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2.
Arq. bras. cardiol ; 115(4): 720-775, out. 2020. tab, graf
Artigo em Português | LILACS, Sec. Est. Saúde SP, SESSP-IDPCPROD, Sec. Est. Saúde SP | ID: biblio-1131346
3.
Interact Cardiovasc Thorac Surg ; 31(4): 461-466, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32901288

RESUMO

OBJECTIVES: Concomitant valvular heart valve disease is a frequent finding, with higher morbidity and mortality among patients undergoing redo surgical procedures. Our goal was to report our initial experience with combined transcatheter Inovare bioprosthesis implants for severe valve dysfunction. METHODS: Among 300 transcatheter procedures, a total of 6 patients had concurrent simultaneous transcatheter bioprosthesis implants for severe mitral bioprosthesis failure (valve-in-valve), with a second valve procedure that included native aortic (n = 2) or degenerated bioprostheses in the aortic position (n = 4). During the procedures, all patients were treated with a balloon-expandable Inovare transcatheter valve, using the transapical approach. RESULTS: Patients were highly symptomatic [New York Heart Association (NYHA) functional class IV: 100%], with a mean age of 62 ± 5 years, yielding a mean European System for Cardiac Operative Risk II (EuroSCORE II) of 24.0 ± 10.1%. There was a mean of 1.6 ± 0.4 prior valve operations/patient, with a median time from prior mitral bioprosthesis surgery of 13.0 (9.2-20.0) years. Device success was 100% according to the Mitral Valve Academic Research Consortium and the Valve Academic Research Consortium-2 criteria. During the hospital stay, only 1 patient required dialysis, and the median intensive care unit and hospital lengths of stay were 5.0 (3.2-6.7) days and 16.0 (12.2-21.2) days, respectively. No deaths occurred at 30 days; at a median follow-up of 287 (194-437) days, 1 patient died of a non-cardiac cause and the rest of patients were in NYHA functional class I or II, with normofunctioning bioprostheses. CONCLUSIONS: Transcatheter double valve interventions using the Inovare bioprosthesis in this initial series were shown to be a reasonable alternative to redo surgical operations. The short- and mid-term clinical and echocardiographic outcomes demonstrate promising results, although future studies with a larger number of patients and longer follow-up are warranted.

4.
Int J Cardiol ; 316: 57-63, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32505373

RESUMO

BACKGROUND: Few and controversial data exist on the outcomes of patients with paradoxical low-flow, low-gradient aortic stenosis (PLFLG-AS) following transcatheter aortic valve replacement (TAVR). This study aims to better characterize clinical outcomes and predictors of treatment futility in PLFLG-AS patients undergoing TAVR. METHODS: In this multicenter study, 318 patients with PLFLG-AS undergoing TAVR were categorized according to treatment futility, defined as all-cause mortality, poor functional status (NYHA class III-IV) or deterioration in functional class at 1-year follow-up. Clinical outcomes and the factors associated with treatment futility were assessed. RESULTS: The mean age of the patients was 81.0 ±â€¯8.3 years and 50.3% were women. At 1-year follow-up, 17.6% died and 12.9% had heart failure hospitalization. Residual impaired functional capacity (NYHA ≥ II) was present in 54.4% of patients who were alive at 1-year, and 9.8% remained in NYHA III/IV. The primary endpoint was observed in 103 (32.4%) patients, of which 54% died and 46% had a poor or worsening functional class. Factors independently associated with treatment futility were the presence of atrial fibrillation (AF) (OR:1.79, 95%CI, 1.04-3.10), chronic obstructive pulmonary disease (COPD) (OR:2.66, 95%CI, 1.50-4.74) and a lower SVi (OR per each decrease in 10 ml/m2:1.89, 95%CI, 1.06-3.45). The risk of treatment futility of patients with AF, COPD and a SVi < 30 ml/m2 was 66.38% (95%CI, 54.29%-78.48%). CONCLUSION: Close to one-third of patients with PLFLG-AS failed to derive a benefit from TAVR. The presence of AF, COPD and a low SVi were predictors of treatment futility. Being able to identify patients less likely to improve after the procedure may help to guide management and improve outcomes in patients with PLFLG-AS.

