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1.
Int Heart J ; 61(2): 249-253, 2020 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-32173706

RESUMO

Cryoballoon ablation is an established catheter-based approach to treat atrial fibrillation (AF). However, thromboembolic events cannot be avoided during cryoablation. There is little data regarding the blood coagulation status during freezing.The thrombin antithrombin complex (TAT) and prothrombin fragment 1+2 (F 1+2) of patient blood were measured during cryoballoon application when the cryoballoon temperature reached the nadir in 63 AF patients. TAT was also measured from porcine blood during cryoballoon freezing in 5 pigs.The TAT and F 1+2 increased from 6.60 ± 5.65 to 9.16 ± 7.28 ng/mL (P = 0.004) and from 279.6 ± 146.4 to 323.6 ± 169.1 pmol/L (P = 0.003) between the control and during freezing, respectively. The TAT increased from 0.46 to 0.87 ng/mL during freezing compared to that of pre-freezing (P < 0.05), and it returned to 0.39 ng/mL in 30 minutes after an intravenous edoxaban administration (N.S.).Dabigatran failed to exert sufficient anticoagulant effects during cryofreezing. In contrast, intravenous edoxaban seemed to provoke anticoagulation effects under extreme low temperature circumstances.


Assuntos
Antitrombinas/uso terapêutico , Criocirurgia/efeitos adversos , Dabigatrana/uso terapêutico , Piridinas/uso terapêutico , Tiazóis/uso terapêutico , Tromboembolia/etiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tromboembolia/prevenção & controle
2.
In Vivo ; 33(5): 1641-1644, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31471417

RESUMO

BACKGROUND: An open-label, single-arm study was conducted to assess the safety of a cryosurgery unit named CRYO2 for debulking at the site of obstruction or stenosis. PATIENTS AND METHODS: In order to treat central airway tumor-related stenosis, debulking at the stenotic site of the airway was performed using CRYO2 under general or local anesthesia. The primary endpoint was the incidence of moderate to massive hemorrhage. RESULTS: Incidence of moderate to massive hemorrhage during surgery was 3.8% (1/26) (95% confidence interval(CI)=0.1-19.6%). Technical success was 96.2% (25/26), with a 95% confidence interval of 80.4-99.9%. CONCLUSION: CRYO2 for debulking at the site of obstruction or stenosis can be performed safely.


Assuntos
Obstrução das Vias Respiratórias/patologia , Obstrução das Vias Respiratórias/cirurgia , Constrição Patológica/cirurgia , Procedimentos Cirúrgicos de Citorredução , Adulto , Idoso , Idoso de 80 Anos ou mais , Obstrução das Vias Respiratórias/etiologia , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Criocirurgia/efeitos adversos , Criocirurgia/instrumentação , Criocirurgia/métodos , Procedimentos Cirúrgicos de Citorredução/efeitos adversos , Procedimentos Cirúrgicos de Citorredução/instrumentação , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Humanos , Hipóxia/etiologia , Hipóxia/terapia , Masculino , Pessoa de Meia-Idade , Oxigênio/administração & dosagem , Neoplasias do Sistema Respiratório/complicações , Neoplasias do Sistema Respiratório/diagnóstico , Neoplasias do Sistema Respiratório/terapia , Resultado do Tratamento
3.
Urology ; 133: 151-156, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31415781

RESUMO

OBJECTIVE: To evaluate the safety, efficacy, and oncologic control of percutaneous image-guided cryoablation in the treatment of completely endophytic renal masses. Percutaneous image-guided cryoablation is a minimally invasive and effective treatment for small renal masses. Image-guided cryoablation is an attractive treatment for completely endophytic tumors given the challenge in visualization of such lesions during surgical extirpation. MATERIALS AND METHODS: A retrospective study evaluating percutaneous cryoablation of completely endophytic renal masses with normal overlying renal cortex was performed. From January 2003 to December 2015, 200 endophytic renal masses (RENAL score 3 - endophytic/exophytic) were identified from an internal renal ablation database. After imaging review, 49 tumors with completely intact overlying renal cortex in 47 patients were included in the study. Outcomes, including complications and oncologic efficacy were evaluated according to standard nomenclature. RESULTS: Patients comprised 37 men and 10 women (mean age 64.0 years) who underwent 48 cryoablation procedures to treat 49 renal masses. Mean tumor size was 2.5 ± 0.5 cm. Major complications occurred following 5 of the 48 (10%) procedures. Forty of 46 (87%) tumors with imaging follow-up were recurrence-free at a mean of 56 months. Five of six local recurrences were successfully retreated with cryoablatoin. CONCLUSION: Percutaneous thermal ablation of completely endophytic renal masses is a relatively safe procedure associated with acceptable complication and local tumor control rates. Given the complexities associated with partial nephrectomy, percutaneous cryoablation may be considered an alternative treatment for these select patients. Long-term follow-up studies are necessary to determine the durable efficacy of this treatment.


Assuntos
Criocirurgia/métodos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Cirurgia Assistida por Computador , Adulto , Idoso , Idoso de 80 Anos ou mais , Criocirurgia/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
4.
Arch Cardiovasc Dis ; 112(8-9): 502-511, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31447317

RESUMO

BACKGROUND: Pulmonary vein isolation (PVI) using cryoballoon ablation is widely used for rhythm control in patients with paroxysmal atrial fibrillation. This technique has a steep learning curve, and PVI can be achieved quickly in most patients. However, the right inferior pulmonary vein (RIPV) is often challenging to occlude and isolate. AIM: We aimed to analyse the efficacy of RIPV ablation using a systematic approach. METHODS: Consecutive patients referred for cryoballoon ablation of paroxysmal atrial fibrillation were enrolled prospectively. A systematic approach was used for RIPV cryoablation. The primary endpoint was acute RIPV isolation during initial freeze. RESULTS: A total of 214 patients were included. RIPV isolation during initial freeze occurred in 179 patients (82.2%). Real-time PVI could be observed in 72 patients (33.6%), whereas cryoballoon stability required pushing the Achieve™ catheter inside the RIPVs in the remaining patients. The rate of unsuccessful or aborted first freeze as a result of insufficient minimal temperature was significantly higher in patients with real-time pulmonary vein potential recording (16.7% vs. 6.3%; P=0.031). To overcome this issue and obtain both stability and real-time PVI, a dedicated "whip technique" was developed. Twelve patients (5.6%) required a redo ablation; only two of these had a reconnected RIPV. CONCLUSIONS: A systematic approach to RIPV cryoablation can lead to a high rate of first freeze application. Operators should not struggle to visualize pulmonary vein potentials before ablation, as this may decrease cryoapplication efficacy. Thus, stability should be preferred over real-time PVI for RIPV ablation. Both stability and real-time PVI can be obtained using a "whip technique".


Assuntos
Fibrilação Atrial/cirurgia , Criocirurgia/métodos , Veias Pulmonares/cirurgia , Potenciais de Ação , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Criocirurgia/efeitos adversos , Criocirurgia/instrumentação , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/fisiopatologia , Recidiva , Reoperação , Resultado do Tratamento
5.
Expert Rev Med Devices ; 16(9): 799-808, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31389263

RESUMO

Introduction: Pulmonary vein isolation (PVI), by catheter ablation, represents the current treatment for drug-resistant atrial fibrillation (AF). Nowadays cryoballoon (CB) is a recognized ablation method in patients with atrial fibrillation, mainly due to its ease of use, leading to reproducible and fast procedures. This novel single shot technology literally revolutionized the approach to AF ablation. Areas covered: The historical development of the cryoballoon, ablation techniques and new approaches beyond the ordinary PVI and complications are summarized here. Expert opinion: Although cryoballoon ablation has greatly standardized the approach to PVI a few critical points still need to be clarified scientifically in order to further uniform this procedure in cath labs worldwide. Duration and dosage of the cryoapplication is undoubtedly a topic of great interest.


Assuntos
Fibrilação Atrial/cirurgia , Ablação por Cateter , Criocirurgia , Fenômenos Biofísicos , Ablação por Cateter/efeitos adversos , Criocirurgia/efeitos adversos , Humanos , Resultado do Tratamento
6.
J Cardiovasc Med (Hagerstown) ; 20(10): 667-675, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31385856

RESUMO

PURPOSE: Currently, information on the mid-term outcome of cryoballoon ablation (CB-A) for drug-resistant atrial fibrillation in patients with reduced left ventricular systolic function is limited. METHODS: Thirty-eight consecutive patients with paroxysmal or persistent atrial fibrillation (84.2% male), with median left ventricular ejection fraction of 37.3% were included in our study. All patients underwent the procedure with the 28-mm cryoballoon advance. RESULTS: There were no mayor complications related to the CB-A procedure. Median follow-up was 26.5 ±â€Š13.7 months. The freedom from atrial fibrillation after a blanking period of 3 months was 42.9% in our cohort of patients. During the follow-up period, 13 patients underwent at least a new electrophysiological procedure. After a single procedure, the univariate predictors of clinical recurrence after the blanking period were age and persistent atrial fibrillation. CONCLUSION: Second-generation CB-A of atrial fibrillation seems feasible and safe in patients with heart failure with reduced ejection fraction and heart failure with mid-range ejection fraction, in terms of complications rate and number of applications per vein. All pulmonary veins could be isolated with the 28-mm cryoballoon advance only.


Assuntos
Fibrilação Atrial/cirurgia , Cateteres Cardíacos , Criocirurgia/instrumentação , Veias Pulmonares/cirurgia , Função Ventricular Esquerda , Idoso , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/fisiopatologia , Criocirurgia/efeitos adversos , Desenho de Equipamento , Estudos de Viabilidade , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Intervalo Livre de Progressão , Veias Pulmonares/fisiopatologia , Recidiva , Fatores de Risco , Volume Sistólico , Sístole , Fatores de Tempo
7.
Scand Cardiovasc J ; 53(6): 323-328, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31407601

RESUMO

Objectives. The aim of the study was to assess the long-term influence of catheter ablation (CA) of different arrhythmias on cardiovascular implantable electronic devices (CIED) endocardial leads durability. Design. This was a retrospective case-control study. Ablation protocols and in- or outpatient medical records were reviewed to identify and extract data on adult patients with CIED undergoing a CA. A cohort of patients with hypertrophic cardiomyopathy and implantable cardioverter-defibrillators (ICD) served as a historical control group. The primary endpoint was the diagnosis of lead damage defined as permanent loss of proper function demanding replacement or removal. Results. Among 145 patients n = 177 catheter ablations were performed. Patients' mean age was 66.4 ± 10.5, 66.1% had an ICD or ICD with cardiac resynchronization function (CRT-D), 18.1% had >1 CA. During median 812 days [IQR 381-1588] of follow-up, there were 11 (6.2%) cases of lead damage in the examined and 13 cases (13%) in the control group, p = 0.054. None of the technical aspects of the CA (indication, type of catheter, transseptal sheath) influenced the primary outcome. Both the number of leads and observation time after CA were significantly related to the risk of endocardial lead damage. Conclusion. This study did not find any significant influence of CA on the long-term durability of CIED endocardial leads. Reported risk factors were consistent with general population of CIED patients.


Assuntos
Arritmias Cardíacas/terapia , Estimulação Cardíaca Artificial , Ablação por Cateter/efeitos adversos , Criocirurgia/efeitos adversos , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Marca-Passo Artificial , Falha de Prótese , Adulto , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
8.
Am J Case Rep ; 20: 971-974, 2019 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-31280280

RESUMO

BACKGROUND Catheter ablation for atrial fibrillation is an important therapeutic intervention. One of the most frequent complications of this procedure is vascular issues including arteriovenous fistula. Iatrogenic atrial septal defect (IASD) has been reported as a complication of transseptal puncture; however, no data are available demonstrating any coexistent of arteriovenous fistula with IASD. CASE REPORT A 61-year-old female patient was admitted to our center for catheter ablation for persistent atrial fibrillation. Her past medical history was significant for cryoballoon ablation for atrial fibrillation in 2015, which was subsequently complicated by hematoma and arteriovenous fistula at puncture site. After general surgery consultation, the patient was qualified for conservative treatment. To exclude left atrial thrombus before redo procedure, transesophageal echocardiography was performed which visualized the presence of 9-mm atrial septal defect with left-to-right shunting, detecting right-to-left shunting using Valsalva maneuver. No significant valvular abnormalities were identified. The next day, pulmonary vein isolation for atrial fibrillation was performed. One month later, a control transthoracic echocardiogram (TTE) revealed hemodynamic significant left-to-right shunting with Qp/Qs 2.0 and high probability of pulmonary hypertension. Vascular surgery for arteriovenous fistula was successfully performed in October 2018. Subsequent TTE, performed a month later, confirmed no left-to-right shunting and no signs of pulmonary hypertension or diminishment of the right atrium. CONCLUSIONS Vascular access during catheter ablation for atrial fibrillation may result in arteriovenous fistula. This condition might affect right atrium pressure leading to increased diameter of previous puncture site at the interatrial septum, causing IASD with significant shunting. In this group of patients, arteriovenous fistula should be treated as soon as possible.


