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Background: In skeletal muscle, adenosine triphosphate stores decrease during the first 3 h of ischemia. In the present study, we performed a comprehensive hemodynamic evaluation during the postoperative period after cardiac surgery and measured skeletal muscle enzyme levels and markers of muscle damage and inflammation. The aim was to determine whether these values change and, if so, whether these changes coincide with the presence of low flow and poor perfusion. Methods: We included a cohort of 280 nonconsecutive adults who were monitored in the postoperative period following cardiac surgery. We measured hemodynamic indices repeatedly in the first 24 h postoperatively, and we identified differences between the levels of skeletal muscle enzymes and muscle damage markers on admission (0 h) and 12 and 24 h postoperatively. Results: A clinically and statistically significant elevation of creatine kinase (CK) level was observed at 12 h postoperatively in patients with low macrocirculatory flow and anaerobic metabolism. Lactate dehydrogenase (LDH) level was significantly elevated in these patients at 24 h. Conclusions: In the first 24 h after cardiac surgery, a state of low macrocirculatory flow and the consequent deficit in flow at the capillary–cell interface in the presence of anaerobic metabolism was associated with clinically and statistically significant elevations of CK level at 12 h and LDH level at 24 h. These changes may be markers of skeletal muscle ischemia and may provide an additional tool in the monitoring and resuscitation of these critically ill patients. Resumen: Antecedentes: En el músculo esquelético, las reservas de trifosfato de adenosina disminuyen durante las primeras 3 h de isquemia. En el presente estudio, realizamos una evaluación hemodinámica integral durante el período postoperatorio de cirugía cardíaca, y medimos los niveles de enzimas del músculo esquelético y los marcadores de daño muscular. El objetivo fue determinar si estos valores cambian y, en caso afirmativo, coinciden con la presencia de bajo flujo y mala perfusión. Métodos: Incluimos una cohorte de 280 adultos no consecutivos que fueron monitorizados en el postoperatorio de cirugía cardíaca. Medimos los índices hemodinámicos postoperatoriamente, e identificamos diferencias entre los niveles de enzimas del músculo esquelético y los marcadores de daño muscular al ingreso (0 h) y a las 12 y 24 h, postoperatoriamente. Resultados: Se observó una elevación clínica y estadísticamente significativa del nivel de creatina cinasa (CK) a las 12 h del postoperatorio en los pacientes con bajo flujo macrocirculatorio y metabolismo anaeróbico. El nivel de lactato deshidrogenasa (LDH) estuvo significativamente elevado en estos pacientes a las 24 h. Conclusiones: En las primeras 24 h después de una cirugía cardíaca, un estado de bajo flujo macrocirculatorio y el consiguiente déficit de flujo en la interfaz capilar/célula en presencia de metabolismo anaeróbico se asoció con elevaciones clínica y estadísticamente significativas del nivel de CK a las 12 h y de la LDH a las 24 h. Estos cambios pueden ser marcadores de isquemia del músculo esquelético y pueden proporcionar una herramienta adicional en el seguimiento y en la reanimación de estos pacientes.

Introduction: Approximately 33% of patients with cardiovascular diseases will require heart surgery at least once in their lifetime; yet, less than a quarter of the world’s population has access to cardiac surgical care when needed. Despite Colombia’s progress in cardiac surgical care delivery in recent decades, little is known regarding access to cardiac care across the country. Therefore, global surgery seeks to study and build upon the current situation in areas of limited access to surgical healthcare and to strengthen health systems. Objetive: Describe the current situation in Colombia in terms of surgical personnel and available infrastructure, to better understand the existing gaps in access to cardiac surgical care for populations in need. Materials and method: Data on the cardiac surgical workforce were obtained from a survey of surgeons registered in the cardiac surgery directory and the Cardiothoracic Surgery Network in Colombia. Procedural data from 2018-2019 were obtained from national government data. Results: There were 110 cardiac surgeons or 1.8 cardiac surgeons per million inhabitants in Colombia, of which 85.0% were male. Densities in each of the 32 departments of Colombia varied from 4.6 surgeons per million inhabitants (Bogotá) to no surgeons in 14 departments. There were 52 institutions registered, with a median of 250 beds (interquartile range 130-350). One in five cardiac surgery departments offered a certified cardiac surgery fellowship program. Coronary artery bypass grafting was the most frequently performed procedure. Conclusions: This study identified data regarding the current situation of cardiac surgery in Colombia. Despite relatively favorable cardiac surgical workforce availability in Colombia, geographical variation and social and economic factors point to an urgent need to evaluate the quality-of-care policies related to cardiac surgical care in underserved populations. [ABSTRACT FROM AUTHOR]

Introduction: transfusion leads to complications and mortality in cardiac surgery, with an incidence of 40-90%. There are scales that predict transfusion risk, however, they differ in the number and type of variables; furthermore, few have been compared in Mexican population. Objective: to evaluate the Transfusion Risk Understanding Scoring Tool (TRUST) and Transfusion Risk and Clinical Knowledge (TRACK) scales for risk of transfusion in cardiovascular surgery in the Mexican population. Material and methods: observational, retrospective, comparative study. It included 300 patients older than 18 years who underwent elective cardiovascular surgery. The area under the curve (AUC) of the TRACK and TRUST scores and their relationship with the transfusion variable were evaluated using the ROC curve. The inferential statistics implemented were Student's t and χ2. Results: there were 83 women (27.7%) and 217 men (72.3%). 227 Patients (75.7%) were transfused; the majority with hematocrit > 35% (82.2%). Sensitivity, specificity, and AUC to identify high and very high risk patients of the TRACK scale were: 76%, 50% and 0.702, respectively; for the TRUST scale were: 68%, 57% and 0.69, respectively. Conclusions: the TRACK and TRUST scales are useful for transfusion risk stratification in elective cardiac surgery in our population. [ABSTRACT FROM AUTHOR]

Introduction: Aortic stenosis is the most common valvular heart disease requiring surgical treatment. Minimally invasive surgical techniques have emerged as alternatives to traditional median sternotomy. Objective: To analyze the possible risk factors associated with major bleeding in patients undergoing aortic valve replacement via right anterior mini-thoracotomy and to share the results found in our center. Materials and methods: A retrospective, observational, longitudinal study was conducted in patients undergoing right anterior mini-thoracotomy from July 2015 to December 2022. Demographic and clinical data, as well as relevant surgical and echocardiographic variables, were collected. Results: The mean age of the study population had a mean age of 58 years, with a predominance of men under 65 years of age. Only three patients experienced major bleeding 4.47%. Advanced age and extracorporeal circulation time (minutes) were associated with bleeding. No significant differences were found in other variables analyzed. Conclusions: The study results indicate a low rate of postoperative bleeding in minimally invasive surgery. Advanced age and prolonged extracorporeal circulation time were identified as significant risk factors for major bleeding. However, further studies with a larger sample size are needed to better understand these factors and the safety of minimally invasive surgery. [ABSTRACT FROM AUTHOR]

Hypoplastic left heart syndrome (HLHS) continues to be a challenge in terms of morbimortality. Norwood-Sano surgery has been classically the correction of choice, the introduction of new techniques like biventricular repair, in favorable cases, and hybrid procedures as a step prior to cardiac transplantation have not improved the univentricular results. Technological advances and improvements in anticoagulation therapies have made possible to implant ventricular assist devices (VAD) during the neonatal period. This has motivated us to start a left VAD program in an animal model of HLHS. Our objective is to use long term VAD in a biventricular condition in patients with HLHS as a bridge to cardiac transplantation. Although the conditions have not been met to start a program for patients, the initial results show that the technique is feasible in pigs. We believe that this line of research is worth exploring as cardiac transplant in conditions of biventricular physiology could be less risky and offer better results than the classical univentricular path. Resumen: El síndrome del corazón izquierdo hipoplásico (SCIH) continúa siendo un reto en términos de morbimortalidad. La cirugía clásica de Norwood-Sano continúa siendo de elección y la introducción de nuevas técnicas como la reparación biventricular en los casos más favorables y los procedimientos híbridos para poder optar a un trasplante cardiaco posterior, no han conseguido una mejora en los resultados de la cirugía univentricular clásica. El avance de la tecnología y la terapia anticoagulante en los últimos años ha hecho realidad la asistencia ventricular mecánica (AVM) de larga duración en el periodo neonatal. Por estos motivos hemos iniciado un programa de implante de AVM izquierda en un modelo animal de hipoplasia de SCIH. Con el objetivo de que en un futuro la SCIH se pueda trasplantar en condiciones de biventricularidad, con el implante de una AVM izquierda de larga evolución. Los resultados iniciales muestran que técnicamente es posible en cerdos y, aunque actualmente no se dan las condiciones para iniciar un programa de este tipo en pacientes, pensamos que es una vía para seguir investigando, porque creemos que, el trasplante cardiaco en condiciones de biventricularidad, puede ser una opción con menos riesgos y mejores resultados que la vía univentricular.

Introduction: Older patients are more likely to have cognitive dysfunction, and a great proportion of patients undergone surgical procedures are older adults. Postoperative cognitive dysfunction (POCD) has been shown as a consistent complication after major surgical procedures such as heart surgery. Aim: To determine the presence of long-term POCD in ≥65-year-old patients undergoing coronary artery bypass grafting and aortic valve replacement, and to establish related risk factors. Methods: We prospectively and sequentially included 44 patients with coronary disease and aortic stenosis scheduled for heart surgery. Follow-up of all patients was standardized and a neurocognitive evaluation were performed preoperatively and at 1, 6 and 12 months after surgery. Results: Patients experienced a significantly postoperative cognitive dysfunction (33.5%, 63.4% and 38.9% at 1, 6 and 12 months, respectively) from baseline (20.5%). Patient-associated aspects such as age (p

