Reemplazo valvular aórtico con bioprótesis sin sutura Perceval S: experiencia de un solo centro

Resumen: Introducción y objetivos: La introducción de la prótesis aórtica sin sutura Perceval S ha supuesto una gran alternativa para el tratamiento quirúrgico de la estenosis aórtica severa, especialmente en pacientes añosos.Se trata de un estudio observacional, retrospectivo, de un grupo de pacientes de nuestro centro sometidos a reemplazo valvular aórtico con bioprótesis sin sutura Perceval S (LivaNova, Saluggia, Italia). Métodos: Entre junio de 2015 y octubre de 2018, 105 pacientes fueron sometidos a reemplazo valvular aórtico con bioprótesis Perceval S. Los procedimientos combinados fueron: reemplazo valvular mitral (n = 1), reparación valvular tricúspide (n = 2), revascularización miocárdica (n = 16) y miectomía (n = 1). El seguimiento clínico y ecocardiográfico se realizó al alta, a los 6 meses y anualmente. Resultados: La edad media fue de 80,5 ± 3,8 años; 57 (54,3%) fueron mujeres. La mortalidad a los 30 días fue del 1,9% (2 de 105). La tasa de supervivencia a los 30 días fue del 98% y al año fue del 95%. La media del Euroscore II fue de 3,8 ± 5,5%. Los tiempos de circulación extracorpórea y de isquemia fueron de 58,4 ± 41,8 min y de 44 ± 19,9 min para el reemplazo valvular aórtico aislado, 94,2 ± 44,1 min y 73,9 ± 35,6 min para procedimientos combinados, respectivamente. La media del gradiente de presión medio transvalvular fue de 13,5 ± 4,9 mmHg. La función ventricular izquierda aumentó desde el 56,8 ± 10,8% al 58,6 ± 11,1%. Solo 7 pacientes requirieron implante de marcapasos definitivo, con una incidencia del 6,7%. Solo 2 pacientes presentaron fuga paravalvular moderada al alta, que no requirió ningún tratamiento. Conclusiones: El reemplazo valvular aórtico con la bioprótesis sin sutura Perceval S se asocia a una baja mortalidad y a un excelente comportamiento clínico y hemodinámico, especialmente en pacientes de edad avanzada. Abstract: Introduction and objectives: Sutureless aortic valve replacement has emerged as an alternative for surgical treatment of severe aortic stenosis, especially in older patients.This is an observational, retrospective study of a group of patients from a single centre undergoing aortic valve replacement with Perceval S sutureless bioprosthesis (LivaNova, Saluggia, Italy). Methods: A total of 105 patients had an aortic valve replacement with a Perceval S bioprosthesis between June 2015 and October 2018. The combined procedures were, mitral valve replacement (n = 1), tricuspid valve repair (n = 2), myocardial revascularisation (n = 16), and myectomy (n = 1). The clinical and echocardiographic follow-up was performed at discharge, at 6 months, and yearly, after surgery. Results: The mean age was 80.5 ± 3.8 years, and 57 (54.3%) were women. The mortality rate at 30 days was 1.9% (2 out of 105).The 30-day survival rate was 98%, and at one year it was 95%. The mean Euroscore II was 3.8% ± 5.5%. The cardiopulmonary bypass and ischaemia times were 58.4 ± 41.8 min, and 44 ± 19.9 min for isolated aortic valve replacement, 94.2 ± 44.1 min and 73.9 ± 35.6 min for combined procedures, respectively. The mean trans-prosthetic gradient was 13.5 ± 4.9 mmHg. The left ventricle function increased from 56.8% ± 10.8% to 58.6% ± 11.1%. Only 7 patients have required a definitive pacemaker implant (6.7%). Only 2 patients presented with a moderate para-valvular leak that did not require any treatment. Conclusions: Aortic valve replacement with the Perceval S sutureless bioprosthesis is associated with low mortality and excellent clinical and haemodynamic behaviour, especially in elderly patients. Palabras clave: Reemplazo valvular aórtico, Perceval S, Estenosis valvular aórtica, Prótesis biológica, Revisión, Keywords: Aortic valve replacement, Perceval S, Aortic valve stenosis, Biological prosthesis, Revie

Prediction of major adverse cardiac, cerebrovascular events in patients with diabetes after acute coronary syndrome

BACKGROUND AND OBJECTIVES: The risk of major adverse cardiac and cerebrovascular events following acute coronary syndrome is increased in people with diabetes. Predicting out-of-hospital outcomes upon follow-up remains difficult, and no simple, well-validated tools exist for this population at present. We aim to evaluate several factors in a competing risks model for actionable evaluation of the incidence of major adverse cardiac and cerebrovascular events in diabetic outpatients following acute coronary syndrome. METHODS: Retrospective analysis of consecutive patients admitted for acute coronary syndrome in two centres. A Fine-Gray competing risks model was adjusted to predict major adverse cardiac and cerebrovascular events and all-cause mortality. A point-based score is presented that is based on this model. RESULTS: Out of the 1400 patients, there were 783 (55.9%) with at least one major adverse cardiac and cerebrovascular event (417 deaths). Of them, 143 deaths were due to non-major adverse cardiac and cerebrovascular events. Predictive Fine-Gray models show that the 'PG-HACKER' risk factors (gender, age, peripheral arterial disease, left ventricle function, previous congestive heart failure, Killip class and optimal medical therapy) were associated to major adverse cardiac and cerebrovascular events. CONCLUSION: The PG-HACKER score is a simple and effective tool that is freely available and easily accessible to physicians and patients. The PG-HACKER score can predict major adverse cardiac and cerebrovascular events following acute coronary syndrome in patients with diabetes

Prediction of major adverse cardiac, cerebrovascular events in patients with diabetes after acute coronary syndrome

BACKGROUND AND OBJECTIVES: The risk of major adverse cardiac and cerebrovascular events following acute coronary syndrome is increased in people with diabetes. Predicting out-of-hospital outcomes upon follow-up remains difficult, and no simple, well-validated tools exist for this population at present. We aim to evaluate several factors in a competing risks model for actionable evaluation of the incidence of major adverse cardiac and cerebrovascular events in diabetic outpatients following acute coronary syndrome. METHODS: Retrospective analysis of consecutive patients admitted for acute coronary syndrome in two centres. A Fine-Gray competing risks model was adjusted to predict major adverse cardiac and cerebrovascular events and all-cause mortality. A point-based score is presented that is based on this model. RESULTS: Out of the 1400 patients, there were 783 (55.9%) with at least one major adverse cardiac and cerebrovascular event (417 deaths). Of them, 143 deaths were due to non-major adverse cardiac and cerebrovascular events. Predictive Fine-Gray models show that the 'PG-HACKER' risk factors (gender, age, peripheral arterial disease, left ventricle function, previous congestive heart failure, Killip class and optimal medical therapy) were associated to major adverse cardiac and cerebrovascular events. CONCLUSION: The PG-HACKER score is a simple and effective tool that is freely available and easily accessible to physicians and patients. The PG-HACKER score can predict major adverse cardiac and cerebrovascular events following acute coronary syndrome in patients with diabetes