RESUMO
A 38-year-old woman presented with acute coronary syndrome 9 days postpartum. Coronary catheterization showed an intramural hematoma of the left main artery (LM) and the left anterior descending artery (LAD). During angiography, dissection of the LM, with involvement of the LAD and circumflex artery occurred. The patient presented unstable hemodynamic status. After resuscitation, intra-aortic balloon pump was inserted. The patient underwent two-vessel off-pump surgical revascularization. She was discharged 10 days later.
Assuntos
Síndrome Coronariana Aguda/etiologia , Dissecção Aórtica/etiologia , Aneurisma Coronário/etiologia , Hematoma/etiologia , Transtornos Puerperais/etiologia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/fisiopatologia , Síndrome Coronariana Aguda/cirurgia , Adulto , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/fisiopatologia , Dissecção Aórtica/cirurgia , Cateterismo Cardíaco , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/fisiopatologia , Aneurisma Coronário/cirurgia , Angiografia Coronária , Ponte de Artéria Coronária sem Circulação Extracorpórea , Eletrocardiografia , Feminino , Hematoma/diagnóstico , Hematoma/fisiopatologia , Hematoma/cirurgia , Humanos , Balão Intra-Aórtico , Período Pós-Parto , Gravidez , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/fisiopatologia , Transtornos Puerperais/cirurgia , Ressuscitação , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVES: This study reports long-term clinical outcomes-up to 17 years-among patients undergoing mitral valve replacement with the On-X bileaflet mechanical valve. Prior data regarding long-term outcomes with the On-X mitral valve have been limited. METHODS: This retrospective observational study included all patients who underwent mitral valve replacement with the On-X (Standard or Conform-X) valve at 2 major Spanish cardiac surgery centres between 2001 and 2018. The primary study end point was freedom from death. The secondary study end points included surgical mortality and freedom from any valve-related events. Data were obtained from an institutional database, medical records review, direct telephone interviews or the Spanish population registry. Statistical and Kaplan-Meier analyses were performed. RESULTS: A total of 661 patients (mean age 63.1 ± 10.9 years, 63% female) were followed for a mean of 5.6 years (range, 0-17.4 years). Survival at 5, 10 and 15 years was 85%, 71% and 63%, respectively. Surgical mortality was 7.3% (48/661). The linearized rate of global mortality was 1.3% patient-year. Freedom from reoperation was 97%, 95% and 92% at 5, 10 and 15 years, respectively; freedom from anticoagulation-related events was 94%, 89% and 89%, respectively. Multivariable analysis showed that mortality increased with total length of stay, age, smoking history, severe pulmonary hypertension and a permanent pacemaker. Patients who received the On-X 25 -mm valve had decreased long-term survival relative to patients who received other On-X valve sizes, possibly due to underlying risk factors. CONCLUSIONS: Patients in this study showed good long-term survival and freedom from valve-related events.