RESUMO
The 25-mm Medtronic Mosaic porcine bioprosthesis (MB25) is the smallest bioprosthesis that has been approved for use in the mitral position in Japan. Various studies have reported satisfactory hemodynamic performance and good long-term outcomes of the Medtronic Mosaic porcine bioprosthesis. However, the hemodynamic and clinical performances of the MB25 in the mitral position remain unknown. This study aimed to evaluate the hemodynamic and clinical performance of the MB25 in mitral valve replacement (MVR). Twenty patients who underwent MVR using the MB25 between February 2013 and April 2018 were studied. We evaluated the hemodynamic performance of the MB25, cardiac chamber size, cardiac function, and systolic pulmonary artery pressure (PAP) using echocardiography during follow-up. The study outcomes were major adverse cardiac events (MACEs) and all-cause mortality. Sixteen patients (80%) had a patient prosthesis mismatch defined as an index effective orifice area of ≤ 1.2 cm2/m2. The left atrial dimension was significantly reduced after surgery (p = 0.0282). The mean pressure gradients (MPG) in the mitral position were 5.5 ± 1.7 mmHg at discharge and 4.2 ± 1.3 mmHg at 1 year postoperatively. The MPG in the mitral position significantly decreased during the follow-up period (p = 0.0489). Systolic PAP significantly improved postoperatively. The 1-, 3-, and 5-year survival rates were 87, 79, and 70%, respectively. No cardiac death occurred. There were no MACEs or reports of structural valve degeneration during the follow-up period. The hemodynamic and clinical performances of the MB25 in the mitral position were satisfactory as the smallest biological mitral valve. The MB25 is a reasonable option for MVR to reduce the surgical difficulty in high-risk patients with an advanced age, a small body size or MAC and when recurrent MVR or complex procedures are performed.
Assuntos
Bioprótese , Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Animais , Valva Aórtica/cirurgia , Seguimentos , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Hemodinâmica , Humanos , Complicações Pós-Operatórias/cirurgia , Desenho de Prótese , SuínosRESUMO
Aortic stenosis (AS) is the most common valve disorder in advanced age. Previous reports have shown that low-flow status of the left ventricle is an independent predictor of cardiovascular mortality after surgery. The Trifecta bioprosthesis has recently shown favorable hemodynamic performance. This study aimed to evaluate the effect of the Trifecta bioprosthesis, which has a large effective orifice area, in patients with low-flow severe AS who have a poor prognosis. We retrospectively evaluated 94 consecutive patients with severe AS who underwent aortic valve replacement (AVR). Patients were divided into two groups according to the stroke volume index (SVI): low-flow (LF) group (SVI < 35 ml/m2, n = 22) and normal-flow (NF) group (SVI ≥ 35 ml/m2, n = 72). Patients' characteristics and early and mid-term results were compared between the two groups. There were no differences in patients' characteristics, except for systolic blood pressure (LF:NF = 120:138 mmHg, p < 0.01) and the rate of atrial fibrillation between the groups. A preoperative echocardiogram showed that the pressure gradient was higher in the NF group than in the LF group, but aortic valve area was similar. The Trifecta bioprosthesis size was similar in both groups. The operative outcomes were not different between the groups. Severe patient-prosthesis mismatch (PPM) (< 0.65 cm2/m2) was not observed in either of the groups. There were no significant differences in mid-term results between the two groups. The favorable hemodynamic performance of the Trifecta bioprosthesis appears to have the similar outcomes in the LF and NF groups. AVR with the Trifecta bioprosthesis should be considered for avoidance of PPM, particularly in AS patients with LV dysfunction.
