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.

Tratamiento percutáneo de las bioprótesis aórticas disfuncionantes con la prótesis CoreValve® / Percutaneous treatment of a dysfunctional aortic bioprosthesis with the coreValveW prosthesis

El implante valvular aórtico percutáneo ha surgido recientemente como alternativa terapéutica para pacientes con estenosis aórtica severa sintomática y alto riesgo quirúrgico. Se presenta la experiencia inicial en el tratamiento de la disfunción de la bioprótesis aórtica mediante el implante percutáneo de prótesis aórtica CoreValve en 4 pacientes, tanto con estenosis como con insuficiencia aórtica, y se analiza los resultados hospitalarios y a medio plazo. El procedimiento se realizó con anestesia local y guiado por angiografía. Se implantaron con éxito en todos los casos, si bien uno precisó una segunda prótesis por posicionamiento alto de la primera. No hubo complicaciones mayores. Tras un seguimiento medio de 7±4,7 meses, todos los pacientes se encuentran asintomáticos (AU)

Recently, percutaneous aortic valve replacement has emerged as a therapeutic option for patients with severe symptomatic aortic stenosis and a high surgical risk. We report our initial experience in four patients with percutaneous implantation of a CoreValve aortic prosthesis to treat aortic bioprosthesis dysfunction involving aortic stenosis or regurgitation. In-hospital and medium-term outcomes were analyzed. The procedure was performed under local anesthesia and guided by angiography. The prosthesis was implanted successfully in all patients, although a second prosthesis was required in one case because the first was positioned too high. There were no major complications. After a mean followup of 7 months (SD, 4.7), all patients remained asymptomatic (AU)

Percutaneous treatment of a dysfunctional aortic bioprosthesis with the CoreValve(®) prosthesis.

Recently, percutaneous aortic valve replacement has emerged as a therapeutic option for patients with severe symptomatic aortic stenosis and a high surgical risk. We report our initial experience in four patients with percutaneous implantation of a CoreValve aortic prosthesis to treat aortic bioprosthesis dysfunction involving aortic stenosis or regurgitation. In-hospital and medium-term outcomes were analyzed. The procedure was performed under local anesthesia and guided by angiography. The prosthesis was implanted successfully in all patients, although a second prosthesis was required in one case because the first was positioned too high. There were no major complications. After a mean follow-up of 7 months (SD, 4.7), all patients remained asymptomatic.

Comparison of medium-term outcomes obtained with drug-eluting stents and coronary artery bypass grafts in an unselected population of diabetic patients with multivessel coronary disease. Propensity score analysis.

INTRODUCTION AND OBJECTIVES: Since the introduction of drug-eluting stents, the optimum revascularization strategy in diabetic patients with multivessel coronary disease has remained controversial. METHODS: This study used multivariate logistic regression analysis and propensity score matching to compare results in 270 consecutive diabetic patients (2000-2004) with multivessel disease (> or =2 vessels with a >70% de novo stenosis involving the proximal left anterior descending coronary artery) who underwent either coronary artery bypass grafting (CABG; n=142) or implantation of a drug-eluting stent (DES; i.e. rapamycin or paclitaxel; n=128). The following clinical outcomes (i.e. major adverse cardiac or cerebrovascular events [MACCEs]) were assessed: death, nonfatal myocardial infarction (MI), stroke and repeat revascularization at 2 years. RESULTS: Patients who received DESs were older (67.5+/-7 years vs. 65.3+/-8 years; P=.05) and more often had a previous MI (49.2% vs. 28.2%; P< .01), but no more often had a depressed left ventricular ejection fraction < or =45% (32.4% vs. 28.1%). Coronary anatomy was more complex in surgical patients (SYNTAX score, 25.9+/-7 vs. 18.5+/-6; P< .001) and the quality of revascularization was better (i.e. anatomically complete revascularization: 52.8% vs. 28.1%; P< .01). The incidence of MACCEs was 18.7% in the CABG group and 21.8% in the DES group (adjusted odds ratio [OR] = 0.93; 95% confidence interval [CI], 0.47-1.86). The composite endpoint of death, MI or stroke occurred in 15.8% undergoing CABG and 12.9% receiving a DES (adjusted OR = 1.19; 95% CI, 0.72-1.88). There was less need for revascularization in CABG patients (4.3% vs. 12.1%; adjusted OR = 0.42; 95% CI, 0.16-1.14; P=.09). CONCLUSIONS: In an unselected population of diabetic patients with multivessel coronary disease, the principle advantage of CABG was the reduced need for revascularization. There was no difference in the rate of death, MI or stroke.

Comparación de los resultados clínicos a medio plazo de los stents farmacoactivos frente a la cirugía de revascularización coronaria en una población no seleccionada de pacientes diabéticos con afección multivaso. Análisis mediante propensity score / Comparison of medium-term outcomes obtained with drug-eluting stents and coronary artery bypass grafts in an unselected population of diabetic patients with multivessel coronary disease. Propensity score analysis

Introducción y objetivos. La estrategia de revascularización en el paciente diabético con enfermedad multivaso en la era actual de los stents farmacoactivos es controvertida. Métodos. Comparamos a 270 pacientes diabéticos consecutivos (2000-2004) con enfermedad multivaso (al menos 2 vasos con estenosis > 70% de novo y afección de la descendente anterior proximal) a los que se practicó cirugía de revascularización coronaria (n = 142) o se implantó stents farmacoactivos (rapamicina/paclitaxel) (n = 128) mediante análisis de regresión logística multivariable con propensity score. Analizamos los resultados clínicos (eventos cardiacos y cerebrovasculares mayores): muerte, infarto no fatal, ictus y necesidad de revascularización a 24 meses. Resultados. Los pacientes que recibieron stents farmacoactivos tuvieron mayor edad (67,5 ± 7 frente a 65,3 ± 8 años; p = 0,05) y más infarto previo (el 49,2 frente al 28,2%; p < 0,01), aunque no hubo diferencias en la presencia de disfunción ventricular significativa (≤ 45%): el 32,4 frente al 28,1%. En los pacientes quirúrgicos, la anatomía coronaria fue más compleja: score SYNTAX (25,9 ± 7 frente a 18,5 ± 6; p < 0,001) y la calidad de la revascularización fue superior (revascularización anatómica completa, el 52,8 frente al 28,1%; p < 0,01). La incidencia total del evento combinado fue del 18,7% en el grupo quirúrgico y el 21,8% en el grupo percutáneo (odds ratio [OR] ajustada = 0,93; intervalo de confianza [IC] del 95%, 0,47-1,86). El evento combinado de muerte, infarto e ictus fue del 15,8% en el grupo quirúrgico, frente al 12,9% en el grupo de stent farmacoactivo (OR ajustada = 1,19; IC del 95%, 0,72-1,88). Los pacientes quirúrgicos tuvieron menor necesidad de revascularización (el 4,3 frente al 12,1%; OR ajustada = 0,42; IC del 95%, 0,16-1,14; p = 0,09). Conclusiones. En una población no seleccionada de diabéticos multivaso, la ventaja de la cirugía de revascularización coronaria se centró en reducir las revascularizaciones. No encontramos diferencias en muerte, infarto o ictus (AU)

