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1. Vía clínica de recuperación intensificada en cirugía cardiaca. Documento de consenso de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR), la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) y la Asociación Española de Perfusionistas (AEP)

Author

Juan A. Margarit, María Azucena Pajares, Carlos García-Camacho, Mario Castaño-Ruiz, María Gómez, Jessica García-Suárez, María José Soto-Viudez, José López-Menéndez, Elio Martín-Gutiérrez, Juan Blanco-Morillo, Eva Mateo, Carlos Hernández-Acuña, Marc Vives, Rafael Llorens, Jesús Fernández-Cruz, Jesús Acosta, Concepción Pradas-Irún, Mercedes García, Eva María Aguilar-Blanco, Beatriz Castaño, Sara López, Ana Bel, Tania Gabaldón, Antonio R. Fernández-López, Encarnación Gutiérrez-Carretero, Cristina López-Forte, Joaquín Moreno, Josefa Galán, Faisa Osseyran, J. Bustamante-Munguira, Sonia Veiras, and Rosario Vicente

Subjects
Enhanced recovery after surgery, Prehabilitation, Cardiac surgery, Cardiac anesthesia, Cardiopulmonary bypass, Medicine, Surgery, RD1-811
Abstract

Resumen: La vía clínica de recuperación intensificada en cirugía cardiaca (RICC) pretende identificar, difundir y favorecer la implementación de las mejores actuaciones basadas en la evidencia científica para disminuir la variabilidad en la práctica clínica. La puesta en marcha de estas prácticas en el proceso clínico global favorecerá la obtención de mejores resultados, acortamiento de estancias hospitalarias y en la Unidad de Cuidados Críticos, lo que permitirá una reducción de costes y una mayor eficiencia. Tras realizar una revisión sistemática en cada uno de los puntos del proceso perioperatorio en cirugía cardiaca, se han redactado recomendaciones basadas en la mejor evidencia científica disponible en la actualidad con el consenso de las sociedades científicas implicadas. Abstract: The ERAS guidelines are intended to identify, disseminate and promote the implementation of the best, scientific evidence-based actions to decrease variability in clinical practice. The implementation of these practices in the global clinical process will promote better outcomes and the shortening of hospital and critical care unit stays, thereby resulting in a reduction in costs and in greater efficiency. After completing a systematic review at each of the points of the perioperative process in cardiac surgery, recommendations have been developed based on the best scientific evidence currently available with the consensus of the scientific societies involved.

Published
2021
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2. Cirugía tras implante fallido del dispositivo MitraClip®

Author

Gertrudis Parody Cuerda, José M. Barquero Aroca, Irene Méndez Santos, Alejandro Recio Mayoral, Antonio R. Fernández López, and Omar Araji Tiliani

Subjects
MitraClip®therapy, Mitral regurgitation, Mitral valve replacement, Medicine, Surgery, RD1-811
Abstract

Resumen: En el presente trabajo exponemos el caso de un hombre de 70 años, pluripatológico, con riesgo quirúrgico alto (STS score del 13,8%) e insuficiencia mitral masiva tras implante fallido del dispositivo MitraClip® que precisó reemplazo valvular mitral, y hacemos una revisión de esta temida complicación y el papel de la cirugía en este escenario. Terapia MitraClip®, regurgitación mitral y reemplazo valvular mitral. Abstract: In this paper we present the case of a 70-year-old man with multiple pathologies, high surgical risk (STS score of 13,8%) and massive mitral valve regurgitation after failed implantation of MitraClip® device that required mitral valve replacement, and we do a review of this dreaded complication and the role of surgery in this setting. MitraClip therapy; Mitral regurgitation; Mitral valve replacement.

