Diuresis inducida frente a hidratación combinada en pacientes sometidos a procedimientos cardiovasculares percutáneos: metanálisis de ensayos clínicos aleatorizados / Diuresis-matched versus standard hydration in patients undergoing percutaneous cardiovascular procedures: meta-analysis of randomized clinical trials

Introducción y objetivos: La nefropatía inducida por contraste (NIC) es una potencial complicación de los procedimientos que requieren la administración de medio de contraste yodado. El RenalGuard, que suministra una adecuada hidratación combinada con diuresis inducida por furosemida, es una alternativa a las estrategias convencionales de hidratación. Según la literatura disponible, la evidencia sobre el RenalGuard no es concluyente, por lo que hemos realizado un metanálisis utilizando una construcción bayesiana. Métodos Se realizaron búsquedas en Medline, Cochrane Library y Web of Science de ensayos aleatorizados de RenalGuard frente a estrategias estándar de hidratación periprocedimiento. El objetivo primario fue el desarrollo de NIC. Los objetivos secundarios fueron muerte por cualquier causa, shock cardiogénico, edema agudo de pulmón (EAP) e insuficiencia renal que requería terapia de reemplazo renal. Para cada resultado se calculó un riesgo relativo (RR) con el correspondiente intervalo de credibilidad del 95% (ICr95%). Registro número CRD42022378489 en PROSPERO database. Resultados Se incluyeron 6 estudios. El RenalGuard se asoció con una reducción relativa significativa de NIC (mediana de RR=0,54; ICr95%, 0,31-0,86) y EAP (mediana de RR=0,35; 95%ICr, 0,12-0,87). No se observaron diferencias significativas para los otros parámetros secundarios [muerte por cualquier causa (RR=0,49; ICr95%, 0,13-1,08), shock cardiogénico (RR=0,06; ICr95%, 0,00-1,91), terapia de reemplazo renal (RR=0,52; ICr95%, 0,18-1,18)]. El análisis Bayesiano también mostró que el RenalGuard obtuvo una alta probabilidad de posicionarse primero con respecto a todos los objetivos secundarios. Estos resultados fueron consistentes en múltiples análisis de sensibilidad. Conclusiones En los pacientes sometidos a procedimientos cardiovasculares percutáneos, el RenalGuard se asoció con un menor riesgo de NIC y EAP. (AU)

Introduction and objectives: Contrast-associated acute kidney injury (CA-AKI) is a potential complication of procedures requiring administration of iodinated contrast medium. RenalGuard, which provides real-time matching of intravenous hydration with furosemide-induced diuresis, is an alternative to standard periprocedural hydration strategies. The evidence on RenalGuard in patients undergoing percutaneous cardiovascular procedures is sparse. We used a Bayesian framework to perform a meta-analysis of RenalGuard as a CA-AKI preventive strategy. Methods We searched Medline, Cochrane Library and Web of Science for randomized trials of RenalGuard vs standard periprocedural hydration strategies. The primary outcome was CA-AKI. Secondary outcomes were all-cause death, cardiogenic shock, acute pulmonary edema, and renal failure requiring renal replacement therapy. A Bayesian random-effect risk ratio (RR) with corresponding 95% credibility interval (95%CrI) was calculated for each outcome. PROSPERO database number CRD42022378489. Results Six studies were included. RenalGuard was associated with a significant relative reduction in CA-AKI (median RR, 0.54; 95%CrI, 0.31-0.86) and acute pulmonary edema (median RR, 0.35; 95%CrI, 0.12-0.87). No significant differences were observed for the other secondary endpoints [all-cause death (RR, 0.49; 95%CrI, 0.13-1.08), cardiogenic shock (RR, 0.06; 95%CrI, 0.00-1.91), and renal replacement therapy (RR, 0.52; 95%CrI, 0.18-1.18)]. The Bayesian analysis also showed that RenalGuard had a high probability of ranking first for all the secondary outcomes. These results were consistent in multiple sensitivity analyses. Conclusions In patients undergoing percutaneous cardiovascular procedures, RenalGuard was associated with a reduced risk of CA-AKI and acute pulmonary edema compared with standard periprocedural hydration strategies. (AU)

Atrapamiento de catéter de Swan-Ganz durante cirugía valvular mitral: a propósito de un caso / Swan-Ganz Catheter Entrapment during mitral valve surgery: a case report

El catéter de Swan-Ganz es un dispositivo ampliamente utilizado para la monitorización del paciente crítico, así como durante lasintervenciones de cirugía cardiovascular. Sin embargo, su implantación y uso no están exentos del desarrollo de complicaciones.Presentamos un caso de atrapamiento del catéter con la sutura de cierre de la atriotomía izquierda durante una intervención de sustitución valvular mitral. (AU)

