Subclinical thrombosis of the ascending aorta: a possible paraneoplastic syndrome.

Thrombosis of the ascending aorta is a rare, potentially lethal complication. We report the case of a 56-year-old woman with a massive but subclinic thrombosis of the ascending aorta after two cycles of chemotherapy due to an epidermoid lung carcinoma stage T3 N2 M0. An emergent aortic thrombectomy was performed under deep hypothermic circulatory arrest. This thrombotic event occurred in an arterial vessel with high laminar flow, which is extremely uncommon and did not present any clinical manifestation.

Early results of off-pump coronary artery bypass graft surgery using bilateral internal thoracic artery grafts in octogenarian patients during ten years.

OBJECTIVES: The aim of this study is to review the outcome of OP-CABG using bilateral internal thoracic artery (BITA) grafts in these patients in terms of morbidity and mortality. PATIENTS AND METHOD: Retrospective data from consecutive 64 octogenarian patients who underwent this surgery in the period between April 1998 and December 2007 were taken. Demographic data, risk factors, and details of surgical intervention and postoperative complications were analysed. RESULTS: The mean age was 81.8+/-1.8 years (males=78.1%). Expected mortality calculated by additive EuroSCORE was 7.1+/-1.9%. The mean of left ventricular ejection fraction was 57.3+/-12.3%. Unstable angina was the main presenting symptom in 70.3% of patients and 18.7% had recent acute myocardial infarction. Hospital morbidity and mortality rates were 60.9 and 6.2%, respectively. The most frequent complications were: respiratory (25%) and atrial fibrillation (17.2%). The means of stay in intensive care unit and total hospital stay were 2.4+/-1.9 and 7.6+/-3.7 days, respectively. CONCLUSION: Realizing OP-CABG using BITA grafts had a high rate of postoperative morbidity, however, the mortality rate was low.

Hybrid procedure for proximal arch and descending aortic aneurysms.

This report describes the feasibility of combined surgical and endovascular repair of extensive pathologies of the aorta with a specially hybrid procedure. An ascending aorta and proximal aortic arch aneurysm, involving the origin of the innominate artery, and a descending thoracic aorta aneurysm were simultaneously repaired in a 65-year-old man. The ascending aorta, proximal arch, and the origin of the innominate artery were replaced by Dacron grafts (InterVascular, Datascope, La Ciotat, France) under circulatory arrest and deep hypothermia. After weaning from extracorporeal circulation, the thoracoabdominal aneurysm was excluded with two endografts deployed in an antegrade fashion through a side branch of the ascending aorta graft.

Septic necrosis of the odontoid apophysis and cervical spondylodiscitis from Enterococcus faecalis endocarditis: a first report.

We describe a 75-year-old male patient who developed a general syndrome, with a fever of 39 degrees C, weight loss, and cervical pain, during the month following a urological procedure. The presence of positive blood cultures for Enterococcus faecalis, aortic vegetations, and severe aortic regurgitation observed with echocardiogram confirmed the diagnosis of infective endocarditis (IE). Magnetic resonance imaging of the spinal cord showed significant erosion and irregularities of the odontoid apophysis, with hyperintensity of bone marrow in T2-weighted images because of edema and inflammation. These findings suggested an infective necrosis of the odontoid apophysis. Despite the common occurrence of rheumatologic manifestations in IE, with prevalence rates of 25% to 44%, spondylodiscitis is rarely observed (5%-13%). The lumbar region is the most commonly involved. We found only one other reported case of cervical spondylodiscitis. The case we describe is the first report of septic necrosis of the odontoid apophysis associated with IE.

[Reconstruction of the right ventricular outflow tract using a Medtronic Freestyle aortic root bioprosthesis]. / Reconstrucción del tracto de salida del ventrículo derecho con raíz aórtica protésica Medtronic Freestyle.

Uncorrected, long-term pulmonary regurgitation leads to right ventricular dilatation and dysfunction in a significant percentage of patients. We used magnetic resonance imaging (MRI) before and after surgery to assess the effect of pulmonary valve replacement with the Medtronic Freestyle bioprosthesis on right ventricular function and volume in nine patients with pulmonary regurgitation or stenosis. Mean follow-up time was 26 (10) months. We observed a decrease in mean end-diastolic volume from 143.6 (85.1) mL/m2 to 74.1 (12.6) mL/m2 (P=.018) and, in end-systolic volume from 88.0 (50.3) mL/m2 to 35.8 (19.3) mL/m2 (P=.016). In pulmonary valve disease, extensive follow-up by MRI is essential for timely evaluation of the degree of right ventricular dilation or dysfunction and for selecting a suitable time for valve replacement. The Medtronic Freestyle bioprosthesis is a good surgical choice for pulmonary valve replacement as its use is associated with low morbidity and mortality and the successful normalization of ventricular volumes.

Reconstrucción del tracto de salida del ventrículo derecho con raíz aórtica protésica Medtronic Freestyle / Reconstruction of the right ventricular outflow tract using a medtronic freestyle aortic root bioprosthesis

La insuficiencia pulmonar no corregida conduce a la dilatación y disfunción del ventrículo derecho a largo plazo en un porcentaje importante de pacientes. Hemos analizado mediante resonancia magnética cardiaca (RMC) preoperatoria y postoperatoria el efecto del recambio valvular pulmonar con prótesis Medtronic Freestyle en la función y los volúmenes del ventrículo derecho en 9 pacientes con insuficiencia y/o estenosis pulmonar con seguimiento de 26 ± 10 meses. Observamos una disminución del volumen telediastólico medio desde 143,6 ± 85,1 hasta 74,1 ± 12,6 ml/m2 (p = 0,018), y del volumen telesistólico medio desde 88 ± 50,3 hasta 35,8 ± 19,3 ml/m2 (p = 0,016). La valvulopatía pulmonar requiere un seguimiento exhaustivo mediante RMC para determinar precozmente el grado de dilatación y disfunción del ventrículo derecho, y así decidir el momento idóneo para la sustitución valvular. La bioprótesis Freestyle en posición pulmonar es una opción quirúrgica adecuada, con una baja morbimortalidad y excelentes resultados en cuanto a restauración volumétrica ventricular (AU)

Uncorrected, long-term pulmonary regurgitation leads to right ventricular dilatation and dysfunction in a significant percentage of patients. We used magnetic resonance imaging (MRI) before and after surgery to assess the effect of pulmonary valve replacement with the Medtronic Freestyle bioprosthesis on right ventricular function and volume in nine patients with pulmonary regurgitation or stenosis. Mean follow-up time was 26 (10) months. We observed a decrease in mean end-diastolic volume from 143.6 (85.1) mL/m2 to 74.1 (12.6) mL/m2 (P=.018) and, in end-systolic volume from 88.0 (50.3) mL/m2 to 35.8 (19.3) mL/m2 (P=.016). In pulmonary valve disease, extensive follow-up by MRI is essential for timely evaluation of the degree of right ventricular dilation or dysfunction and for selecting a suitable time for valve replacement. The Medtronic Freestyle bioprosthesis is a good surgical choice for pulmonary valve replacement as its use is associated with low morbidity and mortality and the successful normalization of ventricular volumes (AU)

[Aortic valve replacement with a Cryolife O'Brien stentless bioprosthesis]. / Reemplazo valvular aórtico con bioprótesis no soportada de Cryolife O'Brien.

INTRODUCTION AND OBJECTIVES: The Cryolife O'Brien xenograft is a stentless bioprosthesis constructed from noncoronary leaflets from three porcine aortic valves. The aim of this study was to investigate short-term results after aortic valve replacement with this composite xenograft. METHODS: Since October 1993, Cryolife O'Brien bioprostheses have been implanted in 210 patients. The patients' mean age was 70.9 (7.5) years (range 23-83 years). The indication was aortic stenosis in 132 cases, aortic insufficiency in 25 cases, and both lesions in 53 cases. Valve function was studied by echocardiography preoperatively, at discharge, and 6 and 12 months postoperatively. RESULTS: The 30-day mortality rate was 5.2% (11/210). Over time, the mean gradients decreased and the effective area index increased. In addition, the left ventricular mass index, wall thickness, and septum thickness also decreased shortly after surgery. CONCLUSIONS: Use of the Cryolife O'Brien stentless bioprosthesis demonstrated satisfactory results at 1-year follow-up. Additional follow-up is required to assess the performance of this bioprosthesis over the long term.

