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1.
Rev Port Cir Cardiotorac Vasc ; 26(3): 195-197, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31734970

RESUMO

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


Assuntos
Aorta/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Doenças Cardiovasculares/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Idoso , Doenças da Aorta/cirurgia , Bioprótese , Doenças das Valvas Cardíacas/cirurgia , Humanos , Masculino , Desenho de Prótese , Resultado do Tratamento
2.
Semin Vasc Surg ; 32(1-2): 41-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31540656

RESUMO

Diagnostic testing performed in the noninvasive vascular laboratory is a cornerstone of care for patients with suspected or known vascular disease. The Society for Vascular Surgery has mandated that vascular surgery resident training include mentored experience in performing vascular laboratory testing and interpreting its results. The trainee should be experienced with vascular laboratory instrumentation and testing protocols, be knowledgeable in ultrasound imaging of vascular anatomy, and be competent to classify disease severity relevant to the study indication. The scope of test interpretation should include peripheral arterial, peripheral venous, cerebrovascular, and visceral abdominal testing using duplex ultrasound supplemented by indirect physiologic testing for peripheral arterial and venous disease. The emergence of endovascular therapy has expanded duplex ultrasound applications in the areas of screening, procedural imaging, and surveillance following intervention. Pre-procedure testing to assess disease location and severity, and vein mapping for dialysis access or extremity bypass grafting provide important patient-specific information that can reduce the need for more invasive vascular imaging. It is recommended that trainees acquire the hand-on skills to perform duplex testing in vascular clinic and inpatient sites, such as the emergency department and operating room. Training programs should have a structured vascular laboratory curriculum that documents annual educational milestones that encompass both test interpretation aptitude and hands-on duplex scanning skills. Before completion of training, the resident should acquire documented experience in test interpretation sufficient to take the Physician Vascular Interpretation examination, which is required for American Board of Surgery certification as a vascular surgeon.


Assuntos
Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/cirurgia , Técnicas de Diagnóstico Cardiovascular , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência , Cirurgiões/educação , Procedimentos Cirúrgicos Vasculares/educação , Tomada de Decisão Clínica , Currículo , Humanos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes
3.
Herz ; 44(7): 611-629, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31468075

RESUMO

There is a close physiological relationship between the kidneys and the heart. Cardiovascular diseases are the most prevalent cause of death in patients with chronic kidney disease (CKD), whereas CKD may directly accelerate the progression of cardiovascular diseases and is considered to be a cardiovascular risk factor. In patients with mild CKD, i.e. an estimated glomerular filtration rate (eGFR) >60 ml/min/1.73 m2, treatment of coronary artery disease and chronic heart failure is not essentially different from patients with preserved renal function; however, as most pivotal trials have systematically excluded patients with advanced renal failure, many treatment recommendations in this patient group are based on observational studies, post hoc subgroup analyses and meta-analyses or pathophysiological considerations, which are not supported by controlled studies. Therefore, prospective randomized studies on the management of heart failure and coronary artery disease are needed, which should specifically focus on the growing number of patients with advanced renal functional impairment.


Assuntos
Doenças Cardiovasculares , Falência Renal Crônica , Revascularização Miocárdica , Insuficiência Renal Crônica , Insuficiência Renal , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/cirurgia , Taxa de Filtração Glomerular , Humanos , Estudos Prospectivos , Insuficiência Renal Crônica/complicações
6.
Rev Med Liege ; 74(S1): S5-S9, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31070309

RESUMO

The management of complex cardiovascular disease has changed considerably with the development of new care strategies. In cardiology, the «Heart Team¼ or literally «Equipe du cœur¼ occupies a prominent place in the latest European and American recommendations, particularly in the management of complex coronary or valvular diseases and in heart failure patients. The concept of «Heart Team¼ is based on the need for a multidisciplinary holistic approach based on evidence (respect of the recommendations of the scientific societies), the patient as a whole (comorbidities, preferences), risks and long-term benefits of the treatment selected and performed, as well as on the level of local expertise. It aims to determine the best management strategy for the patient, and perhaps to guarantee a better result (prognosis).


