Resumo A citologia vaginal é um procedimento de diagnóstico amplamente utilizado. É principalmente ensinado por observação, quer em aulas presenciais, quer através de vídeos. Até agora, os simuladores de citologia vaginal nunca tinham sido avaliados em Medicina Veterinária. Vinte e cinco estudantes sem experiência prévia neste procedimento foram distribuídos aleatoriamente em dois grupos, que praticaram o procedimento num simulador ou num animal. Após assistirem a um vídeo tutorial, os estudantes praticaram com o simulador/animal durante duas aulas. Três semanas depois, realizaram uma citologia vaginal num animal e o procedimento foi gravado. Esses vídeos foram avaliados através dum formulário de Exame Clínico Objetivo Estruturado (OSCE) por um observador cego para o treino prévio dos estudantes. A aprendizagem foi comparada através dos resultados no OSCE. O modelo de simulação foi feito por impressão 3D, com silicone macio para os lábios vulvares e com vaselina de cor rosa e azul nos locais corretos e incorretos para a colheita. O modelo era barato, replicava com precisão o aparelho reprodutor da cadela e fornecia feedback imediato aos estudantes, que obtinham zaragatoas rosa ou azuis consoante recolhiam material nos locais corretos e incorretos, respetivamente. Segundo os estudantes, eram necessárias 3 a 5 ou mais tentativas para aprender adequadamente o procedimento, o que justificava a necessidade dum simulador. Os dois grupos apresentaram resultados idênticos no OSCE. O modelo de simulação foi eficaz para a aprendizagem da colheita de citologias vaginais, substituindo o uso de animais. Este modelo de baixo custo deveria ser incorporado no kit de ferramentas das aulas de Reprodução Animal. This translation was provided by the authors. To view the original article visit: https://doi.org/10.3138/jvme-2022-0141

Vaginal cytology is a widely used cytological technique mostly taught by observation, either through direct tutoring or videos. To the best of our knowledge, vaginal cytology simulators have never been assessed in veterinary medicine. Twenty-five undergraduate students with no prior experience in canine vaginal sampling were randomly assigned to two groups that either practiced the procedure in a simulator or a live animal. An inverted classroom design was followed. After observing a video tutorial, students practiced with the simulator/live animal for two classes. Three weeks later, they performed a vaginal cytology on a live animal being recorded. The videos were evaluated through an objective structured clinical examination (OSCE) by an observer blinded to the student's groups. The learning outcome was compared through OSCE pass rates and questionnaires. The simulation model was made by 3D printing and soft silicone for the vulvar labia, having pink and blue colored vaseline in the correct and incorrect locations for sampling. The model was economic and accurately replicated the female reproductive tract. It provided immediate feedback to students, by obtaining pink or blue swabs from the correct and incorrect locations, respectively. Students reported that three to five or more attempts were needed to properly learn the procedure, thus justifying the need for a simulator. No differences in the OSCE pass rates were observed between the groups. The simulation model was effective for learning the vaginal cytology procedure, replacing the use of live animals. This low-cost model should be incorporated in the tool-kit of reproduction classes.

Vaginal cytology (VC) is an essential technique for monitoring the bitch's estrus cycle. Currently, animal-free teaching methodologies have not been investigated for VC. Hence, this study aimed to evaluate an immersive simulation with a VC model and augmented reality tools. Students (n = 219) from four universities were enrolled, having learning stations with models for practising VC that provided immediate feedback on the technique. Augmented reality tools comprised QR codes that endorsed students to short videos of owners' avatars reporting the clinical reproductive story of the simulated animals and slides with QR codes leading to microscopy slide navigation videos. Proestrus, estrus, diestrus, anestrus and vaginitis were identified in the learning stations. The students' perceptions were evaluated through questionnaires assessing satisfaction, motivation, confidence, impact on learning and diagnostic accuracy. Before the immersive simulation, students had no experience with VC, being afraid of doing a VC with a live dog. Almost all the students considered practicing VC as essential and 94% reported that repeating the procedure (>2 times) was the most important parameter for learning. The simulation activity lasted ≈3 h and significantly improved the confidence of students, being less afraid of doing a VC in a live animal. Slide navigation videos improved the diagnostic accuracy of the estrus cycle stage, and students diagnosed the estrus and vaginitis cases more accurately. The immersive simulation strategy allowed repeated practice in a safe, motivated and standardized environment, being appraised by students as an essential strategy for learning VC.

INTRODUCTION:The benefit of adding a second arterial conduit is still controversial, mainly in specific subgroups. We conducted a meta-analysis of randomized controlled trials (RCTs) and propensity score (PS) studies comparing survival and early results in elderly patients who underwent coronary artery bypass grafting (CABG) with multiple (MAG) versus single arterial grafting (SAG).EVIDENCE ACQUISITION:MEDLINE, Web of Science and Cochrane Library were used to find relevant literature (1960-April 2020). Survival at a ≥1-year follow-up and early outcomes were evaluated. Outcomes were collected from matched samples or PS adjusted analysis: hazard ratio (HR) along with their variance, frequencies or odds ratios. Random effect models were used to compute combined statistical measures and 95% confidence intervals (CI) through generic inverse variance method (time-to-event) or Mantel-Haenszel method (binary events).EVIDENCE SYNTHESIS:Eleven PS cohorts and 1 RCT comprising >18,800 patients older than 70 (>6200 MAG and >12,500 SAG) were included in this meta-analysis. MAG was associated with lower long-term mortality (pooled HR: 0.81, 95% CI: 0.72-0.91, P<0.01, I2=64%) in the absence of higher risk of early mortality (pooled OR: 0.74, 95% CI: 0.44 to 1.25, P=0.27, I2=0%). In a meta-regression, MAG survival advantage was more pronounced in studies with a higher MAG usage rate (β=-0.0052, P=0.021).CONCLUSIONS:Current evidence suggests that advanced age should not limit MAG's use considering its benefits in long-term survival. Of note, an individualized patient selection for this approach is warranted.

Veterinary cytology faced a remarkable evolution in the last 15 years, in part due to increase recognition of the advantages of the cytology by veterinary clinicians. Simultaneously, there has been a growing awareness by the owners about the importance of a complete diagnostic workup aimed at defining a proper treatment protocol. With the extended use of cytology, challenging diagnostic cases are more frequent, and more clinically useful answers are requested. In this scenario, the use of cytology specimens to perform ancillary techniques is a valid approach. Rather than being simply archived, cytology slides can be a valuable source and a good platform to carry out cytochemistry, immunocytochemistry, and molecular techniques. Therefore, several diagnostic techniques can be applied in tiny samples, thus following the “doing more with less” principle. The aim of this approach is to refine the cytologic diagnosis and provide additional prognostic and therapeutic information. Herein, we detailed this principle in veterinary cytology and reviewed the use of cytology specimens for ancillary techniques as a single procedure, i.e., using the whole slide, or multiple procedures, i.e., multiple procedures applied in the same slide.

Quantitative morphologic parameters assessed in cytologic samples of canine cutaneous mast cell tumors (ccMCTs) may assist with surgical planning and prognostication. Robust cutoffs can be defined, with high reproducibility, for parameters such as the nuclear area (NA). The NA may be determined by morphometry (image analysis, NAI) or by stereology, such as the 2D-nucleator method (NAN); stereologic techniques have not been applied to cytologic specimens of ccMCT, to our knowledge. We retrospectively selected routine cytology smears from 51 ccMCT cases and screened them to determine the percentage of neoplastic mast cells with indistinct nuclear borders; this was repeated after the slides were restained with H&E. The NAI and the NAN were estimated in 100 mast cells per animal in H&E-stained slides. All nuclei were visible in H&E smears, and unbiased quantification was feasible. The NAN was similar to NAI, but less time-consuming. Both the NAN and NAI determined by cytology differed in histologic low- and high-grade ccMCTs, and in histologic grade I plus II versus grade III ccMCTs. Stereologic parameters such as the NAN could be considered as complementary techniques for the cytologic evaluation of ccMCTs.

Resumo Fundamento: Pouco se sabe sobre o impacto da estenose aórtica (EA) grave na rigidez aórtica e se ocorre alguma alteração após a remoção da barreira de EA com a cirurgia de substituição da válvula aórtica (SVA). Objetivo: Estimar as mudanças na velocidade de onda de pulso carotídeo-femoral (VOP) após a cirurgia de SVA e definir os preditores de VOP alta em pacientes com EA grave. Métodos: Estudo de coorte retrospectivo unicêntrico, incluindo pacientes com EA grave submetidos à cirurgia de SVA com bioprótese, entre fevereiro de 2017 e janeiro de 2019, e medições da VOP (Complior®) antes e depois do procedimento (2±1 meses). Antes e depois da SVA, os valores da VOP foram comparados por meio de testes pareados. foram analisadas as associações de VOP com dados clínicos, bem como aplicados modelos de regressão linear multivariada para estimar os preditores independentes da VOP pré- e pós-operatória. O nível de significância foi estabelecido em 5%. Resultados: Foram incluídos na amostra 150 pacientes, com média de idade de 72±8 anos, sendo 51% deles do sexo masculino. Identificamos um aumento estatisticamente significativo nos valores de VOP após a cirurgia (9,0 ± 2,1 m/s vs. 9,9 ± 2,2, p<0,001, antes e depois da SVA, respectivamente) e uma associação inversa com as variáveis de gravidade da EA. No modelo de regressão linear multivariada, idade e pressão arterial sistólica (PAS) foram estabelecidas como preditores independentes da VOP pré- e pós-operatória mais alta, enquanto o gradiente valvar médio mais alto foi considerado um determinante da VOP pré-SVA mais baixa. Conclusão: Identificamos uma correlação inversa da rigidez arterial com a gravidade da EA em pacientes acometidos, e um aumento significativo nos valores da VOP após a cirurgia de SVA. Idade avançada e PAS elevada foram associadas a valores mais altos da VOP, embora as medidas de função arterial estivessem dentro da normalidade. (Arq Bras Cardiol. 2021; 116(3):475-476)

Abstract Background The role and the indications for using off-pump coronary artery bypass surgery (OPCAB), instead of the traditional on-pump (ONCAB), is still to be addressed. Aim To describe our centre experience and to compare 15-years survival and early safety outcomes between OPCAB and ONCAB. Methods Single-centre retrospective cohort including 9-years of isolated first CABG (2005–2013). Multi-vessel disease with at least 2 surgical grafts patients were considered and the first 50 surgeries of each surgeon with each technique were excluded to account for the learning curve effect. Emergent surgeries and on-pump beating heart procedures were also excluded. A propensity-score matching (PSM) analysis was performed to balance groups and both survival and early outcomes comparison was done within the matched cohort using Kaplan-Meier or Cox stratified and paired tests, respectively. The median follow-up was 9 years, maximum 15 years. Results From 3012 multi-vessel patients with at least 2 surgical grafts, 2503 were included at the main analysis: 1487 ONCAB and 1016 OPCAB. ONCAB patients presented more frequently 3-vessels disease and left ventricular dysfunction, but received similar number of grafts than OPCAB, who in turn, received more frequently multiple arterial grafts. The surgical completeness of revascularization (CR) was similar, but hybrid procedures were more frequent in OPCAB raising CR rate in this group. After PSM (646 pairs), both groups were similar regarding pre and peri-operative characteristics. The long-term survival was similar (HR stratified by pair: 1.02 (0.81–1.30), but OPCAB evidenced benefits at early term results including bleeding, postoperative atrial fibrillation and stroke incidence. Conclusion At our centre, OPCAB performed by experienced surgeons provides rates of complete revascularization and long-term survival similar to ONCAB. In-hospital results favoured OPCAB. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Universidade do Porto/FMUP; Social European Fund; FCT-Fundação para a Ciência e a Tecnologia

BACKGROUND Fine-needle aspirate (FNA) cytology is often the first-choice method for diagnosing gastrointestinal nodular lesions. The FNA material can be converted to histopathology specimens by a needle rinse cell block (NRCB) technique, allowing ancillary studies to refine the cytologic diagnosis. Despite use in human pathology, NRCB has never been applied to canine or feline gastrointestinal neoplasia. OBJECTIVE This study described NRCB methodology and its diagnostic utility in specific cases of neoplastic gastrointestinal lesions. METHODS Needle rinses with saline were performed after ultrasound-guided FNAs of two intestinal lymphomas (canine and feline) and a canine gastrointestinal stromal tumor (GIST). The NRCB was prepared using the cell tube block technique and processed for paraffin embedding. Routine immunohistochemistry protocols (using CD3, PAX-5, and Ki-67 for lymphoma cases and vimentin, desmin, S-100, and KIT markers for GIST) were applied to NRCB sections, and the results were compared with matched tissue biopsies. RESULTS NRCBs with adequate cell numbers, preservation, and good separation of blood were obtained. The diagnosis and immunophenotyping were confirmed in both cases of lymphoma in NRCBs. In the GIST, the immunolabeling of the neoplastic cells in NRCB was completely concordant with the tissue biopsy. CONCLUSIONS The described methodology is suitable for veterinary settings, having few technical requirements and low invasiveness. The presented cases of gastrointestinal neoplasia highlight the utility of NRCBs as a platform to conduct ancillary studies and refine the cytologic diagnosis.

BACKGROUND:Little is known about the impact of severe aortic stenosis (AS) in aortic stiffness and if there is any change after removing AS barrier with aortic valve replacement (AVR) surgery. OBJECTIVE:To estimate carotid-femoral pulse wave velocity (PWV) changes after AVR surgery and to define PWV predictors in severe AS patients. METHODS:Single-center retrospective cohort, including patients with severe AS who underwent AVR surgery with bioprostheses, between February 2017 and January 2019 and performed PWV measurements (Complior®) before and after the procedure (2±1 months). Before and after AVR, PWV values were compared through paired tests. The associations of PWV with clinical data were studied and linear regression models were applied to estimate pre and postoperative PWV independent predictors. The significance level was set at 5%. RESULTS:We included 150 patients in the sample, with mean age of 72±8 years, and 51% being males. We found a statistically significant increase in PWV values after surgery (9.0±2.1 m/s vs. 9.9±2.2, p<0.001, before and after AVR, respectively) and an inverse association with AS severity variables. In the linear regression model, age and systolic blood pressure (SBP) were established as independent predictors of higher pre- and postoperative PWV, while higher mean valvular gradient emerged as a determinant of lower pre-AVR PWV. CONCLUSION:We documented an inverse correlation of arterial stiffness with the severity of AS in patients with AS, and a significant increase in PWV values after AVR surgery. Advanced age and higher SBP were associated with higher PWV values, although arterial function measurements were within the normal range. (Arq Bras Cardiol. 2021; 116(3):475-482).

Introduction Perioperative medication in cardiac surgery recommends β-blockers' use but it is not clear if its prescription should be started before or after cardiac surgery. Objectives To determine the effect of preoperative β-blocker therapy in long-term survival and postoperative complications after coronary artery bypass grafting surgery (CABG). Also, to study if recent acute myocardial infarction (AMI) changes this therapeutic effect. Materials and Methods Retrospective single-center study including consecutive patients submitted to first isolated CABG in 2006-2007. Data was collected through clinical files and informatic databases. Patients were grouped according to their preoperative Bblocker regimen: without (noBB) or with β-blockers (BB). Chi-square, independent t-tests, Kaplan- -Meier curves, Log Rank test and multivariable Cox regression were used. The mean follow-up time was 10 years, maximum 13 years. Results We included 562 patients, 468 (83%) were on preoperative β-blocker therapy. BB patients were younger (63±10 vs. 66±11, p=0.01) and predominantly male (79% vs. 75%, p=0.30). Recent myocardial infarction occurred in 46% BB vs. 53% noBB, (p=0.23) and BB patients presented less frequently moderate to severe left ventricular dysfunction (19% vs. 32%, p<0.01), history of stroke or transient ischemic attack (5% vs. 11%, p=0.04) and were less often in preoperative critical state (3% vs. 9%, p=0.01). Kaplan- -Meier analysis showed an improvement in cumulative survival in BB group (13-years survival: 66% vs. 57%, Log- -rank, p=0.01). After stratification by preoperative recent AMI occurrence, patients in BB group had better cumulative survival within patients with recent AMI (63% vs. 48%, Log-rank test p<0.01, BB vs. noBB, respectively), while preoperative β-blocker therapy had no impact on 13 years' survival in patients without recent AMI (70% vs. 67%, Log- -rank test p=0.73). After multivariable Cox regression, preoperative β-blocker therapy emerged as a protective agent (HR: 0.56, 95% CI: 0.39-0.81, p<0.01). This effect is maintained in patients with recent AMI (n=267, HR: 0.38, 95% CI: 0.22-0.65, p<0.01) but lost significance in patients without this event (n=295, HR: 0.99 95% CI: 0.55-1.80, p=0.98). There were no significant differences in postoperative complications. Conclusions In this study, β-blocker therapy showed a beneficial effect on long-term survival, particularly in patients with recent AMI. However, we consider that subsequent studies should be performed in order to elaborate more solid conclusions. As has been previously reported in literature, morbidity and mortality after isolated tricuspid surgery are high, with an increased rate of death at first year after surgery. Hypertension, cardiac dysfunction and diabetes mellitus are predictors of poor outcomes.

