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¿La Cirugía Miniinvasiva de la Válvula Mitral, es posible en Pacientes Complejos?;
Is Minimally Invasive Mitral Valve Surgery Possible in Complex Patients?

Creators:Fortunato, German Alberto, Ríos, Matías N., Battellini, Roberto, Halac, Marcelo, Doenst, Torsten, Kotowicz, Vadim
2018-01-16

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Descripción

Introducción: Los pacientes con riesgo preoperatorio alto de morbimortalidad, endocarditis mitral y aquellos con cirugía cardíaca previa son considerados “limitantes” para ser operados por vía cirugía miniinvasiva. Objetivos: Evaluar resultados en pacientes complejos sometidos a cirugía miniinvasiva. Primario: mortalidad posoperatoria dentro de los 30 días. Secundario: resultados técnico-quirúrgicos y complicaciones posoperatorias tempranas. Material y métodos: Análisis retrospectivo de las cirugías mitrales realizadas en el Hospital Italiano de Buenos Aires desde enero de 2010 hasta abril de 2016. Se realizaron 135 cirugías mitrales, 63 de ellas mediante técnica miniinvasiva (46,6%). Los pacientes considerados “complejos” fueron 45 (71,4%), incluyéndose aquellos con riesgo &gt; 10% del STS PROMM, los pacientes con endocarditis activa y/o los pacientes con cirugía cardíaca previa. Resultados: El 73,3% (n = 33) fueron cirugías electivas, el 22,2% (n = 10) de urgencia y el 4,4% (n = 2) de emergencia. El STS PROM% y el STS PROMM% fueron de 6,08 ± 10,8 y de 26,7 ± 16,8, respectivamente. Se incluyen 6 pacientes con cirugía cardíaca previa, 5 pacientes con endocarditis en tratamiento activo. Se realizaron reemplazo valvular mitral (14 reumáticas) en el 62% (n = 28) y plástica mitral en el 38% (n = 17). No se constataron óbitos en plástica mitral ni mediastinitis. La mortalidad a los 30 días fue del 4,4% (n = 2). Hubo conversión a esternotomía en un caso. Conclusiones: La mortalidad observada es inferior a la calculada por puntaje de riesgo (STS PROMM%: 6,08 ± 10,8 vs. 4,4). La minitoracotomía derecha videoasistida nos ofreció una excelente exposición e interpretación de la patología. La técnica de cirugía miniinvasiva puede ser utilizada en pacientes con cirugía cardíaca previa, endocarditis y/o pacientes con puntaje alto de riesgo preoperatorio.

Background: Patients at high risk of preoperative morbidity and mortality, mitral valve endocarditis or prior cardiac surgery are considered “limiting” cases to undergo minimally invasive cardiac surgery. Objectives: The aim of this study was to assess the outcome of complex patients undergoing minimally invasive surgery. The primary endpoint was post-operative mortality at 30 days and the secondary endpoint was the analysis of technical-surgical results and early postoperative complications. Methods: The study consisted in the retrospective analysis of mitral valve surgeries performed at Hospital Italiano de Buenos Aires from January 2010 to April 2016. A total of 135 mitral valve surgeries, 63 by minimally invasive technique (46.6%) were performed. Forty-five patients (71.4%) were considered as “complex”, including those with &gt;10% STS-PROMM risk, active endocarditis, or prior cardiac surgery. Results: Surgeries were elective in 73.3% of cases (n=33), urgent in 22.2% (n=10) and emergent in 4.4% (n=2). Percent STSPROM and %STS-PROMM were 6.08±10.8 and 26.7±16.8, respectively. Six patients with prior cardiac surgery and 5 with endocarditis in active treatment were included. Mitral valve replacement (14 rheumatic) was performed in 62% of patients (n=28) and mitral valve repair in 38% (n=17). No deaths were registered in mitral valve repair or mediastinitis. Mortality at 30 days was 4.4% (n=2) and conversion to sternotomy was necessary in one case. Conclusions: The observed mortality is lower than the one calculated by the risk score (%STS-PROMM 6.08±10.8 vs. 4.4). The right video-assisted minithoracotomy offered excellent exposure and interpretation of the disease. The minimally invasive surgical technique can be used in patients with prior cardiac surgery, endocarditis and/or patients with a high preoperative risk score.

Metadatos destacados

Colecciones
Argentine Journal of Cardiology

Editor

Sociedad Argentina de Cardiología

Fuente

Revista Argentina de Cardiología; Vol 85, No 4 (2017); 328-333, Argentine Journal of Cardiology; Vol 85, No 4 (2017); 328-333

Citación

Fortunato, German Alberto et al., “¿La Cirugía Miniinvasiva de la Válvula Mitral, es posible en Pacientes Complejos?,” Archivo PPCT, consulta 2 de abril de 2026, http://archivoppct.caicyt.gov.ar/items/show/9331.

Dublin Core

Materia

Autor

Fortunato, German Alberto
Ríos, Matías N.
Battellini, Roberto
Halac, Marcelo
Doenst, Torsten
Kotowicz, Vadim

Fuente

Revista Argentina de Cardiología; Vol 85, No 4 (2017); 328-333
Argentine Journal of Cardiology; Vol 85, No 4 (2017); 328-333

Editor

Sociedad Argentina de Cardiología

Fecha

2018-01-16

Derechos

Los que firman al pié, certificamos que tenemos total responsabilidad por la conducción de este estudio y por el diseño y la interpretación de los datos. Nosotros escribimos el manuscrito y somos responsables por la decisión acerca del mismo. Cada uno de nosotros cumple la definición de autor como se afirma en el Comité Internacional de Editores de Revistas Médicas (International Committee of Medical Journal Editors, ver www.icmje.org). Nosotros hemos visto y aprobado el manuscrito final. Ni el artículo, ni ninguna parte esencial del mismo, incluido las tablas y las figuras, será publicado o admitido para arbitrar a otra parte antes de aparecer en la Revista.También notificamos haber leído la sección “conflicto de intereses”, y revelaríamos cualquiera que existiera. Dejamos constancia que si nuestro artículo se publicara en la RAC, cederíamos los derechos (copyright) a la Revista.Los documentos publicados en esta revista están bajo la licencia Creative Commons Atribución-NoComercial-Compartir-Igual 2.5 Argentina.
Those signing below certify that we have full responsibility for the conduction of this study and for the design and interpretation of the information. We wrote the manuscript and are responsible for its decision. Each of us fulfills the definition of authorship as stated by the International Committee of Medical Journal Editors ( www.icmje.org). We have signed and approved the final manuscript. Neither the manuscript, nor any essential part thereof, including tables and figures, will be published or accepted for refereeing elsewhere before being published in the Journal. We have also read the "Conflict of Interest" section and would disclose any existing. We state that if our manuscript is published in the RAC, we shall transfer the copyright to the Journal.

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Idioma

spa
eng

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info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion