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1.
Arch Cardiol Mex ; 2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33621219

RESUMO

Las complicaciones mecánicas del infarto agudo de miocardio (IAM) tienen una incidencia menor al 1%, debido al aumento en el uso de la reperfusión y particularmente la revascularización percutánea precoz1,2.

3.
J Card Surg ; 2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32906197

RESUMO

BACKGROUND: COVID-19 hit hard worldwide. There has been an impact on global activity of cardiac surgery. Spain has been one of the hardest hit countries with one of the highest per population incidences and death. METHODS: The following is an overview of the epidemiology and impact on resources, the caseload and surgical societal implemented recommendations, the description of the ECMO activity and nosocomial transmission among healthcare workers. RESULTS: There was a reduction of 5-6 times of the regular caseload. As of July 17, 160 ECMO implants were performed. In a 13-center survey, at least 1 staff surgeon had SARS-COV-19 infection. CONCLUSION: Cardiac surgical activity has suffered a negative impact all over the country.

4.
J Card Surg ; 2020 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-32845030

RESUMO

Providing complex therapies such as extracorporeal membrane oxygenation (ECMO) during outbreaks of infectious diseases has singular challenges. The impact of the SARS-CoV-2 pandemic has implied a mentality change by force of circumstances, and cardiac surgery has not been stranger to this trend. The need to treat critically ill patients with an unknown evolution has compelled cardiovascular surgeons to decide whether or not to implant an ECMO system, despite the limited scientific evidence available in the context of COVID-19. To add some confusion, doubts were raised about its potential deleterious outcome in COVID-19 patients, due to its effect on lymphocyte counts and interleukin-6 concentrations. The care of the critically ill patient in a moment of national emergency in Spain took precedence over those possible formal doubts. The Spanish perspective on ventricular assist devices during and after the COVID-19 pandemic, focused on ECMO as a particular case of mechanical circulatory support, is presented. We address both the challenges posed by the pandemic and the organizational model established in Spain; changes in ECMO therapy and some lessons learned for the next outbreaks are also described. It is not about reinventing the wheel in each country; it is enough to learn from experience and take advantage of the knowledge generated by those who have already gone through similar situations in our environment.

6.
Rev. colomb. cardiol ; 26(5): 296-299, sep.-oct. 2019. graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1092941

RESUMO

Resumen Se describe el caso de una mujer de 68 años que presentaba insuficiencia tricuspídea severa con ventrículo derecho dilatado, función sistólica levemente deprimida y ventrículo izquierdo no dilatado con fracción de eyección del 47%. Se intervino mediante cirugía realizándose una sustitución valvular tricúspide por prótesis mecánica ATS n( 33 e implante de electrodo de marcapasos epicárdico definitivo. En el postoperatorio inmediato presentó ascenso persistente del segmento ST en la cara inferior. Se implantó balón de contrapulsación intraaórtico y en el ecocardiograma urgente se observó disfunción ventricular global con aquinesia de la cara inferior. Se realizó coronariografía urgente observándose una imagen de angulación y deformidad a nivel distal de la arteria coronaria derecha no presente en la coronariografía prequirúrgica que sugería tracción externa del vaso, probablemente en relación con la sutura quirúrgica. Se intervino en forma percutánea implantándose stent farmacoactivo con lo cual se recuperó el flujo distal y se normalizó el segmento ST. La proximidad del anillo tricúspide a estructuras anatómicas como la arteria coronaria derecha hace posible su lesión durante la cirugía. El daño iatrogénico de la arteria coronaria derecha requiere diagnóstico y tratamiento precoz. Por ello esta complicación se debe incluir en el diagnóstico diferencial de disfunción ventricular derecha tras cirugía cardiaca.


Abstract The case is presented on a 68 year-old woman with severe tricuspid insufficiency. She also had a dilated right ventricle, a slightly depressed systolic function, and an undilated left ventricle with an ejection fraction of 47%. We treated her surgically, the tricuspid valve replacement was carried out with an ATS Nº 33 mechanical prosthesis and implanted a permanent epicardial pacemaker lead. In the immediate post operative period, she presented a persistent ST segment elevation on the inferior wall. An intra-aortic balloon pump was implanted; the urgent echocardiogram showed a global ventricular dysfunction with akinesia of the inferior wall. An urgent coronary angiography was performed, with an image of angulation and deformity being observed at distal level of the right coronary artery that was not present in the pre-surgical coronary angiography, which suggested an external traction of the vessela probably associated with a surgical suture. Percutaneous intervention was carried out, with a drug-eluting stent being implanted. It was percutaneously treated by implanting a drug-eluting stent restoring distal blood flow and normalizing the ST segment. The proximity of the tricuspid ring to anatomical structures like the right coronary artery means that it could be damaged during surgery. The iatrogenic damage to the right coronary artery requires an early diagnosis and treatment. For this reason, this complication must be included in the differential diagnosis of right ventricular dysfunction after cardiac surgery.

7.
Med. clín (Ed. impr.) ; 149(1): 1-8, jul. 2017. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-164384

RESUMO

Fundamento y objetivo: La cirugía de tromboendarterectomía pulmonar es el tratamiento de elección para la hipertensión pulmonar tromboembólica crónica; un factor de riesgo para la mortalidad hospitalaria son las resistencias vasculares pulmonares muy elevadas. El objetivo de este trabajo fue analizar los resultados inmediatos y a largo plazo de la cirugía para la hipertensión pulmonar tromboembólica crónica en pacientes con hipertensión pulmonar muy grave. Material y métodos: Desde febrero de 1996 hemos realizado 160 tromboendarterectomías pulmonares. Dividimos esta población en grupo 1 -40 pacientes con resistencias vasculares pulmonares ≥ 1.090dinas/s/cm-5- y grupo 2 -los 120 restantes-. Resultados: La mortalidad hospitalaria (15 frente a 2,5%), el edema pulmonar de reperfusión (33 frente a 14%) y la insuficiencia cardiaca (23 frente a 3,3%) fueron significativamente mayores en el grupo 1; pero al año, no hay diferencia en la situación clínica, hemodinámica y ecocardiográfica con el grupo 2. La supervivencia a los 5 años fue del 77% en el grupo 1 y del 92% en el grupo 2 (p=0,033). Excluyendo los primeros 46 enfermos, considerados curva de aprendizaje, no hubo diferencia en la mortalidad hospitalaria (3,8 frente a 2,3%) ni en la supervivencia (96,2% en el grupo 1 y 96,2% en el grupo 2 a los 5 años). Conclusiones: La tromboendarterectomía pulmonar tiene una morbimortalidad inicial mayor en pacientes con hipertensión pulmonar tromboembólica crónica muy grave, pero obtiene el mismo beneficio a medio-largo plazo. En nuestra experiencia, tras la curva de aprendizaje, la cirugía ofrece la misma seguridad y excelentes resultados a los pacientes más graves, y ninguna cifra de resistencias vasculares pulmonares debería ser considerada una contraindicación absoluta (AU)


Background and objective: Pulmonary thromboendarterectomy surgery is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension; extremely high pulmonary vascular resistance constitutes a risk factor for hospital mortality. The objective of this study was to analyze the immediate and long-term results of the surgical treatment of chronic thromboembolic pulmonary hypertension in patients with very severe pulmonary hypertension. Material and methods: Since February 1996, we performed 160 pulmonary thromboendarterectomies. We divided the patient population in 2 groups: group 1, which included 40 patients with pulmonary vascular resistance≥1090dyn/sec/cm-5, and group 2, which included the remaining 120 patients. Results: Hospital mortality (15 vs. 2.5%), reperfusion pulmonary edema (33 vs. 14%) and heart failure (23 vs. 3.3%) were all higher in group 1; however, after one year of follow-up, there were no significant differences in the clinical, hemodynamic and echocardiographic conditions of both groups. Survival rate after 5 years was 77% in group 1 and 92% in group 2 (P=.033). After the learning curve including the 46 first patients, there was no difference in hospital mortality (3.8 vs. 2.3%) or survival rate after 5 years (96.2% in group 1 and 96.2% in group 2). Conclusions: Pulmonary thromboendarterectomy is linked to significantly higher morbidity and mortality rates in patients with severe chronic thromboembolic pulmonary hypertension. Nevertheless, these patients benefit the same from the procedure in the mid-/long-term. In our experience, after the learning curve, this surgery is safe in severe pulmonary hypertension and no level of pulmonary vascular resistance should be an absolute counter-indication for this surgery (AU)


Assuntos
Humanos , Endarterectomia , Hipertensão Pulmonar/complicações , Embolia Pulmonar/cirurgia , Resultado do Tratamento , Doença Crônica , Resistência Vascular/fisiologia , Indicadores de Morbimortalidade , Segurança do Paciente
8.
Med Clin (Barc) ; 149(1): 1-8, 2017 Jul 07.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28233561

