Psychological well-being of teachers: influence of burnout, personality, and psychosocial climate.

Introduction: Those who are professionally dedicated to teaching can be exposed with their work to situations that influence their perception of psychological well-being. This study aims to evaluate how the factors of personality, emotional intelligence, burnout and the psychosocial climate derived from the work environment of teachers influence their levels of psychological well-being, to verify whether these variables allow us to establish a predictive model of psychological well-being by means of multiple regression analysis. Methods: Participants were a group of 386 teachers in early childhood, Primary and Secondary education, both in training and in active service (71.5% women; 28.5% men). A correlation and multiple regression analysis were performed to establish a predictive model of psychological well-being. We used 5 instruments: Psychosocial Climate at Work Scales (ECPT); verall Personality Assessment Scale (OPERAS); Questionnaire for Evaluation of Burnout Syndrome at Work (CESQT); Spanish adaptation of the Riff Psychological Well-being Scales (EBP) and Spanish validation of the Trait Meta-Mood Scale (TMMS-24). Results: Most of the relationships were significant, and the multiple regression analysis explains 58.5% of the global variance of psychological well-being in teachers, being emotional stability the most relevant and main predictor of psychological well-being, explaining its 38.1%. Discussion: Personality shows a great influence in psychological well-being of teachers, particularly emotional stability. The ability to establish predictive models to explain psychological well-being in educational environments is confirmed.

Implante alto de las válvulas autoexpandibles con la técnica de "Cusp-Overlap", una estrategia para disminuir la necesidad de marcapasos en el implante percutáneo de válvula aórtica. Evolución a 30 días / High Self-expandable Valve Implantation with the Cusp-Overlap Technique, a Strategy to Reduce the Need for Pacemaker in Transcatheter Aortic Valve Implantation. 30-day Outcome

RESUMEN Objetivo: Analizar si el implante más alto en el implante percutáneo de válvula aórtica (TAVI) con válvulas auto-expandibles utilizando la superposición de las cúspides derecha e izquierda disminuye la necesidad de marcapasos definitivo. Material y Métodos: Se analizaron 164 pacientes consecutivos que recibieron TAVI con válvulas auto- expandibles; en 101(61,6%) de ellos se implantaron utilizando la vista coplanar de las tres cúspides, a la cual llamamos técnica convencional (CON) y en 63 (38,4%) utilizamos la técnica COVL, con superposición de las cúspides derecha e izquierda . El punto final primario (PFP) fue la necesidad de marcapasos definitivo (MCPD) a 30 días. Resultado: No hubo diferencias entre los grupos en la edad media, prevalencia de sexo masculino, hipertensión, cirugía de revascularización previa, antecedente de accidente cerebrovascular (ACV), función renal, o hemodiálisis. Los pacientes en el grupo COVL tuvieron más diabetes, angioplastia coronaria (ATC) e infarto previos. La ATC pre-TAVI fue similar, con mayor score STS (6,3 ± 2,1 vs. 5,8 ± 2,4; p = 0,05). La presencia de fibrilación auricular fue mayor en el grupo COVL sin diferencia en bloqueo auriculoventricular, de rama derecha o izquierda. No hubo diferencia en el área valvular aórtica, gradiente medio y fracción de eyección ventricular izquierda. A 30 días se observó una reducción significativa del PFP en la estrategia COVL, (6,3% vs 17,8%, p = 0,03). No hubo diferencia en mortalidad, ACV, sangrado mayor, infarto agudo de miocardio o regurgitación aórtica. Hubo tendencia a menor presencia de nuevo bloqueo competo de rama izquierda en el grupo COVL (4,8% vs. 12,9%, p = 0,08). Conclusiones: El uso de la técnica de COVL, que permite un implante más alto en el TAVI con válvulas autoexpandibles, demostró en esta serie ser factible y seguro, con disminución de la necesidad de MCPD sin aumento de las complicaciones.

ABSTRACT Objective: The aim of this study was to analyze whether higher transcatheter aortic valve implantation with self-expandable valves using the right and left cusp overlap strategy decreases the need for permanent pacemaker. Methods: A total of 164 consecutive patients undergoing TAVI with self-expandable valves were analyzed: 101 (61.6%) implanted with the conventional technique (CON) using the three-cusp coplanar view, and 63 (38.4%) using the right and left cusp overlap (COVL) technique. The primary endpoint (PEP) was the need for permanent pacemaker (PPM) at 30 days. Results: Mean age, prevalence of male gender, hypertension, prior coronary artery bypass graft surgery (CABG), and history of stroke, kidney function or hemodialysis was not different between groups. Patients in the COVL group had more diabetes, coronary percutaneous transluminal coronary angioplasty (PTCA) and prior infarct, and pre-TAVI PTCA was similar, with higher STS score (6.3±2.2 vs. 5.8±2.4; p=0.05). The presence of atrial fibrillation was greater in the COVL group, without differences in right or left bundle branch or atrioventricular block. There was no difference in aortic valve area, mean gradient and left ventricular ejection fraction. At 30 days, the need of PPM was significantly reduced with the COVL technique (6.3%% vs. 17.8%; p=0.03). No difference was observed in mortality, stroke, major bleeding, acute myocardial infarction or aortic regurgitation, and the presence of new-onset complete left bundle branch block was lower in the COVL group (4.8% vs. 12.9%; p=0.08). Conclusions: Use of the COVL technique, which allows higher self-expandable valve implantation during TAVI, was feasible and safe, decreasing the need for PPM without increasing complications.

Emotional Intelligence, Psychological Well-Being and Burnout of Active and In-Training Teachers.

