Postcranial axial skeletal pathology in Commerson's dolphins Cephalorhynchus c. commersonii from Tierra del Fuego, Argentina.

Commerson's dolphins Cephalorhynchus c. commersonii are the small cetacean most frequently found stranded along the coast of Tierra del Fuego, Argentina, but little is known about their pathologies. We examined the postcranial axial skeleton of 425 Commerson's dolphins collected in the period 1974-2011 for the presence of pathologies. Miscellaneous lesions were detected in 107 (25.2%) of the specimens. Among them, idiopathic hyperostosis was the most frequent pathology (73.8%), followed by spondyloarthropathy (40.2%). Traumata (25.2%), spondylitis (10.3%) and osteoarthritis (11.2%) occurred less frequently. The type of lesion was statistically associated with the region of the vertebral column. Idiopathic hyperostosis occurred significantly more frequently in the lumbar vertebrae than in other parts of the vertebral column, while spondyloarthropathy was more frequent in the thoracic and caudal vertebrae. Both conditions were predominantly seen in mature dolphins. Osteoarthritis affected the transverse processes of the thoracic vertebrae of 6 males, 3 females and 3 individuals of undetermined sex, all mature. Healed and unhealed fractures were observed in the ribs of 27 specimens and in the transverse processes of 3 others. Spondylitis of various degrees of severity affected the cervical, thoracic, lumbar and caudal regions of 11 individuals. Together these data indicate that bone lesions and traumata commonly occur in Commerson's dolphins, likely causing pain and morbidity in severe cases.

Factores de riesgo de evolución desfavorable en niños con plástica de la válvula mitral / Risk Factors of Unfavorable Outcome in Children with Mitral Valve Repair

RESUMEN Objetivo: Analizar los factores de riesgo de evolución desfavorable (ED) en niños con insuficiencia mitral (IM) sometidos a plástica mitral (PM). Métodos: Se analizaron pacientes con IM sometidos a PM entre los años 2004 y 2014. Se definió ED como la reoperación o la IM significativa (3+, moderada a grave, o 4+, grave) durante el seguimiento. Las variables se expresaron como mediana. Se realizó el análisis univariado y el de regresión logística multivariado de los factores predictores de ED. Resultados: Se sometieron a PM 65 pacientes con IM 3+ e IM 4+. La etiología incluyó displasia (44,6%), endocarditis infecciosa (13,8%), fiebre reumática (18,4%), anomalía coronaria (7,7%) y otras (13,8%). La mediana del tiempo de seguimiento fue 26,5 meses (52 pacientes se encuentran aún en seguimiento). El 44,6% presentó disfunción ventricular y el 46,1% hipertensión pulmonar. La cantidad de pacientes con ED fue de 15: 9 fueron reoperados (7 reemplazos valvulares y 2 replástica). El análisis univariado demostró asociación significativa entre ED y las siguientes condiciones: fiebre reumática (p = 0,005), anillo mitral preoperatorio ≥+5 DS (p = 0,002), diámetro sistólico del ventrículo izquierdo (DSVI) ≥ +4 DS (p = 0,022), hipertensión pulmonar (p = 0,024) e IM residual posoperatoria inmediata ≥ moderada (p = 0,021). El análisis multivariado demostró como variables independientes de ED el diámetro del anillo mitral (p = 0,012), la fiebre reumática (p = 0,026) y la IM residual temprana (p = 0,042). No se produjo mortalidad. Conclusiones: La plástica mitral en niños con IM grave demostró resultados favorables a mediano plazo. La fiebre reumática, el diámetro del anillo mitral ≥ +5 DS y la IM residual ≥ 2+ fueron factores predictores de ED. No se hallaron diferencias estadísticamente significativas durante el seguimiento en relación con la edad ni con la presencia de disfunción ventricular.

