Background: The optimal time delay between last clopidogrel dose and surgery is controversial. The aim of the present study was to analyze the impact of preoperative clopidogrel on the need for blood ...transfusions with reference to the proper timing of discontinuation. Methods and Results: Between January 2005 and December 2010, 1,947 consecutive patients undergoing coronary surgery were enrolled. Of these, 255 patients receiving preoperative clopidogrel were matched to a control group by propensity score analysis. Clopidogrel discontinuation interval before surgery was examined in 1-day increments from 0 to 5 days and >5 days. Patients who discontinued clopidogrel within 5 days of surgery accounted for 91% (211/255). Clopidogrel stop within 5 days before surgery was independently associated with transfusion requirement (P=0.001). Preoperative clopidogrel was not associated with an increased risk of hemorrhagic complications (P=0.696). No differences were observed between patients taking clopidogrel and those not taking clopidogrel with regard to hospital resource utilization and mortality. Patients receiving clopidogrel in association with aspirin did not have an additive risk for transfusion or hemorrhagic complications compared with those on clopidogrel alone (odds ratio OR, 1.25; 95% confidence interval CI: 0.77-2.03; OR, 1.02; 95%CI: 0.38-2.79, respectively). Conclusions: Clopidogrel administration in the 5 days preceding coronary surgery was an independent predictor for increased transfusion requirements, supporting the discontinuation of clopidogrel >5 days before surgery. (Circ J 2011; 75: 2805-2812)
Endovascular intervention has emerged as a less traumatic alternative treatment for several diseases of the thoracic aorta.1,2 However, depending on the different aortic pathologies, procedure ...related complications have become increasingly evident: severe complications include type I endoleaks, migration, and endograft (EG) collapse, as well as those observed during conventional surgery (eg, stroke and paraplegia).3,4 One of the emerging and most alarming complication of thoracic endografting is iatrogenic retrograde type A acute dissection (RTAAD).5 Retrograde type A acute dissection is defined as acute aortic dissection that originates distally to the ascending aorta with a retrograde flap progression into the ascending aorta.6 This complication has been previously described during conventional cardiac surgery with high mortality rate; previous case reports suggested that the fragility of the aortic wall and Marfan disease were predisposing factors to such a life-threatening complication.7-9 This report presents a case of iatrogenic RTAAD after EG repair of a descending thoracic penetrating aortic ulcer, requiring emergent surgical replacement of the ascending aorta and the aortic arch. The available English literature on RTAAD was also reviewed, in order to recognize potential predisposing factors and specific strategies to prevent it.
Surgical repair of isolated congenital tricuspid valve (TV) disease is rare with no well-defined indication and outcomes. Moreover, the role of right ventricle (RV) in this context has not yet been ...investigated.
We sought to assess the impact of congenital TV repair on cardiac remodelling and clinical-functional status and the importance of the RV function in an adult congenital heart disease (ACHD) population.
From January 2005 to December 2015, 304 patients underwent TV surgery in our centre. Of these, 27 (ACHD) patients had isolated TV repair. Patients were evaluated with preoperative and postoperative transthoracic echocardiogram. Survival rate has been investigated with a mean clinical follow-up (FU) of 3.7 ± 2.3 years, whereas the mean echocardiographic FU was 2.9 ± 1.8 years. The clinical and functional status of patients showed a statistically significant improvement after the surgical repair in terms of New York Heart Association class (66.7 vs 7.4%;
< 0.01), clinical signs of heart failure (29.6 vs 7.4%;
< 0.01), and left ventricular function (14.8 vs 7.4%;
< 0.01). The RV and right atrium diameter were significantly reduced after surgery (5.15 ± 1.21 vs 4.32 ± 1.16;
< 0.01) and (44.7 ± 16.7 vs 26.7 ± 9.2;
< 0.01), respectively. The degree of postoperative pulmonary hypertension was also significantly reduced (40.7 vs 7.4%;
< 0.01). The survival rate was 96.3% at 1 year and 93.7% at 5 years. One patient (3.7%) had early failure of the tricuspid repair requiring a reoperation.
Isolated TV repair for adult congenital disease significantly improved patients' clinical and functional status and allowed right ventricular remodelling and functional improvement.
Abstract Background A balance between angiogenic and anti-angiogenic factors is critical in tissue development, tissue repair and homeostasis. Aberrant angiogenesis has been implicated in several ...pathologic conditions, including valvular heart disease. The aim of this study was to ascertain the pathogenetic role of angiogenesis in rheumatic and mixomatous mitral valve diseases. Methods Leaflets from mixomatous (n = 20) and rheumatic (n = 20) mitral valves removed from surgical patients, and normal mitral valve (n = 6) obtained at autopsy were collected. Immunohistochemical studies were performed on sequential valve sections, evaluating CD31, CD34, α smooth muscle actin (α-SMA), vascular endothelial growth factor (VEGF), VEGF receptor-1 (VEGFR1), VEGF receptor-2 (VEGFR-2), and chondromodulin-I (Chm-I). Results Immunohistochemistry revealed significant differences among groups in CD31 (p = 0.001), CD34 (p < 0.001), α-SMA (p < 0.001), VEGF (p < 0.001), VEGFR1 (p = 0.007), VEGFR2 (p = 0.011), and Chm-I (p < 0.001) expressions. Rheumatic valves demonstrated a severe up-regulation and down-regulation in pro-angiogenic and anti-angiogenic factors, respectively, compared with mixomatous and normal mitral valves. On the contrary, mixomatous valves showed a significant up-regulation of anti-angiogenic factors with respect to rheumatic and normal valves. Conclusions These findings provide evidence that an imbalance between pro-angiogenic and anti-angiogenic factors is implicated in mitral valve disease. Pro-angiogenic factors are up-regulated in rheumatic disease, while anti-angiogenic ones in mixomatous mitral valves.
PDF
