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1.
J Cardiothorac Surg ; 16(1): 266, 2021 Sep 20.
Artigo em Inglês | MEDLINE | ID: mdl-34544460

RESUMO

BACKGROUND: To compare the short-term safety and efficacy of right anterolateral minithoracotomy (ALMT) and median sternotomy (MS) for the surgical treatment of atrial septal defects (ASDs). METHODS: The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for comparative studies focusing on surgical repair of ASDs via ALMT or MS published up to the end of April 27, 2020. We used random-effect or fixed-effect models to obtain pooled estimates. RESULTS: A total of 7 publications, including 665 patients (ALMT 296 and MS 369), were included. Age (WMD: 1.80 years, 95% CI 0.31-3.29), weight (WMD: - 0.91 kg, 95% CI - 5.57 to 3.75), sex distribution (OR: 1.00, 95% CI 0.74-1.35) and surgical type (patch or direct closure) (OR: 1.00, 95% CI 0.67-1.49) were comparable in the ALMT group and MS group. No significant differences in the success rate (OR 0.23; 95% CI 0.05-1.07) or severe complication rate (OR 1.46; 95% CI 0.41-5.22) were found between the ALMT group and the MS group. In addition, the differences in the cardiopulmonary bypass (CPB) time (WMD 6.33; 95% CI - 1.92 to 14.58 min, p = 0.13) and the operation time (WMD 5.23; 95% CI - 12.49 to 22.96 min, p = 0.56) between the ALMT group and the MS group were not statistically significant. However, the ALMT group had a significantly longer aortic cross-clamp time (2.37 min more, 95% CI 1.07-3.67 min, p = 0.0003). The intubation time was 1.82 h shorter (95% CI - 3.10 to - 0.55 h; p = 0.005), the intensive care unit (ICU) stay was 0.24 days shorter (95% CI - 0.44 to - 0.04 days; p = 0.02), and the postoperative hospital stay was 2.45 days shorter (95% CI - 3.01 to - 1.88 days; p < 0.00001) in the ALMT group than in the MS group. Furthermore, the incision length was significantly shortened by 8.97 cm in the ALMT group compared with the MS group (95% CI - 9.36 to - 8.58 cm; p < 0.00001). CONCLUSIONS: In the surgical treatment of ASD, ALMT and MS are equally safe and effective in terms of success rates and severe complication rates. The surgical procedures are equally difficult, but ALMT is associated with a faster functional recovery and better cosmetic results. Compared to MS, ALMT is the better choice for select ASD patients.


Assuntos
Comunicação Interatrial , Esternotomia , Comunicação Interatrial/cirurgia , Humanos , Recém-Nascido , Tempo de Internação , Procedimentos Cirúrgicos Minimamente Invasivos , Toracotomia , Resultado do Tratamento
2.
Braz J Cardiovasc Surg ; 35(4): 498-503, 2020 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-32864930

RESUMO

OBJECTIVE: To explore the postoperative changes in inflammatory markers in children who underwent device closure of an atrial septal defect (ASD) via a transthoracic or transcatheter approach. METHODS: The experimental and clinical data were retrospectively collected and analyzed for a total of 53 pediatric patients between September 2018 and December 2018. According to the different treatments, 19 patients who underwent transthoracic device closure were assigned to group A, and the remaining 34 patients who underwent a transcatheter approach were assigned to group B. RESULTS: All patients were successfully occluded without any device-related severe complication. Compared with the preoperative levels, the postoperative levels of most inflammatory cytokines in both groups were significantly increased and reached a peak on the first day after the procedure. The level of postoperative inflammatory cytokines was significantly lower in group B than in group A. In addition, there was no significant difference in procalcitonin before and after the transcatheter approach. CONCLUSION: Systemic inflammatory reactions occurred after transthoracic or transcatheter device closure of ASDs in pediatric patients. However, these inflammatory reactions were more significant in patients who underwent a transthoracic approach than in patients who underwent a transcatheter approach.


