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3.
Ann Vasc Surg ; 44: 136-145, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28501659

RESUMO

BACKGROUND: Understanding the difference of Adamkiewicz artery (AKA) presentation in healthy and diseased subjects, and the influence of atherosclerotic factors prevalent in aortic disease patients, are important for aortic disease therapeutic planning. This study used a 320-detector row computed tomography (CT) device to examine the impact of clinical aspects of AKA identification in individuals with and without aortic disease. METHODS: Angio-CTs obtained from 115 patients were assessed and the individuals grouped according to the presence or absence of aortic disease. Datasets were analyzed using OsiriX software, and AKA was identified by three-dimensional multiplanar reconstruction. RESULTS: The group without aortic disease (Group A) comprised 32 (52.5%) men and 29 women, with a mean age of 53.7 ± 16.8 years. The group with aortic disease (Group B) comprised 31 (57.4%) men and 23 women, with a mean age of 64.8 ± 11.6 years. AKA was identified in 49 (80.3%) participants of Group A and 23 (42.6%) individuals of Group B (P ≤ 0.0001). In 53 cases (73.6%), AKA originated on the left side. AKA was mainly detected on the left side (73.6%), at the level of T10 to T12 (70%). Tobacco smokers, former smokers, and hypertensive patients had increased odds of having undetected AKA. CONCLUSIONS: Using the method described and a state of the art 320-detector row CT device, AKA was detected more frequently among individuals without aortic disease. Thus, aortic disease and atherosclerotic risk factors hindered AKA detection.


Assuntos
Doenças da Aorta/diagnóstico por imagem , Aortografia/instrumentação , Artérias/diagnóstico por imagem , Angiografia por Tomografia Computadorizada/instrumentação , Tomografia Computadorizada Multidetectores/instrumentação , Medula Espinal/irrigação sanguínea , Tomógrafos Computadorizados , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Erros de Diagnóstico , Desenho de Equipamento , Feminino , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Interpretação de Imagem Radiográfica Assistida por Computador
4.
Ann Thorac Surg ; 104(2): 577-583, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28347533

RESUMO

BACKGROUND: Coronary allograft vasculopathy is an inflammatory-proliferative process that compromises the long-term success of heart transplantation and currently has no effective prevention and treatment. Lipid nanoparticles, termed LDE can carry chemotherapeutic agents in the circulation and concentrates them in the heart. METHODS: Twenty-eight rabbits fed a cholesterol-rich diet and submitted to heterotopic heart transplantation were treated with cyclosporine A (10 mg/kg daily) and allocated to four groups of 7 animals treated with intravenous LDE-methotrexate (MTX; 4 mg/kg weekly), with LDE-paclitaxel (PACLI; 4 mg/kg weekly), or with LDE-PACLI (4 mg/kg weekly) and LDE-MTX (4 mg/kg weekly). A control group was treated with only weekly intravenous saline solution. Animals were euthanized 6 weeks later for morphometric, histologic, immunohistochemical, and gene expression analysis of the graft and native hearts. RESULTS: Compared with controls, grafts of rabbits treated with LDE-PACLI showed 50% reduction of coronary stenosis, and in the LDE-MTX and LDE-MTX/PACLI stenosis was approximately 18% less than in control, but this difference was not statistically significant. In the three treatment groups, macrophage infiltration was decreased. In the LDE-MTX group, gene expression of proinflammatory factors tumor necrosis factor-α, monocyte chemoattractant protein 1, interleukin 18, vascular cellular adhesion molecule 1, and matrix metalloproteinase 12 was strongly diminished, whereas expression of antiinflammatory interleukin 10 increased. In the LDE-PACLI and LDE-PACLI/MTX groups, proinflammatory and antiinflammatory gene expressions were not consistently changed by the treatments. CONCLUSIONS: LDE-PACLI promoted strong improvement of cardiac allograft vasculopathy, but the decrease in coronary stenosis by LDE-MTX and LDE-MTX/PACLI was not significant. All three treatments decreased macrophage infiltration in the graft. These results may encourage future clinical trials to test this new therapeutic approach to coronary allograft vasculopathy.


