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Search Results: 1 - 10 of 417384 matches for " Edemar M;Costa "
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Avalia??o de resultados tardios com bioprótese de aorta heteróloga porcina
Kalil, Renato A. K;Sant'Anna, Jo?o Ricardo;Schoer, Júlio E;Prates, Paulo Roberto;Lucchese, Fernando A;Pereira, Edemar M;Costa, Altamiro R;Nesralla, Ivo A;
Revista Brasileira de Cirurgia Cardiovascular , 1989, DOI: 10.1590/S0102-76381989000100009
Abstract: the clinical results of an aortic heterograft model (biocor) was evaluated in a series of 150 patients, operated upon from 1982 to 1988 and followed-up for until 7 years post-operatively. sixty-two were female and 88 male. age ranged from 15 to 81 (m = 51.6) years. there were 9 in functional class ii, 120 in iii and 21 in iv. in the isolated mitral position there were 46 implants, aortic isolated 50, multiple 30 and 24 associated with myocardial revascularization (5 mitral and 19 aortic). hospital mortality was 12% (18 cases). twenty seven patients were lost for late follow-up. late mortality was 2.6% (4 cases), caused by rena! failure, meningoencefalitis, congestive heart failure and pulmonary embolism. there were 5 (3.3%), due to infectious endocarditis, paravalvular leaks, primary tissue failure (2 cases at ages 15 and 25). three others patients presented clinical signs of mild regurgitation and were not reoperated. the actuarial survival curves showed a probability of survival and probability of no surgical events, respectively, for the whole group: 82.9 ± 3.7 years and 70.1 ± 6.7 years, for the aortic group: 88.0 ± 5.6% and 60.4 ± 17.4%, for the mitral group: 87.3 ± 5.6% and 70.9 ± 11.1%. at the last clinical evaluation, there were 82 patients in functional class i, 17 in ii and 2 in iii. bioprosthesis attributed failures occurred in 21.4% of the patients operated upon, younger than 30 years, 1.1% between 31 and 60 years, and 2% in the older than 61 years. male sex was related to 4.5% of failures and female, 1.6%. there was no difference between the mitral, aortic, or multiple groups. the bioprosthesis evaluated, for a follow-up of 7 years, presented good results. causes of failure were usually related to age, infection or leaking, at a low incidence in the study period. longer observation, however, is still advisable for definitive conclusions.
Recupera??o por desbridamento manual da valva aórtica estenótica calcificada
Kalil, Renato A. K;Teixeira Filho, Guaracy F;Sant' Anna, Jo?o Ricardo M;Prates, Paulo R;Lucchese, Fernando A;Brauch, Carla R;Pereira, Edemar M. C;Costa, Altamiro R. da;Santos, Marisa F;Nesralla, Ivo A;
Revista Brasileira de Cirurgia Cardiovascular , 1995, DOI: 10.1590/S0102-76381995000200001
Abstract: a series of 21 patients submitted to mechanical debridement for treatment of calcified stenotic aortic valves is presented. there were 8 congenital and 13 senile valves, in 10 male and 11 female patients. mean age 63.8 ± 9.5 (44 to 78) years. six had also coronary bypass grafts and 1 mitral comissurotomy. total perfusion time was 53.8 ± 21.4 min and ischemic time 33.7 ± 12.1 min. all patients had been followedup from 1 month to 2 years. in 16 a late echocardiographic evaluation was performed. there have been no early and 1 late death. surviving patients are in functional classes i or ii. maximum instantaneous gradient dropped from 90.7 ± 23.3 mmhg to 33.0 ±7.9 mmhg (p < 0.01) and mean aortic gradient from 50.3 ± 11.0 mmhg to 19.9 ± 3.5 mmhg (p < 0.05). septal width reduced from 2.0 ± 0.5 cm to 1.2 ± 0.1 (p < 0.01). aortic regurgitation, by echocardiography, was considered minimum in 5, mild in 9 and moderated in 2 cases. mechanical debridement of calcified aortic valves, congenital or senile, provides good medium-term relief for aortic stenosis. this technical alternative may be considered in older patients, small aortic roots and higher risks of anticoagulation.
Proposi??o de técnica endocavitária para remodelamento ventricular esquerdo
NESRALLA, Ivo A.;SANT'ANNA, Jo?o Ricardo M.;PRATES, Paulo R.;TEIXEIRA FILHO, Guaracy F.;WENDER, Orlando;COSTA, Altamiro R.;SANTOS, Marisa S.;PEREIRA, Edemar M.;LARA, Raul F.;SANTOS, Ari Tadeu;
Revista Brasileira de Cirurgia Cardiovascular , 1997, DOI: 10.1590/S0102-76381997000200008
Abstract: left ventricular remodeling by partial ventriculectomy is a recent proposition for palliation in dilated cardiomyopathy when cardiac transplantation is contraindicated. this procedure carries a high morbimortality due to myocardial ischemia, necrosis and arrhythmias. this paper presents a technique for endocavitary left ventricular remodeling which maintains the hearts morpho-functional architecture without myocardial resection. under extracorporeal circulation and hypothermic cardioplegia, a left atriotomy is done, the anterior mitral leaflet removed and a triangular shaped bovine pericardial graft (aproximately 2 x 6 x 6 cm) is implanted inside the left ventricular cavity with 3-0 polipropilene anclosed in dacron felt. the graft is sutured in a divergent way from the apex to the mitral ring, at the middle of the septum and at the posterior papillary muscle. this produces an internal plication with ventricular cavity reduction. myocardium and coronary circulation are preserved. the base of the triangular graft is sutured to the mitral annulus and the mitral bioprosthesis is implanted. the procedure was employed in 8 patients with dilated cardiomyopathy, not candidates to transplantation, 2 females and 6 males, ranging from 24 to 58 years. five had mitral regurgitation. all were in hospital, at class iv (nyha). mortality was 25% (2 cases): 1 in the hospital and 1 at 3 months p.o. the table shows the echocardiographic parameters for lv function: pré-operative post-operative cardiac output (l/min) 2,6 ± 0,4 3,8 ± 0,7 p<0,001 cardiac index 1,9 ± 0,9 2,7 ± 0,6 p<0,005 ejection fraction 21,5 ± 4,0 37,8 ± 1,2 p<0,05 intracavitary left ventricular remodeling presented a satisfactory result related to mortality and morbidity, with functional improvement over the short term. longer follow-up is needed to evaluate its role, which might be a bridge to transplantation. a limitation exists in the necessity for replacing the mitral valve.
Fatores de risco hospitalar para implante de bioprótese valvar de pericárdio bovino
De Bacco, Mateus W.;Sant'Anna, Jo?o Ricardo M.;De Bacco, Gustavo;Sant'Anna, Roberto T.;Santos, Marisa F.;Pereira, Edemar;Costa, Altamiro Reis da;Prates, Paulo Roberto;Kalil, Renato A. K.;Nesralla, Ivo A.;
Arquivos Brasileiros de Cardiologia , 2007, DOI: 10.1590/S0066-782X2007001400009
Abstract: background: identification of preoperative heart valve surgery risk factors aim to improve surgical outcomes with the possibility to offset conditions related to increased morbidity and mortality. objective: intent of this study is to identify hospital risk factors in patients undergoing bovine pericardial bioprosthesis implantation. methods: retrospective study including 703 consecutive patients who underwent implantation of at least one st. jude medical-biocor? bovine pericardial bioprosthesis between september 1991 and december 2005 at the rio grande do sul cardiology institute; 392 were aortic, 250 were mitral and 61 were mitroaortic. characteristics analyzed were gender, age, body mass index, nyha (new york heart association) functional class, ejection fraction, valve lesions, systemic hypertension, diabetes mellitus, kidney function, arrhythmias, prior heart surgery, coronary artery bypass graft, tricuspid valve surgery and elective, urgent or emergency surgery. main outcome was in-hospital mortality. relationship between risk factors and in-hospital mortality was analyzed using logistic regression. results: were 101 (14.3%) in-hospital deaths. characteristics with significant relationship to increased mortality were female gender (p<0.001), age over 70 years (p=0.004), atrial fibrillation (p=0.006), diabetes mellitus (p=0.043), creatinine > 2.4mg/dl (p=0.004), functional class iv (p<0.001), mitral valve lesion (p<0.001), previous heart surgery (p=0.005), tricuspid valve surgery (p<0.001) and emergency surgery (p<0.001). conclusion: mortality rate observed is accepted by literature and is justifiable due to the high prevalence of risk factors, showing an increased significance level for female gender, age above 70, functional class iv, tricuspid valve repairs and emergency surgery. offsetting these factors could contribute to reduced in-hospital mortality for valve surgery.
