Francisco Estévez

Mid-term results of thoracic endovascular aortic repair in surgical high-risk patients.

Between May 2001 and June 2008, the outcome and morphological changes in thoracic aortic lesions of 20 surgical high-risk patients who underwent TEVAR were evaluated. Aortic lesions included 8 (40%) type B dissections, 5 (25%) atherosclerotic aneurysms, 4 (20%) penetrating ulcers and 3 (15%) traumatic aortic ruptures. All patients were classified as American Society of Anaesthesiologists class IV and obtained high scores in both the logistic European System for Cardiac Operative Risk Evaluation, median of 14.5% (range 8.1-65.7%), and the STS Parsonet 95 scoring system, median of 14 (range 10-52). Endovascular stent-graft deployment was technically successful in all cases. No surgical conversion occurred. Early mortality was observed in two patients. Clinical and imaging follow-up was available in all patients at a median time of 28 months (range 4-89 months). Overall actuarial survival was 90% at one and five years and 60% at seven years. Mean diameter of the descending aorta decreased from 51.1+/-13 mm to 45.3+/-8 mm (P=0.032). Mean reduction in dimension of aneurysms was 10.7+/-8 mm. Endovascular thoracic aorta repair will probably benefit more patients with multiple comorbidities that limit their life expectancy than patients with a lower profile.

Reparación mitral de la insuficiencia mitral isquémica con anillo Carpentier-McCarthy-Adams IMR ETlogix®: resultados ecocardiográficos a medio plazo

En este estudio revisamos los fundamentos del anillo asimetrico Carpentier-McCarthy-Adams IMR ETlogix® en el tratamiento de la insuficiencia mitral isquemica cronica y exponemos la experiencia a medio plazo de nuestro centro. La mortalidad hospitalaria fue del 2,8%. El ecocardiograma al alta constato la ausencia de regurgitacion mitral en el 88,8% de pacientes. Se obtuvo seguimiento clinico y ecocardiografico (mediana, 23 meses; intervalo, 12-44 meses). El ecocardiograma de control tardio mostro recidiva de insuficiencia mitral de grado moderado en el 5,7% de pacientes y grado moderado-severo en el 2,9%. La supervivencia libre de recidiva de insuficiencia mitral ≥ 2+ fue del 95,2% a los 15 meses y del 88,9% a los 25 meses.La reparacion mitral con anillo asimetrico Carpentier-McCarthy-Adams IMR ETlogix® en pacientes con insuficiencia mitral isquemica cronica permite una eficaz correccion de la regurgitacion a traves de cambios asimetricos en la morfologia del anillo mitral, con excelentes resultados a medio plazo en cuanto al grado de competencia mitral.

Mitral Valve Repair for Ischemic Mitral Regurgitation Using the Carpentier-McCarthy-Adams IMR ETlogix ® Ring: Medium-Term Echocardiographic Findings

The aims of this study were to review the principles underlying use of the Carpentier-McCarthy-Adams IMR ETlogix® asymmetric annuloplasty ring for the treatment of chronic ischemic mitral regurgitation and to report medium-term clinical outcomes observed at our center. The in-hospital mortality rate was 2.8%. Echocardiography at hospital discharge confirmed the absence of mitral regurgitation in 88.8% of patients. Patients underwent clinical and echocardiographic follow-up (median duration, 23 months; range, 12-44 months). Late follow-up echocardiography demonstrated the recurrence of moderate mitral regurgitation in 5.7% of patients and of moderate-to-severe mitral regurgitation in 2.9%. The rate of survival free from recurrence of ≥grade-2 mitral regurgitation was 95.2% at 15 months and 88.9% at 25 months. Mitral valve repair using the asymmetric Carpentier-McCarthy-Adams IMR ETlogix® ring in patients with chronic ischemic mitral regurgitation enabled regurgitation to be effectively corrected by producing asymmetric changes in the morphology of the mitral ring. Medium-term outcomes, with regard to the degree of mitral valve competence, were excellent.

