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1.
J Card Surg ; 36(10): 3892-3897, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34216393

RESUMO

We present here a case of a symptomatic chest injury with a nail gun causing a delayed occurrence of coronary artery fistula to the left pulmonary artery presenting with unstable angina 4 years after the initial injury, three of which were symptom-free. The patient underwent successful surgical closure of the fistula and removal of the foreign body.


Assuntos
Fístula Artério-Arterial , Doença da Artéria Coronariana , Fístula , Cardiopatias Congênitas , Traumatismos Torácicos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Humanos , Traumatismos Torácicos/complicações , Traumatismos Torácicos/cirurgia
2.
J Cardiothorac Surg ; 16(1): 162, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099011

RESUMO

INTRODUCTION: Multiple studies have shown a decrease in the inflammatory response with minimized bypass circuits leading to less complications and mortality rate. On the other hand, some other studies showed that there is no difference in post-operative outcomes. So, the aim of this study is to investigate the clinical benefits of using the Minimized cardiopulmonary Bypass system in Coronary Artery Bypass Grafting and its effect on postoperative morbidity and mortality in diabetic patients as one of the high-risk groups that may benefit from these systems. METHODS: This is a retrospective study that included 114 diabetic patients who underwent Coronary artery bypass grafting (67 patients with conventional cardiopulmonary bypass system and 47 with Minimized cardiopulmonary bypass system). The patients' demographics, intra-operative characteristics and postoperative complications were compared between the two groups. RESULTS: Coronary artery bypass grafting was done on a beating heart less commonly in the conventional cardiopulmonary bypass group (44.78% vs. 63.83%, p = 0.045). There was no difference between the two groups in blood loss or transfusion requirements. Four patients in the conventional cardiopulmonary bypass group suffered perioperative myocardial infarction while no one had perioperative myocardial infarction in the Minimized cardiopulmonary bypass group. On the other hand, less patients in the conventional group had postoperative Atrial Fibrillation (4.55% vs. 27.5%, p = 0.001). The requirements for Adrenaline and Nor-Adrenaline infusions were more common the conventional group than the Minimized group. CONCLUSION: The use of conventional cardiopulmonary bypass for Coronary Artery Bypass Grafting in diabetic patients was associated with higher use of postoperative vasogenic and inotropic support. However, that did not translate into higher complications rate or mortality.


Assuntos
Ponte Cardiopulmonar/métodos , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Complicações do Diabetes/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Adulto , Idoso , Doença da Artéria Coronariana/complicações , Feminino , Humanos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
3.
Rev. bras. cir. cardiovasc ; 36(1): 10-17, Jan.-Feb. 2021. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1155793

RESUMO

Abstract Introduction: There are scarce data comparing different mechanical valves in the aortic position. The objective of this study was to compare the early hemodynamic changes after aortic valve replacement between ATS, Bicarbon, and On-X mechanical valves. Methods: We included 99 patients who underwent aortic valve replacement with mechanical valves between 2017 and 2019. Three types of mechanical valves were used, On-X valve (n=45), ATS AP360 (n=32), and Bicarbon (n=22). The mean prosthetic valve gradient was measured postoperatively and after six months. Results: Preoperative data were comparable between groups, and there were no differences in preoperative echocardiographic data. Pre-discharge echocardiography showed no difference between groups in the ejection fraction (P=0.748), end-systolic (P=0.764) and end-diastolic (P=0.723) diameters, left ventricular mass index (P=0.348), aortic prosthetic mean pressure gradient (P=0.454), and indexed aortic prosthetic orifice area (P=0.576). There was no difference in the postoperative aortic prosthetic mean pressure gradient between groups when stratified by valve size. The changes in the aortic prosthetic mean pressure gradient of the intraoperative period, at pre-discharge, and at six months were comparable between the three prostheses (P=0.08). Multivariable regression analysis revealed that female gender (beta coefficient -0.242, P=0.027), body surface area (beta coefficient 0.334, P<0.001), and aortic prosthetic size (beta coefficient -0.547, P<0.001), but not the prosthesis type, were independent predictors of postoperative aortic prosthetic mean pressure gradient. Conclusion: The three bileaflet mechanical aortic prostheses (On-X, Bicarbon, and ATS) provide satisfactory early hemodynamics, which are comparable between the three valve types and among different valve sizes.