Assuntos
Doença da Artéria Coronariana/tratamento farmacológico , Portadores de Fármacos , Rejeição de Enxerto/prevenção & controle , Transplante de Coração/efeitos adversos , Metotrexato/farmacocinética , Nanopartículas/administração & dosagem , Paclitaxel/farmacocinética , Animais , Antineoplásicos Fitogênicos/administração & dosagem , Antineoplásicos Fitogênicos/farmacocinética , Doença da Artéria Coronariana/etiologia , Citocinas/biossíntese , Citocinas/genética , Modelos Animais de Doenças , Regulação da Expressão Gênica , Rejeição de Enxerto/genética , Rejeição de Enxerto/metabolismo , Sobrevivência de Enxerto/efeitos dos fármacos , Imuno-Histoquímica , Imunossupressores/administração & dosagem , Imunossupressores/farmacocinética , Injeções Intravenosas , Metotrexato/administração & dosagem , Miocárdio/metabolismo , Paclitaxel/administração & dosagem , RNA/genética , Coelhos , Reação em Cadeia da Polimerase em Tempo Real
6.
Rev Bras Cir Cardiovasc ; 28(3): 317-24, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24343680

RESUMO

INTRODUCTION: The descending branch of the lateral femoral circumflex artery is an option for coronary artery bypass grafting. OBJECTIVE: To evaluate the early patency and adaptation of lumen diameter using multidetector computed angiotomography. METHODS: Thirty-two patients were selected to undergo coronary artery bypass grafting using the descending branch of the lateral circumflex artery, the internal thoracic artery, and other grafts. Evaluations were carried out through high resolution computed tomography performed on the 7th and 90th postoperative day. Diameters of the descending branch of the lateral circumflex artery and the left internal thoracic artery were measured 3 cm before the distal anastomosis, in the middle portion, and 3 cm after the proximal anastomosis. Diameters were compared using paired t-test (P<0.05). RESULTS: Descending branch of the lateral femoral circumflex artery wDescending branch of the lateral femoral circumflex artery was used in 26 patients, as its use was not viable in six patients (18%). It was used as composite graft in all cases. The anterior descending branch was revascularized by the left internal thoracic artery in all cases. Patency rates of the descending branch of the lateral femoral circumflex artery were 96% and 92%, respectively. No occlusions were observed in the left internal thoracic artery (LITA) and no ischemic events were observed in the descending branch of the lateral circumflex. Descending branch of the lateral femoral circumflex artery increased the lumen diameter in the middle (P=0.001) and distal portions (P=0.006); the left internal thoracic artery (LITA) increased in the middle portion (P=0.001). CONCLUSION: Similar to the left internal thoracic artery, the descending branch of the lateral femoral circumflex artery showed high patency rate and positive luminal adaptation. This early evaluation confirms the descending branch of the lateral femoral circumflex artery as a potential alternative for grafting. Due to anatomical variations, preoperative femoral angiographic evaluation appears to be mandatory.


Assuntos
Ponte de Artéria Coronária/métodos , Artéria Femoral/transplante , Grau de Desobstrução Vascular , Adulto , Idoso , Anastomose Cirúrgica/métodos , Angiografia Coronária , Feminino , Artéria Femoral/anatomia & histologia , Seguimentos , Humanos , Masculino , Artéria Torácica Interna/transplante , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
Artif Organs ; 37(11): 958-64, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24219224

RESUMO

Glutaraldehyde is used in order to improve the mechanical and immunogenic properties of biological tissues, such as bovine pericardium membranes, used to manufacture heart valve bioprostheses. Lyophilization, also known as freeze-drying, preserves biological material without damage by freezing the water content and removing ice by sublimation. Through this process, dehydrated products of high quality may be obtained; also, the material may be easily handled. The lyophilization process reduces aldehyde residues in biological tissue previously treated with glutaraldehyde, thus promoting reduction of cytotoxicity, increasing resistance to inflammation, and possibly decreasing the potential for tissue calcification. The objective of this study was to chronically evaluate the calcification of bovine pericardium heart valve prostheses, previously lyophilized or not, in an animal model. Six-month-old sheep received implants of lyophilized and unlyophilized heart valve prostheses in the pulmonary position with right bypass. The study followed 16 animals for a period of 90 days. Right ventricle-pulmonary artery (RV/PA) transvalvular pressure gradient was evaluated before and immediately after implantation and before explantation, as were tissue calcium, inflammation intensity, and thrombosis and pannus formation. The t-test was used for statistical analysis. Twelve animals survived to the end of the experiment, but one of the animals in the control group had endocarditis and was excluded from the data. Four animals died early. The mean RV/PA gradient on implantation was 2.0 ± 1.6 mm Hg in the control group and 6.2 ± 4.1 mm Hg in the lyophilized group (P = 0.064). This mean gradient increased at explantation to 7.7 ± 3.9 mm Hg and 8.6 ± 5.8 mm Hg, respectively (P = 0.777). The average calcium content in the tissue leaflets after 3 months was 21.6 ± 39.1 mg Ca(2+)/g dry weight in the control group, compared with an average content of 41.2 ± 46.9 mg Ca(2+)/g dry weight in the lyophilized group (P = 0.478). In this experimental study there was no reduction of calcification after lyophilization. However, histological analysis showed less inflammation over the lyophilized tissue when compared with the control.


Assuntos
Bioprótese , Cálcio/análise , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valvas Cardíacas/cirurgia , Pericárdio/cirurgia , Animais , Bioprótese/efeitos adversos , Bovinos , Liofilização , Próteses Valvulares Cardíacas/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valvas Cardíacas/patologia , Masculino , Modelos Animais , Pericárdio/patologia , Ovinos
8.
Rev. bras. cir. cardiovasc ; 28(3): 317-324, jul.-set. 2013. ilus, tab
Artigo em Inglês | LILACS | ID: lil-697216

RESUMO

INTRODUCTION: The descending branch of the lateral femoral circumflex artery is an option for coronary artery bypass grafting. OBJECTIVE: To evaluate the early patency and adaptation of lumen diameter using multidetector computed angiotomography. METHODS: Thirty-two patients were selected to undergo coronary artery bypass grafting using the descending branch of the lateral circumflex artery, the internal thoracic artery, and other grafts. Evaluations were carried out through high resolution computed tomography performed on the 7th and 90th postoperative day. Diameters of the descending branch of the lateral circumflex artery and the left internal thoracic artery were measured 3 cm before the distal anastomosis, in the middle portion, and 3 cm after the proximal anastomosis. Diameters were compared using paired t-test (P<0.05). RESULTS: Descending branch of the lateral femoral circumflex artery wDescending branch of the lateral femoral circumflex artery was used in 26 patients, as its use was not viable in six patients (18%). It was used as composite graft in all cases. The anterior descending branch was revascularized by the left internal thoracic artery in all cases. Patency rates of the descending branch of the lateral femoral circumflex artery were 96% and 92%, respectively. No occlusions were observed in the left internal thoracic artery (LITA) and no ischemic events were observed in the descending branch of the lateral circumflex. Descending branch of the lateral femoral circumflex artery increased the lumen diameter in the middle (P=0.001) and distal portions (P=0.006); the left internal thoracic artery (LITA) increased in the middle portion (P=0.001). CONCLUSION: Similar to the left internal thoracic artery, the descending branch of the lateral femoral circumflex artery showed high patency rate and positive luminal adaptation. This early evaluation confirms the descending branch of the lateral femoral circumflex artery as a potential alternative for grafting. Due to anatomical variations, preoperative femoral angiographic evaluation appears to be mandatory.


INTRODUÇÃO: O ramo descendente da artéria circunflexa lateral é um enxerto pouco avaliado e pode ser uma opção para a revascularização do miocárdio. OBJETIVO: Avaliar a perviabilidade e o remodelamento arterial do ramo descendente da artéria circunflexa lateral, em três meses de seguimento, por meio de angiotomografia de artérias coronárias. MÉTODOS: Foram analisados 32 pacientes submetidos à revascularização do miocárdio com ramo descendente da artéria circunflexa lateral, artéria torácica interna esquerda e outros enxertos. A avaliação foi realizada por meio da tomografia computadorizada de alta resolução, realizada no 7º e 90º dias de pós-operatório. O diâmetro do ramo descendente da artéria circunflexa lateral foi medido 3 cm antes da anastomose distal, na porção média e 3 cm após a anastomose proximal. As mesmas medidas foram realizadas para a artéria torácica interna esquerda. Os diâmetros foram comparados pelo método t de Student pareado (significância P<0,05). RESULTADOS: O ramo descendente da artéria circunflexa lateral foi adequado para a utilização em 26 pacientes. Em seis (18%) pacientes, o ramo descendente da artéria circunflexa lateral era inviável. Em todos os casos, o ramo descendente da artéria circunflexa lateral foi empregado sob a forma de enxerto composto. Todos os pacientes receberam artéria torácica interna esquerda para o ramo descendente anterior. A perviabilidade do ramo descendente da artéria circunflexa lateral foi de 96% e 92%, em 7 e 90 dias de pós-operatório, respectivamente. Não foram detectadas oclusões da artéria torácica interna esquerda. Não foram detectados sinais de espasmo do ramo descendente da artéria circunflexa lateral. O ramo descendente da artéria circunflexa lateral apresentou aumento de diâmetro nas porções média (P=0,001) e distal (P=0,006) e a artéria torácica interna esquerda, aumento na porção média (P=0,001). CONCLUSÃO: O remodelamento positivo sugere que o ramo descendente da artéria circunflexa lateral tem comportamento semelhante à artéria torácica interna esquerda e pode ser uma excelente opção para a revascularização do miocárdio com enxertos arteriais. Em virtude das variações anatômicas, estudos de pré-operatório podem auxiliar na seleção de casos.


Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ponte de Artéria Coronária/métodos , Artéria Femoral/transplante , Grau de Desobstrução Vascular , Anastomose Cirúrgica/métodos , Angiografia Coronária , Seguimentos , Artéria Femoral/anatomia & histologia , Artéria Torácica Interna/transplante , Reprodutibilidade dos Testes , Estatísticas não Paramétricas , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Arq Bras Cardiol ; 100(3): 246-54, 2013 Mar.
Artigo em Inglês, Português | MEDLINE | ID: mdl-23598578

RESUMO

BACKGROUND: Risk scores show difficulties to attain the same performance in different populations. OBJECTIVE: To create a simple and accurate risk assessment model for patients submitted to surgery due to coronary and/or valvular disease at Instituto do Coração da Universidade de São Paulo (InCor-HCFMUSP). METHODS: Between 2007 and 2009, 3,000 patients were submitted to surgical procedure due to coronary artery and/or valvular disease at InCor-HCFMUSP. From this record, data of 2/3 of the patients were used for model development (bootstrap technique), and 1/3 for internal validation of the model. The performance of the model (InsCor) was compared to the 2000 Bernstein-Parsonnet (2000BP) and EuroSCORE (ES) complexes. RESULTS: Only 10 variables were selected: age > 70 years, female sex; coronary revascularization + valve, myocardial infarction < 90 days; reoperation; surgical treatment of aortic valve; surgical treatment of tricuspid valve; creatinine < 2mg/dL; ejection fraction < 30%, and events. The Hosmer Lemeshow test for the InsCor was 0.184, indicating excellent calibration. The area under the ROC curve was 0.79 for the InsCor, 0.81 for the ES and 0.82 for 2000BP, confirming that the models are good and have similar discrimination. CONCLUSIONS: The InsCor and ES performed better than 2000BP at all stages of validation, but the new model, in addition to showing identification with the local risk factors, is simpler and more objective for mortality prediction in patients undergoing surgery due to coronary and/or valvular disease at InCor-HCFMUSP.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Doença da Artéria Coronariana/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Idoso , Calibragem/normas , Feminino , Humanos , Modelos Estatísticos , Curva ROC , Reprodutibilidade dos Testes , Medição de Risco/métodos , Medição de Risco/normas
10.
Arq. bras. cardiol ; 100(3): 246-254, mar. 2013. ilus, tab
Artigo em Português | LILACS | ID: lil-670865

RESUMO

FUNDAMENTO: Escores de risco apresentam dificuldades para obter o mesmo desempenho em diferentes populações. OBJETIVO: Criar um modelo simples e acurado para avaliação do risco nos pacientes operados de doença coronariana e/ou valvar no Instituto do Coração da Universidade de São Paulo (InCor-HCFMUSP). MÉTODOS: Entre 2007 e 2009, 3.000 pacientes foram operados consecutivamente de doença coronariana e/ou valvar no InCor-HCFMUSP. Desse registro, dados de 2/3 dos pacientes foram utilizados para desenvolvimento do modelo (técnica de bootstrap) e de 1/3 para validação interna do modelo. O desempenho do modelo (InsCor) foi comparado aos complexos 2000 Bernstein-Parsonnet (2000BP) e EuroSCORE (ES). RESULTADOS: Apenas 10 variáveis foram selecionadas: Idade > 70 anos; sexo feminino; cirurgia de revascularização coronariana + valva; infarto de miocárdio < 90 dias; reoperação; tratamento cirúrgico da valva aórtica; tratamento cirúrgico da valva tricúspide; creatinina < 2mg/dL; fração de ejeção < 30%; e eventos. O teste de Hosmer Lemeshow para o InsCor foi de 0,184, indicando uma excelente calibração. A área abaixo da curva ROC foi de 0,79 para o InsCor, 0,81 para o ES e 0,82 para o 2000BP, confirmando que os modelos são bons e similares na discriminação. CONCLUSÕES: O InsCor e o ES tiveram melhor desempenho que o 2000BP em todas as fases da validação; pórem o novo modelo, além de se identificar com os fatores de risco locais, é mais simples e objetivo para a predição de mortalidade nos pacientes operados de doença coronariana e/ou valvar no InCor-HCFMUSP.


BACKGROUND: Risk scores show difficulties to attain the same performance in different populations. OBJECTIVE: To create a simple and accurate risk assessment model for patients submitted to surgery due to coronary and/or valvular disease at Instituto do Coração da Universidade de São Paulo (InCor-HCFMUSP). METHODS: Between 2007 and 2009, 3,000 patients were submitted to surgical procedure due to coronary artery and/or valvular disease at InCor-HCFMUSP. From this record, data of 2/3 of the patients were used for model development (bootstrap technique), and 1/3 for internal validation of the model. The performance of the model (InsCor) was compared to the 2000 Bernstein-Parsonnet (2000BP) and EuroSCORE (ES) complexes. RESULTS: Only 10 variables were selected: age > 70 years, female sex; coronary revascularization + valve, myocardial infarction < 90 days; reoperation; surgical treatment of aortic valve; surgical treatment of tricuspid valve; creatinine < 2mg/dL; ejection fraction < 30%, and events. The Hosmer Lemeshow test for the InsCor was 0.184, indicating excellent calibration. The area under the ROC curve was 0.79 for the InsCor, 0.81 for the ES and 0.82 for 2000BP, confirming that the models are good and have similar discrimination. CONCLUSIONS: The InsCor and ES performed better than 2000BP at all stages of validation, but the new model, in addition to showing identification with the local risk factors, is simpler and more objective for mortality prediction in patients undergoing surgery due to coronary and/or valvular disease at InCor-HCFMUSP.


Assuntos
Idoso , Feminino , Humanos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Doença da Artéria Coronariana/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Calibragem/normas , Modelos Estatísticos , Reprodutibilidade dos Testes , Curva ROC , Medição de Risco/métodos , Medição de Risco/normas
11.
Rev Bras Cir Cardiovasc ; 27(2): 203-10, 2012.
Artigo em Inglês, Português | MEDLINE | ID: mdl-22996970

RESUMO

BACKGROUND: Longitudinal median sternotomy is the most common surgical approach for access to heart disease treatment. The deep wound infections in postoperative period of cardiovascular surgery are a serious complication requiring high costs during treatment. Different studies have indicated some risk factors for the development of mediastinitis and preoperative variables are currently under investigation. OBJECTIVE: The aim of this study is to identify the preoperative risk factors for postoperative development of mediastinitis in patients undergoing coronary artery bypass grafting and valve replacement. METHODS: This observational study represents a cohort of 2768 consecutive operated patients. The period considered for analysis was from May 2007 to May 2009 and there were no exclusion criteria. Analysis was performed by univariate and multivariate logistic regression model of 38 preoperative variables. RESULTS: Thirty-five (1.3%) patients developed mediastinitis and 19 (0.7%) associated with osteomyelitis. The patient age average was 59.9 ± 13.5 years and the EuroSCORE of 4.5 ± 3.6. Hospital mortality was 42.8%. The multivariate analysis identified three variables as independent predictors of postoperative mediastinitis: intra-aortic balloon pump (OR 5.41, 95% CI [1.83 -16.01], P = 0.002), hemodialysis (OR 4.87, 95% CI [1.41 to 16.86], P = 0.012) and extracardiac vascular intervention (OR 4.39, 95% CI [1.64 to 11.76], P = 0.003). CONCLUSION: This study showed that necessity of preoperative hemodynamic support with intra-aortic balloon, hemodialysis, and extracardiac vascular intervention were risk factors for development of mediastinitis after cardiac surgery.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Valvas Cardíacas/cirurgia , Mediastinite/etiologia , Complicações Pós-Operatórias/etiologia , Período Pré-Operatório , Idoso , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Fatores de Risco , Distribuição por Sexo
12.
BMC Cardiovasc Disord ; 12: 65, 2012 Aug 16.
Artigo em Inglês | MEDLINE | ID: mdl-22898311