RESUMO

BACKGROUND AND OBJECTIVE: Pulmonary thromboendarterectomy surgery is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension; extremely high pulmonary vascular resistance constitutes a risk factor for hospital mortality. The objective of this study was to analyze the immediate and long-term results of the surgical treatment of chronic thromboembolic pulmonary hypertension in patients with very severe pulmonary hypertension. MATERIAL AND METHODS: Since February 1996, we performed 160 pulmonary thromboendarterectomies. We divided the patient population in 2 groups: group 1, which included 40 patients with pulmonary vascular resistance≥1090dyn/sec/cm-5, and group 2, which included the remaining 120 patients. RESULTS: Hospital mortality (15 vs. 2.5%), reperfusion pulmonary edema (33 vs. 14%) and heart failure (23 vs. 3.3%) were all higher in group 1; however, after one year of follow-up, there were no significant differences in the clinical, hemodynamic and echocardiographic conditions of both groups. Survival rate after 5 years was 77% in group 1 and 92% in group 2 (P=.033). After the learning curve including the 46 first patients, there was no difference in hospital mortality (3.8 vs. 2.3%) or survival rate after 5 years (96.2% in group 1 and 96.2% in group 2). CONCLUSIONS: Pulmonary thromboendarterectomy is linked to significantly higher morbidity and mortality rates in patients with severe chronic thromboembolic pulmonary hypertension. Nevertheless, these patients benefit the same from the procedure in the mid-/long-term. In our experience, after the learning curve, this surgery is safe in severe pulmonary hypertension and no level of pulmonary vascular resistance should be an absolute counter-indication for this surgery.


Assuntos
Endarterectomia , Hipertensão Pulmonar/cirurgia , Embolia Pulmonar/cirurgia , Idoso , Doença Crônica , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/mortalidade , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Embolia Pulmonar/mortalidade , Estudos Retrospectivos , Índice de Gravidade de Doença , Taxa de Sobrevida , Resultado do Tratamento
9.
Arch. bronconeumol. (Ed. impr.) ; 51(10): 502-508, oct. 2015. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-142399

RESUMO

Introducción: La tromboendarterectomía pulmonar es el tratamiento de elección en la hipertensión pulmonar tromboembólica crónica. Presentamos nuestra serie completa con esta técnica. Métodos: Desde febrero de 1996 hasta junio de 2014, hemos realizado 106 tromboendarterectomías. Analizamos las características de la población, la mortalidad y morbilidad asociadas a la técnica y los resultados a largo plazo de supervivencia, mejoría funcional y resolución de la hipertensión pulmonar. Resultados: La edad media de la población fue 53 ± 14 años. El 89% estaba en clase funcional III-IV de la OMS. La presión pulmonar media prequirúrgica fue 49 ± 13 mmHg y las resistencias vasculares pulmonares 831 ± 364 dinas.s.cm-5. La mortalidad hospitalaria fue 6,6%. La morbilidad postoperatoria más relevante fue debida al edema pulmonar por reperfusión en el 20%, que fue factor de riesgo independiente (p = 0,015) para mortalidad hospitalaria. Con una mediana de seguimiento de 31 meses (rango intercuartil 50), la supervivencia a los 3 y 5 años es 90 y 84%. Al año de seguimiento, el 91% está en clase funcional I-II de la OMS, la presión pulmonar media en 27 ± 11 mmHg y las resistencias pulmonares vasculares en 275 ± 218 dinas.s.cm-5 (significativamente menores (p < 0,05) que las basales). En 14 pacientes se diagnosticó hipertensión pulmonar persistente; aun así, su supervivencia es, a los 3 y 5 años, 91 y 73%, respectivamente. Conclusiones: La tromboendarterectomía pulmonar ofrece resultados excelentes en el tratamiento de la hipertensión pulmonar tromboembólica crónica. Proporciona una elevada supervivencia a largo plazo, mejora la capacidad funcional y resuelve la hipertensión pulmonar en la mayoría de los pacientes


Introduction: Pulmonary thromboendarterectomy is the treatment of choice in chronic thromboembolic pulmonary hypertension. We report our experience with this technique. Methods: Between February 1996 and June 2014, we performed 106 pulmonary thromboendarterectomies. Patient population, morbidity and mortality and the long-term results of this technique (survival, functional improvement and resolution of pulmonary hypertension) are described. Results: Subjects' mean age was 53 ± 14 years. A total of 89% were WHO functional class III–IV, presurgery mean pulmonary pressure was 49 ± 13 mmHg and mean pulmonary vascular resistance was 831 ± 364 dynes s cm-5. In-hospital mortality was 6.6%. The most important post-operative morbidity was reperfusion pulmonary injury, in 20% of patients; this was an independent risk factor (P = .015) for hospital mortality. With a 31-month median follow-up (interquartile range: 50), 3- and 5-year survival was 90% and 84% respectively. At 1 year, 91% were WHO functional class I–II; mean pulmonary pressure (27 ± 11 mmHg) and pulmonary vascular resistance (275 ± 218 dynes s cm-5) were significantly lower (P < .05) than before the intervention. Although residual pulmonary hypertension was detected in 14 patients, their survival at 3 and 5 years was 91% and 73%, respectively. Conclusions: Pulmonary thromboendarterectomy offers excellent results in chronic thromboembolic pulmonary hypertension. Long-term survival is good, functional capacity improves, and pulmonary hypertension is resolved in most patients


