[show abstract][hide abstract] ABSTRACT: BACKGROUND: Inflammation is a common feature in the majority of cardiovascular disease, including Diabetes Mellitus (DM). Levels of pro-inflammatory markers have been found in increasing levels in serum from diabetic patients (DP). Moreover, levels of Cyclooxygenase-2 (COX-2) are increased in coronary arteries from DP. METHODS: Through a cross-sectional design, patients who underwent CABG were recruited. Vascular smooth muscle cells (VSMC) were cultured and COX-2 was measured by western blot. Biochemical and clinical data were collected from the medical record and by blood testing. COX-2 expression was analyzed in internal mammary artery cross-sections by confocal microscopy. Eventually, PGI2 and PGE2 were assessed from VSMC conditioned media by ELISA. RESULTS: Only a high glucose concentration, but a physiological concentration of triglycerides exposure of cultured human VSMC derived from non-diabetic patients increased COX-2 expression .Diabetic patients showed increasing serum levels of glucose, Hb1ac and triglycerides. The bivariate analysis of the variables showed that triglycerides was positively correlated with the expression of COX-2 in internal mammary arteries from patients (r2 = 0.214, P < 0.04). CONCLUSIONS: We conclude that is not the glucose blood levels but the triglicerydes leves what increases the expression of COX-2 in arteries from DP.
Lipids in Health and Disease 05/2013; 12(1):62. · 2.02 Impact Factor
[show abstract][hide abstract] ABSTRACT: Objective
This study examines the mid-term clinical and echocardiographic results of mitral valve repair using chordal replacement.
A cohort of 110 patients (mean age 63 ± 14 years) underwent mitral valve repair using expanded polytetrafluoroethylene (PTFE) neochordae in a 7-year period. We analyzed the mid-term survival freedom of recurrent mitral regurgitation (MR) > 2 and combined event (reoperation and death) (Kaplan-Meier), also the independent predictors of recurrent MR > 2 with a Cox model.
A mean of 2.5 ± 1.3 pairs of neochordae per patient were implanted. Fifty eight (52.7%) patients had isolated posterior leaflet prolapse, 28 (25.5%) anterior leaflet prolapse and 24 (21.8%) bileaflet prolapse. Nineteen (17.27%) patients underwent Maze procedure. With a median follow-up of 15 months (interquartile range 28.2 months), 2 patients had residual MR > 2, and regurgitation-free survival percentage was 96.1% (± 0.53) at 36 months. There were 3 reoperations (2 at the follow-up), with a combined event-free survival percentage of 98.5% (± 0.29) and 96.6% (± 0.47) at 12 and 36 months, respectively. The Cox model identified as independent predictors of recurrent MR ≥ 2, the number of neochordae HR, 95% CI: 2.77 (1.56-4.9) and the intraoperative MR grade HR, 95% CI: 42.41(3.41-526.182).
Neochordae use in mitral valve repair obtains adequate mid-term results in terms of durability and echocardiographic results.
[show abstract][hide abstract] ABSTRACT: Objectives
Validate the new EuroSCORE (ESII) risk model in terms of discriminative and calibration power and compare this results with the classic EuroSCORE (ES).We also compare our data distribution with the ESII database.
A 4166 patient population operated during a 7 year period was analyzed. The model was then tested on the validation data set for calibration (by comparing the observed and predicted mortality) and for discrimination (using the area under the ROC curve).
The predicted mortality by the ESII was higher than the ES: 9.1(SD: 10.4) vs 3.46 (SD: 4.3): p<0.001. The Hosmer-Lemeshow test showed a poor calibration for both models: ES (χ2=26.6, p=<0.001), ESII (χ2=58.19, p<0.0001). Areas under ROC curves were 0.75 (IC95% 0.72–0.78) for ES and 0.78 (IC95% 0.75–0.81) for ESII (p<0.233).
The new EuroSCORE II risk model has a predicted mortality lower than EuroSCORE and a good predictive value in terms of calibration and poor discrimination. A non significant better discrimination power was observer in the ESII. The distribution of some variables was different between our data and ESII.
[show abstract][hide abstract] ABSTRACT: Cardiovascular disease has been linked to endothelial progenitor cell (EPC) depletion and functional impairment in atherosclerosis and aortic stenosis. EPCs may play a pivotal role in vascular grafting. However, the EPC depletion in coronary artery bypass grafting (CABG) patients has not been compared to coronary artery disease-free valvular replacement patients with aortic stenosis.
We aimed to assess the basal number of CD34+/KDR+ and CD34+/CD144+ cells in CABG patients, compared to aortic stenosis valvular replacement patients. 100 patients (51 CABG and 49 valvular surgery ones) were included in the present study. All CABG or valvular patients had angiographic demonstration of the presence or the absence of coronary artery disease, respectively. Numbers of CD34+/KDR+ and CD34+/CD144+ were assessed by flow cytometry of pre-surgical blood samples.
We found a lower number of CD34+/CD144+ cells in CABG patients compared to valvular patients (0.21 ± 0.03% vs. 0.47 ± 0.08%), and this difference remained statistically significant after the P was adjusted for multiple comparisons (P = 0.01428). Both groups had more EPCs than healthy controls.
Pre-surgical CD34+/CD144+ numbers are decreased in CABG patients, compared to valvular patients with absence of coronary disease.
Journal of Cardiothoracic Surgery 01/2012; 7(1):2. · 0.90 Impact Factor
[show abstract][hide abstract] ABSTRACT: Background and objectives. To compare quadrangular resection with neochordae replacement for the repair of isolated P2 prolapse of the posterior mitral leaflet in terms of clinical progress, durability and echocardiography.
Patients and methods. In this longitudinal prospective study we compare both techniques. Outcome measures analysed during follow-up were clinical (combined event: redo surgery, neurological damage, readmission or death of cardiological cause) and echocardiographic data.
Results. Sixty-three patients underwent surgery for isolated P2 prolapse over a 5 and 1/2-year period. mean patient age was 64.1 (SD: 13) years, and 18 patients were women (27.1%). In 35 patients (55.5%) the procedure was quadrangular resection (group I) and in 28 (44.5%) neochordae were inserted (group II). Preoperative risk using the EuroSCORE was similar in group I 2.5 (IQR: 5.1) and group II 3.3 (IQR: 4.4) (p = 0.67). No differences were recorded in mortality or postoperative hospital stay. The percentages of patients free of mitral regurgitation greater or equal to 2 at 12 and 36 months were 97.1 ± 0.06% and 87.4 ± 1.9% in group I vs. 94.7 ± 0.1% and 89 ± 0.3% in group II (log-rank: p = 0.3). The remaining echocardiographic variables were similar in the two groups during follow-up. Patients free of a combined event at 12 and 36 months were similar in the two groups (group I: 97.1 ± 0.06% and 93.6 ± 0.08% vs. group II: 94.7 ± 0.1% and 89 ± 0.15%; log-rank: p = 0.39).
Conclusions. Both techniques, quadrangular resection and the use of neochordae provided similar midterm results in terms of durability, clinical progress and echocardiography.
[show abstract][hide abstract] ABSTRACT: Objetivos
la fístula coronaria es una malformación poco frecuente con una incidencia de 0,1–0,2% de la población adulta sometida a angiografía coronaria. Presentamos el caso de un varón de 56 años que ingresó en nuestro centro tras presentar infarto agudo de miocardio (IAM) sin elevación del ST. En el ecocardiograma se objetiva dilatación aneurismática del tronco coronario izquierdo (TCI) y fístula del TCI a la aurícula derecha, hallazgos confirmados mediante tomografía computarizada (TC) multicorte, angiorresonancia magnética (angio-RM) y coronariografía.
Material y métodos
se realizó esternotomía media, extracción de arteria mamaria interna bilateral, canulación de aorta ascendente, bicava y de seno coronario. Establecimiento de circulación extracorpórea (CEC) y clampaje aórtico. Se evidenció TCI gravemente dilatado que giraba tras la salida de la circunfleja y la descendente anterior (DA) para desembocar mediante gran fístula en la aurícula derecha, a su vez gravemente dilatada y trombosada. Mediante aortotomía se cerró el ostium del TCI con parche de pericardio. Ligadura de circunfleja y DA en su salida y revascularización con doble derivación mamariocoronaria a DA y OM. Resección de fístula trombosada en aurícula derecha y cierre directo. Cierre de atriotomía, desclampaje y salida de CEC. Cierre esternal.
el paciente fue dado de alta 9 días tras la intervención, sin complicaciones intrahospitalarias. La TC posquirúrgica mostró injertos permeables con obliteración del TCI y de la fístula coronaria.
las fístulas coronarias son malformaciones infrecuentes, con una complejidad importante a la hora de la reparación quirúrgica.
[show abstract][hide abstract] ABSTRACT: Prosthesis deterioration rate, years after a previous surgical valve replacement, is rising. Usually, the standard management is reoperation, but for very high risk patients an alternative has arisen: the valve-in-valve approach. We present an 84-year-old Caucasian woman with a mitral bioprosthesis (Mosaic II, number 29) since 1994. Over the last few months the patient displayed worsening heart failure symptoms, until her current admission in NYHA III-IV functional class, because of a severely degenerated mitral prosthesis (severe regurgitation, severe pulmonary hypertension). The transapical access, conventionally used for transcatheter aortic valve implantation (Edwards SAPIEN THV 23) was chosen, guided by transoesophageal echocardiography (TOE) with a new three-dimensional (3D) probe. After the procedure, the mitral regurgitation completely disappeared, an appropriate valve opening was achieved (valve area >2 cm(2)) and the patient was discharged 6 days later, remaining well in the outpatient follow-up. Only a restricted number of patients have been submitted to mitral transcatheter valve-in-valve implantation and to the best of our knowledge this is the first accurate description of the 3D TOE part, focusing on the surgeon requirements.
[show abstract][hide abstract] ABSTRACT: We sought to determine if early recurrence of atrial fibrillation (AF) after surgical ablation is a risk factor of late failure. Between February 2004 to May 2009, 106 patients underwent surgical ablation of concomitant permanent AF with radiofrequency. Operations primarily consisted of valve surgery in 85% of patients. Hospital mortality was 2.8% (n = 3). The median follow-up was 37 months (interquartile rank 12-77), and was complete in 99% of patients. Freedom from AF was 82%, 76% and 68% at one, two and three years, respectively. Patients with early recurrence of AF had less prevalence of sinus rhythm in late follow-up (P < 0.001). Multivariate Cox regression analysis showed that AF duration [hazard ratio (HR) 1.014, 95% CI 1.009-1.020, P < 0.001] and early recurrence of AF (HR 3.45, 95% CI 1.50-7.95, P = 0.004) were independent risk factors for failure. In conclusion, in our series, early recurrence of AF after surgical ablation is a strong predictor of late failure.
Interactive cardiovascular and thoracic surgery 02/2011; 12(5):681-6.
[show abstract][hide abstract] ABSTRACT: The number of patients with end-stage renal failure requiring dialysis keeps increasing every year. Many of these patients also suffer from peripheral arterial disease. We report the case of a middle age woman receiving dialysis who had undergone amputation of both lower limbs and suffered multiple deep venous thrombosis. Therefore, peripheral accesses for venous dialysis were not available. A catheter had to be implanted right into the right atrium.
Interactive cardiovascular and thoracic surgery 01/2011; 12(4):648-9.
[show abstract][hide abstract] ABSTRACT: Inflammation is a common feature in cardiovascular diseases, including diabetes mellitus. In addition to the well-known inflammatory role of cyclo-oxygenase-2 (COX-2), this protein has also been implicated in apoptosis resistance in tumour cells. Vascular smooth muscle cells (VSMC) from diabetic patients are also resistant to apoptosis because of an increased abundance of B cell lymphoma 2 protein (BCL2). In this work, we investigated whether overproduction of COX-2 was involved in the resistance to apoptosis in VSMC from diabetic patients.
VSMC were obtained from internal mammary arteries from patients who had undergone coronary artery bypass graft surgery. Apoptosis was measured by DNA fragmentation, BCL2 degradation and cytochrome c release.
Apoptosis induced by C-reactive protein in cells from non-diabetic patients was mediated by COX-2. VSMC from diabetic patients showed higher basal levels of COX-2 compared with those from non-diabetic patients. Transfection of VSMC from non-diabetic patients with a plasmid containing COX-2 (also known as PTGS2) increased basal production of COX-2 and BCL2 and mimicked the resistance to apoptosis that occurs in diabetic patients. We also found a significant correlation (R = 0.846, p = 0.016) between COX-2 and BCL2 production in arterial rings from diabetic patients measured by confocal microscopy. However, inhibition of COX-2 production by small interfering RNA proved unable to reverse BCL2 production in diabetic VSMC.
These results suggest a link between inflammation (COX-2) and apoptosis resistance (BCL2) in the arteries of diabetic patients. This relationship is not causative and the common production of these two proteins may be co-regulated by shared regulatory elements in diabetes.
[show abstract][hide abstract] ABSTRACT: The aim of this study was to analyze surgery and survival data in the midterm after aortic root and (or) ascending aorta reoperations and compare these results with those obtained after first time surgery.
Over a 6-year period, 365 patients underwent an aortic root and (or) ascending aorta surgery procedure at our center. Mean patient age was 63.1 + or - 25.5 years; 27.1% were women. Fifty-eight patients had had prior ascending aorta and (or) aortic valve surgery (group I) and the remaining 307 patients were assigned to an initial surgery group (II). The reoperative procedures were Bentall in 45 (77.6%), ascending aorta and valve replacement in 8 (13.8%), and ascending aorta replacement in 5 (8.6%).
The reoperation group showed a worse preoperative risk profile indicated by a higher logistic European system for cardiac operative risk evaluation: group I (26.9) versus group II (9.9) (p < 0.0001). Hospital mortality was 7 of 58 (12.1%) in group I and 21 of 207 (6.8%) in group II (p = 0.18; relative risk 1.9 [0.8 to 4.6]). After adjusting for the different variables, reoperation could not be identified as an independent predictor of postoperative morbidity. Survival rates (including in-hospital mortality) were lower in group I at one year (77.9 + or - 1.11% vs 91.9 + or - 0.3%) and at 3 years (75.3 + or - 0.11% vs 88.9 + or - 0.03% [log-rank p = 0.005]). In the multivariate analysis, reoperation (p = 0.01; hazard ratio 2.6 [1.2 to 5.3]) was a determining factor for survival once corrected for variables predicting mortality during follow-up.
Reoperations on the ascending aorta and aortic root showed acceptable morbidity and mortality. Their midterm survival was lower than for patients not requiring a repeat operation.
The Annals of thoracic surgery 08/2010; 90(2):555-60. · 3.74 Impact Factor
[show abstract][hide abstract] ABSTRACT: We aimed to test the antiproliferative effect of acetylsalicylic acid (ASA) on vascular smooth muscle cells (VSMC) from bypass surgery patients and the role of transforming growth factor beta 1 (TGF-beta1).
VSMC were isolated from remaining internal mammary artery from patients who underwent bypass surgery. Cell proliferation and DNA fragmentation were assessed by ELISA. Protein expression was assessed by Western blot. ASA inhibited BrdU incorporation at 2 mM. Anti-TGF-beta1 was able to reverse this effect. ASA (2 mM) induced TGF-beta1 secretion; however it was unable to induce Smad activation. ASA increased p38(MAPK) phosphorylation in a TGF-beta1-independent manner. Anti-CD105 (endoglin) was unable to reverse the antiproliferative effect of ASA. Pre-surgical serum levels of TGF-beta1 in patients who took at antiplatelet doses ASA were assessed by ELISA and remained unchanged.
