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2.
Interact Cardiovasc Thorac Surg ; 30(1): 159-160, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31539026

RESUMO

Pulmonary artery aneurysms are rare but are associated with a significant risk of rupture and dissection. Moreover, pulmonary valve regurgitation and/or stenosis often coexist. In this study, we present a case of a pulmonary artery aneurysm with severe pulmonary regurgitation in a patient with pulmonary hypertension treated with aneurysm resection and pulmonary valve repair.

4.
Aging Cell ; 18(5): e13008, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31310431

RESUMO

The loss of cognitive function accompanying healthy aging is not associated with extensive or characteristic patterns of cell death, suggesting it is caused by more subtle changes in synaptic properties. In the hippocampal CA1 region, long-term potentiation requires stronger stimulation for induction in aged rats and mice and long-term depression becomes more prevalent. An age-dependent impairment of postsynaptic calcium homeostasis may underpin these effects. We have examined changes in presynaptic calcium signalling in aged mice using a transgenic mouse line (SyG37) that expresses a genetically encoded calcium sensor in presynaptic terminals. SyG37 mice showed an age-dependent decline in cognitive abilities in behavioural tasks that require hippocampal processing including the Barnes maze, T-maze and object location but not recognition tests. The incidence of LTP was significantly impaired in animals over 18 months of age. These effects of aging were accompanied by a persistent increase in resting presynaptic calcium, an increase in the presynaptic calcium signal following Schaffer collateral fibre stimulation, an increase in postsynaptic fEPSP slope and a reduction in paired-pulse facilitation. These effects were not caused by synapse proliferation and were of presynaptic origin since they were evident in single presynaptic boutons. Aged synapses behaved like younger ones when the extracellular calcium concentration was reduced. Raising extracellular calcium had little effect on aged synapses but altered the properties of young synapses into those of their aged counterparts. These effects can be readily explained by an age-dependent change in the properties or numbers of presynaptic calcium channels.

6.
Front Neurosci ; 13: 382, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31068782

RESUMO

The aggregation of α-synuclein (α-syn) is a major factor behind the onset of Parkinson's disease (PD). Sublocalization of this protein may be relevant for the formation of multimeric α-syn oligomeric configurations, insoluble aggregates that form Lewy bodies in PD brains. Processing of this protein aggregation is regulated by associations with distinct lipid classes. For instance, instability of lipid raft (LR) microdomains, membrane regions with a particular lipid composition, is an early event in the development of PD. However, the relevance of membrane microdomains in the regulation and trafficking of the distinct α-syn configurations associated with PD remains unexplored. In this study, using 6- and 14-month-old healthy and MPTP-treated animals as a model of PD, we have investigated the putative molecular alterations of raft membrane microstructures, and their impact on α-syn dynamics and conformation. A comparison of lipid analyses of LR microstructures and non-raft (NR) fractions showed alterations in gangliosides, cholesterol, polyunsaturated fatty acids (PUFA) and phospholipids in the midbrain and cortex of aged and MPTP-treated mice. In particular, the increase of PUFA and phosphatidylserine (PS) during aging correlated with α-syn multimeric formation in NR. In these aggregates, α-syn was phosphorylated in pSer129, the most abundant post-transductional modification of α-syn promoting toxic aggregation. Interestingly, similar variations in PUFA and PS content correlating with α-syn insoluble accumulation were also detected in membrane microstructures from the human cortex of incidental Parkinson Disease (iPD) and PD, as compared to healthy controls. Furthermore, structural changes in membrane lipid microenvironments may induce rearrangements in raft-interacting proteins involved in other neuropathologies. Therefore, we also investigated the dynamic of other protein markers involved in cognition and memory impairment such as metabotropic glutamate receptor 5 (mGluR5), ionotropic NMDA receptor (NMDAR2B), prion protein (PrPc) and amyloid precursor protein (APP), whose activity depends on membrane lipid organization. We observed a decline of these protein markers in LR fractions with the progression of aging and pathology. Overall, our findings demonstrate that lipid alterations in membranous compartments promoted by brain aging and PD-like injury may have an effect on α-syn aggregation and segregation in abnormal multimeric structures.

