Sustitución valvular aórtica por bioprótesis sin suturas Perceval S

Antecedentes: La sustitución valvular aórtica es el tratamiento de elección de la estenosis aórtica severa sintomática. Debido a la edad avanzada y a las comorbilidades de la población contemporánea, cada vez hay más pacientes que no son candidatos a cirugía por presentar un alto riesgo quirúrgico. Esto ha conducido al desarrollo de técnicas alternativas como la implantación de válvula aórtica transcatéter (TAVI) o las bioprótesis sin suturas Perceval S.Métodos: Se realizó un estudio observacional longitudinal retrospectivo, cuyo objetivo principal era evaluar la seguridad y la efectividad de la bioprótesis sin suturas Perceval S en la primera serie de pacientes operados en el Hospital Vall d'Hebron. Se incluyeron 20 pacientes consecutivos con alto riesgo quirúrgico, operados entre los meses de abril de 2014 y diciembre de 2015. Se registraron y analizaron los datos preoperatorios, perioperatorios y del seguimiento a los 30 días, a los 6 meses y al año. Resultados: La supervivencia al año fue del 90%, la incidencia de aparición de complicaciones relacionadas con la bioprótesis fue baja, y todos los pacientes experimentaron una mejoría clínica y hemodinámica tras la implantación de la bioprótesis Perceval S. Conclusiones: La bioprótesis sin suturas Perceval S como sustituto valvular aórtico es una estrategia terapéutica segura y efectiva; que se puede considerar como alternativa a la cirugía convencional en pacientes con alto riesgo quirúrgico.Antecedents: La substitució valvular aòrtica és el tractament d'elecció de l'estenosi aòrtica severa simptomàtica. A causa de l'edat avançada i les comorbiditats de la població contemporània, cada vegada hi ha més pacients que no són candidats a cirurgia per presentar un alt risc quirúrgic. Això ha conduït al desenvolupament de tècniques alternatives com la implantació valvular aórtica transcatéter (TAVI) o les biopròtesis sense sutures Perceval S. Mètodes: Es va dur a terme un estudi observacional longitudinal retrospectiu, l'objectiu principal del qual era avaluar la seguretat i l'efectivitat de la biopròtesi sense sutures Perceval S en la primera sèrie de pacients operats a l'Hospital Vall d'Hebron. Es van incloure 20 pacients consecutius amb alt risc quirúrgic, operats entre els mesos d'abril de 2014 i desembre de 2015. Es van enregistrar i analitzar les dades preoperatòries, perioperatòries i del seguiment als 30 dies, als 6 mesos i a l'any. Resultats: La supervivència a l'any va ser del 90%, la incidència d'aparició de complicacions relacionades amb la biopròtesi va ser baixa, i tots els pacients van experimentar una millora clínica i hemodinàmica després de la implantació de la biopròtesi Perceval S. Conclusions: La biopròtesi sense sutures Perceval S com a substitut valvular aòrtic és una estratègia terapèutica segura i efectiva; que es pot considerar com alternativa a la cirurgia convencional en pacients amb alt risc quirúrgic.Background: Aortic valve replacement is the treatment of choice for severe symptomatic aortic stenosis. Due to the advanced age and comorbidities of contemporary population, there is a significant proportion of patients who are not eligible for surgery because they present an increased surgical risk. This has lead to the development of alternative techniques such as transcatheter aortic valve implantation (TAVI) or Perceval S sutureless bioprosthesis. Methods: A retrospective longitudinal observational study was performed, the main objective of which was to evaluate the safety and effectivity of Perceval S sutureless bioprosthesis in the first group of patients undergoing surgery with this device at Vall d'Hebron Hospital. 20 high-risk consecutive patients operated between Abril 2014 and December 2015 were included. Preoperative, perioperative, 30-days, 6 moths and 1 year follow-up data were recorded and analyzed. Results: One-year survival was 90%, the incidence of valve-related complications was low, and all patients experienced clinical and hemodynamic improvement after the implantation of Perceval S bioprosthesis. Conclusions: Perceval S sutureless bioprosthesis is a safe and effective device, which can be considered as an alternative to conventional aortic valve replacement in patients with an increased surgical risk

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

Papillary fibroelastoma on the pulmonary valve in a young woman

Papillary fibroelastomas are rare benign primary cardiac tumors that usually grow depending on the left heart valves. The pulmonary valve is rarely involved, with only 7% of cases described on it. Most of patients are asymptomatic but these tumors are responsible for life-threatening complications. We present a singular case of papillary fibroelastoma depending on the pulmonary valve in a young woman detected by echocardiography which was surgically removed with an uneventful recovery. Resumen: Los fibroelastomas papilares son unos tumores cardíacos primarios que normalmente crecen dependiendo de las válvulas cardíacas izquierdas. La válvula pulmonar rara vez se ve involucrada, estando presente en tan solo un 7% de los casos descritos. La mayoría de los pacientes están asintomáticos, pero estos tumores son responsables de las complicaciones potencialmente mortales. Se presenta un caso singular de fibroelastoma papilar sobre válvula pulmonar en una mujer joven detectado por ecocardiografía y tratado mediante excisión quirúrgica con un postoperatorio sin complicaciones. Keywords: Cardiac tumors, Echocardiography, Pulmonary valve, Heart valve repair, Palabras clave: Tumores cardíacos, Ecocardiografía, Válvula pulmonar, Reparación valvula

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

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

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