RESUMEN
Background: Aortic valve stenosis (AVS) affects 25% of the population over 65 years. At present, there is no curative medical treatment for AVS and therefore the surgical approach, consisting of transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR), is the treatment of choice. Methodology: The aim of this study was to analyze the sociodemographic and clinical characteristics, quality of life and functionality of a sample of patients with AVS over 75 years of age, who underwent TAVR or SAVR, applying standard clinical practice. A prospective multicenter observational study was conducted in two hospitals of the Spanish National Health System. Data were collected at baseline, 1, 6 months and 1 year. Results: In total, 227 participants were included, with a mean age of 80.6 [SD 4.1]. Statistically significant differences were found in terms of quality of life, which was higher at 1 year in patients who underwent SAVR. In terms of functionality, SAVR patients obtained a better score (p < 0.01). However, patients who underwent TAVR began with a worse baseline situation and managed to increase their quality of life and functionality after 1 year of follow-up. Conclusion: The individualized choice of TAVR or SAVR in patients with AVS improves patients' quality of life and function. Moreover, the TAVR procedure in patients with a worse baseline situation and a high surgical risk achieved a similar increase in quality of life and functionality compared to patients undergoing SAVR with a better baseline situation.
Asunto(s)
Estenosis de la Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Anciano de 80 o más Años , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Calidad de Vida , Implantación de Prótesis de Válvulas Cardíacas/métodos , Estudios Prospectivos , Resultado del Tratamiento , Estenosis de la Válvula Aórtica/epidemiologíaAsunto(s)
Válvula Aórtica/microbiología , Bioprótesis/microbiología , Candidiasis/microbiología , Endocarditis/microbiología , Prótesis Valvulares Cardíacas/microbiología , Válvula Mitral/microbiología , Anciano , Válvula Aórtica/diagnóstico por imagen , Candida albicans/aislamiento & purificación , Candidiasis/diagnóstico por imagen , Remoción de Dispositivos , Endocarditis/diagnóstico por imagen , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Válvula Mitral/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/microbiología , ReoperaciónAsunto(s)
Aneurisma de la Aorta/complicaciones , Disnea/etiología , Anciano , Aneurisma de la Aorta/diagnóstico por imagen , Aneurisma de la Aorta/cirugía , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/cirugía , Aortografía , Angiografía por Tomografía Computarizada , Femenino , HumanosRESUMEN
Leaflet escape in contemporary mechanical valves is an extremely rare and potentially lethal condition. We report the case of a 77-year-old man who presented with embolization of a leaflet from an On-X mitral valve (CryoLife, Kennesaw, GA) with Conform-X Sewing Ring prosthesis (CryoLife) after exercise. The patient recovered completely 6 months after surgery, and he is currently asymptomatic.
Asunto(s)
Prótesis Valvulares Cardíacas , Válvula Mitral/cirugía , Falla de Prótesis , Anciano , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Diseño de Prótesis , Inducción de Remisión , RetratamientoRESUMEN
A patient with advanced rheumatic heart valve disease underwent aortic and mitral valve replacement with tricuspid ring annuloplasty. There was an anomalous left circumflex coronary artery (LCCA) arising from the right coronary artery (RCA) running along the anterior surface of an enlarged right ventricle (RV). During the immediate postoperative course, signs of inferior and lateral myocardial ischemia developed. An emergent coronary angiography revealed LCCA entrapment. An additional suture placed in the RV outflow tract used to optimize exposition of the aortic root during the aortotomy was determined to be the origin of the coronary entrapment. No similar case of LCCA occlusion has previously been reported. This is a description of successful management of this complication.
Asunto(s)
Oclusión Coronaria/diagnóstico , Anomalías de los Vasos Coronarios/diagnóstico , Cardiopatía Reumática/cirugía , Válvula Tricúspide , Anciano , Oclusión Coronaria/diagnóstico por imagen , Oclusión Coronaria/cirugía , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , StentsAsunto(s)
Aorta/cirugía , Enfermedades de la Aorta/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas , Estenosis de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Calcificación Vascular/cirugía , Aorta/diagnóstico por imagen , Aorta/fisiopatología , Enfermedades de la Aorta/diagnóstico por imagen , Enfermedades de la Aorta/fisiopatología , Humanos , Masculino , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Estenosis de la Válvula Mitral/diagnóstico por imagen , Estenosis de la Válvula Mitral/fisiopatología , Diseño de Prótesis , Resultado del Tratamiento , Calcificación Vascular/diagnóstico por imagen , Calcificación Vascular/fisiopatologíaRESUMEN
A 52-year-old male patient, who underwent mitral replacement with a mechanical prosthesis as a child, sustained a cardiac arrest which was successfully resuscitated. Further investigation showed prosthesis malfunction with significant regurgitation in the context of multi-organ failure. In such a life-threatening condition, veno-arterial extracorporeal membrane oxygenation was considered as a rescue procedure to achieve optimisation of clinical status to allow definitive surgical treatment. An unusual complete fracture of the prosthesis was subsequently identified as the cause of acute dysfunction.
Asunto(s)
Trastorno del Sistema de Conducción Cardíaco/etiología , Trombosis Coronaria/etiología , Complicaciones Posoperatorias/diagnóstico , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/cirugía , Trastorno del Sistema de Conducción Cardíaco/diagnóstico , Trastorno del Sistema de Conducción Cardíaco/patología , Trombosis Coronaria/diagnóstico , Trombosis Coronaria/patología , Femenino , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Complicaciones Posoperatorias/patologíaRESUMEN
Postoperative bleeding with its important socioeconomic cost is associated with an increased morbidity and mortality. It causes hemodynamic instability, increases blood loss, and multiplies the number of transfusions required. Especially in vascular or aortic surgery, postoperative bleeding can become a life-threatening complication due to anticoagulant or antiaggregation preoperative status or postoperative coagulation dysfunction after a high level of heparinization. Presently described is the case of a patient who underwent an aortic valve and ascending aorta replacement. A simple but effective method to achieve hemostasis, designed particularly for aortic surgery and the use of Dacron grafts, is presented. No residual adherence or contraindications exist, and it can potentially be applied to any kind of surgical process. This method offers a cheap, biocompatible, and highly effective means to achieve complete hemostasis without the use of extra sutures, or expensive synthetic or allogeneic hemostatic agents or sealants.