Introduction and Objectives. Since the introduction of drug-eluting stents, the optimum revascularization strategy in diabetic patients with multivessel coronary disease has remained controversial. Methods. This study used multivariate logistic regression analysis and propensity score matching to compare results in 270 consecutive diabetic patients (2000-2004) with multivessel disease (≥2 vessels with a >70% de novo stenosis involving the proximal left anterior descending coronary artery) who underwent either coronary artery bypass grafting (CABG; n=142) or implantation of a drug eluting stent (DES; ie, rapamycin or paclitaxel; n=128). The following clinical outcomes (ie, major adverse cardiac or cerebrovascular events [MACCEs]) were assessed: death, nonfatal myocardial infarction (MI), stroke, and repeat revascularization at 2 years. Results. Patients who received DESs were older (67.5 [7] years vs 65.3 [8] years; P=.05) and more often had a previous MI (49.2% vs 28.2%; P < .01), but no more often had a depressed left ventricular ejection fraction ≤45% (32.4% vs 28.1%). Coronary anatomy was more complex in surgical patients (SYNTAX score, 25.9 [7] vs 18.5 [6]; P < .001) and the quality of revascularization was better (ie, anatomically complete revascularization: 52.8% vs 28.1%; P < .01). The incidence of MACCEs was 18.7% in the CABG group and 21.8% in the DES group (adjusted odds ratio [OR] =0.93; 95% confidence interval [CI], 0.47-1.86). The composite endpoint of death, MI or stroke occurred in 15.8% undergoing CABG and 12.9% receiving a DES (adjusted OR =1.19; 95% CI, 0.72-1.88). There was less need for revascularization in CABG patients (4.3% vs 12.1%; adjusted OR=0.42; 95% CI, 0.16-1.14; P=.09). Conclusions. In an unselected population of diabetic patients with multivessel coronary disease, the principle advantage of CABG was the reduced need for revascularization. There was no difference in the rate of death, MI or stroke. and more often had a previous MI (49.2% vs. 28.2%; P < .01), but no more often had a depressed left ventricular ejection fraction ≤45% (32.4% vs. 28.1%). Coronary anatomy was more complex in surgical patients (SYNTAX score, 25.9±7 vs. 18.5±6; P < .001) and the quality of revascularization was better (i.e. anatomically complete revascularization: 52.8% vs. 28.1%; P < .01). The incidence of MACCEs was 18.7% in the CABG group and 21.8% in the DES group (adjusted odds ratio [OR] = 0.93; 95% confidence interval [CI], 0.47-1.86). The composite endpoint of death, MI or stroke occurred in 15.8% undergoing CABG and 12.9% receiving a DES (adjusted OR = 1.19; 95% CI, 0.72-1.88). There was less need for revascularization in CABG patients (4.3% vs. 12.1%; adjusted OR = 0.42; 95% CI, 0.16-1.14; P=.09). Conclusions. In an unselected population of diabetic patients with multivessel coronary disease, the principle advantage of CABG was the reduced need for revascularization. There was no difference in the rate of death, MI or stroke (AU)

Experiência inicial em Málaga(Espanha) com prótese aórtica CoreValve para tratamento de estenose aórtica sintomática grave / Malaga(Spain)early experience with the CoreValve aortic prosthesis for the treatment of severe symptomatic aortic stenosis

Introdução: A prevalência de estenose aórtica grave vem crescendo em decorrência do aumento da expectativa de vida. Alguns pacientes não se beneficiam do tratamento cirúrgico por causa das comorbidades associadas. Apresentamos os resultados de nossa experiência no tratamento percutâneo da estenose aórtica. Método: Estudo prospectivo, realizado entre abril de 2008 e fevereiro de 2009, em que 31 pacientes consecutivos com estenose aórtica grave sintomática e que apresentavam alto risco cirúrgico foram tratados com a prótese aórtica CoreValve. Todos os procedimentos foram realizados com anestesia local. Em 29 casos a via de acesso foi a artéria femoral, com introdutor 18 F, a punção femoral foi fechada com Prostar 10 F, e em 2 pacientes a artéria subclávia esquerda foi a via de acesso. Resultados: A média de idade foi de 77,8 ± 8,9anos e o EuroSCORE logístico médio foi de 17,5 ± 12,6%. O sucesso do implante foi de 100%. O gradiente de pico a pico após o implante desapareceu. Nenhum paciente apresentou insuficiência aórtica residual > grau 2 de Sellers. A mortalidade aos 30 dias foi de 3,2%. Foram necessários marca-passos definitivos em 31% dos pacientes. Depois de acompanhamento médio de 154 ± 90 dias, foram registrados 4 óbitos (1 morte súbita e 3 por causas não-cardíacas). Conclusões: O implante percutâneo da prótese aórtica CoreValve como tratamento alternativo da estenose aórtica grave em pacientes com alto risco cirúrgico é factível e seguro, com elevada taxa de êxito no procedimento e porcentual de complicações abaixo do esperado em função do risco cirúrgico estimado com o EuroSCORE.

