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Resumen Objetivo Este estudio analiza la frecuencia de las complicaciones postoperatorias tras la cirugia cardiaca, la incidencia del fracaso en el rescate (FR) y su relacion con la supervivencia. Metodos Desde enero del 2003 hasta diciembre del 2009, se intervinieron 2.750 pacientes adultos de cirugia cardiaca. Se analizaron 9 complicaciones postoperatorias. Para conocer las variables asociadas con alguna de estas complicaciones, se realizo analisis de regresion logistica multiple. La supervivencia se estimo mediante curvas de Kaplan-Meier y las complicaciones asociadas con la mortalidad se estimaron mediante regresion de Cox. Resultados La mortalidad hospitalaria fue 1,4% (IC del 95%, 1,01%-1,9%). La frecuencia de complicaciones postoperatorias fue del 38,5% (36,7%-40,4%) y el FR, 3,6% (2,5%-4,9%). La cirugia urgente (OR = 2,03, IC del 95%, 1,52-2,72), la insuficiencia renal cronica (OR = 1,50, IC del 95%, 1,25-1,80) y la edad ≥70 anos (OR = 1,42, IC del 95%, 1,20-1,68) fueron las variables que se asociaron con mas fuerza con las complicaciones seleccionadas. La supervivencia a los 5 anos fue del 93% en los pacientes sin complicaciones y el 83% en los pacientes con alguna de las complicaciones (p Conclusiones La incidencia de complicaciones postoperatorias en cirugia cardiaca oscila alrededor del 40% y aumenta la mortalidad hospitalaria aunque el FR fue muy bajo (3,6%; IC del 95%, 2,5-4,9).

Resumen Objetivo Averiguar si existe asociacion entre la transfusion perioperatoria de 1-2 unidades de hematies y la morbilidad hospitalaria, la mortalidad a 30 dias y la supervivencia a largo plazo en los pacientes operados en cirugia cardiaca. Diseno Estudio de cohorte prospectivo. Ambito UCI de un hospital universitario. Pacientes Se valoro a todos los pacientes mayores de 17 anos operados de cirugia cardiaca e ingresados en la UCI desde noviembre del 2002 hasta diciembre del 2009. Se analizo a los pacientes que no recibieron transfusion de hematies (n = 703) y a los que recibieron transfusion perioperatoria de 1-2 unidades de hematies (n = 959). Variables de interes Se analizo el efecto de la transfusion sobre la morbilidad hospitalaria y la mortalidad a 30 dias. El seguimiento de los enfermos dados de alta vivos del hospital finalizo el 31 de diciembre del 2011. La asociacion de la transfusion con la supervivencia a largo plazo se evaluo con el metodo de Kaplan-Meier. La evaluacion de los posibles factores predictivos de mortalidad a largo plazo se realizo mediante la construccion de modelos de regresion de Cox. Resultados La frecuencia de complicaciones postoperatorias cardiacas y no cardiacas fue mayor en los pacientes que recibieron transfusion. La mortalidad a 30 dias de estos ultimos fue mayor que en los pacientes no transfundidos (1% vs. 0,1%, p = 0,02). La presencia de anemia preoperatoria se asocio a un mayor uso de transfusion. La transfusion de hematies no fue un factor de riesgo de mortalidad a largo plazo (Hazard ratio = 1,4; intervalo de confianza del 95%, 0,9-2,1). Conclusiones La transfusion perioperatoria de 1-2 unidades de hematies en los pacientes operados de cirugia cardiaca se asocia a un incremento de la morbilidad hospitalaria y la mortalidad a 30 dias, y no tiene efecto en la mortalidad a largo plazo.

Background: The role that intensive care unit (ICU)-acquired pneumonia plays in the long-term outcomes of cardiac surgery patients is not well known. This study examined the association of pneumonia with in-hospital mortality and long-term mortality after adult cardiac surgery. Methods: A total of 2750 patients admitted to our ICU after cardiac surgery from January 2003 to December 2009 are the basis for this observational study. Patients who developed ICU-acquired pneumonia were matched with patients without it in a 1:2 ratio. The matching criteria were age, urgent or scheduled surgery, surgical procedure, and the propensity score for pneumonia. Multiple regression analysis was used to find predictors of hospital mortality. The relationship between pneumonia and long-term survival was analyzed with Kaplan-Meier survival estimates and a risk-adjusted Cox proportional regression model for patients discharged alive from hospital. Results: Pneumonia was diagnosed in 32 (1.2%) patients and there were 19 cases per 1000 days of mechanical ventilation. Patients with pneumonia had a significantly higher hospital mortality rate (28% vs 6.2%, P = .003) and a higher mortality at the end of follow-up (53% vs 19%, P < .0001) than those without it. Regression analysis showed that pneumonia was a strong predictor of hospital mortality. Five-year survival was as follows: pneumonia, 62%; control, 81%; and cohort patients, 91%. The Cox model showed that, after adjusting for confounding factors, patients with pneumonia (hazard ratio = 3.96, 95% confidence interval [CI]: 1.41-11.14) had poorer long-term survival. Conclusion: Pneumonia remains a serious complication in patients operated for cardiac surgery and is associated with increased hospital mortality and reduced long-term survival.

Introduction and objectives The prognosis of patients with severe aortic stenosis, low aortic gradient and preserved ejection fraction is controversial. Our study analyzed the prognosis of these patients and its relation to pressure gradient and aortic valve flow. Methods We performed a retrospective cohort study of 363 consecutive patients with severe aortic stenosis and preserved ejection fraction, divided into 4 groups, based on the presence of a systolic volume index greater or lower than 35 mL/m 2 and the presence of a mean aortic gradient greater or lower than 40 mmHg. Group I: normal flow, high gradient (n=169, 47%); group II: normal flow, low gradient (n=98, 27%); group III: low flow, high gradient (n=54, 15%), and group IV: low flow, low gradient (n=42, 12%). The primary endpoint was overall mortality. Results Independent risk factors for mortality were age (hazard ratio=1.04; 95% confidence interval, 1.01-1.08) and atrial fibrillation (hazard ratio=2.21; 95% confidence interval, 1.24-3.94). Surgical treatment was associated with longer survival in all groups (hazard ratio=0.25; 95% confidence interval: 0.13-0.49). Mortality was higher in patients with low flow than in those with with normal flow (26.6% vs 13.6%; P =.004). The most favorable mean prognosis was found in group II (hazard ratio=0.4; 95% confidence interval, 0.2-0.9). Conclusions Patients with severe aortic stenosis, normal ejection fraction and low aortic flow have a worse prognosis. Analysis of aortic flow by Doppler echocardiography is useful in risk stratification and therapeutic decision-making in patients with aortic stenosis.

Resumen Introduccion y objetivos El pronostico de los pacientes con estenosis aortica grave con bajo gradiente aortico y fraccion de eyeccion normal es controvertido. Nuestro estudio analiza el pronostico de estos pacientes y su relacion con el gradiente de presion y el flujo valvular aortico. Metodos Cohorte retrospectiva de 363 pacientes consecutivos con estenosis aortica grave y fraccion de eyeccion normal, dividida en cuatro grupos segun indice de volumen sistolico mayor o menor que 35 ml/m2 y gradiente aortico medio mayor o menor que 40 mmHg. Grupo I, flujo normal y gradiente elevado (n = 169; 47%); grupo II, flujo normal y bajo gradiente (n = 98; 27%); grupo III, bajo flujo y gradiente elevado (n = 54; 15%), y grupo IV, bajo flujo y bajo gradiente (n = 42; 12%). El objetivo primario es la mortalidad total. Resultados Los factores de riesgo independientes de mortalidad son la edad (hazard ratio = 1,04; intervalo de confianza del 95%, 1,01-1,08) y la fibrilacion auricular (hazard ratio = 2,21; intervalo de confianza del 95%, 1,24-3,94). El tratamiento quirurgico se asocia a mayor supervivencia en todos los grupos (hazard ratio = 0,25; intervalo de confianza del 95%, 0,13-0,49). Los pacientes con bajo flujo presentan mayor mortalidad que los pacientes con flujo normal (el 26,6 frente al 13,6%; p = 0,004). El grupo II muestra mejor pronostico (hazard ratio = 0,4; intervalo de confianza del 95%, 0,2-0,9). Conclusiones Los pacientes con estenosis aortica grave, fraccion de eyeccion normal y bajo flujo aortico presentan peor pronostico. El analisis del flujo aortico mediante ecocardiografia Doppler es util en la estratificacion de riesgo y en la toma de decisiones terapeuticas en pacientes con estenosis aortica.

Introduction and objectives: Evaluating patient outcomes following cardiac surgery is a means of measuring the quality of that surgery. The present study analyzes survival and the risk factors associated with mid-term mortality of patients undergoing cardiac surgery in Son Dureta University Hospital (Palma, Balearic Islands, Spain). Methods: From November 2002 thru December 2007, 1938 patients underwent interventions. Patients were stratified in 4 age groups. Of 1900 patients discharged from hospital, 1844 were followed until December 31, 2008. Following discharge, we constructed Kaplan-Meier survival curves and performed Cox regression analysis to determine which variables associated with mid-term mortality. Results: In-hospital mortality of the 1,938 patients was 1.96% (CI 95%, 1.36%-2.6%). Survival probability at 1, 3 and 5 years follow-up was 98%, 94% and 90%, respectively. Mean follow-up was 3.2 (0.01-6.06) years. Patients aged 70 years showed a lower survival rate than those aged

Evaluating patient outcomes following cardiac surgery is a means of measuring the quality of that surgery. The present study analyzes survival and the risk factors associated with mid-term mortality of patients undergoing cardiac surgery in Son Dureta University Hospital (Palma, Balearic Islands, Spain).From November 2002 thru December 2007, 1938 patients underwent interventions. Patients were stratified in 4 age groups. Of 1900 patients discharged from hospital, 1844 were followed until December 31, 2008. Following discharge, we constructed Kaplan-Meier survival curves and performed Cox regression analysis to determine which variables associated with mid-term mortality.In-hospital mortality of the 1,938 patients was 1.96% (CI 95%, 1.36%-2.6%). Survival probability at 1, 3 and 5 years follow-up was 98%, 94% and 90%, respectively. Mean follow-up was 3.2 (0.01-6.06) years. Patients aged ≥ 70 years showed a lower survival rate than those aged70 (log rank test, P.0001). At the end of follow-up, mortality was 6.5% (CI 95%, 5.4%-7.7%). Age ≥ 70 years, a history of severe ventricular dysfunction (ejection fraction30%), severe pulmonary hypertension, diabetes mellitus, preoperative anemia, postoperative stroke, and hospital stay were independently associated with mid-term mortality.Mid-term survival after discharge was highly satisfactory. Mid-term mortality varied with age and other pre- and postoperative factors.

Resumen Objetivo El papel de la anemia preoperatoria como factor de riesgo en la cirugia coronaria no esta bien establecido. El objetivo de este estudio es analizar la asociacion de la anemia preoperatoria con las complicaciones postoperatorias y la mortalidad hospitalaria en los enfermos operados de cirugia coronaria aislada en el Hospital de Son Dureta. Material y metodos Se incluyeron en este estudio todos los pacientes operados de cirugia coronaria aislada con circulacion extracorporea desde noviembre de 2002 hasta junio de 2007. La anemia preoperatoria se definio segun los criterios de la OMS como una hemoglobina inferior a 13 g/dl en los hombres e inferior a 12 g/dl en las mujeres. Los efectos adversos postoperatorios cardiacos y no cardiacos se analizaron en funcion de la presencia o ausencia de la anemia preoperatoria y de la estratificacion del riesgo quirurgico, sobre la base del valor del EuroSCORE logistico. Resultados Se incluyeron 623 pacientes. La incidencia de anemia preoperatoria fue del 34,5%. Esta incidencia fue mayor en pacientes con EuroSCORE de 4 o mas que con EuroSCORE inferior a 4 (el 41 y el 27%; p=0,0001). No hubo diferencias significativas entre la incidencia de complicaciones postoperatorias de los pacientes con anemia y sin anemia. La estancia media en la UCI y hospitalaria fue mas larga en los pacientes con anemia preoperatoria que en los pacientes sin ella (UCI: 3,2±2,5 dias y 3,7±2,8; p=0,004; hospitalaria: 17,5±11,3 dias y 14,7±10,2; p=0,001). La mortalidad hospitalaria fue del 0,8% (intervalo de confianza del 95%: 0,3–1,9). No hubo diferencias en la mortalidad de los pacientes con anemia preoperatoria y sin anemia preoperatoria (el 0,9 y el 0,7%; p=0,8). Conclusiones En este estudio, la anemia preoperatoria en los pacientes operados de cirugia coronaria aislada no se asocio con una mayor morbimortalidad hospitalaria, aunque la estancia hospitalaria fue mas larga. La limitacion del tamano de la muestra impide confirmar que la anemia preoperatoria sea o no un factor de riesgo en la cirugia coronaria.

