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BACKGROUND: We aim to provide a comprehensive review of the current state of knowledge of myocardial viability assessment in patients undergoing coronary artery bypass grafting (CABG), with a focus on the clinical markers of viability for each imaging modality. We also compare mortality between patients with viable myocardium and those without viability who undergo CABG. METHODS: A systematic database search with meta-analysis was conducted of comparative original articles (both observations and randomized controlled studies) of patients undergoing CABG with either viable or nonviable myocardium, in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to 2022. Imaging modalities included were dobutamine stress echocardiography (DSE), cardiac magnetic resonance (CMR), single-photon emission computed tomography (SPECT), and positron emission tomography (PET). RESULTS: A total of 17 studies incorporating a total of 2317 patients were included. Across all imaging modalities, the relative risk of death post-CABG was reduced in patients with versus without viability (random-effects model: odds ratio: 0.42; 95% confidence interval: 0.29-0.61; p < 0.001). Imaging for myocardial viability has significant clinical implications as it can affect the accuracy of the diagnosis, guide treatment decisions, and predict patient outcomes. Generally, based on local availability and expertise, either SPECT or DSE should be considered as the first step in evaluating viability, while PET or CMR would provide further evaluation of transmurality, perfusion metabolism, and extent of scar tissue. CONCLUSION: The assessment of myocardial viability is an essential component of preoperative evaluation in patients with ischemic heart disease undergoing surgical revascularization. Careful patient selection and individualized assessment of viability remain paramount.
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Ponte de Artéria Coronária , Isquemia Miocárdica , Função Ventricular Esquerda , Humanos , Cardiomiopatias/fisiopatologia , Cardiomiopatias/cirurgia , Cardiomiopatias/diagnóstico , Cardiomiopatias/etiologia , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/complicações , Ecocardiografia sob Estresse/métodos , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/cirurgia , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/complicações , Miocárdio/patologia , Sobrevivência de Tecidos , Tomografia Computadorizada de Emissão de Fóton Único , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/etiologia , Função Ventricular Esquerda/fisiologiaRESUMO
Background: Evaluation of coronary flow velocity reserve (CFVR) is the physiological approach to assess the severity of coronary stenosis and microvascular dysfunction. Impaired CFVR occurs frequently in women with suspected or known coronary artery disease. The aim of this study was to assess the role of CFVR to predict long-term cardiovascular event rate in women with unstable angina (UA) without obstructive coronary artery stenosis. Methods: CFVR in left anterior descending coronary artery was assessed by adenosine transthoracic echocardiograhy in 161 women admitted at our Department with UA and without obstructive coronary artery disease. Results: During a mean FU of 32.5 ± 19.6 months, 53 cardiac events occurred: 6 nonfatal acute myocardial infarction, 22 UA, 7 coronary revascularization by percutaneous transluminal coronary angioplasty, 1 coronary bypass surgery, 3 ischemic stroke, and 8 episodes of congestive heart failure with preserved ejection fraction and 6 cardiac deaths. Using a ROC curve analysis, CFVR 2.14 was the best predictor of cardiac events and was considered as abnormal CFVR. Abnormal CFVR was associated with lower cardiac event-free survival (30 vs 80%, p < 0.0001). During FU, 70% of women with reduced CFVR had cardiac events whereas only 20% with normal CFVR (p = 0.0001). At multivariate Cox analysis, smoke habitus (p = 0.003), metabolic syndrome (p = 0.01), and CFVR (p < 0.0001) were significantly associated with cardiac events at FU. Conclusion: Noninvasive CFVR provides an independent predictor of cardiovascular prognosis information in women with UA without obstructive coronary artery disease whereas, impaired CFVR seems to be associated with higher CV events at FU.
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INTRODUCTION: Postoperative acute kidney injury (AKI) and the requirement for renal replacement therapy (RRT) remain common and significant complications of both transcatheter valve-in-valve aortic valve replacement (ViV-TAVR) and redo surgical aortic valve replacement (SAVR). Nevertheless, the understanding of renal outcomes in the population undergoing either redo SAVR or ViV-TAVR remains controversial. METHODS: A systematic database search with meta-analysis was conducted of comparative original articles of ViV-TAVR versus redo SAVR in EMBASE, MEDLINE, Cochrane database, and Google Scholar, from inception to September 2021. Primary outcomes were AKI and RRT. Secondary outcomes were stroke, major bleeding, pacemaker implantation rate, operative mortality, and 30-day mortality. RESULTS: Our search yielded 5435 relevant studies. Eighteen studies met the inclusion criteria with a total of 11,198 patients. We found ViV-TAVR to be associated with lower rates of AKI, postoperative RRT, major bleeding, pacemaker implantation, operative mortality, and 30-day mortality. No significant difference was observed in terms of stroke rate. The mean incidence of AKI in ViV-TAVR was 6.95% (±6%) and in redo SAVR was 15.2% (±9.6%). For RRT, our data showed that VIV-TAVR to be 1.48% (±1.46%) and redo SAVR to be 8.54% (±8.06%). CONCLUSION: Renoprotective strategies should be put into place to prevent and reduce AKI incidence regardless of the treatment modality. Patients undergoing re-intervention for the aortic valve constitute a high-risk and frail population in which ViV-TAVR demonstrated it might be a feasible option for carefully selected patients. Long-term follow-up data and randomized control trials will be needed to evaluate mortality and morbidity outcomes between these 2 treatments.
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Injúria Renal Aguda , Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Acidente Vascular Cerebral , Substituição da Valva Aórtica Transcateter , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Reoperação , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do TratamentoRESUMO
INTRODUCTION: Cardiac surgery involving cardiopulmonary bypass (CPB) activates an inflammatory response releasing cytokines that are associated with less favourable outcomes. This study aims to compare i) CPB during cardiac surgery (control) versus ii) CPB with haemoadsorption therapy; and assess the effect of adding this therapy in reducing the inflammatory cytokines burden. METHODS: A systematic literature review with meta-analysis was conducted regarding the main outcomes (operative mortality, ventilation duration, intensive care unit [ICU] and hospital stays) and day-1 inflammatory markers levels post-surgery. Fifteen (15) studies were included for final analysis (eight randomised controlled trials, seven observational studies) with no evidence of publication bias. RESULTS: Subgroup analysis of non-elective surgeries across observational studies (emergency and infective endocarditis) significantly favoured cytokine filters in terms of 30-day mortality (OR 0.40, 95% CI 0.20, 0.83; p=0.01) and shorter ICU stay (MD -42.36, 95% CI -68.07, -16.65; p=0.001). At day-1 post-surgery, there was a significant difference favouring the cytokine filter group in c-reactive protein (CRP) (MD -0.71, 95% CI -0.84, -0.59; p<0.001) with no differences in white blood count (WBC), procalcitonin (PCT), tumour necrosis factor-alpha (TNF-α), IL-6, IL-8 and lactate. When comparing cytokine filters and control across all studies there was no significant difference in operative mortality, ventilation duration, hospital stay and ICU length of stay. Also, there were no statistical differences in randomised controlled trials (RCTs) using haemadsorption filters. CONCLUSIONS: A significant reduction in 30-day mortality and ICU stay could be obtained by using haemadsorption therapy during non-elective cardiac surgery, especially emergency surgery and in patients with higher inflammatory burden such as infective endocarditis.
