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Retroperitoneal sarcoma (RPS) is a rare disease. RPS invading the abdominal aorta is exceedingly rare and has a poor prognosis. There have been scattered cases of RPS treated with combined abdominal aortic replacement. However, the average survival time for these cases was only 8 months, with a 2-year survival rate of 21%, indicating a poor prognosis. In this case study, a 44-year-old man presented to our hospital complaining of abdominal pain. Multiple imaging findings suggested a retroperitoneal mass that was diagnosed as a malignant tumor. The patient underwent tumor resection with abdominal aortic replacement due to an RPS tumor invading the abdominal aorta. The histopathological grade was determined to be grade 3, the most malignant grade tumor, according to the Fédération Nationale des Centres de Lutte Contre le Cancer grading system. Postoperative chemotherapy with doxorubicin and ifosfamide was administered for five cycles. The patient has been alive for over 8 years after the operation without any recurrence. This case presents a long-term survival of RPS requiring abdominal aortic replacement.
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The aVR sign characterized by ST-segment elevation in lead aVR and diffuse ST-segment depression on the electrocardiogram indicates potential life-threatening conditions. We report the case of a 53-year-old male with a history of ascending aortic replacement for acute aortic dissection, who presented to our institution in shock. The initial electrocardiogram revealed the aVR sign, consisting of ST-segment elevation in lead aVR and ST-segment depression in leads II, III, aVF, and V3-6, leading to the initiation of salvage veno-arterial extracorporeal membrane oxygenation (ECMO) due to deteriorating hemodynamics. The aVR sign resolved shortly after ECMO initiation, and hemodynamics stabilized even with reduced ECMO flow. Subsequent coronary angiography showed no impaired coronary perfusion, whereas contrast-enhanced CT revealed severe supra-valvular stenosis due to pseudoaneurysm-induced graft kinking. The patient was then managed with emergency surgery for the pseudoaneurysm. In this report, we encountered a salvaged case of critical circulatory failure presenting with the aVR sign due to severe graft kinking caused by pseudoaneurysm formation.
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PURPOSE: Achieving a secure anastomosis and complete hemostasis is essential for surgically treating type A acute aortic dissection (TAAAD). This study assessed the clinical feasibility of "tailored stand-up collar (TSC)" technique for constructing the distal stump. METHODS: We enrolled 68 patients who underwent ascending aortic repair for TAAAD. Patients were categorized according to the technique for distal stump construction: conventional (C) group using only a felt strip (32 cases); post-aortotomy (P) group, with a Hydrofit-felt strip attached after aortotomy (18 cases), and TSC group, where a Hydrofit-felt strip attached during cooling (18 cases). Pre-operative characteristics, procedural profiles, and post-operative outcomes were evaluated. RESULTS: The pre-operative characteristics were identical among the groups. The durations of cardiopulmonary bypass, hemostasis, and surgery were significantly shorter in the P and TSC groups. The duration of open distal in the TSC group (21 min) was significantly shorter than the other two groups. Post-operative additional procedures were not required for the TSC group and their post-operative hospital stay was significantly shorter (47.1% of patients were discharged within 2 weeks). CONCLUSION: The TSC technique would be practical because of its high reproducibility in terms of ease of use, shorter anastomotic time, and secure hemostasis.
Assuntos
Dissecção Aórtica , Implante de Prótese Vascular , Estudos de Viabilidade , Tempo de Internação , Humanos , Dissecção Aórtica/cirurgia , Dissecção Aórtica/diagnóstico por imagem , Feminino , Masculino , Resultado do Tratamento , Pessoa de Meia-Idade , Idoso , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Fatores de Tempo , Doença Aguda , Estudos Retrospectivos , Duração da Cirurgia , Aneurisma Aórtico/cirurgia , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Adulto , Complicações Pós-Operatórias/etiologiaRESUMO
We describe our first experience with the Triolifter (Fuji Systems, Yokohama, Japan) in cardiac surgery. The Triolifter is a less expensive, novel organ fixation device developed as a fixation indenter mainly for traction of the lung under video-assisted surgery and is now available in Japan. An 84-year-old man diagnosed with unstable angina pectoris underwent emergency coronary artery bypass grafting (CABG) under cardiac arrest. Following the declamping of the aorta and the resumption of the beating heart, bleeding from the left anterior descending artery (LAD) anastomosis site was observed. The Triolifter was used as a heart positioner to expose the anastomosis site for hemostasis in the setting of an on-pump beating heart. Hemostasis of the posterior descending artery (PDA) anastomosis site could also be confirmed by traction of the right ventricular anterior wall using the Triolifter. It could be effectively and safely used with neither significant subepicardial hematoma nor epicardial injury. In Japan, the Triolifter might be used as one of the insurance-covered devices in off-pump CABG in the future, but globally, it could also be used in on-pump CABG without hesitation because it is so inexpensive.
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Double rupture is a very rare, and life-threatening complication after acute myocardial infection (AMI), which defined as the coexistence of any two of the three types of rupture include left ventricular free wall repture (LVFWR), ventricular septal perforation (VSP) and papillary muscule repture (PMR). We report here a case of successful staged repair of double rupture combined LVFWR and VSP. A 77-year-old woman with diagnosis of AMI in the anteroseptal area fell into cardiogenic shock suddenly just before starting coronary angiography. Echocardiography showed left ventricular free wall rupture, then an emergent operation was performed under intraaortic balloon pumping (IABP) and percutaneous cardiopulmonary support (PCPS) assistance using bovine pericardial patch and felt sandwich technique. Intraoperative transesophageal echocardiography revealed ventricular septal perforation on the apical anterior wall. Her hemodynamic condition was stable, therefore we selected a staged VSP repair to avoid surgery on freshly infarcted myocardium. Twenty-eight days after the initial operation, VSP repair was performed using the extended sandwich patch technique via right ventricle incision. Postoperative echocardiography revealed no residual shunt.
Assuntos
Ruptura Cardíaca , Infarto do Miocárdio , Ruptura do Septo Ventricular , Humanos , Feminino , Animais , Bovinos , Idoso , Ruptura do Septo Ventricular/diagnóstico por imagem , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/cirurgia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/cirurgia , Ruptura Cardíaca/diagnóstico por imagem , Ruptura Cardíaca/etiologia , Ruptura Cardíaca/cirurgia , Choque Cardiogênico , Angiografia CoronáriaRESUMO
Stanford type A acute aortic dissection after off-pump coronary artery bypass grafting( OPCAB) is a rare but potentially fatal complication. A 61-year-old man with subacute Stanford type B aortic dissection underwent a triple OPCAB using an automated proximal anastomotic device. On postoperative day 4, he had a sudden syncope. An enhanced computed tomography (CT) scan revealed Stanford type A acute aortic dissection. He underwent emergent total aortic arch replacement along with an open stent graft deployment. The entry of the dissection was located at the proximal anastomosis site of the vein graft. This case demonstrates that this device should be used carefully in patients with a history of Stanford type B aortic dissection.
Assuntos
Dissecção Aórtica , Ponte de Artéria Coronária sem Circulação Extracorpórea , Anastomose Cirúrgica , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Ponte de Artéria Coronária , Humanos , Masculino , Pessoa de Meia-Idade , StentsRESUMO
A 48-year-old woman who was diagnosed with Turner syndrome in her childhood presented with sudden onset of low back pain and respiratory discomfort. Contrast enhanced computed tomography scan revealed Stanford type A acute aortic dissection with persistent left superior vena cava (PLSVC). Emergency ascending aortic replacement was performed. After cardiopulmonary bypass was established through cannulating right femoral artery and right superior vena cava, inferior vena cava, another venous cannula was directly placed into the left superior vena cava. After core cooling, the right atrium was incised for retrograde cardioplegia. At a tympanic temperature of 25 â, circulatory arrest was started and retrograde cerebral perfusion was performed through right and left superior vena cava. Her postoperative course was uneventful.
