[Robotic mitral valve repair and closure of atrial septal defect. Report of 13 procedures]. / Reparación de válvula mitral y cierre de comunicación interauricular, asistida por robot: experiencia inicial.

Background Robot-assisted minimally invasive heart surgery is an effective alternative when compared with classical approaches. It has a low mortality and postoperative complications and its long-term durability is comparable with conventional techniques. AIM: To report short- and long-term results with the use of a robot-assisted transthoracic approach. PATIENTS AND METHODS: Review of patients undergoing heart surgery between 2015 and 2019 using a robot assisted minimally invasive technique in a single center. We analyzed demographic characteristics, surgical and early ultrasound results. RESULTS: Thirteen procedures were reviewed, nine mitral valve repairs (MVR) in patients aged 61 ± 21 years (seven males) and four atrial septal defect (ASD) closures in patients aged from 24 to 52 years (three men). For MVR, the average extracorporeal circulation and myocardial ischemia times were 120 ± 20.9 and 89 ± 21 minutes, respectively. The median hospitalization was four days. Two cases of MVR had postoperative complications. There was no mortality. All cases showed improvement in their symptoms. Ultrasound findings showed no postoperative mitral insufficiency except in one case. CONCLUSIONS: We report very good results in both complex mitral repair and CIA closure, comparable to centers with high standards in minimally invasive robot-assisted heart surgery.

[Transcatheter aortic valve implantation: experience in 17 patients]. / Implante valvular aórtico transarterial: experiencia en Chile.

BACKGROUND: Transcatheter aortic valve implantation (TAVI) is taking a leading role in the management of patients with severe aortic stenosis. Valve replacement surgery prolongs survival and is the technique of choice considering its historical background and long experience worldwide. Recently however, TAVI has positioned itself as the only standard therapy for symptomatic patients who are not candidates for surgery. AIM: To report the experience with this new technique comparing our results with those reported in the literature. MATERIAL AND METHODS: Between May 2010 and December 2011,17 patients aged 81 ± 7.3 years (58.8% men with an Euro SCORE 29 ± 22.4%) underwent a TAVI. RESULTS: The median transvalvular gradient was 54 ± 15.7 mmHg. All patients received a CoreValve™. Technical success was 100%, with a post implant gradient of 6.29 ± 3.3 mmHg. Residual aortic regurgitation was observed in 94%, none greater than grade II. There were no complications at the vascular access site. One patient developed cardiac tamponade during the procedure. Permanent pacemaker implantation was required in 35.2%. Hospital mortality rate was 5.8%, a figure that remained unchanged at 30 days of follow-up. CONCLUSIONS: In high-risk patients with aortic stenosis, TAVI has a high success rate and a low rate of complications. Besides an appropriate patient selection, a trained multidisciplinary team and technical conditions to solve possible complications of the procedure are required.

Reparación de válvula mitral y cierre de comunicación interauricular, asistida por robot: experiencia inicial / Robotic mitral valve repair and closure of atrial septal defect: report of 13 procedures

Background Robot-assisted minimally invasive heart surgery is an effective alternative when compared with classical approaches. It has a low mortality and postoperative complications and its long-term durability is comparable with conventional techniques. Aim: To report short- and long-term results with the use of a robot-assisted transthoracic approach. Patients and Methods: Review of patients undergoing heart surgery between 2015 and 2019 using a robot assisted minimally invasive technique in a single center. We analyzed demographic characteristics, surgical and early ultrasound results. Results: Thirteen procedures were reviewed, nine mitral valve repairs (MVR) in patients aged 61 ± 21 years (seven males) and four atrial septal defect (ASD) closures in patients aged from 24 to 52 years (three men). For MVR, the average extracorporeal circulation and myocardial ischemia times were 120 ± 20.9 and 89 ± 21 minutes, respectively. The median hospitalization was four days. Two cases of MVR had postoperative complications. There was no mortality. All cases showed improvement in their symptoms. Ultrasound findings showed no postoperative mitral insufficiency except in one case. Conclusions: We report very good results in both complex mitral repair and CIA closure, comparable to centers with high standards in minimally invasive robot-assisted heart surgery.

[Negative-pressure wound therapy versus standard wound dressing in the treatment of diabetic foot amputation. A randomised controlled trial]. / Curación asistida por presión negativa comparada con curación convencional en el tratamiento del pie diabético amputado. Ensayo clínico aleatorio.

