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Non-Syndromic atrioventricular septal defects: a refined definition, associated risk factors, and prognostic factors for left atrioventricular valve replacement following primary repairPatel, Sonali Subhashchandra 01 December 2010 (has links)
Congenital heart defects (CHDs) constitute a major proportion of clinically significant birth defects and are an important component of pediatric cardiovascular disease. Atrioventricular septal defects (AVSDs) include a range of anomalies characterized by atrial, ventricular, and atrioventricular (AV) valve defects. AVSDs commonly occur in the presence of a syndrome, most frequently Down syndrome; they also occur in isolation and are referred to as non-syndromic AVSDs (NSAVSDs). These studies were performed to evaluate for presence of an intermediate phenotype in parents and siblings of a child with a NSAVSD, risk factors associated with NSAVSDs, and prognostic risk factors for left AV valve replacement following primary repair of an AVSD.
It was shown that the mean body surface area-standardized AV septal length (AVSL) was significantly shorter in the NSAVSD parents and siblings than in parents and siblings of syndromic AVSD case and control children. Using age- and gender-adjusted body surface area-standardized AVSL, it was determined that there was evidence for two component distributions in parents and siblings of NSAVSD children, suggesting the presence of an intermediate. Broadening the definition of AVSD to include those with a shortened AVSL may increase the power of genetic association and mapping studies to identify susceptibility genes.
Risk factors associated with NSAVSD were examined using the 1997-2005 National Birth Defects Prevention Study database. Mothers who actively smoked or were exposed to passive smoke anytime from one month prior to pregnancy through the end of the first trimester were more likely to have an infant with a NSAVSD. There was a suggestive association between AVSDs and use of antibacterial, antifungal, and antiviral medications. Additional investigations are warranted to investigate associations with specific medications as well as to uncover possible gene-environment interaction effects that may modify these risks in order to develop improved primary prevention strategies.
Using the Pediatric Cardiac Care Consortium database, factors associated with time to first reoperation and time to replacement following primary AVSD repair were evaluated. Type of AVSD repair, closure of the mitral valve cleft, moderate to severe postoperative left AV valve regurgitation, and presence of postoperative complete heart block were associated with earlier time to reoperation after adjusting for age and weight at AVSD repair. Down syndrome and presence of postoperative mitral stenosis were associated with earlier time to replacement. Prognostic risk factors following left AV valve replacement in children who had previously undergone AVSD repair were also identified. A prosthetic valve size to body weight ratio of greater than 3 and the presence of Down syndrome were identified as predictors of in-hospital death following left AV valve replacement.
By adding to our knowledge of the AVSD familial and environmental risk factors from these studies, we will be able to (1) improve genetic counseling, (2) identify other family members for genetic testing, (3) begin to devise primary prevention strategies, and (4) improve treatment modalities. By recognizing prognostic factors which influence survival, optimal patient care can be devised which will not only improve treatment modalities, but also long-term survival.
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Native Valve Candida Metapsilosis Endocarditis Following a Ruptured Appendix: A Case ReportSanku, Koushik, Youssef, Dima 01 January 2022 (has links)
complex has been further divided into , , and . is considered to be the least virulent fungi of the complex. Candida endocarditis is uncommon but is associated with a very high mortality rate. Prosthetic or previously damaged valves act as common targets, but native, structurally normal valves are seldom affected. We hereby present a case of endocarditis involving a native aortic valve in an immunocompetent 55-year-old male who was successfully treated with surgical valve replacement and antifungal therapy.
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Medida do strain bidimensional do ventrículo esquerdo pré-implante percutâneo de endoprótese valvar aórtica: correlação com a evolução após o procedimento / Measurement of bidimensional strain of left ventricle before percutaneous implantation of aortic valve endoprosthesis: correlation with evolution after the procedureFrança, Lucas Arraes de 24 May 2017 (has links)
INTRODUÇÃO: O implante transcateter de prótese valvar aórtica (TAVI) surge nos dias atuais como uma opção terapêutica para os pacientes sintomáticos portadores de estenose aórtica grave. Cerca de 200 mil pacientes em todo o mundo já foram submetidos ao TAVI. Não há grandes estudos que tenham avaliado a correlação prognóstica entre parâmetros ecocardiográficos antes do TAVI e eventos cardiovasculares a longo prazo. É relevante analisar se o strain pré-procedimento e outros parâmetros se comportam como fatores preditores independentes de eventos após o procedimento. MÉTODOS: Foram avaliados, de novembro de 2009 a outubro de 2016, 86 pacientes, submetidos a avaliação ecocardiográfica antes do TAVI e 30 dias após o procedimento, com análise do strain do ventrículo esquerdo pelo speckle tracking bidimensional e outros parâmetros ecocardiográficos. Esses pacientes foram acompanhados clinicamente e avaliados quanto aos desfechos: mortalidade global, mortalidade cardiovascular, classe funcional de insuficiência cardíaca e necessidade de reinternação cardiovascular. RESULTADOS: O strain global longitudinal pré-TAVI reduzido (valor absoluto) aumentou a chance de reinternação cardiovascular (OR: 0,87; 0,77 ±0,99; P= 0,038). A redução da relação E/e´ em 30 dias após o TAVI associou-se à queda da mortalidade global (OR: 0,97; 0,95 ±0,99; P = 0,006), bem como valores elevados pré procedimento dessa relação se associaram a maiores taxas de insuficiência cardíaca classe funcional III ou IV da New York Heart Association após a intervenção (OR: 1,08; 1±1,18; P = 0,049). CONCLUSÃO: Os resultados deste trabalho indicam que o strain global longitudinal pré-procedimento demonstrou ser um preditor de reinternação cardiovascular pós-intervenção a longo prazo. A relação E/e´ pré-procedimento apresentou correlação diretamente proporcional com o desenvolvimento de insuficiência cardíaca classe funcional III ou IV a longo prazo, assim como sua queda acentuada 30 dias após o procedimento correlacionou-se com menor mortalidade global. / INTRODUCTION: Transcatheter aortic valve replacement (TAVR) is a therapeutic option for symptomatic patients with severe aortic stenosis. Approximately 200,000 patients around the world have already undergone TAVR. No large studies have evaluated prognostic correlation between echocardiographic parameters before TAVR and long-term cardiovascular events. It is relevant to analyze strain before procedure and how other parameters work as independent predictors of events after the procedure. METHODS: A total of 86 patients were evaluated from November 2009 to October 2016. They underwent echocardiographic evaluation before TAVR and 30 days after the procedure with analysis of strain of the left ventricle by bidimensional speckle tracking and other echocardiographic parameters. Patients were followed clinically and evaluated in relation to outcomes: global mortality, cardiovascular mortality, functional class of heart failure and need for cardiovascular readmissions. RESULTS: Global longitudinal strain before reduced TAVR (absolute value) increased the chance of cardiovascular readmission (odds ratio: 0.87; 0.77 ± 0.99; p = 0.038). Reduction of E/e´ relationship 30 days after TAVI was associated with a drop in global mortality (odds ratio: 0.97; 0.95 ± 0.99; p = 0.006). In addition, high values for this relation before the procedure were associated with higher rates of New York Heart Association functional class III or IV heart failure after the intervention (odds ratio: 1.08; 1.00 ± 1.18; p = 0.049). CONCLUSIONS: Results of this study indicate that global longitudinal strain before the procedure is a predictor of cardiovascular readmission after TAVR. The E/e´relationship before the procedure presented a correlation directly proportional to the development of long-term functional class III or IV heart failure as well as its accentuated drop 30 days after the procedure was correlated with lower global mortality.
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Comparação da função diastólica entre o pré e pós-operatório de pacientes portadores de estenose aórtica ou insuficiência aórtica, baseados em dados bioquímicos e ecocardiográficos / Comparing after and before aortic valve replacement diastolic function in patients with aortic stenosis(AS) or aortic regurgitation(AR)Boer, Berta Paula Napchan 09 February 2010 (has links)
INTRODUÇÃO: Avaliação da função diastólica de pacientes portadores de estenose ou insuficiência aórtica submetidos à troca valvar. OBJETIVOS: Avaliação da função diastólica através da análise do NTpró-BNP como método não invasivo para caracterização da insuficiência cardíaca diastólica, comparando com os dados ecocardiográficos através do Doppler Pulsado em Fluxo Mitral, Doppler Pulsado em Veias Pulmonares e Doppler Tecidual em portadores de IAO e EAO. MÉTODOS: Foram avaliados 63 pacientes, 32 pacientes com IAO (25 pacientes do sexo masculino e 7 do sexo feminino), 31 pacientes com EAO (11 pacientes do sexo masculino e 20 pacientes do sexo feminino). As variáveis foram comparadas na média entre os pacientes portador de IAO e EAO no pré e pós-operatório. RESULTADOS: A idade dos pacientes variou de 21 a 81 com média de 55 anos. Observa-se diferença quanto à média de idades entre as diferentes patologias (t-Student p< 0,0001). Os pacientes com IAO apresentam uma média de idade igual a 45,7±14,3 com variação entre 21 e 79 anos e os pacientes com EAO apresentam uma média de idade igual a 61,5±14,7 com variação entre 21 e 81 anos. Na IAO em relação à disfunção diastólica tivemos os seguintes dados com significância estatística do pré para o pós-operatório (6 meses): TRIV (p=0,0011), diferença entre Tempo de onda A mitral e onda A pulmonar (p=0,0097), Vol. Sistólico de AE (p=0,0019), Vol Sistólico de AE Indexado (0,0011), Vol. Diastólico de AE (p=0,0110), DDVE (p<0,0001), DSVE (p<0,0001), VSF (p<0,0001), VDF (p<0,0001), Massa Indexada de VE (p<0,0001) e Relação Volume/Massa do VE (p<0,0001). Na EAO em relação à disfunção diastólica tivemos os seguintes dados com significância estatística do pré para o pós-operatório (6 meses): E/E (p=0,0379), TRIV (p=0,0072), diferença entre o tempo de onda A mitral e tempo de onda A pulmonar (p=0,0176), Vol sistólico de AE(p=0,0242), Vol. Sistólico de AE indexado (p=0,0237), FEdeAE (p=0,0339), DDVE (p=0,0002), DSVE (p=0,0085), VDF (p=0,0194), Massa Indexada de VE (p<0,0001) e Relação Volume/Massa de VE(p<0,0001). O NTpró-BNP se correlacionou positivamente com os diversos graus de disfunção diastólica tanto no pré como pós-operatório CONCLUSÃO: Foram verificados no estudo da função diastólica variação com significância estatística tanto na IAO como na EAO na comparação do pré e o pós-operatório. Da mesma forma notamos variação do NT-proBNP com correlação com as variáveis ecocardiográficas que caracterizam a disfunção diastólica. / INTRODUCTION: Assessment of diastolic function in patients with aortic stenosis or aortic regurgitation waiting for aortic valve replacement. OBJECTIVE: Assesment of diastolic function with Doppler methods:Doppler signals from transvalvar mitral inflow, tissue Doppler imaging (TDI) and Doppler in pulmonary veins(DPV) correlating with serum brain peptide natriuretic (NTproNP) before and 6 months after aortic valve replacement (AVR). METHODS: We have analyzed 63 patients, 32 with AR (25 males and 7 females), 31 AS (11 males and 20 females).The indices were compared with AS and AR before and after AVR. RESULTS: The ages of patients ranged from 21 to 81 mean age was 55 years old.We have seen difference between mean age of AS and AR (t-Student-p<0.0001). Patients with AR have had mean age 45.67 plus/minus 14.28, range 21 to 79 years old and patients with AS have had mean age 61.50 plus/minus 14.72, range 21 to 81 years old. The patients who had AR the indices showed differences: Isovolumetric Relaxation Time IRT(p=0.0011), Diference between the pulmonary A wave duration and mitral A duration (p=0.0097), Left Atrial Systolic Volume (p=0.0019), Left Atrial Systolic Volume Index(p=0.0011), Left Atrial Diastolic Volume (p=0.0110), Left Ventricular