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Resumen: De acuerdo con los últimos estudios, la tasa de intervención quirúrgica de la válvula tricúspide es muy baja, pese al gran número de pacientes con insuficiencia tricuspídea severa con indicación de cirugía, según las guías de práctica clínica. Asimismo, datos recientes demuestran que la cirugía aislada de la válvula tricúspide se asocia de manera significativa e independiente con una elevada mortalidad. Las nuevas terapias transcatéter surgen para dar solución a estos problemas. En el presente trabajo, se realiza una revisión no sistemática del estado del arte de los diferentes dispositivos percutáneos existentes en el mercado, organizados en tres grupos: válvula con implante en posición ortotópica o heterotópica, sistemas de anuloplastia y sistemas de coaptación. Así, este documento pretende ofrecer una visión global sobre el panorama actual y las perspectivas futuras del tratamiento endovascular de la enfermedad valvular tricuspídea, un campo de gran interés en plena expansión. Abstract: According to the latest studies, the surgical intervention rate of the tricuspid valve is very low, despite the large number of patients with severe tricuspid regurgitation withindication for surgery according to clinical practice guidelines. Likewise, recent data demonstrate that isolated tricuspid valve surgery is significantly and independently associated withhigh mortality. New transcatheter therapies are emerging to solve these issues. In the present work, a non-systematic review of the state of the art of the different percutaneous devices currently on the market was carried out, organized into three groups: valve with implant in orthotopic or heterotopic position, annuloplasty systems and coaptation systems. Thus, this document aims to offer a global vision of the current landscape and future perspectives of endovascular treatments of tricuspid valve disease, a field of great interest in full expansion.

Resumen: Presentamos el caso de una mujer de 26 años con síndrome antifosfolípido primario y trombosis valvular obstructiva de prótesis mecánica en posición mitral que requirió una reintervención quirúrgica urgente. Abstract: We report a case of a 26 years old female with primary antiphospholipid syndrome and obstructive valvular thrombosis of mechanical prothesis in mitral position that required urgent surgical reintervention. Palabras clave: Síndrome antifosfolípido, Prótesis valvular cardíaca, Trombosis, Keywords: Antiphospholipid syndrome, Heart valve prosthesis, Thrombosis

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

Long-term real-world outcomes are critical for informing decisions about biological (Bio) or mechanical (Mech) prostheses for aortic valve replacement, particularly in patients aged between 50 and 65 years. The objective was to compare long-term survival and major adverse cardiac and cardiovascular events (ie, stroke, reoperation, and major bleeding) within this population.This was a multicenter observational study including all patients aged between 50 and 65 years who underwent an aortic valve replacement because of severe isolated aortic stenosis between the years 2000 and 2018. A total of 5215 patients from 27 Spanish hospitals were registered with a follow-up of 15 years. Multivariable analyses, including a 2:1 propensity score matching (1822 Mech and 911 Bio) and competing risks analyses were applied.Bio prostheses were implanted in 19% of patients (n = 992). No significant differences were observed between matched groups in long-term survival (hazard ratio [HR], 1.14; 95% confidence interval [CI], 0.88-1.47; P = .33). Stroke rates were higher for Mech prostheses, but not significant (HR, 0.72; 95% CI, 0.50-1.03; P = .07). Finally, higher rates of major bleeding were found in the Mech group (HR, 0.65; 95% CI, 0.49-0.87; P = .004), whereas reoperation was more frequent among the Bio group (HR, 3.04; 95% CI, 1.80-5.14; P .001). Bio prostheses increased from 13% in the period from 2000 to 2008 to 24% in 2009 to 2018.Long-term survival was comparable among groups in patients between 50 and 65 years of age. Mech prostheses were associated with a higher risk of major bleeding, whereas Bio prostheses entailed higher reoperation rates. Bio prostheses seem a reasonable choice for patients between 50 and 65 years in Spain.