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1.
Pediatr Transplant ; 28(4): e14770, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38682599

RESUMEN

BACKGROUND: There is a shortage of donor hearts in Switzerland, especially for pediatric recipients. However, the rate and reason for refusals of pediatric donor hearts offered in Switzerland has not been systematically analyzed. METHODS: The national transplant database, Swiss Organ Allocation System, was searched for all hearts from Swiss and foreign donors younger than 16 years from 2015 to 2020. The numbers of accepted and refused hearts and early outcome were assessed, and the reasons for refusal were retrospectively analyzed. RESULTS: A total of 136 organs were offered to the three Swiss pediatric heart centers and foreign donor procurement organizations. Of these, 26/136 (19%) organs were accepted and transplanted: 18 hearts were transplanted in Switzerland, and 13 of these were foreign. Reasons for refusal were (1) no compatible recipient due to blood group or weight mismatch, 89.4%; (2) medical, meaning organ too marginal for transplantation, 7.4%; (3) logistic, 1.4%; and (4) other, 1.8%. Five organs were refused in Switzerland by one center but later accepted and successfully transplanted by another center. Hearts from outside Switzerland were transplanted significantly less than Swiss hearts (n = 16/120 vs. 10/16, p < .001). CONCLUSION: The most common reason for refusing a pediatric donor heart is lack of compatibility with the recipient. Few hearts are refused for medical reasons. A more generous acceptance seems to be justified in selected patients. Switzerland receives a high number of foreign offers, but their rate of acceptance is lower than that of Swiss donations.


Asunto(s)
Trasplante de Corazón , Donantes de Tejidos , Obtención de Tejidos y Órganos , Humanos , Suiza , Niño , Lactante , Preescolar , Estudios Retrospectivos , Obtención de Tejidos y Órganos/estadística & datos numéricos , Adolescente , Masculino , Femenino , Donantes de Tejidos/provisión & distribución , Recién Nacido
2.
J Wound Care ; 32(Sup8a): S24-S30, 2023 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-37591665

RESUMEN

OBJECTIVE: Surgical site infections (SSIs) are a major source of morbidity after cardiac surgery, involving prolonged hospitalisation. Among the numerous techniques of skin closure and dressings available, the optimal method remains undetermined. The DERMABOND-PRINEO (PRINEO) (PRINEO, Ethicon, J&J) is the only skin closure system which combines a topical skin adhesive with a mesh. Other surgical disciplines have highlighted remarkable results with PRINEO. The aim of this study was to evaluate the effects of PRINEO, used as the final layer in sternotomy closure, in the incidence of postoperative SSIs. METHOD: This was a retrospective single-centre cohort study including adult patients who underwent cardiac surgery between January 2015 and December 2018. Patients who had undergone heart transplantation or ventricular assist surgery were excluded. Included patients were divided into two groups depending on the type of post-operative wound care technique used. Group 1 consisted of patients who had their sternotomy closed with a standard dressing and group 2 consisted of patients who were treated with PRINEO. The primary endpoint of our study was the occurrence of SSIs and secondary outcomes were the length of hospitalisation and mortality. RESULTS: A total of 1603 patients were reviewed with the occurrence of 44 SSIs. Both groups were homogeneous in terms of risk factors. The incidence of SSIs was significantly lower in group 2 (PRINEO) than in group 1 (standard dressing) (n=29, 3.8% vs n=15, 1.8%, respectively; p=0.042). However, there was no significant difference in the duration of hospitalisation and mortality. CONCLUSION: In our practice, PRINEO has proven to be a safe wound closure system after sternotomy, with a reduced SSI rate compared to conventional wound care techniques.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Infección de la Herida Quirúrgica , Adulto , Humanos , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/prevención & control , Estudios de Cohortes , Estudios Retrospectivos , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Piel
3.
Ann Vasc Surg ; 80: 396.e1-396.e6, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-34808260

RESUMEN

BACKGROUND: Loeys-Dietz Syndrome is a rare connective tissue disorder that is associated with arterial pathologies such as aortic dissections, tortuosity and aneurysms.We present a child with Loeys-Dietz Syndrome type 2 that received total aortic and bilateral subclavian artery replacement. CASE REPORT: A 9-year old boy with Loeys-Dietz Syndrome type 2 and acute type B aortic dissection received an urgent complete thoracic and thoraco-abdominal aortic repair within three days. First, the ascending aorta and aortic root were replaced in a Tirone David and Frozen Elephant Trunk procedure. Then, the descending and supramesenteric aorta was replaced by a Dacron interposition graft with direct implantation of the celiac trunk. During the 15 months follow-up, the patient required three more surgical interventions for rapid expanding aneurysms of both subclavian arteries and the infrarenal aorta. No major adverse event nor secondary interventions occurred. Ultrasonographic and magnetic resonance imaging follow-up is continued at 6-months intervals. CONCLUSION: Children with Loeys-Dietz Syndrome may require extensive aortic repair for aortic dissection and show rapidly expanding aneurysms. Referral to a center with pediatric vascular expertise and long-term follow-up examinations are crucial.


Asunto(s)
Aorta/cirugía , Disección Aórtica/cirugía , Implantación de Prótesis Vascular/métodos , Prótesis Vascular , Síndrome de Loeys-Dietz/complicaciones , Arteria Subclavia/cirugía , Aneurisma/cirugía , Disección Aórtica/etiología , Niño , Humanos , Masculino
4.
J Card Surg ; 37(1): 151-161, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34758148

RESUMEN

BACKGROUND AND AIM OF THE STUDY: Guidelines indicate for type 5 myocardial infarction (MI) that postoperative troponin need not be exclusively ischemic but may also be caused by epicardial injury. Complexity arises from the introduction of high-sensitive troponin. This study attempts to contribute to the understanding of postoperative high-sensitive cardiac troponin T (hs-cTnT) increase. METHODS: The median enzyme increase of different cardiac operations was compared. Linear regression analyses were used to determine correlations between enzyme rise and independent parameters. Receiver-operating characteristics (ROC) served to evaluate the discriminatory power of enzyme rise in detecting ischemia and to determine possible thresholds. RESULTS: Among 400 patients, 2.8% had intervention-related ischemia analogous to type 5 MI definition. The median postoperative hs-cTnT/creatine kinase myocardial band (CK-MB) increase varied according to types of surgery, with highest increase after mitral valve and lowest after off-pump coronary surgery. After ruling out patients with preoperatively elevated hs-cTnT, regression analysis confirmed Maze procedure (p < .001), intra-pericardial defibrillation (p = .002), emergency intervention (p = .01), blood transfusions (p = .02), and cardiopulmonary bypass time (p = .03) as significant factors associated with hs-cTnT increase. In addition, CK-MB increase was associated with mortality (p = .002). ROC confirmed good discriminatory power for hs-cTnT and CK-MB with ischemia-indicating thresholds of 1705.5 ng/L (hs-cTnT) and 113 U/L (CK-MB) considering different types of operations. CONCLUSIONS: The Influence of the type of surgery and intervention-related parameters on hs-cTnT increase was confirmed. Potential thresholds indicating perioperative ischemia appear to be significantly elevated for high sensitive markers.


Asunto(s)
Infarto del Miocardio/diagnóstico , Troponina T , Biomarcadores , Creatina Quinasa , Humanos , Periodo Posoperatorio , Troponina T/sangre
5.
Pediatr Cardiol ; 41(2): 423-424, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31679056

RESUMEN

Left ventricular assist device is a well-established therapy in heart failure adults, but less in children. A 13-year-old-boy with severe left ventricular dysfunction did not improve under medical treatment. A HeartMate 3 (HM3) was implanted as a bridge to transplantation. Despite the size limitation, the HM3 shows promising results and our case supports its feasibility in children.


Asunto(s)
Cardiomiopatía Dilatada/cirugía , Corazón Auxiliar , Disfunción Ventricular Izquierda/cirugía , Adolescente , Trasplante de Corazón/métodos , Humanos , Masculino
6.
J Card Surg ; 35(1): 40-47, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31899837

RESUMEN

OBJECTIVES: We sought to determine the indications, type, and outcomes of reoperations on the aortic root after repair of tetralogy of Fallot (TOF). METHODS: Eleven centers belonging to the European Congenital Heart Surgeons Association contributed to the data collection process. We included 36 patients who underwent surgical procedures on the aortic root, including surgery on the aortic valve and ascending aorta, between January 1975 and December 2017. Original diagnoses included TOF-pulmonary stenosis (n = 18) and TOF-pulmonary atresia (n = 18). The main indications for reoperation were aortic insufficiency (n = 19, 53%), aortic insufficiency and dilatation of the ascending aorta (n = 10, 28%), aortic root dilatation (n = 4, 11%), and ascending aorta dilatation (n = 3, 8%). RESULTS: The median age at reoperation was 30.4 years (interquartile range 20.3-45.3 years), and mechanical aortic valve replacement was the most common procedure performed. Five patients died early after reoperation (14%), and larger ascending aorta diameters were associated with early mortality (P = .04). The median age at the last follow-up was 41.4 years (interquartile range 24.5-51.6 years). Late death occurred in five patients (5/31, 16%). Most survivors (15/26, 58%) were asymptomatic at the last clinical examination (New York Heart Association, NYHA class I). The remaining patients were NYHA class II (n = 7) and III (n = 3). The most common symptoms were fatigue (n = 5), dyspnea (n = 4), and exercise intolerance (n = 3). CONCLUSIONS: Reoperations on the aortic root are infrequent but may become necessary late after TOF repair. The main indications for reoperation are aortic insufficiency, either isolated or associated with a dilatation of the ascending aorta. The surgical risk at reoperation was high and the presence of ascending aorta dilation is related to higher mortality.


Asunto(s)
Aorta/cirugía , Insuficiencia de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Tetralogía de Fallot/cirugía , Adulto , Aorta/patología , Niño , Preescolar , Dilatación Patológica , Femenino , Estudios de Seguimiento , Humanos , Masculino , Reoperación , Factores de Tiempo , Resultado del Tratamiento
7.
Cardiol Young ; 30(7): 1043-1045, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32508300

RESUMEN

We report an unusual case of a 12-month-old boy diagnosed with anomalous origin of a single coronary artery from the pulmonary artery associated with patent ductus arteriosus. The patient survival was attributed to left-to-right shunt (patent ductus arteriosus) allowing for appropriate myocardial perfusion. Successful surgical correction involved patent ductus arteriosus closure, mitral annuloplasty and reimplantation of the coronary artery into the aortic root.


Asunto(s)
Enfermedad de la Arteria Coronaria , Conducto Arterioso Permeable , Aorta/diagnóstico por imagen , Conducto Arterioso Permeable/diagnóstico , Conducto Arterioso Permeable/diagnóstico por imagen , Humanos , Lactante , Masculino , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/cirugía
8.
Pediatr Cardiol ; 39(3): 595-603, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29327146

RESUMEN

The Ross procedure offers excellent short-term outcome but the long-term durability is under debate. Reinterventions and follow-up of 100 consecutive patients undergoing Ross Procedure at our centre (1993-2011) were analysed. Follow-up was available for 96 patients (97%) with a median duration of 5.3 (0.1-17.1) years. Median age of the patient cohort was 15.2 (0.04-58.4) years with 76 males. 93% had underlying congenital aortic stenosis. Root replacement technique was applied in all. The most common valved conduits used for reconstruction of the right ventricular outflow tract were homografts (66 patients) and bovine jugular vein (ContegraR) graft (31 patients). Additional procedures included Ross-Konno procedure (14%), resection of subaortic stenosis/myectomy (11%) and reduction plasty of the ascending aorta (25%). One patient died within the first 30 days (1%). Late deaths occurred in 4 patients (4%) 0.5-4.5 years postoperatively: causes included pulmonary hypertension due to endocardial fibroelastosis (2), subarachnoid haemorrhage (1) and sudden cardiac death (1). Five-year survival was 93.6 (95% CI 88.1-99.1)%. Moderate or severe aortic (autograft) regurgitation needing reoperation occurred in 8 patients with a 5-year freedom from autograft reoperation of 98.5 (95.6-100)%. Five-year freedom from reintervention (surgery or catheter based) on the right ventricular outflow tract conduit was 91.5 (85.5-96.5)%. Univariate predictors of this reinterventions were smaller graft size (p = 0.03) and use of a ContegraR graft (p = 0.04). Ross procedure can be performed with low mortality and good survival in the long term. Most of the reinterventions are related to the neo-right ventricular outflow tract and may be partly attributed to the lack of growth. While the Ross Procedure remains an invaluable option for aortic valve disease in children, new solutions for the neo-pulmonary valve as well as for the less often occurring problems on the autograft are needed.


Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Válvula Pulmonar/trasplante , Adolescente , Adulto , Animales , Aorta/cirugía , Estenosis de la Válvula Aórtica/congénito , Bovinos , Niño , Preescolar , Femenino , Ventrículos Cardíacos/cirugía , Humanos , Lactante , Masculino , Persona de Mediana Edad , Reoperación , Estudios Retrospectivos , Trasplante Autólogo/métodos , Trasplante Autólogo/mortalidad , Resultado del Tratamiento , Adulto Joven
9.
Eur Arch Otorhinolaryngol ; 275(1): 275-280, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29075983

RESUMEN

OBJECTIVES: To evaluate the role of endovascular stents in temporary tracheal stenting and endoscopic treatment strategy for patients with severe refractory tracheal stenosis following slide tracheoplasty. METHODS: Two patients had severe tracheal stenosis after slide tracheoplasty for long segment congenital tracheal stenosis. Both these patients were managed endoscopically and an endovascular prosthesis was used to temporarily stent the trachea. Short and long term results were evaluated clinically and with repeated endoscopies. RESULTS: The 2 patients had an excellent recovery immediately after the stent placement and continue to have an optimal, age-appropriate stable tracheal diameter after stent removal. CONCLUSION: Endovascular stents can be temporarily used to stent the trachea in the endoscopic treatment strategy to correct refractory severe tracheal stenosis following slide tracheoplasty.


Asunto(s)
Endoscopía , Stents , Estenosis Traqueal/cirugía , Preescolar , Femenino , Humanos , Masculino , Índice de Severidad de la Enfermedad , Tráquea/cirugía , Estenosis Traqueal/congénito
10.
J Heart Valve Dis ; 26(3): 358-360, 2017 05.
Artículo en Inglés | MEDLINE | ID: mdl-29092124

RESUMEN

Fenestrated aortic valve is a frequent condition which is, for most of the time, asymptomatic and generally has no influence on aortic valve competence. However, aortic valve regurgitation could occur, especially in the case of fibrous strand rupture. In this situation, acute aortic regurgitation is poorly tolerated and requires urgent surgical correction. Herein is presented the case of a 70-year-old patient who was admitted as an emergency for acute heart failure after coital exertion. Echocardiography revealed severe acute aortic regurgitation due to leaflet prolapse. Intraoperative inspection of the valve showed a strand rupture of the isolated fenestration.


Asunto(s)
Insuficiencia de la Válvula Aórtica/etiología , Válvula Aórtica , Coito , Rotura Cardíaca/etiología , Anciano , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/fisiopatología , Insuficiencia de la Válvula Aórtica/cirugía , Ecocardiografía Transesofágica , Rotura Cardíaca/diagnóstico por imagen , Rotura Cardíaca/fisiopatología , Rotura Cardíaca/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Hemodinámica , Humanos , Masculino , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
11.
Pediatr Cardiol ; 37(6): 1175-83, 2016 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-27300557

RESUMEN

Pulmonary autograft replacement (Ross procedure) is used as an alternative to prosthetic aortic valve replacement patients with aortic valve disease. There are limited data on incidence and risk factors for dilatation and dysfunction of the neo-aortic after the Ross procedure. Ross procedure was performed in 100 patients at our institution between 1993 and 2011. In 76 patients, complete follow-up data were available. Their median age at surgery was 16 (0.4-58) years (76 % males; 95 % with congenital aortic valve disease). Median follow-up duration was 5.2 years (0.3-16.0 years). We analyzed their clinical and echocardiographic follow-up to identify possible risk factors for neo-aortic root dilatation and dysfunction. Ross procedure included reduction plasty of the native ascending aorta in 25 % of patients. During follow-up, 21 patients (28 %) developed neo-aortic root dilatation, 38 patients (50 %) dilatation oft the native ascending aorta and 7 patients (9 %) at least moderate neo-aortic regurgitation. Univariate risk factors for neo-aortic root dilatation were preoperative aortic regurgitation (p = 0.04), concomitant reduction plasty of the ascending aorta (p = 0.009) and a longer duration of follow-up (p = 0.005). Younger age at surgery was associated with dilatation of the ascending aorta (p = 0.03). Reoperation on the neo-aortic root because of severe dilatation was necessary in 6 patients (8 %), where 2 patients had at least moderate neo-aortic root regurgitation. Neo-aortic root and aortic dilatation are common after the Ross procedure. This is often combined with neo-aortic valve dysfunction. Close follow-up of these patients is mandatory.


