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1.
Braz J Cardiovasc Surg ; 32(3): 202-209, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28832799

RESUMO

OBJECTIVE:: To assess heart rhythm and predictive factors associated with sinus rhythm after one year in patients with rheumatic valve disease undergoing concomitant surgical treatment of atrial fibrillation. Operative mortality, survival and occurrence of stroke after one year were also evaluated. METHODS:: Retrospective longitudinal observational study of 103 patients undergoing rheumatic mitral valve surgery and ablation of atrial fibrillation using uni- or bipolar radiofrequency between January 2013 and December 2014. Age, gender, functional class (NYHA), type of atrial fibrillation, EuroSCORE, duration of atrial fibrillation, stroke, left atrial size, left ventricular ejection fraction, cardiopulmonary bypass time, myocardial ischemia time and type of radiofrequency were investigated. RESULTS:: After one year, 66.3% of patients were in sinus rhythm. Sinus rhythm at hospital discharge, lower left atrial size in the preoperative period and bipolar radiofrequency were associated with a greater chance of sinus rhythm after one year. Operative mortality was 7.7%. Survival rate after one year was 92.3% and occurrence of stroke was 1%. CONCLUSION:: Atrial fibrillation ablation surgery with surgical approach of rheumatic mitral valve resulted in 63.1% patients in sinus rhythm after one year. Discharge from hospital in sinus rhythm was a predictor of maintenance of this rhythm. Increased left atrium and use of unipolar radiofrequency were associated with lower chance of sinus rhythm. Operative mortality rate of 7.7% and survival and stroke-free survival contribute to excellent care results for this approach.


Assuntos
Fibrilação Atrial/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Cardiopatia Reumática/cirurgia , Adulto , Fatores Etários , Idoso , Fibrilação Atrial/mortalidade , Fibrilação Atrial/fisiopatologia , Ponte Cardiopulmonar , Ablação por Cateter/métodos , Ablação por Cateter/mortalidade , Feminino , Frequência Cardíaca/fisiologia , Doenças das Valvas Cardíacas/mortalidade , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Valva Mitral/cirurgia , Análise Multivariada , Reprodutibilidade dos Testes , Estudos Retrospectivos , Cardiopatia Reumática/mortalidade , Cardiopatia Reumática/fisiopatologia , Medição de Risco/métodos , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
2.
Interact Cardiovasc Thorac Surg ; 20(6): 844-7, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25757475

RESUMO

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is robotic mitral valve surgery more expensive than its conventional counterpart?' Altogether 19 papers were found using the reported search, of which 5 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. There is a general impression in the surgical community that robotic operations might incur prohibitive additional costs. There is a paucity of data in the literature regarding cost analysis in cardiac robotic surgery. From the five studies, four were single institution experiences and one was a database inquiry study. These four studies showed that operational costs are higher for robotic cases but this was partially (one study) or completely (three studies) offset by lower postoperative costs. Overall hospital costs were similar between the two approaches in three studies and one study showed higher costs in the robotic group. Higher operating theatre (OT) costs were driven mainly by use of robotic instruments (approximately US$1500 per case) and longer OT times. Savings in postoperative care were driven by shorter length of hospital stay (on average 2 days fewer in robotic cases) and lower morbidity. If amortization cost, that is, the value of the initial capital investment on the robotic system divided by all operations performed, is included in this analysis, robotic approach becomes significantly more expensive by approximately US$3400 per case. The fifth study was a large national database inquiry in which robotic approach was found to be more expensive by US$600 per case excluding amortization cost and by US$3700 if amortization is included. We conclude that the total hospital cost of robotic mitral valve surgery is slightly higher than conventional sternotomy surgery. If amortization is taken into consideration, robotic cases are considerably more expensive.


