CARDIOTHORACIC SURGERY

(1)

FACULTY of MEDICINE

and

UNIVERSITY HOSPITALS of COIMBRA

UNIVERSITY CLINIC

CENTER of

CARDIOTHORACIC SURGERY

Annual Report

2017

Available online at:

(2)

n the Center of Cardiothoracic Surgery Coimbra (CCT), the year 2017 confirmed the

slight trend of a decrease in surgical activity that had been noticed in previous years, the

most evident causes of which are a better distribution of activity in other centers in the

country and, also, a possible decrease in demand resulting from the growing impact of

interventional cardiology, especially in the area of coronary disease. In fact, the numbers of

coronary surgeries performed have registered the lowest level ever, confirming the marked

trend that has been occurring in recent years.

By contrast, valve surgery has had its highest values, especially at the expense of aortic

valve surgery, even taking into account the increasing use of percutaneous implantation,

and which is due to the growing number of elderly patients with aortic stenosis, a worldwide

phenomenon. Otherwise, regarding cardiac surgery, there were no other changes worthy

of reference, including the numbers of surgery for congenital malformations, which have

remained relatively constant, but with an increasing influx of complex cases from the

ex-Portuguese African colonies.

With respect to thoracic surgery, there was a significant decrease in activity resulting from

changes in the reference standards, especially for small public and private centers. Still,

with more than 650 annual surgeries, CCT continues to be the most active service in the

country (and probably in the Iberian Peninsula) in this type of pathology. The preference of

patients and referrers for the less invasive surgery, of lesser expression here, a factor to be

corrected in the near future, also had some influence in the numbers mentioned in this

report.

This situation may change over the next few years due to the changes recently introduced

in the National Network of Reference in Cardiothoracic Surgery. The report of the respective

Working Group, coordinated by Professor Manuel Antunes, and approved by the Health

Ministry in December 2017, extended the geographical area of reference to our Center,

both to the South and to the North. In addition, the CCT is now classified as an alternative

reference for the entire Northern Region. These changes confirm, in fact, a pattern already

followed in practice, since more than one third of our patients come from outside the Center

Region.

In 2017, the first thoracic surgeons completed their specialty since this (sub)specialty

became autonomous from cardiothoracic surgery, half a dozen years ago. Dr. Ana Luís

Garcia was the first of these specialists to be trained at our Center. Dr Filipe Leite also

completed the specialty of cardiothoracic surgery earlier this year.

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Finally, the process of construction and acquisition of the hybrid room and respective

equipment, which is part of the CCT's operating block, is nearing its end, expected to be

awarded during first quarter of 2018 and the start of the activity scheduled for the end of the

first half of the year. This infrastructure represents an important milestone in the

collaboration and interaction between CHUC's cardiology and cardiac surgery services. It

is expected that it will function, exactly as planned, for cardiological and surgical intervention

activity, in a unique project in the Country. This new program will certainly have an impact

in the cardiological panorama of the Center Zone.

In 2018, we celebrate the 30th anniversary of this Center of Cardiothoracic Surgery. As

usual, this event will be associated with the holding, in June, of a symposium which will

count with the participation of 7 or 8 recognized international experts.

This year will also be marked by of my retirement as the director and founder of the Center,

after which important structural and functional changes are anticipated. Hence, this will be

the last report signed by me, after thirty years of functioning of what is undoubtedly the most

prestigious center of Cardiothoracic Surgery in the country, nationally and internationally

recognized for the quality of its assistance to patients and its management model. This does

not pertain only to the Center for Responsibility (CRI) status, almost virtual now, mainly due

to the inability of successive hospital management teams to adjust to the model, which even

seems to be a priority of the current Minister. I hope this will return to normality in the near

future.

This is, therefore, the opportunity to affirm that it has been a great honor for me to serve the

Center as its Director during these 3 decades and to work with a team of undeniable

technical, scientific and human capabilities. It is also the time to wish that the Center

progresses in its path to success and that its employees continue to demonstrate that they

are the most important factor in this success, which I hope will reach even higher levels in

the future.

