Cardiopatías Congénitas, Resultados del Manejo Perioperatorio en 18 Meses. Experiencia en el Departamento de Cardiocirugía - Centro Materno Infantil,Universidad Nacional de Asunción.
Palabras clave:
Cardiopatías congénitas, atención perioperativa, circulación extracorporea, cirugía torácica, niño.Resumen
Introducción: La sobrevida de los pacientes con cardiopatías congénitas ha mejorado en los últimos años gracias al perfeccionamiento en las técnicas diagnósticas, quirúrgicas, anestésicas y de perfusión, así como al advenimiento de nuevas y más selectivas drogas cardiológicas.
Objetivos: Describir el manejo perioperatorio y la evolución postoperatoria de las cirugías realizadas en el Departamento de Cardiocirugía de la Cátedra y Servicio de Pediatría del Centro Materno Infantil (CMI), FCM-UNA en 18 meses de atención y su relación con el carácter de la cirugía (electiva o de urgencia), y el estado físico preoperatorio del paciente, definido por los criterios de la American Society of Anesthesiologists (ASA).
Materiales y Métodos: Estudio observacional, retrospectivo, descriptivo, con componente analítico; se utilizaron fichas clínicas de pacientes operados en el Departamento de Cardiocirugía de enero de 2007 a junio de 2008.
Resultados: Fueron operados 91 pacientes, 38 de sexo masculino (42%) y 53 de sexo femenino (58%), con edades comprendidas entre 2 días y 18 años. Las cardiopatías fueron 54/91 (59,3%) patologías simples y 37/91 (40,7%) patologías complejas, todas con confirmación diagnóstica preoperatoria por ecocardiografía Doppler color. Precisaron cateterismo cardiaco preoperatorio 3/91 pacientes (3,3%). El 100% de las cirugías se realizaron con anestesia general balanceada. De los 91 pacientes operados, 42 (46,2%) fueron sometidos a circulación extracorpórea (CEC) y 49 (53,8%) sin CEC. De los 42 pacientes operados con CEC, todas fueron cirugías correctivas, 40 (95,2%) electivas, 2 (4,8%) de urgencia, 3 (7,1%) reintervenciones y 2 (4,8%) fallecieron. Presentaron complicaciones 16 pacientes (38,1%), 39 (92,9%) requirieron Asistencia Respiratoria Mecánica (ARM) menos de 24 horas y 3 (7,1%) más de 24 horas. Los tiempos de clampado aórtico variaron de 13 a 167 minutos (media 49,1) y los tiempos de CEC de 20 a 253 minutos (media 71,9). Se realizó ultrafiltrado plasmático (UFP) en el 100% de los pacientes operados con CEC, y todos ellos recibieron aprotinina para profilaxis del sangrado. De los 49 pacientes operados sin CEC, 30 (61,2%) fueron cirugías correctivas, 19 (38,8%) paliativas, 31 (63,3%) electivas, 18 (36,7%) urgencias, 1 (2,1%) reintervención y 10 (16,3%) fallecieron. Presentaron complicaciones 18 pacientes (36,7%), 39 (79,6%) precisaron ARM menos de 24 horas y 10 (20,4%) más de 24 horas. Del total de pacientes operados, 34 presentaron alguna complicación, el 50% fue de tipo hemodinámico, 35,3% respiratorio, 23,5% neurológico, 14,7% infeccioso, 14,7% metabólico, 11,8% hematológico y 11,8% renal. El 28% de las complicaciones se presentaron en las cirugías electivas y el 65% en las urgencias.
Conclusiones: La morbimortalidad de los pacientes estuvo directamente relacionada con dos factores: el carácter urgente de la cirugía y el estado físico preoperatorio del paciente (evaluado según criterio de la American Society of Anesthesiologists ASA). No hubo mortalidad en las cirugías electivas y los pacientes fallecidos correspondieron a un estado físico preoperatorio ASA 4. La utilización intraoperatoria de UFP y aprotinina contribuyó para la buena evolución de las cirugías con CEC.
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