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- Surgical aortic valve replacement in octogenarians: single-center perioperative outcomes and five-year survivalPublication . Velho, Tiago R.; Goncalves, Joao; Pereira, Rafael Maniés; Ferreira, Ricardo; Sena, André; Junqueira, Nádia Viviana; Ângelo, Eurídice; Carvalho Guerra, Nuno; Mendes, Mário; Arruda Pereira, Ricardo; Nobre, AngeloIntroduction and objectives: Aortic stenosis is the most common valvular heart disease. The number of octogenarians proposed for intervention is growing due to increased lifespan. In this manuscript we aim to evaluate perioperative outcome and long-term survival after surgical aortic valve replacement (SAVR) in octogenarians, comparing patients with low surgical risk (EuroscoreII <4%) with intermediate-high risk (EuroscoreII ≥4%). Methods: A retrospective observational single-center cohort study with 195 patients aged ≥80 years old, who underwent SAVR between 2017 and 2021, was conducted. Patients were divided into two groups according to EuroscoreII: (1) Low risk (EuroscoreII <4%) with intermediate-high risk (EuroscoreII ≥4%). Continuous variables are presented in median (IQR), analyzed using Wilcoxon rank sum test; categorical variables in percentages, analyzed using chi-squared test; and survival was analyzed by Kaplan-Meier, open cohort, and the log-rank test was performed. Results: The overall median age was 82 (IQR 81-83), with 4.6% of the patients ≥85 years old. 23.6% of the patients presented EuroscoreII ≥4%. No complications were observed in 26.2%, with a significantly higher rate in intermediate-high risk patients. Postoperative need for hemodynamic support was the most frequent complication, followed by postoperative acute kidney injury and the use of blood products. Overall median ICU stay was three days (2-4) and hospital length of stay (LOS) six days (5-8). Patients with intermediate-high risk and those with complications had longer ICU LOS. At 12 months, overall survival was 96.4%, at three years 94.1% and 5 years 75.4%. Patients with low surgical risk had higher survival proportions up to 5 years. Conclusion: SAVR in patients ≥80 years is associated with low in-hospital mortality, although a significant proportion of patients develop complications. Long-term follow-up up to five years after surgery is acceptable in octogenarians with low surgical risk.
- Predicting the burden for surgical aortic valve replacement in a tertiary centre: the impact of aged populations for the next decadesPublication . Pereira, Rafael Maniés; Carvalho Guerra, Nuno; Moreira Gonçalves, João; Ferreira, Ricardo; Nobre, Angelo; Brito, Dulce; Rodrigues, Teresa Ferreira; Velho, Tiago R.Background/Objectives: The incidence of aortic stenosis (AS) is predicted to rise with the aging population, emerging as a growing public health challenge in developed countries, leading to an increased demand for intervention. Our aim is to predict the evolution of proposed cases for SAVR in the geographic referral area of our tertiary hospital until 2041. Methods: We used data from the Portuguese Census for 2001, 2011, and 2021 to analyze the resident population within the Cardiothoracic Surgery Department's referral area. Applying population projection methods (rate of geometric growth), we projected demographic trends over 20 years, from 2021 to 2041. Our analysis focused on AS cases who underwent SAVR in our department between 2001-2011 and 2011-2021. Results: Between 2001 and 2021, there was an increase in the overall population, particularly among the elderly (1.4% growth rate in the population ≥ 65 years old). The aging index increased from 128.4 (110.5-180.6) in 2001 to 189.1 (155.9-222.5) in 2021 (p-value < 0.001). Similarly, the longevity index significantly increased between 2001 [42.6 (40.8-44.80)] and 2021 [49.30 (47.7-51.8)] (p-value < 0.001). The number of SAVRs performed increased, with a mean increase of 8.11 surgeries/year (R2 = 0.6457, p < 0.001). By 2041, our referral center will increase SAVR by at least 51 surgeries/year in a decreasing growth rate scenario, and 67 surgeries/year in a growth rate stagnation scenario. Conclusions: The ongoing trend of population aging will increase the demand for healthcare resources, particularly within the cardiovascular domain. Accurately assessing the volume of SAVR is imperative for reformulating strategies to address the increasing demand effectively.
