RESUMEN
BACKGROUND: Bioprosthesis has been increasingly implanted for the treatment of transvalvular disease across the world. A new Dafodil™ pericardial bioprosthesis (Meril Life Sciences Pvt. Ltd., India) recently approved by Conformité Européenne (CE) is a tri-leaflet, stented, bovine valve. The purpose of Dafodil-1 first-in-human trial was to evaluate clinical safety and performance (including hemodynamic parameters) of the Dafodil pericardial bioprosthesis in patients who underwent aortic or mitral valve replacement. METHODS: This prospective, multicenter clinical trial enrolled 60 patients (Aortic: 30 patients; Mitral: 30 patients) from seven sites across India. Safety endpoints were early (≤30 days) and late (> 30 days) mortality and valve-related morbidity. The performance endpoints were hemodynamic performance, improvement in NYHA functional class, and change in the quality of life using SF-12v1 health survey. RESULTS: From July 2017 to July 2018, 60 patients underwent implantation of the Dafodil pericardial bioprosthesis. Post-operatively, NYHA functional class significantly improved in all the patients (Aortic: 90% NYHA class-I and 10% NYHA class-II; Mitral: 96.55% NYHA class-I and 3.45% NYHA class-II; P < 0.001). There was no death in aortic valve replacement patients till 12-month. In mitral valve replacement patients, early mortalities occurred in three patients, and late mortality occurred in one patient; none of these were valve-related. Freedom from all-cause mortality reported was 93.33% at 12-month. Mean aortic pressure gradient decreased from 52.71 ± 24.47 mmHg [with 0.89 ± 0.70 cm2 effective orifice area (EOA)] pre-operatively to 14.49 ± 6.58 mmHg (EOA: 1.85 ± 0.27 cm2) at 12-month. Overall, the mitral mean pressure gradient and EOA were 4.41 ± 1.69 mmHg and 2.67 ± 0.48 cm2, respectively, at 12-month. Significant improvement (P < 0.05) in the patients' quality of life was reported at all follow-ups. CONCLUSIONS: The clinical safety and performance of the Dafodil pericardial bioprosthesis were favourable at 12-month. Moreover, a study with a larger patient population and longer follow-up is warranted to further assess the device. TRIAL REGISTRATION: Dafodil-1 trial has been prospectively registered on 10/07/2017 under Clinical Trial Registry-India (http://www.ctri.nic.in). (Registration number: CTRI/2017/07/009008).
Asunto(s)
Insuficiencia de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Bioprótesis , Prótesis Valvulares Cardíacas , Hemodinámica , Adulto , Anciano , Anciano de 80 o más Años , Animales , Válvula Aórtica/cirugía , Bovinos , Femenino , Estudios de Seguimiento , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/cirugía , Pericardio/cirugía , Periodo Posoperatorio , Estudios Prospectivos , Calidad de Vida , Stents , Resultado del TratamientoRESUMEN
Immediately after surgical closure of a patent ductus arteriosus, a 12-year-old boy developed severe systemic arterial hypertension refractory to medication. The cause of hypertension could not be found, but it came under control 3 weeks postoperatively with a combination of angiotensin-converting enzyme inhibitor and chlorothiazide.
Asunto(s)
Conducto Arterioso Permeable/cirugía , Hipertensión/etiología , Complicaciones Posoperatorias , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Antihipertensivos/uso terapéutico , Niño , Clorotiazida/uso terapéutico , Quimioterapia Combinada , Enalapril/uso terapéutico , Humanos , Hipertensión/tratamiento farmacológico , MasculinoRESUMEN
A 3-year-old boy with a trivial blunt chest injury presented with a massive bronchopleural leak without any hilar vascular injury. On emergency exploration he had a complete transection of the right main bronchus. An end-to-end anastomosis of the transected bronchial ends was performed. At 1-month clinical and radiologic follow-up, the anastomosis had healed well.