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1.
Ann Vasc Surg ; 77: 351.e1-351.e6, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34437961

RESUMEN

Immunoglobulin G4 (IgG4)-related disease, characterized by high serum IgG4 concentrations and IgG4-positive plasma cell infiltration, often presents as an inflammatory aneurysm. We herein report the case of a 78 year-old man, presenting with elevated inflammatory markers and IgG4 concentrations, who was diagnosed with IgG4-related inflammatory abdominal aortic aneurysm with dense perianeurysmal fibrosis. Before the surgical intervention, steroid therapy was administered to resolve his perianeurysmal inflammatory fibrosis. Half a year after the initiation of steroid therapy, there was an improvement in serum inflammatory markers and IgG4 concentrations, and the perianeurysmal fibrosis had regressed. Thus, we performed a surgical intervention including resection of the aneurysm and interposition with a prosthetic graft. Histopathological examination demonstrated few IgG4-positive plasma cells were distributed in the adventitia, which was suspected to be associated with the preoperative steroid therapy. This case study suggests preoperative steroid therapy is a useful therapeutic strategy for IgG4-related abdominal aortic aneurysm because it allows the use of open surgical procedures with reduced surgical risk.


Asunto(s)
Aneurisma de la Aorta Abdominal/cirugía , Implantación de Prótesis Vascular , Glucocorticoides/uso terapéutico , Enfermedad Relacionada con Inmunoglobulina G4/tratamiento farmacológico , Prednisolona/uso terapéutico , Fibrosis Retroperitoneal/tratamiento farmacológico , Anciano , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/inmunología , Humanos , Enfermedad Relacionada con Inmunoglobulina G4/diagnóstico por imagen , Enfermedad Relacionada con Inmunoglobulina G4/inmunología , Masculino , Fibrosis Retroperitoneal/diagnóstico por imagen , Fibrosis Retroperitoneal/inmunología , Resultado del Tratamiento
3.
Ann Vasc Surg ; 66: 666.e11-666.e14, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31904518

RESUMEN

Profunda femoris artery aneurysm is a rare vascular disorder, which is often diagnosed incidentally on identification of synchronous aneurysms. Herein, we report the case of a 63-year-old man, presenting with a hepatic cyst, who had left profunda femoris artery and left internal iliac artery aneurysms. We performed surgical intervention, including resection of the aneurysm and reconstruction of the profunda femoris artery using a prosthetic graft. The postoperative course was uneventful, and computed tomography revealed good graft patency. We believe surgical reconstruction of the profunda femoris artery should be completed except in complicated cases, such as rupture or aneurysm in the distal segment of the profunda femoris artery.


Asunto(s)
Aneurisma/cirugía , Implantación de Prótesis Vascular , Arteria Femoral/cirugía , Hallazgos Incidentales , Aneurisma/diagnóstico por imagen , Aneurisma/fisiopatología , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Grado de Desobstrucción Vascular
4.
Vasa ; 49(3): 243-246, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-31549930

RESUMEN

Intimal sarcoma of arteries is a rare malignant tumor, which often mimics other vascular disorders; therefore, preoperative diagnosis is often challenging. We herein report a 71-year-old man who presented with fever and elevated inflammatory markers who had a mass in the left internal iliac artery with rapid growth. Based on clinical findings, a diagnosis of mycotic aneurysm was made. We performed surgical intervention, including resection of the affected vessels with omentopexy, although intraoperative findings were not typical of a mycotic aneurysm. Microscopic and immunohistochemical examination demonstrated undifferentiated intimal sarcoma. The patient died of multiorgan failure two months after the surgery. The vascular surgeon should consider the possibility of a diagnosis of intimal sarcoma for patients with atypical findings and the importance of histological and immunohistochemical examination for precise diagnosis in surgical vascular cases.


