Es el reimplante valvular mejor que el bentall biológico modificado para tratar aneurismas de la raíz asociados a insuficiencia?

Es el reimplante valvular mejor que el Bentall Biológico Modificado para tratar aneurismas de la raíz asociados a insuficiencia? Obando CE; Gutiérrez HF; Santamaría G, Bresciani R; Camacho J; Sandoval N; Umaña J. Departamento de Cirugía Cardiovascular, Fundación Cardio Infantil, Bogotá, Colombia. Objetivo: comparar resultados funcionales, morbilidad y sobrevida a corto y mediano plazo, tras la realización de Bentall modificado con prótesis Freestyle vs reimplante valvular de Tirone David, en insuficiencia aortica secundaria a aneurisma de la raíz. Diseño: revisión de registros institucionales de 88 pacientes tratados entre enero de 2003 y agosto de 2009 con insuficiencia aortica secundaria a aneurisma de la raíz sin daño valvular, distribuidos en dos cohortes: Grupo 1 (Bentall modificado) y Grupo 2 (reimplante valvular). Se evaluaron complicaciones perioperatorias, transfusiones, estancias hospitalarias y en el seguimiento a mediano plazo insuficiencia valvular, clase funcional, función ventricular y sobrevida. Solidez de los resultados verificada mediante análisis de propensidad con balanceo de grupos. Resultados: Grupo (1) 51(57.9%) pacientes y grupo (2) 37(42.1%). Aunque el grupo 2 es mas joven, patrones similares de coomorbilidad, anatomía de la raíz, función y diámetros ventriculares hacen comparables los dos grupos. Seguimiento de 3.3 años (IQR 2.0-4.4). Mortalidad temprana 2(3.8%) vs 0 p =0.2 y tardía de 2(4.1%) vs 0 p=0.33. El análisis estratificado de covariables en bloques de distribución tampoco identifica diferencias en mortalidad. El análisis de sobrevida de mortalidad y sobrevida libre de eventos identifica desenlaces similares entre los grupos (Log-Rank chi2=0.9, p=0.3); incluyendo Insuficiencia aortica = II temprana (3.8% vs 0, p=0.2) y tardía (3.8%vs 0, p=0.1), transfusiones perioperatorias, reintervenciones por sangrado (2.3% vs 3.4%, p=0.4), arritmias (25.5% vs 13.5%, p=0.2) y disfunción neurológica (5.7% vs 2.9%, p=0.9). Finalmente la hospitalización total (6.5 {1-35} vs 4{3-16} p=0.001) y estancia en Cuidado intensivo (2.5 {1-21} vs 1{1-16} p=0.001) es superior en el grupo1. Conclusiones: el tratamiento de los aneurismas de la raíz aortica asociados a insuficiencia valvular sin daño estructural, mediante reimplante valvular o Bentall biológico modificado ofrece resultados similares a corto y mediano plazo. La preservación valvular se asocia a estancias mas cortas, pero no hay diferencia en complicaciones postoperatorias, estatus funcional, insuficiencia valvular, función ventricular, mortalidad y sobrevida libre de eventos adversos.Compare functional results, Morbility and median and short term survival, after modified Bentall procedure with Freestyle valve vs. Valvular Reimplantation Tirone David, for the aortic valve insufficiency secondary to aortic root aneurysm. DESIGN: Revision of institutional registers of 88 patients treated from January 2003 to august 2009 with aortic insufficiency secondary to aortic root aneurysm without valve damage, distributed in two cohorts: Group 1 (Modified Bentall), Group 2 (Valvular Reimplantation). Perioperative complications were evaluated as well as transfusions, hospitalization days, median term observation for valve insufficiency, functional class, ventricular function and survival. The solidity of the results were verified by propensity analysis with balance of groups. RESULTS: Group (1) 51(57.9%) patients and group (2) 37(42.1%). Although group 2 is younger, similar patterns of comorbility, aortic root anatomy, function and ventricular diameters of both groups make them comparable. Follow up for 3.3 years (IQR 2.0-4.4). Early Mortality 2(3.8%) vs. 0 p =0.2 and late 2(4.1%) vs. 0 p=0.33. The analysis of stratified co variables in blocks of distribution does not identify differences in mortality. The analysis of survival of mortality and survival free of events identifies similar results between the groups (Log-Rank chi2=0.9, p=0.3); including aortic insufficiency = II early (3.8% vs. 0, p=0.2) and late (3.8%vs 0, p=0.1), perioperative transfusions, reinterventions by bleeding (2.3% vs. 3.4%, p=0.4), arrhythmias (25.5% vs. 13.5%, p=0.2), and neurologic dysfunction(5.7% vs. 2.9%, p=0.9). Finally total hospitalization (6.5 {1-35} vs. 4{3-16} p=0.001) and Intensive care staying (2.5 {1-21} vs. 1{1-16} p=0.001) is superior in group 1. CONCLUSIONS: The treatment of aortic root aneurysm associated to aortic valve insufficiency without structural damage, with valve reimplantation or Modified Bentall (Biological) offers similar results. Valve preservation is associated to shorter hospitalization stay, but there is no difference in post operative complications, functional status, valve insufficiency, ventricular function, mortality, and survival free of adverse events

