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1.
J Pers Soc Psychol ; 126(5): 895-912, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38869894

RESUMO

Affective reactivity, defined as within-person increases in negative affect triggered by daily stressors, has well-established links to personal well-being. Prior work conceptualized affective reactivity as an intrapersonal phenomenon, reflecting reactions to one's own stressors. Here, we conceptualized reactivity interpersonally, examining one's responses to a romantic partner's daily stressors. Across four longitudinal dyadic studies, we investigated how reactivity to partner stress predicts relationship quality appraisals. In fledgling couples, reactivity to a partner's stressors, assessed via weekly (Study 1; N = 152) and daily (Study 2; N = 144) diaries, positively predicted partner relationship quality. In both studies, the associations were mediated by the partner's perceptions of responsiveness. Furthermore, reactivity to partner stress buffered against declines in partner relationship quality over 8 weeks in Study 1 and 13 months in Study 2. The relevance of reactivity to partner stress for relationship quality diminished in the later stages of relationships. Among samples of established couples (Studies 3 and 4, Ns = 164 and 208, respectively), reactivity to partner stress did not directly predict partner relationship quality or moderate its trajectory over time. Overall, the predominant pattern across four studies painted a portrait of relational well-being benefits specific to fledgling relationships. Through its novel framework of situating affective reactivity interpersonally between partners, the present research contributes to both affective science and relationship science. (PsycInfo Database Record (c) 2024 APA, all rights reserved).


Assuntos
Afeto , Relações Interpessoais , Parceiros Sexuais , Estresse Psicológico , Humanos , Feminino , Masculino , Adulto , Estresse Psicológico/psicologia , Parceiros Sexuais/psicologia , Afeto/fisiologia , Adulto Jovem , Estudos Longitudinais , Satisfação Pessoal , Cônjuges/psicologia , Pessoa de Meia-Idade
2.
Curr Opin Psychol ; 52: 101610, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37352794

RESUMO

Theoretical and empirical research on responsiveness focused mostly on cultural ecologies of independence. Emerging studies suggest that the responsiveness process may unfold differently in cultural ecologies of interdependence. We organize these studies into a working conceptual model. The model argues that two mechanisms-expectations of culturally normative relationship behaviors and relative centrality of relationships-carry the influence of cultural ecology on responsiveness. Together, these mechanisms explain variation in (a) self-expressive behaviors thought to elicit responsiveness, (b) associations between partner behaviors and perceived responsiveness, and (c) associations between perceived responsiveness and well-being.


Assuntos
Relações Interpessoais , Modelos Psicológicos , Humanos
3.
J Pers Soc Psychol ; 124(5): 958-970, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-35901364

RESUMO

Motivated by the Attachment Security Enhancement Model (Arriaga et al., 2018), the present research investigated the associations between positive relationship experiences and romantic attachment avoidance in three dyadic studies that combined multiple methods, including daily diaries, laboratory observations, and longitudinal follow-ups. Frequency of daily positive relationship events (but not external positive events) during a 21-day diary period predicted declines in romantic attachment avoidance (but not anxiety) from pre- to post-diary in fledgling couples (Study 1) and newlyweds (Study 2). Video-recorded discussions of fledgling couples' shared positive experiences revealed that behaviors validating the relationship (but not simply showing conversational interest) predicted lagged declines in romantic attachment avoidance (but not anxiety) over 1 month (Study 3). The associations were mediated by positive affect during the diary period in Studies 1 and 2, and by changes in positive affect from pre- to post-discussion in Study 3. Positive relationship experiences did not significantly interact with time in predicting romantic avoidance over a 1-year follow-up with quarterly assessments of attachment orientations in Study 1, over an 8-month follow-up with monthly assessments in Study 2, or over a 2-month follow-up with monthly assessments in Study 3. Altogether, these studies provide one of the most comprehensive tests of how positive relationship experiences in nondistressing contexts are linked to romantic attachment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Assuntos
Relações Interpessoais , Parceiros Sexuais , Humanos , Ansiedade , Casamento , Transtornos de Ansiedade , Apego ao Objeto
4.
Tex Heart Inst J ; 49(3)2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35763034

