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Abstract Introduction: Cardiovascular disease is an important cause of death among patients with chronic kidney disease (CKD). Valve calcification is a predictor of cardiovascular mortality and coronary artery disease. Objective: To assess heart valve disease frequency, associated factors, and progression in CKD patients. Methods: We conducted a retrospective study on 291 CKD patients at Hospital das Clínicas de Pernambuco. Inclusion criteria were age ≥ 18 with CKD and valve disease, while those on conservative management or with missing data were excluded. Clinical and laboratory variables were compared, and patients were categorized by dialysis duration (<5 years; 5-10 years; >10 years). Statistical tests, including chi-square, Fisher's exact, ANOVA, and Kruskal-Wallis, were employed as needed. Simple and multivariate binary regression models were used to analyze valve disease associations with dialysis duration. Significance was defined as p < 0.05. Results: Mitral valve disease was present in 82.5% (240) of patients, followed by aortic valve disease (65.6%; 86). Over time, 106 (36.4%) patients developed valve disease. No significant association was found between aortic, pulmonary, mitral, or tricuspid valve disease and dialysis duration. Secondary hyperparathyroidism was the sole statistically significant factor for mitral valve disease in the regression model (OR 2.59 [95% CI: 1.09-6.18]; p = 0.031). Conclusion: CKD patients on renal replacement therapy exhibit a high frequency of valve disease, particularly mitral and aortic valve disease. However, no link was established between dialysis duration and valve disease occurrence or progression.
Resumo Introdução: Doenças cardiovasculares são uma causa significativa de morte em pacientes com Doença Renal Crônica (DRC). A calcificação valvar é preditor de mortalidade cardiovascular e doença arterial coronariana. Objetivo: Avaliar a frequência, fatores associados e progressão de valvopatias em pacientes com DRC. Métodos: Coorte retrospectiva com 291 pacientes ambulatoriais no Hospital das Clínicas de Pernambuco. Inclusão: ≥18 anos com DRC e valvopatia; exclusão: tratamento conservador ou dados incompletos. Variáveis clínicas e laboratoriais foram comparadas e categorizadas por tempo de terapia dialítica (TTD): <5 anos, 5-10 anos, >10 anos. Foram aplicados os testes Qui-quadrado, exato de Fisher, ANOVA, Kruskal-Wallis. Associação entre valvopatia e TTD foi avaliada por regressão binária. Significância foi definida como p < 0,05. Resultados: A valvopatia mitral foi encontrada em 82,5% (240) dos casos, seguida da aórtica (65,6%; 86). Houve progressão da doença valvar em 106 (36,4%) pacientes. Não houve associação entre valvopatias aórtica, pulmonar, mitral ou tricúspide e TTD. Hiperparatireoidismo secundário foi a única variável explicativa significativa na regressão para valvopatia mitral (OR 2,59 [IC95%: 1,09-6,18]; p = 0,031). Conclusão: Encontramos alta frequência de valvopatias, especialmente mitral e aórtica, aem pacientes com DRC. Não houve associação entre TTD e valvopatia.
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Infective endocarditis (IE) is an infection of the inner lining of the heart, especially the heart valves, and carries high morbidity and mortality. It can manifest itself acutely or subacutely, the latter being more insidious. Diagnosis is challenging, especially in early stages, requiring high clinical suspicion using modified Duke criteria. Treatment involves antimicrobials and in certain cases cardiac surgery is essential. The clinical case presents a patient with a history of aortic valve replacement, who develops acute symptoms. Although the diagnosis of endocarditis is achieved, a por physical examination delays starting optimal treatment. Early diagnosis is crucial to avoid adverse outcomes. Post-hospital discharge follow-up is essential to identify possible long-term complications.
La endocarditis infecciosa es una infección del revestimiento interno del corazón, especialmente de las válvulas cardíacas, con alta morbimortalidad. Se manifiesta como aguda o subaguda, siendo esta última más insidiosa. El diagnóstico es desafiante, especialmente en etapas tempranas, requiriendo sospecha clínica en pacientes con fiebre, factores de riesgo cardiacos o no cardiacos y el uso de los criterios de Duke- International Society of Cardiovascular Infectious Diseases. El tratamiento implica antimicrobianos y en ciertos casos es imprescindible la cirugía cardiaca. Se presenta un caso clínico de un paciente con antecedentes de reemplazo valvular aórtico, que desarrolla síntomas agudos. Aunque se logra el diagnóstico de endocarditis, un examen físico poco exhaustivo causa retraso en el inicio del tratamiento óptimo. Un diagnóstico temprano es crucial para evitar resultados adversos. Es esencial la vigilancia estrecha post alta hospitalaria debido a complicaciones a largo plazo.
