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Aim To obtain a quantitative expression profile of the main genes involved in the cAMP-signaling cascade in human control atria and in different cardiac pathologies. Methods and results Expression of 48 target genes playing a relevant role in the cAMP-signaling cascade was assessed by RT-qPCR. 113 samples were obtained from right atrial appendages (RAA) of patients in sinus rhythm (SR) with or without atrium dilation, paroxysmal atrial fibrillation (AF), persistent AF or heart failure (HF); and left atrial appendages (LAA) from patients in SR or with AF. Our results show that right and left atrial appendages in donor hearts or from SR patients have similar expression values except for AC7 and PDE2A. Despite the enormous chamber-dependent variability in the gene-expression changes between pathologies, several distinguishable patterns could be identified. PDE8A, PI3Kγ and EPAC2 were upregulated in AF. Different phosphodiesterase (PDE) families showed specific pathology-dependent changes. Conclusion By comparing mRNA-expression patterns of the cAMP-signaling cascade related genes in right and left atrial appendages of human hearts and across different pathologies, we show that 1) gene expression is not significantly affected by cardioplegic solution content, 2) it is appropriate to use SR atrial samples as controls, and 3) many genes in the cAMP-signaling cascade are affected in AF and HF but only few of them appear to be chamber (right or left) specific. Topic Genetic changes in human diseased atria. Translational perspective The cyclic AMP signaling pathway is important for atrial function. However, expression patterns of the genes involved in the atria of healthy and diseased hearts are still unclear. We give here a general overview of how different pathologies affect the expression of key genes in the cAMP signaling pathway in human right and left atria appendages. Our study may help identifying new genes of interest as potential therapeutic targets or clinical biomarkers for these pathologies and could serve as a guide in future gene therapy studies.

Resumen Introduccion y objetivos En endocarditis infecciosa (EI), la decision quirurgica es dificil. Un alto porcentaje de pacientes con indicacion quirurgica no son intervenidos. El objetivo fue evaluar el pronostico a corto y largo plazo de los pacientes con indicacion quirurgica, comparando los que se sometieron a cirugia con los que no lo hicieron. Metodos Se incluyeron 271 pacientes con EI izquierda e indicacion quirurgica tratados en el centro desde 2003 a 2018. Ochenta y tres pacientes (31%) no fueron finalmente operados. El objetivo primario fue la mortalidad a 60 dias y el secundario desde el dia 61 a los 3 anos de seguimiento. Se realizo regresion de Cox multivariable y emparejamiento por puntuacion de propension. Resultados A los 60 dias, 40 (21,3%) pacientes operados y 53 (63,9%) pacientes no intervenidos fallecieron (p Conclusiones Dos tercios de los pacientes con indicacion quirurgica no intervenidos fallecieron antes de 60 dias. Entre los supervivientes, la mortalidad a largo plazo depende mas de factores relacionados con comorbilidad previa que del tratamiento recibido durante el ingreso.

INTRODUCTION AND OBJECTIVES In infective endocarditis (IE), decisions on surgical interventions are challenging and a high percentage of patients with surgical indication do not undergo these procedures. This study aimed to evaluate the short- and long-term prognosis of patients with surgical indication, comparing those who underwent surgery with those who did not. METHODS We included 271 patients with left-sided IE treated at our institution from 2003 to 2018 and with an indication for surgery. There were 83 (31%) surgery-indicated not undergoing surgery patients with left-sided infective endocarditis (SINUS-LSIE). The primary outcome was all-cause death by day 60 and the secondary outcome was all-cause death from day 61 to 3 years of follow-up. Multivariable Cox regression and propensity score matching were used for the analysis. RESULTS At the 60-day follow-up, 40 (21.3%) surgically-treated patients and 53 (63.9%) SINUS-LSIE patients died (P

OBJECTIVES This study reports long-term clinical outcomes—up to 17 years—among patients undergoing mitral valve replacement with the On-X bileaflet mechanical valve. Prior data regarding long-term outcomes with the On-X mitral valve have been limited. METHODS This retrospective observational study included all patients who underwent mitral valve replacement with the On-X (Standard or Conform-X) valve at 2 major Spanish cardiac surgery centres between 2001 and 2018. The primary study end point was freedom from death. The secondary study end points included surgical mortality and freedom from any valve-related events. Data were obtained from an institutional database, medical records review, direct telephone interviews or the Spanish population registry. Statistical and Kaplan–Meier analyses were performed. RESULTS A total of 661 patients (mean age 63.1 ± 10.9 years, 63% female) were followed for a mean of 5.6 years (range, 0–17.4 years). Survival at 5, 10 and 15 years was 85%, 71% and 63%, respectively. Surgical mortality was 7.3% (48/661). The linearized rate of global mortality was 1.3% patient-year. Freedom from reoperation was 97%, 95% and 92% at 5, 10 and 15 years, respectively; freedom from anticoagulation-related events was 94%, 89% and 89%, respectively. Multivariable analysis showed that mortality increased with total length of stay, age, smoking history, severe pulmonary hypertension and a permanent pacemaker. Patients who received the On-X 25 -mm valve had decreased long-term survival relative to patients who received other On-X valve sizes, possibly due to underlying risk factors. CONCLUSIONS Patients in this study showed good long-term survival and freedom from valve-related events.

Atrial fibrillation (AF) is a common arrhythmia in the general population and following cardiac surgery. The influence of mitochondrial genomics on AF pathogenesis is not fully understood. We analyzed mitochondrial variables from 78 human atrial samples collected from cardiac surgeries in the following groups: 1) permanent preoperative AF; 2) preoperative sinus rhythm (SR) with postoperative AF; and 3) pre-/postoperative SR. Haplogroup H appeared offer protection against, and haplogroup U predispose to permanent AF. mtDNA content was higher in group 2 than in 3. These findings contribute to a better understanding of the influence of mitochondria on AF pathogenesis., The study was supported by the Ministry of Economy and Competitiveness, Spain for the sample preparation at the Cardiovascular Research Centre and CIBERCV, Spain (SAF2014-58286-C2-1-R).

OBJECTIVES Both off-pump coronary artery bypass grafting surgery (OPCABG) and mini-extracorporeal circulation (MECC) have been associated with lower morbidity and mortality and less inflammation than conventional cardiopulmonary bypass. However, studies comparing the 2 techniques are scarce and the results are controversial. We compared the clinical outcomes and inflammatory response of low-risk patients undergoing coronary bypass grafting with MECC versus OPCABG. METHODS We conducted a prospective, randomized study in patients undergoing coronary heart surgery. Two hundred and thirty consecutive low-risk patients were randomly assigned to either receive OPCABG (n = 117) or MECC (n = 113). Clinical outcomes and postoperative biochemical results were analysed in both groups. We also analysed 19 circulating inflammatory markers in a subgroup of 40 patients at 4 perioperative time points. The area under the curve for each marker was calculated to monitor differences in the inflammatory response. RESULTS No significant differences were found between groups regarding perioperative clinical complications and no deaths occurred during the trial. Plasma levels in 9 of the 19 inflammatory markers were undetectable or showed no temporal variation, 3 were higher in the MECC group [interleukin (IL)-10, macrophage inflammatory protein-1β and epidermal growth factor] and 7 were higher in the OPCABG group (growth regulator oncogene, IL-6, IL-8, soluble CD40 ligand, monocyte chemoattractant protein-1, monocyte chemoattractant protein-3 and tumour necrosis factor-α). Differences in 2 proinflammatory cytokines, IL-6 and monocyte chemoattractant protein 1, between the 2 surgical procedures were statistically significant. CONCLUSIONS No clinical differences were observed between in low-risk patients undergoing MECC or OPCABG surgery, but OPCABG was associated with an increased release of proinflammatory cytokines compared with MECC. Studies in larger cohorts and in patients at higher risk are needed to confirm these findings. Clinical trial registration number NCT02118025.

Resumen: Introducción y objetivos: Los pacientes adultos con cardiopatías congénitas representan un porcentaje pequeño del total de pacientes trasplantados de corazón. Tradicionalmente se ha asociado a este subgrupo de pacientes a una mayor mortalidad precoz. En nuestro centro hemos experimentado un incremento en el número de pacientes adultos con cardiopatía congénita remitidos para valoración de trasplante. Presentamos nuestra experiencia. Métodos: Entre mayo de 1984 y diciembre del 2014 se realizaron 508 trasplantes cardiacos. De ellos 16 (3%) fueron en adultos con cardiopatía congénita. Se han analizado las características de este grupo, comparando su evolución con el resto de trasplantes de causa no congénita. Resultados: En el grupo de pacientes trasplantados con cardiopatía congénita la causa más frecuente fue la transposición completa de grandes vasos. Los pacientes congénitos trasplantados tuvieron una edad media inferior, menos factores de riesgo cardiovascular y mayor número de intervenciones previas que el grupo de trasplantados no congénitos, todas ellas diferencias estadísticamente significativas (p

Background and objective Pulmonary thromboendarterectomy surgery is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension; extremely high pulmonary vascular resistance constitutes a risk factor for hospital mortality. The objective of this study was to analyze the immediate and long-term results of the surgical treatment of chronic thromboembolic pulmonary hypertension in patients with very severe pulmonary hypertension. Material and methods Since February 1996, we performed 160 pulmonary thromboendarterectomies. We divided the patient population in 2 groups: group 1, which included 40 patients with pulmonary vascular resistance ≥ 1090 dyn/s/cm −5 , and group 2, which included the remaining 120 patients. Results Hospital mortality (15 vs. 2.5%), reperfusion pulmonary edema (33 vs. 14%) and heart failure (23 vs. 3.3%) were all higher in group 1; however, after one year of follow-up, there were no significant differences in the clinical, hemodynamic and echocardiographic conditions of both groups. Survival rate after 5 years was 77% in group 1 and 92% in group 2 ( p = 0.033). After the learning curve including the 46 first patients, there was no difference in hospital mortality (3.8 vs. 2.3%) or survival rate after 5 years (96.2% in group 1 and 96.2% in group 2). Conclusions Pulmonary thromboendarterectomy is linked to significantly higher morbidity and mortality rates in patients with severe chronic thromboembolic pulmonary hypertension. Nevertheless, these patients benefit the same from the procedure in the mid-/long-term. In our experience, after the learning curve, this surgery is safe in severe pulmonary hypertension and no level of pulmonary vascular resistance should be an absolute counter-indication for this surgery.

Resumen Fundamento y objetivo La cirugia de tromboendarterectomia pulmonar es el tratamiento de eleccion para la hipertension pulmonar tromboembolica cronica; un factor de riesgo para la mortalidad hospitalaria son las resistencias vasculares pulmonares muy elevadas. El objetivo de este trabajo fue analizar los resultados inmediatos y a largo plazo de la cirugia para la hipertension pulmonar tromboembolica cronica en pacientes con hipertension pulmonar muy grave. Material y metodos Desde febrero de 1996 hemos realizado 160 tromboendarterectomias pulmonares. Dividimos esta poblacion en grupo 1 –40 pacientes con resistencias vasculares pulmonares ≥ 1.090 dinas/s/cm −5 – y grupo 2 –los 120 restantes–. Resultados La mortalidad hospitalaria (15 frente a 2,5%), el edema pulmonar de reperfusion (33 frente a 14%) y la insuficiencia cardiaca (23 frente a 3,3%) fueron significativamente mayores en el grupo 1; pero al ano, no hay diferencia en la situacion clinica, hemodinamica y ecocardiografica con el grupo 2. La supervivencia a los 5 anos fue del 77% en el grupo 1 y del 92% en el grupo 2 (p = 0,033). Excluyendo los primeros 46 enfermos, considerados curva de aprendizaje, no hubo diferencia en la mortalidad hospitalaria (3,8 frente a 2,3%) ni en la supervivencia (96,2% en el grupo 1 y 96,2% en el grupo 2 a los 5 anos). Conclusiones La tromboendarterectomia pulmonar tiene una morbimortalidad inicial mayor en pacientes con hipertension pulmonar tromboembolica cronica muy grave, pero obtiene el mismo beneficio a medio-largo plazo. En nuestra experiencia, tras la curva de aprendizaje, la cirugia ofrece la misma seguridad y excelentes resultados a los pacientes mas graves, y ninguna cifra de resistencias vasculares pulmonares deberia ser considerada una contraindicacion absoluta.

