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Resumen: En los últimos años se ha apreciado un cambio notable en la práctica clínica cardiovascular en cardiología y cirugía. El objetivo del estudio CARDIOXCARDIO es conocer la opinión de los profesionales respecto al modo de trabajo y las relaciones entre especialidades. Se realizó una encuesta remitida simultáneamente a los 4.442 miembros de la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) y de la Sociedad Española de Cardiología (SEC), de la cual se obtuvieron 385 respuestas válidas. El 59% de los encuestados eran varones, mayoritariamente especialistas (el 7,3% residentes), y el 74,8% pertenecía al ámbito de la cardiología, predominantemente en centros públicos (88,3%). Mediante una escala Likert de 1 a 5 (de peor a mejor), los encuestados puntuaron la relación entre cirugía y cardiología con una media de 3,57 ± 0,9 puntos. La opinión de los cardiólogos sobre los cirujanos alcanzó una puntuación media de 3,83 ± 0,8 y viceversa, una media de 3,92 ± 0,72. Además, proporcionaron múltiples sugerencias de mejora que se discuten en detalle, con ciertas diferencias de criterio entre especialidades. La implementación de estrategias basadas en las sugerencias de los profesionales, junto con un enfoque proactivo en la mejora continua, podría tener un impacto sustancial en la calidad de la atención cardiovascular en España. Abstract: In recent years, there has been a notable shift in cardiovascular clinical practice within cardiology and surgery. The CARDIOXCARDIO study aimed to identify professionals’ opinions on working practices and relations between specialties. A survey was simultaneously sent to the 4442 members of the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) and the Spanish Society of Cardiology (SEC), yielding 385 valid responses. More than half (59%) of respondents were men, mostly specialists (7.3% residents), and 74.8% worked in the field of cardiology, predominantly in public centers (88.3%). Using a Likert scale ranging from 1 to 5 (worst to best), respondents rated relations between surgery and cardiology with an average of 3.57 ± 0.9 points. Cardiologists rated surgeons with a mean score of 3.83 ± 0.8, while surgeons gave cardiologists a mean score of 3,92 ± 0.72. In addition, respondents provided numerous suggestions for improvement, which are discussed in detail, highlighting certain discrepancies in criteria between specialties. Implementing strategies based on the suggestions of professionals, together with a proactive approach to continuous improvement, could substantially enhance the quality of cardiovascular care in Spain.

Introduction and aim: Timely detection and diagnosis of hepatitis C virus (HCV) involves identifying the population that is predisposed to treatment and prevention, thus limiting complications and preventing infection. The aim of this study was to analyze and describe risk factors associated with anti-HCV antibody detection in a population with access to public healthcare that participated in a national screening program. Material and methods: An analytic cross-sectional study was conducted that utilized data related to rapid tests carried out between September 2021 and October 2022 in 26 of the 32 states of Mexico. Anti-HCV reactive tests were selected, according to age and sex, for analyzing and comparing possible risk factors through descriptive and inferential statistics. The geographic distribution and density of the screening program at the state and municipal levels was analyzed. Results: There were 75,185 anti-HCV antibody detections, 2,052 reactive tests, and mean participant age was 44.3 years (±15.1). Occupation: 32.3% were employees, 19% were housewives, and 18.2% were healthcare workers. Five out of every 10 cases had no indication of risk factors, but there was a 1.4 and 5-times greater likelihood of anti-HCV detection in men with a history of sharps injury or intravenous psychoactive substance use, compared with women. Regarding place of residence, 80% of the reactive tests were concentrated in the State of Mexico, Mexico City, and Guanajuato. Conclusions: The evidence herein helps determine the population and risk factors that should be focused on in carrying out the HCV microelimination strategy of continuous screening, diagnosis, medical treatment access, and epidemiologic surveillance. Resumen: Introducción y objetivo: La detección y el diagnóstico oportuno del virus de la hepatitis C (VHC) implica identificar la población susceptible de tratamiento, prevenir, limitar complicaciones y evitar contagios. El objetivo de este estudio fue analizar y describir los factores de riesgo asociados a la detección de anticuerpos contra el VHC (anti-VHC) en la población con acceso a la seguridad social que participó en programa nacional de tamizaje. Material y métodos: Estudio transversal/analítico que utilizó datos relacionados con pruebas rápidas realizadas entre septiembre de 2021 y octubre de 2022 en 26 de las 32 entidades federativas de México. Se seleccionaron los reactivos anti-VHC para analizar y comparar, según sexo y edad, los posibles factores de riesgo mediante estadística descriptiva e inferencial. Se analizó la distribución y la densidad geográfica del programa de tamizaje a nivel de la entidad federativa y del municipio. Resultados: Se realizaron 75,185 detecciones anti-VHC; 2,052 reactivos (2.7%), promedio 44.3 años (±15.1). Ocupación: 32.3% empleado, 19% ama de casa y 18.2% trabajador de sector salud. Hasta 5 de cada 10 pacientes no indicaron factores de riesgo, pero en comparación con las mujeres, los varones con antecedente de accidente con material punzocortante o uso de sustancias psicoactivas intravenosas mostraron 1.4 y 5 veces más probabilidad de detección anti-VHC. Según el lugar de residencia, el 80% de los reactivos se concentró en Estado de México, CDMX y Guanajuato. Conclusiones: La evidencia sugiere cuál es la población y los factores de riesgo en los que se debe focalizar la estrategia de microeliminación del VHC, mediante el continuo tamizaje, diagnóstico, acceso a tratamiento médico y seguimiento epidemiológico.

Resumen: Introducción y objetivo: La detección y el diagnóstico oportuno del virus de la hepatitis C (VHC) implica identificar la población susceptible de tratamiento, prevenir, limitar complicaciones y evitar contagios. El objetivo de este estudio fue analizar y describir los factores de riesgo asociados a la detección de anticuerpos contra el VHC (anti-VHC) en la población con acceso a la seguridad social que participó en programa nacional de tamizaje. Material y métodos: Estudio transversal/analítico que utilizó datos relacionados con pruebas rápidas realizadas entre septiembre de 2021 y octubre de 2022 en 26 de las 32 entidades federativas de México. Se seleccionaron los reactivos anti-VHC para analizar y comparar, según sexo y edad, los posibles factores de riesgo mediante estadística descriptiva e inferencial. Se analizó la distribución y la densidad geográfica del programa de tamizaje a nivel de la entidad federativa y del municipio. Resultados: Se realizaron 75,185 detecciones anti-VHC; 2,052 reactivos (2.7%), promedio 44.3 años (±15.1). Ocupación: 32.3% empleado, 19% ama de casa y 18.2% trabajador de sector salud. Hasta 5 de cada 10 pacientes no indicaron factores de riesgo, pero en comparación con las mujeres, los varones con antecedente de accidente con material punzocortante o uso de sustancias psicoactivas intravenosas mostraron 1.4 y 5 veces más probabilidad de detección anti-VHC. Según el lugar de residencia, el 80% de los reactivos se concentró en Estado de México, CDMX y Guanajuato. Conclusiones: La evidencia sugiere cuál es la población y los factores de riesgo en los que se debe focalizar la estrategia de microeliminación del VHC, mediante el continuo tamizaje, diagnóstico, acceso a tratamiento médico y seguimiento epidemiológico. Abstract: Introduction and aim: Timely detection and diagnosis of hepatitis C virus (HCV) involves identifying the population that is predisposed to treatment and prevention, thus limiting complications and preventing infection. The aim of this study was to analyze and describe risk factors associated with anti-HCV antibody detection in a population with access to public healthcare that participated in a national screening program. Material and methods: An analytic cross-sectional study was conducted that utilized data related to rapid tests carried out between September 2021 and October 2022 in 26 of the 32 states of Mexico. Anti-HCV reactive tests were selected, according to age and sex, for analyzing and comparing possible risk factors through descriptive and inferential statistics. The geographic distribution and density of the screening program at the state and municipal levels was analyzed. Results: There were 75,185 anti-HCV antibody detections, 2,052 reactive tests, and mean participant age was 44.3 years (±15.1). Occupation: 32.3% were employees, 19% were housewives, and 18.2% were healthcare workers. Five out of every 10 cases had no indication of risk factors, but there was a 1.4 and 5-times greater likelihood of anti-HCV detection in men with a history of sharps injury or intravenous psychoactive substance use, compared with women. Regarding place of residence, 80% of the reactive tests were concentrated in the State of Mexico, Mexico City, and Guanajuato. Conclusions: The evidence herein helps determine the population and risk factors that should be focused on in carrying out the HCV microelimination strategy of continuous screening, diagnosis, medical treatment access, and epidemiologic surveillance.

DFT (Density Functional Theory) calculations were carried out to evaluate the chemical interaction of CO (carbon monoxide) and NO (nitrogen monoxide) molecules onto nanographenes (NGs) n = 1–6 units; thus, for this range adsorption process is exhibited, excepting for n = 5 desorption is favored. On the other hand, dioxide titanium clusters (TiO2) n = 1–4 were proposed to adsorb CO molecule, atop and parallel adsorption sites were considered to attach CO molecule onto these clusters and four possible isolated models (C1-C4) are generated and as result of this chemical interaction, physisorption was obtained. In order to improve the adsorption of CO molecule, (TiO2)n−CO clusters are deposited onto (NG)2 to play the role as substrate, namely coronene (C) and then a set of nanocomposites are generated to analyze changes on adsorption tendency, for the above systems just CO molecule is considered. Some chemical and structural transition are obtained for largest sizes as well as adsorption energy values are more favored for C−(TiO2)3−CO system due to the close proximity between titanium atom of C-(TiO2)3 clusters and this chemical specie. Therefore, there are substantial chemisorption values in this instance due to the active sites. The values of the electronic gap do not exhibit significant variations, among these nanocomposites, however, the HOMO isosurfaces are shown in distinct ways, and for n ≤ 2 systems examined in this paper, LUMO isosurfaces are displayed at the center of the cluster. In all systems analyzed, the electronic transference goes from chemical species toward atoms at the adsorption site. These results suggest that these C−(TiO2)n nanocomposites are ideal candidates to storing or sense different sort of gases; thereby, these findings can be employed to design a kind of gases storage device for environmentally friendly energy applications.

Obtaining three-dimensional porous materials for different applications, has required complex methods to achieve the desired structure. Crumpling is an alternative to develop three-dimensional structures by randomly folding a sheet of material and offering a simple yet effective method to generate a unique, stiff and lightweight three-dimensional structure with minimal processing. Here, composite films made from polylactic acid (PLA), and exfoliated graphite (EG) were elaborated using solvent casting method. Additional pore formation is achieved adding calcium carbonate (CaCO3) particles as porogen. Films were characterized to corroborate the integration of exfoliated graphite to the PLA matrix as well as crystallinity changes due to EG and CaCO3 particles. Microscopy help to identify pore formation after CaCO3 remotion. Tensile tests, after increasing EG concentration in PLA, corroborate the formation of stiffer films with lower tensile strength, while pore formation decreased tensile strength and Young's modulus. After adding 0.5% wt. of EG, tensile strength partially recovered while Young's modulus was maintained. Composite films allowed to obtain 3D crumpled structures. Tests under compression help finding that 0.5% wt. of EG in PLA matrix resulted in a yield strength (26.6 MPa) and Younǵs modulus (32.5 MPa) increase, making necessary the application of considerable force to deform them.

1,8-Cineole, limonene and α-terpineol are the major terpenes present in Callistemon citrinus. This study reports for the first time that terpenes attenuate the oxidative stress in rats fed with high-fat-sucrose diet (HFSD) via antioxidant and anti-inflammatory mechanisms. Thirty-six male Wistar rats were divided into six groups (n = 6). Control (fed standard food, HFSD (fed with 41.7% fat and 16.6% sucrose), HFSD + 1,8-cineole (0.88 mg/kg body weight), limonene (0.43 mg/kg body weight), α-terpineol (0.32 mg/kg body weight) and a mixture of the three terpenes, given daily by gavage for 15 weeks. Morphometric and biochemical parameters were taken. Paraoxonase (PON1), reduced glutathione (GSH), lipid peroxidation products malondialdehyde (MDA) and hydroxyalkenals (HNE), advanced oxidation protein products (AOPP) and pro-inflammatory cytokines were measured in liver homogenates. All terpenes showed a remarkable reduction in weight gain, fat deposition, serum glucose and, triacylglycerol levels. However, terpenes presented different effects on the hepatic cell and the oxidative biomarkers. Conversely, the three terpenes and the mixture showed the same positive effect on the tumor necrosis factor alpha (TNFα), interleukin-6 (IL-6), leptin and adiponectin levels. Finally, 1,8-cineole, limonene and α-terpineol demonstrate significant anti-inflammatory effects and differential effects on the oxidative stress, suggesting the importance of these terpenes in Callistemon citrinus activities.

Resumen: La incidencia de infección de dispositivos electrónicos implantables cardíacos supone 1,9 por 1.000 dispositivos-año.En los casos de endocarditis sobre electrodo de marcapasos con vegetaciones que no superen los 20 mm está indicada la extracción del sistema mediante abordaje transvenoso. En cuanto a las vegetaciones que superen dicho tamaño, hay poca evidencia sobre qué abordaje debe realizarse: cirugía transvenosa o a corazón abierto.Presentamos el caso de la extracción quirúrgica con bypass cardiopulmonar de un sistema de estimulación infectado con una gran vegetación adherida a su electrodo ventricular derecho. Abstract: The incidence of infection of cardiac implantable electronic devices is 1.9 per 1000 device-years.In cases of endocarditis on a pacemaker lead with vegetations that do not exceed 20 mm, extraction of the system through a transvenous approach is indicated. However, in cases of vegetations that exceed this size, there is little evidence about which approach should be performed, whether transvenous or open-heart surgery.We present the case of the surgical extraction with cardiopulmonary bypass of a pacing system infected with a large vegetation attached to its right ventricular electrode.

Callistemon citrinus has terpenes effective in inducing antioxidant enzymes, an important mechanism involved in cancer chemoprevention. This study investigated the chemopreventive efficacy of herbal preparation of C. citrinus leaves against the oxidative stress produced during the colorectal cancer (CRC) in male Wistar rats. The amelioration of toxicity in a model of CRC induced with 1,2-dimethylhydrazine (DMH) was determined by assessing antioxidant enzymes, phase II enzymes activities and lipid peroxidation (LPO) products after 22 weeks of treatment. C. citrinus was administered at a daily oral dose of 250 mg/kg. The activities in proximal, middle and distal colon, liver, kidney and heart were determined. C. citrinus showed a strong antioxidant activity that correlated with the high content of phenolics and terpenoids. DMH treated animals showed a decrease of the enzymes activity in most tissues and the level of reduced glutathione (GSH). Conversely, the levels of lipid peroxidation products were increased. Macroscopic examination revealed the protective effect of C. citrinus in damaged organs caused by DMH. Moreover, histopathological examination of the liver displayed normal structure in the C. citrinus-treated group, unlike the DMH-treated group. C. citrinus supplementation significantly maintained or increased the antioxidant enzyme activities, whereas lipid peroxidation products levels were reduced to values similar to the level of control group. The ability of C. citrinus to induce the antioxidant system reduced the damage of oxidative stress, which makes this plant a good candidate to be used as a prevention agent in treatment of diseases such as colorectal cancer.

Resumen: Introducción y objetivos: El síndrome aórtico agudo tipo A de Stanford tiene una incidencia de 3 casos/105 habitantes/año, y una mortalidad del 50% con tratamiento conservador y del 17-31% tras cirugía.Queremos analizar los factores predictivos de mortalidad hospitalaria, de supervivencia a largo plazo y reoperación en pacientes operados de forma emergente por síndrome aórtico agudo tipo A. Métodos: Entre noviembre de 1996 y diciembre de 2017 se intervinieron 193 pacientes, el 75,5% hombres, con una mediana de edad de 63 años (17-85). El 51,6% presentaba HTA, el 5,7% EPOC, el 3,6% intervención previa, el 24,9% derrame pericárdico severo y el 45,7% insuficiencia aórtica moderada-severa. Resultados: Realizamos reemplazo aislado de aorta ascendente en el 29,01%, asociado a raíz: 13,95%, al arco: 44,55%, a raíz y al arco: 6,22%, y arco y aorta descendente frozen elephant trunk: 6,22%. Dos (1,04%) pacientes murieron antes de iniciar la circulación extracorpórea.La mortalidad hospitalaria fue del 27,4%. De los 12 antecedentes analizados encontramos como predictores de mortalidad la HTA (OR = 2,2 [p = 0,017]) y la EPOC (OR = 7,5 [p = 0,001]).El tiempo medio de seguimiento de los 140 supervivientes (11 pacientes perdidos) fue de 151 ± 10 meses. La supervivencia a 1, 5 y 10 años es del 94%, 82% y 67%. La rotura de aorta fue la tercera causa de muerte a largo plazo (16,13% [n = 5]). No resultaron factores predictores de reoperación y mortalidad la insuficiencia aórtica severa ni la presencia de disección residual respectivamente. Conclusiones: Esta serie presenta una mortalidad hospitalaria similar a otros estudios y buena supervivencia a largo plazo. Se requiere un seguimiento estrecho de la aorta residual para la prevención de su rotura. Abstract: Introduction and objectives: Stanford type A acute aortic syndrome has an incidence of 3 cases/105 inhabitants/year, and has a mortality of 50% without treatment, and 17-31% after surgery.The purpose of this study is to analyse the predictive factors of in-hospital mortality, long-term survival, and reoperation in patients surgically operated on for type A acute aortic syndrome. Methods: Between November 1996 and December 2017, 193 patients were intervened of which 75.5% were men. The median age was 63 years (range 17-85). High blood pressure (HBP) was observed in 51.6% had HBP, with 5.7% chronic obstructive pulmonary disease (COPD), 3.6% a previous intervention, 24.9% severe pericardial effusion, and 45.7% moderate-severe aortic insufficiency. Results: Isolated replacement of ascending aorta was performed on 29.01%, associated to root replacement: 13.95%, to arch replacement in 44.55%, to root and arch replacement in 6.22%, and arch and descending aorta surgery “frozen elephant trunk “in 6.22%. Two (1.04%) patients died before starting extracorporeal circulation.Hospital mortality was 27.4%. Of the 12 personal backgrounds analysed, we found as mortality predictors the presence of HBP with an OR = 2.2 (P = .017) and COPD OR = 7.5 (P = .001).The mean follow-up time of the 140 survivors (11 lost patients) was 151 ± 10 months. Survival at 1, 5, and 10 years was 94%, 82%, and 67%, respectively. Aortic rupture was the third cause of long-term death in the long-term, 16.13% (n = 5).Neither severe aortic insufficiency nor the presence of residual dissection was predictive factors for reoperation. Conclusions: This sample shows a hospital mortality rate similar to other studies, as well as good long-term survival. Close monitoring of the residual aorta is required to prevent its rupture. Palabras clave: Síndrome aórtico agudo, Cirugía aórtica, Resultados, Seguimiento, Aorta, Keywords: Acute aortic syndrome, Aortic surgery, Outcomes, Follow-up, Aorta

A management approach was developed that combined spatial and non-spatial tools to inform a Coastal and Marine Spatial Planning Process (CMSP) in the Puerto Peñasco-Puerto Lobos Coastal Corridor, Northern Gulf of California, Sonora, Mexico. Four fisheries management tools were applied with an emphasis on ecosystem level management for eleven small-scale fisheries. Two spatial management tools, using a spatial prioritization approach, were combined with a permit regularization process, a non-spatial quota prioritization, and a tradeoff analysis in a novel way:• Locally Managed Marine Areas were developed, these are spatial areas where individual community fishermen are assigned the rights to harvest and manage specific fisheries within defined geographic areas.• Fishery refuges that incorporate information on fisheries, ecological importance, and connectivity.• A non-spatial quota prioritization process using a framework for the integrated assessment of stocks, encompassing a vulnerability analysis, a sustainability analysis, and a management framework analysis.• A trade-off analysis of the combination of these different management tools, using an Atlantis ecosystem model for the northern Gulf of California, that tested the ecosystem effects of alternative scenarios to assess benefits in support of ecosystem-based management.

Aim of the study: To evaluate the anti-leishmanial activity and cytotoxicity of aqueous and organic extracts of ten plants used in Mexican traditional medicine as anti-parasitics. Materials and methods: For the organic extracts, plant material was macerated in dichloromethane (CH2Cl2) and dichloromethane/methanol (CH2Cl2/MeOH) (1:1) during two weeks; the aqueous extracts were prepared by infusion. The extracts were tested against promastigotes and intracellular amastigotes of Leishmania amazonensis. The cytotoxicity was assayed in parallel on peritoneal macrophages of BALB/c mice. Results: Four of the thirty extracts tested were active and selective against L. amazonensis promastigotes: Schinus molle (CH2Cl2 and CH2Cl2/MeOH), Lantana camara (CH2Cl2) and Prosopis laevigata (aqueous). These extracts had a median inhibitory concentration (IC50) against intracellular amastigotes under 50 μg/mL and a selectivity index (SI) higher than 5, which indicates that they constitute valuable candidates to obtain secondary metabolites with leishmanicidal activity. Conclusions: The results derived from this study indicate that L. camara, P. laevigata, and S. molle might provide interesting new leads for the development of antileishmanial drugs.

Laser induced plasma spectroscopy (LIPS) has been applied for the elemental analysis of roman pottery Terra Sigillata from different ceramic production centers. For each sample, representative LIP spectra of slip and body were obtained in addition of compositional depth profiles. In all the cases investigated, calcium and iron are the elements which best define the transition between slip and body in these ceramic samples. Compositional gradient of other elements like silicon and aluminum depends on the samples. Moreover, complementary scanning electron microscopy coupled with energy dispersive X-ray spectroscopy (SEM - EDX) examinations were carried out to analyze morphological differences and to obtain verification of chemical results.En este trabajo se ha aplicado la espectroscopía de plasmas inducidos por láser (LIPS) al análisis elemental de cerámicas romanas Terra Sigillata procedentes de distintos centros de producción. Para cada muestra se han obtenido los espectros característicos tanto del engobe como de la pasta y los perfiles de composición en profundidad. En todos los casos analizados, los elementos Fe y Ca son los que marcan la transición entre el engobe y la pasta en estas cerámicas. El gradiente de composición de otros elementos tales como el Si o el Al presenta diferencias entre las distintas piezas. Se han realizado también análisis complementarios por microscopía electrónica de barrido con espectroscopía de rayos X (SEM – EDX) para determinar las diferencias morfológicas y obtener una verificación de la composición química.

Comparación entre la ablación con criotermia (CT) y con ultrasonidos (US) desde la superficie epicárdica en pacientes intervenidos por otra cardiopatía para valorar su seguridad y eficacia a corto y medio plazo. Material y métodos: Entre julio de 2006 y septiembre de 2009 fueron tratados 86 pacientes (52 hombres/34 mujeres) con US, de edad media 74,15 años, fibrilación auricular (FA) crónica en 60 (69,8%) y 33 (15 hombres/18mujeres) con crioablación, de edad media 73,09 años, FA crónica en 78,8%. Todos fueron intervenidos para tratar su cardiopatía principal. Se hizo un seguimiento al alta, al mes, a los 3, 6, 12 meses y anualmente, en el 100% de los pacientes. Resultados: Mortalidad hospitalaria: 9 (10,6%) y 3 (9,1%) pacientes con ambas técnicas. No hubo complicaciones relacionadas con la técnica (Tabla 1). Conclusiones: En nuestra experiencia, con la crioablación y US no se ha encontrado ninguna diferencia estadística significativa entre ambas.

El objetivo de no dañar la arteria mamaria evitando su disección y clampaje supone un reto para la protección miocárdica debido al lavado de la cardioplejía. Presentamos nuestra experiencia en reintervenciones sin disecar ni clampar los injertos arteriales. Material y métodos: Desde septiembre de 2000 hasta febrero de 2010 se realizaron 29 reintervenciones en 28 pacientes, (89,7% varones), edad media 73,17 ± 7,38 años. Las causas de reoperación fueron: progresión de valvulopatía 17 pacientes (58,6%), endocarditis 10 (34,4%), disfunción protésica no estructural 2 (6,9%). La mediana del EuroS-CORE logístico fue 14,84 (4-77,25). La cirugía fue urgente en 7 pacientes. Se realizó sustitución valvular aórtica aislada en 18 y se asoció revascularización en 4, sustitución/plastia mitral en 4, sustitución de aorta en 2; sustitución mitral aislada en 1. La protección miocárdica se realizó con cardioplejía hemática con esmolol, K+ y Mg+, administrándola siempre que no dificultaba el trabajo quirúrgico (intervalos nunca > 20 min). Temperatura sistémica media 32,26 ± 3,23 °C. Resultados: La mediana del tiempo de circulación extracorpórea (CEC) fue 153 (91-494) y de clampaje 103 (71-430) min. Presentaron infarto postoperatorio 1 paciente (3,4%) y síndrome de bajo gasto postoperatorio 2 pacientes (6,5%). La mediana de troponina I postoperatoria fue 7,03 ng/ml (1,84-109,5). La mortalidad hospitalaria fue 3 pacientes (10,3%) (cirugía urgente por endocarditis). Las causas de mortalidad fueron: daño neurológico irreversible (1 paciente), sepsis y bajo gasto (2 pacientes). La mediana de estancia hospitalaria fue 7 (1-33) días. Conclusión: En nuestra experiencia, sin clampar los injertos arteriales y con la estrategia descrita, la protección miocárdica parece adecuada y la mortalidad hospitalaria aceptable.

El seudoaneurisma del seno de Valsalva constituye una afección aórtica sumamente infrecuente; por encima, incluso, de los aneurismas congénitos. Su etiología engloba desde casos traumáticos e infecciosos hasta otros de naturaleza idiopática. Presentamos el caso de un varón de 74 años, con varios ingresos cardiológicos previos por infarto de miocardio y clínica sincopal y de dolor torácico atípico, en el que las pruebas diagnósticas angiográficas y de resonancia magnética pusieron de manifiesto un seudoaneurisma de génesis espontánea a nivel del seno coronariano izquierdo. Asociaba, además, dilatación de aorta ascendente e insuficiencia aórtica grave sobre una válvula bicúspide. La corrección se llevó a cabo mediante sustitución valvular aórtica y de aorta ascendente sinusal y tubular proximal mediante tubo valvulado de dacrón (prótesis biológica), con buen resultado quirúrgico. En el periodo postoperatorio precisó implantación de marcapasos definitivo por fibrilación auricular (FA) con bloqueo auriculoventricular (AV) completo. El paciente se halla, en la actualidad y tras 8 meses de seguimiento, asintomático.

Evaluar los resultados de la crioablación de la fibrilación auricular (FA) en pacientes sometidos a otra cirugía cardíaca. Material y métodos: Entre julio de 2006 y septiembre de 2009 fueron tratados 152 pacientes (70 hombres/82 mujeres) con edad media de 69,85 años, FA crónica en 122 (80,3%) pacientes, paroxística en 19 (12,5%), y 3 (2%) en flutter, intervenidos de cirugía polivalvular y/o combinada 93, mitral 41, valvular aórtica 13, y coronaria 3. Se realizó de forma endocárdica en el 78,3% y biauricular en 5 pacientes. Ligadura de orejuela izquierda: 79,1%. Se hizo revisión al alta, al mes, a los 3, 6, 12 meses y anualmente. Seguimiento medio de 17 meses (100% de los pacientes). Resultados: Mortalidad hospitalaria: 16 (10,5%) pacientes, sin relación con la técnica. Mortalidad tardía: 10 (7,4%) pacientes. Necesidad de marcapasos 7 (4,6%) pacientes (Tabla 1). Conclusiones: La curación de la FA es posible y segura mediante crioablación, si bien son necesarios estudios más amplios en cuanto a tamaño muestral y seguimiento. Nuestros resultados son similares a los publicados en la literatura.

