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1.
Interact Cardiovasc Thorac Surg ; 31(4): 483-485, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32791519

RESUMO

The coronavirus 2019 (COVID-19) pandemic has disrupted patient care across the NHS. Following the suspension of elective surgery, priority was placed in providing urgent and emergency surgery for patients with no alternative treatment. We aim to assess the outcomes of patients undergoing cardiac surgery who have COVID-19 infection diagnosed in the early postoperative period. We identified 9 patients who developed COVID-19 infection following cardiac surgery. These patients had a significant length of hospital stay and extremely poor outcomes with mortality of 44%. In conclusion, the outcome of cardiac surgical patients who contracted COVID-19 infection perioperatively is extremely poor. In order to offer cardiac surgery, units must implement rigorous protocols aimed at maintaining a COVID-19 protective environment to minimize additional life-threatening complications related to this virus infection.


Assuntos
Betacoronavirus , Procedimentos Cirúrgicos Cardíacos/métodos , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/métodos , Cardiopatias/cirurgia , Pandemias , Pneumonia Viral/epidemiologia , Adulto , Idoso , Comorbidade , Feminino , Cardiopatias/epidemiologia , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Fatores de Tempo , Adulto Jovem
2.
Asian Cardiovasc Thorac Ann ; 28(8): 500-503, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32757656

RESUMO

A regular check up on a 59-year-old man showed a high carcinoembryonic antigen level in his blood. A computed tomography scan showed tumors in the right atrium. We performed tumor resection successfully. The resected specimen was found to be blood cysts that had developed from the right atrium to the inferior vena cava. Intracardiac blood cysts are generally observed in infants, spontaneously disappear during the first 6 months of life, and are located in the left side of heart and on atrioventricular valves. Therefore, this case is extremely rare. Also, it is worth considering the timing of this surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cistos/cirurgia , Átrios do Coração/cirurgia , Cardiopatias/cirurgia , Tempo para o Tratamento , Cistos/diagnóstico por imagem , Cistos/patologia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Cardiopatias/diagnóstico por imagem , Cardiopatias/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
3.
JACC Cardiovasc Interv ; 13(16): 1945-1948, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32819483

RESUMO

Teleproctoring can be used successfully in performing challenging and innovative structural heart interventions using sophisticated technology that allows real-time bidirectional audiovisual communication with digital transmission of live videos and direct observation of the operative field by a remote proctor. The authors share an illustrative case that was performed amid the coronavirus disease-2019 global pandemic that led to travel restrictions to limit spread of the virus. Teleproctoring has future implications beyond the current global health crisis to facilitate rapid dissemination and exchange of knowledge for ultimately helping patients around the globe.


Assuntos
Betacoronavirus , Procedimentos Cirúrgicos Cardíacos/métodos , Infecções por Coronavirus/complicações , Cardiopatias/cirurgia , Monitorização Fisiológica/métodos , Pandemias , Pneumonia Viral/complicações , Telemedicina/métodos , Infecções por Coronavirus/epidemiologia , Cardiopatias/complicações , Cardiopatias/diagnóstico , Humanos , Pneumonia Viral/epidemiologia
4.
Zhonghua Fu Chan Ke Za Zhi ; 55(7): 465-470, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32842250