Published
2020
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3. Cirugía tras implante fallido del dispositivo MitraClip®

Author

José Miguel Barquero Aroca, Alejandro Recio Mayoral, Antonio R. Fernández López, Omar Araji Tiliani, Irene Méndez Santos, and Gertrudis Parody Cuerda

Subjects
Gynecology, medicine.medical_specialty, business.industry, lcsh:R, lcsh:Surgery, lcsh:Medicine, lcsh:RD1-811, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, cardiovascular system, medicine, Surgery, cardiovascular diseases, Mitral valve replacement, Cardiology and Cardiovascular Medicine, business, MitraClip®therapy, Mitral regurgitation
Abstract

Resumen: En el presente trabajo exponemos el caso de un hombre de 70 años, pluripatológico, con riesgo quirúrgico alto (STS score del 13,8%) e insuficiencia mitral masiva tras implante fallido del dispositivo MitraClip® que precisó reemplazo valvular mitral, y hacemos una revisión de esta temida complicación y el papel de la cirugía en este escenario. Terapia MitraClip®, regurgitación mitral y reemplazo valvular mitral. Abstract: In this paper we present the case of a 70-year-old man with multiple pathologies, high surgical risk (STS score of 13,8%) and massive mitral valve regurgitation after failed implantation of MitraClip® device that required mitral valve replacement, and we do a review of this dreaded complication and the role of surgery in this setting. MitraClip therapy; Mitral regurgitation; Mitral valve replacement.

Published
2020

4. Guidelines for enhanced recovery after cardiac surgery. Consensus document of Spanish Societies of Anesthesia (SEDAR), Cardiovascular Surgery (SECCE) and Perfusionists (AEP)

