Resumen: Introducción y objetivos: Evaluar los resultados a corto y a largo plazo del reemplazo valvular aórtico (RVA), exclusivo o asociado, en pacientes octogenarios. Comparar los resultados entre el periodo previo al establecimiento del programa de implante de prótesis percutáneas (TAVI) con el periodo posterior. Método: Se estudian los pacientes mayores de 80 años operados de RVA entre 2007 y 2023 en el Hospital Guillermo Grant Benavente (N=130). Se dividen en 2 grupos que recibieron reemplazo valvular quirúrgico según el establecimiento del programa TAVI: Grupo 1, operados antes de 2017 (sin alternativa de TAVI disponible (N=87), y Grupo 2, operados durante y después de 2017 (con alternativa de TAVI disponible (N=43). Se comparan sus características clínicas, ecocardiográficas, de las cirugías, complicaciones y mortalidad operatoria. Seguimiento hasta enero del 2024. Resultados: No hubo diferencias en las características sociodemográficas, patologías asociadas y patología valvular. El Grupo 2 tuvo menores scores de riesgo (EuroScore II 3,8% versus 4.8% (NS) y STS Score 3,8% versus 4,7% (NS)). Hubo un número similar de cirugías asociadas en ambos grupos. Los tiempos de pinzamiento aórtico y bomba fueron menores en el Grupo 2 (p=0,003). La tasa de complicaciones fue 45% y 21% (p=0,008); y la mortalidad operatoria fue 18.4% y 2.3% (p=0,011) en los Grupos 1 y 2 respectivamente. La sobrevida global estimada a 5 años fue 58% y 80% en los Grupos 1 y 2 (p=0,041). Conclusiones: Con el establecimiento del programa TAVI hubo una mejor selección de los octogenarios para RVA quirúrgico. Esta selección se asoció a una disminución en la tasa de complicaciones, mortalidad operatoria y mejoría de la supervivencia a 5 años.

Abstract: Aim: To evaluate the shortand long-term outcomes of aortic valve replacement (AVR), either exclusive or combined, in octogenarian patients. To compare the results before and after the establishment of the transcatheter aortic valve implantation (TAVI) program. Method: This study includes patients over 80 years old who underwent AVR between 2007 and 2023 at Hospital Guillermo Grant Benavente (N=130). They were divided into two groups based on the establishment of the TAVI program: Group 1, operated before 2017 (N=87), and Group 2, operated during and after 2017 (N=43). Their clinical, echocardiographic characteristics, surgical details, complications, and operative mortality are compared. Follow-up was conducted until January 2024. Results: There were no differences in sociodemographic characteristics, associated pathologies, and valve pathology between the groups. Group 2 had lower risk scores (EuroScore II 3.8% versus 4.8% and STS Score 3.8% versus 4.7%) not significantly different. The number of associated surgeries was similar. Aortic cross-clamp and pump times were shorter in Group 2 (p=0.003). The complication rate was 45% and 21% (p=0.008); and the operative mortality was 18.4% and 2.3% (p=0.011) in Groups 1 and 2 respectively. The estimated overall survival at 5 years was 58% and 80% in Groups 1 and 2 (p=0.041). Conclusion: With the establishment of the TAVI program, there was a better selection of octogenarians for surgical AVR. This selection was associated with a decrease in the complication rate, operative mortality, and an improvement in 5-year survival.

Abstract Background: Transcatheter Aortic Valve Implantation (TAVI) has become the recommended treatment for degenerative aortic stenosis. However, certain demographic and clinical characteristics associated with increased mortality with the implant have been described. Aim: To estimate 30-day mortality, one-year mortality, and overall mortality in patients undergoing TAVI, and identify demographic, clinical, and symptomatic characteristics associated with overall mortality. Methods: Retrospective study based on medical records of 68 patients undergoing TAVI between October 2011 and June 2023 at DIPRECA Hospital in Santiago, Chile. Demographic characteristics, comorbidities, and symptoms were analyzed. 30-day mortality, one-year mortality, and overall mortality were estimated; additionally, a comparison of two periods was made. For the identification of factors associated with overall mortality, a bivariate analysis using logistic regression was conducted. Associations with a p-value ≤ 0.05 were considered significant. Results: The average age was 79.6 years. Procedure success rate was 98.5%. Cumulative mortality at 30 days was 4.43%, at one year 16.46%, and overall mortality was 39.7%. Individuals aged 84 to 95 years showed 6.5 times higher likelihood of death compared to the 50 to 77 age group (OR: 6.5, 95% CI: 1.37-30.68; p: 0.018). Conclusions: There was an increased mortality rate in octogenarian and nonagenarian patients who undergoing TAVI implantation. The 30-day and oneyear mortality for the second period were relatively low compared to other studies.

Resumen Antecedentes: El Implante percutáneo de válvula aórtica (TAVI) se ha convertido en el tratamiento recomendado para la estenosis aórtica degenerativa. Sin embargo, se han descrito ciertas características demográficas y clínicas asociados a una mayor mortalidad con el implante. Objetivos: Estimar la mortalidad a 30 días, al año y la mortalidad general en pacientes sometidos a TAVI e identificar características demográficas, clínicas y sintomáticas asociadas a la mortalidad general. Métodos: Estudio retrospectivo, basado en historias clínicas de 68 pacientes sometidos a TAVI entre octubre 2011 y junio 2023 en el Hospital DIPRECA, Santiago, Chile. Se analizaron características demográficas, de comorbilidad y síntomas. Se estimó la mortalidad a 30 días, al año y mortalidad general. Adicionalmente se compararon dos períodos consecutivos de aplicación de la técnica. Para la identificación de factores asociados a la mortalidad general, se realizó un análisis bivariado utilizando regresión logística. Se consideró asociaciones significativas aquellas con un p ≤ 0,05. Resultados: La edad promedio fue 79,6 años. El éxito del procedimiento fue 98,5%. La mortalidad acumulada a los 30 días fue 4,43%, al año 16,46% y la mortalidad general fue 39,7%. Las personas de 84 a 95 años mostraron 6,5 veces más probabilidad de morir comparado al grupo de 50 a 77 años (OR: 6,5 IC95%: 1,37-30,68; p:0,018). Conclusiones: Se evidencia un aumento de mortalidad en pacientes octogenarios y nonagenarios que fueron sometidos a TAVI. La mortalidad a los 30 días y al año, del segundo periodo, fue relativamente baja comparada con otros estudios.

ABSTRACT Pancreatoduodenectomy represents the only curative alternative in patients with periampullary tumors, currently with acceptable morbidity and mortality rates. However, there is little evidence in octogenarian patients. Aim: To describe the experience of octogenarian patients undergoing pancreatoduodenectomy for tumors of the periampullary area at the Hospital Clínico de la Pontificia Universidad Católica de Chile. Material and method: Retrospective study. All patients aged 80 years or older who underwent pancreatoduodenectomy for tumors in the periampullary area between 2002 and 2022 were included. Descriptive analysis and survival calculation with the Kaplan-Meier curve were performed. Results: 24 patients were included. Median age 82 years (80-88); 62.5% were men. The tumor origin was 20 in the head of the pancreas (83.3%), 2 in the ampulla (8.3%), and 2 in the distal bile duct (8.3%), 100% of malignant origin. No patient received neoadjuvant treatment. 91.7% were classified as ASA II. 2 patients presented major complications, both of a medical nature. One patient presented with a type B pancreatic fistula. No patient presented hemorrhagic or biliary complications nor required reoperation or readmission. There was no postoperative mortality at 30 or 90 days. Adjuvant treatment was performed in 4 patients (16.7%). The 5-year overall survival was 20.1%, with a median of 22 months. Conclusion: Pancreatoduodenectomy is an appropriate treatment alternative in patients over 80 years of age with tumors of the periampullary area, which can offer low morbidity and mortality rates if they are correctly selected in the context of a multidisciplinary preoperative evaluation in high-volume centers.

RESUMEN La pancreatoduodenectomía representa la única alternativa curativa en pacientes con tumores periampulares, actualmente con tasas de morbi-mortalidad aceptables. Sin embargo, existe escasa evidencia en pacientes octogenarios. Objetivos: Describir la experiencia en pacientes octogenarios sometidos a pancreatoduodenectomía por tumores del área periampular en el Hospital Clínico de la Pontificia Universidad Católica de Chile. Material y método: Estudio retrospectivo. Se incluyeron todos los pacientes de 80 años o más sometidos a pancreatoduodenectomía por tumores del área periampular entre 2002 y 2022. Se realizó análisis descriptivo y cálculo de sobrevida con curva de Kaplan-Meier. Resultados: Se incluyeron 24 pacientes. Mediana de edad 82 años (80-88); 62,5% eran hombres. El origen tumoral fue: 20 en cabeza de páncreas (83,3%), 2 en ampolla (8,3%) y 2 en vía biliar distal (8,3%), el 100% de origen maligno. Ningún paciente recibió neoadyuvancia. El 91,7% se clasificó ASA II. 2 pacientes presentaron complicaciones mayores, ambos de naturaleza médica. 1 paciente presentó fístula pancreática tipo B. Ningún paciente presentó complicación hemorrágica ni biliar, ni requirió reoperación ni readmisión. No hubo mortalidad postoperatoria a los 30 ni 90 días. Se realizó adyuvancia a 4 pacientes (16,7%). La sobrevida global a 5 años fue 20,1%, con una mediana de 22 meses. Conclusión: La pancreatoduodenectomía es una adecuada alternativa de tratamiento en pacientes mayores de 80 años con tumores del área periampular, que puede ofrecer bajas tasas de morbilidad y mortalidad, si éstos son correctamente seleccionados en el contexto de una evaluación preoperatoria multidisciplinaria en centros de alto volumen.

Abstract: Background: Background: The significant increase in life expectancy among octogenarians in Chile has raised concerns about the efficacy and need of major cardiac surger in this population, even as 85% of them reach this age in favorable health conditions. Objectives: This study aimed to evaluate in-hospital and medium-term mortality and identify postoperative complications in octogenarian patients undergoing cardiac surgery in Chile. Methods: An observational retrospective study was conducted at Hospital Las Higueras de Talcahuano between January 2014 and December 2022, involving a sample of 79 patients. Results: 86% of procedures utilized extracorporeal circulation, and 84% were elective, predominantly coronary artery surgeries (54%). In-hospital mortality was 9%. Preoperative Intra-Aortic Balloon Pump use identified as a poor prognostic factor. Postoperative complications such as Atrial Fibrillation affected 17%, while only Pneumonia and Renal Failure significantly influenced mortality. Survival at 1, 3, and 5 years was 81%, 76%, and 73%, respectively. Conclusion: Cardiac surgery in octogenarians in Chile yields comparable outcomes to those worldwide, emphasizing the importance of individual assessment by a multidisciplinary team when considering major surgeries in frail patients. The use of minimally invasive techniques may enhance quality of life, although further studies with larger patient cohorts are needed to confirm this hypothesis.

Resumen: Introducción: El aumento significativo de la esperanza de vida en el grupo de octogenarios en Chile ha generado preocupación sobre la eficacia y la necesidad de cirugías cardíacas mayores en esta población incluso cuando el 85 % de ellos llega a dicha edad en condiciones de salud favorables. Objetivos: Este estudio se propuso evaluar la mortalidad hospitalaria y a mediano plazo, así como identificar complicaciones postoperatorias en pacientes octogenarios sometidos a cirugía cardíaca en Chile. Métodos: Se llevó a cabo un estudio observacional retrospectivo en el Hospital Las Higueras de Talcahuano entre enero de 2014 y diciembre de 2022, con una muestra de 79 pacientes. Resultados: Se encontró que el 86% de los procedimientos utilizaron circulación extracorpórea, y el 84% fueron electivos, principalmente cirugías coronarias (54%). La mortalidad intrahospitalaria fue 9%, con el uso preoperatorio de Balón Contrapulsación Intraaórtico identificado como un factor de mal pronóstico. Complicaciones postoperatorias como la Fibrilación Auricular afectaron al 17%, mientras que solo Neumonía y Falla Renal influyeron significativamente en la mortalidad. La supervivencia a 1, 3 y 5 años fue 81%, 76% y 73%, respectivamente. Conclusión: La cirugía cardíaca en octogenarios en Chile presenta resultados comparables a nivel mundial, destacando la importancia del análisis individual por un equipo multidisciplinario al considerar cirugías mayores en pacientes frágiles. El uso de técnicas mínimamente invasivas podría mejorar la calidad de vida, aunque se requieren estudios adicionales con más pacientes para confirmar esta hipótesis.

ABSTRACT BACKGROUND: Small bowel obstruction (SBO) is a major problem in emergencies. Comorbidities increase morbimortality, which is reflected in higher costs. There is a lack of Latin American evidence comparing the differences in postoperative results and costs associated with SBO management. AIMS: To compare the risk of surgical morbimortality and costs of SBO surgery treatment in patients older and younger than 80 years. METHODS: Retrospective analysis of patients diagnosed with SBO at the University of Chile Clinic Hospital from January 2014 to December 2017. Patients with any medical treatment were excluded. Parametric statistics were used (a 5% error was considered statistically significant, with a 95% confidence interval). RESULTS: A total of 218 patients were included, of which 18.8% aged 80 years and older. There were no differences in comorbidities between octogenarians and non-octogenarians. The most frequent etiologies were adhesions, hernias, and tumors. In octogenarian patients, there were significantly more complications (46.3 vs. 24.3%, p=0.007, p<0.050). There were no statistically significant differences in terms of surgical complications: 9.6% in <80 years and 14.6% in octogenarians (p=0.390, p>0.050). In medical complications, a statistically significant difference was evidenced with 22.5% in <80 years vs 39.0% in octogenarians (p=0.040, p<0.050). There were 20 reoperated patients: 30% octogenarians and 70% non-octogenarians without statistically significant differences (p=0.220, p>0.050). Regarding hospital stay, the average was significantly higher in octogenarians (17.4 vs. 11.0 days; p=0.005, p<0.050), and so were the costs, being USD 9,555 vs. USD 4,214 (p=0.013, p<0.050). CONCLUSIONS: Patients aged 80 years and older with surgical SBO treatment have a higher risk of medical complications, length of hospital stay, and associated costs compared to those younger.

RESUMO RACIONAL: A obstrução do intestino delgado (OID) é um grande problema em emergências. As comorbidades aumentam a morbimortalidade, o que se reflete no aumento dos custos. Há uma falta de evidência latino-americana comparando as diferenças nos resultados pós-operatórios e custos associados ao manejo da OID. OBJETIVOS: Comparar o risco de morbimortalidade cirúrgica e os custos de tratamento cirúrgico da OID em pacientes com idade inferior e superior a 80 anos. MÉTODOS: Análise retrospectiva de pacientes diagnosticados com OID no Hospital Clínico da Universidade do Chile entre janeiro de 2014 e dezembro de 2017. Pacientes com qualquer tratamento médico foram excluídos. Estatísticas paramétricas foram usadas: erro de 5% foi considerado estatisticamente significante, com intervalo de confiança de 95%. RESULTADOS: Um total de 218 pacientes foram incluídos, dos quais 18,8% tinham 80 anos ou mais. Não houve diferenças nas comorbidades entre octogenários e não octogenários. As etiologias mais frequentes foram aderências, hérnias e tumores. Nos pacientes octogenários houve significativamente mais complicações (46,3 vs. 24,3%, p=0,007, p<0,050). Não houve diferenças estatisticamente significativas quanto às complicações cirúrgicas: 9,6% em <80 anos e 14,6% em octogenários (p=0,390, p>0,050). Nas complicações médicas foi evidenciada diferença estatisticamente significativa com 22,5% em <80 anos vs. 39.0% em octogenários (p=0,040, p<0,050). Foram reoperados 20 pacientes: 30% octogenários e 70% não octogenários, sem diferenças estatisticamente significativas (p=0,220, p>0,050). Em relação ao tempo de internação, a média foi significativamente maior nos octogenários (17,4 v/s 11,0 dias; p=0,005, p<0,050). Da mesma forma, também foram os custos com 9.555 USD vs. 4.214 USD (p=0,013, p<0,050). CONCLUSÕES: Pacientes com 80 anos ou mais com tratamento cirúrgico de OID têm maior risco de complicações médicas, tempo de internação e custos associados em comparação aos mais jovens.

Resumo Depender de auxílio para a realização de atividades instrumentais da vida diária (AIVDs) na velhice revela robustas relações com vulnerabilidades ao bem-estar e riscos à saúde mental. O presente estudo examinou a formação de agrupamentos de pessoas idosas residentes na comunidade segundo o tipo de atividades instrumentais nas quais há dependência e o relato de sintomas depressivos particulares. Foram utilizados os dados dos 419 participantes (80+ 4,5 anos; 69,4% feminino) da coleta de seguimento do estudo FIBRA - Fragilidade em Idosos Brasileiros. A prevalência de dependência para AIVDs foi de 49,64% de 29,1% para depressão, segundo o escore total da GDS-15. Por meio de análise de cluster foram identificados quatro grupos de manifestação de dependência segundo o número, tipo de AIVD e associações com condições sociodemográficas, saúde, autonomia e controle percebidos. Análises de regressão multinomial identificaram diferenças nas razões de chance para um dos sintomas depressivos que compõem a GDS-15, após ajuste de variáveis. Em relação ao cluster funcionalmente preservado (cluster 1), itens representativos de rebaixamento em afetos positivos e disposição física (“anedonia”) foram mais prováveis no cluster 2. O cluster 3, com maiores dependências para AIVDs realizadas fora do domicílio, foi caracterizado por experiências de isolamento social. O Cluster 4, com maior número de tipos de dependências, apresentou maior probabilidade de apresentar sintomas depressivos centrais de depressão clínica. As evidências sugerem validade em especificar relações entre dependências e experiências emocionais as quais podem fazer parte dos planos de cuidado e políticas públicas em saúde e envelhecimento.

