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[PMID]:29362794
[Au] Autor:Friedman DJ; Piccini JP; Wang T; Zheng J; Malaisrie SC; Holmes DR; Suri RM; Mack MJ; Badhwar V; Jacobs JP; Gaca JG; Chow SC; Peterson ED; Brennan JM
[Ad] Endereço:Duke Clinical Research Institute, Durham, North Carolina.
[Ti] Título:Association Between Left Atrial Appendage Occlusion and Readmission for Thromboembolism Among Patients With Atrial Fibrillation Undergoing Concomitant Cardiac Surgery.
[So] Source:JAMA;319(4):365-374, 2018 01 23.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: The left atrial appendage is a key site of thrombus formation in atrial fibrillation (AF) and can be occluded or removed at the time of cardiac surgery. There is limited evidence regarding the effectiveness of surgical left atrial appendage occlusion (S-LAAO) for reducing the risk of thromboembolism. Objective: To evaluate the association of S-LAAO vs no receipt of S-LAAO with the risk of thromboembolism among older patients undergoing cardiac surgery. Design, Setting, and Participants: Retrospective cohort study of a nationally representative Medicare-linked cohort from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (2011-2012). Patients aged 65 years and older with AF undergoing cardiac surgery (coronary artery bypass grafting [CABG], mitral valve surgery with or without CABG, or aortic valve surgery with or without CABG) with and without concomitant S-LAAO were followed up until December 31, 2014. Exposures: S-LAAO vs no S-LAAO. Main Outcomes and Measures: The primary outcome was readmission for thromboembolism (stroke, transient ischemic attack, or systemic embolism) at up to 3 years of follow-up, as defined by Medicare claims data. Secondary end points included hemorrhagic stroke, all-cause mortality, and a composite end point (thromboembolism, hemorrhagic stroke, or all-cause mortality). Results: Among 10 524 patients undergoing surgery (median age, 76 years; 39% female; median CHA2DS2-VASc score, 4), 3892 (37%) underwent S-LAAO. Overall, at a mean follow-up of 2.6 years, thromboembolism occurred in 5.4%, hemorrhagic stroke in 0.9%, all-cause mortality in 21.5%, and the composite end point in 25.7%. S-LAAO, compared with no S-LAAO, was associated with lower unadjusted rates of thromboembolism (4.2% vs 6.2%), all-cause mortality (17.3% vs 23.9%), and the composite end point (20.5% vs 28.7%) but no significant difference in rates of hemorrhagic stroke (0.9% vs 0.9%). After inverse probability-weighted adjustment, S-LAAO was associated with a significantly lower rate of thromboembolism (subdistribution hazard ratio [HR], 0.67; 95% CI, 0.56-0.81; P < .001), all-cause mortality (HR, 0.88; 95% CI, 0.79-0.97; P = .001), and the composite end point (HR, 0.83; 95% CI, 0.76-0.91; P < .001) but not hemorrhagic stroke (subdistribution HR, 0.84; 95% CI, 0.53-1.32; P = .44). S-LAAO, compared with no S-LAAO, was associated with a lower risk of thromboembolism among patients discharged without anticoagulation (unadjusted rate, 4.2% vs 6.0%; adjusted subdistribution HR, 0.26; 95% CI, 0.17-0.40; P < .001), but not among patients discharged with anticoagulation (unadjusted rate, 4.1% vs 6.3%; adjusted subdistribution HR, 0.88; 95% CI, 0.56-1.39; P = .59). Conclusions and Relevance: Among older patients with AF undergoing concomitant cardiac surgery, S-LAAO, compared with no S-LAAO, was associated with a lower risk of readmission for thromboembolism over 3 years. These findings support the use of S-LAAO, but randomized trials are necessary to provide definitive evidence.
[Mh] Termos MeSH primário: Apêndice Atrial/cirurgia
Fibrilação Atrial
Procedimentos Cirúrgicos Cardíacos/efeitos adversos
Readmissão do Paciente/estatística & dados numéricos
Tromboembolia/prevenção & controle
[Mh] Termos MeSH secundário: Idoso
Valva Aórtica/cirurgia
Ponte de Artéria Coronária/efeitos adversos
Seguimentos
Seres Humanos
Estimativa de Kaplan-Meier
Valva Mitral/cirurgia
Modelos de Riscos Proporcionais
Estudos Retrospectivos
Dispositivo para Oclusão Septal
Tromboembolia/epidemiologia
Tromboembolia/etiologia
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; OBSERVATIONAL STUDY; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.20125


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[PMID]:29297076
[Au] Autor:Feldman TE; Reardon MJ; Rajagopal V; Makkar RR; Bajwa TK; Kleiman NS; Linke A; Kereiakes DJ; Waksman R; Thourani VH; Stoler RC; Mishkel GJ; Rizik DG; Iyer VS; Gleason TG; Tchétché D; Rovin JD; Buchbinder M; Meredith IT; Götberg M; Bjursten H; Meduri C; Salinger MH; Allocco DJ; Dawkins KD
[Ad] Endereço:Evanston Hospital Cardiology Division, Northshore University Health System, Evanston, Illinois.
[Ti] Título:Effect of Mechanically Expanded vs Self-Expanding Transcatheter Aortic Valve Replacement on Mortality and Major Adverse Clinical Events in High-Risk Patients With Aortic Stenosis: The REPRISE III Randomized Clinical Trial.
[So] Source:JAMA;319(1):27-37, 2018 01 02.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Transcatheter aortic valve replacement (TAVR) is established for selected patients with severe aortic stenosis. However, limitations such as suboptimal deployment, conduction disturbances, and paravalvular leak occur. Objective: To evaluate if a mechanically expanded valve (MEV) is noninferior to an approved self-expanding valve (SEV) in high-risk patients with aortic stenosis undergoing TAVR. Design, Setting, and Participants: The REPRISE III trial was conducted in 912 patients with high or extreme risk and severe, symptomatic aortic stenosis at 55 centers in North America, Europe, and Australia between September 22, 2014, and December 24, 2015, with final follow-up on March 8, 2017. Interventions: Participants were randomized in a 2:1 ratio to receive either an MEV (n = 607) or an SEV (n = 305). Main Outcomes and Measures: The primary safety end point was the 30-day composite of all-cause mortality, stroke, life-threatening or major bleeding, stage 2/3 acute kidney injury, and major vascular complications tested for noninferiority (margin, 10.5%). The primary effectiveness end point was the 1-year composite of all-cause mortality, disabling stroke, and moderate or greater paravalvular leak tested for noninferiority (margin, 9.5%). If noninferiority criteria were met, the secondary end point of 1-year moderate or greater paravalvular leak was tested for superiority in the full analysis data set. Results: Among 912 randomized patients (mean age, 82.8 [SD, 7.3] years; 463 [51%] women; predicted risk of mortality, 6.8%), 874 (96%) were evaluable at 1 year. The primary safety composite end point at 30 days occurred in 20.3% of MEV patients and 17.2% of SEV patients (difference, 3.1%; Farrington-Manning 97.5% CI, -∞ to 8.3%; P = .003 for noninferiority). At 1 year, the primary effectiveness composite end point occurred in 15.4% with the MEV and 25.5% with the SEV (difference, -10.1%; Farrington-Manning 97.5% CI, -∞ to -4.4%; P<.001 for noninferiority). The 1-year rates of moderate or severe paravalvular leak were 0.9% for the MEV and 6.8% for the SEV (difference, -6.1%; 95% CI, -9.6% to -2.6%; P < .001). The superiority analysis for primary effectiveness was statistically significant (difference, -10.2%; 95% CI, -16.3% to -4.0%; P < .001). The MEV had higher rates of new pacemaker implants (35.5% vs 19.6%; P < .001) and valve thrombosis (1.5% vs 0%) but lower rates of repeat procedures (0.2% vs 2.0%), valve-in-valve deployments (0% vs 3.7%), and valve malpositioning (0% vs 2.7%). Conclusions and Relevance: Among high-risk patients with aortic stenosis, use of the MEV compared with the SEV did not result in inferior outcomes for the primary safety end point or the primary effectiveness end point. These findings suggest that the MEV may be a useful addition for TAVR in high-risk patients. Trial Registration: ClinicalTrials.gov Identifier: NCT02202434.
[Mh] Termos MeSH primário: Estenose da Valva Aórtica/cirurgia
Valva Aórtica/cirurgia
Próteses Valvulares Cardíacas
Substituição da Valva Aórtica Transcateter/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Estenose da Valva Aórtica/mortalidade
Bioprótese
Doenças Cardiovasculares/etiologia
Doenças Cardiovasculares/mortalidade
Feminino
Seguimentos
Seres Humanos
Masculino
Complicações Pós-Operatórias/etiologia
Desenho de Prótese
Fatores de Risco
Substituição da Valva Aórtica Transcateter/métodos
Substituição da Valva Aórtica Transcateter/mortalidade
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180311
[Lr] Data última revisão:
180311
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180104
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.19132


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[PMID]:28453794
[Au] Autor:Kawahito K; Kimura N; Komiya K; Nakamura M; Misawa Y
[Ad] Endereço:Division of Cardiovascular Surgery, Jichi Medical University, Tochigi, Japan.
[Ti] Título:Blood flow competition after aortic valve bypass: an evaluation using computational fluid dynamics.
[So] Source:Interact Cardiovasc Thorac Surg;24(5):670-676, 2017 05 01.
[Is] ISSN:1569-9285
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Aortic valve bypass (AVB) (apico-aortic conduit) remains an effective surgical alternative for patients in whom surgical aortic valve replacement or transcatheter aortic valve implantation is not feasible. However, specific complications include thrombus formation, possibly caused by stagnation arising from flow competition between the antegrade and retrograde flow, but this has not been fully investigated. The aim of this study was to analyse flow characteristics after AVB and to elucidate mechanisms of intra-aortic thrombus using computational fluid dynamics (CFD). METHODS: Flow simulation was performed on data obtained from a 73-year-old postoperative AVB patient. Three-dimensional cine phase-contrast magnetic resonance imaging at 3 Tesla was used to acquire flow data and to set up the simulation. The vascular geometry was reconstructed using computed tomography angiograms. Flow simulations were implemented at various ratios of the flow rate between the ascending aorta and the graft. Results were visualized by streamline and particle tracing. RESULTS: CFD demonstrated stagnation in the ascending aorta-arch when retrograde flow was dominant, indicating that the risk of thrombus formation exists in the ascending arch in cases with severe aortic stenosis and/or poor left ventricular function. Meanwhile, stagnation was observed in the proximal descending aorta when the antegrade and retrograde flow were equivalent, suggesting that the descending aorta is critical when aortic stenosis is not severe. CONCLUSIONS: Flow stagnation in the aorta which may cause thrombus was observed when retrograde flow was dominant and antegrade/retrograde flows were equivalent. Our results suggest that anticoagulants might be recommended even in patients who receive biological valves.
[Mh] Termos MeSH primário: Aorta Torácica/cirurgia
Estenose da Valva Aórtica/cirurgia
Valva Aórtica/cirurgia
Apêndice Atrial/cirurgia
Velocidade do Fluxo Sanguíneo/fisiologia
Simulação por Computador
Imagem Cinética por Ressonância Magnética/métodos
[Mh] Termos MeSH secundário: Idoso
Anastomose Cirúrgica/métodos
Aorta Torácica/diagnóstico por imagem
Aorta Torácica/fisiopatologia
Valva Aórtica/diagnóstico por imagem
Valva Aórtica/fisiopatologia
Estenose da Valva Aórtica/fisiopatologia
Apêndice Atrial/diagnóstico por imagem
Apêndice Atrial/fisiopatologia
Seres Humanos
Masculino
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/icvts/ivw428


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[PMID]:28453792
[Au] Autor:Risteski P; Monsefi N; Miskovic A; Josic T; Bala S; Salem R; Zierer A; Moritz A
[Ad] Endereço:Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany.
[Ti] Título:Triple valve surgery through a less invasive approach: early and mid-term results.
[So] Source:Interact Cardiovasc Thorac Surg;24(5):677-682, 2017 05 01.
[Is] ISSN:1569-9285
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: A partial upper sternotomy has become established as a less invasive approach mainly for single and double valve surgery. This report evaluates the clinical outcomes of triple valve surgery performed through a partial upper sternotomy. METHODS: We reviewed the medical records of 37 consecutive patients (28 men, 76%) who underwent triple valve surgery through a partial upper sternotomy between 2005 and 2015. The patients' mean age was 67 ± 17 years; 27 (73%) were in New York Heart Association Class III or IV. Aortic and mitral valve insufficiency was more common than stenosis. Ninety-three percent of surviving patients were followed for a mean period of 58 ± 24 months. RESULTS: Aortic valve procedures consisted of 24 (65%) replacements and 13 (35%) repairs. The mitral valve was repaired in 28 (76%) patients, whereas tricuspid valve repair was feasible in all patients. No conversion to full sternotomy was necessary. Myocardial infarction was not observed. Chest tube drainage was 330 ± 190 ml, and 4 patients required reopening for bleeding (1, 3%) or tamponade (3, 8%). One stroke was observed due to heparin-induced thrombocytopaenia after initial unremarkable neurological recovery. Early mortality included 5 (13.5%) patients. Actuarial survival at 5 years was 52 ± 10%. CONCLUSIONS: A partial upper sternotomy provides adequate exposure to all heart valves. We did not experience technical limitations with this approach. Wound dehiscence, postoperative bleeding, intensive care unit and hospital stay and early deaths were low compared to data from other published series of triple valve surgery through a full median sternotomy. Early and mid-term outcomes were not adversely affected by this less invasive approach.
[Mh] Termos MeSH primário: Valva Aórtica/cirurgia
Procedimentos Cirúrgicos Cardíacos/métodos
Doenças das Valvas Cardíacas/cirurgia
Procedimentos Cirúrgicos Minimamente Invasivos/métodos
Valva Mitral/cirurgia
Esternotomia/métodos
Valva Tricúspide/cirurgia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seguimentos
Seres Humanos
Tempo de Internação
Masculino
Meia-Idade
Insuficiência da Valva Mitral/cirurgia
Estudos Retrospectivos
Fatores de Tempo
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/icvts/ivw430


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[PMID]:27773869
[Au] Autor:Doose C; Kütting M; Egron S; Farhadi Ghalati P; Schmitz C; Utzenrath M; Sedaghat A; Fujita B; Schmitz-Rode T; Ensminger S; Steinseifer U
[Ad] Endereço:Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz-Institute Aachen, RWTH Aachen University, Aachen, Germany.
[Ti] Título:Valve-in-valve outcome: design impact of a pre-existing bioprosthesis on the hydrodynamics of an Edwards Sapien XT valve.
[So] Source:Eur J Cardiothorac Surg;51(3):562-570, 2017 03 01.
[Is] ISSN:1873-734X
[Cp] País de publicação:Germany
[La] Idioma:eng
[Ab] Resumo:Objectives: Bioprosthetic aortic heart valves are increasingly implanted in younger patients. Therefore, a strategy for potential valve failure should be developed before implanting the 'first valve'. The goal of this in vitro study was to provide insight into the effects of the design of a bioprosthesis on a valve-in-valve implanted Sapien XT valve. Methods: The hydrodynamic performance of a 23-mm Sapien XT valve implanted in Vascutek Aspire, Edwards Perimount, Medtronic Mosaic and St. Jude Medical Trifecta heart valves was investigated in a left heart simulator. In addition to the hydrodynamic results, the leaflet dynamics were analysed in high-speed video recordings of the tests. Results: All valve-in-valve combinations in this study fulfilled the minimum acceptance criteria defined by relevant approval standards (e.g. ISO 5840) but displayed significant differences in their performances. Small inner diameters of the bioprostheses were associated with increased mean pressure gradients, decreased effective orifice areas and geometric opening areas as well as with pin-wheeling and uneven leaflet motion. In addition, implantation in bioprostheses with internally mounted leaflets was associated with lower paravalvular leakage. Conclusions: The results of this study suggest that a surgical bioprosthesis with a large inner diameter and internally mounted leaflets improves the heamodynamics and potentially the durability of a valve-in-valve combination. These results should give the attending physicians critical information to consider when deciding on a bioprosthesis for younger patients.
[Mh] Termos MeSH primário: Valva Aórtica/cirurgia
Bioprótese
Implante de Prótese de Valva Cardíaca/métodos
Próteses Valvulares Cardíacas
[Mh] Termos MeSH secundário: Valva Aórtica/fisiopatologia
Seres Humanos
Hidrodinâmica
Desenho de Prótese
Falha de Prótese
Reoperação/instrumentação
Reoperação/métodos
Resultado do Tratamento
Gravação em Vídeo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.1093/ejcts/ezw317


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[PMID]:29300074
[Au] Autor:Schneider A; Klautz RJM; Hazekamp M
[Ad] Endereço:Department of Cardiothoracic Surgery Leiden University Medical Center Leiden, The Netherlands.
[Ti] Título:The Ross reimplantation technique.
[So] Source:Multimed Man Cardiothorac Surg;2017, 2017 Sep 25.
[Is] ISSN:1813-9175
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Pulmonary autograft replacement of a diseased aortic valve (the Ross procedure) is effective in children, where growth is essential, and in young patients for whom a biological solution is preferred. Long-term outcomes are generally good. However eventual autograft dilatation may necessitate reoperation. In order to diminish the risk of autograft dilatation, several 'wrapping' techniques have been developed. Here, we present our technique of choice: the reimplantation of the pulmonary autograft in a vascular tube graft, scalloping the sinuses of Valsalva. This leaves no bulky tissue inside the vascular tube graft and makes autograft dilatation impossible.
[Mh] Termos MeSH primário: Valva Aórtica/cirurgia
Implante de Prótese de Valva Cardíaca/métodos
[Mh] Termos MeSH secundário: Bioprótese
Implante de Prótese Vascular
Seres Humanos
Reoperação
Reimplante
Seio Aórtico/cirurgia
Transplante Autólogo
[Pt] Tipo de publicação:VIDEO-AUDIO MEDIA
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180105
[St] Status:MEDLINE
[do] DOI:10.1510/mmcts.2017.019


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[PMID]:27776988
[Au] Autor:Dobarro D; Urban M; Booth K; Wrightson N; Castrodeza J; Jungschleger J; Robinson-Smith N; Woods A; Parry G; Schueler S; MacGowan GA
[Ad] Endereço:Cardiothoracic Directorate, Freeman Hospital, Newcastle upon Tyne Hospitals. NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario, Valladolid, Spain; Department of Medicine, Universidad de Valladolid, Valladolid, Spain.
[Ti] Título:Impact of aortic valve closure on adverse events and outcomes with the HeartWare ventricular assist device.
[So] Source:J Heart Lung Transplant;36(1):42-49, 2017 Jan.
[Is] ISSN:1557-3117
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: This study examined whether aortic valve opening (AVO) and other echocardiographic parameters influence outcomes in patients on left ventricular (LV) assist device (LVAD) support. Pump thrombosis (PT) and ischemic stroke (IS) are known complications of LVAD, but mechanisms that could influence them are not completely understood. METHODS: This was a retrospective analysis of 147 patients who received a HeartWare Ventricular Assist Device ( HeartWare International) as a bridge to transplant or to candidacy between July 2009 and August 2015, of whom 126 had at least 30 days of follow-up before the first event (30-days-out cohort). Outcomes included survival, PT, IS, and PT+IS (combined thrombotic event; CTE). RESULTS: Median time on support was 518 days. Of the 30-days-out cohort, 29% had a first PT and 19% a first IS. AVO was associated with longer survival on device (1,081 vs 723 days; p = 0.01) in the entire cohort. In the 30-days-out cohort, the aortic valve was more frequently closed in patients with lower ejection fractions on support (14% ± 6% vs 18% ± 9%; p = 0.009), more dilated pre-event echocardiogram (LV end-diastolic diameter, 66 ± 12 mm vs 62 ± 10 mm; p = 0.04), and pre-implant LV end-diastolic diameter (70 ± 10 mm vs 66 ± 9 mm; p = 0.06). CTE-free survival on the device was lower with a closed aortic valve (897 vs 1,314 days; p = 0.003) as was PT-free survival on the device (1,070 vs 1,457 days; p = 0.02). Cox regression analysis showed that AVO was an independent predictor of CTE (p = 0.03) CONCLUSIONS: Thrombotic events are relatively frequent in patients on long-term LVAD support. A closed aortic valve was associated with decreased overall survival, thrombosis-free survival, and poorer LV function on support. These are high-risk patients, so whether they require more intense anti-coagulation or prioritizing for transplantation requires further research.
[Mh] Termos MeSH primário: Valva Aórtica/fisiopatologia
Insuficiência Cardíaca/terapia
Ventrículos do Coração/fisiopatologia
Coração Auxiliar/efeitos adversos
Trombose/epidemiologia
Função Ventricular Esquerda/fisiologia
[Mh] Termos MeSH secundário: Valva Aórtica/diagnóstico por imagem
Diástole
Intervalo Livre de Doença
Ecocardiografia
Feminino
Seguimentos
Insuficiência Cardíaca/mortalidade
Insuficiência Cardíaca/fisiopatologia
Transplante de Coração
Ventrículos do Coração/diagnóstico por imagem
Seres Humanos
Incidência
Masculino
Meia-Idade
Prognóstico
Falha de Prótese
Estudos Retrospectivos
Taxa de Sobrevida/tendências
Trombose/etiologia
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


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[PMID]:29466153
[Au] Autor:Goldstone AB; Chiu P; Woo YJ
[Ad] Endereço:Stanford University School of Medicine, Stanford, CA
[Ti] Título:Prosthesis Type for Aortic- and Mitral-Valve Replacement.
[So] Source:N Engl J Med;378(8):778-779, 2018 02 22.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Valva Aórtica/cirurgia
Próteses Valvulares Cardíacas
[Mh] Termos MeSH secundário: Implante de Prótese de Valva Cardíaca
Seres Humanos
Valva Mitral/cirurgia
[Pt] Tipo de publicação:LETTER; COMMENT
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMc1716336


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[PMID]:29178215
[Au] Autor:Rene AG; Desai N; Wald J; Rame JE; Frogel JK; Anwaruddin S
[Ad] Endereço:Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
[Ti] Título:Transfemoral transcatheter aortic valve replacement with a self-expanding valve for severe aortic regurgitation in a patient with left ventricular assist device.
[So] Source:J Card Surg;32(11):741-745, 2017 Nov.
[Is] ISSN:1540-8191
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Aortic insufficiency following left ventricular assist device implantation (LVAD) has been reported in up to 40% of patients and is associated with a worse prognosis. We describe the case of a successful transfemoral transcatheter aortic valve replacement with a self-expanding bioprosthesis for aortic insufficiency following destination LVAD implantation.
