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Resumen Introduccion y objetivos A fin de entender la evolucion de la sustitucion convencional de la valvula aortica (SVAo) en Espana, se llevo a cabo un analisis nacional para investigar, entre 1998 y 2017: a) el volumen de procedimientos; b) perfil de riesgo de los pacientes; c) mortalidad hospitalaria, y d) tipo de protesis aortica utilizada. Metodos Se incluyeron todos los episodios de pacientes sometidos a SVAo del Conjunto Minimo Basico de Datos (Ministerio de Sanidad, Consumo y Bienestar Social de Espana) entre enero de 1998 y diciembre de 2017. La duracion del estudio se dividio en 4 periodos de 5 anos. Se analizaron las tendencias en numero de intervenciones, comorbilidades y mortalidad hospitalaria. Mediante analisis multivariante, se identificaron los factores asociados con la mortalidad hospitalaria y el tipo de protesis utilizada. Se compararon los indices de mortalidad ajustada por el riesgo en el periodo de estudio. Resultados En el periodo de estudio, se sometieron a SVAo 73.668 pacientes. El numero de SVAo/ano aumento desde 16.363 entre 1998 y 2002 a 22.685 entre 2013 y 2017. Se incremento la prevalencia de todas las comorbilidades salvo las de infarto de miocardio e ingreso urgente. El indice de Charlson empeoro entre el primer (1998-2002) y el cuarto (2013-2017) periodo: 2,3 ± 1,4 frente a 3,6 ± 1,7 (p Conclusiones Se detecto un aumento del volumen anual de SVAo en Espana, con un empeoramiento del perfil de riesgo y mas pacientes con bioprotesis. Se observo una reduccion muy relevante de la mortalidad hospitalaria.

Resumen: Introducción y objetivos: Se pretende demostrar la seguridad de la reparación valvular mitral en endocarditis. Material y método: Del 2008 al 2019, hubo un total de 22 casos de reparación mitral de etiología endocardítica en nuestro centro (14 de ellas corresponden a los tres últimos años). Edad media de 60,8 años, la mayoría varones (72,7%), con un EuroSCORE-II medio del 5,9 ± 7,9%. El 63,6% se trataban de endocarditis activas en el momento de la intervención. Resultados: En la mayoría de los casos existía prolapso del velo posterior (54,5%) o de ambos velos (13,6%). La técnica de reparación más usada fue la resección (36,4%), seguida del implante de neocuerdas (22,7%) y la combinación de neocuerdas con cierre de cleft (18,2%). Se empleó anillo en la mayoría de los casos (81,8%). Sólo un caso mantuvo hemocultivos positivos postoperatorios (infección por Candida parapsilosis). Con un seguimiento de 22,1 ± 20,0 meses, no hubo ningún éxitus y sólo un caso de necesidad de reintervención. Conclusiones: En la literatura, la reparación valvular mitral ha demostrado su superioridad en mortalidad, preservación de la función ventricular izquierda y disminución de eventos tromboembólicos respecto a la sustitución valvular mitral. No obstante, la tasa de reparación mitral en endocarditis es menor que la de enfermedad degenerativa. A la vista de nuestros resultados, con ausencia de mortalidad y baja tasa de fallos de reparación, asociado al aumento del número de casos y complejidad cada año, es una estrategia de elección siempre que sea técnicamente posible. Abstract: Introduction and objectives: The aim is to demonstrate the safety of mitral valve repair in endocarditis Material and method: From 2008 to 2019, there were a total of 22 cases of mitral repair of endocardial etiology in our center (14 of them correspond to the last 3 years). Average age of 60.8 years, most of them males (72.7%), with a mean EuroSCORE-II of 5.9 ± 7.9%. 63.6% were active endocarditis at the time of the intervention. Results: In most cases there was prolapse of the posterior leaflet (54.5%) or both leaflet (13.6%). The most used repair technique was resection (36.4%), followed by neo-chord implantation (22.7%) and the combination of neo-chords with cleft closure (18.2%). Ring was used in most cases (81.8%). Only 1 case maintained positive postoperative blood cultures (Candida parapsilosis infection). With a follow-up of 22.1 ± 20.0 months, there were no deaths and only 1 case of need for reoperation. Conclusions: In the literature, mitral valve repair has shown superiority in mortality, preservation of left ventricular function, and decrease in thromboembolic events compared to mitral valve replacement. However, the mitral repair rate in endocarditis is lower than degenerative disease. In view of our results, with absence of mortality and low rate of repair failure, associated with the increase in the number of cases and complexity each year, it is a strategy of choice whenever technically possible.

Resumen: Ante el contexto sanitario de pandemia por COVID-19, la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) asume la obligación de elaborar y transmitir una serie de recomendaciones para asegurar una adecuada cobertura sanitaria de la población, al mismo tiempo que para minimizar la exposición y el riesgo de contagio tanto de pacientes como de profesionales. Para ello, y dentro del marco global que formulan las instrucciones del Ministerio de Sanidad, Consejería de Sanidad y Direcciones o Gerencia de cada uno de los centros sanitarios, debe organizarse un plan de contingencia de los distintos servicios de cirugía cardiovascular. Este plan de contingencia debe mantener el correcto funcionamiento de los servicios de cirugía cardiovascular, asegurando el adecuado cumplimiento de las siguientes dimensiones asistenciales: a) la correcta atención de los pacientes urgentes y emergentes, b) la elaboración de una lista de pacientes preferentes y criterios temporales de tratamiento, c) la demora justificada y segura de aquellos pacientes de tratamiento electivo cuya enfermedad y situación clínica lo permitan y d) la aplicación concreta de los programas de ECMO en el contexto de la COVID-19. Abstract: In the actual COVID-19 pandemic, the Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) assumes the obligation to elaborate special recommendations that ensure an adequate health care of population, while minimizing the exposure and the risk of contagion for both patients and professionals. For that reason, Cardiovascular Surgery Departments need to develop a functional plan of contingency within the global framework formulated by the instructions of the Ministry of Health and hospital authorities. The aim of this strategy is the proper functioning of Cardiovascular Surgery Departments: a) Correct care for urgent and emerging patients. b) The preparation of a list of preferred patients and temporary treatment criteria. c) The justified and safe delay of elective patients if their pathology and clinical situation allow it. d) The concrete application of ECMO programs in the COVID-19 context.

Resumen: La Sociedad Española de Cirugía Torácica-Cardiovascular presenta los resultados de nuestra actividad en pacientes con cardiopatía congénita correspondientes al período 2012-2018 basado en un registro voluntario y anónimo de los centros españoles. Este artículo es complementario al registro general del año 2018 y se publican ambos conjuntamente. Se analizan datos de los últimos 7 años, que muestran una impresión más real de nuestra actividad en estas patologías relativamente infrecuentes. Un total de 15.049 cirugías de cardiopatías congénitas se hicieron en este período, que supone un 9,87% de la cirugía mayor (congénita + adquirida) realizada en nuestro país durante ese tiempo. De estas 15.049 cirugías, 80% se hicieron con circulación extracorpórea y 20% sin ella. Destacamos las intervenciones en neonatos y en adultos por su elevada complejidad, que supusieron respectivamente un 18% y 21% de la actividad total. Las cardiopatías congénitas operadas más prevalentes continúan siendo los defectos septales en los casos que requieren circulación extracorpórea, y los ductus en pacientes operados sin circulación extracorpórea. Presentamos los datos ajustados a la escala Aristóteles básico de riesgo quirúrgico preoperatorio. La mortalidad observada en cirugías con circulación extracorpórea fue 3,12% (Aristóteles-6,72), y en cirugías sin circulación extracorpórea 2,43% (Aristóteles-4,83). Este registro muestra con precisión datos de nuestra actividad quirúrgica en cardiopatías congénitas, y permite comparaciones tanto a nivel nacional como internacional, para establecer estrategias de mejora de nuestros resultados. Abstract: The Spanish Society of Thoracic-Cardiovascular Surgery presents the 2012-2018 report of the activity in congenital cardiovascular surgery, based on a voluntary and anonymous registration involving the majority of Spanish centres. This article is complementary to the 2018 cardiovascular surgery annual report, and they are published together. We included data from the previous 7 years, in order to obtain real information related to our activity in these relatively scarce pathologies. In the last seven years, a total of 15049 congenital heart defect surgeries were performed, accounting for 9.87% of major surgery (congenital + acquired) performed in Spain during that period. Of these 15049 surgeries, 80% of them required extracorporeal circulation and 20% not. Due to its high complexity, we highlight the interventions in neonates and adult patients, which represent respectively 18% and 21% of the whole activity. The most prevalent congenital heart pathologies operated on were septal defects in cases requiring extracorporeal circulation, and ductus in patients not requiring extracorporeal circulation. The data are presented adjusted to the basic Aristotle score of preoperative surgical risk. The observed mortality of surgeries with extracorporeal circulation was 3.12% (Aristotle-6.72), and without cardiopulmonary bypass 2.43% (Aristotle-4.83). This data analysis shows accurate and reliable information about our surgery for congenital heart disease and allows us to compare ourselves within an international framework, and to organize strategies directed to improve our results. Palabras clave: Cirugía cardiovascular, Cardiopatías congénitas, Registro, España, Keywords: Cardiovascular surgery, Congenital heart disease, Registry, Spain

Resumen: La endocarditis infecciosa es una enfermedad mortal, que a pesar de las mejoras en su manejo sigue estando asociada a gran mortalidad y complicaciones graves. Se presenta el caso clínico de un hombre de 35 años con cuadro neurológico asociado a masa valvular aórtica con doble lesión valvular. Sospechando endocarditis infecciosa, fue intervenido de sustitución valvular aórtica. El paciente tenía antecedentes de espondiloartropatía tratada con certolizumab y de betatalasemia. Presentó en el postoperatorio un taponamiento cardiaco tardío, complicaciones en la cicatrización de la herida quirúrgica y un bloqueo aurículo-ventricular que requirió de implante de marcapasos. Al cuarto mes postoperatorio fue reintervenido con el hallazgo de un seudoaneurisma subanular, encontrando una desestructuración del anillo aórtico nativo. Se realizó una nueva reintervención pasados 5 meses, decidiéndose implante de homoinjerto aórtico en posición subcoronaria. Se realizó un exhaustivo diagnóstico diferencial sin confirmación del agente etiológico hasta la positividad de Tropheryma whipplei en el material quirúrgico de la última cirugía. Abstract: Infective endocarditis is a fatal disease, which, despite improvements in its management, is still associated with high mortality and serious complications. A case is presented of a 35 year-old man with neurological symptoms associated with an aortic valve mass with a double valvular lesion. Suspecting infectious endocarditis, aortic valve replacement was performed. The patient had a history of spondyloarthropathy (treated with certolizumab) and beta-thalassaemia. In the postoperative period, he had a late cardiac tamponade, complications in the healing of the surgical wound, and anatrial-ventricular block requiring pacemaker implantation. He was re-intervened in the fourth post-operative month, with the finding of a sub-annular pseudoaneurysm, and a disruption of the native aortic ring. In a further intervention after 5 months it was decided to implant an aortic homograft in a sub-coronary position. An exhaustive differential diagnosis was made without confirmation of the aetiological agent until Tropheryma whipplei was found in the surgical material of the last surgery. Palabras clave: Endocarditis, Enfermedades de las válvulas cardiacas, Enfermedades reumáticas, Tropheryma, Keywords: Endocarditis, Heart valve diseases, Rheumatic diseases, Tropheryma

Resumen: La tromboendarterectomía pulmonar quirúrgica es el tratamiento de elección para la hipertensión pulmonar tromboembólica crónica. No obstante, algunos pacientes cursan con hipertensión pulmonar recidivada tras la cirugía. Presentamos un caso de un varón de 46 años diagnosticado de tromboembolismo pulmonar masivo. Requirió en el plazo de un año y medio de 3 intervenciones para su tratamiento, siendo en la última diagnosticado de sarcoma intimal. Tras un año de seguimiento posterior, se evidenció recurrencia de la masa tumoral en arteria pulmonar principal que crecía hacia la rama pulmonar izquierda, extendiéndose hasta la arteria lobar inferior izquierda. Dada la buena evolución clínica tras la última intervención, no se consideró el crecimiento distal de la enfermedad hacia las ramas lobares una contraindicación para la cirugía y el paciente fue nuevamente intervenido, resecando el árbol vascular proximal y reconstruyéndolo con un homoinjerto en posición pulmonar y creación de neoconductos con parche de pericardio. La evolución posterior fue satisfactoria, reiniciándose la quimioterapia adyuvante y a la espera de evaluar el comportamiento tumoral en el futuro. Abstract: Surgical pulmonary thromboendarterectomy is the treatment of choice for chronic thromboembolic pulmonary hypertension. However, some patients present relapsed pulmonary hypertension after surgery. We present a case of a 46-year-old man diagnosed with massive pulmonary thromboembolism. He required within a year and a half of three interventions for its treatment, being in the last diagnosed of intimal sarcoma. After one year of follow-up, recurrence of the tumor mass in the main pulmonary artery that grew toward the left pulmonary branch, extending to the left inferior lobar artery, was evidenced. Given the good clinical evolution after the last intervention, the distal growth of the disease towards the lobar branches was not considered a contraindication for the surgery and the patient was again operated on, resecting the proximal vascular tree and reconstructing it with a homograft in pulmonary position and creation of neoconducts with pericardial patch. The subsequent evolution was satisfactory, adjuvant chemotherapy was reinitiated and waiting to evaluate the tumor behavior in the future. Palabras clave: Hipertensión pulmonar, Sarcoma, Neoplasias pulmonares, Recurrencia neoplásica, Endarterectomía, Keywords: Pulmonary hypertension, Sarcoma, Lung neoplasms, Neoplastic recurrence, Endarterectomy

