Nuestros investigadores

Gregorio Rabago Juan Aracil

Publicaciones científicas más recientes (desde 2010)

Autores: Serrano-Alonso, M; Guillén, Francisco; Martín, Paloma Leticia; et al.
Revista: TRANSPLANT INFECTIOUS DISEASE
ISSN 1398-2273  Vol. 20  Nº 3  2018  págs. e12873
Background: Cytomegalovirus (CMV) is the most important viral pathogen in solid organ transplant (SOT) recipients. The role of secondary CMV prophylaxis in this population remains unclear. Methods: Retrospective cohort study in a single center. SOT recipients treated for CMV infection from 2007 to 2014 were studied to determine the efficacy and safety of secondary prophylaxis and its impact on graft loss and mortality. The outcome variable was CMV replication in the first 3 months after the end of therapy. Secondary variables were crude mortality and graft lost censored at 5 years after transplantation. Propensity score for the use of secondary prophylaxis was used to control selection bias. Results: Of the 126 treated patients, 103 (83.1%) received CMV secondary prophylaxis. CMV relapse occurred in 44 (35.5%) patients. The use of secondary prophylaxis was not associated with fewer relapses (34.0% in patients with prophylaxis vs. 42.9% in those without prophylaxis, p= 0.29).After a mean follow-up of 32.1 months, graft loss was not different between both groups but patient mortality was significantly lower in patients who received secondary prophylaxis (5.8% vs. 28.6%, p= 0.003). Conclusion: Secondary prophylaxis did not prevent CMV infection relapse but it was associated with improved patient survival.
Autores: Rábago, Gregorio; et al.
Revista: JOURNAL OF CARDIAC SURGERY
ISSN 0886-0440  Vol. 32  Nº 1  2017  págs. 64 - 65
Autores: Martínez, Diego; Echarri, Gemma; et al.
Revista: PLOS ONE
ISSN 1932-6203  Vol. 12  Nº 2  2017  págs.  e0172021
Perioperative anemia is an important risk factor for cardiac surgery-associated acute kidney injury (CSA-AKI). Nonetheless, the severity of the anemia and the time in the perioperative period in which the hemoglobin level should be considered as a risk factor is conflicting. The present study introduces the concept of perioperative hemoglobin area under the curve (pHb-AUC) as a surrogate marker of the evolution of perioperative hemoglobin concentration. Through a retrospective analysis of prospectively collected data, we assessed this new variable as a risk factor for the development of acute kidney injury after cardiac surgery in 966 adult patients who underwent cardiac surgery with cardiopulmonary bypass, at twenty-three academic hospitals in Spain. Exclusion criteria were patients on renal replacement therapy, who needed a reoperation because of bleeding and/or with missing perioperative hemoglobin or creatinine values. Using a multivariate regression analysis, we found that a pHb-AUC < 19 g/dL was an independent risk factor for CSA-AKI even after adjustment for intraoperative red blood cell transfusion (OR 1.41, p < 0.05). It was also associated with mortality (OR 2.48, p < 0.01) and prolonged hospital length of stay (4.67 +/- 0.99 days, p < 0.001).
Autores: Martínez, Nicolás; Alfonso, Ana; Rifón, José Juan; et al.
Revista: EUROPEAN JOURNAL OF HAEMATOLOGY
ISSN 0902-4441  Vol. 98  Nº 1  2017  págs. 38 - 43
This retrospective study evaluates the impact of rituximab on PTLD response and survival in a single-centre cohort. PTLD cases between 1984 and 2009, including heart, kidney, liver and lung transplant recipients, were included. Survival was analysed taking into account the type of PTLD (monomorphic vs. polymorphic), EBV infection status, IPI score, Ann Arbor stage and use of rituximab. Among 1335 transplanted patients, 24 developed PTLD. Median age was 54 yr (range 29-69), median time to diagnosis 50 months (range 0-100). PTLD type was predominantly late/monomorphic (79% and 75%), mostly diffuse large B-cell type. Overall response rate (ORR) was 62% (66% rituximab vs. 50% non-rituximab; P = 0.5). R-CHOP-like regimens were used most frequently (72% of patients treated with rituximab). Median overall survival was 64 months (CI 95% 31-96). OS was significantly increased in patients treated with rituximab (P = 0.01; CI 95% rituximab 58-79 months; non-rituximab 1-30 months). Post-transplant immunosuppression regimen had no effect on survival or time to PTLD, except for cyclosporine A (CyA), which associated with increased time to PTLD (P = 0.02). Rituximab was associated with increased survival in our single-centre series, and it should be considered as first-line therapy for PTLD patients. The possible protective effect of CyA for development of PTLD should be prospectively evaluated.
