[Off-pump coronary revascularization. Late survival]. / Revascularización coronaria sin circulación extracorpórea. Supervivencia alejada.

Although randomized clinical trials have compared the short-term results of coronary revascularization with on-pump vs. off-pump, the long-term survival effect of off-pump coronary surgery has not been analyzed. The aim of this study was to compare the long-term survival of patients with coronary surgery with off-pump technique. All patients that underwent coronary revascularization from November 1996 to March 2015 were included (n = 4687). We analyzed the long-term survival and the incidence of cardiac events between patients who received off-pump coronary revascularization (n = 3402) against those revascularized with on-pump technique (n = 1285). The primary endpoint was defined as death from any cause. To reduce potential biases, risk-adjusted analysis was performed (propensity score). In-hospital mortality and during follow-up (10 years) for both groups were analyzed. The overall hospital mortality was 3.1%. A statistically significant difference between groups in favor of off-pump surgery was observed (2.3% vs. 5.2%, p < 0.0001). In the survival analysis, off-pump surgery proved to have similar long-term survival as on-pump surgery (off-pump vs. on-pump: 77.9% ± 1.2% vs. 80.2% ± 1.3%, p log rank = 0.361); even in the adjusted survival analysis (84.2% ± 2.9% vs. 80.3% ± 2.4%, p = 0.169). In conclusion, off-pump coronary surgery was associated with lower in-hospital mortality; and it was not associated with increased long-term survival compared with on-pump surgery.

Changes in intramuscular fat, fatty acid profile and cholesterol content induced by zeranol implantation strategy in hair lambs.

BACKGROUND: The effect of zeranol implantation strategy on intramuscular fat, fatty acid profile and cholesterol content of the longissimus dorsi muscle of hair lambs was studied. Four treatments were tested: C, control group; Z12, 12 mg zeranol; Z24, 24 mg zeranol in a single application; and RZ12, 12 mg zeranol given twice. One-way analysis of variance was employed to estimate the effect of treatments (P < 0.05). To separate the effect of the mean, orthogonal contrasts were tested: C1, C versus Z12 + Z24 + RZ12; C2, Z12 versus Z24 + RZ12; and C3, Z24 versus RZ12. RESULTS: A decrease (P < 0.05) in intramuscular fat content was observed from implanting (C1 effect) and zeranol reimplantation (C3 effect). Implanted lambs exhibited an increase (P < 0.05) in monounsaturated fatty acids compared with control group (40.60% versus 35.35%). All contrasts were significant for the sum of n-6 and n-3, with values lower (P < 0.05) in the control (n-6: 0.84% and n-3: 1.38%) and higher in the RZ12 treatment (n-6: 7.55% and n-3: 14.9%). Cholesterol decreased by 78% with implantation and increasing the dose. CONCLUSION: The results indicate that it is possible to induce favorable changes in the fatty acid profile and cholesterol content using a zeranol implantation strategy on hair lambs.

Modelling the Effects of Roselle Extract, Potato Peel Flour, and Beef Fat on the Sensory Properties and Heterocyclic Amines Formation of Beef Patties Studied by Using Response Surface Methodology.

Heterocyclic amines (HCAs) are compounds with carcinogenic potential formed during high-temperature processing of meat and meat products. Vegetables or their extracts with high antioxidant capacity can be incorporated into the meat matrix to reduce their formation, but it is necessary to find the optimal levels to achieve maximum inhibition without affecting the sensory properties. The objective of this study was to evaluate the effects of roselle extract (RE, 0-1%), potato peel flour (PP, 0-2%), and beef fat (BF, 0-15%) on the sensory properties and formation of HCAs in beef patties using response surface methodology. IQx, IQ, MeIQx, MeIQ, 4,8-DiMeIQx, and PhIP were identified and quantified by HPLC. Regression models were developed to predict sensory properties and HCAs' formation. All models were significant (p < 0.05) and showed a R2 > 0.70. Roselle extract and beef fat had a negative linear effect on the formation of the total HCAs, while PP had a positive linear effect. The optimal formula that minimizes the formation of HCAs included 0.63% RE, 0.99% PP, and 11.96% BF. RE and PP are foods that can be used as ingredients in low-fat beef patties to minimize the formation of HCAs without affecting their sensory properties.