RESUMO

BACKGROUND: Although the release of cardiac biomarkers after percutaneous (PCI) or surgical revascularization (CABG) is common, its prognostic significance is not known. Questions remain about the mechanisms and degree of correlation between the release, the volume of myocardial tissue loss, and the long-term significance. Delayed-enhancement of cardiac magnetic resonance (CMR) consistently quantifies areas of irreversible myocardial injury. To investigate the quantitative relationship between irreversible injury and cardiac biomarkers, we will evaluate the extent of irreversible injury in patients undergoing PCI and CABG and relate it to postprocedural modifications in cardiac biomarkers and long-term prognosis. METHODS/DESIGN: The study will include 150 patients with multivessel coronary artery disease (CAD) with left ventricle ejection fraction (LVEF) and a formal indication for CABG; 50 patients will undergo CABG with cardiopulmonary bypass (CPB); 50 patients with the same arterial and ventricular condition indicated for myocardial revascularization will undergo CABG without CPB; and another 50 patients with CAD and preserved ventricular function will undergo PCI using stents. All patients will undergo CMR before and after surgery or PCI. We will also evaluate the release of cardiac markers of necrosis immediately before and after each procedure. Primary outcome considered is overall death in a 5-year follow-up. Secondary outcomes are levels of CK-MB isoenzyme and I-Troponin in association with presence of myocardial fibrosis and systolic left ventricle dysfunction assessed by CMR. DISCUSSION: The MASS-V Trial aims to establish reliable values for parameters of enzyme markers of myocardial necrosis in the absence of manifest myocardial infarction after mechanical interventions. The establishments of these indices have diagnostic value and clinical prognosis and therefore require relevant and different therapeutic measures. In daily practice, the inappropriate use of these necrosis markers has led to misdiagnosis and therefore wrong treatment. The appearance of a more sensitive tool such as CMR provides an unprecedented diagnostic accuracy of myocardial damage when correlated with necrosis enzyme markers. We aim to correlate laboratory data with imaging, thereby establishing more refined data on the presence or absence of irreversible myocardial injury after the procedure, either percutaneous or surgical, and this, with or without the use of cardiopulmonary bypass.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/terapia , Creatina Quinase Forma MB/sangue , Cardiopatias/diagnóstico , Imagem Cinética por Ressonância Magnética , Miocárdio , Intervenção Coronária Percutânea/efeitos adversos , Projetos de Pesquisa , Troponina I/sangue , Biomarcadores/sangue , Distribuição de Qui-Quadrado , Ponte de Artéria Coronária sem Circulação Extracorpórea/efeitos adversos , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/patologia , Doença da Artéria Coronariana/cirurgia , Fibrose , Cardiopatias/sangue , Cardiopatias/patologia , Cardiopatias/fisiopatologia , Humanos , Modelos Logísticos , Análise Multivariada , Miocárdio/metabolismo , Miocárdio/patologia , Necrose , Intervenção Coronária Percutânea/instrumentação , Valor Preditivo dos Testes , Estudos Prospectivos , Stents , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Regulação para Cima , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/etiologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda
14.
Rev. bras. cir. cardiovasc ; 27(2): 203-210, abr.-jun. 2012. tab
Artigo em Português | LILACS | ID: lil-649595

RESUMO

INTRODUÇÃO: A esternotomia mediana longitudinal é a via de acesso mais utilizada no tratamento das doenças cardíacas. As infecções profundas da ferida operatória no pós-operatório das cirurgias cardiovasculares são uma complicação séria, com alto custo durante o tratamento. Diferentes estudos têm encontrado fatores de risco para o desenvolvimento de mediastinite e as variáveis pré-operatórias têm tido especial destaque. OBJETIVO: O objetivo deste estudo é identificar fatores de risco pré-operatórios para o desenvolvimento de mediastinite em pacientes submetidos a revascularização do miocárdio e a substituição valvar. MÉTODOS: Este estudo observacional representa uma coorte de 2768 pacientes operados consecutivamente. O período considerado para análise foi de maio de 2007 a maio de 2009 e não houve critérios de exclusão. Foi realizada análise univariada e multivariada pelo modelo de regressão logística das 38 variáveis pré-operatórias eleitas. RESULTADOS: Nesta série, 35 (1,3%) pacientes evoluíram com mediastinite e 19 (0,7%) com osteomielite associada. A idade média dos pacientes foi de 59,9 ± 13,5 anos e o EuroSCORE de 4,5 ± 3,6. A mortalidade hospitalar foi de 42,8%. Na análise multivariada, foram identificadas três variáveis como preditoras independentes de mediastinite: balão intra-aórtico (OR 5,41, 95% IC [1,83 -16,01], P=0,002), hemodiálise (OR 4,87, 95% IC [1,41 - 16,86], P=0,012) e intervenção vascular extracardíaca (OR 4,39, 95% IC [1,64 - 11,76], P=0,003). CONCLUSÃO: O presente estudo demonstrou que necessidade do suporte hemodinâmico pré-operatório com balão intra-aórtico, hemodiálise e intervenção vascular extracardíaca são fatores de risco para o desenvolvimento de mediastinite após cirurgia cardíaca.


