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/)

Prognostic factors of Infective Endocarditis in Patients on Hemodialysis: A Case Series from a National Multicenter Registry.

Background: Infective endocarditis (IE) is a severe complication associated with high mortality. Objectives: To examine the clinical characteristics of IE in hemodialysis (HD) patients and to determine prognostic factors related to HD. Methods: From January 2008 to April 2015, 2,488 consecutive patients with definite IE were included. Clinical characteristics of IE patients on HD were compared with those of IE patients who were not on HD. Results: A total of 126 patients (63% male, median age: 66 years; IQR: 54-74 years) with IE (5.1%) were on HD. Fifty-two patients died during hospitalization (41%) and 17 additional patients (14%) died during the first year. The rate of patients who underwent surgery during hospitalization was lower in HD patients (38 patients, 30%) than in non-HD patients (1,177 patients, 50%; p 70 years (OR: 4.1, 95% CI: 1.7-10), heart failure (OR: 3.3, 95% CI: 1.4-7-6), central nervous system (CNS) vascular events (OR: 6.7, 95% CI: 2.1-22) and septic shock (OR: 4.1, 95% CI: 1.4-12.1) were independently associated with fatal outcome in HD patients. Of the 38 patients who underwent surgery, 15 (39.5%) died during hospitalization. Conclusions. HD patients with IE present a high mortality. Advanced age and complications, such as heart failure, CNS stroke or septic shock, are associated with mortality.pre-print714 K

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

Registro de intervenciones en pacientes con cardiopatía congénita de la Sociedad Española de Cirugía Torácica-Cardiovascular 2017 y retrospectiva de los últimos 6 años

Resumen: La Sociedad Española de Cirugía Torácica-Cardiovascular presenta los resultados de la actividad en cirugía cardiovascular sobre pacientes con cardiopatía congénita correspondientes al período 2012-2017 basados en un registro voluntario y anónimo de los centros españoles. Este artículo es complementario al registro general del año 2017 y ambos se publican conjuntamente. Se analizan datos de los últimos 6 años, que muestran una impresión más real de nuestra actividad en estas patologías relativamente infrecuentes. En este período se realizaron un total de 12.990 cirugías en cardiopatías congénitas, que suponen un 10% de la cirugía mayor (congénita + adquirida) de nuestro país durante ese tiempo. De estas 12.990 cirugías, el 80% se hicieron con circulación extracorpórea y el 20% sin ella. Destacamos las intervenciones en neonatos y en adultos por su elevada complejidad, que supusieron respectivamente un 19% y un 20% de la actividad total. Las cardiopatías congénitas operadas más prevalentes fueron los defectos septales en los casos que requieren circulación extracorpórea y los ductus en pacientes operados sin circulación extracorpórea. Presentamos los datos ajustados a la escala Aristóteles básico de riesgo quirúrgico preoperatorio. La mortalidad observada en cirugías con circulación extracorpórea fue 3,21% (Aristóteles 7,04), y en cirugías sin circulación extracorpórea 2,42% (Aristóteles 4,73). Este registro muestra con precisión datos de nuestra actividad quirúrgica en cardiopatías congénitas y permite compararnos tanto a nivel nacional como internacional para organizar estrategias de mejora de nuestros resultados. Abstract: The Spanish Society of Thoracic-Cardiovascular Surgery presents the 2012-2017 report of the activity in congenital cardiovascular surgery based on a voluntary and anonymous registration involving the majority of Spanish centres. This article is complementary to the 2017 cardiovascular surgery annual report, and they are published together. Data from the previous 6 years is included, in order to obtain improved real information related to our activity in these relatively uncommon pathologies. In the last 6 years, a total of 12,990 congenital heart defect surgeries were performed, accounting for 10% of the major surgery (congenital + acquired) performed in our country during that period. Of these 12,990 surgeries, 80% of them were performed with extracorporeal circulation and 20% without it. Due to their high complexity, the interventions in neonates and adult patients are highlighted as they represent 19% and 20%, respectively, of the total activity. The most prevalent congenital heart diseases operated on, were septal defects in cases requiring extracorporeal circulation, and ductus in patients not requiring extracorporeal circulation. The data are presented adjusted to the basic Aristotle scale of preoperative surgical risk. The observed mortality of surgeries with extracorporeal circulation was 3.21% (Aristotle 7.04), and without cardiopulmonary bypass 2.42% (Aristotle 4.73). This data analysis shows accurate and reliable information about our surgery for congenital heart disease and allows us to compare ourselves within an international framework, and to organise strategies directed at improving our results. Palabras clave: Cirugía cardiovascular, Cardiopatías congénitas, Registro, España., Keywords: Cardiovascular surgery, Congenital heart disease, Registry, Spain

