ABSTRACT
ABSTRACT Introduction: Extracorporeal membrane oxygenation (ECMO) is the first-line therapy for temporary mechanical circulatory support allowing cardiac and pulmonary recovery or as a bridge to further therapeutic alternatives. The aim of this study was to report clinical outcomes in adult patients with refractory cardiac failure after open-heart surgery undergoing ECMO in a single center with an ECMO unit in Chile. Methods: We retrospectively analyzed adults with refractory cardiac failure after open-heart surgery who required a venoarterial (VA) ECMO between 2016 and 2021. Results: Of 16 patients with VA ECMO, 60% were men (n=10), 90% had hypertension (n=14), 69% had < 30% of left ventricular ejection fraction (n=11), and the mean European System for Cardiac Operative Risk Evaluation II score was 12 ± 11%. ECMO support with central cannulation accounts for 81% (n=13), and an intra-aortic balloon pump was used in nine patients (56%). The mean time of support was 4.7 ± 2.6 days (1.5 - 12 days). ECMO weaning was achieved in 88% of patients, and in-hospital mortality was 44% (n=7) after discharge. The freedom from all-cause mortality at one year of follow-up of the entire cohort was 38% (n=6). Conclusion: VA ECMO is now a well-known life-saving therapeutic option, but mortality and morbidity remain high. Implementation of an ECMO program with educational training is mandatory in order to find the proper balance between patient benefits, ethical considerations, and public health financial input in South America.
ABSTRACT
La indicación en el implante de la válvula aortica percutánea (TAVI) se ha incrementado considerablemente en los últimos años, utilizando de preferencia el acceso transfemoral (TF), sin embargo, no queda claro cual debería ser la 2 vía de preferencia ante contraindicaciones a esta última. Presentamos un paciente de 81 años con alto riesgo quirúrgico en quien luego de discusión con heart team se decidió realizar TAVI y posterior a la identificación de obstrucción de la luz aortica descendente de 50%, se decidido realizar acceso transcarotideo izquierdo. Numerosos abordajes alternativos a la vía TF han sido descriptos en los últimos años. La vía transcarotidea ha sido la de mejores resultados en distintas revisiones clínicas y la que se ha presentado como 2° alternativa a la TF en algoritmos establecidos. Reportamos el primer implante de TAVI por vía transcarotidea en el hospital las Higueras, Chile.
The indication for percutaneous aortic valve implantation (TAVI) has increased considerably in recent years, preferably using transfemoral access (TF); however, it is not clear which should be the preferred access in the event of contraindications to the latter. We present an 81-year-old patient with high surgical risk in whom a 50% obstruction of the descending aortic lumen was identified and so, a left transcarotid access was chosen. Numerous alternative approaches to the TF approach have been described in recent years. The transcarotid approach has been the one with the best results in different clinical reviews and the one that has been presented as the second alternative to TF in established algorithms. We report the first transcarotid TAVI implantation in Las Higueras Hospital, Talcahuano, Chile.