Resumen: La cirugía cardiovascular es la especialidad médica que se ocupa de la prevención, diagnóstico y tratamiento quirúrgico de los trastornos y enfermedades del sistema cardiocirculatorio. Los continuos y rápidos avances en el diagnóstico y tratamiento de las enfermedades cardiovasculares justifican la necesidad de llevar a cabo una actualización de los principales aspectos definitorios y organizativos de la especialidad, relacionados con la profesión (de la práctica, calidad asistencial), con el programa docente de la especialidad, la formación continuada de los cirujanos, los procesos de acreditación desde la Sociedad Española de Cirugía Torácica-Cardiovascular, entre otros.Este documento, elaborado por expertos de la cirugía cardiovascular, representa la opinión de la Sociedad Española de Cirugía Torácica-Cardiovascular y actualiza los principales aspectos de la especialidad en nuestro país. Abstract: Cardiovascular surgery is the medical specialty that deals with the prevention, diagnosis, and surgical treatment of disorders and diseases of the circulatory system. The continuous and rapid advances in the diagnosis and treatment of cardiovascular diseases justify the need to update the main, defining, and organisational aspects of the specialty, related to the profession (its practice, quality care), aspects on the teaching program of the specialty, the continuing education program of the surgeons, the processes of accreditation from the Spanish Society of Thoracic-Cardiovascular Surgery, etc.This document, prepared by experts in cardiovascular surgery, represents the opinion of the Spanish Society of Thoracic-Cardiovascular surgery and updates the main aspects of the specialty in our country. Palabras clave: Cirugía cardiovascular, Cirugía cardíaca, Cirugía torácica, Cirugía vascular, Recomendaciones, Keywords: Cardiovascular surgery, Cardiac surgery, Thoracic surgery, Vascular surgery, Recommendations

Resumen: La Sociedad Española de Cirugía Torácica-Cardiovascular presenta los resultados de la actividad en cirugía cardiovascular sobre pacientes con cardiopatía congénita correspondientes al período 2012-2017 basados en un registro voluntario y anónimo de los centros españoles. Este artículo es complementario al registro general del año 2017 y ambos se publican conjuntamente. Se analizan datos de los últimos 6 años, que muestran una impresión más real de nuestra actividad en estas patologías relativamente infrecuentes. En este período se realizaron un total de 12.990 cirugías en cardiopatías congénitas, que suponen un 10% de la cirugía mayor (congénita + adquirida) de nuestro país durante ese tiempo. De estas 12.990 cirugías, el 80% se hicieron con circulación extracorpórea y el 20% sin ella. Destacamos las intervenciones en neonatos y en adultos por su elevada complejidad, que supusieron respectivamente un 19% y un 20% de la actividad total. Las cardiopatías congénitas operadas más prevalentes fueron los defectos septales en los casos que requieren circulación extracorpórea y los ductus en pacientes operados sin circulación extracorpórea. Presentamos los datos ajustados a la escala Aristóteles básico de riesgo quirúrgico preoperatorio. La mortalidad observada en cirugías con circulación extracorpórea fue 3,21% (Aristóteles 7,04), y en cirugías sin circulación extracorpórea 2,42% (Aristóteles 4,73). Este registro muestra con precisión datos de nuestra actividad quirúrgica en cardiopatías congénitas y permite compararnos tanto a nivel nacional como internacional para organizar estrategias de mejora de nuestros resultados. Abstract: The Spanish Society of Thoracic-Cardiovascular Surgery presents the 2012-2017 report of the activity in congenital cardiovascular surgery based on a voluntary and anonymous registration involving the majority of Spanish centres. This article is complementary to the 2017 cardiovascular surgery annual report, and they are published together. Data from the previous 6 years is included, in order to obtain improved real information related to our activity in these relatively uncommon pathologies. In the last 6 years, a total of 12,990 congenital heart defect surgeries were performed, accounting for 10% of the major surgery (congenital + acquired) performed in our country during that period. Of these 12,990 surgeries, 80% of them were performed with extracorporeal circulation and 20% without it. Due to their high complexity, the interventions in neonates and adult patients are highlighted as they represent 19% and 20%, respectively, of the total activity. The most prevalent congenital heart diseases operated on, were septal defects in cases requiring extracorporeal circulation, and ductus in patients not requiring extracorporeal circulation. The data are presented adjusted to the basic Aristotle scale of preoperative surgical risk. The observed mortality of surgeries with extracorporeal circulation was 3.21% (Aristotle 7.04), and without cardiopulmonary bypass 2.42% (Aristotle 4.73). This data analysis shows accurate and reliable information about our surgery for congenital heart disease and allows us to compare ourselves within an international framework, and to organise strategies directed at improving our results. Palabras clave: Cirugía cardiovascular, Cardiopatías congénitas, Registro, España., Keywords: Cardiovascular surgery, Congenital heart disease, Registry, Spain.

Resumen: La Sociedad Española de Cirugía Torácica-Cardiovascular presenta el informe correspondiente al año 2017 de los resultados de la actividad de cirugía cardiovascular en nuestro país. Este registro voluntario y anónimo, de datos agregados, está basado en el análisis conjunto de la actividad de 62 centros, garantizándose la confidencialidad de los datos individuales de cada uno. El registro reporta datos de actividad global, mortalidad observada y riesgo quirúrgico, desglosados en distintas categorías de intervenciones.En conjunto, la actividad global de la cirugía cardiovascular de nuestro país permanece estable, con resultados de mortalidad ajustados al riesgo estimado en la mayor parte de las patologías analizadas.Durante el año 2017 se realizaron un total de 36.692 procedimientos de cirugía cardiovascular, desglosados en 29.056 procedimientos (79,2%) de cirugía cardiaca de patología adquirida, 2.127 procedimientos (5,8%) de cirugía cardiaca de patología congénita y 5.509 procedimientos (15,0%) de cirugía vascular periférica.Del total de 36.692 procedimientos, 23.261 (63,4%) fueron cirugías cardiacas mayores: 21.134 procedimientos de patología adquirida y 2.127 de patología congénita. Por otro lado, 20.895 (89,8%) procedimientos se realizaron con el apoyo de circulación extracorpórea.Los datos desglosados de procedimientos de cirugía de las cardiopatías congénitas se presentan nuevamente en un informe específico.Dentro de los 21.134 procedimientos de cirugía cardiaca mayor de patología adquirida, la cirugía valvular aislada fue la más frecuente (9.682 procedimientos), seguida de la cirugía de revascularización coronaria (5.029 procedimientos), cirugía de la aorta (2.249 procedimientos), cirugía mixta valvular-coronaria (2.172 procedimientos), otros procedimientos misceláneos con circulación extracorpórea (1.209 procedimientos) y cirugía de complicaciones mecánicas del infarto (142 procedimientos). Aparte, se realizaron otros 5.496 procedimientos relacionados con el implante o recambio de dispositivos de electroestimulación cardiaca, y 1.837 procedimientos sin circulación extracorpórea no codificados en otros apartados.La información derivada de este registro nacional permite conocer el estado actual de la especialidad en nuestro país mediante el análisis global de la actividad, el conocimiento del perfil de riesgo de nuestros pacientes y la valoración de los resultados obtenidos, lo cual es fundamental para una adecuada evaluación de la calidad de la atención dispensada a los pacientes afectos de patología cardiovascular. Abstract: The Spanish Society of Thoracic and Cardiovascular surgery reports the results of the 2017 registry of the surgical activity in Spain. The participation in this registry is anonymous and voluntary, and it is based on the analysis of the information gathered from 62 centres with activity in cardiovascular surgery, and the confidentiality of the individual data of each centre is ensured. The registry reports the global activity Spain, the observed mortality and the estimated mortality risk, stratified into different types of procedures.The overall cardiac surgical activity in Spain remains stable, with an observed mortality that is adequately adjusted to the estimated surgical risk.During 2017, a total of 36,692 procedures of cardiovascular surgery were performed, divided into 29.056 (79.2%) procedures of adult cardiac surgery, 2.127 (5.8%) procedures of congenital cardiac surgery, and 5,509 procedures (15.0%) of peripheral vascular surgery.Among the total of 36,692 procedures, 23,261 (63.4%) were major cardiac surgical procedures: 21,134 procedures of acquired adult cardiac surgery, and 2,127 congenital cardiac surgery procedures. Furthermore, 20,895 (89.8%) of these procedures were performed with the use of the cardiopulmonary bypass machine.The results of the activity in congenital heart surgery are presented separately in another specific report.Within the 21,134 procedures of acquired adult cardiac surgery, isolated heart valve procedures were the most frequent (9,682 procedures), followed by coronary artery bypass grafting surgery (5,029 procedures), surgery of the aorta (2,249 procedures), combined heart valve and revascularisation procedures (2,172 procedures), other miscellaneous procedures with the use of cardiopulmonary bypass (1,209 procedures), and surgery of mechanical complications of myocardial infarction (142 procedures). Moreover, there were another other 5,496 procedures related to electronic implantable devices and 1,837 procedures without CPB not included in the previous groups.The information derived from this national registry allows to know the state-of-the-art of the surgical specialty in our country, through the knowledge of the surgical activity, the risk profile and the observed results, which is a keystone for an adequate evaluation of the quality of the health care that is delivered to the patients suffering from cardiovascular diseases. Palabras clave: Patología cardiovascular, Cirugía cardiovascular, Registro, Base de datos, España, Keywords: Cardiovascular disease, Cardiac surgery, National registry, Database, Spain

Introduction and objectives: To help to illustrate the trends in isolated surgical aortic valve replacement (SAVR) in Spain, we performed a national-level analysis to investigate the changes from 1998 to 2017 in a) SAVR volume, b) patients' risk profiles, c) in-hospital mortality, and d) types of aortic valve prostheses. Methods: We included all episodes of patients undergoing isolated SAVR from January 1998 to December 2017 recorded in the Minimum Basic Data Set (Ministry of Health, Consumer Affairs, and Social Welfare, Spain). The study duration was divided into four 5-year periods. We analyzed the trends in SAVR volume, comorbidity prevalence, and in-hospital mortality. Through multivariate logistic regression, we identified factors associated with mortality and type of prosthesis. The risk-adjusted mortality rate was compared over the study period. Results: In total, 73 668 patients underwent an isolated SAVR from 1998 to 2017. The annual volume of procedures increased from 16 363 between 1998 and 2002 to 22 685 between 2013 and 2017. The prevalence of all investigated comorbidities increased, except for history of previous myocardial infarction and unplanned admission. The Charlson comorbidity index worsened from 1998-2002 (2.3; SD, 1.4) to 2013-2017 (3.6; SD, 1.7) (P < .001). In-hospital mortality decreased from 7.2% to 3.3% (P < .001) while the risk-adjusted mortality index improved from 1.3 to 0.7. The proportion of bioprostheses increased from 20.7% (1998-2002) to 59.6% (2013-2017) (P < .001). Conclusions: We detected an increase in the annual SAVR volume in Spain, with more patients receiving bioprostheses. Despite an increased risk profile of the patients, in-hospital mortality substantially reduced. (C) 2020 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

Thorough study is required to decide the appropriate management of hepatic tumors in children. We present a case report of a hepatic embryonal undifferentiated sarcoma with unfavorable prognosis in a nine-year-old girl. After undergoing a detailed cancer characteristics and extension study, a two-stage surgery approach was decided. The hepatic tumor resection was the first procedure to be performed. One week later, under cardiopulmonary bypass, deep hypothermia, and circulatory arrest, thrombectomy of the inferior vena cava and right atrium was accomplished, plus thromboendarterectomy of the right pulmonary artery. During a four-year follow-up, the patient continues to be disease-free.

