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1.
Artigo em Inglês | MEDLINE | ID: mdl-38845282

RESUMO

BACKGROUND: The effect of standardizing an insertion and removal protocol for pVAD devices has not been previously described. OBJECTIVES: We sought to evaluate clinical outcomes in patients who underwent pVAD insertion pre- and post-protocol standardization. METHODS: All patients who underwent pVAD insertion that remained in place at index procedure completion between January 2017 and September 2023 at a single academic center for both high-risk PCI and cardiogenic shock indications were included in the study. The primary outcome was the incidence of limb ischemia and major bleeding before and after the protocol initiation. Secondary outcomes included in-hospital and 30-day MACCE rate (death, myocardial infarction, stroke, emergent CABG), and how often the operators followed the protocol. RESULTS: A total of 89 patients had pVAD left in place (29 pre-protocol initiation and 60 post-protocol initiation). There was a significant decrease in incidence of limb ischemia post-protocol initiation compared to pre (17.2 % vs 1.7 %, p = 0.01) but no difference in bleeding incidence (13.8 % vs 20.0 %, p = 0.47). Adherence increased in all components of the protocol except for right heart catheterization. CONCLUSION: Standardization of an insertion and removal protocol for pVAD devices led to a statistically significant decrease in limb ischemia in a high-risk patient population.

2.
Ann Thorac Surg ; 109(6): 1826-1832, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31604092

RESUMO

BACKGROUND: Advanced hybrid coronary revascularization (AHCR) combines multivessel robotic beating-heart totally endoscopic coronary artery bypass with percutaneous coronary intervention. The aim of this study was to quantify the remaining coronary artery disease after AHCR using the residual Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) study score. METHODS: From July 2013 to September 2017, patients who had postoperative angiography after AHCR were reviewed. The cohort was divided into two groups: group 1, complete or near-complete revascularization (residual SYNTAX score of 8 or less); and group 2, incomplete revascularization (residual SYNTAX score more than 8). RESULTS: Among 308 patients who underwent totally endoscopic coronary artery bypass, 57 patients received AHCR and 51 patients had postoperative angiograms that allowed calculations of residual SYNTAX score. Mean baseline and residual SYNTAX scores were 33.1 ± 11.0 and 4.6 ± 6.5 respectively. There were 44 patients (86%) in the complete or near-complete revascularization group, and of these, 16 patients (31%) achieved true complete revascularization (residual SYNTAX score = 0). Overall graft patency was 96.2%. There were no differences in preoperative characteristics or postoperative outcomes between the two groups. Two-year survival rate and freedom from major adverse cardiac events (death, myocardial infarction, and repeat revascularization) were significantly higher in the complete or near-complete revascularization group compared with the incomplete revascularization group. CONCLUSIONS: Advanced hybrid coronary revascularization at our institution was safely performed with excellent early outcomes, graft patency, and high achievement of complete or near-complete revascularization. Residual SYNTAX score might predict long-term ischemic events after hybrid coronary revascularization.


Assuntos
Doença da Artéria Coronariana/cirurgia , Endoscopia/métodos , Intervenção Coronária Percutânea/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
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