Penetrating cardiac trauma: Analysis of 240 cases from a hospital in Bogota, Colombia

Background: Trauma characteristics and its management is influenced by socioeconomic context. Cardiac trauma constitutes a challenge for surgeons, and outcomes depend on multiple factors including initial care, characteristics of the wounds, and surgical management. Methods: This is a retrospective cross-sectional case series of patients with penetrating cardiac injuries (PCI) from January 1999 to October 2009 who underwent surgery in a trauma referral center in Bogotá, Colombia. Demographic variables, trauma characteristics, treatment, and outcomes were analyzed. Results: The study included 240 cases: 96.2% males, mean age of 27.8 years. Overall mortality was 14.6%: 11.7% from stab wounds and 41.2% from gunshot wounds. Upon admission, 44% had a normal hemodynamic status and 67% had cardiac tamponade. About 32% had Grade II injuries and 29% Grade IV injuries. In 85% of the cases, there were ventricular compromise and 55% of patients had associated lesions. In 150 cases, a pericardial window was performed. Highest mortality occurred in wounds to the right atrium. In tamponade patients, mortality was 20% being higher for gunshot wounds (54.5%) than for stab wounds (18%) (p = 0.0120). Conclusions: The study evidenced predominance of stab wounds. Based on characteristics of the trauma, patients, and survival rate, there is most likely a high pre-hospitalization mortality rate. The difference in mortality due to stab wounds and those produced by gunshots was more related to technical difficulties of the surgical repair than with the type of injury established by the Injury Grading Scale. Mortality was higher in patients with cardiac tamponade. Surgical management was satisfactory using pericardial window as the diagnostic method and sternotomy as the surgical approach. © 2017 The Author(s).Background: Trauma characteristics and its management is influenced by socioeconomic context. Cardiac trauma constitutes a challenge for surgeons, and outcomes depend on multiple factors including initial care, characteristics of the wounds, and surgical management. Methods: This is a retrospective cross-sectional case series of patients with penetrating cardiac injuries (PCI) from January 1999 to October 2009 who underwent surgery in a trauma referral center in Bogotá, Colombia. Demographic variables, trauma characteristics, treatment, and outcomes were analyzed. Results: The study included 240 cases: 96.2% males, mean age of 27.8 years. Overall mortality was 14.6%: 11.7% from stab wounds and 41.2% from gunshot wounds. Upon admission, 44% had a normal hemodynamic status and 67% had cardiac tamponade. About 32% had Grade II injuries and 29% Grade IV injuries. In 85% of the cases, there were ventricular compromise and 55% of patients had associated lesions. In 150 cases, a pericardial window was performed. Highest mortality occurred in wounds to the right atrium. In tamponade patients, mortality was 20% being higher for gunshot wounds (54.5%) than for stab wounds (18%) (p = 0.0120). Conclusions: The study evidenced predominance of stab wounds. Based on characteristics of the trauma, patients, and survival rate, there is most likely a high pre-hospitalization mortality rate. The difference in mortality due to stab wounds and those produced by gunshots was more related to technical difficulties of the surgical repair than with the type of injury established by the Injury Grading Scale. Mortality was higher in patients with cardiac tamponade. Surgical management was satisfactory using pericardial window as the diagnostic method and sternotomy as the surgical approach. © 2017 The Author(s)

Complicaciones en accesos vasculares femorales durante el implante de dispositivos de alto perfil (TAVR, EVAR, TEVAR, FEVAR)

Complicaciones en accesos vasculares femorales durante el implante de dispositivos de alto perfil TAVR, EVAR, TEVAR, FEVA

Accesos vasculares para hemodiálisis, cuál es el más costo efectivo?

