A idade influencia os desfechos em pacientes com idade igual ou superior a 70 anos submetidos à cirurgia de revascularização miocárdica isoladaAge influences outcomes in 70-year or older patients undergoing isolated coronary artery bypass graft surgery Abstract Objective: To analyze the results of isolated on-pump coronary artery bypass graft surgery (CABG) in patients ≥ 70 years old in comparison to patients <70 years old.Methods: Patients undergoing isolated CABG were selected for the study. The patients were assigned into two groups: G1 (age ≥ 70 years old) and G2 (age <70 years old).The endpoints were in-hospital mortality, acute myocardial infarction (AMI), stroke, re-exploration for bleeding, intraaortic balloon pump for circulatory shock, respiratory complications, acute renal failure, mediastinitis, sepsis, atrial fibrillation, and complete atrioventricular block (CAVB).Results: A total of 1,033 were included in the study: G1 Rev Bras Cir Cardiovasc 2012;27(1):45-51
BackgroundHeart failure represents an important public health issue due to its high costs and growing incidence worldwide. Evidence showing the regenerative potential of postmitotic heart tissue has suggested the existence of endogenous cardiac stem cells in adult hearts. Cardiosphere-derived cells (CDC) constitute a candidate pool of such cardiac stem cells. Previous studies using acute myocardial infarction (MI) models in rodents demonstrated an improvement in cardiac function after cell therapy with CDC. We evaluated the therapeutic potential of CDC 60 days after MI in a rat model.MethodsCDC were obtained from human discarded myocardial tissue and rat hearts by enzymatic digestion with collagenase II. At 10–15 days after isolation, small, round, phase-bright cells (PBCs) appeared on top of the adherent fibroblast-like cells. The PBCs were collected and placed on a nonadherent plate for 2 days, where they formed cardiospheres which were then transferred to adherent plates, giving rise to CDC. These CDC were characterized by flow cytometry. Wistar rats were submitted to MI through permanent occlusion of the anterior descending coronary artery. After 60 days, they were immunosuppressed with cyclosporine A during 10 days. On the third day, infarcted animals were treated with 5 × 105 human CDC (hCDC) or placebo through intramyocardial injection guided by echocardiogram. Another group of animals was treated with rat CDC (rCDC) without immunosuppression. hCDC and rCDC were stably transduced with a viral construct expressing luciferase under control of a constitutive promoter. CDC were then used in a bioluminescence assay. Functional parameters were evaluated by echocardiogram 90 and 120 days after MI and by Langendorff at 120 days.ResultsCDC had a predominantly mesenchymal phenotype. Cell tracking by bioluminescence demonstrated over 85% decrease in signal at 5–7 days after cell therapy. Cardiac function evaluation by echocardiography showed no differences in ejection fraction, end-diastolic volume, or end-systolic volume between groups receiving human cells, rat cells, or placebo. Hemodynamic analyses and infarct area quantification confirmed that there was no improvement in cardiac remodeling after cell therapy with CDC.ConclusionOur study challenges the effectiveness of CDC in post-ischemic heart failure.
BackgroundPost-procedure residual ischemia is associated with worse prognosis in patients with coronary artery diasease (CAD).ObjectiveWe evaluated whether autologous bone marrow-derived cells (BMC) contribute to additional reduction in regional stress-induced myocardial ischemia (SIMI) in patients undergoing incomplete coronary artery bypass graft surgery (CABG).MethodsIn a double-blind, randomized, placebo-controlled trial, we enrolled 143 patients (82% men, 58 ± 11 years) with stable CAD and not candidates for complete CABG. They received 100 million BMC (n = 77) or placebo (n = 66) injected into ischemic non-revascularized segments during CABG. The primary outcome was improvement on SIMI quantified as the area at risk in injected segments assessed by cardiovascular magnetic resonance (CMR) 1, 6, and 12 months after CABG.ResultsThe reduction in global SIMI after CABG was comparable (p = 0.491) in both groups indicating sustained beneficial effects of the surgical procedure over 12 month period. In contrast, we observed additional improvement in regional SIMI in BMC treated group (p = 0.047). Baseline regional SIMI values were comparable [18.5 (16.2–21.0) vs. 18.5 (16.5–20.7)] and reached the lowest values at 1 month [9.74 (8.25; 11.49) vs. 12.69 (10.84; 14.85)] for BMC and placebo groups, respectively. The ischemia’s improvement from baseline represented a 50% difference in regional SIMI in favor of the BMC transplanted group at 30 days. We found no differences in clinical and LVEF% between groups during the 12 month follow-up period. The 1 month rate of major adverse cerebral and cardiovascular events (MACCE) (p = 0.34) and all-cause mortality (p = 0.08) did not differ between groups 1 month post intervention.ConclusionWe provided evidence that BMC leads to additional reduction in regional SIMI in chronic ischemic patients when injected in segments not subjected to direct surgical revascularization. This adjuvant therapy deserves further assessment in patients with advanced CAD especially in those with microcirculation dysfunction.Clinical trial registrationhttps://clinicaltrials.gov/, identifier NCT01727063
O tratamento cirúrgico, iniciado há muitos anos 1. 3. 8, vem sofrendo modificações técnicas 2. 4-7, sendo hoje realizado com bons resultados em um grande núme-ro de pacientes.Neste trabalho, será analisada a experiência acumulada nos últimos 11 anos, para o tratamento da dissecção da aorta e suas complicações, assim como as diferentes técnicas operatórias. CASUfSTICA E MÉTODOSEntre janeiro de 1979 e dezembro de 1,989, 81 pacientes foram operados para tratamento da dissecção da aorta, com um total de 85 operações.O diagnóstico da dissecção foi, quase sempre, confirmado pelo estudo cineangiográfico, ou através de tomografia computadorizada. Entretanto, em três dos pacientes com dissecção crónica de tipo II associada a acentuada insuficiência valvar aórtica, o diagnóstico da dissecção ocorreu durante a operação.Quatro pacientes foram operados duas vezes. Dois por recidiva e dois por dissecção em outros segmentos da aorta. Sessenta e dois pacientes (76;5%) eram do sexo masculino e 19 (23,5%) do sexo feminino.A idade variou entre 18 e 75 anos, com média de 45,7 anos. Foram operados 18 pacientes com mais de 60 anos.Em 21 pacientes, havia doença associada, sendo: insuficiência coronária em 13, valvopatia aórtica em seis; coarlação da aorta em um e persistência do canal arterial em um.Dezessete pacientes haviam sido submetidos a cirurgia cardíaca prévia (Tabela 1), sendo sete para revascularização do miocárdio, seis para corração de lesão valvar aórtica e quatro que haviam sido submetidos a correção de dissecção da aorta anteriormente.
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