Cardiopatías congénitas,resultados del manejo perioperatorio en 18 meses: experiencia en el departamento de cardiocirugía: Centro Materno Infantil, Universidad Nacional de Asunción / Results of perioperative care of patients with congenital heart defects during 18 months experience of the cardiac surgery department of the Centro Materno Infantil: National University of Asunción

RESUMEN

Objetivos: Describir el manejo perioperatorio y la evolución postoperatoria de las cirugías realizadas en el Dpto. de Cardiocirugía de la Cátedra y Servicio de Pediatría del CMI-FCM-UNA en 18 meses de atención y su relación con el carácter de la cirugía y el estado físico preoperatorio del paciente. Fueron operados 91 ptes, 53 de sexo femenino (58%), con edades comprendidas entre 2 días y 18 años. Las cardiopatías fueron 54(59,3%) patologías simples y 37(40,7%) patologías complejas, todas con confirmación diagnóstica preoperatoria por ecocardiografía Doppler color. Precisaron cateterismo cardiaco preoperatorio 3 ptes.(3,3%). El 100% de las cirugías se realizaron con anestesia general balanceada. De los 91 ptes operados, 42(46,2%) fueron sometidos a circulación extracorpórea (CEC) y 49 (53,8%) sin CEC. De los 42 ptes. operados con CEC, todas fueron cirugías correctivas, 40(95,2%) electivas, 2(4,8%) de urgencia, 3(7,1%) reintervenciones y 2(4,8%) fallecieron. Presentaron complicaciones 16 ptes.(38,1%), 39(92,9%) requirieron ARM menos de 24 horas y 3(7,1%) más de 24 horas. Los tiempos de clampado aórtico variaron de 13 a 167 minutos (media 49,1) y los tiempos de CEC de 20 a 253 minutos (media 71,9). Se realizó ultrafiltrado plasmático (UFP) en el 100% de los ptes. operados con CEC, y todos ellos recibieron aprotinina para profilaxis del sangrado. De los 49 pacientes operados sin CEC, 30 (61,2%) fueron cirugías correctivas, 19 (38,8%) paliativas, 31 (63,3%) electivas, 18 (36,7%) urgencias, 1 (2,1%) reintervención y 10 (16,3%) fallecieron. Presentaron complicaciones 18 pacientes (36,7%), 39 (79,6%) precisaron ARM menos de 24 horas y 10 (20,4%) más de 24 horas. Del total de pacientes operados, 34 presentaron alguna complicación, el 50% fue de tipo hemodinámico, 35,3% respiratorio, 23,5% neurológico, 14,7% infeccioso, 14,7% metabólico, 11,8% hematológico y 11,8% renal. El 28% de las complicaciones se presentaron en las cirugías electivas y el 65% en las urgencias...

ABSTRACT

Introduction: Survival of patients with congenital heart defects has improved in recent years thanks to improved diagnostic, surgical, anesthetic, and extracorporeal circulation techniques, and the arrival of new and more selective cardioactive drugs. Objectives: To describe perioperative care and postoperative progress of patients following surgery performed in the department of cardiac surgery and pediatrics department of the Centro Materno Infantil (CMI) of the national university's school of medical sciences over a period of 18 months, and its relationship to the type of surgery performed (elective or emergency) and the patient's pre-surgical physical status classification of the American Society of Anesthesiologists (ASA-PS). Materials and Methods: A retrospective, descriptive, observational study with an analytical component using the medical records of patients operated on in the department of cardiac surgery between January 2007 and June 2008. Results:Of the 91 patients undergoing surgery, 38 (42%) were male, and 53 (58%) were female, with ages ranging from 2 days to 18 years. Uncomplicated heart disease was found in 54 patients (59.3%), and complications confirmed by color Doppler echocardiography were found in 37 (40.7%). Cardiac catheters were needed before surgery by 3 patients (3.3%). All surgeries (100%) were performed under balanced general anesthesia. Of the 91 patients operated on, 42 (46.2%) received extracorporeal circulation (ECC) and 49 (53.8%) did not. Of the 42 patients who received ECC, all involved corrective surgery, with 40 (96.2%) of those being elective, and 2 (4.8%) emergency surgery, while 3 (7.1%) were reoperated and 2 (4.8%) died. Complications appeared in 16 patients (38.1%), with 39 (92.9%) requiring mechanically assisted ventilation (MAV) for less than 24 hours, and 3 (7.1%) who received MAV for more than 24 hours...