Search

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.

Background: Frailty is a geriatric syndrome that diminishes potential functional recovery after any surgical procedure. Preoperative surgical risk assessment is crucial to calibrate the risk and benefit of cardiac surgery. The aim of this study was to test usefulness of FRAIL Scale and other surgical-risk-scales and individual features of frailty in cardiac aortic valve surgery. Methods: Prospective study. From May-2014 to February-2016, we collected 200 patients who underwent aortic valve replacement, either surgically or transcatheter. At 1-year follow-up, quality of life measurements were recorded using the EQ-5D (EuroQol). Univariate and multivariate analyses correlated preoperative condition, features of frailty and predicted risk scores with mortality, morbidity and quality of life at 1 year of follow-up. Results: Mean age 78.2y, 56%male. Mean-preoperative-scores: FRAIL scale 1.5(SD 1.02), STS 2.9(SD 1.13), BI 93.8(SD 7.3), ESlog I 12.8(SD 8.5) and GS 7.3s (SD 1.9). Morbidity at discharge, 6 m and 1 year was 51%, 14% and 28%. Mortality 4%. Survival at 6m/ 1-y was 97% / 88%. Complication-rate was higher in TAVI group due to-vascular complications. Renal dysfunction, anemia, social dependence and GS slower than 7 seconds were associated with morbidity. On multivariate analysis adjusted STS, BI and GS speed were statistically significant. Quality of life at 1-year follow-up adjusted for age and prosthesis type showed a significant association with STS and FRAIL scale scores. Conclusions: Frailty increases surgical risk and is associated with higher morbidity. Preoperative GS slower 7 s, and STS and FRAIL scale scores seem to be reliable predictors of quality of life at 1-year follow-up.

Background Frailty is a geriatric syndrome that diminishes potential functional recovery after any surgical procedure. Preoperative surgical risk assessment is crucial to calibrate the risk and benefit of cardiac surgery. The aim of this study was to test usefulness of FRAIL Scale and other surgical-risk-scales and individual features of frailty in cardiac aortic valve surgery. Methods Prospective study. From May-2014 to February-2016, we collected 200 patients who underwent aortic valve replacement, either surgically or transcatheter. At 1-year follow-up, quality of life measurements were recorded using the EQ-5D (EuroQol). Univariate and multivariate analyses correlated preoperative condition, features of frailty and predicted risk scores with mortality, morbidity and quality of life at 1 year of follow-up. Results Mean age 78.2y, 56%male. Mean-preoperative-scores: FRAIL scale 1.5(SD 1.02), STS 2.9(SD 1.13), BI 93.8(SD 7.3), ESlog I 12.8(SD 8.5) and GS 7.3 s (SD 1.9). Morbidity at discharge, 6 m and 1 year was 51, 14 and 28%. Mortality 4%. Survival at 6 m/ 1-y was 97% / 88%. Complication-rate was higher in TAVI group due to-vascular complications. Renal dysfunction, anemia, social dependence and GS slower than 7 s were associated with morbidity. On multivariate analysis adjusted STS, BI and GS speed were statistically significant. Quality of life at 1-year follow-up adjusted for age and prosthesis type showed a significant association with STS and FRAIL scale scores. Conclusions Frailty increases surgical risk and is associated with higher morbidity. Preoperative GS slower 7 s, and STS and FRAIL scale scores seem to be reliable predictors of quality of life at 1-year follow-up.

Resumen Introduccion y objetivos El posoperatorio de cirugia cardiaca incluye el traslado desde la unidad de cuidados intensivos (UCI) a la sala convencional. Las unidades de cuidados intermedios (UCIn) permiten la optimizacion de recursos hospitalarios. Se ha analizado el impacto de una UCIn en las estancias medias (en la UCI y hospitalaria) y los resultados (mortalidad hospitalaria y reingresos a los 30 dias) tras la cirugia cardiaca (UCIn- CC ). Metodos Desde noviembre de 2012 hasta abril de 2015, ingresaron para cirugia cardiaca 1.324 pacientes consecutivos. Se implemento una UCIn-CC (mayo de 2014). Los pacientes se clasificaron en 2 grupos: pre-UCIn-CC (noviembre de 2012 a abril de 2014; n = 674) y post-UCIn-CC (mayo de 2014 a abril de 2015; n = 650). Resultados No se observaron diferencias significativas en edad, sexo, factores de riesgo, EuroSCORE 2, fraccion de eyeccion o tipo de cirugia (el 53% valvular, el 26% coronaria, el 11,5% valvular y coronaria y el 1,8% de aorta). La estancia en la UCI disminuyo del pre-UCIn-CC al post-UCIn-CC una media ± desviacion estandar de 4,9 ± 11 a 2,9 ± 6 dias (p Conclusiones Tras la implementacion de una UCIn-CC para el cuidado del posoperatorio de cirugia cardiaca, se observo una reduccion de las estancias medias en la UCI y hospitalaria, sin que aumentaran la mortalidad hospitalaria ni los reingresos a los 30 dias.

Because of the clinical significance of carotid atherosclerosis, the search for novel biomarkers has become a priority. The aim of the present study was to compare the protein secretion profile of the carotid atherosclerotic plaque (CAP, n = 12) and nonatherosclerotic mammary artery (MA, n = 10) secretomes. We used a nontargeted proteomic approach that incorporated tandem immunoaffinity depletion, iTRAQ labeling, and nanoflow liquid chromatography coupled to high-resolution mass spectrometry. In total, 162 proteins were quantified, of which 25 showed statistically significant differences in secretome levels between carotid atherosclerotic plaque and nondiseased mammary artery. We found increased levels of neutrophil defensin 1, apolipoprotein E, clusterin, and zinc-alpha-2-glycoprotein in CAP secretomes. Results were validated by ELISA assays. Also, differentially secreted proteins are involved in pathways such as focal adhesion and leukocyte transendothelial migration. In conclusion, this study provides a subset of identified proteins that are differently expressed in secretomes of clinical significance.

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 moderatehigh-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 moderatehigh risk with low morbidity and mortality, providing good haemodynamic results.

Introduction and objectives Current postoperative management of adult cardiac surgery often comprises transfer from the intensive care unit (ICU) to a conventional ward. Intermediate care units (IMCU) permit hospital resource optimization. We analyzed the impact of an IMCU on length of stay (both ICU and in-hospital) and outcomes (in-hospital mortality and 30-day readmissions) after adult cardiac surgery (IMCU-CS). Methods From November 2012 to April 2015, 1324 consecutive patients were admitted to a university hospital for cardiac surgery. In May 2014, an IMCU-CS was established for postoperative care. For the purposes of this study, patients were classified into 2 groups, depending on the admission period: pre-IMCU-CS (November 2012-April 2014, n = 674) and post-IMCU-CS (May 2014-April 2015, n = 650). Results There were no statistically significant differences in age, sex, risk factors, comorbidities, EuroSCORE 2, left ventricular ejection fraction, or the types of surgery (valvular in 53%, coronary in 26%, valvular plus coronary in 11.5%, and aorta in 1.8%). The ICU length of stay decreased from 4.9 ± 11 to 2.9 ± 6 days (mean ± standard deviation; P

IntroductionCardiac adipose tissue is a source of progenitor cells with regenerative capacity. Studies in rodents demonstrated that the intramyocardial delivery of cells derived from this tissue improves cardiac function after myocardial infarction (MI). We developed a new reparative approach for damaged myocardium that integrates the regenerative properties of cardiac adipose tissue with tissue engineering. In the adipose graft transposition procedure (AGTP), we dissect a vascularised flap of autologous pericardial adipose tissue and position it over the myocardial scarred area. Following encouraging results in acute and chronic MI porcine models, we performed the clinical trial (NCT01473433, AdiFLAP trial) to evaluate safety in patients with chronic MI undergoing coronary artery bypass graft. The good safety profile and trends in efficacy warranted a larger trial.Study designThe AGTP II trial (NCT02798276) is an investigator initiated, prospective, randomised, controlled, multicentre study to assess the efficacy of the AGTP in 108 patients with non-revascularisable MI. Patients will be assigned to standard clinical practice or the AGTP. The primary endpoint is change in necrotic mass ratio by gadolinium enhancement at 91 and 365 days. Secondary endpoints include improvement in regional contractibility by MRI at 91 and 365 days; changes in functional MRI parameters (left ventricular ejection fraction, left and right ventricular geometric remodelling) at 91 and 365 days; levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) at 7, 91 and 365 days; appearance of arrhythmias from 24 hour Holter monitoring at 24 hours, and at 91 and 365 days; all cause death or re-hospitalisation at 365 days; and cardiovascular death or re-hospitalisation at 365 days.Ethics and disseminationThe institutional review board approved the trial which will comply with the Declaration of Helsinki. All patients will provide informed consent. It may offer a novel, effective and technically simple technique for patients with no other therapeutic options. The results will be submitted to indexed medical journals and national and international meetings.Trial registration numberClinicalTrials.gov:NCT02798276, pre-results.

