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Resumen Antecedentes y objetivo En los ultimos anos la cirugia cardiaca minimamente invasiva (CCMI) se ha desarrollado y aplicado a mayor numero de dolencias, especialmente en cirugias sobre la valvula mitral, por presentar resultados comparables a las tecnicas convencionales con menor agresividad y tiempo de recuperacion. La CCMI que necesita ventilacion unipulmonar se ha asociado a la aparicion de edema pulmonar unilateral (EPU), que constituye una complicacion potencialmente grave. El objetivo es determinar la incidencia de EPU tras CCMI mitral y los factores asociados a su desarrollo. Material y metodos Estudio observacional descriptivo y unicentrico. Se analizaron los pacientes tratados con CCMI sobre valvula mitral (minitoracotomia derecha), recogidos de manera consecutiva entre los anos 2015 y 2017. Resultados Se incluyo a un total de 93 pacientes, de los cuales 23 presentaron EPU. Las complicaciones mas habituales tras la CCMI mitral fueron: fibrilacion auricular (38,7%), EPU (28%) y bloqueo auriculoventricular de segundo o tercer grado transitorio o definitivo (19,4%). El grupo EPU presento mayor tiempo de estancia en UCI (3,3 ± 8,0 vs. 1,84 ± 2,23 dias) y mayor tiempo total de hospitalizacion (15,5 ± 34,7 vs. 10,6 ± 7,5 dias). La mortalidad en el grupo EPU fue del 3,9%. Se encontro asociacion significativa entre las siguientes variables recogidas y el desarrollo de EPU postoperatorio: pulsioximetria basal preoperatoria, uso preoperatorio de IECA, fibrilacion auricular postoperatoria y volumen de drenajes en las primeras 24 h. Conclusiones La incidencia de EPU es elevada y su aparicion se asocia a mayor estancia en UCI y mayor tiempo total de hospitalizacion. Se requieren mas estudios para comprender su fisiopatologia y aplicar medidas que ayuden a disminuir su aparicion.

Tricuspid regurgitation is associated with a poor outcome and its quantification remains a challenge. Tricuspid annulus dilatation is one of the parameters that influences clinical decision-making. The aim of this study was to compare the use of 2D transoesophageal echocardiography with surgical assessment for the measurement of the tricuspid annulus. Sixty-one cardiac patients (median age 64 years) were included in the study. Echocardiographic tricuspid annulus measurements were obtained from four chamber and transgastric short axis views and compared with the surgical measurements of this valve. The study was approved by the Ethics Committee of our institution. The tricuspid annulus measurements were obtained from the four chamber and the short axis views in 57 and 49 patients, respectively, while surgical measurement was performed in all 61 patients. Bland–Altman analysis of 49 tricuspid annulus-matched dimensions of the short axis view and surgical values showed a mean bias of 0.223 mm/m2, with limits of agreement of −5.86 to 6.31 mm/m2. Echocardiographic measurements of the tricuspid annulus dimension were accurate (90% sensitivity and 90% specificity for a four chamber view cut-off value ≥ 24.5 mm/m2, and 89% sensitivity and 97% specificity for a short axis view cut-off value ≥ 37.6 mm/m2, P

International audience; Background - Infective endocarditis (IE) is a common and serious complication in patients receiving chronic hemodialysis (HD). Objectives - This study sought to investigate whether there are significant differences in complications, cardiac surgery, relapses, and mortality between IE cases in HD and non-HD patients. Methods - Prospective cohort study (International Collaboration on Endocarditis databases, encompassing 7,715 IE episodes from 2000 to 2006 and from 2008 to 2012). Descriptive analysis of baseline characteristics, epidemiological and etiological features, complications and outcomes, and their comparison between HD and non-HD patients was performed. Risk factors for major embolic events, cardiac surgery, relapses, and in-hospital and 6-month mortality were investigated in HD-patients using multivariable logistic regression. Results - A total of 6,691 patients were included and 553 (8.3%) received HD. North America had a higher HD-IE proportion than the other regions. The predominant microorganism was Staphylococcus aureus (47.8%), followed by enterococci (15.4%). Both in-hospital and 6-month mortality were significantly higher in HD versus non-HD-IE patients (30.4% vs. 17% and 39.8% vs. 20.7%, respectively; p

El principal objetivo del presente trabajo es clarificar la compleja tributación en el impuesto sobre la renta de las personas físicas que puede tener el abono o el cobro de las arras ante una compraventa de bienes inmuebles. Puesto que existen varios tipos de arras con diferentes efectos, pueden plantearse múltiples supuestos con diferentes características y las consecuencias tributarias pueden afectar tanto al vendedor como al comprador. En concreto, los escenarios en los que se analizará, considerando las distintas singularidades que pueden darse en cada uno, son la entrega y recepción de las arras con anterioridad o en el momento de la transmisión de la propiedad, su cobro o restitución doblada tras el desistimiento o incumplimiento de una de las partes y su restitución justificada. Finalmente, y tras haber puesto de manifiesto las principales cuestiones problemáticas que pueden generarse, el estudio se cerrará con algunas propuestas para mejorar su regulación tanto a nivel civil como tributario.

The incidence of acute kidney injury following cardiac surgery (CSA-AKI) is up to 30%, and it places patients at an increased risk of death. The Leicester score (LS) is a new score that predicts CSA-AKI of any stage with better discrimination compared to previous scores. The aim of this study was to identify risk factors for CSA-AKI and to assess the performance of LS. A unicentric retrospective study of patients that required cardiac surgery with cardio-pulmonary bypass (CPB) in 2015 was performed. The inclusion criteria were patients over 18 years old who were operated on for cardiac surgery (valve substitution (VS), Coronary Artery Bypass Graft (CABG), or a combination of both procedures and requiring CPB). CSA-AKI was defined with the Kidney Disease Improving Global Outcomes (KDIGO) criteria. In the multivariate analysis, hypertension (odds ratio 1.883), estimated glomerular filtration rate (EGFR)

This video tutorial presents the reconstruction of the intervalvular fibrosa and a triple valve replacement, due to prosthetic valve endocarditis, in a patient with previous chest irradiation and bicuspid aortic valve replacement. Constrictive pericarditis was also present since the original operation. A detailed step-by-step demonstration of the reconstruction of the intervalvular fibrosa and debridement of extensive prosthetic valve endocarditis with paravalvular root abscess are provided. A secondary sternotomy was performed and, in the process, the ascending aorta was injured, with associated life-threatening bleeding. Manual compression was applied while peripheral cannulation and cardiopulmonary bypass were started. The bleeding was controlled with cooling and circulatory arrest and the ascending aorta was replaced with a Dacron graft. The intervalvular fibrosa was reconstructed using a folded pericardial patch. Aortic root replacement with a cryopreserved homograft was performed and the mitral and tricuspid valves were replaced with tissue valve prostheses. A complete pericardiectomy was performed. The chest was left packed with cotton due to diffuse bleeding. At the time of the delayed chest closure, a permanent epicardial pacemaker was implanted.

Background Coronavirus disease 2019 (COVID-19) is associated with a high disease burden with 10% of confirmed cases progressing towards critical illness. Nevertheless, the disease course and predictors of mortality in critically ill patients are poorly understood. Methods Following the critical developments in ICUs in regions experiencing early inception of the pandemic, the European-based, international RIsk Stratification in COVID-19 patients in the Intensive Care Unit (RISC-19-ICU) registry was created to provide near real-time assessment of patients developing critical illness due to COVID-19. Findings As of April 22, 2020, 639 critically ill patients with confirmed SARS-CoV-2 infection were included in the RISC-19-ICU registry. Of these, 398 had deceased or been discharged from the ICU. ICU-mortality was 24%, median length of stay 12 (IQR, 5-21) days. ARDS was diagnosed in 74%, with a minimum P/F-ratio of 110 (IQR, 80-148). Prone positioning, ECCO2R, or ECMO were applied in 57%. Off-label therapies were prescribed in 265 (67%) patients, and 89% of all bloodstream infections were observed in this subgroup (n = 66; RR=3·2, 95% CI [1·7-6·0]). While PCT and IL-6 levels remained similar in ICU survivors and non-survivors throughout the ICU stay (p = 0·35, 0·34), CRP, creatinine, troponin, d-dimer, lactate, neutrophil count, P/F-ratio diverged within the first seven days (p

El principal objetivo del presente trabajo es el análisis del método de comprobación del valor real mediante la estimación por referencia a valores catastrales multiplicados por índices o coeficientes en el ámbito del ITPAJD y el ISD, tributos en los que constituye su base imponible. (tributos en los que el valor real configura su base imponible). Para ello, tras la constatación de los diferentes problemas inherentes en esta forma de estimación, al propio método, se estudiará el actual posicionamiento del TS acerca de su insuficiencia en cuanto a método de comprobación (cambio de jurisprudencia establecido por la STS de 23 de mayo de 2018 —Rec. 1880/2017—), analizando posteriormente el papel que actualmente desempeña su uso y las demás consecuencias que de ello se derivan.

GAMES Investigators., [Background] Enterococcal endocarditis (EE) is a growing entity in Western countries. However, quality data from large studies is lacking., [Objectives] The purpose of this study was to describe the characteristics and analyze the prognostic factors of EE in the GAMES cohort., [Methods] This was a post hoc analysis of a prospectively collected cohort of patients from 35 Spanish centers from 2008 to 2016. Characteristics and outcomes of 516 cases of EE were compared with those of 3,308 cases of nonenterococcal endocarditis (NEE). Logistic regression and Cox proportional hazards regression analysis were performed to investigate risk factors for in-hospital and 1-year mortality, as well as relapses., [Results] Patients with EE were significantly older; more frequently presented chronic lung disease, chronic heart failure, prior endocarditis, and degenerative valve disease; and had higher median age-adjusted Charlson score. EE more frequently involved the aortic valve and prosthesis (64.3% vs. 46.7%; p < 0.001; and 35.9% vs. 28.9%; p = 0.002, respectively) but less frequently pacemakers/defibrillators (1.5% vs. 10.5%; p < 0.001), and showed higher rates of acute heart failure (45% vs. 38.3%; p = 0.005). Cardiac surgery was less frequently performed in EE (40.7% vs. 45.9%; p = 0.024). No differences in in-hospital and 1-year mortality were found, whereas relapses were significantly higher in EE (3.5% vs. 1.7%; p = 0.035). Increasing Charlson score, LogEuroSCORE, acute heart failure, septic shock, and paravalvular complications were risk factors for mortality, whereas prior endocarditis was protective and persistent bacteremia constituted the sole risk factor for relapse., [Conclusions] Besides other baseline and clinical differences, EE more frequently affects prosthetic valves and less frequently pacemakers/defibrillators. EE presents higher rates of relapse than NEE.

Purpose: To analyze the influence of adding gentamicin to a regimen consisting of β-lactam or vancomycin plus rifampicin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis (SPVE). Methods: From January 2008 to September 2016, 334 patients with definite SPVE were attended in the participating hospitals. Ninety-four patients (28.1%) received treatment based on β-lactam or vancomycin plus rifampicin and were included in the study. Variables were analyzed which related to patient survival during admission, including having received treatment with gentamicin. Results: Seventy-seven (81.9%) were treated with cloxacillin (or vancomycin) plus rifampicin plus gentamicin, and 17 patients (18.1%) received the same regimen without gentamicin. The causative microorganism was Staphylococcus aureus in 40 cases (42.6%) and coagulase-negative staphylococci in 54 cases (57.4%). Overall, 40 patients (42.6%) died during hospital admission, 33 patients (42.9%) in the group receiving gentamicin and 7 patients in the group that did not (41.2%, P = 0.899). Worsening renal function was observed in 42 patients (54.5%) who received gentamicin and in 9 patients (52.9%) who did not (p = 0.904). Heart failure as a complication of endocarditis (OR: 4.58; CI 95%: 1.84–11.42) and not performing surgery when indicated (OR: 2.68; CI 95%: 1.03–6.94) increased mortality. Gentamicin administration remained unrelated to mortality (OR: 1.001; CI 95%: 0.29–3.38) in the multivariable analysis. Conclusions: The addition of gentamicin to a regimen containing vancomycin or cloxacillin plus rifampicin in SPVE was not associated to better outcome.

