Irene Rovira

• MD, PhD
• Professor (Associate) at University of Barcelona

The accuracy of contemporary risk scores in predicting perioperative mortality in infective endocarditis (IE) remains controversial. The aim is to evaluate the performance of existent mortality risk scores for cardiovascular surgery in IE and the impact on operability at high-risk thresholds. A single-center retrospective review of adult patients d...

Background and objectives In recent years, minimally invasive cardiac surgery (MICS) has been developed and applied to a greater number of pathologies, especially in mitral valve surgeries, as it obtains results comparable to those of conventional techniques while entailing lower surgical trauma and shorter recovery time. MICS requiring one-lung ve...

Resumen Antecedentes y objetivo En los últimos años la cirugía cardíaca mínimamente invasiva (CCMI) se ha desarrollado y aplicado a mayor número de dolencias, especialmente en cirugías sobre la válvula mitral, por presentar resultados comparables a las técnicas convencionales con menor agresividad y tiempo de recuperación. La CCMI que necesita ven...

Introduction Heparin induced thrombocytopenia (HIT) is frequent in patients under extracorporeal membrane oxygenation (ECMO) or ventricular assist device support (VAD). Therapeutic plasma exchange (TPE) and use of direct thrombin inhibitors (DTI) as argatroban have proven to be useful. However, monitoring its effect can be difficult as activated cl...

Introduction Adult congenital heart disease (ACHD) represents a growing population in many cardiac centers and it's a challenge for all physicians involved. Multidisciplinary teams integrated by cardiologists, echocardiographers, cardiac surgeons, cardiac anesthesiologists, radiologists and others, have been created in many hospitals to manage such...

Introduction Left atrial dissection (LATD) is an infrequent (incidence 0.16%) however serious condition (mortality 13.8%). Methods The authors present three-LATD between 2016 and 2018 (from 2475 cardiac-surgery cases). Results Case 1 - A 57-year-old female with severe mitral regurgitation (P2 prolapse) was admitted for elective mitral valve repai...

Purpose: To analyze the influence of adding gentamicin to a regimen consisting of β-lactam or vancomycin plus rifampicin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis (SPVE). Methods: From January 2008 to September 2016, 334 patients with definite SPVE were attended in the participating hospitals. Ninety-fou...

Background: Regional citrate anticoagulation (RCA) is being used increasingly in continuous renal replacement therapy (CRRT) as a safer alternative to heparin. However, complex metabolic control to avoid side effects have generated discrepancies about its introduction into everyday practice. We aimed to compare both anticoagulation techniques in t...

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive and fatal lung disease with limited response to currently available therapies. Alveolar type II cells (ATII) act as progenitor cells in the adult lung, contributing to alveolar repair during pulmonary injury. However, in IPF ATII die and are replaced by fibroblasts and myofibroblasts...

Introduction Pulmonary endarterectomy (PE) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to analyze our experience in the medical and surgical management of CTEPH. Methods We included 80 patients diagnosed with CTEPH between January 2000 and July 2012. Thirty two patients underwent...

Background. The impact of early valve surgery (EVS) on the outcome of Staphylococcus aureus (SA) prosthetic valve infective endocarditis (PVIE) is unresolved. The objective of this study was to evaluate the association between EVS, performed within the first 60 days of hospitalization, and outcome of SA PVIE within the International Collaboration o...

Objective: To determine the importance of intraoperative transesophageal echocardiography (IOTEE) in the surgical decision in patients undergoing cardiac surgery. Patients and method: Prospective observational study of patients undergoing cardiac surgery from January 2009 to May 2012, which was monitored with IOTEE by the anesthesiologist in cha...

Introduction: Pulmonary endarterectomy (PE) is the treatment of choice for chronic thromboembolic pulmonary hypertension (CTEPH). The aim of this study was to analyze our experience in the medical and surgical management of CTEPH. Methods: We included 80 patients diagnosed with CTEPH between January 2000 and July 2012. Thirty two patients underw...

Atrial fibrillation is a frequent complication in the perioperative period. When it appears there is an increased risk of perioperative morbidity due to stroke, thromboembolism, cardiac arrest, myocardial infarction, anticoagulation haemorrhage, and hospital readmissions. The current article focuses on the recommendations for the management of peri...

Objective To determine the importance of intraoperative transesophageal echocardiography (IOTEE) in the surgical decision in patients undergoing cardiac surgery. Patients and method Prospective observational study of patients undergoing cardiac surgery from January 2009 to May 2012, which was monitored with IOTEE by the anesthesiologist in charge....

Perioperative right ventricular failure in patients undergoing cardiac surgery is usually associated with pulmonary hypertension and is an independent risk factor for death with this type of surgery. Following cardiopulmonary bypass, pulmonary vascular resistance increases, which leads to greater right ventricular afterload and the risk of right ve...

Atrial fibrillation is a frequent complication in the perioperative period. When it appears there is an increased risk of perioperative morbidity due to stroke, thromboembolism, cardiac arrest, myocardial infarction, anticoagulation haemorrhage, and hospital readmissions. The current article focuses on the recommendations for the management of peri...

Neuropsychological dysfunction is a major cause of morbidity and mortality after cardiac surgery. To evaluate if intraoperative cerebral desaturation and depth of anesthesia measured by bispectral index are related to postoperative cognitive dysfunction in cardiac surgery. Prospective study in patients undergoing elective cardiac surgery with cardi...

Neuropsychological dysfunction after cardiac surgery. Cerebral saturation and bispectral index: A longitudinal study Background: Neuropsychological dysfunction is a major cause of morbidity and mortality after cardiac surgery. Aim: To evaluate if intraoperative cerebral desatu-ration and depth of anesthesia measured by bispectral index are related...

We sought to investigate the safety and feasibility of obtaining total respiratory support during 72 hours using a pump-driven (Levitronix CentriMag; Levitronix LLC, Waltham, Mass) venous-venous extracorporeal lung membrane (Novalung; Novalung GmbH, Hechingen, Germany) attached through a single double-lumen cannula (Novalung) into the femoral or ju...

The need to compromise between surgical and anesthetic access in airway surgery is an important clinical problem. We wanted to determine the feasibility of performing upper airway surgery under awake anesthesia and spontaneous respiration. This was a prospective, clinical feasibility study. Patients with upper tracheal stenosis were managed through...

Objective To evaluate the common curriculum for teaching theoretical knowledge in anesthesiology in Catalonia, Spain; to assess differences between hospital teaching programs, evaluation systems, and the situation for tutors. Material and methods A 35-item questionnaire was sent to 49 accredited tutors during the 2005–2006 academic year. The quest...

Although the use of pulmonary artery catheters (PACs) in managing critical patients is a subject of debate, they continue to be inserted in many cases and possible complications should be taken into account. Our objective was to review the serious or potentially serious complications associated with PACs in our hospital in the past 15 years. This w...

To evaluate the common curriculum for teaching theoretical knowledge in anesthesiology in Catalonia, Spain; to assess differences between hospital teaching programs, evaluation systems, and the situation for tutors. A 35-item questionnaire was sent to 49 accredited tutors during the 2005-2006 academic year. The questionnaire covered 1) the curricul...

We compared conventional treatment with pumpless extracorporeal lung membrane (Interventional Lung Assist [iLA] Novalung; Novalung GmbH, Hechingen, Germany) support in a pig model of postpneumonectomy severe acute respiratory distress syndrome. Adult pigs underwent a left thoracotomy without (group I) or with a left extrapericardial pneumonectomy a...

Intraoperative Doppler ultrasound can be used to measure cardiac output by transoesophageal echocardiography. Recently, its reliability, when compared to the thermodilution technique, has been questioned. The purpose of this study was to compare intraoperative changes in cardiac output measured by echo-Doppler and by thermodilution in cardiac surge...