Heparin-induced thrombopenia is a common autoimmune complication. It is a prothrombotic state due to the formation of antibodies against heparin/platelet factor 4 complexes. In this situation drugs other than heparin must be used for anticoagulation during extracorporeal circulation (bypass) surgery. Two cases of heart transplantation are presented in whom bivalirudin was used as an anticoagulant during the cardiopulmonary bypass. Severe bleeding complications were observed in both patients. The diagnosis of heparin-induced thrombopenia needs to be improved, as well as the development of protocols for using new drugs other than heparin. For this reason, we have reviewed current protocols and alternative therapies to heparin.

Debido a la evolucion de la cirugia cardiaca y la cardiologia, los pacientes pediatricos que antano fallecian a causa de cardiopatias congenitas actualmente llegan a la edad adulta. Los pacientes con transposicion de grandes vasos y reparacion fisiologica en el seguimiento pueden evolucionar hacia la insuficiencia cardiaca, como consecuencia del fallo progresivo del ventriculo derecho en posicion sistemica. En esta situacion, el trasplante cardiaco aparece como una posible alternativa terapeutica. Las alteraciones anatomicas y la presencia de conductos intraauriculares hacen que el trasplante precise de una serie de variaciones tecnicas. Presentamos la experiencia en nuestro centro. Entre 1992 y 2004 se han realizado cuatro trasplantes cardiacos en transposicion de grandes vasos y correccion fisiologica. No hubo mortalidad quirurgica. Durante el seguimiento (media, 75 meses), se produjo una muerte por rechazo cronico. Los demas pacientes presentan clase I de la NYHA, con injerto normofuncionante.

Thanks to progress in cardiac surgery and cardiology, pediatric patients with complex congenital heart conditions who would previously have died are now reaching adulthood. Patients with transposition of the great arteries who have undergone atrial repair can present during follow-up with progression towards heart failure as a result of progressive systemic right ventricular failure. In this situation, heart transplantation is a possible therapeutic option. Anatomic abnormalities and the presence of intraatrial conduits ensure that transplantation must involve a number of technical modifications. Here, we present our experience during 1992-2004 with heart transplantations in four patients with transposition of the great arteries and atrial repair. There was no operative mortality. During follow-up (mean period, 75 months), there was one death due to chronic rejection. The other patients remain in New York Heart Association class I, with normally functioning grafts.

La hidatidosis es una enfermedad parasitaria producida por la larva del cestodo Echinococcus. El quiste hidatídico, la forma más habitual de presentación, es producida por la especie E. granulosus. la afectación cardíaca es muy rara, produciéndose en aproximadamente el 0,5–2% de los casos. El 65% de los casos de hidatidosis cardíaca se localizan en las cavidades izquierdas. Presentamos el caso de un paciente en el que la primera localización de la enfermedad fue la aurícula derecha (Ad), junto con diseminación pulmonar quística. La localización exclusiva en las cavidades cardíacas derechas y en la arteria pulmonar constituye una presentación clínica inusual. se ha revisado la bibliografía, prestando especial interés en la importancia de las técnicas de imagen disponibles en la actualidad para su diagnóstico, así como la necesidad de un tratamiento quirúrgico precoz para evitar sus posibles complicaciones.Echinococcosis is a human parasitic disease caused by the larval stage of the cestode Echinococcus. Hydatid cyst, the most frequent presentation, is caused by the species E. granulosus. Cardiac involvement of echinococcosis is infrequent and occurs in approximately 0.5–2% of all cases. 65% of cardiac hydatid cysts are located in the left ventricle and interventricular septum. We present a case of primary cardiac hydatid disease with involvement of the right atrium and pulmonary hydatid embolism. the location of the cyst in the right chambers and pulmonary artery is unusual. We emphasize the value of imaging techniques in the evaluation of the extent of echinococcal lesions and the importance of surgical treatment to avoid major complications.

