RESUMO
OBJECTIVE: An aorto-oesophageal fistula is a rare clinical entity, leading to life-threatening gastrointestinal bleeding. Thoracic aortic aneurysms are the most common cause of aorto-oesophageal fistulae; further causes involve foreign body ingestion, trauma (in most cases iatrogenic), carcinoma or, very rarely, aortitis tuberculotica. METHODS: Due to its rarity, there are no large multicentre studies present to evaluate the efficacy of different therapeutic management options. Since it is associated with significant morbidity and mortality, we give a short summary of various treatment approaches performed in our clinical practice in the past three years. The most straightforward therapeutic option may be an endovascular aortic repair and subtotal oesophageal resection followed by gastro-oesophageal reconstruction, but other alternative treatment possibilities are also present, although with probable higher morbidity. CONCLUSIONS: Eliminating the source of bleeding as an emergency, resecting the oesophagus urgently to prevent sepsis and reconstructing the gastrointestinal continuity as an elective case after having the inflammatory processes settled seems to justify the endovascular aortic repair and subtotal oesophageal resection, followed by a gastro-oesophageal reconstruction, as an effective surgical approach.
Assuntos
Doenças da Aorta/patologia , Doenças da Aorta/terapia , Fístula Esofágica/patologia , Fístula Esofágica/terapia , Fístula Vascular/patologia , Fístula Vascular/terapia , Aorta/patologia , Aorta/cirurgia , Doenças da Aorta/complicações , Doenças da Aorta/cirurgia , Fístula Esofágica/complicações , Fístula Esofágica/cirurgia , Esôfago/patologia , Esôfago/cirurgia , Hemorragia Gastrointestinal/etiologia , Humanos , Fístula Vascular/complicações , Fístula Vascular/cirurgiaRESUMO
INTRODUCTION: Severe symptomatic aortic stenosis is associated with a poor prognosis, with most patients dying 2-3 years after diagnosis. We analysed the proportion of patients with severe aortic stenosis not referred for aortic valve replacement (AVR) in a UK-based population and the clinical factors contributing to this. METHODS: Retrospective analysis of patients with echocardiographic evidence of severe aortic stenosis was performed at a university teaching hospital. RESULTS: A total of 178 consecutive patients with severe aortic stenosis (AVA: <1 cm(2), mean pressure gradient: ≥40 mmHg, or visually severe on echocardiography) were included in the study. Eighty-three patients did not have AVR (95% confidence interval: 39-54%). The cohort included 146 symptomatic patients (82%) and 32 (18%) who were asymptomatic. The most common reason for non-referral in symptomatic patients was 'high operative risk' and in asymptomatic patients 'no symptoms'. Of the patients who did not have AVR, only 19% (n=16) were referred for a surgical opinion. None of the patients in the asymptomatic group underwent echocardiographic stress imaging. The thirty-day operative mortality rate in the AVR group was 2.3%. Symptomatic patients who underwent AVR had superior survival, even after adjusting for co-morbidities (p<0.001). CONCLUSIONS: A considerable proportion of patients with severe aortic stenosis are not referred for surgery although they have a clear indication for AVR. Patients are often estimated as being too high risk or having prohibitive co-morbidities. Among asymptomatic patients, stress imaging was rarely used despite its useful role prognostically and in deciding the best time for intervention.
Assuntos
Estenose da Valva Aórtica/terapia , Tomada de Decisões , Encaminhamento e Consulta/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/mortalidade , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de SobrevidaAssuntos
Fibroma/complicações , Neoplasias Cardíacas/complicações , Obstrução do Fluxo Ventricular Externo/etiologia , Idoso , Ecocardiografia , Fibroma/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Masculino , Obstrução do Fluxo Ventricular Externo/diagnóstico por imagemRESUMO
Reconstruction of the mitral valve offers an alternative to replacement in the treatment of active infective endocarditis, with long term benefits for the patient.
Assuntos
Endocardite Bacteriana/cirurgia , Insuficiência da Valva Mitral/cirurgia , Antibacterianos/uso terapêutico , Endocardite Bacteriana/tratamento farmacológico , Humanos , Insuficiência da Valva Mitral/microbiologia , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/prevenção & controleRESUMO
OBJECTIVES: To define best practice standards for mitral valve repair surgery. DESIGN: Development of standards for process and outcome by consensus. SETTING: Multidisciplinary panel of surgeons, anaesthetists, and cardiologists with interests and expertise in caring for patients with severe mitral regurgitation. MAIN OUTCOME MEASURES: Standards for best practice were defined including the full spectrum of multidisciplinary aspects of care. RESULTS: 19 criteria for best practice were defined including recommendations on surgical training, intraoperative transoesophageal echocardiography, surgery for atrial fibrillation, audit, and cardiology and imaging issues. CONCLUSIONS: Standards for best practice in mitral valve repair were defined by multidisciplinary consensus. This study gives centres undertaking mitral valve repair an opportunity to benchmark their care against agreed standards that are challenging but achievable. Working towards these standards should act as a stimulus towards improvements in care.
Assuntos
Insuficiência da Valva Mitral/cirurgia , Prática Profissional/normas , Fibrilação Atrial/cirurgia , Cardiologia/educação , Cardiologia/normas , Consultores , Ecocardiografia Transesofagiana , Educação Médica Continuada , Cirurgia Geral/educação , Cirurgia Geral/normas , Hospitais/normas , Hospitais/estatística & dados numéricos , Humanos , Cuidados Intraoperatórios , Auditoria Médica , Corpo Clínico Hospitalar/normas , Corpo Clínico Hospitalar/estatística & dados numéricos , Equipe de Assistência ao Paciente , Padrões de Referência , Procedimentos Cirúrgicos Torácicos/normas , Procedimentos Cirúrgicos Torácicos/estatística & dados numéricos , Reino UnidoRESUMO
Schinzel-Giedion syndrome comprises multiple congenital anomalies. The orofacial features include coarse facies, frontal bossing, ocular hypertelorism, anterior open bite and macrodontia. Two cases are presented in which the presence of specific craniofacial anomalies with bilateral hydronephrosis confirmed the diagnosis. In one patient, bottle-feeding was associated with caries in maxillary central and lateral incisors, but the second patient was permanently tube fed and did not experience any dental caries. Clinical management of these patients requires a coordinated approach from a team of medical and dental specialists.
Assuntos
Anormalidades Craniofaciais/patologia , Mordida Aberta/patologia , Anormalidades Dentárias/patologia , Anormalidades Múltiplas , Alimentação com Mamadeira/efeitos adversos , Cariostáticos/uso terapêutico , Pré-Escolar , Aconselhamento , Cárie Dentária/etiologia , Fácies , Comportamento Alimentar , Feminino , Fluoretos Tópicos/uso terapêutico , Seguimentos , Osso Frontal/anormalidades , Humanos , Hidronefrose/patologia , Hipertelorismo/patologia , Lactente , Macroglossia/patologia , Higiene Bucal , Planejamento de Assistência ao Paciente , SíndromeRESUMO
BACKGROUND: The purpose of this study was to evaluate the early and late clinical outcome after aortic root replacement (ARR) in patients with Marfan's syndrome. METHODS: A total of 65 consecutive patients with Marfan's syndrome (mean age 41.7 +/- 10.7 years, range 15 to 76 years) undergoing ARR between 1972 and 1998 in Southampton were studied. Of the patients, 45 had a chronic aneurysm of the ascending aorta and 20 had a type A dissection (16 acute and 4 chronic). The operations were elective in 38 and nonelective in 27 cases (emergency in 22 and urgent in 5). Mean size of the ascending aorta was 6.3 +/- 1.4 cm (3.8 to 12 cm). A Bentall procedure was performed in 62 and a homograft root replacement in 3 patients. Mean follow-up was 8 +/- 4.1 years (0 to 22.9 years). RESULTS: Operative mortality was 6.1% (4 deaths) (for the elective vs nonelective procedures it was 2.6% vs 11%, p = 0.2). The 10-year freedom from thromboembolism, hemorrhage, and endocarditis was 88%, 89.8%, and 98.4% (0.9%, 0.9%, and 0.2% per patient-year) and from late aortic events it was 86.3% (1.3% per patient-year). Aortic root replacement for dissection was an independent predictor of occurrence of late aortic events (p = 0.01). Five patients had a reoperation with one early death. The 10-year freedom from reoperation was 89.2% (1.1% per patient year) (for elective and nonelective procedures, 90.8% vs 84.6%, p = 0.6). The 10-year