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Rev. bras. cir. cardiovasc ; 36(1): 71-77, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1155790


Abstract Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia. Sorting nexin 10 (SNX10) has been reported to be an important regulator in embryonic development and human diseases, however, little is known about its role in cardiac disease. The aim of this study was to investigate the clinical significance of SNX10 expression in AF. Methods: Nineteen valvular heart disease patients with AF and nine valvular heart disease patients with sinus rhythm (SR) were enrolled. Atrial tissue samples from patients undergoing open heart surgery were examined. Atrial tissues of normal hearts were obtained from two cases' autopsies. The SNX10 expression and its associations with the degree of fibrosis were analyzed by immunohistochemistry and Masson's trichrome staining. Results: SNX10 expression was detected in the cytoplasm of cardiac cells in human myocardial tissue. The SNX10 expression level was higher in the SR group than in the AF group (P=0.023). SNX10 expression was negatively associated with the degree of fibrosis (P=0.017, Spearman rho=-0.447), the New York Heart Association degree (P=0.003, Spearman rho=-0.545), left atrial diameter (P=0.038, Spearman rho=-0.393), right atrial diameter (P=0.043, Spearman rho=-0.386), and the brain natriuretic peptide (BNP) level 24 hours after surgery (P=0.030, Spearman rho=-0.426), but not the BNP level before surgery and 72 hours after surgery. No statistical significance was observed between SNX10 and the level of troponin T and C-reactive protein. Conclusion: Decreased SNX10 might serve as a potential risk factor in AF of the valvular heart disease.

Humans , Atrial Fibrillation/etiology , Atrial Appendage , Heart Valve Diseases/surgery , Case-Control Studies , Risk Factors , Sorting Nexins , Heart Atria
Rev. eletrônica enferm ; 23: 1-8, 2021.
Article in English, Portuguese | LILACS, BDENF | ID: biblio-1253142


Objetivo: avaliar o impacto da valvopatia no cotidiano dos pacientes em pré-operatório de cirurgia cardíaca. Métodos: estudo transversal, observacional, descritivo, com amostra de conveniência. Utilizado o instrumento "Impacto da Doença no Cotidiano do Valvopata", composto por uma questão geral e 14 itens, distribuídos em quatro domínios: "Impacto físico da doença", "Impacto da doença nas atividades cotidianas", "Impacto social e emocional da doença" e "Adaptação à doença". Obtém-se um escore para cada domínio e um escore total, por meio da soma de todos os escores (14 a 350), quanto maior o valor, maior a percepção negativa do impacto. Resultados: participaram do estudo 73 pacientes. O domínio "Impacto da doença nas atividades cotidianas" apresentou a maior média (82,79; DP=21,35), seguido pelo "Impacto social e emocional da doença" (61,24; DP=22,7). A média do escore total foi 210,55 (DP=51,7). Conclusão: os pacientes avaliaram o impacto da valvopatia como negativo no pré-operatório de cirurgia cardíaca.

Objective: to assess the impact of valvular heart disease on the daily life of patients in the preoperative period of heart surgery. Methods: we conducted a descriptive cross-sectional study using consecutive sampling. We used the assessment instrument "Impact of Valvular Heart Disease on the Daily Life of Patients", consisting of 14 items divided into four domains: "Physical impact - symptoms", "Impact on activities of daily living", "Social and emotional impact" and "Adaptation to the disease". Each domain is scored and an overall score is calculated based on the sum of all items, ranging from 14 to 350. The higher the score, the more negative the perceived impact. Results: 73 patients participated in the study. The domain that obtained the highest mean score was "Impact on activities of daily living" (82.79; SD = 21.35), followed by "Social and emotional impact" (61.24; SD = 22.7). The mean overall score was 210.55 (SD = 51.7). Conclusion: the patients rated the impact of valvular heart disease during the preoperative period of heart surgery as negative.

Sickness Impact Profile , Heart Valve Diseases/surgery , Preoperative Period
Arq. bras. cardiol ; 114(1): 12-22, Jan. 2020. tab, graf
Article in English | LILACS | ID: biblio-1055099


Abstract Background: Prosthesis-patient mismatch (PPM) is associated with worse outcomes. Objective: Determine the frequency and evaluate preoperatory variables independently associated with severe PPM in a tertiary hospital focused on Public Health Care. Methods: A total of 316 patients submitted to aortic valve replacement, who had echocardiography performed within the first 30 days after surgery, were retrospectively analyzed. The indexed effective orifice area (iEOA) of the prosthesis was used to classify the patients into three groups, according to PPM, considering body mass index (BMI): severe PPM (iEOA) < 0.65 cm2/m2), mild to moderate PPM (iEOA, 0.65 cm2/m2 - 0.85 cm2/m2) and without PPM (iEOA > 0.85 cm2/m2) for a BMI < 30 kg/m2 and severe PPM (iEOA) < 0.55 cm2/m2), mild to moderate (iEOA, 0.55 cm2/m2- 0.70 cm2/m2) and without PPM (iEOA > 0.7 cm2/m2) for a BMI > 30 kg/m2. Statistical significance was considered when p < 0.05. Results: iEOA was obtained in 176 patients. The frequency of severe and moderate PPM was 33.4% and 36.2%, respectively. Severe PPM patients were younger and had larger BMI, but smaller left ventricular outflow tract diameter (LVOTD). The independent variables used to predict severe PPM were male gender, BMI > 25 kg/m2, age < 60 years, LVOTD < 21 mm, and rheumatic etiology with an area under the ROC curve of 0.82. Conclusion: The frequency of severe PPM is high in a Brazilian population representative of the Public Health System, and it is possible to predict PPM from preoperative variables such as rheumatic valvular disease, gender, BMI, age and LVOTD.

