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BACKGROUND: The objective of this study was to explore the usefulness of virtual models and three-dimensional (3D) printing technologies for planning complex non-congenital cardiovascular surgery. METHODS: Between July 2018 and December 2019, adult patients with different cardiovascular structural diseases were included in a clinical protocol to explore the usefulness of Standard Tessellation Language (STL)-based virtual models and 3D printing for prospectively planning surgery. A qualitative descriptive analysis from the surgeon's viewpoint was done based on the characteristics, advantages and usefulness of 3D models for guiding, planning and simulating the surgical procedures. RESULTS: A total of 14 custom 3D-printed heart and great vessel replicas with their corresponding 3D virtual models were created for preoperative surgical planning. Six of 14 models helped to redefine the surgical approach, 3 were useful to verify device delivery, while the rest did not change the surgical decision. In all open surgery cases, cardiac and vascular anatomy accuracy of virtual and physical 3D replicas was validated by direct visualisation of the organs during surgery. Printing was achieved through an external provider associated with the Hospital, who printed the final prototype in 5-7 days. Printed production cost was between 100 and 500 USD per model. CONCLUSIONS: In the current study, the selected 3D printed models presented different advantages (visual, tactile, and instrumental) over the traditional flat anatomical images when simulating and planning some complex types of surgery. Notwithstanding 3D printing advantages, STL-based virtual models were pre-printing useful tools when instrumentation on a physical replica was not required.
Assuntos
Imageamento Tridimensional , Impressão Tridimensional , Adulto , Coração , HumanosRESUMO
RESUMEN Introducción: En relación con la cirugía coronaria, existen discrepancias respecto del pronóstico y tratamiento de la enfermedad cardiovascular en la mujer entre distintos estudios internacionales. Objetivo: Analizar los resultados de mortalidad y complicaciones hospitalarias y a 60 días luego de la cirugía de revascularización miocárdica aislada o combinada, en forma comparativa entre mujeres y varones. Material y métodos: Se analizaron en forma retrospectiva los resultados hospitalarios y a 60 días de la cirugía de revascularización coronaria aislada o combinada de acuerdo con el sexo, operados entre 2011 y 2017. Se compararon las variables perioperatorias, la mortalidad esperada con el EuroSCORE II y la mortalidad observada por toda causa. Se realizó un análisis de propensión para equiparar las poblaciones de mujeres y varones. Resultados: De 1670 cirugías de revascularización coronaria aisladas o combinadas, el 27,4% (n: 457) eran mujeres; y, de 1305 cirugías aisladas, el 14,2% (n: 185) eran mujeres. La mortalidad en las mujeres a 30 y 60 días fue del 2,7% y del 4,3% vs. el 2,1% (RR = 1,26 IC95% 0,49-3,26, p = 0,632) y el 2,3% (RR = 1,86 IC95% 0,86-4,05, p = 0,113, potencia 53%) en los varones. Tras el análisis de propensión de los pacientes sometidos a cirugía coronaria asilada, la mortalidad a 60 días en las mujeres fue del 4,0% vs. 2,3% en los varones (RR = 1,75 IC95% 0,52-5,87, p = 0,359). Conclusiones: En comparación con los varones, las mujeres sometidas a cirugía de revascularización coronaria tuvieron más edad y mayor riesgo esperado por el EuroSCORE II, peor función renal tanto para la cirugía coronaria combinada como aislada. La mortalidad luego de la cirugía de revascularización coronaria aislada o combinada fue mayor en mujeres que en hombres a 60 días e, incluso, esta diferencia se mantuvo después de ajustar por confundidores.