- Role of omega-6 fatty acid metabolism in cardiac surgery postoperative bleeding riskPublication . Velho, Tiago R.; Ferreira, Ricardo; Willmann, Katharina; Pedroso, Dora; Paixão, Tiago; Pereira, Rafael Maniés; Junqueira, Nádia; Carvalho Guerra, Nuno; Brito, Dulce; Almeida, Ana G.; Nobre, Angelo; Köcher, Thomas; Pinto, Fausto J.; Moita, Luís FerreiraCardiac surgery is frequently associated with significant postoperative bleeding. Platelet-dysfunction is the main cardiopulmonary bypass (CPB)-induced hemostatic defect. Not only the number of platelets decreases, but also the remaining are functionally impaired. Although lipid metabolism is crucial for platelet function, little is known regarding platelet metabolic changes associated with CPB-dysfunction. Our aim is to explore possible contribution of metabolic perturbations for platelet dysfunction after cardiac surgery. Design: Prospective cohort study. Setting: Tertiary academic cardiothoracic-surgery ICU. Patients: Thirty-three patients submitted to elective surgical aortic valve replacement. Interventions: Samples from patients were collected at three time points (preoperative, 6- and 24-hr postoperative). Untargeted metabolic analysis using high-performance liquid chromatography-tandem mass spectrometry was performed to compare patients with significant postoperative bleeding with patients without hemorrhage. Principal component analyses, Wilcoxon matched-pairs signed-rank tests, adjusted to FDR, and pairwise comparison were used to identify pathways of interest. Enrichment and pathway metabolomic complemented the analyses. Measurements and main results: We identified a platelet-related signature based on an overrepresentation of changes in known fatty acid metabolism pathways involved in platelet function. We observed that arachidonic acid (AA) levels and other metabolites from the pathway were reduced at 6 and 24 hours, independently from antiagreggation therapy and platelet count. Concentrations of preoperative AA were inversely correlated with postoperative chest tube blood loss but were not correlated with platelet count in the preoperative, at 6 or at 24 hours. Patients with significant postoperative blood-loss had considerably lower values of AA and higher transfusion rates. Values of postoperative interleukin-6 were strongly correlated with AA variability. Conclusions and relevance: Our observations suggest that an inflammatory-related perturbation of AA metabolism is a signature of cardiac surgery with CPB and that preoperative levels of AA may be more relevant than platelet count to anticipate and prevent postoperative blood loss in patients submitted to cardiac surgery with CPB.
- Metadherin expression and lung relapse in patients with colorectal carcinomaPublication . Casimiro, Sandra; Fernandes, Afonso; Oliveira, Antonio; Franco, Marco; Pires, Ricardo; Peres, Mafalda; Matias, Margarida; Tato-Costa, Joana; Carvalho Guerra, Nuno; Ramos, Madalena; Cruz, Jorge; Costa, LuisColorectal cancer (CRC) is the third most common malignant disease in men and the second in women worldwide. CRC relapse occurs mostly in liver and lungs, decreasing the 5-year survival to 6 %. Metadherin (MTDH) is overexpressed in several types of cancer, has been implicated in proliferation, invasion, metastasis, angiogenesis, and chemoresistance, and is a factor of poor prognosis in CRC. In this work we addressed the prognostic significance of MTDH expression in CRC progression to the lungs. We found that MTDH gene was more frequently amplified (copy number >1.8) in patients with CRC and relapse to the lung, when compared to patients without lung metastases (17.4 vs 100 %; p < 0.001). We observed a correlation between MTDH gene copy number and MTDH expression by IHC (p = 0.0001). Next we also analyzed MTDH expression by IHC in samples from 85 patients diagnosed with CRC, stage II or III, M0, with at least 3 years of follow-up. Kaplan-Meier survival analysis showed that lung relapse-free survival (HR 5.29, 95 % CI 1.90-14.77, p = 0.0004), liver relapse-free survival (HR 8.59, 95 % CI 0.99-74.18, p = 0.003), relapse-free survival (HR 4.85, 95 % CI 1.88-12.45, p = 0.0003) and overall survival (HR 3.75, 95 % CI 1.15-12.18, p = 0.018) were significantly lower in the group with high MTDH expression. Multivariate analysis showed that high MTDH expression was an independent factor for all outcomes. This study demonstrates that high MTDH expression is a biomarker of relapse in CRC, including lung-specific relapse. Determination of MTDH expression in primary CRC may be useful in the earlier detection of lung metastases in patients with high expression and increased risk.