Impact of prosthesis-patient mismatch on early and late mortality after aortic valve replacement

<p>Background: The influence of prosthesis-patient mismatch (PPM) on survival after aortic valve replacement (AVR) remains controversial. In this study, we sought to determine the effect of PPM on early (30 days) after AVR or AVR combined with coronary artery bypass grafting (AVR with CABG).</p><p>Methods: Between January 1998 and March 2012, 2976 patients underwent AVR (n= 1718) or AVR with CABG (n=1258) at a single institution. PPM was defined as an indexed effective orifice area (EOAI)</p><p>Results: Early mortality was 6.7% in the PPM group vs 4.7% in the group with no PPM (p=0.013). Late mortality for the PPM group at 1, 5 and 10 years was 4%, 16% and 43%, respectively. Late mortality for the group with no PPM at 1, 5 and 10 years was 4%, 15% and 33% respectively. Independent predictors of early mortality included age, severely impaired left ventricular (LV) function, endocarditis, renal dysfunction, chronic obstructive pulmonary disease (COPD) and cardiopulmonary bypass (CPB) time. Multivariate independent predictors of late mortality included age, severely impaired LV function, diabetes, peripheral vascular disease (PVD), renal dysfunction, history of a cerebrovascular accident (CVA), CPB time and a history of previous cardiac surgery. PPM was not an independent predictor of early or late mortality.</p><p>Conclusion: PPM is not an independent predictor of both early and late mortality after AVR or AVR combined with CABG.</p>

Latin American consensus on guidelines for chronic migraine treatment

Chronic migraine is a condition with significant prevalence all around the world and high socioeconomic impact, and its handling has been challenging neurologists. Developments for understanding its mechanisms and associated conditions, as well as that of new therapies, have been quick and important, a fact which has motivated the Latin American and Brazilian Headache Societies to prepare the present consensus. The treatment of chronic migraine should always be preceded by a careful diagnosis review; the detection of possible worsening factors and associated conditions; the stratification of seriousness/impossibility to treat; and monitoring establishment, with a pain diary. The present consensus deals with pharmacological and nonpharmacological forms of treatment to be used in chronic migraine

Consenso latino-americano para as diretrizes de tratamento da migranea cronica

Chronic migraine is a condition with significant prevalence all around the world and high socioeconomic impact, and its handling has been challenging neurologists. Developments for understanding its mechanisms and associated conditions, as well as that of new therapies, have been quick and important, a fact which has motivated the Latin American and Brazilian Headache Societies to prepare the present consensus. The treatment of chronic migraine should always be preceded by a careful diagnosis review; the detection of possible worsening factors and associated conditions; the stratification of seriousness/impossibility to treat; and monitoring establishment, with a pain diary. The present consensus deals with pharmacological and nonpharmacological forms of treatment to be used in chronic migraine.A migrânea crônica é uma condição com prevalência significativa ao redor do mundo e alto impacto socioeconômico, sendo que seu manuseio tem desafiado os neurologistas. Os avanços na compreensão de seus mecanismos e das condições a ela associadas, bem como nas novas terapêuticas, têm sido rápidos e importantes, fato que motivou as Sociedades Latino-americana e Brasileira de Cefaleia a elaborarem o presente consenso. O tratamento da migrânea crônica deve ser sempre precedido por uma revisão cuidadosa do diagnóstico, pela detecção de possíveis fatores de piora e das condições associadas, pela estratificação de gravidade/impossibilidade de se tratar e pelo monitoramento com um diário da dor. Este consenso apresenta abordagens farmacológicas e não-farmacológicas para tratar a migrânea crônica.Universidad de Santiago de Chile and Sociedad de Neurologia Psiquiatria y NeurocirugiaUniversidad de Costa Rica Hospital San Juan de DiosUniversidade Federal de Minas Gerais Hospital das ClinicasUniversidade Jose do Rosario VellanoUniversidade de São Paulo Faculdade de Medicina Barao de Maua Faculdade de Medicina de Ribeirao PretoUniversidad Nacional de CordobaBrazilian and International Headache Societies Academia Brasileira de NeurologiaCentro Universitario de Volta Redonda Universidade Federal Fluminense (UFF)Universidad de la Republica Hospital Maciel Facultad de MedicinaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Sector of Investigation and Treatment of Headaches at Clinical Neurology in the Neurology DisciplineUniversidade Federal do Rio Grande do NorteUniversidade Federal do ParanaUFF Associacao Latino-Americana de CefaleiaUniversidade Estadual de Campinas Faculdade de Medicina de CatanduvaUSP Faculdade de Medicina de Ribeirao PretoUniversidade Federal de Ciencias da Saude de Porto Alegre Academia Brasileira de NeurologiaUniversidade de La SabanaUSP Faculdade de MedicinaHospital Perez CarrenoUFFUniversidad Mayor de San AndresUniversidad Central de Venezuela Hospital Vargas de CaracasUniversidade de Santo Amaro Escola Paulista de Medicina da UNIFESPUniversidad de GuadalajaraUNIFESP Universidade Federal de Santa CatarinaUSP Faculdade de Medicina de Ribeirao Preto Centro Educacional Barao de MauaUniversidade Federal de PernambucoUniversidad Mayor de San Andres Hospital das ClinicasAcademia Mexicana de Neurologia Hospital Especialidades Centro Medico La RazaSociedad NeurologicaHospital Israelita Albert Einstein UNIFESPUniversidad de ConcepcionUniversidade Federal do Rio de Janeiro Hospital Universitario Clementino Fraga Filho Faculdade de MedicinaUniversity of TrondheimASS Colombiana de Neurologia AHSUniversidad de Buenos AiresUniversidad Central de Venezuela Hospital VargasUniversidad Diego PortalesUniversidad de SantiagoInstituto de NeurologiaUFF Medicine SchoolUNIFESP, EPM, Sector of Investigation and Treatment of Headaches at Clinical Neurology in the Neurology DisciplineUniversidade de Santo Amaro Escola Paulista de Medicina da UNIFESP, Universidade Federal de Santa CatarinaHospital Israelita Albert Einstein UNIFESPSciEL

Consenso latino-americano para as diretrizes de tratamento da migranea cronica

Chronic migraine is a condition with significant prevalence all around the world and high socioeconomic impact, and its handling has been challenging neurologists. Developments for understanding its mechanisms and associated conditions, as well as that of new therapies, have been quick and important, a fact which has motivated the Latin American and Brazilian Headache Societies to prepare the present consensus. The treatment of chronic migraine should always be preceded by a careful diagnosis review; the detection of possible worsening factors and associated conditions; the stratification of seriousness/impossibility to treat; and monitoring establishment, with a pain diary. The present consensus deals with pharmacological and nonpharmacological forms of treatment to be used in chronic migraine.A migrânea crônica é uma condição com prevalência significativa ao redor do mundo e alto impacto socioeconômico, sendo que seu manuseio tem desafiado os neurologistas. Os avanços na compreensão de seus mecanismos e das condições a ela associadas, bem como nas novas terapêuticas, têm sido rápidos e importantes, fato que motivou as Sociedades Latino-americana e Brasileira de Cefaleia a elaborarem o presente consenso. O tratamento da migrânea crônica deve ser sempre precedido por uma revisão cuidadosa do diagnóstico, pela detecção de possíveis fatores de piora e das condições associadas, pela estratificação de gravidade/impossibilidade de se tratar e pelo monitoramento com um diário da dor. Este consenso apresenta abordagens farmacológicas e não-farmacológicas para tratar a migrânea crônica.47848