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1.
Ann Thorac Surg ; 2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34403692

RESUMO

BACKGROUND: Readmission after coronary artery bypass grafting (CABG) is associated with adverse outcomes and increased cost. We evaluated the impact of a high value care discharge protocol on readmission, length of stay (LOS) and discharge destination in patients undergoing isolated CABG. METHODS: In 2016, a comprehensive, patient-centered discharge protocol was implemented. A nurse practitioner was the fulcrum of this program, which focused on improving health literacy, disease management and rigorous follow-up. All patients undergoing isolated CABG between 2012-2019 were retrospectively analyzed with regard to 30-day readmission, LOS, and discharge disposition. Differences were analyzed by Mann-Whitney, chi-squared and t-tests. Analyses were repeated using propensity matching. RESULTS: A total of 910 consecutive patients undergoing isolated CABG were included in the analyses - 353 pre-protocol and 557 post-protocol. Pre-protocol patients had a readmission rate of 14.4% (n=51), compared to 6.8% (n=38) in the post-protocol patients (p<0.001). Median postoperative LOS prior to implementation was 6 days (interquartile range 5-8) compared to 5 days (interquartile range 4-6) post-implementation (p<0.001). Post-implementation, a higher proportion of patients were discharged to home compared to a skilled nursing facility (82.7% [n=461] vs 73.9% [n=261], p=0.002). Following propensity matching, 298 well-balanced patients were included for analysis and these significant reductions in LOS, readmission and discharge destination persisted. CONCLUSIONS: Implementation of a new discharge protocol was significantly associated with reduced readmission and LOS, along with higher rates of discharge to home in isolated CABG patients. Importantly, the results were sustainable and did not require additional resources, delivering high value care.

2.
Tex Heart Inst J ; 48(3)2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34383957

RESUMO

During the coronavirus disease 2019 (COVID-19) pandmic, more patients are presenting with complications late after acute myocardial infarction. We report the case of a 71-year-old man who delayed seeking medical care for 2 weeks, despite progressive shortness of breath, cough, and tactile fever, for fear of contracting COVID-19 in the hospital. Clinical and echocardiographic evaluation revealed a ventricular septal rupture secondary to acute myocardial infarction. The patient underwent urgent cardiac catheterization, followed by successful saphenous vein grafting to the left anterior descending coronary artery and open surgical repair of the ventricular septal rupture with a bovine pericardial patch. This case highlights a potential long-lasting negative effect that the COVID-19 pandemic will have on the care-seeking behavior and health of patients with acute cardiovascular disease.


Assuntos
COVID-19 , Cateterismo Cardíaco/métodos , Ponte de Artéria Coronária/métodos , Medo , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Infarto do Miocárdio com Supradesnível do Segmento ST , Ruptura do Septo Ventricular , Idoso , COVID-19/epidemiologia , COVID-19/psicologia , Angiografia Coronária/métodos , Ecocardiografia/métodos , Eletrocardiografia/métodos , Humanos , Masculino , SARS-CoV-2 , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Tempo para o Tratamento/tendências , Resultado do Tratamento , Ruptura do Septo Ventricular/diagnóstico , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/fisiopatologia , Ruptura do Septo Ventricular/cirurgia
3.
J Am Heart Assoc ; 10(16): e019930, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34387093

RESUMO

Background Aortic stenosis is prevalent in end-stage renal disease. Transcatheter aortic valve replacement (TAVR) is a plausible alternative for surgical aortic valve replacement. However, little is known regarding long-term outcomes in patients with end-stage renal disease who undergo TAVR. Methods and Results We identified all patients with end-stage renal disease who underwent TAVR from 2011 through 2016 using the United States Renal Data System. The primary end point was 5-year mortality after TAVR. Factors associated with 1- and 5-year mortality were analyzed. A total of 3883 TAVRs were performed for patients with end-stage renal disease. Mortality was 5.8%, 43.7%, and 88.8% at 30 days, 1 year, and 5 years, respectively. Case volumes increased rapidly from 17 in 2011 to 1495 in 2016. Thirty-day mortality demonstrated a dramatic reduction from 11.1% in 2012 to 2.5% in 2016 (P=0.01). Age 75 or older (hazard ratio [HR], 1.14; 95% CI, 1.05-1.23 [P=0.002]), body mass index <25 (HR, 1.18; 95% CI, 1.08-1.28 [P<0.001]), chronic obstructive pulmonary disease (HR, 1.25; 95% CI, 1.1-1.35 [P<0.001]), diabetes mellitus as the cause of dialysis (HR, 1.22; 95% CI, 1.11-1.35 [P<0.001]), hypertension as the cause of dialysis (HR, 1.17; 95% CI, 1.06-1.29 [P=0.004]), and White race (HR, 1.17; 95% CI, 1.06-1.3 [P=0.002]) were independently associated with 5-year mortality. Conclusions Short-term outcomes of TAVR in patients with end-stage renal disease have improved significantly. However, long-term mortality of patients on dialysis remains high.

4.
Heart Lung Circ ; 30(9): 1281-1291, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33810970

RESUMO

BACKGROUND: Redo coronary artery bypass grafting (CABG) can be performed with either the off-pump (OPCAB) or the on-pump (ONCAB) technique. METHOD: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), this meta-analysis compared the safety and efficacy of OPCAB versus ONCAB redo CABG. RESULTS: Twenty-three (23) eligible studies were included (OPCAB, n=2,085; ONCAB, n=3,245). Off-pump CABG significantly reduced the risk of perioperative death (defined as in-hospital or 30-day death rate), myocardial infarction, atrial fibrillation, and acute kidney injury. The two treatment approaches were comparable regarding 30-day stroke and late all-cause mortality. CONCLUSIONS: Off-pump redo CABG resulted in lower perioperative death and periprocedural complication rates. No difference was observed in perioperative stroke rates and long-term survival between the two techniques.


Assuntos
Fibrilação Atrial , Ponte de Artéria Coronária sem Circulação Extracorpórea , Acidente Vascular Cerebral , Fibrilação Atrial/cirurgia , Estudos de Coortes , Ponte de Artéria Coronária , Humanos , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento
5.
Artigo em Inglês | MEDLINE | ID: mdl-33812684

RESUMO

OBJECTIVES: Dialysis is a well-established risk factor for morbidity and mortality after cardiovascular procedures. However, little is known regarding the outcomes of proximal aortic surgery in this high-risk cohort. METHODS: Perioperative (in-hospital or 30-day mortality) and 10-year outcomes were analyzed for all the patients who underwent open proximal aortic repair with the diagnosis of nonruptured thoracic aortic aneurysm (aneurysm, n = 325) or type A aortic dissection (dissection, n = 461) from 1987 to 2015 using the US Renal Data System database. RESULTS: In patients with aneurysm, perioperative mortality was 12.6%. The 10-year mortality was 81% ± 3%. Age 65 years or more (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.03 to 1.78; P = .03), chronic obstructive pulmonary disease (HR, 1.68; 95% CI, 1.01-2.82; P = .047), and Black race (HR, 1.46; 95% CI, 1.09-1.97; P = .01) were independently associated with worse 10-year mortality. In patients with dissection, perioperative mortality was 24.3% and 10-year mortality was 87.9% ± 2.2%. Age 65 years or more (HR, 1.49; 95% CI, 1.19-1.86; P < .001), congestive heart failure (HR, 1.39; 95% CI, 1.11-2.57; P = .004), and diabetes mellitus as the cause of dialysis (HR, 1.75; 95% CI, 1.2-2.57; P = .004) were independently associated with worse 10-year mortality. Black race (HR, 0.74; 95% CI, 0.6-0.92; P = .008) was associated with a better outcome. CONCLUSIONS: We described challenging perioperative and 10-year outcomes for dialysis patients undergoing proximal aortic repair. The present study suggests the need for careful patient selection in the elective repair of proximal aortic aneurysm for dialysis-dependent patients, whereas it affirms the feasibility of emergency surgery for acute type A aortic dissections.

6.
Aorta (Stamford) ; 2021 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-33761560

RESUMO

We present a unique case of late diagnosis of coarctation of the aorta in an adult, presenting with congestive heart failure associated with severe aortic and mitral valve insufficiency. To minimize operative risk, staged endovascular repair of the coarctation was initially performed, followed by aortic valve replacement and mitral valve repair. Six months postoperatively, the 41-year-old patient remains completely asymptomatic.

7.
Am J Cardiol ; 146: 120-127, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33539860

RESUMO

We sought to systematically describe the epidemiology, etiology, clinical and operative characteristics as well as outcomes of patients who underwent pericardiectomy for constrictive pericarditis in the contemporary era. We conducted a systematic search of the MEDLINE, Embase, and Cochrane databases from their inception to April 1, 2020 for studies assessing the outcomes of pericardiectomy in patients with constrictive pericarditis. Studies with patients enrolled before 1985, pediatric patients or studies including >10% tuberculous pericarditis were excluded. The impact of pericarditis etiology on outcomes was evaluated with a meta-analysis. We analyzed 27 eligible studies and 2,114 patients. Etiology was most commonly idiopathic (50.2%), followed by after-cardiac surgery (26.2%) and radiation (6.9%). Patients were mostly men (76%), mean age 58 and with advanced symptoms (NYHA III/IV 70.1%). Total pericardiectomy was preferred (85.8%) and concomitant cardiac surgery was relatively common (23.8%). Operative mortality was 6.9% and 5-year mortality was 32.7%. Radiation and after-cardiac surgery patients had 3 and 2 times higher long-term risk for mortality respectively compared with idiopathic. A sensitivity analysis did not result in changes in the results. Thirty percent of included studies had more than low bias primarily originating from follow up and selection. Pericardiectomy is therefore performed mostly in middle-aged men with advanced symptoms and low co-morbidity burden and still caries significant operative mortality. Radiation and after-cardiac surgery patients have a significantly higher mortality risk compared with idiopathic. Several methodological issues and significant heterogeneity limit the generalization of these data and randomized controlled trials may have to be considered.


Assuntos
Diagnóstico por Imagem/métodos , Pericardiectomia/métodos , Pericardite Constritiva/cirurgia , Humanos , Pericardite Constritiva/diagnóstico
8.
J Card Surg ; 35(9): 2194-2200, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32579778

RESUMO

BACKGROUND: To evaluate preoperative risk factors and postoperative outcomes in patients with preoperative renal insufficiency undergoing open surgical repair of the aortic root, ascending aorta, or aortic arch. METHODS: Our institutional database was reviewed for all patients undergoing elective aortic root, ascending aorta, and aortic arch open repairs. Patients were separated into two groups based on renal function. Patients with preoperative renal insufficiency were compared to those with normal renal function. Regression analyses were used to identify independent predictors of short and long term postoperative outcomes. RESULTS: The cohort consisted of 2140 patients, of which 55 had preoperative renal insufficiency (PRI). Patients with PRI were older and had worse cardiovascular risk profiles. On presentation, PRI patients were more likely to have lower ejection fraction. There was no difference in operative mortality between the two groups. The most frequent major postoperative complications among renal insufficiency patients were reoperation for bleeding (9.1%, P = .02). Logistic regression analysis indicated that PRI and left ventricular ejection fraction were independent predictors of major adverse events. Long-term survival was significantly reduced in preoperative renal insufficiency patients in the unmatched cohort. CONCLUSIONS: Aortic patients with preoperative renal insufficiency have a higher risk profile of mortality. Renal insufficiency remains an independent predictor of adverse outcomes following aortic surgery and understanding this patient population can guide physicians to improve outcomes.


Assuntos
Insuficiência Renal , Função Ventricular Esquerda , Aorta , Humanos , Complicações Pós-Operatórias/epidemiologia , Insuficiência Renal/complicações , Estudos Retrospectivos , Fatores de Risco , Volume Sistólico , Resultado do Tratamento
9.
J Cardiothorac Vasc Anesth ; 34(12): 3234-3242, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32417005

RESUMO

OBJECTIVE: To characterize the effects markers of socioeconomic status (SES), including race and ethnicity, health insurance status, and median household income by zip code on in-patient mortality after cardiac valve surgery. DESIGN: Retrospective cohort study of adult valve surgery patients included in the State Inpatient Databases and Healthcare Cost and Utilization Project. The primary outcome was mortality during the index admission. Bivariate analyses and multivariate regression models were used to assess the independent effects of race and ethnicity, payer status, and median income by patient zip code on in-hospital mortality. DESIGN: Multistate database of hospitalizations from 2007 to 2014 from New York, Florida, Kentucky, California, and Maryland. PARTICIPANTS: In total, 181,305 patients ≥18 years old underwent mitral or aortic valve repair or replacement and met the inclusion criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Mortality rates were higher among black (5.59%) than white patients (4.28%, p < 0.001) and among Medicaid (4.66%), Medicare (5.22%), and uninsured (4.58%) patients compared with private insurance (2.45%, p < 0.001). After controlling for age, sex, presenting comorbidities, urgent or emergent operative status, and hospital case volume, mortality odds remained significantly elevated for black (odds ratio [OR] 1.127, confidence interval [CI] 1.038-1.223), uninsured (OR 1.213, CI 1.020-1.444), Medicaid (OR 1.270, 95% CI 1.116-1.449) and Medicare (OR 1.316, 95% CI 1.216-1.415) patients. CONCLUSIONS: Markers of low SES, including race/ethnicity, insurance status, and household income, are associated with increased risk of in-hospital mortality following cardiac valve surgery. Further research is warranted to understand and help decrease mortality risk in underinsured, less-wealthy and non-white patients undergoing cardiac valve surgery.


Assuntos
Cobertura do Seguro , Medicare , Adolescente , Adulto , Idoso , Valvas Cardíacas/cirurgia , Mortalidade Hospitalar , Humanos , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia
10.
Int J Surg Case Rep ; 69: 51-54, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32276216

RESUMO

INTRODUCTION: Gemella sanguinis is an extremely rare cause of infectious endocarditis, with only 12 cases previously reported in the literature. Here we report the third known case of isolated mitral valve endocarditis secondary to G. sanguinis. PRESENTATION OF CASE: A 53-year-old man with mitral valve prolapse and history of recent dental instrumentation presented with malaise, thigh and finger pain and new pansystolic murmur. He was diagnosed with severe mitral insufficiency due to infectious endocarditis secondary to G. sanguinis. He underwent mitral valve replacement and was treated with a long course of antibiotics. DISCUSSION: G. sanguinis is a rare cause of infectious endocarditis with very few reported cases in the literature. In the majority of reported cases, a strategy of valve replacement along with prolonged antibiotic course results in good outcome for the patient.