Coimbra, 31st December 2017

Prof Doutor Manuel J Antunes

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STAFF

SURGERY

Director/Professor

Manuel J Antunes

Senior Surgeons

J Ferrão de Oliveira

Luís Eugénio

João Bernardo

Graduated Surgeons

Pedro Antunes

David Prieto

Surgeons

Gonçalo Coutinho

Rita Pancas

Vyacheslav Bihun

Carlos Pinto

Joana Saraiva

Pedro Correia

Interns

Filipe Leite

Filipe Soares

Ana Luís Garcia

Tiago Nogueira

Carlos Branco

João Freitas

André Antunes

ANESTHESIA

Graduated Assistants

_{Manuel Carreira}

_{Manuel Cuervo}

CARDIOLOGY

Assistant

Maria João Maldonado

Ana Rita Ramalho (desde Outubro)

INTERNAL MEDICINE

Assistant

Manuel Batista

NURSING

Emília Sola (Head Nurse)

Anabela Perdigão (ICU)

Graça Caldeira (Pulmonary)

PERFUSION

António Ribeiro

Sofia Santos

Catarina Lopes

Cátia Sá

Mariline Santos

Rui Carvalho

SECRETARIATE

Ana Gonçalves

Fernanda Zacarias

Inês Freire

Susana Rougier

Margarida Pereira

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OPERATIVE ACTIVITY

SUMMARY - I

N Mortality

n %

PULMONARY SURGERY

650

3 0,4

Major

539

3 0,5

Minor

111 CARDIAC SURGERY

1186

8 0,6

With CEC

1069

6 0,5

Without CEC

117

2 1,6

TOTAL

1836 11

0,5

0 200 400 600 800 1000 1200 1400 1600 1800 2000 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Global Activity 1998 - 2017

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SUMMARY - II

N Mortality

n %

CARDIAC SURGERY

%

Acquired

1099

8 0,7

With CEC

990

6 0,6

Without CEC

109

2

1.8 Pediatric/Congénital

87 --

--

With CEC

76 Without CEC

11 Total

1186

8 0,6

0 100 200 300 400 500 600 700 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Cardiac Surgery 1998 - 2017

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CARDIAC SURGERY *

N Mortality

A. ADQUIRIDAS

%

I- Com CEC

Válvula mitral

177 Substituição por prótese

36 + plastia tricúspide

21 + plastia aórtica / excisão de pannus

4 + substituição valvular tricúspide

1 Plastia

83 + plastia tricúspide

28 Encerramento de leak mitral

4 Válvula aórtica

395

3 0,7

Substituição por prótese

375

3 + plastia tricúspide

+

8 Substituição por homoenxerto

5 Plastia

3 Tumor da válvula aórtica

1 Excisão de pannus + tricúspide

3 Válvula aórtica + mitral

38 --

--

Substituição dupla

14 Substituição aórtica + plastia mitral

13 + plastia tricúspide

6 Plastia aórtica + plastia mitral

2 Plastia aórtica + substituição mitral

2 + plastia tricúspide

1 Válvula tricúspide

2 --

--

Substituição tricúspide

1 Plastia tricúspide

1 Aneurismas/Dissecções da aorta

55

1 1,8

Operação de Bentall

5 Substituição aorta ascendente

12

1 + substituição aórtica

32 + plastia aórtica

1 + bypass coronário

1 + substituição aórtica + plastia mitral

2 + substituição aórtica + bypass coronário

2 Revascularização coronária (Bypass) – isolada**

226

1 0,4

Uma mamária

155

1 Duplas mamárias

71 Revascularização coronária + cirurgia associada

51

1

1.9 + substituição mitral

1 + Plastia mitral

7 + plastia tricúspide

1 + Substituição aórtica

42 Transplantação cardíaca (isolada)

25

26 --

--

+ transplantação renal

1 Outras

20 --

--

Mixoma/tumor da aurícula direita/esquerda

8 Assistência com ECMO

7 Correcção MCH+Miectomia SIV

2 Nefrectomia direita + trombectomia da aurícula

direita

3 Subtotal

990

6 0,6

* Inclui 17 doentes operados no I.C. - Maputo – Moçambique; ** Inclui 21 cirurgias s/ CEC

