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1.
Heart Lung Circ ; 31(3): 430-438, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34600814

RESUMO

BACKGROUND: There is some interest in long-term survival after various cardiac surgical strategies, including off-pump versus on-pump coronary artery surgery (CAG), mitral valve (MV) repair versus replacement, and aortic valve (AV) bioprosthetic versus mechanical replacement. METHODS: We studied patients older than 49 years of age, recording risk factors and surgical details at the time of surgery. We classified procedures as: MV surgery with or without concurrent grafts or valves; AV surgery with or without concurrent CAG; or isolated CAG. Follow-up was through the state death register and state-wide hospital attendance records. Risk-adjusted survival was estimated using Cox proportional hazards. Observed survival was compared to the expected age- and sex- matched population survival. RESULTS: During a median follow-up of 14.8 years 5,807 of 11,718 patients died. The difference between observed and expected survival varied between 3.4 years for AV surgery and 9.6 years for females undergoing MV surgery. The risk-adjusted mortality hazard rate after off-pump CAG was 0.93 (95% CI 0.8-1.0, p=0.84), MV repair 0.67 (95% CI 0.6-0.8, p<0.0001), MV bioprosthesis 0.82 (95% CI 0.81 (0.6-1.0, p=0.11) and bioprosthetic AV replacement 1.02 (95% CI 0.9-1.2, p=0.82). CONCLUSIONS: Compared to the general population, cardiac surgical patients have a shorter than expected life expectancy. We observed a survival benefit of mitral valve repair over replacement. We did not observe significant survival differences between off-pump and on-pump CAG, nor between bioprosthetic and mechanical replacement.


Assuntos
Bioprótese , Procedimentos Cirúrgicos Cardíacos , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Valva Aórtica/cirurgia , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Estudos Retrospectivos , Resultado do Tratamento
2.
Asian Cardiovasc Thorac Ann ; 24(4): 378-81, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-25690433

RESUMO

A 42-year-old woman presented to a regional hospital emergency room with palpitations and was found to be in ventricular tachycardia. Chest radiography demonstrated a massively enlarged cardiac silhouette. Echocardiography and cardiac magnetic resonance imaging demonstrated a mass within the left ventricular free wall, consistent with a cardiac fibroma. The patient proceeded to have surgical resection of the mass. Left ventricular function was preserved postoperatively.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Fibroma/cirurgia , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração/cirurgia , Adulto , Ecocardiografia , Feminino , Fibroma/complicações , Fibroma/diagnóstico por imagem , Fibroma/patologia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Imageamento por Ressonância Magnética , Taquicardia Ventricular/etiologia , Resultado do Tratamento , Carga Tumoral , Função Ventricular Esquerda
3.
J Heart Lung Transplant ; 29(12): 1427-32, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-20817566

RESUMO

BACKGROUND: Some patients continue to have significant heart failure symptoms despite optimal medical therapy. METHODS: We describe a first-in-human experience with an implantable non-blood-contacting extra-ascending aortic counterpulsation heart assist system (C-Pulse) in 5 end-stage heart failure patients, aged 54 to 73 years. RESULTS: All patients improved by 1 NYHA class and improvements in invasive hemodynamics were documented in 3 patients. Three of 5 patients (60%) had infectious complications. Two patients were explanted at 5 and 7 weeks, respectively, as a result of mediastinal infection related to the implant procedure. One patient was successfully transplanted at 1 month and 1 remained hemodynamically improved on the device at 6 months but suffered infective complications. The device and protocol have been modified as a result of this pilot study with a further multicenter safety study underway. CONCLUSIONS: Although feasibility of this device is suggested by this pilot study, safety and efficacy will need to be examined in a larger cohort with longer follow-up.


Assuntos
Contrapulsação/instrumentação , Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Implantação de Prótese/métodos , Idoso , Estudos de Viabilidade , Feminino , Seguimentos , Hemodinâmica , Humanos , Masculino , Doenças do Mediastino/microbiologia , Pessoa de Meia-Idade , Projetos Piloto , Implantação de Prótese/efeitos adversos , Resultado do Tratamento
4.
Heart Lung Circ ; 14(4): 266-8, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16360999

RESUMO

Aortic valve papillary fibroelastomas are rare benign tumours which may present with the sequele of embolisation, coronary occlusion or sudden death. We report a case of a 68 year old lady presenting with unstable angina who appeared at coronary angiography to have thrombus in the right coronary ostium. Increasing right territory ischaemia prompted echocardiography, which diagnosed a mass in the right coronary ostium. Urgent surgery was undertaken, demonstrating chronic impaction of an aortic valve fibroelastoma in the right coronary ostium. Aortic valve replacement and coronary bypass grafting to the distal right coronary artery (RCA) was performed. This case illustrates a common cardiology presentation caused by the complication of a rare tumour.


Assuntos
Angina Instável/etiologia , Valva Aórtica , Fibroma/complicações , Fibroma/diagnóstico , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/diagnóstico , Idoso , Feminino , Fibroma/cirurgia , Neoplasias Cardíacas/cirurgia , Humanos
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