[Resultados a corto y medio plazo de la técnica de Florida]. / Early and medium-term results of the Florida Sleeve technique for aortic root ectasia

Introduction: Aortic root dilatation is a frequent disease affecting mostly young patients that often requires surgical repair. Surgical techniques in young patients include aortic valve-sparing procedures to avoid prosthetic valve implant. Objective: The aim of this paper is to describe the results obtained in three patients with aortic root dilatation using the Florida Sleeve technique. Methods: From November 2015 to January 2017, three patients with severe aortic regurgitation due to aortic anuloectasic were intervened applying the Florida Sleeve technique. Results: Excellent postoperative results were obtained in the three cases including freedom of aortic regurgitation and any cause re-operation during three years of follow-up. Conclusion: The Florida Sleeve technique is a safe, reproducible technique with a learning curve and lower surgical times than traditional techniques. The medium-term clinical outcomes in terms of morbidity and mortality are good.

Introducción: La dilatación de la raíz aórtica es una patología frecuente que afecta a pacientes jóvenes y su tratamiento es quirúrgico. Las técnicas quirúrgicas de elección en pacientes jóvenes son las de preservación de la válvula aórtica para evitar el implante de una prótesis valvular. Objetivo: El presente trabajo tiene como objetivo describir la técnica de Florida Sleeve y los resultados de nuestra experiencia. Método: Entre noviembre de 2015 y enero de 2017 fueron intervenidos en nuestro centro tres casos de pacientes con insuficiencia aórtica severa secundaria a anulectasia aórtica en los que se realizó la técnica de Florida Sleeve. Resultados: En los tres casos se obtuvieron excelentes resultados postoperatorios, libres de insuficiencia aórtica residual y de reoperación por cualquier causa, resultados que se mantuvieron a los tres años de seguimiento. Conclusiones: La técnica de Florida Sleeve es una técnica segura, reproducible con una curva de aprendizaje y tiempos quirúrgicos inferiores a las técnicas tradicionales. Los resultados clínicos a medio plazo en términos de morbimortalidad son buenos.

Long-term prognosis after surgery for infective endocarditis: Distinction between predictors of early and late survival / Pronóstico a largo plazo tras cirugía cardiaca en la endocarditis infecciosa: diferencias entre predictores de supervivencia precoz y tardía

OBJECTIVES: Cardiac surgery is a life-saving procedure in patients diagnosed with infective endocarditis (IE). There are several validated risk scores developed to predict early-mortality; nevertheless, long-term survival has been less investigated. The aim of the present study is to analyze the impact of IE-specific risk factors for early and long-term mortality. METHODS: An observational retrospective study was conducted that included all patients who underwent surgery for IE from 2002 to 2016. Median follow-up time after surgery was 53.2 months (IQI 26.2-106.8 months). In-hospital mortality was analyzed using multiple logistic regression. Long-term survival was analyzed after one, two and five years. Cox proportional hazards regression was employed to identify risk factors related to long-term mortality. RESULTS: Of the 180 patients underwent cardiac surgery, 133 were discharged alive (in-hospital mortality was 26.11%). 6 variables were identified as independent factors associated with in-hospital mortality, most of them closely related to the severity of IE: age, multivalvular involvement, critical preoperative status, preoperative mechanical ventilation, abscess and thrombocytopenia. Long-term survival in patients discharged alive was 89.1%, 87.4% and 77.6% after one, two and five years. Long-term mortality was independent of specific IE factors and 86.51% of deaths were not related to cardiovascular or infectious diseases. CONCLUSION: Despite the high perioperative mortality rate after surgical treatment for active IE, long-term survival after hospital discharge was acceptable, regardless of the severity of the endocarditis episode. Although in-hospital survival depended mainly on several IE factors, long-term survival was not related to the severity of endocarditis baseline affection

OBJETIVOS: La cirugía cardíaca es un procedimiento fundamental en pacientes diagnosticados de endocarditis infecciosa (EI). Existen varias escalas de riesgo para predecir la mortalidad temprana; sin embargo, la supervivencia a largo plazo ha sido menos estudiada. El objetivo es analizar el impacto de los factores de riesgo específicos de EI en la mortalidad temprana y a largo plazo. MÉTODOS: Estudio observacional retrospectivo que incluyó a todos los pacientes operados por EI entre 2002 y 2016. La mediana del tiempo de seguimiento fue de 53,2 meses (IQI: 26,2-106,8 meses). La mortalidad intrahospitalaria se analizó mediante regresión logística múltiple. La supervivencia se analizó a uno, 2 y 5 años. Los factores de riesgo de mortalidad tardía se analizaron mediante regresión de Cox. RESULTADOS: De los 180 pacientes operados, 133 sobrevivieron al postoperatorio inmediato (26,11% de mortalidad intrahospitalaria). Encontramos 6 factores asociados a la mortalidad hospitalaria: edad, afectación multivalvular, estado preoperatorio crítico, ventilación mecánica preoperatoria, absceso y trombopenia. La supervivencia a largo plazo fue del 89,1, 87,4 y 77,6% después de uno, 2 y 5 años. La mortalidad a largo plazo fue independiente de factores específicos de la EI, y el 86,51% no se relacionó con enfermedades cardiovasculares o infecciosas. CONCLUSIÓN: A pesar de la alta tasa de mortalidad peri-operatoria tras cirugía, la supervivencia a largo plazo fue aceptable, independientemente de la gravedad del episodio de endocarditis. Aunque la supervivencia intrahospitalaria guardó relación con factores específicos de endocarditis, y la supervivencia a largo plazo no se correlacionó con la gravedad de la afectación inicial

Long-term prognosis after surgery for infective endocarditis: Distinction between predictors of early and late survival.

