[Analysis of mortality and hospital stay in cardiac surgery in Mexico 2015: Data from the National Cardiology Institute]. / Análisis de mortalidad y estancia hospitalaria en cirugía cardiaca en México 2015: datos del Instituto Nacional de Cardiología.

OBJECTIVE: To analyse hospital mortality in patients subjected to cardiac surgery in Mexico during the year 2015, and identify the mortality risks factors, and its correlation with days of hospital stay in the cardiovascular intensive care unit. METHOD: The database of Cardiovascular Intensive Care of the National Institute of Cardiology was examined for this cases and controls study that included only adult patients subjected to cardiac surgery during the year 2015. RESULTS: A total of 571 patients were subjected to a surgical procedure. The predominant indication was single or multiple valve replacement surgery, followed by coronary revascularisation surgery, and correction of adult congenital heart disease. Overall mortality was 9.2, and 8% died in intensive care. The main risk factors for death were preoperative organ failure or pulmonary hypertension, and prolonged time with extracorporeal circulation. The primary cause of death was secondary to cardiogenic shock. The hospital mortality observed in this population was higher for patients undergoing pulmonary thromboendarterectomy, complex aortic disease surgery, and valvular surgery. CONCLUSIONS: The mortality of patients undergoing cardiac surgery in Mexico differs slightly from that reported in the world literature, primarily because there were more multivalvular surgeries and mixed complex procedures performed.

Análisis de mortalidad y estancia hospitalaria en cirugía cardiaca en México 2015: datos del Instituto Nacional de Cardiología / Analysis of mortality and hospital stay in cardiac surgery in Mexico 2015: Data from the National Cardiology Institute

Resumen Objetivo: Analizar las causas de mortalidad hospitalaria de pacientes operados de cirugía cardiaca en México en el año 2015. Identificar los factores de riesgo de mortalidad y realizar una correlación con el tiempo de estancia hospitalaria en terapia intensiva cardiovascular. Método: Estudio de casos y controles. Se estudió la base de datos de la Terapia Intensiva Cardiovascular del Instituto Nacional de Cardiología. Se incluyeron todos los pacientes adultos operados de cirugía cardiaca en el año 2015. Resultados: Se operaron 571 pacientes. La indicación quirúrgica predominante fue la cirugía de cambio valvular único o múltiple, seguida de la cirugía de revascularización coronaria y corrección de cardiopatías congénitas del adulto. La mortalidad global fue de un 9.2% y el 8% falleció en terapia intensiva. Los principales factores de riesgo de muerte fueron la presencia de falla orgánica o hipertensión pulmonar prequirúrgica, y el tiempo prolongado de circulación extracorpórea. La principal causa de muerte fue el choque cardiogénico. La mortalidad hospitalaria observada en esta población fue mayor para los operados de tromboendarterectomía pulmonar, cirugía de enfermedad aórtica compleja y cirugía valvular. Conclusiones: La mortalidad de los pacientes operados de cirugía cardiaca en México difiere levemente de la reportada en la literatura mundial porque se trata mayormente de cirugía multivalvular y de procedimientos quirúrgicos mixtos complejos.

Abstract Objective: To analyse hospital mortality in patients subjected to cardiac surgery in Mexico during the year 2015, and identify the mortality risks factors, and its correlation with days of hospital stay in the cardiovascular intensive care unit. Method: The database of Cardiovascular Intensive Care of the National Institute of Cardiology was examined for this cases and controls study that included only adult patients subjected to cardiac surgery during the year 2015. Results: A total of 571 patients were subjected to a surgical procedure. The predominant indication was single or multiple valve replacement surgery, followed by coronary revascularisation surgery, and correction of adult congenital heart disease. Overall mortality was 9.2, and 8% died in intensive care. The main risk factors for death were preoperative organ failure or pulmo- nary hypertension, and prolonged time with extracorporeal circulation. The primary cause of death was secondary to cardiogenic shock. The hospital mortality observed in this population was higher for patients undergoing pulmonary thromboendarterectomy, complex aortic disease surgery, and valvular surgery. Conclusions: The mortality of patients undergoing cardiac surgery in Mexico differs slightly from that reported in the world literature, primarily because there were more multivalvular surgeries and mixed complex procedures performed.

Immunologic Responses in Biological and Mechanical Valve Prostheses: Inflammation and Functionality Are Not Always Related.

BACKGROUND AND AIM OF THE STUDY: The aim of this retrospective study was to evaluate the inflammatory response in patients with aortic and/or mitral prostheses, and to correlate the level of inflammatory markers with prosthesis functionality. METHODS: A total of 48 patients with biological or mechanical prostheses was included in the study, in which levels of tumor necrosis factor-alpha (TNFα), interleukin (IL)-1, -4, and -6, interferon-gamma (IFNγ), osteopontin (OPN), intercellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM), endothelin-1 and C-reactive protein were analyzed. Functionality of the prosthesis was evaluated using transthoracic echocardiography at three years after surgery. RESULTS: The mean period from the date of surgery was seven years. High levels of IL-1 were found in patients with mechanical prostheses compared to those with bioprostheses (p = 0.04). Patients with aortic bioprostheses and stenosis had higher levels of OPN and endothelin-1, those with aortic mechanical prostheses with stenosis had increased levels of matrix metalloproteinase (MMP)-9, OPN and ICAM, and those with aortic mechanical leakage had increased levels of MMP-1 and endothelin-1. In mitral bioprostheses with leakage of endothelin-1, ICAM and MMP-9 levels were increased, while in mechanical prostheses with leakage there were increases of ICAM and endothelin-1. Tricuspid bioprostheses with double lesions had increased levels of OPN and endothelin-1. CONCLUSIONS: Valvular dysfunction was similar across the types of prosthesis material. IL-1 was increased in subjects with mechanical prostheses independently of dysfunction, while in biological prostheses there were increases in OPN and endothelin-1, and these were related to valvular dysfunction. Given that in the analysis of durability and functionality there were no significant differences between biological and mechanical prostheses, biological prostheses may represent the first treatment option in patients with low economic resources, the elderly, and even young patients.

Pre- and post-surgical evaluation of the inflammatory response in patients with aortic stenosis treated with different types of prosthesis.

BACKGROUND: The inflammatory process in aortic valvular stenosis persists after surgery to replace the valve in almost half of the patients. No association has been found to its persistence. The main objective of this study was to evaluate the inflammatory response in patients with aortic stenosis through the determination of several biomarkers in plasma measured before and after the valvular replacement and to seek an association with the type of prosthesis used. METHODS: This is an observational study with a follow up of 6 months in subjects with severe aortic stenosis. Seric concentrations of TNFa, IL-1, IL-6 and ICAM and echocardiographic variables were quantified previous to the surgery and a week and 6 months after it. A group of control subjects paired by age and gender was included. RESULTS: Seventy-nine subjects were studied of which 57% were male; the average age was of 59 (± 11.4) years. Previous to surgery, the concentration of cytokines was higher in patients than in control subjects. A biological prosthesis was implanted in 48 patients and a mechanical prosthesis in 31. Both, types of prosthesis have components made of titanium. The echocardiograms 1 week and 6 months after the surgery showed a decrease in the mean aortic gradient and an increase in the valvular area (p = 0.001). Half of the patients still showed high proinflammatory cytokine levels. There were no differences according to the type of prosthesis implanted after adjustments for demographic variables, comorbidities and echocardiographic data. CONCLUSIONS: The inflammatory response caused by both types of valvular prothesis at 6 months after implantation were similar. Both types of prosthesis are recommended, they had similarities in hemodynamic profiles registered with Doppler echocardiography. Age of the patient or the suitability use of anticoagulants determines the type of prosthesis to be used.