Introduction Aortic stenosis (AS) in non-cardiac surgery increases perioperative risk of complications (1) Methods Case report of single patient Results A 70-year-old lady with complicated type 2 diabetes with renal, retinal and coronary affection is admitted to a district general hospital (DGH) with a decompensated heart failure. She is known to have hypertension, restrictive pneumopathy due to obesity (Body Mass Index of 49), stable angor with 2 stents in circumflex and right coronary artery, a moderate AS with moderately impaired Left ventricular function, and an untreated umbilical hernia. On admission microcitic anaemia was diagnosed with hemoglobin of 7.4 g/dl thought to be due to NSAID administration. After red blood cell (RBC) transfussion and deplective treatment was instituted, her dyspnea improved. Nevertheless, after 10 days of hospital admission she started with fever and positive blood cultures for Enterococcus faecium and Staphylococcus aureus Methicillin-resistant (MRSA). No vegetation was found in transthoracic and transoesophageal echocardiography, CT brain was normal but in the CT of the abdomen a infrarenal pseudoaneurysm of the Aorta was evidenced. She was transferred to our centre for treatment of the mycotic pseudoaneurysm. Uppon arrival to a PET-scan confirmed the active infective focus in the infra-renal Aorta. She was started on daptomicin+ ceftaroline. Due to high risk of opened surgery an endovascular exclusion of pseudoaneurysm was proposed to prevent aortic rupture. Discussion with heart team took place and aortic ballon valvuloplasty was deemed too risky due to infection scenario and moderate grade of AS. Preoperative optimisation was performed increasing furosemide due to congestive lung signs in chest X-ray. Uppon her arrival at interventional radiology suite, she was monitored invasively with left radial artery blood pressure and central venous pressure via right internal yugular vein. Intraoperative approach was based on conscious sedation with remifentanil and local anaesthesia. Neverthless, equipment for converting to a general anaesthesia was prepared and a second consultant anaesthetist kept available to give assistance to this remote area in case of emergency. During the procedure she maintained tendency to hypertension with mean arterial pressure of 100-110 mmHg and central venous pressure of 22 mmHg. Total diuresis was 100 ml. Blood gas analysis revealed Hb of 8.5 g/dl, p02 of 120 mmHg with 35% of facemask oxygen and pCO2 of 38 mmHg. 1 unit of RBC was transfused. The pseudoaneurysm was excluded with no residual leak. Postoperatively, she was admitted to a surgical intensive care unit where she stayed for 20 hours. After 12 days of uncomplicated hospital admission, she was discharged to original DGH hospital. Discussion Aortic stenosis in vascular surgery modify perioperative approach including intraoperative monitoring, type of anaesthesia and postoperative ICU admission. Preoperative optimisation and multidisciplinar assessment via Heart team of Aortic valvuloplasty is recommended. We report a high risk patient with heart failure and moderate AS that underwent an uneventful endovascular exclusion of mycotic pseudoaneurysm under conscious sedation and local anaesthesia.

Este trabajo ha obtenido el 1.er Premio Estudios Financieros 2017 en la modalidad de Tributación. El principal objetivo del presente trabajo es analizar la poliédrica relación entre los efectos vinculantes de las consultas tributarias escritas y los pronunciamientos judiciales, en concreto desde una triple perspectiva: valorando su papel en los enjuiciamientos de origen nacional, precisando los cambios jurisprudenciales como límite a los mismos y determinando las especialidades de las sentencias prejudiciales y de incumplimiento del Tribunal de Justicia de la Unión Europea al respecto. Asimismo, se analizarán y criticarán las diferentes consecuencias de tales consideraciones, con el fin de clarificar sus efectos respecto a los diferentes obligados tributarios y poner de manifiesto las carencias que presenta en este punto nuestro ordenamiento (especialmente ante el principio de primacía del Derecho de la Unión Europea). Y es que la precisión de tales cuestiones, que no ha estado exenta de opiniones contrapuestas, resulta del todo imprescindible para dotar a las consultas tributarias escritas de la eficacia e importancia que merecen, por cuanto, tanto por la amplitud de su objeto como por sus efectos vinculantes para la Administración, son una de las actuaciones que forman parte del derecho de información de los obligados tributarios más relevante y completa.

Objective: To investigate the rate of colorectal neoplasms (CRNs) in patients who have Enterococcus faecalis infective endocarditis (EFIE) with available colonoscopies and to assess whether this is associated with the identification of a focus the infection. Patients and Methods: Retrospective analysis of data from a prospective multicenter study involving 35 centers who are members of the Grupo de Apoyo para el Manejo de la Endocarditis en Espana [Support Group for the Management of Infective Endocarditis in Spain] cohort. A specific set of queries regarding information on colonoscopy and histopathology of colorectal diseases was sent to each participating center. Four-hundred sixty-seven patients with EFIE were included from January 1, 2008, to December 31, 2017, from whom data on colonoscopy performance and results were available in 411 patients. Results: One hundred forty-two (34.5%) patients had a colonoscopy close to the EFIE episode. The overall rate of colorectal diseases was 70.4% (100 of 142), whereas the prevalence of CRN (advanced adenomas and colorectal carcinoma) was 14.8% (21 of 142), with no significant differences between the group of EFIE of unknown focus and that with an identified focus. Conclusion: Our study adds to prior evidence suggesting a much higher rate of CRN among patients with EFIE than in the general population of the same age and sex. In addition, our findings suggest that this phenomenon might take place both in EFIE with an unknown and an identified source of infection.