Diastolic Diameter (p<0.0001), Left Ventricular Systolic Diameter (p<0.0001), End Systolic Volume (p<0.0001), End Diastolic Volume (p<0.0001), Left Ventricular Mass Index (p<0.0001) and Left Ventricular Volume and Left Ventricular Mass Index ratio (p<0.0001). Analyzing patients with AS the indices who showed differences: (The ratio of mitral velocity to early diastolic velocity of the mitral annulus) E/E (p=0.0379)(Isovolumetric Relaxation Time)(p=0.0072) IRT, Diference between the pulmonary A wave duration and mitral A duration (p=0.0176), Left Atrial Sistolic Volume (p=0.0242), Left Atrial Systolic Volume Index (p=0.0237), Left Atrial Ejection Fraction (p=0.0339) Left Ventricular Diastolic Diameter (p=0.0002), Left Ventricular Systolic Diameter (p=0.0085), End Diastolic Volume (LVEDV) (p=0.0194), Left ventricular Mass Index(p<0.0001), Left Ventricular Volume and Mass Index Ratio (p<0.0001). CONCLUSIONS: As we studied diastolic function we have verified significant statistic variation in aortic regurgitation and aortic stenosis comparing before and after aortic valve replacement. Likewise we have seen there is correlation between NTproBNP and echocardiographic variables that show diastolic dysfunction.
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Compatibility of X-ray Tubes with Magnetic Resonance Imaging Scanners for Aortic Valve ReplacementBracken, John Allan 18 February 2010 (has links)
Aortic stenosis is the most common acquired heart valve condition. Open-heart surgical aortic valve replacement is an effective treatment for patients who receive it. However, approximately one-third of patients who require this treatment do not receive it due to the risks associated with the surgery. Percutaneous aortic valve replacement (PAVR) is a minimally invasive technique that can replace the aortic valve of patients contraindicated for open-heart surgery.
Although PAVR is now entering clinical practice, a closed bore hybrid x-ray/MRI (CBXMR) imaging system is under development to improve the safety and efficacy of PAVR. This system will harness the complementary strengths of x-ray imaging (surgical tool/vascular imaging) and MRI (cardiac soft tissue contrast) to deploy a bioprosthesis in the aortic annulus. An x-ray C-arm will be placed about 1 m from the entrance of the MRI scanner to facilitate smooth intermodality patient transfer during the procedure.
The performance of a rotating-anode x-ray tube in the magnetic fringe field of a 1.5 T MRI scanner was investigated. A rotating-anode x-ray tube provides the fluoroscopy and angiography needed for PAVR.
The magnetic fringe field can affect the ability of the x-ray tube to dissipate heat. It was shown that the fringe field perpendicular to the anode rotation axis can reduce anode rotation frequency. These effects can limit the maximum permissible power that can be safely dissipated on the anode track during a single exposure. In the fringe field strengths at the C-arm position (4-5 mT), anode rotation frequency only decreased by about 1%, which will have negligible impact on tube heat loadability.
The fringe field can cause a field of view shift. The field of view shifted by approximately 3 mm, which can be corrected by active magnetic shielding and further collimation. An active magnetic shielding system was constructed that can correct focal spot deflection. These results are facilitating the construction of a prototype CBXMR system, the goal of which is to improve success rates for PAVR procedures.
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Compatibility of X-ray Tubes with Magnetic Resonance Imaging Scanners for Aortic Valve ReplacementBracken, John Allan 18 February 2010 (has links)
Aortic stenosis is the most common acquired heart valve condition. Open-heart surgical aortic valve replacement is an effective treatment for patients who receive it. However, approximately one-third of patients who require this treatment do not receive it due to the risks associated with the surgery. Percutaneous aortic valve replacement (PAVR) is a minimally invasive technique that can replace the aortic valve of patients contraindicated for open-heart surgery.
