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1.
J Cardiovasc Med (Hagerstown) ; 24(8): 506-513, 2023 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-37115966

RESUMO

AIMS: We describe long-term clinical and echocardiographic outcomes in the largest single-centre cohort of patients who underwent aortic valve replacement (AVR) with sutureless Perceval (CorCym, Italy) bioprosthesis. METHODS: Between March 2011 and March 2021, 1157 patients underwent AVR with Perceval bioprosthesis implantation. Mean age was 77 ±â€Š6 years (range: 46-89 years) and mean EuroSCORE II was 6.7 ±â€Š3.2% (range: 1.7-14.2%). Concomitant procedures were performed in 266 patients (23%). RESULTS: Thirty-day mortality was 1.38% (16/1157). Eight hundred and twenty of 891 (92%) isolated AVRs underwent minimally invasive surgery with a ministernotomy ( n  = 196) or right minithoracotomy ( n  = 624) approach. Cardiopulmonary bypass and aortic cross-clamp times were 81.1 ±â€Š24.3 and 50.6 ±â€Š11.7 min for isolated AVR and 144.5 ±â€Š34.7 and 96.4 ±â€Š21.6 min for combined procedures. At mean follow-up of 53.08 ±â€Š6.7 months (range: 1-120.5 months), survival was 96.5% and mean transvalvular pressure gradient was 13.7 ±â€Š5.8 mmHg. Left ventricular mass decreased from 152.8 to 116.1 g/m 2 ( P  < 0.001) and moderate paravalvular leakage occurred in three patients without haemolysis not requiring any treatment. Freedom from reoperation was 97.6%. Eight patients required surgical reintervention and 19 patients transcatheter valve-in-valve procedure for structural prosthesis degeneration at a mean of 5.6 years after first operation (range: 2-9 years). CONCLUSION: AVR with a Perceval bioprosthesis is associated with good clinical results and excellent haemodynamic performance in our 10-year experience. Structural degeneration rate of Perceval is comparable with other bioprosthetic aortic valves. Sutureless technology may reduce operative time especially in combined procedures and enable minimally invasive AVR.


Assuntos
Estenose da Valva Aórtica , Bioprótese , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Humanos , Idoso , Idoso de 80 Anos ou mais , Implante de Prótese de Valva Cardíaca/métodos , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Desenho de Prótese , Resultado do Tratamento , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia
2.
J Card Surg ; 37(12): 5411-5417, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36403259

RESUMO

OBJECTIVES: To highlight short- and long-term clinical outcomes of the Intuity TM rapid deployment prosthesis for surgical aortic valve replacement. METHODS: We reviewed on PubMed/MEDLINE, Embase, SciELO, LILACS, CCTR/CENTRAL, and Google Scholar for clinical trials, retrospective clinical studies, meta-analysis, and gray literature. RESULTS: Fourty-five clinical studies with 12.714 patients were included in the analysis. Thirty-day mortality ranged from 3.8% for Intuity and 3.9% for transcatheter aortic valve replacement (TAVR). The incidence of paravalvular leak (PVL) (Intuity 0% and TAVR 2.17%), permanent pacemaker implantation (Intuity 11.11% and TAVR 12.5%), stroke (Intuity 2.2% and TAVR 2.6%), myocardial infarction (MI) (Intuity 0% and TAVR 1%), were all higher in the TAVR group. Compared to other sutured bioprosthesis (SB), mortality ranged from 0% to 3.9% for Intuity and 0%-6.9% for SB. Long-term cardiac mortality ranged from 0.9% to 1.55% for Intuity and 1.4%-3.3% for the Perceval valve. The incidence of PVL (Intuity 0.24%-0.7% and Perceval 0%-1%), endocarditis (Intuity 0.2%-0.7% and Perceval 1.6%-6.6%), stroke (Intuity 0.36%-1.4% and Perceval 0%-0.8%), MI (Intuity 0.07%-0.26%), and SVD (Intuity 0.12%-0.7% and Perceval 0%) were comparable. Compared to standard full sternotomy (SFS), minimally invasive surgery (MINV) mortality ranged from 0% to 4.3% for MINV and 0%-2.1% for SFS. Hospital costs outcomes ranged from $37,187-$44,368 for the Intuity, $69,389 for TAVR, and $13,543 for SB. Intuity short-term mortality ranged between 0.9% and 12.4% while long-term mortality ranged between 2.6% and 20%. CONCLUSIONS: This manuscript provides a 360° overview of the current rapid deployments, sutureless, and TAVR prosthesis.


Assuntos
Bioprótese , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Humanos , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Desenho de Prótese , Estudos Retrospectivos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
3.
J Card Surg ; 35(11): 3041-3047, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32827184

RESUMO

OBJECTIVES: Infective endocarditis (IE) with extensive peri-annular abscesses and aortic root involvement is a life-threatening disease. Aortic root replacement with a valved conduit is the most common intervention in this setting and represents a serious challenge for the surgeon. In the present two-center study we analyzed early and midterm outcomes of a high-risk series of IE patients undergoing aortic root reconstruction with a sub-annular implantation of a totally biological valved conduit at our centers. METHODS: The series comprised 29 patients (18 males, mean age: 72.3 ± 10.1 years) operated at "Lancisi Cardiovascular Center" of Ancona and "Pasquinucci Heart Hospital" of Massa, Italy, between May 2016 and October 2019. All patients had undergone a previous cardiac surgery. Median Euroscore-II was 12.6%. Following aggressive debridement, a Bioconduit was implanted using a sub-annular implantation technique in all cases. RESULTS: Thirty-day mortality was 13.8% (n = 4). Multiorgan failure was cause of death in all cases. Respiratory complications occurred in eight patients (27.6%). Renal complications requiring temporary or permanent dialysis occurred in six (20.7%) and two (6.9%) patients, respectively. Mortality and morbidity were not related to the surgical approach. At 1-year follow-up three patients died and no patients underwent reoperation neither reported endocarditis of the biological conduit. CONCLUSION: Considered the high-risk profile of the study cohort, our results suggest safety and efficacy of our approach at 1-year. Indeed, we contend that our subannular implantation of a 100% pericardial valved conduit, allowing an effective abscess exclusion and a conduit anchoring to healthy tissues, can reduce the risk of reinfection and dehiscence.


Assuntos
Aorta/cirurgia , Valva Aórtica/cirurgia , Bioprótese , Implante de Prótese Vascular/métodos , Prótese Vascular , Endocardite/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Procedimentos Cirúrgicos Cardíacos , Feminino , Seguimentos , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Suínos , Fatores de Tempo , Resultado do Tratamento
4.
Ann Cardiothorac Surg ; 9(4): 305-313, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32832412

RESUMO

BACKGROUND: A minimally invasive approach (MIA) reduces mortality and morbidity in patients referred for aortic valve replacement (AVR). Sutureless technology facilitates a MIA. We describe our experience with the sutureless Perceval (LivaNova, Italy) aortic bioprosthesis through a right anterior mini-thoracotomy (RAMT) approach. METHODS: Between March 2011 and October 2019, 1,049 patients underwent AVR with Perceval bioprosthesis. Five hundred and three patients (48%) were operated through a RAMT approach in the second intercostal space. Considering only isolated AVR (881), 98% of patients were operated with MIA, and Perceval in RAMT approach was performed in 57% of these patients. Eight patients (1.6%) had previously undergone cardiac surgery. The prosthesis sizes implanted were: S (n=91), M (n=154), L (n=218) and XL (n=40). Concomitant procedures were mitral valve surgery (n=6), tricuspid valve repair (n=1), mitral valve repair and tricuspid valve repair (n=1) and miectomy (n=2). Mean age was 78±4 years (range, 65-89 years), 317 patients were female (63%) and EuroSCORE II was 5.9%±8.4%. RESULTS: The 30-day mortality was 0.8% (4/503). Cardiopulmonary bypass (CPB) and aortic cross-clamp times were 81.6±30.8 and 50.3±24.5 minutes respectively for stand-alone procedures. In two patients, early moderate paravalvular leakage appeared as a result of incomplete expansion of the sutureless valve due to oversizing of the bioprosthesis, requiring reoperations at two and nine postoperative days with sutured aortic bioprosthesis implantation. Permanent pacemaker implantation within the first thirty days was necessary in 26 (5.2%) patients. At the mean follow-up of 4.6 years (range, 1 month to 8.6 years), survival was 96%, freedom from reoperation was 99.2%, and mean transvalvular pressure gradient was 11.9±4.3 mmHg. CONCLUSIONS: AVR with the Perceval bioprosthesis in a RAMT approach is a safe and feasible procedure associated with low mortality and excellent hemodynamic performance. Sutureless technology facilitates a RAMT approach.

