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Sandner S, Misfeld M, Caliskan E, Böning A, Aramendi J, Salzberg SP, Choi YH, Perrault LP, Tekin I, Cuerpo GP, Lopez-Menendez J, Weltert LP, Böhm J, Krane M, González-Santos JM, Tellez JC, Holubec T, Ferrari E, Doros G, Vitarello CJ, Emmert MY. Clinical outcomes and quality of life after contemporary isolated coronary bypass grafting: a prospective cohort study. Int J Surg 2023; 109:707-715. [PMID: 36912566 PMCID: PMC10389413 DOI: 10.1097/js9.0000000000000259] [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] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 02/01/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVES The objective of the European Multicenter Registry to Assess Outcomes in coronary artery bypass grafting (CABG) patients (DuraGraft Registry) was to determine clinical outcomes and quality of life (QoL) after contemporary CABG that included isolated CABG and combined CABG/valve procedures, using an endothelial damage inhibitor (DuraGraft) intraoperatively for conduit preservation. Here, we report outcomes in the patient cohort undergoing isolated CABG. METHODS The primary outcome was the composite of all-cause death, myocardial infarction (MI), or repeat revascularization (RR) [major adverse cardiac events (MACE)] at 1 year. Secondary outcomes included the composite of all-cause death, MI, RR, or stroke [major adverse cardiac and cerebrovascular events (MACCE)], and QoL. QoL was assessed with the EuroQol-5 Dimension questionnaire. Independent risk factors for MACE at 1 year were determined using Cox regression analysis. RESULTS A total of 2532 patients (mean age, 67.4±9.2 years; 82.5% male) underwent isolated CABG. The median EuroScore II was 1.4 [interquartile range (IQR), 0.9-2.3]. MACE and MACCE rates at 1 year were 6.6% and 7.8%, respectively. The rates of all-cause death, MI, RR, and stroke were 4.4, 2.0, 2.2, and 1.9%, respectively. The 30-day mortality rate was 2.3%. Age, extracardiac arteriopathy, left ventricular ejection fraction less than 50%, critical operative state, and left main disease were independent risk factors for MACE. QoL index values improved from 0.84 [IQR, 0.72-0.92] at baseline to 0.92 [IQR, 0.82-1.00] at 1 year ( P <0.0001). CONCLUSION Contemporary European patients undergoing isolated CABG have a low 1-year clinical event rate and an improved QoL.
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Affiliation(s)
| | - Martin Misfeld
- Royal Prince Alfred Hospital
- Institute of Academic Surgery at Royal Prince Alfred Hospital
- The Baird Institute of Applied Heart and Lung Surgical Research, Sydney
- Medical School, University of Sydney, Camperdown, New South Wales, Australia
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig
| | - Etem Caliskan
- Charité Universitätsmedizin Berlin
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin
| | | | | | | | - Yeong-Hoon Choi
- Kerckhoff Heart Center Bad Nauheim, Campus Kerckhoff Justus-Liebig University Giessen, Giessen
| | | | - Ilker Tekin
- Manavgat Government Hospital, Manavgat
- Bahçeşehir University Faculty of Medicine, Istanbul, Turkey
| | | | | | | | | | - Markus Krane
- Yale University School of Medicine, New Haven, Connecticut
| | | | | | | | | | | | | | - Maximilian Y. Emmert
- Charité Universitätsmedizin Berlin
- Deutsches Herzzentrum der Charité (DHZC), Department of Cardiothoracic and Vascular Surgery, Berlin
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Caliskan E, Misfeld M, Sandner S, Böning A, Aramendi J, Salzberg SP, Choi YH, Perrault LP, Tekin I, Cuerpo GP, Lopez-Menendez J, Weltert LP, Böhm J, Krane M, González-Santos JM, Tellez JC, Holubec T, Ferrari E, Emmert MY. Clinical event rate in patients with and without left main disease undergoing isolated CABG: results from the European DuraGraft registry. Eur J Cardiothorac Surg 2022; 62:6656349. [PMID: 35929787 DOI: 10.1093/ejcts/ezac403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 02/18/2022] [Revised: 07/25/2022] [Accepted: 08/01/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Left main coronary artery disease (LMCAD) is considered an independent risk factor for clinical events after coronary artery bypass grafting (CABG). We have conducted a subgroup analysis of the multicentre European DuraGraft registry to investigate clinical event-rates at 1-year in patients with and without LMCAD undergoing isolated CABG in contemporary practice. METHODS Patients undergoing isolated CABG were selected. The primary end-point was the incidence of a major adverse cardiac event (MACE) defined as the composite of death, myocardial infarction (MI) or repeat revascularization (RR) at 1-year. The secondary end-point was major adverse cardiac and cerebrovascular events (MACCE) defined as MACE plus stroke. Propensity score matching (PSM) was performed to balance for differences in baseline characteristics. RESULTS LMCAD was present in 1,033 (41.2%) and absent in 1,477 (58.8%) patients. At 1-year, the MACE rate was higher for LMCAD patients (8.2% vs 5.1%, p = 0.002) driven by higher rates of death (5.4% vs 3.4%, p = 0.016), MI (3.0% vs 1.3%, p = 0.002) and numerically higher rates of RR (2.8% vs 1.8%, p = 0.13). The incidence of MACCE was 8.8% vs 6.6%, p = 0.043 with a stroke rate of 1.0% and 2.4%, p = 0.011, for LMCAD and non-LMCAD group, respectively. After PSM, the MACE rate was 8.0% vs 5.2%, p = 0.015. The incidence of death was 5.1% vs 3.7%, p = 0.10, MI 3.0% vs 1.4%, p = 0.020, and RR was 2.7% vs 1.6%, p = 0.090, for the LMCAD and non-LMCAD group, respectively. Less strokes occurred in LMCAD patients (1.0% vs 2.4%, p = 0.017). The MACCE rate was not different: 8.5% vs 6.7%, p = 0.12. CONCLUSIONS In this large registry, LMCAD was demonstrated to be an independent risk factor for MACE after isolated CABG. Conversely, the risk of stroke was lower in LMCAD patients. TRIAL REGISTRATION ClinicalTrials.gov NCT02922088.
