Luis Delgado

Ministernotomy versus median sternotomy for aortic valve replacement: a prospective, randomized study.

BACKGROUNDnMinimally invasive aortic valve replacement reduces surgical trauma and, supposedly, postoperative pain, blood loss, and length of stay. A prospective, randomized study was designed to prove these theoretical advantages.nnnMETHODSnForty patients undergoing isolated, elective aortic valve replacement were randomized into two equal groups. Patients in group M underwent aortic valve replacement through a ministernotomy (reversed L or reversed C). In group S, a median sternotomy was used. The anesthetic and surgical protocol was identical for both groups. Pain was evaluated on a daily basis. Pulmonary function tests were performed preoperatively and before hospital discharge in all patients.nnnRESULTSnThere were two deaths in each group. Cross-clamp time was longer in group M: 70 +/- 19 minutes versus 51 +/- 13 minutes in group S (p = 0.005). There were no statistically significant differences between groups M and S in pump time (95 +/- 20 minutes versus 83 +/- 19 minutes), extubation time (9.9 hours in both groups), chest drainage (479 +/- 274 mL/L 24 hours versus 355 +/- 159 mL/24 hours), transfusion requirements (27% in both groups), pain evaluation (1.34 +/- 1.3 versus 2.15 +/- 1.5), length of stay (6.2 +/- 2.3 days versus 6.3 +/- 2.5 days), and cosmetic appraisal. Forced vital capacity decreased 26% from preoperative reference values in group M and 33% in group S (p = not significant). Forced expiratory volume in 1 second decreased 22% and 35%, respectively (p = not significant).nnnCONCLUSIONSnThis study has failed to prove the theoretical advantages of minimally invasive aortic valve replacement. With this technique, cross-clamp time is longer than with a median sternotomy.

Multiple intracardiac lesions after blunt chest trauma

Closed chest trauma can cause rupture of intracardiac structures. We report the case of a 17-year-old boy whose chest was trodden by a horse. He sustained rupture of tricuspid and aortic valve leaflets and rupture of the interventricular septum. He underwent surgical repair of these lesions, but aortic insufficiency developed 2 years later and the aortic valve was replaced with a mechanical prosthesis.

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.

Cirugía coronaria con mini-circulación extracorpórea: experiencia de un grupo en España☆

Introduccion y objetivos El incremento del intervencionismo percutaneo ha conllevado una disminucion significativa de la cirugia coronaria. El perfil del paciente coronario que se remite a cirugia es mas anoso, con mayor comorbilidad, peor funcion ventricular y con procedimientos percutaneos previos. En este sentido la cirugia ha intentado mejorar sus resultados desde varios frentes de actuacion. El objetivo es analizar y describir la experiencia inicial de la cirugia coronaria con mini-circulacion extracorporea (MCEC) en un grupo de cirugia cardiaca en el que se ha convertido en tecnica de eleccion. Metodos Entre enero de 2004 y abril de 2007, se analizo de forma retrospectiva a 408 pacientes sometidos a cirugia coronaria aislada con MCEC, 329 (80,6%) varones, con media (intervalo) de edad de 63,5 (28-83) anos. Un 63% tenia hipertension; el 49,3%, diabetes; el 69%, dislipemia, y el 52% eran fumadores. Resultados El EuroSCORE logistico (mortalidad esperada) era del 3,7% (1%-38%). El 34% de los pacientes tenian afeccion del tronco comun y el 87%, enfermedad de 3 vasos. En el 74% de los casos se realizo revascularizacion completa, con un numero medio de injertos de 2,97 (1-7). Se utilizo injerto de mamaria en el 100% de los casos. La mortalidad hospitalaria fue del 0,74%. Las complicaciones postoperatorias fueron pocas: el 0,98% preciso reintervencion por sangrado, en el 3,4% se elevo la troponina I de forma significativa, en el 6,4% se desarrollo insuficiencia renal y el 0,5% tuvo accidente vascular cerebral. Conclusiones La cirugia coronaria con MCEC permite realizar una revascularizacion completa en la mayoria de los pacientes, con buenos resultados de morbimortalidad.

Mixoma de ventrículo izquierdo como causa de síncope en adolescente

El diagnostico clinico de los tumores cardiacos es, a menudo, dificil. Presentamos el caso de un paciente de 17 anos en el que se diagnostico un tumor del ventriculo izquierdo a partir del estudio de un sincope. El estudio anatomopatologico confirmo el diagnostico de mixoma. Clinical diagnosis of cardiac tumours is often difficult. We present the case of a 17 year-old boy inwhom a left ventricular tumour was discovered duringon diagnostic work-up for a syncope. The tumourwas removed and histology confirmed thediagnosis of myxoma.