Assuntos
Comunicação Interatrial , Dispositivo para Oclusão Septal , Adolescente , Cateterismo Cardíaco/efeitos adversos , Criança , Pré-Escolar , Feminino , Comunicação Interatrial/cirurgia , Humanos , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Dispositivo para Oclusão Septal/efeitos adversos , Resultado do Tratamento
3.
Rev. bras. cir. cardiovasc ; 35(4): 498-503, July-Aug. 2020. tab
Artigo em Inglês | LILACS, Sec. Est. Saúde SP | ID: biblio-1137299

RESUMO

Abstract Objective: To explore the postoperative changes in inflammatory markers in children who underwent device closure of an atrial septal defect (ASD) via a transthoracic or transcatheter approach. Methods: The experimental and clinical data were retrospectively collected and analyzed for a total of 53 pediatric patients between September 2018 and December 2018. According to the different treatments, 19 patients who underwent transthoracic device closure were assigned to group A, and the remaining 34 patients who underwent a transcatheter approach were assigned to group B. Results: All patients were successfully occluded without any device-related severe complication. Compared with the preoperative levels, the postoperative levels of most inflammatory cytokines in both groups were significantly increased and reached a peak on the first day after the procedure. The level of postoperative inflammatory cytokines was significantly lower in group B than in group A. In addition, there was no significant difference in procalcitonin before and after the transcatheter approach. Conclusion: Systemic inflammatory reactions occurred after transthoracic or transcatheter device closure of ASDs in pediatric patients. However, these inflammatory reactions were more significant in patients who underwent a transthoracic approach than in patients who underwent a transcatheter approach.


Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Dispositivo para Oclusão Septal/efeitos adversos , Comunicação Interatrial/cirurgia , Período Pós-Operatório , Cateterismo Cardíaco/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento
4.
J Cardiothorac Surg ; 15(1): 2, 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31910876

RESUMO

BACKGROUND: We want to compare the impact on health-related quality of life (HRQoL) between the Star GK and the SJM valve in the Chinese population. METHODS: We retrospectively enrolled a total of 172 patients who had undergone mechanical mitral valve replacement (MVR) (SJM valve in 87 patients and Star GK valve in 85 patients) at our institution from January 2013 to December 2015. We measured the sound pressure level, and used 2 self-administered questionnaires and the Chinese version of SF-36 to measure the HRQoL and valve-specific questions to evaluate patient anxiety. RESULTS: The Star GK group and the SJM group were similar in age, gender, body surface area, diameter of the implanted valve, underlying disease and current median NYHA class. Regarding the valve sound pressure perceived 1 year after operation, the SJM valve was slightly quieter than the Star GK valve, but the sound pressures of the two valves showed no significant differences. No significant differences in any of the eight subscales of the SF-36 were found between the two groups. CONCLUSIONS: The present study suggests that the Star GK valve is similar to the SJM valve in its impact on HRQoL and audibility of mechanical sound in the Chinese population.


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Estenose da Valva Mitral/cirurgia , Qualidade de Vida , Adulto , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Desenho de Prótese , Reimplante , Estudos Retrospectivos , Inquéritos e Questionários
5.
Thorac Cardiovasc Surg ; 68(6): 492-497, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-31491792

RESUMO

BACKGROUND: The purpose of this study was to compare the opening and closing sounds of three different mechanical mitral valves and to analyze their effects on the quality of life of patients. METHODS: Ninety patients who underwent mechanical mitral valve replacement (MVR) were divided into three groups: those who received Advancing the Standard (ATS), St. Jude Medical (SJM), or Carbomedics (CM) mechanical valves. The sound pressure of the different valves was measured with a microphone. A detailed, self-designed questionnaire with a 1 to 10 analog scale and the 36-item Short Form Health Survey (SF-36) score was used to assess the quality of life of the patients. RESULT: The sound pressure measured by ATS was 64.4 ± 3.1 dB, while that measured by SJM, and CM was 64.5 ± 4.7 and 67.2 ± 5.3 dB, respectively. The overall subjective interference score in the ATS group was the lowest compared with that in the SJM and CM groups (ATS: 1.3 ± 0.9 dB, SJM: 3.9 ± 1.6 dB, CM: 4.1 ± 1.5 dB). Relatives and nonfamily members of the ATS group also had the lowest analog scale scores. Specific questions showed that the ATS valve had the least impact on sleep and daily life (impact on sleep: ATS: 4/30, SJM: 9/30, CM: 11/30, impact on daily life: ATS: 2/30, SJM: 8/30, CM: 8/30). The SF-36 score showed that there were significant differences in social functioning, role-emotional, mental health, and vitality. CONCLUSION: Patients receiving ATS mechanical MVR may be less disturbed by valve noise than those receiving SJM or CM mechanical MVR in a single Chinese cardiac center.


Assuntos
Percepção Auditiva , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Valva Mitral/cirurgia , Qualidade de Vida , Atividades Cotidianas , Adulto , China , Método Duplo-Cego , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Satisfação do Paciente , Pressão , Estudos Prospectivos , Desenho de Prótese , Som , Resultado do Tratamento
6.
Brain Res Bull ; 155: 145-154, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31846697

RESUMO

Deep hypothermia with circulatory arrest (DHCA) in cardiac surgery may exert a significant burden on the neuroinflammation which can cause brain injury. Resveratrol is a natural product and acts as a neuroprotective agent to suppress inflammatory response in brain. Even so, the specific mechanism regarding brain protective effect of resveratrol in DHCA is still unclear. In the current research, we tested brain protective function of resveratrol on neuroinflammation and cognition in rat DHCA model or hypothermic oxygen-glucose deprivation (OGD) model. The activation of microglial, cell apoptosis, inflammation in brain and circulation, NF-κB pathway were evaluated. We found that resveratrol treatment improved neurocognitive function and attenuated the neuroinflammation, cell apoptosis, microglial activation and NF-κB pathway after DHCA. The in vitro studies showed that resveratrol had similar neuroprotective effect in hypothermic OGD model. Importantly, we also found that the modulation of TRAF6 and RIP1 ubiquitination by A20 was playing a pivotal role in relation to the mechanism of resveratrol inhibiting NF-κB pathway. Thus, resveratrol expands the horizons for exploring treatment tactics to avert or restrict brain injury and related neurocognitive obstacles after DHCA.


Assuntos
Parada Circulatória Induzida por Hipotermia Profunda , Encefalite/prevenção & controle , Encefalite/fisiopatologia , Fármacos Neuroprotetores/administração & dosagem , Resveratrol/administração & dosagem , Animais , Apoptose/efeitos dos fármacos , Encéfalo/efeitos dos fármacos , Células Cultivadas , Parada Circulatória Induzida por Hipotermia Profunda/efeitos adversos , Encefalite/etiologia , Masculino , Microglia/efeitos dos fármacos , Ratos Sprague-Dawley , Transdução de Sinais/efeitos dos fármacos
7.
J Cardiothorac Surg ; 14(1): 218, 2019 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-31842949

RESUMO

OBJECTIVES: To investigate the health-related quality of life (HRQOL) in children and adolescents who underwent intraoperative device closure of perimembranous ventricular septal defects (pmVSDs). METHODS: From October 2017 to January 2018, a total of 126 children and adolescents with isolated pmVSDs who underwent intraoperative device closure were enrolled in this study. We used the Pediatric Quality of Life Inventory Measurement Models 4.0 generic core scales to measure HRQOL 24 h before the operation and three months and one year after surgery. RESULTS: A total of 126 patients were successfully occluded. No severe complications occurred during the operative time, and 1 case of Mobitz type I atrioventricular block (AVB) and 1 case of complete cAVB occurred during the postoperative period. Compared with the data before the operation, the total score and five domain scores, including physical, psychosocial, emotional, social and psychological functioning, were significantly higher at three months after the operation. In addition, the total score, physical functioning score, and the psychosocial functioning score at the 1-year follow-up were even higher than those at 3 months after the operation. CONCLUSIONS: The present study suggests that intraoperative device closure of pmVSD could improve health-related quality of life in children/adolescents and that the improvement may progress as the time after the operation increases. Further studies should concentrate on comparisons with other medical methods, larger samples, and longer follow-up periods.


Assuntos
Cateterismo Cardíaco , Comunicação Interventricular/cirurgia , Qualidade de Vida , Dispositivo para Oclusão Septal , Adolescente , Criança , China , Feminino , Comunicação Interventricular/psicologia , Humanos , Masculino , Desenho de Prótese , Resultado do Tratamento
8.
J Cardiothorac Surg ; 14(1): 176, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31639022

RESUMO

OBJECTIVE: To evaluate the health-related quality of life (HRQoL) of adult patients who underwent transthoracic device closure of ventricular septal defect (VSD). METHODS: During the perioperative and postoperative period, a standard scale involving eight dimensions was used to analyze the HRQoL of 85 adult patients who underwent thoracic device closure of VSD and 80 healthy adults located locally were randomly selected as the control group in our center. RESULTS: A total of 80 patients' and 80 healthy adults' questionnaires were received with complete feedback. Out of all of the items that were investigated, postoperative patients experienced better feelings in some dimensions than the control group. Postoperative feedback was also better than preoperative feedback in some dimensions. In the comparison of the subgroups of these patients, the scores of the elderly were lower than those of the young in most dimensions. Males had more positive feedback in two aspects ("role-physical" (p = 0.01) and "vitality" (p = 0.003)), whereas unmarried people seemed to have poor emotional responses ("role-emotional" (p < 0.01) and "vitality" (p = 0.023)). There was no significant difference in any dimensions except "social functioning" (p < 0.01) between people with different levels of education. CONCLUSIONS: Most of the adult patients who underwent thoracic closure of VSD felt that they could lead a normal life. They seemed to have reasonably normal psychosocial responses compared to healthy controls. Many patients even though their HRQoL was better than healthy individuals.


Assuntos
Cateterismo Cardíaco/métodos , Comunicação Interventricular/psicologia , Comunicação Interventricular/cirurgia , Qualidade de Vida , Dispositivo para Oclusão Septal , Adulto , Idoso , Escolaridade , Feminino , Comunicação Interventricular/epidemiologia , Humanos , Masculino , Estado Civil , Pessoa de Meia-Idade , Período Pós-Operatório , Inquéritos e Questionários , Resultado do Tratamento , Adulto Jovem
9.
J Cardiothorac Surg ; 14(1): 137, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324188

RESUMO

OBJECTIVE: To investigate the effect of valve noise on the quality of life (QOL) in Chinese patients who underwent mechanical mitral valve replacement. METHODS: We enrolled a total of 103 patients who underwent mechanical mitral valve replacement (MVR, CM valve in 52 patients, SJM valve in 51 patients) from January 2016 to December 2016 in our institution and used the SF-36 as an instrument to assess patients' QOL. RESULTS: Patients' QOL improved over time. Patients who experienced disturbances due to valve noise had lower SF-36 scores in each scale, especially in general health, vitality, and mental health. Only 8.74% (n = 9) of patients complained of valve noise 1 year after the operation compared to 19.42% (n = 20) in the first month after the operation. The number of patients who experienced disturbances due to valve noise decreased over time, with a P value of 0.58. Logistic regression analysis showed that female patients those aged < 60 years old had a higher risk of experiencing disturbances due to valve noise. The valve type (CM vs SJM), body mass index (BMI) and valve size showed no significant differences in patients who experienced disturbances due to continuous valve noise. The SF-36 results were similar in the CM group and SJM group 1 year after the operation. CONCLUSIONS: QOL evaluated by the SF-36 improved over time in Chinese patients who underwent mechanical MVR. Age less than 60 years and female sex were high risk factors for experiencing disturbances due to valve noise. CM and SJM mechanical valves demonstrated similar valve noise levels and impact on QOL in patients who experienced mechanical MVR.


Assuntos
Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Valva Mitral/cirurgia , Ruído/efeitos adversos , Qualidade de Vida/psicologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , China , Feminino , Seguimentos , Indicadores Básicos de Saúde , Próteses Valvulares Cardíacas/psicologia , Implante de Prótese de Valva Cardíaca/psicologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais
10.
J Cardiothorac Surg ; 14(1): 136, 2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31324190

RESUMO

BACKGROUND: Transcatheter and intraoperative device closure for atrial septal defect (ASD) are widely applied to reduce the incision size and the potential for injury during cardiopulmonary bypass (CPB) in conventional surgical repair. No studies had been conducted to compare the safety and efficiency of these three treatments. METHODS: From January 2018 to April 2018, 87 patients with an isolated ASD who had undergone transcatheter device closure (n = 45), intraoperative device closure (n = 22) and surgical repair (n = 20) were retrospectively reviewed and further analyzed to compare these three treatments. RESULTS: The successful closure rate was similar in the three groups. There was a significant difference in aortic cross-clamping time, CPB duration and operative time between the surgical group and the device groups. The length of intensive care unit stay, postoperative mechanical ventilation time and length of hospital stay were shorter in the two device groups than in the surgical group. The incision was the most extended in the surgical group. Regarding major adverse events, no significant differences were found among the three groups. CONCLUSIONS: Transcatheter and intraoperative device closure and surgical repair for ASD are all safe and effective. Considering their respective disadvantages and advantages, the transcatheter approach may be the first choice for an isolated secundum ASD, the intraoperative approach may be the second choice, and surgical repair may be the last resort.


Assuntos
Cateterismo Cardíaco/métodos , Comunicação Interatrial/cirurgia , Dispositivo para Oclusão Septal , Cateterismo Cardíaco/instrumentação , Ponte Cardiopulmonar , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Duração da Cirurgia , Avaliação de Resultados em Cuidados de Saúde , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
11.
J Cardiothorac Surg ; 14(1): 119, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248430

RESUMO

BACKGROUND: To investigate the safety and efficacy of perventricular device closure of perimembranous VSD (pmVSD). METHODS: PubMed and Scopus were searched for studies in English focusing on perventricular device closure of pmVSD published up to the end of March 2019. We used a random-effects model to obtain pooled estimates of the success and complication rates. RESULTS: A total of 15 publications comprising 1368 patients with pmVSD were included. The median follow-up duration was 2 months to 5 years, with a mean patient age ranging from 2 months to 56 years. The pooled success rate was 0.95 (I2 = 86.2%, P = 0.000). The pooled rate of postoperative residual shunting was 0.02 (95% CI: 0.01-0.03, I2 = 87.3%, P < 0.001). The pooled rate of residual shunting in the follow-up period was 0.001 (95% CI:-0.001-0.002, I2 = 30.5%, P = 0.126). The pooled estimated rate of severe complications was 0.074 (95% CI: 0.046-0.102, I2 = 30.5%, P = 0.126). The pooled incidence of complete atrioventricular block (cAVB) was 0.002 (95% CI: 0.000-0.005, I2 = 0.0%, P = 0.577). CONCLUSIONS: Perventricular device closure may be an alternative to conventional surgical repair in selected patients with pmVSD. The success rate was stable regarding the publication year and sample size and suggested both the short learning curve of this technology and its potential for wide application. The incidence of severe arrhythmia, especially cAVB, was low. These good results may be limited by the number of enrolled patients, and a more detailed and larger sample is required for further analysis.


Assuntos
Comunicação Interventricular/cirurgia , Dispositivo para Oclusão Septal , Adolescente , Adulto , Bloqueio Atrioventricular/etiologia , Cateterismo Cardíaco , Criança , Pré-Escolar , Feminino , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Resultado do Tratamento , Adulto Jovem
12.
J Cardiothorac Surg ; 14(1): 70, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30961628

RESUMO

BACKGROUND: Transthoracic device closure of ventricular septal defect (VSD) is widely used in the clinic, especially in China. Changes in inflammatory marker levels after transthoracic device closure of VSD in pediatric patients have not been reported. METHODS: We retrospectively collected clinical data for 85 pediatric patients in our hospital from September 2017 to January 2018. The patients were divided into two groups according to treatment (device group vs. surgical group). The clinical and experimental data from the two groups were statistically analyzed. RESULTS: Clinical outcomes were good in all patients without any fatal complications. Similar increasing trends in inflammatory markers (white blood cell (WBC) count, procalcitonin (PCT), C-reactive protein (CRP), and interleukin-6 (IL-6)) were found in the two groups, both of which showed noticeable systemic inflammatory responses. In addition, no significant difference in the postoperative levels of inflammatory markers was observed between these two groups. CONCLUSIONS: Although transthoracic device closure of VSD seems to be less traumatic and involves a quicker recovery, it also induces a systemic inflammatory response as measured by WBC count and PCT, CRP and IL-6 levels, and the altered trends in inflammatory markers were similar to those of conventional surgery under CPB.


Assuntos
Biomarcadores/sangue , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Comunicação Interventricular/cirurgia , Dispositivo para Oclusão Septal/efeitos adversos , Síndrome de Resposta Inflamatória Sistêmica/etiologia , Proteína C-Reativa/análise , Pré-Escolar , China , Feminino , Comunicação Interventricular/sangue , Humanos , Lactente , Interleucina-6/sangue , Contagem de Leucócitos/métodos , Masculino , Período Pós-Operatório , Pró-Calcitonina/sangue , Estudos Retrospectivos , Síndrome de Resposta Inflamatória Sistêmica/sangue , Resultado do Tratamento
13.
Thorac Cardiovasc Surg ; 67(1): 8-13, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29954030

RESUMO

BACKGROUND: Transthoracic device closure (TTDC) and surgical repair with right infra-axillary thoracotomy (SRRIAT) or with right submammary thoracotomy (SRSMT) are all the primary alternative treatments for restrictive perimembranous ventricular septal defect (pmVSD). However, few studies have compared them in terms of effectiveness and complications. METHODS: Patients with restrictive pmVSD undergoing TTDC, or SRRIAT, or SRSMT from March 2016 to February 2017 were retrospectively reviewed in our cardiac center. There were no differences in age (1.3 ± 1.2 vs 1.1 ± 1.1 vs 1.2 ± 1.1 years), gender (35/37 vs 30/33 vs 29/29), body weight (8.3 ± 2.6 vs 8.2 ± 2.4 vs 8.1 ± 2.5 kg), and size of VSD (4.2 ± 1.1 vs 5.2 ± 1.3 vs 5.1 ± 1.2 mm) distribution between the three groups. RESULTS: The procedure success rates were similar in the three groups. The TTDC group had the shortest operative time, postoperative mechanical ventilation time, duration of intensive care, postoperative length of hospital stay, medical cost, and length of the incision. There were no significant differences in terms of operative time, aortic cross-clamping time, duration of cardiopulmonary bypass (CPB), blood transfusion volume, mechanical ventilation time, duration of intensive care, duration of hospital stays, pleural fluid drainage, or cost between the SRSMT and SRRIAT groups. No significant differences were noted in terms of major adverse events. CONCLUSIONS: TTDC, SRRIAT, and SRSMT all showed excellent outcomes and cosmetic appearances for selected VSD patients. TTDC had advantages over SRRIAT and SRSMT in terms of short operation duration and smaller incision size and shorter durations of intensive care and hospital stays.


Assuntos
Comunicação Interventricular/cirurgia , Técnicas de Sutura , Toracotomia , Técnicas de Fechamento de Ferimentos/instrumentação , Pré-Escolar , Ecocardiografia Transesofagiana , Feminino , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/fisiopatologia , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Técnicas de Sutura/efeitos adversos , Toracotomia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/efeitos adversos , Cicatrização
14.
Heart Surg Forum ; 21(4): E242-E246, 2018 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-30084771

RESUMO

BACKGROUND: The purpose of this study was to assess the short- and mid-term follow-up results of transthoracic device closure of perimembranous ventricular septal defect (pmVSD) in adults. METHODS: Sixty-one adults underwent transthoracic device closure of pmVSD at our institution from Jan. 2012 to Jan. 2016. All relevant clinical data were recorded and analyzed. All patients were invited to undergo contrast transthoracic echocardiography (TTE) for 12 months to 60 months after VSD closure. Phone interviews were conducted to further evaluate the cardiac function status. RESULTS: All patients were successfully occluded using this procedure. The most frequent complication was transient cardiac arrhythmia, which was easily treated during the perioperative period. During the follow-up period, we found no recurrence, malignant arrhythmia, thrombosis, device embolization, valve damage, device failure, or cases of death. The total occlusion rate was 100 percent in the 12 months of follow-up, and most of patients showed significant improvement in their clinical status. From the TTE data, the intracardiac structure and cardiac function were improved in the follow-up. CONCLUSION: Transthoracic device closure of perimembranous ventricular septal defect in adults is a safe and feasible technique. The short- and mid-term follow-up results were satisfactory, but long-term follow-up is required to better assess the safety and feasibility of this method in adults.


Assuntos
Cateterismo Cardíaco/métodos , Comunicação Interventricular/cirurgia , Dispositivo para Oclusão Septal , Adulto , Ecocardiografia , Feminino , Seguimentos , Comunicação Interventricular/diagnóstico , Humanos , Masculino , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
15.
Ann Thorac Cardiovasc Surg ; 24(6): 308-314, 2018 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-30058611

RESUMO

BACKGROUND: Perventricular and transcatheter device closures are performed for perimembranous ventricular septal defect (pmVSD) to reduce the surgical trauma of conventional surgical repair via median sternotomy. Few comparative studies have been conducted among these three procedures. METHODS: From June 2015 to May 2016, 247 patients with isolated pmVSD who had undergone perventricular or transcatheter device closure or conventional surgical repair were reviewed to compare these three procedures. RESULTS: The procedure success rate was similar in these three groups. There were a statistically significant difference in operative time, aortic cross-clamping time, duration of cardiopulmonary bypass (CPB), blood transfusion amount, and medical cost in these three groups. Meanwhile, postoperative mechanical ventilation time, duration of intensive care, and length of hospital stay were longer in surgical group than the other two groups. The surgical group required the longest incision. No significant difference was noted in major adverse events. There were different advantages and disadvantages in these three kinds of procedures. CONCLUSIONS: Device closure may be alternative to conventional surgical repair for patients with isolated pmVSD. Perventricular device closure was the preferred procedure because it showed more maneuverable than transcatheter procedure with the same clinical result.