ABSTRACT Objective: The aim of this study was to analyze risk factors of unfavorable outcome (UO) in patients with mitral regurgitation (MR) undergoing mitral valve repair (MVR). Methods: Patients with MR who had undergone MVR from 2004 to 2014 were retrospectively analyzed. Unfavorable outcome was defined as reoperation or significant MR [moderate to severe (3+) or severe MR (4+)] during follow-up. Variables were expressed as median. Univariate and multivariate logistic regression analyses were performed to identify predictive factors of UO. Results: Sixty five patients with MR3+ and MR4+ underwent MVR. Etiology was dysplasia in 44.6% of cases, infective endocarditis in 13.8%, rheumatic fever in 18.4%, abnormal coronary origin in 7.7% and other disorders in 13.8%. Median follow-up time was 26.5 months (52 patients are still being followed-up).Ventricular dysfunction was documented in 44.6% of cases and 46.1% had pulmonary hypertension. Fifteen patients presented UO and 9 were reoperated (7 valve replacements and 2 re-repairs). Univariate analysis demonstrated a significant association between UO and the following conditions: rheumatic fever (p=0.005), preoperative mitral annulus ≥+5 SD (p=0.002), left ventricular end-systolic diameter ≥+4 SD (p=0.022), pulmonary hypertension (p=0.024) and immediate postoperative residual MR ≥ moderate (p=0.021). Multivariate analysis demonstrated mitral annulus diameter (p=0.012), rheumatic fever (p=0.026) and early residual MR (p=0.042) as independent variables of UO. No deaths occurred in this series. Conclusions: Mitral valve repair in children with severe MR demonstrated mid-term favourable results. Rheumatic fever, mitral annulus diameter ≥+5 SD and immediate postoperative residual MR ≥2+ were predictive factors of UO. Neither age at surgery nor ventricular dysfunction showed statistically significant differences during follow-up.

Pathology in skeletons of Peale's dolphin Lagenorhynchus australis from southern South America.

Peale's dolphin Lagenorhynchus australis is frequently seen off the coast of southern South America, where it feeds among coastal kelp beds and occasionally strands. We searched for macroscopic evidence of skeletal lesions in 78 specimens of Peale's dolphin from 2 museum collections, which contain almost all of the species' skeletons known in collections worldwide. Thirty-two specimens (41%) had some type of osteological abnormalities. In 21 cases (66%), congenital deformations were the most predominant abnormality found. Acquired lesions included (1) induced trauma: abnormal curvature (n=5 specimens) and fractures (n=2); (2) infectious diseases: spondylo-osteomyelitis (n=3); and (3) degenerative diseases: exostoses (n=8) and spondylosis deformans (n=4). It is noteworthy that all of these animals died incidentally in gillnet entanglement and were presumably healthy at the time of death. The effect that different osseous lesions may have on an animal's quality of life may depend on the area of the spine affected and the number of vertebrae involved.

Series de Pediatría Garrahan. El niño con cardiopatía congénita

A 27 años del nacimiento del Hospital Garrahan, hemos sentido la necesidad de compartir con el equipo de salud las estrategias de atención del niño y su familia utilizadas en nuestro Hospital, colaborar con su actualización permanente y poner énfasis en el trabajo interdisciplinario. En este tomo desarrollamos el tema del niño con cardiopatía congénita. Se trata de la malformación congénita grave más frecuente, que se presenta en aproximadamente 5 a 8 cada mil nacidos vivos. En Argentina, nacen alrededor de 700.000 niños cada año, es decir alrededor de 4.500 con esta patología. La supervivencia actual con calidad de vida futura normal es alta para la mayoría de estos niños. A esto contribuyen las mejoras en el diagnóstico prenatal y neonatal temprano, el traslado seguro, la estabilización preoperatoria y el tratamiento por equipos cardiovasculares interdisciplinarios. El rol del pediatra es fundamental en el diagnóstico y seguimiento de estos pacientes. En este volumen, el pediatra encontrará aspectos epidemiológicos y patogénicos de algunas de las enfermedades más prevalentes, así como claves para el diagnóstico oportuno, con énfasis en la semiología y los estudios complementarios accesibles, indicaciones de derivación, prevención de riesgos y asesoramiento general para pacientes y padres.