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Affiliation(s)
- Etem Caliskan
- Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center Berlin, Berlin, Germany
| | - Martin Misfeld
- Leipzig Heart Center, Leipzig, Germany.,Royal Prince Alfred Hospital, Sydney, Australia.,Institute of Academic Surgery at RPA, Sydney, Australia.,The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia.,Medical School, University of Sydney, Australia
| | - Sigrid Sandner
- Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Andreas Böning
- Universitätsklinikum Gießen und Marburg GmbH, Gießen, Germany
| | | | | | - Yeong-Hoon Choi
- Kerckhoff Heart Center Bad Nauheim, Campus Kerckhoff Justus-Liebig University Giessen
| | | | - Ilker Tekin
- Manavgat Government Hospital, Manavgat, Turkey.,Bahçeşehir University Faculty of Medicine, İstanbul, Turkey
| | | | | | | | | | - Markus Krane
- German Heart Center Munich, Munich, Germany.,Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | - Tomas Holubec
- Goethe University Frankfurt and University Hospital Frankfurt, Frankfurt, Germany
| | - Enrico Ferrari
- Cardiocentro Ticino Institute, Lugano, Switzerland.,University of Zurich, School of Medicine, Zurich, Switzerland
| | - Maximilian Y Emmert
- Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center Berlin, Berlin, Germany
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Castaño M, Sbraga F, de la Sota EP, Arribas JM, Luisa Cámara M, Voces R, Donado A, Sandoval E, Morales CA, González-Santos JM, Barquero-Alemán M, Feliu DFS, Rodríguez-Roda J, Molina D, Bellido A, Vigil-Escalera C, Ángeles Tena M, Reyes G, Gómez F, Rivas J, Guevara A, Tauron M, Miguel Borrego J, Castillo L, Miralles A, Cánovas S, Berastegui E, Aramendi JI, Aldámiz G, Pruna R, Silva J, de Ibarra JIS, Legarra JJ, Ballester C, Rodríguez-Lecoq R, Daroca T, Paredes F. Oxigenación con membrana extracorpórea en el paciente COVID-19: resultados del Registro Español ECMO-COVID de la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE). Cirugía Cardiovascular 2022. [PMCID: PMC8806126 DOI: 10.1016/j.circv.2022.01.007] [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: 11/16/2022] Open
Abstract
Introducción y objetivos La oxigenación con membrana extracorpórea (ECMO) ha resultado ser una opción terapéutica en los pacientes con insuficiencia respiratoria o cardiaca severa por COVID-19. Las indicaciones y manejo de estos pacientes están aún por determinar. Nuestro objetivo es evaluar los resultados de la terapia ECMO en pacientes con COVID-19 incluidos en un registro prospectivo e intentar optimizar los resultados. Métodos En marzo de 2020 se inició un registro multicéntrico anónimo prospectivo de pacientes con COVID-19 tratados mediante ECMO veno-arterial (V-A) o veno-venosa (V-V). Se registraron las variables clínicas, analíticas y respiratorias preimplante, datos de implante y evolución de la terapia. El evento primario fue la mortalidad hospitalaria de cualquier causa y los eventos secundarios fueron la recuperación funcional y el evento combinado de recuperación funcional y mortalidad de cualquier causa a partir de los 3 meses de seguimiento tras el alta. Resultados Se analizó a un total de 365 pacientes procedentes de 25 hospitales, 347 V-V y 18 V-A (edad media de 52,7 y 49,4 años, respectivamente). Los pacientes con ECMO V-V fueron más obesos, presentaban menos fracaso orgánico diferente al pulmonar y precisaron menos terapia inotrópica previa al implante. El 33,3% y el 34,9% de los pacientes con ECMO V-A y V-V, respectivamente, fueron dados de alta del hospital (p = NS) y la mortalidad fue similar, del 56,2% y 50,9% de los casos respectivamente, la inmensa mayoría durante la ECMO y sobre todo por fracaso multiorgánico. El 14,0% (51 pacientes) permanecían ingresados. El seguimiento medio fue de 196 ± 101,7 días. En el análisis multivariante, resultaron protectores de evento primario en pacientes con ECMO V-V el peso corporal (OR 0,967; IC 95%: 0,95-0,99; p = 0,004) y la procedencia del propio hospital (OR 0,48; IC 95%: 0,27-0,88; p = 0,018), mientras que la edad (OR 1,063; IC 95%: 1,005-1,12; p = 0,032), la hipertensión arterial (3,593; IC 95%: 1,06-12,19; p = 0,04) y las complicaciones en ECMO globales (2,44; IC 95%: 0,27-0,88; p = 0,019), digestivas (OR 4,23, IC 95%: 1,27-14,07; p = 0,019) y neurológicas (OR 4,66; IC 95%: 1,39-15,62; p = 0,013) fueron predictores independientes de mortalidad. El único predictor independiente de aparición de los eventos secundarios resultó el momento de seguimiento del paciente. Conclusiones La terapia con ECMO permite supervivencias hospitalarias hasta del 50% en pacientes con COVID-19 grave. La edad, la hipertensión arterial y las complicaciones en ECMO son los predictores de mortalidad hospitalaria en pacientes con ECMO V-V. Un mayor peso corporal y la procedencia del propio hospital son factores protectores. La recuperación funcional solo se ve influida por el tiempo de seguimiento transcurrido tras el alta. La estandarización de los criterios de implante y manejo del paciente con COVID grave mejoraría los resultados y la futura investigación clínica.
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Bermejo J, González-Mansilla A, Mombiela T, Fernández AI, Martínez-Legazpi P, Yotti R, García-Orta R, Sánchez-Fernández PL, Castaño M, Segovia-Cubero J, Escribano-Subias P, Alberto San Román J, Borrás X, Alonso-Gómez A, Botas J, Crespo-Leiro MG, Velasco S, Bayés-Genís A, López A, Muñoz-Aguilera R, Jiménez-Navarro M, González-Juanatey JR, Evangelista A, Elízaga J, Martín-Moreiras J, González-Santos JM, Moreno-Escobar E, Fernández-Avilés F. Persistent Pulmonary Hypertension in Corrected Valvular Heart Disease: Hemodynamic Insights and Long-Term Survival. J Am Heart Assoc 2021; 10:e019949. [PMID: 33399006 PMCID: PMC7955299 DOI: 10.1161/jaha.120.019949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background The determinants and consequences of pulmonary hypertension after successfully corrected valvular heart disease remain poorly understood. We aim to clarify the hemodynamic bases and risk factors for mortality in patients with this condition. Methods and Results We analyzed long-term follow-up data of 222 patients with pulmonary hypertension and valvular heart disease successfully corrected at least 1 year before enrollment who had undergone comprehensive hemodynamic and imaging characterization as per the SIOVAC (Sildenafil for Improving Outcomes After Valvular Correction) clinical trial. Median (interquartile range) mean pulmonary pressure was 37 mm Hg (32-44 mm Hg) and pulmonary artery wedge pressure was 23 mm Hg (18-26 mm Hg). Most patients were classified either as having combined precapillary and postcapillary or isolated postcapillary pulmonary hypertension. After a median follow-up of 4.5 years, 91 deaths accounted for 4.21 higher-than-expected mortality in the age-matched population. Risk factors for mortality were male sex, older age, diabetes mellitus, World Health Organization functional class III and higher pulmonary vascular resistance-either measured by catheterization or approximated from ultrasound data. Higher pulmonary vascular resistance was related to diabetes mellitus and smaller residual aortic and mitral valve areas. In turn, the latter correlated with prosthetic nominal size. Six-month changes in the composite clinical score and in the 6-minute walk test distance were related to survival. Conclusions Persistent valvular heart disease-pulmonary hypertension is an ominous disease that is almost universally associated with elevated pulmonary artery wedge pressure. Pulmonary vascular resistance is a major determinant of mortality in this condition and is related to diabetes mellitus and the residual effective area of the corrected valve. These findings have important implications for individualizing valve correction procedures. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT00862043.
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Affiliation(s)
- Javier Bermejo
- Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónFacultad de Medicina, Universidad Complutense de Madrid, and CIBERCV Madrid Spain
| | - Ana González-Mansilla
- Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónFacultad de Medicina, Universidad Complutense de Madrid, and CIBERCV Madrid Spain
| | - Teresa Mombiela
- Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónFacultad de Medicina, Universidad Complutense de Madrid, and CIBERCV Madrid Spain
| | - Ana I Fernández
- Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónFacultad de Medicina, Universidad Complutense de Madrid, and CIBERCV Madrid Spain
| | - Pablo Martínez-Legazpi
- Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónFacultad de Medicina, Universidad Complutense de Madrid, and CIBERCV Madrid Spain
| | | | | | | | | | | | | | | | - Xavier Borrás
- Hospital Santa Creu i San Pau and CIBERCV Barcelona Spain
| | | | - Javier Botas
- Hospital Universitario Fundación Alcorcón Alcorcón Spain
| | | | | | | | - Amador López
- Hospital Universitario Reina Sofía Córdoba Spain
| | | | | | | | | | - Jaime Elízaga
- Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónFacultad de Medicina, Universidad Complutense de Madrid, and CIBERCV Madrid Spain
| | | | | | | | - Francisco Fernández-Avilés
- Hospital General Universitario Gregorio MarañónInstituto de Investigación Sanitaria Gregorio MarañónFacultad de Medicina, Universidad Complutense de Madrid, and CIBERCV Madrid Spain
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Barrio A, Dobarro D, Alzola E, Raposeiras S, González-Santos JM, Sánchez PL. Durable left ventricular assist device therapy in non transplant centers in Spain: initial experience. ACTA ACUST UNITED AC 2020; 73:338-340. [PMID: 31932234 DOI: 10.1016/j.rec.2019.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 09/27/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Alfredo Barrio
- Servicio de Cardiología, Hospital Universitario de Salamanca-IBSAL, CIBERCV, Salamanca, Spain.
| | - David Dobarro
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, CIBERCV, Vigo, Pontevedra, Spain
| | - Elisabete Alzola
- Servicio de Cardiología, Hospital Universitario de Salamanca-IBSAL, CIBERCV, Salamanca, Spain
| | - Sergio Raposeiras
- Servicio de Cardiología, Hospital Álvaro Cunqueiro, CIBERCV, Vigo, Pontevedra, Spain
| | - José M González-Santos
- Servicio de Cirugía Cardiaca, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Pedro L Sánchez
- Servicio de Cardiología, Hospital Universitario de Salamanca-IBSAL, CIBERCV, Salamanca, Spain
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Bermejo J, Yotti R, García-Orta R, Sánchez-Fernández PL, Castaño M, Segovia-Cubero J, Escribano-Subías P, San Román JA, Borrás X, Alonso-Gómez A, Botas J, Crespo-Leiro MG, Velasco S, Bayés-Genís A, López A, Muñoz-Aguilera R, de Teresa E, González-Juanatey JR, Evangelista A, Mombiela T, González-Mansilla A, Elízaga J, Martín-Moreiras J, González-Santos JM, Moreno-Escobar E, Fernández-Avilés F. Sildenafil for improving outcomes in patients with corrected valvular heart disease and persistent pulmonary hypertension: a multicenter, double-blind, randomized clinical trial. Eur Heart J 2019; 39:1255-1264. [PMID: 29281101 PMCID: PMC5905634 DOI: 10.1093/eurheartj/ehx700] [Citation(s) in RCA: 141] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 11/14/2017] [Indexed: 11/16/2022] Open
Abstract
Aims We aimed to determine whether treatment with sildenafil improves outcomes of patients with persistent pulmonary hypertension (PH) after correction of valvular heart disease (VHD). Methods and results The sildenafil for improving outcomes after valvular correction (SIOVAC) study was a multricentric, randomized, parallel, and placebo-controlled trial that enrolled stable adults with mean pulmonary artery pressure ≥ 30 mmHg who had undergone a successful valve replacement or repair procedure at least 1 year before inclusion. We assigned 200 patients to receive sildenafil (40 mg three times daily, n = 104) or placebo (n = 96) for 6 months. The primary endpoint was the composite clinical score combining death, hospital admission for heart failure (HF), change in functional class, and patient global self-assessment. Only 27 patients receiving sildenafil improved their composite clinical score, as compared with 44 patients receiving placebo; in contrast 33 patients in the sildenafil group worsened their composite score, as compared with 14 in the placebo group [odds ratio 0.39; 95% confidence interval (CI) 0.22–0.67; P < 0.001]. The Kaplan–Meier estimates for survival without admission due to HF were 0.76 and 0.86 in the sildenafil and placebo groups, respectively (hazard ratio 2.0, 95% CI = 1.0–4.0; log-rank P = 0.044). Changes in 6-min walk test distance, natriuretic peptides, and Doppler-derived systolic pulmonary pressure were similar in both groups. Conclusion Treatment with sildenafil in patients with persistent PH after successfully corrected VHD is associated to worse clinical outcomes than placebo. Off-label usage of sildenafil for treating this source of left heart disease PH should be avoided. The trial is registered with ClinicalTrials.gov, number NCT00862043.
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Affiliation(s)
- Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and CIBERCV. Dr Esquerdo 46. 28007 Madrid, Spain
| | - Raquel Yotti
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and CIBERCV. Dr Esquerdo 46. 28007 Madrid, Spain
| | | | | | | | | | | | | | - Xavier Borrás
- Hospital Santa Creu i San Pau and CIBERCV, Barcelona
| | | | - Javier Botas
- Hospital Universitario Fundación Alcorcón, Alcorcón
| | | | | | | | | | | | | | | | | | - Teresa Mombiela
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and CIBERCV. Dr Esquerdo 46. 28007 Madrid, Spain
| | - Ana González-Mansilla
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and CIBERCV. Dr Esquerdo 46. 28007 Madrid, Spain
| | - Jaime Elízaga
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and CIBERCV. Dr Esquerdo 46. 28007 Madrid, Spain
| | | | | | | | - Francisco Fernández-Avilés
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, and CIBERCV. Dr Esquerdo 46. 28007 Madrid, Spain
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Rodríguez-Roda J, Sáez de Ibarra JI, Gualis J, Lima P, Iglesias C, García-Fuster R, Porras C, Fletcher D, Gutiérrez-García F, Castellà M, Carrascal Y, Bernabeu E, Delgado L, Daroca T, Morales C, Sbraga F, González-Santos JM, Martín CE, Otero JJ, Adsuar A, Rodríguez R, Llorens R, Bel AM, Gomez-Vidal M. Registro español de reparación valvular 2016-2017. Cirugía Cardiovascular 2019. [DOI: 10.1016/j.circv.2019.02.003] [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: 11/27/2022] Open
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Rojas SV, Hanke JS, Avsar M, Ahrens PR, Deutschmann O, Tümler KA, Uribarri A, Rojas-Hernández S, Sánchez PL, González-Santos JM, Haverich A, Schmitto JD. Asistencia ventricular izquierda como terapia de destino: ¿la cirugía mínimamente invasiva es una alternativa segura? Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.03.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Barreiro-Pérez M, Uribarri A, López-Rodríguez J, Rojas SV, González-Santos JM, Sánchez PL. Evaluación integral de asistencia ventricular Heartware HVAD mediante tomografía computarizada cardiaca en cuatro dimensiones. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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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Rojas SV, Hanke JS, Avsar M, Ahrens PR, Deutschmann O, Tümler KA, Uribarri A, Rojas-Hernández S, Sánchez PL, González-Santos JM, Haverich A, Schmitto JD. Left Ventricular Assist Device Therapy for Destination Therapy: Is Less Invasive Surgery a Safe Alternative? ACTA ACUST UNITED AC 2017. [PMID: 28645834 DOI: 10.1016/j.rec.2017.03.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 10/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES The number of older patients with congestive heart failure has dramatically increased. Because of stagnating cardiac transplantation, there is a need for an alternative therapy, which would solve the problem of insufficient donor organ supply. Left ventricular assist devices (LVADs) have recently become more commonly used as destination therapy (DT). Assuming that older patients show a higher risk-profile for LVAD surgery, it is expected that the increasing use of less invasive surgery (LIS) LVAD implantation will improve postoperative outcomes. Thus, this study aimed to assess the outcomes of LIS-LVAD implantation in DT patients. METHODS We performed a prospective analysis of 2-year outcomes in 46 consecutive end-stage heart failure patients older than 60 years, who underwent LVAD implantation (HVAD, HeartWare) for DT in our institution between 2011 and 2013. The patients were divided into 2 groups according to the surgical implantation technique: LIS (n = 20) vs conventional (n = 26). RESULTS There was no statistically significant difference in 2-year survival rates between the 2 groups, but the LIS group showed a tendency to improved patient outcome in 85.0% vs 69.2% (P = .302). Moreover, the incidence of postoperative bleeding was minor in LIS patients (0% in the LIS group vs 26.9% in the conventional surgery group, P < .05), who also showed lower rates of postoperative extended inotropic support (15.0% in the LIS group vs 46.2% in the conventional surgery group, P < .05). CONCLUSIONS Our data indicate that DT patients with LIS-LVAD implantation showed a lower incidence of postoperative bleeding, a reduced need for inotropic support, and a tendency to lower mortality compared with patients treated with the conventional surgical technique.
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Affiliation(s)
- Sebastian V Rojas
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
| | - Jasmin S Hanke
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Philipp R Ahrens
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Ove Deutschmann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Kirstin A Tümler
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Aitor Uribarri
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany; Departamento de Cardiología, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | | | - Pedro L Sánchez
- Departamento de Cardiología, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - José M González-Santos
- Departamento de Cirugía Cardiaca, Hospital Universitario de Salamanca-IBSAL, Salamanca, Spain
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Barreiro-Pérez M, Uribarri A, López-Rodríguez J, Rojas SV, González-Santos JM, Sánchez PL. Comprehensive Assessment of the Heartware HVAD Left Ventricular Assist Device With 4-Dimensional Cardiac Computed Tomography. ACTA ACUST UNITED AC 2017; 70:1010-1011. [PMID: 28238649 DOI: 10.1016/j.rec.2017.01.024] [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: 10/14/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Manuel Barreiro-Pérez
- Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
| | - Aitor Uribarri
- Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Javier López-Rodríguez
- Servicio de Cirugía Cardiaca, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Sebastián V Rojas
- Clinic for Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - José M González-Santos
- Servicio de Cirugía Cardiaca, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Pedro L Sánchez
- Servicio de Cardiología, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
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12
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Castaño M, González-Santos JM, López J, García B, Centeno JE, Aparicio B, Bueno MJ, Díez R, Sagredo V, Rodríguez JM, García-Criado FJ. Effect of preoperative oral pravastatin reload in systemic inflammatory response and myocardial damage after coronary artery bypass grafting. A pilot double-blind placebo-controlled study. J Cardiovasc Surg (Torino) 2015; 56:617-629. [PMID: 25968407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Statins exert pleiotropic effects that result in cardioprotective and antiinflammatory properties. There is a lack of information about the effect of preoperative reloading statin administration in surgical coronary patients regarding myocardial protection, systemic inflammatory response (SIR) attenuation and nitric oxide (NO) metabolism. METHODS Thirty consecutive dyslipidemic patients under chronic treatment with statins were randomized to orally receive pravastatin 80 mg (N.=10), 40 mg (N.=10) or placebo (N.=10) two hours before anesthetic induction for non-emergent on-pump coronary artery bypass grafting (CABG) procedures. Perioperative peripheral venous and intraoperative CS blood samples were collected for determination of drug-related adverse effects, NO metabolism and both myocardial damage and SIR biomarkers. RESULTS Pravastatin reloading resulted in a significant and dose-related intense attenuation of SIR, but no differences in cardiac damage biomarker levels were demonstrated. NO release and inducible nitric oxide synthase expression was significantly reduced in both treatment groups. Highest pravastatin doses significantly increased systemic creatine phosphokinase (CPK) concentration compared with intermediate doses but no other adverse effects were observed. CONCLUSION Oral pravastatin reloading before non-emergent CABG significantly attenuates postoperative SIR and systemic NO/iNOS concentrations with no effect in perioperative myocardial damage. Highest pravastatin doses increase CPK levels and must be avoided in susceptible patients.
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Affiliation(s)
- M Castaño
- Department of Cardiac Surgery, León University Hospital, León, Spain -
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13
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López-Rodríguez FJ, González-Santos JM, Dalmau MJ, Bueno M. [Cardiac surgery in the elderly: comparison of medium-term clinical outcomes in octogenarians and the elderly from 75 to 79 years]. Rev Esp Cardiol 2008; 61:579-588. [PMID: 18570778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
INTRODUCTION AND OBJECTIVES The age of patients undergoing cardiac surgery has increased in recent years. Our aims were to investigate the medium-term clinical outcomes of surgery in octogenarians and to compare them with outcomes in other elderly individuals of a less advanced age. METHODS We investigated early mortality, the incidence of postoperative complications, medium-term survival and factors associated with these parameters in 589 consecutive elderly patients undergoing surgery: 140 were octogenarians aged 80-87 years (group I) while 449 were aged between 75 and 79 years (group II). RESULTS The two groups were similar. There was no difference in mortality (10.0% in group I vs. 10.9% in group II) or in the incidence of postoperative complications (22% in group I vs. 30% in group II). Emergency surgery, combined surgery and pulmonary hypertension were all independent predictors of mortality and of major postoperative complications. The 5-year survival rate was 79% in group I and 65% in group II (P=.832) and the cardiac event-free survival rate was 75% in group I and 64% in group II (P=.959). Overall, 97% of patients in both groups were in functional class I or II. The additive EuroSCORE and preoperative atrial fibrillation were both associated with increased mortality during follow-up. Being an octogenarian was not a predictor (hazard ratio=0.78; 95% confidence interval, 0.51-1.21; P=.373). CONCLUSIONS In selected octogenarians, cardiac surgery gives similar results to those obtained in other elderly individuals of a less advanced age. The medium-term survival rate and quality of life are good. Pulmonary hypertension, emergency surgery and combined surgery all increased risk in these patients.