Morbimortalidade em pacientes acima de 75 anos submetidos à cirurgia por estenose valvar aórtica
Valle, Felipe H.;Costa, Altamiro R.;Pereira, Edemar M. C.;Santos, Eduardo Z.;Pivatto Júnior, Fernando;Bender, Luciano P.;Trombka, Marcelo;Modkovski, Thaís B.;Nesralla, Ivo A.;Kalil, Renato A. K.;
Arquivos Brasileiros de Cardiologia , 2010, DOI: 10.1590/S0066-782X2010005000052
Abstract: background: the greater longevity observed today has caused an increase in the number of elderly who need surgery. aortic stenosis is a common condition in this age group. objective: to evaluate morbidity and mortality in people aged 75 years or older who have undergone valvuloplasty or valve replacement surgery for aortic stenosis alone or associated with other injuries. methods: we studied 230 consecutive cases between jan/2002-dec/2007. patients were 79.5 ± 3.7 years (75 - 94), and 53.9% were men. in the sample, 68.7% had hypertension, 17.9% had atrial fibrillation, 15.9% were obese, and 14.4% had undergone previous heart surgery. at surgery, 87.4% underwent aortic stent placement, and 12.6% underwent aortic valvuloplasty. results: the mortality rate was 13.9% (9.4% with isolated aortic stenosis versus 20.9% with an associated procedure, p = 0.023) and the morbidity rate was 30.0% (25.2% with aortic stenosis alone versus 37.4% with an associated procedure, p = 0.068). the most common complications were: low cardiac output (20.2%), renal dysfunction (9.7%), and prolonged ventilatory support (7.9%). in the bivariate analysis, the main predictors of mortality were low cardiac output (rr 10.1, 95% ci: 5.02-20.3), use of intra-aortic balloon (rr 6.6, 95% ci: 3.83-11.4), sepsis (rr 6.77, 95%: 1.66-9.48) and renal dysfunction after surgery (rr 6.21, 95%: 3.47-11.1). as for morbidity, the predictors were: pre-operative renal dysfunction (rr 2.22, 95%: 1.25-3.95), atrial fibrillation (rr 1.74, 95%: 1.16-2.61), and chronic obstructive pulmonary disease (copd) (rr 1.93, 95%: 1.25-2.97). conclusion: aortic valve surgery in the elderly is related to a slightly higher mortality rate than in younger patients, and its main risk factors were associated procedures, renal failure, atrial fibrillation, copd, and sepsis.
Morbimortalidade em octogenários submetidos à cirurgia de revasculariza??o miocárdica
Pivatto Júnior, Fernando;Kalil, Renato A. K.;Costa, Altamiro R.;Pereira, Edemar M. C.;Santos, Eduardo Z.;Valle, Felipe H.;Bender, Luciano P.;Trombka, Marcelo;Modkovski, Thaís B.;Nesralla, Ivo A.;
Arquivos Brasileiros de Cardiologia , 2010, DOI: 10.1590/S0066-782X2010005000071
Abstract: background: given the progressive increase in longevity and the need of an increasingly elderly population to undergo myocardial revascularization surgery (mrs), it becomes necessary to know its risks and benefits. objective: to evaluate the in-hospital morbimortality of patients aged 80 and older submitted to mrs and identify its predictor variables. methods: a total of 140 consecutive cases were studied between january 2002 and december 2007. the patients' mean age was 82.5 ± 2.2 years (range: 80-89) and 55.7% were males. in the sample,72.9% had arterial hypertension, 26.4% had diabetes, 65.7% presented severe lesion in three or more vessels and 28.6% presented a severe lesion in the left coronary trunk. an associated surgery was present in 35.7% of the cases, with aortic valve in 26.4% and mitral valve in 5.6%. results: the mortality rate was 14.3% (isolated mrs 10.0% vs 22.0% with associated procedure; p = 0.091) and the morbidity was 37.9% (isolated mrs 34.4% vs 44.0% with associated procedure; p = 0.35). the most frequent complications were low cardiac output (27.9%), renal dysfunction (10.0%) and prolonged ventilatory support (9.6%). at the bivariate analysis, the most important mortality predictors were sepsis (rr 10.2; 95%ci: 6.10-17.7), previous mrs (rr 8.06; 95%ci: 5.16-12.6), postoperative low cardiac output (rr 7.77; 95%ci: 3.03-19.9) and postoperative renal dysfunction (rr 7.36; 95%ci: 3.71-14.6). the morbidity predictors were extracorporeal circulation time > 120 min. (rr: 2.34; 95%ci: 1.62-3.38) and time of ischemia > 90 min. (rr: 2.29 95%ci: 1.56-3.37). conclusion: the mrs in octogenarians is associated with a higher morbimortality when compared to younger patients, which, however, does not prevent the procedure if the indication is justified by clinical condition.
