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Resumen Objetivo Este estudio analiza la frecuencia de las complicaciones postoperatorias tras la cirugia cardiaca, la incidencia del fracaso en el rescate (FR) y su relacion con la supervivencia. Metodos Desde enero del 2003 hasta diciembre del 2009, se intervinieron 2.750 pacientes adultos de cirugia cardiaca. Se analizaron 9 complicaciones postoperatorias. Para conocer las variables asociadas con alguna de estas complicaciones, se realizo analisis de regresion logistica multiple. La supervivencia se estimo mediante curvas de Kaplan-Meier y las complicaciones asociadas con la mortalidad se estimaron mediante regresion de Cox. Resultados La mortalidad hospitalaria fue 1,4% (IC del 95%, 1,01%-1,9%). La frecuencia de complicaciones postoperatorias fue del 38,5% (36,7%-40,4%) y el FR, 3,6% (2,5%-4,9%). La cirugia urgente (OR = 2,03, IC del 95%, 1,52-2,72), la insuficiencia renal cronica (OR = 1,50, IC del 95%, 1,25-1,80) y la edad ≥70 anos (OR = 1,42, IC del 95%, 1,20-1,68) fueron las variables que se asociaron con mas fuerza con las complicaciones seleccionadas. La supervivencia a los 5 anos fue del 93% en los pacientes sin complicaciones y el 83% en los pacientes con alguna de las complicaciones (p Conclusiones La incidencia de complicaciones postoperatorias en cirugia cardiaca oscila alrededor del 40% y aumenta la mortalidad hospitalaria aunque el FR fue muy bajo (3,6%; IC del 95%, 2,5-4,9).

Introduction and objectives The prognosis of patients with severe aortic stenosis, low aortic gradient and preserved ejection fraction is controversial. Our study analyzed the prognosis of these patients and its relation to pressure gradient and aortic valve flow. Methods We performed a retrospective cohort study of 363 consecutive patients with severe aortic stenosis and preserved ejection fraction, divided into 4 groups, based on the presence of a systolic volume index greater or lower than 35 mL/m 2 and the presence of a mean aortic gradient greater or lower than 40 mmHg. Group I: normal flow, high gradient (n=169, 47%); group II: normal flow, low gradient (n=98, 27%); group III: low flow, high gradient (n=54, 15%), and group IV: low flow, low gradient (n=42, 12%). The primary endpoint was overall mortality. Results Independent risk factors for mortality were age (hazard ratio=1.04; 95% confidence interval, 1.01-1.08) and atrial fibrillation (hazard ratio=2.21; 95% confidence interval, 1.24-3.94). Surgical treatment was associated with longer survival in all groups (hazard ratio=0.25; 95% confidence interval: 0.13-0.49). Mortality was higher in patients with low flow than in those with with normal flow (26.6% vs 13.6%; P =.004). The most favorable mean prognosis was found in group II (hazard ratio=0.4; 95% confidence interval, 0.2-0.9). Conclusions Patients with severe aortic stenosis, normal ejection fraction and low aortic flow have a worse prognosis. Analysis of aortic flow by Doppler echocardiography is useful in risk stratification and therapeutic decision-making in patients with aortic stenosis.

Evaluating patient outcomes following cardiac surgery is a means of measuring the quality of that surgery. The present study analyzes survival and the risk factors associated with mid-term mortality of patients undergoing cardiac surgery in Son Dureta University Hospital (Palma, Balearic Islands, Spain).From November 2002 thru December 2007, 1938 patients underwent interventions. Patients were stratified in 4 age groups. Of 1900 patients discharged from hospital, 1844 were followed until December 31, 2008. Following discharge, we constructed Kaplan-Meier survival curves and performed Cox regression analysis to determine which variables associated with mid-term mortality.In-hospital mortality of the 1,938 patients was 1.96% (CI 95%, 1.36%-2.6%). Survival probability at 1, 3 and 5 years follow-up was 98%, 94% and 90%, respectively. Mean follow-up was 3.2 (0.01-6.06) years. Patients aged ≥ 70 years showed a lower survival rate than those aged70 (log rank test, P.0001). At the end of follow-up, mortality was 6.5% (CI 95%, 5.4%-7.7%). Age ≥ 70 years, a history of severe ventricular dysfunction (ejection fraction30%), severe pulmonary hypertension, diabetes mellitus, preoperative anemia, postoperative stroke, and hospital stay were independently associated with mid-term mortality.Mid-term survival after discharge was highly satisfactory. Mid-term mortality varied with age and other pre- and postoperative factors.

Objective The present study examined the inhibitory effects of pyrophosphate, etidronate, and phytate on bovine pericardium calcification in vitro. Methods Bovine pericardium was glutaraldehyde fixed and then placed in a flow chamber in the presence of a synthetic physiological fluid alone (control) or the fluid plus various concentrations of pyrophosphate, etidronate, or phytate. Following a 96-h incubation, fragments were removed and assayed for calcification by measuring calcium and phosphorus levels. Results The data indicated that both pyrophosphate and etidronate at 1 mg/l (5.75 and 4.95 μM, respectively) inhibited bovine pericardium calcification, whereas neither agent had an effect at 0.5 mg/l (2.87 and 2.47 μM, respectively). Phytate was the most potent inhibitor of calcification, and the effects of this agent were apparent at levels as low as 0.25 mg/l (0.39 μM). Conclusions While pyrophosphate, etidronate, and phytate were all able to inhibit bovine pericardium calcification in vitro, phytate was found to be the most effective.

Cannulation of the axillary artery is one possible means of establishing cardiopulmonary bypass during surgery of the ascending aorta and aortic arch. Use of a Dacron graft for cannulation has a number of advantages. In this article, we report our experience with this technique in seven consecutive patients in whom we performed an ascending aorta replacement. The associated procedures involved were aortic root reconstruction using David's procedure in two patients, the Bentall procedure in one, the hemi-arch technique in two, the complete arch and elephant trunk technique in one, aortic valve repair in one, and Valsalva sinus reconstruction in one. Circulatory arrest with antegrade cerebral perfusion was carried out in three cases. There was no in-hospital mortality, and there were no vascular or infectious complications related to axillary access. One patient presented with transient paresthesia of the brachial plexus. In all cases, cardiopulmonary bypass flow was adequate.

170 Aortic intramural hematoma (AIH) is considered a precursor of aortic dissection. It is caused by vasa vasorum bleeding in the tunica media of the aortic wall. The incidence of AIH ranges from 3% to 53% of cases of acute aortic syndrome. The condition usually manifests as retrosternal pain with interscapular irradiation. It can progress to rupture or calcification, or it can regress. Aortic intramural hematoma is diagnosed by computed tomography (CT), magnetic resonance or transesophageal ultrasonography. The treatment is similar to that used in aortic dissection. The case presented is a 62-year-old patient in whom a 4×3.5×2.5-cm soft, bluish mass was unexpectedly discovered in the distal portion of the ascending aorta (AA) during coronary surgery. The adventitia presented a moderate inflammatory reaction with minor pericardial adhesions. The AA measured 4.5 cm in diameter in this area (Figure 1). A decision was made during surgery to replace the AA with a 30-mm dacron graft. Upon opening the surgical specimen, examination of the AIH showed integrity of the intima without continuity with the aortic lumen (Figure 2). The hematoma had a soft consistency and contained an organized reddish thrombus, probably a consequence of recent IM AG E S I N CA R D I O L O G Y

) and 41.2±9.9 mm Hg, respectively. It was determined that the IVV (0.11±0.03 cm/s vs 0.15±0.02 cm/s, p