RESUMO
Abstract Introduction: Mitral valvuloplasty including ring/band support is widely performed despite potential drawbacks of rings. Unsupported valvuloplasty is performed in only a few centers. This study aimed to report long-term outcomes of patients undergoing unsupported valvuloplasty for degenerative mitral regurgitation (MR) and to identify predictive factors for outcomes. Methods: This is a retrospective cohort including patients undergoing mitral valve repair for degenerative MR from 2000 to 2018. The main techniques were Wooler annuloplasty and quadrangular resection. Kaplan-Meier curves and Cox regression models were used for statistical analysis. Results: One hundred fifty-eight patients were included (median age: 64.0 years). In-hospital mortality was 2.5%. Maximum follow-up was 19.6 years, with a median of 4.7 years (992 patient-years). Overall survival at 5, 10, and 15 years was 91.0% (95% confidence interval [CI]: 85.7-96.3), 87.6% (95% CI: 80.7-94.5), and 78.1% (95% CI: 65.9-90.3), respectively. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was an independent predictor of late death (hazard ratio [HR] 1.42; P=0.016). Freedom from mitral reoperation at 5, 10, and 15 years was 88.1% (95% CI: 82.0-94.2), 82.4% (95% CI: 74.6-90.2), and 75.7% (95% CI: 64.1-87.3), respectively. Left atrial diameter > 56 mm was associated with late reintervention in univariate analysis (HR 1.06; P=0.049). Conclusion: Degenerative MR can be successfully treated with repair techniques without annular support, thus avoiding the technical and logistical drawbacks of ring/band implantation while maintaining good long-term results. EuroSCORE II was a risk factor for late death, and larger left atrium was associated with late reoperation.
Assuntos
Humanos , Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral/cirurgia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Pessoa de Meia-Idade , Valva Mitral/cirurgiaRESUMO
INTRODUCTION: Mitral valvuloplasty including ring/band support is widely performed despite potential drawbacks of rings. Unsupported valvuloplasty is performed in only a few centers. This study aimed to report long-term outcomes of patients undergoing unsupported valvuloplasty for degenerative mitral regurgitation (MR) and to identify predictive factors for outcomes. METHODS: This is a retrospective cohort including patients undergoing mitral valve repair for degenerative MR from 2000 to 2018. The main techniques were Wooler annuloplasty and quadrangular resection. Kaplan-Meier curves and Cox regression models were used for statistical analysis. RESULTS: One hundred fifty-eight patients were included (median age: 64.0 years). In-hospital mortality was 2.5%. Maximum followup was 19.6 years, with a median of 4.7 years (992 patient-years). Overall survival at 5, 10, and 15 years was 91.0% (95% confidence interval [CI]: 85.7-96.3), 87.6% (95% CI: 80.7-94.5), and 78.1% (95% CI: 65.9-90.3), respectively. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II was an independent predictor of late death (hazard ratio [HR] 1.42; P=0.016). Freedom from mitral reoperation at 5, 10, and 15 years was 88.1% (95% CI: 82.0-94.2), 82.4% (95% CI: 74.6-90.2), and 75.7% (95% CI: 64.1-87.3), respectively. Left atrial diameter > 56 mm was associated with late reintervention in univariate analysis (HR 1.06; P=0.049). CONCLUSION: Degenerative MR can be successfully treated with repair techniques without annular support, thus avoiding the technical and logistical drawbacks of ring/band implantation while maintaining good long-term results. EuroSCORE II was a risk factor for late death, and larger left atrium was associated with late reoperation.
Assuntos
Implante de Prótese de Valva Cardíaca , Anuloplastia da Valva Mitral , Insuficiência da Valva Mitral , Humanos , Pessoa de Meia-Idade , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/cirurgia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
Por cerca de 15 anos, o Implante Transcateter Valvar Aórtico (TAVI) passou por avanços tecnológicos, adquiriu experiência acumulada e tornou-se alternativa à cirurgia convencional. A principal indicação é a estenose aórtica degenerativa do idoso. Evidências atuais foram ampliadas para aqueles de risco intermediário e se tornaram mais robustas nos pacientes de alto risco e inoperáveis. Em situações específicas, como valva aórtica bicúspide, regurgitação aórtica pura, pacientes de baixo risco e bioprótese cirúrgica degenerada, os resultados ainda não são totalmente previsíveis, mas muito promissores. Os tipos de dispositivos atualmente liberados para uso clinico são divididos em: da geração inicial e os da nova geração, assim como em auto expansível, balão expansível e expansível mecanicamente. O sítio de acesso preferencial na atualidade é a via transfemoral. Outras alternativas de acessos também têm se mostrado viáveis e confiáveis. As principais complicações são vasculares, eventos neurológicos, distúrbios de condução e regurgitação paravalvar. Apesar da baixa incidência, a ruptura aórtica e a oclusão coronária são uma fonte de maior interesse, devido ao seu potencial impacto na morbimortalidade. A realização mais recente do procedimento em pacientes mais jovens faz necessária mais atenção à questões referentes à durabilidade e ao risco de trombose. Embora o TAVI ainda possa ser um procedimento complexo, após atingida experiência, existe a tendência de migração para uma abordagem mais simplificada com segurança. A seleção do paciente deve, idealmente, ser feita por uma equipe multidisciplinar e uma completa avaliação por imagem, em que a angitomografia é imprescindível, mandatória
For around fifteen years, Transcatheter Aortic Valve Implant (TAVI) has undergone technological advances, acquired accumulated experience, and become an alternative to conventional surgery. The main indication is degenerative aortic stenosis in the elderly patient. Current evidence has been extended to those with intermediate risk, and has become more robust in high-risk and inoperable patients. In specific situations, such as bicuspid aortic valve, pure aortic regurgitation, low-risk patients, and degenerated surgical bioprosthesis, the results are not totally predictable, but are very promising. The types of device currently released for clinical use are divided into first generation and new generation devices, and into auto-expandable, balloon-expandable, and mechanically-expandable. The preferential access site is currently the transfermoral route. Other access alternatives have also proven viable and reliable. The main complications are vascular, neurological events, conduction disturbances, and paravalvular regurgitation. Despite their low incidence, aortic rupture and coronary occlusion have attracted greater interest due to their potential impact on morbimortality. The more recent use of the procedure in younger patients raises issues related to durability and the risk of thrombosis. Although TAVI is still a complex procedure, after gaining experience, there is a tendency to move towards a more simplified, safer approach. The patient selection should ideally be carried out by a multidisciplinary team, and a complete imaging assessment that includes angiotomography is absolutely essential
Assuntos
Humanos , Masculino , Feminino , Valva Aórtica/anormalidades , Implantação de Prótese , Doenças das Valvas Cardíacas , Valva Mitral/anormalidades , Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Marca-Passo Artificial , Bioprótese , Ecocardiografia/métodos , Tomografia/métodos , Fatores de Risco , Bloqueio AtrioventricularRESUMO
INTRODUCTION: Antiplatelet therapy after coronary artery bypass graft (CABG) has been used. Little is known about the predictors and efficacy of clopidogrel in this scenario. OBJECTIVE: Identify predictors of clopidogrel following CABG. METHODS: We evaluated 5404 patients who underwent CABG between 2000 and 2009 at Duke University Medical Center. We excluded patients undergoing concomitant valve surgery, those who had postoperative bleeding or death before discharge. Postoperative clopidogrel was left to the discretion of the attending physician. Adjusted risk for 1-year mortality was compared between patients receiving and not receiving clopidogrel during hospitalization after undergoing CABG. RESULTS: At hospital discharge, 931 (17.2%) patients were receiving clopidogrel. Comparing patients not receiving clopidogrel at discharge, users had more comorbidities, including hyperlipidemia, hypertension, heart failure, peripheral arterial disease and cerebrovascular disease. Patients who received aspirin during hospitalization were less likely to receive clopidogrel at discharge (P≤0.0001). Clopidogrel was associated with similar 1-year mortality compared with those who did not use clopidogrel (4.4% vs. 4.5%, P=0.72). There was, however, an interaction between the use of cardiopulmonary bypass and clopidogrel, with lower 1-year mortality in patients undergoing off-pump CABG who received clopidogrel, but not those undergoing conventional CABG (2.6% vs 5.6%, P Interaction = 0.032). CONCLUSION: Clopidogrel was used in nearly one-fifth of patients after CABG. Its use was not associated with lower mortality after 1 year in general, but lower mortality rate in those undergoing off-pump CABG. Randomized clinical trials are needed to determine the benefit of routine use of clopidogrel in CABG.
Assuntos
Ponte de Artéria Coronária/reabilitação , Revascularização Miocárdica/reabilitação , Inibidores da Agregação Plaquetária/uso terapêutico , Complicações Pós-Operatórias/mortalidade , Ticlopidina/análogos & derivados , Aspirina/administração & dosagem , Aspirina/uso terapêutico , Ponte Cardiopulmonar/reabilitação , Clopidogrel , Ponte de Artéria Coronária/métodos , Quimioterapia Combinada/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Revascularização Miocárdica/métodos , North Carolina , Alta do Paciente/estatística & dados numéricos , Inibidores da Agregação Plaquetária/administração & dosagem , Inibidores da Agregação Plaquetária/normas , Cuidados Pós-Operatórios/mortalidade , Complicações Pós-Operatórias/tratamento farmacológico , Período Pós-Operatório , Prevalência , Prognóstico , Taxa de Sobrevida , Ticlopidina/administração & dosagem , Ticlopidina/normas , Ticlopidina/uso terapêuticoRESUMO
Abstract Introduction: Antiplatelet therapy after coronary artery bypass graft (CABG) has been used. Little is known about the predictors and efficacy of clopidogrel in this scenario. Objective: Identify predictors of clopidogrel following CABG. Methods: We evaluated 5404 patients who underwent CABG between 2000 and 2009 at Duke University Medical Center. We excluded patients undergoing concomitant valve surgery, those who had postoperative bleeding or death before discharge. Postoperative clopidogrel was left to the discretion of the attending physician. Adjusted risk for 1-year mortality was compared between patients receiving and not receiving clopidogrel during hospitalization after undergoing CABG. Results: At hospital discharge, 931 (17.2%) patients were receiving clopidogrel. Comparing patients not receiving clopidogrel at discharge, users had more comorbidities, including hyperlipidemia, hypertension, heart failure, peripheral arterial disease and cerebrovascular disease. Patients who received aspirin during hospitalization were less likely to receive clopidogrel at discharge (P≤0.0001). Clopidogrel was associated with similar 1-year mortality compared with those who did not use clopidogrel (4.4% vs. 4.5%, P=0.72). There was, however, an interaction between the use of cardiopulmonary bypass and clopidogrel, with lower 1-year mortality in patients undergoing off-pump CABG who received clopidogrel, but not those undergoing conventional CABG (2.6% vs 5.6%, P Interaction = 0.032). Conclusion: Clopidogrel was used in nearly one-fifth of patients after CABG. Its use was not associated with lower mortality after 1 year in general, but lower mortality rate in those undergoing off-pump CABG. Randomized clinical trials are needed to determine the benefit of routine use of clopidogrel in CABG.
Assuntos
Humanos , Masculino , Feminino , Complicações Pós-Operatórias/mortalidade , Ticlopidina/análogos & derivados , Inibidores da Agregação Plaquetária/uso terapêutico , Ponte de Artéria Coronária/reabilitação , Revascularização Miocárdica/reabilitação , Alta do Paciente/estatística & dados numéricos , Cuidados Pós-Operatórios/mortalidade , Complicações Pós-Operatórias/tratamento farmacológico , Período Pós-Operatório , Inibidores da Agregação Plaquetária/administração & dosagem , Inibidores da Agregação Plaquetária/normas , Ponte Cardiopulmonar/reabilitação , Aspirina/administração & dosagem , Aspirina/uso terapêutico , North Carolina , Ponte de Artéria Coronária/métodos , Taxa de Sobrevida , Quimioterapia Combinada/mortalidade , Clopidogrel , Revascularização Miocárdica/métodosRESUMO
Introdução: A válvula aórtica transcateter de segunda geração LotusTM foi desenhada para proporcionar ao intervencionista o controle completo de sua liberação durante o procedimento. O presente estudo apresenta a experiência inicial e os desfechos hospitalares de pacientes tratados com essa prótese no Brasil. Métodos: Registro observacional, retrospectivo, que incluiu pacientes com estenose aórtica grave sintomáticos, considerados de alto risco cirúrgico, tratados em sete centros.Resultados: Receberam o dispositivo 31 pacientes, sendo 61,3% do sexo feminino, com idade de 82,9 ± 6,9 anos e escore STS de 6,5 ± 4,1%. A área valvar aórtica foi de 0,73 ± 0,18 cm2 e o gradiente médio de 51,7 ± 13,9 mmHg. Todos os procedimentos foram realizados pela via transfemoral, e a pré-dilatação foi necessária em 65% dos casos. A taxa de sucesso do procedimento foi de 96,7%. Não houve complicação vascular com necessidade de intervenção cirúrgica e nem casos de acidente vascular cerebral. O gradiente médio após o procedimento foi de 10,5 ± 5,8 mmHg e não foram observadas regurgitações aórticas de graus moderado/importante. A taxa de implante de marca-passo definitivo foi de 38,7%, e a permanência hospitalar de 8,5 ± 4,8 dias. Conclusões: Na experiência inicial com o implante da válvula aórtica LotusTM, os resultados hospitalares demostraram a segurança e a eficácia do dispositivo, além de ausência de regurgitação aórtica relevante
Background: The second-generation LotusTM transcatheter aortic valve was designed to provide the interventional cardiologist with complete control of its release during the procedure. This study presents the initial experience and in-hospital outcomes of patients treated with this prosthesis in Brazil. Methods: This observational and retrospective study included patients with symptomatic severe aortic stenosis considered at high surgical risk, treated in seven centers. Results: The device was used in 31 patients, 61.3% female, aged 82.9 ± 6.9 years, and with STS score of 6.5 ± 4.1%. The aortic valve area was 0.73 ± 0.18 cm2 and the mean gradient was 51.7 ± 13.9 mmHg. All procedures were performed by the transfemoral access route, and pre-dilation was necessary in 65% of cases. The success rate of the procedure was 96.7%. There were no vascular complications requiring surgical intervention nor cases of stroke. The mean gradient after the procedure was 10.5 ± 5.8 mmHg; no cases of moderate to severe aortic regurgitation were observed. The rate of permanent pacemaker implantation was 38.7%, and mean in-hospital length of stay was 8.5 ± 4.8 days. Conclusions: In the initial experience with the use of the LotusTM aortic valve, in-hospital results demonstrated the safety and efficacy of the device; no cases of significant aortic regurgitation were observed
Assuntos
Humanos , Masculino , Feminino , Idoso , Valva Aórtica/cirurgia , Próteses e Implantes , Desfibriladores Implantáveis , Estenose da Valva Aórtica/terapia , Bioprótese/tendências , Fatores de Risco , Estudo Observacional , Insuficiência Cardíaca/terapia , Valvas Cardíacas/cirurgia , Ventrículos do Coração/fisiopatologiaRESUMO
Pseudoaneurismas do ventrículo esquerdo são geralmente associados a infarto agudo do miocárdio, entretanto, podem surgir no pós-operatório tardio de cirurgias valvares, assim como os pseudoaneurismas aórticos. Acometem frequentemente pacientes com alto risco cirúrgico, e o tratamento percutâneo éhabitualmente realizado em centros de referência para o tratamento de cardiopatias congênitas devido às características anatômicas dos defeitos. Apresentamos dois casos de pseudoaneurismas do ventrículoesquerdo tratados por via transapical, sem necessidade de circulação extracorpórea, e um caso depseudoaneurisma aórtico tratado por via femoral, no qual foi utilizado laço por acesso contralateral para permitir suporte e direcionamento adequados da bainha longa para acessar o defeito...
Left ventricular pseudoaneurysms are usually associated with acute myocardial infarction; however, these conditions may emerge in the late postoperative period of valvar surgery, and this can also occur with aortic pseudoaneurysms. These pseudoaneurysms often affect patients with high surgical risk,and percutaneous treatment is usually performed in reference centers for treatment of congenital heartdiseases, due to anatomical characteristics of these defects. We present two cases of left ventricularpseudoaneurysms treated by transapical approach without need for cardiopulmonary bypass, and one caseof aortic pseudoaneurysm treated by femoral approach, in which a snare was introduced by contralateral access, to allow for adequate support and guidance of the long sheath for accessing the defect...
