Malformación arteriovenosa a nivel submandibular / Sub-mandibular arteriovenous malformation

No disponible

No disponible

QRS duration and early hemodynamic instability after coronary revascularization surgery.

INTRODUCTION AND OBJECTIVES: The duration of the QRS interval measured by ECG is a marker of ventricular dysfunction and indicates a poor prognosis. Its value in patients undergoing coronary revascularization surgery has not been established. METHODS: The study involved 203 consecutive patients (age 64+/-9 years, 74% male) scheduled for elective coronary surgery. The maximum QRS duration measured on a preoperative 12-lead ECG was recorded. Hemodynamic instability was defined as the occurrence of cardiac death, heart failure, or a need for intravenous inotropic drugs or intra-aortic balloon counterpulsation during the postoperative period. RESULTS: The occurrence of hemodynamic instability (n=94, 46%) was associated with a longer preoperative QRS duration (97.5+/-21.14 ms vs 88.5+/-16.9 ms; P=.001). The QRS duration was also longer in patients who developed heart failure (n=23; 104.3+/-22.9 ms vs. 91.1+/-18.5 ms; P=.002), needed inotropic drugs (n=77; 96.5+/-20.5 ms vs. 90.1+/-18.2 ms; P=.007) or developed postoperative atrial fibrillation (n=58; 98.2+/-23.8 ms vs. 90.4+/-17.0 ms; P=.018). Bundle branch block was associated with a greater need for intra-aortic balloon counterpulsation (29% vs 12%; P=.012) or inotropic drugs (58% vs 35%; P=.014) and a higher incidence of hemodynamic instability (69% vs 42%; P=.006). Multivariate analysis identified the following independent predictors of hemodynamic instability: QRS duration (adjusted odds ratio [OR] per 10 ms=1.49; 95% confidence interval [CI], 1.11-2; P=.007), the lack of an arterial graft (OR=3.6; 95% CI, 1.14-11.6; P=.029) and extracorporeal circulation time (OR per min=1.013; 95% CI, 1.003-1.023; P=.013). CONCLUSIONS: The intraventricular conduction delay, or QRS duration, was associated with a higher risk of postoperative hemodynamic instability following coronary surgery.

[Preliminary experience in an intensive care unit with Impella Recover. A new circulatory support system in patients with low cardiac output]. / Experiencia preliminar en una unidad de cuidados intensivos con Impella Recover. Asistencia ventricular microaxial en pacientes con bajo gasto cardíaco.

The low cardiac output syndrome following cardiopulmonary bypass is characterized by poor left ventricular contractibility that requires the support of high doses of vasoactive drugs, intra-aortic balloon pump, and sometimes makes it impossible to disconnect the extracorporeal circulation. We report 5 cases in which a "recently created" device in left ventricular support was inserted, the Impella Recover (Impella CardioSystems AG, Aachen, Germany) due to cardiogenic shock at the end of the surgery. Four of these patients recovered their heart function and the ventricular support could be removed after 70+/-55 h. In a fifth patient, the right ventricular failure warranted the use of Berlin Heart assist device.

Duración del QRS y deterioro hemodinámico precoz tras cirugía de revascularización coronaria / QRS Duration and Early Hemodynamic instability after coronary Revascularization Surgery

Introducción y objetivos. La duración del intervalo QRS en el ECG es un marcador de disfunción ventricular y peor pronóstico. Su valor en pacientes sometidos a cirugía de revascularización coronaria no ha sido establecido. Métodos. Estudiamos a 203 pacientes consecutivos (64 ± 9 años de edad; el 74% varones) programados para cirugía electiva coronaria. Se registró la duración máxima del intervalo QRS en el ECG de 12 derivaciones preoperatorio. Definimos inestabilidad hemodinámica como la aparición de muerte cardiaca, insuficiencia cardiaca, uso de fármacos inotrópicos intravenosos o balón de contrapulsación intraaórtico durante el postoperatorio. Resultados. La aparición de inestabilidad hemodinámica (n = 94 [46%]) se asoció a una mayor duración del intervalo QRS preoperatorio (97,5 ± 21,14 frente a 88,5 ± 16,9 ms; p = 0,001). El QRS fue mayor en quienes apareció insuficiencia cardiaca (n = 23; 104,3 ± 22,9 frente a 91,1 ± 18,5 ms; p = 0,002), precisaron inotrópicos intravenosos (n = 77; 96,5 ± 20,5 frente a 90,1 ± 18,2 ms; p = 0,007) o sufrieron fibrilación auricular postoperatoria (n = 58; 98,2 ± 23,8 frente a 90,4 ± 17 ms; p = 0,018). El bloqueo de rama se asoció a mayor necesidad de balón de contrapulsación (el 29 frente al 12%; p = 0,012), inotrópicos (el 58 frente al 35%; p = 0,014) y mayor incidencia de inestabilidad hemodinámica (el 69 frente al 42%; p = 0,006). Tras el ajuste multivariable, los predictores de inestabilidad hemodinámica fueron la duración del QRS (odds ratio [OR] = 1,49; intervalo de confianza [IC] del 95%, 1,11-2; p = 0,007), la ausencia de injerto arterial (OR = 3,6; IC del 95%, 1,14-11,6; p = 0,029) y el tiempo de circulación extracorpórea (OR = 1,013; IC del 95%, 1,003-1,023; p = 0,013), con independencia de otros factores de riesgo. Conclusiones. El retraso de la conducción intraventricular o duración del intervalo QRS se asocia a mayor riesgo de inestabilidad hemodinámica durante el post-operatorio de cirugía coronaria (AU)

