strategy in selected high-risk patients. IR can derive from a surgical strategy of target vessel revascularization, where the impact of surgery is minimized to reduce perioperative mortality and morbidity, aiming to achieve the best feasible safe revascularization.
Interactive cardiovascular and thoracic surgery 11/2011; 14(2):176-82.
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ABSTRACT: Multiple strategies to achieve some degree of myocardial revascularization are available. In some, less complete revascularization is accepted to limit invasiveness, mostly in older, high-risk patients and patients with unsuitable coronary anatomy.
Patient and operative data were collected retrospectively for all patients with three-vessel coronary artery disease who had off-pump coronary artery bypass surgery from January 2003 through December 2005. In-hospital outcomes, preoperative risk, survival and postoperative complications were compared between patients with complete (n = 89) and incomplete (n = 61) revascularization.
The mean follow-up was 20.2 +/- 4.6 months. Patients with incomplete revascularization tended to be older (76.8 +/- 1.4 years) than those with complete revascularization (66.3 +/- 1.0 years) and were more likely to have diabetes (43% versus 30%), cerebrovascular disease (18% versus 11%) and peripheral arterial disease (20% versus 9%), poorer ejection fraction (34.7 +/- 1.7% versus 50.8 +/- 1.5%) and greater EuroSCORE risk (9.7 +/- 2.1 vs. 5.1 +/- 1.3). In-hospital (3.3% versus 3.4%) and 6-month (4.9% versus 5.6%) mortality were not statistically different in the two groups, nor was recurrence of angina (3.3% versus 1.1%) or need for repeat revascularization (percutaneous or surgical) (4.9% versus 3.3%).
In high-risk patients with three-vessel coronary artery disease, the potential benefits of less invasive surgery should be considered. Surgical outcomes depend on preoperative condition rather than incomplete revascularization. Medium-term mortality and cardiac-related events associated with this surgical strategy are not increased.
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 11/2008; 27(10):1239-47.
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Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 03/2007; 26(2):185-6.
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Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 07/2005; 24(6):907-8.
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ABSTRACT: A task force commission was created with the support of the Portuguese Society for Cardiothoracic and Vascular Surgery with the aim of organizing a National Adult Cardiac Surgery Registry, collecting clinical data and types of cardiac surgical procedure performed in Portugal. Selected variables include risk factors, cardiac status, preoperative hemodynamics, surgical procedure, hospital stay and mortality. Information is collected into a database in each institution and sent via the internet to a central database responsible for grouping and data analysis. It is hoped that this National Registry, through standardized data collection, will provide information on cardiac surgery activity in Portugal and its risk adjusted results.
Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology 11/2003; 22(10):1173-80.
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ABSTRACT: Left ventricular tumors are extremely rare. Complete surgical resection is usually curative and recurrence is rare. The left atrial approach is safe and advisable when possible. We report a rare case of left ventricular tumor in a 71-year-old man presented with a cerebellar stroke. A two-dimensional echocardiogram revealed a mobile mass with the stalk attached deeply in left ventricular wall. To improve surgical access, a transversal aortotomy was performed and the mass was gently pulled and excised. Intracavitary left ventricular tumors, which are deeply situated, difficult to see, and inaccessible via left atriotomy, may be made surgically accessible by a transaortic approach. A vetriculotomy should be avoided.
Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular 13(1):17-9.
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ABSTRACT: The Carney Complex is a very rare autosomal dominant disease including multiple neoplasia syndrome. This syndrome was initially described in 1985 under the rubric "...the complex of myxomas, spotty pigmentation, and endocrine overactivity". We present a case report of an old woman with Carney Complex who had the characteristic features of facial hirsutism and acromegalic facies, a large pigmented swelling over the face and a cardiac myxoma arising from the left atrium. We emphasize the need for periodic echocardiographic screening of patients and family members.
Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular 13(2):79-81.
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ABSTRACT: A task force commission was created with the support of the Portuguese Society for Cardiothoracic and Vascular Surgery with the aim of organizing a National Adult Cardiac Surgery Registry, collecting clinical data and types of cardiac surgical procedures performed in Portugal. Selected variables include risk factors, cardiac status, preoperative hemodynamics, surgical procedure, hospital stay and mortality. The aim of the project is still far from the expected. However, patients' preoperative risk is clearly shown, based on demographic data and risk factors.
Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular 14(1):11-4.
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ABSTRACT: Adequate exposure of the mitral valve is essential to the safe and effective performance of valve replacement. After a right pneumonectomy, shift of the mediastinum and reduction in respiratory function makes cardiac surgery challenging not only for the surgeon but also for the anaesthetist. We report our experience on performing mitral valve replacement in two patients with previous right pneumonectomy to highlight certain important features while managing these patients.
Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular 15(1):11-4.
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ABSTRACT: Recently we published preoperative risk factors, cardiac status and hemodynamics of Portuguese patients before cardiac surgery. Now we report the type of surgical procedures carried out in 5 portuguese hospitals between January of 2003 and December of 2006. In Portugal coronary artery bypass is still the more prevalent cardiac surgery, in spite of the increase on percutaneous coronary interventions.
Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular 14(2):75-7.
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Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular 10(1):25-7.
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ABSTRACT: Aortic arch aneurysms may be treated with different surgical approaches. Each case represents a complex opportunity for choosing the best available strategy. We present three different cases in which a particular surgical choice was found to be the most adequate to the specific problem.
Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular 14(4):191-4.
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ABSTRACT: The purpose of this study was to investigate the operative results and the clinical outcomes of Portuguese octogenarians who underwent cardiac surgery. Records of 339 consecutive octogenarians who had had cardiac operations between 2003 and 2005 were reviewed. The effect of cardiac and operative risk factors on mortality was evaluated. Selected variables included risk factors, cardiac status, preoperative hemodynamics and surgical procedures were collected on all patients. The mean age was 82.4+/-2.4 years-old (range 80-94) and 51.9% were male. Octogenarians had often diabetes (23.6%), renal failure (5.9%), cerebrovascular disease (8.3%), peripheral vascular disease (16.5%) and chronic lung disease (10.0%). The surgical priority was elective for 206 patients, urgent for 120 patients and it was emergent for 8 patients. Coronary artery bypass grafting was performed in 46.9%of patients, valve surgery was performed in 31.6% and combination of these in 19.5% of patients. Overall hospital mortality was 10.0%. Operative mortality for coronary artery bypass and valve surgery were 9.4% and 8.0%, respectively. Combined surgery (16.7%), diabetes (15.7% vs 9.3%, p<0.05), and urgent/emergent (14.3% vs 7.3%, p<0,05) increased significantly operative mortality. In conclusion, cardiac surgery can be performed within acceptable limits of risk and an acceptable mortality. Several factors might help both in case selection and in perioperative decisions.
Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular 16(2):65-8, 70.
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ABSTRACT: Intraoperative aortic dissection is a rare but potentially fatal complication of cardiac surgery. In this report, we present a case of intraoperative aortic dissection during a Bentall operation for annulo-aortic ectasia repair combined with mitral valve replacement. The aorta was successfully repaired using another dacron tube graft after profound hypothermic circulatory arrest.
Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular 18(3):157-9.
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Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular 15(2):119.
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ABSTRACT: After formation of fungus ball in pre-existing cavities, antifungal agents are very hard to control the infection. Surgical resection offers the only realistic chance of a permanent cure for aspergilloma. However, surgical indications are still a controversy because of the high incidence of postoperative complications. The purpose of this study was to evaluate our indications and results in the surgical treatment of aspergilloma, focusing attention on the postoperative complications and risk factors. From 1990 to 2004, 60 patients with mean age of 44.6 (range, 20-69) were submitted to pulmonary surgery for excision of aspergilloma. Forty-one patients (68.3%) were male, 25 patients (41.7%) were smokers and 47 (78.3%) had tuberculosis as the underlying lung disease. The most frequent indication for surgery was haemoptysis (88.3%). The cavities were mainly situated in the upper lobes (85.0%) and in the right lung (68.3%). Approximately half of aspergillomas (56.7%) were classified as complex aspergillomas. The procedures performed were : 7 pneumectomies (11.7%), 3 bilobectomies (5.0%), 42 lobectomies (70.0%), 7 wedge resections (11.7%) and one cavernostomy (1.7%). There were 3 postoperative deaths (5%), and major complications occurred in 16.3% of the patients including: bleeding (n=3) and bronchopleural fistula (n=2). Recurrence rate was 3.3%. Surgical resection of pulmonary aspergilloma is effective in preventing recurrence of hemoptysis. Preoperative preparation of the patient, meticulous surgical technique, asn postoperative care reduced the rate of complications. We recommend early surgical resection of symptomatic cases with reasonable complications.
Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular 15(3):135-8.
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ABSTRACT: Over the past 20 years, there have been marked increased rates in cardiac surgery among the elderly in Portugal. To evaluate the effects of increasing age on outcome after cardiac surgery, 5652 patients who underwent cardiac surgery from 2003 to 2005 in five portuguese hospitals, were entered into a retrospective study. Patients were placed in five groups according to age: (1) 80 and older, (2) 70-79, (3) 60-69, (4) 50-59 or (5) less than 50. Selected variables included risk factors, cardiac status, preoperative hemodynamics and surgical procedures. In-hospital mortality was collected on all patients. The mean age was 64.7+/-11.6 years-old and younger patients were more often male than older patients (74.4% vs 51.9%). Preoperative COPD and peripheral vascular disease rates increased for those older than 60 years and decreased for those aged 30 to 49 years. Octogenarians had more congestive heart failure (62.5% vs 37.7%), urgent operations (39.2% vs 26.4%), aortic valve surgery (44.5% vs 26,8%) and off-pump CABG (77.8% vs 57.3%) than the younger groups. Hospital mortality was less than 2.0% in patients younger than 69 years-old, 3.5% in septuagenarians and 10,0%in octogenarians. While patients age at operation significantly influenced hospital mortality, this appeared to be a consequence of the increased frequency of risk factors and comorbidities together with decreased physiologic reserve in patients over 80 years of age.
Revista portuguesa de cirurgia cardio-toracica e vascular: orgao oficial da Sociedade Portuguesa de Cirurgia Cardio-Toracica e Vascular 15(4):189-93.
