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1.
Rev. bras. ortop ; 57(1): 120-127, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365755

ABSTRACT

Abstract Objectives Glenoid component failure is the main cause of total shoulder arthroplasty (TSA) revision, and component design seems to influence the failure rate. The aim of the present study was to clinically and radiographically (through X-rays and computed tomography scan) evaluate the results of TSA using a minimally cemented glenoid component. Methods Total should arthroplasties performed using the minimally cemented Anchor Peg (DuPuy Synthes, Warsaw, IN, USA) glenoid component between 2008 and 2013 were evaluated. University of California at Los Angeles (UCLA) scores were calculated, and standardized plain film and computed tomography images were obtained, at a minimum follow-up of 24 months. The presence of bone between the fins of the central component peg, which indicates its integration, was assessed on the images, as well the presence of radiolucent lines around the glenoid component. Results Nineteen shoulders in 17 patients were available for evaluation. According to the UCLA score, clinical results were satisfactory in 74% of cases and fair in 21% of cases. One patient had a poor result. Component integration was found in 58% of patients (total in 42% and partial in 16%). Radiolucent lines were observed in 52% of cases. No relationship was detected between component integration and clinical results. Conclusion Satisfactory clinical results were achieved in most patients undergoing TSA using a minimally cemented glenoid component. Radiolucent lines around the glenoid component are common, but do not interfere with the clinical results. Level of evidence IV; Case series; Treatment study.


Resumo Objetivos A falha do componente glenoidal é a principal causa de revisão da artroplastia total do ombro (ATO) e sua frequência parece ser influenciada pelo design do componente. O objetivo deste estudo foi a avaliação clínica e radiográfica (através de raios X e tomografia computadorizada) dos resultados da ATO com componente glenoidal minimamente cimentado. Métodos O presente trabalho analisou ATOs realizadas com componente glenoidal Anchor Peg (DuPuy Synthes, Warsaw, IN, EUA) minimamente cimentado entre 2008 e 2013. Por um período mínimo de acompanhamento de 24 meses, escores segundo critérios da University of California at Los Angeles (UCLA) e imagens padronizadas de radiografia simples e tomografia computadorizada foram analisadas. A presença de osso entre as aletas do pino do componente central, que é um indicador de sua integração, foi avaliada nas imagens, bem como a presença de linhas radiotransparentes ao redor do componente glenoidal. Resultados Dezenove ombros de 17 pacientes foram avaliados. De acordo com o escore da UCLA, os resultados clínicos foram satisfatórios em 74% dos casos e moderados em 21% dos casos. O resultado foi ruim em um paciente. A integração de componentes foi observada em 58% dos pacientes, sendo total em 42% e parcial em 16% dos casos. Linhas radiotransparentes foram observadas em 52% dos pacientes. Nenhuma relação entre a integração de componentes e os resultados clínicos foi detectada. Conclusão A maioria dos pacientes submetidos à ATO com componente glenoidal minimamente cimentado apresentou resultados clínicos satisfatórios. Linhas radiotransparentes ao redor do componente glenoidal são comuns, mas não interferem nos resultados clínicos Nível de evidência IV; Série de caso; Estudo terapêutico.


Subject(s)
Humans , Male , Female , Middle Aged , Shoulder , Prosthesis Failure , Tomography , Radiographic Image Enhancement , Arthroplasty, Replacement
2.
Rev. cuba. ortop. traumatol ; 35(2): e460, 2021. ilus, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1357325

ABSTRACT

Introducción: El recambio acetabular primario puede llegar a ser una intervención de gran complejidad en dependencia del defecto óseo existente. Las lesiones pueden ser segmentarias, cavitarias o combinadas. Este último patrón es el que se observa con mayor frecuencia en pérdidas óseas periprotésicas por aflojamiento aséptico. Objetivos: Mostrar la evolución de la cirugía de recambio en la artroplastia de cadera, y orientar al cirujano en la toma de decisiones de modo individualizado, para evitar las complicaciones. Método: Se realizó la investigación basada en el tema de estudio, mediante la revisión de libros de texto de la especialidad, artículos científicos publicados en diferentes bases de datos informáticas: Pubmed/MEDLINE, SciELO, BVS, Scopus, Ebsco, Google Scholar, Cochrane, así como otras consultas en bibliotecas médicas. Análisis de la información: Las prioridades en la planificación de la reconstrucción se establecen para proporcionar un implante estable, restaurar la masa ósea y optimizar la biomecánica de la cadera, aunque son los hallazgos intraoperatorios los que definitivamente indicarán el tipo de intervención a seguir. Las exigencias funcionales de los pacientes y las comorbilidades deben ser consideradas, así como el coste-efectividad de la reconstrucción planificada. Conclusiones: La artroplastia total de cadera ha demostrado mejorar significativamente la calidad de vida en pacientes, con una baja tasa de complicaciones. Para prevenir el aflojamiento aséptico es necesario ser cuidadosos en la técnica de colocación de los componentes protésicos y utilizar el tipo de material más adecuado a la edad, demanda funcional y reserva ósea de cada paciente(AU)


Introduction: Primary acetabular replacement can become a highly complex intervention depending on the existing bone defect. Lesions can be segmental, cavitary, or combined. This last pattern is the one most frequently observed in periprosthetic bone loss due to aseptic loosening. Objectives: To show the evolution of replacement surgery in hip arthroplasty, and to guide the surgeon in making individualized decisions, to avoid complications. Method: A research was carried out on the study topic, by reviewing specialty textbooks, scientific articles published in different databases such as Pubmed/ MEDLINE, SciELO, BVS, Scopus, Ebsco, Google Scholar, Cochrane, as well as other inquiries in medical libraries. Information analysis: Reconstruction planning priorities are established to provide a stable implant, restore bone mass, and optimize hip biomechanics, although it is the intraoperative findings that will definitely indicate the type of intervention to follow. The functional demands of the patients and the comorbidities must be considered, as well as the cost-effectiveness of the planned reconstruction. Conclusions: Total hip arthroplasty has been shown to significantly improve the quality of life in patients, with low rate of complications. To prevent aseptic loosening, it is necessary to be careful in the technique of placement of the prosthetic components and to use the type of material most appropriate to the age, functional demand and bone reserve of each patient(AU)


Subject(s)
Humans , Quality of Life , Surgical Procedures, Operative/classification , Bone Transplantation , Arthroplasty, Replacement, Hip , Prosthesis Failure , Radiography/classification
4.
Rev. bras. ortop ; 56(1): 104-108, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1288657

ABSTRACT

Abstract Objective This study aims to evaluate and correlate the nutritional status with potential complications during the immediate postoperative period of elderly patients surgically treated for proximal femoral fractures. Methods A prospective, cross-sectional analytical study with a quantitative approach, targeting patients aged 60 years old or more who were admitted to a hospital in Amazonas, Brazil, for surgical treatment of proximal femoral fractures. Surgical complications during the immediate postoperative period and their relationship with the nutritional status of the patient were determined using the mini nutritional assessment (MNA); in addition, the lymphocyte numbers and serum albumin levels were determined and correlated with the length of hospital stay. Results The sample consisted of 19 elderly patients, of both genders, with a mean age of 70.8 years. Most of the subjects (68.4%) were female. Malnutrition was diagnosed in 15.8% of the subjects using the body mass index (BMI) as, an anthropometric variable, and the MNA identified 31.6% of the subjects with malnutrition. Regarding total lymphocyte count, 100% of the sample showed a positive association with malnutrition in varying degrees; using serum albumin level as a parameter, malnutrition was identified in 89.4% of the subjects. Malnourished patients had the highest average length of stay. Surgical complications as surgical site infections occurred in 10.5% of the patients at risk of malnutrition. Conclusion This study revealed a higher rate of postoperative complications in elderly patients diagnosed with malnutrition.


Resumo Objetivo Avaliar e correlacionar o estado nutricional com possíveis complicações no pós-operatório imediato de pacientes submetidos a tratamento cirúrgico de fraturas de fêmur proximal. Métodos Estudo transversal prospectivo analítico e de abordagem quantitativa, tendo como população-alvo pacientes com idade igual ou superior a 60 anos, internados em uma instituição hospitalar no Amazonas, submetidos a tratamento cirúrgico de fraturas de fêmur proximal. Foram avaliadas as complicações cirúrgicas no pós-operatório imediato e sua relação com o estado nutricional através da mini avaliação nutricional (MAN), assim como a mensuração da contagem de linfócitos e albumina e a sua correlação com o tempo de internação. Resultados A amostra foi composta por 19 pacientes idosos, de ambos os sexos, com média de idade de 70,8 anos. A maioria dos pacientes (68,4%) eram do sexo feminino. Por meio da variável antropométrica índice de massa corporal (IMC), identificou-se a presença de desnutrição em 15,8% dos pacientes e, por meio da MAN, de 31,6%. Na avaliação do cálculo da contagem total de linfócitos, 100% da amostra apresentou associação positiva com desnutrição em graus variáveis e, fazendo-se uso da albumina sérica como parâmetro, a desnutrição foi identificada em 89,4%. Os pacientes desnutridos apresentaram a maior média de tempo de internação. As complicações cirúrgicas, por infecções do sítio cirúrgico, ocorreram em 10,5% nos pacientes em risco nutricional. Conclusão Neste estudo, observou-se maior índice de complicações no pós-operatório em idosos diagnosticados com desnutrição.


Subject(s)
Postoperative Complications , Prosthesis Design , Surgical Wound Infection , Prosthesis Failure , Arthroplasty, Replacement, Knee , Fractures, Bone , Knee Prosthesis
5.
Rev. bras. ortop ; 56(1): 42-46, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1288655

ABSTRACT

Abstract Objective To evaluate the wear of polyethylene in a Brazilian ultracongruent knee prosthesis with a rotating platform (Rotaflex, Víncula, Rio Claro, SP, Brasil). Methods We used the test method with the loading and preparation parameters mentioned in the standards regulation ISO 14243-1:2009, and the measurement methods mentioned in the standards regulation ISO 14243-2:2009, for the evaluation of the wear behavior of a Brazilian prosthesis with a rotating platform. The equipment used for the wear test was the ISO 14243-1 gait simulator (EndoLab, Riedering, Germany). Results After 10 million cycles, the evaluation of the polyethylene wear showed a regular appearance of surface wear at a mean rate of 2.56 mg per million cycles. Conclusion The wear of the polyethylene of the evaluated prosthesis was minimal after the tests performed and with safety limits higher than those recommended by biomechanical engineering.


Resumo Objetivo Avaliar o desgaste do polietileno de uma prótese de joelho brasileira ultracongruente de base rotatória (Rotaflex, Víncula, Rio Claro, SP, Brasil). Métodos Utilizou-se o método de ensaio com os parâmetros de carregamento e preparação citados na norma ISO 14243-1:2009, e os métodos de medição citados na norma ISO 14243-2:2009, para a avaliação do comportamento de desgaste de uma prótese nacional com base rotatória. O equipamento utilizado para o teste de desgaste foi o simulador de marcha ISO 14243-1 (EndoLab, Riedering, Alemanha). Resultados Após 10 milhões de ciclos, a avaliação do desgaste do polietileno mostrou uma aparência regular do desgaste da superfície com taxa média de 2,56 mg por milhão de ciclos. Conclusão O desgaste do polietileno da prótese avaliada foi mínimo após os ensaios realizados e com os limites de segurança superiores aos preconizados pela engenharia biomecânica.


Subject(s)
Prostheses and Implants , Prosthesis Failure , Arthroplasty, Replacement, Knee , Equipment and Supplies , Knee Prosthesis
7.
Article in Chinese | WPRIM | ID: wpr-879395

ABSTRACT

Femorotibial mechanical axis (FTMA) is one of important factors influencing clinical effect after total knee arthroplasty (TKA). It is generally believed that the range of lower limb alignment after TKA is controlled within neutral FTMA ± 3 °, which has more advantages in improving joint function, prolonging prosthesis survival rate and reducing revision rate, and obtain better clinical results. Therefore, neutral FTMA is also considered to be the gold standard for TKA. However, with the application of computer-assisted surgery and other technologies, the alignment of FTMA is more accurate than before, but the clinical effect after surgery has not significantly improved. Some scholars have begun to question the necessity of neutral alignment of FTMA, and proposed alignment methods such as kinematics and retained residual deformity, which could achieve better clinical effects. In recent years, it has been reported that FTMA might not be the most important factor influencing postoperative clinical effects, and it is suggested that the arrangement and measurement of lower limbs and the effects on adjacent joint functions could affect clinical effect after TKA. The paper reviews neutral FTMA alignment is still an important factor for success of TKA. After a thorough evaluation according to the patient's condition, it should be appropriately applied in the case of neutral FTMA alignment; the operator should explore other factors which affect clinical outcome after TKA, and improve it to achieve the best therapeutic effect.


Subject(s)
Arthroplasty, Replacement, Knee , Biomechanical Phenomena , Humans , Knee Joint/surgery , Knee Prosthesis , Lower Extremity , Osteoarthritis, Knee/surgery , Prosthesis Failure , Surgery, Computer-Assisted
8.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353910

ABSTRACT

Introducción: Debido al crecimiento exponencial del número de artroplastias de cadera, se espera una mayor cantidad de re-visiones en las próximas décadas. Los vástagos cónicos estriados modulares se han vuelto populares en la última década por sus resultados favorables. El objetivo de este estudio es evaluar los resultados, las complicaciones y la tasa de supervivencia de estos vástagos en las revisiones de cadera, con un seguimiento a mediano plazo. materiales y métodos: Estudio multicéntrico, retrospectivo. Se incluyeron 182 pacientes a quienes se les realizó una cirugía de revisión de cadera entre 2007 y 2017. Se colo-caron 185 vástagos cónicos estriados de fijación distal. El déficit de stock óseo femoral se clasificó según Paprosky y Burnett; y las facturas periprotésicas, según la clasificación de Vancouver. Se evaluó a los pacientes clínicamente con el Harris Hip Score (HHS) y con radiografías a los 3 meses y anualmente para evaluar la estabilidad del vástago, la subsidencia y el aflojamiento, así como la consolidación de la osteotomía. Resultados: Seguimiento medio 55.18 meses. El HHS posoperatorio tuvo una media de 80,28 (DE = 12,8, IC95% 78,5-82,97). No hubo complicaciones posoperatorias en el 75,4% de los pacientes. Las complicaciones más frecuentes fueron inestabilidad (7,6%) y subsidencia del implante (11,5%). Al final del seguimiento, el 95,05% de los pacientes tenía un implante estable. Conclusiones: Los vástagos cónicos estriados modulares de fijación distal proporcionan una solución confiable, reproducible y duradera para el manejo de revisiones de componentes femorales a medio plazo. Nivel de Evidencia: IV


Background: The number of arthroplasties performed every year is increasing; therefore, a greater number of revisions is expected in the coming decades. Modular fluted tapered stems have become the gold standard for their results in different series of patients. The objective of this article is to evaluate the results, complications and the survival rate of these stems in hip revisions with a medium-term follow-up. Materials and Methods: Retrospective, multicenter analysis. One hundred eighty-two patients who had undergone hip revision surgery between 2007 and 2017 were included. One hundred eighty-five modular fluted tapered stems were placed. Femoral bone stock defects were classified according to Paprosky and Burnett; and periprosthetic femur fractures according to Vancouver classification. Patients were evaluated clinically with Harris Hip Score (HHS) and radiographically 3 months after surgery and every year to assess stem stability, subsidence and loosening, as well as osteotomy healing. Results: Average follow-up was 55.18 months. Postoperative HHS had an average of 80.28 (SD = 12.8, 95% CI = [78.5, 82.97]). There were no postoperative complications in 75.4% of the patients. The most frequent complications were instability in 7.6% and implant subsidence in 11.5%. At the end of the follow-up, 95.05% of the patients had a stable implant. Conclusion: Modular fluted tapered stems provide a reliable, reproducible solution for the management of femoral component revisions at medium-term. Level of Evidence: IV


Subject(s)
Middle Aged , Aged , Postoperative Complications , Reoperation , Prosthesis Failure , Treatment Outcome , Arthroplasty, Replacement, Hip , Hip Joint/surgery
9.
Rev. Asoc. Argent. Ortop. Traumatol ; 86(4) (Nro Esp - ACARO Asociación Argentina para el Estudio de la Cadera y Rodilla): 501-511, 2021.
Article in Spanish | LILACS, BINACIS | ID: biblio-1353951

ABSTRACT

Introducción: El objetivo del estudio fue analizar la supervivencia sin recurrencia de infección en pacientes con reemplazo total de cadera tratados con revisión en dos tiempos, valorando el impacto del cultivo intraoperatorio y la congelación positiva en el reimplante. materiales y métodos: Estudio retrospectivo de 96 casos con infección periprotésica crónica, según los criterios de la MusculoSkeletal Infection Society, sometidos a los dos tiempos quirúrgicos en nuestra institución, entre 2008 y 2013. El seguimiento promedio fue 90 meses. La falla séptica se definió sobre la base de un consenso tipo Delphi modificado. La supervivencia sin falla séptica se definió sobre la base del estimador de Kaplan-Meier. Se compararon los resultados de supervivencia en función del cultivo intraoperatorio y de los estudios de anatomía patológica por congelación mediante la prueba del orden logarítmico. Resultados: La supervivencia sin falla séptica fue del 82,65% a los 2 años (IC95% 73,25-88,99%), 80,40% a los 5 años (IC95% 70,70-87,17%) y 77,32% a 6-10 años (IC95% 66,90-84,33%). Hubo significativamente más fallas en los pacientes con un cultivo positivo en el reimplante que en aquellos con un cultivo negativo (prueba del orden logarítmico, p = 0,0208), y en quienes tuvieron un estudio anatomopatológico por congelación positivo en el reimplante que en aquellos con un resultado negativo (prueba del or-den logarítmico, p = 0,0154). Conclusiones: Los reimplantes sin recurrencias infecciosas por, al menos, 6 años tuvieron un riesgo de falla séptica muy bajo. Cuando se detectó un cultivo o una congelación positivos, la falla séptica fue significativamente mayor. Nivel de Evidencia: IV


Background: We analyzed the survivorship free-from-septic failure in a series of THA cases treated with a two-stage protocol at long-term follow-up, with a special focus on the relevance of positive frozen section and positive intraoperative culture taken during the reimplantation. Materials and methods: We retrospectively reviewed data from 96 cases who met the Musculoskeletal Infec-tion Society criteria for periprosthetic joint infection and who had undergone both stages of a two-stage protocol at our institution between 2008-2013. Mean follow-up was 90 months. Treatment failure was determined with a modified Delphi-based consensus definition. Kaplan-Meier estimate was used to determine survivorship free-from-septic failure. Log-Rank test was used to compare variables associated with septic failure. Results: Survival free-from-septic failure was 82.65% at 2 years (95%CI 73.25%-88.99%), 80.40% at 5 years (95%CI 70.70%-87.17%) and 77.32% at 6-10 years (95%CI 66.90%-84.33%). Patients with a positive culture at reimplantation had significantly more septic failures than those without it (Log-Rank test, p=0.0208), while patients with a positive frozen section at reimplantation had significantly more septic failures than those without it (Log-Rank test, p=0.0154). Conclusions: Reimplantations that remained at least 6 years without septic recurrences had a very low risk of further septic failure. Both positive frozen section and intraoperative culture at reimplantation were risk factors for septic failure. Level of Evidence: IV


Subject(s)
Middle Aged , Reoperation , Prosthesis Failure , Retrospective Studies , Treatment Outcome , Prosthesis-Related Infections , Arthroplasty, Replacement, Hip
10.
Rev. urug. cardiol ; 36(3): e203, 2021. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1366959

ABSTRACT

Introducción: la degeneración valvular protésica es un problema clínico; los métodos de imagen convencionales permiten diagnosticarla en las últimas etapas. La tomografía por emisión de positrones (PET) con 18Ffluoruro puede detectar de manera precoz la degeneración subclínica. Objetivo: correlacionar parámetros de deterioro estructural protésico por PET con parámetros hemodinámicos ecocardiográficos al año de la sustitución valvular aórtica (SVA) por bioprótesis porcina. Métodos: estudio prospectivo ad hoc de un ensayo clínico. Se reclutaron pacientes sometidos a SVA por bioprótesis porcina en dos centros nacionales entre el 01/01/2019 y el 13/02/2020. Se realizaron controles clínicos y ecocardiográficos. Se seleccionaron aleatoriamente 19 sujetos a los que se les realizó PET 18Ffluoruro de sodio con angiotomografía al año de la SVA. Se midió la captación del trazador en la válvula (SUVavV) y aurícula derecha (SUVavA), calculando el índice SUVavV/SUVavA, que se comparó con los gradientes ecocardiográficos medio y máximo al año, mediante análisis de correlación de Spearman. Resultados: de 140 sujetos sometidos a SVA se realizó PET a 19, a los 16,3 meses (15,9-16,9) luego de la SVA. La mediana del índice SUVavV/SUVavA fue de 1,17 (1,11-1,27). Se encontró una correlación negativa moderada entre la captación de 18Ffluoruro y el gradiente medio (coeficiente de correlación -0,516, p = 0,028) y máximo (coeficiente -0,589, p = 0,010) al año. Conclusiones: en el seguimiento de los pacientes en los que se le realizó una sustitución valvular aórtica con bioprótesis, encontramos valores bajos de captación en el PET y gradientes ecocardiográficos normales con una correlación negativa moderada entre estos hallazgos


Introduction: prosthetic valve degeneration is a relevant clinical disorder; conventional imaging methods allow diagnosis in the later stages. 18Ffluoride positron emission tomography (PET) can detect subclinical degeneration earlier. Objective: correlate parameters of prosthetic structural deterioration by PET with echocardiographic hemodynamic parameters one year after aortic valve replacement (AVR) by porcine bioprosthesis. Methods: prospective ad hoc study of a clinical trial. Patients undergoing AVR by porcine bioprosthesis were recruited in two national centers between 01/01/2019 and 02/13/2020. Clinical and echocardiographic controls were carried out. 19 subjects were randomly selected and underwent 18Fsodium fluoride PET with CT angiography one year after AVR. Tracer uptake in the valve (SUVavV) and right atrium (SUVavA) was measured, creating the SUVavV/SUVavA index, which was compared with the mean and maximum gradients at one year, using Spearman's correlation analysis. Results: of a total of 140 subjects, PET was performed on 19 at 16.3 months (15.9-16.9) after the AVR. The median SUVavV/SUVavA ratio was 1.17 (1.11-1.27). A moderate negative correlation was found between. 18Ffluoride uptake and the mean gradient (correlation coefficient -0.516, p = 0.028) and maximum (coefficient of -0.589, p = 0.010) at one year. Conclusions: we found low uptake values in PET, echocardiographic gradients in normal range and no positive correlation between both parameters. It is the first national report with these imaging techniques


Introdução: a degeneração da válvula protética é um problema clínico; os métodos convencionais de imagem permitem o diagnóstico nas fases posteriores. A tomografia por emissão de pósitrons (PET) com fluoreto18F pode detectar a degeneração subclínica precocemente. Objetivo: correlacionar parâmetros de deterioração estrutural protética por PET com parâmetros hemodinâmicos ecocardiográficos após um ano da troca valvar aórtica (SVA) por bioprótese suína. Métodos: estudo ad hoc prospectivo de um ensaio clínico. Pacientes submetidos a SVA por bioprótese suína foram recrutados em dois centros nacionais entre 01/01/2019 e 13/02/2020. Foram realizados controles clínicos e ecocardiográficos. 19 indivíduos foram selecionados aleatoriamente que foram submetidos a PET com fluoreto de sódio 18F com angiotomografia um ano após AVS. A captação do traçador na válvula (SUVavV) e átrio direito (SUVavA) foi medida, criando o índice SUVavV/SUVavA, que foi comparado com os gradientes médio e máximo em um ano, usando a análise de correlação de Spearman. Resultados: de um total de 140 indivíduos submetidos a SVA, PET foi realizado em 19, em 16,3 meses (15,9-16,9) após a SVA. A proporção média de SUVavV/SUVavA foi de 1,17 (1,11-1,27). Uma correlação negativa moderada foi encontrada entre a captação de fluoreto18F e o gradiente médio (coeficiente de correlação -0,516, p = 0,028) e máximo (coeficiente de -0,589, p = 0,010) em um ano. Conclusões: encontramos valores baixos de captação na PET, gradientes ecocardiográficos dentro da normalidade, sem correlação positiva entre os dois parâmetros. É o primeiro trabalho nacional com essas técnicas de imagem


Subject(s)
Humans , Male , Female , Aged , Aortic Valve , Sodium Fluoride/administration & dosage , Bioprosthesis , Prosthesis Failure , Calcinosis/diagnostic imaging , Heart Valve Prosthesis , Echocardiography , Prospective Studies , Follow-Up Studies , Positron-Emission Tomography
11.
Rev. urug. cardiol ; 36(3): e704, 2021. ilus
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1367089

ABSTRACT

La disfunción valvular protésica es cada vez más frecuente debido al envejecimiento de la población portadora de bioprótesis y se presenta como un desafío en el momento de su diagnóstico, valoración y tratamiento. Aplicar un enfoque imagenológico multimodal es fundamental para su manejo. Respecto al tratamiento, surge como nueva alternativa un procedimiento mínimamente invasivo de sustitución valvular percutánea, denominado valve in valve, principalmente en pacientes con riesgo quirúrgico elevado. Presentamos uno de los primeros casos locales de implante percutáneo de prótesis mitral transeptal dentro de una bioprótesis mitral quirúrgica disfuncionante.


Prosthetic valve dysfunction is increasingly common due to the aging of the bioprosthesis-bearing population, and it presents a challenge at the time of diagnosis, evaluation, and treatment. A multimodal imaging approach is essential for its management. In relation to treatment, a minimally invasive percutaneous valve replacement procedure called valve in valve arises as a new alternative, mainly in patients with high surgical risk. We present one of first local cases of percutaneous implantation of a transseptal mitral prosthesis within a dysfunctional surgical mitral bioprosthesis.


A disfunção valvular protética é cada vez mais comum devido ao envelhecimento da população portadora de biopróteses e representa um desafio no momento do diagnóstico, avaliação e tratamento. A multimodalidade da imagem cardiovascular é essencial para sua avaliação. Em relação ao tratamento, um procedimento de troca valvular percutânea minimamente invasivo, denominado valve in valve, surge como uma nova alternativa, principalmente em pacientes com alto risco cirúrgico. Apresentamos um dos primeiros casos realizados no Uruguai de implantação percutânea de prótese mitral transeptal dentro de bioprótese mitral cirúrgica disfuncional.


