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2.
J Investig Med High Impact Case Rep ; 9: 23247096211031135, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34259086

RESUMO

Amid the coronavirus disease 2019 (COVID-19) pandemic, there is an unprecedented increase in public avoidance of hospitals predominantly driven by fear of contracting the virus. Recent publications highlight a re-emergence of rare post-myocardial infarction complications. While mechanical complications are infrequent in the era of primary percutaneous coronary intervention, they are associated with high mortality rates. The concurrent occurrence of mechanical complications such as left ventricular aneurysm and ventricular septal rupture is an extremely rare entity. We hereby delineate a unique case of a 53-year-old Caucasian male who underwent successful concomitant closure of a ventricular septal rupture, left ventricular aneurysmectomy, and 3-vessel coronary artery bypass grafting. Due to a delayed initial presentation owing to the patient's fear of contracting COVID-19, the surgery was carried out 3 months after the myocardial infarction. His postoperative evaluation confirmed normal contractility of the left ventricle and complete closure of the ventricular septal rupture. Six months postoperatively, the patient continues to do well. We also present a literature review of the mechanical complications following delayed presentation of myocardial infarction amid the COVID-19 pandemic. This article illustrates that clinicians should remain cognizant of these extremely rare but potentially lethal collateral effects during the ongoing global public-health challenge. Furthermore, it highlights a significant concern regarding the delay in first medical contact due to the reluctance of patients to visit the hospital during the COVID-19 pandemic.


Assuntos
Aneurisma Cardíaco/cirurgia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Tempo para o Tratamento , Ruptura do Septo Ventricular/cirurgia , COVID-19 , Procedimentos Cirúrgicos Cardíacos , Ponte de Artéria Coronária , Aneurisma Cardíaco/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Resultado do Tratamento , Ruptura do Septo Ventricular/complicações
3.
J Extra Corpor Technol ; 53(2): 137-139, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34194080

RESUMO

Little is reported in the literature regarding hereditary spherocytosis (HS) and cardiopulmonary bypass (CPB). We present a case of a 19-month-old girl child who was referred for an atrioventricular septal defect (AVSD) and HS. The patient underwent surgical repair, and an exchange transfusion was performed at the initiation of CPB. No significant hemolysis or events attributed to HS were observed during or after CPB. The surgical repair of an AVSD in a pediatric patient with HS and total volume exchange transfusion is herein reported.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Defeitos dos Septos Cardíacos , Esferocitose Hereditária , Ponte Cardiopulmonar , Criança , Transfusão Total , Feminino , Humanos , Lactente , Esferocitose Hereditária/complicações , Esferocitose Hereditária/cirurgia
4.
J Extra Corpor Technol ; 53(2): 140-145, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34194081

RESUMO

Blood-primed cardiopulmonary bypass circuits are frequently necessary to achieve safe support during pediatric open-heart surgery. Literature is lacking regarding suitable prime constituents or methods for achieving a physiologically appropriate blood-primed circuit. We examined the chemistry and hematology of neonatal blood-primed circuits from the conclusion of the priming procedure until the initiation of bypass. Base deficit/excess, pH, pO2, pCO2, HCO3, glucose, sodium, potassium, calcium, hematocrit, lactate, and osmolality were analyzed. Any deviation over time from the original prime value was compared for significance. Statistically significant changes were found between T0 and all time points for all parameters, except for pH and pO2 out to 1 hour. Among all parameters, various rates of change were observed. Although most changes in the parameters were found to be statistically significant, those changes may not be clinically significant based on clinician interpretation. Attention to the prime quality beyond the immediate post-priming period may be beneficial. Should the time period between validation of the prime quality and initiation of bypass be extended, it may be advisable to reevaluate the prime quality.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar , Criança , Máquina Coração-Pulmão , Hematócrito , Humanos , Recém-Nascido
5.
Medicine (Baltimore) ; 100(19): e23854, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106581