Assuntos
Implante de Prótese de Valva Cardíaca/economia , Custos Hospitalares , Anuloplastia da Valva Mitral/economia , Valva Mitral/cirurgia , Procedimentos Cirúrgicos Robóticos/economia , Benchmarking , Redução de Custos , Análise Custo-Benefício , Medicina Baseada em Evidências , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Tempo de Internação/economia , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Anuloplastia da Valva Mitral/instrumentação , Duração da Cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/instrumentação , Instrumentos Cirúrgicos/economia , Fatores de Tempo , Resultado do Tratamento
3.
Rev Bras Cir Cardiovasc ; 29(1): 107-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24896171

RESUMO

Internal mammary artery harvesting is an essential part of any coronary artery bypass operation. Totally endoscopic coronary artery bypass graft surgery has become reality in many centers as a safe and effective alternative to conventional surgery in selected patients. Internal mammary artery harvesting is the initial part of the procedure and should be performed equally safely if one wants to achieve excellence in patency rates for the bypass. We here describe the technique for mammary harvesting with the Da Vinci Si robotic system.


Assuntos
Artéria Torácica Interna/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Torácica Vídeoassistida/métodos , Coleta de Tecidos e Órgãos/métodos , Ponte de Artéria Coronária/instrumentação , Ponte de Artéria Coronária/métodos , Humanos , Reprodutibilidade dos Testes , Coleta de Tecidos e Órgãos/instrumentação
4.
Rev Bras Cir Cardiovasc ; 29(4): 654-6, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25714222

RESUMO

Current technology in robotic surgery allows us to perform myocardial revascularization procedures in a totally endoscopic fashion. We will describe the technique of choice for left internal mammary artery to left anterior descendent artery anastomosis with the use of cardiopulmonary bypass machine. The method is efficient and there is long term follow-up showing similar patency of the graft when compared to conventional methods (when performed through sternotomy).


Assuntos
Ponte Cardiopulmonar/métodos , Anastomose de Artéria Torácica Interna-Coronária/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Vídeoassistida/métodos , Anastomose Cirúrgica , Vasos Coronários/cirurgia , Humanos , Artéria Torácica Interna/cirurgia , Reprodutibilidade dos Testes
5.
J Thorac Dis ; 5 Suppl 6: S641-9, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24251021

RESUMO

Robotically assisted totally endoscopic coronary artery bypass surgery has emerged as a feasible and efficient alternative to conventional full sternotomy coronary artery bypass graft surgery in selected patients. This minimally invasive approach using the daVinci robotic system allows fine intrathoracic maneuvers and excellent view of the coronary arteries. Both on-pump and off-pump operations can be performed to treat single and multivessel disease. Hybrid approaches have the potential of offering complete revascularization with the "best of both worlds" from surgery (internal mammary artery anastomosis in less invasive fashion) and percutaneous coronary intervention (least invasive approach). In this article we review the indications, techniques, short and long term results, as well as current developments in totally endoscopic robotic coronary artery bypass operations.

