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A prosthetic disc valve for the mitral position was designed by the Spanish cardiovascular surgeon Francisco Alvarez in 1964. The valve was inserted in Spain and in the United Kingdom until 1967. Multiple thromboembolic complications stopped its application.

Objective Among Basque handball players, the repeated impact of a ball on the palms of their hands hundreds of thousands of times throughout their sporting careers produces Raynaud syndrome. Treating this patient group is complex. Our objective was to assess the efficacy of digital periarterial sympathectomy in this patient group. Methods The study included all of the federated amateur and professional Basque handball patients who presented with Raynaud syndrome assessed in the vascular surgery service between January 2005 and December 2012. The postoperative assessment included a physical examination, basal photoplethysmography and photoplethysmography after heat hyperemia, and arteriography or magnetic resonance angiography. Results All 182 digital periarterial sympathectomies in the 114 fingers of 60 patients were in Porter functional class III or IV. All patients were discharged within the first 48 hours. Follow-up results, with a mean of 2 years ± 5 months, were 100%. All patients presented immediate pain remission, recovery of comfort, normal nail growth, rapid healing of all ulcers, distal anhidrosis, and return to active sport participation. The results remain steady in 58 patients (93.5%). Mean time until return to sports activity was 9.95 ± 1.61 weeks. Conclusions Digital periarterial sympathectomy is a simple, relatively nonaggressive technique without adverse side effects and with excellent medium-term results. In patients with Raynaud syndrome refractory to medical treatment and with threat to the viability of one or several fingers, digital periarterial sympathectomy can be the first treatment option, especially in cases of arteritis associated with very severe spasms.

BACKGROUND Information and communications technologies are transforming our social interactions and life-styles. One of the most promising applications of information technology is healthcare and wellness management that characterized by early detection of conditions, prevention, and long-term healthcare management. OBJECTIVE The main purpose of this document is to do a study, first about the actual literature about mobile phone applications to measure and control heart-rate and second a study about these applications themselves, analyzing the different app stores more popular nowadays, Google Play Store and iTunes (for Android and iOS devices respectively). METHODS The Web portals and databases that were used to perform the searches are IEEE Explorer, National Center for Biotechnology Information, Springer, ResearchGate, Science Direct and Scopus, taking into account the date of publication from 2010 to 2018, publications in English and Spanish. RESULTS 40 relevant papers have been found related to mobile phone apps to measure and control the heart rate. The results show that of a total of 400 applications found 245 of them are in the Play Store (Android systems) and the remaining 155 were found in the iTunes Store (iOS systems). CONCLUSIONS From the review of the research articles analyzed, it can be said that the most applications found are for Android devices. They occupy 76.53% of the world mobile phone market, while iOS only owns 18.97%.

In the last years, handheld devices have experienced an incredible boost and expansion and that expansion has propitiated the creation of a new software industry of mobile apps. These devices and apps are used in every aspect of life, including one of the most important, like is health care. This paper presents the development and QoE evaluation of an application called “Take care your Heart”, designed to work on devices with iOS operative system embedded. This app is aimed to help people with heart problems, giving them some advice about some aspects of their disease, monitoring the doses of their medicines, saving different activities related to it and calculating their risk of suffering a cardiovascular accident. Knowing the level of satisfaction of our patients through this study will allow us to channel the efforts towards more friendly and accepted application by people with heart diseases.