Accurate management of acute post-thoracotomy pain can be obtained with epidural local anaesthetics with or without opioids. The routine in our centre for many years has been boluses of epidural methadone with satisfactory results and a lack of serious complication. Objectives To compare the analgesic effectiveness of two epidural regimens for acut...

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To determine the changes in magnesaemia in cardiac surgical patients submitted to cardiopulmonary bypass (CPB) and their influence on perioperative morbidity. Setting: the cardiovascular surgery department of a university hospital. Patients: 60 patients of both sexes, mean age 60+/-12 yrs, operated on consecutively for myocardial revascularization...

Heart surgery with cardiopulmonary bypass (CPB) leads to changes in supply and consumption of cerebral oxygen (DO2 and VO2C). Monitoring jugular bulb oxygen saturation (SjO2) detects changes in the DO2C/VO2C ratio that occur in patients undergoing heart surgery. The objective of this study was to determine the evolution of SjO2, of the arteriovenou...

Esmolol is a beta-adrenergic receptor antagonist with a relatively specific affinity for beta 1 adrenergic receptors. Its mechanism of action is therefore largely cardioselective and only high doses block beta 2 adrenergic receptors. The pharmacologic features of the drug give it rapid onset of beta-blocking action (distribution half-life = 2 minut...

The use of nitric oxide gas by inhalation to treat hypoxemia and pulmonary hypertension in mechanically ventilated patients has increased in the last few years. Nitric oxide is a potent vasodilator gas that when given by the inhalation route is selective for the pulmonary vessels and for ventilated lung regions. This double selectivity makes nitric...

Patients with chronic obstructive pulmonary disease (COPD) may develop hypoxemia and pulmonary hypertension when exercising. To investigate whether inhaled nitric oxide (NO), a selective pulmonary vasodilator, modifies the changes induced by exercise in pulmonary hemodynamics and gas exchange in COPD, we studied nine patients (FEV1, = 39 +/- 2% pre...

Inhalation of nitric oxide (NO) causes selective pulmonary vasodilation and improves arterial oxygenation in acute respiratory distress syndrome. But some patients do not respond or gas exchange worsens when inhaling NO. We hypothesised that this detrimental effect might be related to the reversion of hypoxic vasoconstriction in those patients wher...

The social and surgical experience of a surgical team in the hospital of East Mostar, Bosnia Herzegovina, is narrated. The special characteristics of this hospital and its proximity to the combat zone determined the type of medical attention that was delivered there. More than 50 major surgeries were done in a month (both elective and urgent). Plas...

Nitric oxide was identified as the relaxing factor derived from the endothelium in 1987. Nitric oxide synthesis allows the vascular system to maintain a state of vasodilation, thereby regulating arterial pressure. Nitric oxide is also found in platelets, where it inhibits adhesion and aggregation; in the immune system, where it is responsible for t...

Inhaling low concentrations of nitric oxide (NO) gas causes selective pulmonary vasodilation of ventilated lung regions. NO activates soluble guanylate cyclase, increasing guanosine 3',5'-cyclic monophosphate (cGMP). Inhibition of NO synthesis enhances hypoxic pulmonary vasoconstriction. Therefore we examined independent and combined effects of NO...

Stevens-Johnson syndrome consists of inflammatory bullous lesions of the skin and mucous membranes and seems to be associated to several pharmacologic and/or infectious triggering factors which might share a common immunologic way. Esophageal stenosis secondary to Stevens-Johnson syndrome is very rare. During the last 40 years, only two cases in ch...

The effects of intravenous cimetidine and ranitidine, given about I h before induction of anaesthesia, on gastric pH and volume, were assessed in three homogeneous groups of 20 adult patients, each undergoing emergency appendectomy. Group I received saline and was used as a control; Group 2 received cimetidine 400 mg in saline and Group 3 received...