Investigación retrospectiva de las cirugías de revascularización de miocardio con ambas arterias mamarias internas, bilateral, realizadas en el Instituto Nacional Cardiovascular (INCOR) de EsSalud, entre enero de 2012 a diciembre de 2015. Los objetivos fueron determinar la mortalidad por cualquier causa y los eventos cardiovasculares mayores a 30 días de seguimiento.

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 tw...

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 p...

We present a 64-year-old man diagnosed with Hodgkin's lymphoma at 3 years, who received chemotherapy and several sessions of Mediastinal Radiotherapy (MRT), which caused torrential tricuspid regurgitation (TR), complete heart block (CHB) and porcelain aorta. The patient successfully underwent complex tricuspid repair without cardiac arrest and implantation of an epicardial pacemaker.

Objective: The study objective was to evaluate the safety and clinical and echocardiographic outcomes of a new surgical technique in adult patients diagnosed with a giant left atrium. Methods: We analyzed a cohort of patients who underwent left atrium reduction surgery between January 2016 and June 2020 performed by a specialized surgical team in 2 national reference centers in Lima, Peru. We assessed the major adverse valvular-related events and the New York Heart Association functional class as primary clinical outcomes. Also, our primary echocardiographic endings were the diameter, area, and volume of the left atrium. We assessed these variables at 3 time periods: baseline (t0), perioperative period (t1), and extended follow-up (t2: 12 ± 3.4 months). We carried out descriptive and bivariate exploratory statistical analysis for dependent measures. Results: We included 17 patients, 70....

Objective: The study objective was to evaluate the safety and clinical and echocardiographic outcomes of a new surgical technique in adult patients diagnosed with a giant left atrium. Methods: We analyzed a cohort of patients who underwent left atrium reduction surgery between January 2016 and June 2020 performed by a specialized surgical team in 2 national reference centers in Lima, Peru. We assessed the major adverse valvular-related events and the New York Heart Association functional class as primary clinical outcomes. Also, our primary echocardiographic endings were the diameter, area, and volume of the left atrium. We assessed these variables at 3 time periods: baseline (t0), perioperative period (t1), and extended follow-up (t2: 12 3.4 months). We carried out descriptive and bivariate exploratory statistical analysis for dependent measures. Results: We included 17 patients, 70.6% ...

La tesis tuvo como objetivo comparar la evolución postoperatoria de los pacientes operados de reconstrucción de válvula aórtica versus los operados de reemplazo valvular aórtico mecánico en el Instituto Nacional Cardiovascular, EsSalud. Se estudiaron a 31 pacientes en cada grupo quirúrgico. Se incluyeron sólo a pacientes menores de 65 años, se excluyeron a pacientes con obesidad mórbida u operados de emergencia. Como resultados se obtuvo que a 30 días la mortalidad en el reemplazo de válvula fue de 1/31 (3%) versus 0/31(0%) en el grupo de reconstrucción, el gradiente máximo fue de 28±9mmHg en el grupo de reemplazo versus 16±9mmHg en el grupo reconstrucción (p<0.01), el gradiente medio fue de 16±5mmHg versus 08±5mmHg (p<0.01), respectivamente. La media de seguimiento del grupo reemplazo fue de 18±9 meses versus 25±11meses en el grupo reconstrucción (p:0.006). En el s...

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 tw...

We present the case of a 39-year-old man with a history of progressive dyspnea. Transthoracic and transesophagealechocardiography revealed severe mitral valve (MV) regurgitation due to P2 flail as well as severe tricuspid valve (TV) regurgitation. The patient underwent surgical treatment, including MV repair and TV annuloplasty, performed through a totally endoscopic periareolar approach. Postoperative evolution was satisfactory.

Mujer de 44 años de edad que, durante el posoperatorio inmediato de una cirugía de reemplazo de válvula mitral presentó súbitamente elevación del segmento ST en las derivadas precordiales V4, V5 y V6 del electrocardiograma, elevación de enzimas cardiacas y disminución de la contractilidad del ventrículo izquierdo con FEVI 24%; ante la sospecha de infarto agudo de miocardio peri-operatorio se realizó el cateterismo cardiaco evidenciándose ausencia de lesiones en arterias coronarias, hallazgos compatibles con miocardiopatía de Takotsubo. La paciente evolucionó con choque cardiogénico, patrón hemodinámico confirmado por catéter en arteria pulmonar y requerimiento de altas dosis de inotrópicos, que incluyó levosimendán, soporte vasopresor y mecánico mediante balón de contra pulsación intra-aórtico; la respuesta al soporte instalado fue favorable y a 6 días del evento...

We present the case of a 56-year-old male patient with a history of atrial flutter for six months; he was admitted to the hospital for presenting a mass of 8 cm in maximum diameter in the right atrium, which prolapsed through the tricuspid valve into the right ventricle. Emergency surgery was scheduled, performing exeresis of the tumor and tricuspid annuloplasty. The Pathological anatomy determined that the removed mass corresponded to a cardiac lipoma.

Se presenta el caso de un paciente varón de 56 años, con antecedente de Flutter auricular desde hace 6 meses; ingresó al hospital por presentar una masa de 8 cm de diámetro máximo en la aurícula derecha, la cual prolapsaba a través de la válvula tricúspide hacia el ventrículo derecho. Se programó la cirugía de urgencia en la que se realizó la exéresis de la tumoración y la anuloplastia tricuspídea. La anatomía patológica determinó que la masa extraida correspondía a un lipoma cardiaco.