Introduction and objectives. The duration of the QRS interval measured by ECG is a marker of ventricular dysfunction and indicates a poor prognosis. Its value in patients undergoing coronary revascularization surgery has not been established.Methods. The study involved 203 consecutive patients (age 64±9 years, 74% male) scheduled for elective coronary surgery. The maximum QRS duration measured on a preoperative 12-lead ECG was recorded. Hemodynamic instability was defined as the occurrence of cardiac death, heart failure, or a need for intravenous inotropic drugs or intra-aortic balloon counterpulsation during the postoperative period.Results. The occurrence of hemodynamic instability (n=94, 46%) was associated with a longer preoperative QRS duration (97.5±21.14 ms vs 88.5±16.9 ms; P=.001). The QRS duration was also longer in patients who developed heart failure (n=23; 104.3±22.9 ms vs. 91.1±18.5 ms; P=.002), needed inotropic drugs (n=77; 96.5±20.5 ms vs. 90.1±18.2 ms; P=.007) or developed postoperative atrial (..) (AU)

Experiencia preliminar en una unidad de cuidados intensivos con Impella Recover®. Asistencia ventricular microaxial en pacientes con bajo gasto cardíaco / Preliminary experience in an intensive care unit with Impella Recover®. A new circulatory support system in patients with low cardiac output

El síndrome de bajo gasto cardíaco tras cardiotomía se caracteriza por una mala contractilidad ventricular izquierda que requiere el apoyo de altas dosis de fármacos vasoactivos, el uso de balón de contrapulsación y en ocasiones imposibilita la desconexión de la circulación extracorpórea. Presentamos 5 casos en los que se implantó un dispositivo de «reciente creación» en la asistencia ventricular izquierda: Impella Recover® (Impella CardioSystems AG, Aachen, Alemania), por shock cardiogénico al final de la intervención. De estos pacientes, 4 recuperaron la función cardíaca y la asistencia ventricular se pudo retirar tras un promedio de 70 ± 55h. En el quinto paciente, el dispositivo no mostró un resultado favorable y se evidenció insuficiencia ventricular derecha, por lo que fue necesario recurrir a una asistencia biventricular tipo Berlin Heart (AU)

The low cardiac output syndrome following cardiopulmonary bypass is characterized by poor left ventricular contractibility that requires the support of high doses of vasoactive drugs, intra-aortic balloon pump, and sometimes makes it impossible to disconnect the extracorporeal circulation. We report 5 cases in which a «recently created» device in left ventricular support was inserted, the Impella Recover® (Impella CardioSystems AG, Aachen, Germany) due to cardiogenic shock at the end of the surgery. Four of these patients recovered their heart function and the ventricular support could be removed after 70 ± 55h. In a fifth patient, the right ventricular failure warranted the use of Berlin Heart assist device (AU)

[Epidemiology and new predictors of atrial fibrillation after coronary surgery]. / Epidemiología y nuevos predictores de la fibrilación auricular tras cirugía coronaria.