Assuntos
Dissecção Aórtica , Veia Cava Superior Esquerda Persistente , Síndrome de Turner , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Criança , Feminino , Parada Cardíaca Induzida/métodos , Humanos , Pessoa de Meia-Idade , Síndrome de Turner/complicações , Veia Cava SuperiorRESUMO
An 82-year-old man underwent total aortic arch replacement with a 24 mm Triplex four-branched graft for aortic arch aneurysm. After two years, he was diagnosed with pseudoaneurysms due to bleeding from a non-anastomotic site of the branch graft to the left common carotid artery and minor leakage from a distal anastomotic site of the main graft. A self-expandable Fluency covered stent and cTAG thoracic endograft were used for the aneurysm. After four years, he was referred to our hospital with a complaint of pulsatile swelling of the anterior chest wall. Contrast enhanced computed tomography (CT) revealed a pseudoaneurysm arising from a non-anastomotic site of the branch graft to the left common carotid artery, which extended into the anterior chest wall and the skin through the sternum. He underwent emergency endovascular repair using a Niti-S ComVi covered stent. The postoperative course was uneventful. Postoperative CT showed shrinkage of the pseudoaneurysm. The patient was discharged and required no reintervention during the follow-up.
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Falso Aneurisma , Aneurisma da Aorta Torácica , Implante de Prótese Vascular , Procedimentos Endovasculares , Idoso de 80 Anos ou mais , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Humanos , Masculino , Stents , Esterno , Resultado do TratamentoRESUMO
A 72-year-old man was referred to our hospital for the suspicion of ruptured abdominal aortic aneurysm. Before admission, he was suspected of having a malignant lymphoma and underwent excisional biopsy in his right groin. A contrast enhanced computed tomography scan revealed a massive retroperitoneal hematoma with an extravasation arising from the infrarenal abdominal aorta coexisting with an extensive retroperitoneal mass surrounding the aorta. An emergency endovascular aneurysm repair was performed and the postoperative course was uneventful. After the treatment, histological examination of the previous biopsy confirmed the diagnosis of mantle cell lymphoma.
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Hemorrhagic pericardial effusion is life-threatening and mostly occurs during pericarditis; however, its underlying mechanism is unclear. We report a case of pericardial hematoma with obvious hemorrhage. A 56-year-old man without prior chest trauma presenting with exertional dyspnea and abdominal fullness was treated for idiopathic pericarditis. The echocardiogram showed a thickened pericardium with effusion. Imaging showed extravasation and neovascularization. Following ineffective pharmacotherapy, we performed pericardiectomy. The site of bleeding was undetectable. Because parietal pericardiectomy with hematoma evacuation did not improve diastolic function, we removed the epicardium. During the follow-up period, the patient remained almost asymptomatic. We identified neovascularization as the potential source of idiopathic pericardial hemorrhage.
Assuntos
Hemorragia/etiologia , Derrame Pericárdico/etiologia , Pericardite Constritiva/complicações , Pericárdio/patologia , Diástole , Dispneia , Ecocardiografia , Hemorragia/diagnóstico por imagem , Humanos , Inflamação , Masculino , Pessoa de Meia-Idade , Neovascularização Patológica/diagnóstico por imagem , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/cirurgia , Pericardiectomia , Pericardite Constritiva/diagnóstico por imagem , Pericardite Constritiva/cirurgia , Pericárdio/diagnóstico por imagem , Pericárdio/cirurgiaRESUMO
INTRODUCTION: We performed a meta-analysis to assess the presence of a day-of-week rhythmic variability of acute aortic rupture or dissection (AARD) onset. EVIDENCE ACQUISITION: Eligible studies were observational studies enrolling patients with AARD and reporting day-of-week variation of AARD. Study-specific estimates, i.e. day-of-week incidence of AARD, were combined using the random-effects model. Chronobiological analysis was performed by applying a partial Fourier series to pooled day-of-week incidence by using the inverse-variance weighted least-squares method. EVIDENCE SYNTHESIS: We identified 9 eligible studies enrolling a total of 28,036 patients with AARD. Pooled incidence of AARD was 12.8% on Sunday, 15.9% on Monday, 14.8% on Tuesday, 15.1% on Wednesday, 14.7% on Thursday, 14.1% on Friday, and 12.1% on Saturday. Chronobiological analysis identified a significant (P=0.0098) day-of-week pattern in the occurrence of AARD with a peak on Monday and a nadir on Saturday. Pooled analysis demonstrated significantly more incidence on Monday than on Saturday (relative risk: 1.247; 95% CI: 1.131 to 1.374; P=0.012). CONCLUSIONS: Incidence of AARD was 12.8%, 15.9%, 14.8%, 15.1%, 14.7%, 14.1%, and 12.1%, on Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, and Saturday, respectively. A significant day-of-week pattern in the occurrence of AARD with a peak on Monday and a nadir on Saturday was identified with significantly more incidence on Monday than on Saturday.
