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ObjectiveThis study aimed to compare the effects of two different perfusion techniques: conventional cardiopulmonary bypass and miniature cardiopulmonary bypass in patients undergoing cardiac surgery at the University Hospital of Santa Maria - RS.MethodsWe perform a retrospective, cross-sectional study, based on data collected from the patients operated between 2010 and 2013. We analyzed the records of 242 patients divided into two groups: Group I: 149 patients undergoing cardiopulmonary bypass and Group II - 93 patients undergoing the miniature cardiopulmonary bypass.ResultsThe clinical profile of patients in the preoperative period was similar in the cardiopulmonary bypass and miniature cardiopulmonary bypass groups without significant differences, except in age, which was greater in the miniature cardiopulmonary bypass group. The perioperative data were significant of blood collected for autotransfusion, which were higher in the group with miniature cardiopulmonary bypass than the cardiopulmonary bypass and in transfusion of packed red blood cells, which was higher in cardiopulmonary bypass than in miniature cardiopulmonary bypass. In the immediate, first and second postoperative period the values of hematocrit and hemoglobin were higher and significant in miniature cardiopulmonary bypass than in the cardiopulmonary bypass, although the bleeding in the first and second postoperative days was higher and significant in miniature cardiopulmonary bypass than in the cardiopulmonary bypass.ConclusionThe present results suggest that the miniature cardiopulmonary bypass was beneficial in reducing the red blood cell transfusion during surgery and showed slight but significant increase in hematocrit and hemoglobin in the postoperative period.

Rev Bras Cir Cardiovasc | Braz J Cardiovasc SurgRev Bras Cir Cardiovasc 2013;28(2):183-9 Silva LLM, et al. -Impact of autologous blood transfusion on the use of pack of red blood cells in coronary artery bypass grafting surgery RBCCV 44205-1456 DOI: 10.5935/1678 Impact of autologous blood transfusion on the use of pack of red blood cells in coronary artery bypass grafting surgery Impacto da transfusão autóloga no uso de concentrado de hemácias em cirurgias de revascularização do miocárdio INTRODUCTIONCardiovascular diseases are the leading causes of mortality not only in Brazil but also throughout the world [1,2], with acute myocardial infarction (AMI) being the main cause of death. The AMI surgical treatment through coronary artery bypass grafting surgery is an usual procedure, which is frequently associated with cardiopulmonary bypass (CPB) and high rates of homologous blood transfusion, varying from 40 to 90% in most publications [3][4][5]. Transfusion therapy is associated with several unfavorable outcomes, such as renal dysfunction, cardiac, neurological and immunological complications, among others [6].There is no consensus regarding an ideal value of hemoglobin or hematocrit which suggests transfusion in cardiac surgeries. The American Society of Anesthesiologists (ASA) recommends that pRBC transfusion in patients with serum level of hemoglobin between 6 and 10 g/dL be based on the risk of developing complications or organic lesion by inappropriate oxygenation [7]. The latest consensus concerning perioperative transfusion in cardiac surgery identified six variables as being important risk indicators of pRBC transfusion: old age, small total amount of red blood cells (anemia or small body size), use of antiplatelet or antithrombotic drugs, reoperation or complex procedures, emergency procedures and non-cardiac comorbidity. This same study stated, with a level A of evidence (class I), that all measures of pre and perioperative blood conservation must be taken into this group of patients, since they correspond to the greatest part of hemocomponent transfusions [8].Among mechanical strategies to reduce the necessity of homologous pRBC transfusion, we find the so-called Cell Saver (CS). It is a specialists' consensual opinion (level C of evidence and class IIb recommendation) that the use of autologous blood transfusion through mechanisms such as Cell Saver is reasonable, during surgeries with cardiopulmonary bypass [8]. However, there are few studies related to the impact of this practice on the real necessity of pRBC transfusion in cardiac surgeries with CPB, especially in coronary artery bypass grafting surgeries. The present study aims to evaluate the impact of Cell Saver on the necessity of pRBC use in coronary artery bypass grafting surgeries associated with miniCPB which were carried out at the University Hospital of Santa Maria (HUSM). METHODSWe carried out a retrospective cross-sectional study in patients who had their health care provided by the Division of Cardiac Surgery of HUSM, undergoing CABG ...

