Reparación robótica de la válvula mitral Sandoval, Elena; Pereda, Daniel
Cirugía cardiovascular,
October 2022, 2022-10-00, 2022-10-01, Volume:
29
Journal Article
Peer reviewed
Open access
En esta revisión presentamos una introducción a la cirugía de reparación robótica de la válvula mitral, sus indicaciones y contraindicaciones, y una visión detallada de la técnica quirúrgica que ...utilizamos. Además, queremos también compartir nuestra experiencia inicial, que actualmente se aproxima al centenar de casos. Finalmente, hemos buscado resumir el desarrollo de esta tecnología en cirugía cardíaca y la evidencia acumulada hasta ahora, aportando nuestra visión sobre este fascinante campo de la especialidad.
In this review, we present an introduction to robotic mitral repair surgery, its indications and contraindications, and a detailed description of our surgical technique. In addition, we wish to share our initial experience, now approaching a hundred cases. Finally, we also wanted to summarize the evolution of this technology in cardiac surgery and the evidence available, sharing our view on this fascinating field of our specialty.
Most studies on autism spectrum disorder (ASD) risk factors have been conducted in developed countries where ethnicity and environment are different than in developing countries. We compared ...nutritional status, immune response and microbiota composition in mestizo children with ASD with matched controls in Ecuador. Twenty-five cases and 35 controls were matched by age, sex and school location. The prevalence of under- and overweight was higher in children with ASD. Nutritional differences were accompanied by abnormal food habits and more frequent gastrointestinal symptoms in children with ASD. Also, greater serum concentrations of TGF-β1 were observed in children with ASD. Finally, there was greater alpha diversity and abundance of Bacteroides (2 OTUs), Akkermansia, Coprococcus and different species of Ruminococcus in ASD children.
Abstract Objective Ventricular reconditioning and device weaning in select patients with continuous-flow left ventricular assist devices (CF LVADs) has been shown to be feasible. However, little is ...known regarding the outcomes associated with different surgical methods of device removal. We examined the effect of surgical explantation approach on early and late outcomes. Methods We retrospectively reviewed data from all patients who underwent successful ventricular weaning and CF LVAD explantation at our center. Patients were stratified by surgical approach. Descriptive univariate statistics, multivariate regression, and survival analyses were performed. Patients were censored by transplant, device reimplantation, or end of follow-up. Results Twenty-seven patients were identified who underwent successful removal of a CF LVAD (25 HeartMate II, 2 HeartWare) after 532 ± 424 days of support (range, 42-1937 days). Four approaches were used that vary primarily in the degree of retained pump material: complete pump removal with plug ventriculotomy closure (n = 13; 48%), pump housing explant with ligation of the inflow and outflow grafts (n = 7; 26%), ligation of the outflow graft and driveline transection (n = 5; 19%), and driveline transection alone (n = 2; 7%). Mean overall postexplant survival was 1286 ± 947 days (range, 143-3072 days). Overall time-to-event and survival analyses showed no significant association between surgical approach and postoperative length of stay ( P = .7), stroke ( P = .12), reoperation ( P = .4), or survival ( P = .12). Conclusions For patients who receive device therapy, pump deactivation and removal represents a favorable outcome. All methods are feasible and produce similar early and late survival and clinical outcomes.
Background
Robotic mitral repair is generally performed with four intercostal trocars and a minithoracotomy. We describe our technique and results with a totally-thoracoscopic closed chest approach ...using a 12 mm valveless trocar as “working port”, without a minithoracotomy. We compared our results with this technique with a control group of robotic mitral repairs performed earlier with a minithoracotomy.
Methods
Review of all patients with degenerative mitral valve disease who underwent robotic mitral valve repair surgery since December 2019 (
n
= 110). Patients with concomitant procedures (
n
= 8) were excluded. The remaining 102 patients were divided in two groups, depending on the approach used, minithoracotomy (
n
= 63) and totally thoracoscopic (
n
= 39).
Results
There were no significant differences between groups regarding preoperative characteristics. All procedures were completed robotically as planned, and repair rate was 100%. The minithoracotomy group showed a higher percentage of leaflet resections (17.9% vs. 38.7%;
p
= 0.03). All surgical times were significatively reduced in the totally thoracoscopic group: Cardiopulmonary bypass (97 vs. 115 min,
p
= 0.0008), ischemic time (67 vs. 80 min,
p
= 0.0013) and total surgical time (185 vs. 225 min;
p
< 0.00001). There were no differences in ICU length of stay (1 day,
p
= 0.07) but hospital length of stay was shorter in the totally thoracoscopic group (4 days;
p
= 0.0001). Postoperative complications were similar between groups. MR at discharge was mild or less in all cases.
Conclusions
Robotic mitral repair for degenerative disease can be safely performed as a closed-chest procedure, using a 12 mm trocar as “working port” and avoiding the need for a minithoracotomy. This approach does not seem to negatively affect the quality of the procedure by any measure, providing similar excellent clinical outcomes and repair rate. All surgical times were shorter in the closed-chest group.