Subject(s)
Humans , Female , Aged , Bioprosthesis/adverse effects , Prosthesis Failure , Heart Valve Prosthesis Implantation/methods , Mitral Valve/transplantation , Mitral Valve Stenosis/surgery , Tomography , Echocardiography, Doppler , Echocardiography, Transesophageal , Multimodal Imaging , Percutaneous Coronary Intervention , Mitral Valve Stenosis/diagnostic imaging
12.
Arch. cardiol. Méx ; 90(2): 108-115, Apr.-Jun. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131018

ABSTRACT

Abstract Background: Paravalvular leak (PVL) is a frequent and important complication after surgical valvular replacement that can cause heart failure and hemolytic anemia and is associated with poor clinical outcomes. Surgical reoperation has been the standard treatment, but it is associated with high morbidity and mortality. Transcatheter closure is a therapeutic alternative. The aim of the present study is to analyze the feasibility and the short- and medium-term outcomes of the transcatheter closure of PVLs. Methods: Single-center registry of consecutive patients with post-surgical PVLs that underwent transcatheter closure, between January 2006 and December 2016. Efficacy and safety results were analyzed during the procedure and at 6-month follow-up. Results: Twenty-one PVLs (15 mitral, 5 aortic, and 1 tricuspid) were closure during 20 procedures. In the initial echocardiography, 91% of the leaks were severe. The most used device was the Amplatzer Vascular Plug III® in 10 procedures (50%). The three-dimensional transesophageal echocardiography was used in 70% of cases. The device was successfully implanted in 95% of cases, a regurgitation reduction ≥ 1 grade was achieved in 95% of the cases, and the clinical success was 79%. Six-month survival was 100%; however, three cases required valvular surgery (15%). Conclusions: Transcatheter closure of PVLs is a feasible and safe procedure with high rates of technical, echocardiographic, and clinical success in the short and medium term. It is an adequate therapeutic alternative, mainly in high surgical risk patients and multiples comorbidities.


Resumen Introducción: La fuga paravalvular es una complicación frecuente e importante posterior al reemplazo valvular quirúrgico que puede ocasionar insuficiencia cardiaca, anemia hemolítica y se relaciona con malos resultados clínicos. La reintervención quirúrgica ha sido el tratamiento habitual, pero se acompaña de alta morbimortalidad. El cierre transcatéter es una alternativa terapéutica. El objetivo del presente estudio es analizar la factibilidad y los resultados a corto y mediano plazo del cierre transcatéter de fugas paravalvulares con dispositivos oclusores. Métodos: Registro unicéntrico de una serie consecutiva de pacientes con fugas paravalvulares posquirúrgicas que fueron cerradas vía transcatéter con dispositivos oclusores, entre enero del 2006 y diciembre del 2016. Se analizaron los resultados de eficacia y seguridad durante el procedimiento y a seis meses. Resultados: Se trataron 21 fugas paravalvulares (15 mitrales, 5 aórticas y 1 tricuspídea) durante 20 procedimientos. El 91% de las fugas fue grave en la ecocardiografía inicial. El dispositivo utilizado con más frecuencia fue el Amplatzer Vascular Plug III® en 10 procedimientos (50%). Se utilizó ecocardiografía transesofágica tridimensional en 70% de los casos. Se logró implantar el dispositivo con éxito en el 95% de los casos; se consiguió una reducción ≥ 1 del grado de regurgitación en el 95% de las veces y se alcanzó el éxito clínico en el 79%. A seis meses la supervivencia fue del 100%; sin embargo, tres casos requirieron cirugía valvular (15%). Conclusiones: El cierre transcatéter de fugas paravalvulares es un procedimiento factible, seguro y con tasas elevadas de éxito técnico, ecocardiográfico y clínico a corto y mediano plazo. Es una alternativa terapéutica adecuada, en particular en pacientes considerados de alto riesgo quirúrgico y múltiples comorbilidades.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aortic Valve Insufficiency/surgery , Tricuspid Valve Insufficiency/surgery , Cardiac Catheterization/methods , Mitral Valve Insufficiency/surgery , Time Factors , Prosthesis Failure , Heart Valve Prosthesis , Registries , Follow-Up Studies , Treatment Outcome , Echocardiography, Transesophageal , Echocardiography, Three-Dimensional , Septal Occluder Device
13.
Acta ortop. mex ; 34(1): 22-26, ene.-feb. 2020. tab
Article in Spanish | LILACS | ID: biblio-1345080

ABSTRACT

Resumen: Introducción: En un reemplazo total de cadera primario (RTC), diferentes materiales son los que se usan para las superficies de apoyo. En nuestro medio, las cabezas de metal o cerámica con polietileno altamente entrecruzado (PA) son los más utilizados. Estas combinaciones tienen buenos resultados, pero no es claro cuál es superior clínicamente. Basados en una revisión sistemática de la literatura y de los registros nacionales de artroplastía, el objetivo de este estudio es determinar si existe alguna diferencia significativa desde el punto de vista clínico. Material y métodos: Realizamos una revisión sistemática de la literatura y de los registros nacionales de artroplastía. Buscamos estudios en los que se compararan los tipos de superficie de contacto: cerámica-polietileno altamente entrecruzado (CP) y metal-polietileno altamente entrecruzado (MP), además de los registros nacionales de artroplastía que describieran, con un seguimiento mínimo de 10 años, la tasa de revisión según el tipo de superficie. El desenlace evaluado fue: tasa de revisión por cualquier causa según el tipo de superficie. Resultados: Dos de quince registros nacionales fueron incluidos: el registro australiano muestra una diferencia en la tasa de revisión a 15 años, comparando CP: 6.3 (IC 5.8, 6.7) contra MP: 5.1 (IC 4.6, 5.7). El registro de Nueva Zelanda no muestra diferencias en la tasa de revisión/100 componentes/año: CP de 0.54 (0.48-0.61) en comparación con MP de 0.61 (0.57-0.66). No encontramos estudios clínicos con los criterios de inclusión que respondan la pregunta de investigación. Conclusión: Los resultados de esta revisión muestran una alta supervivencia cuando se usa polietileno altamente entrecruzado; asimismo, los resultados son similares cuando se utilizan cabezas de cerámica o metálicas.