7.
Basic Res Cardiol ; 114(2): 5, 2019 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-30635778

RESUMO

There is scarce evidence for pulmonary artery denervation (PADN) as a potential treatment for chronic postcapillary pulmonary hypertension (PH). We aimed to perform a proof-of-concept of PADN in a translational model of chronic PH. Nineteen pigs with chronic postcapillary PH (secondary to pulmonary vein banding) were randomized to surgical-PADN (using bipolar radiofrequency clamps) or sham procedure. Additionally, 6 healthy animals underwent percutaneous-PADN to compare the pulmonary artery (PA) lesion generated with both approaches. In the surgical-PADN arm, hemodynamic evaluation and cardiac magnetic resonance (CMR) were performed at baseline and at 2 and 3-month follow-up. Histological assessment was carried out at the completion of the protocol. Eighteen pigs (6 following surgical-PADN, 6 sham and 6 percutaneous-PADN) completed the protocol. A complete transmural PA lesion was demonstrated using surgical clamps, whereas only focal damage to adventitial fibers was observed after percutaneous-PADN. In the surgical-PADN arm, the hemodynamic profile did not significantly differ between groups neither at baseline [mean pulmonary artery pressure (mPAP) median values of 32.0 vs. 27.5 mmHg, P = 0.394 and indexed pulmonary vascular resistance (iPVR) 5.9 vs. 4.7 WU m2, P = 0.394 for PADN/sham groups, respectively] nor at any follow-up (mPAP of 35.0 vs. 35.0 mmHg, P = 0.236 and iPVR of 8.3 vs. 6.7 WU m2, P = 0.477 at third month in PADN/sham groups, respectively). Surgical-PADN was not associated with any benefit in RV anatomy or function on CMR/histology. In a large-animal model of chronic postcapillary PH, transmural PADN with surgical clamps was associated with a neutral pulmonary hemodynamic effect.


Assuntos
Denervação/métodos , Hipertensão Pulmonar , Artéria Pulmonar/inervação , Artéria Pulmonar/cirurgia , Animais , Modelos Animais de Doenças , Distribuição Aleatória , Suínos , Pesquisa Médica Translacional
8.
Asian Cardiovasc Thorac Ann ; 27(2): 124-126, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30011999

RESUMO

Heparin-induced thrombocytopenia is not uncommon in cardiac surgery. Thrombosis is the most frequent complication. A 77-year-old man suffered cardiac arrest due to right coronary emboli. Transesophageal echocardiography revealed tissue valve thrombosis. He required support with an extracorporeal membrane oxygenator that also thrombosed. Heparin-induced thrombocytopenia was diagnosed, and anticoagulation was switched to argatroban. Heparin- induced thrombocytopenia normally presents as vascular thrombosis. In this case, the first symptom was tissue valve thrombosis causing an acute coronary syndrome. It is not an uncommon complication and should be considered if unexpected thrombosis and a sudden drop in platelet count develops after heparin exposure.


Assuntos
Síndrome Coronariana Aguda/induzido quimicamente , Anticoagulantes/efeitos adversos , Valva Aórtica/cirurgia , Parada Cardíaca/induzido quimicamente , Implante de Prótese de Valva Cardíaca/efeitos adversos , Heparina/efeitos adversos , Trombocitopenia/induzido quimicamente , Trombose/etiologia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Idoso , Anticoagulantes/administração & dosagem , Antitrombinas/administração & dosagem , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Substituição de Medicamentos , Ecocardiografia Transesofagiana , Eletrocardiografia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Evolução Fatal , Parada Cardíaca/diagnóstico , Parada Cardíaca/terapia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Ácidos Pipecólicos/administração & dosagem , Trombectomia , Trombocitopenia/diagnóstico , Trombocitopenia/terapia , Trombose/diagnóstico por imagem , Trombose/terapia , Resultado do Tratamento
9.
Artigo em Inglês | MEDLINE | ID: mdl-31990157

RESUMO

Establishment of extracorporeal circulation during open descending and thoracoabdominal aorta repair is necessary in almost all patients. Full cardiopulmonary bypass (CPB) with peripheral cannulation and left heart bypass are the most commonly used circulatory support strategies and they effectively minimize the risk of visceral and central nervous system ischemia. However, both strategies are associated with significant drawbacks. In this video tutorial we present 2 cases demonstrating an alternative strategy for CPB establishment during descending or thoracoabdominal aortic repair. This technique uses two simultaneous (proximal and distal) aortic perfusion cannulas and a single-stage right atrial cannula, both inserted through the main incision. This technique offers all the advantages of full CPB while lowering the risk of proximal hypoperfusion syndrome, and the use of central cannulas virtually eliminates the risk of retrograde perfusion. Complications associated with femoral incision/cannulation are avoided and excellent venous drainage is achieved. This alternative CPB strategy increases the surgical options for extensive thoracoabdominal aortic repair and allows bespoke management for this complex disease.

