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1.
Heart Surg Forum ; 22(4): E281-E282, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31398091

RESUMO

We report a 62-year-old male who had severe aortic insufficiency after a homograft root replacement, requiring venoarterial extracorporeal membrane oxygenation prior to surgery due to profound cardiogenic shock. Severe aortic insufficiency is a contraindication for venoarterial extracorporeal membrane oxygenation, but we were able to stabilize the patient and successfully perform an urgent reoperative surgery.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Oxigenação por Membrana Extracorpórea/métodos , Complicações Pós-Operatórias/cirurgia , Falha de Prótese/efeitos adversos , Reoperação , Choque Cardiogênico/etiologia , Aloenxertos , Insuficiência da Valva Aórtica/etiologia , Contraindicações de Procedimentos , Ponte de Artéria Coronária , Oxigenação por Membrana Extracorpórea/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Terapia de Salvação/métodos , Choque Cardiogênico/cirurgia
2.
Int Heart J ; 60(4): 1009-1012, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31204372

RESUMO

Spontaneous coronary artery rupture (SCAR) is an extremely rare, life-threatening entity without any previous underlying diseases. The clinical presentation may differ according to the site of the rupture and some patients may deteriorate early into sudden death due to the abrupt evolution of the associated cardiac tamponade and cardiogenic shock.1) The correct diagnosis of SCAR deserves a high level of suspicion. It may be confirmed as a differential diagnosis in patients with cardiac tamponade using transthoracic echocardiography (TTE) and computed tomography angiography (CTA) following emergency pericardiocentesis, and a definite diagnosis can be achieved by selective angiography. Although SCAR is associated with a dismal prognosis, some patients have recovered through emergency surgical operations or catheter interventions.2) We report the case of a patient presenting cardiac tamponade and cardiogenic shock due to spontaneous rupture of the circumflex branch of the left coronary artery, which was successfully isolated by bilateral ligation.


Assuntos
Tamponamento Cardíaco/etiologia , Doença da Artéria Coronariana/complicações , Vasos Coronários/diagnóstico por imagem , Choque Cardiogênico/etiologia , Doença Aguda , Tamponamento Cardíaco/diagnóstico , Tamponamento Cardíaco/cirurgia , Angiografia por Tomografia Computadorizada , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/cirurgia , Humanos , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Pericardiocentese , Ruptura Espontânea , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos
3.
Kardiol Pol ; 77(6): 589-595, 2019 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-31095122

RESUMO

Cardiogenic shock (CS) is a low cardiac-output state resulting in end-organ hypoperfusion and hypoxia that if untreated leads to an irreversible condition of multi-organ failure. Acute coronary syndrome (ACS) is the most common cause of CS, with a high prevalence of patients with multi vessels disease. Cardiogenic shock management remains a challenge since mortality rates are still high and have not declined over the last 20 years. The treatment strategy of CS in patients with ACS needs to take into account both the presence of myocardial ischemia and tissue hypoperfusion. The first part of the review will focus on the characteristics, the hemodynamic profile and the evidence available of the mechanical circulatory support devices for an optimal patient-device matching. The second part will focus on the management strategy of CS in terms of myocardial revascularization and hemodynamic support in light of the most recent available evidence.


Assuntos
Coração Auxiliar , Choque Cardiogênico/terapia , Gerenciamento Clínico , Hemodinâmica , Humanos , Revascularização Miocárdica , Choque Cardiogênico/cirurgia
5.
J Invasive Cardiol ; 31(5): E95, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31034443
6.
ESC Heart Fail ; 6(3): 552-554, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30968544

RESUMO

Cardiogenic shock from biventricular failure that requires acute mechanical circulatory support carries high 30 day mortality. Acute mechanical circulatory support can serve as bridge to orthotopic heart transplant (OHT) in selected patients. We report a patient with biventricular failure secondary to rapidly progressive cardiac sarcoidosis refractory to medical management who was bridged to OHT with Impella 5.0 and Impella RP-temporary left and right ventricular assist devices, respectively. This is the first successful bridge to transplantation using these devices in biventricular heart failure and cardiogenic shock. We discuss considerations for using this strategy over veno-arterial extracorporeal membrane oxygenation or surgically implanted assist devices in patients with cardiogenic shock and biventricular failure as a bridge to OHT.


