Lesiones de SLAP. Experiencia sobre 100 casos / SLAP injuries. Experience about 100 cases

Introducción y objetivos: Las lesiones de SLAP tienen una frecuencia del 3.9% al 12%, siendo hasta del 35% en deportistas de contacto. Nuestro objetivo es revisar esta patología en nuestro centro, a propósito de 100 pacientes. Material y métodos: Estudio observacional, descriptivo y retrospectivo, sobre 100 pacientes. Analizamos edad media, sexo, lateralidad, profesión, tipo de SLAP, lesiones asociadas, técnica quirúrgica, complicaciones, test de Rowe, Constant y UCLA, entre otros datos.Resultados91% varones, 9% mujeres. Edad media de 41.2 ± 10.1 años, 69% derechos y 31% izquierdos. Hallazgos intraoperatorios: SLAP predo-minante, tipo II (62%). Lesiones del manguito rotador (21%), Bankart (8%) y Hill-Sachs (8%). Descompresión subacromial en el 52.3% y repa-ración del SLAP en el 64.8%, con 1.3 ± 0.9 arpones por paciente. Resultados: medios finales: Test Rowe: 81.5 ± 18.9 puntos; test de Constant 64.3 ± 18.8 puntos; test UCLA 25.4 ± 7.6 puntos. En las tipo II, realizamos una reinserción labral en el 78.5% de los casos, sin diferencias en cuanto a Constant respecto tenotomía/tenodesis: 65.2 +/- 18.3 frente a 55.1 +/- 18 puntos, p>0.05. Segui-miento 2 +/- 0.5 años. Conclusiones: Las lesiones de SLAP suponen una causa de omalgia a considerar. Su tratamiento artroscópico permite obtener resultados favorables y diagnosticar-tratar otras patologías concomitantes. En nuestra experiencia, en los casos tipo II realizamos reinserción labral, obteniendo mejores resultados que cuando se realizaba otra técnica, como la tenodesis, aunque de modo no significativo. (AU)

Introduction and objectives: SLAP lesions have a frequency of 3.9% to 12%, being up to 35% in contact sportsmen. Our objective is to review this pathology in our center, regarding about 100 patients. Material and methods: Observational, descriptive and retrospective study about 100 patients. We analyzed mean age, sex, laterality, type of SLAP, associated lesions, surgical technique, complications, Rowe, Con-stant and UCLA tests, among other data.Results91% males, 9% females. Mean age 41.2 ± 10.1 years, 69% right and 31% left. Intraoperative findings: predominant SLAP, type II (62%). Rota-tor cuff (21%), Bankart (8%) and Hill-Sachs (8%) injuries. Subacromial decompression in 52.3% and SLAP repair in 64.8%, with 1.3 ± 0.9 anchors per patient. Final mean results: Rowe test: 81.5 ± 18.9 points; Constant test 64.3 ± 18.8 points; UCLA test 25.4 ± 7.6 points. In type II, we performed labral reinsertion in 78.5% of the cases, with no differences in terms of Constant with re-spect to tenotomy/tenodesis: 65.2 +/- 18.3 vs. 55.1 +/- 18 points, p>0.05. Follow up 2 +/- 0.5 years. Conclusions: SLAP lesions are a cause of omalgia to be considered. SLAP`s arthroscopic treatment al-lows to obtain favorable results and to diagnose and treat other concomitant pathologies. In our experience, in type II cases we performed labral reinsertion, obtaining better results than another technique, such as tenodesis, although it was not significative. (AU)

Lipoma arborescente en hombro, una inusual causa de omalgia / Orborescent lipoma on the shoulder, an unusual cause of omalgia

