111 results on '"José M. Revuelta"'
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2. Trasplante cardíaco: organización e indicaciones
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José M. Revuelta
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Cardiomiopatía ,Trasplante cardíaco ,Modelo español ,Medicine ,Surgery ,RD1-811 - Abstract
La legislación que regula los trasplantes en España, Ley 30/1979, establece los principios básicos de esta actividad médica. La acreditación de los centros o unidades de trasplante cardíaco se rige por el RD 2070/1999. La experiencia clínica está demostrando que las indicaciones y las contraindicaciones del trasplante cardíaco están en constante cambio, debido principalmente a los avances en los cuidados pre, per y postoperatorios, a los nuevos fármacos y otras novedosas alternativas terapéuticas. La clase funcional (NY HA) del paciente es poco precisa para indicar el trasplante cardíaco, por lo que se precisa de otras determinaciones, como el consumo máximo de oxígeno: VO2 máx < 10 ml/kg/min conlleva un mortalidad hospitalaria elevada. Asimismo, la fracción de eyección ventricular izquierda disminuida (FEVI < 20%) no debe considerarse como el indicador principal para establecer la indicación de trasplante, siendo necesario valorar otros factores de riesgo preoperatorios. En la última década, la experiencia ha puesto de manifiesto que algunas de las contraindicaciones absolutas, antes vigentes, no siempre deben desaconsejar el trasplante cardíaco. more...
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- 2008
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3. Cirugía reconstructora de la válvula mitral: anuloplastia
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José M. Revuelta and José M. Bernal
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Insuficiencia mitral ,Reparación valvular ,Anuloplastia ,Medicine ,Surgery ,RD1-811 - Abstract
La reparación valvular es considerada actualmente como el tratamiento quirúrgico electivo de la insuficiencia mitral cuando la anatomía valvular es favorable. La anuloplastia mitral provee los mejores resultados en la enfermedad degenerativa, con una mortalidad hospitalaria < 1% y supervivencia actuarial del 90 y 80% a los 5 y 10 años, respectivamente; la mayoría de pacientes permanecen libres de reoperación e insuficiencia mitral residual (90% a los 10 años). Esta técnica no resulta tan satisfactoria en la enfermedad reumática, y aunque hemos obtenido resultados satisfactorios, otros autores presentan incidencia elevada de reoperación por disfunción mitral. La disfunción valvular mitral postoperatoria a largo plazo (20 años) es significativamente mayor en pacientes menores de 20 años (26,8 vs 4,5%). La enfermedad congénita de la válvula mitral constituye un grupo heterogéneo, debiendo considerarse la anuloplastia como una parte de la reconstrucción valvular, siendo preciso tratar quirúrgicamente el resto de anomalías congénitas asociadas. En estos casos, la mortalidad hospitalaria oscila entre 1-10%, con una incidencia de reoperación por disfunción valvular a largo plazo de 20-50%, dependiendo del tipo de cardiopatía congénita. La cirugía reparadora en la insuficiencia mitral isquémica sigue constituyendo motivo de controversia por la complejidad de los mecanismos que la ocasionan. En estos pacientes, la anuloplastia soluciona parcialmente la regurgitación, al aumentar la zona de coaptación de los velos, pero no logra corregir las alteraciones en la movilidad valvular ni los cambios geométricos del aparato subvalvular. En el 25% de los pacientes operados reaparece una insuficiencia mitral, por lo que se recomienda utilizar un anillo restrictivo con objeto de incrementar la coaptación valvular. Recientemente, en estos casos se emplea la anuloplastia asimétrica, que corrige el defecto de la región posterolateral del anillo y válvula. La anuloplastia en pacientes con miocardiopatía dilatada e insuficiencia cardíaca terminal, propuesta por Bolling, ha dado resultados satisfactorios, con mejoría de la clase funcional NY HA, disminución de la hospitalización y supervivencia al año del 84%, a pesar de que a los 5 años sobreviven menos de la mitad de los pacientes. En resumen, la anuloplastia mitral debe considerarse como parte de la cirugía reparadora, siendo necesario individualizar su utilización de forma que, para cada paciente, la reconstrucción valvular «completa» requerirá un determinado modelo de prótesis anular y de técnicas reparadoras asociadas. Debemos evitar, de este modo, generalizar el tratamiento quirúrgico como hemos venido haciendo incorrectamente durante años. more...
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- 2006
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4. Cuerdas artificiales de ePTFE: ¿imprescindibles en las técnicas de preservación mitral actuales?
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José L. Pomar, José M. Revuelta, and Robert Frater
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Medicine ,Surgery ,RD1-811 - Published
- 2013
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5. Shannon entropy as a reliable score to diagnose human fibroelastic degenerative mitral chords: A micro-ct ex-vivo study
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Diego Ferreño, José M. Revuelta, José A. Sainz-Aja, Carlos Wert-Carvajal, José A. Casado, Soraya Diego, Isidro A. Carrascal, Jacobo Silva, Federico Gutiérrez-Solana, and Universidad de Cantabria
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Biomedical Engineering ,Biophysics ,Shannon entropy ,Endothelial Cells ,Mitral Valve Insufficiency ,Degenerative mitral valve disease ,Micro computerized tomography ,X-Ray Microtomography ,Mitral chordae tendineae ,Machine learning ,Humans ,Chordae Tendineae ,Mitral Valve ,Collagen ,K-means - Abstract
This paper is aimed at identifying by means of micro-CT the microstructural differences between normal and degenerative mitral marginal chordae tendineae. The control group is composed of 21 normal chords excised from 14 normal mitral valves from heart transplant recipients. The experimental group comprises 22 degenerative fibroelastic chords obtained at surgery from 11 pathological valves after mitral repair or replacement. In the control group the superficial endothelial cells and spongiosa layer remained intact, covering the wavy core collagen. In contrast, in the experimental group the collagen fibers were arranged as straightened thick bundles in a parallel configuration. 100 cross-sections were examined by micro-CT from each chord. Each image was randomized through the K-means machine learning algorithm and then, the global and local Shannon entropies were obtained. The optimum number of clusters, K, was estimated to maximize the differences between normal and degenerative chords in global and local Shannon entropy; the p-value after a nested ANOVA test was chosen as the parameter to be minimized. Optimum results were obtained with global Shannon entropy and 2≤K≤7, providing p < 0.01; for K=3, p = 2.86⋅10-³. These findings open the door to novel perioperative diagnostic methods in order to avoid or reduce postoperative mitral valve regurgitation recurrences. This work is supported by the “Ministerio de Economía, Industria y Competitividad” (MINECO) and the “Instituto de Salud Carlos III” (ISCIII) of Spain, through projects INTRACARDIO (DTS17/00056) and CIBER-BBN (co-financed by FEDER funds) and IDIVAL under project DiCuTen (INNVAL16/02). The technical contributions from the members of the DICUTEN and the financial contribution from the IDIVAL are gratefully acknowledged. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. This study was approved by the Ethical Committee of Clinical Research of Cantabria – IDIVAL (Acta 02/2018). more...
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- 2022
6. Corazón de mujer
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José M. Revuelta, Ana Rosa Alconero-Camarero, and Universidad de Cantabria
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business.industry ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Humanities - Published
- 2020
7. La sustitución protésica de la válvula tricúspide: de Cenicienta a Princesa
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José L. Pomar and José M. Revuelta
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business.industry ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Humanities - Published
- 2018
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8. La reparación de la insuficiencia mitral entre 2 orillas
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José M. Revuelta
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business.industry ,lcsh:R ,lcsh:Surgery ,lcsh:Medicine ,Medicine ,Surgery ,lcsh:RD1-811 ,Cardiology and Cardiovascular Medicine ,business ,Humanities - Published
- 2015
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9. OCT inspection of degenerative and rheumatic tendinous cords
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Eusebio Real, Jose Miguel Lopez-Higuera, Olga M. Conde, Alejandro Pontón, José M. Revuelta, Marta Calvo-Díez, and Universidad de Cantabria
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medicine.medical_specialty ,Optical coherence tomography ,medicine.diagnostic_test ,business.industry ,Degenerative mitral valve disease ,Tendinous cords ,Rheumatic mitral valve disease ,medicine.anatomical_structure ,Mitral valve ,Internal medicine ,medicine ,Cardiology ,Nuclear medicine ,business - Abstract
Surgical repair of the mitral valve complex presents high mortality rates, strongly dependent on the surgical procedure. Intensity and polarization sensitive OCT are explored as a feasible degradation inspection method for rheumatic and degenerative chords. This work is supported by the “Ministerio de Economía, Industria y Competitividad” (MINECO) under projects DA2TOI (FIS2010-19860), SENSA (TEC2016-76021-C2-2-R), IDIVAL under project DiCuTen (INNVAL16/02) and the “Instituto de Salud Carlos III” (ISCIII) through projects FUSIODERM (DTS15/00238) and CIBERBBN and the co -financed by FEDER funds. more...
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- 2017
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10. Collagen birefringence assessment in heart chordae tendineae through PS-OCT
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Olga M. Conde, Eusebio Real, José M. Revuelta, Jose Miguel Lopez-Higuera, Nieves González-Vargas, Alejandro Pontón, Marta Calvo-Díez, and Universidad de Cantabria
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medicine.medical_specialty ,medicine.medical_treatment ,Volume overload ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,01 natural sciences ,Chordae tendineae ,010309 optics ,03 medical and health sciences ,0302 clinical medicine ,Degenerative disease ,Valve replacement ,Internal medicine ,Mitral valve ,0103 physical sciences ,medicine ,Degradation diagnosis ,Mitral regurgitation ,business.industry ,Tendinous cords ,medicine.disease ,medicine.anatomical_structure ,Mitral incompetence ,Cardiology ,Collagen organization ,business ,PS-OCT ,Birrefringence - Abstract
Degenerative mitral regurgitation is a serious and frequent human heart valve disease. Malfunctioning of this valve brings the left-sided heart through a significant increase of pressure and volume overload. Severe degenerative mitral incompetence generally requires surgical repair or valve replacement with a bioprosthesis or mechanical heart valve. Degenerative disease affects the leaflets or/and the chordae tendineae, which link both leaflets to the papillary muscles. During mitral valve surgical repair, reconstruction of the valve leaflets, annulus and chordae are provided to prevent postoperative recurrence of valve regurgitation. The operative evaluation of the diseased and apparently normal chordae tendineae mainly depends of the surgeon´s experience, without any other objective diagnosis tool. In this work, PS-OCT (Polarization Sensitive-Optical Coherence Tomography) is applied for the first time to evaluate the pathological condition of human chordae coming from the mitral valve. It consists on a prospective study to test the viability of this technique for the evaluation of the collagen core of chords. This core presents a strong birefringence due to the longitudinal and organized arrangement of its collagen bundles. Different densities and organizations of the collagen core translate into different birefringence indicators whose measurement become an objective marker of the core structure. Ex-vivo mitral degenerative chordae tendineae have been analyzed with PS-OCT. Intensity OCT is used to obtain complementary morphological information of the chords. Birefringence results correlate with the previously reported values for human tendinous tissue. The authors thank the “Ministerio de Economía, Industria y Competitividad” (MINECO) for their support in this work under projects DA2TOI (FIS2010-19860), SENSA (TEC2016-76021-C2-2-R), the “Instituto de Salud Carlos III” (ISCIII) through projects FUSIODERM (DTS15/00238) and CIBERBBN and the co-financed by FEDER funds. more...
