Outcomes of rapid deployment aortic valve replacement with concomitant cardiac procedures.

Background: Rapid deployment aortic valve replacement (RD-AVR) has been recently introduced with encouraging results. Outcomes of isolated RD-AVR include good hemodynamic profile, facilitation of minimally invasive techniques, and reduction of surgical times. However, role of this prosthesis in concomitant surgery is not well known. Methods: In 2016, we formed a registry to monitor the introduction of this prosthesis, RApid Deployment Aortic Replacement (RADAR). We aim to report mid-term outcomes focusing on patients who had RD-AVR combined with other surgical procedures. Results: Between July 2012 and February 2021, 370 patients were included in this registry (mean age, 75.8±8.0 years; 64.32% male; mean EuroSCORE II, 3.5±2.8). Of these, 128 (34.59%) had concomitant procedures including myocardial revascularization surgery in 69 patients (53.91%), surgery on the ascending aorta in 34 (26.56%), and procedures on other valves in 10 patients (7.81%). There were no significant differences between the isolated AVR and concomitant AVR groups in postoperative complications, in-hospital mortality (4.72% vs. 3.32%, P=0.524), or hemodynamic behavior of these prostheses. Three-year survival was 83.73% and 89.89% in the isolated and concomitant AVR group respectively. There was no difference in survival between the two groups (log-rank test, P=0.4124). Conclusions: Our results support the safety and efficacy of the Edwards INTUITY valve system even in complex aortic valve disease with additional cardiac procedures. RD-AVR could become a useful tool for concomitant surgeries where surgical times are expected to be prolonged.

Síndrome de West criptogénico: perfil clínico, respuesta al tratamiento y factores pronósticos / Cryptogenic West syndrome: Clinical profile, response to treatment and prognostic factors

INTRODUCCIÓN: El síndrome de West (SW) es una encefalopatía epiléptica dependiente de la edad con pronóstico variable según la etiología subyacente, no siempre identificada. OBJETIVOS: Definir el perfil del SW criptogénico en nuestro medio, subgrupo menos estudiado de forma aislada. Estudiar su evolución, respuesta a los distintos tratamientos y establecer factores pronósticos. PACIENTES Y MÉTODOS: Revisión de historias clínicas de 16 pacientes diagnosticados de SW criptogénico durante el período 2000-2015. El tiempo de seguimiento medio fue 6,6 años y mínimo de 2 años. RESULTADOS: 11 de 16 fueron varones, la edad media de inicio fue de 6 meses y 6/16 presentaban antecedente familiar de epilepsia idiopática. El tratamiento de primera línea con vigabatrina tuvo respuesta electroclínica en 5/16 pacientes, respondiendo los casos restantes a hormona adrenocorticotropa (ACTH). El 44% de los pacientes evolucionaron a otras epilepsias, sin diferencia entre los tratados con vigabatrina o ACTH. Se obtuvo un mayor número de efectos adversos con la ACTH, no se evidenció afectación retiniana con la vigabatrina. Durante el seguimiento se llegó a la causa etiológica en 2/16. El sexo femenino, el comienzo tardío y el control precoz de la hipsarritmia resultaron factores de buen pronóstico. CONCLUSIONES: El pronóstico global del SW criptogénico resultó más grave de los esperado. Aunque la incidencia de síndrome de Lennox-Gastaut fue baja, la epilepsia focal resultó la evolución más frecuente apareciendo en los 2 primeros años del diagnóstico. La respuesta inicial a vigabatrina fue menor a la esperada, pero el resultado a largo plazo resultó superponible a la ACTH

INTRODUCTION: West syndrome (WS) is an age-dependent epileptic encephalopathy in which the prognosis varies according to the, not always identified, underlying origin. OBJECTIVES: To define the profile of cryptogenic (a least studied isolated sub-group) WS, in Spain. To study its outcome, response to different treatments, and to establish prognostic factors. PATIENTS AND METHODS: The study included a review of the medical records of 16 patients diagnosed with cryptogenic WS during the period, 2000-2015. The mean follow-up time was 6.6 years, with a minimum of 2 years. RESULTS: The large majority (11/16) were male. The mean age at onset was 6 months, and 6/16 had a family history of idiopathic epilepsy. The first line treatment with vigabatrin had an electrical-clinical response in 5/16 patients, with the remaining cases responding to adrenocorticotropic hormone (ACTH). Almost half (44%) of the patients progressed to other types of epilepsy, with no difference between those treated with vigabatrin or ACTH. A greater number of adverse effects were obtained with ACTH, with no retinal involvement being observed with vigabatrin. The aetiological cause was found in 2/16. Being female, late onset, and early control of the hypsarrhythmia, were factors of a good prognosis. CONCLUSIONS: The overall prognosis of cryptogenic WS was more serious than expected. Although the incidence of Lennox-Gastaut syndrome was low, the progression to focal epilepsy was the most common, with it appearing within the first 2 years of the diagnosis. The initial response to vigabatrin was lower than expected, but the long-term result was comparable to ACTH

[Cryptogenic West syndrome: Clinical profile, response to treatment and prognostic factors]. / Síndrome de West criptogénico: perfil clínico, respuesta al tratamiento y factores pronósticos.

INTRODUCTION: West syndrome (WS) is an age-dependent epileptic encephalopathy in which the prognosis varies according to the, not always identified, underlying origin. OBJECTIVES: To define the profile of cryptogenic (a least studied isolated sub-group) WS, in Spain. To study its outcome, response to different treatments, and to establish prognostic factors. PATIENTS AND METHODS: The study included a review of the medical records of 16 patients diagnosed with cryptogenic WS during the period, 2000-2015. The mean follow-up time was 6.6 years, with a minimum of 2 years. RESULTS: The large majority (11/16) were male. The mean age at onset was 6 months, and 6/16 had a family history of idiopathic epilepsy. The first line treatment with vigabatrin had an electrical-clinical response in 5/16 patients, with the remaining cases responding to adrenocorticotropic hormone (ACTH). Almost half (44%) of the patients progressed to other types of epilepsy, with no difference between those treated with vigabatrin or ACTH. A greater number of adverse effects were obtained with ACTH, with no retinal involvement being observed with vigabatrin. The aetiological cause was found in 2/16. Being female, late onset, and early control of the hypsarrhythmia, were factors of a good prognosis. CONCLUSIONS: The overall prognosis of cryptogenic WS was more serious than expected. Although the incidence of Lennox-Gastaut syndrome was low, the progression to focal epilepsy was the most common, with it appearing within the first 2 years of the diagnosis. The initial response to vigabatrin was lower than expected, but the long-term result was comparable to ACTH.