Asunto(s)
Válvula Aórtica , Dilatación Patológica , Adolescente , Adulto , Aorta , Insuficiencia de la Válvula Aórtica , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Persona de Mediana Edad , Válvula Pulmonar , Reoperación , Resultado del Tratamiento , Adulto Joven
12.
Perfusion ; 31(7): 593-7, 2016 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-27015915

RESUMEN

Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a treatment option to correct blood oxygenation in cases of severe respiratory failure. However, it is time-limited and, in cases of no- recovery, it is a bridge-to-lung transplant therapy. We report our experience of two patients waiting for emergency lung transplantation under VV-ECMO using the Avalon® cannula. Both presented signs of ECMO failure after prolonged support, i.e. increased hemolysis, decreased blood flow rate and increased negative pressure of the venous inflow line, leading to an inadequate systemic oxygenation. The addition of a second venous inflow line, by the insertion of another venous femoral cannula, significantly increased blood flow rate, decreasing both centrifugal pump rotation speed and negative pressure (suction) of the venous inflow line. These hemodynamic improvements, together with reduced blood consumption, were maintained during an additional week of ECMO support. Ultimately, both patients died from multi-organ failure due to the absence of available donor organs. Few cases having been described up until now, but the addition of a second venous drainage cannula to the Avalon® system could potentially improve hemodynamic parameters and, therefore, stabilize hypoxemic patients. This may be an option to gain time in long-lasting VV-ECMO support as a potential life-saving attempt.


Asunto(s)
Cateterismo/métodos , Oxigenación por Membrana Extracorpórea/métodos , Síndrome de Dificultad Respiratoria/terapia , Insuficiencia Respiratoria/terapia , Adulto , Cánula , Humanos , Trasplante de Pulmón , Masculino , Persona de Mediana Edad , Adulto Joven
13.
Rev Med Suisse ; 12(520): 1042-8, 2016 May 25.
Artículo en Francés | MEDLINE | ID: mdl-27443005

RESUMEN

Mitral regurgitation (MR) is the most frequent valvular disease in industrialised countries. MR is classified as primary (mostly degenerative with valve prolapse) or secondary (mainly due to underlying ischemic heart disease resulting in deformation of the valve structure). Surgical repair represents the optimal treatment for severe primary MR, whereas the benefits of surgical correction of secondary MR are controversial. Over the past few years, transcatheter techniques have been developed to treat MR, such as the percutaneous edge-to-edge procedure (MitraClip). These approaches represent a novel therapeutic choice for patients judged inoperable by the "heart team". This review article aims to summarize the principles of MR assessment and discuss current therapeutic options for severe MR, taking into account the latest advances in the field.


Asunto(s)
Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Insuficiencia de la Válvula Mitral/cirugía , Isquemia Miocárdica/complicaciones , Enfermedad Crónica , Humanos , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/patología , Índice de Severidad de la Enfermedad
14.
World J Surg ; 39(7): 1767-72, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25708509

RESUMEN

OBJECTIVES: Management of malignant pericardial effusion (PE) is complex. Cardiac surgeons are not necessarily familiar with or are challenged by the many underlying etiologies. Analyzing risk factors for mortality may help to estimate the benefit of surgery in high-risk patients. METHODS: Patients undergoing a surgical pericardiotomy for malignant PE, between 2001 and 2011, were included. The influence of tumor type, disease extension, intra-pericardial tumor infiltration on early mortality and long-term survival as well as freedom from symptoms after drainage, and the use of sclerosing agents on PE recurrence rates was analyzed. RESULTS: PE drainage was performed on 46 patients 12 ± 30 months after tumor diagnosis. Malignant diseases were lung cancers (50 %), breast cancers (15 %), lymphoma and leukemia (13 %), cancers of the digestive tract (13 %), and others (9 %). 80 % of patients were symptomatic and symptom relief was achieved in 65 %. Nobody died during surgery. Recurrence rate was 4 %. Early in-hospital mortality was 22 %. After 1 year, 29 % of patients were alive. Eleven patients (24 %) had a complete tumor regression. Metastatic spread (p < 0.001), pericardial infiltration (p = 0.02), and intra-pericardial Bleomycin (p = 0.01) injection were associated with increased mortality. Hematological malignancies had a better prognosis for survival. CONCLUSION: Surgical pericardiotomy is safe, associated with a low recurrence rate and symptom relief in the majority of dyspneic patients. Intra-pericardial Bleomycin may reduce recurrent effusion but does not ameliorate survival. Long-term survival rate was low with an increased mortality in cases of metastatic spreading, pericardial infiltration, and as the tumor of origin: breast cancers. Leukemic and lymphatic tumors have better prognosis.