ResuménCon la introducción en 1953 de la circulación extracorpórea (CEC) se inició la historia de la cirugía cardíaca abierta, y las lesiones regurgitantes valvulares pudieron ser tratadas. En 1965 Kay diseñó una estrategia novedosa para reparar la insuficiencia tricúspide (IT), pero no fue realmente hasta 1972 cuando de Vega describió su técnica de anuloplastia, definiéndola como selectiva, regulable y permanente. Por esta misma época, Carpentier inventó el anillo que lleva su nombre, y probablemente todo parecía indicar que al menos la enfermedad adquirida de la válvula tricúspide (VT) estaba en camino de ser quirúrgicamente resuelta. En este medio siglo, y después de múltiples autoplastias de sutura y múltiples anillos, completos, incompletos, rígidos, flexibles e incluso tridimensionales, puede parecer que aquel entusiasmo se ha desvanecido.Es posible que ni el exceso de certeza inicial ni la desconfianza de la actualidad sean unas actitudes lógicas, porque probablemente la incógnita pueda despejarse aplicando la teoría de las manzanas y las peras.AbstractIn 1953 the use of the cardiopulmonary bypass was responsible for the beginning of the history of open-heart surgery and regurgitant lesions of the heart valves could be treated. Kay, in 1965, designed a novel strategy to repair tricuspid insufficiency, but it wasn't until 1972 that de Vega described his technique of selective, adjustable, and permanent annuloplasty. Around the same time, Carpentier invented the ring that bears his name and probably everything seemed to indicate that at least the acquired pathology of the tricuspid valve was on track to be resolved surgically. since then, with multiple suture annuloplasties and numerous types of rings, complete, incomplete, rigid, flexible, and even three-dimensional rings, it may seem that the initial enthusiasm is vanishing.It is possible that neither the initial confidence nor skepticism of today are logical attitudes, because probably the unknown can be cleared by applying the theory of comparing apples and pears.

J Bustamante,1 E Tamayo,2 J Herreros3,41Department of Cardiovascular Surgery, Hospital Universitario La Princesa, Madrid, 2Department of Anesthesiology and Intensive Care, Hospital Clinico Universitario de Valladolid, Valladolid, 3Department of Cardiovascular Surgery, Hospital Universitario Valdecilla, Santander, 4Biomedical Engineering Institute of Santander, Santander, SpainAbstract: The development of techniques for genomics study makes it possible for us to further our knowledge about the physiopathology of various immunological or infectious diseases. These techniques improve our understanding of the development and evolution of such diseases, including those of cardiovascular origin, whilst they help to bring about the design of new therapeutic strategies. We are reviewing the genetic alterations of immunity in said field, and focusing on the signaling pathway of toll-like receptors because not only does this play a decisive role in response to microorganisms, it is also heavily involved in modulating the inflammatory response to tissue damage, a side effect of numerous cardiovascular diseases. These alterations in tissue homeostasis are present under a wide range of circumstances, such as reperfusion ischemia (myocardial infarction) phenomena, arteriosclerosis, or valvulopathy.Keywords: genome-wide association study, single-nucleotide polymorphism, innate immune system, ischemic/reperfusion, myocardial infarction

Isolated (idiopathic) aortitis is a rare process characterized by giant cells or lymphoplasmacytic inflammation of the aorta and is an uncommon cause of ascending aortic aneurismal disease. Isolated aortitis usually manifests as an aneurysm of the ascending aorta and it is often an incidental finding during the histopathological study of the aortic wall after thoracic surgery. We present two cases of isolated active aortitis discovered on microscopy of surgically excised aneurismal tissue. The patients were 63- and 62-year-old females, both hypertensive, one a heavy smoker but neither of whom had a history of rheumatic disease. Isolated aortitis occurred in 2% of surgical interventions for ascending aneurysms. Isolated aortitis with giant cells in the absence of previously established giant cell (temporal) arteritis is difficult to identify. Cases showing aortitis with giant cells only in the histopathologic study are usually not a manifestation of giant cell (temporal) arteritis. Since incidentally discovered aortitis may represent a focal lesion that has been surgically removed, a conservative approach to the management of these patients, which should include careful periodical evaluation, is recommended. All surgical aortic samples should be submitted for histopathological examination.

Heart failure currently constitutes one of the greatest health problems in the Western world. Its incidence, far from diminishing or even remaining stable, is actually still increasing in association with the aging of the population and its lifestyle. A better knowledge of physiopathological mechanisms has allowed for the development of new therapeutic focal points and lines of research. Nevertheless, its treatment is complex and encompasses a multidisciplinary approach. Patients in an advanced stage still have a very high mortality rate in spite of receiving optimum medical care. The development of new therapeutic techniques that afford a better prognosis has therefore been essential. Of these, and leaving aside surgical treatments, myocardial regeneration by means of cellular therapy, new concepts in tissue engineering and their results, and the applications of new advances in the field of immunomodulation have all recently experienced development. In this article, the aim is to bring the latest concepts in the physiopathology and humoral response of cardiac failure up to date as well as doing the same with the therapeutic approaches in this area.

En pacientes jóvenes y adultos con cardiopatías congénitas y fallo ventricular grave refractarios al tratamiento médico intenso con fármacos vasoactivos y en aquellos pacientes con fallo primario del injerto postrasplante cardíaco, la asistencia circulatoria, bien mediante extracorporeal membrane oxygenation (ECMO), asistencia centrífuga, o asistencia ventricular mecánica (AVM) representan la últimas terapias posibles disponibles en el protocolo de actuación estratégica para mantener al paciente con vida en espera de un corazón donante idóneo para el trasplante, existiendo, no obstante, una mortalidad elevada durante el tiempo de lista de espera.No obstante, a pesar de los grandes avances y excelentes resultados de la asistencia circulatoria (ECMO) y de la AVM en adultos y niños con cardiopatías congénitas, el ECMO presenta un mayor porcentaje de morbimortalidad, y la AVM dificultades y limitaciones en los niños muy pequeños, por debajo de los 10 kg de peso.La estrategia del momento de implantación de la asistencia circulatoria (ECMO y AVM), la anticoagulación y su monitorización siguen siendo uno de los factores más problemáticos, especialmente en niños pequeños.Although heart transplantation has been established as definitive therapy for end-stage cardiac failure in infants, children and adults with congenital heart disease, there continues to be significant mortality during the waiting interval between listing and transplantation.Centrifugal pumps, extracorporeal membrane oxygenation (ECMO) or ventricular assist devices (VAD) of various design and function principles are in use for temporary support of the failing heart, either aiming at recovery of the heart or more successfully for keeping the patient alive until later transplantation, in the so-called bridge-to-transplant concept.Extracorporeal membrane oxygenation and centrifugal pump ventricular assist were suitable for only very short-term application and were associated with significant morbidity, mortality and limitations, especially as the duration of the support extends beyond 2–3 weeks.Anticoagulant treatment and coagulation monitoring and more importantly, earlier decision-making in favor of pump implantation before irreversible shock has set in. despite the remarkable advances with the use of VAD in adults, it is still limited in very small children (less than 10 kg of body weight).

Objective: Cardiacallograft vasculopathy and late graft failure are the main limiting factors of long-termsuccess of heart transplantation, and little is known about graft function in the long-term survivors. The aim of this study was to assess the ventricular function and the allograft vasculopathy in long-term survivors (>15 years) with the cardiac magnetic resonance imaging (MRI) and dual-source computed tomography (DSCT) coronary angiogram. Methods: In our database, 34 cardiac recipients have more than 15 years of follow-up and were evaluated for this study; 22 (65%) of them were enrolled. Mean age at transplant was 46 13.5 years, mean donor age was 28.5 10.1 years, and mean graft ischemictimewas189 58 min.Meanfollow-upwas18.5 2.4years(range15—22).AllpatientsunderwentcardiacMRIandDSCT.Results:Mean leftventricular(LV) volumesindexedtothebodysurfacearea(BSA)werewithinnormalrange:theend-diastolicvolume/BSAwas61 16 ml m 2 , end-systolic volume/BSA was 22 15 ml m 2 , stroke volume/BSA was 38 6m l m 2 , LV mass/BSA: 72 18 g m 2 , and mean ejection fraction (EF)was0.59 0.08.Twopatients(9%)showedaglobalcardiachypokinesiaandtwootherpatients(9%)showedakinesiaofonesegment.AtDSCT, 41% of patients had a strictly normal coronary angiogram, 41% had wall thickening and 18% presented a least one >60% stenosis. Conclusions: CardiacMRI and DSCTcoronaryangiogramrevealeda normalgraftfunctionandmorphologyafter morethan 15yearsof transplantation. However, a certain number of patients have significant cardiac allograft vasculopathy and another consistent group has initial disease. These patients deserve further follow-up and tailoring of the immunosuppressive regimen. # 2011 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Los estudios epidemiológicos recientes sugieren que la prevalencia de la insuficiencia cardíaca (IC) está en aumento, sobre todo a expensas de las personas de edad avanzada, siendo un problema de salud pública de gran magnitud a nivel mundial, con unos costes estimados en torno al 1–2% del total de gasto en materia sanitaria.Debido a los continuos desarrollos y avances tecnológicos tanto en el diagnóstico como en el tratamiento de esta patología, y a que los recursos tanto económicos como humanos son limitados, se hace necesaria una evaluación económica para determinar la eficiencia de diferentes alternativas de actuación, comparándolas tanto en términos de costes como de resultados.Las técnicas de evaluación económica son herramientas de valoración tanto de eficacia como de beneficio y seguridad, proporcionándonos información acerca del balance entre costes y beneficios, existiendo cuatro tipos básicos de estudios: minimización de costes, análisis costebeneficio (ACB), análisis coste-efectividad (ACE) y análisis coste-utilidad (ACU) mediante los años de vida ajustados a la calidad (AVAC), siendo deseable estimar el coste por AVAC ganado y la ratio incremental.Epidemiologic studies suggest that the prevalence of heart failure will rise in aging populations, being now recognized as a major and escalating public health problem. It is estimated that health-care expenditure in developed countries consumes 1–2% of the total healthcare budget. Medicine today is seeing very rapid development of new technologies for the prevention, treatment and diagnosis of this disease. Given this trend there is also a risk that demand for care will exceed its supply, because resources in health care are limited. There-fore government, health insurers, and health care providers explore new opportunities for improving effectiveness and efficiency of CHF care. Decision-makers in the health service and health care professionals have to make choices and define strategies on the basis of criteria of safety, efficacy and benefit. Economic evaluations is an important tool in the evaluation of competing healthcare interventions. Economic evaluation aims at offering structured information about the balance between costs and effects of a intervention in comparison to another intervention. Four basic types of economic evaluation studies exist: cost-minimization analysis, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. In deciding which types of evaluation should be used in the analysis, the aim of the analysis is determinative. A new cost-effectiveness analysis will be carried out using a decision analytic model, and the evaluation will be constrained by available evidence. If possible, the incremental cost-effectiveness will be estimated in terms of cost per qAly gained, in addition with the incremental cost-effectiveness ratios (ICERs).