RESUMO

Guillain-Barré syndrome, a rare peripheral neuropathy, appears to occur more often in patients who have recently undergone surgery than in the general population. However, the pathophysiologic relationship between surgery and Guillain-Barré syndrome is elusive. Few cases of Guillain-Barré syndrome after cardiac surgery have been reported. Autonomic dysfunction, a serious complication of Guillain-Barré syndrome, has not been previously reported after cardiac surgery. We describe the case of a 71-year-old woman in whom the acute motor axonal neuropathic subtype of Guillain-Barré syndrome developed after mitral valve replacement. Despite plasmapheresis and intravenous immunoglobulin therapy, she died of complications from severe autonomic dysfunction 25 days postoperatively. Recognizing the potential cardiovascular involvement of Guillain-Barré syndrome is important, because patients who undergo cardiac surgery can be vulnerable to autonomic dysfunction in the early postoperative period.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Síndrome de Guillain-Barré , Doenças do Sistema Nervoso Periférico , Idoso , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Feminino , Síndrome de Guillain-Barré/diagnóstico , Síndrome de Guillain-Barré/etiologia , Síndrome de Guillain-Barré/terapia , Humanos , Imunoglobulinas Intravenosas , Doenças do Sistema Nervoso Periférico/complicações
5.
Artigo em Inglês | MEDLINE | ID: mdl-35293569

RESUMO

OBJECTIVES: This study presents the mid-term results of a novel tricuspid valve (TV) repair strategy defined as 'mitralization of TV' (resection and plication of the posterior leaflet, ring implantation, optional leaflet procedures) applied for the correction of tricuspid regurgitation (TR). METHODS: Between 2017 and 2020, a total of 22 patients underwent concomitant TV repair using mitralization of the TV. Fourteen of the patients had functional TR (2 of them had severe tethering), 5 patients had prolapse and 3 patients had rheumatic involvement. RESULTS: There was no in-hospital mortality. Moderate or severe TR was not observed in any patient in echocardiographic evaluations before discharge. The mean follow-up duration was 30.9 + 6.2 months. Moderate-to-severe TR-free survival was 100% in the second year and 94.7% in the third year. CONCLUSIONS: Mitralization of the TV is a safe and effective treatment modality in terms of its mid-term results. This new technique provides an innovative perspective for the treatment of TR, especially in complex TV pathologies.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Tricúspide , Ecocardiografia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgia
6.
Exp Clin Transplant ; 20(8): 762-767, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-30251943

RESUMO

OBJECTIVES: Our study was conducted to determine the effects of intraoperative antithymocyte globulin administration on donor hearts procured after cardiocirculatory death. We evaluated the impact of antithymocyte globulin on graft function and related parameters during isothermic blood cardioplegia. MATERIALS AND METHODS: In this prospective and randomized single center study, 30 patients with orthotropic heart transplant were divided into 2 groups: group 1 included 15 patients who received retrograde antithymocyte globulin infusion via coronary sinus intraoperatively and immediately after organ procurement and group 2 included 15 patients who received traditional antithymocyte globulin infusion after implantation. RESULTS: Study patients had a mean age of 33.8 years (range, 15-56 y). All patients had panel reactive antibody less than 10% except for 3 patients. The cluster of differentiation 3-positive cell count decrease was more than 20%. The inotropic therapy dose required and the myocardial pressure (stiffness) were less for group 1 patients. These patients had less acute rejection episodes than group 2 (0% vs 13.3%; P < .05). CONCLUSIONS: Favorable clinical outcomes were observed in terms of less acute rejection episodes and better graft function at least during the early posttransplant period. Intraoperative antithymocyte globulin treatment may have a preventive effect for acute cellular rejection in heart transplant patients.


