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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]: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]:29444392
[Au] Autor:Momeni M; Gaudin A
[Ti] Título:Intraoperative cerebral hypoperfusion and electroencephalogram suppression resulting in neurological complications after cardiac surgery : the need for an in depth investigation.
[So] Source:Acta Anaesthesiol Belg;67(2):73-79, 2016.
[Is] ISSN:0001-5164
[Cp] País de publicação:Belgium
[La] Idioma:eng
[Ab] Resumo:Reports on the demographic profile of older populations estimate that, in 2050, 19 countries will have at least 10% of their population aged 80 years or more. Many high risk elderly patients undergo cardiac surgery. In addition, advanced age has been shown to be a strong predictor of adverse neurological outcome. Despite sig- nificant improvements achieved in the perioperative care of cardiac surgical patients, neurological complications remain a global health issue. Recent findings have pointed out that cerebral hypoperfusion and too deep levels of anesthesia are major sources of adverse neurological outcomes. Cerebral near-in-frared spectroscopy provides information about cerebral perfusion non-invasively, and is increasingly used. Depth of anesthesia is evaluated using monitors that are based on processed electroencephalogram. This non-systematic review focuses on the results of studies performed with each monitor separately, and the need for a combined evaluation of their utility and eventual impact on neurological outcomes. The use of a combined cerebral monitoring strategy based on the two aforementioned monitors is proposed in order to optimize cerebral outcomes.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Cardíacos/efeitos adversos
Transtornos Cerebrovasculares/etiologia
Eletroencefalografia
Monitorização Intraoperatória
Complicações Pós-Operatórias/etiologia
[Mh] Termos MeSH secundário: Disfunção Cognitiva/etiologia
Delírio/etiologia
Seres Humanos
Espectroscopia de Luz Próxima ao Infravermelho
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE


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[PMID]:29223273
[Au] Autor:van der Veer T; In 't Veen JCCM; den Dekker WK; Miedema J
[Ad] Endereço:Department of Pulmonology, Franciscus Gasthuis & Vlietland, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: t.vanderveer@franciscus.nl.
[Ti] Título:A 79-Year-Old Woman With Dyspnea and Hypoxemia That Worsened in an Upright Position.
[So] Source:Chest;152(6):e139-e142, 2017 12.
[Is] ISSN:1931-3543
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:CASE PRESENTATION: A 79-year-old woman presented to the ED with complaints of gradually worsening exertional dyspnea, dizziness, and chest discomfort. For several weeks she had not been able to perform light household work. The patient's medical history mentioned pulmonary embolism following immobilization (2012), several fractures after trauma, an ischemic cerebral vascular accident (2014), and curative treatment for breast cancer (1995). Her current medication included esomeprazole, clopidogrel, simvastatin, calcium/vitamin D, amitriptyline, and acetaminophen.
[Mh] Termos MeSH primário: Anormalidades Múltiplas
Aneurisma da Aorta Torácica/complicações
Dispneia/etiologia
Forame Oval Patente/complicações
Hipóxia/etiologia
[Mh] Termos MeSH secundário: Idoso
Aneurisma da Aorta Torácica/diagnóstico
Cateterismo Cardíaco
Procedimentos Cirúrgicos Cardíacos/métodos
Diagnóstico Diferencial
Dispneia/diagnóstico
Ecocardiografia
Feminino
Forame Oval Patente/diagnóstico
Forame Oval Patente/cirurgia
Seres Humanos
Hipóxia/diagnóstico
Dispositivo para Oclusão Septal
Síndrome
Tomografia Computadorizada por Raios X
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171211
[St] Status:MEDLINE