Introducción: El lipoma arborescente supone tan sólo el 3-5% de los lipomas. El tratamiento artroscópico de esta lesión, junto a una sutura de manguito, son infrecuentes, describiéndose sólo 5 casos, de los cuales sólo 4 presentaban roturas de manguito. Nuestro objetivo es presentar un caso y revisar esta patología. Material y Métodos: Paciente de 55 años, varón, con omalgia derecha. Ecografía: Derrame articular subdeltoideo con mamelones hiperecogénicos, sesiles. RNM: Derrame articular con formaciones ramificadas interiores con señal grasa. Tendinosis, rotura parcial del supraespinoso. Tras ausencia de respuesta conservadora, realizamos sinovectomía artroscópica, descompresión subacromial, biopsia, bursec-tomía y sutura de manguito. Resultados: Lipoma arborescente. Tras 5 meses de rehabilitación, alcanzó un Constant de 92 puntos.DiscusiónEl lipoma arborescente se presenta de modo primario, o bien secundariamente a Artritis Reumatoide, Psoriasis, traumatismos repetitivos, artritis séptica o de modo concomitante a Diabetes o Tuberculosis. Su diagnóstico diferencial es con la sinovitis villonodular pigmentada, ostocondramatosis sinovial, liposarcoma o el hemangioma sinovial. El tratamiento consiste en infiltraciones de corticoides, sinovectomía de radioisótopos (Y-citrato coloidal) o la sinovectomía quirúrgica, abierta o artroscópica, pudiendo tratar lesiones asociadas. Como conclusión, el lipoma arborescente es una causa infrecuente de omalgia y cuyo tratamiento artroscópico obtiene resultados favorables, de modo menos invasivo.(AU)

Introduction: The arborescent lipoma accounts for only 3-5% of lipomas. Arthroscopic treatment of this lesion, together with a cuff suture, is unusual, with only 5 cases described, of which only 4 presented cuff tears. Our aim is to present a case and review this pathology. Material and Methods: 55-year-old male patient with right shoulder pain. Ultrasound: Subdeltoid joint effusion with sessile, hyperechoic pedicles. MRI: Joint effusion with interior branching formations with a fat signal. Tendinosis, partial rupture of the supraspinatus. After the absence of a conservative response, we performed arthroscopic synovectomy, subacromial decompression, biopsy, bursectomy, and rotator cuff suture. Results: Arborescent lipoma. After 5 months of rehabilitation, he reached a Constant’s score of 92 points.Discussion: Arborescent lipoma presents primarily, or secondarily to Rheumatoid Arthritis, Psoriasis, repetitive trauma, septic arthritis or concomitantly to Diabetes or Tuberculosis. Its differential diagnosis is with pigmented villonodular synovitis, synovial ostochondramatosis, liposarcoma or synovial hemangioma. Treatment consists of corticosteroid infiltrations, radioisotope synovectomy (Y-colloidal citrate) or surgical, open or arthroscopic synovectomy, which can treat associated lesions. In conclusion, arborescent lipoma is an infrequent cause of shoulder pain and whose arthroscopic treatment obtains favorable results, in a less invasive way.(AU)

Mid-term assessment of structural valve deterioration of perceval S sutureless prosthesis using the last European consensus definition.

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.

Postoperative Plasma Mitochondrial DNA and Cytokine Profiles of Elderly Patients Undergoing Minimally Invasive Aortic Valve Replacement.

INTRODUCTION: Mitochondrial DNA (mtDNA) is gaining increasing interest as a marker of cellular damage and could also act as an inflammatory mediator in cardiopulmonary bypass induced postoperative inflammatory response. Although minimally invasive heart valve surgery reportedly reduces inflammation, the mtDNA and cytokine profile in this context remains unclear. MATERIALS AND METHODS: Here, we report a prospective series of 40 elderly patients with aortic stenosis who underwent bioprosthetic aortic valve replacement (AVR) through upper ministernotomy with either a sutureless (n = 20) or a conventional (n = 20) valve. Primary end points included serial plasma levels of mtDNA (T1: at baseline; T2: 4 hours after surgery; and T3: 24s hour after surgery), cytokines (interleukin-6 [IL-6], tumor necrosis factor-α [TNF-α]), and myocardial necrosis biomarkers (MNBs), whereas secondary end points included clinical and echocardiographic data. RESULTS: Significant increases in the postoperative plasma levels (T2) of mtDNA, cytokines, and MNBs were observed in all patients. The postoperative plasma levels of mtDNA, TNF-α, and MNBs showed no significant differences between the treatment groups, although there was a trend toward lower levels in the sutureless group. The decreases in aortic cross-clamp and cardiopulmonary bypass times seen in the sutureless group were associated with significant lower postoperative levels (T2 and T3) of IL-6. CONCLUSION: AVR through upper ministernotomy was associated with a significant increase in postoperative plasma levels of mtDNA and cytokines. There was no difference in the mtDNA levels between the sutureless and conventional valve groups, suggesting a similar level of inflammation in both groups. However, the shorter operation time observed in the sutureless valve group was associated with significantly lower postoperative levels of IL-6, indicating potential clinical benefits.