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Aneurisma Aórtico/epidemiologia , Dissecção Aórtica/epidemiologia , Ruptura Aórtica/epidemiologia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Dissecção Aórtica/diagnóstico por imagem , Aneurisma Aórtico/diagnóstico por imagem , Ruptura Aórtica/diagnóstico por imagem , Fenômenos Cronobiológicos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores de Risco , Fatores de TempoRESUMO
OBJECTIVE: To determine which of antegrade and retrograde cerebral perfusion (ACP and RCP) surpasses for a reduction in postoperative incidence of neurological dysfunction and all-cause death in thoracic aortic surgery, we performed a meta-analysis of contemporary comparative studies. METHODS: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched from January 2010 to June 2017. For each study, data regarding the endpoints in both the ACP and RCP groups were used to generate odds ratios (ORs) and 95% confidence intervals (CIs). Study-specific estimates were combined using inverse variance-weighted averages of logarithmic ORs in the fixed-effect model. RESULTS: We identified and included 19 eligible studies with a total of 15,365 patients undergoing thoracic aortic surgery by means of ACP (a total of 7,675 patients) or RCP (a total of 7,690 patients). Pooled analysis demonstrated no statistically significant differences in postoperative incidence of stoke (17 studies enrolling a total of 9,421 patients; OR, 0.92; 95% CI, 0.79-1.08; p = 0.32) and mortality (16 studies including a total of 14,452 patients; OR, 1.07; 95% CI, 0.90-1.26; p = 0.46) between ACP and RCP, whereas a trend toward a significant reduction in incidence of temporary neurological dysfunction (TND) for ACP (12 studies enrolling a total of 7922 patients; OR, 0.85; 95% CI, 0.69-1.04; p = 0.12) was found. CONCLUSION: In thoracic aortic surgery, postoperative incidence of stroke and mortality was similar between ACP and RCP, whereas a trend toward a reduction of TND incidence existed in ACP.
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Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Circulação Cerebrovascular , Perfusão/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Aorta Torácica/fisiopatologia , Doenças da Aorta/mortalidade , Doenças da Aorta/fisiopatologia , Humanos , Incidência , Perfusão/efeitos adversos , Perfusão/mortalidade , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidadeRESUMO
OBJECTIVE: The objective of this study was to determine whether valve-in-valve transcatheter aortic valve implantation (VIV-TAVI) is associated with better survival than redo surgical aortic valve replacement (SAVR) in patients with degenerated aortic valve bioprostheses, and we performed a meta-analysis of comparative studies. METHODS: To identify all comparative studies of VIV-TAVI versus redo SAVR; MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched through October 2017. For each study, data regarding all-cause mortality in both the VIV-TAVI and redo SAVR groups were used to generate odds ratios (ORs). To assess selection bias, we generated ORs and (standardized) mean differences (MDs) for baseline characteristics. Study-specific estimates were combined in the random-effects model. RESULTS: Of 446 potentially relevant articles screened initially, 6 reports of retrospective comparative studies enrolling a total of 498 patients were identified. Pooled analyses of baseline characteristics demonstrated no statistically significant differences in the proportion of women, patients with diabetes mellitus, patients with coronary artery disease, and patients with baseline New York Heart Association functional class of ≥III; baseline ejection fraction; and predicted mortality between the VIV-TAVI and redo SAVR groups. Patients in the VIV-TAVI group, however, were significantly older (MD, 4.20 years) and had undergone prior coronary artery bypass grafting more frequently (OR, 2.19) than those in the redo SAVR group. Main pooled analyses demonstrated no statistically significant differences in early (30 days or in-hospital) (OR, 0.91; p = 0.83) and midterm (180 days-3 years) all-cause mortalities (OR, 1.42; p = 0.21) between the VIV-TAVI and redo SAVR groups. CONCLUSION: In patients with degenerated aortic valve bioprostheses, especially elderly or high-risk patients, VIV-TAVI could be a safe, feasible alternative to redo SAVR. The lack of randomized data and differences in baseline characteristics in the present analysis emphasize the need for prospective randomized trials.
