Cirugía de revascularización miocárdica versus angioplastía coronaria con stent en enfermedad de tres vasos y/o tronco común izquierdo en diabéticos: meta-análisis de estudios aleatorios / Meta-analysis of coronary artery bypass surgery compared to percutaneous transluminal angioplasty with stent in diabetic patients

Background: Diabetic patients are a group of primary interest in the study of myocardial revascularization. Aim: To compare coronary artery bypass grafting surgery (CABG) and percutaneous angioplasty with stents (PCI-S) in diabetic patients with coronary three-vessel or left main coronary artery disease. Material and Methods: Meta-analysis of MEDLINE randomized controlled studies comparing CABG and PCI-S in diabetic patients. The primary outcome measure was major adverse cardiovascular events (MACCE), death, myocardial infarction, cerebrovascular accident (CVA) and coronary re-intervention. Secondary outcomes were the individual components of MACCE. Results: Three studies comparing CABG and PCI-S met the inclusion criteria. One thousand sixty two patients were studied: 565 in the CABG group and 597 in the PCI-S group. At one year follow up MACCE occurred in 24.9 and 12.7% of patients in PCI-S and CABG groups, respectively (Odds ratio (OR) 2.27; 95% confidence intervals (CI) 1.66-3.09). There were no differences in death or myocardial infarction. Strokes were less common in the PCI-S group (OR 0.25, 95% CI0.09-0.68) and coronary re-intervention was required with higher frequency in the PCI-S group (OR 5.32, 95% CI 3.27-8.67). Conclusions: In diabetic patients with three-vessel coronary disease or left main coronary artery, revascularization with CABG had significantly less MACCE at one year than those treated with PCI-S. Stroke frequency was higher in CABG, coronary re-intervention was higher in PCI-S. These results must be interpreted cautiously.

Resultados alejados de la cirugía reparadora de la insuficiencia mitral isquémica / Long-term results of mitral valve repair for ischemic mitral insufficiency

Background: The preferred treatment for ischemic mitral insufficiency is mitral valve repair with a prosthetic ring, because it does not deteriorate left ventricular function, allowing better immediate and long-term results. Aim: To assess long-term results of mitral annuloplasty with a prosthetic ring for ischemic mitral insufficiency. Patients and Methods: One hundred patients (68 men), with a mean age of 65.7 ± 8.6 years were included. They underwent a mitral annuloplasty with a prosthetic ring to treat ischemic mitral insufficiency, between February 1992 and May 2009. Fortyfour had a history of prior myocardial infarction and 46 had an evolving acute coronary syndrome. The inferior left ventricular wall was involved, exclusively or associated with an adjacent wall, in 72 cases. Coronary artery bypass grafts were performed in 92 patients and 32 required intra-aortic balloon pumping at some time during the peri-operative period. Results: Operative mortality was 10% (10 patients). During follow-up 30 patients died, at an average of 39 months after surgery (range: 3-142 months). Actuarial long-term survival rates at 1, 3 and 5 years were 79%, 72% and 64.5%, respectively. Trans esophageal echocardiogram performed in the operating room showed none or minimal residual mitral insufficiency in 96% of the cases. Echocardiographic follow-up was completed in 80% of the survivors; 79% of them had no or minimal mitral insufficiency. Only one patient was re-operated on due to severe mitral insufficiency and 4 required a permanent pacemaker. Conclusions: Considering the critical illness of these patients, good long-term results were observed after treatment of ischemic mitral regurgitation performing a mitral annuloplasty with a prosthetic ring.

Evolución alejada del reemplazo valvular aórtico con prótesis mecánica: experiencia con prótesis de Starr-Edwards (1965-1974) y Bjork Shiley (1973-1981) / Results of isolated aortic valve replacement using either Starr-Edwards or Bjork-Shilley prosthesis

We compared the short and long term results of isolated aortic valve replacement in 98 patients receiving a Starr-Edwards (SE) prosthesis from 1965 to 1974 and 80 pts receiving a Bjork-Shiley (BS) prosthesis from 1973 to 1981 at our institution. Operative mortality was 20% (SE) and 6% (BS). Follow up information was obtained in 88% (SE) and 96% (BS) of pts discharged alive. The mean period of follow up was 8.2 and 6.7 years respectively. the 5 and 10 year acturial survival rates were 72% and 61% (SE) vs 89% and 83% (BS). Complications per 100 pt-years among pts with SE and those with BS were: systemic emboli 2.8 vs 0.6, major hemorrhagic events 1.25 vs 1.36, perivalvular leak 1.6 vs 1.15, endocarditis 0.31 vs 0.39, prosthetic thrombosis 0 vs 0.58 and ball variance 0.47 vs 0m respectively. Some of these differences may reflect shortcomings of the initial surgical experience during the period in which the SE prothesis was used, rather than different performance of both valves

Síndrome de Wolff Parkinson White: resultados alejados del tratamiento quirúrgico / Wolff-Parkinson-White syndrome: late results of surgical treatment

We followed 25 patients operated on for Wolff-Parkinson-White syndrome between august 1985 and octuber 1989. Their mean age was 37 ñ 12 years and arrhythmia had been present for 5 to 30 years. A mean of 3.3 ñ 1.2 years antiarrhytmic agents had failed in controlling rrecurrences. Tachycardia was orthodromic in 21 patients and antidromic in 1, while 3 patients presented rapid atrial fibrillation with hemodynamic deterioration. Drug refractoriness (n = 23) or intolerance (n = 2) were the main surgical indications. The location of accessory pathways was lateral in 19 patients, anteroseptal in 3, posteroseptal in 2, postero lateral in 1 and right lateral in 1 patient. One patient hada a double pathway. There was no surgical mortality. After a follow-up period ranging from 1 to 50 months reccurence of arrythmia was observed in one patient and electrophysiologic evaluation showed persistance of a left lateral pathway in another. The remaining 24 patients are free of symptoms at the end of follow up. Thus, surgical treatment is a curative therapy for most patients with WPW