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Procedimentos Cirúrgicos Cardíacos , Endocardite , Humanos , Ponte Cardiopulmonar/efeitos adversos , Citocinas , Unidades de Terapia IntensivaRESUMO
INTRODUCTION: Numbers of patients undergoing mitral valve repair (MVr) surgery for severe mitral regurgitation have grown and will continue to rise. MVr is routinely performed via median sternotomy; however, there is a move towards less invasive surgical approaches.There is debate within the clinical and National Health Service (NHS) commissioning community about widespread adoption of minimally invasive MVr surgery in the absence of robust research evidence; implementation requires investment in staff and infrastructure.The UK Mini Mitral trial will provide definitive evidence comparing patient, NHS and clinical outcomes in adult patients undergoing MVr surgery. It will establish the best surgical approach for MVr, setting a standard against which emerging percutaneous techniques can be measured. Findings will inform optimisation of cost-effective practice. METHODS AND ANALYSIS: UK Mini Mitral is a multicentre, expertise based randomised controlled trial of minimally invasive thoracoscopically guided right minithoracotomy versus conventional sternotomy for MVr. The trial is taking place in NHS cardiothoracic centres in the UK with established minimally invasive mitral valve surgery programmes. In each centre, consenting and eligible patients are randomised to receive surgery performed by consultant surgeons who meet protocol-defined surgical expertise criteria. Patients are followed for 1 year, and consent to longer term follow-up.Primary outcome is physical functioning 12 weeks following surgery, measured by change in Short Form Health Survey (SF-36v2) physical functioning scale. Early and 1 year echo data will be reported by a core laboratory. Estimates of key clinical and health economic outcomes will be reported up to 5 years.The primary economic outcome is cost effectiveness, measured as incremental cost per quality-adjusted life year gained over 52 weeks following index surgery. ETHICS AND DISSEMINATION: A favourable opinion was given by Wales REC 6 (16/WA/0156). Trial findings will be disseminated to patients, clinicians, commissioning groups and through peer reviewed publication. TRIAL REGISTRATION NUMBER: ISRCTN13930454.
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Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Adulto , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/cirurgia , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Medicina Estatal , Esternotomia , Resultado do Tratamento , Reino Unido , País de GalesRESUMO
OBJECTIVES: Mitral and tricuspid ring annuloplasty dehiscence with consequent recurrent valve regurgitation is a rare but challenging procedural failure. The incidence and predisposing risk factors for annuloplasty ring dehiscence include technical and pathological ones. METHODS: A systematic database search with pooled analysis was conducted of original articles that only included dehiscence rate of mitral and tricuspid ring in EMBASE, MEDLINE, Cochrane database and Google Scholar, from inception to November 2020. The outcomes included were dehiscence rate in mitral and tricuspid, type of ring implanted, dehiscence rate by pathology and by ring size and shape. RESULTS: Our search yielded 821 relevant studies. Thirty-three studies met the inclusion criteria with a total of 10 340 patients (6543 mitral, 1414 tricuspid) of which 87 (mitral) and 30 (tricuspid) had dehiscence. Overall, dehiscence rate was 1.43%, diagnosed at a median of 4.5 ± 1.0 months postoperatively. A significant difference in mitral dehiscence rate was found by ring type (semi-rigid 1.86%, rigid 2.32%; flexible 0.43%; P < 0.001). There was no significant difference in rate of dehiscence by ring size (P = 0.067) and shape in mitral (P = 0.281) but there was higher dehiscence rate in ischaemic compared to non-ischaemic mitral regurgitation (3.91% vs 1.63%; P = 0.022). Among tricuspid studies, 9 of 10 studies did not report any dehiscence. CONCLUSIONS: Although rigid, semi-rigid and flexible annuloplasty rings provide acceptable valve repair outcomes, mitral annuloplasty ring dehiscence is clinically more common among rigid rings. Understanding the multifactorial nature of ring dehiscence will help in identifying the patients at high risk and improve their clinical outcomes.
