Unraveling the Etiology of Dilated Cardiomyopathy through Differential miRNA-mRNA Interactome.

Dilated cardiomyopathy (DCM) encompasses various acquired or genetic diseases sharing a common phenotype. The understanding of pathogenetic mechanisms and the determination of the functional effects of each etiology may allow for tailoring different therapeutic strategies. MicroRNAs (miRNAs) have emerged as key regulators in cardiovascular diseases, including DCM. However, their specific roles in different DCM etiologies remain elusive. Here, we applied mRNA-seq and miRNA-seq to identify the gene and miRNA signature from myocardial biopsies from four patients with DCM caused by volume overload (VCM) and four with ischemic DCM (ICM). Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis were used for differentially expressed genes (DEGs). The miRNA-mRNA interactions were identified by Pearson correlation analysis and miRNA target-prediction programs. mRNA-seq and miRNA-seq were validated by qRT-PCR and miRNA-mRNA interactions were validated by luciferase assays. We found 112 mRNAs and five miRNAs dysregulated in VCM vs. ICM. DEGs were positively enriched for pathways related to the extracellular matrix (ECM), mitochondrial respiration, cardiac muscle contraction, and fatty acid metabolism in VCM vs. ICM and negatively enriched for immune-response-related pathways, JAK-STAT, and NF-kappa B signaling. We identified four pairs of negatively correlated miRNA-mRNA: miR-218-5p-DDX6, miR-218-5p-TTC39C, miR-218-5p-SEMA4A, and miR-494-3p-SGMS2. Our study revealed novel miRNA-mRNA interaction networks and signaling pathways for VCM and ICM, providing novel insights into the development of these DCM etiologies.

Aortic valve replacement using minimally invasive surgery, a safe technique in our setting: experience of one center.

AIM: The aim of this study was to analyze the results of minimum access surgery in comparison with conventional surgery, especially in relation to post-operative (PO) mortality. MATERIALS AND METHODS: This study was retrospective observational study, employing regressions, and bivariate correlations in the statistical analysis. A total of 114 patients over 65 years of age referred to cardiac surgery: 57 subjects in the minimum access group and 57 subjects in the sternotomy group. The main variables of interest were: demographic variables, PO course, mainly mortality, as well as duration of admission to critical care and total admission time. RESULTS: The mean age was 73.11 years, with 52.6% of women and 47.4% of men, and no significant differences between the pre-operative characteristics of either group. Regarding mortality, this was lower in the minimum access group, statistically significant in the analysis using bivariate correlations. CONCLUSIONS: Aortic valve replacement using a minimally invasive approach is a safe technique in our environment, despite its necessary learning curve.

OBJETIVOS: Analizar los resultados de la cirugía de mínimo acceso en comparación con la cirugía convencional, especialmente en cuanto a la mortalidad postoperatoria. MATERIAL Y MÉTODOS: Estudio observacional retrospectivo, empleando regresiones y correlaciones bivariadas en el studio estadístico. Un total de 114 pacientes de más de 65 años derivados a cirugía cardíaca: 57 sujetos en el grupo de mínimo acceso y 57 sujetos en el grupo esternotomía. Las principales variables de interés: demográficas, evolución postoperatoria, sobre todo mortalidad, así como la duración del ingreso en cuidados críticos e ingreso total hospitalario. RESULTADOS: La edad media fue de 73,11 años, con un 52,6% de mujeres y 47,4% de hombres, y sin diferencias estadísticamente significativas entre las características preoperatorias de cada grupo. En cuanto a la mortalidad, ésta result más baja en el grupo de mínimo acceso, siendo estadísticamente significativo en el análisis por correlaciones bivariadas. CONCLUSIONES: La sustitución valvular aórtica mediante cirugía mínimamente invasive es una técnica segura en nuestro medio, a pesar de su curva de aprendizaje.

Análisis de la evolución de los operados mediante cirugía de mínimo acceso en nuestro hospital. ¿Presenta mejores resultados que la convencional? / Analysis of the evolution of those operated on with minimal access surgery in our hospital. Does it present better results than the conventional one?

Resumen La estenosis aórtica severa sintomática es la patología quirúrgica más prevalente en cirugía cardiaca y su sustitución aislada se ha realizado históricamente mediante esternotomía media completa. Sin embargo, se ha producido recientemente una gran revolución, especialmente tras la llegada de las prótesis aórticas sin suturas que, unido a un nuevo impulso por la cirugía cardiaca hacia un rumbo menos invasivo, ha provocado que el reemplazo de dicha válvula se lleve a cabo cada vez más frecuentemente por dichas prótesis y por incisiones de mínimo acceso. Por ello, realizamos una revisión de los casos intervenidos en nuestro servicio desde el inicio del programa de cirugía de mínimo acceso comparándolos con los resultados de los casos intervenidos en la misma época mediante cirugía convencional.

