RESUMEN
OBJECTIVES: We explored the current evidence on coronary disease treatment comparing the survival of 2 therapeutic strategies: coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with drug-eluting stent (DES). METHODS: PubMed, Embase, and Google Scholar were searched for randomized clinical trials comparing CABG versus PCI with DES. The end point was overall mortality. Two statistical approaches were used: the generic inverse variance method, which was used to pool the incident rate ratios, and the pooled meta-analysis of Kaplan-Meier-derived individual patient data. RESULTS: Eight randomized clinical trials comparing 4975 patients undergoing CABG and 4992 patients undergoing PCI were included in our meta-analysis. Generic inverse variance method showed a statistically significant survival benefit of the CABG group (incident rate ratio, 1.21; 95% confidence interval, 1.09-1.35; P < .01). The Kaplan-Meier estimates of survival at 1, 5, and 10 years of the CABG group were 97.1%, 90.3%, and 80.3%, respectively. The Kaplan-Meier estimates of survival at 1, 5, and 10 years of the PCI group were 97.0%, 87.7%, and 76.4%, respectively. The log-rank analysis confirmed a statistically significant benefit in term of overall mortality of the CABG group (hazard ratio, 1.24; 95% confidence interval, 1.11-1.38; P = .0001). CONCLUSIONS: The present meta-analysis suggests that CABG provides a consistent survival benefit over PCI with DES.
Asunto(s)
Implantación de Prótesis de Válvulas Cardíacas , Insuficiencia de la Válvula Tricúspide , Estudios de Factibilidad , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Válvula Tricúspide/diagnóstico por imagen , Válvula Tricúspide/cirugía , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/cirugíaAsunto(s)
Fibrilación Atrial , Insuficiencia Cardíaca , Corazón Auxiliar , Humanos , Periodo PosoperatorioAsunto(s)
Neoplasias Cardíacas/cirugía , Sarcoma/cirugía , Adulto , Anciano , Resultado Fatal , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Adulto JovenRESUMEN
A 68-year-old woman with a history of previous double-valve replacement with On-X mechanical heart valves presented with clinical, echocardiographic and cardiac catheterization signs of obstruction of the On-X tricuspid heart valve prosthesis. The patient was successfully reoperated, but at surgery the valve was seen to be invaded by an abnormal overgrowth of pannus that blocked one of the leaflets. A small amount of non-obstructive fresh thrombus was also observed. The valve was successfully replaced with a biological heart valve prosthesis. The patient was discharged home, and is doing well four months after the operation, when echocardiography demonstrated normal function in the tricuspid valve. The present case represents the first ever report of pannus formation and subsequent dysfunction in an On-X heart valve, and also the first case of tricuspid valve malfunction and obstruction using this type of heart valve substitute.
Asunto(s)
Enfermedades de las Válvulas Cardíacas/cirugía , Prótesis Valvulares Cardíacas , Válvula Mitral/cirugía , Complicaciones Posoperatorias/diagnóstico , Falla de Prótesis , Trombosis/diagnóstico , Válvula Tricúspide/cirugía , Anciano , Bioprótesis , Femenino , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Complicaciones Posoperatorias/cirugía , Reoperación , Trombosis/cirugíaAsunto(s)
Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Factores de Tiempo , Resultado del TratamientoRESUMEN
This report concerns a 69-year-old woman who presented with an asymptomatic myxoma in the left ventricle. The tumor was successfully excised. We provide a very brief review of 72 other published cases of surgically treated left ventricular myxoma.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Neoplasias Cardíacas/cirugía , Ventrículos Cardíacos/cirugía , Mixoma/cirugía , Adolescente , Adulto , Anciano , Enfermedades Asintomáticas , Niño , Ecocardiografía Transesofágica , Femenino , Neoplasias Cardíacas/patología , Ventrículos Cardíacos/patología , Humanos , Masculino , Persona de Mediana Edad , Mixoma/patología , Resultado del Tratamiento , Adulto JovenRESUMEN
Three cases of acute mitral insufficiency after blunt chest trauma are presented. All three patients underwent urgent surgery for mitral valve replacement (MVR). The first patient presented complete detachment of the anterior papillary muscle, while the other two showed rupture of the posterior papillary muscle. The second patient also suffered rupture of the anterior papillary muscle of the tricuspid valve, and subsequently underwent double mitral-tricuspid valve replacement. All patients survived the operation and were discharged in good condition. An extensive review of the literature on surgically managed patients is included. In this group of high-risk patients, MVR represents a rapid and safe operation, and represents a good surgical option.
Asunto(s)
Insuficiencia de la Válvula Mitral/etiología , Heridas no Penetrantes/complicaciones , Adulto , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/cirugíaAsunto(s)
Cateterismo/efectos adversos , Catéteres de Permanencia/efectos adversos , Remoción de Dispositivos/métodos , Embolia/terapia , Migración de Cuerpo Extraño/terapia , Arteria Pulmonar/cirugía , Toracotomía , Cateterismo/instrumentación , Embolia/diagnóstico por imagen , Embolia/etiología , Embolia/cirugía , Migración de Cuerpo Extraño/diagnóstico por imagen , Migración de Cuerpo Extraño/etiología , Migración de Cuerpo Extraño/cirugía , Humanos , Masculino , Persona de Mediana Edad , Arteria Pulmonar/diagnóstico por imagen , Radiografía Intervencional , Técnicas de Sutura , Resultado del TratamientoAsunto(s)
Enfermedad de la Arteria Coronaria/complicaciones , Fibroma/complicaciones , Neoplasias Cardíacas/complicaciones , Defectos del Tabique Interatrial/complicaciones , Vena Cava Superior/anomalías , Enfermedad de la Arteria Coronaria/cirugía , Fibroma/cirugía , Atrios Cardíacos , Neoplasias Cardíacas/cirugía , Defectos del Tabique Interatrial/cirugía , Humanos , Masculino , Persona de Mediana Edad , Vena Cava Superior/cirugíaRESUMEN
We present the case of a 76-year-old woman who presented with dyspnea on exertion. Echocardiography revealed a mass located in the left atrium in proximity to the posterior leaflet of the mitral valve. The mass was successfully excised under cardiopulmonary bypass. Histopathologic analysis showed a capillary hemangioma. Twenty-five months after surgery, the patient remained asymptomatic, and her echocardiogram was normal. Herein, we discuss the histopathology and the clinical, diagnostic, and therapeutic aspects of hemangiomas. We include a selected overview of the literature on surgically treated patients.
