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Background and Purpose-Tricuspid valve (TV) apparatus parameters can vary significantly with demographic and anthropometric factors and could be useful for clinical decision making. Our aim was to (1) establish the reference values for TV apparatus parameters using transthoracic three-dimensional (3D) echocardiography; (2) investigate the influence of age, sex, and body size on TV anatomy. Methods-A total of 180 healthy subjects referred in 2015 to our institution for a screening transthoracic echocardiography were enrolled (mean age 49.7+17.4 years, range 20 to 80 years: 30 subjects per age decade were included in the study, 15 for each gender). A real-time zoom 3D image of the TV and full volume 3D data set were collected from an apical window including TV using Philips iE33 and GE Vivid E9 Ultrasound Machines. After acquisition, the 3D data sets were analysed using 3D Qlab and EchoPAC PC softwares. The volumetric data set was analysed with multiplanar reformatting function to obtain three simultaneous orthogonal 2D slices (sagittal, coronal and axial planes). The following TV parameters were obtained and measured: 1. the 3D diastolic annular diameters (Major and Minor diameters); 2. the 3D diastolic annular area (TDAA); 3. the Tricuspid annular fractional area changes (TAFAC). Results are presented as mean ± SD. Differences between and among groups were tested for significance using the independent samples t-test and ANOVA test for continuous variables. Univariate Pearson correlation was used to assess the relation between these parameters and age, and body size. A p 0.05) and normalized MDD (18.1±2.4 vs 18.4±2.3 mm/m2, p>0.05) did not differ significantly between males and females. TTDAA and TAFAC in overall population were 76.7±17.3 mm2 and 29.6±8.6%. TDAA was significantly different between males and females (82.5±18.3 vs 69.7±13.0 mm2, respectively; p 0.05). After normalization for BSA, TDAA in overall population was 43.3±9.0 mm2/m2. Also normalized TDAA was significantly different between males and females (44.4±9.4 vs 42.0±8.4 mm2/m2, p < 0.05). mDD, MDD, TDAA and TAFAC showed no correlation with age (r = 0.16, p 0.04; r = 0.028, p 0.7; r = 0.17, p 0.27; r = 0.16, p 0.16; respectively). Conclusion- This study can provide normal reference values for TV anatomic parameters that may be useful in the clinical practice, considering the effects of age, sex, and body size.

Barge-Caballero, E., Segovia-Cubero, J., Gonzalez-Vilchez, F., Delgado-Jimenez, J., Perez-Villa, F., Almenar-Bonet, L., Arizon-Del Prado, J.L., Lage-Galle, E., De La Fuente-Galan, L., Manito-Lorite, N., Sanz-Julve, M., Villa-Arranz, A., Lambert Rodriguez, J.L., Brossa-Loidi, V., Pascual-Figal, D., Muniz-Garcia, J., Crespo-Leiro, M.

Background A number of changes in the management of heart transplantation (HT) patients have each tended to reduce the risk of post-HT hematologic cancer, but little information is available concerning the overall effect on incidence in the HT population. Methods Comparison of data from the Spanish Post-Heart-Transplantation Tumour Registry for the periods 1991–2000 and 2001–2010. Results The incidence among patients who underwent HT in the latter period was about half that observed in the former, with a particularly marked improvement in regard to incidence more than five yr post-HT. Conclusions Changes in HT patient management have jointly reduced the risk of hematologic cancer in the Spanish HT population. Long-term risk appears to have benefited more than short-term risk.

[Abstract] Objectives. We sought to investigate the potential impact of preoperative short-term mechanical circulatory support (MCS) with extracorporeal devices on postoperative outcomes after emergency heart transplantation (HT). Methods. We conducted an observational study of 669 patients who underwent emergency HT in 15 Spanish hospitals between 2000 and 2009. Postoperative outcomes of patients bridged to HT on short-term MCS (n = 101) were compared with those of the rest of the cohort (n = 568). Short-term MCS included veno-arterial extracorporeal membrane oxygenators (VA-ECMOs, n = 23), and both pulsatile-flow (n = 53) and continuous-flow (n = 25) extracorporeal ventricular assist devices (VADs). No patient underwent HT on intracorporeal VADs. Results. Preoperative short-term MCS was independently associated with increased in-hospital postoperative mortality (adjusted odds-ratio 1.75, 95% CI 1.05–2.91) and overall post-transplant mortality (adjusted hazard-ratio 1.60, 95% CI 1.15–2.23). Rates of major surgical bleeding, cardiac reoperation, postoperative infection and primary graft failure were also significantly higher among MCS patients. Causes of death and survival after hospital discharge were similar in MCS and non-MCS candidates. Increased risk of post-transplant mortality affected patients bridged on pulsatile-flow extracorporeal VADs (adjusted hazard-ratio 2.21, 95% CI 1.48–3.30) and continuous-flow extracorporeal VADs (adjusted hazard-ratio 2.24, 95% CI 1.20–4.19), but not those bridged on VA-ECMO (adjusted hazard-ratio 0.51, 95% CI 0.21–1.25). Conclusions. Patients bridged to emergency HT on short-term MCS are exposed to an increased risk of postoperative complications and mortality. In our series, preoperative bridging with VA-ECMO resulted in comparable post-transplant outcomes to those of patients transplanted on conventional support.

