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BACKGROUND: The choice of prosthesis for aortic valve replacement (AVR) remains challenging. The risk of anticoagulation complications vs. the risk of aortic valve reintervention should be weighed. This study compared the outcomes of bioprosthetic vs. mechanical AVR in patients older and younger than 50. METHODS: This retrospective study was conducted from 2009 to 2019 and involved 292 adult patients who underwent isolated AVR. The patients were divided according to their age (above 50 years or 50 years and younger) and the type of valves used in each age group. The outcomes of bioprosthetic valves (Groups 1a (>50 years) and 1b (≤50 years)) were compared with those of mechanical valves (Groups 2a (>50 years) and 2b (≤50 years)) in each age group. RESULTS: The groups had nearly equal rates of preexisting comorbidities except for Group 1b, in which the rate of hypertension was greater (32.6% vs. 14.7%; p = 0.025). This group also had higher rates of old stroke (8.7% vs. 0%, p = 0.011) and higher creatinine clearance (127.62 (108.82-150.23) vs. 110.02 (84.87-144.49) mL/min; p = 0.026) than Group 1b. Patients in Group 1a were significantly older than Group 2a (64 (58-71) vs. 58 (54-67) years; p = 0.002). There was no significant difference in the NYHA class between the groups. The preoperative ejection fraction and other echocardiographic parameters did not differ significantly between the groups. Re-exploration for bleeding was more common in patients older than 50 years who underwent mechanical valve replacement (p = 0.021). There was no difference in other postoperative complications between the groups. The groups had no differences in survival, stroke, or bleeding rates. Aortic valve reintervention was significantly greater in patients ≤ 50 years old with bioprosthetic valves. There were no differences between groups in the changes in left ventricular mass, ejection fraction, or peak aortic valve pressure during the 5-year follow-up. CONCLUSIONS: The outcomes of mechanical and bioprosthetic valve replacement were comparable in patients older than 50 years. Using bioprosthetic valves in patients younger than 50 years was associated with a greater rate of valve reintervention, with no beneficial effect on the risk of bleeding or stroke.
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Background: Atrial fibrillation after cardiac surgery (POAF) is associated with increased morbidity and mortality. Several scores were used to predict POAF, with variable results. Thus, this study assessed the performance of several scoring systems to predict POAF after mitral valve surgery. Additionally, we identified the risk factors for POAF in those patients. Methods: This retrospective cohort included 1381 recruited from 2009 to 2021. The patients underwent mitral valve surgery, and POAF occurred in 233 (16.87%) patients. The performance of CHADS2, CHA2DS2-VASc, POAF, EuroSCORE II, and HATCH scores was evaluated. Results: The median age was higher in patients who developed POAF (60 vs. 54 years; p < .001). CHA2-DS2-VASc, POAF, EuroSCORE II, and HATCH scores significantly predicted POAF, with areas under the curve of the receiver operator curve (AUCROC) of 0.56, 0.61, 0.58, and 0.54, respectively. We identified age > 58 years, body mass index > 28 kg/m2, creatinine clearance < 90 mL/min, reoperative surgery, and preoperative inotropic and intra-aortic balloon pump use as predictors of POAF. We constructed a score from these variables (PSCC-AF). A score > 2 significantly predicted POAF (p < .001). The AUCROC of this score was 0.67, which was significantly higher than the AUCROC of the POAF score (p = .009). Conclusion: POAF after mitral valve surgery can be predicted based on preoperative patient characteristics. The new PSCC-AF score significantly predicted POAF after mitral valve surgery and can serve as a bedside diagnostic tool for POAF risk screening. Further studies are needed to validate the PSCC-AF-mitral score externally.