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Humanos , Masculino , Persona de Mediana Edad , Endocarditis/diagnóstico , Endocarditis/terapia , Enfermedades de las Válvulas Cardíacas/diagnóstico , Infarto del Bazo , Endocarditis/epidemiología , Enfermedades de las Válvulas Cardíacas/cirugíaRESUMEN
Resumen En Costa Rica, el Reglamento de la Autopsia Hospitalaria y Médico Legal establece que la autopsia médico legal es obligatoria para toda muerte súbita. La patología cardíaca es responsable aproximadamente del 80 % de las muertes súbitas que requieren una autopsia forense; el prolapso de la válvula mitral (degeneración mixomatosa de la válvula mitral) es una de las formas más comunes de valvulopatía cardíaca, es relativamente común (2%-3% de la población general), y a menudo se considera benigno, la tasa anual de muerte cardíaca súbita (MSC) en individuos con MVP (0,2%-0,4% /año) es aproximadamente el doble que el observado en la población general (0,1%-0,2% año).
Abstract In Costa Rica, the Hospital and Legal Autopsy Regulations establish that a legal medical autopsy is mandatory for all sudden deaths. Cardiac pathology is responsible for approximately 80% of sudden deaths requiring a forensic autopsy; Mitral valve prolapse (myxomatous mitral valve degeneration) is one of the most common forms of heart valve disease, is relatively common (2%-3% of the general population), and is often considered benign, the annual rate of Sudden cardiac death (SCD) in individuals with MVP (0.2%-0.4%/year) is approximately twice that observed in the general population (0.1%-0.2%/year).
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Objective:To explore the rehabilitation effect of Cox health behavior interaction mode in elderly patients with valvular heart disease(VHD)and its impact on their quality of life(QOL).Methods:A total of 120 elderly VHD patients enrolled from Jun 2020 to Jun 2022 were divided into routine nursing group(n=60)and Cox group(n=60,received Cox health behavior interaction mode intervention)according to random number table method.Both groups were intervened for six months.General data,cardiac function,6min walking distance(6MWD),QOL,sleep quality and disease percep-tion before and after intervention were compared between two groups.Results:Compared with routine nursing group after six months,there were significant rise in left ventricular ejection fraction(LVEF)[(48.87±4.41)％vs.(51.94± 4.04)％],6MWD[(353.20±4.83)m vs.(424.93±4.40)m],scores of China questionnaire of quality of life in pa-tients with cardiovascular diseases(CQQC)[(84.67±4.05)scores vs.(134.46±4.58)scores]and control attitude scale-revised(CAS-R)[(22.13±3.21)scores vs.(34.98±3.39)scores],and significant reductions in left ventricular end-systolic diameter(LVESd)[(54.99±6.07)mm vs.(49.01±5.48)mm],left ventricular end-diastolic diameter(LVEDd)[(59.20±7.16)mm vs.(54.05±6.14)mm]and Pittsburgh sleep quality index(PSQI)[(14.53±2.42)scores vs.(9.31±1.10)scores]in Cox group,P=0.001 all.Conclusion:The Cox health behavior interaction mode plays a role in the treatment and rehabilitation of elderly patients with valvular heart disease,which can observably improve their cardiac function,physical endurance and quality of life.
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Objective To investigate the effects patterned structure located on the surface of mechanical valve leaflet exerted on the hydrodynamic properties of valve prostheses.Methods Bileaflet aortic mechanical valves of GKS 21A and 23 A were randomly selected as the control group,hydrodynamic performance of each valve were assessed,as per ISO5840 by calculating mean transvalvular pressure(MTP),regurgitation fraction(REG),effective orifice area(EOA)and effective orifice area(eLoss).Then,laser etching was applied to construct a parallel-groove array pattern on leaflet surface perpendicular to the direction of the blood flow.The valve was subjected a-gain to the same test,and the data obtained were recorded and analyzed.Results In the pulsating flow test,the MTP of the experimental group was smaller than that of the control group at the same flow rate and size.The RE in GKS 21A experimental group was smaller than that in control group,and the RE in GKS 23A experimental group was larger than that in control group.The EOA in the experimental group was larger than that in the control group at the same flow rate and size.The eLoss in the GKS 21A experimental group was smaller than that in the control group,and the eLoss in the GKS 23A experimental group was larger than that in the control group.Conclusion The parallel-groove array pattern on the surface of the leaflet affected the hemodynamic performance of the valve prostheses.
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To summarize the perioperative nursing experience of a patient with the first multiple aortic valve operation in China implanted a new non-sutured biological heart valve. The main contents of nursing included through capacity management, prevention and control of bleeding and thrombocytopenia, arrhythmia monitoring and correction, infection prevention and control, analgesic sedation, prevention of related complications, whole-course psychological counseling and nutritional support. After careful treatment and nursing, the patient recovered well and was transferred out of ICU in 4 days and discharged in 10 days.
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BACKGROUND:Currently,artificial valves used in heart valve operations include biological valves and mechanical valves.The design and processing of the biological valve bracket determine the shape of the biological valves,which in turn determines their service life. OBJECTIVE:Various lobe and bracket models were created based on the spatial geometric equation.Through a comparison of the deformation and stress distribution of various lobe and bracket models,a more rational bracket model was derived.Subsequently,3D printing technology was utilized to produce a solid model. METHODS:According to the geometric and mathematical models of the heart valve leaf and valve bracket,parabolic and ellipsoidal heart valve bracket models were created.Three-dimensional modeling was used to design the heart valve bracket.Two-way fluid-structure coupling analysis was conducted to analyze the force and deformation of the valve bracket in the blood flow field.An appropriate printing method and materials were selected to achieve 3D printing of the heart valve bracket. RESULTS AND CONCLUSION:The distribution rules of deformation,maximum principal stress,and maximum shear stress of the parabolic bracket and ellipsoidal bracket are the same.The deformation and stress of the ellipsoidal bracket were greater than those of the parabolic bracket.The distribution law of maximum principal stress and maximum shear stress was mainly concentrated in the joint part of the lobe and bracket.The total deformation,maximum principal stress,and maximum shear stress of the bracket decrease with the increase of the bracket diameter.
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Objective To establish a method for testing isolated mitral valve in vitro and quantitatively evaluate the effect of transcatheter edge-to-edge repair technology(TEER)on functional mitral regurgitation(FMR)(non-A2-P2 regurgitation).Methods In this study,an FMR(non-A2-P2 regurgitation)model was developed by dilating the annulus orifice and displacing the papillary muscle in isolated porcine mitral valve.The hydrodynamics characteristics of 6 valves were tested by a pulsatile flow testing system under different physiological and pathological conditions before and after TEER.Results The results show that the valve regurgitation improved from moderate-severe[regurgitant fraction(60.2±17.5)％]to mild-moderate[regurgitant fraction(34.7±12.0)％]by repair(P＜0.001).The EOA[(3.8±1.6)cm2 vs.(2.2±0.5)cm2,P＜0.001]and the forward cross valve pressure difference[(1.8±1.3)mmHg vs.(3.8± 1.8)mmHg,P＜0.001],which characterize the forward flow performance of the valve,were compared before and after repair,and the differences were statistically significant.At the same time,the repair caused valve stenosis(the effective orifice area decreased by 40％and the positive differential pressure increased by 110％),but the valves was still within the normal physiological range,and no iatrogenic stenosis was caused.Conclusions It can be seen that TEER has an effect on FMR.This study provides validation and evaluation methods in vitro for expanding indications and improving TEER,and reference for developing standards of transcatheter valve repair testing in vitro.
