Data analysis from the Spanish Registry of Cardiac Surgery (RECC) 2021-2022

Cardiovascular surgery; Acquired cardiac disease; Aortic surgeryCirurgia cardiovascular; Cardiopaties adquirides; Cirurgia aòrticaCirugía cardiovascular; Cardiopatías adquiridas; Cirugía aórticaIntroducción Desde el 8 de febrero de 2021, la Sociedad Española de Cirugía Cardiovascular y Endovascular (SECCE) puso en marcha el Registro Español de Cirugía Cardiaca (RECC) que está disponible para las diferentes unidades de cirujanos cardiovasculares de nuestro país. Es una herramienta que permite recopilar datos de pacientes sometidos a cirugía cardiaca, vascular o endovascular. Tras dos años de desarrollo, hemos llevado a cabo un análisis de la calidad de la información obtenida para adquirir una visión general de su contenido. Métodos La información ha sido analizada de forma anónima a nivel de paciente, hospital y provincia. Para la estimación de la mortalidad ajustada por riesgo se utilizó la escala de estimación de riesgo preoperatorio EuroSCORE II. Resultados Se han incluido en el RECC un total de 7.087 intervenciones, de las cuales 6.267 se trataban de cirugías cardiacas mayores. Del total de intervenciones mayores, 53,9% eran cirugías valvulares, 25,2% de revascularización miocárdica y 14,9% de aorta. La mortalidad global de la serie fue de 5,0% y el índice de mortalidad ajustada al riesgo (IMAR) de 0,88. La calibración del EuroSCORE II en la muestra global fue buena en los pacientes de riesgo más bajo, aunque sobreestimó la mortalidad en los de alto riesgo. Conclusiones El RECC se trata de una base de datos clínica nacional que permite el análisis de datos de pacientes con el fin de evaluar de forma precisa el volumen de la actividad, riesgo y resultados. A nivel local, podría utilizarse como una herramienta para mejorar la calidad de la atención y el desarrollo de programas correctivos.Introduction Since February 8, 2021, the Spanish Society of Cardiovascular and Endovascular Surgery got under way the Spanish Registry of Cardiac Surgery (RECC), which is available for the different units of cardiovascular surgeons in our country. It is a tool that allows collect patient-level data of patients undergoing cardiac, vascular or endovascular surgery. After two years of development, we have carried out an analysis of the quality of the information obtained in order to acquire an overview of its content. Methods The information has been analyzed anonymously at patient, hospital and province level. For risk-adjusted mortality estimation, the EuroSCORE II preoperative risk estimation scale was used. Results A total of 7087 interventions have been included. Six thousand two hundred and sixty-seven were major cardiac surgeries: 53.9% valvular, 25.2% coronary artery bypass grafting, and 14.9% aortic procedures. The overall mortality was 5.0% and the risk-adjusted mortality rate was 0.88. The EuroSCORE II calibration in the overall sample was good in the lowest-risk patients, although it overestimated mortality in high-risk patients. Conclusions RECC is a nationally defined clinical database in the field of cardiovascular surgery. RECC allows a patient-level data analysis in order to perform an accurate analysis of the volumen of activity, risk adjustment and results. Locally, it could be used as a tool to improve the quality of care and development of corrective programs

Rotura iatrogénica de electrodos de marcapasos permanente en la realización de esternotomía media: presentación de un caso

La esternotomía media continúa siendo el gold-standart de abordaje quirúrgico en cirugía cardiaca. Aún realizada correctamente, laapertura media del esternón presenta complicaciones en el 1-5% de los casos que varían en su gravedad desde la infección de la heridaquirúrgica a la lesión de estructuras intratorácicas. En el presente estudio se describe un caso de rotura de electrodos de marcapasostras esternotomía media por retracción y fibrosis del tronco venoso braquiocefálico. Debido a la ausencia de artículos semejantes enla literatura y al extendido empleo de la esternotomía en pacientes portadores de marcapasos permanente, se pretende disminuirlas lesiones asociadas mediante la publicación de un infrecuente caso de lesión iatrogénica durante la apertura esternal, con escasosprecedentes en la literatura publicada hasta la fecha. MÉD.UIS. 2016;29(3):95-9.Palabras clave: Procedimientos quirúrgicos cardiacos. Marcapasos artificial. Esternotomía. Enfermedad iatrogénica

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/)

Search for eccentric black hole coalescences during the third observing run of LIGO and Virgo

Despite the growing number of confident binary black hole coalescences observed through gravitational waves so far, the astrophysical origin of these binaries remains uncertain. Orbital eccentricity is one of the clearest tracers of binary formation channels. Identifying binary eccentricity, however, remains challenging due to the limited availability of gravitational waveforms that include effects of eccentricity. Here, we present observational results for a waveform-independent search sensitive to eccentric black hole coalescences, covering the third observing run (O3) of the LIGO and Virgo detectors. We identified no new high-significance candidates beyond those that were already identified with searches focusing on quasi-circular binaries. We determine the sensitivity of our search to high-mass (total mass M>70 M⊙) binaries covering eccentricities up to 0.3 at 15 Hz orbital frequency, and use this to compare model predictions to search results. Assuming all detections are indeed quasi-circular, for our fiducial population model, we place an upper limit for the merger rate density of high-mass binaries with eccentricities 0<e≤0.3 at 0.33 Gpc−3 yr−1 at 90\% confidence level

Ultralight vector dark matter search using data from the KAGRA O3GK run

Among the various candidates for dark matter (DM), ultralight vector DM can be probed by laser interferometric gravitational wave detectors through the measurement of oscillating length changes in the arm cavities. In this context, KAGRA has a unique feature due to differing compositions of its mirrors, enhancing the signal of vector DM in the length change in the auxiliary channels. Here we present the result of a search for U(1)B−L gauge boson DM using the KAGRA data from auxiliary length channels during the first joint observation run together with GEO600. By applying our search pipeline, which takes into account the stochastic nature of ultralight DM, upper bounds on the coupling strength between the U(1)B−L gauge boson and ordinary matter are obtained for a range of DM masses. While our constraints are less stringent than those derived from previous experiments, this study demonstrates the applicability of our method to the lower-mass vector DM search, which is made difficult in this measurement by the short observation time compared to the auto-correlation time scale of DM

Ligature of the Left Main Coronary Artery after Surgery in Kawasaki Disease: Case Report

Abstract We report a case of a 23-year-old man who was diagnosed with Kawasaki disease that progressed to a coronary aneurysm in the left main coronary artery (LMA). He had suffered from acute coronary syndrome and then underwent an emergent percutaneous coronary angioplasty, in which a polyurethane-covered stent was placed inside the aneurysm. The stent was thrombosed one year later, despite the patient had been treated with anticoagulant and antiplatelet therapy. Emergency percutaneous intervention was then performed. LMA was reopened and stent malposition was observed. Therefore, urgent coronary bypass grafting was performed in which a high degree of competitive flow was observed through the reopened stent. LMA was ligated at the inflow of the aneurysm, resulting in an improvement of graft flow. Left main ligature has not been previously reported

¿Electrodo extravascular o adherencias endovasculares?

Resumen: Paciente varón de 80 años con primer implante de marcapasos DDD Medtronic Kappa el año 2000, con recambio de generador el 2008 y el 2014. El año 2020 se indica actualización del dispositivo a DAI-TRC. Ingresa en septiembre del 2021 por infección del dispositivo, con cultivo positivo a Staphyloccocus aureus y hemocultivos negativos. En la región del bolsillo del generador presenta lesión granulomatosa con exudado hemático. En el ecocardiograma transtorácico se observan un electrodo ventricular totalmente adherido al velo septal de la válvula tricúspide y el otro en ventrículo derecho que interfiere con el movimiento del velo anterior que condiciona una insuficiencia tricúspide severa. Se indica extracción completa del dispositivo y reimplante contralateral de un nuevo sistema DAI-TRC. Para el procedimiento se realizó una tomografía axial computarizada, donde se observa el recorrido de los electrodos más antiguos apoyados completamente en la cara posterior y lateral de la innominada y cava, dando la impresión de estar situados en el espesor de la grasa perivascular y sin poder descartar su curso extravascular. Se realizó extracción completa del dispositivo y reimplante contralateral. Se implantó un electrodo epicárdico de ventrículo izquierdo a través de una pequeña toracotomía izquierda y un electrodo de desfibrilación endocavitario en ventrículo derecho, a través de subclavia derecha. Luego, mediante la utilización de vainas de extracción con láser excimer se consiguió la extracción completa de los electrodos previos. Finalmente, se tuneliza el electrodo de ventrículo izquierdo a la región subclavicular derecha y se conectan los electrodos al generador. Abstract: An 80-year-old male patient with the first DDD Medtronic Kappa pacemaker implantation in 2000, with generator replacement in 2008 and 2014. In 2020, a device upgrade to CRT-ICD is indicated. He was admitted in September 2021 due to device infection, with a positive culture for Staphyloccocus aureus and negative blood cultures. In the region of the generator pocket, he presented a granulomatous lesion with hematic exudate. The transthoracic echocardiogram shows one ventricular electrode totally adhered to the septal leaflet of the tricuspid valve and the other in the right ventricle that interferes with the movement of the anterior leaflet, leading to severe tricuspid insufficiency. Complete removal of the device and contralateral reimplantation of a new ICD-CRT system is indicated. For the procedure, a computed tomography was performed. Where the path of the oldest leads supported completely on the posterior and lateral face of the innominate and vena cava are observed, giving the impression of being located in the thickness of the perivascular fat and without being able to rule out their extravascular course. Complete removal of the device and contralateral reimplantation were performed. A left ventricular epicardial electrode was implanted through a small left thoracotomy and an endocavitary defibrillation electrode in the right ventricle, through the right subclavian artery. Then, by using excimer laser extraction sheaths, complete extraction of the previous leads was achieved. Finally, the left ventricular lead is tunneled to the right subclavicular region and the leads are connected to the generator