La regeneración cardíaca requiere una cascada compleja de acontecimientos con numerosos factores, la mayoría aún no clarificados, que limitan la terapia celular y su traslación a la práctica clínica. Las células tienen que injertarse, sobrevivir e integrarse funcionalmente en el órgano para restaurar su función. De la misma manera que en los tejidos originales, un sistema complejo de señales bien definidas, muchas de ellas generadas desde la matriz extracelular, son necesarias para desarrollar una fisiología celular normal. El planteamiento de combinar conocimientos de biología celular e ingeniería con materiales biocompatibles para restaurar tejidos biológicos y mejorar su función es el fundamento de la ingeniería tisular que define un nuevo abordaje de la regeneración cardíaca.La investigación y desarrollo de un miocardio bioartificial tiene gran interés clínico. La estrategia es el uso de biomateriales para desarrollar una microatmósfera que proporcione a las células endógenas y exógenas un ambiente óptimo para la reparación de tejidos. Los conocimientos adquiridos en el desarrollo de biomateriales aportan las bases para desarrollar matrices 3D que ofrecen el ambiente idóneo para la liberación de células y genes que dirijan las células terapéuticas hacia el fenotipo funcional. La descelularización de órganos para construir nuevas matrices es un nuevo concepto de investigación, desarrollado gracias al desarrollo de nanomateriales que aseguran un nicho celular apropiado para la diferenciación celular y la terapia génica o farmacológica.Cardiac regeneration requires a complex cascade of events. There are many factors, most of them still no clarified, that limit the effectiveness of the stem cell therapy and their translation to the clinic. Cells should graft, survive and functionally integrate to the target organ in order to have a chance to restore its function. As in original tissues, a complex and well defined set of signals, many of them coming from the extracellular matrix, is required for normal cell physiology. The idea of combining principles from cell biology and engineering of biocompatible materials in order to create biologic replacement structures that restore, maintain, or improve tissue function, is at the basis of the tissue engineering and defines a different approach to the cardiac regeneration.Research and development of bioartificial myocardium is of great clinical interest. The rationale for the use of specific biomaterials is to allow the creation of a microatmosphere where the exogenous and endogenous cells find the microenvironment optimal for repair. Biomaterials science gives us important tools to build this extracellular matrix. Functionalized 3D systems can provide the correct environment and act as a delivery system for cells and genes, guiding the therapeutic cells to the functional phenotype. Organ decellularization for bioscaffolds fabrication is a new investigated concept. nanomaterials are emerging as the main candidates to ensure the achievement of a proper instructive cellular niche with good drug release/ administration properties.

Purpose Cardiac surgery-associated acute kidney injury requiring renal replacement therapy (RRT) is independently associated with mortality. Several risk scores have been developed to predict the need for RRT after cardiac surgery. We have compared and verified the external validity of the three main available scores for RRT prediction after cardiac surgery: the Thakar score, the Mehta tool, and the Simplified Renal Index. Methods The risk scores were calculated in a cohort of 1084 adult patients, 248 of whom required RRT, who underwent open-heart surgery in 24 Spanish hospitals in 2007. The performance of the systems was determined by examining their discrimination (areas under the receiver operating characteristic curves (aROC) and calibration (Lemeshow-Hosmer chi-square goodness-of-fit statistics). Results: The aROCs in the Thakar score, the Mehta tool, and the Simplified Renal Index were 0.82, 0.76 and 0.79, respectively. The three scoring systems were poorly calibrated and tended to underestimate the actual need for RRT. Conclusions The Thakar score and the Simplified Renal Index discriminated well between low - and high-risk patients in our cohort, and Thakar outperformed the Mehta tool. These best-performing scores may aid in the selection of optimal therapy, facilitate the planning of hospital resource utilization, improve preoperative counseling, select participants for clinical trials of renal-protective therapies and enable an accurate comparison between different institutions or surgeons.

La miocardiopatía dilatada (MCD) se caracteriza por la dilatación ventricular y la reducción del grosor miocárdico. Es una patología multifactorial con varios mecanismos biológicos que pueden explicar su fisiopatología. Entre estos mecanismos, es relevante el componente inmunitario humoral y celular con una serie de autoanticuerpos (AA) descritos, principalmente los anti-β1 adrenérgicos y los anti-m2 de la acetilcolina. Estos anticuerpos reconocen a un grupo de proteínas presentes en el tejido cardíaco, y desempeñan un papel esencial en la patogénesis de la miocardiopatía, contribuyendo a la disfunción ventricular. La eliminación de estos anticuerpos mediante la inmunoadsorción (IA) implica un beneficio hemodinámico en estos pacientes. Las experiencias piloto más recientes han demostrado que la eliminación de los anticuerpos circulantes mediante la IA mejora la función cardíaca de los pacientes con MCD y reduce la inflamación. Estos anticuerpos son mayoritariamente inmunoglobulinas G de clase 3 (IgG3). La IA mediada por los adsorbentes anti-Ig es eficaz para la eliminación, entre otras, de la IgG3, y es un método seguro y generalmente bien tolerado por los pacientes con MCD.Dilated cardiomyopathy is characterized by ventricular dilatation and progressive depression of myocardial contractile function. It is a multifactorial disease, on which several mechanisms may contribute to the pathophysiology of this process. Disturbances in both humoral and cellular immunity have been described among these patients. A number of antibodies against various cardiac cell proteins, mainly anti-β1-adrenergic and anti-m2 against acetylcholine, have been identified. Recent data indicate that these cardiac antibodies play an active role in the pathogenesis and may contribute to ventricular dysfunction of these patients. Therefore, removal of cardiac autoantibodies by immunoadsorption may induce hemodynamic improvement in dilated cardiomyopathy patients. Recent open pilot trials have consequently shown that removal of circulating antibodies by immunoadsorption induces improvement of cardiac function and decreases myocardial inflammation. These autoantibodies mainly belong to immunoglobulin G subclass 3 (IgG3). The performance achieved by the use of anti-Ig immunoadsorbents is efficacious enough to remove IgG3 and the rest of the immunoglobulin subtypes. IA is a safe and well tolerated therapeutic option for dilated cardiomyopathy patients.

La insuficiencia cardíaca es uno de los problemas de salud de mayor relevancia por su incidencia creciente y sus repercusiones sociales, económicas y sobre todo humanas. El trasplante cardíaco es un abordaje excelente y un tratamiento consolidado para estos pacientes. Sin embargo, la desproporción entre el número de pacientes con una insuficiencia cardíaca terminal y los donantes potenciales restringe el trasplante a aquellos pacientes sin otras posibilidades de tratamiento y ha generado alternativas terapéuticas para mejorar el pronóstico y los síntomas de estos pacientes con alto riesgo. El interés creciente del estudio de la reversibilidad de varias formas de insuficiencia cardíaca terminal y la aplicación de la biología al tratamiento de estos pacientes ha inducido el desarrollo de estrategias terapéuticas, diseñadas para integrar la biología y las nuevas tecnologías médicas, para así intervenir sobre los modelos biomecánicos, moleculares y neurohormonales de la insuficiencia cardíaca. Estos tratamientos incluyen la cardiomioplastia celular, la ingeniería tisular, la cirugía de restauración del ventrículo izquierdo, la inmunoadsorción y la constricción mecánica pasiva ventricular como puente a la recuperación. La integración de estos abordajes puede ofrecer alternativas válidas al trasplante cardíaco.Chronic heart failure is one of the major health care issues in terms of increasing number of patients, rate of hospitalizations and costs. Heart transplantation is an excellent approach and a consolidated treatment for these patients. furthermore, the disproportion between the incidence of heart failure and the number of heart donors makes necessary to restrict cardiac transplant to patients with no other treatment possibilities and has generated alternative treatments to improve prognosis and symptomatology in this high risk patients. The interest in the reversibility of certain forms of end-stage heart failure and the application of biology to the treatments of these patients has generated therapeutic strategies designed to integrate biology and medical technologies in order to act to the biomechanical, the molecular and the neurohormonal model of heart failure. These treatments include cellular cardiomyopathy, tissue engineering, surgical left ventricular restoration and passive mechanical ventricular assistance as a bridge to recovery. The integrated development of these approaches could offer hopeful treatment as alternative to heart transplantation.

Chronic heart failure is one of the major health care issues in terms of increasing number of patients, rate of hospitalizations and costs. Heart transplantation is the best established therapy for patients with severe heart failure. However, the number of donors limits the activity to 5000 heart transplants performed annually worldwide. This limitation has generated alternative treatments. The increase of the interest in the reversibility of the heart failure and the application of new biological alternatives has generated therapeutic strategies designed to integrate biology and medical technologies in order to act to the biomechanical, the molecular and the neurohormonal mechanisms of heart failure. These treatments include cellular cardiomyoplasty, tissue engineering, surgical left ventricular restoration as well as passive and active mechanical ventricular assistance as destination therapy, bridge to recovery or bridge to transplantation. The integrated development of these approaches could offer hopeful treatments, although there is still much to be learned regarding the optimal use of these strategies.

RESUMENLa separación entre la investigación básica y su aplicación clínica ha crecido y, a pesar deuna explosión de conocimientos sobre los mecanismos de los procesos biológicos, ello no seha traducido en el incremento correspondiente de nuevos tratamientos. La necesidad deestrechar lazos entre la investigación básica y la clínica ha dado nacimiento a la investigacióntraslacional, con un objetivo tan fácil de definir como difícil de conseguir: facilitar latransición de la investigación básica a aplicaciones clínicas que redunden en beneficio de lasalud. En el presente artículo se analizan los nuevos retos de la cirugía cardiovascular, ladefinición y los objetivos de la investigación traslacional, los modelos de transferencia delconocimiento, la descripción de los organismos de soporte a la I+D y los modelos jurídicos.REV ARGENT CARDIOL 2010;78:61-68.