Assuntos
Humanos , Masculino , Feminino , Estenose da Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Desenho de Prótese , Ecocardiografia , Ecocardiografia Doppler , Hemodinâmica
4.
Gen Thorac Cardiovasc Surg ; 69(6): 911-918, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33159277

RESUMO

OBJECTIVES: The effect of different degrees of right ventricular (RV) dysfunction on long-term outcomes after tricuspid valve repair is the subject of ongoing research. We sought to evaluate the effect of preoperative RV dysfunction on mortality and recurrence of tricuspid regurgitation (TR) after tricuspid valve repair for secondary TR concomitant with left-side valve surgery. METHODS: This is a retrospective study, including 548 patients who underwent repair of secondary TR (2009-2017) at a single institution. Patients were grouped according to preoperative right ventricular (RV) systolic function into three groups; normal RV function (group 1, n = 451), mild RV dysfunction (group 2, n = 60) and moderate/severe RV dysfunction (group 3, n = 37). Study endpoints were mortality and recurrence of TR. RESULTS: Group 3 was associated with the highest hospital mortality (10.2%, p = .06). Predictors of moderate or higher grade TR were NYHA class (HR 2.1, p = 0.03); preoperative TR grade (HR 1.9, p < 0.01), mild RV dysfunction (HR 2.4, p < 0.01), isolated RV dilatation (HR 2.0, p < 0.01), and flexible TV repair prostheses (HR 2.4, p = 0.01). Predictors of mortality were renal impairment (HR 3.0, p < 0.01), ejection fraction (HR 0.97, p = 0.02), pulmonary artery systolic pressure (HR 1.02, p = 0.02), preoperative TR grade (HR 1.7, p < 0.01), and moderate/severe RV dysfunction (HR 3.1, p = 0.01). CONCLUSION: Compared to normal and mild degree of RV dysfunction, moderate and severe RV dysfunction were independent predictors of poor long-term survival. Isolated RV dilatation increased the recurrence of TR. RV dysfunction and dilatation could be indications of tricuspid valve repair.


Assuntos
Insuficiência da Valva Tricúspide , Disfunção Ventricular Direita , Humanos , Recidiva Local de Neoplasia , Estudos Retrospectivos , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgia , Disfunção Ventricular Direita/etiologia
5.
Braz J Cardiovasc Surg ; 36(1): 10-17, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33355803

RESUMO

INTRODUCTION: There are scarce data comparing different mechanical valves in the aortic position. The objective of this study was to compare the early hemodynamic changes after aortic valve replacement between ATS, Bicarbon, and On-X mechanical valves. METHODS: We included 99 patients who underwent aortic valve replacement with mechanical valves between 2017 and 2019. Three types of mechanical valves were used, On-X valve (n=45), ATS AP360 (n=32), and Bicarbon (n=22). The mean prosthetic valve gradient was measured postoperatively and after six months. RESULTS: Preoperative data were comparable between groups, and there were no differences in preoperative echocardiographic data. Pre-discharge echocardiography showed no difference between groups in the ejection fraction (P=0.748), end-systolic (P=0.764) and end-diastolic (P=0.723) diameters, left ventricular mass index (P=0.348), aortic prosthetic mean pressure gradient (P=0.454), and indexed aortic prosthetic orifice area (P=0.576). There was no difference in the postoperative aortic prosthetic mean pressure gradient between groups when stratified by valve size. The changes in the aortic prosthetic mean pressure gradient of the intraoperative period, at pre-discharge, and at six months were comparable between the three prostheses (P=0.08). Multivariable regression analysis revealed that female gender (beta coefficient -0.242, P=0.027), body surface area (beta coefficient 0.334, P<0.001), and aortic prosthetic size (beta coefficient -0.547, P<0.001), but not the prosthesis type, were independent predictors of postoperative aortic prosthetic mean pressure gradient. CONCLUSION: The three bileaflet mechanical aortic prostheses (On-X, Bicarbon, and ATS) provide satisfactory early hemodynamics, which are comparable between the three valve types and among different valve sizes.


Assuntos
Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Ecocardiografia , Ecocardiografia Doppler , Feminino , Hemodinâmica , Humanos , Masculino , Desenho de Prótese
6.
Asian Cardiovasc Thorac Ann ; 28(6): 307-311, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32586103

RESUMO

The COVID-19 pandemic represents an international health crisis that is challenging to all governments. Health practitioners in different fields have a duty to guide people and governments to achieve safe health practices. The Saudi Society for Cardiac Surgeons recognizes that it is difficult to establish evidence-based guidelines for safe cardiac surgery practices in such a crisis because this is an unprecedented health pandemic. So we decided to work with our colleagues in other societies by reviewing different recommendations and safe practices issued by different health organizations and scientific societies. The aim was to come up with recommendations that could guide hospitals, physicians, and other members of the healthcare team on the best available practices that are applicable to our community and that will not only ensure optimum patient care delivery but also protect healthcare workers from the risk of infection and aid the national effort in containing and managing this worldwide pandemic.


Assuntos
Betacoronavirus , Procedimentos Cirúrgicos Cardíacos/métodos , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , COVID-19 , Consenso , Saúde Global , Humanos , SARS-CoV-2 , Arábia Saudita , Sociedades Médicas , Cirurgiões
7.
J Cardiothorac Surg ; 15(1): 42, 2020 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-32093723

RESUMO

BACKGROUND: Mitral annular calcification (MAC) occurs represents a challenge to surgeons during mitral valve (MV) surgery with increased perioperative risk. CASE PRESENTATION: We describe a challenging case of an elderly female patient with multiple comorbidities who presented with symptoms and signs of heart failure with a previous history of mechanical aortic valve replacement 15 years prior to presentation. Echocardiogram showed severe mitral stenosis and regurgitation with severe calcification of the mitral annulus. Given her high-risk profile and unavailability of suitable percutaneous therapeutic options we decided to replace her mitral valve with Sapien 3 valve under direct exposure. The case describes the technical details for the valve implantation and demonstrates the viability of this option in high risk surgical patients without the need for adjunct techniques like predilatation, additional supporting sutures or patches with a review of the literature on open surgical implantation of Sapien 3 valve. CONCLUSION: Direct open surgical implantation of Sapien 3 valve can be implanted safely in patients with severe MAC, without predilatation and without the use of other adjunctive techniques like fixation sutures or patches.


Assuntos
Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso , Calcinose/complicações , Calcinose/diagnóstico por imagem , Ecocardiografia , Feminino , Próteses Valvulares Cardíacas , Humanos , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/complicações , Estenose da Valva Mitral/diagnóstico por imagem
8.
Artigo em Inglês | MEDLINE | ID: mdl-29686154

RESUMO

The purpose of this study was to investigate the population pharmacokinetics of vancomycin in patients undergoing open heart surgery. In this observational pharmacokinetic study, multiple blood samples were drawn over a 48-h period of intravenous vancomycin in patients who were undergoing open heart surgery. Blood samples were analyzed using an Architect i4000SR immunoassay analyzer. Population pharmacokinetic models were developed using Monolix 4.4 software. Pharmacokinetic-pharmacodynamic (PK-PD) simulations were performed to explore the ability of different dosage regimens to achieve the pharmacodynamic targets. A total of 168 blood samples were analyzed from 28 patients. The pharmacokinetics of vancomycin are best described by a two-compartment model with between-subject variability in clearance (CL), the volume of distribution of the central compartment (V1), and volume of distribution of the peripheral compartment (V2). The CL and the V1 of vancomycin were related to creatinine CL (CLCR), body weight, and albumin concentration. Dosing simulations showed that standard dosing regimens of 1 and 1.5 g failed to achieve the PK-PD target of AUC0-24/MIC > 400 for an MIC of 1 mg/liter, while high weight-based dosing regimens were able to achieve the PK-PD target. In summary, the administration of standard doses of 1 and 1.5 g of vancomycin two times daily provided inadequate antibiotic prophylaxis in patients undergoing open heart surgery. The same findings were obtained when 15- and 20-mg/kg doses of vancomycin were administered. Achieving the PK-PD target required higher doses (25 and 30 mg/kg) of vancomycin.