5.
Can J Physiol Pharmacol ; 98(4): 211-218, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32202442

RESUMO

Antenatal cardiac intervention affords new prospects for hypoplastic left heart syndrome. Its success, however, may come not only from absence of impediments to blood flow but also from a sufficiently developed cardiac wall. Here, we examined the feasibility to perfuse selectively the fetal coronary circulation for treatment with growth promoting agents. Pregnant sheep (94-114 days gestation, term 145 days) were used. An aortic stop-flow procedure was developed for intracoronary access in the nonexposed fetus and human mesenchymal stem cells and their exosomes served as test agents. We found that aortic stop-flow ensures preferential distribution of fluorescent microspheres to the heart. However, intracoronary administration of stem cells or exosomes was detrimental, with fetal demise occurring around surgery or at variable intervals afterwards. Coincidentally, stop-flow caused by itself a marked rise of intraluminal pressure within the occluded aorta along with histological signs of coronary obstruction. We conclude that it is feasible to perfuse selectively the coronary circulation of the preterm fetus, but treatments are not compatible with survival of the animals. The cause for failure is found in the absence of hemodynamic compensation to stop-flow via a left-to-right shunt. This unexpected event is attributed to a largely membranous foramen ovale, characteristic of sheep, that collapses under pressure.


Assuntos
Circulação Coronária/fisiologia , Forame Oval/fisiologia , Ovinos/fisiologia , Animais , Aorta/fisiologia , Feminino , Feto/fisiologia , Coração/fisiologia , Hemodinâmica/fisiologia , Humanos , Síndrome do Coração Esquerdo Hipoplásico/fisiopatologia , Recém-Nascido , Perfusão/métodos , Gravidez
6.
Innovations (Phila) ; 14(5): 445-452, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31476934

RESUMO

OBJECTIVE: Patients with severe aortic stenosis and reduced left ventricular ejection fraction (LVEF) have a poor prognosis compared with patients with preserved LVEF. To evaluate the impact of sutureless Perceval (LivaNova, Italy) aortic bioprosthesis on LVEF and clinical outcomes in patients with baseline left ventricular (LV) dysfunction who underwent isolated aortic valve replacement (AVR). METHODS: Between March 2011 and August 2017, 803 patients underwent AVR with Perceval bioprosthesis implantation. Fifty-two isolated AVR had preoperative LVEF ≤45%. Mean age of these patients was 77 ± 6 years, 24 patients were female (46%), and mean EuroSCORE II was 9.4% ± 4.8%. Perceval bioprosthesis was implanted in 9 REDO operations. In 43 patients (83%), AVR was performed in minimally invasive surgery with an upper ministernotomy (n = 13) or right anterior minithoracotomy (n = 30). RESULTS: One patient died in hospital. Cardiopulmonary bypass and aortic cross-clamp times were 85.5 ± 26 minutes and 55.5 ± 19 minutes, respectively. At mean follow-up of 33 ± 20 months (range: 1 to 75 months), survival was 90%, freedom from reoperation was 100%, and mean transvalvular pressure gradient was 11 ± 5 mmHg. LVEF improved from 37% ± 7% preoperatively to 43% ± 8% at discharge (P < 0.01) and further increased to 47% ± 9% at follow-up (P = 0.06), LV mass decreased from 149.8 ± 16.9 g/m2 preoperatively to 115.3 ± 11.6 g/m2 at follow-up (P < 0.001), and moderate paravalvular leakage occurred in 1 patient without hemolysis not requiring any treatment. CONCLUSIONS: AVR with sutureless aortic bioprosthesis implantation in patients with preoperative LV dysfunction demonstrated a significant immediate and early improvement in LVEF.


Assuntos
Estenose da Valva Aórtica/complicações , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Procedimentos Cirúrgicos Minimamente Invasivos , Disfunção Ventricular Esquerda/complicações , Idoso , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/cirurgia , Bioprótese , Ecocardiografia , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Análise de Sobrevida , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/mortalidade
7.
Heart Lung Circ ; 28(2): 327-333, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29277548

