Search

Sin financiación No data JCR (2021) 0.130 SJR (2021) Q4, 317/356 Cardiology and Cardiovascular Medicine No data IDR 2021 UEM

Introducción y objetivos Se presentan las características clínicas y los resultados de los trasplantes cardiacos realizados en España con la actualización correspondiente a 2019. Métodos Se describen las características clínicas y los resultados de los trasplantes cardiacos realizados en 2019, así como las tendencias de estos en el periodo 2010-2018. Resultados En 2019 se realizaron 300 trasplantes (8.794 desde 1984; 2.745 entre 2010 y 2019). Respecto a años previos, los cambios más llamativos son el descenso hasta el 38% de los trasplantes realizados en código urgente, y la consolidación en el cambio de asistencia circulatoria pretrasplante, con la práctica desaparición del balón de contrapulsación (0, 7%), la estabilización del uso del oxigenador extracorpóreo de membrana (9, 6%) y el aumento de los dispositivos de asistencia ventricular (29%). La supervivencia en el trienio 2016-2018 es similar a la del trienio 2013-2015 (p = 0, 34), y ambas mejores que la del trienio 2010-2012 (p = 0, 002 y p = 0, 01 respectivamente). Conclusiones Se mantienen estables tanto la actividad del trasplante cardiaco en España como los resultados en supervivencia en los últimos 2 trienios. Hay una tendencia a realizar menos trasplantes urgentes, la mayoría con dispositivos de asistencia ventricular. Introduction and objectives: The present report describes the clinical characteristics and outcomes of heart transplants in Spain and updates the data to 2019. Methods: We describe the clinical characteristics and outcomes of heart transplants performed in Spain in 2019, as well as trends in this procedure from 2010 to 2018. Results: In 2019, 300 transplants were performed (8794 since 1984; 2745 between 2010 and 2019). Compared with previous years, the most notable findings were the decreasing rate of urgent transplants (38%), and the consolidation of the type of circulatory support prior to transplant, with an almost complete disappearance of counterpulsation balloon (0.7%), stabilization in the use of extracorporeal membrane oxygenation (9.6%), and an increase in the use of ventricular assist devices (29.0%). Survival from 2016 to 2018 was similar to that from 2013 to 2015 (P = .34). Survival in both these periods was better than that from 2010 to 2012 (P = .002 and P = .01, respectively). Conclusions: Heart transplant activity has remained stable during the last few years, as have outcomes (in terms of survival). There has been a trend to a lower rate of urgent transplants and to a higher use of ventricular assist devices prior to transplant.

Background and objective The main objective was to evaluate the impact of Hepatitis C Virus treatment with direct-acting antiviral agents on tacrolimus blood levels in recipients of kidney and heart allografts. Method We analysed Hepatitis C Virus infected adult patients who received tacrolimus as immunosuppressive maintenance therapy and received direct-acting antiviral agents treatment in a tertiary hospital with solid transplant multidisciplinary program in Madrid, Spain. Liver and renal function, tacrolimus dose and blood levels were analysed before and 12 weeks after the end of treatment. Results We identified 7 kidney and 2 heart transplant recipients. All patients achieved sustained virologic response at 24 weeks. At week 12 after treatment, all liver functionality tests improved significantly with no significant changes in renal function. A decrease in the tacrolimus blood level/dose ratio for every patient was observed (370.04 ± 253.93 vs. 186.44 ± 123.74 ng/mL per mg/kg; p

Introduction and objectives: Recipients of a heart transplant need to receive serial endomyocardial biopsies (EMB) to discard rejection, a procedure that is usually performed through the femoral or jugular vein. Over the last few years, we have developed a technique to perform EMBs using the brachial venous access that we have implemented as the preferential access route. In this article, we describe the technique and the initial clinical experience of 2 different centers. Methods: Between 2004 and 2016, we developed and implemented a brachial venous access technique. We registered the main clinical and procedural variables of all the brachial biopsies performed in both centers and compared them with a retrospective series of femoral and jugular procedures. Results: Brachial EMBs were successfully performed 544 of the time with no major complications. The number of brachial procedures per patient rose from 1 to 14. Over the same period of time 1054 femoral and 686 jugular procedures were performed. The total procedural time was similar with different access routes (mean for brachial/femoral/jugular access: 28/26/29 min., P = .31) while fluoroscopy time was shorter in jugular procedures (mean 5/5/3 min. respectively; P < .001). The brachial procedure was recalled as the least painful procedure of all compared to the jugular or femoral ones (2/8/9 score on a scale from 1 to 10; P = .001) with an overall patient preference towards the brachial access. Conclusions: The venous brachial access route is a good alternative to the central venous one to perform EMBs and is the route of choice in our centers. Also, it has high feasibility and safety and brings additional comfort to patients.