La insuficiencia cardíaca es uno de los problemas de salud pública de mayor envergadura. Los cambios de la geometría ventricular, con su repercusión en el pronóstico y el número limitado de donantes, ha generado un interés creciente para la aplicación de cirugía de restauración ventricular (SVR). Las técnicas quirúrgicas son revisadas, su correlación con los fundamentos anatomicofisiopatológicos de la insuficiencia cardíaca y sus resultados son analizados. Los estudios clínicos de SVR aportan evidencia científica para mantener y potenciar su aplicación, a pesar de los resultados de la hipótesis 2 del estudio STICH (Surgical Treatment for Ischemic Heart Failure). Presentamos un proyecto cuyo desarrollo hemos iniciado y que integra el Registro Latinoamericano de Cirugía de Restauración Ventricular (SVRIR) y los estudios de mecánica computacional. Sus objetivos son realizar aportaciones al conocimiento de la fisiopatología de la insuficiencia cardíaca, correlacionar las técnicas quirúrgicas con los fundamentos anatómicos y fisiopatológicos de la insuficiencia cardíaca, precisar los beneficios de la SVR y diseñar técnicas específicas para cada paciente.Cardiac insufficiency is one of the problems with great magnitude in public health. Changes of ventricular geometry with its repercussion in the prognosis and the limited number of donors have created a growing interest for the application of ventricular restoration techniques (SVR). The surgical techniques are reviewed, their correlation with the anatomic and pathophysiological fundamentals of cardiac insufficiency and their results are analysed. The SVR clinical studies give scientific evidence to keep and improve its application, despite the results of hypothesis 2 of the STICH (Surgical Treatment for Ischemic Heart Failure). We are introducing a project whose development has been initiated and integrates the Registro Latinoamericano de Cirugía de Restauración Ventricular (SVRIR) and the studies in computational mechanics. Their aims are to contribute to knowledge in pathophysiology of cardiac insufficiency, to correlate the surgical techniques with the anatomical and pathophysiological fundamentals of cardiac insufficiency, to detail the benefits of SVR and to design specific techniques for each patient.

Conventional coronary angiography (CCA) is the gold standard in the diagnosis of cardiac allograft vasculopathy (CAV) in heart transplant recipients. Dobutamine stress echocardiography (DSE) is a useful technique for screening. Dual-source computed tomography (DSCT) is the last generation of computed tomography scanners, which could be useful to noninvasively assess CAV. Thirty cardiac transplant recipients underwent DSE and DSCT coronary angiogram. Exclusion criteria were as follows: renal insufficiency, iodinated contrast media allergy, less than 12 months since transplant, and unstable clinical conditions. DSE showed ischemia in two patients. At DSCT scan 13 patients had a normal angiogram, 13 ones wall thickening and four significant diseases. DSCT showed a sensitivity of 100% with a specificity of 92%. DSCT allowed detection of more patients with CAV than DSE. Four patients showed significant CAV at DSCT compared with two at DSE. Thirteen patients showed initial signs of disease at DSCT despite a normal DSE.

Previous studies have demonstrated the potential advantages of pulsatile flow as compared with continuous flow. However, to date, physiologic pumps have been technically complex and their application has therefore remained in the experimental field. We have developed a new type of centrifugal pump, which can provide pulsatile as well as continuous flow. The inner wall of a centrifugal pump is pulsed by means of a flexible membrane, which can be accurately controlled by means of either a hydraulic or pneumatic driver. The aim of this study was to assess the hydraulic behavior of the new pump in terms of surplus hemodynamic energy (SHE). We conducted experiments using a mock circulatory system including a membrane oxygenator. No differences were found in the pressure-flow characteristics between the new pump and a conventional centrifugal pump, suggesting that the inclusion of the flexible membrane does not alter hydraulic performance. The value of SHE rose when systolic volume was increased. However, SHE dropped when the percentage of ejection time was reduced and also when the continuous flow (programmed by the centrifugal console) increased. Mean flow matched well with the continuous flow set by the centrifugal console, that is, the pulsatile component of the flow was exclusively controlled by the pulsatile console, and was therefore independent of the continuous flow programmed by the centrifugal console. The pulsatility of the new pump was approximately 25% of that created with a truly pulsatile pump.

Objective: Torrent Guasp concept, that postulates that the ventricles are formed by a continuous muscle band, provides the basis for two aspects of left ventricular dynamics: The torsion mechanism and the rapid early diastolic filling by the suction effect. We investigated the electrophysiological basis of this mechanism, by electroanatomical left ventricular endoepicardial mapping (EEM) in five patients, during radiofrequency ablation. Results: The apical loop is activated by a simultaneous depolarization of the distal descending and proximal ascending band segments. At the point of crossing of both bands a radial activation spreads from the descending to the ascending band. From this point, begins a simultaneous and opposing activation of the proximal and distal ascending band. The activation of the distal ascending band segment is the latest. Conclusions: The activation sequence of the continuous band provides an electrophysiological basis for the ventricular torsion and suction mechanism.