P14 282. Endocarditis protésica. experiencia de 20 años

ObjetivosRevisamos la experiencia de nuestro centro en endocarditis protésica (EP).Material y métodosEntre 1990–2010, se intervienen 62 casos, que representaron el 23% de 276 casos totales de endocarditis y 2,46% de pacientes valvulares (precoces 0,58% con 20 casos, tardías 1,68% con 42 casos). No hubo diferencias en tipo ni localización de las prótesis, ni en incidencia entre las dos décadas (2,59% en 1990–2000 y 2,32% en 2000–2010). Edad media 59 años. Gérmenes: S. viridans 20,9%; S. epidermidis 16,1%; S. aureus 11,6%; C. burnetii 9,6%; enterococos 8%; difteroides 6,4%; hongos 6,4%. En un 8% de los casos se encontraron gérmenes raros aislados, mientras que no se identificó germen en 12,9%. Se intervinieron de forma urgente el 30% de pacientes (19 casos, el 45% de formas precoces y el 23% de formas tardías).ResultadosLa mortalidad precoz fue del 16%, a expensas sobre todo de EP precoz (12%). La supervivencia global a 10 años fue del 50%, con diferencias entre los dos grupos (EP precoz 15%; EP tardía 66%). El 70% de supervivientes se encuentra actualmente en clase funcional I-II/IV.ConclusiónLa EP sigue teniendo una incidencia relativamente elevada en nuestro medio. La EP precoz tiene una mortalidad muy elevada. La cirugía de la EP tardía tiene muy buenos resultados a largo plazo

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

CO54 277. Nuestra experiencia inicial en la reparación mitral por patología congénita

ObjetivoLas lesiones congénitas de la válvula mitral son un reto quirúrgico. La morfología y el tipo de lesión condicionan y limitan las técnicas quirúrgicas disponibles para su corrección. Recogemos nuestra experiencia en la reparación mitral en niños.Material y métodosEntre 2006–2011 hemos intervenido 29 pacientes con lesiones sintomáticas en la válvula mitral. Edad media 18 meses (2–144). La reparación mitral fue la primera alternativa. El tipo de lesión fue: estenosis o doble lesión mitral (DLM) en 12 pacientes (41%), insuficiencia mitral (IM) grave 5 (17%), poscorrección canal auriculoventricular (AV) 9 (31%), y iatrogénicas 3 pacientes (11%). La corrección se realizó utilizando una o la combinación de estas técnicas: resecciones de valva posterior 3 casos (10%), sutura de cleft 3(10%), comisurotomía 10 (35%), papilotomía 6 (20%), anuloplastia 7 (24%), en 3 de éstos se utilizó un anillo de Kalangos y en otros 2 de Carpentier, resección de rodete supramitral 6 (20%).ResultadosNo hubo mortalidad. Se realizó ecocardiografía transesofágica (ETE) intraoperatoria y se toleró IM residual leve. En la evolución precoz 2 pacientes (6,7%) desarrollaron insuficiencia grave y requirieron reemplazo valvular por prótesis mecánicas. En el seguimiento el 89,6% está libre de IM o con IM leve residual, a los 3,5 años. El 96% está en grado funcional I de la New York Heart Association (NYHA).ConclusionesConsideramos que la reparación de la válvula mitral en lesiones congénitas es la primera alternativa. Los resultados son satisfactorios y estables a lo largo del tiempo, al igual que en adultos. Esto permite a los niños alcanzar la edad adulta en un grado funcional aceptable

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien\u2013Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9\ub72 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4\u20137) and 7 (6\u20138) days respectively (P &lt; 0\ub7001). There were no significant differences in rates of readmission between these groups (6\ub76 versus 8\ub70 per cent; P = 0\ub7499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0\ub790, 95 per cent c.i. 0\ub755 to 1\ub746; P = 0\ub7659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34\ub77 versus 39\ub75 per cent; major 3\ub73 versus 3\ub74 per cent; P = 0\ub7110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Safety of hospital discharge before return of bowel function after elective colorectal surgery

© 2020 BJS Society Ltd Published by John Wiley & Sons LtdBackground: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients