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Carnero-Alcázar M, Montero-Cruces L, Cobiella-Carnicer J, Pérez-Camargo D, Maroto Castellanos L. Advanced considerations in survival analysis. Eur J Cardiothorac Surg 2024; 65:ezae020. [PMID: 38244566 DOI: 10.1093/ejcts/ezae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 02/16/2024] [Accepted: 02/16/2024] [Indexed: 01/22/2024] Open
Abstract
Investigation of survival during the follow-up period is common in cardiovascular research and has intrinsic issues that require precise knowledge, such as survival or censoring. Besides, as the follow-up period lengthens and events other than mortality are studied, the analysis becomes more complex, so Kaplan-Meier analyses or Cox models are not always sufficient. In this primer, we provide the reader with detailed information on the interpretation of the most common survival analyses and delve into methods to analyse competing risks or alternatives to the conventional methods when the proportional hazards assumption is not met.
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Affiliation(s)
| | | | | | - Daniel Pérez-Camargo
- Department of Cardiac Surgery, Hospital Clínico San Carlos, CardioRed1, Madrid, Spain
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Vivas D, Anguita-Gámez M, Ferrandis R, Esteve-Pastor MA, Echeverri M, Igualada J, Anguita M, Egocheaga I, Nozal-Mateo B, Abad-Motos A, Figuero E, Bouzó-Molina N, Lozano T, Álvarez-Ortega C, Torres J, Descalzo MJ, Catalá JC, Martín-Rioboo E, Molines A, Rodríguez-Contreras R, Carnero-Alcázar M, Marín F. Prospective observational registry of perioperative and periprocedural management of antithrombotic therapy in "real world": the REQXAA study. Rev Esp Cardiol (Engl Ed) 2023; 76:729-738. [PMID: 36914025 DOI: 10.1016/j.rec.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 01/23/2023] [Indexed: 03/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES There is scarce real-world evidence on the management of perioperative antithrombotic treatment according to current recommendations. The aim of this study was to analyze the management of antithrombotic treatment in patients undergoing surgery or another invasive intervention and to assess the consequences of this management on the occurrence thrombotic or bleeding events. METHODS This prospective, observational, multicenter and multispecialty study analyzed patients receiving antithrombotic therapy who underwent surgery or another invasive intervention. The primary endpoint was defined as the incidence of adverse (thrombotic and/or hemorrhagic) events after 30 days of follow-up with respect to management of perioperative antithrombotic drugs. RESULTS We included 1266 patients (male: 63.5%; mean age 72.6 years). Nearly half of the patients (48.6%) were under chronic anticoagulation therapy (mainly for atrial fibrillation; CHA2DS2-VASC: 3.7), while 53.3% of the patients were under chronic antiplatelet therapy (mainly for coronary artery disease). Low ischemic and hemorrhagic risk was found in 66.7% and 51.9%, respectively. Antithrombotic therapy management was in line with current recommendations in only 57.3% of the patients. Inappropriate management of antithrombotic therapy was an independent risk factor for both thrombotic and hemorrhagic events. CONCLUSIONS The implementation of recommendations on the perioperative/periprocedural management of antithrombotic therapy in real-world patients is poor. Inappropriate management of antithrombotic treatment is associated with an increase in both thrombotic and hemorrhagic events.
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Affiliation(s)
- David Vivas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain.
| | - María Anguita-Gámez
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - Raquel Ferrandis
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - María Asunción Esteve-Pastor
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, El Palmar, Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Marysol Echeverri
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Jesús Igualada
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Manuel Anguita
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Instituto Maimónides para la Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | | | - Beatriz Nozal-Mateo
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Ane Abad-Motos
- Servicio de Anestesiología y Reanimación, Hospital Universitario Infanta Leonor, Madrid, Spain; Servicio de Anestesiología y Reanimación, Hospital Universitario Donostia, San Sebastián, Gipuzkoa, Spain
| | - Elena Figuero
- Departamento de Especialidades Clínicas Odontológicas, Facultad de Odontología, Universidad Complutense, Madrid, Spain
| | - Nuria Bouzó-Molina
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Teresa Lozano
- Servicio de Cardiología, Hospital General Universitario Doctor Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Alicante, Spain
| | - Carlos Álvarez-Ortega
- Servicio de Cardiología, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPaz), Madrid, Spain
| | - Javier Torres
- Servicio de Cardiología, Hospital Universitario de Jaén, Jaén, Spain
| | | | - Juan Carlos Catalá
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital General Universitario de Valencia, Valencia, Spain
| | - Enrique Martín-Rioboo
- Medicina de Familia, Unidad de Gestión Clínica Poniente, Instituto Maimónides para la Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | - Alejandra Molines
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Marina Baixa, Villajoyosa, Alicante, Spain
| | - Rocío Rodríguez-Contreras
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Torrecárdenas, Almería, Spain
| | | | - Francisco Marín
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB)-Arrixaca, El Palmar, Murcia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Anguita-Gámez M, Giraldo MA, Nombela-Franco L, Eixeres Esteve A, Cuerpo G, Lopez-Menendez J, Gomez-Polo JC, Tirado-Conte G, Torres B, Pedraz Prieto A, Jimenez-Quevedo P, Lopez-Gude MJ, Mahia P, Cobiella J, Zamorano JL, Vilacosta I, Maroto L, Carnero-Alcázar M. Validation of the TRI-SCORE in patients undergoing surgery for isolated tricuspid regurgitation. Heart 2023; 109:1401-1406. [PMID: 37217297 DOI: 10.1136/heartjnl-2022-322067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Estimation of peri-procedural risk in patients with tricuspid regurgitation (TR) undergoing isolated tricuspid valve surgery (ITVS) is of paramount importance. The TRI-SCORE is a new surgical risk scale specifically developed for this purpose, which ranged from 0 to 12 points and included eight parameters: right-sided heart failure signs, daily dose of furosemide ≥125 mg, glomerular filtration rate <30 mL/min, elevated bilirubin (with a value of 2 points), age ≥70 years, New York Heart Association Class III-IV, left ventricular ejection fraction <60% and moderate/severe right ventricular dysfunction (with a value of 1 point). The objective of the study was to evaluate the performance of the TRI-SCORE in an independent cohort of patients undergoing ITVS. METHODS A retrospective observational study was performed in four centres, including consecutive adult patients undergoing ITVS for TR between 2005 and 2022. The TRI-SCORE and the traditional risk scores used in cardiac surgery (Logistic EuroScore (Log-ES) and EuroScore-II (ES-II)) were applied for each patient, and discrimination and calibration of the three scores were evaluated in the entire cohort. RESULTS A total of 252 patients were included. The mean age was 61.5±11.2 years, 164 (65.1%) patients were female, and TR mechanism was functional in 160 (63.5%) patients. The observed in-hospital mortality was 10.3%. The estimated mortality by the Log-ES, ES-II and TRI-SCORE was 8.7±7.3%, 4.7±5.3% and 11.0±16.6%, respectively. Patients with a TRI-SCORE ≤4 and >4 had an in-hospital mortality of 1.3% and 25.0%, p=0.001, respectively. The discriminatory capacity of the TRI-SCORE had a C-statistic of 0.87 (0.81-0.92), which was significantly higher than both the Log-ES (0.65 (0.54-0.75)) and ES-II (0.67 (0.58-0.79)), p=0.001 (for both comparisons). CONCLUSION This external validation of the TRI-SCORE demonstrated good performance to predict in-hospital mortality in patients undergoing ITVS, which was significantly better than the Log-ES and ES-II, which underestimated the observed mortality. These results support the widespread use of this score as a clinical tool.
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Affiliation(s)
- María Anguita-Gámez
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - María A Giraldo
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Gregorio Cuerpo
- Department of Cardiac Surgery, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Jose Lopez-Menendez
- Department of Cardiac Surgery, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Juan Carlos Gomez-Polo
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Gabriela Tirado-Conte
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Berenice Torres
- Department of Cardiac Surgery, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | - Alvaro Pedraz Prieto
- Department of Cardiac Surgery, Gregorio Marañón General University Hospital, Madrid, Spain
| | - Pilar Jimenez-Quevedo
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - Patricia Mahia
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Javier Cobiella
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - José Luis Zamorano
- Department of Cardiology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Isidre Vilacosta
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Luis Maroto
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Manuel Carnero-Alcázar
- Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Carnero-Alcázar M, Beltrao-Sial R, Montero-Cruces L, López-Vyzcaino M, Pérez-Camargo D, Sánchez R, Cobiella-Carnicer J, Fernández-Velasco D, Maroto-Castellanos LC. Ultrafast track versus conventional fast track in patients undergoing cardiac surgery: a propensity score-matched analysis. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad143. [PMID: 37607006 PMCID: PMC10460483 DOI: 10.1093/icvts/ivad143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 07/17/2023] [Accepted: 08/21/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVES We aimed at comparing the risk of major adverse events and length of stay between patients undergoing ultrafast track and conventional fast track. METHODS Retrospective cohort study adjusted by propensity score matching, including patients operated on between March 2020 and December 2022 of any of the following: coronary, valve surgery or ascending aorta surgery. Patients were divided into 2 groups: ultrafast track: extubation in the operating room and fast track: extubation attempted in the first 6 postoperative hours. The primary objective was to compare the risk of the combined event death, lung respiratory outcomes (reintubation, mechanical ventilation longer than 24 h or pneumonia), or acute renal failure. RESULTS A total of 1126 patients were included. A total of 579 (51.4%) were extubated in the operating room. A total of 331 pairs were available after matching by propensity score. The risk of the primary outcome was 11.8% (n = 39) in the fast-track group and 6.3% (n = 21) in the ultrafast-track group (P = 0.013), mostly driven by lung adverse events (6.9% vs 2.4%, P = 0.011) while no significant differences were detected in the risk of death (2.4% vs 1.8%, P = 0.77) or acute renal failure (8% vs 6.3%, P = 0.56). The risk of myocardial infarction was higher in the fast-track group (2.7% vs 0%, P = 0.039). The median length of stay in the postoperative intensive care unit was longer in the fast-track group [24.7 h (interquartile range 21.5; 62.9) vs 23.5 h (interquartile range 22; 46), P = 0.015]. CONCLUSIONS In patients undergoing cardiac surgery, extubation in the operating room is associated to a lower risk of postoperative complications (mostly driven by lung adverse events) and length of stay in intensive care unit as compared to fast track.
