RESUMEN
OBJECTIVES: The reported superiority of mitral valve (MV) repair for isolated MV regurgitation has not been confirmed in mitroaortic valve surgery. Our goals were to evaluate the feasibility of repair in patients undergoing mitral and aortic valve surgery and to identify factors predisposing to MV replacement, to compare long-term outcomes (survival and MV reoperation) of repair and replacement and to perform a subgroup analysis in patients with rheumatic MV disease. METHODS: From January 1992 through December 2016, 1122 consecutive patients were submitted to concomitant aortic and MV surgery in 2 different centres (Coimbra and Santiago). Of these, 837 patients underwent MV repair (74.6%) and 285 patients had MV replacement (25.4%). Rheumatic aetiology was predominant (666 patients; 59.4%). Cumulative follow-up was 9522.6 patient-years (25th-75th percentile 2.6-13.2 years) and was complete for 95.6% of patients. Propensity score matching (1:1) was performed in 232 patients for comparing each treatment option (MV repair and MV replacement). RESULTS: Previous MV intervention, rheumatic aetiology, chronic obstructive pulmonary disease, higher degrees of tricuspid and mitral regurgitation and pulmonary hypertension were independently correlated with MV replacement. The 30-day mortality rate was higher in patients with MV replacement (4.2% vs 1.8%, P = 0.021) and was confirmed in the propensity score matching (4.7% vs 1.7%, P = 0.06). Late survival was lower in the MV replacement group (53.3 ± 4.5% vs 61.7 ± 2.0% at 12 years; P = 0.026) and was confirmed in the propensity score matching (54.6 ± 4.9% vs 63.2 ± 3.8%, P = 0.062) and rheumatic subgroup (57.9 ± 4.8% vs 68.0 ± 2.5%, P = 0.018). Freedom from MV reoperation at 12 years was higher in the MV repair group (94.7 ± 1.1% vs 89.0 ± 3.1%, P = 0.004) but similar in patients with rheumatic MV disease. CONCLUSIONS: MV repair can be performed in most patients undergoing aortic valve replacement. It should be the procedure of choice whenever feasible, because it is associated with lower early and late mortality rates and with freedom from reoperation in non-rheumatic patients.
Asunto(s)
Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Válvula Mitral/cirugía , Reoperación , Anciano , Femenino , Estudios de Seguimiento , Enfermedades de las Válvulas Cardíacas/cirugía , Prótesis Valvulares Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas/estadística & datos numéricos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Implantación de Prótesis de Válvulas Cardíacas/estadística & datos numéricos , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Puntaje de Propensión , Falla de Prótesis , Reoperación/efectos adversos , Reoperación/mortalidad , Reoperación/estadística & datos numéricosRESUMEN
Although drug-eluting stents are increasingly used to treat coronary disease, restenosis remains the major limitation of these devices. We report a case of complete metal jacket using 17 stents for triple-vessel coronary disease in a 73-year-old man, for whom surgery would have been the best choice.
Asunto(s)
Enfermedad de la Arteria Coronaria/terapia , Reestenosis Coronaria/terapia , Metales , Intervención Coronaria Percutánea/instrumentación , Stents , Anciano , Angiografía Coronaria , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Reestenosis Coronaria/diagnóstico por imagen , Reestenosis Coronaria/etiología , Stents Liberadores de Fármacos , Resultado Fatal , Humanos , Masculino , Selección de Paciente , Intervención Coronaria Percutánea/efectos adversos , Diseño de Prótesis , Retratamiento , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
The ideal surgical approach is unclear in adult patients with coarctation of the aorta that is associated with other cardiovascular pathologies that require intervention. Standard median sternotomy allows simultaneous, coronary revascularization surgery, valve replacement and repair of aortic coarctation. However the collateral circulation and the anatomy of the mammary arteries must be determined, to avoid possible complications. We report a case of a 69 year-old man with aortic coarctation, aortic stenosis, coronary artery disease and internal mammary artery dilatation who underwent concomitant surgical procedures through a median sternotomy.
Asunto(s)
Coartación Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Enfermedad de la Arteria Coronaria/cirugía , Dilatación Patológica/cirugía , Arterias Mamarias/cirugía , Anciano , Coartación Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/diagnóstico , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Dilatación Patológica/diagnóstico por imagen , Humanos , Masculino , Esternotomía , Tomografía Computarizada por Rayos XRESUMEN
Absorbable topical hemostatic agents are commonly used in cardiac surgery. In this study, we report an unusual case of an acute ischemic event after coronary revascularization produced by interaction between oxidized cellulose and epsilon aminocaproic acid (EACA). An in vitro study was also performed to test the interaction between oxidized cellulose and EACA.
Asunto(s)
Celulosa Oxidada/efectos adversos , Enfermedad de la Arteria Coronaria/cirugía , Oclusión de Injerto Vascular/etiología , Hemostáticos/efectos adversos , Isquemia Miocárdica/etiología , Administración Tópica , Anciano , Celulosa Oxidada/administración & dosificación , Puente de Arteria Coronaria , Hemostáticos/administración & dosificación , Humanos , MasculinoRESUMEN
This report describes a 41-year-old man who had atypical angina resulting from coronary steal by left atrial myxoma. The tumor was completely excised and the patient was symptoms free after operation.