Pork frankfurters prepared with hydrolyzed whey: Preliminary product quality aspects and inhibitory activity of the resulting peptides on angiotensin-converting enzyme.

The objective of this study was to assess the addition of whey protein hydrolysate (WH) on quality and antihypertensive potential of pork frankfurters, as the first step in development of a functional meat product. A hydrolyzed whey protein solution was incorporated in the frankfurter formula according to the following treatments: T0 (30% water), T1 (10% WH, 20% water), T2 (20% WH, 10% water) and T3 (30% WH). Addition of up to 30% WH increased lightness and yellowness, decreased hardness and chewiness by 15% and shear force by 43%, with no effect on pH (6.36) and cooking yield (93%). The WH addition resulted in an increase in the antihypertensive potential (IC50 258.78 µg/mL) relative to the T0 (IC50 1548.25 µg/mL). Cold storage of the product with 30% WH did not impact physicochemical quality, nor did it modify the antihypertensive potential. Incorporation of whey hydrolysate into pork frankfurters could be an option for providing antihypertensive peptides in food for health-oriented consumers.

Quality evaluation of low fat bologna-type meat product with a nutritional profile designed for the elderly.

The objective of this work was to evaluate the quality of a bologna-type meat product designed for the elderly. Treatments were: control, without addition of cranberries (C), prunes (P), pecan nuts (N) or flaxseed (F); NP, with 5% N+5% P; FC, with 5% F+5% C; NC, with 5% N+5% C; FP, with 5% F+5% P. These formulations resulted in a product with high protein, low SFA and high antioxidant activity. Treatments with pecan nuts had higher MUFA while those with flaxseed had higher polyunsaturated fatty acids (PUFA). Treatments with pecan nuts and flaxseed had higher PUFA/SFA ratios, but only those with flaxseed had very low n6/n3 ratios when compared to the control. Although treatments showed acceptable scores (>5.4), they were lower than the control. A combination of these non-traditional ingredients could be used to develop a meat product for older adults to provide a better nutritional profile with acceptable sensory properties.

Effects and interactions of gallic acid, eugenol and temperature on thermal inactivation of Salmonella spp. in ground chicken.

The combined effects of heating temperature (55 to 65°C), gallic acid (0 to 2.0%), and eugenol (0 to 2.0%) on thermal inactivation of Salmonella in ground chicken were assessed. Thermal death times were determined in bags submerged in a heated water bath maintained at various set temperatures, following a central composite design. The recovery medium was tryptic soy agar supplemented with 0.6% yeast extract and 1% sodium pyruvate. D-values were analyzed by second-order response surface regression for temperature, gallic acid, and eugenol. The observed D-values for chicken with no gallic acid or eugenol at 55, 57.5, 60, 62.5, and 65°C were 21.85, 5.43, 2.83, 0.58, and 0.26min, respectively. A second-order polynomial model developed to inactivate Salmonella was found to be significant (p<0.0001) with a R2=0.95 and a no significant lack of fit (p>0.1073). Efficacy of the additives in increasing the sensitivity of the pathogen to heat was concentration dependent. The model developed in this study can be used by processors to design appropriate thermal process to inactivate Salmonella in chicken products used in the study and thereby, ensuring an adequate degree of protection against risks associated with the pathogen.

Bilateral Internal Thoracic Artery Grafting Increases Mediastinitis: Myth or Fact?