Asunto(s)
Aneurisma Infectado , Sarcoma , Neoplasias Vasculares , Anciano , Aorta Abdominal , Humanos , Arteria Ilíaca , Masculino
5.
Ann Vasc Dis ; 13(4): 418-421, 2020 Dec 25.
Artículo en Inglés | MEDLINE | ID: mdl-33391561

RESUMEN

Although rare, superior mesenteric artery aneurysms (SMAAs) are life-threatening due to their high rupture rate. We herein report a case involving an 80-year-old man who presented with acute cholecystitis and who was incidentally found to have a 36-mm peripheral SMAA. A surgical intervention was performed, involving resection of the SMAA and reconstruction of the superior mesenteric artery (SMA) using an autologous vein graft. Intraoperative and histological findings indicated an inflammatory aneurysm, and the postoperative course was uneventful. We believe that resection of the aneurysm and reconstruction of the SMA is the preferred procedure for SMAAs to maintain adequate mesenteric circulations.

6.
Ann Thorac Cardiovasc Surg ; 25(1): 32-38, 2019 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-30122739

RESUMEN

OBJECTIVE: The aim of this retrospective study was to investigate the early operative results and detect the factors influencing the fate of radial artery grafts (RAGs) by evaluating the mid-term patency. METHODS: We retrospectively reviewed 410 patients who underwent isolated coronary artery bypass grafting using RAG. RAGs were anastomosed to 526 coronary arteries. Mid-term angiography was performed in 214 patients at an average 4.9 years after the operation. RESULTS: The early patency of RAGs was 97.6%. Cumulative 5-year patency was 86.5% for RAG, 94.1% for LITA graft, and 81.0% for saphenous vein graft (SVG). RAG was significantly superior to SVG in mid-term patency. Individual grafting (not sequential grafting) (hazard ratio [HR]: 2.535; 95% confidence interval [CI]: 1.293-5.281; p = 0.006) and grafting to the target coronary artery with ≤75% proximal stenosis (HR: 1.947; 95% CI: 1.090-3.484; p = 0.025) were found to be independent risk factors influencing late RAG patency. CONCLUSIONS: The patency of RAGs was superior to that of SVGs in the studied population. When using RAGs, grafting to the target vessel with severe proximal stenosis is favorable. The RAG is suitable for sequential grafting.


Asunto(s)
Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Estenosis Coronaria/cirugía , Oclusión de Injerto Vascular/etiología , Arteria Radial/trasplante , Anciano , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Estenosis Coronaria/diagnóstico por imagen , Estenosis Coronaria/fisiopatología , Femenino , Oclusión de Injerto Vascular/diagnóstico por imagen , Oclusión de Injerto Vascular/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada Multidetector , Arteria Radial/diagnóstico por imagen , Arteria Radial/fisiopatología , Estudios Retrospectivos , Factores de Riesgo , Vena Safena/diagnóstico por imagen , Vena Safena/fisiopatología , Vena Safena/trasplante , Índice de Severidad de la Enfermedad , Factores de Tiempo , Insuficiencia del Tratamiento , Grado de Desobstrucción Vascular
7.
Osaka City Med J ; 62(2): 111-119, 2016 12.
Artículo en Inglés | MEDLINE | ID: mdl-30721586

RESUMEN

Background: Tolvaptan is an orally administered selective vasopressin 2 receptor antagonist that promotes aquaresis. This study aimed to evaluate the efficacy and safety of tolvaptan on management of systemic fluid balance after cardiovascular surgery using cardiopulmonary bypass. . Methods: Sixty-four patients who underwent cardiovascular surgery using cardiopulmonary bypass in our hospital were enrolled for this prospective, randomized study. These patients were divided into three groups: tolvaptan 15 mg+furosemide 20 mg (TH group), tolvaptan 7.5 mg+furosemide 20 mg (TI group), and furosemide 40 mg+spironolactone 50 mg (C group). The endpoint was safety management of systemic fluid balance using tolvaptan without renal dysfunction and electrolyte imbalance. Results: The mean daily urine output in the TH and TL groups (2656±767 and 2505 ±684 mL) was significantly higher than that in the C group (1956±494 mL, TH vs C: p<0.01 and TL vs C: p=0.03). The lowest serum sodium level during medication in the TH group (139.3 ±2.3 mEq/L) was significantly higher than that in the C group (137.1±2.9 mEq/L, p=0.03) The lowest serum osmolality during medication in the TH group was significantly higher than that in the C group (284.8 ±4.3 vs 279.5± 6.3 mOsm/kg, p<0.01). None had critical hypernatremia, hyperosm6lality, or renal dysfunction in any. of the groups. Conclusions: Tolvaptan exerts, a strong diuretic effect compared with conventional diuretics (furosemide and spironolactone) during the postoperative period after an operation using cardiopulmonary bypass without adverse effects on electrolyte balance and renal function.


Asunto(s)
Puente Cardiopulmonar , Procedimientos Quirúrgicos Cardiovasculares , Furosemida , Complicaciones Posoperatorias , Espironolactona , Tolvaptán , Desequilibrio Hidroelectrolítico/prevención & control , Anciano , Antagonistas de los Receptores de Hormonas Antidiuréticas/administración & dosificación , Antagonistas de los Receptores de Hormonas Antidiuréticas/efectos adversos , Puente Cardiopulmonar/efectos adversos , Puente Cardiopulmonar/métodos , Procedimientos Quirúrgicos Cardiovasculares/efectos adversos , Procedimientos Quirúrgicos Cardiovasculares/métodos , Diuréticos/administración & dosificación , Diuréticos/efectos adversos , Monitoreo de Drogas/métodos , Quimioterapia Combinada/métodos , Femenino , Furosemida/administración & dosificación , Furosemida/efectos adversos , Humanos , Pruebas de Función Renal/métodos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/prevención & control , Espironolactona/administración & dosificación , Espironolactona/efectos adversos , Tolvaptán/administración & dosificación , Tolvaptán/efectos adversos , Resultado del Tratamiento , Equilibrio Hidroelectrolítico/efectos de los fármacos
8.
Kyobu Geka ; 68(2): 125-8, 2015 Feb.
Artículo en Japonés | MEDLINE | ID: mdl-25743356

RESUMEN

A 67-year-old man was admitted to our hospital by ambulance after syncope due to complete A-V block. He had received surgical treatment for mycotic aneurysm of the right coronary artery 3 months before, with patch plasty of the right sinus of Valsalva and bypass grafting to the right coronary artery (RCA) as well as the left anterior descending branch. Computed tomography revealed pseudoaneurysm of the right Valsalva sinus of about 8 cm in diameter and a shunt flow to the right atrium. The previous bypass graft to RCA had been occluded due to compression by the aneurysm. As he was in a shock state, emergency operation was performed. Cardiopulmonary bypass was first established, and after the rectal temperature reached to 26 degrees centigrade, the chest was opened. The pseudoaneurysm burst out when the sternum was re-opened. Under circulatory arrest, the ascending aorta was clamped, and then the circulation was resumed. The previous bovine pericardium patch repairing the Valsalva sinus was detached due to infection, and mural thrombus and pus were observed in the aneurysm. At the bottom of the aneurysm, a fistula connected to the right atrium was found. Debridement around the aneurysm was performed as much as possible. The defect of the Valsalva sinus was repaired with a Dacron patch immersed in gentian violet. The postoperative course was uneventful without any recurrence of infection.


Asunto(s)
Aneurisma Roto/cirugía , Aneurisma Coronario/cirugía , Enfermedad de la Arteria Coronaria/cirugía , Atrios Cardíacos/cirugía , Seno Aórtico/cirugía , Anciano , Humanos , Imagenología Tridimensional , Masculino , Tomografía Computarizada por Rayos X
9.
Ann Vasc Dis ; 7(2): 165-8, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24995064

RESUMEN

Blunt traumatic injury to the innominate artery is relatively rare. We present the case of a 40-year-old woman who fell from a fourth-floor window and was transferred to our hospital with multiple injuries, hemodynamic shock, and disturbance of consciousness. Computed tomography with image reconstruction revealed transection of the innominate artery near its origin. Emergent surgery required establishment of cardiopulmonary bypass before sternotomy in preparation for uncontrollable hemorrhage. Proximal aortic arch replacement with a branch to the right axillary artery was successfully performed using circulatory arrest and selective cerebral perfusion.

