Eduard Permanyer

St. Jude Medical Trifecta™ aortic valve perioperative performance in 200 patients.

OBJECTIVES The St. Jude Medical Trifecta aortic bioprosthesis (St. Jude Medical, Inc., St. Paul, MN, USA) is a new stented pericardial tissue heart valve. The aim of the study was to evaluate the clinical and haemodynamic performance of the Trifecta bioprosthesis in the early postoperative period. METHODS From July 2010 to September 2012, a total of 200 consecutive patients underwent aortic valve replacement with the Trifecta valve in our institution. All intraoperative and postoperative data were prospectively collected. Mean EuroSCORE II was 3.98%. Echocardiography was performed at discharge in all patients. RESULTS The mean age was 71.2 ± 7.7 (range 39-89 years). Extubation in the operating theatre was successfully performed in 96% of patients. Mean hospital stay was 8.5 days. The prosthesis sizes were 19 mm (n = 33), 21 mm (n = 81), 23 mm (n = 59), 25 mm (n = 23) and 27 mm (n = 4). Mean systolic pressure gradients ranged from 9.4 mmHg (size 19 valve) to 4.8 mmHg (size 27 valve). Mean effective orifice area (EOA) ranged from 1.61 cm(2) (size 19 valve) to 2.5 cm(2) (size 27 valve). Severe mismatch (<0.65 cm(2)/m(2)) did not occur in any patient. Of note, 99.5% of patients had mild or no aortic insufficiency at discharge. The early (30-day) mortality was 2.5% (n = 5). CONCLUSIONS The Trifecta valve offers good clinical results and excellent haemodynamic performance. Special care must be taken to avoid oversizing, which can lead to difficulty in implantation and can produce gradient increases due to an excess of prosthetic leaflet tissue.

Anomalous origin of right coronary artery from the left coronary sinus: sudden death and successful surgical reimplantation

A 39-year-old man with no clinical relevant data, elite long-distance runner, was admitted to our institution with the diagnosis of ventricular fibrillation while participating in a half-marathon competition. He was resuscitated at the site of the event with electrical cardioversion, and at his admission, he was clinically stable. Electrocardiogram demonstrated regular …

The 3f Enable sutureless bioprosthesis: Early results, safeguards, and pitfalls

OBJECTIVE The aim of the study was to evaluate the clinical and hemodynamic performance of the 3f Enable (Medtronic Inc, Minneapolis, Minn) sutureless bioprosthesis in the early postoperative period. Its implantation technique was also evaluated highlighting the modifications in regard to the original technique and mistakes made throughout the learning curve. METHODS This is a prospective, nonrandomized study. From February 2011 to March 2014, a total of 60 patients underwent aortic valve replacement with the 3f Enable valve at the Hospiten Rambla. All intraoperative and postoperative data were prospectively collected. RESULTS The mean age was 81.3 ± 3.78 years. Mean logistic European System for Cardiac Operative Risk Evaluation I was 13.78%. An associated concomitant procedure was performed in 23 patients (38.3%). The extracorporeal circulation and crossclamping times were 49.8 ± 15.7 minutes and 35.4 ± 8.9 minutes, respectively. The average stay in the intensive care unit was 34.7 hours. Mean systolic pressure gradients ranged from 8.01 mm Hg (size 19 valve) to 7.2 mm Hg (size 25 valve). Mean effective orifice area ranged from 1.9 cm(2) (size 19 valve) to 2.5 cm(2) (size 25 valve). Severe mismatch (<0.65 cm(2)/m(2)) did not occur in any patient. Only 1.66% of patients had more than mild aortic insufficiency at discharge. The early (30-day) mortality was 6.6% (n = 4). CONCLUSIONS The 3f Enable bioprosthesis is an important alternative to conventional prostheses, with reduction of surgery times and good hemodynamic results on discharge. It is especially useful for high-risk patients and octogenarians. Studies on a greater number of patients and long-term follow-ups are necessary.

The Sorin Freedom SOLO stentless aortic valve: easier implantation technique with potentially less risk of complications

Aortic valve replacement by bioprosthesis is increasingly being used. Among these, stentless bioprosthesis is becoming a valid choice due to its potential hemodynamic improvement. The Sorin Freedom SOLO stentless aortic valve (FS) (Sorin Biomedica Cardio, Saluggia, Italy) is widely used, with initial and midterm promising results. It is designed to be deployed in a straightforward manner in the supraannular position with a single running suture due to its reproducible implantation technique. Few specific valve-related complications, such as transient thrombocytopenia or rare thrombotic events, are known. Our experience, after the implantation of 33 Freedom SOLO, suggests that using the classical implantation technique, the noncoronary sinus adopts a conformation that increases the difficulty of the implant. Besides, it could also be distorted increasing the risk of periprosthetic leakage and hypothetically becoming the origin of thrombus. We present an easy and safe variation in the implantation technique of the FS that decreases the technical difficulty of the implantation, reduces the risk of periprosthetic leakage, and may additionally reduce the risk of thrombosis.

Right atrium traumatic rupture presenting as chronic tamponade

Non-penetrating cardiac traumatisms can cause cardiac rupture, myocardial contusion or, rarely, commotio cordis. In cases of rupture of a cardiac cavity, acute and severe cardiac tamponade almost invariably occurs. This paper presents an exceptionally unusual case of non-penetrating cardiac trauma resulting in right atrium rupture contained by the pericardial cavity. A situation of exceptional hemodynamic balance was established with subacute, progressive cardiac tamponade that evolved during three months, presenting gradual right-heart failure instead of the expected acute and severe cardiac tamponade. The rupture of the atrium was successfully repaired.

Giant Circumflex Coronary Artery Fistula to the Superior Vena Cava in Patient With Multiple Valvular Disease

3 68-year-old man was admitted to our hospital with a history of dyspnea and considerable fatigue with xercise. Transthoracic echocardiography showed severe itral, aortic, and tricuspid regurgitation. The patient nderwent coronary angiography before surgery, which evealed a giant coronary artery fistula arising from the ircumflex artery (Fig 1). A multi-sliced computed tomoraphic scan was performed to delineate the fistula and ocalize its drainage. Three-dimensional reconstruction howed a tortuous course with multiple loops in the ateral wall (Fig 2) that seemed to end in the pulmonary rtery. Intravenous contrast enhancement allowed the ocation of the drainage orifice in the superior vena cava, ear the right atrium. The patient was operated on through a midline ternotomy. On opening the pericardium, the dilated essel (arrow) was seen to course from the lateral wall f the left ventricle through the transverse sinus, and it nished at the superior vena cava (Fig 3). It measured 5 mm in diameter. Cardiopulmonary bypass was stablished (with bi-caval cannulation) after occlusion f the fistula near its drainage. After mitral valve epair, aortic valve replacement, and tricuspid ring nnuloplasty, the superior vena cava was opened and

Response of the human myocardium to ischemic injury and preconditioning: The role of cardiac and comorbid conditions, medical treatment, and basal redox status

Background The diseased human myocardium is highly susceptible to ischemia/reoxygenation (I/R)-induced injury but its response to protective interventions such as ischemic preconditioning (IPreC) is unclear. Cardiac and other pre-existing clinical conditions as well as previous or ongoing medical treatment may influence the myocardial response to I/R injury and protection. This study investigated the effect of both on myocardial susceptibility to I/R-induced injury and the protective effects of IPreC. Methods and results Atrial myocardium from cardiac surgery patients (n = 300) was assigned to one of three groups: aerobic control, I/R alone, and IPreC. Lactate dehydrogenase leakage, as a marker of cell injury, and cell viability were measured. The basal redox status was determined in samples from 90 patients. The response to I/R varied widely. Myocardium from patients with aortic valve disease was the most susceptible to injury whereas myocardium from dyslipidemia patients was the least susceptible. Tissue from females was better protected than tissue from males. Myocardium from patients with mitral valve disease was the least responsive to IPreC. The basal redox status was altered in the myocardium from patients with mitral and aortic valve disease. Conclusions The response of the myocardium to I/R and IPreC is highly variable and influenced by the underlying cardiac pathology, dyslipidemia, sex, and the basal redox status. These results should be taken into account in the design of future clinical studies on the prevention of I/R injury and protection.

Effect of bioprostheses anti-calcification treatment: comparative follow-up between Mitroflow LX and Magna pericardial xenografts using a propensity score-weighted analysis

Objectives The efficacy of anti-calcification treatment of bioprosthetic heart valves remains unclear. The aim of this study was to compare the clinical outcomes between Mitroflow LX valve, without anti-calcification treatment, and the Carpentier-Edwards Perimount Magna (P-Magna), with anti-calcification treatment. Methods Between 2005 and 2012, 625 consecutive patients underwent aortic valve replacement either with a Mitroflow LX ( n  = 329) or a P-Magna ( n  = 296). Variables regarding patient-related risk factors and operative data were accounted for an inverse probability of treatment weighting analysis. Then, adjusted survival outcomes and the rate of structural valve disease (SVD) were assessed for each group. Results Mean follow-up times were 4.1 ± 2.29 years and 3.9 ± 2.63 years, respectively ( P  = 0.34). Adjusted overall survival rate was higher in the P-Magna group than in the Mitroflow LX group at 8 years (69.1% vs 51.9%, respectively) [HR = 1.44, 95% CI: 1.01 to 2.06; P  = 0.0467]. Similarly, the 8-year cardiac-related survival rate was also higher in the P-Magna group [HR = 1.99, 95% CI: 1.19 to 3.32; P  = 0.0083]. One patient (0.8%) with P-Magna and 23 patients (18.5%) with Mitroflow LX group developed SVD (0.24% per patient-year vs 4.5% per patient-year, respectively; P  < 0.001). At 5 and 8 years, valve-related survival rates did not differ significantly between both groups [HR = 1.67, 95% CI: 0.95 to 2.95; P  = 0.075]. Conclusions The P-Magna prosthesis showed significantly better overall and cardiac-related survival than the Mitroflow LX. The higher early SVD and reoperation rates seen with the Mitroflow LX prosthesis did not impact negatively on valve-related survival.

Aortic Arch Mycotic Aneurysm Due to Scedosporium Apiospermum Reconstructed With Homografts.

A 39-year-old female, active parenteral drug user was diagnosed of spondylodiscitis. A computed tomography (CT) scan showed an extensive aortic arch aneurysm. A positron emission tomography (PET)-CT scan, showing significant aortic wall uptake of the tracer through the whole aortic arch and the D8-D9 intervertebral disc, allowed us to suspect an aortitis despite negative blood cultures. The aneurysm was resected and reconstructed with 2 aortic homografts. Cultures of specimens from the aortic wall were positive to the fungi Scedosporium apiospermum. A new PET-CT scan 4 months after surgery showed absence of tracer uptake both at the homografts site and intervertebral disc.

Ischemic postconditioning of the isolated human myocardium: Role of the applied protocol

Background Ischemic postconditioning (IPostC), has been proposed as a useful approach to reduce infarct size in all species, but its clinical utility remains unclear. Objective To investigate the role played by the protocol used on the efficacy of IPostC in protecting the diseased human myocardium. Methods Myocardial atrial samples from patients were subjected to a 90 min ischemia/120 min reoxygenation followed by different IPostC protocols to investigate the role of the time of ischemia (30, 60, 90 and 120 s) and the number of cycles (1, 2, 3 and 4) with 60 and 120 s of total ischemic time. Muscles were also subjected to ischemic preconditioning (IPreC). The release of lactate dehydrogenase (LDH) and the measurement of tetrazolium bromide (MTT) were determined. Results IPostC increased the LDH and decreased the MTT values from those of control, independently of the duration of the conditioning ischemia. LDH and MTT values also worsened by augmenting the number of IPostC cycles whereas they were significantly improved by IPreC. However, analysis of individual results indicated that in approximately 1/3 of the cases IPostC exhibited some degree of protection especially in the presence of increased ischemic injury. Conclusions The present findings show that IPostC of the human myocardium may be influenced by the protocol used and also by the degree of the preceding ischemic injury. IPostC was beneficial in approximately 1/3 of the cases; however in the remaining cases it increased ischemic damage and, therefore, these results raise a word of caution on its broad clinical use.