Assuntos
Transplante de Coração , Transplante de Rim , Adulto , Soro Antilinfocitário/efeitos adversos , Rejeição de Enxerto , Sobrevivência de Enxerto , Transplante de Coração/efeitos adversos , Humanos , Terapia de Imunossupressão , Imunossupressores/efeitos adversos , Estudos Prospectivos , Doadores de Tecidos , Resultado do Tratamento
7.
Vasc Endovascular Surg ; 55(8): 811-816, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34121518

RESUMO

INTRODUCTION: Intraluminal thrombolytic therapy is the first step treatment of thrombotic malfunction of tunneled hemodialysis catheters (THC). The factors that affect catheter restoration and also catheter survival following thrombolytic therapy are not well described. In this study, we aimed to reveal the predictors that affect the success of the procedure and also present post-restoration catheter patency after intraluminal thrombolytic administration. METHOD: This retrospective study included 62 patients with tunneled THC thrombosis treated with alteplase between 2017 and2020 in the study center. Age, comorbidities, the use of antiplatelet and anticoagulants, a history of catheter thrombosis, time on dialysis, the duration of the catheter were investigated as possible predictors of procedural success. The independent predictive factors for procedural success were evaluated by using backward stepwise likelihood ratio logistic regression analysis. Primaryand assisted patencieswere presented with Kaplan-Meier graphs. RESULTS: Thrombolityc was administered to 62 patients 102 times. The median primary patency from the first thrombolytic administration to a second catheter thrombosis was 9 months (range 1-20 months). The overall median patency was 12 months (range 2-23 months). The overall procedural success rate was 79.4% (81/102).Multivariate analyses revealed that a history of prior catheter thrombosis was the only risk factor for procedural success (OR: 0.49; 95% CI: 0.26-0.91; p = 0.004). The need for a second dwell time among patients with prior history of thrombolysis was significantly higher compared to patients without a history of catheter thrombosis (12/26 patients, 46.2% and 6/55 patients, 10.9%; respectively; p = 0.001). CONCLUSION: The success of thrombolysis in subsequent de novo THC thrombosis decreases in patients who previously required intraluminal thrombolytic administration. Identifying patient subgroups with a high risk for THC thrombosis may be useful to investigate effective secondary prevention strategies.


Assuntos
Cateteres de Demora , Terapia Trombolítica , Cateteres de Demora/efeitos adversos , Humanos , Diálise Renal/efeitos adversos , Estudos Retrospectivos , Terapia Trombolítica/efeitos adversos , Resultado do Tratamento
8.
BMC Cardiovasc Disord ; 21(1): 167, 2021 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-33836659

RESUMO

BACKGROUND: New-onset postoperative atrial fibrillation (POAF) is common after cardiac surgery. Early identification of its risk factors during the preoperative period would help in reducing the associated morbidity, mortality, and healthcare costs. AIM OF THE STUDY: This study aimed to identify the predictors of POAF following open cardiac surgery, with emphasis on biochemical parameters. METHODS: A total of 1191 patients with no preoperative atrial fibrillation (AF) and undergoing open cardiac surgery for any reason were included in this retrospective study. Data on clinical and biochemical parameters, the occurrence of new-onset AF, and its clinical course were retrieved from the hospital database. RESULTS: During the early postoperative period 330 patients (27.7%) developed atrial fibrillation, at median third postoperative day (range 1-6 days) and 217 (65.8%) responded to treatment. Multivariate analysis identified the following as the significant independent predictors of any POAF: EF < 60% (Odds ratio (OR), 2.6), valvular intervention (OR, 2.4), liver failure (OR, 2.4), diabetes (OR, 1.6), low hematocrit (OR, 2.1), low thrombocyte (OR, 5.6), low LDL (OR, 1.6), high direct bilirubin (OR, 2.0), low GFR (OR, 1.6), and high CRP (OR, 2.0). Following parameters emerged as significant independent predictors of persistent AF: EF < 60% (OR, 1.9), diabetes (OR, 2.1), COPD (OR, 1.8), previous cardiac surgery (OR, 3.1), valvular intervention (OR, 2.4), low hematocrit (OR, 1.9), low LDL (OR, 2.1), high HbA1c (OR, 2.0), and high CRP (OR, 2.7). CONCLUSIONS: Certain parameters assessed during preoperative physical and laboratory examinations have the potential to be used as markers of POAF.


Assuntos
Fibrilação Atrial/etiologia , Proteína C-Reativa/análise , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Hemoglobinas Glicadas/análise , Lipoproteínas LDL/sangue , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/sangue , Fibrilação Atrial/diagnóstico , Biomarcadores/sangue , Bases de Dados Factuais , Feminino , Hematócrito , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Adulto Jovem
9.
Braz J Cardiovasc Surg ; 36(1): 64-70, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33594862

RESUMO

OBJECTIVE: We aimed to analyze the early and long-term results of open-heart surgery in Turkish patients aged 80 years or older who were operated on at our center. METHODS: All patients aged 80 years or older who underwent surgery between January 2000 and December 2013 at a high-level heart center were included in the study. The in-hospital data of study patients were obtained from the electronic database and from the hospital files. Survival data were analyzed as a long-term outcome. RESULTS: A total of 245 patients aged 80-93 years were evaluated in the study. The patients were followed up 5.4±3.7 years after open-heart surgery. In-hospital mortality rates were 10% in elective cases and 15.1% overall. Age ≥85 years, chronic kidney disease, chronic obstructive pulmonary disease, and emergency surgery were independent predictors of in-hospital mortality. The median survival time was found to be 4.4±0.3 years for all participants. The long-term survival of patients who underwent emergency cardiac surgery was significantly lower than that of elective patients (log-rank <0.001). CONCLUSION: Octogenarians have satisfactory long-term outcomes after open-heart surgery when operated electively. On the other hand, patients operated under emergency conditions have worse inhospital outcomes and long-term follow-up results.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Doença Pulmonar Obstrutiva Crônica , Fatores Etários , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Eletivos , Mortalidade Hospitalar , Hospitais , Humanos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
10.
Rev. bras. cir. cardiovasc ; 36(1): 64-70, Jan.-Feb. 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1155785

RESUMO

Abstract Objective: We aimed to analyze the early and long-term results of open-heart surgery in Turkish patients aged 80 years or older who were operated on at our center. Methods: All patients aged 80 years or older who underwent surgery between January 2000 and December 2013 at a high-level heart center were included in the study. The in-hospital data of study patients were obtained from the electronic database and from the hospital files. Survival data were analyzed as a long-term outcome. Results: A total of 245 patients aged 80-93 years were evaluated in the study. The patients were followed up 5.4±3.7 years after open-heart surgery. In-hospital mortality rates were 10% in elective cases and 15.1% overall. Age ≥85 years, chronic kidney disease, chronic obstructive pulmonary disease, and emergency surgery were independent predictors of in-hospital mortality. The median survival time was found to be 4.4±0.3 years for all participants. The long-term survival of patients who underwent emergency cardiac surgery was significantly lower than that of elective patients (log-rank <0.001). Conclusion: Octogenarians have satisfactory long-term outcomes after open-heart surgery when operated electively. On the other hand, patients operated under emergency conditions have worse in-hospital outcomes and long-term follow-up results.


Assuntos
Humanos , Idoso de 80 Anos ou mais , Doença Pulmonar Obstrutiva Crônica , Procedimentos Cirúrgicos Cardíacos , Estudos Retrospectivos , Fatores de Risco , Fatores Etários , Resultado do Tratamento , Mortalidade Hospitalar , Procedimentos Cirúrgicos Eletivos
11.
Phlebology ; 36(1): 54-62, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32741257

RESUMO

OBJECTIVES: To compare traditional surgery with two minimally invasive endo-venous procedures in terms of their long-term effect on the quality of life in great saphenous vein insufficiency (GSV). METHOD: This prospective observational study included 217 patients that underwent surgical stripping (n = 62), radiofrequency ablation (n = 70), or cyanoacrylate embolization (n = 85) for the treatment of GSV insufficiency. Venous Clinical Severity Score (VCSS) assessments were made, 36-item Short-Form Health Survey (SF-36) questionnaire and Chronic Venous Insufficiency quality of life Questionnaire (CIVIQ-14) were administered, before and 1 year after the treatments. RESULTS: Surgical stripping group had significantly higher closure rates than the other groups (p < 0.05). At 12 months, decrease in VCSS scores was less pronounced in the cyanoacrylate embolization group when compared to the other two groups (p < 0.05). Improvement in CIVIQ-14 scores was better in the radiofrequency ablation group when compared to the cyanoacrylate embolization group (p < 0.05). Surgical stripping or radiofrequency ablation groups performed better on several domains of SF-36, when compared to the cyanoacrylate embolization group. CONCLUSIONS: Surgical stripping and radiofrequency ablation seem to provide a better quality of life results at one year in patients undergoing treatment for GSV insufficiency.


Assuntos
Ablação por Radiofrequência , Varizes , Insuficiência Venosa , Cianoacrilatos , Humanos , Qualidade de Vida , Veia Safena/cirurgia , Fatores de Tempo , Resultado do Tratamento , Insuficiência Venosa/cirurgia
12.
Heart Surg Forum ; 23(6): E883-E887, 2020 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-33234191

RESUMO

PURPOSE: To evaluate the clinical impact of pleurotomy during skeletonized internal thoracic artery (ITA) harvesting in patients undergoing on-pump coronary artery bypass grafting (CABG). METHODS: Consecutive patients (n = 758) who underwent CABG with skeletonized ITA were divided into 2 groups according to pleural integrity: open pleura (OP) and closed pleura (CP). Propensity score matching was performed after retrospective data extraction. The measured outcomes were postoperative pulmonary and hemorrhagic complications, 30-day mortality, and duration of hospital stay. RESULTS: Among 236 propensity score-matched pairs, there was no statistically significant difference between the 2 groups in terms of first 30-day mortality (OP, n = 7 [3%]; CP, n = 5 [2.5%]), blood product use (OP, 0.90 ± 0.71; CP, 0.74 ± 0.7), or median duration of hospital stay. The incidence of postoperative pleural effusion, thoracentesis, prolonged mechanical ventilation, respiratory failure, excessive drainage, cardiac tamponade, and reexploration and the number of patients requiring transfusion were similar in both groups. CONCLUSION: The clinical effect of pleural protection or pleurotomy on postoperative outcomes is limited in patients undergoing on-pump CABG with skeletonized ITA.


Assuntos
Doença da Artéria Coronariana/cirurgia , Artéria Torácica Interna/transplante , Pleura/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento , Turquia/epidemiologia
13.
Braz J Cardiovasc Surg ; 35(5): 732-740, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33118739

RESUMO

OBJECTIVE: To evaluate the frequency, causes, and related predictive factors of intensive care unit (ICU) readmissions after coronary artery bypass grafting (CABG) surgery. METHODS: A total of 4112 consecutive patients who underwent on-pump CABG between January 2007 and January 2017 were retrospectively evaluated. The patients were divided into two groups as patients with and without ICU readmission. Demographic and perioperative characteristics were compared between the two groups. RESULTS: The ICU readmission rate was 3.5%. The most common reasons for ICU readmissions were respiratory (29%) and cardiac (23.4%) complications. The 90-day mortality risk was significantly higher in the readmitted patients than the non-readmitted patients (22.1% and 1.6%, respectively; P<0.001; OR=17.6; 95% CI=11.19-28.41). Severe left ventricular dysfunction, chronic obstructive pulmonary disease, end-stage renal disease, emergency CABG, EuroSCORE II > 5%, cross-clamp time > 35 minutes, postoperative respiratory complications, neurological complications, and cardiac complications showed a strong association with ICU readmissions. CONCLUSION: ICU readmission after CABG is associated with an increased mortality rate. Evaluation, not only of patients' comorbidities, but also of intraoperative conditions and postoperative complications, is important to identify patients at risk for ICU readmission.