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Aorta/cirurgia , Cateterismo Cardíaco , Falso Aneurisma/complicações , Falso Aneurisma/terapia , Ventrículos do Coração/fisiopatologia , Artéria Femoral , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/diagnóstico , Dispositivo para Oclusão Septal , Infarto do Miocárdio/complicações , Procedimentos Cirúrgicos Minimamente InvasivosRESUMO
OBJECTIVE: This study aims to describe the correlation between age and occurrence of atrial fibrillation after aortic stenosis surgery in the elderly as well as evaluate the influence of atrial fibrillation on the incidence of strokes, hospital length of stay, and hospital mortality. METHODS: Cross-sectional retrospective study of > 70 year-old patients who underwent isolated aortic valve replacement. RESULTS: 348 patients were included in the study (mean age 76.8±4.6 years). Overall, post-operative atrial fibrillation was 32.8% (n=114), but it was higher in patients aged 80 years and older (42.9% versus 28.8% in patients aged 70-79 years, P=0.017). There was borderline significance for linear correlation between age and atrial fibrillation (P=0.055). Intensive Care Unit and hospital lengths of stay were significantly increased in atrial fibrillation (P<0.001), but there was no increase in mortality or stroke associated with atrial fibrillation. CONCLUSION: Post-operative atrial fibrillation incidence in aortic valve replacement is high and correlates with age in patients aged 70 years and older and significantly more pronounced in patients aged 80 years. There was increased length of stay at Intensive Care Unit and hospital, but there was no increase in mortality or stroke. These data are important for planning prophylaxis and early treatment for this subgroup.
Assuntos
Estenose da Valva Aórtica/cirurgia , Fibrilação Atrial/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Complicações Pós-Operatórias/etiologia , Doença Aguda , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/mortalidade , Fibrilação Atrial/mortalidade , Estudos Transversais , Feminino , Implante de Prótese de Valva Cardíaca/mortalidade , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Fatores de TempoRESUMO
Objetivo: Descrever, em idosos, a correlação entre faixa etária e ocorrência de fibrilação atrial após cirurgia por estenose aórtica, além de avaliar a influência da ocorrência de fibrilação atrial na incidência de acidente vascular cerebral, tempo de internação e mortalidade hospitalar. Métodos: Estudo transversal retrospectivo incluindo pacientes com idade > 70 anos submetidos à cirurgia de troca valvar aórtica isolada. Resultados: Foram estudados 348 pacientes com idade média de 76,8±4,6 anos. A incidência de fibrilação atrial no pós-operatório foi 32,8% (n=114), sendo superior nos pacientes > 80 anos (42,9 vs. 28,8% 70-79 anos, P=0,017) e havendo significância estatística limítrofe (P=0,055) para tendência linear na correlação idade e incidência de fibrilação atrial. Verificou-se significativo maior tempo de internação na Unidade de Terapia Intensiva e hospitalar total, porém, não se observou maior taxa de acidente vascular cerebral ou de mortalidade hospitalar decorrente da fibrilação atrial. Conclusão: A incidência de fibrilação atrial no pós-operatório de cirurgia para estenose valvar aórtica em pacientes idosos com > 70 anos foi elevada e linearmente correlacionada ao avanço da idade, especialmente após 80 anos, causando aumento dos tempos de internação total e em Unidade de Terapia Intensiva, sem aumento significativo da morbimortalidade. O conhecimento desses dados é importante para evidenciar a necessidade de medidas profiláticas e de tratamento precoce dessa arritmia nesse subgrupo. .
Objective: This study aims to describe the correlation between age and occurrence of atrial fibrillation after aortic stenosis surgery in the elderly as well as evaluate the influence of atrial fibrillation on the incidence of strokes, hospital length of stay, and hospital mortality. Methods: Cross-sectional retrospective study of > 70 year-old patients who underwent isolated aortic valve replacement. Results: 348 patients were included in the study (mean age 76.8±4.6 years). Overall, post-operative atrial fibrillation was 32.8% (n=114), but it was higher in patients aged 80 years and older (42.9% versus 28.8% in patients aged 70-79 years, P=0.017). There was borderline significance for linear correlation between age and atrial fibrillation (P=0.055). Intensive Care Unit and hospital lengths of stay were significantly increased in atrial fibrillation (P<0.001), but there was no increase in mortality or stroke associated with atrial fibrillation. Conclusion: Post-operative atrial fibrillation incidence in aortic valve replacement is high and correlates with age in patients aged 70 years and older and significantly more pronounced in patients aged 80 years. There was increased length of stay at Intensive Care Unit and hospital, but there was no increase in mortality or stroke. These data are important for planning prophylaxis and early treatment for this subgroup. .
