RESUMO
BACKGROUND AND AIM OF THE STUDY: Transcatheter aortic valve replacement (TAVR) requires a safe route of access to the aortic valve. A direct aortic route has been used as alternate access approach in patients where ileo-femoral access is unsafe due to size, calcification and/or tortuosity. The study aim was to review the authors' results obtained with a direct aortic (DA) TAVR, examining in particular the safety and effectiveness of this approach. METHODS: A retrospective analysis was performed of all prospectively collected TAVR data from January 2011 to March 2015 at the authors' institution. DA-TAVRs were performed using either an upper mini- sternotomy (MST) into the second right intercostal space, or via a right anterior mini-thoracotomy (RAT) at the second intercostal space. The choice between MST and RAT approaches was made by the surgeon, based on aortic imaging, patent bypass grafts and pulmonary function. Both, Medtronic CoreValve and Edwards SAPIEN devices were used. All relevant perioperative and clinical outcomes were collected based on Valve Academic Research Consortium 2 (VARC-2) definitions. Median numerical values were used. RESULTS: Seventy-eight consecutive patients underwent DA-TAVR with 100% intraoperative survival and 92% 30-day survival. The procedural success was 97%. The majority of patients (79%) underwent DA-TAVR with the Medtronic CoreValve, via MST (92%). All patients were classified either as extreme (74%) or high risk (26%) for surgical aortic valve replacement. CONCLUSION: DA-TAVR provides a safe and viable alternate access approach for patients with inadequate ileo-femoral access. The clinical outcomes were acceptable in this very high-risk group of patients.
Assuntos
Valva Aórtica , Cateterismo Cardíaco/métodos , Implante de Prótese de Valva Cardíaca/métodos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/fisiopatologia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/mortalidade , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Desenho de Prótese , Punções , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Esternotomia , Texas , Toracotomia , Fatores de Tempo , Resultado do TratamentoAssuntos
Vasos Coronários/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Complicações Intraoperatórias/diagnóstico por imagem , Paraganglioma/diagnóstico por imagem , Paraganglioma/cirurgia , Vasos Coronários/lesões , Feminino , Humanos , Complicações Intraoperatórias/etiologia , Pessoa de Meia-IdadeRESUMO
The MitraClip procedure is an emerging endovascular technique for treating mitral regurgitation and an attractive alternative for patients who are at high risk for open heart mitral valve repair or replacement. We present the case of a failed redo MitraClip procedure that led to acute right ventricular failure in a patient with homozygous familial hypercholesterolemia and a preexisting secundum atrial septal defect. We highlight the sequelae of the failed redo MitraClip procedure and the anesthetic challenges associated with the emergent redo sternotomy and cardiopulmonary bypass procedure required to replace the mitral valve and repair the tricuspid valve and atrial septal defect.
Assuntos
Insuficiência Cardíaca/etiologia , Comunicação Interatrial/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Hiperlipoproteinemia Tipo II/cirurgia , Disfunção Ventricular Direita/etiologia , Ecocardiografia Transesofagiana , Feminino , Insuficiência Cardíaca/diagnóstico , Comunicação Interatrial/complicações , Comunicação Interatrial/genética , Homozigoto , Humanos , Hiperlipoproteinemia Tipo II/complicações , Hiperlipoproteinemia Tipo II/genética , Pessoa de Meia-Idade , Reoperação , Resultado do Tratamento , Valva Tricúspide/fisiopatologia , Valva Tricúspide/cirurgia , Disfunção Ventricular Direita/diagnósticoRESUMO
The Impella 5.0, a percutaneously inserted left ventricular assist device, has been used to support patients who have severe heart failure or who are undergoing high-risk percutaneous coronary intervention. We report our surgical placement of the Impella 5.0, through a graft sewn to the aorta, to unload the left ventricle of a 59-year-old man who was undergoing venoarterial extracorporeal membrane oxygenation for postcardiotomy shock. The patient underwent successful placement of a long-term left ventricular assist device before his discharge from the hospital. The versatility of the Impella 5.0 is exemplified in this patient who was successfully bridged to long-term support.
Assuntos
Ponte de Artéria Coronária/efeitos adversos , Oxigenação por Membrana Extracorpórea , Coração Auxiliar , Choque Cardiogênico/terapia , Função Ventricular Esquerda , Remoção de Dispositivo , Ecocardiografia Transesofagiana , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Recuperação de Função Fisiológica , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/etiologia , Choque Cardiogênico/fisiopatologia , Resultado do TratamentoRESUMO
The ability to attain high-definition imaging for preoperative planning, intraoperative execution, and postoperative evaluation is instrumental in surgical practice. Hybrid room computed tomography (CT) allows for faster, less invasive diagnostic and therapeutic options for patients. We present our diagnostic workup and therapeutic intervention with hybrid CT imaging in a 71-year-old female with a growing lung nodule after previous lobectomy for lung cancer.
Assuntos
Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Recidiva Local de Neoplasia , Pneumonectomia/métodos , Radiografia Intervencionista , Nódulo Pulmonar Solitário/diagnóstico por imagem , Nódulo Pulmonar Solitário/cirurgia , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X , Adenocarcinoma/patologia , Adenocarcinoma de Pulmão , Idoso , Feminino , Humanos , Neoplasias Pulmonares/patologia , Tomografia por Emissão de Pósitrons , Valor Preditivo dos Testes , Reoperação , Nódulo Pulmonar Solitário/patologia , Resultado do Tratamento , Carga TumoralRESUMO
Treatment of patients with INTERMACS class I heart failure can be very challenging, and temporary long-term device support may be needed. In this article, we review the currently available temporary support devices in order to support these severely ill patients with decompensated heart failure. Strategies of using a temporary assist as a bridge to long-term device support are also discussed.