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ABSTRACT Background : Cardiac surgery avoiding full sternotomy began to emerge in the 1990s with the first hemi-sternotomies and mini-thoracotomies. Aortic valve and root surgery is one of the most common procedures in our field. In this paper, we analyze our experience in minimally invasive cardiac surgery (MICS) for the aortic root with the Bentall-De Bono technique (MICS-Bentall). Objective : To analyze the surgical results in the first 10 patients underwent a MICS-Bentall procedure at our site. Materials and Methods : A retrospective observational study was carried out including patients with valve disease and aortic root dilation who underwent a surgery with the MICS-Bentall procedure in a tertiary care hospital from December 2019 to December 2020. Continuous variables were expressed as mean and standard deviation or median and interquartile range according to the observed distribution. Categorical variables were expressed as absolute and relative frequency. Results : Out of 165 patients undergoing aortic root surgery, 10 patients were included. Mean age was 56 ± 17.03 years, 70% male; all cases were elective. Median (interquartile range, IQR) STS PROM % was 1.48 (1- 2.02). Eighty percent had bicuspid valve. Fifty percent of patients were extubated within 6 hours. In the 30-day follow-up, no death was recorded, and two complications were registered: one patient experienced atrial fibrillation without hemodynamic decompensation and another a wound infection. The mean hospital length of stay was 5 days. Conclusion : In our experience, MICS using the Bentall technique showed satisfactory results in terms of low perioperative mortality, early extubation, and short hospital stay.
RESUMEN Introducción : La cirugía cardíaca libre de esternotomía completa surge en los años 90 con las primeras esternotomías y toracotomías mínimas. La cirugía de la válvula y la raíz aórtica constituyen uno de los procedimientos más frecuentes en nuestro campo. En este trabajo analizamos nuestra experiencia en Cirugía Cardíaca Miniinvasiva (MICS) de la raíz aórtica con la técnica Bentall de Bono (MICS-Bentall). Objetivo : Analizar los resultados quirúrgicos en los primeros 10 pacientes intervenidos con MICS-Bentall en nuestra institución. Material y métodos : Se realizó un estudio observacional retrospectivo en el que se incluyeron los casos de valvulopatía y dilatación de la raíz aórtica intervenidos quirúrgicamente mediante MICS-Bentall en un hospital de alta complejidad durante el periodo diciembre 2019 - diciembre 2020. Las variables continuas se expresan como media y desvío estándar o mediana y rango intercuartílico según la distribución observada. Las variables categóricas como frecuencia absoluta y relativa. Resultados : Sobre 165 pacientes sometidos a cirugía de la raíz aórtica, se incluyeron 10 pacientes. La edad media fue de 56 ± 17,6 años, 70% de sexo masculino, todos fueron electivos. La mediana de STS PROM % fue de 1,48 (1-2,02). En el 80% la válvula aórtica era bicúspide. El 50% de los pacientes fue extubado dentro de las 6 horas. En seguimiento a 30 días no se registraron óbitos, y hubo 2 complicaciones: un paciente presentó fibrilación auricular sin descompensación hemodinámica, y otro, infección de herida. La estadía hospitalaria fue en promedio de 5 días. Conclusión : En nuestra experiencia con MICS con la técnica Bentall se obtuvieron resultados satisfactorios con baja mortalidad perioperatoria, extubación precoz y tiempos cortos de estancia hospitalaria.
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OBJECTIVES: Perivalvular abscesses with destruction of the aortomitral junction (AMJ) are a severe complication of infective endocarditis (IE) and are associated with high mortality and complex management. The Hemi-Commando procedure is a mitral valve-sparing alternative to the Commando procedure in suitable patients with complex IE and paravalvular destruction. This study reviews the mid-term outcomes in patients undergoing the Hemi-Commando procedure for treating IE with destruction of the AMJ. METHODS: The clinical outcomes of patients with IE and AMJ involvement who underwent the Hemi-Commando procedure between 2015 and 2021 at the Leipzig Heart Center were retrospectively analysed. Primary outcomes were 30-day mortality and 1-year survival. Secondary outcome was 1-year freedom from reoperation. RESULTS: A total of 22 patients underwent the Hemi-Commando procedure during the study period. The patients' mean age was 59.8 ± 18.3 years. The study population was predominantly male (86.4%). Preoperative sepsis was present in 6 (27.3%) patients, and the median EuroSCORE II was 28.5%. Almost two-thirds (N = 14; 63.6%) of the patients presented with native IE. Streptococci were the most common pathogens (N = 8; 36.4%). Paravalvular abscess was found intraoperatively in 16 (72.7%) patients. The 30-day mortality was 13.6%. The estimated 1- and 3-year survival rates were 77.5% and 66.4%, respectively. The estimated freedom from reoperation at 1 and 3 years was 92.3%. CONCLUSIONS: The Hemi-Commando procedure offers an acceptable mid-term survival chance with low reoperation rates and is, therefore, a reasonable mitral valve-sparing alternative to the Commando procedure in suitable patients with extensive IE and perivalvular involvement.