Influências temporais nas características e fatores de risco de pacientes submetidos a revasculariza??o miocárdica
Feier, Flávia H.;Sant'Anna, Roberto T.;Garcia, Eduardo;Bacco, Felipe de;Pereira, Edemar;Santos, Marisa;Costa, Altamiro Reis da;Nesralla, Ivo A.;Sant'Anna, Jo?o Ricardo M.;
Arquivos Brasileiros de Cardiologia , 2006, DOI: 10.1590/S0066-782X2006001700007
Abstract: objective: to compare clinical and surgical and clinical profiles of two group of patients submitted to coronary artery bypass graft (cabg) at instituto de cardiologia do rgs within a decade interval, define related hospital mortality and to validate a severity risk score for this populations. methods: retrospective cohort study, including 307 cabg patients operated during six months of 1991/92 (n=153) and 2001/02 (n=154). demographic characteristics, heart disease severity, co-morbidities and pre-operative events were evaluated and compared between groups. hospital mortality and severity risk scores for mortality according to cleveland clinic were also assessed. results: patients operated in 2001/02 were older, had more severe cardiac disease (increased nyha functional class, prevalence of heart failure, and distribution of coronary diseased) and presented more co-morbidities than those operated in 1991/92. this patients required urgent surgery more often. the mean cleveland clinic severity risk score wasn't different between groups (2.8 + 3.1 in 1991/92 and 2.2 + 2.5 in 2001/02) and hospital mortality didn't present significant difference (3.3% and 1.9%, respectively). for cleveland clinic score 3 the predicted mortality was estimated as 2.0% (with confidence limit 95% of 0- 4.3%) and observed mortality for surgical patients of this institution was 3.4%. conclusion: patients submitted to cabg currently are older and in worse clinical conditions than those operated 10 years ago, but severity risk scores and hospital mortality were discretely increased for initial series of patients. this may be a consequent of a higher prevalence of urgent surgical indication in those patients. a severity risk score for hospital mortality can be used to predict surgical result and identify patients requiring specific care.
Reopera??es após cirurgia de Bentall-De Bono para ectasia anulo-aórtica
Kalil, Renato A. K;Garcia-Macedo, Ricardo;Prates, Paulo Roberto;Lucchese, Fernando A;Sant'Anna, Jo?o Ricardo;Lara, Raul F. A;Costa, Altamiro R;Daudt, Nestor S;Pereira, Edemar M;Nesralla, Ivo A;
Revista Brasileira de Cirurgia Cardiovascular , 1988, DOI: 10.1590/S0102-76381988000200003
Abstract: a major surgical problem is imposed when late complications occur in patients submitted previously to aortic root replacement by the bentall-de bono technique. during an 11 years period, from january 1976 to december 1986, 37 patients had aortic root replacement with valved conduits and 5 presented late complications (13.5%) requiring a new operation. the lesions were: biological valve degeneration, infective endocarditis and suture leaks leading to pseudo aneurysm, peritubular leakage and hemolysis. there was 1 systemic embolization with an infected vegetation. the 5 patients were re-operated, with 1 surgical death (20%), in a case presenting fungal endocarditis (aspergillus), due to uncontroled bleeding. the remaining 4 had an uneventful hospital course. there was 1 late death during a surgical exploratory thoracic procedure. the remaining 3 patients enjoy a normal active life. one of these still has a small peritubular leakage causing mild aortic regurgitation and hemolysis. the surgical procedure consisted of dacron tube replacement preserving the implanted valve prostheses in the 2 cases with infective endocarditis. two ruptures biological valves were replaced by methalic disc valves. in this situation, the dacron tubes were preserved and the valves approached through a longitudinal incision in the tube. the suture leaks were corrected with direct isolated mattress sutures. late re-operations may be required after aortic root replacement with composite valve-tube grafts. they can be performed at an acceptable surgical risk. the technique should be as conservative as possible and directed to the causing lesions, preserving the remaining structures. a methalic prosthesis should be the first choice for the primary procedure, in order to avoid late tissue degeneration.
