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Desempeño de la palificación cavopulmonar a gran altitud: resultados a medio plazo y factores de riesgo de fallo
Sunil P Malhotra1, D Dunbar Ivy, Max B Mitchell
1Department of Cardiothoracic Surgery, Stanford University, Stanford, CA 94305, USA. spmalhotramd@yahoo.com
Circulation
|October 10, 2008
Resumen
Vivir a grandes alturas plantea riesgos para los pacientes con un solo ventrículo sometidos a paliativos cavopulmonares. Los indicadores clave de un fallo potencial incluyen la presión arterial pulmonar elevada y el gradiente transpulmonar, lo que requiere un monitoreo cuidadoso en estos pacientes.
Área de la Ciencia:
- Cardiología Pediátrica Cardiología pediátrica.
- Enfermedad cardíaca congénita.
- Paliación quirúrgica Paliación quirúrgica.
Sus antecedentes:
- La fisiología del ventrículo único requiere una paliativa quirúrgica compleja, como la conexión cavopulmonar.
- Vivir en altitudes elevadas puede afectar los resultados debido a la dependencia de la circulación pulmonar de la resistencia vascular.
- La identificación de los factores de riesgo específicos de la altitud es crucial para mejorar la gestión del paciente.
Objetivo del estudio:
- Identificar los factores de riesgo para la insuficiencia de la palificación cavopulmonar en pacientes que residen en altitudes elevadas.
- Para evaluar el impacto de la altitud en los resultados después de los procedimientos bidireccionales Glenn (BDG) y Fontan.
Principales métodos:
- Análisis retrospectivo de 122 pacientes que viven a una altitud media de 1600 m que se sometieron a BDG entre 1995 y 2007.
- Evaluación de la presión arterial pulmonar pre y postoperatoria (PAP), el gradiente transpulmonar (TPG) y la resistencia vascular pulmonar indexada (PVRI).
- Evaluación de la supervivencia, la falta de paliativos y el estado funcional (clase de la Asociación del Corazón de Nueva York).
Principales resultados:
- La supervivencia global después de BDG fue del 92,4% a los 5 años, con un 81% de libertad de fallo de la palificación.
- Los pacientes que experimentaron un fracaso de la paliación tenían PAP y TPG significativamente más altos antes y después de la BDG.
- Un PVRI post-BDG más alto también se asoció con el fracaso de la palificación (P = 0,007).
Conclusiones:
- La mayoría de los pacientes en altitudes moderadas experimentan resultados favorables con BDG o Fontan.
- El aumento de PAP (>15 mm Hg), TPG (>8 mm Hg) y PVRI (>2.5 U·m2 de madera) son factores de riesgo significativos para el fracaso de la palificación en altitud.
- Estos hallazgos resaltan la importancia de monitorear los parámetros hemodinámicos en pacientes de ventrículo único que viven en elevaciones más altas.
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