The Swan-Ganz catheter is a widely used device for monitoring critical patients, as well as during cardiovascular surgery. However,its implantation and use are not exempt from the development of complications. We present a case of catheter entrapment with theclosing suture of the left atriotomy during a mitral valve replacement procedure. (AU)

Estudio prospectivo de infección quirúrgica en cirugía cardiaca y adecuación de la profilaxis antibiótica / Prospective study of surgical infection in cardiac surgery and adequacy of antibiotic prophylaxis

Introducción. Las infecciones de localización quirúrgica son un importante problema que limitan los potenciales beneficios de las intervenciones quirúrgicas. Nuestro estudio pretende evaluar si la adecuación de las pautas de profilaxis quirúrgica en cirugía cardiaca disminuye la incidencia de la infección de la localización quirúrgica. Material y método. Estudio prospectivo de la incidencia de infección relacionada con los procedimientos quirúrgicos de cirugía cardíaca en los centros sanitarios del sistema canario de la salud entre los años 2012 y 2019 mediante un sistema de vigilancia epidemiológica. Se evaluó el grado de cumplimiento de la profilaxis antibiótica y las causas de incumplimiento en cirugía cardiaca: indicación, duración, inicio y no repetición. Resultados. En el año 2019 la incidencia acumulada de infección del sitio quirúrgico fue del 3,28% (n = 13), lo que supone mantener la tendencia descendente desde el año 2012 (p<0,05). La aparición de la infección fue más frecuente durante el ingreso (61,5%). La profilaxis quirúrgica fue adecuada en el (95,8%), siendo las principales causas de inadecuación la administración fuera del tiempo estipulado (29%) y la no repetición del antimicrobiano en cirugías de larga duración (29%). No se encontró relación entre la adecuación de la profilaxis y la infección del sitio quirúrgico (p>0,05). Conclusión. Los datos analizados mostraron un cambio evidente en la tendencia de infección. No se encontró asociación significativa entre adecuación de la profilaxis e incidencia de infección de localización quirúrgica. Los sistemas de vigilancia y control de infección permiten evaluar y comparar las tasas de infección en cirugía cardiaca. (AU)

Introduction. Surgically site infections are a major problem that limits the potential benefits of surgical interventions. Our study aims to assess whether the adequacy of surgical prophylaxis guidelines in cardiac surgery reduces the incidence of infection at the surgical site. Material and method. Prospective study of the incidence of infection related to cardiac surgery surgical procedures in the health centers of the Canary Islands health system between 2012 and 2019 using an epidemiological surveillance system. The degree of compliance with antibiotic prophylaxis and the causes of non-compliance in cardiac surgery were evaluated: indication, duration, initiation and non-repetition. Results. In 2019, the cumulative incidence of surgical site infection was 3.28% (n = 13), which implies maintaining the downward trend since 2012 (p <0.05). The appearance of the infection was more frequent during admission (61.5%). Surgical prophylaxis was adequate in (95.8%), the main causes of inappropriateness being administration outside the stipulated time (29%) and non-repetition of the antimicrobial in long-term surgeries (29%). No relationship was found between the adequacy of prophylaxis and surgical site infection (p> 0.05). Conclution. The analyzed data showed an evident change in the infection trend. No significant association was found between adequacy of prophylaxis and incidence of surgical site infection. Surveillance and infection control systems allow the evaluation and comparison of infection rates in cardiac surgery. (AU)

[Study on the Application of A New Type of Anhydrous Thoracic Negative Pressure Drainage Device in Patients after Thoracic Surgery].