Resumo Fundamento: A desproporção entre o tamanho da prótese aórtica-paciente (DPP) está associada a maior mortalidade. Objetivo: Determinar a frequência e avaliar variáveis ​​pré-operatórias associadas à DPP acentuada no cenário da saúde pública em hospital terciário. Métodos: 316 pacientes submetidos à troca valvar aórtica (TVA), com ecocardiograma realizado nos primeiros 30 dias após cirurgia, foram analisados retrospectivamente. A área de orifício efetivo indexado (AOEi) da prótese foi utilizada para classificar os pacientes em três grupos de acordo com a DPP, considerando o índice de massa corporal (IMC): DPP acentuada (AOEi) < 0,65 cm2/m2, DPP discreta a moderada (AOEi, 0,65 cm2/m2 - 0,85 cm2/m2) e sem DPP (iEOA > 0,85 cm2/m2) para IMC < 30 kg/m2 e DPP acentuada (AOEi) < 0,55 cm2/m2), discreta a moderada (AOEi, 0,55 cm2/m2 - 0,70 cm2/m2) e sem DPP (AOEi > 0,7 cm2/m2) para IMC > 30 kg/m2. Significância estatística foi considerada com p < 0,05. Resultados: A AOEi foi obtida em 176 pacientes. A frequência de DPP acentuada foi de 33,4% e moderada de 36,2%. Pacientes com DPP acentuada foram mais jovens e com maior IMC, mas menor diâmetro da via de saída do ventrículo esquerdo (DVSVE). As variáveis independentes que podem predizer DPP acentuada são: gênero masculino, IMC > 25 kg/m2, idade < 60 anos, DVSVE < 21 mm e etiologia reumática com área sob a curva ROC de 0,82. Conclusão: A frequência de DPP acentuada é alta em uma população brasileira submetida à TVA no Sistema Público de Saúde. Os principais determinantes de DPP acentuada são: valvopatia reumática, gênero masculino, IMC alto, idade < 60 anos e menor DVSVE.

Humans , Male , Female , Adult , Middle Aged , Aged , Heart Valve Prosthesis/adverse effects , Heart Valve Prosthesis Implantation/methods , Heart Valve Diseases/surgery , Reoperation , Echocardiography , Cross-Sectional Studies , Retrospective Studies , Treatment Outcome , Heart Valve Prosthesis Implantation/adverse effects , Hospitals, Public
Rev. bras. cir. cardiovasc ; 34(6): 729-738, Nov.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1057506


Abstract Aortic valve disease is one of the most common valvular heart diseases in the cardiovascular category. Surgical replacement of the diseased aortic valve remains the definitive intervention for most diseases. There is a clear consensus that in young patients who require aortic valve replacement, a mechanical prosthesis is the preferred choice due to its durable prosthesis without fear of wear and tear over time. However, this comes at the expense of increased risk of bleeding and thromboembolic events; in addition, there is a lack of strict evidence in using bioprosthesis in patients younger than 50 years. The objective of this review article is to assess the current evidence behind using bioprosthetic aortic valve in this young cohort.

Humans , Young Adult , Aortic Valve/surgery , Bioprosthesis/adverse effects , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Diseases/surgery , Prosthesis Design , Risk Factors , Age Factors , Treatment Outcome , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/mortality
Rev. bras. cir. cardiovasc ; 34(5): 618-623, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042033


Abstract In aortic valve disease cases, prosthetic valves have been used for valve replacement, however, these prostheses have inherent problems, and their quality in some countries is lower comparing to new-generation models, causing shorter durability. Aortic valve neocuspidization (AVNeo) has emerged as an option, which can be applied to a wide spectrum of these diseases. Despite the promising results, this procedure is not widely spread among cardiac surgeons yet. We developed a surgical technique combining Bentall and Ozaki procedures to treat patients with concomitant ascending aorta replacement and AVNeo and we describe it in this paper.

Humans , Aorta/surgery , Aortic Valve/surgery , Prosthesis Design/standards , Heart Valve Prosthesis/standards , Heart Valve Prosthesis Implantation/methods , Heart Valve Diseases/surgery , Reproducibility of Results , Medical Illustration
Rev. bras. cir. cardiovasc ; 34(5): 615-617, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042032


Abstract We report a case of a 59-year-old female patient with vegetative native mitral valve endocarditis caused by Stenotrophomonas maltophilia (SM). She had hemodialysis-dependent chronic renal failure, but no immunosuppressive disease. Echocardiography showed mobile vegetation on her native mitral valve. Right femoral artery embolectomy and mitral valve replacement were performed simultaneously. She awakened from anesthesia, but she passed away due to septic shock complications. To the best of our knowledge, this was the first case in whom native mitral valve endocarditis caused by SM was observed (despite of absence of any immunosuppressive event) and needed to undergo valve replacement.

Humans , Female , Middle Aged , Gram-Negative Bacterial Infections/surgery , Heart Valve Prosthesis Implantation/methods , Stenotrophomonas maltophilia , Endocarditis, Bacterial/surgery , Heart Valve Diseases/surgery , Mitral Valve/surgery , Shock, Septic/etiology , Gram-Negative Bacterial Infections/complications , Fatal Outcome , Heart Valve Prosthesis Implantation/adverse effects , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/microbiology , Heart Valve Diseases/complications , Heart Valve Diseases/microbiology
Rev. bras. cir. cardiovasc ; 34(5): 610-614, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1042030


Abstract In cases of aortic valve disease, prosthetic valves have been increasingly used for valve replacement, however, there are inherent problems with prostheses, and their quality in the so-called Third World countries is lower in comparison to new-generation models, which leads to shorter durability. Recently, transcatheter aortic valve replacement has been explored as a less invasive option for patients with high-risk surgical profile. In this scenario, aortic valve neocuspidization (AVNeo) has emerged as another option, which can be applied to a wide spectrum of aortic valve diseases. Despite the promising results, this procedure is not widely spread among cardiac surgeons yet. Spurred on by the last publications, we went on to write an overview of the current practice of state-of-the-art AVNeo and its results.

Humans , Aortic Valve/surgery , Pericardium/transplantation , Transplantation, Autologous/methods , Glutaral/therapeutic use , Cardiac Valve Annuloplasty/methods , Heart Valve Diseases/surgery , Reoperation , Treatment Outcome
Rev. bras. cir. cardiovasc ; 34(4): 499-502, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1020485


Abstract Cardiac papillary fibroelastoma are rare, benign cardiac tumors that may lead to lethal complications from embolization or valvular dysfunction if left untreated. When working up symptomatic tumors with concomitant angina, traditional diagnostic studies such as cardiac catheterization may predispose the patient to embolic complications if the mass is located in the path of the catheter. Newer, non-invasive diagnostic testing, such as cardiac magnetic resonance imaging or dynamic computed tomography angiography, may be considered in lieu of invasive approaches to avoid potentially devastating complications. We herein present a case report of a 77-year-old female with a symptomatic aortic valve tumor and describe our diagnostic strategy and management.

Humans , Female , Aged , Aortic Valve/diagnostic imaging , Heart Neoplasms/diagnostic imaging , Computed Tomography Angiography/methods , Heart Neoplasms/surgery , Heart Neoplasms/pathology , Heart Valve Diseases/surgery , Heart Valve Diseases/diagnostic imaging
Rev. bras. cir. cardiovasc ; 34(4): 428-435, July-Aug. 2019. tab
Article in English | LILACS | ID: biblio-1020490


Abstract Objective: To analyze and summarize the clinical safety and feasibility of minimally invasive video-assisted mitral valve replacement via a right thoracic minimal incision in patients aged over 65 years. Methods: The clinical data of 45 patients over 65 years old who had mitral valve disease were analyzed retrospectively from January 2014 to January 2017 at Union Hospital, Fujian Medical University. The patients were divided into two groups; 20 patients in group A, who underwent minimally invasive video-assisted mitral valve replacement via a right thoracic minimal incision, and 25 patients in group B, who underwent conventional mitral valve replacement. We collected and analyzed their relevant clinical data. Results: The operation was completed successfully in both groups. Compared with group B, group A was clearly superior for postoperative analgesia time, postoperative hospital length of stay, thoracic drainage liquid, blood transfusion, and length of incision. There were no differences between the two groups in postoperative severe complications and mortality. More patients in group B had pulmonary infections and poor incision healing, while more patients in group A had postoperative pneumothorax and subcutaneous emphysema. Conclusion: In patients aged over 65 years, minimally invasive video-assisted mitral valve replacement with a small incision in the right chest had the same clinical safety and efficacy as the conventional method.

