Heart transplantation at the Peruvian National Heart Institute: One-decade single-center experience.

BACKGROUND: Heart transplantations are ideal for most patients with end-stage heart failure refractory to medical treatment. The transplantation program at the Peruvian National Heart Institute started with a 10-year continuity in 2010. OBJECTIVE: To compare our 10-year heart transplantation experience results with international standards and reflect on our Transplant Program. METHODS: We studied 83 patients who underwent orthotopic heart transplantation at a single center between January 2010 and December 2019. The recipients' profiles and survival rates were analyzed according to sex and age group, ensuring the information's confidentiality. RESULTS: The recipients' mean age was 41.2 ± 17 years, 88% were adults, and 68.7% were male. The main indications for transplantation were idiopathic dilated cardiomyopathy. 85.5% of recipients were clinically categorized as INTERMACS profiles 1-3 before transplantation. There was a significant difference between sexes regarding the preoperative left ventricular ejection fraction and between age groups regarding the waiting time. The average ischemia time was 3.1 h, operating time was 6.1 h, cardiopulmonary bypass time was 3 h, and aortic cross-clamp time was 1.7 h. The principal early postoperative complications were hematological disorders and acute kidney failure. The principal late ones were kidney failure and severe anemia. The postoperative mortality was 15.9%, and the principal causes were infection and then acute rejection. The survival at 1, 5, and 10 years was 87.5%, 79.8%, and 79.8%, respectively. The survival results were not influenced by sex or age group. CONCLUSION: Our patients' postoperative complications, mortality, and survival rates coincided with those reported by the ISHLT registry.

Percutaneous endovascular management of ascending aortic pseudoaneurysm after heart transplantation in a pediatric patient.

Ascending aortic pseudoaneurysm is a rare complication after HT. Surgery is the most conventional management, but in some patients, it is risky. We report the case of a ten-year-old child who underwent HT and developed an ascending aortic pseudoaneurysm in the aortic anastomosis. He was successfully treated with two covered stents through endovascular management. Endovascular therapy is an alternative management in high-risk patients. To our knowledge, this is the first report about endovascular therapy of an AAP after HT in a pediatric patient.

Disponibilidad de cirujanos cardiovasculares pediátricos en el Perú en el año 2019 / Availability of pediatric cardiovascular surgeons in Peru in 2019

RESUMEN Objetivo: describir la disponibilidad de los cirujanos cardiovasculares pediátricos e identificar los factores que influyen en la situación de la certificación de esta subespecialidad en el Perú. Materiales y métodos: estudio transversal y descriptivo. Se realizó un muestreo por bola de nieve discriminatorio exponencial partiendo de los cirujanos cardiovasculares pediátricos que trabajan en el Instituto Nacional Cardiovascular hacia abril, 2019. Se solicitó su participación y posteriormente se aplicaron encuestas virtuales. Los datos recolectados de las preguntas cerradas se procesaron con estadísticos descriptivos y los de las preguntas abiertas, en base a su sistematización, orden y relación, obteniéndose así las conclusiones. Resultados: se encuestó a 20 cirujanos. De ellos, 5 refirieron haber estudiado la subespecialidad, teniendo como principales motivaciones una rotación durante el pregrado o la especialidad, y la vocación quirúrgica. Los tres subespecialistas certificados refirieron haberlo realizado debido al deseo de formalizar su práctica quirúrgica en el Perú y los otros dos refirieron no haberlo realizado por falta de tiempo. Asimismo, 11 cirujanos manifestaron el deseo de certificarse. Por otro lado, 17 encuestados refirieron que el Perú necesita más subespecialistas. Conclusión: existe una carencia de oferta de cirujanos cardiovasculares pediátricos en el Perú, lo cual muestra la necesidad de un aumento de las plazas para la subespecialidad; además, aumentar, mejorar y articular los centros resolutivos.

ABSTRACT Objective: to describe availability of pediatric cardiovascular surgeons and to identify factors influencing accreditation for this specialty in Peru. Materials and methods: this is a cross-sectional and descriptive study. A discriminating exponential snowball sampling procedure was performed in pediatric cardiovascular surgeons working in the Peruvian National Cardiovascular Institute. This was carried out in April 2019. Their participation was requested and virtual surveys were carried out. Data collected from closed questions were processed using descriptive statistics. Data from open questions were processed on the basis of their systematization, order, and relationship, so conclusions could be drawn. Results: twenty surgeons were surveyed. Of them, 5 reported having had training for their subspecialty, and they declared their main motivation was having undergone a training period during pregraduate or specialty studies, as well as their interest in surgery. Three accredited subspecialists declared they wanted to formalize their practice in Peru, and the other two declared not having formalized their training because of lack of time. Also, eleven surgeons expressed their desire for achieving accreditation. On the other hand, seventeen surveyed professionals declared that Peru requires more subspecialists. Conclusion: there is lack of pediatric cardiovascular surgeons in Peru; so increasing posts for such subspecialists is necessary, and also there is an urgent need for increasing, improving, and articulating specialized centers.

Enfermedades concominantes como factor pronostico de morbimortalidad perioperatoria en el abdomen agudo del paciente adulto mayor y anciano en el Centro Naval período enero 1995 a diciembre de 1997

Se realizó el presente estudio descriptivo retrospectivo con el objetivo de determinar que son las enfermedades médicas concominantes el parámetro más importante para determinar los resultados postquirurgicos en el abdomen agudo del paciente anciano. Se consideraron todos los pacientes de 60 a más años que ingresaron con el diagnóstico de abdomen quirúrgico y que fueron intervenidos en el Servicio de Emergencia del Centro Médico Naval, se presentaron 70 casos de abdomen agudo quirúrgico en ancianos, lo que representó el 2.98 por ciento sobre el total de las intervenciones quirúrgicas de emergencia. Los pacientes que no presentaron enfermedades médicas concominantes tuvieron una morbilidad del 16 por ciento. Los que presentaron una enfermedad su morbilidad fue del 47 por ciento y su mortalidad del 5.8 por ciento y los que presentaron tres omás tuvieron una morbilidad del 81.8 por ciento y una mortalidad del 18.15 por ciento. El síntoma principal fue el dolor abdominal 87.14 por ciento, el tiempo promedio de enfermedad fue de 3 días, el tiempo de permanencia preoperatoria en emergencia fue de 16.5 horas. El promedio de días de hospitalización fue de 14.5 días.