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Velho TR, Pereira RM, Guerra NC, Ferreira R, Pedroso D, Neves-Costa A, Nobre Â, Moita LF. The impact of cardiopulmonary bypass time on the sequential organ failure assessment score after cardiac surgery. Interdiscip Cardiovasc Thorac Surg 2024:ivae082. [PMID: 38684174 DOI: 10.1093/icvts/ivae082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
OBJECTIVES Postoperative organ dysfunction is common after cardiac surgery, particularly when cardiopulmonary bypass is used. The Sequential Organ Failure Assessment (SOFA) score is validated to predict morbidity and mortality in cardiac surgery. However, the impact of cardiopulmonary bypass duration on postoperative SOFA remains unclear. METHODS Retrospective study. Categorical values are presented as percentages. The comparison of SOFA groups utilized the Kruskal-Wallis chi-squared test, complemented by ad-hoc Dunn's test with Bonferroni correction. Multinomial logistics regressions were employed to evaluate the relationship between cardiopulmonary bypass time and SOFA. RESULTS 1032 patients were included. Cardiopulmonary bypass time was independently associated with higher postoperative SOFA scores at 24 h. Cardiopulmonary bypass time was significantly higher in patients with SOFA 4-5 (**P = 0.0022) or higher (***P < 0.001) when compared to SOFA 0-1. The percentage of patients with no/mild dysfunction decreased with longer periods of cardiopulmonary bypass, down to 0% for cardiopulmonary bypass time >180min (50% of the patients with >180min of cardiopulmonary bypass presented SOFA ≥ 10). The same trend is observed for each of the SOFA variables, with higher impact in the cardiovascular and renal systems. Severe dysfunction occurs especially >200min of cardiopulmonary bypass (cardiovascular system >100min; other systems mainly >200 min). CONCLUSIONS Cardiopulmonary bypass time may predict the probability of postoperative SOFA categories. Patients with extended cardiopulmonary bypass durations exhibited higher SOFA scores (overall and for each variable) at 24 h, with higher proportion of moderate and severe dysfunction with increasing times of cardiopulmonary bypass.
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Affiliation(s)
- Tiago R Velho
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal
- Department of Cardiothoracic Surgery, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
- Cardiothoracic Surgery Research Unit, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Rafael Maniés Pereira
- Department of Cardiothoracic Surgery, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
- Escola Superior Saúde da Cruz Vermelha Portuguesa, Lisbon, Portugal
| | - Nuno Carvalho Guerra
- Department of Cardiothoracic Surgery, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Ricardo Ferreira
- Department of Cardiothoracic Surgery, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
- Cardiothoracic Surgery Research Unit, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Dora Pedroso
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Ana Neves-Costa
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Ângelo Nobre
- Department of Cardiothoracic Surgery, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
- Cardiothoracic Surgery Research Unit, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Luís Ferreira Moita
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
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Velho TR, Gonçalves J, Maniés Pereira R, Ferreira R, Sena A, Junqueira N, Ângelo E, Carvalho Guerra N, Mendes M, Arruda Pereira R, Nobre Â. Surgical aortic valve replacement in octogenarians: Single-center perioperative outcomes and five-year survival. Rev Port Cardiol 2024:S0870-2551(24)00069-6. [PMID: 38401703 DOI: 10.1016/j.repc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/23/2023] [Accepted: 02/07/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES Aortic stenosis is the most common valvular heart disease. The number of octogenarians proposed for intervention is growing due to increased lifespan. In this manuscript we aim to evaluate perioperative outcome and long-term survival after surgical aortic valve replacement (SAVR) in octogenarians, comparing patients with low surgical risk (EuroscoreII <4%) with intermediate-high risk (EuroscoreII ≥4%). METHODS A retrospective observational single-center cohort study with 195 patients aged ≥80 years old, who underwent SAVR between 2017 and 2021, was conducted. Patients were divided into two groups according to EuroscoreII: (1) Low risk (EuroscoreII <4%) with intermediate-high risk (EuroscoreII ≥4%). Continuous variables are presented in median (IQR), analyzed using Wilcoxon rank sum test; categorical variables in percentages, analyzed using chi-squared test; and survival was analyzed by Kaplan-Meier, open cohort, and the log-rank test was performed. RESULTS The overall median age was 82 (IQR 81-83), with 4.6% of the patients ≥85 years old. 23.6% of the patients presented EuroscoreII ≥4%. No complications were observed in 26.2%, with a significantly higher rate in intermediate-high risk patients. Postoperative need for hemodynamic support was the most frequent complication, followed by postoperative acute kidney injury and the use of blood products. Overall median ICU stay was three days (2-4) and hospital length of stay (LOS) six days (5-8). Patients with intermediate-high risk and those with complications had longer ICU LOS. At 12 months, overall survival was 96.4%, at three years 94.1% and 5 years 75.4%. Patients with low surgical risk had higher survival proportions up to 5 years. CONCLUSION SAVR in patients ≥80 years is associated with low in-hospital mortality, although a significant proportion of patients develop complications. Long-term follow-up up to five years after surgery is acceptable in octogenarians with low surgical risk.
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Affiliation(s)
- Tiago R Velho
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal; Cardiothoracic Surgery Research Unit, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal; Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal.
| | - João Gonçalves
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Rafael Maniés Pereira
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal; Escola Superior de Saúde da Cruz Vermelha Portuguesa, Lisbon, Portugal
| | - Ricardo Ferreira
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - André Sena
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Nádia Junqueira
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Eurídice Ângelo
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Nuno Carvalho Guerra
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Mário Mendes
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Ricardo Arruda Pereira
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Ângelo Nobre
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
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Velho TR. Extracorporeal life support in cardiogenic shock: exploring before liberalizing. Port J Card Thorac Vasc Surg 2024; 30:11-12. [PMID: 38345875 DOI: 10.48729/pjctvs.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/10/2023] [Indexed: 02/15/2024]
Affiliation(s)
- Tiago R Velho
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal; Cardiothoracic Surgery Research Unit, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal; Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal.
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Ângelo E, Ferreira R, Velho TR, Nobre Â. Post-cardiotomy Bronchopericardial Fistula. Port J Card Thorac Vasc Surg 2024; 30:81. [PMID: 38345874 DOI: 10.48729/pjctvs.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/10/2023] [Indexed: 02/15/2024]
Affiliation(s)
- Eurídice Ângelo
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Ricardo Ferreira
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Tiago R Velho
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal; Cardiothoracic Surgery Research Unit, Centro Cardiovascular da Universidade de Lisboa (CCUL@RISE), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal; Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Ângelo Nobre
- Cardiothoracic Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
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Velho TR, Guerra N. The necessity of investigator-initiated trials in cardiothoracic surgery. Eur J Cardiothorac Surg 2023; 64:ezad292. [PMID: 37610357 DOI: 10.1093/ejcts/ezad292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 08/24/2023] Open
Affiliation(s)
- Tiago R Velho
- Department of Cardiothoracic Surgery, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Nuno Guerra
- Department of Cardiothoracic Surgery, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte EPE, Lisboa, Portugal
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Ferreira R, Rua N, Sena A, Velho TR, Gonçalves J, Junqueira N, Almeida AG, Nobre Â, Pinto F. Sutureless bioprosthesis for aortic valve replacement: Surgical and clinical outcomes. J Card Surg 2022; 37:4774-4782. [PMID: 36335595 PMCID: PMC10099473 DOI: 10.1111/jocs.17113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/15/2022] [Accepted: 10/23/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Aortic valve stenosis is the most common adult valve disease in industrialized countries. The aging population and the increase in comorbidities urge the development of safer alternatives to the current surgical treatment. Sutureless bioprosthesis has shown promising results, especially in complex procedures and in patients requiring concomitant surgeries. OBJECTIVES Assess the clinical and hemodynamic performance, safety, and durability of the Perceval® prosthetic valve. METHODS This single-center retrospective longitudinal cohort study collected data from all adult patients with aortic valve disease who underwent aortic valve replacement with a Perceval® prosthetic valve between February 2015 and October 2020. Of the 196 patients included (mean age 77.20 ± 5.08 years; 45.4% female; mean EuroSCORE II 2.91 ± 2.20%), the majority had aortic stenosis. RESULTS Overall mean cross-clamp and cardiopulmonary bypass times were 33.31 ± 14.09 min and 45.55 ± 19.04 min, respectively. Mean intensive care unit and hospital stay were 3.32 ± 3.24 days and 7.70 ± 5.82 days, respectively. Procedural success was 98.99%, as two explants occurred. Four valves were reimplanted due to intraoperative misplacement. Mean transvalvular gradients were 7.82 ± 3.62 mmHg. Pacemaker implantation occurred in 12.8% of patients, new-onset atrial fibrillation in 21.9% and renal replacement support was necessary for 3.1%. Early mortality was 2.0%. We report no structural valve deterioration, strokes, or endocarditis, and one successfully treated valve thrombosis. CONCLUSIONS Our study confirms the excellent clinical and hemodynamic performance and safety of a truly sutureless aortic valve, up to a 5-year follow-up. These results were consistent in isolated and concomitant interventions, solidifying this device as a viable option for the treatment of isolated aortic valve disease.
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Affiliation(s)
- Ricardo Ferreira
- Department of Cardiothoracic Surgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.,Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Nuno Rua
- Faculdade de Ciências Médicas da Universidade da Beira Interior, Covilhã, Portugal
| | - André Sena
- Department of Cardiothoracic Surgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Tiago R Velho
- Department of Cardiothoracic Surgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.,Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - João Gonçalves
- Department of Cardiothoracic Surgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Nádia Junqueira
- Department of Cardiothoracic Surgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal
| | - Ana G Almeida
- Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Department of Cardiology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
| | - Ângelo Nobre
- Department of Cardiothoracic Surgery, Centro Hospitalar Lisboa Norte, Hospital de Santa Maria, Lisbon, Portugal.,Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Fausto Pinto
- Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal.,Department of Cardiology, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon, Portugal
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R Velho T, Maniés Pereira R, Nobre Â. Cerebral malperfusion in acute type A aortic dissection: should surgery proceed? Port J Card Thorac Vasc Surg 2022; 29:51-56. [PMID: 35780412 DOI: 10.48729/pjctvs.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Tiago R Velho
- Cardiothoracic Surgery Department - Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Portugal
| | - Rafael Maniés Pereira
- Cardiothoracic Surgery Department - Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Portugal
| | - Ângelo Nobre
- Cardiothoracic Surgery Department - Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Portugal
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Velho TR, Pereira RM, Guerra NC, Ferreira H, Sena A, Ferreira R, Nobre Â. Low Mean Arterial Pressure During Cardiopulmonary Bypass and the Risk of Acute Kidney Injury: A Propensity Score Matched Observational Study. Semin Cardiothorac Vasc Anesth 2021; 26:179-186. [PMID: 34720005 DOI: 10.1177/10892532211045765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Low mean arterial pressure (MAP) periods occur frequently during cardiopulmonary bypass (CPB), and their management remains controversial. Our aim was to correlate MAP during CPB with the occurrence of post-operative acute kidney injury (AKI), considering two different parameters: consecutive and cumulative low MAP periods. METHODS Single-centre observational retrospective study including 250 patients submitted to non-emergent aortic valve replacement, with tepid to mild hypothermia (not below 32°C). The primary outcome was the occurrence of AKI. A propensity scored matching of 43 patients was used to adjust both populations (AKI and No AKI). MAP measures were automatically and continuously recorded during CPB. Low MAP periods were analysed employing two parameters: consecutive and the cumulative sum of time. RESULTS Patients who experienced at least 5 min with MAP <50 mmHg had an increased risk of post-operative AKI (OR infinity; 95% CI, 1.47 to infinity; P = .026). The risk is also significant with MAP <40 mmHg (OR 2.78; 95% CI 1.1-6.9; = .044) and <30 mmHg (OR 3.36; 95% CI 1.2-9.2; P = .029). Post-operative AKI was associated with cumulative and consecutive periods of low MAP. Patients with periods of low MAP had higher levels of post-operative creatinine and reduced glomerular filtration rate (GFR). Patients with AKI had prolonged endotracheal ventilation time, and ICU and ward lengths of stay. CONCLUSION Low MAP periods during CPB are associated with an increased occurrence of post-operative AKI, leading to 1) higher creatinine levels; 2) decreased GFR and 3) longer ICU and ward lengths of stay. Both consecutive and cumulative periods of low MAP are associated with an increased risk of AKI. MAP appears to be an important contributor to post-operative AKI and should be carefully managed during CPB. Further studies must address if MAP variations lead to definitive and long-term consequences.
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Affiliation(s)
- Tiago R Velho
- Cardiothoracic Surgery Department, 70899Hospital de Santa Maria, CHLN, Lisboa, Portugal, Lisboa, Portugal.,Innate Immunity and Inflammation Laboratory, 70899Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Rafael M Pereira
- Cardiothoracic Surgery Department, 70899Hospital de Santa Maria, CHLN, Lisboa, Portugal, Lisboa, Portugal
| | - Nuno C Guerra
- Cardiothoracic Surgery Department, 70899Hospital de Santa Maria, CHLN, Lisboa, Portugal, Lisboa, Portugal
| | - Hugo Ferreira
- Cardiothoracic Surgery Department, 70899Hospital de Santa Maria, CHLN, Lisboa, Portugal, Lisboa, Portugal
| | - André Sena
- Cardiothoracic Surgery Department, 70899Hospital de Santa Maria, CHLN, Lisboa, Portugal, Lisboa, Portugal
| | - Ricardo Ferreira
- Cardiothoracic Surgery Department, 70899Hospital de Santa Maria, CHLN, Lisboa, Portugal, Lisboa, Portugal
| | - Ângelo Nobre
- Cardiothoracic Surgery Department, 70899Hospital de Santa Maria, CHLN, Lisboa, Portugal, Lisboa, Portugal
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Velho TR, Pereira RM, Fernandes F, Guerra NC, Ferreira R, Nobre Â. Bioprosthetic Aortic Valve Degeneration: a Review from a Basic Science Perspective. Braz J Cardiovasc Surg 2021; 37:239-250. [PMID: 34673516 PMCID: PMC9054148 DOI: 10.21470/1678-9741-2020-0635] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction The increase in the prevalence of aortic stenosis due to an aging population has led to an increasing number of surgical aortic valve replacements. Over the past 20 years, there has been a major shift in preference from mechanical to bioprosthetic valves. However, despite efforts, there is still no "ideal" bioprosthesis. It is crucial to understand the structure, biology, and function of native heart valves to design more intelligent, strong, durable, and physiological heart valve tissues. Methods A comprehensive review of the literature was performed to identify articles reporting the basic mechanisms of bioprosthetic valve dysfunction and the biology of native valve cells. Searches were run in PubMed, MEDLINE® (the Medical Literature Analysis and Retrieval System Online), and Google Scholar. Terms for subject heading and keywords search included “biological heart valve dysfunction”, “bioprosthesis dysfunction”, “bioprosthesis degeneration”, and “tissue heart valves”. Results All the relevant findings are summarized in the appropriate subsections. Structural dysfunction is a logical and expected consequence of the chemical, mechanical, and immunological processes that occur during fixation, manufacture, and implantation. Conclusion Biological prosthesis valve dysfunction is a clinically significant process. It has become a major issue considering the growing rate of bioprosthesis implantation and improved long-term patient survival. Understanding bioprosthetic aortic valve degeneration from a basic science perspective is a key point to improve technologic advances and specifications that lead to a new generation of bioprostheses.