Asunto(s)
Drenaje , Neoplasias/complicaciones , Neoplasias/mortalidad , Derrame Pericárdico/cirugía , Adulto , Anciano , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/cirugía , Neoplasias del Sistema Digestivo/complicaciones , Neoplasias del Sistema Digestivo/cirugía , Femenino , Mortalidad Hospitalaria , Humanos , Estimación de Kaplan-Meier , Leucemia/complicaciones , Leucemia/cirugía , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/cirugía , Linfoma/complicaciones , Linfoma/cirugía , Masculino , Persona de Mediana Edad , Derrame Pericárdico/etiología , Pericardiectomía , Pronóstico , Recurrencia
15.
J Card Surg ; 30(4): 313-8, 2015 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-25644217

RESUMEN

BACKGROUND AND AIM OF THE STUDY: Percutaneous coronary interventions (PCI) are frequently performed before coronary artery bypass graft (CABG) surgery. This study sought to evaluate postoperative outcomes, and incidence of recurrent target ischemia in vessels with prior PCI in patients who had PCI prior to CABG compared to only CABG patients. METHODS: A review included CABG patients operated from 2000 to 2012. PCI prior to CABG patients were compared with patients having had CABG on native coronary arteries. Demographic and risk factors, including hospital morbidity, mortality, and recurrent target vessel ischemia at follow-up (FU), were compared. Major end-points were statistical differences of postoperative morbidity and reintervention rates due to symptomatic graft failure or target vessel ischemia during FU. RESULTS: Twenty-four percent of 1669 isolated CABG patients had PCI prior to CABG, with an increasing percentage during recent years. Demographics, risk factors, comorbidities and mortality rates were similar. Incidence of postoperative hemorrhage (OR 1.9; 95% CI 1.1-3.2; p = 0.02), perioperative myocardial infarction rate (p = 0.02), neurological deficits (OR 3.5; 95% CI 1.2-9.7; p = 0.02) and re-intervention rate for symptomatic graft or target vessel occlusion were higher in pretreated patients (OR 1.8; 95% CI 1.1-3.0; p = 0.01). CONCLUSIONS: PCI prior to CABG increases the risk for postoperative morbidity. Increased postoperative hemorrhage could be attributed to ongoing double anti-platelet therapy.


Asunto(s)
Puente de Arteria Coronaria , Enfermedad de la Arteria Coronaria/cirugía , Intervención Coronaria Percutánea/efectos adversos , Hemorragia Posoperatoria/etiología , Cuidados Preoperatorios/efectos adversos , Anciano , Comorbilidad , Procedimientos Quirúrgicos Electivos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/epidemiología , Isquemia Miocárdica/etiología , Enfermedades del Sistema Nervioso/epidemiología , Enfermedades del Sistema Nervioso/etiología , Inhibidores de Agregación Plaquetaria/efectos adversos , Hemorragia Posoperatoria/epidemiología , Riesgo , Factores de Riesgo
16.
Eur Heart J ; 35(34): 2322-32, 2014 Sep 07.
Artículo en Inglés | MEDLINE | ID: mdl-24917644

RESUMEN

A carrier system for gases and nutrients became mandatory when primitive animals grew larger and developed different organs. The first circulatory systems are peristaltic tubes pushing slowly the haemolymph into an open vascular tree without capillaries (worms). Arthropods developed contractile bulges on the abdominal aorta assisted by accessory hearts for wings or legs and by abdominal respiratory motions. Two-chamber heart (atrium and ventricle) appeared among mollusks. Vertebrates have a multi-chamber heart and a closed circulation with capillaries. Their heart has two chambers in fishes, three chambers (two atria and one ventricle) in amphibians and reptiles, and four chambers in birds and mammals. The ventricle of reptiles is partially divided in two cavities by an interventricular septum, leaving only a communication of variable size leading to a variable shunt. Blood pressure increases progressively from 15 mmHg (worms) to 170/70 mmHg (birds) according to the increase in metabolic rate. When systemic pressure exceeds 50 mmHg, a lower pressure system appears for the circulation through gills or lungs in order to improve gas exchange. A four-chamber heart allows a complete separation of systemic and pulmonary circuits. This review describes the circulatory pumping systems used in the different classes of animals, their advantages and failures, and the way they have been modified with evolution.


Asunto(s)
Evolución Biológica , Corazón/fisiología , Anfibios/anatomía & histología , Anfibios/fisiología , Animales , Artrópodos/anatomía & histología , Artrópodos/fisiología , Aves/anatomía & histología , Aves/fisiología , Circulación Sanguínea/fisiología , Presión Sanguínea/fisiología , Peces/anatomía & histología , Peces/fisiología , Corazón/anatomía & histología , Hemodinámica/fisiología , Invertebrados/anatomía & histología , Invertebrados/fisiología , Mamíferos/anatomía & histología , Mamíferos/fisiología , Moluscos/anatomía & histología , Moluscos/fisiología , Reptiles/anatomía & histología , Reptiles/fisiología , Vertebrados/anatomía & histología , Vertebrados/fisiología
17.
Ann Vasc Surg ; 28(5): 1227-35, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-24184458

RESUMEN

BACKGROUND: Preoperative central neurologic deficits in the context of acute type A dissection are a complex comorbidity and difficult to handle. The aim this study was to analyze this subgroup of patients by comparing them with neurologically asymptomatic patients with type A dissection. Results may help the surgeon in preoperative risk assessment and thereby aid in the decision-making process. METHODS: We reviewed the data of patients admitted for acute type A dissection during the period from 1999 to 2010. Associated risk factors, time to surgery from admission, extension of the dissection, localization of central nervous ischemic lesions, and the influence of perioperative brain protective strategies were analyzed in a comparison of preoperative neurologically deficient to nondeficient patients. RESULTS: Forty-seven (24.5%) of a total of 192 patients had new-onset central neurologic symptoms prior to surgery. Concomitant myocardial infarction (OR 4.9, 95% CI 1.6-15.3, P=0.006), renal failure (OR 5.9, 95% CI 1.1-32.8, P=0.04), dissected carotid arteries (OR 9.2, 95% CI 2.4-34.7, P=0.001), and late admission to surgery at >6 hours after symptom onset (OR 2.7, 95% CI 1.1-6.8, P=0.04) were observed more frequently in neurologically deficient patients. These patients had a higher 30-day in-hospital mortality on univariate analysis (P=0.01) and a higher rate of new postoperative neurologic deficits (OR 9.2, 95% CI 2.4-34.7, P=0.02). Neurologic survivors had an equal hospital stay, and 67% of them had improved symptoms. CONCLUSIONS: The predominance of neurologic symptoms at admission may be responsible for an initial misdiagnosis. The concurrent central nervous system ischemia and myocardial infarction explains a higher mortality rate and a more extensive "character" of the disease. Neurologically deficient patients are at higher risk of developing new postoperative neurologic symptoms, but prognosis for the neurologic evolution of survivors is generally favorable.


Asunto(s)
Aneurisma de la Aorta Torácica/complicaciones , Disección Aórtica/complicaciones , Urgencias Médicas , Medición de Riesgo , Accidente Cerebrovascular/etiología , Procedimientos Quirúrgicos Vasculares , Disección Aórtica/diagnóstico , Disección Aórtica/cirugía , Angiografía , Aneurisma de la Aorta Torácica/diagnóstico , Aneurisma de la Aorta Torácica/cirugía , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Periodo Preoperatorio , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Suiza/epidemiología , Factores de Tiempo , Tomografía Computarizada por Rayos X
18.
Pediatr Cardiol ; 35(5): 851-6, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24442219

RESUMEN

Infants with hypoplastic left heart syndrome (HLHS) are at risk for interstage morbidity and mortality, especially between the first and second surgical stages after the Norwood and hybrid procedures. This study compared the morbidity and mortality of patients treated by either the Norwood or the hybrid procedure for HLHS between the first and second stages who were undergoing interstage monitoring. Between October 2008 and December 2011, 26 infants (14 boys) with HLHS (n = 16) and other univentricular heart malformations with aortic arch anomaly (n = 10) were scheduled for interstage monitoring after Norwood I (n = 12) and hybrid (n = 14) procedures. Three infants (11.5 %) died after first-stage palliation (one hybrid patient and two Norwood patients), and three infants (11.5 %) died after second-stage palliation (two hybrid patients and one Norwood patient) (p = 0.83), all after early second-stage surgery (<90 days). The Norwood I and hybrid procedures did not differ in terms of overall mortality (23 %) (three hybrid and three Norwood patients; p = 1.00). Seven infants (26.9 %) could not be discharged from the hospital due to hemodynamic instability and were referred for early second-stage surgery (<90 days). After the first stage, the invasive reevaluation rate before discharge was high (53.8 %), with cardiac catheterizations for 8 of 14 patients after the hybrid procedure and for 6 of 12 patients after the Norwood procedure (p = 0.69). A total of 11 reinterventions were performed (eight by catheter and three by surgery). Of the eight catheter reinterventions, five were performed for hybrid patients (p = 0.22). For 14 infants, 89 days (range 10-177 days) of interstage monitoring were scheduled. One infant (3.9 %) died during the interstage monitoring. The findings showed a breach of the physiologic criteria for interstage monitoring in seven infants (50 %) after 10 days (range 4-68 days) (five hybrid and two Norwood patients), leading to rehospitalization and catheterization for six patients (four hybrid and two Norwood patients), requiring interventions for two patients (patent arterial duct stent dilation, and atrial septal defect stenting, all for hybrid patients). Overall, three of the seven patients with red flag events of interstage monitoring were candidates for early second-stage surgery. In conclusion, morbidity among infants treated for HLHS remains high, either before or after hospital discharge, emphasizing the need of interstage monitoring programs. Despite retrograde aortic flow in infants with HLHS after the hybrid procedure, the mortality rate was comparable between the two groups. Mortality occurs after early second-stage surgery (<90 days).


