RESUMEN
Between 2000 and 2008, the mitral valve (MV) repair rate in patients with severe mitral regurgitation at our low-volume Veterans Affairs hospital was 21%. After instituting a multidisciplinary valve team in 2009, we determined whether this rate increased and characterized the outcomes of patients with degenerative disease. We retrospectively reviewed data from 103 MV operations performed at our hospital between 1/2009 and 8/2016. MV pathology was categorized as degenerative, rheumatic, endocarditis, ischemic, hypertrophic cardiomyopathy, or failed prior MV repair. The surgical techniques used for MV repair were reviewed. For the patients with degenerative disease who underwent MV repair, we assessed leaflet involvement and postoperative valve function. For the full cohort, the MV repair rate was 67% and the 30-day mortality rate was 0.97%. Of the 74 patients with degenerative disease, 64 (86.5%) underwent MV repair (none required reoperation). For these patients, the MV repair rate was significantly higher when the surgical approach was sternotomy rather than minimally invasive right minithoracotomy (92.5% vs 71.4%, Pâ¯=â¯0.03). After MV repair, 95.3% of the degenerative disease patients had mild or less mitral regurgitation; median echocardiography follow-up time was 555 days. Anatomic features associated with a reduced MV repair rate in patients with degenerative disease were dystrophic leaflet calcification and severe mitral annular calcification. In an institution with a low volume of MV operations, preoperative surgical planning with a multidisciplinary valve team was associated with improved MV repair rates and excellent repair quality in patients with degenerative valve disease.
Asunto(s)
Implantación de Prótesis de Válvulas Cardíacas/tendencias , Hospitales de Bajo Volumen/tendencias , Hospitales de Veteranos/tendencias , Anuloplastia de la Válvula Mitral/tendencias , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Grupo de Atención al Paciente/tendencias , Pautas de la Práctica en Medicina/tendencias , Anciano , Femenino , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/fisiopatología , Anuloplastia de la Válvula Mitral/efectos adversos , Anuloplastia de la Válvula Mitral/mortalidad , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/mortalidad , Insuficiencia de la Válvula Mitral/fisiopatología , Mejoramiento de la Calidad/tendencias , Indicadores de Calidad de la Atención de Salud/tendencias , Recuperación de la Función , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Esternotomía/tendencias , Toracotomía/tendencias , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos , United States Department of Veterans AffairsRESUMEN
Se realizaron cultivos discontinuos (medio Algal con 0.5 mM de NaNO3 y 27% de NaCl) de cinco cepas de Dunaliella sp., aisladas de diferentes lagunas hipersalinas de Venezuela (Araya, Coche, Peonía, Cumaraguas y Boca Chica) y una cepa de referencia (Dunaliella salina LB1644). Los bioensayos se mantuvieron a 25 ± 1 °C con aireación constante, fotoperiodo 12:12 y dos intensidades luminosas (195 y 390 µE.m-2.s-1) durante 30 días. El crecimiento celular se determinó diariamente mediante conteo celular en cámara de Neubaüer. La clorofila a y los carotenoides totales se analizaron al final del ensayo. Las mayores densidades celulares correspondieron a los ensayos de menor intensidad luminosa. La cepa que alcanzó la mayor densidad celular fue la aislada de Boca Chica (8 x106 y 2.5 x106 cel.ml-1 a 195 y 390 µE.m-2.s-1, respectivamente). El incremento de la intensidad luminosa en los cultivos produjo una disminución significativa de las tasas de crecimiento en todas las cepas. Los carotenoides totales por volumen fueron mayores a 390 µE.m-2 .s-1; siendo las cepas de referencia LB1644, Coche y Araya las que produjeron mayor cantidad (38.4; 32.8 y 21.0 µg.ml-1, respectivamente). El contenido de carotenoides totales por célula en los dos tratamientos fue significativamente diferente, obteniéndose la mayor concentración a 390 µE.m-2.s-1. Las cepas LB1644 y Coche fueron las que produjeron los valores más altos de carotenos (137.14 y 106.06 pg.cel-1, respectivamente). La cepa LB1644 presentó la mayor relación carotenoides totales:clorofila a (20:1) a 195 µE.m-2.s-1, mientras que en la cepa Coche no se evidenciaron diferencias significativas entre las dos intensidades (15:1). El resto de las cepas mostraron relaciones inferiores a uno. Nuestros resultados sugieren que las cepas Coche y Araya pueden ser potencialmente utilizadas en la biotecnología de producción de carotenoides
