RESUMEN
Device embolization is a rare major complication of atrial septal defect percutaneous closures which requires surgical management if noninvasive retrieval fails. We report a symptomatic delayed embolization of an Amplatzer septal occluder device into the left ventricle outflow tract tangled with the mitral valve, complicated with ventricular arrhythmias and cardiac tamponade during percutaneous retrieval attempt. Emergent surgical treatment was performed, requiring a combined approach through the right atrium and the aorta for surgical removal.
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Procedimientos Quirúrgicos Cardíacos/métodos , Remoción de Dispositivos/métodos , Embolia/etiología , Embolia/cirugía , Migración de Cuerpo Extraño/cirugía , Ventrículos Cardíacos , Válvula Mitral/cirugía , Dispositivo Oclusor Septal/efectos adversos , Anciano , Aorta , Arritmias Cardíacas/etiología , Taponamiento Cardíaco/etiología , Femenino , Atrios Cardíacos , Humanos , Resultado del TratamientoRESUMEN
Aortic regurgitation due to valve injury after blunt chest trauma is a rare condition that may be caused by leaflet or commissural rupture, aortic dissection, or a combination of both. The case is presented of a 48-year-old male patient with an aortic dissection and aortic valve commissural detachment and massive aortic regurgitation after a 12-meter vertical free fall and secondary thoracic blunt trauma. The aortic root tear and dissection was repaired with a continuous polypropylene 5/0 suture and subcommissural annuloplasty that restored the aortic valve geometry and resulted in a normally functioning aortic valve.
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Disección Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/cirugía , Válvula Aórtica/lesiones , Válvula Aórtica/cirugía , Traumatismos Torácicos/complicaciones , Heridas no Penetrantes/complicaciones , Accidentes por Caídas , Disección Aórtica/etiología , Insuficiencia de la Válvula Aórtica/etiología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Background To evaluate the influence of subclinical hypothyroidism (SCH) on the development of postoperative atrial fibrillation (AF) in patients undergoing aortic valve replacement surgery with extracorporeal circulation. Methods A prospective study in a tertiary hospital between July 2005 and December 2013 in which all patients undergoing aortic valve replacement with no other valve surgery were consecutively included. Patients who were in preoperative sinus rhythm were selected and they underwent thyroxine (T4) and thyroid-stimulating hormone determination in the month before surgery. Postoperative AF was defined as the development of AF during hospital admittance. Descriptive analysis and binary logistic regression were performed for the target variable. Results A total of 467 patients were studied, with 35 cases of SCH. The incidence of postoperative AF was 57% in the group with SCH versus 30.3% (p = 0.001) in the group without hypothyroidism, without significant differences in other postoperative complications. In the logistic regression analysis, the independent predictors of postoperative AF were SCH, age, and aortic clamping time. SCH multiplies the odds ratio of postoperative AF by 3.14 (95% confidence interval: 1.24-7.96). Conclusion SCH behaves like a risk factor for the development of postoperative AF in patients undergoing aortic valve replacement with extracorporeal circulation. Other studies are needed to determine whether preoperative T4 replacement therapy and/or more aggressive AF prophylaxis can prevent this complication in patients undergoing aortic valve replacement.
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Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Fibrilación Atrial/epidemiología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Hipotiroidismo/etiología , Anciano , Anciano de 80 o más Años , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/fisiopatología , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/epidemiología , Estenosis de la Válvula Aórtica/fisiopatología , Enfermedades Asintomáticas , Fibrilación Atrial/diagnóstico , Femenino , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Humanos , Hipotiroidismo/diagnóstico , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Prevalencia , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , España/epidemiología , Centros de Atención Terciaria , Factores de Tiempo , Resultado del TratamientoRESUMEN
We report a case of transapical mitral valve-in-valve implantation for a deteriorated bioprosthesis using the Edwards Sapien 3 prosthesis via the transapical approach. This case demonstrates the safety and feasibility of using the Edwards Sapien 3 prosthesis in treating degenerated bioprosthetic mitral valves.
