RESUMO

Objective: The study objective was to evaluate the safety and clinical and echocardiographic outcomes of a new surgical technique in adult patients diagnosed with a giant left atrium. Methods: We analyzed a cohort of patients who underwent left atrium reduction surgery between January 2016 and June 2020 performed by a specialized surgical team in 2 national reference centers in Lima, Peru. We assessed the major adverse valvular-related events and the New York Heart Association functional class as primary clinical outcomes. Also, our primary echocardiographic endings were the diameter, area, and volume of the left atrium. We assessed these variables at 3 time periods: baseline (t0), perioperative period (t1), and extended follow-up (t2: 12 ± 3.4 months). We carried out descriptive and bivariate exploratory statistical analysis for dependent measures. Results: We included 17 patients, 70.6% of whom were women. Rheumatic mitral valve disease (76.5%) was the main etiology. We performed 14 (82.4%) mitral valve replacements and 3 repairs. Major adverse valvular-related events occurred in 1 patient (5.9%) (hemorrhagic stroke) at t1. A significant reduction in the size of the left atrium was observed: diameter (77 mm vs 48 mm, P < .001), area (75 cm2 vs 31 cm2, P < .001), and volume (332 cm3 vs 90 cm3, P < .001). Compared with t0 and t1, these echocardiographic findings remained without significant changes during t2. Conclusions: Our surgical left atrium reduction technique was associated with improved clinical functionality and reduced left atrium measures in patients with a giant left atrium undergoing mitral valve surgery.

RESUMO

AIMS: In this multicentre study, we compared cardio-pulmonary exercise test (CPET) parameters between heart failure (HF) patients classified as New York Heart Association (NYHA) class I and II to assess NYHA performance and prognostic role in mild HF. METHODS AND RESULTS: We included consecutive HF patients in NYHA class I or II who underwent CPET in three Brazilian centres. We analysed the overlap between kernel density estimations for the per cent-predicted peak oxygen consumption (VO2 ), minute ventilation/carbon dioxide production (VE/VCO2 ) slope, and oxygen uptake efficiency slope (OUES) by NYHA class. Area under the receiver-operating characteristic curve (AUC) was used to assess the capacity of per cent-predicted peak VO2 to discriminate between NYHA class I and II. For prognostication, time to all-cause death was used to produce Kaplan-Meier estimates. Of 688 patients included in this study, 42% were classified as NYHA I and 58% as NYHA II, 55% were men, and mean age was 56 years. Median global per cent-predicted peak VO2 was 66.8% (IQR 56-80), VE/VCO2 slope was 36.9 (31.6-43.3), and mean OUES was 1.51 (±0.59). Kernel density overlap between NYHA class I and II was 86% for per cent-predicted peak VO2 , 89% for VE/VCO2 slope, and 84% for OUES. Receiving-operating curve analysis showed a significant, albeit limited performance of per cent-predicted peak VO2 alone to discriminate between NYHA class I vs. II (AUC 0.55, 95% CI 0.51-0.59, P = 0.005). Model accuracy for probability of being classified as NYHA class I (vs. NYHA class II) across the spectrum of the per cent-predicted peak VO2 was limited, with an absolute probability increment of 13% when per cent-predicted peak VO2 increased from 50% to 100%. Overall mortality in NYHA class I and II was not significantly different (P = 0.41), whereas NYHA class III patients displayed a distinctively higher death rate (P < 0.001). CONCLUSIONS: Patients with chronic HF classified as NYHA I overlapped substantially with those classified as NYHA II in objective physiological measures and prognosis. NYHA classification may represent a poor discriminator of cardiopulmonary capacity in patients with mild HF.

Assuntos

RESUMO

The presence of moderate to severe paravalvular leak increases mortality. We present a case of giant paravalvular leak closure using the 3-dimensional printing model to assess the success of the device to be used for its closure, computed tomography was performed for planning and guiding the procedure by image fusion. (Level of Difficulty: Advanced.).

