C Fontanillas

Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Catalonia, Spain

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Publications (18)28.62 Total impact

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    ABSTRACT: Coronary artery bypass graft (CABG) is recommended for patients with unprotected left main stenosis (ULMS). Percutaneous coronary intervention (PCI) is only recommended in specific anatomic conditions as in patients with low/mid SYNTAX score (SS). The aim of this study was to assess if the clinical and anatomic global risk classification (GRC) can enhance the indication of both revascularization therapies. A total of 407 patients with ULMS treated with CABG (n = 285) or PCI (n = 122) were prospectively collected. The decision to treat with CABG or PCI was dependent on patient and physician's choice. Patients with ST-elevation myocardial infarction, shock, or valve disease were excluded. Clinical follow-up was obtained at 3 years. Patients with low GRC (n = 151) treated with CABG vs those with PCI had similar cardiac mortality (5.9% vs 0%, respectively; P=.17) and major adverse cardiac events (MACE; 18.5% vs 12.5%, respectively; P=.40). Patients classified as mid GRC (n = 175) had similar cardiac death (11.1% vs 10.3%; P=.85) and MACE rates (20.7% vs 22.4%; P=.92) with CABG or PCI, respectively. Patients with high GRC (n = 81) treated with CABG had numerically fewer cardiac deaths (16.3% vs 28.1%; P=.16) and lower MACE rates (24.5% vs 40.6%; P=.048) than with PCI. Statistical models using the GRC as a predictor of cardiac death showed better goodness-of-fit than the SS. Patients with low/mid GRC have similar mid-term outcomes with either CABG or PCI; patients with high GRC seem to benefit from CABG. Although further investigations are required, GRC is a better predictor of outcomes than SS.
    The Journal of invasive cardiology 12/2013; 25(12):650-8. · 0.95 Impact Factor
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    ABSTRACT: Introducción El uso más frecuente de la asistencia circulatoria mecánica (ACM) es como puente al trasplante cardíaco, aunque va en aumento la intención de recuperación. Estudiamos nuestra experiencia y progreso en este último campo. Material y métodos Desde 1992 hemos hecho 54 ACM (78% con Abiomed BVS), de las que 11 se destetaron con fracción de expulsión (FE) entre 35-55%, en 8 hombres y 3 mujeres, con 48 años de media. En nueve la ACM fue de duración corta (6,5 días) por shock cardiogénico, poscardiotomía (4 coronarios; 2 valvulares postinfarto agudo de miocardio [IAM] en 2 y un fallo primario postrasplante). En dos más, se retiró en una miocarditis post partum a los 42 días, con Abiomeds BVS y 5000, y en una miocardiopatía tóxica a los 135 días con una bomba implantable Incor. Resultados Tres (27%) fallecieron en el hospital por infecciones y fallo multiorgánico. A largo plazo, uno lo hizo al año por paro cardiorrespiratorio, y otro a los quince por IAM. Los destetados a largo plazo también siguen bien, 0,7 y 2,6 años después. Conclusiones La recuperación de la función ventricular con ACM es posible no sólo en fallos agudos, sino también a largo plazo en IAM, miocarditis y miocardiopatías dilatadas. Debemos ser prudentes antes de decidir un trasplante.
    Cirugia Cardiovascular 06/2010; 17:38. DOI:10.1016/S1134-0096(10)70659-8
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    ABSTRACT: Toxic cardiomyopathies are rare and the most frequent cause are anthracycline compounds. Early acute toxicity can be reversible, but at present the only effective therapy for late end-stage anthracycline cardiomyopathy seems to be a heart transplantation. Currently, this transplantation is contraindicated in cases of cancer, at least during the first 4 or 5 years. Recently, implantable axial pumps have shown good results and are used with increasing frequency as destination therapy. We present a case of end-stage heart failure due to a toxic cardiomyopathy after a bilateral breast cancer treated with resection and chemotherapy (doxorubicin and trastuzumab). Ejection fraction was 23% with dobutamine. A left ventricular axial pump (Incor) was implanted. The immediate postoperative course was uneventful. The left ventricular function improved and on the fourth month the ejection fraction was 55%. On postoperative day 135, the pump was explanted. After 1.5 years, the patient is doing well, with an ejection fraction of 57%. This is the first application of an implantable axial pump in Spain. Although toxic cardiomyopathies are rare, in cases of late end-stage left ventricular failure and when the heart transplantation is contraindicated, the implantation of an axial pump can be the solution. The results in previous cases are unknown, although it is possible, as in our case.