BACKGROUND: There is currently conflicting evidence regarding outcomes of dual antiplatelet therapy (DAPT) in patients following coronary artery bypass grafting (CABG). We aim to compare the survival and safety outcomes of DAPT versus aspirin (ASA) within a 24h window after CABG. METHODS : Single-center retrospective cohort study on consecutive patients undergoing 1st isolated CABG surgery in 2010. Survival analysis (median follow-up 9 years) was performed using Kaplan-Meier curves and multivariable Cox regression using propensity score (PS) as a covariate along with DAPT. Bleeding was assessed through red blood cells' (RBC) transfusion, re-exploration of thorax and drainage. RESULTS: We included 351 patients (251 were DAPT). Kaplan-Meier curves showed similar cumulative survival between groups (9y: 75% DA PT vs. 67% ASA, Log-rank P=0.103), as well as the PS adjusted analysis (HR DAPT: 0.93, 95% CI: 0.57-1.51). We found no differences in early mortality (2 DAPT and 1 ASA). Total median cell-saver transfusion (300 mL vs. 250 mL) and the re-exploration of thorax due to bleeding (1.6% vs. 4%) showed no statistical significance either. On the other hand, postoperative total median chest tube drainage was higher in the ASA group (1220 mL DAPT vs. 1320 mL ASA, P=0.034). There was also a lower frequency of DAPT patients requiring RBC transfusions (>= 3 units 4.8% vs. 13%, P=0.009, respectively). Redo-CABG was performed in 3 patients (2 DAPT vs. 1 ASA) during follow-up. CONCLUSIONS: Compared with ASA, DAPT showed a non-significant impact on long-term survival and demonstrated to be a safe option. Further studies are needed to provide recommendations on the therapeutical strategy following CABG.

Introduction. The medical course is extremely stimulating but also demanding, and it can interfere with students’ mental health. Stress leads to lower life quality, academic performance, and ultimately to a lower quality of patient care delivered. Objective. To analyse stress levels of sixth-year medical students who attend Portuguese colleges. Methodology. This observational cross-sectional study involved Portuguese medical students attending the sixth year of all Portuguese faculties. We applied an online self-response questionnaire, including the 10 items Perceived Stress Scale (PSS) to assess stress levels and sociodemographic variables. Logistic regression was used to estimate the weight of the studied determinants on stress levels. Results. A total of 501 participants were included for analysis (69.5% females), with a median age of 24 years old. We found significant levels of stress in 49.9% (95% CI: 45.5–54.3%), with 20.8% of total students presenting extremely high levels, irrespective of age, gender, and faculty. Stress was higher when students presented bad sleeping and eating habits, lack of ability to manage time, dissatisfaction with social life and academic experience, and low family support. Also, these students are more worried about their future and present a higher degree of concern about their graduation test performance. Conclusion. This study found high stress levels among Portuguese medical students, associated with social determinants and the intrinsic complexity of the course. This is worrying, and it elucidates the importance of coping strategies to make students deal with stress and be healthier, currently and in the future.