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Affiliation(s)
- Tiago R Velho
- Cardiothoracic Surgery Department, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal.,Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Rafael Maniés Pereira
- Cardiothoracic Surgery Department, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Frederico Fernandes
- Department of Biomedical Sciences and Medicine, Universidade do Algarve, Campus de Gambelas, Faro, Portugal
| | - Nuno Carvalho Guerra
- Cardiothoracic Surgery Department, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Ricardo Ferreira
- Cardiothoracic Surgery Department, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Ângelo Nobre
- Cardiothoracic Surgery Department, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte, Lisboa, Portugal
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Vandewalle J, Timmermans S, Paakinaho V, Vancraeynest L, Dewyse L, Vanderhaeghen T, Wallaeys C, Van Wyngene L, Van Looveren K, Nuyttens L, Eggermont M, Dewaele S, Velho TR, Moita LF, Weis S, Sponholz C, van Grunsven LA, Dewerchin M, Carmeliet P, De Bosscher K, Van de Voorde J, Palvimo JJ, Libert C. Combined glucocorticoid resistance and hyperlactatemia contributes to lethal shock in sepsis. Cell Metab 2021; 33:1763-1776.e5. [PMID: 34302744 DOI: 10.1016/j.cmet.2021.07.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 05/05/2021] [Accepted: 07/01/2021] [Indexed: 12/18/2022]
Abstract
Sepsis is a potentially lethal syndrome resulting from a maladaptive response to infection. Upon infection, glucocorticoids are produced as a part of the compensatory response to tolerate sepsis. This tolerance is, however, mitigated in sepsis due to a quickly induced glucocorticoid resistance at the level of the glucocorticoid receptor. Here, we show that defects in the glucocorticoid receptor signaling pathway aggravate sepsis pathophysiology by lowering lactate clearance and sensitizing mice to lactate-induced toxicity. The latter is exerted via an uncontrolled production of vascular endothelial growth factor, resulting in vascular leakage and collapse with severe hypotension, organ damage, and death, all being typical features of a lethal form of sepsis. In conclusion, sepsis leads to glucocorticoid receptor failure and hyperlactatemia, which collectively leads to a lethal vascular collapse.
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Affiliation(s)
- Jolien Vandewalle
- VIB Center for Inflammation Research, VIB, Ghent 9052, Belgium; Department of Biomedical Molecular Biology, Ghent University, Ghent 9052, Belgium
| | - Steven Timmermans
- VIB Center for Inflammation Research, VIB, Ghent 9052, Belgium; Department of Biomedical Molecular Biology, Ghent University, Ghent 9052, Belgium
| | - Ville Paakinaho
- Institute of Biomedicine, University of Eastern Finland, Kuopio 70210, Finland
| | - Lies Vancraeynest
- Department Basic and Applied Medical Sciences, Ghent University, Ghent 9000, Belgium
| | - Liza Dewyse
- Liver Cell Biology research group, Vrije Universiteit Brussel (VUB), Brussels 1090, Belgium
| | - Tineke Vanderhaeghen
- VIB Center for Inflammation Research, VIB, Ghent 9052, Belgium; Department of Biomedical Molecular Biology, Ghent University, Ghent 9052, Belgium
| | - Charlotte Wallaeys
- VIB Center for Inflammation Research, VIB, Ghent 9052, Belgium; Department of Biomedical Molecular Biology, Ghent University, Ghent 9052, Belgium
| | - Lise Van Wyngene
- VIB Center for Inflammation Research, VIB, Ghent 9052, Belgium; Department of Biomedical Molecular Biology, Ghent University, Ghent 9052, Belgium
| | - Kelly Van Looveren
- VIB Center for Inflammation Research, VIB, Ghent 9052, Belgium; Department of Biomedical Molecular Biology, Ghent University, Ghent 9052, Belgium
| | - Louise Nuyttens
- VIB Center for Inflammation Research, VIB, Ghent 9052, Belgium; Department of Biomedical Molecular Biology, Ghent University, Ghent 9052, Belgium
| | - Melanie Eggermont
- VIB Center for Inflammation Research, VIB, Ghent 9052, Belgium; Department of Biomedical Molecular Biology, Ghent University, Ghent 9052, Belgium
| | - Sylviane Dewaele
- VIB Center for Inflammation Research, VIB, Ghent 9052, Belgium; Department of Biomedical Molecular Biology, Ghent University, Ghent 9052, Belgium
| | - Tiago R Velho
- Instituto Gulbenkian de Ciência, Oeiras 2780-156, Portugal
| | - Luis F Moita
- Instituto Gulbenkian de Ciência, Oeiras 2780-156, Portugal
| | - Sebastian Weis
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich-Schiller University, Jena 07743, Germany; Institute for Infectious Diseases and Infection Control, Jena University Hospital, Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital and Center for Sepsis Control and Care, Jena University Hospital, Jena 07749, Germany
| | - Christoph Sponholz
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Friedrich-Schiller University, Jena 07743, Germany
| | - Leo A van Grunsven
- Liver Cell Biology research group, Vrije Universiteit Brussel (VUB), Brussels 1090, Belgium
| | - Mieke Dewerchin
- Laboratory of Angiogenesis and Vascular Metabolism, Department of Oncology and Leuven Cancer Institute (LKI), KU Leuven, VIB Center for Cancer Biology, VIB, Leuven 3000, Belgium
| | - Peter Carmeliet
- Laboratory of Angiogenesis and Vascular Metabolism, Department of Oncology and Leuven Cancer Institute (LKI), KU Leuven, VIB Center for Cancer Biology, VIB, Leuven 3000, Belgium; Laboratory of Angiogenesis and Vascular Heterogeneity, Department of Biomedicine, Aarhus University, Aarhus 8000, Denmark; State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, Guangdong, P.R. China
| | - Karolien De Bosscher
- Translational Nuclear Receptor Research lab, VIB Center for Medical Biotechnology, VIB, Ghent 9052, Belgium; Department of Biomolecular Medicine, Ghent University, Ghent 9052, Belgium
| | - Johan Van de Voorde
- Department Basic and Applied Medical Sciences, Ghent University, Ghent 9000, Belgium
| | - Jorma J Palvimo
- Institute of Biomedicine, University of Eastern Finland, Kuopio 70210, Finland
| | - Claude Libert
- VIB Center for Inflammation Research, VIB, Ghent 9052, Belgium; Department of Biomedical Molecular Biology, Ghent University, Ghent 9052, Belgium.