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【Objective】 To retrospectively analyze the indexes of autologous blood transfusion during heart valve replacement, in order to provide reference for allogeneic blood transfusion during heart valve replacement surgery under direct vision. 【Methods】 The data of 180 patients who underwent heart valve replacement in our hospital from January 2020 to December 2021 were analyzed retrospectively. The patients were divided into allogeneic and non-allogeneic blood transfusion group based on whether allogeneic blood was transfused during the operation, and the general data and 24 hours pre- and post-operative clinical examination indexes were compared. 【Results】 Multivariate logistic regression analysis showed that age (OR=1.110, 95% CI: 1.058-1.165, P<0.05) and intraoperative cardiopulmonary bypass time (OR=1.062, 95% CI: 1.038-1.086, P<0.05) were risk factors for allogeneic blood transfusion, and preoperative Hb content (OR=0.910, 95%CI: 0.868-0.953, P<0.05) was a protective factor. The RBC count(4.16±0.73 vs 4.52±0.71)×1012/L and Hb(120.94±17.97 vs 136.57±19.33) g/L at 24 hours preoperative in the allogeneic transfusion group were lower than those in the non-allogeneic transfusion group, and the RBC(3.51±0.53 vs 4.13±0.78)×1012/L, Hb(114.15±11.68 vs 124.79±14.96)g/L and platelet count(124.28±32.11 vs 148.29±26.62)×109/L at 24 hours postoperative were significantly lower than those in the non-allogeneic transfusion group (P<0.05). 【Conclusion】 Age and intraoperative cardiopulmonary bypass time are the risk factors for autologous and allogeneic blood transfusion during heart valve replacement under direct vision, and the preoperative Hb content is a protective factor. It is necessary to evaluate the symptomatic treatment of patients before operation and reduce allogeneic blood transfusion.
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In recent years,cardiovascular MRI(CMRI)technology has made significant advances,and multimodal CMRI imaging has been useful to display anatomical structure of the valves,to assess the severity of valvular disease,and to quantify the volume of cardiac chambers and myocardial fibrosis,as well as led to progress in judging mitral stenosis,mitral valve closure insufficiency,and risk stratification.Hence they have been widely used in the assessment of mitral valve lesions.The research progresses of CMRI for assessing mitral valve lesions were reviewed in this article.
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@#The pulsatile flow experiment can not only evaluate the preclinical safety and risk of prosthetic heart valve (PHV) but also play an important role in the computational model and fluid simulation, providing an experimental basis for the performance optimization of PHV. This paper mainly reviews the development and the latest progress of PHV pulsatile flow experiments and the characteristics of experimental pulse duplicator, and discuss the research direction of pulsatile flow experiments, expecting a further development in this field.
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@#Objective To investigate and evaluate the safety and effectiveness of the Chimney technique in mitral valve reoperation. Methods The clinical data of mitral valve reoperation patients who underwent Chimney surgery in Wuhan Asia Heart Hospital from 2019 to 2021 were retrospectively analyzed. Results A total of 26 patients were collected, including 7 males and 19 females, aged 27-67 (53.46±11.18) years. All patients had previous mitral valve surgery, including 23 mitral valve replacements and 3 mitral valve repairs. All patients received Chimney technique using the ideal artificial sized mitral valve, and 1 patient died of neurological complications in hospital. The cardiopulmonary bypass time and the aortic cross-clamping time were 231.11±77.05 min and 148.50±52.70 min, respectively. The mean diameter of the implanted mitral valve prosthesis was 29.08±0.68 mm, which was statistically different from pre-replacement valve prosthesis size of 26.69±0.77 mm (P＜0.001). The mean transvalvular pressure gradient of the prosthetic mitral valve measured on postoperative echocardiography was 14.77±5.34 mm Hg, which was statistically different from preoperative value of 20.92±9.83 mm Hg (P=0.005). Conclusion The Chimney technique is safe and effective for reoperation in patients with small mitral annuli, which can not only reduce the risk of reoperation, but also obtain larger prosthetic valve implants with good hemodynamic characteristics and clinical outcomes.
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ABSTRACT Introduction: Atrial fibrillation is one of the common complications of mitral valve disease. Currently, in the absence of freezing equipment, it's still impossible to fully conduct a minimally invasive Cox-maze IV procedure to treat atrial fibrillation. Methods: We analyzed the clinical data of 28 patients who underwent thoracoscopic minimally invasive mitral valve full maze surgery in our hospital from October 2021 to September 2022; 13 patients were male and 15 were female, three suffered from paroxysmal atrial fibrillation, and 25 suffered from permanent atrial fibrillation; average age was 61.88±8.30 years, and mean preoperative left atrial diameter was 47.12±8.34 mm. Isolation of left atrial posterior wall (box lesion) was completed in all patients by cut-and-sew technique and bipolar clamp ablation. Results: For these subjects, the median cardiopulmonary bypass time was 169 (109.75-202.75) minutes, aortic cross-clamping time was 106 (77.75-125.50) minutes, and ventilator assistance time was 6.5 (0-10) hours. Among them, eight subjects had the endotracheal tubes removed immediately after surgical operation. Three subjects were in the blanking period; two subjects still had atrial fibrillation at three months after operation, one of whom resumed sinus rhythm after electrical cardioversion therapy; and all the remaining 23 subjects had sinus rhythm. Conclusion: The minimally invasive cut-and-sew technique for electrical isolation of left pulmonary veins can improve sinus conversion rate of patients suffering from both mitral valve disease and atrial fibrillation. In selected subjects, it is safe and has good results in the short-term postoperative period.
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RESUMEN Introducción. La endocarditis infecciosa (EI) es una enfermedad potencialmente mortal que puede requerir tratamiento quirúrgico. A pesar de ser fundamentales en la toma de decisiones, los puntajes de riesgo quirúrgico no fueron generados específicamente para estratificar el riesgo de esta enfermedad. Objetivos. Evaluar la capacidad predictiva de los puntajes de riesgo quirúrgico ajustados a la EI. Material y métodos. Estudio unicéntrico observacional y retrospectivo de 270 pacientes mayores de 18 años que cursaron internación por EI en actividad desde 06/2008 hasta 02/2023, de los cuales 70 (26 %) fueron sometidos a cirugía cardíaca central. Se excluyeron las endocarditis asociadas a dispositivos, y los pacientes que no se sometieron a cirugía cardíaca. Los puntajes de riesgo quirúrgico analizados fueron: EuroSCORE II, EURO-IE, STS-IE y PALSUSE (Prótesis, Edad >70, (Large) gran destrucción, Staphylococcus, Urgencia, Sexo femenino, EuroSCORE >10). La capacidad predictiva de cada puntaje se evaluó por medio del estadístico C, calculando el área bajo la curva de la relación sensibilidad/1-especificidad, con sus respectivos intervalos de confianza (IC) 95%, y su significación estadística. Resultados. La mediana (rango intercuartílico, RIC) de edad fue de 60 años (48-67) y la de los días de internación fue de 23 (17-39). Cuarenta y un pacientes (58,57 %) tenían una válvula protésica. Respecto a los gérmenes causales, el Staphylococcus fue responsable del 30 % de las infecciones. Las principales indicaciones de tratamiento quirúrgico fueron la insuficiencia cardíaca (44 %), el absceso (19%) y la disfunción protésica (12 %). Se objetivó absceso anular en el 28,57 % de los pacientes. La necesidad de cirugía de urgencia fue del 45,71 % y de emergencia del 7,14 %. La mortalidad hospitalaria fue del 21,42 %. La capacidad predictiva de todos los puntajes fue estadísticamente significativa, excepto el STS- IE . El STS-IE presentó un área bajo la curva (ABC) de 0,586 (IC 95% 0,429-0,743). El EuroSCORE II, un ABC de 0,685 (IC 95 % 0,541-0,830); el EURO-IE presentó un ABC de 0,695 (IC 95 % 0,556-0,834) y el PALSUSE un ABC de 0,819 (IC 95% 0,697-0,941). Conclusión. Los resultados de este estudio sugieren que el score PALSUSE fue mejor predictor de riesgo quirúrgico en pacientes con EI activa, en comparación con los puntajes Euroscore II, EURO-IE y STS-IE.
ABSTRACT Background. Infective endocarditis (IE) is a life-threatening disease that may require surgical treatment. Despite being fundamental in decision making, surgical scores were not generated specifically to stratify the risk of this disease. Objectives. The objective of this study was to: To evaluate the predictive capacity of surgical risk scores adjusted for IE. Methods. Single-center observational and retrospective study of 270 patients > 18 years, hospitalized for active IE from 06/2008 to 02/2023, of which 70 (26 %) underwent central cardiac surgery. Device-associated endocarditis and patients who did not undergo cardiac surgery were excluded. The surgical risk scores analyzed were: EuroSCORE II, EURO-IE, STS-IE and PALSUSE (Prosthesis, Age >70, large cardiac destruction, Staphylococcus, Urgency, Female gender, EuroScore >10). The predictive capacity of each score was evaluated using the C statistic, calculating the area under the curve of the sensitivity/1- specificity relationship with their respective 95 % confidence intervals (CI), and statistical significance. Results. The median age (interquartile range, IQR) was 60 years (48-67) and the number of days of hospitalization were 23 (17-39). Forty-one patients (58.57 %) had a prosthetic valve. Regarding the causative germs, Staphylococcus was responsible for 30 % of the infections. The main indications for surgical treatment were heart failure (44%), abscess (19 %) and prosthetic dysfunction (12%). Annular abscess was observed in 28.57 % of patients. Urgent surgery was performed in 45.71 % and emergency surgery was performed in 7.14 %. Hospital mortality was 21.42 %. The predictive capacity of all scores was statistically significant, except for the STS-IE. The STS-IE score presented an area under the curve (AUC) of 0.586 (95 % CI 0.429-0.743). The EuroSCORE II, an AUC of 0.685 (95 % CI 0.541-0.830); the EURO-IE presented an AUC of 0.695 (95 % CI 0.556-0.834) and the PALSUSE an AUC of 0.819 (95 % CI 0.697-0.941). Conclusion. The results of this study suggest that the PALSUSE score was a better predictor of surgical risk in patients with active IE, compared to the Euroscore II, EURO-IE and STS-IE scores.
