ABSTRACT
Objective: To investigate the predictive value of ejection fraction for the postoperative myocardial infarction after coronary endarterectomy (CE) in patients with diffuse coronary artery disease (DCAD). Methods: Patients who underwent cardiac artery bypass graft (CABG) surgery and CE in Beijing Anzhen Hospital affiliated to Capital Medical University from May 2018 to December 2020 were enrolled in this prospective observational study. Baseline features including age, sex and echocardiography parameters were obtained. Left ventricular ejection fraction(EF) was measured by echocardiography. The patients were divided into postoperative myocardial infarction (PMI) group and non-PMI group according to PMI occurrence. Linear regression analysis, logistic regression model, and receiver operating characteristic(ROC) curve were used to analyze the correlation between left ventricular ejection fraction and PMI and the influencing factors. Results: A total of 120 patients were enrolled in the study. There were 32 patients (27%) in the PMI group (male 27(84%), age (62±8)), inferior myocardial infarction occurred in 24 (75%) patients. There were 88 patients (73%) in the non-PMI group (male 70(80%), age (62±8)). EF (55% (49%, 64%) vs. 62% (55%, 67%), P=0.01) was significantly lower in the PMI group than in the non-PMI group. Perioperative TNI, IABP use and length of hospitalization were significantly higher in the PMI group than in the non-PMI group. Multivariate logistic regression showed that lower EF was an independent risk factor of PMI (OR=0.93, 95%CI: 0.89-0.98, P=0.01) after adjusting age, sex and body mass index. ROC curve analysis showed that EF<60% could sufficiently predict the occurrence of PMI (AUC= 0.67, sensitivity 64%, specificity 69%, P=0.01). Linear regression analysis showed that left ventricular end-diastolic diameter (OR=-0.52, 95%CI:-1.13-0.60, P<0.001), graft flow in left anterior descending (OR=-0.20, 95%CI:-0.15-0.01, P=0.02) and history of diabetes (OR=-0.28, 95%CI:-8.25-1.85, P=0.002) were negatively correlated with preoperative EF value. Conclusion: Lower preoperative EF is an independent risk factor for PMI after CABG and CE in DCAD patients, closely related to the left ventricular end-diastolic diameter, graft flow in left anterior descending artery and diabetes mellitus.
Subject(s)
Humans , Male , Coronary Artery Disease/surgery , Endarterectomy/adverse effects , Myocardial Infarction/etiology , Stroke Volume , Ventricular Function, LeftSubject(s)
Adult , Humans , Male , Extracorporeal Membrane Oxygenation , Heart Failure/therapy , Endarterectomy/adverse effects , Extracorporeal Membrane Oxygenation/methods , Heart Failure/etiology , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/surgery , Pulmonary Embolism/complications , Pulmonary Embolism/surgeryABSTRACT
Pulmonary artery thromboendarterectomy (PTE) has been regarded as a promising, potentially curative surgical procedure. However, PTE is associated with specific postoperative complications, such as reperfusion pulmonary edema and right heart failure leading to a considerable mortality of 7-24%. Despite its limitations PTE is a better surgical alternative to lung transplantation which carries high morbidity and mortality. The aim of the study is to analyze the efficacy, safety, morbidity and survival associated in the postoperative period and quality of life after six months of PTE in Indian patients. Forty-one patients with surgically correctable chronic thromboembolic pulmonary hypertension underwent pulmonary endarterectomy. All patients were in New York Heart Association (NYHA) Class II, III or IV. Preoperative mean pulmonary artery pressure was 40.98 ± 9.29 mmHg and mean pulmonary vascular resistance was 418.39 ± 95.88 dynes/sec/cm -5 . All patients were followed up to six months and a telephonic survey was conducted using a standard questionnaire. They were assessed and classified as per NYHA grading. There was a significant reduction in the mean pulmonary artery pressure (from 40.98 ± 9.29 mmHg to 24.13 ± 7.36 mmHg, P < 0.001) and pulmonary vascular resistance (from 418.39 ± 95.88 dynes/sec/cm -5 to 142.45 ± 36.27 dynes/sec/cm -5 , P < 0.001) with a concomitant increase in the cardiac index (from 1.99 ± 0.20 L/min/m 2 to 3.28 ± 0.56 L/min/m 2 , P < 0.001) during the postoperative period. The mortality rate in our study was 12.19% (five patients). Ninety per cent of the patients reported a significant improvement in the quality of life and exercise tolerance after surgery compared to the preoperative state. Pulmonary endarterectomy is an effective and potentially curative surgical treatment for patients with severe chronic thromboembolic pulmonary hypertension. The current techniques of operation make the procedure relatively safe and long-term survival, NYHA functional status and exercise capacity improve significantly.
Subject(s)
Adult , Endarterectomy/adverse effects , Endarterectomy/mortality , Female , Humans , Hypertension, Pulmonary/psychology , Hypertension, Pulmonary/surgery , Male , Postoperative Complications/therapy , Pulmonary Artery/surgery , Quality of Life , Treatment OutcomeABSTRACT
OBJETIVO: Analisar comparativamente os resultados, em 30 dias, entre a endarterectomia e a angioplastia com stent auto-expansível e filtro de proteção cerebral, avaliando a incidência de acidente vascular cerebral e óbito, bem como o tempo de permanência hospitalar no tratamento das lesões ateroscleróticas da bifurcação carotídea. MÉTODO: Estudo prospectivo, em que foram tratados 80 pacientes, sintomáticos e assintomáticos, com lesões estenóticas maiores que 60 e 70 por cento, respectivamente, da bifurcação carotídea. Os pacientes foram divididos em dois grupos de 40 pacientes, que foram avaliados quanto a sexo, idade, comorbidades associadas e tabagismo. RESULTADOS: A taxa de acidente vascular cerebral e óbito foi de 5,0 por cento em ambas as técnicas. Ocorreu um caso (2,5 por cento) de ataque isquêmico transitório no grupo endovascular e nenhum na endarterectomia. No que se refere ao tempo de internação, o tratamento endovascular apresentou menor tempo em relação à endarterectomia, sendo estatisticamente significativo (P < 0,002). CONCLUSÕES: Nesta série apresentada, a incidência de acidente vascular cerebral e óbito em 30 dias foi de 5 por cento nas duas técnicas utilizadas. Em relação ao tempo de internação, houve um menor tempo de permanência hospitalar a favor da técnica endovascular, com significância estatística (P < 0,002).
OBJECTIVE: To comparatively analyze the 30-day results between endarterectomy and angioplasty using self-expandable stent and filter protection in the treatment of carotid bifurcation atherosclerotic lesions. The primary endpoint was to analyze stroke and death rate, as well hospitalization time. METHODS: Comparative and prospective study in 80 symptomatic and asymptomatic patients, with carotid bifurcation stenotic lesions greater than 60 and 70 percent, respectively. The patients were divided into two groups of 40 and assessed according to gender, age, associated comorbid conditions and smoking. RESULTS: The stroke and death rate was 5.0 percent for both techniques. There was only one case of transient ischemic attack (2.5 percent) in the endovascular group. Regarding hospitalization time, it was significantly lower in favor of the endovascular technique, with statistical significance (P < 0.002). CONCLUSIONS: This study demonstrated a 5.0 percent incidence of stroke and death in 30 days considering both techniques. However, the endovascular group presented a statistically significant shorter hospitalization time than the endarterectomy group (P < 0.002).
Subject(s)
Humans , Male , Female , Aged , Angioplasty/methods , Angioplasty , Carotid Artery Diseases/complications , Carotid Artery Diseases/diagnosis , Endarterectomy/adverse effects , Endarterectomy , Stroke/complications , Stroke/diagnosis , StentsABSTRACT
Os autores discutem as indicações atuais da endarterectomia de carótida com base nas recomendações da American Heart Association. São revisados os principais estudos clínicos prospectivos multicêntricos internacionais em pacientes sintomáticos e assintomáticos e que sustentam as recomendações atuais. Mesmo com os recursos diagnósticos mais recentes, a indicação cirúrgica tem por base o grau de estenose independente das características da placa. A endarterectomia da carótida está indicada, tanto nos pacientes sintomáticos como nos assintomáticos, somente nas estenoses acima de 70 por cento