RESUMO

BACKGROUND: Myxomas are the most frequent cardiac tumours. Their diagnosis requires prompt removal. In our centre, for valve surgery we use a minimally invasive approach. Here, we report our experience of cardiac myxoma removal through right lateral mini-thoracotomy (RLMT) with particular focus on its feasibility, efficacy and patient safety. METHODS: Between February 2006 and January 2017, 30 consecutive patients (aged 66±12.6years, range 35-83 years) underwent atrial myxoma resection through video-assisted RLMT. Percutaneous venous drainage was performed in all patients and direct cannulation of the ascending aorta was performed in 28 out of 30 (93.3%). The diagnosis of atrial myxoma was confirmed by histology. RESULTS: Complete surgical resection was achieved in all patients. The mean cardiopulmonary bypass (CPB) time was 76.5±40.8minutes and average aortic cross-clamping time was 41.5±29.8minutes. No patient suffered postoperative complications. Five patients (16.7%) received a blood transfusion. Mechanical ventilation ranged from 3 to 51hours (median 6hours), intensive care unit (ICU) stay ranged from 1 to 5days (median 1day). Total hospital length of stay (HLOS) was 5.6±2 days. Home discharge rate was 56.7%. No in-hospital mortality was reported. During follow-up (55.6±32.3 months; range 4-132 months), one tumour recurrence was observed. There were three late non-cardiac deaths. Overall survival was 100%, 85.7% and 85.7% at 1, 5 and 10 years, respectively. CONCLUSIONS: The use of video-assisted RLMT is an effective and reproducible strategy in all patients requiring expedited surgery for left atrial myxoma, independently of coexisting morbidity such as systemic embolisation or previous surgery. This technique leads to complete tumour resection, prompt recovery, early home discharge and high freedom from both symptoms and tumour recurrence.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Neoplasias Cardíacas/cirurgia , Mixoma/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Seguimentos , Átrios do Coração , Neoplasias Cardíacas/diagnóstico , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Mixoma/diagnóstico , Estudos Retrospectivos , Resultado do Tratamento
9.
Ann Thorac Surg ; 105(1): 40-46, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28964415

RESUMO

BACKGROUND: This study describes the clinical and echocardiographic outcomes in a large single-center cohort of patients who underwent aortic valve replacement (AVR) with a sutureless Perceval (LivaNova, Milan, Italy) aortic bioprosthesis. METHODS: Between March 2011 and December 2015, 617 patients underwent AVR with a Perceval bioprosthesis. The mean age was 76 ± 7 years, 388 patients were female (63%), and the mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was 6.2% ± 5.4%. Concomitant procedures were mitral valve surgery (n = 74), tricuspid valve repair (n = 22), coronary artery bypass grafting (n = 42), myectomy (n = 3), and ascending aorta replacement (n = 2). RESULTS: The 30-day mortality rate was 1.9% (12 of 617). A total of 475 of 516 (92%) patients who had isolated AVR underwent minimally invasive surgery with an upper ministernotomy (n = 81) or a right anterior minithoracotomy (n = 394) approach. Cardiopulmonary bypass and aortic cross-clamp times were 81.7 ± 29.1 minutes and 50.5 ± 19.8 minutes for isolated AVR and 139.7 ± 51.5 minutes and 91.5 ± 29.5 minutes for combined procedures, respectively. At mean follow-up of 16.3 months (range, 0 to 51.9 months), the survival rate was 91.3%, the rate of freedom from reoperation was 99%, and the mean transvalvular pressure gradient was 11.9 ± 5.4 mm Hg. Left ventricular ejection fraction increased from 53.6% ± 8.4% to 54.5% ± 4.8% (p = 0.40), left ventricular mass decreased from 146.5 to 112.6 g/m2 (p < 0.001), and moderate paravalvular leakage occurred in 3 patients without hemolysis who did not require any treatment. CONCLUSIONS: AVR with the Perceval bioprosthesis is associated with low mortality rates and excellent hemodynamic performance. Sutureless technology may reduce operative times, especially in combined procedures, and may make minimally invasive AVR more easily reproducible.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bioprótese , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/mortalidade , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Desenho de Prótese , Técnicas de Sutura , Resultado do Tratamento
10.
Innovations (Phila) ; 12(4): 282-286, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28582328

RESUMO

OBJECTIVE: Prediction of operative risk in adults undergoing cardiac surgery remains a challenge. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) is one of the most commonly used in clinical settings. Recently, the new EuroSCORE II was published attempting to improve the accuracy of risk prediction. We sought to assess the predictive value of EuroSCORE or EuroSCORE II in selected field of minimally invasive cardiac surgery. METHODS: Patients who underwent cardiac surgery operation with minimally invasive approach from 2007 to 2013 identified from prospective cardiac surgical database. Additional variables included in EuroSCORE II, but not in original EuroSCORE, were retrospectively collected via electronic health records reviewing. The C-statistic was calculated for the EuroSCORE (additive and logistic) and EuroSCORE II. The Hosmer-Lemeshow test was used to assess model calibration by comparing observed and expected morality in number of risk strata. RESULTS: There were 39 hospitals deaths (1.6%). A total of 2472 patients were identified from the main database. The mean ± SD logistic EuroSCORE was 7.6 ± 8.3, mean ± SD additive EuroSCORE was 6.1 ± 2.7, and mean ± SD EuroSCORE II was 2.9 ± 4.2. EuroSCORE logistic model performed with substantial accuracy of 0.78, EuroSCORE additive performed with accuracy of 0.78, and EuroSCORE II performed as almost perfect 0.82. Model calibration was poor in EuroSCORE II (χ = 17.57, P = 0.02), calibration for logistic EuroSCORE was also poor (χ = 140.58, P < 0.01), and additive model also (χ = 94.95, P < 0.01). The area under the curve was high in all algorithms; logistic EuroSCORE was 0.78 (95% confidence interval = 0.71-0.85), additive EuroSCORE was 0.79 (95% confidence interval = 0.71-0.86), and EuroSCORE II was 0.82 (95% confidence interval = 0.75-0.89). CONCLUSIONS: In overall settings, original EuroSCORE and EuroSCORE II perform poorly in minimally invasive operation conditions. Data suggest that EuroSCORE could not be used for estimating operative risks correctly. New risk score should be explored, developed, and implemented for selective minimally invasive cohorts.


Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Calibragem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Estudos Retrospectivos , Fatores de Risco
11.
Interact Cardiovasc Thorac Surg ; 24(3): 363-368, 2017 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-28040754

RESUMO

Objectives: The aim of the present study was to evaluate the impact of a retrograde arterial perfusion (RAP) strategy versus an antegrade arterial perfusion (AAP) strategy in a consecutive, large cohort of patients who underwent minimally invasive mitral valve surgery with transthoracic aortic clamping through a right minithoracotomy. Methods: Between 2003 and 2015, 1632 consecutive patients underwent first-time minimally invasive mitral valve surgery with transthoracic aortic clamping at our institution; 141 (8.6%) of these patients received retrograde perfusion with femoral artery cannulation, whereas 1421 (91.4%) received antegrade perfusion with ascending aorta cannulation. Logistic regression was used to evaluate outcomes and risk factors for death and stroke between groups. Results: The overall frequency of 30-day mortality was 0.7% (13/1632) and was similar between groups (retrograde arterial perfusion RAP 0.7% vs AAP 0.8%; P = 0.903). The overall postoperative stroke rate was 1.3% (22/1632). The stroke rate was significantly higher in patients receiving retrograde perfusion (3.5% vs 1.1%; P = 0.005). Risk factors for death were advanced age (odds ratio (OR) = 1.3; P = 0.004), mitral valve replacement (OR = 3.9; P = 0.05), emergent procedure (OR = 3.4; P = 0.014) and conversion to sternotomy (OR = 3.7; P = 0.001). Multivariable regression analysis revealed that retrograde perfusion was an independent risk factor for stroke (OR = 3.3; P = 0.004). Other risk factors were conversion to sternotomy (OR = 12; P = 0.001), active endocarditis (OR = 5.8; P = 0.07) and hypercholesterolaemia (OR = 2.4; P = 0.048). Interaction modelling revealed that the only significant risk factor for a neurological event was the use of retrograde perfusion in patients older than 70 years with an atherosclerotic burden (OR = 6.4; P = 0.033). Conclusions: Minimally invasive mitral valve procedures can be performed with low morbidity and mortality. The use of retrograde perfusion is associated with a higher incidence of neurological complications in older patients with atherosclerotic burden. Central aortic cannulation permits avoidance of complications associated with retrograde perfusion and extends the suitability of minimally invasive mitral procedures to those patients who have an absolute contraindication for femoral artery cannulation.


Assuntos
Aorta/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Doenças das Valvas Cardíacas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valva Mitral/cirurgia , Perfusão/métodos , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Previsões , Doenças das Valvas Cardíacas/mortalidade , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Toracotomia/métodos
13.
J Heart Valve Dis ; 25(4): 448-455, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-28009948

