Transcatheter aortic valve replacement using the new Evolut-Pro system: a prospective comparison with the Evolut-R device.

BACKGROUND: Evolut Pro (EVP) is a novel self-expandable aortic valve. This prosthesis consists of an external porcine pericardial wrap designed to reduce paravalvular leak (PVL), maintaining the benefits of its predecessor, the Evolut R (EVR). The aim was to compare the functional and clinical results in the short and medium term of the new EVP with the EVR system. METHODS: Consecutive patients receiving either the EVR (n=50) or the EVP (n=33) from June 2015 to October 2018 were compared. Baseline characteristics, cardiovascular imaging, procedural outcomes, short and mid-term follow-up outcomes were prospectively collected and assessed. RESULTS: Residual mild PVL was common and comparable in the two groups (EVR 79% vs. EVP 70%; P=0.4). In the EVR group, the presence of PVL was directly related to prosthesis size, but this correlation was not observed in the EVP group. Conduction abnormalities were more prevalent with the EVP, but these did not translate into a higher need of permanent pacemaker implantation. Vascular and bleeding complications were infrequent in both groups. At mid-term clinical follow-up (median survival time: EVR 11±0.3 months, EVP 12±0.2 months), the 1-year rate of adverse events was similar (EVR: 24%, EVP: 33%; P=0.3). CONCLUSIONS: Both protheses are effective for the treatment of severe aortic stenosis with excellent results at mid-term clinical follow up. The EVP remains associated with a significant rate of residual mild PVL that appears to be similar to that observed with EVR.

Influence of the Histopathological Features of the Lesion on the Diagnostic Yield of Fine-Needle Aspiration Cytology of Pancreatic Solid Lesions.

OBJECTIVE: The rate of pancreatic lesions has increased in recent decades due to the widespread use of advanced imaging techniques. Nowadays, a significant proportion of cases are incidentally discovered in asymptomatic patients and cytology is an important tool for the diagnosis and multidisciplinary management of these cases. STUDY DESIGN: In this study we retrospectively review the experience with pancreatic fine-needle aspiration cytology in the last 17 years at a single large tertiary hospital in Madrid, Spain. RESULTS: Our results indicate that more than 60% of pancreatic malignant lesions are cytologically confirmed before surgery and 30% of the patients are asymptomatic. Despite this, we have noted that the total number of malignant lesions surgically resected in our hospital has basically remained unchanged over the years, because incidental diagnosis is not always synonymous with resectability and a substantial number of patients are already metastatic at the time of diagnosis. Our series also shows an increase in the number of neuroendocrine tumors, which now represent almost 20% of all cytological diagnoses at our hospital. The sensitivity in our series is 70% and the false negative rate remains 30%, despite sample quality control by experienced cytologists and standardized technical conditions. Fibrosis and necrosis are the 2 features of the primary tumor that significantly and negatively influence the accuracy of cytologic diagnosis. CONCLUSION: We herein report our experience with cytologic diagnosis of pancreatic lesions in a single tertiary hospital. Our results confirm that cytology is a safe, reliable, and important tool for pancreatic lesion diagnosis and management.

Low-pressure cardiac tamponade: A case report.

A 57-year-old woman presented with a large idiopathic pericardial effusion with subsequent cardiac tamponade, in whom the intrapericardial pressure measured by pericardiocentesis was not elevated. The patient did not present with the classical clinical features of cardiac tamponade, requiring echocardiographic follow-up to make accurate diagnosis and treatment. This entity called low-pressure cardiac tamponade has been diagnosed anecdotally being an insidious condition that requires a high degree of suspicion. .

Sealing a ruptured non-culprit coronary plaque in a patient with acute myocardial infarction with bioresorbable vascular scaffolds.

A 49-year-old man was admitted to the emergency department suffering from a large anterior myocardial infarction that was treated by rescue PCI. The patient also had a moderate but complex lesion in the proximal segment of the right coronary artery. Optical coherence tomography showed striking images of a ruptured and ulcerated plaque with significant thrombus content. Although the lumen was not compromised, these unique findings prompted us to treat this non-culprit lesion. We selected a bioresorbable vascular scaffold with the aim of sealing and passivating this complicated and high-risk plaque.

Uso del introductor de Eschmann o Gum elastic bougie en intubación dificultosa prevista: presentación de dos casos clínicos / Use of Eschmann introducer or Gum elastic bougie

La intubación dificultosa prevista o inadvertida continúa siendo un problema en la práctica anestesiológica actual, dada las graves consecuencias que se pueden derivar del manejo inadecuado de la vía aérea. En este trabajo se presentan dos casos clínicos en los cuales se utilizó un recurso novedoso en nuestro medio para el manejo de una vía aérea dificultosa prevista: el introductior de Eschmann o "gum elastic bougie", que en ambos casos permitió realizar una intubación exitosa.