The present review has for objective to stand out some aspects little argued of the cardiopulmonary bypass (CPB), taking in consideration physiology, physiopathology and some new technologies of perfusion. Thus, some points, sometimes philosophical, had motivated the elaboration of this revision: a) To preserve and to bring up to date the surgeon CPB knowledge, for the simple fact to even keep its pedagogical leadership on its team; b) To question if patient aged and/or diabetic, for its individual characteristics, deserved more appropriate protocols as well as adopted for children; c) One third aspect would be the questioning of the systemic inflammatory reaction caused by the exposition of the blood to CPB non-endothelized circuit surface ahead of the increasing importance of the wound surgical contact of the blood; d) In relation to the treatment of the vasoplegic syndrome, methylene blue continues being the best therapeutical option, even so, many times are not efficient because of a highly probable existence of a "therapeutical window" based in the guanylate cyclase dynamics of action (saturation and synthesis "de novo") and; finally, e) The reason of the choice of the heading standing out that, in its current patterns, the CPB would be consequence of empirism, art, or science. The final message comes with the certainty of that as much the empirism, art and science are very strong concerning CPB.Descriptors: Extracorporeal circulation. Cardiopulmonary bypass. Cardiac surgical procedures. 79MOTA, AL ET AL -Adult cardiopulmonary bypass in the twentyfirst century. Science, art or empiricism? Rev Bras Cir Cardiovasc 2008; 23(1): 78-92

OBJECTIVE Engage the UNIFESP Cardiovascular Surgery residents in coronary anastomosis, assess their skills and certify results, using the Arroyo Anastomosis Simulator and UNIFESP surgical models.METHODS First to 6th year residents attended a weekly program of technical training in coronary anastomosis, using 4 simulation models: 1. Arroyo simulator; 2. Dummy with a plastic heart; 3. Dummy with a bovine heart; and 4. Dummy with a beating pig heart. The assessment test was comprised of 10 items, using a scale from 1 to 5 points in each of them, creating a global score of 50 points maximum.RESULTS The technical performance of the candidate showed improvement in all items, especially manual skill and technical progress, critical sense of the work performed, confidence in the procedure and reduction of the time needed to perform the anastomosis after 12 weeks practice. In response to the multiplicity of factors that currently influence the cardiovascular surgeon training, there have been combined efforts to reform the practices of surgical medical training.CONCLUSION 1 - The four models of simulators offer a considerable contribution to the field of cardiovascular surgery, improving the skill and dexterity of the surgeon in training. 2 - Residents have shown interest in training and cooperate in the development of innovative procedures for surgical medical training in the art.

Ausência de arteriosclerose na porção intramiocárdica das artérias coronárias: um mistério a ser resolvido?Absence of arteriosclerosis in intramyocardial coronary arteries: a mystery to be solved? Work AbstractSeveral studies show that portions of intramyocardial coronary arteries are spared of arteriosclerosis, involving morphological, embryological, biochemical and pathophysiological aspects. Endothelial function is significantly affected in the segment of transition, as estimated by the vasoactive response to Ach. These findings suggest that myocardial bridge can provide protection against arteriosclerosis by counteracting the negative effects of endothelial dysfunction. The intramyocardial portion's protection phenomenon deserves further scientific research on all research fronts. Improved morphological, biomechanical and especially physiological and embryological knowledge may be the key to a future window of opportunity for chronic arterial disease therapy and prevention. In addition, this review discusses possible therapeutic approaches for symptomatic coronary ischemia caused by myocardial bridges.Descriptors: Myocardial bridging. Coronary circulation. Endothelium. ResumoDiversos estudos demonstram que as porções intramiocárdicas das artérias coronárias são poupadas da arteriosclerose, envolvendo aspectos morfológicos, embriológicos, biomecânicos e aspectos fisiopatológicos. A função endotelial é significativamente afetada no segmento de transição, tal como estimado pela resposta vasoativa para acetilcolina (Ach). Esses achados sugerem que ponte miocárdica pode fornecer proteção contra a arteriosclerose, por contrariar os efeitos negativos da disfunção endotelial. O fenômeno dessa proteção da porção intramiocárdica merece maior investigação científica em todas as frentes de pesquisa. Maiores conhecimentos sobre os aspectos morfológicos, biomecânicos e, principalmente, fisiológicos e embriológicos podem ser a chave para uma futura janela de oportunidades de terapia e prevenção da doença arterial crônica. Nessa revisão, discutemse, também, possíveis abordagens terapêuticas para fenômenos coronarianos isquêmicos causados por pontes miocárdicas.Descritores: Ponte miocárdica. Circulação coronária. Endotélio. RBCCV 44205-1301

401Rev Bras Cir Cardiovasc | Braz J Cardiovasc SurgRev Bras Cir Cardiovasc 2013;28(3):401-

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