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

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

Fibroelastoma papilar incidental o sintomático ¿Debe intervenirse?

El fibroelastoma papilar, también conocido como papiloma fibroelástico, es un tumor benigno poco común, que se puede observar en las válvulas cardíacas o, en algunas ocasiones, en el endocardio ventricular. Se describen dos casos; el primero corresponde a un paciente de 72 años con fibrilación auricular paroxística, asintomático por lo demás, en quien en estudio de su fibrilación auricular se evidenció masa pediculada de 1 y 1 cm dependiente de la válvula pulmonar y por riesgo de embolia se llevó a cirugía en la que se resecó masa, sin complicaciones. El reporte de histopatología fue positivo para fibroelastoma papilar. El segundo caso es una paciente de 67 años, sintomática, con angina de esfuerzo en quien, mediante ecocardiograma transtorácico, se documentó masa de 1,5 y 1,5 cm dependiente de la valva coronariana derecha, se consideraron síntomas secundarios a la masa. Se llevó a cirugía por técnica mínimamente invasiva y se resecó la masa. El reporte de histopatología fue positivo para fibroelastoma papilar. Conclusión: el fibroelastoma papilar es una causa poco frecuente pero cada vez más reconocida de fenómenos embólicos. Su identificación oportuna permite la extirpación de la lesión, que es aparentemente curativa, segura y bien tolerada

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.\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

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

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

Mechanical circulatory support as bridge therapy for heart transplant: Case series report

Background: Mechanical circulatory support (MCS) represents an effective urgent therapy for patients with cardiac arrest or end-stage cardiac failure. However, its use in developing countries as a bridge therapy remains controversial due to costs and limited duration. This study presents five patients who underwent MSC as bridge therapy for heart transplantation in a developing country. Case presentation: We present five patients who underwent MCS as bridge therapy for heart transplant between 2010 and 2015 at Fundación Cardioinfantil-Instituto de Cardiología. Four were male, median age was 36 (23-50) years. One patient had an ischemic cardiomyopathy, one a lymphocytic myocarditis, two had electrical storms (recurrent ventricular tachycardia) and one an ischemic cardiomyopathy with an electrical storm. Extracorporeal life support (ECLS) was used in three patients, left ventricular assistance in one, and double ventricular assistance in one (Levitronix® Centrimag®). Median assistance time was 8 (2.5-13) days. Due to the inability of cardiopulmonary bypass weaning, two patients required ECLS after transplant. One patient died in the intensive care unit due to type I graft rejection. Endpoints assessed were 30-day mortality, duration of bridge therapy and complications related to MCS. Patients that died on ECLS, or were successfully weaned off ECLS were not included in this study. Conclusions: MCS is often the only option of support for critically ill patients waiting for a heart transplant and could be considered as a short-term bridge therapy. © 2018 The Author(s)

Mechanical circulatory support as bridge therapy for heart transplant: Case series report

Background: Mechanical circulatory support (MCS) represents an effective urgent therapy for patients with cardiac arrest or end-stage cardiac failure. However, its use in developing countries as a bridge therapy remains controversial due to costs and limited duration. This study presents five patients who underwent MSC as bridge therapy for heart transplantation in a developing country. Case presentation: We present five patients who underwent MCS as bridge therapy for heart transplant between 2010 and 2015 at Fundación Cardioinfantil-Instituto de Cardiología. Four were male, median age was 36 (23-50) years. One patient had an ischemic cardiomyopathy, one a lymphocytic myocarditis, two had electrical storms (recurrent ventricular tachycardia) and one an ischemic cardiomyopathy with an electrical storm. Extracorporeal life support (ECLS) was used in three patients, left ventricular assistance in one, and double ventricular assistance in one (Levitronix® Centrimag®). Median assistance time was 8 (2.5-13) days. Due to the inability of cardiopulmonary bypass weaning, two patients required ECLS after transplant. One patient died in the intensive care unit due to type I graft rejection. Endpoints assessed were 30-day mortality, duration of bridge therapy and complications related to MCS. Patients that died on ECLS, or were successfully weaned off ECLS were not included in this study. Conclusions: MCS is often the only option of support for critically ill patients waiting for a heart transplant and could be considered as a short-term bridge therapy. © 2018 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