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1.
Rev. chil. cardiol ; 39(2): 122-132, ago. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138525

ABSTRACT

OBJETIVO: Describir los resultados inmediatos y alejados de la cirugía coronaria sin circulación extracorpórea (CEC) y comparar los resultados de la estrategia de indicación de la técnica en dos períodos. PACIENTES Y MÉTODOS: Estudio retrospectivo de 428 pacientes intervenidos de cirugía coronaria sin CEC entre 2004 y 2019 en el Hospital Guillermo Grant Benavente. Se dividen en Grupo 1, período 2004-2008 (N=216) y Grupo 2, período 2009-2019 (N=212). Se estudiaron sus características clínicas, resultados quirúrgicos, morbi-mortalidad operatoria y eventos adversos al 31 de junio de 2019 y se compararon los resultados de los grupos a 5 años. RESULTADOS: No hubo diferencias en la distribución por sexo, edad, factores de riesgo y patologías asociadas entre los grupos. Hubo diferencias en las lesiones coronarias entre los Grupos 1 y 2: lesión de un vaso en 45 (20,4%) versus 125 (59%) y tres vasos en 75 (34,5%) versus 19 (9%) respectivamente (p<0,001). El riesgo operatorio por EuroSCORE logístico fue 3,3±3,95 versus 5,4±7,7 (p<0,001). Se confeccionaron 2,3±0,9 anastomosis distales en el Grupo 1 versus 1,3±0,6 en Grupo 2 (p<0,001). La tasa de complicaciones fueron 17,6% en el Grupo 1 y 5,7% en el 2 (p<0,001). La mortalidad operatoria globral fue 4 pacientes (0,9%). El seguimiento comprendió 9,2±3,8 años. La sobrevida a 10 años fue 76,9% y tasa de eventos cardiovasculares mayores 37,6%. No hubo diferencia entre los grupos a los 5 años. CONCLUSIONES: La selección de pacientes con anatomía más favorables o de mayor riesgo operatorio tuvo tasas de sobrevida y eventos similares a los observados con la estrategia menos selectiva a 5 años de seguimiento.


AIM: To describe the immediate and long-term results of off pump coronary artery surgery without cardiopulmonary bypass (OPCABG) comparing the results observed in two consecutive periods. PATIENTS AND METHODS: A retrospective study of 428 patients undergoing OPCABG between 2004 and 2019 at the Guillermo Grant Benavente Hospital. Group 1 patients operated between 2004 - 2008 (N = 216) and Group 2 operated between 2009 and 2019 (N = 212). RESULTS: There were no differences in sex, age, risk factors and co morbidities between groups. There were differences in the number of coronary lesions between groups: one vessel disease in 45 (20.4%) versus 125 (59%) and three vessels in 75 (34.5%) versus 19 (9%) in Group 1 vs Group 2, respectively (p <0.001). The operative risk for logistic EuroSCORE was 3.3 ± 3.95 in Group 1 versus 5.4 ± 7.7 in Group 2 (p <0.001). 2.3 ± 0.9 distal anastomoses were performed in Group 1 compared to 1.3 ± 0.6 in Group 2 (p<0.001). Adverse events occurred in 17.6% o patients in Group 1 compared to 5.7% in Group 2 (p<0.001). Overall, 4 patients died (0.9%). Mean overall survival at 10 years was 76.9% and the rate of major cardiovascular events was 37.6%, no differences being observed between groups. CONCLUSIONS: At 5 years of follow-up the selection of patients with more favorable anatomy or greater operative risk had similar survival rates and events than those observed with the least selective strategy.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Coronary Disease/surgery , Coronary Artery Bypass, Off-Pump/methods , Postoperative Complications/epidemiology , Time Factors , Survival Analysis , Retrospective Studies , Risk Factors , Follow-Up Studies , Cause of Death , Treatment Outcome , Coronary Artery Bypass, Off-Pump/mortality
2.
Rev. chil. cardiol ; 39(2): 147-153, ago. 2020. graf
Article in Spanish | LILACS | ID: biblio-1138527

ABSTRACT

Abstract: A 49-year-old woman presented with dyspnea and palpitations, leading to Functional Class III.An echocardiogram showed a heterogeneous mass adhered to the right heart cavities. This was confirmed by NMR. A large right coronary artery was occluded in relation to the tumor, which was hyper vascularized. Resection of the tumor was performed; the right ventricular wall was sutured, and an atrial defect was closed using pericardial tissue. Post operative course was uneventful and she was asymptomatic 4 years after surgery.


Subject(s)
Humans , Female , Middle Aged , Paraganglioma/surgery , Heart Neoplasms/surgery , Paraganglioma/complications , Paraganglioma/diagnostic imaging , Angiography , Magnetic Resonance Spectroscopy , Dyspnea/etiology , Heart Neoplasms/complications , Heart Neoplasms/diagnostic imaging
3.
Rev. chil. cardiol ; 39(1): 49-54, abr. 2020. graf
Article in Spanish | LILACS | ID: biblio-1115450

ABSTRACT

A 20-year-old woman, without known pre-existent conditions presented with a history of dyspnea on exertion, and palpitations for 6 months. Vital signs, as well as cardiac and pulmonary examinations were normal. Routine blood tests were normal. The ECG showed nonspecific ST-T changes. The echocardiogram showed a left ventricle of normal size and function. A cystic image was shown in relation to the right ventricle, with displacement of the interventricular septum. These findings were confirmed on computed tomography. Additional cystic images on the liver or lungs were ruled out. On surgery, a cardiac hydatic cyst adhered to the pericardium next to the right ventricle was found. Puncture, drainage of the mass and surgical removal of cystic membranes were performed. The clinical course was uneventful. A four year follow up revealed no recurrence of the cyst.


Subject(s)
Humans , Female , Young Adult , Echinococcosis/surgery , Echinococcosis/diagnostic imaging , Heart Ventricles/surgery , Heart Ventricles/diagnostic imaging , Cardiac Surgical Procedures
4.
Rev. méd. Chile ; 146(1): 96-106, ene. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-902626

ABSTRACT

There has been a progressive increase in the use of mechanical circulatory support in our country in the last years, mainly in the short-term: as a bridge to cardiac transplant or recovery, which has allowed to rescue patients from a population that concentrates high rates of complications and mortality. This motivated that the Ministry of Health convened a series of experts in the area of heart failure, transplantation and mechanical circulatory support, representatives of different public and private health centers in Chile, with the objective of developing recommendations on the use of short-term mechanical assistance devices, which would serve as a reference for the proper management of these patients. This clinical experts consensus document contains topics related to: definitions and general concepts; indications; contraindications; specific aspects of starting, follow-up and weaning of the devices; process of transfer of patients in circulatory assistance from one center to another and finally criteria of organization, means and competences to be fulfilled by the centers that offer this therapeutic option.


Subject(s)
Humans , Heart-Assist Devices/standards , Extracorporeal Circulation/methods , Chile , Guidelines as Topic , Extracorporeal Circulation/standards
5.
Rev. chil. cardiol ; 34(3): 182-189, 2015. ilus, tab
Article in Spanish | LILACS | ID: lil-775486

ABSTRACT

La cirugía de revascularización mio-cárdica (CRM) exclusiva con arterias mamarias internas en Y (BIMA-Y) podría ofrecer los mejores injertos en términos de durabilidad y menores tasas de eventos adversos en el largo plazo. Objetivo: Analizar los resultados a corto plazo de esta técnica quirúrgica en un hospital universitario chileno. Métodos: Estudio prospectivo de los pacientes intervenidos de CRM con técnica de BIMA-Y entre diciembre 2010 a mayo 2014. Se incluyeron 67 pacientes, 59 hombres, con edad media 58,6±8,5 años. Cinco (5) tenían enfermedad de dos vasos y 62 de 3 vasos. El EuroSCORE aditivo fue 2.3 y el logístico 2,18%. Todas las cirugías se realizaron por esternotomía media con circulación extracorpórea. Ambas arterias mamarias internas se disecaron usando técnica esqueletizada. La arteria mamaria interna derecha (RIMA) se seccionó y anastomosó con la arteria mamaria interna izquierda (LIMA). La pared anterior se revascularizó con LIMA y las paredes lateral e inferior con RIMA. El seguimiento se extendió hasta Junio del 2015. Resultados: Se efectuaron 3,8 anastomosis/paciente: 109 LIMA (67 a arteria descendente anterior, 37 a una arteria diagonal y 5 para otros objetivos) y 145 RIMA (64 a una primera arteria marginal, 23 a una segunda marginal y 58 a descendente posterior). La revascularización fue completa en todos los casos Hubo 1 infarto perioperatorio, 6 fibrilaciones auriculares, 1 neumonía, 1 dehiscencia esternal y 5 infecciones superficiales. No hubo mortalidad operatoria ni reoperaciones por sangrado. El seguimiento medio fue 39,3±12,1 meses. Cuatro pacientes fallecieron y hubo 2 reintervenciones. Conclusiones: La técnica BIMA-Y permitió una revascularización completa con una baja tasa de complicaciones y efectos adversos en el corto plazo.


Myocardial revascularization with both mammary arteries in "Y" (Y-BIMA) might lead to longer graft duration and better clinical results. Aim: To analyze short term results of Y-BIMA in a series of patients operated on at a Chilean university hospital. Methods: Patients operated on using Y-BI-MA between December 2010 and May 2014 were analyzed. There were 67 patients (59 males) aged 58.6± 2.3 years old. Five patients had 2 vessel di-sease and 62 patients 3 vessel disease. The additi-ve Euroscore was 2.3 % and the logistic score was 2.18%. All operations were performed through a medial sternotomy using extracorporeal circulation. Both mammary arteries were dissected and skeleto-nized. The RIMA was divided and anastomosed to the LIMA. The anterior myocardial was revascularized through the LIMA while the lateral and inferior walls were revascularized through the RIMA. Results: An average 3.8 anastomosis per patient were performed: 67 LIMA to the LAD, 37 to the diagonal artery, and 5 to other targets (total 109 LIMA); RIMA was used in 145 arteries: 64 to a first marginal, 23 to a second marginal and 58 to a posterior descending artery. Revascularization was complete in all cases. One patient had a postoperative myocardial infarction, 6 developed atrial fibrillation, 1 a pneumonia, 1 a sternal dehiscence and 5 had superficial infections. There was no surgical mortality nor reoperations for bleeding. Patients were followed an average of 39.2±12.1 months. Four patients died and 2 were reoperated on during follow up.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Anastomosis, Surgical/methods , Coronary Artery Bypass/methods , Mammary Arteries/transplantation , Postoperative Complications , Prospective Studies , Follow-Up Studies , Treatment Outcome , Myocardial Revascularization/methods
6.
Rev. chil. cardiol ; 33(2): 101-108, 2014. tab
Article in Spanish | LILACS | ID: lil-726134

ABSTRACT

Introducción: Se presentan los resultados inmediatos y a 6 años de la cirugía coronaria sin circulación extra corpórea (CEC) en pacientes portadores de lesión de tres vasos y/o del tronco coronario izquierdo (TCI). Métodos y Resultados: Se analiza una cohorte histórica de pacientes con lesión de tres vasos y/o TCI a quienes se realizó cirugía coronaria sin CEC entre junio 2005 y diciembre 2008 (N=100). Corresponden a 81 hombres, edad 61,3 +/- 7,9 años. 20 pacientes tenían lesión del TCI. La fracción de eyección del ventrículo izquierdo fue <30 por ciento en 6, 30 - 50 por ciento en 32 y >50 por ciento en 62 pacientes. El Euro SCORE promedio aditivo era 2,83 y el logístico 3,05. Todas las revascularizaciones se consideraron completas. Se realizaron 3,07 puentes/paciente. Hubo 5 conversiones a cirugía con CEC. Hubo complicaciones postoperatorias en 24 pacientes (3 AVE, 2 IAM, 3 insuficiencias renales agudas, 5 reoperaciones, 1 mediastinitis) y fallecieron 2. El seguimiento promedio fue 72,3 meses (rango 54 - 96). En forma alejada fallecieron 14 pacientes (5 de causa cardiovascular). Hubo 3 IAM; 5 AVE y 7 reintervenciones. Conclusión: En esta serie de pacientes con lesión de TCI y/o 3 vasos, la cirugía coronaria sin CEC no tuvo ventajas respecto a la cirugía con CEC.


Aim: To present early and long term results of Off Pump Coronary artery surgery in patients with three vessel or Main Left Disease. Methods and Results: 100 patients, mean age 61,3 +/- 7,9 years, 81 percent males, with three vessel or main left disease were submitted to off-pump coronary artery bypass between June 2005 and December 2008. Twenty patients had main left disease. Left ventricular ejection fraction was <30 percent in 6 patients, 30-50 percent in 32 and >50 percent in 62. Mean active and logistic Euro scores were 2.83 and 3.05, respectively. Patients were followed up to June 2013. All interventions were considered to have achieved complete revascularization. A mean of 3.07 bypasses were implanted. Five patients had to be converted to open heart surgery. 24 patients had post-operative complications (CVA in 3, AMI in 2, acute renal failure in 3 and mediastinitis in 1 patient. Operative mortality was 2 percent and 5 patients required reoperation. During a period of 72.3 months of follow-up (range 54-96) 14 patients died (5 from cardiovascular causes). There were 3 patients developing AMI, 5 suffered a CVA and 7 required re-revascularization. The overall results described were not different from those observed in similar patients undergoing open heart surgery at our institution. Conclusion: Off-Pump coronary artery bypass had no advantages over on pump surgery in patients with 3 vessel and/or main left disease at our institution.


Subject(s)
Humans , Male , Adult , Female , Middle Aged , Myocardial Revascularization , Coronary Artery Bypass/adverse effects , Coronary Artery Bypass/methods , Extracorporeal Circulation , Follow-Up Studies , Hospital Mortality , Length of Stay , Postoperative Complications , Coronary Artery Bypass/mortality , Risk Assessment , Risk Factors , Stroke Volume , Treatment Outcome
7.
Rev. méd. Chile ; 141(3): 281-290, mar. 2013. ilus
Article in Spanish | LILACS | ID: lil-677334

ABSTRACT

Background: Coronary artery bypass graft surgery without cardiopulmonary bypass (CPB) is an alternative technique for myocardial revascularization. Aim: To report the early results and 4 yearsfollow up ofthefirst 220 cases operated with this technique. Patients and Methods: Descriptive study of 220 patients aged 60.6 ±8.8 years (171 men) undergoing off-pump coronary surgery between 2004 and 2008. One hundred seventy six (80%) patients had hypertension, 59 (26.8%) had diabetes, 86 (39%) dyslipidemia and 85 (38.6%) were smokers. One hundred forty one patients (64.1%) had stable angina. Fiftyfour (24.5%) had a recent infarction (< 90 days) and 46 (20.9%) had a previous angioplasty. Ejection fraction was < 30% in 9 (4.1%), 30% - 50% in 57 (25.9%) and > 50% in 154 (70%). Additive and logistic EuroSCORE were 3.32 and 3.55% respectively. We studied the complications and mortality at 30 days. Long term follow up (late mortality and major cardiovascular events such as myocardial infarction (MI) stroke and re-intervention were assessed using data of medical records and National Identification Registry Service until June 30, 2011. Results: A total of 481 bypasses were performed (2.27 bypassesl patient). There were 4 (1.8%) conversions and no incomplete revascularization. Post-Operative complications occurred in 42 patients. Eight neurological (five strokes), five renal (two required dialysis), 16 cardiovascular (four myocardial infarctions), 15 surgical and 11 infections. Three patients died (1.36%). After a follow up of 4.26 ± 1.02 years, overall survival was 92.3%, and survival free of myocardial infarction, stroke or re - intervention was 96.8%, 96.8% and 95.9% respectively. Conclusions: Off-pump coronary surgery in selected patients has immediate and late results comparable to traditional surgery.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Coronary Artery Bypass, Off-Pump/methods , Coronary Artery Disease/surgery , Coronary Artery Bypass, Off-Pump/adverse effects , Coronary Artery Bypass, Off-Pump , Follow-Up Studies , Retrospective Studies , Treatment Outcome
8.
Rev. chil. cardiol ; 32(3): 196-203, 2013. ilus, tab
Article in Spanish | LILACS | ID: lil-705222

ABSTRACT

Introducción: La principal ventaja de las bioprótesis es no requerir tratamiento anticoagulante. Sin embargo, algunas guías de manejo clínico recomiendan este tratamiento los primeros meses post cirugía. En los últimos años varios autores han demostrado la seguridad del uso exclusivo de aspirina en los primeros 3 meses después del reemplazo valvular aórtico con bioprótesis. Objetivo: Evaluar la morbimortalidad y complicaciones trombo embólicas y hemorrágicas en pacientes sometidos a reemplazo valvular aórtico (RVA) con bioprótesis tratados exclusivamente con aspirina (100 mg) los primeros tres meses post cirugía. Métodos: Estudio retrospectivo de 229 pacientes (137 hombres. edad 65,3 +/- 11,76 años) operados de RVA con bioprótesis entre junio 2006 y diciembre 2011. Hubo 178 cirugías aisladas y 51 combinadas y 20 pacientes tenían endocarditis. Se estudió la morbimortalidad, complicaciones trombo embólicas y sangrado a 30 y 90 días y en el seguimento alejado hasta el 30 de junio de 2012. Resultados: A 30 días hubo 4 accidentes cerebrovasculares, 3 accidentes isquémicos transitorios y una isquemia mesentérica. Fallecieron 8 pacientes (3,5 por ciento). A los 90 días hubo 2 hemorragias (1 hemorragia digestiva, 1 hemotórax), no hubo nuevos eventos trombo embólicos ni otros fallecidos. El seguimiento promedio fue 27.8+/-17,7 meses (rango 6 - 72 meses). Durante el seguimiento fallecieron 17 pacientes y no se registraron eventos trombo embólicos ni hemorrágicos. Conclusión: En pacientes operados de reemplazo valvular aórtico con bioprótesis el uso exclusivo de aspirina fue seguro para prevenir complicaciones trombo embólicas.


Background: The abscense of a need for anticoagulant therapy is a significant advantage of biologic valve prosthesis. However, according to some clinical guidelines conventional anti-coagulant therapy is recommended for the initial 3 months following aortic valve replacement. Aim: The aim of this study was to evaluate morbi-mortality and thrombo-embolic events in patients undergoing aortic valve replacement with a bioprosthesis receiving aspirin during the first 3 months after surgery. Methods: Data on 229 patients (137 males), aged 65.3+/-11.8 years who received biologic aortic valve prosthesis between June 2006 and December 2011 was retrospectively analyzed. 51 patients underwent combined (coronary and/or mitral valve surgery) and 20 patients had infectious endocarditis. Morbidity, mortality, thrombo-embolic and hemorrhagic events were tabulated up to June 30, 2012. Results: During the first 30 days after surgery there were 4 cerebro-vascular events and 1 episode of mesenteric ischemia. Operative (30 day) mortality was 3.5 percent (8 patients). At 90 days, 2 patients had a hemorrhagic event (GI bleeding and hemotho-rax, respectively), but no further embolic events or deaths occurred. Patients were followed for a mean of 27.8 +/-17,7 months (range 6 to 72 months). 17 patients died but no cases of embolism or bleeding were observed. Conclusion: Aspirin was safe and effective for prevention of thrombo-embolic complications following aortic valve replacement with a biologic prosthesis.


Subject(s)
Humans , Male , Female , Middle Aged , Anticoagulants/therapeutic use , Aspirin/therapeutic use , Heart Valve Prosthesis , Coronary Thrombosis/prevention & control , Coronary Thrombosis/etiology
9.
Rev. chil. cardiol ; 27(4): 470-479, dic. 2008. tab, graf
Article in Spanish | LILACS | ID: lil-515275

ABSTRACT

Introducción: Se presenta la experiencia en tratamiento quirúrgico de endocarditis infecciosa (EI) y analizan factores asociados a mortalidad. Método: Estudio retrospectivo de pacientes operados por EI en el Hospital Regional de Concepción entre 1985 y 2005 (N=126). Se estudian características clínicas, cirugía efectuada, y morbimortalidad. Se comparó la mortalidad según periodo (1985–1994, 1995–2005), sexo, edad, válvula afectada, duración del tratamiento médico, indicación de cirugía y procedimiento efectuado. Las diferencias se estudiaron con test de probabilidad exacta de Fisher y test de independencia de variables según la distribución Chi–cuadrado. Resultados: Se operaron 52 pacientes entre 1985 y 1994. Edad promedio 43.5 años. 98 pacientes (77.8%) de sexo masculino. Las válvulas afectadas fueron aórtica (66.7%), mitral (10.3%), mitral y aórtica (21.4%). El tratamiento médico fue < 14 días en 47 (37%), entre 15 y 30 días en 50 (40%) y > 31 días en 29 (23%). Las principales indicaciones quirúrgicas fueron la insuficiencia cardiaca (54.7%) y vegetaciones >1cm (31%). Se realizaron 96 reemplazos univalvulares y 21 reemplazos bivalvulares. Presentaron complicaciones 63 pacientes y fallecieron 19 (15.1%). Se observó una mayor mortalidad en cirugía antes de 1995, sexo femenino, edad mayor de 50 años, compromiso bivalvular, periodo de tratamiento médico inferior a 30 días, indicación quirúrgica por insuficienciacardiaca y reemplazo bivalvular. Las diferencias no tuvieron significación estadística.Conclusiones: En nuestra serie, la mayor mortalidad quirúrgica se observó en los pacientes de mayor edad, sexo femenino y con compromiso bivalvular. Las diferencias observadas no tuvieron significación estadística.


Aim: to review the results of cardiac surgery in patients with Infective Endocarditis (IE) and to determine risk factors associated to surgical mortality. Method: A retrospective study of patients with cardiac surgery for IE at the Hospital Regional de Concepcion between 1985 and 2005 (n=126). We tabulated the clinical characteristics, type of surgery, morbidity and mortality. Mortality was compared for the period 1985-1994 vs. the period 1995-2005, according to sex, age, valve involved, duration of medical treatment, indication for surgery and procedure performed at operation. Differences were evaluated by the Fisher exact test or Chi square, as required Results: The mean age was 34.5 years; 98 patients (77.8%) were males. The aortic valve was affected in 66.7%,mitral valve in 10.3%, and both valves in 21.4%. Medical treatment lasted less than 14 days in 37%, 15-30 Days in 40% and >31 days in 23% of patients. Main surgical indications were congestive heart failure (54.7%) and vegetations greater than 1cm (31%). A single valve was replaced in 96 patients and 2 valves in 21. Complications occurred in 63 patients; the mortality rate was 15.1%. Compared to the later period, patients operated on before 1995 had greater mortality rate, proportion of women, age >50 years, bivalvular disease, frequency of medical treatment under 30 days, CHF as an indication for surgery and bivalvular replacements. However, the differences were not statistically significant.Conclusion: Older age, female sex and bivalvular disease were associated, although not significantly, with surgical mortality for IE.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Endocarditis, Bacterial/surgery , Endocarditis, Bacterial/mortality , Age Factors , Chi-Square Distribution , Chile/epidemiology , Postoperative Complications/etiology , Endocarditis, Bacterial/microbiology , Hospital Mortality , Retrospective Studies , Sex Factors , Staphylococcus/isolation & purification , Streptococcus/isolation & purification , Time Factors
10.
Rev. chil. cardiol ; 27(4): 460-469, dic. 2008. ilus, tab
Article in Spanish | LILACS | ID: lil-515276

ABSTRACT

Introducción: La conservación del velo posterior en reemplazo valvular mitral (RVM) preservaría la función ventricular izquierda. Su utilidad es discutible en valvulopatía reumática. Objetivo: Evaluar los resultados del RVM por enfermedad reumática según la conservación del velo posterior. Método: Revisión de fichas clínicas de pacientes sometidos a RVM en nuestro servicio entre 1990 y 2004 (N=212). Se dividen según conservación (grupo 1, N=119) o no (grupo 2, N=93) del velo posterior. Los grupos son comparables en sexo, edad y patología valvular. Se comparó la morbimortalidad operatoria y realizó análisis de regresión logística de factores asociados a mortalidad. Seguimiento clínico y sobrevida hasta el 31 de julio de 2007. Resultados: Hubo diferencias en la capacidad funcional (CF) preoperatoria entre los grupos (p<0.001). Hubo 9,4% de complicaciones en el grupo 1 y 46,2% en el grupo 2 (NS). Mortalidad operatoria fue 5.1% en grupo 1 y 15.2% en grupo 2 (p<0.012). Análisis de regresión logística mostró sólo a la CF como predictor independiente de mortalidad. Seguimiento promedio de 49 meses en grupo 1 y 73 meses en grupo 2. No hubo diferencias en la CF, diámetro de aurícula izquierda y presión de arteria pulmonar en el seguimiento. Sobrevida a 1, 5 y 10 años fue similar entre los grupos (p=0.226). Sólo la CF pre operatoria fue predictor independiente de sobrevida (p=0.04). Conclusiones: En nuestra serie, sólo la CF preoperatoria se asoció a mortalidad operatoria y sobrevida alejada en RVM. La conservación del velo posterior no influyó en la evolución de los pacientes.


Background: Preservation of the posterior leaflet in mitral valve replacement (MVR) has been advocated to avoid left ventricular dysfunction. This effect is debatable in patients with rheumatic mitral valve disease. Aim: to evaluate results of MVR with preservation of the posterior leaflet in patients with rheumatic valve disease. Method: We reviewed the clinical records of 212 patients submitted to MVR from 1990 to 2004. The posterior leaflet was preserved in 119 patients (Group 1) and not preserved in 93 (Group 2). Both groups had similar age, gender distribution and valve pathology. Operative mortality rate and risk factors for mortality were analyzed using logistic regression. The follow-up period extended through July 31, 2007. Results: Functional class differed significantly among groups (p<0.001). Complications occurred in 29.4% in Group 1 and 46.2% in Group 2 (NS). Operative mortality rate was 5.1 percent in Group 1 (p<0.012). Functional class was the only risk factor mortality. The mean follow-up was 49 months in Group 1 and 73 months in Group 2. There was no difference between groups in functional class, left atrial diameter and pulmonary artery pressure during follow-up. Survival rates at 1,6 and 10 years were also similar between groups (p=0,226). Preoperative functional class was the only predictor of late survival (p=0.4). Conclusion: Preoperative functional class was the only predictor of operative and late mortality in patients undergoing MVR. Preservation of the posterior leaflet was not associated with better results in this series of patients with rheumatic mitral valve disease.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Rheumatic Heart Disease/surgery , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation/methods , Rheumatic Heart Disease/mortality , Heart Valve Diseases/mortality , Follow-Up Studies , Logistic Models , Postoperative Complications , Prognosis , Retrospective Studies , Survival Rate , Time Factors , Ventricular Function, Left
11.
Rev. chil. cardiol ; 27(2): 125-135, 2008. ilus, tab, graf
Article in Spanish | LILACS | ID: lil-504166

ABSTRACT

Introducción: La cirugía coronaria sin circulación extracorpórea (CEC) es una técnica de revascularización miocárdica comparable a la cirugía con CEC. Iniciamos su uso en marzo de 2004. Objetivo: Revisar los resultados de las primeras 100 cirugías con esta técnica en nuestro centro. Método: Los pacientes se seleccionaron según la experiencia del grupo. Se tabularon antecedentes clínicos y datos de hemodinamia. Todas las cirugías se realizaron con anestesia general y por esternotomía media. Se utilizaron estabilizadores coronarios y cardíacos por succión. Se tabuló la morbimortalidad operatoria y realizó seguimiento clínico hasta el 31 de julio de 2007. Resultados: Correspondieron a 75 hombres. Edad promedio 60.2 +/- 9.6 años. Presentaban hipertensión arterial 62 pacientes, diabetes mellitus 20, tabaquismo 23. Infarto reciente 23 pacientes, 6 de ellos trombolizados.17 pacientes con angioplastía previa. Presentaban lesión de un vaso 32 pacientes, lesión de dos vasos 31, lesión de tres vasos 29 y lesión de tronco coronario izquierdo 8. La función del ventrículo izquierdo fue normal en 82 pacientes, compromiso moderado en 12 y disfunción severa en 6. Se realizaron 2.2 +/- 1 puentes por paciente. Un paciente se consideró revascularización incompleta. Un paciente debió ser convertido por disfunción ventricular y falleció en el postoperatorio. Hubo una reoperación por sangrado y un paciente sufrió una mediastinitis. Durante el seguimiento (promedio 14.3 +/-7.6 meses) reingresó un paciente por oclusión de un bypass Conclusiones: En esta serie, la cirugía coronaria sin CEC demostró ser una técnica segura y reproducible de revascularización miocárdica.


