RESUMO
PURPOSE: To evaluate and compare the clinical outcomes and hospital costs of using sutureless aortic valves vs conventional stented aortic valves. METHODS: Between 2007 and 2011, 52 elderly patients undergoing aortic valve replacement for aortic stenosis in our center had a sutureless valve inserted. From among 180 patients who had a stented valve inserted during the same period, 52 patients were matched to the sutureless group, based on age, gender, and operation type. We compared clinical outcomes and hospital costs between the two groups. RESULTS: The sutureless group had a higher Euroscore (logistic Euroscore I) risk (12.8 vs 9.7; p = 0.02), with significantly shorter aortic cross-clamp (ACC) time (p < 0.01), cardiopulmonary bypass (CPB) time (p < 0.01), intensive care unit stay (p < 0.01), intubation time (p < 0.01), and overall hospital stay (p = 0.05). The sutureless group also revealed a significant hospital cost saving of approximately 8200 (p = 0.01). CONCLUSIONS: The clinical and hemodynamic outcomes of using the sutureless bioprosthesis were excellent. The reduced ACC and CPB times had a favorable effect on the duration of intubation and intensive care stay, resulting not only in faster recovery and discharge home, but also in a significant hospital cost reduction.
Assuntos
Estenose da Valva Aórtica/economia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Redução de Custos/economia , Implante de Prótese de Valva Cardíaca/economia , Implante de Prótese de Valva Cardíaca/métodos , Custos Hospitalares , Stents/economia , Procedimentos Cirúrgicos sem Sutura/economia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/fisiopatologia , Bioprótese , Ponte Cardiopulmonar , Estudos de Casos e Controles , Feminino , Hemodinâmica , Humanos , Tempo de Internação/economia , Masculino , Estudos Retrospectivos , Risco , Fatores Sexuais , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: Osteochondroma is the most common benign tumor of the bone. It is usually asymptomatic, but complications may result from mechanical injury to adjacent anatomic structures, such as the diaphragm and lung, when located intrathoracically. CASE REPORT: We report the unusual occurrence of a large hemothorax and lacerated right diaphragm in a 41-year-old woman caused by vertebral osteochondroma affecting the eleventh thoracic vertebra. Thoracoscopic exploration with resection of the osteochondroma and repair of the diaphragm was performed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Spontaneous hemothorax is a potential life-threatening condition when the initial diagnosis is postponed and hemodynamic instability and hypovolemic shock occurs. Osteochondroma as a cause of spontaneous hemothorax is uncommon but may require urgent surgical intervention with video-assisted thoracoscopic surgery of thoracotomy to control the hemorrhage and prevent recurrence.
Assuntos
Dor no Peito/etiologia , Hemotórax/etiologia , Osteocondroma/complicações , Ruptura Espontânea/fisiopatologia , Adulto , Dor no Peito/fisiopatologia , Serviço Hospitalar de Emergência/organização & administração , Feminino , Hemotórax/fisiopatologia , Humanos , Recidiva Local de Neoplasia/patologia , Osteocondroma/diagnóstico , Osteocondroma/fisiopatologia , Radiografia/métodos , Ruptura Espontânea/diagnóstico , Tomografia Computadorizada por Raios X/métodosRESUMO
As the incidence of heart failure rises and given the shortage of donor organs, left ventricular assist device implantation offers a viable therapy in patients with end-stage heart disease. The CircuLite Synergy™ device is a less invasive support device for Intermacs class 4 heart failure patients. We report the first case of successful weaning from the CircuLite Synergy™ pump and propose our surgical technique to explant the device while leaving the inflow cannula in situ.