ResumenIntroducción y objetivosLa reparación mitral es adecuada cuando en el control ecocardiográfico poscirculación extracorpórea no hay insuficiencia mitral residual o es ligera. Poco se conoce de la evolución clínica y ecocardiográfica de esta insuficiencia mitral ligera residual. El objetivo del estudio era valorar la evolución clínica y ecocardiográfica de los enfermos según la presencia o no de insuficiencia mitral residual ligera poscirugía.MétodosEstudio prospectivo de pacientes con reparación mitral por regurgitación mitral severa degenerativa operados durante el período comprendido entre 2002–2010.ResultadosFueron intervenidos 105 pacientes con afectación de 1 o 2 segmentos según la clasificación de Carpentier (edad media 67±12 años, hombres 61%). En 102 casos (97,1%), la reparación mitral fue adecuada, y en 3 (2,9%) no, sustituyéndose la válvula. La mortalidad hospitalaria fue del 2,9% (EuroSCORE logístico 5±5,5%). En el ecocardiograma transesofágico en quirófano, de los 102 pacientes reparados satisfactoriamente, 69 no presentaban insuficiencia mitral residual (grupo A) y 33 presentaban una regurgitación leve (grupo B). Durante el seguimiento [mediana 37 meses (1–105)], la evolución clínica fue correcta, aunque los pacientes del grupo B evolucionaron peor desde el punto de vista ecocardiográfico por recidiva más precoz de la insuficiencia mitral.ConclusionesLa reparación valvular mitral se ha mostrado como una técnica segura y eficaz. La ausencia de insuficiencia mitral al final de la reparación determina una mejor evolución con mínima recidiva durante un seguimiento a medio plazo.AbstractIntroduction and objectivesA successful mitral valve repair is considered when no or mild residual regurgitation is determined in the echocardiography after weaning from cardiopulmonary bypass. Little is known about the clinical and echocardiographic outcome, in the medium term, of the patients with mild residual regurgitation post-repair. The aim of this study was to evaluate the clinical and echocardiographic outcome depending on the presence or absence of mild residual regurgitation after weaning from cardiopulmonary bypassMethodsA prospective study was conducted on patients with severe degenerative mitral regurgitation, who underwent mitral valve repair in our hospital during the period 2002–2010.ResultsMitral valve repair was performed on 105 patients (66%males, mean age 67±12 years-old) with prolapse of 1 or 2 scallops/segments according to the Carpentier classification. In three patients the repair was not adequate and the valve was replaced. The successful repair rate was 97.1%. After weaning from cardiopulmonary bypass, 69 patients had no residual regurgitation (group A), and in 33 it was mild (group B). The postoperative mortality was 2.9% (logistic EuroSCORE 5±5.5%). During a median follow-up period of 37 months (1–105) both groups had improved their clinical condition, but group B patients suffered an earlier II or III mitral regurgitation recurrence.ConclusionsMitral valve repair proved to be a safe and effective technique. Absence of mitral regurgitation post-repair determines a better outcome with minimal recurrence in the medium term.

Background Novel pro-inflammatory and anti-inflammatory derivatives from adipose tissue, known as adipokines, act as metabolic factors. The aim of this study was to analyse the secreted expression of different adipo/cytokines in secretomes of unstable carotid atherosclerotic plaque versus non-atherosclerotic mammary artery. Methods We evaluated the secretion levels of adiponectin, visfatin, lipocalin-2, resistin, IL-6 and TNFR2 by ELISA in human secretomes from cultured unstable carotid atherosclerotic plaque (n = 18) and non-atherosclerotic mammary artery (n = 13). We also measured visfatin serum levels in patients suffering from atherosclerosis and in a serum cohort of healthy subjects (n = 16). Results We found that visfatin levels were significantly increased in unstable carotid atherosclerotic plaque secretome than in non-atherosclerotic mammary artery secretome. No differences were found with regard the other adipo/cytokines studied. Regarding visfatin circulating levels, there were no differences between unstable carotid atherosclerotic plaque and non-atherosclerotic mammary artery group. However, these visfatin levels were increased in comparison to serum cohort of healthy subjects. Conclusions Of all the adipo/cytokines analysed, only visfatin showed increased levels in secretomes of unstable carotid atherosclerotic plaque. Additional human studies are needed to clarify the possible role of visfatin as prognostic factor of unstable carotid atherosclerotic plaque.