[EN] Some of the elements that have been most transformed after the installation of the European Higher Education Area (EHEA) and the generalization of Information and Communication Technologies (ICT) have been the learning resources, a point at which the videos of a teaching nature is configured as a tool of high potential. For example, the results in the Master's Degree in Taxation (MUF) of the Open University of Catalonia (UOC), constitute the proposal of the different uses of the same the main objective of this work: the use of video by the part of the students the task of carrying out the tasks, the use of contents related to the content of some subjects to consolidate them and the integral formation and the elaboration of the own videos by the teaching team to facilitate the learning. In the three cases, there have been few drawbacks (especially those focused on the work that is supposed to be created and that has been compensated with its possible reuse) and many advantages for both students and teachers, so it is clearly They raise As work tools with a suitable potential for any degree., [ES] Unos de los elementos que más se han visto transformados tras la instauración del Espacio Europeo de Educación Superior (EEES) y la generalización de las Tecnologías de la Información y la Comunicación (TIC) han sido los recursos de aprendizaje, punto en el que los vídeos de carácter docente se configuran como una herramienta de elevado potencial. Por ello, conscientes de su relevancia, la apuesta por su implementación ha sido uno de los principales objetivos en el Máster Universitario de Fiscalidad (MUF) de la Universitat Oberta de Catalunya (UOC), constituyendo la propuesta de tres usos distintos de los mismos el principal objetivo del presente trabajo: la utilización del vídeo por parte de los estudiantes para garantizar la adquisición de determinadas competencias, la utilización de vídeos externos relacionados con el contenido de algunas asignaturas para consolidar contenidos específicos y reforzar la formación integral y la elaboración de vídeos propios por parte del equipo docente para facilitar el aprendizaje. En los tres casos, han sido pocos los inconvenientes que plantean (especialmente focalizados en el trabajo que supone su creación pero que se ve compensado con su posible reutilización) y muchas las ventajas tanto para los estudiantes como los profesores, por lo que claramente se alzan como herramientas docentes con un potencial idóneo para cualquier titulación.

The main scope of this study is the analysis of the incidence of residing in a geriatric residence in the taxation of mortis causa acquisitions. Specifically, within the scope of the Inheritance and Gift Tax, this incidence will be determined in the subjection to the Tax of the purchasers, in the transfer of the Tax, in the reduction of the tax base for the transmission of the main residence of the deceased, in the calculation of the household items and in the reduction of tax liability due to the residence in Ceuta or Melilla. Finally, we will also analyse the incidence in the optional reduction in the amount of the Tax on the Increase in Value of Urban Land due to the transmission of the main residence of the deceased. El objetivo principal del presente trabajo es el análisis de los diferentes aspectos de la tributación de las adquisiciones mortis causa en los que puede incidir el hecho de habitar en una residencia geriátrica, ya sea por parte del causante o del adquirente. En concreto, dentro del ámbito del ISD, se determinará su implicación en la sujeción al Impuesto por parte del adquirente, en su cesión, en la reducción de la base imponible por la transmisión de la vivienda habitual del causante, en el cálculo del ajuar doméstico y en la bonificación de la cuota por la residencia en Ceuta o Melilla, acabando con el análisis de la bonificación prevista en el IIVTNU en relación con la adquisición de la vivienda habitual del causante que prevén algunos Ayuntamientos.

Background Idiopathic pulmonary fibrosis (IPF) is a progressive and fatal lung disease with limited response to currently available therapies. Alveolar type II (ATII) cells act as progenitor cells in the adult lung, contributing to alveolar repair during pulmonary injury. However, in IPF, ATII cells die and are replaced by fibroblasts and myofibroblasts. In previous preclinical studies, we demonstrated that ATII-cell intratracheal transplantation was able to reduce pulmonary fibrosis. The main objective of this study was to investigate the safety and tolerability of ATII-cell intratracheal transplantation in patients with IPF. Methods We enrolled 16 patients with moderate and progressive IPF who underwent ATII-cell intratracheal transplantation through fiberoptic bronchoscopy. We evaluated the safety and tolerability of ATII-cell transplantation by assessing the emergent adverse side effects that appeared within 12 months. Moreover, pulmonary function, respiratory symptoms, and disease extent during 12 months of follow-up were evaluated. Results No significant adverse events were associated with the ATII-cell intratracheal transplantation. After 12 months of follow-up, there was no deterioration in pulmonary function, respiratory symptoms, or disease extent. Conclusions Our results support the hypothesis that ATII-cell intratracheal transplantation is safe and well tolerated in patients with IPF. This study opens the door to designing a clinical trial to elucidate the potential beneficial effects of ATII-cell therapy in IPF.

Background: There is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP). Currently, IE antibiotic prophylaxis (IEAP) is not recommended for these conditions. Objectives: This study sought to describe the clinical and microbiological features of IE in patients with BAV and MVP and compare them with those of IE patients with and without IEAP indication, to determine the potential benefit of IEAP in these conditions. Methods: This analysis involved 3,208 consecutive IE patients prospectively included in the GAMES (Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España) registry at 31 Spanish hospitals. Patients were classified as high-risk IE with IEAP indication (high-risk group; n = 1,226), low- and moderate-risk IE without IEAP indication (low/moderate-risk group; n = 1,839), and IE with BAV (n = 54) or MVP (n = 89). Results: BAV and MVP patients had a higher incidence of viridans group streptococci IE than did high-risk group and low/moderate-risk group patients (35.2% and 39.3% vs. 12.1% and 15.0%, respectively; all p < 0.01). A similar pattern was seen for IE from suspected odontologic origin (14.8% and 18.0% vs. 5.8% and 6.0%; all p < 0.01). BAV and MVP patients had more intracardiac complications than did low/moderate-risk group (50% and 47.2% vs. 30.6%, both p < 0.01) patients and were similar to high-risk group patients. Conclusions: IE in patients with BAV and MVP have higher rates of viridans group streptococci IE and IE from suspected odontologic origin than in other IE patients, with a clinical profile similar to that of high-risk IE patients. Our findings suggest that BAV and MVP should be classified as high-risk IE conditions and the case for IEAP should be reconsidered. Sin financiación 18.639 JCR (2018) Q1, 3/136 Cardiac & Cardiovascular Systems 9.280 SJR (2018) Q1, 1/365 Cardiology and Cardiovascular Medicine No data IDR 2018 UEM

Introduction Adult congenital heart disease (ACHD) represents a growing population in many cardiac centers and it's a challenge for all physicians involved. Multidisciplinary teams integrated by cardiologists, echocardiographers, cardiac surgeons, cardiac anesthesiologists, radiologists and others, have been created in many hospitals to manage such patients (1). The objective was to describe the adult congenital cardiac population scheduled for cardiac surgery in our reference center. Methods We included all patients scheduled for cardiac surgery with a diagnosis of ACHD from January 2017 to May 2018. A retrospective review of medical records was performed for demographics, type of heart defect, intraoperative management, postoperative evolution, ICU length of stay and outcome at 30 days. Results A total of 1060 patients underwent elective cardiac surgery between the study period. Sixty-six patients (6.22%) had the diagnosis of ACHD. Mean age was 53.5±17 years [range 19 to 85 years], 63.6% were male and mean EuroSCORE II was 1.51 [range 0.5 to 5.41]. Type and number of diagnoses were: bicuspid aortic valve 45 patients, atrial septal defect 12 patients, congenital pulmonary stenosis 2 patients, congenital aortic stenosis 1 patient, sub-aortic membrane 1 patient, right coronary artery anomaly 1 patient, single ventricle 1 patient, tetralogy of Fallot 1 patient, Ebstein's anomaly 1 patient and partial atrioventricular canal defect 1 patient. Eight of the 45 patient with aortic bicuspid valve had associated aortic root aneurysm. All patients were monitored with transesophageal echocardiography (TEE). Twenty-five patients (37.8%) were extubated in the operating room. Nine patients (13.6%) required blood products. Percentage of postoperative complications were: arrhythmias (28.7%), renal dysfunction (15.1%), hemorrhage >500ml at 24h (10.6%), respiratory alterations (7.5 %), neurologic events (4.5%), intubation >24h (4.5%), re-operation (3.03 %) and gastrointestinal problems (1.51%). Mean ICU length of stay was 3.27 days [range 1 to 9 days]. There was no mortality at 30 days. Discussion The incidence of ACHD in this review was low and bicuspid aortic valve was the most common anomaly. Operative cardiac risk and age showed a wide range. In this small sample post-operative complications were lower than reported in the literature (2). As reference center for ACHD now the number of complex cases is increasing mainly by those diagnosed and treated in the childhood and coming for a second or third operation.

We investigated whether the addition of fosfomycin or cloxacillin to daptomycin provides better outcomes in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) experimental aortic endocarditis in rabbits. Five MRSA strains were used to perform in vitro time-kill studies using standard (10 6 ) and high (10 8 ) inocula. Combined therapy was compared to daptomycin monotherapy treatment in the MRSA experimental endocarditis model. A human-like pharmacokinetics model was applied, and the equivalents of cloxacillin at 2 g/4 h, fosfomycin at 2 g/6 h, and daptomycin at 6 to 10 mg/kg/day were administered intravenously. A combination of daptomycin and either fosfomycin or cloxacillin was synergistic in the five strains tested at both inocula. A bactericidal effect was detected in four of five strains tested with both combinations. The MRSA-277 strain (vancomycin MIC, 2 μg/ml) was used for the experimental endocarditis model. Daptomycin plus fosfomycin significantly improved the efficacy of daptomycin monotherapy at 6 mg/kg/day in terms of both the proportion of sterile vegetations (100% versus 72%, P = 0.046) and the decrease in the density of bacteria within the vegetations ( P = 0.025). Daptomycin plus fosfomycin was as effective as daptomycin monotherapy at 10 mg/kg/day (100% versus 93%, P = 1.00) and had activity similar to that of daptomycin plus cloxacillin when daptomycin was administered at 6 mg/kg/day (100% versus 88%, P = 0.48). Daptomycin nonsusceptibility was not detected in any of the isolates recovered from vegetations. In conclusion, for the treatment of MRSA experimental endocarditis, the combination of daptomycin plus fosfomycin showed synergistic and bactericidal activity.