Assuntos
Estenose da Valva Aórtica , Bioprótese , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Hemodinâmica , Humanos , Desenho de Prótese , Estudos Retrospectivos , Resultado do TratamentoRESUMO
To assess the early hemodynamics after mitral valve replacement (MVR) using the St Jude Medical (SJM) Epic bioprosthesis. MVR was performed using the SJM Epic bioprosthesis in 35 patients from June 2018 to April 2020; three patients were excluded because the postoperative transthoracic echocardiography (TTE) data were unavailable. Data from postoperative TTE at 1 week and 3 months after the procedure were reviewed. The mean mitral pressure gradient (mMPG) was calculated using a continuous wave Doppler method. Left ventricular outflow tract (LVOT) was calculated using a pulse wave Doppler method. The effective orifice area (EOA) was measured from pressure half time. There were 12 men (37.5%) and 20 women (62.5%) with a mean age of 75.9 years (61-88 years). The mean body surface area was 1.51 ± 0.22 cm2. The 25 mm and 27 mm valves were used in more than 50% of cases. The mMPG was 4.9 ± 1.7 mmHg and 5.4 ± 1.6 mmHg at 1 week and 3 months after surgery, respectively. EOA was 2.18 ± 0.50 cm2 and 2.31 ± 0.59 cm2 at 1 week and 3 months after surgery, respectively. The peak velocity of the LVOT (n = 22) was 103.3 ± 21.3 cm/s and 106.8 ± 27.4 cm/s at 1 week and 3 months after surgery, respectively. No findings suggested paravalvular regurgitation and LVOT obstruction. Using the SJM Epic bioprosthesis in MVR resulted in satisfactory hemodynamics in the early postoperative period, even with small valve sizes. Further accumulation of cases and evidence, including mid- to long-term results, is required in the future.
Assuntos
Bioprótese , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Idoso , Valva Aórtica , Feminino , Hemodinâmica , Humanos , Japão , Masculino , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Desenho de PróteseRESUMO
PURPOSE: Hepatocellular carcinoma (HCC) is one of the most common primary cancers worldwide. HCC has unique characteristics such as co-existing chronic liver damage and a high recurrence rate. A negative impact on the surgical outcome due to these backgrounds could be expected. We aimed to evaluate the clinical outcomes of cardiac surgery in these patients. METHODS: Between January 2000 and December 2019, 16 patients with remitted cancer and 5 patients with active HCC who underwent open heart surgery were studied. The clinical data were retrospectively evaluated from hospital records. Follow-up information was collected via telephone interviews. RESULTS: The major cause of HCC was viral hepatitis. Eighteen patients (86%) were classified as having Child-Pugh class A cirrhosis. The mean model of end-stage liver disease (MELD) score was 7.2 ± 5.2. There was no 30-day mortality. During follow-up, 11 patients died due to HCC. The 1-, 3-, and 5-year survival rates were 80.0, 42.5, and 22.3%, respectively. A univariate analysis identified a higher preoperative MELD score and lower serum cholinesterase levels as prognostic factors for long-term survival. CONCLUSION: We could safely perform cardiac surgery in selected patients with remitted and active HCC. The postoperative life expectancy of these patients was limited but acceptable.
Assuntos
Carcinoma Hepatocelular/complicações , Cardiopatias/cirurgia , Neoplasias Hepáticas/complicações , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Seguimentos , Cardiopatias/complicações , Humanos , Expectativa de Vida , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
Degenerative aortic stenosis is the most common structural heart valve disease affecting the aging population. Catheter-based heart valve interventions are less invasive and very useful for very elderly patients. However, we often consider open heart surgery for these patients because of anatomical reasons and co-existing cardiac diseases, i.e., severe coronary artery disease. We aimed to analyze the outcomes of very elderly patients aged ≥ 85 years undergoing aortic valve replacement (AVR) with or without coronary artery bypass grafting (CABG). Twenty-nine very elderly patients aged ≥ 85 years who underwent AVR with CABG (n = 11, Group AC) or isolated AVR (n = 18, Group A) were examined. The overall mean age of the patients was 87.2 ± 2.6 (range 85-94) years. The estimated operative mortality rate, calculated using the Japan score, EuroSCORE II, and STS risk score, was 5.72%-10.88% in Group AC and 5.63%-8.30% in Group A. Aortic cross-clamp time (126.5 ± 29.0 vs. 96.9 ± 29.2 min, p = 0.016) was significantly longer in Group AC than in Group A. Although the major morbidity rate was higher in Group AC than in Group A (36% vs. 6%, p = 0.0336), the length of intensive care unit stay and hospital stay was comparable between both groups. There was no 30-day and hospital mortality in both groups. Eleven patients died during follow-up (senility, 5; cerebrovascular events, 2; renal failure, 1; unknown, 3). There were no significant differences in survival rates during follow-up (log-rank p value = 0.1051). The 1-, 2-, 3-, 4- and 5-year survival rates were 91%, 80%, 69%, 69% and 69%, respectively, in Group AC and 94%, 94%, 94%, 94% and 88%, respectively, in Group A. In conclusion, AVR with or without CABG could be safely performed in carefully selected very elderly patients with acceptable early- and long-term results. AVR with CABG in very elderly patients aged ≥ 85 offers similar results to isolated AVR in terms of 30-day mortality, hospital mortality, and long-term survival.
Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Ponte de Artéria Coronária , Doença da Artéria Coronariana/cirurgia , Implante de Prótese de Valva Cardíaca , Fatores Etários , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico por imagem , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Duração da Cirurgia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do TratamentoRESUMO
We report an 83-year-old man with a mycotic left ventricular apical pseudoaneurysm and aortic prosthetic valve endocarditis caused by Enterococcus spp. Mycotic left ventricular pseudoaneurysm is very rare and is associated with a high risk of rupture. Here, we report the clinical presentation, diagnosis, prognosis, and treatment of a case of mycotic left ventricular pseudoaneurysm to raise awareness regarding this unusual and potentially fatal complication.
Assuntos
Valva Aórtica/cirurgia , Aneurisma Coronário/cirurgia , Endocardite/cirurgia , Ventrículos do Coração/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Idoso de 80 Anos ou mais , Endocardite/microbiologia , Enterococcus , Humanos , Masculino , Infecções Relacionadas à Prótese/microbiologia , Resultado do TratamentoRESUMO
BACKGROUND: The aim of this study was to determine the influence of preoperative kidney dysfunction (ie, chronic kidney disease (CKD)) on postoperative cardiovascular events, infection, acute kidney injury and hospital mortality in patients undergoing coronary artery bypass grafting (CABG). METHODSâANDâRESULTS: A multi-institutional retrospective study was performed at 14 hospitals of adult patients undergoing isolated CABG from 2007 to 2008 (n=1,522). We classified CKD level according to preoperative estimated glomerular filtration rate (eGFR): normal, eGFR >90 ml·min(-1)·1.73 m(-2); mild, eGFR 60-90 ml·min(-1)·1.73 m(-2); moderate, eGFR 30-59 ml·min(-1)·1.73 m(-2); and severe, eGFR <30 ml·min(-1)·1.73 m(-2), and assessed postoperative outcome. Preoperative CKD distribution was as follows: normal, n=121 (8%); mild, n=713 (47%); moderate, n=515 (34%); and severe, n=169 (11%). Risk of infection was strongly correlated with CKD level (normal, 3.3%; mild, 7.0%; moderate, 8.3%; severe, 17.0%; P<0.01). The risk of in-hospital death was also strongly correlated with CKD level (normal, 1.7%; mild, 1.0%; moderate, 1.6%; severe, 5.9%; P<0.01). On multivariate logistic regression analysis, CKD level was identified as a significant risk factor for postoperative infection, acute kidney injury, and in-hospital death. CONCLUSIONS: Advanced preoperative CKD is a strong predictor of postoperative infection, acute kidney injury and in-hospital death after CABG.
Assuntos
Ponte de Artéria Coronária/efeitos adversos , Infecções/mortalidade , Complicações Pós-Operatórias/mortalidade , Insuficiência Renal Crônica/mortalidade , Adulto , Idoso , Feminino , Mortalidade Hospitalar , Humanos , Infecções/etiologia , Masculino , Pessoa de Meia-Idade , Insuficiência Renal Crônica/cirurgia , Fatores de RiscoRESUMO
OBJECTIVE: To assess the occurrence, predictors, and outcomes of hypo-attenuated leaflet thickening (HALT) and thrombus outside the prosthetic valve following surgical aortic valve replacement. METHODS: A total of 118 patients underwent surgical aortic valve replacement with bioprosthetic valves between July 2020 and June 2022. Sixty-two (52.5%) patients, which is a fairly high number of patients, underwent cardiac computed tomography and transthoracic echocardiography one week after surgery. Patients were divided into two groups, those with HALT (n = 14) and those without HALT (n = 48). RESULTS: Of the 62 patients who underwent cardiac computed tomography, HALT was observed in 14 (22.5%) patients during the very early postoperative phase. Reduced leaflet motion was observed in two of the 14 patients. The low-attenuation areas were located outside the prosthetic valve in 10 cases (71.4%) in the HALT group and in 14 cases (29.2%) in the non-HALT group. More than 50% of patients (57.1%) with HALT and 79.2% without HALT were administered warfarin. Neither in-hospital deaths nor postoperative thromboembolic events were observed during hospitalization. No patient had a mean pressure gradient > 20 mmHg in either group. CONCLUSION: HALT was observed in one-fifth of the cases after surgical aortic valve replacement during the very early postoperative phase in an institution wherein administration of continuous heparin infusion after surgery is a standard practice. HALT did not affect the early prognosis or incidence of cerebral infarction.
Assuntos
Valva Aórtica , Bioprótese , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Trombose , Humanos , Feminino , Masculino , Bioprótese/efeitos adversos , Idoso , Trombose/etiologia , Próteses Valvulares Cardíacas/efeitos adversos , Valva Aórtica/cirurgia , Valva Aórtica/diagnóstico por imagem , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Pessoa de Meia-Idade , Estudos Retrospectivos , Anticoagulantes/uso terapêutico , Anticoagulantes/administração & dosagem , Idoso de 80 Anos ou mais , Fatores de Tempo , Resultado do Tratamento , Fatores de Risco , Ecocardiografia , Estenose da Valva Aórtica/cirurgia , Desenho de PróteseRESUMO
Background: Mitral valve repair (MVr) is an established procedure for patients who require surgery for primary mitral regurgitation (PMR). The Colvin-Galloway Future Band (CGFB) is a semi-rigid posterior band expected to improve the clinical outcomes of MVr. However, information on the hemodynamic and functional performance and long-term outcomes of CGFB is limited. We evaluated the quality, durability, and clinical performance after MVr using CGFB for PMR as the cohort study. Methods: A total of 244 patients who underwent MVr with CGFB were enrolled. Clinical and echocardiographic assessments were performed (mean follow-up period, 4.0±2.4 years). Results: Posterior mitral leaflet resection was the most common MVr procedure. CGFBs measuring 28 mm (35.2%) and 30 mm (36.5%) were used. The incidence of systolic anterior motion (SAM) was 1.6%. A total of 93.4% of the patients had no or trace MR at discharge. Over 90% of patients had no or mild MR at the last follow-up. The mean pressure gradient and mitral valve orifice area one year after MVr ranged between 2.6 and 3.6 mmHg and 2.3 and 3.4 cm2, respectively. At follow-up, 85.4% of the patients were New York Heart Association class I. Three patients underwent repeat mitral valve surgery. Conclusions: The CGFB demonstrates satisfactory quality and durability in MVr for PMR. Other advantages include a low occurrence of SAM and acceptable hemodynamic outcomes, particularly in patients requiring a smaller annuloplasty device.
RESUMO
Mechanical circulatory support has been an indispensable treatment for severe heart failure. While the development of a total artificial heart has failed, left ventricular assist devices (LVAD) have evolved from extracorporeal to implantable types. The first generation implantable LVAD (pulsatile device) was used as a bridge to transplantation, and demonstrated improvement in survival rate and activity of daily living. The evolution from the first-generation (pulsatile device) to the second-generation (continuous flow device: axial flow pump and centrifugal pump) has resulted in many clinical benefits by reducing mechanical failures and minimizing device size. Furthermore, third-generation devices, which use a moving impeller suspended by magnetic and/or hydrodynamic forces, have improved overall device reliability and durability. Unfortunately, there are still many device-related complications, and further device development and improvement of patient management methods are required. However, we expect to see further development of implantable VADs, including for destination therapy, in future.
Assuntos
Insuficiência Cardíaca , Coração Auxiliar , Humanos , Insuficiência Cardíaca/cirurgia , Reprodutibilidade dos TestesRESUMO
BACKGROUND AND PURPOSE: Postoperative bowel dysfunction is still a major unsolved problem following transperitoneal abdominal aortic surgery. We conducted this study to establish if gum chewing during the postoperative period promotes recovery of bowel function following abdominal aortic surgery. METHODS: The subjects were 44 patients who underwent elective abdominal aortic surgery. The patients were allocated to a control group (n = 21), who received standard postoperative care, or a "gum group" (n = 23), who received standard postoperative care and were also given gum to chew three times a day from postoperative day (POD) 0-5. RESULTS: The patient characteristics, intraoperative, and postoperative care were equivalent in both groups. Flatus was passed on POD 1.49 in the gum group and on POD 2.35 in the control group (P = .0004) and the time to oral intake was 3.09 days in the gum group and 3.86 days in the control group (P = .023). The number of days to full mobilization in the hospital room was 3.35 versus 5.59 for the gum and control groups, respectively (P < .0001). CONCLUSIONS: Gum chewing enhances early recovery of bowel function following transperitoneal abdominal aortic surgery. Moreover, it is a physiologically sound, safe, and an inexpensive part of the postoperative care.
Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Goma de Mascar , Íleus/prevenção & controle , Mastigação , Complicações Pós-Operatórias/prevenção & controle , Recuperação de Função Fisiológica , Enxerto Vascular/reabilitação , Idoso , Deambulação Precoce , Feminino , Humanos , Íleus/etiologia , Masculino , Peritônio/cirurgia , Cuidados Pós-Operatórios/métodos , Resultado do TratamentoRESUMO
A case of wear and entrapment of a polyethylene disc observed in a Starr-Edwards (SE) mitral caged-disc valve at 37 years after implantation is reported. A 66-year-old woman who had undergone mitral valve replacement with a SE disc valve 37 years previously was admitted to the authors' hospital. Cinefluoroscopy showed the polyethylene disc of the SE valve to have impinged against a calcified mass on the left ventricular posterior wall, causing a tipping motion of the disc during opening. The valve was successfully replaced at surgery. A macroscopic examination of the excised valve revealed wear of the polyethylene disc at sites where the disc abutted the cage struts, and where it impinged on the calcified mass. The long-term durability of the SE caged-disc valves has been favorable; however, when implanted for over 20 years, they should be carefully followed up.
Assuntos
Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Polietileno , Falha de Prótese/etiologia , Idoso , Feminino , Humanos , Desenho de Prótese , ReoperaçãoRESUMO
Our aim was to evaluate the long-term results of implantation of the Carpentier-Edwards pericardial (CEP) valve in the aortic position. Between January 1996 and December 2007, 244 patients who underwent aortic valve replacement using the CEP valve were enrolled in this study. A 19-mm valve was used in 39 patients, a 21-mm valve in 94 patients, a 23-mm valve in 81 patients, and a 25-mm valve in 30 patients. The early and the late results were evaluated. Furthermore, echocardiographic examination was performed at follow-up. There were 5 early deaths, with an early mortality rate of 2.0%. Follow-up was performed in 95.4% of the survivors of the operation for a mean period of 4.1 years. Actuarial survival rates at 5, 10, and 12 years were 85.3 ± 2.8, 80.0 ± 3.7 and 70.0 ± 9.8%, respectively. Thromboembolism was observed in 6 patients, endocarditis in 2 patients, reoperation in 4 patients, and structural valve deterioration in 2 patients. Actuarial freedoms from thromboembolism, endocarditis, and reoperation at 10 years were 96.9 ± 0.14, 97.7 ± 0.16, and 97.0 ± 0.16%, respectively. Echocardiographic examination revealed that the pressure gradients across the valve prosthesis for valves of each size were acceptable. Left ventricular mass index decreased significantly in all valve sizes. The long-term results of implantation of the CEP bioprosthesis in the aortic position were satisfactory. The CEP bioprosthesis maintained its hemodynamic performance even as late as 10 years after implantation.
Assuntos
Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Idoso , Idoso de 80 Anos ou mais , Feminino , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Reoperação , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
We herein describe a rare case of a concurrent submitral left ventricular (LV) aneurysm and an aneurysm of the sinus of Valsalva in a 65-year-old Japanese woman. The patient had a history of mitral valve replacement (MVR) for mitral regurgitation caused by a submitral LV aneurysm at the age of 58. At the time of the MVR, the orifice of the submitral LV aneurysm without thrombi was beneath the posterior leaflet, but surgical repair of the submitral LV aneurysm was not attempted. Although the patient was asymptomatic, when she underwent an echocardiogram at 65 years of age an aneurysm of the noncoronary sinus of Valsalva was detected. However, echocardiography performed before the initial operation had shown that the aneurysm of the sinus of Valsalva was coexistent with the submitral LV aneurysm. Since the submitral LV aneurysm revealed no progressive enlargement during the 7 years, patch closure of the aneurysm of the sinus of Valsalva alone was successfully performed.
Assuntos
Aneurisma da Aorta Torácica/patologia , Aneurisma Cardíaco/patologia , Cardiopatias Congênitas/patologia , Ventrículos do Coração/patologia , Seio Aórtico/patologia , Disfunção Ventricular Esquerda/patologia , Idoso , Aneurisma da Aorta Torácica/diagnóstico , Aneurisma da Aorta Torácica/diagnóstico por imagem , Feminino , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Humanos , Seio Aórtico/diagnóstico por imagem , Fatores de Tempo , Ultrassonografia , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/diagnóstico por imagemRESUMO
This study was performed to evaluate surgical outcomes in octogenarian patients undergoing valve surgery. Sixty patients (mean age 82.3 ± 1.9 years) who underwent valve surgery were reviewed. Aortic valve disease was found in 65% of the patients. Preoperatively, 20% of the patients were in NYHA class IV. An urgent operation and concomitant coronary artery bypass grafting were performed in ten patients each. A bioprosthetic valve was exclusively used for valve replacement except in two patients. Mitral valve repair was done in seven patients. Operative mortality was 13.3% for the period. No risk factors for operative mortality were detected by multivariate analysis; however, urgent operation, preoperative NYHA class IV, preoperative renal dysfunction, perioperative use of an intra-aortic balloon pumping, and prolonged cardiopulmonary bypass time had significant effects on operative mortality. The actuarial survival rate at 1 and 3 years after surgery was 82.6 and 71.5%, respectively, and 97.6% of late survivors reported that their activity level was equal to or better than the preoperative level. Valve surgery can be performed in octogenarian patients with acceptable mortality, good long-term results, and good quality of life. Early referral to surgery should be important to obtain a better postoperative outcome.
Assuntos
Valva Aórtica/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Valva Mitral/cirurgia , Fatores Etários , Idoso de 80 Anos ou mais , Bioprótese , Distribuição de Qui-Quadrado , Feminino , Doenças das Valvas Cardíacas/mortalidade , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Japão , Modelos Logísticos , Masculino , Desenho de Prótese , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Análise de Sobrevida , Taxa de Sobrevida , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND AND AIM OF THE STUDY: The durability and potential for creating functional mitral stenoses are major concerns in the edge-to-edge (E-to-E) repair of mitral regurgitation (MR). METHODS: Valve repair for MR was performed using the classical Carpentier technique in 120 patients (group C), and with the E-to-E technique in 37 patients (group E). A ring annuloplasty was performed in all patients. The mid-term results were examined and exercise echocardiography was conducted. RESULTS: No significant differences were observed between the two groups with regards to early and late mortality rates, actuarial survival rate and valve-related complication-free rate at five years after surgery. Postoperatively, MR was decreased significantly in both groups. Exercise echocardiography was undertaken in 35 operative survivors (20 from group C, 15 from group E). At peak exercise, the mean transmitral pressure gradient (MTPG) increased significantly in both groups. Systolic pulmonary artery pressure (SPAP) was also significantly elevated, but still within the accepted upper limits in both groups. The mitral valve area (MVA) showed no significant increase in either group. At peak exercise there were no significant differences in MTPG, SPAP and MVA between the two groups. CONCLUSION: Edge-to-edge repair is equally effective and durable as a conventional repair using the Carpentier technique. A mitral valve redesigned by E-to-E repair with ring annuloplasty may be slightly restrictive compared to a normal healthy mitral valve under exercise conditions; however, the hemodynamic performance did not differ significantly from that of a valve repaired with the Carpentier technique. These hemodynamics were not related to the use of E-to-E repair per se as the only causal factor, but rather to the ring annuloplasty.
Assuntos
Ecocardiografia sob Estresse , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Hemodinâmica/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/mortalidade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Taxa de Sobrevida , Técnicas de SuturaRESUMO
BACKGROUND AND AIM OF THE STUDY: The ATS open pivot bileaflet valve has been the prosthesis of choice at the authors' hospital since 1997. Herein is presented a retrospective analysis of the mid-term results of valve replacement with the ATS valve prosthesis. METHODS: Between 1997 and 2005, a total of 280 patients (mean age 58.3 years) underwent valve replacement with the ATS valve; these included 133 aortic valve replacements (AVR), 115 mitral valve replacements (MVR), and 32 double (aortic plus mitral) valve replacements (DVR). Preoperatively, 162 patients (57.9%) were in NYHA functional class II, 97 (34.6%) in class III, 19 (6.8%) in class IV, and two (0.7%) in class V. Atrial fibrillation was detected in 105 patients (37.5%), and significant coronary artery disease was found concomitantly in 13 (4.6%). Postoperative anticoagulant therapy consisting of warfarin and an antiplatelet drug was usually instituted on the first postoperative day, and the International Normalized Ratio maintained between 1.6 and 2.5. RESULTS: Overall hospital mortality was 3.6% (n = 10). Hospital survivors were followed for a mean period of 4.2 years (maximum 10 years); the total follow up was 1,127.9 patient-years (pt-yr). Follow up was complete for 267 patients (98.9%). Actuarial survival at seven years was 87.1% for AVR, 79.8% for MVR, and 90.1% for DVR. The probability of freedom from valve-related death at seven years was 96.7% for AVR, 94.4% for MVR, and 100% for DVR. The linearized rates for postoperative complications were thromboembolism 1.2%/pt-yr, major bleeding 0.7%/pt-yr, prosthetic valve endocarditis 0.2%/pt-yr, non-structural dysfunction 0.7%/pt-yr, and reoperation 0.5%/pt-yr. Structural valve failure was not encountered. CONCLUSION: This clinical experience with the ATS open pivot heart valve demonstrated low rates of adverse events and valve-related complications.
Assuntos
Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Valva Mitral/cirurgia , Adolescente , Adulto , Idoso , Endocardite/etiologia , Feminino , Seguimentos , Doenças das Valvas Cardíacas/mortalidade , Doenças das Valvas Cardíacas/cirurgia , Próteses Valvulares Cardíacas/efeitos adversos , Hemorragia/etiologia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Infecções Relacionadas à Prótese/etiologia , Reoperação , Estudos Retrospectivos , Tromboembolia/etiologia , Trombose/etiologia , Resultado do TratamentoRESUMO
OBJECTIVES: In most patients with aortic regurgitation (AR), aortic valve replacement (AVR) improves left ventricular (LV) function, but some patients will not have favorable remodeling. Our objectives were to review long term clinical results of AVR for AR and to examine what factors affect the normalization of LV function after AVR for chronic AR. METHODS: Between 1989 and 2010, 177 patients underwent isolated AVR for chronic pure AR. The patients were divided into 2 groups based on indexed end-systolic LV diameter (iESD): Group L (iESD) ≥25 mm/m(2)) (130 patients) and Group S (iESD <25 mm/m(2)) (47 patients). RESULTS: There was no significant difference between groups in late mortality, freedom from cardiac-related death and rehospitalization for heart failure at late follow up after operation. At postoperative follow-up, 16% of patients had not recovered normal LV systolic function. By means of multivariate analysis, iESD and cardiac index (CI) were independent predictors of recovery of LV function and iESD >26.7 mm/m(2) and CI <2.71 l/min/m(2) were the best cut-off values. CONCLUSIONS: Early and late surgical results of AVR for chronic AR were good, but for the preservation of postoperative normal LV function, AVR for AR patients should be performed before iESD reaches 26.7 mm/m(2).
Assuntos
Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/cirurgia , Volume Sistólico , Substituição da Valva Aórtica Transcateter , Função Ventricular Esquerda , Adulto , Idoso , Idoso de 80 Anos ou mais , Insuficiência da Valva Aórtica/mortalidade , Índice de Massa Corporal , Doença Crônica , Feminino , Seguimentos , Próteses Valvulares Cardíacas , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/métodos , Resultado do Tratamento , UltrassonografiaRESUMO
BACKGROUND: High-intensity transient signals (HITS) can be detected by transcranial Doppler ultrasonography (TCD) in patients carrying a mechanical prosthetic valve. The HITS counts and a frequency analysis were evaluated in patients with prosthetic valve obstruction in the aortic position. METHODS: Simultaneous echocardiographic, cineradiographic, and TCD evaluations for a St. Jude Medical valve were performed in 108 patients. All patients were asymptomatic and had no significant stenosis of the carotid artery. The HITS were identified according to criteria established by consensus of the International Cerebral Hemodynamics Symposium. RESULTS: The HITS counts in 69 patients with normal prosthetic valve function were 2.2 +/- 4.4, and the counts in 39 patients with prosthetic valve obstruction (group D) were 8.3 +/- 10.8. This difference was significant (p = 0.0002). In 2 patients of group D who had a greater rate of less than 400 Hz HITS, which were produced by solid microemboli, thrombolysis resulted in a mitigation of restricted leaflet movement equal to or greater than 10(o). The total number of HITS decreased and the rate of less than 400 Hz HITS also markedly decreased after thrombolysis in these 2 patients. On the other hand, 4 patients who obtained no improvement of leaflet movement by thrombolysis had lower rates of less than 400 Hz HITS than did the 2 patients. CONCLUSIONS: These results suggest that measurement of HITS counts is useful for detection of prosthetic valve obstruction, and that a frequency analysis of HITS may be valuable to clarify the cause of the obstructed prosthetic valves.
Assuntos
Cinerradiografia , Próteses Valvulares Cardíacas/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Ultrassonografia Doppler Transcraniana , Adulto , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/tratamento farmacológico , Desenho de Prótese , Falha de Prótese , Terapia TrombolíticaRESUMO
BACKGROUND AND PURPOSE: There have been no large-scale studies on the impact of diabetes mellitus (DM) on outcomes in Japanese patients undergoing coronary artery bypass grafting (CABG). METHODS AND SUBJECTS: A multi-institutional retrospective cohort study was conducted in 14 Japanese centers. All adult patients who underwent isolated CABG from 2007 to 2008 were included (n=1522, mean age: 68.5years). The definitions of DM were all patients admitted with diagnosis of DM and preoperative glycated hemoglobin (Hb) A1c≥6.5%. Univariate and multivariate analyses were performed to identify the risk of morbidity and mortality. RESULTS: There were 849 DM and 572 non-DM patients. Preoperative mean HbA1c were 7.1% in the DM group and 5.7% in the non-DM group (p<0.0001). Preoperative, intraoperative, and 3-day average postoperative blood glucose (BG) were 146mg/dl, 172mg/dl, and 168mg/dl in the DM group, and 103mg/dl, 140mg/dl, and 136mg/dl in the non-DM group (all p<0.0001). Although there were no significant differences in postoperative cardiovascular events, the incidence of infection was significantly higher in the DM group than in the non-DM group (9.2% vs 6.1%, p=0.036) on the univariate analysis. The all-cause death was also relatively higher in the DM group than in the non-DM group (2.1% vs 1.1%, p=0.12), and this was likely related to infection. CONCLUSION: DM patients had worse perioperative BG control, higher incidence of infection, and higher mortality than non-DM patients. These results indicate that perioperative BG control guidelines should be standardized to obtain better surgical outcomes in Japanese DM patients.