Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.334
Filtrar
1.
Medicine (Baltimore) ; 99(37): e22157, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925775

RESUMO

Endovascular aneurysm repair (EVAR) and thoracic endovascular aortic repair (TEVAR) are effective and minimally invasive treatment options for high-risk surgical candidates. Nevertheless, knowledge about the management of aortic stent graft therapy in chronic kidney disease (CKD) is scarce. This study aimed to examine outcomes after EVAR and TEVAR in patients with CKD.Utilizing data from the Taiwan National Health Insurance Research Database, we retrospectively assessed patients who underwent EVAR and TEVAR therapy between January 1, 2006, and December 31, 2013. Patients were divided into CKD and non-CKD groups. Outcomes were in-hospital mortality, all-cause mortality, readmission, heart failure, and major adverse cardiac and cerebrovascular events.There were 1019 patients in either group after matching. The CKD group had a higher in-hospital mortality rate than the non-CKD group (15.2% vs 8.3%, respectively; odds ratio, 1.92; 95% confidence interval [CI], 1.46-2.54). Patients with CKD had higher risks of all-cause mortality including in-hospital death (46.1% vs 33.1%; hazard ratio [HR], 1.61; 95% CI, 1.35-1.92), readmission rate (62.6% vs 55.0%; subdistribution HR [SHR], 1.61; 95% CI, 1.32-1.69), redo stent (7.8% vs 6.2%; SHR, 1.50; 95% CI, 1.09-2.07), and major adverse cardiac and cerebrovascular events (13.3% vs 8.8%; SHR, 1.50; 95% CI, 1.15-1.95). The subgroup analysis did not demonstrate a variation in mortality between the TEVAR and EVAR cohorts (P for interaction = .725). The dialysis group had higher risks of all-cause mortality and readmission than the CKD without dialysis and non-CKD groups.Among EVAR/TEVAR recipients, CKD was independently associated with higher in-hospital mortality, postoperative complication, and all-cause mortality rates. Patients with end-stage renal disease on dialysis had worse outcomes than those in the CKD non-dialysis and non-CKD groups.


Assuntos
Aneurisma Aórtico/epidemiologia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/métodos , Insuficiência Renal Crônica/epidemiologia , Fatores Etários , Idoso , Aneurisma , Aorta Abdominal/cirurgia , Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Doenças Cardiovasculares/epidemiologia , Comorbidade , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/métodos , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente , Fatores Sexuais , Medicina Estatal , Taiwan
2.
Ann Ital Chir ; 91: 273-276, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877380

RESUMO

CASE REPORT: A 64-year-old woman presented to our emergency department during the outbreak of the covid-19 emergency in Italy with syncope, anosmia, mild dyspnoea and atypical chest and dorsal pain. A chest CT scan showed an acute type B aortic dissection (ATBAD) and bilateral lung involvement with ground-glass opacity, compatible with interstitial pneumonia. Nasopharyngeal swabs resulted positive for SARS-CoV-2. For the persistence of chest pain, despite the analgesic therapy, we decided to treat her with a TEVAR. Patient's chest and back pain resolved during the first few days after the procedure. No surgical or respiratory complications occurred and the patient was discharged 14 days after surgery. DISCUSSION: By performing the operation under local anesthesia, it was possible to limit both the staff inside the operatory room and droplet/aerosol release. Since we had to perform the operation in a hemodynamics room, thanks to the limited extension of the endoprosthesis and the good caliber of the right vertebral artery we were able to reduce the risk of spinal cord ischemia despite the lack of a revascularization of the left subclavian artery. CONCLUSIONS: A minimally invasive total endovascular approach allows, through local anesthesia and percutaneous access, to avoid surgical cut down and orotracheal intubation. This, combined with a defined management protocol for infected patients, seems to be a reasonable way to perform endovascular aortic procedures in urgent setting, even in a SARSCoV- 2 positive patient. KEY WORDS: COVID-19, Dissection, TEVAR.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Betacoronavirus/isolamento & purificação , Implante de Prótese Vascular/métodos , Infecções por Coronavirus/prevenção & controle , Procedimentos Endovasculares/métodos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Anestesia Local , Aneurisma Dissecante/complicações , Antibioticoprofilaxia , Anticoagulantes/uso terapêutico , Antivirais/uso terapêutico , Aneurisma da Aorta Torácica/complicações , Contraindicações de Procedimentos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/transmissão , Darunavir/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Quimioterapia Combinada , Enoxaparina/uso terapêutico , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Complicações Intraoperatórias/prevenção & controle , Intubação Intratraqueal/efeitos adversos , Pessoa de Meia-Idade , Nasofaringe/virologia , Salas Cirúrgicas , Isolamento de Pacientes , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/transmissão , Ritonavir/uso terapêutico , Isquemia do Cordão Espinal/prevenção & controle , Artéria Vertebral/cirurgia
3.
J Card Surg ; 35(8): 1840-1847, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32643831

