Cirugía de revascularización miocárdica: comparación de supervivencia a 10 años de la cirugía coronaria con y sin circulación extracorpórea mediante Propensity Score Matching / Ten-year survival after off-pump coronary artery bypass grafting compared with traditional bypass grafting

BACKGROUND: Long-term outcomes of Off-Pump Coronary Artery Bypass Grafting (OPCAB) as an alternative to the traditional Coronary Artery Bypass Grafting (CABG) technique with cardiopulmonary bypass (CPB) are not well defined. AIM: To compare 10-year survival of isolated OPCAB versus CABG with CPB. MATERIAL AND METHODS: Analysis of information obtained from databases, clinical records and surgical protocols of patients treated with isolated CABG between January 2006 and November 2008 at a Regional Hospital. Of 658 isolated CABG, 192 (29.2%) were OPCAB and 466 (79.9%) CPB. Propensity Score Matching (PSM) was performed to compare both groups. After PSM, two groups of 192 cases were obtained. Mortality data was obtained from the Chilean public identification service. Ten-year survival was calculated and compared with Kaplan-Meier and log-rank methods. RESULTS: Follow-up data was obtained in all cases. No statistically significant differences were found when comparing 10-year survival between OPCAB versus CPB (78.6% and 80.2% respectively, p 0.720). There was also no statistical difference in cardiovascular death free survival (90.1% with CPB versus 89.1% OPCAB, p 0.737). Survival was comparable when analyzing subgroups with diabetes mellitus, left ventricular dysfunction or chronic kidney disease, among others. CONCLUSIONS: In our series, OPBAB has a comparable 10-year survival with CABG with CPB.

Enfermedad coronaria: factores de riesgo y supervivencia a 10 años en la cirugía coronaria / Risk factors associated with 10-year survival after coronary artery bypass grafting

Background: Coronary artery bypass grafting (CABG) is the treatment of choice for a broad spectrum of patients with coronary disease. Aim: To describe global survival and factors associated with lower long-term survival in patients operated with isolated CABG. Material and Methods: Analysis of a cohort of patients who underwent CABG between January 2006 and December 2008 at a public hospital. The database and operation records of 1.003 cardiac surgeries were reviewed. Of these, an isolated CABG was performed in 658 patients aged 62 ± 9 years including 516 male (78%). Survival data were obtained from the Chilean Civil Registry Office and a complete ten-year follow up was accomplished. Survival was analyzed with Kaplan-Meier method with log-rank test and Cox regression. Results: Operative mortality occurred in 13 patients (2%). Survival at 1, 3, 5 and 10 years was 97, 94, 91 and 76%, respectively. One, 3, 5 and 10-year free of cardiovascular death survival was 98, 97, 95 y 89%, respectively. Factors associated with long-term survival were chronic kidney disease in hemodialysis (Hazard ratio (HR) 7.9; 95% confidence intervals (CI) 4.6-13.6), chronic obstructive pulmonary disease (HR 2.3; 95% CI 1.4-3.7), chronic arterial occlusive disease (HR 2.2; 95% CI 1.4-3.4) and diabetes mellitus (HR 1.9; 95% CI 1.4-2.6). According to EuroSCORE, 10-year survival was 86, 75 and 62% (p < 0.01) in low, medium and high-risk patients, respectively. Conclusions: These patients had a 10-year survival comparable to large international series. Groups associated with lower 10-year survival were identified.

Traumatismo torácico con lesión de grandes vasos del tórax: características, tratamiento y variables asociadas a mortalidad / Thoracic trauma with injury to the great vessels of the chest: characteristics, treatments and variables associated with mortality

Resumen Introducción: Las lesiones de grandes vasos del tórax por traumatismo torácico (TTLGV) son un grupo heterogéneo de lesiones con alta morbimortalidad que constituyen un 0,3-10% de los hallazgos en el traumatismo torácico (TT). Objetivos: Describir características, tratamientos y variables asociadas a mortalidad en pacientes hospitalizados con TTLGV. Material y Métodos: Estudio analítico-observacional. Período enero-1981 y diciembre-2020. Revisión de protocolos de TT prospectivos y fichas clínicas. Se clasificaron los TTLGV según American Association for the Surgery of Trauma (AAST), se calcularon índices de gravedad del traumatismo: Injury Severity Score (ISS), Revised Trauma Score Triage (RTS-T) y Trauma Injury Severity Score (TRISS). Se realizó análisis univariado y multivariado con cálculo de Odds Ratio (OR) para variables asociadas a mortalidad. Se usó SPSS25®, con pruebas UMann Whitney y chi-cuadrado, según corresponda. Resultados: de un total 4.577 TT, 97 (2,1%) cumplieron criterios de inclusión. Hombres: 81 (91,8%), edad promedio: 32,3 ± 14,8 años. TT penetrante: 65 (67,0%). Lesión de arterias axilo-subclavias en 39 (40,2%) y aorta torácica en 31 (32,0%) fueron las más frecuentes. Fueron AAST 5-6: 39 (40,2%). Tratamiento invasivo: 87 (89,7%), de éstos, en 20 (20,6%) reparación endovascular, 14 (14,4%) de aorta torácica. Cirugía abierta en 67 (69,1%). Mortalidad en 13 (13,4%), fueron variables independientes asociadas a mortalidad el shock al ingreso (OR 6,34) e ISS > 25 (OR 6,03). Conclusión: En nuestra serie, los TTLGV fueron más frecuentemente de vasos axilo-subclavios y aorta torácica. El tratamiento fue principalmente invasivo, siendo la cirugía abierta el más frecuente. Se identificaron variables asociadas a mortalidad.

Background: Thoracic great vessel injuries in thoracic trauma (TTGVI) are a heterogeneous group of injuries with high morbimortality that constituting 0.3-10% of the findings in thoracic trauma (TT). Aim: To describe characteristics, treatments and variables associated with mortality in hospitalized patients with TTGVI. Methods: Observational-analytical study. Period January-1981 and December-2020. Review of prospective TT protocols and clinical records. TTGVI were classified according to American Association for the Surgery of Trauma (AAST), trauma severity index were calculated: Injury Severity Score (ISS), Revised Trauma Score Triage (RTS-T) and Trauma Injury Severity Score (TRISS). Univariate and multi- variate analysis was performed with calculation of Odds Ratio (OR) for variables associated with mortality. SPSS25® was used, with U Mann Whitney and chi-squared tests, as appropriate. Results: From a total of 4.577 TT in the period, 97 (2.1%) met the inclusion criteria. Males: 81 (91.8%), mean age: 32.3 ± 14.8 years. Penetrating TT: 65 (67.0%). Axillary-subclavian artery lesions in 39 (40.2%) and thoracic aorta in 31 (32.0%) were more frequent. AAST 5-6: 39 (40.2%). Invasive treatment: 87 (89.7%), of these, in 20 (20.6%) endovascular repair, 14 (14.4%) of thoracic aorta. Open surgery in 67 (69.1%). Mortality in 13 (13.4%), shock on admission was independently associated with mortality (OR 6.34) and ISS > 25 (OR 6.03). Conclusión: In our series, TTGVI were more frequent in axillary-subclavian vessels and thoracic aorta. Treatment was mainly invasive, with open surgery being the most frequent. Variables associated with mortality were identified.

Hidatidosis pulmonar: comparación de los resultados de la cirugía con y sin capitonaje mediante Propensity Score Matching / Pulmonary hydatidosis: comparison results of surgery with capitonnage versus surgery without capitonnage using Propensity Score Matching

Resumen Introducción: El tratamiento de elección del Quiste Hidatídico Pulmonar (QHP) es la resección quirúrgica. Actualmente, existe controversia sobre la superioridad de la cirugía con capitonaje (CC) versus la cirugía sin capitonaje (SC). Objetivo: Comparar los resultados de la cirugía conservadora CC y SC mediante Propensity Score Matching (PSM). Materiales y Método: Se realizó un estudio analítico retrospectivo de los pacientes con QHP tratados quirúrgicamente en el Hospital Guillermo Grant Benavente, Concepción, Chile; entre enero-1995 y diciembre-2018. Se realizó un PSM con una relación 1:1 entre los pacientes operados con la técnica CC y SC. Posterior al PSM se balancearon las características basales. Resultados: Total 205 episodios de QHP en el período. Se realizó cirugía conservadora en 165 casos, 101 CC y 64 SC. Posterior al emparejamiento se obtuvieron 53 pacientes operados CC y 53 SC. No se observaron diferencias significativas en la presencia de fuga aérea persistente (CC = 9,4%; SC = 11,3%, p 0,75), empiema (CC = 3,8%; SC = 0%, p 0,49), días con pleurotomía (CC = 9,1 ± 8,9; SC 10,1 ± 10,7, p 0,39, mediana 6 versus 6 días, respectivamente), ni días de estadía posoperatoria (CC = 10,4 ± 9,0; SC = 11,7 ± 11,9, p 0,22, mediana 7 versus 7 días, respectivamente). Conclusiones: La cirugía SC demostró resultados comparables a la técnica CC en el tratamiento quirúrgico conservador del QHP.

Background: The treatment of choice for Pulmonary Hydatid Cys (PHC) is surgical resection. There is currently controversy about the superiority of surgery with capitonage (SC) versus surgery without it (SWC). Aim: To compare the results of conservative surgery with capitonnage and versus surgery without capitonnage using Propensity Score Matching (PSM). Materials and Method: A retrospective analytical study was carried out with patients with PHC treated surgically at the Guillermo Grant Benavente Hospital, Concepción, Chile, between January-1995 and December-2018. A PSM was performed with a 1:1 ratio. Results: Conservative surgery was done in 165 cases, 101 SC and 64 SWC. After matching, 53 SC and 53 SWC operated patients were obtained. No significant differences were observed in the presence of persistent air leak (9.4% vs11.3%, SC vs SWC respectively, p 0.75), empyema (3.8% vs 0%, p 0.49), days with pleurotomy (9.1 ± 8.9 vs 10.1 ± 10.7, p 0.39), nor days of postoperative stay (10.4 ± 9.0 vs 11.7 ± 11.9, p 0.22). Conclusión: The SWC demonstrated comparable results to the SC technique in the conservative surgical treatment of PHC.

Cirugías por traumatismo torácico: caracterización y variables asociadas a mortalidad / Thoracic trauma surgery: indications, findings and mortality associated variables

Resumen Introducción: El traumatismo torácico (TT) es la causa de aproximadamente un cuarto de las muertes por traumatismos. Los pacientes tratados con cirugía por traumatismo torácico (CTT) presentan un amplio espectro de características y pronósticos. Objetivos: Describir características clínicas, indicaciones, temporalidad, morbilidad, mortalidad y las variables asociadas a mortalidad en pacientes con CTT. Materiales y Método: Estudio observacional de pacientes tratados con CTT, período enero-1981 a diciembre-2019. Revisión de protocolos prospectivos de TT y base de datos. Se realizó regresión logística para variables asociadas a mortalidad. Se utilizó SPSS25® con prueba chi-cuadrado para comparar clasificación, tipo de TT y su distribución temporal, considerando significativo p < 0,05. Resultados: En total 808 casos (18,2%) de 4.448 TT requirieron CTT. Fueron hombres 767 (94,9%) y la edad promedio fue 31,5 ± 13,8 años. El traumatismo fue penetrante y por arma blanca en la mayoría de los casos. Fueron politraumatizados 164 (20,3%). La cirugía fue urgente en 474 (58,7%), precoz en 41 (5,0%) y diferida en 293 (36,3%) casos. La mortalidad global fue de 6,7% y fue significativamente mayor en TT contusos, politraumatizados y en cirugía urgente. La mortalidad fue 9,7% en CTT urgente, 4,9% en precoz y 2,0% en diferida (p < 0,001). Se observaron variables independientes asociadas a mortalidad. Conclusión: En nuestra serie, las CTT se realizaron principalmente en hombres jóvenes con TT penetrantes. Correspondieron a un grupo heterogéneo en cuanto a las indicaciones, hallazgos y lesiones intratorácicas y/o asociadas. Múltiples variables demostraron influir significativamente en la mortalidad de los pacientes tratados con CTT.

Background: Thoracic Trauma (TT) is the cause of approximately a quarter of trauma deaths. The patients who undergo Thoracic Trauma Surgery (TTS) present a wide spectrum of characteristics and prognosis. Aim: To describe clinical characteristics, indications, temporality, morbidity, mortality and mortality associated variables in TTS patients. Materials and Method: Observational study of TT hospitalized patients, period January-1981 to December-2019. A review of operation notes and database was done. A logistic regression for mortality associated variables was made. To compare classification, type of TT and its temporal distribution, SPSS25® with chi-square test was used, considering significant p < 0.05. Results: A total of 808 (18.2%) of 4.448 TT patients required TTS, 767 (94.9%) were men with average age: 31.5 ± 13.8. The trauma was penetrating trauma due to a stab in most cases, 164 (20.3%) were polytraumatized. The surgery was urgent in 474 (58.7%), early in 41 (5.0%) and delayed in 293 (36.3%) cases. The global mortality was 6.7% and was significantly higher in the blunt TT, polytrauma, urgent and early surgery patients. Mortality in urgent TTS was 9.7%, early 4.9% and 2.0% in delayed (p < 0.001). Independent variables associated with mortality were observed. Conclusions: In our series, TTS were performed mainly in young men with penetrating TT. The group was heterogeneous regarding surgical indications, findings and intrathoracic or associated injuries. Multiple variables showed to influence significantly on mortality in patients who underwent TTS.

Cáncer pulmonar: caracterización, estadificación y supervivencia en una cohorte de una década en un hospital del sistema público de salud de Chile / Lung cancer at a Chilean public hospital

Background: Lung cancer is the world's leading cause of cancer death. Aim: To describe the clinical, staging and survival characteristics of lung cancer in a public Chilean regional hospital. Material and Methods: Analysis of a prospective database of a thoracic surgery service, retrieving histologically confirmed lung cancer cases from January 2010 to December 2019 and reviewing their medical records. Cases were re-staged by the TNM-8 system and variables were compared between periods 2010-2014 and 2015-2019. Results: We retrieved 551 lung cancer cases, 333 (60 %) men, with a mean age of 65 years. Distant metastases were found in 72% of cases (excluding lymphatic metastases). Of the non-small cell lung cancers (NSCLC), 50 (10%) cases were in stage I, 18 (4%) in stage II, 81 (16%) in stage III and 347 (70%) in stage IV. Global five-year survival was 18%, 20% for NSCLC, 71% for excised NSCLC, 8% for non-excised NSCLC, 88% for stage I and 92% for subgroup IA. Resective surgery was performed in 81 (14%) cases. When comparing 2010-2014 and 2015-2019 periods, the frequency of resective surgery increased from 7% to 20%. Conclusions: The diagnosis of lung cancer was frequently made in advanced stages. There was a significant increase in early diagnosis and frequency of surgeries with curative intent in the second observation period.

Reconstrucción de válvula aórtica con pericardio autólogo según técnica de Ozaki

Prosthetic valve replacement is the standard treatment for aortic valvulopathy. Due to the structural valve deterioration of biological prosthesis and the anticoagulation requirements of mechanical valves, the repair of aortic valve disease is receiving more attention in recent years. The Ozaki technique consists in the reconstruction of a trileaflet valve using autologous pericardium. We report our first two cases of successful reconstruction of the aortic valve using this technique with 12-month echocardiographic and 24-month clinical follow up.

Mortalidad en hospitalizados con traumatismo torácico: variables asociadas, causas y distribución temporal / Associated variables, causes and time distribution of mortality in thoracic trauma patients

Resumen Introducción: Los traumatismos están entre las diez principales causas de muerte a nivel mundial y son la primera en jóvenes. El traumatismo torácico (TT) está presente en un alto porcentaje de las muertes por traumatismos y es la segunda causa de muerte después del traumatismo encefalocraneano. Objetivos: Analizar las variables asociadas a mortalidad, las causas principales y la distribución temporal de la mortalidad en hospitalizados fallecidos con TT. Materiales y Método: Estudio observacional de hospitalizados con TT, período enero de 1981 a diciembre de 2018. Revisión de protocolos prospectivos de TT y base de datos. Se consignaron las causas de muerte sindromáticas principales y se realizó una regresión logística para variables asociadas a mortalidad. Se utilizó SPSS25® con pruebas chi-cuadrado para comparar clasificación, tipo de TT y su distribución temporal, considerando significativo p < 0,05. Resultados: Total 4.297 TT, mortalidad global de 120 (2,8%) casos. Las principales variables independientes asociadas a mortalidad fueron el deterioro fisiológico al ingreso, el hemotórax masivo y el TT por arma de fuego. La principal causa de muerte fue el shock hipovolémico, con diferencias significativas según tipo de TT en las primeras 4 y 24 horas. En la distribución temporal se observó que las muertes con TT penetrante y aislado fueron más precoces y no se evidenció un nuevo peak en la mortalidad luego de la primera semana. Conclusiones: Se observaron variables independientes asociadas a mortalidad en hospitalizados con TT, siendo el deterioro fisiológico al ingreso el factor más importante. Además, existen diferencias significativas en las causas de muerte y distribución temporal de la mortalidad entre diferentes subgrupos de hospitalizados con TT.

Background: Trauma is one of the ten leading causes of death worldwide and the first among the youth. Thoracic trauma (TT) is present in a high percentage of deaths due to trauma and is the second leading cause of death after traumatic brain injury. Aim: To analyze the mortality associated variables, major causes and temporal distribution of mortality among dead hospitalized patients with TT. Materials and Method: Observational study in hospitalized patients with TT, period January 1981 to December 2018. Review of prospective TT protocols and data base. Major syndromic causes of death were recorded and a logistic regression for variables associated with mortality was made. SPSS25® with chi-quadrat tests was used to compare classification, type of TT and temporal distribution. A p value < 0,05 was considered significant. Results: Total 4.297 TT and global mortality was 120 (2,8%) cases. The main independent variables associated with mortality were the physiological decline upon admission, massive hemothorax and TT by firearms. The leading cause of death was hypovolemic shock, with significant differences according to the type of TT in the first 4 and 24 hours. In the temporal distribution was observed that, the deaths with penetrating and isolated TT were earlier and that there was no second peak of mortality following the first week. Conclusions: Independent variables associated with mortality were observed among hospitalized patients with TT, being physiological deterioration the most important factor. Besides, there are significant differences in the death causes and temporal distribution of mortality among the different subgroups of hospitalized patients with TT.

Traumatismo torácico: análisis de hospitalizaciones según grupo etario / Thoracic trauma: analysis of hospitalizations among different age-groups

Resumen Introducción: El traumatismo es la primera causa de muerte en adolescentes y la quinta en el adulto mayor. El traumatismo torácico (TT) posee características particulares en diferentes grupos de edad. Objetivos: Analizar características clínicas, índice de gravedad de traumatismo (IGT) y mortalidad en hospitalizados por TT según grupo etario. Materiales y Método: Estudio descriptivo de hospitalizaciones por TT, período enero de 1981 a diciembre de 2018. Revisión de protocolos prospectivos de TT y base de datos. Se definió grupo etario según Organización Mundial de la Salud (Adolescente: 10-19 años; Adulto Joven: 20-44 años; Adulto Maduro 45-59 años; Adulto Mayor: ≥ 60 años). Se comparó clasificación, mecanismo, agente, tratamiento, IGT, Trauma Injury Severity Score (TRISS) y mortalidad del TT según grupo etario. Se utilizó SPSS25® con pruebas chi-cuadrado y ANOVA, considerando significativo p < 0,05. Resultados: Total 4.297 TT. Grupo etario Adolescente: 608 (14,1%); Adulto Joven: 2.544 (59,2%); Adulto Maduro: 601 (14,0%); Adulto Mayor: 544 (12,7%). Se observó disminución progresiva y significativa en TT penetrante, por agresión y del TT por arma blanca desde grupo etario Adolescente hasta Adulto Mayor. En Adulto Joven predominó tratamiento invasivo: cirugía 541 (21,2%) y en Adulto Maduro el TT con lesiones asociadas 215 (35,8%), p < 0,05. Según grupo etario, se observaron diferencias significativas en TRISS y en mortalidad. La mortalidad fue 1,6%; 2,5%; 3,3%; 5,0%, según grupo etario respectivamente (p < 0,05). Conclusiones: Existen diferencias estadísticamente significativas en las características clínicas, IGT y mortalidad del TT al comparar distintos grupos etarios. La edad es uno de los factores que determina el pronóstico de pacientes hospitalizados por TT.

Background: Trauma is the leading death cause among adolescents and the fifth in the elderly. Thoracic trauma (TT) has particular characteristics in different age-groups. Aim: To analyze clinical characteristics, trauma severity indices (TSI) and mortality in patients hospitalized for TT among different age-groups. Materials and Method: Descriptive study of patients hospitalized for TT between January-1981 and December-2018. Prospective TT surgical operation notes and data base were reviewed. Age-groups were determined according to the World Health Organization (Adolescent: 10-19 years; Young Adult: 20-44 years; Mature Adult: 45-59 years; Elderly > 60 years). TT classification, mechanism, agent, treatment, TSI, Trauma Injury Severity Score (TRISS) and mortality were compared among age-groups. SPSS25® with chi-square test and ANOVA were used, considering p < 0.05 significant. Results: Total 4.297 TT. Adolescent age-group: 608 (14.1%); Young Adult: 2,544 (59.2%); Mature Adult: 601 (14.0%); Elderly: 544 (12.7%). Was observed a progressive and significant decrease of penetrating TT, aggression-caused and bladed weapon-caused TT from Adolescent to Elderly. In Young Adult the invasive treatment predominant: surgery 541 (21.2%), whereas in Mature Adult TT with associated injuries 215 (35.8%), p < 0.05. Differences in TRISS and mortality 1.6%; 2.5%; 3.4%; 5.0% (p < 0.05) were observed among age-groups, respectively. Conclusions: There are statistical significant differences in clinical characteristics, TSI and mortality when comparing TT by age group. Age is an important factor determining the outcome in TT hospitalized patients.

Evolución del traumatismo penetrante cardíaco operado / Penetrating cardiac injury: evolution of characteristics, severity and mortality in surgery treated patients

Resumen Introducción: El traumatismo penetrante cardíaco (TPC) es una lesión poco frecuente y con alta morbilidad y mortalidad. Objetivo: Analizar la evolución de características clínicas, anatómicas, gravedad, morbilidad y mortalidad de pacientes operados por TPC. Materiales y Métodos: Estudio analítico de pacientes tratados quirúrgicamente por TPC en Hospital Clínico Regional "Dr. Guillermo Grant Benavente", Concepción, Chile. Se analizaron los periodos: enero-1990 a diciembre-2004 y enero-2005 a diciembre-2019. Se comparó: sexo, edad, lesiones asociadas, agente y mecanismo del traumatismo, comportamiento fisiopatológico, ubicación anatómica de la lesión, clasificaciones del traumatismo cardíaco Attar, Saadia y OIS-AAST, IGT (índices de gravedad del traumatismo): ISS, RTS-T y TRISS, morbilidad y mortalidad según periodos. Se realizó análisis estadístico con SPSS25®, se utilizaron las pruebas chi-cuadrado, exacta de Fisher y Mann-Whitney. Se consideró significativo un valor p < 0,05. Resultados: Total 235 TPC, 112 en el primer periodo y 123 en el segundo. Mecanismo arma blanca en 96 (85,7%) y 104 (84,6%) según periodos. En el segundo periodo se observó un aumento de lesiones extratorácicas asociadas, paro cardiorrespiratorio y lesión de ubicación izquierda. Las clasificaciones del traumatismo cardíaco y los IGT ISS, RTS-T y TRISS mostraron mayor gravedad y probabilidad de muerte en los pacientes del segundo periodo. La mortalidad no mostró diferencias: 14 (12,5%) y 14 (11,4%) según periodos (p = 0,792). Discusión: En nuestra serie los pacientes tratados por TPC han evolucionado hacia un perfil de mayor gravedad tanto en parámetros fisiológicos como anatómicos. La mortalidad se ha mantenido estable a través del tiempo.

Background: Penetrating cardiac injury (PCI) is a rare injury with high morbidity and mortality. Aim: To analyze the evolution of clinical and anatomical characteristics, severity, morbidity and mortality of patients operated on by PCI. Materials and Methods: Analytical study of patients surgically treated for PCI at the "Guillermo Grant Benavente" Regional Clinical Hospital, Concepción, Chile. Two periods were analyzed: January-1990 to December-2004 and January-2005 to December-2019. Sex, age, associated injuries, trauma agent and mechanism, pathophysiological behavior, anatomic location of the injury, classifications of cardiac trauma: Attar, Saadia and OIS-AAST, TSI (trauma severity indices): ISS, RTS-T and TRISS, morbidity and mortality were compared according to periods. Statistical analysis was performed with SPSS25®, the chi-square, Fisher exact and Mann-Whitney tests were used. A p value < 0.05 was considered significant. Results: Total 235 PCI, 112 in the first period and 123 in the second. Stab as mechanism in 96 (85.7%) and 104 (84.6%) according to periods. An increase in associated extra thoracic injuries, cardiorespiratory arrest, and injury to the left location were observed in the second period. The cardiac trauma classifications and the TSI ISS, RTS-T and TRISS showed greater severity and probability of death in the second period patients. Mortality did not show differences: 14 (12.5%) and 14 (11.4%) according to periods, p = 0.792. Discussion: In our series, patients treated with PCI have evolved towards a more severity profile in both, physiological and anatomical parameters. Mortality has been stable over time.

Secuestro pulmonar: caracterización y tratamiento en pacientes adultos y pediátricos / Pulmonary sequestration: characteristics and treatment in adult and pediatric patients

Resumen Introducción: El secuestro pulmonar (SP) es una malformación congénita caracterizada por tejido pulmonar con vascularización de una arteria sistémica anómala. Objetivo: Analizar las características y tratamiento de pacientes adultos y pediátricos con secuestro pulmonar. Materiales y Método: Estudio descriptivo transversal. Periodo: enero de 1988 a diciembre de 2018. La información se obtuvo de fichas clínicas y registros de anatomía patológica. Se describen edad, sexo, características clínicas, diagnóstico, tratamiento quirúrgico y hallazgos anatomopatológicos. Se realizó análisis estadístico mediante SPSS25® y se usó la prueba Mann-Whitney y X2, considerándose significativo p < 0,05. Resultados: Total 33 pacientes, 25 (75,8%) mujeres. Edad promedio 30,2 años, rango: 0-68. Adultos 23 (69,7%) pacientes y pediátricos (< 15 años) 10 (30,3%) pacientes. La presentación clínica fue sintomatología pulmonar en 23 (69,7%) casos y 9 (27,3%) eran asintomáticos. Tres (9,1%) presentaron malformación congénita asociada. Diagnóstico preoperatorio en 15 (45,5%) pacientes. La ubicación más frecuente fue lóbulo inferior izquierdo. El tipo intralobar fue el más frecuente en 23 (69,7%) casos. La cirugía más frecuente fue la lobectomía con identificación y ligadura del vaso sistémico. El vaso aberrante se originó en aorta torácica en 27 (81,8%) casos e infradiafragmático (no precisado) en 3 (9,1%) casos. Vaso único en 26 (78,8%) y doble en 5 (15,2%) casos. No hubo mortalidad. Existen diferencias en las características entre los secuestros en pacientes adultos y pediátricos. Discusión y Conclusión: Los SP son infrecuentes, se presentan principalmente en adultos jóvenes como neumopatías a repetición, se distinguen diferencias en las características entre los pacientes adultos y pediátricos, y tienen excelente pronóstico posoperatorio.

Background: Pulmonary sequestration (PS) is a congenital malformation characterized by lung tissue with vascularization from anomalous systemic arteries. Aim: To analyze characteristics and treatment of adult and pediatric patients with pulmonary sequestration. Materials and Method: Transversal descriptive study. Period: January-1988 to December-2018. Information was obtained from clinical files and pathological anatomy records. Age, sex, clinical characteristics, diagnosis, surgical treatment and pathological findings are described. Statistical analysis was performed using SPSS25® and the Mann-Whitney and Chi square test were used, considering p < 0.05 to be significant. Results: Total 33 patients, 25 (75.8%) women. Average age 30.2 years, range: 0-68. Adults 23 (69.7%) patients and pediatric (< 15 years) 10 (30.3%) patients. The clinical presentation was pulmonary symptoms in 23 (69.7%) cases and 9 (27.3%) were asymptomatic. Three (9.1%) presented another congenital malformation. Preoperative diagnosis in 15 (48.4%) patients. The most frequent location was the left lower lobe. The intralobar type was the most frequent: 23 (69.7%) cases. The most frequent surgery was lobectomy with identification and ligation of the systemic vessel. The systemic vessel originated in the thoracic aorta in 27 (81.8%) cases and infradiaphragmatic (not specified) in 3 (9.1%) cases. Single vessel in 26 (78.8%) and double in 5 (15.2%) cases. There was no mortality. Differences were found in characteristics between adult and pediatric patients. Conclusion: SP are infrequent, they mostly appear in young adults as recurrent lung diseases, differences in characteristics are distinguished between adult and pediatric patients and they have an excellent postoperative prognosis.

Hemotórax masivo por traumatismo torácico en pacientes tratados quirúrgicamente / Massive hemothorax by thoracic trauma in surgically treated patients

Resumen Introducción: El hemotórax masivo (HM) se puede definir como el acúmulo súbito de ≥ 1.500 ml de sangre en la cavidad pleural o débito ≥ 200 ml/h de sangre en 3-4 h por pleurotomía; es considerada una complicación traumática grave. Objetivo: Describir las características clínicas, índices de gravedad de traumatismo (IGT), morbilidad y variables asociadas a mortalidad en pacientes con hemotórax masivo por traumatismo torácico operados (HMTT). Materiales y Método: Estudio analítico longitudinal. Período enero de 1981 a diciembre de 2018. Revisión prospectiva de base de datos, protocolos quirúrgicos y fichas clínicas. Descripción de características de HMTT. Se calcularon IGT: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Para mortalidad se realizó análisis univariado con cálculo de Odds Ratio. Resultados: Total 4.306 traumatismos torácicos (TT), HMTT 119 (2,8%). Hombres 112 (94,1%), edad promedio 32 ± 13,2 años, 91 (76,5%) pacientes presentaron TT aislado, 28 (23,5%) asociado a lesiones extratorácicas, de estos, 23 (19,3%) fueron politraumatismos. Fueron traumatismos penetrantes 102 (85,7%). El HMTT se atribuyó principalmente a: lesión de pared en 38 (31,9%) y lesión pulmonar en 29 (24,4%). De las cirugías torácicas: 87 (73,1%) fueron urgentes (≤ 4 h), 10 (8,4%) precoces (> 4-24 h) y 22 (18,5%) diferidas (> 24 h). Hospitalización postoperatoria promedio 7,9 ± 6,4 días. Según IGT: ISS promedio 17,4 ± 9,6, RTS-T promedio 10,2 ± 2,7, TRISS promedio 12,7. Morbilidad 46 (38,7%) y mortalidad 15 (12,6%). Discusión: Los HMTT se atribuyeron principalmente a lesiones de pared y lesión pulmonar. En la mayoría se requirió cirugía torácica de urgencia. La mortalidad observada es semejante a la esperada según IGT. Existen variables asociadas a mayor mortalidad.

Introduction: Massive hemothorax (MH) can be defined as the sudden accumulation of ≥ 1500 ml of blood in the pleural cavity or debit ≥ 200 ml/h in 3-4 hours through pleurostomy, and it is considered a serious complication. Aim: To describe features, trauma severity indexes (TSI), morbidity and variables associated with mortality in patients with traumatic MH who required surgical treatment. Materials and Method: analytical longitudinal study. Period January 1981 to December 2018. Database, surgical protocols, medical records review. Description of MH characteristics. The following TSI were calculated: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). An Odds Ratio univariate analysis was used for mortality. Results: Total 4306 TT, operated MH 119 (2.8%). Men were 112 (94.1%), average age 32 ± 13.2 years, 91 (76.5%) had isolated TT, 28 (23.5%) were associated with extrathoracic injuries and of these 23 (19.3%) were polytraumatized patients. Penetrating TT was 102 (85.7%). MH was mainly attributed to: chest wall injury in 38 (31.9%), pulmonary lacerations 29 (24.4%). Of the thoracic surgeries: 87 (73.1%) were urgent (≤ 4 h), 10 (8.4%) early (> 4-24 h) and 22 (18.5%) deferred (> 24 h). Average post operatory stay (days): 7.9 ± 6.4 According to TSI: average ISS 17.4 ± 9.6; RTS-T average 10.2 ± 2.7; TRISS average 12.7. Morbidity 46 (38.7%). Mortality 15 (12.6%). Discussion: MH is mainly attributed to chest wall injuries and pulmonary lacerations. Most of HM required urgent thoracic surgery. The observed mortality is similar to that expected one by TSI. There are variables associated with higher mortality in MH.

Traumatismo torácico por arma de fuego / Thoracic trauma by firearms

Resumen Introducción: Los traumatismos torácicos por armas de fuego (TTAF) son cada vez más frecuentes. Objetivos: Describir características clínicas, morbilidad, mortalidad y la evolución a través del tiempo de hospitalizados por TTAF. Materiales y Método: Estudio analítico longitudinal. Período enero de 1981-diciembre de 2018. Revisión base de datos, protocolos prospectivos y fichas clínicas. Se utilizó planilla Microsoft Excel® y programa SPSS24® con chi cuadrado y de Mann-Whitney. Descripción de características de TTAF en pacientes hospitalizados y comparación por períodos. Se calcularon índices de gravedad del traumatismo (IGT): Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Resultados: Total 4.306 pacientes hospitalizados por traumatismo torácico (TT), 205 (4,8%) hospitalizados por TTAF. Hombres: 188 (91,7%), edad promedio 28,8 ± 11,2 años, TTAF aislado 115 (56,1%), asociado a lesiones extratorácicas 90 (43,9%), de estos 55 (26,8%) se consideraron politraumatismos. Mecanismo: Agresión 193 (94,1%), autoagresión 11 (5,4%) y accidental 1 (0,5%). Lesiones y/o hallazgos torácicos más frecuentes: Hemotórax 127 (62,0%), neumotórax 96 (46,8%) y contusión pulmonar 51 (24,9%). Tratamiento definitivo: Pleurotomía 88 (42,9%), cirugía 71 (34,6%) y tratamiento médico 46 (22,4%). Mediana de hospitalización 7 días. Según IGT: ISS promedio 16,7 ± 11,7, RTS-T promedio 11,1 ± 2,1, TRISS promedio 9,6. Morbilidad: 44 (21,5%). Mortalidad: 14 (6,8%). En los diferentes períodos, se observó aumento de politraumatismos y TRISS, sin cambios en mortalidad. Discusión: La mayoría de los TTAF fueron aislados. Aproximadamente un tercio de los pacientes requirió cirugía. La mortalidad observada es menor a la esperada. Se observan cambios en los TTAF a través del tiempo.

Background: Thoracic trauma by firearms (TTF) are increasingly frequent. Aim: To describe clinical characteristics, morbidity and mortality and the evolution over time of patients hospitalized due TTF. Materials and Method: Longitudinal analytical study. Period January 1981 - December 2018. Database review, prospective protocols and clinical files. Microsoft Excel® spreadsheet and SPSS24® program with chi square and Mann-Whitney tests were used. Description of characteristics of TTF in hospitalized patients and comparison of TTF by periods. Trauma severity indexes (TSI) were calculated: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Results: Total: 4306 hospitalized patients due thoracic trauma (TT), 205 (4.8%) hospitalized due TTF. Men: 188 (91.7%), average age 28.8 ± 11.2 years, isolated TTF 115 (56.1%), associated with extrathoracic lesions 90 (43.9%), and of these 55 (26.8%) were considered polytraumatism. Mechanisms: aggression 193 (94.1%), self-harm 11 (5.4%) and accidental 1 (0.5%). Frequent thoracic injuries and/or findings: hemothorax 127 (62.0%), pneumothorax 96 (46.8%) and pulmonary contusion 51 (24.9%). Definitive treatment: Pleurotomy 88 (42.9%), surgery 71 (34.6%) and medical treatment 46 (22.4%). Median hospitalization 7 days. According TSI: Average ISS 16.7 ± 11.7, average RTS-T 11.1 ± 2.1, average TRISS 9.6. Morbidity: 44 (21.5%). Mortality: 14 (6.8%). There is an increase in polytraumatism and average TRISS, without changes in mortality. Discussion: The majority of TTF were isolated TT. Approximately one third of patients required surgery. The observed mortality is lower than expected. Changes in TTF were observed over time.

Hidatidosis pulmonar: hallazgos y tratamiento quirúrgico en quistes complicados versus no complicados / Pulmonary hydatidosis: findings and surgical treatment in complicated versus uncomplicated cysts

Resumen Introducción: La hidatidosis humana es una zoonosis prevalente en nuestro medio, causada principalmente por el parásito Echinococcus granulosus. Las complicaciones más frecuentes en el pulmón son la rotura y la infección del quiste. Objetivos: Describir y comparar características clínicas, tratamiento, morbilidad y mortalidad de los pacientes hospitalizados por quiste hidatídico pulmonar (QHP) complicado versus no complicado. Materiales y Método: Estudio analítico longitudinal. Período enero de 1973 - diciembre de 2017 en Hospital Clínico Regional de Concepción "Dr. Guillermo Grant Benavente", Chile. Revisión de base de datos, protocolos de QHP y fichas clínicas. Se utilizó planilla Microsoft Excel® y programa SPSS24®, con función chi cuadrado y t de Student. Se consideró significativo p < 0,05. Resultados: Total 364 episodios de QHP, complicados 179 (49,2%) versus no complicados 185 (50,8%). Edad promedio 36,4 ± 18,9 versus 32,4 ± 19,1 años, hombres 114 (63,7%) versus 107 (57,8%), respectivamente. Se encontró diferencia estadísticamente significativa en: sintomatología tos 147 (82,1%) versus 120 (64,9%), hemoptisis 93 (52,0%) versus 45 (24,3%), respectivamente; QHP derecho 115 (64,2%) versus 99 (53,5%), respectivamente; cirugía conservadora 139 (77,7%) versus 167 (90,3%), reoperaciones 22 (12,3%) versus 8 (4,3%), respectivamente; morbilidad 47 (26,3%) versus 30 (16,2%), mortalidad 6 (3,4%) versus 0 (0%), estadía hospitalaria postoperatoria promedio 16,1 ± 14,3 versus 10,7 ± 7,7 días, recidivas 15 (8,4%) versus 13 (7,0%), respectivamente. Discusión: Aproximadamente la mitad de los QHP son complicados. Los QHP complicados presentan diferencias estadísticamente significativas en su clínica, tratamiento, morbilidad, mortalidad y estadía hospitalaria postoperatoria.

Background: Human hydatidosis is a prevalent zoonosis in our environment, caused mainly by the Echinococcus granulosus parasite. The most common complications in the lung are cyst rupture and infection. Aim: To describe and compare clinical characteristics, treatment, morbidity and mortality of patients hospitalized for complicated versus uncomplicated hydatid pulmonary cyst (HPC). Materials and Method: Longitudinal analytical study. Period January 1973 - December 2017 at the Regional Clinical Hospital of Concepción "Dr. Guillermo Grant Benavente", Chile. Database, prospective protocols and medical records were reviewed. Microsoft Excel® spreadsheet and SPSS24® program with chi square and Student's t-test were used. It was considered significant p < 0.05. Results: Total 364 episodes of HPC, complicated 179 (49.2%) versus uncomplicated 185 (50.8%). Average age 36.4 ± 18.9 versus 32.4 ± 19.1 years, male 114 (63.7%) versus 107 (57.8%), respectively. A statistically significant difference was found in: symptomatology cough 147 (82.1%) versus 120 (64.9%), hemoptysis 93 (52.0%) versus 45 (24.3%), respectively; HPC right 115 (64.2%) versus 99 (53.5%), respectively; resective cyst surgery 139 (77.7%) versus 167 (90.3%), reoperation 22 (12.3%) versus 8 (4.3%), respectively; morbidity 47 (26.3%) versus 30 (16.2%), mortality 6 (3.4%) versus 0 (0%), average postoperative hospital stay 16.1 ± 14.3 versus 10.7 ± 7.7 days, recurrence 15 (8.4%) versus 13 (7.0%), respectively. Conclusions: Approximately half of the HPCs are complicated. Complicated HPCs present statistically significant differences in their clinical, treatment, morbidity, mortality and postoperative hospital stay.

Hidatidosis pulmonar: características, manifestaciones clínicas y tratamiento en pacientes hospitalizados en Concepción, Región del Biobío, Chile / Features of pulmonary hydatidosis in 368 patients admitted to a regional hospital

Background: Lungs are the second location in frequency of hydatidosis or cystic echinococcosis. Aim: To characterize the clinical manifestations, diagnosis, findings and treatment of patients hospitalized for a pulmonary hydatid cyst (PHC). Materials and Methods: Review of databases, medical records, operation notes and death certificates of patients admitted to a Chilean regional hospital with a PHC. Results: Four hundred twenty-nine cases were identified and complete data was obtained from 368 patients aged 34 ± 19 years, 224 (60,9%)men. The most common clinical manifestations were cough in 269 (73%) and chest pain in 217 (59%). The most frequent locations were the right lung in 210 (57%) and lower lobes in 218 (59%). One hundred eighty-seven cysts (51%) were complicated. Conservative surgery (cystectomy) was performed in 308 (84%). Postoperative morbidity was observed in 77 (21%) and mortality in 6 (2%) patients. Recurrence was observed in 28 (8%) patients. There was a significant reduction in morbidity, mortality, reoperations, and postoperative days over time. Conclusions: In these patients, pulmonary hydatidosis was diagnosed mainly during working ages and half of patients had a complicated cyst.

Traumatismo torácico en el adulto mayor / Thoracic trauma in the elderly

Resumen Introducción: Los traumatismos constituyen la quinta causa de muerte en el adulto mayor (60 años o más), siendo los traumatismos contusos los más frecuentes. Objetivo: Describir características, índices de gravedad de traumatismo (IGT), morbilidad y mortalidad en adultos mayores (AM) hospitalizados con traumatismo torácico (TT). Materiales y Método: Estudio descriptivo transversal. Período desde enero de 1981 a diciembre de 2017. Revisión de base de datos, protocolos quirúrgicos y fichas clínicas. Descripción de características de TT en AM hospitalizados. Se calculó IGT: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Resultados: Total 4.163 TT, AM 513 (12,3%). Hombres: 350 (68,2%), edad promedio 71,2 ± 8,4 años, mediana 70 (rango: 60-103), TT aislado 350 (68,2%), asociado a lesiones extratorácicas 163 (31,8%) y de estos 96 (18,7%) se consideraron politraumatismos. Traumatismo contuso 456 (88,9%) y penetrante 57 (11,1%). La causa más frecuente fueron las caídas en 252 (49,1%). Lesiones y/o hallazgos torácicos más frecuentes: fracturas costales 409 (79,7%), hemotórax 186 (36,3%) y neumotórax 185 (36,1%). Tratamiento definitivo: médico 287 (55,9%), pleurotomía 193 (37,6%) y cirugía 40 (7,8%). Cirugía extratorácica 33 (6,4%). Hospitalización promedio 9,0 ± 8,8 días. Según IGT: ISS promedio 12,1 ± 9,6, RTS-T promedio 11,6 ± 1,3, TRISS promedio 8,1. Morbilidad 76 (14,8%) y mortalidad 26 (5,1%). Discusión: La mayoría de los TT en AM son contusos, causados por accidentes domésticos. Las lesiones y hallazgos más frecuentes fueron fracturas costales y hemotórax. La mortalidad fue menor a la esperada según IGT.

Introduction: Trauma is the fifth leading cause of death in the elderly (60 or older), with blunt trauma being the most frequent. Objective: To describe characteristics, Trauma Severity Indices (TSI) and morbidity and mortality in hospitalized elderly for Thoracic Trauma (TT). Materials and Method: Crosssectional descriptive study was carried out. Term: from January 1981 to December 2017. Database review, surgical protocols and medical records were performed. TT description of characteristics was conducted in hospitalized elderly. TSI was calculated: Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). Results: Total 4.163 TT, 513 elderly (12.3%). Men: 350 (68.2%), average age 71.2 ± 8.4 years, 70 median (range 60-103). Isolated TT: 350 (68.2%), 163 associated with extrathoracic trauma (31.8%) and of these 96 (18.7%) were considered polytraumatism. Blunt trauma 456 (88.9%) and penetrating 57 (11.1%). Most frequent domestic accident mechanism was 196 (38.2%) and 158 traffic accidents (30.8%). Frequently thoracic injuries or findings: 409 rib fractures (79.7%), 186 hemothorax (36.3%), and 185 pneumothorax (36.1%). Final treatment: 287 Medical treatment (55.9%), 193 pleurotomy (37.6%), and 40 thoracic surgery (7.8%). Extrathoracic surgery 33 (6.4%). Average hospitalization: 9.0 ± 8.8 days. According IGT: ISS 12.1 ± 9.6, RTS-T 11.6 ± 1.3, TRISS 8.1. Morbidity: 76 (14.8%) and mortality: 26 (5.1%). Discussion: Most TT in elderly are blunt, caused by domestic accidents. Injuries and most frequent findings were rib fractures and hemothorax. Mortality was lower than expected according to TSI.

Traumatismo torácico por arma blanca / Thoracic trauma by a bladed weapon

Resumen Objetivos Describir las características, índices de gravedad de traumatismo (IGT), morbilidad, mortalidad y factores asociados a mortalidad en pacientes hospitalizados por traumatismo torácico por arma blanca (TTAB). Materiales y Método Estudio analítico transversal. Período enero de 1981 a diciembre de 2017. Revisión base de datos prospectiva, protocolos quirúrgicos, fichas clínicas. Se describe y compara las características de los TTAB. Se calculó IGT: Injury Severity Score (ISS), Revised Trauma Score ( RTS-T) y Trauma Injury Severity Score (TRISS). Resultados Total 4.163 pacientes hospitalizados por TT, 2.286 hospitalizados por TTAB. Hombres: 2.131 (93,2%), edad promedio 27,8 ± 10,7 años, TTAB aislado 2.035 (89,0%), asociado a lesiones extratorácicas 251 (11,0%) y de éstos 124 (5,5%) se consideraron politraumatismos. Mecanismos principales del traumatismo: agresión 2.246 (98,3%) y autoagresión 22 (1,0%). Lesiones y hallazgos torácicos más frecuentes: neumotórax 1.473 (64,4%), hemotórax 1.408 (61,6%), enfisema subcutáneo 485 (21,2%). Tratamiento definitivo: pleurotomía 1.378 (60,3%), cirugía torácica 537 (23,5%) y tratamiento médico 370 (16,2%). Hospitalización promedio 6,2 ± 6,5 días, IGT: ISS promedio 10,9 ± 7,2, RTS-T promedio 11,6 ± 1,4 y TRISS promedio 3,6. Morbilidad: 318 (13,9%). Mortalidad: 32 (1,4%). Conclusión Los TTAB ocurren frecuentemente en hombres jóvenes por agresión. La mayoría se puede tratar con pleurotomía exclusiva.

Aim Our objectives are to describe and correlate the clinical characteristics, trauma severity indexes (TSI) and morbidity and mortality in patients hospitalized for thoracic trauma by a bladed weapon (TTBW). Materials and Method Transversal analytic study. Period January-1981 to December-2017. Prospective database review, surgical protocols, clinical files. The characteristics of the TTBW are described and compared. Injury Severity Score (ISS), Revised Trauma Score (RTS-T) and Trauma Injury Severity Score (TRISS) were calculated. Results Total of 4,163 patients hospitalized for TT, 2,286 hospitalized for TTBW. Men: 2,131 (93.2%), average age 27.8 ± 10.7 years, isolated TTBW 2,035 (89.0%), associated with extra thoracic injuries 251 (11.0%) and of these 124 (5.5%) were considered polytrauma. Main mechanisms of trauma: Aggression 2,246 (98.3%) and self-aggression 22 (1.0%). Most frequent injuries and thoracic findings: pneumothorax 1,473 (64.4%), hemothorax 1,408 (61.6%), subcutaneous emphysema 485 (21.2%). Definitive treatment: Pleurotomy 1,378 (60.3%), thoracic surgery 537 (23.5%) and medical treatment 370 (16.2%). Average hospital stay: 6.2 ± 6.5 days. ISS average 10.9 ± 7.2, RTS-T average 11.6 ± 1.4 and TRISS average 3.6. Morbidity: 318 (13.9%). Mortality: 32 (1.4%). Discussion TTBW are frequent in our environment, unlike on an international level. Conclusions TTBW frequently occur in young male patients due to aggression. The majority can be treated with exclusive pleurotomy.

Tumores cardíacos primarios / Primary cardiac tumors. Experience in 72 cases

Background: Primary cardiac tumors have a low incidence, and their presentation form and clinical course are not well known. Aim: To describe the characteristics, treatment, follow up and survival of patients with primary cardiac tumors (PCT). Material and Methods: Review of all surgical procedures for PCT performed between 1984 and 2019 in a regional general hospital. The information was obtained from surgical protocols, surgical and pathology databases, medical records and registries of the Chilean National Identification Service. The clinical features of patients, immediate and long term outcomes are described. Results: Seventy-two surgical procedures for PCT were reviewed. Patients' age was 55 ± 15 years and 60% were women. The most common histological types were myxoma in 49 patients (68%), papillary fibroelastoma in 13 (18%) and sarcoma in 6 (8.3%). Forty-nine (68.1%) were symptomatic and all tumors were found on echocardiography. Fifty-one (71%) were in the left atrium, 10 (14%) in the aortic valve and eight (11%) in the right atrium. The surgical procedures were tumor resection in 48 patients (67%) and resection and repair with patch in 23 (32%). Mean postoperative stay was 6.6 ± 4.4 days, eight patients (11%) had complications and no patient died in the immediate postoperative period. Long term survival was higher in patients with benign PCT as compared with those with malignant tumors. Conclusions: Most PCTs in this group of patients were benign neoplasms and the most common tumors were myxomas. The main diagnostic method is echocardiography and the prognosis of surgical treatment is excellent when the tumors are benign. (Rev Med Chile 2020; 148: 327-335)

Traumatismo torácico contuso / Blunt Thoracic Trauma

INTRODUCCIÓN: El traumatismo torácico (TT) es una causa importante de morbilidad y mortalidad, presente en el 25-50% de la mortalidad por traumatismo. El TT contuso (TTC) es el tipo más frecuente de TT según las diferentes publicaciones internacionales. OBJETIVO: Nuestros objetivos son describir las características, tratamientos, morbilidad y mortalidad en pacientes hospitalizados por TTC en nuestra institución. MATERIAL Y MÉTODOS: Estudio descriptivo transversal desde enero-1981 a diciembre-2017. Revisión de una base de datos prospectiva, protocolos quirúrgicos y fichas clínicas. Se describen y comparan las características de los TTC. Se calcularon índices de gravedad de traumatismo (IGT): Injury Severity Score (ISS), Revised Trauma Score (RTS-T), Trauma Injury Severity Score (TRISS). RESULTADOS: Total 4.163 pacientes hospitalizados por TT, 1.719 (41,3%) TTC. Hombres 1.327 (77,2%), edad promedio 46,7±18,8 años. Se consideró TT aislado 966 (56,2%), asociado a lesiones extratorácicas 753 (43,8%) y de estos 508 (29,6%) eran politraumatizados. Mecanismo: Accidente de tránsito 838 (48,7%), caída de altura 279 (16,2%). Lesiones y hallazgos torácicos: fractura costal 1.294 (75,3%), neumotórax 752 (43,1%). Tratamiento: médico 874 (50,8%), pleurotomía 704 (41%) y cirugía torácica 141 (8,2%). Período de hospitalización 9,2 ± 9,5 días. Según IGT: ISS promedio 14,1 ± 11,1, RTS-Tpromedio 11,5 ± 1,5, TRISS promedio 6,6. Morbilidad en 297 (17,3%), mortalidad en 68 (4%). DISCUSIÓN: La causa principal de los TTC fue el accidente de tránsito. La fractura costal correspondió a la lesión torácica más frecuente. La mayoría requirió solo tratamiento médico. La mortalidad fue menor a la esperada según IGT.

BACKGROUND: Thoracic trauma (TT) is a major cause of morbimortality, involved in 25-50% of trauma deaths. Internationally, blunt thoracic trauma (BTT) is the most frequent type of TT. OBJECTIVE: Our objectives are to describe the clinical characteristics, treatments, morbidity and mortality in patients hospitalized by blunt thoracic trauma (BTT) in our institution. MATERIAL AND METHODS: Cross-sectional descriptive study from january-1981 to december-2017. Prospective database review, surgical protocols and clinical files. The characteristics of the BTT are described and compared. The following trauma severity indices (TSI) were calculated: Injury Severity Score (ISS), Revised Trauma Score (RTS-T) and Trauma Injury Severity Score (TRISS). RESULTS: 4,163 patients were hospitalized because of TT, 1.719 (41.3%) of them with BTT. 1,327 (77.2%)patients were men, average age 46.7 ± 18.8 years-old. We considered isolated TT 966 (56.2%), associated with extrathoracic lesions 753 (43,8%) and 508 (29.6%)with polytraumatism. Mechanism: Traffic accident 838 (48.7%), fall down from a height 279 (16.2%). Lesions and intrathoracic findings: rib fracture 1.294 (75.3%), pneumothorax 752 (43.7%). Treatment: Medical 876 (50.8%), pleurotomy 704 (41%) and thoracic surgery 141 (8.2%). Average hospitalized period 9.2 ± 9.5 days. According to TSI: ISS average 14.1 ± 11.1, RTS-T average 11.5 ± 1.5, TRISS average 6.6. Morbidity in 297 (17.3%), mortality in 68 (4%). DISCUSSION: The TTC was mainly attributed to the traffic accident. Rib fracture was the most common chest injury. The majority of patients required only medical treatment. Mortality was lower than expected according to TSI.

Traumatismo penetrante cardiaco: caracterización, resultados inmediatos y variables asociadas a morbilidad y mortalidad en pacientes operados / Penetrating cardiac trauma: findings, outcomes and prognostic factors in operated patients

INTRODUCCIÓN: El traumatismo penetrante cardiaco (TPC) por sus características y en particular por su alta mortalidad, constituye un desafío quirúrgico permanente. OBJETIVOS: Describir las características, resultados inmediatos y factores pronósticos en TPC. MATERIALES Y MÉTODO: Estudio descriptivo transversal, revisión de protocolos prospectivos de traumatismo torácico, registros de pabellón y fichas clínicas. Período enero de 1990-diciembre de 2017. Se incluyeron todos los pacientes con TPC operados. Se describen y analizan diversas variables. Se realizó regresión logística con análisis univariado y multivariado para identificar variables asociadas a morbilidad, deterioro neurológico y mortalidad. RESULTADOS: 220 pacientes operados por TPC, 209 (95,0%) hombres, edad promedio 30,4 ± 13,3, mediana 27 años. Mecanismo: agresión en 202 (91,8%). El agente traumático fue en 186 (84,5%) arma blanca, en 21 (9,5%) arma de fuego. Presentaban taponamiento 169 (76,8%) pacientes, ingresaron en shock 103 (46,8%) y en paro cardiorrespiratorio 20 (9,1%). Vía de abordaje fue esternotomía en 157 (71,4%), toracotomía izquierda en 58 (26,4%). Las cavidades cardiacas lesionadas más frecuentes fueron ventrículo derecho en 110 (50,0%), ventrículo izquierdo en 72 (32,7%). Se hospitalizaron en UCI en el postoperatorio 135 (61,4%), se transfundieron 74 (33,6%), presentaron complicaciones 60 (27,3%) y se reoperaron 21 (9,5%). Mortalidad 28 (12,7%). La estadía postoperatoria tuvo una mediana de 6 días (rango 1-150). Se identificaron factores pronósticos. DISCUSIÓN: Los TPC operados son más frecuentes en hombres agredidos con arma blanca, la cavidad lesionada más frecuente es el ventrículo derecho. Nuestra morbimortalidad es comparable con series internacionales.

INTRODUCTION: Penetrating cardiac trauma (PCT) constitute a permanent surgical challenge due to it characteristics and high mortality. AIM: To describe the findings, outcomes and prognostic factors in PCT. MATERIAL AND METHOD: Cross-sectional descriptive study, review of prospective thoracic trauma protocols and surgical registries. Period January 1990-December 2017. All patients with PCT were included. Various variables are described and analyzed. Univariate and multivariate analysis were performed to identify factors associated with morbidity, neurologic dysfunction and mortality. RESULTS: 220 patients PCT, 209 (95.0%) men, mean age 30.4 ± 13.3, median 27 years. Mechanism: Aggression in 202 (91.8%). The traumatic agent was cold steel in 186 (84.4%) and fire arm in 21 (9.5%). 169 (76.8%) patients presented with tamponade, 103 (46.8%) shock and 20 (9.1%) cardiopulmonary arrest. Approach was sternotomy in 157 (71.4%), left thoracotomy in 58 (26.4%). The most common injured areas were right ventricle in 110 (50.0%), left ventricle in 72 (32.7%). 135 (61.4%) patients needed postoperative ICU and 74 (33.6%) were transfused. Complications occurred in 60 (27.3%). Twenty-one (9.5%) were reoperated. Mortality 28 (12.7%). The postoperative median stay was 6 days (Range 1-150). Prognostic factors were identified. DISCUSSION: Operated PCT are more frequent in men with stab wound, the most common injured area is the right ventricle. The morbidity and mortality is comparable with international series.