Background— Postoperative outcomes of patients with advanced heart failure undergoing ventricular assist device implantation are strongly influenced by their preoperative Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) profiles. We sought to investigate whether a similar association exists in patients undergoing emergency heart transplantation. Methods and Results— By means of the Spanish National Heart Transplant Registry database, we identified 704 adult patients treated with emergency heart transplantation in 15 Spanish centers between 2000 and 2009. Post-transplant outcomes were analyzed pertaining to patient preoperative INTERMACS profiles, which were retrospectively assigned by 2 blinded cardiologists. Before transplantation, INTERMACS profile 1 (critical cardiogenic shock) was present in 207 patients, INTERMACS profile 2 (progressive decline) in 291, INTERMACS profile 3 (inotropic dependence) in 176, and INTERMACS profile 4 (resting symptoms) was present in 30 patients. In-hospital postoperative mortality rates were, respectively, 43%, 26.8%, and 18% in patients with profiles 1, 2, and 3 to 4 ( P P =0.03) and postoperative need for dialysis (1: 33.2%, 2: 18.9%, 3–4: 21.5%; P Conclusions— Preoperative INTERMACS profiles determine outcomes after emergency heart transplantation. Results call for a change in policies related to the management of heart transplant candidates presenting with INTERMACS profiles 1 and 2.

Background. Little information is available regarding the controversial issue of steroid withdrawal following heart transplantation (HT), or instead in the incidence of adverse steroid effects at dosages typically employed in Spain. Methods. We analyzed the 5-year follow-up records of 1209 patients (82.5% men, aged 18 years) who underwent HT between 2000 and 2005 and survived at least 1 month in 13 Spanish centers. The incidences of first steroid withdrawal before 1, 3, and 5 years post-HT were expressed as Kaplan-Meier probability estimates. Three patient groups defined in accordance with steroid dosage at 1-year follow-up (0, 5, and 5 mg/d; groups A, B, and C, respectively) were compared with regard to the incidence of de novo hypertension, diabetes, and bone fractures over the following 2 years. Results. The 5-year incidence of withdrawal was 28%, 21% of whom required reintroduction of steroids. Kaplan-Meier probabilities of withdrawal before 1, 3, and 5 years post-HT were 8.8% (95% confidence interval ([CI] 7.3%‐10.7%), 27.8% (CI 25.2%‐ 30.6%), and 30.2% (CI 27.5%‐33.2%), respectively. At 1-year follow-up, 9.9% of patients were steroid-free, 28.9% were taking 5 mg/d, and 61.3% 5 mg/d. The 2-year incidence of de novo hypertension increased significantly (P .012) from 13.5% to 29.6% to 35.3% in groups A, B, and C respectively. These groups did not differ significantly in regard to the 2-year incidence of diabetes or bone fractures. Conclusions. Reintroduction of steroids was required by 21% of the 28% of Spanish HT patients who has been weaned from steroids within 5 years of HT. The incidence of de novo hypertension between 1 and 3 years post-HT increased with steroid dosage at 1-year follow-up. De novo diabetes and bone fractures showed no similar significant association.

Generally, the need for information about varicella-zoster virus (VVZ) infection in cardiac transplantation (CT) is greater than that for other organ transplants. All cases of VVZ infection among the 175 CT patients included herpes zoster as the clinical syndrome in all 11 cases (men, 90.9%; mean age, 50.3+/-5 years; incidence, 6.3%). The infection was limited to one dermatome in seven patients (63.6%: thoracic, 6%; ophthalmic, 1), or two contiguous dermatomes in four patients (36.4%). The infection onset was after the first semester in seven patients (63.6%). All patients received three drug immunosuppressive therapy. Cardiac rejection during the three previous months occurred in one patient (3A grade). Previous CMV disease was observed in three patients (27.3%: range, 7-14 months). Intravenous acyclovir was administered to five patients (ophthalmic and several dermatome forms), and oral therapy for the rest. All the patients recovered; there were no complications or postherpetic neuralgia (mean follow-up: 16.5 months). VVZ infection, a frequent late infection among CT recipients, presents as a clinical syndrome of herpes zoster, frequently in patients with previous CMV infection. In CT, herpes zoster frequently affects two dermatomes, but the clinical courses and responses to treatment are favorable. There was no postherpetic neuralgia.

Background: For many years, high-emergency cardiac re-transplantation (HE-CR) has been considered as the choice therapeutic option for patients with irreversible primary graft failure during the early postoperative period of a previous heart transplantation (HT). HE-CR is also occasionally considered for HT patients in a critical clinical condition due to late graft failure secondary to chronic rejection. Aims: To describe the early postoperative and long-term outcomes of patients undergoing HE-CR and to compare them with those of patients undergoing a first heart transplantation under a high-emergency status (FHT-HE). Methods: Multicenter registry including 711 patients aged >18 who underwent high-emergency HT between January 1, 2000 and December 31, 2009 in fifteen out of the sixteen hospitals provided with an adult HT program. All patients suffered from severe cardiac failure depending on intravenous inotropes or mechanical circulatory support, or complicated with refractory arrythmic storm. Data were collected from the National Heart Transplant Registry database and clinical records. Early postoperative outcomes and long-term survival of HE-CR and FHT-HE patients were compared. Data on patients' vital status were available as for October 31, 2010. Kaplan-Meier post-transplant long-term survival curves were estimated, and then compared by means of the log-rank test. Results: 31 (4.5%) patients underwent HE-CR and 680 patients underwent FHT-HE. Mean age was 50 years, and 20% were women. No significant differences regarding basal clinical characteristics of recipients or donors were observed between the two groups, with the exception that HE-CR patients showed a higher mean serum creatinin (1.7±0.7 versus 1.3±0.7 mg/dl, p=0.01). The proportion of patients supported on a short-term VAD was 26% in the HE-CR group and 15% in the HE-FHT group (p=0.09). During the early postoperative period, the HE-CR group presented significantly higher rates of major surgical bleeding (48% versus 24%, p=0.02), primary graft failure (52% versus 24%, p