survival, including operative mortality, was 72.7% (for elective and nonelective procedures, 78% vs 66.5%, p = 0.6). Late aortic events was an independent adverse predictor of survival (p = 0.02). CONCLUSIONS: In patients with Marfan's syndrome, elective ARR, usually for chronic aneurysm, is associated with a low mortality, low rate of aortic complications, and good late survival. Nonelective ARR, mostly for dissection, has a greater operative risk and a significantly higher incidence of late catastrophic aortic events. Early prophylactic surgery in these patients is therefore recommended. Long-term clinical and radiologic follow-up to prevent or to treat late aortic events is highly desirable.
Assuntos
Aorta/cirurgia , Valva Aórtica/cirurgia , Síndrome de Marfan/cirurgia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Taxa de Sobrevida , Fatores de TempoRESUMO
We report the cases of 4 patients in whom surgical ostioplasty was performed for isolated severe ostial stenosis of the left main stem coronary artery. No perioperative death or myocardial infarction occurred. One patient required reoperation for symptomatic recurrent ostial stenosis after 6 months. The others remained angina free after a mean follow-up of 23 months. The literature associated with this procedure is briefly reviewed.
Assuntos
Angioplastia/métodos , Estenose Coronária/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pericárdio/transplante , Técnicas de SuturaRESUMO
INTRODUCTION: 10% of blood issued by the National Blood Service (220,000) is utilised in cardiac procedures. Transfusion reactions, infection risk and cost should stimulate us to decrease this transfusion rate. We tested the efficacy of autotransfusion of washed postoperative mediastinal fluid in a prospective randomized trial. PATIENTS AND METHODS: 166 patients undergoing coronary artery bypass grafting (CABG), valve or CABG + valve procedures were randomized into three groups. The indication for transfusion was a postoperative haemoglobin (Hb) < 10 g/l or a packed cell volume (PCV) < 30. When applicable, group A patients received washed post-operative drainage fluid. Group B all received blood processed from the cardiopulmonary bypass (CPB) circuit following separation from CPB and if appropriate washed post-operative drainage fluid. Group C were controls. Groups were compared using analysis of variance. RESULTS: There was no significant difference in age, sex, type of operation, CPB time and preoperative Hb and PCV between the groups. Blood requirements were as shown. [table - see text] Twelve patients in group A and 10 in group B did not require a homologous transfusion following processing of the mediastinal drainage fluid. CONCLUSION: Autotransfusion of washed postoperative mediastinal fluid can decrease the amount of homologous blood transfused following cardiac surgery. There was no demonstrable benefit in processing blood from the CPB circuit as well as mediastinal drainage fluid.
Assuntos
Transfusão de Sangue Autóloga , Procedimentos Cirúrgicos Cardíacos , Adulto , Idoso , Ponte de Artéria Coronária , Feminino , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino , Período Pós-Operatório , Estudos ProspectivosRESUMO
OBJECTIVE: To evaluate differences in investigation results and treatment between men and women referred for diagnostic treadmill exercise testing and coronary arteriography. DESIGN: Cohort study. SETTING: Tertiary cardiology centre. SUBJECTS: 1522 subjects referred by primary care physicians to an open access chest pain clinic for initial investigation of chest pain, of whom 485 were subsequently referred for coronary arteriography; and a similar cohort of 107 subjects referred directly by secondary care physicians for diagnostic coronary arteriography. MAIN OUTCOME MEASURES: Rates of positive exercise tests and rates for referral for arteriography and revascularisation according to sex. RESULTS: Overall, women were less likely to be referred for arteriography and revascularisation than men. However, men were more likely to have positive exercise tests, and for various exercise test diagnostic end points men were also more likely to have significant coronary artery disease. After taking this into account, there was no sex difference in referral rates for arteriography or revascularisation. CONCLUSIONS: There was no evidence of a sex bias resulting in inappropriate underinvestigation or undertreatment of women. However, the positive predictive value of treadmill exercise testing is low for women and further research is needed into how best to investigate women with chest pain.
