Un método alternativo para la predicción del riesgo de complicaciones postoperatorias en la resección pulmonar / An Alternative Method for Predicting the Risk of Postoperative Complications in Lung Resection

Objetivos: Los objetivos de este trabajo son rediseñar un modelo de regresión lineal para estimar el valor de VO2max (VO2 estimado) ya publicado y comparar la capacidad predictiva de los valores VO2 medido y VO2 estimado en la aparición de complicaciones cardiorrespiratorias en una serie de pacientes sometidos a resección pulmonar por cáncer de pulmón. Método: Estudio prospectivo y observacional en 83 pacientes. Variables analizadas: demográficas, comorbilidad, IMC, FEV1%, FVC%, DLCO%, distancia recorrida media diaria (km), VO2max medido en el test de ejercicio cardiopulmonar (CPET) y complicación postoperatoria. Estadística descriptiva y comparativa de variables usando Mann-Whitney test para categóricas y t de Student para continuas normales. Se diseña un modelo de regresión lineal donde VO2max, la variable dependiente, se estima desde la distancia recorrida, DLCO% y edad del paciente y su resultado es la VO2 estimada. Se compara la capacidad predictiva de los VO2max medido y estimado mediante t de Student, agrupando por ocurrencia o no de complicaciones cardiorrespiratorias. Resultados: Los 2 grupos son homogéneos en edad, distribución de sexos, IMC, FEV1%, DLCO%, comorbilidad, cirugía realizada y distancia media recorrida/día. VO2 medida y VO2 estimada tienen distribución normal (K-Smirnov p > 0,32). En la predicción de complicaciones, las medias del VO2 estimado a partir del modelo son significativamente diferentes entre los pacientes con/sin complicación (t de Student p = 0,037); frente a los valores de VO2 medido que no distinguen grupos (t de Student p = 0,42). Conclusiones: El VO2max estimado por el modelo es más predictivo en esta serie de casos que el VO2max medido en una CPET

Objectives: The aims of this study were to design a best fit linear regression model to estimate VO2max (estimated VO2) and to compare the ability of VO2 values (measured and estimated) predicting cardiorespiratory complications in a series of patients undergoing lung resection for lung cancer. Method: This was a prospective, observational study performed in 83 patients. Variables analyzed were: demographic characteristics, comorbidity, body mass index (BMI), FEV1%, FVC%, diffusion capacity (DLCO%), mean daily distance walked in kilometers, VO2max measured by cardio-pulmonary exercise test(CPET) and postoperative complications. Descriptive and comparative statistical analysis of the variables was performed using the Mann-Whitney test for categorical variables and the Student’s t-test for continuous variables. A new linear regression model was designed, where the dependent variable (measured VO2max) was estimated by the distance, DLCO% and age, resulting in the estimated VO2. The predictive power of the measured and estimated consumption was analyzed using the Student’s t-test, grouping by the occurrence or absence of cardiorespiratory complications. Results: Both groups were homogeneous for age, sex, BMI, FEV1%, DLCO%, comorbidity, type of resection performed and mean distance walked per day. Estimated VO2 and measured VO2 were normally distributed (K-Smirnov test, P > 0.32). VO2 means estimated by the model (age, DLCO% and mean distance walked per day) were significantly different between patients with and without complications (Student’s t test, P = 0.037) compared with measured VO2 values, which did not differentiate groups (Student's t test , P = 0.42). Conclusion: The VO2max estimated by the model is more predictive in this case series than the VO2max measured during a standard exercise test

An alternative method for predicting the risk of postoperative complications in lung resection.

OBJECTIVES: The aims of this study were to design a best fit linear regression model to estimate VO2max (estimated VO2) and to compare the ability of VO2 values (measured and estimated) predicting cardiorespiratory complications in a series of patients undergoing lung resection for lung cancer. METHOD: This was a prospective, observational study performed in 83 patients. Variables analyzed were: demographic characteristics, comorbidity, body mass index (BMI), FEV1%, FVC%, diffusion capacity (DLCO%), mean daily distance walked in kilometers, VO2max measured by cardio-pulmonary exercise test (CPET) and postoperative complications. Descriptive and comparative statistical analysis of the variables was performed using the Mann-Whitney test for categorical variables and the Student's t-test for continuous variables. A new linear regression model was designed, where the dependent variable (measured VO2max) was estimated by the distance, DLCO% and age, resulting in the estimated VO2. The predictive power of the measured and estimated consumption was analyzed using the Student's t-test, grouping by the occurrence or absence of cardiorespiratory complications. RESULTS: Both groups were homogeneous for age, sex, BMI, FEV1%, DLCO%, comorbidity, type of resection performed and mean distance walked per day. Estimated VO2 and measured VO2 were normally distributed (K-Smirnov test, P>.32). VO2 means estimated by the model (age, DLCO% and mean distance walked per day) were significantly different between patients with and without complications (Student's t test, P=.037) compared with measured VO2 values, which did not differentiate groups (Student's t test, P=.42). CONCLUSION: The VO2max estimated by the model is more predictive in this case series than the VO2max measured during a standard exercise test.

Amplatzer Amulet left atrial appendage occluder entrapment through mitral valve.

We report on a 77-year-old woman in whom percutaneous left atrial appendage (LAA) closure was performed. The patient had a left atrial myxoma resection 3 years previously, and 2 years later, she suffered a transient ischemic attack. Atrial fibrillation was detected and anticoagulation therapy was established. An episode of intracranial bleeding forced interruption of anticoagulation. Thus, percutaneous LAA closure with an Amplatzer Amulet LAA Occluder (St Jude Medical) was proposed. During the procedure, the LAA occluder migrated and became trapped in the mitral valve. Secondary massive mitral regurgitation and hemodynamic instability forced emergent cardiac surgery. Successful removal of the Amplatzer Amulet LAA Occluder was achieved.