Humans , Male , Female , Aged , Minimally Invasive Surgical Procedures/methods , Heart Valve Prosthesis Implantation/methods , Video-Assisted Surgery/methods , Heart Valve Diseases/surgery , Mitral Valve/surgery , Postoperative Complications , Thoracotomy/methods , Echocardiography/methods , Retrospective Studies , Surgical Wound
Arq. bras. cardiol ; 112(3): 292-301, Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-989329


Abstract Background: The choice of a mechanical (MP) or biological prosthesis (BP) for patients with valvular heart disease undergoing replacement is still not a consensus. Objective: We aimed to determine the clinical outcomes of MP or BP placement in those patients. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) that compared biological prostheses and mechanical prostheses in patients with valvular heart diseases and assessed the outcomes. RCTs were searched in the MEDLINE, EMBASE, LILACS, CENTRAL, SCOPUS and Web of Science (from inception to November 2014) databases. Meta-analyses were performed using inverse variance with random effects models. The GRADE system was used to rate the quality of the evidence. A P-value lower than 0.05 was considered significant. Results: A total of four RCTs were included in the meta-analyses (1,528 patients) with follow up ranging from 2 to 20 years. Three used old generation mechanical and biological prostheses, and one used contemporary prostheses. No significant difference in mortality was found between BP and MP patients (risk ratio (RR = 1.07; 95% CI 0.99-1.15). The risk of bleeding was significantly lower in BP patients than MP patients (RR = 0.64; 95% CI 0.52-0.78); however, reoperations were significantly more frequent in BP patients (RR = 3.60; 95% CI 2.44-5.32). There were no statistically significant differences between BP and MP patients with respect to systemic arterial embolisms and infective endocarditis (RR = 0.93; 95% CI 0.66-1.31, RR = 1.21; CI95% 0.78-1.88, respectively). Results in the trials with modern and old prostheses were similar. Conclusions: The mortality rate and the risk of thromboembolic events and endocarditis were similar between BP and MP patients. The risk of bleeding was approximately one third lower for BP patients than for MP patients, while the risk of reoperations was more than three times higher for BP patients.

Resumo Fundamento: A escolha de próteses mecânicas ou biológicas para pacientes com doença de válvula cardíaca ainda não é um consenso. Objetivo: Determinar os desfechos clínicos de próteses mecânicas e biológicas nesses pacientes. Métodos: Conduzimos uma revisão sistemática e metanálise e estudos controlados randomizados (RCTs) que compararam próteses mecânicas e biológicas em pacientes com doenças de válvulas cardíaca, e avaliamos seus resultados. A busca por RCTs foi feita nas bases de dados MEDLINE, EMBASE, LILACS, CENTRAL, SCOPUS e Web of Science (do início a novembro de 2014). As metanálises foram realizadas usando variação inversa com modelos de efeitos aleatórios. Usamos o sistema GRADE para avaliar a qualidade da evidência. Um valor menor que 0,05 foi considerado significativo. Resultados: Um total de quatro RCTs foi incluído na metanálise (1528 pacientes) com acompanhamento de 2 a 20 anos. Em três estudos, foram utilizadas próteses mecânicas e biológicas mais antigas, e em um estudo próteses contemporâneas. Não foi observada diferença de mortalidade entre os pacientes que receberam próteses mecânicas e biológicas (risco relativo, RR = 1,07; IC95% 0,99-1,15). O risco de sangramento foi significativamente mais baixo nos pacientes que receberam próteses biológicas que naqueles com próteses mecânicas (RR = 0,64; IC95% 0,52-0,78). Contudo, as reoparações foram mais frequentes em pacientes com próteses biológicas (RR = 3,60; IC95% 2,44-5,32). Não houve diferenças estatisticamente significativas entre pacientes com próteses biológicas e mecânicas em relação à embolia arterial sistêmica e endocardite infecciosa (RR = 0,93; IC95% 0,66-1,31; RR = 1,21; IC95% 0,78-1,88, respectivamente). Resultados entre os estudos com próteses modernas e antigas foram similares. Conclusões: A taxa de mortalidade e o risco de eventos tromboembólicos e endocardite foram similares entre os pacientes que receberam próteses biológicas e mecânicas. O risco de sangramentos foi aproximadamente um terço menor nos pacientes com próteses biológicas que mecânicas, ao passo que o risco de reoperação foi mais que três vezes maior nos pacientes com próteses biológicas.

Humans , Heart Valve Prosthesis/standards , Heart Valve Diseases/surgery , Reoperation , Bioprosthesis , Randomized Controlled Trials as Topic , Treatment Outcome , Evidence-Based Medicine , Heart Valve Prosthesis Implantation/methods
Rev. méd. Chile ; 147(2): 243-246, Feb. 2019. graf
Article in Spanish | LILACS | ID: biblio-1004338


Embolic stroke secondary to cardiac tumors is uncommon. However, 25-30% of cardiac tumors may cause systemic emboli. We report a 29-year-old male consulting for a sudden episode of aphasia and right hemiparesis, compatible with infarct of the left middle cerebral artery territory. Transthoracic echocardiography reported an ovoid tumor of 8 × 7 × 7 mm in relation to the sub valvular apparatus of the mitral valve. After neurologic stabilization, surgical treatment was performed. Approached by median sternotomy and in cardiopulmonary bypass, the mitral valve was explored. A macroscopic tumor consistent with a papillary fibroelastoma curled in sub valvular chordae was found. It was deployed and resected from its base, while the anterior mitral leaflet was preserved intact. Histopathological examination confirmed the intraoperative macroscopic diagnosis. The patient recovered uneventfully postoperatively and was discharged on the fifth day after surgery. He currently is in functional capacity I without cardiovascular symptoms at five years follow-up.

Humans , Male , Adult , Infarction, Middle Cerebral Artery/etiology , Fibroma/complications , Heart Neoplasms/complications , Heart Valve Diseases/complications , Papillary Muscles , Echocardiography , Sternotomy , Fibroma/surgery , Fibroma/pathology , Fibroma/diagnostic imaging , Heart Neoplasms/surgery , Heart Neoplasms/pathology , Heart Neoplasms/diagnostic imaging , Heart Valve Diseases/surgery , Heart Valve Diseases/diagnostic imaging , Mitral Valve
Rev. Col. Bras. Cir ; 46(3): e20192176, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1013166


RESUMO Objetivo: identificar os fatores associados à mortalidade em reoperação valvar mitral, criar um modelo preditivo de mortalidade e avaliar o EuroSCORE. Métodos: foram avaliados 65 pacientes submetidos à reoperação de valva mitral no período de janeiro de 2008 a dezembro de 2017. Foi verificada a associação das variáveis com o óbito e criado um modelo de regressão logística múltiplo para estratificar os pacientes. Resultados: a mortalidade hospitalar foi de 13,8% e, neste grupo, o EuroSCORE foi de 12,33±8,87 (p=0,017), a fração de ejeção do ventrículo esquerdo (FEVE) foi de 45,33±5,10 (p=0,000), a creatinina foi 1,56±0,29 (p=0,002), o tempo de atividade da protrombina (TAP): 1,64±0,15 (p=0,001), pressão sistólica da artéria pulmonar (PSAP): 66,1±13,6 (p=0,002), sexo feminino: 88% (p=0,000), desnutrição: 77,7% (p=0,007), doença tricúspide associada: 44,4% (p=0,048), presença de arritmia ventricular: 77,7% (p=0,005), implante de prótese biológica: 55,5% (p=0,034), broncopneumonia e sepse: 33,3% (p=0,048), síndrome da resposta inflamatória sistêmica (SIRS): 55,5% (p=0,001), síndrome do baixo débito cardíaco: 88,8% (p=0,000). Conclusão: os fatores associados à mortalidade foram: EuroSCORE, FEVE, creatinina, TAP, PSAP, sexo feminino, desnutrição, doença tricúspide, arritmia ventricular, implante de prótese biológica, SIRS, SBDC, broncopneumonia e sepse. As variáveis explicativas de óbito do modelo foram: EuroSCORE, creatinina, TAP, FEVE, tempo de internamento na unidade de terapia intensiva (UTI), intervalo entre cirurgias e presença de arritmia ventricular. O EuroSCORE elevado está relacionado à maior mortalidade.

ABSTRACT Objective: to identify the factors associated with mortality in mitral valve reoperation, to create a predictive model of mortality and to evaluate the EuroSCORE. Methods: a total of 65 patients were evaluated from January 2008 to December 2017. It was verified the association of variables with death and a multiple logistic regression model was used to stratify patients. Results: hospital mortality was 13.8% and in the Death Group: EuroSCORE was 12.33±8.87 (p=0.017), the left ventricular ejection fraction (LVEF) was 45.33±5.10 (p=0.000), the creatinine was 1.56±0.29 (p=0.002), the prothrombin time (TAP) was 1.64 (p=0.001), pulmonary artery systolic pressure (PSAP): 66.1±13.6 (p=0.002), female: 88% (p=0.000), malnutrition: 77.7% (p=0.007), associated tricuspid disease: 44,4% (p=0.048), presence of ventricular arrhythmia: 77.7% (p=0.005), implantation of a biological prosthesis: 55.5% (p=0.034), bronchopneumonia and sepsis: 33,3% (p=0.048), systemic inflammatory response syndrome (SIRS): 55.5% (p=0.001), low cardiac output syndrome (LCOS): 88.8% (p=0.000). Conclusion: the factors associated with mortality were: EuroSCORE, LVEF, creatinine, TAP, PSAP, female, malnutrition, tricuspid disease, ventricular arrhythmia, implantation of biological prosthesis, SIRS, SBDC, bronchopneumonia and sepsis. The explanatory variables of death of the model were: EuroSCORE, creatinine, TAP, LVEF, length of stay in the intensive care unit (ICU), interval between surgeries and presence of ventricular arrhythmia. The high EuroSCORE is related to higher mortality.