5.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 29(2 (Supl)): 201-201, abr.-jun. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1009930

RESUMO

A prótese de Star-Edwards foi a primeira válvula mecânica a ser implantada no mundo, no ano de 1960. Cerca de 200.000 pacientes foram beneficiados com esse modelo, porém, caiu em desuso por suas frequentes complicações como hemólise, anemia e tromboembolismos, apesar de sua notável durabilidade. Neste artigo apresentamos um caso de paciente com a maior durabilidade com manutenção da funcionalidade da prótese S-E, já relatado na literatura. O paciente fez o seguimento cardiológico corretamente, bem como usou a anticoagulação adequada. Apresentou disfunção de outras valvas, porém a prótese S-E manteve-se estável e funcional. Inclusive, necessitou de cirurgia para troca valvar mitral, mas não da prótese de S-E em posição aórtica. Este relato foi realizado através da história clínica do paciente e do levantamento de dados da literatura sobre próteses valvares e sua durabilidade. Existem relatos de durabilidade de próteses valvares com aproximadamente 30 a 40 anos, mas nenhum relato próximo ou igual a este com 49 anos de durabilidade. A importância dos cuidados pós-operatórios, uso correto dos anticoagulantes e o seguimento clínico para controle das possíveis complicações da prótese, foi mostrada neste artigo através do relato desse caso


In 1960, the Starr-Edwards prosthesis became the first mechanical valve to be implanted, worldwide. Roughly 200,000 patients benefited from this model. However, it has now fallen out of use due to its frequent complications, such as hemolysis, anemia and thromboembolisms, despite its noteworthy durability. In this article, we present a case of a patient with the longest durability with maintenance of functionality of the S-E prosthesis reported in the literature. The patient had correctly followed the cardiological follow-up, including adequate use of anti-coagulant medications. The patient presented dysfunction in other valves, but the S-E prosthesis remained stable and functional. The patient even required mitral valve replacement surgery, but not for the S-E prosthesis in the aortic position. This report was based on patient's clinical history and a survey of the literature data on valve prostheses and their durability. There are reports of prostheses remaining stable for approximately 30 to 40 years, but none that came close to this one, which had lasted for 49 years The importance of postoperative care, the correct use of anti-coagulant medicines, and clinical follow-up to minimize the possible complications of the prosthesis, were shown in this article through this case report


Assuntos
Humanos , Masculino , Idoso , Próteses Valvulares Cardíacas , Valvas Cardíacas , Valva Aórtica , Estenose da Valva Aórtica/cirurgia , Ecocardiografia/métodos , Doenças das Valvas Cardíacas , Anticoagulantes/uso terapêutico
8.
Rev. Soc. Cardiol. Estado de Säo Paulo ; 27(1): f:14-l:19, jan.-mar. 2017. ilus
Artigo em Português | LILACS | ID: biblio-836936

RESUMO

Com o envelhecimento populacional, o implante percutâneo de bioprótese valvular aórtica (TAVI, sigla em inglês) vem ganhando espaço no tratamento da estenose aórtica em indivíduos de maior risco operatório. A seleção do paciente para intervenção, no atual momento, leva em consideração risco cirúrgico, comorbidades, fragilidade e patologias que contraindicam o procedimento operatório, além de exames de imagem, tais como a tomografia de tórax, que tem papel importante na avaliação anatômica da válvula aórtica, aorta e seus ramos, e auxilia a escolha da via de acesso, da prótese adequada e a predição de complicações. A avaliação do Heart Team é imprescindível e desaconselha-se a realização do TAVI em locais desprovidos desse grupo. Desta forma, apesar de complexa, a avaliação e seleção do paciente adequado pode reduzir de maneira signficativa a morbidade e a mortalidade do procedimento e se faz estritamente necessária


With the aging of the population, transcatheter aortic valve implantation (TAVI) has gained popularity in the treatment of aortic stenosis in individuals with higher operative risk. The patient selection for intervention, at the present time, takes into account surgical risk, comorbidities, frailty and pathologies that contraindicate the surgical procedure, as well as imaging tests, such as computed tomography of the chest, which plays an important role in the anatomical evaluation of the aortic valve, the aorta and its branches, assisting in the choice of access route and appropriate prosthesis, and the prediction of complications. Evaluation by the Heart Team is imperative, and it is not advisable to perform TAVI in services that do not have this group. Thus, although complex, evaluation and selection of the appropriate patient can significantly reduce the morbidity and mortality of the procedure, and is essential


