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1.
Sci Rep ; 13(1): 2084, 2023 02 06.
Article in English | MEDLINE | ID: mdl-36747073

ABSTRACT

The aims of this study were to perform pre-surgery miRNA profiling of patients who develop Vasoplegic syndrome (VS) after coronary artery bypass grafting (CABG) and identify those miRNAs that could be used as VS prognostic tools and biomarkers. The levels of 754 microRNAs (miRNAs) were measured in whole blood samples from a cohort of patients collected right before the coronary artery bypass grafting (CABG) surgery. We compared the miRNA levels of those who developed VS (VASO group) with those who did not (NONVASO group) after surgery. Six miRNAs (hsa-miR-548c-3p, -199b-5p, -383-5p -571 -183-3p, -30d-5p) were increased and two (hsa-1236-3p, and hsa-miR770-5p) were decreased in blood of VASO compared to NONVASO groups. Receiver Operating Characteristic (ROC) curve analysis revealed that a combination of the miRNAs, hsa-miR-30d-5p and hsa-miR-770-5p can be used as VS predictors (AUC = 0.9615, p < 0.0001). The computational and functional analyses were performed to gain insights into the potential role of these dysregulated miRNAs in VS and have identified the "Apelin Liver Signaling Pathway" as the canonical pathway containing the most target genes regulated by these miRNAs. The expression of the combined miRNAs hsa-miR-30d and hsa-miR-770-5p allowed the ability to distinguish between patients who could and could not develop VS, representing a potential predictive biomarker of VS.


Subject(s)
MicroRNAs , Vasoplegia , Humans , Vasoplegia/genetics , MicroRNAs/metabolism , Biomarkers , Prognosis , Signal Transduction , Gene Expression Profiling
2.
Article in English | MEDLINE | ID: mdl-36314438

ABSTRACT

This case report shows how to perform simultaneously an open surgical correction of an aortic root aneurysm and aortic stenosis by interposition of an aortic composite graft and the transdiaphragmatic extra-anatomical correction of an aortic coarctation.


Subject(s)
Aortic Aneurysm, Thoracic , Aortic Coarctation , Blood Vessel Prosthesis Implantation , Humans , Aortic Coarctation/complications , Aortic Coarctation/surgery , Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/surgery , Aortic Aneurysm, Thoracic/complications , Aorta/surgery
3.
Diagn. tratamento ; 27(1): 1-3, jan-mar. 2022. *Este editorial foi publicado em inglês na revista São Paulo Medical Journal, volume 140, edição número 2, de março e abril de 2022 (https://doi.org/10.1590/1516-3180.2022.140225112021)
Article in Portuguese | LILACS | ID: biblio-1359742

Subject(s)
Telemedicine
4.
Article in English | MEDLINE | ID: mdl-34662003

ABSTRACT

Traumatic aortic injury is potentially fatal. Although uncommon, involvement of the aortic arch and the ascending aorta can occur. This case shows concomitant dissection of the ascending and descending sections of the aorta after blunt chest trauma where the open surgical approach was successfully performed to treat both aortic injuries.


Subject(s)
Aortic Aneurysm, Thoracic , Aortic Diseases , Blood Vessel Prosthesis Implantation , Thoracic Injuries , Wounds, Nonpenetrating , Aorta/surgery , Aorta, Thoracic/surgery , Aortic Aneurysm, Thoracic/surgery , Humans , Thoracic Injuries/surgery , Wounds, Nonpenetrating/surgery
5.
Interact Cardiovasc Thorac Surg ; 30(2): 229-235, 2020 02 01.
Article in English | MEDLINE | ID: mdl-31713609

ABSTRACT

OBJECTIVES: Our goal was to analyse the initial results of the first 50 transapical transcatheter mitral valve-in-valve procedures performed in a single Latin American centre. METHODS: A prospective, single centre, database analysis was conducted to evaluate immediate, 30-day and 1-year postoperative results of 50 consecutive patients who had a transcatheter mitral valve-in-valve procedure from May 2015 to June 2018. All patients were operated on in a hybrid operating room and received a balloon-expandable valve via the transapical approach. Preoperative and postoperative characteristics were analysed and compared between the first 25 and the second 25 patients to evaluate the impact of the learning curve. Twenty patients had a follow-up examination at 1 year. RESULTS: There was a 98% device success rate. The patients had a mean age of 64.8 years; 72% were women; 80% were in New York Heart Association functional class ≥III preoperatively; and 36% of the procedures were urgent. The mean Society of Thoracic Surgeons scores and EuroSCORE II were 8.3% and 12.4%, respectively. Patients had a median of 2 previous operations; valve durability was 12.1 years; and 64% mitral valve disease of rheumatic fever aetiology. Echocardiography showed decreases in the maximum and mean mitral gradients from 23.5 to 14.6 and 11.5 to 6.4 mmHg postoperatively; the overall mean hospitalization period was 15 days. The overall mortality rate at 30 days was 14%, with 1 intraprocedural death. Further subanalyses between the first and the second half of the cases showed a drop in the mortality rate from 20% to 8% (P < 0.01). CONCLUSION: The transcatheter mitral valve-in-valve procedure was shown to be a safe and effective procedure to treat bioprosthetic dysfunction, with potential benefits in patients with rheumatic disease.


Subject(s)
Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation/methods , Heart Valve Prosthesis , Mitral Valve/surgery , Echocardiography , Female , Heart Valve Diseases/diagnosis , Humans , Latin America , Male , Middle Aged , Mitral Valve/diagnostic imaging , Prospective Studies , Prosthesis Design , Time Factors , Treatment Outcome
6.
J Heart Valve Dis ; 24(6): 780-784, 2015 Nov.
Article in English | MEDLINE | ID: mdl-27997787

ABSTRACT

BACKGROUND: The study aim was to review the authors' experience with the surgical thrombectomy of mechanical valve thrombosis at the Heart Institute of the Medical School of São Paulo University, Brazil. METHODS: Between January 1993 and March 2014, a total of 21 patients (16 females, five males; mean age 48.2 years) with mechanical valve thrombosis was treated surgically. Of these patients, 70% were in NYHA class IV, including two in cardiogenic shock; 71% of the patients had inadequate anticoagulation levels. The median period between the initial valve replacement and valve thrombosis was 105 months. Thrombosis occurred in the mitral position in 12 patients (57%) and in the aortic position in nine (43%). Clinical and surgical data were collected from hospital records. RESULTS: The major surgical finding was thrombus (57.1%), and pannus formation was found in 42.9% of patients. The mean cardiopulmonary bypass time was 90 min, and aortic cross-clamp time 63 min. Operative complications occurred in three patients (14%): two patients required revisions for bleeding and one patient needed ventricular assistance and hemodialysis. The operative mortality rate was 19% (n = 4). Two of these deaths occurred in patients who had been transferred to the operating room with cardiopulmonary resuscitation, one death was due to prolonged mechanical ventilator support and sepsis, and one was due to cardiac tamponade. The 11-year actuarial survival rate was 69.3 ± 12.9%, and the actuarial rate freedom from reintervention was 85.7 ± 13.2% during an 11-year follow up period. CONCLUSIONS: Early surgical intervention is a safe and effective treatment in patients with mechanical valve thrombosis.