Abstract Background There is currently conflicting evidence regarding the security profile and outcomes of dual antiplatelet therapy (DAPT) in patients following coronary artery bypass grafting (CABG). Aim We aim to compare the effect of early DAPT in short and long-term survival versus acetylsalicylic acid in a monotherapy regimen (ASA). Therapy's safety was evaluated through immediate or early postoperative outcomes, with particular emphasis on the haemorrhagic. Methods Single-centre retrospective cohort study on consecutive patients undergoing 1st isolated CABG surgery in 2010. Median follow-up time was 9 years. Pre-, peri- and postoperative data was collected through clinical files and digital databases. The DAPT and ASA groups were defined considering the administration of clopidogrel plus acetylsalicylic acid and only acetylsalicylic acid, respectively, within a 24h window after CABG. T-tests and Pearson's chi-squared tests were used for group comparison. Survival analysis was performed using Kaplan-Meier curves, Log-Rank test and multivariable Cox regression. Propensity scores (PS) were estimated using a multivariable logistic regression model and included in multivariable regressions as a covariate along with DAPT. Early mortality was defined if occurred before discharge or within the 30 days following the surgery; bleeding was assessed through red blood cells' (RBC) transfusion, re-exploration of thorax and drainage. Results We included 351 patients, 81% were male, and DAPT was performed in 251 patients (72%). DAPT patients were younger (63±10 vs. 66±10 years, p=0.007) but both groups were similar regarding the cardiovascular modifiable risk factors. Kaplan-Meier curves showed similar cumulative survival between groups (75% in DAPT vs. 67% in ASA group, at 9 years of follow-up, Log-rank p=0.103), as well as the PS adjusted analysis (HR DAPT: 0.93, 95% CI: 0.57–1.51). Regarding safety outcomes, we found no differences in early mortality (two cases in the DAPT group and one in the ASA group). Total median cell-saver transfusion (300mL vs. 250mL, p=0.318) and the re-exploration of thorax due to bleeding (1.6% vs. 4% p=0.231) showed no statistical significance either. On the other hand, post-operative total median chest tube drainage was higher in the ASA group (1220mL in DAPT vs. 1300mL in ASA, p=0.043). There was also a lower frequency of DAPT patients requiring 3 or more peri and postoperative RBC transfusions (8.5% vs. 13.3% p<0.001 and 4.8% vs. 13%, p=0.009, respectively) and a shorter in-hospital stay following CABG (median of 7 days for DAPT and 8 days for ASA, P<0.001). Redo-CABG was performed in 3 patients (2 DAPT vs. 1 ASA) during follow-up. Conclusion Compared with ASA, DAPT showed a non-significant impact on long-term survival but demonstrated to be a safe option within the assessed bleeding outcomes. Further studies are needed to provide recommendations on the therapeutical strategy following CABG. Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): Universidade do Porto/FMUP, FSE-Fundo Social Europeu, NORTE 2020-Programa Operacional Regional do Norte, Programas Doutorais. Project NetDIAMOND, supported by ESIF under Lisbon Portugal Regional Operational Programme and National Funds through FCT

OBJECTIVES:To study the incidence of acute kidney injury (AKI) in the postoperative period of cardiac surgery in patients without preoperative renal insufficiency who underwent cardiac surgery with cardiopulmonary bypass (CPB), and to explore the association between the incidence of AKI and predictors related to CPB.METHODS:Observational, cross-sectional study. Participants were divided in two groups, those who developed AKI in the postoperative period and those who did not develop AKI. Kidney Disease: Improving Global Outcomes - Clinical Practice Guideline for Acute Kidney Injury (KDIGO) classification was used to characterize AKI. The analysis included preoperative variables (anthropometric data, cardiovascular risk factors and blood parameters), as well as the type of surgery, intraoperative variables related to CPB, and postoperative creatinine variation. Association between variables was studied with binary logistic regression.RESULTS:We have included 329 patients, of which 62 (19%), developed AKI. There were statistically significant differences between the groups in age (p<0.001; OR (95%)-1.075 (1.037-1.114)), duration of CPB (p=0.011; 1.008 (1.002-1.014)), urine output during CPB (p=0.038; 0.998 (0.996-0.999)), mannitol and furosemide administration during CPB, (respectively, p=0.032; 2.293 (1.075-4.890) and p=0.013; 2.535 (1.214-5.296)).CONCLUSIONS:A significant number of patients developed AKI in the postoperative period of cardiac surgery and this incidence was influenced by factors related to CPB, namely: age, duration of CPB, urine output during CPB, mannitol and furosemide administration during CPB.