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- 2017
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11. Cirugía coronaria en España: en busca de la realidad oculta
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José M. Revuelta
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business.industry ,lcsh:R ,lcsh:Surgery ,Medicine ,lcsh:Medicine ,Surgery ,lcsh:RD1-811 ,Cardiology and Cardiovascular Medicine ,business ,Humanities - Published
- 2014
12. Identification of Human Pathological Mitral Chordae Tendineae Using Polarization-sensitive Optical Coherence Tomography
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Alejandro Pontón, Olga M. Conde, José Miguel López Higuera, Marta Calvo Díez, Gaspar Fernandez-Barreras, J.F. Gutiérrez, Eusebio Real, José M. Icardo, José M. Revuelta, and Universidad de Cantabria
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medicine.medical_treatment ,030204 cardiovascular system & hematology ,lcsh:Chemical technology ,01 natural sciences ,Biochemistry ,Article ,Chordae tendineae ,Analytical Chemistry ,010309 optics ,03 medical and health sciences ,0302 clinical medicine ,Optical coherence tomography ,Mitral valve ,Osteoarthritis ,0103 physical sciences ,medicine ,Humans ,lcsh:TP1-1185 ,Electrical and Electronic Engineering ,Instrumentation ,Pathological ,Reduction (orthopedic surgery) ,Birefringence ,Tricuspid valve ,medicine.diagnostic_test ,business.industry ,Heart ,Anatomy ,Atomic and Molecular Physics, and Optics ,medicine.anatomical_structure ,Polarization sensitive ,Polarization sensitive optical coherence tomography ,Collagen ,business ,Tomography, Optical Coherence - Abstract
Defects of the mitral valve complex imply heart malfunction. The chordae tendineae (CTs) are tendinous strands connecting the mitral and tricuspid valve leaflets to the papillary muscles. These CTs are composed of organized, wavy collagen bundles, making them a strongly birefringent material. Disorder of the collagen structure due to different diseases (rheumatic, degenerative) implies the loss or reduction of tissue birefringence able to be characterized with Polarization Sensitive Optical Coherence Tomography (PS-OCT). PS-OCT is used to discriminate healthy from diseased chords, as the latter must be excised and replaced in clinical conventional interventions. PS-OCT allows to quantify birefringence reduction in human CTs affected by degenerative and rheumatic pathologies. This tissue optical property is proposed as a diagnostic marker for the identification of degradation of tendinous chords to guide intraoperative mitral valve surgery. Research was funded by Ministerio de Economía, Industria y Competitividad, Gobierno de España, grant numbers FIS2010-19860 (DA2TOI) and TEC2016-76021-C2-2-R (SENSA), Instituto de Salud Carlos III, grant number DTS17-00055 (FUSIODERM), Instituto de Investigación Marqués de Valdecilla (IDIVAL), grant number INNVAL 16/02 (DICUTEN) and INNVAL 18/23 (DAPatOO), University of Cantabria postdoctoral grant, POS-UC-2018-16. Co-funded with FEDER funds. more...
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- 2019
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13. El irrepetible Pedro Antonio. Pedro Antonio Sánchez Fernández (Sevilla, 1935-Madrid, 2016)
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José M. Revuelta
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business.industry ,lcsh:R ,lcsh:Surgery ,Medicine ,lcsh:Medicine ,Surgery ,lcsh:RD1-811 ,Cardiology and Cardiovascular Medicine ,business ,Humanities - Published
- 2016
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14. Hessian analysis for the delineation of amorphous anomalies in optical coherence tomography images of the aortic wall
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Marta Mayorga, José M. Revuelta, Jose Miguel Lopez-Higuera, Eusebio Real, Alejandro Pontón, José Fernando Val-Bernal, Marta Calvo Díez, and Olga M. Conde
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Hessian matrix ,02 engineering and technology ,01 natural sciences ,Edge detection ,Article ,010309 optics ,Aortic aneurysm ,symbols.namesake ,Optical coherence tomography ,medicine.artery ,0103 physical sciences ,medicine ,Gaussian function ,Computer vision ,Image resolution ,Aorta ,medicine.diagnostic_test ,business.industry ,Attenuation ,021001 nanoscience & nanotechnology ,medicine.disease ,Atomic and Molecular Physics, and Optics ,symbols ,cardiovascular system ,Artificial intelligence ,0210 nano-technology ,business ,Geology ,Biotechnology ,Biomedical engineering - Abstract
The aortic aneurysm is a disease originated mainly in the media layer of the aortic wall due to the occurrence of degraded areas of altered biological composition. These anomalous regions affect the structure and strength of the aorta artery, being their occurrence and extension proportional to the arterial vessel health. Optical Coherence Tomography (OCT) is applied to obtain cross-sectional images of the artery wall. The backscattering mechanisms in tissue make aorta images difficult to analyze due to noise and strong attenuation with penetration. The morphology of anomalies in pathological specimens is also diverse with amorphous shapes and varied dimensions, being these factors strongly related with tissue degradation and the aorta physiological condition. Hessian analysis of OCT images from aortic walls is used to assess the accurate delineation of these anomalous regions. A specific metric of the Hessian determinant is used to delineate degraded regions under blurry conditions and noise. A multiscale approach, based on an anisotropic Gaussian kernel filter, is applied to highlight and aggregate all the heterogeneity present in the aortic wall. An accuracy estimator metric has been implemented to evaluate and optimize the delineation process avoiding subjectivity. Finally, a degradation quantification score has been developed to assess aorta wall condition by OCT with validation against common histology. more...
- Published
- 2016
15. Repair of Rheumatic Tricuspid Valve Disease: Predictors of Very Long-Term Mortality and Reoperation
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Javier Llorca, J. Aurelio Sarralde, Lorena Díez-Solorzano, Alejandro Pontón, José M. Bernal, José M. Revuelta, and Juan R Sanz Giménez-Rico
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Male ,Reoperation ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Time Factors ,Heart Valve Diseases ,Lesion ,Internal medicine ,medicine ,Humans ,Cardiac Surgical Procedures ,Retrospective Studies ,Surgical repair ,Tricuspid valve ,business.industry ,Incidence (epidemiology) ,Rheumatic Heart Disease ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Circulatory system ,Cardiology ,Female ,Tricuspid Valve ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Commissurotomy ,business ,Rheumatism - Abstract
Background We examined predictors of reoperation and late mortality in patients undergoing tricuspid valve repair for rheumatic disease. Methods Between 1997 and 2007, 299 consecutive patients (mean age 50.8 ± 13.7 years) underwent surgical repair of the tricuspid valve for multivalvular organic rheumatic disease. A total of 184 patients was found to have mitral and tricuspid valve disease, 108 triple valve disease, 5 isolated tricuspid lesion, and 2 aortic and tricuspid valve disease. Prosthetic ring annuloplasty was performed in 78 patients, commissurotomy and ring annuloplasty in 82, isolated commissurotomy in 10, suture annuloplasty in 105, and commissurotomy and suture annuloplasty in 24. Results Thirty-day mortality was 7.4%. Previous valve surgery and reoperation for bleeding were risk factors for early death. Late mortality was 51.2%, in the majority of patients due to cardiac causes. There was a median follow-up of 16.4 years (range, 6 months to 34 years) and cumulative follow-up of 5,432 patients per year (96.7% complete). Age, New York Heart Association functional class IV and postclamping time were predictive factors for late mortality. At 25 years, the Kaplan-Meier survival was 26.6% ± 4.2%. A total of 106 patients required valve reoperation. Age older than 40 years was a protective factor for reoperation. At 25 years, Kaplan-Meier freedom from reoperation was 35.0% ± 5.3%. Conclusions Repair of the tricuspid valve in patients with rheumatic valve disease can be performed with acceptable early results, but progression of rheumatic disease is associated with a high incidence of valve dysfunction and mortality in the long term. more...
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- 2010
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16. Cambios en el perfil de la endocarditis sobre válvula protésica en un hospital de tercer nivel: 1986-2005
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Francisco Gutiérrez-Díez, Rafael Martín-Durán, José M. Bernal-Marco, Jesús González-Macías, María Carmen Fariñas, Héctor Alonso-Valle, J.R. Berrazueta, J D García-Palomo, Concepción Fariñas-Álvarez, and José M. Revuelta-Soba more...
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Gynecology ,medicine.medical_specialty ,business.industry ,Medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Introduccion y objetivos. Estudiar la evolucion de las caracteristicas clinicas, la etiologia y el pronostico de la endocarditis sobre valvula protesica en un hospital de tercer nivel. Metodos. Estudio de cohortes retrospectivo de todos los pacientes diagnosticados de endocarditis sobre valvula protesica desde 1986 a 2005 segun los criterios de Duke modificados. Se analizaron dos periodos temporales: enero de 1986 a diciembre de 1995 (P1) y enero de 1996 a diciembre de 2005 (P2). Resultados. Se estudiaron 133 episodios en 122 pacientes. En 73 episodios (54,9%) la endocarditis fue diagnosticada en el P1 y en 60 (45,1%), en el P2 (incidencia del 2,19 y el 2,18% respectivamente). La edad, media ± desviacion estandar, fue de 52,6 ± 16,6 anos en el P1 y 66,2 ± 11,5 anos en el P2 (p = 0,0001). Las caracteristicas clinicas fueron similares en ambos periodos de estudio. Fue llamativo el incremento de infecciones por enterococo (el 12,5% en el P2 y el 4,9% en el P1; riesgo relativo [RR] = 2,5; intervalo de confianza [IC] del 95%, 0,7-9,6) asi como el descenso de las infecciones por estreptococos del grupo viridans (el 12,5% en el P2 y el 31,1% en el P1; RR = 0,4; IC del 95%, 0,2-0,9). Los pacientes intervenidos en el P1 fueron el 90,4% (63/73), mientras que en el P2 fueron el 68,3% (41/60), diferencias que resultaron estadisticamente significativas (RR = 0,8; IC del 95%, 0,6-0,9). La mortalidad intrahospitalaria fue del 28,8% en el P1 y el 30% en el P2 (RR = 1; IC del 95%, 0,6-1,7). Conclusiones. Durante los 20 anos de estudio, se ha observado un cambio en la epidemiologia y la etiologia microbiologica de la endocarditis sobre valvula protesica. El abordaje diagnostico y terapeutico tambien se ha modificado, aunque la mortalidad se ha mantenido elevada more...
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- 2010
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17. The Changing Face of Prosthetic Valve Endocarditis at a Tertiary-Care Hospital: 1986-2005
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José M. Bernal-Marco, José M. Revuelta-Soba, Francisco Gutiérrez-Díez, Rafael Martín-Durán, María Carmen Fariñas, Jesús González-Macías, Héctor Alonso-Valle, J.R. Berrazueta, Concepción Fariñas-Álvarez, and J D García-Palomo more...
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Adult ,Male ,medicine.medical_specialty ,Prosthesis-Related Infections ,Cohort Studies ,Epidemiology ,medicine ,Humans ,Endocarditis ,Aged ,Retrospective Studies ,biology ,business.industry ,Mortality rate ,Retrospective cohort study ,Endocarditis, Bacterial ,General Medicine ,Middle Aged ,biology.organism_classification ,medicine.disease ,Surgery ,Viridans streptococci ,Heart Valve Prosthesis ,Relative risk ,Etiology ,Female ,business ,Cohort study - Abstract
Introduction and objectives To investigate changes in the clinical characteristics, etiology, and prognosis of prosthetic valve endocarditis at a tertiary-care hospital. Methods Retrospective cohort study of all patients diagnosed with prosthetic valve endocarditis using modified Duke criteria between 1986 and 2005. The analysis covered two time periods: January 1986 to December 1995 (P1) and January 1996 to December 2005 (P2). Results In total, 133 episodes of endocarditis occurred in 122 patients. Of these, 73 (54.9%) were diagnosed in P1 and 60 (45.1%) in P2, with incidences of 2.19% and 2.18%, respectively. The patients’ mean age (SD) was 52.6 (16.6) years in P1 and 66.2 (11.5) years in P2 ( P =.0001). Clinical characteristics were similar in the two study periods. The increase in Enterococcus infection was remarkable (12.5% in P2 vs 4.9% in P1; relative risk [RR] = 2.5; 95% confidence interval [CI], 0.7-9.6), as was the decrease in viridans group Streptococcus infection (12.5% in P2 vs 31.1% in P1; RR=0.4; 95% CI, 0.2-0.9). Some 90.4% of patients (63/73) underwent surgery in P1, while 68.3% (41/60) underwent surgery in P2. The difference was significant (RR=0.8; 95% CI, 0.6-0.9). The in-hospital mortality rate was 28.8% in P1 and 30% in P2 (RR=1; 95% CI, 0.6-1.7). Conclusions Changes in the epidemiology and microbiological etiology of prosthetic valve endocarditis were observed over the 20-year study period. Diagnostic and therapeutic approaches also changed, but mortality remained high. more...
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- 2010
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18. Repeat Mitral Valve Replacement: 30-Years’ Experience
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J.R. Berrazueta, José M. Revuelta, Iván García, Tamara García-Camarero, Elena Arnaiz, Víctor Expósito, Aurelio Sarralde, and José M. Bernal
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Male ,Reoperation ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Heart Valve Diseases ,Emergency surgery ,Mitral valve ,Internal medicine ,Humans ,Medicine ,Endocarditis ,Significant risk ,Survival rate ,business.industry ,Mortality rate ,Mitral valve replacement ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Natural history ,medicine.anatomical_structure ,Heart Valve Prosthesis ,Cardiology ,Mitral Valve ,Female ,business ,Follow-Up Studies - Abstract
Prosthetic heart valve dysfunction is an acquired condition that carries a significant risk of emergency surgery. However, the long-term natural history of the condition is not well understood. Between 1974 and 2006, 1535 isolated mitral valve replacements were performed at our hospital (in-hospital mortality 5%). In total, 369 patients needed a second operation (in-hospital mortality 8.1%), while 80 (age 59.8+/-11.4 years) needed a third. The reasons for the third intervention were structural deterioration (67.5%), paravalvular leak (20%) and endocarditis (6.3%). Some 15 patients died in hospital (18.8%). After a mean follow-up period of 17.8 years, 21 patients needed another intervention (i.e., a fourth intervention). The actuarial reoperation-free rate at 20 years was 40.1+/-13.8%. The late mortality rate was 58.5% (18-year survival rate 15.4+/-5.4%). Indications for repeat mitral valve replacement must be judged on an individual basis given the high risk associated with surgery. more...
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- 2009
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19. Reintervenciones múltiples sobre la válvula mitral: 30 años de experiencia
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Tamara García-Camarero, J.R. Berrazueta, José M. Revuelta, Elena Arnaiz, Iván García, Aurelio Sarralde, Víctor Expósito, and José M. Bernal
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Gynecology ,medicine.medical_specialty ,business.industry ,medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
La disfuncion protesica es una enfermedad adquirida con significativo riesgo quirurgico inmediato, aunque la historia natural a largo plazo es poco conocida. Entre 1974 y 2006 se realizaron 1.535 recambios mitrales aislados (mortalidad hospitalaria, 5%). Un total de 369 pacientes requirieron una segunda intervencion (mortalidad hospitalaria, 8,1%) y 80, una tercera (59,8 ± 11,4 anos). Las causas de la tercera intervencion fueron deterioro estructural (67,5%), dehiscencia periprotesica (20%) y endocarditis (6,3%). La mortalidad hospitalaria fue 15 (18,8%) pacientes. Tras un seguimiento medio de 17,8 anos, 21 pacientes precisaron nueva intervencion (cuarta intervencion) y la curva actuarial libre de reoperacion fue del 40,1% ± 13,8% a 20 anos. La mortalidad tardia fue del 58,5% (supervivencia a 18 anos, 15,4% ± 5,4%). La indicacion de una reintervencion reiterativa mitral debe evaluarse de forma individualizada, dado el alto riesgo quirurgico asociado. more...
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- 2009
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20. Stent Fracture in Wessex Porcine Heart Valve Bioprostheses
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Hurlé A, José M. Revuelta, and Nistal Jf
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Adult ,Reoperation ,Aortic valve ,medicine.medical_specialty ,Swine ,medicine.medical_treatment ,Biomedical Engineering ,Medicine (miscellaneous) ,Bioengineering ,Prosthesis ,Cohort Studies ,Biomaterials ,Mitral valve ,medicine ,Animals ,Humans ,Porcine heart ,Longitudinal Studies ,cardiovascular diseases ,Aged ,Bioprosthesis ,Prosthetic valve ,Tricuspid valve ,business.industry ,Stent ,General Medicine ,Middle Aged ,Biomechanical Phenomena ,Prosthesis Failure ,Surgery ,medicine.anatomical_structure ,Echocardiography ,Aortic Valve ,Heart Valve Prosthesis ,Mitral Valve ,Stents ,Tricuspid Valve ,STRUCTURAL DYSFUNCTION ,business - Abstract
By January 1994, a total of 40 Wessex porcine bioprostheses (21 mitral, 18 aortic, and 1 tricuspid) were explanted from 31 subjects. They belonged to a series of 150 patients who received 184 of such prostheses in our unit. Seventeen of these explanted prostheses were available for study, and 11 of them presented some sort of stent fracture or fissuring (mean of 3.6 +/- 1.6 fractures per prosthesis). The disruption occurred in all cases at the base of the commissural arch or at the commissural bar of the stent. The fractures were not detected clinically nor echo-cardiographically before reoperation, and most valves were explanted for reasons other than the stent rupture itself. The actuarial probability of freedom from stent fracture in our series is 66 +/- 12% at 9 years of follow-up. In our experience, fracture of the stent is an important mode of structural dysfunction of the Wessex porcine bioprostheses. more...
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- 2008
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21. Surgical site infections in cardiac surgery after a hospital catastrophe
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Daniel Nan, José M. Revuelta, Concepción Fariñas-Álvarez, Marta Fernández-Ayala, Juan Francisco Nistal, Jesús González-Macías, and María Carmen Fariñas
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Male ,Microbiology (medical) ,medicine.medical_specialty ,Bacteremia ,Severity of Illness Index ,Teaching hospital ,Severity of illness ,Surgical site ,Prevalence ,medicine ,Humans ,Surgical Wound Infection ,Infection control ,Hospitals, Teaching ,Respiratory Tract Infections ,Aged ,Cross Infection ,business.industry ,Thoracic Surgery ,Respiratory infection ,Surgical wound ,General Medicine ,Length of Stay ,Cardiac surgery ,Surgery ,Infectious Diseases ,Spain ,Urinary Tract Infections ,Emergency medicine ,Female ,business ,Hospital stay - Abstract
Summary On 2 November 1999, one of the main hospital facades adjoining cardiovascular surgery collapsed in a 900-bed teaching hospital in Santander, Spain. The purpose of this study was to determine whether the accident affected the safety of patients by increasing the risk for nosocomial and surgical site infections (SSI). Measures for the prevention of nosocomial infections were immediately reinforced. A total of 217 consecutive patients were operated on before 2 November 1999, with another 296 after this date. Patients in both study periods showed similar severity of illness, complexity of surgical procedure and length of hospital stay. The overall rate of nosocomial infection before and after the accident was 28.1% and 24.7%, respectively (P = 0.381). The rates of respiratory infection, urinary infection and bacteraemia were also similar. A statistically significant reduction in the SSI rate in the second period was observed (14.8% vs 4.4%, P = 0.008). The collapse of the facade was not associated with any increase in nosocomial infection rates, but there was a significant reduction of SSI rates in relation to intensive infection control measures implemented after the collapse. more...
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- 2008
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22. Surgery for rheumatic tricuspid valve disease: A 30-year experience
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Alejandro Pontón, José M. Bernal, José M. Revuelta, Begoña Diaz, Carmen Diago, Iván García, Aurelio Sarralde, and Javier Llorca
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Adult ,Male ,Reoperation ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Heart Valve Diseases ,Regurgitation (circulation) ,Lesion ,Postoperative Complications ,Valve replacement ,Mitral valve ,Internal medicine ,Humans ,Medicine ,Hospital Mortality ,cardiovascular diseases ,Cardiac Surgical Procedures ,Aged ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,Tricuspid valve ,business.industry ,Rheumatic Heart Disease ,Mitral valve replacement ,Middle Aged ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Circulatory system ,cardiovascular system ,Cardiology ,Female ,Tricuspid Valve ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Rheumatism ,Follow-Up Studies - Abstract
Objective This study was undertaken to assess factors influencing short- and long-term outcomes of surgery for rheumatic disease of the tricuspid valve. Methods Between 1974 and 2005, a total of 328 consecutive patients (mean age 51.3 ± 13.6 years) underwent tricuspid valve surgery for rheumatic disease. There were 12 cases of isolated tricuspid lesion, 199 of triple-valve disease, 114 of tricuspid and mitral valve disease, and 3 of aortic and tricuspid valve disease. Most patients (72%) had predominantly tricuspid regurgitation. Tricuspid valve prosthetic replacement was performed in 31 cases and valve repair in 297. Results In-hospital mortality was 7.6%. Late mortality was 52.1%, whereas the expected mortality of the Spanish population of the same age was 24.2%. Predictors of in-hospital mortality were male sex, isolated tricuspid lesion, moderate aortic insufficiency, postclamping time, and tricuspid valve replacement. Mean follow-up was 8.7 years (range 1–31 years). Follow-up was 98.9% complete. Predictors of late mortality were age, New York Heart Association functional class IV, postclamping time, and mitral valve replacement. In total, 114 patients required valve reoperation, but only 4 (3.5%) for isolated tricuspid valve dysfunction. At 30 years, actuarial survival was 12.1% ± 4.4%, actuarial freedom from reoperation was 27.5% ± 5.8%, and actuarial freedom from valve-related complications was 2.0% ± 1.3%. Conclusion Organic tricuspid valve disease associated with rheumatic mitral or aortic lesions increases hospital and late mortality, but valve repair compared favorably with valve replacement. Long-term results may be considered acceptable for otherwise incurable valve disease. more...
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- 2008
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23. Iterative Otsu's method for OCT improved delineation in the aorta wall
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Olga M. Conde, Jose Miguel Lopez-Higuera, Alejandro Pontón, José Fernando Val-Bernal, Daniel Alonso, Marta Calvo Díez, Marta Mayorga, Eusebio Real, José M. Revuelta, and Universidad de Cantabria
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Aorta ,Ascending thoracic aorta ,Aortic wall degradation ,medicine.diagnostic_test ,Computer science ,Speckle noise ,Anatomy ,Otsu’s method ,Thresholding ,Otsu's method ,Speckle pattern ,symbols.namesake ,Signal-to-noise ratio ,OCT ,Optical coherence tomography ,medicine.artery ,cardiovascular system ,medicine ,symbols ,Thoracic aorta ,Biomedical engineering - Abstract
Degradation of human ascending thoracic aorta has been visualized with Optical Coherence Tomography (OCT). OCT images of the vessel wall exhibit structural degradation in the media layer of the artery, being this disorder the final trigger of the pathology. The degeneration in the vessel wall appears as low-reflectivity areas due to different optical properties of acidic polysaccharides and mucopolysaccharides in contrast with typical ordered structure of smooth muscle cells, elastin and collagen fibers. An OCT dimension indicator of wall degradation can be generated upon the spatial quantification of the extension of degraded areas in a similar way as conventional histopathology. This proposed OCT marker can offer in the future a real-time clinical perception of the vessel status to help cardiovascular surgeons in vessel repair interventions. However, the delineation of degraded areas on the B-scan image from OCT is sometimes difficult due to presence of speckle noise, variable signal to noise ratio (SNR) conditions on the measurement process, etc. Degraded areas can be delimited by basic thresholding techniques taking advantage of disorders evidences in B-scan images, but this delineation is not optimum in the aorta samples and requires complex additional processing stages. This work proposes an optimized delineation of degraded areas within the aorta wall, robust to noisy environments, based on the iterative application of Otsu’s thresholding method. Results improve the delineation of wall anomalies compared with the simple application of the algorithm. Achievements could be also transferred to other clinical scenarios: carotid arteries, aorto-iliac or ilio-femoral sections, intracranial, etc. This work has been supported by projects DA2TOI (FIS2010-19860) and FOS4 (TEC2013-47264-C2-1-R). more...
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- 2015
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24. Enhanced delineation of degradation in aortic walls through OCT
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Alejandro Pontón, Olga M. Conde, Marta Mayorga, Marta Calvo Díez, José Fernando Val-Bernal, Jose Miguel Lopez-Higuera, Eusebio Real, José M. Revuelta, and Universidad de Cantabria
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Materials science ,medicine.diagnostic_test ,biology ,Thoracic aorta aneurysm ,Speckle noise ,Otsu’s method ,Thresholding ,Frangi’s filter ,Speckle pattern ,Optical coherence tomography ,OCT ,medicine.artery ,medicine ,biology.protein ,cardiovascular system ,Thoracic aorta ,Process (anatomy) ,Elastin ,Biomedical engineering ,Degradation (telecommunications) - Abstract
Degradation of the wall of human ascending thoracic aorta has been assessed through Optical Coherence Tomography (OCT). OCT images of the media layer of the aortic wall exhibit micro-structure degradation in case of diseased aortas from aneurysmal vessels or in aortas prone to aortic dissections. The degeneration in vessel walls appears as low-reflectivity areas due to the invasive appearance of acidic polysaccharides and mucopolysaccharides within a typical ordered microstructure of parallel lamellae of smooth muscle cells, elastin and collagen fibers. An OCT indicator of wall degradation can be generated upon the spatial quantification of the extension of degraded areas in a similar way as conventional histopathology. This proposed OCT marker offers a real-time clinical insight of the vessel status to help cardiovascular surgeons in vessel repair interventions. However, the delineation of degraded areas on the B-scan image from OCT is sometimes difficult due to presence of speckle noise, variable SNR conditions on the measurement process, etc. Degraded areas could be outlined by basic thresholding techniques taking advantage of disorders evidences in B-scan images, but this delineation is not always optimum and requires complex additional processing stages. This work proposes an optimized delineation of degraded spots in vessel walls, robust to noisy environments, based on the analysis of the second order variation of image intensity of backreflection to determine the type of local structure. Results improve the delineation of wall anomalies providing a deeper physiological perception of the vessel wall conditions. Achievements could be also transferred to other clinical scenarios: carotid arteries, aorto-iliac or ilio-femoral sections, intracranial, etc. This work has been supported by the Spanish Government through the CYCIT projects DA2TOI (FIS2010-19860) and FOS4 (TEC2013-47264-C2-1-R). more...
- Published
- 2015
25. Iterative Otsu’s method for OCT enhanced delineation in the aorta wall
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Daniel Alonso, Eusebio Real, José Fernando Val-Bernal, José M. Revuelta, Alejandro Pontón, Marta Calvo Díez, Marta Mayorga, José M. López-Higuera, and Olga M. Conde
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- 2015
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26. Experiencia inicial en el tratamiento endovascular de los aneurismas de la aorta abdominal en un servicio de cirugía cardiovascular. Valoración de la curva de aprendizaje
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José M. Bernal, Francisco Gutiérrez Díez, Alejandro Pontón, Iván García, Manuel Bustamante, Andrés González Tutor, José M. Revuelta, and J.A. Sarralde
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Gynecology ,medicine.medical_specialty ,Aneurisma ,Endoprótesis ,business.industry ,lcsh:R ,lcsh:Surgery ,lcsh:Medicine ,lcsh:RD1-811 ,Aneurysm ,Endoprosthesis ,cardiovascular system ,Medicine ,Surgery ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Aorta - Abstract
IntroducciónEl empleo de endoprótesis en el tratamiento de los aneurismas de la aorta abdominal AAA es un procedimiento cada vez más frecuente.ObjetivosAnalizar el impacto de la curva de aprendizaje en la puesta en marcha de un programa de tratamiento endovascular de los AAA en un servicio de cirugía cardiovascular.MetodologíaSe incluyen los primeros 58 pacientes consecutivos con AAA tratados mediante endoprótesis. Todos los enfermos eran varones, con una edad media de 73,2 años y de alto riesgo anestésico y quirúrgico. Las intervenciones fueron efectuadas por cirujanos cardiovasculares y radiólogos.ResultadosSe pudo completar el procedimiento en todos los casos. En dos ocasiones se produjo una lesión del acceso arterial precisando un abordaje retroperitoneal para su control. En el postoperatorio inmediato un paciente falleció debido a una isquemia intestinal (1,7%). El seguimiento medio fue de 8,97 meses/paciente (1–32 meses), no presentándose durante el mismo roturas aneurismáticas, ni reconversiones a cirugía abierta, ni muertes en relación con el dispositivo o el procedimiento. Un paciente precisó la colocación de una extensión proximal por una endofuga tipo I y otro enfermo una derivación femorofemoral por una trombosis de rama protésica.ConclusionesCon la colaboración de cirujanos cardiovasculares y radiólogos, y el adecuado asesoramiento de expertos en los primeros casos realizados, el inicio en el tratamiento endovascular de los AAA puede afrontarse con garantías de éxito minimizando los efectos de la curva de aprendizaje.IntroductionThe number of cases of abdominal aortic aneurysms treated with an endovascular stent-graft prosthesis is steadily increasing.Objectives. To analyse the impact of the learning curve in a starting program of endovascular treatment of AAA in a cardiovascular surgery service.MethodsFifty-eight patients with AAA, all males, at high risk for conventional surgical therapy were treated with endovascular grafts. Mean age was 73.2 years. All interventions were performed by cardiovascular surgeons and interventional radiologists.ResultsThe aneurysmal sac was excluded in all cases. Retroperitoneal dissection was performed to repair the arterial access in two cases. Early mortality was 1.7% (an 83-year-old man with intestinal ischemia). Mean follow-up was 8.97 months (1–32). There were no aneurysmal ruptures, conversions to open surgery or procedure-related deaths in the follow- up. A proximal graft extension was implanted for a type 1 endoleak and a femorofemoral bypass was performed after an iliac branch thrombosis.ConclusionsWith the cooperation between cardiovascular surgeons and interventional radiologists and the appropriate advice given by experts, a successfully program of AAA endovascular treatment can start minimizing the effects of the learning curve. more...
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- 2006
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27. Reunión anual de médicos residentes de Cirugía Cardiovascular: 10 años después
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José M. Revuelta
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Reunión anual ,Docencia ,business.industry ,Residents ,Teaching ,lcsh:R ,lcsh:Surgery ,lcsh:Medicine ,Cardiovascular surgery ,lcsh:RD1-811 ,Annual meeting ,Cirugía cardiovascular ,Médicos residentes ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Humanities - Abstract
En 1995, la entonces Sociedad Española de Cirugía Cardiovascular (SECCV) y la corporación multinacional Medtronic decidieron organizar una reunión dirigida a los médicos residentes. Dicha reunión se ha llevado a cabo cada año, con la excepción de 2002. Los objetivos han sido organizar un programa de formación continuada con actividades teóricas y prácticas, poniendo especial atención en el Taller de Cirugía Experimental. Dicha reunión permitiría el estrechamiento de lazos profesionales y personales entre los médicos en formación y los profesores, cirujanos cardiovasculares de diversas instituciones españolas. Las primeras cinco reuniones se realizaron en España. La etapa europea contempló la organización conjunta bajo los auspicios de la SECTCV y la European Association of Cardio-thoracic Surgery (EACTS). La tercera etapa, recién iniciada con la Reunión de Palma de Mallorca de 2005, ha representado la consolidación de las actividades organizativas de la SECTCV a través de una nueva normativa. Se han cubierto todos los aspectos del programa formativo de la cirugía cardiovascular tal y como está estructurada en España. Este programa docente ha representado un éxito por la colaboración de todas las partes implicadas, profesores, médicos residentes, la industria y las sociedades científicas, y por la mejora de la calidad profesional y humana de los futuros cirujanos cardiovasculares.In 1995, the then called Spanish Society of Cardiovascular Surgery (SECCV) and the multinational corporation Medtronic decided to organize a meeting dedicated to the surgical residents in training. This meeting has been organized every year with the exception of 2002. The objectives have been to organize a continuous education programme with lectures and practical activities paying special attention to the Workshop of Experimental Surgery. This meeting would allow the enhancement of professional and personal relations between the trainees and the teachers. The first five meetings were organized in Spain. The European period was defined by the joint organization of the SECTCV and the European Association for Cardio-thoracic Surgery (EACTS). The recently initiated period with the meeting hold in Palma de Mallorca in 2005 represents the consolidation of the activities of the SECTCV through a new structure and rules. All aspects of the teaching programme in cardiovascular surgery as it is organized in Spain have been covered. This teaching programme has been very successful due to the cooperation of all the involved parts, namely the teachers, the trainees, the industry and the scientific societies and also because of the improvement in the human and professional quality of the future cardiovascular surgeons. more...
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- 2005
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28. Cirugía de la insuficiencia mitral isquémica funcional
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José M. Revuelta
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Gynecology ,Insuficiencia mitral ,medicine.medical_specialty ,Ischemic mitral regurgitation ,business.industry ,Anuloplastia mitral ,lcsh:R ,Insuficiencia mitral isquémica ,lcsh:Surgery ,lcsh:Medicine ,lcsh:RD1-811 ,Cardiopatía isquémica ,Coronary artery disease ,Mitral annuloplasty ,cardiovascular system ,medicine ,Surgery ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Mitral Annuloplasty ,Mitral valve insufficiency - Abstract
La insuficiencia mitral isquémica funcional constituye una lesión valvular compleja que se presenta de diversas formas anatómicas dependiendo del tipo disfunción ventricular, la extensión del daño miocárdico, los cambios morfológicos del ventrículo izquierdo, así como del desplazamiento espacial experimentado por los diferentes elementos que componen la válvula mitral. En la actualidad se acepta que las regurgitaciones de grado moderado y grave deben corregirse quirúrgicamente, ya que en caso contrario el pronóstico no es satisfactorio. Se precisa modificar la clasificación clásica de Carpentier para que las diferentes formas de la insuficiencia mitral isquémica puedan englobarse en un mismo tipo (tipo IV: movilidad valvular variable). La reparación valvular debe conseguir una adecuada coaptación valvular, por lo que debe corregirse la regurgitación simétrica o asimétrica, individualizarse el tipo de anuloplastia y las técnicas reparadoras utilizadas. La anuloplastia restrictiva con anillo de pequeño tamaño (dos medidas menos) asegura la competencia valvular al reducir de manera apropiada el anillo mitral, incluyendo la región intertrigonal cuando está dilatada. Recientemente, se están utilizando nuevos sistemas de reparación mitral (anuloplastia asimétrica, tracción intracavitaria con cuerdas artificiales) que abren nuevas alternativas al tratamiento quirúrgico de esta interesante y no del todo bien conocida insuficiencia valvular.Functional ischemic mitral regurgitation represents a complex valvular lesion with different anatomical types, depending on left ventricular dysfunction, extension of the myocardial damage, changes of left ventricular morphology, or the spatial displacement suffered by the different components of the mitral valve. Currently, it is generally accepted that moderate and severe ischemic mitral regurgitation must be surgically corrected, since the non-corrected lesions entail a poor prognosis. The classical Carpentier classification of the mitral insufficiency requires some modifications in order to allow a proper categorization of the ischemic mitral regurgitation with its various anatomical forms (type IV: variable mitral valve motion). Valve reconstruction must obtain an adequate valve coaptation by the correction of the symmetric or asymmetric regurgitation, so the surgical technique must be individually selected. The restrictive mitral annuloplasty with a small prosthetic ring (two sizes smaller) allows an optimal valvular coaptation by reducing the annular size, including the intertrigonal distance when is dilated. Recently, new annuloplasty systems have been utilized (asymmetric annuloplasty, intracardiac traction with artificial chordae) which open new surgical alternatives to the treatment of this interesting and no totally well-known valvular insufficiency. more...
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- 2005
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29. Functional Ischemic Mitral Regurgitation: an Open Debate
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José M. Revuelta and José M. Bernal
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Mitral regurgitation ,medicine.medical_specialty ,medicine.diagnostic_test ,Ischemic mitral regurgitation ,business.industry ,medicine.medical_treatment ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,Prosthesis ,Surgery ,Coronary artery disease ,Lesion ,medicine.anatomical_structure ,Mitral valve ,Internal medicine ,cardiovascular system ,medicine ,Cardiology ,cardiovascular diseases ,medicine.symptom ,Ventricular remodeling ,business - Abstract
Functional ischemic mitral regurgitation is a complex disorder with a poor prognosis. Although the underlying anatomical and pathophysiological mechanisms are not entirely clear, it is known that postinfarction left ventricular remodeling is the most significant factor in the development of this mitral valve lesion. Echocardiography and magnetic resonance imaging have made significant contributions to clarifying the many mechanisms that progressively worsen mitral regurgitation. There is still controversy about the best surgical approach, particularly with regard to whether to replace or repair the valve, the type and size of prosthesis to be used in mitral annuloplasty, the durability of repair, valve-related complications, and medium-term survival. The early recurrence (≤6 months) of mitral regurgitation after surgery has been reported in 17%-29% of patients. Better understanding of the origin and evolution of functional ischemic mitral regurgitation is necessary to enable the adoption of a more effective surgical approach to this enigmatic valvular disease. more...
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- 2005
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30. Insuficiencia mitral isquémica funcional: un debate abierto
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José M. Revuelta and José M. Bernal
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business.industry ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Humanities - Abstract
La insuficiencia mitral isquemica funcional es una enfermedad compleja de mal pronostico. Los mecanismos anatomicos y fisiopatologicos causales no han sido totalmente aclarados. El remodelado ventricular izquierdo postinfarto es el principal factor inductor de la lesion mitral. La ecocardiografia y la resonancia magnetica han contribuido de manera importante al esclarecimiento de los diferentes mecanismos que progresivamente agravan la regurgitacion mitral. El tratamiento quirurgico optimo es controvertido, sobre todo en lo relativo a la decision de sustituir o reparar la valvula, el tipo y el tamano de la anuloplastia mitral, la durabilidad de la reparacion, las complicaciones relacionadas con la valvula mitral y la supervivencia a medio plazo. Recientemente se ha descrito la reaparicion precoz (≤ meses) de la regurgitacion mitral tras la cirugia en el 17-29% de los pacientes. Es preciso aumentar los conocimientos sobre el origen y la evolucion de la insuficiencia mitral isquemica funcional con el fin de que sea posible realizar una cirugia mas eficiente para esta enigmatica enfermedad valvular. more...
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- 2005
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31. Comparative Evaluation of Small-Size Sorin Slimline and St. Jude HP Heart Valve Prostheses
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Eduardo Otero, Rufilanchas Jj, José M. Revuelta, and José L. Pomar
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Adult ,Male ,Pulmonary and Respiratory Medicine ,Thorax ,medicine.medical_specialty ,medicine.medical_treatment ,Hemodynamics ,Prosthesis ,Aortic valve replacement ,Humans ,Medicine ,Cardiac skeleton ,Heart valve ,Aged ,Aged, 80 and over ,business.industry ,Valve prosthesis ,Middle Aged ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Echocardiography ,Aortic Valve ,Heart Valve Prosthesis ,Female ,Hypertrophy, Left Ventricular ,Cardiology and Cardiovascular Medicine ,business ,Body orifice - Abstract
Background The Sorin Slimline aortic valve prosthesis, a modification of the Sorin Bicarbon valve with increased internal orifice diameter and geometric orifice area, may show improved hemodynamic performance when compared with other previous prosthesis, but so far no comparison study has been reported. Methods Between May 1999 and March 2002, 80 patients (31 to 81 years of age; mean, 65 years) with a small aortic annulus were randomized to undergo aortic valve replacement with either the Sorin Slimline (n = 40) or St. Jude High Performance (n = 40) valve prosthesis. Clinical and echocardiographic Doppler follow-up was performed at 3 to 4 weeks, and 6 and 12 months postoperatively. Results One patient died of non–valve-related causes 9 months after operation. Mean and peak pressure gradients at 6 and 12 months in the Sorin Slimline valve were lower than in the St. Jude High Performance valve for both size 19 and 21 mm. Effective orifice area and effective orifice area index were not significantly different. There was a significant ( p = 0.0001) reduction in left ventricular mass and left ventricular mass index between preoperative measurements and at 12 months after surgery for both valves, but there was no difference ( p = 0.27) between the Sorin Slimline and St. Jude High Performance valve prosthesis at any other follow-up period. Clinical results showed similarly good results with both valves. Conclusions No clinically significant difference in the hemodynamics of both valves was appreciated; patients with a Sorin Slimline valve exhibited statistically significantly lower pressure gradients, but the small differences in effective orifice area and effective orifice area index did not reach significance. A significant left ventricular mass regression was observed with both valve models. Both prostheses provided a satisfactory clinical outcome. more...
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- 2005
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32. La cirugía cardiovascular del futuro: nuevos retos
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José L. Pomar, Jesús Herreros, Carlos-A. Mestres, Juan V. Comas, José M. Revuelta, and Alberto Juffe
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business.industry ,lcsh:R ,lcsh:Surgery ,lcsh:Medicine ,lcsh:RD1-811 ,Cardiovascular surgery ,The future ,Cirugía Cardiovascular ,Medicine ,Surgery ,Challenges ,El futuro ,Cardiology and Cardiovascular Medicine ,business ,Retos ,Humanities - Abstract
Diversos factores indican que la cirugía cardiovascular se enfrenta a un futuro incierto. Esta inquietud existente también en EE.UU. y Europa tiene un mayor fundamento en España, debido al retraso acumulado por nuestra especialidad en las últimas décadas, si nos comparamos con otros países europeos. Con el objetivo de procurar aportar posibles soluciones que eviten un deterioro mayor de nuestra profesión, se analizan en este artículo las posibles causas para, a partir de ahí, explorar las oportunidades. Los resultados llevan a una estrategia que incluye el desarrollo de nuevas tecnologías, la educación, los cambios en los patrones para referir pacientes, nuevas aplicaciones de la circulación extracorpórea, la integración de los cirujanos en las técnicas endovasculares y el desarrollo de departamentos innovadores.Cardiovascular surgery has an uncertain future ahead. There is a major concern with regards to this in the US and Europe. This feeling of uncertainty is even stronger in Spain due to the delay and differences accumulated in our country by our specialty in comparison to other countries of Western Europe. With the aim of looking for possible solutions to avoid a further deterioration of our profession, the factors that may influence on this currently deteriorated situation are analyzed. The results lead to a strategy that includes the development of new technologies, education, changes in the patient referral pattern, new applications of extracorporeal circulation, the integration of surgeons in endovascular techniques and the development of innovative departments. more...
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- 2005
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33. Are women delaying in attending to both their own health care and making decisions on the acute phase of myocardial infarction?
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Ana Rosa Alconero-Camarero, Pedro Muñoz-Cacho, and José M. Revuelta
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Male ,medicine.medical_specialty ,Time Factors ,Decision Making ,Time to treatment ,030204 cardiovascular system & hematology ,Phase (combat) ,Time-to-Treatment ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,St elevation myocardial infarction ,Sex factors ,Health care ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Myocardial infarction ,Non-ST Elevated Myocardial Infarction ,Prospective cohort study ,Intensive care medicine ,Aged ,business.industry ,Middle Aged ,medicine.disease ,Self Care ,Self care ,ST Elevation Myocardial Infarction ,Female ,Cardiology and Cardiovascular Medicine ,business - Published
- 2016
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34. OCT for anomaly detection in aortic aneurysm resection
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José M. Revuelta, Alejandro Pontón, Jose Miguel Lopez-Higuera, José Fernando Val-Bernal, Eusebio Real, Marta Mayorga, Marta Calvo Díez, and Olga M. Conde
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Aortic aneurysm ,medicine.medical_specialty ,business.industry ,medicine ,Anomaly detection ,Radiology ,medicine.disease ,business ,Resection - Published
- 2014
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35. OCT assessment of aortic wall degradation for surgical guidance
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Eusebio Real, José M. Revuelta, Marta Mayorga, Alejandro Pontón, M. Calvo Díez, Jose Miguel Lopez-Higuera, José Fernando Val-Bernal, Olga M. Conde, and Universidad de Cantabria
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medicine.medical_specialty ,Aorta ,medicine.diagnostic_test ,business.industry ,Gabor wavelet ,Anomalies automatic identification ,Thoracic aorta ,medicine.disease ,Reflectivity ,Arterial wall ,Aneurysm ,Aortic wall ,medicine.anatomical_structure ,Optical coherence tomography ,OCT ,Homogeneous ,medicine.artery ,cardiovascular system ,Medicine ,Radiology ,business ,Artery - Abstract
The degradation of the wall in large cardiovascular vessels, such as the aorta artery, induces weakness in the vessel that can lead to the formation of aneurysms and the rupture of the vessel. Characterization of the wall integrity is assessed by OCT for future intraoperative assistance in aneurysm graft surgery interventions. Optical Coherence Tomography (OCT) provides cross sectional images of the wall of the aortic media layer. Wall degradations appear as spatial anomalies in the reflectivity profile through the wall thickness. Wall degradation assessment is proposed by automatic identification and dimensioning of these anomalies within the homogeneous surrounding tissue. more...
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- 2014
36. The Rheumatic Tricuspid Valve
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José M. Revuelta and José M. Icardo
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medicine.medical_specialty ,Tricuspid valve ,Heart disease ,business.industry ,Rheumatic disease ,medicine.disease ,Tricuspid valve disease ,medicine.anatomical_structure ,Internal medicine ,Distortion ,cardiovascular system ,Cardiology ,Medicine ,cardiovascular diseases ,TRICUSPID VALVE REPAIR ,business - Abstract
The tricuspid valve becomes frequently affected in the course of rheumatic heart disease but has often been overlooked. Morphological distortion and dysfunction of the mitral and aortic valves dominate the clinical picture in the rheumatic disease; consequently, most of the attention has been focused on the left-sided valves. Sixty years after open-heart surgery introduction, the timing of surgery and the optimal operation for tricuspid valve disease continues as a matter for discussion in most of international meetings. more...
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- 2014
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37. Identification of vessel wall anomalies in thoracic aortic aneurysms through optical coherence tomography and gradient-based strategies
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Jose Miguel Lopez-Higuera, Alma Eguizabal, Marta Mayorga, José M. Revuelta, Eusebio Real, J. Fernando Val-Bernal, Olga M. Conde, Alejandro Pontón, Marta Calvo Díez, and Universidad de Cantabria
- Subjects
Materials science ,medicine.diagnostic_test ,biology ,Optical coherence tomography ,business.industry ,Gradient-based image processing ,medicine.disease ,Reflectivity ,Aneurysm ,Optics ,Region of interest ,medicine.artery ,Digital image processing ,medicine ,biology.protein ,Thoracic aorta ,Aorta aneurysm ,Abnormality ,business ,Elastin ,Wall degradation ,Biomedical engineering - Abstract
Optical Coherence Tomography is a natural candidate for imaging biological structures just under tissue surface. Human thoracic aorta from aneurysms reveal elastin disorders and smooth muscle cell alterations when visualizing the media layer of the aortic wall, which is only some tens of microns in depth from surface. The resulting images require a suitable processing to enhance interesting disorder features and to use them as indicators for wall degradation, converting OCT into a hallmark for diagnosis of risk of aneurysm under intraoperative conditions. This work proposes gradient-based digital image processing approaches to conclude this risk. These techniques are believed to be useful in these applications as aortic wall disorders directly affect the refractive index of the tissue, having an effect on the gradient of the tissue reflectivity that conform the OCT image. Preliminary results show that the direction of the gradient contains information to estimate the tissue abnormality score. The detection of the edges of the OCT image is performed using the Canny algorithm. The edges delineate tissue disorders in the region of interest and isolate the abnormalities. These edges can be quantified to estimate a degradation score. Furthermore, the direction of the gradient seems to be a promising enhancement technique, as it detects areas of homogeneity in the region of interest. Automatic results from gradient-based strategies are finally compared to the histopathological global aortic score, which accounts for each risk factor presence and seriousness. more...
- Published
- 2014
38. Guías de práctica clínica de la Sociedad Española de Cardiología en cardiología intervencionista: angioplastia coronaria y otras técnicas
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Fernando Alfonso, Joaquín Alonso, Esplugas E, Jaime Elízaga, Andrés Iñiguez, José M. Revuelta, and Enrique Asín
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medicine.medical_specialty ,medicine.diagnostic_test ,Interventional cardiology ,business.industry ,medicine.medical_treatment ,Stent ,Guideline ,Balloon ,Atherectomy ,Angioplasty ,Internal medicine ,Intravascular ultrasound ,Cardiology ,Medicine ,Cutting balloon ,Cardiology and Cardiovascular Medicine ,business - Abstract
Interventional cardiology has had an extraordinary expansion in last years. This clinical guideline is a review of the scientific evidence of the techniques in relation to clinical and anatomic findings. The review includes: 1. Coronary arteriography. 2. Coronary balloon angioplasty. 3. Coronary stents. 4. Other techniques: directional atherectomy, rotational atherectomy, transluminal extraction atherectomy, cutting balloon, laser angioplasty and transmyocardial laser and endovascular radiotherapy. 5. Platelet glycoprotein IIb/IIIa inhibitors. 6. New diagnostic techniques: intravascular ultrasound, coronary angioscopy, Doppler and pressure wire. For the recommendations we have used the classification system: class I, IIa, IIb, III like in the guidelines of the American College of Cardiology and the American Heart Association. more...
- Published
- 2000
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39. The CarboMedics 'Top-Hat' supraannular prosthesis
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José M. Rabasa, José M. Bernal, José M. Revuelta, and Rafael Martín-Durán
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Adult ,Male ,Pulmonary and Respiratory Medicine ,Aortic valve ,medicine.medical_specialty ,Aortic root ,medicine.medical_treatment ,Heart Valve Diseases ,Prosthesis Design ,Prosthesis ,Valvula aortica ,Aortic prosthesis ,medicine ,Humans ,In patient ,Prospective Studies ,Aged ,Aged, 80 and over ,Heart Valve Prosthesis Implantation ,business.industry ,Hemodynamics ,Middle Aged ,Echocardiography, Doppler ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Aortic Valve ,Heart Valve Prosthesis ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
The CarboMedics "Top-Hat" supraannular prosthesis was designed to permit the implantation of a larger prosthesis.Between June 1993 and November 1996, 127 patients (average age, 61.8+/-10.2 years) received a CarboMedics "Top-Hat" supraannular aortic prosthesis. The average follow-up was 15.7 months, and all surviving patients underwent echocardiographic study. This group is compared with 656 patients in whom a standard CarboMedics prosthesis was implanted and also with 2,927 patients who received other aortic prostheses.Using the standard and the supraannular sizers, there was an average increase of one size in favor of the supraannular prosthesis: 18.9+/-2.8 mm standard versus 20.8+/-2.6 mm supraannular (p0.005). For each prosthesis size (19 to 23 mm), the body surface area of the patients in whom a CarboMedics supraannular prosthesis was implanted was significantly smaller than that in those who received a CarboMedics standard prosthesis or any other model. Hospital mortality was 3.9%, and late mortality was 5.5%. The actuarial survival was 86.5%+/-3.9% at 42 months.Using the CarboMedics supraannular prosthesis allows implantation of a larger prosthesis compared with the standard CarboMedics prosthesis or other models. This advantage is especially important in patients with a small aortic root. more...
- Published
- 1999
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40. The CarboMedics Valve: Experience With 1,049 Implants
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Carlos Morales, José M. Revuelta, Francisco Gutiérrez-García, José M. Rabasa, J. Francisco Nistal, and José M. Bernal
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Adult ,Male ,Reoperation ,Pulmonary and Respiratory Medicine ,Aortic valve ,medicine.medical_specialty ,Adolescent ,Rotation ,medicine.medical_treatment ,Prosthesis Design ,Prosthesis ,Postoperative Complications ,Valve replacement ,Aortic valve replacement ,Thromboembolism ,Internal medicine ,Mitral valve ,Humans ,Medicine ,Survival rate ,Aged ,Heart Valve Prosthesis Implantation ,business.industry ,Clinical performance ,Middle Aged ,medicine.disease ,Surgery ,Survival Rate ,medicine.anatomical_structure ,Aortic Valve ,Heart Valve Prosthesis ,Cardiology ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business ,Complication ,Follow-Up Studies - Abstract
The lack of valve rotatability, the structural deterioration, and the rate of valve-related complications with the standard mechanical bileaflet prosthesis led to the development of a new second-generation bileaflet valve in 1986.Between January 1989 and March 1994, 1,049 CarboMedics valves were implanted in 859 patients. The rotatability was used in 109 mitral prostheses (21.5%) and in 61 aortic prostheses (11.6%). Follow-up was 97.1% complete, with 3,049 patient-years.The hospital mortality was 6.9% for the mitral group, 3.4% for the aortic group, and 10.7% for the double-valve group (p0.005). The actuarial survival curve at 5 years was 77.3% +/- 3.6%, 90.1% +/- 2.5%, and 79.2% +/- 3.7% (p = 0.0003), freedom from thromboembolism was 89.1% +/- 3.6%, 87.1% +/- 3.8%, and 68.8% +/- 8.2%, freedom from reoperation was 95.9% +/- 1.4%, 98.9% +/- 0.6%, and 94.9% +/- 2.4%, and freedom from valve-related complications was 68.8% +/- 4.1%, 79.5% +/- 3.5%, and 55.3% +/- 5.9% after mitral, aortic, and mitral and aortic valve replacement, respectively. There were five episodes of valve thrombosis, but no structural deterioration occurred.The clinical performance of the CarboMedics valve is quite satisfactory, with a low incidence of valve-related mortality and morbidity. The rotatability feature was useful when the native valve was preserved or for repeat valve replacement. more...
- Published
- 1998
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41. Cirugía cardiaca en testigos de Jehová. Experiencia en Santander
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Manuel Trugeda, Carmen Diago, Aurelio Sarralde, José M. Revuelta, Sara Naranjo, and José M. Bernal
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business.industry ,Medicine ,Cardiology and Cardiovascular Medicine ,business ,Humanities - Abstract
Los testigos de Jehova constituyen una poblacion de dificil tratamiento para las intervenciones de cirugia cardiaca. Entre 1998 y 2004, todos los pacientes testigos de Jehova con indicacion de cirugia cardiaca (n = 10) fueron intervenidos por un mismo equipo. El descenso medio del hematocrito fue, durante la circulacion extracorporea, del 30%, durante el postoperatorio, del 35% y en el alta, del 22%. Un paciente preciso una reintervencion precoz por sangrado importante de origen esternal. Todos los pacientes fueron dados de alta y durante el seguimiento un enfermo fallecio de causa respiratoria. Las medidas para disminuir y recuperar la perdida de sangre permiten realizar intervenciones de riesgo hemorragico en pacientes testigos de Jehova. more...
- Published
- 2006
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42. Cardiac Surgery in Jehovah's Witnesses. Experience in Santander, Spain
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Sara Naranjo, José M. Revuelta, José M. Bernal, Aurelio Sarralde, Manuel Trugeda, and Carmen Diago
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Male ,medicine.medical_specialty ,Blood transfusion ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Blood Loss, Surgical ,General Medicine ,Middle Aged ,Hematocrit ,Multidisciplinary team ,humanities ,law.invention ,Cardiac surgery ,Surgery ,Respiratory failure ,law ,Cardiopulmonary bypass ,medicine ,Humans ,Female ,Cardiac Surgical Procedures ,Bloodless surgery ,business ,Jehovah's Witnesses - Abstract
As patients who are Jehovah's Witnesses are against blood transfusion, they are difficult to manage when a cardiac intervention is required. Between 1998 and 2004, all Jehovah's Witness patients with an indication for cardiac surgery (n=10) were operated on by the same multidisciplinary team. The mean fall in hematocrit was 30% during cardiopulmonary bypass, 35% during the postoperative period, and 22% at discharge. One patient required cardiac re-exploration because of sternal bleeding. All patients survived operation and were discharged. At follow-up, 1 patient died due to respiratory failure. Technological developments that reduce bleeding and enable lost blood to be recovered have made it possible to perform operations involving a risk of hemorrhage in Jehovah's Witnesses. more...
- Published
- 2006
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43. Incidental in vivo detection of an isolated hemangioma of the aortic valve in a man with a history of renal transplantation
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José M. Revuelta, M. Francisca Garijo, J. Fernando Val-Bernal, and Marta Cuadrado
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Male ,Aortic valve ,medicine.medical_specialty ,Sudden death ,Pathology and Forensic Medicine ,Heart Neoplasms ,Angioma ,Hemangioma ,medicine ,Humans ,cardiovascular diseases ,Heart valve ,Molecular Biology ,Incidental Findings ,Tricuspid valve ,business.industry ,Aortic Valve Stenosis ,Cell Biology ,General Medicine ,Middle Aged ,medicine.disease ,Kidney Transplantation ,eye diseases ,Surgery ,body regions ,Transplantation ,Treatment Outcome ,medicine.anatomical_structure ,Aortic Valve ,Aortic valve stenosis ,Chronic Disease ,sense organs ,business - Abstract
Hemangiomas of the cardiac valves are exceptional. To our knowledge, only ten cases of valve hemangiomas, six in the mitral and four in the tricuspid valve, have been reported in the English literature. We describe an incidentally detected aortic valve hemangioma of a 62-year-old man with chronic, degenerative aortic valve stenosis, who underwent renal transplantation 7 years before. We believe that this is the first report of a hemangioma in this localization and the first one in association with solid organ transplantation. The review of the literature of the adult cases of valve hemangioma, including this report, revealed that the average age was 47.2 years (range, 24 to 68 years). No clear sex predominance has been noted. Patients can be asymptomatic or experience sudden death. Symptomatic patients have complaints of palpitations, dyspnea, or syncopal episodes. Histologically, these valve tumors are classified as capillary, cavernous, and mixed. Mean tumor size is 1.1 cm (range, 0.6 to 2 cm). In 50% of cases the hemangioma is an incidental finding at autopsy or in a removed valve. Valve aortic hemangioma, despite its rarity, should be considered in the differential diagnosis of vascular lesions of this cardiac valve. more...
- Published
- 2006
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44. Poor clinical performance of the Wessex porcine heart valve bioprosthesis at nine years' follow up
- Author
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José M. Revuelta, Nistal Jf, and A. Hurlé
- Subjects
Male ,Aortic valve ,Cardiac Catheterization ,medicine.medical_specialty ,Prosthesis-Related Infections ,medicine.medical_treatment ,Prosthesis Design ,Valve replacement ,Aortic valve replacement ,Thromboembolism ,Internal medicine ,Mitral valve ,medicine ,Humans ,Heart valve ,Retrospective Studies ,Bioprosthesis ,Tricuspid valve ,business.industry ,Mitral valve replacement ,Endocarditis, Bacterial ,Middle Aged ,medicine.disease ,Prosthesis Failure ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Echocardiography ,Aortic Valve ,Heart Valve Prosthesis ,Heart catheterization ,Cardiology ,Mitral Valve ,Female ,Stents ,Tricuspid Valve ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies ,Research Article - Abstract
OBJECTIVE: To assess the long term performance of the Wessex porcine bioprostheses implanted in a consecutive series of patients. DESIGN: A retrospective case series. PATIENTS: Between January 1985 and July 1991, 184 Wessex bioprostheses (78 mitral, 102 aortic, and 4 tricuspid) were implanted in 150 patients. The patients were 55% (83/150) male and 45% (67/150) female; mean age was 60 (SD 10) years. RESULTS: Hospital mortality was 9.3% (14/150). Total follow up was 696 patient-years (mean 4.7 years per patient). Linearised rates (events per 100 patient-years (SEM) for postoperative complications for patients with isolated mitral valve replacement, isolated aortic valve replacement, and multiple valve replacement were, respectively: late mortality: 4.7 (1.6), 3.3 (0.9), and 4.9 (1.9); thromboembolism: 5.8 (1.8), 3.0 (0.9), and 2.8 (1.4); valve thrombosis: 1.0 (0.7), 0.3 (0.3), and 0.7 (0.7); structural failure: 5.8 (1.7), 1.9 (0.7), and 7.1 (2.2). Actuarial freedom from complications at nine years (70% confidence interval) was: late mortality: 61 (9)%, 57 (13)%, and 59 (12)%; thromboembolism and valve thrombosis: 71 (9)%, 79 (6)%, and 81 (8)%; structural failure: 33 (14)%, 50 (16)%, and 12 (14)%; all valve related morbidity/mortality: 31 (10)%, 21 (11)%, and 7 (9)%. Stent fractures appeared in 11 of 17 explanted prostheses; actuarial freedom from stent fracture at nine years was 66 (12)%. CONCLUSIONS: The Wessex bioprosthesis is associated with high thrombogenicity, early structural dysfunction, and a high valve related morbidity/mortality which justifies very close follow up of patients fitted with them. more...
- Published
- 1997
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45. Coagulación, genética y reestenosis postangioplastia
- Author
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Miguel Garcia-Ribes, Thierry Colman, José M. Revuelta, Miguel García-Fuentes, and Domingo González-Lamuño
- Subjects
Gynecology ,medicine.medical_specialty ,Disease susceptibility ,Platelet aggregation ,business.industry ,medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
En las ultimas decadas se han identificado diferentes factores relacionados con la estenosis coronaria, cuya manifestacion clinica, la cardiopatia isquemica, es la primera causa de muerte en los paises desarrollados. Distintos modelos experimentales han contribuido a definir alguno de estos factores, y a comprender la fisiopatologia de los sucesos que tienen lugar en la pared arterial durante la formacion de la lesion aterosclerotica. Actualmente se estan tratando de establecer las bases geneticas relacionadas con este fenomeno, que condicionan las diferentes respuestas individuales ante una misma situacion. Dado el papel fundamental de los mecanismos de reparacion endotelial en el desarrollo de estas lesiones, los pacientes que sufren un proceso de reestenosis tras ser sometidos a intervenciones de revascularizacion, son un modelo util para el estudio de posibles condicionantes geneticos en el desarrollo de la lesion aterosclerotica. Recogemos, de los diferentes trabajos de la bibliografia, aquellos factores geneticos relacionados con los procesos de la formacion del coagulo que pueden estar implicados en los fenomenos de reestenosis tras una angioplastia coronaria transluminal percutanea ( ACTP) , cuya caracterizacion podria ayudar a definir la terapeutica mas adecuada para cada individuo. Nos referimos a la reciente caracterizacion de los genes que codifican los receptores de membrana plaquetaria y su relacion con el fibrinogeno, a la implicacion del factor de la coagulacion Xa y del peptido inhibidor del activador del plasminogeno, asi como al papel que puede desempenar la apolipoprotei na ( a) en los fenomenos de coagulacion. COAGULATION, GENETICS AND REESTENOSIS POST-ANGIOPLASTY Throughout the last few decades, different factors have been related to coronary stenosis which is clinically evidenced by coronary heart disease, the leading cause of death in developed countries. Different experimental models have contributed towards defining some of these factors, and to an understanding of the physiopathology of the atherosclerotic lesion. The genetic basis related to individual responses to the same event is currently being established. As endothelial injury reparative mechanisms are fundamental in atherosclerosis pathogeny, patients who experiment restenosis after undergoing revascularization procedures are useful human models in the study of these processes. We review from the literature the genetic factors related to thrombus formation, which may be associated with restenosis after percutaneous transluminal coronary angioplasty, in order to define the most suitable anticoagulant therapy for each patient. We refer to the recently characterized gene for the platelet receptors and its relationship with fibrinogenus, factor Xa, PAI-1, and the involvement of apolipoprotein ( a) in the coagulation process. more...
- Published
- 1997
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- View/download PDF
46. Optical coherence tomography assessment of vessel wall degradation in aneurysmatic thoracic aortas
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José M. Revuelta, Marta Mayorga, Eusebio Real, Olga M. Conde, Alejandro Pontón, J. Fernando Val-Bernal, Jose Miguel Lopez-Higuera, Alma Eguizabal, and Universidad de Cantabria
- Subjects
medicine.medical_specialty ,Materials science ,Ascending thoracic aorta ,medicine.diagnostic_test ,Aneurysm diagnosis ,medicine.disease ,Elastin degradation ,Reflectivity ,Vessel wall ,Media layer ,Aneurysm ,Optical coherence tomography ,Smooth muscle ,OCT ,medicine ,cardiovascular system ,Cell structure ,Radiology ,Third order polynomial ,Biomedical engineering - Abstract
Optical coherence tomographic images of ascending thoracic human aortas from aneurysms exhibit disorders on the smooth muscle cell structure of the media layer of the aortic vessel as well as elastin degradation. Ex-vivo measurements of human samples provide results that correlate with pathologist diagnosis in aneurysmatic and control aortas. The observed disorders are studied as possible hallmarks for aneurysm diagnosis. To this end, the backscattering profile along the vessel thickness has been evaluated by fitting its decay against two different models, a third order polynomial fitting and an exponential fitting. The discontinuities present on the vessel wall on aneurysmatic aortas are slightly better identified with the exponential approach. Aneurysmatic aortic walls present uneven reflectivity decay when compared with healthy vessels. The fitting error has revealed as the most favorable indicator for aneurysm diagnosis as it provides a measure of how uniform is the decay along the vessel thickness. This work has been supported by the Spanish Government through CYCIT projects DA2TOI (FIS2010-19860), TFS (TEC2010-20224-C02-02) and the Alma’s Eguizabal PhD Grant (FPU12/04130) more...
- Published
- 2013
47. Clinical experience with the carbomedics valve: Early results with a new bileaflet mechanical prosthesis
- Author
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José M. Revuelta, Marco Gandarillas, J. Francisco Nistal, and Aquilino Hurlé
- Subjects
Adult ,Reoperation ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Hospital mortality ,Prosthesis Design ,Prosthesis ,Postoperative Complications ,Aortic valve replacement ,Valve replacement ,Internal medicine ,Humans ,Medicine ,Hospital Mortality ,Heart valve ,Aged ,Retrospective Studies ,business.industry ,Mitral valve replacement ,Middle Aged ,medicine.disease ,Surgery ,Treatment Outcome ,medicine.anatomical_structure ,Early results ,Aortic Valve ,Heart Valve Prosthesis ,Cardiology ,Mitral Valve ,STRUCTURAL DYSFUNCTION ,Cardiology and Cardiovascular Medicine ,business - Abstract
Between January 1989 and August 1992, 612 CarboMedics mechanical prostheses (CarboMedics, Inc., Austin, Tex.) (295 mitral, 308 aortic, and 9 tricuspid) were implanted in 504 patients: 189 patients had isolated mitral valve replacement, 209 had isolated aortic valve replacement, and 106 had multiple valve replacement. The total follow-up was 1182 patient-years. The hospital mortality rate was 7.4% for mitral valve replacement, 5.3% for aortic valve replacement, and 13.2% for multiple valve replacement. Linearized rates for the different complications for mitral valve replacement, aortic valve replacement, and multiple valve replacement (in events per 100 patient-years) were, respectively, as follows: late mortality, 2.6 +/- 0.8, 1.5 +/- 0.5, and 3.9 +/- 1.3; thromboembolism [correction of thromboembolim], 3.7 +/- 0.9, 3.1 +/- 0.8, and 3.9 +/- 1.3; valve thrombosis, 0.5 +/- 0.3 for mitral valve replacement and 0.4 +/- 0.4 for multiple valve replacement; anticoagulant-related hemorrhage, 2.8 +/- 0.8, 1.9 +/- 0.6, and 2.6 +/- 1.1; nonstructural dysfunction, 1.6 +/- 0.6, 0.8 +/- 0.4, and 3.5 +/- 1.2; and reoperation, 1.1 +/- 0.5, 0.4 +/- 0.3, and 3.1 +/- 1.1. Actuarial estimates of freedom from the different complications for mitral valve replacement, aortic valve replacement, and multiple valve replacement (at 5 years of follow-up for mitral valve replacement and aortic valve replacement and 4.5 years for multiple valve replacement) were, respectively, as follows: overall death, 83% +/- 4%, 89% +/- 2%, and 76% +/- 4%; thromboembolism or valve thrombosis, 88% +/- 3%, 91% +/- 2%, and 86% +/- 5%; anticoagulant-related hemorrhage, 89% +/- 3%, 95% +/- 2%, and 90% +/- 5%; nonstructural dysfunction, 97% +/- 1%, 98% +/- 1%, and 91% +/- 3%; and reoperation, 96% +/- 2%, 99% +/- 1%, and 87% +/- 5%. There were no instances of prosthetic structural dysfunction. The performance of the CarboMedics valve is satisfactory at 5 years of follow-up but thromboembolic and hemorrhagic phenomena are still serious complications of mechanical prostheses. more...
- Published
- 1996
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48. Commissural dehiscence of Carpentier-Edwards mitral bioprostheses: Explant analysis and pathogenesis
- Author
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Francisco Mazorra, Aquilino Hurlé, José M. Revuelta, J.Antonio Gutiérrez, and J.Francisco Nistal
- Subjects
Adult ,Male ,Reoperation ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Heart Valve Diseases ,Dehiscence ,Prosthesis ,Pathogenesis ,Mitral valve ,Internal medicine ,medicine ,Humans ,education ,Aorta ,Aged ,Retrospective Studies ,Bioprosthesis ,education.field_of_study ,business.industry ,Calcinosis ,Stent ,Middle Aged ,Commissure ,Prosthesis Failure ,Surgery ,medicine.anatomical_structure ,Heart Valve Prosthesis ,cardiovascular system ,Cardiology ,Mitral Valve ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,Complication ,business - Abstract
Manufacturing factors have seldom been implicated as a direct cause of structural deterioration of valvular bioprostheses; this phenomenon has generally been considered to be of a host-dependent origin. We analyzed the clinical and pathologic data from 12 Carpentier-Edwards mitral bioprostheses removed from 12 patients because of severe dysfunction and showing detachment of the porcine aortic wall from the stent in one commissure or more. These 12 prostheses were part of a group of 92 such valves that were explanted and displayed structural deterioration. They belong to a population of 405 Carpentier-Edwards bioprostheses implanted in the mitral position in our institution between May 1978 and November 1988. The patients included three men and nine women with a mean age of 54 ± 13 years. One patient had a history of chronic renal failure, and two had systemic hypertension. Prosthesis sizes were 29, 31, and 33 mm (n = 4 for each size). The models of the valves were 6625 (n = 8) and 6650 (n = 4). Mean duration of implantation of the prostheses was 99 ± 27 months (52 to 136 months) and did not differ depending on the model. There was no significant clustering of commissural detachments depending on valve size, year of implantation, or gender of the patient. No similar phenomenon was observed among 76 explanted aortic Carpentier-Edwards bioprostheses with structural deterioration from a population of 441 valves implanted during the same time frame. Native porcine aortic roots (n = 5) and aortic Carpentier-Edwards bioprostheses explanted because of structural deterioration (n = 4) were used as controls for comparison. Macroscopic examination showed single commissural dehiscence in 10 patients and double in two. Radiology disclosed no or mild mineralization in eight valves and no calcium in the area of aortic wall dehiscence, except for heavily calcified valves. Light microscopy evidenced a significant thinning of the aortic wall at the paracommissural level of mitral bioprostheses (351 ± 68 μm) compared with either aortic bioprostheses (526 ± 59 μm; p < 0.01) or control native porcine aortic roots (419 ± 50 μm; p < 0.01). No difference was found in terms of aortic wall thickness between detached (322 ± 42 μm) and intact (366 ± 74 μm) commissures in mitral bioprostheses. It is concluded that the dehiscence of the aortic wall from the Dacron cover of the stent in the commissural area of Carpentier-Edwards bioprostheses in the mitral position is most likely produced by its weakening, as a consequence of excessive trimming with elimination of the outer layers of the aorta, during the manufacturing process. The reason this phenomenon appears in mitral bioprostheses and in a particular commissure seems to be linked to the areas of concentration of mechanical stress. (J T HORAC CARDIOVASC SURG 95;110:688-96) more...
- Published
- 1995
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49. Lateral caval flap repair of adult sinus venosus atrial septal defect: a natural novel approach
- Author
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Carlos-A. Mestres, Marcos Murtra, and José M. Revuelta
- Subjects
Pulmonary and Respiratory Medicine ,Male ,Heart septal defect ,medicine.medical_specialty ,Vena Cava, Superior ,Vena cava ,business.industry ,Sinus venosus atrial septal defect ,medicine.disease ,Flap repair ,Heart Septal Defects, Atrial ,Surgical Flaps ,Surgery ,Internal medicine ,medicine ,Cardiology ,Humans ,Female ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine ,business - Published
- 2012
50. 147. Soporte mecánico circulatorio tras fallo primario del injerto como alternativa al retrasplante cardíaco
- Author
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C. Castrillo, Alejandro Pontón, J.A. Fernández-Divar, Miguel Llano, J.F. Gutiérrez, L. Díez Solórzano, V. Tascón, José M. Revuelta, J.A. Sarralde, and A. Canteli
- Subjects
business.industry ,lcsh:R ,lcsh:Surgery ,lcsh:Medicine ,Medicine ,Surgery ,lcsh:RD1-811 ,Cardiology and Cardiovascular Medicine ,business ,Humanities - Abstract
Introduccion La prevalencia del fallo primario del injerto (FPI) varia entre 1,4–30,7% y es responsable del 40% de mortalidad hospitalaria. Ocasionalmente, se precisan medios de soporte hasta la recuperacion o retrasplante. Objetivo Analizar la utilidad de soportes mecanicos en pacientes que sufren FPI tras trasplante cardiaco. Material y metodos En nuestro centro se han implantado 6 dispositivos a 6 pacientes con FPI. Hemos realizado un estudio descriptivo de esta cohorte analizando las causas, complicaciones y resultados a corto-medio y largo plazo. Resultados La edad media fue de 43 ± 11,3 anos (50% varones). Tres se trasplantaron en alarma 0. La edad de los donantes fue 35,6 ± 7,5. El tiempo de isquemia 193,8 ± 35 min y de circulacion extracorporea (CEC) 156,5 ± 39,8. Se realizo terapia antibiotica anticipada en todos los pacientes. Los 6 presentaron disfuncion ventricular derecha grave y fraccion de eyeccion del ventriculo izquierdo (FEVI) media de 38 ± 23,1% tras el procedimiento. Se implantaron 5 oxigenadores de membrana extracorporea (ECMO) venoarteriales y 1 asistencia biventricular Levitronix Centrimag®. Se pudieron retirar todos los dispositivos por considerar que el 100% de los pacientes se habian recuperado del FPI (sin retrasplante) a los 6,8 ± 5,3 dias del implante. Fallecio el paciente que habia sido portador de la asistencia biventricular a los 4 dias de la retirada del soporte por sepsis. El resto fueron dados de alta a los 64 ± 10,9 dias, permaneciendo estables tras un seguimiento de 341,4 ± 217,4 dias, con un seguimiento acumulado de 1.707 dias. Conclusiones El implante de asistencias en pacientes con FPI tras el trasplante supone un avance en el tratamiento de esta patologia. Es una tecnica rapida y segura que permite recuperar el organo trasplantado. more...
- Published
- 2012
- Full Text
- View/download PDF
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