Survival after heart transplantation for Chagas cardiomyopathy using a conventional protocol: A 10-year experience in a single center.

BACKGROUND: Heart transplant (HT) remains the most frequently indicated therapy for patients with end-stage heart failure that improves prognosis in Chagas cardiomyopathy (CCM). However, the lack of benznidazole therapy and availability of RT-PCR follow-up in many centers is a major limitation to perform this life-saving intervention, as there are concerns related with the risk of reactivation. We aimed to describe the outcomes of a cohort of patients with CCM who underwent HT using a conventional protocol with mycophenolate mofetil, without benznidazole prophylaxis or RT-PCR follow-up. METHODS: Retrospective cohort study. Between 2008 and 2018, 43 patients with CCM underwent HT. A descriptive analysis to characterize outcomes as rejection, infectious and neoplastic complications and a survival analysis was carried out. RESULTS: Median of follow-up was 4.3 (IR 4.28) years. Survival at 1 month, 1 year, and 5 years was 95%, 85%, and 75%, respectively, infections being the main cause of death (60%). Reactivations occurred in only three patients (7.34%) and were not related to mortality. CONCLUSION: This cohort showed a favorable survival and a low reactivation rate without an impact on mortality. Our results suggest that performing HT in patients with CCM following conventional guidelines and recommendations for other etiologies is a safe approach.

Somatic Support with Veno-venous ECMO in a Pregnant Woman with Brain Death: A Case Report.

Supporting homeostasis in a pregnant woman with brain death to achieve fetal viability is called somatic support. We present a case of young pregnant woman at 21 weeks' gestation who developed acute respiratory distress syndrome secondary to influenza A H2N3 infection requiring veno-venous extracorporeal membrane oxygenation (VV ECMO) support for refractory hypoxemia. The clinical course was complicated by intracranial hemorrhage and subsequent brain death. After multidisciplinary team discussion with her family, consensus was reached to continue somatic support with VV ECMO to enable fetal development to attain extrauterine viability. The challenging clinical, ethical, and legal concerns are discussed.

Clinical Proof of Concept for Stabilization of Tracheostomy Tubes Using Novel DYNAtraq Device.

Introduction: Tracheostomy is one of the most common surgical strategies in intensive care units (ICU) and provides relevant clinical benefit for multiple indications. However, the complications associated with its use range from 5 to 40% according to different series. The risk of these complications could be reduced if fixation strategies and alignment of the tracheostomy tube with respect to the tracheal axis are improved. Aim: To build a functional device of technological innovation in respiratory medicine for the fixation and alignment of tracheostomy cannula (acronym DYNAtraq) and to evaluate its feasibility and safety in a pilot study in mechanically ventilated patients. Methods: Study carried out in four phases: (1) design engineering and functional prototyping of the device; (2) study of cytotoxicity and tolerance to the force of traction and push; (3) pilot study of feasibility and safety of its use in tracheostomized and mechanically ventilated patients; and (4) health workers satisfaction study. Results: The design of the innovative DYNAtraq device included, on the one hand, a connector with very little additional dead space to be inserted between the cannula and the ventilation tubes, and, on the other hand, a shaft with two supports for adhesion to the skin of the thorax with very high tolerance (several kilograms) to pull and push. In patients, the device corrected the malpositioned tracheostomy tubes for the latero-lateral (p < 0.001) and cephalo-caudal angles (p < 0.001). Its effect was maintained throughout the follow-up time (p < 0.001). The use of DYNAtraq did not induce serious adverse events and showed a 70% protective effect for complications (RR = 0.3, p < 0.001) in patients. Conclusion: DYNAtraq is a new device for respiratory medicine that allows the stabilization, alignment and fixation of tracheostomy tubes in mechanically ventilated patients. Its use provides additional benefits to traditional forms of support as it corrects misalignment and increases tolerance to habitual or forced movements. DYNAtraq is a safe element and can reduce the complications of tracheostomy tubes.