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Implantación de Prótesis de Válvulas Cardíacas/métodos , Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Anciano de 80 o más Años , Bioprótesis , Ecocardiografía Transesofágica , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Falla de Prótesis , Riesgo , Resultado del TratamientoRESUMEN
We describe a technique that implants a rigid tricuspid annuloplasty ring over a previously inserted flexible ring for the treatment of recurrent tricuspid regurgitation. This technique avoids the trauma associated with the excision of a flexible ring in patients with friable annular tissue.
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Bioprótesis , Anuloplastia de la Válvula Cardíaca/instrumentación , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Insuficiencia de la Válvula Mitral/cirugía , Insuficiencia de la Válvula Tricúspide/cirugía , Anciano , Anuloplastia de la Válvula Cardíaca/métodos , Femenino , Estudios de Seguimiento , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Falla de Prótesis , Recurrencia , Reoperación/métodos , Medición de Riesgo , Esternotomía/métodos , Resultado del Tratamiento , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/etiología , UltrasonografíaRESUMEN
OBJECTIVE: Elevations of myocardial injury biomarkers after cardiac surgery without ablation of atrial fibrillation (AF) are related to perioperative myocardial ischemia and associated with an increased risk of mortality and cardiac events. However, there have not been any studies that examined the release of cardiac biomarkers after AF cryoablation procedures with concomitant cardiac surgery. The authors determined the levels of these biomarkers for 2 different procedures involving cryoablation and assessed their clinical implications. DESIGN: A prospective cohort study with cardiac surgical patients. SETTING: A tertiary care university hospital. PARTICIPANTS: One hundred fifty-two cardiac surgical patients. INTERVENTIONS: Patients underwent 1 of 2 different cryoablation approaches: the modified Cox-Maze (CM) III procedure (n = 63) or the isolated left atrial (LA) maze procedure (n = 89). Plasma levels of cardiac biomarkers were measured at 1, 6, 12, and 24 hours after surgery. Twenty-four-hour Holter monitoring was performed at 1 month and 1 year after surgery. MEASUREMENTS AND MAIN RESULTS: Both groups reached very high peak levels of CPK-MB (CM group, 368 ± 171.4 ng/mL and LA group, 203 ± 86.4 ng/mL) and troponin T (CM, 8 ± 4.5 ng/mL and LA, 3.4 ± 2.4 ng/mL). The CPK, CPK-MB, and troponin T levels were significantly higher in the modified CM group compared with the LA maze group. In the first 24 hours after surgery, the average CPK-MB and troponin T values were 78.2 ng/mL higher and 2.3 ng/mL higher, respectively, in the CM group compared with the LA group. In both groups, 79% of the patients remained free of AF at 12 months after surgery. CONCLUSIONS: Cryoablation in cardiac surgery causes the release of very high levels of myocardial injury biomarkers. The modified CM lesion causes a greater elevation of serum biomarker levels than the isolated LA maze procedure, but this increase does not seem to have an adverse effect on rhythm or overall outcome. Cryoablation is a safe and effective surgical treatment for AF.
