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1.
Kyobu Geka ; 73(3): 178-182, 2020 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-32393698

RESUMO

The Jehovah's Witnesses (JW) is well known for declining blood transfusions. Especially, cardiovascular surgery on JW poses unique challenges. We herein report 12 JW emergent cases of Stanford type A acute aortic dissection which underwent graft replacement between 2003 and 2019. Graft replacement of ascending aorta was performed in all cases. Operative time and anesthetic time were 344±100 and 396±109 minutes respectively. The mean intraoperative hemoglobin nadir was 4.9±1.2 g/dl. The postoperative hemoglobin nadir was 6.3 ±2.4 g/dl. There were 2 deaths within 24 hours after surgery. We did not transfuse any packed red blood cells, fresh frozen plasma or platelets for JW patients of Stanford type A acute aortic dissection surgery.


Assuntos
Dissecção Aórtica , Testemunhas de Jeová , Dissecção Aórtica/cirurgia , Transfusão de Sangue , Hemoglobinas , Humanos
2.
Br J Radiol ; 90(1074): 20170004, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28406315

RESUMO

OBJECTIVE: Boron neutron-capture therapy (BNCT) has been used to inhibit the growth of various types of cancers. In this study, we developed a 10BSH-entrapped water-in-oil-in-water (WOW) emulsion, evaluated it as a selective boron carrier for the possible application of BNCT in hepatocellular carcinoma treatment. METHODS: We prepared the 10BSH-entrapped WOW emulsion using double emulsification technique and then evaluated the delivery efficacy by performing biodistribution experiment on VX-2 rabbit hepatic tumour model with comparison to iodized poppy-seed oil mix conventional emulsion. Neutron irradiation was carried out at Kyoto University Research Reactor with an average thermal neutron fluence of 5 × 1012 n cm-2. Morphological and pathological analyses were performed on Day 14 after neutron irradiation. RESULTS: Biodistribution results have revealed that 10B atoms delivery with WOW emulsion was superior compared with those using iodized poppy-seed oil conventional emulsion. There was no dissemination in abdomen or lung metastasis observed after neutron irradiation in the groups treated with 10BSH-entrapped WOW emulsion, whereas many tumour nodules were recognized in the liver, abdominal cavity, peritoneum and bilateral lobes of the lung in the non-injected group. CONCLUSION: Tumour growth suppression and cancer-cell-killing effect was observed from the morphological and pathological analyses of the 10BSH-entrapped WOW emulsion-injected group, indicating its feasibility to be applied as a novel intra-arterial boron carrier for BNCT. Advances in knowledge: The results of the current study have shown that entrapped 10BSH has the potential to increase the range of therapies available for hepatocellular carcinoma which is considered to be one of the most difficult tumours to cure.


Assuntos
Terapia por Captura de Nêutron de Boro/métodos , Carcinoma Hepatocelular/radioterapia , Neoplasias Hepáticas/radioterapia , Animais , Boro , Modelos Animais de Doenças , Emulsões , Papaver , Óleos de Plantas , Coelhos , Sementes , Distribuição Tecidual
3.
Gen Thorac Cardiovasc Surg ; 65(3): 160-163, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26362052

RESUMO

An 81-year-old woman developed severe hemolytic anemia after aortic valve replacement. The anemia was not caused by paravalvular leakage, as in most cases. Instead, it occurred secondary to left ventricular outflow tract obstruction that had not been seen preoperatively and was induced by afterload reduction following aortic valve replacement. The hemolytic anemia was drug-refractory and finally treated with dual-chamber pacing, as for hypertrophic cardiomyopathy.


Assuntos
Estenose da Valva Aórtica/diagnóstico , Estimulação Cardíaca Artificial/métodos , Obstrução do Fluxo Ventricular Externo/diagnóstico , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Ecocardiografia , Feminino , Humanos , Obstrução do Fluxo Ventricular Externo/terapia
4.
Gen Thorac Cardiovasc Surg ; 65(1): 10-16, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27485246

RESUMO

OBJECTIVE: This study aimed to evaluate the efficacy of the Functional Independence Measure to assess preoperative frailty for elderly patients undergoing surgical aortic valve replacement. METHODS: Eighty-five patients >65 years who survived elective isolated aortic valve replacement from January 2008 to October 2015 were included. The mean age at the operation was 78 ± 6 years old (n = 28 males, n = 57 females). The patients were divided into two groups according to their status at discharge: impossible to discharge home or hospitalization for >30 days (compromised group, n = 8), or unaffected (unaffected group, n = 77). Preoperative frailty was evaluated with the Functional Independence Measure, which comprises 18 items divided into six domains: self-care, sphincter control, mobility, locomotion, communication, and social cognition. RESULTS: The preoperative total Functional Independence Measure score was significantly lower in the compromised group (79 ± 32) than in the unaffected group (120 ± 9, p < 0.01). The preoperative motor Functional Independence Measure score was significantly lower in the compromised group (45 ± 24) than in the unaffected group (85 ± 9, p = <0.01). The duration of postoperative intubation, intensive care unit stay, and postoperative hospitalization were significantly longer in the compromised group than in the unaffected group (48 ± 67 vs 16 ± 12 h, p < 0.01; 6.7 ± 5.3 vs 3.4 ± 2.0 days, p < 0.01; 34 ± 27 vs 23 ± 11 days, p = 0.02, respectively). CONCLUSIONS: The preoperative Functional Independence Measure is effective for assessing preoperative frailty in elderly patients undergoing aortic valve replacement in terms of predicting operative morbidity.


Assuntos
Valva Aórtica/cirurgia , Avaliação Geriátrica/métodos , Implante de Prótese de Valva Cardíaca/reabilitação , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Idoso Fragilizado , Próteses Valvulares Cardíacas , Hospitalização , Humanos , Vida Independente , Tempo de Internação/estatística & dados numéricos , Masculino , Alta do Paciente , Cuidados Pré-Operatórios/métodos , Estudos Retrospectivos , Resultado do Tratamento
5.
Ann Vasc Surg ; 36: 320-324, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27423713

RESUMO

Debranching thoracic endovascular aortic repair for aortic arch pathology is an important alternative to total arch replacement. However, the problem of intraoperative stroke due to atherosclerotic changes in the aorta remains. We apply our minimally invasive mini-cardiopulmonary bypass system to prevent intraoperative stroke during the endovascular procedure. Once debranching from the right axillary artery to the left common carotid and the left axillary artery is constructed; only the brachiocephalic artery is a pathway to the brain. After mini-cardiopulmonary bypass using the debranching graft is established, all cerebral perfusions are not only maintained, but retrograde blood flow from the brachiocephalic artery to the aortic arch is secured. All endovascular procedures can be performed under this situation. Our technique could be effective for preventing intraoperative stroke for endovascular repair with the debranching method for aortic arch pathology.


Assuntos
Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular , Ponte Cardiopulmonar/métodos , Procedimentos Endovasculares , Acidente Vascular Cerebral/prevenção & controle , Idoso , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/fisiopatologia , Aortografia/métodos , Artéria Axilar/fisiopatologia , Artéria Axilar/cirurgia , Implante de Prótese Vascular/efeitos adversos , Ponte Cardiopulmonar/efeitos adversos , Artéria Carótida Primitiva/fisiopatologia , Artéria Carótida Primitiva/cirurgia , Circulação Cerebrovascular , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
6.
Asian Cardiovasc Thorac Ann ; 22(7): 775-80, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24887898

RESUMO

AIM: to evaluate the strategy for open heart surgery after renal transplantation performed in a single institution in Japan. METHODS: we reviewed 6 open heart surgeries after renal transplantation in 5 patients, performed between January 1992 and December 2012. The patients were 3 men and 2 women with a mean age of 60 ± 11 years (range 46-68 years). They had old myocardial infarction and unstable angina, aortic and mitral stenosis, left arterial myxoma, aortic stenosis, and native valve endocarditis followed by prosthetic valve endocarditis. Operative procedures included coronary artery bypass grafting, double-valve replacement, resection of left arterial myxoma, 2 aortic valve replacements, and a double-valve replacement. Renal protection consisted of steroid cover (hydrocortisone 100-500 mg or methylprednisolone 1000 mg) and intravenous immunosuppressant infusion (cyclosporine 30-40 mg day(-1) or tacrolimus 1.0 mg day(-1)). RESULTS: 5 cases were uneventful and good renal graft function was maintained at discharge (serum creatinine 2.1 ± 0.5 mg dL(-1)). There was one operative death after emergency double-valve replacement for methicillin-resistant Staphylococcus aureus-associated prosthetic valve endocarditis. Although the endocarditis improved after valve replacement, the patient died of postoperative pneumonia on postoperative day 45. CONCLUSIONS: careful perioperative management can allow successful open heart surgery after renal transplantation. However, severe complications, especially methicillin-resistant Staphylococcus aureus infection, may cause renal graft loss.