7.
Eur J Cardiothorac Surg ; 36(2): 383-91; discussion 391-2, 2009 Aug.
Article in English | MEDLINE | ID: mdl-19324571

ABSTRACT

OBJECTIVE: Fast-track rehabilitation is a group of simple measures that reduces morbidity, postoperative complication and accelerates postoperative rehabilitation reducing hospital stay. It can be applied to lung cancer lobectomy. Fast-track rehabilitation cornerstones are: minimally invasive surgical techniques using video-assisted and muscle sparring incisions, normovolemia, normothermia, good oxygenation, euglicemia, no unnecessary antibiotics, epidural patient-controlled analgesia, systemic opiods-free analgesia, early ambulation and oral feeding. Our objective is to describe a five-year experience with fast-track rehabilitation for lung cancer lobectomy. PATIENTS AND METHODS: A retrospective non-controlled study including 109 consecutive patients submitted to fast-track rehabilitation in the postoperative care of lung cancer lobectomy was performed. Only collaborative patients who could receive double-lumen intubation, epidural catheters with patient-controlled analgesia, who had Karnofsky index of 100, previous normal feeding and ambulation, absence of morbid obesity, diabetes or asthma, were eligible. Postoperative oral feeding and aggressive ambulation started as soon as possible. RESULTS: Immediate postoperative extubation even in the operation room was possible in 107 patients and oral feeding and ambulation were possible before the first hour in 101 patients. Six patients could not receive early oral feeding or ambulate due to hypnosis secondary to preoperative long effect benzodiazepines. Two patients could not ambulate immediately due to epidural catheter misplacement with important postoperative pain. Ninety-nine discharges occurred at the second postoperative day, four of them with a chest tube connected to a Heimlich valve due to air leak. No complication of early feeding and ambulation was observed. Postoperative hypnosis due to long duration benzodiazepines or pain does not allow early oral feeding or ambulation. Avoiding long duration preoperative benzodiazepines, immediate postoperative extubation, regional thoracic PCA and early oral feeding and ambulation were related to a lesser frequency of complication and a shorter hospital stay. CONCLUSION: Fast-track rehabilitation for lung cancer lobectomies can be safely performed in a selected group of patients if a motivated multidisciplinary group of professionals is available and seems to reduce postoperative complication and hospital stay.


Subject(s)
Lung Neoplasms/surgery , Pneumonectomy/rehabilitation , Aged , Aged, 80 and over , Analgesia, Epidural , Conscious Sedation , Early Ambulation , Enteral Nutrition/methods , Female , Humans , Length of Stay/statistics & numerical data , Lung Neoplasms/rehabilitation , Male , Middle Aged , Minimally Invasive Surgical Procedures/adverse effects , Minimally Invasive Surgical Procedures/methods , Minimally Invasive Surgical Procedures/rehabilitation , Pain, Postoperative/prevention & control , Perioperative Care/methods , Pneumonectomy/adverse effects , Pneumonectomy/methods , Postoperative Nausea and Vomiting/prevention & control , Postoperative Period , Retrospective Studies , Thoracic Surgery, Video-Assisted/rehabilitation
8.
J Laparoendosc Adv Surg Tech A ; 16(6): 598-603, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17243877

ABSTRACT

BACKGROUND: Different techniques of video-assisted thoracic sympathectomy have been suggested to control the symptoms of axillary hyperhidrosis. We compared the results using two different levels of ganglion resection for treating axillary hyperhidrosis: T3/T4 vs. T4. MATERIALS AND METHODS: From a group of 1119 patients operated on between July 2000 and January 2005, 276 patients with axillary hyperhidrosis were studied. The mean age was 26 (range, 13-54 years) and 61.6% were female. Of these patients, 216 (78.3%) were treated with thermal ablation of T3/T4 and 60 (21.7%) with thermal ablation of T4 alone. The procedures were bilateral and simultaneous, using two 5.5-mm trocars and 30-degree optical systems, under general anesthesia in all cases. RESULTS: There was no mortality and no important postoperative complications or need to convert to thoracotomy in either group. The mean follow-up in the T4 group was 11 months (range, 2-23 months) and in the T3/T4 group mean follow-up was 24 months (range, 13-54 months). The immediate therapeutic success rate was 100% in both groups. There were recurrences in 7 (2.5%) patients, all from the T3/T4 group. The satisfaction rate was higher and more stable in the T4 group and compensatory sweating was lower in the T4 group. CONCLUSION: Both techniques proved effective for controlling the axillary symptoms. Group T4 presented a higher satisfaction rate, lower recurrence rate, and lower severity of compensatory sweating.


Subject(s)
Hyperhidrosis/surgery , Sympathectomy/methods , Thoracic Nerves/surgery , Thoracic Surgery, Video-Assisted , Adolescent , Adult , Axilla , Female , Follow-Up Studies , Humans , Male , Middle Aged , Patient Satisfaction , Retrospective Studies , Treatment Outcome
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