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Affiliation(s)
| | - Rosa Beltrao-Sial
- Department of Anesthesiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | - Rubén Sánchez
- Department of Anesthesiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - Luis C Maroto-Castellanos
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
- Complutense University, Madrid, Spain
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Carnero-Alcázar M, Maroto-Castellanos L, González-Ferrer JJ. Stand-alone surgery for atrial fibrillation. Rev Esp Cardiol (Engl Ed) 2023; 76:398-401. [PMID: 36669730 DOI: 10.1016/j.rec.2022.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 01/19/2023]
Affiliation(s)
| | | | - Juan José González-Ferrer
- Unidad de Electrofisiología, Servicio de Cardiología, Hospital Clínico San Carlos, CardioRed1, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Vivas D, Anguita-Gámez M, Ferrandis R, Pastor MAE, Echeverri M, Igualada J, Anguita M, Egocheaga I, Nozal-Mateo B, Abad-Motos A, Figuero E, Bouzó-Molina N, Lozano T, Álvarez-Ortega C, Torres J, Descalzo MJ, Catalá JC, Martín-Rioboo E, Molines A, Rodríguez-Contreras R, Carnero-Alcázar M, Marín F. Registro observacional prospectivo sobre la utilización del tratamiento antitrombótico durante el periodo perioperatorio y periprocedimiento en el «mundo real»: estudio REQXAA. Rev Esp Cardiol 2023. [DOI: 10.1016/j.recesp.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Pérez-Camargo D, Montero L, Carnero-Alcázar M, Cuervo J, Cobiella J, Campelos-Fernández P, Reguillo-Lacruz F, Martí B, González P, Maroto LC. Resultados clínicos y consumo de recursos tras sustitución valvular aórtica con prótesis biológicas o mecánicas en pacientes de 65 años o más. Cirugía Cardiovascular 2022. [DOI: 10.1016/j.circv.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Fernández-de-Velasco D, Villamor-Jiménez C, Carnero-Alcázar M, Sánchez-Del-Hoyo R, Pérez-Camargo D, Montero-Cruces L, Torres-Maestro B, Giraldo MA, Reguillo-Lacruz FJ, Campelos-Fernández P, Villagrán-Medinilla E, Kisuule F, Calleja-Sanz J, Maroto-Castellanos L, Álvarez-de-Arcaya A. Co-Management Reduces Mortality in Post-Sternotomy Mediastinitis. Surg Infect (Larchmt) 2022; 23:873-879. [PMID: 36346276 DOI: 10.1089/sur.2022.176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Post-sternotomy mediastinitis (PSM) is one of the most feared complications of cardiac surgery. The impact of a multidisciplinary management approach on this pathology is yet unknown. Patients and Methods: A multidisciplinary approach based on a co-management model (CMM) of care was initiated in January 2018 because of the incorporation of a hospitalist unit on a cardiac surgery department. An observational retrospective cohort study was designed to evaluate the impact of the CMM of care compared to the standard model (SM) of care in patients diagnosed with PSM. Our primary and secondary outcomes were survival time and treatment failure rate (two or more surgical procedures needed to solve PSM or PSM-related death), respectively. Data related to patient death date were collected from the Spanish National Death Index. A multivariable Cox regression model was created using those variables believed to be clinically relevant. Results: Ninety-one patients developed PSM from January 2010 to June 2020. Regarding the pre-operative clinical status, surgical procedure, and PSM severity, both groups had similar baseline characteristics. Patients were followed for a mean of 27.54 ± 30.5 months. A total of 60.3% of the SM group and 11.1% of the CMM group (p < 0.001) died. Treatment failure occurred in 53 patients (72.6%) in the SM group versus 7 (38.6%) in the CMM group (p = 0.007). The CMM independently reduced overall mortality (hazard ratio [HR], 0.11; 95% confidence interval [CI]. 0.01-0.83) and treatment failure rate (HR, 0.01; 95% CI, 0.001-0.183). Gram-positive bacterial infection (HR, 3.73; 95% CI, .6-8.3), and complete osteosynthesis material removal (HR, 0.47; 95% CI, 0.24-0.91) also influenced mortality in our model. Conclusions: A co-management care model reduced overall mortality in patients diagnosed with post-sternotomy mediastinitis.
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Affiliation(s)
| | - Cristina Villamor-Jiménez
- Department of Hospital Medicine, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Manuel Carnero-Alcázar
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Rafael Sánchez-Del-Hoyo
- Department of Methodological and Preventive Health Medicine and IdISSC of Hospital Clínico San Carlos, Madrid, Spain
| | - Daniel Pérez-Camargo
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Lourdes Montero-Cruces
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Blanca Torres-Maestro
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - María Alejandra Giraldo
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | | | - Paula Campelos-Fernández
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | | | - Flora Kisuule
- Division of Hospital Medicine, The Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jorge Calleja-Sanz
- Department of Hospital Medicine, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Luis Maroto-Castellanos
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
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Carnero-Alcázar M, Montero-Cruces L, Maroto-Castellanos L. Mixed models: an essential tool for non-independent data analysis. Eur J Cardiothorac Surg 2022; 62:6696720. [PMID: 36099051 DOI: 10.1093/ejcts/ezac462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/12/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Manuel Carnero-Alcázar