Assuntos
Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Endarterectomia/instrumentação , Endarterectomia/métodos , Endarterectomia , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/cirurgia , Hipertensão Pulmonar , Embolia Pulmonar/complicações , Embolia Pulmonar/cirurgia , Indicadores de Morbimortalidade , Sobrevivência/fisiologia , Mortalidade Hospitalar/tendências , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Relação Ventilação-Perfusão/fisiologia , Esternotomia , Seguimentos , Intervalos de Confiança
10.
Arch Bronconeumol ; 51(10): 502-8, 2015 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-25605526

RESUMO

INTRODUCTION: Pulmonary thromboendarterectomy is the treatment of choice in chronic thromboembolic pulmonary hypertension. We report our experience with this technique. METHODS: Between February 1996 and June 2014, we performed 106 pulmonary thromboendarterectomies. Patient population, morbidity and mortality and the long-term results of this technique (survival, functional improvement and resolution of pulmonary hypertension) are described. RESULTS: Subjects' mean age was 53±14 years. A total of 89% were WHO functional class III-IV, presurgery mean pulmonary pressure was 49±13mmHg and mean pulmonary vascular resistance was 831±364 dynes.s.cm(-5). In-hospital mortality was 6.6%. The most important post-operative morbidity was reperfusion pulmonary injury, in 20% of patients; this was an independent risk factor (p=0.015) for hospital mortality. With a 31-month median follow-up (interquartile range: 50), 3- and 5-year survival was 90 and 84%. At 1 year, 91% were WHO functional class I-II; mean pulmonary pressure (27±11mmHg) and pulmonary vascular resistance (275±218 dynes.s.cm(-5)) were significantly lower (p<0.05) than before the intervention. Although residual pulmonary hypertension was detected in 14 patients, their survival at 3 and 5 years was 91 and 73%, respectively. CONCLUSIONS: Pulmonary thromboendarterectomy offers excellent results in chronic thromboembolic pulmonary hypertension. Long-term survival is good, functional capacity improves, and pulmonary hypertension is resolved in most patients.


Assuntos
Endarterectomia/métodos , Hipertensão Pulmonar/etiologia , Embolia Pulmonar/cirurgia , Trombectomia/métodos , Adulto , Idoso , Ponte Cardiopulmonar , Doença Crônica , Endarterectomia/estatística & dados numéricos , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Hipotermia Induzida , Hipóxia/etiologia , Hipóxia/terapia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/terapia , Embolia Pulmonar/complicações , Recuperação de Função Fisiológica , Traumatismo por Reperfusão/etiologia , Traumatismo por Reperfusão/terapia , Respiração Artificial , Trombectomia/estatística & dados numéricos , Resultado do Tratamento , Resistência Vascular , Adulto Jovem
11.
Rev. esp. cardiol. (Ed. impr.) ; 66(8): 644-648, ago. 2013. tab
Artigo em Espanhol | IBECS | ID: ibc-114042

RESUMO

Introducción y objetivos. Cuando la válvula aórtica bicúspide se asocia a dilatación de la aorta, la reparación quirúrgica precisa actuar sobre todos los componentes de la raíz de aorta. Revisamos nuestra experiencia en esta cirugía. Métodos. Se realizó un estudio observacional descriptivo y retrospectivo con el objetivo de analizar la morbilidad y la mortalidad de estas técnicas y valorar la durabilidad a medio plazo de la válvula aórtica. Se incluyó a todos los pacientes con válvula aórtica bicúspide y dilatación de la aorta intervenidos en nuestro centro entre 1999 y 2011 con alguna técnica de preservación valvular. Resultados. Se intervino a 151 pacientes. En 51 se empleó alguna técnica de preservación valvular. La media de edad era 51 ± 12 años y el 92% eran varones. En el 69% la insuficiencia aórtica era menor de grado II y los velos aórticos presentaban poca degeneración estructural. En 32 pacientes se realizó reimplante valvular. No hubo mortalidad hospitalaria. Con una mediana de seguimiento de 36 [intervalo intercuartílico, 18-45] meses, ningún paciente ha fallecido o ha requerido reintervención y todos los pacientes están libres de insuficiencia aórtica mayor de grado II . Conclusiones. La cirugía de preservación de la válvula aórtica bicúspide asociada a dilatación de la aorta muestra unos resultados a corto y medio plazo excelentes en válvulas seleccionadas. La estabilización de todos los componentes de la raíz de aorta mejora la durabilidad de la válvula, y las técnicas propuestas se muestran reproducibles y estables a medio plazo (AU)