INTRODUCTION AND OBJECTIVES: Postoperative atrial fibrillation (PAF) is a frequent complication of coronary artery bypass grafting (CABG). Our aims were to study its epidemiology and to identify predictors in everyday clinical practice, while taking into account statin use, extracorporeal circulation, and new biomarkers of inflammation and ventricular stress. METHODS: The study included 102 consecutive patients (65 [9] years, 72% male) who were undergoing CABG. Blood samples were taken the day before surgery to determine baseline levels of C-reactive protein (CRP) and N-terminal probrain natriuretic peptide (NT-proBNP). Details of baseline clinical characteristics, preoperative treatment and surgery were recorded. The end-point was PAF at 30 days. RESULTS: The incidence of PAF was 23% (n=23; 3.2 [2.9] days, range 1-15 days). Its appearance was associated with a longer stay in the intensive care unit (+ 1 day; P=.019), but not with an increased total hospital stay (P=.213). Among patients with PAF, 4.3% had an embolism and 8.6% remained in atrial fibrillation at discharge. Moreover, PAF was associated with a longer duration of ischemia (28.5 [22.3] vs 18.0 [27.9]; P=.045) and a lower statin pretreatment rate (39% vs 66%; P=.022). Multivariate analysis showed that the only factor associated with a higher risk of PAF was the absence of statin pretreatment (odds ratio = 4.31, 95% confidence interval 1.33-13.88; P=.015). There was no association between either extracorporeal circulation or the baseline CRP or NT-proBNP level and an increased risk of PAF. CONCLUSION: In everyday clinical practice, PAF is a frequent complication. Statin pretreatment could have a protective effect against its appearance.

Epidemiología y nuevos predictores de la fibrilación auricular tras cirugía coronaria / Epidemiology and new predictors of atrial fibrillation after coronary surgery

Introducción y objetivos. La fibrilación auricular postoperatoria (FAP) es una complicación frecuente tras la cirugía de revascularización coronaria. Estudiamos su epidemiología y los predictores en la práctica actual, considerando el uso de estatinas, la circulación extracorpórea y los nuevos biomarcadores de inflamación y estrés ventricular. Métodos. Se estudió a 102 pacientes consecutivos (65 ± 9 años, 72% varones) en los que se realizó cirugía coronaria. El día previo se obtuvieron las muestras plasmáticas para medida de proteína C reactiva (PCR) y porción amino-terminal del propéptido natriurético cerebral (NT-proBNP), se recogieron las características clínicas basales y el tratamiento preoperatorio, posteriormente se registraron los datos quirúrgicos y se estudió la aparición de FAP a 30 días. Resultados. La incidencia de FAP fue del 23% (n = 23) (3,2 ± 2,9 días; intervalo, 1-15 días). Su aparición prolongó los cuidados intensivos (mediana + un día; p = 0,019) pero no la estancia hospitalaria total (p = 0,213). Entre los pacientes con FAP, los embolismos y la persistencia en FA en el momento del alta fueron del 4,3 y el 8,6%, respectivamente. La FAP se asoció con un mayor tiempo de isquemia (28,5 ± 22,30 frente a 18,0 ± 27,9 min; p = 0,045) y una menor tasa de estatinas preoperatorias (el 39 frente al 66%; p = 0,022). En el análisis multivariable, sólo la ausencia de estatinas conllevó un mayor riesgo de FAP (odds ratio [OR] = 4,31; intervalo de confianza [IC] del 95%, 1,33-13,88; p = 0,015). El uso de circulación extracorpórea (CEC) y los valores basales de PCR y NT-proBNP no se asociaron con un mayor riesgo. Conclusión. En la práctica actual, la FAP es una complicación frecuente y la administración de estatinas en el preoperatorio podría proteger frente a su aparición (AU)

Introduction and objectives. Postoperative atrial fibrillation (PAF) is a frequent complication of coronary artery bypass grafting (CABG). Our aims were to study its epidemiology and to identify predictors in everyday clinical practice, while taking into account statin use, extracorporeal circulation, and new biomarkers of inflammation and ventricular stress. Methods. The study included 102 consecutive patients (65 [9] years, 72% male) who were undergoing CABG. Blood samples were taken the day before surgery to determine baseline levels of C-reactive protein (CRP) and N-terminal probrain natriuretic peptide (NT-proBNP). Details of baseline clinical characteristics, preoperative treatment and surgery were recorded. The end-point was PAF at 30 days. Results. The incidence of PAF was 23% (n=23; 3.2 [2.9] days, range 1-15 days). Its appearance was associated with a longer stay in the intensive care unit (+ 1 day; P=.019), but not with an increased total hospital stay (P=.213). Among patients with PAF, 4.3% had an embolism and 8.6% remained in atrial fibrillation at discharge. Moreover, PAF was associated with a longer duration of ischemia (28.5 [22.3] vs 18.0 [27.9]; P=.045) and a lower statin pretreatment rate (39% vs 66%; P=.022). Multivariate analysis showed that the only factor associated with a higher risk of PAF was the absence of statin pretreatment (odds ratio = 4.31, 95% confidence interval 1.33­13.88; P=.015). There was no association between either extracorporeal circulation or the baseline CRP or NT-proBNP level and an increased risk of PAF. Conclusion. In everyday clinical practice, PAF is a frequent complication. Statin pretreatment could have a protective effect against its appearance (AU)