RESUMO

BACKGROUND: Porcine aortic roots (PAR) have been reported in the literature with acceptable short- and long-term outcomes for the treatment of aortic root aneurysms. However, their efficacy in type A aortic dissection (TAAD) is yet to be defined. METHODS: Using data from a locally collated aortic dissection registry, we compared the outcomes in patients undergoing aortic root replacement for TAAD using either of two surgical options: (a) PAR or (b) composite valve grafts (CVG). A retrospective analysis was conducted for all procedures in the period from 2005 to 2018. RESULTS: A total of 252 patients underwent procedures for TAAD in the time period. Sixty-five patients had aortic root replacements (PAR n = 30, CVG n = 35). Between-group comparisons identified a younger CVG group (50.5 vs 64.5, P < .05) although all other covariates were comparable. Operative parameters were comparable between the two groups. The use of PAR did not significantly impact operative mortality (odds ratio [OR], 0.93; 95% confidence interval [CI], 0.22-3.61; P = .992), stroke (OR, 2.91, 0.25-34.09, P = .395), reoperation (OR, 0.91; 95% CI, 0.22-3.62; P = .882) or length of stay (coeff 2.33, -8.23 to 12.90; P = .659) compared to CVG. Five-year survival was similar between both groups (PAR 59% vs CVG 69%; P = .153) and reoperation was negligible. Echocardiography revealed significantly lower aortic valve gradients in the PAR group (8.69 vs 15.45mm Hg; P < .0001), and smaller left ventricular dimensions both at 6-week and 1-year follow-up (P < .05). CONCLUSIONS: This study highlights the comparable short- and midterm outcomes of PAR in cases of TAAD, in comparison to established therapy.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Implante de Prótese de Valva Cardíaca/métodos , Animais , Humanos , Estudos Retrospectivos , Suínos , Fatores de Tempo , Resultado do Tratamento
4.
PLoS One ; 15(6): e0235168, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32579611

RESUMO

OBJECTIVE: There is an increasing need for small diameter vascular grafts with superior host hemo- and cytocompatibilities, such as low activation of platelets and leukocytes. Therefore, we aimed to investigate whether the preparation of bacterial nanocellulose grafts with different inner surfaces has an impact on in vitro host cytocompatibility. METHODS: We have synthesized five different grafts in a bioreactor, namely open interface surface (OIS), inverted (INV), partially air dried (PAD), surface formed in air contact (SAC) and standard (STD) that were characterized by a different surface roughness. The grafts (length 55 mm, inner diameter 5 mm) were attached to heparinized polyvinyl chloride tubes, loaded with human blood and rotated at 37°C for 4 hours. Then, blood was analyzed for frequencies of cellular fractions, oxidative products, soluble complement and thrombin factors. The results were compared to clinically approved grafts made of polyethylene terephthalate and expanded polytetrafluoroethylene. Additionally, blood platelets were labelled with 111Indium-oxine to visualize the distribution of adherent platelets in the loop by scintigraphy. RESULTS: SAC nanocellulose grafts with the lowest surface roughness exhibited superior performance with <10% leukocyte and <50% thrombocyte loss in contrast to other grafts that exhibited >65% leukocyte and >90% thrombocyte loss. Of note, SAC nanocellulose grafts showed lowest radioactivity with scintigraphy analyses, indicating reduced platelet adhesion. Although the levels of reactive oxygen species and cell free DNA did not differ significantly, the levels of thrombin-antithrombin complexes were lowest in SAC grafts. However, all nanocellulose grafts exhibited enhanced complement activation. CONCLUSION: The systematic variation of the inner surfaces of BNC vascular grafts significantly improves biocompatibility. Especially, SAC grafts exhibited the lowest loss of platelets as well as leukocytes and additionally significantly diminished activation of the coagulation system. Further animal studies are needed to study in vivo biocompatibilities.


Assuntos
Materiais Biocompatíveis/química , Prótese Vascular , Celulose/química , Polissacarídeos Bacterianos/química , Grau de Desobstrução Vascular/fisiologia , Animais , Coagulação Sanguínea/efeitos dos fármacos , Implante de Prótese Vascular/métodos , Celulose/ultraestrutura , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/prevenção & controle , Heparina/farmacologia , Humanos , Teste de Materiais/métodos , Microscopia Eletrônica de Varredura , Adesividade Plaquetária/fisiologia , Polietilenotereftalatos/química , Politetrafluoretileno/química , Propriedades de Superfície , Grau de Desobstrução Vascular/efeitos dos fármacos
5.
J Card Surg ; 35(7): 1736-1739, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32497341

RESUMO

The impact of the coronavirus disease 2019 (COVID-19) pandemic in New York City (NYC) is dramatic. COVID-19 cases surged, hospitals expanded to meet capacity, and NYC remains the global epicenter of this pandemic. During this unprecedented time, a young woman with known Marfan syndrome presented with an acute complicated type B aortic dissection to our Aortic Center. Using the provisional extension to induce a complete attachment technique, we treated this patient and quickly discharged her the next day to decrease the risk of COVID-19 infection. Her progress was monitored using frequent phone calls and one office visit at two weeks.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Infecções por Coronavirus/epidemiologia , Procedimentos Endovasculares/métodos , Pneumonia Viral/epidemiologia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Doença Aguda , Adulto , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/etiologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/etiologia , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Infecções por Coronavirus/diagnóstico , Infecção Hospitalar/prevenção & controle , Feminino , Seguimentos , Humanos , Tempo de Internação , Angiografia por Ressonância Magnética/métodos , Síndrome de Marfan/complicações , Síndrome de Marfan/diagnóstico , Cidade de Nova Iorque , Pandemias , Pneumonia Viral/diagnóstico , Índice de Gravidade de Doença , Resultado do Tratamento
6.
J Card Surg ; 35(7): 1714-1716, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32557775

RESUMO

OBJECTIVE: This study highlights the management strategy in simultaneous bicuspid aortic valve infective endocarditis and mycotic pseudoaneurysm of an aortic coarctation. METHODS: A staged repair of mycotic pseudoaneurysm of aortic coarctation and infective bicuspid aortic valve endocarditis. RESULTS: We present a 19-year old gentleman who was admitted with aching pain in his bilateral lower extremities with associated purpuric rash and fevers. Work-up was significant for severe aortic valve regurgitation and a pseudoaneurysm in the distal aortic arch. He underwent operative repair through a left posterior-lateral thoracotomy with femoral-femoral partial cardiopulmonary bypass. Intraoperative findings were significant for a juxta-ductal coarctation and pseudoaneurysm. The mycotic pseudoaneurysm and remnant ligamentum arteriosum were completely resected and were replaced with a 18 mm Gelweave graft (Terumo Cardiovascular Group, Ann Arbor, MI) from the distal arch to the descending thoracic aorta. The patient underwent a planned secondary washout and omental flap for biologic coverage of the graft. Subsequently, a staged aortic valve replacement was completed 1 week later. The patient's postoperative course was uncomplicated, and he was discharged with intact motor and sensory function. CONCLUSIONS: A staged approach is a prudent strategy to manage a patient with simultaneous endocarditis and aortic mycotic pseudoaneurysm, with precedence toward the most critical lesion.


Assuntos
Falso Aneurisma/cirurgia , Coartação Aórtica/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Endocardite/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Falso Aneurisma/complicações , Coartação Aórtica/complicações , Ponte Cardiopulmonar , Endocardite/complicações , Humanos , Masculino , Reoperação , Retalhos Cirúrgicos , Toracotomia , Resultado do Tratamento , Adulto Jovem
8.
J Cardiothorac Surg ; 15(1): 120, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32471445

RESUMO

BACKGROUND: Thoracic aortic graft infection (TAGI) is a rare and serious complication after surgery for which the treatment is controversial and challenging. Rather than following the traditional surgical strategy of graft replacement and extensive debridement, we have chosen to preserve the graft and cover it by a laparoscopic omental flap. In this article, we describe the clinical manifestation, diagnostic modalities, and treatment of this disease and analyze the role of laparoscopic omental flaps in its treatment. CASE PRESENTATION: We present two cases of thoracic aortic graft infections that had undergone surgical graft replacement for acute Stanford type A dissection. Their clinical manifestation of infection was atypical, with computed tomography suggesting infection of the grafts. Both patients were successfully treated with debridement, laparoscopic omental transposition, and antibiotics. The first case, a 55-year-old male, was found to have an infection at the aortic arch. The second case is a 52-year-old male who was found to have infection at the ascending aorta and arch. Surprisingly, both intraoperative cultures were negative. The infections were brought under control and the patients recovered steadily after surgery. Early follow-up results showed no signs of graft infection. CONCLUSION: These findings suggest that graft replacement for the treatment of TAGI is not always necessary in selected patients. Conservative surgical treatment, including laparoscopic omental transposition, is effective and less invasive for treating TAGI.


Assuntos
Aorta Torácica , Prótese Vascular , Omento/cirurgia , Retalhos Cirúrgicos , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Infecção da Ferida Cirúrgica/cirurgia
9.
J Card Surg ; 35(7): 1683-1686, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32390157

RESUMO

BACKGROUND AND AIM: A 73-year-old female patient had right coronary button stenosis following aortic root replacement. METHODS: Myocardial ischemia led to hemodynamic instability followed by cardiogenic shock, which was successfully managed using venoarterial extracorporeal membrane oxygenation-supported right coronary button angioplasty. RESULTS AND CONCLUSION: Although the incidence of such complications is low, it is a life-threatening event that requires prompt diagnosis and it may pose a challenging clinical scenario for the treating team.


Assuntos
Angioplastia , Aorta/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Estenose Coronária/cirurgia , Oxigenação por Membrana Extracorpórea/métodos , Complicações Pós-Operatórias/cirurgia , Idoso , Diagnóstico Precoce , Feminino , Humanos , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/cirurgia , Intervenção Coronária Percutânea , Complicações Pós-Operatórias/diagnóstico , Reoperação , Resultado do Tratamento
10.
J Card Surg ; 35(7): 1694-1696, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32419257

RESUMO

A 58-year-old male patient presented with acute type A aortic dissection. Complete arch and ascending aorta replacement were performed using a Thoraflex Hybrid prosthesis. The left subclavian artery was ligated and the remaining supra-aortic trunks were reimplanted using the branches of the prosthesis. After an uneventful early postoperative period, sudden onset of hypotension and bradycardia occurred, with severe vasoplegia, requiring vasopressors. Ischemia of the upper left limb and compartment syndrome ensued, leading to left carotid subclavian bypass. After discontinuation of sedation, tetraplegia was noted due to spinal cord ischemia from C3 to C7.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aorta/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular , Complicações Pós-Operatórias/etiologia , Quadriplegia/etiologia , Vértebras Cervicais , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia do Cordão Espinal/etiologia , Artéria Subclávia/cirurgia
12.
J Cardiovasc Surg (Torino) ; 61(4): 402-415, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32337939

RESUMO

This article reviews endovascular management of chronic post-dissection aneurysms of the aortic arch. Therapeutic strategies intended for this complex aortic condition are evolving rapidly to allow the treatment of various hostile aortic anatomy and frail patients. Principles, technical considerations, devices and outcomes of each technique are reviewed and summarized. Hybrid repair offer similar early mortality and stroke rates compared to open conventional surgery. Arch chimney and other parallel graft techniques present poor long term outcome, and should be limited to emergency situations where no other option is available. Fenestrated stent-grafting is subjected to many technical challenges in aortic arch due to difficulties in stent-graft orientation and fenestration positioning. In situ fenestration is an off-label technique that should only be used as an emergency bailout maneuver, considering that temporary coverage of supra aortic trunk vessel and its long-term durability raise concern. Finally, in experienced hands and appropriate anatomic conditions, arch branched graft technology has shown itself to be a safe and effective alternative to open conventional surgery. No randomized controlled trials have yet compared total endovascular aortic arch repair with hybrid techniques and open arch repair. The management of chronic post-dissection aneurysms of the aortic arch is challenging, decision-making and interventions should continue to be performed in high-volume centers with a dedicated aortic team with an expertise in both open and endovascular repairs.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular , Procedimentos Endovasculares , Doença Crônica , Humanos
13.
J Cardiovasc Surg (Torino) ; 61(4): 385-391, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32337942

RESUMO

Aortic dissection is a complex pathology that carries significant morbidity and mortality if not treated in a timely fashion. While the open repair remains the gold standard treatment for patients with acute type A dissection, ascending aortic replacement is associated with high incidence of arch and descending thoracic aorta residual false lumen patency and aneurysmal degeneration. Multiple approaches have been used over the decades to address aneurysmal degeneration in the arch and thoracoabdominal aorta. This article summarizes anatomical requirements for total endovascular repair of aortic arch and TAAAs using fenestrated and branched endografts.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/anatomia & histologia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular , Procedimentos Endovasculares , Humanos
14.
Ann Thorac Surg ; 110(2): 664-669, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32278750

RESUMO

PURPOSE: This report describes first-in-human experiences and early results of gutter-free chimney stent graft implantation for aortic arch pathologies. DESCRIPTION: The gutter-free chimney stent graft consists of an inner stent and an outer skirt fabric to form an integrated structure. The inner and outer layers are nickel-titanium self-expanding skeletal structures with double polytetrafluoroethylene coating. The outer skirt fabric fits the gutter to prevent endoleak, and the proximal inner stent has a larger radial force to ensure the blood flow. All these designs have the advantages to overcome the native defects of current chimney techniques. EVALUATION: We reported 2 patients who were diagnosed as having aortic arch pathologies and received the gutter-free chimney stent graft implantation during thoracic endovascular aortic repair. In all patients, aortic arch lesions were covered, and supraaortic branches were patent without complications after thoracic endovascular aortic repair and during the 17 months of follow-up. CONCLUSIONS: Novel gutter-free chimney stent graft may be safely and effectively utilized for endovascular repair in aortic arch pathologies. Long-term durability should be confirmed by larger studies and ongoing research.


Assuntos
Aorta Torácica/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/métodos , Prótese Vascular , Procedimentos Endovasculares/métodos , Stents , Aorta Torácica/diagnóstico por imagem , Doenças da Aorta/diagnóstico , Aortografia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Resultado do Tratamento
18.
J Card Surg ; 35(5): 1110-1111, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32293043

RESUMO

We describe a case of a patient with acute aortic syndrome referred to an emergent surgery. Aortic dissection presented with all-in-one imaging and pathologic entities: aortic dissection with intimal flap and true/false lumen, intramural hematoma and penetrating aortic ulcer. Usually, only one of these entities is present in a single patient, but it is possible that one entity evolve into or coexist with another. Extended hemiarch replacement was performed and the patient was discharged in a good condition.


Assuntos
Aneurisma Dissecante/cirurgia , Doenças da Aorta/cirurgia , Implante de Prótese Vascular/métodos , Hematoma/cirurgia , Úlcera/cirurgia , Idoso , Aneurisma Dissecante/diagnóstico por imagem , Aorta/diagnóstico por imagem , Aorta/cirurgia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Doenças da Aorta/diagnóstico por imagem , Emergências , Feminino , Humanos , Síndrome , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Úlcera/diagnóstico por imagem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA