CB6 87. Sustitución valvular aórtica en octogenarios

IntroducciónEn las últimas décadas, la población mayor de 80 años que requiere una cirugía por estenosis aórtica degenerativa ha aumentado sustancialmente.Material y métodosSe compararon los resultados a corto y medio plazo de la sustitución valvular aórtica convencional (SVAo) en estenosis aórtica degenerativa en pacientes mayores y menores de 80 años intervenidos en nuestro centro entre abril de 2004 y diciembre de 2008. Los predictores de mortalidad y eventos adversos mayores cardio y cerebrovasculares (MACCE) en el postoperatorio y el seguimiento se determinaron por análisis multivariante.ResultadosCuatrocientos cincuenta y un pacientes fueron incluidos; 94 (20,8%) eran mayores de 80 años. La cirugía cardíaca previa (odds ratio [OR]: 4,08; p=0,047), la insuficiencia renal (OR: 6,75; p < 0,001), la cirugía coronaria concomitante (OR: 2,57; p=0,034), el sexo femenino (OR: 2,49; p=0,047) y la hipertensión pulmonar grave (OR: 3,68; p=0,024) fueron predictores independientes de mortalidad hospitalaria. En el seguimiento, la edad (hazard ratio [HR]: 2,24; p=0,02), la vasculopatía periférica (HR: 5,1; p < 0,001) e hipertensión arterial (HTA) (HR: 5,2; p=0,025) fueron predictores independientes de mortalidad tardía. Sólo la vasculopatía periférica (HR: 3,55; p=0,014) e HTA (HR: 8,24; p=0,04) fueron predictores independientes de mortalidad cardíaca tardía. La insuficiencia renal (OR: 2,57; p=0,005), hipertensión pulmonar grave (OR: 3,49; p=0,005) y cirugía coronaria asociada (OR: 2,49; p=0,002) fueron predictores independientes de MACCE postoperatorios. Diabetes mellitus (HR: 2,03; p=0,033) y vasculopatía periférica (HR: 2,3; p=0,041) predijeron una mayor incidencia de MACCE en el seguimiento.ConclusionesLa edad mayor de 80 años no empeora el pronóstico a corto y medio plazo tras la SVAo por estenosis aórtica grave degenerativa

P28 85. Análisis de la supervivencia a corto y medio plazo de la cirugía de aorta ascendente

ObjetivosEvaluar la mortalidad hospitalaria y la supervivencia a medio plazo de los pacientes sometidos a una cirugía de aorta ascendente y determinar cuáles son sus factores de riesgo.Material y métodosSe analizó de forma retrospectiva toda la población de pacientes sometidos a un procedimiento quirúrgico de aorta ascendente (sustitución con o sin cirugía valvular o de raíz asociada) entre enero de 2003 y diciembre de 2008. Se evaluó la mortalidad hospitalaria y la supervivencia absoluta en el seguimiento, y mediante análisis uni y multivariante se determinaron las correspondientes variables predictoras.ResultadosTrescientos sesenta y cinco pacientes fueron sometidos de forma consecutiva a algún procedimiento quirúrgico de la aorta ascendente. Edad media: 63,1 años (desviación estándar [DE] 13); n = 99 (27,1%) fueron mujeres; n = 58 (15,9%) habían sido sometidos a una cirugía previa. En 32 pacientes se sustituyó total o parcialmente el arco aórtico. EuroSCORE mediano de 11,72% (interquartile range [IQR]: 6,78-20,43). La mortalidad hospitalaria fue 7,7% (n = 28). Los predictores de mortalidad en análisis multivariante fueron: cirugía cardíaca previa (odds ratio [OR]: 3,18; p = 0,045), tabaquismo activo (OR: 5,7; p = 0,021), insuficiencia renal (OR: 3,03; p = 0,043), estado crítico preoperatorio (OR: 5,63; p = 0,005), edad (OR: 1,06; p = 0,018) y cirugía coronaria asociada (OR: 3,17; p = 0,35). La supervivencia a 1, 3 y 5 años fue 96, 94 y 92%. Sólo edad (hazard ratio [HR]: 1,08; p = 0,022) e hipertensión pulmonar grave (HR: 3,5; p = 0,026) fueron predictores independientes de mortalidad en el seguimiento.ConclusionesEn nuestra experiencia, la sustitución de la aorta ascendente demuestra una baja mortalidad hospitalaria y una adecuada supervivencia a medio plazo

Retrospective cohort analysis of Spanish national trends of coronary artery bypass grafting and percutaneous coronary intervention from 1998 to 2017

Introduction Spain is one of the countries with the lowest rates of revascularisation and highest ratio of percutaneous coronary intervention (PCI) to coronary artery bypass grafting (CABG). Objectives To investigate the changes and trends in the two revascularisation procedures between 1998 and 2017 in Spain. Design Retrospective cohort study. Analysis of in-hospital outcomes. Setting Minimum basic data set from the Spanish National Department of Health: mandatory database collecting information of patients who are attended in the Spanish public National Health System. Participants 603 976 patients who underwent isolated CABG or PCI in the Spanish National Health System. The study period was divided in four 5-year intervals. Patients with acute myocardial infarction on admission were excluded. Primary and secondary outcomes We investigated the volume of procedures nationwide, the changes of the risk profile of patients and in-hospital mortality of both techniques. Results We observed a 2.2-fold increase in the rate of any type of myocardial revascularisation per million inhabitants-year: 357 (1998) to 776 (2017). 93 682 (15.5%) had a coronary surgery. PCI to CABG ratio rose from 2.2 (1998-2002) to 8.1 (2013-2017). Charlson's index increased by 0.8 for CABG and 1 for PCI. The median annual volume of PCI/hospital augmented from 136 to 232, while the volume of CABG was reduced from 137 to 74. In the two decades, we detected a significant reduction of CABG in-hospital mortality (6.5% vs 2.6%, p&lt;0.001) and a small increase in PCI (1.2% vs 1.5%, p&lt;0.001). Risk adjusted mortality rate was reduced for both CABG (1.51 vs 0.48, p&lt;0.001), and PCI (1.42 vs 1.05, p&lt;0.001). Conclusion We detected a significant increase in the volume of revascularisations (particularly PCI) in Spain. Risk-adjusted in-hospital mortality was significantly reduce

Anatomic mapping of the collateral branches of the external carotid artery with regard to daily clinical practice

Background: To identify the anatomical variations of the main branches of the external carotid artery (lingual, facial, occipital, ascending pharyngeal and sternocleidomastoid), giving information about the calibers and origins with the aim of creating a new classification useful in clinical practice. Material and methods: 193 human embalmed body-donors were dissected. The data collected were analyzed using the Chi² test. The results of previous studies were reviewed. Results: The majority of the anterior arterial branches (superior thyroid, facial and lingual artery) were observed with an independent origin, respectively, classified as pattern I (80.83%, 156/193). In 17.62% (34/193) a linguofacial trunk, pattern II, has been observed, only in 1,04% (2/193) a thyrolingual trunk, pattern III, has been found and in one case (1/193, 0.52%) one thyrolinguofacial trunk, pattern IV, was found. Depending on the posterior branches (occipital and ascending pharyngeal), four different types could be determined: type a, the posterior arteries originated independently, type b, the posterior arteries originated in a common trunk, type c, the ascending pharyngeal artery was absent, type d, the occipital artery was absent. Conclusion: Anatomical variations in these arteries are relevant in daily clinical practice due to growing applications, e.g., in Interventional Radiology techniques. Knowledge of these anatomical references could help clinicians in the interpretation of the carotid system

Conservative management versus open reduction and internal fixation for mid-shaft clavicle fractures in adults - The Clavicle Trial: Study protocol for a multicentre randomized controlled trial

