cirurgia híbrida ecuador
DESCRIPTION
ÂTRANSCRIPT
![Page 1: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/1.jpg)
Dr. Paulo Roberto Lunardi Prates Cirurgião Cardiovascular Instituto de Cardiologia – FUC
![Page 2: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/2.jpg)
Nada a declarar em relação a conflito de interesses
![Page 3: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/3.jpg)
¡ Tratamento seguro
¡ Menor risco cirúrgico
¡ Associado a menos comorbidades
¡ Menor mortalidade
¡ Anatomia favorável
Abordagem Endovascular
![Page 4: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/4.jpg)
Risco Fisiológico
Complexidade Anatômica Abordagem preferencial
Baixo Baixo Reparo endovascular ou aberto
Baixo Alto Reparo aberto Alto Baixo Reparo endovascular Alto Alto Abordagem alternativa
(Cirurgia Híbrida) Adapted from Greenberg and colleagues – J Vasc Surg 2003
![Page 5: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/5.jpg)
Alguns pacientes que poderiam de beneficiar do tratamento endovascular possuem anatomia desfavorável.
Landing zones – muito curtas
– muito anguladas – com muitos trombos
![Page 6: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/6.jpg)
Cirurgia Híbrida
Objetivos Diminuir tempo de internação Diminuir morbidade Diminuir mortalidade Recuperação mais rápida Retorno a vida normal Tempo cirúrgico complexidade
![Page 7: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/7.jpg)
Cirurgia Híbrida
• Procedimento realizados na sala de hemodinâmica • Conversão cirúrgica na sala de hemodinâmica • Procedimentos de assepsia • Bloco cirúrgico em “stand by” • Procedimento em tempos diferentes
![Page 8: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/8.jpg)
![Page 9: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/9.jpg)
¡ Realizar procedimentos complexos no ambiente cirúrgico
¡ Maior segurança ¡ Disponibilidade imediata de CEC, instrumental, equipe de enfermagem
![Page 10: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/10.jpg)
¡ Pacientes que se beneficiariam do reparo endovascular mas possuem uma anatomia desfavorável
¡ Impossibilidade de acesso percutâneo ¡ Derivação extra-‐anatômica de ramos arteriais importantes
¡ Realização do reparo cirúrgico com associação de técnicas endovasculares
![Page 11: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/11.jpg)
Fulton ·∙ J Vasc Surg 2005
![Page 12: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/12.jpg)
J Thorac Cardiovasc Surg 2012;143:1007-‐13
![Page 13: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/13.jpg)
¡ Cirurgia com complexidade elevada
¡ Potencial benefício muito grande quando comparado com o tratamento convencional
![Page 14: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/14.jpg)
Melhores resultados
Diminuição da Morbimortalidade
![Page 15: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/15.jpg)
sobrevida
Retorno as atividades
Reabilitação rápida
![Page 16: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/16.jpg)
![Page 17: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/17.jpg)
![Page 18: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/18.jpg)
![Page 19: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/19.jpg)
![Page 20: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/20.jpg)
![Page 21: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/21.jpg)
![Page 22: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/22.jpg)
Planning Surgical aortic arch debranching
1 – Comformable Gore TAG 45x200 mm
![Page 23: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/23.jpg)
aortic arch debranching
![Page 24: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/24.jpg)
![Page 25: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/25.jpg)
![Page 26: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/26.jpg)
![Page 27: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/27.jpg)
![Page 28: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/28.jpg)
¡ Tem mostrado bons resultados no tto da dissecções agudas e crônicas.
¡ Aumento do calibre da luz verdadeira
¡ Diminuição do diâmetro a falsa luz
![Page 29: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/29.jpg)
Seguimento do luz verdadeira Seguimento
da luz falsa
![Page 30: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/30.jpg)
¡ Correção híbrida da aorta ascendente e descendente nas dissecções tipo A
¡ Agudas e crônicas
![Page 31: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/31.jpg)
![Page 32: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/32.jpg)
![Page 33: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/33.jpg)
¡ Pseudoaneurisma de aorta ¡ 3 cirurgias prévias ¡ Reimplante de coronárias (Cabrol) ¡ Tubo valvado com prótese metálica ¡ Localização do pseudoaneurisma na VSVE
![Page 34: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/34.jpg)
![Page 35: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/35.jpg)
![Page 36: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/36.jpg)
![Page 37: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/37.jpg)
¡ Existem limitações nas correções endovasculares e híbridas
¡ A maioria das patologias da aorta serão tratadas com procedimentos híbridos
¡ Não existe substituto para o aprendizado que vem da experiência
Endovascular and Hybrid Management of the Thoracic Aorta A Case-‐based Approach
![Page 38: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/38.jpg)
¡ Equipes multidisciplinares ¡ Treinamento do cirurgião
§ cateteres e guias § uso do fluoroscopia § uso de simuladores
![Page 39: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/39.jpg)
¡ Avanços na tecnologia ¡ Avanços nos resultados ¡ Definir as limitações ¡ Expandir o uso para necessidades complexas § Segmentos com ramos § Dissecção aguda § Trauma aórtico fechado § Aneurismas rotos
![Page 40: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/40.jpg)
¡ Equipes multidisciplinares ¡ Treinamento ¡ Segurança ¡ Diminuição da morbimortalidade ¡ Retorno rápido do paciente as suas atividades
![Page 41: Cirurgia híbrida ecuador](https://reader031.vdocuments.pub/reader031/viewer/2022013119/5790705e1a28ab68749d2944/html5/thumbnails/41.jpg)
FUNDAÇÃO UNIVERSITÁRIA DE CARDIOLOGIA