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Isolated hepatic perfusion for metastases of uveal melanoma: hospital outcomes 葡萄膜黑色素瘤转移的孤立肝灌注治疗:医院结果
Q4 Medicine Pub Date : 2023-09-29 DOI: 10.21688/1681-3472-2023-3-74-82
V.M. Unguryan, A.N. Kazantsev, A.V. Korotkikh, S.A. Ivanov, Yu.V. Belov, A.D. Kaprin
Objective: To evaluate hospital outcomes of isolated hepatic perfusion for metastases of uveal melanoma.Methods: In 2020-2022, 38 isolated hepatic perfusion procedures for unresectable metastases of uveal melanoma were performed in the Kostroma Regional Cancer Center. Our study included the following complications: death, bleeding, tumor lysis syndrome, abscess in the left lobe of the liver, peritonitis, asystole, lower extremity deep vein thrombosis, hydrothorax, acute liver failure, anasarca, polyserositis, ischemic cholangiopathy, common hepatic artery thrombosis, detachment of the common hepatic artery intima. We calculated a composite end point (the sum of all the complications).Results: In 2 cases, there was an accidental decannulation of the cannula placed in the proper hepatic artery in the 30th minute of perfusion. Due to hemodynamic instability, the procedure was terminated. Death from worsening liver failure was reported in 3 cases. Postoperative bleeding was diagnosed in 7 patients, and relaparotomy was performed to stop the bleeding. Subsequently, no concerns were reported. The combined end point was 42.11%.Conclusion: Isolated hepatic perfusion is an unsafe treatment option for patients with liver metastases of uveal melanoma. Received 12 May 2023. Revised 16 June 2023. Accepted 21 June 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: A.D. Kaprin, Yu.V. BelovData collection and analysis: A.N. Kazantsev, V.M. UnguryanStatistical analysis: A.N. Kazantsev, V.M. Unguryan, A.V. KorotkikhDrafting the article: A.N. Kazantsev, V.M. UnguryanCritical revision of the article: A.D. Kaprin, Yu.V. Belov, S.A. IvanovFinal approval of the version to be published: V.M. Unguryan, A.N. Kazantsev, A.V. Korotkikh, S.A. Ivanov, Yu.V. Belov, A.D. Kaprin
目的:评价葡萄膜黑色素瘤转移灶肝灌注治疗的临床效果。方法:2020-2022年,在Kostroma地区癌症中心对38例不可切除的葡萄膜黑色素瘤转移患者进行了分离肝灌注手术。我们的研究包括以下并发症:死亡、出血、肿瘤溶解综合征、肝左叶脓肿、腹膜炎、心脏骤停、下肢深静脉血栓形成、胸腔积液、急性肝功能衰竭、肺水肿、多浆液炎、缺血性胆管病、肝总动脉血栓形成、肝总动脉内膜脱离。我们计算了一个复合终点(所有并发症的总和)。结果:2例患者在灌注30min时发生置管意外脱管。由于血流动力学不稳定,手术终止。3例因肝功能衰竭加重而死亡。术后出血7例,行开腹手术止血。随后,没有关于关切的报告。合并终点为42.11%。结论:游离肝灌注治疗葡萄膜黑色素瘤肝转移是一种不安全的治疗方法。收到2023年5月12日。2023年6月16日修订。2023年6月21日接受。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者贡献。构想与研究设计:a.d Kaprin, Yu.V.。数据收集与分析:A.N. Kazantsev, V.M. Unguryan统计分析:A.N. Kazantsev, V.M. Unguryan, A.V. korotkik文章起草:A.N. Kazantsev, V.M. Unguryan文章评论修订:A.D. Kaprin, Yu.V。最终批准出版的版本:V.M. Unguryan, A.N. Kazantsev, A.V. Korotkikh, S.A. Ivanov, Yu.V.。别洛夫,A.D.卡普林
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引用次数: 0
Routine left atrial appendage closure: a retrospective analysis of mid-term outcomes 常规左心耳闭合:中期结果回顾性分析
Q4 Medicine Pub Date : 2023-09-29 DOI: 10.21688/1681-3472-2023-3-53-61
R.N. Komarov, D.V. Shevyakin, Ye.B. Solovyev, N.V. Kulikov
Background: There is strong evidence that stroke associated with atrial fibrillation (AF) has a cardioembolic origin. Given that the main source of thrombi in such patients is the left atrial appendage (LAA), there is a prospect of its closure becoming an adjunct or alternative to lifelong anticoagulant therapy.Objective: To evaluate the long-term effectiveness of routine LAA closure for ischemic stroke (IS) prevention in patients who underwent cardiac surgery with cardiopulmonary bypass (CPB).Methods: Our retrospective single-center study included patients who underwent cardiac surgery with CPB within 3 years. All participants were older than 18 years. The exclusion criteria: lack of information on the long-term outcomes; hemodynamically significant lesion of brachiocephalic vessels; porcelain aorta; infective endocarditis; history of malignant neoplasms, autoimmune diseases, and systemic vasculitis; acute coronary syndrome, repeated open heart surgery, and minimally invasive procedures. The selected patients were divided into 2 groups. Group 1 included patients who underwent concomitant LAA closure. Group 2 consisted of patients with intact LAA. We further divided patients based on whether they had preoperative AF or not. The primary end point was IS. The secondary end points were survival, perioperative myocardial infarction and AF, CPB and aortic cross-clamp time, number of resternotomies for bleeding, length of stay in the intensive care and cardiac surgery units.Results: After the primary analysis and use of exclusion criteria, we formed an LAA closure group (216 patients) and a group with intact LAA (179 patients). Among 129 patients with preoperative AF, concomitant LAA closure was performed in 69 patients and was not performed in 60 patients. Among 266 patients with no history of AF, this procedure was performed in 147 patients and was not performed in 119 patients. Multivariable Cox regression analysis included all the patients and showed that LAA closure was an independent predictor of decrease in IS incidence (hazard ratio, 0.20; 95% CI, 0.06-0.62; P = .006). At the same time, the procedure lost its benefits when patients with AF were excluded from the analysis. There were no differences in the secondary end points.Conclusion: LAA closure is an effective and safe method for long-term IS prevention in patients with AF operated on using CPB. The use of this procedure as a routine addition to the main cardiac surgery is not viable. Received 12 December 2022. Revised 4 September 2023. Accepted 5 September 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article.
背景:有强有力的证据表明卒中合并心房颤动(AF)有心脏栓塞的起源。鉴于此类患者血栓的主要来源是左心耳(LAA),因此其关闭有可能成为终身抗凝治疗的辅助或替代方法。目的:评价常规LAA关闭预防心脏手术合并体外循环(CPB)患者缺血性脑卒中(IS)的远期疗效。方法:我们的回顾性单中心研究纳入了3年内接受CPB心脏手术的患者。所有的参与者都在18岁以上。排除标准:缺乏关于长期结果的信息;头臂血管血流动力学显著病变;瓷主动脉;感染性心内膜炎;恶性肿瘤、自身免疫性疾病、全身性血管炎病史;急性冠状动脉综合征,反复心内直视手术和微创手术。选取的患者分为两组。组1包括合并LAA闭合的患者。第二组为LAA完整的患者。我们进一步根据术前是否有房颤对患者进行分类。主要终点是IS。次要终点为生存期、围手术期心肌梗死和房颤、CPB和主动脉交叉钳夹时间、因出血而切除胸腔的次数、在重症监护室和心脏外科病房的住院时间。结果:经过初步分析和排除标准的使用,我们形成LAA闭合组(216例)和LAA完整组(179例)。在129例术前房颤患者中,69例患者行LAA闭合术,60例患者未行LAA闭合术。在266例无房颤病史的患者中,147例患者行此手术,119例患者未行此手术。多变量Cox回归分析纳入了所有患者,结果显示LAA闭合是IS发病率降低的独立预测因子(风险比,0.20;95% ci, 0.06-0.62;P = .006)。与此同时,当心房颤动患者被排除在分析之外时,该手术失去了其益处。在次要终点上没有差异。结论:房颤患者行CPB手术后,LAA闭合是长期预防房颤的有效、安全的方法。将此手术作为主要心脏手术的常规补充是不可行的。收到2022年12月12日。2023年9月4日修订。2023年9月5日录用。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者的贡献:作者对本文的贡献相同。
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引用次数: 0
Minimal invasive extracorporeal circulation in comorbid patients 微创体外循环在合并症患者中的应用
Q4 Medicine Pub Date : 2023-09-29 DOI: 10.21688/1681-3472-2023-3-62-73
A.Sh. Revishvili, R.A. Kornelyuk, G.P. Plotnikov, L.B. Berikashvili, I.P. Komkov, E.S. Malyshenko, V.M. Zemskov, V.A. Popov
Background: As the severity of comorbid diseases increases, risks of cardiopulmonary bypass (CPB) complications significantly increase. A complex of the procedure’s damaging factors provokes a systemic inflammatory response that in some cases is accompanied by the damage to target organs, transitioning from chronic organ dysfunctions into acute ones. Some studies on the use of minimal invasive extracorporeal circulation (MiECC) systems show their advantage over conventional extracorporeal circulation (CECC); however, the diversity of MiECC systems, patients, and outcomes precludes us from confidently extrapolating these data to older comorbid patients.Objective: To compare the severity of systemic inflammation and treatment outcomes in comorbid patients who underwent cardiac surgery with CECC and MiECC.Methods: We conducted a retrospective cohort study of 760 patients who consecutively underwent elective cardiac operations in 2019-2022. Inclusion criteria: comorbid status (age-adjusted Charlson Comorbidity Index score of ≥6); CPB time ≥90 min. Exclusion criteria: emergency surgery, refusal to participate in the study. A total of 68 patients met the inclusion criteria. We formed 2 study groups based on the extracorporeal circulation method: CECC group (n = 51) and MiECC group (n = 17). Control points: before CPB and 24 hours after the surgery (lactate; creatinine; oxygenation index, hemolysis level). For systemic inflammatory response markers: 1 hour after the CPB start and 24 hours after the CPB end (interleukin 6; interleukin 10; procalcitonin; C-reactive protein; soluble Triggering Receptor Expressed on Myeloid Cells-1 [sTREM-1]). We evaluated respiratory and renal complications, drainage-related hemorrhages, hemostatic disorders, the need for sympathomimetic drugs, and the length of stay in an intensive care unit and inpatient hospital.Results: Between the groups there were no statistically significant differences in gender and anthropometric characteristics, surgery types, and main perfusion parameters. In the CECC group, we observed significantly higher doses of vasoconstrictors (norepinephrine) as well as a decrease in urine output and lung injury and an increase in lactate and hemolysis. The systemic inflammatory response markers were also significantly higher.Conclusion: Compared with CECC, MiECC does not significantly affect the frequency of organ dysfunctions; however, it reduces the severity of the systemic inflammatory response and immune suppression that are trigger mechanisms for multiple organ dysfunction syndrome. It is particularly important for patients with chronic organ dysfunctions. A range of indications for MiECC systems should be defined given its high cost and off-target effect on pleiotropic factors of systemic inflammatory response development. Received 6 April 2023. Revised 17 August 2023. Accepted 18 August 2023. Funding: The study was conducted within the framework of the research project "Development of minimally in
背景:随着合并症严重程度的增加,体外循环(CPB)并发症的风险显著增加。手术过程中损伤因素的复合体会引发全身炎症反应,在某些情况下,炎症反应会伴随着对目标器官的损害,从慢性器官功能障碍转变为急性器官功能障碍。一些关于使用微创体外循环(MiECC)系统的研究显示其优于传统体外循环(CECC);然而,MiECC系统、患者和结果的多样性使我们无法自信地将这些数据外推到老年合并症患者。目的:比较心脏手术合并CECC和MiECC合并症患者全身炎症的严重程度和治疗结果。方法:对760例2019-2022年连续接受心脏择期手术的患者进行回顾性队列研究。纳入标准:共病状态(年龄校正Charlson共病指数评分≥6);CPB时间≥90 min。排除标准:急诊手术,拒绝参与研究。共有68例患者符合纳入标准。我们根据体外循环方法分为2个研究组:CECC组(n = 51)和MiECC组(n = 17)。控制点:CPB前、术后24小时(乳酸;肌酐;氧合指数,溶血水平)。对于全身炎症反应标志物:CPB开始后1小时和CPB结束后24小时(白细胞介素6;白介素10;原降钙素;c反应蛋白;髓样细胞表达的可溶性触发受体-1 [sTREM-1])。我们评估了呼吸和肾脏并发症、引流相关出血、止血障碍、对拟交感神经药物的需求以及在重症监护病房和住院医院的住院时间。结果:两组患者在性别、人体测量特征、手术类型、主要灌注参数等方面无统计学差异。在CECC组中,我们观察到血管收缩剂(去甲肾上腺素)的剂量明显增加,尿量和肺损伤减少,乳酸和溶血增加。全身炎症反应指标也明显升高。结论:与CECC相比,MiECC对脏器功能障碍发生频率无显著影响;然而,它降低了作为多器官功能障碍综合征触发机制的全身炎症反应和免疫抑制的严重程度。这对慢性器官功能障碍患者尤为重要。鉴于MiECC系统的高成本和对全身性炎症反应发展的多效因子的脱靶效应,应该确定其适应症范围。收到2023年4月6日。2023年8月17日修订。2023年8月18日接受。资助:这项研究是在"开发用于心脏疾病手术治疗的微创和混合技术"研究项目框架内进行的。利益冲突:作者声明无利益冲突。作者贡献:构思与研究设计:A.Sh。数据收集和分析:R.A. Kornelyuk, L.B. Berikashvili, I.P. Komkov, E.S. Malyshenko, V.M. zemskov统计分析:L.B. Berikashvili文章起草:R.A. Kornelyuk, G.P. Plotnikov, L.B. Berikashvili文章评论修改:G.P. Plotnikov最终批准出版版本:A.Sh。雷维什维利,R.A. Kornelyuk, G.P. Plotnikov, L.B. Berikashvili, I.P. Komkov, E.S. Malyshenko, V.M. Zemskov, V.A. Popov
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引用次数: 0
Dynamic volume status assessment with the VExUS score after heart valve surgery complicated by acute kidney injury: a case series 心脏瓣膜手术并发急性肾损伤后动态容积状态评估的VExUS评分:一个病例系列
Q4 Medicine Pub Date : 2023-09-29 DOI: 10.21688/1681-3472-2023-3-89-98
M.V. Zozulya, A.V. Sotnikov, A.I. Lenkin
Background: Fluid overload is an independent risk factor for acute kidney injury after cardiac surgery. An objective volume status assessment remains an unsolved clinical problem.Objective: To analyze the relationship between the dynamic changes in splanchnic blood flow patterns (portal, hepatic, and interlobar renal veins), reflecting the venous congestion severity, and severity of renal dysfunction in the studied patients.Methods: From February to May 2023, 3 patients after open heart surgery developed acute kidney injury in the postoperative period: 2 of them required renal replacement therapy. In the perioperative period, all patients underwent Doppler ultrasonographic assessment of the splanchnic blood flow according to the venous excess ultrasound (VExUS) score.Results: The most distinct changes in blood flow patterns were observed in portal and interlobar renal veins. Two anuric patients requiring renal replacement therapy had a pulsatile portal venous flow with systolic flow reversal that indicated severe venous congestion and biphasic renal venous flow. After restoration of urine output in 1 patient, the blood flow pattern in the portal vein returned to the normal pattern. In another patient, the blood flow remained pulsatile, which manifested itself by persisting clinical signs of overhydration. In the third patient, the portal blood flow also was pulsatile but had no systolic flow reversal. The renal blood flow was biphasic, although it was initially continuous. After restoration of urine output and overhydration improvement, the blood flow pattern returned to the preoperative pattern.Conclusion: In the studied patients, the dynamic assessment of splanchnic blood flow using the VExUS score allowed to objectively assess the venous congestion severity and served as an additional criterion for initiating renal replacement therapy in case of acute kidney injury progression. Further research could validate this type of monitoring because its interpretation requires a comprehensive assessment due to moderate specificity. Received 21 June 2023. Revised 17 July 2023. Accepted 24 July 2023. Informed consent: The patients’ informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflicts of interests. Contribution of the authors: The authors contributed equally to this article.
背景:液体超载是心脏手术后急性肾损伤的独立危险因素。客观的体积状态评估仍然是一个未解决的临床问题。目的:分析反映静脉充血严重程度的内脏血流模式(门静脉、肝静脉和肾叶间静脉)的动态变化与肾功能障碍严重程度的关系。方法:2023年2月至5月,3例心内直视手术患者术后出现急性肾损伤,其中2例需要肾脏替代治疗。围手术期,所有患者均根据静脉过量超声(VExUS)评分行多普勒超声检查评估内脏血流。结果:门静脉和肾叶间静脉血流模式的改变最为明显。两名需要肾脏替代治疗的无尿患者有脉动性门静脉血流伴收缩期血流逆转,表明严重的静脉充血和双相肾静脉血流。1例患者尿量恢复后,门静脉血流模式恢复正常。在另一名患者中,血流仍有搏动,这表现为持续的水合过度的临床症状。第三例患者门静脉血流也有搏动,但无收缩血流逆转。肾血流呈双相,虽然最初是连续的。在恢复尿量和过度水化改善后,血流模式恢复到术前模式。结论:在研究的患者中,使用VExUS评分动态评估内脏血流量可以客观评估静脉充血严重程度,并可作为急性肾损伤进展时启动肾脏替代治疗的附加标准。进一步的研究可以验证这种类型的监测,因为它的解释需要一个全面的评估,由于中等特异性。收到2023年6月21日。2023年7月17日修订。2023年7月24日接受。知情同意:获得患者对病历用于医疗目的的知情同意。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者的贡献:作者对本文的贡献相同。
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引用次数: 0
Spinal cord stimulation for refractory angina pectoris: a case series 脊髓刺激治疗难治性心绞痛:一个病例系列
Q4 Medicine Pub Date : 2023-09-29 DOI: 10.21688/1681-3472-2023-3-83-88
D.D. Duse, V.Ya. Babchenko, R.S. Kiselev, V.I. Murtazin
Background: Refractory angina pectoris significantly reduces the length and quality of life. One of the methods to control symptoms and improve the quality of life of patients with refractory angina pectoris is spinal cord stimulation.Objective: To evaluate the effectiveness of spinal cord stimulation in controlling anginal pain in the long-term period over a long follow-up (>7 years).Methods: We retrospectively studied treatment results of 9 patients (6 men and 3 women) in the long-term follow-up from October 2012 to November 2022. Anginal pain and patients' quality of life were assessed using the visual analog scale and the Seattle Angina Questionnaire, respectively.Results: The mean follow-up was 7.33 ± 1.11 years. In the long-term postoperative period, regression of pain according to the visual analog scale was 52.3% (P = .0025). The Seattle Angina Questionnaire showed an improvement of the quality of life by 52.2% (P = .0993).Conclusion: Spinal cord stimulation allows to make control of chronic anginal pain more efficient, improve patients’ length and quality of life, and reduce the frequency and severity of disability. Received 8 December 2022. Revised 17 July 2023. Accepted 18 July 2023. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authors: The authors contributed equally to this article.
背景:难治性心绞痛显著降低患者的生活质量和寿命。脊髓刺激是控制难治性心绞痛患者症状、提高患者生活质量的方法之一。目的:通过长期随访(>7年),评价脊髓刺激对控制心绞痛的效果。方法:回顾性分析2012年10月至2022年11月长期随访的9例患者(男6例,女3例)的治疗结果。分别采用视觉模拟量表和西雅图心绞痛问卷对心绞痛疼痛和患者生活质量进行评估。结果:平均随访时间为7.33±1.11年。术后长期疼痛恢复率为52.3% (P = 0.0025)。西雅图心绞痛问卷调查显示生活质量改善了52.2% (P = .0993)。结论:脊髓刺激可以更有效地控制慢性心绞痛,提高患者的生存时间和质量,减少残疾的发生频率和严重程度。收到2022年12月8日。2023年7月17日修订。2023年7月18日接受。知情同意:已取得患者知情同意将病历用于医疗目的。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者的贡献:作者对本文的贡献相同。
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引用次数: 0
Microscope-assisted coronary artery bypass grafting in diffuse coronary artery disease: immediate and mid-term results 显微镜辅助冠状动脉旁路移植术治疗弥漫性冠状动脉疾病:近期和中期结果
Q4 Medicine Pub Date : 2023-09-29 DOI: 10.21688/1681-3472-2023-3-31-43
A.N. Semchenko, A.M. Shevchenko, I.V. Zaicev, A.V. Semchenko, T.B. Vnukova
Background: In recent years, a typical candidate for coronary artery bypass grafting (CABG) has become a patient with complex, multivessel coronary artery disease (CAD), often with an unsatisfactory and small distal bed. The prevalence of diffuse CAD is 4.2%-46.0%, and the CABG refusal rate due to this disease accounts for 1.3%-15.0%. Diffuse CAD is an independent predictor of mortality and poor prognosis after CABG. Due to a lack of uniform criteria for diffuse CAD and randomized trials, there is no preferred surgical treatment option for such patients.Objective: To evaluate immediate and mid-term results of microscope-assisted CABG in patients with ischemic heart disease and diffuse CAD.Methods: We calculated a diffuseness score and determined whether the criterion of diffuse lesion by SYNTAX score was met. For our retrospective study we selected 187 ischemic heart disease patients with 3-vessel CAD who underwent microscope-assisted CABG. A coronary lesion with a diffuseness score of >18 was considered diffuse if the SYNTAX score criterion was met for each of the main coronary arteries. The patients were divided into 2 groups: group 1 for patients with diffuse CAD (n = 60) and group 2 for patients with CAD that did not meet the criterion to be considered diffused (n = 127). The propensity score matching was used to reduce differences between the groups. The primary end point was death from any cause; the secondary end points were adverse cardiovascular events (death from cardiac causes, myocardial infarction, repeated revascularization, acute cerebrovascular accident) and angina.Results: No significant differences in the frequency of in-hospital specific and nonspecific complications were found. The frequency of achieved complete revascularization was comparable between the groups. There were no significant differences in the long-term survival, adverse cardiovascular events, and freedom from angina during the median follow-up of 39 months (min 1 month; max 60 months). The univariate analysis after the propensity score matching showed that diffuse CAD was not a significant predictor of death from any cause [hazard ratio (HR), 1.141; 95% CI, 0.348-3.742; P = .83], adverse cardiovascular events [HR, 0.940; 95% CI, 0.425-2.078; P = .88], and angina [HR, 0.817; 95% CI, 0.394-1.696; P = .59]. The multivariate analysis revealed no significant association between diffuse CAD and death from any cause both before [HR, 1.382; 95% CI, 0.396-4.815; P = .61] and after propensity score matching [HR, 2.079; 95% CI, 0.158-27.422; P = .58]. We found that within 60 months after CABG, the risk of death from any cause was increased: by patient’s age [HR, 1.166; 95% CI, 1.043-1.303; P = .007], male sex [HR, 5.583; 95% CI, 1.062-29.344; P = .042], and diabetes mellitus [HR, 3.673; 95% CI, 1.143-11.805; P = .029] before the propensity score matching and by patient’s age [HR, 2.055; 95% CI, 1.028-4.104; P = .041] and cardiopulmonary bypass time [HR, 1.190; 95% CI,
背景:近年来,冠状动脉旁路移植术(CABG)的典型候选者是复杂的多支冠状动脉疾病(CAD)患者,通常远端床不理想且小。弥漫性CAD的患病率为4.2% ~ 46.0%,因此病导致的CABG拒绝率为1.3% ~ 15.0%。弥漫性CAD是冠脉搭桥后死亡率和不良预后的独立预测因子。由于弥漫性CAD缺乏统一的标准和随机试验,对于这类患者没有首选的手术治疗选择。目的:评价显微镜辅助冠状动脉搭桥治疗缺血性心脏病和弥漫性冠心病的中期和近期效果。方法:计算弥漫性评分,以SYNTAX评分判断是否符合弥漫性病变标准。在我们的回顾性研究中,我们选择了187例患有三支血管CAD的缺血性心脏病患者,他们接受了显微镜辅助的冠脉搭桥手术。如果每个主要冠状动脉的SYNTAX评分标准都满足,弥漫性评分为18的冠状动脉病变被认为是弥漫性的。将患者分为2组:1组为弥漫性CAD患者(n = 60), 2组为不符合弥漫性CAD标准的患者(n = 127)。倾向评分匹配用于减少组间差异。主要终点是任何原因导致的死亡;次要终点为心血管不良事件(心脏原因死亡、心肌梗死、反复血运重建术、急性脑血管意外)和心绞痛。结果:两组住院特异性和非特异性并发症发生率无显著性差异。两组间实现完全血运重建的频率具有可比性。中位随访39个月(最短1个月;最多60个月)。倾向评分匹配后的单因素分析显示弥漫性CAD不是任何原因死亡的显著预测因子[危险比(HR), 1.141;95% ci, 0.348-3.742;P = .83],心血管不良事件[HR, 0.940;95% ci, 0.425-2.078;P = 0.88],心绞痛[HR, 0.817;95% ci, 0.394-1.696;P = 0.59]。多因素分析显示,弥漫性CAD与任何原因的死亡均无显著相关性[HR, 1.382;95% ci, 0.396-4.815;P = .61]和倾向评分匹配后[HR, 2.079;95% ci, 0.158-27.422;P = .58]。我们发现,CABG后60个月内,任何原因导致的死亡风险都随着患者年龄的增加而增加[HR, 1.166;95% ci, 1.043-1.303;P = .007],男性[HR, 5.583;95% ci, 1.062-29.344;P = 0.042],糖尿病[HR, 3.673;95% ci, 1.143-11.805;P = 0.029]倾向评分匹配前和患者年龄[HR, 2.055;95% ci, 1.028-4.104;P = 0.041]和体外循环时间[HR, 1.190;95% ci, 1.014-1.397;P = .033]。结论:弥漫性CAD患者行显微镜辅助冠状动脉搭桥治疗可获得满意的近期和中期疗效。我们发现弥漫性CAD与不良事件风险之间没有关联。2023年1月30日收到。2023年6月29日修订。2023年7月5日录用。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者贡献:构思和研究设计:A.N. Semchenko数据收集和分析:A.M.舍甫琴科,I.V.扎伊耶夫,A.V.塞姆琴科,T.B.伏努科夫统计分析:A.N.塞姆琴科文章起草:A.N.塞姆琴科,I.V.扎伊切夫文章关键修改:A.M.舍甫琴科,A.V.塞姆琴科,T.B.伏努科娃最终批准的版本将出版:A.N.塞姆琴科,A.M.舍甫琴科,扎伊耶夫,塞姆琴科,伏努科娃
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引用次数: 0
Stent thrombectomy for acute upper limb ischemia associated with thrombosis or thromboembolism: a case series 急性上肢缺血伴血栓形成或血栓栓塞的支架取栓术:病例系列
