RESUMO
BACKGROUND: Although donor scarcity and intolerance to immunosuppression tend to exclude elderly patients from transplantation, partial left ventriculectomy (PLV) has been performed without bias against advanced age. METHODS: Among 392 patients undergoing PLV, 61 elderly patients aged 65 or older (> or =65) were compared with the rest of the patients in terms of underlying disease, postoperative course, and survival time. RESULTS: The aged patients (> or =65) compared to younger patients (<65), had ischemic disease (37.7% vs. 19.3%, p < 0.05) more frequently than cardiomyopathy (34.4% vs. 43.2%) or valvular disease (23.9% vs. 16.4%) and underwent lateral PLV (74% vs. 79%) more frequently than extended PLV (26% vs. 21%). Although the elderly patients required coronary bypass grafting more frequently (39.3% vs.17.2%, p < 0.05), surgical complexity was similar in terms of bypass time (63 minutes vs. 63 minutes) and percentage requiring cardiac arrest (31% vs. 44%). Despite advanced age, they required comparable ICU care (6.6 days vs. 5.4 days) and postoperative hospital stay (12 days vs. 11 days), resulting in a low but similar hospital survival (57% vs. 62%) and functional capacity after discharge (NYHA class 1.5 vs. 1.4). CONCLUSION: The results suggest that PLV can be performed in elderly patients (> or =65 years) with comparable risks and benefits with the younger patients, promoting its application in patients disqualified for heart transplantation because of age criteria.
Assuntos
Transplante de Coração , Ventrículos do Coração/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Cardiomiopatia Dilatada/mortalidade , Cardiomiopatia Dilatada/cirurgia , Doença de Chagas/mortalidade , Doença de Chagas/cirurgia , Criança , Pré-Escolar , Doença da Artéria Coronariana/mortalidade , Doença da Artéria Coronariana/cirurgia , Feminino , Transplante de Coração/efeitos adversos , Ventrículos do Coração/patologia , Humanos , Lactente , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Análise de Sobrevida , Tempo , Resultado do TratamentoRESUMO
Angiographic, Doppler-echocardiographic and hemodynamic studies early (+6 days) and late (+180 days) after partial left ventriculectomy (PLV) on 24 patients revealed that PLV decreased end-systolic volume (or dimension) more than the end-diastolic volume (or dimension), improving stroke volumes (or contractile excursion), and doubling ejection fraction (or fractional shortening). Results of PLV appeared to depend on a balance between improved systolic contractility and reduced diastolic performance. All these survivors had improved diastolic relaxation, suggesting myocardial viability is a prerequisite for PLV to be successful.
Assuntos
Procedimentos Cirúrgicos Cardíacos , Angiografia Coronária , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/cirurgia , Adulto , Idoso , Brasil/epidemiologia , Ecocardiografia Doppler , Feminino , Seguimentos , Insuficiência Cardíaca/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Ventrículos do Coração/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Contração Miocárdica , Pressão Propulsora Pulmonar , Volume Sistólico , Resultado do Tratamento , Pressão VentricularRESUMO
We present a case of a 19-year old female with systemic pulmonary artery (PA) pressure due to a congenital ventricular septal defect (VSD) and atrial septal defect (ASD). She was pink at rest and cyanotic on exercise. Lung biopsy revealed grade IV pulmonary vascular changes. As a preliminary step PA was banded to increase right-to-left shunt and decrease aortic (Ao) saturation with consequent decrease in PA saturation. After one year, when she was no longer cyanotic, even on exercise, lung biopsy revealed total regression of pulmonary vascular changes. As a definitive procedure VSD and ASD were closed and PA was debanded. Cardiac catheterization one week postoperatively showed PA pressure to be 50of systemic pressure. We postulate that reversal of pulmonary vascular changes were due to lowered PA saturation. We further believe that lower PA pressure could have contributed to this regression of pulmonary vascular changes. We performed the same procedure in six more patients with similar positive clinical response. This new concept brings renewed hope to many children who otherwise are candidates for heart lung transplantation.