RESUMEN
No disponible
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Vasos Coronarios/patología , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/prevención & control , Supervivencia , Revascularización Miocárdica/tendencias , Hemodinámica , Análisis de Supervivencia , Tasa de Supervivencia , Indicadores de MorbimortalidadRESUMEN
BACKGROUND AND AIM: The clinical impact of patient-prosthesis mismatch (PPM) on outcomes in young and middle-aged patients undergoing surgery for aortic valve replacement (AVR) remains unknown. Our objective was to examine the mid-term impact of PPM on overall mortality, quality of life, and cardiac events in this population. METHODS: All patients younger than 70 years of age undergoing isolated AVR from October 2005 to October 2011 were analyzed. PPM was defined as the indexed effective orifice area ≤ 0.85 cm(2) /m(2) . We studied the impact of PPM on mid-term overall mortality, cardiac events, and New York Heart Association functional class using an analysis stratified for propensity score. Cardiac events were defined as cardiac death, sudden death, hospital readmission due to angina, syncope or heart failure or reoperation on aortic prosthesis. RESULTS: Two hundred and ninety-three patients were included in the study, of whom 81 (27.61%) had some degree of PPM. PPM had no impact on mid-term overall mortality (HR=1.45; 95% CI=0.65-3.22; p=0.36), although it had a negative impact on cardiac events (HR=11.52; 95% CI=5.25-25.24; p<0.001) and functional class (RR=7.55; 95% CI=2.59-22.03; p<0.001). CONCLUSIONS: Moderate PPM appears to be a strong and independent predictor of cardiac events and advanced functional class in young and middle-aged patients undergoing AVR for severe stenosis. However, it is possible that it has no impact on overall mortality.
Asunto(s)
Estenosis de la Válvula Aórtica/fisiopatología , Válvula Aórtica/cirugía , Enfermedades Cardiovasculares/etiología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas , Falla de Prótesis/efectos adversos , Ajuste de Prótesis/efectos adversos , Anciano , Estenosis de la Válvula Aórtica/mortalidad , Estenosis de la Válvula Aórtica/cirugía , Enfermedades Cardiovasculares/epidemiología , Causas de Muerte , Estudios de Cohortes , Supervivencia sin Enfermedad , Femenino , Predicción , Pruebas de Función Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
OBJECTIVES: Recent studies have found increased long-term cardiovascular morbidity after off-pump coronary artery bypass surgery (OPCAB). We evaluated the efficacy and safety of dual antiplatelet therapy (DAT) in the prevention of cardiovascular events at two years after OPCAB surgery. METHODS: Retrospective study that included all patients that underwent OPCAB surgery in our institution between 2009 and 2010. Single or dual antiplatelet therapy was initiated at hospital discharge, and its effect in patients' prognosis was analyzed. Follow-up was conducted by telephone and using the hospital databases. The primary end-point was the composite of acute coronary syndrome (ACS), revascularization, stroke, or cardiovascular death. RESULTS: The study included 237 patients divided into: (A) 128 patients who received single antiplatelet therapy and (B) 109 patients who received dual antiplatelet therapy. The mean follow-up was 23.85 months (standard deviation 0.5 months). 13.9% of patients had a primary end-point event. Patients in group A had a higher event rate compared with group B (18.8% vs. 8.3%, p = 0.02), with a significant reduction in hospital readmissions for ACS (10.9% vs. 3.7%, p = 0.035). In the multivariate analysis, dual antiplatelet therapy was an independent protective factor in the occurrence of events (hazard ratio = 0.395, 95% CI, 0.176 to 0.885, p = 0.024). There were no significant differences between the two groups with respect to bleeding events. CONCLUSION: Dual antiplatelet therapy after OPCAB surgery is associated with a decrease in the appearance of new cardiovascular events, due to a reduction in the number of hospital readmissions for ACS.
Asunto(s)
Aspirina/administración & dosificación , Enfermedades Cardiovasculares/prevención & control , Puente de Arteria Coronaria Off-Pump , Inhibidores de Agregación Plaquetaria/administración & dosificación , Complicaciones Posoperatorias/prevención & control , Ticlopidina/análogos & derivados , Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/prevención & control , Anciano , Enfermedades Cardiovasculares/epidemiología , Clopidogrel , Estudios de Cohortes , Quimioterapia Combinada , Determinación de Punto Final , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Readmisión del Paciente/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Pronóstico , Estudios Retrospectivos , Ticlopidina/administración & dosificación , Factores de TiempoRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Anciano de 80 o más Años , Rotura de la Aorta/diagnóstico , Rotura de la Aorta/cirugía , Válvula Aórtica/lesiones , Válvula Aórtica/cirugía , Válvula Aórtica , Cateterismo/instrumentación , Cateterismo/métodos , Cateterismo , Estenosis Aórtica Subvalvular/complicaciones , Cateterismo/tendencias , Estenosis Aórtica Subvalvular/diagnóstico , Constricción Patológica/cirugía , Estenosis Aórtica Subvalvular , Estenosis de la Válvula Aórtica/cirugíaRESUMEN
BACKGROUND: The impact of patient-prosthesis mismatch (PPM) on early outcomes in young and middle-aged patients undergoing conventional aortic valve replacement for severe aortic stenosis remains unknown. Our objective was to evaluate the incidence of some degree of PPM and its influence on early mortality and morbidity. METHODS: We analyzed our single center experience in all patients <70 years undergoing first-time isolated aortic valve replacement for severe stenosis in our center from September 2007 to September 2011. PPM was defined as an indexed effective orifice area ≤ 0,85 cm(2)/m(2). The influence of PPM on early mortality and postoperative complications was studied using propensity score analysis. Follow up at 30 postoperative days was 100% complete. RESULTS: Of 199 patients studied, 61 (30,7%) had some degree of PPM. PPM was associated with an increased postoperative mortality (OR = 8,71; 95% CI = 1,67-45,29; p = 0,04) and major postoperative complications (OR = 2,96; CI = 1,03-8,55; p = 0,044). However, no association between PPM and prolonged hospital or ICU stay was demonstrated. CONCLUSIONS: Moderate PPM is a common finding in young and middle-aged patients undergoing surgery for aortic valve replacement due to severe stenosis. In addition, its influence on early outcomes may be relevant.
Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas , Falla de Prótesis , Adulto , Anciano , Femenino , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
Introducción y objetivos. La repercusión clínica del desajuste paciente-prótesis en el pronóstico de pacientes octogenarios operados de recambio valvular aórtico por estenosis aórtica severa es desconocida. Nuestro objetivo es cuantificar la frecuencia con que se presenta algún grado de desajuste paciente-prótesis, así como su repercusión en la mortalidad y la calidad de vida. Métodos. Se analizó a todos los octogenarios operados en nuestro centro para recambio valvular por estenosis aórtica severa desde febrero de 2004 hasta abril de 2009. Se consideró que había desajuste cuando el área efectiva del orifico indexada era <= 0,85cm2/m2. Se analizó la influencia del desajuste paciente-prótesis ajustado por propensity score en la mortalidad intrahospitalaria, la supervivencia a medio plazo y el grado funcional New York Heart Association. Resultados. Se estudió a 149 pacientes (seguimiento medio, 32,71±14,42 meses). El 61,7% presentó algún grado de desajuste paciente-prótesis. Una vez ajustados los datos por propensity score, no se observaron diferencias en la mortalidad intrahospitalaria (odds ratio=0,75; intervalo de confianza del 95%, 0,15-3,58; p=0,72), supervivencia a medio plazo (hazard ratio=1; intervalo de confianza del 95%, 0,36-2,78; p=0,99) ni en el grado funcional durante el seguimiento (odds ratio=1,46; intervalo de confianza del 95%, 0,073-29,24; p=0,8). Conclusiones. Pese a que el desajuste paciente-prótesis en grado moderado es un hallazgo muy habitual en los pacientes octogenarios intervenidos para recambio valvular aórtico, su influencia pronóstica en la mortalidad y la calidad de vida no parece relevante. Las condiciones biológicas propias del paciente anciano, con menores requerimientos metabólicos y una actividad física limitada, podrían justificar los resultados obtenidos (AU)
Introduction and objectives. The clinical impact of patient-prosthesis mismatch on the outcome in octogenarians who undergo surgery for aortic valve replacement due to severe stenosis is unknown. Our objective was to quantify the frequency of some degree of patient-prosthesis mismatch and its impact on mortality and life quality. Methods. We analyzed all the octogenarian patients who underwent surgery for aortic valve replacement due to severe stenosis in our center from February 2004 to April 2009. Patient-prosthesis mismatch was considered to exist when the indexed effective orifice area was <=0.85cm2/m2. The influence of patient-prosthesis mismatch on in-hospital mortality, medium-term survival, and New York Heart Association functional class was studied using an analysis adjusted for propensity score. Results. Of 149 patients studied, 61.7% had some degree of patient-prosthesis mismatch (mean follow-up was 32.71±14.42 months). After adjusting for propensity score, there were no differences in in-hospital mortality (odds ratio=0.75; 95% confidence interval, 0.15-3.58; P=.72), medium-term survival (hazard ratio=1; 95% confidence interval, 0.36-2.78; P=.99) or functional class during follow-up (odds ratio=1.46; 95% confidence interval, 0.073-29.24; P=.8). Conclusions. Although moderate patient-prosthesis mismatch is a very common finding in octogenarian patients who undergo aortic valve replacement, its influence on mortality and quality of life does not seem to be relevant. The biological profile of elderly patients with lower metabolic requirements and limited physical activity could justify the results obtained (AU)
Asunto(s)
Humanos , Masculino , Femenino , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/diagnóstico , Estenosis de la Válvula Aórtica/terapia , Prótesis e Implantes/efectos adversos , Mortalidad Hospitalaria/tendencias , Esternotomía/métodos , Accidente Cerebrovascular/complicaciones , Intervalos de Confianza , Oportunidad Relativa , Ecocardiografía , Insuficiencia de la Válvula Tricúspide/complicaciones , Insuficiencia de la Válvula TricúspideRESUMEN
INTRODUCTION AND OBJECTIVES: The clinical impact of patient-prosthesis mismatch on the outcome in octogenarians who undergo surgery for aortic valve replacement due to severe stenosis is unknown. Our objective was to quantify the frequency of some degree of patient-prosthesis mismatch and its impact on mortality and life quality. METHODS: We analyzed all the octogenarian patients who underwent surgery for aortic valve replacement due to severe stenosis in our center from February 2004 to April 2009. Patient-prosthesis mismatch was considered to exist when the indexed effective orifice area was ≤ 0.85 cm²/m². The influence of patient-prosthesis mismatch on in-hospital mortality, medium-term survival, and New York Heart Association functional class was studied using an analysis adjusted for propensity score. RESULTS: Of 149 patients studied, 61.7% had some degree of patient-prosthesis mismatch (mean follow-up was 32.71 ± 14.42 months). After adjusting for propensity score, there were no differences in in-hospital mortality (odds ratio=0.75; 95% confidence interval, 0.15-3.58; P=.72), medium-term survival (hazard ratio=1; 95% confidence interval, 0.36-2.78; P=.99) or functional class during follow-up (odds ratio=1.46; 95% confidence interval, 0.073-29.24; P=.8). CONCLUSIONS: Although moderate patient-prosthesis mismatch is a very common finding in octogenarian patients who undergo aortic valve replacement, its influence on mortality and quality of life does not seem to be relevant. The biological profile of elderly patients with lower metabolic requirements and limited physical activity could justify the results obtained.
Asunto(s)
Anciano de 80 o más Años/fisiología , Estenosis de la Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Estenosis de la Válvula Aórtica/mortalidad , Puente Cardiopulmonar , Femenino , Estudios de Seguimiento , Humanos , Masculino , Complicaciones Posoperatorias/epidemiología , Calidad de Vida , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
INTRODUCTION AND OBJECTIVES: Greater life-expectancy has led to an increase in the incidence of severe aortic stenosis, which accounts for a significant proportion of the workload of cardiology departments. With the imminent arrival of percutaneous aortic valve prostheses, it is important to know how effective surgery currently is in octogenarians. METHODS: The study included all patients aged >or=80 years with severe aortic stenosis who underwent cardiac catheterization prior to aortic valve replacement between May 1996 and May 2006. The percentage of patients who underwent surgery, outcomes at 30 days, long-term survival, and predictors of mortality were analyzed. RESULTS: Of the 137 patients evaluated, 104 (75.9%) underwent surgery, while 33 did not due to a low ejection fraction or severe chronic bronchitis, or because the patient's family did not give consent. The patients' mean age was 81.7 (1.5) years, 61.5% were female, 18.4% had diabetes, 7.8% had had a previous infarction, and 32.7% had coronary disease. Three patients (2.9%) had a perioperative myocardial infarction, six (5.8%) had a stroke, and six (5.8%) had a permanent pacemaker. Four patients (3.8%) died during the first 30 days. The survival rates at 1, 2, 3, 4, 5 and 6 years were 90 (2.9), 81 (4.2), 78 (4.8), 75 (5.3), 65 (7.2) and 60 (8.2)%, respectively. The following predictors of long-term mortality were identified: creatinine level, emergency surgery, and reintervention because of bleeding. Some 76.3% of patients remained in New York Heart Association functional class I-IV. CONCLUSIONS: Aortic valve replacement can be performed successfully in patients aged >or=80 years with severe aortic stenosis; the complication rate was low, and the survival rate and long-term results were good. Predictors of mortality in this series were the creatinine level, emergency surgery, and reintervention because of bleeding.
Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Anciano de 80 o más Años , Estenosis de la Válvula Aórtica/mortalidad , Femenino , Humanos , Masculino , Índice de Severidad de la Enfermedad , Tasa de SupervivenciaRESUMEN
Introducción y objetivos. El aumento de la expectativa de vida ha incrementado la incidencia de estenosis aórtica severa, que representa un volumen importante en la actividad de los servicios de cardiología. Con la inminente llegada de las prótesis aórticas percutáneas es necesario conocer los resultados actuales de la cirugía en octogenarios. Métodos. Desde mayo de 1996 hasta mayo de 2006 se estudió a todos los pacientes ≥ 80 años con estenosis aórtica severa que fueron remitidos para la realización de un cateterismo cardiaco. Se analizaron el porcentaje de pacientes operados, la evolución a los 30 días y la supervivencia a largo plazo, así como los predictores de mortalidad. Resultados. De 137 pacientes, 104 (75,9%) fueron operados y 33 rechazados por baja fracción de eyección, bronquitis crónica severa y negativa de la familia. La edad era de 81,7 ± 1,5 años, el 61,5% era mujer, el 18,4% tenía diabetes, el 7,8% infarto previo y el 32,7%, enfermedad coronaria. Hubo 3 (2,9%) casos de infarto perioperatorio, 6 (5,8%) accidentes cerebrovasculares y 6 (5,8%) marcapasos definitivos. Cuatro (3,8%) pacientes fallecieron en los 30 primeros días y la supervivencia a 1, 2, 3, 4, 5 y 6 años fue del 90 ± 2,9, 81 ± 4,2, 78 ± 4,8, 75 ± 5,3, 65 ± 7,2 y 60 ± 8,2%, respectivamente. Los predictores de mortalidad a largo plazo fueron: concentración de creatinina, cirugía urgente y reexploración por sangrado. El 76,3% de los pacientes se mantuvo en grado funcional I-IV de la New York Heart Association. Conclusiones. Los pacientes ≥ 80 años con estenosis aórtica severa pueden ser tratados con recambio valvular con una baja incidencia de complicaciones, buena supervivencia y resultados funcionales a largo plazo; los predictores de mortalidad en nuestra serie fueron las concentraciones de creatinina, la cirugía urgente y la reexploración por sangrado (AU)
Introduction and objectives. Greater life-expectancy has led to an increase in the incidence of severe aortic stenosis, which accounts for a significant proportion of the workload of cardiology departments. With the imminent arrival of percutaneous aortic valve prostheses, it is important to know how effective surgery currently is in octogenarians. Methods. The study included all patients aged ≥80 years with severe aortic stenosis who underwent cardiac catheterization prior to aortic valve replacement between May 1996 and May 2006. The percentage of patients who underwent surgery, outcomes at 30 days, long-term survival, and predictors of mortality were analyzed. Results. Of the 137 patients evaluated, 104 (75.9%) underwent surgery, while 33 did not due to a low ejection fraction or severe chronic bronchitis, or because the patient's family did not give consent. The patients' mean age was 81.7 (1.5) years, 61.5% were female, 18.4% had diabetes, 7.8% had had a previous infarction, and 32.7% had coronary disease. Three patients (2.9%) had a perioperative myocardial infarction, six (5.8%) had a stroke, and six (5.8%) had a permanent pacemaker. Four patients (3.8%) died during the first 30 days. The survival rates at 1, 2, 3, 4, 5 and 6 years were 90 (2.9), 81 (4.2), 78 (4.8), 75 (5.3), 65 (7.2) and 60 (8.2)%, respectively. The following predictors of long-term mortality were identified: creatinine level, emergency surgery, and reintervention because of bleeding. Some 76.3% of patients remained in New York Heart Association functional class I-IV. Conclusions. Aortic valve replacement can be performed successfully in patients aged ≥80 years with severe aortic stenosis; the complication rate was low, and the survival rate and long-term results were good. Predictors of mortality in this series were the creatinine level, emergency surgery, and reintervention because of bleeding (AU)
Asunto(s)
Masculino , Femenino , Anciano , Humanos , Estenosis de la Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Estenosis de la Válvula Aórtica/epidemiología , Pronóstico , Supervivencia sin Enfermedad , Cateterismo Cardíaco/métodos , Complicaciones Posoperatorias , Calidad de VidaRESUMEN
Objetivo: Se realizó un estudio experimental para valorar la utilidad de la angiogénesis en la enfermedad coronaria empleando inicialmente un modelo en arteria femoral de conejo, seguido de un estudio en arteria coronaria de cerdo. El estudio en conejos incluye catorce animales divididos en tres grupos: Grupo Tratado (seis animales con ligadura de la arteria femoral superficial más inyección de factor de crecimiento fibroblástico "in situ"), Grupo Placebo (cuatro animales con ligadura más placebo) y Grupo Sham (cuatro animales sin ligadura y sin placebo). El factor y el placebo se inyectaron a los siete días postligadura. Se comparó el desarrollo de circulación colateral valorando la densidad .de capilares por mm2 sacrificando al animal a los 15 días post-inyección. La media y desviación estándar de los Grupo Tratado, Placebo y Sham fue de 40,1+/-5,0; 20,1+/-6,1 y 8,2+/-5,1 respectivamente. La diferencia entre los Grupos Factor y Placebo resultó estadística mente significativa (p<0,001) así como entre Placebo y Sham (p<0,05). El estudio en cerdos incluye 14 animales distribuidos en los siguientes grupos: seis casos con ligadura de la coronaria descendente anterior más factor de crecimiento fibroblástico "in situ", cuatro casos con ligadura más placebo y un cerdo como grupo Sham. Tres cerdos más murieron tras la ligadura. La media y desviación estándar de los Grupos Tratado, Placebo y Sham fue de 133,5+/-35,1; 94,1+/-2,6 y 30,1+/-3,2 (diez cortes) respectivamente. La diferencia entre los Grupos Factor y Placebo resultó estadísticamente significativa (p<0,05) asi como entre Placebo y Sham (p<0,001). Conclusión:Los resultados obtenidos entre los tres grupos, tanto en el estudio en conejos como en cerdos, refuerza la idea de que la isquemia "per se" aumenta la circulación colateral, efecto que se potencia cuando se añaden factores de crecimiento
Objective: An experimental study was carried out to validate the utility of the angiogenic therapy in coronary artery disease using a model initially in rabbit femoral artery followed by a study in pig coronary artery. The study in rabbits includes 14 animals divided in three groups: Treated Group (six animals with surgical ligation of the superficial femoral artery and local injection of fibroblastic growth factor), Placebo Group (four animals with ligature and placebo injection) and Sham Group (four animals neither ligated nor injected). The growth factor and the placebo were injected at 7th day postligature. The development of collateral circulation by capillary density was studied sacrificing the animal 15th day post-injection. Mean and standard deviation values of the Treated, Placebo and Sham Groups were 40,1+/-5,0; 20,1+/-6, 1 and 8,2+/-5,1 respectively. The difference between the Factor and Placebo Groups was statistically significant (p <0,001) as well as between Placebo and Sham Groups (p<0,05). The study in pigs includes 14 animals distributed in the following groups: six cases with anterior descending coronary artery ligature and local fibroblastic growth factor injection, four cases with ligature and placebo injection and a pig as Sham Group. Three more pigs died after coronary ligature. Mean and standard deviation values of the Treated, Placebo and Sham Groups were 133,5+/-35,1; 94,1+/-2,6 and 30,1+/-3,2 respectively. The difference between the Factor and Placebo Groups is statistically significant (p <0,05) as well as between Placebo and Sham Groups (p <0,001). Conclusion: The results obtained among the three groups, both in rabbits and pigs, reinforces the idea that the ischemia "per se" increases the collateral circulation, effect that is powered when growth factors are added
Asunto(s)
Animales , Neovascularización Patológica/etiología , Neovascularización Patológica/fisiopatología , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/patología , Circulación Colateral/fisiología , Electrocardiografía , Mioblastos CardíacosRESUMEN
INTRODUCTION AND OBJECTIVES: The purpose of this study was to evaluate the experience of a multidisciplinary team in the percutaneous treatment of thoracic aorta disease. PATIENTS AND METHOD: Between December 2001 and January 2004, 15 patients were selected for percutaneous treatment at the Thoracic Aorta Unit of the Hospital Universitario Central de Asturias. The motives for stent implantation were: degenerative aneurysm (n=7), acute dissection (n=4), penetrating atherosclerotic ulcer (n=1), posttraumatic aneurysm (n=2) and postsurgery pseudoaneurysm (n=1). Four procedures were considered emergencies. Another two patients underwent prior surgery of the supra-aortic branches. Previous computed tomographic angiography and arteriography were performed, and in complex cases of dissection, magnetic resonance imaging was used. All stent placement procedures were performed in the hemodynamics laboratory. All patients underwent computed tomographic angiography during follow-up. RESULTS: Stent positioning was technically successful in 14 patients. The mean length of aortic coverage was 230 +/- 110 mm (range 110-440 mm). No intraoperative deaths occurred. There was one in-hospital death. Transient postimplantation syndrome was presented in three patients. Two type I endoleaks, one type II endoleak and one thrombosis of the superior mesenteric artery were found on computed tomographic angiography at one month. One type III endoleak and one type II endoleak were found during subsequent follow-up. CONCLUSIONS: Endovascular stent-grafting is a valid alternative in the treatment of aortic disease in high-risk patients. Coordination between different medical specialties and appropriate selection of patients are needed. Long-term follow-up is necessary to ensure the usefulness and efficacy of the procedure.