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.21688/1681-3472-2023-2-87-93
I. S. Sem’in, A. N. Ivanenko, G. A. Sobolev, A. Kiselev, A. Kazantsev, A. Korotkikh, I. V. Chernikova, V. Unguryan
Objective: To evaluate the effectiveness of endovascular stent thrombectomy for acute upper limb ischemia caused by thrombosis or thromboembolism of the major arteries of the upper limb.Methods: We evaluated the effectiveness and safety of this technique in 18 patients with acute upper limb ischemia. The mean age was 72 (38‐93) years; 66.7% of the patients were women. Arterial hypertension was observed in 94.4% of the patients, and 38.9% of the patients had confirmed atrial fibrillation.Results: The primary success rate (complete revascularization according to angiography findings) was 83.3% (15 of 18 cases). We used this technique as a stand-alone procedure in 15 cases. Two patients received self-expanding stents, and 1 patient had selective thrombolytic therapy. In 3 cases we did not relieve symptoms of acute ischemia and perform any upper limb amputations during hospitalization, nor did we have any conversions to open surgery. Two patients died during hospitalization: one patient died of acute myocardial infarction, and another died of multiple organ dysfunction syndrome in the postoperative period.Conclusion: This endovascular thrombectomy technique in combination with other endovascular techniques is highly effective and has a number of benefits, such as low trauma, no need for general anesthesia, accurate intra- and postoperative patency control, timely detection of emboli with the possibility of their removal from arteries comparable in diameter to a stent delivery system (up to 1.8 mm).Received 15 February 2023. Revised 29 March 2023. Accepted 6 April 2023.Informed consent: The patient’s informed consent to use the records for medical purposes is obtained.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.Contribution of the authorsLiterature review: A.V. Korotkikh, I.V. Chernikova, V.M. Unguryan, A.D. KiselevDrafting the article: A.N. Kazantsev, A.N. Ivanenko, G.A. SobolevCritical revision of the article: I.S. SeminSurgical treatment: A.N. Ivanenko, G.A. SobolevFinal approval of the version to be published: I.S. Semin, A.N. Ivanenko, G.A. Sobolev, A.D. Kiselev, A.N. Kazantsev, A.V. Korotkikh, I.V. Chernikova, V.M. Unguryan
目的:评价血管内支架取栓术治疗上肢大动脉血栓形成或血栓栓塞引起的急性上肢缺血的疗效。方法:对18例急性上肢缺血患者的临床疗效和安全性进行评价。平均年龄为72岁(38‐93岁);66.7%的患者为女性。94.4%的患者出现动脉高血压,38.9%的患者确诊房颤。结果:18例患者中15例首次成功(血管造影显示完全血运重建)83.3%。我们在15例病例中使用该技术作为独立手术。2例患者接受自扩张支架,1例患者接受选择性溶栓治疗。在3例患者中,我们在住院期间没有缓解急性缺血症状,也没有进行任何上肢截肢手术,也没有进行任何转开腹手术。2例患者在住院期间死亡:1例患者死于急性心肌梗死,1例患者死于术后多器官功能障碍综合征。结论:这种血管内取栓技术与其他血管内技术联合使用是非常有效的,并且具有许多优点,如创伤小、不需要全身麻醉、准确的术中和术后通畅控制、及时发现栓塞并有可能将其从直径与支架输送系统相当的动脉中取出(最大1.8 mm)。2023年2月15日收到。2023年3月29日修订。2023年4月6日录用。知情同意:已取得患者知情同意将病历用于医疗目的。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者贡献文献综述:A.V. Korotkikh, I.V. Chernikova, V.M. Unguryan, A.D. kiselevv文章起草:A.N. Kazantsev, A.N. Ivanenko, G.A. sobolev文章关键修改:I.S. Semin手术治疗:A.N. Ivanenko, G.A. Sobolev, A.N. Kiselev, A.V. Korotkikh, I.V. Chernikova, V.M. Unguryan最终批准出版:I.S. Semin, A.N. Ivanenko, G.A. Sobolev, A.V. Kiselev, A.V. Chernikova
{"title":"Stent thrombectomy for acute upper limb ischemia associated with thrombosis or thromboembolism: a case series","authors":"I. S. Sem’in, A. N. Ivanenko, G. A. Sobolev, A. Kiselev, A. Kazantsev, A. Korotkikh, I. V. Chernikova, V. Unguryan","doi":"10.21688/1681-3472-2023-2-87-93","DOIUrl":"https://doi.org/10.21688/1681-3472-2023-2-87-93","url":null,"abstract":"Objective: To evaluate the effectiveness of endovascular stent thrombectomy for acute upper limb ischemia caused by thrombosis or thromboembolism of the major arteries of the upper limb.Methods: We evaluated the effectiveness and safety of this technique in 18 patients with acute upper limb ischemia. The mean age was 72 (38‐93) years; 66.7% of the patients were women. Arterial hypertension was observed in 94.4% of the patients, and 38.9% of the patients had confirmed atrial fibrillation.Results: The primary success rate (complete revascularization according to angiography findings) was 83.3% (15 of 18 cases). We used this technique as a stand-alone procedure in 15 cases. Two patients received self-expanding stents, and 1 patient had selective thrombolytic therapy. In 3 cases we did not relieve symptoms of acute ischemia and perform any upper limb amputations during hospitalization, nor did we have any conversions to open surgery. Two patients died during hospitalization: one patient died of acute myocardial infarction, and another died of multiple organ dysfunction syndrome in the postoperative period.Conclusion: This endovascular thrombectomy technique in combination with other endovascular techniques is highly effective and has a number of benefits, such as low trauma, no need for general anesthesia, accurate intra- and postoperative patency control, timely detection of emboli with the possibility of their removal from arteries comparable in diameter to a stent delivery system (up to 1.8 mm).\u0000Received 15 February 2023. Revised 29 March 2023. Accepted 6 April 2023.\u0000Informed consent: The patient’s informed consent to use the records for medical purposes is obtained.\u0000Funding: The study did not have sponsorship.\u0000Conflict of interest: The authors declare no conflict of interest.\u0000Contribution of the authorsLiterature review: A.V. Korotkikh, I.V. Chernikova, V.M. Unguryan, A.D. KiselevDrafting the article: A.N. Kazantsev, A.N. Ivanenko, G.A. SobolevCritical revision of the article: I.S. SeminSurgical treatment: A.N. Ivanenko, G.A. SobolevFinal approval of the version to be published: I.S. Semin, A.N. Ivanenko, G.A. Sobolev, A.D. Kiselev, A.N. Kazantsev, A.V. Korotkikh, I.V. Chernikova, V.M. Unguryan","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90550607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Immediate outcomes of transcatheter aortic valve implantation in patients with horizontal aorta 水平主动脉经导管主动脉瓣植入术的即时疗效
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.21688/1681-3472-2023-2-54-65
A. A. Baranov, O. Krestyaninov, A. Badoian, D. Khelimskii, S. Manukian, A. Tsydenova, M.A. Makhmudov
Background: Transcatheter aortic valve implantation (TAVI) is an effective and safe procedure for severe aortic stenosis. Increased aortic root angulation is an important anatomical feature that may cause technical difficulties and negatively affect immediate and long-term outcomes.Objective: To evaluate immediate outcomes of TAVI in patients with increased aortic root angulation.Methods: Our retrospective single-center study included 412 patients with severe aortic stenosis who underwent TAVI using self-expanding bioprostheses from 2015 to 2022. Patients with aortic root angulation ≥ 49° were included in group 1 (n = 200), and those with aortic root angulation <  49° comprised group 2 (n = 212).Results: The mean age of the patients was 75.2 ± 7.2 years. In a subgroup with the first-generation CoreValve prosthesis and a ≥ 49° angle, we observed moderate aortic regurgitation significantly more often (7.4% vs 0.0%, P = .010) and technical success significantly less often (90.1% vs 98.9%, P = .010) compared with a similar subgroup with a <  49° angle. In subgroups with CoreValve Evolute R and ACURATE neo prostheses, there were no significant differences in terms of the mentioned parameters. Independent predictors of technical failure were the aortic root angle [OR for each degree increase: 0.44, 95% CI: 0.30-0.63, P < .001], no postdilation [OR: 5.0, 95% CI: 1.33-20.00, P = .074], indexed mass of the left ventricular myocardium [OR: 1.02, 95% CI: 1.01-1.03, P = .003], and higher implantation relative to the aortic annulus [OR for every 1 mm decrease in implantation depth: 0.44, 95% CI: 0.30-0.63, P < .001].Conclusion: Increased aortic angulation ≥ 49° negatively affected the technical success of TAVI only in patients with the first-generation CoreValve prostheses. Independent predictors of technical failure in TAVI were the aortic root angle, no postdilation, indexed mass of the left ventricular myocardium, and higher implantation relative to the aortic annulus.Received 9 January 2023. Revised 10 May 2023. Accepted 30 May 2023.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.Contribution of the authorsConception and study design: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. BadoianData collection and analysis: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. BadoianStatistical analysis: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. BadoianDrafting the article: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, S.N. Manukian, A.Yu. Tsydenova, M.A. MakhmudovCritical revision of the article: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, S.N. Manukian, A.Yu. Tsydenova, M.A. MakhmudovFinal approval of the version to be published: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, S.N. Manukian, A.Yu. Tsydenova, M.A. Makhmudov
背景:经导管主动脉瓣植入术(TAVI)是治疗严重主动脉瓣狭窄的一种安全有效的方法。主动脉根部成角增加是一个重要的解剖特征,可能会导致技术上的困难,并对近期和长期的预后产生负面影响。目的:评价主动脉根部成角增加患者行TAVI的即时疗效。方法:我们的回顾性单中心研究纳入了2015年至2022年412例使用自膨胀生物假体进行TAVI的严重主动脉瓣狭窄患者。主动脉根部成角≥49°的患者纳入1组(n = 200),主动脉根部成角< 49°的患者纳入2组(n = 212)。结果:患者平均年龄75.2±7.2岁。在第一代CoreValve假体和≥49°角度的亚组中,与< 49°角度的亚组相比,我们观察到中度主动脉反流的频率显著增加(7.4% vs 0.0%, P = 0.010),技术成功率显著降低(90.1% vs 98.9%, P = 0.010)。在使用CoreValve Evolute R和accurate neo假体的亚组中,上述参数没有显著差异。技术失败的独立预测因子是主动脉根角[OR: 0.44, 95% CI: 0.30-0.63, P <。001],无后扩张[OR: 5.0, 95% CI: 1.33-20.00, P =。[074],左心室心肌指数质量[OR: 1.02, 95% CI: 1.01-1.03, P =。[003],相对于主动脉环的植入更高[OR: 0.44, 95% CI: 0.30-0.63, P < .001]。结论:主动脉角≥49°的增加仅对第一代CoreValve假体患者的TAVI技术成功产生负面影响。TAVI技术失败的独立预测因素是主动脉根角、无后扩张、左心室心肌指数质量和相对于主动脉环较高的植入。2023年1月9日收。2023年5月10日修订。2023年5月30日录用。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者贡献:A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian数据收集与分析:A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian统计分析:A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian论文撰写:A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, S.N. Manukian, a.u. yu。本文关键修订:A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, S.N. Manukian, a.a yu。最终批准出版的版本:A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, S.N. Manukian, a.a yu。Tsydenova, M.A. Makhmudov
