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1.
J Vis Exp ; (165)2020 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-33283790

RESUMO

Percutaneous coronary intervention (PCI), combined with the deployment of a coronary stent, represents the gold standard in interventional treatment of coronary artery disease. In-stent restenosis (ISR) is determined by an excessive proliferation of neointimal tissue within the stent and limits the long-term success of stents. A variety of animal models have been used to elucidate pathophysiological processes underlying in-stent restenosis (ISR), with the porcine coronary and the rabbit iliac artery models being the most frequently used. Murine models provide the advantages of high throughput, ease of handling and housing, reproducibility, and a broad availability of molecular markers. The apolipoprotein E deficient (apoE-/- ) mouse model has been widely used to study cardiovascular diseases. However, stents must be miniaturized to be implanted into mice, involving important changes of their mechanical and (potentially) biological properties. The use of apoE-/- rats can overcome these shortcomings as apoE-/- rats allow for the evaluation of human-sized coronary stents while at the same time providing an atherogenic phenotype. This makes them an excellent and reliable model to investigate ISR after stent implantation. Here, we describe, in detail, the implantation of commercially available human coronary stents into the abdominal aorta of rats with an apoE-/- background using a trans-femoral access.


Assuntos
Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Vasos Coronários/cirurgia , Artéria Femoral/cirurgia , Stents , Animais , Aorta Abdominal/patologia , Feminino , Humanos , Masculino , Ratos , Reprodutibilidade dos Testes , Resultado do Tratamento
2.
Kyobu Geka ; 73(12): 1018-1021, 2020 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-33268754

RESUMO

A 61-year-old woman was referred to our hospital with a complaint of chest compression. Coronary angiography revealed a giant coronary artery aneurysm, located in the middle of a coronary-pulmonary artery fistula originating from the right coronary artery. Another fistula was also shown between the left anterior descending artery and the pulmonary artery. Surgical correction was indicated due to the risks of the aneurysmal rupture and coronary events. Under cardiopulmonary bypass, suture-closure of the coronary artery aneurysm and ligations of the fistulae were carried. Postoperative coronary angiography showed no aneurysm or fistula, and she was discharged uneventfully on the 12th postoperative day.


Assuntos
Fístula Artério-Arterial , Aneurisma Coronário , Doença da Artéria Coronariana , Fístula Artério-Arterial/complicações , Fístula Artério-Arterial/diagnóstico por imagem , Fístula Artério-Arterial/cirurgia , Aneurisma Coronário/complicações , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia
3.
Kardiologiia ; 60(7): 64-71, 2020 Aug 11.
Artigo em Russo | MEDLINE | ID: mdl-33155942

RESUMO

Aim      To analyze the relationship between serum concentrations of high-sensitivity C-reactive protein (hsCRP) in dynamics and development of restenosis at 12 months following elective coronary stent placement (CSP).Material and methods  The key role in atherogenesis, neointimal proliferation and restenosis belongs to inflammation. This study included 91 patients (median age, 60 [56; 66] years) with stable exertional angina after an elective CSP using second-generation stents. Follow-up coronarography was performed for 60 patients at 12 months. Concentration of hsCRP was measured immediately prior to CSP and at 1, 3, 6, and 12 months after CSP. Restenosis of the stented segment (50% or more narrowing of the stented segment or a 5-mm vessel segment proximally or distally adjacent to the stented segment) was observed in 8 patients.Results According to results of the ROC analysis, the increase in hsCRP concentration >0.9 mg/l (>25%) at one month after CSP had the highest predictive significance with respect of restenosis (area under the ROC curve, 0.89 at 95 % confidence interval (CI) from 0.79 to 0.99; sensitivity, 87.5 %; specificity, 82.8 %; р=0.0005), which was superior to the absolute value of hsCRP concentration >3.0 mg/l (area under the ROC curve, 0.82 at 95 % CI from 0.68 to 0.96; р=0.0007).Conclusion      Increased concentration of hsCRP ≥0.9 mg /l (≥25 %) at a month after CSP was associated with restenosis of the coronary artery stented segment.