Abstract Background Considering selected patients and the expertise of the surgical team, aortic valve repair (REPAIR) has been recognized as an alternative to aortic valve replacement. Aim To compare mid-term survival, need of reoperation and hemodynamic results after mechanical replacement (MECH) or REPAIR in non-stenotic aortic valve disease. Methods Retrospective single-center cohort study including consecutive patients younger than 70 years-old, with non-stenotic aortic valve disease, who underwent 1st aortic valve surgery with MECH or REPAIR (2 experienced surgeons), during a 6-year period. Concomitant procedures were not excluded. First follow-up echocardiogram was performed within 3 months after surgery (median). Mean follow-up time was 4 years, maximum 7. According to the data distribution appropriate statistical tests to compare independent samples were used. Mid-term survival and need of reoperation were studied through Kaplan-Meier curves and Cox regression. Results MECH was performed in 94 (56.6%) and REPAIR in 72 patients. Individuals in MECH group were older and presented higher NYHA functional class than REPAIR group (51±11 vs 47±13 years, p=0.048; 30 vs 4%, p<0.001). MECH group presented higher prevalence of rheumatic etiology (17 vs 3%, p<0.001). Although aortic root intervention was more frequent in MECH group (41 vs 17%, p<0.001), there were no differences in cardiopulmonary bypass and cross clamping aortic times (166 vs 148 minutes, p=0.16; and 121 vs 108 minutes, p=0.15 in MECH and REPAIR group, respectively). Left ventricle mass regression was similar (18 vs 21%, p=0.450, in MECH and REPAIR group, respectively). Mid-term survival (REPAIR cumulative survival 97% and MECH 93%, Log-Rank test p=0.752) and reoperation rates were similar between the two groups. REPAIR procedure failed in 3 patients: 2 months (new aortic regurgitation, AR), 7 months (infective endocarditis, IE) and 4 years (AR). MECH failed in 2 patients: 6 months (IE) and 2 months after surgery (prosthesis thrombosis) (Figure 1). Conclusion Aortic valve repair seems to be safe and effective in this single-center study showing similar results comparing with mechanical aortic valve replacement. We should reinforce the need of judiciously select patients for this complex surgical technique and the specialized training of the surgical team. Further studies are needed to provide reliable recommendations on this theme.

INTRODUCTION:Postoperative atrial fibrillation (PoAF) is the most common arrhythmia following cardiac surgery, which increase the patient's morbidity and mortality.PURPOSE:The aim of this study was to evaluate new onset of atrial fibrillation (AF) after isolated coronary artery bypass grafting (CABG) surgery, its clinical and surgical predictors, and its impact in immediate and long-term outcomes.METHODS:Retrospective study including all CABG surgeries performed in a tertiary centre, between 2004 and 2011. Patients with documented episodes of AF or pacing rhythm before cardiac surgery were excluded. Preoperative, surgical and postoperative data were collected through clinical files and informatics databases. Qui-square tests and independent t-tests were used to compare categorical and continuous data, respectively, between patients with and without PoAF. A multivariate logistic regression model was used to identify independent risk factors of PoAF. To determine the effect of PoAF in long-term survival, we used Kaplan-Meier curves, Log Rank test and multivariate Cox regression (maximum follow-up time: 13 years).RESULTS:We included 2511 patients, mean age of 63±10 years, 78.7% being male. PoAF occurred in 450 patients (18.0%), 3±3 days after surgery, the majority pharmacologically cardioverted with amiodarone (96.2%). These patients were older (67±9 vs. 62±10 years, p<0.001), more frequently obese (27.8% vs. 22.9%, p=0.026), hypertensive (76.7% vs. 69.7%, p=0.003) and had lower preoperative creatinine clearance (CC) values (73.2±27.4 vs. 81.4±28.3 ml/min, p<0.001), longer cardiopulmonary bypass time (60.0% vs. 54.8%, p=0.043) compared with patients without PoAF. In multivariate analysis, older age (OR: 1.035, 95% CI: 1.015-1.056, p=0.001), lower preoperative CC values (OR: 0.992, 95% CI: 0.985-0.999, p=0.032) and larger left atrial diameter (OR: 1.058, 95% CI: 1.024-1.093, p=0.001) were determined as independent predictors of PoAF. These patients also revealed longer hospitalization time (8 [4 to 193] vs. 6 [4 to 114] days, p<0.001) and higher hospital mortality (2.9% vs. 0.8%, p<0.001). Regarding long-term survival, patients with PoAF showed lower cumulative survival than patients without AF events (52% vs. 66%, p<0.001). PoAF was also found as an independent predictor of mortality in multivariate Cox regression (HR: 1.394, 95% CI: 1.147- 1.695, p=0.001).CONCLUSION:PoAF incidence after CABG surgery was 18%. Older age, lower CC values and larger left atrial diameter were settled as PoAF independent predictors. Additionally, the occurrence of this arrhythmia was independently associated with lower long-term survival, after CABG surgery.

INTRODUCTIONThe degenerative process that results in aortic valve stenosis (AS) has pathophysiological features similar to the atherosclerotic process. We therefore hypothesized that, as in atherosclerosis, endothelial and vascular dysfunction could be a pathophysiologic feature of AS.AIMTo evaluate endothelial function before and after aortic valve replacement (AVR) surgery in patients with severe AS. To correlate endothelial function with severity of AS and clinical profile.METHODSTwo noninvasive methods were used to evaluate endothelial function (Reactive Hyperemia Index (RHI) measure with EndoPATTM2000 system) and vascular properties (carotid-femoral Pulse Wave Velocity (PWV) measured by Complior® Analyse) in 13 patients with severe AS undergoing AVR. Sample was collected by convenience in a single-center between February and July of 2017. Pre- -operative, surgical and post-operative data were collected through clinical files and informatics databases. PWV, RHI, Augmentation Index (AI) were assessed at the day of surgery and 2.4±1.2 months post-operatively. Mean transvalvular gradients (MTG), aortic valve area (AVA) and left ventricular function were evaluated by transthoracic echocardiography at 3.4±1.6 months of follow-up. Wilcoxon or paired t-tests were used to compare pre- and post-operative values of continuous variables. Spearman correlations (rho) were done to find associations between endothelial/ vascular function parameters and clinical data.RESULTSIn our sample, mean age was 70±8 years and 69% were females. Arterial hypertension was present in 11 (85%) patients, diabetes in 3 (23%) and pre-operative NYHA functional class ≥III in 4 (31%). No patient was currently smoker and only 2 had previous history of smoking. No significant changes were observed between pre- and post-operative endothelial/vascular function values. PWV (m/s), AI (%) and RHI before and after AVR surgery were: 10.5 (6.1 to 16) vs. 9.4 (4.7 to 21.6), p=0.701; 33% [-24 to 54] vs. 23% [0 to 47], p=0.116 and 1.83 (1.08 to 3.13) vs. 1.71 (1.06 to 3.12), p=0.638, respectively. We found a significant inverse correlation between pre- operative AVA and AI (rho= -0.652, p=0.016) and a positive correlation between age and post-operative PWV (rho= 0.639, p=0.019). Pre- and post-operative MTG and AVA were 54±5 mmHg and 0.7± 0.1 cm2 vs.12±4 mmHg and 2.0±0.5 cm2, respectively (p<0.001).CONCLUSIONConsidering small sample size, no differences were found in indices of endothelial/vascular function before and after AVR surgery due to AS. However, it seems that endothelial dysfunction is associated with severity of AS assessed by AVA.

Acute kidney injury (AKI) in the postoperative period of cardiac surgery occurs in 1 to 30% of the patients, mainly caused by ischemia secondary to renal hypoperfusion. Cardiopulmonary bypass (CPB) has a deleterious effect on renal function, constituting an aggression to the patient's homeostasis.To evaluate the incidence of AKI in the postoperative period of cardiac surgery in patients without preoperative renal insufficiency who underwent cardiac surgery with CPB, and explore the association between incidence of AKI and predictors related to CPB.Observational, retrospective, cross-sectional study. Participants were divided in two groups, those who developed AKI in the postoperative period and those who did not develop AKI. KDIGO Clinical Practice Guideline for Acute Kidney Injury classification was used to characterize AKI. The preoperative variables analysed were anthropometric data, cardiovascular risk factors and blood parameters. The type of surgery, intraoperative variables related to CPB and postoperative creatinine variation were also analysed. The association between variables was studied using binary logistic regression.Of the 329 patients included, 62 (18.8%), developed AKI. There were statistically significant differences between the groups in age (p<0.001), CPB time (p=0.011), diuresis during CPB (p=0.038) and mannitol and furosemide administration during CPB (respectively, p=0.032 and p=0.013). Odds ratio showed a significant positive association between AKI and age (OR (95%)- 1.08 (1.04-1.11)), CPB time (OR (95%)-1.01 (1.00-1.01)), mannitol and furosemide administration during CPB (respectively, OR (95%)-2.29 (1.08-4.89) and OR (95%)-2.54 (1.21-5.30)).This study shows that a significant number of patients developed AKI in the postoperative period of cardiac surgery and this incidence was influenced by factors related to CPB.