RESUMO

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate the long-term clinical outcomes of the modified Bentall procedure (MBP) with a mechanical conduit. METHODS: Between 1993 and 2014, a total of 249 patients (mean age 62 ± 12 years; range: 25-87 years) underwent a MBP at the authors' institution. The main indication was annuloaortic ectasia in 102 patients (41%), followed by acute aortic dissection in 82 patients (33%); moderate to severe aortic regurgitation was present in 79% of cases. A bicuspid aortic valve was found in 17% of patients, and Marfan syndrome in 7%. The mean NYHA functional class was 2.5 ± 1.1. Concomitant procedures were performed in 36 patients (14%). The mean follow up was 8.7 ± 5.0 years (range: 0.3-21.5 years) and was 99% complete. The total follow up was 6.475 patient-years (pt-yr). RESULTS: Operative mortality was 3% in elective cases. Age, prolonged cardiopulmonary bypass times and mechanical ventilation >96 h were independent risk factors for early mortality. Actuarial survival at 15 and 20 years was 62% and 60%, respectively. Risk factors for late mortality were age and emergency operation. Actuarial freedom from thromboembolism (linearized incidence 0.93%/pt-yr) was 82% at 15 years, and 74% at 20 years. Seven patients required reoperation (0.38%/pt-yr), with an actuarial freedom from reoperation of 91% at 15 years and 87% at 20 years. The incidence of overall valve-related complications was 0.32%/pt-yr, with actuarial freedoms of 94% at 15 and 20 years. CONCLUSIONS: The MBP has shown excellent long-term results with a low incidence of procedure-related complications up to 20 years postoperatively. For this reason, it is considered to be a valid option for the treatment of aortic root disease, whenever valvesparing procedures are not indicated.


Assuntos
Aorta/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Hemorragia/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Tromboembolia/epidemiologia , Fatores de Tempo
14.
Interact Cardiovasc Thorac Surg ; 22(6): 756-61, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26953330

RESUMO

OBJECTIVES: (i) To establish who is at high risk for mitral surgery. (ii) To assess the performance of minimally invasive mitral valve surgery in high-risk patients by presenting early and late outcomes and compare these with those of the non-high-risk population. METHODS: We reviewed our database of prospective data of 1873 consecutive patients who underwent minimally invasive mitral surgery from 2003 to 2015. To establish an unbiased definition of risk cut-off, we considered as high-risk the 'outliers of risk' identified using boxplot analysis in relation to EuroSCORE II. RESULTS: Two hundred and five patients were outliers, with 98 as minor (EuroSCORE II ≥ 6%) and 107 as major outliers (EuroSCORE II ≥ 9%). Outliers accounted for several different comorbidities. Nineteen patients died while in hospital (9.2%); different postoperative complications were observed. Outliers had a significantly lower mean survival time and a higher risk of cardiac-related death than the general population; however, the worst outcomes were observed in major outliers. No statistically significant difference was found with regard to the need for mitral reintervention and the degree of mitral regurgitation at follow-up. CONCLUSIONS: Boxplot analysis helped to achieve an internal definition of risk cut-off, starting from EuroSCORE II ≥ 6%. Minimally invasive mitral surgery in these outliers of risk was associated with acceptable early and long-term results; however, major outliers with EuroSCORE II ≥ 9% may benefit from catheter-based procedures.


Assuntos
Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Ablação por Cateter/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Complicações Pós-Operatórias/mortalidade , Idoso , Fibrilação Atrial/complicações , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/complicações , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo
15.
Innovations (Phila) ; 10(5): 328-33, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26575380

RESUMO

OBJECTIVE: This study aimed to assess in a retrospective series of truly high-risk patients who underwent minimally invasive mitral valve surgery: (1) postoperative and long-term results and (2) logistic EuroSCORE and EuroSCORE II discrimination power. METHODS: Between 2003 and 2013, we reviewed in our institution patients who underwent minimally invasive mitral valve surgery with or without tricuspid valve repair via right minithoracotomy with logistic EuroSCORE of 20 or higher. RESULTS: Among a total number of 1604, 88 patients were identified. Median logistic and EuroSCORE II was 27.29 (interquartile range, 15.3) and 12.7% (11.3%), respectively. Mean (SD) age was 71.9 (8.4) years; 42 were female (47.7%); 60 patients (68.1%) underwent previous sternotomy. Mitral valve was replaced in 59 (67%) and repaired in 29 (32.9%) patients; tricuspid valve repair was performed in 23 patients (26.1%). Median cardiopulmonary bypass and cross-clamp times were 157 minutes (interquartile range, 131-187 minutes) and 83 minutes (81-116 minutes), respectively; conversion to sternotomy and reopening for bleeding was necessary in 4 (4.5%) and 3 (3.4%) patients; permanent and transient neurological injuries were reported in 6 (6.8%) and 3 (3.4%) patients; acute kidney injury was reported in 13 patients (14.7%); 15 patients (17%) had pulmonary complications. Ten patients died while in the hospital (11.2%). Survival at 6 years was 78% (95% confidence interval, 69-88). CONCLUSIONS: In this series of truly high-risk patients, minimally invasive mitral surgery was associated with acceptable early mortality and morbidity as well as long-term outcomes; both logistic and EuroSCORE II showed suboptimal discrimination power.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valva Mitral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Toracotomia/efeitos adversos , Toracotomia/métodos
16.
Innovations (Phila) ; 10(4): 230-5; discussion 235, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26371451

RESUMO

OBJECTIVE: The sutureless prostheses may facilitate minimally invasive aortic valve replacement because of easy and fast deployment. However, correct device sizing remains a crucial step of this procedure, which may be difficult and time consuming in minimal invasive approaches. We sought to analyze the accuracy of contrast-enhanced preoperative multidetector-row computed tomography (MDCT) in predicting the size of the prosthesis to be implanted in patients undergoing aortic valve replacement through a right anterior minithoracotomy (RAMT). METHODS: From January 2011 to September 2013, 235 patients underwent aortic valve surgery as sole procedure with implantation (Sorin Perceval S) in RAMT. Inclusion criterion for this study was presence of preoperative multidetector-row computed tomography (MDCT) with contrast enhancement and Doppler echocardiography. A preoperative MDCT was used to measure the aortic annulus as the diameter derived from either the area (aD) or the circumference (cD) of the virtual basal ring, left ventricular outflow tract (LVOT) diameter derived either from the area (aLVOT) or the circumference (cLVOT). Multidetector-row CT was reviewed by a single operator who was blind to implanted valve size. The operator measured the aortic annulus and LVOT in multiplanar reconstruction modality. Aortic annular diameter and LVOT diameter were retrieved from echocardiographic records. Predictive models were built based on logistic regression; outcome variable was the sutureless valve size, and covariates (annular and LVOT measurements) were used as single and multivariate predictors. A classification tree was built and then pruned with limited nodes to be able to obtain better predictive performance. RESULTS: We identified 54 patients who had preoperative contrast-enhanced MDCT. Seven patients received a size S, 21 received a size M, and 26 received a size L prosthesis. The mean age of the patients at the time of intervention was 76.3 ± 6.8 years, and the mean logistic EuroSCORE was 10.4% ± 8.7%. Echocardiographic measurements showed lower accuracy compared to MDCT measurements. Echocardiographic LVOT measurement was 61.11% to predict the valve size, whereas annulus measurement was 53.7%. The aLVOT from MDCT had an accuracy of approximately 62.96%, and cLVOT had 64.81% predictive accuracy. Aortic annulus perimeter cD had the highest accuracy to predict the valve size [62.96%, under the curve, 0.61] followed by aortic annular surface aD having an accuracy of approximately 70.37% (under the curve, 0.75). Classification tree models, after pruning with 4 nodes, increased their accuracy (83.33%), and it was easy to interpret and possibly to implement for clinical use. CONCLUSIONS: Multidetector-row CT-derived estimates seem to have higher predictive value for valve size determination in patients undergoing RAMT with the Perceval S prosthesis, thus facilitating this delicate procedure and preventing the selection of wrong candidates. Possibly for precise aortic annulus measurement, contrast-enhanced MDCT is preferable.


Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Tomografia Computadorizada Multidetectores/métodos , Suturas , Idoso , Idoso de 80 Anos ou mais , Ecocardiografia , Feminino , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valor Preditivo dos Testes , Técnicas de Sutura
17.
Interact Cardiovasc Thorac Surg ; 21(6): 748-53, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26403175

RESUMO

OBJECTIVES: EuroSCORE II has been implemented with the view to providing better performance than the previous logistic EuroSCORE. However, until now, no external validations have been carried out in the minimally invasive context. Therefore, we sought to validate the accuracy of EuroSCORE II in a retrospective series of consecutive patients undergoing minimally invasive mitral valve surgery. METHODS: Data of 1609 consecutive patients who underwent minimally invasive mitral valve surgery in our institution were retrospectively reviewed. The accuracy of EuroSCORE II was assessed in terms of discrimination and calibration. Discrimination was tested via analysis of the area under the curve of receiver operator characteristic; calibration was achieved by calculating the observed versus expected mortality ratio and the Hosmer-Lemeshow test for test probability; global accuracy was assessed by using Brier's score; results were compared with the previous logistic EuroSCORE version. EuroSCORE II performance was also tested for discrimination of postoperative complications. Discrimination subgroup analysis was carried out for single surgeon results, and for high-risk patients those outliers were defined after boxplot analysis (EuroSCORE II ≥6%). RESULTS: EuroSCORE II showed good discrimination power (area under the curve 0.846), and was statistically superior to logistic EuroSCORE (P = 0.01). In terms of calibration, both EuroSCORE II and logistic over-predicted mortality; with regard to adverse events, the discrimination of EuroSCORE II was adequate for acute renal failure, low-output syndrome and increased intensive care unit stay; area under the curve of receiver operating characteristic for high-risk patients with EuroSCORE ≥6% was suboptimal (0.654); single surgeon results did not influence the discrimination of EuroSCORE II. CONCLUSIONS: EuroSCORE II showed good discrimination power in our series of minimally invasive mitral valve patients; however, it over-predicted mortality. Individual performance did not influence discrimination. Performance was suboptimal for prediction of complications and for high-risk subgroup in-hospital mortality.


Assuntos
Indicadores Básicos de Saúde , Doenças das Valvas Cardíacas/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Valva Mitral/cirurgia , Idoso , Fibrilação Atrial/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Valva Tricúspide/cirurgia
18.
Interact Cardiovasc Thorac Surg ; 16(3): 282-5, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23223671

RESUMO

OBJECTIVES: The incidence of recurrent aortic arch obstruction after Norwood procedure and other types of aortic arch reconstruction in newborns remains high. Biological and synthetic materials are used to enlarge the aorta. We report our experience using autologous pericardium to reconstruct the aortic arch in patients with hypoplastic left heart syndrome, aortic arch interruption and hypoplastic aortic arch. METHODS: A retrospective analysis of 39 consecutively operated patients evaluated after an initial Norwood and other types aortic arch repair was performed. The presence of recurrent arch obstruction (mean gradient ≥ 20 mmHg) and its management were noted. The mean weight of our patients was 3.2 ± 0.7 kg. RESULTS: The mean age at primary surgical correction was 7.4 ± 6.8 (range 1-35 days). All patients were discharged without a significant residual gradient at the aortic arch except 4 who had a peak gradient of ≥ 30 mmHg. The overall incidence of recurrent arch obstruction was 28.2% (11 patients). Four (12.1%) patients had a distal obstruction, 1 (3%) had proximal obstruction and 1 had a mid-transverse arch obstruction. All patients underwent aortic arch reintervention consisting of balloon dilatation, and only after unsuccessful dilatation, 3 underwent surgical patch aortoplasties. CONCLUSIONS: The use of autologous pericardium in aortic arch reconstruction procedure is effective and associated with an acceptable incidence of recurrent arch obstruction. Its availability and characteristics make it an attractive alternative to other materials.


Assuntos
Aorta Torácica/cirurgia , Cardiopatias Congênitas/cirurgia , Procedimentos de Norwood , Pericárdio/transplante , Procedimentos de Cirurgia Plástica , Aorta Torácica/anormalidades , Aorta Torácica/fisiopatologia , Pressão Arterial , Distribuição de Qui-Quadrado , Cardiopatias Congênitas/mortalidade , Cardiopatias Congênitas/fisiopatologia , Humanos , Lactente , Recém-Nascido , Estimativa de Kaplan-Meier , Procedimentos de Norwood/efeitos adversos , Procedimentos de Norwood/mortalidade , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/mortalidade , Recidiva , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Transplante Autólogo , Resultado do Tratamento
20.
Interact Cardiovasc Thorac Surg ; 10(1): 113-4, 2010 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19822607

RESUMO

Big pulmonary artery-left atrial fistula malformation (PALAF) was diagnosed in a 5-year-old boy. Although transcatheter therapy would be preferred as a treatment of PALAF, the lesion, which was 20 mm in diameter and almost totally shunting the right main pulmonary artery, it was decided to treat by surgical approach.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas/cirurgia , Artéria Pulmonar/cirurgia , Fístula Vascular/cirurgia , Cateterismo Cardíaco , Ponte Cardiopulmonar , Pré-Escolar , Angiografia Coronária/métodos , Átrios do Coração/anormalidades , Átrios do Coração/cirurgia , Cardiopatias Congênitas/diagnóstico , Humanos , Masculino , Artéria Pulmonar/anormalidades , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Fístula Vascular/congênito , Fístula Vascular/diagnóstico
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