Marco conceptual: La enfermedad renal crónica es un serio problema de salud pública en nuestro país por la gran cantidad de recursos económicos que requiere su atención. La hemodiálisis es el tratamiento más usado en nuestro medio; el acceso vascular y sus complicaciones derivadas son el principal aspecto que incrementa los costos de atención en éstos pacientes.\ud Materiales y métodos: Se realizó un estudio económico de los accesos vasculares en pacientes incidentes de hemodiálisis en el año 2012 en la agencia RTS-Fundación Cardio Infantil. Se estableció el costo de creación y mantenimiento del acceso con catéter central, fístula arteriovenosa nativa, fístula arteriovenosa con injerto; y el costo de atención de las complicaciones para cada acceso. Se determinó la probabilidad de ocurrencia de complicaciones. Mediante un árbol de decisiones se trazó el comportamiento de cada acceso en un período de 5 años. Se establecieron los años de vida ajustados por calidad (QALY) en cada acceso y el costo para cada uno de éstos QALY.\ud Resultados: de 36 pacientes incidentes de hemodiálisis en 2012 el 100% inició con catéter central, 16 pacientes cambiaron a fístula arteriovenosa nativa, 1 a fístula arteriovenosa con injerto que posteriormente pasó a CAPD, 15 continuaron su acceso con catéter y 4 pacientes fallecieron. En 5 años se obtuvieron 2,36 QALY para los pacientes con catéter central que costarían $24.813.036,39/QALY y 2,535 QALY para los pacientes con fístula nativa que costarían$ 6.634.870,64/QALY. \ud Conclusiones: el presente estudio muestra que el acceso vascular mediante fístula arteriovenosa nativa es el más costo-efectivo que mediante catéterBackground: end stage chronic renal disease is a serious public health problem in our country because of the big economic burden that is spent on its management. Hemodialysis is the most used treatment in our setting; vascular access and its derived complications are the most important aspect for raising attention’s costs in this group of patients. \ud Materials and methods: an economical study was undertaken with the hemodialysis incident patients attended in RTS-Fundación Cardio Infantil agency during 2012. The costs of creation, maintenance and complication management of the vascular access via central venous catheter, native arteriovenous fistula and graft arteriovenous fistula were established. The probability of complication occurrence was calculated and a decision tree model was used to establish the behavior or each access in a five years period. The quality adjusted life years (QALYs) were established for each access and the economic ratio for each QALY was calculated also.\ud Results: there were 36 incident hemodialysis patients in 2012, 100% started hemodialysis via central venous catheter, 16 patients change their access to a native arteriovenous fistula, 1 to a graft arteriovenous fistula and latter to CAPD, 15 patients continued with central venous catheter and 4 patients died. In 5 years 2,36 QALY were obtained for central venous catheter patients that cost $24.813.036,39/QALY and 2,535 QALY for arteriovenous fistula with a ratio of$ 6.634.870,64/QALY. \ud Conclusions: the present study demonstrates that native arteriovenous fistula is a more cost-effective vascular access for hemodialysis than central venous catheters

Accesos vasculares para hemodiálisis, cuál es el más costo efectivo?