Improving Extracorporeal Membrane Oxygenation Survival in COVID-19. Effect of a Bundle of Care.

Veno-venous extracorporeal membrane oxygenation (ECMO) support surged during the COVID-19 pandemic. Our program changed the model of care pursuing to protect the multidisciplinary team from the risk of infection and to serve as many patients as possible. Patient-healthcare interactions were restricted, and the ECMO bed capacity was increased by reducing the ECMO specialist-patient ratio to 1:4 with non-ECMO trained nurses support. The outcomes worsened and we paused while we evaluated and modified our model of care. The ECMO bed capacity was reduced to allow a nurse ECMO-specialist nurse ratio 2:1 with an ECMO trained nurse assistant's support. Intensivists, general practitioners, nurse assistants, and physical and respiratory therapists were trained on ECMO. Tracheostomy, bronchoscopy, and microbiological molecular diagnosis were done earlier, and family visits and rehabilitation were allowed in the first 48 hours of ECMO cannulation. There were 35 patients in the preintervention cohort and 66 in the postintervention cohort. Ninety days mortality was significantly lower after the intervention (62.9% vs. 31.8%, p = 0.003). Factors associated with increased risk of death were the need for cannulation or conversion to veno arterial or veno arterio venous ECMO, hemorrhagic stroke, and renal replacement therapy during ECMO. The interventions associated with a decrease in the risk of death were the following: early fiberoptic bronchoscopy and microbiological molecular diagnostic tests. Increasing the ECMO multidisciplinary team in relation to the number of patients and the earlier performance of diagnostic and therapeutic interventions, such as tracheostomy, fiberoptic bronchoscopy, molecular microbiological diagnosis of pneumonia, rehabilitation, and family support significantly decreased mortality of patients on ECMO due to COVID-19.

Invention and Pilot Study of the Efficacy and Safety of the SUPRAtube Device in Continuous Supraglottic Aspiration for Intubated and Mechanically Ventilated Patients.

BACKGROUND: Bronchoaspiration of content that accumulates in the supraglottic area (eg, saliva, gastroesophageal reflux) is a risk factor for ventilator-associated pneumonia. A continuous supraglottic suction system may decrease the risk of bronchoaspiration in these patients. OBJECTIVE: (1) Constructing a conceptual model and functional prototype of a continuous supraglottic suction device for use in humans; (2) defining functional characteristics in ex vivo swine head models; and (3) evaluating its efficacy and safety in mechanically ventilated patients. METHODS: Study conducted in three phases. First phase: definition of distances and diameters of the triangle determined by dental arch, posterior oropharynx and vallecula, and diameter of the oropharynx in axial projection; and identification of the declining area of supraglottic suction. Second phase: design engineering and functional prototype evaluated in ex vivo models. Third phase: evaluation of device use in terms of safety and efficacy in ventilated patients. RESULTS: We obtained a final functional model of the SUPRAtube device injected into PVC for medical use. Device effectiveness in in vitro simulation showed a high and fast suction capacity of liquid and thick volumes. Study of swine heads allowed to validate the shape, size and functional fenestration of the device. Study in intubated and mechanically ventilated patients showed a high supraglottic suction capacity and the absence of local adverse events during 72 (7-240) hours of continuous operation. CONCLUSION: Our study describes the process of conceptualization, design and production of a practical, safe, low-cost continuous supraglottic suction device without representing antibiotic pressure, which appears to be a new complementary preventive strategy for the standard management of intubated and mechanically ventilated patients.

The complementarity of the technical tools of tissue engineering and the concepts of artificial organs for the design of functional bioartificial tissues.

Although tissue engineering uses powerful biological tools, it still has a weak conceptual foundation, which is restricted at the cell level. The design criteria at the cell level are not directly related with the tissue functions, and consequently, such functions cannot be implemented in bioartificial tissues with the currently used methods. On the contrary, the field of artificial organs focuses on the function of the artificial organs that are treated in the design as integral entities, instead of the optimization of the artificial organ components. The field of artificial organs has already developed and tested methodologies that are based on system concepts and mathematical-computational methods that connect the component properties with the desired global organ function. Such methodologies are needed in tissue engineering for the design of bioartificial tissues with tissue functions. Under the framework of biomedical engineering, artificial organs and tissue engineering do not present competitive approaches, but are rather complementary and should therefore design a common future for the benefit of patients.

Experience with veno-venous ecmo in patients with adult respiratory distress syndrome secondary to viral pneumonia. Case series / Experiencia con ecmo veno-venoso en pacientes con síndrome de dificultad respiratoria del adulto secundario a neumonía viral. Serie de casos

Abstract Introduction The use of extracorporeal membrane oxygenation (ECMO) has increased exponentially in recent years and has shown to be effective in treating adult respiratory distress syndrome (ARDS) secondary to HiNi-related pneumonia. However, evidence remains controversial. This study describes a case series of ECMO in ARDS secondary to viral pneumonia. Methods A search was conducted in the ECMO database of Fundación Cardiovascular de Colombia for the 20132017 period. A case series report was written of patients diagnosed with ARDS secondary to confirmed or suspected viral pneumonia. Results Nineteen patients with ECMO support and ARDS due to viral pneumonia were included in the study. The survival rate upon discharge was 11 patients (58%) and weaning from ECMO support was successful in 13 patients (68%). Hemorrhagic complications were the most frequent: gastrointestinal bleeding, 10 patients (53%); intracranial bleeding, 2 (10%); alveolar hemorrhage, 2 (10%);' hemothorax requiring thoracostomy with chest tube drainage, 2 (10%); cannulation site bleeding, 9 patients (47%); and surgical site bleeding in 3 patients (25%) who required tracheostomy. Other complications were: pneumothorax, 1 patient (5%); sepsis, 6 patients (32%); and growth of microorganisms in bronchial lavage, 6 patients (32%). Conclusions This study supports the use of veno-venous ECMO to achieve a higher survival rate than expected in patients with severe ARDS and refractory hypoxemia secondary to viral pneumonia. Early initiation of the therapy should improve overall results.

Resumen Introducción El uso de la oxigenación por membrana extracorpórea (ECMO) ha tenido un incremento exponencial en los últimos años y ha demostrado ser efectivo en el manejo del síndrome de dificultad respiratoria del adulto (SDRA) secundario a neumonía por H1N1, si bien la evidencia sigue siendo controvertida. En este estudio describimos una serie de casos de ECMO por SDRA secundario a neumonía viral. Métodos Se realizó una búsqueda en la base de datos de ECMO de la Fundación Cardiovascular desde el año 20132017. Reportamos una serie de casos donde se incluyeron pacientes diagnosticados con SDRA secundario a neumonía viral sospechosa o confirmada. Resultados Se incluyeron en el estudio 19 pacientes con soporte de ECMO y SDRA por neumonía viral. La sobrevida al alta fue 11 pacientes (58%) y el destete del ECMO fue exitoso en 13 pacientes (68%). Las complicaciones hemorrágicas presentadas fueron: sangrado digestivo, 10 pacientes (53%), sangrado cerebral, 2 (10%), hemorragia alveolar, 2 (10%), hemotórax con requerimiento de toracostomía a drenaje cerrado, 2 (10%), sangrado activo por sitio de canulación, 9 pacientes (53%), y 3 pacientes traqueostomizados (25%) que sangraron por el sitio quirúrgico. Otras complicaciones presentadas fueron: neumotórax, 1 paciente (5%), septicemia, 6 (32%) y crecimiento de microorganismos en lavados bronquiales 6 (32%). Conclusion El presente estudio permite indicar que el uso de la ECMO VV viabiliza una sobrevida mayor a la esperada en pacientes con SDRA severo e hipoxemia refractaria secundario a neumonía viral. Su inicio tempranamente debe mejorar los resultados globales.

[High risk infective endocarditis embolism during pregnancy: Medical or surgical management?]. / Endocarditis infecciosa de alto riesgo embolígeno durante el embarazo: ¿manejo conservador o quirúrgico?

A 22-year-old pregnant woman was seen at 14 weeks of pregnancy for infective endocarditis with a vegetation of 15 mm and wide mobility, which affected the native mitral valve accompanied by severe valvular insufficiency. Antibiotic treatment was given for 4 weeks despite the embolism risk. Due to persistence of vegetation size and after considering the fetal and maternal risk, the surgical procedure was favored. We decided to perform valvuloplasty and removal of lesion at 18 weeks of pregnancy. Fetal protection techniques were used and a bioprosthesis was placed before attempting a repair. The postoperative follow-up was satisfactory, achieving a successful birth by cesarean section at 30 weeks.

Nuevo dispositivo de micronebulización con control continuo de la fracción inspirada de oxígeno ("CONTROLizer") / New micronebulizer device with continuous control of the inspired oxygen fraction ("CONTROLizer")

Resumen Una de las técnicas más comunes de tratamiento respiratorio es la nebulización de medicamentos para administrarlos por vía inhalada utilizando oxígeno como propelente, el cual a su vez es considerado un fármaco que puede generar efectos adversos relacionados con la dosificación. El objetivo de esta investigación fue diseñar, desarrollar y analizar un sistema dual de micronebulización con control preciso de la FIO2. Métodos: se diseñó, construyó y evaluó un modelo virtual y un prototipo funcional siguiendo la metodología de bioingeniería de un nuevo dispositivo de micronebulización con control de FIO2. Se evaluó el funcionamiento del dispositivo y su impacto en voluntarios sanos y pacientes hospitalizados mediante escalas psicométricas específicas. Resultados: se conceptualizó, diseñó y construyó un dispositivo que integra un micronebulizador (recipiente), que permite nebulizar suero fisiológico o soluciones de diversos fármacos basado en la presurización de un gas propelente (aire u oxígeno) junto a un mecanismo de ajuste de la fracción inspirada de O2 (mínimo 21%; máximo 99%). Los límites (máximo y mínimo) de flujo recomendado para generar el aerosol son 6-8 l/min. En ningún caso de uso se presentaron complicaciones. Conclusiones: CONTROLizer es un dispositivo integrado dual y no-invasivo para la micronebulización de soluciones respiratorias y control continuo de la fracción inspirada de oxígeno. Por sus cualidades y funcionamiento, el dispositivo fue percibido como adecuado y seguro para aplicarse en individuos sanos y pacientes ingresados tanto en salas de cuidados intensivos como de hospitalización convencional. (Acta Med Colomb 2018; 43: 90-99).

Abstract One of the most common techniques of respiratory treatment is the nebulization of medications to be administered by inhalation using oxygen as a propellant, which in turn is considered a drug that can generate adverse effects related to the dosage. The objective of this research was to design, develop and analyze a dual micronebulization system with precise control of FIO2. Methods: a virtual model and a functional prototype were designed, constructed and evaluated following the bioengineering methodology of a new micronebulizer device with FIO2 control. The functioning of the device and its impact on healthy volunteers and hospitalized patients were evaluated through specific psychometric scales. Results: a device that integrates a micronebulizer (container), which allows to nebulize physiological saline or solutions of diverse drugs based on the pressurization of a propellant gas (air or oxygen) along with a mechanism of adjustment of the fraction of inspired oxygen (minimum 21%, maximum 99%), was conceptualized, designed and constructed. The limits (maximum and minimum) of recommended flow to generate the aerosol are 6-8 l / min. In no case of use complications occurred. Conclusions: CONTROLizer is a dual and non-invasive integrated device for the micronebulization of respiratory solutions and continuous control of the fraction of inspired oxygen. Due to its qualities and functioning, the device was perceived as adequate and safe to be applied in healthy individuals and patients admitted in both intensive care and conventional hospitalization rooms. (Acta Med Colomb 2018; 43: 90-99).

Reporte del primer caso de implante exitoso de asistencia ventricular izquierda HeartMate II como terapia de destino en Suramérica / Report of the first successful case of HeartMate II Left Ventricular Assist Device placement as a destination therapy in South America

Resumen Se describe el caso de una paciente de sexo femenino de 55 años de edad, con insuficiencia cardiaca congestiva descompensada secundaria a cardiopatía dilatada idiopática y con contraindicación para trasplante cardiaco, en quien se implanta de manera exitosa el primer dispositivo de asistencia ventricular izquierda HeartMate II en Suramérica.

Abstract The case of a 55 year-old woman with decompensated congestive heart failure secondary to idiopathic dilated cardiomyopathy is described. Cardiac transplantation was contraindicated, and the first HeartMate II Left Ventricular Assist Device was placed in South America.

TriBURTER: invención y validación perceptual del dispositivo portátil de vibración de alta frecuencia y entrenamiento muscular para pacientes con enfermedades respiratorias / TriBURTER: invention and perceptual validation of a portable device aimed to induce high- frequency vibration and respiratory muscle training in patients with respiratory diseases

Introducción: los dispositivos respiratorios vibrátiles son útiles como elementos de terapia respiratoria pues facilitan la expectoración de las secreciones bronquiales. Un dispositivo respiratorio de vibración que incorpore válvulas duales representa una innovación relevante respecto a los modelos existentes. El presente estudio describe la invención y evaluación de un nuevo dispositivo médico portátil de vibración de alta frecuencia para uso humano que permite simultáneamente el entrenamiento muscular respiratorio para pacientes con enfermedades respiratorias, al que se ha denominado con el acrónimo TriBURTER. Métodos: se conceptualizaron, diseñaron y construyeron modelos virtuales y prototipos funcionales siguiendo metodología de bioingeniería y evaluación in situ del funcionamiento a través de simuladores electrónicos. Adicionalmente se evaluaron, mediante escalas psicométricas específicas, los aspectos perceptuales de la morfología y funcionamiento del dispositivo tanto en voluntarios sanos como pacientes. Resultados: se creó un dispositivo que logra tres efectos: facilitar la movilización de secreciones bronquiales, inducir efecto de entrenamiento sobre los músculos inspiratorios, e inducir entrenamiento de músculos espiratorios. La evaluación perceptual demostró que el diseño final del dispositivo es seguro, adecuado, suficiente y práctico. Conclusión: TriBURTER es un dispositivo médico innovador de terapia respiratoria vibrátil que facilita el drenaje de secreciones y genera una sobrecarga muscular, tanto inspiratoria como espiratoria, regulable y útil en el tratamiento de las enfermedades respiratorias, y que puede ser aplicado tanto en ámbito ambulatorio como domiciliario u hospitalario. Su evaluación perceptual demostró seguridad clínica y una adecuada aceptación de uso por parte de los voluntarios sanos y pacientes en términos de cualidad y funcionamiento. MÉD.UIS. 2016;29(2):49-57.

Introduction: vibratory devices are used in respiratory therapy in order to facilitate removal of bronchial secretions. A portable hydraulic system incorporating inspiratory and expiratory valves could provide additional advantages over existing ones. The present study describes the invention and evaluation of a new portable medical device able to induce high frequency vibration and allowing respiratory muscle training for patients with respiratory diseases, which has been named with the acronym TriBURTER. Methods: based on conventional methods of bioengineering, a hydraulic device was conceptualized, designed, built, and validated using electronic simulators. In addition, perceptual evaluations of morphology, final prototype design and function were evaluated in both healthy volunteers and patients through specific psychometric scales. Results: a hydraulic device including two unidirectional valves was finally obtained allowing to induce simultaneously a triple effect: mobilization of bronchial secretions, inspiratory muscle training, and expiratory muscle training. Perceptual evaluations showed that the final design is safe, adequate, sufficient and practical. Conclusion: TriBURTER is an innovative hydraulic medical device for respiratory therapy that facilitates drainage of secretions and generates adjustable inspiratory and expiratory muscle loads. The perceptual evaluations of the device showed proper acceptance of use by healthy volunteers and patients in terms of quality and performance. This device is useful for the treatment of respiratory diseases and can be prescribed for both outpatient and domiciliary or hospital settings. MÉD.UIS. 2016;29(2):49-57.

Endocarditis infecciosa de alto riesgo embolígeno durante el embarazo: ¿manejo conservador o quirúrgico? / High risk infective endocarditis embolism during pregnancy: Medical or surgical management?

Presentamos el caso de una paciente de 22 años de edad con embarazo de 14 semanas y endocarditis infecciosa de válvula mitral nativa con una vegetación de 15 mm con amplia movilidad, acompañada de insuficiencia valvular severa. Inicialmente, y pese al riesgo embolígeno, se dio tratamiento antibiótico durante 4 semanas. Por persistencia del tamaño de la vegetación se decide llevar a cirugía para reparación mitral y remoción de la lesión en la semana 18 de gestación, considerando que el balance entre el riesgo fetal y materno estaba a favor del procedimiento quirúrgico. Se usaron técnicas de protección fetal intraoperatoria y se colocó una prótesis biológica previo intento de reparación. La evolución postintervención fue satisfactoria, lográndose parto por cesárea a las 30 semanas.

A 22-year-old pregnant woman was seen at 14 weeks of pregnancy for infective endocarditis with a vegetation of 15 mm and wide mobility, which affected the native mitral valve accompanied by severe valvular insufficiency. Antibiotic treatment was given for 4 weeks despite the embolism risk. Due to persistence of vegetation size and after considering the fetal and maternal risk, the surgical procedure was favored. We decided to perform valvuloplasty and removal of lesion at 18 weeks of pregnancy. Fetal protection techniques were used and a bioprosthesis was placed before attempting a repair. The postoperative follow-up was satisfactory, achieving a successful birth by cesarean section at 30 weeks.

Estenosis subglótica idiopática: tratamiento con traqueoplastia endoscópica con balón / Idiophatic subglotal estenosis: treatment with endoscopic tracheoplasty with ballon

La broncoplastia endoscópica es un procedimiento útil en el tratamiento de estenosis tráqueales o bronquiales, por lo general, antes de la colocación de un stent de silicona para preparar el área anatómica de inserción, o como terapéutica provisional para la resolución de estenosis de tráquea, o subglotis en pacientes estables; mientras se programa el tratamiento endoscópico, médico o quirúrgico definitivo. Se presenta el caso de una paciente con estenosis subglótica idiopática a quien se le realizó tratamiento broncoplastia endoscópica con balón obteniéndose resultados favorables hasta la fecha. El objetivo de este artículo es dar a conocer esta útil alternativa terapéutica en Bucaramanga.

Endoscopic bronchoplasty is a useful procedure in the treatment of tracheobronchial stenosis, generally, before the positioning of stent of silicone to prepare the anatomical area of insertion, or like therapeutic provisional for the resolution of estenosis of trachea, or subglottis in stable patients; while the endoscópico treatment is programmed, medical or surgical definitive. We presented the case of a patient with idiophatic subglottal estenosis who we made endoscopic treatment with broncoplastia with ball with favorable results.

Experiencia en el manejo endovascular para el tratamiento de la aorta torácica / Experience in endovascular management for thoracic aorta treatment

Antecedentes: el tratamiento endovascular ofrece la posibilidad de cubrir el origen de la disección y evitar que progrese hasta aneurisma de la aorta, y con ello demuestra una reducción en la mortalidad hasta del 16 porciento.Objetivo: evaluar los resultados quirúrgicos en términos de morbi-mortalidad de los pacientes sometidos a manejo endovascular de las lesiones de la aorta torácica en la Fundación Cardiovascular de Colombia desde 2003 hasta 2005. Diseño–método: estudio longitudinal tipo descriptivo retrospectivo, en el que se evaluaron las historias clínicas de todos los pacientes sometidos a manejo endovascular de patología toracoabdominal; en éste sólo se incluyeron los pacientes con procedimientos de la aorta torácica, desde 2003 hasta 2005. El análisis de los datos se realizó en Stata/SE 8,0...

