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1.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(1): 71-75, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-31958934

RESUMO

Objective: To evaluate the long-term healing rate of transsphincteric anal fistula treated with anal fistula plug procedure and the risk factors affecting the healing of anal fistula. Methods: A retrospective case-control study was conducted to analyze the clinical data of 207 patients with transsphincteric anal fistulas who received anal fistula plug procedure at the Department of General Surgery, Beijing Chaoyang Hospital of Capital Medical University from August 2008 to September 2012. Inclusion criteria: (1) consistent with the diagnosis of transsphincteric anal fistula: the anal fistula passed through the internal and external sphincter; (2) complete data; (3) initial treatment with anal fistula plug procedure. Exclusion criteria: (1) acute rectal or perianal infection or poorly controlled focal infection; (2) recent incision and drainage of perianal abscess or spontaneous rupture of abscess; (3) patients with malignant tumor; (4) patients with Crohn's disease or ulcerative colitis; (5) patients with heart, liver, brain, lung or renal insufficiency; (6) cachexia due to various chronic wasting diseases; (7) patients could not tolerate surgery. Patients were followed up for anal fistula healing. The cumulative healing rate of patients with transsphincteric anal fistula was plotted using the Kaplan-Meier method, and the factors affecting anal fistula healing were explored by univariate and multivariate logistic regression analysis. Results: There were 186 males and 21 females with age of 15 to 69 (mean 38) years. The duration of anal fistula was 3-60 (mean 15) months. Three patients had a history of previous episodes of perianal abscess and underwent incision and drainage of perianal abscess (all more than 3 months). During follow-up ending on October 31, 2018, 72 patients (34.8%) were lost to follow-up. Among 135 patients who were successfully followed up, the average follow-up period was 96 (75-124) months. Seventy-five patients had anal fistula healing, with healing rate of 55.6%. Kaplan-Meier survival curve showed that the healing time of anal fistula was prolonged and finally stabilized at 55.6%. In the patients who failed initial treatment with anal fistula plug packing, there were 6 cases whose anal fistula healed spontaneously without other treatment. Among them, 3 cases healed spontaneously 2 years and 3 cases 3 years after operation without recurrence. From 2008 to 2012, the annual healing rates of anal fistula plug treatment were 3/6, 61.5% (24/39), 42.1% (24/57), 12/15 and 12/18, respectively. Multivariate logistic regression analysis showed that the duration of anal fistula≥6 months (OR=3.187, 95% CI: 1.361-7.466, P=0.008) was an independent risk factor for anal fistula healing after treatment with anal fistula plug. Conclusion: The long-term efficacy of anal fistula plug procedure in the treatment of transsphincteric anal fistula is positive, and this procedure should be implemented as soon as possible.


Assuntos
Canal Anal/cirurgia , Implantação de Prótese , Fístula Retal/cirurgia , Adolescente , Adulto , Bioprótese , Incontinência Fecal/etiologia , Incontinência Fecal/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Retal/complicações , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Cicatrização , Adulto Jovem
2.
Zhonghua Wai Ke Za Zhi ; 57(12): 947-950, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826601

RESUMO

Late tricuspid regurgitation after left-sided valve surgery can negatively affect long-term prognosis. The surgical timing and strategy of tricuspid valve reoperation will have important impact on the surgical outcomes. However, there is no clear recommendations of the surgical timing for this condition in the current guidelines. Generally, tricuspid valve reoperation should be performed before irreversible right heart failure occurs. Although tricuspid valve repair is the first choice for tricuspid regurgitation, bioprosthetic tricuspid valve replacement might be a reliable alternative when tricuspid leaflets have severe rheumatic damage or right ventricle and tricuspid annulus significantly dilate. Combined minimally invasive surgical techniques, including right minithoracotomy approach, accessing the right atrium directly through the pericardium with limited dissection, peripheral cannulation strategy with the vacuum-assist single venous drainage technique and heart beating technique, can significantly decrease the operative mortality and postoperative bleeding. With development of interventional therapy, transcatheter tricuspid valve repair or replacement may become alternatives for tricuspid regurgitation after left-sided valve surgery in the future.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Insuficiência da Valva Tricúspide/cirurgia , Bioprótese , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Reoperação , Resultado do Tratamento , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/etiologia
3.
Arkh Patol ; 81(6): 16-23, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31851188

RESUMO

OBJECTIVE: To perform immunohistochemical typing of cells as a component of bioprosthetic (BP) heart valves explanted during reoperations for prosthetic valve endocarditis. MATERIAL AND METHODS: The authors investigated 8 models of KemCor and PeriCor artificial heart valves produced by NeoCor Company (Kemerovo, Russia), which were explanted from the mitral position due to infection of xenogeneic implanted material. The following markers: CD3 (T-lymphocytes), CD20 (B-lymphocytes), CD34 and VEGFR2 (endotheliocytes), CD68 (monocytes/macrophages), vimentin (fibroblasts), and α-smooth muscle actin (smooth muscle cells), were used for immunohistochemical typing of cells as a component of the analyzed samples. RESULTS: Recipient cells were found to colonize devitalized BP tissues in infective endocarditis. This process simultaneously involved several types of cells performing their functions in infectious lesion and its initiation of BP remodeling. Macrophages contributed to the sanitation of the foci of infection and destruction of BP xenotissue; endotheliocytes ensured neovascularization and resistance of the implanted valve surface to infection; fibroblasts played a role in the neoplastic transformation of collagen, and smooth muscle cells were likely to take on the role in forming the elastic framework of a leaflet and in ensuring the mechanical properties of the bioprosthesis. CONCLUSION: In the time course of development of prosthetic endocarditis, the recipient cells populate xenovalve leaflets that are a modified extracellular matrix obtained from the porcine aortic valve complex. This process is a consequence of the destruction of the BP surface and deep components. The observed cellular reactions are likely to be adaptive and to be aimed at eliminating microorganisms and regenerating structural damages.


Assuntos
Bioprótese , Endocardite , Próteses Valvulares Cardíacas , Animais , Valvas Cardíacas , Federação Russa , Suínos
4.
Kyobu Geka ; 72(13): 1057-1060, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31879379

RESUMO

Pregnant women undergoing mechanical valve replacement are at a considerable risk of thromboembolic events, bleeding, and fetotoxicity associated with the administration of vitamin K antagonists and some other anticoagulants. We present our clinical experience of pregnancy and childbirth in a young woman who underwent aortic valve replacement (AVR) with a mechanical valve. A young woman underwent AVR with a bioprosthetic valve for a diagnosis of aortic regurgitation and bicuspid aortic valve at age 23. Four years later, structural valve deterioration(SVD) of the prosthetic valve necessitated redo AVR with bioprosthesis. Three years after the redo AVR, she developed recurrent SVD of the bioprosthesis, and the 3rd AVR operation was performed using an On-X mechanical valve, which allows reduced anticoagulation. She conceived 5 months after AVR using the On-X valve. Anticoagulation therapy was administered with a low-dose vitamin K antagonist combined with heparin infusion during pregnancy. No anticoagulation-induced maternal and fetal complications occurred throughout the pregnancy. The On-X valve, which allows lower levels of anticoagulation is useful in women wishing to get pregnant.


Assuntos
Bioprótese , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Complicações Cardiovasculares na Gravidez/cirurgia , Anticoagulantes , Valva Aórtica , Feminino , Humanos , Gravidez , Resultado da Gravidez , Reoperação , Resultado do Tratamento , Adulto Jovem
5.
Kyobu Geka ; 72(12): 1015-1018, 2019 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-31701914

RESUMO

An 81-year-old man who had undergone aortic valve replacement was transferred to our hospital due to suspected prosthetic valve endocarditis(PVE) from the regional hospital. Transesophageal echocardiography findings showed severe aortic regurgitation with mobile vegetation on the right coronary cusp and annular abscess corresponding to left-none coronary cusps. Urgent operation was performed under the diagnosis of PVE with aortic root abscess. Intraoperative findings demonstrated tiny vegetation on one of the bio-prosthetic leaflets and abscess formation beneath the left sinus of valsalva( LSOV). Complete debridement of the infected tissue followed by patch closure of the cavity below the LSOV and reconstruction of the aortic root with Freestyle stentless aortic bioprosthesis was performed. His postoperative course was uneventful. Aortic root replacement using a stentless bioprosthesis seems to represent one of the useful options for PVE with aortic root abscess.


Assuntos
Bioprótese , Endocardite , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Abscesso , Idoso de 80 Anos ou mais , Valva Aórtica , Humanos , Masculino
6.
Tex Heart Inst J ; 46(3): 219-221, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708708

RESUMO

Bioprosthetic valve thrombosis was previously considered to be a relatively rare complication of surgical or transcatheter bioprosthetic valve replacement. Although echocardiograms can reliably show the characteristic findings of prosthetic valve stenosis, differentiating between thrombus formation and pannus overgrowth as the underlying cause of prosthetic valve dysfunction can be challenging. We present the case of a 75-year-old man who underwent transthoracic Doppler echocardiography in the presence of an elevated valvular gradient 2 years after his aortic valve had been surgically replaced with a bioprosthesis. The echocardiographic findings suggested prosthetic valve stenosis. Cardiac computed tomography, performed to distinguish between thrombus formation and pannus overgrowth, revealed hypoattenuated leaflet thickening and reduced leaflet mobility, which suggested thrombus. After the patient took oral anticoagulants for 3 months, images showed complete resolution of the previous abnormalities, thus confirming the diagnosis of bioprosthetic valve thrombosis. We found cardiac computed tomography valuable when evaluating our patient who had an elevated prosthetic valve gradient.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Bioprótese/efeitos adversos , Cardiopatias/diagnóstico , Trombose/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico , Diagnóstico Diferencial , Ecocardiografia Doppler , Ecocardiografia Transesofagiana , Cardiopatias/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Desenho de Prótese
7.
Rev Port Cir Cardiotorac Vasc ; 26(3): 195-197, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734970

RESUMO

INTRODUCTION: The association between aortic valve disease and dilatation of the ascending aorta is well known and concomitant surgery is recommended when the aortic diameter is higher than 45mm. The use of the rapid deployment valves allows less cross-clamping and cardiopulmonary bypass times for both isolated and combined procedures in comparison to regular valves. We describe our initial experience of concomitant aortic valve and the ascending aortic replacement, using the rapid deployment valve Edward Intuity EliteTM. CASE PRESENTATION: All patients were male, with a mean age of 72-years-old. The mean cross-clamping time was 48 minutes, with a mean cardiopulmonary time of 61 minutes. The mean time of ICU stay was 4 days. All the patients had follow-up 1 and 3 months after discharge and were doing well. CONCLUSIONS: The rapid deployment aortic valves have recognized advantages in aortic valve replacement. Our small experience reinforces that replacement the ascending aortic and aortic valve with this prothesis is one procedure that can benefits from generalization without increased risks and with potentially better clinical outcomes. Larger cohort studies would allow clarification over this subject.


Assuntos
Aorta/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Doenças Cardiovasculares/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Idoso , Doenças da Aorta/cirurgia , Bioprótese , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino , Desenho de Prótese , Resultado do Tratamento
8.
Int Heart J ; 60(6): 1344-1349, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31735769

RESUMO

This study aimed to analyze the early and mid-term outcomes of aortic valve replacement with bovine pericardium in the treatment of aortic valve regurgitation.From January 2015 to March 2018, 36 patients (19 men; mean ± standard deviation [SD] age, 46.70 ± 16.60 years) underwent aortic valve replacement with bovine pericardium. The bovine pericardium was intraoperatively measured and shaped using an Ozaki template, according to the shape and size of the individual patient's aortic valve leaflets. Additional procedures were performed, including ventricular septal defect repair in 5 cases, mitral valve reconstruction in 6 cases, tricuspid valve reconstruction in 6 cases, and coronary artery bypass grafting in 3 cases.There were no perioperative deaths. One elderly patient with postoperative respiratory failure recovered after symptomatic treatment. One patient with frequent ventricular tachycardia after intraoperative cardiac re-jump underwent intra-aortic balloon counterpulsation (IABP), and the IABP device was successfully removed on the second postoperative day. Within the first 6 months of follow-up, there were no death events, no reoperation events, and no additional thromboembolic events. Follow-up echocardiography was performed for 6 months, with average left ventricular ejection fraction of 62.01 ± 3.21%, mean transvalvular pressure gradient of 11.17 ± 4.90 mmHg, and mean aortic valve velocity of 1.60 ± 0.58 m/s. Compared with the preoperative transthoracic echocardiography findings, the results at the six-month follow-up were statistically significant (P < 0.05). Mild aortic valve regurgitation occurred in 2 patients (5.56%), whereas other patients had no or only minimal aortic valve regurgitation (n = 34, 94.44%). Moderate aortic valve regurgitation occurred in one patient at 9 months after the initial operation. This was found to be due to infective endocarditis, and a biological valve was finally implanted.Aortic valve replacement with bovine pericardium in the treatment of aortic valve regurgitation is feasible, and good early and mid-term results are achieved. Long-term results need to be followed up in the future.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Bioprótese , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Pericárdio , Adulto , Idoso , Animais , Bovinos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Técnicas de Sutura , Resultado do Tratamento
9.
Heart Surg Forum ; 22(5): E343-E351, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31596709