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Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Substituição da Valva Aórtica Transcateter , Fatores Etários , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Bioprótese , Tomada de Decisão Clínica , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Hemodinâmica , Humanos , Falha de Prótese , Recuperação de Função Fisiológica , Reoperação , Fatores de Risco , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do TratamentoRESUMO
BACKGROUND: Partial anomalous pulmonary venous return is a rare congenital cardiac anomaly that usually involves the right pulmonary vein and an atrial septal defect. Isolated partial anomalous pulmonary venous return with an intact atrial septum is even rarer, and this condition is usually treated surgically in younger patients. We describe isolated partial anomalous pulmonary venous return in a 65-year-old woman who was treated by caval division with pericardial patch baffling through a surgically created atrial septal defect and reconstruction of the superior vena cava using a prosthetic graft. CASE PRESENTATION: A 65-year-old Asian woman who presented with exertional dyspnea was diagnosed with isolated partial anomalous pulmonary venous return. The surgical indications and strategy were controversial because of the rarity of this pathology. She had an indication for surgery because she was symptomatic and had a high ratio of pulmonary to systemic blood flow. We considered that surgical procedures should avoid postoperative stenosis of a reconstructed flow tract, sinus node dysfunction, and thrombogenesis. We created a caval division with pericardial patch baffling through a surgically created atrial septal defect and reconstructed the superior vena cava using a prosthetic graft for the isolated partial anomalous pulmonary venous return. She has since remained free of exertional dyspnea, arrhythmia, and thrombotic complications. This surgical strategy is safe and effective for treating isolated partial anomalous pulmonary venous return in older symptomatic adults. CONCLUSIONS: The long-term outcome of surgical repair of partial anomalous pulmonary venous return with an intact atrial septum in our patient, a symptomatic 65-year-old woman, was excellent.
Assuntos
Septo Interatrial/patologia , Cardiopatias Congênitas/cirurgia , Veias Pulmonares/cirurgia , Veia Cava Superior/cirurgia , Idoso , Implante de Prótese Vascular , Dispneia , Feminino , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/fisiopatologia , Humanos , Veias Pulmonares/anormalidades , Resultado do Tratamento , Veia Cava Superior/anormalidadesRESUMO
OBJECTIVES: We sought to determine whether off-pump coronary artery bypass grafting (CABG) increases long-term mortality, by performing a meta-analysis of randomized controlled trials (RCTs) of off-pump versus on-pump CABG with ≥5-year follow-up. METHODS: MEDLINE and EMBASE, and the Cochrane Central Register of Controlled Trials were searched through July 2018. Hazard, risk, or odds ratios (HRs, RRs, or ORs) of long-term (≥5-year) mortality for off-pump versus on-pump CABG were extracted from each individual trial. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic HRs in the random-effects model. RESULTS: Our search identified eight medium- to large-size RCTs at low risk of bias with long-term follow-up of off-pump versus on-pump CABG enrolling a total of 8780 patients. Combining four RCTs reporting actual HRs generated a statistically significant result favoring on-pump CABG (HR, 1.21; P = 0.02). A pooled analysis of all eight RCTs demonstrated a statistically significant increase in mortality with off-pump CABG (HR/RR, 1.19; P = 0.01). There was no evidence of significant publication bias in the meta-analysis of all eight RCTs. In a sensitivity analysis, extracting RRs or ORs from all eight RCTs and pooling them demonstrated a statistically significant increase in mortality with off-pump CABG (RR, 1.17; P = 0.01; OR, 1.20; P = 0.007). Eliminating 2 RRs and combining six HRs still generated a statistically significant result favoring on-pump CABG (HR, 1.19; P = 0.05). CONCLUSIONS: Off-pump CABG increases long-term (≥5-year) mortality compared with on-pump CABG.
