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1.
J Cardiothorac Surg ; 15(1): 291, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008467

RESUMO

BACKGROUND: Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. In the current study, we aimed to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF). METHODS: This was a retrospective study of patients aged ≥70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-centre between January 2006 and March 2015. The early postoperative results and long-term clinical outcomes were compared after propensity score matching. RESULTS: A total of 34 pairs of patients (73.94 ± 2.64 years old; 34 in the AF with ablation group and 34 in the AF without ablation group) were enrolled in the propensity score matching analysis. There were no significant differences between the two matched groups in terms of surgical mortality (5.88% vs. 2.94%, P = 0.555) and major postoperative morbidity. Kaplan-Meier analysis revealed a significantly better overall survival in the AF with ablation group compared to the AF without ablation group (P = 0.009). Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF with ablation group (P = 0.025, Gray's test). Patients in the AF with ablation group had a reduced incidence of stroke compared to patients in the AF with ablation group (P = 0.009, Gray's test). The freedom from AF after 5 years was 58.0% in the AF with ablation group and 3.0% in the AF without ablation group. CONCLUSIONS: The addition of bipolar radiofrequency ablation is a safe and feasible procedure, even in patients aged ≥70 years, with a better long-term survival and a reduced incidence of stroke compared to valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF who require cardiac surgery. However, a large-scale, prospective, multi-centre, randomized study should be performed in the future to fully validate our findings.


Assuntos
Ablação por Cateter , Doenças das Valvas Cardíacas/cirurgia , Idoso , Fibrilação Atrial/cirurgia , Procedimentos Cirúrgicos Cardíacos , Ablação por Cateter/métodos , Cateteres , Feminino , Humanos , Incidência , Masculino , Período Pós-Operatório , Pontuação de Propensão , Estudos Retrospectivos , Resultado do Tratamento
2.
J Cardiothorac Surg ; 15(1): 294, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33008486

RESUMO

BACKGROUND: Ever since the coronavirus disease 2019 (COVID-19) has become a pandemic, worldwide efforts are being made to "flatten the curve". Israel was amongst the first countries to impose significant restrictions. As a result, cardiac surgeons have been required to scale down their routine practice, resulting in a significant reduction in the number of cardiac surgeries. The aim of this study is to characterize the impact of COVID-19 on cardiac surgery in Israel. METHODS: This is a retrospective observational study performed in two cardiac surgery departments in Israel and includes all patients who underwent cardiac surgery in March and April during the years 2019 and 2020. The patient cohort was divided into two groups based on the year of operation. Analysis of the patients' baseline characteristics, operative data, and postoperative outcome, was performed. RESULTS: The 2019 group (n = 173), and the 2020 group (n = 108) were similar regarding their baseline characteristics, previous medical history, and rates of previous revascularization interventions. However, compared to the 2019 group, patients in the 2020 group were found to be more symptomatic (NYHA class IV; 2.4% vs. 6.2%, p = 0.007). While all patients underwent similar procedures, patients in the 2020 group had significantly longer procedural time (p < 0.001). In-hospital mortality rate was found to be significantly higher in group 2020 (13% vs. 5.2%, p = 0.037). CONCLUSIONS: While the number of patients undergoing cardiac surgery declined during the outbreak period, the rate of surgical mortality increased. One explanation for this might be delayed hospital arrival.


Assuntos
Betacoronavirus , Procedimentos Cirúrgicos Cardíacos , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Idoso , Procedimentos Cirúrgicos Cardíacos/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos
3.
Best Pract Res Clin Anaesthesiol ; 34(3): 643-650, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33004173

RESUMO

During this coronavirus disease 2019 (COVID-19) pandemic, there is an international call to postpone all elective surgeries. Cardiac surgery carries a combined risk for cardiac patients, who are at risk for higher complications of COVID-19, and healthcare workers. In response to the COVID-19 pandemic, the American College of Surgeons and the American Society of Anesthesiologists recommended a sustained reduction in the rate of new COVID-19 cases for 14 days before the resumption of the elective surgery, but postponing surgery may impact patients' daily activities and increase the risk the of deterioration of their cardiac condition. We will discuss the risks and benefits of the decision whether to postpone or proceed with elective cardiac surgical procedures during the escalating COVID-19 pandemic considering the specific risk of the cardiac patients, the unique characteristics of the surgery, and the international health system capacity.


Assuntos
Betacoronavirus , Procedimentos Cirúrgicos Cardíacos , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Humanos , Tempo
5.
Artigo em Alemão | MEDLINE | ID: mdl-33053589

RESUMO

The current S3-Guideline for intensive care therapy in patients after cardiac surgery provides a wealth of information and recommendations ranging from monitoring to treatment options for various perioperative clinical situations. This article focuses on the most relevant information applicable to every-day critical care practice, covering important aspects of general and advanced monitoring, goal directed hemodynamic therapy and treatment principles for perioperative left and right heart failure.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Insuficiência Cardíaca , Cuidados Críticos , Hemodinâmica , Humanos
6.
Kyobu Geka ; 73(9): 704-707, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32879277

RESUMO

Massive pulmonary hemorrhage, although rare, is a potentially life-threatening complications during heart surgery. We herein present 1 such case successfully treated by selective bronchial occlusion using an Endobronchial Watanabe Spigot (EWS). The 82-year-old female underwent mitral valve replacement, tricuspid annuloplasty, and maze procedure. An hour and a half after cessation of cardiopulmonary bypass, the patient suffered a massive pulmonary hemorrhage. A subsequent bronchoscopy identified the hemorrhage site at the right middle lobe bronchus (B5b), and an EWS was then selectively deployed into this bronchus to block the hemorrhage. The following day, bronchial arterial embolization was performed, enabling the removal of the spigot on the next day. The patient's respiratory condition gradually improved, allowing for extubation on the 21st postoperative day. By preventing bleeding into neighboring bronchi, which, in turn, avoids the risk of exacerbating hypoxia, bronchial occlusion with EWSs is highly effective in managing massive pulmonary hemorrhage during heart surgery.


Assuntos
Broncopatias , Procedimentos Cirúrgicos Cardíacos , Idoso de 80 Anos ou mais , Brônquios , Broncoscopia , Feminino , Hemorragia , Humanos , Recém-Nascido
7.
Orv Hetil ; 161(37): 1579-1587, 2020 09.
Artigo em Húngaro | MEDLINE | ID: mdl-32894738

RESUMO

The accessibility to blood products is increasingly limited worldwide. Approximately half of the blood products is utilized in cardiovascular surgery. The rational use of the available blood products has therefore paramount importance in everyday practice. In the present publication, the possible methods of blood-product sparing in cardiac surgery are summarized. We have emphasized the principles of the treatment and the prevention of severe peri-operative bleeding. Orv Hetil. 2020; 161(37): 1579-1587.


Assuntos
Anestesia em Procedimentos Cardíacos , Procedimentos Cirúrgicos Cardíacos , Hemorragia , Cirurgia Torácica , Transfusão de Sangue , Hemorragia/terapia , Humanos
8.
J Cardiovasc Med (Hagerstown) ; 21(10): 765-771, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32890069

RESUMO

AIMS: The aim of this study was to evaluate the clinical course of COVID-19 in patients who had recently undergone a cardiac procedure and were inpatients in a cardiac rehabilitation department. METHODS: All patients hospitalized from 1 February to 15 March 2020 were included in the study (n = 35; 16 men; mean age 78 years). The overall population was divided into two groups: group 1 included 10 patients who presented with a clinical picture of COVID-19 infection and were isolated, and group 2 included 25 patients who were COVID-19-negative. In group 1, nine patients were on chronic oral anticoagulant therapy and one patient was on acetylsalicylic acid (ASA) and clopidogrel. A chest computed tomography scan revealed interstitial pneumonia in all 10 patients. RESULTS: During hospitalization, COVID-19 patients received azithromycin and hydroxychloroquine in addition to their ongoing therapy. Only the patient on ASA with clopidogrel therapy was transferred to the ICU for mechanical ventilation because of worsening respiratory failure, and subsequently died from cardiorespiratory arrest. All other patients on chronic anticoagulant therapy recovered and were discharged. CONCLUSION: Our study suggests that COVID-19 patients on chronic anticoagulant therapy may have a more favorable and less complicated clinical course. Further prospective studies are warranted to confirm this preliminary observation.


Assuntos
Anticoagulantes/uso terapêutico , Azitromicina/administração & dosagem , Procedimentos Cirúrgicos Cardíacos , Infecções por Coronavirus , Hidroxicloroquina/administração & dosagem , Pandemias , Inibidores da Agregação de Plaquetas/uso terapêutico , Pneumonia Viral , Complicações Pós-Operatórias , Idoso , Anti-Infecciosos/administração & dosagem , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Terapia Combinada/métodos , Infecções por Coronavirus/sangue , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/fisiopatologia , Feminino , Humanos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Pneumonia Viral/sangue , Pneumonia Viral/diagnóstico , Pneumonia Viral/etiologia , Pneumonia Viral/mortalidade , Pneumonia Viral/fisiopatologia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/virologia , Tomografia Computadorizada por Raios X/métodos
9.
Pediatr Clin North Am ; 67(5): 973-993, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32888693

RESUMO

This article aims to summarize some of the key advances in congenital interventional cardiology over the past few years, from novel imaging technologies, such as virtual reality, fusion imaging, and 3-dimensional printed models, to newly available devices and techniques to facilitate complex procedures including percutaneous pulmonary valve replacement and hybrid procedures. It is an exciting time for the field, with rapid development of techniques, devices, and imaging tools that allow a minimally invasive approach for many congenital cardiac defects with progressively less radiation and contrast doses.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiologia/tendências , Diagnóstico por Imagem/métodos , Cardiopatias Congênitas/cirurgia , Cirurgia Assistida por Computador/tendências , Humanos
10.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(8): 905-914, 2020 08.
Artigo em Chinês | MEDLINE | ID: mdl-32912401

RESUMO

Pulmonary hypertension (PH) is a common disease. Pulmonary hypertension caused by left heart disease (PH-LHD) and congenital heart disease related pulmonary artery hypertension (PAH-CHD) account for main parts of PH and pulmonary artery hypertension (PAH) respectively. Patients are often complicated with PH before, during and after cardiac surgery. PH can cause right heart failure, and is a high risk factor for cardiac surgery. Accurate evaluation and reasonable treatment on HP can reduce perioperative complications and mortality, hence improve prognosis. This article elaborates the consensus of Chinese experts on the definition, classification, pathophysiology, diagnosis and perioperative treatment of PH related to cardiac surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Hipertensão Pulmonar/diagnóstico , Consenso , Cardiopatias Congênitas , Humanos , Hipertensão , Hipertensão Pulmonar/terapia
11.
Rev Lat Am Enfermagem ; 28: e3337, 2020.
Artigo em Português, Espanhol, Inglês | MEDLINE | ID: mdl-32876294

RESUMO

OBJECTIVE: to determine the microbiological characteristics of the red blood cells obtained with the cell saver in heart surgery patients on an extra-body circuit. METHOD: a cross-sectional and descriptive study conducted with 358 patients scheduled for heart surgery where the saver was used. Sociodemographic variables were collected, as well as from the saver and of the microbial identification in the re-infusion bag proceeding from the cell saver. Informed consent performed. RESULTS: of the 170 GRAM+ bacteria isolations, the most frequent species were Staphylococcus epidermidis in 69% (n=138) of the cases and Streptococcus sanguinis with a report of 10% (n=20). Significant differences were found in the Staphylococcus epidermidis strain in patients with a Body Mass Index ≥25 (p=0.002) submitted to valve surgery (p=0.001). Vancomycin was the antimicrobial which resisted the Staphylococcus epidermidis strain with a minimum inhibitory concentration of >16 µg/ml. CONCLUSION: the microbiological characteristics of the red blood cells obtained after processing autologic blood recovered with the cell saver during heart surgery are of GRAM+ bacterial origin, the most isolated species being Staphylococcus epidermidis. Consequently, in order to reduce the presence of these GRAM+ cocci, an antibiotic should be added to the cell saver reservoir, according to a previously established protocol.


Assuntos
Bacteriemia/epidemiologia , Procedimentos Cirúrgicos Cardíacos , Estudos Transversais , Eritrócitos , Humanos , Testes de Sensibilidade Microbiana
12.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(7): 812-818, 2020 Jul 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-32879085

RESUMO

OBJECTIVES: To explore the method and significance of prenatal counseling in cardiac surgery for fetal congenital heart disease (CHD). METHODS: The prenatal counseling should be provided by experienced CHD experts. The preliminary clinical diagnosis based on relevant data was carried out, the prognosis risk for fetal CHD was graded, and the pathophysiological process and potential hazards of the disease were analyzed. The current condition of CHD in the treatment plan, the long-term quality of life, and the special requirements of parturition in place, period and mode were described. A reliable follow-up system of the fetuses was established, the diagnosis after delivery was verified, and surgical treatment was carried out timely. RESULTS: From January 2016 to December 2018, 225 parents with fetal CHD received prenatal counseling, including 60 fetuses (26.7%) with simple CHD and 165 (73.3%) with complex CHD, among which 59 cases (98.3%) and 93 cases (56.4%) decided to continue the pregnancy, respectively. During the follow-up, 118 fetuses were born, of which 66 infants received surgical treatment within 6 months after birth, 63 infants (95.5%) recovered and 3 infants (4.5%) died. The rest 52 infants continued to be followed up. CONCLUSIONS: The prenatal counseling for fetal CHD can provide the parents a comprehensive medical information about CHD, which is beneficial to making appropriate pregnancy decisions, and can turn the fetuses from unreasonable birth and passive treatment to selective birth and active treatment in CHD.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas/cirurgia , Aconselhamento , Feminino , Feto , Humanos , Gravidez , Diagnóstico Pré-Natal , Qualidade de Vida , Ultrassonografia Pré-Natal
13.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(6): 864-868, 2020 Jun 30.
Artigo em Chinês | MEDLINE | ID: mdl-32895199

RESUMO

OBJECTIVE: To compare the median effective dose (ED50) of intranasal dexmedetomidine for procedural sedation in uncooperative pediatric patients with acyanotic congenital heart disease before and after cardiac surgery. METHODS: We prospectively recruited 47 children (22 in preoperative group and 25 in postoperative group) who needed sedation for transthoracic echocardiography (TTE). A modified up-and-down sequential study design was employed to determine dexmedetomidine dose for each patient with a starting dose of 2 µg/kg in both groups; dexmedetomidine doses for subsequent subjects were determined according to the responses from the previous subject using the up-and-down method at a 0.25 µg/kg interval. The ED95 was determined using probit regression. The onset time, examination time, wake-up time and adverse effects were measured, and the safety was evaluated in terms of changes in vital signs every 5 min. RESULTS: The ED50 value of intranasal dexmedetomidine for sedation was 1.84 µg/kg (95% CI: 1.68-2.00 µg/kg) in children with congenital heart disease before cardiac surgery, and 3.38 µg/kg (95% CI: 3.21-3.54 µg/kg) after the surgery. No significant difference was found between the two groups in the demographic variables, onset time, examination time, wake-up time, or adverse effects. CONCLUSIONS: In children with acyanotic congenital heart disease, the ED50 of intranasal dexmedetomidine for TTE sedation increases to 3.38 µg/ kg after cardiac surgery from the preoperative value of 1.84 µg/kg.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias Congênitas , Administração Intranasal , Criança , Dexmedetomidina , Cardiopatias Congênitas/cirurgia , Humanos , Hipnóticos e Sedativos
14.
BMC Infect Dis ; 20(1): 705, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32977755

RESUMO

BACKGROUND: Infective endocarditis (IE) is associated with high mortality. Surgery may improve survival and reduce complications, but the balance between benefit and harm is difficult and may be closely related to age and type of surgical intervention. We aimed to examine how age and type of left-sided surgical intervention modified mortality in patients undergoing surgery for IE. METHODS: By crosslinking nationwide Danish registries we identified patients with first-time IE undergoing surgical treatment 2000-2017. Patients were grouped by age < 60 years, 60-75 years, and ≥ 75 years. Multivariable adjusted Cox proportional hazard analysis was used to examine factors associated with 90-day mortality. RESULTS: We included 1767 patients with IE undergoing surgery, 735 patients < 60 years (24.1% female), 766 patients 60-75 years (25.8% female), and 266 patients ≥75 years (36.1% female). The proportions of patients undergoing surgery were 35.3, 26.9, and 9.1% for patients < 60 years, 60-75 years, and > 75 years, respectively. Mortality at 90 days were 7.5, 13.9, and 22.3% (p < 0.001) for three age groups. In adjusted analyses, patients 60-75 years and patients ≥75 years were associated with a higher mortality, HR = 1.84 (95% CI: 1.48-2.29) and HR = 2.47 (95% CI: 1.88-3.24) as compared with patients < 60 years. Factors associated with 90-day mortality were: mitral valve surgery, a combination of mitral and aortic valve surgery as compared with isolated aortic valve surgery, age, diabetes, and prosthetic heart valve implantation prior to IE admission. CONCLUSIONS: In patients undergoing surgery for IE, mortality increased significantly with age and 1 in 5 died above age 75 years. Mitral valve surgery as well as multiple valve interventions augmented mortality further.


Assuntos
Procedimentos Cirúrgicos Cardíacos/mortalidade , Procedimentos Cirúrgicos Cardíacos/métodos , Endocardite/cirurgia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Dinamarca , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Fatores de Risco , Resultado do Tratamento
15.
Ann Surg ; 272(4): e275-e279, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32932327

RESUMO

OBJECTIVE: The aim of this study was to describe the clinical course of a consecutive series of patients operated of urgent cardiac surgery during COVID-19 outbreak. BACKGROUND: In Italy, COVID outbreak has mostly occurred in the metropolitan area of Milan, and in the surrounding region of Lombardy, and previously "conventional" hospitals were converted into COVID spokes to increase ICU beds availability, and to allow only urgent CS procedures. METHODS: Among urgent CS patients (left main stenosis with unstable angina, acute endocarditis, valvular regurgitation with impending heart failure), 10 patients (mean age = 57 ± 9 years), despite a negative admission triage, developed COVID-pneumonia postoperatively, at a median of 7 days after CS. RESULTS: Patients showed typical lymphopenia, higher prothrombotic profile, and higher markers of inflammation (ferritin and interleukin-6 values). At the zenith of pulmonary distress, patients presented with severe hypoxia (median PaO2/FIO2 ratio = 116), requiring advanced noninvasive ventilation (Venturi mask and continuous positive airway pressure) in the majority of cases. All patients were treated with hydroxychloroquine, azithromycin, and low-molecular-weight heparin at anticoagulant dose. Overall in-hospital mortality was 10% (1/10), peaking 25% in patients who developed COVID pneumonia immediately after CS. The remaining patients, with late infection, were all discharged home without oxygen support, at a median of 25 days after symptom onset. CONCLUSIONS: As postoperative mortality in case of COVID pneumonia is not negligible, meticulous rules (precise triage, safe hospital path, high level of protection for health-care teams, prompt diagnosis of suspicious symptoms) should be strictly followed in patients undergoing CS during COVID pandemic. The role of therapies alternative to CS should be further assessed.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Idoso , Procedimentos Cirúrgicos Cardíacos/mortalidade , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Emergências , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Controle de Infecções/métodos , Unidades de Terapia Intensiva/estatística & dados numéricos , Itália , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Medição de Risco
16.
Am J Case Rep ; 21: e925931, 2020 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-32980852

RESUMO

BACKGROUND The worldwide spread of the severe acute respiratory syndrome-coronavirus-2 (SARS-COV-2) has created unprecedented situations for healthcare professionals and healthcare systems. Although infection with this virus is considered the main health problem currently, other diseases are still prevalent. CASE REPORT This report describes a 59-year-old man who presented with symptoms of dyspnea and fever that were attributed to Covid-19 infection. His clinical condition deteriorated and further examinations revealed a subjacent severe aortic regurgitation due to acute infective endocarditis. Surgical treatment was successful. CONCLUSIONS The results of diagnostic tests for Covid-19 should be re-evaluated whenever there are clinical mismatches or doubts, as false-positive Covid-19 test results can occur. Clinical interpretation should not be determined exclusively by the Covid-19 pandemic. This case report highlights the importance of using validated and approved serological and molecular testing to detect infection with SARS-CoV-2, and to repeat tests when there is doubt about presenting symptoms.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Diagnóstico Tardio , Endocardite/complicações , Endocardite/diagnóstico , Pneumonia Viral/diagnóstico , Anticorpos Antivirais/análise , Insuficiência da Valva Aórtica/complicações , Insuficiência da Valva Aórtica/diagnóstico , Procedimentos Cirúrgicos Cardíacos/métodos , Infecções por Coronavirus/complicações , Estado Terminal , Progressão da Doença , Dispneia/diagnóstico , Dispneia/etiologia , Endocardite/virologia , Reações Falso-Positivas , Febre/diagnóstico , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Prognóstico , Reação em Cadeia da Polimerase em Tempo Real/métodos , Medição de Risco , Resultado do Tratamento
17.
JACC Cardiovasc Interv ; 13(16): 1945-1948, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32819483

RESUMO

Teleproctoring can be used successfully in performing challenging and innovative structural heart interventions using sophisticated technology that allows real-time bidirectional audiovisual communication with digital transmission of live videos and direct observation of the operative field by a remote proctor. The authors share an illustrative case that was performed amid the coronavirus disease-2019 global pandemic that led to travel restrictions to limit spread of the virus. Teleproctoring has future implications beyond the current global health crisis to facilitate rapid dissemination and exchange of knowledge for ultimately helping patients around the globe.


Assuntos
Betacoronavirus , Procedimentos Cirúrgicos Cardíacos/métodos , Infecções por Coronavirus/complicações , Cardiopatias/cirurgia , Monitorização Fisiológica/métodos , Pandemias , Pneumonia Viral/complicações , Telemedicina/métodos , Infecções por Coronavirus/epidemiologia , Cardiopatias/complicações , Cardiopatias/diagnóstico , Humanos , Pneumonia Viral/epidemiologia
18.
JACC Cardiovasc Interv ; 13(16): 1949-1950, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32819484

RESUMO

The coronavirus disease-19 (COVID-19) period have dictated a different approach to cardiac interventions at our medical institution. We prioritize emergent care geared toward lesser invasive approaches while minimizing hospitalization duration. This reflects upon coronary and structural/valvular cases altogether. Despite potential criticism of this approach, we believe it is the most appropriate therapeutic strategy for this unique period. Further investigation is needed to examine the external validity of our approach in other medical centers worldwide.


Assuntos
Betacoronavirus , Procedimentos Cirúrgicos Cardíacos/normas , Doenças Cardiovasculares/cirurgia , Infecções por Coronavirus/complicações , Gerenciamento Clínico , Fidelidade a Diretrizes , Pandemias , Pneumonia Viral/complicações , Doenças Cardiovasculares/complicações , Infecções por Coronavirus/epidemiologia , Humanos , Pneumonia Viral/epidemiologia
19.
JACC Cardiovasc Interv ; 13(16): 1951-1957, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32819485

RESUMO

As the world slowly starts to recover from the coronavirus disease-2019 pandemic, health care systems are now thinking about resuming elective cardiovascular procedures, including procedures in cardiac catheterization laboratories. Rebooting catheterization laboratories will be an arduous process, in part because of limited health care resources, new processes, and fears stemming from the coronavirus disease-2019 pandemic. The authors propose a detailed phased-in approach that considers clinical, patient-centered, and operational strategies to safely and effectively reboot catheterization laboratory programs during these unprecedented times. This model balances the delivery of essential cardiovascular care with reduced exposure and preservation of resources. The guiding principles detailed in this review can be used by catheterization laboratory programs when restarting elective interventional procedures.


Assuntos
Betacoronavirus , Cateterismo Cardíaco/normas , Procedimentos Cirúrgicos Cardíacos/normas , Infecções por Coronavirus/complicações , Assistência à Saúde/normas , Laboratórios Hospitalares/normas , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/normas , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia
20.
Zhonghua Fu Chan Ke Za Zhi ; 55(7): 465-470, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32842250

RESUMO

Objective: To explore the efficacy and safety of open cardiac operation and interventional therapy in pregnant patients and describe the feto-neonatal and maternal outcomes. Methods: A retrospective study of 39 cases of women undergoing open cardiac operation or interventional therapy during pregnancy was conducted in Guangdong Provincial People's Hospital from Jan. 2014 to Oct. 2019. Results: The age of 39 pregnant women with gestational heart disease was (30±6) years old (21-43 years old). Among them, 37 cases were single and 2 cases were twin pregnancy. Modified World Health Organization (mWHO) pregnancy risk classification were all level Ⅳ. There were 22 women receiving cardiac operation under cardiopulmonary bypass during pregnancy, 14 patients undergoing percutaneous balloon mitral valvuloplasty, 2 patients accepting percutaneous balloon pulmonary valvuloplasty, and 1 case receiving atrial septal defect occluder with ultrasound guidance. Three were no maternal deaths during and after the operation. One patient had an inevitable abortion. Four fetuses died in the uterine after open cardiac surgery. There patients chose termination of the pregnancy after cardiac operation. There were 31 live birth, in which 7 cases were preterm live birth and 24 patients were term live birth. The total number of newborns were 33. Two fetuses suffered neonatal intracranial hemorrhage and died after birth. Thirty-one fetuses were alive and born without any abnormity. Conclusion: For pregnant women with high risk of cardiovascular disease and classified as mWHO pregnancy risk level Ⅳ, cardiopulmonary bypass and interventional therapy during pregnancy could be used as an alternative for better materal and fetal outcomes.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Cardiopatias/cirurgia , Complicações Cardiovasculares na Gravidez/cirurgia , Adulto , Feminino , Cardiopatias/diagnóstico , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Adulto Jovem
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