RESUMO

BACKGROUND: To comprehensively investigate early and late outcomes for all valve replacement surgery patients in a non-referral regional hospital database and to compare these results with the literature. METHODS: This was a retrospective study and made up of patients undergoing heart valve replacement in the cardiovascular department of a non-referral regional hospital between May 2008 and February 2018. Inclusion criteria were aortic, mitral and double valve replacement with or without CABG. RESULTS: 212 patients were included in the study. Of the 212 patients, 65 were aortic valve replacement, 119 were mitral valve replacement, 28 were double valve replacement patients. Mean follow-up of all patients was 3.4 ± 2.9 years. There was no significant difference among the groups regarding hospital mortality. The occurrence of acute renal failure and neurological event was the main factors of morbidity-associated mortality. Concomitant CABG procedure was found to be an independent predictor of early mortality after MVR. In the AVR group, there was no significant difference between AVR with CABG and without CABG regarding the 5-year survival rates; whereas in MVR and DVR group, there was a statistically significant difference between the groups. According to Cox proportional hazards model for determining factors related to late mortality, preoperative chronic renal failure and concomitant CABG were factors independently related to late mortality after MVR. CONCLUSION: We believe that our study will contribute to the development of the outcomes of heart valve replacement surgery in these centers by supporting other non-heart center clinics in working toward acceptable morality rates for complex valve surgeries.


Assuntos
Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Lesão Renal Aguda/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Bioprótese , Ponte de Artéria Coronária/mortalidade , Feminino , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Valva Tricúspide/cirurgia , Adulto Jovem
11.
Lancet ; 394(10209): 1619-1628, 2019 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-31570258

RESUMO

BACKGROUND: Transcatheter aortic valve replacement (TAVR) is the preferred treatment option for older patients with symptomatic severe aortic stenosis. Differences in the properties of available TAVR systems can affect clinical outcomes. Among patients undergoing TAVR, we compared the self-expanding ACURATE neo TAVR system with the balloon-expandable SAPIEN 3 TAVR system with regard to early safety and efficacy. METHODS: In this randomised non-inferiority trial, patients (aged ≥75 years) undergoing transfemoral TAVR for treatment of symptomatic severe aortic stenosis, and who were deemed to be at increased surgical risk, were recruited at 20 tertiary heart valve centres in Germany, the Netherlands, Switzerland, and the UK. Participants were randomly assigned (1:1) to receive treatment with the ACURATE neo or the SAPIEN 3 with a computer-based randomly permuted block scheme, stratified by study centre and Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) category. The primary composite safety and efficacy endpoint comprised all-cause death, any stroke, life-threatening or disabling bleeding, major vascular complications, coronary artery obstruction requiring intervention, acute kidney injury (stage 2 or 3), rehospitalisation for valve-related symptoms or congestive heart failure, valve-related dysfunction requiring repeat procedure, moderate or severe prosthetic valve regurgitation, or prosthetic valve stenosis within 30 days of the procedure. Endpoint assessors were masked to treatment allocation. Non-inferiority of ACURATE neo compared with SAPIEN 3 was assessed in the intention-to-treat population on the basis of a risk-difference margin of 7·7% for the primary composite endpoint, with a one-sided α of 0·05. This trial is registered with ClinicalTrials.gov (number NCT03011346) and is ongoing but not recruiting. FINDINGS: Between Feb 8, 2017, and Feb 2, 2019, up to 5132 patients were screened and 739 (mean age 82·8 years [SD 4·1]; median STS-PROM score 3·5% [IQR 2·6-5·0]) were enrolled. 30-day follow-up was available for 367 (99%) of 372 patients allocated to the ACURATE neo group, and 364 (99%) of 367 allocated to the SAPIEN 3 group. Within 30 days, the primary endpoint occurred in 87 (24%) patients in the ACURATE neo and in 60 (16%) in the SAPIEN 3 group; thus, non-inferiority of the ACURATE neo was not met (absolute risk difference 7·1% [upper 95% confidence limit 12·0%], p=0·42). Secondary analysis of the primary endpoint suggested superiority of the SAPIEN 3 device over the ACURATE neo device (95% CI for risk difference -1·3 to -12·9, p=0·0156). The ACURATE neo and SAPIEN 3 groups did not differ in incidence of all-cause death (nine patients [2%] vs three [1%]) and stroke (seven [2%] vs 11 [3%]); whereas acute kidney injury (11 [3%] vs three [1%]) and moderate or severe prosthetic aortic regurgitation (34 [9%] vs ten [3%]) were more common in the ACURATE neo group. INTERPRETATION: TAVR with the self-expanding ACURATE neo did not meet non-inferiority compared to the balloon-expandable SAPIEN 3 device in terms of early safety and clinical efficacy outcomes. An early composite safety and efficacy endpoint was useful in discriminating the performance of different TAVR systems. FUNDING: Boston Scientific (USA).


