RESUMO
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.
Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Substituição da Valva Aórtica Transcateter , Humanos , Idoso de 80 Anos ou mais , Substituição da Valva Aórtica Transcateter/métodos , Qualidade de Vida , Implante de Prótese de Valva Cardíaca/métodos , Estudos Prospectivos , Resultado do Tratamento , Estenose da Valva Aórtica/epidemiologiaAssuntos
Valva Aórtica/microbiologia , Bioprótese/microbiologia , Candidíase/microbiologia , Endocardite/microbiologia , Próteses Valvulares Cardíacas/microbiologia , Valva Mitral/microbiologia , Idoso , Valva Aórtica/diagnóstico por imagem , Candida albicans/isolamento & purificação , Candidíase/diagnóstico por imagem , Remoção de Dispositivo , Endocardite/diagnóstico por imagem , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Valva Mitral/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/microbiologia , ReoperaçãoAssuntos
Aneurisma Aórtico/complicações , Dispneia/etiologia , Idoso , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/cirurgia , Aortografia , Angiografia por Tomografia Computadorizada , Feminino , HumanosRESUMO
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.
Assuntos
Próteses Valvulares Cardíacas , Valva Mitral/cirurgia , Falha de Prótese , Idoso , Implante de Prótese de Valva Cardíaca , Humanos , Masculino , Desenho de Prótese , Indução de Remissão , RetratamentoRESUMO
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.
Assuntos
Oclusão Coronária/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico , Cardiopatia Reumática/cirurgia , Valva Tricúspide , Idoso , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/cirurgia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , StentsAssuntos
Aorta/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Calcificação Vascular/cirurgia , Aorta/diagnóstico por imagem , Aorta/fisiopatologia , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/fisiopatologia , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/fisiopatologia , Desenho de Prótese , Resultado do Tratamento , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/fisiopatologiaRESUMO
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.
Assuntos
Doença do Sistema de Condução Cardíaco/etiologia , Trombose Coronária/etiologia , Complicações Pós-Operatórias/diagnóstico , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/cirurgia , Doença do Sistema de Condução Cardíaco/diagnóstico , Doença do Sistema de Condução Cardíaco/patologia , Trombose Coronária/diagnóstico , Trombose Coronária/patologia , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Complicações Pós-Operatórias/patologiaRESUMO
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.