Humans , Male , Female , Adult , Reoperation/mortality , Hospital Mortality , Heart Valve Diseases/mortality , Predictive Value of Tests , Retrospective Studies , Risk Factors , Heart Valve Diseases/surgery , Length of Stay , Middle Aged
Rev. bras. cir. cardiovasc ; 33(6): 542-552, Nov.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-977484


Abstract Objective: The effects of energy source on the maintenance of sinus rhythm and the contribution of demographic characteristics to the case selection in patients submitted to ablation performed concurrently with mitral valve surgery were analyzed. Methods: Cryothermal (n=42; 43.8%) and radiofrequency (n=54; 56.3%) energy were employed in 96 patients submitted to mitral valve replacement and Cox maze IV procedure. Patients were called for control visits between 15 days and 12 months after discharge. The causal relationship between recurrence of atrial fibrillation and factors such as left atrial diameter, C-reactive protein, hypertension, left ventricular ejection fraction, chronic obstructive pulmonary disease, and body mass index was determined. Results: Maintenance rates of the sinus rhythm with radiofrequency and cryoablation were 97.6% and 96.3%, respectively, in the first postoperative month, whereas at the 12th postoperative month were 88.1% and 83.3%. No significant difference was found between groups in relation to the energy source. Sensitivity and specificity for left atrial diameter with a cut-off value of 50.5 mm were 85.7% and 70.7%, respectively. Sensitivity and specificity for C-reactive protein with a cut-off value of 12 mg/dL on the 15th postoperative day were 83.3% and 88.9%, respectively. The effect of body mass index on atrial fibrillation recurrence was 3.2 times. Sensitivity and specificity for left ventricular ejection fraction 37% cut-off value were 96.3% and 11.4%, respectively. Atrial fibrillation in hypertensive cases was 5.3 times more. In patients with chronic obstructive pulmonary disease, recurrence of atrial fibrillation was 40%. The causal relation between recurrence of atrial fibrillation and the studied factors was established. Conclusion: Demographic characteristics have a significant impact on ablation efficiency, while the type of energy source does not.

Humans , Male , Female , Middle Aged , Atrial Fibrillation/surgery , Catheter Ablation/methods , Heart Valve Prosthesis Implantation/methods , Cryosurgery/methods , Radiofrequency Ablation/methods , Mitral Valve/surgery , Postoperative Period , Case-Control Studies , Polymerase Chain Reaction , Retrospective Studies , Risk Factors , Electrocardiography , Cardiac Surgical Procedures , Heart Valve Diseases/surgery
Rev. bras. cir. cardiovasc ; 33(6): 573-578, Nov.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-977481


Abstract Introduction: The aim of this study is to investigate the change in the dimension of sinus of Valsalva in patients who underwent supracoronary ascending aorta replacement with aortic valve replacement. Methods: A total of 81 patients who underwent supracoronary ascending aorta replacement with aortic valve replacement were included. Ten of 81 patients died during the follow-up. The patients were divided into three groups according to the aortic valve diseases. Group I (n=17) included patients with bicuspid valves, group II (n=30) included patients with stenotic degenerative valves, and patients with aortic regurgitation constituted group III (n=24). In preoperative and follow-up periods, the sinus of Valsalva diameter of the patients was evaluated by echocardiographic examination. The mean age was 54.1±15.1 years. Twenty-eight (34.6%) patients were female and 12 (14.8%) patients were in New York Heart Association functional class III. Results: There was no early mortality. Late mortality was developed in 10 (12.4%) patients, 8 (9.9%) due to non-cardiac reasons. Late follow-up was obtained in 71 patients with a mean of 60±30.1 months postoperatively. During follow-up, the increase in the diameter of the sinus of Valsalva was significant in Group I (P<0.01), while in Group II and III it was insignificant (P>0.05). Conclusion: To avoid the risks associated with sinus of Valsalva dilatation, it is reasonable to replace the sinus of Valsalva in the setting of aortic valve replacement and ascending aorta replacement for bicuspid aortic valve with a dilated ascending aorta and relatively normal sinuses of Valsalva in young patients.

Humans , Male , Female , Middle Aged , Aortic Valve/abnormalities , Aortic Valve/surgery , Sinus of Valsalva/surgery , Heart Valve Prosthesis Implantation/methods , Heart Defects, Congenital/surgery , Heart Valve Diseases/surgery , Mitral Valve/surgery , Aortic Valve/diagnostic imaging , Aortic Valve Insufficiency/surgery , Aortic Valve Insufficiency/diagnostic imaging , Sinus of Valsalva/diagnostic imaging , Echocardiography , Retrospective Studies , Age Factors , Heart Valve Prosthesis Implantation/mortality , Heart Defects, Congenital/mortality , Heart Defects, Congenital/diagnostic imaging , Heart Valve Diseases/mortality , Heart Valve Diseases/diagnostic imaging , Mitral Valve/diagnostic imaging
Rev. bras. cir. cardiovasc ; 33(5): 496-504, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-977457


Abstract Objective: To compare del Nido cardioplegia (DNC) with blood cardioplegia (BC) in coronary artery bypass grafting (CABG) combined with mitral valve replacement. Methods: A 3-year single-center retrospective cohort study was carried out. Subjects who underwent CABG (up to triple bypass) combined with mitral valve replacement were divided into DNC and BC groups. Each group had thirty subjects. Results: Both groups demonstrated similar baseline characteristics, including age, gender, cardiac/non-cardiac comorbidity, and preoperative echocardiographic parameters. Compared with the BC group, the DNC group demonstrated significantly lower cardioplegia volume (BC = 1130.00±194.1 mL, DNC = 884.33±156.8 mL, P=0.001), cardiopulmonary bypass time (DNC = 110.90±12.52 min, BC = 121.70±13.57 min, P=0.002), aortic clamp time (DNC = 91.37±11.58 min, BC = 101.37±13.87 min, P=0.004), and need for intraoperative defibrillation (DNC = 6 events, BC = 21 events, P=0.001). Postoperative creatine kinase-MB levels and troponin levels were significantly lower in the DNC group than in the BC group. Postoperative haemoglobin and haematocrit levels were significantly higher in the DNC group than in the BC group. The intubation period (hours) in intensive care unit (ICU) was significantly small in the BC group (DNC = 8.13±12.21, BC = 6.82±1.57, P=0.037); however, ICU stay, total hospital stay, and postoperative complication rates were not significantly different between them. At pre-discharge echocardiography, the DNC group demonstrated significantly higher ejection fraction rates than the BC group (47.79±5.50 and 45.72±5.86, respectively, P=0.005). Conclusion: DNC presented better intraoperative and postoperative parameters and it is an effective and safe alternative to BC for CABG combined with mitral valve replacement.

Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Cardioplegic Solutions/administration & dosage , Coronary Artery Bypass/methods , Heart Valve Prosthesis Implantation/methods , Heart Valve Diseases/surgery , Mitral Valve/surgery , Retrospective Studies , Cohort Studies , Treatment Outcome
Rev. bras. cir. cardiovasc ; 33(4): 398-403, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-958424


Abstract Introduction: Carcinoid heart disease most frequently involves the tricuspid or, more rarely, the pulmonary valve and presents with right heart failure as 5-HT is metabolized by the lung. Left-sided valve involvement is quite rare. We describe our experience of 3 patients presenting with heart failure secondary to carcinoid heart disease affecting all four cardiac valves. There are only four previous isolated case reports in the literature. Methods: All three patients underwent quadruple valve replacement during a single operation. Right ventricular outflow tract reconstruction with a pericardial patch was performed in all patients. For 24 hours prior to surgery, all patients received intravenous octreotide, which continued in intensive care for at least 24 hours. Results: Mean cross-clamp and bypass times were 175 (range 164-197 minutes) and 210 (range 195-229 minutes) minutes, respectively. Mean intensive treatment unit (ITU) and inpatient stays were 2.3 (range 2-3 days) and 12 (range 9-16 days) days, respectively. One patient was reopened for bleeding 4 hours postoperatively from a ventricular pacing wire site. None required a permanent pacemaker postoperatively. There were no other complications in any patient. The quality of life was excellent at 6-16 months clinic follow-up as they were in NYHA 1. Postoperative echocardiography showed no paravalvular leaks and well-functioning prostheses in all cases. Conclusion: Surgery to replace all four valves is feasible with excellent medium-term survival and a very low rate of complications. Patients with carcinoid heart disease should always be considered for surgery irrespective of the extent of valvular involvement.

Humans , Carcinoid Heart Disease/surgery , Heart Valve Prosthesis Implantation/methods , Heart Valve Diseases/surgery , Bioprosthesis , Severity of Illness Index , Heart Valve Prosthesis , Carcinoid Heart Disease/diagnostic imaging , Echocardiography , Heart Valve Diseases/diagnostic imaging , Heart Valves/surgery , Heart Valves/diagnostic imaging
Arq. bras. cardiol ; 110(4): 312-320, Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-888058


Abstract Background: Atrial fibrillation frequently affects patients with valvular heart disease. Ablation of atrial fibrillation during valvular surgery is an alternative for restoring sinus rhythm. Objectives: This study aimed to evaluate mid-term results of successful atrial fibrillation surgical ablation during valvular heart disease surgery, to explore left atrium post-ablation mechanics and to identify predictors of recurrence. Methods: Fifty-three consecutive candidates were included. Eligibility criteria for ablation included persistent atrial fibrillation <10 years and left atrium diameter < 6.0 cm. Three months after surgery, echocardiogram, 24-hour Holter monitoring and electrocardiograms were performed in all candidates who maintained sinus rhythm (44 patients). Echo-study included left atrial deformation parameters (strain and strain rate), using 2-dimensional speckle-tracking echocardiography. Simultaneously, 30 healthy individuals (controls) were analyzed with the same protocol for left atrial performance. Significance was considered with a P value of < 0.05. Results: After a mean follow up of 17 ± 2 months, 13 new post-operative cases of recurrent atrial fibrillation were identified. A total of 1,245 left atrial segments were analysed. Left atrium was severely dilated in the post-surgery group and, mechanical properties of left atrium did not recover after surgery when compared with normal values. Left atrial volume (≥ 64 mL/m2) was the only independent predictor of atrial fibrillation recurrence (p = 0.03). Conclusions: Left atrial volume was larger in patients with atrial fibrillation recurrence and emerges as the main predictor of recurrences, thereby improving the selection of candidates for this therapy; however, no differences were found regarding myocardial deformation parameters. Despite electrical maintenance of sinus rhythm, left atrium mechanics did not recover after atrial fibrillation ablation performed during valvular heart disease surgery.