[Coronary artery bypass surgery using the mini-extracorporeal circulation system: a Spanish unit's experience].

INTRODUCTION AND OBJECTIVESnThe increasing use of percutaneous interventions has resulted in a significant reduction in coronary artery bypass grafting. Today, patients referred for surgery are older, have more comorbidities, and have undergone previous percutaneous intervention, and their ventricular function is poorer. As a result, surgery has attempted to improve its results by adopting a number of different strategies. The aim of this study was to investigate and describe one cardiac surgery units initial experience with coronary artery bypass grafting using mini-extracorporeal circulation (MECC), which had become its technique of choice.nnnMETHODSnA retrospective analysis of 408 patients who underwent isolated coronary artery bypass grafting using MECC between January 2004 and April 2007 was carried out. Of the 408, 329 (80.6%) were men, their mean age was 63.5 years (28-83 years), 63% had hypertension, 49.3% had diabetes, 69% had hyperlipidemia, and 52% were smokers.nnnRESULTSnThe surgical mortality rate predicted by the logistic EuroSCORE was 3.7% (range, 1-38). Overall, 34% of patients had left main coronary artery disease and 87% had three-vessel disease. In 74%, complete revascularization was carried out using a mean of 2.97 (range, 1-7) grafts per patient. A mammary artery graft was used in all cases. The in-hospital mortality rate was 0.74%. There were few postoperative complications: 0.98% of patients required further surgery because of bleeding, 3.4% had a significantly elevated troponin-I level, 6.4% developed kidney failure, and 0.5% suffered a stroke.nnnCONCLUSIONSnCoronary artery bypass grafting using MECC enabled complete revascularization to be performed in most patients, and morbidity and mortality rates were low.

Reparación valvular mitral en el curso de una endocarditis infecciosa activa. Estudio de cuatro pacientes

BACKGROUND AND OBJECTIVEnMitral valve (MV) repair is the preferred surgical treatment for degenerative mitral regurgitation (MR). However, questions remain about the efficacy of MV repair when performed for MR caused by infective endocarditis (IE), particularly during its active phase. Although several observational studies have suggested the superiority of MV repair over replacement in patients undergoing surgery for IE, many centres are still opting for valve replacement because of its technical feasibility and reproducibility. In the following document we expose the experience of our hospital.nnnPATIENTS AND METHODnWe present a series of 4 patients who recently underwent surgery for IE during its active phase. Epidemiological and clinical characteristics are discussed.nnnRESULTSnAll patients underwent different MV repair techniques. No relapse or reinfection has been reported. All patients present MR grades 0 or iI/ivIV at follow up.nnnCONCLUSIONSnEven during the active phase of IE, MV repair is a feasible technique with good postoperatory results.

Cirugía reparadora de la insuficiencia mitral degenerativa. Análisis, resultados y seguimiento de 100 pacientes

Introduccion y objetivos La reparacion mitral es el tratamiento de eleccion de la insuficiencia mitral grave degenerativa por prolapso. El objetivo del estudio es analizar los resultados a medio plazo de la cirugia reparadora mitral. Metodos Estudio prospectivo de pacientes con insuficiencia mitral grave degenerativa, por prolapso de uno o dos segmentos valvulares en los que se realizo cirugia reparadora mitral en nuestro centro (2002–2008). Se practico valoracion clinica y ecocardiografica precirugia, en la intervencion y en el seguimiento. Resultados Se intervinieron 100 pacientes (edad media 65xa0±xa012 anos, hombres 66%). El estudio ecocardiografico prequirurgico nos permitio una correcta identificacion de los segmentos valvulares afectos en el 96,3% de los casos. La mortalidad quirurgica fue del 0% y la postoperatoria del 4%. Durante el seguimiento (mediana 31 meses [1–93) hubo una tasa de pacientes libres de reintervencion del 98% al ano y del 96% a los 5 anos. La supervivencia actuarial fue del 94% al ano y del 92% a los 5 anos. Ningun paciente operado en CF I-II requirio reintervencion, siendo la mortalidad hospitalaria y durante el seguimiento de cero. Conclusiones La reparacion valvular mitral se ha mostrado como una tecnica segura y eficaz. Un equipo multidisciplinario permite la correcta identificacion de pacientes candidatos y la aplicacion de las tecnicas quirurgicas adecuadas. A la espera de un mayor seguimiento, los resultados son satisfactorios.

Reparación valvular de la insuficiencia mitral degenerativa. Evolución clínica y ecocardiográfica según el grado de regurgitación residual intraoperatoria

Resumen Introduccion y objetivos La reparacion mitral es adecuada cuando en el control ecocardiografico poscirculacion extracorporea no hay insuficiencia mitral residual o es ligera. Poco se conoce de la evolucion clinica y ecocardiografica de esta insuficiencia mitral ligera residual. El objetivo del estudio era valorar la evolucion clinica y ecocardiografica de los enfermos segun la presencia o no de insuficiencia mitral residual ligera poscirugia. Metodos Estudio prospectivo de pacientes con reparacion mitral por regurgitacion mitral severa degenerativa operados durante el periodo comprendido entre 2002–2010. Resultados Fueron intervenidos 105 pacientes con afectacion de 1 o 2 segmentos segun la clasificacion de Carpentier (edad media 67xa0±xa012 anos, hombres 61%). En 102 casos (97,1%), la reparacion mitral fue adecuada, y en 3 (2,9%) no, sustituyendose la valvula. La mortalidad hospitalaria fue del 2,9% (EuroSCORE logistico 5xa0±xa05,5%). En el ecocardiograma transesofagico en quirofano, de los 102 pacientes reparados satisfactoriamente, 69 no presentaban insuficiencia mitral residual (grupo A) y 33 presentaban una regurgitacion leve (grupo B). Durante el seguimiento [mediana 37 meses (1–105)], la evolucion clinica fue correcta, aunque los pacientes del grupo B evolucionaron peor desde el punto de vista ecocardiografico por recidiva mas precoz de la insuficiencia mitral. Conclusiones La reparacion valvular mitral se ha mostrado como una tecnica segura y eficaz. La ausencia de insuficiencia mitral al final de la reparacion determina una mejor evolucion con minima recidiva durante un seguimiento a medio plazo.

259. Prótesis mecánica on-x conform 25–33 mm: válvula de elección para reemplazo valvular mitral

Las complicaciones tromboembolicas y hemorragicas a largo plazo tras sustitucion valvular mitral con protesis mecanicas han sido comunicadas en la literatura. Sin embargo, existen escasos estudios con la valvula mecanica On-X Conform (MCRI). La protesis mitral On-X Conform tiene un unico tamano (25–33), con un orificio efectivo de 3,73xa0cm2, y se implanta en posicion supraanular (cara auricular). nMaterial y metodos nEntre 2000-2009 se implanto la protesis On-X Conform en posicion mitral en 353 pacientes. Todos los pacientes fueron estudiados retrospectivamente a partir de los registros de la base de datos del servicio de cirugia cardiaca y se realizo un seguimiento via telefonica, visita medica y busquedas en historia clinica. De ese grupo, se analizan 138 pacientes con patologia mitral (±tricuspide) aislada, y con un minimo de 1 ano de seguimiento. El seguimiento fue del 100%, con un seguimiento maximo de 7,66 anos y medio de 4,53 (591,87 patient-years-follow-up). n nTodos los pacientes iniciaron tratamiento anticoagulante con Sintrom® con indice internacional normalizado (INR) diana entre 2,5–3,5 y fueron controlados en su hospital o CAP de referencia (n.o medio controles/ano 10,8). nConclusiones n1) La protesis On-X Conform mitral puede implantarse de forma segura en cualquier paciente que requiera sustitucion valvular mitral; 2) En el seguimiento, las complicaciones relacionadas con la valvula han sido muy bajas, con tasas de tromboembolia del 1% ppy y hemorragia del 0,3% ppy. n n n n nResultados n n nTrombosis 0,5% ppy nTromboembolia 1,01% ppy nHemorragia mayor 0,3% ppy nLeak perivalvular 0,16% ppy nEndocarditis 0,5% ppy nHemolisis 0 nDisfuncion estructural 0 nDisfuncion no estructural 0,16% ppy nReoperaciones relacionada valvula 0,84% ppy nExplantes 0,67% ppy nMuerte subita 0 nMortalidad relacionada valvula 0,33% ppy nMorbilidad y mortalidad total 2,18% ppy n nFull-size table n nTable options n n n nView in workspace n nDownload as CSV