Resumen Introduccion Los tumores productores de mucina suponen el 1% de los tumores malignos pancreaticos. Entre estos destacan las neoplasias papilares intraductales mucinosas (NPIM) debido a su comportamiento clinico variable, a su mayor frecuencia y a la controversia sobre el tratamiento idoneo y los metodos diagnosticos. El objetivo de este estudio es analizar las caracteristicas epidemiologicas, clinicas y patologicas, los metodos diagnosticos, el tratamiento y la supervivencia de una serie de pacientes con NPIM del pancreas. Pacientes y metodo Se revisaron las NPIM del pancreas diagnosticadas entre 1996-2001. Se recogieron las caracteristicas epidemiologicas, la forma de presentacion, la localizacion pancreatica, los metodos diagnosticos, el tratamiento y la supervivencia. Resultados Se estudio a 8 pacientes con una edad media de 65 anos. La forma de presentacion mas frecuente fue el dolor abdominal y la localizacion mas habitual, la cabeza pancreatica. Los metodos diagnosticos mas empleados fueron la tomografia computarizada (TC) abdominal, la colangiopancreatografia retrograda endoscopica y la determinacion del CA-19.9. Se practicaron 7 resecciones y 1 caso no fue intervenido. Tras un seguimiento medio de 38 meses, la supervivencia es del 75% y la recidiva del 25%. Conclusion La NPIM suele aparecer despues de los 60 anos y se manifiesta como un dolor en el hemiabdomen superior. En la mayoria de las ocasiones se encuentra localizado en la cabeza del pancreas; la TC es la prueba diagnostica mas empleada y la escision quirurgica realizada de forma precoz es el tratamiento mas utilizado. El pronostico es bueno tras la reseccion completa, con supervivencias del 60-70% a los 5 anos.

Objetivos Comparar los resultados (prevalencia de complicaciones, estancia hospitalaria y coste economico) entre el nuevo circuito ambulatorio y el circuito antiguo con ingreso para pacientes tributarios a implante de marcapasos de forma electiva. Material y metodos Desde enero de 2008 - mayo de 2012 se recogieron los datos de los pacientes intervenidos de forma electiva (remitidos desde el dispensario de arritmias) de implantacion de marcapasos definitivo y se dividieron en dos grupos: grupo 1, circuito antiguo (dos noches de ingreso) y grupo 2, nuevo circuito ambulatorio (sin ingreso). Resultados Disminucion de la estancia hospitalaria, de la lista de espera y del coste economico en el nuevo circuito ambulatorio, sin hallarse diferencia significativa en la prevalencia de complicaciones comparado con los marcapasos implantados de forma electiva con ingreso. Conclusiones El circuito ambulatorio a traves de cirugia sin ingreso para implantacion de marcapasos electivos es un modelo seguro, eficaz y mas barato.

3 68-year-old man was admitted to our hospital with a history of dyspnea and considerable fatigue with xercise. Transthoracic echocardiography showed severe itral, aortic, and tricuspid regurgitation. The patient nderwent coronary angiography before surgery, which evealed a giant coronary artery fistula arising from the ircumflex artery (Fig 1). A multi-sliced computed tomoraphic scan was performed to delineate the fistula and ocalize its drainage. Three-dimensional reconstruction howed a tortuous course with multiple loops in the ateral wall (Fig 2) that seemed to end in the pulmonary rtery. Intravenous contrast enhancement allowed the ocation of the drainage orifice in the superior vena cava, ear the right atrium. The patient was operated on through a midline ternotomy. On opening the pericardium, the dilated essel (arrow) was seen to course from the lateral wall f the left ventricle through the transverse sinus, and it nished at the superior vena cava (Fig 3). It measured 5 mm in diameter. Cardiopulmonary bypass was stablished (with bi-caval cannulation) after occlusion f the fistula near its drainage. After mitral valve epair, aortic valve replacement, and tricuspid ring nnuloplasty, the superior vena cava was opened and