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11
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Velho TR, Gonçalves JM, Pereira RM, da Cruz RM, Guerra NC, Ferreira R, Nobre Â. Primary cardiac hydatic cyst with multiple locations: an unusual case of chest pain. Gen Thorac Cardiovasc Surg 2021; 69:1147-1150. [PMID: 33846933 DOI: 10.1007/s11748-021-01631-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 03/31/2021] [Indexed: 11/30/2022]
Abstract
Cardiac echinococcosis is a rare manifestation of Echinococcus infection, affecting 0.5-2% of the patients. Since it may be a life-threatening condition, surgical treatment should be always considered. Herein, here we present a case of a 66-year-old male with chest pain. Subsequent exams confirmed the diagnosis of multiple cardiac hydatic cysts. The patient initiated treatment with albendazole and was submitted to a surgical resection with cardiopulmonary bypass. A complete surgical resection was achieved, and patient remains asymptomatic without disease signs of recurrence on imaging exams. We highlight the necessity of cardiac screening in echinococcosis cases and the surgical management in this case.
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Affiliation(s)
- Tiago R Velho
- Cardiothoracic Surgery Department, Hospital de Santa Maria-CHLN, Av. Prof. Egas Moniz, 1649-035, Lisboa, Portugal. .,Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Rua da Quinta Grande n. 6, 2780-156, Oeiras, Portugal.
| | - João Moreira Gonçalves
- Cardiothoracic Surgery Department, Hospital de Santa Maria-CHLN, Av. Prof. Egas Moniz, 1649-035, Lisboa, Portugal
| | - Rafael Maniés Pereira
- Cardiothoracic Surgery Department, Hospital de Santa Maria-CHLN, Av. Prof. Egas Moniz, 1649-035, Lisboa, Portugal
| | - Rafael Moiteiro da Cruz
- Instituto de Histologia E Biologia Do Desenvolvimento, Faculdade de Medicina da Universidade de Lisboa, Av. Prof. Egas Moniz, 1649-035, Lisboa, Portugal.,Pathology Department, Hospital de Santa Maria-CHLN, Av. Prof. Egas Moniz, 1649-035, Lisboa, Portugal
| | - Nuno Carvalho Guerra
- Cardiothoracic Surgery Department, Hospital de Santa Maria-CHLN, Av. Prof. Egas Moniz, 1649-035, Lisboa, Portugal
| | - Ricardo Ferreira
- Cardiothoracic Surgery Department, Hospital de Santa Maria-CHLN, Av. Prof. Egas Moniz, 1649-035, Lisboa, Portugal
| | - Ângelo Nobre
- Cardiothoracic Surgery Department, Hospital de Santa Maria-CHLN, Av. Prof. Egas Moniz, 1649-035, Lisboa, Portugal
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12
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Velho TR, Carvalho Guerra N, Ferreira H, Pereira RM, Sena A, Ferreira R, Nobre Â. Age Is Not Just A Number For A Rapid Deployment Valve In Octogenarians. Rev Port Cir Cardiotorac Vasc 2020; 27:191-197. [PMID: 33068507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Aortic valve stenosis (AS) is the most common valvular pathology in the elderly and surgery (AVR) remains the gold-standard. However, transcatheter aortic valve replacement (TAVI) has become an emerging alternative to surgery. In a recent survey from the European Society of Cardiology, 9,4% stated that age was the main reason to propose for TAVI. METHODS Single-center retrospective study including 353 patients (149 ≥80 years-old;204 with 60-69 years-old) submitted to AVR between 2013-2016. Primary endpoint was survival. Secondary outcomes included the rate of post- -operative complications. Long-term survival was determined by Kaplan-Meier survival analysis. Continuous variables were analyzed with t-test and linear regression and categorical variables with chi-square or Fisher. RESULTS clinical characteristics were similar between the two groups. Both had similar survival at 30 days, 12 (93,29% 60-69yo vs 91,47% ≥80yo) and 24 months (88,34% 60-69yo vs 86,11% ≥80yo). However, rapid deployment valves (RD) had better survival rates in elderly patients. Cross-clamp time was lower in ≥80yo group, with higher percentage of RD valves (20,1% vs 4.9% in 60-69yo). The rate of post-operative atrial fibrillation was higher in >80yo group (29,06% vs. 17,28%,p=0,0147). In all patients, cross-clamp time was directly related to ventilation time(p=0,025) and chest drainage(p=0,0015). CONCLUSION AVR after 80yo is safe. Cross-clamp time is directly correlated with ventilation time and bleeding, with a stronger correlation in patients over 80yo. RD valves reduce cross-clamp times, so their use in elderly may improve surgery outcome. Prospective studies are needed to evaluate if age may be clinical criteria for a RD.