6.
Rev. bras. cir. cardiovasc ; 32(3): 202-209, May-June 2017. tab, graf
Artigo em Inglês | LILACS | ID: biblio-897907

RESUMO

Abstract Objective: To assess heart rhythm and predictive factors associated with sinus rhythm after one year in patients with rheumatic valve disease undergoing concomitant surgical treatment of atrial fibrillation. Operative mortality, survival and occurrence of stroke after one year were also evaluated. Methods: Retrospective longitudinal observational study of 103 patients undergoing rheumatic mitral valve surgery and ablation of atrial fibrillation using uni- or bipolar radiofrequency between January 2013 and December 2014. Age, gender, functional class (NYHA), type of atrial fibrillation, EuroSCORE, duration of atrial fibrillation, stroke, left atrial size, left ventricular ejection fraction, cardiopulmonary bypass time, myocardial ischemia time and type of radiofrequency were investigated. Results: After one year, 66.3% of patients were in sinus rhythm. Sinus rhythm at hospital discharge, lower left atrial size in the preoperative period and bipolar radiofrequency were associated with a greater chance of sinus rhythm after one year. Operative mortality was 7.7%. Survival rate after one year was 92.3% and occurrence of stroke was 1%. Conclusion: Atrial fibrillation ablation surgery with surgical approach of rheumatic mitral valve resulted in 63.1% patients in sinus rhythm after one year. Discharge from hospital in sinus rhythm was a predictor of maintenance of this rhythm. Increased left atrium and use of unipolar radiofrequency were associated with lower chance of sinus rhythm. Operative mortality rate of 7.7% and survival and stroke-free survival contribute to excellent care results for this approach.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Cardiopatia Reumática/cirurgia , Fibrilação Atrial/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Cardiopatia Reumática/fisiopatologia , Cardiopatia Reumática/mortalidade , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/mortalidade , Ponte Cardiopulmonar , Fatores Sexuais , Análise Multivariada , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores Etários , Resultado do Tratamento , Ablação por Cateter/métodos , Ablação por Cateter/mortalidade , Medição de Risco/métodos , Estimativa de Kaplan-Meier , Frequência Cardíaca/fisiologia , Doenças das Valvas Cardíacas/fisiopatologia , Doenças das Valvas Cardíacas/mortalidade , Valva Mitral/cirurgia , Valva Mitral/fisiopatologia
9.
Case Rep Cardiol ; 2011: 340681, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-24826214

RESUMO

Despite cardiac metastases are found in about 20% of cancer deaths, the presence of primary cardiac tumors is rare. Most primary tumors are benign, and malignant tumors comprise about 15%. We report a 21-year-old man with fever, dyspnea, and hemoptysis that was diagnosed with angiosarcoma of the right atrium and pulmonary metastasis. Patient was submitted to surgical tumor resection without adjuvant therapy and died four months after diagnosis.

10.
Rev Bras Cir Cardiovasc ; 26(4): 565-72, 2011.
Artigo em Inglês, Português | MEDLINE | ID: mdl-22358271

RESUMO

OBJECTIVE: To analyze the effectiveness of surgical treatment of atrial fibrillation (AF) using bipolar radiofrequency ablation during mitral valve procedures of rheumatic etiology in heart surgery. METHODS: We retrospectively reviewed medical registries of 53 patients submitted to atrial ablation with bipolar radiofrequency energy during mitral valve surgery. Thirty four (64%) patients were women and the age varied from 27 to 72 years old (average: 49.3 ± 10.7 years). Aortic and/or tricuspid procedures were also present in 36 (68%) patients. Average time of reported atrial fibrillation was 41 months (from 3 to 192 months). Type of AF was classified as: paroxysmal in 8 patients, persistent in 3, permanent in 42. Left atrium had an average size of 52.9 ± 8.5 mm. The surgeries in these series were: 47 mitral valve replacements and 6 mitral valve repairs. Electrocardiografic follow up was 83% complete in 14 months. Data from 24h Holter were explored. RESULTS: Seven (13%) perioperative deaths were observed and survival after 14 months was 87%. Observed heart rhythm after 1 year of surgery was sinus rhythm in 25 (66%) patients, AF in 7 (18%), flutter in 7 (13%), junctional in 1 (3%). CONCLUSION: Bipolar radiofrequency ablation in patients submitted to mitral valve surgery of rheumatic etiology is effective in converting to sinus rhythm in 68% of patients after 14 months.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Frequência Cardíaca/fisiologia , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Cardiopatia Reumática/cirurgia , Adulto , Idoso , Ablação por Cateter/efeitos adversos , Ablação por Cateter/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
11.
Arq Bras Cardiol ; 96(6): 456-64, 2011 Jun.
Artigo em Inglês, Português | MEDLINE | ID: mdl-21537529