Author

Ana Bel Sra, Beatriz Castaño Sra, José López Meléndez, Sonia Veiras Sra, Jesús Acosta, Juan Blanco Morillo, Evaº Mateo Sra, Juan Bustamante, Carlos Garcia Camacho, Josefa Galán Sra, Jessica García Suárez Sra, Juan Antonio Margarit, Cristina López Forte Sra, Rosario Vicente Sra, Encarnación Gutiérrez Carretero Sra, Antonio R Fernández López, Mario Castaño Ruiz, Faisa Osseyran Sra, Joaquín Moreno, Concepción Pradas Irún Sra, Carlos Hernández Acuña, Maria Gómez Sra, Sara López Sra, Jesús Fernández Cruz, Maria Azucena Pajares Sra, Eva María Aguilar Blanco Sra, Tania Gabaldón Sra, Rafael Llorens, María José Soto Sra, Marc Vives, Elio Martín Gutiérrez, Mercedes García Sra, [Margarit, Juan A.] Hosp Univ Ribera, Serv Cirugia Cardiaca, Valencia, Spain, [Jose Soto-Viudez, Maria] Hosp Univ Ribera, Serv Cirugia Cardiaca, Valencia, Spain, [Hernandez-Acuna, Carlos] Hosp Univ Ribera, Serv Cirugia Cardiaca, Valencia, Spain, [Azucena Pajares, Maria] Hosp Univ & Politecn La Fe, Serv Anestesiol Reanimac & Terapeut Dolor, Valencia, Spain, [Lopez-Forte, Cristina] Hosp Univ & Politecn La Fe, Serv Anestesiol Reanimac & Terapeut Dolor, Valencia, Spain, [Osseyran, Faisa] Hosp Univ & Politecn La Fe, Serv Anestesiol Reanimac & Terapeut Dolor, Valencia, Spain, [Vicente, Rosario] Hosp Univ & Politecn La Fe, Serv Anestesiol Reanimac & Terapeut Dolor, Valencia, Spain, [Garcia-Camacho, Carlos] Hosp Univ Puerta Mar, Unidad Perfus Serv Cirugia Cardiaca, Cadiz, Spain, [Castano-Ruiz, Mario] Complejo Asistencial Univ Leon, Serv Cirugia Cardiaca, Leon, Spain, [Martin-Gutierrez, Elio] Complejo Asistencial Univ Leon, Serv Cirugia Cardiaca, Leon, Spain, [Gomez, Maria] Hosp Univ Ribera, Serv Anestesiol Reanimac & Terapeut Dolor, Valencia, Spain, [Fernandez-Cruz, Jesus] Hosp Univ Ribera, Serv Anestesiol Reanimac & Terapeut Dolor, Valencia, Spain, [Garcia-Suarez, Jessica] Hosp Univ Puerta Hierro, Serv Anestesiol Reanimac & Terapeut Dolor, Madrid, Spain, [Lopez-Menendez, Jose] Hosp Ramon & Cajal, Serv Cirugia Cardiaca, Madrid, Spain, [Blanco-Morillo, Juan] Hosp Clin Univ Virgen Arrixaca, Unidad Perfus Serv Cirugia Cardiovasc, Murcia, Spain, [Mateo, Eva] Hosp Gen Univ Valencia, Serv Anestesiol Reanimac & Terapeut Dolor, Valencia, Spain, [Lopez, Sara] Hosp Gen Univ Valencia, Serv Anestesiol Reanimac & Terapeut Dolor, Valencia, Spain, [Gabaldon, Tania] Hosp Gen Univ Valencia, Serv Anestesiol Reanimac & Terapeut Dolor, Valencia, Spain, [Moreno, Joaquin] Hosp Gen Univ Valencia, Serv Anestesiol Reanimac & Terapeut Dolor, Valencia, Spain, [Vives, Marc] Hosp Univ Dr Josep Trueta, Serv Anestesiol Reanimac & Terapeut Dolor, Girona, Spain, [Llorens, Rafael] Hosp Rambla, Serv Cirugia Cardiovasc, Santa Cruz De Tenerife, Spain, [Acosta, Jesus] Hosp Univ Virgen Rocio, Serv Anestesiol Reanimac & Terapeut Dolor, Seville, Spain, [Pradas-Irun, Concepcion] Hosp Univ Dr Josep Trueta, Serv Cirugia Cardiaca, Girona, Spain, [Garcia, Mercedes] Hosp Santa Creu & Sant Pau, Serv Anestesiol Reanimac & Terapeut Dolor, Barcelona, Spain, [Galan, Josefa] Hosp Santa Creu & Sant Pau, Serv Anestesiol Reanimac & Terapeut Dolor, Barcelona, Spain, [Maria Aguilar-Blanco, Eva] Hosp Univ 12 Octubre, Serv Cirugia Cardiaca, Madrid, Spain, [Castano, Beatriz] Complejo Hosp Toledo, Serv Anestesiol Reanimac & Terapeut Dolor, Toledo, Spain, [Bel, Ana] Hosp Univ & Politecn La Fe, Serv Cirugia Cardiaca, Valencia, Spain, [Fernandez-Lopez, Antonio R.] Hosp Univ Virgen Macarena, Serv Anestesiol Reanimac & Terapeut Dolor, Seville, Spain, [Gutierrez-Carretero, Encarnacion] Hosp Univ Virgen Rocio, Serv Cirugia Cardiaca, Seville, Spain, [Bustamante-Munguira, J.] Hosp Clin Univ Valladolid, Serv Cirugia Cardiaca, Valladolid, Spain, and [Veiras, Sonia] Hosp Clin Univ Santiago, Serv Anestesiol Reanimac & Terapeut Dolor, Santiago De Compostela, Spain

Subjects
Bypass graft-surgery, medicine.medical_specialty, Acute normovolemic hemodilution, 030204 cardiovascular system & hematology, Mild perioperative hypothermia, 03 medical and health sciences, 0302 clinical medicine, Aortic-valve-replacement, Enhanced recovery, Medicine, 030212 general & internal medicine, business.industry, Cardiopulmonary bypass, High-risk patients, Pulse contour analysis, General Medicine, Cardiac surgery, Acute kidney injury, Randomized controlled-trial, Cardiac anesthesia, Anesthesia, Anestesia cardiaca, Cardiac anesthesia, Cardiac surgery, Cardiopulmonary bypass, Circulación extracorpórea, Cirugía cardiaca, Enhanced recovery after surgery, Prehabilitación, Prehabilitation, Recuperación intensificada en cirugía, Acute-renal-failure, business, Enhanced recovery after surgery, Prehabilitation, Surgical site infection
Abstract

The ERAS guidelines are intended to identify, disseminate and promote the implementation of the best, scientific evidence-based actions to decrease variability in clinical practice. The implementation of these practices in the global clinical process will promote better outcomes and the shortening of hospital and critical care unit stays, thereby resulting in a reduction in costs and in greater efficiency. After completing a systematic review at each of the points of the perioperative process in cardiac surgery, recommendations have been developed based on the best scientific evidence currently available with the consensus of the scientific societies involved. (C) 2020 Sociedad Espanola de Cirugia Cardiovascular y Endovascular. Published by Elsevier Espana, S.L.U.

Published
2021

5. Postoperative Costs Associated With Outcomes After Cardiac Surgery With Extracorporeal Circulation: Role of Antithrombin Levels

Author

J. Llagunes, Blanca de Prada, Francisco Hidalgo, Antonio R. Fernández-López, S. Veiras, Juan V. Llau, Pilar Paniagua, Cristina Valiño, A. Pajares, Carmen Diago, Laura Huicochea Gómez, Vicente Muedra, Enric Moret, and Jesús Gil

Subjects
Male, medicine.medical_specialty, Extracorporeal Circulation, extracorporeal circulation, Cardiotonic Agents, Myocardial Infarction, Antithrombins, Drug Costs, law.invention, Postoperative Complications, Drug Therapy, law, Surveys and Questionnaires, Thromboembolism, Atrial Fibrillation, medicine, Cardiopulmonary bypass, Humans, Blood Transfusion, Cardiac Surgical Procedures, Cardiothoracic anesthesiology, Average cost, Aged, Postoperative Care, business.industry, Antithrombin, Extracorporeal circulation, Decision Trees, Antithrombin Activity, Length of Stay, Middle Aged, Surgery, Cardiac surgery, Stroke, Intensive Care Units, antithrombin, Anesthesiology and Pain Medicine, Treatment Outcome, Spain, Health Care Surveys, Emergency medicine, Costs and Cost Analysis, Female, Kidney Diseases, Cardiology and Cardiovascular Medicine, business, cardiopulmonary bypass, Hospital stay, medicine.drug
Abstract

Objective: To study the impact on postoperative costs of a patient's antithrombin levels associated with outcomes after cardiac surgery with extracorporeal circulation. Design: An analytic decision model was designed to estimate costs and clinical outcomes after cardiac surgery in a typical patient with low antithrombin levels (= 63.7%). The data used in the model were obtained from a literature review and subsequently validated by a panel of experts in cardiothoracic anesthesiology. Setting: Multi-institutional (14 Spanish hospitals). Participants: Consultant anesthesiologists. Measurements and Main Results: A sensitivity analysis of extreme scenarios was carried out to assess the impact of the major variables in the model results. The average cost per patient was (sic)18,772 for a typical patient with low antithrombin levels and (sic)13,881 for a typical patient with normal antithrombin levels. The difference in cost was due mainly to the longer hospital stay of a patient with low antithrombin levels compared with a patient with normal levels (13 v 10 days, respectively, representing a (sic)4,596 higher cost) rather than to costs related to the management of postoperative complications ((sic)215, mostly owing to transfusions). Sensitivity analysis showed a high variability range of approximately +/- 55% of the base case cost between the minimum and maximum scenarios, with the hospital stay contributing more significantly to the variation. Conclusions: Based on this analytic decision model, there could be a marked increase in the postoperative costs of patients with low antithrombin activity levels at the end of cardiac surgery, mainly ascribed to a longer hospitalization. (C) 2013 Elsevier Inc. All rights reserved.

Published
2013

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