Abstract Depending on help to carry out instrumental activities of daily living (IADLs) in old age reveals robust relationships with vulnerabilities to well-being and risks to mental health. The present study examined the formation of groups of elderly people living in the community according to the type of instrumental activities in which there is dependence and the report of particular depressive symptoms. Data from 419 participants (80+ 4.5 years old; 69.4% female) from the follow-up collection of the FIBRA study - Frailty in Brazilian Elderly people were used. The prevalence of dependence for IADLs was 49.64% of 29.1% for depression, according to the total GDS-15 score. Through cluster analysis, four groups of manifestation of dependence were identified according to the number, type of IADL, and associations with sociodemographic conditions, health, perceived autonomy, and control. Multinomial regression analyzes identified differences in odds ratios for one of the depressive symptoms that make up the GDS-15, after adjusting variables. Regarding the functionally preserved cluster (cluster 1), items representative of downgrading in positive affects and physical disposition (“anhedonia”) were more likely in cluster 2. Cluster 3, with greater dependencies for IADLs performed outside the home, was characterized by experiences of social isolation. Cluster 4, with the highest number of types of addictions, was more likely to have central depressive symptoms of clinical depression. The evidence suggests validity in specifying relationships between addictions and emotional experiences which may be part of care plans and public policies in health and aging.

Resumen Objetivo: Comparar los resultados inmediatos y a largo plazo de la reparación endovascular del aneurisma de aorta abdominal (REVA) entre pacientes menores de 80 años y octogenarios. Método: Cohorte retrospectiva que incluyó pacientes con aneurisma de aorta abdominal (AAA) sometidos a REVA electiva desde 2011 hasta 2017. Se evaluaron como punto finales primarios la mortalidad hospitalaria, la duración de la estadía hospitalaria, la incidencia de insuficiencia renal aguda y el requerimiento de reintervenciones. Los puntos finales secundarios incluyeron la mortalidad asociada al aneurisma, infarto agudo de miocardio, accidente cerebrovascular, isquemia arterial aguda de las extremidades y ventilación mecánica prolongada. Resultados: Se incluyeron 77 (62.6%) pacientes menores de 80 años y 46 (37.4%) octogenarios. La prevalencia de sexo masculino y el diámetro del AAA no difirieron entre ambos grupos (92.2% vs. 82.6%, p = 0.11 y 5.4 cm [4.9-6.2 cm] vs. 5.4 cm [5-6 cm], p = 0.53, respectivamente). Los pacientes más jóvenes presentaron una mayor prevalencia de tabaquismo (72.7% vs. 41.7%, p = 0.01). No se registraron muertes durante la hospitalización índice. La incidencia de reintervenciones (5.3% vs. 15.2%, p = 0.11) e insuficiencia renal aguda (14.3% vs. 23.9%, p = 0.18) no difirieron entre ambos grupos, pero la estadía hospitalaria fue más prolongada en pacientes octogenarios (3 días [2-4 días] vs. 2 días [2-3 días], p = 0.04). La causa más frecuente de reintervenciones fue la presencia de endofugas (81.8%), con una prevalencia del 34% en toda la cohorte. No se observaron diferencias en ninguno de los puntos finales secundarios entre ambos grupos. Conclusión: En pacientes octogenarios con AAA, la REVA presentó un buen perfil de seguridad perioperatorio y a largo plazo.

Abstract Objective: The aim of the study was to compare the immediate and long-term outcomes of endovascular aneurysm repair (EVAR) between patients under and over the age of 80 with abdominal aortic aneurysm (AAA). Methods: From 2011 to 2017, we conducted a retrospective cohort study with AAA patients who received elective EVAR. Primary outcomes included hospital mortality, length of stay, acute kidney injury, and the need for re-interventions. Secondary outcomes included aneurysm-related mortality, acute myocardial infarction, stroke, acute limb ischemia, and prolonged mechanical ventilation. Results: A total of 77 (62.6%) patients under the age of 80 years old and 46 (37.4%) octogenarians were included in the study. The male gender and AAA diameter did not differ among groups (92.2% vs. 82.6%, p = 0.11 and 5.4 cm [4.9-6.2 cm] vs. 5.4 cm [5-6 cm], p = 0.53, respectively). The younger patients had a higher prevalence of tobacco use (72.7% vs. 41.7%, p = 0.01). There were no deaths during the index hospitalization. The incidence of reinterventions (5.3% vs. 15.2%, p = 0.11) and acute kidney injury (14.3% vs. 23.9%, p = 0.18) did not differ between groups, but the length of stay was longer for octogenarian patients (3 days [2-4] vs. 2 days [2-3, p = 0.04]). Endoleaks were the most common cause for re-interventions (81.8%), with a prevalence of 34% across the entire cohort. There were no differences in any of the secondary outcomes between groups. Conclusion: In octogenarian patients with AAA, EVAR represents a safe procedure both during the index hospitalization and during long-term follow-up.

Resumen Introducción: En las últimas dos décadas, el avance del tratamiento percutáneo del síndrome coronario agudo ha disminuido su mortalidad, siendo la angioplastia coronaria el tratamiento de elección. Dicha terapia representa un reto en pacientes de edad avanzada, debido al riesgo de complicaciones y la mayor prevalencia de comorbilidades asociadas. Objetivo: Evaluar el perfil clínico basal y la evolución clínica luego de seis meses posprocedimiento de pacientes de 85 años o mayores, sometidos a revascularización coronaria percutánea por síndrome coronario agudo en un servicio de Hemodinamia en los últimos tres años. Materiales y método: Estudio “all-comers”, en el que se incluyeron todos los pacientes de 85 años o más, tratados con angioplastia primaria. Resultados: Se incluyeron 20 pacientes con edad promedio de 90.3 años, 55% de sexo femenino. Como comorbilidades se presentaron: hipertensión arterial (80%) e hiperlipidemia (58%). Al momento de la intervención, el 40% de los pacientes tenía diagnóstico de síndrome coronario agudo con elevación del ST. Se realizó abordaje radial en el 70% y reperfusión exitosa en el 90%. Se presentaron 4 casos de hematomas no complicados en el sitio de punción. La mortalidad en el seguimiento a seis meses fue de 0%. Conclusión: La angioplastia coronaria percutánea es un procedimiento factible, eficaz y con bajo riesgo de complicaciones en adultos mayores de 85 años con síndrome coronario agudo.

Abstract Introduction: In the last two decades, advances in the percutaneous treatment of acute coronary syndrome have led to a reduction on its mortality, positioning percutaneous coronary intervention as the treatment of choice. The percutaneous coronary intervention is a challenging procedure due to its higher risk of related complications and the prevalence of multiple comorbidities. Objective: To evaluate the baseline profile and clinical outcomes over 6 months of follow-up post-percutaneous coronary intervention in patients older than 85 years-old submitted in the last three years to in-hospital coronary revascularization. Materials and method: This is an “all-comers” registry including patients ≥ 85 years-old treated with PCI in the last three years due to acute coronary syndrome. Results: We included 20 patients with a mean age of 90.3 years; of them, 55% female. The main comorbidities were: arterial hypertension (80%) and hyperlipidemia (58%). At the time of the intervention, 40% of the patients were diagnosed with ST-elevation coronary syndrome. Transradial percutaneous coronary intervention was performed on 70%, with successful target vessel revascularization in 90% of patients. There were 4 non-complicated vascular access-related bruises. Mortality was 0% over 6-months of follow-up. Conclusion: Percutaneous coronary intervention is a feasible and effective procedure with low rates of complications in patients over 85 years of age with diagnosis of acute coronary syndrome.

Resumen El presente artículo expone la manera en la cual pastos africanos y variedades de ganado vacuno provenientes de la India modificaron el uso del suelo de la periferia costarricense, específicamente en los cantones de Mora y Puriscal. Resulta clave para las primeras décadas del siglo XX la expansión en estas zonas de una gramínea particular llamada Calinguero -Me-linis multiflora- impulsada por la Revista de la Escuela Nacional de Agricultura, un medio de divulgación científica. En la reconstrucción de estas transformaciones productivas al igual que en los efectos en el paisaje de estos dos cantones se utilizaron fuentes primarias tales como documentos de archivo, publicaciones de la época y entrevistas a agricultores y vaqueros octogenarios de ambos cantones; así como fuentes secundarias que permiten entender este acápite de la historia ambiental de este país centroamericano, específicamente en regiones no cafetaleras dedicadas a la producción de alimentos. Finalmente, la selección de los pastos sembrados fue realizada entre variedades que provenían de latitudes tropicales incluidas en rutas comerciales organizadas por los europeos. Así, los pastos dominaron sobre otras especies y demás superficies productivas, constatándose una simplificación ecológica más acentuada que la ocurrida en los agroecosistemas tales como el policultivo y el cafetal.

Abstract This article describes how African grasses and cattle varieties from India modified land use of peripheral zones in Costa Rica, specifically in the cantons of Mora and Puriscal. During the early decades of the 20th century, the expansion of a particular grass called Calinguero -Melinis multiflora in these areas was of key relevance, as promoted by Revista de la Escuela Nacional de Agricultura, a scientific dissemination publication. To reconstruct these production transformations and their effects on the landscape in these two cantons, we used primary sources such as archival documents, publications of the time, and interviews with farmers and octogenarian stockbreeders of both cantons; additionally, we used secondary sources that allow us to understand this part of the environmental history of this Central American country, specifically regarding non-coffee regions engaged in food production. Finally, the selection of the grasses sown consisted of varieties from tropical latitudes included in the commercial routes organized by the Europeans. Thus, grasses were predominant over other species and other production surfaces, evidencing an ecological simplification that was more marked than the one that took place in agroecosystems such as polycultures and coffee plantations.

Resumo Este artigo expõe a forma como as gramíneas africanas e variedades de gado nativas da Índia modificaram o uso da terra na periferia costarriquenha, especificamente nos municípios de Mora e Puriscal. Em particular, destaca nas primeiras décadas do século XX a expansão nessas áreas de uma determinada gramínea chamada Calinguero -Melinis multiflora- promovida pela Revista da Escola Nacional de Agricultura, um meio de divulgação científica. Na reconstrução dessas transformações produtivas, bem como nos efeitos na paisagem desses dois municípios, foram utilizadas fontes primárias como documentos de arquivo, publicações da época e entrevistas com agricultores e vaqueiros octogenários de ambos os municípios; assim como fontes secundárias que nos permitem compreender esta parte da história ambiental do país centro-americano, especificamente em regiões não cafeeiras dedicadas à produção de alimentos. Por fim, a seleção das gramíneas plantadas foi feita entre variedades provenientes de latitudes tropicais incluídas nas rotas comerciais organizadas pelos europeus. Assim, as pastagens dominaram outras espécies e outras superfícies produtivas, verificando uma simplificação ecológica mais acentuada do que a ocorrida em agroecossistemas como a policultura e os cafezais.

RESUMEN Introducción: La edad representa uno de los mayores predictores de riesgo de complicaciones cardiovasculares en pacientes con síndrome coronario agudo. La prevalencia de este síndrome en el grupo de los pacientes octogenarios es elevada. Métodos: Estudio prospectivo de cohortes analítico de todos los pacientes ingresados en la unidad de cuidados coronarios intensivos del Hospital Universitario “Comandante Manuel Fajardo” de la Habana, entre el año 2016 y el 2020. Objetivo: Caracterizar la población de pacientes octogenarios con síndrome coronario agudo y las posibles asociaciones entre la ocurrencia de complicaciones intrahospitalarias no letales y los factores de riesgo cardiovasculares. Resultados: Prevaleció el sexo femenino (64,2 %), los antecedentes de hipertensión arterial (89,7 %), cardiopatía isquémica (66,7 %), y el tabaquismo (32 %). Se encontraron asociaciones estadísticas significativas entre el tipo de síndrome coronario agudo y la presencia de complicaciones cardiovasculares de cualquier tipo (p=0,006); el aumento de la creatinina se asoció con la presencia de complicaciones hemodinámicas (Mdn=97; Rango=97,52; p=0,012), así como también la fracción de eyección del ventrículo izquierdo mostró una asociación muy significativa con la presencia de complicaciones cardiovasculares de cualquier tipo (Mdn=59; Rango=63,3; p<0,001) y hemodinámicas (Rango=55,2; p<0,001). Conclusiones: Se caracterizó la población de pacientes octogenarios con síndrome coronario agudo con elevación del segmento ST se asoció con un aumento de las complicaciones cardiovasculares intrahospitalarias, de la misma manera que sucedió con el valor de la fracción de eyección del ventrículo izquierdo.

ABSTRACT Introduction: Age represents one of the greatest predictors of risk of cardiovascular complications in patients with acute coronary syndrome. The prevalence of this syndrome in the group of octogenarian patients is high. Objective: To characterize the population of octogenarian patients with acute coronary syndrome and the possible associations between the occurrence of non-lethal intrahospital complications and cardiovascular risk factors. Methods: This is a prospective analytical cohort study of all patients admitted to the intensive coronary care unit of Manuel Fajardo University Hospital in Havana, from 2016 to 2020. Results: The female sex (64.2%), a history of arterial hypertension (89.7%), ischemic heart disease (66.7%), and smoking habits (32%) outweighed. Significant statistical associations were found between the type of acute coronary syndrome and the presence of cardiovascular complications of any type (p=0.006); the increase in creatinine was associated with the presence of hemodynamic complications (Mdn=97; Range=97.52; p=0.012), as well as the left ventricular ejection fraction showed a highly significant association with the presence of cardiovascular complications of any type (Mdn=59; Range=63.3; p<0.001) and hemodynamic (Range=55.2; p<0.001). Conclusions: The octogenarian population of patients with ST-segment elevation acute coronary syndrome was characterized and was associated with an increase in in-hospital cardiovascular complications, in the same way that it happened with the value of the left ventricular ejection fraction.

RESUMEN El objetivo de la presente investigación es evaluar la asociación entre la edad octogenaria y la tasa de morbimortalidad posoperatoria y supervivencia a los 5 años en adultos mayores tratados mediante gastrectomía R0 D2 en el Instituto Nacional de Enfermedades Neoplásicas (INEN) durante el periodo 2000-2013. Se realizó un estudio observacional, retrospectivo, analítico de cohorte pareado, que incluye pacientes con diagnóstico de adenocarcinoma gástrico tratados mediante gastrectomía R0 D2 en el INEN durante los años 2000 a 2013. Un grupo compuesto por todos los pacientes octogenarios que cumplieron los criterios de inclusión (92) y otro grupo compuesto por pacientes no octogenarios, con edades entre 50 a 70 años por ser el pico de presentación para esta patología (276). En una proporción 1:3, pareados según sexo, estadio tumoral y tipo de gastrectomía, los cuales constituyen los principales factores que podrían influir en la sobrevida de esta población. Los octogenarios presentaron menor albúmina (p<0,002), menor hemoglobina preoperatoria (p<0,001) y mayor clase ASA (p<0,001). La tasa de mortalidad a 30 días fue mayor en los octogenarios, pero no estadísticamente significativa (4,1% vs 1,4%; p=0,099). La probabilidad acumulada de supervivencia a 5 años fue 56% para octogenarios y 58% para los controles (p=0,763). El estadio clínico ≥ III y complicación posoperatoria grado ≥3 por Clavien Dindo fueron factores asociados de supervivencia. En conclusión, los octogenarios presentan mayor tasa de morbilidad posoperatoria, principalmente de causa respiratoria. Las tasas de mortalidad posoperatoria y supervivencia global no difieren entre octogenarios y no octogenarios con cáncer de estómago tratados mediante gastrectomía R0 D2.

ABSTRACT The objective was to evaluate the association between octogenarian age and the rate of postoperative morbidity and mortality and 5-year survival in older adults at the National Institute of Neoplastic Diseases (INEN) during the period 2000-2013. We developed an observational, retrospective, analytical, paired cohort study. It includes patients with gastric adenocarcinoma as diagnosis, treated by R0 D2 gastrectomy at INEN during the period 2000 to 2013. One group included all octogenarian patients who met the inclusion criteria (92) and the other group made up of non-octogenarian patients, aged between 50 to 70 years because it is the age peak for this pathology (276). In a 1:3 ratio, paired according to sex, tumor stage, and type of gastrectomy, which are the main factors that could influence survival in this population. Octogenarians had lower albumin level (p<0.002), lower preoperative hemoglobin (p<0.001) and higher ASA classification (p<0.001). 30 days mortality rate was higher in octogenarians but not statistically significant (4.1% vs 1.4%; p=0.099). The 5-year cumulative survival probability was 56% for octogenarians and 58% for non- octogenarians (p=0.763). Clinical stage ≥ III and postoperative complication grade ≥ 3 by Clavien Dindo scale were predictors of survival. In conclusion, octogenarians have a higher rate of postoperative morbidity, mainly for respiratory causes. Postoperative mortality and overall survival rates do not differ between octogenarians and non-octogenarians with stomach cancer treated by R0 D2 gastrectomy.

Resumen Objetivo: Validar el uso de la clasificación de Killip- Kimball como predictor de desenlaces en una cohorte de pacientes octogenarios con síndrome coronario agudo. Métodos: Se realizó un análisis retrospectivo de pacientes sometidos a cateterismo por síndrome coronario agudo (ACS). Se incluyeron infarto al miocardio con y sin elevación del segment ST, así como angina inestable, utilizando las definiciones de la American Heart Association (AHA). Se determinaron los factores que influyeron en la clasificación de Killip-Kimball (KC) al momento de ingreso al hospital. Se comparó la mortalidad, la estancia intrahospitalaria y otros desenlaces, dividiendo a los pacientes por su KC. Resultados: Un total de 133 pacientes se incluyeron en el análisis y se clasificaron dependiendo de su KC (I-IV). Cada grupo incluyó 86, 9, 23 y 15 pacientes, respectivamente. La edad media fue de 83 años. La mortalidad intrahospitalaria fue de 5, 11, 22 y 40%, respectivamente para cada KC, y 12% global. Hubo una diferencia significativa en la mortalidad por clase (p = 0.002). Adicionalmente, se encontró que a mayor KC, mayor riesgo de lesión renal aguda durante la hospitalización (p < 0.01). Conclusión: A pesar de una reducción en la mortalidad de adultos mayores con ACS en décadas recients, pacientes con ACS y mayor KC tienen riesgo aumentado de morir, igual que pacientes en grupos de edad menores. La KC continñua siendo una herramienta confiable para la clasificación y con utilidad pronóstica, con aplicabilidad en pacientes mayores de 80 años.

Abstract Objective: The objective of the study is to validate the use of the Killip-Kimball classification (KC) as a predictor of outcomes in an octogenarian cohort with acute coronary syndrome. Methods: A retrospective analysis of patients who underwent a catheterization procedure for acute coronary syndrome (ACS) was performed. ACS was defined as per the American Heart Association guidelines, and included ST-elevation myocardial infarction (STEMI), non-STEMI and Unstable Angina. We determined factors associated with the KC upon admission to the emergency room. Likewise, we compared in-hospital mortality, length of stay, and other outcomes dividing the patients by KC. Results: A total of 133 patients with a mean age of 83 years were analyzed and assigned a KC from 1 to 4 according to clinical presentation. Each group included 86, 9, 23, and 15 patients, respectively. In-hospital mortality was 12%, 5% in KC-I, 11% in KC-II, 22% in KC-III, and 40% in KC-IV with a significant difference between classes (p = 0.002). In addition, we found higher KC groups to be associated with acute kidney injury during the hospitalization (p < 0.01). Conclusion: Despite a strong reduction in mortality for elderly patients with ACS in recent decades, patients presenting with ACS and higher KC have a high mortality rate, as described in younger cohorts. KC remains a reliable prognostic tool, with applicability in octogenarian patients.

Resumo Objetivo O objetivo do presente estudo foi comparar os resultados funcionais após a substituição do Calcar cimentado em comparação com a hemiartroplastia cimentada de haste longa em pacientes com mais de 80 anos com fratura intertrocantérica instável. Métodos O presente estudo prospectivo e randomizado incluiu 140 pacientes com fratura de fêmur intertrocantérica, conforme classificação AO/OTA tipo 31-A2, A3, randomizados em 2 grupos de tratamento e acompanhados por um período mínimo de 2 anos. Sessenta e sete pacientes do grupo A foram tratados com uma prótese de substituição do calcar cimentada e 65 pacientes do grupo B foram tratados com uma prótese femoral de haste longa cimentada. Os desfechos primários foram as funções do quadril em 2 anos. Os eventos secundários foram as complicações encontradas, a mortalidade, o tempo cirúrgico, segunda cirurgia, perda de sangue e as atividades do cotidiano. Resultados Não houve grandes diferenças entre os grupos em termos de função do quadril, qualidade de vida (relacionada à saúde), segunda cirurgia, mortalidade e perda de sangue. No entanto, a função da articulação do quadril e as atividades da vida diária se deterioraram em ambos os grupos em comparação com os níveis pré-fratura. Conclusão Nos octogenários com fratura intertrocantérica instável, a prótese de substituição do calcar cimentada apresentou resultados clínicos semelhantes em comparação com a hemiartroplastia de haste longa cimentada. A hemiartroplastia comqualquer umdos implantes é uma boa opção nesse subgrupo de pacientes. Nível de evidência: I

Abstract Objective The aim of the present study was to compare functional results after Cemented Calcar replacement vis-a-vis Long stem Cemented hemiarthroplasty in patients aged more than 80 years with unstable intertrochanteric fractures. Methods The present prospective, randomized trial included 140 patients with AO/OTA type 31-A2, A3 intertrochanteric femur fracture, randomized into 2 treatment groups and followed-up for a minimum of 2 years. Sixty-seven patients in group A were treated with a cemented calcar replacing prosthesis, and 65 patients in group B were treated with a cemented long stem femoral stem prosthesis. The primary end points were hip functions at 2 years. The secondary end points were the complications encountered, mortality, surgical time, reoperation, blood loss, and activities of daily living. Results There were no major differences between the groups in terms of hip function, quality of life (health related), reoperation, mortality, and blood loss. However, the function in hip joint and activities of daily living deteriorated in both groups in comparison with prefracture levels. Conclusion In octogenarians with an unstable intertrochanteric fracture, cemented calcar replacing prosthesis has similar clinical results in comparison with long stem cemented hemiarthroplasty. Hemiarthroplasty with either implant is a good option in this subset of patients. Level of evidence: I

