Cierre quirúrgico del ductus arterioso persistente del prematuro: ¿influye la técnica quirúrgica en los resultados? / Surgical closure of patent ductus arteriosus in premature neonates: Does the surgical technique affect the outcome?

INTRODUCCIÓN: El cierre quirúrgico del ductus arterioso persistente en el prematuro es una técnica agresiva y no exenta de complicaciones. Diseñamos un estudio con el objetivo de describir nuestra experiencia con una técnica menos invasiva, el abordaje extrapleural vía minitoracotomía posterior, y de comparar sus resultados con los del abordaje clásico transpleural. PACIENTES Y MÉTODOS: Estudio de cohortes retrospectivo de los neonatos prematuros a los que se les realizó cierre quirúrgico del ductus en un periodo de 10 años (marzo de 2005-marzo de 2015). Se compararon las complicaciones agudas, los resultados al alta y en el seguimiento entre los grupos de abordaje extrapleural y abordaje clásico transpleural. Se incluyó a 48 pacientes, 30 en el grupo de abordaje clásico y 18 en el grupo extrapleural. RESULTADOS: Las características demográficas y preoperatorias fueron similares en ambos grupos. No se encontraron diferencias entre los 2 grupos en la incidencia de complicaciones postoperatorias agudas (56,6 vs. 44,4%), en la dependencia de oxígeno a las 36 semanas (33,3 vs. 55,5%), ni en la mortalidad hospitalaria (10 vs. 16,6%). En la evolución a corto plazo, el grupo extrapleural precisó menos días hasta la retirada del oxígeno suplementario (36,3 vs. 28,9) y hasta el alta hospitalaria (67,5 vs. 53,2), aunque solo el tiempo hasta la extubación alcanzó una diferencia estadísticamente significativa (11,5 vs. 2,7, p = 0,03). CONCLUSIONES: El abordaje extrapleural por minitoracotomía posterior para el cierre quirúrgico del ductus en el prematuro es factible y podría conllevar algunos beneficios clínicos a corto plazo

INTRODUCTION: Surgical closure of patent ductus arteriosus in premature neonates is an aggressive technique and is not free of complications. A study was designed with the aim of describing our experience with a less invasive technique, the extra-pleural approach via a posterior minithoracotomy, and to compare the results with the classic transpleural approach. PATIENTS AND METHODS: A retrospective cohort study was conducted on premature neonates on whom surgical closure of the ductus was performed during a ten-year period (March 2005 to March 2015). A comparison was made of the acute complications, the outcomes on discharge, and follow-up, between the extra-pleural approach and the classic transpleural approach. The study included 48 patients, 30 in the classical approach and 18 in the extra-pleural group. RESULTS: The demographic and pre-operative characteristics were similar in both groups. No differences were found between the 2 groups in the incidence of acute post-operative complications (56.6 vs. 44.4%), on the dependence on oxygen at 36 weeks (33.3 vs. 55.5%), or in hospital mortality (10 vs. 16.6%). As regards the short-term progress, the extra-pleural group required fewer days until the withdrawal of supplementary oxygen (36.3 vs. 28.9) and until hospital discharge (67.5 vs. 53.2), although only the time until extubation achieved a statistically significant difference (11.5 vs. 2.7, P=.03). CONCLUSIONS: The extra-plural approach by posterior minithoracotomy for the surgical closure of ductus in the premature infant is viable and could bring some clinical benefits in the short-term

[Surgical closure of patent ductus arteriosus in premature neonates: Does the surgical technique affect the outcome?] / Cierre quirúrgico del ductus arterioso persistente del prematuro: ¿influye la técnica quirúrgica en los resultados?

INTRODUCTION: Surgical closure of patent ductus arteriosus in premature neonates is an aggressive technique and is not free of complications. A study was designed with the aim of describing our experience with a less invasive technique, the extra-pleural approach via a posterior minithoracotomy, and to compare the results with the classic transpleural approach. PATIENTS AND METHODS: A retrospective cohort study was conducted on premature neonates on whom surgical closure of the ductus was performed during a ten-year period (March 2005 to March 2015). A comparison was made of the acute complications, the outcomes on discharge, and follow-up, between the extra-pleural approach and the classic transpleural approach. The study included 48 patients, 30 in the classical approach and 18 in the extra-pleural group. RESULTS: The demographic and pre-operative characteristics were similar in both groups. No differences were found between the 2 groups in the incidence of acute post-operative complications (56.6 vs. 44.4%), on the dependence on oxygen at 36 weeks (33.3 vs. 55.5%), or in hospital mortality (10 vs. 16.6%). As regards the short-term progress, the extra-pleural group required fewer days until the withdrawal of supplementary oxygen (36.3 vs. 28.9) and until hospital discharge (67.5 vs. 53.2), although only the time until extubation achieved a statistically significant difference (11.5 vs. 2.7, P=.03). CONCLUSIONS: The extra-plural approach by posterior minithoracotomy for the surgical closure of ductus in the premature infant is viable and could bring some clinical benefits in the short-term.

