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Publications (12)10.24 Total impact

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    ABSTRACT: OBJECTIVES: Large aortic root aneurysms might increase leaflet stress and compromise aortic valve durability after the reimplantation technique. We analysed the impact of the preoperative aorto-ventricular junction (AVJ) diameter on the durability of the valve. METHODS: Between March 2004 and January 2012, 150 patients underwent the David operation on the aortic root. We identified 47 patients with a preoperative AVJ >28 mm (Group A) and 103 patients with a diameter ≤28 mm (Group B). The mean follow-up was 44 ± 27 months. Both groups were compared regarding mortality, freedom from moderate or severe aortic valve regurgitation and freedom from reoperation. RESULTS: Early mortality was 1.3%. Actuarial survival at 1, 3 and 5 years was 97 ± 2, 94 ± 3 and 94 ± 3% for Group A, and 99 ± 1, 97 ± 1 and 94 ± 3% for Group B, respectively (P = 0.3). Two patients in Group B were reoperated for severe aortic regurgitation (AR). Actuarial freedom from reoperation at 1, 3 and 5 years was 100% for Group A, and 98 ± 1, 98 ± 1 and 96 ± 2% for Group B, respectively (P = 0.3). During the follow-up, 6 patients (3 in each group) developed AR ≥Grade II. Therefore, actuarial freedom from AR grade II or greater at 1.3 and 5 years was 97 ± 2, 94 ± 4 and 87 ± 7% for Group A, and 99 ± 1, 97 ± 1 and 95 ± 2% for Group B (P = 0.3). CONCLUSIONS: The reimplantation technique shows excellent results. Medium-term stability of the aortic valve repair was not influenced by the preoperative aorto-ventricular junction diameter.
    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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    ABSTRACT: Introduction Aortic root aneurysms are very common in Marfan syndrome. Several techniques have been described to preserve the aortic valve in these patients. Reimplantation technique has been shown to be the most effective. We report our experience with this technique in patients with Marfan syndrome. Methods Between March 2004 and August 2010, 117 patients with aortic root aneurysms underwent valve-sparing operations. Of these, 50 were diagnosed of Marfan syndrome, according to the Ghent diagnostic criteria. Mean age was 31 ± 12 years. The mean diameter of the Valsalva sinuses was 51 ± 5 mm (range 42–70 mm) and moderate/severe aortic regurgitation was present in 16% of the patients. The David V modification was performed in the last 41 patients. Results There were no in hospital deaths and no major adverse outcomes. Mean follow-up was 37 ± 21 months (range 1–80 months). One late death occurred. At the latest follow-up, all patients are free from over grade II aortic regurgitation. No patient required reoperation. No endocarditis or thromboembolic complications have been documented, and 96% of the patients are free from anticoagulation. Conclusions Short- and mid-term results with the reimplantation technique for aortic root aneurysms in M arfan patients are excellent. This technique prevents chronic anticoagulation and mechanical prostheses complications and it should be the treatment of choice for these patients.
    Cirugía Cardiovascular. 01/2010; 17(4):363–367.
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    ABSTRACT: We reviewed our experience with aortic valve-sparing operations in Marfan syndrome during last 5 years. Between March 2004 and June 2009, 94 patients with aortic root aneurysms underwent valve-sparing operations. Of these, 37 (68% male) were diagnosed with Marfan syndrome, according to the Ghent diagnostic criteria. Mean age was 30 +/- 10 years (range, 11 to 59 years). Moderate/severe aortic regurgitation was present in 13%, and the mean diameter of the Valsalva sinuses was 50 +/- 4 mm (range, 42 to 62 mm). The David V modification was performed in the last 28 patients. Additional procedures were mitral valve repair in 6, tricuspid valve repair in 3, closure of septal atrial defect in 2, and closure of a patent foramen ovale in 13. Mean follow-up was 27 +/- 16 months (range, 1 to 61 months). There were no in-hospital deaths and no major adverse outcomes. One patient required implantation of a mechanical prosthesis during the same procedure because of moderate aortic regurgitation. One late death occurred. No patients required reoperation. In the last follow-up, 23 patients did not have aortic regurgitation, 12 had grade I, and 1 had grade II. No thromboembolic complications have been documented, and 97% of the patients are free from anticoagulation. Short-term and midterm results with the reimplantation technique for aortic root aneurysms in Marfan patients are excellent. If long-term results are similar, this technique could be the treatment of choice for these patients.