Background: Clavicle fractures account for around 4% of all fractures and up to 44% of fractures of the shoulder girdle. Fractures of the middle third (or mid-shaft) account for approximately 80% of all clavicle fractures. Management of this group of fractures is often challenging and the outcome can be unsatisfactory. In particular it is not clear whether surgery produces better outcomes than non-surgical management. Currently there is much variation in the use of surgery and a lack of good quality evidence to inform our decision.Methods/Design: We aim to undertake a multicentre randomised controlled trial evaluating the effectiveness and safety of conservative management versus open reduction and internal fixation for displaced mid-shaft clavicle fractures in adults. Surgical treatment will be performed using the Acumed clavicle fixation system. Conservative management will consist of immobilisation in a sling at the side in internal rotation for 6 weeks or until clinical or radiological union. We aim to recruit 300 patients. These patients will be followed-up for at least 9 months. The primary endpoint will be the rate of non-union at 3 months following treatment. Secondary endpoints will be limb function measured using the Constant-Murley Score and the Disabilities of the Arm, Shoulder and Hand (DASH) Score at 3 and 9 months post-operatively.Discussion: This article presents the protocol for a multicentre randomised controlled trial. It gives extensive details of, and the basis for, the chosen methods, and describes the key measures taken to avoid bias and to ensure validity.Trial Registration: United Kingdom Clinical Research Network ID: 8665. The date of registration of the trial is 07/09/2006. The date the first patient was recruited is 18/12/2007. © 2011 Longo et al; licensee BioMed Central Ltd

A educação em Cuba: seus fundamentos e desafios

O artigo trata da importância da educação para qualquer nação, e para Cuba em particular, com seus fundamentos políticos, pedagógicos e sociológicos, e mostra seu comportamento nos últimos 50 anos. Para isso, são expostos os princípios que sustentam a política educativa do Estado cubano, que dão base ao Sistema Nacional de Educação (SNE), como instrumento para levar adiante a obra educativa do país. Oferece, também, uma caracterização de cada um dos subsistemas que o integram para garantir o cumprimento dos objetivos principais da educação: formar as novas gerações e todo o povo na concepção científica do mundo; desenvolver em toda sua plenitude as capacidades intelectuais, físicas e espirituais; fomentar elevados sentimentos e gostos estéticos; e converter os princípios ideológicos, políticos e morais comunistas em convicções pessoais e hábitos de conduta diária, com a participação da escola, da família e de toda a sociedade. O artigo apresenta, também, as transformações que atualmente se levam adiante no Ministério da Educação com a participação de seus diretores, docentes, estudantes e demais agentes sociais, para continuar trabalhando na elevação da qualidade de seus resultados.Se argumenta la importancia de la educación para cualquier nación y para Cuba en particular, con sus fundamentos políticos, pedagógicos y sociológicos y se muestra su comportamiento en los últimos 50 años. Se exponen los principios que sustentan la política educacional del Estado cubano, que dan base al Sistema Nacional de Educación (SNE), como instrumento para llevar adelante la obra educacional del país. Se ofrece una caracterización de cada uno de los subsistemas que lo integran para garantizar el cumplimiento del objetivo principal de la educación: formar a las nuevas generaciones y a todo el pueblo en la concepción científica del mundo, desarrollar en toda su plenitud las capacidades intelectuales, físicas y espirituales, fomentar elevados sentimientos y gustos estéticos y convertir los principios ideo políticos y morales comunistas en convicciones personales y hábitos de conducta diaria, con la participación de la escuela, la familia y toda la sociedad. Se presentan también las transformaciones que actualmente se llevan a cabo en el Ministerio de Educación con la participación de sus directivos, docentes, estudiantes y demás agentes sociales, para continuar trabajando en la elevación de la calidad de sus resultados.This article discusses the importance of education for any nation and for Cuba in particular, examining its political, pedagogical and sociological foundations, and portraying its accomplishments over the last 50 years. The principles underlying the educational policy of the Cuban government are explained, as they underpin the mission of the National Education System (NES) to carry forward educational work in the country. The essay also depicts each of the subsystems that comprise the NES and ensure the fulfillment of the key educational goals: to educate the new generations and the people as a whole in a scientific conception of the world; to develop fully their intellectual, physical and spiritual skills; to promote high aesthetic tastes and feelings; and to convert communist ideological, political and moral principles into personal convictions and daily habits of conduct, with the participation of school, family and society as a whole. The essay also presents the changes that are currently being made in the Ministry of Education with the participation of administrators, principals, teachers, students and other social agents, to continuously raise the quality of its results