Autores: Sarmiento, E.; Jaramillo, M.; Calahorra, L.; et al.
Revista: JOURNAL OF HEART AND LUNG TRANSPLANTATION
ISSN 1053-2498  Vol. 36  Nº 5  2017  págs. 529 - 539
BACKGROUND: New biomarkers are necessary to improve detection of the risk of infection in heart transplantation. We performed a multicenter study to evaluate humoral immunity profiles that could better enable us to identify heart recipients at risk of severe infections. METHODS: We prospectively analyzed 170 adult heart recipients at 8 centers in Spain. Study points were before transplantation and 7 and 30 days after transplantation. Immune parameters included IgG, IgM, IgA and complement factors C3 and C4, and titers of specific antibody to pneumococcal polysaccharide antigens (anti-PPS) and to cytomegalovirus (CMV). To evaluate potential immunologic mechanisms leading to IgG hypogammaglobulinemia, before heart transplantation we assessed serum B-cell activating factor (BAFF) levels using enzyme-linked immunoassay. The clinical follow-up period lasted 6 months. Clinical outcome was need for intravenous anti-microbials for therapy of infection. RESULTS: During follow-up, 53 patients (31.2%) developed at least 1 severe infection. We confirmed that IgG hypogammaglobulinemia at Day 7 (defined as IgG <600 mg/dl) is a risk factor for infection in general, bacterial infections in particular, and CMV disease. At Day 7 after transplantation, the combination of IgG <600 mg/dl + C3 <80 mg/dl was more strongly associated with the outcome (adjusted odds ratio 7.40; 95% confidence interval 1.48 to 37.03; p = 0.014). We found that quantification of anti-CMV antibody titers and lower anti-PPS antibody concentrations were independent predictors of CMV disease and bacterial infections, respectively. Higher pre-transplant BAFF levels were a risk factor of acute cellular rejection. CONCLUSION: Early immunologic monitoring of humoral immunity profiles proved useful for the identification of heart recipients who are at risk of severe infection. (C) 2017 International Society for Heart and Lung Transplantation. All rights reserved.
Autores: Huerta, Ana; López, B; Ravassa, S; et al.
Revista: JOURNAL OF HYPERTENSION
ISSN 0263-6352  Vol. 34  Nº 1  2016  págs. 130 - 138
OBJECTIVES: Cystatin C has been shown to be associated with heart failure with preserved ejection fraction (HFPEF). In addition, myocardial fibrosis has been involved in diastolic dysfunction in HFPEF. Therefore, we hypothesized that increased cystatin C levels may be associated with altered collagen metabolism, contributing to diastolic dysfunction in patients with HFPEF. METHODS: One hundred and forty-one elderly hypertensive patients with HFPEF were included. Cardiac morphology and function was assessed by echocardiography. Circulating levels of cystatin C, biomarkers of collagen type I synthesis (carboxy-terminal propeptide of procollagen type I) and degradation [matrix metalloproteinase-1 (MMP-1) and its inhibitor TIMP-1] and osteopontin were analyzed by ELISA. Twenty elderly sex-matched patients with no identifiable cardiac disease were used as controls. In-vitro studies were performed in human cardiac fibroblasts. RESULTS: Compared with controls, cystatin C was increased (P¿<¿0.001) in patients with HFPEF, even in those with a normal estimated glomerular filtration rate (eGFR; P¿<¿0.05). Cystatin C was directly correlated with the estimated pulmonary capillary wedge pressure (P¿<¿0.01), TIMP-1 and osteopontin (P¿<¿0.001) and inversely correlated with MMP-1:TIMP-1 (P¿<¿0.01), but not with carboxy-terminal propeptide of procollagen type I or MMP-1 in all patients with HFPEF. These associations were independent of eGFR. In vitro, osteopontin (P¿<¿0.01) and TIMP-1 (P¿<¿0.0
Autores: Martinez Selles, M.; Almenar, L.; Paniagua Martin, M. J.; et al.