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N Mortality

n

%

II - Sem CEC

Pericardiectomia

2 Revisão de hemóstase

46 Drenagem pericárdica

10 Assistência com ECMO

3 Colocação de balão intra-aórtico

2 Refixação esterno

2 Esternotomia

4

2 Traqueostomia

2 Colheitas de coração

30 Drenagem de derrame pleural

1 Rafia do ventrículo direito

2 Limpeza cirúrgica do esterno

1 Bypass femoro-poplíteo + fasciectomia

1 Remoção de cânulas ECMO/assistência VE

3 Subtotal

109

2

1.9 TOTAL

1099

8 0,7

B. PEDIATRIC / CONGÉNITAL

N Mortality

n

%

I - Com CEC

Plastia mitral

13 Substituição mitral

2 Substituição aórtica + plastia mitral

1 Plastia mitral + plastia tricúspide

3 Plastia mitral + plastia aórtica

3 Comunicação interauricular

9 + plastia tricúspide

6 Comunicação interventricular

13 + CIA

4 + homoenxerto pulmonar

1 Canal A-V parcial

3 Tetralogia de Fallot

11 TGV – switch arterial

2 Ressecção de membrana subaórtica

4 Substituição V. pulmonar após ressecção de prótese

1 Retorno venoso anómalo

1 Subtotal

76 --

--

II - Sem CEC

Canal arterial

3 Coartação da aorta

2 Shunt B-T

2 Rafia do VD

1 Banding da artéria pulmonar

2 Anel vascular

1 Subtotal

11 --

--

TOTAL

87 --

--

Inclui 13 doentes operados na Jordânia

* Inclui 1 cirurgia s/ CEC

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TORACIC / PULMONARY SURGER

N Mortality

n

%

A. GRANDE CIRURGIA

Pneumectomia / pneumectomia extrapleural

2 Bilobectomia

4 Lobectomia / linfadenectomia mediastínica

90

2 Segmentectomia

3 Ressecção em cunha / enucleação

126 Biópsia pulmonar

32 Fístula bronco-pleural / exérese de bolha gigante

26 Pneumotórax espontâneo (abrasão pleural)

11 Descorticação pulmonar

47 Exérese de tumor da pleura

1 Hemotórax / limpeza cirúrgica / revisão hemostase

15 Toracotomia exploradora / diagnóstica / biópsia

8 Artrodese esterno clavicular

3 Exérese de arco costal

5 Osteossíntese costal

9 Tumor parede torácica c/s reconstrução

3 Correcção de pectus carinatum / excavatum

4 Exérese de tumor mediastínico

18 Exérese de quisto broncogénico / pericárdico

3 Timectomia / alargada

10 Eventração / hérnia diafragmática

8 Janela pleuro-pericárdica

14

1 Bócio mergulhante / paratiróides ectópicas

6 Cirurgia da traqueia

4 Colocação de CDIs

3 Esofagectomia

1 Encerramento de fístula gastro-esofágica

1 Mediastinite / Colocação sistema de lavagem

4 Exérese de nódulo do esófago

2 Subtotal

463

3 0,6

B. CIRURGIA POR VIDEOTORACOSPIA (VATS)

Biópsia pulmonar / pleural / mediastínica

28 Simpaticectomia dorsal

9 Toracoscopia / ressecção nódulo

2 Exérese de tumor mediastínico

2 Pneumotórax por VATS

35

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C. CIRURGIA MINOR / DIAGNÓSTICO

Mediastinoscopia

51 Mediastinotomia

9 Remoção de material de osteossíntese

1 Traqueostomia

4 Biópsia cervical

1 Biópsia de massa mediastínica / parede torácica

8 Colocação/extracção de implantofix

7 Reposicionamento PM/CDI e limpeza de loca

13 Implantação de eléctrodos epicárdicos

1 Refixação do esterno

2 Fistulectomias/exérese de fios de aço

5 Excisão de corpo estranho da parede torácica

2 Adenopatia supraclavicular

6 Excisão de massa axilar

1 Subtotal

111 --

--

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Publications

1. Antunes MJ

Price and cost: An unfriendly relationship in the institutions of the National Health Service. Rev Port Cardiol 2017; 36:43-4

2. Antunes MJ

Suture Annuloplasty for Functional Tricuspid Regurgitation (Chapter). In: In: Chan K. (eds) Functional Mitral and Tricuspid Regurgitation. Springer, Cham 2017;191-9

3. Coutinho GF, Antunes MJ

Mitral valve repair for degenerative mitral valve disease: surgical approach, patient selection and long-term outcomes

Heart 2017; 103:1663–9

4. Yankah C, Fynn-Thompson F, Yuko-Jowi C, Edwin F, Antunes MJ, Marath A, Smit F, Nwiloh J, Onakpoya U, Koen W, Bolman M, Urban A, Mestres C, Falk V

Concepts for Regional Referral Cardiac Centers in Sub-Saharan Africa Thorac Cardiovasc Surg 2017;65:S1-S110

5. Saraiva J, Antunes PE, Antunes MJ

Coronary artery bypass surgery in young adults: excellent perioperative results and long-term survival

Interact Cardiovasc Thorac Surg. 2017;24:691-5 6. Antunes MJ

Reply to Redondo et al.

Eur J Cardiothorac Surg. 2017 Dec 12. 7. Fonseca DA, Antunes PE, Cotrim MD

The Morphology, Physiology and Pathophysiology of Coronary Microcirculation, Microcirculation Revisited - From Molecules to Clinical Practice, Dr. Helena Lenasi (Ed.), InTech, DOI:

10.5772/64537. Indexed in the Book Citation Index in Web of Science™ Core Collection (BKCI) 8. Antunes PE

Comentário a «Avaliação do desempenho de dois sistemas de estratificação de risco - European System for Cardiac Operative Risk Evaluation score and the Society of Thoracic Surgeons score - em doentes submetidos a implantação valvular aórtica transcateter»

Rev Port Cardiol 2017: 9. Antunes MJ

Extra-Corporeal Membrane Oxygenation na insuficiência respiratória e circulatória agudas: uma terapêutica cada vez mais à mão

Rev Port Cardiol. 2017;36:843-5 10. Antunes MJ

"The Operation", half a century later. Rev Port Cardiol. 2017;36:879-0

11. Ibánez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, Caforio ALP, Crea F, Goudevenos JA, Halvorsen S, Hindricks G, Kastrati A, Lenzen MJ, Prescott E, Roffi M, Valgimigli M, Varenhorst C, Vranckx P, Widimský P.

2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.

Eur Heart J. 2017;39:119-77

12..Ramalho AR, Prieto D, Franco F, Antunes MJ. Heart transplantation for Chagas cardiomyopathy. Rev Port Cardiol. 2017;36:871

13. Antunes MJ, Rodríguez-Palomares J, Prendergast B, De Bonis M, Rosenhek R, Al-Attar N, Barili F, Casselman F, Folliguet T, Iung B, Lancellotti P, Muneretto C, Obadia JF, Pierard L, Suwalski P, Zamorano P

Management of tricuspid valve regurgitation: Position statement of the European Society of Cardiology Working Groups of Cardiovascular Surgery and Valvular Heart Disease.

Eur J Cardiothorac Surg. 2017;52:1022-30 14. Antunes MJ

The real world: What does it mean? Do I belong to it? J Thorac Cardiovasc Surg. 2017;154:1913-4

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15. Coutinho GF, Leite F, Antunes MJ.

Circumflex artery injury during mitral valve repair: Not well known, perhaps not so lessons learned from a 6-case experience.

J Thorac Cardiovasc Surg. 2017;154:1613-20 16. Antunes MJ

Is new-onset postoperative atrial fibrillation a benign complication? J Thorac Cardiovasc Surg. 2017;154:490-91

17. Antunes MJ

Pulmonary hypertension and mitral valve disease: Still a beast. J Thorac Surg. 2017;153:1083-4

18. Antunes MJ

Early failure of transcatheter aortic valves: A timely warning! J Thorac Cardiovasc Surg. 2017;153:e95-e96

19. Fonseca DA, Antunes PE, Cotrim MD

Ultrastructural and histomorphologic properties of the internal thoracic artery: implications for coronary revascularization.

Coron Artery Dis. 2017;28:518-52

20. Fonseca DA, Guerra AF, Carvalho F, Fernandes E, Ferreira LM, Branco PS, Antunes PE, Antunes MJ, Cotrim MD.

Hyperthermia Severely Affects the Vascular Effects of MDMA and Metabolites in the Human Internal Mammary Artery In Vitro.

Cardiovasc Toxicol. 2017;17:405-16

21. Couceiro R, Henriques J, Paiva RP, Antunes M, Carvalho P. Physiologically motivated detection of Atrial Fibrillation. Conf Proc IEEE Eng Med Biol Soc. 2017;1278-81 22. Ferreira JSSM, Moreira N, Ferreira MJ, Antunes M

Angiosarcoma Arising from the Main Pulmonary Artery Mimicking Pulmonary Thromboembolism. Arq Bras Cardiol. 2017;109:90-1

23. Ferreira A, Alexandre P, Sola E

Capacidade de auto-cuidado de adesão ao regime terapêutico da pessoa transplantada ao coração Sinais Vitais – Revista de Investigação em Enfermagem 2017; 2ª Série