Assuntos
Ponte de Artéria Coronária/mortalidade , Ponte de Artéria Coronária/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Idoso , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Bases de Dados Bibliográficas , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Risco , Fatores de TempoRESUMO
OBJECTIVES: To synthesize evidence regarding long-term survival after transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) for severe aortic stenosis (AS) from real-world clinical practice, we performed a meta-analysis of observational studies with a propensity-score analysis and ≥3-year follow-up. METHODS: Databases including MEDLINE and EMBASE were searched through April 2017 using PubMed and OVID. Eligible studies were observational comparative studies with a propensity-score analysis of TAVI versus SAVR enrolling patients with severe AS and reporting ≥3-year all-cause mortality as an outcome. A hazard ratio (HR) with its 95% confidence interval (CI) of follow-up (including early) mortality for TAVI versus SAVR was extracted from each individual study. RESULTS: Our search identified 14 eligible studies enrolling a total of 4,197 patients. A pooled analysis of all the 14 studies demonstrated a statistically significant 54% increase in mortality with TAVI relative to SAVR (HR, 1.54; 95% CI, 1.31-1.81; P for effect < 0.00001; P for heterogeneity = 0.14; I2 = 30%). Several sensitivity analyses did not substantially change the statistically significant benefit for SAVR. There was no evidence of significant publication bias. CONCLUSIONS: On the basis of a meta-analysis of 14 observational comparative studies with a propensity-score analysis including a total of ≥4,000 patients, TAVI is associated with worse ≥3-year overall survival than SAVR.
Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/mortalidade , Hemodinâmica , Humanos , Masculino , Estudos Observacionais como Assunto , Pontuação de Propensão , Recuperação de Função Fisiológica , Medição de Risco , Fatores de Risco , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do TratamentoRESUMO
Off-pump coronary artery bypass grafting (CABG) is suggested to be associated with an increase in long-term (≥5-year) all-cause mortality. To determine whether off-pump CABG is associated with an increase in very long-term (≥10-year) all-cause mortality, we performed a meta-analysis of propensity-score matched observational comparative studies of off-pump versus on-pump CABG. MEDLINE and EMBASE were searched through May 2017. A hazard ratio of follow-up (including early) all-cause mortality for off-pump versus on-pump CABG was extracted from each individual study. Study-specific estimates were combined using inverse variance-weighted averages of logarithmic hazard ratios in the random-effects model. Of 164 potentially relevant studies, our search identified 16 propensity-score matched observational comparative studies of off-pump versus on-pump CABG with ≥10-year follow-up enrolling a total of 82,316 patients. A pooled analysis of all the 16 studies demonstrated that off-pump CABG was significantly associated with an increase in all-cause mortality (hazard ratio 1.07, 95% confidence interval 1.03 to 1.12, p for effect = 0.0008; p for heterogeneity = 0.30, I2 = 12%). In a sensitivity analysis, exclusion of any single hazard ratio from the analysis (leave-one-out meta-analysis) did not substantively alter the overall result. There was no evidence of a significant publication bias. In conclusion, off-pump CABG is associated with an increase in very long-term (≥10 years) all-cause mortality compared with on-pump CABG.
Assuntos
Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/cirurgia , Previsões , Ponte de Artéria Coronária sem Circulação Extracorpórea/mortalidade , Doença da Artéria Coronariana/mortalidade , Saúde Global , Humanos , Pontuação de Propensão , Fatores de RiscoRESUMO
PURPOSE: We herein investigated the influence of smoking on changes in the levels of perioperative oxidative stress after pulmonary resection. METHODS: A total of 31 patients with primary lung cancer who underwent curative pulmonary lobectomy were analyzed prospectively. The degree of perioperative oxidative stress was evaluated based on the serum levels of derivatives of reactive oxygen metabolites (d-ROM) and biological antioxidant potential (BAP). The patients were divided into two groups: group A (smoking < 40 pack-years) and group B (smoking ≥ 40 pack-years). The d-ROM and BAP measurements were obtained preoperatively, postoperatively and on the first, second, third and fifth postoperative days. RESULTS: In all 31 cases, the d-ROM values were higher on the third and fifth postoperative days than preoperatively. The extent of change in the d-ROM levels was greater in group A than in group B on the second, third and fifth postoperative days (1.05 ± 0.159 vs. 0.920 ± 0.205, p = 0.008; 1.20 ± 0.233 vs. 1.02 ± 0.186, p = 0.032; 1.34 ± 0.228 vs. 1.07 ± 0.200, p = 0.003, respectively). In contrast, there were no significant differences in the BAP values. The maximum increase in the d-ROM level and decrease in the BAP level negatively correlated with the amount of smoking (|r| = 0.428, p = 0.016 and |r| = 0.357. p = 0.049, respectively). CONCLUSIONS: Surgical stress associated with pulmonary lobectomy induces oxidative stress. In addition, smoking reduces the oxidative stress reaction, and the degree of this change is correlated with the amount of smoking.