Background: Coronary obstruction (CO) following transcatheter aortic valve replacement (TAVR) is a life-threatening complication, scarcely studied., Objectives: The authors analyzed the incidence of CO after TAVR, presentation, management, and in-hospital and 1-year clinical outcomes in a large series of patients undergoing TAVR., Methods: Patients from the Spanish TAVI (Transcatheter Aortic Valve Implantation) registry who presented with CO in the procedure, during hospitalization or at follow-up were included. Computed tomography (CT) risk factors were assessed. In-hospital, 30-day, and 1-year all-cause mortality rates were analyzed and compared with patients without CO using logistic regression models in the overall cohort and in a propensity score-matched cohort., Results: Of 13,675 patients undergoing TAVR, 115 (0.80%) presented with a CO, mainly during the procedure (83.5%). The incidence of CO was stable throughout the study period (2009-2021), with a median annual rate of 0.8% (range 0.3%-1.3%). Preimplantation CT scans were available in 105 patients (91.3%). A combination of at least 2 CT-based risk factors was less frequent in native than in valve-in-valve patients (31.7% vs 78.3%; P < 0.01). Percutaneous coronary intervention was the treatment of choice in 100 patients (86.9%), with a technical success of 78.0%. In-hospital, 30-day, and 1-year mortality rates were higher in CO patients than in those without CO (37.4% vs 4.1%, 38.3% vs 4.3%, and 39.1% vs 9.1%, respectively; P < 0.001)., Conclusions: In this large, nationwide TAVR registry, CO was a rare, but often fatal, complication that did not decrease over time. The lack of identifiable predisposing factors in a subset of patients and the frequently challenging treatment when established may partly explain these findings., Competing Interests: Funding Support and Author Disclosures The Spanish TAVI registry is managed and maintained with funding from the Interventional Cardiology Association of the Spanish Cardiology Society. Dr Ojeda has received consulting fees from Medtronic and Edwards Lifesciences; has received speaker fees from Philips and World Medical; and holds a research grant (PI21/00949) from the Spanish Ministry of Science and Innovation (Instituto de Salud Carlos III). Dr Asmarats is proctor for Abbott Vascular; and has received speaker fees from Edwards Lifesciences. Dr Amat-Santos is a proctor for Medtronic, Boston Scientific, and Meril Life. Dr Romaguera is proctor for Biosensor. Dr Moreno is a proctor for Boston Scientific and Biosensor. Dr Pan has received speaker fees from Abbott, Boston Scientific, World Medical, and Philips; and holds a research grant (PI21/00949) from the Spanish Ministry of Science and Innovation (Instituto de Salud Carlos III). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Severe allograft dysfunction after heart transplant (HT), without ischemia or evidence of cellular rejection upon endomyocardial biopsy (EMB), is a rare but potentially fatal condition that suggests humoral rejection (HR). Its incidence, and the methods of choice for its diagnosis and management, remain uncertain. We retrospectively studied 445 HT patients (April 1991-December 2003) to determine incidence of HR diagnosed by clinical and conventional histopathological criteria. We used immunofluorescence (IF) techniques to test archived frozen EMB issue for IgM, IgG, C1q, C3, fibrin and C4d. Twelve patients (2.7%) fulfilled the criteria for HR after a mean time post-HT of 21.3 +/- 24.7 months (range: 2-72 months). Patients were treated with high doses of steroids and plasmapheresis, with successful recovery in 11 cases. IF studies using classical markers were mainly negative for the six patients with enough EMB tissue for testing. All six patients showed positivity for C4d during the HR episode but not before or after. Humoral rejection was observed in less than 3% of HT patients. Plasmapheresis treatment was highly effective. Classical IF tests were not useful for diagnosis, but C4d appears to be useful both for confirmation of diagnosis and for monitoring response to treatment.