Juan Martínez-León

Consorcio Hospital General Universitario de Valencia, Valencia, Valencia, Spain

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Publications (46)116.13 Total impact

  • Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology. 11/2013;
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    ABSTRACT: Aims In the present study we investigated the intervention of nitric oxide and prostacyclin in the responses to vasopressin of isolated thyroid arteries obtained from multi-organ donors. Main methods Paired artery rings from glandular branches of the superior thyroid artery, one normal and the other deendothelized, were mounted in organ baths for isometric recording of tension. Concentration-response curves to vasopressin were determined in the absence and in the presence of either the vasopressin V1 receptor antagonist d(CH2)5Tyr(Me)AVP (10(-8)M), the nitric oxide synthase inhibitor N(G)-monomethyl-L-arginine (L-NMMA, 10(-4)M), or the inhibitor of prostaglandins indomethacin (10(-6)M). Key findings In artery rings under resting tension, vasopressin produced concentration-dependent, endothelium-independent contractions. The vasopressin V1 receptor antagonist d(CH2)5Tyr(Me)AVP (10(-8)M) displaced the control curve to vasopressin 19-fold to the right in a parallel manner. The contractile response to vasopressin was unaffected by L-NMMA or by indomethacin. Significance Vasopressin causes constriction of human thyroid arteries by stimulation of V1 vasopressin receptors located on smooth muscle cells. These effects are not linked to the presence of an intact endothelium or to the release of nitric oxide or prostaglandins. The constriction of thyroid arteries may be particularly relevant in certain pathophysiological circumstances in which vasopressin is released in amounts that could interfere with the blood supply to the thyroid gland.
    Life sciences 08/2013; · 2.56 Impact Factor
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    ABSTRACT: Functional mitral regurgitation often is associated with dilated cardiomyopathy, or left ventricular remodeling. Surgical repair result commonly in an annuloplasty ring. We present a case of severe mitral regurgitation due to dilated cardiomyopathy treated with implant of Geoform® annuloplasty ring, with a good immediate outcome, and a successive failure of the annuloplasty due to dehiscence of the ring and requirement of a mitral valve replacement.
    Cirugía Cardiovascular. 07/2013; 20(3):153–155.
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    ABSTRACT: Background The use of neochordal repair has recently increased, not only as a combined procedure with quadrangular resection, but also as an isolated technique. Our aim was to evaluate its impact on the feasibility and outcomes of mitral valve repair. Material and methods A global group of 203 patients underwent valve repair for degenerative mitral regurgitation between 1997-2011. Their mean age was 62 ± 12 years and 36% were females. Complex repair was considered in case of multi-scalloped, bileaflet or commissural prolapse. Two technical subgroups were compared: resection without neochordal repair (Group-A: 140 patients) and neochordal repair without resection (Group-B: 46 patients). Seventeen patients with artificial chordae combined with resection were excluded. Complexity of valvular lesions, early and long-term mortality and repair durability were studied. Results In-hospital mortality was 3.4% (7 patients); 4.3% in Group-A (6 patients) and 2.2% in Group-B (one patient). Five and 10-year survival was 89 ± 2% and 77 ± 4%. At follow-up (58 ± 42 months), 22 patients from Group-A (15.7%) and 2 from Group-B (4.3%) died. The recurrence of grade 3-4/4 mitral regurgitation in Group-B versus Group-A was 1 (2.2%) versus 20 (14.3%); P < .05. Sixty five patients (32.0%) underwent complex repairs, especially from Group-B: 27 (58.7%) vs 27 (19.3%), P < .0001. This group had a higher incidence of multi-scalloped prolapse (mean number of segments): 1.80 ± 0.80 vs 1.20 ± 0.44, P < .0001; anterior leaflet prolapse: 14 (30.4%) vs 14 (10.0%), P < .01, and multiple chordal rupture: 24 (52.2%) vs 29 (20.7%), P < .0001. Conclusions Neochordal repair showed excellent mid-term results with significant increase of repair feasibility. Its use as an isolated procedure has been really effective in patients with more extensive and complex lesions
    Cirugía Cardiovascular. 07/2013; 20(3):130–138.
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    ABSTRACT: INTRODUCTION AND OBJECTIVES: The aim of this study was to compare the in-hospital clinical outcomes of minimally invasive, isolated aortic valve replacement vs median sternotomy. METHODS: Between 2005 and 2012, 615 patients underwent aortic valve replacement at a single institution, 532 by a median sternotomy (E group) and 83 by a J-shaped ministernotomy (M group). RESULTS: No significant differences were found between the E and M groups in terms of age (69.27 [9.31] years vs 69.40 [10.24] years, respectively), logistic EuroSCORE (6.27 [2.91] vs 5.64 [2.17], respectively), size of implanted valve prosthesis (21.94 [2.04] mm vs 21.79 [2.01] mm, respectively), or the incidence of diabetes, hypercholesterolemia, high blood pressure, or chronic obstructive pulmonary disease. Mean cardiopulmonary bypass time was 102.90 (41.68) min for the E group vs 81.37 (25.41) min for the M group (P<.001). Mean cross-clamp time was 77.31 (29.20) min vs 63.45 (17.71) min for the S and M groups, respectively (P<.001). Mortality in the E group was 4.88% (26). There were no deaths in the M group (P<.05). The E group was associated with longer intensive care unit and hospital stays: 4.17 (5.23) days vs 3.22 (2.01) days (P=.045) and 9.58 (7.66) days vs 7.27 (3.83) days (P<.001), respectively. E group patients had more postoperative respiratory complications (42 [8.0] vs 1 [1.2%]; P<.05). There were no differences when postoperative hemodynamic, neurologic, and renal complications, systemic infection, and wound infection were analyzed. CONCLUSIONS: In terms of morbidity, mortality, and operative times, outcomes after minimally invasive surgery for aortic valve replacement are at least comparable to those achieved with median sternotomy. The length of the hospital stay was reduced by minimally invasive surgery in our single-institution experience. The retrospective nature of this study warrants further randomized prospective trials to validate our results. Full English text available from:www.revespcardiol.org/en.
    Revista Espa de Cardiologia 06/2013; · 3.20 Impact Factor
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    ABSTRACT: Background Etiology and other factors may influence the outcomes of mitral valve repair. We have analyzed survival and durability in a variety of etiologies. Material and Methods 406 patients underwent mitral valve repair (1997–2011) with ages between 19–84 years. 156 were females (38.4%). 57.1% patients were in NYHA class III-IV. 5 groups were considered: degenerative (group-D), 203; ischemic (group-I), 90; functional (non-ischemic) (group-F), 19; rheumatic (group-R), 61 and endocarditis (group-E), 33 patients. Undersized annuloplasty was used in ischemic and functional groups. Quadrangular resection and neochordal repair were predominant in case of degenerative etiology whereas a variety of resective and reconstructive techniques were used in rheumatic and endocarditis groups. Results 30-day mortality was 4.4%: 3.4%, 4.4%, 0%, 6.6% and 10% in respective groups. 5 and 10-year survival: 86 ± 1% and 70 ± 4%. Long-term mortality was higher in groups F and I (31.6% and 20%) compared with 12.3%, 11.5% and 13.3% in groups D, R and E. Group-D had higher durability and freedom from grade 3–4/4 mitral regurgitation than non-degenerative groups: 86 ± 2 vs 84 ± 2% (p = 0.46) at 5 years and 82 ± 3 vs 54 ± 1% (p = 0.02) at later follow-up. Group-R was associated with recurrent grade-3 and grade-4 mitral regurgitation (OR: 1.98, 95%-CI: 1.01–3.89; p = 0.05 and OR: 3.31, 95%-CI: 1.17–9.32; p = 0.02). 14 patients underwent mitral valve replacement: 3, 1, 1, 6 and 3. Conclusions The outcomes of mitral valve repair were successful. Survival, recurrence rate and reoperation were excellent in group-D. Rheumatic regurgitation had shorter durability and functional mitral regurgitation had lower survival.
    Cirugía Cardiovascular. 04/2013; 20(2):65–73.
