ABSTRACT
Objective: To determine the clinical and epidemiological characteristics of patients with short-term mechanical circulatory support devices (MCSD) after myocardial infarction (MI) at a national referral hospital. Materials and methods: Descriptive, retrospective study of post-MI patients in whom short-term mechanical circulatory support devices were implanted from 2015 to 2020. Results: Nine mechanical support devices were implanted, in the same number of patients due to cardiogenic shock post MI. All patients were men with ST-elevation myocardial infarction (STEMI). Eight extracorporeal membrane oxygenation devices (ECMO) and one centrifugal flow pump (in LVAD configuration) were implanted. The median time of use of the devices was eight days. The most frequent complications were non-fatal bleeding (55.6%), acute kidney injury (44.4%) and sepsis (44.4%).In-hospital mortality was 55.6 %. Conclusions: The use of short term MCSD after myocardial infarction is still limited in our institution and its main representative is the ECMO post STEMI complicated by cardiogenic shock. Despite the use of these devices, in-hospital mortality is high.
ABSTRACT
BACKGROUND: Heart transplantations are ideal for most patients with end-stage heart failure refractory to medical treatment. The transplantation program at the Peruvian National Heart Institute started with a 10-year continuity in 2010. OBJECTIVE: To compare our 10-year heart transplantation experience results with international standards and reflect on our Transplant Program. METHODS: We studied 83 patients who underwent orthotopic heart transplantation at a single center between January 2010 and December 2019. The recipients' profiles and survival rates were analyzed according to sex and age group, ensuring the information's confidentiality. RESULTS: The recipients' mean age was 41.2 ± 17 years, 88% were adults, and 68.7% were male. The main indications for transplantation were idiopathic dilated cardiomyopathy. 85.5% of recipients were clinically categorized as INTERMACS profiles 1-3 before transplantation. There was a significant difference between sexes regarding the preoperative left ventricular ejection fraction and between age groups regarding the waiting time. The average ischemia time was 3.1 h, operating time was 6.1 h, cardiopulmonary bypass time was 3 h, and aortic cross-clamp time was 1.7 h. The principal early postoperative complications were hematological disorders and acute kidney failure. The principal late ones were kidney failure and severe anemia. The postoperative mortality was 15.9%, and the principal causes were infection and then acute rejection. The survival at 1, 5, and 10 years was 87.5%, 79.8%, and 79.8%, respectively. The survival results were not influenced by sex or age group. CONCLUSION: Our patients' postoperative complications, mortality, and survival rates coincided with those reported by the ISHLT registry.
Subject(s)
Heart Transplantation , Ventricular Function, Left , Adult , Female , Heart Transplantation/methods , Humans , Male , Middle Aged , Peru/epidemiology , Postoperative Complications/epidemiology , Retrospective Studies , Stroke Volume , Survival Rate , Young AdultABSTRACT
Objective: To know the most frequent acute cardiovascular complications in a Peruvian population of oncologic patients. Materials and methods: Retrospective, descriptive study of oncologic patients treated at Clinica Delgado between January 2014 and December 2019, from which the subgroup with the seven most prevalent cancers at the national level was selected according to information from Globocan 2018. Additionally, we evaluated the epidemiology of patients with cardiovascular complications that conditioned their hospitalization or were detected during this, calculating their cardiovascular risk according to Hermann and SCORE risk scales. Results: Forty-four patients had complications; 27 (61.4%) were hospitalized due to acute cardiovascular causes. The mean age of this subgroup was 69.88 years (SD 12.77), and 22 (81.5%) were older than 60 years. Fourteen (51.9%) were male. According to the Hermann scale, 33.3% had intermediate-risk and 14.9% had a high or very high risk. According to the SCORE scale, 62.97% had an intermediate-risk and 7.40% high risk. The most common acute cardiovascular complications were deep vein thrombosis and ischemic stroke (66.65%). One patient (3.7%) reported previous cardiovascular disease. Four patients (14.8%) had a fatal outcome during hospitalization. The median length of hospitalization was five days. Conclusions: We present the cases of acute cardiovascular complications in a population of oncologic patients and their vascular risk according to Hermann and SCORE scales. The most common complications were deep vein thrombosis (48.14%), stroke (18.51%), and myocardial infarction (14.81%).
ABSTRACT
Objective: To evaluate the epidemiological, clinical, surgical, pathological characteristics and outcomes in the follow-up of heart transplant recipients at the National Cardiovascular Institute during 2010-2020. Material and Methods: A retrospective descriptive study was performed by reviewing the medical records of patients undergoing heart transplantation at a national referral center, describing the clinical, surgical, laboratory, pathology characteristics and survival of patients up to 10 years of follow-up. Results: Eighty-six patients were transplanted in 10 years, the median age was 41 years (RIQ 28-56), being predominantly male (66.3%). The three leading causes of indication for heart transplantation were: dilated cardiomyopathy (48.9%), ischemic heart disease (17.4%), and myocarditis (6.9%). Total ischemia time was 160 minutes (RIQ 129.7-233.5). Survival at one, five, and ten years was 84.8%, 73.6%, and 65.7% respectively. The main cause of death was non-cardiac: infectious (39.1%) and of unknown origin (26%). Conclusions: The main etiology of heart failure in heart transplant recipients in Peru in recent years was nonischemic dilated cardiomyopathy. We observed that the survival rate was similar to that of international registries; however, the rate of mortality due to infectious causes and death of unknown origin is high, which poses a challenge in the management of post-transplant patients.
ABSTRACT
Mujer de 44 años de edad que, durante el posoperatorio inmediato de una cirugía de reemplazo de válvula mitral presentó súbitamente elevación del segmento ST en las derivadas precordiales V4, V5 y V6 del electrocardiograma, elevación de enzimas cardiacas y disminución de la contractilidad del ventrículo izquierdo con FEVI 24%; ante la sospecha de infarto agudo de miocardio peri-operatorio se realizó el cateterismo cardiaco evidenciándose ausencia de lesiones en arterias coronarias, hallazgos compatibles con miocardiopatía de Takotsubo. La paciente evolucionó con choque cardiogénico, patrón hemodinámico confirmado por catéter en arteria pulmonar y requerimiento de altas dosis de inotrópicos, que incluyó levosimendán, soporte vasopresor y mecánico mediante balón de contra pulsación intra-aórtico; la respuesta al soporte instalado fue favorable y a 6 días del evento, la función del ventrículo izquierdo se recuperó con FEVI de 60%.
A case of a 44 year old woman who presented during the immediate post operative period of a mitral valve replacement with sudden elevation of the ST segment in the V4-6 derivations of an electrocardiogram, elevation of cardiac enzymes and reduced left vetricualr contractility with LVEF of 24% rising the suspicion of and cute myocardial infarction in presented. A cardiac catheterisation did not reveal lesions on the coronary arteries, findins sugegstive of Takotsubo cardiomyocardioapthy. The patient developed cardiogenic shock needing high inotropic doses including the use of levosimendan and intra-aortic balloon pump. The clinical response was favorable, 6 days later the LVEF was 60%.