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Javier López-Rodríguez F, González-Santos JM, José Dalmau M, Bueno M. Cirugía cardiaca en el anciano: comparación de resultados a medio plazo entre octogenarios y ancianos de 75 a 79 años. Rev Esp Cardiol 2008. [DOI: 10.1157/13123063] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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15
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Dalmau MJ, González-Santos JM, López-Rodríguez J, Arribas A. The new carpentier-edwards perimount magna bioprosthesis: early clinical and hemodynamic performance. Thorac Cardiovasc Surg 2006. [DOI: 10.1055/s-2006-925698] [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: 10/19/2022]
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16
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Vallejo JL, González-Santos JM, Guisasola JS, Albertos J, Castaño M, Ruiz M, Riesgo MJ, Bastida E, Rico MJ, Fortuny R, González de Diego F, Alvarez Valdivielso M. [Reoperations of myocardial revascularization]. Rev Esp Cardiol 1998; 51 Suppl 3:86-92. [PMID: 9717409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
UNLABELLED Coronary by-pass grafting is a well established procedure for ameliorating ischemic coronary disease. From time to time it is necessary to re-operate these patients. The objective of our paper is to present our experience in this field. Retrospective analysis of 128 patients operated on between February 1978 and November 1996, has been analyzed. The mean age was 57.4 +/- 0.7 years. 77.2 +/- 5 months elapsed between operations. Stable angina (20.4%) or unstable angina (76.3%), myocardial infarction (48%) and congestive heart failure (17%) were the predominant clinical manifestations. RESULTS Hospital mortality was 10.9% (14 patients) and in the follow-up there were 16 deaths (14%). Perioperative myocardial infarction was the main cause of in-hospital mortality. In the follow-up there were 4 deaths due to myocardial infarction and another 4 patients died from neoplasms. Perioperative myocardial infarction was present in 9.3% (12 patients) IN CONCLUSION a) Re-do coronary by-pass grafting is still a good procedure for solving myocardial ischemia in spite of a higher mortality and morbidity than in the original operation. b) There is no progression in the number of patients according to our experience, probably due to better techniques and the frequent actions by an intervention cardiologist. c) The long-term results are good enough, but with a higher mortality.
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Affiliation(s)
- J L Vallejo
- Servicio de Cirugía Cardiovascular, Hospital General Universitario Gregorio Marañón, Madrid
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Abstract
BACKGROUND Massive calcification of the atrial walls ("porcelain atrium") is a rare condition that usually has been reported as an incidental radiologic findings. METHODS Between January 1988 and June 1993, 971 patients underwent valvular operation at our institution; 21 patients showed extensive calcification of the left atrium. In 8 patients the calcification was massive, involving almost all the atrial surface. The diagnoses were established by radiology and were confirmed at operation. The mean age of these patients (4 men, 4 women) was 55 +/- 9.6 years. All had rheumatic valve disease, were on atrial fibrillation, and had undergone at least one operation previously. Pulmonary artery pressure was severely increased, even up to systemic levels, in all patients except 1. Total endoatriectomy of the left atrium and mitral valve replacement were performed. No patient was lost during the follow-up. RESULTS Hospital mortality rate was 12.5% (1 patient) and 2 patients died in the late postoperative period. None of these deaths are attributable to the surgical procedure. CONCLUSIONS In toto endoatriectomy of a massively calcified atrium is an easy to perform technique that helps to replace the mitral valve and close the atrial wall.
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Affiliation(s)
- J L Vallejo
- Department of Cardiovascular Surgery, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Merino CM, Albertos J, Ortega OA, González-Santos JM, Garrido P, Fortuny R, González-de Diego JF, Rico MJ, Vallejo JL, Arcas R. [The implantable endocavitary cardioverter-defibrillator: the initial and short-term results]. Arch Inst Cardiol Mex 1993; 63:303-9. [PMID: 8215700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Utilization of endocavitary defibrillation electrodes avoids thoracotomy used in implantable cardioverter-defibrillator procedures, reducing associated morbi-mortality. In our institution we have used this approach in 16 patients during a two years period (July 1990-July 1992). Fifteen were males, with a mean age of 56.9 +/- 10.6 (range 32-73). Nine patients suffered ischemic cardiomyopathy, 4 non ischemic cardiomyopathy and in three there was no structural heart disease. Mean ejection fraction was 44.3 +/- 18.3% (range 20-73%). Clinical arrhythmia was ventricular tachycardia in 8 cases, ventricular fibrillation in 6 cases and both types in 2. Endocavitary implantation procedure was not completed in 3 patients, thus an open trans-sternal approach was performed. In 13 patients it was completed successfully, using a total amount of 14 units (1 patient required two procedures due to sepsis in the generator pouch). Most important intraoperative incidences have been defibrillation thresholds between 20-24 J in 4 cases, displacement of defibrillation electrode from vena cava into coronary sinus in 4 cases, epicardial patch implantation via subcostal approach in 1 case and right ventricle perforation in 1 case. No operative mortality was registered. One patient suffered sudden death during follow-up. Surgical complications were few: 1 case of lead dislodgement and 1 infected wound in the generator's pouch. Non-surgical complications were also few: 1 case with superior vena cava syndrome and 1 patient with inadequate discharges. In conclusion, due to our early experience, we believe that endocavitary implantation of an implantable cardioverter-defibrillator is the procedure of choice at the present time.
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Affiliation(s)
- C M Merino
- Servicio de Cirugía Cardiovascular, Hospital Gregorio Marañón, Madrid, España
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González-Santos JM, Bastida E, Vallejo JL, Fortuny R, Abukassem K, Ortega OA, Arcas R. Selective and adjustable pericardial flap to protect internal mammary artery grafts. Ann Thorac Surg 1990; 50:995-7. [PMID: 1978642 DOI: 10.1016/0003-4975(90)91145-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [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: 12/29/2022]
Abstract
We describe the surgical technique of a localized and adjustable pericardial flap to protect internal mammary artery grafts. This flap allows selective pulmonary retraction, maintains pleural integrity, and saves most of the pericardium for later closure. This technique has proved to be simple and highly effective. We have used it in 80 patients and have not had any related complications.
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Affiliation(s)
- J M González-Santos
- Department of Cardiovascular Surgery, Hospital General Gregorio Marañón Universidad Complutense, Madrid, Spain
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González-Santos JM, Bastida E, Riesgo M, Vallejo JL, Albertos JV, Fortuny R, Arcas R. Flow capacity of the human retrograde internal mammary artery: surgical considerations. Ann Thorac Surg 1990; 50:360-6. [PMID: 2400255 DOI: 10.1016/0003-4975(90)90475-l] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The diastolic flow of the retrograde internal mammary artery (IMA) was calculated in 30 patients and compared with the expected coronary flow of the left ventricle and that of specific branches. Arterial pressure and free flow were measured in the proximal and distal IMA as well as in the superior epigastric and musculophrenic arteries. Systolic and mean arterial pressure were significantly higher in the proximal IMA than in any other site, but diastolic pressure was comparable. Overall and diastolic antegrade IMA flows (77 +/- 6 and 44 +/- 3 mL/min) were significantly greater than the retrograde flows through the distal IMA (18.5 +/- 2 and 11.5 +/- 1 mL/min), musculophrenic artery (13.3 +/- 1 and 7.9 +/- 1 mL/min), and superior epigastric artery (5.3 +/- 0.4 and 3.1 +/- 0.2 mL/min). Only patient-size-related variables correlated significantly with retrograde IMA flow. Diastolic retrograde IMA flow represented 8.5% +/- 0.6% of the expected left ventricle coronary flow and in 12 patients (40%) was greater than the expected flow of at least one posteroinferior coronary artery. Based on these data, the retrograde IMA may adequately perfuse the posterior descending or other posterolateral coronary branches in select patients. Previous measuring of the retrograde flow is mandatory.
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Affiliation(s)
- J M González-Santos
- Department of Cardiovascular Surgery, Hospital General Gregorio Marañón, Universidad Complutense, Madrid, Spain
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González-Santos JM, Vallejo JL, Rico MJ, González-Santos ML, Horno R, García-Dorado D. Thrombosis of a mechanical valve prosthesis late in pregnancy. Case report and review of the literature. Thorac Cardiovasc Surg 1986; 34:335-7. [PMID: 2431509 DOI: 10.1055/s-2007-1022166] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A case of acute thrombosis of a mechanical mitral valve prosthesis (Medtronic-Hall) in a 34 weeks pregnant woman is reported. The clinical diagnosis was confirmed by Doppler echocardiography. Emergency surgery was performed starting with a cesarean section to save the fetus, followed by an obstetric hysterectomy. Valve thrombectomy could then be safely carried out. Both, the mother and child could be rescued by this combined intervention and were discharged from the hospital without further complications.
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González-Santos JM, González-Santos ML, Vallejo JL. Acute obstructive hydrocephalus: an unusual complication after cardiopulmonary bypass. Thorac Cardiovasc Surg 1986; 34:201-3. [PMID: 2426839 DOI: 10.1055/s-2007-1020411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A case of acute obstructive hydrocephalus in a patient undergoing an aortic valve replacement is presented. This condition came about as a result of massive left cerebellar hemisphere infarction, probably due to a calcific embolism from the aortic valve. The cerebrospinal fluid circulation was blocked by compression of the fourth ventricle and the Sylvius aqueduct secondary to ischemic edema. Following external ventricular drainage, the hydrocephalus resolved but a neurological deficit secondary to the cerebellar and brain stem infarction became evident. The diagnostic, prognostic and therapeutic implications of this unusual complication following cardiac surgery are discussed.
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