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2.
Ann Thorac Surg ; 2022 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-35452664

RESUMO

BACKGROUND: Transfusion in acute aortic syndromes has been studied in a limited fashion. We sought to describe contemporary transfusion practice for root replacement in acute (Stanford) type A aortic dissection. METHODS: The Society of Thoracic Surgeons Adult Cardiac Surgery Database was interrogated to identify patients who underwent primary aortic root replacement for acute (Stanford) type A aortic dissection (July 2014 to June 2017). Patients (n = 1558) were stratified by type of root replacement. Multivariate regression was used to determine those variables associated with transfusion and postoperative morbidity. RESULTS: Transfusion was required in 90.5% of cases (n = 1410). Operative mortality for all patients was 17.3% (261 deaths). Intraoperative red blood cell transfusion portended reduced short-term survival (odds ratio [OR] 2.00, P = .025). Massive postoperative transfusion was associated with prolonged ventilation (OR 13.47, P < .001), sepsis (OR 4.13, P < .001), and new dialysis-dependent renal failure (OR 2.43, P < .001). Women were more likely to require transfusion (OR 3.03, P < .001), as were patients who had coronary artery bypass (OR 1.57, P = .009), and those in shock (OR 2.27, P < .001). Valve-sparing aortic root replacement was associated with reduced transfusion requirements vs composite roots. Institutional case volume was not appreciably correlated with transfusion. CONCLUSIONS: Most patients undergoing root replacement for aortic dissection require blood products. Composite root replacement is associated with a greater likelihood of transfusion than a valve-sparing operation. Transfusion independently foreshadows greater operative mortality.

4.
J Cardiol ; 2022 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-35016808

RESUMO

A shift to lifetime management has gained more focus with the approval of low-risk transcatheter aortic valve replacement (TAVR). This paper is therefore focused on the different approaches for lifetime management. Herein we discuss the procedural safety, durability, performance, and future options for each lifetime management strategy. In younger patients that elect to undergo surgical aortic valve replacement (SAVR), options for bioprosthetic failure are TAV-in-SAV or redo SAVR. Among patients that undergo TAVR, options for valve failure include TAVR explant with SAVR or TAV-in-TAV. Additionally, there are patients who may require a third valvular intervention. The initial therapy may limit re-intervention options down the road. This review discusses how options for future therapies affect the decision of SAVR vs TAVR in younger patients.

5.
J Thorac Cardiovasc Surg ; 163(5): 1839-1846.e1, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-32653282

RESUMO

OBJECTIVE: Debate continues as to the optimal minimally invasive treatment modality for complex disease of the left anterior descending coronary artery, with advocates for both robotic-assisted minimally invasive direct coronary artery bypass and percutaneous coronary intervention with a drug-eluting stent. We analyzed the midterm outcomes of patients with isolated left anterior descending disease, revascularized by minimally invasive direct coronary artery bypass or drug-eluting stent percutaneous coronary intervention, focusing on those with complex lesion anatomy. METHODS: A retrospective review was undertaken of all patients who underwent coronary revascularization between January 2008 and December 2016. From this population, 158 propensity-matched pairs of patients were generated from 158 individuals who underwent minimally invasive direct coronary artery bypass for isolated complex left anterior descending disease and from 373 patients who underwent percutaneous coronary intervention using a second-generation drug-eluting stent. Midterm survival and incidence of repeat left anterior descending intervention were analyzed for both patient groups. RESULTS: Overall 9-year survival was not significantly different between patient groups both before and after propensity matching. Midterm mortality in the matched minimally invasive direct coronary artery bypass group was low, irrespective of patient risk profile. By contrast, advanced age (hazard ratio, 1.10; P = .012) and obesity (hazard ratio, 1.09; P = .044) predicted increased late death after drug-eluting stent percutaneous coronary intervention among matched patients. Patients who underwent minimally invasive direct coronary artery bypass were significantly less likely to require repeat left anterior descending revascularization than those who had percutaneous coronary intervention, both before and after propensity matching. Smaller stent diameter in drug-eluting stent percutaneous coronary intervention was associated with increased left anterior descending reintervention (hazard ratio, 3.53; P = .005). CONCLUSIONS: In patients with complex disease of the left anterior descending artery, both minimally invasive direct coronary artery bypass and percutaneous coronary intervention are associated with similar excellent intermediate-term survival, although reintervention requirements are lower after surgery.


Assuntos
Doença da Artéria Coronariana , Estenose Coronária , Stents Farmacológicos , Intervenção Coronária Percutânea , Constrição Patológica/etiologia , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Intervenção Coronária Percutânea/efeitos adversos , Resultado do Tratamento
7.
Cardiol Rev ; 2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34380944

RESUMO

Over the last decade multiple transcatheter mitral valve repair and replacement strategies have emerged, yet there is only one US Food and Drug Administration approved device, the MitraClip (Abbott Vascular, Inc., Santa Clara, California). Current guidelines support the use of the MitraClip in high or prohibitive surgical risk patients, but there are many patients that are not anatomically suited for the device. This review article discusses the approach to degenerative and functional mitral regurgitation in the high-prohibitive risk patient, how to choose transcatheter treatment options (both approved and investigational), and potential management for therapy failure.

8.
J Card Surg ; 35(12): 3354-3361, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32996186

RESUMO

BACKGROUND: Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) has become a valuable option in patients with bioprosthetic failure. However, potential issues with ViV TAVR may occur in patients with high-risk anatomy for coronary obstruction and patients with baseline smaller bioprosthetic valves at risk for patient prosthesis mismatch. The purpose of this study was, therefore, to use preoperative electrocardiography-gated, multidetector computed tomography (MDCT) in patients undergoing isolated surgical aortic valve replacement (SAVR) to (1) identify which would be high risk for coronary occlusion with ViV TAVR, and (2) predict intraoperative SAVR sizing. METHODS: Among 223 patients from our institutions' database that underwent SAVR for aortic insufficiency (AI) or aortic stenosis (AS) between January 2012 and January 2020, 48 patients had MDCT imaging before surgery (AI; n = 31, AS; n = 17). Of all patients, 67% (n = 32) were bicuspid morphology. RESULTS: With the use of virtual valve implantation, all patients with AI and bicuspid AS had feasible anatomy for ViV TAVR, while 38% of patients with tricuspid AS were high risk for coronary obstruction. There was a strong correlation between actual valve size implanted and preoperative MDCT measurements using annulus average diameter, area, and/or perimeter. CONCLUSION: Preoperative MDCT in patients undergoing SAVR is a useful tool for lifetime management, particularly in patients with tricuspid AS. Decisions for surgical management may change based on MDCT's ability to predict intraoperative SAVR size and determine which patients may be high-risk candidates for future ViV TAVR due to coronary artery obstruction.


Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Humanos , Tomografia Computadorizada Multidetectores , Resultado do Tratamento
9.
Crit Care Clin ; 36(4): 617-630, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32892817

RESUMO

Enhanced recovery after surgery (ERAS) protocols recognize early postoperative mobilization as a driver of faster postoperative recovery, return to normal activities, and improved long-term patient outcomes. For patients undergoing open cardiac surgery, an opportunity for facilitating earlier mobilization and a return to normal activity lies in the use of improved techniques to stabilize the sternal osteotomy. By following the key orthopedic principles of approximation, compression, and rigid fixation, a more nuanced approach to sternal precaution protocols is possible, which may enable earlier patient mobilization, physical rehabilitation, and recovery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Esternotomia , Placas Ósseas , Fios Ortopédicos , Humanos , Esterno , Resultado do Tratamento
10.
J Card Surg ; 35(10): 2710-2718, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32725629

RESUMO

BACKGROUND: Hybrid coronary revascularization (HCR) constitutes a left internal mammary artery graft to the left anterior descending (LAD) coronary artery, coupled with percutaneous coronary intervention (PCI) for non-LAD lesions. This management strategy is not commonly offered to patients with complex multivessel disease. Our objective was to evaluate 8-year survival in patients with triple-vessel disease (TVD) treated by HCR, compared with that of concurrent matched patients managed by traditional coronary artery bypass grafting (CABG) or multivessel PCI. METHODS: A retrospective review was undertaken of 4805 patients with TVD who presented between January 2009 and December 2016. A cohort of 100 patients who underwent HCR were propensity-matched with patients treated by CABG or multivessel PCI. The primary endpoint was all-cause mortality at 8 years. RESULTS: Patients with TVD who underwent HCR had similar 8-year mortality (5.0%) as did those with CABG (4.0%) or multivessel PCI (9.0%). A composite endpoint of death, repeat revascularization, and new myocardial infarction, was not significantly different between patient groups (HCR 21.0% vs CABG 15.0%, P = .36; HCR 21.0% vs PCI 25.0%, P = .60). Despite a higher baseline synergy between percutaneous coronary intervention with taxus and cardiac surgery(SYNTAX) score, HCR was able to achieve a lower residual SYNTAX score than multivessel PCI (P = .001). CONCLUSIONS: In select patients with TVD, long-term survival and FREEDOM from major adverse cardiovascular events after HCR are similar to that seen after traditional CABG or multivessel PCI. HCR should be considered for patients with multivessel disease, presuming a low residual SYNTAX score can be achieved.


Assuntos
Doença da Artéria Coronariana/cirurgia , Revascularização Miocárdica/métodos , Idoso , Ponte de Artéria Coronária , Doença da Artéria Coronariana/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Revascularização Miocárdica/mortalidade , Intervenção Coronária Percutânea , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
11.
Innovations (Phila) ; 15(2): 177-179, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32352899

RESUMO

Galactorrhea, or nonpuerperal lactation, is a rare complication that can occur after trauma to the chest wall. Although galactorrhea has been reported after thoracic surgery, it has not been previously noted as a potential outcome following cardiac surgery. We present a unique case of hyperprolactinemic galactorrhea experienced by a 39-year-old nongravid female patient after having undergone reoperative mitral valve replacement via a right minithoracotomy. To the best of our knowledge, this is the first reported case of spontaneous lactation occurring after cardiac surgery.


Assuntos
Galactorreia/etiologia , Estenose da Valva Mitral/cirurgia , Reoperação/efeitos adversos , Adulto , Bioprótese , Cabergolina/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Agonistas de Dopamina/uso terapêutico , Feminino , Galactorreia/tratamento farmacológico , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Prolactina/sangue , Toracotomia/métodos , Resultado do Tratamento
12.
Ann Thorac Surg ; 110(4): 1225-1233, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32119850

RESUMO

BACKGROUND: Data on blood use in proximal aortic surgery is limited. This study sought to establish quality benchmarks in the pattern of transfusion during elective aortic root replacement. METHODS: The Society of Thoracic Surgeons Adult Cardiac Surgery Database was queried to identify all patients who underwent primary elective aortic root replacement between July 2014 and June 2017. Multivariable negative binomial regressions were used to determine whether perioperative transfusion was associated with demographic or procedural factors. Multivariable logistic regression analysis was performed for clinical outcomes. RESULTS: Of 5559 patients analyzed, 38.95% (n = 2165) received no blood products. Patients who had a valve-sparing root replacement were less likely to undergo transfusion than those who received composite roots (bioprosthetic or mechanical valves) or homografts. The 30-day mortality for all patients was 2.57% (n = 143). Transfusion was associated with an increased risk of death at 30 days (odds ratio [OR], 1.833; P = .012), more frequent reoperation for bleeding (OR, 1.766; P < .001), prolonged ventilation (OR, 1.935; P < .001), a longer postoperative hospital stay (OR, 1.056; P < .001), and a higher incidence of new dialysis-dependent renal failure (OR, 2.088; P = .003). There was no correlation between institutional case volume and transfusion practice. CONCLUSIONS: Elective aortic root replacement can be performed with acceptable requirements for blood products. Composite root replacement has a greater likelihood of transfusion than does a valve-sparing procedure. Transfusion is independently associated with more complications after elective aortic root surgery, including 30-day mortality.


Assuntos
Doenças da Aorta/cirurgia , Transfusão de Sangue , Implante de Prótese Vascular , Implante de Prótese de Valva Cardíaca , Adulto , Idoso , Bases de Dados Factuais , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
13.
Surg Clin North Am ; 100(2): 219-236, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32169177

RESUMO

Robotic minimally invasive direct coronary artery bypass is the most common robotic coronary procedure performed worldwide. It can be used to treat isolated left anterior descending (LAD) stenosis or can be coupled with percutaneous coronary intervention to diseased non-LAD targets in patients with multivessel disease. Virtually all types of mitral valve repair can be performed using the robot; valve replacement can also be undertaken. The robot can be used to repair atrial septal defects and resect cardiac myxoma. Increased cost of the robotic procedure may be offset by fewer perioperative complications, shorter hospital stay, and faster postoperative recovery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Ponte de Artéria Coronária , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Insuficiência da Valva Mitral/cirurgia , Revascularização Miocárdica , Intervenção Coronária Percutânea
14.
Innovations (Phila) ; 15(2): 131-137, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893954

RESUMO

OBJECTIVE: There is a high prevalence of concomitant coronary artery disease (CAD) and aortic stenosis (AS), and these conditions can be treated with a variety of invasive and/or percutaneous approaches. The aim of this study is to demonstrate the feasibility, efficacy, and safety of a staged transcatheter aortic valve replacement (TAVR) after a hybrid minimally invasive direct coronary artery bypass surgery (MIDCAB) to treat combined complex CAD and AS. METHODS: Six patients with concomitant CAD and severe AS underwent staged treatment of their CAD with MIDCAB and TAVR. All patients had significant complex left main or left anterior descending artery (LAD) stenosis deemed to be not amenable to percutaneous coronary intervention (PCI). RESULTS: The average syntax score was 22±8 and the Society of Thoracic Surgeons score for surgical AVR was 8±3%. All patients underwent a single vessel MIDCAB for revascularization of the LAD (three patients required additional PCI for non-LAD disease). Two patients had pre-TAVR balloon aortic valvuloplasty and one patient also required treatment of severe mitral valve regurgitation with percutaneous edge-to-edge repair (the MitraClip). There was no intraprocedural or hospital mortality. No neurological deficits or vascular complications were recorded. CONCLUSIONS: A hybrid staged approach for combined complex CAD and severe AS with MIDCAB, PCI, and TAVR is a valid option in high-risk patients. The order and timing of these procedures must be tailored to the patient's clinical symptoms, stability, and severity of disease.


Assuntos
Estenose da Valva Aórtica/cirurgia , Ponte de Artéria Coronária/instrumentação , Doença da Artéria Coronariana/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/complicações , Doença da Artéria Coronariana/complicações , Estudos de Viabilidade , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/tendências , Intervenção Coronária Percutânea/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Segurança , Índice de Gravidade de Doença , Resultado do Tratamento
15.
J Card Surg ; 34(10): 976-982, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31376216

RESUMO

BACKGROUND: There is, as yet, no broad consensus regarding the optimal surgical approach for patients requiring reoperative mitral valve surgery. Consequently, we sought to evaluate the perioperative outcomes for patients undergoing redo mitral surgery via right mini thoracotomy as compared with traditional resternotomy. METHODS: A comprehensive retrospective review of our prospectively collected database was undertaken from January 2011 to December 2017. We propensity matched 90 patients who underwent reoperative mitral valve surgery via right mini thoracotomy with a concurrent cohort of patients who had redo median sternotomy. Intraoperative data and short-term clinical outcomes were analyzed. RESULTS: The 30-day mortality was 3.3% (six deaths) in the entire cohort, not significantly different between redo sternotomy and mini thoracotomy groups. Patients who had their procedure via right mini thoracotomy had reduced intensive care unit (P = .029) and overall hospital (P < .0001) lengths of stay, a diminished requirement for perioperative transfusion (P = .023), and a trend towards faster postoperative extubation. Right thoracotomy patients experienced shorter cardiopulmonary bypass (P = .012) and cardiac arrest (P < .0001) times than did the sternotomy cases. Peripheral cannulation was utilized more frequently in the mini thoracotomy group, as were fibrillatory arrest techniques. CONCLUSION: Reoperative mitral valve surgery via right mini thoracotomy is safe, and is associated with shorter extracorporeal circulation times, reduced transfusion, and faster postoperative recovery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Pontuação de Propensão , Esternotomia/métodos , Toracotomia/métodos , Idoso , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Reoperação/métodos , Estudos Retrospectivos , Estados Unidos/epidemiologia
16.
Heart Surg Forum ; 22(4): E298-E300, 2019 07 25.
Artigo em Inglês | MEDLINE | ID: mdl-31398096

RESUMO

Subclinical and clinical thrombosis of bioprosthetic cardiac valves is more common than has been previously recognized. We present a unique case of acute thrombosis of a bioprosthetic mitral valve in a 40-year-old female patient undergoing hormonal stimulation as part of in vitro fertilization therapy, who also had concomitant protein C deficiency that was undiagnosed at the time. To the best of our knowledge, this is the first reported case of acute bioprosthetic valve thrombosis in this complex thrombophilic milieu, and suggests the need for increased screening for prothrombotic risk factors in female patients with bioprosthetic valves before they commence gonadotropin stimulation therapy.


Assuntos
Bioprótese/efeitos adversos , Fertilização In Vitro/efeitos adversos , Doenças das Valvas Cardíacas/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Valva Mitral , Deficiência de Proteína C/complicações , Trombose/etiologia , Doença Aguda , Adulto , Feminino , Fármacos para a Fertilidade Feminina/administração & dosagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Humanos , Leuprolida/administração & dosagem , Valva Mitral/cirurgia , Reoperação , Fatores de Risco , Trombose/diagnóstico por imagem , Trombose/cirurgia
17.
Eur J Cardiothorac Surg ; 55(5): 867-873, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30590416

RESUMO

OBJECTIVES: Ring annuloplasty reduces the septal-lateral diameter (SLD) indirectly by circumferential annular cinching and frequently results in the recurrence of mitral regurgitation (MR) in patients with functional MR (FMR). Our goal was to report the results from the trial and the 2-year post-trial surveillance data. We evaluated whether direct reduction of the SLD with a transannular mitral bridge could achieve significant and durable MR reduction in patients with FMR. METHODS: In a prospective trial, 34 consecutive patients with FMR had a mitral bridge implanted surgically. Primary end points were MR ≤1+ at 1, 3 and 6 months postimplant and freedom from subsequent surgical mitral valve repair or replacement. RESULTS: Thirty-two of 34 (94.1%) patients met the primary end points with MR ≤1+ at 6 months. At 2 years, there were no strokes or device-related adverse events. At 2 years, MR was reduced from 3.32 ± 0.47 to 0.50 ± 0.83 (P ≤ 0.001) with ≤1+ MR in 33/34 patients, including 4 reinterventions for periprosthetic recurrent MR ≥3 without mitral bridge explants or conventional mitral repair or replacement. At 2 years, the mean mitral gradient was 2.15 ± 0.82 mmHg; the mitral annular SLD decreased from 40.4 ± 2.91 mm to 28.9 ± 1.55 mm (P ≤ 0.001). The left ventricular ejection fraction increased (57.9 ± 10.4-62.4 ± 9.7%; P ≤ 0.001). The New York Heart Association functional class improved (2.19 ± 0.76-1.41 ± 0.61; P ≤ 0.001). CONCLUSIONS: The single-centre trial data indicate that direct reduction in the SLD with a mitral bridge is feasible, safe and efficacious in patients with FMR. Validation in a larger population of patients and comparison to conventional annuloplasty ring are necessary. CLINICAL TRIAL REGISTRATION NUMBER: NCT03511716.


Assuntos
Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso , Feminino , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Anuloplastia da Valva Mitral/instrumentação , Anuloplastia da Valva Mitral/mortalidade , Anuloplastia da Valva Mitral/estatística & dados numéricos , Insuficiência da Valva Mitral/fisiopatologia , Estudos Prospectivos , Recidiva , Resultado do Tratamento
18.
Innovations (Phila) ; 13(4): 273-281, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30142111

RESUMO

OBJECTIVE: The commercially available C-Port distal anastomotic device (Food and Drug Administration cleared in 2007) is an automated miniature vascular stapler that performs the coronary anastomosis. This prospective multicenter registry sought to evaluate midterm patency using this device compared with hand-sewn grafts. METHODS: Patients receiving at least one C-Port anastomosis during coronary artery bypass grafting surgery were enrolled at eight sites. Of the 117 patients enrolled, 78 patients (67%) with 104 C-Port vein grafts completed the study to patency assessment via computed tomography angiography. Clinical follow-up and index graft patency (Gated 64-slice computed tomography scan) were performed at least 12 months postoperatively. The primary efficacy endpoint was patency compared with the peer-reviewed results from the PRoject of Ex-vivo Vein graft ENgineering via Transfection IV (PREVENT IV) trial. RESULTS: The patient population was consistent with the PREVENT IV placebo cohort. The mortality at 12 months was 0.85% (1/117). The major cardiac morbidity rate was 3.4% (4/117). The C-Port vein graft occlusion rate was 16.3% (17/104) compared with 26.6% (597/2242) in the PREVENT IV trial (P = 0.011). Within this study, C-Port graft occlusion rates were not significantly different from the hand-sewn grafts (P = 0.821). CONCLUSIONS: The C-Port device is safe and effective in creating the distal anastomosis with equivalent patency rates to hand-sewn grafts at 12 months. When compared with hand-sewn anastomoses from a recent large prospective trial, the C-Port device demonstrated a statistically significant reduction in midterm graft occlusion. Further studies are required to evaluate its effect in less invasive coronary surgery.