The main activating variables of psychological well-being and Emotional Intelligence that influence teachers include the process of evaluating well-being, their motivation, and their ability to perceive and regulate sources of stress and burnout. The relationship and influence of psychological well-being and emotional intelligence was analyzed with the adequate regulation of burnout. Those who participated included 386 active teachers (55%), and teachers in training (45%), studying for degrees in Pre-School and Primary Education, and Master's degrees in Secondary Education Teacher Training of which 71.5% were women. The following were used: Psychological Well-Being Scales, Trait Meta-Mood Scale and the Spanish Burnout Inventory. Pearson's correlation analysis and multiple regression analysis were performed. The results showed that enthusiasm for the teaching job is related to psychological well-being, especially domain of the environment and personal growth. Multiple regression analysis made it possible to establish a predictive model of well-being, showing that psychological well-being is the main adjustment predictor and/or the mismatch in the work of the teaching staff in both samples, through an adequate regulation of positive relationships, mastery of their environment and having a purpose in life.

Endocarditis infecciosa luego del implante de válvula aórtica por cateterismo / Infective Endocarditis after Transcatheter Aortic Valve Implantation

RESUMEN Introducción: La endocarditis infecciosa (EI) post implante percutáneo de válvula aórtica (TAVI) es poco frecuente, con una alta tasa de morbimortalidad. Métodos: Se analizaron 630 pacientes consecutivos con TAVI, de los cuales 6 (0,95%) presentaron EI. Resultados: Cuatro eran hombres, edad 81,3 ± 2,2 años, y todos sintomáticos. La fracción de eyección ventricular izquierda (FEVI) fue 56,8 ± 5,3%. Todos recibieron un implante exitoso y uno presentó regurgitación moderada. Dos requirieron marcapaso definitivo, a uno de ellos se le debió recolocar el cable a las 24 hs. La EI se presentó a los 63,5 ± 73,3 días (mediana de 35 días). El germen aislado fue un coco (+) en cuatro casos. En uno se observó una vegetación en el ecocardiograma transesofágico. Un paciente falleció dentro de los 30 días. El seguimiento fue a 23 ± 22 meses, ningún paciente presentó nuevos eventos o internaciones. En el eco Doppler la FEVI fue de 55,9 ± 4,6%, el gradiente medio 8,2 ± 1,8 mmHg y la velocidad pico de 1,8 ± 0,2 m/seg. Un paciente terminó una regurgitación moderada. Conclusiones: En esta serie de pacientes, la EI post TAVI fue poco frecuente y presentó una evolución favorable con el tratamiento antibiótico.

ABSTRACT Background: Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is a rare complication with high morbidity and mortality. Methods: Of 630 consecutive patients undergoing TAVI, 6 (0.95%) presented IE. Results: Four patients were men, mean age was 81.3 ± 2.2 years and all the patients were symptomatic. Left ventricular ejection fraction (LVEF) was 56.8 ± 5.3%. The procedure was successful in all the patients and one presented moderate regurgitation. Two patients required definitive pacemaker and the lead had to be reimplanted 24 hours later in 1 patient. Time to IE was 63.5 ± 73.3 days (median 35 days). A Gram-positive coccus was isolated in four cases. One patient presented a vegetation on transesophagic echocardiography. One patient died within 30 days. During follow-up of 23 ± 22 months none of the patients presented new events or hospitalizations. On Doppler echocardiography, LVEF was 55.9 ± 4.6%, mean trans-aortic gradient was 8.2 ± 1.8 mm Hg and peak systolic velocity was 1.8 ± 0.2 m/s. One patient had moderate regurgitation. Conclusions: In this series of patients, IE after TAVI was uncommon and had a favorable course with antibiotic treatment.

CSI-SF: Propiedades psicométricas de la versión española del inventario breve de estrategias de afrontamiento / CSI-SF: Psychometric properties of Spanish version of the coping strategies inventory - short form

Antecedentes/Objetivo: El estudio establece las propiedades psicométricas de la adaptación española de la versión abreviada del Inventario de Estrategias de Afrontamiento (CSI-SF) publicado por Addison et al. (2007). La prueba utiliza un modelo de dos ejes para clasificar las estrategias de afrontamiento (de compromiso y de evitación) y las categorías objetivas del afrontamiento (centrada en el problema y centrada en la emoción). Método: Participaron 940 personas (62.87% mujeres; 37.12% hombres) divididas en dos submuestras. Se realizó un análisis factorial exploratorio (AFE) y un análisis factorial confirmatorio (AFC), así mismo la correlación de Pearson y el Alfa de Cronbach para examinar la fiabilidad y validez de la adaptación al español del CSI-SF. Resultados: El análisis de consistencia interna reveló una alta fiabilidad para todas las escalas (EFE = .890, PFE = .836. PFD = .767, EFD = .934), y todos los índices de ajuste utilizados para examinar el CSI-SF versión española proporcionaron soporte para su uso como una medida adecuada de las estrategias de afrontamiento del estrés. Discusión/Conclusión: La escala CSI-SF versión española es una prueba que proporciona un diagnóstico rápido y eficiente cuyos factores explican el 62.79% de la varianza común total de las estrategias de afrontamiento que se emplean frente a la situación de estrés en distintos ámbitos.(AU)

Background / Objective: The study establishes the psychometric properties of the Spanish adaptation of the abbreviated version of the Coping Strategies Inventory (CSI-SF) published by Addison et al. (2007). The test uses a two-axis model to classify coping strategies (commitment and avoidance) and objective categories of coping (problem-focused and emotion-focused). Method: 940 people participated (62.87% women; 37.12% men) aged between 18 and 66 years (x̄= 33.2; dt = 12.01). An exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA) were carried out, as well as Pearson's correlation and Cronbach's Alpha to examine the reliability and validity of the Spanish adaptation of the CSI-SF. Results: Internal consistency analysis revealed high reliability for all scales, and all adjustment indexes used to examine the CSI-SF Spanish version provided support for its use as an adequate measure of stress coping strategies. Discussion/Conclusions: The CSI-SF scale Spanish version is a test that provides a quick and efficient diagnosis of the coping strategies used in the face of stress in different settings.

