Cirugia Cardiovascular最新文献

Aorto-enteric fistula is a rare entity with high mortality, occasionally surgically treated. Classically, the proposed treatment is open surgical repair with a Dacron prosthetic graft and intestinal resection in the same act. Given the poor results, in recent years some cases of endovascular treatment with stent implantation have been described.

We present a case of an aortoenteric fistula resolved by a hybrid approach through stent implantation and intestinal resection with fistulaa sealing by open surgery in a second stage. This is a 75-year-old male patient who was admitted to our hospital with symptoms of acute aortic syndrome. The CT aortogram revealed a known abdominal aortic aneurysm of 8.4 × 8.4 × 9.5 cm and a vascular luz of 5 × 3.4 cm with signs of periaortic fat infiltration suggesting luz rupture vs. aortoenteric fistula. Given the hemodynamic instability of the patient, the team decided on emergent EVAR implantation with intestinal resection surgery in a second stage. The endoprosthesis was implanted without initial incidents but a resealing had to be performed due to endoleak in the subsequent control CT aortogram. In a second stage, the team performed the intestinal resection and closure of the fistula. The patient recovered favorably and was discharged.

The hybrid open and endovascular approach in complex pathologies with high mortality, such as aortoenteric fistula, may offer an alternative approach in patients with high morbidity.

Mitral regurgitation is a complication that may occur during transcatheter aortic valve implantation (TAVI) and may require different treatments depending on the mechanism. In this report we describe for a «skipping rope sign» in transapical TAVI as a cause of severe mitral regurgitation due to extreme tethering of the anterior mitral leaflet caused by an extra-stiff guidewire entangled in its chordae tendineae during a transapical TAVI.

Introduction

Since February 8, 2021, the Spanish Society of Cardiovascular and Endovascular Surgery got under way the Spanish Registry of Cardiac Surgery (RECC), which is available for the different units of cardiovascular surgeons in our country. It is a tool that allows collect patient-level data of patients undergoing cardiac, vascular or endovascular surgery. After two years of development, we have carried out an analysis of the quality of the information obtained in order to acquire an overview of its content.

Methods

The information has been analyzed anonymously at patient, hospital and province level. For risk-adjusted mortality estimation, the EuroSCORE II preoperative risk estimation scale was used.

Results

A total of 7087 interventions have been included. Six thousand two hundred and sixty-seven were major cardiac surgeries: 53.9% valvular, 25.2% coronary artery bypass grafting, and 14.9% aortic procedures. The overall mortality was 5.0% and the risk-adjusted mortality rate was 0.88. The EuroSCORE II calibration in the overall sample was good in the lowest-risk patients, although it overestimated mortality in high-risk patients.

Conclusions

RECC is a nationally defined clinical database in the field of cardiovascular surgery. RECC allows a patient-level data analysis in order to perform an accurate analysis of the volumen of activity, risk adjustment and results. Locally, it could be used as a tool to improve the quality of care and development of corrective programs.

Aortoesophageal fistula (AEF) is a rare but life-threatening complication of esophageal stent placement characterized by the formation of a communication between the aorta and the esophagus, which can result in catastrophic hemorrhage and sepsis, making it a potentially fatal complication that requires prompt diagnosis and management. The surgical treatment strategy for each case should be designed based on the patient's clinical presentation and the availability of endovascular or open-surgical expertise and resources.

The aim of this study is to show the first latinoamerican experience in the treatment of AEF secondary to self-expandable partially covered metal stents (PCSEMS) with a retrospective case series study between January 2018 and April 2023 aimed at evaluating the surgical approach and postoperative outcomes of patients with AEF secondary to PCSEMS placement in 2 centers in Bogota, Colombia. A study with a sample of 2 patients was performed. The two patients were treated using an open surgical approach with laparotomy and left anterolateral thoracotomy.

Introduction and objectives

The relationship between pre-intervention physical exercise and quality of life, risk of complications or death has not been studied.

Methods

Prospective cohort study. Improvement in quality of life between preoperatively and at 6 months was analyzed using the EUROQOL scale and VAS. The level of physical exercise was analyzed by METS. The improvement in quality of life was evaluated according to the previous level of exercise and we studied whether the higher the level of exercise, the greater the increase in quality of life.

Results

Quality of life improved according both scales; VAS 17.8 ± 18.8 points (p < 0.001) and EUROQOL 1.1 ± 1.1 points (p < 0.001). Patients improved their quality of life. The higher level of previous exercise did not lead to a greater improvement in quality of life, but it did reduce the event of cardiogenic shock (p = 0.032), complicated postoperative (p = 0.034) and the combined event combined postoperative or death (p = 0.027).

Conclusions

Cardiac surgery improves quality of life at six months for all patients. A higher level of exercise is not related with a greater improvement in quality of life. A higher level of physical exercise is associated with less risk of postoperative complications or death.

Percutaneous aortic valve implantation represents an alternative for the treatment of patients with aortic stenosis. This is an option in patients with high surgical risk or contraindication for intervention by conventional sternotomy; with good results in the short and medium term. However it is a procedure associated with complications such as endocarditis, which may require a urgent intervention in these patients with an increase in morbidity and mortality given the history and condition at the time of surgery. We present a clinical case of a nonagenarian patient with post-percutaneous aortic valve implantation endocarditis due to Enterococcus faecalis who presented 8 months after percutaneous aortic valve implantation in our center and required surgical management with excellent results.

Objective

The exact prevalence of nutcracker syndrome (NCS) is unknown, due to the very low incidence of this disease plus the absence of definitive diagnostic criteria. Some authors have reported a higher prevalence of this condition in women, however published and available information is limited. Due to symptoms and consequences that can cause, it is important to suspect it and diagnose it. The aim of this study was to report the outcomes of the first Latin-American experience in the treatment of NCS using an endovascular approach with a left renal vein (LRV) balloon and arterial stent angioplasty.

Methods

The study design was a retrospective cohort analysis of 11 patients who underwent endovascular approach with LRV balloon and arterial stent angioplasty for the treatment of NCS between January 2019 and April 2022 in Bogota, Colombia.

Results

During January 2019 to April 2022, 553 patients were treated for congestive pelvic syndrome. Only 11 patients have clinical criteria (hematuria, varicose pelvic veins, and left flank pain), imaging diagnostic criteria (abdominal veins Doppler ultrasound or abdominal computed tomography with superior mesentery artery – abdominal aorta angle <39°) and an average of LRV – inferior vena cava pressure measurement comparison difference of 6 mmHg for NCS. The 100% were female patients. All the patients were under 65 years and underwent endovascular approach (EVA) with LRV balloon and arterial stent angioplasty. The 100% of patients presented resolution of the collateral vein circulation in the final control phlebo-cavography. The average age was 46.5 years old. Ten patients had an anterior type of NCS and only 1 had a posterior type of NCS. None of the patients had NCS due to secondary causes such as pancreatic head tumors.

Conclusions

This study shows that the endovascular approach with LRV balloon and arterial stent angioplasty is a safe and cost-effective treatment for NCS with low incidence of complications and no need of postoperative reintervention in short and middle term follow-up.