Asunto(s)
Síndrome del Corazón Izquierdo Hipoplásico/cirugía , Procedimientos de Norwood/métodos , Femenino , Humanos , Síndrome del Corazón Izquierdo Hipoplásico/mortalidad , Síndrome del Corazón Izquierdo Hipoplásico/fisiopatología , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Monitoreo Fisiológico , Morbilidad , Procedimientos de Norwood/efectos adversos , Procedimientos de Norwood/mortalidad , Resultado del Tratamiento
19.
Front Pediatr ; 12: 1341443, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38379912

RESUMEN

Fontan physiology creates a chronic state of decreased cardiac output and systemic venous congestion, leading to liver cirrhosis/malignancy, protein-losing enteropathy, chylothorax, or plastic bronchitis. Creating a fenestration improves cardiac output and relieves some venous congestion. The anatomic connection of the thoracic duct to the subclavian-jugular vein junction exposes the lymphatic system to systemic venous hypertension and could induce plastic bronchitis. To address this complication, two techniques have been developed. A surgical method that decompresses the thoracic duct by diverting the innominate vein to the atrium, and a percutaneous endovascular procedure that uses a covered stent to create an extravascular connection between the innominate vein and the left atrium. We report a novel variant transcatheter intervention of the innominate vein turn-down procedure without creating an extravascular connection in a 39-month-old patient with failing Fontan circulation complicated by plastic bronchitis and a 2-year post-intervention follow-up.

20.
Circulation ; 126(1): 22-30, 2012 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-22626745

RESUMEN

BACKGROUND: To evaluate indications and results of surgery for primary cardiac tumors in children. METHODS AND RESULTS: Eighty-nine patients aged ≤18 years undergoing surgery for cardiac tumor between 1990 and 2005 from 16 centers were included retrospectively (M/F=41/48; median age 4.3 months, range 1 day to 18 years). Sixty-three patients (68.5%) presented with symptoms. Surgery consisted of complete resection in 62 (69.7%) patients, partial resection in 21 (23.6%), and cardiac transplant in 4 (4.5%). Most frequent histotypes (93.2%) were benign (rhabdomyoma, myxoma, teratoma, fibroma, and hemangioma). Postoperative complications occurred in 29.9%. Early and late mortality were 4.5% each (mean follow-up, 6.3±4.4 years); major adverse events occurred in 28.2% of the patients; 90.7% of patients are in New York Heart Association class I. There were no statistically significant differences in survival, postoperative complications, or adverse events after complete and partial resection in benign tumors other than myxomas. Cardiac transplant was associated significantly with higher mortality rate (P=0.006). Overall mortality was associated to malignancy (P=0.0008), and adverse events during follow-up (P=0.005). CONCLUSIONS: Surgery for primary cardiac tumors in children has good early and long-term outcomes, with low recurrence rate. Rhabdomyomas are the most frequent surgical histotypes. Malignant tumors negatively affect early and late survival. Heart transplant is indicated when conservative surgery is not feasible. Lack of recurrence after partial resection of benign cardiac tumors indicates that a less risky tumor debulking is effective for a subset of histotypes such as rhabdomyomas and fibromas.


Asunto(s)
Neoplasias Cardíacas/mortalidad , Neoplasias Cardíacas/cirugía , Médicos , Complicaciones Posoperatorias/mortalidad , Cuidados Preoperatorios/tendencias , Adolescente , Niño , Preescolar , Estudios de Cohortes , Europa (Continente)/epidemiología , Femenino , Estudios de Seguimiento , Cardiopatías Congénitas/mortalidad , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Recién Nacido , Masculino , Complicaciones Posoperatorias/etiología , Diagnóstico Prenatal/tendencias , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Resultado del Tratamiento
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