Cirugía cardiovascular en España en el año 2017. Registro de intervenciones de la Sociedad Española de Cirugía Torácica-Cardiovascular

Resumen: La Sociedad Española de Cirugía Torácica-Cardiovascular presenta el informe correspondiente al año 2017 de los resultados de la actividad de cirugía cardiovascular en nuestro país. Este registro voluntario y anónimo, de datos agregados, está basado en el análisis conjunto de la actividad de 62 centros, garantizándose la confidencialidad de los datos individuales de cada uno. El registro reporta datos de actividad global, mortalidad observada y riesgo quirúrgico, desglosados en distintas categorías de intervenciones.En conjunto, la actividad global de la cirugía cardiovascular de nuestro país permanece estable, con resultados de mortalidad ajustados al riesgo estimado en la mayor parte de las patologías analizadas.Durante el año 2017 se realizaron un total de 36.692 procedimientos de cirugía cardiovascular, desglosados en 29.056 procedimientos (79,2%) de cirugía cardiaca de patología adquirida, 2.127 procedimientos (5,8%) de cirugía cardiaca de patología congénita y 5.509 procedimientos (15,0%) de cirugía vascular periférica.Del total de 36.692 procedimientos, 23.261 (63,4%) fueron cirugías cardiacas mayores: 21.134 procedimientos de patología adquirida y 2.127 de patología congénita. Por otro lado, 20.895 (89,8%) procedimientos se realizaron con el apoyo de circulación extracorpórea.Los datos desglosados de procedimientos de cirugía de las cardiopatías congénitas se presentan nuevamente en un informe específico.Dentro de los 21.134 procedimientos de cirugía cardiaca mayor de patología adquirida, la cirugía valvular aislada fue la más frecuente (9.682 procedimientos), seguida de la cirugía de revascularización coronaria (5.029 procedimientos), cirugía de la aorta (2.249 procedimientos), cirugía mixta valvular-coronaria (2.172 procedimientos), otros procedimientos misceláneos con circulación extracorpórea (1.209 procedimientos) y cirugía de complicaciones mecánicas del infarto (142 procedimientos). Aparte, se realizaron otros 5.496 procedimientos relacionados con el implante o recambio de dispositivos de electroestimulación cardiaca, y 1.837 procedimientos sin circulación extracorpórea no codificados en otros apartados.La información derivada de este registro nacional permite conocer el estado actual de la especialidad en nuestro país mediante el análisis global de la actividad, el conocimiento del perfil de riesgo de nuestros pacientes y la valoración de los resultados obtenidos, lo cual es fundamental para una adecuada evaluación de la calidad de la atención dispensada a los pacientes afectos de patología cardiovascular. Abstract: The Spanish Society of Thoracic and Cardiovascular surgery reports the results of the 2017 registry of the surgical activity in Spain. The participation in this registry is anonymous and voluntary, and it is based on the analysis of the information gathered from 62 centres with activity in cardiovascular surgery, and the confidentiality of the individual data of each centre is ensured. The registry reports the global activity Spain, the observed mortality and the estimated mortality risk, stratified into different types of procedures.The overall cardiac surgical activity in Spain remains stable, with an observed mortality that is adequately adjusted to the estimated surgical risk.During 2017, a total of 36,692 procedures of cardiovascular surgery were performed, divided into 29.056 (79.2%) procedures of adult cardiac surgery, 2.127 (5.8%) procedures of congenital cardiac surgery, and 5,509 procedures (15.0%) of peripheral vascular surgery.Among the total of 36,692 procedures, 23,261 (63.4%) were major cardiac surgical procedures: 21,134 procedures of acquired adult cardiac surgery, and 2,127 congenital cardiac surgery procedures. Furthermore, 20,895 (89.8%) of these procedures were performed with the use of the cardiopulmonary bypass machine.The results of the activity in congenital heart surgery are presented separately in another specific report.Within the 21,134 procedures of acquired adult cardiac surgery, isolated heart valve procedures were the most frequent (9,682 procedures), followed by coronary artery bypass grafting surgery (5,029 procedures), surgery of the aorta (2,249 procedures), combined heart valve and revascularisation procedures (2,172 procedures), other miscellaneous procedures with the use of cardiopulmonary bypass (1,209 procedures), and surgery of mechanical complications of myocardial infarction (142 procedures). Moreover, there were another other 5,496 procedures related to electronic implantable devices and 1,837 procedures without CPB not included in the previous groups.The information derived from this national registry allows to know the state-of-the-art of the surgical specialty in our country, through the knowledge of the surgical activity, the risk profile and the observed results, which is a keystone for an adequate evaluation of the quality of the health care that is delivered to the patients suffering from cardiovascular diseases. Palabras clave: Patología cardiovascular, Cirugía cardiovascular, Registro, Base de datos, España, Keywords: Cardiovascular disease, Cardiac surgery, National registry, Database, Spai