    The Annals of thoracic surgery 01/2010; 89(1):93-6. · 3.45 Impact Factor
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    ABSTRACT: Acute type A aortic dissection is an uncommon complication after orthotopic heart transplantation and usually affects the native aorta. Seven cases reported in the literature describe an aortic dissection confined to the donor aorta and only in two of them were they detected during the early postoperative period. We describe the case of a 58-year-old man, the recipient of a cardiac allograft for ischemic cardiomyopathy 20 days earlier, who presented an acute type A aortic dissection limited to the donor aorta. Transesophageal echocardiography revealed severe aortic regurgitation and an intimal tear 2 cm above commissures. The patient was successfully treated with a composite valve graft. This case is the first successful repair in a cardiac allograft with acute aortic dissection of the donor aorta during the early postoperative period using a Bentall procedure.
    Interactive Cardiovascular and Thoracic Surgery 08/2009; 9(4):715-6. · 1.11 Impact Factor
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    ABSTRACT: Pulmonary thromboendarterectomy (PTE) is considered the potential curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH). We analysed the results of the PTE application in our institution. From February 1996 to December 2007, 30 patients with CTEPH underwent video-assisted PTE. Preoperative hemodynamic data were: systolic pulmonary artery pressure (SPAP) 87+/-17mmHg, mean pulmonary artery pressure (MPAP) 51+/-11mmHg, pulmonary total resistance 1067+/-485dynes x s x cm(-5), pulmonary vascular resistance 873+/-389dynes x s x cm(-5) and cardiac index 2.2+/-0.5l/min/m(2). We analysed the influence of several factors on hospital mortality and survival, and we performed partial analysis of mortality since 2004. PTE resulted in significant improvements in SPAP (P<0.001), MPAP (P=0.001) and cardiac index (P<0.001). Hospital mortality was 17% (5/30) (95% confidence interval, 6%-35%). From 2004, it dropped to 5% (1/20) (95% confidence interval, 0%-25%). Hospital mortality was influenced by preoperative pulmonary total resistance, preoperative pulmonary vascular resistance, postoperative SPAP, reduction of SPAP, reduction of MPAP, reperfusion pulmonary oedema and residual postoperative pulmonary hypertension (P=0.036; P=0.018;P=0.013; P=0.050; P=0.050; P=0.030; P=0.045). Survival after PTE, including hospital mortality, was 76+/-9% at 10 years. Through long-term follow-up, functional status (P=0.001), 6min walking distance (P=0.001), end-diastolic right ventricle size (P<0.001), and tricuspid regurgitation (P<0.001) significantly improved. PTE effectively reduces pulmonary hypertension and offers CTEPH patients a substantial improvement in survival and quality of life.
    Archivos de Bronconeumología 08/2009; 45(10):496-501. · 2.17 Impact Factor
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    ABSTRACT: Here, we review our experience in acute type A aortic dissection analyzing the role of antegrade brain protection. A total of 105 patients underwent surgery for acute type A aortic dissection between March 1990 and October 2008. An open technique with deep hypothermia was used in 81 patients. Deep hypothermia alone was induced in 32 patients; in combination with retrograde cerebral perfusion in 26 patients and in combination with antegrade cerebral perfusion (ACP) in the final 23 patients. The overall hospital mortality rate was 15%. Hospital mortality risk factors were age >or=70 years and preoperative shock (P<0.05). Hospital mortality was reduced to 9% in the last 23 consecutive patients in whom ACP was accomplished (P=0.05). Survival rate after 1, 5, 10 and 15 years of follow-up was 97.6+/-1.7%, 84.3+/-4.4%, 60.7+/-7.5% and 57.1+/-7.8%, respectively. The only late death risk predictor was the non-use of ACP (P<0.05). Surgery for acute aortic dissection provides excellent results. ACP via the axillary artery improves the prognosis for these patients and should be the brain protection method of choice.
    Interactive Cardiovascular and Thoracic Surgery 06/2009; 9(3):426-30. · 1.11 Impact Factor
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    ABSTRACT: Introduction Postinfarction ventricular septal defect is an uncommon entity that is usually fatal without surgical treatment. We analyze predictive factors of operative mortality and long-term survival after surgical repair. Materials and methods From november 1990, 27 patients with postinfarction ventricular septal defect underwent surgical repair (median age 65 years; median logistic Euroscore 74%). the site of the rupture was posterior in 16 patients (59.3%). the mean interval between myocardial infarction and ventricular septal defect was 3.2 ± 3.4 days. The intervention was urgent in 21 patients (77.8%). six patients (22.2%) received a concomitant myocardial revascularization. Results Operative mortality was 44.4% (CI 95%: 25.5–64.7%). the main cause of death was cardio-genic shock. Predictors for early death were the location of the ventricular septal defect (posterior 62.5 vs. anterior 18%; p = 0.028), the interval between ventricular septal defect and surgical intervention (dead patients 0 ± 0 days vs. alived patients 7 ± 12 days; p = 0.004), urgent procedure (urgent 57.1 vs. delayed 0%; p = 0.017) and pre-operative pulmonary hypertension (p = 0.022). Mean follow-up is 119.1 ± 10.6 months. Actuarial survival rate is 67.5 ± 20.7% at 11 years. NYHA functional class after operation is I-II in 91% of the patients and the main cause of late death is myo-cardial infarction. Conclusions surgical repair of postinfarction ventricular septal defect is associated with very high operative risk. the posterior location of the defect and short time interval between ventricular septal defect and surgical intervention are negative factors influencing early outcome. long-term survival is appropriate and patients show optimal functional status.