CO75 313. Implantación de prótesis cardíacas por vía transapical. Resultados de nuestra experiencia

IntroducciónPresentamos nuestra experiencia en la implantación de bioprótesis transcatéter vía transapical.Material y métodosDesde junio de 2008 se han implantado un total de 107 bioprótesis vía transapical, dos en posición mitral valve in valve (Edwards Sapiens THV, 62 tamaño 23mm, 43 de 26mm y 2 de 29mm). Cuarenta y siete fueron mujeres, la edad mediana fue 81,30 años (interquartile range [IQR] 76,28–84,74). EuroSCORE medio 20,55 (desviación estándar [DE] 1,43). Criterios de inclusión: estenosis aórtica grave sintomática, EuroSCORE superior al 20%, aorta en porcelana, reoperados con injertos permeables o disfunción de bioprótesis en pacientes de alto riesgo. Todos los procedimientos se realizaron en quirófano bajo control radioscópico y ecocardiograma transesofágico 3D.ResultadosLa prótesis se implantó con éxito en los 107 pacientes, 4 precisaron conversión a circulación extracorpórea (CEC) por dislocación precoz, 1 requirió implante de prótesis valve in valve intraoperatorio. Mediana de estancia en unidad de vigilancia intensiva (UVI): 1 día (IQR 1–4). Mediana de estancia postoperatoria: 7,5 días (IQR 6-11). Morbilidad: ventilación mecánica prolongada (> 48h) 10%; insufciencia renal aguda (IRA) 34,3%; bloqueo auriculo-ventricular (BAV) 4,3% y accidente cerebrovascular (ACV) 5,7%. La mortalidad hospitalaria fue del 12%. Seguimiento en consultas a 6, 12, 24 y 36 meses con ecocardiografía transtorácica. La supervivencia a 36 meses fue del 78% y la totalidad de los pacientes continuaban en clase funcional I–II.ConclusiónEn nuestra experiencia se han obtenido buenos resultados, haciendo de la vía transapical una alternativa adecuada para los pacientes excluidos para cirugía convencional

The carotid axis revisited

The aim was to determine the variations in the level of origin of carotid bifurcation and diameters of the common, internal, and external carotid arteries which is clinically important for several interventional procedures. Therefore, 165 human embalmed corpses were dissected. The data collected were analyzed using the Chi square-test and the Pearson correlation test. The results of previous studies have been reviewed. In relation to the level of the carotid bifurcation, taking as a reference point the hyoid bone, the values ranged from 4 cm below the hyoid body to 2.5 cm above the body of the hyoid, being the average height-0.33 cm, with a standard deviation of 1.19 cm. The right carotid bifurcation was established at a higher level (x = - 0.19 cm.) than the left one (x = - 0.48 cm.) (p = 0.046). On the contrary, no significant gender differences could be observed. The arterial calibres of the common and internal carotid arteries were higher in male than female. In the internal carotid artery (X = 0.76 cm.), the left was greater than the right (X = 0.72 cm.) (P = 0.047). However, no differences in the distribution of the calibre of the external carotid artery were found neither by side nor gender. Variations in the level of bifurcation and calibres of carotid arteries are relevant for interventional radiology procedures and head and neck surgeries. Knowledge of these anatomical references might help clinicians in the interpretation of the carotid system