Navegando por Palavras-chave "Prótese biológica"
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- ItemAcesso aberto (Open Access)Evolução de longo prazo de próteses biológica e mecânica para cirurgia de valvas cardíacas. Revisão sistemática de estudos clínicos randomizados(Universidade Federal de São Paulo (UNIFESP), 2018-10-25) Kiyose, Alberto Takeshi [UNIFESP]; Moises, Valdir Ambrosio [UNIFESP]; http://lattes.cnpq.br/7272777672324904; http://lattes.cnpq.br/3383543123255106; Universidade Federal de São Paulo (UNIFESP)Background: The choice of a mechanical (MP) or biological prosthesis (BP) for patients with valvular heart disease undergoing replacement is still not a consensus. We aimed to determine the longterm clinical outcomes of MP or BP placement in those patients. Methods: We conducted a systematic review and metaanalysis of randomized controlled trials (RCTs) that compared biological prostheses and mechanical prostheses in patients with valvular heart diseases and assessed the longterm outcomes. RCTs were searched in the MEDLINE, EMBASE, LILACS, CENTRAL, SCOPUS and Web of Science (from inception to November 2014) databases. Metaanalyses were performed using inverse variance with random effects models. The GRADE system was used to rate the quality of the evidence. Results: A total of four RCTs were included in the metaanalyses (1,528 patients): three used old generation mechanical and biological prostheses, and one used contemporary prostheses. No significant difference in mortality was found between BP and MP patients (risk ratio (RR=1.07; 95% CI 0.991.15). The risk of bleeding was significantly lower in BP patients than MP patients (RR=0.64; 95% CI 0.520.78) ; however, reoperations were significantly more frequent in BP patients (RR=3.60; 95% CI 2.445.32). There were no statistically significant differences between BP and MP patients with respect to systemic arterial embolisms and infective endocarditis (RR= 0.93; 95% CI 0.661.31, RR= 1.21; CI95% 0.781.88, respectively). Results in the trials with modern and old prostheses were similar. Conclusions: The longterm mortality rate and the risk of thromboembolic events and endocarditis were similar between BP and MP patients. The risk of bleeding was approximately one third lower for BP patients than for MP patients, while the risk of reoperations was more than three times higher for BP patients.
- ItemAcesso aberto (Open Access)Experiência inicial da Universidade Federal de São Paulo no desenvolvimento e aplicação do implante valvar aórtico transcateter(Universidade Federal de São Paulo (UNIFESP), 2009-11-25) Santos, Diego Felipe Gaia dos [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: The aortic valve replacement is a routine procedure, and involves replacement of the native valve/prosthesis. In most of the patients who undergo such procedure the risk is acceptable, but in some cases, such risk can justify contraindication. The minimally invasive transcatheter aortic valve implantation has been viable, with lower morbidity and mortality. The aim of this study was to develop a national catheter-mounted aortic bioprosthesis for aortic position implant. METHOD: After animal studies, 14 patients with high EuroSCORE underwent transcatheter aortic valve implantation. Median age was 75,5 years. Median Logistic EuroSCORE was 43,7%. Four patients presented with disfunctional bioprosthesis, remainig ones presented calcified aortic stenosis (peak transvalvular gradient 79,7 mmHg). After minithoracotomy and under echocardiograph and fluoroscopic control, a balloon catheter was placed on aortic position and inflated. After, a second balloon with valved endoprosthesis was positioned and released under high ventricular rate. Echocardiograph and angiograph controls were performed and the patients were referred to ICU. RESULTS: Implant was feasible in 13 cases. There were no intra-operative deaths. Mortality was 42%. Median peak transvalvular aortic gradient reduced to 25,0 mmHg, and left ventricular function improved in the first 7 post operative days. Paravalvular aortic regurgitation was mild and present in most cases. Platelet count significantly decreased after procedure, but returned to normal values after 30 days. CONCLUSION: The transapical implantation of catheter-mounted bioprosthesis was a feasible procedure. Technical details and learning curve require further discussion.
- ItemAcesso aberto (Open Access)Guia terapêutico para implante de próteses valvares cardíacas transcateter Braile Inovare em biopróteses convencionais Braile, em valvas transcateter Braile inovare previamente implantadas em biopróteses convencionais Braile, e em anéis de anuloplastia valvar mitral Braile(Universidade Federal de São Paulo, 2024-09-30) Cardoso, Caio Cesar [UNIFESP]; Santos, Diego Felipe Gaia dos [UNIFESP]; Fonseca, José Honório de Almeida Palma da [UNIFESP]; http://lattes.cnpq.br/9343172569048429; http://lattes.cnpq.br/6986305020681547; http://lattes.cnpq.br/3985581977200400Objetivos: Construção de guia terapêutico para implante de valva transcateter (VT) Braile Inovare em biopróteses (BP) Braile (valve-in-valve - VIV), em conjuntos valve-in-valve (valve-in-valve-in-valve - V-I-V-I-V) e em anéis de anuloplastia mitral Braile (valve-in-ring – V-I-R). Material e Métodos: Em cada conjunto proposto, com o Duplicador de Pulsos e padronizações do FDA e ISO, calculou-se EOA (área orificial efetiva) e ΔP (gradiente transvalvar), além de incremento porcentual do volume regurgitante (R%). Nos testes V-I-V, em cada BP implantou-se uma VT 1mm maior e 1mm menor. Para os testes V-I-V-I-V, em cada conjunto V-I-V mais adequado, alocou-se VT de imediato tamanho menor à VT já implantada. Nos testes V-I-R, em cada anel implantou-se VT de mesmo diâmetro nominal, 2mm maior e 2mm menor. Resultados: Nos testes V-I-V, houve melhores resultados hidrodinâmicos com VT de tamanho 1mm menor em relação à BP, e resultados limítrofes para aplicação clínica em BP aórtica 21mm e BP mitral 27mm. Os testes V-I-V-I-V propostos mostraram boa performance, com resultados limítrofes com VT 20mm para a posição aórtica, e 24mm para posição mitral. Os melhores resultados nos testes V-I-R se deram com VT de mesmo tamanho em relação ao anel, com restrições no anel 24mm. Conclusão: Foi possível a criação de guia terapêutico para emprego de VT Braile Inovare nas modalidades: V-I-V em BP Braile; V-I-V-I-V em conjuntos de BP Braile com VT Braile Inovare previamente implantada; e V-I-R em anéis de anuloplastia mitral Braile.