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[PMID]:29428031
[Au] Autor:Rosati CM; Gaudino M; Vardas PN; Weber DJ; Blitzer D; Hameedi F; Koniaris LG; Girardi LN
[Ti] Título:Academic Clinical Productivity of Cardiac Surgeons in the State of New York: Who Publishes More and Who Operates More.
[So] Source:Am Surg;84(1):71-79, 2018 Jan 01.
[Is] ISSN:1555-9823
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We investigated whether/how cardiac surgeons can be productive both academically and clinically. Using online resources (New York State Adult Cardiac Surgery database, SCOPUS), we collected individual clinical volumes (operations performed/year), academic metrics (ongoing publications, role as author), practice setting, and seniority for all cardiac surgeons in the State of New York from 1994 to 2011. Over time, individual clinical volumes decreased (median operations/year: 193 in 1995 vs 126 in 2010; P < 0.001), whereas academic productivity remained unchanged (median publications/year: 0.7 vs 0.3; P = 0.55). There was no correlation (Spearman's correlation coefficient: -0.061; P = 0.08) between the number of new publications and operations/year for the whole population. More operations/year (median: 155 vs 144; P = 0.03) were performed by surgeons without versus with publications during that same year. Who published more worked at hospitals with higher clinical volumes (Spearman's correlation coefficient: 0.16; P < 0.001) and was more likely affiliated with thoracic surgery fellowship programs (median publications/year: 1.7 for affiliated vs 0 for nonaffiliated surgeons; P < 0.001). Cardiac surgeons could be classified into four categories: ∼40 per cent clinically busy, but not publishing at all; ∼45 per cent operating less, but publishing a little; ∼15 per cent clinically very productive (operating as much as the nonpublishers) and publishing a lot; and ∼1 per cent operating the least, but publishing the most.
[Mh] Termos MeSH primário: Academias e Institutos
Eficiência
Transplante de Coração/estatística & dados numéricos
Hospitais Universitários/estatística & dados numéricos
Editoração/estatística & dados numéricos
Cirurgia Torácica/recursos humanos
Cirurgia Torácica/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos
Bases de Dados Factuais
Hospitais/estatística & dados numéricos
Seres Humanos
New York
Procedimentos Cirúrgicos Torácicos/estatística & dados numéricos
[Pt] Tipo de publicação:COMPARATIVE STUDY; 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:180212
[St] Status:MEDLINE


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[PMID]:29466160
[Au] Autor:Groeneveld GH; van Paassen J; van Dissel JT; Arbous MS
[Ad] Endereço:Leiden University Medical Center, Leiden, the Netherlands g.h.groeneveld@lumc.nl.
[Ti] Título:Influenza Season and ARDS after Cardiac Surgery.
[So] Source:N Engl J Med;378(8):772-773, 2018 02 22.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Cardíacos/efeitos adversos
Influenza Humana/complicações
Complicações Pós-Operatórias/etiologia
Síndrome do Desconforto Respiratório do Adulto/etiologia
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Criança
Seres Humanos
Incidência
Síndrome do Desconforto Respiratório do Adulto/epidemiologia
Estudos Retrospectivos
Fatores de Risco
Estações do Ano
[Pt] Tipo de publicação:COMPARATIVE STUDY; LETTER; OBSERVATIONAL STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[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/NEJMc1712727


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[PMID]:29360851
[Au] Autor:Wang X; Wang C; Ye M; Lin J; Jin J; Hu Q; Zhu C; Chen B
[Ad] Endereço:Department of Thoracic and Cardiovascular Surgery, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, China.
[Ti] Título:Left atrial concomitant surgical ablation for treatment of atrial fibrillation in cardiac surgery: A meta-analysis of randomized controlled trials.
[So] Source:PLoS One;13(1):e0191354, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Surgical ablation is a generally established treatment for patients with atrial fibrillation undergoing concomitant cardiac surgery. Left atrial (LA) lesion set for ablation is a simplified procedure suggested to reduce the surgery time and morbidity after procedure. The present meta-analysis aims to explore the outcomes of left atrial lesion set versus no ablative treatment in patients with AF undergoing cardiac surgery. METHODS: A literature research was performed in six database from their inception to July 2017, identifying all relevant randomized controlled trials (RCTs) comparing left atrial lesion set versus no ablative treatment in AF patient undergoing cardiac surgery. Data were extracted and analyzed according to predefined clinical endpoints. RESULTS: Eleven relevant RCTs were included for analysis in the present study. The prevalence of sinus rhythm in ablation group was significantly higher at discharge, 6-month and 1-year follow-up period. The morbidity including 30 day mortality, late all-cause mortality, reoperation for bleeding, permanent pacemaker implantation and neurological events were of no significant difference between two groups. CONCLUSIONS: The result of our meta-analysis demonstrates that left atrial lesion set is an effective and safe surgical ablation strategy for AF patients undergoing concomitant cardiac surgery.
[Mh] Termos MeSH primário: Fibrilação Atrial/cirurgia
Procedimentos Cirúrgicos Cardíacos/métodos
Ablação por Cateter/métodos
[Mh] Termos MeSH secundário: Fibrilação Atrial/complicações
Procedimentos Cirúrgicos Cardíacos/efeitos adversos
Procedimentos Cirúrgicos Cardíacos/mortalidade
Ablação por Cateter/efeitos adversos
Ablação por Cateter/mortalidade
Átrios do Coração/cirurgia
Cardiopatias/complicações
Cardiopatias/cirurgia
Seres Humanos
Ensaios Clínicos Controlados Aleatórios como Assunto
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T
[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:180124
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191354


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[PMID]:29269690
[Au] Autor:Kikuno M; Koga M; Kume Y; Ohtsuka T; Hayakawa M; Toyoda K
[Ad] Endereço:Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center.
[Ti] Título:[A case of cardiogenic embolism, which occurred under appropriate warfarin use, treated with thoracoscopic left atrial appendectomy].
[So] Source:Rinsho Shinkeigaku;58(1):9-14, 2018 Jan 26.
[Is] ISSN:1882-0654
[Cp] País de publicação:Japan
[La] Idioma:jpn
[Ab] Resumo:A 74-year-old man with a past medical history of bradycardiac atrial fibrillation and an old cerebral infarction presented with dysarthria. He had been treated with warfarin and PT-INR on admission was 2.0. MRI of the head revealed an acute ischemic stroke involving the cerebellum and left occipital lobe. Because transesophageal cardiac echography showed a thrombus in the left atrial appendage, anticoagulant treatment with warfarin and heparin was initiated. The thrombus was enlarging; therefore, we changed the anticoagulant therapy to apixaban with heparin on day 11. On day 17, a hemorrhagic cerebral infarction occurred. After the hemorrhage diminished, we treated him with warfarin aiming for a PT-INR between 3 and 4. The thrombus gradually shrank and disappeared on day 110. Finally, a thoracoscopic left atrial appendectomy was performed as a secondary prevention, with no recurrence till date.
[Mh] Termos MeSH primário: Anticoagulantes/administração & dosagem
Procedimentos Cirúrgicos Cardíacos/métodos
Infarto Cerebral/etiologia
Átrios do Coração/cirurgia
Cardiopatias/etiologia
Toracoscopia/métodos
Trombose/etiologia
Varfarina/administração & dosagem
[Mh] Termos MeSH secundário: Idoso
Quimioterapia Combinada
Cardiopatias/terapia
Heparina/administração & dosagem
Seres Humanos
Coeficiente Internacional Normatizado
Masculino
Pirazóis/administração & dosagem
Piridonas/administração & dosagem
Recidiva
Síndrome do Nó Sinusal/complicações
Trombose/terapia
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anticoagulants); 0 (Pyrazoles); 0 (Pyridones); 3Z9Y7UWC1J (apixaban); 5Q7ZVV76EI (Warfarin); 9005-49-6 (Heparin)
[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:171223
[St] Status:MEDLINE
[do] DOI:10.5692/clinicalneurol.cn-001065