RESUMO

Background: Despite the rapid adoption of transcatheter aortic valve replacement (TAVR), aortic valve reintervention, particularly surgical TAVR valve explantation (TAVR explant), has not been well described. Methods: MEDLINE, Embase, and Web of Science were searched through July 2021 to identify observational studies and case series reporting clinical outcomes of TAVR explant. Data on the frequency of TAVR explant, patient demographic characteristics, clinical indications, operative data, and perioperative outcomes were extracted. Study-specific estimates were combined using one-group meta-analysis in a random-effects model. Results: A total of 10 studies were identified that included 1690 patients undergoing a TAVR explant. The frequency of TAVR explant among TAVR recipients was 0.4% (95% confidence interval [CI], 0.2%-0.6%). The mean patient age was 73.7 years (95% CI, 72.9-74.6 years). The mean Society of Thoracic Surgeons predicted risk of mortality was 5.9% (95% CI, 2.9%-8.8%) at the index TAVR and 8.1% (95% CI, 5.4%-10.8%) at TAVR explant. The mean time from implant to explant was 345.0 days (95% CI, 196.7-493.3 days). Among patients with documented device type, 59.8% (95% CI, 43.5%-76.0%) had a balloon-expandable valve and 40.2% (95% CI, 24.0%-56.5%) had a self-expandable valve. Concomitant procedures during TAVR explant were performed in 52.9% of patients (95% CI, 33.8%-72.0%), and the most common concomitant procedure was aortic repair (28.5%; 95% CI, 14.0%-42.9%). The 30-day mortality after TAVR explant was 16.7% (95% CI, 12.2%-21.2%). Conclusions: TAVR explant in patients with a failing TAVR appears to be rare; however, the clinical impact of TAVR explant is substantial. Implanters must be mindful of the need for a lifetime management strategy in younger and lower-risk patients when choosing the valve type for the initial procedure.

RESUMO

We describe the endovascular management of a middle-aged woman who developed a bleeding suprasternal fistula after conventional aortic valve replacement. The patient's condition was considered inoperable. A customized stent attached to a transcatheter valve was successfully used to treat the individual, this being the first-in-human case of the promising Endo-Bentall procedure. (Level of Difficulty: Advanced.).

RESUMO

Introducción: Hasta 60% de los casos tratados con intervención coronaria percutánea (ICP) o cirugía (CRVC) tienen enfermedad coronaria de múltiples vasos (ECMV). Objetivo: Comparar la evolución clínica de estos pacientes después de su comparativo, de una cohorte tratada por ECMV con CRVC o ICP más stents farmacoactivos o bioactivos entre enero de 2004 a julio de 2011. Se utilizó expediente clínico, consignando eventos cardiovasculares adversos. Resultados: Ingresaron 134 pacientes, predominando varones con enfermedad trivascular y angina estable con un seguimiento de 35.7 ± 20.4 meses. El grupo quirúrgico tuvo más dislipidemia (41.9 vs 36.7%), diabetes (59.5 vs 38.3%), hipertensión arterial (67.6 vs 60%), infarto del miocardio antiguo (37.8 vs 23.3%) y lesión tipo C en la arteria descendente anterior (63.9 vs 30.4%), p < 0.05 para todas. Los tratados con ICP tuvieron más necesidad de revascularización repetida (30.50 vs 2.73%) p < 0.01, recurrencia de angina (44 vs 20%), ergometrías positivas (39 vs 18%), hospitalizaciones (25 vs 9%) y deterioro funcional según la New York Heart Association III o IV (22 vs 11%), p < 0.05 para todos. Conclusión: En pacientes de un hospital comunitario con ECMV, la ICP presenta una recurrencia superior de isquemia y revascularización repetida comparada con la CRVC.

Introduction: 60% of the patients treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) suffer from multivessel coronary artery disease. Objective: Our objective was to compare the clinical course of patients with this diagnosis after revascularization. Methods: We‚ consulted and compared the clinical records‚ of‚ a multivessel coronary artery disease cohort treated with either coronary artery bypass grafting or angioplasty with drug eluting stents or bioactive stents between January 2004 and July 2011, consigning adverse cardiovascular events. Results: 134 patients, mostly male, with‚ 3-vessel disease and stable angina, were followed up for‚ 35.7 ± 20.4 months. Dyslipidemia‚ (41.9 vs 36.7%),‚ diabetes mellitus type 2‚ (59.5 vs 38.3%), hypertension (67.6 vs 60%),‚ old myocardial infarction‚ (37.8 vs 23.3%) and type C lesion in left anterior descendent artery (63.9 vs 30.4%) were all more frequent in the surgery group (p < 0.05). On the other hand, the angioplasty treated patients needed more frequently revascularization (30.50 vs 2.73%; p < 0.01) and hospitalization (25 vs 9%) and had more often angina‚ (44 vs 20%), positive ergometry (39 vs 18%), and functional impairment type New York Heart Association III/IV‚ (22 vs 11%) (p < 0.05). Conclusion: In patients at a community hospital with multivessel coronary artery disease, PCI has a higher recurrence of ischemia and repeated revascularization compared to CABG.