Long-Term Outcomes and Durability of the Mitroflow Aortic Bioprosthesis.

BACKGROUND: This study aims to determine the incidence and causes of structural valve deterioration (SVD) among all models of Mitroflow bioprostheses (A12/LX/DL), as well as to define their long-term clinical and hemodynamic performance. METHODS AND RESULTS: We retrospectively reviewed a series of 1023 patients who underwent aortic valve replacement with Mitroflow bioprostheses between 2001 and 2014. A small aortic root was found in 22.4% of patients. There were two cases of severe patient-prosthesis mismatch. Only 31 patients developed SVD. The rate of incidence was 8.1 cases per 1000 patient-years. Cumulative incidence of SVD was 1.4% and 3% at five and 10 years, respectively. Freedom from SVD was 97.4% and 88.2% at five and 10 years, respectively. Anticalcification phospholipid reduction treatment (PRT) for model DL was a protective factor for SVD. Multivariable analysis confirmed age <70 years and use of 19 mm valve as independent predictors of SVD. Cumulative survival was 76.6% at five years and 42.3% at 10 years (mean follow-up 3.8 ± 3.1 years). In multivariable analysis, neither the use of small aortic prosthesis (p = 0.18) nor the occurrence of SVD (p = 0.85) was found to be independent predictors of long-term survival. CONCLUSIONS: Mitroflow valves demonstrate an acceptable rate of SVD and satisfactory long-term hemodynamic performance, particularly in patients with small aortic roots, age >70 years, and cases with severe left ventricular hypertrophy. PRT might contribute to improved long-term durability. doi: 10.1111/jocs.12726 (J Card Surg 2016;31:264-273).

Successful cardiac transplantation in a patient with congenital generalized lipodystrophy.

We report a case of a 12-yr-old boy referred to our unit with congenital generalized lipodystrophy and dilated cardiomyopathy related to a lamin gene mutation. He progressively developed end-stage heart failure and was referred for heart transplant evaluation. The patient's lipid profile, glucose level, and renal function were normal, and vascular retinopathy was ruled out. He underwent orthotopic bicaval HT and had an uneventful recovery. He was discharged home two wk after surgery with good graft function. During follow-up, he developed hyperglycemia and dyslipidemia, which were controlled by increasing leptin dose and starting oral antidiabetic drugs. The patient is currently doing well two yr after transplantation.

Lower mini-sternotomy in congenital heart disease: just a cosmetic improvement?

OBJECTIVES: Lower mini-sternotomy represents a minimally invasive surgical technique that has been utilized for the repair of a wide variety of congenital heart defects with excellent surgical and cosmetic outcomes. However, clinical improvements provided for this technique beyond cosmetic results are controversial. The aim of our study is to report our results with lower mini-sternotomy for the repair of congenital heart malformations and compare them with a matched group with a full median sternotomy approach. METHODS: From 2010 through 2013, 105 consecutive congenital patients (81 paediatric) underwent lower mini-sternotomy at our centre (Group 1). We analysed in-hospital and follow-up outcomes, and compare them with an age-sex-diagnosis-type of surgery-matched group (Group 2). Both groups were managed following the same clinical protocols. RESULTS: In Group 1, age at the time of surgery was 12 ± 17 years (range from 0.2 to 64.6 years). In this group, 81 patients were paediatric and 62 were female. Operative techniques were atrial septal defect (n = 72), ventricular septal defect (n = 24) and atrioventricular canal repairs (n = 9). There were no deaths or major in-hospital complications. Two adult patients required conversion to full median sternotomy. For a medium follow-up of 1.5 years (range from 1 month to 5 years), there were no deaths, reinterventions or reoperations and no significant residual defects were found. Compared with Group 2, patients in Group 1 had longer cardiopulmonary bypass times (58.71 ± 19.08 vs 45.39 ± 20.45, P < 0.001) and cross-clamp times (32.75 ± 13.11 vs 23.22 ± 13.93, P < 0.001), higher rate of early extubation (96 vs 85%, P = 0.018) and lower rate of postoperative complications (11.6 vs 22.3%, P = 0.034). CONCLUSIONS: At our centre, lower mini-sternotomy represents a safe alternative for the repair of congenital heart defects in paediatric and adult populations. Cardiopulmonary bypass and cross-clamp times were longer in the mini-sternotomy group. However, these patients showed earlier extubation and less postoperative complications when compared with patients with a full sternotomy approach. Combined with improved cosmetic outcomes, lower mini-sternotomy could represent the technique of choice for these populations.

[Mitral valve repair using polytetrafluoroethylene neochordae: short-term outcomes]. / Reparación valvular mitral con neocuerdas de politetrafluoroetileno: resultados iniciales.

In recent years, mitral valve repair using polytetrafluoroethylene (PTFE) neochordae has been shown to be an effective technique for correcting valve prolapse due to chordal rupture or elongation. In this study, we evaluated our experience using this technique in a group of 21 patients. The median (range) follow-up period was 9 (1-26) months. There was no in-hospital mortality. During follow-up, improvement in both clinical and echocardiographic parameters were observed: 95.2% of patients were in I-II NYHA class and the mitral regurgitation jet area was less than 4 cm(2) in 85.7% of patients. These findings are consistent with those previously reported in the literature. However, these results relate to our initial experience, and long-term follow-up is still required.

Reparación valvular mitral con neocuerdas de politetrafluoroetileno: resultados iniciales / Mitral valve repair using polytetrafluoroethylene neochordae: short-term outcomes

La cirugía de reparación valvular mitral con neocuerdas de politetrafluoroetileno (PTFE) se ha mostrado en los últimos años como una técnica eficaz en la corrección del prolapso de los velos mitrales debido a rotura o elongación de cuerdas tendinosas. En el presente estudio hemos analizado la experiencia inicial con esta técnica en nuestro centro, con un total de 21 pacientes. La mediana (intervalo) de seguimiento fue de 9 (1-26) meses. No se produjo mortalidad hospitalaria. En el seguimiento se evidenció mejoría clínica (el 95,2% de los pacientes en clase funcional NYHA ≤ II) y ecocardiográfica (el 85,7% de los pacientes con área de regurgitación mitral < 4 cm2). Los resultados se ajustaron a los de las series de referencia previamente publicados, si bien se trata de una experiencia inicial que precisa seguimiento a largo plazo (AU)

In recent years, mitral valve repair using polytetrafluoroethylene (PTFE) neochordae has been shown to be an effective technique for correcting valve prolapse due to chordal rupture or elongation. In this study, we evaluated our experience using this technique in a group of 21 patients. The median (range) follow-up period was 9 (1-26) months. There was no in-hospital mortality. During follow-up, improvement in both clinical and echocardiographic parameters were observed: 95.2% of patients were in I-II NYHA class and the mitral regurgitation jet area was less than 4 cm2 in 85.7% of patients. These findings are consistent with those previously reported in the literature. However, these results relate to our initial experience, and long-term follow-up is still required (AU)

[Management by hypothermia of junctional ectopic tachycardia appearing after pediatric heart surgery]. / Tratamiento mediante hipotermia de la taquicardia ectópica de una unión tras cirugía cardíaca infantil.

Junctional ectopic tachycardia (JET) is a complication of the repair of congenital cardiac malformations that responds poorly to conventional treatment. We report our experience with the use of moderate hypothermia in its management. Twelve infants with postoperative JET treated with hypothermia were reviewed. The mean interval between the diagnosis of JET and initiation of hypothermia was 1.5 0.5 hours. In the first 24 hours of hypothermia, central temperature and heart rate decreased significantly. Arterial pressure and diuresis tended to increase and central venous pressure tended to decrease. No direct adverse events occurred. All the patients but one survived and are alive and free of neurological deficits after 15 12 months.

Tratamiento mediante hipotermia de la taquicardia ectópica de la unión tras cirugía cardíaca infantil / Management by hypothermia of junctional ectopic tachycardia appearing after pediatric heart surgery

La taquicardia ectópica de la unión (TEU) es una complicación que aparece tras las reparaciones de cardiopatías congénitas, con una escasa respuesta al tratamiento convencional. Describimos nuestra experiencia en el uso de hipotermia moderada como parte de su tratamiento. Se revisaron las historias de 12 pacientes con TEU postoperatoria tratados con hipotermia. El intervalo entre el diagnóstico de TEU y el inicio de la hipotermia fue de 1,5 ñ 0,5 h. Durante las primeras 24 h hubo un descenso significativo de la temperatura y la frecuencia cardíaca, con tendencia al aumento de la presión arterial y de la diuresis y al descenso de la presión venosa central. No hubo complicaciones relacionadas con la hipotermia. Todos excepto un paciente sobrevivieron y tras un seguimiento de 15 ñ 12 meses permanecen vivos y sin secuelas neurológicas (AU)