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Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral , Insuficiência da Valva Tricúspide , Próteses Valvulares Cardíacas/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Anuloplastia da Valva Mitral/efeitos adversos , Insuficiência da Valva Mitral/epidemiologia , Insuficiência da Valva Mitral/cirurgia , Desenho de Prótese , Resultado do Tratamento , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgiaRESUMO
BACKGROUND: Assessing patient fitness prior to high-risk operations is becoming increasingly vital in cardiothoracic surgery. Physical activity (PA) and frailty measures are powerful perioperative tools, albeit underused in clinical practice. This study aimed to assess the influence of patient frailty on PA postsurgery and other short-term outcomes. METHODS: Eighty patients undergoing a variety of cardiac surgical procedures (coronary revascularisation, valve repair/replacement, or combination) were recruited to participate. The Reported Edmonton Frailty Scale was used to measure preoperative frailty. As objective measures of PA, participants wore a wrist accelerometer device for 14 days prior to their operation and early in the postoperative period for 30 days. RESULTS: A global reduction in PA was observed in the early postoperative period. Frailty was a significant predictor of reduced light (coefficient -2.23, 95% CI -4.21 to -0.25, P = .028) and moderate activity (coefficient -1.85, 95% CI -2.99 to -0.70, P = .002) postoperatively. Neither frailty nor preoperative PA were predictors of postoperative composite complications. Both frailty (coefficient 0.134, 95% CI 0.106-0.162, P < .001) and PA scores (P < .05) were strong predictors of length of hospital stay (coefficient 1.76, 95% CI 0.003-3.524, P = .05). Furthermore, patients who stayed in hospital longer were more likely to suffer early postoperative complications (stroke, renal failure, reoperation, pacemaker) if they were frail (P < .0001) compared to non-frail patients (P = .607). CONCLUSIONS: This study highlights the predictive ability of objective frailty scoring and PA measurement for outcomes after cardiac surgery. This has important implications for surgical risk stratification and personalized postoperative planning.
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Procedimentos Cirúrgicos Cardíacos , Exercício Físico , Fragilidade/diagnóstico , Avaliação Geriátrica , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
AIM: The aim of this study was to compare minimally invasive surgery (MI) and median sternotomy (MS) in terms of post-procedure health-related quality of life (HRQoL) and functional outcome. METHOD: We conducted a multicentre prospective cohort study that enrolled patients from January 2015 until February 2017. Combined cardiac procedures were performed with MS and isolated valve procedures with either MS or MI, depending on patient preference and surgeon experience. HRQoL was measured using the five-level version of the EQ-5D (EQ-5D-5L) and physical activity before and after surgery was evaluated using a wearable accelerometer. Activity patterns and intensity recorded by the accelerometer in each period were classified as "sedentary", "light physical activity", "moderate physical activity", and "vigorous physical activity" for each patient. We also conducted a sub-analysis of frail patients in each group, as identified by the Reported Edmonton Frail Scale (>10 points). Patients were followed for 1 year. RESULTS: The study included 100 consecutive patients who underwent MI (n=50) or MS (n=50) during the study period. Patients in the MI group showed a faster recovery of physical activity in the immediate postoperative period and superior HRQoL in the first 3 months (both p<0.001) versus the MS group. Differences between the MI and MS group were indistinguishable over a longer follow-up. A similar correlation was observed in the frailty subanalysis. Overall, the MS group had a higher cumulative incidence of events than the MI group (p<0.001). CONCLUSIONS: Compared to conventional MS, MI was associated with better HRQoL and early functional outcome, even in frail patients.
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Procedimentos Cirúrgicos Minimamente Invasivos , Qualidade de Vida , Esternotomia , Exercício Físico , Humanos , Estudos Prospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: Cor-Knot automated fastener has been used as an adjunct in heart valve surgery to eliminate the need for manual tying during valve implantation. Although reduced operative time and facilitation for minimally invasive surgery are clear benefits, whether their use translates to improved patient outcome remains debatable. This study aims to review the safety and efficacy of automated fasteners in heart valve surgeries. METHOD: Specific searches were conducted via online medical databases (Pubmed, Embase, Ovid) between 1950 and June 2019. Longitudinal studies were included that provided operative parameters. RESULTS: The initial literature search identified 3773 articles, but only eight met the inclusion criteria and were used for analysis: four studies related to aortic valve replacement (AVR), four related to mitral valve (MV) intervention (total n = 810). The meta-analysis revealed the significantly shorter aortic cross-clamp time in the Cor-knot group compared to manual tying, both in AVR and MV surgeries (P < .05). Cardiopulmonary bypass time was significantly shorter in the Cor-knot group when analyzing studies in MV surgery (weighted mean difference [WMD]: 110.0; 95% confidence interval: 12.3-207.7; P = .027) The use of Cor-Knot did not increase the risk of permanent pacemaker implantation, paravalvular leak, and 30-day mortality. The majority of studies reported no change in the length of intensive unit care and total hospital stay. CONCLUSION: We confirmed that the majority of existing literatures indicated the safety and intraoperative efficacy with automated fastener application. Nevertheless, there is currently no evidence to support automated fastened sutures can translate its intraoperative advantages to improved patient outcome.
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Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Complicações Pós-Operatórias/epidemiologia , Valva Aórtica/cirurgia , Humanos , Valva Mitral/cirurgiaRESUMO
A high prevalence of depression is observed in patients undergoing cardiac surgery, and depression has been shown to be an independent predictor of morbidity and mortality in this patient population. Selective serotonin re-uptake inhibitors (SSRIs) are the first-line recommended therapy for depressive disorders, however due to their platelet inhibitory actions they have been associated with increased incidences of post-operative bleeding. This review has sought to address whether the use of SSRIs is associated with a higher rate of mortality, major adverse events or bleeding events following cardiac surgery. A retrospective literature search selected studies comparing the use of SSRIs with no SSRI use in patients undergoing cardiac surgery. Seven of the ten studies analysed reported no significant difference in mortality in SSRI users. Five of the seven studies reporting bleeding events demonstrated no significant difference in SSRI users. Three of the five studies reporting other significant morbidity demonstrated no significant difference in SSRI users. Our study demonstrates the safety of the use of SSRIs for the treatment of depressive disorders in patients undergoing cardiac surgery.
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INTRODUCTION: Depressive illness has a high prevalence in patients undergoing coronary artery bypass graft surgery (CABG). The first line treatment for depression are selective serotonin reuptake inhibitors (SSRIs) which inhibit serotonin reuptake in the presynaptic neuronal membrane and uptake by platelets, inhibiting subsequent serotonin-mediated platelet activation. This presents a theoretically increased risk of bleeding and subsequent postoperative mortality. This review aims to investigate the effects of SSRIs on postoperative bleeding, defined as the need for transfusions and re-operation for bleeding, as well as 30-day mortality in patients undergoing CABG. METHOD: Four hundred and thirty-seven papers were screened with seven meeting the full inclusion criteria. RESULTS: Meta-analysis demonstrated that SSRI use increased the risk of red blood cell transfusion (odds ratio (OR) = 1.15; 95% confidence interval (CI): 1.06-1.26), but resulted in no difference in the rate of re-operation for bleeding (OR = 1.07; 95% CI: 0.66-1.74). SSRI use had no effect on the rates of platelet (OR = 0.93; 95% CI: 0.79-1.09) or fresh frozen plasma (OR = 0.96; 95% CI: 0.74-1.24) transfusion nor on the mortality rate (OR =1.03; 95 CI: 0.90-1.17). CONCLUSION: This review demonstrates that SSRIs are largely safe in cardiac surgery as no increase in mortality was observed. However, there is a significantly raised chance of red blood cell transfusion. The heterogeneous nature of the current evidence base highlights the need for further research into SSRIs and whether any effect on patient outcomes in cardiac surgery occurs.
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Ponte de Artéria Coronária/efeitos adversos , Hemorragia Pós-Operatória/induzido quimicamente , Inibidores Seletivos de Recaptação de Serotonina/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Transtorno Depressivo/tratamento farmacológico , Transfusão de Eritrócitos , Humanos , Estudos Observacionais como Assunto , Hemorragia Pós-Operatória/mortalidade , Hemorragia Pós-Operatória/terapia , RiscoRESUMO
Subvalvular techniques are gaining ground as adjunct procedures for addressing ischaemic mitral regurgitation. The aim of this study was to describe the different techniques and assess their results. A systematic review of the literature was performed. The end points of interest were recurrence of mitral regurgitation, cardiac events and early and late echocardiographic measurements. After initial screening, 450 articles were identified, of which 24 provided the best available evidence on the topic. The different subvalvular techniques had similar mortality rates when compared with the standard restrictive annuloplasty. Recurrence of mitral regurgitation was of lower degree and the remodelling process was better for these techniques. Reoperation rates were also quite low. The subvalvular techniques showed superiority, addressing more successfully the leaflet tethering. However, larger randomized studies are needed to confirm these early positive results.