Although PAVR is now entering clinical practice, a closed bore hybrid x-ray/MRI (CBXMR) imaging system is under development to improve the safety and efficacy of PAVR. This system will harness the complementary strengths of x-ray imaging (surgical tool/vascular imaging) and MRI (cardiac soft tissue contrast) to deploy a bioprosthesis in the aortic annulus. An x-ray C-arm will be placed about 1 m from the entrance of the MRI scanner to facilitate smooth intermodality patient transfer during the procedure.
The performance of a rotating-anode x-ray tube in the magnetic fringe field of a 1.5 T MRI scanner was investigated. A rotating-anode x-ray tube provides the fluoroscopy and angiography needed for PAVR.
The magnetic fringe field can affect the ability of the x-ray tube to dissipate heat. It was shown that the fringe field perpendicular to the anode rotation axis can reduce anode rotation frequency. These effects can limit the maximum permissible power that can be safely dissipated on the anode track during a single exposure. In the fringe field strengths at the C-arm position (4-5 mT), anode rotation frequency only decreased by about 1%, which will have negligible impact on tube heat loadability.
The fringe field can cause a field of view shift. The field of view shifted by approximately 3 mm, which can be corrected by active magnetic shielding and further collimation. An active magnetic shielding system was constructed that can correct focal spot deflection. These results are facilitating the construction of a prototype CBXMR system, the goal of which is to improve success rates for PAVR procedures.
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[en] NUMERICAL STUDY OF THE INFLUENCE OF TILT VALVE ANGLE ON BLOOD FLOW IN AN AORTIC MODEL / [pt] ESTUDO NUMÉRICO DA INFLUÊNCIA DA INCLINAÇÃO DO ÂNGULO DA VÁLVULA NO ESCOAMENTO SANGUÍNEO EM UM MODELO AÓRTICODIEGO FERNANDO CELIS TORRES 13 December 2017 (has links)
[pt] A substituição de válvula aórtica por cateter (Transcatheter Aortic Valve Replacement, TAVR) tornou-se uma poderosa alternativa para pacientes com estenose aórtica e com alto risco de serem submetidos à cirurgia tradicional de peito aberto. O conhecimento da distribuição da pressão, bem como a tensão cisalhante
na superfície da aorta podem ajudar a identificar regiões críticas, onde o processo de remodelamento da aorta pode ocorrer. O objetivo do presente trabalho é avaliar numericamente a influência do posicionamento do orifício da válvula protética no campo de escoamento. O estudo foi realizado com base em um paciente submetido a TAVR. Um modelo 3D foi gerado a partir de angiotomografia e de segmentação de imagens da aorta. Dados experimentais obtidos anteriormente na mesma geometria indicaram que o fluxo do jato através da válvula de entrada é de natureza turbulenta. O escoamento foi determinado numericamente com o software comercial FLUENT. A turbulência foi modelada com o modelo de dois equações k-omega SST. Para representar um fluxo pulsátil, foram impostos diferentes fluxo de massa na entrada da válvula. Para todas as vazões investigadas, obteve-se um padrão de escoamento semelhante. Mostrou-se que uma pequena variação dos ângulos de inclinação pode modificar a natureza do fluxo, deslocando a posição dos vórtices e alterando a localização das regiões de alta tensão de cisalhamento, assim como de alta pressão, na superfície interna da aorta. Mostrou-se também que um
aumento da intensidade da turbulência na entrada diminui os valores de tensão cisalhante e de pressão nas paredes da aorta. Essas características hemodinâmicas podem ser relevantes no processo de remodelação aórtica e os estresses mecânicos podem influenciar na durabilidade da prótese valvular. / [en] Transcatheter Aortic Valve Replacement (TAVR) has become a powerful alternative for patients with aortic stenosis and a high surgical risk to face a traditional open chest surgery. The knowledge of the pressure distribution as well as shear stress at the aortic surface may help identify critical regions, where aortic
remodeling process may occur. The purpose of the present work is to evaluate numerically the influence of the positioning of the prosthetic valve orifice in the flow field. The study was carried out on the basis of a particular patient who had undergone a TAVR. A 3D model was generated from computed tomography
angiography and image segmentation of the aorta. Experimental data previously obtained in the same geometry indicated that the jet flow through the inlet valve is turbulent flow. The flow field was numerically determined with the commercial software Fluent. The turbulence was modeled with the two-equation k-omega SST model. To represent a pulsatile flow, different mass flow rates were imposed at the inlet valve. Similar flow pattern was observed for all flow rates investigated. It was shown that small variations of the tilt angle can modify the nature of the flow, displacing the position of the vortices and altering the location of high shear stress, as well as high pressure, at the aortic inner wall. It was also shown that an increase
of the turbulent intensity at the entrance decreases the values of shear stress and pressure on the walls. These hemodynamic features may be relevant in the aortic remodeling process and the mechanical stresses may influence the durability of the valve prosthesis.