Assuntos
Fístula Arteriovenosa/etiologia , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Criocirurgia/efeitos adversos , Comunicação Interatrial/etiologia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Fibrilação Atrial/diagnóstico por imagem , Ecocardiografia Transesofagiana , Feminino , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/cirurgia , Humanos , Doença Iatrogênica , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Vasculares
9.
Respir Res ; 20(1): 140, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277659

RESUMO

BACKGROUND: Bronchoscopic cryobiopsy is a new method of bronchoscopic tissue sampling in interstitial lung disease. In case of transbronchial biopsies, the resultant tissue samples are of high quality, and the lung parenchyma seen in the samples is adequate for a histological diagnosis in most cases. Bleeding after transbronchial biopsy is the most important procedure- associated complication and may be life threatening. This study addresses the risk of bleeding of transbronchial cryobiopsy. METHODS: In this prospective, randomized, controlled multicentre study 359 patients with interstitial lung disease requiring diagnostic bronchoscopic tissue sampling were included. Both conventional transbronchial forceps biopsy and transbronchial cryobiopsy were undertaken in each patient. The sequence of the procedures was randomized. Bleeding severity was evaluated semi-quantitatively as "no bleeding", "mild" (suction alone), "moderate" (additional intervention) or "severe" (prolonged monitoring necessary or fatal outcome), for each intervention. RESULTS: In 359 patients atotal of 1160 cryobiopsies and 1302 forceps biopsies were performed. Bleeding was observed after forceps biopsy in 173 patients (48.2%) and after cryobiopsy in 261 patients (72.7%). Bleeding was significantly greater in the cryobiopsy group (cryobiopsy/forceps biopsy: no bleeding 27.3%/51.8%; mild 56.5%/44.0%; moderate 15.0%/4.2%; severe 1.2%/0%; p < 0.001). The rate of clinically relevant bleeding (moderate or severe) was higher after the cryobiopsy procedures compared to the forceps biopsies (16.2% vs. 4.2%, p < 0.05). No fatal bleeding complications occurred. CONCLUSIONS: Compared to transbronchial forceps biopsy, transbronchial cryobiopsy was associated with an increased risk of bleeding which is of clinical relevance. Therefore training and additional precautions for bleeding control should be considered. TRIAL REGISTRATION: The study was registered with clinicaltrials.gov ( NCT01894113 ).


Assuntos
Brônquios/patologia , Criocirurgia/efeitos adversos , Hemorragia/diagnóstico , Hemorragia/etiologia , Doenças Pulmonares Intersticiais/diagnóstico , Instrumentos Cirúrgicos/efeitos adversos , Idoso , Biópsia/efeitos adversos , Biópsia/métodos , Estudos Cross-Over , Criocirurgia/métodos , Feminino , Humanos , Doenças Pulmonares Intersticiais/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
10.
PLoS One ; 14(6): e0217554, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31158264

RESUMO

INTRODUCTION: Diffuse parenchymal lung diseases (DPLD) constitute a heterogeneous group of disorders, sometimes requiring surgical lung biopsies (SLB) to obtain a definite diagnosis. Transbronchial cryobiopsy (TBCB) is a new promising interventional bronchoscopic method of obtaining lung tissue that is gaining ground against SLB. METHODS: Fifty consecutive patients with indeterminate DPLD (definite/possible UIP excluded), after expert panel review referral, were retrospectively analyzed from January 2016 to August 2018. Patients underwent TBCB under deep sedation with endotracheal intubation and spontaneous breathing at a single, tertiary-care, reference hospital. RESULTS: A total of 110 TBCBs (2.7 per patient, range 1 to 4) were performed. Frequent complications included mild pneumothorax in 5 patients (10%), requiring only oxygen supplementation, and bleeding in 31 patients (62%) that was mild in 19 patients and moderate in 12 patients. No serious bleeding was observed. There was zero mortality and no serious adverse events. Adequate samples for diagnostic purposes were obtained in 46 patients (92%) and pathologic histologic diagnosis was reached in 40 patients (80%). The most frequent histopathological patterns were organizing pneumonia (OP) (25%) and non-specific interstitial pneumonia (NSIP) (15%). After an expert panel review of all cases a final diagnosis was achieved in 38 patients, corresponding to a diagnostic yield of 76% for TBCB. CONCLUSION: Our single center cohort demonstrates that establishing TBCBs as a new technique is safe and feasible after proper training in specialized centers, resulting in low complication rates and adequate diagnostic yields.


Assuntos
Brônquios/patologia , Criocirurgia , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/patologia , Padrões de Prática Médica , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Criocirurgia/efeitos adversos , Feminino , Grécia , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
11.
Urology ; 131: e3-e4, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31195008

RESUMO

Needle tract metastases can be a rare complication following percutaneous procedures for renal malignancies. We report a case of cryoprobe tract tumor seeding following cryoablation of a small biopsy proven renal cell carcinoma.


Assuntos
Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/cirurgia , Criocirurgia/efeitos adversos , Neoplasias Renais/patologia , Neoplasias Renais/cirurgia , Inoculação de Neoplasia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Idoso , Criocirurgia/métodos , Humanos , Masculino
12.
J Vasc Interv Radiol ; 30(7): 1027-1033.e3, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31176590

RESUMO

PURPOSE: To compare the overall survival (OS) of patients receiving cryoablation versus heat-based thermal ablation for clinical T1a renal cell carcinoma (RCC) in a large national cohort. MATERIALS AND METHODS: Patients with RCC from 2004 to 2014 who were treated with ablation were identified from the National Cancer Database. OS was estimated with the use of the Kaplan-Meier method and evaluated by means of log-rank test, univariate and multivariate Cox proportional hazard regression, and propensity score-matched analysis. RESULTS: A total of 3,936 patients who received cryoablation and 2,322 who received heat-based thermal ablation met the inclusion criteria. The mean age was 67 ± 12 year, and the mean size of tumors was 25 ± 8 mm. The 3-, 5-, and 10-year survival rates were, respectively, 91%, 82%, and 62% for cryoablation and 89%, 81%, and 55% for heat-based thermal ablation. After propensity score matching, cryoablation was associated with longer OS compared with heat-based thermal ablation (median 11.3 vs 10.4 years; hazard ratio 1.175, 95% CI 1.03-1.341; P = .016). For patients with tumors ≤2 cm, propensity score-matched analyses demonstrated no significant difference between the 2 treatment groups (P = .772). CONCLUSIONS: Overall, cryoablation may be associated with longer OS compared with heat-based thermal ablation in cT1a RCC. No significant difference in survival rates was observed between the 2 treatments for patients with tumor sizes ≤2 cm. Owing to the inherent limitations of this study, further study with details on technology, local outcome, and complications is needed.


Assuntos
Técnicas de Ablação , Carcinoma de Células Renais/cirurgia , Criocirurgia , Temperatura Alta/uso terapêutico , Neoplasias Renais/cirurgia , Técnicas de Ablação/efeitos adversos , Técnicas de Ablação/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/patologia , Criocirurgia/efeitos adversos , Criocirurgia/mortalidade , Bases de Dados Factuais , Feminino , Temperatura Alta/efeitos adversos , Humanos , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Carga Tumoral , Estados Unidos , Adulto Jovem
14.
Semin Thorac Cardiovasc Surg ; 31(4): 796-802, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31077808

RESUMO

Surgical management for patients with long-standing persistent (LSP) AF and giant left atria (GLA) associated with mitral valve diseases remains a challenge. We aimed to assess the efficacy of the cut-and-sew maze procedure (CSM) in this subgroup of patients, in terms of maintenance of sinus rhythm (SR), atrial function, and to identify the operative risks of this procedure. A total of 229 patients with LSP-AF underwent CSM at our institution from December 2013 to October 2017. Patients were divided into 2 groups based on LA diameter: NGLA group (<65 mm, n = 171), GLA group (≥65 mm, n = 58). Patients with GLA were propensity score matched to patients without GLA resulting in 45 pairs of patients. Early death occurred in 1 (2.2%) in GLA group and no deaths in NGLA group (P = 0.315). Early complications did not differ significantly between the 2 groups. The GLA group showed similar rates of SR on and off antiarrhythmic drugs compared with NGLA group at 2 years (86.36% vs 93.9%, P = 0.338; 81.82% vs 90.91%, P = 0.322). At 2 years, LA contraction was comparable between patients with and without GLA (81.81% vs 90.9%, P = 0.322). Right atrial contraction recovery rate was 96% in NGLA group, and 86.36% in GLA group (P = 0.138). Concomitant CSM is effective and feasible for restoration of SR and atrial contraction, for patients with LSP-AF and GLA associated with mitral valve diseases with acceptable operative risks.


Assuntos
Fibrilação Atrial/cirurgia , Criocirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Valva Mitral/cirurgia , Técnicas de Sutura , Suturas , Adulto , Idoso , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/mortalidade , Fibrilação Atrial/fisiopatologia , Função do Átrio Esquerdo , Remodelamento Atrial , Criocirurgia/efeitos adversos , Criocirurgia/mortalidade , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/mortalidade , Doenças das Valvas Cardíacas/fisiopatologia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Anuloplastia da Valva Mitral/instrumentação , Complicações Pós-Operatórias/mortalidade , Pontuação de Propensão , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
15.
Diagn Interv Radiol ; 25(3): 225-230, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31063139

RESUMO

PURPOSE: We aimed to evaluate the safety and effectiveness of cryoablation in the treatment of low-flow malformations, specifically venous malformation (VM) and fibroadipose vascular anomaly (FAVA). METHODS: We conducted a retrospective review of 11 consecutive patients with low-flow malformations (14 lesions; 9 VM, 5 FAVA), median lesion volume 10.8 cm3, (range, 1.8-55.6 cm3) with a median age of 19 years (range, 10-50 years) who underwent cryoablation to achieve symptomatic control. Average follow-up was at a median of 207 days postprocedure (range, 120-886 days). Indications for treatment included focal pain and swelling. Technical success was achieved if the cryoablation ice ball covered the region of the malformation that corresponded to the patient's symptoms. Clinical success was considered complete if all symptoms resolved and partial if some symptoms persisted but did not necessitate further treatment. RESULTS: The technical success rate was 100%. At 1-month follow-up, 13 of 14 lesions (93%) had a complete response and one (7%) had a partial response. At 6-month follow-up 12 of 13 (92%) had a complete response and 1 (8%) had a partial response. A total of 6 patients underwent primary cryoablation. Out of 9 VM cases, 7 had prior sclerotherapy and 2 had primary cryoablation. Out of the 5 FAVA cases, 1 had prior sclerotherapy and the remaining 4 cases underwent primary cryoablation. There were 3 minor complications following cryoablation including 2 cases of skin blisters and 1 case of transient numbness. These complications resolved with conservative management. CONCLUSION: Cryoablation is safe and effective in the treatment of low-flow vascular malformations, either after sclerotherapy or as primary treatment.


Assuntos
Criocirurgia/métodos , Criocirurgia/estatística & dados numéricos , Malformações Vasculares/terapia , Adolescente , Adulto , Vesícula/etiologia , Criança , Criocirurgia/efeitos adversos , Feminino , Humanos , Hipestesia/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Escleroterapia/métodos , Escleroterapia/normas , Resultado do Tratamento , Malformações Vasculares/patologia , Adulto Jovem
17.
Arch Dermatol Res ; 311(6): 499-504, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31115658

RESUMO

Immunocryosurgery, the combination modality of a cryosurgery session at day 14 of a 5-week daily imiquimod treatment cycle, has shown remarkable efficacy in the treatment of basal cell carcinoma (BCC). The modality was designed to exploit synergy of antitumor effects, including the induction of immune responses, elicited by imiquimod and cryosurgery. Herein, we report on the infiltration of the BCC by selected inflammatory cell species during an immunocryosurgery treatment cycle. The density of tissue infiltrating CD68+, CD3+ and Foxp3+ cells was studied by immunohistochemistry in 56 BCC biopsies from 28 treated sites (26 patients) at baseline and at days 12, 16 or 28 during treatment. Immunocryosurgery induces statistically significant alterations in all three cell species (p < 0.003): The density of CD68+ increased already by day 12 and remained at a higher level during the treatment thereafter. The density of CD3+ cells increased significantly between days 12 and 16 of treatment. The density of Treg (Foxp3+) cells increased in the early phase of treatment (highest at day 12) to decrease significantly already 2 days after the cryosurgery session (day 16) and thereafter up to day 28 of the treatment cycle (p = 0.033). Within the tumor tissue, these alterations result in an abrupt increase in the CD3+/Foxp3+ ratio, a finding suggesting that the cryosurgical perturbation may probably play a decisive modulating role in the cellular composition of the inflammatory infiltrate during immunocryosurgery, eventually heralding the induction of an effective tumor-destructing immune response.


Assuntos
Carcinoma Basocelular/imunologia , Carcinoma Basocelular/terapia , Criocirurgia/métodos , Neoplasias Cutâneas/imunologia , Neoplasias Cutâneas/terapia , Idoso , Idoso de 80 Anos ou mais , Biópsia , Carcinoma Basocelular/patologia , Criocirurgia/efeitos adversos , Feminino , Humanos , Imiquimode/uso terapêutico , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/patologia
18.
J Pediatr Surg ; 54(11): 2250-2256, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30935731

RESUMO

PURPOSE: Minimally-invasive repair of pectus excavatum by the Nuss procedure is associated with significant postoperative pain, prolonged hospital stay, and high opiate requirement. We hypothesized that intercostal nerve cryoablation during the Nuss procedure reduces hospital length of stay (LOS) compared to thoracic epidural analgesia. DESIGN: This randomized clinical trial evaluated 20 consecutive patients undergoing the Nuss procedure for pectus excavatum between May 2016 and March 2018. Patients were randomized evenly via closed-envelope method to receive either cryoanalgesia or thoracic epidural analgesia. Patients and physicians were blinded to study arm until immediately preoperatively. SETTING: Single institution, UCSF-Benioff Children's Hospital. PARTICIPANTS: 20 consecutive patients were recruited from those scheduled for the Nuss procedure. Exclusion criteria were age < 13 years, chest wall anomaly other than pectus excavatum, previous repair or other thoracic surgery, and chronic use of pain medications. MAIN OUTCOMES AND MEASURES: Primary outcome was postoperative LOS. Secondary outcomes included total operative time, total/daily opioid requirement, inpatient/outpatient pain score, and complications. Primary outcome data were analyzed by the Mann-Whitney U-test for nonparametric continuous variables. Other continuous variables were analyzed by two-tailed t-test, while categorical data were compared via Chi-squared test, with alpha = 0.05 for significance. RESULTS: 20 patients were randomized to receive either cryoablation (n = 10) or thoracic epidural (n = 10). Mean operating room time was 46.5 min longer in the cryoanalgesia group (p = 0.0001). Median LOS decreased by 2 days in patients undergoing cryoablation, to 3 days from 5 days (Mann-Whitney U, p = 0.0001). Cryoablation patients required significantly less inpatient opioid analgesia with a mean decrease of 416 mg oral morphine equivalent per patient (p = 0.0001), requiring 52%-82% fewer milligrams on postoperative days 1-3 (p < 0.01 each day). There was no difference in mean pain score between the groups at any point postoperatively, up to one year, and no increased incidence of neuropathic pain in the cryoablation group. No complications were noted in the cryoablation group; among patients with epidurals, one patient experienced a symptomatic pneumothorax and another had urinary retention. CONCLUSIONS AND RELEVANCE: Intercostal nerve cryoablation during the Nuss procedure decreases hospital length of stay and opiate requirement versus thoracic epidural analgesia, while offering equivalent pain control. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: Level I.


Assuntos
Analgésicos Opioides/uso terapêutico , Criocirurgia , Tórax em Funil/cirurgia , Nervos Intercostais/cirurgia , Tempo de Internação/estatística & dados numéricos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Criocirurgia/estatística & dados numéricos , Humanos , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico
19.
J Vasc Interv Radiol ; 30(7): 1035-1042, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30956075

RESUMO

PURPOSE: To compare the therapeutic and renal function outcomes of radiofrequency (RF) ablation, cryoablation, and microwave (MW) ablation for treatment of T1a renal cell carcinoma (RCC). MATERIALS AND METHODS: A retrospective assessment of 297 patients (mean age 72 years range 24-90 years) with biopsy-proven RCC treated with image-guided percutaneous thermal ablation was performed between October 2006 and December 2016. Mean tumor size was 2.4 cm; mean radius, exophytic/endophytic properties, nearness of tumor to collecting system or sinus, anterior/posterior, hilar tumor touching the main renal artery or vein, and location relative to polar lines; Preoperative Aspects and Dimensions Used for an Anatomical; and c-centrality scores were 6.0, 7.0, and 2.8, respectively. Assessments of adverse events, treatment efficacy, and therapeutic outcomes were performed among RF ablation, cryoablation, and MW ablation. The 2-year disease-free, metastatic-free, and cancer-specific survival rates were tabulated. Estimated glomerular filtration rate was used to assess for treatment related changes in renal function. RESULTS: A total of 297 T1aN0M0 biopsy-proven RCCs measuring 1.2-3.9 cm were treated with computed tomography-guided RF ablation (n = 244, 82%), cryoablation (n = 26, 9%), and MW ablation (n = 27, 9%). There were no significant differences in patient demographics among the 3 groups (P = .09). Technical success rates were similar among the 3 treatments (P = .33). Primary efficacy at 1 month postablation was more likely to be achieved with RF ablation and MW ablation than with cryoablation. At 2 years' follow-up, there was no local recurrence, metastatic progression, or RCC-related death observed in the 3 groups. There was no significant change in estimated glomerular filtration rate among the 3 ablation groups compared with baseline at 2-year follow-up (P = .71). CONCLUSION: RF ablation, cryoablation, and MW ablation are equivalent at 2 years for treatment of T1a RCC for therapeutic outcome, stability of renal function, and low adverse event rate.


Assuntos
Carcinoma de Células Renais/cirurgia , Criocirurgia , Taxa de Filtração Glomerular , Neoplasias Renais/cirurgia , Micro-Ondas/uso terapêutico , Ablação por Radiofrequência , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/mortalidade , Carcinoma de Células Renais/secundário , Criocirurgia/efeitos adversos , Criocirurgia/mortalidade , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/mortalidade , Neoplasias Renais/patologia , Masculino , Micro-Ondas/efeitos adversos , Pessoa de Meia-Idade , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/mortalidade , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Carga Tumoral , Adulto Jovem
20.
Can J Cardiol ; 35(4): 396-404, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30935630

RESUMO

BACKGROUND: Persistent iatrogenic atrial septal defect (iASD) is a common but poorly characterized complication after cryoballoon (CB) pulmonary vein isolation (PVI) procedures. We therefore investigate its prevalence, evolution, risk factors, and clinical outcomes in a prospective longitudinal study. METHODS: A total of 108 patients (41 women, mean age 57 ± 11.3) underwent CB PVI for AF. Serial transesophageal echocardiography (TEE) was performed 9 months and then annually until 6 years after the procedure to study the characteristics of persistent iASD. RESULTS: Persistent iASD occurred in 33 (30.6%) patients 9 months after CB PVI. Spontaneous closure of iASD was found in 6 (22.2%) and 3 (15.8%) patients 2 and 3 years after the procedures, respectively. No spontaneous closure was observed on 4, 5, and 6-year TEE follow-up. The projected long-term persistence rate of iASD after CB PVI was therefore 20% (30.6% × 0.778 × 0.842). Using multivariate logistic regression, a higher number of cryoapplications (≥ 2 minutes) was the only independent predictor of persistent iASD 9 months after CB PVI (odds ratio [OR] 1.207; 95% confidence interval [CI], 1.033-1.411, P = 0.018). Two (1.9%) patients with significantly larger iASD size than the others (long diameter 12.6 ± 0.8 vs 3.7 ± 1.5 mm, P < 0.001; short diameter 10.9 ± 0.2 vs 3 ± 1.1 mm, P < 0.001) required percutaneous closure because of exertional dyspnea and right ventricular enlargement. Over 129.7 patient-years follow-up, during which iASD persisted, there was no occurrence of neurologic events. CONCLUSIONS: Approximately one fifth of patients undergoing CB PVI will have permanently persistent iASD. Patients with defect sizes of greater than 10 mm may need percutaneous closure due to significant left-to-right shunting.


Assuntos
Fibrilação Atrial/terapia , Ablação por Cateter/efeitos adversos , Criocirurgia/efeitos adversos , Comunicação Interatrial/etiologia , Doença Iatrogênica , Ablação por Cateter/métodos , Ecocardiografia Transesofagiana , Feminino , Comunicação Interatrial/diagnóstico por imagem , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Veias Pulmonares/cirurgia
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