Assuntos
Proteína C-Reativa , Reestenose Coronária , Idoso , Angiografia Coronária , Reestenose Coronária/diagnóstico , Reestenose Coronária/etiologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Humanos , Prognóstico , Curva ROC , Stents
4.
J Vis Exp ; (163)2020 09 26.
Artigo em Inglês | MEDLINE | ID: mdl-33044442

RESUMO

Testing regenerative properties of 3D bioprinted cardiac patches in vivo using murine models of heart failure via permanent left anterior descending (LAD) ligation is a challenging procedure and has a high mortality rate due to its nature. We developed a method to consistently transplant bioprinted patches of cells and hydrogels onto the epicardium of an infarcted mouse heart to test their regenerative properties in a robust and feasible way. First, a deeply anesthetized mouse is carefully intubated and ventilated. Following left lateral thoracotomy (surgical opening of the chest), the exposed LAD is permanently ligated and the bioprinted patch transplanted onto the epicardium. The mouse quickly recovers from the procedure after chest closure. The advantages of this robust and quick approach include a predicted 28-day mortality rate of up to 30% (lower than the 44% reported by other studies using a similar model of permanent LAD ligation in mice). Moreover, the approach described in this protocol is versatile and could be adapted to test bioprinted patches using different cell types or hydrogels where high numbers of animals are needed to optimally power studies. Overall, we present this as an advantageous approach which may change preclinical testing in future studies for the field of cardiac regeneration and tissue engineering.


Assuntos
Bioimpressão , Infarto do Miocárdio/patologia , Impressão Tridimensional , Anestesia , Animais , Vasos Coronários/cirurgia , Modelos Animais de Doenças , Insuficiência Cardíaca , Estimativa de Kaplan-Meier , Ligadura , Camundongos Endogâmicos C57BL , Pericárdio/patologia , Toracotomia , Engenharia Tecidual
5.
Angiol Sosud Khir ; 26(3): 151-157, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063761

RESUMO

AIM: The purpose of this study was to assess the long-term results of right coronary artery bypass grafting and identify predictors of coronary artery bypass graft occlusion. PATIENTS AND METHODS: Our retrospective single-centre study included a total of 245 patients subjected to isolated coronary artery bypass graft operations during the follow up period from 2010 to 2015. All patients endured bypass grafting of the right coronary artery (RCA) with either autovenous or autoarterial conduits. Control coronary bypass angiography was performed in all patients in connection with a relapse of angina pectoris. The duration of the follow up period amounted to 43.7±20.2 months. The patients were divided into two groups depending on the type of the conduit used to bypass the RCA. Group One patients (n=106) endured bypass grafting of the RCA and its branches using the internal thoracic artery. Group Two patients (n=139) underwent autovenous coronary artery bypass grafting of the RCA basin. By the main clinical, demographic and intraoperative parameters the groups were statistically homogeneous (p>0.05). The effect of the degree of proximal stenosis, the diameter of the grafted artery on the viability of bypass grafts was assessed. RESULTS: During the follow-up period up to 84 months, 19 (17.9%) occluded arterial and 29 (20.9%) venous conduits were revealed. The Kaplan-Meier analysis showed that the probability of the absence of venous graft occlusion during the follow-up period up to 84 months was significantly lower than that of arterial grafts (log rank=0.012). The Cox regression analysis results revealed that shunt occlusion was influenced by the degree of proximal stenosis and the diameter of the shunted artery. CONCLUSION: When shunting a moderate stenosis of the RCA (up to 70%), an advantage of autovenous conduits was revealed. When shunting the RCA with a critical stenosis and occlusion, advantages were revealed for the internal thoracic artery.


Assuntos
Ponte de Artéria Coronária , Vasos Coronários , Constrição Patológica , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Humanos , Estudos Retrospectivos
6.
Am J Cardiol ; 135: 62-67, 2020 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-32958219

RESUMO

Ostial coronary artery lesions can be challenging during percutaneous coronary intervention (PCI) because of elastic fiber content, calcium burden, and angulation. We assessed procedural and clinical major adverse cardiac events (MACE) associated with PCI for ostial lesions, focusing on ostial left circumflex (LC) lesions compared with ostial left anterior descending artery (LAD) and right coronary artery lesions. All patients with ostial or very proximal coronary artery lesions treated with PCI at MedStar Washington Hospital Center (Washington, DC) from 2003 to 2018 were included. The primary end point was target lesion revascularization (TLR)-MACE, defined as the composite of all-cause mortality, Q-wave myocardial infarction (MI), and TLR at 1 year. A total of 4,759 patients with available 1-year follow-up were included: 2,236 ostial/very proximal LAD, 980 ostial/very proximal LC, and 1,543 ostial/very proximal right. The presenting clinical syndrome for the LC group was mainly stable or unstable angina, whereas MI was more common in the LAD. At 1 year, the TLR-MACE rate was 16.7% in the LC group versus 12.5% in the LAD and 11.8% in the right group (p = 0.001). Mortality rates were 11.2% in the LC group versus 8.4% in the LAD and 6% in the right group (p <0.001). A Cox model showed that dialysis had the highest impact on TLR-MACE. In conclusion, compared with PCI of ostial or very proximal LAD or right lesions, PCI of ostial or very proximal LC lesions was associated with higher rates of TLR-MACE.


Assuntos
Doença da Artéria Coronariana/cirurgia , Intervenção Coronária Percutânea , Adulto , Idoso , Idoso de 80 Anos ou mais , Angina Estável/epidemiologia , Angina Instável/epidemiologia , Vasos Coronários/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento
7.
Am Heart J ; 228: 98-108, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32871329

RESUMO

About half of patients with acute ST-segment elevation myocardial infarction (STEMI) present with multivessel coronary artery disease (MVD). Recent evidence supports complete revascularization in these patients. However, optimal timing of non-culprit lesion revascularization in STEMI patients is unknown because dedicated randomized trials on this topic are lacking. STUDY DESIGN: The MULTISTARS AMI trial is a prospective, international, multicenter, randomized, two-arm, open-label study planning to enroll at least 840 patients. It is designed to investigate whether immediate complete revascularization is non-inferior to staged (within 19-45 days) complete revascularization in patients in stable hemodynamic conditions presenting with STEMI and MVD and undergoing primary percutaneous coronary intervention (PCI). After successful primary PCI of the culprit artery, patients are randomized in a 1:1 ratio to immediate or staged complete revascularization. The primary endpoint is a composite of all-cause death, non-fatal myocardial infarction, ischemia-driven revascularization, hospitalization for heart failure, and stroke at 1 year. CONCLUSIONS: The MULTISTARS AMI trial tests the hypothesis that immediate complete revascularization is non-inferior to staged complete revascularization in stable patients with STEMI and MVD.


Assuntos
Vasos Coronários , Intervenção Coronária Percutânea , Complicações Pós-Operatórias , Infarto do Miocárdio com Supradesnível do Segmento ST , Tempo para o Tratamento/normas , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Índice de Gravidade de Doença
9.
J Cardiothorac Surg ; 15(1): 217, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32795345

RESUMO

BACKGROUND: With the ageing of China's population, the incidence and mortality of coronary atherosclerotic heart disease (CAD) is increasing year by year, which brings a heavy burden to the family and society [1]. We aimed to analyse the strategy of coronary artery bypass grafting (CABG) in the right coronary artery and to compare the haemodynamic characteristics of the sequential grafts with those of single grafts and to observe the patency rate of those grafts for 1 week after the operation. METHODS: A total of 242 patients (178 men, mean age 62.6 ± 8.8 years) underwent right coronary artery bypass grafting in our hospital from October 2016 to January 2019. The blood flow (Q, ml/min), pulsatility index (PI) and related parameters of the grafts were measured and recorded by TTFM during the CABG. The patency of the grafts was evaluated by coronary computed tomography (CT) for 1 week after the operation. RESULTS: The most common material used for the graft in the right coronary system of CABG is the greater saphenous vein (92.3%), followed by the radial artery (5.5%) and the internal mammary artery (1.9%). The highest frequency target of the right coronary artery is the posterior descending artery (PDA) (47.6%), followed by the right main coronary artery (RCA) (29.1%) and the posterior branch of the left ventricle (PL) (23.3%). The proportion of single grafts was the highest for the right coronary artery in CABG (178 cases, 67.9%), followed by a graft of the PDA-PL (42 cases, 16.0%) and other sequential grafts among the different coronary artery systems (including the system of the left anterior descending artery (LAD) and the left circumflex (LCX)). Whether there were sequential grafts of the PDA-PL or other sequential grafts among the different systems of the coronary artery, the instantaneous flow of a group of sequential grafts was higher than that of a single graft, and the difference had statistical significance (P < 0.01). However, there were no significant differences in the flow between the groups of sequential grafts (P = 0.410). Diastolic flow (DF) in the group of sequential grafts of the right coronary system was better than that in the non-sequential group (P < 0.001), and the difference had statistical significance. There was no significant difference between the DF of the groups of the other system of sequential grafts and that of the right coronary sequential grafts. Coronary artery CT suggested that there were 11 cases of poorly developing grafts or stenosis and occlusion a week after the operation, and those phenomenon mainly occurred in the group with a single graft. There was only one case that was occluded in the group of other systems of sequential grafts, and statistically significant differences existed between the two groups (P < 0.01). CONCLUSIONS: In our centre, the most common form of CABG in the right coronary artery system is a non-sequential vein bridge to the PDA. Whether there are sequential grafts of the PDA-PL or other sequential grafts among the different coronary artery systems, the instantaneous flow of a group of sequential grafts is higher than that of a single graft. DF in the group of sequential grafts of the right coronary system was better than that in the non-sequential group.


Assuntos
Ponte de Artéria Coronária/métodos , Vasos Coronários/cirurgia , Idoso , Velocidade do Fluxo Sanguíneo , Circulação Coronária , Doença das Coronárias/cirurgia , Vasos Coronários/diagnóstico por imagem , Feminino , Coração , Hemodinâmica , Humanos , Masculino , Artéria Torácica Interna/transplante , Pessoa de Meia-Idade , Período Perioperatório , Fluxo Pulsátil , Artéria Radial/cirurgia , Estudos Retrospectivos , Veia Safena/transplante , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Grau de Desobstrução Vascular
11.
Medicine (Baltimore) ; 99(28): e20850, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664079

RESUMO

RATIONALE: With the development and standardization of modern chronic total occlusions (CTOs) recanalization technique, percutaneous coronary intervention has become a promising treatment alternative to surgery after bypass graft failure. Treatment of a native coronary CTO lesion is preferable to treatment of a saphenous vein graft (SVG) CTO supplying the same territory; however, technical expertise is required. PATIENT CONCERNS: This is a 69-year-old male with prior history of coronary artery bypass grafting presented with severe dyspnea at mild exertion (NYHA III) of 2 months duration. DIAGNOSIS: The patient was diagnosed as heart failure caused by ischemia after SVG failure (SVG to right coronary artery) according to electrocardiogram, plasma N-terminal pro-B-type natriuretic peptide levels, and coronary angiogram. INTERVENTIONS: We recanalized native right coronary artery CTO by retrograde approach using septal collaterals by surfing technique after recanalization of totally occluded left coronary artery. OUTCOMES: Dyspnea was relieved at discharge. At 6-month follow-up, the patient had no recurrence of dyspnea. LESSONS: In case of SVG failure, percutaneous coronary intervention of native vessel should be considered as a treatment option. Retrograde approach through native vessel is safe but has requirements for operators' volume, skill, and experience.


Assuntos
Vasos Coronários/cirurgia , Dispneia/etiologia , Insuficiência Cardíaca/diagnóstico , Veia Safena/transplante , Assistência ao Convalescente , Idoso , Angiografia Coronária/métodos , Ponte de Artéria Coronária/efeitos adversos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Eletrocardiografia/métodos , Oclusão de Enxerto Vascular/complicações , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Intervenção Coronária Percutânea/métodos , Resultado do Tratamento
12.
J Am Coll Cardiol ; 76(2): 146-158, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32646563

RESUMO

BACKGROUND: Outcome data after extended long-term follow-up of patients with coronary artery disease treated with drug-eluting stents (DES) in randomized clinical trials are scant. OBJECTIVES: Performance differences among devices may be expected to emerge over time depending on whether stenting is done with polymer-free or durable polymer DES. This study assessed the 10-year outcomes of patients enrolled in the ISAR-TEST-5 (Test Efficacy of Sirolimus- and Probucol-Eluting Versus Zotarolimus-Eluting Stents) trial. METHODS: A total of 3,002 patients were randomized to treatment with either polymer-free sirolimus- and probucol-eluting stents (n = 2,002) or durable polymer zotarolimus-eluting stents (n = 1,000). The primary endpoint was the composite of cardiac death, target vessel-related myocardial infarction, or target lesion revascularization (a device-oriented composite endpoint [DOCE]). Additional endpoints of interest were the patient-oriented composite endpoint (POCE), including all-cause death, any myocardial infarction, or any revascularization; individual components of the composite endpoints; and definite or probable stent thrombosis. RESULTS: The median age of the patients at randomization was 67.8 years. At 10 years, 63.9% of patients were alive. The rates of DOCE and POCE were high in both groups with no difference in the incidence between polymer-free sirolimus- and probucol-eluting stents and durable polymer zotarolimus-eluting stents (DOCE: 43.8% vs. 43.0%, respectively; hazard ratio: 1.01; 95% confidence interval [CI]: 0.89 to 1.14; p = 0.90; POCE: 66.2% vs. 67.7%, respectively; hazard ratio: 0.94; 95% CI: 0.86 to 1.04; p = 0.22). The rates of the individual components of the composite endpoints were comparable in both groups. The incidence of definite/probable stent thrombosis over 10 years was low and comparable in both groups (1.6% vs. 1.9%; hazard ratio: 0.85; 95% CI: 0.46 to 1.54; p = 0.58). CONCLUSIONS: At 10 years, there were no measurable differences in outcomes between patients treated with polymer-free versus durable polymer DES. The incidence of stent thrombosis was low and comparable in both groups. High overall adverse clinical event rates were observed during extended follow-up. (Test Efficacy of Sirolimus- and Probucol-Eluting Versus Zotarolimus-Eluting Stents [ISAR-TEST-5]; NCT00598533).


Assuntos
Implantes Absorvíveis , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/cirurgia , Stents Farmacológicos , Previsões , Polímeros , Sirolimo/análogos & derivados , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Desenho de Prótese , Estudos Retrospectivos , Sirolimo/farmacologia , Resultado do Tratamento
13.
Sci Rep ; 10(1): 11362, 2020 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-32647194

RESUMO

Although the usefulness of intravascular ultrasound (IVUS) in rotational atherectomy (RA) has been widely recognized, an IVUS catheter may not cross the target lesion because of severe calcification. The aim of this study was to compare the incidence of slow flow following RA between IVUS-crossable versus IVUS-uncrossable calcified lesions. We included 284 RA lesions, and divided into an IVUS-crossable group (n = 150) and an IVUS-uncrossable group (n = 134). The primary endpoint was slow flow just after RA. The incidence of slow flow (TIMI flow grade ≤ 2) was significantly greater in the IVUS-uncrossable group than in the IVUS-crossable group (26.1% vs. 10.7%, p = 0.001). The incidence of severe slow flow (TIMI grade ≤ 1) was also greater in the IVUS-uncrossable group than in the IVUS-crossable group (9.7% vs. 2.7%, p = 0.022). The multivariate logistic regression model showed a significant association between slow flow and pre-IVUS uncrossed lesions (vs. crossed lesions: odds ratio 2.103, 95% confidence interval 1.047-4.225, p = 0.037). In conclusion, the incidence of slow flow/severe slow flow just after RA was significantly greater in the IVUS-uncrossable lesions than in the IVUS-crossable lesions. Our study suggests the possibility that the IVUS-crossability can be used as a risk stratification of severe calcified lesions.


Assuntos
Aterectomia Coronária/efeitos adversos , Doença da Artéria Coronariana/cirurgia , Fenômeno de não Refluxo/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Aterectomia Coronária/métodos , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fenômeno de não Refluxo/diagnóstico , Fenômeno de não Refluxo/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento , Ultrassonografia de Intervenção
14.
World J Pediatr Congenit Heart Surg ; 11(5): 649-651, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32662353

RESUMO

Coronary ostial stenosis is a rare congenital cardiac anomaly, frequently associated with hypoplasia of the proximal coronary artery. This condition is potentially life-threatening, as it may present with myocardial ischemia and sudden death. We present a case of left coronary ostial stenosis in a 48-day-old infant symptomatic for sudden cardiac arrest, who successfully underwent surgical angioplasty. Any cardiac arrest in a neonate or young infant should raise suspicion of coronary ostial stenosis/atresia, considering the difficulty in diagnosing this congenital heart defect.


Assuntos
Angioplastia Coronária com Balão/métodos , Estenose Coronária/diagnóstico , Vasos Coronários/diagnóstico por imagem , Angiografia Coronária , Estenose Coronária/cirurgia , Vasos Coronários/cirurgia , Humanos , Lactente
15.
Sci Rep ; 10(1): 11842, 2020 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-32678228

RESUMO

Progranulin is a secreted growth factor associated with multiple physiological functions in ischemic pathophysiology. However, it is still not fully understood how progranulin is involved in ischemic lesion and cardiac remodeling after myocardial infarction (MI). In this study, we investigated the effects of progranulin on myocardial ischemia and reperfusion injury. We investigated progranulin expression using Western blotting and immunostaining after permanent left coronary artery (LCA) occlusion in mice. Infarct size and the number of infiltrating neutrophils were measured 24 h after permanent LCA occlusion. Recombinant mouse progranulin was administered before LCA occlusion. In addition, we evaluated cardiac function using cardiac catheterization and echocardiography, and fibrosis size by Masson's trichrome staining after myocardial ischemia/reperfusion in rabbits. Recombinant human progranulin was administered immediately after induction of reperfusion. Progranulin expression increased in the myocardial ischemic area 1, 3, and 5 days after permanent LCA occlusion in mice. The administration of recombinant mouse progranulin significantly attenuated infarct size and infiltrating neutrophils 24 h after permanent LCA occlusion in mice. We also found that administration of recombinant human progranulin ameliorated the deterioration of cardiac dysfunction and fibrosis after myocardial ischemia/reperfusion in rabbits. These findings suggest that progranulin may protect myocardial ischemia/reperfusion injury.


Assuntos
Cardiotônicos/farmacologia , Fibrose Endomiocárdica/tratamento farmacológico , Infarto do Miocárdio/tratamento farmacológico , Isquemia Miocárdica/tratamento farmacológico , Traumatismo por Reperfusão Miocárdica/tratamento farmacológico , Progranulinas/farmacologia , Animais , Transtornos Cerebrovasculares/cirurgia , Vasos Coronários/cirurgia , Modelos Animais de Doenças , Ecocardiografia , Fibrose Endomiocárdica/diagnóstico por imagem , Fibrose Endomiocárdica/patologia , Humanos , Masculino , Camundongos , Camundongos Endogâmicos ICR , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/patologia , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/patologia , Traumatismo por Reperfusão Miocárdica/diagnóstico por imagem , Traumatismo por Reperfusão Miocárdica/patologia , Infiltração de Neutrófilos , Neutrófilos , Coelhos , Proteínas Recombinantes/farmacologia , Resultado do Tratamento
16.
J Interv Cardiol ; 2020: 4587414, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32607081

RESUMO

Background: The outcomes of patients with concomitant left main coronary artery (LMCA) and right coronary artery (RCA) diseases are reportedly worse than those with only LMCA disease. To date, only few studies have investigated the clinical impact of percutaneous coronary intervention (PCI) on RCA stenosis during the same hospitalization, in which LMCA disease was treated. This study was aimed at comparing the outcomes between patients with and without right coronary artery intervention during the same hospital course for LMCA intervention. Methods and Results: From a total of 776 patients who were undergoing PCI to treat LMCA disease, 235 patients with concomitant RCA significant stenosis (more than 70% stenosis) were enrolled. The patients were divided into two groups: 174 patients received concomitant PCI for RCA stenosis during the same hospitalization, in which LMCA disease was treated, and 61 patients did not receive PCI for RCA stenosis. Patients without intervention to the right coronary artery had higher 30-day cardiovascular mortality rates and 3-year RCA revascularization rates compared to those with right coronary artery intervention. Patients without RCA intervention at the same hospitalization did not increase the 30-day total death, 3-year myocardial infarction rate, 3-year cardiovascular death, and 3-year total death. Conclusions: In patients with LM disease and concomitant above or equal to 70% RCA stenosis, PCI for RCA lesion during the same hospitalization is recommended to reduce the 30-day cardiovascular death and 3-year RCA revascularization rate.


Assuntos
Doença da Artéria Coronariana , Vasos Coronários , Intervenção Coronária Percutânea , Complicações Pós-Operatórias , Reoperação , Idoso , Causas de Morte , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/cirurgia , Estenose Coronária/mortalidade , Estenose Coronária/terapia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Vasos Coronários/cirurgia , Feminino , Humanos , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Reoperação/métodos , Reoperação/estatística & dados numéricos , Índice de Gravidade de Doença , Falha de Tratamento
17.
Ann Thorac Surg ; 110(6): e549-e550, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32544456

RESUMO

We describe a novel technique, in situ composition of a valved conduit, for complex reoperative aortic root replacement. The absence of a rigid stented aortic valve prosthesis facilitates left ventricular outflow tract (LVOT) reconstruction and coronary reimplantation. First, a Dacron graft, inverted and inserted into the LVOT, is sewn to the LVOT, followed by coronary button reimplantation and then prosthetic valve implantation. For cases that require LVOT reconstruction, the graft below the prosthetic valve serves as a circumferential patch. Our technique requires only surgical materials that are readily available without the need for a specialized skillset.


