The Brazilian Registry of Adult Patient Undergoing Cardiovascular Surgery, the BYPASS Project: Results of the First 1,722 Patients

Objective: To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Methods: Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8), Northeast (5), South (3), and Center-West (1). The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG), mitral valve, aortic valve (either conventional or transcatheter), surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults. Results: 83.1% of patients came from the public health system (SUS), 9.6% from the supplemental (private insurance) healthcare systemsand 7.3% from private (out-of-pocket) clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%for CABG was 2.6%, and for valve operations, 4.4%. Conclusion: This first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.Univ Fed Sao Paulo UNIFESP EPM, Hosp Sao Paulo, Sao Paulo, SP, BrazilHosp Caridade Sao Vicente Paulo, Jundiai, SP, BrazilInst Med Integral Prof Fernando Figueira IMIP, Recife, PE, BrazilHosp Base FUNFARME & FAMERP, Sao Jose Do Rio Preto, SP, BrazilIMC, Sao Jose Do Rio Preto, SP, BrazilIrmandade Santa Casa Sao Paulo INCT HPV, Fac Ciencias Med Santa Casa Sao Paulo, Sao Paulo, SP, BrazilFundacao Univ Cardiol, Inst Cardiol Rio Grande do Sul, Porto Alegre, RS, BrazilInst Coracao Natal, Natal, RN, BrazilInst Cardiol Dist Fed, Brasilia, DF, BrazilUniv Fed Maranhao HU UFMA, Univ Hosp, Sao Luis, MA, BrazilHosp Evangelico, Cachoeiro De Itapemirim, ES, BrazilHosp Coracao Sergipe, Aracaju, SE, BrazilHosp Nossa Senhora Salete, Inst Cirurgia Cardiovasc ICCV, Cascavel, PR, BrazilHosp Wilson Rosado, Mossoro, RN, BrazilHosp Bosque Saude, Sao Paulo, SP, BrazilHosp Univ Santa Maria, Santa Maria, RS, BrazilHosp Coracao HCor, Sao Paulo, SP, BrazilHosp Coracao IP HCor, Ins Pesquisa, Sao Paulo, SP, BrazilInst Coracao InCor, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP EPM, Hosp Sao Paulo, Sao Paulo, SP, BrazilWeb of Scienc

Options for a national REDD+ architecture

Key criteria for assessing different institutional options are their overall legitimacy and ability to produce 3E+ outcomes. Four major options for channelling (international) REDD+ finance are projects, funds – independent or within the state administration – and budget support. The mix of these depends crucially on national conditions and the choice of REDD+ actions. Building national REDD+ institutions takes time, and early design might constrain later options. Countries must therefore ensure that the immediate steps taken fit future and more developed solutions

Use of venoarterial extracorporeal membrane oxygenation in fulminant chagasic myocarditis as a bridge to heart transplant

RESUMO Jovem com 17 anos de idade atendido com dispneia progressiva há 15 dias e piora nas últimas 24 horas. Foi admitido em estado de insuficiência respiratória e choque cardiogênico com disfunção de múltiplos órgãos. O ecocardiograma mostrou fração de ejeção ventricular esquerda de 11%, grave hipocinesia difusa e pressão sistólica da artéria pulmonar de 50mmHg. Houve necessidade de suporte hemodinâmico com uso de dobutamina (20mcg/kg/minuto) e noradrenalina (1,7mcg/kg/minuto). Após 48 horas, o paciente não apresentou melhora hemodinâmica nem clínica, optando-se, então, pela implantação de membrana de oxigenação extracorpórea. Ocorreu melhora do ponto de vista hemodinâmico, da perfusão sistêmica, da função renal e hepática, porém, após 72 horas, não houve recuperação da função cardíaca. Optou-se, assim, pela transferência para outro hospital. O paciente foi transferido por transporte aéreo de Salvador (BA) para Recife (PE). Foi realizado transplante cardíaco com rápida recuperação da função hepática e renal, e boa função do enxerto. A histopatologia do coração explantado demonstrou miocardite crônica ativa e amastigotas de Trypanosoma cruzi. A prevalência global estimada de infecção por T. cruzi caiu de 18 milhões em 1991, quando a primeira iniciativa regional de controle teve início, para 5,7 milhões em 2010. A miocardite é uma doença inflamatória causada por condições infecciosas ou não infecciosas. As manifestações clínicas variam desde um quadro subclínico até insuficiência cardíaca e choque cardiogênico. Diversos relatos sugerem que o uso de membrana de oxigenação extracorpórea em pacientes com quadro grave e refratário de miocardite é uma opção como terapia ponte até transplante cardíaco, nos casos sem recuperação espontânea da função ventricular. Em uma consulta ambulatorial de acompanhamento realizada 6 meses após o transplante, o paciente encontrava-se bem e assintomático

Embolization by Bullet Dislodged from the Heart

Abstract Embolization by a dislodged projectile is a rare complication that may occur in cases of gunshot cardiac injuries. We report a case of a firearm projectile cardiac injury that evolved, with dislocation of the projectile during cardiac surgery, into embolization of the right external carotid artery

Embolization by Bullet Dislodged from the Heart

<div><p>Abstract Embolization by a dislodged projectile is a rare complication that may occur in cases of gunshot cardiac injuries. We report a case of a firearm projectile cardiac injury that evolved, with dislocation of the projectile during cardiac surgery, into embolization of the right external carotid artery.</p></div

The Brazilian Society for Cardiovascular Surgery (SBCCV) and Brazilian Society for Extracorporeal Circulation (SBCEC) standards and guidelines for perfusion practice

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Temporal analysis of COVID-19 epidemiological indicators in a low-income Brazilian context: a retrospective analysis in Paraiba State

Northeast Brazil is a region with great international tourist potential. Among the states that make up this region, Paraíba stands out due to the presence of vulnerable groups and factors that contribute to adverse outcomes of COVID-19. Therefore, the aim of this study was to analyze the epidemiological data on the incidence, mortality, and case fatality of COVID-19 in Paraíba. An ecological, population-based study was performed, with data extracted from the Brazilian Ministry of Health database. All cases and deaths from COVID-19 from March 2020 to December 2022 were included. The time series was built by applying the Prais–Winsten regression model, and the daily percent change was calculated to analyze the trends. The highest case fatality of the entire period was in April 2020 (7.8%), but in March 2021, the state broke the dismal record of 1248 deaths and the highest mortality rate (30.5 deaths per 100,000 inhabitants). Stationary mortality and case fatality were better in 2022; however, in February 2022, the mortality rate was at levels similar to the same month of the previous year. These results illustrate that COVID-19 is evolving and needs to be constantly monitored.</p