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1.
Hernández-Antolín RA García E Sandoval S Almería C Cuadrado A Serrano J de Obeso E Del Valle R Bañuelos C Alfonso F Guerrero F Heredia J Benítez JC García-Rubira JC Rodríguez E Macaya C 《Revista espa?ola de cardiología》2011,64(1):35-42
Introduction and objectives
Transfemoral implantation of an Edwards SAPIEN (ES) or Medtronic CoreValve (MCV) aortic valve prosthesis is an alternative to surgical replacement for patients with severe aortic stenosis and a high surgical risk. The study's aim was to compare results obtained with these two devices.Methods
Prospective observational study of transfemoral prosthesis implantation performed at our center.Results
Of the 76 patients (age 83 ± 6 years, 63% female, logistic EuroSCORE 18 ± 9) included, 50 were assigned the ES and 26 the MCV device. There was no difference between the groups in age, sex, functional class, valve area, associated conditions, or EuroSCORE. Implantation was successful in 84% of the ES group and 100% of the MCV group (P = .04). There were three cases of tamponade, two aortic dissections and one valve malposition in the ES group. The two groups had similar vascular access complication rates (26% vs. 23%; P = NS), but pacemaker need was greater with the MCV (10% vs. 39%; P = .003). Mortality rates at 30 days were 12% and 20% (P = NS) in the ES and MCV groups, respectively, and at 1 year, 24% and 20% (P = NS), respectively. After a follow-up of 367 ± 266 days in the ES group and 172 ± 159 days in the MCV group, three patients died. Clinical improvement was maintained in other patients and no echocardiographic changes were observed.Conclusions
In-hospital mortality, the complication rate and medium-term outcomes were similar with the two devices. The only difference observed was a higher implantation success rate with the MCV, although at the expense of a greater frequency of atrioventricular block.Full English text available from: www.revespcardiol.org 相似文献2.
3.
Introduction and objectives
The Working Group on Cardiac Catheterization and Interventional Cardiology presents on a yearly basis a report on the data collected for the national registry. This information displays how procedures are distributed throughout Spain and makes comparisons with other countries feasible.Methods
Institutions render their data voluntarily (online) and they are analyzed by the Working Group's steering committee.Results
Data was sent by 113 hospitals (71 public and 41 private) that treat mainly adults, reporting 135 486 diagnostic procedures, 119 118 of them coronary angiograms, slightly less than the year before, and with a rate of 2945 coronary angiograms per million inhabitants. Percutaneous coronary interventions increased a bit, to 64 331 procedures and a rate of 1398 interventions per million. Of 100 371 stents implanted, 61.3% were drug-eluting stents. In the acute phase of myocardial infarction, 14 248 coronary interventions were carried out, 6% more than in 2009 and 22% of the total number of coronary interventions. The most frequent intervention for adult congenital heart disease was closure of an atrial septal defect (295 procedures). Percutaneous mitral valvuloplasty continues to decrease (326 procedures) and percutaneous aortic valve implantations are growing rapidly, with 655 units implanted in 2010.Conclusions
The greatest increase in activity has occurred in the field of myocardial infarction and percutaneous aortic valve implantation. The other procedures, both diagnostic and therapeutic, remain stable.Full English text available from:www.revespcardiol.org 相似文献4.
López-Otero D Muñoz-García AJ Avanzas P Lozano I Alonso-Briales JH Souto-Castro P Morís C Hernández-García JM Trillo-Nouche R 《Revista espa?ola de cardiología》2011,64(2):121-126
Introduction and objectives
To validate the axillary approach as a safe and efficient option for the transcatheter aortic valve implantation in patients who have contraindication for femoral approach at three Spanish hospitals.Methods
We included patients with severe symptomatic aortic stenosis at very high or prohibitive surgical risk, selected by a multidisciplinary team, for transcatheter aortic valve implantation, and had contraindication to the femoral approach.Results
We included 19 of 186 (10.5%) patients, who were implanted a percutaneous aortic valve, between November 2008 and March 2010. The mean age was 78.3 (standard deviation [SD] ± 8.65) years and 73.7% were males. The mean logistic EuroSCORE was 28.7% (SD ± 16.3%). The procedural success rate was 100%. After the procedure the maximum transvalve gradient decreased from 81.7 mmHg (SD ± 21.5) to 15.8 mmHg (SD ± 5.5), and no patient presented residual aortic regurgitation >2. The all-cause mortality, with a mean follow-up time of 9.2 (SD ± 3.2) months was 10.5%, and the in-hospital and 30-day mortality rates were 0%. The global incidence of major complications due to the procedure was 15.7%. Definitive pacemaker implantation was carried out for atrioventricular block in 8 patients (44.4%).Conclusions
The axillary approach for transcatheter aortic valve implantation using the CoreValve® and contraindication to the femoral approach is safe and efficient for selected patients, with excellent results in terms of success implantation and in hospital and 30-day mortality.Full English text available from: www.revespcardiol.org 相似文献5.
Gaspar Melis Guillem Frontera Guillem Caldentey Ana Sahuquillo Carlos Fernández-Palomeque José F. Forteza Armando Bethencourt José I. Sáez-Ibarra Oriol Bonnin 《Revista espa?ola de cardiología》2013
Introduction and objectives
The prognosis of patients with severe aortic stenosis, low aortic gradient and preserved ejection fraction is controversial. Our study analyzed the prognosis of these patients and its relation to pressure gradient and aortic valve flow.Methods
We performed a retrospective cohort study of 363 consecutive patients with severe aortic stenosis and preserved ejection fraction, divided into 4 groups, based on the presence of a systolic volume index greater or lower than 35 mL/m2 and the presence of a mean aortic gradient greater or lower than 40 mmHg. Group I: normal flow, high gradient (n=169, 47%); group II: normal flow, low gradient (n=98, 27%); group III: low flow, high gradient (n=54, 15%), and group IV: low flow, low gradient (n=42, 12%). The primary endpoint was overall mortality.Results
Independent risk factors for mortality were age (hazard ratio=1.04; 95% confidence interval, 1.01-1.08) and atrial fibrillation (hazard ratio=2.21; 95% confidence interval, 1.24-3.94). Surgical treatment was associated with longer survival in all groups (hazard ratio=0.25; 95% confidence interval, 0.13-0.49). Mortality was higher in patients with low flow than in those with with normal flow (26.6% vs 13.6%; P=.004). The most favorable mean prognosis was found in group II (hazard ratio=0.4; 95% confidence interval, 0.2-0.9).Conclusions
Patients with severe aortic stenosis, normal ejection fraction and low aortic flow have a worse prognosis. Analysis of aortic flow by Doppler echocardiography is useful in risk stratification and therapeutic decision-making in patients with aortic stenosis.Full English text available from:www.revespcardiol.org/en. 相似文献6.
Forteza A Centeno J Bellot R López Gude MJ Pérez de la Sota E Sánchez V Rufilanchas JJ Cortina J 《Revista espa?ola de cardiología》2011,64(6):470-475
Introduction and objectives
Several aortic valve sparing techniques have been described for the treatment of aortic root aneurysms. We report our experience using the reimplantation technique in 120 patients.Methods
Between March 2004 and October 2010, 120 patients with aortic root aneurysms underwent David operations. Of these, 51 were diagnosed with Marfan syndrome. Mean patient age was 31 ± 12 years. The mean diameter of the sinuses of Valsalva was 51 ± 5 mm and moderate/severe aortic regurgitation was present in 16% of these patients. In the other 69 patients mean age was 56 ± 14 years, the mean diameter of the sinuses of Valsalva was 53 ± 7 mm and moderate/severe aortic regurgitation was present in 66%. A bicuspid aortic valve was presented in 14 cases.Results
Hospital mortality was 1.7%. Mean follow-up was 37 ± 21 months; 94% of the patients survived and 96% had an aortic regurgitation below grade II during 5 years of follow-up. One patient required re-operation because of severe aortic regurgitation. No endocarditis or thromboembolic complications have been documented, and 96% of the patients did not receive any anticoagulation therapy.Conclusions
Short- and mid-term results with the reimplantation technique for aortic root aneurysms are excellent. This technique prevents the need for chronic anticoagulation treatment as well as the complications arising from mechanical prostheses, and it should be the treatment of choice for young patients.Full English text available from: www.revespcardiol.org 相似文献7.
