Objective: To assess the applicability of the European Risk Score System in Cardiac Operations (EuroSCORE) in patients undergoing myocardial revascularization at the Heart Institute of Pernambuco.Method: From 2003 to 2004, 759 patients underwent myocardial revascularization. For the study, seven were excluded due to the lack of information on one aspect or another involved in obtaining the EuroSCORE. In order to assess the applicability of the EuroSCORE, an adjustment was made using a logistic regression model of operative mortality (response variable) on the EuroSCORE (explanatory variable). The calibration of the model was measured by comparing the morbidity observed with that expected, using the Hosmer-Lemeshow Test of Goodness of Fit. The accuracy of the model was evaluated by means of Statistics-c.Results: The accuracy of the model, estimated at 69.9%, and the calibration (Hosmer-Lemeshow test, p=0.663) were satisfactory. The total predicted mortality was practically identical to the observed -1.7%. The low-risk group (EuroSCORE: 0-2) comprised 231 patients and had two (0.87%) deaths within this group. The medium-risk group (EuroSCORE: 3-5) comprised 268 patients and one (0.37%) death occurred. The high-risk group (EuroSCORE: =6) comprised 253 patients and ten (3.95%) deaths occurred. The discrepancies between the percentages of deaths observed in these groups and those predicted by the model were not statistically significant on the basis of the result of the chisquare test (p=0.624).Conclusion: The EuroSCORE, a simple and objective index, proved to be a satisfactory predictor of operative mortality in patients submitted to myocardial revascularization in the Heart Institute of Pernambuco.

Our case series is the longest follow-up of recipients of recycled antemortem CRM devices. Our findings support the feasibility and safety of this alternative acquisition of life-saving technology.

Chylothorax is a well-recognized complication after neonatal cardiothoracic surgery. Management strategies include cessation of enteral feedings, repeated aspiration, chest drainage, and total parenteral nutrition. Somatostatin and its analogue, octreotide, have been used with promising results. The authors present three cases of neonatal postoperative chylothorax in which octreotide was used. After literature review, we can say that octreotide is relatively safe, and may reduce clinical course and complications associated with neonatal postoperative chylothorax. One should be aware of possible association between octreotide and necrotizing enterocolitis. Prospective controlled trials supporting octreotide use are lacking.

Disfunção vagal cardíaca está associada com um pior prognóstico clínico e um dos potenciais benefícios do exercício físico regular é aumentar o tônus vagal cardíaco (TVC). Como nas transições repouso-exercício-repouso o TVC é rapidamente inibido e reativado, hipotetizou-se que um treinamento repetido desta transição-denominado treinamento vagal (TV)-, em indivíduos com TVC reduzido, poderia reverter essa disfunção. Participantes que ingressaram em um programa de exercício supervisionado (PES) com índice vagal cardíaco (IVC) baixo (≤ 1,30 no teste de exercício de quatro segundos) foram randomizados para um estudo com delineamento cruzado (duas etapas de oito semanas), com ou sem três sessões semanais de TV. O TV consistiu de cinco repetições em 5s de pedalada rápida sem carga com 55 s de intervalo em repouso. Após rígidos critérios de inclusão e exclusão (controle de uso de medicação, condição clinica e aderência ao PES) 44 pacientes (64% homens; 65,5 ±11,4 anos) finalizaram o estudo. Houve discreta melhora no IVC ao final de 16 semanas (1,19 vs 1,22; p=0,02), mas não se pôde afirmar que a diferença no IVC se deveu ao período em que foi realizado o TV (p=0,36). Portanto, 16 semanas de PES incluindo oito semanas de TV aumentou a resposta vagal à transição repouso-exercício, embora não tenha sido possível atribuir os resultados exclusivamente ao TV. Futuros estudos são necessários para esclarecer se o TV, com maior número de repetições e/ou período de duração mais longo, poderá promover uma melhora mais acentuada do TVC em indivíduos com níveis iniciais baixos. Palavras-chave Sistema nervoso parassimpático; Reabilitação cardíaca; Teste de 4 segundos; Testes autonômicos.

Objective: To assess the applicability of the European Risk Score System in Cardiac Operations (EuroSCORE) in patients undergoing myocardial revascularization at the Heart Institute of Pernambuco. Method: From 2003 to 2004, 759 patients underwent myocardial revascularization. For the study, seven were excluded due to the lack of information on one aspect or another involved in obtaining the EuroSCORE. In order to assess the applicability of the EuroSCORE, an adjustment was made using a logistic regression model of operative mortality (response variable) on the EuroSCORE (explanatory variable). The calibration of the model was measured by comparing the morbidity observed with that expected, using the Hosmer-Lemeshow Test of Goodness of Fit. The accuracy of the model was evaluated by means of Statistics-c. Results: The accuracy of the model, estimated at 69.9%, and the calibration (Hosmer-Lemeshow test, p=0.663) were satisfactory. The total predicted mortality was practically identical to the observed-1.7%. The low-risk group (EuroSCORE: 0-2) comprised 231 patients and had two (0.87%) deaths within this group. The medium-risk group (EuroSCORE: 3-5) comprised 268 patients and one (0.37%) death occurred. The high-risk group (EuroSCORE: =6) comprised 253 patients and ten (3.95%) deaths occurred. The discrepancies between the percentages of deaths observed in these groups and those predicted by the model were not statistically significant on the basis of the result of the chisquare test (p=0.624). Conclusion: The EuroSCORE, a simple and objective index, proved to be a satisfactory predictor of operative mortality in patients submitted to myocardial revascularization in the Heart Institute of Pernambuco.