Nota: estas Atualizações se prestam a informar e não a substituir o julgamento clínico do médico que, em última análise, deve determinar o tratamento apropriado para seus pacientes.
BackgroundParavalvular regurgitation (paravalvular leak) is a serious and rare
complication associated with valve replacement surgery. Studies have shown a
3% to 6% incidence of paravalvular regurgitation with hemodynamic
repercussion. Few studies have compared surgical and percutaneous approaches
for repair.ObjectivesTo compare the surgical and percutaneous approaches for paravalvular
regurgitation repair regarding clinical outcomes during hospitalization and
one year after the procedure.MethodsThis is a retrospective, descriptive and observational study that included 35
patients with paravalvular leak, requiring repair, and followed up at the
Dante Pazzanese Institute of Cardiology between January 2011 and December
2013. Patients were divided into groups according to the established
treatment and followed up for 1 year after the procedure.ResultsThe group submitted to percutaneous treatment was considered to be at higher
risk for complications because of the older age of patients, higher
prevalence of diabetes, greater number of previous valve surgeries and lower
mean creatinine clearance value. During hospitalization, both groups had a
large number of complications (74.3% of cases), with no statistical
difference in the analyzed outcomes. After 1 year, the percutaneous group
had a greater number of re-interventions (8.7% vs 20%, p = 0.57) and a
higher mortality rate (0% vs. 20%, p = 0.08). A high incidence of residual
mitral leak was observed after the percutaneous procedure (8.7% vs. 50%, p =
0.08).ConclusionSurgery is the treatment of choice for paravalvular regurgitation. The
percutaneous approach can be an alternative for patients at high surgical
risk.
Note: These statements are for information purposes and should not replace the clinical judgment of a physician, who must ultimately determine the appropriate treatment for each patient.
IntroductionActive infective endocarditis is associated with high morbidity and
mortality. Surgery is indicated in high-risk conditions, and the main
determinants of mortality in surgical treatment should be evaluated.ObjectiveTo identify mortality predictors in the surgical treatment of active
infective endocarditis in a long-term follow-up.MethodsThis prospective observational study involved 88 consecutive patients
diagnosed with active infective endocarditis, who underwent surgery between
January 2005 and December 2015. Fifty-eight (65.9%) patients were male, the
mean age was 50.87±16.15 years. A total of 31 (35.2%) patients had a
history of rheumatic fever; 48 (54.5%) had had heart surgery with prosthetic
valve implantation; 45 (93.8%) had biological prosthetic valve endocarditis
and 3 (6.3%) mechanical prosthetic valve; 40 (45.5%) patients had the
disease in their native valve. The mean EuroSCORE II was 8.9±6.5%,
and the main surgical indication was refractory heart failure in 38 (43.2%)
patients. A total of 68 bioprosthesis (36 aortic, 32 mitral) and 29
mechanical prostheses (12 aortic, 17 mitral) were implanted and three mitral
valve plasties performed. A total of 25 (28.4%) patients underwent double or
triple valve procedures. Aortic annulus reconstruction by abscess was
performed in 18 (20.5%) and six (6.81%) patients had combined procedure. The
mean surgery time was 359±97.6 minutes.ResultsThe overall survival in up to a 10-year follow-up period was 79.5%. In the
univariate analysis, the main mortality predictors were positive blood
cultures (P=0.003), presence of typical microorganisms
(P=0.008), most frequently Streptococcus
viridans (12 cases; 25%); C-reactive protein (hazard ratio
[HR] 1.034, 95% confidence interval [CI] 1.000
to 1.070, P=0.04); creatinine clearance (HR 0.977, 95% CI
0.962 to 0.993, P=0.005); length of surgery: every five
minutes multiplies the chance of death 1.005-fold (HR 1.005, 95% CI 1.001 to
1.009, P=0.0307); age (HR 1.060, 95% CI 1.026 to 1.096,
P=0.001); and EuroSCORE II (HR 1.089, 95% CI 1.030 to
1.151, P=0.003).ConclusionA positive blood culture with typical microorganism, C-reactive protein, age,
EuroSCORE II, total surgical time and the presence of postoperative
complications were the major predictors of mortality and significantly
impacted survival in up to a 10-year follow-up period.
Early LA reverse remodeling and functional improvement occur after successful surgery of symptomatic organic MR regardless of surgical technique. Diastolic blood pressure and transmitral mean gradient augmentation are variables negatively related to Vol-max reduction. Besides, e' is positively correlated with both Vol-max reduction and AAEF increase.
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