BACKGROUND: After general thoracic surgery, a chest tube is usually placed for closed drainage to expel gas accumulation in the thoracic cavity and fluid accumulation to promote lung re-expansion. It can also be observed whether there is active bleeding after the operation and whether there is a pulmonary leak. The conventional drainage of the chest cavity is connected with a water-sealed drainage bottle, and the patient condition is judged by observing the drainage situation and the fluctuation of the water column, which is a very classic method. However, the water-sealed bottle has the disadvantages of being easy to overturn and inconvenient to carry, which is not conducive to the early activities of patients. Under the concept of accelerated rehabilitation, our center applied a new type of anhydrous thorax negative pressure drainage device and achieved good results. The purpose of this study was to observe the effect of a new type of anhydrous thoracic negative pressure drainage device in patients after thoracic surgery. METHODS: Retrospective analysis of patients who underwent lung surgery in the First Affiliated Hospital of Zhejiang University Medical College from January 2018 to December 2019, patients were divided into two groups. One group of patients used a traditional closed-chest drainage water-sealed bottle as a control group, and the other group used a new type of anhydrous negative-pressure drainage bottle as an experimental group. Patients' gender, age, hypertension, diabetes, smoking history, surgical incisions and surgical methods, and the length of hospital stay and postoperative hospital stay were calculated. RESULTS: There were no statistical differences in age, gender, comorbidities (hypertension, diabetes, smoking history), scope of surgery, and duration of surgery between the two groups of patients, but there were statistical differences in surgical incisions between the two groups of patients (P=0.01). We found that patients using the new waterless negative pressure drainage device were shorter than patients with water negative pressure drainage device in terms of postoperative hospital stay and total hospitalization time, and the difference was statistically significant (P=0.02, P=0.04). CONCLUSIONS: The new type of anhydrous thoracic negative pressure drainage device has a good effect on the rapid recovery and advancement after thoracic surgery.

General Thoracic Surgery in Rwanda: An Assessment of Surgical Volume and of Workforce and Material Resource Deficits.

BACKGROUND: Benchmarking operative volume and resources is necessary to understand current efforts addressing thoracic surgical need. Our objective was to examine the impact on thoracic surgery volume and patient access in Rwanda following a comprehensive capacity building program, the Human Resources for Health (HRH) Program, and thoracic simulation training. METHODS: A retrospective cohort study was conducted of operating room registries between 2011 and 2016 at three Rwandan referral centers: University Teaching Hospital of Kigali, University Teaching Hospital of Butare, and King Faisal Hospital. A facility-based needs assessment of essential surgical and thoracic resources was performed concurrently using modified World Health Organization forms. Baseline patient characteristics at each site were compared using a Pearson Chi-squared test or Kruskal-Wallis test. Comparisons of operative volume were performed using paired parametric statistical methods. RESULTS: Of 14,130 observed general surgery procedures, 248 (1.76%) major thoracic cases were identified. The most common indications were infection (45.9%), anatomic abnormalities (34.4%), masses (13.7%), and trauma (6%). The proportion of thoracic cases did not increase during the HRH program (2.07 vs 1.78%, respectively, p = 0.22) or following thoracic simulation training (1.95 2013 vs 1.44% 2015; p = 0.15). Both university hospitals suffer from inadequate thoracic surgery supplies and essential anesthetic equipment. The private hospital performed the highest percentage of major thoracic procedures consistent with greater workforce and thoracic-specific material resources (0.89% CHUK, 0.67% CHUB, and 5.42% KFH; p < 0.01). CONCLUSIONS AND RELEVANCE: Lack of specialist providers and material resources limits thoracic surgical volume in Rwanda despite current interventions. A targeted approach addressing barriers described is necessary for sustainable progress in thoracic surgical care.

Impact of an ultraviolet air sterilizer on cardiac surgery patients, a randomized clinical trial / Impacto de un esterilizador ultravioleta en pacientes de cirugía cardíaca: ensayo clínico aleatorizado

Background: Numerous studies have evaluated the use of ultraviolet-C devices for terminal disinfection in hospitals, however, to date there is little information about the device's final impact on patients. We investigated the effect of an ultraviolet air sterilizer (UVAS) on the clinical outcomes of cardiac surgery patients. Materials and methods: This random, prospective and non-interventional study included 1097 adult patients undergoing elective cardiac surgery: 522 stayed in an ICU room with UVAS (Medixair®) and 575 patients ICU room without UVAS and were used as a control. The primary outcome measure was to evaluate the effect of a UVAS on the overall prevalence of nosocomial infections in postoperative cardiac patients in ICUs. Results: No significant differences in ventilator-associated pneumonia (4.6% vs. 5.0%, p=0.77) and total infection (14.0% vs. 15.5%, p=0.45) rates were detected in patients with and without the UVAS. The length of stay in the intensive care unit and at the hospital was similar in both groups, UVAS (4.6 (8.2) days and 18.3 (5.5) days) and without UVAS (4.6 (7.3) days and 19.2 (18.6) days). The 30-day in-hospital mortality rate was 5.3%, no significant differences between groups were observed (p=0.053). Conclusion: Novel ultraviolet-C technology has not been shown to significantly reduce nosocomial infections or mortality rates in cardiac surgery patients