24. Margato R, Oliveira T, Duarte JP

Efeito de redução funcional respiratória na pessoa com DPOC

Sinais Vitais – Revista de Investigação em Enfermagem 2017; 2ª Série

Presented at Congresses and other Scientific Meetings

1. Antunes MJ

Surgery in RHD: The role of valve reconstrutive procedures Rheumatic Heart Disease. Mirage City – Cairo, Janeiro 2017 2. Antunes MJ

Centros de Responsabilidade Integrados. O pael do diretor do Serviço Escola Nacional de Saúde Pública, Janeiro 2017

3. Branco CF, Soares F, Coutinho GF, Antunes PE, Antunes MJ

No survival impact of single vs multiple bypass grafts to each diseased coronary territory 53rd Annual Meeting of The Society of Thoracic Surgeons, Houston, Janeiro 2017

4. Yankah C, Fynn-Thompson F., Yuko-Jowi C., Edwin F., Antunes MJ, Marath A, Smit F, Nwiloh J, Onakpoya U, Koen W, Bolman III M, Urban A, Mestres C, Falk V

Concepts for regional referral cardiac centres in sub-Saharan Africa

German Society for Cardiothoracic and Vascular Surgery Meeting Feb 2017 5. Antunes MJ

Jantar-debate "Um Outro Olhar Sobre o Hospital"- "Centro de Responsabilidade Integrada: Constrangimentos e Oportunidades"

Associação Portuguesa para o Desenvolvimento Hospitalar. Lisboa, Abril 2017 5. Antunes MJ

Fatores e preconceitos – gestão hospitalar pública e privada. Problemas e soluções – um olhar multidisciplinar

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6. Antunes MJ

O melhor da Revista Portuguesa de Cardiologia 2016

XXXVII Congresso Português de Cardiologia. Albufeira. Abril 2017 7. Antunes MJ

Implantação percutânea de válvula aórtica – o meu pai tem 70 anos e estenose aórtica grave XXXVII Congresso Português de Cardiologia. Albufeira. Abril 2017

8. Leite F, Coutinho G, Antunes MJ

Lesão da artéria circunflexa durante plastia mitral

XXXVII Congresso Português de Cardiologia. Albufeira. Abril 2017 9. Branco C, Coutinho FG, Correia P, Soares F, Antunes PE, Antunes MJ

Impact of occult renal impairment in long-term survival of patients undergoing isolated

coronary artery bypass grafting surgery: a propensity-score matched analysis. Comunicação oral nomeada para o Prémio Manuel Machado Macedo

XXXVII Congresso Português de Cardiologia. Albufeira. Abril 2017 10. Branco C, Soares F, Coutinho GF, Antunes MJ

Triple valve surgery: is mitral valve repair better than replacement? XXXVII Congresso Português de Cardiologia. Albufeira. Abril 2017 11. Branco C, Soares F, Coutinho GF, Antunes PE, Antunes MJ

Coronary artery bypass grafting surgery in octagenarians: impact of complete anatomical revascularization in long-term survival.

XXXVII Congresso Português de Cardiologia. Albufeira. Abril 2017 12. Prieto D, Batista M, Antunes MJ

Primary graft failure after cardiac transplantation: prevalence, prognosis and risk factors XXXVII Congresso Português de Cardiologia. Albufeira. Abril 2017

13. Prieto D, Batista M, Antunes MJ

Survival after heart transplantation: infection and tumoral development ahead of acute cellular Rejection

XXXVII Congresso Português de Cardiologia. Albufeira. Abril 2017 14. Antunes MJ

Basic principles of rheumatic valve repair AATS Mitral Conclave. New York, Abril 2017 15. Antunes MJ

Coronary ischemia after valve surgery AATS Mitral Conclave. New York, Abril 2017 16. Antunes MJ

Burn-Out rheumatic mitral valve disease in adolescents: repair versus replacement AATS Centennial Meeting. Boston, Maio 2017

17. Leite F, Branco C, Antunes PE, Prieto D, Coutinho G, Antunes MJ

Combined aortic valve replacement and coronary artery bypass grafting: impact of incomplete revascularization in long-term survival

American Association for Thoracic Surgery Annual Meeting. Boston, Abril/Maio 2017 18. Bernardo J

Resseção pulmonary – estratégias

Reunião de cirurgia colorectal. “Actualizações em cancro colorectal”. Monte Real, Junho 2017 19. Antunes MJ

