Cirugía convencional del aneurisma tóraco-abdominal / Open surgical treatment of thoracoabdominal aortic aneurysm. Experience in 45 patients

BACKGROUND: Thoracoabdominal aortic aneurysm (TAAA) is an infrequent disease and demands a highly specialized and experienced management. Open repair (OR) is the gold standard but it is associated with significant morbidity and mortality. Paraplegia and renal failure are the most important complications. AIM: To report our results with OR treatment of TAAA. MATERIAL AND METHODS: Descriptive study including all patients with TAAA operated electively and consecutively by OR between 1983 and 2019. Main outcomes are operative mortality, renal and neurological morbidity, and long-term survival. RESULTS: We report 45 operated patients aged 33 to 84 years, 74% males. Aneurysm extension according to Crawford classification was I in 18%, II in 18 %, III in 36% and IV in 29%. Operative mortality was 4%. The frequency of paraplegia or paraparesis at discharge was 9%. No patient was discharged on hemodialysis. Survival at 5 and 10 years were 60% and 40% respectively. CONCLUSIONS: OR of TAAA is a complex procedure. Our results show perioperative mortality rates comparable to highly experienced centers. Although being a major procedure, OR remains an alternative to treat this serious condition.

[Open surgical treatment of thoracoabdominal aortic aneurysm. Experience in 45 patients]. / Cirugía convencional del aneurisma tóraco-abdominal.

BACKGROUND: Thoracoabdominal aortic aneurysm (TAAA) is an infrequent disease and demands a highly specialized and experienced management. Open repair (OR) is the gold standard but it is associated with significant morbidity and mortality. Paraplegia and renal failure are the most important complications. AIM: To report our results with OR treatment of TAAA. MATERIAL AND METHODS: Descriptive study including all patients with TAAA operated electively and consecutively by OR between 1983 and 2019. Main outcomes are operative mortality, renal and neurological morbidity, and long-term survival. RESULTS: We report 45 operated patients aged 33 to 84 years, 74% males. Aneurysm extension according to Crawford classification was I in 18%, II in 18 %, III in 36% and IV in 29%. Operative mortality was 4%. The frequency of paraplegia or paraparesis at discharge was 9%. No patient was discharged on hemodialysis. Survival at 5 and 10 years were 60% and 40% respectively. CONCLUSIONS: OR of TAAA is a complex procedure. Our results show perioperative mortality rates comparable to highly experienced centers. Although being a major procedure, OR remains an alternative to treat this serious condition.

Comprehensive investigation of pesticides in Brazilian surface water by high resolution mass spectrometry screening and gas chromatography-mass spectrometry quantitative analysis.

In this work, a comprehensive investigation on the occurrence of pesticides in the Paraná 3 hydrographic basin of Paraná State, Brazil, was made by application of wide-scope screening based on ultra-high performance liquid chromatography (LC) and gas chromatography (GC) both coupled to quadrupole time-of-flight mass spectrometry (QTOF MS). The use of two complementary techniques, such as GC-QTOF MS and LC-QTOF MS, allowed screening a large number of compounds with different polarity and volatility. This screening approach was applied to 17 samples, enabling the detection of fifty-two pesticides and six metabolites. In a second step, an specific research was made on the herbicide atrazine, one of the most frequent compounds in samples, and its major transformation products (TPs), which were quantitatively analyzed by dispersive liquid-liquid microextraction (DLLME) followed by GC-MS measurement. Twenty-one agricultural streams from the Paraná 3 hydrographic basin were sampled twice in 2017, each time along six successive weeks. Additional samples were also collected after rain events exceeding 10 mm. In total, 407 samples were quantitatively analyzed by DLLME/GC-MS. Atrazine concentrations did not exceed the maximum permitted concentration of 2 µg L-1 according to Brazilian legislation, and only one surface water sample, collected after precipitation events, was slightly above this value (2.89 µg L-1). The maximum concentrations for the TPs desethylatrazine and deisopropylatrazine were 0.80 and 1.22 µg L-1, respectively. Based on the quantification results, a map was produced showing the occurrence of atrazine and its TPs in the area under study. This is the first time that the presence of agrochemicals is evaluated in the Paraná 3 hydrographic basin.

[Cardiac Magnetic Resonance in long term follow-up of Tetralogy of Fallot]. / Resonancia magnética cardíaca en el seguimiento alejado de pacientes con tetralogía de Fallot.

INTRODUCTION: Tetralogy of Fallot (TOF) is the most frequent cyanotic congenital heart disease. Pulmonary regurgitation (PR) and right ventricle (RV) enlargement and dysfunction are the most common long-term complications. Cardiac magnetic resonance (CMR) is the gold standard for RV evaluation. OBJECTIVE: To analyze CMR results in the follow-up of TOF patients. PATIENTS AND METHOD: All CMR performed between 2007 and 2012 in TOF patients with transannular patch (TAP) repair or infundibular widening, and without pulmonary valve replacement (PVR) were included. Pulmonary regurgitant fraction (PRF), ventricular end-diastolic (EDV) and end-systolic volume (ESV), and ejection fraction (EF) were examined. RESULTS: 122 CMR were performed in 114 patients. Average age at CMR was 15.4±7.4 years. 53.3% of them presented severe PR (> 40%). RVEDV was 157.3 ± 38.6 ml/m2, RVESV was 85.3 ± 27 ml/m2 and RVEF was 46.4 ± 7.1%. RVEDV was > 150 ml/ m2 in 48.4% and > 170 ml/m2 in 32.8% of patients. Patients with TAP showed larger RV volumes compared with those with infundibular widening. RVEDV > 170 ml/m2 showed worse RVEF that those with lower RVEDV (47.9 ± 7% vs 43.2 ± 6.4%, p < 0.01). CONCLUSION: Almost half of the pa tients showed significant RV enlargement, demonstrating that the indication of CMR is late in their follow-up. TAP was associated with higher RVEDV and RVESV, but no worse RVEF.

Resonancia magnética cardíaca en el seguimiento alejado de pacientes con tetralogía de Fallot / Cardiac Magnetic Resonance in long term follow-up of Tetralogy of Fallot

INTRODUCCIÓN: La tetralogía de Fallot (TF) es la cardiopatía congénita cianótica más frecuente. La insuficiencia pulmonar (IP) y dilatación del ventrículo derecho (VD) son las complicaciones más frecuentes a largo plazo. La resonancia magnética cardiaca (RMC) es el "gold standard" para la evaluación del VD. OBJETIVO: Analizar la información obtenida de las RMC en el seguimiento de pacientes con TF. PACIENTES Y MÉTODO: Se incluyeron RMC realizadas entre 2007 y 2012 a pacientes con TF, reparados con parche transanular (PTA) o ampliación infundibular (AInf) y sin recambio valvular pulmonar (RVP). La fracción de regurgitación pulmonar (FRP), el volumen y función ventricular fueron evaluados. RESULTADOS: Se realizaron 122 RMC a 114 pacientes. Edad promedio al examen 15,4 ± 7,4 años. 53,3% presentó IP severa (> 40%). La media del volumen de fin de diástole del VD (VFDVD) fue 157,3 ± 38,6 ml/m2, fin de sístole (VFSVD) de 85,3 ± 27 ml/m2 y fracción de eyección (FEVD) 46,4 ± 7,1%. 48,4% presentaba un VFDVD mayor de 150 ml/m2 y el 32,8% mayor a 170 ml/ m2. El PTA se relacionó con mayores volúmenes de VD que la AInf. VFDVD mayor a 170 ml/m2 mostraron peor FEVD (FEVD 47,9 ± 7% vs 43,2 ± 6,4%, p < 0,01). DISCUSIÓN: Casi la mitad mostró una significativa dilatación del VD demostrando que la indicación de RMC es tardía en el seguimiento. El PTA se asoció con mayores VFDVD y VFSVD pero no a peor FEVD.

INTRODUCCIÓN: Tetralogy of Fallot (TOF) is the most frequent cyanotic congenital heart disease. Pulmonary regurgitation (PR) and right ventricle (RV) enlargement and dysfunction are the most common long-term complications. Cardiac magnetic resonance (CMR) is the gold standard for RV evaluation. OBJECTIVE: To analyze CMR results in the follow-up of TOF patients. PATIENTS AND METHOD: All CMR performed between 2007 and 2012 in TOF patients with transannular patch (TAP) repair or infundibular widening, and without pulmonary valve replacement (PVR) were included. Pulmonary regurgitant fraction (PRF), ventricular end-diastolic (EDV) and end-systolic volume (ESV), and ejection fraction (EF) were examined. RESULTS: 122 CMR were performed in 114 patients. Average age at CMR was 15.4±7.4 years. 53.3% of them presented severe PR (> 40%). RVEDV was 157.3 ± 38.6 ml/m2, RVESV was 85.3 ± 27 ml/m2 and RVEF was 46.4 ± 7.1%. RVEDV was > 150 ml/ m2 in 48.4% and > 170 ml/m2 in 32.8% of patients. Patients with TAP showed larger RV volumes compared with those with infundibular widening. RVEDV > 170 ml/m2 showed worse RVEF that those with lower RVEDV (47.9 ± 7% vs 43.2 ± 6.4%, p < 0.01). CONCLUSION: Almost half of the pa tients showed significant RV enlargement, demonstrating that the indication of CMR is late in their follow-up. TAP was associated with higher RVEDV and RVESV, but no worse RVEF.

Phytotoxicity as an indicator of stability of broiler production residues.

Beddings used for successive broiler lots act as substrate to absorb water and feed from the excreta and may be subsequently used as agricultural fertilizers. This study evaluated the physicochemical characteristics and the phytotoxicity of beddings used to raise five consecutive broiler lots in five aviaries. Samples were collected for beddings not used yet and for beddings used at each of the five broiler lots. Lettuce and cucumber seeds were considered as phytotoxicity bioindicators. As beddings were used for greater number of lots, N, Ca, K, Mg and P contents generally increased, but the C content decreased, the pH alkalinized and humidity was reduced (P < 0.05). The germination index for lettuce and cucumber seeds was reduced with increased bedding (P < 0.05). Beddings used for at least five broiler lots presented decreased C:N ratio and would not recommended for agricultural use due to its toxicity for both tested seeds.

DNA barcoding and morphological identification of neotropical ichthyoplankton from the Upper Paraná and São Francisco.

The identification of fish larvae from two neotropical hydrographic basins using traditional morphological taxonomy and DNA barcoding revealed no conflicting results between the morphological and barcode identification of larvae. A lower rate (25%) of correct morphological identification of eggs as belonging to migratory or non-migratory species was achieved. Accurate identification of ichthyoplankton by DNA barcoding is an important tool for fish reproductive behaviour studies, correct estimation of biodiversity by detecting eggs from rare species, as well as defining environmental and management strategies for fish conservation in the neotropics.

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.

Dose selection for a direct and selective factor IXa inhibitor and its complementary reversal agent: translating pharmacokinetic and pharmacodynamic properties of the REG1 system to clinical trial design.

We performed detailed pharmacokinetic and pharmacodynamic modeling of REG1, an anticoagulation system composed of the direct factor IXa (FIXa) inhibitor pegnivacogin (RB006) and its matched active control agent anivamersen (RB007), with a focus on level of target inhibition to translate phase 1 results to phase 2 dose selection. We modeled early-phase clinical data relating weight-adjusted pegnivacogin dose and plasma concentration to prolongation of the activated partial thromboplastin time (aPTT). Using an in vitro calibration curve, percent FIXa inhibition was determined and related to aPTT prolongation and pegnivacogin dose and concentration. Similar methods were applied to relate anivamersen dose and level of reversal of pegnivacogin anticoagulation. Combined early-phase data suggested that ≥0.75 mg/kg pegnivacogin was associated with >99% inhibition of FIX activity and prolongation of plasma aPTT values ≈2.5 times above baseline, leading to selection of a 1 mg/kg dose for a phase 2a elective percutaneous coronary intervention study to achieve a high intensity of anticoagulation and minimize intersubject variability. Phase 2 validated our predictions, demonstrating 1 mg/kg pegnivacogin yielded plasma concentrations ≈25 µg/ml and >99% inhibition of FIX activity. The relationship between the anivamersen to pegnivacogin dose ratio and degree of pegnivacogin reversal was also validated. Our approach decreased the need for extensive dose-response studies, reducing the duration, complexity and cost of clinical development. The 1 mg/kg pegnivacogin dose and a range of anivamersen dose ratios are being tested in the phase 2b RADAR study (NCT00932100).

