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Postoperative cognitive dysfunction affects the quality of recovery, particularly affecting the elderly, and poses a burden on the health system. We hypothesize that the use of sugammadex (SG) could optimize the quality of postoperative cognitive function and overall recovery through a neuroprotective effect., This study has been financed through the agreement signed with Merck Sharp & Dohme Spain and CEU Cardenal Herrera University.

Producción Científica, Background: procalcitonin is a valuable marker in the diagnosis of bacterial infections; however, the impairment of renal function can influence its diagnostic precision. The objective of this study is to evaluate the differential behaviour of procalcitonin, as well as its usefulness in the diagnosis of postoperative pulmonary infection after cardiac surgery, depending on the presence or absence of impaired renal function. Materials and methods: A total of 805 adult patients undergoing cardiac surgery with extracorporeal circulation (CBP) were prospectively recruited, comparing the behaviour of biomarkers between the groups with and without postoperative pneumonia and according to the presence or absence of renal dysfunction. Results: Pulmonary infection was diagnosed in 42 patients (5.21%). In total, 228 patients (28.32%) presented postoperative renal dysfunction. Procalcitonin was significantly higher in infected patients, even in the presence of renal dysfunction. The optimal procalcitonin threshold differed markedly in patients with renal dysfunction compared to patients without renal dysfunction (1 vs. 0.78 ng/mL p < 0.05). The diagnostic accuracy of procalcitonin increased significantly when the procalcitonin threshold was adapted to renal function. Conclusions: Procalcitonin is an accurate marker of postoperative infection in cardiac surgery, even in the presence of renal dysfunction. Renal function is an important determinant of procalcitonin levels and, therefore, its diagnostic thresholds must be adapted in the presence of renal dysfunction., Instituto de Salud Carlos III - (grant COV20/00491, PI18/01238, CIBERINFEC CB21/13/00051), Junta de Castilla y León - (grant VA321P18, GRS 1922/A/19, GRS 2057/A/19), Junta de Castilla y León, Consejería de Educación - (grant VA256P20), Fundación Ramón Areces - (grant CIVP19A5953), Instituto de Salud Carlos III y Fondo Europeo de Desarrollo Regional (FEDER)/Fondo Social Europeo - (grant CM20/00138)

Producción Científica, Background: Transcatheter mitral valve repair (TMVR) is an effective therapy for high-risk patients with severe mitral regurgitation (MR) but heart failure (HF) readmissions and death remain substantial on mid-term follow-up. Recently, right ventricular (RV) to pulmonary arterial (PA) coupling has emerged as a relevant prognostic predictor in HF. In this study, we aimed to assess the prognostic value of tricuspid annular plane systolic excursion (TAPSE) to PA systolic pressure (PASP) ratio as a non-invasive measure of RV-to-PA coupling in patients undergoing TMVR with MitraClip (Abbott, CA, USA). Methods: Multicentre registry including 228 consecutive patients that underwent successful TMVR with MitraClip. The sample was divided in two groups according to TAPSE/PASP median value: 0.35. The primary combined endpoint encompassed HF readmissions and all-cause mortality. Results: Mean age was 72.5 ± 11.5 years and 154 (67.5%) patients were male. HF readmissions and all-cause mortality were more frequent in patients with TAPSE/PASP ≤ 0.35: Log-Rank 8.844, p = 0.003. On Cox regression, TAPSE/PASP emerged as a prognostic predictor of the primary combined endpoint, together with STS-Score. TAPSE/PASP was a better prognostic predictor than either TAPSE or PASP separately. Conclusions: TAPSE/PASP ratio appears as a novel prognostic predictor in patients undergoing MitraClip implantation that might improve risk stratification and candidate selection.

13 páginas, 6 figuras, 2 tablas., Introduction: Decreased antithrombin (AT) activity in patients scheduled for cardiovascular surgery under cardiopulmonary bypass (CPB) is related to increased postoperative complications and hospitalization time. Indirect evidence suggests that glucocorticoids mitigate this decreased AT activity. To better understand the beneficial effects of AT we have analyzed: (i) the clinical relevance of acute dexamethasone (DX) administration before cardiac surgery on AT activity, (ii) the modulation by DX of AT expression in human endothelial cells (hECs), (iii) the activity of AT on migration and angiogenesis of hECs, or on angiogenesis of rat aorta. Methods: A retrospective cohort study in patients undergoing aortic valve replacement surgery was designed to evaluate the effect of DX administration on AT activity at five separate time points: preoperatively, during CPB, at intensive care unit admission and at 12 and 24 h post-intervention. We have analyzed also clinical differences in postoperative outcomes as safety and the length of stay in hospitalization. Changes in mRNA levels of AT induced by DX were determined by qRT-PCR in human coronary (hCEC), aorta (hAEC) and cardiac microvasculature (hCMEC) endothelial cells. AT activity on migration and angiogenesis were also assayed. Angiogenic growth of rat aortic rings incubated in Matrigel® was determined in presence and absence of AT. Results: The cohort comprised 51 patients in the control group and 29 patients in the group receiving dexamethasone. Preoperative DX supplementation reduced intraoperative decrease of AT activity (67.71 ± 10.49% DX treated vs. 58.12 ± 9.11% untreated, p < 0.001) that could be related to a decrease in the hospitalization time (7.59 ± 4.08 days DX treated vs. 13.59 ± 16.00 days untreated, p = 0.014). Treatment of hECs with 500 nM DX slightly increased AT expression. Incubation with 0.5 and 1 IU/mL of AT increased migration and angiogenesis in hCAECs and hAECs, but not in hCMECs. The same concentrations of AT potentiated angiogenic sprouting of new vessels from rat aorta. Conclusion: Preoperative DX supplementation could be an interesting procedure to avoid excessive decrease in AT levels during cardiac surgery. Positive outcomes associated with maintaining adequate AT levels could be related to its potential beneficial effect on endothelial function (migration and angiogenesis)., This work (UGP-15-171) was supported by Fundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO) de la Comunitat Valenciana. Conselleria de Sanitat. Generalitat Valenciana.

Tesis - Universidad CEU Cardenal Herrera (Valencia), Facultad de Ciencias de la Salud, Departamento de Cirugía, leída el 06-04-2017.

The rapid development of interventional procedures for the treatment of arrhythmias in humans, especially the use of catheter ablation techniques, has renewed interest in cardiac anatomy. Although the substrates of atrial fibrillation (AF), its initiation and maintenance, remain to be fully elucidated, catheter ablation in the left atrium (LA) has become a common therapeutic option for patients with this arrhythmia. Using ablation catheters, various isolation lines and focal targets are created, the majority of which are based on gross anatomical, electroanatomical, and myoarchitectual patterns of the left atrial wall. Our aim was therefore to review the gross morphological and architectural features of the LA and their relations to extracardiac structures. The latter have also become relevant because extracardiac complications of AF ablation can occur, due to injuries to the phrenic and vagal plexus nerves, adjacent coronary arteries, or the esophageal wall causing devastating consequences. Ministerio de Economía y Competitividad (TIN2012-37546-C03-02) 0.763 SJR (2014) Q2, 11/340 Cardiology and cardiovascular medicine UEM

