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1. P1598Electrophysiological and structural characterization of acute atrial myocardial infarction

Author

Juan Cinca, S Casabella-Ramon, Damián Sánchez-Quintana, Xavier Millán, J Nevado-Medina, Dabit Arzamendi, Esther Jorge, Jose M. Guerra, G Amoros-Figueras, E Rosello-Diez, and C. Alonso-Martin

Subjects
medicine.medical_specialty, business.industry, Internal medicine, cardiovascular system, Cardiology, Medicine, cardiovascular diseases, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, medicine.disease
Abstract

Background Atrial myocardial infarction may be a risk for atrial fibrillation. However, the electrophysiological and structural characteristics of the infarcted atrial myocardium are not well known. This study aimed to analyse the changes in local atrial electrograms and myocardial structure in an experimental model of isolated atrial myocardial infarction. Methods Five anesthetized, open-chest pigs were submitted to 4 hours of acute atrial myocardial ischemia induced by direct surgical clamping of atrial coronary branches originating from the right coronary artery. In all cases, we recorded simultaneously the 12-lead surface electrocardiogram (ECG) and the epicardial mapping of local atrial electrograms (17 x 12.5 mm patches containing 128 electrodes, with 1 mm inter-electrode distance) in a region close to the occluded branches and in control non-treated atria. The changes in local atrial QRS-ST segment and the amplitude of the P-wave of the ECG were sequentially analysed (Figure). The hearts were removed and processed for anatomopathological examination. Results Selective atrial coronary branch occlusion induced a patchy atrial myocardial necrosis with an irregular and abrupt border zone (circled areas in the Figure). During the first 15 min of ischemia, the local atrial electrograms showed increasing R waves, widening of QRS complex, and ST segment elevation leading to monophasic potentials (maximal ST segment at 30 min: from 0.2±0.7 mV to 1.9±1.4 mV, ANOVA p Structural and electrical atrial changes Conclusion Selective occlusion of atrial coronary branches induced patchy atrial myocardial necrosis with abrupt anatomical and electrical border zone. The overt QRS and ST segment changes in local atrial electrograms resembled those described in acute ventricular myocardial ischemia, and were associated with widening of the P-wave on the surface ECG. Although acute ischemic arrhythmias were not observed, the atrial structural alterations might set the substrate for re-entrant arrhythmias late after the healing over process. Acknowledgement/Funding Supported by grants from ISCI-MINECO (FISPI17/00069), CIBERCV (CB16/11/00276), FEDER and Fundaciό “La Maratό” TV3 (20150830).

Published
2019
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2. Perceval Less Invasive Aortic Replacement Register: multicentric Spanish experience with the Perceval S bioprosthesis in moderate-high-risk aortic surgery.

Author

Berastegui García E, Camara Rosell ML, Estevez Cid F, Sanchez Dominguez E, Rios Barrera R, Sbraga F, Garcia Puente J, Rosello Diez E, Cuerpo Caballero GP, Bustamante Munguira J, Reyes Copa G, Tena Pajuelo M, Serrano Fiz S, Buendía Miñano JA, García Martin I, Cuenca Castillo J, Cánovas Lopez S, Gonzalez Pinto A, and Ruyra Baliarda X

Subjects
Aged, Aortic Valve diagnostic imaging, Aortic Valve Stenosis diagnosis, Echocardiography, Female, Humans, Incidence, Prospective Studies, Prosthesis Design, Spain epidemiology, Survival Rate trends, Aortic Valve surgery, Aortic Valve Stenosis surgery, Bioprosthesis, Heart Valve Prosthesis, Postoperative Complications epidemiology, Registries, Transcatheter Aortic Valve Replacement methods
Abstract

Objectives: The development of new percutaneous and surgical techniques has reduced the risk associated with aortic valve replacement procedures. We present the results of a Spanish register after initiating a programme for sutureless prostheses in moderate-high-risk patients., Methods: This prospective multicentre study was carried out from November 2013 to November 2016. Data were obtained from 448 patients in whom a Perceval S prosthesis was implanted., Results: The mean age was 79.24 (standard deviation [SD] 4.1) years, and 61.2% were women. The estimated EuroSCORE I log risk was 11.15% (SD 7.6), with an observed mortality of 4.4% (20 patients). Isolated aortic valve replacement was performed on 69.26% of patients, with 64% involving ministernotomy. The incidence of neurological events was 2%, with 2 permanent cerebrovascular accidents, and 41 (9.2%) patients were implanted with a permanent endocavitary pacemaker. At discharge, 12 (2.6%) patients presented minimal periprosthetic leakage, and 4 (0.89%) patients had moderate leakage. There were 3 reinterventions during follow-up (2 endocarditis and 1 dysfunction due to periprosthetic leak progression). The mean gradient at discharge, 6 months and 1 year was 12.94 (SD 5.3) mmHg, 12.19 (SD 4.7) mmHg and 11.77 (SD 4.7) mmHg, respectively; 59.4% of the patients were octogenarians, with a survival rate of 98% at both 6 months and 1 year at discharge. There was neither valve migration nor early structural degeneration. The mean follow-up was 12 ± 3 months. The 6-month and 1-year mortality was 1.4% and 2.1%, respectively., Conclusions: This is a prospective multicentric study on the largest cohort of patients with sutureless valves conducted in Spain to date. It is a reproducible procedure that has enabled surgery on patients with a moderate-high risk with low morbidity and mortality, providing good haemodynamic results.

Published
2018
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