Reemplazo valvular aórtico con prótesis biológica en pacientes mayores de 70 años con estenosis aórtica / Aortic valve replacement with bioprosthesis in patients 70 years old or older with aortic stenosis

Background: Aortic valve stenosis is the most prevalent valvulopathy in the elderly, but it is frequently undertreated. Aim: To assess early and long term results of valve replacement with bioprostheses in patients 70 years old or older with aortic stenosis. Patients and Methods: A review of the database of the Cardiovascular Surgery Service of our hospital, for the period 1990-2007, identified 156 patients with aortic valve stenosis, aged 76.7 ± 4.5 years (67 percent males), that were subjected to an aortic valve replacement with bioprosthesis. Seventy eight (50 percent) were in functional class III-IV. Six patients had emergency surgery. In 67 patients (43 percent) coronary artery bypass graft were performed. Long term mortality was ascertained obtaining death records from Chilean death registry. Results: Operative mortality was 3.2 percent (5 patients). Four patients (2.6 percent) required a reoperation due to bleeding. The mean follow up was 66 ± 41 months. The survival rate at 1, 3 and 5years was 94 percent, 88 percent and 80 percent, respectively. Forty two patients (27 percent) were 80years old or older. In this sub-group, 1 patient (2.3 percent) died during the peri operative period and the estimated survival rate at 1, 3 and 5years was 97 percent, 92 percent, and 80 percent, respectively. Multivariate risk analysis, for the whole group, identified low ejection fraction and concomitant coronary artery bypass graft surgery as predictors of late mortality. Conclusions: Aortic valve replacement for aortic stenosis with bioprostheses in patients 70 years old or older had low perioperative mortality and morbidity and a good long term survival.

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

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. Forty four 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.

[Surgery of post myocardial infarction papillary muscle rupture]. / Cirugía de la rotura de músculo papilar por infarto miocárdico.

BACKGROUND: Papillary muscle rupture is a serious complication of myocardial infarction whose only treatment is surgery. AIM: To analyze our most recent surgical experience with papillary muscle rupture. PATIENTS AND METHODS: The database of our Service was reviewed for the period 1995-2005, to identify patients with papillary muscle rupture. Then, the clinical records and operating protocols were analyzed. Survival and functional class of patients were assessed. RESULTS: Twelve patients (7 men), aged 52 to 89 years, had papillary muscle rupture. They represented 2.2% of all mitral procedures for mitral insufficiency and 8.8% of mitral surgeries for ischemic mitral regurgitation, during the study period. In eight cases myocardial infarction was inferior, in three lateral and in one, anterior. In 10 patients, a mitral replacement was carried-out and in two the mitral valve was repaired. In seven patients, myocardial revascularization was performed. Mean lapse between infarction and surgery was 13.5 days (1 to 85). Two patients died in the perioperative period. Follow-up ranged from 1.7 to 120.4 months. Four patients died during follow-up, 2 due to a cardiovascular cause. Thus, at the end of follow-up 6 patients were alive. All were in functional class I-II. CONCLUSIONS: Papillary muscle rupture is an uncommon complication of myocardial infarction, with considerable operative and long-term mortality. However, survivors have good quality of life.

Cirugía de la rotura de músculo papilar por infarto miocárdico / Surgery of post myocardial infarction papillary muscle rupture

Background: Papillary muscle rupture is a serious complication of myocardial infarction whose only treatment is surgery. Aim: To analyze our most recent surgical experíence with papillary muscle rupture. Patients and Methods: The datábase of our Service was reviewed for the period 1995-2005, to identify patients with papillary muscle rupture. Then, the clinical records and operating protocols were analyzed. Survival and functional class of patients were assessed. Results: Twelve patients (7 men), aged 52 to 89 years, had papillary muscle rupture. They represented 2.2 percent of all mitral procedures for mitral insufficiency and 8.8% of mitral surgeries for ischemic mitral regurgitation, during the study períod. In eight cases myocardial infarction was inferior, in three lateral and in one, anterior. In 10 patients, a mitral replacement was carried-out and in two the mitral valve was repaired. In seven patients, myocardial revascularization was performed. Mean lapse between infarction and surgery was 13.5 days (1 to 85). Two patients died in the perioperative period. Follow-up ranged from 1.7 to 120.4 months. Four patients died during follow-up, 2 due to a cardiovascular cause. Thus, at the end of follow-up 6 patients were alive. All were in functional class III. Conclusions: Papillary muscle rupture is an uncommon complication of myocardial infarction, with considerable operative and ¡ong-term mortality. However, survivors have good quality of life.

[Cardiac myxoma: clinical characterization, diagnostic methods and late surgical results]. / Mixoma cardiaco: Caracterización clínica, métodos diagnósticos y resultados alejados del tratamiento quirúrgico durante tres décadas de experiencia.

BACKGROUND: Cardiac myxoma is the most common primary cardiac tumor. AIM: To evaluate clinical aspects, diagnostic methods and surgical outcomes in patients with cardiac myxoma. PATIENTS AND METHODS: AH patients who underwent surgical resection of a cardiac myxoma between January 1973 and December 2004 at our institution, were identified and their medical records and diagnostic data reviewed. RESULTS: Thirty seven patients identified (24 women), with a median age of 54 years (range 2-74). The most common symptom was dyspnea (51%), followed by embolism (24%) and cardiac murmurs (16%). The diagnosis was made by echocardiogram in 84% of patients. The mean tumor size was 4.9 +/- 1.3 cm. The tumor was located in the left atrium in 83% of the patients, right atrium in 8% and left ventricle in 3%. Two patients had multiple tumors. Surgical approach was transeptal in 51%, left atriotomy in 22%, combined transeptal and roof of the left atrium in 19% and right atriotomy in 8%. The tumor and its attachment base were excised in one piece. There were two operative deaths and five late deaths. The mean follow-up was 11.5 years. The 5, 10, 15 and 20 years survival was 89%, 83%, 75% and 64%, respectively. Two patients had recurrence (5.4%), at 2 and 25 years after surgery, respectively, and the recurrence free survival at 10 and 25 years was 97% and 73%, respectively. CONCLUSIONS: Dyspnea was the most common symptom and echocardiogram the main diagnostic method. Surgical treatment was highly effective, with low mortality and recurrence rate, with good long term survival.

Mixoma cardiaco: Caracterización clínica, métodos diagnósticos y resultados alejados del tratamiento quirúrgico durante tres décadas de experiencia / Cardiac myxoma: Clinical characterization, diagnostic methods and late surgical results

Background: Cardiac myxoma is the most common primary cardiac tumor. Aim: To evaluate clinical aspects, diagnostic methods and surgical outcomes in patients with cardiac myxoma. Patients and Methods: AH patients who underwent surgical resection of a cardiac myxoma between January 1973 and December 2004 at our institution, were identified and their medical records and diagnostic data reviewed. Results: Thirty seven patients identified (24 women), with a median age of 54 years (range 2-74). The most common symptom was dyspnea (51 percent), followed by embolism (24 percent) and cardiac murmurs (16 percent). The diagnosis was made by echocardiogram in 84 percent of patients. The mean tumor size was 4.9 ± 1.3 cm. The tumor was located in the ¡eft atrium in 83 percent of the patients, right atrium in 8 percent and ¡eft ventricle in 3 percent. Two patients had multiple tumors. Surgical approach was transeptal in 51 percent, left atriotomy in 22 percent, combined transeptal and roof of the left atrium in 19 percent and right atriotomy in 8 percent. The tumor and its attachment base were excised in one piece. There were two operative deaths and five late deaths. The mean follow-up was 11.5 years. The 5, 10, 15 and 20 years survival was 89 percent, 83 percent, 75 percent and 64 percent, respectively. Two patients had recurrence (5.4 percent), at 2 and 25years after surgery, respectively, and the recurrence free survival at 10 and 25years was 97 percent and 73 percent, respectively. Conclusions: Dyspnea was the most common symptom and echocardiogram the main diagnostic method. Surgical treatment was highly effective, with low mortality and recurrence rate, with good long term survival.

[Risk factors for postoperative atrial fibrillation after coronary artery bypass grafting. A prospective analysis]. / Factores determinantes en la aparición de fibrilación auricular post-cirugía de revascularización miocárdica. Un estudio prospectivo.