Subject(s)
Endocarditis, Bacterial , Endocarditis , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Humans , Male , Adult , Middle Aged , Aged , Female , Aortic Valve/surgery , Retrospective Studies , Heart Valve Prosthesis Implantation/methods , Endocarditis/surgery , Endocarditis/complications , Reoperation/adverse effects , Abscess/surgery , Treatment Outcome , Heart Valve Prosthesis/adverse effectsSubject(s)
COVID-19/diagnosis , Heart Rupture/diagnosis , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/therapy , Myocardial Infarction/diagnosis , Aged , COVID-19/complications , COVID-19/physiopathology , COVID-19/therapy , Delayed Diagnosis , Diagnosis, Differential , Female , Heart Rupture/physiopathology , Heart Rupture/therapy , Humans , Mitral Valve Insufficiency/genetics , Mitral Valve Insufficiency/physiopathology , Myocardial Infarction/complications , Myocardial Infarction/physiopathology , Myocardial Infarction/therapy , Predictive Value of Tests , Treatment OutcomeABSTRACT
Background The authors present two cases with type B aortic dissection initially treated by endovascular stent graft who developed aortic complications posttreatment and required surgical treatment. Case Description A 50-year-old woman and a 65-year-old man underwent endovascular treatment for thoracic aortic aneurysm associated with type B dissection and -both of them evolved with endoleak type 1. The first case was related to aortobronchial fistula, and the second one was associated with ascending aortic aneurysm. An extra-anatomical ascending aorta-supraceliac aorta bypass grafting was decided due to the persistent leak. Conclusion Surgery is an excellent choice for complex complications after thoracic endovascular aortic repair with previous failed attempts of endovascular resolution.
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The correct management of acute Type A dissection continues to be a challenge. The primary goal is to save the patient´s life. However, the decision regarding the surgical approach determines possible later complications. We present the case of a 59-year-old female patient with a past history of emergent surgery for acute Type A dissection treated by supracoronary ascending and aortic valve replacement 19 years previously. Later, in a second endovascular approach, the descending aorta was treated by a thoracic endoprosthesis. During follow-up a dilated aortic root and a Type I endoleak were observed, and complex reoperation was required. We performed a total aortic arch replacement with a 4-branched graft and a complete aortic root replacement using the Cabrol technique for the reinsertion of the coronary arteries. The mechanical aortic normally functioning valve was preserved. The patient was discharged 30 days postoperatively.
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El Síndrome del Hiato interescalénico Anterior está incluido en el Síndrome de compresión neurovascular de la salida superior del tórax junto con la costilla cervical, la estrechez del desfiladero costoclavicular y la compresión del músculo pectoral menor. Una de las posibles causas de este síndrome es la existencia de bandas musculares o músculos accesorios entre el escaleno anterior y el medio que producirían compresión del plexo braquial y la arteria subclavia en el hiato interescalénico anterior.
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Humans , Thoracic Outlet Syndrome/diagnosis , Cadaver , DissectionABSTRACT
En el presente trabajo efectuamos una apretada síntesis orientativa para el médico internista, de la bacteriología de la sepsis. Se hace hincapié en la metodología de la recolección de muestras, las tinciones de Gram, el concepto de microflora, colonización, infección local y sistemática, como así también en el tratamiento empírico inicial según foco y según estado inmune del paciente, y además un tratamiento orientativo según los gérmenes aislados.
Subject(s)
Bacteriology , Sepsis/microbiology , Sepsis/therapy , Anti-Bacterial Agents/therapeutic use , Blood Specimen Collection , Clinical Laboratory Techniques , Diarrhea/therapy , Endocarditis, Bacterial/therapy , Gram-Negative Bacteria/classification , Gram-Positive Bacteria/classification , Surgical Wound Infection/therapy , Cross Infection/etiology , Cross Infection/therapyABSTRACT
En el presente trabajo efectuamos una apretada síntesis orientativa para el médico internista, de la bacteriología de la sepsis. Se hace hincapié en la metodología de la recolección de muestras, las tinciones de Gram, el concepto de microflora, colonización, infección local y sistemática, como así también en el tratamiento empírico inicial según foco y según estado inmune del paciente, y además un tratamiento orientativo según los gérmenes aislados. (AU)