Resumen: El tratamiento de elección en la hipertensión pulmonar tromboembólica crónica es la tromboendarterectomía pulmonar quirúrgica (indicación clase I). La incidencia de hipertensión pulmonar posterior a una tromboendarterectomía aparentemente exitosa está poco descrita en la literatura, representando más de un tercio de los casos intervenidos. Puede ser debida a resección incompleta del trombo distal, a enfermedad concomitante de los microvasos o a la presencia de tumores. Se presenta un caso de un varón de 46 años intervenido en 2 ocasiones de tromboendarterectomía pulmonar, con hipertensión pulmonar recurrente. En la segunda intervención la enferrmedad relevó un tumor miofibroblástico inflamatorio. Fue intervenido nuevamente por tercera vez de forma precoz, tras 2 años de la primera cirugía, ante un empeoramiento clínico y radiológico, sin incidencias postoperatorias. El diagnóstico definitivo con la anatomía patológica fue de sarcoma. Abstract: The treatment of choice in chronic thromboembolic pulmonary hypertension is surgical pulmonary thromboendarterectomy (class I indication). The incidence of pulmonary hypertension after an apparently successful thromboendarterectomy is little described in the literature, representing more than a third of cases intervened. It may be due to incomplete resection of the distal thrombus, to concomitant disease of the microvessels or to the presence of tumors. We present a case of a 46-year-old male who underwent pulmonary thromboendarterectomy twice, with recurrent pulmonary hypertension. In the second intervention, the pathology revealed an inflammatory myofibroblastic tumor. He was intervened again for the third time in a precocious manner, two years after the first surgery, before a clinical and radiological worsening, without postoperative incidents. The definitive diagnosis with pathological anatomy was sarcoma. Palabras clave: Embolismo pulmonar, Hipertensión pulmonar, Enfermedad cardiaca pulmonar, Neoplasias pulmonares, Keywords: Pulmonary embolism, Pulmonary hypertension, Pulmonary heart disease, Lung neoplasms

Resumen Las fistulas coronarias son anomalias raras de las arterias coronarias que afectan mas frecuentemente a la arteria coronaria derecha, seguida de la arteria descendente anterior, y raramente a la arteria circunfleja. Se presenta un caso clinico de un varon de 70 anos que ingreso en situacion de edema agudo de pulmon debido a estenosis aortica severa, con depresion moderada de la funcion ventricular. Durante el estudio preoperatorio fue diagnosticado de una fistula coronaria de la arteria circunfleja a la vena cava superior en la coronariografia preoperatoria realizada para cribado de lesiones coronarias. Y en la tomografia axial computarizada fue mejor caracterizada, asociando tambien el paciente un aneurisma de la aorta ascendente. Se realizo cirugia preferente con cierre quirurgico de la fistula coronaria, implante de bioprotesis aortica y sustitucion de aorta ascendente. La evolucion postoperatoria fue favorable.

ResumenLa Sociedad Española de Cirugía Torácica-Cardiovascular presenta los resultados de la actividad en cirugía cardiovascular correspondientes al año 2015 basado en un registro voluntario y anónimo en el que participaron 62 centros. Se realizaron un total de 35.413 procedimientos, siendo cirugías mayores 22.298, y requirieron el apoyo de circulación extracorpórea el 89,24% de estas. Este año hemos obtenido la máxima participación de centros desde que en 1984 se comenzó a registrar nuestra actividad y el grado de cumplimentación del registro cada vez es mayor. De acuerdo con esta participación, el número de procedimientos va aumentando discretamente respecto a los años anteriores. La cirugía valvular es la más frecuente en el 33,29%, seguida de los procedimientos misceláneos en el 27,88%, la cirugía coronaria en el 15,23% y la cirugía vascular periférica en el 11,96% de los casos. Menos frecuentes pero de gran importancia son la cirugía de cardiopatías congénitas y la cirugía de la aorta ascendente, que suponen, respectivamente, el 6 y el 5,64% de nuestra actividad. El 79% de los centros comunicaron sus datos ajustados a las escalas de riesgo quirúrgico preoperatorio. Los resultados en términos de mortalidad observada frente a la esperada son excelentes y siguen manteniéndose por debajo en casi todos los grupos de patologías. El análisis pormenorizado de los datos permite tener información precisa y fiable de la actividad de cirugía cardiovascular en nuestro país y es una magnífica herramienta para compararnos dentro de un marco internacional y organizar estrategias de mejora de nuestros resultados.AbstractThe Spanish Society of Thoracic-Cardiovascular Surgery presents the 2015 annual report of activity in cardiovascular surgery based on a voluntary and anonymous registration involving 62 centres. A total of 35.413 procedures were performed, 22.298 were major procedures of which 89,24% were performed with extracorporeal circulation. This is the year with the maximal participation of centres since the activity registration started in 1984 and the year in which the degree of completion has been the highest. According to this high participation, the number of procedures discreetly increased over previous year activity. Valve surgery is the most common in 33,29%, followed by miscellaneous procedures 27,88%, coronary surgery in 15,23%, and peripheral vascular surgery in 11,96% of cases. Less frequent but also important, are congenital heart surgery and surgery of the ascending aorta which represent respectively 6% and 5,64% of our activity. 79% of participants reported their preoperative surgical risk-adjusted data. The results in terms of observed mortality are excellent, and remain below expected mortality scores in most groups of pathologies. The detailed analysis of the data allows accurate and reliable information about the activity of cardiovascular surgery in our country, and it is a great tool to compare within an international framework, and to organize strategies in order to improve our results.

The incidence of allergic reactions due to mechanical prosthesis or rings is not well established. We report the case of a 56-year-old man who presented a persistent urticarial rash and anaphylactic shock after a mitral valve repair operation. Prick skin tests were positive for nickel. After the nucleus from the mitral annulus was removed, the urticarial rash disappeared.

Coronary and chronic lung diseases have become a common association. This comorbidity has been generically considered by most of the operative risk scores, but its functional severity has seldom been addressed by these models. Our objective was to analyze its prognostic relevance considering preoperative pulmonary function parameters.All patients undergoing CABG from May 1993 to December 2004 have been reviewed. One thousand four hundred and twelve patients with preoperative pulmonary function test were finally included in the study. Obstructive lung disease was defined when FEV1/FVC0.7. In-hospital mortality and complication rate related to chronic obstructive pulmonary disease and its degree of severity (FEV1%) were assessed. Logistic regression analysis was used to determine independent predictors of mortality.A pathologic preoperative pulmonary function test was found in 39% of patients: obstructive in 26% (FEV1/FVC0.7), restrictive in 9% and combined obstructive-restrictive in 4%. In-hospital mortality was higher in patients with abnormal test: 6.5% versus 0.9% (p0.001). Mortality was clearly related with the severity of lung disease: 0.9% in patients with FEV1:80%, 0.4% in FEV1: 60-80%, 10.8% in FEV1: 40-59% and 54% in FEV1:40%. In the latter group, other intercurrent prognostic factors were observed. Patients with FEV160% had higher mortality than those with FEV160%: 24.6% versus 1.4% (p0.001). Chronic obstructive lung disease was not an independent predictor of mortality but FEV1or =60% was significantly associated with death.This study on chronic lung comorbidity in CABG patients shows that this association can be of deleterious prognostic value but this effect is directly related to the degree of functional severity. Preoperative FEV160% must be considered as a primary prognostic factor in patients undergoing CABG procedures.

Introducción y objetivosSe describen los hallazgos de la tomografía computarizada (TC) multicorte como técnica incruenta para la valoración de la permeabilidad de los injertos coronarios.Pacientes y métodosEntre 2002-2005 se realizó TC multicorte en 31 pacientes intervenidos de cirugía coronaria, utilizando un escáner Light Speed 16 de GE® con contraste yodado. La indicación en la mayoría de los casos fue la recurrencia de angina. Se excluyeron pacientes con alergia a contrastes, insuficiencia renal y fibrilación auricular. En siete pacientes se realizó además coronariografía.ResultadosSe valoraron 143 injertos coronarios, 37 venosos y 106 arteriales. Se analizaron las diferencias en permeabilidad en función del injerto empleado, el territorio revascularizado y la técnica anastomótica. La permeabilidad fue del 97, 40, 88 y 86% al emplear, respectivamente, la arteria mamaria izquierda (AMI), la derecha (AMD), arteria radial y arteria safena. En función del territorio revascularizado, la permeabilidad fue de 97, 85, 85, 78 y 83% en la descendente anterior, diagonales, marginales, coronaria derecha y descendente posterior. Según el tipo de anastomosis empleada, la permeabilidad de los injertos individuales fue del 89%, secuenciales del 75% y del 100% en composiciones en «Y» en esta serie.ConclusionesLa TC multicorte es una técnica incruenta potencialmente útil en la valoración postoperatoria de los injertos coronarios.BackgroundTo evaluate the results of multislice computed tomography (CT) as non invasive technique for the assessment of coronary artery bypass grafting patency.Patients and methodBetween 2002-2005, multislice CT was performed in 31 patients with previous coronary surgery, using a 16 slice CT scanner, receiving contrast material. Most of the patients were referred by recurrence of angina. Contraindications were contrast allergy, abnormal renal function or atrial fibrillation. Additional invasive angiography was performed in seven of these patients.Results143 conduits were studied, 37 vein grafts and 106 arterial grafts. We evaluate differences in patency based on the conduit, the coronary territories or the type of anastomosis. Patency was 97, 40, 88 and 86% for LIMA, RIMA, radial artery and saphenous vein, respectively. Depending on the target territories, patency was 97, 85, 85, 78 and 83% for left anterior descending coronary artery, diagonals, marginals, right coronary artery and posterior descending coronary artery. Based on type of anastomosis, patency for individual anastomosis was 89%, for sequential was 75 and 100% for «Y» grafts.ConclusionMulti-slice CT is a non-invasive technique useful to evaluate patency after coronary artery bypass grafting.

Ventricular dysfunction and high hypertrophy may influence surgical outcome in aortic stenosis. Our aim was to determine whether an excessive left ventricular mass index (LVMI) discriminates different risk profiles in aortic stenosis with low ventricular ejection fraction (LVEF). Three hundred and thirty-nine patients with severe aortic stenosis underwent valve replacement (Mar-1994 and Nov-2001). LVMI values over the superior quartile were considered increased. Mortality models were constructed in global and LVEF

Introduccion y objetivos Actualmente la ablacion quirurgica de la fibrilacion auricular (FA) es un procedimiento simple que puede realizarse en la mayoria de los pacientes durante la cirugia cardiaca. Diferentes fuentes de energia para la ablacion permiten crear con facilidad las lineas de ablacion en las auriculas. Presentamos nuestra experiencia durante los ultimos 3 anos. Pacientes y metodo En 93 pacientes con diferentes afecciones quirurgicas cardiacas y FA permanente (> 3 meses) se asocio la ablacion quirurgica de la arritmia. La antiguedad media de la FA fue de 6 anos (rango, 0,3-24). El tamano preoperatorio por ecocardiografia (ECO) de la auricula izquierda (AI) fue de 51,7 ± 8,8 mm (rango, 35-77). Resultados La mortalidad hospitalaria fue de 5 pacientes (5,3%). Tras un seguimiento medio de 10 meses, el 16,1% de los pacientes siguen en FA permanente y el 83,8% han recuperado y mantenido el ritmo sinusal; 3 pacientes necesitaron la implantacion de un marcapasos definitivo. Analizando el resultado en los 82 pacientes con un seguimiento mayor de 6 meses, la prevalencia del ritmo sinusal fue del 84,1%. Se evidencio funcion contractil biauricular (ecocardiografica) en el 50% de los pacientes. Las complicaciones mayores relacionadas con el procedimiento de la ablacion fueron del 3,5%: 1 leak perivalvular al segundo mes postoperatorio, 1 espasmo de la arteria circunfleja y 1 fistula auriculoesofagica. Conclusiones La ablacion quirurgica de la FA permanente puede realizarse de forma simple, con baja morbimortalidad quirurgica, con recuperacion del ritmo sinusal en la mayoria de los pacientes. La incidencia de arritmias en el postoperatorio inicial es el principal problema del procedimiento.

Introduccion y objetivos La valvulopatia mitral se asocia con frecuencia a dilatacion y fibrilacion auriculares. La cirugia mitral permite un remodelado auricular quirurgico inmediato que, ademas, en aquellos casos en los que se consigue restablecer el ritmo sinusal, se sigue de un remodelado tardio. El objetivo de este estudio es conocer el proceso de remodelado auricular postoperatorio en pacientes intervenidos de valvulopatia mitral en fibrilacion auricular permanente. Pacientes y metodo De forma prospectiva, 50 pacientes en fibrilacion auricular permanente por valvulopatia mitral con indicacion de reparacion quirurgica, fueron aleatorizados en 2 grupos: 25 pacientes con reduccion de la auricula izquierda y cirugia mitral (grupo I), y 25 pacientes con solo cirugia mitral (grupo II). Preoperatoriamente ambos grupos fueron homogeneos. Resultados Tras un seguimiento medio de 31 meses, el 46% de los pacientes del grupo I recupero el ritmo sinusal, frente al 18% del grupo II (p = 0,06). En todos los pacientes que recuperaron el ritmo sinusal se produjo un remodelado auricular con regresion del tamano, que fue mas acentuado en el grupo II (–10,8% de reduccion del volumen auricular izquierdo en el grupo I frente a –21,5% en el grupo II; p Conclusiones La cirugia mitral produce una disminucion quirurgica del volumen auricular postoperatorio, en especial cuando se asocian tecnicas de reduccion. El remodelado auricular tardio de la auricula izquierda dependio del tipo de ritmo auricular y del volumen auricular quirurgico postoperatorio.