Introducción: Numerosos estudios han evaluado el uso de dispositivos ultravioleta C para la desinfección terminal en hospitales; sin embargo, hasta la fecha existen pocos datos sobre el impacto en los pacientes. Hemos evaluado el efecto de un esterilizador de aire ultravioleta (UVAS) sobre las variables clínicas de los pacientes operados de cirugía cardíaca. Materiales y métodos: Este estudio prospectivo, aleatorizado no intervencional incluyó 1.097 pacientes adultos intervenidos de cirugía cardíaca electiva: 522 ingresaron en una habitación de UCI con UVAS (Medixair®) y 575 pacientes en habitación de UCI sin UVAS se utilizaron como control. La variable principal medida fue el efecto del UVAS sobre la prevalencia global de infecciones en el postoperatorio de cirugía cardíaca en UCI. Resultados: No hubo diferencias significativas en la neumonía asociada a ventilación mecánica (4,6% vs. 5,0%, p=0,77) e índices totales de infección (14,0% vs. 15,5%, p=0,45) detectados en pacientes con y sin UVAS. La duración del ingreso en UCI y en el hospital fue similar en ambos grupos, UVAS (4,6 [8,2] días y 18,3 [5,5] días) y sin UVAS (4,6 [7,3] días y 19,2 [18,6] días). La mortalidad a 30 días hospitalaria fue del 5,3%, sin diferencias significativas entre los grupos (p=0,053). Conclusión: La nueva tecnología ultravioleta C no ha demostrado disminuir las infecciones nosocomiales ni la mortalidad en pacientes de cirugía cardíaca

Behavior of stroke volume variation in hemodynamic stable patients during thoracic surgery with one-lung ventilation periods / Comportamento da variação do volume sistólico em pacientes hemodinamicamente estáveis durante cirurgia torácica com períodos de ventilação monopulmonar

Abstract Introduction: In last few years, emphasis was placed in goal-directed therapy in order to optimize patient's hemodynamic status and improve their prognosis. Parameters based on the interaction between heart and lungs have been questioned in situations like low tidal volume and open chest surgery. The goal of the study was to analyze the changes that one-lung ventilation can produce over stroke volume variation and to assess the possible impact of airway pressures and lung compliance over stroke volume variation. Methods: Prospective observational study, 112 patients undergoing lung resection surgery with one-lung ventilation periods were included. Intravenous fluid therapy with crystalloids was set at 2 mL.g-1. Hypotension episodes were treated with vasoconstrictive drugs. Two-lung Ventilation was implemented with a TV of 8 mL.g-1 and one-lung ventilation was managed with a TV of 6 mL.g-1. Invasive blood pressure was monitored. We recorded the following cardiorespiratory values: heart rate, mean arterial pressure, cardiac index, stroke volume index, airway peak pressure, airway plateau pressure and static lung compliance at 3 different times during surgery: immediately after lung collapse, 30 min after initiating one-lung ventilation and after restoration of two-lung ventilation. Results: Stroke volume variation values were influenced by lung collapse (before lung collapse 14.6 (DS) vs. OLV 9.9% (DS), p < 0.0001); or after restoring two-lung ventilation (11.01 (DS), p < 0.0001). During two-lung Ventilation there was a significant correlation between airway pressures and stroke volume variation, however this correlation lacks during one-lung ventilation. Conclusion: The decrease of stroke volume variation values during one-lung ventilation with protective ventilatory strategies advices not to use the same threshold values to determine fluid responsiveness.

Resumo Introdução: Nos últimos anos, a importância da terapia alvo-dirigida foi enfatizada para aprimorar o estado hemodinâmico do paciente e melhorar seu prognóstico. Os parâmetros baseados na interação entre o coração e os pulmões foram questionados em situações como baixo volume corrente e cirurgia aberta do tórax. O objetivo do estudo foi analisar as alterações que a ventilação monopulmonar pode produzir na variação do volume sistólico e avaliar o possível impacto das pressões da via aérea e da complacência pulmonar sobre a variação do volume sistólico. Métodos: Estudo observacional prospectivo, no qual 112 pacientes submetidos à cirurgia de ressecção pulmonar com períodos de ventilação monopulmonar foram incluídos. A terapia de fluídos intravenosos com cristaloides foi ajustada a 2 mL.kg-1.h-1. Os episódios de hipotensão foram tratados com vasoconstritores. A ventilação dos dois pulmões (VDP) foi implantada com volume corrente de 8 mL.kg-1 e a ventilação monopulmonar foi controlada com volume corrente de 6 mL.kg-1. Foi monitorada a pressão arterial invasiva. Registramos os seguintes valores cardiorrespiratórios: frequência cardíaca, pressão arterial média, índice cardíaco, índice de volume sistólico, pressão de pico das vias aéreas, pressão de platô das vias aéreas e complacência pulmonar estática em três tempos durante a cirurgia: imediatamente após o colapso do pulmão, 30 minutos após o início da ventilação monopulmonar e após a restauração da ventilação dos dois pulmões. Resultados: Os valores de variação do volume sistólico foram influenciados pelo colapso pulmonar (antes do colapso pulmonar 14,6 [DS] vs. ventilação monopulmonar 9,9% [DS], p < 0,0001), ou após o restabelecimento da ventilação dos dois pulmões (11,01 [DS], p < 0,0001). Durante a ventilação dos dois pulmões houve uma correlação significativa entre as pressões das vias aéreas e a variação do volume sistólico, porém, essa correlação não existe durante a ventilação monopulmonar. Conclusão: A diminuição dos valores da variação do volume sistólico durante a ventilação monopulmonar com estratégias ventilatórias protetoras sugere não usar os mesmos valores de limiar para determinar a responsividade aos fluídos.

