13 results on '"Miguel Solla-Buceta"'
Search Results
2. In-Hospital Post-Operative Infection after Heart Transplantation: Epidemiology, Clinical Management, and Outcome
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Rocío Gómez-López, Eduardo Barge-Caballero, Vanesa Aller-Fernández, María J. Paniagua-Martín, María G. Crespo-Leiro, Gonzalo Barge-Caballero, Paula Fernández-Ugidos, Miguel Solla-Buceta, Laura Fernández-Arias, José Manuel Vázquez-Rodríguez, David Couto-Mallón, and Carlos Velasco Garcia de Sierra
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Adult ,Male ,Microbiology (medical) ,medicine.medical_specialty ,Post operative infection ,medicine.medical_treatment ,Severity of Illness Index ,Sepsis ,03 medical and health sciences ,Postoperative Complications ,Nosocomial infection ,0302 clinical medicine ,Epidemiology ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Retrospective Studies ,Heart transplantation ,Cross Infection ,0303 health sciences ,030306 microbiology ,business.industry ,Post-operative infection ,Hemodynamics ,Antibiotic Prophylaxis ,Length of Stay ,Middle Aged ,medicine.disease ,Infectious Diseases ,Emergency medicine ,Heart Transplantation ,Female ,Heart transplant ,Surgery ,business - Abstract
Observational study [Abstract] Background: Infection is a major cause of morbidity and mortality after heart transplantation (HT). Little information about its importance in the immediate post-operative period is available. The aim of this study was to analyze the characteristics, incidence, and outcomes of in-hospital post-operative infections after HT. Methods: We conducted an observational, single-center study based on 677 adults who underwent HT from 1991 to 2015 and who survived the surgical intervention. In-hospital post-operative infections were identified retrospectively according to the medical finding in the clinical records. Results: Over a mean hospital stay of 24.5 days, 239 patients (35.3%) developed 348 episodes of infection (2 episodes per 100 patient-days). The most common sources of infection were those related to invasive procedures (respiratory infections, 115 [33%]; urinary tract infections, 47 [13.5%]; bacteremia, 42 [12.1%]; surgical site infections, 25 [7.2%]), in addition to abdominal focus (33, 9.5%). Enterobacteriaceae (76, 21.8%) and gram-positive cocci (58, 16.7%) were the predominant germs, although opportunistic infections were not infrequent (69, 19.8%). Ninety-five septic episodes were detected with a mean Sequential Organ Failure Assessment Score of 9.5 ± 5.3 points, with hemodynamic failure being the most severe organ dysfunction and renal dysfunction the most frequent one. Management included broad-spectrum antibiotics in 48.8% of episodes and surgical management in 13.8%. The overall antimicrobial success rate was 96.3%. Higher in-hospital mortality was observed among infected patients (15.1% vs. 10.3%), but this difference was not statistically significant (p = 0.067). The one-year survival and events were not different between patients suffering from a post-operative infection and those who did not. Conclusions: In-hospital infections were frequent in the post-operative period after HT and were associated with a poor short-term outcome. Patients who survived sepsis had a similar one-year morbidity and mortality compared with patients who did not develop an infection.
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- 2020
3. Galectina-3 circulante tras el trasplante cardiaco: dinámica a largo plazo y valor pronóstico
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Jorge Pombo-Otero, Antoni Bayes-Genis, Lucía Moreda-Santamaría, Nieves Doménech, Francisco Estévez-Cid, Natalia Suárez-Fuentetaja, Javier Muñiz, María J. Paniagua-Martín, Miguel Solla-Buceta, María G. Crespo-Leiro, José J. Cuenca-Castillo, Eduardo Barge-Caballero, Z. Grille-Cancela, Gonzalo Barge-Caballero, David Couto-Mallón, Paula Blanco-Canosa, and José Manuel Vázquez-Rodríguez
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03 medical and health sciences ,0302 clinical medicine ,business.industry ,Medicine ,030204 cardiovascular system & hematology ,Cardiology and Cardiovascular Medicine ,business ,Humanities - Abstract
Resumen Introduccion y objetivos Los valores plasmaticos de galectina-3 (Gal-3) estan elevados y se correlacionan con la mortalidad total y cardiovascular en pacientes con insuficiencia cardiaca, pero su correlacion con el pronostico tras el trasplante cardiaco (TxC) es desconocida. El objetivo fue describir la tendencia evolutiva y el valor pronostico de este biomarcador tras el TxC. Metodos Mediante enzimoinmunoensayo, se midieron las concentraciones plasmaticas de Gal-3 en muestras de suero de 122 receptores de TxC, antes y 1, 3, 6 y 12 meses despues de este. Mediante regresion de Cox se analizo el valor pronostico del valor plasmatico de Gal-3 a los 12 meses del TxC. El objetivo primario del estudio fue la variable combinada muerte o disfuncion del injerto. Resultados Las concentraciones de Gal-3 disminuyeron progresivamente durante el primer ano tras el TxC (medianas: pretrasplante, 19,1 ng/ml; 1 ano postrasplante, 14,6 ng/ml; p Conclusiones Las concentraciones plasmaticas de Gal-3 disminuyeron progresivamente durante el primer ano tras el TxC. Un valor plasmatico elevado de Gal-3 1 ano tras el TxC se correlaciono con un pronostico adverso.
- Published
- 2019
4. Galectina-3 circulante tras el trasplante cardiaco: dinámica a largo plazo y valor pronóstico
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Paula Blanco-Canosa, José Manuel Vázquez-Rodríguez, Javier Muñiz, Natalia Suárez-Fuentetaja, Gonzalo Barge-Caballero, David Couto-Mallón, María J. Paniagua-Martín, María G. Crespo-Leiro, Francisco Estévez-Cid, Miguel Solla-Buceta, Eduardo Barge-Caballero, Z. Grille-Cancela, José J. Cuenca-Castillo, Nieves Doménech, Jorge Pombo-Otero, Antoni Bayes-Genis, and Lucía Moreda-Santamaría
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Graft Rejection ,Male ,Trasplante cardiaco ,medicine.medical_specialty ,Time Factors ,Galectin 3 ,030204 cardiovascular system & hematology ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Immune system ,Risk Factors ,Cause of Death ,Internal medicine ,Galectina-3 ,Clinical endpoint ,Humans ,Galectin-3 ,Medicine ,In patient ,Retrospective Studies ,Cardiovascular mortality ,business.industry ,Proportional hazards model ,Incidence ,Pronóstico ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,ROC Curve ,Spain ,Heart failure ,Heart Transplantation ,Biomarker (medicine) ,Female ,Heart transplant ,business ,Biomarkers ,Follow-Up Studies - Abstract
[Abstract] Introduction and objectives: Circulating galectin-3 (Gal-3) is elevated and significantly correlates with all-cause and cardiovascular mortality in patients with heart failure. However, the relationship between serum Gal-3 and heart transplant (HT) outcomes is unclear. The aim of this study was to describe the longitudinal trend and prognostic value of Gal-3 levels after HT. Methods: Banked serum samples were available from 122 HT recipients, collected before transplant and at 1, 3, 6, and 12 months posttransplant. Gal-3 levels in these serum samples were measured by enzyme immune assay. Multivariable Cox regression was performed to determine the prognostic value of 12-month posttransplant Gal-3 serum levels. The primary endpoint was the composite variable all-cause death or graft failure over long-term posttransplant follow-up. Results: Circulating Gal-3 concentration steadily decreased during the first year after HT (median values: pretransplant, 19.1 ng/mL; 1-year posttransplant, 14.6 ng/mL; P
- Published
- 2019
5. Prognostic Value of the Nutritional Risk Index in Heart Transplant Recipients