Chronic anemia in heart transplant patients: prevalence, risk factors, and prognostic significance

Introduction and objectives Data on chronic anemia following heart transplantation (HT) are scarce and contradictory. Our aims were to determine the prevalence of chronic anemia after HT, to identify predisposing factors for the condition at 12 months, and to evaluate its influence on mediumterm and long-term survival. Methods Retrospective analysis of patients who underwent HT between 1991 and 2005 (n=457). Chronic anemia was defined as a hemoglobin level Results The prevalence of post-HT chronic anemia was 75.5% at 1 month, 31% at 12 months, and 26.2% at 120 months. The condition was significantly more prevalent among women than men. Predisposing factors for chronic anemia 1 year post-HT were mild-to-moderate chronic renal failure (ie, creatinine level > 1.5 mg/dL; odds ratio [OR]=2.8; 95% confidence interval [CI], 1.5-5.0), female sex (OR=6.4; 95% CI, 3.1-13.2), and immunosuppression with mycophenolate mofetil compared with azathioprine (OR=2.6; 95% CI, 1.4-4.8). The prevalence of chronic anemia 12 months after HT was independent of the donors sex, the recipients age, the etiology of the recipients heart failure, diabetes mellitus, mild-to-moderate graft rejection, cytomegalovirus infection, and angiotensin-converting enzyme inhibitor treatment. The presence of chronic anemia 12 months after HT did not influence either long-term survival (mean, 11.5 years with chronic anemia vs 13.0 years without) or actuarial survival. Conclusions Post-HT chronic anemia is common, but improves with time and treatment. Predisposing factors for the condition 1 year post-HT include chronic renal failure, female sex, and immunosuppression with mycophenolate mofetil. The presence of chronic anemia does not appear to influence long-term survival.

Use of the Perceval Sutureless Valve in Active Prosthetic Aortic Valve Endocarditis

BACKGROUND Surgical treatment of active prosthetic aortic valve endocarditis presents a challenge for cardiac surgeons because of tissue friability and destruction caused by infection. Sutureless prostheses, such as the Perceval S (LivaNova, Saluggia, Italy), have emerged as an option among the different surgical approaches for these complicated cases. METHODS This study presents data from 9 patients who underwent aortic valve re-replacement with the Perceval S because of active prosthetic aortic valve endocarditis between January 2014 and August 2016. Hemodynamic performance (mean transprosthetic gradient and type of aortic regurgitation) was assessed intraoperatively after weaning from cardiopulmonary bypass, at discharge, and to 6 months postoperatively. RESULTS After weaning from cardiopulmonary bypass, cases 1 and 3 through 6 had no or trivial aortic regurgitation, cases 7 and 8 presented with trivial to mild regurgitation, case 9 showed mild intraprosthetic regurgitation, and case 2 had mild periprosthetic regurgitation. Cases 4 and 7 died of septic shock and multiorgan failure in the perioperative period. In the remaining patients, severity of aortic regurgitation maintained practically invariable at discharge compared with intraoperative results. These 7 patients did well at 6-month follow-up, with good clinical and hemodynamic performance of the Perceval S prosthesis. The median of mean transprosthetic gradient was 11 mm Hg (interquartile range: 10 to 12 mm Hg). Only patient 2 showed mild periprosthetic regurgitation; patient 9 showed mild intraprosthetic insufficiency, and the remaining patients had no or trivial regurgitation. CONCLUSIONS The sutureless Perceval S valve is a reasonable alternative for surgical treatment of prosthetic aortic valve endocarditis.

Mycotic Pseudoaneurysm Following a Bentall Procedure

(J Card Surg 2010;25:566‐567)

Reemplazo valvular aórtico con bioprótesis no soportada de Cryolife O'Brien

Introduccion y objetivos El xenoinjerto de Cryolife O’Brien es una bioprotesis no soportada, construida por valvas no coronarias de 3 valvulas aorticas porcinas. El objetivo de este estudio es investigar los resultados precoces despues del reemplazo valvular aortico con este xenoinjerto compuesto. Metodos Desde octubre de 1993, la bioprotesis Cryolife O’Brien ha sido implantada en 210 pacientes. La edad media fue de 70,9 ± 7,5 anos (intervalo, 23 y 83 anos). La indicacion fue estenosis aortica en 132 casos, insuficiencia aortica en 25 casos y doble lesion en 53 casos. Se ha estudiado la funcion valvular, mediante ecocardiografia preoperatoria, en el momento del alta y a los 6 y 12 meses del postoperatorio. Resultados La mortalidad a 30 dias fue del 5,2% (11/210). Los gradientes medios se reducen y el indice de area efectiva aortica aumenta con el tiempo. El indice de masa ventricular izquierda, el grosor de la pared y el espesor del septo tambien se reducen de forma precoz en el postoperatorio. Conclusiones El uso de la bioprotesis no soportada de Cryolife O’Brien ha mostrado unos resultados satisfactorios en el seguimiento a un ano. Sera necesario realizar seguimientos futuros para analizar el comportamiento de esta bioprotesis a largo plazo.