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Background The return of extracorporeal circuit blood at the termination of cardiopulmonary bypass (CPB) is an important feature of blood conservation during cardiac surgery procedures globally. We report our initial clinical evaluation of the Hemobag system a blood-salvaging device designed for whole blood recovery of residual post-CPB volume. Methods Residual whole blood is hemoconcetrated through the multipass “recovery loop” circuit separate from the CPB and collected in the Hemobag System. This allows the surgeons to continue with surgery, decannulate, and administer protamine simultaneously while the Hemobag is in use and the CPB circuit remains safely primed. We have compared 25 patients receiving the Hemobag to a control group of 25 patients treated with the cell washer that represented our previous standard of care method of circuit blood-salvaging technique. Results The Hemobag system provided significantly higher hemoglobin, hematocrit, fibrinogen, albumin, and total protein levels in the final product reducing the amount of wasted autologous blood cells. There were no device-related complications. There were no significant differences in terms of blood utilization, chest tube drainage and clinical outcomes over the entire postoperative period among groups. Conclusions These results suggest that the Hemobag system is a safe and efficient method to multipass hemoconcentrate the residual diluted blood of the CPB circuit. The Hemobag has demonstrated its ability to maximize the composition of the residual CPB volume to achieve the best possible post-CPB hemoglobin, plasma protein and coagulation factors profile for the patient respect to CW.

The purpose of this study was to evaluate the safety and the clinical outcomes of aortic valve replacement (AVR) performed with minimally invasive extracorporeal circulation (miniECC) technique vs. standard cardiopulmonary bypass (CPB). From February 2006 to December 2007 a total of 181 isolated AVR were performed, of these 53 patients were operated using minimal extracorporeal circulation system and 128 patients were operated using the standard CPB. Demographic characteristics and operative data were similar in both groups except for EuroSCORE (P0.0001). Operative mortality (30 days) was 3.8% for miniECC group and 4.7% for CPB group (P=ns). Patients in both groups showed similar postoperative chest tube drainage (432+/-325 ml vs. 460+/-331 ml, P=ns). The percentage of transfused patients was similar in both groups (37.7% vs. 43.8%, P=0.45). The number of transfused blood bank products was higher in patients with a body surface area1.7 m(2) and who underwent traditional CPB in respect to miniECC system. Postoperatively renal injury, atrial fibrillation episodes, neurologic event rate, ICU and hospital stay length were similar in both groups. The miniECC is suitable for AVR providing good clinical results but the present results should not identify the miniECC system to be superior to the conventional CPB.

ObjetivoTras más de 10 años desde las primeras aplicaciones de la operación de Ross en España describimos el grado de implantación y sus resultados.MétodosAnualmente los centros nacionales que realizan esta intervención envían sus datos al coordinador. Analizamos morbimortalidad, disfunción de auto y homoinjerto, y necesidad de reintervención.ResultadosDesde febrero de 1991 hasta mayo de 2004 se han incluido 281 pacientes. La etiología más frecuente fue la congénita (166, 59,4%). La insuficiencia aórtica fue el tipo de lesión predominante (126, 44,83%). Nueve (3,2%) pacientes requirieron balón de contrapulsación intraaórtico. La mortalidad a 30 días fue del 3,2% (n=7). El seguimiento está completo en el 98,2%, con una media de 46,08 ± 33,09 meses (rango 1–159), estando el 28,89% (n=84) de los pacientes seguidos más de 4 años. Respecto al estatus del autoinjerto, el 82,91% (233) se encuentra sin insuficiencia, presentando 12 (4,27%) insuficiencia moderada y cuatro (1,42%) insuficiencia grave (96,73±1,2% libres de reintervención). El homoinjerto se encuentra normofuncionante o con disfunción leve en 255 pacientes (90,74%), presentando siete (2,49%) estenosis grave. Cuatro (1,42%) pacientes han requerido alguna reintervención sobre el tracto de salida del ventrículo derecho. La supervivencia a 48 meses es de 96,3 ± 1,05%.Conclusiones1. El número de pacientes incluidos de forma anual tiende a mantenerse y crecer. 2. El número de centros implicados continúa en aumento pero la mayor actividad se concentra en un grupo reducido de centros. 3. La morbimortalidad inicial es baja. 4. El índice de disfunción del homo y/o autoinjerto es aceptable.ObjectiveTen years after the introduction of the Ross operation in Spain, we intend to describe and analyze the national experience with this approach for aortic valve replacement.MethodsCardiac Surgery Centers in Spain currently performing this intervention submit data from new patients or follow-ups to the coordinator on a yearly basis. Morbidity, mortality, autograft and homograft dysfunction and need for reintervention are reported.ResultsSince February 1991 to May 2004, 281 patients were included. The most frequent aortic lesion was aortic regurgitation (126, 44.83%), being congenital the most prevalent ethiology (166, 59.4%). Nine (3.2%) patients required intraoperative aortic counterpulsation. Perioperative mortality was 3.2% (n=7). Follow-up is 98.7% complete, with an average of 46.08 ± 33.09 months (range 1-159), being 28.89% (n=84%) followed for more than 4 years. The autograft remains competent in 233 patients (82.91%), presenting 4 (1.18%) with severe regurgitation (96.73±1.2 free from reoperation). The homograft is normal or shows mild stenosis in 255 patients (90.74%), presenting 7 (2.49%) with severe stenosis. Four (1.42%) required reintervention (surgical or interventional) on the right ventricular outflow tract. Actuarial survival is 96.3 ± 1.05% at 48 months.Conclusions1. The indications for this procedure tends to increase in Spain, with more patients included every year. 2. The number of centers involved remains stable although there is a small group of reference centers. 3. The initial morbid- ity and mortality of the procedure remains low. 4. The long-term complications related to homo or autograft failure remain as low as those previously reported with shorter follow-up.

Presentamos dos pacientes que sufrieron un accidente de tráfico con resultado de traumatismo de la válvula mitral. En el primer caso, al cuarto día del accidente, se diagnosticó insuficiencia mitral masiva por ruptura de la cabeza del músculo papilar anterolateral, con versión completa de los segmentos A1 y P1, procediéndose a reparación quirúrgica al mes del accidente, siendo la válvula mitral estructuralmente normal. En el segundo caso, el diagnóstico se hizo a los 10 días del accidente. Se trataba de una insuficiencia mitral grave por ruptura de cuerdas del velo posterior. La reparación quirúrgica se llevó a cabo a los 2 meses y medio del accidente. En este caso la válvula mitral era, además, degenerativa. En ambos casos la cirugía consistió en reparación valvular mitral. Se revisa la ruptura traumática de la válvula mitral.