BACKGROUND: There is controversy about the risk of mediastinitis associated with the use of both internal thoracic arteries (ITA). METHODS: We performed a case-control study of patients operated on at a single institution from January 2003 to December 2014. A total of 3,118 consecutive patients undergoing isolated coronary artery bypass graft surgery were included; 81.3% (n = 2,533) underwent bilateral ITA (BITA) grafts exclusively and constitute the BITA group, and 18.7% (n = 585) constitute the single ITA (SITA) group. Mediastinitis was defined as deep tissue mediastinal infection, with clinical or microbiologic evidence. Continuous variables were expressed as mean ± SD, and categoric variables as percentage (range). Student's t test and Fisher's exact test were used, as appropriate. Propensity score matching analysis was performed according to the nearest neighbor estimation method (n = 1,040). RESULTS: The incidence of diabetes mellitus was similar in both groups (29%, p = 0.9). The BITA patients were more like to be younger (p < 0.001), men (p < 0.001), had a higher prevalence of hypertension (p < 0.01), higher body mass index (p < 0.001), lower prevalence of left ventricular dysfunction (p < 0.001) and of previous myocardial infarction (p < 0.01), and greater use of off-pump coronary artery bypass graft surgery (p < 0.01). The BITA patients had lower unadjusted hospital mortality (1.6%, versus 5.3% for SITA, p < 0.0001). The total incidence of mediastinitis was 1.8% (BITA 1.9% versus SITA 1.5%, p = 0.6). Diabetes (p < 0.01) and nonelective surgery (p = 0.004) were the only predictors of mediastinitis in the entire population. Propensity score matching showed no differences in mediastinitis: BITA 2.5% versus SITA 1.3% (p = 0.17). CONCLUSIONS: In this series of patients, BITA did not increase the risk of mediastinitis in the total population or in the propensity score matched subgroups.

Myocardial Revascularization Exclusively With Bilateral Internal Thoracic Arteries in T-Graft Configuration: Effects on Late Survival.

BACKGROUND: We studied long-term survival using bilateral internal thoracic artery (BITA) grafting in a T-configuration exclusively versus using single internal thoracic artery (SITA) grafting in patients with multivessel disease. METHODS: Consecutive coronary operations performed at a single center between 1996 and 2014 were reviewed. Long-term survival among patients receiving coronary revascularization exclusively with BITA grafting in a T-configuration (n = 2,098) versus SITA grafts plus other types of conduits (saphenous vein graft [SVG] and radial artery [RA]) grafts (n = 1,659). In patients who underwent BITA grafting, the left internal thoracic artery (LITA) was grafted mainly to the left anterior descending artery, whereas the right internal thoracic artery (RITA) was used more commonly to graft the circumflex (Cx) artery and the right coronary system as T-grafts. A total of 485 pairs of patients were matched using propensity scores. Cox proportional hazard models were generated to examine the association of arterial BITA grafting with mortality. RESULTS: Patients in the BITA group were more likely to be younger (BITA, 63.7 ± 9.1 versus SITA, 65.0 ± 9.9; p < 0.0001). At 30 days, patients who underwent BITA grafting experienced reduced unadjusted mortality (BITA, 1.2% versus SITA, 4.4%; p < 0.0001). At 10 years, patients who underwent BITA grafting experienced superior unadjusted survival (BITA, 82.6% ± 1.8% versus SITA, 76.1% ± 1.3%; p = 0.001). Cox regression analysis in the entire study cohort showed that BITA grafting was associated with improved survival (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.58-0.87; p < 0.001). In the propensity-score-adjusted analysis, patients who underwent BITA grafting had similar in-hospital mortality (BITA, 1.6% versus SITA, 2.9%; p = 0.196). Patients who underwent BITA grafting still showed improved survival at 10 years (BITA, 81.0% ± 4.1% versus SITA, 71.8% ± 2.5%; p = 0.039). CONCLUSIONS: This study suggests that coronary artery operations exclusively with BITA grafting in a T-configuration may be associated with better long-term survival than grafting with SITA plus other types of conduits.

Effect of Grapefruit Seed Extract on Thermal Inactivation of Listeria monocytogenes during Sous-Vide Processing of Two Marinated Mexican Meat Entrées.

D- and z-values for Listeria monocytogenes were obtained for two Mexican meat entrées: pork meat marinated in tomatillo (green tomato) sauce (PTS) and beef marinated in a red chili sauce (BRCS), with addition of 0, 200, and 800 ppm of grapefruit seed extract (GSE). Meat samples inoculated with L. monocytogenes were packaged in sterile bags, immersed in a water bath, and held at 55, 57.5, 60, and 62.5°C for different periods of time. Depending upon the temperature, D-values at 0 ppm of GSE ranged from 26.19 to 2.03 min in BRCS and 26.41 to 0.8 min in PTS. Adding 800 ppm of GSE to BRCS thermally treated at 55 and 62.5°C significantly decreased inactivation time by 35%. A reduction in time of 25.9, 10.6, and 40.1% at 55, 57.5, and 60°C, respectively, was observed in PTS with 800 ppm of GSE. The z-values of L. monocytogenes were not significantly affected by GSE addition; average z-values were 7.25 and 5.09°C for BRCS and PTS, respectively. Estimated thermal lethality for a 7-D log reduction of L. monocytogenes under commercial-size sous-vide conditions at a reference temperature of 55°C was reached at 78 and 71 min for BRCS without and with 800 ppm of GSE, respectively. For PTS, 7-D reduction was attained at 69 and 61 min without and with addition of 800 ppm of GSE, respectively. Supplementing both Mexican meat entrées (BRCS and PTS) with 800 ppm of GSE rendered L. monocytogenes cells more sensitive to the lethal effect of heat. The results of this study will assist the retail food industry in designing acceptance limits on critical control points pertaining to cooking regimes to effectively eliminate L. monocytogenes in BRCS and PTS sous-vide processed Mexican meat entrées.

Development of a predictive model for Salmonella spp. reduction in meat jerky product with temperature, potassium sorbate, pH, and water activity as controlling factors.

The objective of this study was to develop a predictive model for the inactivation of Salmonella spp. in ground beef jerky as a function of temperature (T), pH, potassium sorbate (PS), and final water activity (aw). Following a central composite design, ground beef was combined with PS (0 to 0.3%, w/w), pH adjusted from 5 to 7, inoculated with a cocktail of 6 serotypes of Salmonella spp. and heat processed at temperatures between 65 and 85°C until the final aw ranging from 0.65 to 0.85 was achieved. Surviving Salmonella cells were enumerated on tryptic soy agar overlaid with xylose lysine deoxycholate agar (pre-tempered to 47°C) after incubation for 48h at 30°C. Bacterial inactivation was quantified in terms of logarithmic reductions of Salmonella counts (log10CFU/g) and inactivation rate (log10(CFU/g)/h). The results indicated that pH, PS and T significantly (p<0.05) interacted to inactivate Salmonella in beef jerky. Decreasing meat pH significantly (p<0.05) increased the efficacy of PS and T to reduce the levels of Salmonella spp. Beef jerky processed at 82°C, pH5.5, with 0.25% PS to a final aw of 0.7 resulted in a maximum Salmonella logarithmic reduction of 5.0log10CFU/g and an inactivation rate of 1.3log10(CFU/g)/h. The predictive model developed can be used to effectively design drying processes for beef jerky under low humidity conditions and thereby, ensuring an adequate degree of protection against risks associated with Salmonella spp.

Modeling the effects of temperature, sodium chloride, and green tea and their interactions on the thermal inactivation of Listeria monocytogenes in turkey.

The interactive effects of heating temperature (55 to 65°C), sodium chloride (NaCl; 0 to 2%), and green tea 60% polyphenol extract (GTPE; 0 to 3%) on the heat resistance of a five-strain mixture of Listeria monocytogenes in ground turkey were determined. Thermal death times were quantified in bags that were submerged in a circulating water bath set at 55, 57, 60, 63, and 65°C. The recovery medium was tryptic soy agar supplemented with 0.6% yeast extract and 1% sodium pyruvate. D-values were analyzed by second-order response surface regression for temperature, NaCl, and GTPE. The data indicated that all three factors interacted to affect the inactivation of the pathogen. The D-values for turkey with no NaCl or GTPE at 55, 57, 60, 63, and 65°C were 36.3, 20.8, 13.2, 4.1, and 2.9 min, respectively. Although NaCl exhibited a concentration-dependent protective effect against heat lethality on L. monocytogenes in turkey, addition of GTPE rendered the pathogen more sensitive to the lethal effect of heat. GTPE levels up to 1.5% interacted with NaCl and reduced the protective effect of NaCl on heat resistance of the pathogen. Food processors can use the predictive model to design an appropriate heat treatment that would inactivate L. monocytogenes in cooked turkey products without adversely affecting the quality of the product.

Revascularización coronaria sin circulación extracorpórea: Supervivencia alejada / Off-pump coronary revascularization. Late survival

Aunque los ensayos clínicos aleatorizados han comparado los resultados de la cirugía de revascularización coronaria (CRM) con y sin circulación extracorpórea (CEC), el efecto a largo plazo con la utilización de estas técnicas no ha sido evaluado. El objetivo del estudio fue evaluar la supervivencia alejada con la utilización de CRM con y sin CEC. Se incluyeron todos los pacientes sometidos a CRM durante el período 1996-2015 (n = 4687). La supervivencia a largo plazo y la incidencia de eventos cardíacos se compararon entre los que recibieron CRM sin-CEC (n = 3402) frente a los pacientes con-CEC (n = 1285). El punto final primario se definió como muerte por cualquier causa, analizándose la supervivencia a 10 años. Para reducir posibles sesgos se realizó un análisis ajustado por riesgo. La mortalidad hospitalaria global fue 3.1%, observándose una diferencia entre ambos grupos (2.3% vs. 5.2%, p < 0.0001) a favor de la cirugía sin-CEC. El análisis de la mortalidad no ajustada a largo plazo no mostró una diferencia significativa a 10 años (sin-CEC vs. con-CEC: 77.9% ± 1.2% vs. 80.2% ± 1.3%, p log rank = 0.361). En el análisis ajustado por riesgo tampoco se observó una diferencia significativa de supervivencia a 10 años (84.2% ± 2.9% vs. 80.3% ± 2.4%, p = 0.169). En conclusión, la CRM sin-CEC presentó una menor mortalidad hospitalaria, y no se encontró una diferencia en la mortalidad a largo plazo en comparación con CRM con-CEC.

Although randomized clinical trials have compared the short-term results of coronary revascularization with on-pump vs. off-pump, the long-term survival effect of off-pump coronary surgery has not been analyzed. The aim of this study was to compare the long-term survival of patients with coronary surgery with off-pump technique. All patients that underwent coronary revascularization from November 1996 to March 2015 were included (n = 4687). We analyzed the long-term survival and the incidence of cardiac events between patients who received off-pump coronary revascularization (n = 3402) against those revascularized with on-pump technique (n = 1285). The primary endpoint was defined as death from any cause. To reduce potential biases, risk-adjusted analysis was performed (propensity score). In-hospital mortality and during follow-up (10 years) for both groups were analyzed. The overall hospital mortality was 3.1%. A statistically significant difference between groups in favor of off-pump surgery was observed (2.3% vs. 5.2%, p < 0.0001). In the survival analysis, off-pump surgery proved to have similar long-term survival as on-pump surgery (off-pump vs. on-pump: 77.9% ± 1.2% vs. 80.2% ± 1.3%, p log rank = 0.361); even in the adjusted survival analysis (84.2% ± 2.9% vs. 80.3% ± 2.4%, p = 0.169). In conclusion, off-pump coronary surgery was associated with lower in-hospital mortality; and it was not associated with increased long-term survival compared with on-pump surgery.

Cirugía coronaria con doble arteria mamaria interna: efecto en sobrevida a largo plazo / Coronary Artery Bypass Graft Surgery with Double Internal Mammary Artery: Effect on Long-Term Survival

Introducción: El uso de la arteria mamaria interna (AMI) izquierda en la cirugía de revascularización miocárdica (CRM) se asocia con mejor sobrevida alejada libre de eventos cardíacos tardíos; asimismo, el empleo de la AMI derecha como complemento de la izquierda ha mostrado resultados favorables. Sin embargo, aún no queda claro si la revascularización con doble AMI es una mejor opción para los pacientes a largo plazo. Objetivo: Analizar la sobrevida a largo plazo de pacientes con CRM con doble arteria mamaria interna (2AMI) en comparación con pacientes con una AMI (1AMI) en la enfermedad de múltiples vasos. Material y métodos: Se revisaron CRM consecutivas realizadas entre 1996 y 2014 de pacientes con 2AMI (n = 2.098) y con 1AMI (n = 1.659). Se comparó la sobrevida a largo plazo entre los grupos en forma global y entre 485 pares de pacientes ajustados por un puntaje de riesgo. Se generaron modelos de riesgos proporcionales de Cox. Resultados: Los pacientes con 2AMI eran más jóvenes (63,7 ± 9,1 años 2AMI vs. 65,0 ± 9,9 años 1AMI; p < 0,0001). La mortalidad hospitalaria global fue menor en el grupo 2AMI (1,2% 2AMI vs. 4,4% 1AMI; p < 0,0001). A los 10 años, la sobrevida no ajustada fue superior en el grupo 2AMI (82,6% ± 1,8% 2AMI vs. 76,1% ± 1,3% 1AMI; p = 0,001). El análisis de regresión logística de Cox en el grupo global demostró mayor sobrevida en los pacientes con 2AMI (HR 0,71, IC 95% 0,58-0,87; p < 0,001). En el análisis ajustado por puntaje de riesgo, la mortalidad hospitalaria fue similar en ambos grupos (1,6% 2AMI vs. 2,9% 1AMI; p = 0,196). La sobrevida alejada a los 10 años fue significativamente superior en el grupo de pacientes con 2AMI que en el grupo con 1AMI (81,0% ± 4,1% vs. 71,8% ± 2,5%, respectivamente; p = 0,039). Conclusión: Los pacientes con CRM y 2AMI presentaron mejor sobrevida alejada que los pacientes con 1AMI más otro tipo de conducto.

Background: Utilization of the left internal mammary artery (IMA) in coronary artery bypass graft surgery (CABG) is associated with long-term survival free from late cardiac events; moreover, use of the right IMA as a complement of the left artery has shown favorable results. However, it is not yet clear whether double IMA revascularization is a better long-term option. Objective: The aim of this work was to analyze long-term survival of patients with multi-vessel disease undergoing double IMA (2IMA) compared with single IMA (1IMA) CABG. Methods: Consecutive 2IMA (n=2,098) and 1IMA (n=1,659) CABG surgeries performed between 1996 and 2014 were reviewed, comparing overall long-term survival between groups and between 485 pairs of patients matched by propensity score. Cox proportional hazard models were generated. Results: Patients with 2IMA CABG were younger (2IMA: 63.7±9.1 years vs. 1IMA: 65.0±9.9 years; p<0.0001). Overall in­hospital mortality was lower in the 2IMA group (2IMA: 1.2% vs. 1IMA: 4.4%; p<0.0001). At 10 years, unadjusted survival was higher in the 2IMA group (2IMA: 82.6%±1.8% vs. 1IMA: 76.1%±1.3%; p=0.001). Overall Cox logistic regression analysis showed higher survival in patients with 2IMA CABG (HR 0.71, 95% CI 0.58-0.87; p<0.001). In the propensity score adjusted analysis, in-hospital mortality was similar in both groups (2IMA: 1.6% vs. 1IMA: 2.9%; p=0.196), but the 2IMA group still had higher long-term survival at 10 years (2IMA: 81.0%±4.1% vs. 1IMA: 71.8%±2.5%; p=0.039). Conclusion: Patients with 2IMA CABG evidenced better long-term survival than patients with 1IMA plus another type of conduit.