Spanish Society of Cardio & Endovascular Surgery registry of interventions in patients with congenital heart disease: 2020, and retrospective of the previous 9 years

The Spanish Society of Cardiovascular & Endovascular Surgery presents the 2012-2020 report of the activity in congenital cardiovascular surgery, based on a voluntary and anonymous registration involving the most of Spanish centres. This article is complementary to the 2020 cardiovascular surgery annual report, and they are published together. In 2020, seriously damaged by the COVID-19 pandemic related to all sanitary fields, we observe a 14% drop in our congenital activity compared with 2019. Data from the previous 9 years are included, in order to obtain real information related to our activity in the serelatively scarce pathologies. In the last nine years, a total of 18526 congenital heart surgeries were performed, accounting for 9.6% of major surgery (congenital + acquired) performed in Spain during that period. Of these surgeries, 81% of them required extracorporeal circulation and 19% not. We highlight the interventions in neonates and adult patients, which represent respectively 19% and 21% of the whole activity and are a real challenge. The most prevalent congenital heart pathologies operated on were septal defects in cases requiring extracorporeal circulation, and ductus in patients not requiring extracorporeal circulation. The presented data are adjusted to the basic Aristotle score of preoperative surgical risk. The observed mortality of surgeries with extracorporeal circulation was 3.1% (Aristotle-6.48), and without cardiopulmonary bypass 2.41% (Aristotle-4.81). This data analysis shows accurate and reliable information about our surgery for congenital heart disease and allow us to compare ourselves within an international framework, and to organize strategies directed to improve our results. (C) 2022 Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Cirugia Cardiovascular y Endovascular

Cardiovascular surgery in Spain in 2019. Interventions registry from the Spanish Society of Cardiovascular Surgery (SECCE)

The Spanish Society of Cardiovascular and Endovascular Surgery (SECCE) reports the results of the 2019 registry of the surgical activity in our country. This year represents the 31th consecutive year in which this report is published. The participation in this registry is anonymous and voluntary, and it is based on the analysis of the information gathered from 57 centers with activity in cardiovascular surgery in our country, and the confidentiality of the individual data of each center is warranted. For the first time, in the last 15 years, a tendency is broken and fewer hospitals have communicated their activity. In certain cases, estimations have to be calculated in order to make comparisons possible. The registry reports the global activity in our country, the observed mortality and the estimated mortality risk, stratified in different types of procedures.The global cardiac surgical activity in our country remains stable, with an observed mortality that is adequately adjusted to the estimated surgical risk.During 2019, a total of 33,660 procedures of cardiovascular surgery were performed. Major heart surgery was performed in 21,525 cases, among which 19,657 procedures of adult cardiac surgery and 1,868 procedures of congenital cardiac surgery. Out of those, 19,221 procedures were performed under extracorporeal circulation (CEC). Congenital and transplant registries are specifically analysed in their corresponding reports.Among the 19,720 procedures of acquired major cardiac surgery, isolated valve surgery was predominant (8,607 procedures), followed by coronary by-pass surgery (4,734), aorta surgery (2,315) and combined coronary-valvular surgery (1,983). Vascular surgery and transcatheter activity are also reported.The information derived from this national registry allows to know the state-of-the-art of the surgical specialty in our country, through the knowledge of the surgical activity, the risk profile and the observed results, which is a keystone for an adequate evaluation of the quality of the health care that we deliver to the patients affected with cardiovascular pathologies. Risk adjusted mortality seems adequately adjusted, though important local differences are observed. (C) 2021 Sociedad Espanola de Cirugia Cardiovascular y Endovascular. Published by Elsevier Espana, S.L.U

Spanish Society of Cardio & Endovascular Surgery registry of interventions in patients with congenital heart disease: 2019, and retrospective of the last 8 years