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Female gender is a risk factor in several cardiac surgery risk stratification systems. This study explored the differences in the outcomes following triple heart valve surgery in men vs women. The study included 250 patients (males n = 101; females n = 149) who underwent triple valve surgery from 2009 to 2020. BMI (body mass index) was higher in females (29.6 vs 26.5 kg/m2, P < .001), and diabetes was more common in males (44 vs 42%, P = .012). The ejection fraction was higher in females (55 vs 50%, P < .001). The severity of mitral valve stenosis and tricuspid valve regurgitation was significantly greater in females (33.11 vs 27.72%, P = .003 and 44.30 vs 19.8%, P < .001, respectively). Mitral valve replacement was more common in females (P < .001), and they had lower concomitant coronary artery bypass grafting (P = .001). Bleeding and renal failure were lower in females (P = .021 and <0.001, respectively). Hospital mortality, readmission, and reintervention were not significantly different between genders. By multivariable analysis, male gender was a risk factor for lower survival [HR (hazard ratio): 2.18; P = .024]. Triple valve surgery can be performed safely in both genders, with better long-term survival in females. Female gender was not a risk factor in patients undergoing triple valve surgery.
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BACKGROUND: Limited data evaluated the outcomes of extracorporeal membrane oxygenation (ECMO) in patients with prosthetic valves. This study aimed to compare the outcomes of ECMO support for postcardiotomy cardiogenic shock in patients with mechanical versus bioprosthetic valves. METHODS: This retrospective study included patients with ECMO support for postcardiotomy cardiogenic shock after valve replacement. Patients were grouped into bioprosthetic (n = 49) and mechanical valve (n = 22) groups. RESULTS: There were no differences in ECMO duration, inotropic support, intra-aortic balloon pump (IABP), stroke, duration of ICU, and hospital stay between groups. Postoperative thrombosis occurred in 2 patients with bioprosthetic valves (5.41%) and 2 with mechanical valves (14.29%), p = .30. All patients with thrombosis had central ECMO cannulation, concomitant IABP, and inotropic support during ECMO. All thrombi were related to the mitral valve. Three patients with thrombi had hospital mortality.Survival at 6, 12, and 36 months for bioprosthetic valve patients was 30.88%, 28.55%, and 25.34% and for mechanical valves was 36.36% for all time intervals (Log-rank p = .93). One patient had bioprosthetic aortic valve endocarditis after 1 year. Three patients with bioprosthetic valves had structural valve degeneration after 1, 2, and 5 years. CONCLUSIONS: Outcomes of ECMO in patients with prosthetic valves are comparable between bioprosthetic and mechanical valves. Thrombosis might occur in both valve types and was associated with high mortality. ECMO could affect the long-term durability of the bioprosthetic valves.
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Oxigenação por Membrana Extracorpórea , Acidente Vascular Cerebral , Trombose , Humanos , Choque Cardiogênico/etiologia , Choque Cardiogênico/cirurgia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia , Trombose/etiologiaRESUMO
AIMS: Type 2 diabetes mellitus (T2DM) increases the risk of major cardiovascular events. In SAVOR-TIMI53 trial, the excess heart failure (HF) hospitalization among patients with T2DM in the saxagliptin group remains poorly understood. Our aim was to evaluate left ventricular (LV) diastolic function after 6 months of saxagliptin treatment using cardiac magnetic resonance imaging (CMR) in patients with T2DM. METHODS: In this prospective study, 16 T2DM patients without HF were prescribed saxagliptin as part of routine guideline-directed management. CMR performed at baseline and 6 months after initiation of saxagliptin treatment were evaluated in a blinded fashion. We assessed LV diastolic function by measuring LV peak filling rate with correction for end-diastolic volume (PFR/LVEDV), time to peak filling rate with correction for cardiac cycle (TPF/RR), and early diastolic strain rate parameters [global longitudinal diastolic strain rate (GLSR-E), global circumferential diastolic strain rate (GCSR-E)] by feature tracking (FT-CMR). RESULTS: Among the 16 patients (mean age of 59.9, 69% males, mean hemoglobin A1c 8.3%, mean left ventricular ejection fraction 57%), mean PFR was 314 ± 108 ml/s at baseline and did not change over 6 months (- 2.7, 95% CI - 35.6, 30.2, p = 0.86). There were also no significant changes in other diastolic parameters including PFR/EDV, TPF, TPF/RR, and GLSR-E and GCSR-E (all p > 0.50). CONCLUSION: In T2DM patients without HF receiving saxagliptin over 6 months, there were no significant subclinical changes in LV diastolic function as assessed by CMR.
