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Background and Objective: Studies of frailty in primary health care (PHC) using frailty indexes are scarce. Frail-VIG index assesses the level of frailty through a multidimensional approach. The main objective was to investigate the convergent and discriminative validity of the frail-VIG index with respect to Short Physical Performance Battery (SPPB) in general population ≥ 70 years., Population, Materials and Methods: Descriptive cross-sectional study. We included 416 non-institutionalized patients aged 70 years or over from two lists of general practitioners in a semi-urban healthcare center. Main variables were: frail-VIG index and SPPB., Results: The value of the area under the ROC curve of frail-VIG index respect SPPB < 7 was 0.81 (95% CI: 0.76-0.86). Pearson's correlation coefficient was -0.59 (95% CI: -0.524 to -0.649). The mean of frail-VIG index in those classified as not frail by SPPB < 7 was 0.103 (95% CI: 0.094-0.112) and in the frail was 0.242 (95% CI: 0.215-0.269). We obtained significant differences in the mean and distribution of the SPPB according to the frail-VIG index categories. The frailty prevalence according to the frail-VIG index was 29.3% (95% CI: 25.2-33.9), initial 19%, intermediate 7.5% and advanced 2.9%. There were frailty people by frail-VIG index and not by SPPB < 7 the 10.4%; on the contrary the 9.6%, the mean of affected domains of frail-VIG index was 3.9 and 2.2, respectively., Conclusions: The frail-VIG index presents adequate convergent and discriminative validity with respect to the SPPB that supports the use in PHC. There is a 20% of participants classified as frail in a discordant way, who presents a different profile., (Copyright © 2023 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.)

The use of extracorporeal techniques in cardiopulmonary support has spread in the last 20 years. ECMO (extracorporeal membrane oxygenation) devices are the most commonly employed option, and have been used for years in lung transplant programs. Nevertheless, few articles on the results of ECMO involving large numbers of cases have been published to date. The use of ECMO in respiratory failure affords immediate oxygen support in patients with severe hypoxia and/or acidosis, and moreover provides pulmonary protection, since it allows an instantaneous decrease in the ventilator pressure and FiO2 needs. The complications of ECMO have been minimized thanks to the technological improvements found in the latest devices, though renal failure, infections, bleeding, and vascular and mechanical complications are still reported in many studies. At present there is less controversy regarding the use of cardiorespiratory assists with ECMO as an alternative in decompensated patients who are on the waiting list, referred to the intra- and postoperative periods of lung transplantation., (Copyright © 2012 Elsevier España, S.L. and SEMICYUC. All rights reserved.)

Objective: The purpose of the study was to analyze some variables of donors, recipients and surgical procedures in order to discover factors that could predict mortality during the early stage (< 30 days) of orthotopic heart transplants., Material and Method: 125 consecutive orthotopic heart transplants in adults were analyzed. The average age was 51 +/- 11 (range: 12-67), 109 (87%) were men, 16 were women (13%). Two groups were compared: 15 patients who died within 30 days after heart transplant and 110 who survived during that period. Immunosuppressive protocol: preoperative: Cyclosporin + Azathioprine. Intraoperative: Methylprednisolone Postoperative: Methylprednisolone (first 24 h), antilymphocyte monoclonal antibodies (7-10 days after heart transplant) + Cyclosporin + Azathioprine + Corticoids. The following parameters of the recipient were analyzed: sex, age, weight, size, thoracic perimeter, pretransplant cardiopathy, previous thoracic operations, functional stage or need for catecholamines during the days prior to the transplant, pulmonary artery pressure and resistance, history of systemic arterial hypertension, elevation of creatinine, blood type, urgent transplant indication, receptor/donor weight relationship. The following parameters of donors and operation were analyzed: sex, age, weight, thoracic perimeter, period in intensive care unit, dose of dopamine and dobutamine, blood type, origin of the organ, cause of death, ischaemia time, cardiopulmonary by-pass time and cardioplegia type., Results: The rate of early mortality was 12%. The univariate analysis showed differences in: prior cardiovascular surgery, receptor blood type, need for urgent transplantation, pulmonary artery resistance > 2.5 Wood Units, cardiopulmonary by-pass time, weight relationship between receptor and donor. The death cause of the donor proved significant. On multivariate analysis, the following parameters independently predicted early mortality: history of operation with extracorporeal circulation, high pulmonary artery resistance, urgent transplant, receptor/donor weight relation and time of extracorporeal circulation., Conclusions: We believe that the results of our experience can help to stratify the risk in the orthotopic heart transplant recipient and even to contraindicate the procedure in some cases showing an accumulation of poor prognostic factors in borderline recipients.

We present the case of a 29-year-old women with a cardiac primary angiosarcoma diagnosis. The initial symptom was a cardiac tamponade. The tests for screening metastasis proved negative. She was preoperatively treated with chemotherapy, followed by a heart transplant. There were no incidents related to surgery nor to the transplant except for a rejection in the second week biopsy. Four weeks after the transplant, the patient had a sudden dyspnea, the radiological tests confirmed the existence of a massive pleural overflow and lung and pleural metastasis. All types of therapeutical approaches were rejected except for pleurodesis. The patient died 60 days after the heart transplant.

Aim: The purpose of this study was to analyze a series of variables in donors as well as of the preoperative and early and late postoperative of patients developing a right branch block of the bundle of His (RBBBH) in the first week after heart transplantation (HT), and to evaluate factors predicting the disappearance or progression of this conduction disorder., Material and Methods: 58 consecutive patients having undergone an orthotopic HT were studied. 15 of them showed a RBBBH after the HT (age: 43 +/- 13, 12 male, 3 female) and 43 did not (age: 54 +/- 17, 40 male and 3 female). ECGs and echocardiographic studies were performed after 1 week, 1, 3 and 6 months and 1 year. The following factors were analyzed: age and sex of the donor baseline cardiopathy, donor's weight related to recipient's weight, time of ischaemia and cardiopulmonary by-pass, number of rejections per patient/year, previous pulmonary vascular resistance. These parameters were compared among the patients who showed RBBBH and those who did not, and between those whose blocks disappeared in the follow-up and those whose blocks persisted., Results: We found differences is the sex of donors, age of recipients, baseline etiology and time of cardiopulmonary by-pass (with block: 43 +/- 13 years old, dilated cardiomyopathy 73%, 106 +/- 25 minutes, whereas without block: 54 +/- 17 years old, dilated cardiomyopathy 42%, 92 +/- 18). The different parameters between the patients whose block underwent a regression or a progression were sex, lung resistances and right ventricle diameter (progression of the block: men 100%, 3.43% +/- 1.05 UW, progressively growing ventricular diameters. No progression or regression of the block: men 67%, 1.63 +/- 0.74 UW, ventricular diameters with progressive decrease)., Conclusion: Younger recipients, with a diagnosis of dilated cardiomyopathy, to whom a woman's heart is implanted and who show a longer extracorporal circulation time are those who show a higher incidence of RBBBH: Male patients with high pulmonary resistances undergo a progressive increase in the diameter of the right ventricle and a progressive increase in the RBBBH degree.