The Spanish Society of Cardiovascular & Endovascular Surgery presents the 2012-2019 report of the activity in congenital cardiovascular surgery, based on a voluntary and anonymous registration involving the majority of Spanish centres. This article is complementary to the 2019 cardiovascular surgery annual report, and they are published together. Data from the previous 8 years are included, in order to obtain real information related to our activity in these relatively scarce pathologies. In the last eight years, a total of 16,917 congenital heart surgeries were performed, accounting for 9.7% of major surgery (congenital + acquired) performed in Spain during that period. Of these surgeries, 81% of them required extracorporeal circulation and 19% not. We highlight the interventions in neonates and adult patients, which represent respectively 18% and 21% of the whole activity, and are a real challenge. The most prevalent congenital heart pathologies operated on were septal defects in cases requiring extracorporeal circulation, and ductus in patients not requiring extracorporeal circulation. The presented data are adjusted to the basic Aristotle score of preoperative surgical risk. The observed mortality of surgeries with extracorporeal circulation was 3.06% (Aristotle: 6.72), and without cardiopulmonary bypass 2.41% (Aristotle: 4.79). This data analysis show accurate and reliable information about our surgery for congenital heart disease and allow us to compare ourselves within an international framework, and to organize strategies directed to improve our results. (C) 2021 Sociedad Espanola de Cirugia Cardiovascular y Endovascular. Published by Elsevier Espana, S.L.U

Reparación de la insuficiencia mitral funcional mediante abordaje del aparato subvalvular. Resultados a medio plazo

Introducción y objetivos: El tratamiento quirúrgico de la insuficiencia mitral funcional continúa siendo objeto de amplio debate dada su elevada morbimortalidad y la ausencia de consenso acerca de la mejor opción terapéutica (reparación vs. sustitución). Presentamos nuestra experiencia a medio plazo en su tratamiento mediante reparación valvular con abordaje del aparato subvalvular. Métodos: Entre los años 2012 y 2016 se intervino en nuestro centro a un total de 16 pacientes con insuficiencia mitral de mecanismo iiib de Carpentier con un EuroSCORE logístico medio del 10,81%. En todos ellos se llevó a cabo una anuloplastia mitral restrictiva, junto con reposicionamiento del músculo papilar posteromedial en 14 casos y reaproximación de los músculos papilares en 2 casos. En 12 pacientes se llevó a cabo otro procedimiento asociado. Resultados: El tiempo de seguimiento medio fue de 29,5 meses. Hubo 2 muertes perioperatorias. No hubo más fallecimientos durante el seguimiento. La recurrencia de insuficiencia mitral > 2 fue del 12,5% (2 pacientes). Únicamente los 2 pacientes con insuficiencia mitral > 2 reingresaron en algún momento del seguimiento por insuficiencia cardíaca, permaneciendo el resto en clase funcional i-ii/iv. Conclusiones: El abordaje del aparato subvalvular en la reparación de la insuficiencia mitral funcional se presenta como una alternativa válida en el tratamiento de este tipo de insuficiencia, ofreciendo buenos resultados en lo que a evolución postoperatoria y tasa de recidiva a medio plazo se refiere

Prognostic assessment of valvular surgery in active infective endocarditis: multicentric nationwide validation of a new score developed from a meta-analysis

OBJECTIVES Several risk prediction models have been developed to estimate the risk of mortality after valve surgery for active infective endocarditis (IE), but few external validations have been conducted to assess their accuracy. We previously developed a systematic review and meta-analysis of the impact of IE-specific factors for the in-hospital mortality rate after IE valve surgery, whose obtained pooled estimations were the basis for the development of a new score (APORTEI). The aim of the present study was to assess its prognostic accuracy in a nationwide cohort. METHODS We analysed the prognostic utility of the APORTEI score using patient-level data from a multicentric national cohort. Patients who underwent surgery for active IE between 2008 and 2018 were included. Discrimination was evaluated using the area under the receiver operating characteristic curve, and the calibration was assessed using the calibration slope and the Hosmer-Lemeshow test. Agreement between the APORTEI and the EuroSCORE I was also analysed by Lin's concordance correlation coefficient (CCC), the Bland-Altman agreement analysis and a scatterplot graph. RESULTS The 11 variables that comprised the APORTEI score were analysed in the sample. The APORTEI score was calculated in 1338 patients. The overall observed surgical mortality rate was 25.56%. The score demonstrated adequate discrimination (area under the receiver operating characteristic curve = 0.75; 95% confidence interval 0.72-0.77) and calibration (calibration slope = 1.03; Hosmer-Lemeshow test P = 0.389). We found a lack of agreement between the APORTEI and EuroSCORE I (concordance correlation coefficient = 0.55). CONCLUSIONS The APORTEI score, developed from a systematic review and meta-analysis, showed an adequate estimation of the risk of mortality after IE valve surgery in a nationwide cohort