Localizaciones del dolor en el postoperatorio de cirugía cardiaca: cronología del dolor y respuesta al tratamiento / Pain locations in the postoperative period after cardiac surgery: chronology of pain and response to treatment

Introducción. Tras la cirugía cardiaca (CC) el dolor postoperatorio procede de varios focos, además de la esternotomía. Métodos. Estudio prospectivo, descriptivo y longitudinal sobre la evolución cronológica del dolor en 11 localizaciones tras CC. Se incluyeron pacientes operados consecutivamente de CC por esternotomía. Los objetivos fueron establecer los principales focos del dolor, su evolución cronológica durante la primera semana, correlacionar la intensidad del dolor con otras variables y describir las características del dolor de la esternotomía. Se utilizó la escala de valoración numérica Numerical Pain Rate Scale de 0-10 en reposo y en movimiento en los días postoperatorios 1, 2, 4 y 6. Una puntuación>3 en la Numerical Pain Rate Scale fue considerado dolor moderado. Los datos se sometieron a las pruebas U de Mann-Whitney, Chi cuadrado, exacta de Fisher y la correlación de Pearson. Resultados. Se incluyeron 47 pacientes. En 4 de las 11 localizaciones del dolor este fue valorado como una puntuación>3 en la Numerical Pain Rate Scale (esternotomía, orofaringe, safenectomía y hombros y espalda). La máxima intensidad de dolor se registró en la esternotomía en los días postoperatorios 1 y 2, mientras que en los días postoperatorios 4 y 6 fue en la safenectomía. El dolor en movimiento fue significativamente mayor que en reposo en la esternotomía, las extremidades inferiores y en la orofaringe. El movimiento no aumentó el dolor en espalda y hombros ni en la entrada del catéter venoso central. El dolor en la esternotomía fue descrito como opresivo. Los pacientes con artrosis y los más jóvenes presentaron dolor más intenso (p=0,049 y p=0,004, respectivamente). Conclusiones. Los principales focos del dolor tras CC fueron la esternotomía, la orofaringe, la safenectomía y el osteoarticular en hombros y espalda. Los focos de dolor mostraron diferente cronología y distinta influencia del movimiento (AU)

Introduction. Postoperative pain after cardiac surgery (CS) can be generated at several foci besides the sternotomy. Methods. Prospective descriptive longitudinal study on the chronological evolution of pain in 11 sites after CS including consecutive patients submitted to elective CS through sternotomy. The primary endpoints were to establish the main origins of pain, and to describe its chronological evolution during the first postoperative week. Secondary endpoints were to describe pain characteristics in the sternotomy area and to correlate pain intensity with other variables. Numerical Pain Rating Scale from 0 to 10 at rest and at movement on postoperative days 1, 2, 4 and 6. Numerical Pain Rating Scale>3 was considered moderate pain. Statistical analysis consisted in Mann-Whitney U-test, a Chi-squared, a Fisher exact text and Pearson's correlations. Results. Forty-seven patients were enrolled. In 4 of 11 locations pain was reported as Numerical Pain Rating Scale>3 (sternotomy, oropharynx, saphenectomy and musculoskeletal pain in the back and shoulders). Maximum intensity of pain on postoperative days 1 and 2 was reported in the sternotomy area, while on postoperative days 4 and 6 it was reported at the saphenectomy. Pain at rest and at movement differed considerably in the sternotomy, saphenectomy and oropharynx. Pain at back and shoulders and at central venous catheter entry were not influenced by movement. Pain in the sternotomy was mainly described as oppressive. Patients with arthrosis and younger patients presented higher intensity of pain (P=.004; P=.049, respectively). Conclusions. Four locations were identified as the main sources of pain after CS: sternotomy, oropharynx, saphenectomy, and back and shoulders. Pain in different focuses presented differences in chronologic evolution and was differently influenced by movement (AU)