Abstract
Aims
Our objectives were to compare effectiveness and long-term prognosis after epicardial thoracoscopic atrial fibrillation (AF) ablation vs. endocardial catheter ablation, in patients with ...prior failed catheter ablation or high risk of failure.
Methods and results
Patients were randomized to thoracoscopic or catheter ablation, consisting of pulmonary vein isolation with optional additional lines (2007–2010). Patients were reassessed in 2016/2017, and those without documented AF recurrence underwent 7-day ambulatory electrocardiography. The primary rhythm outcome was recurrence of any atrial arrhythmia lasting >30 s. The primary clinical endpoint was a composite of death, myocardial infarction, or cerebrovascular event, analysed with adjusted Cox proportional hazard ratios (HRs). One hundred and 24 patients were randomized with 34% persistent AF and mean age 56 years. Arrhythmia recurrence was common at mean follow-up of 7.0 years, but substantially lower with thoracoscopic ablation: 34/61 (56%) compared with 55/63 (87%) with catheter ablation adjusted HR 0.40, 95% confidence interval (CI) 0.25–0.64; P < 0.001. Additional ablation procedures were performed in 8 patients (13%) compared with 31 (49%), respectively (P < 0.001). Eleven patients (19%) were on anti-arrhythmic drugs at end of follow-up with thoracoscopy vs. 24 (39%) with catheter ablation (P = 0.012). There was no difference in the composite clinical outcome: 9 patients (15%) in the thoracoscopy arm vs. 10 patients (16%) with catheter ablation (HR 1.11, 95% CI 0.40–3.10; P = 0.84). Pacemaker implantation was required in 6 patients (10%) undergoing thoracoscopy and 3 (5%) in the catheter group (P = 0.27).
Conclusion
Thoracoscopic AF ablation demonstrated more consistent maintenance of sinus rhythm than catheter ablation, with similar long-term clinical event rates.
Background
Glyphosate is one of the most commonly used pesticides in agricultural activities worldwide. For the last 20 years, its use has increased rapidly becoming a public health concern. The IARC ...classified glyphosate as probably carcinogenic; however, the reported evidence is not enough to establish a statement.
Objective
This work aimed to measure glyphosate levels in the urine of children from a single rural community in an endemic region of chronic kidney disease and malnutrition.
Methods
A cross-sectional study was carried out in a rural community in western Mexico. The study included 95 children between the ages of 6 and 16. A urine sample (first-morning spot) was obtained from children and processed to measure glyphosate levels using high-performance liquid chromatography coupled with tandem mass spectrometry.
Results
All samples tested positive for glyphosate levels. Urine glyphosate levels were related to the season and the age of the children.
Conclusion
Glyphosate is present in children of all ages in the community even if they were not in direct contact with it. No toxicity cases were reported, nor were there other health problems related to glyphosate. However, more long-term studies should be done that provide a statement regarding the harmful effects that glyphosate has on public health.
Glutathione (GSH) biosynthesis is essential for cellular redox homeostasis and antioxidant defense. The rate-limiting step requires glutamate-cysteine ligase (GCL), which is composed of the catalytic ...(GCLc) and the modulatory (GCLm) subunits. To evaluate the contribution of GCLc to endothelial function we generated an endothelial-specific Gclc haplo-insufficient mouse model (Gclc e/+ mice). In murine lung endothelial cells (MLEC) derived from these mice we observed a 50% reduction in GCLc levels compared to lung fibroblasts from the same mice. MLEC obtained from haplo-insufficient mice showed significant reduction in GSH levels as well as increased basal and stimulated ROS levels, reduced phosphorylation of eNOS (Ser 1177) and increased eNOS S-glutathionylation, compared to MLEC from wild type (WT) mice. Studies in mesenteric arteries demonstrated impaired endothelium-dependent vasodilation in Gclc(e/+) male mice, which was corrected by pre-incubation with GSH-ethyl-ester and BH4. To study the contribution of endothelial GSH synthesis to renal fibrosis we employed the unilateral ureteral obstruction model in WT and Gclc(e/+) mice. We observed that obstructed kidneys from Gclc(e/+) mice exhibited increased deposition of fibrotic markers and reduced Nrf2 levels. We conclude that the preservation of endothelial GSH biosynthesis is not only critical for endothelial function but also in anti-fibrotic responses.
Specific endothelial reduction of GSH synthesis increases basal and stimulated ROS levels, reduces phosphorylation of eNOS (Ser 1177) and increases eNOS S-glutathionylation, impairing endothelium-dependent vasodilation and promoting renal fibrosis following UUO. Display omitted
•Endothelial haplo-insufficiency of GCLc increases basal and stimulated ROS levels.•Decreased endothelial GSH promotes eNOS S-glutathionylation.•Endothelial GSH reduction impairs endothelium-dependent vasodilation in male mice.•Reduced endothelial GSH levels promotes renal fibrosis.
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