[Redefining the gold standard for aortic valve replacement: Minimally invasive with accelerated recovery]. / Redefiniendo el estándar de oro para el reemplazo valvular aórtico: mínimamente invasivo y recuperación acelerada.

BACKGROUND: Despite being introduced 20 years ago minimally invasive aortic valve replacement is only performed routinely in a minority of patients world-wide. AIM: To report the operative outcome of minimally invasive aortic valve replacement done through a partial upper sternotomy. PATIENTS AND METHODS: Retrospective analysis of data recorded prospectively of 450 consecutive patients with a median age of 66 years (59% males) who had a minimally invasive aortic replacement. RESULTS: 79% of patients had aortic stenosis. Cross clamp/cardiopulmonary bypass times (median) were 56 and 68 minutes respectively. Conversion to full sternotomy was required in 2.6% of patients, reoperation for bleeding in 2.9%. 1.6% suffered a stroke and 19% postoperative atrial fibrillation. 0.9% required a permanent pacemaker. Postoperative mortality was 0.9%. Median postoperative hospital stay was six days. CONCLUSIONS: Minimally invasive aortic valve replacement can be performed with satisfactory results.

[Transcatheter aortic valve implantation.Experience in 26 patients]. / Experiencia inicial del implante percutáneo de válvula aórtica en el Instituto Nacional del Tórax.

BACKGROUND: Aortic valve stenosis (AS) is the most common valvular disease. Its surgical indication is undisputed in symptomatic severe AS, however, 30% of patients are at high surgical risk or inoperable. Transcatheter Valve Implantation (TAVI) is an alternative for this group of patients. AIM: To describe the clinical outcomes of TAVI in a group of patients treated at the Instituto Nacional del Tórax, Santiago, Chile. PATIENTS AND METHODS: Prospective study including all patients referred for TAVI due to their high surgical risk or being inoperable. All-cause mortality, secondary stroke, permanent pacemaker implantation, vascular complications, prosthetic and periprosthetic regurgitation, Karnosfky test and Functional Capacity (FC) were assessed as endpoints. RESULTS: We evaluated 26 patients with a mean age of 82 years (74% women) in whom 27 procedures were done. The mean Society of Thoracic Surgeons score was 8.8%. Overall mortality at 30 days, one and two years was 11.1, 18.5 and 29.6% respectively. Karnofsky score increased significantly from 62.3% at baseline to 83.9; 88.6 and 88.8% at six months, one and two years, respectively. Prior to the procedure, FC was 3.1 ± 0.6, decreasing significantly to 1.2; 1.3 and 1 at six months, one and two years of follow up. CONCLUSIONS: TAVI is an effective alternative treatment for patients with severe symptomatic AS and high surgical risk.

A Study on a Polymeric Foam Based on Pulse Proteins and Cellulose Fibrils.

Biofoams are a challenge for scientists in terms of innovation. Incorporation of cellulose fibrils (CF), might help improve the microstructure of foams, thus this study focuses on studying the impact of CF on the foaming properties and rheology of lentil protein (LP) foams at various pH and CF concentrations. Additionally, LP-CF mixtures were transformed into solid foams, and their microstructure, physical properties, and morphology were evaluated. CF concentration significantly impacted on LP-CF foam properties, primarily due to high viscosity values. Increased CF concentration resulted in improved FS values (up to 77 min) at all pH values. This is likely attributed to associative interactions and coacervates formation. Also, foam microstructure could be related to apparent viscosity, suggesting the role of viscosity in preserving the integrity of the wet foam structure during freezing and lyophilization processes. However, elevated viscosity values might negatively impact properties such as foaming capacity and produce denser microstructures. The microstructure and morphology analysis revealed that certain foams exhibited a sponge-like structure with open pores and semi-spherical shapes, supported by CF fibers extending and forming layers. However, the structure itself was irregular. While others exhibited non-uniform, irregular pore size, and shape, along with a denser structure. These findings contribute to understanding the behavior of LP-CF mixtures, although additional investigations on mechanical properties, biodegradability, and hydrophobicity are necessary to reach their full potential for various applications.

Exome Sequencing Identifies Genetic Variants Associated with Extreme Manifestations of the Cardiovascular Phenotype in Marfan Syndrome.

Marfan Syndrome (MFS) is an autosomal dominant condition caused by variants in the fibrillin-1 (FBN1) gene. Cardinal features of MFS include ectopia lentis (EL), musculoskeletal features and aortic root aneurysm and dissection. Although dissection of the ascending aorta is the main cause of mortality in MFS, the clinical course differs considerably in age of onset and severity, even among individuals who share the same causative variant, suggesting the existence of additional genetic variants that modify the severity of the cardiovascular phenotype in MFS. We recruited MFS patients and classified them into severe (n = 8) or mild aortic phenotype (n = 14) according to age of presentation of the first aorta-related incident. We used Exome Sequencing to identify the genetic variants associated with the severity of aortic manifestations and we performed linkage analysis where suitable. We found five genes associated with severe aortic phenotype and three genes that could be protective for this phenotype in MFS. These genes regulate components of the extracellular matrix, TGFß pathway and other signaling pathways that are involved in the maintenance of the ECM or angiogenesis. Further studies will be required to understand the functional effect of these variants and explore novel, personalized risk management and, potentially, therapies for these patients.

Redefiniendo el estándar de oro para el reemplazo valvular aórtico: mínimamente invasivo y recuperación acelerada / Redefining the gold standard for aortic valve replacement: minimally invasive with accelerated recovery

Background: Despite being introduced 20 years ago minimally invasive aortic valve replacement is only performed routinely in a minority of patients world-wide. Aim: To report the operative outcome of minimally invasive aortic valve replacement done through a partial upper sternotomy. Patients and Methods: Retrospective analysis of data recorded prospectively of 450 consecutive patients with a median age of 66 years (59% males) who had a minimally invasive aortic replacement. Results: 79% of patients had aortic stenosis. Cross clamp/cardiopulmonary bypass times (median) were 56 and 68 minutes respectively. Conversion to full sternotomy was required in 2.6% of patients, reoperation for bleeding in 2.9%. 1.6% suffered a stroke and 19% postoperative atrial fibrillation. 0.9% required a permanent pacemaker. Postoperative mortality was 0.9%. Median postoperative hospital stay was six days. Conclusions: Minimally invasive aortic valve replacement can be performed with satisfactory results.

Tendencia de la depresión según licencia médica psiquiátrica en Ñuble, Chile 2008 - 2017 / Trend of depression according to psychiatric sick leave in Ñuble, Chile 2008-2017

Resumen Objetivo: Identificar cambios en la tendencia anual (CTA) de la Depresión según las Licencias Médicas Psiquiátricas del Fondo Nacional de Salud en la Región de Ñuble, Chile 2008-2017 Materiales y métodos: Estudio descriptivo y de tendencia que incluyó 34.467 de estas licencias médicas registradas en la Comisión de Medicina Preventiva e Invalidez de la Secretaría Ministerial de Salud de la Región de Ñuble, según características en número de licencias, tipo de licencia, tipo de diagnóstico CIE-10, y entidad pagadora de subsidio. Los resultados se presentaron en números absolutos y porcentajes, para el CTA se construyó un modelo de regresión de Joinpoint, y se utilizó el software Joinpoint Regression Program, Version 4.7.0.0. Resultados: El número de licencias médicas por depresión aumentaron 152.3% del 2008 al 2017, según Tipo de Licencia 99.7% fue por enfermedad o accidente común, por Tipo de Diagnóstico CIE-10 50.7% fue por episodio depresivo inespecífico (F32.9), 71.6% por pagadora de subsidio cajas de compensación. El modelo Joinpoint no identificó CTA de la depresión según el número de las licencias médicas, más bien hubo un aumento constante estimado en 166 licencias (p=0.122) por cada año, diferentes CTA se observó en los diagnósticos de depresión según CIE-10. Conclusiones: La depresión va en aumento constante en la Región de Ñuble, y con la aparición de la COVID-19 más se agrava la salud mental de la población. Aumentar la inversión en salud mental, capacitar al personal sanitario en estas materias y que los tomadores de decisiones reconsideren la implementación del nuevo Plan Nacional de Salud Mental 2017-2025 es apremiante, para que estos esfuerzos reflejen un adecuado control de esta patología y una disminución de este tipo de licencias médicas psiquiátricas.

Abstract Objective: Identify changes in the annual trend (CTA) of Depression according to the Psychiatrics sick leave of the National Health Fund in the Ñuble Region, Chile 2008-2017 Materials and methods: Descriptive and trend study that included 34,467 of these medical licenses registered in the Commission for Preventive Medicine and Disability of the Ministerial Secretary of Health of the Ñuble Region and issued in 10 years, according to characteristics in number of licenses, type of license, type of ICD-10 diagnosis, and subsidy paying entity. The results were presented in absolute numbers and percentages. For the CTA, a Joinpoint regression model was constructed, and the Joinpoint Regression Program, Version 4.7.0.0 software was used. Results: The number of medical leave for depression increased 152.3% from 2008 to 2017, according to Type of Leave 99.7% was due to common illness or accident, by Type of ICD-10 Diagnosis 50.7% was due to nonspecific depressive episode (F32 .9), 71.6% per compensation fund subsidy payer.The Joinpoint model did not identify a CTA in depression according to the number of medical licenses, rather there was a constant increase estimated at 166 licenses (p = 0.122) for each year, and the depression diagnoses according to ICD-10 had different CTAs. Conclusions: Depression is constantly increasing in the Ñuble Region, and with the appearance of covid -19 the mental health of the population worsens, increase investment in mental health, train health personnel in these matters and that decisionmakers reconsider the implementation of the new National Mental Health Plan 2017-2025 is urgent so that these efforts are reflected in the control of this pathology and in the reduction of this type of psychiatrics sick leave.

Oxidative stress in pericardial fluid and plasma and its association with ventricular function.

UNLABELLED: There are no studies evaluating oxidative stress markers both in pericardial fluid and plasma and whether they correlate with cardiac function indexes. The purpose of the study was to investigate whether oxidative stress markers in pericardial fluid and plasma are associated with left ventricular function. METHODS AND RESULTS: Twenty-eight consecutive patients (class I or II NYHA) scheduled for myocardial revascularization, valve replacement, valve repair or closure of atrial septal defect. Plasma and pericardial fluid were collected and malondialdehyde, catalase, superoxide dismutase and glutathione peroxidase were determined. Left ventricular ejection fraction, left ventricular end diastolic diameter and left ventricular end systolic diameter were determined as echocardiographic indexes of ventricular function. We found that oxidative stress determined by a simple malondialdehyde (MDA) assay, correlated in plasma and pericardial fluid, and this parameter was associated with left ventricular end systolic diameter. CONCLUSION: Plasma and pericardial fluid malondialdehyde levels can be used as an early marker of ventricular dysfunction.

Experiencia inicial del implante percutáneo de válvula aórtica en el Instituto Nacional del Tórax: Experience in 26 patients / Transcatheter aortic valve implantation

Background: Aortic valve stenosis (AS) is the most common valvular disease. Its surgical indication is undisputed in symptomatic severe AS, however, 30% of patients are at high surgical risk or inoperable. Transcatheter Valve Implantation (TAVI) is an alternative for this group of patients. Aim: To describe the clinical outcomes of TAVI in a group of patients treated at the Instituto Nacional del Tórax, Santiago, Chile. Patients and Methods: Prospective study including all patients referred for TAVI due to their high surgical risk or being inoperable. All-cause mortality, secondary stroke, permanent pacemaker implantation, vascular complications, prosthetic and periprosthetic regurgitation, Karnosfky test and Functional Capacity (FC) were assessed as endpoints. Results: We evaluated 26 patients with a mean age of 82 years (74% women) in whom 27 procedures were done. The mean Society of Thoracic Surgeons score was 8.8%. Overall mortality at 30 days, one and two years was 11.1, 18.5 and 29.6% respectively. Karnofsky score increased significantly from 62.3% at baseline to 83.9; 88.6 and 88.8% at six months, one and two years, respectively. Prior to the procedure, FC was 3.1 ± 0.6, decreasing significantly to 1.2; 1.3 and 1 at six months, one and two years of follow up. Conclusions: TAVI is an effective alternative treatment for patients with severe symptomatic AS and high surgical risk.

[Early and long term results of mechanical aortic valve replacement at the Instituto Nacional del Torax in Chile]. / Resultados del reemplazo valvular aórtico con prótesis mecánica en el Instituto Nacional del Tórax.

BACKGROUND: Mechanical aortic valve replacement (AVR) results have been published extensively in industrialized countries. AIM: To assess our immediate and late results in patients subjected to AVR. PATIENTS AND METHODS: We retrospectively studied 194 patients subjected to isolated AVR between 1995 and 2003. Mean age was 57 +/- 13 years and 119 (61%) were male. One hundred thirty nine (73%) were in functional class III-IV, 20 (10%) had a previous cardiac operation and 25 (13%) were operated as an emergency. Surgical indication was stenosis in 110 (58%), regurgitation in 49 (26%) and stenosis/regurgitation in 31 (16%). Etiology was bicuspid valve 56 (29%), degenerative lesions 55 (28%), rheumatic valve disease 38 (20%) and endocarditis 27 (14%). Medtronic Hall was the most common prosthesis used in 157 patients (81%). Mean cardiopulmonary bypass time 97 +/- 29 min and mean cross clamp time was 69 +/- 21 min. RESULTS: Operative mortality was 4.6% (3% in elective surgery, 16% in emergency surgery and 0% in reoperations). Follow-up was complete in 100% of cases, totalizing 636 patients-year. Survival was 91 +/- 2%, 80 +/- 4% and 73 +/- 6%, at 1, 5 and 7 years, respectively. Multivariate risk analysis identified renal failure and endocarditis as predictors of early and late mortality. During follow up, the linear incidence rate for hemorrhage was 3.29% /patients-year, thromboembolism 2.04% patients-year and endocarditis 1.1% patients-year. CONCLUSIONS: AVR has low overall and elective mortality. Midterm survival is good but linear event rates related to anticoagulant treatment are higher than those previously published in industrialized countries. Renal failure and endocarditis were risk factors for early and late death.

Desbalance autonómico y procoagulación debido a contaminación atmosférica en Santiago: un estudio prospectivo / Autonomic imbalance and procoagulation due to Santiago’s atmospheric pollution: a prospective study

La contaminación atmosférica (CA) está asociada a aumento de morbilidad cardiovascular a través de mecanismos poco conocidos. Postulamos que la CA por partículas finas se asocia a disminución de la variabilidad de la frecuencia cardíaca (VFC) y a aumento de parámetros procoagulantes. Métodos: Cohorte prospectiva de 6 meses de duración en Santiago (n=88; edad 57±1 años; 44 pts.s con enfermedad coronaria y 44 controles pareados por edad, sexo y comuna de residencia). En cada sujeto se realizó Holter de arritmias de 24 hrs y se determinó proteína C reactiva, viscosidad plasmática, hematocrito y recuento de plaquetas durante un episodio de aumento de la CA y 6 meses después. Se obtuvieron los niveles diarios contemporáneos de partículas PM 2,5 y se analizaron sus efectos sobre la VFC y sobre los parámetros circulantes utilizando modelos aditivos generalizados con ajuste por condiciones meteorológicas, condición caso/control, edad, sexo, índice de masa corporal, colesterol total y HDL, presión arterial sistólica y diastólica, creatinina y uso de aspirina o de betabloqueadores. Resultados: Las concentraciones elevadas de partículas PM 2,5 en el aire los días previos a la medición se asociaron en forma independiente y significativa (p<0,05) con aumento de la FC y disminución en la desviación standard de los intervalos RR normales (SDNN). Se observó además una asociación independiente y significativa (p<0,05) con aumento de la viscosidad plasmática, hematocrito, VHS y del recuento de plaquetas. Conclusiones: Los resultados muestran que la CA por partículas pequeñas disminuye la VFC y aumenta parámetros circulantes de procoagulación, que podrían ser mecanismos que expliquen un aumento de la morbimortalidad cardiovascular debido a CA.