The troubled heparin issue in the Brazilian market and the search for solutions

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaSão Paulo Medical JournalFAMERPUNICAMPUNIFESP, EPMSciEL

On-pump versus off-pump coronary artery bypass surgery: the impact on costs of health care systems

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaFaculdade de Medicina de São José do Rio PretoUniversidade de CampinasUNIFESP, EPMSciEL

O conceito do heart team nas doenças cardíacas: o paciente novamente como prioridade nas decisões médicas

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaFaculdade de Medicina de São José do Rio PretoUniversidade Estadual de CampinasUNIFESP, EPMSciEL

SYNTAX trial: analysis and clinical implications

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaFAMERPUNICAMPUNIFESP, EPMSciEL

Evolución de la cirugía cardiovascular: la saga brasileña. Una historia de labor, vanguardia y éxito

Faculdade Estadual de Medicina de S.J. Rio PretoUnicamp Faculdade de Ciências MédicasUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM)UNIFESP, EPMSciEL

Vinte e cinco anos de marcapasso

A história do marcapasso (MP) no interior do Estado de Sao Paulo é, de modo geral, a história do MP no Brasil. Ela iniciou-se com MP de freqüência fixa, munido com baterias de mercúrio-zinco, e que permitia aos pacientes com bloqueio AV total ficarem livres da Síndrome de Stokes Adams e da morte súbita

Surgical ablation of atrial fibrillation using energy sources

Surgical ablation, concomitant with other operations, is an option for treatment in patients with chronic atrial fibrillation. The aim of this study is to present a literature review on surgical ablation of atrial fibrillation in patients undergoing cardiac surgery, considering energy sources and return to sinus rhythm. A comprehensive survey was performed in the literature on surgical ablation of atrial fibrillation considering energy sources, sample size, study type, outcome (early and late), and return to sinus rhythm. Analyzing studies with immediate results (n=5), the percentage of return to sinus rhythm ranged from 73% to 96%, while those with long-term results (n=20) (from 12 months on) ranged from 62% to 97.7%. In both of them, there was subsequent clinical improvement of patients who underwent ablation, regardless of the energy source used. Surgical ablation of atrial fibrillation is essential for the treatment of this arrhythmia. With current technology, it may be minimally invasive, making it mandatory to perform a procedure in an attempt to revert to sinus rhythm in patients requiring heart surgery

Chronic atrial fibrillation ablation with harmonic scalpel during mitral valve surgery

Objective: to evaluate surgical treatment of chronic atrial fibrillation with ultrasound in patients with mitral valve disease, considering preoperative clinical characteristics of patients undergoing surgical procedure and follow-up in the immediate postoperative period, in hospital and up to 60 months after discharge. Methods: we studied 100 patients with chronic atrial fibrillation and mitral valve disease who underwent surgical treatment using ultrasound ablation. Patient data were reviewed by consulting the control reports, including signs and symptoms, underlying disease, functional class, hospital stay, surgical procedure time, ablation time, immediate complications, and complications at discharged and up to 60 months later. Actuarial curve (Kaplan-Meier) was used for the study of permanence without recurrence after 12, 24, 36, 48 and 60 months. Results: 86% of the patients had rheumatic mitral valve disease, 14% had degeneration of the mitral valve, 40% had mitral regurgitation, and 36% had mitral stenosis. Main symptoms included palpitations related to tachycardia by chronic atrial fibrillation (70%), congestive heart failure (70%), and previous episodes of acute pulmonary edema (27%). Early results showed that 94% of the patients undergoing ultrasound ablation reversed the rate of chronic atrial fibrillation, 86% being in sinus rhythm and 8% in atrioventricular block. At hospital discharge, maintenance of sinus rhythm was observed in 86% of patients and there was recurrence of chronic atrial fibrillation in 8% of patients. At follow-up after 60 months, 83.8% of patients maintained the sinus rhythm. Conclusion: surgical treatment of chronic atrial fibrillation with ultrasound concomitant with mitral valve surgery is feasible and satisfactory, with maintenance of sinus rhythm in most patients (83.8%) after 60 months of follow-up

Vinte e cinco anos de marcapasso

A história do marcapasso (MP) no interior do Estado de Sao Paulo é, de modo geral, a história do MP no Brasil. Ela iniciou-se com MP de freqüência fixa, munido com baterias de mercúrio-zinco, e que permitia aos pacientes com bloqueio AV total ficarem livres da Síndrome de Stokes Adams e da morte súbita