Repercusión de la pandemia COVID-19 en la práctica de la cardiología intervencional en Chile: datos aportados por la encuesta del grupo Stent-Save a Life! LATAM working group / Decrease in the activity of interventional cardiology in Chile: a report from the "Stent-Save a Life! LATAM working group"

RESUMEN: Introducción: El Stent-Save a Life! (SSL) LATAM working group diseñó una encuesta para objetivar la reducción de la actividad de los laboratorios de hemodinamia en Latinoamérica durante la pandemia COVID-19. Ante la amenaza de nuevos confinamientos en Chile, nos propusimos objetivar las consecuencias de la primera ola de contagios en nuestra actividad. Objetivos: Discutir la repercusión de la pandemia en la cardiología intervencional en Chile. Métodos: El grupo SSL realizó una encuesta telemática a todos los países de Latinoamérica incluido Chile. Se registraron las coronariografías (CAG), intervenciones coronarias percutáneas (ACTP) e intervenciones estructurales, comparando dos períodos determinados por el confinamiento por la pandemia, cada uno de dos semanas. Pre-COVID-19: período previo al confinamiento, y COVID-19: período durante el confinamiento. Se analizan, a partir de esta encuesta, los resultados aplicados a nuestro país. Resultados: Se obtuvo respuesta de trece centros. Hubo una reducción en el número global de procedimientos entre período Pre-COVID-19 y COVID-19 de un 65,1%. Se reportó una disminución de 67% en las CAG, de un 59,4% en las ACTP y de un 92% en los procedimientos terapéuticos estructurales. Entre ambos períodos se redujo la consulta por Síndrome Coronario Agudo por elevación del segmento ST (SCACEST) en 40,8%. Conclusiones: En nuestro país se objetivó una reducción marcada de la actividad asistencial de la cardiología intervencional durante la pandemia COVID-19 y una disminución significativa en el número de pacientes tratados por SCACEST. Los resultados de nuestro país son similares a los reportados por países de Latinoamérica, Europa y Norteamérica.

ABSTRACT: Background: The Stent-Save a Life! (SSL) LATAM working group designed a survey to demonstrate the reduction in the activity of cardiac catheterization laboratories in Latin America during the COVID-19 pandemic. Considering the risk of a new confinement in Chile, we decided to assess the impact of the first wave of contagions on our activity. Aims: To discuss the repercussion of the COVID-19 pandemic on the activity of interventional cardiology in Chile. Methods: The SSL group conducted a telematic survey in all Latin American countries. Coronary angiography, coronary interventions (PCI) and structural interventions were registered, comparing two periods of two weeks duration each: before and during COVID-19 confinement. Results obtained in Chile are analyzed. Results: Thirteen centers in Chile answered the survey. There was an overall decrease of 65.1% in the number of procedures between the pre and the post COVID-19 periods. Coronary angiographies decreased 67%, PCI 59.4% and therapeutical structural procedures 92%. The reduction in acute coronary syndrome with ST segment elevation (STEMI) was 40,8% between periods. Conclusions: In Chile, a significant reduction in healthcare activity related to interventional cardiology and a significant decrease in the number of patients treated with STEMI was observed during the COVID-19 pandemic. The results are similar to those reported by Latin American, European and North American countries.

Imagem Cardiovascular e Procedimentos Intervencionistas em Pacientes com Infecção pelo Novo Coronavírus / Cardiovascular Imaging and Interventional Procedures in Patients with Novel Coronavirus Infection

Resumo A pandemia da doença causada pelo novo coronavírus (COVID-19) trouxe grandes desafios para o sistema de saúde devido ao aumento exponencial do número de pacientes acometidos. A racionalização de recursos e a indicação correta e criteriosa de exames de imagem e procedimentos intervencionistas tornaram-se necessárias, priorizando a segurança do paciente, do ambiente e dos profissionais da saúde. Esta revisão visa auxiliar e orientar os profissionais envolvidos na realização desses exames e procedimentos a fazê-los de forma eficaz e segura.

Abstract The coronavirus disease 2019 (COVID-19) pandemic is a huge challenge to the health system because of the exponential increase in the number of individuals affected. The rational use of resources and correct and judicious indication for imaging exams and interventional procedures are necessary, prioritizing patient, healthcare personnel, and environmental safety. This review was aimed at guiding health professionals in safely and effectively performing imaging exams and interventional procedures.

Avaliação do tempo de permanência hospitalar em cirurgia cardíaca em um hospital universitário / Evaluation of hospital permanence time in heart surgery in a university hospital / Evaluación del tiempo permanencia en el hospital en la cirugía del corazón en un hospital universitario

Objetivos: verificar a associação entre o tempo de internação hospitalar de pacientes submetidos à cirurgia cardíaca com as variáveis sociodemográficas e clínicas. Método: estudo transversal, retrospectivo a partir da análise de dados secundários de indivíduos que realizaram cirurgias cardíacas em um hospital universitário, na região Sudeste do Brasil. Resultados: foi identificada mediana de tempo de internação hospitalar maior nos pacientes com idade de 60 anos ou mais, sexo masculino, com comorbidades prévias. Além disso, a internação foi mais prolongada nos indivíduos que apresentaram complicações no pós-operatório como eventos neurológicos, arritmias cardíacas, insuficiência renal aguda, complicações pulmonares e infecção hospitalar. Conclusão: a associação das características e a identificação do perfil de pacientes que em geral permanecem mais tempo no leito poderão ser úteis na elaboração de protocolos e fluxos institucionais

Objectives: to verify the association between the length of hospital stay of patients undergoing cardiac surgery and the sociodemographic and clinical variables. Method: cross-sectional, retrospective study based on secondary data analysis of individuals who underwent cardiac surgery at a university hospital in the Southeast region of Brazil. Results: median length of hospital stay was identified higher in patients aged 60 years or older, male, with previous comorbidities. In addition, hospitalization was longer in individuals with postoperative complications such as neurological events, cardiac arrhythmias, acute renal failure, pulmonary complications, and nosocomial infection. Conclusion: the association of the characteristics and the identification of the profile of patients who usually stay longer in bed may be useful in the elaboration of protocols and institutional flows

Objetivos: verificar la asociación entre la duración de la estancia hospitalaria de los pacientes sometidos a cirugía cardíaca y las variables sociodemográficas y clínicas. Método: estudio transversal retrospectivo basado en el análisis de datos secundarios de individuos que se sometieron a una cirugía cardíaca en un hospital universitario en la región sudeste de Brasil. Resultados: la mediana de la duración de la estancia hospitalaria se identificó más alta en pacientes de 60 años o más, hombres, con comorbilidades previas. Además, la hospitalización fue más prolongada en individuos con complicaciones postoperatorias como eventos neurológicos, arritmias cardíacas, insuficiencia renal aguda, complicaciones pulmonares e infección nosocomial. Conclusión: la asociación de las características y la identificación del perfil de los pacientes que suelen permanecer más tiempo en la cama puede ser útil en la elaboración de protocolos y flujos institucionales

Oral health status, health behaviour and treatment needs of patients undergoing cardiovascular surgery

Abstract Objective: The aim of the present study was to assess the oral health status and treatment needs of cardiovascular surgery patients. Second, the awareness of cardiovascular surgery patients regarding the association between oral health and heart disease was considered. Methods: Assessment of oral health status, oral hygiene practices and treatment needs of 106 hospitalized patients in preparation for cardiovascular surgery. Patients were interviewed using a structured questionnaire designed for this study and oral examination was carried out by a dentist. Results: The oral hygiene practices of the study cohort were not up to the standard. Patients' awareness of infective endocarditis was poor. Approximately 68% patients experienced dental caries as decayed teeth or missing teeth due to caries and filled teeth. The mean plaque index in the study group was 1.25. In this study cohort, the mean probing depth of periodontal pockets was 5.7±1.3, whereas the mean number of teeth with periodontal pockets > 6 mm was 0.5±0.9. A total of 84 (74.2%) of the patients required dental treatment. Conclusion: The principal finding in this study was that patients with heart disease had poor oral health. This study also highlights the importance of better interaction among all healthcare professionals to integrate oral health as part of comprehensive inpatient healthcare.

The brazilian registry of adult patient undergoing cardiovascular surgery, the bypass project: results of the first 1,722 patients

Abstract Objective: To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Methods: Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8), Northeast (5), South (3), and Center-West (1). The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG), mitral valve, aortic valve (either conventional or transcatheter), surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults. Results: 83.1% of patients came from the public health system (SUS), 9.6% from the supplemental (private insurance) healthcare systems; and 7.3% from private (out-of -pocket) clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%; for CABG was 2.6%, and for valve operations, 4.4%. Conclusion: This first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.

Tratamento das cardiopatias congênitas em Sergipe: proposta de racionalização dos recursos para melhorar a assistência / Heart defects treatment in Sergipe: propose of resources' rationalization to improve care

OBJETIVO: Avaliar o tratamento das cardiopatias congênitas realizadas de 2000 a 2009. MÉTODOS: A amostra constituiu-se de todos os pacientes submetidos a correção cirúrgica para cardiopatias congênitas por dez anos em Sergipe, Brasil. Os pacientes foram operados em três hospitais localizados na cidade de Aracaju (SE, Brasil), capital do estado de Sergipe. O estudo foi dividido em dois períodos, definidos pela data do início da centralização das cirurgias. As variáveis coletadas foram: faixa etária, gênero, diagnóstico pós-operatório, destino, tipo de cirurgia e hospital em que foi realizado o procedimento e a classificação RACHS -1. RESULTADOS: No período I, a estimativa do déficit de cirurgia foi de 69%, ocorrendo decréscimo no período II para 55,3%. O diagnóstico pós-operatório mais frequente foi de fechamento de comunicação interventricular (20,5%), fechamento de canal arterial (20,2%) e da comunicação interatrial (19%). Houve correlação estatisticamente significativa entre mortalidade esperada pelo RACHS-1 e a observada na amostra. A avaliação do RACHS-1 como fator preditor da mortalidade hospitalar por meio da curva ROC demonstrou área de 0,860 IC 95% 0,818 a 0,902, com P < 0,0001. CONCLUSÃO: Os resultados deste estudo indicam que a centralização e a organização dos recursos existentes são necessárias para melhora no desempenho das correções cirúrgicas das cardiopatias congênitas.

OBJECTIVE: This study aims evaluate the treatment of congenital heart disease conducted from 2000 to 2009. METHODS: The sample consisted of all patients undergoing surgical correction for congenital heart disease for ten years in Sergipe, Brazil. The patients were operated in three hospitals located in the city of Aracaju, capital of the state of Sergipe (Brazil). The study was divided into two periods defined by the start date of centralization of surgery. The variables collected were: age, sex, postoperative diagnosis, destination, type of surgery and hospital where the procedure was performed and the classification RACHS -1. RESULTS: In the period I, the estimate deficit of surgery was 69% decrease occurring in the period II to 55.3%. The postoperative diagnosis was more frequent closure of the interventricular communication (20.5%), closure of patent ductus arteriosus (20.2%) and atrial septal defect (19%). There was a statistically significant correlation between the expected mortality RACHS-1 and observed in the sample. The evaluation of RACHS-1 as a predictor of hospital mortality by ROC curve showed area of 0.860 95% CI 0.818 to 0.902 with P <0.0001. CONCLUSION: The results of this study indicate that the centralization and organization of existing resources are needed to improve the performance of surgical correction of congenital heart diseases.

