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3.
Arq Bras Cardiol ; 105(2 Suppl 1): 1-105, 2015 Aug.
Artigo em Português | MEDLINE | ID: mdl-26375058
4.
Rev. bras. cir. cardiovasc ; 29(4): 494-504, Oct-Dec/2014. tab, graf
Artigo em Inglês | LILACS | ID: lil-741721

RESUMO

Objective: To compare in-hospital outcomes in aortic surgery in our cardiac surgery unit, before and after foundation of our Center for Aortic Surgery (CTA). Methods: Prospective cohort with non-concurrent control. Foundation of CTA required specialized training of surgical, anesthetic and intensive care unit teams, routine neurological monitoring, endovascular and hybrid facilities, training of the support personnel, improvement of the registry and adoption of specific protocols. We included 332 patients operated on between: January/2003 to December/2007 (before-CTA, n=157, 47.3%); and January/2008 to December/2010 (CTA, n=175, 52.7%). Baseline clinical and demographic data, operative variables, complications and in-hospital mortality were compared between both groups. Results: Mean age was 58±14 years, with 65% male. Group CTA was older, had higher rate of diabetes, lower rates of COPD and HF, more non-urgent surgeries, endovascular procedures, and aneurysms. In the univariate analysis, CTA had lower mortality (9.7 vs. 23.0%, P=0.008), which occurred consistently across different diseases and procedures. Other outcomes which were reduced in CTA included lower rates of reinterventions (5.7 vs 11%, P=0.046), major complications (20.6 vs. 33.1%, P=0.007), stroke (4.6 vs. 10.9%, P=0.045) and sepsis (1.7 vs. 9.6%, P=0.001), as compared to before-CTA. Multivariable analysis adjusted for potential counfounders revealed that CTA was independently associated with mortality reduction (OR=0.23, IC 95% 0.08 – 0.67, P=0.007). CTA independent mortality reduction was consistent in the multivariable analysis stratified by disease (aneurysm, OR=0.18, CI 95% 0.03 – 0.98, P=0.048; dissection, OR=0.31, CI 95% 0.09 – 0.99, P=0.049) and by procedure (hybrid, OR=0.07, CI 95% 0.007 – 0.72, P=0.026; Bentall, OR=0.18, CI 95% 0.038 – 0.904, P=0.037). Additional multivariable predictors of in-hospital mortality included creatinine ...


Objetivo: Comparar desfechos intrahospitalares em pacientes submetidos a cirurgia da aorta torácica e toracoabdominal, antes e após a constituição do Centro Especializado de Tratamento da Aorta (CTA). Métodos: Coorte prospectiva com controle não contemporâneo. A criação do CTA envolveu treinamento cirúrgico especializado, sala híbrida, monitorização neurológica, capacitação de pessoal de apoio, aperfeiçoamento dos registros e uso de protocolos específicos. Foram incluídos 332 pacientes operados em 2 períodos: janeiro/2003 a dezembro/2007 (pré-CTA, n=157, 47,3%); e janeiro/2008 a dezembro/2010 (CTA, n=175, 52,7%). As características demográficas, clínicas, dados cirúrgicos, complicações e mortalidade hospitalar foram comparados nos 2 grupos. Resultados: A idade média foi 58±14 anos, com 65% sexo masculino. O grupo CTA teve idade, prevalência de diabete (DM) e glicemia maiores; menor prevalência de doença pulmonar obstrutiva crônica e insuficiência cardíaca; maior proporção de aneurismas e cirurgias eletivas; e mais procedimentos endovasculares que o pré-CTA. Na análise univariada, o grupo CTA mostrou redução de mortalidade (9,7% x 23,0%, P=0,008), que foi consistente nos diferentes subgrupos estratificados por patologia e por procedimento. O grupo CTA teve também redução de reoperações (5,7% x 11%, P=0,046), complicações maiores (20,6% x 33,1%, P=0,007), acidente vascular cerebral (4,6% x 10,9%, P=0,045) e sepse (1,7% x 9,6%, P=0,001), comparado ao pré-CTA. Na análise multivariada, o CTA se associou de forma independente a redução de mortalidade hospitalar (OR=0,23, IC 95% 0,08 - 0,67, P=0,007). A redução de mortalidade do CTA também ocorreu na análise estratificada por patologia (cirurgias de aneurisma, OR=0,18, IC 95% 0,03 - 0,98, P=0,048; cirurgias de dissecção, OR=0,31, IC 95% 0,09 - 0,99, P=0,049) e por procedimento (híbridos, OR=0,07, IC 95% 0,007 - 0,72, P=0,026; Bentall, OR=0,18, IC 95% 0,038 – 0,904, P=0,037). Também foram ...


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aorta/cirurgia , Doenças da Aorta/mortalidade , Doenças da Aorta/cirurgia , Hospitais Especializados/estatística & dados numéricos , Valva Aórtica/cirurgia , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/mortalidade , Métodos Epidemiológicos , Procedimentos Endovasculares/métodos , Mortalidade Hospitalar , Unidades de Terapia Intensiva , Tempo de Internação , Fatores Sexuais , Resultado do Tratamento
5.
Rev Bras Cir Cardiovasc ; 29(4): 494-504, 2014 Oct-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25714201

RESUMO

OBJECTIVE: To compare in-hospital outcomes in aortic surgery in our cardiac surgery unit, before and after foundation of our Center for Aortic Surgery (CTA). METHODS: Prospective cohort with non-concurrent control. Foundation of CTA required specialized training of surgical, anesthetic and intensive care unit teams, routine neurological monitoring, endovascular and hybrid facilities, training of the support personnel, improvement of the registry and adoption of specific protocols. We included 332 patients operated on between: January/2003 to December/2007 (before-CTA, n=157, 47.3%); and January/2008 to December/2010 (CTA, n=175, 52.7%). Baseline clinical and demographic data, operative variables, complications and in-hospital mortality were compared between both groups. RESULTS: Mean age was 58±14 years, with 65% male. Group CTA was older, had higher rate of diabetes, lower rates of COPD and HF, more non-urgent surgeries, endovascular procedures, and aneurysms. In the univariate analysis, CTA had lower mortality (9.7 vs. 23.0%, P=0.008), which occurred consistently across different diseases and procedures. Other outcomes which were reduced in CTA included lower rates of reinterventions (5.7 vs 11%, P=0.046), major complications (20.6 vs. 33.1%, P=0.007), stroke (4.6 vs. 10.9%, P=0.045) and sepsis (1.7 vs. 9.6%, P=0.001), as compared to before-CTA. Multivariable analysis adjusted for potential confounders revealed that CTA was independently associated with mortality reduction (OR=0.23, IC 95% 0.08 - 0.67, P=0.007). CTA independent mortality reduction was consistent in the multivariable analysis stratified by disease (aneurysm, OR=0.18, CI 95% 0.03 - 0.98, P=0.048; dissection, OR=0.31, CI 95% 0.09 - 0.99, P=0.049) and by procedure (hybrid, OR=0.07, CI 95% 0.007 - 0.72, P=0.026; Bentall, OR=0.18, CI 95% 0.038 - 0.904, P=0.037). Additional multivariable predictors of in-hospital mortality included creatinine (OR=1.7 [1.1-2.6], P=0.008), urgent surgery (OR=5.0 [1.5-16.7], P=0.008) and thoracoabdominal aneurysm (OR=24.6 [3.1-194.1], P=0.002). CONCLUSION: Thoracic aorta surgery in specialized center was associated with lower incidence of complications and all-cause mortality as compared to usual care.


Assuntos
Aorta/cirurgia , Doenças da Aorta/mortalidade , Doenças da Aorta/cirurgia , Hospitais Especializados/estatística & dados numéricos , Adulto , Idoso , Valva Aórtica/cirurgia , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/mortalidade , Procedimentos Endovasculares/métodos , Métodos Epidemiológicos , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Resultado do Tratamento
6.
Arq. bras. cardiol ; 83(supl.4): 1-86, set. 2004. ilus, tab
Artigo em Português | LILACS | ID: lil-389546
9.
Arq. bras. cardiol ; 67(4): 243-247, Out. 1996.
Artigo em Português | LILACS | ID: lil-319249

RESUMO

PURPOSE: To evaluate pulmonary function of patients submitted to muscle flap for treatment of mediastinitis. METHODS: Fifteen patients operated with the muscle flap technique were compared with 26 consecutive patients submitted to heart surgery with extracorporeal circulation, that did not present wound complications. Both groups were evaluated for age, sex, body weight, height, surgery, forced vital capacity (FVC), forced expiratory volume in first second (FEV1) and the relation (FEV1/FVC) in absolute and percentual values, espirometry conclusions and clinical evidences of lung disease. RESULTS: There was no statistical difference between preoperative and postoperative period for FVC (p = 0.98), FEV1 (p = 0.68) and FEV1/FVC (p = 0.30) in the group with no sternal complications. In the control group, the median of FVC was 3907 +/- 1053.25 and in the study group was 2818 +/- 766.86 in absolute values (p = 0.0015). The median of FEV1, in the control group, was 2995 +/- 855.68 and in the study group was 2232 +/- 617.68 in absolute values (p = 0.0046). There was statistical difference, between groups, in FVC (104.78 +/- 21.73 and 82.04 +/- 21.16) and FEV1 (99 +/- 22.67 and 79.04 +/- 19.17) in percentual (p = 0.0026 and 0.0067) values. There was no statistical difference for the ratio FEV1/FVC. The study group had five patients diagnosed as having restrictive ventilatory insufficiency by espirometry against none in the control group (p = 0.0031). CONCLUSION: Patients with infectious complications of sternum and mediastinum, treated surgically with muscle flap rotation may present restrictive pulmonary insufficiency in moderate degree, that must be considered in this situation.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Cardíacos , Infecção da Ferida Cirúrgica/cirurgia , Mediastinite , Retalhos Cirúrgicos/efeitos adversos , Esterno , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/fisiopatologia , Mediastinite
10.
Rev. méd. St. Casa ; 2(3): 293-5, dez. 1990.
Artigo em Português | LILACS | ID: lil-99746

RESUMO

Os autores apresentam os aspectos atuais sobre a fisiopatogenia do infarto agudo do miocardio e a importancia do seu entendimento na esquematizacao terapeutica.. Sao destacados os dados da literatura referentes ao papel dos betabloqueadores e dos antagonistas do calcio na moderna terapeutica do infarto agudo


Assuntos
Humanos , Masculino , Feminino , Angina Instável/tratamento farmacológico , Bloqueadores dos Canais de Cálcio/uso terapêutico , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/tratamento farmacológico , Atenolol/uso terapêutico , Diltiazem/uso terapêutico , Metoprolol/uso terapêutico , Nifedipino/uso terapêutico , Propranolol/uso terapêutico , Timolol/uso terapêutico , Verapamil/uso terapêutico
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