Introduction and objectives: When the bicuspid aortic valve is associated with dilatation of the aorta, surgical repair requires correction of all the components of the aortic root. Here, we review our experience in this type of surgery. Methods: A descriptive and retrospective observational study was carried out to analyze morbidity and mortality in valve-sparing techniques and evaluate the medium-term durability of the aortic valve. We included all patients with a bicuspid aortic valve and dilatation of the aorta who underwent surgery with a valve-sparing technique in our center between 1999 and 2011. Results: A total of 151 patients underwent surgery. A valve-sparing technique was used in 51 patients. The mean (standard deviation) age of the patients was 51 (12) years and 92% were men. In 69% of the patients, aortic insufficiency was less than grade II and the aortic cusps showed little structural degeneration. Valve reimplantation was performed in 32 patients. There was no hospital mortality. With a median follow-up of 36 months (interquartile range, 18-45 months), none of the patients died or required reoperation, and all patients were free of aortic insufficiency greater than grade II. Conclusions: Valve-preserving surgery in bicuspid aortic valves associated with dilatation of the aorta shows excellent short- and medium-term results in selected valves. The stabilization of all of the components of the aortic root improves the durability of the valve, and the techniques proposed are reproducible and stable in the medium-term (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Valva Mitral/patologia , Valva Mitral/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/cirurgia , Aneurisma Aórtico/fisiopatologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Cardiovasculares/métodos , Procedimentos Cirúrgicos Cardiovasculares , Ecocardiografia/instrumentação , Ecocardiografia/métodos , Ecocardiografia
12.
Interact Cardiovasc Thorac Surg ; 17(2): 353-8; discussion 358, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23628652

RESUMO

OBJECTIVES: To develop a multivariate predictive risk score of perioperative in-hospital stroke after coronary artery bypass grafting (CABG) surgery. METHOD: A total of 26 347 patients were enrolled from 21 Spanish hospital databases. Logistic regression analysis was used to predict the risk of perioperative stroke (ictus or transient ischaemic attack). The predictive scale was developed from a training set of data and validated by an independent test set, both selected randomly. The assessment of the accuracy of prediction was related to the area under the ROC curve. The variables considered were: preoperative (age, gender, diabetes mellitus, arterial hypertension, previous stroke, cardiac failure and/or left ventricular ejection fraction<40%, non-elective priority of surgery, extracardiac arteriopathy, chronic kidney failure and/or creatininemia≥2 mg/dl and atrial fibrillation) and intraoperative (on/off-pump). RESULTS: Global perioperative stroke incidence was 1.38%. Non-elective priority of surgery (priority; OR=2.32), vascular disease (arteriopathy; OR=1.37), cardiac failure (cardiac; OR=3.64) and chronic kidney failure (kidney; OR=6.78) were found to be independent risk factors for perioperative stroke in uni- and multivariate models in the training set of data; P<0.0001; AUC=0.77, 95% CI 0.73-0.82. The PACK2 stroke CABG score was established with 1 point for each item, except for chronic kidney failure with 2 points (range 0-5 points); AUC=0.76, 95% CI 0.72-0.80. In patients with PACK2 score≥2 points, off-pump reduced perioperative stoke incidence by 2.3% when compared with on-pump CABG. CONCLUSIONS: PACK2 risk scale shows good predictive accuracy in the data analysed and could be useful in clinical practice for decision making and patient selection.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Técnicas de Apoio para a Decisão , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Distribuição de Qui-Quadrado , Feminino , Humanos , Incidência , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Seleção de Pacientes , Curva ROC , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Espanha/epidemiologia , Resultado do Tratamento
13.
Eur J Cardiothorac Surg ; 44(4): 725-31, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23435524

RESUMO

OBJECTIVES: To determine the effect of the off-pump technique in preventing stroke development during the early perioperative period after coronary artery bypass graft surgery (CABG). METHODS: Patients undergoing isolated CABG surgery were enrolled from 21 Spanish cardiac-surgery centres. Baseline variables related to perioperative stroke risk were recorded in the preoperative (age, gender, diabetes mellitus, arterial hypertension, prior stroke, cardiac failure: preoperative New York Heart Association class III-IV and/or left ventricular ejection fraction <40%, non-elective priority of surgery, peripheral arteriopathy, chronic renal failure) and intraoperative periods (on/off-pump performance). The Northern New England Cardiovascular Disease Study Group (NNECDSG) stroke risk schema was used to stratify stroke risk and compare observed neurological outcomes in this study. RESULTS: A total of 26 347 patients were included in the study. Global perioperative stroke incidence was 1.38%. Non-elective priority of surgery (OR = 2.37), peripheral arteriopathy (OR = 1.62), cardiac failure (OR = 2.98), prior stroke (OR = 1.57) and chronic renal failure (OR = 6.16) were found to be independent risk factors for perioperative stroke in uni- and multivariate models; Hosmer-Lemeshow test: χ(2) = 4.62, P = 0.59. Perioperative stroke incidence increased whenever NNECDSG score or the number of preoperative risk factors increased. However, on- vs off-pump surgery did not show statistical differences in NNECDSG strata. For patients with two or more preoperative independent risk factors, off-pump surgery showed a significant reduction in perioperative stroke incidence (4.29 vs 6.76%, P < 0.05), particularly when one of these factors was chronic renal failure or preoperative cardiac failure. However, when both factors were present concomitantly there was no difference between on and off-pump techniques, P < 0.0001. CONCLUSIONS: Off-pump surgery has a lower perioperative stroke incidence than on-pump only in cases associated with cardiovascular stroke-risk factors, in particular, with chronic renal failure and preoperative cardiac failure, but also with peripheral arteriopathy, prior stroke and non-elective surgery. The perioperative stroke rate remains high in cases with two or more preoperative stroke risk factors, even when using the off-pump technique, particularly when chronic renal failure is present.


Assuntos
Ponte de Artéria Coronária sem Circulação Extracorpórea/métodos , Acidente Vascular Cerebral/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Período Perioperatório , Estudos Retrospectivos , Fatores de Risco
14.
Rev Esp Cardiol (Engl Ed) ; 66(8): 644-8, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24776333

RESUMO

INTRODUCTION AND OBJECTIVES: When the bicuspid aortic valve is associated with dilatation of the aorta, surgical repair requires correction of all the components of the aortic root. Here, we review our experience in this type of surgery. METHODS: A descriptive and retrospective observational study was carried out to analyze morbidity and mortality in valve-sparing techniques and evaluate the medium-term durability of the aortic valve. We included all patients with a bicuspid aortic valve and dilatation of the aorta who underwent surgery with a valve-sparing technique in our center between 1999 and 2011. RESULTS: A total of 151 patients underwent surgery. A valve-sparing technique was used in 51 patients. The mean (standard deviation) age of the patients was 51 (12) years and 92% were men. In 69% of the patients, aortic insufficiency was less than grade II and the aortic cusps showed little structural degeneration. Valve reimplantation was performed in 32 patients. There was no hospital mortality. With a median follow-up of 36 months (interquartile range, 18-45 months), none of the patients died or required reoperation, and all patients were free of aortic insufficiency greater than grade II. CONCLUSIONS: Valve-preserving surgery in bicuspid aortic valves associated with dilatation of the aorta shows excellent short- and medium-term results in selected valves. The stabilization of all of the components of the aortic root improves the durability of the valve, and the techniques proposed are reproducible and stable in the medium-term.


Assuntos
Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/cirurgia , Adulto , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos
16.
Rev. esp. cardiol. (Ed. impr.) ; 65(supl.1): 35-41, 2012.
Artigo em Espanhol | IBECS | ID: ibc-123054

RESUMO

La Sección de Insuficiencia Cardiaca y Trasplante de la Sociedad Española de Cardiología tiene como misión el estudio, la potenciación y la difusión de todos los temas relacionados con la disfunción miocárdica y el trasplante de corazón. La insuficiencia cardiaca es una enfermedad de alta prevalencia que consume gran cantidad de recursos sanitarios. Por ello, el interés en ella es máximo y las líneas de investigación clínicas y básicas, así como los puntos de vista que intentan incrementar los conocimientos de esta enfermedad, múltiples. En este artículo se exponen las novedades más actuales relacionadas con esta enfermedad y sus tratamientos. En primer lugar, se analizan las últimas publicaciones relacionadas con la insuficiencia cardiaca. Posteriormente, se revisan los estudios más recientes en materia de insuficiencia cardiaca avanzada y dispositivos de asistencia ventricular. Para finalizar, se enumeran los últimos conocimientos relacionados con el trasplante cardiaco (AU)


The mission of the Heart Failure and Heart Transplantation Section of the Spanish Society of Cardiology is to study, promote interest in, and disseminate information about all aspects of myocardial dysfunction and heart transplantation. Heart failure is a highly prevalent disorder that consumes a substantial proportion of healthcare resources. Consequently, there is a very high level of interest in the condition and a wide range of preclinical and clinical research is being carried out, including research into new ways of looking at the disease that will increase our understanding. The aim of this article was to describe current developments concerning this disease and its treatment. Firstly, the latest publications on heart failure are summarized. Then, the most recent studies on advanced heart failure and ventricular assist devices are reviewed. Finally, the latest findings on heart transplantation are reported (AU)


Assuntos
Humanos , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Avaliação de Resultado de Intervenções Terapêuticas , Indicadores de Morbimortalidade , Telemedicina
17.
Rev. esp. cardiol. (Ed. impr.) ; 64(6): 470-475, jun. 2011. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-89430

