Deterioro cognitivo en pacientes con enfermedad coronaria: relación con variables clínicas / Cognitive impairment in patients with coronary disease: Relationship with clinical variables

Fundamentos y objetivo: La enfermedad coronaria puede actuar como factor de riesgo cognitivo. Se ha estudiado en pacientes programados para cirugía coronaria la presencia de deterioro cognitivo leve disejecutivo. Pacientes y método: Se ha evaluado en 35 pacientes la función ejecutiva (Trail Making Test). Se clasificaron en grupos con rendimiento normal o con deterioro, estudiándose su relación con otras variables (Mann-Whitney, ji al cuadrado y análisis de regresión múltiple). Resultados: El grupo con deterioro disejecutivo (n = 7; 20%) presentó mayor grado de angina (odds ratio [OR] 1,4, intervalo de confianza del 95% [IC 95%] 1,1-2,6; p = 0,04), enfermedad de 3 vasos (OR 1,3, IC 95% 1,08-3,6; p = 0,04) e índice de masa corporal (OR 1,56, IC 95% 1,16-3,65; p = 0,03), y menor presión arterial diastólica (OR 1,56, IC 95% 1,2-2,98; p = 0,02), hemoglobina (OR 2,03, IC 95% 1,18-4,05; p = 0,02) y hematocrito (OR 2,45, IC 95% 1,67-3,99; p < 0,001); estas variables resultaron significativas del rendimiento en el test como variable dependiente (R2 = 0,62). Conclusiones: Se muestra una importante prevalencia de deterioro cognitivo leve disejecutivo asociado a factores de riesgo cardiovascular. Se recomienda realizar una valoración cognitiva prequirúrgica y un seguimiento posterior por las posibles complicaciones neurológicas posquirúrgicas (AU)

Background and objectives: Coronary disease has been associated with cognitive disorders. We studied the presence of dysexecutive mild cognitive impairment in patients scheduled for coronary surgery. Patients and methods: The executive function of 35 patients was evaluated (Trail Making Test). They were classified into 2 groups: normal performance or cognitive impairment, and we assessed the relationship with others variables (Mann-Whitney, chi-square and multiple regression analysis). Results: The dysexecutive cognitive impairment group (n = 7; 20%) showed greater degree of angina (odds ratio [OR] 1.4, 95% confidence interval [95% CI] 1.1-2.6; P = .04), 3-vessels coronary artery disease (OR 1.3, 95% CI 1.08-3.6; P = .04) and body mass index (OR 1.56, 95% CI 1.16-3.65; P = .03) and lower diastolic blood pressure (OR 1.56, 95% CI 1.2-2.98; P = .02), hemoglobin (OR 2.03, 95% CI 1.18-4.05; P = .02) and hematocrit (OR 2.45, 95% CI 1.67-3.99; P < .001); these variables proved to be significant in the test performance considered as a dependent variable (R2 = 0.62). Conclusions: We found a significant prevalence of dysexecutive mild cognitive impairment, which was associated with cardiovascular risk factors. We recommend assessment and monitoring of cognitive performance for probable neurological complications after cardiac surgery (AU)

[Cognitive impairment in patients with coronary disease: relationship with clinical variables]. / Deterioro cognitivo en pacientes con enfermedad coronaria: relación con variables clínicas.

BACKGROUND AND OBJECTIVES: Coronary disease has been associated with cognitive disorders. We studied the presence of dysexecutive mild cognitive impairment in patients scheduled for coronary surgery. PATIENTS AND METHODS: The executive function of 35 patients was evaluated (Trail Making Test). They were classified into 2 groups: normal performance or cognitive impairment, and we assessed the relationship with others variables (Mann-Whitney, chi-square and multiple regression analysis). RESULTS: The dysexecutive cognitive impairment group (n=7; 20%) showed greater degree of angina (odds ratio [OR] 1.4, 95% confidence interval [95% CI] 1.1-2.6; P=.04), 3-vessels coronary artery disease (OR 1.3, 95% CI 1.08-3.6; P=.04) and body mass index (OR 1.56, 95% CI 1.16-3.65; P=.03) and lower diastolic blood pressure (OR 1.56, 95% CI 1.2-2.98; P=.02), hemoglobin (OR 2.03, 95% CI 1.18-4.05; P=.02) and hematocrit (OR 2.45, 95% CI 1.67-3.99; P<.001); these variables proved to be significant in the test performance considered as a dependent variable (R(2)=0.62). CONCLUSIONS: We found a significant prevalence of dysexecutive mild cognitive impairment, which was associated with cardiovascular risk factors. We recommend assessment and monitoring of cognitive performance for probable neurological complications after cardiac surgery.

An unexpected left atrial cavernous hemangioma: the cardiac surgeon needs an optimal preoperative study!

An optimal preoperative evaluation is fundamental to the assessment of all patients undergoing cardiac surgery. We report the case of a male patient who underwent elective coronary artery bypass surgery, and intraoperative transesophageal echocardiography (TEE) revealed an unexpected left atrial cavernous hemangioma. The tumor was resected via a transatrial approach, and a definitive diagnosis was made after histological examination. This uncommon intra-atrial tumor (which accounts for approximately 2.8% of all benign cardiac neoplasms) was detected at the time of the operation as no basic echocardiography study had been performed on the patient during the process of diagnosing his coronary heart disease because of a suboptimal cardiological work-up. Most cardiac masses are discovered incidentally by imaging techniques; in this patient, transthoracic echocardiography could have aided in the preoperative study and enabled the cardiac surgeon to plan and perform the adequate surgical procedure beforehand. Intraoperative TEE should be used routinely in all patients undergoing cardiac surgery: the clinical information obtained in certain cases might have a direct impact on surgical decision-making and might therefore positively influence patient's outcome.