BACKGROUND: Atrial fibrillation (AF) is a relevant complication after coronary artery bypass grafting (CABG). However there is controversy regarding possible contributing factors. AIM: To study the incidence of AF, its risk factors and its repercussion on hospital stay and charges, in patients undergoing CABG. MATERIAL AND METHODS: We prospectively collected information from all patients undergoing CABG in our institution, including demographic, surgical and laboratory variables. Exclusion criteria were chronic AF, recent onset AF and patients who needed additional surgical procedures. The primary endpoint was the incidence of AF during the hospital stay. Secondary endpoints were hospital length of stay and hospital charges. RESULTS: We included 250 patients aged 62+/-9 years (199 males) in the analysis. Incidence of AF was 22% (54 patients). Multivariable analysis showed that age (Odds Ratio (OR) =1.10), previous CABG (OR =9.39), previous use of ACE inhibitors (OR =3.28) and aortic clamp >57 minutes (OR =3.97) were significantly associated with an increased risk of postoperative AF. Previous use of beta-blockers was associated with risk reduction (OR =0.43). Patients who developed AF had a longer hospital stay (p <0.001) and higher hospital charges (p =0.003). CONCLUSION: AF is a frequent complication in patients undergoing CABG. Risk factors are age, time of aortic clamp, previous CABG and ACE inhibitors. Beta-blockers may prevent its occurrence. Furthermore, AF has a negative impact on both hospital stay and hospital charges.

[Cryoablation of pulmonary veins as complementary treatment of atria I fibrillation in valvular surgery]. / Criocoagulación de venas pulmonares como tratamiento complementario de la fibrilación auricular en cirugía valvular.

BACKGROUND: The Cox MAZE III operation for the treatment of atrial fibrillation (AF) is complex and consumes significant operative time. Cryoablation of the pulmonary veins (CPV) is a simpler alternative for patients that require concomitant valvular surgery. AIM: To evaluate CPV in patients with AF submitted to valvular surgery. PATIENTS AND METHODS: Twenty one patients had simultaneous valvular surgery and CPV, 81 % of them had permanent AF for an average of 5 years. Twenty patients had mitral valve disease. The etiology was rheumatic in 14. Average left atrial diameter was 60 mm. In 7 patients the mitral valve was replaced, in 5 it was repaired, in 7 both mitral and aortic valve were replaced, in 1 the mitral valve was repaired and the aortic valve was replaced and in 1 only the aortic valve was replaced. A combined transeptal and superior approach was used for all patients. The CPV was performed after the valvular procedure with cryothermy at -60 degrees C for 2 minutes with two 15 mm cryoprobes applied simultaneously. RESULTS: CPV increased surgical time by 10 to 20 minutes. Operative mortality was 4.8% (1 patient). One patient developed a pericardial effusion and another a complete heart block that required a permanent pacemaker. All patients improved their functional class. At the end of an average 10.5 months of follow-up, 50% of patients were in normal sinus rhythm and 25% persisted in AF. The remaining patients were in some type of regular rhythm. CONCLUSIONS: CPV as a complementary procedure in patients with AF undergoing valvular surgery had good results to abate AF. It restored normal sinus rhythm in 50% of the cases, with low morbidity and mortality and little increment in surgical time.

Factores determinantes en la aparición de fibrilación auricular post-cirugía de revascularización miocárdica: un estudio prospectivo / Risk factors for postoperative atrial fibrillation after coronary artery bypass grafting: a prospective analysis

Background: Atrial fibrillation (AF) is a relevant complication after coronary artery bypass grafting (CABG). However there is controversy regarding possible contributing factors. Aim: To study the incidence of AF, its risk factors and its repercussion on hospital stay and charges, in patients undergoing CABG. Material and methods: We prospectively collected information from all patients undergoing CABG in our institution, including demographic, surgical and laboratory variables. Exclusion criteria were chronic AF, recent onset AF and patients who needed additional surgical procedures. The primary endpoint was the incidence of AF during the hospital stay. Secondary endpoints were hospital length of stay and hospital charges. Results: We included 250 patients aged 62±9 years (199 males) in the analysis. Incidence of AF was 22 percent (54 patients). Multivariable analysis showed that age (Odds Ratio (OR) =1.10), previous CABG (OR =9.39), previous use of ACE inhibitors (OR =3.28) and aortic clamp >57 minutes (OR =3.97) were significantly associated with an increased risk of postoperative AF. Previous use of beta-blockers was associated with risk reduction (OR =0.43). Patients who developed AF had a longer hospital stay (p <0.001) and higher hospital charges (p =0.003). Conclusion: AF is a frequent complication in patients undergoing CABG. Risk factors are age, time of aortic clamp, previous CABG and ACE inhibitors. Beta-blockers may prevent its occurrence. Furthermore, AF has a negative impact on both hospital stay and hospital charges.