Dalbavancin as sequential therapy in infective endocarditis: Real-life experience in elder and comorbid patients.

OBJECTIVES: This study aimed to evaluate the effectiveness of dalbavancin as sequential therapy in patients with infective endocarditis (IE) due to gram positive bacteria (GPB) in a real-life heterogenous cohort with comorbid patients. METHODS: A single center retrospective cohort study including all patients with definite IE treated with dalbavancin between January 2017 and February 2022 was developed. A 6-month follow-up was performed. The main outcomes were clinical cure rate, clinical and microbiological relapse, 6-month mortality, and adverse effects (AEs) rate. RESULTS: The study included 61 IE episodes. The median age was 78.5 years (interquartile range [IQR] 63.2-85.2), 78.7% were male, with a median Charlson comorbidity index of 7 (IQR 4-9) points. Overall, 49.2% suffered native valve IE. The most common microorganism was Staphylococcus aureus (26.3%) followed by Enterococcus faecalis (21.3%). The median duration of initial antimicrobial therapy and dalbavancin therapy were 27 (IQR 20-34) and 14 days (IQR 14-28) respectively. The total reduction of hospitalization was 1090 days. The most frequent dosage was 1500mg of dalbavancin every 14 days (96.7%). An AE was detected in 8.2% of patients, only one (1.6%) was attributed to dalbavancin (infusion reaction). Clinical cure was achieved in 86.9% of patients. One patient (1.6%) with Enterococcus faecalis IE suffered relapse. The 6-month mortality was 11.5%, with only one IE-related death (1.6%). CONCLUSION: This study shows a high efficacy of dalbavancin in a heterogeneous real-world cohort of IE patients, with an excellent safety profile. Dalbavancin allowed a substantial reduction of in-hospital length of stay.

Angioplastia pulmonar con balón en la hipertensión pulmonar tromboembólica crónica no operable. Estudio observacional en una unidad de referencia / Balloon pulmonary angioplasty for inoperable patients with chronic thromboembolic pulmonary hypertension. Observational study in a referral unit

Introducción y objetivos: Se consolida la angioplastia con balón de arterias pulmonares (ABAP) en la hipertensión pulmonar tromboembólica crónica (HPTEC) no operable. El procedimiento se ha perfeccionado y han disminuido las complicaciones. Se analizan como objetivo primario los resultados y las complicaciones del primer programa nacional de ABAP. Métodos: Estudio prospectivo, unicéntrico y observacional que incluyó a todos los pacientes con HPTEC no quirúrgica tratados mediante ABAP desde mayo de 2013 hasta febrero de 2017. Se analizaron la mejoría clínica y hemodinámica, el edema de reperfusión y la mortalidad. Resultados: Se realizaron 156 sesiones de ABAP en 46 pacientes. Se redujeron las resistencias vasculares pulmonares un 44% (10,1 ± 4,9 frente a 5,6 ± 2,2 UW; p < 0,001) y la presión arterial pulmonar media un 23,6% (49,5 ± 12 frente a 37,8 ± 9 mmHg; p < 0,001); el índice cardiaco aumentó un 17,1% (2,3 frente a 2,7 l/min/m2; p = 0,002); las cifras de la fracción aminoterminal del propéptido natriurético cerebral se redujeron el 79,2% (1.233 ± 1.327 frente a 255,5 ± 318 pg/dl; p < 0,001), y la distancia recorrida en la prueba de 6 min de marcha aumentó 74 m (394 frente a 468 m; p = 0,001). Apareció edema de reperfusión en 9 procedimientos (5,8%), y falleció 1 paciente (mortalidad, 2,1%). Conclusiones: El perfeccionamiento actual de la ABAP en pacientes con HPTEC no operable la convierte en una técnica eficaz y segura que mejora el perfil hemodinámico, la clase funcional y los biomarcadores, con baja incidencia de complicaciones graves y mortalidad periprocedimento

Introduction and objectives: Balloon pulmonary angioplasty (BPA) for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) is becoming widely accepted. Procedural refinement has reduced complications. Our primary objective was to analyze the results and complications of the first national BPA program. Methods: Observational, prospective series that included all consecutive BPA procedures in inoperable CTEPH patients between May 2013 and February 2017 performed at a single institution. We analyzed clinical and hemodynamic improvement, reperfusion pulmonary edema, and mortality. Results: We performed 156 BPA sessions in 46 patients. Pulmonary vascular resistance was reduced by 44% (10.1 ± 4.9 vs 5.6 ± 2.2 WU; P < .001) and mean pulmonary arterial pressure by 23.6% (49.5 ± 12 vs 37.8 ± 9 mmHg; P < .001); cardiac index rose by 17.1% (2.3 vs 2.7 L/min/m2; P = .002), N-terminal pro-B-type natriuretic peptide levels were reduced by 79.2% (1233 ± 1327 vs 255.5 ± 318 pg/dL; P < .001) and the 6-minute walk test distance improved by 74 meters (394 vs 468 m; P = .001). Reperfusion pulmonary edema developed after 9 interventions (5.8%) and 1 patient died (mortality 2.1%). Conclusions: Due to its current refinement, BPA has become a safe and effective treatment for inoperable CTEPH that improves hemodynamics, functional status, and biomarkers with a low rate of severe periprocedural complications and mortality

Balloon Pulmonary Angioplasty for Inoperable Patients With Chronic Thromboembolic Pulmonary Hypertension. Observational Study in a Referral Unit.

INTRODUCTION AND OBJECTIVES: Balloon pulmonary angioplasty (BPA) for inoperable chronic thromboembolic pulmonary hypertension (CTEPH) is becoming widely accepted. Procedural refinement has reduced complications. Our primary objective was to analyze the results and complications of the first national BPA program. METHODS: Observational, prospective series that included all consecutive BPA procedures in inoperable CTEPH patients between May 2013 and February 2017 performed at a single institution. We analyzed clinical and hemodynamic improvement, reperfusion pulmonary edema, and mortality. RESULTS: We performed 156 BPA sessions in 46 patients. Pulmonary vascular resistance was reduced by 44% (10.1 ± 4.9 vs 5.6 ± 2.2 WU; P < .001) and mean pulmonary arterial pressure by 23.6% (49.5 ± 12 vs 37.8 ± 9mmHg; P < .001); cardiac index rose by 17.1% (2.3 vs 2.7 L/min/m2; P = .002), N-terminal pro-B-type natriuretic peptide levels were reduced by 79.2% (1233 ± 1327 vs 255.5 ± 318 pg/dL; P < .001) and the 6-minute walk test distance improved by 74 meters (394 vs 468 m; P = .001). Reperfusion pulmonary edema developed after 9 interventions (5.8%) and 1 patient died (mortality 2.1%). CONCLUSIONS: Due to its current refinement, BPA has become a safe and effective treatment for inoperable CTEPH that improves hemodynamics, functional status, and biomarkers with a low rate of severe periprocedural complications and mortality.