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.

Revascularización miocárdica de la arteria descendente anterior con arteria mamaria interna izquierda: comparación de dos técnicas en el largo plazo / Anterior descending coronary artery grafting with left internal mammary artery with and without extracorporeal circulation: comparison of two techniques in the long term follow up

En años recientes el uso de arteria mamaria interna izquierda (LIMA) como injerto a la arteria descendente anterior (DA) sin circulación extracorpórea (CEC) ha demostrado resultados similares a la técnica convencional. Objetivo: Comparar y comunicar los resultados obtenidos con el uso de LIMA a DA con y sin CEC en lesiones aisladas de la DA. Material y método: Estudio descriptivo de 85 pacientes en quienes se realizó cirugía coronaria entre 1992 y 2004. Resultados: Edad promedio fue 62.5 años (DE + 9.575, rango 35-77 años), 59 de sexo masculino; el test de ANOVA no demostró diferencias entre los grupos en relación a factores de riesgo preoperatorios, características angiográficas y presentación clínica. 40 pacientes fueron operados con CEC y 45 sin CEC. El tiempo quirúrgico promedio y en ventilador mecánico fue mas corto para el grupo sin CEC (p<0.005). No hubo mortalidad operatoria, infarto miocárdico, accidente cerebrovascular o necesidad de reoperación en el grupo con CEC. Se realizó una reoperación en 1 paciente sin CEC. En el seguimiento hubo 2 muertes alejadas debido a falla cardiaca y renal avanzadas en el grupo con CEC y ninguna en el grupo sin CEC. La probabilidad de sobrevida actuarial fue 96 por ciento a 139 meses en el grupo con CEC y 98 por ciento a 64 meses en el grupo sin CEC. Conclusiones: En este grupo de pacientes el uso de LIMA como injerto a la DA con ambas técnicas es un procedimiento seguro, el que provee un tiempo prolongado libre de eventos como mortalidad, angina, infarto miocárdico y necesidad de un nuevo procedimiento coronario en el seguimiento a largo plazo.

Background: In recent years the use of left internal mammary artery (LIMA) as a graft to anterior descending artery (DA) with the off pump technique has been associated with similar good long term results as with the on pump technique. Aim: To compare and report the results of LIMA to DA bypass grafting with and without extracorporeal circulation (EC) for isolated DA lesions. Patients and methods: Descriptive study of 85 patients subjected to coronary surgery between 1992 and 2004. Results: Mean age was 62.5 years (DE+9.575, range 35-77 years), 59 were male, ANOVAtest showed no differences between groups related to preoperative risk factors, angiographic characteristics and clinical presentation. 40 patients were operated on pump and 45 off pump. Mean operative time and time in mechanical ventilator were shorter for the off pump group (p<0.005). There was no operative mortality, myocardial infarction, stroke or need of a reoperation in the on pump group. There was a reoperation in 1 patient in the off pump group. In the follow up there were 2 late deaths because of advanced cardiac and chronic renal failure in the on pump group and none in the off pump group. Actuarial survival probability was 96 percent at 139 months in the on pump group and 98 percent at 64 months in the off pump group. Conclusions: In this group of patients the use of LIMA as a coronary bypass graft to DA with both techniques is a safe surgical procedure, providing a prolonged time free from cardiac events as mortality, angina, myocardial infarction, and need of a new coronary procedure in the long term follow up.