In vitro antiproliferative effects of aspirin (at antiinflammatory concentration) on human VSMC obtained from bypass patients are mediated by TGF-beta1 and p38(MAPK). Pre-surgical serum levels of TGF- beta1 from bypass patients who took aspirin at antiplatelet doses did not change.
PLoS ONE 01/2010; 5(3):e9800. · 3.73 Impact Factor
[show abstract][hide abstract] ABSTRACT: IntroductionEndothelial dysfunction underlies the increased cardiovascular disease burden in diabetic patients. Endothelial progenitor cell (EPC) function seems to be defective in these patients. Pioglitazone has been shown to improve the number and function of EPCs and to decrease cardiovascular mortality in the diabetic population.
Clínica e Investigación en Arteriosclerosis. 01/2010; 22(5).
[show abstract][hide abstract] ABSTRACT: A 52-year-old male with history of stent implant in the left main coronary artery was admitted to our center few days after the procedure with persistent fever, heart failure and pulmonary edema. Transesophageal echocardiography revealed aortic valve endocarditis with 12 × 16 mm vegetation on the left coronary sinus causing severe aortic insufficiency (Fig. 1). Surgical findings were mobile vegetation on the left coronary leaflet with a noncoronary leaflet perforation, as well as the stent protruding 3 mm out of the left coronary ostium (Fig. 2). Aortic valve replacement with a 25 mm Mitroflow tissue valve was performed.
[show abstract][hide abstract] ABSTRACT: Subacute rupture of the left ventricular free wall is a complication that occurs during the acute phase of a myocardial infarction. The subacute presentation makes surgical management possible. However, it is not known whether either pericardial manipulation or the use of pericardial patches influences left ventricular function over the medium term. Our aim was to monitor changes in left ventricular function and the development of constrictive pericarditis over the medium term in patients who had been treated surgically for subacute rupture of the left ventricle. Eleven patients with subacute rupture underwent surgery, of whom six were followed up over the medium term. A modest improvement in left ventricular systolic function was observed and there was no evidence of constrictive pericarditis. In conclusion, the surgical approach appears to be safe over the medium term and had no influence on left ventricular function. Nor did it lead to the development of constrictive pericarditis.
Revista Espa de Cardiologia 12/2009; 62(12):1478-81. · 3.20 Impact Factor
[show abstract][hide abstract] ABSTRACT: Several studies have shown that the glomerular filtration rate is a strong predictor of mortality following cardiac surgery. This study was designed to identify the estimated glomerular filtration rate using the MDRD-4 equation as an independent predictive variable of mortality and to determine whether the inclusion of this variable could improve the discriminating power of the EuroSCORE. Data from 2014 consecutive patients who underwent cardiac surgery over a 3-year period were analysed. Mean glomerular filtration rate was 68.4+/-22.7 ml/min per 1.73 m(2); 704 patients (35%) showed a rate <or=60 ml/min/1.73 m(2). An estimated glomerular filtration rate <or=60 ml/min/1.73 m(2) was found to be an independent predictor of mortality adjusted for age, sex and EuroSCORE (P<0.001, OR 2.4, 95% CI 1.6-3.4). The discriminating power of the EuroSCORE improved when this variable was included: area under the ROC curve for EuroSCORE plus estimated glomerular filtration rate was 0.77 (0.73-0.81) compared to 0.75 (0.71-0.80) for the additive EuroSCORE (z=2.55, P<0.05) and 0.75 (0.71-0.80) for the logistic EuroSCORE (z=2.45, P<0.05). The estimated glomerular filtration rate using the MDRD-4 equation is an independent predictive factor of perioperative mortality in cardiac surgery. The inclusion of this variable could improve the discriminatory capacity of the EuroSCORE.
Interactive cardiovascular and thoracic surgery 10/2008; 7(6):1054-7.