11.
Pediatr Transplant ; 24(3): e13698, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32189417

RESUMO

Bradyarrhythmias are a common complication following pediatric OHT and may require permanent pacemaker implantation (PPM). The purpose of this study was to investigate the incidence, predictors, and outcomes of children undergoing PPM implantation following OHT. A PRISMA-compliant systematic literature review was performed using the PubMed database and the Cochrane Library (end-of-search date: January 27, 2019). The Newcastle-Ottawa scale and the Joanna Briggs Institute tool were used to assess the quality of cohort studies and case reports, respectively. We analyzed data from a total of 11 studies recruiting 7198 pediatric patients who underwent heart transplant. PPM implantation was performed in 1.9% (n = 137/7,198; 95% CI: 1.6-2.2) of the patients. Most patients underwent dual-chamber pacing (46%, 95% CI: 32.6-59.7). Male-to-female ratio was 1.3:1. Mean patient age at the time of OHT was 10.1 ± 6.3. Overall, biatrial anastomosis was used in 62.2% (95% CI: 52.8-70.6) of the patients. The bicaval technique was performed in the remaining 37.8% (95% CI: 29.4-47.1). Sinus node dysfunction was the most frequent indication for PPM implantation (54.4%; 95% CI: 42.6-65.7) followed by AV block (45.6%; 95% CI: 34.3-57.3). The median time interval between OHT and PPM implantation ranged from 17 days to 12.5 years. All-cause mortality was 27.9% (95% CI: 18.6-39.6) during a median follow-up of 5 years. PPM implantation is rarely required after pediatric OHT. The most common indication for pacing is sinus node dysfunction, and patients undergoing biatrial anastomosis may be more likely to require PPM.


Assuntos
Bradicardia/terapia , Transplante de Coração , Marca-Passo Artificial , Complicações Pós-Operatórias/terapia , Adolescente , Bradicardia/epidemiologia , Bradicardia/etiologia , Criança , Pré-Escolar , Humanos , Incidência , Lactente , Recém-Nascido , Complicações Pós-Operatórias/epidemiologia
12.
Pediatr Cardiol ; 41(5): 853-861, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32162027

RESUMO

Device closure is the first-line treatment for most atrial septal defects (ASDs). Minimally invasive cardiac surgery (MICS) has been found safe and effective for ASD closure with comparable mortality/morbidity and superior cosmetic results compared to conventional median sternotomy. Our goal was to compare percutaneous versus MICS of ASDs. A systematic review was performed using PubMed and the Cochrane Library (end-of-search date on May 22, 2019). Meta-analyses were conducted using fixed and random effects models. In the present systematic review, we analyzed six studies including 1577 patients with ASDs who underwent either MICS (n = 642) or device closure (n = 935). Treatment efficacy was significantly higher in the MICS (99.8%; 95% CI 98.9-99.9) compared to the device closure group (97.3%; 95% CI 95.6-98.2), (OR 0.1; 95% CI 0.02-0.6). Surgical patients experienced significantly more complications (16.2%; 95% CI 13.0-19.9) compared to those that were treated with a percutaneous approach (7.1%; 95% CI 5.0-9.8), (OR 2.0; 95% CI 1.2-3.2). Surgery was associated with significantly longer length of hospital stay (5.6 ± 1.7 days) compared to device closure (1.3 ± 1.4 days), (OR 4.8; 95% CI 1.1-20.5). Residual shunts were more common with the transcatheter (3.9%; 95% CI 2.7-5.5) compared to the surgical approach (0.95%; 95% CI 0.3-2.4), (OR 0.1; 95% CI 0.06-0.5). There was no difference between the two techniques in terms of major bleeding, hematoma formation, transfusion requirements, cardiac tamponade, new-onset atrial fibrillation, permanent pacemaker placement, and reoperation rates. MICS for ASD is a safe procedure and compares favorably to transcatheter closure. Despite longer hospitalization requirements, the MICS approach is feasible irrespective of ASD anatomy and may lead to a more effective and durable repair.


Assuntos
Cateterismo Cardíaco/métodos , Comunicação Interatrial/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Adulto , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Comunicação Interatrial/mortalidade , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Dispositivo para Oclusão Septal , Esternotomia , Dispositivos de Fixação Cirúrgica , Resultado do Tratamento , Adulto Jovem
14.
Adv Exp Med Biol ; 1226: 51-56, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030675

RESUMO

Cardiac tumors are found in less than 1% of adult and pediatric autopsies. More than three-fourths of primary cardiac neoplasms are benign, with myxomas and rhabdomyomas being the most common cardiac tumors seen in adults and children, respectively. Primary malignant cardiac tumors are extremely rare, whereas metastatic lesions can be seen in approximately 8% of patients dying from cancer. Attempting to understand why the heart is so resistant to carcinogenesis and which fail-safe mechanisms malfunction when cardiac tumors do develop is particularly challenging considering the rarity of these tumors and the fact that when relevant clinical studies are published, they rarely focus on molecular pathogenesis. Apart from cancer cells, solid tumors are comprised of a concoction of noncancerous cells, and extracellular matrix constituents, which along with pH and oxygen levels jointly constitute the so-called tumor microenvironment (TME). In the present chapter, we explore mechanisms through which TME may influence cardiac carcinogenesis.


Assuntos
Carcinogênese , Neoplasias Cardíacas/patologia , Microambiente Tumoral , Humanos , Mixoma/patologia , Rabdomioma/patologia
15.
Interact Cardiovasc Thorac Surg ; 30(3): 353-358, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31808516

RESUMO

OBJECTIVES: A pericardial hernia is defined as the protrusion of abdominal viscera through the central tendon of the diaphragm into the pericardial sac. It is a rare clinical entity whose symptoms vary considerably. The objective of this study was to evaluate the clinical manifestations of and the optimal surgical treatments for pericardial hernias. METHODS: PubMed and the Cochrane bibliographical databases were searched (last search: 20 April 2019) for studies on pericardial diaphragmatic hernias in the adult population. RESULTS: Eighty studies met our inclusion criteria and reported on 85 patients (62 men and 23 women) with a mean age of 55.86 ± 15.79 years (mean ± standard deviation) presenting with a pericardial hernia at health care facilities. The leading aetiology was trauma (56.5%) followed by iatrogenic interventions (30.6%). The most common herniated organs were the transverse colon (49.4%) and the greater omentum (48.2%). Seventy-one patients (83.5%) underwent an open surgical repair, whereas 14 (16.5%) had a laparoscopic approach. Mesh or a patch was applied in 41.9% of cases. A postoperative morbidity rate of 16.9% was recorded, whereas the mortality rate reached 2.4%. CONCLUSIONS: Pericardial hernia is a rare disease characterized by abdominal organs herniating into the pericardium. It requires a high degree of suspicion for early diagnosis, and all medical professionals should be encouraged to report such cases to clarify the best available therapeutic approach.


Assuntos
Hérnia Diafragmática/cirurgia , Herniorrafia/métodos , Laparoscopia/métodos , Omento/cirurgia , Pericárdio , Telas Cirúrgicas , Adulto , Humanos
17.
Ann Thorac Surg ; 108(6): 1738-1744, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31445910

RESUMO

BACKGROUND: Blood conservation with antifibrinolytics, topical hemostatics, and strict transfusion triggers are becoming commonplace in cardiac surgery. The aim of this study was to evaluate the effect of a blood conservation protocol centering on standardized intraoperative autologous blood donation (IAD) use in cardiac surgery. METHODS: We reviewed charts of patients who underwent cardiac surgery at our hospital over an 8-year period to analyze transfusion tendencies before and after a new blood conservation policy was implemented. Propensity score matching was used to account for population differences in preoperative and perioperative covariates. RESULTS: Over an 8-year period (January 2009 to December 2017) 1002 patients were studied. Three hundred fifty-two patients before the new blood conservation policy (group 1) were compared with 650 patients after the change (group 2). Fewer group 2 patients required blood transfusions during their hospital stay (78% vs 61%, P < .001), were transfused fewer units (2.8 vs 1.81 units, P < .001), and experienced a shorter length of stay (8.02 vs 7.28 days, P = .012). Propensity score-matched cohorts revealed reductions in any complication (29.5% vs 18.8%, P = .007), fewer postoperative transfusions (70.1% vs 50.9%, P < .001), and a lower transfusion volume (1.82 vs 1.21 units, P = .002) associated with IAD without any associated change in mortality. CONCLUSIONS: IAD use is associated with reduced transfusions in cardiac surgery and may be considered a complementary aspect of blood conservation. Our experience suggests it may be applied with few limitations. A causal relationship between IAD and outcomes should be established with prospective studies.


Assuntos
Doadores de Sangue/provisão & distribuição , Transfusão de Sangue Autóloga/métodos , Procedimentos Cirúrgicos Cardíacos , Cuidados Intraoperatórios/métodos , Hemorragia Pós-Operatória/prevenção & controle , Idoso , Transfusão de Sangue/estatística & dados numéricos , Procedimentos Médicos e Cirúrgicos sem Sangue/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/epidemiologia , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos/epidemiologia
18.
Pediatr Cardiol ; 40(6): 1105-1112, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31214731

RESUMO

Tetralogy of Fallot (ToF) is one of the most common cyanotic congenital heart defects. We sought to summarize all available data regarding the epidemiology and perioperative outcomes of syndromic ToF patients. A PRISMA-compliant systematic literature review of PubMed and Cochrane Library was performed. Twelve original studies were included. The incidence of syndromic ToF was 15.3% (n = 549/3597). The most prevalent genetic syndromes were 22q11.2 deletion (47.8%; 95% CI 43.4-52.2) and trisomy 21 (41.9%; 95% CI 37.7-46.3). Complete surgical repair was performed in 75.2% of the patients (n = 161/214; 95% CI 69.0-80.1) and staged repair in 24.8% (n = 53/214; 95 CI 19.4-30.9). Relief of RVOT obstruction was performed with transannular patch in 64.7% (n = 79/122; 95% CI 55.9-72.7) of the patients, pulmonary valve-sparing technique in 17.2% (n = 21/122; 95% CI 11.5-24.9), and RV-PA conduit in 18.0% (n = 22/122; 95% CI 12.1-25.9). Pleural effusions were the most common postoperative complications (n = 28/549; 5.1%; 95% CI 3.5-7.3). Reoperations were performed in 4.4% (n = 24/549; 95% CI 2.9-6.4) of the patients. All-cause mortality rate was 9.8% (n = 51/521; 95% CI 7.5-12.7). Genetic syndromes are seen in approximately 15% of ToF patients. Long-term survival exceeds 90%, suggesting that surgical management should be dictated by anatomy regardless of genetics.


Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Tetralogia de Fallot/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Síndrome de DiGeorge/epidemiologia , Síndrome de Down/epidemiologia , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Valva Pulmonar/cirurgia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Tetralogia de Fallot/epidemiologia , Tetralogia de Fallot/etiologia , Tetralogia de Fallot/genética , Resultado do Tratamento
20.
Respir Med Case Rep ; 23: 52-54, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29276673

RESUMO

Clear cell tumor of the lung (CCTL) is an extremely rare neoplasm with about 50 cases reported in the literature so far. CCTL belongs to a family arising from putative perivascular epithelioid cells and is otherwise named as "sugar tumor" due to its high cellular glycogen concentration. Due to its rarity, diagnostic features of this entity are not widely known and this usually leads to misdiagnosis. Herein, we report a case of benign CCTL, which was primarily evaluated intraoperatively by FNA cytology and then by a pathological examination of the resected tumor. The cytologic preparations were moderately cellular and showed multiple large, irregular, cohesive clusters of ovoid or spindle tumor cells. Cells had clear cytoplasm, showing positivity with the periodic acid-Schiff (PAS) staining method owing to the glycogen (sugar) content. The rapid cytologic report excluded the possibility of malignancy and a middle lobectomy along with an anterior upper segmentectomy was performed. Immunochemistry revealed a diffuse positivity for HMB45, MART-1, SMA and focally for desmin, while specimen was negative for pancytokeratin cocktail AE1/AE3, cytokeratin7, cytokeratin20 and EMA. These findings confirmed the diagnosis of a benign CCTL. Due to its rarity and similarity with other clear cell tumors of the lung, awareness of this entity, recognition of the cytomorphologic features and familiarity with the associated clinical features can help clinicians avoid certain pitfalls in the diagnostic process. Considering its benign course, unnecessary extensive lung resections may also be avoided thus permitting conservative management of these patients.

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