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Gonzalo Barge-Caballero, David Couto-Mallón, Miguel Solla-Buceta, José Manuel Vázquez-Rodríguez, José J. Cuenca-Castillo, Raquel Marzoa-Rivas, María J. Paniagua-Martín, Carlos Velasco-Sierra, María G. Crespo-Leiro, José M. Herrera-Noreña, Fernando García-López, Francisco Pita-Gutiérrez, and Eduardo Barge-Caballero
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Male ,Trasplante cardiaco ,Desnutrición ,medicine.medical_specialty ,Pediatrics ,Ventricular Dysfunction, Right ,medicine.medical_treatment ,Nutritional Status ,Nutritional risk index ,Outcomes ,030204 cardiovascular system & hematology ,Body weight ,Logistic regression ,Ventricular Dysfunction, Left ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,030212 general & internal medicine ,Nutritional risk ,Retrospective Studies ,Heart Failure ,Heart transplantation ,Proportional hazards model ,business.industry ,Malnutrition ,Pronóstico ,Nutritional status ,Índice de riesgo nutricional ,General Medicine ,Length of Stay ,Middle Aged ,Prognosis ,medicine.disease ,Malnourishment ,Nutrition Assessment ,Heart Transplantation ,Female ,Heart transplant ,Primary Graft Dysfunction ,business - Abstract
[Abstract] Introduction and objectives. To study the prognostic impact of preoperative nutritional status, as assessed through the nutritional risk index (NRI), on postoperative outcomes after heart transplantation (HT). Methods. We conducted a retrospective, single-center study of 574 patients who underwent HT from 1991 to 2014. Preoperative NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (body weight [kg] / ideal body weight [kg]). The association between preoperative NRI and postoperative outcomes was analyzed by means of multivariable logistic regression and multivariable Cox regression. Results. Mean NRI before HT was 100.9 ± 9.9. According to this parameter, the prevalence of severe nutritional risk (NRI < 83.5), moderate nutritional risk (83.5 ≤ NRI < 97.5), and mild nutritional risk (97.5 ≤ NRI < 100) was 5%, 22%, and 10%, respectively. One year post-transplant mortality rates in these 4 categories were 18.2%, 25.3%, 7.9% and 10.2% (P < .001), respectively. The NRI was independently associated with a lower risk of postoperative infection (adjusted OR, 0.97; 95%CI, 0.95-1.00; P = .027) and prolonged postoperative ventilator support (adjusted OR, 0.96; 95%CI, 0.94-0.98; P = .001). Patients at moderate or severe nutritional risk had significantly higher 1-year post-HT mortality (adjusted HR, 1.55; 95%CI, 1.22-1.97; P < .001). Conclusions. Malnourished patients have a higher risk of postoperative complications and mortality after HT. Preoperative NRI determination may help to identify HT candidates who might benefit from nutritional intervention. [Resumen] Introducción y objetivos. Analizar el impacto del estado nutricional preoperatorio, evaluado mediante el índice de riesgo nutricional (IRN), en el pronóstico tras el trasplante cardiaco (TxC). Métodos. Se realizó un estudio retrospectivo de 574 pacientes que recibieron un TxC entre 1991 y 2014 en un centro. El IRN preoperatorio se calculó como 1,519 × albúmina (g/l) + 41,7 × (peso real [kg] / peso ideal [kg]). La asociación entre IRN preoperatorio y eventos clínicos posoperatorios se analizó mediante modelos multivariables de regresión logística y regresión de Cox. Resultados. El IRN preoperatorio medio de la población del estudio era de 100,9 ± 9,9. Según este parámetro, las prevalencias de riesgo nutricional grave (IRN < 83,5), moderado (83,5 ≤ IRN < 97,5) y leve (97,5 ≤ IRN < 100) antes del TxC eran el 5, el 22 y el 10% respectivamente. Las tasas de mortalidad a 1 año tras el TxC en estas 4 categorías fueron del 18,2, el 25,3, el 7,9 y el 10,2% (p < 0,001) respectivamente. El IRN preoperatorio resultó predictor independiente de menor riesgo de infección posoperatoria (odds ratio ajustada [ORa] = 0,97; intervalo de confianza del 95% [IC95%], 0,95-1,00; p = 0,027) y ventilación mecánica prolongada posoperatoria (ORa = 0,96; IC95%, 0,94-0,98; p = 0,001). Los pacientes con riesgo nutricional moderado a grave mostraron mayor mortalidad a 1 año tras el TxC (hazard ratio ajustada = 1,55; IC95%, 1,22-1,97; p < 0,001). Conclusiones. Los pacientes desnutridos tienen mayor riesgo de complicaciones posoperatorias y muerte tras el TxC. La determinación del IRN podría facilitar la identificación de candidatos a TxC que se beneficien de intervenciones nutricionales en espera del órgano.
- Published
- 2017
6. Valor pronóstico del índice de riesgo nutricional en receptores de trasplante cardiaco
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Gonzalo Barge-Caballero, José Manuel Vázquez-Rodríguez, Raquel Marzoa-Rivas, José M. Herrera-Noreña, David Couto-Mallón, Fernando García-López, Carlos Velasco-Sierra, Eduardo Barge-Caballero, Miguel Solla-Buceta, José J. Cuenca-Castillo, Francisco Pita-Gutiérrez, María J. Paniagua-Martín, and María G. Crespo-Leiro
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03 medical and health sciences ,0302 clinical medicine ,business.industry ,Medicine ,030212 general & internal medicine ,030204 cardiovascular system & hematology ,Cardiology and Cardiovascular Medicine ,business ,Humanities - Abstract
Resumen Introduccion y objetivos Analizar el impacto del estado nutricional preoperatorio, evaluado mediante el indice de riesgo nutricional (IRN), en el pronostico tras el trasplante cardiaco (TxC). Metodos Se realizo un estudio retrospectivo de 574 pacientes que recibieron un TxC entre 1991 y 2014 en un centro. El IRN preoperatorio se calculo como 1,519 × albumina (g/l) + 41,7 × (peso real [kg] / peso ideal [kg]). La asociacion entre IRN preoperatorio y eventos clinicos posoperatorios se analizo mediante modelos multivariables de regresion logistica y regresion de Cox. Resultados El IRN preoperatorio medio de la poblacion del estudio era de 100,9 ± 9,9. Segun este parametro, las prevalencias de riesgo nutricional grave (IRN Conclusiones Los pacientes desnutridos tienen mayor riesgo de complicaciones posoperatorias y muerte tras el TxC. La determinacion del IRN podria facilitar la identificacion de candidatos a TxC que se beneficien de intervenciones nutricionales en espera del organo.
- Published
- 2017
7. Transaxillary Implantation of the Impella CP Mechanical Circulatory Support Device as a Bridge to Heart Transplant. First Experience in Spain
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Francisco Estévez-Cid, Carlos García-Velasco, María G. Crespo-Leiro, Miguel Solla-Buceta, José J. Cuenca-Castillo, and David Couto-Mallón
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03 medical and health sciences ,0302 clinical medicine ,business.industry ,Forensic engineering ,Medicine ,General Medicine ,030204 cardiovascular system & hematology ,business ,Bridge (interpersonal) ,Impella - Published
- 2019
8. Reparación de seudoaneurisma posquirúrgico de aorta ascendente complicado con rotura inminente y hemoptisis severa
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Víctor Mosquera, Francisco Felipe-Pombo, Miguel Solla-Buceta, and Carlos E. Velasco
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Gynecology ,medicine.medical_specialty ,Aneurisma ,Emergencia ,business.industry ,lcsh:R ,lcsh:Surgery ,lcsh:Medicine ,lcsh:RD1-811 ,030204 cardiovascular system & hematology ,Aneurysm ,03 medical and health sciences ,0302 clinical medicine ,030228 respiratory system ,Cirugía ,Emergency ,cardiovascular system ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Aorta - Abstract
ResumenLos seudoaneurismas de aorta ascendente son complicaciones posquirúrgicas infrecuentes, pero extremadamente letales. Su reparación supone un reto quirúrgico debido fundamentalmente al elevado riesgo de rotura durante la re-esternotomía y consiguiente exanguinación del paciente, así como a la necesidad de períodos prolongados de parada circulatoria para su reparación.Presentamos una alternativa para el manejo quirúrgico de un gran seudoaneurisma de aorta ascendente, complicado con datos de rotura inminente y hemoptisis severa 6 meses tras una cirugía de sustitución valvular aórtica.AbstractPseudoaneurysms of the ascending aorta are rare but extremely lethal complications after cardiac surgery. The repair of ascending aorta pseudoaneurysms poses a great surgical challenge because the sternal re-entry is associated with a significant risk of rupture and it usually requires a prolonged period of deep hypothermic circulatory arrest.A report is presented of a successfully managed case of a large pseudoaneurysm of the ascending aorta complicated by impending rupture and severe haemoptysis, months after an aortic valve replacement.We report a successfully managed case of a large pseudoaneurysm of the ascending aorta complicated by impending rupture and severe hemoptysis months after an aortic valve replacement.