Abstract Symptomatic severe aortic stenosis is the most prevalent surgical pathology in cardiac surgery, and its isolated replacement has historically been performed by means of complete middle sternotomy. However, a great revolution has recently taken place, especially after the arrival of sutureless aortic prostheses that, together with a new impulse by cardiac surgery towards a less invasive course, has caused the replacement of said valve to be carried out more and more frequently due to these prostheses and minor access incisions. For this reason, we carried out a review of the cases operated on in our service from the beginning of the minimum access surgery program, comparing them with the results of the cases operated at the same time using conventional surgery.

Analysis of the evolution of those operated on with minimal access surgery in our hospital. Does it present better results than the conventional one? / Análisis de la evolución de los operados mediante cirugía de mínimo acceso en nuestro hospital. ¿Presenta mejores resultados que la convencional?

Symptomatic severe aortic stenosis is the most prevalent surgical pathology in cardiac surgery, and its isolated replacement has historically been performed by means of complete middle sternotomy. However, a great revolution has recently taken place, especially after the arrival of sutureless aortic prostheses that, together with a new impulse by cardiac surgery towards a less invasive course, has caused the replacement of said valve to be carried out more and more frequently due to these prostheses and minor access incisions. For this reason, we carried out a review of the cases operated on in our service from the beginning of the minimum access surgery program, comparing them with the results of the cases operated at the same time using conventional surgery.

La estenosis aórtica severa sintomática es la patología quirúrgica más prevalente en cirugía cardiaca y su sustitución aislada se ha realizado históricamente mediante esternotomía media completa. Sin embargo, se ha producido recientemente una gran revolución, especialmente tras la llegada de las prótesis aórticas sin suturas que, unido a un nuevo impulso por la cirugía cardiaca hacia un rumbo menos invasivo, ha provocado que el reemplazo de dicha válvula se lleve a cabo cada vez más frecuentemente por dichas prótesis y por incisiones de mínimo acceso. Por ello, realizamos una revisión de los casos intervenidos en nuestro servicio desde el inicio del programa de cirugía de mínimo acceso comparándolos con los resultados de los casos intervenidos en la misma época mediante cirugía convencional.

Biological or mechanical prostheses for isolated aortic valve replacement in patients aged 50-65 years: the ANDALVALVE study.

OBJECTIVES: The decision about whether to use a biological or a mechanical prosthesis for aortic valve replacement remains controversial in patients between 50 and 65 years of age and has yet to be addressed in a Mediterranean population. This research aimed to analyse long-term survival and major morbidity rates (30-day mortality, stroke, any prosthetic reoperation and major bleeding) within this population. METHODS: Our multicentre observational retrospective study included all subjects aged 50-65 years who had a primary isolated aortic valve replacement due to severe aortic stenosis at 7 public hospitals from Andalusia (Spain) between 2000 and 2015. Concomitant surgery, reoperations and endocarditis were the exclusion criteria. A total of 1443 patients were enrolled in the study (272 with biological and 1171 with mechanical valves). Multivariate analyses including a 2:1 propensity score matching (506 mechanical and 257 biological prostheses) were conducted. RESULTS: Bioprostheses were implanted in 18.8% (n = 272): 35% were women; the mean EuroSCORE-I was 3%. The mean follow-up was 8.1 ± 4.9 years in a matched sample: 8.8 ± 4.9 years in those receiving a mechanical vs 7.1 ± 4.5 years in those receiving a biological prosthesis (P = 0.001). In the paired sample, the 15-year survival rate was 73% in those who had a biological vs 76% in those who had a mechanical valve [hazard ratio (HR) 0.80, 95% confidence interval (CI) 0.54-1.20; P = 0.159]. No significant differences were observed in patients ≥55 years old (74% of 15-year survival in both groups: HR 0.88, 95% CI 0.56-1.34; P = 0.527). A higher rate of major bleeding was found in patients with a mechanical prosthesis (P = 0.004), whereas reoperation was more frequent among those with a biological prosthesis (P = 0.01). CONCLUSIONS: Long-term survival was comparable in patients above 55 years of age. Mechanical prostheses were associated with more major bleeding and bioprostheses, with more reoperations. A bioprosthesis in patients above 55 years old is a reasonable choice. CLINICAL TRIAL REGISTRATION NUMBER: NCT03239509.

High intensity focused ultrasound ablation for atrial fibrillation: results from the National Spanish Registry.

BACKGROUND: A National Spanish Registry to compile all patients treated with high intensity focused ultrasound (HIFU) energy for atrial fibrillation (AF) was created to evaluate the safety and efficacy of AF surgical ablation. METHODS: A national Spanish registry was created, and ten hospitals using HIFU to ablate AF joined it. A total of 412 patients undergoing cardiac surgery between 2006 and February 2013 were included. AF was divided between paroxysmal AF (33%) and persistent AF (67%) with a mean AF duration of 29.3±108.2 months. Mean left atrial diameter was 51.2±6.5 mm. Mean underlying heart disease were aortic valve disease (49.3%), ischemic disease (25.2%) and mitral disease (33.2%) Clinical follow-up of patients and a 6 months postoperative echocardiogram were performed in all patients. RESULTS: A pacemaker implantation was needed in 4.9% of patients with a perioperative stroke in 2.5%. Rhythm at discharge from hospital was sinus rhythm in 58%, AF in 35.9% and atrial flutter in 0.8% of patients. Sinus rhythm restoration at 6, 12, 24 and 36 months follow-up was achieved in 66.1%, 63.8%, 63.9% and 45.9% of patients respectively. Multivariate analysis showed paroxysmal AF and sinus rhythm restoration in the operating theatre as factors related to sinus rhythm long term restoration. CONCLUSIONS: The Spanish national registry showed an efficacy of AF ablation with the HIFU Epicor system of 66.1%, 63.8%, 63.9% and 45.9% at 6, 12, 24 and 36 months follow-up. There were no device-related complications.

An external open ring for isolated aortic valve repair.

Experience with repair of isolated aortic insufficiency (AI) is increasing, encouraged by the results of valve-sparing procedures. Current techniques associate the treatment of cusp prolapse with the reduction of the almost constantly dilated aortic annular base diameter. Although few series provided satisfying mid-term results in selected patients, the lack of standardization limits their widespread use. We developed a standardized aortic valve repair procedure for isolated AI (sinuses of Valsalva ≪40 mm), combining cusp repair with a subvalvular external aortic ring annuloplasty. Alignment of cusp free edges and resuspension of the cusp effective height are performed prior to implantation of the external subvalvular ring. The prosthetic ring is of an open configuration to allow its placement externally to the aorta and below the coronary arteries without detaching them from the aortic wall. Ring size is undersized by one size relative to annular base inner diameter measured intraoperatively. The aim of the ring is to reduce the dilated aortic annular base diameter while increasing coaptation height.

Prótesis aórticas biológicas no soportadas: resultado y control ecocardiográfico a un año / Aortic stentless bioprotheses: results and echocardiographic evolution in one year

Objetivos: En el presente estudio se realiza una valoración clínica y ecocardiográfica en pacientes a los que se les implantó una bioprótesis sin soporte de Toronto. Material: Presentamos 84 pacientes a los que se les implantó una bioprótesis de Toronto (80 Toronto SPV y 4 Toronto Root), con una edad media de 67 años, de los cuales el 71% presentaban estenosis aórtica degenerativa. Siete pacientes tenían endocarditis aórtica nativa activa. El 18% requirieron revascularización coronaria. Se les realizó ecocardiografía al alta hospitalaria y al año. Resultados: En el 70% de nuestros pacientes no hubo ninguna complicación postoperatoria. La causa de morbilidad más frecuente fue la fibrilación auricular. El seguimiento ecocardiográfico al año reveló una reducción significativa de los gradientes transvalvulares respecto al alta hospitalaria. La presencia de insuficiencia aórtica se presentó en 6% de nuestros pacientes. Conclusiones: La bioprótesis de Toronto es una alternativa con ventajas hemodinámicas importantes respecto a las bioprótesis con soporte. Sus principales indicaciones son pacientes mayores, con anillos aórticos pequeños y en casos de endocarditis previa

Objective: The present study was undertaken to evaluate mid term clinical and echocardiographic outcome after aortic valve replacement with the Toronto stentless valve bioprosthesis. Methods: Toronto stentless valve was implanted in 84 patients (80 Toronto SPV and 4 Toronto Root), with a mean age of 67 years. Preoperative diagnosis were aortic stenosis (71%).Seven patients presented active native aortic infective endocarditis. 18% required coronary artery by-pass surgery. Echocardiographic evaluation at the discharge and the year was done to them. Results: In 70% of these patients there was no postoperating complication. The main morbidity cause was the auricular fibrillation. The echocardiographic evaluation at year revealed a significant reduction of the mean gradient with respect to the discharge. The presence of regurgitation aortic appeared in 6% of our patients. Conclusions: Stentless bioprosthesis of Toronto is an alternative with important haemodinamic advantages. It main indication is in older patients, small aortic annulus and previous endocarditis