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Fibrilación Atrial/cirugía , Procedimientos Quirúrgicos Cardíacos/métodos , Criocirugía/métodos , Lesiones Cardíacas/cirugía , Complicaciones Posoperatorias/cirugía , Anciano , Amiodarona/uso terapéutico , Anestesia , Antiarrítmicos/uso terapéutico , Anticoagulantes/uso terapéutico , Biomarcadores , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Puente de Arteria Coronaria/efectos adversos , Forma MB de la Creatina-Quinasa/sangre , Criocirugía/efectos adversos , Electrocardiografía Ambulatoria , Determinación de Punto Final , Femenino , Estudios de Seguimiento , Lesiones Cardíacas/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Estudios Prospectivos , Resultado del Tratamiento , Troponina T/sangreRESUMEN
OBJECTIVES: Durability of sutureless aortic bioprosthetic valves remains a major issue. The aim of this study was to assess structural valve deterioration (SVD) and bioprosthetic valve failure (BVF) of the Perceval bioprosthesis using the new proposed standardized definitions. METHODS: All patients who underwent aortic valve replacement with sutureless Perceval S prostheses up to September 2016 were included. Clinical and echocardiographic follow-up was performed. New standardized definitions were used to assess the durability of sutureless bioprosthetic valves. From 2013 to 2016, 214 patients were included. RESULTS: The mean age and EuroSCORE II were 79 years and 2.74. Thirty-day mortality was 0.47%. The survival rate was 96.8%, 88.1% and 85.7% at 1, 3 and 4 years, respectively. The median echocardiographic follow-up was 3.28 years. The mean pressure gradient was 11.3 mmHg. No cases showed evidence of severe SVD, 17 patients had moderate SVD with a mean pressure gradient of 24 mmHg and 8 patients had definite late BVF. The incidence of moderate SVD and BVF at 4 years was 8.8% and 2.9%, respectively. CONCLUSIONS: Mid-term follow-up to 6.3 years after aortic valve replacement with the Perceval bioprosthesis documents favourable haemodynamic and clinical outcomes and low rates of SVD and BVF.
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Estenosis de la Válvula Aórtica , Prótesis Valvulares Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Anciano , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Bioprótesis , Consenso , Humanos , Diseño de Prótesis , Resultado del TratamientoAsunto(s)
Neoplasias Cardíacas/diagnóstico por imagen , Hemangioma Cavernoso/diagnóstico por imagen , Adulto , Ecocardiografía , Ecocardiografía Transesofágica , Femenino , Atrios Cardíacos , Neoplasias Cardíacas/patología , Neoplasias Cardíacas/cirugía , Hemangioma Cavernoso/patología , Hemangioma Cavernoso/cirugía , Humanos , Tomografía Computarizada por Rayos XRESUMEN
In non-rheumatic atrial fibrillation (AF), left atrial appendage (LAA) is thought to be the source of embolism in 90% of the strokes. Thus, as recent clinical trials have shown the non-inferiority of percutaneous LAA closure (LAAc) in comparison to medical treatment, and despite a IIb recommendation in the latest guidelines for concomitant surgical LAAc, we sought to investigate the beneficial effect of LAAc in the surgical population. A meta-analysis model was performed comparing studies including any cardiac surgery with or without concomitant surgical LAAc reporting stoke/embolic events and/or mortality, from inception to January 2019. Twenty-two studies (280 585 patients) were included in the model. Stroke/embolic events both in the perioperative period [relative risk (RR) 0.66, 95% confidence interval (CI) 0.53-0.82; P = 0.0001] and during follow-up of >2 years (RR 0.67, 95% CI 0.51-0.89; P < 0.005) were significantly reduced in patients who underwent surgical LAAc (RR 0.71, 95% CI 0.58-0.87; P = 0.001). Regarding the rate of preoperative AF, LAAc showed protective effect against stroke/embolic events in studies with >70% preoperative AF (RR 0.64, 95% CI 0.53-0.77; P < 0.00001) but no benefit in the studies with <30% of preoperative AF (RR 0.77, 95% CI 0.46-1.28; P = 0.31). Postoperative mortality was also significantly lower in surgical patients with LAAc at the mid- and long-term follow-up. (RR 0.72, 95% CI 0.67-0.78; P < 0.00001; I2 = 0%). Based on these findings, concomitant surgical LAAc is associated with lower rates of embolic events and stroke in the postoperative period in patients with preoperative AF and also improves postoperative mortality in the mid- and long-term follow-up.
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Apéndice Atrial , Fibrilación Atrial , Procedimientos Quirúrgicos Cardíacos , Embolia , Accidente Cerebrovascular , Apéndice Atrial/cirugía , Fibrilación Atrial/cirugía , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Humanos , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/prevención & control , Resultado del TratamientoRESUMEN
Transcatheter valve implantation has become an alternative to open-heart conventional surgery in high-risk patients. We describe a new surgical technique that allows the implantation of a transcatheter valvular prosthesis through an open surgical approach to prevent the appearance of paravalvular leaks in patients with large native rings.
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Fuga Anastomótica/prevención & control , Implantación de Prótesis de Válvulas Cardíacas/métodos , Insuficiencia de la Válvula Pulmonar/cirugía , Fuga Anastomótica/diagnóstico por imagen , Prótesis Valvulares Cardíacas , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Pulmonar/diagnóstico por imagen , StentsAsunto(s)
Estenosis de la Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Marcapaso Artificial , Reemplazo de la Válvula Aórtica Transcatéter , Humanos , Incidencia , Válvula Aórtica/cirugía , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Diseño de Prótesis , Estenosis de la Válvula Aórtica/cirugía , Resultado del Tratamiento , Implantación de Prótesis de Válvulas Cardíacas/métodosRESUMEN
Surgery of both the ascending and descending aortic segments in the context of an acute aortic syndrome is one of the greatest challenges for the cardiac surgeon. In the case of surgery of the descending aorta, surgical risk increases due to the technical complexity, the required aggressive approach and because surgical indication is usually established as a result of complications and therefore involves, almost always, critically ill patients. The aging of the population is causing such surgery to be considered in an increasing number of octogenarians. The present review analyzes the available scientific evidence on the surgical indications and outcomes of these complex procedures in this population, particularly in the emergent scenario. Ascending and descending thoracic aortic diseases are reviewed separately, and the role of both the current risk scores and frailty assessments are comprehensively discussed.
RESUMEN
Aortic valve replacement (AVR) is the treatment of choice for aortic valve disease, with excellent results reported in the short- and long-term follow-up. Due to the increasing number of patient comorbidities and older age, various technical alternatives have been developed such as transcatheter aortic valve implantation and, more recently, sutureless valve bioprostheses. For patients with very high surgical risk, transcatheter implantation is becoming the top therapeutic option. However, the percutaneous technique still has major disadvantages including those related to implantation without excision of the diseased native valve without direct view of the annulus, which increases the probability of developing perivalvular leaks and a high percentage of atrioventricular block. Due to the need for aggressive crimping of pericardial layers, there is uncertainty about their long-term durability. A new technique for AVR using sutureless bioprosthesis has recently been developed. The main advantages of this technique are the excellent haemodynamic performance and fast deployment under direct view, thereby avoiding the knotting of surgical stitches, which is especially advantageous in more technically demanding procedures (e.g. minimally invasive surgery, calcified aortic root and reoperations). The good clinical results of these valves have been supported by scientific evidence, making it a feasible option for patients who are candidates for AVR using biologic prosthesis, especially for those with mid-high surgical risk for standard AVR and percutaneous transcatheter valve implantation. In this article, we review the latest evidence on these new prostheses, including their advantages and possible disadvantages.
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Válvula Aórtica/cirugía , Bioprótesis , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Prótesis Valvulares Cardíacas , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos sin Sutura/métodos , Humanos , Diseño de PrótesisRESUMEN
Preserving the subvalvular mitral valve apparatus during mitral valve replacement is extremely important to minimize progressive postoperative left ventricular remodeling and dysfunction. We describe a simple and reproducible surgical technique that prevents the complications that can occur after total mitral anterior leaflet preservation.
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Implantación de Prótesis de Válvulas Cardíacas/métodos , Válvula Mitral/cirugía , Obstrucción del Flujo Ventricular Externo/prevención & control , Bioprótesis , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Humanos , Válvula Mitral/fisiopatología , Diseño de Prótesis , Resultado del Tratamiento , Obstrucción del Flujo Ventricular Externo/etiología , Obstrucción del Flujo Ventricular Externo/fisiopatologíaRESUMEN
UNLABELLED: The long-term results of cryomaze in patients with longstanding persistent atrial fibrillation during concomitant surgical procedures are still uncertain. METHODS: Between 2006 and 2011, 150 consecutive patients with associated long-lasting permanent atrial fibrillation and associated heart disease underwent heart surgery were treated by biatrial Cox-Maze (63 patients) or by isolated endocardial or epicardial left atrial cryoablation (83 patients) concomitantly. The results at 3 years in these groups were compared with clinical monitoring, electrocardiography, 24-hour Holter, and echocardiography with measurement of the transmitral A wave at 1, 6 and 12 months and annually thereafter in all patients. RESULTS: Patients undergoing Cox-Maze IV ablation presented rates of freedom from atrial fibrillation of 97, 94, 89, 80 and 54% at 1, 6, 12, 24 and 36 months, respectively. In the 12-month follow-up, these differences were significant (p<.05). The independent risk factors of atrial fibrillation recurrence was isolated ablation of left atrium. CONCLUSIONS: Atrial fibrillation by cryothermia ablation had a high success rate before 2 years postoperatively. Recurrence of atrial fibrillation increased thereafter regardless of the technique used, although it was more intense and developed earlier in cases of monoatrial ablation. For the treatment of other long-lasting permanent atrial fibrillation cardiac surgery-associated pathology, an aggressive biatrial treatment with Cox maze ablation should be performed.
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Fibrilación Atrial/cirugía , Criocirugía/métodos , Atrios Cardíacos/cirugía , Anciano , Procedimientos Quirúrgicos Cardíacos/métodos , Femenino , Humanos , Masculino , Estudios Prospectivos , Recurrencia , Factores de TiempoRESUMEN
The customary recommendation is that oral anticoagulation be withdrawn a few months after cryoablation for atrial fibrillation, independently of left atrial mechanical contraction in patients in sinus rhythm. Recently, a 5-fold increase in stroke has been described in sinus-rhythm patients who lack atrial mechanical contraction. One aim of this study was to evaluate the efficacy of oral anticoagulation in preventing postoperative stroke in such patients. This prospective study divided 154 sinus-rhythm patients into 2 groups, depending on the presence (108 patients) or absence (46 patients) of left atrial mechanical contraction at 6 months after surgery, and monitored them annually for 5 years. Those without left atrial contraction were maintained on acenocumarol. The primary endpoint was the occurrence of ischemic stroke. The median follow-up period was 29 ± 16 months; 4 patients (2.5%), all belonging to the group with preserved atrial contraction, had ischemic stroke; the group of patients without left atrial contraction had no episodes of stroke during follow-up. Logistic binary regression analyses showed no evidence of factors independently predictive of stroke. Among anticoagulated patients in sinus rhythm without left atrial contraction, we found the incidence of stroke to be zero. In a small, nonrandomized group such as this, we cannot discount the element of chance, yet we suggest that maintaining anticoagulation might lower the incidence of stroke in this population.
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Anticoagulantes/administración & dosificación , Fibrilación Atrial/cirugía , Función del Atrio Izquierdo , Isquemia Encefálica/prevención & control , Criocirugía/efectos adversos , Accidente Cerebrovascular/prevención & control , Administración Oral , Anciano , Anticoagulantes/efectos adversos , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/epidemiología , Fibrilación Atrial/fisiopatología , Isquemia Encefálica/epidemiología , Supervivencia sin Enfermedad , Esquema de Medicación , Femenino , Humanos , Incidencia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Contracción Miocárdica , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , España/epidemiología , Accidente Cerebrovascular/epidemiología , Factores de Tiempo , Resultado del TratamientoRESUMEN
Myocardial ischaemia due to extrinsic left main coronary artery compression is unusual. Most cases are related to pulmonary hypertension with severe main pulmonary artery dilatation. An extremely rare cause is a left sinus of Valsalva aneurysm (SVA). We describe the case of a patient diagnosed of left SVA after a coronary angiography and aortography, whose initial clinical manifestation was an acute coronary syndrome complicated with an out-hospital resuscitated sudden cardiac death.