Assuntos
Cardiologia , Doenças Cardiovasculares , Cardiologistas , Doenças Cardiovasculares/cirurgia , Comorbidade , Humanos , Prognóstico
7.
BMC Infect Dis ; 19(1): 438, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31109283

RESUMO

BACKGROUND: Gram-positive organisms are a leading cause of infection in cardiovascular surgery. Furthermore, these patients have a high risk of developing postoperative renal failure in intensive care unit (ICU). Some antibiotic drugs are known to impair renal function. The aim of the study was to evaluate whether patients treated for Gram-positive cardiovascular infection with daptomycin (DAP) experienced a lower incidence of acute kidney injury (AKI) when compared to patients treated with vancomycin (VAN), with comparable efficacy. METHODS: ICU patients who received either DAP or VAN, prior to or after cardiovascular surgery or mechanical circulatory support, from January 2010 to December 2012, were included in this observational retrospective cohort study. We excluded patients with end stage renal disease and antibiotic prophylaxis. The primary endpoint was the incidence of AKI within the first week of treatment. Secondary endpoints were the incidence of AKI within the first 14 days of treatment, the severity of AKI including renal replacement therapy (RRT), the rates of clinical failure (unsuccessful infection treatment) and of premature discontinuation and mortality. To minimize selection bias, we used a propensity score to compare the 2 groups. Univariate and multivariate analysis were performed to determine factors associated with AKI. RESULTS: Seventy two patients, treated for infective endocarditis, cardiovascular foreign body infection, or surgical site infection were included (DAP, n = 28 and VAN, n = 44). AKI at day 7 was observed in 28 (64%) versus 6 (21%) of the VAN and DAP patients, respectively (p = 0.001). In the multivariate analysis adjusted to the propensity score, vancomycin treatment was the only factor associated with AKI (Odds Ratio 4.42; 95% CI: 1.39-15.34; p = 0.014). RRT was required for 2 (7%) DAP patients and 13 (30%) VAN patients, p = 0.035. Premature discontinuation and clinical failure occurred more frequently in VAN group than in DAP group (25% versus 4%, p = 0.022 and 42% versus 12%, respectively, p = 0.027). CONCLUSIONS: Daptomycin appears to be safer than vancomycin in terms of AKI risk in ICU patients treated for cardiovascular procedure-related infection. Daptomycin could be considered as a first line treatment to prevent AKI in high-risk patients.


Assuntos
Lesão Renal Aguda/etiologia , Daptomicina/efeitos adversos , Vancomicina/efeitos adversos , Lesão Renal Aguda/epidemiologia , Idoso , Antibacterianos/uso terapêutico , Doenças Cardiovasculares/cirurgia , Estado Terminal , Daptomicina/uso terapêutico , Endocardite/tratamento farmacológico , Endocardite/epidemiologia , Endocardite/etiologia , Feminino , Humanos , Incidência , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Razão de Chances , Pontuação de Propensão , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Vancomicina/uso terapêutico
8.
Ann Thorac Surg ; 108(2): 641-644, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30986417

RESUMO

Dr Dwight C. McGoon, a prolific surgeon at the Mayo Clinic in Rochester, Minnesota, achieved an amazing feat during the early days of cardiac surgery. In 1965, he reported a series of 100 consecutive aortic valve replacements with no in-hospital mortality. As a pioneer in adult and congenital cardiac surgery, his other contributions included novel uses of left ventricular and biventricular extracardiac conduits and describing repairs for mitral regurgitation resulting from ruptured chordae, transposition of the great arteries, truncus arteriosus, pulmonary stenosis, and pulmonary atresia. More than 50 years later, Dr McGoon is still remembered for his technical prowess, innovation, mentorship, and humanism.


