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1.
Kyobu Geka ; 73(11): 940-943, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130719

RESUMO

A 42-year-old woman had undergone aortic valve replacement with a 19 mm bioprosthetic valve for aortic stenosis due to a bicuspid valve 8 years before. She was admitted to our hospital for valve re-replacement owing to the prosthetic valve dysfunction. As the patient's valve annulus was markedly thickened owing to pannus formation, we were unable to pass a 19 mm valve sizer through the annulus even after removal of the prosthetic valve and the tissue surrounding the annulus. Valve re-replacement combined with patch enlargement of the aortic annulus was performed to obtain maximally effective orifice area. Her postoperative course was uneventful, and echocardiography revealed no perivalvular leak. In valve re-replacement, it is important to remove the prosthetic valve and the tissue surrounding the annulus to the greatest extent possible and consider patch enlargement of the aortic annulus to avoid patient-prosthesis mismatch in a patient with a small aortic annulus.


Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Adulto , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Feminino , Humanos , Valva Mitral
2.
Kyobu Geka ; 73(11): 950-953, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130722

RESUMO

A 33-year-old man presenting with fever, fatigue, and delirium was diagnosed with infectious endocarditis(IE). He had already undergone surgery for IE twice;initial valve repair 4 years ago and mitral valve replacement(MVR) 1 year later. He has refractory atopic dermatitis, which was considered to be the cause of his repeated IE. Initially, antibiotics were administered but the infection was not controlled. Therefore, we decided to perform the 3rd surgery. MVR was performed, and using bovine pericardium, we covered valve cuff and suture felts to separete these parts from blood stream. Postoperative echocardiography showed good prosthetic valve motion without transvalvular regurgitation or paravalvular leak. He was discharged on the 39th postoperative day and has been doing well for 2 years since.


Assuntos
Endocardite , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral , Adulto , Animais , Bovinos , Endocardite/cirurgia , Humanos , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Pericárdio , Suturas
3.
Kyobu Geka ; 73(10): 744-748, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130759

RESUMO

Severe atherosclerosis of the ascending aorta frequently causes difficulties during heart operations, hindering surgical maneuvers and potentially leading to systemic embolism. There have been several methods to solve these problems but the best way to treat patients requiring aortic valve replacement (AVR) has not been established yet. Surgical techniques for AVR in these patients include AVR under deep hypothermic circulatory arrest with or without endarterectomy of the ascending aorta or replacement of the ascending aorta. Endovascular clamping using a balloon is another approach but require manipulation of the heavily calcified aorta that may result in a certain risk for stroke. Another option to avoid the ascending aorta and cross-clamping is the apico-aortic conduit. Trans-catheter AVR( TAVR),especially trans-apical AVR, has been shown to be feasible in such patients. Large studies and longer follow-up will be required to scientifically prove the superiority of trans-apical AVR over conventional surgical strategies in patients with porcelain aorta requiring AVR.


Assuntos
Doenças da Aorta , Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Aorta/diagnóstico por imagem , Aorta/cirurgia , Doenças da Aorta/complicações , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Humanos
4.
Kyobu Geka ; 73(10): 775-777, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130764

RESUMO

Cardiovascular surgery for renal failure patients with dialysis is challenging. According to the nationwide cardiovascular surgery database in Japan(Japan Cardiovascular Surgery Database;JCVSD), dialysis patients have occupied about 10% of whole surgery of coronary artery bypass grafting( CABG). In CABG, ratio of off-pump surgery did not change between non-dialysis (63%) and dialysis (64%) patients. Operative mortality of dialysis patients (7.8%) was 3 times higher than non-dialysis patients (2.1%). In aortic valve replacement (AVR) dialysis patients occupied about 9% of whole AVR in Japan. In dialysis patients the percentage of bioprostheses was 65% and the choice of bioprostheses steeply increased when the age was over 70, which was similar to the non-dialysis patients. For dialysis before cardiovascular surgery, it is important not to dehydrate too much in order to maintain stable hemodynamics during the surgery. It is also important not to dehydrate too much after surgery in order to prevent non-occlusive mesenteric ischemia(NOMI).


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valva Aórtica , Ponte de Artéria Coronária , Humanos , Japão/epidemiologia , Diálise Renal , Estudos Retrospectivos , Resultado do Tratamento
5.
Kyobu Geka ; 73(10): 778-782, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130765

RESUMO

Arteritis is an inflammatory disease of the vessel walls, resulting in vascular damage and a wide variety of clinical symptoms and multisystem disorders. Because aneurysmal disease, coronary disease, and aortic insufficiency affect patient prognosis, surgical intervention plays an important role. Preoperatively, systemic vessels, cardiac function, and other major organs should be evaluated. Regarding the surgical technique, reinforcement of the anastomosis to the fragile aortic wall is important to prevent pseudoaneurysmal formation and prosthetic valvular detachment. As aortic root replacement, we have been applying the modified Bentall procedure with a "double fixation technique" and obtained desirable outcomes. Although endovascular repair for aneurysmal disease is one of the treatment options, its longterm efficacy remains uncertain. Postoperative control of inflammation with corticosteroids and/or immunosuppressive agents is also important for long-term management. Pseudoaneurysmal formation and prosthetic valvular detachment may occur progressively over a long period of time. To prevent these complications, strict follow-up with imaging and inflammation control should be performed.


Assuntos
Falso Aneurisma , Insuficiência da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Arterite de Takayasu , Aorta/cirurgia , Insuficiência da Valva Aórtica/cirurgia , Humanos , Arterite de Takayasu/complicações , Arterite de Takayasu/diagnóstico por imagem , Arterite de Takayasu/cirurgia
6.
Kardiologiia ; 60(7): 91-97, 2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-33155946

RESUMO

Aim      Evaluation of efficacy and safety of minimally invasive, valve-sparing interventions on the aortic root and a comparative analysis of outcomes versus a group of patients with a complete sternotomy intervention using the method of propensity score matching (PSM).Materials and methods From 2016 through 2019, 458 interventions on the aortic root were performed, including 160 (36.6 %) interventions with mini-sternotomy. The study included 106 patients with the valve-sparing surgery (David procedure). Two groups of 30 patients each were formed using PSMC: group 1, complete sternotomy (CS) and group 2, J-shaped mini-sternotomy (MS). Immediate and long-term outcomes were evaluated at 13.8±10.3 (1-38 months (min-max) in the MS group and 42±21 (1-61 months (min-max) in the CS group.Results Statistically significant differences in death rate, echocardiographic indexes, absence of reoperations and complications in the postoperative period were not observed. In group 2, durations of extracorporeal circulation (p=0.04) and period of myocardial ischemia (p=0.004) were increased. The same group showed decreased intraoperative blood loss (p=0.001), postoperative drainage losses (p=0.0001), extubation time (р=0.0001), duration of stay in resuscitation and intensive care units and in the department of reconstructive recovery cardiovascular surgery (p=0,005).Conclusion      The David procedure with mini-sternotomy is a safe and effective alternative to the traditional approach. This technique significantly reduces the time of rehabilitation and duration of patients' stay in the hospital without significant differences in the long-term period, which suggests advantages of this method. However, despite these promising results, the retrospective nature of this study, a small sample of patients, and a short follow-up period warrant further study.


Assuntos
Implante de Prótese de Valva Cardíaca , Procedimentos Cirúrgicos Minimamente Invasivos , Valva Aórtica/cirurgia , Humanos , Tempo de Internação , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
7.
Herz ; 45(7): 703-714, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33030560

RESUMO

The progress in cardiology during the last 50 years can best be studied by looking at the diagnostics and treatment of patients with aortic valve stenosis. Previously, the clinical examination, electrocardiography (ECG) and chest X­ray were used before heart catheterization, which included a transseptal puncture to complete the indications for surgery in young patients. Nowadays, echocardiography, often combined with a dobutamine stress test, is the primary diagnostic tool to which computed tomography for quantification of valve calcification and cardiac magnetic resonance imaging can be of additive value. The treatment of severe aortic valve stenosis is no longer only treated by aortic valve replacement but transluminal aortic valve implantation also represents a new therapeutic option. The change in the age groups of treated patients is also noteworthy. Surgery is recommended for patients under 75 years old but for older patients, especially those with a high risk, interventional catheter-assisted treatment is preferred.


Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Idoso , Algoritmos , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Cateterismo Cardíaco , Humanos
8.
J Card Surg ; 35(10): 2522-2528, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33043663

RESUMO

BACKGROUND AND AIM: Prosthetic valve thrombosis (PVT) is a rare but life-threatening complication of heart valve replacement. Based on the current guidelines, the treatment of a large number of these patients could be performed through the administration of thrombolytic agents. In the present study, we aim to assess the safety of thrombolytic therapy in patients with PVT who have high international normalized ratio (INR) levels. METHODS: In this study, we retrospectively analyzed outcomes of thrombolytic therapy in 65 PVT patients with different levels of INR at the time of fibrinolysis at a tertiary cardiac center. RESULTS: Mean age of patients was 51.6 ± 12.47 years. The tricuspid valve was the most common site of prosthetic valve thrombosis (64.6%). The Median (range) of INR was 2.1 (0.9-4.9). The majority of patients (50.8%) achieved a complete response following thrombolytic treatment. There were no cases of intracranial hemorrhage. Other major and minor bleedings occurred in 3 (4.6%) and 10 (15.4%) patients, respectively. No embolic stroke and systemic embolism were observed. We found no significant difference in the frequency of major (P-value = .809) and minor (P-value = .483) bleeding as well as response to thrombolytic therapy (P-value = .658) between patients with different levels of INR. Total administered dose of Streptokinase was also similar in PVT patients with or without major (P-value = .467) and minor (P-value = .221) bleeding complications. CONCLUSIONS: We concluded that there was no significant difference between PVT patients presenting with subtherapeutic and high INR levels who received thrombolytic treatments regarding both minor and major bleeding complications as well as response to thrombolysis.


Assuntos
Fibrinolíticos/uso terapêutico , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Coeficiente Internacional Normatizado , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Estreptoquinase/uso terapêutico , Terapia Trombolítica/métodos , Trombose/tratamento farmacológico , Trombose/etiologia , Adulto , Feminino , Fibrinolíticos/efeitos adversos , Doenças das Valvas Cardíacas/cirurgia , Valvas Cardíacas/cirurgia , Hemorragia/etiologia , Humanos , Coeficiente Internacional Normatizado/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Segurança , Estreptoquinase/efeitos adversos , Terapia Trombolítica/efeitos adversos
9.
Asian Cardiovasc Thorac Ann ; 28(7): 381-383, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33023307
10.
Medicine (Baltimore) ; 99(40): e22195, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019394

RESUMO

BACKGROUND: Conflicting data have been reported related to the impact of atrial fibrillation (AF) on outcomes after transcatheter mitral valve repair with MitraClip (MC) implantation. In this study, we assessed the prognosis of MC-treated patients according to the presence of pre-existing AF. METHODS: Randomized and observational studies reporting outcomes of pre-existing AF or sinus rhythm in patients undergoing MC treatment were identified with an electronic search. Outcomes of interest were short-and long-term mortality, stroke, bleeding, rehospitalization, myocardial infarction (MI), cardiogenic shock, acute procedure success, the hospital stay, and the number of Clips implanted. RESULTS: Eight studies (8466 individuals) were eligible. Compared to sinus rhythm, long-term mortality, the risk of bleeding, rehospitalization, and longer hospital stay were significantly higher in AF groups, whereas similar correlations were found in the analysis of other outcomes. CONCLUSION: AF may be related with worse outcomes in patients undergoing MC implantation, including long-term mortality, major bleeding, and rehospitalization. AF should be taken into account when referring a patient for MC treatment.


Assuntos
Fibrilação Atrial/mortalidade , Implante de Prótese de Valva Cardíaca/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Implante de Prótese de Valva Cardíaca/mortalidade , Implante de Prótese de Valva Cardíaca/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Readmissão do Paciente/estatística & dados numéricos
12.
Medicine (Baltimore) ; 99(41): e22584, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031309

RESUMO

NATIONALE: Trichosporon species are widely distributed in nature and are emerging opportunistic human pathogens. Trichosporon infections are associated with superficial cutaneous involvement in immunocompetent individuals to severe systemic disease in immunocompromised patients. Until now, there is no report in infective endocarditis by Trichosporon mucoides confirmed by molecular diagnostics PATIENT CONCERNS:: A 66-year-old man presented with a fever that had occurred for a period of 6 months. He had undergone aortic valve replacement 10 years prior. Transthoracic echocardiography showed vegetations on the prosthetic aortic valve and native mitral valve. T mucoides was detected in the cultures of blood and vegetations. DIAGNOSIS: DNA sequencing using D/D2 region of rRNA and internal transcribed spacer were performed. INTERVENTIONS: Infections were successfully controlled with valve replacement and voriconazole plus liposomal amphotericin B therapy. OUTCOMES: There has been no sign of recurrence for 18-months after treatment completion. LESSONS: This is the first reported case of infective endocarditis due to T mucoides. Clinicians should consider Trichosporon species as causative agents of endocarditis in patients who have undergone cardiac surgery.


Assuntos
Endocardite/microbiologia , Implante de Prótese de Valva Cardíaca , Infecções Relacionadas à Prótese/microbiologia , Trichosporon/isolamento & purificação , Tricosporonose/microbiologia , Idoso , Antifúngicos/uso terapêutico , Terapia Combinada , Endocardite/diagnóstico por imagem , Endocardite/terapia , Humanos , Masculino , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/terapia , Reoperação , Tricosporonose/diagnóstico por imagem , Tricosporonose/terapia
13.
Asian Cardiovasc Thorac Ann ; 28(7): 390-397, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32938206

RESUMO

BACKGROUND: Emergency or urgent surgery is often required in patients with papillary muscle rupture and active mitral valve infective endocarditis. The aim of this study was to analyze the outcomes of patients with active endocarditis who underwent emergency or urgent mitral valve repair. METHODS: From 2005 to 2014, 154 ischemic mitral regurgitation patients and 41 infective endocarditis patients underwent mitral valve repair in our institution; 23 had emergency operations due to papillary muscle rupture, and 18 with active infective endocarditis underwent urgent surgery. RESULTS: Cardiopulmonary bypass time (141.4 ± 43.3 versus 145.3 ± 46.5 min) and crossclamp time (77.7 ± 34.1 versus 79.2 ± 33.0 min) were similar in the papillary muscle rupture and elective ischemic mitral regurgitation subgroups, and major postoperative complications were comparable. Hospital mortality was 17.4% in the papillary muscle rupture subgroup and 8.4% in the elective ischemic mitral regurgitation subgroup. Cardiopulmonary bypass time (103.6 ± 37.0 versus 75.5 ± 20.8 min) and crossclamp time (61.7 ± 21.2 versus 45.3 ± 18.0 min) were significantly longer in infective endocarditis patients. There were no major complications or hospital deaths. Eight years postoperatively, overall survival was 94.4% and 86.5% in the papillary muscle rupture and elective ischemic mitral regurgitation subgroups, respectively (p = 0.730). Overall survival was 100% in both infective endocarditis subgroups. CONCLUSION: The feasibility and effectiveness of emergency or urgent mitral valve repair in patients with papillary muscle rupture and active infective endocarditis are satisfactory. Early and mid-term outcomes are comparable to those of elective operations.


Assuntos
Endocardite/cirurgia , Ruptura Cardíaca/cirurgia , Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Músculos Papilares/cirurgia , Idoso , Procedimentos Cirúrgicos Eletivos , Emergências , Endocardite/diagnóstico por imagem , Endocardite/mortalidade , Endocardite/fisiopatologia , Feminino , Ruptura Cardíaca/diagnóstico por imagem , Ruptura Cardíaca/mortalidade , Ruptura Cardíaca/fisiopatologia , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/mortalidade , Mortalidade Hospitalar , 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 , Anuloplastia da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/fisiopatologia , Duração da Cirurgia , Músculos Papilares/diagnóstico por imagem , Músculos Papilares/fisiopatologia , Complicações Pós-Operatórias/mortalidade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
15.
PLoS One ; 15(9): e0237000, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32946439

RESUMO

Currently, aortic valve replacement is the only treatment capable of relieving left ventricle pressure overload in patients with severe aortic stenosis. It aims to improve cardiac function and revert hypertrophy, by triggering myocardial reverse remodeling. Despite immediately relieving afterload, reverse remodeling turns out to be extremely variable. Among other factors, the extent of reverse remodeling may depend on how well ubiquitin-proteasome system tackle hypertrophy. Therefore, we assessed tagged ubiquitin and ubiquitin ligases in the left ventricle collected from patients undergoing valve replacement and tested their association to the degree of reverse remodeling. Patients were classified according to the regression of left ventricle mass (ΔLVM) and assigned to complete (ΔLVM≥15%) or incomplete (ΔLVM≤5%) reverse remodeling groups. No direct inter-group differences were observed. Nevertheless, correlation analysis supports a fundamental role of the ubiquitin-proteasome system during reverse remodeling. Indeed, total protein ubiquitination was associated to hypertrophic indexes such as interventricular septal thickness (r = 0.55, p = 0.03) and posterior wall thickness (r = 0.65, p = 0.009). No significant correlations were observed for Muscle Ring Finger 3. Surprisingly, though, higher levels of atrogin-1 were associated to postoperative interventricular septal thickness (r = 0.71, p = 0.005). In turn, Muscle Ring Finger 1 correlated negatively with this postoperative hypertrophy marker (r = -0.68, p = 0.005), suggesting a cardioprotective role during reverse remodeling. No significant correlations were found with left ventricle mass regression, although a trend for a negative association between the ligase Murine Double Minute 2 and mass regression (r = -0.44, p = 0.10) was found. Animal studies will be necessary to understand whether this ligase is protective or detrimental. Herein, we show, for the first time, an association between the preoperative myocardial levels of ubiquitin ligases and postoperative hypertrophy, highlighting the therapeutic potential of targeting ubiquitin ligases in incomplete reverse remodeling.


Assuntos
Estenose da Valva Aórtica/enzimologia , Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca , Hipertrofia Ventricular Esquerda/enzimologia , Ubiquitina-Proteína Ligases/metabolismo , Remodelação Ventricular , Idoso , Estenose da Valva Aórtica/cirurgia , Feminino , Humanos , Hipertrofia Ventricular Esquerda/cirurgia , Masculino , Miocárdio/enzimologia , Miocárdio/patologia , Período Pós-Operatório , Período Pré-Operatório
16.
PLoS One ; 15(9): e0238463, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32881919

RESUMO

In a clinical decision support system, the purpose of case-based reasoning is to help clinicians make convenient decisions for diagnoses or interventional gestures. Past experience, which is represented by a case-base of previous patients, is exploited to solve similar current problems using four steps-retrieve, reuse, revise, and retain. The proposed case-based reasoning has been focused on transcatheter aortic valve implantation to respond to clinical issues pertaining vascular access and prosthesis choices. The computation of a relevant similarity measure is an essential processing step employed to obtain a set of retrieved cases from a case-base. A hierarchical similarity measure that is based on a clinical decision tree is proposed to better integrate the clinical knowledge, especially in terms of case representation, case selection and attributes weighting. A case-base of 138 patients is used to evaluate the case-based reasoning performance, and retrieve- and reuse-based criteria have been considered. The sensitivity for the vascular access and the prosthesis choice is found to 0.88 and 0.94, respectively, with the use of the hierarchical similarity measure as opposed to 0.53 and 0.79 for the standard similarity measure. Ninety percent of the suggested solutions are correctly classified for the proposed metric when four cases are retrieved. Using a dedicated similarity measure, with relevant and weighted attributes selected through a clinical decision tree, the set of retrieved cases, and consequently, the decision suggested by the case-based reasoning are substantially improved over state-of-the-art similarity measures.


Assuntos
Valva Aórtica/cirurgia , Substituição da Valva Aórtica Transcateter/métodos , Algoritmos , Valva Aórtica/fisiologia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Sistemas de Apoio a Decisões Clínicas , Próteses Valvulares Cardíacas/tendências , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Seleção de Pacientes , Resolução de Problemas , Desenho de Prótese , Sensibilidade e Especificidade , Resultado do Tratamento
18.
PLoS One ; 15(9): e0238953, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915895

RESUMO

Whether the subtype of atrial fibrillation affects outcomes after transcatheter aortic valve replacement for aortic stenosis is unclear. The nationwide FinnValve registry included 2130 patients who underwent primary after transcatheter aortic valve replacement for aortic stenosis during 2008-2017. Altogether, 281 (13.2%) patients had pre-existing paroxysmal atrial fibrillation, 651 (30.6%) had pre-existing non-paroxysmal atrial fibrillation and 160 (7.5%) were diagnosed with new-onset atrial fibrillation during the index hospitalization. The median follow-up was 2.4 (interquartile range: 1.6-3.8) years. Paroxysmal atrial fibrillation did not affect 30-day or overall mortality (p-values >0.05). Non-paroxysmal atrial fibrillation demonstrated an increased risk of overall mortality (hazard ratio: 1.61, 95% confidence interval: 1.35-1.92; p<0.001), but not 30-day mortality (p = 0.084). New-onset atrial fibrillation demonstrated significantly increased 30-day mortality (hazard ratio: 2.76, 95% confidence interval: 1.25-6.09; p = 0.010) and overall mortality (hazard ratio: 1.68, 95% confidence interval: 1.29-2.19; p<0.001). The incidence of early or late stroke did not differ between atrial fibrillation subtypes (p-values >0.05). In conclusion, non-paroxysmal atrial fibrillation and new-onset atrial fibrillation are associated with increased mortality after transcatheter aortic valve replacement for aortic stenosis, whereas paroxysmal atrial fibrillation has no effect on mortality. These findings suggest that non-paroxysmal atrial fibrillation rather than paroxysmal atrial fibrillation may be associated with structural cardiac damage which is of prognostic significance in patients with aortic stenosis undergoing transcatheter aortic valve replacement.


Assuntos
Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/cirurgia , Fibrilação Atrial/classificação , Fibrilação Atrial/complicações , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/mortalidade , Fibrilação Atrial/mortalidade , Estudos de Coortes , Feminino , Finlândia/epidemiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
20.
Int Heart J ; 61(5): 951-960, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32879260

RESUMO

The aim of this meta-analysis was to compare the clinical outcomes in patients who underwent rapid deployment aortic valve replacement (RDAVR) and conventional bio prosthetic aortic valve replacement (CAVR).We performed a literature search by August 2018. The primary outcomes were hospital and 1-year mortality, and the secondary endpoints included the aortic cross-clamp (ACC), cardiopulmonary bypass (CPB) time, and postoperative and valve-related complications.Two randomized controlled trials and 13 propensity score-matched studies were included. There was no difference between RDAVR and CAVR in hospital mortality (2.5% versus 2.1%; risk ratio (RR) 1.16 [95% confidence interval (CI) 0.80-1.68]) or 1-year mortality (2.9% versus 4.1%; RR 0.69 [95% CI 0.34-1.34]). RDAVR significantly reduced the ACC time ( (mean difference (MD) -24.33 [95% CI -28.35 to -20.32]) and CPB time (MD -21.51 [95% CI -22.83 to -20.20]). The pooled analysis showed that RDAVR doubled the occurrence of permanent pacemaker implantation (8.6% versus 4.3%; RR 2.05 [95% CI 1.62-2.60]). Meanwhile, the blood transfusion amount (MD -1.54 [95% CI -2.22 to -0.86]) and postoperative atrial fibrillation (POAF) occurrence (RR 0.83 [95% CI 0.69-0.99]) was reduced. The difference of paravalvular leakage frequency between RDAVR and CAVR was marginal (RR 1.77 [95% CI 1.00-3.17]; P = 0.05). Furthermore, RDAVR was related to larger valves (MD 0.70 cm [95% CI 0.33-1.07]) and lower mean pressure gradients (MD -1.93 mmHg [95% CI -3.58 to -0.28]).The hospital and 1-year survival rates between RDAVR and CAVR are comparable. RDAVR reduces POAF occurrence and blood transfusion but is associated with a higher occurrence of pacemaker implantation.


Assuntos
Estenose da Valva Aórtica/cirurgia , Bioprótese , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Mortalidade Hospitalar , Desenho de Prótese , Aorta , Ponte Cardiopulmonar , Constrição , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Fatores de Tempo
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