[Mh] Termos MeSH primário: Insuficiência da Valva Aórtica/cirurgia
Valva Aórtica/cirurgia
Bioprótese
Próteses Valvulares Cardíacas
Ventrículos do Coração
Coração Auxiliar
Substituição da Valva Aórtica Transcateter/métodos
[Mh] Termos MeSH secundário: Adulto
Insuficiência da Valva Aórtica/diagnóstico por imagem
Insuficiência da Valva Aórtica/terapia
Ecocardiografia Transesofagiana
Artéria Femoral
Seres Humanos
Masculino
Índice de Gravidade de Doença
Resultado do Tratamento
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171128
[St] Status:MEDLINE
[do] DOI:10.1111/jocs.13238


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[PMID]:28457950
[Au] Autor:Bettinger N; Khalique OK; Krepp JM; Hamid NB; Bae DJ; Pulerwitz TC; Liao M; Hahn RT; Vahl TP; Nazif TM; George I; Leon MB; Einstein AJ; Kodali SK
[Ad] Endereço:Division of Cardiology, New-York-Presbyterian Hospital and Columbia University Medical Center, New York, NY, United States; Division of Cardiology, Hospital Charles Nicolle, University Hospital of Rouen, Rouen, France.
[Ti] Título:Practical determination of aortic valve calcium volume score on contrast-enhanced computed tomography prior to transcatheter aortic valve replacement and impact on paravalvular regurgitation: Elucidating optimal threshold cutoffs.
[So] Source:J Cardiovasc Comput Tomogr;11(4):302-308, 2017 Jul - Aug.
[Is] ISSN:1876-861X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The threshold for the optimal computed tomography (CT) number in Hounsfield Units (HU) to quantify aortic valvular calcium on contrast-enhanced scans has not been standardized. Our aim was to find the most accurate threshold to predict paravalvular regurgitation (PVR) after transcatheter aortic valve replacement (TAVR). METHODS: 104 patients who underwent TAVR with the CoreValve prosthesis were studied retrospectively. Luminal attenuation (LA) in HU was measured at the level of the aortic annulus. Calcium volume score for the aortic valvular complex was measured using 6 threshold cutoffs (650 HU, 850 HU, LA × 1.25, LA × 1.5, LA+50, LA+100). Receiver-operating characteristic (ROC) analysis was performed to assess the predictive value for > mild PVR (n = 16). Multivariable analysis was performed to determine the accuracy to predict > mild PVR after adjustment for depth and perimeter oversizing. RESULTS: ROC analysis showed lower area under the curve (AUC) values for fixed threshold cutoffs (650 or 850 HU) compared to thresholds relative to LA. The LA+100 threshold had the highest AUC (0.81), and AUC was higher than all studied protocols, other than the LA x 1.25 and LA + 50 protocols, where the difference approached statistical significance (p = 0.05, and 0.068, respectively). Multivariable analysis showed calcium volume determined by the LAx1.25, LAx1.5, LA+50, and LA+ 100 HU protocols to independently predict PVR. CONCLUSIONS: Calcium volume scoring thresholds which are relative to LA are more predictive of PVR post-TAVR than those which use fixed cutoffs. A threshold of LA+100 HU had the highest predictive value.
[Mh] Termos MeSH primário: Insuficiência da Valva Aórtica/etiologia
Estenose da Valva Aórtica/diagnóstico por imagem
Valva Aórtica/diagnóstico por imagem
Valva Aórtica/patologia
Calcinose/diagnóstico por imagem
Meios de Contraste/administração & dosagem
Tomografia Computadorizada por Raios X
Substituição da Valva Aórtica Transcateter/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Valva Aórtica/fisiopatologia
Valva Aórtica/cirurgia
Insuficiência da Valva Aórtica/fisiopatologia
Estenose da Valva Aórtica/fisiopatologia
Estenose da Valva Aórtica/cirurgia
Área Sob a Curva
Calcinose/fisiopatologia
Calcinose/cirurgia
Ecocardiografia Transesofagiana
Feminino
Próteses Valvulares Cardíacas
Seres Humanos
Modelos Logísticos
Masculino
Análise Multivariada
Valor Preditivo dos Testes
Modelos de Riscos Proporcionais
Curva ROC
Estudos Retrospectivos
Medição de Risco
Fatores de Risco
Índice de Gravidade de Doença
Substituição da Valva Aórtica Transcateter/instrumentação
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Contrast Media)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE



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