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Resumen Antecedentes: El reemplazo valvular por prótesis mecánicas o biológicas implica riesgo de tromboembolismo y complicaciones hemorrágicas. Objetivo: Determinar las complicaciones relacionadas con la terapia de anticoagulación complementaria y la probabilidad de riesgo en pacientes portadores de prótesis valvulares del corazón. Métodos: Se estudiaron 163 pacientes entre 2002 y 2016, portadores de prótesis mecánicas y biológicas, quienes recibieron antagonistas de la vitamina K posterior al egreso hospitalario. La terapia de anticoagulación se categorizó en óptima y no óptima conforme a los valores de INR previos a las complicaciones. Fueron excluidos los pacientes con comorbilidades y otros factores de riesgo de trombosis y/o sangrado. Resultados: a 68.7 % de los pacientes se les colocó prótesis mecánica y a 31.3 %, biológica (p ≤ 0.001); 25.2 % presentó las complicaciones motivo de estudio (p ≤ 0.001), hemorrágicas en 48.8 %, tromboembólicas en 26.8 % y de ambos tipos en 24.4 % (riesgo relativo = 4.229); a 95.1 % de los pacientes con complicaciones se les colocó prótesis mecánica y a 4.9 %, biológica (p = 0.005); 49.7 % presentó INR no óptimo (p ≤ 0.001). Conclusiones: Ante riesgo alto de complicaciones tromboembólicas y hemorrágicas, la elección de las prótesis valvulares, la prevención y el seguimiento son prioridades, principalmente en quienes requieren terapia de anticoagulación.
Abstract Background: Heart valve replacement surgery with mechanical or biological prostheses entails a risk of thromboembolism and bleeding complications. Objective: To determine the complications related to complementary anticoagulation therapy and the probability of risk. Methods: One-hundred and sixty-three patients who underwent heart valve replacement between 2002 and 2016 with either mechanical or biological prostheses, and who received vitamin K antagonists after hospital discharge, were studied. Anticoagulation therapy was categorized into optimal and non-optimal according to INR values prior to the development of complications. Patients with comorbidities and other risk factors for thrombosis and/or bleeding were excluded. Results: In total, 68.7 % of patients received mechanical prostheses, and 31.3 %, biological prostheses (p ≤ 0.001); 25.2 % experienced the complications that motivated the study (p ≤ 0.001), which were hemorrhagic in 48.8 %, thromboembolic in 26.8 %, and of both types in 24.4 % (relative risk = 4.229). Among the patients with complications, 95.1 % received mechanical prostheses, and 4.9 %, biological (p = 0.005); non-optimal INR was identified in 49.7 % (p ≤ 0.001). Conclusions: Given the high risk of thromboembolic and hemorrhagic complications, valve prostheses must be carefully chosen, and care priorities should include prevention and follow-up, especially in those patients who require anticoagulation therapy.
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RESUMEN Introducción : El reemplazo de la raíz aórtica con conservación valvular (valve-sparing aortic root replacement, VSAR) se ha consolidado como un procedimiento eficaz para el tratamiento del aneurisma de la raíz aórtica, el síndrome de Marfan, la válvula bicúspide y la disección aórtica. Sin embargo, es necesario llegar a una opinión unánime sobre los aspectos clave del VSAR. Material y métodos : Se realizó una revisión bibliográfica de los debates y controversias más frecuentes del VSAR. A partir de esta información se elaboró una encuesta en línea que se envió a cirujanos con experiencia comprobada en VSAR para conocer su opinión sobre los factores relacionados con los pacientes, los aspectos técnicos, la ecocardiografía, la investigación, la formación y el futuro del VSAR. Resultados : Veinte cirujanos completaron la encuesta. Según 14 de cada 20 encuestados, la fracción de eyección grave se consideró una contraindicación para el llevar a cabo este procedimiento. El límite del diámetro del anillo aórtico para la remodelación fue heterogéneo entre los participantes. Todos ellos consideraron que el VSAR es un procedimiento seguro para los pacientes con síndrome de Marfan y válvula bicúspide. En el caso de disección de tipo A, 11 de cada 20 prefirieron este procedimiento solo para los pacientes jóvenes. En lo que respecta al tamaño del injerto, la altura del triángulo intervalvar (8/20) y el diámetro sinotubular (7/20) fueron los más frecuentes. Los cirujanos informaron una tasa de fracaso del 7% en la conversión al procedimiento de Bentall, y un cambio de estrategia intraoperatoria del 26%. No se consideró que un abordaje mínimamente invasivo mejorara los resultados. La mayoría de los cirujanos coincidieron en que el VSAR lo deben realizar cirujanos con mucha experiencia. Conclusiones : El VSAR ha sido aceptado como una opción terapéutica para el aneurisma de la raíz aórtica, y, aunque todavía no es posible llegar a un consenso definitivo, se presenta la valiosa experiencia de los cirujanos más destacados en este campo.
ABSTRACT Background : The valve-sparing aortic root replacement (VSAR) has been established as a successful procedure for aortic root aneurysms, Marfan's syndrome, bicuspid valves, and aortic dissections. However, there is a need for a consensus opinion regarding key aspects of VSAR. Methods : A literature review was performed regarding the most frequent debates and controversies in VSAR. An online survey was developed based on this information, and sent to surgeons with known expertise in VSAR regarding their opinion on patient-related factors, technical aspects, echocardiography, research, training, and the future of VSAR. Results : Twenty surgeons completed the survey. The reduction of left ventricular ejection fraction was considered a contra indication to VSAR when severe by 14/20 surveyed. The aortic annulus diameter cutoff point for the remodeling was heterogenous among participants. All of them felt that VSAR is safe for the Marfan´s syndrome population and bicuspid valves. For type A dissections, 11/20 preferred this procedure only in young patients. Regarding to graft sizing, the height of the interleaflet triangle (8/20) and the sino-tubular diameter (7/20) were the more frequent considered parameters. Surgeons reported a 7% of failure rate, leading to conversion to Bentall surgery, and a 26% change of strategy intraoperatively. A minimally invasive approach was not considered to improve results. Most of the surgeons agreed that VSAR should be performed by high-experienced surgeons. Conclusions : The VSAR has been accepted as a treatment option for the aortic root´s aneurysms, and even though there is still not possible to reach a final consensus, a valuable experience from the most relevant surgeons in the field is presented.
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INTRODUCTION: The measurement of the health-related quality of life construct can reveal the positive repercussions on the lives of patients undergoing corrective valve procedures, as well as revealing points that prevent new surgical approaches. OBJECTIVE: To identify the health-related quality of life of valvular heart disease in the perioperative period of conventional valve surgery. METHODS: This is an integrative literature review. Searches were performed independently in four databases using controlled and uncontrolled descriptors. Eligibility criteria were: original articles that addressed the assessment of the health-related quality of life of valvular patients undergoing valve repair and/or valve prosthesis implantation; in Portuguese, English, and Spanish; with a time frame for convenience between 2015 and 2019. RESULTS: 14 studies comprised the final review sample, despite being studies conducted in different countries and with different designs, it was possible to verify the improvement in health-related quality of life when evaluated through generic instruments in valvular patients after valve surgery. However, in studies in which the assessment of the construct occurred through specific instruments, the existence of factors that can interfere with the quality of life of patients undergoing valve implantation was revealed. CONCLUSION: It was noticed that there was generally an improvement in health-related quality of life after the surgical intervention.