Factores de riesgo para sangrado postoperatorio que requiere reintervención en cirugía de revascularización miocárdica

Objetivo: Determinar cuáles factores del paciente, el tratamiento farmacológico y el procedimiento quirúrgico que se asocian a la aparición de sangrado postoperatorio que requiere reintervención en cirugía de revascularización miocárdica. Diseño: Estudio de casos y controles no pareado, anidado en una cohorte de pacientes sometidos a cirugía de revascularización miocárdica con circulación extracorpórea. Los casos fueron pacientes que presentaron sangrado posoperatorio que requirió reintervención y los controles pacientes sin ningún tipo de intervención quirúrgica adicional hasta el egreso entre enero de 2007 y junio de 2013.Objective: To determine which preoperative factors and the procedure are associated with the occurrence of postoperative bleeding requiring reoperation CABG. Design: Case controls study, nested in a cohort of patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. The cases were patients who had postoperative bleeding requiring reoperation and controls patients without any additional surgery until discharge, from January 2007 to June 2013

Percepciones de los estudiantes de pregrado de Medicina sobre la formación en Medicina Interna durante la pandemia Covid-19 en La Universidad Militar Nueva Granada

Estudio para evaluar las percepciones de los estudiantes de pregrado de medicina durante la pandemia covid 1

El uso de sangre fresca total en cardiopatías congénitas complejas

Objetivos: Describir si el uso de sangre fresca total (SFT) intraoperatoria en pacientes llevados a procedimientos RACHS 3 y 4 en la Fundación Cardioinfantil, disminuye el sangrado postoperatorio y el volumen de transfusión de elementos sanguíneos, en comparación a aquellos en quienes no se usa SFT. Materiales y métodos: Se realizó un estudio de cohorte histórica, tomando una población menor de 1 año expuesta a la sangre fresca total y comparándola con una población de similares características, llevadas a procedimientos de riesgo similar no expuesta. Los análisis se realizaron mediante pruebas estándar para variables continuas y discretas. Un valor de p menor a 0.05 fue aceptado como signficativo. Resultados: 46 pacientes expuestos a SFT y se compararon con 50 pacientes no expuestos. La principal diferencia entre los grupos fue la edad, siendo mayor en el grupo de no expuestos (3.8 años vs 0.9; p<0.001). El volumen de sangrado postoperatorio fue similar, sin embargo los pacientes expuestos a SFT recibieron mayor volumen de transfusiones, sin ser una diferencia estadísticamente significativa (155cc vs 203cc, P=0.9). No hubo diferencia significativa en complicaciones o mortalidad. Conclusiones: En nuestro estudio no se encontró una disminución en el volumen de sangrado postoperatorio en los pacientes menores de 1 año, sometidos a cirugías catalogadas como RACHS 3 y 4, expuestos a SFT, sin embargo se necesitan estudios clínicos controlados que respondan definitivamente a la pregunta.Introduction: The use of Fresh Whole Blood (FWB) has become a useful tool to lower postoperative bleeding in patients with complex congenital heart diseases, categorized as RACHS 3 and 4 procedures. The aim of this study is to evaluate the effectiveness of this procedure, in patients operated between 2007 and 2011 at Fundación Cardioinfantil. Materials and methods: We made a cohort study, taking a group of patients who receives FWB, and comparing it with another group of patients with similar characteristics and similar surgical procedures. Results: 46 patients who received FWB where compared to 50 controls that didn´t receive FWB. The main population difference was age. The non FWB group were older than the FWB group (3.8 años vs 0.9; p<0.001). The postoperative bleeding volume was similar between the two groups, but the FWB group received more transfusion volume, although it had no statistically significance (155cc vs 203cc, P=0.9). There was no difference in morbidity or mortality Conclusions: In our study we could not demonstrate a decrease in postoperative bleeding volume in patients less than one year, with RACHS 3 or 4 surgeries, who received FWB. More studies are needed to answer this questio

More on the Kronecker Structured Covariance Matrix

In this paper the multivariate normal distribution with a Kronecker product structured covariance matrix is studied. Particularly, estimation of a Kronecker structured covariance matrix of order three, the so called double separable covariance matrix. The estimation procedure, suggested in this paper, is a generalization of the procedure derived by Srivastava et al. (2008), for a separable covariance matrix. Furthermore, the restrictions imposed by separability and double separability are discussed

Es el reimplante valvular mejor que el bentall biológico modificado para tratar aneurismas de la raíz asociados a insuficiencia?

