Jorge Rodríguez-Roda

Mortality risk prediction in infective endocarditis surgery: reliability analysis of specific scores†

OBJECTIVES We assessed the prognostic utility of risk scores in surgery for infective endocarditis (IE) to evaluate their reliability in mortality risk prediction. METHODS An observational retrospective study was developed to include all patients who underwent surgery for active IE from 2002 to 2016. Classical and endocarditis-specific risk scores were calculated. RESULTS A total of 180 patients were included in the study. The 30-day mortality rate was 26.82% [95% confidence interval (CI) 20.26-33.20%]. Classical risk scores were confirmed to have a suboptimal prognostic ability. Therefore, 4 IE-specific risk scores were calculated. Discrimination was evaluated using the area under the receiver operating characteristic curve. It was 0.76 (95% CI 0.68-0.82) for the Society of Thoracic Surgeons-IE (STS-IE) score; 0.68 (95% CI 0.58-0.76) for the De Feo-Cotrufo score; 0.73 (95% CI 0.66-0.79) for the PALSUSE score and 0.65 (95% CI 0.57-0.72) for the Costa score. The STS-IE score had higher discrimination when compared with the De Feo-Cotrufo score (P = 0.055) and the Costa score (P = 0.024); however, there was no significant difference when we compared the STS-IE score with the PALSUSE score (P = 0.58). Calibration was assessed using the Hosmer-Lemeshow test; an adequate calibration was confirmed in all 4 scores. CONCLUSIONS Specific risk scores had better prognostic performance than classical risk scores. The STS-IE score had the highest discrimination and was adequately calibrated. The PALSUSE score also showed optimal discrimination and calibration. The De Feo-Cotrufo score had a lower discrimination in our sample; however, the De Feo-Cotrufo score is recommended in the current guidelines. The Costa score had the lowest discrimination.

Situaciones especiales. Insuficiencia mitral isquémica

La insuficiencia mitral (IM) funcional tras un infarto de miocardio (IAM) se produce por un desequilibrio entre los componentes del aparato subvalvular mitral, conllevando un pronostico adverso, y llega a doblar la mortalidad. Esta enfermedad se denomina «insuficiencia mitral isquemica» (IMI). La ecocardiografia continua siendo la herramienta mas util en su diagnostico, aunque las pruebas para demostrar viabilidad miocardica son cada vez mas necesarias. En la actualidad se continua debatiendo cual es el tratamiento optimo debido a que ninguna de las multiples estrategias ha conseguido resultados realmente satisfactorios y por la ausencia de estudios aleatorizados. Las tecnicas quirurgicas han evolucionado desde la revascularizacion aislada a la cirugia mitral asociada con resultados controvertidos. Nuestro objetivo es revisar sus fundamentos basicos y las opciones quirurgicas para clarificar su tratamiento.

How to Adjust Neo-Chordae Length Accurately in Degenerative Mitral Regurgitation

We describe a simple technique for the accurate adjustment of polytetrafluoroethylene neochordae length in degenerative mitral regurgitation using the annuloplasty rings own suture as a reference instead of using sophisticated or less precise maneuvers. Two threads of the annuloplasty ring suture are placed at the level of the mitral valve annulus plane to be used as a reference to tie the neochordae.

Transapical Valve-in-valve Implantation in Failed Mitral Bioprostheses

4. Seib PM, Faulkner SC, Erickson CC, vanDevanter SH, Harrell JE, Fasules JW, et al. Blade and balloon atrial septostomy for left heart decompression in patients with severe ventricular dysfunction on extracorporeal membrane oxygenation. Catheter Cardiovasc Interv. 1999;46:179–86. 6. Amat-Santos IJ, Bergeron S, Bernier M, Allende R, Barbosa H, Urena M, et al. Leftatrial decompression through unidirectional left-to-right interatrial shunt for the treatment of left heart failure: first-in-man experience with the V-Wave device. Eurointervention. 2015;10:1127–31. 5. Gossett JG, Rocchini AP, Lloyd TR, Graziano JN. Catheter-based decompression of the left atrium in patients with hypoplastic left heart syndrome and restrictive atrial septum is safe and effective. Catheter Cardiovasc Interv. 2006;67:619–24.

Situaciones especiales. Endocarditis mitral

A pesar de los avances en el diagnostico y en el tratamiento, la endocarditis mitral continua presentando una alta morbimortalidad. El manejo de la endocarditis mitral requiere la participacion de todos los especialistas involucrados en el paciente, incluidos los cirujanos cardiovasculares. La indicacion quirurgica y el momento de la intervencion estan determinados por la funcion cardiaca, el control de la infeccion y los eventos embolicos. Diferentes estudios han demostrado la viabilidad y los buenos resultados de la reparacion mitral, por lo que aun no esta definido cual es la mejor opcion quirurgica.