Riesgo inmediato y alejado de la cirugía de revascularización miocárdica en el síndrome coronario agudo / Short and Long-term Risk of Coronary Artery Bypass Graft Surgery in Acute Coronary Syndrome

Introducción: En pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST), la angioplastia transluminal coronaria es el método de revascularización más utilizado; sin embargo, la cirugía de revascularización miocárdica es una alternativa terapéutica que permite tratar a este tipo de pacientes con buenos resultados. Objetivos: Comparar la evolución hospitalaria y alejada de los pacientes sometidos a cirugía de revascularización miocárdica según el cuadro clínico de presentación. Material y métodos: Entre enero de 1998 y julio de 2013 se realizó cirugía de revascularización miocárdica aislada en 3.604 pacientes en forma consecutiva. La población se dividió en pacientes con SCASEST (Grupo SCA, n = 2.079) o con angina crónica estable (Grupo ACE, n = 1.525). Se efectuó un análisis de la morbimortalidad posoperatoria y al seguimiento. Resultados: El Grupo ACE tuvo mayor uso de mamaria bilateral (58,2% vs. 50,3%; p = 0,001) y mayor tiempo operatorio (211 min vs. 203 min; p = 0,002). El Grupo SCA presentó más bajo gasto cardíaco posoperatorio (4,5% vs. 3,1%; p = 0,043). La mortalidad hospitalaria fue mayor en los pacientes con SCA (2,8% vs. 1,8%; p = 0,046). Luego de ajustar por puntaje de riesgo no hubo diferencia estadísticamente significativa en la mortalidad hospitalaria (1,3% en ACE vs. 1,6% en SCA; p = 0,681) ni en la tasa de complicaciones posoperatorias. La sobrevida global alejada en el seguimiento a 10 años no fue diferente entre grupos (ACE 85% ± 1,3% vs. SCA 83% ± 1,1%; p = 0,363). El tiempo libre de reintervención a los 10 años fue similar entre ambos grupos (ACE 89,5% ± 1,2% vs. SCA 89,1% ± 0,9%; p = 0,1680). Estos resultados se mantuvieron luego de ajustar por puntaje de riesgo. Conclusiones: Los pacientes sometidos a cirugía de revascularización miocárdica en el contexto de un SCASEST presentaron una mortalidad perioperatoria mayor, pero con una evolución a largo plazo similar a la de los pacientes intervenidos en forma electiva. No hubo diferencias en la mortalidad perioperatoria cuando se ajustó por puntaje de riesgo.

Background: Percutaneous coronary intervention is the revascularization procedure most widely used in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). However, coronary artery bypass graft surgery is a therapeutic alternative which allows treating these patients with a favorable outcome. Objectives: The aim of this study was to compare in-hospital and long-term outcome of patients undergoing coronary artery bypass graft surgery according to their clinical presentation. Methods: Between January 1998 and July 2013, 3604 consecutive patients underwent isolated coronary artery bypass graft surgery. The population was divided in patients with NSTEACS (ACS Group, n = 2079) or with chronic stable angina (CSA Group, n = 1525). Postoperative and at follow-up morbidity and mortality were analyzed. Results: The CSA Group had greater use of double mammary artery (58.2% vs. 50.3%; p = 0.001) and longer operative time (211 min vs. 203 min; p = 0.002). The ACS Group presented lower postoperative cardiac output (4.5% vs. 3.1%; p = 0.043) and higher in-hospital mortality (2.8% vs. 1.8%; p = 0.046). After adjusting for risk score, there were no statistically significant differences in in-hospital mortality (1.3% in CSA vs. 1.6% in ACS; p = 0.681) or in the rate of postoperative complications between the two groups. Overall long-term survival at 10 years was not different between groups (CSA 85% ± 1.3% vs. ACS 83% ± 1.1%; p = 0.363). The time-related freedom from reintervention was similar for both groups (CSA 89.5% ± 1.2% vs. ACS 89.1% ± 0.9%; p = 0.1680). These results did not change after adjusting for risk score. Conclusions: Patients with NSTEACS submitted to coronary artery bypass graft surgery presented greater perioperative mortality, but a long-term outcome similar to patients undergoing elective surgery. No difference in perioperative mortality was found between both groups after adjusting for risk score.

Resultados a largo plazo de la plástica mitral en enfermedad degenerativa: prolapso posterior versus anterior o bivalvar / Long-Term Outcomes of Mitral Valve Repair in Degenerative Valve Disease: Comparison Between Posterior and Anterior or Bileaflet Mitral Valve Prolapse

Objetivo: Comparar la evolución clínica y ecocardiográfica de la plástica mitral secundaria a insuficiencia mitral degenerativa en pacientes con prolapso de la valva posterior versus prolapso anterior o bivalvar. Material y métodos: Entre abril de 1997 y julio de 2013 fueron intervenidos 255 pacientes por insuficiencia mitral moderada/ grave degenerativa. De ellos, 175 tenían compromiso de la valva posterior exclusivamente (Grupo 1) y 80 de la valva anterior 0 bivalvar (Grupo 2). No hubo diferencias en edad ni predominio de sexo entre los grupos. El seguimiento clínico se completó en el 95% de los casos con un promedio de 5,6 ± 3,8 años y el ecocardiográfico en el 77% con un promedio de 4,8 ± 3,7 años. Resultados: El éxito del procedimiento se alcanzó en el 87% de los casos (33 conversiones intraoperatorias a reemplazo valvular) (Grupo 1: 98% vs. Grupo 2: 62,5%; p < 0,01). La mortalidad hospitalaria global fue del 2,3% (6/255). La sobrevida a los 10 años fue del 92,0 ± 2,1% (Grupo 1: 94,4% ± 2,2% vs. Grupo 2: 86,3 ± 5,1%; p = 0,036). La libertad de reoperación a 10 años de seguimiento fue del 95,6 ± 1,6% (Grupo 1: 97,1 ± 1,4% vs. Grupo 2: 89,7 ± 5,0%; p = 0,035). La libertad de insuficiencia mitral moderada/grave en el ecocardiograma a los 10 años fue del 79,0 ± 4,4% (Grupo 1: 80,8 ± 4,8% vs. Grupo 2: 71,9 ± 9,6%; p = 0,14). El 91,2% de los pacientes se encontraban libres de síntomas a los 10 años (92% Grupo 1 vs. 89,3% Grupo 2; p = 0,5). Conclusiones: Los pacientes con plástica mitral secundaria a enfermedad degenerativa de la valva posterior tuvieron mayor sobrevida y una incidencia menor de reoperación en el seguimiento alejado. No hubo diferencias en libertad de insuficiencia mitral moderada/grave entre ambos grupos a 10 años de seguimiento.

Objective: The aim of this study is to compare the clinical and echocardiographic outcome of mitral valve repair secondary to degenerative mitral valve regurgitation in patients with posterior versus anterior or bileaflet mitral valve prolapse. Methods: Between April 1997 and July 2013, 255 patients underwent surgery for moderate to severe degenerative mitral valve regurgitation: 175 had posterior mitral valve prolapse (Group 1) and 80 had anterior or bileaflet mitral valve prolapse (Group 2). There were no differences in age or sex between the groups. Clinical follow-up was completed in 95% of the cases with a mean follow-up period of 5.6 ± 3.8 years and 77% completed echocardiographic follow-up with a mean of 4.8 ± 3.7 years. Results: The procedure was successful in 87% of cases (33 intraoperative conversions to mitral valve replacement) (Group 1: 98% vs. Group 2: 62.5%; p < 0.01). Overall in-hospital mortality was 2.3% (6/255), and 10-year survival was 92.0 ± 2.1% (Group 1: 94.4% ± 2.2% vs. Group 2: 86.3 ± 5.1%; p = 0.036). At 10-year follow-up, 95.6 ± 1.6% of patients were free from reoperation (Group 1: 97.1 ± 1.4% vs. Group 2: 89.7 ± 5.0%; p = 0.035), 79.0 ± 4.4% remained free from moderate to severe mitral regurgitation (Group 1: 80.8 ± 4.8% vs. Group 2: 71.9 ± 9.6%; p = 0.14) and 91.2% were asymptomatic (92% Group 1 vs. 89.3% Group 2; p = 0.5). Conclusions: Patients undergoing mitral valve repair secondary to degenerative posterior mitral valve prolapse had higher survival and lower incidence or reoperation in the long-term follow-up. There were no differences in freedom from moderate to severe mitral regurgitation between both groups at 10-year follow-up.