RESUMO

Introducción y objetivos. Existen varias técnicas para tratar de preservar la válvula aórtica en los aneurismas de la raíz aórtica. Presentamos nuestra experiencia con la técnica del reimplante valvular aórtico en 120 pacientes. Métodos. Desde marzo de 2004 hasta octubre de 2010, se ha realizado la técnica de David en 120 pacientes con aneurismas de la raíz de aorta; 51 tenían síndrome de Marfan, con una media de edad de 31±12 años. El diámetro aórtico medio a nivel de los senos de Valsalva fue de 51±5mm y el 16% tenía una insuficiencia aórtica moderada/severa. En los 69 pacientes restantes, la media de edad era 56±14 años, el diámetro aórtico medio, 53±7mm y el 66% tenía una insuficiencia aórtica moderada/severa. En 14 pacientes la válvula aórtica era bicúspide. Resultados. La mortalidad hospitalaria fue del 1,7%. Con un seguimiento medio de 37±21 meses, la supervivencia a los 5 años es del 94±3%, y el 96% presenta insuficiencia aórtica de grado ≤ II (el 87% de los pacientes con insuficiencia aórtica ausente o de grado I). Un paciente ha sido reoperado por presentar insuficiencia aórtica severa. No ha habido endocarditis o eventos cerebrovasculares, y el 96% está libre de tratamiento anticoagulante. Conclusiones. La técnica de reimplante de la válvula aórtica ofrece unos resultados excelentes. Elimina las complicaciones asociadas a las prótesis valvulares, por lo que debe considerarse el tratamiento de elección para los aneurismas de la raíz de aorta en pacientes jóvenes (AU)


Introduction and objectives. Several aortic valve sparing techniques have been described for the treatment of aortic root aneurysms. We report our experience using the reimplantation technique in 120 patients. Methods. Between March 2004 and October 2010, 120 patients with aortic root aneurysms underwent David operations. Of these, 51 were diagnosed with Marfan syndrome. Mean patient age was 31±12 years. The mean diameter of the sinuses of Valsalva was 51±5mm and moderate/severe aortic regurgitation was present in 16% of these patients. In the other 69 patients mean age was 56±14 years, the mean diameter of the sinuses of Valsalva was 53±7mm and moderate/severe aortic regurgitation was present in 66%. A bicuspid aortic valve was presented in 14 cases. Results. Hospital mortality was 1.7%. Mean follow-up was 37±21 months; 94% of the patients survived and 96% had an aortic regurgitation below grade II during 5 years of follow-up. One patient required re-operation because of severe aortic regurgitation. No endocarditis or thromboembolic complications have been documented, and 96% of the patients did not receive any anticoagulation therapy. Conclusions. Short- and mid-term results with the reimplantation technique for aortic root aneurysms are excellent. This technique prevents the need for chronic anticoagulation treatment as well as the complications arising from mechanical prostheses, and it should be the treatment of choice for young patients (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Mortalidade Hospitalar/tendências , Síndrome de Marfan/complicações , Síndrome de Marfan/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/cirurgia , Procedimentos Cirúrgicos Operatórios/métodos , Manobra de Valsalva/fisiologia , Complicações Pós-Operatórias/epidemiologia , Próteses e Implantes , Taxa de Sobrevida , Próteses e Implantes/tendências
18.
Rev Esp Cardiol ; 64(6): 470-5, 2011 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-21550160

RESUMO

INTRODUCTION AND OBJECTIVES: Several aortic valve sparing techniques have been described for the treatment of aortic root aneurysms. We report our experience using the reimplantation technique in 120 patients. METHODS: Between March 2004 and October 2010, 120 patients with aortic root aneurysms underwent David operations. Of these, 51 were diagnosed with Marfan syndrome. Mean patient age was 31 ± 12 years. The mean diameter of the sinuses of Valsalva was 51 ± 5 mm and moderate/severe aortic regurgitation was present in 16% of these patients. In the other 69 patients mean age was 56 ± 14 years, the mean diameter of the sinuses of Valsalva was 53 ± 7 mm and moderate/severe aortic regurgitation was present in 66%. A bicuspid aortic valve was presented in 14 cases. RESULTS: Hospital mortality was 1.7%. Mean follow-up was 37 ± 21 months; 94% of the patients survived and 96% had an aortic regurgitation below grade II during 5 years of follow-up. One patient required re-operation because of severe aortic regurgitation. No endocarditis or thromboembolic complications have been documented, and 96% of the patients did not receive any anticoagulation therapy. CONCLUSIONS: Short- and mid-term results with the reimplantation technique for aortic root aneurysms are excellent. This technique prevents the need for chronic anticoagulation treatment as well as the complications arising from mechanical prostheses, and it should be the treatment of choice for young patients.