Assuntos
Ponte de Artéria Coronária , Unidades de Terapia Intensiva , Readmissão do Paciente , Feminino , Humanos , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco
14.
Rev. bras. cir. cardiovasc ; 35(5): 732-740, Sept.-Oct. 2020. tab, graf
Artigo em Inglês | LILACS, Sec. Est. Saúde SP | ID: biblio-1137335

RESUMO

Abstract Objective: To evaluate the frequency, causes, and related predictive factors of intensive care unit (ICU) readmissions after coronary artery bypass grafting (CABG) surgery. Methods: A total of 4112 consecutive patients who underwent on-pump CABG between January 2007 and January 2017 were retrospectively evaluated. The patients were divided into two groups as patients with and without ICU readmission. Demographic and perioperative characteristics were compared between the two groups. Results: The ICU readmission rate was 3.5%. The most common reasons for ICU readmissions were respiratory (29%) and cardiac (23.4%) complications. The 90-day mortality risk was significantly higher in the readmitted patients than the non-readmitted patients (22.1% and 1.6%, respectively; P<0.001; OR=17.6; 95% CI=11.19-28.41). Severe left ventricular dysfunction, chronic obstructive pulmonary disease, end-stage renal disease, emergency CABG, EuroSCORE II > 5%, cross-clamp time > 35 minutes, postoperative respiratory complications, neurological complications, and cardiac complications showed a strong association with ICU readmissions. Conclusion: ICU readmission after CABG is associated with an increased mortality rate. Evaluation, not only of patients' comorbidities, but also of intraoperative conditions and postoperative complications, is important to identify patients at risk for ICU readmission.


Assuntos
Humanos , Masculino , Feminino , Readmissão do Paciente , Ponte de Artéria Coronária , Unidades de Terapia Intensiva , Complicações Pós-Operatórias , Estudos Retrospectivos , Fatores de Risco
15.
Braz J Cardiovasc Surg ; 35(4): 452-458, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32864923

RESUMO

OBJECTIVE: To evaluate the clinical impact of coronary dominance type in terms of early and long-term outcomes in patients undergoing elective coronary artery bypass grafting (CABG). METHODS: A total of 844 consecutive patients who underwent elective CABG were divided into two groups based on preoperative angiographic views as left dominant (LD) and right dominant or co-dominant (RD+CD). The measured outcomes were postoperative complications, 30-day mortality, long-term mortality, and major adverse cardiac and cerebrovascular events (MACCE). RESULTS: RD+CD was present in 87.9% (n=742) and LD in 12.1% (n=102) of patients. Postoperative complications, 30-day mortality, and 30-day readmissions were similar in both groups. The median duration of follow-up was 3.4 years. LD was not an independent predictor of mortality (adjusted hazard ratio [HR] 1.53, 95% confidence interval [CI] 0.89-2.45, P=0.12), but it was an independent predictor of MACCE in the long term (adjusted HR 2.18, 95% CI 1.39-3.42, P=0.001). CONCLUSION: In patients undergoing elective surgical revascularization, left coronary dominance is associated with increased MACCE risk in the long term. Therefore, the assessment of coronary dominance type should be an integral part of outpatient management after CABG.