Assuntos
Ponte de Artéria Coronária , Cardiopatias/cirurgia , Implante de Prótese de Valva Cardíaca , Transplante de Rim , Adolescente , Adulto , Idoso , Ponte de Artéria Coronária/efeitos adversos , Ponte de Artéria Coronária/mortalidade , Quimioterapia Combinada , Feminino , Sobrevivência de Enxerto/efeitos dos fármacos , Cardiopatias/microbiologia , Cardiopatias/mortalidade , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Japão , Transplante de Rim/efeitos adversos , Transplante de Rim/mortalidade , Masculino , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Pessoa de Meia-Idade , Reoperação , Fatores de Risco , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Fatores de Tempo , Resultado do Tratamento
7.
Appl Radiat Isot ; 88: 32-7, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24559940

RESUMO

A 63-year-old man with multiple HCC in his left liver lobe was enrolled as the first patient in a pilot study of boron neutron capture therapy (BNCT) involving the selective intra-arterial infusion of a (10)BSH-containing water-in-oil-in-water emulsion ((10)BSH-WOW). The size of the tumorous region remained stable during the 3 months after the BNCT. No adverse effects of the BNCT were observed. The present results show that (10)BSH-WOW can be used as novel intra-arterial boron carriers during BNCT for HCC.


Assuntos
Boroidretos/administração & dosagem , Terapia por Captura de Nêutron de Boro/métodos , Carcinoma Hepatocelular/radioterapia , Neoplasias Hepáticas/radioterapia , Recidiva Local de Neoplasia/radioterapia , Compostos de Sulfidrila/administração & dosagem , Boroidretos/química , Carcinoma Hepatocelular/diagnóstico , Emulsões/administração & dosagem , Emulsões/química , Humanos , Injeções Intra-Arteriais , Neoplasias Hepáticas/diagnóstico , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Óleos/química , Projetos Piloto , Compostos de Sulfidrila/química , Resultado do Tratamento , Água/química
8.
Ann Thorac Surg ; 97(2): 492-7, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24268749

RESUMO

BACKGROUND: Various rings are available to achieve more physiologic mitral valve repair from viewpoints of physiologic mitral annular structure or dynamics. We evaluated preoperative and postoperative mitral annular structures and dynamics. METHODS: Thirty-six patients underwent mitral valve repair for degenerative mitral insufficiency. Carpentier-Edwards Physio II ring (semirigid [Edwards Lifesciences, Irvine, CA]), St. Jude Medical Rigid Saddle Ring (RSR [St. Jude Medical, St. Paul, MN]), and MEMO 3D ring (semirigid [Sorin SpA, Milan, Italy]) were implanted in 13, 12, and 11 patients, respectively. Intraoperative real-time three-dimensional transesophageal echocardiography was performed before and after repair. RESULTS: The postoperative anteroposterior diameter reduction rate from end diastole to end systole was significantly (p<0.0001) larger in MEMO (9.58%±2.91%) than in Physio II (0.98%±1.04%) and RSR (1.94%±1.95%). There were no significant differences in the commissure-to-commissure diameter reduction rates among the groups: 0.81%±1.98% for Physio II, 0.12%±0.53% for RSR, and 0.51%±1.98% for MEMO. The postoperative end-systolic annular height commissure width ratio was significantly (p<0.0001) larger in both Physio II (17.9%±3.0%) and RSR (18.5%±1.6%) than in MEMO (13.6%±3.0%). The postoperative annular height commissure width ratio increase rate from end diastole to end systole was significantly larger in MEMO (5.1%±2.3%) than in Physio II (0.1%±0.6%) and RSR (0.3%±0.5%). CONCLUSIONS: Physio II and RSR could restore the physiologic three-dimensional annular shape, but the annular motion was diminished. Conversely, MEMO could preserve both the anteroposterior movement and folding dynamics, but no three-dimensional restoration of the mitral annulus was obtained.


Assuntos
Insuficiência da Valva Mitral/cirurgia , Valva Mitral/fisiologia , Valva Mitral/cirurgia , Próteses e Implantes , Procedimentos Cirúrgicos Cardíacos/métodos , Hemodinâmica , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Desenho de Prótese
9.
Appl Radiat Isot ; 69(12): 1854-7, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21752660

RESUMO

INTRODUCTION: Hepatocellular carcinoma (HCC) is one of the most difficult to cure with surgery, chemotherapy, or other combinational therapies. In the treatment of HCC, only 30% patients can be operated due to complication of liver cirrhosis or multiple intrahepatic tumours. Tumour cell destruction in boron neutron-capture therapy (BNCT) is due to the nuclear reaction between (10)B atoms and thermal neutrons, so it is necessary to accumulate a sufficient quantity of (10)B atoms in tumour cells for effective tumour cell destruction by BNCT. Water-in-oil-in-water (WOW) emulsion has been used as the carrier of anti-cancer agents on intra-arterial injections in clinical. In this study, we prepared (10)BSH entrapped WOW emulsion by double emulsifying technique using iodized poppy-seed oil (IPSO), (10)BSH and surfactant, for selective intra-arterial infusion to HCC, and performed simulations of the irradiation in order to calculate the dose delivered to the patients. MATERIALS AND METHODS: WOW emulsion was administrated with intra-arterial injections via proper hepatic artery on VX-2 rabbit hepatic tumour models. We simulated the irradiation of epithermal neutron and calculated the dose delivered to the tissues with JAEA computational dosimetry system (JCDS) at JRR4 reactor of Japan Atomic Research Institute, using the CT scans of a HCC patient. RESULTS AND DISCUSSIONS: The (10)B concentrations in VX-2 tumour obtained by delivery with WOW emulsion were superior to those by conventional IPSO mix emulsion. According to the rabbit model, the boron concentrations (ppm) in tumour, normal liver tissue, and blood are 61.7, 4.3, and 0.1, respectively. The results of the simulations show that normal liver biologically weighted dose is restricted to 4.9 Gy-Eq (CBE; liver tumour: 2.5, normal liver: 0.94); the maximum, minimum, and mean tumour weighted dose are 43.1, 7.3, and 21.8 Gy-Eq, respectively, in 40 min irradiation. In this study, we show that (10)B entrapped WOW emulsion could be applied to novel intra-arterial boron delivery carrier for BNCT, and we show the possibility to apply BNCT to HCC. We can irradiate tumours as selectively and safety as possible, reducing the effects on neighbouring healthy tissues.


Assuntos
Terapia por Captura de Nêutron de Boro , Boro/metabolismo , Carcinoma Hepatocelular/radioterapia , Neoplasias Hepáticas Experimentais/radioterapia , Animais , Carcinoma Hepatocelular/metabolismo , Emulsões , Estudos de Viabilidade , Infusões Intra-Arteriais , Neoplasias Hepáticas Experimentais/metabolismo , Óleos , Coelhos , Água
10.
ASAIO J ; 56(4): 309-12, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20559134

RESUMO

Since 2005, we have used a novel technique based on the closed cardiopulmonary bypass system without cardiotomy suction (minimal cardiopulmonary bypass [mini-CPB]) for aortic valve replacement (AVR). In this study, we investigated the clinical advantages of this approach. We prospectively studied 32 patients who underwent isolated AVR using the mini-CPB (group M, n = 13) or conventional CPB (group C, n = 19). We compared the hemodilution ratio, serum interleukin (IL)-6 and IL-8 levels, and blood transfusion volume between the two groups. The characteristics, duration of CPB, and aortic cross-clamping time did not differ between the two groups. The hemodilution ratio was significantly lower in group M just after starting CPB (M vs. C: 14% +/- 2% vs. 25% +/- 3%, p = 0.0009). IL-6 levels increased significantly after surgery in both groups, but the postoperative levels were significantly lower in group M at 6 (84.9 +/- 24.9 pg/ml vs. 152 +/- 78 pg/ml, p = 0.042) and 12 (72.7 +/- 36.1 pg/ml vs. 123 +/- 49.6 pg/ml, p = 0.029) hours after CPB. There were no differences in IL-8 or blood transfusion volume after CPB. Mini-CPB offers an alternative to conventional CPB for AVR and has some advantages regarding hemodilution and serum IL-6 levels. However, it is unlikely to become the standard approach for AVR because there are no marked clinical advantages of mini-CPB.


Assuntos
Valva Aórtica/cirurgia , Ponte Cardiopulmonar/métodos , Idoso , Ponte Cardiopulmonar/instrumentação , Feminino , Próteses Valvulares Cardíacas , Hemodiluição , Humanos , Interleucina-6/sangue , Interleucina-8/sangue , Masculino , Tempo
11.
Ann Thorac Cardiovasc Surg ; 15(5): 343-5, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19901892

RESUMO

A 66-year-old man with severe aortic stenosis had previously undergone esophagectomy with retrosternal gastric tube (GT) reconstruction for esophageal cancer. A chest computed tomography scan demonstrated severe aortic calcification, and we treated him with median sternotomy. A small upper laparotomy was made, and the surface of the GT was detected. The posterior and right sides of the GT were dissected, and the pericardium was then opened. An aortic cross clamp was performed in the least calcified lesion of the ascending aorta, and an aortotomy was performed just above the sinotubular junction. The aortic valve was successfully replaced with a mechanical valve.


Assuntos
Doenças da Aorta/complicações , Estenose da Valva Aórtica/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia , Gastrostomia/instrumentação , Implante de Prótese de Valva Cardíaca , Idoso , Doenças da Aorta/diagnóstico por imagem , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Constrição , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Pericárdio/cirurgia , Índice de Gravidade de Doença , Esternotomia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
Gen Thorac Cardiovasc Surg ; 57(5): 235-8, 2009 May.
Artigo em Inglês | MEDLINE | ID: mdl-19440818

RESUMO

PURPOSE: There have been many reports on open heart surgery in hemodialysis patients; however, the mortality rates in these patients are higher than those in nonhemodialysis patients. The purpose of this study was to identify the risk factors for mortality following open heart surgery in hemodialysis patients. METHODS: We evaluated 76 consecutive patients (76/2030 total open heart surgeries, 3.7%) who required hemodialysis before open heart surgery between January 1990 and January 2008. There were 46 men and 30 women (mean age 63 +/- 11 years). The mean duration of hemodialysis was 9 years 5 months (8 months to 30 years). Chronic glomerulonephritis (25 cases, 33%) and diabetic nephropathy (17 cases, 22%) were the most common diseases leading to a requirement for hemodialysis. Operations included 36 coronary artery bypass grafting (CABG) cases (48%; emergency/elective 22: 14), 24 aortic valve replacements (AVR) (34%), and 9 cases of concomitant AVR plus CABG (12%). Multivariate logistic analyses were performed to identify the risk factors. No patient was lost during follow-up. RESULTS: The overall in-hospital mortality rate was 17.1% (13/76). The 5-year survival rate was 39% +/- 8%. Univariate logistic analysis showed that age (>70 years), low-output syndrome (ejection fraction <40% and/or intraaortic balloon pump support), and concomitant surgery were significant risk factors for mortality. Multivariate logistic analysis suggested that only concomitant surgery was the significant risk factor (odds ratio 4.37, P = 0.007). CONCLUSION: Concomitant surgery is a significant risk factor for mortality following open heart surgery in hemodialysis patients.


Assuntos
Estenose da Valva Aórtica/epidemiologia , Ponte de Artéria Coronária/mortalidade , Doença das Coronárias/epidemiologia , Nefropatias Diabéticas/epidemiologia , Glomerulonefrite/epidemiologia , Implante de Prótese de Valva Cardíaca/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/epidemiologia , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Comorbidade , Doença das Coronárias/cirurgia , Nefropatias Diabéticas/terapia , Feminino , Glomerulonefrite/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal , Fatores de Risco
13.
Eur J Cardiothorac Surg ; 35(4): 684-7; ; discussion 687-8, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19162503

RESUMO

OBJECTIVE: During selective cerebral perfusion (SCP), only the upper body is perfused. However, blood actually returns into the descending aorta through collaterals during SCP. This collateral blood flow (CBF) is thought to be important to protect the visceral organs and spinal cord from ischemia. The left subclavian artery is postulated to be important as a collateral source to the lower body. Therefore, we measured CBF and examined whether a perfusion technique (three- or two-vessel perfusion) affects CBF to the lower body during SCP. METHODS: CBF was measured in 49 patients who underwent aortic arch surgery with SCP between August 2006 and July 2008. CBF, the amount of blood returning into the descending aorta during SCP, was measured under conditions of constant flow during SCP, with three-vessel cannulation that included the left subclavian artery, or with two-vessel cannulation that excluded the left subclavian artery. To prove visceral perfusion during SCP, hepatic (n=22) and stomach (n=5) tissue blood flows were measured using a laser-Doppler flowmeter. RESULTS: The mean perfusion flow rate during SCP was 804+/-91ml/min. The mean CBF under three-vessel perfusion (53+/-34ml/min, 6.5+/-3.8% of SCP) was significantly (p<0.0001) higher compared with that under two-vessel perfusion (43+/-29ml/min, 5.3+/-3.1% of SCP). There was substantial perfusion in the visceral organs during SCP as determined by laser-Doppler flowmeter. CONCLUSION: Visceral organs were perfused to some extent through collaterals and protected from ischemia during SCP. Left subclavian arterial perfusion enabled significant CBF to the lower body. Considering this CBF, three-vessel perfusion appears to be better than two-vessel perfusion during SCP; however, the choice of perfusion technique may not be so important under conditions of hypothermia because the difference in CBF between the two methods was small.


Assuntos
Aorta Torácica/cirurgia , Circulação Cerebrovascular/fisiologia , Circulação Colateral/fisiologia , Cuidados Intraoperatórios/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Implante de Prótese Vascular/métodos , Isquemia Encefálica/prevenção & controle , Feminino , Humanos , Circulação Hepática , Masculino , Pessoa de Meia-Idade , Perfusão/métodos , Estudos Prospectivos , Estômago/irrigação sanguínea , Artéria Subclávia/fisiopatologia
14.
Gen Thorac Cardiovasc Surg ; 56(7): 330-4, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18607679

RESUMO

PURPOSE: The aim of this study was to analyze the effect of patient-prosthesis mismatch (PPM) on survival and left ventricular mass regression in elderly patients after aortic valve replacement (AVR). MATERIALS AND METHODS: Data on patients >65 years old who underwent isolated AVR from 1990 and 2007 were analyzed retrospectively. A bioprosthesis was used in 42 cases and a mechanical valve in 59. The mean follow-up period was 3.1 years (0.1-14.2 years). The indexed effective orifice area (i-EOA) was determined from echocardiographic data in clinical reports in the literature and indexed to body surface area (cm2/m2). Mild PPM was defined as an i-EOA between 0.65 and 0.85. We also evaluated the New York Heart Association (NYHA) classification and the left ventricular mass (LVM) index. RESULTS: A total of 34 patients (33.6%) had PPM. No patient had an i-EOA <0.65. Freedom from valve-related death was 86.3% +/- 6.7% in the PPM-negative group and 85.7% +/- 7.9% in the PPM-positive group at 5 years after AVR. The mean LVM index (g/m2) decreased significantly (P < 0.01), from 239.2 to 167.4 in the PPM-negative group and from 229.1 to 154.4 in the PPM-positive group, respectively. NYHA functional status was excellent at late follow-up in both groups. CONCLUSION: Mild PPM occurred in a large proportion of elderly patients undergoing AVR but did not affect midterm survival or LV mass regression.


Assuntos
Valva Aórtica/cirurgia , Bioprótese , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Feminino , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/mortalidade , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/mortalidade , Ventrículos do Coração/diagnóstico por imagem , Mortalidade Hospitalar , Humanos , Masculino , Desenho de Prótese , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia
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