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2.
Kyobu Geka ; 76(4): 305-311, 2023 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-36997179

RESUMO

Infectious endocarditis is a severe infectious disease in cardiovascular surgery fields. Appropriate antibiotics administration is the principle of treatment, while surgical intervention is required when there is intensive tissue destruction, refractory infection, or high risk of embolism. Usually, surgical risks of infectious endocarditis are rather high as preoperative general condition is often poor. Homografts, which have excellent anti-infective properties, become one of the graft options for infectious endocarditis. Fortunately, we are able to use homografs without so much obstacles thanks to the presence of a tissue bank in our hospital. We will report our strategy and clinical courses of aortic root replacement using homograft for infective endocarditis.


Assuntos
Endocardite Bacteriana , Endocardite , Próteses Valvulares Cardíacas , Humanos , Valva Aórtica/transplante , Endocardite Bacteriana/cirurgia , Transplante Homólogo , Endocardite/cirurgia , Aloenxertos
6.
Kyobu Geka ; 75(10): 768-774, 2022 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-36155567

RESUMO

Aortic root pseudoaneurysm is often derived from suture sites after aortic root replacement on the basis of connective tissue disease, aortitis, or prosthetic valve endocarditis. Preoperative computed tomography (CT) and echocardiography are useful not only for diagnosing a pseudoaneurysm but also for planning to repair it. Redo aortic root replacement is necessary to repair it in most cases. When a giant pseudoaneurysm is close to a sternal posterior wall, resternotomy may be challenging. In such a case, precedent cardiopulmonary bypass with left ventricular apical vent under mild-moderate hypothermia is useful to control bleeding during resternotomy. Regarding graft selection, cryopreserved homograft is effective for repairing pseudoaneurysm in an active infectious phase, but modified Bentall procedure may be still considerable to expect long-term durability if infection is well controlled by preoperative sufficient antibiotic treatment and intraoperative debridement. In the author's institute, 45 patients with aortic root pseudoaneurysm underwent surgical repair since 2011. Thirty cases (67%) was infectious. Thirty-six patients( 80%) underwent aortic root replacement, including homograft in 14 patients and modified Bentall procedure in 22 patients. All the patients survived at discharge, and 1-year and 5-year survival were 96.8% and 74.9%, respectively. Preoperative infectious status and graft selection did not significantly affect remote-phase survival.


Assuntos
Falso Aneurisma , Endocardite Bacteriana , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/cirurgia , Antibacterianos , Valva Aórtica/transplante , Endocardite Bacteriana/cirurgia , Humanos
7.
Artigo em Inglês | MEDLINE | ID: mdl-35786719

RESUMO

OBJECTIVES: The aim of this retrospective study was to assess the early- and long-term outcomes following the use of cryopreserved allografts in aortic valve endocarditis with peri-annular abscess formation. METHODS: From 2001 to 2021, 110 consecutive patients with active infective endocarditis and peri-annular abscess, underwent a cryopreserved allograft root replacement. In 100 patients (91%), the operation was performed <48 h after admission due to refractory heart failure and or septic shock. In 95 patients (86.4%), a redo operation was performed due to a prosthetic valve endocarditis. Preoperatively, 12 patients were dialysis-dependent and 30 patients suffered from a recent stroke. RESULTS: The 30-day mortality was 18% (20 patients). Freedom from reintervention was 98.3% (standard deviation: 1.7) at 1 year and 83.3% (standard deviation: 8.5) at 10 years. Four patients required a redo operation. Three patients did develop re-endocarditis. Freedom from re-endocarditis was 95% after 17 years of follow-up. Preoperative dialysis dependency (odds ratio: 22.75, 95% confidence interval: 4.79-108.14, P < 0.001), ejection fraction under 30% (odds ratio: 17.91, 95% confidence interval: 3.27-98.01, P < 0.001) and stroke within 14 days prior to operation (odds ratio: 5.21, 95% confidence interval: 1.28-21.2, P = 0.021) were incremental factors associated with the 30-day mortality. CONCLUSIONS: In aortic root endocarditis with abscesses formation, cryopreserved allografts exhibit excellent clinical performance with a low rate of reinfection and reintervention, which make its use as valve replacement a very desirable option. Dialysis dependency, ejection fraction under 30% and recent stroke have the highest impact on the 30-day mortality.


Assuntos
Endocardite Bacteriana , Endocardite , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Acidente Vascular Cerebral , Abscesso/etiologia , Abscesso/cirurgia , Aloenxertos/cirurgia , Valva Aórtica/cirurgia , Valva Aórtica/transplante , Endocardite/cirurgia , Endocardite Bacteriana/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Reoperação , Estudos Retrospectivos
9.
Eur J Cardiothorac Surg ; 62(3)2022 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-35388890

RESUMO

OBJECTIVES: The aim of this study was to evaluate early- and long-term outcomes of cryopreserved aortic homograft (CAH) implantation for aortic valve replacement (AVR) or aortic root replacement (ARR) in patients with or without complex infective endocarditis. METHODS: All adult patients undergoing AVR or ARR with CAH at our institution between January 1993 and July 2021 were included in the study. RESULTS: One hundred four patients, 75 males and 29 females, aged 59 ± 17 years, underwent AVR or ARR with CAH for infective endocarditis (n = 94, 90%) or aortic valve disease (n = 10, 10%). There were 33 (35%) native valve endocarditis and 61 (65%) prosthetic valve endocarditis, which were complicated by annular abscess in 77 (82%) patients, mitral valve endocarditis in 13 (14%) and tricuspid valve endocarditis in 13 (14%). The mean cardiopulmonary bypass time was 214 ± 80 min and the mean aortic cross-clamping time was 164 ± 56 min. There were 12 (12%) hospital deaths and 7 (7%) postoperative low cardiac output syndrome requiring extracorporeal membrane oxygenation in 4 patients and intra-aortic balloon pump in 3. Thirty-nine (42%) patients died during the follow-up (94% complete). The mean survival time was 13.9 ± 1.2 years. Twenty-five patients (26%) underwent late reoperation for aortic homograft degeneration (n = 17, 18%), homograft endocarditis (n = 6, 7%), homograft dehiscence (n = 1, 1%) and mitral valve regurgitation (n = 1, 1%). The mean survival free from reintervention was 15.7 ± 1.2 years. CONCLUSIONS: AVR or ARR with a CAH for complex endocarditis is associated with satisfactory hospital survival, considering the critical patient presentation at surgery, and excellent survival free from recurrent infection. Need for reoperation late after surgery is similar to other biological prostheses.


Assuntos
Endocardite Bacteriana , Endocardite , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Adulto , Aloenxertos/cirurgia , Valva Aórtica/transplante , Endocardite/cirurgia , Endocardite Bacteriana/cirurgia , Feminino , Seguimentos , Próteses Valvulares Cardíacas/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Reoperação
10.
J Cardiovasc Pharmacol ; 79(1): e103-e115, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34654784

RESUMO

ABSTRACT: Aortic valve replacement for severe stenosis is a standard procedure in cardiovascular medicine. However, the use of biological prostheses has limitations especially in young patients because of calcifying degeneration, resulting in implant failure. Pioglitazone, a peroxisome proliferator-activated receptor gamma (PPAR-gamma) agonist, was shown to decrease the degeneration of native aortic valves. In this study, we aim to examine the impact of pioglitazone on inflammation and calcification of aortic valve conduits (AoC) in a rat model. Cryopreserved AoC (n = 40) were infrarenally implanted into Wistar rats treated with pioglitazone (75 mg/kg chow; n = 20, PIO) or untreated (n = 20, controls). After 4 or 12 weeks, AoC were explanted and analyzed by histology, immunohistology, and polymerase chain reaction. Pioglitazone significantly decreased the expression of inflammatory markers and reduced the macrophage-mediated inflammation in PIO compared with controls after 4 (P = 0.03) and 12 weeks (P = 0.012). Chondrogenic transformation was significantly decreased in PIO after 12 weeks (P = 0.001). Calcification of the intima and media was significantly reduced after 12 weeks in PIO versus controls (intima: P = 0.008; media: P = 0.025). Moreover, echocardiography revealed significantly better functional outcome of the AoC in PIO after 12 weeks compared with control. Interestingly, significantly increased intima hyperplasia could be observed in PIO compared with controls after 12 weeks (P = 0.017). Systemic PPAR-gamma activation prevents inflammation as well as intima and media calcification in AoC and seems to inhibit functional impairment of the implanted aortic valve. To further elucidate the therapeutic role of PPAR-gamma regulation for graft durability, translational studies and long-term follow-up data should be striven for.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/efeitos dos fármacos , Valva Aórtica/transplante , Bioprótese , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , PPAR gama/agonistas , Pioglitazona/farmacologia , Animais , Valva Aórtica/metabolismo , Valva Aórtica/patologia , Insuficiência da Valva Aórtica/metabolismo , Insuficiência da Valva Aórtica/patologia , Calcinose/metabolismo , Calcinose/patologia , Calcinose/prevenção & controle , Condrogênese/efeitos dos fármacos , Criopreservação , Citocinas/genética , Citocinas/metabolismo , Modelos Animais de Doenças , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Mediadores da Inflamação/metabolismo , Osteogênese/efeitos dos fármacos , PPAR gama/metabolismo , Ratos Sprague-Dawley , Ratos Wistar , Transdução de Sinais
11.
Sci Rep ; 11(1): 11975, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099815

RESUMO

Transcatheter aortic valve replacement (TAVR) has shown to reduce mortality compared to surgical aortic valve replacement (sAVR). However, it is unknown which procedure is associated with better post-procedural valvular function. We conducted a meta-analysis of randomized clinical trials that compared TAVR to sAVR for at least 2 years. The primary outcome was post-procedural patient-prosthesis-mismatch (PPM). Secondary outcomes were post-procedural and 2-year: effective orifice area (EOA), paravalvular gradient (PVG) and moderate/severe paravalvular leak (PVL). We identified 6 trials with a total of 7022 participants with severe aortic stenosis. TAVR was associated with 37% (95% CI [0.51-0.78) mean RR reduction of post-procedural PPM, a decrease that was not affected by the surgical risk at inclusion, neither by the transcatheter heart valve system. Postprocedural changes in gradient and EOA were also in favor of TAVR as there was a pooled mean difference decrease of 0.56 (95% CI [0.73-0.38]) in gradient and an increase of 0.47 (95% CI [0.38-0.56]) in EOA. Additionally, self-expandable valves were associated with a higher decrease in gradient than balloon ones (beta = 0.38; 95% CI [0.12-0.64]). However, TAVR was associated with a higher risk of moderate/severe PVL (pooled RR: 9.54, 95% CI [5.53-16.46]). All results were sustainable at 2 years.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/transplante , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Próteses Valvulares Cardíacas , Humanos , Masculino , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
12.
Ann Thorac Surg ; 112(6): 1929-1938, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33434545

RESUMO

BACKGROUND: Aortic homografts have been used in young patients requiring aortic valve replacement. Currently, these grafts are generally reserved for aortic valve endocarditis with or without root abscess; however, longitudinal data are lacking. Our aim was to assess the long-term safety and durability of homograft implantation. METHODS: All adult patients undergoing aortic homograft implantation at a single institution from 1992 to 2019 were included. Outcomes of interest included all-cause mortality and aortic valve reoperation, studied over a median follow-up duration of 19 years. RESULTS: In all, 252 patients with a mean age of 49 years were included. Infective endocarditis was the primary indication for surgery in 95 patients (38%). The endocarditis group, compared with the no-endocarditis group, had a higher prevalence of New York Heart Association class III-IV (56% vs 26%), chronic kidney disease (22% vs 1%), prior cardiac surgery (40% vs 10%), and emergency status (7% vs 0%; all P < .001). Operative mortality was higher among endocarditis patients (16% vs 0.6%, P < .001), which persisted after risk adjustment. Among patients who survived to discharge, however, there was no difference in long-term survival between the endocarditis group and no-endocarditis group. Overall survival and freedom from reoperation were 88.3% and 80% at 15 years and 87.2% and 78% at 25 years, respectively. Indications for reoperation included structural valve deterioration (83%), endocarditis (12%), and mitral valve disease (5%). Reoperative mortality occurred in 2 patients (4.9%). CONCLUSIONS: Aortic homografts are associated with good long-term survival and admissible freedom from reoperation. Operative mortality is high among patients with endocarditis; however, for those who survive to discharge, long-term survival and durability are the same as for patients without endocarditis.


Assuntos
Valva Aórtica/transplante , Previsões , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante Homólogo , Resultado do Tratamento
14.
Arch Cardiovasc Dis ; 113(11): 674-678, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32868256

RESUMO

BACKGROUND: Donor heart shortage has extended the waiting time and increased the mortality of patients on the transplant waiting list. Widening old standard donor criteria has successfully increased the number of heart transplantations, but for many years, a valve disease in a donor heart has been considered a primary contraindication for organ donation. AIMS: To analyse the results of aortic and mitral valvular surgery in marginal donor hearts with valvulopathy before orthotopic heart transplantation. METHODS: Between January 2012 and November 2015, we performed 53 heart transplantations in our department. In four donors, echocardiography performed at the time of organ procurement showed a valvular disease: three had moderate-to-severe mitral regurgitation; and one had moderately severe aortic valve stenosis. RESULTS: The mean bench mitral repair and aortic replacement time, aortic cross-clamp time and total ischaemic time were: 18 (range 7-25) minutes, 78.7 (range 57-98) minutes and 184 (range 89-255) minutes, respectively. Intraoperative transoesophageal echocardiography showed good mitral repair or aortic prosthetic valve function, and good right and left ventricular function. One patient died of infectious pneumonia after 1 month. The mean duration of follow-up for the patients discharged home was 75±13 months, and all have returned to an active unrestricted lifestyle. CONCLUSIONS: Our limited series demonstrates that conventional valvular procedures performed on otherwise healthy donor hearts with mitral and aortic valve pathology can efficaciously expand the donor pool for orthotopic cardiac transplantation and decrease the mortality rate on the waiting list.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/patologia , Valva Aórtica/transplante , Calcinose/cirurgia , Seleção do Doador , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/transplante , Doadores de Tecidos/provisão & distribuição , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/fisiopatologia , Calcinose/diagnóstico por imagem , Calcinose/fisiopatologia , Estudos de Viabilidade , Feminino , Sobrevivência de Enxerto , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Valva Mitral/fisiopatologia , Anuloplastia da Valva Mitral/efeitos adversos , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
15.
Artigo em Inglês | MEDLINE | ID: mdl-32356619

RESUMO

The implantation of a decellularized aortic homograft in children and young adults has been shown to be a good alternative to existing surgical approaches. Lower risk of calcification and the potential of growth render a homograft a promising valve substitute. The child presented in this video tutorial is a 10-year-old boy diagnosed with congenital aortic stenosis which was treated by balloon valvuloplasty early in life. Current echocardiographic findings show severe aortic regurgitation and stenosis. The tutorial provides detailed insight into how to implant a decellularized aortic homograft as a total root replacement.


Assuntos
Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/congênito , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/transplante , Valvuloplastia com Balão , Aloenxertos , Insuficiência da Valva Aórtica/etiologia , Criança , Ecocardiografia , Humanos , Masculino , Transplante Homólogo
16.
Medicina (Kaunas) ; 56(4)2020 Apr 06.
Artigo em Inglês | MEDLINE | ID: mdl-32268535