Es el reimplante valvular mejor que el Bentall Biológico Modificado para tratar aneurismas de la raíz asociados a insuficiencia? Obando CE; Gutiérrez HF; Santamaría G, Bresciani R; Camacho J; Sandoval N; Umaña J. Departamento de Cirugía Cardiovascular, Fundación Cardio Infantil, Bogotá, Colombia. Objetivo: comparar resultados funcionales, morbilidad y sobrevida a corto y mediano plazo, tras la realización de Bentall modificado con prótesis Freestyle vs reimplante valvular de Tirone David, en insuficiencia aortica secundaria a aneurisma de la raíz. Diseño: revisión de registros institucionales de 88 pacientes tratados entre enero de 2003 y agosto de 2009 con insuficiencia aortica secundaria a aneurisma de la raíz sin daño valvular, distribuidos en dos cohortes: Grupo 1 (Bentall modificado) y Grupo 2 (reimplante valvular). Se evaluaron complicaciones perioperatorias, transfusiones, estancias hospitalarias y en el seguimiento a mediano plazo insuficiencia valvular, clase funcional, función ventricular y sobrevida. Solidez de los resultados verificada mediante análisis de propensidad con balanceo de grupos. Resultados: Grupo (1) 51(57.9%) pacientes y grupo (2) 37(42.1%). Aunque el grupo 2 es mas joven, patrones similares de coomorbilidad, anatomía de la raíz, función y diámetros ventriculares hacen comparables los dos grupos. Seguimiento de 3.3 años (IQR 2.0-4.4). Mortalidad temprana 2(3.8%) vs 0 p =0.2 y tardía de 2(4.1%) vs 0 p=0.33. El análisis estratificado de covariables en bloques de distribución tampoco identifica diferencias en mortalidad. El análisis de sobrevida de mortalidad y sobrevida libre de eventos identifica desenlaces similares entre los grupos (Log-Rank chi2=0.9, p=0.3); incluyendo Insuficiencia aortica = II temprana (3.8% vs 0, p=0.2) y tardía (3.8%vs 0, p=0.1), transfusiones perioperatorias, reintervenciones por sangrado (2.3% vs 3.4%, p=0.4), arritmias (25.5% vs 13.5%, p=0.2) y disfunción neurológica (5.7% vs 2.9%, p=0.9). Finalmente la hospitalización total (6.5 {1-35} vs 4{3-16} p=0.001) y estancia en Cuidado intensivo (2.5 {1-21} vs 1{1-16} p=0.001) es superior en el grupo1. Conclusiones: el tratamiento de los aneurismas de la raíz aortica asociados a insuficiencia valvular sin daño estructural, mediante reimplante valvular o Bentall biológico modificado ofrece resultados similares a corto y mediano plazo. La preservación valvular se asocia a estancias mas cortas, pero no hay diferencia en complicaciones postoperatorias, estatus funcional, insuficiencia valvular, función ventricular, mortalidad y sobrevida libre de eventos adversos.Compare functional results, Morbility and median and short term survival, after modified Bentall procedure with Freestyle valve vs. Valvular Reimplantation Tirone David, for the aortic valve insufficiency secondary to aortic root aneurysm.\ud DESIGN: Revision of institutional registers of 88 patients treated from January 2003 to august 2009 with aortic insufficiency secondary to aortic root aneurysm without valve damage, distributed in two cohorts: Group 1 (Modified Bentall), Group 2 (Valvular Reimplantation). Perioperative complications were evaluated as well as transfusions, hospitalization days, median term observation for valve insufficiency, functional class, ventricular function and survival. The solidity of the results were verified by propensity analysis with balance of groups.\ud RESULTS: Group (1) 51(57.9%) patients and group (2) 37(42.1%). Although group 2 is younger, similar patterns of comorbility, aortic root anatomy, function and ventricular diameters of both groups make them comparable. Follow up for 3.3 years (IQR 2.0-4.4).\ud Early Mortality 2(3.8%) vs. 0 p =0.2 and late 2(4.1%) vs. 0 p=0.33. The analysis of stratified co variables in blocks of distribution does not identify differences in mortality. The analysis of survival of mortality and survival free of events identifies similar results between the groups (Log-Rank chi2=0.9, p=0.3); including aortic insufficiency = II early (3.8% vs. 0, p=0.2) and late (3.8%vs 0, p=0.1), perioperative transfusions, reinterventions by bleeding (2.3% vs. 3.4%, p=0.4), arrhythmias (25.5% vs. 13.5%, p=0.2), and neurologic dysfunction(5.7% vs. 2.9%, p=0.9). Finally total hospitalization (6.5 {1-35} vs. 4{3-16} p=0.001) and Intensive care staying (2.5 {1-21} vs. 1{1-16} p=0.001) is superior in group 1.\ud CONCLUSIONS: The treatment of aortic root aneurysm associated to aortic valve insufficiency without structural damage, with valve reimplantation or Modified Bentall (Biological) offers similar results. Valve preservation is associated to shorter hospitalization stay, but there is no difference in post operative complications, functional status, valve insufficiency, ventricular function, mortality, and survival free of adverse events

Risk factors for mortality in Reoperations for Pediatric and Congenital Heart Surgery in a Developing Country