RESUMO

Objective: To explore the efficacy and safety of open cardiac operation and interventional therapy in pregnant patients and describe the feto-neonatal and maternal outcomes. Methods: A retrospective study of 39 cases of women undergoing open cardiac operation or interventional therapy during pregnancy was conducted in Guangdong Provincial People's Hospital from Jan. 2014 to Oct. 2019. Results: The age of 39 pregnant women with gestational heart disease was (30±6) years old (21-43 years old). Among them, 37 cases were single and 2 cases were twin pregnancy. Modified World Health Organization (mWHO) pregnancy risk classification were all level Ⅳ. There were 22 women receiving cardiac operation under cardiopulmonary bypass during pregnancy, 14 patients undergoing percutaneous balloon mitral valvuloplasty, 2 patients accepting percutaneous balloon pulmonary valvuloplasty, and 1 case receiving atrial septal defect occluder with ultrasound guidance. Three were no maternal deaths during and after the operation. One patient had an inevitable abortion. Four fetuses died in the uterine after open cardiac surgery. There patients chose termination of the pregnancy after cardiac operation. There were 31 live birth, in which 7 cases were preterm live birth and 24 patients were term live birth. The total number of newborns were 33. Two fetuses suffered neonatal intracranial hemorrhage and died after birth. Thirty-one fetuses were alive and born without any abnormity. Conclusion: For pregnant women with high risk of cardiovascular disease and classified as mWHO pregnancy risk level Ⅳ, cardiopulmonary bypass and interventional therapy during pregnancy could be used as an alternative for better materal and fetal outcomes.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias/cirurgia , Complicações Cardiovasculares na Gravidez/cirurgia , Adulto , Feminino , Cardiopatias/diagnóstico , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Adulto Jovem
5.
Pediatr Cardiol ; 41(7): 1532-1537, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32813029

RESUMO

In this review, we provide a brief description of recently published articles addressing topics relevant to pediatric cardiologists. Our aim is to provide a summary of the latest articles published recently in other journals in our field. The articles address (1) cardiac resynchronization in children with symptomatic ventricular dysfunction and dyssynchrony which seems to result in higher transplant-free survival, (2) outcomes of aortic leaflet reconstruction including Ozaki procedure to repair aortic valve disease in adolescents, (3) meta-analysis for risk factors of ventricular tachycardia and death after repaired tetralogy of Fallot which reiterates the known risk factors and showed that the severity of pulmonary regurgitation is not in itself associated with outcomes although the ventricular response to regurgitation (dilation and dysfunction) is, (4) preschool promotion of healthy life style did not associate with sustained effect when evaluated later in childhood although repeated intervention seems to have a dose-related effect to promote healthy life style, (5) the lack of beneficial effects of angiotensin-converting enzyme inhibitors in the interstage period, and (6) a new phenomenon of acute heart failure and multisystem inflammatory syndrome in children temporarily related to the COVID-19 pandemic.


Assuntos
Cardiopatias/complicações , Cardiopatias/terapia , Adolescente , Betacoronavirus , Terapia de Ressincronização Cardíaca/métodos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criança , Pré-Escolar , Infecções por Coronavirus/complicações , Cardiopatias Congênitas/terapia , Cardiopatias/cirurgia , Insuficiência Cardíaca/complicações , Ventrículos do Coração/fisiopatologia , Humanos , Síndrome do Coração Esquerdo Hipoplásico/tratamento farmacológico , Pandemias , Pneumonia Viral/complicações , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/complicações , Taquicardia Ventricular/complicações , Tetralogia de Fallot/complicações , Tetralogia de Fallot/cirurgia
6.
J Card Surg ; 35(10): 2479-2485, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32789988

RESUMO

BACKGROUND: Both coronavirus disease (COVID-19) and cardiac surgery have a negative impact on pulmonary function. This study aimed to determine the postoperative respiratory outcomes of patients with COVID-19 who underwent cardiac surgery. METHODS: In this retrospective study, we reviewed and analyzed the patient characteristics and clinical data of 25 asymptomatic patients with COVID-19 who underwent urgent or emergency cardiac surgery at Tehran Heart Center Hospital, Iran, between 29 February and 10 April 2020. RESULTS: The mean age, EuroSCORE, and body mass index were 57.3 ± 15.1 years, 6.65 ± 1.29, and 25.7 ± 3.7 kg/m2 , respectively. Four patients underwent off-pump cardiac surgery and 21 underwent on-pump cardiac surgery with a median cardiopulmonary bypass time of 85 minutes (interquartile range (IQR, 50-147). The overall mortality rate and the length of stay in the intensive care unit (ICU) were higher compared to those of a propensity-matched group of patients who underwent cardiac surgery in the pre-COVID era. The median intubation time was 13 hours (IQR, 9.5-18), which was comparable to that of pre-COVID cardiac surgery patients. The readmission rate to the ICU was 16%. In this ICU readmitted group, the mean oxygen index, FiO2 , and mortality rate were higher and the PaO2 /FiO2 ratio was lower than those of the nonreadmitted patients. CONCLUSIONS: Although early respiratory outcomes of asymptomatic COVID-19 patients who underwent early cardiac surgery appeared to be satisfactory, compared to the propensity-scored matched non-COVID group, the postoperative outcomes were worse, especially in the ICU readmitted patients. We suggest postponing cardiac operations unless the patient requires emergency surgery.


Assuntos
Betacoronavirus , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Infecções por Coronavirus/epidemiologia , Cardiopatias/cirurgia , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Volume de Ventilação Pulmonar/fisiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Feminino , Cardiopatias/epidemiologia , Mortalidade Hospitalar , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Testes de Função Respiratória , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências
7.
J Card Surg ; 35(10): 2486-2488, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32743814

RESUMO

The coronavirus disease (COVID) pandemic and the decision-making process of whether to perform urgent procedures during a surge are issues that will likely not disappear in the near future as reflected by the current rise in COVID cases in the southern and western United States and the resurgent numbers of confirmed cases around that world leading to are leading to new lock-downs. Multi-disciplinary discussions will continue to be important to decide individual risk and benefit profiles for patients with asymptomatic COVID patients moving forward. While imperfect, this most recent study provides more insight to some of the risks that should be weighed in these discussions. Further prospective, longitudinal research and better understanding of the heterogeneity of the COVID positive patient will further enhance understanding the decision-making process in the cardiac surgical patient through these difficult times.


Assuntos
Betacoronavirus , Procedimentos Cirúrgicos Cardíacos/métodos , Infecções por Coronavirus/epidemiologia , Tomada de Decisões , Cardiopatias/cirurgia , Pneumonia Viral/epidemiologia , Tempo para o Tratamento/estatística & dados numéricos , Comorbidade , Cardiopatias/epidemiologia , Humanos , Pandemias , Estados Unidos/epidemiologia
8.
Am J Cardiol ; 130: 24-29, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32654754

RESUMO

There is limited national data regarding emergency cardiac surgery for complications sustained after percutaneous coronary intervention (PCI). This study aimed to examine emergency cardiac surgery after PCI in England and Wales and postsurgical patient outcomes. We analyzed patients in the British Cardiovascular Intervention Society database who underwent PCI between 2007 and 2014 and compared characteristics and outcomes for patients with and without emergency cardiac surgery. A total of 549,303 patients were included in the analysis and 362 (0.07%) underwent emergency cardiac surgery. There was a modest decline in the annual rate of emergency cardiac surgery from 0.09% to 0.06% between 2007 and 2014. Variables associated with emergency cardiac surgery included receipt of circulatory support (Odds ratio (OR) 39.20 95% confidence interval (CI) 27.75 to 55.36), aortic dissection (OR 28.39 95%CI 14.59 to 55.26), coronary dissection (OR 18.50 95%CI 13.60 to 25.18), coronary perforation (OR 7.86 95%CI 4.27 to 14.46), cardiac tamponade (OR 6.77 95%CI 3.13 to 14.66), and on-site surgical cover (OR 2.15 95%CI 1.56 to 2.97). After adjustments, patients with emergency cardiac surgery were at increased odds of 30-day mortality (OR 4.41 95%CI 2.94 to 6.62) and in-hospital major adverse cardiac and cerebrovascular events (OR 1.63 95%CI 1.07 to 2.48). On site surgical cover was independently associated with increased odds of mortality (OR 1.26 95%CI 1.20 to 1.33) following emergency cardiac surgery. In conclusion, emergency cardiac surgery after PCI is a rarely required procedure and in England and Wales there appears to be a decline in recent years. Patients who underwent emergency cardiac surgery have higher risk of adverse outcomes and longer length of hospital stay.


Assuntos
Cardiopatias/cirurgia , Intervenção Coronária Percutânea , Complicações Pós-Operatórias/cirurgia , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos , Estudos de Coortes , Tratamento de Emergência , Inglaterra , Feminino , Cardiopatias/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/etiologia , País de Gales
9.
J Card Surg ; 35(7): 1621-1623, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32627233

RESUMO

Rupture of a congenital left ventricular diverticulum (CLVD), a rare anatomical anomaly, is a catastrophic event, with potential fatal consequences. Repair techniques documented in the literature include primary closure and single patch closure. We describe a case of a 57-year-old woman with symptomatic anterolateral CLVD. Our approach involves a linear incision through the epicardial surface of the diverticulum with exclusion of the cavity, and restoration of normal ventricular geometry via a two-patch technique.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Divertículo/cirurgia , Cardiopatias/cirurgia , Ventrículos do Coração/cirurgia , Técnicas de Fechamento de Ferimentos , Divertículo/congênito , Feminino , Cardiopatias/congênito , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
10.
J Thorac Cardiovasc Surg ; 160(2): 447-451, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32689700

RESUMO

The COVID-19 pandemic necessitates aggressive infection mitigation strategies to reduce the risk to patients and healthcare providers. This document is intended to provide a framework for the adult cardiac surgeon to consider in this rapidly changing environment. Preoperative, intraoperative, and postoperative detailed protective measures are outlined. These are guidance recommendations during a pandemic surge to be used for all patients while local COVID-19 disease burden remains elevated.


Assuntos
Betacoronavirus/patogenicidade , Procedimentos Cirúrgicos Cardíacos/normas , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Cardiopatias/cirurgia , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Salas Cirúrgicas/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Sala de Recuperação/normas , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Consenso , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Infecção Hospitalar/virologia , Cardiopatias/epidemiologia , Humanos , Saúde do Trabalhador/normas , Segurança do Paciente/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco , Virulência
11.
J Thorac Cardiovasc Surg ; 160(2): 452-455, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689701

RESUMO

In the setting of the current novel coronavirus pandemic, this document has been generated to provide guiding statements for the adult cardiac surgeon to consider in a rapidly evolving national landscape. Acknowledging the risk for a potentially prolonged need for cardiac surgery procedure deferral, we have created this proposed template for physicians and interdisciplinary teams to consider in protecting their patients, institution, and their highly specialized cardiac surgery team. In addition, recommendations on the transition from traditional in-person patient assessments and outpatient follow-up are provided. Lastly, we advocate that cardiac surgeons must continue to serve as leaders, experts, and relevant members of our medical community, shifting our role as necessary in this time of need.


Assuntos
Betacoronavirus/patogenicidade , Procedimentos Cirúrgicos Cardíacos/normas , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Cardiopatias/cirurgia , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Triagem/normas , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Consenso , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Infecção Hospitalar/virologia , Cardiopatias/epidemiologia , Humanos , Saúde do Trabalhador/normas , Segurança do Paciente/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco , Virulência
12.
Methodist Debakey Cardiovasc J ; 16(2): 130-137, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32670473

RESUMO

Structural heart interventions (SHIs) are increasingly applicable in a wide range of heart defects, but the intricate and dynamic nature of cardiac structures can make SHIs challenging to perform. Three-dimensional (3D) printed modeling integrates advanced clinical imaging and 3D printing technology to replicate patient-specific anatomy for comprehensive planning and simulation of SHIs. This review discusses the basic principles of patient-specific 3D print model development, print material selection, and model fabrication and highlights how cardiovascular 3D printing can be used in preprocedural planning, device sizing, enhanced communication, and procedure simulation.


Assuntos
Procedimentos Cirúrgicos Cardíacos/tendências , Cardiopatias/diagnóstico por imagem , Cardiopatias/cirurgia , Modelos Cardiovasculares , Modelagem Computacional Específica para o Paciente/tendências , Impressão Tridimensional/tendências , Difusão de Inovações , Previsões , Cardiopatias/fisiopatologia , Humanos
13.
J Card Surg ; 35(10): 2605-2610, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32667069

RESUMO

BACKGROUND: Covid-19 was declared a pandemic by the World Health Organization (WHO) on 11 March 2020. Responses to this crisis integrated resource allocation for the increased amount of infected patients while maintaining an adequate response to other severe and life-threatening diseases. Though cardiothoracic patients are at high risk for Covid-19 severe illness, postponing surgeries would translate to increased mortality and morbidity. We reviewed our practice during the initial time of the pandemic, with emphasis on safety protocols. METHODS: From 11 March to 15 May 2020, 148 patients underwent surgery at the Department of Cardiothoracic Surgery of Centro Hospitalar Universitário de São João. The clinical characteristics of the patients were retrospectively registered, along with novel containment and infection prevention measures targeting the new coronavirus. RESULTS: The majority of adult cardiac patients were operated on an emergency basis. Hospital mortality was 1.9% (n = 2 patients). Most adult thoracic patients were admitted from home, with a diagnosis of neoplastic disease in 60% of patients. Hospital mortality was 3.3% (1 patient). Fifteen children underwent cardiothoracic surgery. There was no mortality. The infection prevention procedures applied, totally excluded the transmission of Covid-19 in the department. CONCLUSION: While guaranteeing a prompt response to emergent, urgent, and high priority cases, novel safety measures in individual protection, patients circuits, and preoperative diagnoses of symptomatic and asymptomatic infection were adopted. The surgical results corroborate that it was safe to undergo cardiothoracic surgery during the initial time of the Covid-19 pandemic. The new policies will be maintained while the virus stays in the community.


Assuntos
Betacoronavirus , Procedimentos Cirúrgicos Cardíacos/métodos , Infecções por Coronavirus/epidemiologia , Cardiopatias/cirurgia , Pandemias , Assistência Perioperatória/métodos , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Cardiopatias/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Portugal/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento , Adulto Jovem
14.
J Cardiothorac Vasc Anesth ; 34(11): 3073-3077, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32660929

RESUMO

Worldwide, the majority of heart transplant organs are from donation after brain death. However, the shortage of suitable donors places severe limitations on this route. One option to increase the donor pool is to use organs from donation after circulatory death (DCD). Transplant centers for solid organs have been using DCD organs for years. At this time, 40% of solid organ transplantation in the United Kingdom uses organs from DCD. Use of DCD for solid organ transplants in Canada is also rising. Recently, there has been interest in using DCD organs for heart transplantation. The authors will discuss their experience of 4 heart transplants with organs from DCD donors after normothermic regional perfusion (NRP). The authors' first heart transplant using a DCD organ was in January 2020, and the fourth was in March 2020, just before the coronavirus disease 2019 (COVID-19) pandemic. The authors' protocol using NRP allows adequate evaluation of the donor heart to confidently determine organ acceptance. The co-location of the donor and the recipient in neighboring operating rooms limits ischemic times. Avoidance of an expensive ex vivo organ perfusion machine is an additional benefit for programs that may not have the resources required to purchase and maintain the machine. Some hospitals may not have the resources and space to be able to co-locate both the donor and recipient. Use of cold storage may be an option to transport the procured organ, similar to donation after brain death organs. The authors hope that this technique of NRP in DCD donors can help further increase the donor pool for heart transplantation in the United States.


