ABSTRACT
ABSTRACT Introduction: Since the coronavirus disease 2019 (COVID-19) pandemic, cardiac surgeries in patients with previous infection by COVID-19 were suspended or postponed, which led to surgeries performed in patients with an advanced stage of their disease and an increase in the waiting list. There is a heterogeneous attitude in Latin America on the optimal timing to cardiac surgery in patients with previous COVID-19 infection due to scarce data on its outcome. Two Latin American associations joined to establish common suggestions on the optimal timing of surgery in patients with previous COVID-19 infection. Methods: Data collection was performed using a pre-established form, which included year of publication, objective, type of study (prospective/retrospective, descriptive/analytical), number of patients, year of study, waiting time between infection and surgery, type of surgery, morbidity, mortality, and conclusions regarding the association between mortality and morbidity. Final recommendations were approved by the board of directors of Latin American Association of Cardiac and Endovascular Surgery (LACES) and Latin American Confederation of Anesthesia Societies (CLASA). Results: Of the initial 1,016 articles, 11 comprised the final selection. Only six of them included patients who underwent cardiac surgery. According to the analyzed literature, optimal timing for cardiac surgery needs to consider the following aspects: deferable surgery, symptomatic COVID-19 infection, completeness of COVID-19 vaccination. Conclusion: These recommendations derive from the analysis of the scarce literature published at present on outcomes after cardiac surgery in patients with previous COVID-19 infection. These are to be taken as a dynamic recommendation in which Latin American reality was taken into consideration.
ABSTRACT
INTRODUCCION: Para mantener la funcionalidad del corazón luego de un infarto agudo al miocardio (IAM), se activa entre otros, el sistema renina-angiotensina (SRA). En condiciones fisiológicas existe un equilibrio enzimático dentro de este sistema entre la enzima convertidora de angiotensina I (ECA) y su homóloga (ECA-2). La primera aumenta el remodelamiento miocárdico (RM) contribuyendo a la disfunción del ventrículo y la segunda lo disminuye. Este equilibrio podría verse afectado frente a condiciones fisiopatológicas como el IAM. HIPOTESIS: La progresión de la disfunción ventricular post IAM se asocia a un aumento de los niveles de ARNm de la ECA y a una disminución del ARNm para ECA-2. OBJETIVO: Medir niveles de expresión génica, de ambas vías enzimáticas, en el ventrículo de ratas a corto y largo plazo post IAM. METODO: Se determinaron los niveles de ARNm de ECA y ECA-2 mediante RT-PCR a partir de ventrículos infartados en ratas Sprague Dawley sacrificadas1 y 8 semanas post IAM. RESULTADOS: Los niveles de ARNm para ECA-2 disminuyeron 8 semanas post IAM respecto a su grupo control (IAM=0.6+-0.1 v/s Sham=1.0+-0.1, p<0,008). Los niveles de expresión de ECA a las 8 semanas post IAM muestran un aumento significativo respecto del grupo control (IAM=4.7+- 0.9 v/s Sham=1.0+-0.3, p<0,05). CONCLUSIONES: Se puede concluir que luego de 8 semanas de sufrido un IAM, se produce un desbalance en la expresión de los componentes del SRA que favorece su vía enzimática de ECA y atenúa su vía enzimática de ECA-2 contribuyendo al RM y aumento de la disfunción miocárdica.
INTRODUCTION: To keep the heart function after a miocardial infarction (MI), there is an activation of the Renin-Angiotensin system (RAS). Under physiologic conditions this system has anenzymatic balance between the Angiotensin Converting EnzymeI (ACE) and its homologue (ACE-2). While ACE enhance the miocardial remodeling (MR), wich contributes to the ventricular dysfunction, ACE-2 decreases it. This balance could be afected in physiopathologic conditions like MI. HYPOTHESIS: The progression of the ventricular dysfunction after a MI is associated with an increase in the levels of mRNA of the ACE and a decrease in mRNA for ACE-2. OBJECTIVE: To measure gene expression levels of both enzymatic ways in rat ventricles at short and long term after a MI. METHOD: We established differences in the mRNA levels for ACE and ACE-2 by RT-PCR. We obtained them RNA from the infarcted ventricles of Sprague Dawley rats, sacrified 1 and 8 weeks after MI. RESULTS: The mRNA levels for ACE-2 were lower at 8 weeks after MI than the control group (MI=0.6+-0.1 v/s Control=1.0+-0.1, p<0.008). The expression levels of ACE show a significative increase at 8 weeks after MI in comparison with the control group (MI=4.7+-0.9 v/s Control=1.0+-0.3, p<0.05). CONCLUTIONS: After eight weeks of a MI there is an imbalance in the expression of the components of the RAS that favors the ACE enzymatic way and disfavor theACE-2 way. Thus, contributing to MR and miocardial dysfuntion.