Assuntos
Aneurisma Aórtico/cirurgia , Valva Aórtica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Reimplante/métodos , Adulto , Idoso , Aneurisma Aórtico/mortalidade , Valva Aórtica/anormalidades , Insuficiência da Valva Aórtica/cirurgia , Circulação Extracorpórea , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Hipotermia Induzida , Masculino , Síndrome de Marfan/complicações , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos , Seio Aórtico/patologia , Seio Aórtico/cirurgia , Sobrevida , Análise de Sobrevida , Resultado do Tratamento
19.
Rev Esp Cardiol ; 64 Suppl 1: 42-9, 2011.
Artigo em Espanhol | MEDLINE | ID: mdl-21276489

RESUMO

The mission of the Heart Failure and Transplantation Section of the Spanish Society of Cardiology is to study, to promote interest in, and to disseminate information about all aspects of myocardial dysfunction and heart transplantation. Heart failure is a highly prevalent condition that consumes a substantial proportion of healthcare resources. Consequently, there is considerable interest in the disorder. Numerous lines of clinical and preclinical research are actively being pursued and new ways of increasing knowledge about the disease are constantly being explored. The aim of this article was to describe the most recent developments concerning heart failure and its treatment. Firstly, the latest publications on chronic heart failure are analyzed. Then, there is a review of the most recent studies on resynchronization therapy and of clinical trials on acute heart failure. Thirdly, new developments in right heart dysfunction and pulmonary hypertension, and the findings of the Spanish Pulmonary Hypertension Registry are discussed. Finally, the latest information on ventricular assist devices and heart transplantation is presented. In addition, the most important data obtained from official transplantation registries (i.e. the Spanish Heart Transplantation Registry and the Spanish Post-Heart Transplantation Tumor Registry) are reviewed.


Assuntos
Insuficiência Cardíaca/cirurgia , Insuficiência Cardíaca/terapia , Transplante de Coração/tendências , Doença Aguda , Procedimentos Cirúrgicos Cardíacos , Doença Crônica , Transplante de Coração/estatística & dados numéricos , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/terapia
20.
Rev. esp. cardiol. (Ed. impr.) ; 64(supl.1): 42-49, 2011. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-123038

RESUMO

La Sección de Insuficiencia Cardiaca y Trasplante de la Sociedad Española de Cardiología tiene como misión el estudio, la potenciación y la difusión de todos los temas relacionados con el mundo de la disfunción miocárdica y el trasplante de corazón. La insuficiencia cardiaca es una enfermedad muy prevalente que consume gran cantidad de recursos sanitarios. Por ello, el interés de esta patología es máximo y las líneas de investigación, clínicas y básicas, así como los puntos de vista que intentan incrementar los conocimientos de esta enfermedad son múltiples. En este artículo se exponen las novedades más actuales relacionadas con esta enfermedad y sus tratamientos. En primer lugar, se analizan las últimas publicaciones relacionadas con la insuficiencia cardiaca crónica. Posteriormente, se revisan los estudios más recientes en materia de terapia de resincronización y los ensayos relacionados con la insuficiencia cardiaca aguda. En tercer lugar, se comentan las novedades en el campo de la disfunción cardiaca derecha, la hipertensión pulmonar y el Registro Español de Hipertensión Pulmonar. Para finalizar, se exponen los últimos conocimientos relacionados con la asistencia ventricular y el trasplante. Asimismo, se comentan los datos más relevantes que se extraen de los registros oficiales relacionados con el trasplante (Registro Español de Trasplante Cardiaco y Registro Español de Tumores Postrasplante Cardiaco) (AU)


The mission of the Heart Failure and Transplantation Section of the Spanish Society of Cardiology is to study, to promote interest in, and to disseminate information about all aspects of myocardial dysfunction and heart transplantation. Heart failure is a highly prevalent condition that consumes a substantial proportion of healthcare resources. Consequently, there is considerable interest in the disorder. Numerous lines of clinical and preclinical research are actively being pursued and new ways of increasing knowledge about the disease are constantly being explored. The aim of this article was to describe the most recent developments concerning heart failure and its treatment. Firstly, the latest publications on chronic heart failure are analyzed. Then, there is a review of the most recent studies on resynchronization therapy and of clinical trials on acute heart failure. Thirdly, new developments in right heart dysfunction and pulmonary hypertension, and the findings of the Spanish Pulmonary Hypertension Registry are discussed. Finally, the latest information on ventricular assist devices and heart transplantation is presented. In addition, the most important data obtained from official transplantation registries (i.e. the Spanish Heart Transplantation Registry and the Spanish Post-Heart Transplantation Tumor Registry) are reviewed (AU)


Assuntos
Humanos , Insuficiência Cardíaca/cirurgia , Transplante de Coração , Bloqueadores do Receptor Tipo 2 de Angiotensina II/uso terapêutico , Terapia de Ressincronização Cardíaca/métodos , Hipertensão/epidemiologia
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