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- 2016
9. Toxoplasma Gondii Serostatus in Heart Transplant Recipients: Is It an Independent Prognostic Factor?
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Miguel Solla-Buceta, David Couto-Mallón, José J. Cuenca-Castillo, Gonzalo Barge-Caballero, José M. Herrera-Noreña, José Manuel Vázquez-Rodríguez, Francisco Estévez-Cid, Raquel Marzoa-Rivas, Eduardo Barge-Caballero, Cayetana Barbeito-Caamaño, María J. Paniagua-Martín, and María G. Crespo-Leiro
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Adult ,Graft Rejection ,Male ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Risk Factors ,Internal medicine ,medicine ,Humans ,Mortality ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Heart Failure ,biology ,Proportional hazards model ,business.industry ,Incidence (epidemiology) ,Incidence ,Confounding ,Hazard ratio ,Toxoplasma gondii ,General Medicine ,Middle Aged ,biology.organism_classification ,Prognosis ,Confidence interval ,Immunology ,Multivariate Analysis ,Heart Transplantation ,030211 gastroenterology & hepatology ,Female ,business ,Serostatus ,Toxoplasma ,Immunosuppressive Agents ,Toxoplasmosis - Abstract
Introduction and objectives To assess the potential association between recipient Toxoplasma gondii serostatus and outcomes after heart transplant (HT). Methods We conducted a retrospective single-center study of 657 HT recipients from 1991 to 2015. Survival and the incidence of adverse clinical events of T. gondii -seropositive (n = 481) vs T. gondii -seronegative (n = 176) recipients were compared by means of 2 different multivariable Cox regression models. Model 1 included solely age and sex, and model 2 included other potential confounders. Results Over a median follow-up of 2903 days (interquartile range: 898-4757), 250 seropositive recipients (52%) and 72 seronegative recipients (41%) died. Univariable analysis showed increased posttransplant mortality among T. gondii -seropositive recipients (hazard ratio [HR] = 1.31; 95% confidence interval [95%CI], 1,00-1.70). After multivariable adjustment, the statistical significance of this association was lost (model 1: HR = 1.09; 95%CI, 0.83-1.43; model 2:HR = 1.12; 95%CI, 0.85-1.47). Recipient T. gondii seropositivity was independently associated with an increased risk of acute rejection (model 1: HR = 1.36; 95%CI, 1.06-1.74; model 2: HR = 1.29; 95%CI, 1.01-1.66). Multivariable models showed no statistically significant impact of recipient T. gondii serostatus on the incidence of infection, malignancy, coronary allograft vasculopathy, or the composite outcome of cardiac death or retransplant. No significant association was found between donor-recipient T. gondii serostatus matching and posttransplant outcome. Conclusions In this study, recipient T. gondii serostatus was not an independent predictor of long-term post-HT outcome.
- Published
- 2016
10. Utilidad de la escala INTERMACS para estratificar el pronóstico tras el trasplante cardiaco urgente
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María J. Paniagua-Martín, María G. Crespo-Leiro, Raquel Marzoa-Rivas, Alberto J. Pérez-Pérez, Zulaika Grille Cancela, Eduardo Barge-Caballero, Javier Muñiz, José J. Cuenca-Castillo, Paula Blanco-Canosa, Miguel Solla Buceta, Alberto Juffé-Stein, Lourdes García-Bueno, José Ángel Rodríguez-Fernández, Rosa Campo-Pérez, Alfonso Castro-Beiras, and José M. Herrera-Noreña
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Gynecology ,medicine.medical_specialty ,business.industry ,medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Resumen Introduccion y objetivos Analizar el valor pronostico de la escala INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) en pacientes tratados con trasplante cardiaco urgente. Metodos Analisis retrospectivo de 111 pacientes tratados con trasplante cardiaco urgente en nuestro centro entre abril de 1991 y octubre de 2009. Se asigno retrospectivamente a los pacientes a tres niveles de la escala INTERMACS en funcion de su situacion clinica previa al trasplante cardiaco. Resultados Los pacientes del grupo INTERMACS 1 (n = 31) presentaban mayor frecuencia de cardiopatia isquemica (p = 0,03) y shock tras cardiotomia (p = 0,02) que los pacientes del grupo INTERMACS 2 (n = 55) y los pacientes del grupo INTERMACS 3–4 (n = 25), asi como mayores dosis de catecolaminas (p = 0,001), mayor empleo de ventilacion mecanica (p Conclusiones Nuestros resultados indican que la escala INTERMACS resulta util para estratificar el pronostico postoperatorio tras el trasplante cardiaco urgente.