Assuntos
Estenose da Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/mortalidade , Causas de Morte/tendências , Feminino , Alemanha/epidemiologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Países Baixos/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Desenho de Prótese , Índice de Gravidade de Doença , Suíça/epidemiologia , Substituição da Valva Aórtica Transcateter/métodos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento , Reino Unido/epidemiologia
12.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(5): 827-833, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31631632

RESUMO

In the present study, the performance of the liquid nitrogen frozen and thinned bovine pericardium was studied and compared with the porcine pericardium. The microstructure and mechanical properties of the bovine pericardium were observed and tested by hematoxylin-eosin (HE) staining and tensile test respectively. In all conditions, porcine pericardium was selected as a control group. The results showed that there was little difference in the performance of bovine pericardium after being frozen by liquid nitrogen. The secant modulus and ultimate strength of the thinned bovine pericardium were similar to those of porcine pericardium, however, the elastic modulus was a little higher than porcine pericardium. The study suggested that the performance of the thinned bovine pericardium was similar to those of porcine pericardium. It was easy for the thinned bovine pericardium to obtain a relatively ideal thickness and expected performance, therefore, the thinned bovine pericardium can be used as the materials of transcatheter aortic valve leaflets.


Assuntos
Bioprótese , Congelamento , Próteses Valvulares Cardíacas , Pericárdio/fisiologia , Animais , Valva Aórtica , Bovinos , Módulo de Elasticidade , Nitrogênio , Suínos
13.
Artigo em Inglês | MEDLINE | ID: mdl-31593380

RESUMO

In this video tutorial, we emphasize the main pitfalls in adequate sizing and expansion of the Perceval valve during a concomitant mitral valve replacement with a bioprosthetic. Following mitral valve replacement with a tissue-stented bioprosthesis, a transverse aortotomy was performed at 3 cm above the level of the aortic annulus. Three guiding sutures were then placed 120° apart in each valve sinus, 2-3 mm below the leaflet hinge point. The commissural struts of the mitral prosthesis can be seen in the aortic annulus. This positioning minimizes any potential protrusion in the left ventricular outflow tract.  Next, sizing of the Perceval was performed. The small transparent sizer fit nicely; however, a clear gap at the annulus could be appreciated with the small white sizer. The medium transparent sizer was then utilized, and it fit nicely; however, the medium white sizer was not able to pass through the aortic annulus. Given the gap present with the small sizer, we opted for a medium-size prosthesis. A medium Perceval prosthesis was parachuted into the aortic annulus with the help of the guiding sutures and the valve was deployed. Next, balloon expansion of the stent was performed. Given the potential concern of under-expansion of the stent, we opted for a longer dilatation at 4 atm for 1 min rather than the usual 30 sec. The aortotomy was then closed.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Bioprótese , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Estenose da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso , Estenose da Valva Aórtica/complicações , Feminino , Humanos , Estenose da Valva Mitral/complicações , Desenho de Prótese
14.
Urology ; 134: 143-147, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31542462

RESUMO

OBJECTIVES: To assess the postoperative complication rate and overall survival when bovine pericardium is used as graft material for inferior vena cava (IVC) reconstructions in patients with renal cell carcinoma (RCC). The ideal graft material is yet to be established, with synthetic grafts widely studied and used in the current literature. METHODS: We performed a retrospective cohort analysis of consecutive patients who underwent IVC reconstructions as part of resection for RCC, using bovine pericardium as either a patch repair or tubular interposition graft. RESULTS: A total of 15 patients underwent resection with IVC reconstruction between 2010 and 2018. Nine patients had tubular interposition grafts and 6 had patch repairs. Three patients had Clavien-Dindo grade 3 or higher short-term complications. There was no difference in Comprehensive Complications Index between those who had interposition grafts and patch repairs. Two patients had a long-term graft-associated thrombus requiring temporary anticoagulation. Overall survival was 46.5 months (95% confidence interval [CI] 36.9-56.1). There were no perioperative deaths. All long-term deaths were due to disease progression. CONCLUSION: Reconstruction of the IVC with a bovine pericardium graft is safe in experienced centers. Bovine pericardium could be considered as the material of choice, given its safety in the immediate postoperative period, ease of use, and patency without routine long-term anticoagulation. Advanced surgical management leads to good overall survival in this cohort with high tumor burden.


Assuntos
Bioprótese , Prótese Vascular , Carcinoma de Células Renais/patologia , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/patologia , Veia Cava Inferior/cirurgia , Idoso , Animais , Anticoagulantes/uso terapêutico , Carcinoma de Células Renais/mortalidade , Bovinos , Estudos de Coortes , Progressão da Doença , Feminino , Oclusão de Enxerto Vascular/tratamento farmacológico , Oclusão de Enxerto Vascular/etiologia , Humanos , Neoplasias Renais/mortalidade , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Pericárdio/transplante , Complicações Pós-Operatórias , Estudos Retrospectivos , Trombose/tratamento farmacológico , Trombose/etiologia
15.
J Cardiothorac Surg ; 14(1): 170, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533849

RESUMO

BACKGROUND: Finegoldia magna, a Gram-positive anaerobic coccus, is part of the human normal microbiota as a commensal of mucocutaneous surfaces. However, it remains an uncommon pathogen in infective endocarditis, with only eight clinical cases previously reported in the literature. Currently, infective endocarditis is routinely treated with prolonged intravenous antibiotic therapy. However, recent research has found that switching patients to oral antibiotics is non-inferior to prolonged parenteral antibiotic treatment, challenging the current guidelines for the treatment of infective endocarditis. CASE PRESENTATION: This case report focuses on a 52-year-old gentleman, who presented with initially culture-negative infective endocarditis following bioprosthetic aortic valve replacement. Blood cultures later grew Finegoldia magna. Following initial intravenous antibiotic therapy and re-do surgical replacement of the prosthetic aortic valve, the patient was successfully switched to oral antibiotic monotherapy, an unusual strategy in the treatment of infective endocarditis inspired by the recent publication of the POET trial. He made excellent progress on an eight-week course of oral antibiotics and was successfully discharged from surgical follow-up. CONCLUSIONS: This case is the 9th reported case of Finegoldia magna infective endocarditis in the literature. Our case also raises the possibility of a more patient-friendly and cost-effective means of providing long-term antibiotic therapy in suitable patients with prosthetic valve endocarditis and suggests that the principles highlighted in the POET trial can also be applicable to post-operative patients after cardiac surgery.


Assuntos
Antibacterianos/uso terapêutico , Bioprótese/efeitos adversos , Endocardite Bacteriana/tratamento farmacológico , Firmicutes , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Administração Oral , Valva Aórtica/cirurgia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade
17.
Acta Chir Orthop Traumatol Cech ; 86(4): 264-270, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31524587

RESUMO

PURPOSE OF THE STUDY Irreparable rotator cuff tear continues to be a point of discussion. Several surgical techniques have been proposed so far. None of them, however, can be considered the method of choice. This study presents the first clinical results of superior capsule reconstruction (SCR) using the DX Reinforcement Matrix. MATERIAL AND METHODS The evaluation included patients with the minimum follow-up of 6 months. The follow-up period in these patients was 1 year (6-18 months) on average. The active (AROM) and passive (PROM) ranges of motion were assessed-anterior flexion, abduction, external rotation and external rotation at 90° abduction. The patients were assessed using clinical scores before and after the surgery-pain assessment scale (VAS), UCLA (University of California at Los Angeles) Shoulder Rating Scale and ASES (American Shoulder and Elbow Surgeons) Shoulder Score. RESULTS In the period from October 2016 to October 2018, a total of 20 SCRs were performed. The mean age of patients was 61 years. Nine patients were clinically assessed, with the mean follow-up of 1 year. The mean UCLA Shoulder Score was 10 points preoperatively. Postoperatively, the values went up to 29 points on average. The reported ASES score was 23.8 points preoperatively. Postoperatively, the mean score was 73.2 points. The VAS subjective pain score ranged around 7 points before the surgery. After the surgery, the mean VAS score was 2 points. The mean active shoulder flexion was 74° preoperatively and 161° postoperatively. The mean active abduction was 74° preoperatively and 161° postoperatively. The mean active external rotation of the shoulder joint was 20° preoperatively and 56° postoperatively. The mean active external rotation at 90° abduction was 21° preoperatively and 82° postoperatively. The changes in all the followed-up mean parameters of UCLA, ASES, VAS, AROM and PROM reported by our group show a relatively high level of substantive significance. DISCUSSION Results of arthroscopic superior capsule reconstruction using the DX Reinforcement Matrix have not been published in literature so far. Compared to the results for fascia lata published in literature, our results are slightly worse. By contrast, our results are similar to those achieved by human dermal allograft. CONCLUSIONS Arthroscopic superior capsule reconstruction currently appears to be the method of choice in unreconstructed supraspinatus and infraspinatus tear. Our group of patients shows that early clinical outcomes of SCR using xenograft are very promising. A significant pain relief and a considerable improvement in the range of motion of the operated shoulder joint were observed. No complication specifically associated with the use of xenograft has been reported as yet. A longer follow-up period and assessment of a larger group of patients will be necessary to confirm the success of this surgical procedure. Key words: massive rotator cuff tears; irreparable rotator cuff tears; superior capsular reconstruction; xenograft; DX Reinforcement Matrix.


Assuntos
Cápsula Articular/cirurgia , Lesões do Manguito Rotador/cirurgia , Articulação do Ombro/cirurgia , Artroscopia , Bioprótese , Matriz Extracelular/transplante , Humanos , Cápsula Articular/fisiopatologia , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Lesões do Manguito Rotador/fisiopatologia , Articulação do Ombro/fisiopatologia , Transplante Heterólogo , Resultado do Tratamento
19.
Rev Port Cir Cardiotorac Vasc ; 26(2): 101-107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31476809

RESUMO

OBJECTIVES: The goal of this study is to establish the relation between aortic bio prosthesis, patient prosthesis mismatch (PPM) and short-term mortality and morbidity as well as and long-term mortality. METHODS: This is a single center retrospective study with 812 patients that underwent isolated stented biologic aortic valve replacement between 2007 and 2016. The projected indexed orifice area was calculated using the in vivo previously published values. Outcomes were evaluated with the indexed effective orifice area (iEOA) as a continuous variable and/or nominal variable. Multivariable models were developed including clinically relevant co-variates. RESULTS: In the study population 65.9% (n=535) had no PPM, 32.6% (n=265) had moderate PPM and 1.5% (n=12) severe PPM. PPM was related with diabetes (OR:1.738, CI95:1.333-2.266; p<0.001), heart failure (OR:0.387, CI95:0.155-0.969; p=0.043) and older age (OR:1.494, CI95:1.171-1.907; p=0.001). iEOA was not an independent predictor of in-hospital mortality (OR 1.169, CI 0.039-35.441) or MACCE (OR 2.753, CI 0.287-26.453). Long term survival is significantly inferior with lower iEOA (HR 0.116, CI 0.041-0.332) and any degree of PPM decreases survival when compared with no PPM (Moderate: HR 1.542, CI 1.174-2.025; Severe HR 4.627, CI 2.083-10.276). CONCLUSIONS: PPM appears to have no impact on short-term outcomes including mortality and morbidity. At ten years follow-up, moderate or severe PPM significantly reduces the long-term survival.


Assuntos
Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas/efeitos adversos , Idoso , Bioprótese/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Desenho de Prótese , Falha de Prótese , Ajuste de Prótese , Estudos Retrospectivos , Resultado do Tratamento
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