Introduction: the EuroSCORE model has been used in various countries, including México, to estimate the probability of surgery-associated mortality. Several studies have shown deficiencies in its calibration while retaining good discrimination. The model was updated in 2012 and called EuroSCORE II. Objective: to evaluate the calibration and discrimination of the EuroSCORE II model in patients undergoing cardiac surgery in a high specialty hospital in México. Material and methods: an observational, cross-sectional, and retrospective study was performed. Patients ≥ 16 years old years who underwent cardiac surgery between the years 2008-2013 were included. The hospital mortality rate was obtained, and the EuroSCORE II was calculated online. Discrimination of the EuroSCORE II model was evaluated with the area under the curve of a receiver operating characteristics curve (AUC-ROC), and the calibration was assessed using χ² of Hosmer-Lemeshow (H-L) goodness of fit test and risk-adjusted ratio (RAMR). Results: three hundred thirty-eight patients were included. The mean age of participants was 49.8 ± 16.61 years; 162 were women (47.9%), and 176 (52.1%) were men. Surgery types were valvular 108 (31.9%), coronary revascularization 101 (29.8%), congenital 51 (15.08%), and other 78 (23.07%). The average EuroSCORE II was 4.1 (95% CI, 3.53-4.68). Mortality observed was 10.9%. The AUC-ROC was 0.806 (95% CI, 0.739-0.872), consistent compatible with adequate calibration. The RAMR was 2.65, indicating an underestimation of the model. Conclusion: the EuroSCORE II model showed good discrimination. The calibration was adequate according to the χ² of H-L, but the value of the RAMR suggests that the model underestimates the risk of mortality. with good discrimination. The χ² of H-L of 14.2, p = 0.08, compatible with adequate calibration. The RAMR was 2.65, indicating an underestimation of the model. Conclusion: the EuroSCORE II model showed good discrimination. The calibration was adequate according to the χ² of H-L, but the value of the RAMR suggests that the model underestimates the risk of mortality. [ABSTRACT FROM AUTHOR]

RESUMEN Introducción y objetivos: El implante percutáneo de válvula aórtica (TAVI) se introdujo en 2007 como una alternativa a la cirugía a corazón abierto para tratar a pacientes con estenosis aórtica grave sintomática, y desde entonces han aumentado las indicaciones autorizadas. Recientemente, el Placement of Aortic Transcatheter Valve Study (PARTNER) 3 ha demostrado beneficios clínicos con el TAVI con la válvula SAPIEN 3 frente al reemplazo quirúrgico de válvula aórtica (RVAo) en pacientes seleccionados con bajo riesgo de mortalidad quirúrgica. Utilizando los datos del PARTNER 3 junto con datos económicos de España, se evaluó la relación coste-efectividad del TAVI en comparación con el RVAo en pacientes con estenosis aórtica grave sintomática con bajo riesgo de mortalidad quirúrgica. Métodos: Se utilizó un modelo en dos etapas para estimar los costes directos sanitarios y los datos de calidad de vida relacionadas con la salud para TAVI con la válvula SAPIEN 3 y RVAo. Los eventos adversos tempranos relacionados con TAVI del PARTNER 3 se incluyeron en un modelo de Markov, que capturó los resultados a más largo plazo tras TAVI o RVAo. Resultados: El TAVI con SAPIEN 3 mejoró los años de vida ajustados por calidad por paciente (+1,00), con un aumento en el coste frente al RVAo de 6.971 € por paciente. Esto representó una ratio coste-efectividad incremental por año de vida ganado ajustado por calidad de 6.952 € por paciente. Los resultados fueron robustos en los diversos análisis de sensibilidad realizados, en los que el TAVI con SAPIEN 3 se mantiene como una opción coste-efectiva. Conclusiones: El TAVI con SAPIEN 3 es coste-efectivo en comparación con el RVAo en pacientes con estenosis aórtica grave sintomática con bajo riesgo de mortalidad quirúrgica. Estos resultados pueden informar a los decisores políticos en España para facilitar el desarrollo de políticas sobre la selección de opciones terapéuticas en esta población de pacientes.

Introduction: Postoperative atrial fibrillation (POAF) after cardiac surgery is a frequent complication associated with higher risk of thromboembolism. The best anticoagulation strategy in patients with postoperative atrial fibrillation of more than 48 hours is still uncertain. Objective: Evaluate the results of treatment with direct oral anticoagulants and warfarin in postoperative atrial fibrillation patients in terms of ischemic events, bleeding, mortality, and cost-effectiveness in this population. Method: A systematic review of the literature and meta-analysis were conducted including information from studies comparing these treatments. The GRADE system was used for grading the quality of evidence. Effect summary odds ratios (OR) and 95% confidence intervals (CI) were obtained by means of the random effect model. Results: From 752 studies, 3 randomized clinical trials and 2 observational studies were included. Our data revealed a decrease of ischemic events in patients receiving direct oral anticoagulants as compared with warfarin (OR: 0.59; CI 95%: 0.36-0.97; p = 0.045). There were not statistical differences in mortality, bleeding and cost-effectiveness. Conclusions: Our findings suggest that direct oral anticoagulants might decrease the risk of ischemic events in postoperative atrial fibrillation patients. However, further randomized clinical trials are needed to define the choice of optimal treatment. [ABSTRACT FROM AUTHOR]

Objective: To describe the exp in quality indicators in the care of patients in the post-surgery period of coronary artery bypass graft without pump oxigenator. Materials and method: Descriptive observational retrospective cohort study in a single center. The information was obtained from our database of patients undergoing cardiovascular surgery. All patients over 18 years of age who underwent coronary artery bypass graft without pump oxigenator were included. The quality indicators analyzed were: number of reoperations, prolonged mechanical ventilation, cerebrovascular disease and low cardiac output syndrome in the postoperative period, acute kidney injury, atrial fibrillation, and risk-adjusted mortality. Results: During the study period from May 2015 to May 2019, 274 patients underwent coronary artery bypass graft without pump oxygenator. There was a predominance of the male gender (69.3%), age between 45 and 65 years (52.9%) and the most frequent comorbidity was arterial hypertension (76.3%). The quality indicators were: reoperation for bleeding, 4 cases (1.5%), prolonged mechanical ventilation, 20 cases (7.3%), stroke, 1 case (0.4%), low cardiac output syndrome, 10 cases (3.6%), acute kidney injury, 28 cases (10.2%) and atrial fibrillation, 29 cases (10.6%). Overall mortality in the ICU was 3 patients (1.1%). Conclusions: The results obtained show important information about quality indicators recorded in a regional cardiovascular surgery center in the postoperative period of myocardial revascularization surgery without the use of extracorporeal circulation. The creation of a national multicenter database is proposed for the registration and comparison of postoperative cardiovascular indicators. [ABSTRACT FROM AUTHOR]