- Published
- 2011
11. Lower limb overflow syndrome in extracorporeal membrane oxygenation
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Miguel Solla-Buceta, Víctor Mosquera, Laura Fernández-Arias, and Concepción Pradas-Irún
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_treatment ,Fistula ,Arteriovenous fistula ,Lower limb ,Blister ,Extracorporeal Membrane Oxygenation ,Multidetector Computed Tomography ,medicine ,Extracorporeal membrane oxygenation ,Limb perfusion ,Edema ,Humans ,Aged ,business.industry ,Hemodynamics ,Syndrome ,Femoral Vein ,medicine.disease ,Peripheral ,body regions ,Femoral Artery ,surgical procedures, operative ,Embolism ,Lower Extremity ,Regional Blood Flow ,Anesthesia ,Arteriovenous Fistula ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Perfusion - Abstract
Peripheral extracorporeal membrane oxygenation (ECMO) is associated with a not negligible rate of vascular morbidity. Most vascular complications are related to limb ischaemia mainly due to insufficient limb perfusion or embolic events. To the best of our knowledge, this is the first report of a severe epidermolysis and overflow syndrome as a result of an overperfusion phenomenon through an unknown femoral arterio-venous fistula in a patient requiring ECMO support.
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- 2014
12. [Persistent candidemia in a renal-pancreatic transplant patient]
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Miguel, Solla-Buceta, Ana, Hurtado-Doce, and Luis, Álvarez-Rocha
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Adult ,Postoperative Complications ,Candidemia ,Humans ,Candida glabrata ,Female ,Pancreas Transplantation ,Kidney Transplantation - Abstract
In recent decades, there has been an increase in the survival of recipients of solid organ transplants related to the improvement of the surgical technique, the introduction of protocols for immunosuppressive therapy, and the use of antimicrobial prophylaxis. Nonetheless, invasive fungal infection (IFI) is currently the major cause of morbidity and mortality in this group of patients. Invasive candidiasis is the most common IFI found after renal transplantation and is usually associated with total parenteral nutrition, broad-spectrum antibiotic therapy and abdominal surgery.We report the case of a recent kidney-pancreas transplant recipient who developed a persistent catheter-related candidemia caused by Candida glabrata. The patient was treated with anidulafungin and had a good clinical course with no significant drug interactions. We discuss the possible causes and diagnostic and therapeutic alternatives of this kind of infection.