8.
Diego A Pérez de Prado A Cuellas C Pérez-Martínez C Gonzalo-Orden M Altonaga JR de Miguel A Regueiro M Ajenjo J Sánchez-Lasheras F Alvarez-Arenal A Fernández-Vázquez F 《Revista espa?ola de cardiología》2011,64(9):745-751
Introduction and objectives
Drug-eluting stents are useful for preventing restenosis, but the patho-physiological processes involved in the proliferative response after implantation are still not known in detail. The aim of this study is to compare the coronary vascular histomorphometry after implanting drug-eluting stents and bare metal stents in a swine model.Methods
Sixty stents were randomly implanted in 20 Large White female pigs with a ratio of baremetal/drug-eluting stents of 1:2. After 28 days, euthanasia and histomorphometry were performed. We defined the vessel injury score in accordance to whether the internal elastic lamina was intact or ruptured.Results
There were no differences between drug-eluting stents and bare metal stents in the intact internal elastic lamina group regarding neointimal area or % restenosis (1.3 [1.1-2.2]) vs 2.0 [1.3-2.5] mm2; P=.6; and 14.0 [12.1-20.8] vs 22.2 [14.1-23.3] %; P=.5). We assessed statistically significant differences for the ruptured internal elastic lamina group, (neointimal area 1.2 [0.8-2.0] vs 2.9 [2.3-3.7] mm2; P=.001 and % restenosis 16.63 [11.2-23.5] vs 30.4 [26.4-45.7] %; P=.001).Conclusions
In our swine model, we did not find any differences between proliferative response of drug-eluting stents and bare metal stents when the internal elastic lamina is intact; differences are only found when vascular injury is deeper.Full English text available from: www.revespcardiol.org 相似文献9.
Ardoy DN Fernández-Rodríguez JM Ruiz JR Chillón P España-Romero V Castillo MJ Ortega FB 《Revista espa?ola de cardiología》2011,64(6):484-491
Introduction and objectives
Physical fitness level is a marker of cardiovascular health in young people. The aim of this study was to analyze the effects of a school-based intervention program, focused on increasing the volume and intensity of physical education (PE) sessions, on adolescents’ physical fitness.Methods
Sixty-seven adolescents (12-14 years old) from three secondary school classes participated in a 16-week intervention. The classes were randomly allocated to the control group, experimental group 1 (EG1) or experimental group 2 (EG2). The control group received standard PE (2 sessions/week), the EG1 received 4 standard PE sessions/week and the EG2 received four high-intensity PE sessions/week. Aerobic fitness, muscle strength, speed-agility and flexibility were assessed using previously validated field-based tests before and after the intervention.Results
Doubling the number of PE sessions/week resulted in improvements in aerobic fitness and flexibility (P=.008 and P=.04, respectively). Further increases in the intensity of the sessions were related to improvements in speed-agility (P<.001). The maximal oxygen consumption increased by 3 and 5 mL/kg/min in the EG1 and EG2, respectively. No differences were observed for muscle strength.Conclusions
The results suggest that doubling the frequency of PE sessions is a sufficient stimulus to improve physical fitness, particularly aerobic fitness, which has been shown to be a powerful indicator of cardiovascular health in children and adolescents. Future studies involving larger sample sizes should confirm or refute these findings.Full English text available from: www.revespcardiol.org 相似文献10.
Arias MA Domínguez-Pérez L Toquero J Jiménez-Candil J Olagüe J Díaz-Infante E Tercedor L Valverde I Castro J García-Fernández FJ Rodríguez-Padial L 《Revista espa?ola de cardiología》2011,64(4):312-318
Introduction and objectives
Sprint Fidelis defibrillation leads are prone to early failure. Most of the reported series come from a single institution. This paper describes the clinical experience in nine Spanish hospitals.Methods
Clinical, implant, and follow-up data of all patients with a Sprint Fidelis lead were analyzed. All cases of lead failure were identified, medium-term lead survival was calculated, and possible predictors for lead failure were determined.Results
In total, 378 leads in 376 patients were studied. The mean age (male 85.7%) was 64.9±13.6 years. The majority of patients (59.8%) had ischemic heart disease. Mean left ventricular ejection fraction was 33.4%±14.5%. Left subclavian vein puncture was used in 74.8%. During a mean follow-up of 30.9±14 months, 16 lead failures have occurred, with a lead survival of 96.1% at 36 months after implantation. Eleven of 16 lead failures were caused by failure of pace/sense conductors, 3 by defects in the high-voltage conductor, and 2 by defects in both types of conductors. A less depressed left ventricular ejection fraction was associated with an increased probability of lead failure (42.4%±16% vs. 33%±14.3%; P=.011). Three hospitals presented a rate of lead failure higher than 10%; the rate was less than 5% in the remaining 6 hospitals.Conclusions
In this multicenter series of 378 leads, the 3-year estimated survival was higher than that reported in prior series. Clinical presentation of lead failures was similar to that reported previously. Left ventricular ejection fraction and hospital of implantation were variables associated to lead failure.Full English text available from: www.revespcardiol.org 相似文献11.
12.
Isaac Pascual Pablo Avanzas Antonio J. Muñoz-García Diego López-Otero Manuel F. Jimenez-Navarro Belén Cid-Alvarez Raquel del Valle Juan H. Alonso-Briales Raimundo Ocaranza-Sanchez Fernando Alfonso José M. Hernández Ramiro Trillo-Nouche César Morís 《Revista espa?ola de cardiología》2013
Introduction and objectives
There is little information on the use of transcatheter aortic valve implantation in patients with severe aortic stenosis and porcelain aorta. The primary aim of this study was to analyze death from any cause after CoreValve® implantation in patients with severe aortic stenosis, with and without porcelain aorta.Methods
In this multicenter, observational prospective study, carried out in 3 hospitals, percutaneous aortic valves were implanted in 449 patients with severely calcified aortic stenosis. Of these, 36 (8%) met the criteria for porcelain aorta. The primary end-point was death from any cause at 2 years.Results
Patients with porcelain aorta more frequently had extracardiac vascular disease (11 [30.6%] vs 49 [11.9%]; P=.002), prior coronary revascularization (15 [41.7%] vs 98 [23.7%]; P=.017), and dyslipidemia (26 [72.2%] vs 186 [45%]; P=.02). In these patients, there was greater use of general anesthesia (15 [41.7%] vs 111 [16.9%]; P=.058) and axillary access (9 [25%] vs 34 [8.2%]; P=.004). The success rate of the procedure (94.4 vs 97.3%; P=.28) and the incidence of complications (7 [19.4%] vs 48 [11.6%]; P=.20) were similar in both groups. There were no statistically significant differences in the primary end point at 24 months of follow-up (8 [22.2%] vs 66 [16%]; P=.33). The only predictive variable for the primary end point was the presence of complications during implantation (hazard ratio=2.6; 95% confidence interval, 1.5-4.5; P=.001).Conclusions
In patients with aortic stenosis and porcelain aorta unsuitable for surgery, percutaneous implantation of the CoreValve® self-expanding valve prosthesis is safe and feasible.Full English text available from: www.revespcardiol.org/en 相似文献13.
The decrease in QRS amplitude after aortic valve replacement in patients with aortic valve stenosis 总被引:1,自引:1,他引:0
Satoshi Kurisu MD Ichiro Inoue MD Takuji Kawagoe MD Masaharu Ishihara MD Yuji Shimatani MD Yasuharu Nakama MD Tatsuya Maruhashi MD Eisuke Kagawa MD Kazuoki Dai MD Junichi Matsushita MD Hiroki Ikenaga MD 《Journal of electrocardiology》2009,42(5):410-413
Purpose
The purpose of this study was to evaluate the effect of aortic valve replacement on electrocardiogram (ECG) in patients with aortic valve stenosis.Methods
Serial 12-lead ECGs were obtained in 15 patients with aortic valve stenosis who underwent aortic valve replacement. Three ECG indexes for left ventricular hypertrophy were manually measured in each ECG: Sokolow-Lyon index (sum of S wave in V1 and R wave in V5), Cornell voltage index (sum of R wave in aVL and S wave in V3), and Gubner index (sum of R wave in I and S wave in III).Results
After aortic valve replacement, Sokolow-Lyon index gradually decreased during 2 years (51.1 ± 17.9 to 34.8 ± 12.5 mm, P < .01). Cornell voltage index (25.6 ± 7.0 to 15.0 ± 4.8 mm, P < .01) and Gubner index (15.8 ± 7.6 to 10.3 ± 5.5 mm, P < .01) also gradually decreased during 2 years. ST depression in V6 was found in 14 patients (93%) before aortic valve replacement. It resolved in 9 of 14 patients during 2 years.Conclusions
Electrocardiographic evidence of left ventricular hypertrophy gradually resolved after aortic valve replacement in patients with aortic valve stenosis. 相似文献14.
Lehr EJ Wang PZ Oreopoulos A Kanji H Norris C Macarthur R 《The Canadian journal of cardiology》2011,27(2):262-262.e20
Background
Aortic root replacement is a complex operation for severe aortic root pathology such as aneurysms and dissections with concomitant aortic valve disease. Biological and mechanical valve conduits are available.Methods
Early and midterm results were analyzed in patients undergoing aortic root replacement. From January 1, 1998, to May 31, 2007, 144 patients underwent aortic root replacement (Bentall procedures) with either a mechanical (n = 51) or a biological (n = 93) valve conduit. Cox proportional hazard analysis was used to determine whether valve type was an independent predictor of all-cause mortality, and analysis of covariance was used to compare general and disease-specific health-related quality-of-life scores.Results
Operative mortality was 2.1%. Median follow-up time was 40 months; 1- and 5-year survival rates for the mechanical group were 96.0% and 89.0%, respectively, vs 93.0% and 84.0% for the biological group. Valve type was not predictive of all-cause mortality, and valve-related complications were not significantly different between groups. At follow-up, 31.5% of patients in the biological group were on anticoagulant. General and disease-specific health-related quality-of-life scores were not significantly different between groups.Conclusions
Aortic root replacement with either mechanical or biological valved conduits is a safe procedure. Morbidity, mortality, and adverse quality of life were not associated with the type of valve conduit. Further studies are required to assess long-term durability of biological valve conduits used for aortic root replacement. 相似文献15.
Jorge Rodríguez-Capitán Juan J. Gómez-Doblas Leticia Fernández-López Raúl López-Salguero Manuel Ruiz Inés Leruite Fernando Cabrera-Bueno María J. Mataró-López Gemma Sánchez-Espín José M. Melero-Tejedor Carlos Porras-Martín Miguel Such Eduardo de Teresa 《Revista espa?ola de cardiología》2013
Introduction and objectives
There is little data available for Spain on the outcomes of surgical treatment for severe tricuspid regurgitation. The aim of this study was to analyze clinical and echocardiographic outcomes in a series of patients who received surgical treatment for severe tricuspid regurgitation and to compare outcomes according to the operative approach to valve repair or replacement.Methods
Retrospective study in 119 consecutive patients with severe tricuspid regurgitation undergoing valve surgery between April 1996 and February 2010.Results
A total of 61 ringless and 23 ring annuloplasties were performed and 11 bioprostheses and 24 mechanical prostheses were implanted. Perioperative mortality was 18.5% and was associated with age and cardiopulmonary bypass time. During clinical follow-up (median, 41 [interquartile range, 24-89] months), 2 reoperations were required in the ring annuloplasty and mechanical prosthesis groups; prosthetic thrombosis was diagnosed in 4 patients in the latter group. Total mortality after follow-up was 29.9% and was associated with age>70 years and extracorporeal circulation time. The emergence of new severe tricuspid regurgitation was associated with age and ringless annuloplasty (P=.04).Conclusions
Ringless repair was significantly associated with recurrence of severe tricuspid regurgitation. The use of mechanical prostheses was associated with a high rate of thrombosis. No significant differences in perioperative or total mortality were found between the different methods used for repair or valve replacement.Full English text available from:www.revespcardiol.org/en. 相似文献16.
17.
Manzano-Fernández S Januzzi JL Boronat García M Bonaque-González JC Muñoz-Esparza C Albaladejo-Otón MD Pastor-Pérez FJ Pastor P Valdés M Pascual-Figal DA 《Revista espa?ola de cardiología》2011,64(5):365-372
Introduction and objectives
Urinary concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP) may be prognostically meaningful; however, direct comparison to plasma concentrations of this marker have not been performed in patients with acutely decompensated heart failure (ADHF). The aims of this study were to compare the prognostic value of plasma versus urinary NT-proBNP concentration for the risk stratification of patients with ADHF.Methods
Consecutive hospitalized patients with ADHF were prospectively studied. Blood and urine samples were simultaneously collected on hospital arrival to determine NT-proBNP concentrations. Clinical follow-up was obtained, and the occurrence of mortality and heart failure hospitalization was registered.Results
The study included 138 patients (median, 74 years [interquartile range, 67-80]; 54% men). During a median follow-up period of 387 days [interquartile range, 161-559], 65 patients (47%) suffered adverse clinical events. Plasma NT-proBNP concentration was higher among patients who presented adverse events (4561 pg/mL [2191-8631] vs 2906 pg/mL [1643-5823]; P = .03), whereas urinary NT-proBNP was similar in both groups (P = .62). After multivariable Cox regression analyses, plasma NT-proBNP concentration was associated with a higher risk of adverse events, whether considered continuously (per 100 pg/mL; hazard ratio [HR] = 1.004; 95% confidence interval [CI], 1.001-1.007; P = .003) or categorically (≥3345 pg/mL; HR = 2.35; 95%CI, 1.41-3.93; P = .001). In contrast, urinary NT-proBNP concentration was not associated with adverse outcomes.Conclusions
Plasma NT-proBNP concentration is superior to urinary NT-proBNP concentration for the prediction of adverse clinical outcomes among unselected patients with ADHF.Full English text available from: www.revespcardiol.org 相似文献18.
19.
Riera M Herrero J Ibáñez J Campillo C Amézaga R Sáez de Ibarra JI Fiol M Bonnín O 《Revista espa?ola de cardiología》2011,64(6):463-469
Introduction and objectives
Evaluating patient outcomes following cardiac surgery is a means of measuring the quality of that surgery. The present study analyzes survival and the risk factors associated with mid-term mortality of patients undergoing cardiac surgery in Son Dureta University Hospital (Palma, Balearic Islands, Spain).Methods
From November 2002 thru December 2007, 1938 patients underwent interventions. Patients were stratified in 4 age groups. Of 1900 patients discharged from hospital, 1844 were followed until December 31, 2008. Following discharge, we constructed Kaplan-Meier survival curves and performed Cox regression analysis to determine which variables associated with mid-term mortality.Results
In-hospital mortality of the 1,938 patients was 1.96% (CI 95%, 1.36%-2.6%). Survival probability at 1, 3 and 5 years follow-up was 98%, 94% and 90%, respectively. Mean follow-up was 3.2 (0.01-6.06) years. Patients aged ≥70 years showed a lower survival rate than those aged <70 (log rank test, P <.0001). At the end of follow-up, mortality was 6.5% (CI 95%, 5.4%-7.7%). Age ≥70 years, a history of severe ventricular dysfunction (ejection fraction <30%), severe pulmonary hypertension, diabetes mellitus, preoperative anemia, postoperative stroke, and hospital stay were independently associated with mid-term mortality.Conclusions
Mid-term survival after discharge was highly satisfactory. Mid-term mortality varied with age and other pre- and postoperative factors.Full English text available from: www.revespcardiol.org 相似文献20.
Marrugat J Vila J Baena-Díez JM Grau M Sala J Ramos R Subirana I Fitó M Elosua R 《Revista espa?ola de cardiología》2011,64(5):385-394