Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 6 de 6
Filtrar
1.
Future Cardiol ; : 1-9, 2024 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-38985451

RESUMO

Mitral valve repair is the ideal intervention for mitral valve disease with excellent long-term survival comparable to the age-matched general population. When the mitral valve is not repairable, mechanical prostheses may be associated with improved survival as compared with biological prostheses. Newer mechanical and biological valve prostheses have the potential to improve outcomes following mitral valve replacement in young patients. Patients presenting for mitral valve surgery after failed transcatheter mitral valve-in-valve have high rates of postoperative mortality and morbidity, exceeding those seen with reoperative mitral valve surgery, which poses issues in young patients who have a higher cumulative incidence of reintervention.


Patients presenting with mitral valve disease, the most common type of heart valve disease, have a survival advantage when they undergo mitral valve repair as opposed to replacement, and this is particularly true for young patients. When the mitral valve is not repairable, mechanical prostheses (prosthetic implants) may be associated with improved survival as compared with biological prostheses, and this difference is mostly observed until the age of 70 years. Newer techniques of treating mitral valve disease without requiring open heart surgery have not yet been shown to be superior or even equivalent to traditional open heart surgery in the general population. Patients presenting for mitral valve surgery after failure of these newer techniques have high rates of death, exceeding those seen with mitral valve reoperation, which has important implications for young patients with mitral valve disease.

2.
Asian Cardiovasc Thorac Ann ; 31(2): 102-114, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36571785

RESUMO

BACKGROUND: The optimal nadir temperature for hypothermic circulatory arrest during aortic arch surgery remains unclear. We aimed to assess and compare clinical outcomes of all three temperature strategies (deep, moderate, and mild hypothermia) using a network meta-analysis. METHODS: After literature search with MEDLINE and EMBASE through December 2021, studies comparing clinical outcomes with deep (<20°C), moderate (20-28°C), or mild (>28°C) hypothermic circulatory arrest were included. The outcomes of interest were perioperative mortality, stroke, transient ischemia attack (TIA), acute kidney injury (AKI), postoperative bleeding, operative time, and length of hospital stay. RESULTS: Twenty-four comparative studies were identified, including 6018 patients undergoing aortic arch surgery using hypothermic circulatory arrest (deep: 2,978, moderate: 2,525, and mild: 515). Compared to deep hypothermia, mild and moderate hypothermia were associated with lower mortality (mild vs. deep: odds ratio [OR] 0.50; 95% confidence interval (CI) 0.29-0.87, moderate vs. deep: OR 0.68; 95% CI 0.54-0.86). In addition, mild hypothermia was associated with lower stroke (OR 0.50; 95% CI 0.28-0.89), AKI (OR 0.36; 95% CI 0.15-0.88) and postoperative bleeding (OR 0.55; 95% CI 0.31-0.97) compared to deep hypothermia. There was no significant difference between mild and moderate hypothermia in mortality, AKI or bleeding occurrence, while mild hypothermia was associated with shorter operative time and hospital stay. There was no significant difference in TIA rate among three groups. CONCLUSIONS: Mild hypothermia was associated with overall more favorable clinical outcomes with comparable neurological complications compared to deep hypothermia. Furthermore, considering the shorter operative time and hospital stay compared with moderate hypothermia, mild hypothermia may be warranted when appropriate adjunctive cerebral perfusion is employed.


Assuntos
Injúria Renal Aguda , Hipotermia Induzida , Hipotermia , Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Humanos , Aorta Torácica/cirurgia , Temperatura , Metanálise em Rede , Hipotermia/complicações , Ataque Isquêmico Transitório/complicações , Parada Circulatória Induzida por Hipotermia Profunda/efeitos adversos , Acidente Vascular Cerebral/complicações , Perfusão/efeitos adversos , Injúria Renal Aguda/diagnóstico , Injúria Renal Aguda/etiologia , Injúria Renal Aguda/terapia , Circulação Cerebrovascular , Estudos Retrospectivos , Hipotermia Induzida/efeitos adversos , Resultado do Tratamento
3.
BMJ Open ; 7(6): e014491, 2017 06 10.
Artigo em Inglês | MEDLINE | ID: mdl-28601820

RESUMO

INTRODUCTION: Neurological injury remains the major cause of morbidity and mortality following open aortic arch repair. Systemic hypothermia along with antegrade cerebral perfusion (ACP) is the accepted cerebral protection approach, with axillary artery cannulation being the most common technique used to establish ACP. More recently, innominate artery cannulation has been shown to be a safe and efficacious method for establishing ACP. Inasmuch as there is a lack of high-quality data comparing axillary and innominate artery ACP, we have designed a randomised, multi-centre clinical trial to compare both cerebral perfusion strategies with regards to brain morphological injury using diffusion-weighted MRI (DW-MRI). METHODS AND ANALYSIS: 110 patients undergoing elective aortic surgery with repair of the proximal arch requiring an open distal anastamosis will be randomised to either the innominate artery or the axillary artery cannulation strategy for establishing unilateral ACP during systemic circulatory arrest with moderate levels of hypothermia. The primary safety endpoint of this trial is the proportion of patients with new radiologically significant ischaemic lesions found on postoperative DW-MRI compared with preoperative DW-MRI. The primary efficacy endpoint of this trial is the difference in total operative time between the innominate artery and the axillary artery cannulation group. ETHICS AND DISSEMINATION: The study protocol and consent forms have been approved by the participating local research ethics boards. Publication of the study results is anticipated in 2018 or 2019. If this study shows that the innominate artery cannulation technique is non-inferior to the axillary artery cannulation technique with regards to brain morphological injury, it will establish the innominate artery cannulation technique as a safe and potentially more efficient method of antegrade cerebral perfusion in aortic surgery. TRIAL REGISTRATION NUMBER: NCT02554032.


Assuntos
Aorta Torácica/cirurgia , Cateterismo Periférico/métodos , Circulação Cerebrovascular , Parada Circulatória Induzida por Hipotermia Profunda/métodos , Perfusão/métodos , Idoso , Artéria Axilar , Tronco Braquiocefálico , Isquemia Encefálica/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia
4.
Expert Rev Cardiovasc Ther ; 12(4): 407-11, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24506325

RESUMO

Paravalvular leak is a common complication occurring after transcatheter aortic valve implantation and is associated with at least a 2-fold increase in 30-day and 1-year mortality risk. In high-risk, inoperable patients with severe aortic stenosis, paravalvular leak may even negate the survival benefit of transcatheter aortic valve implantation. This editorial reviews the anatomy, pathophysiology and predictors of paravalvular leak and discusses preventative and therapeutic strategies to optimally treat this previously underappreciated complication.


Assuntos
Valva Aórtica/cirurgia , Cateterismo Cardíaco/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Estenose da Valva Aórtica/cirurgia , Humanos , Fatores de Risco , Resultado do Tratamento
5.
Can J Plast Surg ; 20(1): e16-8, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23598769

RESUMO

BACKGROUND: Microsurgical breast reconstruction is a popular choice in breast reconstruction. Recipient vessel use for these autologous tissue reconstructions has shifted from the thoracodorsal to the internal mammary vessels. Coronary artery bypass (CAB) surgery remains the optimal revascularization strategy in patients with significant, diffuse coronary artery disease. The conduits of choice for coronary revascularization are the internal mammary arteries (IMA) because of their superior long-term graft patency rate and improved patient survival. OBJECTIVE: To review the cardiac risk factors in the breast reconstruction population, and to report the incidence of postoperative cardiac events at the London Health Sciences Centre, London, Ontario. The authors present the index cases illustrating cardiac complications following the use of internal mammary vessels. METHOD: A retrospective, single-centre, cumulative audit of breast reconstruction practice from 2005 to 2009 was conducted. A total of 81 patients undergoing autologous breast reconstruction were reviewed. Two women were noted to have experienced postoperative myocardial infarction requiring intervention. Both were noted to have triple-vessel disease, an indication for CAB; however, during the breast reconstruction, their IMAs had been utilized. As a result, both women subsequently underwent triple-vesssel percutaneous intervention, with one woman later requiring CAB without IMA because of recurrent ischemia. CONCLUSION: While there is limited overlap with the breast reconstruction and cardiac disease population, there can be significant cardiac health implications in the postoperative status (both short and long term) of women undergoing autologous breast reconstruction using the IMAs as recipient vessels.


HISTORIQUE: La reconstruction mammaire microchirurgicale est un choix populaire. Le recours à des vaisseaux receveurs dans le cadre de ces reconstructions par tissus autologues est passé des vaisseaux thoracodorsaux aux vaisseaux mammaires internes. Le pontage aortocoronarien (PAC) demeure la stratégie de revascularisation optimale chez les patients ayant une coronaropathie diffuse. Les artères mammaires internes (AMI) représentent des conduits de choix pour la revascularisation coronarienne en raison du taux de perméabilité supérieur de la greffe à long terme et du meilleur taux de survie des patients. OBJECTIF: Analyser les facteurs de risque cardiaque des personnes subissant une reconstruction mammaire et signaler l'incidence d'événements cardiaques postopératoires survenus au London Health Sciences Centre de London, en Ontario. Les auteurs présentent les cas de référence démontrant des complications cardiaques après l'utilisation des vaisseaux mammaires internes. MÉTHODOLOGIE: Les chercheurs ont procédé à une vérification cumulative monocentriquerétrospective des pratiques de reconstruction mammaire entre 2005 et 2009. Au total, ils ont analysé 81 patients ayant subi une reconstruction mammaire par tissus autologues. Ils ont constaté que deux femmes avaient subi un infarctus du myocarde après l'opération, lequel avait nécessité une intervention. Toutes deux avaient unetriple vasculopathie, ce qui constitue une indication de PAC, mais pendant la reconstruction mammaire, on avait utilisé leurs AMI. Par conséquent, les deux femmes ont ensuite subi une triple intervention percutanée, et l'une d'elles a ensuite dû subir un PAC sans AMI en raison d'une ischémie récurrente. CONCLUSION: Le chevauchement entre la population de personnes qui subissent une reconstruction mammaire et celle qui est atteinte d'une maladie cardiaque est limité. Toutefois, les femmes qui subissent une reconstruction mammaire par tissus autologues chez qui les AMI servent de vaisseaux receveurs peuvent voir leur état postopératoire (à court et à long terme) entaché par d'importants effets cardiaques.

6.
Can J Cardiol ; 26(8): 326-7, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20931103

RESUMO

Anomalous coronary arteries that course between the aorta and pulmonary artery are subject to compressive forces and can manifest angina, myocardial infarction and sudden death. The current report presents a young, female patient who presented with a short duration of severe, rapidly progressive angina despite optimal medical therapy. Combined computed tomography and myocardial perfusion scanning identified an anomalous dominant right coronary artery that appeared kinked at its origin between the aorta and main pulmonary artery. A robot-assisted right internal thoracic artery to right coronary artery bypass was performed, which was confirmed to be widely patent (FitzGibbon grade A) on routine intraoperative angiography. The procedure completely resolved the patient's angina symptoms.


Assuntos
Ponte de Artéria Coronária/métodos , Estenose Coronária/cirurgia , Anomalias dos Vasos Coronários/complicações , Robótica/métodos , Adulto , Angiografia Coronária , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/etiologia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Feminino , Seguimentos , Humanos , Tomografia Computadorizada por Raios X
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...