1,721,047 research outputs found
Atrial fibrillation after surgical aortic valve replacement: the dark side of safe procedure
No full textAtrial fibrillation (AF) is the most common arrhythmia that occurs after cardiac surgery. Postoperative atrial fibrillation (POAF) has an incidence of 20–40%, depending on the type of procedure, with higher rates after valvular surgery (30–50%). Postoperative AF is more common in older patients, patients with concomitant valvular heart disease, hypertension, heart dysfunction and renal failure. The cause of postoperative AF is multifactorial and related to both the underlying atrial substrate and the acute inflammation, oxidative stress and sympathetic output associated with cardiac surgery. Current European Society of Cardiology and European Association for Cardio-thoracic Surgery joint guidelines state that oral anticoagulation (OAC) therapy may be considered in patients with POAF (class IIb, lever of evidence B), after taking stroke risk and bleeding risk into consideration. This recommendation is based on a few retrospective studies involving cardiac surgery patients, while the remaining evidence come from non-surgical AF
patients. No specific recommendations for OAC in surgical aortic valve replacement (SAVR) patients with POAF have been published
Heart valve surgery in a very high-risk population: a preliminary experience in awake patients.
No full textSt.Jude Medical-Biocor Porcine Prosthesis, A New Design Tissue Valve for an Extended Durability in Mitral Position: The Pathologist Point of View
No full textEarly and long-term prognostic value of Troponin-I after cardiac surgery in newborns and children
Full text linkBackground: Troponin-I (Tn-I) is a well-recognized early postoperative marker for myocardial damage in adults and children. The present prospective study was undertaken to investigate whether a postoperative Tn-I value higher than 35 μg/l is able to predict long-term outcome as it does in early postoperative course, after surgery for congenital heart defects (CHD). Materials and methods: Five hundred and twenty patients (median age 11 months; male 54.7%: 284 patients) undergoing congenital heart defect repair on cardiopulmonary by-pass were prospectively updated in our database including postoperative Tn-I values. Seventy of them (13.4%) (mean age 2.6 ± 5.8 months) (70/520) experienced low output syndrome in the early postoperative period. According to the complexity of their malformations, we have arbitrarily divided these patients into two groups: group A included atrial and ventricular septal defects (13 patients), while group B included hypoplastic left heart syndrome, atrio-ventricular canal, transposition of great vessels, tetralogy of Fallot, double outlet right ventricle, truncus arteriosus, total anomalous venous return, and other combined diseases (57 patients). These patients are the object of our study. We reviewed clinical, laboratory, and echocardiographic data performed in the immediate postoperative course (within 24 h) and in the follow-up. Results: In this study, 13 patients died (13/70 patients; 18.5%), 12 in group B and 1 in group A. In deceased patients, mean Tn-I value was 130 ± 175 μg/l (CK-MB 570 ± 280 μg/l). Conversely, survivors showed a lower mean Tn-I value (25.5 ± 28.9 μg/l; CK-MB 76 ± 86 μg/l). Overall, Tn-I peak value was higher than 35 μg/l in 19 patients (19/70; 27.2%); among these, 9 died (median Tn-I was 163 ± 186 μg/l), whereas in survivors it was 73.4 ± 37 μg/l (p = 0.37). The remaining four patients who died had a median Tn-I value of 21 μg/l. When Tn-I exceeded 35 μg/l (>100 μg/l in two cases), at echocardiogram a severely depressed cardiac function was evident. Nevertheless, at long-term follow-up (12 ± 6 months), the echocardiogram showed an enhanced cardiac performance with an ejection fraction of 70 ± 8.5% in all; none of these patients presented with worsened ventricular function. Conclusion: Cardiac Tn-I is a specific and sensitive marker of myocardial injury after cardiac surgery and it may predict early in-hospital outcomes. However, by long-term echocardiographic analysis, cardiac Tn-I value looses its prognostic significance and therefore it is not a predictor of long-term ventricular dysfunction. © 2006 Elsevier B.V. All rights reserved
Valve surgery in octogenarians: does it prolong life?
No full textObjectives: Age-related degenerative heart-valve disease is a health issue in the present era. Octogenarians are frequently affected by concomitant diseases and, with the present lack of resources, the risk/benefit of valvular replacement therapy poses serious medical, economical and political challenge. We analysed the long-term survival of 346 octogenarians who underwent 352 operations between 1 January 1987 and 1 January 2009 and we compared it with the survival of the general population, matched for age, sex and operative year. Methods: The total follow-up was of 1352 years, maximum 15.7 years and was nearly complete except for a single foreigner. Heart diseases, concomitant pathologies, complications and actuarial survival of this study group were compared with 4649 younger counterparts, who received 5416 operations during the same time frame. Octogenarians were sorted by age, sex and operative year and the expected survival was calculated by applying US survival rate and added to the Kaplan-Meier plot for visual comparison. Results: A total of 279 aortic, 38 mitral and 35 mitro-aortic valves were replaced or repaired using 357 bioprostheses, 18 mechanical prostheses, 12 reparative operations and 24 re-operations. A total of 75% of patients were younger than 84 years, 95% were younger than 87 years and 99% younger than 90 years. Sex prevalence was 215 female versus 131 male. Operative (30 days) mortality was 5.5% and overall survival was 84.3% at 1 year, 65.4% at 5 years, 27.3% at 10 years and 5.4% at 15 years. The expected survival of the age-, sex-, operative year-matched population was 26.9% at 10 years and 7.9% at 15 years. Female operative mortality was 5.9% and survival was respectively 86.3%, 70.2%, 27.5% and 9.1%, male mortality was 4.5% and survival was respectively 81%, 56.7%, 28.8% and 0% (p = 0.16). Expected female survival was 30% at 10 years and 10% at 15 years versus 22% and 5.6%, respectively, in males. Six octogenarians underwent re-operation, with one death. Conclusions: Despite the highest prevalence of concomitant diseases and the requirement of additional resources for the detection and neutralisation of risk factors, heart-valve operations in octogenarians offer excellent results that compare favourably with the expected survival of the age-, sex- and operative year-matched population, particularly after primary operations. © 2009 European Association for Cardio-Thoracic Surgery
Valve-sparing aortic root replacement in a patient with a rare connective tissue disorder: arterial tortuosity syndrome.
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