[Prognostic role of new biomarkers in off-pump coronary artery bypass surgery]. / Papel pronóstico de los nuevos biomarcadores en la cirugía coronaria sin circulación extracorpórea.

The value of biomarkers of myocardial damage or inflammation in off-pump coronary artery bypass (OPCAB) surgery has not yet been established. In a prospective study of 51 consecutive patients scheduled for elective OPCAB surgery, preoperative levels of troponin T, C-reactive protein, interleukin-6 and tumor necrosis factor-alpha were determined. The primary endpoint was the combination of cardiac death or acute myocardial infarction (AMI) within 30 days. Seven patients (14%) presented with an adverse event: three cardiac deaths and six AMIs. Univariate analysis identified the following adverse event predictors: renal failure (50% vs 11%, P=.028), left ventricular ejection fraction 0.10 ng/dL (43% vs 9%, P=.016), and EuroSCORE rating (7.6 [2.5] VS. 5.2 [2.6], P=.031). A preoperative troponin-T level > 0.10 ng/dL (P=.03) was the only independent adverse event predictor. No significant differences were found with biomarkers of inflammation (P.05). The presence of a preoperative troponin-T level > 0.10 ng/dL is associated with a higher risk of cardiac death or AMI in patients undergoing OPCAB surgery.

Papel pronóstico de los nuevos biomarcadores en la cirugía coronaria sin circulación extracorpórea / Prognostic Role of new biomarkers in off-pump coronary artery bypass surgery

El papel de los marcadores de daño miocárdico e inflamación en la cirugía de revascularización coronaria (CRC) sin circulación extracorpórea (CEC) no ha sido establecido. Se realizó un estudio prospectivo de 51 pacientes consecutivos que recibieron CRC sin CEC. Se determinaron las concentraciones preoperatorias de troponina T, proteína C reactiva, interleucina-6 y factor de necrosis tumoral alfa. El evento primario fue el combinado de muerte cardiaca o infarto agudo de miocardio (IAM) a los 30 días. Un total de 7 pacientes (14%) presentaron eventos (3, muerte cardiaca y 6, IAM). En el análisis univariable fueron predictores la insuficiencia renal (el 50 frente al 11%; p = 0,028), la fracción de eyección del ventrículo izquierdo 0,10 ng/dl (el 43 frente al 9%; p = 0,016) y el EuroSCORE (7,6 +/- 2,5 frente a 5,2 +/- 2,6; p = 0,031). La troponina T > 0,10 ng/dl preoperatoria fue el único predictor independiente de eventos (p = 0,03). Los marcadores de inflamación no mostraron diferencias (p > 0,05). La presencia de troponina T preoperatoria > 0,10 ng/dl se asocia con un mayor riesgo de muerte o IAM en pacientes que reciben CRC sin CEC

The value of biomarkers of myocardial damage or inflammation in off-pump coronary artery bypass (OPCAB) surgery has not yet been established. In a prospective study of 51 consecutive patients scheduled for elective OPCAB surgery, preoperative levels of troponin T, C-reactive protein, interleukin-6 and tumor necrosis factor-alpha were determined. The primary endpoint was the combination of cardiac death or acute myocardial infarction (AMI) within 30 days. Seven patients (14%) presented with an adverse event: three cardiac deaths and six AMIs. Univariate analysis identified the following adverse event predictors: renal failure (50% vs 11%, P=.028), left ventricular ejection fraction 0.10 ng/dL (43% vs 9%, P=.016), and EuroSCORE rating (7.6 [2.5] VS. 5.2 [2.6], P=.031). A preoperative troponin-T level > 0.10 ng/dL (P=.03) was the only independent adverse event predictor. No significant differences were found with biomarkers of inflammation (P>.05). The presence of a preoperative troponin-T level > 0.10 ng/dL is associated with a higher risk of cardiac death or AMI in patients undergoing OPCAB surgery