    Cirugía Cardiovascular. 01/2009; 16(2):197–205.
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    ABSTRACT: Background and objectivesPulmonary thromboendarterectomy (PTE) is considered the potential curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH). We analysed the results of the PTE application in our institution.Patients and methodsFrom February 1996 to December 2007, 30 patients with CTEPH underwent videoassisted PTE. Preoperative hemodynamic data were: systolic pulmonary artery pressure (SPAP) 87±17 mmHg, mean pulmonary artery pressure (MPAP) 51±11 mmHg, pulmonary total resistance 1067±485 dynes·s·cm−5, pulmonary vascular resistance 873±389 dynes·s·cm−5 and cardiac index 2.2±0.5 l/min/m2. We analysed the influence of several factors on hospital mortality and survival, and we performed partial analysis of mortality since 2004.ResultsPTE resulted in significant improvements in SPAP (P<0.001), MPAP (P=0.001) and cardiac index (P<0.001). Hospital mortality was 17% (5/30) (95% confidence interval, 6%-35%). From 2004, it dropped to 5% (1/20) (95% confidence interval, 0%-25%). Hospital mortality was influenced by preoperative pulmonary total resistance, preoperative pulmonary vascular resistance, postoperative SPAP, reduction of SPAP, reduction of MPAP, reperfusion pulmonary oedema and residual postoperative pulmonary hypertension (P=0.036; P=0.018;P=0.013; P=0.050; P=0.050; P=0.030; P=0.045). Survival after PTE, including hospital mortality, was 76±9% at 10 years. Through long-term follow-up, functional status (P=0.001), 6 min walking distance (P=0.001), end-diastolic right ventricle size (P<0.001), and tricuspid regurgitation (P<0.001) significantly improved.ConclusionsPTE effectively reduces pulmonary hypertension and offers CTEPH patients a substantial improvement in survival and quality of life.ResumenIntroducciónLa tromboendarterectomía pulmonar (TP) constituye el tratamiento potencialmente curativo de la hipertensión pulmonar tromboembólica crónica (HTPTC). Analizamos los resultados de la aplicación de la TP en nuestra institución.Pacientes y métodosEntre febrero de 1996 y diciembre de 2007 se realizó TP videoasistida a 30 pacientes con HTPTC. Los datos hemodinámicos preoperatorios fueron (valores medios±desviación estándar): presión sistólica pulmonar (PSP), 87±17 mmHg; presión arterial pulmonar media (PAPm), 51 ± 11 mmHg; resistencia pulmonar total, 1.067 ± 485 dinas·s·cm−5; resistencia vascular pulmonar, 873 ± 389 dinas·s·cm−5, e índice cardíaco, 2,2 ± 0,5 l/min/m2. Se han analizado los factores que influyeron en la mortalidad hospitalaria y la supervivencia, además de realizarse un análisis parcial de la mortalidad a partir de 2004.ResultadosTras la TP se objetivó un descenso tanto de la PSP (p < 0,001) como de la PAPm (P = 0,001) y un aumento del índice cardíaco (p < 0,001). La mortalidad hospitalaria registrada fue del 17% (5/30; intervalo de confianza del 95%, 6–35%); a partir de 2004 se redujo al 5% (1/20; intervalo de confianza del 95%, 0–25%). La resistencia pulmonar total y la resistencia vascular pulmonar preoperatorias, la PSP postoperatoria, el descenso porcentual de la PSP y de la PAPm, la presencia de edema de reperfusión y la persistencia de la HTP evidenciaron asociación con la mortalidad hospitalaria (p = 0,036; p = 0,018; p = 0,013; p = 0,050; p = 0,050; p = 0,030; p = 0,045, respectivamente). La supervivencia actuarial a 10 años, incluyendo la mortalidad hospitalaria, fue del 76 ± 9%. Durante el seguimiento mejoró la clase funcional (p = 0,001), aumentó la distancia recorrida en la prueba de la marcha de 6 min (p = 0,001) y se redujeron tanto el diámetro telediastólico del ventrículo derecho (p < 0,001) como el grado de regurgitación tricuspídea (p < 0,001).ConclusionesLa TP mejora la hemodinámica pulmonar, prolonga la supervivencia y optimiza el estado funcional de pacientes con HTPTC.
    Archivos de Bronconeumología ((English Edition)). 01/2009;
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    ABSTRACT: Background and objectivesPulmonary thromboendarterectomy (PTE) is considered the potential curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH). We analysed the results of the PTE application in our institution.
    Archivos De Bronconeumologia - ARCH BRONCONEUMOL. 01/2009; 45(10):496-501.
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    ABSTRACT: We report an extremely rare case of extensive aneurysm of right-sided aortic arch and descending thoracic aorta. Although the descending thoracic aorta was located to the right of the spinal column, it presented an elongation to the left at the aortic isthmus and distally returned to usual position to level of the aortic hiatus. Extraanatomical reconstruction and exclusion of the aneurysmal sac were successfully performed under deep hypothermia through a left thoracotomy.
    Cirugía Cardiovascular. 01/2009; 16(3):263–266.
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    ABSTRACT: Introduction Pulmonary thromboendarterectomy is considered the potentially curative treatment for chronic thromboembolic pulmonary hypertension. Material and methods From February 1996 to May 2006, 20 patients with chronic thromboembolic pulmonary hypertension underwent pulmonary thromboendarterectomy . 90% (18/20) were in New York Heart Association functional class III-IV . Preoperative hemodynamic data were: systolic pulmonary artery pressure 86 ± 17 mmHg, mean pulmonary artery pressure 49 ± 9 mmHg, pulmonary total resistance 1081 ± 553 dynes·s·cm−5, pulmonary vascular resistance 954 ± 427 dynes·s cm−5 and cardiac index 2.2 ± 0.6 l/min/m2. Results Pulmonary thromboendarterectomy resulted in significant improvement of systolic pulmonary artery pressure (p = 0.002), mean pulmonary artery pressure (p = 0.001) and cardiac index (p = 0.002). 10 patients (50%) developed reperfusion pulmonary edema and residual postoperative pulmonary hypertension. Hospital mortality was 25% (5/20). From 2004 mortality rate has been reduced, and was 1 of the latest 10 patients operated on (10%). Hospital mortality is influenced by preoperative pulmonary vascular resistance (p = 0.029), preoperative mean pulmonary artery pressure (p = 0,050), postoperative systolic pulmonary ar-tery pressure (p = 0.048) and postoperative mean pulmonary artery pressure (p = 0.003). Survival after pulmonary thromboendarterectomy is 60% at 10 years; reperfusion pulmonary edema (p = 0.046) and residual postoperative pulmonary hypertension (p = 0.028) are predictors for long-term survival. Through long-term follow-up, functional status, 6 min walking distance, end-diastolic right ventricle size, tricuspid regurgitation and systolic pulmonary pressure significantly improved (p = 0.004; p = 0.027; p = 0.003; p = 0.02; p = 0.001). Conclusions Pulmonary thromboendarterectomy effectively reduces pulmonary hypertension and offers chronic thromboembolic pulmonary hypertension patients substantial improvement in survival and quality of life.
    Cirugía Cardiovascular. 01/2007; 14(1):21–29.
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    ABSTRACT: ba Abstract Here, we review our experience in acute type A aortic dissection analyzing the role of antegrade brain protection. A total of 105 patients underwent surgery for acute type A aortic dissection between March 1990 and October 2008. An open technique with deep hypothermia was used in 81 patients. Deep hypothermia alone was induced in 32 patients; in combination with retrograde cerebral perfusion in 26 patients and in combination with antegrade cerebral perfusion (ACP) in the final 23 patients. The overall hospital mortality rate was 15%. Hospital mortality risk factors were age G70 years and preoperative shock (P-0.05). Hospital mortality was reduced to 9% in the last 23 consecutive patients in whom ACP was accomplished (Ps0.05). Survival rate after 1, 5, 10 and 15 years of follow-up was 97.6"1.7%, 84.3"4.4%, 60.7"7.5% and 57.1"7.8%, respectively. The only late death risk predictor was the non-use of ACP (P-0.05). Surgery for acute aortic dissection provides excellent results. ACP via the axillary artery improves the prognosis for these patients and should be the brain protection method of choice. 2009 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.