Non-conventional vascular accesses for the management of superior vena cava syndrome in patients with Intestinal Failure. Case series and systematic review.

BACKGROUND: Type III Intestinal Failure (IF) is a devastating clinical condition.characterized by the inability of the gut to absorb necessary macronutrients, and/or water and electrolytes, requiring Parenteral Nutrition (PN) as chronic therapy. Long-term PN may lead to life-threatening complications; the loss of central venous access (LCVA) is the most frequent and challenging. To date, few studies in the literature have reported the relevance of Non-conventional Vascular Accesses (NCVA) in the management IF as part of the comprehensive multidisciplinary care. METHODS: A retrospective analysis of a database collected from January 2006 to December 2019 was performed using SPSS v25.0 for statistical analysis, followed by a systematic review, using the PRISMA.methodology RESULTS: From January 2006 to December 2019, 184 NCVA were placed in 71 patients with LCVA as IF-related complication; 173 were placed in 61 patients by interventional radiology (IR) and 11 NCVA were placed in 10 patients by the surgical team during the intestinal transplant (ITx) operation. From the 173 IR procedures 166 (95.9%) were successful with 3 ± 2.7 procedures/patient; average catheter permanence rate was 738.68 ± 997 days; complications related to the procedures occurred in 18/173 (10.4%), including two deaths. On the other hand, among the 11 NCVA implanted by the surgical team, 7 (64%) were successful and were safely withdrawn 30 days after ITx when were no longer needed; 2 (18%) catheters malfunctioned during the first week and could not be further used, and 1 was accidently removed; average catheter permanence rate was 26 ± 4 days. There was one complication (9%) requiring laparotomy; there was no mortality associated the procedure in this group. A systematic review was conducted to evaluate the success and safety of NCVA as part of the treatment of HPN-related complications; from 337,542 papers, 14 studies were included. A total of 28 HPN-patients with LCVA received NCVA; 34 procedures were successfully performed, while procedure-related complications were reported in 11.7%, as well as one death. CONCLUSIONS: The data analyzed show that NCVAs may be successfully placed by expert teams, allowing to sustain long-term PN, as well as increasing the Intestinal Transplantation applicability for candidates in the extreme need of vascular access.

Impact of Cusp-Overlap View for TAVR with Self-Expandable Valves on 30-Day Conduction Disturbances.

METHODS AND RESULTS: We retrospectively compared 257 consecutive patients undergoing TAVR with self-expandable valves using either CON (n = 101) or COVL (n = 156) in four intermediate/low volume centers. There were no significant differences in baseline characteristics between the groups. The 30-day incidence of new-onset LBBB (12.9% vs. 5.8%; p=0.05) and PPMI rate (17.8% vs. 6.4%; p=0.004) was significantly lower when using the COVL implantation view. There was no difference between the CON and COVL groups in 30-day incidence of death (4.9% vs. 2.6%), any stroke (0% vs. 0.6%), and the need for surgical aortic valve replacement (0% for both groups). CONCLUSION: Using the COVL view for implantation, we achieved a significant reduction of the LBBB and PPMI rate after TAVR in comparison with the traditional CON view, without compromising the TAVR outcomes when using self-expandable prostheses.

Tratamiento endovascular de aneurismas de aorta con estrategia minimalista / Endovascular Treatment of Aortic Aneurysms with Minimalistic Approach

RESUMEN Introducción: Los aneurismas de aorta siguen siendo una patología frecuente, en especial aquellos localizados en la aorta abdominal. Desde 1990, gracias al avance en los dispositivos y las técnicas endovasculares, la cirugía convencional ha dejado de ser la única opción de tratamiento. Presentamos nuestros resultados en el manejo del aneurisma de aorta con técnica endovascular mínimamente invasiva. Objetivos: Analizar los resultados a 30 días del implante de endoprótesis en la aorta torácica y abdominal con una estrategia mínimamente invasiva. Material y métodos: Entre marzo de 2012 y abril de 2019 se realizaron 395 implantes consecutivos de endoprótesis de aorta; en 264 (67%) de los cuales se utilizó una técnica mínimamente invasiva (MIN-A). De este grupo 240 procedimientos (90,9%) fueron llevados a cabo para reparar la aorta abdominal (EVAR) y 24 (9,1%) la aorta torácica (TEVAR). Resultados: De 264 pacientes se logró éxito técnico (ET) del implante en el 99,6% y éxito clínico (EC) en el 97,7%. La mortalidad a 30 días fue del 1,1% dado por neumonía, insuficiencia cardíaca y EPOC. Ningún paciente presentó IAM, ACV o necesitó de conversión a reparación quirúrgica de urgencia. El tiempo promedio del procedimiento fue de 62 minutos (SD ± 17). Algunos pacientes requirieron conversión a cierre quirúrgico del acceso [20 (7%) durante los primeros 100 casos, y 7 (3%) en los últimos 164 pacientes p = 0,05)]. El sangrado mayor que requirió transfusión fue del 1,1%. El tiempo promedio para la deambulación fue de 18 horas (SD ± 10), que luego de los primeros 100 pacientes disminuyó en forma significativa a 13 horas (SD ± 2,9 p = 0,05). La estadía hospitalaria en promedio fue de 1,4 días (SD ± 1,14) con 5 casos externados el mismo día del procedimiento. Conclusiones: Los procedimientos de reparación endovascular de aneurismas de la aorta con una estrategia miniinvasiva fueron factibles y seguros, ya que permitieron convertir estos procedimientos en abordajes percutáneos, con bajas tasas de complicaciones asociadas al acceso, menor tiempo quirúrgico, rápida deambulación y menor estadía hospitalaria, sin modificar la seguridad global del procedimiento. La curva de aprendizaje permitió bajar la tasa de conversiones a cirugía, así como los tiempos de deambulación.