Aspectos pronósticos de la cirugía aislada de sustitución valvular tricuspídea

Resumen: Introducción: La cirugía de sustitución valvular tricúspide (SVT) aislada es una intervención poco frecuente, con una indicación controvertida, en gran parte debido a su mal pronóstico. Material y métodos: Se analizaron todos los pacientes intervenidos de SVT aislada entre los años 2003 y 2014. Se analizó: a) Mortalidad perioperatoria y a largo plazo; y b) Aparición de complicaciones relacionadas con las prótesis tricúspides a largo plazo (trombosis y degeneración protésica). Resultados: Durante el periodo de estudio se realizaron 40 intervenciones de SVT aislada. El 82,5% de los pacientes se encontraban en clase funcional iii/iv de la NYHA, y el 70% tenían hipertensión pulmonar al menos moderada (presión sistólica arterial pulmonar > 40 mmHg). La mortalidad perioperatoria fue del 25%, infraestimada por EuroSCORE I (mortalidad estimada del 13,89%). La anemia preoperatoria (OR: 0,52; IC 95%: 0,30-0,89; p = 0,017) se asoció con una mayor mortalidad perioperatoria. La reintervención se asoció con una tendencia a una mayor mortalidad perioperatoria (p = 0,081). La supervivencia tardía, tras 44 meses de seguimiento mediano, fue del 57,50%. Los factores significativamente asociados con una peor supervivencia en el seguimiento fueron: 1) Hipertensión pulmonar severa (OR: 5,77; IC 95%: 1,06-31,26; p = 0,042) y 2) Clase funcional iv (OR: 8,31; IC 95%: 1,48-49,06; p = 0,004). Los pacientes intervenidos en clase funcional iv de la NYHA presentaron una escasa supervivencia a largo plazo (12,5% de supervivencia al año; log rank p = 0,004). Conclusiones: La SVT aislada se asocia con una alta mortalidad, debido a la indicación de la intervención en avanzados estados de cardiopatía.La indicación de cirugía ha de hacerse de manera precoz, antes del deterioro de la función ventricular derecha o de la aparición de hipertensión pulmonar severa. La cirugía en clase funcional NYHA iv supone un escaso beneficio en términos de supervivencia tardía. Abstract: Background: Isolated tricuspid valve replacement (TVR) is a rarely performed procedure, with controversial indications for performing surgery, mostly due to the poor outcomes reported. Material and methods: All patients undergoing isolated TVR between 2003 and 2014 were included. We analyzed: a) Perioperative mortality and long-term mortality; b) Prosthetic valves related complications during follow-up (thrombosis and biological valve deterioration). Results: A total of 40 patients underwent isolated TVR during the study period. 82.5% of these patients where in III-IV/IV NYHA functional class, and 70% of them had at least moderate pulmonary hypertension (mean PAP > 40 mmHg). Perioperative mortality was 25%. The EuroSCORE I underestimated the mortality associated to this procedure (estimated mortality of 13.89%). Preoperative anemia (OR: 0.52; CI 95%: 0.30-0.89; P = .017) was associated to a higher perioperative mortality. There was a trend towards a higher mortality in patients with previous cardiac surgery (P = .081). Late survival, after 44 months of median follow-up, was 57.50%. Long-term survival was influenced by: 1) Severe pulmonary hypertension (OR: 5,77; CI: 95%: 1.06-31.26; P = .042); 2) NYHA class IV (OR: 8.31; CI: 95%: 1.48-49.06; P = .004). Patients who were operated in NYHA IV had a poor long-term survival (12.5% of one-year survival, log Rank P = .004). Conclusions: Isolated TVR is associated to a high mortality, mostly due to surgery timing, when the patient is already in an advanced heart failure situation.Indication for surgery must be done promptly, before the right ventricle function deterioration or the development of severe pulmonary hypertension. Performing surgery when the patient is in IV NYHA functional class, provides scarce benefit regarding long-term survival. Palabras clave: Valvulopatía, Insuficiencia tricúspide, Sustitución valvular tricúspide, Cirugía tricúspide aislada, Keywords: Valvular heart disease, Tricuspid tegurgitation, Tricuspid valve replacement, Isolated tricuspid surger