RESUMO

BACKGROUND: Atrial fibrillation with tissue ablation device through bipolar radiofrequency in conjunction with cardiac surgery has proven to be an effective method to treat this arrhythmia. OBJECTIVE: Describe the initial experience of the Instituto Nacional de Cardiologia in the surgical treatment of atrial fibrillation using bipolar radiofrequency device in patients undergoing cardiac surgery, reporting the results of postoperative follow-up of one year. METHODS: Between January 2008 and March 2009, 47 consecutive patients (36 women), with mean age of 53.7 ± 10.6 years, with atrial fibrillation for a mean period of 34.6 months (3-192 months) underwent surgical ablation of this arrhythmia, through bipolar radiofrequency during the procedure which led to the indication of surgery. Eight of them showed intermittent atrial fibrillation and 39, continued. Eighty-one percent underwent valve surgery as the main procedure. This is a one-year postoperative retrospective, observational evaluation of clinical variables and 24-h Holter. RESULTS: Out of the 47 patients, 40 survived one year. Out of these, 33 underwent 24 h Holter, at an average interval of 401 days after the surgery. The following rhythm distribution was found: 24 (73.0%) sinus, five (15.0%) atrial fibrillation, three (9.0%) atrial Flutter and one (3.0%) junctional rhythm. Two cerebrovascular accidents were observed, one of which was associated with supraventricular arrhythmia. CONCLUSION: Surgical ablation of atrial fibrillation with bipolar radiofrequency device concomitant with cardiac surgery is an effective method for treating this arrhythmia.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/instrumentação , Fibrilação Atrial/fisiopatologia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
12.
Rev Bras Cir Cardiovasc ; 25(2): 245-8, 2010.
Artigo em Inglês, Português | MEDLINE | ID: mdl-20802919

RESUMO

INTRODUCTION: The present report describes the technique for "inverted L" upper ministernotomy with central canulation for the treatment of simple congenital cardiopathies and presents the initial results. METHODS: Ten patients (mean age: 7 +/- 4.2 years; mean weight 29.1 +/- 13.5 kg) were operated on between January 2006 and July 2007. RESULTS: All defects were corrected. No death was observed and no complication that required reintervention occurred. CONCLUSION: The described technique showed to be feasible and safe for the correction of certain congenital cardiopathies, with less surgical trauma, besides the aesthetic benefit and an expectation of diminished thoracic deformity in the future.


Assuntos
Cardiopatias Congênitas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Esternotomia/métodos , Veias Cavas/cirurgia , Criança , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Esternotomia/efeitos adversos
13.
Rev. bras. cir. cardiovasc ; 29(1): 107-109, Jan-Mar/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-710085

RESUMO

Internal mammary artery harvesting is an essential part of any coronary artery bypass operation. Totally endoscopic coronary artery bypass graft surgery has become reality in many centers as a safe and effective alternative to conventional surgery in selected patients. Internal mammary artery harvesting is the initial part of the procedure and should be performed equally safely if one wants to achieve excellence in patency rates for the bypass. We here describe the technique for mammary harvesting with the Da Vinci Si robotic system.


Dissecção da artéria mamária interna é parte essencial de qualquer operação de revascularização do miocárdio. Cirurgia de revascularização do miocárdio totalmente endoscópica se tornou realidade em muitos centros como uma alternativa segura e efetiva, comparável à cirurgia convencional, em pa cientes selecionados. Dissecção da artéria mamária interna é a parte inicial do procedimento e deve ser realizada com igual se gurança se quisermos atingir excelentes taxas de patência para a ponte. Descreveremos aqui a técnica de dissecção de artéria mamária interna com o sistema robótico Da Vinci.


Assuntos
Humanos , Artéria Torácica Interna/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Torácica Vídeoassistida/métodos , Coleta de Tecidos e Órgãos/métodos , Ponte de Artéria Coronária/instrumentação , Ponte de Artéria Coronária/métodos , Reprodutibilidade dos Testes , Coleta de Tecidos e Órgãos/instrumentação
14.
Rev. bras. cir. cardiovasc ; 29(4): 654-656, Oct-Dec/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-741738

RESUMO

Current technology in robotic surgery allows us to perform myocardial revascularization procedures in a totally endoscopic fashion. We will describe the technique of choice for left internal mammary artery to left anterior descendent artery anastomosis with the use of cardiopulmonary bypass machine. The method is efficient and there is long term follow-up showing similar patency of the graft when compared to conventional methods (when performed through sternotomy).