Assuntos
Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Ponte de Artéria Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento
16.
Rev. bras. cir. cardiovasc ; 35(4): 452-458, July-Aug. 2020. tab, graf
Artigo em Inglês | LILACS, Sec. Est. Saúde SP | ID: biblio-1137293

RESUMO

Abstract Objective: To evaluate the clinical impact of coronary dominance type in terms of early and long-term outcomes in patients undergoing elective coronary artery bypass grafting (CABG). Methods: A total of 844 consecutive patients who underwent elective CABG were divided into two groups based on preoperative angiographic views as left dominant (LD) and right dominant or co-dominant (RD+CD). The measured outcomes were postoperative complications, 30-day mortality, long-term mortality, and major adverse cardiac and cerebrovascular events (MACCE). Results: RD+CD was present in 87.9% (n=742) and LD in 12.1% (n=102) of patients. Postoperative complications, 30-day mortality, and 30-day readmissions were similar in both groups. The median duration of follow-up was 3.4 years. LD was not an independent predictor of mortality (adjusted hazard ratio [HR] 1.53, 95% confidence interval [CI] 0.89-2.45, P=0.12), but it was an independent predictor of MACCE in the long term (adjusted HR 2.18, 95% CI 1.39-3.42, P=0.001). Conclusion: In patients undergoing elective surgical revascularization, left coronary dominance is associated with increased MACCE risk in the long term. Therefore, the assessment of coronary dominance type should be an integral part of outpatient management after CABG.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doença da Artéria Coronariana/cirurgia , Doença da Artéria Coronariana/diagnóstico por imagem , Intervenção Coronária Percutânea , Complicações Pós-Operatórias , Prognóstico , Ponte de Artéria Coronária , Estudos Retrospectivos , Resultado do Tratamento
17.
Vasc Endovascular Surg ; 54(7): 650-655, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32666909

RESUMO

Atherosclerotic true aneurysms of the superficial femoral artery (SFA) and profunda femoris artery (PFA) are rare and difficult to detect. The synchronous presence of SFA and PFA aneurysms is even rarer. Herein, we present a case with ipsilateral true SFA and PFA aneurysms diagnosed with rupture. A review of the international literature is made, and the diagnosis and treatment options of this rare condition are discussed. A 75-year-old male was admitted to our hospital with an aneurysm on the distal SFA and the ipsilateral PFA, as well as a hematoma around the PFA. It was difficult to determine the source of the rupture before surgery, even with proper imaging. Successful ligation of the PFA and an aneurysmectomy followed by a bypass grafting for the SFA were performed. An intraoperative examination revealed that the SFA aneurysm had ruptured. In elderly males with a history of ectasia or aneurysm on the aorta or peripheral arteries, a synchronous aneurysm on the SFA or the PFA should be suspected.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Artéria Femoral/diagnóstico por imagem , Idoso , Aneurisma Roto/cirurgia , Artéria Femoral/cirurgia , Oclusão de Enxerto Vascular , Humanos , Ligadura , Masculino , Valor Preditivo dos Testes , Resultado do Tratamento
18.
Braz J Cardiovasc Surg ; 35(2): 198-205, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32369301

RESUMO

OBJECTIVE: To compare the anatomical and physiological scoring systems and the outcomes of surgical management of penetrating cardiovascular trauma at a rural center. METHODS: Seventy-seven patients underwent emergency surgery at our center between January/2012 and October/2018 due to penetrating cardiovascular trauma. Injury Severity Score (ISS), Revised Trauma Score (RTS), New Injury Severity Score (NISS), and Trauma and Injury Severity Score (TRISS) were calculated. The validation of these risk scores to predict mortality was assessed by the area under the receiver operating characteristic curve analysis. RESULTS: All trauma scores were correlated with mortality. As ISS, NISS, and TRISS values increased and RTS values decreased, the mortality rate increased. The area under the curve (AUC) in the receiver operating characteristic curve analysis was 0.943 for TRISS, 0.915 for RTS, 0.890 for ISS, and 0.896 for NISS (P<0.001 for each). Logistic regression analysis revealed that scores were correlated with mortality (P<0.001 for each). By investigating cardiac injuries alone, only TRISS and RTS results correlated with mortality for cardiac injuries (Mann-Whitney U test, P=0.003 and P=0.01, respectively). The AUC was only statistically significant for TRISS and RTS (AUC=0.929, P<0.05 for both). For vascular injuries, all the scores were significantly correlated with in-hospital mortality (Mann-Whitney U test, P<0.001 for each). TRISS had the highest AUC (AUC=0.946, P<0.001). CONCLUSION: TRISS has the highest predictivity for in-hospital mortality in patients with penetrating cardiovascular trauma.