Resumo Fundamento: A fibrilação atrial frequentemente afeta pacientes com doenças das valvas cardíacas. A ablação da fibrilação atrial durante a cirurgia das válvulas é uma alternativa para restaurar o ritmo sinusal. Objetivos: Este estudo teve como objetivos avaliar resultados em médio prazo da ablação cirúrgica bem sucedida da FA durante cirurgia para doença valvar, para explorar a mecânica do AE após a ablação e identificar preditores de recorrência. Métodos: Foram incluídos 53 candidatos consecutivos. Os critérios de elegibilidade para ablação foram fibrilação atrial persistente <10 anos e diâmetro do átrio esquerdo < 6 cm. Três meses após a cirurgia, foram realizados ecocardiografia, Holter por 24 horas, e eletrocardiografias em todos os candidatos que mantiveram o ritmo sinusal (44 pacientes). O estudo eco incluiu parâmetros de deformação ao átrio esquerdo (strain e taxa de strain) usando ecocardiografia bidimensional com speckle tracking. Simultaneamente, 30 indivíduos sadios (controles) foram analisados com o mesmo protocolo para o desempenho do átrio esquerdo. Um valor de P < 0,05 foi considerado significativo. Resultados: Após um período médio de acompanhamento de 17 ± 2 meses, 13 novos casos de fibrilação atrial no pós-operatório foram identificados. Um total de 1245 segmentos do átrio esquerdo foi analisado. O grupo pós-cirúrgico apresentou dilatação grave do átrio esquerdo, e as propriedades mecânicas do átrio esquerdo não se recuperaram após a cirurgia quando comparadas com valores normais. O volume do átrio esquerdo (≥ 64 mL/m2) foi o único preditor independente de recorrência de fibrilação atrial (p = 0,03). Conclusões: O volume do átrio esquerdo foi maior nos pacientes com fibrilação atrial recorrente, e desponta como o principal preditor de recorrência, melhorando, assim, a seleção de candidatos para essa terapia. No entanto, não foram encontradas diferenças em relação aos parâmetros de deformação do miocárdio. Apesar da manutenção elétrica do ritmo sinusal, a função mecânica do átrio esquerdo não se recuperou após a ablação da fibrilação atrial realizada durante a cirurgia para doença da valva cardíaca.

Humans , Male , Female , Middle Aged , Aged , Atrial Fibrillation/surgery , Atrial Fibrillation/diagnostic imaging , Cryosurgery/methods , Heart Valve Diseases/surgery , Heart Valve Diseases/diagnostic imaging , Recurrence , Atrial Fibrillation/physiopathology , Time Factors , Echocardiography/methods , Prospective Studies , Reproducibility of Results , Risk Factors , Follow-Up Studies , Atrial Function, Left/physiology , Treatment Outcome , Statistics, Nonparametric , Electrocardiography , Heart Atria/surgery , Heart Atria/physiopathology , Heart Atria/diagnostic imaging , Heart Rate/physiology , Heart Valve Diseases/physiopathology
Rev. bras. cir. cardiovasc ; 33(1): 8-14, Jan.-Feb. 2018. tab
Article in English | LILACS | ID: biblio-897988


Abstract Objective: The aim of this retrospective study is to evaluate the safety and performance of the Perceval sutureless valve in patients undergoing aortic valve replacement. We report the 30-day clinical outcomes of 139 patients. Methods: From January 2014 to December 2016, 139 patients underwent sutureless aortic valve replacement. Their operation notes, National Adult Cardiac Surgery Database and perioperative transoesophageal echocardiography findings were studied retrospectively. Results: Ninety-two patients underwent isolated aortic valve replacement (group A) with Perceval valve and 47 patients had combined procedures of aortic valve replacement and coronary artery bypass grafting (group B). The patients received a size S (n=23), M (n=39), L (n=42) or XL (n=35) prosthesis. Perceval valve was successfully implanted in 135 (97.1%) patients. Mean cross-clamping time and bypass time were 40 and 63 minutes for isolated cases, while 68 and 107 minutes for combined cases. Three (2.1%) patients died within 30 days. Four patients suffered stroke and 5 patients went into acute renal failure. Median intensive care unit and hospital stay was 2 and 8.5, respectively. Four valves were explanted due to significant paravalvular leak after surgery. Five patients had permanent pacemaker as a result of complete heart block and mean postoperative drainage was 295 mL for isolated case and 457 mL for combined cases. The mean gradient across Perceval valve was 12.5 mmHg while its effective orifice area was 1.5 cm2. Conclusion: Early postoperative results showed that Perceval valve is safe. Further follow up is needed to evaluate the long-term outcome with this bioprosthesis.

Humans , Male , Middle Aged , Aged , Aged, 80 and over , Bioprosthesis/adverse effects , Heart Valve Prosthesis/adverse effects , Heart Valve Prosthesis Implantation/methods , Sutureless Surgical Procedures , Heart Valve Diseases/surgery , Retrospective Studies , Treatment Outcome , Heart Valve Prosthesis Implantation/adverse effects