Assuntos
Dor no Peito/etiologia , Doença das Coronárias/diagnóstico , Acessibilidade aos Serviços de Saúde , Avaliação de Processos e Resultados em Cuidados de Saúde , Preconceito , Encaminhamento e Consulta/estatística & dados numéricos , Idoso , Serviço Hospitalar de Cardiologia , Estudos de Coortes , Angiografia Coronária , Doença das Coronárias/terapia , Inglaterra , Teste de Esforço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica , Clínicas de Dor , Valor Preditivo dos Testes , Fatores SexuaisRESUMO
BACKGROUND AND AIM OF THE STUDY: The study aim was to determine risk factors for operative mortality, recurrent infection, reoperation and long-term survival following aortic valve replacement (AVR) for infective endocarditis. METHODS: Between 1973 and 1997, 109 patients (91 male, 18 female, mean age 52.6 years) underwent isolated AVR for infective endocarditis in our unit. Native valve endocarditis was present in 89 (81.6%) and prosthetic valve endocarditis in 20 (18.4%). Active culture-positive endocarditis was present in 53 (48.6%). Preoperatively, 99 patients (90.8%) were in NYHA classes III and IV. Indications for surgery included cardiac failure in 41 patients, valvular dysfunction in 38, vegetations in 18, sepsis in seven, abscess in six and embolism in four. Mechanical valves were implanted in 69 patients (63.3%) and bioprostheses in 40 (36.7%), including a homograft in 19 (17.4%). Follow up was complete (mean 5.8 years; range: 0-23.8 years; total 633.5 patient-years). RESULTS: The operative mortality was 10.1% (11 deaths). At ten years, freedom from recurrent infection was 94.2%, and freedom from reoperation 83.6%. Biological valve and younger age were significant adverse parameters for freedom from reoperation (p = 0.01 and p = 0.01). There have been 21 late deaths, 15 due to cardiac causes. Kaplan-Meier survival, including operative mortality, at five and ten years was 77.4% and 68.0%, respectively. On Cox proportional hazards regression, Staphylococcus aureus infection (p = 0.008) and older age (p = 0.04) were independent adverse predictors of survival. CONCLUSION: AVR for endocarditis carries a relatively high operative mortality, but can result in a satisfactory freedom from recurrent infection, reoperation and long-term survival. Analysis of our series demonstrates that implantation of a biological valve limits the freedom from reoperation and that infection by Staph. aureus reduces the probability of long-term survival.
Assuntos
Valva Aórtica/cirurgia , Endocardite Bacteriana/cirurgia , Implante de Prótese de Valva Cardíaca , Adolescente , Adulto , Idoso , Bioprótese , Criança , Endocardite Bacteriana/mortalidade , Feminino , Seguimentos , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios , Recidiva , Reoperação , Infecções Estafilocócicas/cirurgia , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND AND AIMS OF THE STUDY: The study aim was to review our experience in surgical treatment of infective mitral valve endocarditis, and to identify predictors of early and late outcome. METHODS: Ninety-one consecutive patients (52 males, 39 females, mean age 55.6 years) underwent surgery between 1973 and 1997 for endocarditis of isolated mitral (n = 65, 71%), mitral and aortic (n = 25, 28%) and mitral, aortic and tricuspid valves (n = 1, 1%). Native valve endocarditis (NVE) was present in 60 patients (66%) and prosthetic valve endocarditis (PVE) in 31 (34%). The main indications for surgery were heart failure in 32 patients, valve dysfunction in 23, vegetations in 21, and persistent sepsis in 11. Eighty-six patients (95%) were in NYHA classes III-IV, and 58 (64%) had active culture-positive endocarditis at surgery. Mechanical valves were implanted in 73 patients and bioprosthetic valves in 13; valves were repaired in five patients. The impact of 46 parameters on early and late outcome was defined by means of univariate and multivariate statistical analysis. Follow up was complete (mean 5.5 years; range: 0-23.1 years; total 507.3 patient-years). RESULTS: Operative mortality rate was 11% (n = 10). Recurrent infection was recorded in five patients (6%), and reoperation was required in eight (9%). Freedom from recurrent infection and reoperation at 10 years was 89.1% and 87.8% respectively. There were 22 late deaths, 15 from cardiac causes. Actuarial survival rates for all patients at 5, 10 and 15 years were 73.0%, 62.7% and 58.7% (for hospital survivors, the corresponding rates were 81.9%, 69.7% and 66.0%). On multiple logistic regression and Cox proportional hazards models, the following were independent predictors: preoperative pulmonary edema (p = 0.01) for operative mortality; PVE (p = 0.02) for recurrence; younger age (p = 0.02) and PVE (p = 0.02) for reoperation; male gender (p = 0.004) and longer ITU stay for survival (if all patients were included); male gender (p = 0.01) and myocardial invasion by infection (p = 0.02) for survival (if only the hospital survivors were analyzed). CONCLUSION: Surgery for infective mitral valve endocarditis carries a relatively high, though acceptable, risk but provides satisfactory freedom from recurrent infection, reoperation and improved long-term survival. Analysis of these data demonstrated that the preoperative hemodynamic status was the major predictor of in-hospital outcome, PVE increased the risk for recurrent infection and reoperation, whereas male gender and myocardial invasion by the infective process critically reduced the probability of long-term survival. The type of offending pathogen, the activity of infection and the involvement of more than one valve did not appear to influence early and/or late outcome.
Assuntos
Endocardite Bacteriana/mortalidade , Endocardite Bacteriana/cirurgia , Valva Mitral , Análise Atuarial , Feminino , Seguimentos , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Modelos de Riscos Proporcionais , Infecções Relacionadas à Prótese/cirurgia , Recidiva , Reoperação/estatística & dados numéricos , Fatores de Risco , Taxa de Sobrevida , Fatores de TempoRESUMO
BACKGROUND AND AIM OF THE STUDY: The CarboMedics bileaflet prosthetic heart valve was introduced in 1986, and first implanted by the authors in March 1991. The aim of this study was to analyze the authors' clinical experience with this valve. METHODS: Between March 1991 and October 1998, 1,503 valves were implanted in 1,350 patients (758 males, 592 female; mean age 62 +/- 13 years). Follow up was 99% complete and totaled 4,342 patient-years (pt-yr). RESULTS: The hospital mortality rate was 4.3% (59/1,350). Preoperative NYHA class (p = 0.012), emergency surgery (p = 0.03) and cardiopulmonary bypass time (p = 0.01) were significantly associated with increased risk of operative death (multiple logistic regression). Mean (+/- SEM) survival rates at one and five years were 92.0 +/- 0.7% (n = 1,109) and 80.0 +/- 1.3% (n = 335). Freedom from valve-related complications (linearized rate 5.6%/pt-yr) at one and five years was 89.5 +/- 0.8% (n = 1,031) and 76.3 +/- 1.4% (n = 284). Linearized rates for bleeding events were 2.19%/pt-yr, thromboembolic events 2%/pt-yr, operated valvular endocarditis 0.18%/pt-yr, valve thrombosis 0.14%/pt-yr and non-structural dysfunction 1.22%/pt-yr. Freedom from reoperation at one and five years was 98.5 +/- 0.3% (n = 1,107) and 97.3 +/- 0.5% (n = 334). CONCLUSION: Mid-term results demonstrate that the CarboMedics prosthetic heart valve exhibits a low incidence of valve-related complications.
Assuntos
Próteses Valvulares Cardíacas , Idoso , Valva Aórtica/cirurgia , Endocardite/epidemiologia , Feminino , Seguimentos , Próteses Valvulares Cardíacas/efeitos adversos , Implante de Prótese de Valva Cardíaca , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Morbidade , Complicações Pós-Operatórias/epidemiologia , Desenho de Prótese , Reoperação/estatística & dados numéricos , Tromboembolia/epidemiologia , Fatores de TempoRESUMO
BACKGROUND: The purpose of this study was to describe a single unit experience in the surgical treatment of active culture-positive endocarditis and identify determinants of early and late outcome. PATIENTS AND METHODS: One hundred eighteen consecutive patients with positive blood culture up to 3 weeks before operation (or positive valve culture) and macroscopic evidence of lesions typical for endocarditis, undergoing operation between January 1973 and December 1996 in Southampton, were evaluated. The aortic valve was infected in 53 (48.9%), the mitral in 46 (39%), both aortic and mitral in 12 (10.1%), the tricuspid in 4 (3.9%), and the pulmonary valve in 3 (2.5%). Native valve endocarditis was present in 83 (70.3%) and prosthetic valve endocarditis in 35 (29.7%). Streptococci and staphylococci were the most common pathogens. Mean follow-up was 5.6 years (range, 0 to 25 years). RESULTS: Operative mortality was 7.6% (9 patients). Endocarditis recurred in 8 (6.7%). A reoperation was required in 12 (10.2%). There was 24 late deaths, 17 of them cardiac. Actuarial freedom from recurrent endocarditis, reoperation, late cardiac death, and long-term survival at 10 years were 85.9%, 87.2%, 85.2%, and 73.1%, respectively. On multiple regression analysis the following were independent adverse predictors: pulmonary edema (p = 0.007) and impaired left ventricular function (p = 0.02) for operative mortality; prosthetic valve endocarditis (p = 0.01) for recurrent infection; myocardial invasion by the infection (p = 0.01) and reoperation (p = 0.04) for late cardiac death; and coagulase-negative staphylococcus (p = 0.02), annular abscess (p = 0.02), and longer intensive care unit stay (p = 0.02) for long-term survival. CONCLUSIONS: Operation for active culture-positive endocarditis carries an acceptable mortality. Freedom from recurrent infection, reoperation, and long-term survival are satisfactory. In our data, patients' hemodynamic status at operation was the major determinant of operative mortality. Prosthetic valve endocarditis, coagulase-negative staphylococcus, and annular or myocardial infectious invasion were the critical adverse determinants of late outcome.
Assuntos
Endocardite Bacteriana/cirurgia , Adolescente , Adulto , Idoso , Valva Aórtica/microbiologia , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/mortalidade , Feminino , Seguimentos , Valvas Cardíacas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/microbiologia , Infecções Relacionadas à Prótese , Recidiva , Reoperação , Fatores de Risco , Staphylococcus/isolamento & purificação , Streptococcus/isolamento & purificação , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: The CarboMedics bileaflet prosthetic heart valve was introduced in 1986. We first implanted it in March 1991. The purpose of this study was to analyze our clinical experience with this valve. METHODS: Between March 1991 and December 1997, 1,378 valves were implanted in 1,247 patients, 705 men (56.5%) and 542 (43.5%) women with a mean age of 62 +/- 11.9 years (+/- the standard deviation). Follow-up is 99% complete and totals 3,978 patient-years. RESULTS: The early mortality rate was 4.4% (55/1,247). The survival rates at 1 year and 5 years were 91.8% +/- 0.8% (+/- the standard error of mean) (n = 1,062) and 79.2% +/- 1.4% (n = 281), respectively. Freedom from valve-related complications (linearized rate, 4.9% per patient-year) at 1 year and 5 years was 90.6% +/- 0.8% (+/- the standard error of the mean) (n = 996) and 80.6% +/- 1.4% (n = 243), respectively. Linearized rates for various complications were as follows: bleeding events, 1.73% per patient-year; embolic events, 1.76% per patient-year; operated valvular endocarditis, 0.18% per patient-year; valve thrombosis, 0.10% per patient year; and nonstructural dysfunction, 1.21% per patient-year. Freedom from reoperation at 1 year and 5 years was 98.6% +/- 0.3% (+/- the standard error of the mean) (n = 1,070) and 97.7% +/- 0.5% (n = 285), respectively. CONCLUSIONS: Midterm results demonstrate that the CarboMedics prosthetic heart valve exhibits a low incidence of valve-related complications.
Assuntos
Próteses Valvulares Cardíacas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Avaliação como Assunto , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese , ReoperaçãoRESUMO
The relationship between red blood cell hematocrit and hemolysis during cryopreservation has been examined. Cells were frozen with glycerol, thawed, and deglycerolized in a model system based on the protocols used in transfusion medicine. Analysis included determination of hemolysis following thaw (Thaw) and deglycerolization (Overall) and osmotic fragility of the final cell suspensions. Results demonstrate that thaw hemolysis decreased with increasing hematocrit at all glycerol levels tested. Overall hemolysis increased with increasing hematocrit at low (15% w/v) glycerol and decreased with increasing hematocrit at high (40% w/v) glycerol levels. These results were paralleled by changes in the fragility index. Furthermore, these results indicate a distinction between freeze/thaw lysis and damage which leads to lysis during postthaw processing. To examine this further, a biochemical stabilizing solution, having no cryoprotective effects itself, was added to suboptimal glycerol concentrations. This addition resulted in hemolysis levels and fragility indices comparable to those using high (40% w/v) glycerol levels. Thus, the damage observed with increasing hematocrit is not necessarily a function of the packing on the volume of the ice-free zone, but rather an expression of cell damage. Furthermore, this damage is, in part, biochemical in nature and may be protected against through specific cellular stabilization prior to cryopreservation.
Assuntos
Criopreservação , Eritrócitos , Eritrócitos/citologia , Hematócrito , Hemólise , Humanos , Fragilidade OsmóticaRESUMO
OBJECTIVE: We report the combined early results from two centers in the United Kingdom using a composite conduit consisting of a bileaflet mechanical valve incorporated into a gelatin-impregnated, ultra-low porosity, woven polyester graft (Carbo-Seal; Sulzer Carbomedics, Inc, Austin, Tex). METHODS: Between August 1992 and March 1997, 143 patients underwent aortic root replacement with the Carbo-Seal composite prosthesis. The indication for surgery was acute type A dissection in 31 (22%), chronic type A dissection in 9 (6%), ascending aortic aneurysm without dissection in 100 (70%), and false aneurysm of the ascending aorta in 3 (2%). Twenty-seven patients (19%) had undergone previous sternotomy, and 40 (28%) were seen as emergencies. Concomitant procedures were performed in 38 (27%), including 18 aortic arch or hemiarch replacements. Total follow-up is 270 patient-years. Follow-up is 100% complete. RESULTS: The early (30-day) mortality was 7% (10 patients). Permanent neurologic events occurred in 2%. At a mean follow-up of 23 months, 94% of survivors were in New York Heart Association functional class I. Freedom from reoperation was 97.2% +/- 1.6% (1 standard error [1 SE]) at 12 months and 95.7% +/- 2.2% at 48 months. Including early mortality, survival was 90.1% +/- 2.6% at 12 months and 83.1% +/- 3. 5% at 48 months. CONCLUSIONS: Aortic root replacement with use of the Carbo-Seal prosthesis can be undertaken with a relatively low early mortality and morbidity. A low reoperation rate and high intermediate-term survival can be expected, but continued follow-up is needed to determine the long-term efficacy of this prosthesis.