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Lourdes Montero-Cruces
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Luis Maroto-Castellanos
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
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Montero-Cruces L, Cobiella-Carnicer FJ, Carnero-Alcázar M, Pérez-Camargo D, Campelos Fernández P, Maroto-Castellanos LC. Experiencia de un centro en el reemplazo percutáneo de la válvula mitral mediante el dispositivo Tendyne™. Cirugía Cardiovascular 2022. [DOI: 10.1016/j.circv.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Giraldo-Molano MA, Pérez-Camargo D, Carnero-Alcázar M, Montero-Cruces L, Campelos-Fernández P, Reguillo-Lacruz F, Cobiella-Carnicer J, Maroto Castellanos LC. Sustitución valvular aórtica con bioprótesis convencionales o sin sutura: resultados clínicos y comportamiento hemodinámico a 3 años. Cirugía Cardiovascular 2022. [DOI: 10.1016/j.circv.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Carnero-Alcázar M, Montero-Cruces L, Pérez-Camargo D, Cobiella-Carnicer J, Beltrao Sial R, Villamor-Jiménez C, Maroto-Castellanos LC. Resultados de la cirugía coronaria en España. Análisis del conjunto mínimo básico de datos 2001-2020. Cirugía Cardiovascular 2022. [DOI: 10.1016/j.circv.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Pérez-Camargo D, Travieso A, Carnero-Alcázar M, Taramasso M, Cobiella-Carnicer J, Maroto-Castellanos LC. Neurological outcomes of transcatheter aortic valve implantation with or without cerebral embolic protection devices: A meta-analysis. J Stroke Cerebrovasc Dis 2022; 31:106605. [PMID: 35843052 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/20/2022] [Accepted: 06/12/2022] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION Cerebral embolic protection devices (CEPDs) are designed to prevent embolization of debris during transcatheter aortic valve implantation (TAVI). Current evidence from randomized clinical trials (RCTs) and observational studies is controversial. AIMS The purpose of this meta-analysis was to study the influence of CEPDs on stroke, silent ischemic lesions and neurocognitive function. METHODS A systematic search was conducted including RCTs or adjusted observational studies comparing TAVI with or without CEPDs. Pooled odds ratios, risk ratios or standardized mean differences with 95% confidence intervals were calculated using the inverse of variance method. Risk of bias sensitivity analyses and meta regression for CEPD type were also conducted. RESULTS Five RCTs and five adjusted observational studies were included (n= 159,865). Mean age of the patients was 81.1 (SD 1.04) years in CEPDs and 81 (SD 1.86) in non-CEPD. The overall quality of evidence using the GRADE system for each endpoint was low to very low, mainly due to serious risk of bias, inconsistency and imprecision. Random effects meta-analysis detected no significant differences between CEPD and non-CEPD (OR= 0.74; 95% CI 0.51-1.07; P= 0.105; I2= 82.1%) for 30-day stroke. This finding was consistent in meta regression for CEPD type and subgroup analyses by study type and CEPD type. No significant differences between groups were observed in cerebral DW-MRI assessment and neurocognitive function evaluation. CONCLUSION In the present meta- analysis of five RCTs and five adjusted observational studies, the use of a CEPD during TAVI was not associated with a significant benefit on 30- day stroke, total lesion volume per patient, number of ischemic lesions per patient and neurocognitive function assessments.
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Affiliation(s)
- Daniel Pérez-Camargo
- Cardiac Surgery Department, Hospital Universitario Clínico San Carlos, Madrid, Spain.
| | - Alejandro Travieso
- Cardiology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
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Montero-Cruces L, Carnero-Alcázar M, Reguillo-Lacruz FJ, Cobiella-Carnicer FJ, Pérez-Camargo D, Campelos-Fernández P, Maroto-Castellanos LC. One-Year Hemodynamic Performance of Three Cardiac Aortic Bioprostheses: A Randomized Comparative Clinical Trial. J Clin Med 2021; 10:jcm10225340. [PMID: 34830622 PMCID: PMC8625181 DOI: 10.3390/jcm10225340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background: We aimed to compare 1 year the hemodynamic in-vivo performance of three biological aortic prostheses (Carpentier Perimount Magna EaseTM, Crown PRTTM, and TrifectaTM). Methods: The sample used in this study comes from the “BEST-VALVE” clinical trial, which is a phase IV single-blinded randomized clinical trial with the three above-mentioned prostheses. Results: 154 patients were included. Carpentier Perimount Magna EaseTM (n = 48, 31.2%), Crown PRTTM (n = 51, 32.1%) and TrifectaTM (n = 55, 35.7%). One year after the surgery, the mean aortic gradient and the peak aortic velocity was 17.5 (IQR 11.3–26) and 227.1 (IQR 202.0–268.8) for Carpentier Perimount Magna EaseTM, 21.4 (IQR 14.5–26.7) and 237.8 (IQR 195.9–261.9) for Crown PRTTM, and 13 (IQR 9.6–17.8) and 209.7 (IQR 176.5–241.4) for TrifectaTM, respectively. Pairwise comparisons demonstrated improved mean gradients and maximum velocity of TrifectaTM as compared to Crown PRTTM. Among patients with nominal prosthesis sizes ≤ 21, the mean and peak aortic gradient was higher for Crown PRTTM compared with TrifectaTM, and in patients with an aortic annulus measured with metric Hegar dilators less than or equal to 22 mm. Conclusions: One year after surgery, the three prostheses presented a different hemodynamic performance, being TrifectaTM superior to Crown PRTTM.
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Carnero-Alcázar M, Pérez-Camargo D. Turn off the lights when leaving the operating room. Eur J Cardiothorac Surg 2021; 60:1332-1333. [PMID: 34568903 DOI: 10.1093/ejcts/ezab411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rodríguez-Caulo EA, Villaescusa JM, Hernández-Vaquero D, Aldámiz-Echevarría G, Bustamante-Munguira J, Carnero-Alcázar M, Berastegui E, Sbraga F, González-Santos JM, Garrido Jiménez JM, Gutiérrez E, López-Gude MJ, Laguna G, Valderrama-Marcos JF, Juárez C, Irabien Á, Ventosa-Fernández G, Margarit JA, Gracia-Baena JM, Cánovas S, Sádaba R, González-Barbeito M, Campos E, Barquero-Aroca JM. Impacto de la COVID-19 en los servicios de cirugía cardiovascular en España: Análisis de los grupos relacionados con el diagnóstico (Estudio SECCE-COVID-19 fase 2). Cirugía Cardiovascular 2021. [PMCID: PMC8017562 DOI: 10.1016/j.circv.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introducción y objetivos La pandemia por COVID-19 causada por infección del virus SARS-CoV-2 ha saturado al sistema sanitario español, afectándose la atención de las enfermedades cardiovasculares. Queremos cuantificar el impacto de la pandemia en el número de las intervenciones quirúrgicas cardíacas analizando los grupos relacionados con el diagnóstico (GRD) más prevalentes de nuestra especialidad. Métodos A instancias de la Sociedad Española de Cirugía Cardiovascular y Endovascular, se solicitó a todos los centros nacionales que quisieron participar, los datos de los códigos de GRD números 162 (cirugía sobre válvulas cardíacas con infarto o diagnóstico complejo), 163 (cirugía sobre válvulas cardíacas sin infarto o diagnóstico complejo), 165 (bypass coronario con infarto o diagnóstico complejo), 166 (bypass coronario sin infarto o diagnóstico complejo) y 167 (otros procedimientos cardiotorácicos o vasculares torácicos) entre el 1 de marzo de 2020 y el 30 de septiembre de 2020 (siete meses), y como período control las mismas fechas de 2019. Resultados Se recibieron los datos de 24 hospitales, 22 públicos y dos privados. Existió un descenso global en el número de intervenciones del 30% (rango -19 a -42%, p < 0,001) de 4.648 en 2019 a 3.262 en 2020 (-1.386 de diferencia), siendo +7% para el GRD 162 (p = 0,500), -37% para el 163 (p = 0,001), -9% para el 165 (p = 0,304), -32% para el 166 (p = 0,001), y -16% para el 167 (p = 0,062). Conclusiones Existió un descenso global de cirugías estadísticamente significativo en 2020 del 30% respecto del 2019 entre el 1 de marzo y el 30 de septiembre.
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Carnero-Alcázar M, Maroto-Castellanos LC. Debate: The role of coronary artery bypass grafting for left main disease after EXCEL and NOBLE trials. ACTA ACUST UNITED AC 2021; 74:648-650. [PMID: 33715978 DOI: 10.1016/j.rec.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/21/2020] [Indexed: 10/21/2022]
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Carnero-Alcázar M, Maroto-Castellanos LC. Debate: Papel de la revascularización quirúrgica del tronco coronario izquierdo tras los ensayos EXCEL y NOBLE. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Carnero-Alcázar M, Maroto-Castellanos LC, Hernández-Vaquero D, López-Menéndez J, Hornero-Sos F, Silva-Guisasola J, Cobiella-Carnicer J, Pérez-Camargo D, Álvarez-de Arcaya MA, Campelos-Fernández P, Elvira-Martínez C. Sustitución valvular aórtica convencional aislada en España: tendencias nacionales de riesgo, tipo de prótesis y mortalidad entre 1998 y 2017. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2020.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Carnero-Alcázar M, Cobiella-Carnicer J, Mahia-Casado P, Maroto-Castellanos LC. Combined off-pump mitral repair and thoracoscopic maze surgery. Asian Cardiovasc Thorac Ann 2020; 29:217-219. [PMID: 32998525 DOI: 10.1177/0218492320963978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 67-year-old man with severe mitral regurgitation and paroxysmal atrial fibrillation was admitted to our institution for surgical repair. The procedure was carried out off-pump. We first performed a totally thoracoscopic maze box lesion set with epicardial transmural radiofrequency, and clipped the left atrial appendage. The mitral valve prolapse was repaired by implanting three transapical neochordae. Six months later, the patient was in sinus rhythm with minimal residual mitral regurgitation on echocardiography. This novel approach is less invasive than the standard surgical correction and should ensure a faster recovery with similar safety and efficacy in selected cases.
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Montero-Cruces L, Luque-Díaz TS, Ramchandani-Ramchandani B, Carnero-Alcázar M, Maroto-Castellanos LC. Endocarditis protésica precoz tras implante de prótesis valvular aórtica transcatéter por vía transfemoral. Cirugía Cardiovascular 2019. [DOI: 10.1016/j.circv.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ferrera C, Vilacosta I, Fernández C, López J, Sarriá C, Olmos C, Carnero-Alcázar M, Vivas D, Di Stefano S, Sáez C, Cobiella J, García-Arribas D, Maroto Castellanos LC, San Román JA. Early surgery for acute-onset infective endocarditis. Eur J Cardiothorac Surg 2019; 54:1060-1066. [PMID: 29873701 DOI: 10.1093/ejcts/ezy208] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 04/28/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Acute onset of infective endocarditis has been previously linked to the development of septic shock and a worse prognosis. The purpose of this study was to analyse the clinical features and in-hospital evolution of patients with acute-onset endocarditis as well as the potential role of early surgery in the treatment of these patients. METHODS From 1996 to 2014, 1053 consecutive patients with left-sided endocarditis were prospectively included. Patients were classified into 2 groups according to the clinical presentation: patients with acute-onset endocarditis (n = 491) and patients with non-acute endocarditis (n = 562). Acute-onset endocarditis was considered when the time between the appearance of symptoms and diagnosis was <15 days. RESULTS At admission, acute renal failure, septic shock and cerebral embolism predominated among patients with acute-onset endocarditis. Staphylococcus aureus was more frequently isolated in patients with an acute onset (27.7% vs 7.8% P < 0.001). During hospitalization, patients with acute onset developed systemic embolism and septic shock more frequently. Death was much more common in this group (42.7 vs 30.1%, P < 0.001). Paravalvular complications, nosocomial infection, heart failure, S. aureus and septic shock were predictors of mortality. Acute-onset presentation of endocarditis was strongly associated with increased mortality. Among patients with acute-onset endocarditis, early surgery, performed within the first 2 days after diagnosis, was associated with a 64% of reduction in mortality. CONCLUSIONS Patients with endocarditis and acute onset of symptoms are at high risk of septic in-hospital complications and mortality. Early surgery, performed within the first 2 days after diagnosis, plays a central role in the treatment of these patients.
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Affiliation(s)
- Carlos Ferrera
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Isidre Vilacosta
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Cristina Fernández
- Servicio de Medicina Preventiva, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier López
- Instituto de Ciencias del Corazón (ICICOR), Hospital Universitario de Valladolid, CIBERCV, Valladolid, Spain
| | - Cristina Sarriá
- Servicio de Medicina Interna, Hospital Universitario de la Princesa, Madrid, Spain
| | - Carmen Olmos
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | - David Vivas
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Salvatore Di Stefano
- Instituto de Ciencias del Corazón (ICICOR), Hospital Universitario de Valladolid, CIBERCV, Valladolid, Spain
| | - Carmen Sáez
- Servicio de Medicina Interna, Hospital Universitario de la Princesa, Madrid, Spain
| | - Javier Cobiella
- Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | - J Alberto San Román
- Instituto de Ciencias del Corazón (ICICOR), Hospital Universitario de Valladolid, CIBERCV, Valladolid, Spain
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Montero-Cruces L, Ramchandani Ramchandani B, Villagrán-Medinilla E, Reguillo-LaCrucz FJ, Carnero-Alcázar M, Maroto-Castellanos LC. Tratamiento quirúrgico de la pericarditis constrictiva; 15 años de experiencia. Cirugía Cardiovascular 2019. [DOI: 10.1016/j.circv.2019.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Rodríguez-Cubillo B, Carnero-Alcázar M, Cobiella-Carnicer J, Rodríguez-Moreno A, Alswies A, Velo-Plaza M, Pérez-Camargo D, Sánchez Fructuoso A, Maroto-Castellanos L. Impact of postoperative acute kidney failure in long-term survival after heart valve surgery. Interact Cardiovasc Thorac Surg 2019; 29:35-42. [DOI: 10.1093/icvts/ivz035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/26/2019] [Accepted: 01/29/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Manuel Carnero-Alcázar
- Department of Cardiac Surgery, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Javier Cobiella-Carnicer
- Department of Cardiac Surgery, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Ali Alswies
- Department of Cardiac Surgery, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Daniel Pérez-Camargo
- Department of Cardiac Surgery, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Luis Maroto-Castellanos
- Department of Cardiac Surgery, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
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Pérez-Camargo D, Ramchandani B, Torres-Maestro B, Alswies AM, Cobiella-Carnicer J, Carnero-Alcázar M, Maroto-Castellanos LC. ¿Prótesis aórticas biológicas o mecánicas? Un análisis de supervivencia a largo plazo en pacientes de 50 a 69 años. Cirugía Cardiovascular 2018. [DOI: 10.1016/j.circv.2018.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Garcia-Bouza M, Carnero-Alcázar M, Ramchandani B, Cobiella FJ, Pérez-Camargo D, Villagrán-Medinilla E, Maroto-Castellanos LC. Prótesis híbridas en el tratamiento de la patología compleja de la aorta torácica. Experiencia de un centro en España. Cirugía Cardiovascular 2018. [DOI: 10.1016/j.circv.2018.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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García-Arribas D, Vilacosta I, Ortega Candil A, Rodríguez Rey C, Olmos C, Pérez Castejón MJ, Vivas D, Pérez-García CN, Carnero-Alcázar M, Fernández-Pérez C, Maroto L, Carreras JL. Usefulness of positron emission tomography/computed tomography in patients with valve-tube graft infection. Heart 2018; 104:1447-1454. [DOI: 10.1136/heartjnl-2017-312918] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/27/2018] [Accepted: 01/29/2018] [Indexed: 01/22/2023] Open
Abstract
ObjectiveInfection of valved aortic grafts is a rare entity whose diagnosis remains challenging. Positron emission tomography (PET)/CT has become a criterion for the diagnosis of infective endocarditis (IE) in prosthetic valves, but its role on ascending aortic graft infections remains unclear. This study aims to assess the diagnostic value of PET/CT in patients with valved aortic graft infection.Methods12 episodes with a valved aortic graft who had undergone a PET/CT due to suspicion of IE were prospectively included (group I) and compared with five controls free of infection who underwent PET/CT for other reasons (group II). Pathological uptake of 18F-fluorodeoxyglucose (FDG) and its pattern at the prosthetic valve and aortic graft were studied.ResultsDiagnosis of IE was confirmed in 9 out of 12 episodes of group I. 18F-FDG uptake was detectable in eight out of nine cases with a final diagnosis of IE. The most repeated pattern of uptake was homogeneous around the valve and heterogeneous around the tube. There was one false-negative study. Of the three patients in which IE was ruled out, there were two false positives and one true negative. In group II, there were three patients with a positive PET/CT study, two of them had active aortitis and the third was considered false positive.Conclusions18F-FDG PET/CT shows high sensitivity in the detection of infected aortic grafts. Thus, this technique should be considered in the diagnostic work-up of patients with suspicion of aortic graft infection. However, further validation of this approach is needed.
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Ferrera C, Vilacosta I, Gómez-Polo JC, Villanueva-Medina S, Cabeza B, Ortega L, Cañadas V, Carnero-Alcázar M, Martínez-López I, Maroto-Castellanos L, Serrano-Hernando FJ. Evolution and prognosis of intramural aortic hematoma. Insights from a midterm cohort study. Int J Cardiol 2017; 249:410-413. [DOI: 10.1016/j.ijcard.2017.09.170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 05/19/2017] [Accepted: 09/18/2017] [Indexed: 01/16/2023]
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Carnero-Alcázar M, Maroto LC, Cobiella-Carnicer J, Vilacosta I, Nombela-Franco L, Alswies A, Villagrán-Medinilla E, Macaya C. Transcatheter versus surgical aortic valve replacement in moderate and high-risk patients: a meta-analysis. Eur J Cardiothorac Surg 2017; 51:644-652. [PMID: 28007879 DOI: 10.1093/ejcts/ezw388] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 10/26/2016] [Indexed: 01/27/2023] Open
Abstract
Objectives The evidence of the benefits of transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR) for patients of high or intermediate surgical risk is not consistent. We performed a meta-analysis to compare major adverse outcomes after TAVR or SAVR. Methods We searched propensity score matched studies or randomized clinical trials comparing the risks of mortality, stroke, major bleeding, acute renal injury, pacemaker implantation, vascular complications and prostheses haemodynamic performance between TAVR and SAVR in patients with moderate or high risk. Combined odds ratios (ORs), relative risk or mean differences with corresponding 95% confidence intervals (CIs) were calculated using a random effects model. Analyses of sensitivity and publication bias were also conducted. Results We included 5 clinical trials and 37 observational studies, enrolling 20 224 patients (TAVR, n = 9099 and SAVR, n = 11 125). The pooled analysis suggested no differences in early (OR = 1.11, 95% CI 0.9-1.39, P = 0.355) or late mortality (relative risk = 0.91, 95% CI 0.78-1.05, P = 0.194). TAVR was associated with a lower risk of major bleeding (OR = 0.42, 95% CI 0.25-0.69, P < 0.001) and acute kidney injury (OR = 0.51, 95% CI 0.34-0.71) but with an increase in the incidence of pacemaker implantation (OR = 2.31, 95% CI 1.73-3.08) and vascular complications (OR = 4.88, 95% CI 2.84-8.39). Residual aortic regurgitation was more frequent after TAVR (OR= 6.83, 95% CI 4.87-9.6). SAVR prostheses were associated with poor trans-prosthetic gradients (mean difference: -2.4 mmHg, 95% CI - 3.27 to - 1.53). Conclusions TAVR and SAVR have similar short and long-term all-cause mortality and risk of stroke among patients of moderate or high surgical risk. TAVR decreases the risk of major bleeding, acute kidney injury and improves haemodynamic performance compared with SAVR but increases the risk of vascular complications, the need for a pacemaker and residual aortic regurgitation.
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Affiliation(s)
| | - Luis Carlos Maroto
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Isidre Vilacosta
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Ali Alswies
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Carlos Macaya
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
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Ayaon-Albarrán A, García-Bouza M, Ramchandani-Ramchandani B, Pérez-Camargo D, Cobiella-Carnicer J, Alswies A, Carnero-Alcázar M, Castañón-Cristóbal JL, Maroto Castellanos LC. Resultados de la cirugía coronaria sin circulación extracorpórea en el contexto del infarto agudo de miocardio. Cirugía Cardiovascular 2017. [DOI: 10.1016/j.circv.2016.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Carnero-Alcázar M, Villagrán-Medinilla E. Nuestra verdad sobre SYNTAX. Cirugía Cardiovascular 2017. [DOI: 10.1016/j.circv.2016.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Carnero-Alcázar M, Maroto-Castellanos LC, Rodríguez-Hernández JE. Letter by Carnero-Alcazar et al regarding article, "Quantification of incomplete revascularization and its association with five-year mortality in the Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) Trial: validation of the residual SYNTAX Score". Circulation 2014; 129:e354. [PMID: 24566071 DOI: 10.1161/circulationaha.113.005773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Carnero-Alcázar M, Silva Guisasola JA, Reguillo Lacruz FJ, Maroto Castellanos LC, Cobiella Carnicer J, Villagrán Medinilla E, Tejerina Sánchez T, Rodríguez Hernández JE. Validation of EuroSCORE II on a single-centre 3800 patient cohort. Interact Cardiovasc Thorac Surg 2012. [PMID: 23178391 DOI: 10.1093/icvts/ivs480] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To compare and validate the new European System for Cardiac Operative Risk Evaluation (EuroSCORE) II with EuroSCORE at our institution. METHODS The logistic EuroSCORE and EuroSCORE II were calculated on the entire patient cohort undergoing major cardiac surgery at our centre between January 2005 and December 2010. The goodness of fit was compared by means of the Hosmer-Lemeshow (HL) chi-squared test and the area under the curve (AUC) of the receiver operating characteristic curves of both scales applied to the same sample of patients. These analyses were repeated and stratified by the type of surgery. RESULTS Mortality of 5.66% was observed, with estimated mortalities according to logistic EuroSCORE and EuroSCORE II of 9 and 4.46%, respectively. The AUC for EuroSCORE (0.82, 95% confidence interval [CI] 0.79-0.85) was lower than that for EuroSCORE II (0.85, 95% CI 0.83-0.87) without the differences being statistically significant (P = 0.056). Both scales showed a good discriminative capacity for all the pathologies subgroups. The two scales showed poor calibration in the sample: EuroSCORE (χ(2) = 39.3, P(HL) < 0.001) and EuroSCORE II (χ(2) = 86.69, P(HL) < 0.001). The calibration of EuroSCORE was poor in the groups of patients undergoing coronary (P(HL) = 0.01), valve (P(HL) = 0.01) and combined coronary valve surgery (P(HL) = 0.012); and that of EuroSCORE II in the group of coronary (P(HL) = 0.001) and valve surgery (P(HL) < 0.001) patients. CONCLUSIONS EuroSCORE II demonstrated good discriminative capacity and poor calibration in the patients undergoing major cardiac surgery at our centre.