El objetivo principal del presente trabajo radica en la voluntad de poner de manifiesto los importantes problemas que, a pesar de la reforma, sigue planteando el régimen de la tributación de las pensiones de alimentos a favor de los hijos, el cual puede considerarse incluso contrario a la Constitución. Asimismo, se analizará la problemática derivada de la posición de la Administración mantenida hasta el momento respecto a la normativa anterior a la hora de entender la tributación procedente en relación con los progenitores que, teniendo la guarda y custodia compartida, abonaban también una pensión de alimentos a sus hijos, pues su derecho para determinar la deuda tributaria aún no ha prescrito. Y por último, con base en las consideraciones expuestas, se pretende aportar la propuesta de un nuevo modelo de tributación, tanto de las mencionadas pensiones como, por su intrínseca relación, del denominado mínimo por descendientes.

Resumen Objetivo Determinar la importancia de la ecocardiografia transesofagica (ECOTE) intraoperatoria en la decision quirurgica en pacientes intervenidos de cirugia cardiaca. Pacientes y metodo Estudio prospectivo observacional en pacientes de cirugia cardiaca intervenidos desde enero de 2009 hasta mayo de 2012, a los que se monitorizo con ECOTE por el anestesiologo responsable. Los datos recogidos fueron: 1) tipo de cirugia; 2) diagnostico ecocardiografico preoperatorio (ECO basal); 3) diagnostico ecocardiografico antes de entrar en circulacion extracorporea (CEC) (ECOTE pre-CEC); 4) si habia diferencias entre la ECO basal y la ECOTE pre-CEC (hallazgo nuevo pre-CEC) y si estas diferencias modificaban la cirugia planeada, y 5) diagnostico ecocardiografico despues de la desconexion de CEC (hallazgo no esperado pos-CEC) y si estos hallazgos ecocardiograficos pos-CEC hacian reinstaurarla. Para el analisis de datos se utilizo el programa de software SPSS®. Resultados El total de pacientes estudiados fue de 1.273; la monitorizacion con ECOTE mostro «hallazgos nuevos pre-CEC» en 98 pacientes (7,7%) y en 43,8% de estos modifico la cirugia programada; de estos hallazgos, los mas frecuentes fueron alteraciones de la valvula mitral que no habian sido diagnosticadas, lo que determino la sustitucion o reparacion de la misma que no estaba programada. La incidencia de «hallazgos no esperados pos-CEC» fue del 6,2% (79 pacientes), y de estos, en el 46,8% se requirio reinstaurar la CEC y modificar la cirugia realizada. Las reparaciones valvulares fallidas y las protesis valvulares disfuncionantes fueron las causas principales que motivaron la reentrada en CEC. En los 42 pacientes restantes, con «hallazgos no esperados pos-CEC», no hubo cambios en la conducta quirurgica, ya que se considero que el hallazgo ecocardiografico no era lo suficientemente significativo como para reinstaurar la CEC y revisar o cambiar el procedimiento quirurgico. Conclusion En cirugia cardiaca, la monitorizacion intraoperatoria con ECOTE por el anestesiologo aporta informacion importante antes y despues de la CEC que modifico el manejo quirurgico.

Objective To determine the importance of intraoperative transesophageal echocardiography (IOTEE) in the surgical decision in patients undergoing cardiac surgery. Patients and method Prospective observational study of patients undergoing cardiac surgery from January 2009 to May 2012, which was monitored with IOTEE by the anaesthesiologist in charge. The data collected were: (1) type of surgery; (2) preoperative echocardiographic diagnosis (baseline ECHO); (3) echocardiographic diagnosis before entering cardiopulmonary bypass (CPB) (pre-CPB IOTEE); (4) any differences between the baseline ECHO and the pre-CPB IOTEE (new pre-CPB finding) and whether these differences modified the planned surgery, and (5) echocardiographic diagnosis after disconnection of CPB (unexpected post-CPB finding) and whether these post-CPB echocardiographic findings led to reinstating it. The software program SPSS ® was used for data analysis. Results The total number of patients studied was 1273. Monitoring with IOTEE showed “new pre-CPB” findings in 98 patients (7.7%), and 43.8% of these led to a change in the scheduled surgery. Of these findings, the most frequent were abnormalities of the mitral valve that had not been diagnosed, and which led to a replacement or repair that had not been scheduled. The incidence of “unexpected post-CPB findings” was 6.2% (79 patients), and 46.8% of those required reinstating the CPB and modifying the surgery performed. The failed valve repairs and dysfunctional valve prostheses were the main causes that led to re-entry into CPB. In the remaining 42 patients, with “unexpected post-CPB findings”, there were no changes in the surgical procedure as the echocardiographic findings were not considered to be significant enough to re-establish CPB and revise or change the surgical procedure. Conclusion Intraoperative monitoring with IOTEE by the anaesthesiologist during surgery provides important information before and after the CPB that resulted in modifying surgical management.

Resumen Introduccion La endarterectomia pulmonar (EP) es el tratamiento de eleccion para la hipertension pulmonar tromboembolica cronica (HPTEC). El objetivo del estudio fue analizar nuestra experiencia en el tratamiento medico (TM) y quirurgico de la HPTEC. Metodos Se evaluaron 80 pacientes diagnosticados de HPTEC en el periodo enero 2000-julio 2012. En 32 casos se realizo EP, el resto recibio TM. Se analizaron: clase funcional (CF), distancia recorrida en seis minutos (PM6M) y hemodinamica pulmonar. Se analizo la mortalidad segun el tratamiento y el periodo. Resultados Los pacientes del grupo EP eran mas jovenes, mayoritariamente hombres y recorrieron mayor distancia en la PM6M. No hubo diferencias hemodinamicas ni de CF al diagnostico. Al ano del tratamiento, el 100% del grupo EP y el 41% del grupo TM estaban en CF I-II. Al seguimiento, el grupo EP presento mayor incremento en la PM6M y mayor reduccion de la PAPm y la RVP que en el grupo TM (p Conclusiones La EP proporciona buenos resultados clinicos, hemodinamicos y de supervivencia en los pacientes que superan satisfactoriamente el postoperatorio inmediato. Tras un periodo de aprendizaje, la mortalidad perioperatoria actual en nuestro centro es superponible a los estandares internacionales.

Background Regional citrate anticoagulation (RCA) is being used increasingly in continuous renal replacement therapy (CRRT) as a safer alternative to heparin. However, complex metabolic control to avoid side effects have generated discrepancies about its introduction into everyday practice. We aimed to compare both anticoagulation techniques in terms of efficacy, safety and feasibility. Methods Observational retrospective study performed in 3 specialized ICUs in patients receiving CVVHDF with RCA between January 2013 and May 2016. Heparin-treated patients matched by age, sex and disease severity treated in the preceding year were selected as historic controls. Filter lifetime, number of filters used, haemorrhagic complications and metabolic complications were recorded. Results 54 patients (27 treated with RCA and 27 with heparin) were included in the study. Filter lifetimes in the first 72 hours were 55.1 ± 21.8 hours in the RCA group compared to 38.8 ± 24.8 hours in the heparin group, (p = 0.004). In addition, the number of filters used in the first 72 hours was significantly higher in the heparin group (2.4 ± 1.3 vs. 1.5 ± 0.7; p = 0.004). There was a trend toward a lower incidence of bleeding in the RCA group, with a significantly lower red blood cell transfusion rate (p = 0.027) in the citrate group. No clinically significant metabolic disturbances were observed in the RCA group. Regarding outcomes, there were no significant differences between groups. Conclusions These results suggest that the implementation of CVVHDF with RCA using concentrated citrate solutions prolongs filter lifetime, achieves a longer effective hemodiafiltration time and is a safe and feasible method.

Resumen La fibrilacion auricular es una complicacion frecuente en el periodo perioperatorio, y cuando aparece se incrementa el riesgo de morbimortalidad perioperatoria debido a ACV, tromboembolismo, fallo cardiaco, IAM, hemorragia debida a anticoagulacion y reingresos hospitalarios. En el presente articulo se recogen las recomendaciones para el manejo de la fibrilacion auricular perioperatoria basandose en las ultimas Guias de Practica Clinica de la fibrilacion auricular publicadas por la Sociedad Europea de Cardiologia y la Sociedad Espanola de Cardiologia, prestando atencion tanto a su optimizacion preoperatoria, como al manejo del episodio agudo perioperatorio. En este sentido se incluyen las ultimas recomendaciones para control de la frecuencia cardiaca, control del ritmo y anticoagulacion.