Assuntos
Anestesia/métodos , Anestésicos/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Cardiopatias/cirurgia , Transplante de Coração/métodos , Pneumonia Viral/epidemiologia , Doadores de Tecidos/provisão & distribução , Adolescente , Adulto , Comorbidade , Feminino , Cardiopatias/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Adulto Jovem
15.
Cardiovasc Revasc Med ; 21(8): 939-945, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32586744

RESUMO

BACKGROUND: Because of the COVID-19 pandemic, cath labs have had to modify their workflow for elective and urgent patients. METHODS: We surveyed 16 physicians across 3 hospitals in our healthcare system to address COVID-19 related concerns in the management of interventional and structural heart disease patients, and to formulate system wide criteria for deferring cases till after the pandemic. RESULTS: Our survey yielded common concerns centered on the need to protect patients, cath lab staff and physicians from unnecessary exposure to COVID-19; for COVID-19 testing prior to arrival to the cath lab; for clear communication between the referring physician and the interventionalist; but there was initial uncertainty among physicians regarding the optimal management of ST elevation myocardial infarction (STEMI; percutaneous coronary intervention versus thrombolytics). Patients with stable angina and hemodynamically stable acute coronary syndromes were deemed suitable for initial medical management, except when they had large ischemic burden. Most transcatheter aortic valve implantations (TAVI) were felt appropriate for postponement except in symptomatic patients with aortic valve area <0.5 cm2 or recent hospitalization for heart failure (HF). Most percutaneous mitral valve repair (pMVR) procedures were felt appropriate for postponement except in patients with HF. All left atrial appendage closure (LAAC) and patent foramen ovale (PFO)/atrial septal defect (ASD) closure procedures were felt appropriate for postponement. CONCLUSION: Our survey of an experienced team of clinicians yielded concise guidelines to direct the management of CAD and structural heart disease patients during the initial phases of the COVID-19 pandemic.


Assuntos
Betacoronavirus , Procedimentos Cirúrgicos Cardíacos/métodos , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/métodos , Cardiopatias/cirurgia , Pneumonia Viral/epidemiologia , Comorbidade , Feminino , Cardiopatias/epidemiologia , Humanos , Masculino , Pandemias
17.
Am Heart J ; 226: 188-197, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32599259

RESUMO

BACKGROUND: Randomized controlled trials (RCTs) in children with heart disease are challenging and therefore infrequently performed. We sought to improve feasibility of perioperative RCTs for this patient cohort using data from a large, multicenter clinical registry. We evaluated potential enrollment and end point frequencies for various inclusion cohorts and developed a novel global rank trial end point. We then performed trial simulations to evaluate power gains with the global rank end point and with use of planned covariate adjustment as an analytic strategy. METHODS: Data from the Society of Thoracic Surgery-Congenital Heart Surgery Database (STS-CHSD, 2011-2016) were used to support development of a consensus-based global rank end point and for trial simulations. For Monte Carlo trial simulations (n = 50,000/outcome), we varied the odds of outcomes for treatment versus placebo and evaluated power based on the proportion of trial data sets with a significant outcome (P < .05). RESULTS: The STS-CHSD study cohort included 35,967 infant index cardiopulmonary bypass operations from 103 STS-CHSD centers, including 11,411 (32%) neonatal cases and 12,243 (34%) high-complexity (Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category ≥4) cases. In trial simulations, study power was 21% for a mortality-only end point, 47% for a morbidity and mortality composite, and 78% for the global rank end point. With covariate adjustment, power increased to 94%. Planned covariate adjustment was preferable to restricting to higher-risk cohorts despite higher event rates in these cohorts. CONCLUSIONS: Trial simulations can inform trial design. Our findings, including the newly developed global rank end point, may be informative for future perioperative trials in children with heart disease.


Assuntos
Ponte Cardiopulmonar , Cardiopatias/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Projetos de Pesquisa/estatística & dados numéricos , Criança , Cardiopatias/congênito , Humanos
19.
Pediatr Cardiol ; 41(6): 1244-1247, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32572547

RESUMO

In this review, we provide a brief description of recently published articles addressing topics relevant to pediatric cardiologists. Our hope is to provide a summary of the latest articles published recently in other journals in our field. The articles address the following: (1) transcatheter closure of sinus venous atrial septal defect which is feasible in adults with careful planning, (2) exercise echocardiography in children with hypertrophic cardiomyopathy which was found to be very helpful to identify low-risk patients when there is no gradient at rest or during exercise, (3) features of Fontan patients with normal exercise capacity who typically report more active life style and have less complications during the post-Fontan admissions, (4) the natural history of Anderson-Tawil syndrome which is characterized by high incidence of life-threatening arrhythmogenic events especially when there is history of syncope, ventricular tachycardia, or the use of amiodarone, (5) pulmonary artery banding in complete atrioventricular septal defects which were found to be a safe alternative to early complete repair and served as a bridge to biventricular repair with variable effect on common atrioventricular valve regurgitation and (6) tricuspid valve interventions (TVI) in patients undergoing pulmonary valve replacement (PVR) which further reduce tricuspid regurgitation beyond what is expected in PVR alone without increasing early complications or hospital length of stay.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias/terapia , Publicações Periódicas como Assunto , Adolescente , Adulto , Cardiologia , Cardiomiopatia Hipertrófica/terapia , Criança , Ecocardiografia , Exercício Físico , Feminino , Técnica de Fontan/métodos , Cardiopatias/cirurgia , Defeitos dos Septos Cardíacos/cirurgia , Comunicação Interatrial/cirurgia , Humanos , Masculino , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/epidemiologia
20.
Anesth Analg ; 130(6): 1534-1544, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32384343

RESUMO

BACKGROUND: Although frailty has been associated with major morbidity/mortality and increased length of stay after cardiac surgery, few studies have examined functional outcomes. We hypothesized that frailty would be independently associated with decreased functional status, increased discharge to a nonhome location, and longer duration of hospitalization after cardiac surgery, and that delirium would modify these associations. METHODS: This was an observational study nested in 2 trials, each of which was conducted by the same research team with identical measurement of exposures and outcomes. The Fried frailty scale was measured at baseline. The primary outcome (defined before data collection) was functional decline, defined as ≥2-point decline from baseline in Instrumental Activities of Daily Living (IADL) score at 1 month after surgery. Secondary outcomes were absolute decline in IADL score, discharge to a new nonhome location, and duration of hospitalization. Associations were analyzed using linear, logistic, and Poisson regression models with adjustments for variables considered before analysis (age, gender, race, and logistic European Score for Cardiac Operative Risk Evaluation [EuroSCORE]) and in a propensity score analysis. RESULTS: Data were available from 133 patients (83 from first trial and 50 from the second trial). The prevalence of frailty was 33% (44 of 133). In adjusted models, frail patients had increased odds of functional decline (primary outcome; odds ratio [OR], 2.41 [95% confidence interval {CI}, 1.03-5.63]; P = .04) and greater decline at 1 month in the secondary outcome of absolute IADL score (-1.48 [95% CI, -2.77 to -0.30]; P = .019), compared to nonfrail patients. Delirium significantly modified the association of frailty and change in absolute IADL score at 1 month. In adjusted hypothesis-generating models using secondary outcomes, frail patients had increased discharge to a new nonhome location (OR, 3.25 [95% CI, 1.37-7.69]; P = .007) and increased duration of hospitalization (1.35 days [95% CI, 1.19-1.52]; P < .0001) compared to nonfrail patients. The increased duration of hospitalization, but no change in functional status or discharge location, was partially mediated by increased complications in frail patients. CONCLUSIONS: Frailty may identify patients at risk of functional decline at 1 month after cardiac surgery. Perioperative strategies to optimize frail cardiac surgery patients are needed.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Delírio/etiologia , Fragilidade/complicações , Fragilidade/cirurgia , Complicações Pós-Operatórias/diagnóstico , Atividades Cotidianas , Idoso , Delírio/cirurgia , Feminino , Idoso Fragilizado , Avaliação Geriátrica , Cardiopatias/complicações , Cardiopatias/cirurgia , Hospitalização , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Índice de Gravidade de Doença , Resultado do Tratamento
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