    Transplantation Proceedings 07/2009; 41(6):2237-9. DOI:10.1016/j.transproceed.2009.06.029 · 0.98 Impact Factor
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    ABSTRACT: Heart transplantation (HT) due to valvular cardiomyopathy is rare, namely, about 3% of cases in the Registry of the International Society for Heart and Lung Transplantation (ISHLT). Usually, these patients present some risk factors such as previous valvular operations and pulmonary hypertension. Since there are few studies in the literature, we retrospectively analyzed our early and long-term results. We studied our experience in 22 HT cases for valvular cardiomyopathy (9.3% of our total experience), namely, 12 men and 10 women, of overall mean age of 52.6 +/- 10 years. Five patients had mitral; 8, aortic; and 1, tricuspid valve disease; 7 had double valve disease and 1, triple valve disease. Nineteen patients (87%) had been operated previously between 1 and 4 times. The mean ejection fraction was 23% +/- 7.3% and the mean New York Heart Association (NYHA) functional class was 3.7. Fifty-three percent of the patients had pulmonary hypertension. Two patients were operated as an emergency "O." We used the standard HT technique. Four patients (18%) were reoperated due to hemorrhage. The hospital mortality was 2 cases (9%). Another patients (9%) died on follow-up due to cardiac allograft vasculopathy. All surviving patients have been followed to the end of 2006. The mean follow-up has been 72 +/- 53 months. They are functional class I or II. HT for this indication was more frequent in our experience than in the Registry of the ISHLT. The immediate and long-term results were good, with an 82% mean survival at 6 years. HT can be a good treatment for patients with valvular cardiomyopathy and bad ventricular function and/or multiple valvular reoperations.
    Transplantation Proceedings 10/2007; 39(7):2355-6. DOI:10.1016/j.transproceed.2007.07.062 · 0.98 Impact Factor
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    ABSTRACT: The mortality of cardiogenic shock (CS) after an acute myocardial infarction (AMI) still remains high. Thrombolysis, PTCA or CABG, when possible, can improve the results, but when all the treatments fail death is almost certain. We investigate the use of the mechanical circulatory assistance (MCA) and heart transplantation (HT) to improve the adverse results in this irreversible situation. Among 11 patients with irreversible CS after an AMI we used a MCA (Abiomed BVS-5000). After improvement and hemodynamic stabilization, we performed heart transplantation in 7 patients of mean age 52 years (35-60) including two women. The MCA was univentricular in 7 patients and biventricular in 4. Mean duration of the MCA was 5 days (1-12). Three patients died during the MCA: two due to cerebrovascular accidents and one multiorgan failure. Weaning was possible in one patient. Among Seven transplanted patients one died due to sepsis. Seven (64%) patients are long-term survivors. When all the treatments have failed for CS after an AMI, MCA may be used as a bridge to heart transplantation in a select group of patients where the procedure is not contraindicated. The long-term results of 64% survivors in our experience is satisfactory.
    Transplantation Proceedings 09/2003; 35(5):1940-1. DOI:10.1016/S0041-1345(03)00738-3 · 0.98 Impact Factor
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    ABSTRACT: To analyze the results of surgical treatment of left ventricular free wall rupture after acute myocardial infarct in a case series. From 1984 to 2001, 25 patients (10 women and 15 men) were surgically treated in our Center for left ventricular free wall rupture after acute myocardial infarction. Their mean age was 62 years (range, 42-80). Cardiac symptoms (chest pain and/or dyspnea) prior to admission were recorded in 4 patients. One patient had acute myocardial infarction of the anterolateral wall, 6 patients of the lateral wall, 13 patients of the anterior wall, 4 patients of the inferior wall, and one patient had a right ventricle infarction. Thrombolytic therapy was administered in 10 patients, according to the criteria of the American Heart Association and Spanish Society of Cardiology criteria. In all patients, the final diagnosis was established echocardiographically before the surgery. All patients underwent surgical intervention on an emergency basis. Extracorporeal circulation was used in the first 9 cases, whereas the next 16 patients had off-pump surgery. Two patients had heart arrest during off-pump surgery, which required extracorporeal circulation support. One patient was found false positive for rupture only at surgery. In the first 4 cases, we performed a direct suture after excising necrotic tissue, in the next 15 cases we sutured a patch over the infarction zone, and in the last 5 patients we used Teflon patch fixed with fibrin glue and polypropylene and stitched to the epicardium with a continuous suture. Out of 24 patients, 8 died: one in the surgical room from uncontrollable bleeding and another 7 between 30 and 90 days after the surgery in the intensive care unit. All of them underwent surgery with extracorporeal circulation. There were no deaths among the patients undergoing off-pump surgery. Three out of 4 patients in whom direct suture and necrotic tissue excision was performed died in the hospital. Five out of 19 patients in whom patch correction with direct suture was done died in the hospital. The left ventricle free wall rupture, as a complication of acute myocardial infarction, can be diagnosed early and treated on time. Rapid diagnosis and emergency surgery are crucial for successful treatment of patients with impending heart rupture. Off-pump surgery and patch with glue technique seem to yield best results.
    Croatian Medical Journal 01/2003; 43(6):643-8. · 1.31 Impact Factor
  • Transplantation Proceedings 10/1999; 31(6):2507-8. DOI:10.1016/S0041-1345(99)00438-8 · 0.98 Impact Factor
  • Transplantation Proceedings 10/1999; 31(6):2509-10. DOI:10.1016/S0041-1345(99)00439-X · 0.98 Impact Factor
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    ABSTRACT: Left ventricular aneurysm as a complication of myocardial infarction is observed in 10% of patients. In recent years, all surgical teams have observed a significant decrease of this complication. There is no doubt that this is due to the current medical treatment in the acute phase of myocardial infarction. Surgical treatment is considered only when the ventricular aneurysm presents complications such as congestive heart failure, thromboembolism, malignant ventricular arrhythmias or angina. In this review, we comment on the principle surgical procedures reported up to now. The indication of surgery is based on good functional results and long-term survival.
    Revista Espa de Cardiologia 02/1998; 51 Suppl 3:80-5. · 3.79 Impact Factor
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    ABSTRACT: Between April 1987 and October 1992, six cases of Brucella endocarditis were operated on in the authors' hospital for valve replacement. They were five men and one woman with a mean(s.d.) age of 52(15) years (range 30-71 years). Three patients were in New York Heart Association (NYHA) class III and three in class IV. Two patients had previous history of rheumatic fever, one was a drug abuser, two had peripheral embolism and one constrictive pericarditis. Most were living in rural areas. Echocardiographic diagnoses were: severe aortic regurgitation in two patients, mixed disease in two and double valve involvement in two. Valve vegetations were demonstrated in two patients, valve calcification in two and annulus abscess in two others. Serological tests were positive in all patients. All patients had valve replacements and three were operated on as emergencies. Surgical findings were: valve vegetations in two patients, cusp perforation in two annulus abscess in two and prosthetic leak in two. Mean(s.d.) cardiopulmonary bypass time was 123(77) min with a mean ischaemic time of 79(43) min. All patients were given specific antibiotic treatment after surgery. There was no intraoperative mortality and the 5-year survival rate was 100%. Early reoperations were needed in three patients, two because of prosthetic leakage causing severe regurgitation and one for tamponade. The results suggests that Brucella endocarditis is rare, but still occurs in Mediterranean areas. Surgical replacement is needed in spite of antibiotic treatment and recurrences with prosthetic leaks are usual.
    Cardiovascular Surgery 05/1996; 4(2):227-30. DOI:10.1016/0967-2109(96)82321-0
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    ABSTRACT: Aortic regurgitation is one of the usual pathologic findings necessitating valve replacement in cardiac surgery. Several diseases may result in leaflet incompetence. Circumferential intimal tear of the aortic root with prolapse of the aortic valve commissures is a rare cause of aortic incompetence. We report the repair of the aortic wall and valve in 1 patient with such a tear 6 months after an important thoracic trauma. Three months after the aortic valve reconstruction the patient is in good condition and fully asymptomatic.
    The Annals of Thoracic Surgery 11/1995; 60(4):1098-100. DOI:10.1016/0003-4975(95)00431-J · 3.85 Impact Factor
  • Transplantation Proceedings 09/1995; 27(4):2343-5. DOI:10.1016/0967-2109(95)94340-3 · 0.98 Impact Factor
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    ABSTRACT: Fungal endocarditis of the bioprosthetic heart valve, implanted in a patient without evidence of impaired immunity, is reported. Clinical manifestations of endocarditis appeared 7 years after aortic valve replacement for rheumatic disease and included embolization into the popliteal artery. Trichosporon beigelii was isolated from the cultured fragments of the embolus. Two valve replacements were performed because of recurrent infection during the following 4 years. In spite of prolonged antifungal therapy, the patient died from multiorgan septic involvement.
    Cardiovascular Surgery 03/1994; 2(1):119-23. DOI:10.1177/096721099400200128
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    ABSTRACT: Long-term results of the surgical treatment of cardiac myxomas are not completely understood due to its recurrence. We review our experience in 27 operated cases with a follow-up to 22 years (mean 6.5 years), in order to throw light on results and review the problem of recurrence. One patient had a previous recurrent myxoma. At surgery we resect all the tumors and their attachment bases. We prefer a biatrial approach, ample resection and exploration of all cardiac chambers. Hospital mortality was 3.7% (1 case of associated aortic valve replacement) and late mortality 7%. Long-term results were satisfactory, without recurrences. The postoperative life expectancy of these patients seems similar to that of the normal population, except in cases of recurrence or associated valve replacement. Recurrence is very low (4.7% in 526 cases reported in the literature), except in the case of young patients and recurrent, familial, multiple or complex myxomas. The multigrowth potential of the tumor seems more important than an inadequate surgical resection.
    The Journal of cardiovascular surgery 03/1993; 34(1):49-53. · 1.46 Impact Factor
  • J Barthe · C Fontanillas · E Freixa · V Ferrán · E Esplugas
    Revista Espa de Cardiologia 03/1988; 41(2):127-8. · 3.79 Impact Factor
  • Revista Espa de Cardiologia 02/1981; 34(1):3-6. · 3.79 Impact Factor
  • Revista Espa de Cardiologia 02/1980; 33(4):397-402. · 3.79 Impact Factor
  • P Michaud · J Chassignolle · G Champsaur · E Saura · C Fontanillas · B du Gres · D Samuel
    Annales de chirurgie thoracique et cardio-vasculaire 08/1975; 14(3):267-71.