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Adamantano/análogos & derivados , Diabetes Mellitus Tipo 2 , Dipeptídeos , Insuficiência Cardíaca , Disfunção Ventricular Esquerda , Masculino , Humanos , Pessoa de Meia-Idade , Feminino , Função Ventricular Esquerda , Volume Sistólico , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/tratamento farmacológico , Estudos Prospectivos , Imageamento por Ressonância Magnética , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/tratamento farmacológico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/tratamento farmacológico , Disfunção Ventricular Esquerda/etiologiaRESUMO
INTRODUCTION: We studied the effect of tricuspid valve (TV) surgery combined with surgical ventricular restoration (SVR) on operative outcomes, rehospitalization, recurrent tricuspid regurgitation, and survival of patients with ischemic cardiomyopathy. Additionally, surgery was compared to conservative management in patients with mild or moderate tricuspid regurgitation. To the best of our knowledge, the advantage of combining TV surgery with SVR in patients with ischemic cardiomyopathy had not been investigated before. METHODS: This retrospective cohort study included 137 SVR patients who were recruited from 2009 to 2020. Patients were divided into two groups - those with no concomitant TV surgery (n=74) and those with concomitant TV repair or replacement (n=63). RESULTS: Extracorporeal membrane oxygenation use was higher in SVR patients without TV surgery (P=0.015). Re-exploration and blood transfusion were significantly higher in those with TV surgery (P=0.048 and P=0.037, respectively). Hospital mortality occurred in eight (10.81%) patients with no TV surgery vs. five (7.94%) in the TV surgery group (P=0.771). Neither rehospitalization (log-rank P=0.749) nor survival (log-rank P=0.515) differed in patients with mild and moderate tricuspid regurgitation in both groups. Freedom from recurrent tricuspid regurgitation was non-significantly higher in mild and moderate tricuspid regurgitation patients with no TV surgery (P=0.059). Conservative management predicted the recurrence of tricuspid regurgitation. CONCLUSION: TV surgery concomitant with SVR could reduce the recurrence of tricuspid regurgitation; however, its effect on the clinical outcomes of rehospitalization and survival was not evident. The same effects were observed in patients with mild and moderate tricuspid regurgitation.
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Cardiomiopatias , Implante de Prótese de Valva Cardíaca , Isquemia Miocárdica , Insuficiência da Valva Tricúspide , Humanos , Insuficiência da Valva Tricúspide/cirurgia , Resultado do Tratamento , Estudos Retrospectivos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Fatores de Risco , Fatores de Tempo , Isquemia Miocárdica/complicações , Isquemia Miocárdica/cirurgia , Cardiomiopatias/cirurgiaRESUMO
BACKGROUND: Tricuspid valve repair (TVr) is the recommended approach for managing tricuspid regurgitation; however, there is a concern about the long-term durability of the repair. Therefore, this study aimed to compare the long-term outcomes of TVr versus tricuspid valve replacement (TVR) in a matched cohort of patients. METHODS: This study included 1161 patients who underwent tricuspid valve (TV) surgery from 2009 to 2020. Patients were grouped according to the procedure into two groups: patients who underwent TVr (n = 1020) and patients who underwent TVR (n = 159). The propensity score identified 135 matched pairs. RESULTS: Renal replacement therapy and bleeding were significantly higher in the TVR group compared to the TVr group both before and after matching. Thirty-day mortality occurred in 38 (3.79%) patients in TVr group versus 3 (1.89%) in the TVR group (P ≤ 0.001) but was not significant after matching. After matching, TV reintervention (hazard ratio (HR): 21.44 (95% CI: 2.17-211.95); P = 0.009) and heart failure rehospitalization (HR: 1.89 (95% CI: 1.13-3.16); P = 0.015) were significantly higher in the TVR group. There was no difference in mortality in the matched cohort (HR: 1.63 (95% CI: 0.72-3.70); P = 0.25). CONCLUSIONS: TVr was associated with lower renal impairment, reintervention, and heart failure rehospitalization than replacement. TVr remains the preferred approach whenever feasible.