Tratamiento de aorta abdominal e ilíacas con técnica endovascular / Treatment of abdominal aorta and iliac arteries with endovascular technique

Antecedentes: desde 1991 la técnica endovascular se ha aplicado con éxito en el manejo de los aneurismas de aorta infrarrenal, y se ha perfeccionado de manera tal que rápidamente se ha convertido en una alternativa para pacientes de alto riesgo para la cirugía convencional. Objetivo: describir los resultados institucionales en el manejo de las patologías de aorta abdominal e ilíacas mediante técnica endovascular desde 2003 a 2005.Diseño-Método: estudio descriptivo, longitudinal, retrospectivo, en el que se analizaron las historias clínicas de los pacientes sometidos a procedimiento endovascular de aorta abdominal e ilíacas. El análisis se realizó en Stata 8,0 S/E...

Antecedents: since 1991 endovascular technique has been successfully used in the management of infra-renal aortic aneurysms and it has been improved in such a way that it has quickly turned into an alternative for patients considered having high risk for conventional surgery. Objective: describe the institutional results in the management of abdominal aortic pathologies through endovascular technique from 2003 to 2005. Design-Method: descriptive, longitudinal, retrospective study in which clinical histories of patients that underwent an endovascular procedure of abdominal aorta and iliac arteries were analyzed. The analysis was performed in Stata 8,0 S/E. Results: 9 patients received exclusively treatment for abdominal aortic and iliac lesions. All were male individuals with mean age 68.9 ± 8.1 years. 6 patients had diagnosis of infra-renal aortic aneurysm and the other 3 had anastomotic aneurysms. Requirement of endoprosthesis was evidenced in an average of 1.9 ± 0.8. Femoro-femoral bypass surgery was performed as simultaneous procedure in 4 of the 9 patients. 77.8% of patients had no complications. Mortality due to the procedure was 22% (2 patients) and it is important to notice that only these 2 patients had complications. Conclusions: exclusion of aortic and iliac aneurysms with modular endoprosthesis is being widely implemented as a valid treatment option, with excellent results that avoid the risks of conventional surgery and its associated morbidity.

Manejo endovascular de la aorta torácica / Endovascular treatment of thoracic aorta

En comparación con el tratamiento convencional, la terapia endovascular en aneurisma de aorta torácica, presenta los mejores resultados, por lo que se convierte en el tratamiento de elección para la patología de aorta torácica descendente endovascular, por su baja morbimortalidad perioperatoria. El tratamiento quirúrgico por vía retroperitoneal y/o endovascular para aneurisma de aorta abdominal infrarrenal, resulta ser especialmente seguro en pacientes octogenarios o con alta morbilidad. Esta cohorte institucional presenta resultados perioperatorios y en el seguimiento, similares a los reportados en la literatura mundial.

Compared with the conventional treatment, endovascular therapy in thoracic aortic aneurysm shows the best results, being the election treatment for the pathology of the descending thoracic aorta, due to its low peri-operative morbid-mortality. Surgical treatment by retro-peritoneal route and/or endovascular for infra-renal abdominal aortic aneurysm is especially safe in octogenarian patients or in those with a high mortality rate. This institutional cohort show peri-operative and follow-up results similar to those reported in the world literature.

Arteria carótida y placa carótida un órgano / Carotid artery and plaque. Carotid: an organ

En estos momentos es posible hacer recomendaciones sobre las indicaciones de la endarterectomía carotídea, basadas en los ensayos clínicos publicados y en la revisión de grandes series quirúrgicas. Las indicaciones para la cirugía dependerán del grado de estenosis y de la morfología de la placa, así como del estado clínico del paciente y de la morbi-mortalidad del equipo quirúrgico. Este al igual que otros estudios con grandes series de casos, evidencia que la endarterectomía carotídea y/o el manejo endovascular, realizado por equipos expertos, es un procedimiento seguro en pacientes con indicación quirúrgica.

It is now possible to recommend indications for aortic endarterectomy, based on published clinical essays and revision of large surgical series. Surgery indications will depend on the stenosis degree and the plaque morphology, as well as on the patient's clinical state and the morbid-mortality in this surgical team. As other studies with large case series, evidences that carotid endarterectomy and/or endovascular management, when realized by expert teams, is a safe procedure in patients with surgical indication.

Endarterectomía carotídea en pacientes sintomáticos y asintomáticos: resultados de morbi-mortalidad desde 1998 hasta 2005 / Carotid endarterectomy in symptomatic and asymptomatic patients: morbid-mortality results from 1998 to 2005

Antecedentes: el accidente cerebrovascular es la tercera causa de muerte y probablemente la causa más importante de discapacidad a largo plazo. La tasa de mortalidad está entre 15% y 35% con el primer ataque y se eleva a 65% para los accidentes cerebrovasculares subsiguientes. Los resultados a largo y mediano plazo avalan esta técnica quirúrgica para el tratamiento de la enfermedad carotídea, al demostrar altos perfiles de seguridad. Objetivo: determinar los resultados de morbilidad y mortalidad quirúrgica y a 3, 6 y 12 meses de seguimiento, en los pacientes sometidos a endarterectomía carotídea desde 1998 hasta septiembre de 2005. Diseño-método: se evaluaron las historias clínicas de los pacientes sometidos a endarterectomía carotídea, desde 1998 hasta septiembre de 2005. Resultados: se realizaron 42 procedimientos desde 1998 hasta septiembre de 2005; el 57% de los pacientes eran hombres, con edad promedio de 68,8 ± 9,9 años. Los antecedentes de importancia fueron: hipertensión arterial (82%), tabaquismo (61%) y dislipidemia (50%). El 82% de los pacientes mostraban síntomas de enfermedad carotídea. Once pacientes tuvieron lesión de carótida derecha, 16 de carótida izquierda y 15 lesión bilateral, con un promedio de obstrucción de 85 ± 11,4%. La mortalidad fue de 4,7% y no estaba relacionada con el procedimiento quirúrgico. A septiembre de 2005 el 57% de los pacientes egresados estaban libres de síntomas. Conclusiones: la mortalidad para este grupo de pacientes es comparable con los resultados publicados en todo el mundo. La seguridad del procedimiento avala esta técnica quirúrgica como la primera opción en el manejo de la patología carotídea.

Antecedents: cerebrovascular disease is the third cause of death and probably the most common cause of significant long term disability. Mortality rate with first stroke is between 15% and 35% and goes up to 65% with subsequent strokes. Results at long and middle term endorse carotid endarterectomy for carotid artery disease treatment by demonstrating high safety profiles. Objective: to determine the surgical morbidity and mortality results at 3, 6 and 12 months of follow-up in patients submitted to carotid endarterectomy from 1998 to 2005. Design-Method: clinical histories of patients submitted to carotid endarterectomy from 1998 to September 2005 were evaluated. Results: 42 procedures were realized since 1998 until September 2005. 57% of the patients were men with mean age 68.8 ± 9.9 years. Important antecedents were arterial hypertension (82%), cigarette smoking (61) and dyslipidemia (50%). 82% showed symptoms of carotid disease. 11 patients had right carotid lesion and in 15 the lesion was bilateral, with mean obstruction of 85 ± 11.4%. Mortality was 4.7% and was not related to the surgical procedure. At September 2005, 57% of the discharged patients were asymptomatic. Conclusions: mortality for this group of patients is comparable to the worldwide published results. Procedure safety guarantees this surgical technique as the first option in this carotid pathology management.