Asistencia circulatoria mecánica en pediatría: Experiencia en el Hospital de Pediatría Dr. Juan P. Garrahan. Argentina / Mechanical circulatory support in pediatrics: Experience at the Hospital de Pediatría Dr. Juan P. Garrahan. Argentina

Introducción: La asistencia circulatoria mecánica permite aportar oxígeno a los tejidos en pacientes con enfermedades cardiacas y/o respiratorias reversibles refractarios a tratamientos convencionales. Objetivo: Mostrar los resultados iniciales de asistencia circulatoria mecánica en niños con cardiopatía en nuestra institución. Método: Estudio de cohorte descriptivo retrospectivo entre marzo de 2006 y marzo de 2012. Datos demográficos (edad, sexo, peso, diagnóstico cardiológico), de la cirugía (técnica, tiempo de bomba y de pinzamiento aórtico) y de la asistencia circulatoria mecánica (tipo, indicación, duración, complicaciones y evolución). Resultados: Fueron asistidos 33 pacientes (1.3% del total de cirugías), con oxigenación por membrana extracorpórea en 32 casos y un caso con dispositivo de asistencia ventricular. Mediana de edad 7.4 meses (un día-18 años) y peso 6 kg (2.3-75). Las malformaciones cardiacas que se asistieron con mayor frecuencia son las trasposiciones de grandes arterias asociadas a otras anomalías y las trasposiciones corregidas (inversión ventricular-doble discordancia). El motivo de ingreso más frecuente fue disfunción biventricular poscardiotomía. En 28 pacientes la asistencia circulatoria mecánica fue postoperatoria y en 4 preoperatoria. Un paciente presentó miocarditis. Mediana de asistencia 3 días (1-10). Complicaciones más frecuentes: infección el 21% y sangrado el 21%. Decanulación electiva en un 94% de los casos. Supervivencia con alta hospitalaria: 52%. Conclusiones: La asistencia circulatoria mecánica en nuestra institución es una herramienta segura con procedimiento estandarizado. Se utiliza en un reducido número de casos, con supervivencia similar a informes internacionales. Es un procedimiento complejo, plenamente justificado que permitió la recuperación en más de la mitad de los pacientes que de otro modo hubieran fallecido.

Introduction: Mechanical circulatory support provides oxygen to the tissues in patients with cardiac and/or respiratory reversible disease refractory to conventional treatments. Objective: The aim of this study is to show our initial results of mechanical circulatory support in children with heart disease. Method: Retrospective cohort between March 2006 and March 2012. Demographic data (age, sex, weight, cardiac diagnosis), surgery (technique, pump, aortic cross clamping time) and mechanical circulatory support (type of assistance, indication, duration, complications and outcome) were collected. Results: Thirty-three patients were supported (1.3% of all surgeries), extracorporeal membrane oxygenation 32 cases and one ventricular assist device. The median age 7.4 months (one day-18 years) and weight 6 kg (2.3-75). The most frequent cardiac malformations supported were the transpositions of the great arteries associated with other anomalies and the corrected transpositions (ventricular inversion or double discordance). The most common reason for admission was post-cardiotomy biventricular dysfunction. Twenty-eight patients were supported in the postoperative period, 4 in the preoperative period and in one with myocarditis. Median days of support were 3 days (1-10). The most common complications were infection (21%), bleeding (21%). Elective decannulation was achieved in 94% of cases. Hospital discharge survival: 52%. Conclusions: The mechanical circulatory support in our institution is a safe and standard procedure. We have been using it in a small number of cases with a similar survival to that reported internationally. This complex procedure is widely justified because it allows for the recovery of more than half of the patients who otherwise would have died.

[Mechanical circulatory support in pediatrics. Experience at the Dr. Juan P. Garrahan Pediatric Hospital. Argentina]. / Asistencia circulatoria mecánica en pediatría. Experiencia en el Hospital de Pediatría Dr. Juan P. Garrahan. Argentina.