{"title":"Immediate outcomes of transcatheter aortic valve implantation in patients with horizontal aorta","authors":"A. A. Baranov, O. Krestyaninov, A. Badoian, D. Khelimskii, S. Manukian, A. Tsydenova, M.A. Makhmudov","doi":"10.21688/1681-3472-2023-2-54-65","DOIUrl":"https://doi.org/10.21688/1681-3472-2023-2-54-65","url":null,"abstract":"Background: Transcatheter aortic valve implantation (TAVI) is an effective and safe procedure for severe aortic stenosis. Increased aortic root angulation is an important anatomical feature that may cause technical difficulties and negatively affect immediate and long-term outcomes.Objective: To evaluate immediate outcomes of TAVI in patients with increased aortic root angulation.Methods: Our retrospective single-center study included 412 patients with severe aortic stenosis who underwent TAVI using self-expanding bioprostheses from 2015 to 2022. Patients with aortic root angulation ≥ 49° were included in group 1 (n = 200), and those with aortic root angulation <  49° comprised group 2 (n = 212).Results: The mean age of the patients was 75.2 ± 7.2 years. In a subgroup with the first-generation CoreValve prosthesis and a ≥ 49° angle, we observed moderate aortic regurgitation significantly more often (7.4% vs 0.0%, P = .010) and technical success significantly less often (90.1% vs 98.9%, P = .010) compared with a similar subgroup with a <  49° angle. In subgroups with CoreValve Evolute R and ACURATE neo prostheses, there were no significant differences in terms of the mentioned parameters. Independent predictors of technical failure were the aortic root angle [OR for each degree increase: 0.44, 95% CI: 0.30-0.63, P < .001], no postdilation [OR: 5.0, 95% CI: 1.33-20.00, P = .074], indexed mass of the left ventricular myocardium [OR: 1.02, 95% CI: 1.01-1.03, P = .003], and higher implantation relative to the aortic annulus [OR for every 1 mm decrease in implantation depth: 0.44, 95% CI: 0.30-0.63, P < .001].Conclusion: Increased aortic angulation ≥ 49° negatively affected the technical success of TAVI only in patients with the first-generation CoreValve prostheses. Independent predictors of technical failure in TAVI were the aortic root angle, no postdilation, indexed mass of the left ventricular myocardium, and higher implantation relative to the aortic annulus.\u0000Received 9 January 2023. Revised 10 May 2023. Accepted 30 May 2023.\u0000Funding: The study did not have sponsorship.\u0000Conflict of interest: The authors declare no conflict of interest.\u0000Contribution of the authorsConception and study design: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. BadoianData collection and analysis: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. BadoianStatistical analysis: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. BadoianDrafting the article: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, S.N. Manukian, A.Yu. Tsydenova, M.A. MakhmudovCritical revision of the article: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, S.N. Manukian, A.Yu. Tsydenova, M.A. MakhmudovFinal approval of the version to be published: A.A. Baranov, O.V. Krestyaninov, D.A. Khelimskii, A.G. Badoian, S.N. Manukian, A.Yu. Tsydenova, M.A. Makhmudov","PeriodicalId":19853,"journal":{"name":"Patologiya krovoobrashcheniya i kardiokhirurgiya","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80687253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Reasons for and time to seeking healthcare in cardiac clinics by women with a history of successfully treated breast cancer 成功治疗过乳腺癌的妇女在心脏诊所寻求医疗保健的原因和时间
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.21688/1681-3472-2023-2-19-26
E. Kushnareva, O. E. Astafurova, E. Zorina, O. Moiseeva
Background: Various methods of breast cancer treatment are potentially cardiotoxic: anthracycline chemotherapy, HER2-targeted therapy, and radiation therapy to the left side of the chest. In clinical practice, cardiologists deal with a wide range of complications caused by the mentioned methods.Objective: To analyze the reasons for and timing of seeking healthcare in cardiac clinics by women with a history of successfully treated breast cancer.Methods: Our single-center retrospective observational study included 125 women (mean age at the time of seeking healthcare was 68.1 ± 8.6 years).Results: Patients with a history of radiation therapy had higher peak velocity (P = .015) and peak gradient (P = .017) across the aortic valve. As part of their examination and treatment 71 patients underwent coronary angiography. Of them, 21 patients (29.6%) had coronary artery stenting, and 23 patients (32.4%) underwent coronary artery bypass grafting. Forty-two patients (33.6%) underwent heart valve replacement: aortic valve replacement in 92.9% of the cases (n = 39) and mitral valve replacement in 7.1% of the cases (n = 3). We found a strong negative correlation between the age at the time of radiation therapy and the time to onset of valvular heart disease (r = −0.748; P = .000004) and an average negative correlation between the age and the time to surgical treatment (r = −0.695; P = .00003).Conclusion: We studied the main reasons for seeking healthcare in cardiac clinics by women with a history of breast cancer, analyzed cardiac operations in terms of antitumor therapy types, and found a strong correlation between the age at the time of antitumor therapy and the time to onset of valvular heart disease, as well as the time to cardiac surgery.Received 20 November 2022. Revised 21 May 2023. Accepted 31 May 2023.Funding: The study was supported by Ministry of Science and Higher Education of Russian Federation (No. 075-15-2022-301).Conflict of interest: The authors declare no conflict of interest.Contribution of the authors: The authors contributed equally to this article.
背景:各种乳腺癌治疗方法都有潜在的心脏毒性:蒽环类化疗、her2靶向治疗和胸部左侧放射治疗。在临床实践中,心脏病专家处理由上述方法引起的各种并发症。目的:分析有乳腺癌成功治疗史的妇女到心脏诊所求医的原因和时机。方法:我们的单中心回顾性观察研究纳入125名妇女(就诊时平均年龄为68.1±8.6岁)。结果:有放射治疗史的患者在主动脉瓣上的峰值流速(P = 0.015)和峰值梯度(P = 0.017)更高。作为检查和治疗的一部分,71例患者接受了冠状动脉造影。其中21例(29.6%)行冠状动脉支架置入术,23例(32.4%)行冠状动脉旁路移植术。42例(33.6%)患者行心脏瓣膜置换术,其中主动脉瓣膜置换术占92.9% (n = 39),二尖瓣置换术占7.1% (n = 3)。我们发现,接受放射治疗时的年龄与发生瓣膜性心脏病的时间呈很强的负相关(r = - 0.748;P = 0.000004),年龄与手术时间呈平均负相关(r = - 0.695;p = .00003)。结论:我们研究了有乳腺癌病史的女性到心脏诊所就诊的主要原因,分析了心脏手术的抗肿瘤治疗类型,发现抗肿瘤治疗时的年龄与瓣膜性心脏病发病时间以及心脏手术时间有很强的相关性。收到2022年11月20日。2023年5月21日修订。2023年5月31日录用。资助:本研究由俄罗斯联邦科学和高等教育部(No. 07515-2022 -301)资助。利益冲突:作者声明无利益冲突。作者的贡献:作者对本文的贡献相同。
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引用次数: 0
High-power radiofrequency ablation for ventricular tachycardia in patients with structural heart disease: one-year follow-up data from the multicenter prospective registry 高功率射频消融治疗结构性心脏病患者室性心动过速:来自多中心前瞻性登记的一年随访数据
Q4 Medicine Pub Date : 2023-06-30 DOI: 10.21688/1681-3472-2023-2-66-73
S. Korolev, E. Artyukhina, V. Shabanov, O. Sapelnikov, A. Tsyganov, A. Revishvili, A. Romanov
Background: The outcomes of ventricular tachycardia (VT) ablation in patients with structural heart disease (SHD) are not ideal. High-power radiofrequency ablation (RFA) may have a long-term beneficial effect in this patient cohort.Objective: To evaluate the safety, early and long-term efficacy of high-power RFA for VT and concomitant SHD in a multicenter prospective registry.Methods: Our study included a total of 63 patients (66,7% of them were men; median age was 61.0 [51.0-66.5] years) with ischemic heart disease and drug-resistant VT who were scheduled for RFA (50 W). Non-fluoroscopic 3D mapping systems were used for bipolar and activation mapping with standard settings. The safety end point included perioperative complications, such as death, hemopericardium, stroke, myocardial infarction, electrical storm, and vascular complications. The efficacy end points included VT non-inducibility at the end of ablation and freedom from VT at 12 months of the follow-up. The secondary end points were changes in implantable cardioverter-defibrillator (ICD) therapy, sonographic findings, and number of hospital admissions.Results: All patients underwent VT ablation under general sedation. One clinical VT was induced in 96.8% of the patients before ablation. After ablation no clinical VTs were induced (P < .0001 vs baseline). No perioperative complications were observed. Freedom from VT without antiarrhythmic drugs was 82.6% at 12 months of the follow-up. The number of ICD therapies significantly decreased at 12 months of the follow-up compared with baseline (3.2% vs 31.7%, respectively; P = .0001). The left ventricular ejection fraction increased from 48.7% ± 14.7% at baseline to 50.3% ± 11.9% at 12 months of the follow-up (P = .038). There was a statistically significant decrease in hospital admission rate before and after ablation (from 2 [range: 0-12] to 0 [range: 0-3], P < .0001).Conclusion: High-power RFA for VT in patients with ischemia demonstrated its safety and high perioperative and long-term efficacy, which were linked to clinical improvement. Further randomized studies will help introduce this VT ablation approach into routine clinical practice.Received 5 September 2022. Revised 16 February 2023. Accepted 31 May 2023.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.Contribution of the authorsConception and study design: S.V. Korolev, A.Sh. Revishvili, A.B. Romanov Data collection and analysis: S.V. Korolev, E.A. Artyukhina, V.V. Shabanov, O.V. Sapelnikov, A.V. Tsyganov, A.Sh. Revishvili, A.B. RomanovStatistical analysis: S.V. Korolev Drafting the article: S.V. Korolev Critical revision of the article: A.B. Romanov, A.Sh. Revishvili Final approval of the version to be published: S.V. Korolev, E.A. Artyukhina, V.V. Shabanov, O.V. Sapelnikov, A.V. Tsyganov, A.Sh. Revishvili, A.B. Romanov
背景:室性心动过速(VT)消融术治疗结构性心脏病(SHD)的效果并不理想。高功率射频消融术(RFA)在该患者队列中可能具有长期有益的效果。目的:在一项多中心前瞻性研究中,评价高功率射频消融治疗VT及合并SHD的安全性、早期和长期疗效。方法:本研究共纳入63例患者(66.7%为男性;中位年龄为61.0[51.0-66.5]岁,伴有缺血性心脏病和耐药室速,计划进行RFA (50 W)。非透视3D制图系统用于双极和标准设置的激活制图。安全性终点包括围手术期并发症,如死亡、心包积血、中风、心肌梗死、电风暴和血管并发症。疗效终点包括消融结束时室速无诱导性和随访12个月时无室速。次要终点是植入式心律转复除颤器(ICD)治疗的变化、超声检查结果和住院人数。结果:所有患者均在全身镇静下行房室消融术。96.8%的患者在消融前发生1次临床室速。消融后无临床室性心动过速(P < 0.05)。0001 vs基线)。无围手术期并发症。随访12个月时,无抗心律失常药物的室性心动过速自由率为82.6%。随访12个月时,与基线相比,ICD治疗的次数显著减少(分别为3.2%对31.7%;p = 0.0001)。左室射血分数从基线时的48.7%±14.7%上升至随访12个月时的50.3%±11.9% (P = 0.038)。消融前后住院率下降有统计学意义(从2[范围:0-12]降至0[范围:0-3],P < 0.0001)。结论:大功率射频消融术治疗VT缺血患者安全性高,围手术期和远期疗效高,与临床改善有关。进一步的随机研究将有助于将VT消融方法引入常规临床实践。2022年9月5日收到。2023年2月16日修订。2023年5月31日录用。经费来源:本研究未获得赞助。利益冲突:作者声明无利益冲突。作者贡献。研究构思与设计:S.V. Korolev, A.Sh。数据收集与分析:S.V. Korolev, E.A. Artyukhina, V.V. Shabanov, O.V. Sapelnikov, A.V. Tsyganov, A.Sh。统计分析:S.V.科罗廖夫文章起草:S.V.科罗廖夫文章评论修订:A.B.罗曼诺夫,a.h.。最终批准出版的版本:S.V.科罗廖夫,E.A.阿图奇娜,V.V.沙巴诺夫,O.V.萨佩尔尼科夫,A.V.茨加诺夫,a.s.。莱什维利,A.B.罗曼诺夫
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引用次数: 1
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Patologiya krovoobrashcheniya i kardiokhirurgiya
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