Claudio Fernández

Aortic valve replacement with minimal extracorporeal circulation versus standard cardiopulmonary bypass.

The purpose of this study was to evaluate the safety and the clinical outcomes of aortic valve replacement (AVR) performed with minimally invasive extracorporeal circulation (miniECC) technique vs. standard cardiopulmonary bypass (CPB). From February 2006 to December 2007 a total of 181 isolated AVR were performed, of these 53 patients were operated using minimal extracorporeal circulation system and 128 patients were operated using the standard CPB. Demographic characteristics and operative data were similar in both groups except for EuroSCORE (P<0.0001). Operative mortality (<30 days) was 3.8% for miniECC group and 4.7% for CPB group (P=ns). Patients in both groups showed similar postoperative chest tube drainage (432+/-325 ml vs. 460+/-331 ml, P=ns). The percentage of transfused patients was similar in both groups (37.7% vs. 43.8%, P=0.45). The number of transfused blood bank products was higher in patients with a body surface area >1.7 m(2) and who underwent traditional CPB in respect to miniECC system. Postoperatively renal injury, atrial fibrillation episodes, neurologic event rate, ICU and hospital stay length were similar in both groups. The miniECC is suitable for AVR providing good clinical results but the present results should not identify the miniECC system to be superior to the conventional CPB.

Ruptura traumática de la válvula mitral

Presentamos dos pacientes que sufrieron un accidente de trafico con resultado de traumatismo de la valvula mitral. En el primer caso, al cuarto dia del accidente, se diagnostico insuficiencia mitral masiva por ruptura de la cabeza del musculo papilar anterolateral, con version completa de los segmentos A1 y P1, procediendose a reparacion quirurgica al mes del accidente, siendo la valvula mitral estructuralmente normal. En el segundo caso, el diagnostico se hizo a los 10 dias del accidente. Se trataba de una insuficiencia mitral grave por ruptura de cuerdas del velo posterior. La reparacion quirurgica se llevo a cabo a los 2 meses y medio del accidente. En este caso la valvula mitral era, ademas, degenerativa. En ambos casos la cirugia consistio en reparacion valvular mitral. Se revisa la ruptura traumatica de la valvula mitral.

Intra-aortic filtration is effective in collecting hazardous materials.

Neurological complications after cardiac operations are mostly due to particle embolization. This case illustrates the embolic potential of any material. A 77-year-old lady underwent re-operation for homograft aortic regurgitation and mitral valve replacement. Intra-aortic filtration was used. After cardiopulmonary bypass the filter was found to have captured a pledget from a suture used to secure the mitral replacement device.