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Affiliation(s)
- Tiago R Velho
- Cardiothoracic Surgery Department, Hospital de Santa Maria - CHLN, Lisboa, Portugal; Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, Oeiras, Portugal
| | - Nuno Carvalho Guerra
- Cardiothoracic Surgery Department, Hospital de Santa Maria - CHLN, Lisboa, Portugal
| | - Hugo Ferreira
- Cardiothoracic Surgery Department, Hospital de Santa Maria - CHLN, Lisboa, Portugal
| | | | - André Sena
- Cardiothoracic Surgery Department, Hospital de Santa Maria - CHLN, Lisboa, Portugal
| | - Ricardo Ferreira
- Cardiothoracic Surgery Department, Hospital de Santa Maria - CHLN, Lisboa, Portugal
| | - Ângelo Nobre
- Cardiothoracic Surgery Department, Hospital de Santa Maria - CHLN, Lisboa, Portugal
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13
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Santos I, Colaço HG, Neves-Costa A, Seixas E, Velho TR, Pedroso D, Barros A, Martins R, Carvalho N, Payen D, Weis S, Yi HS, Shong M, Moita LF. CXCL5-mediated recruitment of neutrophils into the peritoneal cavity of Gdf15-deficient mice protects against abdominal sepsis. Proc Natl Acad Sci U S A 2020; 117:12281-12287. [PMID: 32424099 PMCID: PMC7275717 DOI: 10.1073/pnas.1918508117] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Sepsis is a life-threatening organ dysfunction condition caused by a dysregulated host response to an infection. Here we report that the circulating levels of growth and differentiation factor-15 (GDF15) are strongly increased in septic shock patients and correlate with mortality. In mice, we find that peptidoglycan is a potent ligand that signals through the TLR2-Myd88 axis for the secretion of GDF15, and that Gdf15-deficient mice are protected against abdominal sepsis due to increased chemokine CXC ligand 5 (CXCL5)-mediated recruitment of neutrophils into the peritoneum, leading to better local bacterial control. Our results identify GDF15 as a potential target to improve sepsis treatment. Its inhibition should increase neutrophil recruitment to the site of infection and consequently lead to better pathogen control and clearance.
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Affiliation(s)
- Isa Santos
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal
- Serviço de Cirurgia Geral, Hospital de São Bernardo-Centro Hospitalar de Setúbal EPE, 2910-446 Setúbal, Portugal
| | - Henrique G Colaço
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal
| | - Ana Neves-Costa
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal
| | - Elsa Seixas
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal
| | - Tiago R Velho
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal
| | - Dora Pedroso
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal
| | - André Barros
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal
| | - Rui Martins
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal
| | - Nuno Carvalho
- Serviço de Cirurgia Geral, Hospital Garcia de Orta, 2801-951 Almada, Portugal
- Faculdade de Medicina, Universidade de Lisboa, 1649-004 Lisboa, Portugal
| | - Didier Payen
- INSERM, UMR 1160, Universite Paris 7 Denis Diderot, Universite-Sorbonne Cité, 75013 Paris, France
| | - Sebastian Weis
- Institute for Infectious Disease and Infection Control, Jena University Hospital, 07747 Jena, Germany
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, 07747 Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, 07747 Jena, Germany
| | - Hyon-Seung Yi
- Research Center for Endocrine and Metabolic Diseases, Chungnam National University School of Medicine, 35015 Daejeon, Korea
| | - Minho Shong
- Research Center for Endocrine and Metabolic Diseases, Chungnam National University School of Medicine, 35015 Daejeon, Korea
| | - Luís F Moita
- Innate Immunity and Inflammation Laboratory, Instituto Gulbenkian de Ciência, 2780-156 Oeiras, Portugal;
- Instituto de Histologia e Biologia do Desenvolvimento, Faculdade de Medicina, Universidade de Lisboa, 1649-004 Lisboa, Portugal
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14
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R Velho T, Ferreira H, Guerra N, Gallego J, Nobre Â. [Persistent left superior vena cava with agenesis of the right superior vena cava in a patient with complete atrioventricular block]. Rev Port Cir Cardiotorac Vasc 2019; 26:139-141. [PMID: 31476815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Indexed: 06/10/2023]
Abstract
Persistant left superior vena cava is a rare systemic venous anomaly that can be associated with agenesis of the right superior vena cava. It is usually assymptomatic and discovered incidentally during surgery or other procedures. The authors present the case of a 72-year-old male submitted to an aortic valve replacement surgery. After sternotomy, persistant left superior vena cava and absence of the right superior vena cava were identified. The patient developed complete atrioventricular block after surgery, requiring the implantation of a definitive cardiac pacemaker through the brachiocephalic vein and coronary sinus. This case highlights and ilustrates the clinical implications of the described systemic venous anomalies, discussing the necessary management both in the perioperative and intraoperative periods.