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Comparação da sobrevida entre indivíduos submetidos à cirurgia para substituição valvar aórtica utilizando próteses mecânicas ou biológicas em uma coorte brasileiraAlmeida, Adriana Silveira de January 2010 (has links)
Este estudo avalia mortalidade, eventos hemorrágicos e reoperação em pacientes submetidos à cirurgia para troca valvar aórtica utilizando substituto biológico ou mecânico, com poder de relevância na seleção do tipo da prótese. Foram selecionados, randomicamente, 301 pacientes submetidos à cirurgia para troca valvar aórtica entre 1990 e 2005, com seguimento máximo de 20 anos. A sobrevivência em 5, 10 e 15 anos após cirurgia utilizando substituto mecânico foi de 83,9%, 75,4% e 60,2% e, para substituto biológico, foi de 89,3%, 70,4% e 58,4%, respectivamente (p=0,939). Os fatores associados com o óbito foram: idade, obesidade, doença pulmonar, arritmias, eventos hemorrágicos e insuficiência valvar aórtica. A probabilidade livre de reoperação desses pacientes em 5, 10 e 15 anos após cirurgia utilizando substituto mecânico foi de 97,9%, 95,8% e 95,8% e, para bioprótese, foi de 94,6%, 91,0% e 83,3%, respectivamente (p=0,057). Os fatores associados com reoperação foram: insuficiência renal, endocardite de prótese e idade. A probabilidade livre de eventos hemorrágicos em 5, 10 e 15 anos após cirurgia utilizando substituto mecânico foi de 94,5%, 91,7% e 91,7% e, para bioprótese, foi de 98,6%, 97,8% e 97,8%, respectivamente (p=0,047). Os fatores associados com eventos hemorrágicos foram: insuficiência renal e prótese mecânica. Os autores concluíram que: 1) a mortalidade foi estatisticamente semelhante entre os grupos; 2) as características basais dos pacientes foram os maiores determinantes de mortalidade tardia após a cirurgia; 3) houve uma tendência à reoperação para o grupo com bioprótese; 4) pacientes com prótese mecânica tiveram mais eventos hemorrágicos ao longo do tempo; 5) os dados encontrados no presente estudo são concordantes com a literatura atual. / This paper evaluates mortality, bleeding events and reoperation in patients subjected to surgery for replacement of the aortic valve using a biological or a mechanical substitute, where selection of the type of prosthesis is relevant. Three hundred and one patients who had been subjected to aortic valve replacement surgery between 1990 and 2005, with a maximum follow-up period of 20 years, have been randomly selected. Survival at 5, 10 and 15 years after surgery using a mechanical substitute was 83.9%, 75.4% and 60.2% and, for a biological substitute, was 89.3%, 70.4% and 58.4%, respectively (p=0.939). Factors associated with death were: age, obesity, pulmonary disease, arrhythmia, bleeding and aortic valve failure. The probability free of reoperation for these patients at 5, 10 and 15 years after surgery using a mechanical substitute was 97.9%, 95.8% and 95.8% and, for those using bioprostheses, was 94.6%, 91.0% and 83.3%, respectively (p=0.057). Factors associated with reoperation were: renal failure, prosthesis endocarditis and age. The probability free of bleeding events at 5, 10 and 15 years after surgery using the mechanical substitute was 94.5%, 91.7% and 91.7% and, for bioprostheses, was 98.6%, 97.8% and 97.8%, respectively (p=0.047). Factors associated with bleeding events were: renal failure and mechanical prostheses. The authors have concluded that: 1) mortality was statistically similar in the groups; 2) patient characteristics at baseline were a major determinant of late mortality after surgery; 3) there was a tendency toward reoperation in the bioprostheses group; 4) patients using a mechanical prosthesis had more bleeding events as time passed; 5) the data presented in this paper is in accordance with current literature.
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Comparação da sobrevida entre indivíduos submetidos à cirurgia para substituição valvar aórtica utilizando próteses mecânicas ou biológicas em uma coorte brasileiraAlmeida, Adriana Silveira de January 2010 (has links)
Este estudo avalia mortalidade, eventos hemorrágicos e reoperação em pacientes submetidos à cirurgia para troca valvar aórtica utilizando substituto biológico ou mecânico, com poder de relevância na seleção do tipo da prótese. Foram selecionados, randomicamente, 301 pacientes submetidos à cirurgia para troca valvar aórtica entre 1990 e 2005, com seguimento máximo de 20 anos. A sobrevivência em 5, 10 e 15 anos após cirurgia utilizando substituto mecânico foi de 83,9%, 75,4% e 60,2% e, para substituto biológico, foi de 89,3%, 70,4% e 58,4%, respectivamente (p=0,939). Os fatores associados com o óbito foram: idade, obesidade, doença pulmonar, arritmias, eventos hemorrágicos e insuficiência valvar aórtica. A probabilidade livre de reoperação desses pacientes em 5, 10 e 15 anos após cirurgia utilizando substituto mecânico foi de 97,9%, 95,8% e 95,8% e, para bioprótese, foi de 94,6%, 91,0% e 83,3%, respectivamente (p=0,057). Os fatores associados com reoperação foram: insuficiência renal, endocardite de prótese e idade. A probabilidade livre de eventos hemorrágicos em 5, 10 e 15 anos após cirurgia utilizando substituto mecânico foi de 94,5%, 91,7% e 91,7% e, para bioprótese, foi de 98,6%, 97,8% e 97,8%, respectivamente (p=0,047). Os fatores associados com eventos hemorrágicos foram: insuficiência renal e prótese mecânica. Os autores concluíram que: 1) a mortalidade foi estatisticamente semelhante entre os grupos; 2) as características basais dos pacientes foram os maiores determinantes de mortalidade tardia após a cirurgia; 3) houve uma tendência à reoperação para o grupo com bioprótese; 4) pacientes com prótese mecânica tiveram mais eventos hemorrágicos ao longo do tempo; 5) os dados encontrados no presente estudo são concordantes com a literatura atual. / This paper evaluates mortality, bleeding events and reoperation in patients subjected to surgery for replacement of the aortic valve using a biological or a mechanical substitute, where selection of the type of prosthesis is relevant. Three hundred and one patients who had been subjected to aortic valve replacement surgery between 1990 and 2005, with a maximum follow-up period of 20 years, have been randomly selected. Survival at 5, 10 and 15 years after surgery using a mechanical substitute was 83.9%, 75.4% and 60.2% and, for a biological substitute, was 89.3%, 70.4% and 58.4%, respectively (p=0.939). Factors associated with death were: age, obesity, pulmonary disease, arrhythmia, bleeding and aortic valve failure. The probability free of reoperation for these patients at 5, 10 and 15 years after surgery using a mechanical substitute was 97.9%, 95.8% and 95.8% and, for those using bioprostheses, was 94.6%, 91.0% and 83.3%, respectively (p=0.057). Factors associated with reoperation were: renal failure, prosthesis endocarditis and age. The probability free of bleeding events at 5, 10 and 15 years after surgery using the mechanical substitute was 94.5%, 91.7% and 91.7% and, for bioprostheses, was 98.6%, 97.8% and 97.8%, respectively (p=0.047). Factors associated with bleeding events were: renal failure and mechanical prostheses. The authors have concluded that: 1) mortality was statistically similar in the groups; 2) patient characteristics at baseline were a major determinant of late mortality after surgery; 3) there was a tendency toward reoperation in the bioprostheses group; 4) patients using a mechanical prosthesis had more bleeding events as time passed; 5) the data presented in this paper is in accordance with current literature.
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Comparação da sobrevida entre indivíduos submetidos à cirurgia para substituição valvar aórtica utilizando próteses mecânicas ou biológicas em uma coorte brasileiraAlmeida, Adriana Silveira de January 2010 (has links)
Este estudo avalia mortalidade, eventos hemorrágicos e reoperação em pacientes submetidos à cirurgia para troca valvar aórtica utilizando substituto biológico ou mecânico, com poder de relevância na seleção do tipo da prótese. Foram selecionados, randomicamente, 301 pacientes submetidos à cirurgia para troca valvar aórtica entre 1990 e 2005, com seguimento máximo de 20 anos. A sobrevivência em 5, 10 e 15 anos após cirurgia utilizando substituto mecânico foi de 83,9%, 75,4% e 60,2% e, para substituto biológico, foi de 89,3%, 70,4% e 58,4%, respectivamente (p=0,939). Os fatores associados com o óbito foram: idade, obesidade, doença pulmonar, arritmias, eventos hemorrágicos e insuficiência valvar aórtica. A probabilidade livre de reoperação desses pacientes em 5, 10 e 15 anos após cirurgia utilizando substituto mecânico foi de 97,9%, 95,8% e 95,8% e, para bioprótese, foi de 94,6%, 91,0% e 83,3%, respectivamente (p=0,057). Os fatores associados com reoperação foram: insuficiência renal, endocardite de prótese e idade. A probabilidade livre de eventos hemorrágicos em 5, 10 e 15 anos após cirurgia utilizando substituto mecânico foi de 94,5%, 91,7% e 91,7% e, para bioprótese, foi de 98,6%, 97,8% e 97,8%, respectivamente (p=0,047). Os fatores associados com eventos hemorrágicos foram: insuficiência renal e prótese mecânica. Os autores concluíram que: 1) a mortalidade foi estatisticamente semelhante entre os grupos; 2) as características basais dos pacientes foram os maiores determinantes de mortalidade tardia após a cirurgia; 3) houve uma tendência à reoperação para o grupo com bioprótese; 4) pacientes com prótese mecânica tiveram mais eventos hemorrágicos ao longo do tempo; 5) os dados encontrados no presente estudo são concordantes com a literatura atual. / This paper evaluates mortality, bleeding events and reoperation in patients subjected to surgery for replacement of the aortic valve using a biological or a mechanical substitute, where selection of the type of prosthesis is relevant. Three hundred and one patients who had been subjected to aortic valve replacement surgery between 1990 and 2005, with a maximum follow-up period of 20 years, have been randomly selected. Survival at 5, 10 and 15 years after surgery using a mechanical substitute was 83.9%, 75.4% and 60.2% and, for a biological substitute, was 89.3%, 70.4% and 58.4%, respectively (p=0.939). Factors associated with death were: age, obesity, pulmonary disease, arrhythmia, bleeding and aortic valve failure. The probability free of reoperation for these patients at 5, 10 and 15 years after surgery using a mechanical substitute was 97.9%, 95.8% and 95.8% and, for those using bioprostheses, was 94.6%, 91.0% and 83.3%, respectively (p=0.057). Factors associated with reoperation were: renal failure, prosthesis endocarditis and age. The probability free of bleeding events at 5, 10 and 15 years after surgery using the mechanical substitute was 94.5%, 91.7% and 91.7% and, for bioprostheses, was 98.6%, 97.8% and 97.8%, respectively (p=0.047). Factors associated with bleeding events were: renal failure and mechanical prostheses. The authors have concluded that: 1) mortality was statistically similar in the groups; 2) patient characteristics at baseline were a major determinant of late mortality after surgery; 3) there was a tendency toward reoperation in the bioprostheses group; 4) patients using a mechanical prosthesis had more bleeding events as time passed; 5) the data presented in this paper is in accordance with current literature.
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