Assuntos
Procedimentos Cirúrgicos Cardíacos/história , Doenças Cardiovasculares/história , Cirurgia Torácica/história , Doenças Cardiovasculares/cirurgia , História do Século XX , Humanos , Minnesota
10.
PLoS One ; 14(1): e0211429, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30703146

RESUMO

The long-term prognosis of patients with postoperative acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT) after cardiovascular surgery is unclear. We aimed to investigate long-term renal outcomes and survival in these patients to determine the risk factors for negative outcomes. Long-term prognosis was examined in 144 hospital survivors. All patients were independent and on renal replacement therapy at hospital discharge. The median age at operation was 72.0 years, and the median pre-operative estimated glomerular filtration rate (eGFR) was 39.5 mL/min/1.73 m2. The median follow-up duration was 1075 days. The endpoints were death, chronic maintenance dialysis dependence, and a composite of death and chronic dialysis. Predictors for death and dialysis were evaluated using Fine and Gray's competing risk analysis. The cumulative incidence of death was 34.9%, and the chronic dialysis rate was 13.3% during the observation period. In the multivariate proportional hazards analysis, eGFR <30 mL/min/1.73 m2 at discharge was associated with the composite endpoint of death and dialysis [hazard ratio (HR), 2.1; 95% confidence interval (CI), 1.1-3.8; P = 0.02]. Hypertension (HR 8.7, 95% CI, 2.2-35.4; P = 0.002) and eGFR <30 mL/min/1.73 m2 at discharge (HR 26.4, 95% CI, 2.6-267.1; P = 0.006) were associated with dialysis. Advanced age (≥75 years) was predictive of death. Patients with severe CRRT-requiring AKI after cardiovascular surgery have increased risks of chronic dialysis and death. Patients with eGFR <30 mL/min/1.73 m2 at discharge should be monitored especially carefully by nephrologists due to the risk of chronic dialysis and death.


Assuntos
Lesão Renal Aguda/mortalidade , Doenças Cardiovasculares/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Diálise Renal/mortalidade , Terapia de Substituição Renal/mortalidade , Sobreviventes/estatística & dados numéricos , Lesão Renal Aguda/etiologia , Lesão Renal Aguda/terapia , Idoso , Feminino , Seguimentos , Taxa de Filtração Glomerular , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida
11.
Am J Hosp Palliat Care ; 36(4): 316-320, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30791705

RESUMO

BACKGROUND:: Secondary palliative care (SPC) provides several benefits for patients with cardiovascular disease, but historically, it has been underutilized in this population. Prior research suggests a low rate of SPC consultation by surgical teams in general, but little is known about how surgical teams utilize SPC in the setting of severe cardiovascular disease. AIM:: To determine if surgical team assignment affects the probability of SPC for inpatients dying of cardiovascular disease. DESIGN:: Retrospective, cohort study. METHODS:: We identified all inpatients at a large cardiac hospital who had anticipated death under the care of a cardiology, cardiac surgery, or vascular surgery team in 2016. Our primary outcome was referral to SPC, including palliative medicine consultation or inpatient hospice care. Informed by univariate analysis, we created a multivariable logistic regression model, the significance of which was assessed with the Wald test. RESULTS:: Two hundred thirty-seven patients were included in our analysis: 93 (39%) received SPC and 144 (61%) were "missed opportunities." Secondary palliative care was less frequent in patients assigned to a surgical, versus medical, team (11% vs 47%, P < .001). On multivariate analysis, surgical versus medical team assignment was the strongest risk-adjusted predictor of SPC (odds ratio [OR]: 0.10, P < .001). Other predictors of SPC included do not resuscitate status on admission (OR: 14, P < .001), length of stay (OR = 1.05/day, P < .001), and having Medicare (OR = 3.9, P = .002). CONCLUSIONS:: Primary inpatient care by a surgical team had a strong inverse relationship with SPC. This suggests a possible cultural barrier within surgical disciplines to SPC.