Surgical steps in mitral valve repair

Cardiovascular Master Summit – Latin America. Cartagena, Julho 2017 20. Antunes MJ

Good valves and bad valves to repair

The value of echocardiography in mitral valve repair

Nightmares in mitral valve repair

Mitral valve repair and replacement for rheumatic heart disease

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24. Branco C, Soares F, Coutinho GF, Antunes PE, Antunes MJ

Combined aortic valve replacement and coronary artery bypass grafting: the impact of incomplete revascularization in long term survival

ESC Congress. Barcelona, Agosto 2017

25. Branco C, Coutinho GF, Correia P, Soares P, Antunes PE, Antunes MJ

Impact of occult renal impairment in long-term survival of patients undergoing isolated coronary artery bypass grafting surgery: a propensity-score matched analysis.

ESC Congress. Barcelona, Agosto 2017 26. Branco C, Soares F, Coutinho GF, Antunes MJ

Triple valve surgery: is mitral valve repair better than replacement? ESC Congress. Barcelona, Agosto 2017

27. Antunes MJ

The tricuspid valve: the “not so forgotten” valve

STS/EACTS Latin America Cardiovascular Surgery Conference. Cartagena, Colombia, Setembro 2017

28. Antunes MJ

Stump the Professor: aortic valve/mitral valve

29. Antunes MJ

The tricuspid valve: the “not so forgotten” valve

30. Ferreira A, Sola, E, Loureiro M, Simões R

ECMO VA como ponte para transplantação cardíaca, implicações para os cuidados de enfermagem Jornadas de Cardiologia de Santarém. Santarém, Setembro 2017

31. Ferreira A

Projectos humanitários em cirurgia cardíaca

CPSS. III Reunião das Clinicas Universitárias. Salamanca, Setembro 2017 32. Azevedo T, manata J, Sola E

Dor no pós-operatório de cirurgia cardíaca: Efeitos de um protocolo de intervenção farmacológica para o alivio da dor no pós-operatório de cirurgia cardíaca

Jornadas de cardiologia do Centro. Viseu, Novembro 2017 33. Pinheiro B, Ferreira A, Sola E

ECMO VA como ponte para transplantação cardíaca, implicações para os cuidados de enfermagem Jornadas de cardiologia do Centro. Viseu, Novembro 2017

34. Coutinho GF

Cirurgia em valvulopatias assintomáticas

Coração no Centro. As Doenças Cardiovasculares 2017. Coimbra, outubro 2017. 35. Antunes MJ

Panorama actual dos transplantes torácicos – solução para falta de dadores

XV congresso Brasileiro de Transplantes. XVI Congresso Luso Brasileiro de Transplantes. Boubon Cataratas Foz do Iguaçu/PR. Outubro 2017.

36. Prieto D

Primary graft failure after cardiac transplantation: prevalence, prognosis and risk factors

37. Prieto D

Retrnasplante cardiac: mito ou realidade?

38. Bernardo JB

Cirurgia de redução do volume pulmonar. Ponte para transplante pulmonar. XXXIII Congresso Português de Pneumologia. Albufeira, Novembro 2017. 39. Branco C, Prieto D, Antunes A, Batista M, Antunes MJ

Heart transplantation: early results of two different regimes of immunosuppression Congresso SPCCTV. Albufeira, Novembro 2017.

40. Pinto C, Costa M, Oliveira H, Antunes MJ

Cardiac surgery. With synchronous carotid angioplasty, our experience Congresso SPCCTV. Albufeira, Novembro 2017.

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41. Madeira F, Cortesão J, Pancas R, Paiva T

Major hemorrhage during mediastinoscopy: do you panic or do you have a protocol? Congresso SPCCTV. Albufeira, Novembro 2017.

42. Antunes A, Prieto D, Pinto C, Branco C , Correia P, Batista M, Antunes MJ

Coronary allograft vasculopathy after cardiac transplantation: prevalence, prognostic and risk factors.

Congresso SPCCTV. Albufeira, Novembro 2017. 43. Bernardo JB

Ressecção alargada de tumores do mediastino anterior. Congresso SPCCTV. Albufeira, Novembro 2017. 44. Antunes MJ. Pioneering mitral valve repair in Africa.

50th Anniversary of the 1st Heart Transplant. Cape Town, Dezembro 20017 45. Antunes MJ

Implementing Guidelines and Recommendations into Clinical Practice EuroEcho Imaging 2017. Lisboa, Dezembro 2017