Marco conceptual: La enfermedad renal crónica es un serio problema de salud pública en nuestro país por la gran cantidad de recursos económicos que requiere su atención. La hemodiálisis es el tratamiento más usado en nuestro medio; el acceso vascular y sus complicaciones derivadas son el principal aspecto que incrementa los costos de atención en éstos pacientes. Materiales y métodos: Se realizó un estudio económico de los accesos vasculares en pacientes incidentes de hemodiálisis en el año 2012 en la agencia RTS-Fundación Cardio Infantil. Se estableció el costo de creación y mantenimiento del acceso con catéter central, fístula arteriovenosa nativa, fístula arteriovenosa con injerto; y el costo de atención de las complicaciones para cada acceso. Se determinó la probabilidad de ocurrencia de complicaciones. Mediante un árbol de decisiones se trazó el comportamiento de cada acceso en un período de 5 años. Se establecieron los años de vida ajustados por calidad (QALY) en cada acceso y el costo para cada uno de éstos QALY. Resultados: de 36 pacientes incidentes de hemodiálisis en 2012 el 100% inició con catéter central, 16 pacientes cambiaron a fístula arteriovenosa nativa, 1 a fístula arteriovenosa con injerto que posteriormente pasó a CAPD, 15 continuaron su acceso con catéter y 4 pacientes fallecieron. En 5 años se obtuvieron 2,36 QALY para los pacientes con catéter central que costarían $24.813.036,39/QALY y 2,535 QALY para los pacientes con fístula nativa que costarían$ 6.634.870,64/QALY. Conclusiones: el presente estudio muestra que el acceso vascular mediante fístula arteriovenosa nativa es el más costo-efectivo que mediante catéterBackground: end stage chronic renal disease is a serious public health problem in our country because of the big economic burden that is spent on its management. Hemodialysis is the most used treatment in our setting; vascular access and its derived complications are the most important aspect for raising attention’s costs in this group of patients. Materials and methods: an economical study was undertaken with the hemodialysis incident patients attended in RTS-Fundación Cardio Infantil agency during 2012. The costs of creation, maintenance and complication management of the vascular access via central venous catheter, native arteriovenous fistula and graft arteriovenous fistula were established. The probability of complication occurrence was calculated and a decision tree model was used to establish the behavior or each access in a five years period. The quality adjusted life years (QALYs) were established for each access and the economic ratio for each QALY was calculated also. Results: there were 36 incident hemodialysis patients in 2012, 100% started hemodialysis via central venous catheter, 16 patients change their access to a native arteriovenous fistula, 1 to a graft arteriovenous fistula and latter to CAPD, 15 patients continued with central venous catheter and 4 patients died. In 5 years 2, 36 QALY were obtained for central venous catheter patients that cost $24. 813. 036, 39/QALY and 2, 535 QALY for arteriovenous fistula with a ratio of$ 6. 634. 870, 64/QALY. Conclusions: the present study demonstrates that native arteriovenous fistula is a more cost-effective vascular access for hemodialysis than central venous catheters

Penetrating cardiac trauma: Analysis of 240 cases from a hospital in Bogota, Colombia

Background: Trauma characteristics and its management is influenced by socioeconomic context. Cardiac trauma constitutes a challenge for surgeons, and outcomes depend on multiple factors including initial care, characteristics of the wounds, and surgical management. Methods: This is a retrospective cross-sectional case series of patients with penetrating cardiac injuries (PCI) from January 1999 to October 2009 who underwent surgery in a trauma referral center in Bogotá, Colombia. Demographic variables, trauma characteristics, treatment, and outcomes were analyzed. Results: The study included 240 cases: 96.2% males, mean age of 27.8 years. Overall mortality was 14.6%: 11.7% from stab wounds and 41.2% from gunshot wounds. Upon admission, 44% had a normal hemodynamic status and 67% had cardiac tamponade. About 32% had Grade II injuries and 29% Grade IV injuries. In 85% of the cases, there were ventricular compromise and 55% of patients had associated lesions. In 150 cases, a pericardial window was performed. Highest mortality occurred in wounds to the right atrium. In tamponade patients, mortality was 20% being higher for gunshot wounds (54.5%) than for stab wounds (18%) (p = 0.0120). Conclusions: The study evidenced predominance of stab wounds. Based on characteristics of the trauma, patients, and survival rate, there is most likely a high pre-hospitalization mortality rate. The difference in mortality due to stab wounds and those produced by gunshots was more related to technical difficulties of the surgical repair than with the type of injury established by the Injury Grading Scale. Mortality was higher in patients with cardiac tamponade. Surgical management was satisfactory using pericardial window as the diagnostic method and sternotomy as the surgical approach. © 2017 The Author(s).Background: Trauma characteristics and its management is influenced by socioeconomic context. Cardiac trauma constitutes a challenge for surgeons, and outcomes depend on multiple factors including initial care, characteristics of the wounds, and surgical management. Methods: This is a retrospective cross-sectional case series of patients with penetrating cardiac injuries (PCI) from January 1999 to October 2009 who underwent surgery in a trauma referral center in Bogotá, Colombia. Demographic variables, trauma characteristics, treatment, and outcomes were analyzed. Results: The study included 240 cases: 96.2% males, mean age of 27.8 years. Overall mortality was 14.6%: 11.7% from stab wounds and 41.2% from gunshot wounds. Upon admission, 44% had a normal hemodynamic status and 67% had cardiac tamponade. About 32% had Grade II injuries and 29% Grade IV injuries. In 85% of the cases, there were ventricular compromise and 55% of patients had associated lesions. In 150 cases, a pericardial window was performed. Highest mortality occurred in wounds to the right atrium. In tamponade patients, mortality was 20% being higher for gunshot wounds (54.5%) than for stab wounds (18%) (p = 0.0120). Conclusions: The study evidenced predominance of stab wounds. Based on characteristics of the trauma, patients, and survival rate, there is most likely a high pre-hospitalization mortality rate. The difference in mortality due to stab wounds and those produced by gunshots was more related to technical difficulties of the surgical repair than with the type of injury established by the Injury Grading Scale. Mortality was higher in patients with cardiac tamponade. Surgical management was satisfactory using pericardial window as the diagnostic method and sternotomy as the surgical approach. © 2017 The Author(s)

