ABSTRACT
BACKGROUND: Hypertrophic cardiomyopathy is a condition associated with an increased risk of sudden death compared to the general population. Extended septal myectomy surgery has been suggested to impact the reduction of sudden death events according to various publications. The aim of this study was to assess changes in the prevalence of sudden death predictors in a population of patients undergoing extended septal myectomy surgery. METHODS: Ninety-four consecutive patients underwent extended septal myectomy surgery due to symptomatic hypertrophic cardiomyopathy. Risk factors for sudden death, as defined by the American Heart Association and the European Society of Cardiology, were evaluated before and three months after surgery. RESULTS: The mean age of the population was 57 ± 13 years. A significant reduction was observed in the maximum septal thickness from 21.3 to 14 mm (p<0.001), along with a decrease in the anteroposterior diameter of the left atrium from 51 to 47 mm (p=0.021). Resting intraventricular gradients decreased from 49.2 to 6.4 mmHg (p<0.001), and Valsalva-induced gradients decreased from 93.9 to 8.7 mmHg (p<0.001). Non-sustained ventricular tachycardia decreased from 6% to 2% (p<0.001), and atrial fibrillation decreased from 30% to 15% (p<0.001). Ischemic behavior during exercise stress echo decreased from 6% to 0%, and the European Society of Cardiology sudden death risk score reduced from 3.32 to 1.44 (p<0.001). CONCLUSIONS: In this cohort of hypertrophic cardiomyopathy patients, extended septal myectomy surgery was associated with a reduction in the number and magnitude of sudden death predictors, potentially explaining the reduced mortality reported in the literature.
Subject(s)
Cardiac Surgical Procedures , Cardiomyopathy, Hypertrophic , Death, Sudden, Cardiac , Heart Septum , Humans , Cardiomyopathy, Hypertrophic/surgery , Male , Middle Aged , Female , Heart Septum/surgery , Heart Septum/diagnostic imaging , Death, Sudden, Cardiac/epidemiology , Death, Sudden, Cardiac/etiology , Death, Sudden, Cardiac/prevention & control , Risk Factors , Cardiac Surgical Procedures/methods , Cardiac Surgical Procedures/adverse effects , Aged , Echocardiography/methods , AdultABSTRACT
RESUMEN La decisión sobre la mejor estrategia de revascularización para los pacientes con enfermedad de múltiples vasos se ha tornado una tarea compleja a medida que la angioplastia coronaria ha mejorado sus resultados. En la siguiente revisión nos propusimos evaluar las variables que en nuestra experiencia definen el beneficio de una técnica sobre la otra, entendiendo que de esta manera la decisión del médico tratante se hace más sencilla y objetiva. Por otro lado, y festejando el saludable protagonismo que se le da al paciente, creemos que esta evaluación permite ofrecer argumentos sólidos para ayudarlo en la toma de la decisión.
ABSTRACT The decision on the best revascularization strategy for patients with multivessel disease has become a complex task as coronary angioplasty has improved its results. In the following review, we set out to evaluate the variables that, in our experience, define the benefit of one technique over the other, understanding that in this way the treating physician's decision will become simpler and more objective. On the other hand, and celebrating the healthy prominence given to patients, we believe that this evaluation allows solid arguments to help them in decision making.
ABSTRACT
Venoarterial extracorporeal membrane oxygenation (VA ECMO) is a form of temporary mechanical circulatory support and simultaneous extracorporeal gas exchange for acute cardiorespiratory failure, including refractory cardiogenic shock (CS) and cardiac arrest (CA). Few studies have assessed predictors of successful weaning (SW) from VA ECMO. This systematic review and meta-analysis aimed to identify a multiparameter strategy associated with SW from VA ECMO. PubMed and the Cochrane Library and the International Clinical Trials Registry Platform were searched. Studies reporting adult patients with CS or CA treated with VA ECMO published from the year 2000 onwards were included. Primary outcomes were hemodynamic, laboratory, and echocardiography parameters associated with a VA ECMO SW. A total of 11 studies (n=653) were included in this review. Pooled VA ECMO SW was 45% (95%CI: 39-50%, I2 7%) and in-hospital mortality rate was 46.6% (95%CI: 33-60%; I2 36%). In the SW group, pulse pressure [MD 12.7 (95%CI: 7.3-18) I2 = 0%] and mean blood pressure [MD 20.15 (95%CI: 13.8-26.4 I2 = 0) were higher. They also had lower values of creatinine [MD -0.59 (95%CI: -0.9 to -0.2) I2 = 7%], lactate [MD -3.1 (95%CI: -5.4 to -0.7) I2 = 89%], and creatine kinase [-2779.5 (95%CI: -5387 to -171) I2 = 38%]. And higher left and right ventricular ejection fraction, MD 17.9% (95%CI: -0.2-36.2) I2 = 91%, and MD 15.9% (95%CI 11.9-20) I2 = 0%, respectively. Different hemodynamic, laboratory, and echocardiographic parameters were associated with successful device removal. This systematic review demonstrated the relationship of multiparametric assessment on VA ECMO SW.