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Ayaon Albarrán A, Carnero-Alcázar M, Maroto Castellanos LC, Rodríguez Hernández JE. Giant aneurysm of the non-coronary sinus of Valsalva. Eur J Cardiothorac Surg 2012; 43:649. [PMID: 23002186 DOI: 10.1093/ejcts/ezs506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ali Ayaon Albarrán
- Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain.
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Carnero-Alcázar M, Alswies A, Villagrán Medinilla E, Maroto LC, Silva Guisasola JA, Cobiella Carnicer J, Tejerina Sánchez MT, Rodríguez Hernández JE. Mid-term outcomes after off-pump coronary surgery in patients with prior intracoronary stent. Eur J Cardiothorac Surg 2012; 41:1295-303. [PMID: 22219477 DOI: 10.1093/ejcts/ezr210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE An increasing number of patients undergoing heart surgery have had a prior coronary stent placement. This study was designed to examine the effect of this situation on the mid-term outcomes of off-pump coronary artery bypass graft (OP-CABG) surgery. METHODS A comparative retrospective non-randomized comparison was performed as follows: all patients undergoing OP-CABG from January 2005 to December 2009 at our centre were divided into two groups: those who did or did not have stents at the time of surgery. We compared the incidences of the following events: (i) death and (ii) combined major adverse cardiac events (MACEs): death, myocardial infarction (MI) and repeat revascularization. Cox's proportional hazards analysis adjusted by a propensity score (n:m) were performed to determine the effects of prior stent placement on the risks of such events. RESULTS A total of 1020 patients were included, of which 156 (15.6%) had at least one stent. The median follow-up was 32.32 months (interquartile rank 18.08-48). The overall 1, 3 and 5-year survival rates were 95, 92 and 91% for the without-stent group vs. 82, 77 and 74% for the with-stent group, respectively. The 1, 3 and 5-year survival rates free from MACEs were: 92, 87 and 76% for patients without stent vs. 77, 66 and 56% for those with stents. Patients with stent showed an increased risk of death [hazard ratio (HR) 3.631, 95% confidence interval (CI) 2.29-5.756] and MACEs (HR 2.784, 95% CI 1.962-3.951). When adjusted by the propensity score, prior stent placement continued to increase the risks of death (HR 3.795, 95% CI 2.319-6.21) and MACEs (HR 2.89, 95% CI 2.008-4.158). CONCLUSIONS Patients with intracoronary stents have a lower survival rate and a greater risk of death, MI or need for repeat revascularization during the mid-term follow-up after OP-CABG.
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Carnero-Alcázar M, Reguillo-Lacruz F, Alswies A, Villagrán-Medinilla E, Maroto-Castellanos LC, Rodríguez-Hernández JE. Short- and mid-term results for aortic valve replacement in octogenarians. Interact Cardiovasc Thorac Surg 2010; 10:549-54. [DOI: 10.1510/icvts.2009.218040] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Carnero-Alcázar M, Silva Guisasola JA, Rodríguez Hernández JE. eComment: Right ventricle bleeding secondary to vacuum assisted therapy? Interact Cardiovasc Thorac Surg 2010; 10:472. [DOI: 10.1510/icvts.2009.223891a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Carnero-Alcázar M, Reguillo-Lacruz F, Montes-Villalobos L, Rodríguez-Hernández JE. Mechanical prosthetic mitral valve thrombosis in a first trimester pregnant woman. Interact Cardiovasc Thorac Surg 2009; 10:116-8. [PMID: 19822606 DOI: 10.1510/icvts.2009.220806] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pregnant women with a mechanical heart prosthesis are at a higher risk of thromboembolic complications. The optimal anticoagulation strategy in this setting remains unclear. When prosthesis thrombosis happens and cardiac surgery must be performed, the risk of fetal mortality is high. Special attention must be paid to improve the placental perfusion during cardiopulmonary bypass (CPB) in order to improve fetal outcomes. A 31-year-old woman, nine weeks pregnant, was admitted to our institution due to a mitral mechanical prosthesis thrombosis. She had been receiving low molecular weight heparin (LMWH) since pregnancy was detected. She underwent a mitral valve replacement with CPB at 34 degrees C and a short cardiac arrest time. Both mother and fetus survived. We briefly review the different anticoagulation options during pregnancy and perfusion strategies on CPB to improve fetal outcomes.
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Carnero-Alcázar M, Alswies A, Pérez-Isla L, Silva-Guisasola JA, González-Ferrer JJ, Reguillo-Lacruz F, Zamorano JL, Rodríguez-Hernández E. Short-term and mid-term follow-up of sutureless surgery for postinfarction subacute free wall rupture. Interact Cardiovasc Thorac Surg 2009; 8:619-23. [PMID: 19324919 DOI: 10.1510/icvts.2008.200535] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report our short-term and mid-term results with sutureless repair of postinfarction subacute left ventricular free wall rupture (LVFWR). For this purpose, we evaluated the short-term and mid-term postoperative results assessed by clinical examination and echocardiography of all patients who underwent surgery for subacute LVFWR between January 2004 and January 2009. Twenty-one patients were operated. Direct suture repair of LVFWR was carried out in only one patient. In all other cases we used a pericardial patch with biological glue. Early mortality was 19% (n=4). The median duration of follow-up was 17.3 months (interquartile range, 5-38.7), with a 13-month survival of 76%. Follow-up echocardiography showed no constriction associated with the rupture zone in any patient. According to our early experience, sutureless LVFWR repair is safe, effective and reproducible, and offers acceptable morbidity and mortality during follow-up.
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