Cirugia Cardiovascular最新文献

The Spanish Society of Cardiovascular & Endovascular Surgery presents the 2012-2022 report of the activity in congenital cardiovascular surgery, based on a voluntary and anonymous registration involving most of Spanish centres. This article is complementary to the 2022 cardiovascular surgery annual report, and they are published together. In 2022 we observe an increase in congenital cardiovascular surgery, reaching numbers similar to pre-pandemic activity in year 2019. We included data from the previous 11 years, in order to obtain real information related to our activity with these relatively scarce pathologies. From year 2012 to 2022, 22,056 congenital heart surgeries were performed, accounting for 9.5% of all major surgery (congenital + acquired) performed in Spain during that period. Of these surgeries, 82% of them required extracorporeal circulation and 18% not. We highlight the interventions in neonates and adult patients, which mean respectively 18% and 22% of our whole activity and are a real challenge. The most prevalent congenital heart pathologies operated on were: septal defects in cases requiring extracorporeal circulation, and ductus in patients without extracorporeal circulation. The presented data are adjusted to the basic Aristotle score of preoperative surgical risk. The observed mortality of surgeries with extracorporeal circulation was 3% (Aristotle-6.39), and without cardiopulmonary bypass 2.34% (Aristotle-4.89).

Our national registry of surgical activity in congenital heart disease shows good results, allows us to compare ourselves within a national and international framework, design improvement strategies, set objectives and improve the quality of our actions.

Minimally invasive aortic valve replacement (AVR) benefits avoiding sternal wound complications, prolonged hospitalization and reduced postoperative pain has been widely reported. The benefits of a small sternal incision in obese patients decreases the potential risk of sternal dehiscence otherwise present on a conventional sternotomy. Here we report the case of a 76-year-old woman with moderate obesity who was referred to our institution with severe degenerative aortic stenosis. She underwent aortic valve replacement with a novel technique for annulus enlargement through upper ministernotomy.

Transvenous lead extraction is a secure procedure usually indicated in patients with infection of the cardiac stimulation devices. However, there are certain particularities in which the use of cardiac stimulation lead extraction techniques may be also indicated. We present the case of a 88 years old female patient with history of repeated syncope, which after a recovered cardiorespiratory arrest episode, required an urgent pacemaker implantation. After the implantation of the pacemaker, she vas discharged, and consulted again a month after discharge due to neurological symptoms (bilateral vision loss). A cranial CT scan was performed showing ischemics acutes-subacutes areas, and it was also evaluated by cardiology for suspicion of a cardioembolic event, who after complementary studies (echocardiogram and chest CT angiography) showed the presence of the pacemaker lead trans-aortic, with its distal end in the left ventricle.

This manuscript summarizes the data corresponding to the cardiovascular surgery activity carried out in Spain in 2022. It has been written based on an anonymous and voluntary registry of aggregated data from hospitals throughout the country, who transfer their data to the Spanish Society of Cardiovascular and Endovascular Surgery. This is the 34th consecutive year in which national activity data has been reported. The analysis of the information collected in 2022 will serve to evaluate the activity in Spain after the end of the COVID-19 pandemic and its impact to the National Health System.

In 2022, 58 centers reported their activity. 28,998 interventions were performed, with 20,127 major cardiac surgery procedures. Of these, 17,923 procedures were performed with cardiopulmonary bypass, 18,210 were for acquired disease and 1,917 were for congenital disease. In addition, 2,828 peripheral vascular surgery interventions were recorded. Regarding the different types of major cardiac surgery, the following were performed: 7,596 isolated valve surgery procedures, 1,621 combined valve surgery, 4,701 revascularization procedures, 2,432 aortic surgery, and 579 transcatheter valve procedures.

Compared to 2021, we observed an increase in acquired major cardiac surgery, but without recovering the level of activity prior to the pandemic. Likewise, a significant reduction in mortality was observed compared to 2021, with risk-adjusted mortality rates below 1 in all types of interventions except for multiple valve, combined valve and coronary procedures, and repair of mechanical complications of infarction.

Objective

To estimate blood flow in the small intestine and liver by administration of coloured microspheres in the left atrium, comparing this estimate with continuous flow perfusion and pulsatile flow, in order to confirm or reject hypoperfusion and hypoxia in these organs attributed to loss of pulse amplitude as the cause of Heyde's syndrome.

Material and method

Twenty-two minipig pigs of both sexes weighing 29.5 ± 9.6 kg were implanted with 11 continuous and 11 pulsatile mechanical circulatory assist devices were implanted in 22 minipig. Haemodynamic and analytic parameter were measured. Liver and terminal ileum blood perfusión was estimated by administration of stained microspheres previus to circulatory support, at 30 minutes of full assist and at 30 minutes of partial assist.

Results

Data were reported as percent of estimated perfusion at baseline. The study was performed by analysis of variance for repeated measures with a significance α of 0.05. In the liver, type of assistance (total or partial), type of pump (continuous or pulsatile) and the interaction between the 2 had the following statistical significance: 0.518. 0.364 and 0.237 respectively. In the terminal ileum the results were: 0.264. 0.193 and 0.141.

Analytically significant differences were observed in bilirubin level related to the continuous flow pump, as well as pH and urea.

Conclusions

We observed no significant differences in the estimation of perfusion in ileum and liver when comparing continuous flow and pulsatile flow CMA.