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Affiliation(s)
- Tiago R Velho
- Serviço de Cirurgia Cardiotorácica - Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Portugal
| | - Hugo Ferreira
- Serviço de Cirurgia Cardiotorácica - Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Portugal
| | - Nuno Guerra
- Serviço de Cirurgia Cardiotorácica - Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Portugal
| | - Javier Gallego
- Serviço de Cirurgia Cardiotorácica - Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Portugal
| | - Ângelo Nobre
- Serviço de Cirurgia Cardiotorácica - Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Portugal
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R Velho T, Duarte Ferreira H, Carvalheiro C, Sena A, Juqueira N, Guerra N, Gallego J, Nobre Â. [Minimally invasive approach vs full sternotomy for aortic valve and ascending aorta replacement: results from our center]. Rev Port Cir Cardiotorac Vasc 2018; 25:35-40. [PMID: 30317708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Aortic valve disease is the most common valvular heart disease. Surgical aortic valve replacement remains the gold-standard of treatment. Recently, minimally invasive approaches have been developed to reduce surgical trauma and to compete with percutaneous treatment of valvular heart disease. Minimally invasive approaches are associated with reduced perioperative morbidity and mortality. METHODS Single-center retrospective study comparing clinical data of patients submitted to surgical treatment of aortic stenosis by limited sternotomy versus conventional sternotomy between January 2014 and August 2016. RESULTS The demographic and clinical characteristics between the two groups were similar. Median surgery time was 142.5 min by limited sternotomy vs 98.15 min by conventional sternotomy (p< 0.0001). Total surgery time was 142.5 min for limited sternotomy vs 98.15 min conventional sternotomy (p< 0.0001). Aortic cross-clamping time and cardiopulmonary bypass time were 58.58 and 72.92 min for limited sternotomy vs 37.46 and 72.92 min for conventional sternotomy (p<0.0001). There were not statistically significant differences between the two groups regarding pos-operative time of ventilation (8.05h ± 1.65 limited sternotomy vs 16.31h ± 9.67 conventional sternotomy, p=0.42) and post-operative blood loss (432cc limited sternotomy vs 539cc conventional sternotomy, p=0.14). Use of vasopressor support was higher with limited sternotomy (46% vs 27.3% conventional sternotomy, p=0.07), although it was not statistically significant. Rate of re-operation (8% limited sternotomy vs 5.5% conventional sternotomy, p=0.90), median intensive care unit length of stay (59.04h limited sternotomy vs 50.75h conventional sternotomy, p=0.47) and total hospital length of stay (6.96 days limited sternotomy vs 7.7 days sternotomy, p=0.75) had no differences between the two groups. The rate of post-operative complications was similar between the two groups. DISCUSSION In our population there were not significant differences between the two approaches. It may be related to the early phase of the learning curve and to our good results concerning conventional sternotomy. Although surgery time, aortic cross-clamping time and cardiopulmonary bypass time were higher with limited sternotomy, it was not related to higher rates of post-operative complications. Limited sternotomy reduces surgical trauma and has cosmetic advantages. Our data encourages the minimally invasive surgery program of our Department.
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Affiliation(s)
- Tiago R Velho
- Cirurgia Cardiotorácica, Hospital de Santa Maria, Lisboa, Portugal
| | | | | | - André Sena
- Cirurgia Cardiotorácica, Hospital de Santa Maria, Lisboa, Portugal
| | - Nádia Juqueira
- Cirurgia Cardiotorácica, Hospital de Santa Maria, Lisboa, Portugal
| | - Nuno Guerra
- Cirurgia Cardiotorácica, Hospital de Santa Maria, Lisboa, Portugal
| | - Javier Gallego
- Cirurgia Cardiotorácica, Hospital de Santa Maria, Lisboa, Portugal
| | - Ângelo Nobre
- Cirurgia Cardiotorácica, Hospital de Santa Maria, Lisboa, Portugal
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Velho TR, Junqueira N, Sena A, Ferreira H, Carvalheiro C, Guerra N, Gallego J, Nobre Â. Occult Metastatic Melanoma Presenting as an Acute Coronary Syndrome. Braz J Cardiovasc Surg 2017; 32:225-227. [PMID: 28832802 PMCID: PMC5570384 DOI: 10.21470/1678-9741-2017-0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 05/22/2017] [Indexed: 11/29/2022] Open
Abstract
Melanoma is a tumor that virtually involves any tissue and commonly metastasizes
to the heart. It is usually not diagnosed because of the absent/nonspecific
cardiac signs and symptoms. Herein, we present a case of a 41-year-old man
without any cardiovascular risk factor, admitted to the emergency room with
chest pain, diagnosed with a myocardial infarction. Due to the presence of a
mass adjacent to the mitral valve on the cardiac ultrasound examination, causing
mitral regurgitation, the patient was referred to surgery. Pathological analysis
of the excised specimens diagnosed the melanoma. The chemotherapy was started
and achieved a partial response. Cardiac metastases usually affect the
myocardium, leaving the valves unaffected. In this case, the acute coronary
syndrome was the first manifestation of the malignant melanoma. We highlight the
high level of suspicion needed in these cases.
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Affiliation(s)
- Tiago R Velho
- Cardiothoracic Surgery Department, Hospital de Santa Maria - CHLN, Lisboa, Portugal
| | - Nádia Junqueira
- Cardiothoracic Surgery Department, Hospital de Santa Maria - CHLN, Lisboa, Portugal
| | - André Sena
- Cardiothoracic Surgery Department, Hospital de Santa Maria - CHLN, Lisboa, Portugal
| | - Hugo Ferreira
- Cardiothoracic Surgery Department, Hospital de Santa Maria - CHLN, Lisboa, Portugal
| | - Catarina Carvalheiro
- Cardiothoracic Surgery Department, Hospital de Santa Maria - CHLN, Lisboa, Portugal
| | - Nuno Guerra
- Cardiothoracic Surgery Department, Hospital de Santa Maria - CHLN, Lisboa, Portugal
| | - Javier Gallego
- Cardiothoracic Surgery Department, Hospital de Santa Maria - CHLN, Lisboa, Portugal
| | - Ângelo Nobre
- Cardiothoracic Surgery Department, Hospital de Santa Maria - CHLN, Lisboa, Portugal
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Abstract
Sepsis is a life-threatening condition that arises as a systemic inflammatory response syndrome to an infection. Its uncontrolled progression can in frequent cases lead to multiple organ failure, which is still associated with high mortality rates. Modern antibiotics made clear that the infection is only an initiating, and not always necessary, event of this syndrome as many patients with sepsis die despite effective eradication of the inciting pathogen. This observation critically contributed to a paradigm shift that focused the pathogenesis of sepsis on the host and not on the pathogen. However, therapeutic strategies based on the inhibition of proinflammatory critical mediators of sepsis or immunostimulation have so far failed to improve sepsis outcome and, therefore, this condition urgently needs transformative therapeutic ideas and strategies. Here we argue that the induction of tolerance, a defence strategy that minimises the impact of an infection on organ function without directly affecting the pathogen burden, is perhaps the missing but essential element to add to the current components of sepsis care and treatment.
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Affiliation(s)
| | - Isa Santos
- Instituto Gulbenkian de Ciência, Oeiras, Portugal
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R Velho T, Junqueira N, Sena A, Guerra N, Caldeira J, Gallego J, Nobre Â. [Video-assisted thoracic sympathectomy - the results from a center outpatient surgery program]. Rev Port Cir Cardiotorac Vasc 2016; 23:37-40. [PMID: 28889702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Indexed: 06/07/2023]
Abstract
BACKGROUND The outpatient surgery program from our department has started in 2014 to improve patient access to surgery and to reduce the surgical waitlist. Focused on the thoracic surgery, the most common intervention is the surgical treatment of primary hyperhidrosis by thoracic sympathectomy by video-assisted thoracoscopic surgery (VATS). It is performed according to the patient's symptoms, with section or application of surgical clips between R2-R5. MATERIALS AND METHODS Retrospective study including all the patients submitted to thoracic sympathectomy by video- -assisted thoracoscopy surgery from our department's outpatient surgery program from January 2014 to January 2016. RESULTS In our outpatient program we performed 198 thoracic sympathectomy by VATS. The mean age of the patients was 32,8 years old. 63,6% of the patients were females and 36.4% were males. From the 198 endoscopic thoracic sympathectomy performed, 181 (91,4%) were performed bilatellary with section between R3-R5, 12 (6,1%) were performed with the application of surgical clips in R2-R4 and 3 (1.5%) could not be performed due to the presence of pleuropulmonary adhesions. One of the patients was re-operated due to recurrent symptoms and another patients had surgery to remove the surgical clips (bilaterally in R2) due to exaggerated abdominal compensatory hyperhidrosis. Three patients had pneumothorax. CONCLUSION The surgical treatment of primary hyperhidrosis was the most frequent procedure in our outpatient surgery program. The procedure without the use of a thoracic drainage allowed its inclusion in the outpatient surgery program. Excluding 3 patients, all the patients were discharged within 12 hours after the surgery. The good results and the reduction of the surgical waitlist encourage the cardiothoracic outpatient surgery program.
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Affiliation(s)
- Tiago R Velho
- Serviço de Cirurgia Cardiotorácica - Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Nádia Junqueira
- Serviço de Cirurgia Cardiotorácica - Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - André Sena
- Serviço de Cirurgia Cardiotorácica - Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Nuno Guerra
- Serviço de Cirurgia Cardiotorácica - Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - João Caldeira
- Serviço de Cirurgia Cardiotorácica - Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Javier Gallego
- Serviço de Cirurgia Cardiotorácica - Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Ângelo Nobre
- Serviço de Cirurgia Cardiotorácica - Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
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Velho TR, Kapiteijn E, Jager MJ. New therapeutic agents in uveal melanoma. Anticancer Res 2012; 32:2591-2598. [PMID: 22753717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Uveal melanoma is the most common primary intraocular malignant tumour in adults. Five, ten and fifteen years after primary tumour treatment, up to 25%, 34% and 50% of patients may develop metastases, respectively. There are only a few systemic therapies that have been approved for uveal melanoma, all with doubtful efficacy. As the molecular knowledge over cancer has improved, new therapies are being developed. Several drugs, such as bortezomib, celecoxib, dacarbazine, anti-angiogenic agents (such as bevacizumab, sorafenib and sunitinib), temsirolimus, mitogen-activated protein kinase kinase (MEK) inhibitors, ipilimumab and AEB071 are candidate drugs, and studies are underway to determine the therapeutic effects of these drugs in uveal melanoma.
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Affiliation(s)
- T R Velho
- Faculty of Lisbon, University of Lisbon, Lisbon, Portugal.
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