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1.
Angiol Sosud Khir ; 25(4): 159-165, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855213

RESUMO

Despite the present-day level of the development of cardiac surgery, a low left ventricular ejection fraction (LLVEF) is an important independent predictor of high complication rates and increased in-hospital mortality related to open surgical interventions. The method of myocardial endovascular revascularization is associated with the lowest rates of both intraoperative and early postoperative complications. However, percutaneous coronary intervention (PCI) does not always make it possible to perform anatomically complete myocardial revascularization. Comparisons of the remote results of anatomically complete and incomplete revascularization of the myocardium in the world literature seem to be extremely scarce and ambiguous, with a low ejection fraction in the majority of cases being an exclusion criterion. In order to elucidate these problems we carried out a prospective, single-centre study, including a total of 151 patients suffering from ischaemic heart disease with a left ventricular ejection fraction of less than 35%, who were subjected to myocardial endovascular revascularization. The patients were divided into 2 groups: those with complete (n=87) and incomplete (n=64) revascularization, followed by comparing the alterations in the echocardiographic parameters, assessing the incidence of repeat myocardial revascularization due to a relapse of the clinical course of angina pectoris, and the survival rate in the remote period. The obtained findings were suggestive of efficacy of both complete and incomplete endovascular revascularization of the myocardium in patients with a low left ventricular ejection fraction (LLVEF), with no statistically significant differences between the patients of both groups in the examined parameters revealed.


Assuntos
Isquemia Miocárdica/cirurgia , Revascularização Miocárdica/métodos , Disfunção Ventricular Esquerda/cirurgia , Procedimentos Endovasculares , Humanos , Isquemia Miocárdica/fisiopatologia , Intervenção Coronária Percutânea/métodos , Estudos Prospectivos , Volume Sistólico/fisiologia , Resultado do Tratamento , Disfunção Ventricular Esquerda/fisiopatologia
2.
Int Heart J ; 60(6): 1268-1275, 2019 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666451

RESUMO

Few reports have focused on which patients with moderate ischemic mitral regurgitation (IMR) were not good candidates for coronary artery bypass grafting (CABG) alone. This single-center study aimed to assess risk factors for moderate or more residual regurgitation within two years after CABG alone for the treatment of moderate chronic IMR to optimize the operation strategy and prognosis.A total of 189 eligible patients were entered into a failure group (n = 108) or an improved group (n = 81) according to whether moderate or more residual regurgitation occurred within two years after surgery. Baseline and surgical characteristics were analyzed, and clinical outcomes were compared between groups.Prior myocardial infarction (MI)/chronic myocardial ischemia and region wall motion abnormality (anterior/inferior-posterior wall) were two independent risk factors for moderate or more residual regurgitation, following CABG alone, for the treatment of moderate chronic IMR (OR = 3.15, 95% CI 1.66-5.75, and OR = 2.45, 95% CI 1.36-4.84, respectively). During a median follow-up of 40 months, compared with the improved group, the failure group was more likely to present with New York Heart Association (NYHA) class III-IV and cardiac re-hospitalization (57.4% versus 11.1%, P < 0.001, and 13.9% versus 4.9%, P = 0.043, respectively) and had worse cumulative survival (χ2 = 4.259, log-rank P = 0.039).Patients suffering from moderate chronic IMR secondary to prior MI (rather than chronic ischemia) with anterior wall motion abnormalities (rather than inferior-posterior wall motion abnormalities) may not be good candidates for CABG alone, and may have a poor prognosis after CABG alone.


Assuntos
Ponte de Artéria Coronária , Insuficiência da Valva Mitral/etiologia , Isquemia Miocárdica/complicações , Isquemia Miocárdica/cirurgia , Idoso , Doença Crônica , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/mortalidade , Insuficiência da Valva Mitral/cirurgia , Isquemia Miocárdica/mortalidade , Seleção de Pacientes , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo , Falha de Tratamento
3.
Transplant Proc ; 51(9): 3174-3177, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31619345

