RESUMO
OBJECTIVE: Diffuse coronary artery disease jeopardizes myocardium, increasing surgical mortality in primary coronary artery bypass grafting (CABG). We sought to determine the impact of diffuseness on pre- and post-discharge outcomes for both primary and reoperative CABG (REOP). METHODS: Using a validated system for measuring diffuseness of coronary disease, preoperative angiograms were scored for primary CABG (n=792) and REOP cases (n=268) performed 1997-2004. A diffuseness score (DS)>18 was defined as elevated. In-hospital mortality, intermediate-term survival, and in-hospital composite outcome (COMP) (one or more of: mortality, stroke, MI, deep sternal infection, sepsis, IABP insertion, or return to OR) were examined. RESULTS: In-hospital mortality and COMP for patients with DS>18 were significantly higher (7.9% vs 2.4%, p<0.0001), (17.8% vs 9.2%, p<0.0001). DS (mean+/-SD) was higher in REOP cases than primary CABG (18.9+/-7.1 vs 14.4+/-6.0, p<0.0001). By multivariate analysis, DS>18 (OR 2.00, 95%CI, 1.20-3.32, p=0.008) and REOP (OR 2.40, 95%CI, 1.53-3.77, p<0.0001) were independently associated with COMP. Using propensity scores 82% of cases with DS>18 (n=289) were matched 1:1 to cases with DS
Assuntos
Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Idoso , Estudos de Coortes , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Cuidados Pré-Operatórios/métodos , Reoperação , Resultado do TratamentoRESUMO
Transcatheter aortic valve implantation (TAVR) has grown rapidly over the past 10 years. Device and delivery catheter systems have evolved to facilitate the procedure and reduce the risk of associated complications, including those related to vascular access. It is important to understand the utility of the TAVR equipment in patients with more challenging anatomy to select the most appropriate technique for this complex procedure. We report the first case, to our knowledge, of a patient with dextrocardia situs inversus and previous coronary artery bypass grafting who underwent TAVR from the femoral route using the Edwards SAPIEN XT Novaflex+ Transfemoral System (Edwards Lifesciences, Irvine, CA).
Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Dextrocardia/complicações , Ponte de Artéria Coronária , Artéria Femoral , Humanos , Masculino , Pessoa de Meia-Idade , Implantação de Prótese/métodos , Situs Inversus/complicaçõesAssuntos
Serviço Hospitalar de Cardiologia/organização & administração , Angiografia Coronária/normas , Equipe de Assistência ao Paciente , Serviço Hospitalar de Radiologia/organização & administração , Encaminhamento e Consulta/organização & administração , Canadá , Erros de Diagnóstico/prevenção & controle , Humanos , Nova Escócia , Qualidade da Assistência à SaúdeRESUMO
With the goal of optimizing patient care, standards for training in cardiac computed tomography have been developed collaboratively by the Canadian Association of Radiologists and the Canadian Cardiovascular Society. These standards apply to both radiologists and cardiologists.