Assuntos
Insuficiência Cardíaca/cirurgia , Transplante de Coração , Coração Auxiliar , Idoso , Cardiomiopatias/cirurgia , Feminino , Transplante de Coração/instrumentação , Transplante de Coração/métodos , Humanos , Sarcoidose/cirurgia , Choque Cardiogênico/cirurgia
7.
PLoS One ; 14(4): e0214417, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943217

RESUMO

OBJECTIVE: Whether the cardiovascular (CV) outcomes of second-generation limus-eluting stents (LESs) differ from those of paclitaxel-eluting stents (PESs) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is still unclear. METHODS: We used the Taiwan National Health Insurance Research Database to analyse data of 516 patients with AMI and CS diagnosed from January 2007 to December 2011. We used propensity score matching to adjust for the imbalance in covariate baseline values between these two groups. We evaluated clinical outcomes by comparing 197 subjects who used second-generation LESs to 319 matched subjects who used PESs. RESULTS: The risk of the primary composite outcomes (i.e., myocardial infarction, coronary revascularisation or CV death) was significantly lower in the second-generation LES group than in the PES group [37.3% vs. 51.8%; hazard ratio (HR), 0.73; 95% CI: 0.56-0.95] at the 12-month follow-up. The patients who received second-generation LESs had a lower risk of coronary revascularisation (HR 0.62; 95% CI: 0.41-0.93) than those who used PESs. However, the risks of myocardial infarction (HR 0.56; 95% CI: 0.26-1.24), ischemic stroke (HR 0.73; 95% CI: 0.23-2.35), or CV death (HR 0.90; 95% CI: 0.63-1.28) were not significantly different between the two groups. CONCLUSIONS: Among patients with CS-complicating AMI, second-generation LES implantation significantly reduced the risk of coronary revascularisation and composite CV events compared to PES implantation at the 12-month follow-up.


Assuntos
Stents Farmacológicos , Insuficiência Cardíaca/tratamento farmacológico , Infarto do Miocárdio/tratamento farmacológico , Choque Cardiogênico/tratamento farmacológico , Idoso , Ponte de Artéria Coronária/métodos , Ponte de Artéria Coronária/mortalidade , Feminino , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/cirurgia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Mortalidade , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/cirurgia , Paclitaxel/administração & dosagem , Intervenção Coronária Percutânea/métodos , Intervenção Coronária Percutânea/mortalidade , Fatores de Risco , Choque Cardiogênico/mortalidade , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/cirurgia , Resultado do Tratamento
8.
Interv Cardiol Clin ; 8(2): 225-234, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30832944

RESUMO

ST-elevation myocardial infarction (STEMI) patients with multivessel disease and without shock are a common clinical entity, but the best approach to nonculprit vessel lesions remains controversial. In contrast, STEMI patients with shock do not appear to benefit from primary multivessel percutaneous coronary interventions (PCIs) during the index procedure. The optimal treatment strategy in a given STEMI patient involves an individualized approach, incorporating clinical, hemodynamic, and angiographic/imaging parameters. Patients with STEMI and cardiogenic shock may benefit from therapies other than PCI, such as mechanical cardiovascular support.


Assuntos
Vasos Coronários/cirurgia , Eletrocardiografia , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Choque Cardiogênico/etiologia , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Choque Cardiogênico/cirurgia , Resultado do Tratamento
9.
J Invasive Cardiol ; 31(2): E46, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30700635

RESUMO

This is the first reported case of full biventricular mechanical circulatory support with the combination of Impella and Protek Duo, which is a dual-lumen cannula inserted via the right internal jugular vein, with its proximal inflow lumen positioned in the right atrium and distal lumen positioned in the main pulmonary artery. These lumens are connected with the paracorporeal TandemHeart pump allowing flows up to 5 L/min. The alternative percutaneous option for right ventricular support is the Impella RP (Abiomed), which has to be placed in the femoral vein, preventing ambulation. The axillary and internal jugular vein positions for devices are probably less prone to infection compared to the femoral area. The combination of an Impella inserted via the axillary artery with the Protek Duo is a viable option, allowing ambulation while providing biventricular support.


Assuntos
Cateterismo Cardíaco/métodos , Oxigenação por Membrana Extracorpórea/métodos , Insuficiência Cardíaca/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Coração Auxiliar , Choque Cardiogênico/cirurgia , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/fisiopatologia , Ventrículos do Coração/fisiopatologia , Humanos , Pessoa de Meia-Idade , Radiografia Torácica , Choque Cardiogênico/etiologia , Choque Cardiogênico/fisiopatologia
10.
World J Pediatr Congenit Heart Surg ; 10(2): 239-241, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30651045

RESUMO

Surgical palliation of many types of congenital heart defects requires the use of a conduit between the right ventricle and the pulmonary artery. Dissections of these conduits are very infrequent. We report a case of a ten-year-old girl who developed acute right heart failure related to a Contegra conduit dissection. She underwent a new conduit replacement on an emergency basis.


Assuntos
Prótese Vascular , Cardiopatias Congênitas/cirurgia , Insuficiência Cardíaca/etiologia , Ventrículos do Coração/cirurgia , Falha de Prótese/efeitos adversos , Artéria Pulmonar/cirurgia , Bioprótese , Criança , Ecocardiografia , Eletrocardiografia , Feminino , Cardiopatias/diagnóstico por imagem , Cardiopatias/etiologia , Humanos , Choque Cardiogênico/etiologia , Choque Cardiogênico/cirurgia , Trombose/diagnóstico por imagem , Trombose/etiologia
11.
J Card Surg ; 34(2): 92-98, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30625252

RESUMO

OBJECTIVE: The aim of this study is to evaluate the open transaxillary placement of the Impella 5.0 with a modified surgical technique. METHODS: From January to July 2018, nine patients (eight males; mean age 60 years) underwent surgical transaxillary Impella 5.0 (Abiomed Inc., Danvers, MA) implantation. Patient and periprocedural data were recorded in a prospectively maintained institutional database. The primary endpoint was technical success. The secondary endpoints were: neurological complications (peripheral or central), bleeding, and wound infection, duration of Impella support, and device failure requiring device replacement. RESULTS: Assisted technical success was 100%. The right axillary artery was used in 8/9 cases. Three patients (all on extracorporeal membrane oxygenation) suffered from access site bleeding which required surgical reintervention. One patient suffered from peripheral neurological dysfunction which recovered in 1 month and one patient had a local hematoma which was managed conservatively. The median length of treatment was 16 days (range 8-35). Five patients had myocardial recovery and the Impella could be explanted; the remaining were transitioned to a durable left ventricular assist device with an uneventful postoperative course. Hospital mortality was 33%. CONCLUSIONS: Open Impella 5.0 device implantation through the axillary artery is safe and effective; technical success was 100% and low rates of major complications are reported.


Assuntos
Cateterismo Cardíaco/métodos , Coração Auxiliar , Implantação de Prótese/métodos , Choque Cardiogênico/cirurgia , Síndrome Coronariana Aguda/complicações , Adulto , Idoso , Axila , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Choque Cardiogênico/etiologia , Resultado do Tratamento
12.
Intern Med ; 58(10): 1459-1462, 2019 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-30626823

RESUMO

We herein report the clinical potential of Impella 5.0 support, which is a catheter-mounted micro-axial left ventricular support device, in a 39-year-old man with recurrent fulminant viral myocarditis complicated with profound cardiogenic shock despite inotropic infusion and an intra-aortic balloon pumping. Switching from these therapies to the Impella 5.0 device provided sufficient systemic perfusion with well-controlled left ventricular diastolic properties to facilitate a prompt recovery from profound cardiogenic shock. The patient was uneventfully discharged on the 27th hospital day. Given its effect of cardiac protection with sufficient systemic perfusion, the Impella device should be considered the first-line therapy for the treatment of fulminant myocarditis complicated with cardiogenic shock.


Assuntos
Cateteres Cardíacos , Coração Auxiliar , Coração/fisiopatologia , Miocardite/cirurgia , Choque Cardiogênico/etiologia , Choque Cardiogênico/cirurgia , Adulto , Procedimentos Cirúrgicos Cardíacos/instrumentação , Procedimentos Cirúrgicos Cardíacos/métodos , Humanos , Balão Intra-Aórtico , Masculino , Mediastinite , Resultado do Tratamento
13.
Artif Organs ; 43(2): 142-149, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30346032

RESUMO

The aim of this study is to report the combined application of extracorporeal membrane oxygenation (ECMO) with intra-aortic balloon pumping (IABP) in postcardiotomy cardiac shock (PCS). A total of 60 consecutive patients who received both ECMO and IABP (concomitantly 24 hours) for PCS from February 2006 to March 2017 at Fuwai Hospital were included in our study. Clinical characteristics of the patients were collected retrospectively and compared between survivors and non-survivors. Logistic regression analysis was used as predictors for survival to discharge. The study cohort had a mean age of 51.4±12.7 years with 75% males. ECMO was implanted intra-operatively in 38 (63%) patients and post-operatively in 22 (37%) patients. ECMO was implanted concurrently with IABP in 38 (63%) patients. Heart transplantation (38%) and coronary artery bypass graft (33%) were the main surgical procedures. ECMO was weaned successfully in 48% patients, and the rate of survival to discharge was 43%. Survivors showed less bedside ECMO implantation (12% vs. 41%, P=0.012) and more concurrent implantation of ECMO with IABP (81% vs. 50%, P=0.014). Concurrent implantation of IABP with ECMO (OR=0.177, P=0.015, 95% CI: 0.044-0.718) was an independent predictor of survival to discharge. As for complications, the rate of renal failure (59% vs. 15%, P=0.001) and multiple organ dysfunction syndrome (29% vs. 0, P=0.003) was higher in patients who failed to survive to discharge. Patients who had heart transplantation had a better long-term survival than others (P=0.0358). In summary, concurrent implantation of ECMO with IABP provides better short-term outcome for PCS and combined application of ECMO with IABP for PCS after heart transplantation had a favorable long-term outcome.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Oxigenação por Membrana Extracorpórea , Balão Intra-Aórtico , Choque Cardiogênico/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Choque Cardiogênico/etiologia , Choque Cardiogênico/mortalidade , Taxa de Sobrevida
14.
Perfusion ; 34(1): 35-41, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30024298

RESUMO

BACKGROUND: Left ventricular (LV) afterload increase with protracted aortic valve (AV) closure may represent a complication of veno-arterial extracorporeal membrane oxygenation (V-A ECMO). The aim of the present study was to assess the effects of an intra-aortic balloon pump (IABP) to overcome such a hemodynamic shortcoming in patients submitted to peripheral V-A ECMO. METHODS: Among 184 adult patients who were treated with peripheral V-A ECMO support at Medical University Center Maastricht Hospital between 2007 and 2018, patients submitted to IABP implant for protracted AV closure after V-A ECMO implant were retrospectively identified. All clinical and hemodynamic data, including echocardiographic monitoring, were collected and analyzed. RESULTS: During the study period, 10 subjects (mean age 60 years old, 80% males) underwent IABP implant after peripheral V-A ECMO positioning due to the diagnosis of protracted AV closure and inefficient LV unloading as assessed by echocardiography and an absence of pulsation in the arterial pressure wave. Recovery of blood pressure pulsatility and enhanced LV unloading were observed in 8 patients after IABP placement, with no significant differences in the main hemodynamic parameters, inotropic therapy or in the ECMO flow (p=0.48). The weaning rate in this patient subgroup (mean ECMO duration 8 days), however, was only 10%, with another patient finally transplanted, leading to a 20% survival-to-hospital discharge. CONCLUSION: IABP placement was an effective solution in order to reverse the protracted AV closure and impaired LV unloading observed during peripheral V-A ECMO support. However, the impact on the weaning rate and survival needs further investigations.


Assuntos
Valva Aórtica/fisiopatologia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Rejeição de Enxerto/prevenção & controle , Implante de Prótese de Valva Cardíaca/efeitos adversos , Hemodinâmica , Balão Intra-Aórtico/métodos , Choque Cardiogênico/complicações , Adulto , Idoso , Valva Aórtica/cirurgia , Circulação Cerebrovascular , Feminino , Rejeição de Enxerto/etiologia , Coração Auxiliar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Choque Cardiogênico/cirurgia , Resultado do Tratamento
15.
Heart Lung Circ ; 28(8): 1267-1276, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30075944

RESUMO

BACKGROUND: Coronary artery bypass grafting (CABG) performed early after acute myocardial infarction (AMI) carries a high risk of mortality. By avoiding cardioplegic arrest and aortic cross-clamping, on-pump beating heart CABG (ONBEAT) may benefit patients requiring urgent or emergency revascularisation in the setting of AMI. We evaluated the early and long-term outcomes of ONBEAT versus conventional CABG (ONSTOP) utilising the ANZSCTS National Cardiac Surgery Database. METHODS: Between 2001 and 2015, 5,851 patients underwent non-elective on-pump CABG within 7 days of AMI. Of these, 77 patients (1.3%) underwent ONBEAT and 5774 (98.7%) underwent ONSTOP surgery. Propensity-score matching (with a 1:2 matching ratio) was performed for risk adjustment. Survival data were obtained from the National Death Index. RESULTS: Before matching, the unadjusted 30-day mortality was ONBEAT: 9/77 (11.7%) vs. ONSTOP: 256/5,774 (4.4%), p<0.001. Preoperative factors independently associated with the ONBEAT were: septuagenarian age, peripheral vascular disease, redo surgery, cardiogenic shock, emergency surgery and single-vessel disease. After propensity-score matching, 30-day mortality was similar (ONBEAT: 9/77 (11.7%) vs. ONSTOP: 16/154 (10.4%), p=0.85), as was the rate of major adverse cardiac and cerebrovascular events (ONBEAT: 17/77 (22.1%) vs. ONSTOP: 38/154 (24.7%), p=0.84). ONBEAT patients received fewer distal anastomoses and were more likely to have incomplete revascularisation (ONBEAT: 15/77 (19.5%) vs. ONSTOP: 15/154, (9.7%), p=0.03). Despite this, 12-year survival was comparable (ONBEAT: 64.8% (95% CI 39.4-82.4%) vs. ONSTOP: 63.6% (95% CI 50.5, 74.3%), p=0.89). CONCLUSIONS: ONBEAT can be performed safely in high-risk patients requiring CABG early after AMI with similar short and long-term survival compared to ONSTOP.


Assuntos
Ponte de Artéria Coronária , Bases de Dados Factuais , Parada Cardíaca Induzida , Infarto do Miocárdio , Choque Cardiogênico , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/fisiopatologia , Infarto do Miocárdio/cirurgia , Estudos Retrospectivos , Choque Cardiogênico/mortalidade , Choque Cardiogênico/fisiopatologia , Choque Cardiogênico/cirurgia , Taxa de Sobrevida , Fatores de Tempo
16.
Ann Cardiol Angeiol (Paris) ; 68(1): 53-55, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30149894

RESUMO

A 58 year-old man was admitted in our ICU for cardiogenic shock and electrical storm. His medical history was marked by a triple redo valvular surgery complicated by a recurrent aortic pseudoaneurysm of the ascending aorta. Coronary angiogram and heart CT scan diagnosed an extensive anterior myocardial infarction related to an extrinsic compression of the left main stem by this massive and calcified pseudoaneurysm. Angioplasty or new cardiac surgery options were rejected by the heart team. Despite an unusual indication, the patient was registered on the heart transplant list, and underwent it successfully.


Assuntos
Falso Aneurisma/cirurgia , Aorta , Oclusão Coronária/cirurgia , Transplante de Coração , Choque Cardiogênico/cirurgia , Falso Aneurisma/complicações , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/etiologia , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/etiologia , Trombose Coronária/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Infarto do Miocárdio/etiologia , Recidiva , Choque Cardiogênico/etiologia , Calcificação Vascular/complicações , Calcificação Vascular/cirurgia
17.
J Am Heart Assoc ; 7(22): e010193, 2018 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-30571481

RESUMO

Background There are limited data on the role of temporary mechanical circulatory support ( MCS ) devices for cardiogenic shock before left ventricular assist device ( LVAD ) surgery. This study sought to evaluate the trends of use and outcomes of MCS in cardiogenic shock before LVAD surgery. Methods and Results This was a retrospective cohort study from 2005 to 2014 using the National Inpatient Sample (20% stratified sample of US hospitals). This study identified admissions undergoing LVAD surgery with preoperative cardiogenic shock. Admissions for other cardiac surgery and heart transplant were excluded. Temporary MCS was identified using administrative codes. The primary outcome was hospital mortality and secondary outcomes were hospital costs and lengths of stay in admissions with and without MCS use. In this 10-year period, 9753 admissions were identified with 40.6% requiring pre- LVAD MCS . There was a temporal increase in the frequency of cardiogenic shock associated with an increase in non-intra-aortic balloon pump MCS devices. The cohort receiving MCS had greater in-hospital myocardial infarction, ventricular arrhythmias, and use of coronary angiography. On multivariable analysis, older age, myocardial infarction, and need for MCS devices were independently predictive of higher in-hospital mortality. In 696 propensity-matched pairs, use of MCS was predictive of higher in-hospital mortality (odds ratio 1.4 [95% confidence interval 1.1-1.6]; P=0.02) and higher hospital costs, but similar lengths of stay. Conclusions In patients with cardiogenic shock bridged to LVAD therapy, there was a steady increase in preoperative MCS use. Use of MCS identified patients at higher risk for in-hospital mortality and greater resource utilization.


Assuntos
Circulação Extracorpórea , Coração Auxiliar , Choque Cardiogênico/cirurgia , Circulação Extracorpórea/métodos , Circulação Extracorpórea/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Implantação de Prótese , Fatores de Risco , Choque Cardiogênico/mortalidade
18.
J Heart Valve Dis ; 27(1): 114-116, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30560609

RESUMO

A patient with ischemic myocardiopathy who had undergone resynchronization therapy was admitted to the authors' institution with progressive dyspnea. Echocardiography demonstrated a left ventricular ejection fraction (LVEF) of 25%, with a massive mitral regurgitation (MR) secondary to anterior leaflet prolapse and posterior leaflet restriction. Despite intensive medical treatment, the patient developed cardiogenic shock and required mechanical ventilation, inotropic support and intra-aortic balloon pumping. The patient was rejected for surgery due to the high operative risk, but subsequently underwent a successful percutaneous repair with two MitraClip® devices. Immediately after the intervention there was a progressive improvement that allowed the patient to be discharged, such that the clinical outcome was favorable at the six-month follow up (NYHA class II/IV). This case report describes the benefits of minimally invasive therapy in selected patients who are at very high surgical risk and who, despite being in a critical condition and with low LVEF, experience an outstanding clinical improvement following the resolution of a massive MR.


Assuntos
Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Choque Cardiogênico/cirurgia , Doença Aguda , Humanos , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/fisiopatologia , Choque Cardiogênico/etiologia , Choque Cardiogênico/fisiopatologia , Volume Sistólico , Resultado do Tratamento
19.
J Invasive Cardiol ; 30(12): 456-460, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30504514

RESUMO

OBJECTIVES: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is most commonly used in patients with cardiac arrest and cardiogenic shock. There are limited data on the use of VA-ECMO for elective, high-risk percutaneous coronary intervention (PCI). We examined the in-hospital and mid-term clinical outcomes in patients undergoing complex, high-risk PCI with VA-ECMO support. METHODS: . We conducted a retrospective review of ECMO-supported elective high-risk PCIs performed at our institution between May 2012 and May 2017. The electronic medical records and angiograms were individually reviewed. We assessed the in-hospital and mid-term major adverse cardiovascular and cerebrovascular event (MACCE) rates, and reviewed bleeding and vascular complications. RESULTS: Five patients underwent elective high-risk PCI with ECMO support. Mean age was 66.8 ± 8.6 years and all patients were men. The mean ejection fraction was 26.6 ± 18.0%. Most procedures were unprotected left main PCIs. All PCIs were successful; 1 patient required femoral artery surgical repair. The mean hospital stay post procedure was 6.4 ± 2.0 days. ECMO was successfully weaned in all cases, and the duration of ECMO was <24 hours in 4 cases. There was no occurrence of in-hospital and 1-year MACCE. CONCLUSION: ECMO can be successfully used for hemodynamic support during elective high-risk PCI.


Assuntos
Procedimentos Cirúrgicos Eletivos/métodos , Oxigenação por Membrana Extracorpórea/métodos , Parada Cardíaca/cirurgia , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea/métodos , Choque Cardiogênico/cirurgia , Parada Cardíaca/complicações , Humanos , Infarto do Miocárdio/complicações , Fatores de Risco , Choque Cardiogênico/complicações , Resultado do Tratamento
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