BACKGROUND: Longitudinal median sternotomy is the most common surgical approach for access to heart disease treatment. The deep wound infections in postoperative period of cardiovascular surgery are a serious complication requiring high costs during treatment. Different studies have indicated some risk factors for the development of mediastinitis and preoperative variables are currently under investigation. OBJECTIVE: The aim of this study is to identify the preoperative risk factors for postoperative development of mediastinitis in patients undergoing coronary artery bypass grafting and valve replacement. METHODS: This observational study represents a cohort of 2768 consecutive operated patients. The period considered for analysis was from May 2007 to May 2009 and there were no exclusion criteria. Analysis was performed by univariate and multivariate logistic regression model of 38 preoperative variables. RESULTS: Thirty-five (1.3%) patients developed mediastinitis and 19 (0.7%) associated with osteomyelitis. The patient age average was 59.9 ± 13.5 years and the EuroSCORE of 4.5 ± 3.6. Hospital mortality was 42.8%. The multivariate analysis identified three variables as independent predictors of postoperative mediastinitis: intra-aortic balloon pump (OR 5.41, 95% CI [1.83 -16.01], P = 0.002), hemodialysis (OR 4.87, 95% CI [1.41 to 16.86], P = 0.012) and extracardiac vascular intervention (OR 4.39, 95% CI [1.64 to 11.76], P = 0.003). CONCLUSION: This study showed that necessity of preoperative hemodynamic support with intra-aortic balloon, hemodialysis, and extracardiac vascular intervention were risk factors for development of mediastinitis after cardiac surgery.


Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ponte de Artéria Coronária/efeitos adversos , Valvas Cardíacas/cirurgia , Mediastinite/etiologia , Período Pré-Operatório , Complicações Pós-Operatórias/etiologia , Métodos Epidemiológicos , Osteomielite/etiologia , Fatores de Risco , Distribuição por Sexo
15.
Arq. bras. cardiol ; 98(5): 390-397, maio 2012. ilus, tab
Artigo em Português | LILACS | ID: lil-643641

RESUMO

FUNDAMENTO: O número crescente de crianças com cardiopatias congênitas em evolução demanda maior preparo dos profissionais e das instituições que as manuseiam. OBJETIVO: Descrever o perfil dos pacientes com idade superior a 16 anos com cardiopatia congênita operados e analisar os fatores de risco preditivos de mortalidade hospitalar. MÉTODOS: Mil, quinhentos e vinte pacientes (idade média 27 ± 13 anos) foram operados entre janeiro de 1986 e dezembro de 2010. Foram realizadas análise descritiva do perfil epidemiológico da população estudada e análise dos fatores de risco para mortalidade hospitalar, considerando escore de complexidade, ano em que a cirurgia foi realizada, procedimento realizado pelo cirurgião pediátrico ou não e presença de reoperação. RESULTADOS: Ocorreu um crescimento expressivo no número de casos a partir do ano 2000. A média do escore de complexidade foi 5,4 e os defeitos septais corresponderam a 45% dos casos. A mortalidade geral foi 7,7% e o maior número de procedimentos (973 ou 61,9%) com maior complexidade foi realizado por cirurgiões pediátricos. Complexidade (OR 1,5), reoperação (OR 2,17) e cirurgião pediátrico (OR 0,28) foram fatores de risco independentes que influenciaram a mortalidade. A análise multivariada mostrou que o ano em que a cirurgia foi realizada (OR 1,03), a complexidade (OR 1,44) e o cirurgião pediátrico (OR 0,28) influenciaram no resultado. CONCLUSÃO: Observa-se um número crescente de pacientes com idade superior a 16 anos e que, apesar do grande número de casos simples, os mais complexos foram encaminhados para os cirurgiões pediátricos, que apresentaram menor mortalidade, em especial nos anos mais recentes. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).


BACKGROUND: The increasing number of children with evolving congenital heart diseases demands greater preparation of professionals and institutions that handle them. OBJECTIVE: To describe the profile of patients aged over 16 years with congenital heart disease, who have undergone surgery, and analyze the risk factors that predict hospital mortality. METHOD: One thousand five hundred twenty patients (mean age 27 ± 13 years) were operated between January 1986 and December 2010. We performed a descriptive analysis of the epidemiological profile of the study population and analyzed risk factors for hospital mortality, considering the complexity score, the year in which surgery was performed, the procedure performed or not performed by the pediatric surgeon and reoperation. RESULTS: There was a significant increase in the number of cases from the year 2000. The average complexity score was 5.4 and the septal defects represented 45% of cases. Overall mortality was 7.7% and most procedures (973 or 61.9%) with greater complexity were performed by pediatric surgeons. Complexity (OR 1.5), reoperation (OR 2.17) and pediatric surgeon (OR 0.28) were independent risk factors influencing mortality. Multivariate analysis showed that the year in which the surgery was performed (OR 1.03), the complexity (OR 1.44) and the pediatric surgeon (OR 0.28) influenced the result. CONCLUSION: There is an increasing number of patients aged 16 years which, despite the large number of simple cases, the most complex ones were referred to pediatric surgeons, who had lower mortality, especially in recent years. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).


