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Resumen: Introducción y objetivos: La cirugía valvular tricúspide aislada (QxVT) es una intervención infrecuente, considerándose un procedimiento con elevada mortalidad y evolución a medio plazo desconocida. El objetivo del presente estudio es analizar la supervivencia a medio plazo de la población intervenida de QxVT aislada, determinar los factores que influyen en la supervivencia hospitalaria y a medio plazo y la capacidad predictiva de escalas de riesgo quirúrgico habituales. Métodos: Estudio observacional, unicéntrico y retrospectivo de pacientes intervenidos de QxVT aislada desde el año 2012 hasta enero del 2020. Mediante regresión logística se analizaron factores relacionados con la mortalidad hospitalaria, y la supervivencia tardía con el método de Kaplan-Meier. Resultados: Fueron intervenidos 51 pacientes (18 anuloplastias y 33 recambios por prótesis).El 62,75% fueron mujeres, con edad media de 66,07 años (DE 10,57). El 54% se encontraban en clase funcional III-IV de la NYHA.La mortalidad hospitalaria observada fue del 7,8%. Los factores más influyentes en la mortalidad perioperatoria fueron la clase funcional III/IV de la NYHA (mortalidad del 0% vs. 14,3%; p Fisher = 0,13) y la anemia (OR: 11,1; IC 95%: 1,04-118,6; p = 0,046).Se realizó seguimiento completo del 94,1%, con mediana de seguimiento de 26 meses. La supervivencia global fue del 90,1%, 84,3%, 80,2%, 75,2% a 1, 2, 3 y 4 años. Al último seguimiento, el 75% de los supervivientes se encontraban en clase funcional I-II de la NYHA. Conclusiones: La clase funcional preoperatoria y la anemia son factores determinantes en la supervivencia en el postoperatorio inmediato. La supervivencia a medio plazo y la mejoría de clase funcional tras QxVT aislada son satisfactorias. Abstract: Introduction and objectives: Isolated tricuspid valve surgery (TVS) is an infrequent procedure, and it is considered that it entails a high surgical mortality. The objective is to analyze the medium-term survival, and to determine the variables that impact perioperative and medium-term survival. The predictive accuracy of the usual surgical risk scores was also evaluated. Methods: Unicentric, observational retrospective study, which included all the patients operated on isolated TVS since 2012 to January 2020. Perioperative mortality was analyzed through logistic regression, and long-term survival was analyzed using the Kaplan-Meier survival curves. Results: 51 patients were operated on isolated TVS (18 annuloplasties and 33 replacements for prosthetic valves).The study population consisted of a 62.75% of female, with a mean age of 66.07 years (SD 10.57). In the 54% of the cases, the patient was in NYHA functional class of III-IV.Observed in-hospital mortality was 7.8%. The variables with a strongest association with perioperative mortality were a NYHA functional class of III-IV (0% vs 14.3% mortality; p Fisher = 0.13) and preoperative anemia (OR: 11.1; CI 95%: 1.04-118.6; p = 0.046).Complete clinical follow-up was achieved in the 94.1% of the study population, with a median follow-up of 26 months (interquartile interval 12-57 months). Overall survival was 90.1%, 84.3%, 80.2%, 75.2% at 1, 2, 3 and 4 years. In the final follow-up, 75% of the patients were in NYHA functional class I-II. Conclusions: Preoperative NYHA functional class and preoperative anemia are determining factors for early postoperative survival. Medium-term survival and NYHA improvement after isolated TVS are satisfactory.

Resumen Introduccion El grado de fragilidad puede influir mas que la edad o la gravedad en el pronostico de pacientes mayores de 70 anos intervenidos de cirugia del aparato digestivo que precisan control postoperatorio inmediato en UCI. Metodos Estudio prospectivo y observacional de pacientes mayores de 70 anos que ingresaron en UCI quirurgica de un hospital de tercer nivel inmediatamente despues de una intervencion quirurgica electiva o urgente sobre el aparato digestivo desde el 1 de junio de 2018 hasta el 1 de junio de 2019. Se registraron al ingreso las variables edad, fragilidad (Clinical Frailty Scale, CFS, y Modified Frailty Index, mFI), gravedad (APACHE II), tipo de cirugia y entidad quirurgica. Se realizo un analisis bivariante para evaluar la influencia de la fragilidad y gravedad en la morbimortalidad hospitalaria y situacion basal del paciente (en cuanto a dependencia) a 6 meses. Resultados Fueron seleccionados 90 pacientes, de los que el 54,4% fueron reintervenidos; el 74,4% fueron dados de alta inicialmente en UCI, con un reingreso del 28,4% y con relacion directa con la fragilidad (CFS y mFI: p Conclusiones La estimacion de la fragilidad mediante CSF y mFI tiene relacion directa con la morbilidad quirurgica y el reingreso de pacientes graves de edad avanzada ingresados en UCI. Ademas, CFS y mFI han resultado eficientes como predictores de mortalidad a los 6 meses.

Frailty degree can influence more than age or severity in the outcome of patients older than 70 years undergoing surgery of the digestive system that require immediate postoperative control in the ICU.A prospective and observational study of patients over 70 years of age who were admitted to the surgical ICU of a third level hospital immediately after an elective or emergent surgical intervention on the digestive system from June 1, 2018 until June 1, 2019. The variables age, frailty Clinical Frailty Scale (CFS), and modified Frailty Index (mFI), severity (APACHE II), type of surgery, surgical pathology were recorded upon admission. A bivariate analysis was performed to assess the influence of frailty and severity on hospital morbidity and mortality and baseline situation of the patient (in terms of dependence) at 6 months.A total of 90 patients were recruited, 54.4% of whom were reoperated; 74.4% were initially discharged from the ICU, with 28.4% of readmission and directly associated to frailty (CFS and mFI: P0.01). The overall mortality at 6 months was 44.5% being CFS (OR = 64.3; P0.05, 95% CI: 12.3-333.9) and APACHE II (OR = 1.17; P0.05; 95% CI: 1.04-1.32) the covariates that best related.The estimation of frailty by CSF and mFI is directly associated to the surgical morbidity and readmission of elderly and severe patients admitted to the ICU. In addition, CFS and mFI has been efficient as a predictive of mortality at 6 months.

Background During the last years, the concept of frailty has become increasingly familiar in many surgical specialties, including cardiac surgery. One of the main characteristics of frailty is its potentially reversible nature. With the aim of reducing the incidence of complications after surgery, efforts are being made to preoperatively decrease the level of frailty, however, the effect that the surgery itself may have in the postoperative frailty status is still unknown. Methods A prospective cohort of 137 patients aged 70 or more undergoing cardiac surgery with the use of cardiopulmonary bypass were recruited at three university-affiliated hospitals in Spain. Frailty status was assessed preoperatively and six months after surgery using two different validated frailty measurements: The Fried frailty scale and the Clinical Frailty Scale. We analyzed the changes in these frailty scores and the transitions between frailty status after surgery. Results Prevalence of frailty was 27.5% with the Fried Frailty Scale and 11% with the Clinical Frailty Scale. Even though frail patients presented a higher incidence of postoperative major complications than their robust counterparts, up to 50% of frail patients improved their frailty status after surgery. The distribution of frailty groups at baseline and six months after surgery changed significantly, decreasing the overall burden of frailty after surgery. Besides, robust patients showed a slightly worsening of their previous frailty scores. Conclusions Frailty is a multifactorial and dynamic condition that can be significantly reduced after cardiac surgery, suggesting that cardiac pathology is an important contributor to the preoperative patient’s frailty status.

Resumen: La radioterapia mediastínica es uno de los tratamientos fundamentales de las enfermedades malignas torácicas, pero también representa una causa potencial de complicaciones, tanto a corto como a largo plazo. Se presenta una serie de casos de rotura de vena innominada durante esternotomía media en pacientes con fibrosis mediastínica. Los tres casos descritos corresponden a pacientes intervenidos de cirugía cardiaca con antecedentes de radioterapia mediastínica, entre 15-30 años antes de la cirugía, por tres diferentes enfermedades malignas (linfoma de Hodgkin, timoma y cáncer de mama). En los tres casos se reporta rotura de la vena innominada, con desinserción de su origen en la vena cava superior debido a fibrosis mediastínica intensa. Abstract: Although mediastinal radiotherapy is one of the basic treatments of malignant thoracic diseases, it is also a potential cause of short and long-term complications. A series of cases of rupture of the innominate vein during sternotomy are presented in patients with mediastinal fibrosis. The three cases described correspond to patients intervened by cardiac surgery, with a history of mediastinal radiotherapy between 15 to 30 years before the surgery, due to three different malignant diseases (Hodgkin lymphoma, thymoma, and breast cancer). In the three cases, a rupture of the innominate vein is reported; with de-insertion of its origin in the superior vena cava sue to intense mediastinal fibrosis. Palabras clave: Fibrosis mediastínica post-irradiación, Cirugía cardiovascular, Rotura de la vena innominada, Keywords: Post-radiation mediastinal fibrosis, Cardiovascular surgery, Rupture of innominate vein

Objectives Cardiac surgery is a life-saving procedure in patients diagnosed with infective endocarditis (IE). There are several validated risk scores developed to predict early-mortality; nevertheless, long-term survival has been less investigated. The aim of the present study is to analyze the impact of IE-specific risk factors for early and long-term mortality. Methods An observational retrospective study was conducted that included all patients who underwent surgery for IE from 2002 to 2016. Median follow-up time after surgery was 53.2 months (IQI 26.2–106.8 months). In-hospital mortality was analyzed using multiple logistic regression. Long-term survival was analyzed after one, two and five years. Cox proportional hazards regression was employed to identify risk factors related to long-term mortality. Results Of the 180 patients underwent cardiac surgery, 133 were discharged alive (in-hospital mortality was 26.11%). 6 variables were identified as independent factors associated with in-hospital mortality, most of them closely related to the severity of IE: age, multivalvular involvement, critical preoperative status, preoperative mechanical ventilation, abscess and thrombocytopenia. Long-term survival in patients discharged alive was 89.1%, 87.4% and 77.6% after one, two and five years. Long-term mortality was independent of specific IE factors and 86.51% of deaths were not related to cardiovascular or infectious diseases. Conclusion Despite the high perioperative mortality rate after surgical treatment for active IE, long-term survival after hospital discharge was acceptable, regardless of the severity of the endocarditis episode. Although in-hospital survival depended mainly on several IE factors, long-term survival was not related to the severity of endocarditis baseline affection.

Background Frailty has emerged as one of the main predictors of worse outcomes after cardiac surgery, but scarce evidence is available about its influence on postoperative quality of life. Whether frail patients may improve their quality of life or not after the surgical procedure is a matter that still remains unclear. Methods This observational and multicenter cohort study was conducted in 3 university-affiliated hospitals of three different regions of Spain (Madrid, Asturias, and Canary Islands). Patients were categorized into three ordinal levels of frailty (frail, prefrail, robust) using the Fried, FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale, and Clinical Frailty Scale frailty scales. We analyzed the changes on health-related quality-of-life for each level of frailty using the EuroQoL 5-Dimension 5 Level questionnaire before and 6 months after the operation. Results The study included 137 patients, and 109 completed the 6-month follow-up. Median age of the entire cohort was 78 years (interquartile interval, 72 to 83 years). Frailty prevalence varied between 10% and 29%, depending on which scale was used. There was a statistically significant linear trend in the incidence of death or major morbidity among the different levels of frailty. On one hand, robust patients did not show significant changes in their previously high score of quality of life during follow-up. On the other hand, frail and prefrail patients significantly improved their scores after the operation. These results were comparable regardless the scale used for frailty assessment. Conclusions Frail and prefrail patients have a significant improvement in their quality of life 6 months after their cardiac operation, and they have a proportionally greater increase in their postoperative health-related quality of life scores than robust patients.

La perforación tardía de miocardio (PTMI) secundaria a un dispositivo electrónico intracardiaco (DEI), es una complicación poco frecuente pero que puede ser mortal.

Resumen: Introducción: La trombocitopenia preoperatoria se ha relacionado con un peor pronóstico en la endocarditis infecciosa. Objetivo: Valorar la influencia de la trombocitopenia en la cirugía de la endocarditis infecciosa en nuestra serie. Métodos: Análisis retrospectivo unicéntrico de los pacientes intervenidos por endocarditis infecciosa entre 2002 y 2016. Análisis de supervivencia a corto y a largo plazo, estratificado en función de la presencia de trombocitopenia (recuento plaquetario

Resumen: Introducción: La vancomicina tópica ha demostrado su eficacia para disminuir la incidencia de infección de la herida quirúrgica, sin embargo, su utilidad en cirugía cardiaca permanece en duda. Objetivos: Estudiar el efecto de la vancomicina tópica sobre la incidencia de infección de la herida de esternotomía tras cirugía cardiaca. Material y método: Estudio observacional, retrospectivo, comparando la incidencia de infección de esternotomía entre una cohorte en la que se empleó la profilaxis antibiótica habitual, frente a otra en la que además se asoció vancomicina tópica. Resultados: Se incluyeron un total de 525 pacientes, 47,43% en el grupo tratado con vancomicina. La incidencia global de infección fue significativamente superior en el grupo sin vancomicina (3,6% frente a 10,1%) implicando un riesgo relativo de 2,8 (IC 95% 1,35-5,83; p = 0,004). Las diferencias fueron significativas en la incidencia de infecciones superficial y profunda (p = 0,05), sin alcanzar la significación estadística en la infección órgano-espacio (p = 0,22). El efecto beneficioso de la vancomicina se mantuvo en un modelo de regresión ajustado por los posibles factores de confusión identificados (tabaquismo, reintervención, nefropatía y grado NYHA): odss ratio 3,48 (IC 95% 1,44-8,41; p = 0,006). Los gramnegativos fueron el principal agente causal en el grupo con vancomicina (57,1%) y los grampositivos en el grupo sin vancomicina (66,7%), aunque estas diferencias no alcanzaron la significación estadística. Conclusión: El empleo de vancomicina tópica disminuye la incidencia de infección de la herida de esternotomía, tanto superficial como profunda. Su uso podría producir un cambio en el espectro etiológico de la infección esternal. Abstract: Introduction: Topical vancomycin has demonstrated effectiveness in decreasing the incidence of surgical wound infection; however, its usefulness in cardiac surgery remains in doubt. Objectives: To analyse the effectiveness of topical vancomycin in the reduction of sternal wound infection in cardiac surgery. Material and method: A retrospective observational study was conducted to compare the incidence of sternotomy infection in a cohort in which the usual antibiotic prophylaxis was used, with another cohort in which topical vancomycin was also used. Results: A total of 525 patients were included in the study, with 47.43% in the group treated with vancomycin. The incidence of infection was significantly higher in the group without vancomycin (3.6% versus 10.1%), implying a relative risk of infection of 2.8 (95% CI; 1.35-5.83, p = .0035). The differences were statistically significant as regards the incidence of superficial and deep infections (p = .05), but did not reach statistical significance in organ-space infection (p = .22). The beneficial effect of vancomycin was maintained in a logistic regression model adjusted for possible confounding factors (smoking, re-operation, nephropathy, and NYHA functional grade class): odss ratio 3.48 (95% CI; 1.44-8.41, p = .006). Gramnegative microorganisms were the main causative agent in the vancomycin group (57.1%), whereas it was grampositive in the group without vancomycin (66.70%), although these differences did not reach statistical significance. Conclusion: The use of topical vancomycin decreases the incidence of superficial and deep sternotomy wound infections. Its use could lead to a change in the aetiological spectrum of sternal wound infection. Palabras clave: Infección herida quirúrgica, Vancomicina, Esternotomía media, Profilaxis antibiótica, Antibioterapia tópica, Keywords: Surgical site infection, Vancomycin, Median sternotomy, Antibiotic prophylaxis, Topical antibiotic therapy

