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1.
Angiol Sosud Khir ; 26(4): 168-174, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33332320

RESUMO

Surgical policy in treatment of patients suffering from concomitant valvular pathology and ischaemic heart disease is an extremely important problem of contemporary cardiac surgery. With the advent of advanced techniques and due to the improvement of old ones, there have over the last decades appeared new approaches to treatment of this cohort of patients. Presented in the article is a review of current publications regarding the problem of surgical treatment of patients with a combination of pronounced valvular pathology requiring surgical correction and ischaemic heart disease necessitating the need for myocardial revascularization. This is followed by providing the data concerning contemporary strategies of treatment of patients with concomitant pathology, as well as the comparison of various approaches and the effect of the chosen technique on the outcome.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Doença da Artéria Coronariana , Implante de Prótese de Valva Cardíaca , Isquemia Miocárdica , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Estudos de Coortes , Doença da Artéria Coronariana/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/cirurgia
2.
Asian Cardiovasc Thorac Ann ; 28(9): 633-637, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32870026

RESUMO

Optimal treatment for patients with ischemic heart disease and severe left ventricular dysfunction is a debatable subject in the literature. The largest and only trial on the subject so far is the Surgical Treatment for Ischemic Heart Failure trial. This trial compared coronary artery bypass grafting with optimal medical treatment in one arm versus coronary artery bypass grafting with surgical ventricular restoration in the second arm. Recently, the 10-year follow-up data of various subsets of the trial have been published. This study reviews various pertinent clinical issues related to the trial and its sub-studies and their relevance in routine modern-day clinical practice.


Assuntos
Ponte de Artéria Coronária , Insuficiência Cardíaca/cirurgia , Isquemia Miocárdica/cirurgia , Ensaios Clínicos Controlados Aleatórios como Assunto , Disfunção Ventricular Esquerda/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda
3.
J Interv Cardiol ; 2020: 8179849, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32684867

RESUMO

Background: Although drug-eluting stents (DES) have reduced the rates of in-stent restenosis (ISR) compared with bare-metal stents (BMS), DES related ISR (DES-ISR) still occurs and outcomes of DES-ISR remain unclear. The objective of this meta-analysis was to investigate the long-term clinical outcomes of patients with DES-ISR compared with patients with BMS related ISR (BMS-ISR) after the treatment of DES or drug-eluting balloon (DEB). Methods and results. We searched the literature in the main electronic databases including PUBMED, EMBASE, Cochrane Library, and Web of Science. The primary endpoints were target lesion revascularization (TLR) and target vessel revascularization (TVR). The secondary endpoints included all cause death (ACD), cardiac death (CD), myocardial infarction (MI), stent thrombosis or re-in-stent restenosis (ST/RE-ISR), and major adverse cardiovascular events (MACEs). A total of 19 studies with 6256 participants were finally included in this meta-analysis. Results showed that the rates of TLR (P < 0.00001), TVR (P < 0.00001), CD (P=0.02), ST/RE-ISR (P < 0.00001), and MACEs (P < 0.00001) were significantly higher in the DES-ISR group than in the BMS-ISR group. No significant differences were found between the two groups in the rates of MI (P=0.05) and ACD (P=0.21). Conclusions: Our study demonstrated that patients with DES-ISR had worse clinical outcomes at the long-term follow-up than patients with BMS-ISR after the treatment of DES or DEB, suggesting that DES and DEB may be more effective for BMS-ISR than that for DES-ISR. Positive prevention of DES-ISR is indispensable and further studies concentrating on detecting the predictors of outcomes of DES-ISR are required.


Assuntos
Reestenose Coronária/cirurgia , Stents Farmacológicos/efeitos adversos , Isquemia Miocárdica , Revascularização Miocárdica , Stents , Pesquisa Comparativa da Efetividade , Humanos , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/cirurgia , Revascularização Miocárdica/efeitos adversos , Revascularização Miocárdica/instrumentação , Revascularização Miocárdica/métodos , Stents/efeitos adversos , Stents/classificação
5.
J Surg Res ; 253: 173-184, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32361612

RESUMO

BACKGROUND: Heart chymase rather than angiotensin (Ang)-converting enzyme has higher specificity for Ang I conversion into Ang II in humans. A new pathway for direct cardiac Ang II generation has been revealed through the demonstration that Ang-(1-12) is cleaved by chymase to generate Ang II directly. Herein, we address whether Ang-(1-12), chymase messenger RNA (mRNA), and activity levels can be differentiated in human atrial tissue from normal and diseased hearts and if these measures associate with various pathologic heart conditions. MATERIALS AND METHODS: Atrial appendages were collected from 11 nonfailing donor hearts and 111 patients undergoing heart surgery for the correction of valvular heart disease, resistant atrial fibrillation, or ischemic heart disease. Chymase mRNA was analyzed by real-time polymerase chain reaction and enzymatic activity by high-performance liquid chromatography using Ang-(1-12) as the substrate. Ang-(1-12) levels were determined by immunohistochemical staining. RESULTS: Chymase gene transcripts, chymase activity, and immunoreactive Ang-(1-12) expression levels were higher in left atrial tissue compared with right atrial tissue, irrespective of cardiac disease. In addition, left atrial chymase mRNA expression was significantly higher in stroke versus nonstroke patients and in cardiac surgery patients who had a history of postoperative atrial fibrillation versus nonatrial fibrillation. Correlation analysis showed that left atrial chymase mRNA was positively related to left atrial enlargement, as determined by echocardiography. CONCLUSIONS: As Ang-(1-12) expression and chymase gene transcripts and enzymatic activity levels were positively linked to left atrial size in patients with left ventricular heart disease, an important alternate Ang II forming pathway, via Ang-(1-12) and chymase, in maladaptive atrial and ventricular remodeling in humans is uncovered.


Assuntos
Angiotensinogênio/metabolismo , Fibrilação Atrial/epidemiologia , Quimases/metabolismo , Átrios do Coração/patologia , Fragmentos de Peptídeos/metabolismo , Acidente Vascular Cerebral/epidemiologia , Idoso , Angiotensinogênio/análise , Animais , Fibrilação Atrial/patologia , Fibrilação Atrial/fisiopatologia , Fibrilação Atrial/cirurgia , Quimases/análise , Quimases/genética , Ecocardiografia , Feminino , Perfilação da Expressão Gênica , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Átrios do Coração/cirurgia , Doenças das Valvas Cardíacas/patologia , Doenças das Valvas Cardíacas/cirurgia , Ventrículos do Coração/fisiopatologia , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/patologia , Isquemia Miocárdica/cirurgia , Fragmentos de Peptídeos/análise , RNA Mensageiro/isolamento & purificação , RNA Mensageiro/metabolismo , Remodelação Ventricular
6.
JAAPA ; 33(6): 18-22, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32384294

RESUMO

A major outcome of cardiology research over the last 2 decades is the finding that intensive medical management of patients with stable ischemic heart disease is as effective as revascularization procedures in preventing cardiac events and death. This finding has generated management guidelines that often are overlooked because of misplaced enthusiasm for revascularization procedures.


Assuntos
Isquemia Miocárdica/cirurgia , Isquemia Miocárdica/terapia , Intervenção Coronária Percutânea/métodos , Guias de Prática Clínica como Assunto , Cateterismo Cardíaco , Hemorragia , Humanos , Isquemia Miocárdica/diagnóstico , Intervenção Coronária Percutânea/efeitos adversos , Risco , Medição de Risco , Stents , Procedimentos Desnecessários
7.
Zhonghua Yi Xue Za Zhi ; 100(18): 1376-1379, 2020 May 12.
Artigo em Chinês | MEDLINE | ID: mdl-32392986

RESUMO

Objective: To evaluate the efficacy of coronary artery bypass grafting (CABG) surgery in left ventricular dysfunction patients complicated with different degrees of ischemic mitral regurgitation (IMR). Methods: The clinical data of 525 patients (428 males and 97 females) undergoing CABG in Fuwai Hospital Chinese Academy of Medical Sciences Shenzhen, and Tianjin Medical University General Hospital between January 2015 and December 2018 were collected. The average age was (61±7) years old. Among them, the patients with moderate to serve IMR and left ventricular ejection fraction(LVEF)≤40% were further selected, and the outcomes of CABG were analyzed. Results: In total, 67 patients (48 males and 19 females) with moderate to severe IMR and LVEF≤40% were enrolled, among which 52 patients had moderate IMR, with a LVEF of 38%(35%, 40%). Transesophageal echocardiography (TEE) of 52 cases displayed no damage of papillary muscles, and ventricular wall motion was improved after CABG. Therefore, no treatment on the mitral valve was performed in this group. Six patients were with moderate-severe mitral insufficiency, with a LVEF of 38%(35%, 39%). After surgery, TEE found that the ventricular wall motion and regurgitation were improved, and the mitral valve structures were well. Thus, mitral valves were not treated in these patients. Nine patients were with severe mitral regurgitation, with a LVEF of 38%(35%, 39%). Two of them received valve repair because the papillary muscle function and the ring were well. Another 7 patients received valve replacements because the valve ring was dilatated and the leaflet was prolapsed. All patients recovered well. The LVEF increased significantly at 6 months after surgery [47%(45%, 48%) vs 38%(35%, 39%), P=0.024], and the left ventricular end diastolic diameter also became smaller [57(56, 59) mm vs 61(59, 64) mm, P=0.002]. Conclusions: For patients suffered from left ventricular dysfunction complicated with IMR, TEE is crucial to evaluate the valve function. To those with moderate-severe regurgitation, if papillary muscle function and the ring were seriously affected by ischemia, the valve replacement could facilitate the improvement of postoperative cardiac function.


Assuntos
Insuficiência da Valva Mitral , Isquemia Miocárdica , Disfunção Ventricular Esquerda , Idoso , Ponte de Artéria Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/cirurgia , Isquemia Miocárdica/cirurgia , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
8.
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
9.
Arch Med Res ; 51(5): 406-412, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32376040

RESUMO

BACKGROUND: PCI is an expensive procedure in our population and it implies a huge cost for the institutions and National Health Service. AIM OF THE STUDY: The main objective was to evaluate the technical and biological success of two stents designed in Mexico. METHODS: Ten York pigs, 4-6 months of age, underwent implantation of the bare metal INC-01 (10 stents) and INC-02 (6 stents) coronary stent in addition to a conventional commercial stent (10 stents). Technical success was evaluated immediately with angiography and Intravascular Ultrasound IVUS, continued by a mean follow-up of 4 month and a final angiographic, IVUS and histological evaluation. RESULTS: Initial technical success, angiography and IVUS between the three stents were not significant. One stent presented restenosis in follow-up (commercial stent), but all other stents presented excellent clinical outcome, satisfactory angiographic and IVUS results. Inflammation, proliferation and endothelialization between the stents had no major differences in histological analysis in a mean of 4 months follow-up. CONCLUSIONS: In this pig model, the INC 01 and INC 02 stents showed the same delivering technical success, angiographic and IVUS features, biological and histological response compared to commercial last generation stents.


Assuntos
Isquemia Miocárdica/cirurgia , Intervenção Coronária Percutânea/métodos , Stents/normas , Animais , Humanos , Metais , Pessoa de Meia-Idade , Suínos , Resultado do Tratamento
10.
N Engl J Med ; 382(17): 1619-1628, 2020 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-32227754

RESUMO

BACKGROUND: In the ISCHEMIA-CKD trial, the primary analysis showed no significant difference in the risk of death or myocardial infarction with initial angiography and revascularization plus guideline-based medical therapy (invasive strategy) as compared with guideline-based medical therapy alone (conservative strategy) in participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease (an estimated glomerular filtration rate of <30 ml per minute per 1.73 m2 or receipt of dialysis). A secondary objective of the trial was to assess angina-related health status. METHODS: We assessed health status with the Seattle Angina Questionnaire (SAQ) before randomization and at 1.5, 3, and 6 months and every 6 months thereafter. The primary outcome of this analysis was the SAQ Summary score (ranging from 0 to 100, with higher scores indicating less frequent angina and better function and quality of life). Mixed-effects cumulative probability models within a Bayesian framework were used to estimate the treatment effect with the invasive strategy. RESULTS: Health status was assessed in 705 of 777 participants. Nearly half the participants (49%) had had no angina during the month before randomization. At 3 months, the estimated mean difference between the invasive-strategy group and the conservative-strategy group in the SAQ Summary score was 2.1 points (95% credible interval, -0.4 to 4.6), a result that favored the invasive strategy. The mean difference in score at 3 months was largest among participants with daily or weekly angina at baseline (10.1 points; 95% credible interval, 0.0 to 19.9), smaller among those with monthly angina at baseline (2.2 points; 95% credible interval, -2.0 to 6.2), and nearly absent among those without angina at baseline (0.6 points; 95% credible interval, -1.9 to 3.3). By 6 months, the between-group difference in the overall trial population was attenuated (0.5 points; 95% credible interval, -2.2 to 3.4). CONCLUSIONS: Participants with stable ischemic heart disease, moderate or severe ischemia, and advanced chronic kidney disease did not have substantial or sustained benefits with regard to angina-related health status with an initially invasive strategy as compared with a conservative strategy. (Funded by the National Heart, Lung, and Blood Institute; ISCHEMIA-CKD ClinicalTrials.gov number, NCT01985360.).


Assuntos
Angiografia Coronária , Ponte de Artéria Coronária , Nível de Saúde , Isquemia Miocárdica/tratamento farmacológico , Isquemia Miocárdica/cirurgia , Intervenção Coronária Percutânea , Insuficiência Renal Crônica/complicações , Idoso , Teste de Esforço , Feminino , Seguimentos , Estilo de Vida Saudável , Humanos , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/mortalidade , Razão de Chances , Modelos de Riscos Proporcionais , Inquéritos e Questionários
11.
N Engl J Med ; 382(17): 1608-1618, 2020 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-32227756

RESUMO

BACKGROUND: Clinical trials that have assessed the effect of revascularization in patients with stable coronary disease have routinely excluded those with advanced chronic kidney disease. METHODS: We randomly assigned 777 patients with advanced kidney disease and moderate or severe ischemia on stress testing to be treated with an initial invasive strategy consisting of coronary angiography and revascularization (if appropriate) added to medical therapy or an initial conservative strategy consisting of medical therapy alone and angiography reserved for those in whom medical therapy had failed. The primary outcome was a composite of death or nonfatal myocardial infarction. A key secondary outcome was a composite of death, nonfatal myocardial infarction, or hospitalization for unstable angina, heart failure, or resuscitated cardiac arrest. RESULTS: At a median follow-up of 2.2 years, a primary outcome event had occurred in 123 patients in the invasive-strategy group and in 129 patients in the conservative-strategy group (estimated 3-year event rate, 36.4% vs. 36.7%; adjusted hazard ratio, 1.01; 95% confidence interval [CI], 0.79 to 1.29; P = 0.95). Results for the key secondary outcome were similar (38.5% vs. 39.7%; hazard ratio, 1.01; 95% CI, 0.79 to 1.29). The invasive strategy was associated with a higher incidence of stroke than the conservative strategy (hazard ratio, 3.76; 95% CI, 1.52 to 9.32; P = 0.004) and with a higher incidence of death or initiation of dialysis (hazard ratio, 1.48; 95% CI, 1.04 to 2.11; P = 0.03). CONCLUSIONS: Among patients with stable coronary disease, advanced chronic kidney disease, and moderate or severe ischemia, we did not find evidence that an initial invasive strategy, as compared with an initial conservative strategy, reduced the risk of death or nonfatal myocardial infarction. (Funded by the National Heart, Lung, and Blood Institute and others; ISCHEMIA-CKD ClinicalTrials.gov number, NCT01985360.).


Assuntos
Angiografia Coronária , Ponte de Artéria Coronária , Isquemia Miocárdica/tratamento farmacológico , Isquemia Miocárdica/cirurgia , Intervenção Coronária Percutânea , Insuficiência Renal Crônica/complicações , Antagonistas Adrenérgicos beta/uso terapêutico , Idoso , Bloqueadores dos Canais de Cálcio/uso terapêutico , Teste de Esforço , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/prevenção & controle , Isquemia Miocárdica/complicações , Isquemia Miocárdica/mortalidade , Fatores de Risco
13.
JAMA Netw Open ; 3(4): e201451, 2020 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-32250432

RESUMO

Importance: More than 1 million US veterans are dually enrolled in a Medicare Advantage (MA) plan and in the Veterans Affairs (VA) health care system. The federal government prepays private MA plans to cover veterans; if a dually enrolled veteran receives an MA-covered service at the VA, the government is making 2 payments for the same service. It is not clear what proportion of veterans dually enrolled in VA and MA are undergoing coronary revascularization at VA vs non-VA hospitals. Objective: To describe where veterans who are enrolled in both VA and MA undergo coronary revascularization and the associated costs. Design, Settings, and Participants: This is a cohort study consisting of US veterans dually enrolled in VA and MA from January 1, 2010, to December 31, 2013, who had at least 1 VA encounter and underwent coronary revascularization during the study period. Data were analyzed from April 2019 to September 2019. Main Outcomes and Measures: Number of coronary artery bypass graft (CABG) operations and percutaneous coronary interventions (PCIs) performed through the VA and through MA during years 2010 to 2013, and the associated VA costs of coronary revascularization. In addition, multivariable logistic regression was performed to assess patient factors associated with receiving care through the VA. Results: A total of 18 874 VA users with concurrent MA enrollment who underwent coronary revascularization during 2010 to 2013 were identified (mean [SD] age, 75.3 [8.8] years; 18 739 men [99.0%]). Enrollees were predominantly white (17 457 patients [92.0%]). Among patients, 4115 (22.0%) underwent either CABG or PCI through the VA only, 14 281 (75.0%) did so through MA only, and 478 (2.5%) underwent coronary revascularization procedures through both payers. From 2010 to 2013, these veterans underwent 4764 coronary revascularization procedures (721 CABGs and 3043 PCIs) that cost the VA $214.7 million ($115.8 million for CABGs and $99.0 million for PCIs). In multivariable analysis, nonwhite patients were more likely than white patients to undergo coronary revascularization through the VA (odds ratio, 1.73; 95% CI, 1.52-1.96; P < .001), and for each year of age, veterans were less likely to undergo coronary revascularization through the VA (odds ratio, 0.95; 95% CI, 0.94-0.95; P < .001). There was no statistically significant association between undergoing coronary vascularization through the VA and distance in miles to the nearest VA hospital (odds ratio, 1.00; 95% CI, 0.99-1.00; P = .30). Conclusions and Relevance: A substantial share of VA users concurrently enrolled in an MA plan underwent coronary revascularization procedures through the VA, incurring significant duplicative federal health care spending. Given the financial pressures facing both Medicare and the VA, government officials should consider policy solutions to mitigate redundant spending.


Assuntos
Ponte de Artéria Coronária/economia , Ponte de Artéria Coronária/estatística & dados numéricos , Medicare Part C/estatística & dados numéricos , Intervenção Coronária Percutânea/economia , Intervenção Coronária Percutânea/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Ponte de Artéria Coronária/métodos , Assistência à Saúde/organização & administração , Feminino , Humanos , Masculino , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/cirurgia , Avaliação de Resultados em Cuidados de Saúde , Intervenção Coronária Percutânea/métodos , Estudos Retrospectivos , Estados Unidos/epidemiologia , United States Department of Veterans Affairs/organização & administração
15.
Ann Thorac Surg ; 110(4): e295-e297, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32151581

RESUMO

We report a case of a 23-day-old girl who presented with repeated life-threatening myocardial ischemia from intermittent aortic insufficiency because of fixation of the left coronary cusp against the aortic wall. The patient underwent aortic valve repair with partial commissuroplasty of the left-right and left-noncommissures. After the surgical intervention the patient has been well, with no ischemic event for over 1 year. This diagnosis should be considered as a differential diagnosis in pediatric cases with myocardial ischemia.


Assuntos
Insuficiência da Valva Aórtica/complicações , Isquemia Miocárdica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Feminino , Humanos , Recém-Nascido , Isquemia Miocárdica/cirurgia
17.
Rev Invest Clin ; 72(1): 32-36, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32132738

RESUMO

Background: The cost of performing a percutaneous coronary intervention is considerably high for the patient as well as for health systems, which have promoted the development of local technology to help meet the need for these devices. Methods: The INC-01 bare-metal stent was developed at the National Institute of Cardiology in Mexico City and was first implanted on porcine models with technical success in 100% of the evaluated parameters. Presentation of Cases: We present the first three cases of patients with ischemic heart disease, to whom the INC-01 bare-metal stent was implanted. Intracoronary ultrasonography was performed post-stent implantation, showing all the characteristics of implant success during evaluation and clinical follow-up. Conclusions: Angiography and intracoronary ultrasound were carried out demonstrating that the INC-01 bare-metal stent has physical, biological, and histological characteristics similar to those found in commercial metallic stents.


Assuntos
Isquemia Miocárdica/cirurgia , Desenho de Prótese , Stents , Adulto , Idoso , Seguimentos , Humanos , Masculino , México , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/fisiopatologia , Projetos Piloto , Resultado do Tratamento , Ultrassonografia
18.
Am J Cardiol ; 125(9): 1421-1428, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32145895

RESUMO

The impact of uncommon etiology cardiomyopathies on Left-ventricular assist device (LVAD)-recipient outcomes is not very well known. This study aimed to characterize patients with uncommon cardiomyopathy etiologies and examine the outcomes between uncommon and ischemic/idiopathic dilated cardiomyopathy. This observational study was conducted in 19 centers between 2006 and 2016. Baseline characteristics and outcomes of patients with uncommon etiology were compared to patients with idiopathic dilated/ischemic cardiomyopathies. Among 652 LVAD-recipients included, a total of 590 (90.5%) patients were classified as ischemic/idiopathic and 62 (9.5%) patients were classified in the "uncommon etiologies" group. Main uncommon etiologies were: hypertrophic (n = 12(19%)); cancer therapeutics-related cardiac dysfunction (CTRCD) (n = 12(19%)); myocarditis (n = 11(18%)); valvulopathy (n = 9(15%)) and others (n = 18(29%)). Patients with uncommon etiologies were significantly younger with more female and presented less co-morbidities. Additionally, patients with uncommon cardiomyopathies were less implanted as destination therapy compared with ischemic/idiopathic group (29% vs 38.8%). During a follow-up period of 9.1 months, both groups experienced similar survival. However, subgroup of hypertrophic/valvular cardiomyopathies and CTRCD had significantly higher mortality compared to the ischemic/idiopathic or myocarditis/others cardiomyopathies. Conversely, patients with myocarditis/others etiologies experienced a better survival. Indeed, the 12-months survival in the myocarditis/others; ischemic/idiopathic and hypertrophic/CTRCD/valvulopathy group were 77%; 65%, and 46% respectively. In conclusion, LVAD-recipients with hypertrophic cardiomyopathy, valvular heart disease and CTRCD experienced the higher mortality rate.


Assuntos
Cardiomiopatia Dilatada/cirurgia , Cardiomiopatia Hipertrófica/cirurgia , Coração Auxiliar , Isquemia Miocárdica/cirurgia , Adulto , Idoso , Cardiomiopatia Dilatada/etiologia , Cardiomiopatia Hipertrófica/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/etiologia , Estudos Retrospectivos , Resultado do Tratamento
19.
Am J Physiol Heart Circ Physiol ; 318(3): H696-H705, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32056445

RESUMO

Remodeling of the coronary microcirculation is known to occur distal to a chronic coronary stenosis, but the reversibility of these changes and their functional significance on maximum myocardial perfusion before and after revascularization is unknown. Accordingly, swine instrumented with a chronic silastic stenosis on the left anterior descending coronary artery to produce hibernating myocardium underwent percutaneous coronary intervention (PCI; n = 8) and were compared with animals with a persistent stenosis (n = 8), as well as sham controls (n = 6). Stenotic animals demonstrated an increased subendocardial arteriolar wall thickness-to-lumen ratio (37.8 ± 3.3 vs. 28.3 ± 1.3% in sham, P = 0.04), reduced lumen area per arteriole (597 ± 88 vs. 927 ± 113 µm2, P = 0.04), and a compensatory increase in arteriolar density (9.4 ± 1.0 vs. 5.3 ± 0.4 arterioles/mm2, P < 0.01). As a result, vasodilated flow immediately after PCI was similar to normally perfused remote regions (5.1 ± 1.0 vs. 4.8 ± 0.9 ml·min-1·g-1, P = 0.87). When assessed 1-mo after PCI, increases in wall thickness-to-lumen diameter (42.2 ± 3.3%) and reductions in lumen area per arteriole (638 ± 59 µm2) remained unchanged, but arteriolar density returned to normal (5.2 ± 0.5 arterioles/mm2). As a result, maximum subendocardial flow during adenosine declined and was lower than remote regions (2.6 ± 0.3 vs. 5.9 ± 1.1 ml·min-1·g-1, P = 0.01). There was no microvascular remodeling in subepicardial arterioles, and maximum perfusion remained unchanged. These data demonstrate that subendocardial microvascular remodeling occurs distal to a chronic epicardial stenosis. The regression of arteriolar density without increases in luminal area may precipitate stress-induced subendocardial ischemia in the absence of a physiologically significant stenosis.NEW & NOTEWORTHY Swine with a chronic coronary stenosis exhibit subendocardial microvascular remodeling distal to a critical stenosis characterized by an increase in arteriolar wall thickness and reduction in lumen area with a compensatory increase in arteriolar density. The present study is the first to demonstrate that subendocardial arteriolar density normalizes 1-mo after revascularization, but the lumen area of individual arterioles remains reduced. This leads to a reduction in maximal subendocardial perfusion at this time point despite initial normalization of vasodilator reserve after revascularization. This pattern of chronic microvascular structural remodeling could contribute to recurrent subendocardial ischemia in the absence of coronary restenosis during tachycardia and increases in myocardial oxygen demand.


Assuntos
Circulação Coronária/fisiologia , Estenose Coronária/cirurgia , Vasos Coronários/fisiopatologia , Isquemia Miocárdica/cirurgia , Intervenção Coronária Percutânea , Remodelação Vascular/fisiologia , Animais , Estenose Coronária/fisiopatologia , Modelos Animais de Doenças , Feminino , Masculino , Microcirculação/fisiologia , Isquemia Miocárdica/fisiopatologia , Suínos
20.
Gen Thorac Cardiovasc Surg ; 68(5): 534-537, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-30875004

RESUMO

The patient was a 64-year-old man who had aortic regurgitation, ischemic heart disease, a transverse aortic aneurysm, and an abdominal-common iliac aneurysm. Concomitant operations including aortic valve replacement, coronary artery bypass grafting, and total aortic arch replacement with elephant trunk technique were performed successfully. The patient developed postoperative cardiac tamponade on the 5th postoperative day, resulting in bulbar palsy due to occlusion of the dominant left vertebral artery. Thrombectomy of the vertebral artery with reconstruction by a saphenous vein was performed. The patient's neurological symptoms improved after the operation. Revascularization of ischemic stroke may yield neurological improvement even in patients after cardiovascular surgery.


Assuntos
Isquemia Encefálica/cirurgia , Acidente Vascular Cerebral/cirurgia , Trombectomia , Trombose/cirurgia , Artéria Vertebral/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/cirurgia , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Isquemia Encefálica/etiologia , Paralisia Bulbar Progressiva/etiologia , Tamponamento Cardíaco/etiologia , Ponte de Artéria Coronária , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Isquemia Miocárdica/cirurgia , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos , Acidente Vascular Cerebral/etiologia , Trombose/etiologia
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