ABSTRACT Background: Aortic aneurysms, particularly of the abdominal aorta, are still common. Since 1990, conventional surgery is no longer the only treatment option due to advances in endovascular devices and techniques. We present our results in the management of aortic aneurysms with a minimally invasive endovascular technique. Objectives: The aim of this study was to analyze the 30-day outcomes of endograft implantation in the thoracic aorta and abdominal aorta using a minimally invasive approach. Methods: Between March 2012 and April 2019, 395 consecutive endografts were implanted in the aorta, and 264 (67%) were performed using a minimally invasive approach (MIN-A). Among this group, 240 (90.9%) corresponded to abdominal endo-vascular aortic repair (EVAR) and 24 (9.1%) to thoracic endovascular aortic repair (TEVAR). Results: Technical success (TS) of the implant was achieved in 99.6% of the 264 patients and clinical success (CS) in 97.7%. Thirty-day mortality was 1.1% due to pneumonia, heart failure and chronic obstructive pulmonary disease. There were no cases of myocardial infarction, stroke or need for conversion to urgent surgical repair. Mean duration of the procedure was 62 minutes (SD ± 17). Some patients required conversion to surgical closure of the access site [20 (7%) during the first 100 cases and 7 (3%) in the final 164 patients, p = 0.05]. Three (1.1%) patients presented major bleeding requiring transfusion. Mean time to ambulation was 18 hours (SD ± 10) that significantly decreased to 13 hours after the first 100 patients (SD ± 2.9; p= 0.05). Mean length of hospital stay was 1.4 days (SD ± 1.14) with 5 patients discharged on the same day of the procedure. Conclusions: Endovascular aortic aneurysm repair using a minimally invasive strategy was feasible and safe, turning this procedure into a percutaneous approach, with low access site-related complications, shorter operative time, rapid ambulation and shorter length of hospital stay, without modifying overall safety of the procedure. The learning curve resulted in reduced rate of conversion to surgery and earlier ambulation.

Causal attributions in early childhood education: a new categorization system / Atribuciones causales en Educación Infantil: nuevo sistema de categorización

BACKGROUND: From Early Childhood Education onwards, causal attributions influence explanations of school performance. We performed a systematic review of the available knowledge (1970-2019) about Weiner's (1986) Attribution Theory of the Motivation of Achievement in order to examine studies related to the causal attributions of success and failure at school. We found numerous empirical studies related to Bernard Weiner's theory. However, little research exists about students in Early Childhood Education. Therefore, the aim of this study was to identify the causes to which children attribute their successes and failures during this educational period. METHOD: A sample of 200 students aged between 3 and 6 years old was selected. To collect the data, an individually implemented Piagetian clinical interview was used. RESULTS: A large volume of qualitative information was collected for classification which exceeded Weiner's traditional causal attributions. Creating a category to group all new attributions implied losing too much information under a non-specific label. CONCLUSION: A new categorization of the causal attributions was designed, made up of 10 categories -adapted to the 3-6 years age range- which revises and expanding on the categorization created by Weiner

ANTECEDENTES: las atribuciones causales de la motivación influyen desde Educación Infantil en la explicación del rendimiento escolar. Se realizó una revisión sistemática de los conocimientos disponibles (1970-2019) de la Teoría Atribucional de la Motivación de Logro de Weiner (1986) para conocer los trabajos relacionados con las atribuciones causales del éxito y fracaso escolar. Se hallaron numerosos estudios empíricos relacionados con la teoría de Bernard Weiner. Sin embargo, son escasas las investigaciones con estudiantes de Educación Infantil. Por ello, el objetivo de este estudio fue identificar las causas a las que atribuyen sus éxitos y fracasos escolares en Educación Infantil. MÉTODO: se seleccionó una muestra de 200 estudiantes con edades comprendidas entre los 3 y 6 años. Para recopilar los datos se utilizó una entrevista clínica piagetiana implementada individualmente. RESULTADOS: se recopiló un gran volumen de información cualitativa para clasificar que desbordaba las atribuciones causales tradicionales de Weiner. Crear una categoría para agrupar todas las nuevas atribuciones implicaba perder demasiada información bajo una etiqueta inespecífica. CONCLUSIÓN: se diseñó una nueva categorización de las atribuciones causales formada por 10 categorías -adaptada al rango de edad 3-6 años- que revisa y amplía la creada por Weiner

Causal attributions in Early Childhood Education: A new categorization system.

BACKGROUND: From Early Childhood Education onwards, causal attributions influence explanations of school performance. We performed a systematic review of the available knowledge (1970-2019) about Weiner's (1986) Attribution Theory of the Motivation of Achievement in order to examine studies related to the causal attributions of success and failure at school. We found numerous empirical studies related to Bernard Weiner's theory. However, little research exists about students in Early Childhood Education. Therefore, the aim of this study was to identify the causes to which children attribute their successes and failures during this educational period. METHOD: A sample of 200 students aged between 3 and 6 years old was selected. To collect the data, an individually implemented Piagetian clinical interview was used. RESULTS: A large volume of qualitative information was collected for classification which exceeded Weiner's traditional causal attributions. Creating a category to group all new attributions implied losing too much information under a non-specific label. CONCLUSION: A new categorization of the causal attributions was designed, made up of 10 categories -adapted to the 3-6 years age range- which revises and expanding on the categorization created by Weiner.

Implante percutáneo de la válvula aórtica con estrategia minimalista / Minimalist Approach for Percutaneous Aortic Valve Implantation

RESUMEN Introducción: El reemplazo de válvula aórtica transcatéter (TAVR) se está convirtiendo en un procedimiento estándar para pacientes con alto riesgo quirúrgico que necesitan el reemplazo de la válvula aórtica. Esta técnica ha evolucionado rápidamente y la llamada estrategia minimalista está ganando adeptos en todo el mundo, mientras la evidencia en su favor todavía se está acumulando. Objetivo: Analizar los resultados a 30 días de la estrategia minimalista (MIN-A) en comparación con la técnica convencional (CON-A) en la experiencia de un solo centro. Material y métodos: Entre septiembre de 2009 y febrero de 2018, se realizaron 303 procedimientos consecutivos de TAVR por acceso femoral, 229 (75,6%) de ellos con MIN-A y 74 (24,4%) con CON-A. Resultados: La edad promedio de los pacientes fue de 79,5 años y ambos grupos tenían características similares. No hubo diferencias entre estos en lo referido a hipertensión, diabetes, tabaquismo, ICP o CRM previa, IAM, EPOC, fibrilación auricular y diálisis. La ATC por etapas antes del TAVR (procedimiento combinado) y la insuficiencia renal (eGFR < 60 ml / min / 1,73 m2) fueron más frecuentes en los sometidos a CON-A. El score del STS fue similar en ambos grupos. El tiempo del procedimiento fue menor en el grupo MIN-A (125 ± 26 vs. 211 ± 48 minutos; p < 0,001), al igual que el tiempo de hospitalización (4,1 vs. 6,3 días; p = 0,01). A los 30 días, no hubo diferencias en la mortalidad (3,9% frente a 1,4%; p = 0,29), IAM, accidente cerebrovascular, hemorragia, transfusión y complicaciones vasculares. Cuatro pacientes tuvieron falla del dispositivo de cierre (1 requirió reparación quirúrgica, 3 requirieron stent cubierto). Las fugas paravalvulares (PVL) moderadas fueron más frecuentes en el grupo CON-A (11,8% vs. 23%; p = 0,01), pero las PVL graves tuvieron similar incidencia (1,3% vs. 2,7%). Conclusión: La estrategia minimalista en el implante percutáneo de la válvula aórtica demostró ser factible y segura; dicha estrategia disminuyó el tiempo del procedimiento y la estadía en el hospital, con similares resultados clínicos que la estrategia convencional a 30 días, pero con mejor confort para el paciente.

ABSTRACT Background: Transcatheter aortic valve implantation (TAVI) is becoming the standard procedure for high-risk patients requiring aortic valve replacement. This technique has evolved rapidly and the so-called minimalist strategy is gaining worldwide attention, while supporting evidence is still being assembled. Objective: The aim of this study was to compare 30-day outcomes of the minimalist approach (MA) versus the standard approach (SA) for TAVI performed in a single center. Methods: Between September 2009 and February 2018, 303 consecutive TAVI procedures were performed, 229 (75.6%) using the MA and 74 (24.4%) with the SA. Results: Mean age was 79.5 years and both groups had similar characteristics. There were no differences in hypertension, diabetes, smoking habits, previous percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery, acute myocardial infarction (AMI), chronic obstructive pulmonary disease, atrial fibrillation and dialysis. PCI before TAVI (combined procedure) and kidney failure (eGFR <60 ml / min / 1.73 m2) were more common in the SA group. The STS score was similar in both groups. The total duration of the procedure and in-hospital stay were lower in the MA group (125±26 vs. 211±48 minutes; p <0.001, and 4.1 vs. 6.3 days; p=0.01, respectively). There were no differences in mortality (3.9% vs. 1.4%; p=ns), incidence of AMI, stroke, major bleeding requiring transfusion or vascular complications at 30 days. The closure device failed in four patients (one underwent surgical repair and three required a covered stent). Moderate paravalvular leaks (PVL) were more frequent in the SA group (11.8% vs. 23%; p=0.01) but the incidence of severe PVL was similar (1.3% vs. 2.7%). Conclusion: The MA for TAVI proved to be feasible and safe, reducing the procedure duration and in-hospital stay, with 30-day outcomes similar to those of the SA but providing better comfort for the patient.

Reparación valvular mitral por cateterismo: experiencia inicial con MitraClip® / Percutaneous Mitral Valve Repair: Initial Experience with MitraClip™