Abstract: Introduction: In primary hip replacement, different materials are used for bearing surfaces. In our medium metal or ceramic heads with highly crossed-linked polyethylene (PA) are the most used. These combinations have good results, but it is not clear which is clinically superior. The objective of this study is to determine whether there is any clinically significant difference based on a systematic review of the literature and national registries of arthroplasty. Material and methods: We conduct a systematic review of the literature and national registries of arthroplasty and we were looking for studies comparing bearing surfaces: ceramic-highly cross-linked polyethylene (CP) and metal-highly cross-linked polyethylene (MP); describing the revision rate according to the surface type with a minimum 10-year follow-up. The outcome evaluated was: review rate for any cause depending on surface type. Results: Two out of fifteen national registries were included. The Australian registry shows a difference in the 15-year revision rate: CP: 6.3 (IC 5.8, 6.7) vs MP: 5.1 (IC 4.6, 5.7). The New Zealand registry shows no differences in revision rate/100 components/year: CP 0.54 (0.48-0.61) vs MP 0.61 (0.57-0.66). We do not find clinical studies with inclusion criteria that answer the research question. Conclusion: The results of this review show a high survival rate with the use of highly cross-linked polyethylene, the results are similar when using ceramic or metal heads.


Subject(s)
Humans , Arthroplasty, Replacement, Hip , Hip Prosthesis , Prosthesis Design , Reoperation , Australia , Prosthesis Failure , Ceramics , Polyethylene
14.
Artrosc. (B. Aires) ; 27(4): 146-154, 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1177890

ABSTRACT

El propósito de este trabajo fue realizar una evaluación retrospectiva, clínica y radiológica, de una serie de pacientes intervenidos quirúrgicamente de una artroplastia total de rodilla con prótesis abisagrada, analizando las causas de falla y complicaciones en el corto y mediano plazo.Se evaluaron un total de veinticuatro prótesis abisagradas de rodilla en reconstrucciones no oncológicas. Trece fueron mujeres y once, hombres, con un promedio de setenta y dos años (cincuenta y tres a ochenta y siete años). El seguimiento promedio fue de cuarenta meses (rango de veinte a setenta meses). En once pacientes la cirugía realizada fue una artroplastia primaria compleja y en trece casos, una cirugía de revisión protésica. Se realizó un examen radiográfico y una evaluación clínica y funcional en el preoperatorio y en el último control mediante la utilización del score de la Knee Society (KSS).Siete pacientes (29%) presentaron complicaciones mayores dentro del primer año de seguimiento; tres pacientes evidenciaron una luxación patelofemoral y dos pacientes presentaron una luxación femorotibial de la prótesis por ruptura del componente abisagrado. El puntaje promedio de la evaluación clínica mediante el score del KSS fue de 36 en preoperatorio (rango 22 a 54 puntos) y de 78 puntos promedio en el último control (rango 56 a 95 puntos), lo que implica una mejora de 42 puntos. La sobrevida del implante fue de 92% a los cuarenta meses. No se observaron diferencias funcionales significativas al comparar los pacientes con artroplastias primarias con aquellos pacientes con artroplastias de revisión.La utilización de implantes abisagrados en artroplastias complejas de rodilla primarias, o de revisión, presentó resultados funcionales y radiológicos aceptables, con una sobrevida del implante del 92% en el mediano plazo, sin embargo, se observa un elevado índice de complicaciones.Tipo de estudio: Serie de casosNivel de evidencia: IV


The purpose of this study was to retrospectively evaluate a series of patients who underwent surgery for a total knee arthroplasty with a hinged prosthesis and determinate clinical and radiological outcomes, analyzing the causes of failure and complications in the short and medium term.A total of twenty-four hinged knee prostheses were evaluated in non-oncological reconstructions. Thirteen were women and eleven men, with an average age of seventy-two years (fifty-three to eighty-seven years). The average follow-up was forty months (range from twenty to seventy months). In eleven cases the patients underwent a complex primary arthroplasty and in thirteen cases a prosthetic revision surgery. Radiographic control and clinical and functional evaluation are performed preoperatively and in the last control using the Knee Society Score (KSS).Seven patients (29%) have a major complication in the first year of follow-up, three patients with an extensor mechanism dislocation and two patients with a prosthetic dislocation because a rupture of the hinged component. The average clinical evaluation KSS score was 36 in the preoperative (range 22 to 54 points) and 78 average points in the last control (range 56 to 95 points), which an improvement of 42 points. Implant survival was 92% at forty months. There are no differences between patients with primary arthroplasties with those with revision arthroplasties.The use of hinged implants in complex primary, or revision knee arthroplasties, provides acceptable functional and radiological results with an implant survival of 92% in the medium term, however we observed a high rate of complications.Type of study: Case series Level of evidence: IV


Subject(s)
Middle Aged , Aged , Aged, 80 and over , Postoperative Complications , Reoperation , Survival , Prosthesis Failure , Arthroplasty, Replacement, Knee
15.
Rev. Col. Bras. Cir ; 47: e20202481, 2020. tab, graf
Article in English | LILACS | ID: biblio-1136536

ABSTRACT

ABSTRACT Endovascular treatment for femoropopliteal arterial disease has made revascularization procedures less invasive, but the self-expanding stents used can suffer great wear in arteries with extreme mobility. Objective: to evaluate the prevalence of fractures in stents implanted in the femoropopliteal segment, to identify predisposing factors and consequences on arterial patency. Method: between March and June 2019, thirty patients previously operated for femoropopliteal obstruction underwent stent X-rays in anteroposterior and lateral views to detect fractures and Doppler to analyze arterial patency. Results: we observed 12 cases with fractures (33.3%): 1 type I (2.8%), 3 type II (8.3%), 5 type III (13.9%), 3 type IV (8.3%) and no type V. According to the TASC II we had 1 in group B (8.3%), 6 in group C (50%) and 5 in group D (41.6%) p <0.004. The number of stents per limb was 3.1 (± 1.3) in cases of fracture versus 2.3 (± 1.3) in cases without fracture (p = 0.08). The extension was 274.17mm (± 100.94) in cases of fracture and 230.83mm (± 135.44) in cases without fracture (p = 0.29). On Doppler we had: 17 patients (47.2%) without stenosis, 9 patients (25%) with stenosis> 50% and 10 patients (27.8%) with occlusion (p = 0.37). There was no correlation between fracture and arterial obstruction (p = 0.33). Conclusion: stent fractures are a frequent finding in the femoropopliteal area (33.3%), being more prevalent in cases of more advanced disease (C and D). There was no association between the finding of fracture and arterial obstruction.


RESUMO Os tratamentos endovasculares para a doença arterial obstrutiva fêmoro-poplítea tornaram os procedimentos de revascularização menos invasivos, porém os stents metálicos autoexpansíveis utilizados podem sofrer grande desgaste em artérias com extrema mobilidade. Objetivo: avaliar a prevalência de fraturas em stents implantados no segmento fêmoro-poplíteo, identificar fatores predisponentes e possíveis consequências sobre a patência arterial. Métodos: entre março a junho de 2019, trinta pacientes previamente operados por obstrução fêmoro-poplítea realizaram RX dos stents em incidências ântero-posterior e perfil para detectar fraturas e eco Doppler para analisar a patência arterial. Resultados: observamos 12 casos com fraturas (33,3%): 1 do tipo I (2,8%), 3 do tipo II (8,3%), 5 do tipo III (13,9%), 3 do tipo IV (8,3%) e nenhuma tipo V. Segundo a classificação TASC II, tivemos 1 no grupo B (8,3%), 6 no grupo C (50%) e 5 no grupo D (41,6%) p<0,004. O número de stents por membro foi de 3,1 (±1,3) nos casos de fratura contra 2,3 (±1,3) nos casos sem fratura (p = 0,08). A extensão tratada foi 274,17mm (±100,94) nos casos de fratura e 230,83mm (±135,44) nos casos sem fratura (p=0,29). No Doppler tivemos: 17 pacientes (47,2%) sem estenose, 9 pacientes (25%) com estenose>50% e 10 pacientes (27,8%) com oclusão (p=0,37). Não houve correlação entre fratura e obstrução arterial (p=0,33). Conclusão: as fraturas de stents são um achado frequente no setor fêmoro-poplíteo (33,3%) sendo mais prevalentes nos casos de doença mais avançada TASC II C e D. Não houve associação entre o achado de fratura e obstrução arterial.


Subject(s)
Humans , Popliteal Artery , Prosthesis Failure , Stents , Peripheral Vascular Diseases/therapy , Ultrasonography, Doppler, Color/methods , Peripheral Arterial Disease , Endovascular Procedures/methods , Prosthesis Design , Vascular Patency , Prevalence , Retrospective Studies , Risk Factors , Treatment Outcome , Peripheral Vascular Diseases/diagnostic imaging , Leg/blood supply
16.
Braz. j. otorhinolaryngol. (Impr.) ; 85(3): 290-296, May-June 2019. tab
Article in English | LILACS | ID: biblio-1011625

ABSTRACT

Abstract Introduction: The surgery during which the cochlear implant internal device is implanted is not entirely free of risks and may produce problems that will require revision surgeries. Objective: To verify the indications for cochlear implantation revision surgery for the cochlear implant internal device, its effectiveness and its correlation with certain variables related to language and hearing. Methods: A retrospective study of patients under 18 years submitted to cochlear implant surgery from 2004 to 2015 in a public hospital in Brazil. Data collected were: age at the time of implantation, gender, etiology of the hearing loss, audiological and oral language characteristics of each patient before and after cochlear implant surgery and any need for surgical revision and the reason for it. Results: Two hundred and sixty-five surgeries were performed in 236 patients. Eight patients received a bilateral cochlear implant and 10 patients required revision surgery. Thirty-two surgeries were necessary for these 10 children (1 bilateral cochlear implant), of which 21 were revision surgeries. In 2 children, cochlear implant removal was necessary, without reimplantation, one with cochlear malformation due to incomplete partition type I and another due to trauma. With respect to the cause for revision surgery, of the 8 children who were successfully reimplanted, four had cochlear calcification following meningitis, one followed trauma, one exhibited a facial nerve malformation, one experienced a failure of the cochlear implant internal device and one revision surgery was necessary because the electrode was twisted. Conclusion: The incidence of the cochlear implant revision surgery was 4.23%. The period following the revision surgeries revealed an improvement in the subject's hearing and language performance, indicating that these surgeries are valid in most cases.


Resumo Introdução: A cirurgia para a implantação do dispositivo interno do implante coclear não é inteiramente livre de riscos e pode apresentar problemas que exigem cirurgias revisionais. Objetivo: Verificar a incidência das indicações de cirurgias revisionais para a implantação do dispositivo interno do implante coclear, sua efetividade e correlacionar às variáveis relacionadas às categorias de linguagem e audição. Método: Estudo retrospectivo de pacientes menores de 18 anos submetidos à cirurgia de implante coclear de 2004 a 2015 em um hospital público no Brasil. Os dados coletados foram: idade no momento da implantação, sexo, etiologia da surdez, características audiológicas e da linguagem oral de cada paciente no pré e pós-operatório, necessidade de revisão cirúrgica e razão para ela. Resultados: Foram feitas 265 cirurgias em 236 pacientes. Oito pacientes foram submetidos ao implante coclear bilateral e 10 necessitaram de cirurgia de revisão. Foram necessárias 32 cirurgias para essas 10 crianças (um implante coclear bilateral), das quais 21 foram cirurgias de revisão. Em duas crianças, a remoção do implante coclear foi necessária, sem realização de reimplante; uma delas apresentava malformação coclear, por partição incompleta tipo I; e a outra, devido a trauma. Quanto à causa da necessidade da cirurgia revisional, das oito crianças que permaneceram com implante coclear, quatro apresentaram calcificação coclear após meningite, seguida de trauma (1), malformação do nervo facial (1), falha do dispositivo interno da IC (1) e torção do feixe de eletrodos (1). Conclusão: A incidência de cirurgias revisionais foi de 4,23%. O pós-operatório das cirurgias revisionais permite uma melhoria no desempenho de audição e na linguagem dos pacientes, indicando que essas cirurgias são válidas na maioria dos casos.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Reoperation , Cochlear Implantation/adverse effects , Deafness/surgery , Speech Perception , Prosthesis Failure , Retrospective Studies , Device Removal , Hearing Tests
17.
Rev. bras. cir. cardiovasc ; 34(3): 318-326, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013462

ABSTRACT

Abstract Objectives: This study sought to evaluate the impact of prosthesis-patient mismatch (PPM) on the risk of early-term mortality after transcatheter aortic valve implantation (TAVI). Methods: Databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], Excerpta Medica dataBASE [EMBASE], Cochrane Controlled Trials Register [CENTRAL/CCTR], ClinicalTrials.gov, Scientific Electronic Library Online [SciELO], Latin American and Caribbean Literature on Health Sciences [LILACS], and Google Scholar) were searched for studies published until February 2019. PPM after TAVI was defined as moderate if the indexed effective orifice area (iEOA) was between 0.85 cm2/m2 and 0.65 cm2/m2 and as severe if iEOA ≤ 0.65 cm2/m2. Results: The search yielded 1,092 studies for inclusion. Of these, 18 articles were analyzed, and their data extracted. The total number of patients included who underwent TAVI was 71,106. The incidence of PPM after TAVI was 36.3% (25,846 with PPM and 45,260 without PPM). One-year mortality was not increased in patients with any PPM (odds ratio [OR] 1.021, 95% confidence interval [CI] 0.979-1.065, P=0.338) neither in those with moderate PPM (OR 0.980, 95% CI 0.933-1.029, P=0.423). Severe PPM was separately associated with high risk (OR 1.109, 95% CI 1.041-1.181, P=0.001). Conclusion: The presence of severe PPM after TAVI increased early-term mortality. Although moderate PPM seemed harmless, the findings of this study cannot not rule out the possibility of it being detrimental, since there are other registries that did not address this issue yet.


