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2.
Sultan Qaboos Univ Med J ; 21(3): 403-407, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34522405

RESUMO

Objectives: Bicuspid aortic valve (BAV) is the most common congenital lesion found in adults. It can be seen in combination with a transverse left ventricular (LV) band. This study aimed to find an essential relationship between the presence of transverse ventricular band and BAV. Methods: A total of 13 patients from a tertiary care centre in India with transverse LV band were investigated during a six-month period from January 2019 to July 2019. LV band thickness and gradients at the site of the LV band were evaluated as part of its effect on LV haemodynamics. The morphology of the aortic valve and LV outflow tract gradients was assessed. Results: The mean age of the participants was 41 years. A majority had a BAV (n = 11). Average thickness of the LV band was 6.2 mm and the average mean aortic gradient was 4 mmHg. Sequestration of blood was noted at the level of the transverse band in all the patients with two separate jets at the left ventricular outflow tract. The anterolateral jet was deflected from the transverse band and showed higher velocity compared to the other jet, causing turbulence at the BAV. No correlation was found between the thickness of the transverse band and aortic valve gradient. Conclusion: Presence of a robust transverse LV band can serve as a surrogate marker for BAV.


Assuntos
Estenose da Valva Aórtica , Doença da Válvula Aórtica Bicúspide , Doenças das Valvas Cardíacas , Adulto , Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/diagnóstico , Hemodinâmica , Humanos
3.
Angiol Sosud Khir ; 27(3): 115-124, 2021.
Artigo em Inglês, Russo | MEDLINE | ID: mdl-34528595

RESUMO

AIM: The study was aimed at comparing the immediate clinical and haemodynamic results of open implantation of the balloon-expandable aortic prosthesis 'MedLab-KT' with the respective parameters of standard replacement of the aortic valve by a mechanical prosthesis in high-risk surgical patients. PATIENTS AND METHODS: We analysed a total of 209 cases of prosthetic repair of the aortic valve. The Study Group comprised 28 patients subjected to open implantation of the 'MedLab-KT' prosthesis in conditions of extracorporeal circulation and myocardial ischaemia and belonging to a high-surgical risk cohort. The Comparison Group included 181 patients who endured standard open prosthetic repair of the aortic valve with a mechanical prosthesis. Using the ppropensity score matching method, we selected 28 patients from the Comparison Group, followed by assessing the incidence of adverse clinical events and haemodynamic parameters of the aortic valve prosthesis at the in-hospital stage. RESULTS: There were no lethal outcomes in the study group, with one in the group of standard aortic valve repair - 3.6%. The mean operative time in the Study and Comparison Group patients amounted to 121.5±51.2 and 274.2±55.3 min (p=0.04), the duration of extracorporeal circulation to 56.1±19.5 and 119.9±23.4 min (p=0.04), that of myocardial ischaemia to 38.4±17.1 and 96.7±20.8 (p=0.03), respectively. The mean gradient on the aortic valve in the 'MedLab-KT' group was less (7.5±3.2 mm Hg) than in those of the second group (9±3.5 mm Hg), with no statistically significant differences in the parameters revealed (p=0.096). All patients of the study group were discharged from hospital in a satisfactory condition, with the haemodynamic result of the operation regarded as satisfactory. CONCLUSION: Comparing the main clinical characteristics and haemodynamic parameters in the groups of 'MedLab-KT' and aortic valve prosthetic repair at the hospital stage revealed no statistically significant differences. Open implantation of the 'MedLab-KT' prosthesis proved safe and effective.


Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Desenho de Prótese , Resultado do Tratamento
4.
Rev Med Chil ; 149(2): 286-290, 2021 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-34479276

RESUMO

The deployment of a percutaneous aortic valve is challenging in patients with a mitral prosthesis. The risk of prosthetic deformation, embolization or dysfunction is higher in this group of patients, which requires a series of technical considerations. We report a successful implantation of an Evolut Pro # 29 self-expanding valve in a 67-year-old female with a previous Starr-Edwards caged-ball mitral prosthesis.


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Feminino , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Desenho de Prótese
5.
Rev Med Chil ; 149(4): 508-513, 2021 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-34479337

RESUMO

BACKGROUND: Despite being introduced 20 years ago minimally invasive aortic valve replacement is only performed routinely in a minority of patients world-wide. AIM: To report the operative outcome of minimally invasive aortic valve replacement done through a partial upper sternotomy. PATIENTS AND METHODS: Retrospective analysis of data recorded prospectively of 450 consecutive patients with a median age of 66 years (59% males) who had a minimally invasive aortic replacement. RESULTS: 79% of patients had aortic stenosis. Cross clamp/cardiopulmonary bypass times (median) were 56 and 68 minutes respectively. Conversion to full sternotomy was required in 2.6% of patients, reoperation for bleeding in 2.9%. 1.6% suffered a stroke and 19% postoperative atrial fibrillation. 0.9% required a permanent pacemaker. Postoperative mortality was 0.9%. Median postoperative hospital stay was six days. CONCLUSIONS: Minimally invasive aortic valve replacement can be performed with satisfactory results.


Assuntos
Valva Aórtica , Implante de Prótese de Valva Cardíaca , Idoso , Valva Aórtica/cirurgia , Feminino , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
6.
Kyobu Geka ; 74(8): 574-577, 2021 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-34334596

RESUMO

A 79-year-old man presented with progressive congestive heart failure symptom as a result of severe aortic stenosis. A rescue balloon aortic valvuloplasty was performed. After a transient improvement, computed tomographic scan revealed a porcelain aorta, and it showed a high risk for a surgical aortic valve replacement. Routine preoperative coronary angiography revealed tight stenosis of a proximal left anterior descending coronary artery. Percutaneous coronary intervention was performed unsuccessfully due to the severe calcification of the coronary artery. Therefore, a concomitant transapical transcatheter aortic valve implantation and coronary artery bypass grafting via the left thoracotomy was indicated. Under a veno-arterial extracorporeal circulatory support, we performed the transcatheter aortic valve implantation (TAVI) and coronary artery bypass grafting (CABG) successfully via a left thoracotomy. Even though the approach for TAVI is from fifth and CABG is from forth intercostal space respectively, it could be manipulated using the same skin incision. Concomitant TAVI and CABG via the left thoracotomy might be a reasonable and feasible option for the patients presented with severe aortic stenosis and coronary artery disease who are not eligible for conventional surgical solutions.


Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Substituição da Valva Aórtica Transcateter , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Ponte de Artéria Coronária , Humanos , Masculino , Toracotomia , Resultado do Tratamento
7.
Kyobu Geka ; 74(8): 578-582, 2021 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-34334597

RESUMO

We report a 63-year-old woman came to our hospital with exertional dyspnea, palpitations, and abdominal distention. Echocardiography showed mitral, aortic, and tricuspid valve insufficiency, for which surgery was indicated. Twenty-six years ago, during dental therapy, she was diagnosed with metal allergy. A patch test demonstrated allergic reactions to manganese, chromium, and zinc. The patient underwent mitral and aortic valve replacement with the On-X prosthetic heart valve, which is primarily made of titanium and devoid of the allergens. She also underwent tricuspid valve repair with a Contour 3D annuloplasty ring, which is made of titanium alloy. She manifested no allergic symptoms three years after surgery. This case elucidates the importance of history taking regarding metal allergy and identification of allergens by patch testing in patients undergoing cardiac surgery involving metal device implantation.


Assuntos
Anuloplastia da Valva Cardíaca , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Hipersensibilidade , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral , Insuficiência da Valva Tricúspide , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Feminino , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Hipersensibilidade/etiologia , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/cirurgia , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/cirurgia
8.
Medicina (Kaunas) ; 57(7)2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34356976

RESUMO

Background and Objectives: Conduction disturbances such as left bundle branch block (LBBB) and complete atrio-ventricular block (cAVB) are relatively frequent complications following trans-catheter aortic valve implantation (TAVI). We investigated the dynamics of these conduction blocks to further understand luxating factors and predictors for their persistency. Materials and Methods: We prospectively included 157 consecutive patients who underwent a TAVI procedure. Electrocardiograms (ECGs) were obtained at specific time points during the TAVI procedure and at follow-up until at least six months post-procedure. Results: Of the 106 patients with a narrow QRS complex (nQRS) before TAVI, ~70% developed LBBB; 28 (26.4%) being classified as super-transient (ST-LBBB), 20 (18.9%) as transient (T-LBBB) and 24 (22.6%) as persistent (P-LBBB). Risk of LBBB was higher for self-expandable (SE) than for balloon-expandable (BE) prostheses and increased with larger implant depth. During the TAVI procedure conduction disturbances showed a dynamic behavior, as illustrated by alternating kinds of blocks in 18 cases. Most LBBBs developed during balloon aortic valvuloplasty (BAV) and at positioning and deployment of the TAVI prosthesis. The incidence of LBBB was not significantly different between patients who did and did not undergo BAV prior to TAVI implantation (65.3% and 74.2%, respectively (p = 0.494)). Progression to cAVB was most frequent for patients with preexisting conduction abnormalities (5/34) patients) and in patients showing ST-LBBB (6/28). Conclusions: During the TAVI procedure, conduction disturbances showed a dynamic behavior with alternating types of block in 18 cases. After a dynamic period of often alternating types of block, most BBBs are reversible while one third persist. Patients with ST-LBBB are most prone to progressing into cAVB. The observation that the incidence of developing LBBB after TAVI is similar with and without BAV suggests that a subgroup of patients has a substrate to develop LBBB regardless of the procedure.


Assuntos
Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Marca-Passo Artificial , Substituição da Valva Aórtica Transcateter , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Eletrocardiografia , Humanos , Estudos Retrospectivos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
9.
Medicina (Kaunas) ; 57(7)2021 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-34356992

RESUMO

Transcatheter aortic valve implantation (TAVI) has become the leading technique for aortic valve replacement in symptomatic patients with severe aortic stenosis with conventional surgical aortic valve replacement (SAVR) now limited to patients younger than 65-75 years due to a combination of unsuitable anatomies (calcified raphae in bicuspid valves, coexistent aneurysm of the ascending aorta) and concerns on the absence of long-term data on TAVI durability. This incredible rise is linked to technological evolutions combined with increased operator experience, which led to procedural refinements and, accordingly, to better outcomes. The article describes the main and newest technical improvements, allowing an extension of the indications (valve-in-valve procedures, intravascular lithotripsy for severely calcified iliac vessels), and a reduction of complications (stroke, pacemaker implantation, aortic regurgitation).


Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Humanos , Fatores de Risco , Resultado do Tratamento
10.
Med Sci Monit ; 27: e930596, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34433799

RESUMO

BACKGROUND The aim of this study was to measure sleep quality among patients who underwent infective endocarditis (IE) surgery and identify the risk factors involved in sleep disorders. MATERIAL AND METHODS In this study, we used actigraphy, the Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleep Scale (ESS) to determine the clinical characteristics of sleep disorders in 116 patients with IE who were in rehabilitation after surgery. RESULTS Our results showed that 46 (39.7%) patients had sleep efficiency over 85%, while 70 (60.3%) patients had sleep efficiency below 85%. The correlation analysis showed that sleep efficiency was related to the duration of the disease, with a longer duration leading to lower sleep efficiency (P=0.031). The sleep efficiency of patients with IE following surgery was also affected by alcohol consumption; however, surprisingly, patients with "heavy" alcohol consumption had higher sleep efficiency (P=0.030). We found a significant correlation between sleep efficiency and postoperative interleukin-6 (IL) levels, C-reactive protein (CRP) levels, and preoperative erythrocyte sedimentation rate (P<0.05). No significant correlation was found between brain natriuretic peptide levels and sleep efficiency, PSQI score, or ESS score. Postoperative hemoglobin (Hb) level was associated with sleep efficiency (R=0.194, P=0.036), but there was no statistically significant correlation between the PSQI and ESS scores. Postoperative alanine transaminase (ALT) showed a significant negative correlation with sleep efficiency (R=-0.27, P=0.003). CONCLUSIONS We found a high prevalence of sleep disorders in patients with IE along with an increase in inflammatory factors, including postoperative IL-6, CRP, ALT, and Hb levels.


Assuntos
Valva Aórtica/cirurgia , Cateterismo Cardíaco/efeitos adversos , Endocardite/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Complicações Pós-Operatórias/patologia , Transtornos do Sono-Vigília/patologia , Adulto , Valva Aórtica/lesões , Endocardite/patologia , Feminino , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Prognóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos , Transtornos do Sono-Vigília/etiologia , Inquéritos e Questionários
11.
Mayo Clin Proc ; 96(8): 2145-2156, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34353469

RESUMO

OBJECTIVE: To examine contemporary clinical differences between men and women with hemodynamically significant chronic aortic regurgitation (AR). PATIENTS AND METHODS: We retrospectively identified 1072 consecutive patients with moderate to severe or severe AR diagnosed between February 21, 2004, and April 29, 2019. Echocardiographic data, aortic valve surgical intervention (AVS), and all-cause death were analyzed. RESULTS: At baseline, the 189 women in the study group were older than the 883 men (mean ± SD age, 64±18 years vs 58±17 years), had more advanced symptoms, and had larger left ventricular end-systolic dimension index (LVESDi) (all P<.001) despite similar AR severity. An LVESDi of greater than 20 mm/m2 was noted in 60 of 92 asymptomatic women (65%) vs 225 of 559 asymptomatic men (40%) (P<.001). Median follow-up was 5.6 years (interquartile range, 2.5 to 10.0 years). Female sex was associated with less AVS (P=.009), and overall 10-year survival was better in men (76%±2%) than in women (64%±5%) (P=.004). However, 10-year post-AVS survival was similar between the sexes (P=.86), and women had better left ventricular reverse remodeling than men regarding end-diastolic dimension (P=.02). Multivariable independent predictors of death were age, advanced symptoms, LVESDi, ejection fraction, and AVS (all P≤.03) but not female sex. When compared with the age-matched US population, women exhibited a 1.3-fold increased relative risk of death (P=.0383) while men had similar survival (P=.11). CONCLUSION: In contemporary practice, women with AR continue to exhibit an overall survival penalty not related to female sex but to late referral markers, including more advanced symptoms, larger LVESDi, and less AVS. Nonetheless, women in our study exhibited outstanding post-AVS left ventricular remodeling and had good post-AVS survival, a step forward toward closing the sex-related mortality gap. The high percentage of LVESDi of 20 mm/m2 or greater in asymptomatic women represents a window of opportunity for advanced-symptom prevention and timely AR surgical correction that may close the mortality gap.


Assuntos
Insuficiência da Valva Aórtica/epidemiologia , Valva Aórtica/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Função Ventricular Esquerda/fisiologia , Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/diagnóstico , Insuficiência da Valva Aórtica/cirurgia , Doença Crônica , Ecocardiografia , Feminino , Seguimentos , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Distribuição por Sexo , Fatores Sexuais , Taxa de Sobrevida/tendências , Fatores de Tempo , Estados Unidos/epidemiologia
12.
BMJ Open ; 11(8): e045330, 2021 08 04.
Artigo em Inglês | MEDLINE | ID: mdl-34348946

RESUMO

OBJECTIVES: Transfemoral transcatheter aortic valve implantation (TF-TAVI) is an established therapy for patients with symptomatic aortic stenosis, which requires periprocedural anaesthesia care. In 2015, the German Federal Joint Committee released a directive on minimally invasive heart valve interventions which defines institutional infrastructural requirements in German heart centres. But still generally accepted expert consensus recommendations or national or international guidelines regarding periprocedural anaesthesia management for TF-TAVI are lacking. This nationwide cross-sectional study had two major objectives: first to assess the concordance with existing national regulations regarding infrastructural requirements and second to evaluate the status quo of periprocedural anaesthesia management for patients undergoing TF-TAVI in German heart centres. DESIGN: Multicentre cross-sectional online study to evaluate the periprocedural anaesthesia management. SETTING: In this nationwide cross-sectional study, electronic questionnaires were sent out to anaesthesia departments at TF-TAVI-performing centres in Germany in March 2019. PARTICIPANTS: 78 anaesthesia departments of German heart centres. RESULTS: 54 (69.2%) centres returned the questionnaire of which 94.4% stated to hold regular Heart Team meetings, 75.9% to have ready-to-use heart-lung machines available on-site, 77.8% to have cardiac surgeons and 66.7% to have perfusionists routinely attending throughout TF-TAVI procedures. Regarding periprocedural anaesthesia management, 41 (75.9%) of the participating centres reported to predominantly use 'monitored anaesthesia care' and 13 (24.1%) to favour general anaesthesia. 49 (90.7%) centres stated to use institutional standard operating procedures for anaesthesia. Five-lead ECG, central venous lines, capnometry and intraprocedural echocardiography were reported to be routine measures in 85.2%, 83.3%, 77.8% and 51.9% of the surveyed heart centres. CONCLUSIONS: The concordance with national regulations, anaesthesia management and in-house standards for TF-TAVI vary broadly among German heart centres. According to the opinion of the authors, international expert consensus recommendations and/or guidelines would be helpful to standardise peri interventional anaesthesia care.


Assuntos
Estenose da Valva Aórtica , Implante de Prótese de Valva Cardíaca , Substituição da Valva Aórtica Transcateter , Anestesia Geral , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Estudos Transversais , Humanos , Resultado do Tratamento
13.
Kyobu Geka ; 74(9): 681-685, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34446622

RESUMO

Surgical results of aortic regurgitation with Behcet's aortitis is associated with high morbidity and mortality due to risk of annular dehiscence. Here we describe a case of severe aortic regurgitation with Behcet's disease in 51-year-old man who underwent aortic valve replacement and subannular patch reconstruction for suspected infectious endocarditis with severe aortic regurgitation and subannular abcess. Then we performed three times aortic valve replacement for recurrent prosthetic valve dehiscence. Before the fourth operation, the patient was diagnosed with Behcet's disease and given immunosuppressant. Postoperative course was uneventful and he was discharged on postoperative day 59th, and doing well.


Assuntos
Insuficiência da Valva Aórtica , Síndrome de Behçet , Implante de Prótese de Valva Cardíaca , Aorta , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Síndrome de Behçet/complicações , Síndrome de Behçet/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
14.
Kyobu Geka ; 74(9): 687-691, 2021 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-34446623

RESUMO

The patient was an 81-year-old man. Transcatheter aortic valve implantation( TAVI) was performed for severe aortic stenosis using Evolut R. The patient moved to intensive care unit without an adverse event after the operation. But repeated acute heart failure occurred several times during hospital stay. Mitral regurgitation (MR) was worsened from mild at baseline to moderate or more by transthoracic echocardiography. Various factors that worsened MR after TAVI have been reported, and treatment strategy for severe aortic stenosis patients with MR should be carefully developed.


Assuntos
Estenose da Valva Aórtica , Insuficiência Cardíaca , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Insuficiência Cardíaca/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Desenho de Prótese , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
15.
Trials ; 22(1): 462, 2021 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-34275476

RESUMO

BACKGROUND: With the expanded utilization of transcatheter aortic valve implantation (TAVI) to younger and lower surgical risk patients with severe aortic stenosis (AS), optimal medical therapy after TAVI procedure has become the main concern. Renin-angiotensin system inhibitors (RASi) are widely utilized in the area of cardiovascular disease including heart failure and myocardial infarction and revealed the ability to reverse left ventricular (LV) remodeling. Interests have, thus, been drawn in investigating whether the prescription of RASi after the TAVI procedure can prevent or reverse cardiac remodeling and improve long-term clinical outcomes. No recommendation regarding the prescription of RASi after TAVI is proposed yet due to the lack of evidence from randomized controlled trials, especially in the Chinese population. We, therefore, designed this randomized controlled trial to explore the effect of adding fosinopril to standard care in patients who underwent a successful TAVI procedure on the LV remodeling. METHODS: A total of 200 post-TAVI patients from seven academic hospitals across China will be recruited and randomized with a ratio of 1:1 to receive standard care or standard care plus fosinopril. Follow-up visits will take place at 30 days, 3 months, 6 months, 12 months, and 24 months from randomization to assess the clinical symptoms, any adverse events, cardiac function, and quality of life. Cardiac magnetic resonance will be performed at baseline and repeated at the 24-month follow-up visit to assess LV remodeling. DISCUSSION: This study will provide evidence regarding medical therapy for AS patients who underwent TAVI and filling the gap in the Chinese population. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2100042266 . Registered on 17 January 2021.


Assuntos
Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , China , Humanos , Estudos Multicêntricos como Assunto , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
16.
Ann Palliat Med ; 10(7): 7157-7172, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34263628

RESUMO

BACKGROUND: Transcatheter aortic valve replacement (TAVR) has been increasingly used in all levels of risk patients, which is less invasive and has fewer complications. However, the benefits of transcatheter and surgical methods of aortic valve replacement remain controversial for aortic stenosis (AS) patients with advanced chronic kidney disease (stage 3-5). METHODS: We comprehensively searched PubMed, Embase, the Cochrane Library, and the International Clinical Trials Registry Platform (ICTRP) from January 2000 to October 2020 and performed a systematic review to evaluate the two techniques. Two investigators independently conducted the literature searches, study eligibility assessment, and data extraction in duplicate. RESULTS: Compared to surgical aortic valve replacement (SAVR), TAVR had lower risk of in-hospital mortality [odds ratio (OR): 0.53; 95% confidence interval (CI): 0.36-0.78; P=0.001], lower stroke rate (OR: 0.68; 95% CI: 0.47-0.96; P=0.03), lower risk of acute kidney injury (AKI) (OR: 0.42; 95% CI: 0.34-0.52; P<0.00001) and AKI requiring dialysis (OR: 0.65; 95% CI: 0.58-0.73; P<0.00001), lower rate of bleeding (OR: 0.35; 95% CI: 0.31-0.38; P<0.00001) and blood transfusion (OR: 0.41; 95% CI: 0.32-0.52; P<0.00001), lower infection rate (OR: 0.23; 95% CI: 0.13-0.38; P<0.00001), lower risk of atrial fibrillation (AF) (OR: 0.37; 95% CI: 0.17-0.79; P=0.01) and cardiac tamponade (OR: 0.53; 95% CI: 0.37-0.75; P=0.0003), shorter ICU stay [weighted mean difference (WMD): -2.55; 95% CI: -4.13 to -0.98; P=0.002] and hospital stay (WMD: -7.06; 95% CI: -8.41 to -5.71; P<0.00001). DISCUSSION: TAVR is a safe, efficient, and feasible technique for AS patients with advanced CKD and probably a better solution for its advantage in reducing in-hospital mortality, postoperative complications, ICU, and hospital stay.


Assuntos
Estenose da Valva Aórtica , Insuficiência Renal Crônica , Substituição da Valva Aórtica Transcateter , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Humanos , Complicações Pós-Operatórias , Fatores de Risco , Resultado do Tratamento
17.
J Coll Physicians Surg Pak ; 31(8): 891-896, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34320703

RESUMO

OBJECTIVE: To compare the results of sutureless aortic valve replacement (AVR) with the conventional method. STUDY DESIGN: A case-control study. PLACE AND DURATION OF STUDY: Cardiovascular Surgery Unit, Istanbul Yeni Yuzyil University, Gaziosmanpasa Hospital, Turkey, from December 2014 to December 2019. METHODOLOGY: Patients undergoing AVR were enrolled. The inclusion criteria were severe symptomatic aortic valve disease, New York Heart Association (NYHA) class II or higher, and age >55 years. Perioperative clinical and echocardiographic outcomes were assessed in all patients. RESULTS: Ninety-one patients (45 women, 46 men) underwent AVR (49 sutureless, 42 conventional). The average age was 73.08 ± 7.54 years in the sutureless group and 66.26±8.63 years in the conventional group. The mean cross-clamp and cardiopulmonary bypass (CPB) times were 72.86 ± 34.09 and 91.88 ± 36.98 minutes, respectively, in the former; and 104.96 ± 41.64 and 119.81 ± 40.45 minutes, respectively, in the latter. In the sutureless group, 30 (61.2%) patients underwent additional procedures such as CABG, mitral interventions, tricuspid repair, ascending aortic surgery, and myxoma removal. Preoperative peak and mean pressure gradients decreased from 76 and 48 mmHg to 16 and 9 mmHg postoperatively in the sutureless group; and from 70.9 and 44 mmHg to 24 and 12 mmHg in the conventional group. Paravalvular leak and permanent pacemaker requirement due to AV-block rates were 6.1%. The mean ICU stay was 3.69±6.75 and 2.31±1.80 days, the mean hospital stay was 10.08±6.56 and 8.62±3.28 days, and the 30-day overall mortality rates were 8.2% and 4.8% in the sutureless and conventional groups, respectively.   Conclusion: Sutureless AVR has advantages of shorter cross-clamp time, reduced CPB duration, and postoperative aortic gradients. However, there was no advantage in terms of mortality or hospital stay. Its benefits could be more prominent in complex cases or minimally invasive surgery. Key Words: Sutureless valves, Aortic valve stenosis, Valve replacement.


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Resultado do Tratamento , Turquia
18.
Medicina (Kaunas) ; 57(6)2021 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-34201104

RESUMO

Background and objectives: In this study, we aimed to evaluate whether the systemic immune-inflammation index (SII) has a prognostic value for major adverse cardiac events (MACEs), including stroke, re-hospitalization, and short-term all-cause mortality at 6 months, in aortic stenosis (AS) patients who underwent transcatheter aortic valve implantation (TAVI). Materials and Methods: A total of 120 patients who underwent TAVI due to severe AS were retrospectively included in our study. The main outcome of the study was MACEs and short-term all-cause mortality at 6 months. Results: The SII was found to be higher in TAVI patients who developed MACEs than in those who did not develop them. Multivariate Cox regression analysis revealed that the SII (HR: 1.002, 95%CI: 1.001-1.003, p < 0.01) was an independent predictor of MACEs in AS patients after TAVI. The optimal value of the SII for MACEs in AS patients following TAVI was >1.056 with 94% sensitivity and 96% specificity (AUC (the area under the curve): 0.960, p < 0.01). We noted that the AUC value of SII in predicting MACEs was significantly higher than the AUC value of the C-reactive protein (AUC: 0.960 vs. AUC: 0.714, respectively). Conclusions: This is the first study to show that high pre-procedural SII may have a predictive value for MACEs and short-term mortality in AS patients undergoing TAVI.


Assuntos
Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Humanos , Inflamação , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento
19.
Curr Cardiol Rep ; 23(8): 108, 2021 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-34213661

RESUMO

PURPOSE OF REVIEW: Preservation or repair of the aortic valve has evolved dynamically in the past 20 years. It leads to a high freedom from valve-related complications if an adequate valve durability can be achieved; it may possibly also improve survival. To date, little structured information is available about which valves can be repaired and which should better be replaced. RECENT FINDINGS: For surgical decision-making, the size of the aortic root is important and the anatomy of the aortic valve must be considered. In the presence of root aneurysm, most tricuspid and bicuspid aortic valves can be preserved. In aortic regurgitation and normal aortic dimensions, the majority of tricuspid and bicuspid aortic valves can be repaired with good long-term durability. In bicuspid aortic valves, the morphologic characteristics must be taken into consideration. Unicuspid and quadricuspid aortic valves can be repaired in selected cases. Generally, cusp calcification is a sign of a poor substrate for repair; the same is true for cusp retraction and cusp destruction due to active endocarditis. They are associated with limited valve durability. Using current concepts, many non-calcified aortic valves can be repaired. Modern imaging, in particular three-dimensional transesophageal echocardiography (TEE), should be able to define repairable aortic valves with a high probability.


Assuntos
Insuficiência da Valva Aórtica , Doença da Válvula Aórtica Bicúspide , Aorta , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/cirurgia , Humanos , Reoperação
20.
J Card Surg ; 36(9): 3393-3395, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34196040

RESUMO

Here, we present a case of acute myocardial infarction caused by an aortic valve tumor. Electrocardiography (ECG)-gated four-dimensional computed tomography revealed obstruction of the right coronary ostium by a mobile mass during systole. To ensure an accurate diagnosis of angina in patients without significant coronary artery disease, ECG-gated four-dimensional computed tomography is useful because it can simultaneously visualize the coronary ostium and arteries, aortic valve leaflets, and mass.


Assuntos
Estenose da Valva Aórtica , Oclusão Coronária , Neoplasias , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Angiografia Coronária , Oclusão Coronária/diagnóstico por imagem , Oclusão Coronária/etiologia , Humanos , Sístole
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