Background: The prevalence of severe aortic stenosis is increasing with the rise in life expectancy. Some patients cannot undergo surgical treatment of aortic stenosis due to associated disorders. We present the results of our experience with the percutaneous treatment of aortic stenosis as an alternative to surgery in high-risk patients. Methods: This prospective cohort study included 31 consecutive high surgical risk patients with severe and symptomatic aortic stenosis treated with a CoreValve aortic prosthesis from April 2008 to February 2009. All the procedures were undertaken with local anesthesia. In 29 patients we used a femoral artery access, with an 18 F introducer, closing the femoral puncture with a 10 F Prostar, and in two patients the access was via the left subclavian artery. Results: The mean age of the patients was 77.8 ± 8.9 years and the mean logistic EuroSCORE was 17.5 ± 12.6%. The implant was successful in 100% of cases. The peak-to-peak gradient after the implant disappeared. No patient had residual aortic insufficiency Sellers' grade > 2. One-month mortality was 3.2%. A definitive pacemaker was required in 31% of the patients. After a mean follow-up of 154 ± 90 days there were four deaths (1 sudden death and 3 for noncardiac causes). Conclusions: Percutaneous implantation of the CoreValve aortic prosthesis as an alternative treatment for severe aortic stenosis in high surgical risk patients is feasible and safe, with a high success rate for the procedure and a percentage of complications below the expected for the surgical risk, as estimated by the EuroSCORE.

[Influence of sex on perioperative outcomes in patients undergoing valve replacement for severe aortic stenosis]. / Influencia del sexo en el pronóstico perioperatorio de pacientes sometidos a sustitución valvular por estenosis aórtica severa.

INTRODUCTION AND OBJECTIVES: The influence of sex on the prognosis of patients undergoing aortic valve replacement for severe stenosis is unclear. Nevertheless, a number of studies have regarded sex as an independent risk factor. The aim of this study was to evaluate the influence of sex on perioperative outcomes in patients undergoing valve replacement for severe aortic stenosis. METHODS: This retrospective study involved 577 consecutive patients who underwent aortic valve replacement surgery for severe aortic stenosis between 1996 and April 2007. RESULTS: Women (44% of patients) were older than men (70.3+/-7.9 years vs. 66.8+/-9.8 years; P< .001), had a smaller body surface area (1.68+/-0.15 m(2) vs. 1.83+/-0.16 m(2); P< .001), more often had arterial hypertension (73% vs. 49%; P< .001), diabetes mellitus (33.5% vs. 24.5%; P=.001) and ventricular hypertrophy (89.1% vs. 83.1%; P< .001), and less often had coronary artery disease (19.1% vs. 31.8%; P< .001) and severe ventricular dysfunction (7.9% vs. 17.4%; P< .001). Nevertheless, women more often suffered acute myocardial infarction perioperatively (3.9% vs. 0.9%; P=.016), had a low cardiac output in the postoperative period (30.3% vs. 22.3%; P=.016) and experienced greater perioperative mortality (13% vs. 7.4%; P=.019) than men. However, after adjustment for various confounding factors, female sex was not a significant independent risk factor for mortality (odds ratio = 2.40; 95% confidence interval, 0.79-7.26; P=.119). CONCLUSIONS: Perioperative mortality in women with severe aortic stenosis who underwent valve replacement was high. However, after adjustment for potential confounding factors, particularly body surface area, female sex was not an independent risk factor for mortality.

Influencia del sexo en el pronóstico perioperatorio de pacientes sometidos a sustitución valvular por estenosis aórtica severa / Influence of sex on perioperative outcomes in patients undergoing valve replacement for severe aortic stenosis

Introducción y objetivos. La influencia pronóstica del sexo de los pacientes sometidos a sustitución valvular aórtica por estenosis severa tiene un papel controvertido, y algunos estudios le atribuyen un papel relevante como marcador de riesgo independiente. El objetivo del estudio es valorar la influencia pronóstica perioperatoria del sexo de los pacientes sometidos a sustitución valvular por estenosis aórtica severa. Métodos. Estudio retrospectivo en el que se analizó una cohorte de 577 pacientes sometidos a cirugía de reemplazo valvular aórtico por estenosis aórtica entre 1996 y abril de 2007. Resultados. Las mujeres (44%) tenían mayor edad (70,3 ± 7,9 frente a 66,8 ± 9,8 años; p < 0,001), menos superficie corporal (1,68 ± 0,15 frente a 1,83 ± 0,16 m2; p < 0,001), más hipertensión arterial (el 73 frente al 49%; p < 0,001), diabetes mellitus (el 33,5 frente al 24,5%; p = 0,001) e hipertrofia ventricular (el 89,1 frente al 83,1%; p < 0,001), menos enfermedad coronaria (el 19,1 frente al 31,8%; p < 0,001) y menos disfunción ventricular severa (el 7,9 frente al 17,4%; p < 0,001). A pesar de esto, las mujeres tuvieron más infarto agudo de miocardio perioperatorio (el 3,9 frente al 0,9%; p = 0,016), bajo gasto en el postoperatorio (el 30,3 frente al 22,3%; p = 0,016) y mortalidad perioperatoria que los varones (el 13 frente al 7,4%; p = 0,019). El sexo femenino no se mostró, al ajustar por los diferentes factores de confusión, como factor independiente relacionado con la mortalidad (odds ratio = 2,4; intervalo de confianza del 95%, 0,79-7,26; p = 0,119). Conclusiones. La mortalidad perioperatoria de las mujeres con estenosis aórtica severa sometidas a sustitución valvular es alta. Al ajustar por potenciales factores de confusión, especialmente superficie corporal, el sexo femenino no se comporta como factor independiente de mortalidad (AU)

Introduction and objectives. The influence of sex on the prognosis of patients undergoing aortic valve replacement for severe stenosis is unclear. Nevertheless, a number of studies have regarded sex as an independent risk factor. The aim of this study was to evaluate the influence of sex on perioperative outcomes in patients undergoing valve replacement for severe aortic stenosis. Methods. This retrospective study involved 577 consecutive patients who underwent aortic valve replacement surgery for severe aortic stenosis between 1996 and April 2007. Results. Women (44% of patients) were older than men (70.3±7.9 years vs. 66.8±9.8 years; P<.001), had a smaller body surface area (1.68±0.15 m2 vs. 1.83±0.16 m2; P<.001), more often had arterial hypertension (73% vs. 49%; P<.001), diabetes mellitus (33.5% vs. 24.5%; P=.001) and ventricular hypertrophy (89.1% vs. 83.1%; P<.001), and less often had coronary artery disease (19.1% vs. 31.8%; P<.001) and severe ventricular dysfunction (7.9% vs. 17.4%; P<.001). Nevertheless, women more often suffered acute myocardial infarction perioperatively (3.9% vs. 0.9%; P=.016), had a low cardiac output in the postoperative period (30.3% vs. 22.3%; P=.016) and experienced greater perioperative mortality (13% vs. 7.4%; P=.019) than men. However, after adjustment for various confounding factors, female sex was not a significant independent risk factor for mortality (odds ratio = 2.40; 95% confidence interval, 0.79-7.26; P=.119). Conclusions. Perioperative mortality in women with severe aortic stenosis who underwent valve replacement was high. However, after adjustment for potential confounding factors, particularly body surface area, female sex was not an independent risk factor for mortality (AU)

Derrame pericárdico severo secundario a fístula vertebroyugular iatrogénica tardía / Severe pericardical effusion secondary to late iatrogenic vertebrojugular fistula

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[Comparative analysis of antioxidant defense during on-pump and off-pump cardiac surgery]. / Análisis comparativo de la defensa antioxidante en cirugía cardíaca con y sin circulación extracorpórea.

INTRODUCTION AND OBJECTIVES: The transient myocardial ischemia that occurs during cardiac surgery leads to oxidative stress and the production of free radicals. The resulting damage can be reduced if cardiopulmonary bypass is avoided. We obtained indirect measures of the oxidative damage occurring during cardiac surgery by monitoring the glutathione system and we studied the influence of cardiopulmonary bypass. PATIENTS AND METHOD: The study included 19 patients undergoing cardiac surgery. Cardiopulmonary bypass was used in 9 (47.4%). Blood samples were obtained from each patient at different times during and after surgery. Total, oxidized and reduced glutathione levels were measured, as was the activity of related enzymes (i.e., glutathione peroxidase, glutathione reductase, and glutathione transferase). RESULTS: The total glutathione level decreased more in patients in whom cardiopulmonary bypass had been used. In addition, the oxidized glutathione level was reduced in these patients, which suggests that antioxidant defense was not fully effective. In contrast, the oxidized glutathione level tended to increase in patients in whom cardiopulmonary bypass had not been used. There was no significant difference in enzymatic activity between the two groups. CONCLUSIONS: In this study, patients who underwent off-pump cardiac surgery had a better antioxidant profile. The implication could be that cardiac surgery without cardiopulmonary bypass has a less damaging effect on ischemic myocardium.