RESUMO

Background and objectives: Plasma arginine vasopressin (P-AVP) is regulated by the non-osmotic pathway in patients with heart failure (HF) and reduced ejection fraction. However, the regulation of P-AVP in patients with severe aortic stenosis (AS) remains unknown. Materials and Methods: Consecutive patients with severe AS who received trans-catheter aortic valve implantation (TAVI) between Apr 2016 and Apr 2019 were enrolled in this prospective study. Clinical data including P-AVP were obtained just before TAVI, and the correlation between P-AVP and other variables was investigated. Results: In total, 159 patients with severe AS (85.3 ± 4.6 years, male 26%) were enrolled. P-AVP was 1.45 ± 1.13 ng/mL and cardiac index was relatively preserved (2.76 ± 0.54 L/min/m2). There was no significant correlation between cardiac index and P-AVP (p > 0.05), whereas plasma osmolality had a moderate positive correlation with P-AVP (r = 0.35, p < 0.01), predominantly due to blood urea nitrogen (r = 0.27, p < 0.01). Patients with diuretics had significantly higher P-AVP than those without diuretics (1.65 ± 1.43 vs. 1.22 ± 0.57 pg/mL, p < 0.01). Two-year survivals free from HF readmission were statistically comparable irrespective of the level of pre-procedural P-AVP (p = 0.44). Conclusion: In patients with severe high-gradient AS who received TAVI, the P-AVP level was dominantly regulated by plasma osmolality instead of arterial underfilling. The clinical implication of elevated P-AVP in the TAVI candidates is the next concern.


Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/anormalidades , Arginina Vasopressina/uso terapêutico , Implante de Prótese de Valva Cardíaca/normas , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Valva Aórtica/transplante , Estenose da Valva Aórtica/tratamento farmacológico , Arginina Vasopressina/farmacologia , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Implante de Prótese de Valva Cardíaca/tendências , Humanos , Masculino , Estudos Prospectivos , Estatísticas não Paramétricas
17.
Cardiovasc Eng Technol ; 11(1): 84-95, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31667784

RESUMO

PURPOSE: Accurately reproducing physiological and time-varying variables in cardiac bioreactors is a difficult task for conventional control methods. This paper presents a new controller based on a genetic algorithm for the control of a cardiac bioreactor dedicated to the study and conditioning of heart valve substitutes. METHODS: A multi-objective genetic algorithm was designed to obtain an accurate simultaneous reproduction of physiological periodic time functions of the three most relevant variables characterizing the blood flow in the aortic valve. These three controlled variables are the flow rate and the pressures upstream and downstream of the aortic valve. RESULTS: Experimental results obtained with this new algorithm showed an accurate dynamic reproduction of these three controlled variables. Moreover, the controller can react and adapt continuously to changes happening over time in the cardiac bioreactor, which is a major advantage when working with living biological valve substitutes. CONCLUSION: The strong non-linear interaction that exists between the three controlled variables makes it difficult to obtain a precise control of any of these, let alone all three simultaneously. However, the results showed that this new control algorithm can efficiently overcome such difficulties. In the particular field of bioreactors reproducing the cardiovascular environment, such a flexible, versatile and accurate reproduction of these three interdependent controlled variables is unprecedented.


Assuntos
Algoritmos , Valva Aórtica/fisiologia , Bioprótese , Reatores Biológicos , Pressão Sanguínea , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Engenharia Tecidual/instrumentação , Valva Aórtica/transplante , Velocidade do Fluxo Sanguíneo , Células Cultivadas , Humanos , Mecanotransdução Celular , Estresse Mecânico , Fatores de Tempo , Técnicas de Cultura de Tecidos
18.
A A Pract ; 13(12): 457-460, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31651414

RESUMO

The angle correction feature in ultrasound systems is used when there is difficulty accurately aligning the Doppler beam with the flow to be interrogated. The operator can manually "correct" the angle to the actual direction of flow. Subsequently, the machine corrects the peak velocity for the angle. We present a case of aortic valve replacement (AVR) in which falsely high transaortic gradients were obtained immediately after separation from cardiopulmonary bypass (CPB). We recommend that there be a more prominent notification when the angle correction feature is used with machine prompts confirming when a peak velocity is obtained using angle correction.


Assuntos
Implante de Prótese de Valva Cardíaca , Ultrassonografia Doppler , Idoso , Aorta/transplante , Valva Aórtica/transplante , Humanos , Masculino , Valva Mitral/transplante
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