RESUMO

A 19-year-old Asian woman presented to the emergency department with ventricular fibrillation. Emergent coronary angiography revealed a 99% ostial stenosis of the left main coronary trunk, and percutaneous coronary intervention was performed. Takayasu arteritis was suspected, but fluorodeoxyglucose positron emission tomography scanning showed no active inflammation. Cardiac function was affected by ischemic cardiomyopathy, and an extracorporeal left ventricular assisted device was implanted under INTERMACS profile 1 status. Histopathology of the ascending aortic wall at the outflow anastomosis site showed no significant sign of Takayasu arteritis. The absence of systemic inflammation led to the replacement of the extracorporeal left ventricular assisted device with a Jervik 2000 as a bridge to transplant. An orthotropic heart transplant took place after a 39-month wait. Histopathology of the explanted heart revealed intimal and adventitial thickening with destruction of the elastic lamina localized at the sinus of Valsalva. Our final pathologic diagnosis was localized Takayasu arteritis. To counter the increased risk of stenosis or pseudoaneurysm formation at the vascular anastomosis site, anti-inflammatory therapy was essential in Takayasu arteritis. The post-heart transplant immunosuppression regime was considered stronger than that for Takayasu arteritis, and we therefore administered prednisolone, mycophenolate mofetil, and tacrolimus as standard protocol. There have been no signs of either relapse or rejection of transplantation for over 1 year. Further closed observation is required to clarify the long-term outcome of this rare condition with regard to heart transplantation.


Assuntos
Cardiomiopatias/etiologia , Cardiomiopatias/cirurgia , Transplante de Coração , Seio Aórtico/patologia , Arterite de Takayasu/complicações , Arterite de Takayasu/patologia , Feminino , Coração Auxiliar , Humanos , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/cirurgia , Adulto Jovem
5.
N Engl J Med ; 381(8): 739-748, 2019 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-31433921

RESUMO

BACKGROUND: The role of assessment of myocardial viability in identifying patients with ischemic cardiomyopathy who might benefit from surgical revascularization remains controversial. Furthermore, although improvement in left ventricular function is one of the goals of revascularization, its relationship to subsequent outcomes is unclear. METHODS: Among 601 patients who had coronary artery disease that was amenable to coronary-artery bypass grafting (CABG) and who had a left ventricular ejection fraction of 35% or lower, we prospectively assessed myocardial viability using single-photon-emission computed tomography, dobutamine echocardiography, or both. Patients were randomly assigned to undergo CABG and receive medical therapy or to receive medical therapy alone. Left ventricular ejection fraction was measured at baseline and after 4 months of follow-up in 318 patients. The primary end point was death from any cause. The median duration of follow-up was 10.4 years. RESULTS: CABG plus medical therapy was associated with a lower incidence of death from any cause than medical therapy alone (182 deaths among 298 patients in the CABG group vs. 209 deaths among 303 patients in the medical-therapy group; adjusted hazard ratio, 0.73; 95% confidence interval, 0.60 to 0.90). However, no significant interaction was observed between the presence or absence of myocardial viability and the beneficial effect of CABG plus medical therapy over medical therapy alone (P = 0.34 for interaction). An increase in left ventricular ejection fraction was observed only among patients with myocardial viability, irrespective of treatment assignment. There was no association between changes in left ventricular ejection fraction and subsequent death. CONCLUSIONS: The findings of this study do not support the concept that myocardial viability is associated with a long-term benefit of CABG in patients with ischemic cardiomyopathy. The presence of viable myocardium was associated with improvement in left ventricular systolic function, irrespective of treatment, but such improvement was not related to long-term survival. (Funded by the National Institutes of Health; STICH ClinicalTrials.gov number, NCT00023595.).


Assuntos
Ponte de Artéria Coronária , Coração/fisiologia , Isquemia Miocárdica/cirurgia , Volume Sistólico , Idoso , Ecocardiografia sob Estresse , Feminino , Seguimentos , Coração/diagnóstico por imagem , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/fisiopatologia , Modelos de Riscos Proporcionais , Estudos Prospectivos , Tomografia Computadorizada de Emissão de Fóton Único , Resultado do Tratamento , Função Ventricular Esquerda
6.
Braz J Cardiovasc Surg ; 34(4): 396-405, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31454193

RESUMO

OBJECTIVE: To evaluate whether there is any difference on the results of patients treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) in the setting of ischemic heart failure (HF). METHODS: Databases (MEDLINE, Embase, Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Literatura Latino-americana e do Caribe em Ciências da Saúde [LILACS], and Google Scholar) were searched for studies published until February 2019. Main outcomes of interest were mortality, myocardial infarction, repeat revascularization, and stroke. RESULTS: The search yielded 5,775 studies for inclusion. Of these, 20 articles were analyzed, and their data were extracted. The total number of patients included was 54,173, and those underwent CABG (N=29,075) or PCI (N=25098). The hazard ratios (HRs) for mortality (HR 0.763; 95% confidence interval [CI] 0.678-0.859; P<0.001), myocardial infarction (HR 0.481; 95% CI 0.365-0.633; P<0.001), and repeat revascularization (HR 0.321; 95% CI 0.241-0.428; P<0.001) were lower in the CABG group than in the PCI group. The HR for stroke showed no statistically significant difference between the groups (random effect model: HR 0.879; 95% CI 0.625-1.237; P=0.459). CONCLUSION: This meta-analysis found that CABG surgery remains the best option for patients with ischemic HF, without increase in the risk of stroke.


