Revista Argentina de Cirugía Cardiovascular最新文献

{"title":"Experiencia inicial en la implementación de un programa de plastia mitral: ¿es una técnica con resultados reproducibles?","authors":"Marcos Alcántaro Montoya, Alejandro Villar Inclán, Wildor R Dongo, Diana Yépez Ramos, Damián Arcos Alcívar, John Barba Pacheco","doi":"10.55200/raccv.v21.n3.0054","DOIUrl":"https://doi.org/10.55200/raccv.v21.n3.0054","url":null,"abstract":"Introducción: La reparación de la válvula mitral ha demostrado una amplia superioridad sobre el reemplazo valvular mitral en el tratamiento de la insuficiencia mitral severa, por lo cual es considerada la primera opción terapéutica que recomiendan las guías de la práctica clínica para el tratamiento de las valvulopatías. Por este motivo, debería ser un recurso ampliamente utilizado por los cirujanos de corazón en todo el mundo. Objetivo: Demostrar la reproductibilidad de la plastia mitral en nuestro hospital, tanto en técnicas como resultados, en comparación con los datos publicados en hospitales del primer mundo. Este análisis comparativo nos permitirá evaluar nuestra competencia y calidad de la atención en el campo de la cirugía de la válvula mitral de acuerdo con los estándares mundiales. Material y métodos: Entre enero del 2018 y enero del 2022 se intervinieron a 63 pacientes con insuficiencia mitral severa por enfermedad degenerativa o funcional con criterios quirúrgicos en el Hospital Luis Vernaza, entre los que se incluyeron 22 pacientes a los que se les realizó reparación mitral. Se llevó a cabo un estudio longitudinal retrospectivo de una corte en el que se evaluó la evolución postquirúrgica. Los principales resultados fueron la patencia, reintervención y mortalidad. El seguimiento se efectuó mediante contacto telefónico y a todos los pacientes se les realizó al menos un ecocardiograma por año. Resultados: Se analizaron 22 pacientes (73% hombres) con una edad media de 48 años (rango de 36 a 72 años). Todos los pacientes presentaron insuficiencia mitral severa y el 91% de etiología primaria. Se reparó de forma exitosa la insuficiencia mitral severa de etiología primaria, el 55% de ellas por compromiso del segmento P2. Solo 2 pacientes necesitaron reintervención, uno por desinserción del anillo y el otro por rotura de nuevas cuerdas tendinosas. Solo hubo una mortalidad intrahospitalaria asociada a reintervención mediata por falla de la plastia, y tres fallecidos por causas no cardiovasculares. Los pacientes restantes permanecen asintomáticos, reincorporados a sus actividades ordinarias habituales, sin insuficiencia mitral residual y con una fracción de eyección del ventrículo izquierdo mayor del 45%. Conclusiones: La plastia valvular mitral con anillo es una técnica que se puede reproducir de manera exitosa en nuestro medio, con personal adecuadamente entrenado y tutorizado, y se logran resultados similares a centros de nivel mundial que cuentan con un mayor volumen quirúrgico y experiencia en plastias mitrales.","PeriodicalId":417308,"journal":{"name":"Revista Argentina de Cirugía Cardiovascular","volume":"13 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139166246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial Experience Implementing a Mitral Plasty Program: Is It a Technique with Reproducible Results?","authors":"Marcos Alcántaro Montoya, Alejandro Villar Inclán, Wildor R Dongo, Diana Yépez Ramos, Damián Arcos Alcívar, John Barba Pacheco","doi":"10.55200/raccv.v21.n3.0053","DOIUrl":"https://doi.org/10.55200/raccv.v21.n3.0053","url":null,"abstract":"Background: Repairing the mitral valve has demonstrated a significant advantage over managing severe mitral insufficiency over mitral valve replacement. Therefore, the clinical practice guidelines considered it the first therapeutic option for treating valvular pathologies. Consequently, it should be widely adopted as a standard procedure by cardiac surgeons worldwide. Objective: To establish the reproducibility of mitral valve repair within our hospital in terms of techniques and outcomes, we aim to compare our performance with data published by leading international medical institutions. This comparative analysis will allow us to evaluate our proficiency and quality of care in the field of mitral valve surgery in line with global standards. Methods: Between January 2018 and January 2022, 63 patients with severe mitral insufficiency due to degenerative or functional disease who met surgical criteria were operated at Luis Vernaza Hospital. Of these, 22 patients underwent mitral valve repair. We conducted a retrospective longitudinal study and assessed