Endocarditis trombótica no bacteriana (Libman-Sacks)

Mujer de 47 años ingresada en 2002 por ictus. Se diagnosticó masa valvular aórtica. Se intervino realizándose exéresis de trombo no bacteriano (Fig 1a, b). Durante el estudio de trombofilia fue diagnosticada de síndrome antifosfolípido primario (SAP), inciándose anticoagulación. Hasta la fecha, ha padecido múltiples accidentes cerebrovasculares, isquémicos y hemorrágicos. Está en diálisis peritoneal con probable origen en SAP. SAP es un trastorno autoinmune caracterizado por fenómenos trombóticos iterativos y alargamiento de tiempos de coagulación. La cirugía cardiaca conlleva morbimortalidad por tromboembolias, suponiendo un reto en el manejo de la circulación extracorpórea. Las complicaciones tromboembólicas son frecuentes durante el seguimiento.A 47-year-old woman was admitted in 2002 due to stroke. An aortic valve mass was diagnosed and surgical removal of non-bacterial thrombus performed (Fig. 1a, b). During the study for thrombophilia, primary antiphospholipidic syndrome (PSA) was diagnosed and oral anticoagulation started. Up to date, she presented with multiple episodes of cerebrovascular accident, ischemic and hemorrhagic. She is on peritoneal dialysis. PAS is an autoimmune disorder characterized by recurrent thrombotic phenomena and prolonged coagulation time. Cardiac surgery carries morbidity and mortality due to thromboembolic events, representing a challenge in the management of extracorporeal circulation. Thromboembolic complications are frequent during the follow-up

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Seventeen-year follow-up after ascending-to-infrarenal aorta bypass for recurrent coarctation in an adult

Anatomic repair of complex aortic coarctation is associated with significant mortality and morbidity, including paraplegia. Extra-anatomic bypass strategies have been developed to reduce these complications and allow the correction of any concomitant conditions during the same operation. We present the case of a woman with uncontrolled hypertension and preductal coarctation of the aorta diagnosed at age 22 who underwent an unsuccessful attempt at primary repair, followed by extra-anatomic bypass from the ascending-to-infrarenal aorta. The patient has remained normotensive, with no additional complications related to the disease or the procedure, during a follow-up of 17 years

Resultados a corto plazo del tratamiento en un solo tiempo de la enfermedad del arco aórtico y aorta torácica descendente con endoprótesis integrada anterógrada

Comunicar nuestra experiencia con endoprótesis integradas anterógradas en el tratamiento de la disección del arco y aorta torácica descendente. Material y métodos: Entre marzo de 2006 y abril de 2008 se implantó en 12 pacientes por disección aórtica. Resultados: La mediana de edad fue 60,6 años (33,2-71,1), todos bajo parada circulatoria e hipotermia (mediana: 20 °C). Diez por disección tipo A (cuatro agudas) y 2 tipo B (una aguda), completándose en todos los casos. La mortalidad hospitalaria es de cuatro pacientes (dos intraoperatorias). El seguimiento medio es 12,03 meses (IC 95%: 6,72-17,34), presentando una muerte más (sin complicaciones en la aorta). En todos los casos se observó trombosis de la falsa luz hasta el nivel cubierto. No se ha observado crecimiento. No hay casos de migración, endofuga, accidente cerebrovascular o paraplejía. Discusión: La técnica estándar en dos tiempos acarrea considerable morbimortalidad en ambos. Esta técnica ofrece una alternativa permitiendo el tratamiento completo de la aorta torácica en un tiempo a través de esternotomía. Los resultados publicados muestran una mortalidad y complicaciones similares a las técnicas clásicas a medio plazo. Conclusiones: Es posible el tratamiento completo de la aorta torácica sin aumentar la complejidad ni el tiempo de parada circulatoria, con una morbimortalidad similar a las técnicas clásicas. Parece disminuir el riesgo de paraplejía, migración y endofugas. No requiere ninguna infraestructura especial y permite su uso en situaciones de emergencia. Es necesaria más información para conocer la evolución de la reparación a largo plazo

Combined Lung Resection and Aortic Valve Replacement via Ministernotomy

A technique for simultaneous cardiac operation and pulmonary resection via a small upper midline sternotomy is described. It was employed in a 62-year-old man undergoing aortic valve replacement and right lower lobectomy for a carcinoid tumor

Evaluación preoperatoria del riesgo en la endocarditis infecciosa con el modelo EuroScore. Datos iniciales

La predicción de riesgo en cirugía cardíaca tiene un papel importante. Los modelos de predicción son útiles en la toma de decisiones. Los pacientes con endocarditis infecciosa tienen un riesgo alto de morbilidad y mortalidad. El objetivo fue evaluar el modelo de riesgo EuroScore en la endocarditis infecciosa. Métodos: Los modelos EuroScore aditivo y logístico fueron aplicados a todos los pacientes operados por endocarditis infecciosa entre enero de 1995 y junio de 2006. Se compararon la mortalidad observada y la esperada. La calibración de los modelos fue probada mediante la prueba de bondad de ajuste de Hosmer-Lemeshow, y la capacidad discriminación mediante curvas ROC. Resultados: Durante el periodo de estudio se realizaron 191 intervenciones quirúrgicas por endocarditis infecciosa en nuestra institución. La mortalidad observada fue 28,8%. Para la cohorte completa la media de la puntuación aditiva fue 10,37 ± 10. La media de la mortalidad logística predicha fue 27,1 ± 20,3%. La calibración de ambos modelos fue buena (prueba de Hosmer-Lemeshow: p > 0,05). El área bajo la curva ROC fue de 0,835 (modelo aditivo) y 0,842 (modelo logístico). Conclusiones: Aunque la muestra puede ser pequeña, tanto el modelo aditivo como el logístico del EuroScore predicen adecuadamente el riesgoen la endocarditis infecciosa. Se necesita un volumen superior para confirmar estos resultados iniciales

Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis—The ESCAPE Study

International audienceBackground: Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment.Methods: We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome.Results: Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects.Conclusion: L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients

Role of age and comorbidities in mortality of patients with infective endocarditis.

The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups: A total of 3120 patients with IE (1327  There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in th