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RESUMEN Introducción: La cirugía de revascularización miocárdica (CRM) ha sido el abordaje indicado para el tratamiento de la lesión del tronco de la coronaria izquierda (TCI), siendo la angioplastia coronaria (ATC) un tratamiento alternativo en un grupo muy seleccionado de pacientes. Sin embargo, los criterios de no inferioridad de los resultados de la ATC en términos de mortalidad e infarto de miocardio (IAM) en el seguimiento a mediano plazo es tema de discusión actual. Objetivo: Evaluar las características clínicas, funcionales y angiográficas de los pacientes sometidos a CRM con y sin TCI, y las implicancias de morbimortalidad halladas. Material y métodos: Se sometió a 458 pacientes consecutivos a CRM; 187 (40.82%) presentaban TCI. El grupo con TCI tenía un perfil de riesgo mayor: ArgenScore: 2.78 (1.55-5.9) vs 2.78 (1.95-7) p=0.03, STS score: 0.85 (0.55-1.8) vs 0.77 (0.5-1.17) p=0.01 y EuroSCORE II: 2.2 (1.35-3.97) vs 1.75 (1.08-2.9) p=0.04 respecto al grupo sin TCI. Resultados: A pesar del mayor riesgo esperado no hubo diferencias estadísticamente significativas en mortalidad 3.2% vs 1.1%, IAM 2.6% vs 1.1% y ACV 1% vs 0.3% en los dos grupos. En el análisis multivariado el TCI no fue predictor de morbimortalidad (HR = 2.1; IC 95% 0.70-6.23; p = 0.18) e identifico positivamente a la fracción de eyección preoperatoria (HR = 0.96; IC 95%: 0.93-0.99; p = 0.040) y la cirugía no programada (HR = 3.44; IC 95%: 1.60-7.41; p = 0.002). Conclusiones: en nuestra experiencia los pacientes intervenidos con CRM el TCI no es predictor de muerte, IAM y/o ACV.
ABSTRACT Background: Coronary artery bypass graft surgery (CABG) has been the indicated approach for the treatment of left main coronary artery disease (LMCA), with percutaneous coronary intervention (PCI) as an alternative treatment in a highly selected group of patients. However, the non-inferiority criteria of PCI outcomes in terms of mortality and acute myocardial infarction (AMI) in the mid-term follow-up are currently subject of debate. Objective: The aim of this study was to evaluate the clinical, functional and angiographic characteristics of patients undergoing CABG with and without LMCA disease, and the implications of morbidity and mortality encountered. Methods: A total of 458 consecutive patients underwent CABG; 187 (40.82%) presented LMCA disease. This group had a higher risk profile compared with the group without LMCA disease: ArgenSCORE: 2.78 (1.55-5.9) vs. 2.78 (1.95-7); p=0.03, STS score: 0.85 (0.55-1.8) vs. 0.77 (0.5-1.17); p=0.01 and EuroSCORE II: 2.2 (1.35-3.97) vs. 1.75 (1.08-2.9); p=0.04. Results: Despite the higher expected risk, there were no statistically significant differences in mortality (3.2% vs. 1.1%), AMI (2.6% vs. 1.1%) and stroke (1% vs. 0.3%) in the two groups. In the multivariate analysis, LMCA disease was not a predictor of morbidity and mortality (HR=2.1; 95% CI 0.70-6.23; p=0.18) and positively identified the preoperative ejection fraction (HR=0.96; 95% CI 0.93-0.99; p=0.040) and non-programmed surgery (HR=3.44; 95% CI 1.60-7.41; p=0.002). Conclusions: In our experience, LMCA disease in patients undergoing CABG is not a predictor of death, AMI and/or stroke.
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Objective To investigate the efficacy and safety of cool-tipped saline-irrigated catheter ablation of epicardial accesso-ry pathway in the patients after failure of conventional radiofrequency ablation .Methods 30 patients with epicardial accessory path-way after failuer of conventional radiofrequency ablation were included in this study ,among them ,25 cases of the left accessory pathway and 5 cases of the right accessory prathway used the cool-tipped catheter for conducting ablation through the endocardium (ventricular side or atrial side) or coronary sinus .Results All patients achieved success ,no intraoperative and postoperative related complications occurred .Conclusion The cool-tipped saline-irrigated catheter ablation of epicardial accessory pathway is effective and safe in the patients after failure of conventional radiofrequency ablation ,which may improve the success rate of epicardial acces-sory pathway ablation .