Asunto(s)
Enfermedades de la Aorta/terapia , Prótesis Vascular , Aorta Torácica , Humanos , Persona de Mediana Edad , Grupo de Atención al Paciente , Diseño de PrótesisRESUMEN
Introducción y objetivos. El objetivo del presente estudio es presentar la experiencia de un equipo multidisciplinario en el tratamiento percutáneo de las afecciones de la aorta torácica. Pacientes y método. Entre diciembre de 2001 y enero de 2004 se seleccionó, en la Unidad de Aorta Torácica del Hospital Universitario Central de Asturias, a 15 pacientes para tratamiento percutáneo. Las causas fueron: aneurisma degenerativo (n = 7), disección aguda (n = 4), úlcera penetrante (n = 1), postraumatismo (n = 2) y seudoaneurisma posquirúrgico (n = 1). Cuatro procedimientos fueron urgentes. En 2 casos se realizó una cirugía previa de los troncos supraaórticos. Los pacientes fueron estudiados mediante estudio angiográfico por tomografía computarizada (angio-TC) y arteriografía. En disecciones complejas se practicó una resonancia magnética. Los procedimientos se desarrollaron en el laboratorio de hemodinámica bajo anestesia general. El seguimiento se realizó mediante angio-TC. Resultados. El tratamiento se realizó con éxito en 14 pacientes. La longitud media de aorta recubierta fue de 230 ± 110 mm (rango, 110-440 mm). No hubo complicaciones intraoperatorias. Se produjo 1 fallecimiento durante el ingreso. Tres pacientes presentaron síndrome postimplantación. En la tomografía computarizada de control se detectaron 1 endofuga de tipo II, 2 de tipo I y 1 trombosis de la arteria mesentérica superior. En el seguimiento se produjeron 2 endofugas, 1 de tipo III y 1 de tipo II. Conclusiones. La técnica endovascular es una alternativa válida aplicable en pacientes de alto riesgo. Su empleo requiere una labor coordinada de varias especialidades médicas y una correcta selección de los casos. Es necesario realizar un seguimiento a largo plazo para asegurar su utilidad y eficacia
Introduction and objectives. The purpose of this study was to evaluate the experience of a multidisciplinary team in the percutaneous treatment of thoracic aorta disease. Patients and method. Between December 2001 and January 2004, 15 patients were selected for percutaneous treatment at the Thoracic Aorta Unit of the Hospital Universitario Central de Asturias. The motives for stent implantation were: degenerative aneurysm (n=7), acute dissection (n=4), penetrating atherosclerotic ulcer (n=1), posttraumatic aneurysm (n=2) and postsurgery pseudoaneurysm (n=1). Four procedures were considered emergencies. Another two patients underwent prior surgery of the supra-aortic branches. Previous computed tomographic angiography and arteriography were performed, and in complex cases of dissection, magnetic resonance imaging was used. All stent placement procedures were performed in the hemodynamics laboratory. All patients underwent computed tomographic angiography during follow-up. Results. Stent positioning was technically successful in 14 patients. The mean length of aortic coverage was 230 ± 110 mm (range 110-440 mm). No intraoperative deaths occurred. There was one in-hospital death. Transient postimplantation syndrome was presented in three patients. Two type I endoleaks, one type II endoleak and one thrombosis of the superior mesenteric artery were found on computed tomographic angiography at one month. One type III endoleak and one type II endoleak were found during subsequent follow-up. Conclusions. Endovascular stent-grafting is a valid alternative in the treatment of aortic disease in high-risk patients. Coordination between different medical specialties and appropriate selection of patients are needed. Long-term follow-up is necessary to ensure the usefulness and efficacy of the procedure