Background: Off pump coronary bypass surgery results have been reported as similar to those of full pump surgery Aim: to review the first 100 cases with this technique at Hospital Regional de Concepcion Method: patients were selected according to prior experience from the surgical group. Clinical and hemodynamic data were recorded. All operations were performed under general anesthesia and through a medial sternotomy. Suction coronary and cardiac stabilizers were used. Operative morbidity and mortality as well as follow up data up to July 2007 were tabulated. Results: 75 out of 100 patients were males. Mean age of the series was 60.2 (SD 9.6) years. Hypertension was present in 62 patients, diabetes in 20, smoking in 23. Twenty three patients had a prior myocardial infarction, and 6 had received thrombolytics. 17 patients had prior PTCA. Single vessel disease was present in 32 patients, double vessel disease in 31, triple vessel disease in 29 and main left disease in 8. Left ventricular function was normal in82, moderately depressed in 12 and 6 had severe generalized dysfunction. A mean of 2.2 (SD 1) grafts per patient were performed. Only1 patient had incomplete revascularization. One patient was switched to full pump due to severe left ventricular dysfunction and died postoperatively. Bleeding led to reoperation in 1 patient and mediastinitis developed in another one. During follow up (mean 14 +/-7.6 months) one patients was readmitted for bypass occlusion. Conclusion: Off pump revascularization surgery was a safe and reproducible technique in this series.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged, 80 and over , Coronary Artery Bypass, Off-Pump , Coronary Disease/surgery , Chile , Diabetes Mellitus/epidemiology , Coronary Disease/epidemiology , Follow-Up Studies , Hypertension/epidemiology , Postoperative Complications , Reproducibility of Results , Myocardial Revascularization/methods , Tobacco Use Disorder/adverse effects , Coronary Vessels/surgery
12.
Rev. chil. cardiol ; 27(2): 137-145, 2008. tab, graf
Article in Spanish | LILACS | ID: lil-504180

ABSTRACT

Introducción: El EuroSCORE es una escala de riesgo diseñada para predecir mortalidad en cirugía cardiaca. Objetivo: Evaluar el EuroSCORE como predictor de mortalidad, complicaciones y duración de la estadía hospitalaria. Método: Aplicación prospectiva del EuroSCORE a todos los pacientes sometidos a cirugía cardíaca en el Hospital Regional de Concepción entre enero de 2002 y diciembre de 2005 (N=698). Edad promedio 56.7 años. Correspondieron a 452 hombres, 19 pacientes con EPOC, 29 con enfermedad vascular periférica, 52 reoperaciones, 21 con endocarditis activa y 70 considerados como estado preoperatorio crítico. Presentaron angina inestable 155 pacientes, 82 disfunción moderada y 10 disfunción severa del ventrículo izquierdo. 128 pacientes tenían antecedente de infarto menor a 90 días. Se consideraron de urgencia 59 cirugías. Se efectuaron 251 cirugías distintas de bypass coronario aislado. Los pacientes se dividieron en 3 grupos (grupo I: 0-2 puntos; grupo II: 3-5 puntos; grupo III: 6 y más). Se correlacionó cada grupo con mortalidad, complicaciones y duración de la estadía post operatoria con prueba de Chi cuadrado de independencia de variables y análisis de varianza de una vía. Resultados: Grupo I: 224 pacientes, grupo II: 279 pacientes y grupo III: 195 pacientes. La mortalidad observada fue de 1.3%, 4.6% y 7.2% respectivamente (p = 0.012). Se presentaron complicaciones en un 15.2%, 26.5% y 30.2%, respectivamente (p = 0.002). Los días de estada postoperatoria promedio fueron 7.4, 7.4 y 9.2 (p = 0.01). Conclusiones: El EuroScore se correlacionó adecuadamente con la mortalidad, complicaciones y duración de la estadía post - operatoria.


Background: The EuroSCORE is a risk scale designed to predict mortality in cardiac surgery. Aim: to evaluate the EuroSCORE as a predictor of mortality, complications and length of hospital stay in patients undergoing cardiac surgery. Methods: the EuroSCORE was determined in all patients undergoing cardiac surgery at the Hospital Regional de Concepcion between January 2002 and December 2005 (n=698). Mean age was 56.7 years, 452 patients were males. Obstructive pulmonary disease was present in 19, peripheral vascular disease in 29, and active infective endocarditis in 21. Seventy patients were critically ill before surgery and 52 were reoperations. Unstable angina waspresent in 155; the left ventricular ejection fraction was severely depressed in 10 and moderately depressed in 82. Prior myocardial infarction within 90 days was present in 128. Surgery was classified as urgent in 59. According to the EuroSCORE, three groups were identified: G1 (0-2 points, n=224), G2 (3-5 points, n=279) and G3 (³ 6 points, n=195). Operative mortality, complications and length of hospital stay were compared across groups using one way ANOVA. Results: Operative mortality was 1.3%, 4.5% and 7.2% in G1, G2 and G3, respectively (p=0.012). Complications developed in 15.2%, 26.5% and 30.2%, respectively (p=0.002). Mean hospital stay was 7.4, 7.4 and 9.2 days, respectively (p=0.01). Conclusion: The EuroSCORE was a useful predictor of mortality, complications and length of hospital stay in patients undergoing cardiac surgery.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Heart Diseases/surgery , Postoperative Complications/diagnosis , Risk Assessment/methods , Cardiac Surgical Procedures/mortality , Length of Stay/statistics & numerical data , Analysis of Variance , Chi-Square Distribution , Chile , Heart Diseases/mortality , Postoperative Complications/epidemiology , Predictive Value of Tests , Prospective Studies , Cardiac Surgical Procedures/statistics & numerical data , Risk Factors
13.
Rev. chil. cardiol ; 26(4): 407-414, 2007. ilus, tab
Article in Spanish | LILACS | ID: lil-499077

ABSTRACT

Introducción: La prótesis Ultracor® es una válvula mecánica monodisco. Se utilizó para reemplazo valvular aórtico(RVA) en nuestro servicio entre 1995 y 2003. Objetivo: Evaluar los resultados del uso de prótesis Ultracor en posición aórtica. Método: Revisión retrospectiva de fichas clínicas de pacientes sometidos a RVA exclusivo con prótesis Ultracor entre 1995 y 2003 en el Hospital Regional de Concepción (N=117). Se tabularon los datos demográficos, patología valvular, capacidad funcional (CF) y fracción de eyección pre operatorios; y la morbi - mortalidad operatoria. En el seguimiento se evaluaron los episodios de hemorragia, tromboembolismo, endocarditis, necesidad de reoperación y defunciones tardías. Resultados: 77 pacientes (65.8 por ciento) de sexo masculino. Edad promedio 54.4 años. 62 pacientes (53 por ciento) estaban en CF I ó II. La indicación quirúrgica fue por estenosis en 59 (50.4 por ciento) e insuficiencia en 42 (53.9 por ciento). Se presentaron complicaciones en 34 pacientes (29 por ciento) y fallecieron 6 (5.1 por ciento). Seguimiento en 105 pacientes (94.6 por ciento) con un total de 402 años/paciente (promedio 3.9 años). Las tasas de complicaciones ( por ciento / año) fueron: 1.2 para tromboembolismo y 2.5 para hemorragia, 1 para endocarditis y 1 para reoperación. Fallecen 18 pacientes en el seguimiento (2.2 por ciento /año). Se realizó ecocardiograma a 75 pacientes. No hubo disfunción estructural y se presentaron 4 leak perivalvulares. Conclusiones: En esta serie observamos tasas de complicaciones similares a las publicadas para otras prótesis. La mayoría de ellas (tromboembolismo, hemorragia, endocarditis y reoperación por endocarditis) no son atribuibles directamente a la prótesis y consideramos que los resultados obtenidos con ella son satisfactorios.


Background: The Ultracor® monodisk prosthesis was used to correct aortic valve disease in our institution in the 1995-2003 period. Aim: To evaluate late results of aortic valve replacement using the Ultracor® prosthetic valve Methods: The clinical records of patients receiving an Ultracor® prosthesis as isolated valve replacement for aortic valve disease at the Hospital de Concepción from 1995 to 2003 were reviewed. A total of 117 patients were evaluated preoperatively to determine the type of aortic valve disease, functional class and LV ejection fraction. Operative mortality and morbidity were recorded. Late results were evaluated in terms of thrombo-embolic and hemorrhagic complications, infective endocarditis, need for reoperation and late death. Results: There were 77 males (66 percent) and the mean age was 54.4 years. Sixty two patients were functional class 1 or 2 (53 percent). Aortic stenosis in 50.4 percent and aortic insufficiency in 53.9 percent were the indications for surgery. Operative mortality was 5.1 percent and significant complications developed in 29 percent. Follow up was obtained in 105 patients (94.6 percent) for a total of 402 patient-years (mean 3.9). Complication rates ( percent per year) were: thrombo-embolism 1.2, bleeding 2.5, endocarditis 1 and reoperation 1. Eighteen patients died during follow up (2.2 percent per year). An echocardiogram performed in 75 patients showed a paravalvular leak in 4; there were no instances of structural damage of the prosthesis. Conclusion: Overall clinical results of aortic valve replacement with the Ultracor® prosthesis were quite satisfactory and complications occurred with rates similar to those reported for other aortic prosthesis. They were not related to the valve.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Blood Vessel Prosthesis , Blood Vessel Prosthesis Implantation/methods , Aortic Valve/surgery , Aortic Valve Stenosis/surgery , Hemorrhage/etiology , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis Implantation/mortality , Aortic Valve Insufficiency/surgery , Postoperative Complications , Reoperation , Retrospective Studies , Survival Rate , Treatment Outcome , Thromboembolism/etiology
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