Assuntos
Antibacterianos/farmacocinética , Antibioticoprofilaxia/métodos , Procedimentos Cirúrgicos Cardíacos , Infecção da Ferida Cirúrgica/prevenção & controle , Vancomicina/farmacocinética , Antibacterianos/sangue , Antibacterianos/uso terapêutico , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Método de Monte Carlo , Vancomicina/sangue , Vancomicina/uso terapêutico
9.
Artigo em Inglês | MEDLINE | ID: mdl-29358296

RESUMO

The purpose of this study was to investigate the population pharmacokinetics (PK) of cefuroxime in patients undergoing coronary artery bypass graft (CABG) surgery. In this observational pharmacokinetic study, multiple blood samples were collected over a 48-h interval of intravenous cefuroxime administration. The samples were analyzed by using a validated high-performance liquid chromatography (HPLC) method. Population pharmacokinetic models were developed using Monolix (version 4.4) software. Pharmacokinetic-pharmacodynamic (PD) simulations were performed to explore the ability of different dosage regimens to achieve the pharmacodynamic targets. A total of 468 blood samples from 78 patients were analyzed. The PK for cefuroxime were best described by a two-compartment model with between-subject variability on clearance, the volume of distribution of the central compartment, and the volume of distribution of the peripheral compartment. The clearance of cefuroxime was related to creatinine clearance (CLCR). Dosing simulations showed that standard dosing regimens of 1.5 g could achieve the PK-PD target of the percentage of the time that the free concentration is maintained above the MIC during a dosing interval (fTMIC) of 65% for an MIC of 8 mg/liter in patients with a CLCR of 30, 60, or 90 ml/min, whereas this dosing regimen failed to achieve the PK-PD target in patients with a CLCR of ≥125 ml/min. In conclusion, administration of standard doses of 1.5 g three times daily provided adequate antibiotic prophylaxis in patients undergoing CABG surgery. Lower doses failed to achieve the PK-PD target. Patients with high CLCR values required either higher doses or shorter intervals of cefuroxime dosing. On the other hand, lower doses (1 g three times daily) produced adequate target attainment for patients with low CLCR values (≤30 ml/min).


Assuntos
Antibacterianos/farmacocinética , Antibacterianos/uso terapêutico , Ponte Cardiopulmonar/métodos , Cefuroxima/farmacocinética , Cefuroxima/uso terapêutico , Ponte de Artéria Coronária/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cromatografia Líquida de Alta Pressão , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Método de Monte Carlo , Adulto Jovem , beta-Lactamas/farmacocinética , beta-Lactamas/uso terapêutico
10.
Ann Thorac Surg ; 103(2): 533-540, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27788942

