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

<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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Coronary Artery Bypass Surgery in Brazil: Analysis of the National Reality Through the BYPASS Registry

Abstract Introduction: Coronary artery bypass grafting (CABG) is the most frequently performed heart surgery in Brazil. Recent international guidelines recommend that national societies establish a database on the practice and results of CABG. In anticipation of the recommendation, the BYPASS Registry was introduced in 2015. Objective: To analyze the profile, risk factors and outcomes of patients undergoing CABG in Brazil, as well as to examine the predominant surgical strategy, based on the data included in the BYPASS Registry. Methods: A cross-sectional study of 2292 patients undergoing CABG surgery and cataloged in the BYPASS Registry up to November 2018. Demographic data, clinical presentation, operative variables, and postoperative hospital outcomes were analyzed. Results: Patients referred to CABG in Brazil are predominantly male (71%), with prior myocardial infarction in 41.1% of cases, diabetes in 42.5%, and ejection fraction lower than 40% in 9.7%. The Heart Team indicated surgery in 32.9% of the cases. Most of the patients underwent cardiopulmonary bypass (87%), and cardioplegia was the strategy of myocardial protection chosen in 95.2% of the cases. The left internal thoracic artery was used as a graft in 91% of the cases; the right internal thoracic artery, in 5.6%; and the radial artery in 1.1%. The saphenous vein graft was used in 84.1% of the patients, being the only graft employed in 7.7% of the patients. The median number of coronary vessels treated was 3. Operative mortality was 2.8%, and the incidence of cerebrovascular accident was 1.2%. Conclusion: CABG data in Brazil provided by the BYPASS Registry analysis are representative of our national reality and practice. This database constitutes an important reference for indications and comparisons of therapeutic procedures, as well as to propose subsequent models to improve patient safety and the quality of surgical practice in the country

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

Abstract 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 systems; and 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