RESUMO

INTRODUCTION: Ventricular septal defect (VSD) accounts for up to 40% of all congenital cardiac malformations. Transthoracic closure of VSDs has been well described in literature. In the current report, we described a procedure to successfully close a VSD with 2 occluders from different incisions simultaneously under the guidance of trans-esophageal echocardiography (TEE), to save the patient from undergoing another surgery. PATIENT CONCERNS: A 52-year-old man was referred to our clinic for repeating palpitations for 6 months without chest pain and polypnea after activity. DIAGNOSIS: The diagnosis of VSD was established due to the findings of a juxtatricuspid VSD with a left-to-right shunt at ventricular level and mild mitral regurgitation by TTE. INTERVENTIONS: A transcatheter VSD closure was firstly performed but failed to repair the VSD. After the failure of transcatheter VSD closure, the patient received transthoracic closure of VSD operated by a cardiac surgeon. The VSD was closed with 2 occluders from different incisions (median thoracic skin incision and subxiphoid incision) simultaneously under the TEE guidance. OUTCOMES: The patient was extubated in intensive care unit and was discharged 4 days after the operation. During the follow up, there were no significant clinical nor laboratory side-effects of the procedure found as compared to the patient's condition before the procedure. CONCLUSION: VSD can be closed with 2 occluders from different incisions simultaneously under the TEE guidance to save the patient from undergoing repeated surgeries. Meanwhile, TEE plays a significant role in cardiac surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Dispositivo para Oclusão Septal , Cateterismo Cardíaco , Procedimentos Cirúrgicos Cardíacos/instrumentação , Ecocardiografia Transesofagiana , Humanos , Masculino , Pessoa de Meia-Idade
6.
Nat Commun ; 12(1): 3764, 2021 06 18.
Artigo em Inglês | MEDLINE | ID: mdl-34145265

RESUMO

Post-surgical cardiac adhesions represent a significant problem during routine cardiothoracic procedures. This fibrous tissue can impair heart function and inhibit surgical access in reoperation procedures. Here, we propose a hydrogel barrier composed of oxime crosslinked poly(ethylene glycol) (PEG) with the inclusion of a catechol (Cat) group to improve retention on the heart for pericardial adhesion prevention. This three component system is comprised of aldehyde (Ald), aminooxy (AO), and Cat functionalized PEG mixed to form the final gel (Ald-AO-Cat). Ald-AO-Cat has favorable mechanical properties, degradation kinetics, and minimal swelling, as well as superior tissue retention compared to an initial Ald-AO gel formulation. We show that the material is cytocompatible, resists cell adhesion, and led to a reduction in the severity of adhesions in an in vivo rat model. We further show feasibility in a pilot porcine study. The Ald-AO-Cat hydrogel barrier may therefore serve as a promising solution for preventing post-surgical cardiac adhesions.


Assuntos
Materiais Biocompatíveis/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Hidrogéis/química , Hidrogéis/uso terapêutico , Aderências Teciduais/prevenção & controle , Aldeídos/química , Animais , Materiais Biocompatíveis/química , Catecóis/química , Linhagem Celular , Masculino , Camundongos , Oximas/química , Oximas/uso terapêutico , Polietilenoglicóis/química , Ratos , Ratos Sprague-Dawley , Suínos
7.
Thorac Cardiovasc Surg ; 69(4): 294-307, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34176107

RESUMO

Based on a longtime voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS) in 1980, well-defined data of all cardiac, thoracic and vascular surgery procedures performed in 78 German heart surgery departments during the year 2020 are analyzed. Under the more than extraordinary conditions of the ongoing worldwide coronavirus disease 2019 pandemic, a total of 161,817 procedures were submitted to the registry. A total of 92,809 of these operations are summarized as heart surgery procedures in a classical sense. The unadjusted in-hospital survival rate for the 29,444 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 3.6:1) was 97.2%. For the 35,469 isolated heart valve procedures, (17,471 transcatheter interventions included), the survival rate was 96.7%. Concerning short- and long-term circulatory support, a total of 2,852 extracorporeal life support/extracorporeal membrane oxygenation implantations, respectively, 843 assist device implantations (left/right/biventricular assist device, total artificial device), were registered. In 2020, the number of isolated heart transplantations increased to 340, a rise of 2.1% compared with the previous year. The isolated lung transplantations amounted to 291, a decrease of 6.4%.This annually updated registry of the GSTCVS represents voluntary public reporting by accumulating actual information for nearly all heart surgical procedures in Germany, constitutes advancements in heart medicine, and represents a basis for quality management for all participating institutions. In addition, the registry demonstrates that the provision of cardiac surgery in Germany is up to date, appropriate, and nationwide patient treatment is guaranteed all the time.


Assuntos
COVID-19/epidemiologia , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Cardiopatias/cirurgia , Indicadores de Qualidade em Assistência à Saúde , Sistema de Registros , Sociedades Médicas , Cirurgia Torácica , Comorbidade , Alemanha/epidemiologia , Cardiopatias/epidemiologia , Humanos , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
8.
Medicine (Baltimore) ; 100(23): e26179, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34115000

RESUMO

BACKGROUND: Cigarette smoking is an important modifiable risk factor for incident atrial fibrillation. However, the impact of smoking on postoperative atrial fibrillation in patients undergoing cardiac surgery remains controversial. We performed this meta-analysis to explore the association of smoking with postoperative atrial fibrillation in patients with cardiac surgery. METHODS: We systematically searched 2 computer-based databases (PubMed and EMBASE) up to July 2019 for all relevant studies. A random-effects model was selected to pool the odds ratios (ORs) and 95% confidence intervals (CIs). In this meta-analysis, the protocol and reporting of the results were based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. RESULTS: A total of 36 studies were included in this meta-analysis. Overall, smoking was not associated with an increased risk of postoperative atrial fibrillation in patients undergoing cardiac surgery (odds ratio [OR] = 0.89; 95% confidence interval [CI] 0.79-1.02). The corresponding results were stable in the subgroup analyses. Specifically, smoking was not associated with an increased risk of postoperative atrial fibrillation regardless of the type of cardiac surgery: coronary artery bypass grafting (OR = 0.91; 95% CI 0.77-1.07), valve surgery (OR = 0.15; 95% CI 0.01-1.56), and coronary artery bypass grafting+valve surgery (OR = 0.91; 95% CI 0.70-1.18). CONCLUSIONS: Based on currently published studies, smoking was not associated with an increased risk of postoperative atrial fibrillation in patients undergoing cardiac surgery.


Assuntos
Fibrilação Atrial/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Fumar/efeitos adversos , Fibrilação Atrial/epidemiologia , Fibrilação Atrial/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/psicologia , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Correlação de Dados , Humanos , Razão de Chances , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Medição de Risco/métodos , Fatores de Risco , Fumar/epidemiologia , Fumar/psicologia
9.
Medicine (Baltimore) ; 100(22): e26152, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087871

RESUMO

RATIONALE: Patients with cancer have elevated risk of both venous thromboembolism and bleeding compared with patients without cancer due to cancer- and patient-specific factors. Balancing the increased and competing risks of clotting and bleeding in these patients can be difficult because management of cancer-associated thrombosis requires anticoagulation despite its known increased risks for bleeding. The adjustment of blood transfusion or cessation of anticoagulants can be a challenge in surgical diagnosis or treatment of cancer patients with such an imbalanced coagulate status. PATIENT CONCERNS: A 45-year-old woman with no underlying disease was suspected of ovarian cancer and was awaiting diagnostic laparoscopic exploration surgery. DIAGNOSES: While waiting for the surgery, the patient developed chest pain and underwent stent insertion under diagnosis of myocardial infarction. Two weeks later, endocarditis developed, and replacement of the aortic valve and mitral valve was planned. In addition, the patient developed multiple thromboembolisms and was administered anticoagulants to eliminate vegetation of valves and multiple thromboses. Her blood test showed anemia (7.4 g/dL) and severe thrombocytopenia (24 × 109/L). INTERVENTIONS: The patient underwent double valve replacement. OUTCOMES: A color change of the left lower extremity was noted 5 hours after double valve replacement, and angiography was performed. Thrombectomy was performed under diagnosis of thrombosis in the left iliac artery. One month later, the patient underwent laparoscopic exploration surgery as scheduled. LESSONS: This case will help establish the criteria of blood coagulation for surgical treatment of cancer patients with imbalanced clotting and bleeding.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Neoplasias/complicações , Trombocitopenia/complicações , Tromboembolia/etiologia , Trombose/complicações , Anticoagulantes/uso terapêutico , Endocardite/complicações , Endocardite/cirurgia , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/cirurgia , Stents , Trombose/tratamento farmacológico
10.
Methodist Debakey Cardiovasc J ; 17(1): 36-42, 2021 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-34104318

RESUMO

The treatment of drug-refractory chronic ventricular tachycardia (VT) has undergone a revolution over the last 50 years. We now have automatic implantable cardioverter defibrillator therapy with pace-terminating capabilities, and catheter ablation of VT has refined mapping and improved methods of lesion generation. Between 1980 and 1993, Houston Methodist Hospital became a leader in the diagnosis and surgical ablation of VT and other arrhythmias. This is a brief account of that period and some of the experiences and lessons that have led to significant advances used today.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Frequência Cardíaca , Taquicardia Ventricular/cirurgia , Potenciais de Ação , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/história , Difusão de Inovações , Técnicas Eletrofisiológicas Cardíacas , História do Século XX , História do Século XXI , Humanos , Complicações Pós-Operatórias/etiologia , Recidiva , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/história , Taquicardia Ventricular/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
11.
J Card Surg ; 36(8): 2876-2889, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34120376

RESUMO

BACKGROUND: Mental health and wellbeing continue to gain more attention as they are inextricably associated with clinical outcomes, particularly quality of life. Many medical ailments and major surgeries affect patients' mental health, including depression and delirium. AIMS: The objective of this manuscript was to comprehensively review and critically examine the literature pertaining to cardiac surgery, depression, and delirium. METHODS: This is a narrative review article. We performed our search analysis by using the following key words: "Cardiac Surgery", "Depression", "Delirium", "Clinical outcomes", and "Mental Health". Search analysis was done on MedLine PubMed, accessing indexed peer-reviewed publications. RESULTS: Cardiac Surgery is a life-altering intervention indicated to improve morbidity and mortality in patients with cardiovascular diseases. Psychiatric conditions before and after cardiac surgery worsen patient prognosis and increase mortality rate. Specifically, preoperative depression increases postoperative depression and is associated with impaired functional status, slow physical recovery, and an increased readmission rate. DISCUSSION: Although the exact pathophysiology between depression and cardiovascular disease (CVD) is unknown, several pathways have been implicated. Unmanaged depression can also lead to other psychological conditions such as delirium. Like depression, the exact association between delirium and CVD is not well understood, but believed to be multifactorial. CONCLUSION: Herein, we provide a comprehensive review of the links between depression, delirium, and cardiovascular surgery. We critically examine the current data that pertains to the pathophysiology of these debilitating mental health issues in the context of cardiac surgery. Finally, we summarize the various treatment options available for managing depression and delirium in the cardiac surgery patient population.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Delírio , Delírio/etiologia , Depressão/etiologia , Humanos , Complicações Pós-Operatórias , Qualidade de Vida , Fatores de Risco
12.
Thorac Cardiovasc Surg ; 69(4): 294-307, 2021 06.
Artigo em Inglês | MEDLINE | ID: covidwho-1281759

RESUMO

Based on a longtime voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS) in 1980, well-defined data of all cardiac, thoracic and vascular surgery procedures performed in 78 German heart surgery departments during the year 2020 are analyzed. Under the more than extraordinary conditions of the ongoing worldwide coronavirus disease 2019 pandemic, a total of 161,817 procedures were submitted to the registry. A total of 92,809 of these operations are summarized as heart surgery procedures in a classical sense. The unadjusted in-hospital survival rate for the 29,444 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 3.6:1) was 97.2%. For the 35,469 isolated heart valve procedures, (17,471 transcatheter interventions included), the survival rate was 96.7%. Concerning short- and long-term circulatory support, a total of 2,852 extracorporeal life support/extracorporeal membrane oxygenation implantations, respectively, 843 assist device implantations (left/right/biventricular assist device, total artificial device), were registered. In 2020, the number of isolated heart transplantations increased to 340, a rise of 2.1% compared with the previous year. The isolated lung transplantations amounted to 291, a decrease of 6.4%.This annually updated registry of the GSTCVS represents voluntary public reporting by accumulating actual information for nearly all heart surgical procedures in Germany, constitutes advancements in heart medicine, and represents a basis for quality management for all participating institutions. In addition, the registry demonstrates that the provision of cardiac surgery in Germany is up to date, appropriate, and nationwide patient treatment is guaranteed all the time.


Assuntos
COVID-19/epidemiologia , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Cardiopatias/cirurgia , Indicadores de Qualidade em Assistência à Saúde , Sistema de Registros , Sociedades Médicas , Cirurgia Torácica , Comorbidade , Alemanha/epidemiologia , Cardiopatias/epidemiologia , Humanos , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
13.
BMJ Open ; 11(6): e050919, 2021 06 09.
Artigo em Inglês | MEDLINE | ID: covidwho-1263926

RESUMO

INTRODUCTION: Cardiothoracic surgical outcomes are poorer in people with diabetes compared with those without diabetes. There are two important uncertainties in the management of people with diabetes undergoing major surgery: (1) how to improve diabetes management in the weeks leading up to an elective procedure and (2) whether that improved management leads to better postoperative outcomes. We previously demonstrated the feasibility of delivering the Optimising Cardiac Surgery ouTcOmes in People with diabeteS (OCTOPuS) intervention, an outpatient intervention delivered by diabetes healthcare professionals for people with suboptimally managed diabetes over 8-12 weeks before elective cardiac surgery. The present study will assess the clinical and cost-effectiveness of the intervention in cardiothoracic centres across the UK. METHODS AND ANALYSIS: A multicentre, parallel group, single-blinded 1:1 individually randomised trial comparing time from surgery until clinically fit for discharge in adults with suboptimally managed type 1 diabetes or type 2 diabetes undergoing elective surgery between the OCTOPuS intervention and usual care (primary endpoint). Secondary endpoints will include actual time from surgery to discharge from hospital; days alive and either out of hospital or judged as clinically fit for discharge; mortality; time on intensive therapy unit (ITU)/ventilator; infections; acute myocardial infarction; change in weight; effect on postoperative renal function and incidence of acute kidney injury; change in HbA1c; frequency and severity of self-reported hypoglycaemia; operations permanently cancelled for suboptimal glycaemic levels; cost-effectiveness; psychosocial questionnaires. The target sample size will be 426 recruited across approximately 15 sites. The primary analysis will be conducted on an intention-to-treat population. A two-sided p value of 0.05 or less will be used to declare statistical significance for all analyses and results will be presented with 95% CIs. ETHICS AND DISSEMINATION: The trial was approved by the South Central-Hampshire A Research Ethics Committee (20/SC/0271). Results will be disseminated through conferences, scientific journals, newsletters, magazines and social media. TRIAL REGISTRATION NUMBER: ISRCTN10170306.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Octopodiformes , Adulto , Animais , Humanos , Estudos Multicêntricos como Assunto , Pacientes Ambulatoriais , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
Clin Chim Acta ; 520: 196-201, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34090881

RESUMO

BACKGROUND: C-reactive protein (CRP) is expected to increase in response to a range of inflammatory stimuli such as infections or extensive tissue trauma. CASE REPORT: We present a novel case of severely impaired CRP response following NSTEMI, influenza A infection and open-heart surgery in which serum CRP concentrations remained < 1 mg/L during an observational period of 28 days. CONCLUSION: To our knowledge, no previous publications exists describing patients with a lack of CRP response following cardiothoracic surgery. We believe this to be a novel finding warranting further investigations regarding the etiology and prevalence of this phenomenon.


Assuntos
Proteína C-Reativa , Procedimentos Cirúrgicos Cardíacos , Biomarcadores , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Humanos
15.
JAMA ; 325(24): 2480-2494, 2021 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-34156404

RESUMO

Importance: More than 40 million people are living with either mitral or aortic valve disease worldwide, and more than 180 000 heart valve replacement surgeries are performed each year in the US. Transcatheter valve repair has emerged as an important therapeutic option for patients who are candidates for heart valve replacement. Observations: All transcatheter valve therapies involve a multidisciplinary team of interventional cardiologists, cardiothoracic surgeons, radiologists, echocardiographers, nurses, and social workers, termed the heart team, to determine the optimal approach for managing each patient. Transcatheter aortic valve implantation (TAVI) is an aortic valve replacement procedure that is performed percutaneously and is currently approved for patients with severe, symptomatic aortic stenosis in all surgical risk categories. The TAVI procedure can be performed using a balloon-expandable or self-expanding valve. In a low-risk cohort of patients (PARTNER [Placement of Aortic Transcatheter Valves] 3 trial), the rates of death from any cause, stroke, or rehospitalization were 8.5% for patients receiving TAVI and 15.1% for patients undergoing surgical aortic valve replacement. Decision-making regarding therapy choice should be based on individual anatomy (including the number of leaflets, annular size, and peripheral arterial anatomy), comorbidities (including concomitant coronary artery disease and aortopathies), and patient preference guide. A mitral transcatheter edge-to-edge repair device is approved by the US Food and Drug Administration for high-risk patients with degenerative and functional mitral regurgitation that has excellent safety and efficacy in these populations. In the COAPT (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial, the annualized rate of all hospitalizations for heart failure was 35.8% among patients who underwent transcatheter edge-to-edge repair and received medical therapy compared with 67.9% among patients in the medical therapy alone group. Transcatheter tricuspid valve repair and replacement trials are ongoing and show promise for the treatment of patients with tricuspid regurgitation, which previously had limited therapeutic options. Multimodality imaging, which includes transthoracic echocardiography, transesophageal echocardiography, computed tomography, and intracardiac echocardiography, is important for preprocedural planning, device selection, and optimal outcomes. Conclusions and Relevance: Approximately 78 000 TAVI procedures and 10 000 transcatheter mitral valve repairs take place yearly in the US to treat patients with severe, symptomatic aortic stenosis and mitral regurgitation, respectively. Transcatheter valve therapies have expanded therapeutic options for patients, including for those who previously had no viable surgical options.


Assuntos
Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Substituição da Valva Aórtica Transcateter , Humanos , Fatores de Risco , Substituição da Valva Aórtica Transcateter/métodos , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/cirurgia
16.
J Cardiothorac Surg ; 16(1): 174, 2021 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-34127025

RESUMO

BACKGROUND: After sternotomy, the spectrum for sternal osteosynthesis comprises standard wiring and more complex techniques, like titanium plating. The aim of this study is to develop a predictive risk score that evaluates the risk of sternum instability individually. The surgeon may then choose an appropriate sternal osteosynthesis technique that is risk- adjusted as well as cost-effective. METHODS: Data from 7.173 patients operated via sternotomy for all cardiovascular indications from 2008 until 2017 were retrospectively analyzed. Sternal dehiscence occurred in 2.5% of patients (n = 176). A multivariable analysis model examined pre- and intraoperative factors. A multivariable logistic regression model and a backward elimination based on the Akaike Information Criterion (AIC) a logistic model were selected. RESULTS: The model showed good sensitivity and specificity (area under the receiver-operating characteristic curve, AUC: 0.76) and several predictors of sternal instability could be evaluated. Multivariable logistic regression showed the highest Odds Ratios (OR) for reexploration (OR 6.6, confidence interval, CI [4.5-9.5], p < 0.001), obesity (body mass index, BMI > 35 kg/m2) (OR 4.23, [CI 2.4-7.3], p < 0.001), insulin-dependent diabetes mellitus (IDDM) (OR 2.2, CI [1.5-3.2], p = 0.01), smoking (OR 2.03, [CI 1.3-3.08], p = 0.001). After weighting the probability of sternum dehiscence with each factor, a risk score model was proposed scaling from - 1 to 5 points. This resulted in a risk score ranging up to 18 points, with an estimated risk for sternum complication up to 74%. CONCLUSIONS: A weighted scoring system based on individual risk factors was specifically created to predict sternal dehiscence. High-scoring patients should receive additive closure techniques.


Assuntos
Esternotomia/métodos , Deiscência da Ferida Operatória/prevenção & controle , Técnicas de Fechamento de Ferimentos , Adulto , Idoso , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Tomada de Decisões , Diabetes Mellitus Tipo 1/complicações , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Obesidade/complicações , Curva ROC , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fumar/efeitos adversos , Esternotomia/efeitos adversos , Deiscência da Ferida Operatória/etiologia
17.
J Cardiothorac Surg ; 16(1): 175, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34130728

RESUMO

BACKGROUND: Mitral regurgitation (MR) is a rather common valvular heart disease. The aim of this systematic review and meta-analysis was to compare the outcomes, and complications of mitral valve (MV) replacement with surgical MV repair of non-ischemic MR (NIMR) METHODS: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched until October, 2020. Studies were eligible for inclusion if they included patients with MR and reported early (30-day or in-hospital) or late all-cause mortality. For each study, data on all-cause mortality and incidence of reoperation and operative complications in both groups were used to generate odds ratios (ORs) or hazard ratios (HRs). This study is registered with PROSPERO, CRD42018089608. RESULTS: The literature search yielded 4834 studies, of which 20 studies, including a total of 21,898 patients with NIMR, were included. The pooled analysis showed that lower age, less female inclusion and incident of hypertension, significantly higher rates of diabetes and atrial fibrillation in the MV replacement group than MV repair group. No significant differences in the rates of pre-operative left ventricle ejection fraction (LVEF) and heart failure were observed between groups. The number of patients in the MV repair group was lower than in the MV replacement group. We found that there were significantly increased risks of mortality associated with replacement of MR. Moreover, the rate of re-operation and post-operative MR in the MV repair group was lower than in the MV replacement group. CONCLUSIONS: In patients with NIMR, MV repair achieves higher survival and leads to fewer complications than surgical MV replacement. In light of these results, we suggest that MV repair surgery should be a priority for NIMR patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Idoso , Procedimentos Cirúrgicos Cardíacos/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/mortalidade , Razão de Chances , Complicações Pós-Operatórias , Modelos de Riscos Proporcionais , Viés de Publicação , Reoperação/estatística & dados numéricos , Volume Sistólico , Resultado do Tratamento
18.
J Cardiothorac Surg ; 16(1): 177, 2021 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-34147120

RESUMO

BACKGROUND: Coronary artery aneurysms are rare findings in patients undergoing coronary angiography. The presence of multiple coronary artery aneurysms located in more than one coronary artery is even more uncommon. The pathophysiology of such aneurysms is unknown, but the majority are often due to atherosclerosis, congenital heart disease, or vasculitis. CASE PRESENTATION: We present a rare case of a 78-year-old female patient who presented with unstable angina and non-ST segment elevation myocardial infarction. On coronary angiography, she was found to have three separate 1 cm saccular aneurysms involving the proximal left anterior descending coronary artery. The right coronary artery could not be visualized. Computed chest tomography revealed a 6.6 × 6.3 cm saccular aneurysm of the right coronary artery, and a 4.4 cm fusiform aneurysm of the ascending aorta. The patient gave no history of percutaneous coronary intervention or cardiac surgical procedures. She had a previous history of endovascular stenting of an abdominal aortic aneurysm. The sizable right coronary artery aneurysm showed extrinsic compression of both the right atrium and ventricle with right ventricular hypokinesis. Serological studies for vasculitis were all negative. Pathology of the aneurysm wall revealed calcific atherosclerosis without evidence of vasculitis. The patient underwent subtotal resection of the right coronary aneurysm with ligation of the proximal and distal ends of the right coronary artery and double bypass surgery to the left anterior descending and right posterior descending coronary arteries. CONCLUSION: The presence of multiple, large coronary artery aneurysms is very rare. Treatment can be challenging and should be individualized. Surgical treatment is recommended for giant coronary artery aneurysms to prevent potential complications.


Assuntos
Aneurisma Coronário/cirurgia , Vasos Coronários/diagnóstico por imagem , Idoso , Procedimentos Cirúrgicos Cardíacos , Aneurisma Coronário/diagnóstico por imagem , Angiografia Coronária , Vasos Coronários/patologia , Feminino , Humanos , Tomografia Computadorizada por Raios X
19.
Gen Thorac Cardiovasc Surg ; 69(8): 1271-1273, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34146239

RESUMO

Gaining bloodless field in minimally invasive mitral valve surgery is crucial for a successful surgery. We here demonstrate a simple method to obtain bloodless field in minimally invasive mitral valve surgery with only single venous cannula through the femoral vein. A dual-stage venous cannula is inserted through the femoral vein, with its tip located deep in superior vena cava. After establishing full flow, the inferior vena cava (IVC) was snared. Returning blood from the IVC was blocked at the snare, and drained through the side holes at the midportion of the cannula. This technique collapsed the right atrium, and made the left atrium almost bloodless. Pressures of the femoral vein measured in 28 patients were 9.5 ± 4.1 mmHg before bypass, 6.8 ± 4.8 mmHg before snaring IVC, and 7.2 ± 4.8 mmHg after snaring. By blocking returning blood from the lower body, venous congestion of the lower body did not occur.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Veia Cava Inferior , Drenagem , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia , Veia Cava Superior
20.
BMC Health Serv Res ; 21(1): 550, 2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-34090421

RESUMO

BACKGROUND: Bleeding during cardiac surgery is a common complication that often requires the transfusion of blood products. The combination of bleeding and blood product transfusion incrementally increases adverse outcomes including infection and mortality. Following bleeding management guideline recommendations could assist with minimising risk but adherence is not high, and the cause for lack of adherence is not well understood. This study aimed to identify barriers and facilitators to practicing and implementing evidenced-based intra-operative, bleeding management in Australian cardiac surgery units. METHODS: We used a qualitative descriptive design to conduct semi-structured interviews with Australian cardiac surgeons, anaesthetists and perfusionists. The Theoretical Domains Framework (TDF) was utilised to guide interviews and thematically analyse the data. Categorised data were then linked with the three key domains of the COM-B model (capability, opportunity, motivation - behaviour) to explore and understand behaviour. RESULTS: Seventeen interviews were completed. Nine of the 14 TDF domains emerged as significant. Analysis revealed key themes to improving capability included, standardisation, monitoring, auditing and feedback of data and cross discipline training. Opportunity for change was improved with interpersonal and interdepartmental collaboration through shared goals, and more efficient and supportive processes allowing clinicians to navigate unfamiliar business and financial models of health care. Results suggest as individuals, clinicians had the motivation to make change and healthcare organisations have an obligation and a responsibility to partner with clinicians to support change and improve goal directed best practice. CONCLUSION: Using a theory-based approach it was possible to identify factors which may be positively or negatively influence clinicians ability to implement best practice bleeding management in Australian cardiac surgical units.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Motivação , Austrália , Humanos , Pesquisa Qualitativa
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