10.
Front Cell Neurosci ; 12: 209, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30072872

RESUMO

Genetically encoded calcium indicators (GECIs) have gained widespread use for measurement of neuronal activity but their low expression levels in transgenic mice tend to limit sensitivity. We have developed a transgenic mouse line (SyG37) that expresses a ratiometric calcium sensor, SyGCaMP2-mCherry, that is expressed throughout the brain but targeted to presynaptic terminals. Within the CA1 and CA3 regions of hippocampus of male and female mice, SyGaMP2 fluorescence responds linearly up to 10 electrical stimuli at frequencies up to 100 Hz and it can detect responses to a single stimulus. Responses in single boutons can be measured using multiphoton microscopy. The ensemble amplitude of SyGCaMP2 responses is a function of the number of stimuli applied and the number of contributing boutons. The peak responses and initial rates of calcium influx in single boutons in CA1 and CA3 were similar but the rate of calcium clearance from CA3 boutons after stimulation was significantly faster. In CA1, DNQX reduced SyGCaMP2 responses to Schaffer collateral stimulation to 86% of baseline indicating that 14% of the total response originated from presynaptic terminals of neurones synaptically driven via AMPA receptors. Theta burst stimulation induced long-term potentiation (LTP) of both SyGCaMP2 and fEPSP responses in both young and 18-month-old mice. The proportion of postsynaptically connected terminals increased significantly to 76% of the total after LTP induction. The SyG37 mouse allows stable optical detection of synaptic activation and connectivity at the single bouton level and can be used to characterize the contributions of presynaptic calcium to synaptic transmission and plasticity.

14.
Interact Cardiovasc Thorac Surg ; 24(1): 140-142, 2017 01.
Artigo em Inglês | MEDLINE | ID: mdl-27624352

RESUMO

Entrapment or device loss during percutaneous coronary intervention is a rare but potentially fatal complication. Percutaneous retrieval is possible but surgery can be required on an emergency basis. We present the case of an entrapped balloon catheter in the left anterior descending coronary artery during an elective percutaneous coronary intervention. The patient developed acute myocardial ischaemia and cardiac arrest. Emergency surgical intervention with device retrieval and distal bypass grafting was life-saving.


Assuntos
Cateteres/efeitos adversos , Vasos Coronários/cirurgia , Isquemia Miocárdica/cirurgia , Intervenção Coronária Percutânea/efeitos adversos , Choque Cardiogênico/cirurgia , Idoso , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Falha de Equipamento , Humanos , Masculino , Isquemia Miocárdica/diagnóstico , Intervenção Coronária Percutânea/instrumentação , Reoperação , Choque Cardiogênico/etiologia
16.
Artigo em Inglês | MEDLINE | ID: mdl-27601365

RESUMO

BACKGROUND: Pulmonary hypertension (PH) and right ventricular (RV) dysfunction are strong predictors of morbidity and mortality among patients with congenital heart disease. Early detection of RV involvement may be useful in the management of these patients. We aimed to assess progressive cardiac adaptation and quantify myocardial extracellular volume in an experimental porcine model of PH because of aorto-pulmonary shunt using cardiac magnetic resonance (CMR). METHODS AND RESULTS: To characterize serial cardiac adaptation, 12 pigs (aorto-pulmonary shunt [n=6] or sham operation [n=6]) were evaluated monthly with right heart catheterization, CMR, and computed tomography during 4 months, followed by pathology analysis. Extracellular volume by CMR in different myocardial regions was studied in 20 animals (aorto-pulmonary shunt [n=10] or sham operation [n=10]) 3 months after the intervention. All shunted animals developed PH. CMR evidenced progressive RV hypertrophy and dysfunction secondary to increased afterload and left ventricular dilatation secondary to volume overload. Shunt flow by CMR strongly correlated with PH severity, left ventricular end-diastolic pressure, and left ventricular dilatation. T1-mapping sequences demonstrated increased extracellular volume at the RV insertion points, the interventricular septum, and the left ventricular lateral wall, reproducing the pattern of fibrosis found on pathology. Extracellular volume at the RV insertion points strongly correlated with pulmonary hemodynamics and RV dysfunction. CONCLUSIONS: Prolonged systemic-to-pulmonary shunting in growing piglets induces PH with biventricular remodeling and myocardial fibrosis that can be detected and monitored using CMR. These results may be useful for the diagnosis and management of congenital heart disease patients with pulmonary overcirculation.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Hipertensão Pulmonar/diagnóstico por imagem , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Hipertrofia Ventricular Direita/diagnóstico por imagem , Imagem Cinética por Ressonância Magnética , Miocárdio/patologia , Circulação Pulmonar , Função Ventricular Esquerda , Função Ventricular Direita , Remodelação Ventricular , Adaptação Fisiológica , Animais , Biópsia , Cardiomiopatias/etiologia , Cardiomiopatias/patologia , Cardiomiopatias/fisiopatologia , Modelos Animais de Doenças , Progressão da Doença , Fibrose , Hemodinâmica , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/patologia , Hipertensão Pulmonar/fisiopatologia , Hipertrofia Ventricular Esquerda/etiologia , Hipertrofia Ventricular Esquerda/patologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Hipertrofia Ventricular Direita/etiologia , Hipertrofia Ventricular Direita/patologia , Hipertrofia Ventricular Direita/fisiopatologia , Masculino , Valor Preditivo dos Testes , Sus scrofa , Fatores de Tempo , Tomografia Computadorizada por Raios X
17.
Basic Res Cardiol ; 111(4): 49, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27328822

RESUMO

Beta-3 adrenergic receptor (ß3AR) agonists have been shown to produce vasodilation and prevention of ventricular remodeling in different conditions. Given that these biological functions are critical in pulmonary hypertension (PH), we aimed to demonstrate a beneficial effect of ß3AR agonists in PH. An experimental study in pigs (n = 34) with chronic PH created by pulmonary vein banding was designed to evaluate the acute hemodynamic effect and the long-term effect of ß3AR agonists on hemodynamics, vascular remodeling and RV performance in chronic PH. Ex vivo human experiments were performed to explore the expression of ß3AR mRNA and the vasodilator response of ß3AR agonists in pulmonary arteries. Single intravenous administration of the ß3AR agonist BRL37344 produced a significant acute reduction in PVR, and two-weeks treatment with two different ß3AR selective agonists, intravenous BRL37344 or oral mirabegron, resulted in a significant reduction in PVR (median of -2.0 Wood units/m(2) for BRL37344 vs. +1.5 for vehicle, p = 0.04; and -1.8 Wood units/m(2) for mirabegron vs. +1.6 for vehicle, p = 0.002) associated with a significant improvement in magnetic resonance-measured RV performance. Histological markers of pulmonary vascular proliferation (p27 and Ki67) were significantly attenuated in ß3AR agonists-treated pigs. ß3AR was expressed in human pulmonary arteries and ß3AR agonists produced vasodilatation. ß3AR agonists produced a significant reduction in PVR and improved RV performance in experimental PH, emerging as a potential novel approach for treating patients with chronic PH.


Assuntos
Agonistas de Receptores Adrenérgicos beta 3/farmacologia , Hipertensão Pulmonar/metabolismo , Receptores Adrenérgicos beta 3/metabolismo , Resistência Vascular/efeitos dos fármacos , Acetanilidas/farmacologia , Animais , Western Blotting , Modelos Animais de Doenças , Feminino , Humanos , Imuno-Histoquímica , Masculino , Nebivolol/farmacologia , Artéria Pulmonar/efeitos dos fármacos , Artéria Pulmonar/metabolismo , Distribuição Aleatória , Reação em Cadeia da Polimerase em Tempo Real , Suínos , Tiazóis/farmacologia , Remodelação Ventricular/efeitos dos fármacos
18.
Cir. Esp. (Ed. impr.) ; 94(4): 227-231, abr. 2016. tab
Artigo em Espanhol | IBECS | ID: ibc-149896

RESUMO

Introducción: Analizar las indicaciones, acciones y resultados de las operaciones realizadas en la Unidad de Cuidados Intensivos (UCI) de Cirugía Cardiovascular. Métodos: Análisis retrospectivo de pacientes adultos consecutivos intervenidos en la Unidad de Cuidados Intensivos (UCI). Se incluyeron todas las intervenciones practicadas. Se realizó estadística descriptiva. Resultados: Entre 2008 y 2013 se intervinieron 3379 pacientes adultos consecutivos. Se practicaron en la UCI 124 intervenciones en 109 pacientes, 70 hombres (64,2%) y 39 mujeres (35,8%) con un promedio de edad de 61,6 años (12-80). Ello ha representado un 3,2%. Durante el mismo periodo de tiempo, se intervinieron en quirófano 185 pacientes por taponamiento cardiaco/hemorragia postoperatoria (5,5%). Las intervenciones previas fueron por cardiopatía valvular (34,9%), patología aórtica (22,9%), cardiopatía isquémica (15,6%), valvular/isquémica (12%), valvular/de la aorta (11%) y miscelánea (3,6%). Las indicaciones de intervención fueron hemorragia persistente 54 (43,5%), taponamiento cardiaco 41 (33%), bajo gasto cardiaco 13 (10,5%), parada cardíaca/arritmias 8 (6,5%), insuficiencia respiratoria 6 (4,8%) e isquemia de extremidades 2 (1,7%). Las intervenciones fueron: exploración mediastínica 73 (58,9%), colocación/retirada de ECMO 17 (13,7%), cierre esternal 16 (12,9%), resucitación abierta 9 (7,3%), drenaje subxifoideo 7 (5,6%) y embolectomía femoral 2 (1,6%). La mortalidad fue 33%. Hubo un caso de mediastinitis (0,9%), sin diferencias con la tasa de infecciones profundas en pacientes no intervenidos en UCI. Conclusiones: La intervención en UCI es una alternativa segura y de rescate en subgrupos específicos de pacientes. no incrementa el riesgo de infección, evita el transporte de pacientes inestables y permite ahorrar tiempo en la decisión quirúrgica postoperatoria (AU)


Background: To analyze the indications, actions and results of the operations performed in the Cardiovascular Surgery Intensive Care Unit. Methods: Retrospective analysis of consecutive non-selected adult patients operated in the ICU. All operations were included. Descriptive statistics were used. Results: Between 2008 and 2013, 3379 consecutive adult patients were operated upon. A total of 124 operations were performed in the ICU in 109 patients, 70 male (64.2%) and 39 female (35.8%) with a mean age of 61.6 years (12-80). This represented 3.2% of all operations. During the study period, 185 patients (5.5%) were reoperated for postoperative bleeding/tamponade in the operating room. The index interventions were for valvular heart disease (34.9%), aortic disease (22.9%), ischemic heart disease (15.6%), combined valvular/ischemic (12%), valvular/aorta (11%) and miscellaneous (3.6%). The indications for reoperation were persistent bleeding 54 (43.5%), pericardial tamponade 41 (33%), low cardiac output 13 (10.5%), cardiac arrest/arrhythmia 8 (6.5%), respiratory insufficiency 6 (4.8%) and acute ischemic limb 2 (1.7%). Operations performed were: mediastinal exploration 73 (58.9%), implant/removal of ECMO 17 (13.7%), sternal closure 16 (12.9%), open resuscitation 9 (7.3%), subxyphoid drainage 7 (5.6%) and femoral embolectomy 2 (1.6%). Overall mortality was 33%. There was one case of mediastinitis (0,9%), with no difference from patients operated in the regular operating room. Conclusions: Operations in the ICU represent a safe, life-saving alternative in specific subgroups of patients. The risk of wound infection is not increased, unstable patients are not transferred and there is time savings (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Cirurgia Torácica , Unidades de Terapia Intensiva , Reoperação/estatística & dados numéricos , /estatística & dados numéricos , Complicações Pós-Operatórias , Hemorragia Pós-Operatória , Tamponamento Cardíaco , Esternotomia , Insuficiência Cardíaca , Insuficiência Respiratória , Mortalidade Hospitalar , Infecção da Ferida Cirúrgica/epidemiologia , Estudos Retrospectivos
19.
Cir Esp ; 94(4): 227-31, 2016 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-26319571

RESUMO

BACKGROUND: To analyze the indications, actions and results of the operations performed in the Cardiovascular Surgery Intensive Care Unit. METHODS: Retrospective analysis of consecutive non-selected adult patients operated in the ICU. All operations were included. Descriptive statistics were used. RESULTS: Between 2008 and 2013, 3379 consecutive adult patients were operated upon. A total of 124 operations were performed in the ICU in 109 patients, 70 male (64.2%) and 39 female (35.8%) with a mean age of 61.6 years (12-80). This represented 3.2% of all operations. During the study period, 185 patients (5.5%) were reoperated for postoperative bleeding/tamponade in the operating room. The index interventions were for valvular heart disease (34.9%), aortic disease (22.9%), ischemic heart disease (15.6%), combined valvular/ischemic (12%), valvular/aorta (11%) and miscellaneous (3.6%). The indications for reoperation were persistent bleeding 54 (43.5%), pericardial tamponade 41 (33%), low cardiac output 13 (10.5%), cardiac arrest/arrhythmia 8 (6.5%), respiratory insufficiency 6 (4.8%) and acute ischemic limb 2 (1.7%). Operations performed were: mediastinal exploration 73 (58.9%), implant/removal of ECMO 17 (13.7%), sternal closure 16 (12.9%), open resuscitation 9 (7.3%), subxyphoid drainage 7 (5.6%) and femoral embolectomy 2 (1.6%). Overall mortality was 33%. There was one case of mediastinitis (0,9%), with no difference from patients operated in the regular operating room. CONCLUSIONS: Operations in the ICU represent a safe, life-saving alternative in specific subgroups of patients. The risk of wound infection is not increased, unstable patients are not transferred and there is time savings.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criança , Cuidados Críticos , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Reoperação , Estudos Retrospectivos , Adulto Jovem
20.
Eur J Cardiothorac Surg ; 49(1): 249-54, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25694471

RESUMO

OBJECTIVES: Recurrent mitral regurgitation is a significant problem after mitral valve repair in patients with functional valve disease. We report the safety and feasibility of a novel adjustable mitral annuloplasty device that permits downsizing of the anterior-posterior diameter late after initial surgery. METHODS: In this multicentre, non-randomized, observational register, patients with moderate or severe mitral regurgitation undergoing surgical mitral valve repair with the MiCardia EnCorSQ™ Mitral Valve Repair system were evaluated. Patient characteristics, operative specifications and results as well as postoperative follow-up were collected for all five centres. RESULTS: Ninety-four patients with a median age of 71 (64-75) years (EuroSCORE II 6.7 ± 6.3; 66% male, 48% ischaemic MR, 37% dilated cardiomyopathy and 15% degenerative disease) were included. Operative mortality was 1% and the 1-year survival was 93%. Ring adjustment was attempted in 12 patients at a mean interval of 9 ± 6 months after surgery. In three of these attempts, a technical failure occurred. In 1 patient, mitral regurgitation was reduced two grades, in 2 patients mitral regurgitation was reduced one grade and in 6 patients, mitral regurgitation did not change significantly. The mean grade of mitral regurgitation changed from 2.9 ± 0.9 to 2.1 ± 0.7 (P = 0.02). Five patients were reoperated after 11 ± 9 months (Ring dehiscence: 2; failed adjustment: 3). CONCLUSION: We conclude that this device may provide an additional treatment option in patients with functional mitral regurgitation, who are at risk for reoperation due to recurrent mitral regurgitation. Clinical results in this complex disease were ambiguous and patient selection seems to be a crucial step for this device. Further trials are required to estimate the clinical value of this therapeutic concept.


Assuntos
Anuloplastia da Valva Mitral/instrumentação , Insuficiência da Valva Mitral/cirurgia , Próteses e Implantes , Idoso , Progressão da Doença , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Anuloplastia da Valva Mitral/efeitos adversos , Anuloplastia da Valva Mitral/métodos , Insuficiência da Valva Mitral/diagnóstico por imagem , Próteses e Implantes/efeitos adversos , Desenho de Prótese , Falha de Prótese , Reoperação , Resultado do Tratamento , Ultrassonografia
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