We present the case of a 56-year-old male patient with a history of atrial flutter for six months; he was admitted to the hospital for presenting a mass of 8 cm in maximum diameter in the right atrium, which prolapsed through the tricuspid valve into the right ventricle. Emergency surgery was scheduled, performing exeresis of the tumor and tricuspid annuloplasty. The Pathological anatomy determined that the removed mass corresponded to a cardiac lipoma.

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.

Objetivo. Determinar la mortalidad posoperatoria y las complicaciones posoperatorias de pacientes sometidos a cirugía cardiaca en el Servicio de Cirugía Cardiovascular del Instituto Nacional Cardiovascular, EsSalud, Lima, Perú en el año 2023. Materiales y métodos. Estudio descriptivo, retrospectivo, de las historias clínicas de los pacientes. Resultados. En el año 2023 se realizaron 538 cirugías cardiacas en nuestro centro, la mortalidad global fue del 5,6%; sin embargo, la mortalidad de cirugías electivas fue del 4,1%. La mortalidad de la cirugía coronaria aislada fue del 1,9% y de la cirugía valvular asilada fue de 0,7%. El Stroke se presentó en el 1,5% de pacientes, la reoperación por sangrado se realizó en el 8,1% de los casos. La cirugía más frecuentemente realizada fue la valvular (ya sea aislada o multivalvular) con el 40,1% de los casos, seguida de la coron...

Objective. To describe cardiac surgeries, their approaches, and determine operative mortality according to the type of surgery and the main complications recorded within 30 days postoperatively, performed at the National Cardiovascular Institute of Peru. Materials and methods. A descriptive study was conducted on all patients over 18 years of age who underwent cardiovascular surgery at the National Cardiovascular Institute “Carlos Alberto Peschiera Carrillo”. Results. During the year 2022, a total of 503 cardiac surgeries were performed. Of the patients undergoing surgery, 63.6% (320) were males. Isolated valvular surgery, primarily aortic or mitral valve replacement, was the most frequent surgical procedure, with 136 surgeries (27.0%). This was followed by myocardial revascularization surgery with 110 procedures (21.9%). Throughout the year, there were 23 deaths, resulting in an ove...

Objetivo. Describir las cirugías cardíacas, su abordaje y determinar la mortalidad operatoria según el tipo de cirugía y las principales complicaciones registradas hasta los 30 días del posoperatorio realizadas en el Instituto Nacional Cardiovascular de Perú. Materiales y métodos. Se llevó a cabo un estudio descriptivo en todos los pacientes mayores de 18 años que fueron sometidos a cirugía cardiovascular en el Instituto Nacional Cardiovascular «Carlos Alberto Peschiera Carrillo». Resultados. Durante el año 2022 se realizaron 503 cirugías cardíacas. De los pacientes intervenidos, el 63,6% (320) fueron varones. La cirugía valvular aislada, principalmente el reemplazo de la válvula aórtica o mitral, fue el procedimiento quirúrgico más frecuente, con 136 cirugías (27,0%). Le siguió la cirugía de revascularización de miocardio con 110 procedimien...

Objective. To describe cardiac surgeries, their approaches, and determine operative mortality according to the type of surgery and the main complications recorded within 30 days postoperatively, performed at the National Cardiovascular Institute of Peru. Materials and methods. A descriptive study was conducted on all patients over 18 years of age who underwent cardiovascular surgery at the National Cardiovascular Institute “Carlos Alberto Peschiera Carrillo”. Results. During the year 2022, a total of 503 cardiac surgeries were performed. Of the patients undergoing surgery, 63.6% (320) were males. Isolated valvular surgery, primarily aortic or mitral valve replacement, was the most frequent surgical procedure, with 136 surgeries (27.0%). This was followed by myocardial revascularization surgery with 110 procedures (21.9%). Throughout the year, there were 23 deaths, resulting in an ove...

l síndrome aórtico agudo involucra 3entidades (la úlcera aórtica penetrante, la disección de la aorta y el hematoma intramural) que de no ser tratadas a tiempo causan en la mayoría de los casos la muerte del paciente. El tratamiento oportuno (quirúrgico en la mayoría de los casos) requiere de un sistema de referencias eficiente, disponibilidad inmediata de recursos, médicos entrenados, etc. Los hospitales del Ministerio de Salud del Perú habitualmente tienen escasez de recursos que no permiten el tratamiento oportuno de la enfermedad cardiovascular de alta complejidad. En este contexto presentamos nuestra experiencia inicial en el manejo de 2pacientes con disección de la aorta tipo A y un paciente con úlcera aórtica penetrante rota complicada con un seudoaneurisma aórtico.

Objective. To determine the discriminative capacity of myocardial perfusion with single photon emission tomography (SPECT) to predict coronary obstructions by coronary angiography. To determine mortality and major cardiovascular events at follow-up. Materials and methods. Retrospective observational study with clinical follow-up in patients undergoing SPECT and then coronary angiography. We excluded patients with myocardial infarction and percutaneous and/or surgical revascularization in the previous 6 months. Results: 105 cases were included in the study. The most commonly used SPECT protocol was pharmacological (70%). Patients with perfusion defect ≥10% of total ventricular mass (TVM) had significant coronary lesions (SCL) in 88% of cases (sensitivity 87.5% and specificity 83%). On the other hand, having ischemia ≥10% of the TVM was associated with 80% SCL (sensitivity: 72%, specif...