Influencia del sexo en los resultados de la cirugía coronaria. Análisis comparativo entre hombres y mujeres / Influence of gender on coronary surgery results. Comparative analysis between men and women

El propósito del presente trabajo fue comparar las características clínicas, técnica quirúrgica y resultados hospitalarios entre hombres (H) y mujeres (M) sometidos a cirugía coronaria (CC)...Se observó que ambos sexos presentan diferencias significativas en las características clínicas basales, en la técnica quirúrgica y en los resultados hospitalarios, con peor evolución en el sexo femenino

Marcapasos endocavitario: acceso difícil / Difficult approach during a pacemaker placement

Objetivo: Comunicar nuestra experiencia en acceso dificultoso durante la colocación de marcapasos endocavitario. Material y método: Análisis retrospectivo de las historias clínicas de 258 pacientes durante el período 1994-1996. Se definió como acceso vascular difícil, a la necesidad de utilizar más de un acceso venoso para colocar el electrodo endocavitario. Se analizó la incidencia de acceso difícil, sus causas y la conducta tomada en cada caso. Resultados: En 254 pacientes se implantaron marcapasos y en 4 cardiodesfibriladores. La incidencia de acceso dificultoso fue de 2,3 por ciento (6 pacientes). La causa más frecuente de fracaso fue la trombosis venosa. Las vías alternativas para colocar el electrodo fueron por punción subclavia o yugular interna durante el mismo procedimiento en todos los casos menos en uno que requirió (catéteres?) epicárdicos. Conclusión: La incidencia de acceso difícil es baja, pudiendo realizarse en la mayoría de los casos un acceso alternativo durante el mismo acto quirúrgico. Es conveniente prever esta dificultad, preparando el campo quirúrgico para ello

Infecciones mediastinales postesternotomía / Post sternotomy mediastinal infections

Objetivo: El objetivo de este trabajo es describir las variables de esta grave complicación relativas a sus características clínico-quirúrgicas, resultado del tratamiento y mortalidad. Material y métodos: Se revisan restrospectivamente los casos de infecciones mediastinales postesternotomía en 613 pacientes operados con circulación estracorpórea en el período comprendido entre mayo de 1995 hasta marzo de 1998. Resultados: Ocurrieron 7 casos de infecciones mediastinales postesternotomía (1,14 por ciento), 6 eran de sexo masculino y 1 femenino. Las cirugías realizadas en estos pacientes fueron: by pass coronario con arteria mamaria en 6 casos y cirugía valvular en 1 caso. Dentro de los factores de riesgo fue prevalente el deterioro de la función sistólica del ventrículo izquierdo en 5 pacientes, asistencia mecánica respiratoria en 4 pacientes, cirugía cardíaca previa en 2 y tiempo prolongado de circulación extracorpórea sólo en 2. El intervalo entre la cirugía y la aparición de infección osciló entre 4 y 30 días. Clínicamente se presentó con secreción purulenta o serohemática de la herida y dehiscencia esternal, excepto en un paciente que debutó con clínica de taponamiento cardíaco. El tratamiento realizado fue: toilette mediastinal, resíntesis esternal, drenaje e irrigación continua con solución antibiótica. Los gérmenes aislados fueron: estafilococo 4n 4 pacientes, pseudomona Aeruginosa y estreptococo B hemolítico en 1 paciente, escherichia Coli en 1 y cultivo negativo en 1. De los 7 pacientes, 2 fallecieron: 1 por sepsis y otro por hemorragia mediastinal masiva; resultando en una mortalidad de 28,5 por ciento. Cinco pacientes fueron externados y viven libres de enfermedad. Conclusiones: Las infecciones mediastinales postesternotomía deben ser tratadas en forma precoz, agresiva y multidisciplinaria a los fines de disminuir la elevada mortalidad que conllevan estos graves pacientes