INTRODUCTION: Mechanical circulatory support provides oxygen to the tissues in patients with cardiac and/or respiratory reversible disease refractory to conventional treatments. OBJECTIVE: The aim of this study is to show our initial results of mechanical circulatory support in children with heart disease. METHOD: Retrospective cohort between March 2006 and March 2012. Demographic data (age, sex, weight, cardiac diagnosis), surgery (technique, pump, aortic cross clamping time) and mechanical circulatory support (type of assistance, indication, duration, complications and outcome) were collected. RESULTS: Thirty-three patients were supported (1.3% of all surgeries), extracorporeal membrane oxygenation 32 cases and one ventricular assist device. The median age 7.4 months (one day-18 years) and weight 6kg (2.3-75). The most frequent cardiac malformations supported were the transpositions of the great arteries associated with other anomalies and the corrected transpositions (ventricular inversion or double discordance). The most common reason for admission was post-cardiotomy biventricular dysfunction. Twenty-eight patients were supported in the postoperative period, 4 in the preoperative period and in one with myocarditis. Median days of support were 3 days (1-10). The most common complications were infection (21%), bleeding (21%). Elective decannulation was achieved in 94% of cases. Hospital discharge survival: 52%. CONCLUSIONS: The mechanical circulatory support in our institution is a safe and standard procedure. We have been using it in a small number of cases with a similar survival to that reported internationally. This complex procedure is widely justified because it allows for the recovery of more than half of the patients who otherwise would have died.

Glenn bidireccional: resultados y análisis de factores de riesgo en una experiencia de 5 años / Bidirectional Glenn: Outcomes and risk factor analysis in a 5 years' experience

Objetivo: La anastomosis de Glenn es un procedimiento paliativo en pacientes con ventrículo único. Si bien se asocia a baja morbimortalidad, el objetivo es exponer los resultados en cirugía de Glenn y analizar los factores de riesgo en nuestra población. Métodos: Estudio retrospectivo de pacientes con cirugía de Glenn entre 2005 y 2009. Se registraron variables demográficas, tipo de ventrículo único, cirugía previa, método de cirugía y evolución en postoperatorio. Se efectuó un análisis estadístico univariado y multivariado para identificar factores de riesgo de mortalidad y/o de internación prolongada (Stata 9.0). Resultados: Se operaron 101 pacientes, 87 con Glenn bidireccional y 14 con Glenn bilateral. Edad mediana 15 meses (2.5-108), peso 8.5 kg (4.2-27). El 74% tenían cirugía previa, en 54 se realizó algún procedimiento asociado al Glenn y en 4 se dejó una fuente adicional de flujo pulmonar. La mediana de internación fue de 8 días (2-97). El 35% presentó complicaciones postoperatorias. No encontramos asociación entre edad, peso o cirugías previas y mortalidad. Tampoco entre tiempo de bomba y <

Objective: Bidirectional Glenn shunt is a palliative surgical procedure in patients with single ventricle. Although morbimortality in this surgery is low, risk factors have been described. The purpose of this study is to report our outcomes in Glenn surgery, identifying mortality risk factors in our population. Methods: Retrospective study between 2005 and 2009. Age, weight, previous surgery, surgical procedure, and postoperative condition were analyzed. Results are reported as median and rank, or absolute values and percentage. Uni and multivariate analysis was made to identify risk factors of mortality and/or prolonged hospitalization (Stata 9.0). Results: One hundred and one patients were operated; 87 bidirectional Glenn and 14 bilateral Glenn. Median age 15 months (2.5-108), median weight 8.5 kg (4.2-27), and 74% of them with previous surgery. In 54 patients an associated procedure was performed simultaneously, only in 4 additional pulmonary blood flow was left. Median hospitalization was 8 days (2-97). Thirty-five percent of the patients presented complications. No association between age, weight, pulmonary hypertension, cardiopulmonary bypass, cross clamping, associated procedures or Glenn bilateral with mortality or morbidity was found. Overall mortality was 3.9%. Conclusion: Mortality was similar to other centers, but morbidity in this group of patients is high. No independent risk factors associated with morbidity or mortality were identified.

[Bidirectional Glenn: outcomes and risk factor analysis in a 5 years' experience]. / Glenn bidireccional: resultados y análisis de factores de riesgo en una experiencia de 5 años.

