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Altres ajuts: Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV); Instituto de Salud Carlos III (ISCIII); Ministerio de Economía y Competitividad (MINECO). Biological differences between males and females change the course of different diseases and affect therapeutic measures' responses. Heart failure is not an exception to these differences. Women account for a minority of patients on the waiting list for heart transplantation or other advanced heart failure therapies. The reason for this under-representation is unknown. Men have a worse cardiovascular risk profile and suffer more often from ischemic heart disease. Conversely, transplanted women are younger and more frequently have non-ischemic cardiac disorders. Women's poorer survival on the waiting list for heart transplantation has been previously described, but this trend has been corrected in recent years. The use of ventricular assist devices in women is progressively increasing, with comparable results than in men. The indication rate for a heart transplant in women (number of women on the waiting list for millions of habitants) has remained unchanged over the past 25 years. Long-term results of heart transplants are equal for both men and women. We have analyzed the data of a national registry of heart transplant patients to look for possible future directions for a more in-depth study of sex differences in this area. We have analyzed 1-year outcomes of heart transplant recipients. We found similar results in men and women and no sex-related interactions with any of the factors related to survival or differences in death causes between men and women. We should keep trying to approach sex differences in prospective studies to confirm if they deserve a different approach, which is not supported by current evidence.

The study of gender differences may lead into improvement in patient care. We have aimed to identify the gender differences in heart transplantation (HT) of adult HT recipients in Spain and their evolution in a study covering the years 1993–2017 in which 6740 HT (20.6% in women) were performed. HT indication rate per million inhabitants was lower in women, remaining basically unchanged during the 25‐year study period. HT rate was higher in men, although this decreased over the 25‐year study period. Type of heart disease differed in men versus women (p < .001): ischemic heart disease 47.6% versus 22.5%, dilated cardiomyopathy 41.3% versus 34.6%, or other 36% versus 17.8%, respectively. Men were more frequently diabetics (18% vs. 13.1% p < .001), hypertensives (33.1% vs. 24% p < .001), and smokers (21.7% vs. 12.9% p < .001), respectively. Women had more pre‐HT malignancies (7.1% vs. 2.8% p < .001), and their clinical status was worse at HT due to renal function and mechanical ventilation. Adjusted survival (p = .198) and most of the mortality‐related variables were similar in men and women. Death occurred more frequently in women due to rejection (7.9% vs. 5.1% p < .001) and primary failure (18.2% vs. 12.5% p < .001) and in men due to malignancies (15.1% vs. 6.6% p < .001). Sin financiación 2.863 JCR (2020) Q2, 80/211 Surgery 0.918 SJR (2020) Q2, 15/42 Transplantation No data IDR 2020 UEM

OBJECTIVES To investigate the potential clinical benefit of an intra-aortic balloon pump (IABP) in patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO) as a bridge to heart transplantation (HT). METHODS We studied 169 patients who were listed for urgent HT under VA-ECMO support at 16 Spanish institutions from 2010 to 2015. The clinical outcomes of patients under simultaneous IABP support (n = 73) were compared to a control group of patients without IABP support (n = 96). RESULTS There were no statistically significant differences between the IABP and control groups with regard to the cumulative rates of transplantation (71.2% vs 81.2%, P = 0.17), death during VA-ECMO support (20.6% vs 14.6%, P = 0.31), transition to a different mechanical circulatory support device (5.5% vs 5.2%, P = 0.94) or weaning from VA-ECMO support due to recovery (2.7% vs 0%, P = 0.10). There was a higher incidence of bleeding events in the IABP group (45.2% vs 25%, P = 0.006; adjusted odds ratio 2.18, 95% confidence interval 1.02–4.67). In-hospital postoperative mortality after HT was 34.6% in the IABP group and 32.5% in the control group (P = 0.80). One-year survival after listing for urgent HT was 53.3% in the IABP group and 52.2% in the control group (log rank P = 0.75). Multivariate adjustment for potential confounders did not change this result (adjusted hazard ratio 0.94, 95% confidence interval 0.56–1.58). CONCLUSIONS In our study, simultaneous IABP therapy in transplant candidates under VA-ECMO support did not significantly reduce morbidity or mortality. Sin financiación 1.675 JCR (2019) Q3, 98/138 Cardiac & Cardiovascular Systems, 123/210 Surgery; Q4, 53/64 Respiratory System 0.660 SJR (2019) Q2, 137/362 Cardiology and Cardiovascular Medicine, 63/147 Pulmonary and Respiratory Medicine, 138/451 Surgery No data IDR 2019 UEM

Resumen Objetivos Dado que el infarto agudo de miocardio (IAM) con onda Q es una afeccion con elevada mortalidad en mujeres ancianas, intentamos conocer cual es su evolucion actual, su tratamiento y los factores que condicionan el pronostico. Material y metodos Estudio descriptivo que incluyo a todas las mujeres ≥ 75 anos con diagnostico de IAM transmural en el periodo 2002-2005. Se analizaron las variables epidemiologicas, clinicas, complicaciones vasculares y la evolucion durante la estancia intrahospitalaria y a medio plazo. Se compararon estas variables segun hubieran recibido en fase aguda terapia de reperfusion o no, y se registro el motivo de no recibir ese tratamiento. Resultados Se incluyo a 152 mujeres; la edad media fue de 82,2 ± 6,2 anos. Un 34,2% eran diabeticas y con IAM anterior en el 40,8%; el 27% tenia un grado Killip III-IV. Se realizo tratamiento de revascularizacion en fase aguda al 21,1%. La mortalidad intrahospitalaria fue del 25,8% y la acumulada a 6 meses del 37,3%. La incidencia de eventos mayores al ano fue 43,8%. No recibir terapia de reperfusion estuvo condicionado por. la edad, el bloqueo de la rama izquierda, la demora en acudir al hospital y por decision medica. La mortalidad fue 3,3 veces menor en el grupo tratado, aunque con un riesgo relativo de complicacion hemorragica del 2,5. Ademas de la ausencia de tratamiento revascularizador, el grado Killip y la fraccion de eyeccion fueron predictores independientes de mortalidad. Conclusiones El IAM en las ancianas continua siendo una afeccion con elevada morbimortalidad. A pesar del beneficio observado, estas pacientes reciben escasa terapia de reperfusion en fase aguda, aunque no existe contraindicacion formal en la mitad de los casos.

Los aneurismas coronarios son una patolog��a infrecuente (0,5-3% de incidencia). Suelen asociarse con estenosis coronarias y la aterosclerosis es la etiología más frecuente. Nuestro paciente debutó con muerte súbita. Posteriormente presentó taponamiento cardíaco y a las 24 horas desarrolló un IAM inferior. La coronariografía mostró una gran dilatación esferoidal (4,5 × 5 cm) en la coronaria derecha proximal. Se trató con resección del aneurisma y puente aortocoronario. La evolución suele ser asintomática. La rotura o la muerte súbita son formas raras de presentación. La actitud conservadora es el tratamiento más comúnmente aplicado. La indicación quirúrgica dependerá de la presencia de estenosis coronarias asociadas o de la existencia de complicaciones.