Assuntos
Anastomose Cirúrgica , Prótese Vascular , Ponte de Artéria Coronária , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/estatística & dados numéricos , Prótese Vascular/efeitos adversos , Prótese Vascular/estatística & dados numéricos , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/instrumentação , Ponte de Artéria Coronária/estatística & dados numéricos , Desenho de Equipamento , Seguimentos , Humanos , Estudos Prospectivos , Resultado do Tratamento , Grau de Desobstrução Vascular
19.
J Thorac Cardiovasc Surg ; 156(5): 1799-1807.e3, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30119899

RESUMO

OBJECTIVE: We sought to evaluate midterm survival data and resource use for patients who received hybrid coronary revascularization for 2-vessel coronary disease (robotic-assisted left internal thoracic artery graft to left anterior descending coronary artery (minimally invasive direct coronary artery bypass), coupled with a stent to the circumflex or right coronary artery), compared with a concurrent cohort who had traditional coronary artery bypass grafting. METHODS: A comprehensive retrospective review was undertaken of our prospectively collected database from January 2009 to December 2016. We propensity matched 207 patients who underwent hybrid coronary revascularization for double-vessel disease with patients who underwent coronary artery bypass grafting. Eight-year survival data were obtained from the National Death Index. RESULTS: Thirty-day mortality was 1 patient (0.5%) in each of the hybrid coronary revascularization and coronary artery bypass grafting groups. Eight-year survival for the hybrid coronary revascularization group was 187 of 207 patients (90.3%) compared with 182 of 207 patients (87.9%) for the coronary artery bypass grafting cohort. End-stage renal disease independently predicted late mortality in all patients (overall hazard ratio, 5.60, P < .001; hybrid coronary revascularization hazard ratio, 5.58, P = .002; coronary artery bypass grafting hazard ratio, 4.59, P = .006). Female patients who underwent hybrid coronary revascularization had a higher incidence of late death (hazard ratio, 2.47, P = .05). Length of stay and perioperative transfusion requirements were lower in the hybrid coronary revascularization group (P < .0001). CONCLUSIONS: Hybrid coronary revascularization for double-vessel coronary disease is associated with similar short-term outcomes and intermediate-term survival as traditional coronary artery bypass grafting. Hybrid coronary revascularization is associated with lower transfusion requirements and a shorter length of stay than coronary artery bypass grafting.


Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea , Procedimentos Cirúrgicos Robóticos , Idoso , Transfusão de Sangue , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Bases de Dados Factuais , Stents Farmacológicos , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/mortalidade , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/mortalidade , Fatores de Tempo , Resultado do Tratamento
20.
Eur J Cardiothorac Surg ; 53(3): 545-551, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29048474

RESUMO

OBJECTIVES: Iliofemoral arteries have been the preferred access for transcatheter aortic valve replacement (TAVR). When these arteries are too small, calcified or tortuous, an alternative access must be considered. Transinnominate (TI) access is an extrathoracic approach that does not require manipulation of major neurovascular structures or the apex. The aim of this study is to evaluate the efficacy and safety of TI TAVR as an alternative access in patients with severe aortic stenosis not amenable to a transfemoral approach. METHODS: Thirteen patients with severe aortic stenosis underwent TI TAVR between February 2016 and January 2017 at our institution. The average Society of Thoracic Surgeons (STS) score was 7.7 ± 4.5%. Eight patients had previous surgical revascularization, 7 of which involved the left thoracic artery. All patients underwent preoperative computed tomography angiography that revealed significant atheromatous and calcific disease of the iliofemoral vessels and/or the descending aorta. The innominate artery was found to be of appropriate calibre (>10 mm), free of plaque and easy to access via surgical incision. Fusion multimodality imaging was utilized in all cases to guide the procedure. RESULTS: The innominate artery was accessed via a 2-inch right parasternal supraclavicular incision. Nine self-expandable valves and 4 balloon-expandable valves were implanted. Procedural success occurred in all cases without intraprocedural and in-hospital mortality. No neurological deficits or vascular complications were recorded; postoperative bleeding was trivial. Ten patients were discharged on Day 3 and 3 patients who required PPM on Day 5. CONCLUSIONS: TI approach represents a safe, reproducible and minimally invasive hybrid technique for TAVR in high-risk patients. In our early experience, surgical trauma and perioperative complications are minimal with rapid patient recovery.


Assuntos
Valva Aórtica/cirurgia , Tronco Braquiocefálico/cirurgia , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Substituição da Valva Aórtica Transcateter/mortalidade , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos
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