Assuntos
Adolescente , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Mortalidade Hospitalar , Cardiopatias Congênitas/cirurgia , Fatores Etários , Brasil/epidemiologia , Métodos Epidemiológicos , Cardiopatias Congênitas/mortalidade , Especialidades Cirúrgicas , Fatores de Tempo , Resultado do Tratamento
16.
Arq Bras Cardiol ; 98(5): 390-7, 2012 May.
Artigo em Inglês, Português | MEDLINE | ID: mdl-22460167

RESUMO

BACKGROUND: The increasing number of children with evolving congenital heart diseases demands greater preparation of professionals and institutions that handle them. OBJECTIVE: To describe the profile of patients aged over 16 years with congenital heart disease, who have undergone surgery, and analyze the risk factors that predict hospital mortality. METHOD: One thousand five hundred twenty patients (mean age 27 ± 13 years) were operated between January 1986 and December 2010. We performed a descriptive analysis of the epidemiological profile of the study population and analyzed risk factors for hospital mortality, considering the complexity score, the year in which surgery was performed, the procedure performed or not performed by the pediatric surgeon and reoperation. RESULTS: There was a significant increase in the number of cases from the year 2000. The average complexity score was 5.4 and the septal defects represented 45% of cases. Overall mortality was 7.7% and most procedures (973 or 61.9%) with greater complexity were performed by pediatric surgeons. Complexity (OR 1.5), reoperation (OR 2.17) and pediatric surgeon (OR 0.28) were independent risk factors influencing mortality. Multivariate analysis showed that the year in which the surgery was performed (OR 1.03), the complexity (OR 1.44) and the pediatric surgeon (OR 0.28) influenced the result. CONCLUSION: There is an increasing number of patients aged 16 years which, despite the large number of simple cases, the most complex ones were referred to pediatric surgeons, who had lower mortality, especially in recent years.


Assuntos
Cardiopatias Congênitas/cirurgia , Mortalidade Hospitalar , Adolescente , Adulto , Fatores Etários , Idoso , Brasil/epidemiologia , Métodos Epidemiológicos , Cardiopatias Congênitas/mortalidade , Humanos , Pessoa de Meia-Idade , Especialidades Cirúrgicas , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
Rev Bras Cir Cardiovasc ; 26(1): 1-6, 2011.
Artigo em Inglês, Português | MEDLINE | ID: mdl-21881704

RESUMO

OBJECTIVE: To evaluate the performance of 2000 Bernstein-Parsonnet (2000BP) and additive EuroSCORE (ES) for predicting surgical mortality at the Heart Institute, University of São Paulo. METHODS: A prospective observational design. Seven hundred and seventy four patients were operated for coronary artery bypass graft, valve or combined procedure between May and October, 2007, were analyzed. The mortality was estimated with the 2000BP and ES. The correlation between expected mortality and observed mortality was validated through calibration and discrimination test. RESULTS: The patients were stratified into five groups for the 2000BP and three for the ES. The Hosmer-Lemeshow test for 2000BP (P = 0.70) and for ES (P = 0.39) indicate a good calibration. The ROC curve for the 2000BP = 0.84 and for the ES = 0.81 confirms that the models are good predictors (P<0.001). CONCLUSION: Both models are similar and adequate in predicting surgical mortality at the InCor-USP.


Assuntos
Institutos de Cardiologia/estatística & dados numéricos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Procedimentos Cirúrgicos Cardíacos/classificação , Ponte de Artéria Coronária/mortalidade , Métodos Epidemiológicos , Feminino , Valvas Cardíacas/cirurgia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco/métodos , Medição de Risco/normas , Adulto Jovem
20.
Rev Bras Cir Cardiovasc ; 26(1): 128-30, 2011.
Artigo em Inglês, Português | MEDLINE | ID: mdl-21881722

RESUMO

It is reported a ruptured descending thoracic aortic aneurysm in a 25-year-old systemic lupus erythematosus woman who underwent 19 years steroid therapy. She was treated with 2 endovascular stent-grafts, discharged from hospital 13 days after the procedure in good health. Three months later she returned with hemorrhagic shock due to high digestive hemorrhage secondary to an aortic-esophageal fistula. She underwent to an open emergency surgery, and died during the post-operative period.


Assuntos
Aneurisma da Aorta Torácica/induzido quimicamente , Ruptura Aórtica/induzido quimicamente , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Esteroides/efeitos adversos , Adulto , Aneurisma da Aorta Torácica/cirurgia , Ruptura Aórtica/cirurgia , Fístula Esofágica/complicações , Evolução Fatal , Feminino , Hemorragia/etiologia , Humanos , Stents , Fístula Vascular/complicações
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