Background: Down syndrome is the most common chromosomal abnormality, it is associated with a wide variety of con-genital heart defects, being considered as clinical elements of high infant morbidity and mortality. Objective: To describe the clinical outcomes of patients with Down syndrome undergoing surgery and interventionism as treatment for congenital heart disease at this Institution. Material and methods: 368 patients with Down syndrome and associated congenital heart disease were diagnosed. The variables studied were weight, stature, sex, age, type of heart disease, corrective procedure, length of stay in the hospital and intensive care unit, morbidity and mortality. Results: 368 pediatric patients underwent surgical or interventional correction. Of which 197 (54%) were female, the median age was 24 months (interquartile range [IQR]: 14-48) in the surgical group and 36 months (IQR: 17-85) in the interventional group. The most frequent congenital heart diseases were: PCA (31%), IVC (28%), CAV (20%), ASD (16%) and tetralogy of Fallot with 4% respectively. Hospital stay was 9 days (IQR: 7-15) in the surgical group and 3 days (IQR: 2-5) in the hemodynamic group. Morbidities were postoperative infection in 30 patients (14%) and complete atrioventricular block in 19 patients (9%). Overall mortality in-cluding both surgical and interventional was 2%. Conclusions: The therapeutic, surgical and interventional results in children with Down syndrome and congenital heart disease have improved very satisfactorily. The lower prevalence of the atrioventricular canal in the Mexican population is noteworthy. It is essential to carry out a cardiological evaluation of chil-dren with Down syndrome and those with congenital heart disease to correct them in a timely manner to promote survival and quality of life. [ABSTRACT FROM AUTHOR]

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Surgery for obstructive left ventricular outflow tract pathology with aortic valve disease and aortic annulus hypoplasia remains a surgical challenge. Various surgical techniques have been described for aortic annulus enlargement of which the Konno-Rastan procedure is an attractive option; however, it is not very often done due to the high degree of difficulty. It is presented the case of a 15-year-old female patient diagnosed with severe aortic valve stenosis and aortic annulus hypoplasia who underwent aortic annulus enlargement with the Konno-Rastan technique and aortic valve replacement. [ABSTRACT FROM AUTHOR]

Copyright of Argentinian Journal of Respiratory & Physical Therapy (AJRPT) is the property of Asociacion Civil Cientifica de Difusion y Promocion de la Kinesiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objetivo: Describir las características clínico-demográficas y la distancia caminada previa y posterior a la cirugía cardiovascular en sujetos ingresados a la unidad de cardiología de un hospital privado de la Provincia de Buenos Aires. Materiales y método: Estudio observacional, descriptivo y retrospectivo que incluyó 17 adultos sometidos a cirugía cardíaca en la unidad coronaria del Hospital Universitario Austral. Se registraron variables clínico-demográficas (sexo, edad, índice de masa corporal, factores de riesgo cardiovascular, comorbilidades, Euroscore y fracción de eyección), variables quirúrgicas (tipo de cirugía, tiempo de circulación extracorpórea y clampeo), complicaciones postoperatorias y distancia caminada previa y posterior a la cirugía (distancia caminada en la prueba de marcha de 6 minutos (PM6M) y porcentaje del predicho teórico). Las variables fueron recolectadas mediante bases de datos del Servicio de Kinesiología y fueron analizadas con el programa IBM SPSS Statistics 27. Resultados: La muestra estaba compuesta por 11 hombres (64,7%), con una media de edad de 58,18 años +/- 14,05 y una media de fracción de eyección de 63% +/- 6,06. La distancia caminada en la PM6M preoperatoria fue de 479,30 m +/- 84,01, mientras que la distancia caminada en la PM6M al alta fue de 388,09 m +/- 72,72. La mediana de días de internación en el postoperatorio de cirugía cardíaca fue de 7 días (RIQ 6-8). Conclusión: La distancia caminada en el postoperatorio de cirugía cardiovascular, evaluada mediante la PM6M, fue menor que la distancia caminada en el preoperatorio.

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Resumen: El shock cardiogénico (SC) es un proceso patológico multifactorial con alta morbimortalidad. Cuando ocurre en relación con el entorno perioperatorio de cirugía cardiovascular, elementos como causa de la cirugía (preoperatorio), procedimiento realizado (intraoperatorio), eventos anestésicos y fenómenos fisiopatológicos postquirúrgicos precoces y tardíos (postoperatorio) pueden afectar negativamente los resultados del paciente. En este contexto, y como consecuencia de la gran heterogeneidad de fenómenos fisiopatológicos relacionados a una causa única o múltiples del shock cardiogénico (pre, intra y postoperatorio), es imprescindible un enfoque multidisciplinario que abarque todos los aspectos de la clínica del paciente para decidir el tratamiento más adecuado para cada escenario que evalúelos riesgos de cada tratamiento y proyecte una posible evolución del cuadro. La oxigenación por membrana extracorpórea veno-arterial (ECMO-VA) entrega un soporte hemodinámico y de oxigenación más sólido que otros soportes, reemplazando parcial o totalmente los sistemas cardíaco y respiratorio del paciente. El ECMO-VA periférico puede instalarse rápidamente al lado de la cama en el caso de pacientes gravemente inestables. El ECMO-VA central tiene la ventaja única de servir como soporte estable en el caso de shock cardiogénico posterior a la cardiotomía y se puede convertir fácilmente mediante las inserciones de cánulas para el bypass cardiopulmonar, constituyendo un puente para toma de decisiones. La elección de la configuración adecuada (periférico o central) dependerá, por tanto, de la causa que generó el shock cardiogénico y lo agudo del cuadro, por lo que la estrategia más adecuada de manejo debe ser realizada por un equipo multidisciplinario a modo de velar por un diagnóstico y tratamiento más temprano y asegurar la preservación de la función miocárdica al considerar todas las posibles complicaciones derivadas de cada tipo de soporte Abstract: Cardiogenic shock (CS) is a multifactorial pathological process with high morbidity and mortality. When it occurs in relation to the perioperative environment of cardiovascular surgery, elements such as the cause of the surgery (preoperative), the procedure performed (intraoperative), anesthetic events, and early and late postoperative pathophysiological phenomena (postoperative) can negatively affect patient outcomes. In this context, and as a consequence of the great heterogeneity of pathophysiological phenomena related to a single or several causes of cardiogenic shock (pre, intra and postoperative), a multidisciplinary approach that encompasses all aspects of the patient's clinic is essential to decide the most appropriate treatment for each scenario, evaluating the risks of each treatment, as well as projecting a possible evolution of the condition. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides more robust hemodynamic support and oxygenation than other supports, partially or totally replacing the patient's cardiac and respiratory systems. Peripheral VA-ECMO can be quickly installed at the bedside in severely unstable patients. VA-ECMO has the unique advantage of serving as a stable support in the event of cardiogenic shock following cardiotomy and can be easily converted from cannula insertions to cardiopulmonary bypass, providing a bridge to decision making. The choice of the appropriate configuration (peripheral or central) will depend, therefore, on the cause that generated the cardiogenic shock and the acuteness of the condition, so the most appropriate management strategy must be carried out by a multidisciplinary team in order to ensure an early diagnosis and treatment and guarantee the preservation of myocardial function by considering all the possible complications derived from each type of support.

Introducción: La nutrición enteral temprana (EEN) se ha asociado con mejores desenlaces clínicos en subpoblaciones de pacientes que se encuentran en la unidad de cuidados intensivos (UCI). Sin embargo, existe poca evidencia disponible en pacientes críticos sometidos a cirugía cardiaca. Objetivo: analizar la asociación entre la EEN con desenlaces clínicos importantes. Métodos: Estudio de cohorte retrospectivo en pacientes adultos postquirúrgicos ingresados a la UCI entre agosto de 2021 y octubre de 2022 que requirieron ventilación mecánica invasiva (VMI) por más de 48 horas. Se evaluó la asociación entre el uso de EEN y mortalidad hospitalaria y en la UCI, días bajo VMI, y días de estancia en UCI a través de pruebas de regresión logística y lineal. Resultados: 74 pacientes fueron considerados en el análisis. La mediana de días de estancia en la UCI fue menor en el grupo con EEN comparado con el grupo nutrición enteral tardía [8 (IQR 6 - 14) vs. 18 (7 - 31), p = 0.005, respectivamente], esto mismo fue observado con los días bajo VMI [4 (3 - 6) vs. 11 (5 - 24), p = 0.000, respectivamente]. La EEN se asoció con una disminución de mortalidad hospitalaria (OR 0.21; IC95% 0.07, 0.67; p = 0.009) y en la UCI (OR 0.21; IC95% 0.5, 0.84; p = 0.027), así como con los días de estancia en la UCI (β -8.03; IC95% -13.44, -2.62; p = 0.004) y días bajo VMI (β -11.86; IC95% -17.97, -5.74; p = 0.000) en el modelo ajustado. Conclusiones: En pacientes críticos sometidos a cirugía cardiaca el inicio de EEN puede estar relacionado con una disminución en la mortalidad hospitalaria y en la UCI, así como con los días de estancia en la UCI y bajo VMI.

Introduction: recent demographic changes have meant that more and more frail patients undergo surgery. The relationship between frailty, measured by dynamometry, and morbidity and mortality in cardiac surgery has not been fully studied. Objective: determine the usefulness of frailty, as measured by dynamometry, as a predictor of morbidity and mortality in geriatric patients with low surgical risk undergoing cardiac surgery. Material and methods: a prospective cohort study including 65 geriatric patients with moderate surgical risk undergoing elective cardiac surgery with cardiopulmonary bypass. The patients underwent preoperative dynamometry to determine their frailty, whose relationship with postoperative morbidity and mortality was evaluated. Sensitivity, specificity, predictive values, positive and negative probability coefficients, Cronbach's alpha coefficient and area under the ROC curve were calculated. The data were processed with SPSS v-24.0. Results: the evaluation of the calibration component showed that it fitted our sample (Cronbach's alpha coefficient 0.79). The evaluation of the discrimination component showed that it was able to distinguish between risk of morbidity (0.625) and risk of mortality (0.597). Conclusion: frailty, measured by dynamometry, is a useful predictor of morbidity and mortality in elderly patients with low surgical risk undergoing cardiac surgery. [ABSTRACT FROM AUTHOR]

Copyright of Gaceta Médica de México is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Enfermería en Cardiologia is the property of Asociacion Espanola de Enfermeria en Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To know the family's experience in the face of illness and cardiac surgery. Qualitative, descriptive research related to the family. Data collection was carried out in an intensive cardiology unit of a hospital in Rio Grande do Sul, with nine families, totaling 10 people, through a public sociodemographic structure and unstructured interview. Data were selected for content analysis. The category "Illness and cardiac surgery as (dis)organizers of the family unit" explains situations experienced by the family from the moment of diagnosis of a cardiovascular disease to the performance of cardiac surgery. These situations are disorganizing the family unit, causing the same strategy to seek to reorganize itself and guarantee the care of the sick family member, while waiting for the surgery. Illness and the need for a procedure modify family functioning, trigger suffering and conflicts, but also promote unity and collectives to overcome difficulties. [ABSTRACT FROM AUTHOR]

In the mid-twentieth century, cardiac surgery emerged thanks to John Gibbon & IBM Company heart-lung machine incorporation in Philadelphia, USA, allowing open heart surgery to be carry out, which was soon possible in most developing countries. However, a few years before, some surgeons tried to cure their patients with ingenious closed-heart surgical techniques. During World War II, several military surgeons landed a decisive role in the development of this surgery by incorporating some surgical techniques that saved the life of numerous soldiers on the battlefront, among them Dwight E. Harken and C. Walton Lillehei, worldwide considered «fathers of cardiac surgery». Several important achievements emerged later, from these pioneers, regardless of their military activity, such as the intensive care units, the first mitral valvuloplasties and mechanical artificial heart valves, the implantable cardiac pacemakers, or the use of moderate hypothermia in open heart surgery. The important contributions of these admirable surgeons constituted the building blocks on which modern cardiac surgery was built. [ABSTRACT FROM AUTHOR]

Introduction: Inducing hypocapnia is a common practice during pediatric general anesthesia, even though it has not shown clear benefits. Objective: To compare the impact of carbon dioxide values after aortic impingement (< 32.7 vs ≥ 32.7 mmHg) on postoperative morbimortality among pediatric patients undergoing cardiac surgery. Material and methods: A case-control study included 90 pediatric patients undergoing cardiac surgery with cardiopulmonary bypass. The study cases consisted of 45 patients who died within 30 days of the postoperative period. Cases and controls were individually matched (1:1 ratio). Descriptive and inferential statistics (Mann-Whitney’s U, Student’s t and χ² tests) were used to analyze the results. A p < 0.05 was considered significant. A univariate analysis was also carried out. The strength of association between morbimortality and carbon dioxide values after aortic impingement was determined using the odds ratio. The data were processed using SPSS v-24.0. Results: The group with carbon dioxide values of < 32.7 mmHg after aortic impingement was associated with greater morbidity (OR 24.75; 95% CI 4.92-124.32) and mortality (OR 22.47; 95% CI 4.85- 10.17) at 30 days. Conclusion: Pediatric patients undergoing cardiac surgery with carbon dioxide values of < 32.7 mmHg after aortic impingement showed higher postoperative morbimortality than those with carbon dioxide values of ≥ 32.7 mmHg. [ABSTRACT FROM AUTHOR]

Multimodal analgesia in cardiac surgery sternotomy includes bilateral continuous erector spinae plane block (BC-ESPB). However, the effectiveness of the local anesthetic regimens is still uncertain. The purpose of this study was to assess pain control achieved with a multimodal analgesia regimen including BC-ESPB at the level of T5 with PCA with a 0.125 % bupivacaine infusion and rescue boluses. This is a descriptive case series study which recruited 11 adult patients undergoing cardiac surgery through sternotomy in whom multimodal analgesia including BC-ESPB was used, between February and April 2021, at a fourth level institution. All patients reported pain according to the numeric rating scale (NRS) ≤ 3 both at rest and in motion, at extubation and then 4 and 12 hours after surgery. After 24 hours the pain was NRS ≤ 3 in 100 % of the patients at rest and in 63.6 % in motion. At 48 h 81 % of the patients reported pain NRS ≤ 3 at rest and in motion. At 72h all patients reported pain NRS ≤ 3 at rest and 82 % in motion. The average intraoperative use of fentanyl was 2.35 µg/kg and postoperative hydromorphone was 5.3, 4.1 and 3.3 mg at 24, 48 and 72 hours, respectively. Hence, bilateral ESP block in continuous infusion plus rescue boluses allows for proper control of acute intra and post-operative pain. [ABSTRACT FROM AUTHOR]

