Miniesternotomía para cirugía valvular aórtica: experiencia inicial en un centro cardiovascular en Chile / Ministernotomy for aortic valve surgery: report of 20 patients

Background: Aortic valve surgery can be performed through a reduced mid sternotomy with excellent long term results. Aim: To report the initial results obtained with this technique. Patients and methods: Descriptive study of 20 patients aged 48±11 years, subjected to valve replacement surgery for aortic valve disease between 2004 and 2007. Arterial and venous cannulation were performed with the usual method and extracorporeal circulation was performed with a mean perfusion of 4.5 L/min. Hypothermia and cardioplegia were performed infusing the hematic cardioplegic solution at 4°C in the aortic root or coronary ostia. Results: Sixteen patients were in functional class (FC) III. Fourteen patients had aortic insufficieney and six had predominant stenosis. There was no operative mortality One patient had a left hemothorax and was reoperated. All patients were discharged between 4 and 6 days after surgery. Mean follow up was 21 ± 4 months. AU patients are in FC I and free from cardiac events. Echocardiographic assessment was done in 16 patients, showing a good motility of valve disks. Actuarial survival probability was 100 percent and probability of freedom from cardiac events was 100 percent at 42 months of follow up. Conclusions: Ministernotomy is an excellent approach for aortic valve surgery providing good visualization ofthe ascending aorta, simplifying the surgical technique.

Factores asociados a mortalidad en la cirugía de reemplazo valvular por endocarditis complicada / Risk factors related to mortality in heart valve replacement for complicated endocarditis

La Endocarditis Infecciosa (El) es una enfermedad grave, dada por la agresividad del agente sobre el aparato cardiovascular y otros órganos. La cirugía de reemplazo valvular (CRV) es el tratamiento definitivo frente al fracaso del tratamiento médico, la cual está asociada a una elevada mortalidad al presentarse con daño estructural severo. Objetivo: Evaluar los factores asociados a mortalidad en pacientes sometidos a CRV por El. Pacientes y método: Estudio descriptivo de 32 pacientes consecutivos sometidos a CRV en el período 1993-2005, consignando antecedentes clínicos que determinen una probable mortalidad. Resultados: La mortalidad global fue de 25 por ciento, principalmente en los primeros 15 días (60 por ciento). Los principales factores asociados son sepsis (p =0.002), la cirugía mitro-aórtica (p <0.001) y la presencia de alcoholismo (p =0.049). La probabilidad de supervivencia actuarial es de 78 por ciento a 146 meses. Conclusión: La mortalidad de nuestra serie es semejante a otros centros, existiendo un mayor riesgo en los primeros días post CRV. El reemplazo bivalvular y la presencia de sepsis son los principales factores de riesgo precoz.

Infectious endocarditis is a severe illness related to the aggressiveness of the microbial agent to the cardiovascular system. Heart valve replacement surgery is the definitive treatment in these patients but is related to high mortality when the structural damage is severe. Objective: To assess risk factors related to mortality in patients operated for complicated endocarditis. Patients and method: Descriptive study of 32 patients operated between 1993-2005 period in which clinical factors were evaluated and related to mortality. Results: Overall mortality was 25 percent, mainly in the first two weeks after surgery (60 percent). Mortality related risk factors were sepsis (p =0.002), mitro-aortic replacement (p <0.001) and alcoholism (p =0.049). Actuarial survival probability is 78 percent to 146 months in the group. Conclusion: Mortality is similar to others cardiac centres and is higher in the first two weeks alter surgery. Mitro aortic replacement and sepsis are the main factors of early mortality risk.

Cirugía de la endocarditis infecciosa en un centro regional en Chile: Análisis de casos y resultados en el largo plazo / Surgery for bacterial endocarditis: Retrospective study of 32 patients

Background: Surgery for active endocarditis is indicated in cases of congestive heart failure (CHF), persistent sepsis, systemic embolization and paravalvular involvement. Aim: To assess and report the long term results of surgery in adult patients. Patients and methods: Retrospective review of clinical records and operative procedures of 32 patients aged 43± 13 years (28 women) subjected to reparative surgery for complications of endocarditis between 1993 to 2005. Results: In 25 percent of cases, endocarditis presented as a prolonged sepsis syndrome and in 31 percent as a CHF or both. The causative bacteria was Gram (+) in 53 percent and blood cultures were negative in 47 percent. Preoperative echocardiography showed vegetations in 56 percent of cases. An annular abscess, aortic valve rupture and bicuspid valve, was observed in 13 percent of patients. Post operative mortality was due to persistent sepsis and multiorganic dysfunction in 16 percent. Mean long term follow up was 43.8±47.2 months. Actuarial survival was 78 percent at 146 months. Conclusion: Surgical management of active endocarditis provides a good symptomatic recovery, with an excellent long term actuarial survival.