Background: The survival of patients with congenital heart disease has increased in the recent years, because of enhanced diagnostic capabilities, better surgical techniques and improved perioperative care. Many patients will require reoperations as part of staged procedures, or to treat grafts deterioration and residual or recurrent lesions. Reoperations favor the formation of cardiac adhesions and consequently increase surgery time, however, the impact on morbidity and operative mortality is certain. The objective of the study was to describe the risk factors for mortality in pediatric patients undergoing a reoperation for congenital heart disease. Methods: Historic cohort of patients who underwent reoperations after pediatric cardiac surgery from January 2009 to December 2015. Operations with previous surgical approach different to sternotomy were excluded from the analysis. Results: In seven years, 3.086 surgeries were performed, 481 were reoperations and 238 patients fulfilled the inclusion criteria. Mean number of prior surgeries was 1.4 ± 0.6. Median age at the time of reoperation was 6.4 years. The most common surgical procedures were staged palliation for functionally univentricular heart (17.6%). Median cross clamp time was 66 minutes. Younger age at the moment of resternotomy, longer cross clamp time and a STAT risk category greater than 3 were risk factors for mortality. The number of resternotomies was not associated to mortality. Mortality prior to hospital discharge was 4.6% and mortality after discharge but prior to 30 days after surgery was 0.54%. Operative Mortality was 5.1%. Conclusions: Resternotomy in pediatric cardiac surgery is a safe procedure in our center.2019-08-01 06:01:01: Script de automatizacion de embargos. info:eu-repo/date/embargoEnd/2019-04-2

Risk factors for mortality in Reoperations for Pediatric and Congenital Heart Surgery in a Developing Country

Background: The survival of patients with congenital heart disease has increased in the recent years, because of enhanced diagnostic capabilities, better surgical techniques and improved perioperative care. Many patients will require reoperations as part of staged procedures, or to treat grafts deterioration and residual or recurrent lesions. Reoperations favor the formation of cardiac adhesions and consequently increase surgery time, however, the impact on morbidity and operative mortality is certain. The objective of the study was to describe the risk factors for mortality in pediatric patients undergoing a reoperation for congenital heart disease. Methods: Historic cohort of patients who underwent reoperations after pediatric cardiac surgery from January 2009 to December 2015. Operations with previous surgical approach different to sternotomy were excluded from the analysis. Results: In seven years, 3.086 surgeries were performed, 481 were reoperations and 238 patients fulfilled the inclusion criteria. Mean number of prior surgeries was 1.4 ± 0.6. Median age at the time of reoperation was 6.4 years. The most common surgical procedures were staged palliation for functionally univentricular heart (17.6%). Median cross clamp time was 66 minutes. Younger age at the moment of resternotomy, longer cross clamp time and a STAT risk category greater than 3 were risk factors for mortality. The number of resternotomies was not associated to mortality. Mortality prior to hospital discharge was 4.6% and mortality after discharge but prior to 30 days after surgery was 0.54%. Operative Mortality was 5.1%. Conclusions: Resternotomy in pediatric cardiac surgery is a safe procedure in our center

Es el reimplante valvular mejor que el bentall biológico modificado para tratar aneurismas de la raíz asociados a insuficiencia?

Es el reimplante valvular mejor que el Bentall Biológico Modificado para tratar aneurismas de la raíz asociados a insuficiencia? Obando CE; Gutiérrez HF; Santamaría G, Bresciani R; Camacho J; Sandoval N; Umaña J. Departamento de Cirugía Cardiovascular, Fundación Cardio Infantil, Bogotá, Colombia. Objetivo: comparar resultados funcionales, morbilidad y sobrevida a corto y mediano plazo, tras la realización de Bentall modificado con prótesis Freestyle vs reimplante valvular de Tirone David, en insuficiencia aortica secundaria a aneurisma de la raíz. Diseño: revisión de registros institucionales de 88 pacientes tratados entre enero de 2003 y agosto de 2009 con insuficiencia aortica secundaria a aneurisma de la raíz sin daño valvular, distribuidos en dos cohortes: Grupo 1 (Bentall modificado) y Grupo 2 (reimplante valvular). Se evaluaron complicaciones perioperatorias, transfusiones, estancias hospitalarias y en el seguimiento a mediano plazo insuficiencia valvular, clase funcional, función ventricular y sobrevida. Solidez de los resultados verificada mediante análisis de propensidad con balanceo de grupos. Resultados: Grupo (1) 51(57.9%) pacientes y grupo (2) 37(42.1%). Aunque el grupo 2 es mas joven, patrones similares de coomorbilidad, anatomía de la raíz, función y diámetros ventriculares hacen comparables los dos grupos. Seguimiento de 3.3 años (IQR 2.0-4.4). Mortalidad temprana 2(3.8%) vs 0 p =0.2 y tardía de 2(4.1%) vs 0 p=0.33. El análisis estratificado de covariables en bloques de distribución tampoco identifica diferencias en mortalidad. El análisis de sobrevida de mortalidad y sobrevida libre de eventos identifica desenlaces similares entre los grupos (Log-Rank chi2=0.9, p=0.3); incluyendo Insuficiencia aortica = II temprana (3.8% vs 0, p=0.2) y tardía (3.8%vs 0, p=0.1), transfusiones perioperatorias, reintervenciones por sangrado (2.3% vs 3.4%, p=0.4), arritmias (25.5% vs 13.5%, p=0.2) y disfunción neurológica (5.7% vs 2.9%, p=0.9). Finalmente la hospitalización total (6.5 {1-35} vs 4{3-16} p=0.001) y estancia en Cuidado intensivo (2.5 {1-21} vs 1{1-16} p=0.001) es superior en el grupo1. Conclusiones: el tratamiento de los aneurismas de la raíz aortica asociados a insuficiencia valvular sin daño estructural, mediante reimplante valvular o Bentall biológico modificado ofrece resultados similares a corto y mediano plazo. La preservación valvular se asocia a estancias mas cortas, pero no hay diferencia en complicaciones postoperatorias, estatus funcional, insuficiencia valvular, función ventricular, mortalidad y sobrevida libre de eventos adversos.Compare functional results, Morbility and median and short term survival, after modified Bentall procedure with Freestyle valve vs. Valvular Reimplantation Tirone David, for the aortic valve insufficiency secondary to aortic root aneurysm. DESIGN: Revision of institutional registers of 88 patients treated from January 2003 to august 2009 with aortic insufficiency secondary to aortic root aneurysm without valve damage, distributed in two cohorts: Group 1 (Modified Bentall), Group 2 (Valvular Reimplantation). Perioperative complications were evaluated as well as transfusions, hospitalization days, median term observation for valve insufficiency, functional class, ventricular function and survival. The solidity of the results were verified by propensity analysis with balance of groups. RESULTS: Group (1) 51(57.9%) patients and group (2) 37(42.1%). Although group 2 is younger, similar patterns of comorbility, aortic root anatomy, function and ventricular diameters of both groups make them comparable. Follow up for 3.3 years (IQR 2.0-4.4). Early Mortality 2(3.8%) vs. 0 p =0.2 and late 2(4.1%) vs. 0 p=0.33. The analysis of stratified co variables in blocks of distribution does not identify differences in mortality. The analysis of survival of mortality and survival free of events identifies similar results between the groups (Log-Rank chi2=0.9, p=0.3); including aortic insufficiency = II early (3.8% vs. 0, p=0.2) and late (3.8%vs 0, p=0.1), perioperative transfusions, reinterventions by bleeding (2.3% vs. 3.4%, p=0.4), arrhythmias (25.5% vs. 13.5%, p=0.2), and neurologic dysfunction(5.7% vs. 2.9%, p=0.9). Finally total hospitalization (6.5 {1-35} vs. 4{3-16} p=0.001) and Intensive care staying (2.5 {1-21} vs. 1{1-16} p=0.001) is superior in group 1. CONCLUSIONS: The treatment of aortic root aneurysm associated to aortic valve insufficiency without structural damage, with valve reimplantation or Modified Bentall (Biological) offers similar results. Valve preservation is associated to shorter hospitalization stay, but there is no difference in post operative complications, functional status, valve insufficiency, ventricular function, mortality, and survival free of adverse events