E. Villagrán

Ascending Aorta and Aortic Root Reoperations: Are Outcomes Worse Than First Time Surgery?

BACKGROUND The aim of this study was to analyze surgery and survival data in the midterm after aortic root and (or) ascending aorta reoperations and compare these results with those obtained after first time surgery. METHODS Over a 6-year period, 365 patients underwent an aortic root and (or) ascending aorta surgery procedure at our center. Mean patient age was 63.1 + or - 25.5 years; 27.1% were women. Fifty-eight patients had had prior ascending aorta and (or) aortic valve surgery (group I) and the remaining 307 patients were assigned to an initial surgery group (II). The reoperative procedures were Bentall in 45 (77.6%), ascending aorta and valve replacement in 8 (13.8%), and ascending aorta replacement in 5 (8.6%). RESULTS The reoperation group showed a worse preoperative risk profile indicated by a higher logistic European system for cardiac operative risk evaluation: group I (26.9) versus group II (9.9) (p < 0.0001). Hospital mortality was 7 of 58 (12.1%) in group I and 21 of 207 (6.8%) in group II (p = 0.18; relative risk 1.9 [0.8 to 4.6]). After adjusting for the different variables, reoperation could not be identified as an independent predictor of postoperative morbidity. Survival rates (including in-hospital mortality) were lower in group I at one year (77.9 + or - 1.11% vs 91.9 + or - 0.3%) and at 3 years (75.3 + or - 0.11% vs 88.9 + or - 0.03% [log-rank p = 0.005]). In the multivariate analysis, reoperation (p = 0.01; hazard ratio 2.6 [1.2 to 5.3]) was a determining factor for survival once corrected for variables predicting mortality during follow-up. CONCLUSIONS Reoperations on the ascending aorta and aortic root showed acceptable morbidity and mortality. Their midterm survival was lower than for patients not requiring a repeat operation.

Validación del EuroSCORE II: ¿funciona en nuestro medio?

a b s t r a c t Objectives: Validate the new EuroSCORE (ESII) risk model in terms of discriminative and calibration power and compare this results with the classic EuroSCORE (ES).We also compare our data distribution with the ESII database. Methods: A 4166 patient population operated during a 7 year period was analyzed. The model was then tested on the validation data set for calibration (by comparing the observed and predicted mortality) and for discrimination (using the area under the ROC curve). Results: The predicted mortality by the ESII was higher than the ES: 9.1(SD: 10.4) vs 3.46 (SD: 4.3): p<0.001. The Hosmer-Lemeshow test showed a poor calibration for both models: ES (x 2 =26.6, p=<0.001),ESII (x 2 =58.19, p<0.0001). Areas under ROC curves were 0.75 (IC95% 0.72-0.78) for ES and 0.78 (IC95% 0.75-0.81) for ESII (p<0.233). Conclusions: The new EuroSCORE II risk model has a predicted mortality lower than EuroSCORE and a good predictive value in terms of calibration and poor discrimination. A non significant better discrimination power was observer in the ESII. The distribution of some variables was different between our data and ESII.

Reoperation for composite valve graft failure: Operative results and midterm survival

The replacement of a failed composite valve graft is technically more demanding and is associated with increased morbidity and mortality. We present our technique and outcomes for reoperations for composite graft failures.

314. Extracción de dispositivos intracardíacos en pacientes sometidos previamente a procedimientos de cardiología intervencionista

Objetivos Descripcion de una cohorte de pacientes sometidos a la implantacion de algun dispositivo intracardiaco percutaneo (DCIP) que finalmente fueron intervenidos quirurgicamente por disfuncion de los mismos. Material y metodos Se analizo de forma retrospectiva toda la cohorte de pacientes sometidos a extraccion de DCIP intervenidos en nuestro centro. Se describe la muestra de pacientes y se resumen los resultados quirurgicos. Resultados Desde julio de 2007 – julio de 2011, 25 pacientes intervenidos tras haberse sometido al implante de algun DCIP; 18 mujeres. Edad mediana: 64 anos (rango 26–90). EuroSCORE logistico preimplante de DCIP 6% interquartile range (IQR) (4–9%) y prequirurgico 10% IQR (8–14%). En 8 se implanto Amplatzer para cierre de CIA: 5 quedaron con shunt residual importante; 2 libres en auricula derecha (AD); 1 en ventriculo derecho (VD); 1 implante de Amplatzer para cierre de comunicacion interventricular (CIV) postinfarto agudo de miocardio (post-IAM) con fracaso terapeutico y perforacion de VD. En 8 se implanto un Amplatzer para cierre de leak protesico mitral y 2 aorticos, quedando todos incompetentes; 1 implante de Mitraclip con desagarro del aparato subvalvular e insuficiencia mitral (IM) grave; 5 casos de implante de protesis aorticas transapicales (TAVI) transfemoral con 3 desgarros ventriculares y 2 migraciones de la protesis hacia ventriculo y aorta ascendente. En todos se extrajo el dispositivo y se procedio a sustitucion valvular, cierre de defecto y/o contencion de rotura ventricular. Cuatro pacientes fallecieron. Conclusiones La extraccion de DCIP se esta convirtiendo en una indicacion frecuente de cirugia cardiaca. El riesgo quirurgico aumenta ostensiblemente en la cirugia de retirada de DCIP. Es necesario definir con mas precision esta nueva poblacion de pacientes asi como conocer sus resultados operatorios.

Tricuspid Valve Stenosis Due to a Pacemaker Lead

the maximum gradient was 11 mm Hg, mean gradient 7.7 mm Hg, and the area was 0.76 cm2 (Figure 1). During surgery, we found a highly unstructured tricuspid valve with severe stenosis due to fusion of the commissures and thickening of the subvalvular apparatus (Figure 2A). The lead was embedded in one of the tricuspid leaflets (Figure 2B), and therefore, any attempt at repair was impossible. Valve replacement with a 25-mm Carpentier Perimount bioprosthesis (Figure 3) was decided upon, based on the patient’s history of thromboembolism and the low thrombogenic profile of this type of prosthesis. She was discharged at 7 days following the procedure, at which time echocardiographic study showed a normally functioning prosthesis.