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Ecocardiografia/métodos , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Isquemia Miocárdica/cirurgia , Saúde Global , Humanos , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/mortalidade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/epidemiologia , Recidiva , Taxa de Sobrevida/tendênciasRESUMO
A best evidence topic in cardiothoracic and vascular surgery was written according to a structured protocol. The question addressed was whether endovascular treatment with multilayer flow modulator stents (MFMS) can be considered a safe alternative to open surgery for high-risk patients with thoracoabdominal aortic aneurysm (TAAA). Altogether 27 papers were identified using the reported search, of which 11 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study limitations are tabulated. The outcomes of interest were all-cause survival, aneurysm-related survival, branch vessel patency and major adverse events. Aneurysm-related survival exceeded 78% in almost all studies, with the exception of one where the MFMS was inserted outside the instructions for use. In that study the aneurysm-related survival was 28.9%. The branch vessel patency was higher than 95% in 10 studies and not reported in one. At 12-month follow-up, several studies showed a low incidence of major adverse events, including stroke, paraplegia and aneurysm rupture. We conclude that MFMS represent a suitable and safe treatment for high-risk patients with TAAA maintaining branch vessel patency when used within their instructions for use. However, a number of limitations must be considered when interpreting this evidence, particularly the complete lack of randomised controlled trials (RCTs), short follow-up in all studies, and heterogeneity of the pathologies among the different populations studied. Further innovative developments are needed to improve MFMS safety, expand their instructions for use, and enhance their efficacy.
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Objectives: Patient frailty is increasingly recognised as contributing to adverse postoperative outcomes in cardiothoracic surgery. The goal of this review is to evaluate the predictive ability of frailty scoring systems and their limitations in risk assessment of patients undergoing cardiac surgery. Methods: Frailty studies were identified by searching electronic databases. Studies in which the measuring instrument was defined as a multidimensional tool focusing on a population undergoing cardiac operations were included. The focus was on the predictive ability of frailty in this population and a comparison with conventional risk scoring systems. Unfortunately, the lack of a significant number of studies with the same postoperative outcome precluded a formal meta-analysis. Results: Of 783 studies identified in our initial search, 6 fulfilled our inclusion criteria. Frailty was identified as a predictor of mortality, morbidity and/or prolonged hospital stay in patients undergoing cardiac surgery. Our systematic review revealed the increased application of frailty scores compared to standardized risk stratification scores in cardiothoracic patients. In approximately 50% of these studies, frailty scores continued to be predictive even after adjusting for the conventional risk scoring systems. Conclusions: The assessment of frailty may enhance the preoperative workup and offer an optimized risk stratification measure in patients undergoing cardiothoracic procedures even though the reporting standards of calibration and classification measures have been relatively poor.
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Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Idoso , Feminino , Idoso Fragilizado , Nível de Saúde , Humanos , Tempo de Internação , Masculino , Morbidade , Medição de Risco , Fatores de RiscoAssuntos
Veias Braquiocefálicas/patologia , Procedimentos Cirúrgicos Cardíacos/métodos , Remoção de Dispositivo/métodos , Procedimentos Endovasculares/métodos , Migração de Corpo Estranho/cirurgia , Átrios do Coração/cirurgia , Stents/efeitos adversos , Idoso , Angiografia , Veias Braquiocefálicas/diagnóstico por imagem , Constrição Patológica/etiologia , Ecocardiografia , Migração de Corpo Estranho/diagnóstico por imagem , Átrios do Coração/diagnóstico por imagem , Humanos , Masculino , Derrame Pericárdico/diagnóstico por imagem , Risco , Veia Subclávia/diagnóstico por imagem , Veia Subclávia/patologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Minimally invasive and robotic coronary revascularization strategies offer less pain, fewer adverse events, better cosmesis, and speedier recovery. These procedures are vulnerable to left internal mammary artery (LIMA) injury that may require a full sternotomy, which eliminates the benefits of minimally invasive procedures. We present a management protocol to avoid conversion to sternotomy in minimally invasive cases based on the location of the LIMA injury at proximal, mid, and distal locations. By applying axillary bypass, LIMA extension, and repair over a shunt approaches, our protocol can be used as a successful bailout to LIMA damage in minimally invasive coronary cases.