Assuntos
Institutos de Cardiologia/estatística & dados numéricos , Doenças Cardiovasculares/terapia , Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Fatores Etários , Idoso , Doenças Cardiovasculares/cirurgia , Humanos , Pacientes Internados , Modelos Logísticos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos
12.
Perspect Health Inf Manag ; 16(Winter): 1b, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30766453

RESUMO

Coronary catheterization is the gold standard for diagnosis and treatment of cardiovascular conditions. The development of a catheterization and percutaneous coronary intervention (CathPCI) registry considering key steps of data management has a pivotal role in coronary catheterization because it could help improve CathPCI approaches, develop equipment and devices, and minimize complications of the CathPCI procedure. Data management comprises data gathering, data processing, and information distribution. Data gathering involves the collection of data elements, including demographics, episode of care, history and relevant risk factors, visits to the catheterization laboratory, diagnosis of cardiac catheterization, estimation of the coronary arterial anatomy, percutaneous coronary intervention procedures, lesions, devices, outcomes, and discharge. Data processing is performed with respect to the number of procedures performed in different circumstances, the outcomes of the performed procedures, improvement in the healthcare approach, development of devices and equipment, and the quality of the performed procedures. Information distribution involves the sharing of information and making information accessible to researchers and clinicians, relevant health care managers, and manufacturers of medical devices and equipment. This study reviewed relevant English-language publications regarding cardiac catheterization registries, data collection, data processing, and information distribution, regardless of the date of publication.


Assuntos
Cateterismo Cardíaco/métodos , Doenças Cardiovasculares/cirurgia , Gestão da Informação em Saúde/organização & administração , Intervenção Coronária Percutânea/métodos , Sistema de Registros/estatística & dados numéricos , Algoritmos , Cateterismo Cardíaco/estatística & dados numéricos , Doenças Cardiovasculares/diagnóstico , Coleta de Dados/métodos , Gestão da Informação em Saúde/normas , Humanos , Intervenção Coronária Percutânea/estatística & dados numéricos , Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos
13.
Pediatr Surg Int ; 35(3): 321-328, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30683989

RESUMO

PURPOSE: Survival of neonatal and pediatric patients undergoing extracorporeal membrane oxygenation (ECMO) ≥ 21 days has not been well described. We hypothesized that patients would have poor survival and increased long-term complications. METHODS: Retrospective, single center, review and case analysis. Tertiary-care university children's hospital including neonatal, pediatric and cardiac intensive care units. After institutional review board approval, the charts of all patients < 18 years of age undergoing ECMO for ≥ 21 continuous days were performed, and they were compared to comparative patients undergoing shorter runs. Overall survival, incidence of complications, and post-discharge recovery were recorded. RESULTS: Overall survival was 36% in patients undergoing ≥ 21 days of ECMO (N = 14). 5/8 patients with cardiopulmonary failure from acquired etiologies survived versus 0/6 patients with congenital anomalies. 1/5 survivors achieved complete recovery with no neurologic deficits. The remaining survivors suffer from multiple medical and neurodevelopmental morbidities. CONCLUSION: ECMO support for ≥ 21 days is associated with poor survival, particularly in neonates with congenital anomalies. Long-term outcomes for survivors ought to be carefully weighed and discussed with parents given the high incidence of neurologic morbidities in this population.


Assuntos
Doenças Cardiovasculares/cirurgia , Ética Médica , Oxigenação por Membrana Extracorpórea/ética , Complicações Pós-Operatórias/epidemiologia , Doenças Cardiovasculares/mortalidade , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Incidência , Lactente , Masculino , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia
14.
Diabetes Metab Syndr ; 13(1): 420-423, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30641736

RESUMO

INTRODUCTION: An inadequate glycemic control in cardiovascular postoperative is a predictor of mortality, postoperative infections and a prolonged hospital stay. This study evaluates the incidence of hypoglycemia in the first 72 h of postoperative and its association with different factors, such as tissue perfusion parameters, and the administration of medicines that induct hypoglycemia during surgery, in patients that undergo cardiovascular surgery in a 4th level hospital in Bogota, Colombia. METHODS AND MATERIALS: A nested cases and controls study was developed, taking as cases the patients that presented hypoglycemia episodes (<70 mg/dl) and the controls were the patients without this outcome. A systematic record of the glycemic control in the first 72 h of postoperative was registered. An univariate and multivariate analysis was conducted to determine the factor associated with hypoglycemia. RESULTS: 327 patients were evaluated (35% with coronary bypass and 27% with valvular replacement). 7.65% of the patients presented at least one episode of hypoglycemia <70 mg/dL (25 episodes). The multivariate analysis showed an association with chronic kidney failure in dialysis (OR6,21; IC:0,97-43.27,p:0.05), administration of preoperative steroids (OR4,41; IC:1,27-15,20,p:0.02), intraoperative insulin (OR2,61; IC:1.09-6,22, p:0.03), and postoperative hydrocortisone (OR 7,15; IC 1,46-34,9 p:0.01). CONCLUSIONS: Hypoglycemia is frequent in patients that undergo a cardiovascular surgery. The associated factors were chronic kidney failure in dialysis, administration of preoperative steroids, intraoperative insulin and hydrocortisone during postoperative. Other factors such as tissue perfusion, administration of vasoactive or beta blockers substances, showed no association with hypoglycemia.


Assuntos
Biomarcadores/análise , Doenças Cardiovasculares/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/efeitos adversos , Hipoglicemia/etiologia , Complicações Pós-Operatórias , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco
17.
Heart Vessels ; 34(2): 318-323, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30132060

RESUMO

We recently reported that preoperative endothelial dysfunction [i.e., reactive hyperemia index (RHI) ≤ 1.64] predicted short-term postoperative adverse events in patients undergoing cardiovascular surgery. However, the relationship between preoperative RHI and long-term cardiovascular risk in these patients is unclear. A total of 195 patients with at least 1-year follow-up who underwent cardiovascular surgery were included. Preoperative endothelial function was assessed by RHI. The primary outcome was a composite of cardiac death, stroke, myocardial infarction, rehospitalization due to heart failure, and any coronary revascularization. Nineteen patients (9.7%) met the primary outcome, including cardiac death (n = 7), stroke (n = 5), heart failure (n = 9), and coronary revascularization (n = 2) during a median follow-up of 20 months. There was no significant difference in the baseline characteristics between patients with RHI ≤ 1.64 (n = 86) and those with RHI > 1.64 (n = 109). The primary outcome occurred in 13 patients with RHI ≤ 1.64 (15.1%) and in 6 patients with RHI > 1.64 (5.5%). Kaplan-Meier analysis demonstrated a significantly higher incidence of the primary outcome in patients with RHI ≤ 1.64 compared to their counterpart (hazard ratio 2.94; 95% confidence interval 1.12-7.75; p = 0.02). Multivariate analysis showed diabetes and RHI ≤ 1.64 as independent predictors for the primary outcome. In conclusion, preoperative endothelial dysfunction assessed by RHI was associated with long-term cardiovascular events in patients undergoing cardiovascular surgery.


Assuntos
Doenças Cardiovasculares/fisiopatologia , Procedimentos Cirúrgicos Cardiovasculares/métodos , Endotélio Vascular/fisiopatologia , Vasodilatação/fisiologia , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Período Pré-Operatório , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Fatores de Tempo
18.
Biomarkers ; 24(3): 268-276, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30512977

RESUMO

Objectives: Soluble suppression of tumorigenicity 2 (sST2) biomarker is an emerging predictor of adverse clinical outcomes, but its prognostic value for in-hospital mortality after coronary artery bypass grafting (CABG) is not well understood. This study measured the association between operative sST2 levels and in-hospital mortality after CABG. Methods: A prospective cohort of 1560 CABG patients were analyzed from the Northern New England Cardiovascular Disease Study Group Biomarker Study. The primary outcome was in-hospital mortality after CABG surgery (n = 32). Results: After risk adjustment, patients in the third tercile of pre-, post- and pre-to-postoperative sST2 values experienced significantly greater odds of in-hospital death compared to patients in the first tercile of sST2 values. The addition of both postoperative and pre-to-postoperative sST2 biomarker significantly improved ability to predict in-hospital mortality status following CABG surgery, compared to using the EuroSCORE II mortality model alone, (c-statistic: 0.83 [95% CI: 0.75, 0.92], p value 0.0213) and (c-statistic: 0.83 [95% CI: 0.75, 0.92], p value 0.0215), respectively. Conclusion: sST2 values are associated with in-hospital mortality after CABG surgery and postoperative and pre-to-post operative sST2 values improve prediction. Our findings suggest that sST2 can be used as a biomarker to identify adult patients at greatest risk of in-hospital death after CABG surgery.


Assuntos
Biomarcadores/sangue , Ponte de Artéria Coronária/mortalidade , Proteína 1 Semelhante a Receptor de Interleucina-1/sangue , Intervenção Coronária Percutânea/mortalidade , Idoso , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/genética , Complicações Pós-Operatórias/patologia , Prognóstico , Fatores de Risco
19.
J Vasc Surg ; 69(6): 1989-1998.e2, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30591292

RESUMO

OBJECTIVE: This review sought to describe the current state of knowledge of the impact of frailty on perioperative clinical outcomes in patients undergoing vascular interventions. METHODS: A scoping review of the literature from both PubMed and Ovid Embase databases was conducted to identify relevant English- and French-language articles published from inception to May 31, 2018. Patients undergoing vascular surgery interventions were included. RESULTS: Twenty-three studies have addressed the prevalence or prognostic impact of frailty in patients undergoing vascular surgery procedures. The prevalence of frailty ranged from 20% to 60%, and notably 14 different frailty assessments were used in these studies. Frailty was associated with increased comorbid status, prolonged length of stay, discharge to assisted living facility, loss of independence, postoperative morbidity, and all-cause mortality. CONCLUSIONS: There are a variety of heterogeneous tools to measure frailty in patients undergoing vascular surgery interventions. The prevalence of frailty varies by the scale used to measure it, as does its predictive value. Clinicians and surgeons should be sensitized to the importance of assessing frailty preoperatively in older adults undergoing vascular surgery and using it to assist in the decision-making process and allocation of surgical resources.


Assuntos
Doenças Cardiovasculares/cirurgia , Fragilidade/epidemiologia , Procedimentos Cirúrgicos Vasculares , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Tomada de Decisão Clínica , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/mortalidade , Avaliação Geriátrica , Nível de Saúde , Humanos , Pessoa de Meia-Idade , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Prevalência , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
20.
Chirurgia (Bucur) ; 114(6): 725-731, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31928577

RESUMO

Introduction: Nowadays, obesity is a major worldwide health problem due to its serious consequences and toits increasing prevalence. Bariatric surgery has demonstrated a sustained weight loss and an efficient long-term control of the co-morbidities associated with obesity. The objective of our study was to compare cardiovascular risk factors before and after bariatric surgery. Material and Method: We have retrospectively studied 59 consecutive patients scheduled for bariatric surgery (gastric sleeve) in Ponderas Academic Hospital between January and March 2016, excluding the ones that didn't commit to respect the follow-up terms. The preoperative, 6 and 12 postoperative months blood tests and anthropometric measurements were comparatively analyzed. Results: BMI, waist circumference and total body weight decreased by 38%, 31%, and 41%; Glycemia, triglycerides and LDL cholesterol decreased by 16%, 37% and 9% respectively; HDL cholesterol increased by 18%. The decline was statistically significant for all variables (P 0.001) except for LDL cholesterol. The need for antihypertensive treatment was reduced by 60% and for lipid lowering treatment diminished by 21%. In diabetic patients glycated hemoglobin (HbA1c) decreased by 28% and the necessity for antidiabetic medical treatment dropped by 69%. Conclusions: Weight loss obtained by bariatric surgery in this study, improved the metabolic syndrome in all its components, obesity, hyperglycemia/type 2 diabetes, hypertension, and dyslipidemia, thus reducing the cardiovascular risk.


Assuntos
Doenças Cardiovasculares/cirurgia , Diabetes Mellitus Tipo 2/cirurgia , Gastrectomia , Obesidade/cirurgia , Índice de Massa Corporal , Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2/complicações , Dislipidemias/etiologia , Dislipidemias/terapia , Humanos , Obesidade/complicações , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
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