12.
Ann Thorac Cardiovasc Surg ; 20(1): 48-54, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-23411851

RESUMEN

PURPOSE: This study aimed to determine if preoperative time course changes in serum C-reactive protein (CRP) levels can predict clinical outcome of surgical intervention for active infective endocarditis. METHODS: Surgically treated patients (n = 109) with active infective endocarditis were reviewed retrospectively. We divided the patients into 2 subgroups according to preoperative transition of increasing or decreasing serum CRP levels, and performed a comparative study. The increasing CRP group included 29 patients and the decreasing CRP group included 80 patients. RESULTS: There were more patients with methicillin-resistant Staphylococcus aureus and New York Heart Association functional class IV in the increasing CRP group. Hospital mortality was significantly higher in the increasing CRP group (34.5%) than that in the decreasing CRP group (5.0%) (p <0.05). In multivariate analysis, 3 significant risk factors of surgical outcome were identified: a tendency for increasing preoperative CRP levels (odds ratio [OR]: 18.15, 95% confidence interval [CI]: 1.03-320.78), nosocomial infective endocarditis (OR: 18.73, 95% CI: 1.57-223.60), and dialysis (OR: 1025.46, 95% CI: 2.89-363587.12). CONCLUSION: The outcome of operations for patients with increasing preoperative CRP levels is poor. For treatment of active infective endocarditis, a better operative result is expected when preoperative CRP levels are decreasing.


Asunto(s)
Proteína C-Reactiva/metabolismo , Procedimientos Quirúrgicos Cardíacos , Infección Hospitalaria/cirugía , Endocarditis Bacteriana/sangre , Endocarditis Bacteriana/cirugía , Adulto , Anciano , Antibacterianos/uso terapéutico , Biomarcadores/sangre , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/mortalidad , Infección Hospitalaria/sangre , Infección Hospitalaria/diagnóstico , Infección Hospitalaria/microbiología , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/mortalidad , Femenino , Mortalidad Hospitalaria , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Regulación hacia Arriba
13.
Ann Thorac Cardiovasc Surg ; 20 Suppl: 790-3, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-23518625

RESUMEN

A 76-year-old woman with malignant rheumatic arthritis developed dysphagia and hoarseness secondary to an aberrant right subclavian artery aneurysm. We performed a hybrid endovascular repair with concomitant surgical treatment for the aberrant right subclavian artery aneurysm. One month after discharge, she was emergently admitted to our hospital because of chest pain and fever. We diagnosed aortoesophageal fistula and stent graft infection based on computed tomography, gallium scintigraphy, and esophagoscopy results. Esophagectomy, elimination of the infected stent graft, and muscle plombage were performed during several surgeries. However, she died of hemorrhagic shock secondary to an aortobronchial fistula.


Asunto(s)
Aneurisma/cirugía , Enfermedades de la Aorta/etiología , Implantación de Prótesis Vascular/efectos adversos , Anomalías Cardiovasculares/cirugía , Trastornos de Deglución/cirugía , Procedimientos Endovasculares/efectos adversos , Fístula Esofágica/etiología , Arteria Subclavia/anomalías , Fístula Vascular/etiología , Anciano , Enfermedades de la Aorta/diagnóstico , Enfermedades de la Aorta/cirugía , Fístula Esofágica/diagnóstico , Fístula Esofágica/cirugía , Resultado Fatal , Femenino , Humanos , Stents/efectos adversos , Arteria Subclavia/cirugía , Fístula Vascular/diagnóstico , Fístula Vascular/cirugía
14.
Interact Cardiovasc Thorac Surg ; 17(6): 944-9, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-23959772

RESUMEN

OBJECTIVES: In coronary artery bypass grafting (CABG), graft flow distal to a mild stenosis can compete with relatively preserved native flow through the stenosis and the competition can result in graft stenosis. In chronic total occlusion (CTO), coronary collateral circulation, which is essential to maintain myocardial viability distal to CTO, varies in extent among patients and the extent can be scored by Rentrop grade in coronary angiography. We investigated whether rich collateral circulation distal to CTO competes with distally anastomosed graft flow in association with Rentrop grade. METHODS: Of 666 patients who underwent CABG from January 2001 to December 2012, 70 patients whose left internal thoracic artery (ITA) was grafted distal to CTO in the left anterior descending artery (LAD) were divided into three groups: Poor collaterals (Rentrop grades 0 and 1, Group P, n = 22), Moderate collaterals (grade 2, Group M, n = 23) and Rich collaterals (grade 3, Group R, n = 25). The intraoperative measurements of mean graft flow (MGF) and pulsatility index (PI) of left ITA grafts, early graft patency and long-term clinical outcomes were compared. RESULTS: The MGF and PI of left ITA grafts differed significantly among the three groups (P = 0.025 and P = 0.046, respectively). Lower Rentrop grade was associated with preferable results of higher MGF and lower PI. The graft flow pattern in Group P showed a significantly higher MGF (P = 0.020) and lower PI (P = 0.041) than those in Group R. All early postoperative coronary angiograms showed patent left ITA grafts. Serial echocardiographic evaluations, survival rates and cardiac event-free rates were comparable with the follow-up of 5.00 ± 3.11 years. CONCLUSIONS: Rich collateral circulation distal to CTO in LADs can potentially compete with graft flow, although the competition seems not to affect clinical outcomes probably due to the regression of collaterals surmounted by the graft flow. Rentrop grade is shown to certainly reflect the degree of collateral haemodynamic circulation distal to CTO and especially important to evaluate intraoperative graft flow appropriately, considering the possible phenomenon of graft flow competition.


Asunto(s)
Circulación Colateral , Puente de Arteria Coronaria , Circulación Coronaria , Oclusión Coronaria/cirugía , Vasos Coronarios/cirugía , Anciano , Velocidad del Flujo Sanguíneo , Angiografía Coronaria , Puente de Arteria Coronaria/efectos adversos , Oclusión Coronaria/diagnóstico , Oclusión Coronaria/fisiopatología , Vasos Coronarios/diagnóstico por imagen , Vasos Coronarios/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis de la Onda del Pulso , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Grado de Desobstrucción Vascular
15.
Interact Cardiovasc Thorac Surg ; 17(3): 507-14, 2013 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-23728087

RESUMEN

OBJECTIVES: Guidelines recommend the avoidance of direct return of pericardial blood based on evidence from coronary surgery. A continuous auto-transfusion system (CATS) can be a good alternative to cardiotomy suction by reinfusing aspirated pericardial blood without the necessity of intermittent collection. To clarify the effects of direct return of pericardial blood in aortic valve replacement (AVR), we compared the effects of cardiotomy suction and an alternative CATS on perioperative coagulofibrinolysis and inflammation systems, and clinical outcomes. METHODS: In 40 AVR operations between April 2009 and April 2011, the retransfusion method of pericardial blood during cardiopulmonary bypass (CPB) was allocated to the use of cardiotomy suction (non-Cell-Saver group, n = 20) or CATS (Cell-Saver group, n = 20) under identical protocols of anticoagulation and transfusion. The blood from the left ventricular vent was returned to the venous reservoir. We obtained blood samples at nine points up to the morning after surgery. RESULTS: Perioperative values for coagulofibrinolysis markers, such as thrombin-antithrombin III complex, fibrinogen degeneration products, D-dimer and plasmin-α2 plasmin inhibitor complex, were significantly lower in the Cell-Saver group than those in the non-Cell-Saver group from 1 h after the initiation of cardiopulmonary bypass to 3 or 6 h after termination of cardiopulmonary bypass (P < 0.05 for all markers). A fibrinolysis inhibition marker of plasminogen activator inhibitor-1 and the inflammation markers of interleukin-6, 8 and 10 as well as tumour necrosis factor-α were not significantly different. The amount of packed red blood cells required after the termination of CPB was significantly less in the Cell-Saver group compared with that in the non-Cell-Saver group (P = 0.004). There were no significant differences in the other clinical outcomes between the two groups. CONCLUSIONS: In AVR, the avoidance of direct return of pericardial blood induced considerable suppressions of coagulofibrinolysis responses. A CATS is a favourable alternative for managing pericardial blood during cardiopulmonary bypass. Our results support the published guidelines and could help to establish ideal strategies for eliminating the use of cardiotomy suction, thus facilitating less-invasive valve surgeries with marked suppression of coagulofibrinolysis responses.


Asunto(s)
Coagulación Sanguínea , Transfusión de Sangre Autóloga , Fibrinólisis , Implantación de Prótesis de Válvulas Cardíacas/métodos , Inflamación/prevención & control , Recuperación de Sangre Operatoria/métodos , Anciano , Anciano de 80 o más Años , Anticoagulantes/administración & dosificación , Biomarcadores/sangre , Coagulación Sanguínea/efectos de los fármacos , Puente Cardiopulmonar , Distribución de Chi-Cuadrado , Transfusión de Eritrocitos , Femenino , Fibrinólisis/efectos de los fármacos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Inflamación/sangre , Inflamación/etiología , Mediadores de Inflamación/sangre , Masculino , Recuperación de Sangre Operatoria/efectos adversos , Estudios Prospectivos , Succión , Factores de Tiempo , Resultado del Tratamiento
16.
Kyobu Geka ; 66(5): 371-3, 2013 May.
Artículo en Japonés | MEDLINE | ID: mdl-23674033

RESUMEN

We describe a case of coronary-subclavian steal syndrome in a 77-year-old man who presented with progressive coronary ischemia 8 years after coronary artery bypass grafting with an in-situ left internal thoracic artery graft. Coronary and left subclavian artery angiogram revealed completely patent internal thoracic artery graft and 90% stenosis in the proximal left subclavian artery. We performed axilloaxillary artery bypass using expanded polytetrafluoroethylene (ePTFE)[8 mm] graft. No coronary ischemia was noted postoperatively. Axillo-axillary artery bypass grafting was effective for coronary subclavian steal syndrome.


Asunto(s)
Arteria Axilar/cirugía , Síndrome de Robo Coronario-Subclavio/cirugía , Anciano , Prótesis Vascular , Puente de Arteria Coronaria , Humanos , Masculino , Complicaciones Posoperatorias
17.
Gen Thorac Cardiovasc Surg ; 61(11): 626-31, 2013 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23494627

RESUMEN

OBJECTIVE: This retrospective study aimed to determine the effect of simultaneous aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) on operative outcomes and long-term survival in elderly patients with a high prevalence of comorbidity. METHODS: One hundred and fifty-seven elderly patients (70 years old or older) undergoing isolated AVR (n = 120) or combined AVR/CABG (n = 37) were evaluated. Operative outcomes were compared between the two surgical groups. Long-term survival was also compared between the groups using the Kaplan-Meier method and long-rank (Mantel-Cox) test. RESULTS: Operative mortality was 0.8 % for the isolated AVR group and 5.4 % for the combined AVR/CABG group (p = 0.076). The length of the intensive care unit stay for the combined AVR/CABG group was significantly longer than that for the isolated AVR group (median: 40 vs. 21 h, p = 0.008). However, the occurrence rate of hospital complications, such as reoperation for bleeding, deep sternal infection, supra-ventricular arrhythmia, and neurological complications, was similar between the two groups. Actuarial survival at 3 and 5 years was 82.3 and 80.9 % for the isolated AVR group, and 88.3 and 73.0 % for the combined AVR/CABG group, respectively (p = 0.637). CONCLUSIONS: The satisfactory operative and long-term results in our study support a more aggressive simultaneous coronary revascularization combined with AVR for aortic valve stenosis in elderly patients.


Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Puente de Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/cirugía , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Anciano , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/complicaciones , Estenosis de la Válvula Aórtica/mortalidad , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/mortalidad , Femenino , Humanos , Masculino , Estudios Retrospectivos , Análisis de Supervivencia
18.
Ann Thorac Cardiovasc Surg ; 19(5): 368-74, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23237930

RESUMEN

PURPOSE: Few recent studies have examined the long-term outcomes after aortic valve replacement (AVR), and independent predictors for long-term survival and valve-related mortality have not been elucidated. METHODS: From January 1993 to December 2009, 132 elderly patients (≥70 years old) with aortic stenosis underwent AVR in our hospital. The patients comprised 61 men and71 women with a mean age of 76.1 ± 3.7 years. Patients with acute or old myocardial infarction, mitral valve disease, and re-do surgery were not included in this study. Risk factors for late valve-related mortality were examined. RESULTS: The 5-year freedom from valve-related mortality rate was 89.6%. The following significant independent risk factors for late valve-related mortality were identified:increase in the preoperative left ventricular mass index (hazard ratio, 1.10 [per 10 g/m(2)];p = 0.040); lack of sinus rhythm (hazard ratio, 7.11; p = 0.005); peak transvalvular pressure gradient of <60 mmHg (hazard ratio, 7.48; p = 0.008). CONCLUSION: In the elderly, AVR should be performed at an early stage of aortic stenosis, before an increase in the left ventricular mass index has occured, and while the heart rhythm is in sinus rhythm and the peak transvalvular pressure gradient is high.


Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Factores de Edad , Anciano , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/fisiopatología , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Mortalidad Hospitalaria , Humanos , Estimación de Kaplan-Meier , Masculino , Análisis Multivariante , Oportunidad Relativa , Selección de Paciente , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
19.
Int Heart J ; 53(6): 359-63, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-23258136

RESUMEN

The goal of this prospective study was to examine the effects of landiolol hydrochloride on prevention of atrial fibrillation and on hemodynamics in the acute postoperative phase after heart valve surgery. The subjects were 60 patients who underwent valve surgery at our hospital from April 2008 to July 2010. The patients were randomly divided into two groups: the landiolol group (30 patients) and the control (no landiolol) group (30 patients). In the landiolol group, continuous intravenous landiolol was initiated immediately on admission to the intensive care unit at a dose of 10 µg/kg/ minute. Occurrence of atrial fibrillation was compared between the groups over an observation period of 72 hours after surgery. Atrial fibrillation occurred in 6 patients (20%) in the landiolol group and 16 (53.3%) in the control group during the observation period. Landiolol hydrochloride significantly reduced the occurrence of atrial fibrillation in the acute postoperative phase after heart valve surgery. Heart rate was significantly decreased by landiolol, but aggravation of hemodynamics was not observed. These results suggest that landiolol is a useful drug for prevention of atrial fibrillation after valve surgery.


Asunto(s)
Fibrilación Atrial/prevención & control , Frecuencia Cardíaca/efectos de los fármacos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Morfolinas/uso terapéutico , Urea/análogos & derivados , Anciano , Antiarrítmicos/uso terapéutico , Fibrilación Atrial/etiología , Fibrilación Atrial/fisiopatología , Relación Dosis-Respuesta a Droga , Femenino , Estudios de Seguimiento , Humanos , Infusiones Intravenosas , Masculino , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Resultado del Tratamiento , Urea/uso terapéutico
20.
Gen Thorac Cardiovasc Surg ; 60(6): 386-90, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22566247

RESUMEN

Three patients with poor left ventricular function (left ventricular ejection fraction <30 %) developed postoperative atrial tachyarrhythmia in intensive care. Case 1 was a 64-year-old man who underwent a modified Bentall procedure and mitral valve annuloplasty. Case 2 was a 63-year-old woman who underwent quintuple coronary artery bypass grafting. Case 3 was a 65-year-old man who underwent mitral valve replacement. Preoperative intra-aortic balloon pumping was required in Cases 2 and 3. Excellent heart rate control with no hemodynamic deterioration was achieved in all three cases by very-low-dose continuous drip infusion of landiolol hydrochloride (2-5 µg/kg/min). Very-low-dose continuous drip infusion of landiolol hydrochloride is a safe and useful alternative for the control of perioperative atrial tachyarrhythmias in patients with poor left ventricular function.


Asunto(s)
Antiarrítmicos/administración & dosificación , Puente de Arteria Coronaria/efectos adversos , Cardiopatías/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Anuloplastia de la Válvula Mitral/efectos adversos , Morfolinas/administración & dosificación , Volumen Sistólico , Taquicardia Supraventricular/tratamiento farmacológico , Urea/análogos & derivados , Función Ventricular Izquierda , Anciano , Femenino , Cardiopatías/fisiopatología , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Infusiones Intravenosas , Contrapulsador Intraaórtico , Masculino , Persona de Mediana Edad , Taquicardia Supraventricular/etiología , Taquicardia Supraventricular/fisiopatología , Resultado del Tratamiento , Urea/administración & dosificación
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