the postoperative progression, focusing on key outcomes, including valve patency, reintervention rates, and mortality. The patients’ follow-up was made by telephone communication, and they underwent at least one annual echocardiogram as a part of the monitoring process. Results: As a result, 22 patients (73% males) with an average age of 48 years (ranging from 36 to 72 years) were analyzed. All patients presented severe mitral insufficiency, with 91% of cases attributed to primary etiology. In our experience, severe primary mitral insufficiency was successfully repaired in 55% of cases, with the P2 segment involvement being the most common cause. On the other hand, only two patients required reoperation, one due to ring dehiscence and the other due to rupture of new chordae tendineae. In contrast, we had one case of hospital mortality associated with immediate reoperation due to repair failure, and three patients passed away later due to non-cardiovascular causes. Finally, the remaining patients are asymptomatic, maintain regular activities, have no residual mitral insufficiency, and maintain a left ventricular function with more than 45% ejection fraction. Conclusion: Mitral valve repair with an annuloplasty ring is a technique that can be successfully replicated in our hospital and provided by cardiac surgeons with adequate training. This approach yields outcomes similar to those achieved in globally renowned centers with higher surgical volumes and extensive experience in mitral valve repairs.","PeriodicalId":417308,"journal":{"name":"Revista Argentina de Cirugía Cardiovascular","volume":"23 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139166287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IMPACTO EN LA ACTIVIDAD ASISTENCIAL DURANTE LA PANDEMIA COVID-19 DE UN SERVICIO DE CIRUGÍA CARDÍACA EN ZONA SUR DEL ÁREA METROPOLITANA DE BUENOS AIRES","authors":"Neyda Daniela Contreras Barrientos, Marilyn Eugenia Toro Cárdenas, María Belén Rosell, Iván Leonel Horisberger, Beymar Flores Omonte, Nicolás Miragaya, Alejandra Inés Christen, Javier Andrés Duval, Fabián Marcelo Crespo, Alejandro Trainini","doi":"10.55200/raccv.v21.n3.0045","DOIUrl":"https://doi.org/10.55200/raccv.v21.n3.0045","url":null,"abstract":"Introduction and objective: The Pandemic caused by the SARS-CoV-2 virus (COVID-19) impacted healthcare, which led surgical services to adapt their functional structure according to the different temporal phases. This paper aims to analyze the pandemic's impact on outpatient care and surgical interventions in the Cardiac Surgery Service of a third-level public hospital in the Southern area of the Metropolitan Area of Buenos Aires, Argentina. Methods: The consecutive medical records of 561 operated patients and the office records of 943 patients treated were retrospectively evaluated from March 2018 to December 2022. The number of consultations and surgeries, the epidemiological parameters, and the postoperative evolutions were analyzed. Results: During the pandemic, concerning the pre-pandemic period, a significant decrease in the monthly number of consultations (18.9 vs. 14.8; p <0.05) and of surgeries (12 vs. 8.3; p <0.0001) was recorded. A significant increase in patients referred from the Intensive Care Unit before surgery was also observed (p <0.005). Among the presurgical risk factors, a significantly higher prevalence of acute myocardial infarction (AMI) and insulin-requiring diabetes (IR-DBT) was found, as well as a more significant number of patients with deterioration of left ventricular systolic function (LVSF) (p <0.005). The total amount of infections increased significantly (p <0.05), with respiratory infections as the primary cause (p <0.05). However, this cause was associated with COVID-19 in only one patient. Conclusions: During the pandemic, consultations and surgeries decreased in the Cardiac Surgery Service, with more patients referred from intensive care areas. The patients who underwent surgery had a more significant history of AMI, DBT, and impaired LVFS. Infections increased, predominantly due to respiratory causes, although unrelated to COVID-19.","PeriodicalId":417308,"journal":{"name":"Revista Argentina de Cirugía Cardiovascular","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139166184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CORONARY ENDARTERECTOMY: BENEFIT OR DETRIMENT TO MYOCARDIAL REVASCULARIZATION?","authors":"Manuel Avallone, Maria Soledad Alvarez","doi":"10.55200/raccv.v21.n1.0023","DOIUrl":"https://doi.org/10.55200/raccv.v21.n1.0023","url":null,"abstract":"Cardiovascular disease is the leading cause of death worldwide. In the same sense, coronary artery bypass graft (CABG) surgery is one of the most frequently performed cardiac surgery procedures worldwide. In clinical practice, myocardial revascularization can be followed by a procedure called endarterectomy to reinforce the sanitation of the vessel with decreased flow and improved irrigation. However, there is sufficient evidence in the medical literature that reports serious adverse events due to the application of endarterectomy, the most feared complication being the perioperative infarction itself, which is why it has fallen into disuse. This work aims to disseminate our experience regarding coronary endarterectomy to be valued as an intervention tool within a complex spectrum like diffuse coronary disease.","PeriodicalId":417308,"journal":{"name":"Revista Argentina de Cirugía Cardiovascular","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124802467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SURGICAL ANATOMY OF THE MITRAL VALVE","authors":"S. Cubas, Camila Cajelli Bregante, A. Villar, Camila Rodríguez, Sofía Martínez, Juan E. Kenny, Juan Paganini, Gustavo Jorge Armand Ugon Bigi","doi":"10.55200/raccv.v21.n1.0021","DOIUrl":"https://doi.org/10.55200/raccv.v21.n1.0021","url":null,"abstract":"Introduction: The gold standard for mitral valve disease is surgical treatment, for which it is essential to have a deep understanding of its anatomy. Our work aims to specify the relationships of the mitral annulus with the circumflex artery and define areas of proximity and greater risk of compromise during mitral interventions. Material and methods: A descriptive, observational, cross-sectional study was conducted, in which 39 hearts from adult cadavers fixed in formaldehyde solution were dissected. From an atrial view of the mitral valve, taking the mitral annulus as a reference, several measurements were taken using Carpentier ́s classification of the sectors of the posterior mitral valve (P1, P2, and P3). Distance 1: from the anterolateral commissure to the circumflex artery. Distance 2: from the middle third of P1 to the artery. Distance 3: from P2 to the artery. Distance 4: from P3 to the artery.Results: The global mean of distance 1 was 8.38 mm, of distance 2 was 8.16 mm, of distance 3 was 7.09 mm, and of distance 4 was 7.97 mm. We found no statistically significant differences according to coronary dominance. Conclusion: The area of highest risk of injury to the circumflex artery concerning to the mitral annulus corresponds to the P2 sector of the posterior mitral leaflet. Left dominance and codominance would be associated with a greater risk.","PeriodicalId":417308,"journal":{"name":"Revista Argentina de Cirugía Cardiovascular","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128280275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RENO-CAVO BIOLOGICAL BYPASS WITH TUBULIZED BOVINE PATCH FOR NUTCRACKER SYNDROME","authors":"Alexis Manuel Rojas Guerreiro, Angel Martinez Monsalve, A. Reyes Monasterio, L. F. Cabrera Vargas","doi":"10.55200/raccv.v21.n1.0025","DOIUrl":"https://doi.org/10.55200/raccv.v21.n1.0025","url":null,"abstract":"Nutcracker syndrome (NCS) is the set of symptoms resulting from compression of the left renal vein. A 19-year-old female patient with abdominal pain is approached. In the physical examination, we found pain in the left flank and left iliac fossa with abdominal palpation. Computed tomography and renal Doppler were performed and showed direct NCS signs. A reno-cavo bypass was performed with a tubulized bovine pericardium patch. NCS is a rare and underdiagnosed entity, and more follow-up data are needed to evaluate reno-cavo bypass in reducing symptoms and long-term complications.","PeriodicalId":417308,"journal":{"name":"Revista Argentina de Cirugía Cardiovascular","volume":"124 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128041205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EXPECTATIONS FOR THE FUTURE OF CARDIOVASCULAR SURGERY","authors":"R. Sádaba","doi":"10.55200/raccv.v21.n1.0029","DOIUrl":"https://doi.org/10.55200/raccv.v21.n1.0029","url":null,"abstract":"","PeriodicalId":417308,"journal":{"name":"Revista Argentina de Cirugía Cardiovascular","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131047073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SURGICAL AND ENDOVASCULAR TREATMENT IN THE ASSOCIATION OF BILATERAL POPLITEAL ANEURYSM AND ABDOMINAL AORTIC ANEURYSM","authors":"J. R. Rodríguez Asensio, L. R. Maciel, G. Sposito, H. Bassani Molinas, María Rosario Rey","doi":"10.55200/raccv.v21.n1.0027","DOIUrl":"https://doi.org/10.55200/raccv.v21.n1.0027","url":null,"abstract":"The association of popliteal aneurysms (PAs) with other aneurysms of the arterial tree is very frequent. Although PAs are an infrequent entity, the popliteal artery is the second most frequent location of arterial aneurysms. In this paper we present the case of a patient with right lower limb ischemia as a result of a thrombosed popliteal aneurysm associated to contralateral popliteal aneurysm and aortic aneurysm. The case was resolved with a combination of surgical revascularization in the lower limbs and EVAR.","PeriodicalId":417308,"journal":{"name":"Revista Argentina de Cirugía Cardiovascular","volume":"149 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121989118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACCESO VASCULAR PARA HEMODIÁLISIS POR TRANSPOSICIÓN BASÍLICO-CUBITAL EN LOOP AXILAR","authors":"Javier H. Rodríguez Asensio, G. Sposito, Lorena Rocío Maciel, María Rosario Rey, Dora Agüero","doi":"10.55200/raccv.v20.n3.0017","DOIUrl":"https://doi.org/10.55200/raccv.v20.n3.0017","url":null,"abstract":"La población en diálisis está aumentando debido a múltiples factores, como el incremento de la esperanza de vida en este siglo y el ingreso de pacientes cada vez más jóvenes por enfermedades como la diabetes. Además, la esperanza de vida de la población en diálisis también creció por las mejoras en la tecnología médica. Los accesos vasculares nativos clásicos como la FAV Brescia-Cimino radiocefálica, la FAV braquiocefálica y las transposiciones de las venas basílica y cubital siguen siendo de primera elección, ya que presentan una mayor tasa de permeabilidad y menor tasa de complicaciones en comparación con los materiales protésicos. Ante el agotamiento de todas las posibilidades de acceso convencional en miembros superiores, una alternativa es la creación de una FAV basílica-cubital en asa axilar. Este procedimiento se realizó con buenos resultados en cuatro pacientes entre 30 y 52 años con insuficiencia renal crónica en hemodiálisis trisemanal.","PeriodicalId":417308,"journal":{"name":"Revista Argentina de Cirugía Cardiovascular","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133824011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocardial revascularization surgery with bilateral internal mammary artery","authors":"Paulina Ramírez, Nicolás Lopera, Manuela de la Cuesta, Juan José Turizo, A. Escobar, R. Meza","doi":"10.55200/raccv.v20.n3.0018","DOIUrl":"https://doi.org/10.55200/raccv.v20.n3.0018","url":null,"abstract":"Introduction: The internal mammary artery is the only graft with a long-term impact on mortality in patients with coronary artery disease. Some questions limit the use of both arteries simultaneously, such as prolonged surgical time, risk of sternal infections, especially in diabetic and obese patients. This study sought to describe the 5-year experience in patients revascularized with bilateral internal mammary artery (BIMA). Methods: Descriptive cohort follow-up study. 42 patients underwent myocardial revascularization with BIMA between 2015-2020, Manuel-Uribe-Ángel Hospital, Envigado-Colombia. Secondary and primary information sources. Univariate analysis was developed for the description of variables. Results: Mean age of 55.2 years, 19% were diabetic, mean body mass index (BMI) 24.5 kg/sq.mt; severe coronary artery disease 90.5%, 95.2% with complete revascularization. No patient presented surgical site infection. Median follow-up of 5.1 years during which 5.4% suffered an acute myocardial infarction, 13.5% required percutaneous coronary intervention, 16.2% died, 33.3% of which were attributed to a cardiac cause. Discussion: The participants had a normal average BMI, 19% were diabetic; they had adequate metabolic control, presenting mean glycosylated hemoglobin of 7.09%. In the studied population there were no cases of surgical site infection and 16.2% of the cohort presented angina, which is lower than that described in other studies. Incidence of acute myocardial infarction and percutaneous coronary intervention was similar to the ones reported in other studies. Conclusion: In the studied population, patients with BMI in the normal range and glycemia with adequate metabolic control, myocardial revascularization with BIMA was a safe technique with acceptable medium-term cardiovascular outcomes.","PeriodicalId":417308,"journal":{"name":"Revista Argentina de Cirugía Cardiovascular","volume":"124 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116319225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}