RESUMO

BACKGROUND: Less-invasive techniques have previously been described for mitral and aortic valve operations; however, few studies have examined their benefit for aortic root and ascending aorta reconstruction. Using propensity matching, we compared outcomes of patients undergoing proximal aortic operations through a J incision compared with full sternotomy. METHODS: From January 1995 to January 2014, 8,533 patients underwent proximal aortic operations at Cleveland Clinic. The study population comprised 1,827 patients after those with prior cardiac operations, emergency procedures, endocarditis, or circulatory arrest were excluded; 568 (31%) underwent a J incision. A propensity score based on 57 variables was generated to account for differences in characteristics of full-sternotomy and J-incision patients, producing 483 matched patient pairs (85% of possible) for comparison of outcomes. RESULTS: Among propensity-matched patients, in-hospital mortality (0 [0%] J incision vs 2 [0.41%] full sternotomy; p = 0.2), renal failure (3 [0.62%] vs 6 [1.2%]; p = 0.3), stroke (3 [0.62%] vs 3 [0.62%; p > 0.9), reoperation for bleeding (17 [3.5%] vs 15 [3.1%]; p = 0.7), intraoperative blood products (60 [15%] vs 78 [19%]; p = 0.08), and postoperative transfusions (97 [20%] vs 103 [22%]; p = 0.6) were similar. Intensive care unit (median 24 vs 26 hours) and postoperative hospital stays (median 5.2 vs 6.0 days) were shorter (p < 0.0001) for the J incision, and operative and postoperative direct technical costs were 6% less. CONCLUSIONS: A J incision is a feasible technique for primary isolated elective proximal aortic operations, with a low risk of complications similar to those of full sternotomy, but with the advantages of shorter intensive care unit and hospital stays, lower costs, and better cosmesis.


Assuntos
Aorta/cirurgia , Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Doenças das Valvas Cardíacas/cirurgia , Mortalidade Hospitalar , Adulto , Idoso , Valva Aórtica/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/mortalidade , Estudos de Coortes , Feminino , Seguimentos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Duração da Cirurgia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Pontuação de Propensão , Estudos Retrospectivos , Esternotomia/métodos , Esternotomia/mortalidade , Análise de Sobrevida , Toracoscopia/métodos , Toracoscopia/mortalidade , Fatores de Tempo , Resultado do Tratamento
11.
Heart Surg Forum ; 18(3): E093-7, 2015 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-26115151

RESUMO

OBJECTIVE: The aim of this study was to report for the first time the phenomenon of thrombocytopenia associated with the use of sutureless aortic valve replacements (AVR), and try to find an explanation for its occurrence. METHODS: The data was collected retrospectively for all patients who had sutureless AVR (7 patients) and was compared to patients who underwent sutured AVR (22 patients) by the same surgeon between February 2012 and November 2013.  RESULTS: Cardiopulmonary bypass and cross-clamp durations were shorter in the sutureless group (96.4 min, 70.6 min) compared to the sutured group (128.3 min, 97.3 min), (P = .04, P = .003) respectively. Mean transvalvular gradients were lower in the sutureless group (mean = 9.6 mmHg) compared to the sutured group (mean = 17.3 mmHg). Platelet levels were significantly lower in the Perceval patients compared to the Enable patients and sutured valves. Platelet transfusion was higher for sutureless valves (6.5 units versus 5.4 units for the sutured group, P = .63), especially the Perceval valve (7.6 units versus 5.3 for the Enable valve, P = .35), but was not statistically significant. Packed red blood cells (PRBCs) transfusion was significantly higher in the sutureless group (6 units versus 3.1 for the sutured group, P = .002).  CONCLUSION: The implantation of sutureless aortic valves, especially the Perceval valve, was associated with a significant drop in platelet count postoperatively with slow recovery and higher PRBCs transfusion requirements. Extreme caution should be taken before the routine use of these valves in elderly patients who are already at risk of thrombocytopenia postoperatively.


Assuntos
Implante de Prótese de Valva Cardíaca/efeitos adversos , Técnicas de Sutura/efeitos adversos , Trombocitopenia/etiologia , Idoso , Bioprótese , Ponte Cardiopulmonar , Transfusão de Eritrócitos , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Desenho de Prótese , Estudos Retrospectivos , Fatores de Risco
12.
J Thorac Cardiovasc Surg ; 147(1): 355-361.e5, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23332188