Introduccion y objetivos El incremento del intervencionismo percutaneo ha conllevado una disminucion significativa de la cirugia coronaria. El perfil del paciente coronario que se remite a cirugia es mas anoso, con mayor comorbilidad, peor funcion ventricular y con procedimientos percutaneos previos. En este sentido la cirugia ha intentado mejorar sus resultados desde varios frentes de actuacion. El objetivo es analizar y describir la experiencia inicial de la cirugia coronaria con mini-circulacion extracorporea (MCEC) en un grupo de cirugia cardiaca en el que se ha convertido en tecnica de eleccion. Metodos Entre enero de 2004 y abril de 2007, se analizo de forma retrospectiva a 408 pacientes sometidos a cirugia coronaria aislada con MCEC, 329 (80,6%) varones, con media (intervalo) de edad de 63,5 (28-83) anos. Un 63% tenia hipertension; el 49,3%, diabetes; el 69%, dislipemia, y el 52% eran fumadores. Resultados El EuroSCORE logistico (mortalidad esperada) era del 3,7% (1%-38%). El 34% de los pacientes tenian afeccion del tronco comun y el 87%, enfermedad de 3 vasos. En el 74% de los casos se realizo revascularizacion completa, con un numero medio de injertos de 2,97 (1-7). Se utilizo injerto de mamaria en el 100% de los casos. La mortalidad hospitalaria fue del 0,74%. Las complicaciones postoperatorias fueron pocas: el 0,98% preciso reintervencion por sangrado, en el 3,4% se elevo la troponina I de forma significativa, en el 6,4% se desarrollo insuficiencia renal y el 0,5% tuvo accidente vascular cerebral. Conclusiones La cirugia coronaria con MCEC permite realizar una revascularizacion completa en la mayoria de los pacientes, con buenos resultados de morbimortalidad.

OBJECTIVES In high-risk patients with severe aortic stenosis, aortic valve replacement (AVR) with a sutureless Perceval prosthesis (SU-AVR) can be performed instead of conventional AVR or transcatheter aortic valve implantation. Little data are available regarding postoperative conduction disorders after SU-AVR. We aimed to determine the incidence and predictors of new-onset complete atrioventricular block (NO-AVB) requiring permanent cardiac stimulation following SU-AVR. METHODS We studied consecutive patients who underwent SU-AVR between 2013 and 2015. Early patients underwent partial aortic decalcification and subannular valve implantation (standard technique), while later patients underwent complete/symmetrical decalcification and intra-annular valve deployment (modified technique). Predictive baseline and procedural variables and electrocardiographic parameters were identified using a logistic regression model. RESULTS We included 140 patients (mean age, 78 ± 6.5 years; mean Log EuroSCORE II, 8.9 ± 10%; 28.6% concomitant myocardial revascularization). The most common postoperative conduction disturbances were LBBB (25%), NO-AVB (12.1%) and first-degree atrioventricular block (AVB) (7.9%). The incidence of NO-AVB was 61% lower with the modified versus the standard technique (P= 0.04). NO-AVB predominantly appeared within 24 h post-surgery, occurring >24 h post-surgery in only 2 patients (both with baseline conduction defects). Independent predictors of NO-AVB included baseline left QRS axis deviation (LaQD; P= 0.03), first-degree AVB (P< 0.01) and standard surgical technique (P= 0.02). CONCLUSIONS NO-AVB is a frequent complication following SU-AVR, and its incidence strongly depends on the surgical technique. Baseline first-degree AVB and LaQD independently predict NO-AVB and should be considered when deciding the duration of postoperative electrocardiographic monitoring.