Reemplazo valvular aórtico con bioprótesis no soportada de Cryolife O'Brien / Aortic valve replacement with a cryolife O'Brien stentless bioprosthesis

Introducción y objetivos. El xenoinjerto de Cryolife O'Brien es una bioprótesis no soportada, construida por valvas no coronarias de 3 válvulas aórticas porcinas. El objetivo de este estudio es investigar los resultados precoces después del reemplazo valvular aórtico con este xenoinjerto compuesto. Métodos. Desde octubre de 1993, la bioprótesis Cryolife O'Brien ha sido implantada en 210 pacientes. La edad media fue de 70,9 ± 7,5 años (intervalo, 23 y 83 años). La indicación fue estenosis aórtica en 132 casos, insuficiencia aórtica en 25 casos y doble lesión en 53 casos. Se ha estudiado la función valvular, mediante ecocardiografía preoperatoria, en el momento del alta y a los 6 y 12 meses del postoperatorio. Resultados. La mortalidad a 30 días fue del 5,2% (11/210). Los gradientes medios se reducen y el índice de área efectiva aórtica aumenta con el tiempo. El índice de masa ventricular izquierda, el grosor de la pared y el espesor del septo también se reducen de forma precoz en el postoperatorio. Conclusiones. El uso de la bioprótesis no soportada de Cryolife O'Brien ha mostrado unos resultados satisfactorios en el seguimiento a un año. Será necesario realizar seguimientos futuros para analizar el comportamiento de esta bioprótesis a largo plazo

Introduction and objectives. The Cryolife O'Brien xenograft is a stentless bioprosthesis constructed from noncoronary leaflets from three porcine aortic valves. The aim of this study was to investigate short-term results after aortic valve replacement with this composite xenograft. Methods. Since October 1993, Cryolife O'Brien bioprostheses have been implanted in 210 patients. The patients' mean age was 70.9 (7.5) years (range 23-83 years). The indication was aortic stenosis in 132 cases, aortic insufficiency in 25 cases, and both lesions in 53 cases. Valve function was studied by echocardiography preoperatively, at discharge, and 6 and 12 months postoperatively. Results. The 30-day mortality rate was 5.2% (11/210). Over time, the mean gradients decreased and the effective area index increased. In addition, the left ventricular mass index, wall thickness, and septum thickness also decreased shortly after surgery. Conclusions. Use of the Cryolife O'Brien stentless bioprosthesis demonstrated satisfactory results at 1-year follow-up. Additional follow-up is required to assess the performance of this bioprosthesis over the long term

Factores preoperatorios predictores de morbimortalidad. Mayor en la cirugía coronaria sin el uso de la circulación extracorpórea. Presentación del Canalejo Score / No disponible

Objetivos: Este es un estudio cooperativo entre el “Hospital Juan Canalejo” in A Coruña, Galicia España y el Cardiocentro “Ernesto Ché Guevara” de Villa Clara, Cuba. Este trabajo fue realizado con el objetivo de conocer cuáles son los factores de riesgo predictores de morbimortalidad mayor en los pacientes revascularizados sin el uso de la circulación extracorpórea (OPCABG) y mostrar un informe sobre la construcción del Canalejo Score. Método: De enero de 1997 a diciembre del 2002, un total de 762 pacientes fueron sometidos a cirugía de revascularización miocárdica sin el uso de la circulación extracorpórea en el servicio de cirugía cardiaca del Complejo hospitalario Juan Canalejo de A Coruña, Galicia, España. Fallecieron 25 pacientes lo que representa un 3,3% de total y presentaron complicaciones mayores 61 pacientes (8% del total de pacientes). Las variables estudiadas en cada paciente fueron recogidas de forma estudiadas en cada paciente fueron recogidas de forma prospectiva en la base de datos Apolo del servicio de cirugía cardiaca de nuestro Hospital. Para determinar las variables predictoras de presencia de eventos de interés se realizó un análisis de regresión logística utilizando como variable dependiente las complicaciones mayores y como covariables las variables que en el análisis univariado estuviesen asociadas a dichas variables o fuesen clínicamente o quirúrgicamente relevantes. Con dichas variables y teniendo en cuenta el coeficiente de regresión se calculó el score. (Canalejo score). La precisión y el poder discriminante del modelo fueron evaluados con curvas ROC. El Canalejo score fue validado en un total de 200 pacientes, de ellos 16 son fallecidos y 22 son complicaciones mayores que fueron sometidos a OPCABG durante el año 2004 en el Cardiocentro “Ernesto Ché Guevara” de Villa Clara, Cuba. Resultados y conclusiones. Las variables que modifican significativamente el riesgo de tener complicaciones mayores son: la insuficiencia renal, la arteriopatía periférica, la resucitación cardiopulmonar, la enfermedad del tronco de la arteria coronaria izquierda más los tres vasos coronarios con lesiones significativas, el antecedente de accidente cerebrovascular con secuelas, la inestabilidad hemodinámica y la fracción de eyección. El área bajo la curva con la probabilidad del modelo para predecir complicaciones mayores fue del 80% (AU)

Objective: This a cooperative study between “Juan Canalejo Hospital” in A Coruña, Galicia, Spain and “Ernesto Ché Guevara” heart Institute in Cuba. The aim of this study is to know the risk factors to predict greater morbidity in patients that underwent coronary artery bypass grafting surgery without extracorporeal circulation (OPCABG) and show the preliminary report about how we built the Canalejo score. Methods: Between January 1, 1997 and December 30, 2002, 762 patients underwent OPCABG in the cardiac service of Juan Canalejo Hospital in A Coruña, Galicia, Spain, Twenty five patients (3,3%) died in the first month postoperative and Sixty one patients (8%) had greater morbidity. The variables that were investigated in each patient were collected in prospect form in the Apolo database. To know the preoperative risk factors to predict greater morbidity a multivariate logistic regression analysis were developed. The Canalejo score was built with the variables to reach statistic significant in the logistic regression analysis. The Canalejo score was built with the variables to reach statistic significant in the logistic regression analysis. The weight of each variable into de score was calculated according the coefficient? In the logistic regression analysis. The weight of each variable into the score was calculated according the coefficient? In the logistic regression analysis. The accuracy of the model was assessed with ROC curve. The Canalejo score was validated in200 patients that underwent OPCABG in “Ernesto Ché Guevara” Heart Institute in Villa Clara, Cuba. Results and conclusions: The risk factors that results significant (p=0,05) in the morbidity logistic regression analysis were: ejection fraction, renal failure, peripheral vascular disease, preoperative cardiopulmonary resuscitation, left main trunk disease associated with significant stenosis in the three coronary vessel, preoperative hemodynamic instability, and history of cerebrovascular disease with sequel. The Canalejo score show an area under the ROC curve of 0,80 (80%) (AU)

[Preoperative risk evaluation in beating-heart coronary artery bypass surgery]. / Evaluación preoperatoria del riesgo en la cirugía coronaria sin circulación extracorpórea.

INTRODUCTION AND OBJECTIVES: Operative risk stratification scales for use in cardiac surgery have been developed for patients who undergo procedures using extracorporeal circulation. The aims of the present study were to investigate the use of six preoperative risk stratification scales in patients undergoing beating-heart surgery and to identify risk factors for major complications and mortality in our group of patients who underwent revascularization using this approach. PATIENTS AND METHOD: Between January 1997 and December 2002, we performed 762 coronary artery bypass operations on the beating heart; 61 patients suffered major complications (8%) and 25 died (3.3%). Risk factors for major complications and death were identified using logistic regression analysis of prospectively collected data. The following risk scores were calculated for each patient: Parsonnet 95, Parsonnet 97, Euroscore, Cleveland, Ontario, and French. Receiver operating characteristic curves were used to compare the ability of each scale to predict mortality and major complications. RESULTS: In our patient group, the preoperative variables associated with increased risk were: need for cardiopulmonary resuscitation, renal dysfunction, peripheral vasculopathy, and the presence of severe left main coronary artery disease, three-vessel disease, or an impaired ejection fraction. CONCLUSIONS: Mortality and major complications were best predicted by the Parsonnet 95 and Euroscore scales.

Evaluación preoperatoria del riesgo en la cirugía coronaria sin circulación extracorpórea / Preoperative assessment of risks: coronary bypass surgery

Los modelos de estratificación del riesgo quirúrgico en cirugía cardiaca han sido elaborados a partir de pacientes intervenidos con circulación extracorpórea. El objetivo del presente estudio es valorar como se comportan 6 modelos de riesgo preoperatorio en pacientes intervenidos sin circulación extracorpórea, así como conocer cuáles son los factores de riesgo predictores de complicaciones mayores y mortalidad en nuestros pacientes revascularizados mediante dicha técnica. Entre nero de 1997 y diciembre de 2002 se realizó cirugía de revascularización miocárdica sin el uso de circulación estracorpórea en un total de 762 pacientes consecutivos; de ellos, 61 (8 por ciento)presentaron complicaciones mayores y 25 (3,3 por ciento) murieron. A partir de variables recogidas de forma prospectiva, se calcularon mediante un análisis de regresión logística los factores predictores para complicaciones mayores y mortalidad. En cada uno de los pacientes se calcularon las escalas de riesgo Parsonnet 97, Euroscore, Cleveland, Ontario y Francesa. Mediante curvas ROC se comparó la capacidad de cada una de las escalas para predecir la mortalidad y la presencia de complicaciones mayores. En nuestra serie, las variables preoperatorias que aumentan significativamente el riesgo fueron:reanimación cardiopulmonar, la presencia de insuficiencia renal, la arteriopatía periférica, la presencia de enfermedad coronaria severa de tronco izquierdo en más de 3 vasos y la fracción de eyección deprimida. Las escalas de riesgo que mejor predicen la mortalidad y la presencia de complicaciones mayores fueron Parsonnet 95 y Euroscore(AU)

Evaluación preoperatoria del riesgo en la cirugía coronaria sin circulación extracorpórea / Preoperative risk evaluation in beating-heart coronary artery bypass surgery

Introducción y objetivos. Los modelos de estratificación del riesgo quirúrgico en cirugía cardíaca han sido elaborados a partir de pacientes intervenidos con circulación extracorpórea. El objetivo del presente estudio es valorar cómo se comportan 6 modelos de riesgo preoperatorio en pacientes intervenidos sin circulación extracorpórea, así como conocer cuáles son los factores de riesgo predictores de complicaciones mayores y mortalidad en nuestros pacientes revascularizados mediante dicha técnica.Pacientes y método. Entre enero de 1997 y diciembre de 2002 se realizó cirugía de revascularización miocárdica sin el uso de circulación extracorpórea en un total de 762 pacientes consecutivos; de ellos, 61 (8%) presentaron complicaciones mayores y 25 (3,3%) murieron. A partir de variables recogidas de forma prospectiva, se calcularon mediante un análisis de regresión logística los factores predictores para complicaciones mayores y mortalidad. En cada uno de los pacientes se calcularon las escalas de riesgo Parsonnet 95, Parsonnet 97, Euroscore, Cleveland, Ontario y Francesa. Mediante curvas ROC se comparó la capacidad de cada una de las escalas para predecir la mortalidad y la presencia de complicaciones mayores.Resultados. En nuestra serie, las variables preoperatorias que aumentan significativamente el riesgo fueron: la resucitación cardiopulmonar, la presencia de insuficiencia renal, la arteriopatía periférica, la presencia de enfermedad coronaria severa de tronco izquierdo en más de 3 vasos y la fracción de eyección deprimida.Conclusiones. Las escalas de riesgo que mejor predicen la mortalidad y la presencia de complicaciones mayores fueron Parsonnet 95 y Euroscore

Introduction and objectives. Operative risk stratification scales for use in cardiac surgery have been developed for patients who undergo procedures using extracorporeal circulation. The aims of the present study were to investigate the use of six preoperative risk stratification scales in patients undergoing beating-heart surgery and to identify risk factors for major complications and mortality in our group of patients who underwent revascularization using this approach.Patients and method. Between January 1997 and December 2002, we performed 762 coronary artery bypass operations on the beating heart; 61 patients suffered major complications (8%) and 25 died (3.3%). Risk factors for major complications and death were identified using logistic regression analysis of prospectively collected data. The following risk scores were calculated for each patient: Parsonnet 95, Parsonnet 97, Euroscore, Cleveland, Ontario, and French. Receiver operating characteristic curves were used to compare the ability of each scale to predict mortality and major complications.Results. In our patient group, the preoperative variables associated with increased risk were: need for cardiopulmonary resuscitation, renal dysfunction, peripheral vasculopathy, and the presence of severe left main coronary artery disease, three-vessel disease, or an impaired ejection fraction.Conclusions. Mortality and major complications were best predicted by the Parsonnet 95 and Euroscore scales

Valor de 6 escalas de riesgo para predecir mortalidad en la cirugía coronaria sin circulación extracorpórea / Value of six risk stratification models in cardiac surgery to predict mortality in coronary artery bypass grafting surgery without extracorporeal circulation

Objetivo: Los modelos de estratificación del riesgo quirúrgico en cirugía cardíaca han sido elaborados a partir de pacientes intervenidos con el uso de la circulación extracorpórea. Con el presente trabajo nos proponemos ver como se comportan 6 modelos de riesgo preoperatorio en pacientes intervenidos sin circulación extracorpórea (CEC). Método: En el período comprendido entre enero de 1997 y diciembre del 2002, 762 pacientes fueron sometidos a cirugía de revascularización miocárdica sin el uso de la circulación extracorpórea (OPCABG) por el servicio de cirugía cardíaca del Complejo Hospitalario Juan Canalejo de A Coruña, Galicia, España. Hubo 25 fallecidos lo que representa un 3,3% de mortalidad. Los datos correspondientes a cada paciente fueron recogidos de forma prospectiva en la base de datos Apolo del servicio de cirugía cardíaca. A cada uno de los pacientes le fueron calculados los siguientes scores de riesgo (Parsonnet 95, Parsonnet 97, Euroscore, Cleveland Clinic, Ontario y Francés). La comparación de diferentes escores para predecir mortalidad, se realizó por medio de curvas ROC. Resultados: Todos los scores mostraron diferencias estadísticamente significativas (p≤0,05) entre los vivos y los muertos. La probabilidad de muerte según los diferentes scores analizados no es lineal, sino que aumenta proporcionalmente con el incremento del valor del score. El score que mejor predice la mortalidad en nuestra serie es el Parsonnet 95, con un área bajo la curva del 90%, seguido del Euroscore y el Parsonnet 97 con un área bajo la curva del 86% y 82% Conclusión: Estos resultados nos permiten conocer que scores de riesgo que fueron diseñados con pacientes que fueron sometidos a cirugía cardíaca usando la CEC, pueden ser usados en los pacientes que serán sometidos a OPCABG (AU)

Objective: The risk stratification models have been developed in patients that underwent cardiac surgery using cardiopulmonary bypass and cardioplegic arrest. The aim of this study is to know how predict mortality six risk scores in patients that underwent coronary artery bypass grafting surgery without extracorporeal circulation (OPCABG). Methods: Between January 1, 1997 and December 30, 2002, 762 patients were submitted to OPCABG in the cardiac service of Juan Canalejo Hospital in A Coruña, Galicia, Spain. Twenty five patients (3,3%) died in the first month postoperative. The dates for each patient were collected in cardiac service Apolo database and were calculated the following risk scores: Parsonnet 95, Parsonnet 97, Euroscore, Cleveland Clinic, Ontario and Frances. The comparisons between different scores were made by ROC curves. Results: All risk scores showed statistic significant (p≤ 0,05) between alive and dead patients. The probability of dead is not lineal, but it is increase proportionality with the risk score value. The best score to predict mortality was Parsonnet 95 with an area under the ROC curve of 90%. Other scores that show a good value of ROC curve were Euroscore (0, 86) and Parsonnet 97 (0, 82). Conclusion: These results permit us to know that risk scores which were developed in patients that underwent cardiac surgery with cardiopulmonary bypass (CEC), can be used in patients that will undergo OPCABG (AU)

Valor de 6 escalas de riesgo para predecir mortalidad en la cirugía coronaria sin circulación extracorpórea / Value of 6 risk scores for predicting mortality in coronary bypass surgery

Los modelos de estratificación del riesgo quirúrgico en cirugia cardíaca han sido elaborados a partir de pacientes intervenidos con el uso de la circulación extracorpórea. Con el presente trabajo nos proponemos ver como se comportan 6 modelos de riesgo preoperatorio en pacientes intervenidos sin circulación extracorpórea. En el período comprendido entre enero de 1997 y diciembre del 2002, 762 pacientes fueron sometidos a cirugía de revascularización miocárdica sin el uso de la circulación extracorpórea (OPCABG) por el servicio de cirugía cardíaca del Complejo Hospitalario Juan Canalejo de A Coruña, Galicia, España. Hubo 25 fallecidos lo que representa un 3,3 por ciento de mortalidad. Los datos correspondientes a cada paciente fueron recogidos de forma prospectiva en la base de datos Apolo del Servicio de Cirugía Cardíaca. A cada uno de los pacientes le fueron calculados los siguientes scores de riesgo(Parsonnet 95, Parsonnet 97, Euroscore, Cleveland Clinic, Ontario y Francés). La comparación de diferentes escores para predecir mortalidad, se realizó por medio de curvas ROC(AU)

Transgenic expression in pig hearts of both human decay-accelerating factor and human membrane cofactor protein does not provide an additional benefit to that of human decay-accelerating factor alone in pig-to-baboon xenotransplantation.