RESUMO

OBJECTIVE: In patients with pulmonary dysfunction, it is unclear whether a less-invasive approach for aortic valve replacement is well tolerated or even beneficial. We investigated whether a partial upper J-incision for aortic valve replacement leads to more favorable outcomes than a full sternotomy in patients with chronic lung disease by using forced expiratory volume in 1 second as a surrogate. METHODS: From January 1995 to July 2010, 6931 patients underwent primary isolated aortic valve replacement; 655 had forced expiratory volume in 1 second measured and expressed as percent of predicted (FEV1%; 368 via J-incision, 287 via full sternotomy). Postoperative outcomes were compared among 223 propensity-matched pairs. RESULTS: Patients diagnosed with chronic lung disease had longer median intensive care unit (41 vs 27 hours, P = .001) and postoperative (7.1 vs 6.1 days, P < .0001) lengths of stay than those without chronic lung disease. At normal values of FEV1%, little difference was observed in either of these times for J-incision versus full sternotomy; however, at progressively lower FEV1%, these times lengthened, with increasing benefit for J-incision. Among propensity-matched patients, other postoperative complications were similar. Early survival (93% vs 89% at 1 year, P = .07) was possibly higher in matched patients with J-incision, but late survival was similar (P = .9). Patients with FEV1% less than 50 who underwent J-incision had the greatest survival advantage, which persisted for 5 years. CONCLUSIONS: In patients with preoperative respiratory dysfunction, a less-invasive partial upper J-incision for aortic valve replacement can lead to more favorable outcomes than a full sternotomy, including shorter intensive care unit and postoperative lengths of stay and better early survival, which are amplified with decreasing pulmonary function.


Assuntos
Valva Aórtica/cirurgia , Volume Expiratório Forçado , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Pneumopatias/fisiopatologia , Pulmão/fisiopatologia , Esternotomia/métodos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/fisiopatologia , Doença Crônica , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico , Doenças das Valvas Cardíacas/mortalidade , Doenças das Valvas Cardíacas/fisiopatologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Estimativa de Kaplan-Meier , Tempo de Internação , Modelos Logísticos , Pneumopatias/complicações , Pneumopatias/diagnóstico , Pneumopatias/mortalidade , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Seleção de Pacientes , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Pontuação de Propensão , Sistema de Registros , Fatores de Risco , Esternotomia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
13.
J Card Surg ; 28(4): 394-6, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23879341

RESUMO

We describe the surgical management of a 35-year-old male with multiple coronary aneurysms and a diffuse form of supravalvular aortic stenosis who presented with acute myocardial infarction and left ventricular dysfunction. The patient underwent a Bentall procedure with left internal mammary artery to left anterior descending artery bypass grafting with the use of cardiopulmonary bypass utilizing the right axillary artery for arterial cannulation.


Assuntos
Estenose Aórtica Supravalvular/complicações , Estenose Aórtica Supravalvular/cirurgia , Aneurisma Coronário/complicações , Aneurisma Coronário/cirurgia , Anastomose de Artéria Torácica Interna-Coronária/métodos , Adulto , Artéria Axilar , Ponte Cardiopulmonar , Cateterismo/métodos , Humanos , Masculino , Infarto do Miocárdio/etiologia , Resultado do Tratamento , Disfunção Ventricular Esquerda/etiologia
14.
J Card Surg ; 27(4): 511-7, 2012 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22784205

RESUMO

BACKGROUND AND AIM OF STUDY: Right-sided aortic arch is a rare congenital anomaly for which different surgical approaches have been reported. This study reviewed our experience with several techniques. METHODS: We retrospectively reviewed 17 patients undergoing right-sided arch repair at the Cleveland Clinic from 2001 to 2010. Computed tomographic angiograms of the aorta and its branches were reviewed and correlated with patient presentation and surgical approach. RESULTS: Fourteen patients had type II right aortic arch with aberrant left subclavian artery. Fifteen patients presented with obstructive symptoms. Surgical approach included right thoracotomy (11 patients), left thoracotomy (two patients), full sternotomy (one patient), and hybrid repair (three patients). Cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest was used in 11 patients, and two patients had partial CPB. Left subclavian artery bypass was performed in seven patients. Median duration of intubation was 1.9 days. Average length of intensive care unit stay was three days and average hospital stay 11 days. Postoperative outcomes included respiratory failure (one patient), renal failure (one patient), bloodstream infection (two patients), and death (one patient). No patient had stroke or paraplegia. In-hospital death occurred in one patient, and all survivors were alive and asymptomatic for a mean of 38 months. CONCLUSION: The surgical treatment for right-sided aortic arch can be performed with excellent perioperative outcomes when tailored to patient presentation and anatomic configuration. Patients with obstructive symptoms benefit from open or hybrid surgical treatment, with immediate relief of compression. Patients with aneurysmal dilatation without compression symptoms can be managed with open, endovascular, or hybrid surgical intervention.