Objective The present study examined the inhibitory effects of pyrophosphate, etidronate, and phytate on bovine pericardium calcification in vitro. Methods Bovine pericardium was glutaraldehyde fixed and then placed in a flow chamber in the presence of a synthetic physiological fluid alone (control) or the fluid plus various concentrations of pyrophosphate, etidronate, or phytate. Following a 96-h incubation, fragments were removed and assayed for calcification by measuring calcium and phosphorus levels. Results The data indicated that both pyrophosphate and etidronate at 1 mg/l (5.75 and 4.95 μM, respectively) inhibited bovine pericardium calcification, whereas neither agent had an effect at 0.5 mg/l (2.87 and 2.47 μM, respectively). Phytate was the most potent inhibitor of calcification, and the effects of this agent were apparent at levels as low as 0.25 mg/l (0.39 μM). Conclusions While pyrophosphate, etidronate, and phytate were all able to inhibit bovine pericardium calcification in vitro, phytate was found to be the most effective.

Cannulation of the axillary artery is one possible means of establishing cardiopulmonary bypass during surgery of the ascending aorta and aortic arch. Use of a Dacron graft for cannulation has a number of advantages. In this article, we report our experience with this technique in seven consecutive patients in whom we performed an ascending aorta replacement. The associated procedures involved were aortic root reconstruction using David's procedure in two patients, the Bentall procedure in one, the hemi-arch technique in two, the complete arch and elephant trunk technique in one, aortic valve repair in one, and Valsalva sinus reconstruction in one. Circulatory arrest with antegrade cerebral perfusion was carried out in three cases. There was no in-hospital mortality, and there were no vascular or infectious complications related to axillary access. One patient presented with transient paresthesia of the brachial plexus. In all cases, cardiopulmonary bypass flow was adequate.

La canulacion de las arterias axilares para instaurar la circulacion extracorporea es una alternativa en la cirugia del arco y la aorta ascendente. Su canulacion mediante una protesis de Dacron presenta ciertas ventajas. En el presente trabajo comunicamos nuestra experiencia con esta tecnica en 7 pacientes consecutivos. En todos se realize un recambio de la aorta ascendente. Se asociaron los siguientes procedimientos: reconstruccion de la raiz aortica segun tecnica de David en 2 pacientes, intervencion de Bentall en uno, hemiarco en dos, arco completo y trompa de elefante en uno, resuspension de velos aorticos en uno y reconstruccion de senos de Valsalva en uno. Se realizo parada circulatoria con perfusion anterograda en 3 casos. La mortalidad hospitalaria fue nula. No hubo complicaciones vasculares ni infecciosas del abordaje axilar. Un paciente presento una parestesia transitoria por afeccion del plexo braquial. El flujo de la circulacion extracorporeal fue adecuado en todos los casos.

Pathological calcification generally consists of the formation of solid deposits of hydroxyapatite (calcium phosphate) in soft tissues. Supersaturation is the thermodynamic driving force for crystallization, so it is believed that higher blood levels of calcium and phosphate increase the risk of cardiovascular calcification. However several factors can promote or inhibit the natural process of pathological calcification. This cross-sectional study evaluated the relationship between physiological levels of urinary phytate and heart valve calcification in a population of elderly out subjects. A population of 188 elderly subjects (mean age: 68 years) was studied. Valve calcification was measured by echocardiography. Phytate determination was performed from a urine sample and data on blood chemistry, end-systolic volume, concomitant diseases, cardiovascular risk factors, medication usage and food were obtained. The study population was classified in three tertiles according to level of urinary phytate: low (1.21 mu M). Subjects with higher levels of urinary phytate had less mitral annulus calcification and were less likely to have diabetes and hypercholesterolemia. In the multivariate analysis, age, serum phosphorous, leukocytes total count and urinary phytate excretion appeared as independent factors predictive of presence of mitral annulus calcification. There was an inverse correlation between urinary phytate content and mitral annulus calcification in our population of elderly out subjects. These results suggest that consumption of phytate-rich foods may help to prevent cardiovascular calcification evolution., This work was supported by grant PI14/00853 from the Ministerio de Economia y Competitividad (Gobierno de Espana), and by FEDER funds (European Union). JP expresses his appreciation to Ministerio de Educacion y Cultura (Gobierno de Espana) for the fellowship of the FPU program. BI expresses his appreciation to the Conselleria d'Innovacio i Energia del (Govern de les Illes Balears) for the doctoral fellowship. PS express her appreciation for the postdoctoral fellowship PD/009/2013 to the Conselleria de Educacio, Cultura i Universitats (Govern de les Illes Balears) and the European Social Fund through the ESF Operational Programme of the Balearic Islands 2013-2017.

Se presenta el caso de un paciente joven portador de un angiosarcoma primario de auricula derecha que se inicio clinicamente con cuadros de taponamiento cardiaco hematico de repeticion, y cuyo diagnostico se llevo a cabo por un estudio de resonancia magnetica. La reseccion quirurgica del tumor no impidio una evolucion desfavorable, con fallecimiento del paciente a causa de diseminacion metastasica.

Introduccion la tecnica de referencia para la correccion de la insuficiencia mitral por prolapso del velo posterior es la reseccion cuadrangular con anuloplastia, ofreciendo resultados reproducibles y una excelente durabilidad a largo plazo, aunque para ello necesitemos realizar resecciones amplias del velo posterior. Se han descrito tecnicas para limitar la reseccion de tejido con el objetivo de conseguir una mayor superficie de coaptacion. Material y metodos varon de 48 anos, asintomatico con contractilidad conservada, pero con el ventriculo ya ligeramente dilatado e insuficiencia mitral grado IV por prolapso de P2 por ruptura de cuerda entre P2-P3. Se realiza una reparacion mitral con reseccion triangular de P2 + neocuerda de politetrafluoroetileno (PTFE) 5/0, sin plicatura de anillo posterior, y anuloplastia con anillo semirrigido Edwards Physio II #32. Resultado la ecocardiografia al alta mostro un ventriculo no dilatado con funcion conservada. Valvula mitral correctamente reparada sin insuficiencia residual y con gradiente medio de 2 mmHg. En el postoperatorio unicamente destaca fibrilacion auricular postoperatoria, siendo dado de alta sin complicaciones. Conclusiones la reseccion limitada con neocuerdas en velo posterior permite una correcta reparacion mitral con una amplia superficie de coaptacion.

Introduccion la insuficiencia mitral (IM) isquemica secundaria a alteraciones segmentarias de la contraccion del ventriculo izquierdo (VI) es debida a una restriccion de la movilidad de los velos en sistole (tipo IIIb de Carpentier), impidiendo una correcta coaptacion. Se han descrito multiples tecnicas para su correccion, pero un numero significativo de pacientes presentan IM residual o recurrente. El anillo Edwards IMR es un anillo especificamente disenado para la correccion de esta patologia, aumentando especificamente la coaptacion en la comisura posterior. Metodos desde 2007 hasta 2011 hemos intervenido a 64 pacientes por IM isquemica, realizando revascularizacion coronaria e implante de anillo IMR en 58 pacientes y anuloplastia aislada en 6 (3 reintervenciones con puentes permeables). Se ha excluido 23 pacientes con IM por etiologia mixta. La IM preoperatoria era superior a III en 21 pacientes (32,8%), III en 35 (54,7%), inferior a III en 8 (12,5%, en 5 realizandose una ecocardiografia transtoracica (ETT) de esfuerzo, demostrando incremento de la IM). LA fraccion de eyeccion del ventriculo izquierdo (FEVI) preoperatoria media era 40,9%, presentando el 28% disfuncion ventricular grave (≤ 30%). Resultados la mortalidad operatoria fue 1 paciente (1,56%). La IM en el primer mes fue grado inferior a II en 57 pacientes (89%), grado II en 7 (8%), y grado III en 2 (3%), con un gradiente medio de 3,1 mmHg. Ningun paciente ha sido reintervenido durante este periodo. Conclusiones la reparacion de la IM isquemica con el anillo IMR ofrece unos buenos resultados clinicos con una excelente correccion de la IM. Es una tecnica simple y reproductible en la mayoria de pacientes con disfuncion tipo IIIb.