espanolIntroduccion y objetivos: Los pacientes receptores de un trasplante cardiaco necesitan someterse a biopsias endomiocardicas (BEM) para descartar el rechazo, procedimiento que habitualmente se realiza por acceso venoso yugular o femoral. En los ultimos anos hemos desarrollado una tecnica de biopsia por via braquial, que hemos implementado como acceso preferente. En este articulo describimos la tecnica y la experiencia clinica inicial de 2 centros empleando el acceso braquial. Metodos: Entre 2004 y 2016 desarrollamos e implementamos la tecnica de biopsia por via venosa braquial. Se registraron las principales variables clinicas y del procedimiento de todas las BEM realizadas por via braquial en ambos centros, y se compararon las caracteristicas con los procedimientos realizados por via femoral y yugular. Resultados: Se realizo la BEM por via braquial en 544 casos, sin complicaciones mayores. El numero de procedimientos braquiales por paciente vario entre 1 y 14. En el mismo periodo se realizaron 1.054 BEM femorales y 686 yugulares. La duracion total del procedimiento fue similar por los distintos accesos (mediana braquial/femoral/yugular: 28/26/29 min; p = 0,31), con un menor tiempo de escopia por via yugular (mediana 5/5/3 min, respectivamente; p Conclusiones: La BEM por via venosa braquial es una buena alternativa a la puncion venosa central y la via de eleccion en nuestros centros, con altas factibilidad y seguridad, y mayor comodidad para el paciente. EnglishABSTRACT Introduction and objectives: Recipients of a heart transplant need to receive serial endomyocardial biopsies (EMB) to discard rejection, a procedure that is usually performed through the femoral or jugular vein. Over the last few years, we have developed a technique to perform EMBs using the brachial venous access that we have implemented as the preferential access route. In this article, we describe the technique and the initial clinical experience of 2 different centers. Methods: Between 2004 and 2016, we developed and implemented a brachial venous access technique. We registered the main clinical and procedural variables of all the brachial biopsies performed in both centers and compared them with a retrospective series of femoral and jugular procedures. Results: Brachial EMBs were successfully performed 544 of the time with no major complications. The number of brachial procedures per patient rose from 1 to 14. Over the same period of time 1054 femoral and 686 jugular procedures were performed. The total procedural time was similar with different access routes (mean for brachial/femoral/jugular access: 28/26/29 min., P = .31) while fluoroscopy time was shorter in jugular procedures (mean 5/5/3 min. respectively; P Conclusions: The venous brachial access route is a good alternative to the central venous one to perform EMBs and is the route of choice in our centers. Also, it has high feasibility and safety and brings additional comfort to patients.

Introduction and objectives The present report describes the clinical characteristics and outcomes of heart transplants in Spain and updates the data to 2019. Methods We describe the clinical characteristics and outcomes of heart transplants performed in Spain in 2019, as well as trends in this procedure from 2010 to 2018. Results In 2019, 300 transplants were performed (8794 since 1984; 2745 between 2010 and 2019). Compared with previous years, the most notable findings were the decreasing rate of urgent transplants (38%), and the consolidation of the type of circulatory support prior to transplant, with an almost complete disappearance of counterpulsation balloon (0.7%), stabilization in the use of extracorporeal membrane oxygenation (9.6%), and an increase in the use of ventricular assist devices (29.0%). Survival from 2016 to 2018 was similar to that from 2013 to 2015 (P=.34). Survival in both these periods was better than that from 2010 to 2012 (P=.002 and P=.01, respectively). Conclusions Heart transplant activity has remained stable during the last few years, as have outcomes (in terms of survival). There has been a trend to a lower rate of urgent transplants and to a higher use of ventricular assist devices prior to transplant.

INTRODUCTION AND OBJECTIVES The present report updates the characteristics and results of heart transplantation in Spain, mainly focused in the 2008-2017 period. METHODS We describe the recipient and donor characteristics, surgical procedures, and outcomes of heart transplants performed in 2017. The 2017 data were compared with those obtained from 2008 to 2016. RESULTS A total of 304 cardiac transplants were performed in 2017. Between 1984 and 2017, 8173 procedures were performed, 2689 of them after 2008. Significant temporal trends were observed in recipient characteristics (lower pulmonary vascular resistance, lower use of mechanical ventilation, and a higher percentage of diabetic patients and those with previous cardiac surgery), donor characteristics (older donor age and a higher percentage of female donors and those with a prior cardiac arrest) and procedures (lower ischemia time). In 2017, 27% of patients were transplanted after undergoing mechanical ventricular assistance (P