Assuntos
Cateterismo Cardíaco/instrumentação , Procedimentos Cirúrgicos Cardíacos/instrumentação , Comunicação Interventricular/terapia , Dispositivo para Oclusão Septal , Esternotomia , Transfusão de Sangue , Cateterismo Cardíaco/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte Cardiopulmonar , Pré-Escolar , Feminino , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/terapia , Desenho de Prótese , Respiração Artificial , Fatores de Risco , Esternotomia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
16.
J Cardiothorac Surg ; 13(1): 47, 2018 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-29783998

RESUMO

BACKGROUND: Right submammary thoracotomy and right vertical infra-axillary thoracotomy are performed for ventricular septal defect (VSD) to reduce the invasiveness of the conventional surgical repair through median sternotomy approach. No comparative studies have been conducted among these three procedures. METHODS: From January 2016 to December 2016, 182 patients with isolated VSD who underwent surgical repair via one of these 3 approaches were reviewed to compare these three procedures. RESULTS: The procedure success rates were similar in these three groups. There was no statistically significant difference in operative time, aortic cross-clamping time, the duration of CPB, blood transfusion amount and medical cost. However, postoperative mechanical ventilation time, the duration of intensive care and postoperative length of hospital stay were longer in median sternotomy group than the other two groups. (P < 0.05) The median sternotomy group required the longest incision. No significant difference was noted in major adverse events. There were different advantages and disadvantages in the three kinds of operative procedures. CONCLUSIONS: Regarding conventional surgical repair VSD, right submammary thoracotomy and right vertical infra-axillary thoracotomy both delivered better cosmetic results for patients with isolated VSD, while all the three procedures could obtain satisfactory clinical effect.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/cirurgia , Esternotomia/métodos , Toracotomia/métodos , Axila , Transfusão de Sangue/estatística & dados numéricos , Pré-Escolar , Feminino , Custos de Cuidados de Saúde , Humanos , Lactente , Unidades de Terapia Intensiva , Tempo de Internação/estatística & dados numéricos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Duração da Cirurgia , Período Pós-Operatório , Respiração Artificial , Estudos Retrospectivos , Resultado do Tratamento
17.
Ann Thorac Surg ; 105(6): 1797-1802, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29596821

RESUMO

BACKGROUND: This study summarizes the clinical experience and 8-year follow-up results of the intraoperative device closure of ventricular septal defects (VSD). METHODS: From January 2009 to June 2017, 1,090 patients with isolated VSD were enrolled at our institute to participate in the study. The procedure involved a small lower sternal incision that was performed after full evaluation of VSD by transesophageal/transthoracic echocardiographic (TEE/TTE) guidance and the deployment of a domestically made occluder to close the VSD periventricularly and off cardiopulmonary bypass. Follow-up was in the first 3 months and then every 1 to 2 years with TTE, electrocardiography, and upon symptoms. RESULTS: In all, 1,033 patients were occluded successfully under this approach, and the remaining patients were converted to surgical repair. The size of the occluder deployed ranged from 6 to 14 mm and included 825 symmetric devices and 208 asymmetric devices. A total of 25 patients developed severe arrhythmias, including 11 cases of complete atrioventricular block and 14 cases of Mobitz type II atrioventricular block, during and after the procedure. CONCLUSIONS: Minimally invasive transthoracic device closure of VSD with an asymmetric or symmetric domestically made device on a beating heart is a safe and feasible alternative to conventional surgical repair. More experience in multicenter and long-term follow-up is necessary to assess the actual feasibility and safety of this procedure.


Assuntos
Ecocardiografia Transesofagiana/métodos , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Dispositivo para Oclusão Septal , Cirurgia Assistida por Computador/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Criança , Pré-Escolar , Estudos de Coortes , Ecocardiografia/métodos , Eletrocardiografia/métodos , Feminino , Seguimentos , Humanos , Cuidados Intraoperatórios/métodos , Masculino , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Resultado do Tratamento
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