Objectives. To assess mortality, major valve-related events (MAVRE), and other complications in the perioperative period and follow up in patients with aortic valve replacement (AVR) through minithoracotomy (MT). Methods. We retrospectively analyzed patients aged <80 who underwent AVR through MT between January 2017 and December 2021 in a national reference center in Lima, Peru. Patients undergoing other surgical approaches (mini-sternotomy, etc.), other concomitant cardiac procedures, redo, and emergency surgeries were excluded. We measured the variables (MAVRE, mortality, and other clinical variables) at 30 days and a mean follow-up of 12 months. Results. Fifty-four patients were studied, the median age was 69.5 years, and 65% were women. Aortic valve (AV) stenosis was the main indication for surgery (65%), and bicuspid AV represented 55.6% of cases. At 30-days, MAVRE occurred in two patients (3.7%), with no in-hospital mortality. One patient had an intraoperative ischemic stroke, and one required a permanent pacemaker. No patient underwent reoperation due to prosthesis dysfunction or endocarditis. In a mean follow-up of one year, MAVRE occurrence did not show variations with the perioperative period, most patients remained in NYHA I (90.7%) or II (7.4%) compared to the preoperative period (p<0.001). Conclusions. AV replacement through MT is a safe procedure in our center for patients under 80 years.
Coronary artery bypass using bilateral internal thoracic artery (BITA) has been related to survival benefits in patients with coronary artery disease, but data is not conclusive. In South America, several centers reported their own experience with good results in survival, minimal postoperative cardiovascular events, and a low degree of mediastinal infection, however, the number of cases is low, and the absence of publications in several countries is a matter of concern. We review the leading publications on BITA grafting in our region, assessing how far we have advanced in coronary surgery.
Se reporta un caso de cor triatriatum sinister asociado a drenaje venoso pulmonar anómalo, en paciente adulto que debutó con palpitaciones, edema de miembros inferiores, disnea, posteriormente ortopnea, bendopnea y ascitis. El cuadro clínico se inició con episodios de fibrilación auricular, asociado a rehospitalizaciones por falla cardiaca derecha, por lo que se solicitó angiotomografía y ecografía transesofágica que dieron con el diagnostico final. El abordaje quirúrgico se realizó mediante exéresis total del septum fibromuscular multifenestrado y doble plastia valvular, debido a que presentaba insuficiencia mitral y tricuspidea severas; lo que mejoró la condición clínica del paciente. Se reconoce la importancia de considerar dentro del diagnóstico diferencial de las causas de insuficiencia cardiaca derecha originadas en el atrio izquierdo a esta cardiopatía congénita acianótica.
We present a 64-year-old woman who underwent mitral, aortic, and tricuspid valve (TV) replacement with mechanical prostheses. Two months after TV surgery, she presented third-degree atrioventricular block. After attempting to place a pacemaker lead through the coronary sinus, it was placed through the mechanical valve in the tricuspid position as the last option. At 1 year of follow-up, the device shows no signs of dysfunction, and the prosthesis has moderate regurgitation.
La esternotomía media es el acceso “Gold Standard” para la revascularización quirúrgica del miocardio, pero no está exenta de complicaciones, sobre todo en pacientes con comorbilidades múltiples. El acceso mínimamente invasivo ofrece la ventaja de evitar la esternotomía, además de una recuperación posoperatoria más acelerada, con menos tiempo de estancia hospitalaria y un mayor nivel de satisfacción en la calidad de vida. Se presenta el caso de un paciente varón de 49 años, diabético, hipertenso, tabaquista, con enfermedad coronaria multiarterial, muy sintomático, quien fue revascularizado quirúrgicamente por minitoracotomía izquierda.
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