Resultados del recambio valvular pulmonar según el tipo de prótesis implantada

Introducción y objetivos: El recambio valvular pulmonar (RVP) es actualmente la intervención más frecuente de las cardiopatías congénitas del adulto. Existen numerosas controversias sobre cuándo implantar una prótesis y; sobre todo, acerca de cuál es el sustituto ideal. El objetivo del estudio es revisar el resultado de 3 tipos de prótesis biológicas implantadas en nuestro centro. Métodos: Desde 2003 se implantaron 3 tipos de prótesis biológicas en diferentes momentos: grupo 1-prótesis Medtronic Freestyle (n = 14); grupo 2-prótesis Sorin Soprano (n = 24), y grupo 3-prótesis Carpentier Edwards (n = 15). Se analizaron datos clínicos, ecocardiográficos y de seguimiento, tanto pre como postoperatorios. Resultados: El RVP se asoció a una mejoría de la New York Heart Association y a un aumento de la fracción eyección ventrículo izquierdo postoperatoria en nuestra serie. Las características preoperatorias fueron similares entre grupos. El grupo 1 presentó un gradiente mayor inicial (p = 0,053), aunque estable en el tiempo. El grupo 2 se asoció a una mayor tasa de disfunciones protésicas tardías (p = 0,004). La degeneración protésica global de la serie fue de 20 pacientes con 5 reintervenciones. No hubo mortalidad precoz y durante el seguimiento fallecieron 4 pacientes, 1 por causa cardiaca. T medio ± desviación estándar de seguimiento global: 49,98 ± 42,79 meses. Conclusiones: El RVP en nuestra serie se ha asociado a una baja tasa de mortalidad perioperatoria. Cuando comparamos según el tipo de prótesis, la prótesis Medtronic Freestyle presentó un mayor gradiente inicial y en el grupo Sorin Soprano se observa una degeneración protésica superior a la esperada. Sin embargo, será necesario más seguimiento para definir el comportamiento de la prótesis Carpentier Edwards

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

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