Resumen: Recientemente, se ha publicado en la Revista Española de Cardiología un Documento de Consenso sobre el manejo del tratamiento antitrombótico en el paciente quirúrgico, fruto de la colaboración de varias de las sociedades de especialidades implicadas en el manejo de este tipo de pacientes, entre ellas la SECTCV. En esta revisión, se intenta tanto comentar este documento como ampliarlo con puntualizaciones, centrándolo en nuestra especialidad.Para ello, además de seguir las recomendaciones aportadas en la citada publicación, se añaden las presentes en las guías clínicas de medicación perioperatoria elaboradas por la European Association for Cardio-Thoracic Surgery en 2017.El paciente con tratamiento antitrombótico (tanto anticoagulante como antiagregante) es una entidad común en el contexto de la cirugía cardíaca, por lo que estas pautas son de aplicación frecuente en la práctica diaria. No obstante, cada caso debe someterse a una evaluación individualizada, teniendo en cuenta tanto el riesgo hemorrágico como trombótico, según las características del paciente o de la intervención a realizar, a la hora de tomar las decisiones. Abstract: A Consensus Document has recently been published in the Spanish Journal of Cardiology (Revista Española de Cardiología) on the management of antithrombotic treatment in the surgical patient. This has been prepared with the collaboration of several societies of the specialties involved in the management of this type of patient, among them the Spanish Society of Thoracic-Cardiovascular Surgery (SECTCV). In this review, it is intended to comment on this Document, as well as to amplify it with some points, focusing them on our speciality.For this, besides following the recommendations provided in the aforementioned publication, the present ones are added in the clinical guides for peri-operative medication prepared by the European Association for Cardio-Thoracic Surgery in 2017.The patient on antithrombotic treatment (both anticoagulant as well as anti-platelet) is a common entity in the cardiac surgery context, so these recommendations are frequently applied in daily practice. However, each case must be subjected to an individualised assessment, taking into account the haemorrhagic, as well as the thrombotic risk, depending on the patient characteristics or the intervention to be performed, when making decisions. Palabras clave: Tratamiento antitrombótico, Antiagregante, Anticoagulante, Manejo perioperatorio, Keywords: Antithrombotic treatment, Anti-platelet, Anticoagulant, Perioperative management

Resumen La radioterapia mediastínica es uno de los tratamientos fundamentales de las enfermedades malignas torácicas, pero también representa una causa potencial de complicaciones, tanto a corto como a largo plazo. Se presenta una serie de casos de rotura de vena innominada durante esternotomía media en pacientes con fibrosis mediastínica. Los tres casos descritos corresponden a pacientes intervenidos de cirugía cardiaca con antecedentes de radioterapia mediastínica, entre 15-30 años antes de la cirugía, por tres diferentes enfermedades malignas (linfoma de Hodgkin, timoma y cáncer de mama). En los tres casos se reporta rotura de la vena innominada, con desinserción de su origen en la vena cava superior debido a fibrosis mediastínica intensa. Abstract Although mediastinal radiotherapy is one of the basic treatments of malignant thoracic diseases, it is also a potential cause of short and long-term complications. A series of cases of rupture of the innominate vein during sternotomy are presented in patients with mediastinal fibrosis. The three cases described correspond to patients intervened by cardiac surgery, with a history of mediastinal radiotherapy between 15 to 30 years before the surgery, due to three different malignant diseases (Hodgkin lymphoma, thymoma, and breast cancer). In the three cases, a rupture of the innominate vein is reported; with de-insertion of its origin in the superior vena cava sue to intense mediastinal fibrosis.

Resumen: Introducción: La cirugía de sustitución valvular tricúspide (SVT) aislada es una intervención poco frecuente, con una indicación controvertida, en gran parte debido a su mal pronóstico. Material y métodos: Se analizaron todos los pacientes intervenidos de SVT aislada entre los años 2003 y 2014. Se analizó: a) Mortalidad perioperatoria y a largo plazo; y b) Aparición de complicaciones relacionadas con las prótesis tricúspides a largo plazo (trombosis y degeneración protésica). Resultados: Durante el periodo de estudio se realizaron 40 intervenciones de SVT aislada. El 82,5% de los pacientes se encontraban en clase funcional iii/iv de la NYHA, y el 70% tenían hipertensión pulmonar al menos moderada (presión sistólica arterial pulmonar > 40 mmHg). La mortalidad perioperatoria fue del 25%, infraestimada por EuroSCORE I (mortalidad estimada del 13,89%). La anemia preoperatoria (OR: 0,52; IC 95%: 0,30-0,89; p = 0,017) se asoció con una mayor mortalidad perioperatoria. La reintervención se asoció con una tendencia a una mayor mortalidad perioperatoria (p = 0,081). La supervivencia tardía, tras 44 meses de seguimiento mediano, fue del 57,50%. Los factores significativamente asociados con una peor supervivencia en el seguimiento fueron: 1) Hipertensión pulmonar severa (OR: 5,77; IC 95%: 1,06-31,26; p = 0,042) y 2) Clase funcional iv (OR: 8,31; IC 95%: 1,48-49,06; p = 0,004). Los pacientes intervenidos en clase funcional iv de la NYHA presentaron una escasa supervivencia a largo plazo (12,5% de supervivencia al año; log rank p = 0,004). Conclusiones: La SVT aislada se asocia con una alta mortalidad, debido a la indicación de la intervención en avanzados estados de cardiopatía.La indicación de cirugía ha de hacerse de manera precoz, antes del deterioro de la función ventricular derecha o de la aparición de hipertensión pulmonar severa. La cirugía en clase funcional NYHA iv supone un escaso beneficio en términos de supervivencia tardía. Abstract: Background: Isolated tricuspid valve replacement (TVR) is a rarely performed procedure, with controversial indications for performing surgery, mostly due to the poor outcomes reported. Material and methods: All patients undergoing isolated TVR between 2003 and 2014 were included. We analyzed: a) Perioperative mortality and long-term mortality; b) Prosthetic valves related complications during follow-up (thrombosis and biological valve deterioration). Results: A total of 40 patients underwent isolated TVR during the study period. 82.5% of these patients where in III-IV/IV NYHA functional class, and 70% of them had at least moderate pulmonary hypertension (mean PAP > 40 mmHg). Perioperative mortality was 25%. The EuroSCORE I underestimated the mortality associated to this procedure (estimated mortality of 13.89%). Preoperative anemia (OR: 0.52; CI 95%: 0.30-0.89; P = .017) was associated to a higher perioperative mortality. There was a trend towards a higher mortality in patients with previous cardiac surgery (P = .081). Late survival, after 44 months of median follow-up, was 57.50%. Long-term survival was influenced by: 1) Severe pulmonary hypertension (OR: 5,77; CI: 95%: 1.06-31.26; P = .042); 2) NYHA class IV (OR: 8.31; CI: 95%: 1.48-49.06; P = .004). Patients who were operated in NYHA IV had a poor long-term survival (12.5% of one-year survival, log Rank P = .004). Conclusions: Isolated TVR is associated to a high mortality, mostly due to surgery timing, when the patient is already in an advanced heart failure situation.Indication for surgery must be done promptly, before the right ventricle function deterioration or the development of severe pulmonary hypertension. Performing surgery when the patient is in IV NYHA functional class, provides scarce benefit regarding long-term survival. Palabras clave: Valvulopatía, Insuficiencia tricúspide, Sustitución valvular tricúspide, Cirugía tricúspide aislada, Keywords: Valvular heart disease, Tricuspid tegurgitation, Tricuspid valve replacement, Isolated tricuspid surgery

OBJECTIVES We assessed the prognostic utility of risk scores in surgery for infective endocarditis (IE) to evaluate their reliability in mortality risk prediction. METHODS An observational retrospective study was developed to include all patients who underwent surgery for active IE from 2002 to 2016. Classical and endocarditis-specific risk scores were calculated. RESULTS A total of 180 patients were included in the study. The 30-day mortality rate was 26.82% [95% confidence interval (CI) 20.26-33.20%]. Classical risk scores were confirmed to have a suboptimal prognostic ability. Therefore, 4 IE-specific risk scores were calculated. Discrimination was evaluated using the area under the receiver operating characteristic curve. It was 0.76 (95% CI 0.68-0.82) for the Society of Thoracic Surgeons-IE (STS-IE) score; 0.68 (95% CI 0.58-0.76) for the De Feo-Cotrufo score; 0.73 (95% CI 0.66-0.79) for the PALSUSE score and 0.65 (95% CI 0.57-0.72) for the Costa score. The STS-IE score had higher discrimination when compared with the De Feo-Cotrufo score (P = 0.055) and the Costa score (P = 0.024); however, there was no significant difference when we compared the STS-IE score with the PALSUSE score (P = 0.58). Calibration was assessed using the Hosmer-Lemeshow test; an adequate calibration was confirmed in all 4 scores. CONCLUSIONS Specific risk scores had better prognostic performance than classical risk scores. The STS-IE score had the highest discrimination and was adequately calibrated. The PALSUSE score also showed optimal discrimination and calibration. The De Feo-Cotrufo score had a lower discrimination in our sample; however, the De Feo-Cotrufo score is recommended in the current guidelines. The Costa score had the lowest discrimination.

Background Previous studies have analyzed the efficacy of crystalloid cardioplegic solutions, but the use of Celsior (Genzyme Corp, Boston, MA) as a crystalloid cardioplegic solution has not been evaluated. Methods In this observational retrospective study, Celsior crystalloid solution was compared with an all-blood continuous myocardial protection (microplegia). The study included all patients who underwent elective aortic valve replacement operations in whom the myocardial protection was Celsior or microplegia. The primary end points were surrogates of myocardial protection and death at 30 days. The secondary end point was the safety analysis of the use of Celsior. Results The study included 631 patients, divided in two groups: 219 (34.7%) with microplegia and 412 (65.3%) with Celsior. Troponin T release accurately predicted postoperative death (area under the receiver operating characteristic curve = 0.85). Troponin T increased with the duration of clamp time, and the adjusted time-related increase was lower in the Celsior group. There were no statistically significant differences in the postoperative use of inotropic medication or intraaortic balloon pump. Adjusted postoperative death was lower in Celsior group (odds ratio, 0.33; 95% confidence interval, 0.15 to 0.76). There were no allergic reactions attributed to Celsior and no unexpected toxicity with the use of Celsior (coagulopathy, renal dysfunction, liver dysfunction, or encephalopathy). Conclusions Isolated crystalloid Celsior may be an optimal and safe myocardial protection strategy in aortic valve replacement operations.

The original version of this article unfortunately contained a mistake.

A 59-year-old man with a pacemaker who was admitted for evaluation of fever was found to have a redundant loop of the ventricular lead and a vegetation attached to it. An FDG PET/CT revealed a focus of FDG uptake at the ventricular lead loop. Surgical extraction of the pacemaker device confirmed a Propionibacterium acnes pacemaker endocarditis. We hypothesize that the redundant loop of the ventricular lead induced a chronic mechanical stress both to the tricuspid valve and to the lead itself, facilitating the bacterial colonization of the lead.

There is a lack of consensus about which endocarditis-specific preoperative characteristics have an actual impact over postoperative mortality. Our objective was the identification and quantification of these factors. We performed a systematic review of all the studies which reported factors related to in-hospital mortality after surgery for acute infective endocarditis, conducted according to PRISMA recommendations. A search string was constructed and applied on three different databases. Two investigators independently reviewed the retrieved references. Quality assessment was performed for identification of potential biases. All the variables that were included in at least two validated risk scores were meta-analyzed independently, and the pooled estimates were expressed as odds ratios (OR) with their confidence intervals (CI). The final sample consisted on 16 studies, comprising a total of 7484 patients. The overall pooled OR were statistically significant (p

Background: We analyzed the adequacy of the myocardial protection achieved with a single dose of retrograde crystalloid Celsior®, compared with an accepted standard (microplegia), in on-pump coronary artery bypass grafting surgery (CABG). Methods: This was a retrospective comparative clinical study conducted in a single institution that included all the patients operated on who had elective isolated on-pump CABG, from March 2006 to June 2014. We evaluated maximum postoperative troponin T (TnT) as a marker of myocardial damage, adjusted for possible confounders using propensity score matching. We also analyzed markers of recovery of myocardial function, and the safety of the intravenous use of Celsior®. Results: During the study period, 261 patients were included, divided in two groups: (a) continuous retrograde blood-based microplegia (114 patients); (b) retrograde single-dose crystalloid Celsior® (147 patients). The propensity score adjusted maximum TnT was significantly lower in the Celsior group [average treatment effect = −0.55 ng/dl; 95% confidence interval (CI) −1.10 to −0.1 ng/dl; p = 0.048]. There were no differences in the postoperative use of intra-aortic balloon of counterpulsation or in the requirements of high-dose inotropic medications. In-hospital mortality was equivalent in both study groups ( p = 0.73); surgical re-exploration because of bleeding was equivalent ( p = 0.37). There were no differences in prolonged mechanical ventilation ( p = 0.65) and intensive care unit length of stay ( p = 0.87). Conclusion: An isolated single dose of retrograde Celsior® may be an effective and safe myocardial protection strategy in on-pump CABG.

Background The optimal management of patients with multivessel coronary artery disease (MVD) admitted with STEMI is under debate. CABG is rarely performed, even on ideal candidates. A provisional PCI without stent implantation may allow complete surgical revascularization (CSR) in a subset of patient that we sought to identify in this study. Methods Patients with STEMI from April 2014 to October 2016 were evaluated and those with a TIMI flow 70% in an epicardial vessel or sidebranch >2.5 mm were selected. Epidemiological variables, surgical risk scores and SYNTAX and SYNTAX II scores were analyzed. All the selected patients were discussed in a post hoc heart-team, and predictors of 12-month events were also analyzed. Results Seventy-two (19.0%) accomplished MVD criteria. Mean SYNTAX was 19 ± 13 points and SYNTAX II score recommended CABG in 12 patients (16.7%) and heart-team discussion in 60 (83.3%). All patients were discussed in a post hoc heart-team, which concluded that 21 (29.2%) patients could have been good candidates for CSR. After one year follow-up, SYNTAX II PCI > 40 was found to be the sole independent predictor for 12-month events (OR 12.9 [2.7–62.1], p = 0.001). Conclusions MVD and STEMI with a SYNTAX II PCI > 40 should be discussed in an ad-hoc heart team, after a provisional revascularization of the culprit vessel, and should be considered for CSR, especially when the RCA is the culprit artery and there is a complex disease in the left coronary artery.

Cardiac surgery induces geometrical and functional changes, which are not clearly explained. Objective: to investigate the physiopathology of the heart after cardiac surgery using advanced techniques of echocardiography. Thirty patients undergoing cardiac surgery had echocardiographic study prior and after surgery. Left and right ventricular (RV) longitudinal displacement and strain were studied with speckle-tracking. Using longitudinal displacement, we defined a static longitudinal reference-point (sLRP) to which the other segments moved during systole. Transversal displacement and global function were determined by conventional-echo. Left and RV segments showed systolic longitudinal displacement towards the apex, which was the sLRP before surgery; and towards the medium segment of lateral RV-wall one week after surgery. The displacement of basal RV segment towards this sLRP was smaller, causing decreased TAPSE. Apical segments showed an inverse displacement towards the new sLRP, and septum displacement was decreased or inverted towards the lateral RV-wall, causing paradoxus septal motion. RV-wall longitudinal strain was reduced (− 23.1 ± 8.6 vs. − 14.6 ± 5.3;p

We describe a simple technique for the accurate adjustment of polytetrafluoroethylene neochordae length in degenerative mitral regurgitation using the annuloplasty ring's own suture as a reference instead of using sophisticated or less precise maneuvers. Two threads of the annuloplasty ring suture are placed at the level of the mitral valve annulus plane to be used as a reference to tie the neochordae.

La esternotomia media continua siendo el gold-standart de abordaje quirurgico en cirugia cardiaca. Aun realizada correctamente, laapertura media del esternon presenta complicaciones en el 1-5% de los casos que varian en su gravedad desde la infeccion de la heridaquirurgica a la lesion de estructuras intratoracicas. En el presente estudio se describe un caso de rotura de electrodos de marcapasostras esternotomia media por retraccion y fibrosis del tronco venoso braquiocefalico. Debido a la ausencia de articulos semejantes enla literatura y al extendido empleo de la esternotomia en pacientes portadores de marcapasos permanente, se pretende disminuirlas lesiones asociadas mediante la publicacion de un infrecuente caso de lesion iatrogenica durante la apertura esternal, con escasosprecedentes en la literatura publicada hasta la fecha. MED.UIS. 2016;29(3):95-9.Palabras clave: Procedimientos quirurgicos cardiacos. Marcapasos artificial. Esternotomia. Enfermedad iatrogenica.