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Nota: estas Atualizações se prestam a informar e não a substituir o julgamento clínico do médico que, em última análise, deve determinar o tratamento apropriado para seus pacientes.

Background This study aims to evaluate the effects of preoperative electroacupuncture (EA) on the need for opioids in the postoperative stage of conventional cardiac surgery.

The periareolar access has been the preferred technique used at our institution for minimally invasive cardiac surgery since 2006. The surgical approach consists of video-assisted minithoracotomy in the 4th right intercostal space, through a periareolar incision. Initially, the technique was restricted to minimally invasive mitral valve surgeries but, due to its feasibility and safety, was soon incorporated as an ideal access for other cardiac pathologies such as tricuspid valve disease, atrial septal defect, atrial fibrillation, and pacemaker leads endocarditis. The technique was performed in 214 patients, and it is associated with excellent aesthetic and functional results, with low morbimortality and no reoperations at long-term follow-up. Here, we describe and support the use of periareolar access as a routine surgical technique for correction of several cardiac pathologies, especially in women.

Results: The surgical procedures were: plasty (n=20) or mitral valve replacement (n=36), aortic valve replacement (n=14), atrioseptoplasty using pericardial patch (n=32), tricuspid valve repair with rigid ring (n=6) and surgical correction of atrial fibrillation with radiofrequency (n=12). There were no complications during the procedures. There was no conversion to thoracotomy in neither case. Two patients developed atrial fibrillation in the postoperative period. There was an episode of stroke seven days after the hospital discharge and one death (0,9%) due to systemic inflammatory response syndrome (SIRS).Conclusion: This study demonstrates the coverage of pathologies that are possible to be approached by videoassisted cardiac surgery with cardiopulmonary bypass being a safe and effective procedure with low morbimortality. Minimally invasive video-assisted cardiac surgery is already a reality in Brazil, demonstrating excellent aesthetic and functional results. Rev Bras Cir Cardiovasc 2009; 24(3): 318-326 and transesophageal echocardiogram, ultrasound of the carotid arteries, abdominal, iliac and femoral arteries. In patients with suspicion of some obstruction of peripheral arteries, angiotomography of the thoracoabdominal aorta was requested. Special care was taken at the time of cardiac catheterization, avoiding puncturing the femoral vessels, giving preference to puncture of the radial artery and complete aortography was performed during the exam. After the first 40 cases, we included patients with an ejection fraction below 55%, emergencies, reoperations and obese patients.The age ranged from 18 to 68 years, and 57 patients were female (55.8%).