Background. Atrial fibrillation is frequent in surgical patients with cardiac valvulopathies. Radiofrequency energy applied by means of surgical probes permits the reproduction of atriotomies described in the maze surgical procedure for the ablation of atrial fibrillation in a fast, safe and efficient way. This study presents our initial experience in treatment of chronic atrial fibrillation through radiofrequency performed in patients with surgical cardiac valvulopathies. Patients and method. From June to November 2000, 10 patients, with surgical indications of valvulopathy, were intraoperatively treated through radiofrequency for its atrial fibrillation. Ablations were performed in the right auricle from the epicardium before starting extracorporeal circulation, and in the left auricle from the endocardium, while under circulation. Radiofrequency was applied through a surgical multielectrode probe. Results. Eight patients (80%) presented some type of postoperative arrhythmia, with relapse of paroxysmal fibrillation in 3 patients and flutter in another one. At discharge, none of the patients presented relapse of chronic atrial fibrillation. There was no in-hospital mortality. After a mean follow-up of 3 months (range, 1-6), 8 patients (80%) have recovered and maintained sinus rhythm. Only one patient has re-established echocardiographic biatrial contraction. Conclusions. Intraoperative radiofrequency has allowed us to perform the auricular lesions, in both auricles, in a simple way, with an initial effectiveness of 80%. Epicardial ablation of the right auricle was simple and safe. Although no patient presented relapse of chronic atrial fibrillation at hospital discharge, postoperative arrhythmias have continued to be the main postsurgical problem.

Background. Atrial fibrillation is frequently observed under conditions associated with atrial dilatation. Atrial size is a factor related to the genesis and maintenance of atrial fibrillation. Predictive parameters of persistence of atrial fibrillation after maze procedure are atrial size and long duration of atrial fibrillation. The aim of this study was to investigate the effects of surgical left atrial reduction in chronic atrial fibrillation by mitral valvulopathy. Patients and method. Nineteen patients with chronic atrial fibrillation and dilated left atrium undergoing mitral valve procedures were included in this prospective study: group I with left atrial reduction (10 patients) and group II including control (9 patients). Both groups were with similar preoperative characteristics. Results. At the mean follow-up of 12 months, all the patients in group II had chronic atrial fibrillation, and 7 patients in group I showed in atrial rhythm (p < 0.003). The patients in whom atrial fibrillation continued after surgery showed left atrial area of 33.8 ± 12.3 cm 2 and a volume of 98.5 ± 53.9 ml; and the patients with normal rhythm had a left atrial area of 24.5 ± 5.3 cm 2 and a volume 60.3 ± 21.2 ml. Conclusions. Preliminary results indicate that surgical left atrial reduction in patients with chronic atrial fibrillation may be a mechanism implicated in the elimination of arrhythmia after surgery.

Varon de 71 anos con angina estable por enfermedad coronaria severa, en fibrilacion auricular cronica, que fue intervenido realizando un procedimiento radial modificado para la fibrilacion auricular y 3 bypass aortocoronarios sin circulacion extracorporea. El procedimiento para la ablacion de la arritmia fue realizado epicardicamente mediante radiofrecuencia con cateter multielectrodo. Intraoperatoriamente, el paciente restablecio el ritmo sinusal, presentando un postoperatorio sin complicaciones. La ecocardiografia postoperatoria demostro la presencia de contraccion auricular con onda A

Prosthetic valve endocarditis remains as one of the most life-threatening complication of valve replacement surgery. Homografts are the valve of choice with a lower early risk of endocarditis than other valve substitutes, however they are not always available. Recently a new prosthesis has been introduced with a silver-coated sewing cuff (St. Jude Medical with Silzone coating). Silver is an antimicrobial agent that has been proven to reduce bacterial colonization. We present the case of a 48-year-old man with an early prosthetic valve endocarditis which affected an aortic stentless prosthesis. He was successfully treated with a silver-coated prosthesis. Indications for surgery and the use of this prosthesis as a valuable option in this disease entity are discussed. Although the present patient is an isolated case, the interest of this article is the encouraging result obtained with this new prosthesis for this serious complication. Moreover, the clinical experience is reduced with only a few reports in the literature.

Introduction. Surgical ablation of atrial fibrillation is currently a simple procedure that can be done during cardiac surgery in most patients. A number of different energy sources now available allow to easily create ablation lines in the atria. We describe our experience during the previous three years. Patients and method. In 93 patients with cardiac problems treated with surgery and permanent atrial fibrillation (longer than 3 months), surgical ablation of the arrhythmia was done at the same time. Mean duration of the atrial fibrillation was 6 years (range 0.3 to 24 years). Mean (SD) preoperative size of the atrium as measured echocardiographically was 51.7 (8.8) mm (range 35 to 77 mm). Results. Five patients died in the hospital (5.3% in-hospital mortality). After a mean follow-up of 10 months, 83.8% of the patients had recovered and maintained sinus rhythm, and 16.1% of the patients remained in atrial fibrillation. A permanent pacemaker was implanted in 3 of these patients. Among the 82 patients followed for more than 6 months, the prevalence of sinus rhythm was 84.1%. Echocardiographically documented contractility in both atria was observed in 50% of the patients. Major complications related to the ablation procedure occurred in 3.5% of the patients, and consisted of a perivalvular leak 2 months after surgery, a circumflex artery spasm, and an atrio-esophageal fistula. Conclusions. Surgical ablation of permanent atrial fibrillation is a simple procedure associated with low morbidity and mortality, and with recovery of sinus rhythm in most patients. The main problem with the procedure is the incidence of early postoperative arrhythmias.