Resumen Objetivo: Describir las características clínicas y los resultados operatorios y a siete años del reemplazo valvular aórtico en una cohorte de pacientes mayores de 80 años. Materiales y métodos: Estudio descriptivo retrospectivo de 75 pacientes consecutivos mayores de 80 años, intervenidos de reemplazo valvular aórtico exclusivo entre 2007 y 2019 en el Hospital Guillermo Grant Benavente. Se estudian sus características demográficas, clínicas, ecocardiográficas, riesgo operatorio, cirugías, complicaciones y mortalidad operatoria y supervivencia alejada hasta el 15 de marzo 2021. Resultados: La edad media de la cohorte fue 83,05 ± 2,9 años (rango 80-95) y 43 pacientes eran mujeres (57,3%). La lesión valvular predominante fue la estenosis aórtica (89,3%). 10 pacientes tenían enfermedad coronaria asociada (13,3%) y 2 endocarditis activa. El riesgo de mortalidad operatoria calculado por EuroSCORE aditivo, logístico, II y STS score fue 7,58 ± 1,8; 9,88 ± 6,5%; 3,72 ± 3,5% y 4,27 ± 3,2%, respectivamente. Se utilizó prótesis biológica en 70 (92%) pacientes. Hubo 29 complicaciones operatorias y fallecieron 11 (14,7%) pacientes. El seguimiento promedio fue 7,1 años (rango 2-14), durante el cual fallecen 28 pacientes. La supervivencia a uno, tres y cinco años fue 82, 76, 66 y 48% respectivamente. Conclusiones: La cirugía de reemplazo valvular aórtico en octogenarios en nuestro medio es un procedimiento poco frecuente. La mortalidad observada fue mayor que la estimada por las escalas de riesgo. El reemplazo valvular quirúrgico es una alternativa de tratamiento de la enfermedad de la válvula aórtica en pacientes seleccionados. Se deben evaluar estrategias para mejorar los resultados.

Abstract Objective: To describe the clinical characteristics and operative and 7-year results of aortic valve replacement in a cohort of patients older than 80 years. Materials and methods: Retrospective descriptive study of 75 consecutive patients older than 80 years of age who underwent exclusive aortic valve replacement between 2007 and 2019 at the Guillermo Grant Benavente Hospital. Demographic, clinical, echocardiographic characteristics, operative risk, surgeries, complications and operative mortality and long-term survival until March 15, 2021 are studied. Results: The mean age of the cohort was 83.05 ± 2.9 years (range 80-95) and 43 patients were women (57.3%). The predominant valve lesion was aortic stenosis (89.3%). Ten patients had an associated coronary artery disease (13.3%) and 2 had active endocarditis. The risk of operative mortality calculated by EuroSCORE additive, logistic, II and STS score was 7.58 ± 1.8; 9.88 ± 6.5%; 3.72 ± 3.5% and 4.27 ± 3.2%, respectively. A biological prosthesis was used in 70 (92%) patients. There were 31 operative complications and 11 (14.7%) patients died. The mean follow-up was 7.1 years (range 2-14), during which 28 patients died. Survival at 1, 3, and 5 years was 82, 76, 66 and 48%, respectively. Conclusions: Aortic valve replacement surgery in octogenarians in our setting is a rare procedure. The observed mortality was higher than that estimated by the risk scales. Surgical valve replacement is an alternative treatment for aortic valve disease in selected patients. Strategies to improve results should be evaluated.

Aim: To compare diagnostic yield of significant findings rate and safety of screening colonoscopies in two groups of elderly patients. Materials and Method: A retrospective analysis was performed on patients who underwent screening colonoscopies at INDISA Clinic, from November 2017 to March 2019. Exclusion criteria were those with “alarm” symptoms according to Rome IV criteria, emergencies and therapeutic colonoscopies were excluded. Comparison groups were patients between 70-79 years old (Grupo I), and those over 80 years old (Grupo II). The primary outcome was the diagnostic yield of screening colonoscopy, defined as its capacity to identify adenomas, high-grade dysplasia, and colorectal cancer. Secondary outcomes were morbidity and mortality of the procedure. Statistical analysis was descriptive and inferential. Results: A total of 125 patients met our inclusion criteria; Grupo I: 70 and Grupo II 55 patients. Significant findings were observed in 27.1% in Grupo I and 30.9% in Grupo II (p = 0.675). No differences in bowel prep quality or procedure-related complications were observed between both groups. Discussion and Conclusion: Screening colonoscopies for colorectal cancer are well tolerated in patients over 80 years of age, with equivalent diagnostic rates compared with the younger patient group. Given the increasing life expectancy worldwide, it is recommended to continue checking for colorectal cancer with screening colonoscopies in octogenarians, particularly healthy ones.

Resumen Objetivo: Comparar el rendimiento y seguridad de las colonoscopías de screening en el diagnóstico del cáncer colorrectal en dos grupos de pacientes añosos. Materiales y Método: Un análisis retrospectivo de pacientes sometidos a colonoscopías de screening en Clínica INDISA, desde noviembre de 2017 hasta marzo de 2019. Se excluyeron pacientes con síntomas de alarma según criterios de Roma IV, colonoscopías de urgencia y terapéuticas. Se compararon 2 grupos de pacientes: Grupo I entre 70-79 años y Grupo II mayores de 80 años. El objetivo primario fue el rendimiento diagnóstico de la colonoscopía de screening, definida como su capacidad para identificar hallazgos significativos definidos como la presencia de adenomas, displasia de alto grado y cáncer colorrectal. Los resultados secundarios consideraron la morbilidad y mortalidad del procedimiento. Análisis estadístico descriptivo e inferencial. Resultados: Un total de 125 pacientes cumplieron con los criterios de inclusión; Grupo I: 70 pacientes y Grupo II: 55 pacientes. Los hallazgos significativos se presentaron en un 27,1% en el Grupo I y en 30,9% en el Grupo II (p = 0,675). No se observaron diferencias en la calidad de la preparación intestinal o las complicaciones relacionadas con el procedimiento. Discusión y Conclusión: Las colonoscopías de screening en el diagnóstico de cáncer colorrectal son bien toleradas en pacientes mayores de 80 años, con un rendimiento equivalente en comparación al grupo más joven. Dado el aumento de la esperanza de vida, se recomienda realizar colonoscopías en octogenarios, especialmente en aquellos con buen estado de salud.