Assuntos
Ponte de Artéria Coronária/mortalidade , Insuficiência Cardíaca/cirurgia , Isquemia Miocárdica/cirurgia , Intervenção Coronária Percutânea/mortalidade , Acidente Vascular Cerebral/etiologia , Idoso , Brasil/epidemiologia , Ponte de Artéria Coronária/efeitos adversos , Métodos Epidemiológicos , Medicina Baseada em Evidências , Feminino , Humanos , Masculino , Metanálise como Assunto , Estudos Multicêntricos como Assunto , Isquemia Miocárdica/mortalidade , Intervenção Coronária Percutânea/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Guias de Prática Clínica como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Literatura de Revisão como Assunto , Acidente Vascular Cerebral/mortalidade , Resultado do Tratamento
7.
Int Heart J ; 60(4): 796-804, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31308329

RESUMO

The benefits of concomitant mitral valve procedure (MVP) for treating moderate chronic ischemic mitral regurgitation (IMR) during coronary artery bypass grafting (CABG) have not been clearly established. This study aimed to determine the incidence of moderate or more residual mitral regurgitation (MR) following CABG plus MVP for moderate chronic IMR, and to evaluate the impacts of concomitant MVP vs. CABG alone on clinical outcomes based on propensity-matched data.All eligible patients were entered into either the MVP group (CABG plus MVP, n = 184) or CABG group (CABG alone, n = 162). Moderate or more residual MR rate was investigated, and in-hospital and follow-up outcomes between the groups were compared after matching.Moderate or more residual MR rate was 11.4% at 1 year and 22.9% at 2 years after CABG plus MVP, respectively. Patients in the MVP group as compared with the CABG group had significantly lower moderate or more residual MR rates at various postoperative time points (all P < 0.001). Grouping was not an independent risk factor for in-hospital adverse events in multivariate logistic regression analysis. Also, grouping was a significant variable related to moderate or more residual MR rate and NYHA class III-IV at the latest follow-up in Cox regression analysis (HR = 0.391, 95% CI 0.114-0.628; HR = 0.419, 95% CI 0.233-0.819, respectively).Concomitant MVP as compared with CABG alone for treating moderate chronic IMR was associated with a reduction in moderate or more residual MR rate and an improvement in NYHA functional status, with no increase in in-hospital adverse events or follow-up death.


Assuntos
Ponte de Artéria Coronária/métodos , Implante de Prótese de Valva Cardíaca/métodos , Insuficiência da Valva Mitral/complicações , Valva Mitral/cirurgia , Isquemia Miocárdica/cirurgia , Idoso , China/epidemiologia , Doença Crônica , Angiografia Coronária , Ecocardiografia Doppler , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/cirurgia , Isquemia Miocárdica/complicações , Isquemia Miocárdica/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Fatores de Risco
8.
Braz J Cardiovasc Surg ; 34(3): 265-270, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31310463

RESUMO

OBJECTIVE: To report our center's experience in the surgical treatment of ventricular reconstruction, an effective and efficient technique that allows patients with end-stage heart failure of ischemic etiology to have clinical improvement and increased survival. METHODS: Observational, clinical-surgical, sequential, retrospective study. Patients with ischemic cardiomyopathy and left ventricular aneurysm were attended at the Heart Failure, Ventricular Dysfunction and Cardiac Transplant outpatient clinic of the Dante Pazzanese Cardiology Institute, from January 2010 to December 2016. Data from 34 patients were collected, including systemic arterial hypertension, ejection fraction, New York Heart Association (NYHA) functional classification (FC), European System for Cardiac Operative Risk Evaluation (EuroSCORE) II value, Society of Thoracic Surgeons (STS) score, ventricular reconstruction technique, and survival. RESULTS: Overall mortality of 14.7%, with hospital admission being 8.82% and late death being 5.88%. Total survival rate at five years of 85.3%. In the preoperative phase, NYHA FC was Class I in five patients, II in 18, III in eight, and IV in three vs. NYHA FC Class I in 17 patients, II in eight, III in six, and IV in three, in the postoperative period. EuroSCORE II mean value was 6.29, P≤0.01; hazard ratio (HR) 1.16 (95% confidence interval [CI] 1.02-1.31). STS mortality/morbidity score mean value was 18.14, P≤0.004; HR 1.19 (95% CI 1.05-1.33). Surgical techniques showed no difference in survival among Dor 81% vs. Jatene 91.7%. CONCLUSION: Surgical treatment of left ventricular reconstruction in candidates for heart transplantation is effective, efficient, and safe, providing adequate survival.


Assuntos
Cardiomiopatias/cirurgia , Aneurisma Cardíaco/cirurgia , Transplante de Coração/métodos , Ventrículos do Coração/cirurgia , Isquemia Miocárdica/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Idoso , Cardiomiopatias/mortalidade , Feminino , Aneurisma Cardíaco/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/mortalidade , Complicações Pós-Operatórias , Modelos de Riscos Proporcionais , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Estudos Retrospectivos , Volume Sistólico , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
9.
Georgian Med News ; (290): 17-20, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31322507

RESUMO

Our aim was to compare early post-operative period of Endo-ACAB with OPCABG. We retrospectively studied 760 cases of all patients who had underwent urgent or planned coronary artery bypass grafting at the "Tbilisi Heart and Vascular Clinic" from November 2015 till November 2017. Patients were divided into two group: first group patients who had underwent Endo-ACAB and second group patients who had underwent OPCABG. Early postoperative complications including pneumonia, stroke, ventricular fibrillation, pain intensity, wound infection and hospital stay were studied. After analyzing both groups of the patients we concluded that no statistically significant difference was revealed in presence of preoperative risk-factors like diabetes mellitus and arterial hypertension between the study groups. Mean ejection fraction was slightly lower in Endo-ACAB group but statistical analysis showed no significant difference. Moreover, no statistical difference was seen in early postoperative complications like pneumonia, stroke, ventricular fibrillation or early mortality. Respectively severely of pain was similar in Endo-ACAB group compared with CABG. Statistical analyses revealed significant lower rate of surgical wound complication and hospital stay in Endo-ACAB group. In both group no intraoperative mortality was detected. To conclude Endo-ACAB has significantly lower rate of early postoperative complications compared to OPCABG according to the date of "Tbilisi Heart and Vascular Clinic".


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Ponte de Artéria Coronária/métodos , Doença das Coronárias/cirurgia , Isquemia Miocárdica/cirurgia , Idoso , Feminino , Georgia/epidemiologia , Humanos , Pessoa de Meia-Idade , Isquemia Miocárdica/mortalidade , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento
10.
Medicine (Baltimore) ; 98(24): e15846, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31192914

RESUMO

Ischemic heart disease (IHD) has a genetic predisposition and a number of cardiovascular risk factors are known to be affected by genetic factors. Development of metabolic syndrome and insulin resistance, strongly influenced by lifestyle and environmental factors, frequently occur in subjects with a genetic susceptibility. The definition of genetic factors influencing disease susceptibility would allow to identify individuals at higher risk and thus needing to be closely monitored.To this end, we focused on a complex of soluble-N-ethylmaleimide-sensitive factor attachment protein receptors (SNAREs), playing an important role in metabolic syndrome and insulin resistance, involved in endothelial dysfunction and heart disease. We assessed if genetic variants of the SNARE genes are associated with IHD.SNAP25 rs363050, Stx-1A rs4717806, rs2293489, and VAMP2 26bp ins/del genetic polymorphisms were analyzed in a cohort of 100 participants who underwent heart surgery; 56 of them were affected by IHD, while 44 were not. A statistical association of plasma glycemia and insulin resistance, calculated as Triglyceride glucose (TyG) index, was observed in IHD (P < .001 and P = .03, respectively) after binomial logistic stepwise regression analysis, adjusted by age, gender, diabetes positivity, waist circumference, and cholesterol plasma level. Among genetic polymorphisms, rs4717806(A) and rs2293489(T), as well as the rs4717806 - rs2293489 (A-T) haplotype were associated with higher risk for IHD (Pc = .02; Pc = .02; P = .04, respectively). Finally, a statistical association of rs4717806(AA) genotype with higher TyG index in IHD patients (P = .03) was highlighted by multiple regression analysis considering log-transformed biochemical parameters as dependent variable and presence of coronary artery disease, age, gender, waist circumference, presence of diabetes as predictors. These results point to a role of the Stx-1A rs4717806 SNP in IHD, possibly due to its influence on Stx-1A expression and, as a consequence, on insulin secretion and glucose metabolism.


Assuntos
Estudos de Associação Genética/métodos , Isquemia Miocárdica/genética , Isquemia Miocárdica/cirurgia , Polimorfismo de Nucleotídeo Único , Sintaxina 1/genética , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos , Estudos de Coortes , Feminino , Predisposição Genética para Doença , Humanos , Mutação INDEL , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Proteína 25 Associada a Sinaptossoma/genética , Proteína 2 Associada à Membrana da Vesícula/genética
11.
J Invasive Cardiol ; 31(6): 183-186, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31158807

RESUMO

BACKGROUND: Rotational atherectomy (RA) has been traditionally performed via the transfemoral approach, mostly utilizing large guide catheters (≥7 Fr), which can accommodate the passage of large burrs (≥1.75 mm). However, contemporary data show that using smaller sheath and catheter sizes reduces the risk of procedural access-site related complications. Therefore, the aim of this study was to assess the feasibility of performing RA using smaller burrs and subsequently smaller-sized sheath catheters. METHODS: A total of 220 patients underwent RA procedures between January 2011 and July 2017. We compared 162 patients who underwent RA using a maximal burr size of 1.5 mm (small-burr group) with 58 patients who underwent RA using burrs >1.5 mm in diameter (large-burr group). Clinical, procedural, safety, and feasibility data were evaluated and compared between the two groups. RESULTS: Baseline characteristics of the two groups were quite similar other than a higher prevalence of smoking (21.0% vs 5.2%; P<.01) and a lower body weight (80.9 ± 17.5 kg vs 86.8 ± 17.2 kg; P=.03) in the small-burr group vs the large-burr group. The indications for the procedure for the small-burr group vs large-burr group were stable angina in 53% vs 62%, unstable angina in 16% vs 17%, non-ST elevation myocardial infarction (MI) in 26% vs 17%, and ST-elevation MI in 3.7% vs 3.4%, respectively (P=NS for all). The target-vessel (TV) diameter was significantly larger in the large-burr group vs the small-burr group (3.5 ± 0.3 mm vs 3.2 ± 0.5 mm, respectively; P<.01). Importantly, a sheath size >6 Fr was used in 56.0% of the small-burr group vs 89.5% of the large-burr group (P<.01). Moreover, in 53% of the small-burr group, a guide catheter >6 Fr was used. Radial access was used in 33% of the small-burr group and 17% of the large-burr group (P=.03). Procedural success was achieved in 93% of the small-burr group and 100% of the large-burr group (P=.07). CONCLUSION: In the majority of cases, RA can be successfully performed using smaller-sized burrs while achieving a high procedural success rate. Notably, our study also highlights the overuse of large sheaths and catheters to deliver small burrs. These results further support the contemporary strategy of using 6 Fr guide catheters, thereby increasing the possibility of using the radial approach for more complex interventional procedures.


Assuntos
Aterectomia Coronária/instrumentação , Cateteres , Vasos Coronários/cirurgia , Isquemia Miocárdica/cirurgia , Idoso , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Desenho de Equipamento , Feminino , Humanos , Masculino , Isquemia Miocárdica/diagnóstico , Estudos Retrospectivos
12.
J Invasive Cardiol ; 31(6): E157, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31158814

RESUMO

Left heart catheterization graft study is commonly performed via the femoral approach to allow selective angiography of internal mammary grafts, which originate from either subclavian artery. A straightforward mother-and-child catheter-extension technique allows this procedure to be performed successfully via radial approach, which improves patient comfort and offers less likelihood of vascular complications.


Assuntos
Cateterismo Cardíaco/instrumentação , Angiografia Coronária/métodos , Anastomose de Artéria Torácica Interna-Coronária/métodos , Isquemia Miocárdica/cirurgia , Idoso , Desenho de Equipamento , Humanos , Masculino , Isquemia Miocárdica/diagnóstico , Artéria Radial
13.
Braz J Cardiovasc Surg ; 34(4): 420-427, 2019 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-31165611

RESUMO

OBJECTIVE: To evaluate the patency of individual and sequential coronary artery bypass in patients with ischemic heart disease. METHODS: We searched PubMed, Cochrane Library, Excerpta Medica Database, and ClinicalTrials.gov databases for controlled trials. Endpoints included graft patency, anastomosis patency, occluded rates in left anterior descending (LAD) system and right coronary artery (RCA) system, in-hospital mortality, and follow-up mortality. Pooled risk ratios (RRs) and standardized mean difference (SMD) were used to assess the relative data. RESULTS: Nine cohorts, including 7100 patients and 1440 grafts under individual or sequential coronary artery bypass. There were no significant differences between individual and sequential coronary artery bypass in the graft patency (RR=0.96; 95% CI=0.91-1.02; P=0.16; I2=87%), anastomosis patency (RR=0.95; 95% CI=0.91-1.00; P=0.05; I2=70%), occluded rate in LAD system (RR=1.03; 95% CI=0.92-1.16; P=0.58; I2=37%), occluded rate in RCA system (RR=1.36; 95% CI=0.72-2.57; P=0.35; I2=95%), in-hospital mortality (RR=1.57; 95% CI=0.92-2.69; P=0.10; I2=0%), and follow-up mortality (RR=0.96; 95% CI=0.36-2.53; P=0.93; I2=0%). CONCLUSION: No significant differences on clinical data were observed regarding anastomosis patency, occluded rate in LAD system, occluded rate in RCA system, in-hospital mortality, and follow-up mortality, indicating that the patency of individual and the patency of sequential coronary artery bypass are similar to each other.


Assuntos
Ponte de Artéria Coronária/métodos , Oclusão Coronária/terapia , Isquemia Miocárdica/cirurgia , Grau de Desobstrução Vascular/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Oclusão Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico por imagem , Interpretação de Imagem Radiográfica Assistida por Computador , Fatores de Risco , Resultado do Tratamento
14.
Trials ; 20(1): 357, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200756

RESUMO

BACKGROUND: Intraoperative and postoperative management of cardiac surgery patients is complex, involving the application of differential vasopressors and volume therapy. It has been shown that a positive fluid balance has a major impact on postoperative outcome. Today, the advantages and disadvantages of buffered crystalloid solutes are a topic of controversy, with no consensus being reached so far. The use of hypertonic saline (HS) has shown promising results with respect to lower total fluid balance and postoperative weight gain in critically ill patients in preliminary studies. However, collection of more data on HS in critically ill patients seems warranted. This preliminary study aims to investigate whether fluid resuscitation using HS in patients following cardiac surgery results in less total fluid volume being administered. METHODS: In a prospective double-blind randomised controlled clinical trial, we aim to recruit 96 patients undergoing elective cardiac surgery for ischaemic and/or valvular heart disease. After postoperative admission to the intensive care unit (ICU), patients will be randomly assigned to receive 5 ml/kg ideal body weight HS (7.3% NaCl) or normal saline (NS, 0.9% NaCl) infused within 60 min. Blood and urine samples will be collected preoperatively and postoperatively up to day 6 to assess changes in renal, cardiac, inflammatory, acid-base, and electrolyte parameters. Additionally, we will perform renal ultrasonography studies to assess renal blood flow before, during, and after infusion, and we will measure total body water using preoperative and postoperative body composition analysis (bioimpedance). Patients will be followed up for 90 days. DISCUSSION: The key objective of this study is to assess the cumulative amount of fluid administered in the intervention (HS) group versus control (NS) group during the ICU stay. In this preliminary, prospective, randomised controlled clinical trial we will test the hypothesis that use of HS results in less total fluids infused and less postoperative weight gain when compared to the standard of intensive care in cardiac surgery patients. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03280745 . Registered on 12 September 2017.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Hidratação/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Solução Salina Hipertônica/administração & dosagem , Método Duplo-Cego , Doenças das Valvas Cardíacas/cirurgia , Humanos , Unidades de Terapia Intensiva , Isquemia Miocárdica/cirurgia , Estudos Prospectivos
15.
J Card Surg ; 34(8): 663-669, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31212371

RESUMO

BACKGROUND: In patients with end-stage renal disease requiring hemodialysis (HD patients), myocardial ischemia after coronary artery disease is a major cause of mortality. Coronary pathophysiology, namely myocardial microvascular dysfunction, appears to differ from patients not requiring HD (non-HD patients). OBJECTIVES: We compared functional improvement of myocardial ischemia after coronary artery bypass surgery (CABG) between HD and non-HD patients by transthoracic coronary flow velocity reserve (CFVR). METHODS: We retrospectively reviewed isolated CABG patients from between 2008 and 2017. Finally, 161 patients were enrolled; each underwent pre- and postoperative CFVR assessment, and left anterior descending (LAD) artery revascularization with "in-situ" internal mammary artery (IMA). Graft patency was confirmed, and after successful CABG, postoperative CFVR improvement between the two groups was compared. RESULTS: Preoperative CFVR value in group H was 1.81 ± 0.52, group N was 1.93 ± 0.66. There was no significant difference between the groups. IMA to LAD grafts were patent in postoperative evaluation in all patients. Postoperative CFVR in group H was 2.48 ± 0.72 and group N was 2.83 ± 0.73 (P = .042). Significant difference was observed. CONCLUSION: In both groups, CFVR values improved after successful CABG, but postoperative CFVR values were significant different. In younger populations CFVR values are generally higher. Our HD group was significantly younger than the non-HD group, but CFVR values were postoperatively significantly lower. CFVR values are reportedly affected by both epicardial and microcoronary circulation. In this study population, as all grafts to the LAD were patent, the lower CFVR value in the HD group was considered to have resulted in microvascular disorders.


Assuntos
Velocidade do Fluxo Sanguíneo , Ponte de Artéria Coronária , Vasos Coronários/fisiopatologia , Falência Renal Crônica/terapia , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/cirurgia , Diálise Renal , Idoso , Circulação Coronária , Feminino , Humanos , Falência Renal Crônica/complicações , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/complicações , Estudos Retrospectivos , Resultado do Tratamento
16.
Int J Cardiovasc Imaging ; 35(9): 1651-1659, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31053980

RESUMO

We investigated the influence of the extent of viability using low dose dobutamine wall motion score index (WMS) on the survival benefit of surgical revascularization (CABG) versus medical therapy. In the STICH trial, viability assessment was not helpful in determining the benefit of CABG. However, the extent of viable myocardium with contractile function was not assessed in the trial. Dobutamine echocardiography was performed in 250 patients with ischemic left ventricular dysfunction (125-medically treated, 125-CABG). The mean ejection fraction (EF) was 32% in both groups. WMS during low dose dobutamine infusion was used to classify patients into groups with extensive (WMS < 2.00), intermediate (WMS 2.00-2.49), and limited (WMS ≥ 2.50) viability. Survival free of cardiac death was assessed at 2 years and for the complete duration of follow-up. There were 44 (35.2%) and 67 (53.6%) cardiac deaths in the revascularized and medically treated patients respectively (follow-up of 5.7 ± 5.8 years). Revascularized and medically treated patients with extensive viability had similar 2-year survival (p = 0.567) but revascularized patients had improved long-term survival (p = 0.0001). In those with intermediate viability, revascularization improved both 2 year (p = 0.014) and long-term survival (p = 0.0001). In patients with limited viability, 2-year survival was worse in revascularized patients (p = 0.04) and long-term survival was similar (p = 0 .25) in revascularized and medically treated groups. Patients with extensive and intermediate amounts of viability have improved survival with CABG but those with limited viability have poorer short-term outcome and no long-term benefit.


Assuntos
Cardiomiopatias/diagnóstico por imagem , Cardiotônicos/administração & dosagem , Ponte de Artéria Coronária , Dobutamina/administração & dosagem , Ecocardiografia sob Estresse/métodos , Isquemia Miocárdica/diagnóstico por imagem , Volume Sistólico , Disfunção Ventricular Esquerda/diagnóstico por imagem , Função Ventricular Esquerda , Idoso , Cardiomiopatias/mortalidade , Cardiomiopatias/fisiopatologia , Cardiomiopatias/cirurgia , Fármacos Cardiovasculares/uso terapêutico , Tomada de Decisão Clínica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/cirurgia , Miocárdio/patologia , Seleção de Pacientes , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Sobrevivência de Tecidos , Resultado do Tratamento , Disfunção Ventricular Esquerda/mortalidade , Disfunção Ventricular Esquerda/fisiopatologia , Disfunção Ventricular Esquerda/cirurgia
17.
Gac Med Mex ; 155(2): 196-198, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31056601

RESUMO

The treatment of refractory terminal heart failure has been heart transplantation. However, there are limitations with regard to clinical conditions of the recipient and availability of donors, and ventricular support has therefore been alternatively used as destination therapy. We describe the case is of a female patient with ischemic cardiomyopathy-associated heart failure who had a left ventricular assist device successfully implanted and at eight months of the procedure was at functional class I, with no complications.


Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Isquemia Miocárdica/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Isquemia Miocárdica/complicações , Implantação de Prótese/métodos
18.
Gen Thorac Cardiovasc Surg ; 67(11): 925-933, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30972531

RESUMO

OBJECTIVES: To analyze our surgical experiences with surgical ventricular restoration (SVR) for dilated ischemic cardiomyopathy (ICM) and to determine the significance of preoperative right ventricular (RV) function on outcomes. METHODS AND RESULTS: This study retrospectively analyzed 19 patients who underwent SVR between April 2010 and May 2016. Their mean age and New York Heart Association functional class were 62 ± 11 years and 2.9 ± 0.8, respectively. The preoperative mean left ventricular (LV) end-systolic volume index and LV ejection fraction (LVEF) were 134 ± 56 mL/m2 and 24 ± 7%, respectively. The preoperative mean RV fractional area change (RVFAC) to quantify RV systolic function was 33 ± 13%, as assessed by transthoracic echocardiography. The mean follow-up period was 47 ± 20 months. Three patients died of cardiac causes during the follow-up, with the 3-year and 5-year freedoms from cardiac-related death of 89% and 79%, respectively. Major adverse cardiac events (MACEs) occurred in ten patients, with the 3-year and 5-year MACE-free survival rates of 58% and 41%, respectively. RVFAC (risk ratio [RR] = 0.92, 95% confidence interval [CI] 0.86-0.98, p = 0.01) and LVEF (RR = 0.83, 95% CI 0.68-0.97, p = 0.02) were significant predictors of MACEs in the multivariate analysis. Patients with RVFAC of < 35% had significantly poorer MACE-free survival rates (33% at 3 years) than those with RVFAC of ≥ 35% (80% at 3 years). CONCLUSION: SVR for ICM provided acceptable freedom from cardiac-related death; however, MACEs commonly occurred and was associated with RV dysfunction.


Assuntos
Cardiomiopatia Dilatada/fisiopatologia , Cardiomiopatia Dilatada/cirurgia , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Direita , Adulto , Idoso , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/cirurgia , Estudos Retrospectivos , Volume Sistólico , Taxa de Sobrevida , Sístole , Resultado do Tratamento , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Esquerda
19.
J Cardiovasc Med (Hagerstown) ; 20(5): 313-320, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30921269

RESUMO

AIMS: To systematically review literature comparing bare metal stent (BMS) to drug-eluting stent (DES) in end-stage renal disease (ESRD) patients on dialysis. ESRD patients on dialysis often suffer from accelerated atherosclerosis and higher rate of stent-related complications including major adverse cardiovascular events. Because dialysis usually qualifies ineligibility for randomized clinical trials, an evidenced-based stent choice for these patients is scarce. METHODS: PUBMED, CINHAL, COCHRANE, EMBASE and WEB OF SCIENCE were searched for studies comparing BMS vs. DES outcome in ESRD patients on dialysis. RESULTS: Twenty studies including 64 232 patients were considered. The use of DES was significantly associated with a reduction in all-cause mortality [odds ratio (OR) 0.83, 95% confidence interval (CI) 0.76-0.89], death from a cardiovascular cause (OR 0.80, 95% CI 0.76-0.84) and target lesion revascularization/target vessel revascularization (OR 0.73, 95% CI 0.53-1.00). No significant difference was found in stent thrombosis (OR 1.08, 95% CI 0.50-2.33) and myocardial infarction incidence (OR 0.91, 95% CI 0.69-1.20). CONCLUSIONS: Our meta-analysis shows a significant reduction in all-cause and cardiovascular mortality with the use of DES over BMS in dialyzed patients. Despite the lack of randomized studies, systematic use of DES in these high-risk patients should thus reasonably be considered as a first option in percutaneous coronary intervention candidates.


Assuntos
Stents Farmacológicos , Falência Renal Crônica/terapia , Metais , Isquemia Miocárdica/cirurgia , Intervenção Coronária Percutânea/instrumentação , Diálise Renal , Stents , Idoso , Feminino , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/mortalidade , Masculino , Pessoa de Meia-Idade , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/mortalidade , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Desenho de Prótese , Diálise Renal/efeitos adversos , Diálise Renal/mortalidade , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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