RESUMEN
OBJECTIVE: The Acute Physiology and Chronic Health Evaluation (APACHE) severity of disease classification system, which is one of the most widely used scoring systems to predict mortality, is used for intensive care units (ICU) patients. This study aimed to evaluate the predictive ability of APACHE II for mortality in patients after undergoing cardiac surgery. We studied if APACHE II could successfully predict the outcome in post-cardiac surgery patients. METHODS: This study involved retrospective data collection of all adult patients who were admitted to Ordu State Hospital cardiovascular surgery ICU following cardiac surgery from August 2013 to December 2015. Area under the receiver operating characteristic (ROC) curve (AUC) values were calculated for the APACHE II model. RESULTS: During the two years of data collection, we included 600 patients with a mean age of 64.77±10.148 years. Of these, 180 (30.0%) were females. The ICU mortality rate was 8.33%, and the mean length of ICU stay was 4.210±6.913 days. The mean pre-operative EuroSCORE was 3.890±2.565, and the mean pre-operative APACHE II score was 6.790±3.617. The AUC values for APACHE II and EuroSCORE were 0.743 and 0.767, respectively. CONCLUSION: The APACHE II model can be used to predict mortality in a Turkish population of patients who have undergone cardiac surgery.
RESUMEN
OBJECTIVE: The purpose of this study was to compare the operative mortality rate and outcomes of endovascular aneurysm repair (EVAR) between young and geriatric people in a single center. METHODS: Eighty-five patients with abdominal aortic aneurysms who underwent EVAR between January 2012 and September 2016 were included. Outcomes were compared between two groups: the young (aged < 65 years) and the geriatric (aged ≥ 65 years). The primary study outcome was technical success; the secondary endpoints were mortality and secondary interventions. The mean follow-up time was 36 months (3-60 months). RESULTS: The study included 72 males and 13 females with a mean age of 71.08±8.6 years (range 49-85 years). Of the 85 patients analyzed, 18 (21.2%) were under 65 years old and 67 patients (78.8%) were over 65 years old. There was no statistically significant correlation between chronic disease and age. We found no statistically significant difference between aneurysm diameter, neck angle, neck length, or right and left iliac angles. The secondary intervention rate was 7% (six patients). The conversion to open surgery was necessary for only one patient and only three deaths were reported (3.5%). There was no statistically significant difference in the mortality and reintervention rates between the age groups. The three deaths occurred only in the geriatric group and two died secondary to rupture. Kidney failure was observed in three patients in the geriatric group (4.5%). CONCLUSION: Our single-center experience shows that EVAR can be used safely in both young and geriatric patients.
Asunto(s)
Aneurisma de la Aorta Abdominal/mortalidad , Aneurisma de la Aorta Abdominal/cirugía , Procedimientos Endovasculares/mortalidad , Procedimientos Endovasculares/métodos , Distribución por Edad , Factores de Edad , Anciano , Anciano de 80 o más Años , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/mortalidad , Enfermedad Arterial Periférica/cirugía , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Enfermedad Pulmonar Obstructiva Crónica/cirugía , Valores de Referencia , Insuficiencia Renal Crónica/mortalidad , Insuficiencia Renal Crónica/cirugía , Estudios Retrospectivos , Distribución por Sexo , Resultado del TratamientoRESUMEN
Abstract Objective: The purpose of this study was to compare the operative mortality rate and outcomes of endovascular aneurysm repair (EVAR) between young and geriatric people in a single center. Methods: Eighty-five patients with abdominal aortic aneurysms who underwent EVAR between January 2012 and September 2016 were included. Outcomes were compared between two groups: the young (aged < 65 years) and the geriatric (aged ≥ 65 years). The primary study outcome was technical success; the secondary endpoints were mortality and secondary interventions. The mean follow-up time was 36 months (3-60 months). Results: The study included 72 males and 13 females with a mean age of 71.08±8.6 years (range 49-85 years). Of the 85 patients analyzed, 18 (21.2%) were under 65 years old and 67 patients (78.8%) were over 65 years old. There was no statistically significant correlation between chronic disease and age. We found no statistically significant difference between aneurysm diameter, neck angle, neck length, or right and left iliac angles. The secondary intervention rate was 7% (six patients). The conversion to open surgery was necessary for only one patient and only three deaths were reported (3.5%). There was no statistically significant difference in the mortality and reintervention rates between the age groups. The three deaths occurred only in the geriatric group and two died secondary to rupture. Kidney failure was observed in three patients in the geriatric group (4.5%). Conclusion: Our single-center experience shows that EVAR can be used safely in both young and geriatric patients.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/mortalidad , Procedimientos Endovasculares/métodos , Procedimientos Endovasculares/mortalidad , Valores de Referencia , Enfermedad de la Arteria Coronaria/cirugía , Enfermedad de la Arteria Coronaria/mortalidad , Estudios Retrospectivos , Estudios de Seguimiento , Factores de Edad , Resultado del Tratamiento , Distribución por Sexo , Distribución por Edad , Enfermedad Pulmonar Obstructiva Crónica/cirugía , Enfermedad Pulmonar Obstructiva Crónica/mortalidad , Insuficiencia Renal Crónica/cirugía , Insuficiencia Renal Crónica/mortalidad , Enfermedad Arterial Periférica/cirugía , Enfermedad Arterial Periférica/mortalidadRESUMEN
The rupture of the right ventricular anterior wall after myocardial infarction is a rare and life-threatening complication associated with high mortality. Early diagnosis by echocardiographic examination and successful treatment is discussed in this case report.
RESUMEN
Aortic fenestration is a technique that treats organ ischemia in descending aortic dissection. Open surgical aortic fenestration is an effective yet uncommonly used and widely forgotten procedure. Here, we describe 2 patients suffering from chronic thoracoabdominal aortic dissection, and we aimed to identify under what circumstances surgical aortic fenestration should be applied, to assess its safety and efficacy.
Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Implantación de Prótesis Vascular/métodos , Disección Aórtica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aortografía/métodos , Prótesis Vascular , Implantación de Prótesis Vascular/instrumentación , Enfermedad Crónica , Angiografía por Tomografía Computarizada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Resultado del TratamientoRESUMEN
AIM: To determine whether concomitant surgery is a predictor of mortality in patients undergoing surgery for ascending aortic aneursym. METHODS: Ninety-nine patients who underwent ascending aortic aneursym surgery between January 2010 and January 2015 were included in this study. Nineteen patients underwent ascending aortic replacement (RAA) only, 36 underwent aortic valve replacement (AVR) and RAA, 25 underwent coronary artery bypass grafting (CABG) and RAA, 11 underwent the Bentall procedure, and eight underwent AVR, CABG and RAA. RESULTS: Depending on the concomitant surgery performed with RAA, the mortality risk increased 2.25-fold for AVR, 4.5-fold for CABG, 10.8-fold for AVR + CABG and four-fold for the Bentall procedure, compared with RAA alone. CONCLUSION: Concomitant cardiac surgery increased the mortality risk in patients undergoing RAA, but the difference was not statisticaly significant. Based on these study results, patients undergoing cardiac surgery, with a pre-operative ascending aortic diameter of over 45 mm, should undergo concomitant RAA.
Asunto(s)
Aneurisma de la Aorta/cirugía , Válvula Aórtica/cirugía , Implantación de Prótesis Vascular , Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta/complicaciones , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/mortalidad , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/mortalidad , Femenino , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/mortalidad , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Resultado del TratamientoRESUMEN
Aortic injury caused by the penetration of a fractured rib is rare, but aortic graft penetration is even less common. This is a case report describing perforation of a Dacron aortic graft by the sharp margin of a displaced rib, which occurred after a thoracotomy. This case illustrates the importance of fixing fractured ribs.
Asunto(s)
Aorta Torácica/lesiones , Aneurisma de la Aorta Torácica/cirugía , Disección Aórtica/cirugía , Prótesis Vascular , Fracturas de las Costillas/complicaciones , Toracotomía/efectos adversos , Lesiones del Sistema Vascular/etiología , Disección Aórtica/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Reoperación , Fracturas de las Costillas/diagnóstico , Fracturas de las Costillas/cirugía , Tomografía Computarizada por Rayos X , Lesiones del Sistema Vascular/diagnósticoRESUMEN
Aortic dissection can occur in pregnancy or during the postpartum period without pre-existing disease and it is a rare but potentially life-threatening event. Herein, we present a young woman without Marfan's syndrome who developed a postpartum ascending aortic dissection 5 days after cesarean section.
RESUMEN
OBJECTIVE: To describe aspects of the natural history and pathophysiology of coronary arteriovenous fistula and to propose potential treatment strategies. METHODS: Eleven adult patients were treated surgically for coronary arteriovenous fistulas (8 male, 3 female) during the last three years. Mean age was 48,7 +/- 9,5 years (range 32-65 years). Diagnosis was made by coronary angiography and transesophageal echocardiography RESULTS: All patients were symptomatic due to the associating cardiac disorder or fistula. Presenting symptoms were chest pain, exertional dyspnea and palpitation. All patients were diagnosed by selective angiography. Transthoracic and transoesophageal echocardiography was performed to identify the Qp/Qs ratio in one patient. One patient who had an LAD to pulmonary artery coronary arteriovenous fistula with a vascular malformation needed early reoperation due to recurrence of the fistula. Echocardiographic evaluation at the postoperative third month revealed no residual shunts in all patients. CONCLUSION: Because of the severe complications that may develop due to coronary arteriovenous fistula, we believe that every coronary artery fistula should be treated invasively by surgery or transcatheter closure. But both treatment modalities still need to be evaluated with randomized multicenter studies for long term survival and effectiveness.
Asunto(s)
Fístula Arteriovenosa/cirugía , Puente Cardiopulmonar/métodos , Adulto , Anciano , Fístula Arteriovenosa/diagnóstico , Angiografía Coronaria , Drenaje , Ecocardiografía Transesofágica , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
The Starr-Edwards caged ball valve is one of the oldest cardiac valve prosthesis and was widely used all around the world in the past decades. Despite the long-term results that have been reported there are only a few cases reported that exceed 30 years of durability. Here in, we report a 53-year-old patient with a well-functioning 35-year-old aortic Starr-Edwards caged ball prosthesis.