Necrotizing fasciitis of the chest wall is a rare disease that usually takes place as a complication of surgical procedures in the cervical region, spreading downward to the anterior chest wall, pericardium, and even the deep mediastinal structures 1 . Reports in the medical literature are very plentiful regarding necrotizing fasciitis occurring in other topographic body areas but otherwise scarce when focusing primarily on the thoracic incidence and management. Although the general therapeutic strategies used in necrotizing fasciitis are also applied to thoracic fasciitis, some special features exist that should be emphasized when dealing with thoracic necrotizing infections, beyond the unique postoperative issues involving either an intra-or extra-cardiac implanted prosthesis. The differential diagnosis between necrotizing fasciitis and non-necrotizing soft tissue infections should be a priority, as they present different prognostic and therapeutic implications 2 . In this brief communication, we focus on a literature review regarding concepts, pathophysiology, and treatment of necrotizing fasciitis and report and discuss a rare case of anterior chest wall necrotizing fasciitis as a complication of cardiac surgery. To our knowledge, no such cases have been reported in the medical literature. Case ReportThe patient is a 38-year-old male with Marfan's Syndrome, who presented with a huge aneurysm of the ascending aorta (8 cm in diameter), severe aortic valve regurgitation, and severe left ventricular dysfunction. His previous medical history included septic shock as a complication in the postoperative period of an orthopedic procedure to the left ankle due to a traumatic fracture. At present, the surgical procedure was an aortoplasty with a composite Dacron and bovine pericardium graft (Labcor Laboratórios Belo Horizonte -Brazil), in which a double leaflet mechanical aortic prosthesis was attached Carbomedics Inc., USA, and coronary ostia reimplantation was performed. The immediate evolution included persistent fever and inflammatory signs at the upper and lower incision limits, with a yellowish discharge. Computerized tomography of the thorax and mediastinum showed a viscid pus-like collection around the aortic graft suggestive of mediastinitis. The sternum was stable. Incision and drainage of 2 incisional abscesses were performed. The infectious process spread through the neighboring tissues with formation of small abscesses, frankly purulent discharge, cellulites, and skin necrosis (Fig. 1). The first wide debridement, with resection of all apparently necrotic tissues, was performed, but soon we realized that it was ineffective (Fig. 2). Septic shock and local crepitus were established, and the diagnosis of necrotizing fasciitis of

(1) . As limitações dos programas de TX, dificultando-os na maioria das vezes em caráter de urgência, envidam que sejam procuradas alternativas para o TX (2) ou ainda pontes para transplante, incluindo pontes farmacológicas, apesar das limitações (3) , dispositivos mecânicos de assistência cardiocirculatória (4,5) , cardiomioplastia (6,7) , valvuloplastia mitral (8) e ventriculectomia parcial Frota Filho J D, Lucchese F A, Blacher C, Leães P E, Halperin C, Lúcio E A, Pereira W, Sales M, Lunkenheimer P P, Redmann K, Vargas L E, Stuermer R, Lobo R, Moreira F, Bueno A P, Jung L A -Ventriculectomia parcial esquerda: ponte para transplante? Rev Bras Cir Cardiovasc 2000; 15 (4): 320-7. RESUMO: Objetivo: Analisar os resultados e a viabilidade da ventriculectomia parcial esquerda (VPE) como ponte para transplante cardíaco (TX).Delineamento: Estudo de coorte histórica e prospectivo. Casuística e Métodos: Cinquenta e três pacientes (pts) foram submetidos a VPE em um período de 5 anos. Destes, 7 pts com contra-indicação inicial ao TX, idades variando de 37 a 64 anos, 5 homens e 2 mulheres, com miocardiopatia dilatada, foram subseqüentemente relistados e transplantados. Foram analisados a fração de ejeção (FE), o diâmetro diastólico final do ventrículo esquerdo (DDFVE), a CF da NYHA, o consumo máximo de oxigênio (VO 2 máx) e os escores de qualidade de vida (QV) antes da VPE, aos 3 e 6 meses, e pré-transplante.Resultados: Os valores expressos a seguir referem-se, respectivamente, àqueles obtidos antes da VPE, aos 3 e 6 meses e antes do TX. Variação da CF da NYHA: 3,71±0,49, 2,57±1,13 (p=0,011), 3,0±1,29 e 3, 86±0,38. Evolução da FE: 25,17±6,15, 35,5±8,41 (p=0,013), 32,33±7,12 e 26,17±3,76. Variação do DDFVE: 79,16±10,85, 67,66±9,2, 65,83±9,57 e 64,25±8,99. O VO 2 máx era de 8,12±3,47 antes da VPE e de 13,2±7,75 aos 6 meses (p=0,068). Variação dos escores de QV: 4,29±1,25, 3,0±1,41 (p=0,050), 3,29±1,8 e 4,57±1,13. Foram transplantados 7/53 pts (13,20%). A sobrevida, até a data do transplante, variou de 7 a 37 meses (18,71±11,78 meses). O seguimento foi de 100%.Conclusão: A curto prazo melhoraram a CF da NYHA, a QV, o VO 2 máx, o DDFVE e a FE dos pts. Estes resultados sugerem a possibilidade da indicação da VPE como ponte para TX. Entretanto, a mortalidade elevada no primeiro semestre pós-operatório limita a sua indicação rotineira como ponte para TX. Estudos futuros poderão validar ou não esta possibilidade.