Objective: Several studies have demonstrated favorable results despite patient-prosthesis mismatch after aortic valve replacement with the use of third generation prostheses. Our aim was to determine whether this mismatch is always tolerable. Methods: A clinical-echocardiographic study has been performed in 339 consecutive patients who underwent aortic valve replacement because of aortic stenosis. In-hospital outcome and left ventricular mass index regression (1st month-1st year) were analyzed in the presence or absence of mismatch (indexed effective orifice area %0.85 cm 2 /m 2 ). The influence of high degrees of preoperative left ventricular mass on in-hospital mortality has also been evaluated. Left ventricular mass index was considered increased if the calculated value was over the superior quartile of the frequency distribution of all the values observed in both sexes. Results: Mismatch was found in 38% of the patients. In the absence of mismatch, the absolute mass regression was proportional to the preoperative left ventricular mass. This regression was higher in patients with increased left ventricular mass indexed (vs not increased): K38.0G7.8 vs K8.8G4.7 g/m 2 , p!0.01 (1st month) and K67.7G16.9 vs K23.5G6.7 g/m 2 , p!0.05 (1st year). Mass regression was impaired in the presence of mismatch, particularly, in patients with previously increased left ventricular mass: K8.2G11.6 vs K5.6G 6.3 g/m 2 (pZ0.83) and K24.6G12.6 vs K11.7G10.5 g/m 2 (pZ0.54). This worse regression was reflected on a 100% incidence of residual hypertrophy at follow-up (1st month-1st year). In the presence of mismatch, increased ventricular mass was associated with higher mortality: 14.7% vs 2.1% (p!0.01). In the absence of mismatch, ventricular mass was not associated with mortality: 4.1 vs 2.5% (pZ0.55). Conclusions :I n patients with severe ventricular hypertrophy it may be important to elude patient-prosthesis mismatch to avoid a significant increase in mortality and improve ventricular mass regression. Mismatch may be tolerable in those patients with lesser degree of hypertrophy. q 2004 Elsevier B.V. All rights reserved.

Mitral valve pathology is frequently associated with atrial dilation and fibrillation. Mitral surgery allows immediate surgical atrial remodeling, and in those cases in which sinus rhythm is achieved, it is followed by late remodeling. The aim of this study was to investigate the process of postoperative atrial remodeling in patients with permanent atrial fibrillation who undergo mitral surgery.In a prospective randomized trial, 50 patients with permanent atrial fibrillation and dilated left atrium, repaired surgically, were divided into two groups: group I, 25 patients with left atrial reduction and mitral surgery, and group II, 25 patients with isolated valve surgery. The characteristics of both groups were considered homogeneous in the preoperative assessment.After a mean follow-up of 31 months, 46% of the patients in group I versus 18% in group II regained sinus rhythm (p = 0.06). Atrial remodeling with shrinkage occurred in patients who recovered sinus rhythm, with larger changes in group II (-10.8% left atrial volume reduction in group I compared to -21.5% in group II; p0.05). The atrium became enlarged again in patients whose atrial fibrillation did not remit (+16.8% left atrial volume increase in group I versus +8.4% in group II; p0.05).Mitral surgery produces a postoperative decrease in atrial volume, especially when reduction techniques are used. Late left atrial remodeling was influenced by the type of atrial rhythm and postoperative surgical volume.

Objective: Increased left ventricular mass index has been associated with higher mortality. We analyze the effect of increased left ventricular mass index on outcomes in patients undergoing aortic valve replacement. Methods: Echocardiographic left ventricular dimensions were used to calculate left ventricular mass index in 614 patients who underwent aortic valve replacement between June 1993 and November 2001. Left ventricular mass index was considered increased if higher than the value of the superior decile (277 g/m 2 in males and 251 in females). Results: Mean left ventricular mass index was: 178 ^ 111 g/m 2 , and increased index was considered in 9.9% of patients. Postoperative complications (low cardiac output syndrome, respiratory failure, arrhythmias, pneumonia and mediastinitis), median length of hospital stay: 12 days (6‐ 57) versus 11 days (5 ‐ 51), and in-hospital mortality (11.4, 3.2%, P , 0:01) were higher in patients with increased left ventricular mass index. Multivariable analysis identified increased left ventricular mass index (odds ratio: 5.6; 95% confidence interval: 1.2 ‐ 25.0; P ¼ 0:02) and other three variables: age (P ¼ 0:04), history of chronic renal failure (P ¼ 0:03) and cardiopulmonary bypass time (P ¼ 0:004), as independent predictors of early mortality. Conclusions: Increased left ventricular mass index is associated with an inhospital adverse outcome and a significantly higher in-hospital mortality in patients undergoing aortic valve replacement. Outcomes in asymptomatic patients could be improved before a clinically significant increase in left ventricular mass index. Further studies should be performed to determine the usefulness of this index in selecting patients for earlier aortic valve replacement. q 2003 Elsevier Science B.V. All rights reserved.

Atrial fibrillation is frequent in surgical patients with cardiac valvulopathies. Radiofrequency energy applied by means of surgical probes permits the reproduction of atriotomies described in the maze surgical procedure for the ablation of atrial fibrillation in a fast, safe and efficient way. This study presents our initial experience in treatment of chronic atrial fibrillation through radiofrequency performed in patients with surgical cardiac valvulopathies.From June to November 2000, 10 patients, with surgical indications of valvulopathy, were intraoperatively treated through radiofrequency for its atrial fibrillation. Ablations were performed in the right auricle from the epicardium before starting extra corporeal circulation, and in the left auricle from the endocardium, while under circulation. Radiofrequency was applied through a surgical multielectrode probe.Eight patients (80%) presented some type of postoperative arrhythmia, with relapse of paroxysmal fibrillation in 3 patients and flutter in another one. At discharge, none of the patients presented relapse of chronic atrial fibrillation. There was no in-hospital mortality. After a mean follow-up of 3 months (range 1-6), 8 patients (80%) have recovered and maintained sinus rhythm. Only one patient has re-established echocardiographic biatrial contraction.Intraoperative radiofrequency has allowed us to perform the auricular lesions, in both auricles, in a simple way, with an initial effectiveness of 80%. Epicardial ablation of the right auricle was simple and safe. Although no patient presented relapse of chronic atrial fibrillation at hospital discharge, postoperative arrhythmias have continued to be the main postsurgical problem.

A 40-year-old male with a history of i.v. drug abuse was referred to our hospital because of dyspnoea. He had a history of pulmonary valve replacement for native valve endocarditis in 2001 and pulmonary homograft was implanted 2 years later because prosthetic endocarditis. The patient complained of dyspnoea on moderate exertion ( New York Heart …