INTRODUÇÃO: A mensuração do constructo qualidade de vida relacionada à saúde pode revelar as repercussões positivas na vida dos pacientes submetidos a procedimentos valvares corretivos, bem como revelar pontos que para prevenção de novas abordagens cirúrgica. OBJETIVO: Identificar a qualidade de vida relacionada à saúde de valvopatas no perioperatório de intervenção cirúrgica valvar convencional. MÉTODO: Trata-se de uma revisão integrativa da literatura. As buscas foram realizadas de forma independente, em quatro bases de dados por meio de descritores controlados e não controlados. Os critérios de elegibilidade foram: artigos originais que abordassem a avaliação da qualidade de vida relacionada à saúde de valvopatas submetidos à plastia valvar e/ou implante de prótese valvar; nos idiomas português, inglês e espanhol; com recorte temporal por conveniência entre 2015 e 2019. RESULTADOS: 14 estudos compuseram a amostra final da revisão, apesar de serem estudos realizados em distintos países e com diferentes delineamentos foi possível verificar a melhora da qualidade de vida relacionada à saúde quando avaliada por meio de instrumentos genéricos em valvopatas após a intervenção cirúrgica valvar. Todavia, nos estudos em que a avaliação do constructo ocorreu por meio de instrumentos específicos, foi revelada a existência de fatores que podem interferir na qualidade de vida dos pacientes submetidos aos implantes valvares. CONCLUSÃO: Percebeu-se que geralmente houve melhora da qualidade de vida relacionada à saúde após a intervenção cirúrgica.
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Calidad de Vida , Procedimientos Quirúrgicos Operativos , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas , Periodo Perioperatorio , Enfermedades de las Válvulas CardíacasRESUMEN
ABSTRACT Introduction: There are few circulating biomarkers for valvular heart disease. Angiopoietin (Ang) 1, Ang2, and vascular endothelial growth factor are important inflammation-associated cytokines. The aim of this study was to investigate the clinical significance and association of Ang1, Ang2, and vascular endothelial growth factor in valvular heart disease. Methods: This is a retrospective study; a total of 62 individuals (valvular heart disease patients [n=42] and healthy controls [n=20]) were included. Plasma levels of Ang1, Ang2, and vascular endothelial growth factor were detected by enzyme-linked immunosorbent assays. We retrospectively collected the baseline characteristics and short-term outcomes; logistic regression was performed to identify predictor for short-term mortality. Results: Ang2 was significantly decreased in the valvular heart disease group compared with the healthy control group (P=0.023), while no significant difference was observed in the Ang1 and vascular endothelial growth factor levels. The Ang2 level of New York Heart Association (NYHA) I/II patients — but not NYHA III/IV patients — was significantly decreased compared with that of healthy control individuals (NYHA I/II: P=0.017; NYHA III/IV: P=0.485). Univariable logistic regression analysis indicated that Ang2 was a significant independent predictor for short-term mortality (odds ratio 18.75, P=0.033, 95% confidence interval 8.08-102.33). Ang1 was negatively correlated with Ang2 (P=0.032, Pearson's correlation coefficient =-0.317) and was positively correlated with vascular endothelial growth factor (P=0.019, Pearson's correlation coefficient = 0.359). Conclusion: Ang2 might serve as a therapeutic and prognostic target for valvular heart disease.
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Objective:To investigate the current situation of kinesiophobia in patients after heart valve replacement surgery and to analyze its influencing factors, and to provide reference for the intervention research of patients with cardiophobia after cardiac valve replacement.Methods:Using cross-sectional survey method and convenient sampling method, 109 patients who underwent cardiac valve replacement surgery in department of cardiothoracic and vascular surgery of Guangxi Zhuang Autonomous Region People′s Hospital from March 2021 to January 2022 were selected as the study subjects. The patients were surveyed with the general questionnaire, Tampa Scale of Kinesiophobia and Visual Analogue Scale.Results:After heart valve replacement, the score of Tampa Scale of Kinesiophobia was (46.90 ± 9.30) points. The score of Visual Analogue Scale was (5.83 ± 1.01) points. The score of Tampa Scale of Kinesiophobia was positively correlated with the score of Visual Analogue Scale ( r=0.46, P<0.01). Multiple linear regression analysis showed that patient′s age, cardiac function level, left ventricular ejection fraction, pain were the main influencing factors of Kinesiophobia ( t values were -2.37-4.34, all P<0.05). Conclusions:Medical staff should understand and accurately assess the status of patient′s kinesiophobia after heart valve replacement surgery, identify high-risk groups of kinesiophobia, and take targeted nursing measures to effectively alleviate postoperative pain, thereby reducing the incidence of kinesiophobia in patients, helping patients to carry out early functional exercise, and prorroting physical recovery.