Assuntos
Doenças da Aorta/cirurgia , Valva Aórtica/cirurgia , Implante de Prótese Vascular/métodos , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Prótese Vascular , Vasos Coronários/cirurgia , Próteses Valvulares Cardíacas , Humanos , Reoperação , Reimplante
18.
Ann Thorac Surg ; 110(6): 1847-1853, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32561313

RESUMO

BACKGROUND: This study evaluated the feasibility and durability of the modified Cabrol coronary reattachment technique after aortic root replacement. METHODS: The study retrospectively reviewed 370 patients who underwent aortic root replacement, during 1991 and 2018, and who were separated into 2 groups: a modified Carol (mCabrol) group (n = 84), consisting of patients with 1 or both coronary ostia reimplanted using a modified Cabrol technique; and a Carrel group (n = 286), consisting of patients with both coronary ostia reimplanted using the Carrel button technique. RESULTS: Baseline characteristics were similar in the 2 groups, except the mCabrol group had higher rates of redo sternotomy (74% vs 16%), chronic aortic dissection (58% vs 19%), and infection (14% vs 3%). In the mCabrol group, 60% had both coronary arteries reattached with the technique, and 40% of the procedures were unilateral. Operative mortality was significantly higher in mCabrol group compared with the Carrel group. However, in the stratified analysis for resternotomy, operative mortality between 2 groups were similar (16% vs 13%; P = .786). The survival rate at 5 years and 10 years was 68 ± 6% and 44 ± 6%, respectively, in the mCabrol group and 87 ± 2% and 80 ± 3%, respectively, in the Carrel group (log-rank P < .001). After propensity adjustment, chronic kidney disease and prior coronary artery bypass grafting, but not the modified Cabrol technique, were independent predictors of both operative mortality and follow-up mortality (operative, P = .518; follow-up, P = .080). A total of 47 (66%) of 71 discharged patients in the mCabrol group had follow-up imaging, and no Cabrol graft was occluded. Two patients in the mCabrol group required interventions related to the reattachment technique: 1 coronary ostial anastomosis stenosis and 1 graft-to-graft anastomosis pseudoaneurysm. CONCLUSIONS: The modified Cabrol reattachment technique was not predictive of increased mortality and has excellent patency.


Assuntos
Aneurisma Dissecante/cirurgia , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/métodos , Vasos Coronários/cirurgia , Complicações Pós-Operatórias/epidemiologia , Reimplante/métodos , Adulto , Aneurisma Dissecante/mortalidade , Aneurisma Aórtico/mortalidade , Prótese Vascular , Implante de Prótese Vascular/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reimplante/efeitos adversos , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
19.
Medicine (Baltimore) ; 99(21): e20349, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-32481325

RESUMO

AIMS: The purpose of the present trial is to determine whether opening co-existing chronic total occlusions (CTOs) using percutaneous coronary interventions (PCIs) improves cardiac function in patients with multi-vessel disease (MVD). Patients with MVD are defined as having at least one additional major vessel exhibiting no less than 75% stenosis combined with the presence of a CTO artery. METHODS AND RESULTS: Patients will be prospectively recruited who meet the following criteria:Patients presenting with no necrosis of myocardial tissue in the territory of the CTO will be excluded. Recruited patients will be randomized into 2 groups: those undergoing PCI of only the non-CTO artery (non-CTO PCI group), and those undergoing PCI of the non-CTO artery concurrently with the CTO artery (CTO-PCI group). The primary outcome will be the change in cardiac function evaluated via CMR at a 12-month of follow-up appointment, which will be compared to a baseline measurement. Secondary outcomes include occurrence of major cardiac events, CMR-assessed myocardial viability in the CTO-supplied territory, and quality of life assessed by Seattle angina questionnaire, Patient Health Questionnaire 9 and Generalized Anxiety Disorder Scale-7 after 12-month follow-up. CONCLUSION: The SOS-moral trial will provide data necessary to determine whether to open concurrent CTOs among MVD patients with CMR-detected necrotic myocardial tissue.


Assuntos
Oclusão Coronária/cirurgia , Vasos Coronários/diagnóstico por imagem , Contração Miocárdica/fisiologia , Intervenção Coronária Percutânea/métodos , Função Ventricular Esquerda/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Angiografia Coronária , Oclusão Coronária/diagnóstico , Vasos Coronários/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
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