Mortalidad por trauma cardiaco penetrante en un hospital de Bogotá, Colombia : análisis de factores asociados

Objetivó: Caracterizar los pacientes con heridas cardiacas penetrantes grado II a VI, describir las características del trauma, tratamiento quirúrgico, evolución clínica e identificar los factores asociados a un desenlace. Metodología: Se diseñó un estudio de asociación en 308 pacientes que ingresaron a cirugía con diagnóstico de herida penetrante de corazón entre enero de 1999 y octubre de 2009. Se excluyeron 68 casos. La serie analizada incluyó 240 pacientes con heridas cardiacas. Se analizaron variables demográficas, clínicas, quirúrgicas y de evolución, tabulados en EXCEL® y analizados en SPSS 20®. Resultados: El promedio de edad fue 27.8 años, principalmente hombres (96%), lesiones por arma cortopunzante 93% y un 7% por proyectil arma de fuego. El estado hemodinámico al ingreso (según Ivatury) fue normal 44%; Shock profundo 34%; Agónicos 18% y 3% fatales. El 67% (n=161) presentaron taponamiento cardiaco. Los grados de lesión cardiaca según la clasificación OIS-AAST fueron: grado II 33%, grado III 13%, grado IV 29%, grado V 22% y grado VI 3%. La ventana pericárdica fue el método diagnóstico confirmatorio de lesión en 63% y las incisiones de abordaje quirúrgico fueron la esternotomía 63% y la toracotomía anterolateral 35%. La mortalidad fue 15% (n=36). Las diferencias en mortalidad entre el estado hemodinámico al inicio de cirugía, mecanismo de lesión y grado de herida, demostraron ser estadísticamente significativas (valor de p<0.001). Conclusiones: El estado hemodinámico y las heridas por arma de fuego son factores asociados a mortalidad. La ventana pericárdica subxifoidea favorece la preferencia y buenos resultados de la esternotomía como vía de abordaje quirúrgico.Objective: To characterize patients with penetrating cardiac injury grade II to VI describe the characteristics of trauma, surgical treatment, clinical outcome and identify factors associated with otcome. Methodology: We performed an association study in 308 patients admitted to surgery with a diagnosis of penetrating heart injury between January 1999 and October 2009. 68 cases were excluded. The series analyzed included 240 patients with cardiac wounds. We analyzed demographic, clinical, surgical and evolution, tabulated in Excel ® and analyzed in SPSS 20 ®. Results: Mean age was 27.8 years, mainly men (96%), sharp weapon injuries by 93% and 7% for projectile gun. The hemodynamic status at admission (according Ivatury) was normal 44%; Shock 34%; deep agonizing 18% and 3% fatal. 67% (n = 161) had cardiac tamponade. The degrees of cardiac injury as classified by OIS-AAST were 33% grade II, grade III 13%, grade IV 29%, 22% grade V and grade VI 3%. The pericardial window was the confirmatory method of injury in 63% and surgical incisions were 63% sternotomy and anterolateral thoracotomy 35%. Mortality was 15% (n=36). The differences in mortality between the hemodynamic status at the start of surgery, mechanism of injury and degree of injury, proved to be statistically significant (p<0.001). Conclusions: The hemodynamic status and gunshot wounds are factors associated with mortality. The subxifoidea pericardial window favors the choice and success of the sternotomy as surgical approach

Mortalidad por trauma cardiaco penetrante en un hospital de Bogotá, Colombia : análisis de factores asociados

Objetivó: Caracterizar los pacientes con heridas cardiacas penetrantes grado II a VI, describir las características del trauma, tratamiento quirúrgico, evolución clínica e identificar los factores asociados a un desenlace. \ud Metodología: Se diseñó un estudio de asociación en 308 pacientes que ingresaron a cirugía con diagnóstico de herida penetrante de corazón entre enero de 1999 y octubre de 2009. Se excluyeron 68 casos. La serie analizada incluyó 240 pacientes con heridas cardiacas. Se analizaron variables demográficas, clínicas, quirúrgicas y de evolución, tabulados en EXCEL® y analizados en SPSS 20®. \ud Resultados: El promedio de edad fue 27.8 años, principalmente hombres (96%), lesiones por arma cortopunzante 93% y un 7% por proyectil arma de fuego. El estado hemodinámico al ingreso (según Ivatury) fue normal 44%; Shock profundo 34%; Agónicos 18% y 3% fatales. El 67% (n=161) presentaron taponamiento cardiaco. Los grados de lesión cardiaca según la clasificación OIS-AAST fueron: grado II 33%, grado III 13%, grado IV 29%, grado V 22% y grado VI 3%. La ventana pericárdica fue el método diagnóstico confirmatorio de lesión en 63% y las incisiones de abordaje quirúrgico fueron la esternotomía 63% y la toracotomía anterolateral 35%. La mortalidad fue 15% (n=36). \ud Las diferencias en mortalidad entre el estado hemodinámico al inicio de cirugía, mecanismo de lesión y grado de herida, demostraron ser estadísticamente significativas (valor de p<0.001). \ud Conclusiones: El estado hemodinámico y las heridas por arma de fuego son factores asociados a mortalidad. La ventana pericárdica subxifoidea favorece la preferencia y buenos resultados de la esternotomía como vía de abordaje quirúrgico.Objective: To characterize patients with penetrating cardiac injury grade II to VI describe the characteristics of trauma, surgical treatment, clinical outcome and identify factors associated with otcome.\ud Methodology: We performed an association study in 308 patients admitted to surgery with a diagnosis of penetrating heart injury between January 1999 and October 2009. 68 cases were excluded. The series analyzed included 240 patients with cardiac wounds. We analyzed demographic, clinical, surgical and evolution, tabulated in Excel ® and analyzed in SPSS 20 ®. \ud Results: Mean age was 27.8 years, mainly men (96%), sharp weapon injuries by 93% and 7% for projectile gun. The hemodynamic status at admission (according Ivatury) was normal 44%; Shock 34%; deep agonizing 18% and 3% fatal. 67% (n = 161) had cardiac tamponade. The degrees of cardiac injury as classified by OIS-AAST were 33% grade II, grade III 13%, grade IV 29%, 22% grade V and grade VI 3%. The pericardial window was the confirmatory method of injury in 63% and surgical incisions were 63% sternotomy and anterolateral thoracotomy 35%. Mortality was 15% (n=36). \ud The differences in mortality between the hemodynamic status at the start of surgery, mechanism of injury and degree of injury, proved to be statistically significant (p<0.001).\ud Conclusions: The hemodynamic status and gunshot wounds are factors associated with mortality. The subxifoidea pericardial window favors the choice and success of the sternotomy as surgical approach

Complicaciones en accesos vasculares femorales durante el implante de dispositivos de alto perfil (TAVR, EVAR, TEVAR, FEVAR)

Complicaciones en accesos vasculares femorales durante el implante de dispositivos de alto perfil TAVR, EVAR, TEVAR, FEVA