RESUMEN
Abstract Objective: To investigate whether axillary artery cannulation has supremacy over innominate artery cannulation in thoracic aortic surgery. Methods: A comprehensive search was undertaken among the four major databases (PubMed, Excerpta Medica dataBASE [EMBASE], Scopus, and Ovid) to identify all randomized and nonrandomized controlled trials comparing axillary to innominate artery cannulation in thoracic aortic surgery. Databases were evaluated and assessed up to March 2017. Results: Only three studies fulfilled the criteria for this meta-analysis, including 534 patients. Cardiopulmonary bypass time was significantly shorter in the innominate group (P=0.004). However, the innominate group had significantly higher risk of prolonged intubation > 48 hours (P=0.04) than the axillary group. Further analysis revealed no significant difference between the innominate and axillary groups for deep hypothermic circulatory arrest time (P=0.06). The relative risks for temporary and permanent neurological deficits as well as in-hospital mortality were not significantly different for both groups (P=0.90, P=0.49, and P=0.55, respectively). Length of hospital stay was similar for both groups. Conclusion: There is no superiority of axillary over innominate artery cannulation in thoracic aortic surgery in terms of perioperative outcomes; however, as the studies were limited, larger scale comparative studies are required to provide a solid evidence base for choosing optimal arterial cannulation site.
Asunto(s)
Humanos , Masculino , Femenino , Aorta Torácica/cirugía , Arteria Axilar/cirugía , Cateterismo/métodos , Tronco Braquiocefálico/cirugía , Complicaciones Posoperatorias , Cateterismo/efectos adversos , Cateterismo/mortalidad , Resultado del Tratamiento , Mortalidad HospitalariaRESUMEN
OBJECTIVE: To investigate whether axillary artery cannulation has supremacy over innominate artery cannulation in thoracic aortic surgery. METHODS: A comprehensive search was undertaken among the four major databases (PubMed, Excerpta Medica dataBASE [EMBASE], Scopus, and Ovid) to identify all randomized and nonrandomized controlled trials comparing axillary to innominate artery cannulation in thoracic aortic surgery. Databases were evaluated and assessed up to March 2017. RESULTS: Only three studies fulfilled the criteria for this meta-analysis, including 534 patients. Cardiopulmonary bypass time was significantly shorter in the innominate group (P=0.004). However, the innominate group had significantly higher risk of prolonged intubation > 48 hours (P=0.04) than the axillary group. Further analysis revealed no significant difference between the innominate and axillary groups for deep hypothermic circulatory arrest time (P=0.06). The relative risks for temporary and permanent neurological deficits as well as in-hospital mortality were not significantly different for both groups (P=0.90, P=0.49, and P=0.55, respectively). Length of hospital stay was similar for both groups. CONCLUSION: There is no superiority of axillary over innominate artery cannulation in thoracic aortic surgery in terms of perioperative outcomes; however, as the studies were limited, larger scale comparative studies are required to provide a solid evidence base for choosing optimal arterial cannulation site.
Asunto(s)
Aorta Torácica/cirugía , Arteria Axilar/cirugía , Tronco Braquiocefálico/cirugía , Cateterismo/métodos , Cateterismo/efectos adversos , Cateterismo/mortalidad , Femenino , Mortalidad Hospitalaria , Humanos , Masculino , Complicaciones Posoperatorias , Resultado del TratamientoRESUMEN
This study aimed to investigate the clinical characteristics, prognosis, and factors for survival of patients who underwent early-start peritoneal dialysis (PD) within 24 h after catheter insertion three years after PD. This study was conducted from January 1, 2013 to December 31, 2017. All adult patients who were diagnosed with end-stage renal disease (ESRD) and underwent PD for the first time within 24 h after catheter insertion in our hospital were included. All patients with PD were followed-up until they withdrew from PD, switching to hemodialysis, were transferred to other medical centers, underwent renal transplantation, died or were lost to follow-up, or continued to undergo dialysis until the end of the study period. The follow-up observation lasted three years. The number of eligible patients was 110, and switching to hemodialysis and death were the main reasons for patients to withdraw from PD. The 1-, 2-, and 3-year technical survival rates of patients were 89.1, 79.1, and 79.1% respectively, while the 1-, 2- and 3-year survival rates were 90, 81.8, and 81.8%, respectively. The Charlson comorbidity index, age, hemoglobin, serum albumin, diabetic nephropathy, chronic glomerulonephritis, and hypertensive renal damage were independent risk factors that affected the prognosis of PD patients. Under the condition of ensuring the quality of the PD catheter insertion, early-start PD within 24 h after catheter insertion is a safe treatment approach for ESRD patients.
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Cateterismo/métodos , Catéteres de Permanencia , Fallo Renal Crónico/terapia , Diálisis Peritoneal/métodos , Adulto , Factores de Edad , Índice de Masa Corporal , Cateterismo/mortalidad , Femenino , Humanos , Estimación de Kaplan-Meier , Fallo Renal Crónico/mortalidad , Masculino , Persona de Mediana Edad , Análisis Multivariante , Diálisis Peritoneal/mortalidad , Pronóstico , Modelos de Riesgos Proporcionales , Factores de Riesgo , Factores de TiempoRESUMEN
This study aimed to investigate the clinical characteristics, prognosis, and factors for survival of patients who underwent early-start peritoneal dialysis (PD) within 24 h after catheter insertion three years after PD. This study was conducted from January 1, 2013 to December 31, 2017. All adult patients who were diagnosed with end-stage renal disease (ESRD) and underwent PD for the first time within 24 h after catheter insertion in our hospital were included. All patients with PD were followed-up until they withdrew from PD, switching to hemodialysis, were transferred to other medical centers, underwent renal transplantation, died or were lost to follow-up, or continued to undergo dialysis until the end of the study period. The follow-up observation lasted three years. The number of eligible patients was 110, and switching to hemodialysis and death were the main reasons for patients to withdraw from PD. The 1-, 2-, and 3-year technical survival rates of patients were 89.1, 79.1, and 79.1% respectively, while the 1-, 2- and 3-year survival rates were 90, 81.8, and 81.8%, respectively. The Charlson comorbidity index, age, hemoglobin, serum albumin, diabetic nephropathy, chronic glomerulonephritis, and hypertensive renal damage were independent risk factors that affected the prognosis of PD patients. Under the condition of ensuring the quality of the PD catheter insertion, early-start PD within 24 h after catheter insertion is a safe treatment approach for ESRD patients.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Cateterismo/métodos , Catéteres de Permanencia , Diálisis Peritoneal/métodos , Fallo Renal Crónico/terapia , Pronóstico , Factores de Tiempo , Cateterismo/mortalidad , Índice de Masa Corporal , Modelos de Riesgos Proporcionales , Análisis Multivariante , Factores de Riesgo , Factores de Edad , Diálisis Peritoneal/mortalidad , Estimación de Kaplan-Meier , Fallo Renal Crónico/mortalidadRESUMEN
OBJECTIVES: The aim of this article is to report a 16-year experience with percutaneous balloon aortic valvuloplasty (BAVP) in newborns and young infants up to 3 months of age in a tertiary care cardiac reference center in a developing country and to determine its value in postponing open heart surgery. BACKGROUND: Congenital aortic stenosis (AS) is a potentially life threatening disorder. BAVP and surgical procedures have similar short and medium-term efficacy. METHODS: Thirty-one consecutive newborns and young infants with critical AS underwent BAVP in our department from 1991 to 2007. Mean patient age at time of the procedure was 22 days (range 2-92 days) and mean weight was 3,310 g (1,840-4,400 g). RESULTS: There was a significant reduction in mean Doppler-derived peak gradient across the aortic valve immediately after the procedure (75.1 ± 22 versus 32.2 ± 13.02, P < 0.001), and this finding was maintained throughout follow-up. Since 2003, when the carotid approach became routine practice, no major vascular complications were observed. Mean time of follow-up was 81 months (5 days-196 months) with only two deaths (7.4%). Only 24% patients required surgical reintervention on the aortic valve during follow-up. Survival free from aortic valve surgery was 80% at 24 months, 66% at 63 months, and 50% at 80 months. CONCLUSION: Percutaneous intervention for relief of critical aortic stenosis in newborns in a tertiary center of a developing country is safe and has excellent short and long-term results comparable to other centers throughout the world.
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Estenosis de la Válvula Aórtica/terapia , Arterias Carótidas , Cateterismo/métodos , Arteria Femoral , Estenosis de la Válvula Aórtica/congénito , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/fisiopatología , Brasil , Procedimientos Quirúrgicos Cardíacos , Cateterismo/efectos adversos , Cateterismo/mortalidad , Países en Desarrollo , Supervivencia sin Enfermedad , Ecocardiografía Doppler , Femenino , Hemodinámica , Mortalidad Hospitalaria , Humanos , Lactante , Recién Nacido , Estimación de Kaplan-Meier , Masculino , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Tasa de Supervivencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: The greater longevity observed today has caused an increase in the number of elderly who need surgery. Aortic stenosis is a common condition in this age group. OBJECTIVE: To evaluate morbidity and mortality in people aged 75 years or older who have undergone valvuloplasty or valve replacement surgery for aortic stenosis alone or associated with other injuries. METHODS: We studied 230 consecutive cases between Jan/2002-Dec/2007. Patients were 79.5 +/- 3.7 years (75 - 94), and 53.9% were men. In the sample, 68.7% had hypertension, 17.9% had atrial fibrillation, 15.9% were obese, and 14.4% had undergone previous heart surgery. At surgery, 87.4% underwent aortic stent placement, and 12.6% underwent aortic valvuloplasty. RESULTS: The mortality rate was 13.9% (9.4% with isolated aortic stenosis versus 20.9% with an associated procedure, p = 0.023) and the morbidity rate was 30.0% (25.2% with aortic stenosis alone versus 37.4% with an associated procedure, p = 0.068). The most common complications were: low cardiac output (20.2%), renal dysfunction (9.7%), and prolonged ventilatory support (7.9%). In the bivariate analysis, the main predictors of mortality were low cardiac output (RR 10.1, 95% CI: 5.02-20.3), use of intra-aortic balloon (RR 6.6, 95% CI: 3.83-11.4), sepsis (RR 6.77, 95%: 1.66-9.48) and renal dysfunction after surgery (RR 6.21, 95%: 3.47-11.1). As for morbidity, the predictors were: pre-operative renal dysfunction (RR 2.22, 95%: 1.25-3.95), atrial fibrillation (RR 1.74, 95%: 1.16-2.61), and chronic obstructive pulmonary disease (COPD) (RR 1.93, 95%: 1.25-2.97). CONCLUSION: Aortic valve surgery in the elderly is related to a slightly higher mortality rate than in younger patients, and its main risk factors were associated procedures, renal failure, atrial fibrillation, COPD, and sepsis.
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Estenosis de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Anuloplastia de la Válvula Cardíaca/mortalidad , Implantación de Prótesis de Válvulas Cardíacas/mortalidad , Factores de Edad , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Cateterismo/mortalidad , Femenino , Humanos , Masculino , Morbilidad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Estadísticas no Paramétricas , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: To analyze the long term evolution of patients undergoing percutaneous balloon mitral valvoplasty comparing the Inoue and Balt single balloon methods, and to identify predictors of death and major events (death, repeat balloon mitral valvoplasty or mitral valve surgery). METHODS: The follow-up for the single and Inoue balloon groups were 54 +/- 31 (1 to 126) months and 34 +/- 26 (2 to 105) months, respectively (p < 0.0001). The Balt single balloon was used in 254 (84.1%) patients and the Inoue balloon in 48 (15.9%). RESULTS: The following data were found for the Inoue and single balloon groups, respectively: age, 36.9 +/- 10.4 (19 to 63) years and 38.0 +/- 12.6 (13 to 83) years (p = 0.5769); echocardiographic score, 7.5 +/- 1.3 points and 7.2 +/- 1.5 points (p = 0.1307); female gender, 72.9% and 87.4% (p = 0.0097); atrial fibrillation, 10.4% and 16.1% (p = 0.4275); mortality during follow-up, 2.1% and 4.3% (0.6984); and major events, 8.3% and 17.7% (p = 0.1642). Univariate and Kaplan-Meier curve analyses revealed no differences between the Inoue and Balt single balloon techniques in relation to survival and major event free survival. In the multivariate analysis, age > 50 years and an echocardiographic score > 8 were independent predictors of death; and an echocardiographic score > 8 and post operative mitral valve area < 1.50 cm(2) were predictors for major events. CONCLUSION: No differences were found in the long term evolution of patients undergoing the Inoue versus the single balloon technique. Predictors of death and/or major events were: age > 50 years, echocardiographic score > 8 and mitral valve area < 1.50 cm(2) after the procedure.
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Cateterismo/métodos , Estenosis de la Válvula Mitral/terapia , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/epidemiología , Fibrilación Atrial/etiología , Cateterismo/efectos adversos , Cateterismo/mortalidad , Ecocardiografía/estadística & datos numéricos , Métodos Epidemiológicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Estenosis de la Válvula Mitral/diagnóstico por imagen , Valores de Referencia , Factores de Tiempo , Resultado del TratamientoRESUMEN
Los catéteres de derivación externa en patología neuroquirúrgicas como la hemorragia subaracnoidea, accidentes vascular cerebral hemorrágico, traumatismo cranoencefálico grave y tumores cerebrales, son utilizados con frecuencia en la práctica diaria, siendo la infección la más común de sus complicaciones y como causante de las mismas se menciona: la manipulación del catéter en el mismo acto quirúrgico; en la sala de internados no se cumplen las medidas de aislamiento en forma externa como lo demuestra la presencia de gérmenes habituales del medio hospitalario aislados en el clutivo de líquido cefalorraquídeo y en la punta del catéter. Contribuyen además la permanencia de catérter por mas de 5 días y la frecuencia de cambio muy prolongada. El objetivo es observar la frecuencia de edad, sexo, determinar patologías que requirieron la utilización de los catéteres de derivación externa, los días de permanencia y la frecuencia de cambio. Además identificar los gérmenes aislados en cultivos, hallar la letalidad relacionada con dicha causa. Los hallazgos más relevantes fueron el sexo masculino en 58%, el grupo erario entre los 60 y 70 años, las patologías en que se requirieron CDE fueron el accidente vascular cerebral intraparenquimatoso (28%), la hemorragia subaracnoidea (19%) y el traumatismo craneoencefálico grave (19%), se hallaron LCR infectados en 28% de los casos y los gérmenes aislados en cultivos: acinetobacter sp (61%) y klebsiella pneumoniae (15%). Se utilizó la cefazolina como profiláctico en 64% de los casos y se registró 20% de mortalidad. La correlación entre los datos hallados en las literaturas internacionales difiere en aspectos profilácticos y nos ayudan a unificar criterios y extremas estrategias de prevención de las infecciones a fin de disminuir la morbilidad y mortalidad relacionadas a las infecciones.
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Cateterismo/efectos adversos , Cateterismo/mortalidad , Infección Hospitalaria/etiología , Infección Hospitalaria/prevención & control , Líquido CefalorraquídeoRESUMEN
Percutaneous mitral balloon valvuloplasty (PMV) can be performed during pregnancy without significant maternal risk or fetal morbidity or mortality. However, little is known about long-term follow-up results after PMV in populations of pregnant women. Thus, the present study was undertaken to determine the immediate and long-term outcomes after PMV in a large cohort of pregnant patients with severe mitral stenosis. The patient population consisted of 71 consecutive pregnant women with severe rheumatic mitral stenosis admitted to the hospital with severe congestive heart failure (New York Heart Association class III and IV) for PMV. All patients underwent clinical and obstetric evaluations, electrocardiography, and 2-dimensional and Doppler echocardiography. PMV was successful in all patients, resulting in a significant increase in mitral valve area from 0.9 0.2 to 2.0 0.3 cm2 (p <0.001). At the end of pregnancy, 98% of the patients were in New York Heart Association functional class I or II. At a mean follow-up of 44 31 months, the total event-free survival rate was 54%. The mean gestational age at delivery time was 38 1 weeks. Preterm deliveries occurred in 9 patients (13%), including 2 twin pregnancies. The remaining 66 of 75 newborns (88%) had normal weight (mean 2.8 0.6 kg) at delivery. At long-term follow-up of 44 31 months after birth, the 66 children exhibited normal growth and development and did not show any clinical abnormalities. In conclusion, PMV is safe and effective, has a low morbidity and mortality rate for the mother and the fetus, and has favorable long-term results in pregnant women with rheumatic mitral stenosis in New York Heart Association functional class III or IV.
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Femenino , Embarazo , Recién Nacido , Adulto , Humanos , Cateterismo/mortalidad , Estenosis de la Válvula Mitral/complicaciones , Estenosis de la Válvula Mitral/mortalidad , Insuficiencia Cardíaca , Mortalidad MaternaRESUMEN
OBJECTIVE: To analyze our experience with percutaneous aortic balloon valvuloplasty in newborn infants with aortic stenosis, emphasizing the extraordinary importance of myocardial perfusion. METHODS: Over a 10-year-period, 21 neonates underwent percutaneous aortic balloon valvuloplasty. Age ranged from 2 to 27 days, weight ranged from 2.2 to 4.1 kg and 19 were males. All patients presented with congestive heart failure that could not be treated clinically. The onset of symptoms in the first week of life occurred in 9 patients considered as having critical aortic stenosis. Severe aortic stenosis occurred in 12 patients with the onset of symptoms in the second week of life. RESULTS: Mortality reached 100% in the patients with critical aortic stenosis. The procedure was considered effective in the 12 patients with severe aortic stenosis. Vascular complications included the loss of pulse in 12 patients and rupture of the femoral artery in 2 patients. Cardiac complications included acute aortic regurgitation in 2 patients and myocardial perforation in one. In an 8.2+/-1.3-year follow-up, 5 of the 12 patients died (2 patients due to septicemia and 3 patients due to congestive heart failure). Five of the other 7 patients underwent a new procedure and 2 required surgery. CONCLUSION: Percutaneous aortic valvuloplasty in neonates is not an effective procedure in the 1st week of life, because at this age the common presentation is cardiogenic shock. It is possible that, in those patients with critical aortic stenosis, dilation of the aortic valve during fetal life may change the prognosis of its clinical outcome.
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Estenosis de la Válvula Aórtica/terapia , Cateterismo , Estenosis de la Válvula Aórtica/mortalidad , Cateterismo/mortalidad , Femenino , Estudios de Seguimiento , Humanos , Recién Nacido , Masculino , Pronóstico , Resultado del TratamientoRESUMEN
OBJETIVO: Estabelecer a circulação extracorpórea através de canulação da artéria subclávia direita por meio de incisão supraclavicular. MÉTODO: Foram estudados, no período de outubro de 2001 a março de 2002, quatro pacientes com diagnóstico de dissecção aguda de aorta tipo A de Stanford, sendo realizada em todos os casos canulação da artéria subclávia direita por via supraclavicular e realização de perfusão cerebral anterógrada durante o período de parada circulatória total. RESULTADOS: A artéria subclávia direita foi canulada diretamente e não houve nenhuma complicação neurovascular relacionada ao procedimento. A circulação extracorpórea foi mantida com fluxo adequado durante toda a operação. Houve 1 óbito hospitalar, não relacionado ao procedimento. DISCUSSÃO: Um dos passos mais importantes na melhora dos resultados operatórios é a perfusão sistêmica anterógrada, realizada através do sistema arterial e a subclávia para isso permite a perfusão da luz verdadeira. A abordagem supraclavicular nos proporciona um campo operatório adequado e facilidade para a realização da perfusão cerebral anterógrada que também é importante neste arsenal para uma redução da mortalidade operatória. CONCLUSÃO: A incisão supraclavicular nos proporciona um acesso factível com boa exposição da artéria subclávia direita em uma região em que ela apresenta um bom calibre e com poucas estruturas adjacentes que poderiam ser lesadas. Além disso, possibilita a canulação de forma direta e com boa posição da cânula arterial
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Humanos , Masculino , Femenino , Adulto , Enfermedades de la Aorta/cirugía , Enfermedades de la Aorta/patología , Arteria Subclavia/cirugía , Cateterismo/mortalidad , Disección/efectos adversos , Disección/historia , Disección/métodos , Insuficiencia de la Válvula Aórtica , Dolor en el Pecho , Circulación Extracorporea , Arteria Femoral , Perfusión , Derrame Pericárdico , Factores de TiempoRESUMEN
A diversidade de formulações farmacêuticas para a manutenção da integridade da pele peri-cateter é vasta, porém os resultados referentes à melhor terapêutica e técnica antisséptica ainda são inconclusivos. Esse fato contribui para a manutenção da infecção como uma das principais causas de morte do paciente portador de insuficiência renal crônica. Este estudo teve como objetivo verificar a associação entre a incidência de sinais clínicos ou laboratoriais de infecção no local de inserção do cateter venoso central para hemodiálise e o tipo de solução utilizada na realização do curativo em pacientes portadores de insuficiência renal crônica. Foram estudados 54 pacientes em programa de hemodiálise no período de março de 2000 a fevereiro de 2001. Os pacientes foram aleatoriamente distribuídos em grupos em que se utilizou três diferentes produtos no curativo do cateter : em 19 pacientes utilizou-se mupirocin (antibiótico tópico); em 17 utilizou-se PVPI e 18 pacientes receberam violeta genciana. A infecção no local de inserção do cateter foi avaliada através de observação do local, cultura da ponta do cateter e hemocultura conforme procedimento de acompanhamento. A média de idade dos pacientes foi de 51 anos e a mediana 53, não ocorrendo variação significante na distribuição de pacientes por sexo. As principais causas de IRC foram a nefropatia hipertensiva (27,8%), a glomerulonefrite crônica (9,3%); e a uropatia obstrutiva (7,4%). O acesso mais utilizado para implante do cateter foi a veia subclávia (88,9%) dos pacientes seguido da veia jugular (11,1%) . O grupo que permaneceu maior tempo com o cateter (43,7 dias) foi o grupo mupirocin seguido pelo grupo (40 dias) e por último o grupo PVPI (31,2 dias). De forma geral 35,2% pacientes apresentaram infecção no local de inserção do cateter venoso para hemodiálise. Os sinais e sintomas observados foram a febre (24,1%), dor no local da inserção (13%), edema (5,6%), e exsudato (3,7%). ...