Trasplante cardíaco en pacientes portadores de asistencia ventricular izquierda de larga duración: «trucos y consejos»

Performing heart transplantation in patients with long-term ventricular assist devices (LVADs) is both a surgical and medical management challenge. Given the lack of donors, heart transplants under these conditions are increasing, so it is necessary to plan the entire process starting from the implantation of the device, which will allow to foresee possible complications and their respective solutions, thus obtaining best results. We describe the guidelines to be taken into account in LVAD implantation (access, location and route of the outflow graft, driveline, closure), as well as in the planning and performance of the transplant, making a brief comment on two important aspects about the usual hemodynamic management in these cases. (C) 2022 Sociedad Espanola de Cirugla Cardiovascular y Endovascular. Published by Elsevier Espana, S.L.U

Criterios de ordenación temporal de las intervenciones quirúrgicas en patología cardiovascular y endovascular adquirida. Versión 2022

Waiting list management of cardiac surgical procedures is a main concern for all the Spanish autonomic health systems and for our scientific Society. The first statement for optimal timing of patients waiting for cardiac surgery was published in 2000. Since then, after significant changes in the management of some pathologies, new normative frameworks and the current healthcare situation, a review of the timing criteria to offer an adequate and updated standard of care is needed. In this document we aim to review the available literature in the field and stablish a consensus within a working group of the Spanish Society of Cardiovascular and Endovascular Surgery to optimize the priority recommendations in cardiac surgical waiting lists in our country. (c) 2022 Sociedad Espanola de Cirugia Cardiovascular y Endovascular. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ riccuses/by-nc-nri/4.0/)

ECMO for COVID-19 patients in Europe and Israel

Since March 15th, 2020, 177 centres from Europe and Israel have joined the study, routinely reporting on the ECMO support they provide to COVID-19 patients. The mean annual number of cases treated with ECMO in the participating centres before the pandemic (2019) was 55. The number of COVID-19 patients has increased rapidly each week reaching 1531 treated patients as of September 14th. The greatest number of cases has been reported from France (n = 385), UK (n = 193), Germany (n = 176), Spain (n = 166), and Italy (n = 136) .The mean age of treated patients was 52.6 years (range 16–80), 79% were male. The ECMO configuration used was VV in 91% of cases, VA in 5% and other in 4%. The mean PaO2 before ECMO implantation was 65 mmHg. The mean duration of ECMO support thus far has been 18 days and the mean ICU length of stay of these patients was 33 days. As of the 14th September, overall 841 patients have been weaned from ECMO support, 601 died during ECMO support, 71 died after withdrawal of ECMO, 79 are still receiving ECMO support and for 10 patients status n.a. . Our preliminary data suggest that patients placed on ECMO with severe refractory respiratory or cardiac failure secondary to COVID-19 have a reasonable (55%) chance of survival. Further extensive data analysis is expected to provide invaluable information on the demographics, severity of illness, indications and different ECMO management strategies in these patients

Estudio retrospectivo de la asistencia ventricular Abiomed BVS 5000® en los primeros 10 años de experiencia en el Hospital Universitario de Bellvitge

Introducción y objetivo: Nuestra serie es una serie histórica, homogénea en cuanto a tipo de dispositivo y manejo. Esto nos permite conocer la incidencia, características, complejidad y evolución de los pacientes, así como saber si fue un tratamiento adecuado como asistencia ventricular de corta/media duración. Métodos: La población a estudio estuvo formada por 37 pacientes a los que se les implantó la Abiomed BVS 5000® en el período 1992-2001. Se analizan datos demográficos, comorbilidades, causa de la indicación, cuantificación de la disfunción ventricular, características de la asistencia y evolución. Resultados: De los 37 pacientes a los que se les colocó la asistencia, 13 murieron durante la implantación. De los 24 sobrevivientes (64,8%) a 7 de ellos (29%) se les realizó destete y a 17 de ellos (71%) se les practicó un trasplante cardíaco. De los 7 pacientes a los que se les hizo destete 3 murieron durante el ingreso y 4 pudieron ser dados de alta. De los 17 pacientes trasplantados 5 (29%) murieron en el postoperatorio y 12 (71%) recibieron el alta. Del total de la serie, 16 pudieron ser dados de alta (43,2%). Conclusiones: Los pacientes de la serie tenían importantes comorbilidades y presentaron graves complicaciones pre- y postoperatorias. El hecho de obtener una supervivencia inicial del 64% lo avala como opción de tratamiento en la insuficiencia cardíaca crítica. Abiomed BVS 5000® proporcionó una supervivencia final al alta del 43,2% lo cual puede considerarse como un buen resultado en estas circunstancias

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective