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1.
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
2.
Orv Hetil ; 161(34): 1414-1422, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32804671

RESUMO

INTRODUCTION: Bleeding and transfusions following cardiac surgery significantly increase the rate of complications. Early diagnosis of "surgical" and "coagulopathic" bleeding is a prerequisite for effective treatment. Thromboelastometry with targeted hemostasis therapy can help in setting up the indication for reoperation and reduction of blood loss, transfusions and costs. AIM: We aimed to develop a local "reoperation for bleeding" protocol derived from the data of our former patients. METHOD: Based on data from 1011 cardiac surgical patients (control group), we developed a statistical algorithm to distinguish between "coagulopathic" and "surgical" bleeding. We used viscoelastic coagulation test and risk stratification. In 112 consecutive patients (study group), we examined the reoperations, and the impact of the protocol on the rates of transfusions and treatment costs. RESULTS: There was no difference in the rate of reoperations between the two groups (6.2% vs. 5.4%; p = 0.584). No coagulopathic bleeding occurred in the study group, compared to 12.7% in the control group. In the study group, we experienced reduction in bleeding (p = 0.026), an increased application of fibrinogen (p<0.001), prothrombin complex concentrate (p<0.001), and tranexamic acid (p<0.001). Red blood cell transfusions decreased by 30% (1.7 ± 2.6 E vs. 2.3 ± 3.3 E; p = 0.012). No difference was found in the amounts of fresh frozen plasma or platelet transfusions used. Calculated cost savings were HUF -20,333 per patient. CONCLUSION: Using this algorithm, reoperations were performed only in cases of surgical bleeding. The amount of bleeding, requirement for transfusions and treatment costs were reduced. Orv Hetil. 2020; 161(34): 1414-1422.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Hemostasia Cirúrgica/métodos , Hemostáticos/uso terapêutico , Terapia de Alvo Molecular , Reoperação , Algoritmos , Estudos de Casos e Controles , Terapia Combinada , Humanos , Resultado do Tratamento
3.
J Thorac Cardiovasc Surg ; 160(3): 757-771.e5, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32800265

RESUMO

OBJECTIVES: It remains unclear when sudden cardiac event risk outweighs surgical risk for patients with anomalous aortic origin of a coronary artery. The Congenital Heart Surgeons' Society sought to characterize the surgical risks by determining the techniques, complications, and outcomes of repair. METHODS: Between January 2000 and September 2018, 682 patients with anomalous aortic origin of a coronary artery aged 30 years or less were enrolled. Demographic, morphologic, operative, imaging, and ischemia-related data were analyzed. RESULTS: There were 395 of 682 (57%) surgical patients (45 centers, median follow-up 2.8 years). In addition to primary repair (87% unroofing, 26% commissural manipulation), 13 patients had 15 coronary-related reoperations. Of 358 patients with pre/postoperative aortic insufficiency assessment, 27 (8%) developed new mild or greater aortic insufficiency postoperatively, and 7 (2%) developed new moderate or greater aortic insufficiency. Freedom from mild aortic insufficiency differed in those with versus without commissural manipulation (85%/91% at 6 months, 83%/90% at 1 year, and 77%/88% at 3 years, respectively) (P = .05). Of 347 patients with preoperative/postoperative ejection fraction, 6 (2%) developed new abnormal ejection fraction (<50%) within 30 days of surgery which persisted. Although 64 of 395 patients (16%) had preoperative ischemia, after surgery 51 of 64 patients (80%) no longer had ischemia (13 = new postoperative ischemia, P < .0001). Four patients died postoperatively (preoperatively 2 asymptomatic, 1 symptomatic, 1 in extremis). Composite surgical adverse event rates were 7% to 13% in the entire cohort (increasing/decreasing by presentation/anatomy/repair strategy). CONCLUSIONS: Anomalous aortic origin of a coronary artery surgery may relieve ischemia with low mortality; however, it can result in a variety of important morbidities, varying by the group evaluated. Strategies avoiding commissural manipulation may decrease the risk of developing aortic insufficiency. Understanding these risks should inform surgical decision-making and support the need for standardized assessment and management.


Assuntos
Aorta/cirurgia , Procedimentos Cirúrgicos Cardíacos , Anomalias dos Vasos Coronários/cirurgia , Complicações Pós-Operatórias , Adolescente , Adulto , Insuficiência da Valva Aórtica/epidemiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Adulto Jovem
4.
Crit Care ; 24(1): 478, 2020 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-32736589

RESUMO

BACKGROUND: Cardiac surgery-associated acute kidney injury (CSA-AKI) is a major complication that results in increased morbidity and mortality after cardiac surgery. Most established prediction models are limited to the analysis of nonlinear relationships and fail to fully consider intraoperative variables, which represent the acute response to surgery. Therefore, this study utilized an artificial intelligence-based machine learning approach thorough perioperative data-driven learning to predict CSA-AKI. METHODS: A total of 671 patients undergoing cardiac surgery from August 2016 to August 2018 were enrolled. AKI following cardiac surgery was defined according to criteria from Kidney Disease: Improving Global Outcomes (KDIGO). The variables used for analysis included demographic characteristics, clinical condition, preoperative biochemistry data, preoperative medication, and intraoperative variables such as time-series hemodynamic changes. The machine learning methods used included logistic regression, support vector machine (SVM), random forest (RF), extreme gradient boosting (XGboost), and ensemble (RF + XGboost). The performance of these models was evaluated using the area under the receiver operating characteristic curve (AUC). We also utilized SHapley Additive exPlanation (SHAP) values to explain the prediction model. RESULTS: Development of CSA-AKI was noted in 163 patients (24.3%) during the first postoperative week. Regarding the efficacy of the single model that most accurately predicted the outcome, RF exhibited the greatest AUC (0.839, 95% confidence interval [CI] 0.772-0.898), whereas the AUC (0.843, 95% CI 0.778-0.899) of ensemble model (RF + XGboost) was even greater than that of the RF model alone. The top 3 most influential features in the RF importance matrix plot were intraoperative urine output, units of packed red blood cells (pRBCs) transfused during surgery, and preoperative hemoglobin level. The SHAP summary plot was used to illustrate the positive or negative effects of the top 20 features attributed to the RF. We also used the SHAP dependence plot to explain how a single feature affects the output of the RF prediction model. CONCLUSIONS: In this study, machine learning methods were successfully established to predict CSA-AKI, which determines risks following cardiac surgery, enabling the optimization of postoperative treatment strategies to minimize the postoperative complications following cardiac surgeries.


Assuntos
Lesão Renal Aguda/epidemiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Aprendizado de Máquina , Modelos Estatísticos , Complicações Pós-Operatórias/epidemiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Medição de Risco/métodos
5.
Pediatr Cardiol ; 41(7): 1532-1537, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32813029

RESUMO

In this review, we provide a brief description of recently published articles addressing topics relevant to pediatric cardiologists. Our aim is to provide a summary of the latest articles published recently in other journals in our field. The articles address (1) cardiac resynchronization in children with symptomatic ventricular dysfunction and dyssynchrony which seems to result in higher transplant-free survival, (2) outcomes of aortic leaflet reconstruction including Ozaki procedure to repair aortic valve disease in adolescents, (3) meta-analysis for risk factors of ventricular tachycardia and death after repaired tetralogy of Fallot which reiterates the known risk factors and showed that the severity of pulmonary regurgitation is not in itself associated with outcomes although the ventricular response to regurgitation (dilation and dysfunction) is, (4) preschool promotion of healthy life style did not associate with sustained effect when evaluated later in childhood although repeated intervention seems to have a dose-related effect to promote healthy life style, (5) the lack of beneficial effects of angiotensin-converting enzyme inhibitors in the interstage period, and (6) a new phenomenon of acute heart failure and multisystem inflammatory syndrome in children temporarily related to the COVID-19 pandemic.


Assuntos
Cardiopatias/complicações , Cardiopatias/terapia , Adolescente , Betacoronavirus , Terapia de Ressincronização Cardíaca/métodos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Criança , Pré-Escolar , Infecções por Coronavirus/complicações , Cardiopatias Congênitas/terapia , Cardiopatias/cirurgia , Insuficiência Cardíaca/complicações , Ventrículos do Coração/fisiopatologia , Humanos , Síndrome do Coração Esquerdo Hipoplásico/tratamento farmacológico , Pandemias , Pneumonia Viral/complicações , Fatores de Risco , Síndrome de Resposta Inflamatória Sistêmica/complicações , Taquicardia Ventricular/complicações , Tetralogia de Fallot/complicações , Tetralogia de Fallot/cirurgia
6.
J Card Surg ; 35(10): 2479-2485, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32789988

RESUMO

BACKGROUND: Both coronavirus disease (COVID-19) and cardiac surgery have a negative impact on pulmonary function. This study aimed to determine the postoperative respiratory outcomes of patients with COVID-19 who underwent cardiac surgery. METHODS: In this retrospective study, we reviewed and analyzed the patient characteristics and clinical data of 25 asymptomatic patients with COVID-19 who underwent urgent or emergency cardiac surgery at Tehran Heart Center Hospital, Iran, between 29 February and 10 April 2020. RESULTS: The mean age, EuroSCORE, and body mass index were 57.3 ± 15.1 years, 6.65 ± 1.29, and 25.7 ± 3.7 kg/m2 , respectively. Four patients underwent off-pump cardiac surgery and 21 underwent on-pump cardiac surgery with a median cardiopulmonary bypass time of 85 minutes (interquartile range (IQR, 50-147). The overall mortality rate and the length of stay in the intensive care unit (ICU) were higher compared to those of a propensity-matched group of patients who underwent cardiac surgery in the pre-COVID era. The median intubation time was 13 hours (IQR, 9.5-18), which was comparable to that of pre-COVID cardiac surgery patients. The readmission rate to the ICU was 16%. In this ICU readmitted group, the mean oxygen index, FiO2 , and mortality rate were higher and the PaO2 /FiO2 ratio was lower than those of the nonreadmitted patients. CONCLUSIONS: Although early respiratory outcomes of asymptomatic COVID-19 patients who underwent early cardiac surgery appeared to be satisfactory, compared to the propensity-scored matched non-COVID group, the postoperative outcomes were worse, especially in the ICU readmitted patients. We suggest postponing cardiac operations unless the patient requires emergency surgery.


Assuntos
Betacoronavirus , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Infecções por Coronavirus/epidemiologia , Cardiopatias/cirurgia , Pneumonia Viral/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Volume de Ventilação Pulmonar/fisiologia , Comorbidade , Infecções por Coronavirus/diagnóstico , Feminino , Cardiopatias/epidemiologia , Mortalidade Hospitalar , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Testes de Função Respiratória , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências
7.
Int Heart J ; 61(4): 848-850, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32728003

RESUMO

Right ventricular (RV) dysfunction may occur after cardiac surgery and it is not rare after corrective repair of tetralogy of Fallot (TOF). If traditional treatments with volume management, infusion of inotropic agents, and use of pulmonary vasodilators cannot stabilize the patient, extracorporeal membrane oxygenation (ECMO) or a ventricular assist device (VAD) will be considered as the last resort. Here, we report a young infant patient with RV failure after corrective repair of TOF and without closure of an atrial septal defect (ASD), who was rescued by veno-venous (VV) -ECMO.


Assuntos
Septo Interatrial/cirurgia , Oxigenação por Membrana Extracorpórea/métodos , Tetralogia de Fallot/cirurgia , Disfunção Ventricular Direita/terapia , Assistência ao Convalescente , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ecocardiografia/métodos , Insuficiência Cardíaca/fisiopatologia , Comunicação Interatrial/diagnóstico por imagem , Comunicação Interatrial/fisiopatologia , Comunicação Interatrial/cirurgia , Coração Auxiliar , Humanos , Lactente , Masculino , Dispositivo para Oclusão Septal/normas , Tetralogia de Fallot/diagnóstico por imagem , Resultado do Tratamento
8.
J Thorac Cardiovasc Surg ; 160(2): 447-451, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32689700

RESUMO

The COVID-19 pandemic necessitates aggressive infection mitigation strategies to reduce the risk to patients and healthcare providers. This document is intended to provide a framework for the adult cardiac surgeon to consider in this rapidly changing environment. Preoperative, intraoperative, and postoperative detailed protective measures are outlined. These are guidance recommendations during a pandemic surge to be used for all patients while local COVID-19 disease burden remains elevated.


Assuntos
Betacoronavirus/patogenicidade , Procedimentos Cirúrgicos Cardíacos/normas , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Cardiopatias/cirurgia , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Salas Cirúrgicas/normas , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Sala de Recuperação/normas , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Consenso , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Infecção Hospitalar/virologia , Cardiopatias/epidemiologia , Humanos , Saúde do Trabalhador/normas , Segurança do Paciente/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco , Virulência
9.
Lancet ; 396(10245): 177-185, 2020 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-32682483

RESUMO

BACKGROUND: Atrial fibrillation and delirium are common consequences of cardiac surgery. Dexmedetomidine has unique properties as sedative agent and might reduce the risk of each complication. This study coprimarily aimed to establish whether dexmedetomidine reduces the incidence of new-onset atrial fibrillation and the incidence of delirium. METHODS: A randomised, placebo-controlled trial was done at six academic hospitals in the USA. Patients who had had cardiac surgery with cardiopulmonary bypass were enrolled. Patients were randomly assigned 1:1, stratified by site, to dexmedetomidine or normal saline placebo. Randomisation was computer generated with random permuted block size 2 and 4, and allocation was concealed by a web-based system. Patients, caregivers, and evaluators were all masked to treatment. The study drug was prepared by the pharmacy or an otherwise uninvolved research associate so that investigators and clinicians were fully masked to allocation. Participants were given either dexmedetomidine infusion or saline placebo started before the surgical incision at a rate of 0·1 µg/kg per h then increased to 0·2 µg/kg per h at the end of bypass, and postoperatively increased to 0·4 µg/kg per h, which was maintained until 24 h. The coprimary outcomes were atrial fibrillation and delirium occurring between intensive care unit admission and the earlier of postoperative day 5 or hospital discharge. All analyses were intention-to-treat. The trial is registered with ClinicalTrials.gov, NCT02004613 and is closed. FINDINGS: 798 patients of 3357 screened were enrolled from April 17, 2013, to Dec 6, 2018. The trial was stopped per protocol after the last designated interim analysis. Among 798 patients randomly assigned, 794 were analysed, with 400 assigned to dexmedetomidine and 398 assigned to placebo. The incidence of atrial fibrillation was 121 (30%) in 397 patients given dexmedetomidine and 134 (34%) in 395 patients given placebo, a difference that was not significant: relative risk 0·90 (97·8% CI 0·72, 1·15; p=0·34). The incidence of delirium was non-significantly increased from 12% in patients given placebo to 17% in those given dexmedetomidine: 1·48 (97·8% CI 0·99-2·23). Safety outcomes were clinically important bradycardia (requiring treatment) and hypotension, myocardial infarction, stroke, surgical site infection, pulmonary embolism, deep venous thrombosis, and death. 21 (5%) of 394 patients given dexmedetomidine and 8 (2%) of 396 patients given placebo, had a serious adverse event as determined by clinicians. 1 (<1%) of 391 patients given dexmedetomidine and 1 (<1%) of 387 patients given placebo died. INTERPRETATION: Dexmedetomidine infusion, initiated at anaesthetic induction and continued for 24 h, did not decrease postoperative atrial arrhythmias or delirium in patients recovering from cardiac surgery. Dexmedetomidine should not be infused to reduce atrial fibrillation or delirium in patients having cardiac surgery. FUNDING: Hospira Pharmaceuticals.


Assuntos
Fibrilação Atrial/prevenção & controle , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Delírio/prevenção & controle , Dexmedetomidina/administração & dosagem , Hipnóticos e Sedativos/administração & dosagem , Esquema de Medicação , Feminino , Humanos , Infusões Intravenosas , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Resultado do Tratamento
10.
J Thorac Cardiovasc Surg ; 160(2): 452-455, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689701

RESUMO

In the setting of the current novel coronavirus pandemic, this document has been generated to provide guiding statements for the adult cardiac surgeon to consider in a rapidly evolving national landscape. Acknowledging the risk for a potentially prolonged need for cardiac surgery procedure deferral, we have created this proposed template for physicians and interdisciplinary teams to consider in protecting their patients, institution, and their highly specialized cardiac surgery team. In addition, recommendations on the transition from traditional in-person patient assessments and outpatient follow-up are provided. Lastly, we advocate that cardiac surgeons must continue to serve as leaders, experts, and relevant members of our medical community, shifting our role as necessary in this time of need.


Assuntos
Betacoronavirus/patogenicidade , Procedimentos Cirúrgicos Cardíacos/normas , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Cardiopatias/cirurgia , Controle de Infecções/normas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Triagem/normas , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Consenso , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/transmissão , Infecção Hospitalar/virologia , Cardiopatias/epidemiologia , Humanos , Saúde do Trabalhador/normas , Segurança do Paciente/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Medição de Risco , Fatores de Risco , Virulência
11.
J Cardiovasc Magn Reson ; 22(1): 52, 2020 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-32669114

RESUMO

BACKGROUND: Maternal right ventricular (RV) dysfunction (measured by echocardiography) is associated with impaired uteroplacental circulation, however echocardiography has important limitations in the assessment of RV function. We therefore aimed to investigate the association of pre-pregnancy RV and left ventricular (LV) function measured by cardiovascular magnetic resonance with uteroplacental Doppler flow parameters in pregnant women with repaired Tetralogy of Fallot (ToF). METHODS: Women with repaired ToF were examined, who had been enrolled in a prospective multicenter study of pregnant women with congenital heart disease. Clinical data and CMR evaluation before pregnancy were compared with uteroplacental Doppler parameters at 20 and 32 weeks gestation. In particular, pulsatility index (PI) of uterine and umbilical artery were studied. RESULTS: We studied 31 women; mean age 30 years, operated at early age. Univariable analyses showed that reduced RV ejection fraction (RVEF; P = 0.037 and P = 0.001), higher RV end-systolic volume (P = 0.004) and higher LV end-diastolic and end-systolic volume (P = 0.001 and P = 0.003, respectively) were associated with higher uterine or umbilical artery PI. With multivariable analyses (corrected for maternal age and body mass index), reduced RVEF before pregnancy remained associated with higher umbilical artery PI at 32 weeks (P = 0.002). RVEF was lower in women with high PI compared to women with normal PI during pregnancy (44% vs. 53%, p = 0.022). LV ejection fraction was not associated with uterine or umbilical artery PI. CONCLUSIONS: Reduced RV function before pregnancy is associated with abnormal uteroplacental Doppler flow parameters. It could be postulated that reduced RV function on pre-pregnancy CMR (≤2 years) is a predisposing factor for impaired placental function in women with repaired ToF.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Imagem Cinética por Ressonância Magnética , Circulação Placentária , Tetralogia de Fallot/cirurgia , Artérias Umbilicais/fisiopatologia , Artéria Uterina/fisiopatologia , Disfunção Ventricular Direita/diagnóstico por imagem , Função Ventricular Direita , Adulto , Velocidade do Fluxo Sanguíneo , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Feminino , Humanos , Valor Preditivo dos Testes , Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos , Fatores de Risco , Tetralogia de Fallot/complicações , Tetralogia de Fallot/diagnóstico por imagem , Tetralogia de Fallot/fisiopatologia , Ultrassonografia Doppler , Artérias Umbilicais/diagnóstico por imagem , Artéria Uterina/diagnóstico por imagem , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/fisiopatologia
12.
Eur J Vasc Endovasc Surg ; 60(3): 469-478, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32620348

RESUMO

OBJECTIVE: In vascular and cardiac surgery, the ability to maintain haemostasis and seal haemorrhagic tissues is key. Fibrin and thrombin based sealants were introduced as a means to prevent or halt bleeding during surgery. Whether fibrin and thrombin sealants affect surgical outcomes is poorly established. A systematic review and meta-analysis was performed to examine the impact of fibrin or thrombin sealants on patient outcomes in vascular and cardiac surgery. DATA SOURCES: Cochrane CENTRAL, Embase, and MEDLINE, as well as trial registries, conference abstracts, and reference lists of included articles were searched from inception to December 2019. REVIEW METHODS: Studies comparing the use of fibrin or thrombin sealant with either an active (other haemostatic methods) or standard surgical haemostatic control in vascular and cardiac surgery were searched for. The Cochrane risk of bias tool and the ROBINS-I tool (Risk Of Bias In Non-randomised Studies - of Interventions) were used to assess the risk of bias of the included randomised and non-randomised studies; quality of evidence was assessed by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Two reviewers screened studies, assessed risk of bias, and extracted data independently and in duplicate. Data from included trials were pooled using a random effects model. RESULTS: Twenty-one studies (n = 7 622 patients) were included: 13 randomised controlled trials (RCTs), five retrospective, and three prospective cohort studies. Meta-analysis of the RCTs showed a statistically significant decrease in the volume of blood lost (mean difference 120.7 mL, in favour of sealant use [95% confidence interval {CI} -150.6 - -90.7; p < .001], moderate quality). Time to haemostasis was also shown to be reduced in patients receiving sealant (mean difference -2.5 minutes [95% CI -4.0 - -1.1; p < .001], low quality). Post-operative blood transfusions, re-operation due to bleeding, and 30 day mortality were not significantly different for either RCTs or observational data. CONCLUSION: The use of fibrin and thrombin sealants confers a statistically significant but clinically small reduction in blood loss and time to haemostasis; it does not reduce blood transfusion. These Results may support selective rather than routine use of fibrin and thrombin sealants in vascular and cardiac surgery.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Procedimentos Cirúrgicos Cardíacos , Adesivo Tecidual de Fibrina/administração & dosagem , Hemostasia , Hemostáticos/administração & dosagem , Hemorragia Pós-Operatória/prevenção & controle , Trombina/administração & dosagem , Adesivos Teciduais/administração & dosagem , Procedimentos Cirúrgicos Vasculares , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Adesivo Tecidual de Fibrina/efeitos adversos , Hemostáticos/efeitos adversos , Humanos , Hemorragia Pós-Operatória/etiologia , Fatores de Risco , Trombina/efeitos adversos , Fatores de Tempo , Adesivos Teciduais/efeitos adversos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos
13.
J Stroke Cerebrovasc Dis ; 29(8): 105003, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689610

RESUMO

INTRODUCTION: A syndrome of focal neurologic deficits with characteristic imaging features, acute encephalopathy, and seizures after cardiac and thoracic interventions has been previously briefly reported in the literature. In a retrospective observational study, we aim to identify the prevalence and characteristics of this syndrome, in addition to discussing the possible underlying pathophysiology. METHODS: In a retrospective study, we reviewed records of consecutive adult patients (≥18 years old) who underwent cardiac and thoracic procedures at a single institution between September 2014 to September 2019 and found to have evidence of focal cerebral edema following their procedure. We included and reported clinical course of patients who developed post-operative neurologic dysfunction and underwent magnetic resonance imaging (MRI) showing (1) asymmetric cerebral edema with (2) cortical diffusion restriction and (3) T2 cortical or subcortical hyperintensity and (4) no proximal vascular occlusion. RESULTS: Three out of 107 patients (2.8%) met our inclusion criteria. These represented one male and two females with age at presentation of 63, 81 and 69, respectively. All patients developed severe neurologic impairment on the same day following their procedure (sternotomy with valve or bypass surgery in 2 patients; esophageal dilatation procedure in 1 patient). All patients underwent MRI of the brain and vessel imaging qualifying our inclusion criteria. Two patients improved neurologically prior to discharge, and one patient expired after family elected to withdraw care. CONCLUSION: We present a series of cases with a rare syndrome after cardiac and thoracic interventions. Although the exact mechanism of this syndrome remains unclear, we believe it to be related to relative cerebral hyperperfusion and cerebral dysautoregulation following anesthesia and thoracic manipulation. Future studies should focus on understanding the true prevalence and pathophysiology of this syndrome.


Assuntos
Edema Encefálico/fisiopatologia , Encéfalo/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Transtornos Cerebrovasculares/fisiopatologia , Convulsões/fisiopatologia , Procedimentos Cirúrgicos Torácicos/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Encéfalo/diagnóstico por imagem , Edema Encefálico/diagnóstico , Edema Encefálico/epidemiologia , Edema Encefálico/terapia , Transtornos Cerebrovasculares/diagnóstico , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/terapia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Exame Neurológico , Ohio/epidemiologia , Prevalência , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Convulsões/diagnóstico , Convulsões/epidemiologia , Convulsões/terapia , Síndrome , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
Rev. cir. (Impr.) ; 72(3): 231-235, jun. 2020. ilus
Artigo em Espanhol | LILACS | ID: biblio-1115547

RESUMO

Resumen Introducción: La disección de la aurícula izquierda es una complicación infrecuente, pero potencialmente fatal de la cirugía cardíaca. Es frecuentemente asociada a cirugías de la válvula mitral, tanto su reparación el reemplazo, con una incidencia de 0,16%. Sin embargo, otros procedimientos como intervenciones percutáneas también presentan este riesgo. Objetivos: Presentar la resolución quirúrgica de un caso de disección de aurícula izquierda y aportar a la casuística nacional. Materiales y Método: Registro clínico, imagenológico y fotográfico del episodio clínico. Resultados: Una paciente que fue sometida a ablación por radiofrecuencia por vía retrógrada, y cursa durante el periodo postintervencional con insuficiencia cardíaca y su estudio identifica una disección auricular. Se realiza reparación del anillo mitral, plastía del aparato subvalvular y parche de pericardio, la paciente presenta evolución clínica y ecográfica favorable. Discusión: El tratamiento de esta entidad debe analizarse caso a caso, ya que la etiología relacionada a procedimientos percutáneos es diferente a la causada por cirugía valvular mitral. Conclusión: La reparación de una disección auricular con parche es una buena alternativa de tratamiento en estos casos.


Introduction: Left atrial dissection is an infrequent but potentially fatal complication of cardiac surgery. It is frequently associated with mitral valve surgery, both its repair and replacement, with an incidence of 0.16%. However, other procedures such as percutaneous interventions can also be predisposing factors. Objectives: To report the surgical resolution of a left atrial dissection case and contribute to the national casuistry. Materials and Method: Clinical, imaging and photographic record of the clinical episode. Results: A patient who underwent retrograde radiofrequency ablation during the post-interventional period with heart failure and whose study identifies an atrial dissection. Mitral ring repair, subvalvular apparatus repair and pericardial patch was performed, the patient evolves with favorable clinical and sonographic evolution. Discussion: The treatment of this entity should be analyzed case by case, the etiology related to percutaneous procedures is different to that caused by mitral valve surgery and this should be considered when choosing a therapeutic option. Conclusion: Repairing an atrial dissection with a patch is a good alternative in these cases.


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Aneurisma Dissecante/cirurgia , Aneurisma Dissecante/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Doenças Raras , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Valva Mitral/cirurgia
15.
J Thorac Cardiovasc Surg ; 160(2): 522-528, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32507689
16.
Asian Cardiovasc Thorac Ann ; 28(6): 336-338, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32539424

RESUMO

Rapidly progressive epicardial hemorrhagic blebs during weaning from cardiopulmonary bypass after perimembranous ventricular septal defect closure has not been reported previously. Here, we describe the case of a 3-month-old baby with life-threatening epicardial hemorrhagic blebs and an interventricular septal hematoma after perimembranous ventricular septal defect patch closure.


Assuntos
Vesícula/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Comunicação Interventricular/cirurgia , Hematoma/etiologia , Pericárdio/transplante , Vesícula/diagnóstico por imagem , Evolução Fatal , Comunicação Interventricular/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Humanos , Lactente , Masculino
18.
Circ Cardiovasc Interv ; 13(1): e008320, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-32525412

RESUMO

BACKGROUND: The Harmony transcatheter pulmonary valve (TPV) was designed for treatment of postoperative pulmonary valve regurgitation in patients with repaired right ventricular outflow tracts. METHODS: The Native TPV EFS (Early Feasibility Study) is a prospective, multicenter, nonrandomized feasibility study. Three-year outcomes are reported. RESULTS: Of 20 implanted patients, 17 completed 3-year follow-up (maximum: 4.1 years). There were no deaths and 2 early explants. One patient did not complete the 3-year visit. In patients with available 3-year echocardiographic data, 1 had a mild paravalvular leak and the rest had none/trace; 1 patient had mild pulmonary valve regurgitation and the remainder had none/trace. The 3-year mean right ventricular outflow tract echocardiographic gradient was 15.7±5.5 mm Hg. Radiographically, no late frame fractures or erosions were identified. At 2 years, 2 patients presented with an increased echocardiographic outflow gradient (1 mixed lesion with moderate/severe pulmonary valve regurgitation). Computed tomography scans identified neointimal tissue ingrowth within the stent frame in both patients, and they were treated successfully with a transcatheter valve-in-valve procedure (Melody TPV). Additional follow-up computed tomography scans performed at 3.2±0.5 years after implant were obtained in 16 patients and revealed luminal tissue thickening at the inflow and outflow portion of the frame with no significant alteration of the valve housing. CONCLUSIONS: Three-year results from the Native TPV EFS revealed stable Harmony TPV device position, good valve function in most, and the absence of moderate/severe paravalvular leak and significant late frame fractures. Two patients developed significant neointimal proliferation requiring valve-in-valve treatment, while all others had no clinically significant right ventricular outflow tract obstruction. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01762124.


Assuntos
Bioprótese , Cateterismo Cardíaco/instrumentação , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Insuficiência da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Obstrução do Fluxo Ventricular Externo/cirurgia , Adolescente , Adulto , Canadá , Cateterismo Cardíaco/efeitos adversos , Estudos de Viabilidade , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Estudos Prospectivos , Desenho de Prótese , Falha de Prótese , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos , Adulto Jovem
19.
Khirurgiia (Mosk) ; (5): 34-41, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32500687

RESUMO

OBJECTIVE: To evaluate bacterial flora in patients with deep sternal wound infection and the effect of negative pressure wound therapy on eradication of the pathogen. MATERIAL AND METHODS: There were 102 patients with deep wound infection after cardiac surgery. Mean age was 66.9±9.9 years. Diabetes mellitus was detected in 21 (20.5%) cases, chronic obstructive pulmonary disease - in 15 (14.7%). Wound debridement via daily dressings was performed in 64 patients; vacuum-assisted dressings were applied in 38 patients. Bacteriological analysis of discharge was carried out every week.Results. Mixed infection was observed in 38 (37.3%) patients. S.aureus was the most common pathogen (n=51, 50%), Gram negative bacteria were found in 36 (35.3%) patients. Negative pressure wound therapy ensured eradication of S.aureus within 3 weeks while dressings were associated with only 40% decrease of the incidence of positive analyses (p<0.05). Effectiveness of the method was not obtained for Gram negative bacteria. CONCLUSION: Negative pressure wound therapy accelerates eradication of Gram positive pathogens but does not affect eradication of Gram negative microbes.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Tratamento de Ferimentos com Pressão Negativa , Infecções Estafilocócicas/terapia , Esternotomia/efeitos adversos , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/terapia , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Desbridamento , Resistência Microbiana a Medicamentos , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/terapia , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/terapia , Humanos , Pessoa de Meia-Idade , Infecções Estafilocócicas/etiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Esterno/microbiologia , Esterno/cirurgia , Infecção da Ferida Cirúrgica/etiologia
20.
J Card Surg ; 35(6): 1202-1208, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32531126

RESUMO

BACKGROUND AND AIM: It has been demonstrated that patients with pre-frailty have more adverse outcomes after cardiac surgery; however, data on prognosis and long-term evolution in patients with pre-frailty after elective cardiac surgery without postoperative complications are still scarce. To evaluate the impact of pre-frailty status on functional survival in patients after elective cardiac surgery without surgical complications. METHODS: This was a retrospective study with 141 patients over 65 years old, with an established diagnosis of myocardial infarction or valve disease. Patients were evaluated by Clinical Frailty Scale (CFS) before surgery, according to the hospital protocol, and allocated into two groups: non-frail (CFS, 1-3) and pre-frail (CFS = 4). Patients with adverse cardiovascular events during surgery or at intensive care unit (ICU), mechanical ventilation more than 24 hours, ICU length of stay more than 48 hours, and in-hospital complications were excluded. For all analyses, the statistical significance was set at 5% (P < .05). RESULTS: There were no differences in demographic, anthropometric, surgical procedure, or baseline data on ICU. Pre-frail patients had more adverse events during the 3-year follow-up period with rehospitalization compared to non-frail (39.4% vs 14.3%, respectively). Rehospitalizations in pre-frail patients were in the first year after cardiac surgery (P < .05), and higher cumulative events in pre-frail have occurred with increased odds ratio (OR) (2.828, 95% confidence interval [CI]: 1.298-6.160; P = .001) and hazard ratio (HR) (3.560, 95% CI: 1.508-84.04; P = .004). The OR and HR for stroke or death were similar between groups when analyzed separately. CONCLUSION: Pre-frail patients have more adverse events after elective cardiac surgery without complications when compared to non-frail patients.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Procedimentos Cirúrgicos Eletivos , Fragilidade , Readmissão do Paciente/estatística & dados numéricos , Idoso , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Feminino , Humanos , Masculino , Complicações Pós-Operatórias , Estudos Retrospectivos , Risco
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