ABSTRACT Background: The outcome and treatment of cardiovascular disease in women differ among international studies. Objective: The aim of this study was to compare in-hospital mortality and complications with mortality and complications at 60 days following isolated or combined coronary artery bypass graft surgery between women and men. Methods: The outcomes during hospitalization and at 60 days following isolated or combined coronary artery bypass graft surgery procedures performed between 2011 and 2017 were retrospectively analyzed. Perioperative variables, expected all-cause mortality estimated by EuroSCORE II and observed all-cause mortality were compared. A propensity score analysis was performed to match female and male populations. Results: Of the 1670 isolated or combined coronary artery bypass graft procedures, 27.4% (n=457) were performed in women, and 185 (14.2%) of 1305 isolated surgeries corresponded to women. Mortality in women at 30 and 60 days was 2.7% and 4.3%. respectively, vs. 2.1% (RR: 1.26; 95% CI, 0.49-3.26; p=0.632) and 2.3% (RR: 1.86; 95% CI, 0.86-4.05, p=0.113, power 53%), respectively, in men. After analyzing the propensity score of patients undergoing isolated revascularization procedures, 60-day mortality in women was 4.0% vs. 2.3% in men (RR: 1.75; 95% CI; 0.52-5.87, p=0.359). Conclusions: Compared with men, women undergoing isolated or combined coronary artery bypass graft surgery were older and had higher expected risk calculated by EuroSCORE II and worse renal function. Mortality after isolated or combined coronary artery bypass graft surgery was higher in women than in men at 60 days, and this difference remained even after adjusting for confounders.
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RESUMEN Introducción: Los resultados del seguimiento a largo plazo constituyen uno de los mejores parámetros para evaluar la calidad de una intervención médica. Objetivos: Analizar la supervivencia global y la supervivencia libre de eventos cardiovasculares a 20 años de la cirugía coronaria en un hospital de comunidad con historia clínica electrónica de larga data. Métodos: Se estudiaron en forma retrospectiva los resultados alejados de las cirugías coronarias aisladas efectuadas en pacientes con enfermedad de múltiples vasos o tronco de coronaria izquierda entre 1999 y 2003 en un hospital de comunidad. El seguimiento hasta 20 años se realizó a través de la historia clínica electrónica. Resultados: Se logró un tiempo de seguimiento medio de 125 meses (rango: 6-268) en 254 pacientes de los 272 operados en ese período (93,4%). El número promedio de puentes fue 3,3 (desvío estándar: 0,97); en 97,6% se usó al menos una arteria mamaria y 59,4% recibieron un puente con arteria radial. Se obtuvo un seguimiento de 2646 pacientes-años, con un riesgo anual de muerte por toda causa de 2,5%. La supervivencia global al seguimiento medio fue de 0,806 (error estándar, EE: 0,03), y la supervivencia libre de eventos cardiovasculares fue de 0,826 (EE: 0,03). Conclusiones: El registro electrónico completo de los afiliados a un hospital de comunidad operados hace más de 15 años permitió analizar la supervivencia global y libre de eventos a largo plazo. Estos resultados servirán como estándar al momento de elegir entre la cirugía y la angioplastia de múltiples vasos.
ABSTRACT Background: The outcomes of long-term follow-up constitute one of the best parameters to assess the quality of a medical intervention. Objectives: To analyze the overall and the free-of-cardiovascular events 20-year survival after coronary surgery in a community hospital with a long-standing electronic medical records. Methods: The results of coronary surgeries in patients with multi-vessel or trunk disease operated between 1999 and 2003 in a community hospital were retrospectively studied. The follow-up up to 20 years was carried out through the electronic medical record. Results: Of 272 patients operated, a mean follow-up of 125 months (range 6-268) was achieved in 254 (93.4%). The average number of bypasses was 3.3 (standard deviation 0.97); in 97.6%, at least one internal mammary artery was used and 59.4% received a radial artery graft. A follow-up of 2646 patient-years was obtained with an annual risk of death from all causes of 2.5%. The overall survival at the mean follow-up time was 0.806 (standard error (SE) 0.03), and the cardiovascular event-free survival 0.826 (SE 0.03). Conclusions: The complete electronic registration of affiliates to a community hospital operated more than 15 years ago allowed us to analyze the overall survival and the freedom of long-term events. These results will serve as a standard when choosing between surgery and multi-vessel angioplasty.