OBJECTIVES: Cardiac surgery is a life-saving procedure in patients diagnosed with infective endocarditis (IE). There are several validated risk scores developed to predict early-mortality; nevertheless, long-term survival has been less investigated. The aim of the present study is to analyze the impact of IE-specific risk factors for early and long-term mortality. METHODS: An observational retrospective study was conducted that included all patients who underwent surgery for IE from 2002 to 2016. Median follow-up time after surgery was 53.2 months (IQI 26.2-106.8 months). In-hospital mortality was analyzed using multiple logistic regression. Long-term survival was analyzed after one, two and five years. Cox proportional hazards regression was employed to identify risk factors related to long-term mortality. RESULTS: Of the 180 patients underwent cardiac surgery, 133 were discharged alive (in-hospital mortality was 26.11%). 6 variables were identified as independent factors associated with in-hospital mortality, most of them closely related to the severity of IE: age, multivalvular involvement, critical preoperative status, preoperative mechanical ventilation, abscess and thrombocytopenia. Long-term survival in patients discharged alive was 89.1%, 87.4% and 77.6% after one, two and five years. Long-term mortality was independent of specific IE factors and 86.51% of deaths were not related to cardiovascular or infectious diseases. CONCLUSION: Despite the high perioperative mortality rate after surgical treatment for active IE, long-term survival after hospital discharge was acceptable, regardless of the severity of the endocarditis episode. Although in-hospital survival depended mainly on several IE factors, long-term survival was not related to the severity of endocarditis baseline affection.

Which type of valve should we use in tricuspid position? Long-term comparison between mechanical and biological valves.

BACKGROUND: Nowadays, tricuspid valve replacement (TVR) is much less common than aortic or mitral valve replacement, since repair is almost always preferable. Prosthetic tricuspid valves are associated with high mortality and morbidity, mostly due to thrombotic or hemorrhagic events. Nevertheless, there is lack of evidence of which is the optimal type of valve (biological versus mechanical) in tricuspid position. METHODS: We analyzed all the patients who underwent TVR in our Institution, from 2005 to 2015. Patient baseline characteristics were recorded (such as functional class, previous cardiac surgery, right ventricular dysfunction or pulmonary hypertension), and a clinical long-term follow-up was conducted. We compared the outcomes between mechanical and biological prostheses: in-hospital mortality, long-term mortality, need for reintervention and adverse events (such as stroke or valve thrombosis). RESULTS: During the study period 120 tricuspid prosthetic valves were implanted in 111 patients. 81 of them (67.5%) were bioprostheses, and 39 (32.5%) mechanical valves. 73 patients (60.8%) had undergone a previous cardiac surgery (28.4% had previous tricuspid surgery). Most of the patients (87.1%) were in high functional class (grade III-IV of the NYHA classification), and 85% had moderate to severe pulmonary hypertension. Mean logistic EuroSCORE I was 14.80%. Only 37 cases were isolated TVR (30.6%), as most of the cases were TVR concomitant to mitral valve replacement. In-hospital mortality was 21.7%, and during the follow-up (mean follow-up of 7 years) reached 37.5%. Three mechanical tricuspid valves (7.7%) had to be replaced due to thrombosis, while 7 biological valves (8.6%) had to be replaced due to valve deterioration. The incidence of stroke was 7.5%. CONCLUSIONS: Tricuspid valve replacement is an infrequent procedure with a high incidence of perioperative morbidity and mortality. Biological or mechanical valves have similar mortality, and a reasonably low incidence of need for reintervention due to thrombosis or valve deterioration.

Rotura iatrogénica de electrodos de marcapasos permanente en la realización de esternotomía media: presentación de un caso / Iatrogenic rupture of permanent pacemaker electrodes while performing a median sternotomy: a case report

RESUMEN La esternotomía media continúa siendo el gold-standart de abordaje quirúrgico en cirugía cardiaca. Aún realizada correctamente, la apertura media del esternón presenta complicaciones en el 1-5% de los casos que varían en su gravedad desde la infección de la herida quirúrgica a la lesión de estructuras intratorácicas. En el presente estudio se describe un caso de rotura de electrodos de marcapasos tras esternotomía media por retracción y fibrosis del tronco venoso braquiocefálico. Debido a la ausencia de artículos semejantes en la literatura y al extendido empleo de la esternotomía en pacientes portadores de marcapasos permanente, se pretende disminuir las lesiones asociadas mediante la publicación de un infrecuente caso de lesión iatrogénica durante la apertura esternal, con escasos precedentes en la literatura publicada hasta la fecha. MÉD.UIS. 2016;29(3):95-9.

ABSTRACT Median sternotomy is still the gold-standard surgical approach in cardiac surgery. Even correctly performed, the sternum median opening presents complications in an incidence of 1-5% of cases comprising in severity from infection of the surgical wound to the injury of intrathoracic structures. We describe a case in which the pacemaker leads were broken after median sternotomy because of the brachiocephalic vein fibrosis. Due to the absence of similar items in the literature and the widespread use of sternotomy in patients with permanent pacemakers, we intended to reduce associated injuries by posting a rare case of iatrogenic injury during sternal opening with few precedents in the literature. MÉD.UIS. 2016;29(3):95-9.