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    ABSTRACT: OBJECTIVES: Increasing degrees of renal impairment are associated with higher rates of morbimortality after coronary artery bypass grafting (CABG). This incremental risk has not been well studied in off-pump procedures (OPCAB). We assessed its impact on OPCAB and on-pump CABG (ONCAB). METHODS: A total of 1769 patients undergoing primary CABG (January 1995 through June 2011) had complete data on glomerular filtration rate (eGFR). 930 patients had Stage 2 renal insufficiency, 330 Stage 3, 27 Stage 4 and 465 normal renal function (Stage 1). Seventeen patients with end-stage disease (Stage 5) were excluded. The OPCAB technique was selectively used in 350 high-risk patients. Preoperative variables and postoperative outcomes were compared among eGFR subgroups and between matched and unmatched OPCAB vs ONCAB groups. RESULTS: Stages 3-4 patients were older (P < 0.0001), with higher prevalence of diabetes (36.8, 35.0, 39.7 and 74.1%, P < 0.01, 1-4 eGFR groups) peripheral arteriopathy (6.0, 9.0, 15.8 and 29.6%, P < 0.0001) and lower left ventricular ejection fraction (LVEF) (GFR-LVEF correlation: Pearson: 0.12, P < 0.0001). On-pump GFR groups had increasingly higher in-hospital mortality (1.0, 1.2, 3.5 and 15.4%, P < 0.0001), but no differences were observed in OPCAB (5.5, 4.8, 5.4 and 7.1%, P = 0.97). Similar trends on in-hospital morbidity were observed in ONCAB vs OPCAB groups: low cardiac output (P < 0.01), pneumonia (P < 0.01) and stroke (P < 0.05). GFR only predicted mortality in ONCAB patients (odds ratio (OR): 0.96, 95% CI: 0.94-0.98; P < 0.01). Patients with higher eGFR stages had statistically more reduced long-term survival, and this pattern was similar in the three treatment groups, also including the OPCAB group, who had the lowest survival in patients with eGFR stage 4. CONCLUSIONS: Patients with low GFR (Stages 3-4) undergoing ONCAB were at increased risk of early morbimortality. In contrast, there were no significant differences in operative morbimortality among eGFR groups in OPCAB patients. This 'off-pump advantage' on early outcomes was not observed at the long-term follow-up.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 02/2013; · 2.40 Impact Factor
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    Revista chilena de cardiología. 12/2012; 32(2):97-103.
  • Mayte Ballester, Julio Llorens, Juan Martinez-Leon
    European Journal of Anaesthesiology 06/2012; 29(6):297-298. · 2.79 Impact Factor
  • E. Martín, S. Cánovas, P. Carmona, I. Casanova, A. García, F. Paredes, O. Gil, F. Hornero, R. García, J. Martínez-León
    Cirugía Cardiovascular. 04/2012; 19(2):257.
  • Cirugía Cardiovascular. 04/2012; 19(2):244.
  • E. Martín, F. Hornero, A. Berenguer, F. Pomar, O. Gil, S. Cánovas, R. García, S. Morell, J. Martínez-León
    Cirugía Cardiovascular. 04/2012; 19(2):245.
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    ABSTRACT: Myocardial oxidative stress plays an essential role in the pathogenesis of ischaemia-reperfusion injury associated with coronary artery bypass grafting (CABG). Both propofol and volatile anaesthetics have been shown to reduce reactive oxygen species in experimental and clinical studies. To compare the influence of sevoflurane and propofol on myocardial oxidative stress markers (F2-isoprostanes and nitrates/nitrites) in coronary sinus blood samples from patients undergoing off-pump CABG. Randomised controlled clinical study of patients scheduled for off-pump CABG in a tertiary academic university hospital from June 2007 to August 2009. Forty patients consented to enrolment and were assigned to receive either propofol or sevoflurane. Upon completion of the proximal anastomosis, a retroplegia cannula was inserted in the coronary sinus to obtain blood samples, according to the study protocol. Markers of lipoperoxidation (F2-isoprostanes) and nitrosative stress (nitrates/nitrites) were measured in coronary sinus blood samples at three time points: after the end of the proximal anastomosis (T1), after completion of all grafts (T2) and 15 min after revascularisation (T3). Of the 40 recruited patients, 38 fully completed the study. In the sevoflurane group (n = 20), concentrations of oxidative stress markers in the coronary sinus remained almost constant and were significantly lower than those in the propofol group (n = 18) at all time points. F2-isoprostanes concentrations were as follows at T1: sevoflurane group 37.2 ± 27.5 pg ml vs. propofol group 170.7 ± 30.9 pg ml [95% confidence interval (CI) 112.16-155.08, P < 0.0001); at T2: sevoflurane group 31.94 ± 24.6 pg ml vs. propofol group 171.6 ± 29.7 pg ml (95% CI 119.78-159.63, P < 0.0001); and at T3: sevoflurane group 23.8 ± 13.0 pg ml vs. propofol group 43.6 ± 31 pg ml (95% CI 2.87-36.63, P = 0.023). In patients undergoing off-pump CABG, sevoflurane showed better antioxidative properties than propofol.
    European Journal of Anaesthesiology 09/2011; 28(12):874-81. · 2.79 Impact Factor
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    ABSTRACT: The aim of this study was to describe a previously unreported mutation in the SDHD gene, which has been linked to familial paraganglioma. Clinical data were collected from all members of the family, which had four siblings affected with paraganglioma. For the index patient, genomic DNA extraction from whole blood was performed using the High Pure PCR Template Preparation kit. The nucleotide sequence in the index patient revealed a deletion in the SDHD gene, c.165_169 + 14del. The loss of nucleotides in the DNA led to production of an anomalous protein. RNA analysis showed the absence of exon 2 in the sequence that corresponded to the mRNA from the index case. Genetic testing of this deletion was extended to the symptomatic and asymptomatic brothers and sisters of the index patient and other family members at risk. The deletion was detected in both symptomatic brothers, in accordance with their phenotype, but not in the asymptomatic sister. In the other asymptomatic brother (II.7) the deletion was detected and magnetic resonance angiography revealed the vascular characteristics of two tumors in both carotid bifurcations. Thus, we report a novel punctual mutation in the SDHD gene, which is related to familial paraganglioma: the deletion was c.165_169 + 14del.
    Acta oto-laryngologica 05/2011; 131(10):1110-6. · 0.98 Impact Factor
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    ABSTRACT: Development of late significant tricuspid regurgitation (TR) after successful mitral valve replacement (MVR) is not infrequent. The impact of different aetiologies or diverse surgical procedures has not been adequately investigated. We studied the influence of subvalvular preservation techniques during MVR on the incidence of late TR. A total of 801 patients with grade ≤ 2+/4+ preoperative TR underwent MVR without associated tricuspid procedures from January 1994 to August 2008. In 595 patients, only posterior mitral leaflet preservation was performed (group A). In the remaining 206 patients, both anterior and posterior leaflets were retained (group B). Postoperative development of significant TR was defined as a TR increase by more than one grade from preoperative or final TR grade ≥ 3+/4+ at follow-up. The global incidence of postoperative significant TR was 8.6%, with higher incidence in females (9.4% vs 6.7%, p=0.12), rheumatic disease (9.7% vs 6.5%, p=0.07), patients with previous AF (11.8% vs 3.8%, p<0.001) and, especially, in group A (10.8% vs 2.4%, p<0.001). The Maze procedure was protective in patients with AF (the incidence with and without associated Maze was 6.7% vs 13.2%, p=0.04). Preoperative left-atrial diameters were higher in patients with postoperative development of TR (56 ± 9 mm vs 51 ± 12 mm, p=0.01). Group A (p=0.04) and preoperative atrial fibrillation (p=0.001) were significant predictors of late postoperative TR. Late functional TR decreased free survival from chronic heart failure. Several clinical and operative factors are associated with the development of significant TR after MVR. Although early surgical intervention for TR may be recommended in selected patients, complete subvalvular preservation of the mitral valve and routine surgical ablation of atrial fibrillation can significantly reduce its incidence.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 12/2010; 39(6):866-74; discussion 874. · 2.40 Impact Factor
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    ABSTRACT: We present a simple technique for facilitating accurate polytetrafluoroethylene chordal height adjustment in surgical repair of myxomatous mitral valve disease. This approach is based on the annulus as the reference level. The artificial chordae are first fixed to the corresponding papillary muscle. Each chordal pair is then attached to the free edge of the prolapsed leaflet, and subsequently, the leaflet edge is also attached to the adjacent annulus by temporary fixing sutures. As a result, the leaflet is gently folded. Finally, the polytetrafluoroethylene suture is knotted during proper apposition of the free edge of the leaflet to the annulus.
    The Annals of thoracic surgery 05/2010; 89(5):1682-4. · 3.45 Impact Factor
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    ABSTRACT: La mejora de la calidad de vida de la sociedad actual genera una población cada vez más envejecida, y con ello el aumento de las enfermedades degenerativas, así como de las morbilidades asociadas. Ello exige el desarrollo de técnicas que produzcan una menor agresión quirúrgica a estos pacientes. El recambio valvular aórtico transcatéter actualmente permite tratar a aquellos pacientes con valvulopatía aórtica que presentan un elevado riesgo quirúrgico. Es una técnica en auge, aumentando paulatinamente los pacientes que son sometidos a esta técnica. Sin embargo, no todos los pacientes son candidatos a este procedimiento, bien por dificultades técnicas asociadas a la anatomía del paciente, bien por la necesidad de una mayor oferta tecnológica de la industria. La mayoría de las publicaciones actuales se centran en los resultados y complicaciones asociadas a la técnica, no existiendo en la literatura actual una revisión de casos que analice los resultados quirúrgicos de aquellos pacientes que han sido descartados para la misma. Realizamos una revisión de 19 casos incluidos en programa de recambio valvular aórtico transcatéter, en los que la técnica fue desestimada, incluyéndose en lista de espera para cirugía convencional. Analizamos las causas por las que fueron rechazados, riesgo quirúrgico, morbilidades asociadas, el manejo posterior de estos pacientes, así como de los resultados quirúrgicos.
    Cirugía Cardiovascular. 01/2010; 17:99.
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    ABSTRACT: Mujer de 39 años, que ingresa desde otro centro con clínica de insuficiencia cardíaca congestiva (New York Heart Association [NYHA] III) y diagnóstico ecocardiográfico de prótesis mecánica tricúspide disfuncionante. Entre los antecedentes destaca adicción a drogas vía parenteral, hepatitis C, cirrosis hepática estadio Child B y endocarditis tricuspídea, que requirió tratamiento quirúrgico a los 21 y 27 años, implantándose en ambos casos una válvula mecánica. Tratamiento con anticoagulantes de forma irregular, con periodos de no ingesta. La ecografía transesofágica (ETE) informa de trombosis de la prótesis con fijación de ambos discos, procediendo al explante de la válvula. Se implanta un homoinjerto pulmonar de 27 mm, soportado sobre un conducto de dacrón, el cual se sutura a la cara auricular del anillo tricuspídeo. Alta a los 5 días del postoperatorio sin incidencias, con ETE que informa de gradiente ligero transprotésico (< 3 mmHg).
    Cirugía Cardiovascular. 01/2010; 17:100.
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    ABSTRACT: Purpose To present the initial experience with thoracoscopic approach as a treatment option for lone atrial fibrillation (AF). Methods Between April and October 2007, five patients with symptomatic lone AF underwent a surgical ablation procedure through right thoracoscopic approach, consisting in a circunferential epicardial electric isolation pattern of the four pulmonary veins with a flexible microwave ablation device. Results There were no hospital deaths and the average hospital stay was 4 days. In one patient an in situ conversion to mini-sternotomy was needed. At the end of the follow-up, three patients were again in AF. Conclusions The thoracoscopic ablation surgery is reproducible and has a low morbidity rate. The technology used, unique for this kind of unilateral approaches, did not show the expected effectiveness. We have abandoned this procedure waiting for new technical means.
    Cirugía Cardiovascular. 07/2009; 16(3):235–239.
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    ABSTRACT: Background Although valve repair is the gold-standard in mitral valve regurgitation, durability and reoperation are relevant issues. Several factors may increase the probability of failure. We reviewed our experience addressing these issues. Material and methods Two hundred eighteen patients underwent mitral valve repair from febru-ary-98 to August-07. Their mean age was 62 ± 12 years and 76 (34.9%) were female; 68.8% were in NYHA functional class III-IV. According to the etiology 5 groups were considered: degenerative (group A) with 119 patients, ischemic (group B) with 44, functional non-ischemic (group C) with 14, rheumatic (group D) with 26 and endocarditis (group E) with 15 patients. The main techniques used in group A were: quadrangular resection (83), sliding plasty (8), PTFE-neochordae (16), chordal transposition (8) and edge-to-edge repair (11); in group D: annuloplasty (16), commissurotomy (11), resection-decalcification (5) and edge-to-edge (2) and in group E: perforation closure (9), resection (7) and commissuroplasty (2). Isolated annuloplasty was used in groups B and C. Results Early mortality was higher in groups B, C and E. The global 30-day mortality was 5.9% and only 3 patients died at follow-up. Actuarial survival at 5 years was 97 ± 1% (mean follow-up: 44 ± 29 months), freedom from REDO 91 ± 2% and freedom from recurrent 3+4+ regurgitation at 5 and 10 years: 85 ± 2 and 82 ± 3%. Age (HR: 1.07; IC 95%: 1.01-1.13; p < 0.05) and bileaflet prolapse (HR: 3.71; IC 95%: 1.02-13.45; p < 0.05) were predictors of recurrent regurgitation. Conclusions Degenerative was the most frequent etiology (54%). Survival and durability were excellent in the global group. The higher mortality was 30-day mortality, particularly in ischemic, functional and endocarditis groups.
    Cirugía Cardiovascular. 01/2009; 16(1):23–30.

Publication Stats

298 Citations
116.13 Total Impact Points


  • 2007–2013
    • Consorcio Hospital General Universitario de Valencia
      • Departamento de Cirugía Cardiaca
      Valencia, Valencia, Spain
  • 1997–2006
    • University of Valencia
      • • Departamento de Fisiología
      • • Departamento de Cirugía
      Valencia, Valencia, Spain
  • 2005
    • Hospital Clínico Universitario de Valencia
      Valenza, Valencia, Spain