Asian cardiovascular & thoracic annals
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Asian Cardiovasc Thorac Ann · Jun 2014
Randomized Controlled TrialPreoperative levosimendan in ischemic mitral valve repair.
Levosimendan is a new calcium sensitizing drug with vasodilatory and inotropic properties, which is used for the treatment of postoperative low cardiac output syndrome and difficult weaning from cardiopulmonary bypass. ⋯ Preoperative treatment with levosimendan in patients undergoing coronary artery bypass grafting and mitral valve repair resulted in improved hemodynamics and a stable postoperative course.
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Asian Cardiovasc Thorac Ann · Jun 2014
Perioperative predictors of midterm survival after aortic valve replacement.
Elderly patients with aortic stenosis are under-referred for aortic valve replacement surgery. This study investigated the perioperative factors associated with midterm outcomes in a consecutive series of patients undergoing aortic valve replacement with or without coronary artery bypass graft surgery. ⋯ 5-year survival among octogenarians was 59.2% with an observed 30-day mortality of 1% for aortic valve replacement and 3% for aortic valve replacement with coronary artery bypass. Kaplan-Meier survival analysis showed that age ≥80 years, New York Heart Association functional class III/IV, and left ventricular ejection fraction <35% were significantly associated with increased midterm mortality. Cox regression modeling demonstrated that age ≥80 years was the only significant independent factor associated with midterm mortality; older patients had a 3-fold increase in mortality (adjusted hazard ratio = 3.231, 95% confidence interval: 1.764-5.920, p < 0.0001). While hospital and 30-day mortality were not statistically different between age groups, age ≥80 years was the most powerful predictor of midterm death. These results support early aortic valve replacement with or without coronary artery bypass in aortic stenosis management.
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Gastrointestinal bleeding due to colonic angiodysplasia can be associated with calcified aortic stenosis. This association is referred to as Heyde's syndrome. ⋯ We describe the case of a 46-year-old woman with congestive heart failure related to aortic stenosis, and severe anemia, with multiple angiodysplasias on the ileum and colon. After aortic valve replacement, there were no further episodes of bleeding and her hemoglobin levels normalized.