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OBJETIVO: Descrever a experiência do serviço com a correção da coarctação da aorta em adultos utilizando assistência circulatória esquerda. MÉTODOS: De novembro de 2007 a outubro de 2009, oito pacientes adultos com coarctação da aorta foram submetidos a correção cirúrgica com interposição de enxerto tubular através de toracotomia póstero-lateral esquerda e uso de assistência circulatória com uso de circuito átrio esquerdo e artéria femoral. Cinco pacientes eram do sexo feminino e tinham idade média de 31,5 ± 13,1 anos. Todos tinham hipertensão arterial sistêmica (HAS) e apresentavam doenças cardiovasculares associadas. RESULTADOS: Não houve óbitos ou complicações neurológicas. O tempo médio cirúrgico foi de 308 minutos, o tempo médio de assistência circulatória de 73 minutos e o de pinçamento aórtico médio de 65 minutos. O sangramento médio no pós-operatório foi de 696 ml. Seis pacientes evoluíram com HAS grave no pós-operatório, sendo necessário uso de vasodilatadores endovenosos. As altas hospitalares ocorreram em média no 9º dia pós-operatório. Houve redução significativa do gradiente médio da pressão arterial sistêmica. O seguimento ambulatorial com ecocardiograma até dois meses de pós-operatório demonstrou gradiente aorta/enxerto médio de 20,3 mmHg. CONCLUSÃO: O uso da assistência circulatória esquerda pode ser uma opção na correção cirúrgica da coarctação da aorta em adultos, principalmente em pacientes com alterações parede da aorta, não sendo observada isquemia medular nos casos estudados.
OBJECTIVE: To describe our experience with repair of coarctation of the aorta in adults using left heart bypass. METHODS: From November 2007 to October 2009, eight adult patients with coarctation of the aorta underwent surgical repair under circulatory support using a left atrium to femoral artery bypass circuit, with graft interposition tube through left posterolateral thoracotomy. Five patients were female, with mean age of 31.5 ± 13.1 years. All patients had hypertension and others associated cardiovascular diseases. RESULTS: There were no deaths or neurological complications. The mean surgical time was 308 minutes with mean left heart bypass and distal aortic clamping time of 73 and 65 minutes respectively. Postoperative bleeding was 696 ml in average. Six patients developed severe hypertension postoperatively requiring intravenous vasodilators. The mean length of stay was 9 days. A significant reduction of gradient blood pressure occurred. Echocardiographic follow-up up to two months postoperatively showed mean aortic / graft gradient of 20.3 mmHg. CONCLUSION: In this series the use of left heart bypass showed to be a safe option in the surgical correction of coarctation of the aorta in adults, especially in patients with abnormal aortic wall. There was no spinal cord ischemia in the cases studied.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Aortic Coarctation/surgery , Heart Bypass, Left/methods , Paraplegia/prevention & control , Blood Pressure/physiology , Catheterization/methods , Femoral Artery , Follow-Up Studies , Heart Bypass, Left/adverse effects , Time Factors , Treatment OutcomeABSTRACT
Objective: This study was undertaken to explore the effect of left ventricular assist device (LVAD) on failing heart after myocardial ischemia. By detecting the changes of plasma atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and cardiac troponin I (cTnI) levels within 6 hours after the implantation of LVAD, we review the basis on which neurohormones may be used to determine prognoses of failing heart and choose an optimal predictor. Methods: 15 adult healthy dogs were divided into 3 groups randomly. The LVAD was implanted in LA-AO bypass in all three groups. Myocardial ischemia was induced by ligating the main left anterior descending coronary artery (LAD). In group A, after a ligation of 10 minutes, the myocardium was reperfused for 6 hours. In group B, after a ligation of 40 minutes, the myocardium was reperfused for 6 hours. In group C, after a ligation of 40 minutes, the LVAD was used for LV support for 6 hours. Results: After 6 hours reperfusion,in group C, the hemodynamics was significantly improved, the ANP, BNP and cTnI were return to normal level, and myocardial ultrastructure was recovered significantly. While in group B, the hemodynamic, the neurohormones, and myocardial ultrastructure were worse. Relational analysis demonstrated that ANP and cTnI levels were influenced by hemodynamics obviously, but there was a weak relationship between circulating BNP and hemodynamics. Plasma BNP level was able to identify the cardiac function status. Conclusion: LVAD can be beneficial to improve cardiac function and can reduce the plasma levels of ANP, BNP and cTnI. Plasma BNP level can identify the cardiac function status. Those findings indicated that plasma BNP determination provides important prognostic information about cardiac function and may be a better prognostic indicator.