A tecnologia atual em cirurgia robótica permite realizar-se procedimento de revascularização do miocárdio de modo totalmente endoscópico. Descreveremos aqui a técnica de escolha para anastomose de artéria mamaria interna esquerda em artéria coronariana descendente anterior com uso de circulação extracorpórea. O método e eficaz e já existe acompanhamento a longo prazo mostrando patência do enxerto semelhante ao método convencional por esternotomia.


Assuntos
Humanos , Ponte Cardiopulmonar/métodos , Anastomose de Artéria Torácica Interna-Coronária/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgia Vídeoassistida/métodos , Anastomose Cirúrgica , Vasos Coronários/cirurgia , Artéria Torácica Interna/cirurgia , Reprodutibilidade dos Testes
15.
Interact Cardiovasc Thorac Surg ; 9(3): 535-6, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19491129

RESUMO

Myxomas are the most common type of cardiac benign tumors and most of them are located in the left atrium, followed by the right atrium. Myxomas in the right atrium may rarely embolize to the pulmonary arterial vasculature. Here, we present a case report of a patient with right atrial myxoma and massive embolism to the pulmonary arteries treated surgically with right atrial mass removal and pulmonary embolectomy. The right atrium mass presented with prolapse through the tricuspid valve causing a stenotic physiology. The left pulmonary artery was completed occluded and the right pulmonary artery was partially obstructed. Surgical tactics included a brief hypothermic circulatory arrest. The patient had an uneventful recovery and was asymptomatic after 6 months of follow-up.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Embolectomia , Neoplasias Cardíacas/cirurgia , Mixoma/cirurgia , Embolia Pulmonar/cirurgia , Adulto , Parada Circulatória Induzida por Hipotermia Profunda , Feminino , Átrios do Coração/cirurgia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Humanos , Mixoma/complicações , Mixoma/diagnóstico por imagem , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
Arq Bras Cardiol ; 93(4): 334-42, 327-35, 2009 Oct.
Artigo em Inglês, Português, Espanhol | MEDLINE | ID: mdl-19936452

RESUMO

BACKGROUND: The prevalence of atrial fibrillation, expenses with the healthcare system and the associated high morbidity and mortality have justified the search for new therapeutic approaches. OBJECTIVE: To evaluate the reproducibility of the surgical technique, its safety and the initial outcome of the video-assisted surgery for the isolated atrial fibrillation ablation with bipolar radiofrequency. METHODS: Ten patients (90% men) with symptomatic atrial fibrillation (50% paroxystic type) that was refractory to drug therapy, with no heart disease that required concomitant surgical treatment, were submitted to arrhythmia ablation guided by thoracoscopy from May 2007 to May 2008. Clinical, laboratory and image variables were prospectively collected before, during surgery and at the postoperative follow-up. RESULTS: The surgery was carried out as planned in all patients. There was no intra-thoracic structure iatrogenic lesion or deaths. At the mean 6-month follow-up, 80% of the patients were free of atrial fibrillation. There was a significant improvement in the symptoms of New York Heart Association Functional Class heart failure (2.4 + or - 0.5 to 1.6 + or - 0.7; p = 0.011). There was no evidence of pulmonary vein stenosis at the angiotomography in this series. CONCLUSION: The video-assisted surgery for the treatment of atrial fibrillation is reproducible and safe. There is a heart failure symptom evolution improvement after the surgery.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Cirurgia Torácica Vídeoassistida , Adulto , Idoso , Ablação por Cateter/efeitos adversos , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
17.
Rev Bras Cir Cardiovasc ; 23(3): 422-4, 2008.
Artigo em Inglês, Português | MEDLINE | ID: mdl-19082335

RESUMO

Cardiac tamponade secondary to the use of central venous catheter is a rare complication; however, it is potentially reversible when it is caught in time. We report two cases of cardiac tamponade that was diagnosed using a transthoracic echocardiography, followed by urgent pericardiocentesis and surgical pericardial drainage as a complication from umbilical venous catheterization. In one case, the tip of the catheter was properly placed, and in the other case, it was not. In both cases, a hyperosmolar solution was being injected. Although it may be an uncommon situation, it should be always considered as a possibility in a newborn who develops cardiogenic shock without an apparent cause.