Subject(s)
Humans , Prosthesis Failure/adverse effects , Heart Valve Prosthesis/adverse effects , Transcatheter Aortic Valve Replacement/adverse effects , Transcatheter Aortic Valve Replacement/mortality , Severity of Illness Index , Risk Factors , Treatment Failure , Risk Assessment
18.
Rev. bras. cir. cardiovasc ; 34(3): 361-365, Jun. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013459

ABSTRACT

Abstract Prosthesis-patient mismatch (PPM) after surgical aortic valve replacement (SAVR) is an issue that has been overlooked (not to say neglected). Cardiac surgeons must bear in mind that this is a real problem that we must tackle. The purpose of this paper is to be a wake-up call to the surgical community by giving a brief overview of what PPM is, its incidence and impact on the outcomes. We also discuss the increasing role played by imaging for predicting and assessing PPM after SAVR (with which surgeons must become more acquainted) and, finally, we present some options to avoid PPM after the surgical procedure.


Subject(s)
Humans , Prosthesis Failure/adverse effects , Heart Valve Prosthesis/adverse effects , Transcatheter Aortic Valve Replacement/adverse effects , Postoperative Complications/mortality , Postoperative Complications/diagnostic imaging , Severity of Illness Index , Risk Factors , Treatment Failure , Risk Assessment , Transcatheter Aortic Valve Replacement/mortality
19.
Rev. bras. cir. cardiovasc ; 34(2): 203-212, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-990564

ABSTRACT

Abstract Objective: This study sought to evaluate the impact of prosthesis-patient mismatch on the risk of perioperative and long-term mortality after mitral valve replacement. Methods: Databases were researched for studies published until December 2018. Main outcomes of interest were perioperative and 10-year mortality and echocardiographic parameters. Results: The research yielded 2,985 studies for inclusion. Of these, 16 articles were analyzed, and their data extracted. The total number of patients included was 10,239, who underwent mitral valve replacement. The incidence of prosthesis-patient mismatch after mitral valve replacement was 53.7% (5,499 with prosthesis-patient mismatch and 4,740 without prosthesis-patient mismatch). Perioperative (OR 1.519; 95%CI 1.194-1.931, P<0.001) and 10-year (OR 1.515; 95%CI 1.280-1.795, P<0.001) mortality was increased in patients with prosthesis-patient mismatch. Patients with prosthesis-patient mismatch after mitral valve replacement had higher systolic pulmonary artery pressure and transprosthethic gradient and lower indexed effective orifice area and left ventricle ejection fraction. Conclusion: Prosthesis-patient mismatch increases perioperative and long-term mortality. Prosthesis-patient mismatch is also associated with pulmonary hypertension and depressed left ventricle systolic function. The findings of this study support the implementation of surgical strategies to prevent prosthesis-patient mismatch in order to decrease mortality rates.


Subject(s)
Humans , Male , Female , Prosthesis Failure , Heart Valve Prosthesis/adverse effects , Heart Valve Prosthesis Implantation/mortality , Mitral Valve/surgery , Postoperative Complications/mortality , Risk Factors , Treatment Outcome , Perioperative Period/mortality
20.
Acta ortop. mex ; 33(2): 67-72, mar.-abr. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1248637

ABSTRACT

Resumen: El incremento en la cirugía de artroplastía total de cadera es motivado por muchos factores, como el aumento en la expectativa de vida, mejoría continua en la técnica quirúrgica e innovaciones en el diseño y los materiales de los implantes que, sumados, han convertido a este procedimiento en una solución efectiva a la degeneración articular, con excelentes resultados. Sin embargo, a pesar de los avances tecnológicos, la infección periprotésica se ha mantenido como una de las complicaciones más devastadoras. Este estudio evalúa la aplicación profiláctica de perlas de sulfato de calcio medicadas en el canal femoral y superficie acetabular para prevenir infecciones periprotésicas en pacientes que fueron sometidos a una artroplastía total de cadera primaria no cementada contra un grupo control mediante la medición de reactantes de fase aguda y cultivo de líquido sinovial. Se sometieron al estudio 146 individuos: 67 a quienes se les aplicaron perlas de sulfato de calcio medicado y 79 a quienes se les aplicó antibiótico profiláctico intravenoso de Septiembre de 2013 a Agosto de 2016. Como método diagnóstico de infección periprotésica temprana se evaluaron la proteína C reactiva asociada a velocidad de sedimentación globular aumentada, una fístula que comunicara con la prótesis, cultivo positivo de dos o más sitios periprotésicos de líquido sinovial o tejido. Los resultados clínicos demostraron que hubo una disminución en los valores de los reactantes de fase aguda en los sujetos a quienes se les aplicaron las perlas de sulfato de calcio medicado. Se encontró que 14 personas presentaron infección en el grupo con profilaxis parenteral, comparado con tres del grupo con profilaxis local con perlas de sulfato de calcio medicado; ambos grupos con ceftriaxona. Se consideró que el uso profiláctico de perlas de sulfato de calcio dentro de canal medular y la superficie acetabular es una buena opción para prevenir infecciones periprotésicas en quienes han sido sometidos a una artroplastía total de cadera primaria no cementada; sin embargo el estudio amerita seguimiento con más pacientes para tener significancia estadística.


Abstract: The increase in total hip arthroplasty occurs by many factors, such as increasing life expectancy, improving surgical technique as well as innovating the design and implant material. However, despite technological advances, peri-prosthetic infection has remained one of the most devastating complications. This study evaluates the prophylactic application of calcium sulfate pearls medicated in the femoral canal and acetabular surface to prevent peri-prosthetic infections in patients who underwent total uncemented primary hip arthroplasty against a control group by measuring acute phase reactants. 146 patients, 67 were applied calcium sulfate pearls medicated and 79 prophylactic antibiotic intravenous in the period from 2013 to 2016. To perform the diagnosis of peri-prosthetic infection was assessed PCR associated with VSG, communication between fistula and prostheses and positive culture in 2 or more different sites. There was a decrease in the values of acute-phase reactants in patients who were given calcium sulfate pearls. 14 patients presented infection in the control group and 3 in the study group. The prophylactic use of calcium sulphate pearls within the medullary canal and acetabular surface is an option for the prophylaxis of peri-prosthetic infections, however the study deserves follow-up with more patients.


Subject(s)
Humans , Calcium Sulfate/therapeutic use , Arthroplasty, Replacement, Hip , Hip Prosthesis , Prosthesis Design , Reoperation , Prosthesis Failure
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