Assuntos
Humanos , Masculino , Feminino , Idoso , Pacientes , Cirurgia Torácica/métodos , Substituição da Valva Aórtica Transcateter/métodos , Aorta/cirurgia , Estenose da Valva Aórtica/terapia , Comorbidade , Dinâmica Populacional , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/métodos , Prognóstico , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos
12.
Rev Assoc Med Bras (1992) ; 62(1): 32-7, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27008490

RESUMO

INTRODUCTION: the EuroSCORE II and STS are the most used scores for surgical risk stratification and indication of transcatheter aortic valve implantation (TAVI). However, its role as a tool for mortality prediction in patients undergoing TAVI is still unclear. OBJECTIVE: to evaluate the performance of the EuroSCORE II and STS as predictors of in-hospital and 30-day mortality in patients undergoing TAVI. METHODS: we included 59 symptomatic patients with severe aortic stenosis that underwent TAVI between 2010 and 2014. The variables were analyzed using Student's t-test and Fisher's exact test and the discriminative power was evaluated using receiver operating characteristic curve (ROC) and area under the curve (AUC) with a 95% confidence interval. RESULTS: mean age was 81±7.3 years, 42.3% men. The mean EuroSCORE II was 7.6±7.3 % and STS was 20.7±10.3%. Transfemoral procedure was performed in 88.13%, transapical in 3.38% and transaortic in 8.47%. In-hospital mortality was 10.1% and 30-day mortality was 13.5%. Patients who died had EuroSCORE II and STS higher than the survivors (33.7±16.7vs. 18.6±7.3% p=0,0001 for STS and 13.9±16.1 vs. 4.8±3.8% p=0.0007 for EuroSCORE II). The STS showed an AUC of 0.81 and the EuroSCORE II of 0.77 and there were no differences in the discrimination ability using ROC curves (p=0.72). CONCLUSION: in this cohort, the STS and EuroSCORE II were predictors of in-hospital and 30-days mortality in patients with severe aortic stenosis undergoing TAVI.


Assuntos
Medição de Risco/métodos , Substituição da Valva Aórtica Transcateter/mortalidade , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/cirurgia , Brasil , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Substituição da Valva Aórtica Transcateter/efeitos adversos
13.
Rev. Assoc. Med. Bras. (1992) ; 62(1): 32-37, Jan.-Feb. 2016. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: lil-777440

RESUMO

SUMMARY Introduction: the EuroSCORE II and STS are the most used scores for surgical risk stratification and indication of transcatheter aortic valve implantation (TAVI). However, its role as a tool for mortality prediction in patients undergoing TAVI is still unclear. Objective: to evaluate the performance of the EuroSCORE II and STS as predictors of in-hospital and 30-day mortality in patients undergoing TAVI. Methods: we included 59 symptomatic patients with severe aortic stenosis that underwent TAVI between 2010 and 2014. The variables were analyzed using Student's t-test and Fisher's exact test and the discriminative power was evaluated using receiver operating characteristic curve (ROC) and area under the curve (AUC) with a 95% confidence interval. Results: mean age was 81±7.3 years, 42.3% men. The mean EuroSCORE II was 7.6±7.3 % and STS was 20.7±10.3%. Transfemoral procedure was performed in 88.13%, transapical in 3.38% and transaortic in 8.47%. In-hospital mortality was 10.1% and 30-day mortality was 13.5%. Patients who died had EuroSCORE II and STS higher than the survivors (33.7±16.7vs. 18.6±7.3% p=0,0001 for STS and 13.9±16.1 vs. 4.8±3.8% p=0.0007 for EuroSCORE II). The STS showed an AUC of 0.81 and the EuroSCORE II of 0.77 and there were no differences in the discrimination ability using ROC curves (p=0.72). Conclusion: in this cohort, the STS and EuroSCORE II were predictors of in-hospital and 30-days mortality in patients with severe aortic stenosis undergoing TAVI.


RESUMO Introdução: STS e EuroSCORE II são os escores mais utilizados para a estratificação de risco cirúrgico e indicação do implante de válvula aórtica transcateter (TAVI). Entretanto, seu papel como ferramenta para predição de mortalidade em pacientes submetidos ao TAVI ainda é incerto. Objetivo: avaliar o desempenho do EuroSCORE II e STS como preditores de mortalidade intra-hospitalar em 30 dias em pacientes submetidos ao TAVI. Métodos: 59 pacientes com estenose aórtica importante submetidos ao TAVI entre 2010 e 2014. Variáveis foram analisadas por meio do teste t-Student e teste exato de Fisher, e o poder discriminativo foi avaliado pela curva ROC e área sob a curva, acompanhada de intervalo de confiança de 95%. Resultados: a idade média foi de 81±7,3 anos, 42,3% homens. Média do EuroSCORE II foi de 6,07±7,3%, e do STS, 20,7±10,3%. Procedimento transfemoral foi realizado em 88,13%, transapical, em 3,38% e transaórtico, em 8,47%. A mortalidade intra-hospitalar foi 10,1%, e em 30 dias, 13,5%. Os pacientes que evoluíram para óbito apresentavam STS e EuroSCORE II mais elevados que os sobreviventes (33,7±16,7% vs. 18,6±7,3%; p=0,0001 para STS e 13,9±16,1% vs. 4,8±3,8%; p=0,0007 para EuroSCORE II). O STS apresentou AUC de 0,81, e o EuroSCORE II, 0,77. Não houve diferença na capacidade de discriminação pelas curvas ROC (p=0,72). Conclusão: STS e EuroSCORE II foram preditores de mortalidade intra-hospitalar em 30 dias.

14.
Arq Bras Cardiol ; 105(4): 426-9, 2015 Oct.
Artigo em Inglês, Português | MEDLINE | ID: mdl-26559990

RESUMO

Prosthetic thrombosis is a rare complication, but it has high mortality and morbidity. Young women of childbearing age that have prosthetic heart valves are at increased risk of thrombosis during pregnancy due to changes in coagulation factors. Anticoagulation with adequate control and frequent follow-up if pregnancy occurs must be performed in order to prevent complications related to anticoagulant use. Surgery remains the treatment of choice for prosthetic heart valve thrombosis in most clinical conditions. Patients with metallic prosthetic valves have an estimated 5% risk of thrombosis during pregnancy and maternal mortality of 1.5% related to the event. Anticoagulation with vitamin K antagonists during pregnancy is related to varying degrees of complications at each stage of the pregnancy and postpartum periods. Warfarin sodium crosses the placental barrier and when used in the first trimester of pregnancy is a teratogenic agent, causing 1-3% of malformations characterized by fetal warfarin syndrome and also constitutes a major cause of miscarriage in 10-30% of cases. In the third trimester and at delivery, the use of warfarin is associated with maternal and neonatal bleeding in approximately 5 to 15% of cases, respectively. On the other hand, inadequate anticoagulation, including the suspension of the oral anticoagulants aiming at fetal protection, carries a maternal risk of about 25% of metallic prosthesis thrombosis, particularly in the mitral valve. This fact is also due to the state of maternal hypercoagulability with activation of coagulation factors V, VI, VII, IX, X, platelet activity and fibrinogen synthesis, and decrease in protein S levels. The Registry of Pregnancy and Cardiac Disease (ROPAC), assessing 212 pregnant women with metal prosthesis, showed that prosthesis thrombosis occurred in 10 (4.7%) patients and maternal hemorrhage in 23.1%, concluding that only 58% of patients with metallic prosthesis had a complication-free pregnancy.


Assuntos
Anticoagulantes/uso terapêutico , Fatores de Coagulação Sanguínea/efeitos dos fármacos , Próteses Valvulares Cardíacas/efeitos adversos , Período Pós-Parto/efeitos dos fármacos , Complicações Cardiovasculares na Gravidez/prevenção & controle , Trombose/prevenção & controle , Feminino , Idade Gestacional , Heparina/uso terapêutico , Humanos , Metais , Gravidez , Fatores de Risco , Varfarina/uso terapêutico
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