Assuntos
Ferimentos Penetrantes , Mortalidade Hospitalar , Humanos , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Índices de Gravidade do Trauma
19.
Turk Gogus Kalp Damar Cerrahisi Derg ; 28(1): 55-62, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32175143

RESUMO

BACKGROUND: In this study, we aimed to investigate frequency, patterns, etiologies, and costs of unplanned readmissions after left ventricular assist device implantation. METHODS: Between April 2012 and September 2016, 99 unplanned readmissions of a total of 50 consecutive bridge-to-transplant patients (45 males, 5 females; mean age 46.9±10.3 years; range, 19 to 67 years) who were successfully discharged after left ventricular assist device implantation were retrospectively analyzed. Patient demographic data, hemodynamic measurements before implantation, and readmissions after discharge were recorded. Hospitalizations due to major problems which were unable to be managed in routine outpatient clinic were accepted as unplanned readmissions. Survival analysis was performed. RESULTS: The readmission rate was 1.7 per year after discharge. Survival of patients who were readmitted within the first 90 days was found to be significantly lower than those without early readmission. The most common reasons of readmissions during follow-up were major infection (23.2%), neurological dysfunction (22.2%), cardiac causes (12.1%), bleeding (11.1%), and device malfunction (10.1%). Neurological dysfunctions (82,005 USD) and device malfunctions (73,300 USD) caused the highest economic burden. CONCLUSION: Among patients with a left ventricular assist device, hospital readmissions are common. Development of preventive strategies as well as effective treatment methods focused on longterm adverse events is critical to reduce the frequency and costs of hospital readmissions.

20.
Fam Process ; 59(4): 1874-1890, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32035010

RESUMO

Guided by the self-determination theory, this weekly diary study tested a process model in which week-to-week mother-reported interparental conflict and perceived partner responsiveness were associated with maternal autonomy support by means of maternal psychological need satisfaction. During six consecutive weeks, 258 mothers (Mage  = 41.71 years) and their 157 adolescents (51.4% females, Mage  = 14.92 years) from Turkey provided weekly reports of the study variables via an online survey. Multilevel analyses showed that maternal need satisfaction was predicted by lower levels of interparental conflict and greater levels of perceived partner responsiveness. Maternal need satisfaction, in turn, was positively associated with maternal and adolescent reports of maternal autonomy support. Further, these week-to-week associations were partly moderated by maternal perfectionism. The results underscore the dynamic nature of the intra-family relationships, the important role of particular conditions in which mothers may become more autonomy supportive, and the necessity to consider mother's personal characteristics while examining these dynamics.


Guided by the self-determination theory, this weekly diary study tested a process model in which week-to-week mother-reported interparental conflict and perceived partner responsiveness were associated with maternal autonomy-support by means of maternal psychological need satisfaction. During 6 consecutive weeks, 258 mothers (Mage = 41.71 years) and their 157 adolescents (51.4% females, Mage = 14.92 years) from Turkey provided weekly reports of the study variables via an online survey. Multilevel analyses showed that maternal need satisfaction was predicted by lower levels of interparental conflict and greater levels of perceived partner responsiveness. Maternal need satisfaction, in turn, was positively associated with maternal and adolescent reports of maternal autonomy-support. Further, these week-to-week associations were partly moderated by maternal perfectionism. The results underscore the dynamic nature of the intra-family relationships, the important role of particular conditions in which mothers may become more autonomy supportive, and the necessity to consider mother's personal characteristics while examining these dynamics.


Assuntos
Conflito Familiar/psicologia , Mães/psicologia , Poder Familiar/psicologia , Autonomia Pessoal , Satisfação Pessoal , Adolescente , Adulto , Diários como Assunto , Feminino , Humanos , Masculino , Relações Mãe-Filho , Análise Multinível , Teoria Psicológica , Turquia
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