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estenose da Valva Aórtica/cirurgia , Fibrilação Atrial/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Complicações Pós-Operatórias/etiologia , Doença Aguda , Distribuição por Idade , Fatores Etários , Estenose da Valva Aórtica/mortalidade , Fibrilação Atrial/mortalidade , Estudos Transversais , Mortalidade Hospitalar , Implante de Prótese de Valva Cardíaca/mortalidade , Unidades de Terapia Intensiva , Tempo de Internação , Complicações Pós-Operatórias/mortalidade , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Fatores de TempoRESUMO
A estimulação epicárdica predomina no implante de marcapasso em crianças pequenas. Objetivo: revisar a evolução de pacientes menores de dois anos submetidos a estimulação epimiocárdica após a alta hospitalar e até uma década. Método: Estudo de coorte histórica entre 1997 e 2010 que incluiu 34 pacientes, 22 (64,7%) do sexo feminino e 12 (35,3%) do masculino, com idades variando de 1 dia a 22 meses, submetidos a implante de marcapasso utilizando cabo-eletrodo epimiocárdico sem sutura e gerador unicameral (VVI). A arritmia pre dominante foi o bloqueio atrioventricular (n=30; 88,2%); 29 (85,3%) tinham cardiopatia estrutural e 22 (67,4%) haviam sido previamente submetidos a cirurgia cardíaca. Acompanhados durante um tempo médio de 60,5 meses, tiveram registrados os eventos adversos e calculada a probabilidade de sobrevida conforme Kaplan-Meyer. Resultados: Ocorreram três óbitos (8,8%) por infecção, cirurgia cardíaca ou mal súbito. A mortalidade foi superior naqueles sem cirurgia cardíaca prévia (16,7% versus 4,5%). Ao longo do acompanhamento, cinco pacientes (14,7%) necessitaram de nova intervenção, dois por infecção e três para reimplante de cabo-eletrodo. Um dos pacientes submetidos a nova intervenção por infecção evoluiu para óbito. A probabilidade de sobrevida foi de 93,8% no primeiro ano e 90,3% até 10º ano. A sobrevida livre de eventos adversos foi de 90,8% no primeiro ano, 79,8% do 5º ao 9º e 66,5% no 10º ano. Conclusão: Os resultados evidenciam sobrevida satisfatória das crianças após o implante epicárdico, especialmente aquelas com cirurgia cardíaca prévia. O implante de cabo-eletrodo epimiocárdico merece cuidados adicionais em pacientes com estatura reduzida, malformações cardíacas específicas, acesso dificultado à veia cava superior ou com procedimento cirúrgico associado...
Objective: Epicardial stimulation remains the technique of choice for pacing in small children. Our objective is to review the results of epicardial pacemaker implantation in patients with less than 2 years of age and after hospital discharge. Methods: Historical cohort study including 34 patients with age ranging from one day to 22 months with hospital discharge after permanent pacemaker implantation with a sutureless epimyocardial electrode and single chamber generator (VVI mode) between 1997 and 2010. Twenty-two patients were female and 12 male. Predominant arrhythmia was atrioventricular block (30 patients; 88.2%). Twenty-nine patients (85.3%) had structural heart disease and 22 (67.4%) had been submitted to a previous heart surgery. Patients were followed-up for a mean time of 60.5 months. Recorded events were analyzed and probability of survival was estimated according to Kaplan-Meyer analysis. Results: There were 3 (8.8%) deaths, due to infection, heart surgery or sudden death. Increased mortality was observed for patients without previous heart surgery (16.7% versus 4.5%). Five patients (14.7%) required pacemaker reintervention during the follow-up, 2 due to infection and 3 to re-implant the electrode. One of the patients who had a reintervention due to infection died. Probability of survival was 93.8% in the first year and 90.3% subsequently up to the 10 years of follow-up. Event-free survival was 90.8% in the first year, 79.8% from year 5 to 9, 66.5% after 10 years. Conclusion: This study demonstrates the probability of satisfactory survival after epicardial pacemaker implantation, especially in patients with previous heart surgery. Epimyocardial electrode implantation deserves consideration in patients with small physical structure, those with specific cardiac malformations, and difficult access to superior vena cava or those who need to have an associated surgical procedure...