Estudo das artérias coronárias no cora??o transplantado
Nesralla, Ivo A;Sant'Anna, Jo?o Ricardo;Prates, Paulo Roberto;Lucchese, Fernando A;Kalil, Renato A. K;Pereira, Edemar M;Costa, Altamiro R;Rossi, Martinez;Moraes, Cláudio;Santos, Marisa F;Souza, Blau F;
Revista Brasileira de Cirurgia Cardiovascular , 1991, DOI: 10.1590/S0102-76381991000300004
Abstract: late post-operative serial coronariographic evaluation was performed in a series of 6 patients submitted to cardiac transplantation. they were part of a series of 16 patients operated on from june 1984 to december 1990. their age were from 10 days to 54 years, 14 male and 2 female. the followup time was from 2 to 6 years. the cineangiograms were performed yearly for coronary pattern evolutive evaluation. the mean donor age was 18 ± 3 years. in 4 patientes it was possible to compare late results with the preoperative donor cinecoronaryangiogram. the comparative morphometric analysis, at serial examination did not reveal any proximal or distal coronary lesion in any patient. left ventricular function was considered normal, but varied degrees of myocardial hypertrophy were present in all patients. in conclusion: 1) coronary artery disease, although frequent in transplanted hearts, was not present in this series; 2) early donor age could have been an important factor, as well as the immunossupressive regime emploied; 3) cinecoronary ventriculoangiogram is important for follow-up of transplanted patients, and could eventually orient for retransplantation.
Tratamento cirúrgico para ectasia anulo-aórtica
García-Macedo, Ricardo;Kalil, Renato A. K;Prates, Paulo Roberto;Lucchese, Fernando A;Sant'Ana, Jo?o Ricardo;Pereira, Edemar M;Costa, Altamiro Reis;Lara, Raul Feck A;Nesralla, Ivo A;
Revista Brasileira de Cirurgia Cardiovascular , 1986, DOI: 10.1590/S0102-76381986000100007
Abstract: this is a report of 27 patients presenting annulo-aortic ectasia submitted to surgical correction with a composite valve-tube graft (bentall-de bono technique), between 1976 and 1985. twenty three (85.2%) had cystic medial necrosis, 3 (11,1%) were chronic aortic disections and 1 (3.7%) was luetic aortitis. age ranged from 29 to 64 years (m = 48). three were female and 24 male patients. the valves used were homologous dura maier in 7 cases, heterologous aorta in 9 and mechanical prosthesis in 11. functional class (nyha) was i-ii in 7 and iii-iv in 9 patients. there was 1 (3.7%) hospital death, due to bleeding and renal failure. significant early complications were represented by arrhythmias in 13 cases (48%) and bleeding in 3 (11%). in the late follow-up therev.were 9 deaths, due to: sudden death (2 patients, 7.4%), bleeding in reoperation (1 patient, 3.7%), hospital infection (1 patient, 3.7%), infectious endocarditis (1 patient, 3.7%) and accidental causes (2 patients, 7.4%). five patients (18.5%) needed reoperation in the late follow-up: 2 due to bioprosthetic failure, 2 for replacement of an infected dacron tube and 1 for repair of pseudo-aneurysm and periprosthetic leak. the actuarial survival curve showed a probability of 83.7% up to the 3rd. year, 61 % for the 5th. year and 42.7% from the 6th. to the 9th. year of follow-up. the 17 patients surviving are in functional class i-ii (nyha). the composite valve-dacron tube graft (bentall-de bono) technique for correction of annulo-aortic ectasia is associated with a low hospital mortality. the improvement in functional class is significant. there have been a small number of complications and the long term survival is very satisfactory.
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