Pilar Garrido

Factors associated with excessive bleeding in cardiopulmonary bypass patients: a nested case-control study

IntroductionExcessive bleeding (EB) after cardiopulmonary bypass (CPB) may lead to increased mortality, morbidity, transfusion requirements and re-intervention. Less than 50% of patients undergoing re-intervention exhibit surgical sources of bleeding. We studied clinical and genetic factors associated with EB.MethodsWe performed a nested case-control study of 26 patients who did not receive antifibrinolytic prophylaxis. Variables were collected preoperatively, at intensive care unit (ICU) admission, at 4 and 24 hours post-CPB. EB was defined as 24-hour blood loss of >1 l post-CPB. Associations of EB with genetic, demographic, and clinical factors were analyzed, using SPSS-12.2 for statistical purposes.ResultsEB incidence was 50%, associated with body mass index (BMI)< 26.4 (25–28) Kg/m2, (P = 0.03), lower preoperative levels of plasminogen activator inhibitor-1 (PAI-1) (P = 0.01), lower body temperature during CPB (P = 0.037) and at ICU admission (P = 0.029), and internal mammary artery graft (P = 0.03) in bypass surgery. We found a significant association between EB and 5G homozygotes for PAI-1, after adjusting for BMI (F = 6.07; P = 0.02) and temperature during CPB (F = 8.84; P = 0.007). EB patients showed higher consumption of complement, coagulation, fibrinolysis and hemoderivatives, with significantly lower leptin levels at all postoperative time points (P = 0.01, P < 0.01 and P < 0.01).ConclusionExcessive postoperative bleeding in CPB patients was associated with demographics, particularly less pronounced BMI, and surgical factors together with serine protease activation.

Thoracic aneurysm as a cause of chyluria: resolution by surgical treatment.

A 37-year-old man who had suffered a thoracic trauma presented night release of whitish urine 2 years later. Thoracic computed tomography and aortography demonstrated an aneurysm of the thoracic aorta. Lymphography confirmed the compression of the thoracic duct by the aneurysm. After surgical repair the patient has remained asymptomatic.

Impact of bendopnea on postoperative outcomes in patients with severe aortic stenosis undergoing aortic valve replacement

OBJECTIVES Bendopnea is a recently described symptom of advanced heart failure. Its prevalence and prognostic utility in other cardiac conditions are unknown. METHODS We prospectively enrolled 108 consecutive patients (75 ± 3 years, 68% men) with severe symptomatic aortic stenosis referred for surgical aortic valve replacement (SAVR). Preoperatively, patients were tested for bendopnea, which was considered to be present when dyspnoea occurred within 30 s of bending forward. Univariable and stepwise multivariable analyses tested the association of bendopnea with preoperative echocardiographic parameters and postoperative clinical outcomes. RESULTS Bendopnea was present in 46 of 108 (42%) patients. The mean time of onset was 10.5 ± 3.4 s. Bendopnea was associated with higher estimated pulmonary artery systolic pressures [51 (11) mmHg vs 40 (11) mmHg), P < 0.0001], smaller aortic valve area [0.66 (0.16) cm2 vs 0.76 (0.13) cm2, P = 0.0006] and longer duration of mechanical ventilation (P = 0.002) and length of stay in the hospital (P = 0.007). Following SAVR, in-hospital mortality in those with bendopnea versus those without bendopnea was 13% vs 3% (P = 0.07). In multivariable analysis, bendopnea was associated with duration of mechanical ventilation (parameter estimate 2.4, P < 0.0001) and length of stay in the hospital (parameter estimate 10.2, P ≤ 0.0001). CONCLUSIONS Bendopnea was present in a sizeable minority of patients (42%) with severe aortic stenosis referred for SAVR. Bendopnea was associated with higher pulmonary artery systolic pressure and smaller aortic valve area preoperatively and with longer duration of mechanical ventilation and length of hospitalization postoperatively. These data suggest that bendopnea provides prognostic information in patients with severe aortic stenosis undergoing SAVR.

Aortic root full detachment from the aortic annulus. aortitis role in the formation of a pseudoaneurysm to 3 years of an aortic valve replacement.

Results Redo open-heart surgery was performed, using femoral cannulation, mild hypothermia at 28°C, and circulatory arrest during 4 minutes, just to open and inspect the aorta. A big cavity acting as the aortic root, with irregular contour was observed. The floor of the cavity was the aortic prosthesis, the roof the beginning of true aortic root including both coronary ostia and the walls were formed by the roof of the left atrium, the main pulmonary artery, superior vena cava, right pulmonary artery and the rests of fibrotic and adhered pericardium. Aortic prosthesis seemed normofunctional, but the walls of the ascending aorta and aortic root were inflamed. A Bentall-De bono technique was performed. An Enterococcus faecalis was identified in the aortic wall by polymerase chain reaction. He was given six weeks of antibiotic therapy.

Factors related to permanent disability employment on patients fewer than 62 years operated by open heart surgery.

Results A cohort of 204 patients was studied. Age 51 +/9 years; 156 (76,5%) were male; Logistic Euroscore (LE) of 5.1 +/8.4, LVEF 58 +/11. Surgery was 86 (42.2%) CABG, 79 (38.7%) valvular, 16 (7.8%) combined surgery and 23 (11.3%) others. 28 (13.7%) were self-employed. 15 of them already had a PI at the time of surgery. Patients with PI presented a LE of 6.7+/3.9 Vs. 11+/5 (p = 0.006); age 53+/-6 vs 48 +/-10 (p < 0.001), with no difference in LVEF. There were more PI among women (57%) than male 41% (p = 0.046). There was a higher percentage of valvular surgery in women. Higher number of CABG and valvular surgery was associated with PI (p = 0.015). Conclusions Permanent work cessation activity after open-heart surgery was statistically determined with an older age, comorbidity, female gender and type of intervention. Valve surgery, the number of valves operated or higher number of bypasses increase the probability of PI.

Alternatives in the treatment of prosthetic infection after the Bentall-de Bono operation.

Method In case 1, three months after hospital discharge, a small fistula in the upper sternal scar was observed. When it was explored surgically, the fistula affected the superiorposterior part of the sternum and the pericardium was covering the prosthesis except in a small area over the left distal anastomosis of the dacron graft, which had a drop of pus. Cases 2 and 3 presented clear mediastinitis, with fever, leucocytosis and purulent effusion around the conduit, at 7 and 10 days after Bentall procedure. In case 1 s. Epidermidis was isolated and in cases 2 and 3 enterococci were cultured.

CARDIOVASCULAR RISK ASSESSMENT IN SMOKERS WHO ATTEND PRIMARY CARE SETTING: RETRATOS STUDY: PP.23.417

Introduction: Tobacco smoking is widespread and is one of the worlds most prevalent modifiable risk factors for morbidity and mortality, being one of the cardiovascular risk factors. Accordingly the SCORE model developed a scoring system for risk management, which provides an estimation of 10-years risk for fatal cardiovascular disease in Europeans. The SCORE model shows that quitting smoking would move many individuals from a high risk category to a lower one,. Design: Non-interventional study performed in Spanish primay care settings nation wide Objective: Assess the cardiovacular risk for a smoking patient who attends to a Spanish primary care setting based on the Score model and loss in life expectancy attributable to tobacco smoking. Material and Methodos: 2124 patients, aged 35 to 80 were included in 52 Spanish Primary Care setting. 1597 smokers and 527 non-smokers. Patients were asked for their smoking habits, comorbidities, cardiovascular Risk Factors, treatments. Results: Mean baseline characteristics were: age 53,1, 60,6% were men with Body Mass Index 27,2,. Number of cigarettes/day was 20,3, smoking duration 28,6 years. All of the smokers had a high nicotine dependence. 77,1% live in a city. 12,6% of the smokers had a previous history of peripheral artery disease vs 6,1% non-smokers, and 23,9% of Chronic Obstructive Pulmonary Disease vs 5,8% of non-smokers. Global cardiovascular disease Mortality risk based on the SCORE model was for non-smokers vs smokers (1,9 vs 4,0 respectively) p < 0,0001. Coronary arterial disease mortality risk 1,1 vs 2,6; p < 0,0001. Non-coronary mortality risk 0,8 vs 1,4;p < 0,0001. The Global cardiovascular disease mortality, no matter the age, was higher in the smoker group than in the non—smoker group: Between 35 to 55 years of age cardiovascular disease mortality for non-smokers vs smokers was 0,5 vs 1,2; p < 0,0001; between 56–70 years of age: 3,3 vs 7,3; p < 0,0001 and between 71 to 80 years of age: 7,7 vs 17,4; p < 0,0001. Conclusion: Cardiovascular mortality calculated by the SCORE equation is higher for smokers than for non smokers at any age range.

CARDIOVASCULAR RISK FACTORS IN SMOKERS VS NON-SMOKERS IN A PRIMARY CARE SETTING: RETRATOS STUDY: PP.20.305

Introduction and Objective: Smoking is a key cardiovascular risk factor. The potential contributory effect of smoking cessation to survival and quality of life of cardiovascular patients in daily clinical practice in Spain is not known. The objective of the study is to assess the Cardiovascular risk for a smoker who attends to a Spanish primary care setting based on the Score model and loss in life expectancy attributable to tobacco smoking. Methods: Non-interventional study performed in a Spanish primary care setting at a national level. Patients: 2124 patients, aged 35 to 80 years, 1597 smokers and 527 non-smokers, were included in 52 Spanish primary units. Patients were asked about their smoking habits, comorbidities, Cardiovascular risk factors and medications. Results: Mean age was 53.1 years; Body Mass Index27.2 and 60.6% were men. The mean number of cigarettes/day was 20.3 and the average smoking duration was 28.6 years. All smokers had a high nicotine dependence and 77.1% lived in an urban environment. Comparing smokers with non-smokers all comorbidities and risk factors were significantly more prevalent in smokers Figure 1. No caption available. The prevalence of previous myocardial infarction or peripheral vascular disease was 3.13 times higher and 1.51 times higher respectively in smokers patients than in non-smokers. Conclusion: Cigarette smoking is a major cardiovascular risk factor and is associated with a negative lipid profile, higher blood pressure and worse glucose metabolism. Smoking cessation is beneficial at any stage as it improves prognosis and quality of life, even after disease onset.

Drenajes torácicos flexibles de pequeño calibre en cirugía cardíaca. Eficacia y seguridad de un nuevo sistema

INTRODUCTION The use of thoracic drains after cardiac surgery is distressing to patients and can cause a local inflammatory response. The objective of this study was to demonstrate the efficacy and safety of the flexible Blake drain for mediastinal and pleural drainage following cardiac surgery. MATERIAL AND METHOD We retrospectively studied 292 consecutive patients who underwent open heart surgery. The patients were divided in 2 groups: group A: 152 patients (Blake drain, 19 Ch) and group B: 140 patients (semi-flexible drains, 32 Ch). There were no significant differences in gender (56 males and 96 females in group A vs 49 males and 91 females in group B), age (67 +/- 14 in group A vs 65 +/- 14 in group B) or type of intervention (group A: 90 coronary, 59 valvular, 3 other; group B: 82 coronary, 53 valvular, 6 other). Preoperative parameters were similar in both groups. All patients received tranexamic acid as anti-fibrinolytic treatment. RESULTS Postoperative bleeding was lower in group A (742 +/- 368) than in group B (872 +/- 439) (p = 0.042). The number of transfusions and re-operations for bleeding re-exploration was similar in both groups. Patient satisfaction was significantly greater in the group with flexible drains (p < 0.005). CONCLUSIONS The use of flexible Blake drains reduced drainage after cardiac surgery without increasing the risk of bleeding or tamponade and can therefore be systematically used in cardiac surgery. Because of their flexibility, these drains produce less irritation, with accelerated recovery and lower analgesic use.