We evaluated discontinuous cultures (Algal medium at 0.5 mM of NaNO3 , and 27% NaCl) of five strains of Dunaliella sp. isolated from Venezuelan hypersaline lagoons (Araya, Coche, Peonía, Cumaraguas, and Boca Chica) and one strain from a reference collection (Dunaliella salina, LB1644). Cultures were maintained to 25±1 °C, with constant aeration, photoperiod 12:12, and two light intensities (195 and 390 µE.m-2 .s-1) during 30 days. Cell count was recorded on a daily basis using a Neubaüer camera. Totals of chlorophyll a and carotenoids were measured at the end of the experiment. The largest cellular densities were measured during the smallest light intensities. The strain with the largest cellular density was isolated from Boca Chica (8 x106 and 2.5 x106 cel.ml-1 a 390 and 195µE.m-2 .s-1, respectively). The increment of light intensity produced a significant reduction of growth rates in all strains. Totals of carotenoids by volume were as large as 390 µE.m-2 .s-1. Strains LB1644, from Coche and Araya were those that produced the largest amount of carotenoids (38.4; 32.8 and 21.0 µg.ml-1 , respectively). Differences total carotenoids by cell between treatments were significant. The largest concentration was 390 µE.m-2 .s-1 . The strains LB1644 and Coche produced the highest values of carotenes (137.14 and 106.06 pg.cel-1, respectively). Differences in the relation carotenoid:chlorophyll a between the strains at various light intensities was significant. Strains LB1644 presented the largest value of the relation carotenoids:chlorophyll a (20:1) at 195 µE.m-2 .s-1. No significant differences were detected in the strain Coche (15:1). All the other strains showed relations lower than one. Our results suggest that the strains of Coche and Araya show potential to be used in the biotechnology of carotenoids production
Asunto(s)
Chlorophyta/metabolismo , Carotenoides/biosíntesis , Clorofila/biosíntesis , Chlorophyta/clasificación , Luz , Cloruro de Sodio , VenezuelaRESUMEN
We evaluated discontinuous cultures (Algal medium at 0.5 mM of NaNO3, and 27% NaCI) of five strains of Dunaliella sp. isolated from Venezuelan hypersaline lagoons (Araya, Coche, Peonia, Cumaraguas. and Boca Chica) and one strain from a reference collection (Dunaliella salina, LB1644). Cultures were maintained to 25+/-1 degrees C, with constant aeration, photoperiod 12:12, and two light intensities (195 and 390 microE.m(-2).s(-1)) during 30 days. Cell count was recorded on a daily basis using a Neubaüer camera. Totals of chlorophyll a and carotenoids were measured at the end of the experiment. The largest cellular densities were measured during the smallest light intensities. The strain with the largest cellular density was isolated from Boca Chica (8 xl0(6) and 2.5 xl0(6) cel.ml(-1) a 390 and 195microE.m(-2).s(-1), respectively). The increment of light intensity produced a significant reduction of growth rates in all strains. Totals of carotenoids by volume were as large as 390 microE.m(-2).s(-1). Strains LB 1644, from Coche and Araya were those that produced the largest amount of carotenoids (38.4; 32.8 and 21.0 microg.ml(-1), respectively). Differences total carotenoids by cell between treatments were significant. The largest concentration was 390 microE.m(-2).s(-1). The strains LB 1644 and Coche produced the highest values of carotenes (137.14 and 106.06 pg.cel(-1), respectively). Differences in the relation carotenoid:chlorophyll a between the strains at various light intensities was significant. Strains LB1644 presented the largest value of the relation carotenoids:chlorophyll a (20:1) at 195 microE.m(-2).s(-1). No significant differences were detected in the strain Coche (15:1). All the other strains showed relations lower than one. Our results suggest that the strains of Coche and Araya show potential to be used in the biotechnology of carotenoids production.