Cirugía mínimamente invasiva en niños. Corrección de la comunicación interauricular por vía axilar y submamaria / Minimally invasive pediatric cardiac surgery. Atrial septal defect closure through axillary and submammary approaches

Introducción y objetivos. Los accesos mínimamente invasivos en cardiopatías no complejas ofrecen alternativas que disminuyen las secuelas estéticas. Asimismo, la cirugía se indica en edades más tempranas. En trabajos previos, comparamos la incisión submamaria con la esternotomía media. Presentamos nuestra experiencia inicial en el acceso axilar para el cierre de las comunicaciones interauriculares con circulación extracorpórea en comparación con el acceso submamario. Métodos. Se recoge en total a 20 pacientes: 10 casos por vía submamaria derecha (7 ostium secundum, 2 seno venoso, 1 ostium primum) y 10 casos operados a través de la axila derecha (7 ostium secundum, 3 seno venoso). Las medias de edad y de peso eran 6,4±3,62 (3-13) años y 23,5±8,74 (12-38) kg en el grupo submamaria y 5,5±2,04 (3-9) años y 19,7±5,88 (14-29) kg en el grupo axilar. En todos ellos, el procedimiento (canulación y corrección) se realiza completamente a través de la propia incisión respetando grupos musculares, sin puertos complementarios. Resultados. No se registran defectos residuales en la ecografía de control al alta. Ningún caso precisó reconversión a esternotomía media. Las maniobras de abordaje y canulación axilares son algo más complejas que las submamarias. Los tiempos de circulación extracorpórea y pinzamiento son superponibles en ambos grupos, comparados por enfermedades (p>0,05). Conclusiones. En pacientes seleccionados y con defectos abordables a través de la aurícula, la vía axilar derecha es tan segura como la submamaria. El resultado estético es excelente(AU)

Introduction and objectives: Minimally invasive approaches in less-complex cardiac procedures can avoid unpleasant cosmetic results. Moreover, surgery can be scheduled in younger patients. In previous papers, we compared submammary and midline sternotomy.We present our initial experience with an axillary, compared to submammary, approach to repair atrial septal defects under extracorporeal circulation. Methods: 20 patients are included: 10 in the submammary group (7 ostium secundum, 2 sinus venosus, 1 ostium primum) and 10 in the axillary group (7 ostium secundum, 3 sinus venosus). Mean age and weight are 6.4 +/- 3.62 years (range 3-13) and 23.5 +/- 8.74 Kg (range 12-38) in the submammary group, and 5.5 +/- 2.04 years (range 3-9) and 19.7 +/- 5.88 Kg (range 14-29) in the axillary one, respectively. Muscles are spared (pectoralis in submammary and latissimus in axillary). The whole procedure (cannulation and correction) is performed through a single incision, with no side ports. Results: No residual defects were found at discharge. Surgical approach maneuvers are more cumbersome through the axillary than the submammary approach. In a peer comparison, extracorporeal circulation and cross-clamp time were similar in both groups (P > .05). Conclusions: 1. Axillary approach is as safe as submammary access in selected patients and for defects approached through the atrium. 2. Cosmetic result is excellent(AU)

Minimally invasive pediatric cardiac surgery. Atrial septal defect closure through axillary and submammary approaches.

INTRODUCTION AND OBJECTIVES: Minimally invasive approaches in less-complex cardiac procedures can avoid unpleasant cosmetic results. Moreover, surgery can be scheduled in younger patients. In previous papers, we compared submammary and midline sternotomy. We present our initial experience with an axillary, compared to submammary, approach to repair atrial septal defects under extracorporeal circulation. METHODS: 20 patients are included: 10 in the submammary group (7 ostium secundum, 2 sinus venosus, 1 ostium primum) and 10 in the axillary group (7 ostium secundum, 3 sinus venosus). Mean age and weight are 6.4±3.62 years (range 3-13) and 23.5±8.74 Kg (range 12-38) in the submammary group, and 5.5±2.04 years (range 3-9) and 19.7±5.88 Kg (range 14-29) in the axillary one, respectively. Muscles are spared (pectoralis in submammary and latissimus in axillary). The whole procedure (cannulation and correction) is performed through a single incision, with no side ports. RESULTS: No residual defects were found at discharge. Surgical approach maneuvers are more cumbersome through the axillary than the submammary approach. In a peer comparison, extracorporeal circulation and cross-clamp time were similar in both groups (P>.05). CONCLUSIONS: 1. Axillary approach is as safe as submammary access in selected patients and for defects approached through the atrium. 2. Cosmetic result is excellent.

Left atrial myxoma: extraction by robotic and vacuum assistance.

We report a single case of left atrial giant myxoma excision using the da Vinci S surgical system in a 47-year-old woman. A vacuum extractor device was designed to avoid tumor fragmentation or embolization. The myxoma was entirely removed under aspiration through the extractor device, achieving all the surgical tenets of myxoma excision.