The present study evaluates the safety and efficacy of the Adipose Graft Transposition Procedure (AGTP) as a biological regenerative innovation for patients with a chronic myocardial scar. This prospective, randomized single-center controlled study included 10 patients with established chronic transmural myocardial scars. Candidates for myocardial revascularization were randomly allocated into two treatment groups. In the control arm (n = 5), the revascularizable area was treated with CABG and the non-revascularizable area was left untouched. Patients in the AGTP-treated arm (n = 5) were treated with CABG and the non-revascularizable area was covered by a biological adipose graft. The primary endpoint was the appearance of adverse effects derived from the procedure including hospital admissions and death, and 24-hour Holter monitoring arrhythmias at baseline, 1 week, and 3 and 12 months. Secondary endpoints of efficacy were assessed by cardiac MRI. No differences in safety were observed between groups in terms of clinical or arrhythmic events. On follow-up MRI testing, participants in the AGTP-treated arm showed a borderline smaller left ventricular end systolic volume (LVESV; p = 0.09) and necrosis ratio (p = 0.06) at 3 months but not at 12 months. The AGTP-treated patient with the largest necrotic area and most dilated chambers experienced a noted improvement in necrotic mass size (− 10.8%), and ventricular volumes (LVEDV: − 55.2 mL and LVESV: − 37.8 mL at one year follow-up) after inferior AGTP. Our results indicate that AGTP is safe and may be efficacious in selected patients. Further studies are needed to assess its clinical value. (ClinicalTrials.org , AdiFlap Trial). The Adipose Graft Transposition Procedure (AGTP) is a new surgical technique for reducing the scar after a heart attack. It has been evaluated in 10 patients for the first time and has been proved to be safe. This technique consists on the use of the existing fat surrounding the heart that has beneficial properties. The procedure is easy for the surgeons to perform. The next step will be to test the efficacy in a larger population.

Las complicaciones tromboembolicas y hemorragicas a largo plazo tras sustitucion valvular mitral con protesis mecanicas han sido comunicadas en la literatura. Sin embargo, existen escasos estudios con la valvula mecanica On-X Conform (MCRI). La protesis mitral On-X Conform tiene un unico tamano (25–33), con un orificio efectivo de 3,73 cm2, y se implanta en posicion supraanular (cara auricular). Material y metodos Entre 2000-2009 se implanto la protesis On-X Conform en posicion mitral en 353 pacientes. Todos los pacientes fueron estudiados retrospectivamente a partir de los registros de la base de datos del servicio de cirugia cardiaca y se realizo un seguimiento via telefonica, visita medica y busquedas en historia clinica. De ese grupo, se analizan 138 pacientes con patologia mitral (±tricuspide) aislada, y con un minimo de 1 ano de seguimiento. El seguimiento fue del 100%, con un seguimiento maximo de 7,66 anos y medio de 4,53 (591,87 patient-years-follow-up). Todos los pacientes iniciaron tratamiento anticoagulante con Sintrom® con indice internacional normalizado (INR) diana entre 2,5–3,5 y fueron controlados en su hospital o CAP de referencia (n.o medio controles/ano 10,8). Conclusiones 1) La protesis On-X Conform mitral puede implantarse de forma segura en cualquier paciente que requiera sustitucion valvular mitral; 2) En el seguimiento, las complicaciones relacionadas con la valvula han sido muy bajas, con tasas de tromboembolia del 1% ppy y hemorragia del 0,3% ppy. Resultados Trombosis 0,5% ppy Tromboembolia 1,01% ppy Hemorragia mayor 0,3% ppy Leak perivalvular 0,16% ppy Endocarditis 0,5% ppy Hemolisis 0 Disfuncion estructural 0 Disfuncion no estructural 0,16% ppy Reoperaciones relacionada valvula 0,84% ppy Explantes 0,67% ppy Muerte subita 0 Mortalidad relacionada valvula 0,33% ppy Morbilidad y mortalidad total 2,18% ppy