Assuntos
Tamponamento Cardíaco/etiologia , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Veias Umbilicais , Tamponamento Cardíaco/diagnóstico por imagem , Cateterismo Venoso Central/instrumentação , Análise de Falha de Equipamento , Humanos , Recém-Nascido , Ultrassonografia
18.
Arq Bras Cardiol ; 91(1): 34-41, 2008 Jul.
Artigo em Inglês, Português | MEDLINE | ID: mdl-18660943

RESUMO

BACKGROUND: The extracorporeal membrane oxygenation (ECMO) has been used in the neonatal and childhood periods with excellent results. The adult experience has been modest with inferior immediate results. The intermediate survival, however, has been promising. We have been using the extracorporeal membrane oxygenation for temporary mechanical circulatory support of adults that present with acute refractory cardiogenic shock in our institution. There is no other published experience of the use of this system in this scenario in Brazil. OBJECTIVE: To describe our experience with the use of the extracorporeal membrane oxygenation for circulatory support in adults. METHODS: Retrospective analysis of the medical files of patients submitted to the implant of extracorporeal membrane oxygenation system for circulatory assistance in acute and refractory cardiogenic shock. RESULTS: Eleven patients (63,5 yo; 45,5% male) were considered for analysis from 2005 to 2007. Median support time was 77 hours (10-240 h) and 5 patients have survived 30 days (45,5%). Two patients were subsequently submitted to prolonged paracorporeal circulatory assistance. Mortality on ECMO (6 patients) was due to multiple organ failure (66,6%) and refractory bleeding (33,4%). CONCLUSION: ECMO system is an option to be used in acute refractory cardiogenic shock as a bridge to recovery or selecting patients that might benefit from prolonged paracorporeal assist devices (bridge to bridge).


Assuntos
Oxigenação por Membrana Extracorpórea/normas , Insuficiência Cardíaca/terapia , Coração Auxiliar , Choque Cardiogênico/terapia , Adulto , Brasil/epidemiologia , Reanimação Cardiopulmonar/métodos , Reanimação Cardiopulmonar/normas , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Cardiopatias/cirurgia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos/terapia , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Choque Cardiogênico/mortalidade , Taxa de Sobrevida
19.
Rev Bras Cir Cardiovasc ; 22(3): 285-90, 2007.
Artigo em Inglês, Português | MEDLINE | ID: mdl-18157413

RESUMO

OBJECTIVES: To analyze the feasibility, the safety, and the primary outcomes of a minimally invasive thoracotomy for the occlusion of ligamentum arteriosum (ductus arteriosus) in preterm infants. METHODS: Between October 1991 and June 2003, 273 preterm infants and very low birth weight preterm infants were submitted to a surgical occlusion of the ligamentum arteriosum (ductus arteriosus) through muscle-sparing thoracotomy under general anesthesia in the neonatal ICU. Pre-operative demographic data, mortality outcomes, and adverse events were retrospectively analyzed through medical records consultation. RESULTS: There were no deaths related to surgery, and 234 (86%) patients were discharged from hospital. Thirty-nine deaths have occurred between the 1st and the 51st days. The cause of death was sepsis (14 patients); intracranial bleeding (11 patients); and necrotizing enterocolitis (9 patients). All causes were related to prematurity. In five patients the cause of death was not established or could not be found in the medical records. The most frequent adverse events related to the surgery were: pneumothorax: 3.3% (9 patients), bleeding: 1.4% (4 patients). CONCLUSIONS: The minimally invasive thoracotomy technique for the occlusion of the ligamentum arteriosum (ductus arteriosus) when performed in preterm infants and very low birth weight infants is feasible, safe, efficient, related to low morbidity, and not dependent of hospital resources.


Assuntos
Permeabilidade do Canal Arterial/cirurgia , Toracotomia/normas , Estudos de Viabilidade , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido de muito Baixo Peso , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/normas , Pneumotórax/etiologia , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Toracotomia/efeitos adversos , Resultado do Tratamento
20.
Rev. bras. cir. cardiovasc ; 26(4): 565-572, out.-dez. 2011. ilus, tab
Artigo em Português | LILACS | ID: lil-614748

RESUMO

OBJETIVO: Avaliar a eficácia do tratamento cirúrgico da fibrilação atrial (FA) utilizando ablação com radiofrequência bipolar durante cirurgia cardíaca de procedimentos mitrais de etiologia reumática. MÉTODOS: Foram avaliados, retrospectivamente, os prontuários e exames de 53 pacientes submetidos à cirurgia valvar mitral, com ou sem cirurgia tricúspide ou aórtica associada, em que foi realizada ablação de FA utilizando radiofrequência bipolar. Trinta e quatro (64 por cento) pacientes eram mulheres e a idade variou de 27 a 72 anos (média: 49,3 anos ± 10,7 anos). O tempo médio de FA relatado foi de 41 meses (variou de 3 a 192 meses). O tipo de FA apresentado foi: paroxística em oito pacientes, persistente em três, permanente em 42. O átrio esquerdo apresentava tamanho médio de 52,9 ± 8,5 mm. As cirurgias realizadas foram: 47 trocas de valva mitral e seis plastias mitrais. O seguimento eletrocardiográfico foi completo em 83 por cento dos pacientes, ao final de 14 meses. Informações adicionais oriundas de Holter 24h foram exploradas. RESULTADOS: Ocorreram sete (13 por cento) óbitos per-operatórios e a sobrevida após 14 meses foi de 87 por cento. Os ritmos cardíacos encontrados após um ano de cirurgia foram: sinusal em 25 (66 por cento) pacientes, FA em sete (18 por cento), Flutter em cinco (13 por cento), Juncional em um (3 por cento). CONCLUSÃO: O uso de radiofrequência bipolar para tratamento de FA em pacientes submetidos à cirurgia valvar mitral de origem reumática é efetivo no controle da arritmia em 68 por cento dos pacientes, após 14 meses.


OBJECTIVE: To analyze the effectiveness of surgical treatment of atrial fibrillation (AF) using bipolar radiofrequency ablation during mitral valve procedures of rheumatic etiology in heart surgery. METHODS: We retrospectively reviewed medical registries of 53 patients submitted to atrial ablation with bipolar radiofrequency energy during mitral valve surgery. Thirty four (64 percent) patients were women and the age varied from 27 to 72 years old (average: 49.3 ± 10.7 years). Aortic and/or tricuspid procedures were also present in 36 (68 percent) patients. Average time of reported atrial fibrillation was 41 months (from 3 to 192 months). Type of AF was classified as: paroxysmal in 8 patients, persistent in 3, permanent in 42. Left atrium had an average size of 52.9 ± 8.5 mm. The surgeries in these series were: 47 mitral valve replacements and 6 mitral valve repairs. Eletrocardiografic follow up was 83 percent complete in 14 months. Data from 24h Holter were explored. RESULTS: Seven (13 percent) perioperative deaths were observed and survival after 14 months was 87 percent. Observed heart rhythm after 1 year of surgery was sinus rhythm in 25 (66 percent) patients, AF in 7 (18 percent), flutter in 7 (13 percent), junctional in 1 (3 percent). CONCLUSION: Bipolar radiofrequency ablation in patients submitted to mitral valve surgery of rheumatic etiology is effective in converting to sinus rhythm in 68 percent of patients after 14 months.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fibrilação Atrial/cirurgia , Ablação por Cateter/métodos , Frequência Cardíaca/fisiologia , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Cardiopatia Reumática/cirurgia , Ablação por Cateter/efeitos adversos , Ablação por Cateter/mortalidade , Seguimentos , Estudos Retrospectivos , Resultado do Tratamento
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