Assuntos
Aorta Torácica/anormalidades , Doenças da Aorta/cirurgia , Enxerto Vascular/métodos , Idoso , Aorta Torácica/cirurgia , Doenças da Aorta/congênito , Doenças da Aorta/diagnóstico , Doenças da Aorta/mortalidade , Ponte Cardiopulmonar/métodos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , Esternotomia , Toracotomia , Resultado do Tratamento , Enxerto Vascular/mortalidade
15.
Ann Thorac Surg ; 93(1): 300-2, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22186452

RESUMO

The constellation of Takayasu's disease most commonly includes aortitis with resultant coarctations and aneurysm formation. Surgical repair of these lesions can be compromised by the chronic inflammation of Takayasu's arteritis. We present a case of a 22-year-old female with Takayasu's disease who had undergone an ascending and aortic hemiarch replacement then subsequently developed anastomotic dehiscence and re-expansion of the previous aneurysmal sac. Complete aneurysm resection and replacement of the ascending aorta and aortic arch was performed on repeated surgery.


Assuntos
Fístula Anastomótica/cirurgia , Aorta Torácica/cirurgia , Reoperação/métodos , Arterite de Takayasu/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Fístula Anastomótica/diagnóstico , Feminino , Seguimentos , Humanos , Imageamento Tridimensional , Arterite de Takayasu/diagnóstico , Tomografia Computadorizada por Raios X , Falha de Tratamento , Adulto Jovem
16.
Ann Thorac Surg ; 92(6): 2275-7, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22115251

RESUMO

Patients with thoracoabdominal aneurysm that require concomitant cardiac surgery present a complex surgical challenge. A staged hybrid technique including combined cardiac surgery and visceral revascularization from the ascending aorta, followed by endovascular aneurysmal exclusion is reported in four patients. No perioperative death and no neurological complications were observed. The surgical technique is described.


Assuntos
Aorta/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Stents , Humanos
17.
J Card Surg ; 26(5): 483-5, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21848606
18.
J Card Surg ; 26(1): 37-9, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-20459453

RESUMO

Left main coronary artery aneurysm is a rare condition that presents as a potential surgical challenge due to its location. We present a case of successful repair of a posterior saccular aneurysm of the left main coronary artery by aneurysm exclusion, afferent and efferent ligation with coronary artery bypass grafting.


Assuntos
Aneurisma Coronário/cirurgia , Vasos Coronários/cirurgia , Aneurisma Coronário/diagnóstico por imagem , Angiografia Coronária , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
20.
J Card Surg ; 25(2): 174-5, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20492029

RESUMO

We describe an unusual presentation of cardiac tamponade as superior vena cava syndrome post minimally invasive mitral valve repair. The tamponade was caused by local compression of junction between the right atrium and superior vena cava. This case illustrates the importance of using transesophageal echocardiogram in postoperative management of cardiac surgery patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Tamponamento Cardíaco/etiologia , Procedimentos Cirúrgicos Minimamente Invasivos , Valva Mitral/cirurgia , Complicações Pós-Operatórias/etiologia , Síndrome da Veia Cava Superior/etiologia , Tamponamento Cardíaco/diagnóstico por imagem , Tamponamento Cardíaco/cirurgia , Átrios do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/cirurgia , Resultado do Tratamento , Ultrassonografia , Veia Cava Superior
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