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[PMID]:27770407
[Au] Autor:Li S; Fu S; Xiao Y; Xu G
[Ad] Endereço:Jiangxi Medical College, Nanchang University, Nanchang, People's Republic of China.
[Ti] Título:Recent Perioperative Pharmacological Prevention of Acute Kidney Injury after Cardiac Surgery: A Narrative Review.
[So] Source:Am J Cardiovasc Drugs;17(1):17-25, 2017 Feb.
[Is] ISSN:1179-187X
[Cp] País de publicação:New Zealand
[La] Idioma:eng
[Ab] Resumo:Acute kidney injury (AKI) is a common and severe complication of cardiac surgery, and related rates of both hospitalization and long-term mortality are increasing. A number of studies have explored the preventive effects of perioperative pharmacological therapy on AKI after cardiac surgery. However, the mechanisms of AKI are multifaceted, and no universal treatment has been confirmed as beneficial. We review and analyze several current perioperative pharmacological therapies for AKI after cardiac surgery to identify promising preventive strategies.
[Mh] Termos MeSH primário: Lesão Renal Aguda/prevenção & controle
Procedimentos Cirúrgicos Cardíacos/efeitos adversos
Assistência Perioperatória/métodos
Complicações Pós-Operatórias/prevenção & controle
[Mh] Termos MeSH secundário: Lesão Renal Aguda/etiologia
Lesão Renal Aguda/metabolismo
Dexmedetomidina/uso terapêutico
Seres Humanos
Hidrazonas/uso terapêutico
Complicações Pós-Operatórias/etiologia
Complicações Pós-Operatórias/metabolismo
Piridazinas/uso terapêutico
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Hydrazones); 0 (Pyridazines); 349552KRHK (simendan); 67VB76HONO (Dexmedetomidine)
[Em] Mês de entrada:1701
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161023
[St] Status:MEDLINE
[do] DOI:10.1007/s40256-016-0194-z


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[PMID]:29390532
[Au] Autor:Lai Y; Guo H; Li J; Dai J; Ren C; Wang Y
[Ti] Título:Comparison of surgical results in patients with hypertrophic obstructive cardiomyopathy after classic or modified morrow septal myectomy.
[So] Source:Medicine (Baltimore);96(51):e9371, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The study was conducted to evaluate the surgical results in patients with hypertrophic obstructive cardiomyopathy (HOCM) who underwent either classic Morrow septal myectomy or modified procedure.The modified Morrow septal myectomy has gained interest as a new treatment for patients with drug-refractory symptoms of HOCM; however, its benefits in comparison to the classic procedure are unknown.In all, 236 symptomatic HOCM patients underwent surgical treatment from January 2006 to January 2015. Among them, 86 patients were treated by the classic Morrow myectomy and 150 patients via the modified procedure. Septal thickness, maximal left ventricular outflow tract (LVOT) pressure gradient (PG), and the presence of a permanent pacemaker were recorded after operation and follow-upThe left ventricular septal thickness (22.1 ±â€Š11.9 vs 17.1 ±â€Š4.0 mm for classic procedure, and 22.3 ±â€Š4.4 vs 16.1 ±â€Š3.5 mm for modified procedure; P < .001), LVOT velocity (410.6 ±â€Š134.0 vs 210.5 ±â€Š81.4 mm/s for classic procedure, and 432.7 ±â€Š119.3 vs 167.7 ±â€Š50.1 mm/s for modified procedure; P < .001), LVOT PG (76.0 ±â€Š43.5 vs 19.8 ±â€Š16.7 mm Hg for classic procedure, and 80.8 ±â€Š40.7 vs 12.3 ±â€Š8.5 mm Hg for modified procedure; P < .001) were significantly decreased after the operation in both groups. The modified group, however, showed significantly greater reduction in these echocardiographic parameters than the classic group. PG was completely eliminated in 142 (94.7%) patients receiving the modified myectomy, and a resting PG over 30 mm Hg was demonstrated in 16 (18.6%) patients in the classic group at follow-up (P = .001). Thirty-two (37.2%) patients in the classic groups had a mitral valve replacement, which is significant more than 14 (9.3%) in the modified group (P < .001).Both the classic procedure and the modified procedure can reduce LVOT obstruction and alleviate symptoms in patients with HOCM. The modified Morrow septal myectomy is superior to the classic procedure in reducing the LVOT gradient with a lower incidence of mitral valve replacement.
[Mh] Termos MeSH primário: Procedimentos Cirúrgicos Cardíacos/métodos
Cardiomiopatia Hipertrófica/cirurgia
Ecocardiografia Doppler
Septos Cardíacos/cirurgia
[Mh] Termos MeSH secundário: Adulto
Cardiomiopatia Hipertrófica/diagnóstico por imagem
Estudos de Coortes
Feminino
Seguimentos
Septos Cardíacos/diagnóstico por imagem
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Meia-Idade
Estudos Retrospectivos
Medição de Risco
Análise de Sobrevida
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009371



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