Assuntos
Aneurisma da Aorta Torácica/cirurgia , Dissecção Aórtica/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Procedimentos Endovasculares/instrumentação , Desenho de Prótese , Stents , Dissecção Aórtica/diagnóstico por imagem , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Angiografia por Tomografia Computadorizada , Embolização Terapêutica , Feminino , Humanos , Pessoa de Meia-Idade , Reoperação , Resultado do TratamentoRESUMO
PURPOSE: Ventricular septal perforation represents a serious complication after acute myocardial infarction. This study aimed to evaluate the short-term and longterm outcomes of postinfarction ventricular septal perforation (VSP). METHODS: We evaluated outcomes for VSP repair for 42 patients over 19 years. A retrospective analysis of clinical records, risk factors for hospital death, and long-term survival was performed. RESULTS: In-hospital mortality was 33.3%. The most common cause of hospital death was left-sided heart failure. A low ejection fraction and short time interval from acute myocardial infarction to the onset of VSP were significant risk factors. The actuarial survival rates of in-hospital survivors at 5 and 10 years were 81.7% and 43.5%, respectively. There were 17 cardiac events among the survivors during the follow-up period. The most influential factor affecting long-term outcomes was the number of diseased coronary arteries. CONCLUSION: The long-term survival outcome of VSP patients during the postoperative period was comparatively good, but the prognosis of VSP patients with multivessel disease was not satisfactory because of congestive heart failure or ventricular arrhythmia. We believe that postoperative medical treatment for preventing cardiac remodeling is important for improving long-term survival outcomes in such patients.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Infarto do Miocárdio/complicações , Ruptura do Septo Ventricular/cirurgia , Idoso , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Fármacos Cardiovasculares/uso terapêutico , Distribuição de Qui-Quadrado , Feminino , Mortalidade Hospitalar , Humanos , Japão , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Infarto do Miocárdio/tratamento farmacológico , Infarto do Miocárdio/mortalidade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento , Remodelação Ventricular , Ruptura do Septo Ventricular/etiologia , Ruptura do Septo Ventricular/mortalidade , Ruptura do Septo Ventricular/fisiopatologiaRESUMO
Triplex (Terumo Co., Tokyo, Japan), a newly developed large diameter vascular graft sealed with a non-biodegradable material, is expected to reduce inflammatory reaction. We confirmed its safe implantation and assessed inflammatory reaction after thoracic aortic surgery. Between January 2009 and February 2010, 101 consecutive patients underwent thoracic aortic replacement. Triplex grafts were implanted in 40 patients, and bovine-collagen coated grafts (Hemashield, Boston Scientific, Boston, MA, USA) were implanted in 61 patients. During the postoperative course, body temperature and laboratory findings including inflammatory markers were examined. The mean operation time and amount of bleeding during operation were equivalent in the two groups. The mean body temperature and C-reactive protein in patients implanted with Triplex were significantly lower than those in patients implanted with Hemashield grafts. The mean white blood cell count tended to be at lower levels in patients implanted with Triplex grafts. No patients in both groups suffered postoperative complications associated with the prosthetic grafts. Triplex was confirmed to be safely applied for thoracic aortic surgery as well as the conventional vascular grafts and to reduce postoperative inflammatory reaction.
