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Diario Oficial de la Sociedad Mexicana de Cirugía Cardiaca, A.C., y del Colegio Mexicano de Cirugía Cardiovascular y Torácica, A.C.

2018, Número 1

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Cir Card Mex 2018; 3 (1)


Tratamiento sustitutivo en aneurismas de aorta ascendente: mortalidad a uno y doce meses

Torres-Bernal D, López-Gutiérrez A, Claire-Guzmán S, Ramírez-Castañeda S, Rosas-Peralta M, Riera-Kinkel C

Idioma: Español
Referencias bibliográficas: 48
Paginas: 39-42
Archivo PDF: 218.91 Kb.


RESUMEN

Objetivo. Un aneurisma se define como una dilatación de un vaso sanguíneo por arriba del 50% de su diámetro esperado, con compromiso de la totalidad de la pared arterial. El propósito de este artículo es presentar nuestra experiencia en el tratamiento de los aneurismas de la aorta torácica.
Material y Métodos. En el Hospital de Cardiología del Centro Médico Nacional Siglo XXI, IMSS, del 1 de enero de 2012 hasta el 31 de julio del 2016 se realizó una investigación documental sobre etiología, tipos, localización, factores de riesgo, técnicas de tratamiento quirúrgico y resultados posquirúrgicos de aneurismas de la aorta torácica.
Resultados. Fueron 79 pacientes con 59 (75%) del sexo masculino y 20 (25%) femeninos. Con antecedente de hipertensión arterial en 40 (51%), diabetes mellitus en seis (8%) y siete (9%) con Marfán. En 27 (34%) presentaban disección aórtica Stanford A. En 56 casos (71%) se les colocó tubo valvulado con técnica de Bentall-Bono, a 18 pacientes (23%) se les coloco un tubo supracoronario, a cuatro pacientes (5.1%) se les colocó tubo de Dacron® para sustitución de hemiarco y a un paciente (1.3%) se le realizó aortoplastia. En 45 casos (57%) hubo alguna complicación. Al mes hubo 17 fallecimientos (22%) y al año dos casos (3%).
Conclusiones. En nuestro centro hospitalario de tercer nivel contamos con casuística suficiente para compararnos con lo reportado en la literatura, si bien nuestra mortalidad se ve incrementada respecto a la literatura mundial, es de importancia señalar que nuestra casuística de disección aortica aguda es mayor a lo que se ha documentado a nivel mundial.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Johnston KW, Rutherford RB, Tilson MD, et al. Suggested standards for reportingon arterial aneurysms. Subcommittee on Reporting Standards, Society for VascularSurgery and North American Chapter, International Society for CardiovascularSurgery. J Vasc Surg. 1991; 13:452-8.

  2. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI /SIR/STS/ SVM guidelines for the diagnosis and management of patientswith Thoracic Aortic Disease: a report of the American College of CardiologyFoundation/American Heart Association Task Force on Practice Guidelines,American Association for Thoracic Surgery, American College of Radiology,American Stroke Association, Society of Cardiovascular Anesthesiologists, Societyfor Cardiovascular Angiography and Interventions, Society of InterventionalRadiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation2010; 121:e266.

  3. Creager MA, Belkin M, Bluth EI, et al. 2012 ACCF/AHA/ACR/SCAI/SIR/STS/SVM/SVN/SVS Key data elements and definitions for peripheral atheroscleroticvascular disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Data Standards (WritingCommittee to develop Clinical Data Standards for peripheral atherosclerotic vasculardisease). J Am Coll Cardiol 2012; 59:294-357.

  4. Itani Y, Watanabe S, Masuda Y, et al. Measurement of aortic diameters and detectionof asymptomatic aortic aneurysms in a mass screening program using amobile helical computed tomography unit. Heart Vessels 2002; 16:42-5.

  5. Kälsch H, Lehmann N, Möhlenkamp S, et al. Body-surface adjusted aortic referencediameters for improved identification of patients with thoracic aortic aneurysms:results from the population-based Heinz Nixdorf Recall study. Int J Cardiol2013; 163:72-8

  6. Bickerstaff LK, Pairolero PC, Hollier LH, et al. Thoracic aortic aneurysms: a population-based study. Surgery 1982; 92:1103-8.

  7. Clouse WD, Hallett JW Jr, Schaff HV, et al. Improved prognosis of thoracic aorticaneurysms: a population-based study. JAMA 1998; 280:1926-9.

  8. Elefteriades JA, Farkas EA. Thoracic aortic aneurysm clinically pertinent controversiesand uncertainties. J Am Coll Cardiol 2010; 55:841-57.

  9. Ferro CR, de Oliveira DC, Guerra F de F, et al. Prevalence and risk factors forcombined coronary artery disease and aortic aneurysm. Arq Bras Cardiol 2007;88:40-4.

  10. Booher AM, Eagle KA. Diagnosis and management issues in thoracic aortic aneurysm.Am Heart J 2011; 162:38-46.

  11. Germain DP, Herrera-Guzman Y. Vascular Ehlers-Danlos syndrome. Ann Genet2004; 47:1-9.

  12. Loeys BL, Schwarze U, Holm T, et al. Aneurysm syndromes caused by mutationsin the TGF-beta receptor. N Engl J Med 2006; 355:788-98.

  13. Coady MA, Davies RR, Roberts M, et al. Familial patterns of thoracic aortic aneurysms.Arch Surg 1999; 134:361-7.

  14. Pannu H, Fadulu VT, Chang J, et al. Mutations in transforming growth factor-betareceptor type II cause familial thoracic aortic aneurysms and dissections. Circulation2005; 112:513-20.

  15. Verma S, Siu SC. Aortic dilatation in patients with bicuspid aortic valve. N Engl JMed 2014; 370:1920-9.

  16. Michelena HI, Khanna AD, Mahoney D, et al. Incidence of aortic complications inpatients with bicuspid aortic valves. JAMA 2011; 306:1104-12.

  17. Cheung C, Bernardo AS, Trotter MW, et al. Generation of human vascular smoothmuscle subtypes provides insight into embryological origin-dependent diseasesusceptibility. Nat Biotechnol 2012; 30:165-73.

  18. Coady MA, Rizzo JA, Goldstein LJ, Elefteriades JA. Natural history, pathogenesis,and etiology of thoracic aortic aneurysms and dissections. Cardiol Clin 1999;17:615-35.

  19. Albornoz G, Coady MA, Roberts M, et al. Familial thoracic aortic aneurysms anddissections, incidence, modes of inheritance, and phenotypic patterns. Ann ThoracSurg 2006; 82:1400-5.

  20. Dapunt OE, Galla JD, Sadeghi AM, et al. The natural history of thoracic aorticaneurysms. J Thorac Cardiovasc Surg 1994; 107:1323-32.

  21. Davies RR, Goldstein LJ, Coady MA, et al. Yearly rupture or dissection ratesfor thoracic aortic aneurysms: simple prediction based on size. Ann Thorac Surg2002; 73:17-28.

  22. Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry ofAcute Aortic Dissection (IRAD): new insights into an old disease. JAMA 2000;283:897-903.

  23. Borger MA, Preston M, Ivanov J, et al. Should the ascending aorta be replacedmore frequently in patients with bicuspid aortic valve disease? J Thorac CardiovascSurg 2004; 128:677-83.

  24. Booher AM, Eagle KA. Diagnosis and management issues in thoracic aortic aneurysm.Am Heart J 2011; 162:38-46.

  25. Fattori R, Cao P, De Rango P, et al. Interdisciplinary expert consensus documenton management of type B aortic dissection. J Am Coll Cardiol 2013; 61:1661-78.

  26. Appoo JJ, Tse LW, Pozeg ZI, et al. Thoracic aortic frontier: review of currentapplications and directions of thoracic endovascular aortic repair (TEVAR). Can JCardiol 2014; 30:52-63.

  27. Cotton BA, Au BK, Nunez TC, et al. Predefined massive transfusion protocolsare associated with a reduction in organ failure and postinjury complications. JTrauma 2009; 66:41-9.

  28. Benedetto U, Raja SG, Amrani M, et al. The impact of arterial cannulation strategyon operative outcomes in aortic surgery: evidence from a comprehensive meta-analysis of comparative studies on 4476 patients. J Thorac Cardiovasc Surg2014; 148:2936-43.