Subject(s)
Extracorporeal Membrane Oxygenation , Heart Arrest , Humans , Adult , Shock, Cardiogenic/therapy , Stroke Volume , Ventricular Function, Right , Heart Arrest/therapy , Lactic AcidABSTRACT
Objectives: Veno-arterial Extracorporeal membrane oxygenation (VA ECMO) is a salvage intervention in patients with cardiogenic shock (CS), and cardiac arrest (CA) refractory to standard therapies. The design of ECMO Teams has achieved the standardization of processes, although its impact on survival and prognosis is unknown. Objective: We aimed to analyze whether the creation of an ECMO Team has modified the prognosis of patients undergoing VA ECMO for refractory CS or CA. Materials and methods: . We conducted a single-center retrospective cohort study. Patients with refractory CS or CA who underwent VA ECMO were divided in two consecutive periods: from 2014 to April 2019 (pre-ECMO T) and from May 2019 to December 2022 (Post ECMO T). The main outcomes were survival on ECMO, in-hospital survival, complications, and annual ECMO volume. Results: Eighty-three patients were included (36 pre-ECMO T and 47 post-ECMO T). The mean age was 53 +/-13 years. The most common reason for device indication was different: postcardiotomy shock (47.2%) pre-ECMO T and refractory cardiogenic shock (29.7%) post-ECMO T. The rate of extracorporeal cardiopulmonary resuscitation was 14.5%. The median duration of VA ECMO was longer after ECMO team implementation: 8 days (IQR 5-12.5) vs. five days (IQR 2-9, p=0.04). Global in-hospital survival was 45.8% (38.9% pre-ECMO T vs. 51.1% post-ECMO T; p=0.37), and the survival rate from VA ECMO was 60.2% (55.6% pre-ECMO T vs 63.8% post-ECMO T; p= 0.50). The volume of VA ECMO implantation was significantly higher in the post-ECMO team period (13.2 +/3.5 per year vs. 6.5 +/-3.5 per year, p: 0.02). The rate of complications was similar in both groups. Conclusions: After the implementation of an ECMO team, there was no statistical difference in the survival rate of patients treated with VA ECMO. However, a significant increase in the number of patients supported per year was observed after the implementation of this multidisciplinary team. Post-ECMO T, the most common reason for device indication was cardiogenic shock, with longer run times and a higher rate of extracorporeal cardiopulmonary resuscitation.
ABSTRACT
RESUMEN Introducción: Los ensayos clínicos aleatorizados que compararon la cirugía de revascularización miocárdica (CRM) con la angioplastia transluminal coronaria (ATC) incluyeron todo tipo de técnicas quirúrgicas (con y sin bomba de circulación extracorpórea) y diversos conductos (arteriales y venosos). ¿Es razonable suponer que todas las técnicas quirúrgicas son iguales en términos de mortalidad tardía? Objetivos: Evaluar si la CRM sin circulación extracorpórea y con el empleo de ambas arterias mamarias tiene un beneficio adicional a la revascularización convencional utilizando una sola arteria mamaria en términos de sobrevida a largo plazo para la enfermedad del tronco de la coronaria izquierda (TCI). Material y métodos: Estudio observacional retrospectivo comparativo (n = 723) ajustado por riesgo. Se realizó análisis estratificado según el uso de arteria mamaria interna única (SITA, n = 144) o ambas arterias mamarias internas (BITA, n = 579). Se analizó la sobrevida a los 10 años de la intervención. Resultados: La supervivencia a los 10 años fue significativamente mayor en el grupo en que se utilizaron ambas arterias mamarias (79,0% ± 3,4% vs 67,0% ± 4,9%, log-rank test, p <0,01). Este beneficio también se observó en el análisis ajustado por riesgo (93,0% ± 4,6 vs 69,0% ± 5,7 respectivamente, p = 0,03). El uso de ambas arterias mamarias fue un predictor independiente de sobrevida a 10 años (HR 0,57, IC 95% 0,37-0,87; p = 0,01). Conclusión: El uso de ambas arterias mamarias internas en pacientes con enfermedad del tronco coronario izquierdo sometidos a revascularización coronaria sin circulación extracorpórea se asoció con mayor sobrevida a los 10 años.
ABSTRACT Background: The randomized controlled trials comparing coronary artery bypass graft (CABG) surgery versus percutaneous coronary intervention (PCI) included all types of surgical techniques (on-pump and off-pump) and different conduits (arterial and venous). Is it reasonable to assume that all surgical techniques are equal in terms of late mortality? Objectives: The aim of this study was to evaluate whether off-pump CABG surgery using both mammary arteries provides additional benefit over conventional revascularization using single mammary artery in terms of long-term survival for left main coronary artery (LMCA) disease. Methods: We conducted a retrospective, observational and comparative study (n=723) adjusted for risk. A stratified analysis was performed according to the use of single internal thoracic artery (SITA, n=144) or bilateral internal thoracic arteries (BITA, n=579) analyzing survival at 10 years after the intervention. Results: Survival at 10 years was significantly higher in BITA group (79.0%±3.4% vs 67.0%±4.9%, log-rank test, p <0.01). This advantage was also observed in the risk-adjusted analysis (93.0%±4.6 vs 69.0%±5.7 respectively, p=0.03). The use of BITA was an independent predictor of 10-year survival (HR 0.57, 95% CI 0.37-0.87, p=0.01). Conclusion: The use of bilateral internal mammary arteries in patients with left main coronary artery disease undergoing off-pump coronary artery bypass grafting was associated with higher survival at 10 years.
ABSTRACT
OBJECTIVE: The purpose of the present study was to compare survival outcomes in propensity score-matched patients aged 70 years or greater receiving a bilateral internal thoracic artery graft with patients receiving a single internal thoracic artery graft. METHODS: Among 4083 consecutive patients with isolated coronary artery bypass grafting who underwent operation between January 2001 and December 2018, we identified 1300 patients aged 70 years or greater; of these, 968 received a bilateral internal thoracic artery (bilateral internal thoracic artery group) and 332 received a single internal thoracic artery (single internal thoracic artery group). Propensity score matching was used to reduce the preoperative patient differences. The 10-year survival and postoperative complications were compared between the 2 groups. RESULTS: A Kaplan-Meier curve at 10 years of follow-up showed that crude survival was significantly superior in patients with bilateral internal thoracic artery grafts than in patients with single internal thoracic artery grafts (67.0% ± 2.5% vs 56.0% ± 3.4%, respectively; P < .016). In the actuarial survival, estimates for propensity score-matched patients with a bilateral internal thoracic artery showed a significantly higher rates of survival than patients with a single internal thoracic artery by the end of follow-up (66.0% ± 5.3% vs 53.0% ± 3.9%, respectively; hazard ratio, 0.64; 95% confidence interval, 0.44-0.94; P = .022, univariable Cox Model and multivariable analysis hazard ratio, 0.66; 95% confidence interval, 0.45-0.97; P = .036 Cox model). Postoperative complications were all similar between the single internal thoracic artery and bilateral internal thoracic artery groups. CONCLUSIONS: The use of bilateral internal thoracic artery grafting in older patients improves 10-year survival, with similar postoperative morbidity. This surgical technique might have beneficial effects in survival in patients aged more than 70 years. Its use could be considered more frequently.
Subject(s)
Coronary Artery Disease , Mammary Arteries , Aged , Coronary Artery Bypass/methods , Coronary Artery Disease/complications , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/surgery , Humans , Mammary Arteries/transplantation , Postoperative Complications/etiology , Retrospective Studies , Treatment OutcomeABSTRACT
RESUMEN Introducción: El objetivo del estudio es evaluar los resultados alejados de la reparación de la válvula mitral (VM) con insuficiencia de tipo degenerativo. Material y Métodos: Entre enero 2008 y diciembre 2019 se efectuó cirugía reparadora de la VM en 457 pacientes con insuficiencia mitral grave (IM). La edad promedio fue 64,9 ± 12,2 años, y 61,1% eran de sexo masculino. El seguimiento clínico mediana 3,0 (RIC 4,1 años) se completó en el 98,7% de los pacientes. Se efectuaron estudios ecocardiográficos de seguimiento en forma periódica, se analizó la sobrevida, la recurrencia de IM moderada-grave en forma global y según el tipo de valva afectada, y la necesidad de re intervención en el seguimiento alejado. Resultados: A 10 años de seguimiento la sobrevida alejada fue elevada sin diferencias significativas según la valva afectada: valva posterior 95 ± 2,1%, y valva anterior 94 ± 2,2% (p=0,54). El grupo de pacientes con clase funcional preoperatoria III/IV (n = 142) presentó mayor mortalidad al seguimiento: 13,9 ± 4,1% vs. 2,7% ± 1,2% (p = 0,001). El porcentaje de recurrencia de IM moderada-grave al finalizar el seguimiento para el grupo total de pacientes fue del 14,6 ± 4,3% y el periodo de libertad de recurrencia según valva afectada fue elevado sin diferencia significativas: valva posterior 90 ± 3,4% y valva anterior 80 ± 8,5 (p = 0,97). Por último, la necesidad de reintervención en el seguimiento post reparación fue del 4,7 ± 3,3 % Conclusiones: la sobrevida alejada post reparación de IM es elevada y la necesidad de reintervención poco frecuente. Existe un aumento progresivo en la recurrencia de IM en el seguimiento alejado.
ABSTRACT Objective: The aim of this study was to evaluate long-term results of degenerative mitral valve regurgitation (MR) repair. Methods: Between January 2008 and December 2019, 457 patients (mean age 64.9±12.2 years; 61.1% men) with severe MR underwent MV repair surgery. Median follow-up was 3.0 years (IQR 4.1 years) and was completed in 98.7% of patients. Periodic echocardiographic studies were performed, and long-term survival, the recurrence rate of moderate-severe MR and the need for reintervention were analyzed. Results: At 10-year follow-up, long-term survival was high without significant differences according to the affected leaflet: between posterior leaflet 95±2.1%, and anterior leaflet 94±2.2% (p=0.54). Patients with preoperative functional class III/IV (n=142) presented higher mortality at follow-up: 13.9±4.1% vs. 2.7%±1.2% (p=0.001). The risk of recurrence for moderatesevere MR at the end of follow-up for the total group of patients was 14.6±4.3% and freedom from recurrence according to the affected leaflet was high without significant difference: posterior leaflet 90±3.4% and anterior leaflet 80 ± 8.5 (p=0.97). Finally, the need for reoperation in post-repair follow-up was 4.7±3.3% Conclusions: Long-term survival after MV repair is high and the need for reoperation is infrequent. There is a progressive increase in MR recurrence at the long-term follow-up.
ABSTRACT
RESUMEN Introducción: La oxigenación por membrana extracorpórea venoarterial (ECMO VA) es una intervención de rescate en pacientes con shock cardiogénico (SC), y paro cardiorrespiratorio (PCR) refractarios a las terapias convencionales. Objetivo: Describir las características, y resumir nuestra experiencia inicial de 7 años de pacientes que requirieron ECMO VA por SC o PCR. Material y métodos: Se realizó un estudio de cohorte unicéntrico. Se analizaron retrospectivamente los pacientes adultos consecutivos que fueron asistidos con ECMO VA por SC o PCR refractarios entre 2014 y 2020 en el ICBA Instituto Cardiovascular. Resultados: Se incluyeron 54 pacientes, (54 ± 12 años). El 36,5% presentó miocardiopatía isquémica, y el 23,1% enfermedad valvular significativa. Las indicaciones para ECMO VA fueron: poscardiotomía (43,4%), SC refractario (28,3%), y falla primaria del injerto (20,8%). La reanimación cardiopulmonar previa a la ECMO VA se realizó en el 18,5%. La canulación fue periférica en el 81,5%, el 83,3% se asistió en INTERMACS 1, y el 87% presentaba balón de contrapulsación intraaórtico. La duración de asistencia en ECMO VA fue de 5,5 días (RIC 2,8-10). La tasa de supervivencia en ECMO VA fue del 63% (37% puente a trasplante cardíaco, y 26% recuperación), y al alta del 42,6%. Las complicaciones más frecuentes fueron: sangrado (61,1%), infección (51,9%), y complicaciones tromboembólicas (46,3%). Conclusión: La ECMO VA como tratamiento del SC o PCR refractarios en nuestro centro presentó una sobrevida aceptable al alta hospitalaria. La ECMO VA es un tratamiento efectivo cuando las terapias convencionales fallan, siendo aparentemente útil y aplicable en un país donde existe acceso limitado a los dispositivos de asistencia ventricular compleja.
ABSTRACT Background: Venoarterial extra corporeal membrane oxygenation (VA-ECMO) is a rescue intervention used in patients with cardiogenic shock (CS) or cardiac arrest (CA) refractory to conventional medical therapies. Objective: The aim of the present study is to describe the characteristics and summarize our 7-year experience in patients with CS or CA supported with VA-ECMO. Methods: We conducted a single-center retrospective study analyzing consecutive adult patients requiring VA-ECMO due to refractory CS or CA at ICBA, Instituto Cardiovascular between January 2014 and December 2020. Results: A total age 54 patients were included (54 ± 12 years), 36.5% presented ischemic cardiomyopathy and 23.1% significant valvular heart disease. The indications for VA-ECMO implantation were post-cardiotomy (43.4%), refractory CS (28.3%) and primary graft dysfunction (20.8%). Cardiopulmonary resuscitation before VA-ECMO occurred in 18.5% of the cases. Peripheral cannulation was performed in 81.5% of the cases, 83.3% had INTERMACS profile 1 and 87% were on intraaortic balloon pump. Duration of ventricular assistance on VA- ECMO was 5.5 days (IQR 2.8-10). Survival rate on ECMO VA was 63% (37% as a bridge to cardiac transplantation and 26% as a bridge to recovery) and survival to discharge was 42.6%. The most common complications were hemorrhage (61.1%), infections (51.9%), and thromboembolic complications (46.3%). Conclusion: In our center, VA-ECMO as a treatment for refractory CS or CA showed acceptable survival during ventricular support and on hospital discharge. It is an effective life support treatment to rescue critically ill patients when conventional therapies fail, is apparently useful and can be implemented in a country with limited resources and access to complex ventricular assist devices.
ABSTRACT
Antecedentes y objetivos: El sistema de calificación APACHE II permite predecir la mortalidad intrahospitalaria en terapia intensiva. Sin embargo, no está validado para cirugía cardíaca, ya que no posee buena capacidad diferenciadora. El objetivo es determinar el valor pronóstico de APACHE II en el postoperatorio de procedimientos cardíacos. Materiales y métodos: Se analizó en forma retrospectiva la base de cirugía cardíaca. Se incluyó a pacientes intervenidos entre 2017 y 2018, de los cuales se calculó la puntuación APACHE II. Se utilizó curva ROC para determinar el mejor valor de corte. El punto final primario fue mortalidad intrahospitalaria. Como puntos finales secundarios se evaluó la incidencia de bajo gasto cardíaco (BGC), accidente cerebrovascular (ACV), sangrado quirúrgico y necesidad de diálisis. Se realizó un modelo de regresión logístico multivariado para ajustar a las variables de interés. Resultados: Se analizó a 559 pacientes. La media del sistema de calificación APACHE II fue de 9.9 (DE 4). La prevalencia de mortalidad intrahospitalaria global fue de 6.1%. El mejor valor de corte de la calificación para predecir mortalidad fue de 12, con un área bajo la curva ROC de 0.92. Los pacientes con APACHE II ≥ 12 tuvieron significativamente mayor mortalidad, incidencia de BGC, ACV, sangrado quirúrgico y necesidad de diálisis. En un modelo multivariado, el sistema APACHE II se relacionó de modo independiente con mayor tasa de mortalidad intrahospitalaria (OR, 1.14; IC95%, 1.08-1.21; p < 0.0001). Conclusiones: El sistema de clasificación APACHE II demostró ser un predictor independiente de mortalidad intrahospitalaria en pacientes que cursan el postoperatorio de cirugía cardíaca. Background and objectives: The APACHE II score allows predicting in-hospital mortality in patients admitted to intensive care units. However, it is not validated for patients undergoing cardiac surgery, since it does not have a good discriminatory capacity in this clinical scenario. The aim of this study is to determine prognostic value of APACHE II score in postoperative of cardiac surgery. Materials and methods: The study was performed using the cardiac surgery database. Patients undergoing surgery between 2017 and 2018, with APACHE II score calculated at the admission, were included. The ROC curve was used to determine a cut-off value The primary endpoint was in-hospital death. Secondary endpoints included low cardiac output (LCO), stroke, surgical bleeding, and dialysis requirement. A multivariable logistic regression model was developed to adjust to various variables of interest. Results: The study evaluated 559 patients undergoing cardiac surgery. The mean of APACHE II Score was 9.9 (SD 4). The prevalence of in-hospital death was 6.1%. The best prognostic cut-off value for the primary endpoint was 12, with a ROC curve of 0.92. Patients with an APACHE II score greater than or equal to 12 had significantly higher mortality, higher incidence of LCO, stroke, surgical bleeding and dialysis requirement. In a multivariate logistic regression model, the APACHE II score was independently associated with higher in-hospital death (OR, 1.14; 95CI%, 1.08-1.21; p < 0.0001). Conclusions: The APACHE II Score proved to be an independent predictor of in-hospital death in patients undergoing postoperative cardiac surgery, with a high capacity for discrimination.
Subject(s)
Cardiac Surgical Procedures/adverse effects , Hospital Mortality , Postoperative Complications/epidemiology , APACHE , Aged , Aged, 80 and over , Blood Loss, Surgical/statistics & numerical data , Cardiac Output, Low/epidemiology , Cardiac Surgical Procedures/mortality , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Postoperative Complications/mortality , Prognosis , Renal Dialysis/statistics & numerical data , Retrospective Studies , Stroke/epidemiologyABSTRACT
Resumen Antecedentes y objetivos: El sistema de calificación APACHE II permite predecir la mortalidad intrahospitalaria en terapia intensiva. Sin embargo, no está validado para cirugía cardíaca, ya que no posee buena capacidad diferenciadora. El objetivo es determinar el valor pronóstico de APACHE II en el postoperatorio de procedimientos cardíacos. Materiales y métodos: Se analizó en forma retrospectiva la base de cirugía cardíaca. Se incluyó a pacientes intervenidos entre 2017 y 2018, de los cuales se calculó la puntuación APACHE II. Se utilizó curva ROC para determinar el mejor valor de corte. El punto final primario fue mortalidad intrahospitalaria. Como puntos finales secundarios se evaluó la incidencia de bajo gasto cardíaco (BGC), accidente cerebrovascular (ACV), sangrado quirúrgico y necesidad de diálisis. Se realizó un modelo de regresión logístico multivariado para ajustar a las variables de interés. Resultados: Se analizó a 559 pacientes. La media del sistema de calificación APACHE II fue de 9.9 (DE 4). La prevalencia de mortalidad intrahospitalaria global fue de 6.1%. El mejor valor de corte de la calificación para predecir mortalidad fue de 12, con un área bajo la curva ROC de 0.92. Los pacientes con APACHE II ≥ 12 tuvieron significativamente mayor mortalidad, incidencia de BGC, ACV, sangrado quirúrgico y necesidad de diálisis. En un modelo multivariado, el sistema APACHE II se relacionó de modo independiente con mayor tasa de mortalidad intrahospitalaria (OR, 1.14; IC95%, 1.08-1.21; p < 0.0001). Conclusiones: El sistema de clasificación APACHE II demostró ser un predictor independiente de mortalidad intrahospitalaria en pacientes que cursan el postoperatorio de cirugía cardíaca.
Abstract Background and objectives: The APACHE II score allows predicting in-hospital mortality in patients admitted to intensive care units. However, it is not validated for patients undergoing cardiac surgery, since it does not have a good discriminatory capacity in this clinical scenario. The aim of this study is to determine prognostic value of APACHE II score in postoperative of cardiac surgery. Materials and methods: The study was performed using the cardiac surgery database. Patients undergoing surgery between 2017 and 2018, with APACHE II score calculated at the admission, were included. The ROC curve was used to determine a cut-off value The primary endpoint was in-hospital death. Secondary endpoints included low cardiac output (LCO), stroke, surgical bleeding, and dialysis requirement. A multivariable logistic regression model was developed to adjust to various variables of interest. Results: The study evaluated 559 patients undergoing cardiac surgery. The mean of APACHE II Score was 9.9 (SD 4). The prevalence of in-hospital death was 6.1%. The best prognostic cut-off value for the primary endpoint was 12, with a ROC curve of 0.92. Patients with an APACHE II score greater than or equal to 12 had significantly higher mortality, higher incidence of LCO, stroke, surgical bleeding and dialysis requirement. In a multivariate logistic regression model, the APACHE II score was independently associated with higher in-hospital death (OR, 1.14; 95CI%, 1.08-1.21; p < 0.0001). Conclusions: The APACHE II Score proved to be an independent predictor of in-hospital death in patients undergoing postoperative cardiac surgery, with a high capacity for discrimination.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Postoperative Complications/epidemiology , Hospital Mortality , Cardiac Surgical Procedures/adverse effects , Postoperative Complications/mortality , Prognosis , Cardiac Output, Low/epidemiology , Cross-Sectional Studies , Retrospective Studies , Blood Loss, Surgical/statistics & numerical data , Renal Dialysis/statistics & numerical data , APACHE , Stroke/epidemiology , Cardiac Surgical Procedures/mortalityABSTRACT
RESUMEN Introducción: El compromiso cardíaco es la principal causa de morbimortalidad en la amiloidosis, independientemente de la patogenia productora del amiloide subyacente. La amiloidosis por transtiretina (TTR) es una de las variantes más frecuentes, por lo cual el objetivo de este trabajo fue evaluar las características de una cohorte de pacientes con diagnóstico de cardiopatía amiloidótica por TTR (CA-TTR) Material y métodos: Se recabaron datos de los estudios basales, de la metodología diagnóstica y de la evolución de 49 pacientes en seguimiento en la Clínica de Miocardiopatías de nuestra institución. Resultados: La mediana del tiempo de seguimiento fue de 1258 días (410-2004) y la edad promedio de 79 ± 9 años. Al inicio del seguimiento, el 57% de los pacientes estaban en clase funcional I, el 26%, en II y el 16%, en III-IV. El diagnóstico se basó en centellograma con difosfonatos en el 92%; en el 24% requirió biopsia. La mortalidad global fue del 19%, con 15% de muerte cardiovascular. La tasa de internación por insuficiencia cardíaca fue 29%; el 63% de los pacientes empeoró su clase funcional. Conclusiones: El seguimiento de nuestros pacientes con CA-TTR expresa los cambios que ha sufrido el proceso diagnóstico, con una reducción de estudios invasivos y tiempo para la caracterización. El diagnóstico de pacientes en etapas "tempranas" de la enfermedad parece impactar en los resultados a mediano plazo.