Aspectos táticos e técnicos observados nas ressecções pulmonares anatômicas por videotoracoscopia / Tactical and technical aspects observed in thoracoscopic anatomical pulmonary resections

Introdução: A cirurgia torácica caminha para realização de procedimentos menos invasivos e mórbidos, com objetivo de poupar parênquima pulmonar. Dados da literatura sugerem que a lobectomia por VATS (videoassisted thoracic surgery) apresenta menos complicações que a cirurgia aberta. Objetivo: Analisar os aspectos táticos e técnicos relacionados a diferentes tipos de ressecção pulmonar anatômica, realizadas por videotoracoscopia. Métodos: Estudo de caso de 26 pacientes operados pela equipe de cirurgia de tórax do Hospital Luxemburgo (Instituto Mário Penna), Hospital Mater Dei em Belo Horizonte. Resultados: A taxa de conversão para operação convencional foi de 15,38%, tendo por complicação pós-operatória dois casos de pneumonia nosocomial e nenhum óbito. Conclusão: A VATS tende a se tornar um procedimento cada vez mais comum na condução de afecções do tórax, todavia, devese sempre ter disponível material para toracotomia, já que a conversão é uma opção para solucionar intercorrência. (AU)

Introduction: Thoracic surgery walks to perform less invasive, morbid and goal of saving lung parenchyma procedures. Published data suggest that VATS (video-assisted thoracic surgery) lobectomy for has fewer complications than open surgery. Objectives: To analyze the tactical and technical aspects related to different types of anatomical lung resection performed by thoracoscopy. Methods: A case study in 26 patients operated by the team of thoracic surgery at the Hospital Luxemburgo (Instituto Mário Penna), Hospital Mater Dei and in Belo Horizonte. Results: The conversion rate for conventional surgery was 15.38%, two cases of pneumonia and no deaths due to postoperative complications. Conclusion: VATS tends to become an increasingly common procedure in the management of chest affections, however thoracotomy material must always be available, since conversion is an option to resolve intercurrence. (AU)

El cateterismo radial previo dificulta la monitorización invasiva durante la cirugía cardíaca / Previous radial artery catheterization complicates invasive monitoring during cardiac surgery

No disponible

Temporary extracorporeal bypass modalities during aortic surgery.

The key to aortic surgery is protection of the brain, heart, spinal cord, and viscera. For operations involving the aortic arch, the focus is on cerebral protection, while for pathology involving the descending thoracic aorta, the focus is on spinal protection. Optimal cerebral and spinal protection requires an extensive knowledge of the operative steps and an understanding of the cardiopulmonary bypass modalities that are possible. A bloodless field is required when operating on the aorta. As a result, periods of ischemia to the central nervous system and end-organ viscera are often unavoidable. The main techniques to mitigate ischemia include hypothermia and selective perfusion of the ischemic organ in question. This chapter will first briefly review bypass modalities and then describe how they can be used for various aortic scenarios.

Anesthetic management for thoracic surgery in Rubinstein-Taybi syndrome / Manejo anestésico en cirugía torácica en el síndrome de Rubinstein-Taybi

Rubinstein-Taybi syndrome (RTS) is a chromosomopathy associated to molecular mutations or microdeletions of chromosome 16. It has an incidence of 1:125,000-700,000 live births. RTS patients present craniofacial and thoracic anomalies that lead to a probable difficult-to-manage airway and ventilation. They also present mental retardation and comorbidity, such as congenital cardiac defects, pulmonary structural anomalies and recurrent respiratory infections, which increase the risk of aspiration pneumonia. Cardiac arrhythmias have been reported after the use of certain drugs such as succinylcholine and atropine, in a higher incidence than in general population. There is an increased risk of postoperative apnea-hypopnea in these patients. We report the anesthetic management in a RTS patient undergoing emergent thoracic surgery due to oesophageal perforation and mediastinitis. Lung isolation was achieved with a bronchial blocker guided with a fiberoptic bronchoscope and one-lung ventilation was performed successfully (AU)

El síndrome de Rubinstein-Taybi es una enfermedad de baja incidencia (1:125.000-700.000 RN vivos) asociada a mutaciones o microdeleciones del cromosoma 16. Los pacientes afectos presentan frecuentemente anomalías craneofaciales y torácicas que condicionan una vía aérea y ventilación dificultosas. Asimismo, asocian retraso mental y comorbilidades, entre las que cabe destacar cardiopatías congénitas, infecciones respiratorias de repetición y enfermedad por reflujo gastroesofágico, que aumenta el riesgo de broncoaspiración. En estos pacientes se ha descrito una mayor incidencia de arritmias tras la administración de fármacos, como la succinilcolina y atropina, así como una mayor incidencia de apnea e hipopnea en el postoperatorio. Presentamos el manejo anestésico de un paciente afecto de síndrome de Rubinstein–Taybi sometido a cirugía torácica urgente por perforación esofágica y mediastinitis, con exclusión pulmonar llevada a cabo con bloqueador bronquial (AU)

Heater-cooler units: contamination of crucial devices in cardiothoracic surgery.

BACKGROUND: Several cases of Mycobacterium chimaera infection have recently been reported in cardiosurgical patients. So-called heater-cooler units (HCUs) used in cardiosurgical procedures are suspected to be the reservoir for pathogen growth and dissemination. AIM: To assess the contamination status of HCUs at our facility. METHODS: Air sampling for mycobacteria was conducted at different distances from the machines and in the area around the operating table. Air sampling was also conducted for non-fermenters as a surrogate parameter for water-associated pathogens. FINDINGS: Mycobacterium chimaera was detected in the water tanks of the HCUs. When the devices were operating, M. chimaera was also found in their exhaust air, as well as in the area around the operating table. Non-fermenters were identified at different distances from the running HCU and the area around the operating table. Cultures remained negative when the devices were switched off. CONCLUSIONS: Exhaust air from HCUs may be a pathway of pathogen transmission to patients undergoing open chest heart surgery. Although, for technical reasons, relocation of HCUs is difficult to achieve, only strict separation of the HCU from the operating room appears to enhance patient safety. Using non-fermenters as a surrogate parameter may be considered a viable option for a timely risk assessment. The design of HCUs should be modified to keep susceptibility to contamination at a minimum.

Benchmarking en cirugía torácica. Tercera edición / Benchmarking in Thoracic Surgery. Third Edition

Introducción: Benchmarking hace referencia a la comparación continuada de la eficiencia y la calidad entre productos y actividades con el objetivo fundamental de alcanzar la excelencia. Objetivo: Analizar los resultados del benchmarking realizado en 2013 con la actividad asistencial de Cirugía Torácica en el año 2012 en 17 servicios de Cirugía Torácica españoles participantes. Métodos: La fuente de información para el estudio ha sido el conjunto mínimo básico de datos de hospitalización correspondiente al año 2012. Los datos han sido proporcionados por los centros participantes, a partir de los informes de alta hospitalaria, sin intervención de los responsables de los correspondientes servicios asistenciales. Los casos objeto del estudio han sido todas las altas de hospitalización registradas en los centros participantes. Los episodios incluidos han sido los de enfermedad quirúrgica respiratoria (CDM4-Q) y los del servicio de Cirugía Torácica. La identificación de estos casos se realizó usando los códigos de la novena edición de la Clasificación Internacional de Enfermedades, Modificación Clínica. Para valorar las diferencias en gravedad y complejidad de los casos se ha utilizado la clasificación de los grupos relacionados por el diagnóstico refinados. Resultados: Los diversos parámetros generales estudiados (casuística, estancia media, complicaciones, readmisiones, mortalidad y actividad) han tenido una gran variabilidad entre los participantes. El análisis concreto de intervenciones (lobectomía, neumonectomía, resecciones atípicas y neumotórax), también han oscilado considerablemente. Conclusiones: Se observa, al igual que en ediciones previas, una considerable variabilidad entre los grupos participantes. Existen áreas de mejora evidentes: estandarización de los procesos de admisión, evitando ingresos urgentes y mejorando la estancia preoperatoria; agilización de las altas hospitalarias y mejora de los informes de alta, reflejando toda la actividad y las complicaciones habidas. Algunas unidades de Cirugía Torácica deben hacer una revisión profunda de sus procesos porque pueden tener algunos parámetros con una desviación excesiva de la norma. También deben mejorarse los procesos de codificación de diagnósticos y comorbilidades

Introduction: Benchmarking entails continuous comparison of efficacy and quality among products and activities, with the primary objective of achieving excellence. Objective: To analyze the results of benchmarking performed in 2013 on clinical practices undertaken in 2012 in 17 Spanish thoracic surgery units. Methods: Study data were obtained from the basic minimum data set for hospitalization, registered in 2012. Data from hospital discharge reports were submitted by the participating groups, but staff from the corresponding departments did not intervene in data collection. Study cases all involved hospital discharges recorded in the participating sites. Episodes included were respiratory surgery (Major Diagnostic Category 04, Surgery), and those of the thoracic surgery unit. Cases were labelled using codes from the International Classification of Diseases, 9th revision, Clinical Modification. The refined diagnosis-related groups classification was used to evaluate differences in severity and complexity of cases. Results: General parameters (number of cases, mean stay, complications, readmissions, mortality, and activity) varied widely among the participating groups. Specific interventions (lobectomy, pneumonectomy, atypical resections, and treatment of pneumothorax) also varied widely. Conclusions: As in previous editions, practices among participating groups varied considerably. Some areas for improvement emerge: admission processes need to be standardized to avoid urgent admissions and to improve pre-operative care; hospital discharges should be streamlined and discharge reports improved by including all procedures and complications. Some units have parameters which deviate excessively from the norm, and these sites need to review their processes in depth. Coding of diagnoses and comorbidities is another area where improvement is needed

The MAVID heart holder: a demonstration device to anchor cadaver hearts for surgical simulation and practical education.

Performing open heart surgery involves learning challenging techniques and a need for realistic training models to achieve and maintain a high level of surgical skills. The MAVID heart holder is an organ holder primarily designed to hold the heart in its anatomic position for the purpose of surgical simulation and education, thereby closing the gap between surgical performance in the laboratory and in the operating room. The device is simple to use, can be adjusted to organ size, and has the necessary instrumentation to be used with any solid organ. The MAVID heart holder also provides a platform for presentation and assists in advancing the research sphere. The advantage over other existing models is that the MAVID heart holder uses real tissue and does not distort the organ at the attachment sites. Further, it offers superior stability as well as the ability to manipulate the organ during presentation and dissection. Training with the MAVID heart holder has the potential to shorten training time to acquire surgical skills and proficiency before performing these techniques in the operating room and in so doing enhance patient safety.

La Unidad de Cardiología Pediátrica del Hospital Infantil Universitario Miguel Servet de Zaragoza / Pediatric Cardiology Unit of the Hospital Infantil Universitario Miguel Servet of Zaragoza

La cardiología pediátrica es la subespecialidad de la Pediatría que se ocupa del estudio y asistencia al niño con patología congénita o adquirida del sistema cardiovascular, abarcando las diferentes edades desde el feto, el lactante y el nño, hasta el adulto con cardiopatía congénita. El Hospital Universitario Miguel Servet de Zaragoza, cuenta con una Unidad de Cardiología Pediátrica con amplia tradición y experiencia, de referencia para una amplia çarea compuesta por toda la Comunidad Autonoma de Aragón, gran parte de la Comunidad Autonoma de La Rioja, y zonas limítrofes de las Comunidades de Castilla-Leon y Castilla—La Mancha, con una población de ú1.720.292 habitantes segun datos de 2011 del Instituto Nacional de Estadistica. Se trata de una Unidad Terciaria, capacitada y dotada para la atención integral al niño cardiópata con todos los medios diagnósticos y terapéuticos disponibles en la actualidad, coordinada con la Unidad de Cirugía Cardíaca Infantil, y en colaboración con las Unidades de Neonatología y Cuidados Intensivos Pediátricos. En este artículo, revisamos la actividad de la Unidad de Cardiologia Pediátrica del Hospital Miguel Servet, detallando la cartera de servicios, las características de la actividad asistencial y otros aspectos de la Unidad (AU)

Paediatric Cardiology is a paediatric subspecialty in charge of the study and care of the child with acquired or congenital vascular system pathology, across the different life periods, from the foetus, to the infant, child and adults with congenital heart disease. The Universitary Hospital Miguel Servet has a Paediatric Cardiology Unit with broad tradition and experience, receiving patients from a broad reference area, the whole Comunidad Autónoma de Aragón, a great part of the Comunidad Autónoma de La Rioja and border regions of Castilla-Leon and Castilla—La Mancha, with a population near 1,720,292 inhabitants (data from Instituto Nacional de Estadistica, year 2011). It is a tertiary Unit, with capacity for integral care to the child with heart disease, with every diagnostic and therapeutic possibility, and closely related with other units, as the Paediatric Cardiac Surgery Unit, the Paediatric Intensive Care Unit and the Neonatology Unit. On this report, we review the activity of the Paediatric Cardiology Unit of the Universitary Hospital Miguel Servet, listing the services offer and assistential activity characteristics (AU)