Se ha comprobado que comparado con Propofol, la administración de Sevoflurano en el intraoperatorio de los pacientes sometidos a cirugía de revascularización miocárdica, disminuye el daño miocárdico a través de los mecanismos de acondicionamiento miocárdico (precondicionamiento farmacológico). Además pueden inducir protección cuando se administran después de la isquemia, durante el periodo de reperfusión (postcondicionamiento farmacológico) , así como protección de otros órganos como el riñón. La mayor duración de la exposición intraoperatoria al Sevoflurano se correlaciona con un mayor grado de organoprotección para los pacientes. Hasta hoy muy pocos estudios han evaluado la aplicación de uno u otro fármaco hipnótico en el postoperatorio inmediato, como estrategia terapéutica beneficiosa en el postoperatorio en pacientes de cirugía de revascularización miocárdica. Hipotetizamos que frente a la anestesia con Propofol, la anestesia con Sevoflurano de los pacientes intervenidos de cirugía cardiaca y la prolongación de la misma durante el postoperatorio inmediato conseguirá, además de una mayor protección cardiaca, un mayor grado de nefroprotección, así como una disminución en los días de estancia en UCI. Objetivos: Por ello nos planteamos como objetivos: Evaluar los efectos de la administración de Sevoflurano en el intra y postoperatorio de los pacientes intervenidos de cirugía de revascularización miocárdica sin circulación extracorpórea, frente a Propofol en el grado de lesión/preservación miocárdica, y su repercusión en la función renal de estos pacientes. Determinar si el efecto beneficioso de Sevoflurano en el periodo intraoperatorio aislado o en el intra y postoperatorio, modifica la necesidad de uso de agentes inotrópicos y la estancia en la unidad de cuidados intensivos de los pacientes respecto a los tratados sólo con Propofol. Material y métodos: Durante un periodo de 18 meses, se ha enrolado 60 pacientes de forma consecutiva intervenidos de cirugía de revascularización miocárdica sin CEC, realizando un estudio prospectivo, observacional, aleatorizado, controlado, ciego para el analizador, con 3 brazos de estudio en función del tratamiento: • Tratamiento 1: Anestesia y sedación postoperatoria basada en Propofol (PP). • Tratamiento 2: Anestesia y sedación postoperatoria basada en Sevoflurano (SS). • Tratamiento 3: Anestesia con Sevoflurano y sedación postoperatoria con Propofol (SP). Se ha realizado un control y seguimiento de los pacientes para determinar el grado de preservación orgánica, en cuanto a función hemodinámica, parámetros analíticos con biomarcadores de daño miocárdico y función renal en 6 momentos distintos (previo a la esternotomía, al ingreso a la Unidad de Críticos, y a las 6 horas, 12 horas, 24 horas y 48 horas del inicio de la intervención). Resultados: Al analizar los niveles de troponina I a lo largo del seguimiento observamos un aumento estadísticamente significativo a las 24 horas en los grupos en los que se usaba Propofol, así los niveles de troponina I en el grupo SS (0,5 ± 0,4 ng/ml) fueron significativamente menores que los niveles del biomarcador observados en el grupo SP (1,61 ± 1,30 ng/mL, una razón de 1:3,22) y en el grupo PP (2,27 ± 1,5 ng/ml, una razón de 1:1,40 respecto a SP y una razón de 1:4,54 respecto a SS) (p< 0,05). El péptido NT-proBNP mostró un incremento significativo entre los grupos a las 24 y 48 horas del postoperatorio, con niveles significativamente más bajos en el grupo SS (501 ± 280 pg/ml) en comparación tanto con SP (1270 ± 498 pg/ml, una razón de 1:2,53 respecto a SP) como con PP (1775 ± 527 pg/ml, una razón de 1:1,39 respecto a SP y una razón de 1:3,54 respecto a SS) (p

OBJECTIVES: Acute kidney injury (AKI) after cardiac surgery is associated with adverse patient outcome. A new definition and staging system for AKI based on creatinine kinetics (CKs) has been proposed recently. Their proponents hypothesize that early absolute increases in serum creatinine (sCr) after kidney injury are superior to percentage increases, especially in patients with chronic kidney disease (CKD). The aims of our study were to measure agreement between CK definition and the current consensus definition [risk, injury, failure, loss and end-stage renal disease (RIFLE) system], and to compare time to diagnosis and prognostic value between both systems. METHODS: Retrospective cohort study. Agreement on AKI diagnosis by both classifications, time to diagnosis and prognostic value of both systems were compared in cardiac surgeries performed during a 6-year period (2002-2007) in a single centre. RESULTS: We found substantial agreement between both classifications (0.67). More patients were diagnosed with AKI by the CK definition than by RIFLE criteria both globally (28.2 vs 13.9%) and in every category (16.5 vs 8.4% for CK-1 vs RIFLE-R; 8.4 vs 3.6% for CK-2 vs RIFLE-I and 3.2 vs 2.0% for CK-3 vs RIFLE-F). Time to diagnosis was shorter for the CK definition (1.8 vs 2.5 days). Prognostic value in terms of information about in-hospital death and need for renal replacement was comparable between classifications. CONCLUSIONS: In cardiac surgery, the CK definition and classification system showed substantial agreement with the current standard, was more sensitive than RIFLE and detected AKI earlier without loss of prognostic information. 1.329 JCR (2015) Q3, 91/124 Cardiac & cardiovascular systems UEM

Transcatheter aortic valve implantation (TAVI) is associated with various complications, usuallyrelated to valve positioning or prosthesis delivery. We report the rare complication of an iatrogenicventricular septal defect, secondary to aortic annulus disruption after TAVI-transfemoral procedure,generating a significant left-to-right shunt and cardiac failure. Open surgical procedures undercardiopulmonary bypass remain the best option for this lethal complication. 0.890 JCR (2014) Q4, 106/123 Cardiac & cardiovascular system, 150/198 Surgery UEM