Purpose: It is unclear whether preoperative serum uric acid (SUA) elevation may play a role in the development of acute kidney injury (AKI) associated with cardiac surgery (CSA-AKI). We conducted a cohort study to evaluate the influence of preoperative hyperuricemia on AKI in patients at high risk for developing SC-AKI., Design: Multicenter prospective international cohort study., Setting: Fourteen university hospitals in Spain and the United Kingdom., Participants: We studied 261 consecutive patients at high risk of developing CSA-AKI, according to a Cleveland score ≥ 4 points, from July to December 2017., Interventions: None., Measurements and Main Results: AKIN criteria were used for the definition of AKI. Multivariable logistic regression models and propensity score-matched pairwise analysis were used to determine the adjusted association between preoperative hyperuricemia (≥7 mg/dL) and AKI. Elevated preoperative AUS (≥7 mg/dL) was present in 190 patients (72.8%), whereas CSA-AKI occurred in 145 patients (55.5%). In multivariable logistic regression models, hyperuricemia was not associated with a significantly increased risk of AKI (adjusted Odds Ratio [OR]: 1.58; 95% confidence interval [CI]: 0.81-3; P = .17). In propensity score-matched analysis of 140 patients, the hyperuricemia group experienced similar adjusted odds of AKI (OR 1.05, 95%CI 0.93-1.19, P = .37)., Conclusions: Hyperuricemia was not associated with an increased risk of AKI in this cohort of patients undergoing cardiac surgery at high risk of developing CSA-AKI., (Copyright © 2024 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The impact on the immune system of normovolemic hemodilution as a perioperative bloodsaving technique raises a possible increase in immunoglobulin M, and a possible increase in infections, especially those associated with catheters. Objective: To compare the role of acute normovolemic hemodilution in postoperative infections in groups of patients undergoing cardiac surgery. Material and methods: A controlled clinical trial in 99 patients undergoing elective cardiac surgery who were randomized into two groups: group I (non-hemodiluted) and group II (hemodiluted). The presence or absence of infection was determined during the postoperative period. Data analysis was performed using descriptive and inferential statistics χ2. A p < 0.05 was considered significant. The data were processed using SPSS v.25.0. Results: The overall incidence of infection was 3.03%. Hemodiluted patients became infected more frequently than non-hemodiluted patients. The isolated organisms were Escherichia coli and Enterobacter aerogenes. Conclusion: Patients undergoing cardiac surgery who undergo acute normovolemic hemodilution suffer more frequently from postoperative infections than those who do not undergo acute normovolemic hemodilution. [ABSTRACT FROM AUTHOR]

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Copyright of Revista Médica Clínica Las Condes is the property of Editorial Sanchez y Barcelo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Médica Clínica Las Condes is the property of Editorial Sanchez y Barcelo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Médica Clínica Las Condes is the property of Editorial Sanchez y Barcelo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Médica Clínica Las Condes is the property of Editorial Sanchez y Barcelo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introducción: La isquemia mesentérica no oclusiva puede ocurrir después de una cirugía cardiaca electiva y es fundamental identificar quienes tienen alto riesgo de desarrollar esta complicación. Objetivo: Identificar los factores de riesgo asociados a la isquemia mesentérica no oclusiva luego de cirugía cardiaca. Desarrollo: Los factores de riesgo identificados fueron la edad mayor de 70 años, uso de vasopresores, implante de un balón de contrapulsación intraaórtico, uso de baipás cardiovascular, transfusiones sanguíneas, pérdida de ritmo sinusal, fracción de eyección del ventrículo izquierdo menor de 35 % y tiempo de pinzamiento aórtico mayor de 100 minutos. Conclusiones: Los factores de riesgo encontrados en la revisión fueron la edad > 70 años, uso de vasopresores, implante de un balón de contrapulsación intraaórtico, uso de bypass cardiovascular, transfusiones sanguíneas, pérdida de ritmo sinusal, fracción de eyección del ventrículo izquierdo (FEVI) < 35 % y tiempo de pinzamiento aórtico > 100 minutos.

Introduction: Several methods have been proposed to control inflammation and to preserve the myocardium during cardiopulmonary bypass (CABG), including the administration of electrolytes such as magnesium (Mg2+). Objective: To compare the effect of using magnesium sulfate (MgSO4) or a placebo before aortic clamping (AoC) on the serum levels of lactate in the coronary sinus in patients undergoing myocardial multivessel revascularization (MRV) with CABG. Material and methods: A clinical assay was conducted with 52 patients undergoing MRV multivessel with CEC; the patients were randomized to receive a placebo (group I) or MgSO4 (group II) before AoC, and blood samples were taken from the coronary sinus to quantify serum lactate at two different times: T0: pre-AoC and T1: before closing the chest. Statistical analysis was performed on Student's t-test and X2. A p < 0.05 was considered statistically significant. The data were processed with SPSS v-22.0. Results: Serum levels of lactate in the coronary sinus post-AoC were lower in group II (2.967 ± 0.86 vs 2.154 ± 1.14), with significant differences (p = 0.006). Conclusion: The use of MgSO4 before AoC reduces serum lactate levels in the coronary sinus in patients undergoing MRV multivessel with CABG. [ABSTRACT FROM AUTHOR]

Copyright of Gaceta Médica de Caracas is the property of Academia Nacional de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cardiac hydatid cyst is very a rare manifestation of hydatid disease. It is potentially life threatening, and characterized by its clinical polymorphism, thus making an early preoperative diagnosis challenging. The sole curative treatment of this disease is surgery, and it should be done as emergent as possible after diagnosis, in order to minimize the risk of serious complications like embolism and anaphylaxis.We report a case of a 22 years old male who had multivesicular cyst formation in the left ventricle free wall, which was measuring 14 × 8 cm. The patient underwent surgery in order to remove this hydatid cyst, by using the cardiopulmonary bypass, and his postoperative course was unremarkable. Resumen: El quiste hidatídico cardiaco es una manifestación muy rara de la enfermedad hidatídica y potencialmente mortal, caracterizada por su polimorfismo clínico, lo que dificulta su diagnóstico preoperatorio temprano. La cirugía sigue siendo el único tratamiento curativo del quiste hidatídico cardiaco. Este debe ser tratado lo más pronto posible después del diagnóstico, ya que minimiza el riesgo de complicaciones graves como embolia y anafilaxia.Presentamos el caso de un varón de 22 años que presenta una formación de quiste multivesicular en la pared libre del ventrículo izquierdo de 14 × 8 cm. El paciente fue intervenido quirúrgicamente mediante bypass cardiopulmonar para extirpar el quiste hidatídico de la pared libre del ventrículo izquierdo, con un resultado satisfactorio para el curso postoperatorio.

Objetivo: Describir las características demográficas y la proporción de sujetos sometidos a cirugía cardiovascular (CCV), que requieren ventilación mecánica prolongada (VMP) y analizar los factores asociados al desarrollo de dicha entidad. Materiales y método: Serie de casos. Se incluyeron sujetos mayores de 18 años que requirieron una CCV a través de esternotomía, entre julio de 2017 y noviembre de 2018. Se excluyeron sujetos con datos faltantes y se eliminaron quienes fallecieron durante la cirugía. Se llevó a cabo un análisis de regresión logística para determinar las variables predictoras de la ocurrencia de VMP. Resultados: De 70 sujetos analizados, 17,1% requirió VMP, cuya mortalidad fue de 41,7%. En el análisis univariado la obesidad, días de internación, tiempo de cirugía, necesidad de circulación extracorpórea (CEC), desarrollo de complicaciones posoperatorias (POP) y puntaje del score Sequential Organ Failure Assessment (SOFA) en el posquirúrgico inmediato, se asociaron significativamente a VMP. Conclusión: La proporción de sujetos con requerimiento de VMP fue superior a lo reportado en la literatura. El tiempo de cirugía, el SOFA en el POP inmediato, obesidad, necesidad de CEC, días de internación y desarrollo de complicaciones POP se asociaron con VMP.

Introduction: One of the various instruments that can be used to evaluate the impact of risk factors on the survival of patients undergoing valve surgery is the VMCP score. This work evaluates the performance of this tool. Objective: To validate the surgical risk score for heart valve surgery (VMCP score) in our hospital unit. Material and method: A prospective cohort study was conducted on 239 patients undergoing heart valve surgery, estimating the risk with the VMCP score. The sample was divided into two groups at a cut-off point of 8. The discriminating power of the score was analyzed based on the area under the ROC curve. A value of p < 0.05 was considered significant. The data were processed using SPSS v.25.0. Results: The score stratified the samples as follows: 40.6% of patients were without risk and 59.4% were at risk. The evaluation of the calibration component showed that the score was not appropriate for our sample (Cronbach’s alpha coefficient: 0.59). The discrimination component of the score showed a poor capacity to distinguish between the population at risk of mortality (0.630) and/or morbidity (0.655). Conclusion: It is not valid to use the surgical risk score for heart valve surgery (VMCP score) in our hospital unit. [ABSTRACT FROM AUTHOR]

A 24-year-old male patient, who had no complaints before, applied to our hospital for general tests in order to get a medical report due to his job application. A murmur was detected by the physician in the internal medicine clinic as a finding of listening and was referred to the cardiology clinic. The oval, well-circumscribed lobulated echogenic mass appeared in right ventricular in the research performed in the cardiology clinic and it was transferred to our clinic for emergency surgery. The right ventricular mass did not move towards either the pulmonary valve or the tricuspid valve during systole and diastole. During the operation, it was determined that the tumor originated from the right ventricular free wall. Right ventricular mass excision was performed with right atriotomy under cardiopulmonary bypass. The pathology confirmed the diagnosis of myxoma. At the sixth month of follow-up, the patient was asymptomatic and there was no evidence of myxoma recurrence. [ABSTRACT FROM AUTHOR]

Introduction: Psychocardiology has become essential in the field of cardiovascular disease and cardiac surgery, not only in the characterization of certain processes but also in intervention. Objective: To identify self-regulation mechanisms in patients indicated for cardiovascular surgery. Method: A study was conducted with 63 pre-surgical patients at the Instituto de Cardiología y Cirugía Cardiovascular of Havana, Cuba, between March and June 2017. The Dembo-Rubinstein self-assessment scale, semi-structured interview, State-Trait Anxiety Inventory (STAI), and two intellectual work capacity tests (story retelling and ten words) were applied. Results: Most patients had illness-centered aspirations, increased adequacy with respect to self-assessment, especially of their current health status, and intellectual work-capacity disorders, derived from high levels of stress and anxiety. Conclusions: The maximized self-awareness was the self-regulation mechanism with higher expression among the group of patients studied. These patients are afraid of facing cardiovascular surgery, since they fear death, disability, leaving their children and parents alone; but they feel sensitive to the surgical procedure. [ABSTRACT FROM AUTHOR]

Copyright of Fisioterapia e Pesquisa is the property of Universidade de Sao Paulo, Faculdade de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Evidence points out that many of the causes that require such surgeries, could be avoided through prevention. To characterize the profile of patients undergoing cardiac surgery at a hospital in the interior of Minas Gerais. Descriptive, exploratory, documentary, quantitative field research. The studies revealed the predominant age range was 54 - 65 years old, being female, married and retired. The main access route was through the Unified Health System and the main types of surgeries were myocardial revascularization, valve replacement and prosthesis implantation. It is important for nursing to understand the responses of each individual through the involvement related to cardiovascular disease. The care process promotes health promotion aimed at the quality of life of patients, yet the research made it possible to raise subsidies for the prevention of cardiovascular diseases, with a view to the performance of nursing. [ABSTRACT FROM AUTHOR]