Javier Cobiella
Cardiovascular Institute of the South
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Featured researches published by Javier Cobiella.
Circulation | 2015
Ignacio J. Amat-Santos; David Messika-Zeitoun; Hélène Eltchaninoff; Samir Kapadia; Stamatios Lerakis; Asim N. Cheema; Enrique Gutiérrez-Ibañes; Antonio J. Muñoz-García; Manuel Pan; John G. Webb; Howard C. Herrmann; Susheel Kodali; Luis Nombela-Franco; Corrado Tamburino; Hasan Jilaihawi; Jean-Bernard Masson; Fabio Sandoli de Brito; Maria Cristina Ferreira; Valter Correa Lima; José Armando Mangione; Bernard Iung; Alec Vahanian; Eric Durand; E. Murat Tuzcu; Salim Hayek; Rocio Angulo-Llanos; Juan José Gómez-Doblas; Juan Carlos Castillo; Danny Dvir; Martin B. Leon
Background— We aimed to determine the incidence, predictors, clinical characteristics, management, and outcomes of infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI). Methods and Results— This multicenter registry included 53 patients (mean age, 79±8 years; men, 57%) who suffered IE after TAVI of 7944 patients after a mean follow-up of 1.1±1.2 years (incidence, 0.67%, 0.50% within the first year after TAVI). Mean time from TAVI was 6 months (interquartile range, 1–14 months). Orotracheal intubation (hazard ratio, 3.87; 95% confidence interval, 1.55–9.64; P=0.004) and the self-expandable CoreValve system (hazard ratio, 3.12; 95% confidence interval, 1.37–7.14; P=0.007) were associated with IE (multivariate analysis including 3067 patients with individual data). The most frequent causal microorganisms were coagulase-negative staphylococci (24%), followed by Staphylococcus aureus (21%) and enterococci (21%). Vegetations were present in 77% of patients (transcatheter valve leaflets, 39%; stent frame, 17%; mitral valve, 21%). At least 1 complication of IE occurred in 87% of patients (heart failure in 68%). However, only 11% of patients underwent valve intervention (valve explantation and valve-in-valve procedure in 4 and 2 patients, respectively). The mortality rate in hospital was 47.2% and increased to 66% at the 1-year follow-up. IE complications such as heart failure (P=0.037) and septic shock (P=0.002) were associated with increased in-hospital mortality. Conclusions— The incidence of IE at 1 year after TAVI was 0.50%, and the risk increased with the use of orotracheal intubation and a self-expandable valve system. Staphylococci and enterococci were the most common agents. Although most patients presented at least 1 complication of IE, valve intervention was performed in a minority of patients, and nearly half of the patients died during the hospitalization period.Background— We aimed to determine the incidence, predictors, clinical characteristics, management, and outcomes of infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI). Methods and Results— This multicenter registry included 53 patients (mean age, 79±8 years; men, 57%) who suffered IE after TAVI of 7944 patients after a mean follow-up of 1.1±1.2 years (incidence, 0.67%, 0.50% within the first year after TAVI). Mean time from TAVI was 6 months (interquartile range, 1–14 months). Orotracheal intubation (hazard ratio, 3.87; 95% confidence interval, 1.55–9.64; P =0.004) and the self-expandable CoreValve system (hazard ratio, 3.12; 95% confidence interval, 1.37–7.14; P =0.007) were associated with IE (multivariate analysis including 3067 patients with individual data). The most frequent causal microorganisms were coagulase-negative staphylococci (24%), followed by Staphylococcus aureus (21%) and enterococci (21%). Vegetations were present in 77% of patients (transcatheter valve leaflets, 39%; stent frame, 17%; mitral valve, 21%). At least 1 complication of IE occurred in 87% of patients (heart failure in 68%). However, only 11% of patients underwent valve intervention (valve explantation and valve-in-valve procedure in 4 and 2 patients, respectively). The mortality rate in hospital was 47.2% and increased to 66% at the 1-year follow-up. IE complications such as heart failure ( P =0.037) and septic shock ( P =0.002) were associated with increased in-hospital mortality. Conclusions— The incidence of IE at 1 year after TAVI was 0.50%, and the risk increased with the use of orotracheal intubation and a self-expandable valve system. Staphylococci and enterococci were the most common agents. Although most patients presented at least 1 complication of IE, valve intervention was performed in a minority of patients, and nearly half of the patients died during the hospitalization period. # CLINICAL PERSPECTIVE {#article-title-37}
European Journal of Cardio-Thoracic Surgery | 2010
Luis Maroto; José E. Rodríguez; Javier Cobiella; Pedro Marcos
Re-operative heart-valve replacement is a high-risk procedure and even more so in elderly patients. Another option in high-risk patients with a degenerated aortic xenograft is the implant of a second aortic bioprosthesis using a transcatheter approach. We report two cases of patients with a severely degenerated porcine aortic bioprosthesis who were successfully treated by a transapical valve-in-a-valve implantation.
European Journal of Echocardiography | 2011
Iván J. Núñez-Gil; Alexandra Gonçalves; Enrique Rodríguez; Javier Cobiella; Pedro Marcos-Alberca; Luis Maroto; Covadonga Fernandez-Golfin; Manuel Carnero; Carlos Macaya; José Zamorano
Prosthesis deterioration rate, years after a previous surgical valve replacement, is rising. Usually, the standard management is reoperation, but for very high risk patients an alternative has arisen: the valve-in-valve approach. We present an 84-year-old Caucasian woman with a mitral bioprosthesis (Mosaic II, number 29) since 1994. Over the last few months the patient displayed worsening heart failure symptoms, until her current admission in NYHA III-IV functional class, because of a severely degenerated mitral prosthesis (severe regurgitation, severe pulmonary hypertension). The transapical access, conventionally used for transcatheter aortic valve implantation (Edwards SAPIEN THV 23) was chosen, guided by transoesophageal echocardiography (TOE) with a new three-dimensional (3D) probe. After the procedure, the mitral regurgitation completely disappeared, an appropriate valve opening was achieved (valve area >2 cm(2)) and the patient was discharged 6 days later, remaining well in the outpatient follow-up. Only a restricted number of patients have been submitted to mitral transcatheter valve-in-valve implantation and to the best of our knowledge this is the first accurate description of the 3D TOE part, focusing on the surgeon requirements.
Interactive Cardiovascular and Thoracic Surgery | 2011
Luis Maroto; Manuel Carnero; Jacobo Silva; Javier Cobiella; Nicasio Pérez-Castellano; Fernando Reguillo; Julián Pérez-Villacastín; José E. Rodríguez
We sought to determine if early recurrence of atrial fibrillation (AF) after surgical ablation is a risk factor of late failure. Between February 2004 to May 2009, 106 patients underwent surgical ablation of concomitant permanent AF with radiofrequency. Operations primarily consisted of valve surgery in 85% of patients. Hospital mortality was 2.8% (n = 3). The median follow-up was 37 months (interquartile rank 12-77), and was complete in 99% of patients. Freedom from AF was 82%, 76% and 68% at one, two and three years, respectively. Patients with early recurrence of AF had less prevalence of sinus rhythm in late follow-up (P < 0.001). Multivariate Cox regression analysis showed that AF duration [hazard ratio (HR) 1.014, 95% CI 1.009-1.020, P < 0.001] and early recurrence of AF (HR 3.45, 95% CI 1.50-7.95, P = 0.004) were independent risk factors for failure. In conclusion, in our series, early recurrence of AF after surgical ablation is a strong predictor of late failure.
The Annals of Thoracic Surgery | 2010
Jacobo Silva; Luis Maroto; Manuel Carnero; Isidre Vilacosta; Javier Cobiella; E. Villagrán; José E. Rodríguez
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.
European Journal of Cardio-Thoracic Surgery | 2009
Luis Maroto; José E. Rodríguez; Javier Cobiella; Jacobo Silva
Trans-apical aortic bioprosthesis implantation is currently evaluated as an alternative technique in high-risk patients. We report the case of a delayed upward displacement of a prosthesis after this procedure. It is hypothesised that the asymmetric calcification of the native valve and the presence of a mitral prosthesis caused the dislocation.
Heart | 2017
Carmen Olmos; Isidre Vilacosta; Gilbert Habib; Luis Maroto; Cristina Fernández; Javier Lopez; Cristina Sarriá; Erwan Salaun; Salvatore Di Stefano; Manuel Carnero; Sandrine Hubert; Carlos Ferrera; Gabriela Tirado; Afonso Freitas-Ferraz; Carmen Sáez; Javier Cobiella; Juan Bustamante-Munguira; Cristina Sánchez-Enrique; Pablo Elpidio García-Granja; Cécile Lavoute; Benjamin Obadia; David Vivas; Ángela Gutiérrez; José Alberto San Román
Objective To develop and validate a calculator to predict the risk of in-hospital mortality in patients with active infective endocarditis (IE) undergoing cardiac surgery. Methods Thousand two hundred and ninety-nine consecutive patients with IE were prospectively recruited (1996–2014) and retrospectively analysed. Left-sided patients who underwent cardiac surgery (n=671) form our study population and were randomised into development (n=424) and validation (n=247) samples. Variables statistically significant to predict in-mortality were integrated in a multivariable prediction model, the Risk-Endocarditis Score (RISK-E). The predictive performance of the score and four existing surgical scores (European System for Cardiac Operative Risk Evaluation (EuroSCORE) I and II), Prosthesis, Age ≥70, Large Intracardiac Destruction, Staphylococcus, Urgent Surgery, Sex (Female) (PALSUSE), EuroSCORE ≥10) and Society of Thoracic Surgeons’s Infective endocarditis score (STS-IE)) were assessed and compared in our cohort. Finally, an external validation of the RISK-E in a separate population was done. Results Variables included in the final model were age, prosthetic infection, periannular complications, Staphylococcus aureus or fungi infection, acute renal failure, septic shock, cardiogenic shock and thrombocytopaenia. Area under the receiver operating characteristic curve in the validation sample was 0.82 (95% CI 0.75 to 0.88). The accuracy of the other surgical scores when compared with the RISK-E was inferior (p=0.010). Our score also obtained a good predictive performance, area under the curve 0.76 (95% CI 0.64 to 0.88), in the external validation. Conclusions IE-specific factors (microorganisms, periannular complications and sepsis) beside classical variables in heart surgery (age, haemodynamic condition and renal failure) independently predicted perioperative mortality in IE. The RISK-E had better ability to predict surgical mortality in patients with IE when compared with other surgical scores.
Interactive Cardiovascular and Thoracic Surgery | 2008
Jacobo Silva; Natalia Ridao-Cano; Antonio Segura; Luis Maroto; Javier Cobiella; Manuel Carnero; Alberto Barrientos; José E. Rodríguez
Several studies have shown that the glomerular filtration rate is a strong predictor of mortality following cardiac surgery. This study was designed to identify the estimated glomerular filtration rate using the MDRD-4 equation as an independent predictive variable of mortality and to determine whether the inclusion of this variable could improve the discriminating power of the EuroSCORE. Data from 2014 consecutive patients who underwent cardiac surgery over a 3-year period were analysed. Mean glomerular filtration rate was 68.4+/-22.7 ml/min per 1.73 m(2); 704 patients (35%) showed a rate <or=60 ml/min/1.73 m(2). An estimated glomerular filtration rate <or=60 ml/min/1.73 m(2) was found to be an independent predictor of mortality adjusted for age, sex and EuroSCORE (P<0.001, OR 2.4, 95% CI 1.6-3.4). The discriminating power of the EuroSCORE improved when this variable was included: area under the ROC curve for EuroSCORE plus estimated glomerular filtration rate was 0.77 (0.73-0.81) compared to 0.75 (0.71-0.80) for the additive EuroSCORE (z=2.55, P<0.05) and 0.75 (0.71-0.80) for the logistic EuroSCORE (z=2.45, P<0.05). The estimated glomerular filtration rate using the MDRD-4 equation is an independent predictive factor of perioperative mortality in cardiac surgery. The inclusion of this variable could improve the discriminatory capacity of the EuroSCORE.
Cirugía Cardiovascular | 2013
Jacobo Silva; Manuel Carnero; Fernando Reguillo; Javier Cobiella; E. Villagrán; L. Montes; Zaadi Garcés; A. Ayaon; Luis Maroto; Ali Alswies; Enrique Rodríguez
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.
International Journal of Cardiology | 2014
Carlos Ferrera; Carlos Almería; Luis Maroto; Javier Cobiella; Jose Alberto de Agustin; José Luis Rodrigo; Fabián Islas; Pedro Marcos-Alberca; Jose E Rodriguez; Leopoldo Pérez de Isla; Carlos Macaya
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