This study investigated whether the coexpression of human decay-accelerating factor (hDAF) and human membrane cofactor protein (hMCP) on porcine organs provides an additional benefit to that of hDAF alone to prevent rejection. Heterotopic heart xenotransplantation was performed in baboons with either hDAF (n=5) or hDAF/hMCP (n=5) transgenic pig organs. The only immunosuppression given was GAS914 (a soluble Gal [alpha1-3] Gal polymer) and cyclosporine A. With the exception of one hDAF organ that failed from a left atrium thrombosis, all xenografts developed acute humoral xenograft rejection. Acute humor xenograft rejection occurred at a median time of 152 hr in hDAF hearts and 162 hr in hDAF/hMCP organs. Recipients of hDAF or hDAF/hMCP hearts did not differ in their patterns of serum antiporcine antibodies or in plasma levels of the soluble terminal complement complex sC5b-9. It is concluded that in this pig-to-baboon heterotopic heart transplant, model expression of hDAF/hMCP does not provide an additional benefit in prevention of rejection to that of hDAF alone.

Off-pump total arterial revascularization: our experience.

BACKGROUND AND AIM: Off-pump coronary artery bypass grafting with both the internal thoracic arteries, such as the Tector technique, can reduce the morbidity associated with extracorporeal circulation and aortic cross-clamp. The aim of the present study is to describe our experience and the results obtained. METHODS: From April 1998 to December 2003, the off-pump Tector technique was performed on 743 patients, of whom 621 were male (83.5%), with a mean age of 65.3 +/- 9.5 years (23-90). Preoperative risk factors were diabetes mellitus in 29.5% and peripheral vasculopathy in 14.7% of the patients. Angiography showed left main disease in 25.6% and triple-vessel disease in 50.3% of the patients, with a mean ejection fraction of 60%+/- 13% (23-88). Both the internal thoracic arteries were harvested using the skeletonization technique and were anastomosed as "Y" or "T" grafts. Intraoperative graft patency was checked using a Doppler flowmeter. RESULTS: A total of 2028 distal anastomoses were performed, the average being 2.7 (1 to 5) per patient. At least three distal anastomoses were undertaken in 62% of the patients. Postoperative complications included atrial fibrillation in 40 patients (5.4%), myocardial infarction in 24 (3.2%), mediastinitis and reoperation for bleeding in 7 (0.9%) and stroke in 3 (0.4%). Twenty-four patients (3.2%) died in the first month postoperatively. CONCLUSIONS: The off-pump Tector technique appears to be safe, showing a low surgical morbidity.

Autologous human serum for cell culture avoids the implantation of cardioverter-defibrillators in cellular cardiomyoplasty.

BACKGROUND: Current clinical experience with cellular cardiomyoplasty (using serum bovine-cultivated myoblasts) has demonstrated significant malignant ventricular arrhythmias and sudden deaths in patients. In some ongoing clinical trials the implantation of cardioverter-defibrillator is mandatory. We have hypothesized that contact of human cells with fetal bovine serum results after 3-week fixation of animal proteins on the cell surface, representing an antigenic substrate for immunological and inflammatory adverse events. METHODS AND RESULTS: Autologous myoblasts were transplanted into infarcted LV in 20 patients (90% males, mean age 62+/-8 years). Cells were cultivated in a complete human medium during 3 weeks, using the patients' own serum obtained from a blood sample or from plasmapheresis. Injections were performed during CABG (2.1 grafts/pt). All patients had an uneventful recovery. At a mean follow-up of 14 +/- 5 months without mortality, no malignant cardiac arrhythmias are reported. LV ejection fraction improved from 28 +/- 3% to 52 +/- 4.7% (p = 0.03), and regional wall motion score index (WMSI) from 3.1 to 1.4 (p = 0.04) in the cell-treated segments. Myocardial viability tests showed areas of regeneration. Patients moved from mean NYHA class 2.5 to class 1.2. CONCLUSIONS: A total autologous cell culture procedure was used in cellular cardiomyoplasty reducing the risk of arrhythmia. Human-autologous-serum cell expansion avoids the risk of prion, viral or zoonoses contamination. Since patients treated with noncultivated bone marrow cells are free of arrhythmia, the bovine-culture medium seems to be responsible for this complication. Cellular cardiomyoplasty may be efficient to avoid progression of ventricular remodeling and subsequent heart failure in ischemic heart disease.