Background Sternal wound infection remains a serious potential complication after cardiac surgery. A recent development for preventing wound complications after surgery is the adjunctive treatment of closed incisions with negative pressure wound therapy. Suggested mechanisms of preventive action are improving the local blood flow, removing fluids and components in these fluids, helping keep the incision edges together, protecting the wound from external contamination and promoting incision healing. This work reports on our initial evaluation and clinical experience with the Prevena™Incision Management System, a recently introduced new negative pressure wound therapy system specifically developed for treating closed surgical incisions and helping prevent potential complications. We evaluated the new treatment on sternal surgical incisions in patients with multiple co-morbidities and consequently a high risk for wound complications. Methods The Prevena™incision management system was used in 10 patients with a mean Fowler risk score of 15.1 [Range 8-30]. The negative pressure dressing was applied immediately after surgery and left in place for 5 days with a continuous application of -125 mmHg negative pressure. Wounds and surrounding skin were inspected immediately after removal of the Prevena™ incision management system and at day 30 after surgery. Results Wounds and surrounding skin showed complete wound healing with the absence of skin lesions due to the negative pressure after removal of the Prevena™ dressing. No device-related complications were observed. No wound complications occurred in this high risk group of patients until at least 30 days after surgery. Conclusions The Prevena™system appears to be safe, easy to use and may help achieve uncomplicated wound healing in patients at risk of developing wound complications after cardiothoracic surgery.

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.

Introduction and objectives. The increasing use of percutaneous interventions has resulted in a significant reduction in coronary artery bypass grafting. Today, patients referred for surgery are older, have more comorbidities, and have undergone previous percutaneous intervention, and their ventricular function is poorer. As a result, surgery has attempted to improve its results by adopting a number of different strategies. The aim of this study was to investigate and describe one cardiac surgery unit’s initial experience with coronary artery bypass grafting using mini-extracorporeal circulation (MECC), which had become its technique of choice. Methods. A retrospective analysis of 408 patients who underwent isolated coronary artery bypass grafting using MECC between January 2004 and April 2007 was carried out. Of the 408, 329 (80.6%) were men, their mean age was 63.5 years (28-83 years), 63% had hypertension, 49.3% had diabetes, 69% had hyperlipidemia, and 52% were smokers. Results. The surgical mortality rate predicted by the logistic EuroSCORE was 3.7% (range, 1-38). Overall, 34% of patients had left main coronary artery disease and 87% had 3-vessel disease. In 74%, complete revascularization was carried out using a mean of 2.97 (range, 1-7) grafts per patient. A mammary artery graft was used in all cases. The in-hospital mortality rate was 0.74%. There were few postoperative complications: 0.98% of patients required further surgery because of bleeding, 3.4% had a significantly elevated troponin-I level, 6.4% developed kidney failure, and 0.5% suffered a stroke. Conclusions. Coronary artery bypass grafting using MECC enabled complete revascularization to be performed in most patients, and morbidity and mortality rates were low.

La valvula Mitroflow (Sorin Group) ha sido utilizada frecuentemente como sustituto protesico en la valvulopatia aortica. Sin embargo algunos estudios han favorecido la duda acerca del deterioro estructural acelerado de dicha protesis incluso en pacientes de edad avanzada. Material y metodos Analizamos de forma retrospectiva nuestra experiencia en los ultimos 10 anos. El seguimiento medio fue de 4,2 anos y completo en el 97%. En el periodo de enero de 2001 a 2010 se implantaron 181 protesis Mitroflow. Edad media al implante 76,0 ± 5,6 anos (83,4% mayores de 69 anos); 61,4% mujeres; 95% estenosis aortica (EAo) predominante; 53 pacientes (29,2%) con procedimientos asociados. La poblacion a estudio presentaba 90% hipertension arterial (HTA); 51% diabetes mellitus; 48% dislipemia, y 12,1% insuficiencia renal cronica (IRC). El 85% de las protesis fueron de tamano 19–21. Se analiza el deterioro estructural progresivo y necesidad de reintervencion mediante controles ecocardiograficos (anuales). Resultados Durante el periodo estudiado la supervivencia del grupo a los 3, 5 y 10 anos fue del 98, 92 y 82%, respectivamente. La presencia de mismatch teorico en el postoperatorio inmediato fue del 4,9% (EAo/SC Conclusiones – Los gradientes transprotesicos en pacientes con EOA/SC superior a 1 cm2/m2 fueron bajos y se mantuvieron estables en el seguimiento a largo plazo. – Durante el seguimiento tres pacientes se reintervinieron por deterioro estructural, a los 6, 5 y 3 anos. Tabla 1 Endocarditis 1,04% ppy Disfuncion no estructural 0 Leak periprotesico 1,44% ppy Tromboembolia 0 Hemorragias mayores 2 AV C hemorragicos (1 paciente ACXFA – sintrom) 1 HDA 0,9% ppy Disfuncion estructural 1,015% ppy Reintervencion deterioro Estructural 1,01% ppy Aparicion insuficiencias 1,92% ppy

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.