Análisis comparativo de la defensa antioxidante en cirugía cardíaca con y sin circulación extracorpórea / Comparative analysis of antioxidant defense during on-pump and off-pump cardiac surgery

Introducción y objetivos. Durante la cirugía cardíaca se produce una isquemia miocárdica transitoria que implica el desarrollo de fenómenos de estrés oxidativo con liberación de radicales libres. El daño resultante puede ser menor si se obvia el bypass aortopulmonar. Se estudia el sistema antioxidante del glutatión como medida indirecta del daño oxidativo asociado con la cirugía cardíaca. Se analiza la influencia del empleo de circulación extracorpórea. Pacientes y método. Se incluye a 19 pacientes en los que se realizó cirugía cardíaca, 9 de ellos con bomba (47,4%). De cada paciente se extrajeron muestras sanguíneas en diferentes momentos (intraoperatorios y postoperatorios) y en ellas se cuantificaron el glutatión (total, oxidado y reducido) plasmático e intraeritrocitario y se determinó la actividad enzimática implicada (glutatión-peroxidasa, glutatión-reductasa y glutatión-transferasa).Resultados. El glutatión total disminuyó más en los pacientes operados con circulación extracorpórea. También se redujo el glutatión oxidado plasmático e intraeritrocitario, lo que expresa una defensa antioxidante ineficaz, mientras que en los casos sin bomba esta tendencia fue creciente. No hubo diferencias significativas en la actividad enzimática entre ambos grupos. Conclusiones. En nuestra serie, los pacientes intervenidos sin circulación extracorpórea mostraron un mejor perfil antioxidante en relación con el sistema del glutatión. Esto puede traducirse en que la cirugía cardíaca sin bomba resulta menos agresiva para el miocardio

Introduction and objectives. The transient myocardial ischemia that occurs during cardiac surgery leads to oxidative stress and the production of free radicals. The resulting damage can be reduced if cardiopulmonary bypass is avoided. We obtained indirect measures of the oxidative damage occurring during cardiac surgery by monitoring the glutathione system and we studied the influence of cardiopulmonary bypass.Patients and method. The study included 19 patients undergoing cardiac surgery. Cardiopulmonary bypass was used in 9 (47.4%). Blood samples were obtained from each patient at different times during and after surgery. Total, oxidized and reduced glutathione levels were measured, as was the activity of related enzymes (i.e., glutathione peroxidase, glutathione reductase, and glutathione transferase). Results. The total glutathione level decreased more in patients in whom cardiopulmonary bypass had been used. In addition, the oxidized glutathione level was reduced in these patients, which suggests that antioxidant defense was not fully effective. In contrast, the oxidized glutathione level tended to increase in patients in whom cardiopulmonary bypass had not been used. There was no significant difference in enzymatic activity between the two groups. Conclusions. In this study, patients who underwent off-pump cardiac surgery had a better antioxidant profile. The implication could be that cardiac surgery without cardiopulmonary bypass has a less damaging effect on ischemic myocardium

Regurgitación valvular causada por fármacos anorexígenos / Valvular regurgitation caused by anorectic agents

La enfermedad cardíaca valvular asociada al uso de fármacos anorexígenos es una entidad clínica recientemente descrita. Presentamos el caso de una paciente de 46 años con regurgitación severa mitral, aórtica y tricúspide que había estado tomando fenfluramina y dexfenfluramina durante 2 años. Requirió tratamiento quirúrgico con recambio de las tres válvulas por prótesis mecánicas. El antecedente de toma de fármacos anorexígenos, las características ecocardiográficas de las válvulas afectadas y los hallazgos macroscópicos e histopatológicos sugieren una fuerte asociación entre los anorexígenos y la enfermedad valvular de la paciente (AU)