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Insuficiência Cardíaca , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Tricúspide , Humanos , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia , Pontuação de Propensão , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgia , Insuficiência Cardíaca/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
We aimed to compare the outcomes of ECMO with and without IABP for postcardiotomy cardiogenic shock. The study included 103 patients who needed ECMO for postcardiotomy cardiogenic shock. Patients were grouped according to the use of IABP into ECMO without IABP (n = 43) and ECMO with IABP (n = 60). The study endpoints were hospital complications, successful weaning, and survival. Patients with IABP had lower preoperative ejection fraction (p = 0.002). There was no difference in stroke (p = 0.97), limb ischemic (p = 0.32), and duration of ICU stay (p = 0.11) between groups. Successful weaning was non-significantly higher with IABP (36 (60%) vs 19 (44.19%); p = 0.11). Predictors of successful weaning were inversely related to the high pre-ECMO lactate levels (OR: 0.89; p = 0.01), active endocarditis (OR: 0.06; p = 0.02), older age (OR: 0.95; p = 0.02), and aortic valve replacement (OR: 0.26; p = 0.04). There was no difference in survival between groups (p = 0.80). Our study did not support the routine use of IABP during ECMO support.
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Oxigenação por Membrana Extracorpórea , Coração Auxiliar , Humanos , Choque Cardiogênico/etiologia , Choque Cardiogênico/terapia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Balão Intra-Aórtico/efeitos adversos , Coração Auxiliar/efeitos adversos , Valva Aórtica , Estudos RetrospectivosRESUMO
BACKGROUND: The optimal venoarterial extracorporeal membrane oxygenation (VA ECMO) cannulation strategy in patients with postcardiotomy cardiogenic shock is still debatable. Studies evaluating the effect of cannulation strategy on long-term survival are scarce. OBJECTIVES: We investigated the impact of central versus peripheral cannulation strategy for ECMO insertion on hospital outcomes and survival in postcardiotomy cardiogenic shock patients. METHODS: This retrospective study involved 101 patients who had either central or peripheral ECMO due to postcardiotomy shock between June 2009 and December 2020. Study endpoints were limb ischemia, bleeding, blood transfusion, wound infection, and overall survival. RESULTS: Eighty-four patients received central (c) ECMO, and 17 patients had peripheral (p) ECMO. In the group of pECMO, limb ischemia was significantly higher (5 [29.41%] vs 6 [7.14%]; p = .01). Other endpoints were similar in both groups. Thirty-day mortality was nonsignificantly different between both cohorts (cECMO 34 [41.67%] vs pECMO 10 [58.82%]; p = .29). However, overall survival was better with cECMO (Log-rank p = .02). Patients' age [HR: 1.04 (95% CI: 1.02-1.06); p = .001], pECMO [HR: 1.98 (95% CI: 1.11-3.55), p = .002] and presence of infective endocarditis [HR: 3.54 (95% CI: 1.52-8.24), p = .03] were significant predictors of overall mortality. CONCLUSIONS: Peripheral ECMO was associated with an increased risk of limb ischemia; however, bleeding, blood transfusion, infection, and 30-day mortality were comparable to central ECMO. Central cannulation was associated with a better 1-year survival rate. Therefore, central cannulation might be the preferred strategy for patients with postcardiotomy cardiogenic shock.
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Oxigenação por Membrana Extracorpórea , Choque Cardiogênico , Humanos , Choque Cardiogênico/etiologia , Choque Cardiogênico/cirurgia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Estudos Retrospectivos , Cateterismo , Isquemia/etiologia , Hemorragia/etiologiaRESUMO
Currently, there is no preference for surgical (SAVR) vs transcatheter (TAVR) aortic valve replacement in patients with low ejection fraction (EF). The present study retrospectively compared the outcomes of SAVR vs TAVR in patients with EF ≤40% (70 SAVR and 117 TAVR patients). Study outcomes were survival and the composite endpoint of stroke, aortic valve reintervention, and heart failure readmission. The patients who had TAVR were older (median: 75 (25-75th percentiles: 69-81) vs 51 (39-66) years old; P < .001) with higher EuroSCORE II (4.95 (2.99-9.85) vs 2 (1.5-3.25); P < .001). Postoperative renal impairment was more common with SAVR (8 (12.5%) vs 4 (3.42%); P = .03), and they had longer hospital stay [9 (7-15) vs 4 (2-8) days; P < .001). There was no difference between groups in stroke, reintervention, and readmission (Sub-distributional Hazard ratio: .95 (.37-2.45); P = .92). Survival at 1 and 5 years was 95% and 91% with SAVR and 89% and 63% with TAVR. Adjusted survival was comparable between groups. EF improved significantly (ß: .28 (.23-.33); P < 0.001) with no difference between groups (P = .85). In conclusion, TAVR could be as safe as SAVR in patients with low EF.
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Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Acidente Vascular Cerebral , Substituição da Valva Aórtica Transcateter , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Substituição da Valva Aórtica Transcateter/efeitos adversos , Estudos Retrospectivos , Estenose da Valva Aórtica/cirurgia , Volume Sistólico , Valva Aórtica/cirurgia , Acidente Vascular Cerebral/cirurgia , Resultado do Tratamento , Fatores de RiscoRESUMO
ABSTRACT Introduction: We studied the effect of tricuspid valve (TV) surgery combined with surgical ventricular restoration (SVR) on operative outcomes, rehospitalization, recurrent tricuspid regurgitation, and survival of patients with ischemic cardiomyopathy. Additionally, surgery was compared to conservative management in patients with mild or moderate tricuspid regurgitation. To the best of our knowledge, the advantage of combining TV surgery with SVR in patients with ischemic cardiomyopathy had not been investigated before. Methods: This retrospective cohort study included 137 SVR patients who were recruited from 2009 to 2020. Patients were divided into two groups - those with no concomitant TV surgery (n=74) and those with concomitant TV repair or replacement (n=63). Results: Extracorporeal membrane oxygenation use was higher in SVR patients without TV surgery (P=0.015). Re-exploration and blood transfusion were significantly higher in those with TV surgery (P=0.048 and P=0.037, respectively). Hospital mortality occurred in eight (10.81%) patients with no TV surgery vs. five (7.94%) in the TV surgery group (P=0.771). Neither rehospitalization (log-rank P=0.749) nor survival (log-rank P=0.515) differed in patients with mild and moderate tricuspid regurgitation in both groups. Freedom from recurrent tricuspid regurgitation was non-significantly higher in mild and moderate tricuspid regurgitation patients with no TV surgery (P=0.059). Conservative management predicted the recurrence of tricuspid regurgitation. Conclusion: TV surgery concomitant with SVR could reduce the recurrence of tricuspid regurgitation; however, its effect on the clinical outcomes of rehospitalization and survival was not evident. The same effects were observed in patients with mild and moderate tricuspid regurgitation.
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Tumor Carcinoide , Neoplasias Pulmonares , Células Neuroendócrinas , Tumores Neuroendócrinos , Humanos , Células Neuroendócrinas/patologia , Hiperplasia/patologia , Pulmão/diagnóstico por imagem , Pulmão/patologia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Tumores Neuroendócrinos/patologia , Tumor Carcinoide/patologiaRESUMO
BACKGROUND: The debate about the optimal mitral valve prosthesis continues. We aimed to compare the early and late outcomes, including stroke, bleeding, survival, and reoperation after isolated mitral valve replacement (MVR) using tissue versus mechanical valves. METHODS: This retrospective cohort study included 291 patients who had isolated MVR from 2005 to 2015. Patients were grouped into the tissue valve group (n = 140) and the mechanical valve group (n = 151). RESULTS: There were no differences in duration of mechanical ventilation, hospital stay, and hospital mortality between groups. Fifteen patients required cardiac rehospitalization, nine in the tissue valve group, and six in the mechanical valve group (p = .44). Stroke occurred in nine patients, five with tissue valves, and four with mechanical valves (p = .66). Bleeding occurred in 22 patients, seven patients with tissue valves, and 15 patients with mechanical valves (p = .09). Freedom from reoperation was 95%, 93%, 84%, 67% at 3, 5, 7, and 10 years for tissue valve and 97%, 96%, 96%, and 93% for mechanical valves, respectively (pË .001). The median follow-up was 84 months (Q1: Q3: 38-139). Survival at 3, 5, 7, and 10 years was 94%, 91%, 89%, 86% in tissue valves and 96%, 93%, 91%, 91% in mechanical valves, respectively (p = .49). CONCLUSIONS: Tissue valve degeneration is still an issue even in the new generations of mitral tissue valves. The significant risk of reoperation in patients with mitral tissue valves should be considered when using those valves in younger patients. Mechanical valves remain a valid option for all age groups.
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Bioprótese , Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Acidente Vascular Cerebral , Humanos , Valva Mitral/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Próteses Valvulares Cardíacas/efeitos adversos , Hemorragia/etiologia , Acidente Vascular Cerebral/etiologia , Reoperação , Valva Aórtica/cirurgiaRESUMO
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has drastically disrupted primary health care and pharmacy services, posing a challenge in people with chronic diseases who receive routine care. Currently, there exists limited literature on the indirect impact of the pandemic on chronic disease management, particularly related to accessibility to medications and health care resources. OBJECTIVES: To determine the prevalence of medical- and medication-related problems reported by people with chronic diseases during the pandemic. The secondary objective was to identify the barriers and contributing factors related to these medical- and medication-related problems. METHODS: The anonymous and voluntary, Web-based survey was filled out by interested adult respondents with chronic disease(s) across Michigan between September 1, 2020, and January 1, 2021. The primary outcome included self-reported medical- and medication-related problems during the pandemic. Secondary outcomes included potential risk factors for medical- and medication-related problems. Descriptive statistics was used to describe respondents' demographics, chronic disease characteristics, medication adherence, medical- and medication-related problems, and COVID-19-related factors. The multivariable Firth logistic regression was used to analyze correlations between potential risk factors associated with medical- and medication-related problems. RESULTS: A total of 1103 respondents completed the survey and were included in the analysis. Approximately, 51% of respondents reported a medication-related problem with 19.6% reported problems obtaining medication(s) and 31.7% reported forgetting or not taking their medication(s). The top reason for problems obtaining medication(s) was doctor's office being closed for in-person visit(s). In addition, of all responses, more than half reported worsening symptoms of their chronic disease(s) during the pandemic especially with psychiatric disorders (79.5%) and inflammatory bowel disease (60%). Respondents with a significantly higher risk of medication-related problems included those who were younger, were female, and had psychiatric disorder(s), diabetes, arthritis, or lupus, and respondents with a significantly higher risk of medical-related problems included those with multiple chronic diseases, psychiatric disorder(s), and heart failure. CONCLUSION: Understanding the consequences of the pandemic, such as medical- and medication-related problems, in this population is critical to improving health care accessibility and resources through potential outpatient pharmacy services during this and future pandemics.
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COVID-19 , Pandemias , Adulto , Doença Crônica , Feminino , Humanos , Masculino , Adesão à Medicação , Inquéritos e QuestionáriosRESUMO
The authors report a 27-year-old woman with a remote left femoral osteosarcoma and amputation above the left knee who presented with a large right ventricular mass. Initial evaluation with thoracic CT was inconclusive regarding thrombus versus tumor, but metastatic osteosarcoma was suggested by findings at transthoracic echocardiography, cardiac CT, and cardiac MRI. The patient underwent tumor debulking, and osteosarcoma was confirmed with pathologic examination. She responded to chemotherapy, which resulted in reduction in size of the residual right ventricular tumor and of a few pulmonary metastases. Following induction chemotherapy, patient remains well undergoing maintenance therapy with an oral tyrosine kinase inhibitor. Keywords: CT, Echocardiography, MR Imaging, Intraoperative, Cardiac, Heart, Right Ventricle, Imaging Sequences, Metastases, Oncology Supplemental material is available for this article. © RSNA, 2021.
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The COVID-19 pandemic represents an international health crisis that is challenging to all governments. Health practitioners in different fields have a duty to guide people and governments to achieve safe health practices. The Saudi Society for Cardiac Surgeons recognizes that it is difficult to establish evidence-based guidelines for safe cardiac surgery practices in such a crisis because this is an unprecedented health pandemic. So we decided to work with our colleagues in other societies by reviewing different recommendations and safe practices issued by different health organizations and scientific societies. The aim was to come up with recommendations that could guide hospitals, physicians, and other members of the healthcare team on the best available practices that are applicable to our community and that will not only ensure optimum patient care delivery but also protect healthcare workers from the risk of infection and aid the national effort in containing and managing this worldwide pandemic.
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Betacoronavirus , Procedimentos Cirúrgicos Cardíacos/métodos , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , COVID-19 , Consenso , Saúde Global , Humanos , SARS-CoV-2 , Arábia Saudita , Sociedades Médicas , CirurgiõesRESUMO
BACKGROUND: Paediatric del Nido cardioplegia (DNC) has been tested in selected populations of low-risk adult patients. This study examined its use in an unselected medium-to-high-risk adult population and compared the results with a propensity-matched population that received intermittent warm blood cardioplegia (IWBC). METHODS: Data from the last 1,000 consecutive adult patients who underwent a variety of surgical procedures under cardioplegic arrest with the use of IWBC or DNC between 2016 and 2018 were propensity score matched on preoperative clinical and demographic variables. Two (2) main populations were 102 patients who received DNC and another set of matched 102 patients from a total of 1,000 patients who received IWBC, along with a subgroup with an ejection fraction (EF) ≤40% (EFDNC vs EFIWBC). Postoperative outcomes were mortality, peak troponin T, postoperative EF%, and aortic cross-clamp time. RESULTS: There were no preoperative differences amongst the groups in the main cohort (Euroscore II: DNC 4.1±8, IWBC 4.0±7; EF%: DNC 47±10, IWBC 47±11) and in the subgroup (EF%: EFDNC 32±6%, EFIWBC 32±6%; p=0.45). There were also no differences in three of the outcomes. A significant postoperative improvement was noticed in the EF% in the DNC (32±6% 95% CI 29-34 to 39±12 95% CI 34-44; p=0.001) in the EFDNC group. CONCLUSIONS: This initial experience of del Nido cardioplegia proved to be effective in a variety of challenging pathologies in adult populations.
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Procedimentos Cirúrgicos Cardíacos/métodos , Parada Cardíaca Induzida/métodos , Cardiopatias/terapia , Pontuação de Propensão , Adulto , Feminino , Cardiopatias/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
BACKGROUND: Glomerular filtration rate (GFR) measured by Chromium-51-EDTA excretion (51Cr-GFR) is considered the gold standard of renal function assessment, but serum creatinine in the Cockcroft-Gault (CG) formula is routinely used to estimate GFR for carboplatin dosing. Serum creatinine measured by isotope-dilution-mass-spectrometry (IDMS) can generate spuriously high GFR estimates when used in the CG formula. We hypothesized that GFR calculated using IDMS-creatinine in the CG formula (CG-GFR) exposes patients to inaccurate carboplatin dosing. METHODS: This is a multicenter retrospective study of patients who had a 51Cr-GFR assessment for malignant or non-malignant indications, with a matched CG-GFR. Carboplatin dose based on 51Cr-GFR at AUC5 was used as the reference. RESULTS: 550 patients were analyzed, median age 62 (19-90), 64% female. Indication for GFR evaluation: malignancy (85%), assessment for live kidney donation (12%), other (3%). Median ratio of CG-GFR: 51Cr-GFR 1.04 (0.43-3.38); <0.8 in 72 patients (13%), >1.2 in 180 patients (33%). Despite capping of CG-GFR at 125 mL/min, dosing according to AUC6 would have resulted in 18% of patients being underdosed and 23% overdosed by >100 mg compared to 51Cr-GFR. Subgroup analysis identified BMI (>35, MPE 39%), gender (female MPE 15%), GFR indication (malignancy MPE 11%) as risk factors for overestimate of CG-GFR, and BMI < 20 for underestimate (MPE -3.5%). CONCLUSIONS: The convention of considering AUC5 carboplatin based on 51Cr-GFR, and AUC6 carboplatin based on CG-GFR as equivalent is invalid and should be abandoned. When 51Cr-GFR is unavailable, capping CG-GFR at 125 mL/min is recommended.
Assuntos
Antineoplásicos/uso terapêutico , Carboplatina/uso terapêutico , Creatinina/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/farmacologia , Carboplatina/farmacologia , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Obesity increases risk of venous thromboembolism (VTE) in obstetric patients regardless of delivery mode and for up to six weeks postpartum. AIM: This study aimed to examine postpartum pharmacological VTE prophylaxis practices for obese women at an Australian tertiary referral hospital. MATERIALS AND METHODS: Medical records were retrieved for obese obstetric patients who delivered during May 2016-May 2017. Records were examined for demographic data, VTE risk factors, and LMWH (low-molecular-weight heparin) use. Due to lack of specific Australian or local guidelines, practice was evaluated using recommendations from the Royal College of Obstetricians and Gynaecologists (RCOG-UK). Patients with BMI (body mass index) <30, incomplete/unavailable medical records, and those discharged from other health services were excluded. RESULTS: One hundred and eight postpartum patients (70 caesareans, 38 vaginal deliveries) with a BMI ≥ 30 kg/m2 were reviewed. Of these patients, 53 (49.1%) had a BMI ≥ 40 kg/m2 . Ninety-eight of 108 (90.7%) patients had ≥2 VTE risk factors including a BMI ≥ 30 kg/m2 . One hundred and three of 108 (95.4%) patients were indicated for postpartum VTE prophylaxis with LMWH, and 77 of 103 (74.8%) patients received it. Three of five patients meeting criteria for ≥6 weeks of LMWH thromboprophylaxis had it prescribed. Of the 72 patients whose weight exceeded 90 kg and who also received LMWH, 32 (44.4%) were prescribed a weight-adjusted dose. CONCLUSION: VTE prophylaxis practices using LMWH in obese postpartum patients, including weight-adjusting doses and extended-course prescribing, appear variable. Limited literature, recommendation discrepancies, and varied awareness of recommendations may be contributing factors. Further education and research regarding this high-risk cohort are warranted.
Assuntos
Obesidade/complicações , Complicações Cardiovasculares na Gravidez/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Adulto , Anticoagulantes/administração & dosagem , Austrália , Índice de Massa Corporal , Estudos de Coortes , Estudos Transversais , Feminino , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Período Pós-Parto , Gravidez , Transtornos Puerperais/prevenção & controle , Fatores de Risco , Centros de Atenção Terciária , Adulto JovemRESUMO
Coronary arteriovenous (AV) fistula is a rare congenital anomaly, mostly diagnosed incidentally during routine coronary angiography. We report a symptomatic patient with right coronary artery to coronary sinus (RCA-CS) fistula, complicated by aneurysmal dilatation and thrombosis of the CS, causing severe mitral regurgitation (MR) and tricuspid regurgitation (TR).