OBJECTIVE: Bidirectional Glenn shunt is a palliative surgical procedure in patients with single ventricle. Although morbimortality in this surgery is low, risk factors have been described. The purpose of this study is to report our outcomes in Glenn surgery, identifying mortality risk factors in our population. METHODS: Retrospective study between 2005 and 2009. Age, weight, previous surgery, surgical procedure, and postoperative condition were analyzed. Results are reported as median and rank, or absolute values and percentage. Uni and multivariate analysis was made to identify risk factors of mortality and/or prolonged hospitalization (Stata 9.0). RESULTS: One hundred and one patients were operated; 87 bidirectional Glenn and 14 bilateral Glenn. Median age 15 months (2.5-108), median weight 8.5 kg (4.2-27), and 74% of them with previous surgery. In 54 patients an associated procedure was performed simultaneously, only in 4 additional pulmonary blood flow was left. Median hospitalization was 8 days (2-97). Thirty-five percent of the patients presented complications. No association between age, weight, pulmonary hypertension, cardiopulmonary bypass, cross clamping, associated procedures or Glenn bilateral with mortality or morbidity was found. Overall mortality was 3.9%. CONCLUSION: Mortality was similar to other centers, but morbidity in this group of patients is high. No independent risk factors associated with morbidity or mortality were identified.

[Congenital heart disease: surgical results in a public hospital in Argentina]. / Cardiopatías congénitas: resultados quirúrgicos en un hospital público en Argentina.

OBJECTIVE: To describe the results of congenital heart surgery at the Hospital de Pediatría J. P.Garrahan. METHODS: Between 2004 and 2009, 2942 patients, median age 2.5 years (1 d to 22.5 y), median weight 11.5 kg (1.6 kg to 96 kg), and 84% with cardiopulmonary bypass, were analyzed. Adjusted mortality risk analysis using RACHS and Aristotle score was performed. Newborn surgery and one stage repair in Fallot and ventricular septal defect with coarctation were analyzed as subgroupes. RESULTS: Mortality was 5.5%. Required mechanical ventilation 45%, 5% peritoneal dialysis, 12% delayed sternal closure and 8.4% reoperation. Twenty five percent with previous surgery, and 10% in poor clinical conditions. RACHS-1 categories morality distribution were 0.4% in one, 2.4% in two, 7.1% in three, 14% in four y 34 % in 5 and 6. One stage repair was performed in 84% of Fallots and 90% of ventricular septal defects with coarctation, with 3.2% and 10% mortality rate respectively. Two hundred and five newborns were operated with cardiopulmonary bypass with a mortality rate of 15% in the last year. CONCLUSIONS: Almost every congenital heart disease can be repaired without previous palliation, with satisfactory results in our institution. Poor clinical conditions significantly increased morbidity and mortality.

Cardiopatías congénitas: resultados quirúrgicos en un hospital público en Argentina / Congenital heart disease: surgical results in a public hospital in Argentina

Objetivo: Describir los resultados en cirugía cardiovascular del Hospital de Pediatría J. P. Garrahan. Métodos: Se analizaron 2942 pacientes entre 2004 y 2009; de los cuales, 84% con circulación extracorpórea, mediana de edad 2.5 años, rango de un día a 22.5 años y peso 11.5 kg (1.6 kg a 96 kg); con cirugías previas 25% y 10% malas condiciones preoperatorias. Se analizó la mortalidad por RACHS-1 y Aristóteles, la cirugía neonatal, la cirugía en un tiempo de Fallot y de comunicación interventricular con coartación de aorta. Resultados: La mortalidad fue 5.5%. Requirió ventilación mecánica 45%, 5% diálisis peritoneal, 12% cierre esternal diferido y 8.4% reoperación. De los Fallot 84% y 90% de las comunicaciones interventriculares con coartación se repararon en un tiempo, con 3.2% y 10% de mortalidad respectivamente. Se operaron 205 neonatos con bomba y con 15% de mortalidad en el último año. Las malas condiciones previas aumentaron la morbilidad, (Odds ratio 3.63 IC 95%, 2.27 -4.81) y la mortalidad (Odds ratio 6.47 IC 95%, 4.36 - 9.60). La mortalidad por RACHS fue 0.4% en categoría uno, 2.4% en la dos, 7.1% en la tres, 14% en la cuatro y 34% en la cinco y seis. Conclusiones: En nuestra institución la mayoría de las cardiopatías se resuelven en un tiempo con resultados satisfactorios. Las malas condiciones preoperatorias aumentan significativamente la morbimortalidad.

Objective: To describe the results of congenital heart surgery at the Hospital de Pediatría J. P.Garrahan. Methods: Between 2004 and 2009, 2942 patients, median age 2.5 years (1 d to 22.5 y), median weight 11.5 kg (1.6 kg to 96 kg), and 84% with cardiopulmonary bypass, were analyzed. Adjusted mortality risk analysis using RACHS and Aristotle score was performed. Newborn surgery and one stage repair in Fallot and ventricular septal defect with coarctation were analyzed as subgroupes. Results: Mortality was 5.5%. Required mechanical ventilation 45%, 5% peritoneal dialysis, 12% delayed sternal closure and 8.4% reoperation. Twenty five percent with previous surgery, and 10% in poor clinical conditions. RACHS-1 categories morality distribution were 0.4% in one, 2.4% in two, 7.1% in three, 14% in four y 34 % in 5 and 6. One stage repair was performed in 84% of Fallots and 90% of ventricular septal defects with coarctation, with 3.2% and 10% mortality rate respectively. Two hundred and five newborns were operated with cardiopulmonary bypass with a mortality rate of 15% in the last year. Conclusions: Almost every congenital heart disease can be repaired without previous palliation, with satisfactory results in our institution. Poor clinical conditions significantly increased morbidity and mortality.

Uso de VNI en una unidad de cuidados intensivos cardiovasculares pediátricos. Factores de riesgo asociados al fracaso / Use of non-invasive ventilation in a cardiovascular pediatric intensive care unit: Risk factors associated failure

Objetivo: Describir el uso de Ventilación No Invasiva en pacientes internados en una Unidad de Cuidados Intensivos cardiovascular pediátrica e identificar factores de riesgo que lleven al fracaso, definido como requerimiento de ARM a las 72 hs. Diseño: Estudio observacional analítico, de cohorte retrospectiva. Método: Se estudiaron 340 niños internados en UCI 35 del Hospital Garrahan durante el período 2005-2008 con indicación de VNI por insuficiencia cardiaca, como rescate en el fallo post-extubación y como destete de ARM: se registraron datos demográficos, la presencia de atelectasias , paresia diafragmática, hipertensión pulmonar, infecciones, lesiones cutáneas, síndromes genéticos, y obstrucción de vías aéreas superiores, tiempo de exposición a la VNI y fracaso de la VNI. Resultados: Se estudiaron 182 niñas y 158 varones, edad mediana 4,2 meses, peso mediana 4,7 kilos. En el período prequirúrgico 20 y 320 en post quirúrgico. La indicación más frecuente: destete en un 86,76%, la interfase más utilizada fue la cánula nasal 99,71%, el tiempo de VNI fue de 1 a 11 días con una mediana de 2 días. Se presentaron lesiones cutáneas en un 5,29% y se consideró fracaso en un 17,65%. En el modelo de regresión logística multivariado, fueron identificadas como factores de riesgo de fracaso: ATL OR: 2,99 (IC 95%1,23-7,25); edad<=6meses OR: 3,50 (IC95% 1,59-7,73); infecciones OR: 6,93 (IC95% 1,77-27,14); DV, OR: 10,88 (IC 95% 4,44-26,68); el tener obstrucción de VAS OR: 11,66 (IC 95% 4,47-26,68) Conclusiones: Los factores de riesgo que explicaron el fracaso de la VNI en el MRLM fueron la presencia de atelectasia, la edad menor o igual a seis meses, las comorbilidades infecciosas, así como la disfunción ventricular y la obstrucción de VAS. Si bien faltan aún estudios controlados en pediatría, la consideramos una alternativa terapéutica de soporte respiratorio útil y en expansión tanto en el periodo pre como en el post quirúrgico de CCV pediátrica y neonatal.

[Cardiac surgical repair in newborns: five years' experience in neonatal open surgery]. / Cirugía cardíaca reparadora en recién nacidos: experiencia de 5 años en cirugía neonatal con circulación extracorpórea.

INTRODUCTION: Four hundred newborns die every year in our country suffering from congenital heart disease. Definitive surgical repair, whenever possible, is nowadays the optimal therapeutic strategy. Our goal is to describe mortality and morbidity in neonatal surgery with cardiopulmonary bypass in a tertiary public hospital in Argentina. PATIENTS AND METHODS: Descriptive, retrospective study. Every patient, younger than 45 days, with cardiac surgery requiring cardiopulmonary bypass, at the Garrahan Hospital between 2004 and 2008 was included. Demographic, surgical and postoperative data were collected. Adjusted mortality risk analysis, and descriptive statistics from the most frequent diagnosis were performed. Results are expressed as median and rank or percentage. RESULTS: 200 newborns were operated, 62% males. Median age was 21 days (r 1- 45) and median weight 3.1 kg (r 1.6-6.2). Total anomalous pulmonary venous return, transposition of great arteries an hypoplastic left heart syndrome diagnoses accounted for 75% of the procedures. Median length of stay was 12 days (r 0-191), and 6 days of mechanical ventilation (r 0-180). Eighteen percent of the patients required peritoneal dialysis. Whole series mortality was 19% and fell to 14% in 2008. Unstable preoperative condition and postoperative complications increased mortality, OR= 2.23 (1.02-4.89) and OR= 10 (3.6-33.4), respectively. CONCLUSIONS: Our postoperative mortality is similar to those reported in foreign countries databases. Patients with unstable preoperative condition and post-operative complications had higher mortality.

Cirugía cardíaca reparadora en recién nacidos: experiencia de 5 años en cirugía neonatal con circulación extracorpórea / Cardiac surgical repair in newborns: five years experience in neonatal open surgery

Introducción. En nuestro país fallecen anualmente 400 niños con cardiopatía congénita, en el 1er mes de vida. La cirugía constituye la estrategia actual para su tratamiento. El objetivo es describir la mortalidad hospitalaria y las complicaciones de la cirugía cardíaca neonatal con circulación extracorpórea en un hospital público de alta complejidad. Pacientes y métodos. Estudio descriptivo retrospectivo. Se registraron datos demográficos, de la cirugía y del postoperatorio de los pacientes con circulación extracorpórea, menores de 45 días, operados en el Hospital Garrahan, entre 2004-2008. Se realizó un análisis por patologías y de mortalidad ajustado por riesgo. Los resultados se expresan en mediana e intervalo, o en porcentaje, según corresponda. Resultados. Se operaron 200 recién nacidos, 62 por ciento varones. La edad fue 21 (1- 45) días y el peso 3,1 (1,6-6,2) kg. Anomalía total de retorno venoso pulmonar, transposición de grandes arterias y síndrome de corazón izquierdo hipoplásico concentraronel 75 por ciento de las cirugías. El tiempo de internación fue 12 (0-191) días, con 6 (0-180) días de ventilación mecánica, y 18 por ciento de los pacientes requirieron diálisis. La mortalidad global fue 19 por ciento y 14 por ciento en el último año analizado. Los pacientes en mala condición preoperatoria, así como los que presentaron complicaciones, exhibieron una mortalidad mayor (OR= 2,23 [1,02-4,89] y OR= 10 [3,6-33,4], respectivamente). Conclusiones. La mortalidad postoperatoria es similar a la comunicada en bases de datos del exterior. Los pacientes con mala condición preoperatoria y aquellos con complicaciones presentaron mayor mortalidad en nuestra serie.

Introduction. Four hundred newborns die every year in our country suffering from congenital heart disease. Definitive surgical repair, whenever possible, is nowadays the optimal therapeutic strategy. Our goal is to describe mortality and morbidity in neonatal surgery with cardiopulmonary bypass in a tertiary public hospital in Argentina. Patients and methods. Descriptive, retrospective study. Every patient, younger than 45 days, with cardiac surgery requiring cardiopulmonary bypass, at the Garrahan Hospital between 2004 and 2008 was included. Demographic, surgical and postoperative data were collected. Adjusted mortality risk analysis, and descriptive statistics from the most frequent diagnosis were performed. Results are expressed as median and rank or percentage. Results. 200 newborns were operated, 62 percent males. Median age was 21 days (r 1- 45) and median weight 3.1 kg (r 1.6-6.2). Total anomalous pulmonary venous return, transposition of great arteries and hypoplastic left heart syndrome diagnoses accounted for 75 percent of the procedures. Median length of stay was 12 days (r 0-191), and 6 days of mechanical ventilation (r 0-180). Eighteen percent of the patients required peritoneal dialysis. Whole series mortality was 19 percent and fell to 14 pecent in 2008. Unstable preoperative condition and postoperative complications increased mortality, OR= 2.23 (1.02-4.89) and OR= 10 (3.6-33.4), respectively. Conclusions. Our postoperative mortality is similar to those reported in foreign countries databases. Patients with unstable preoperative condition and post-operative complications had higher mortality.

Cirugía cardíaca reparadora en recién nacidos: experiencia de 5 años en cirugía neonatal con circulación extracorpórea / Cardiac surgical repair in newborns: five years experience in neonatal open surgery

Introducción. En nuestro país fallecen anualmente 400 niños con cardiopatía congénita, en el 1er mes de vida. La cirugía constituye la estrategia actual para su tratamiento. El objetivo es describir la mortalidad hospitalaria y las complicaciones de la cirugía cardíaca neonatal con circulación extracorpórea en un hospital público de alta complejidad. Pacientes y métodos. Estudio descriptivo retrospectivo. Se registraron datos demográficos, de la cirugía y del postoperatorio de los pacientes con circulación extracorpórea, menores de 45 días, operados en el Hospital Garrahan, entre 2004-2008. Se realizó un análisis por patologías y de mortalidad ajustado por riesgo. Los resultados se expresan en mediana e intervalo, o en porcentaje, según corresponda. Resultados. Se operaron 200 recién nacidos, 62 por ciento varones. La edad fue 21 (1- 45) días y el peso 3,1 (1,6-6,2) kg. Anomalía total de retorno venoso pulmonar, transposición de grandes arterias y síndrome de corazón izquierdo hipoplásico concentraronel 75 por ciento de las cirugías. El tiempo de internación fue 12 (0-191) días, con 6 (0-180) días de ventilación mecánica, y 18 por ciento de los pacientes requirieron diálisis. La mortalidad global fue 19 por ciento y 14 por ciento en el último año analizado. Los pacientes en mala condición preoperatoria, así como los que presentaron complicaciones, exhibieron una mortalidad mayor (OR= 2,23 [1,02-4,89] y OR= 10 [3,6-33,4], respectivamente). Conclusiones. La mortalidad postoperatoria es similar a la comunicada en bases de datos del exterior. Los pacientes con mala condición preoperatoria y aquellos con complicaciones presentaron mayor mortalidad en nuestra serie.(AU)

Introduction. Four hundred newborns die every year in our country suffering from congenital heart disease. Definitive surgical repair, whenever possible, is nowadays the optimal therapeutic strategy. Our goal is to describe mortality and morbidity in neonatal surgery with cardiopulmonary bypass in a tertiary public hospital in Argentina. Patients and methods. Descriptive, retrospective study. Every patient, younger than 45 days, with cardiac surgery requiring cardiopulmonary bypass, at the Garrahan Hospital between 2004 and 2008 was included. Demographic, surgical and postoperative data were collected. Adjusted mortality risk analysis, and descriptive statistics from the most frequent diagnosis were performed. Results are expressed as median and rank or percentage. Results. 200 newborns were operated, 62 percent males. Median age was 21 days (r 1- 45) and median weight 3.1 kg (r 1.6-6.2). Total anomalous pulmonary venous return, transposition of great arteries and hypoplastic left heart syndrome diagnoses accounted for 75 percent of the procedures. Median length of stay was 12 days (r 0-191), and 6 days of mechanical ventilation (r 0-180). Eighteen percent of the patients required peritoneal dialysis. Whole series mortality was 19 percent and fell to 14 pecent in 2008. Unstable preoperative condition and postoperative complications increased mortality, OR= 2.23 (1.02-4.89) and OR= 10 (3.6-33.4), respectively. Conclusions. Our postoperative mortality is similar to those reported in foreign countries databases. Patients with unstable preoperative condition and post-operative complications had higher mortality.(AU)