Papers by Luis Roberto P Dallan
Clinics, 2009
Nicolau JC, Lemos PA, Wajngarten M, Giraldez RR, Serrano-Jr. CV, Eulógio E, et al. The role of in... more Nicolau JC, Lemos PA, Wajngarten M, Giraldez RR, Serrano-Jr. CV, Eulógio E, et al. The role of invasive therapies in elderly patients with acute myocardial infarction. Clinics. 2009;64(6):553-60.
Revista Brasileira de Cirurgia Cardiovascular, 2003
Objective: To report on our initial clinical experience of the utilization of a mechanical anasto... more Objective: To report on our initial clinical experience of the utilization of a mechanical anastomotic device (MAD) to perform saphenous vein graft to aorta anastomosis. Method: Between June 2002 and May 2003, 17 patients, including 13 male, with a mean age of 64.4 ± 9.4 years, were selected for coronary artery bypass grafting using MAD. A total of 49 anastomoses, 19 arterial and 30 vein grafts, were performed with a mean of 2.9 ± 0.5 anastomoses per patient. Eleven (36.7%) vein-graft anastomoses were performed with conventional sutures and 19 (63.3%) using MAD. The clinical evolution, enzymatic and electrocardiographic alterations as well as an angiographic study were analyzed in the postoperative period. Results: Of the 17 patients, the mechanical device was used on 16 (94.1%). Six (37.5%) patients were operated on under cardiopulmonary bypass with a mean time of 102.9 ± 16.9 minutes. The postoperative evolution was satisfactory in all patients. No patient presented with enzymatic, myocardial infarction or other ischemic electrocardiographic alterations in the immediate postoperative period. Early postoperative angiography was performed in 9 (52.9%) patients. The anastomoses of the left internal thoracic artery to left anterior descending artery were patent in all cases. Of the 15 saphenous vein grafts studied, 11 (73.3%) were performed using MAD, 9 (81.8%) of which were patent. All the 4 conventionally sutured vein anastomoses were patent. No hospital deaths occurred. In the late follow-up, 88.2% of the patients were free of cardiac-related events. Conclusions: MAD for vein graft-to-aorta anastomosis proved to be feasible, but a wider analysis of the benefits of its utilization regarding operative time, aggression to the patient, patency of the grafts and final cost are necessary. Descriptors: Cardiovascular diseases, surgery. Myocardial revascularization, methods. Coronary disease, surgery. JATENE, FB ET AL -Initial results on the use of mechanical devices for proximal saphenous vein graft anastomoses: a clinical and angiographic evaluation Rev Bras Cir Cardiovasc 2003; 18(4): 332-338
Arquivos Brasileiros de Cardiologia, 2012
Métodos: Foram operados 73 pacientes, sendo 51 do sexo masculino, com idades variando de 37 a 83 ... more Métodos: Foram operados 73 pacientes, sendo 51 do sexo masculino, com idades variando de 37 a 83 anos, com média de 61,2 anos, portadores de lesão isolada do ramo interventricular anterior acima de 80%. Foi utilizada intubação orotraqueal com sonda de duplo lume. O ...
Arquivos Brasileiros de Cardiologia, 2015
Heart surgery has developed with increasing patient complexity. To assess the use of resources an... more Heart surgery has developed with increasing patient complexity. To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS). All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups. Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001), as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata. Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.
Revista Brasileira de Cirurgia Cardiovascular, 1995
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Papers by Luis Roberto P Dallan