Abordaje mínimamente invasivo para la asistencia biventricular con bombas centrífugas: primera experiencia en España / Minimally invasive approach for biventricular assist device with centrifugal pump: first experience in Spain

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Galectina-3 circulante tras el trasplante cardiaco: dinámica a largo plazo y valor pronóstico / Circulating galectin-3 following heart transplant: long-term dynamics and prognostic value

Introducción y objetivos Los valores plasmáticos de galectina-3 (Gal-3) están elevados y se correlacionan con la mortalidad total y cardiovascular en pacientes con insuficiencia cardiaca, pero su correlación con el pronóstico tras el trasplante cardiaco (TxC) es desconocida. El objetivo fue describir la tendencia evolutiva y el valor pronóstico de este biomarcador tras el TxC. Métodos Mediante enzimoinmunoensayo, se midieron las concentraciones plasmáticas de Gal-3 en muestras de suero de 122 receptores de TxC, antes y 1, 3, 6 y 12 meses después de este. Mediante regresión de Cox se analizó el valor pronóstico del valor plasmático de Gal-3 a los 12 meses del TxC. El objetivo primario del estudio fue la variable combinada muerte o disfunción del injerto. Resultados: Las concentraciones de Gal-3 disminuyeron progresivamente durante el primer año tras el TxC (medianas: pretrasplante, 19,1 ng/ml; 1 año postrasplante, 14,6 ng/ml; p<0,001). Los valores de Gal-3 1 año tras el TxC se asociaron con mayor riesgo de muerte o disfunción del injerto (HR por 1 ng/ml: 1.04; IC95%: 1,01-1,08; p=0,008). La capacidad predictiva del biomarcardor fue moderada: área bajo la curva ROC, 0,72 (IC95%: 0,60-0,82; p<0,001). Conclusiones Las concentraciones plasmáticas de Gal-3 disminuyeron progresivamente durante el primer año tras el TxC. Un valor plasmático elevado de Gal-3 1 año tras el TxC se correlacionó con un pronóstico adverso

Introduction and Objectives: Circulating galectin-3 (Gal-3) is elevated and significantly correlates with all-cause and cardiovascular mortality in patients with heart failure. However, the relationship between serum Gal-3 and heart transplant (HT) outcomes is unclear. The aim of this study was to describe the longitudinal trend and prognostic value of Gal-3 levels after HT. Methods: Banked serum samples were available from 122 HT recipients, collected before transplant and at 1, 3, 6, and 12 months posttransplant. Gal-3 levels in these serum samples were measured by enzyme immune assay. Multivariable Cox regression was performed to determine the prognostic value of 12-month posttransplant Gal-3 serum levels. The primary endpoint was the composite variable all-cause death or graft failure over long-term posttransplant follow-up. Results: Circulating Gal-3 concentration steadily decreased during the first year after HT (median values: pretransplant, 19.1 ng/mL; 1-year posttransplant, 14.6 ng/mL; P<.001). Circulating Gal-3 levels 1-year posttransplant were associated with an increased risk of all-cause death or graft failure (adjusted HR per 1 ng/mL, 1.04; 95%CI, 1.01-1.08; P=.008). The predictive accuracy of this biomarker was moderate: (area under the ROC curve, 0.72 (95%CI, 0.60-0.82; P<.001). Conclusions: Circulating Gal-3 steadily decreased during the first year after HT. However, 1-year posttransplant Gal-3 serum levels that remained elevated were associated with increased long-term risk of death and graft failure

Surgical technique modifies the postoperative atrioventricular block rate in sutureless prostheses.

BACKGROUND: The main objective was to analyse the impact of the modification of the Perceval S implantation technique on the prevalence of postoperative atrioventricular block, which requires a permanent pacemaker, in our aortic valve replacement series. In addition, we attempted to identify those risk factors that are related to the appearance of this complication. METHODS: Five hundred and seventy-two valve replacements were carried out with PERCEVAL S in our centre up to July 2018. Use of modified technique (n=302). Minimally invasive approach (n=340). Associated coronary surgery (n=95). Patients with pacemakers prior to surgery (n=27) and associated mitral or tricuspid valve surgery (n=26) were excluded. We analysed variables of interest that could influence the increase in postoperative atrioventricular block. Technique performed, disorders of intraventricular conduction and pre/intraoperative characteristics. The influence of the modified technique was analysed. RESULTS: Five hundred and nineteen aortic valve replacements with PERCEVAL S. Age (years) (median 77, interquartile range 8). Height (cm) (159, 13.5). Euroscore II (%) (2.25, 2.27). Postoperative atrioventricular block standard technique (n=23, 10.14%). Modified technique (n=14, 4.30%) (P=0.009). Multivariate regression analysis. Final model AUC =0.740, maximum model AUC =0.774 (P>0.05). Includes: Technique used (P=0.024), height (P=0.043) and disorders of interventricular conduction, right bundle branch block (P=0.005), trifascicular block (P=0.008). CONCLUSIONS: In our experience, the modified technique significantly decreases the incidence of postoperative atrioventricular block that requires a permanent pacemaker in the aortic valve replacement with PERCEVAL S. The prior electrocardiographic presence of right bundle branch block, trifascicular block and the height of the patient are associated with an increased risk of blocking.

Tratamiento de la obstrucción del tracto de salida en la miocardiopatía hipertrófica mediante reparación mitral: «miectomía sin miectomía» / Mitral repair as a treatment of outflow tract obstruction in hypertrophic cardiomyopathy: "myectomy without myectomy"

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Implante transaxilar del dispositivo de asistencia circulatoria Impella CP como puente al trasplante cardiaco. Primera experiencia en España / Transaxillary implantation of the Impella CP mechanical circulatory support device as a bridge to heart transplant. First experience in Spain

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The "Auto-sliding Graft" Aortic Wrapping Technique.

We describe the "auto-sliding graft" technique, a different anastomotic option for reconstructive prosthetic procedures on the ascending aorta especially in patients at risk of circulatory arrest with mild aortic dilatation. This simple technique provides not only an important hemostatic reinforcement for the distal aortic graft anastomosis but also a protective effect on the native ascending aorta beyond the suture line.

Circulating Galectin-3 Following Heart Transplant: Long-term Dynamics and Prognostic Value.

INTRODUCTION AND OBJECTIVES: Circulating galectin-3 (Gal-3) is elevated and significantly correlates with all-cause and cardiovascular mortality in patients with heart failure. However, the relationship between serum Gal-3 and heart transplant (HT) outcomes is unclear. The aim of this study was to describe the longitudinal trend and prognostic value of Gal-3 levels after HT. METHODS: Banked serum samples were available from 122 HT recipients, collected before transplant and at 1, 3, 6, and 12 months posttransplant. Gal-3 levels in these serum samples were measured by enzyme immune assay. Multivariable Cox regression was performed to determine the prognostic value of 12-month posttransplant Gal-3 serum levels. The primary endpoint was the composite variable all-cause death or graft failure over long-term posttransplant follow-up. RESULTS: Circulating Gal-3 concentration steadily decreased during the first year after HT (median values: pretransplant, 19.1 ng/mL; 1-year posttransplant, 14.6 ng/mL; P<.001). Circulating Gal-3 levels 1-year posttransplant were associated with an increased risk of all-cause death or graft failure (adjusted HR per 1 ng/mL, 1.04; 95%CI, 1.01-1.08; P=.008). The predictive accuracy of this biomarker was moderate: area under the ROC curve, 0.72 (95%CI, 0.60-0.82; P<.001). CONCLUSIONS: Circulating Gal-3 steadily decreased during the first year after HT. However, 1-year posttransplant Gal-3 serum levels that remained elevated were associated with increased long-term risk of death and graft failure.

Intracoronary tenecteplase versus abciximab as adjunctive treatment during primary percutaneous coronary intervention in patients with anterior myocardial infarction.

AIMS: We sought to compare the effects of intracoronary administration of a fibrinolytic drug (tenecteplase) to those of a glycoprotein IIb/IIIa inhibitor (abciximab) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). METHODS AND RESULTS: In this pilot trial, 76 patients (59 male) with anterior STEMI were randomised to intracoronary infusion of reduced-dose tenecteplase or abciximab during PPCI. Angiography was repeated at 48 hours to assess corrected TIMI frame count (cTFC) and TIMI myocardial perfusion grade (TMPG). The primary endpoint was infarct size as assessed by cardiac MRI. The abciximab group showed lower cTFC (median 14.1 [IQR 9.4-17.1]) than the tenecteplase group (18.2 [10.0-28.2]) (p=0.02), and the proportion of patients with TMPG grade 2/3 was higher in the abciximab group (90.3% vs. 67.7%; p=0.03). Major cardiac and cerebrovascular event rates did not differ; however, notably, 2/38 patients in the tenecteplase group experienced subacute stent thrombosis. At four months, there were no significant differences in infarct size between the tenecteplase and abciximab groups (17.0 g [9.6-27.5] vs. 21.1 g [11.3-35.0], p=0.33). CONCLUSIONS: Intracoronary administration of tenecteplase did not reduce infarct size compared to abciximab in STEMI patients undergoing PPCI. Tenecteplase exhibited poorer myocardial reperfusion and might be associated with increased subacute stent thrombosis.

Cirugía cardiaca mediante mínimo acceso. Registro multicéntrico español / Miniaccess heart surgery. A spanish multicenter registry

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Perceval Less Invasive Aortic Replacement Register: multicentric Spanish experience with the Perceval S bioprosthesis in moderate-high-risk aortic surgery.

OBJECTIVES: The development of new percutaneous and surgical techniques has reduced the risk associated with aortic valve replacement procedures. We present the results of a Spanish register after initiating a programme for sutureless prostheses in moderate-high-risk patients. METHODS: This prospective multicentre study was carried out from November 2013 to November 2016. Data were obtained from 448 patients in whom a Perceval S prosthesis was implanted. RESULTS: The mean age was 79.24 (standard deviation [SD] 4.1) years, and 61.2% were women. The estimated EuroSCORE I log risk was 11.15% (SD 7.6), with an observed mortality of 4.4% (20 patients). Isolated aortic valve replacement was performed on 69.26% of patients, with 64% involving ministernotomy. The incidence of neurological events was 2%, with 2 permanent cerebrovascular accidents, and 41 (9.2%) patients were implanted with a permanent endocavitary pacemaker. At discharge, 12 (2.6%) patients presented minimal periprosthetic leakage, and 4 (0.89%) patients had moderate leakage. There were 3 reinterventions during follow-up (2 endocarditis and 1 dysfunction due to periprosthetic leak progression). The mean gradient at discharge, 6 months and 1 year was 12.94 (SD 5.3) mmHg, 12.19 (SD 4.7) mmHg and 11.77 (SD 4.7) mmHg, respectively; 59.4% of the patients were octogenarians, with a survival rate of 98% at both 6 months and 1 year at discharge. There was neither valve migration nor early structural degeneration. The mean follow-up was 12 ± 3 months. The 6-month and 1-year mortality was 1.4% and 2.1%, respectively. CONCLUSIONS: This is a prospective multicentric study on the largest cohort of patients with sutureless valves conducted in Spain to date. It is a reproducible procedure that has enabled surgery on patients with a moderate-high risk with low morbidity and mortality, providing good haemodynamic results.