RESUMEN Objetivos: Reportar y analizar los resultados iniciales de una serie de pacientes con insuficiencia mitral (IM) grave sintomática y alto riesgo para cirugía que recibieron reparación percutánea de la válvula mitral (RPVM) con MitraClip®. Material y métodos: Entre marzo de 2016 y octubre de 2018 recibieron RPVM con MitraClip® en forma consecutiva 12 sujetos con IM grave sintomática, con alto riesgo o contraindicación para cirugía. Se consideró "éxito del implante" (EI) el correcto agarre de las valvas con el clip que dejó una IM residual leve o moderada al finalizar el procedimiento, y "éxito del procedimiento (EP) a 30 días" el EI en ausencia de eventos adversos mayores (MACE), los que incluyeron muerte, infarto agudo de miocardio (IAM), accidente cerebrovascular (ACV), necesidad de cirugía valvular, derrame pericárdico, taponamiento o sangrado mayor. Datos basales y antecedentes de los pacientes: la media de edad fue de 74,1 ± 8,9 años; 7 eran hombres; 3, diabéticos; 10 eran hipertensos y dislipidémicos; 4 eran tabaquistas, 5 tenían fibrilación auricular, 2 portaban marcapasos definitivo, 3 documentaban IAM previo, 2 habían sido sometidos antes a ATC y 4 a cirugía cardíaca. La tasa de filtración glomerular estimada (eGFR) fue de 73,8 ± 34,8 ml/m2, 2 tenían < 60 ml/m2 y uno se encontraba en diálisis. Todos los pacientes estaban en clase funcional (CF) III-IV, con antecedentes de internaciones por insuficiencia cardíaca (IC). Características ecográficas: diámetro diastólico del ventrículo izquierdo (DDVI): 61,8 ± 6,4 mm; diámetro sistólico (DSVI): 46,3±2,1 mm; fracción de eyección del ventrículo izquierdo (FEVI): 47,5±13,4% (rango: 25-60%). La causa de la IM era degenerativa en 7 pacientes y funcional en 5. La evaluación del riesgo mostró un EuroSCORElog de 9,6±6,8; el STS score de mortalidad fue 16,1 ±1 3,5 y el de morbimortalidad 22,8 ± 17,7. Resultados: Se obtuvo EI en todos los pacientes; en 7 enfermos se implantó 1 solo clip y en los otros 5 se colocaron 2 clips; el gradiente residual medio posimplante fue 3,6 ± 0,2 mmHg. La IM posprocedimiento fue leve en 11 y mínima en 1. La estadía hospitalaria media fue de 1,9 ± 0,8 días (rango: 1-3 días). A los 30 días, todos los sujetos se encontraban en CF I-II; ningún paciente presentó eventos mayores o reinternación por IC. El seguimiento abarcó a todos los pacientes y se extendió por un tiempo medio de 8,8 ± 6,7 meses (rango: 1-30 meses). Dos pacientes fallecieron: 1 de neumonía a los 14 meses y otro a los 30 meses por IC refractaria luego de un reemplazo valvular aórtico por cateterismo (TAVI), manteniendo IM leve. No hubo otras complicaciones. Todos se encontraban en CF I-II, 1 requirió reinternación por IC (a los 7 meses). El eco-Doppler cardíaco de seguimiento demostró IM leve en 11 pacientes y moderada a grave en 1. Hubo una mejoría en la calidad de vida en todos los casos. Conclusiones: En esta serie inicial de un solo centro y que incluye la curva de aprendizaje, la RPVM con MitraClip® en pacientes con IM grave sintomática y alto riesgo quirúrgico fue segura y efectiva, con una mejoría clínica significativa y también en la calidad de vida en el seguimiento.

ABSTRACT Objective: To analyze and report our initial outcomes of Percutaneous Mitral Valve Repair (PMVR) with MitraClip® for patients with severe symptomatic Mitral Regurgitation (MR) and high surgical risk. Methods: Between March 2016 and October 2018 twelve consecutive PMVR with MitraClip® were performed in patients with severe symptomatic MR and contraindication or high surgical risk. Implantation Success (IS) was defined as adequate leaflets grasping, leaving < moderate residual MR at the end of the procedure and 30-day Procedural Success when IS was achieved without any Major Adverse Cardiovascular Event (MACE: death, AMI, Stroke, need of valvular surgery, pericardial effusion, tamponade or major bleeding). Results: Mean age was 74.1±8.9 years, all of them had hypertension and Dyslipemia 7 were men, 3 diabetics, 4 smokers, 5 had previous atrial fibrillation, 2 permanent pacemakers, 3 previous AMI, 2 of them had received PCI and 4 cardiac surgery. The eGFR was 73.8±34.8 ml/m2, 2 had <60 ml/m2 and one on dialysis. All Ptes were in FC III-IV and history of previous hospitalizations because heart failure. Echocardiographic findings: Left Ventricle End Diastolic Diameter (LVEDD) 61.8±6.4, End Systolic Diameter (LVESD) 46.3±2.1; left ventricular ejection fraction (LVEF) 47.5±13.4 (25-60). MI were degenerative in 7 Ptes and functional in 5. Risk Scores: EuroSCORE log was 9.6±6.8, STS for mortality 16.1±13.5 and the STS for morbimortality of 22.8±17.7 EI was achieved in all Ptes; 1 Single Clip was implanted in 7 Pts and 2 Clips in 5; Mean residual post-implantation gradient was 3.6±0.2 mmHg. IS was achieved in all; post-procedural MR was mild in 11 and trivial in one. Mean length of hospital stay was 1.9±0.8 (1-3) days. At 30 days all were in FC 0-II, no one presented MACE or rehospitalization because heart failure. Follow-Up was performed in all Ptes with an average time of 8.8±6.7 (1-30) months. Two patients died (1 from pneumonia at 14 months and another at 30 months due to refractory cardiac failure after TAVI, maintaining mild MR.) There were no other complications, all were in FC I-II, one required rehospitalization due to heart failure (at 7 month). Echo Doppler at follow-Up showed that 11 Ptes had <2 MR and 1 had >2 MR. The QOL improved during the follow-up Conclusion: In this initial series, from a single center that includes the learning curve of the team, PMVR with MitraClip® in Ptes with severe mitral regurgitation and high surgical risk was safe and effective, with a significant clinical improvement at follow-up

Percutaneous repair of left ventricular pseudoaneurysm after transcatheter aortic valve replacement.

Transcatheter aortic valve replacement (TAVR) represents a viable therapeutic option in patients with severe symptomatic aortic valve stenosis. The development of a left ventricular pseudoaneurysm (LVP) represents an infrequent but potentially catastrophic complication after transapical TAVR. In this case report, we present a patient undergoing TAVR through subclavian access which had an LVP and underwent successful percutaneous closure.

Transradial Versus Transfemoral Carotid Artery Stenting: A 16-Year Single-Center Experience.

AIMS: Limited data exist on radial access in carotid artery stenting (CAS). This single-center study was performed to compare the outcome and complication rates of transradial (TR) and transfemoral (TF) CAS. METHODS AND RESULTS: The clinical and angiographic data of 775 consecutive patients with high risk for carotid endarterectomy, treated between 1999 and 2016 by CAS with cerebral protection, were evaluated. Patients were divided into 2 groups according to vascular access: TR (n = 101; 13%) and TF (n = 674). Primary combined end-point: in-hospital major adverse cardiac and cerebral events. Secondary end-points: angiographic outcome of the procedure and crossover rate to another puncture site. Angiographic success was achieved in all 775 patients, the crossover rate was 4.9% in the TR and 0% in the TF group (P < 0.05). TR was performed at the right side in 97% of cases. The incidence of in-hospital major adverse cardiac and cerebral events was 2% in the TR and 3.6% in the TF group (P = ns). CONCLUSIONS: The TR approach for CAS is safe and efficacious, with acceptable cross-over rate. In both groups, vascular complications rarely occurred.

Vascular endothelial growth factor overexpression does not enhance adipose stromal cell-induced protection on muscle damage in critical limb ischemia.

OBJECTIVES: Critical limb ischemia complicates peripheral artery disease leading to tissue damage and amputation. We hypothesized that modifying adipose stromal cells (ASCs) to overexpress human vascular endothelial growth factor 165 (VEGF) would limit ischemic muscle damage to a larger extent than nonmodified ASCs. APPROACH AND RESULTS: Rabbits with critical hindlimb ischemia were injected with allogeneic abdominal fat-derived ASCs transfected with plasmid-VEGF165 (ASCs-VEGF; n=10). Additional rabbits received nontransfected ASCs (ASCs; n=10) or vehicle (placebo; n=10). One month later, ASCs-VEGF rabbits exhibited significantly higher density of angiographically visible collaterals and capillaries versus placebo (both P<0.05) but not versus ASCs (both P=NS). Arteriolar density, however, was increased in both ASCs and ASCs-VEGF groups (both P<0.05 versus placebo). ASCs-VEGF and ASCs showed comparable post-treatment improvements in Doppler-assessed peak systolic velocity, blood pressure ratio, and resistance index. Ischemic lesions were found in 40% of the muscle samples in the placebo group, 19% in the ASCs-VEGF group, and 17% in the ASCs groups (both P<0.05 versus placebo, Fisher test). CONCLUSIONS: In a rabbit model of critical limb ischemia, intramuscular injection of ASCs genetically modified to overexpress VEGF increase angiographically visible collaterals and capillary density. However, both modified and nonmodified ASCs increase arteriolar density to a similar extent and afford equal protection against ischemia-induced muscle lesions. These results indicate that modifying ASCs to overexpress VEGF does not enhance the protective effect of ASCs, and that arteriolar proliferation plays a pivotal role in limiting the irreversible tissue damage of critical limb ischemia.

Hybrid strategy for unstable patients with severe carotid and cardiac disease requiring surgery.

BACKGROUND: Concurrent severe carotid and cardiac disease is a challenging situation where staged surgery is probably the most common strategy. However, in patients with an unstable clinical presentation, the best approach is still a matter of debate. The aim of the study was to report in-hospital and midterm outcome in patients who received carotid artery stenting and synchronous cardiac surgery. METHODS: From June 1998 to July 2012, 54 consecutive patients who were treated at a high-volume university medical center with this hybrid approach were included in the study. All of the patients received carotid angioplasty while being administered aspirin and regular unfractionated heparin. Then, all of the patients were immediately transferred to the operating room for coronary and/or cardiac valve surgery. All of the patients were administered aspirin and clopidogrel once bleeding was ruled out, after surgery. RESULTS: There were 5 in-hospital surgical related deaths, and no patient suffered a stroke or required carotid urgent re-intervention. At follow-up (55 ± 28 months; range 1-144 months), there were no new neurological deficits, while one additional death occurred. CONCLUSIONS: In this series, synchronous carotid stenting and cardiac surgery were feasible with an acceptable complication rate in a high-surgical-risk population, which could not undergo staged procedures.

Complicaciones eléctricas posimplante de válvula aórtica percutáneo: evolución clínica y eléctrica / Clinical Outcomes of Electrical Disorders after Transcatheter Aortic Valve Implantation

Introducción El implante valvular aórtico percutáneo es una opción terapéutica cada vez más utilizada en pacientes en los que se descarta la cirugía. A pesar de que las alteraciones agudas de la conducción son una de las complicaciones más frecuentes, su significado clínico y electrocardiográfico no es del todo claro. Objetivos Determinar las implicaciones pronósticas del desarrollo de alteraciones agudas de la conducción luego del implante valvular aórtico percutáneo. Resultados Entre marzo de 2009 y febrero de 2012 se incluyeron para el análisis 47 pacientes; de ellos, 30 (63%) presentaron alteraciones agudas de la conducción: 19 pacientes solo bloqueo completo de rama izquierda (BCRI), 9 pacientes solo bloqueo auriculoventricular completo (BAVC) y 2 pacientes presentaron ambos trastornos, los que totalizaron 21 BCRI y 11 BAVC. A 12 (25%) se les implantó un marcapasos definitivo previo al alta: en 11 por BAVC y en 1 por BCRI agudo más fibrilación auricular. En solo un paciente el BAVC revirtió en hemodinamia. Los pacientes que persistieron con BAVC posintervención presentaron una media de estimulación ventricular en la intervalometría al mes del 90%, mientras que en el paciente con BAVC que revirtió en hemodinamia fue de solo el 3% y en el paciente con BCRI más fibrilación auricular fue < 10%. La incidencia de insuficiencia cardíaca en el posoperatorio fue mayor en los pacientes con alteraciones agudas de la conducción (p = 0,007), al igual que la estadía hospitalaria (p = 0,045). En el seguimiento no hubo diferencias en la tasa de reinternación ni en la mortalidad. Conclusiones En el presente estudio el desarrollo de alteraciones agudas de la conducción mostró un aumento en la incidencia de insuficiencia cardíaca y en los días de internación, sin incremento en la tasa de otros eventos mayores. La colocación de un marcapasos definitivo luego del BAVC podría realizarse en forma inmediata, ya que el trastorno generalmente es irreversible.

Introduction The indication of transcatheter aortic valve implantation in patients considered not suitable candidates for surgery is increasing. Despite acute disorders of the conduction system are common complications, their clinical and electrocardiographic significance is not completely clear. Objectives To determine whether acute disorders of the conduction system after transcatheter aortic valve implantation has prognostic implications. Results Between March 2009 and February 2012, 47 patients were included in the analysis. Thirty patients (63%) had acute disorders of the conduction system: 19 patients presented isolated complete left bundle branch block (LBBB), 9 patients isolated complete atrioventricular block (CAVB), and 2 patients both conduction disorders, with a total of 21 LBBBs and 11 CAVBs. A definite pacemaker was implanted in 12 patients (25%) before discharge: in 11 due to CAVB and in 1 due to acute LBBB plus atrial fibrillation. Complete AVB reverted in the catheterization laboratory in only one patient. At one month, average ventricular pacing was 90% in patients with persistent CAVB after the intervention, only 3% in the only patient in whom CAVB reverted at the catheterization laboratory and < 10% in the patient with LBB plus atrial fibrillation. The incidence of postoperative heart failure and hospital stay was greater in patients with acute disorders of the conduction system (p = 0.007 and p = 0.045, respectively). There were no differences in new hospitalizations and mortality during follow-up. Conclusions In this study, the development of acute disorders of the conduction system was associated with increased incidence of heart failure and hospital stay but not with the incidence of major events. A definite pacemaker could be implanted immediately after CAVB develops as the conduction disorder is generally irreversible.

Complicaciones eléctricas posimplante de válvula aórtica percutáneo: evolución clínica y eléctrica / Clinical Outcomes of Electrical Disorders after Transcatheter Aortic Valve Implantation

Introducción El implante valvular aórtico percutáneo es una opción terapéutica cada vez más utilizada en pacientes en los que se descarta la cirugía. A pesar de que las alteraciones agudas de la conducción son una de las complicaciones más frecuentes, su significado clínico y electrocardiográfico no es del todo claro. Objetivos Determinar las implicaciones pronósticas del desarrollo de alteraciones agudas de la conducción luego del implante valvular aórtico percutáneo. Resultados Entre marzo de 2009 y febrero de 2012 se incluyeron para el análisis 47 pacientes; de ellos, 30 (63%) presentaron alteraciones agudas de la conducción: 19 pacientes solo bloqueo completo de rama izquierda (BCRI), 9 pacientes solo bloqueo auriculoventricular completo (BAVC) y 2 pacientes presentaron ambos trastornos, los que totalizaron 21 BCRI y 11 BAVC. A 12 (25%) se les implantó un marcapasos definitivo previo al alta: en 11 por BAVC y en 1 por BCRI agudo más fibrilación auricular. En solo un paciente el BAVC revirtió en hemodinamia. Los pacientes que persistieron con BAVC posintervención presentaron una media de estimulación ventricular en la intervalometría al mes del 90%, mientras que en el paciente con BAVC que revirtió en hemodinamia fue de solo el 3% y en el paciente con BCRI más fibrilación auricular fue < 10%. La incidencia de insuficiencia cardíaca en el posoperatorio fue mayor en los pacientes con alteraciones agudas de la conducción (p = 0,007), al igual que la estadía hospitalaria (p = 0,045). En el seguimiento no hubo diferencias en la tasa de reinternación ni en la mortalidad. Conclusiones En el presente estudio el desarrollo de alteraciones agudas de la conducción mostró un aumento en la incidencia de insuficiencia cardíaca y en los días de internación, sin incremento en la tasa de otros eventos mayores. La colocación de un marcapasos definitivo luego del BAVC podría realizarse en forma inmediata, ya que el trastorno generalmente es irreversible.(AU)

Introduction The indication of transcatheter aortic valve implantation in patients considered not suitable candidates for surgery is increasing. Despite acute disorders of the conduction system are common complications, their clinical and electrocardiographic significance is not completely clear. Objectives To determine whether acute disorders of the conduction system after transcatheter aortic valve implantation has prognostic implications. Results Between March 2009 and February 2012, 47 patients were included in the analysis. Thirty patients (63%) had acute disorders of the conduction system: 19 patients presented isolated complete left bundle branch block (LBBB), 9 patients isolated complete atrioventricular block (CAVB), and 2 patients both conduction disorders, with a total of 21 LBBBs and 11 CAVBs. A definite pacemaker was implanted in 12 patients (25%) before discharge: in 11 due to CAVB and in 1 due to acute LBBB plus atrial fibrillation. Complete AVB reverted in the catheterization laboratory in only one patient. At one month, average ventricular pacing was 90% in patients with persistent CAVB after the intervention, only 3% in the only patient in whom CAVB reverted at the catheterization laboratory and < 10% in the patient with LBB plus atrial fibrillation. The incidence of postoperative heart failure and hospital stay was greater in patients with acute disorders of the conduction system (p = 0.007 and p = 0.045, respectively). There were no differences in new hospitalizations and mortality during follow-up. Conclusions In this study, the development of acute disorders of the conduction system was associated with increased incidence of heart failure and hospital stay but not with the incidence of major events. A definite pacemaker could be implanted immediately after CAVB develops as the conduction disorder is generally irreversible.(AU)

[Pharmacological and mechanical thrombolysis in submassive pulmonary embolism]. / Trombolisis farmacológica y mecánica en tromboembolismo pulmonar submasivo.

Thromboembolic pulmonary disease is challenging for physicians when diagnosed in acute, sub-acute and chronic clinical patients, not only due to its morbi-mortality, but also because of its complex therapeutic management. Severity of the acute condition and potential commitment of right ventricular systolic function require therapeutic strategies, sometimes combined, in order to change the disease's course, optimizing patient survival. Pharmacological and mechanical thrombolysis are useful therapeutic tools for patients suffering from severe acute pulmonary embolism. This study refers to a young woman who developed a sub-massive pulmonary embolism, of sub-acute onset. She underwent the combined sequential therapeutic strategy of pharmacological and mechanical thrombolysis with successful outcome.