Abstract The long-term results of cryomaze in patients with longstanding persistent atrial fibrillation during concomitant surgical procedures are still uncertain. Methods Between 2006 and 2011, 150 consecutive patients with associated long-lasting permanent atrial fibrillation and associated heart disease underwent heart surgery were treated by biatrial Cox-Maze (63 patients) or by isolated endocardial or epicardial left atrial cryoablation (83 patients) concomitantly. The results at 3 years in these groups were compared with clinical monitoring, electrocardiography, 24-hour Holter, and echocardiography with measurement of the transmitral A wave at 1, 6 and 12 months and annually thereafter in all patients. Results Patients undergoing Cox-Maze IV ablation presented rates of freedom from atrial fibrillation of 97, 94, 89, 80 and 54% at 1, 6, 12, 24 and 36 months, respectively. In the 12-month follow-up, these differences were significant (p < .05). The independent risk factors of atrial fibrillation recurrence was isolated ablation of left atrium. Conclusions Atrial fibrillation by cryothermia ablation had a high success rate before 2 years postoperatively. Recurrence of atrial fibrillation increased thereafter regardless of the technique used, although it was more intense and developed earlier in cases of monoatrial ablation. For the treatment of other long-lasting permanent atrial fibrillation cardiac surgery-associated pathology, an aggressive biatrial treatment with Cox maze ablation should be performed.

Resumen Los resultados a largo plazo del procedimiento de maze con criotermia en pacientes con fibrilación auricular durante procedimientos quirúrgicos concomitantes son todavía inciertos. Método Entre 2006 y 2011, 150 pacientes consecutivos con fibrilación auricular persistente y cardiopatía asociada fueron sometidos a cirugía de ablación mediante criotermia asociada a cirugía concomitante. El procedimiento de Cox-Maze biauricular fue realizado en 67 pacientes y ablación aislada de la aurícula izquierda en 83 pacientes. Los resultados a tres años en estos grupos fueron comparados mediante seguimiento clínico, electrocardiográfico y mediante Holter 24 horas y ecocardiografía con medición de la onda A transmitral al mes, a los 6 y 12 meses y después anualmente. Resultados Los pacientes sometidos a ablación Cox-Maze presentaron una libertad de fibrilación auricular del 97, 94, 89, 80 y 54% a 1, 6, 12, 24 y 36 meses respectivamente. En el seguimiento de los 12 meses estas diferencias resultaron significativas (p < 0.05). Como factor de riesgo de recurrencia de fibrilación auricular se identificó la ablación aislada de la aurícula izquierda. Conclusiones La ablación mediante criotermia tiene un elevado porcentaje de éxitos a dos años; la recurrencia se incrementa a partir de entonces independientemente de la técnica realizada. Para el tratamiento de la fibrilación auricular persistente asociada a otra patología quirúrgica cardiaca se debe realizar un tratamiento intensivo mediante ablación biauricular.

Objectives: To analyze the factors that influence outcomes of surgical myocardial revascularization in the female population. Patients and method: This is a retrospective study in which 128 woman, subjected to GABC[IBM1] from January to September 2004, were enrolled in an univariate and multivariate analysis of risk factors associated with morbidity and mortality. Results: The mean age was 69.19 ± 9.05 [IBM2] years, the most frequent pathologies, comorbilities, were dyslipemia, hypertension, and myocardial infarction. Unestable angina was found in 63.28% patients and stenosis in the left main coronary artery 42.96%; NYHA III-IV in 23.43%. The EuroSCORE mean preoperative risk was [IBM3] 5.57. Twelve surgeries were emergencies. Mean of grafts was 2.57. Mortality corresponded to 5.4% in programmed surgeries, 7% global. Univariate analysis identified this risk factors releated to mortality (p < 0.05): age older than 67 years, NYHA III-IV and emergency surgery, complicated in 25.2%. Follow-up was kept in 90.8% of patients, mean follow-up time was 17.11 (± 14.94) months; 115 patients did not present angina. The risk factor for angina during follow-up, in the univariate analysis (p < 0.05) was not having used the left internal thoracic artery as graft for the anastomosis of the anterior descending artery. Conclusions: Emergency surgery, age older than 67 years, and NYHA III-IV, were independent risk factors associated with mortality in this group. The use of artery grafts associated to reduced angina during follow-up.

Introducción y objetivos: Realizamos estudio de los factores que influyen en los resultados de la revascularización miocárdica quirúrgica en la población femenina. Pacientes y método: Analizamos retrospectivamente los factores de riesgo preoperatorios asociados a morbi-mortalidad hospitalaria en 128 pacientes intervenidas entre enero de 2000 y septiembre de 2004. Resultados: La edad media fue 69.19 ± 9.05 años, las patologías asociadas más frecuentes fueron dislipemia, HTA e IAM. Presentaron angina inestable 63.28% pacientes, teniendo lesión del TCI (42.96%), permaneciendo en clase funcional (NYHA) III-IV 23.43%. El riesgo preoperatorio medio (EuroSCORE) fue 5.57; realizando 12 cirugías urgentes; anastomosando una media de 2.57 injertos. La mortalidad hospitalaria fue 5.4% en cirugía programada, 7% global. Fueron factores de riesgo de mortalidad en análisis univariante (p < 0.05): grado funcional (NYHA) III-IV, FEVI < 50%, cirugía urgente y edad superior a 67 años. Fueron factores de riesgo de mortalidad en análisis multivariante (p < 0.05): edad superior a 67 años, grado funcional (NYHA) y realización de cirugía urgente. Se complicaron 25.2%. Se realizó seguimiento en el 90.8% de los supervivientes, seguimiento medio 17.11 ± 14.94 meses, estando 115 pacientes asintomáticos para angor. El factor de riesgo de angina en seguimiento en análisis univariante (p < 0.05) fue no usar AMI como injerto anastomosado a la descendente anterior. Conclusiones. La urgencia, edad superior a 67 años y deterioro de clase funcional son factores de riesgo directamente relacionados con mortalidad en este grupo. El uso de injertos arteriales está asociado a la disminución de recurrencia de angor en el seguimiento.

We report a case of spontaneous dissection of the left anterior descending coronary artery in a 51 year-old woman with unrelated known risk factors. Clinical onset was an acute anterior non-Q myocardial infarction, medically treated with good outcome. Coronary angiography revealed a dissection of the left anterior descending coronary artery with impaired systolic function. Emergency arterial revascularization by means of a left-internal thoracic-artery to left-anterior-descending-coronaryartery without cardiopulmonary bypass was performed. The postoperative status was straightforward and the patient is asymptomatic 25 months after surgery. The clinical features of this pathology are discussed.

Se presenta un caso de disección espontánea de la arteria coronaria descendente anterior en una mujer de 51 años, sin relación con factores desencadenantes conocidos. El inicio clínico fue un IAM no Q anterior, controlado con tratamiento médico y buena evolución clínica. El cateterismo cardíaco evidenció la disección de la arteria descendente anterior, que producía deterioro de la función sistólica. Se realizó revascularización arterial urgente mediante injerto de mamaria interna izquierda a descendente anterior sin CEC. El posoperatorio cursó sin complicaciones y a 25 meses del procedimiento la paciente se encuentra asintomática. Se realiza, además, una exposición de las consideraciones clínicas relacionadas con esta patología.

OBJETIVO: Estudar retrospectivamente os resultados de 264 pacientes submetidos à implementação cirúrgica de válvula modelo Omnicarbon entre abril 1985 e maio 1995. MÉTODOS: No momento da cirurgia, a média de idade dos pacientes que receberam essa prótese mecânica era de 57±11 anos. As válvulas modelo Omnicarbon foram colocadas em posição aórtica em 36% dos casos, na posição mitral em 44% dos casos, e nas duas posições em 20% dos casos. O seguimento clínico foi feito cuidadosamente, com a maioria dos pacientes submetidos ao exame físico em nossa clínica. Levando em conta o histórico do caso, os cardiologistas faziam perguntas aos pacientes sobre as complicações relacionadas à válvula. RESULTADOS: O seguimento acumulado dos pacientes foi de 1291 anos, com média de seguimento de 5,4 anos. A sobrevida após 10 anos foi de 79,4±3,9%, incluindo todas as causas de morte e os casos de mortalidade precoce. As complicações relatadas durante os 11 anos de estudo incluem: tromboembolismo (0,1 %), hemorragia (0,4%), endocardite (0,2%), e insuficiência não-estrutural (1,2%). Não foram detectadas anemia hemolítica, trombose valvar, ou insuficiência estrutural durante esse longo período de estudo. A capacidade funcional desses pacientes foi avaliada subjetivamente pelo sistema de classificação da NYHA. Com o tempo de seguimento maior do que 5 anos em média, nossos pacientes que receberam a válvula modelo Omnicarbon se encontram na classe I ou II da NYHA. CONCLUSÃO: As próteses mecânicas modelo Omnicarbon apresentam um bom desempenho clínico por até 10 anos, tanto em posição aórtica quanto mitral. Os resultados indicam uma baixa incidência de tromboembolismo e complicações hemorrágicas.

OBJECTIVE: We retrospectively examined the outcomes of 264 patients who underwent consecutive Omnicarbon valve implantation surgery between April 1985 and May 1995. METHODS: At the time of surgery, patients who received this mechanical prosthesis averaged 57±11 years of age. Omnicarbon valves were placed in the aortic position in 36% of the cases, in the mitral position in 44%, and in both positions in 20%. Follow-up was carefully performed, with most patients undergoing physical examination at our clinic. While taking the case history, cardiac physicians specifically questioned the patient about valve-related complications. RESULTS: Accumulated total patient-years is 1291, with a mean follow-up time of 5.4 years. Survival at 10 years is 79.4±3.9%, including all causes of death and early mortality. Complications recorded during the 11-year study include: thromboembolism (0.1%), hemorrhage (0.4%), endocarditis (0.2%), and nonstructural failure (1.2%). No hemolytic anemia, valve thrombosis, or structural failure was detected during this long-term experience. Functional capability of these patients was subjectively assessed by the NYHA classification system. With follow-up time averaging over 5 years, 97% of our Omnicarbon valve patients are in NYHA I or II. CONCLUSION: The Omnicarbon mechanical prosthesis provides a good clinical performance for up to 10 years in both the aortic and mitral positions. Results indicated a low incidence of thromboembolism and of hemorrhagic complications.