ABSTRACT
We present a case report of fatal respiratory failure after cardiac surgery in the early stages of the coronavirus disease 2019 outbreak. Although not supported by epidemiological data nor clinical course, coronavirus disease 2019 infection was revealed post-mortem by immunohistochemical detection of the severe acute respiratory syndrome coronavirus 2 spike protein in lung tissue.
Subject(s)
Aortic Valve Stenosis/surgery , COVID-19/epidemiology , Heart Valve Prosthesis Implantation/adverse effects , SARS-CoV-2 , Aged , Aortic Valve Stenosis/epidemiology , Comorbidity , Fatal Outcome , Female , HumansABSTRACT
After the popularization of transcatheter aortic valve-in-valve replacement, mitral valve-in-valve is being increasingly performed for failing bioprostheses or annuloplasty rings. In the tricuspid position, despite smaller experience, valve-in-valve is also becoming an alternative to high-risk redo tricuspid surgery. We report the case of a patient with 2 failing mitral and tricuspid bioprostheses who was successfully treated with simultaneous transapical mitral and percutaneous transjugular tricuspid transcatheter valve-in-valve replacements.
Subject(s)
Bioprosthesis , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation/methods , Heart Valve Prosthesis , Mitral Valve/surgery , Tricuspid Valve/surgery , Aged , Female , Heart Valve Diseases/diagnostic imaging , Heart Valve Diseases/etiology , Humans , Prosthesis Failure , ReoperationABSTRACT
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Subject(s)
Humans , Male , Adult , Vascular Fistula/surgery , Arteriovenous Fistula/surgery , Truncus Arteriosus/surgery , Venae Cavae/pathology , Venae Cavae/surgery , Heart Failure/complications , Heart Failure/surgery , Arteriovenous Fistula , Venae Cavae , Heart Failure/congenitalABSTRACT
We describe a 38-year-old patient with ankylosing spondylitis complicated by a non-traumatic dissection of the ascending aorta without concomitant Marfan's syndrome.
Subject(s)
Aorta/pathology , Aortic Aneurysm/pathology , Aortic Dissection/pathology , HLA-B27 Antigen/metabolism , Spondylitis, Ankylosing/pathology , Adult , Aortic Dissection/complications , Aortic Dissection/metabolism , Aorta/metabolism , Aorta/surgery , Aortic Aneurysm/complications , Aortic Aneurysm/metabolism , Humans , Male , Spondylitis, Ankylosing/complications , Spondylitis, Ankylosing/metabolism , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
The objective of this study was to investigate the effect of preoperative mild renal dysfunction (RD) not requiring dialysis on mortality and morbidity after valve cardiac surgery (VCS). We studied 681 consecutive patients (2002-2006) who underwent valve cardiac surgery with or without coronary artery bypass graft (CABG). Preoperative RD was calculated with the abbreviated Modification of Diet in Renal Disease formula and was defined as a glomerular filtration rate <60 ml/min/1.73 m(2). Logistic regression analysis was used to assess the effect of preoperative renal dysfunction on operative and adverse outcomes. Two hundred and seven patients (30%) had preoperative mild RD. Patients with preoperative RD were older, had a higher rate of preoperative anaemia (43% vs. 25%, P<0.001) and more comorbidities. Patients with preoperative RD had worse outcomes with more reoperation (6.8% vs. 2.3%, P<0.001). Preoperative RD was significantly and independently associated with more red blood cell transfusions and longer hospital stay (median 9 vs. 8 days, P<0.001). Mortality was similar in both groups (3.4% vs. 2.3%, P=0.43). Preoperative mild renal dysfunction in patients undergoing cardiac valve surgery is an independent marker of postoperative morbidity.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Heart Valve Diseases/mortality , Heart Valve Diseases/surgery , Renal Insufficiency/complications , Renal Insufficiency/mortality , Aged , Anemia/etiology , Anemia/mortality , Erythrocyte Transfusion , Female , Glomerular Filtration Rate , Heart Valve Diseases/complications , Humans , Incidence , Length of Stay , Logistic Models , Male , Middle Aged , Morbidity , Postoperative Complications/etiology , Postoperative Complications/mortality , Prospective Studies , Renal Insufficiency/physiopathology , Reoperation , Risk Assessment , Risk Factors , Severity of Illness Index , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVES: Cerebrovascular accidents (CVA) after CABG are deleterious complications whose prevention remains poorly defined. The aim of this study was to identify the determinants for CVA after CABG. METHODS: Nine thousand nine hundred and sixteen patients underwent CABG at our institution from January 1992 to June 2002. Data were prospectively collected and univariate/multivariate analyses conducted. RESULTS: Two hundred and eight patients (2.1%) suffered perioperative CVA. Univariate analysis showed a higher risk profile in the CVA group including advanced age, depressed percent left ventricular ejection fraction (LVEF), unstable angina, diabetes mellitus (DM), chronic renal failure (CRF), redo surgery, peripheral vascular disease (PVD), previous CVA, and higher Parsonnet score (P<0.001). Furthermore, the CVA group had longer myocardial ischemia (CVA 56.2 +/-40.9 vs. Control 50.4+/-20.9 min, P=0.03) and cardiopulmonary bypass (CPB) times (CVA 87.4+/-30.0 min vs. Control 78.9 +/-25.9 min, P<0.0001), and lower off-pump surgery rate (CVA 1.4% vs. Control 4.7%, P=0.01). Multivariable analysis identified seven preoperative and two perioperative determinants for CVA: LVEF<30% (odds ratio (OR)=2.49), previous CVA (OR=2.15), DM (OR=1.78), redo (OR=1.76), PVD (OR=1.66), CRF (OR=1.55), age (OR=1.03), perioperative intra-aortic balloon pump (OR=1.83), and transfusion rate (OR=1.59). Perioperative mortality was higher in the CVA group (CVA 18.6% vs. Control 2.6%, P<0.0001). CONCLUSIONS: Although occurrence of CVA seems mainly related to preoperative comorbidities, perioperative surgical variables, such as off-pump surgery, myocardial ischemia and cardiopulmonary bypass time, do not seem to independently influence CVA rate after CABG. In this regard CVA prevention should be performed before posing an indication to CABG, and closer evaluation of patients' risk profiles and tailored clinical/surgical strategies for those patients at higher risk for CVA occurrence should be included.