- Published
- 2012
13. Usefulness of the INTERMACS scale for predicting outcomes after urgent heart transplantation
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Alberto Juffé-Stein, Rosa Campo-Pérez, José M. Herrera-Noreña, Miguel Solla-Buceta, José J. Cuenca-Castillo, Javier Muñiz, Alberto J. Pérez-Pérez, Lourdes García-Bueno, Paula Blanco-Canosa, Eduardo Barge-Caballero, Zulaika Grille Cancela, María J. Paniagua-Martín, María G. Crespo-Leiro, Raquel Marzoa-Rivas, José Ángel Rodríguez-Fernández, and Alfonso Castro-Beiras
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Transplante cardiaco ,Renal function ,Heart failure ,Heart transplantation ,chemistry.chemical_compound ,INTERMACS ,Internal medicine ,medicine ,Humans ,Renal replacement therapy ,Emergency Treatment ,Retrospective Studies ,Heart Failure ,Mechanical ventilation ,Creatinine ,business.industry ,Central venous pressure ,Pronóstico ,Retrospective cohort study ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Surgery ,Treatment Outcome ,chemistry ,Cardiology ,Heart Transplantation ,Female ,business ,Insuficiencia cardiaca - Abstract
[Abstract] Introduction and objectives. Our aim was to assess the prognostic value of the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) scale in patients undergoing urgent heart transplantation (HT). Methods. Retrospective analysis of 111 patients treated with urgent HT at our institution from April, 1991 to October, 2009. Patients were retrospectively assigned to three levels of the INTERMACS scale according to their clinical status before HT. Results. Patients at the INTERMACS 1 level (n = 31) more frequently had ischemic heart disease (p = 0.03) and post-cardiothomy shock (p = 0.02) than patients at the INTERMACS 2 (n = 55) and INTERMACS 3-4 (n = 25) levels. Patients at the INTERMACS 1 level showed higher preoperative catecolamin doses (p = 0.001), a higher frequency of use of mechanical ventilation (p < 0.001), intraaortic balloon (p = 0.002) and ventricular assist devices (p = 0.002), and a higher frequency of preoperative infection (p = 0.015). The INTERMACS 1 group also presented higher central venous pressure (p = 0.02), AST (p = 0.002), ALT (p = 0.006) and serum creatinine (p < 0.001), and lower hemoglobin (p = 0.008) and creatinine clearance (p = 0.001). After HT, patients at the INTERMACS 1 level had a higher incidence of primary graft failure (p = 0.03) and postoperative need for renal replacement therapy (p = 0.004), and their long-term survival was lower than patients at the INTERMACS 2 (log rank 5.1, p = 0.023; HR 3.1, IC 95% 1.1-8.8) and INTERMACS 3-4 level (log rank 6.1, p = 0.013; HR 6.8, IC 95% 1.2-39.1). Conclusions. Our results suggest that the INTERMACS scale may be a useful tool to stratify postoperative prognosis after urgent HT. [Resumen] Introducción y objetivos. Analizar el valor pronóstico de la escala INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) en pacientes tratados con trasplante cardiaco urgente. Métodos. Análisis retrospectivo de 111 pacientes tratados con trasplante cardiaco urgente en nuestro centro entre abril de 1991 y octubre de 2009. Se asignó retrospectivamente a los pacientes a tres niveles de la escala INTERMACS en función de su situación clínica previa al trasplante cardiaco. Resultados. Los pacientes del grupo INTERMACS 1 (n = 31) presentaban mayor frecuencia de cardiopatía isquémica (p = 0,03) y shock tras cardiotomía (p = 0,02) que los pacientes del grupo INTERMACS 2 (n = 55) y los pacientes del grupo INTERMACS 3-4 (n = 25), así como mayores dosis de catecolaminas (p = 0,001), mayor empleo de ventilación mecánica (p < 0,001), balón de contrapulsación (p = 0,002) y dispositivos de asistencia ventricular (p = 0,002) y mayores tasas de infección preoperatoria (p = 0,015). El grupo INTERMACS 1 también mostraba mayores cifras de presión venosa central (p = 0,02), GOT (p = 0,002), GPT (p = 0,006) y creatinina (p < 0,001) y menores cifras de hemoglobina (p = 0,008) y aclaramiento de creatinina (p = 0,001). Tras el trasplante cardiaco, los pacientes del grupo INTERMACS 1 presentaron mayores incidencias de fracaso primario del injerto (p = 0,03) y necesidad de terapia de sustitución renal (p = 0,004), y su supervivencia a largo plazo fue menor que la de los pacientes de los grupos INTERMACS 2 (log rank = 5,1; p = 0,023; razón de riesgos [HR] = 3,1; intervalo de confianza [IC] del 95%, 1,4-6,8) e INTERMACS 3-4 (log rank = 6,1; p = 0,013; HR = 4; IC del 95%, 1,3-12,3). Conclusiones. Nuestros resultados indican que la escala INTERMACS resulta útil para estratificar el pronóstico postoperatorio tras el trasplante cardiaco urgente.
- Published
- 2011
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