Objetivo Analizar el efecto de la disfuncion ventricular izquier-da grave (DSVS) en la mortalidad de la cirugia valvular aortica. Metodos Cuatrocientos treinta y cuatro pacientes intervenidos de sustitucion valvular ± cirugia coronaria por estenosis aortica grave. Se clasificaron en dos grupos seg? fraccion de eyeccion: igual o inferior a 35% y superior a 35%. Mediante curvas de supervivencia y analisis de regresion de Cox se estudio el efecto de la disfuncion ventricular en la mortalidad a medio plazo. Resultados La tabla 1 (mediana/%, rango IC) resume las principales variables. La mortalidad bruta hospitalaria observada fue 2,3% (n = 10). La tabla 2 (mediana/%, rango IC) resume las complicaciones postoperatorias. El tiempo medio de seguimiento fue 3,1 anos (1,9–4,2). La figura 1 muestra la probabilidad de supervivencia. El analisis de regresion de Cox mostro asociacion entre DSVS y mortalidad a medio plazo (hazard ratio [HR]: 2,8; intervalo de confianza [IC] 95%: 1,3–6,1). Conclusiones La DSVI (fraccion de eyeccion [FE] ≤ 35%) aumenta la mortalidad a medio plazo de los pacientes intervenidos por estenosis aortica grave.

Left ventricular free wall rupture is an unusual but highly lethal complication of acute myocardial infarction. We report on the extremely rare occurrence of a patient surviving two episodes of free wall rupture within a seven-month period. The first event happened in the course of an exercise testing after a seemingly uncomplicated inferior acute myocardial infarction; the second, seven months after the first, as a pseudoaneurysm in the setting of a new inferior wall infarction. Surgical repair was successful in both instances, with patient remaining asymptomatic in follow-up.

La rotura de musculo papilar es una afeccion poco frecuente, normalmente secundaria a una complicacion mecanica del infarto agudo de miocardio o a un traumatismo toracico. Presentamos el caso clinico de una paciente que presento una rotura espontanea completa de musculo papilar posteromedial e insuficiencia mitral severa secundaria, por necrosis aislada del papilar, sin lesiones coronarias angiograficas, que evoluciono a shock cardiogenico, requiriendo cirugia emergente de sustitucion valvular mitral, realizada con exito. Se ha revisado la escasa bibliografia clinica e histopatologica al respecto y se comentan los posibles mecanismos de dicha rotura.

Objetivo. El uso de modelos de predicción del riesgo de cirugía cardíaca permite comparar y evaluar la calidad asistencial entre distintos centros y países. El objetivo de este estudio fue valorar la eficacia del modelo EuroSCORE (European system for cardiac operative risk evaluation) en estimar el riesgo de mortalidad en la cirugía cardíaca de nuestro hospital. Pacientes y métodos. Se aplicaron los modelos EuroSCORE aditivo y logístico a todos los pacientes sometidos a cirugía cardíaca con circulación extracorpórea desde el inicio de la actividad, en noviembre de 2002, hasta febrero de 2006. Todos los datos se obtuvieron de una base de datos cumplimentada de forma prospectiva cuando los pacientes ingresaban en la Unidad de Cuidados Intensivos. Se comparó la mortalidad observada con la estimada en los siguientes subgrupos: cirugía cardíaca global, cirugía coronaria aislada, cirugía valvular aislada, cirugía valvular y coronaria combinada y cirugía de la aorta torácica. La discriminación del modelo se comprobó midiendo el área bajo la curva ROC (receiver operating characteristics curve). Resultados. Estudiamos a 1.053 pacientes que presentaron varias diferencias con la población del modelo EuroSCORE. La mortalidad global observada fue de 2,2% (IC 95%: 1,2-3,1). Los modelos EuroSCORE sobrevaloraron la mortalidad observada (aditivo 5% y logístico 4,6%). La mortalidad observada en la cirugía coronaria aislada fue del 1,2% y ambos modelos EuroSCORE la sobrevaloraron. El poder discriminante de ambos modelos fue bueno con un área bajo la curva ROC de 0,78 (score aditivo) y 0,79 (score logístico). Conclusiones. El uso de ambos modelos EuroSCORE sobrevalora la mortalidad global observada y la de los distintos subgrupos quirúrgicos de la cirugía cardíaca practicada en nuestro centro. Objective. The use of risk prediction models in cardiac surgery makes it possible to compare and evaluate health care quality between different institutions in countries. This study aimed to assess the performance of the European System for Cardiac Operative Risk Evaluation (EuroSCORE) model in estimating the risk of mortality of cardiac surgery patients of our hospital. Patients and methods. The additive and logistic EuroSCORE models were applied to all patients who underwent cardiac surgery with extracorporeal circulation from the time the cardiac surgery unit was opened in our center in November 2002 until February 2006. All data were obtained prospectively when the patients were admitted to the Intensive Care Unit. Mortality observed was compared with that estimated in the following subgroups: global cardiac surgery, isolated coronary surgery, isolated valvular surgery, combined valvular and coronary surgery and thoracic aorta surgery. Model discrimination was tested by determining the area under the receiver operating characteristic (ROC) curve. Results. We studied 1,053 patients who had several differences with the EuroScore model population. Overall observed mortality was 2.2% (95% CI 1.2 - 3.1). The EuroSCORE models overestimated mortality (additive predicted 5%, logistic predicted 4.6%). Mortality of coronary bypass graft surgery was 1.2% and both EuroSCORE models overestimated it. Discriminative power of both models was good with an Area under ROC curve for both models of 0.78 and 0.79. Conclusions. The use of both EuroSCORE models overestimated overall observed mortality and that of the different surgical subgroups of cardiac surgery performed in our institution.

170 Aortic intramural hematoma (AIH) is considered a precursor of aortic dissection. It is caused by vasa vasorum bleeding in the tunica media of the aortic wall. The incidence of AIH ranges from 3% to 53% of cases of acute aortic syndrome. The condition usually manifests as retrosternal pain with interscapular irradiation. It can progress to rupture or calcification, or it can regress. Aortic intramural hematoma is diagnosed by computed tomography (CT), magnetic resonance or transesophageal ultrasonography. The treatment is similar to that used in aortic dissection. The case presented is a 62-year-old patient in whom a 4×3.5×2.5-cm soft, bluish mass was unexpectedly discovered in the distal portion of the ascending aorta (AA) during coronary surgery. The adventitia presented a moderate inflammatory reaction with minor pericardial adhesions. The AA measured 4.5 cm in diameter in this area (Figure 1). A decision was made during surgery to replace the AA with a 30-mm dacron graft. Upon opening the surgical specimen, examination of the AIH showed integrity of the intima without continuity with the aortic lumen (Figure 2). The hematoma had a soft consistency and contained an organized reddish thrombus, probably a consequence of recent IM AG E S I N CA R D I O L O G Y

We describe the echocardiographic features of an unusual hemodynamic phenomenon of intermittent electromechanical dissociation during regular sinus tachycardia in a patient with prosthetic mitral valve thrombosis. Thrombolysis with a solution of recombinant tissue-type plasminogen activator resulted in the disappearance of electromechanical dissociation and was effective in stabilizing the patient's condition. The later discovery of panus covering the valve ring after the lysis of clots confirmed surgery as the definitive treatment.

) and 41.2±9.9 mm Hg, respectively. It was determined that the IVV (0.11±0.03 cm/s vs 0.15±0.02 cm/s, p

A newly designed temporary pacemaker wire has been tested in 20 patients who underwent open-heart operations. This new device has a small tip that stays securely buried in the myocardium, thus greatly reducing the risk of accidental dislodgment. In addition, the increase in thresholds during the postoperative period is slighter than with the standard electrode.

A patient with severe isolated right-sided cardiac failure of unknown origin is presented in whom three right ventricular endomyocardial biopsies obtained in different bioptome positions disclosed a yellowish material which was confirmed at histological examination as fat. At operation, a complete replacement of atrial and ventricular myocardium by fat was noted. this previously unreported use of endomyocardial biopsy is emphasized, especially when the differential diagnosis of isolated right-sided heart failure is considered.