ABSTRACT Background: Cardiac involvement is the main cause of morbidity and mortality in amyloidosis, regardless of the underlying pathogenesis of amyloid production, and transthyretin (TTR) amyloidosis is one of the most frequent variants. Objective: The aim of this study was thus to assess the characteristics of a cohort of patients with diagnosis of TTR cardiac amyloidosis (ATTR-CA). Methods: Baseline data and diagnostic and follow-up methodology were collected from 49 patients treated at the cardiomy-opathy clinic of our institution. Results: Median follow-up was 1,258 days (410-2004). Mean age was 79±9 years, and 57% of patients were in functional class (FC) I, 26% in FC II and 16% in FC III-IV at follow-up onset. Diagnosis was made with diphosphonate scintigraphy in 92% of patients and 24% required a biopsy. Overall mortality was 19%, with 15% of cardiovascular death. The rate of hospitalization for heart failure was 29% and 63% of patients worsened their FC. Conclusions: Follow-up of patients with ATTR-CA expresses the changes undergone by the diagnostic process, with a reduction of invasive studies and time to characterization. The diagnosis of patients at "early stages of the disease" seems to have an impact on mid-term outcomes.
ABSTRACT
INTRODUCTION: Veno-arterial extracorporeal membrane oxygenation may be used to support patients with refractory cardiogenic shock. Many patients can be successfully weaned, the ability of some medications to facilitate weaning from veno-arterial extracorporeal membrane oxygenation were reported. To date, there are limited studies investigating the impact of levosimendan on veno-arterial extracorporeal membrane oxygenation weaning. The objective of this systematic review and meta-analysis was to assess the effects of levosimendan on successful weaning from veno-arterial extracorporeal membrane oxygenation and survival in adult patients with cardiogenic shock. METHODS: We performed a systematic review and meta-analysis (PubMed, the Cochrane Library, and the International Clinical Trials Registry Platform published from the year 2000 onwards) investigating whether levosimendan offers advantages compared to standard therapy or placebo, in cardiogenic shock adult patients treated with veno-arterial extracorporeal membrane oxygenation. The primary outcome was veno-arterial extracorporeal membrane oxygenation successful weaning, whereas secondary outcome was all-cause mortality at the longest follow-up available. We pooled risk ratio and 95% confidence interval using fixed and random effects models according to the heterogeneity. RESULTS: A total of five non-randomized clinical trials comprising 557 patients were included, 299 patients for levosimendan and 258 patients for control groups. The pooled prevalence of veno-arterial extracorporeal membrane oxygenation successful weaning was 61.4% (95% confidence interval 39.8-82.9%), and all-cause mortality was 36% (95% confidence interval 29.6-48.8%). There was a significant increase in veno-arterial extracorporeal membrane oxygenation successful weaning with levosimendan compared to the controls (risk ratio = 1.42 (95% confidence interval 1.12-1.8), p for effect = 0.004, I2 = 71%). A decrease risk of all-cause mortality in the levosimendan group was also observed, risk ratio = 0.62 (95% confidence interval 0.44-0.88), p for effect = 0.007, I2 = 36%. CONCLUSION: The use of levosimendan on adult patients with cardiogenic shock may facilitate the veno-arterial extracorporeal membrane oxygenation weaning and reduce all-cause mortality. Few articles of this topic are available, and prospective, randomized multi-center trials are warranted to conclude decisively on the benefits of levosimendan in this setting.
Subject(s)
Extracorporeal Membrane Oxygenation/methods , Shock, Cardiogenic/therapy , Simendan/therapeutic use , Vasodilator Agents/therapeutic use , Female , Humans , Male , Shock, Cardiogenic/mortality , Simendan/pharmacology , Survival Analysis , Vasodilator Agents/pharmacologyABSTRACT
Los bacilos gram negativos (BGN) que no pertenecen al grupo HACEK son una causa infrecuente de endocarditis infecciosa. Los aspectos epidemiológicos, diagnósticos y pronósticos de esta entidad son poco conocidos y la experiencia aún es limitada. Nuestros objetivos fueron analizar las características clínicas y microbiológicas de las endocarditis infecciosas (EI) por BGN no HACEK diagnosticadas en un centro de alta complejidad de Argentina en el período 1998-2016 y conocer su evolución hospitalaria, a fin de compararlas con las EI debidas a otros microorganismos.
Non-HACEK Gram-negative bacilli are a rare cause of infective endocarditis. Epidemiological, diagnostic and prognostic aspects of this entity are little known, and there is limited experience. The aim of this study was to analyze the clinical, microbiological and in-hospital outcomes of non-HACEK Gram negative bacilli endocarditis and to compare them with those due to other microorganisms.