INTRODUCTION: Foot amputation wounds in patients with diabetes are complex and treatment is often difficult. At the moment negative pressure wound therapy (NPWT) is widely used for the treatment of several types of wounds. Nevertheless, the clinical evidence to support the application of this dressing in foot amputation wounds in patients with diabetes is scarce. The aim of this study was to evaluate the efficacy of NPWT compared with standard wound dressing to treat diabetic foot amputation wounds. PATIENTS AND METHOD: Randomised controlled trial. Diabetic patients aged 18 years or older with a foot amputation wound were assigned to treatment with NPWT (A group) or standard wound dressing (B group). Primary efficacy end point was time in reaching 90% of wound granulation. A size of sample of 11 patients per group was used. NPWT was prepared with a polyurethane ether foam dressing, a Nelaton catheter, a transparent adhesive drape and continuous negative pressure of 100 mmHg. The wound was treated every 48-72 h and evaluated weekly. Descriptive and analytical statistics were used. RESULTS: There were 24 patients, with a mean age of 61.8 +/- 9 years (79% men), 12 in each group. The average time to reach 90% of granulation was lower in A group (18.8 +/- 6 days versus 32.3 +/- 13.7 days), a statistically significant difference (P = 0.007). CONCLUSION: NPWT reduces the granulation time of diabetic foot amputation wounds by 40%, compared with the standard wound dressing.

Implante valvular aórtico transarterial: experiencia en Chile / Transcatheter aortic valve implantation: Experience in 17 patients

Background: Transcatheter aortic valve implantation (TAVI) is taking a leading role in the management of patients with severe aortic stenosis. Valve replacement surgery prolongs survival and is the technique of choice considering its historical background and long experience worldwide. Recently however, TAVI has positioned itself as the only standard therapy for symptomatic patients who are not candidates for surgery. Aim: To report the experience with this new technique comparing our results with those reported in the literature. Material and Methods: Between May 2010 and December 2011,17patients aged 81 ± 7.3 years (58.8% men with an Euro SCORE 29 ± 22.4%) underwent a TAVI. Results: The median transvalvular gradient was 54 ± 15.7 mmHg. All patients received a CoreValveTM. Technical success was 100%, with a post implant gradient of 6.29 ± 3.3 mmHg. Residual aortic regurgita-tion was observed in 94%, none greater than grade II. There were no complications at the vascular access site. One patient developed cardiac tamponade during the procedure. Permanent pacemaker implantation was required in 35.2%. Hospital mortality rate was 5.8%, a figure that remained unchanged at 30 days offollow-up. Conclusions: In high-risk patients with aortic stenosis, TAVI has a high success rate and a low rate of complications. Besides an appropriate patient selection, a trained multidisciplinary team and technical conditions to solve possible complications of the procedure are required.

[Endoluminal stent-graft placement for acute dissection of the descending aorta complicated with rupture. Report of one case]. / Tratamiento endoluminal de disección aguda complicada en aorta descendente. Comunicación de un caso.

Acute dissection of the aorta, although not common, has early and highly lethal complications. The type A dissection is treated with surgery. Patients with type B dissections are treated with surgery if they have complications like rupture, growth or visceral ischemia. Surgery, however, has complications such as spinal cord ischemia. Endovascular grafts have less mortality and complications. We report a 59 years old male patient with a type B dissection complicated with rupture. He was treated successfully with the placement of an endoluminal graft. He was discharged five days after the procedure in good conditions. After one year of follow up, the patient remains asymptomatic.

Tratamiento endoluminal de disección aguda complicada en aorta descendente: Comunicación de un caso / Endoluminal stent-graft placement for acute dissection of the descending aorta complicated with rupture: Report of one case

Acute dissection of the aorta, although not common, has early and highly lethal complications. The type A dissection is treated with surgery. Patients with type B dissections are treated with surgery if they have complications like rupture, growth or visceral ischemia. Surgery, however, has complications such as spinal cord ischemia. Endovascular grafts have less mortality and complications. We report a 59 years old male patient with a type B dissection complicated with rupture. He was treated successfully with the placement of an endoluminal graft. He was discharged five days after the procedure in good conditions. After one year of follow up, the patient remains asymptomatic.