  29. Yan TD, Bannon PG, Bavaria J, et al. Consensus on hypothermia in aortic archsurgery. Ann Cardiothorac Surg 2013; 2:163.

  30. Griepp RB, Stinson EB, Hollingsworth JF, Buehler D. Prosthetic replacement ofthe aortic arch. J Thorac Cardiovasc Surg 1975; 70:1051-63.

  31. Livesay JJ, Cooley DA, Duncan JM, et al. Open aortic anastomosis: improved resultsin the treatment of aneurysms of the aortic arch. Circulation 1982; 66:I122-7.

  32. Kapadia MR, Popowich DA, Kibbe MR. Modified prosthetic vascular conduits.Circulation 2008; 117:1873-82.

  33. Kannan RY, Salacinski HJ, Butler PE, et al. Current status of prosthetic bypassgrafts: a review. J Biomed Mater Res B Appl Biomater 2005; 74:570-81.

  34. Piazza M, Ricotta JJ 2nd. Open surgical repair of thoracoabdominal aortic aneurysms.Ann Vasc Surg 2012; 26:600-5.

  35. Quinones-Baldrich W, Jimenez JC, DeRubertis B, Moore WS. Combined endovascularand surgical approach (CESA) to thoracoabdominal aortic pathology: A10-year experience. J Vasc Surg 2009; 49:1125-34.

  36. Zehr KJ, Orszulak TA, Mullany CJ, et al. Surgery for aneurysms of the aortic root:a 30-year experience. Circulation 2004; 110:1364-71.

  37. Arabkhani B, Mookhoek A, Di Centa I, et al. Reported Outcome After Valve-SparingAortic Root Replacement for Aortic Root Aneurysm: A Systematic Reviewand Meta-Analysis. Ann Thorac Surg. 2015; 100:1126-31.

  38. Ishimitsu T, Tsukada K, Ohta S, et al. Increased cardiovascular risk in long-termhemodialysis patients carrying deletion allele of ACE gene polymorphism. Am JKidney Dis. 2004; 44:466-75.

  39. Sarsam MA, Yacoub M. Remodeling of the aortic valve anulus. J Thorac CardiovascSurg 1993; 105:435-8.

  40. Bentall H, De Bono A. A technique for complete replacement of the ascendingaorta. Thorax 1968; 23:338-9.

  41. Vallabhajosyula P, Jassar AS, Menon RS, et al. Moderate versus deep hypothermiccirculatory arrest for elective aortic transverse hemiarch reconstruction. Ann ThoracSurg. 2015; 99:1511-7.

  42. Hu Z, Wang Z, Ren Z, et al. Similar cerebral protective effectiveness of antegradeand retrograde cerebral perfusion combined with deep hypothermia circulatory arrestin aortic arch surgery: a meta-analysis and systematic review of 5060 patients.J Thorac Cardiovasc Surg. 2014; 148:544-60.

  43. Achneck HE, Rizzo JA, Tranquilli M, Elefteriades JA. Safety of thoracic aorticsurgery in the present era. Ann Thorac Surg. 2007; 84:1180-5.

  44. Sundt TM 3rd, Orszulak TA, Cook DJ, Schaff HV. Improving results of open archreplacement. Ann Thorac Surg. 2008; 86:787-96.

  45. Aftab M, Songdechakraiwut T, Green SY, et al. Contemporary outcomes of openthoracoabdominal aortic aneurysm repair in octogenarians. J Thorac CardiovascSurg. 2015; 149:S134-41.

  46. Higgins J, Lee MK, Co C, Janusz MT. Long-term outcomes after thoracic aorticsurgery: a population-based study. J Thorac Cardiovasc Surg. 2014; 148:47-52.

  47. Achneck HE, Rizzo JA, Tranquilli M, Elefteriades JA. Safety of thoracic aorticsurgery in the present era. Ann Thorac Surg. 2007; 84:1180-5.

  48. Nezafati P, Shomali A, Nezafati MH. A simple modified Bentall technique forsurgical reconstruction of the aortic root - short and long term outcomes. J CardiothoracSurg. 2015;10:132. doi: 10.1186/s13019-015-0336-4.




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