Revista: TRANSPLANT INTERNATIONAL
ISSN 0934-0874  Vol. 28  Nº 3  2015  págs. 305 - 313
The results of studies on the association between sex mismatch and survival after heart transplantation are conflicting. Data from the Spanish Heart Transplantation Registry. From 4625 recipients, 3707 (80%) were men. The donor was female in 943 male recipients (25%) and male in 481 female recipients (52%). Recipients of male hearts had a higher body mass index (25.9 +/- 4.1 vs. 24.3 +/- 3.7; P < 0.01), and male donors were younger than female donors (33.4 +/- 12.7 vs. 38.2 +/- 12.3; P < 0.01). No further relevant differences related to donor sex were detected. In the univariate analysis, mismatch was associated with mortality in men (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.06-1.32; P = 0.003) but not in women (HR, 0.91; 95% CI 0.74-1.12; P = 0.4). A significant interaction was detected between sex mismatch and recipient gender (P = 0.02). In the multivariate analysis, sex mismatch was associated with long-term mortality (HR, 1.14; 95% CI 1.01-1.29; P = 0.04), and there was a tendency toward significance for the interaction between sex mismatch and recipient gender (P = 0.08). In male recipients, mismatch increased mortality mainly during the first month and in patients with pulmonary gradient >13 mmHg. Sex mismatch seems to be associated with mortality after heart transplantation in men but not in women.
Autores: de Frutos, F. ; Gea, Alfredo; et al.
Revista: INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY
ISSN 1569-9293  Vol. 20  Nº 2  2015  págs. 254 - 259
Coenzyme Q10 (CoQ10) is a lipid-soluble antioxidant that could have beneficial effects in patients undergoing cardiac surgery with cardiopulmonary bypass. There is no clear evidence about its clinical effects or a systematic review published yet. We aimed to conduct a systematic review and meta-analysis of the literature to elucidate the role of coenzyme Q10 in preventing complications in patients undergoing cardiac surgery with cardiopulmonary bypass. We searched the PubMed Database using the following keywords: Coenzyme Q10, ubiquinone, ubiquinol, CoQ10, Heart Surgery, Cardiac surgery. Articles were systematically retrieved, selected, assessed and summarized for this review. We performed separate meta-analyses for different outcomes (inotropic drug requirements after surgery, incidence of ventricular arrhythmias and atrial fibrillation, cardiac index 24 h after surgery and hospital stay), estimating pooled odds ratios (ORs) or mean differences of the association of CoQ10 administration with the risk of these outcomes. Eight clinical trials met our inclusion criteria. Patients with CoQ10 treatment were significantly less likely to require inotropic drugs after surgery {OR [95% confidence interval (CI) 0.47 (0.27-0.81)]}, and to develop ventricular arrhythmias after surgery [OR (95% CI) 0.05 (0.01-0.31)]. However, CoQ10 treatment was not associated with Cardiac index 24 h after surgery [mean difference (95% CI) 0.06 (-0.30 to 0.43)], hospital stay (days) [mean difference (95% CI) -0.61 (-4.61 to 3.39)] and incidence of atrial fibrillation [OR (95% CI) 1.06 (0.19-6.04)]. Since none of the clinical trials included in this review report any adverse effects associated to CoQ10 administration, and coenzyme Q10 has been demonstrated to be safe even at much higher doses in other studies, we conclude that CoQ10 should be considered as a prophylactic treatment for preventing complications in patients undergoing cardiac surgery with cardiopulmonary bypass. However, better quality randomized, controlled trials are needed to clarify the role of CoQ10 in patients undergoing cardiac surgery with cardiopulmonary bypass.
Autores: Ezponda, A; Alfonso, Ana; Iribarren, María Josefa; et al.
Revista: REVISTA ESPAÑOLA DE CARDIOLOGIA
ISSN 0300-8932  Vol. 68  Nº 7  2015  págs. 638-640
Nuestra experiencia indica que, para los pacientes con asistencia ventricular que sufran TIH sin trombosis asociada, en ausencia de test de activación plaquetaria disponible, la reexposición precoz a HNF exclusivamente durante el trasplante cardiaco podría ser una alternativa al uso de inhibidores directos de la trombina durante la CEC, siempre y cuando el recuento plaquetario se haya recuperado previamente y tras la intervención se reinicie un tratamiento anticoagulante alternativo a la heparina.
Autores: López, B; González, A; Querejeta, R.; et al.
Revista: HYPERTENSION
ISSN 0194-911X  Vol. 63  Nº 3  2014  págs. 483 - 489
Cardiotrophin-1 has been shown to be profibrogenic in experimental models. The aim of this study was to analyze whether cardiotrophin-1 is associated with left ventricular end-diastolic stress and myocardial fibrosis in hypertensive patients with heart failure. Endomyocardial biopsies from patients (n=31) and necropsies from 7 control subjects were studied. Myocardial cardiotrophin-1 protein and mRNA and the fraction of myocardial volume occupied by collagen were increased in patients compared with controls (P<0.001). Cardiotrophin-1 overexpression in patients was localized in cardiomyocytes. Cardiotrophin-1 protein was correlated with collagen type I and III mRNAs (r=0.653, P<0.001; r=0.541, P<0.01) and proteins (r=0.588, P<0.001; r=0.556, P<0.005) in all subjects and with left ventricular end-diastolic wall stress (r=0.450; P<0.05) in patients. Plasma cardiotrophin-1 and N-terminal pro-brain natriuretic peptide and serum biomarkers of myocardial fibrosis (carboxy-terminal propeptide of procollagen type I and amino-terminal propeptide of procollagen type III) were increased (P<0.001) in patients compared with controls. Plasma cardiotrophin-1 was correlated with N-terminal pro-brain natriuretic peptide (r=0.386; P<0.005), carboxy-terminal propeptide of procollagen type I (r=0.550; P<0.001), and amino-terminal propeptide of procollagen type III (r=0.267; P<0.05) in all subjects. In vitro, cardiotrophin-1 stimulated the differentiation of human cardiac fibroblast to myofibroblasts (P<0.05) and the expression of procollagen type I (P<0.05) and III (P<0.01) mRNAs. These findings show that an excess of cardiotrophin-1 is associated with increased collagen in the myocardium of hypertensive patients with heart failure. It is proposed that exaggerated cardiomyocyte production of cardiotrophin-1 in response to increased left ventricular end-diastolic stress may contribute to fibrosis through stimulation of fibroblasts in heart failure of hypertensive origin.
Autores: Cosío Carmena, M. D. G.; Gómez Bueno, M.; Almenar, L.; et al.
Revista: JOURNAL OF HEART AND LUNG TRANSPLANTATION
ISSN 1053-2498  Vol. 32  Nº 12  2013  págs. 1187 - 1195
BACKGROUND: Primary graft failure (PGF) is the leading cause of early heart transplantation (HT) mortality. Our aim was to analyze PGF currently and explore the ability of a dedicated score for PGF risk stratification. METHODS: After applying a dedicated PGF definition, we analyzed its incidence, mortality, and associated factors in a multicenter cohort of 857 HTs performed in 2006 to 2009. We used the following criteria: recipient right (R) atrial pressure >= 10 mm Hg; age (A) >= 60 years; diabetes (D) mellitus, and inotrope (I) dependence; donor age (A) >= 30 years, and length (L) of ischemia >= 240 minutes to calculate the RADIAL score for PGF risk prediction. RESULTS: PGF incidence was 22%. The right ventricle was almost always affected, alone (45%) or as part of biventricular failure (47%). Mechanical circulatory support was used in 55%. Mortality attributable to PGF was 53% and extended through the third month after HT, but thereafter, PGF had little influence in long-term outcome. The RADIAL score was higher in PGF patients (2.78 +/- 1.1 vs 2.42 +/- 1.1, p = 0.001) and stratified 3 groups with incremental PGF incidence: low risk (12.1%), intermediate risk (19.4%), and high risk (27.5%, p = 0.001). CONCLUSIONS: PGF had a strong impact, with an incidence of 22% and a mortality exceeding 50% that extends through the third post-HT month. The RADIAL score classified patients into 3 groups with incremental risk for PGF and may be useful for its prevention and early therapy. (C) 2013 International Society for Heart and Lung Transplantation. All rights reserved.
Autores: Neves, J. P. ; et al.
Revista: MEDICINA CLINICA
ISSN 0025-7753  Vol. 138  Nº 6  2012  págs. 254 - 260
Autores: Hernández-Estefanía, R.; Praschker, BL; Bastarrika, Gorka; et al.
Revista: EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
ISSN 1010-7940  Vol. 41  Nº 1  2012  págs. 134 - 136
Left atrial appendage (LAA) plays a crucial role as a source of atrial thrombus in patients with atrial fibrillation (AF). Thus, the need to close LAA becomes evident in patients with AF who undergo concomitant mitral valve surgery. Unfortunately, it has been reported a high rate of unsuccessful LAA occlusion, regardless of the technique employed. We propose a safe and simple method for LAA occlusion consisting in invagination of the appendage into the left atrium, followed by two sutures (purse string suture around the base of the LAA and a reinforce running suture).
Autores: Arraiza, María; Arias, Javier; et al.
Revista: RADIOLOGY
ISSN 0033-8419  Vol. 54  Nº 5  2012  págs. 432-441
Autores: Rábago, Gregorio; et al.
Revista: JOURNAL OF CARDIOVASCULAR SURGERY
ISSN 0021-9509  Vol. 53  Nº 3  2012  págs. 381-386
Aim. We report on nine highly selected patients in whom the resection of the tumor was only possible with cardiopulmonary bypass (CPB). Methods. Between November 1996 and November 2009, nine patients with non-cardiac tumors underwent surgery under CPB. Indications were: infiltration of the pulmonary vein in the left atrium (four cases), one case where the tumor (a paraganglioma apparently located in the subcarinal space) was actually in the atrium wall, one mediastinal liposarcoma with massive infiltration of the pericardium and the main pulmonary artery, and three tracheal tumors (2 cylindromas and 1 carcinoid). Results. Indication for CPB was decided preoperatively in 7 cases and intraoperatively in the other 2 patients. Cardiac infiltration was confirmed with intraoperative transesophageal cardiac echography in 2 patients, which proved to be very useful. Concerning postoperative complications, one patient died intraoperatively because it was impossible to stop the CPB after reconstruction of the bifurcation of the main pulmonary artery. Although the duration of the operation was significantly increased by the use of cardiopulmonary by-pass, it did not influence postoperative recovery in any of the other eight patients, as far as bleeding or infection was concerned. In one patient, a thoracic drain had to be replaced due to a partial pneumothorax. In another patient a partial dehiscence of the neo-carina was conservatively treated. Long-term results were influenced by the initial pathology of the patient. Conclusion. CPB provides the possibility of safely re-secting intrathoracic tumors invading cardiac structures that were previously inoperable. This can be achieved with an acceptable level of risk and - in very selected cases - may achieve long-term survival.
Autores: Dell'aquila, A. M; Bastarrika, Gorka; et al.
Revista: INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY
ISSN 1569-9293  Vol. 14  Nº 4  2012  págs. 457-462
Despite a more physiological morphology of atrial anastomosis in the bicaval technique with respect to standard biatrial anastomosis in orthotopic heart transplantation (OHT), the impact on the long-term outcome is still not clear. In this retrospective study, we sought to investigate the morphology and function of the atria through magnetic resonance imaging (MRI) and transthoracic echocardiography (TIE). Moreover, we aimed to analyse the accuracy of TIE with respect to MRI. Cox regression analysis of 216 consecutive patients receiving OHT between August 1987 and January 2010 identified only recipient age at the time of transplant to be an independent predictor of mortality (P = 0.048, odds ratio = 1.04). After a mean follow-up of 96.6 +/- 77.7 months, 108 patients were alive, of which 35 were found to be eligible for MRI assessment. In this analysis, left and right atrial volumes were found to be significantly larger in the standard group in comparison with the bicaval group (P = 0.001), and no significant difference between the two techniques was observed in left and right atrio-ventricular output. Moreover, a significantly reduced accuracy was observed (CCC < 0.3) when TIE results were compared with MRI assessment in evaluating atrial dimensions. Although left and right atrial volumes are significantly larger in the standard group in comparison with the bicaval group, we concluded that no significant difference in the atrial output and survival between the two techniques could be demonstrated.
Autores: Arraiza, María; De Cecco, C. N.; et al.
Revista: EUROPEAN JOURNAL OF RADIOLOGY
ISSN 0720-048X  Vol. 81  Nº 11  2012  págs. 3282-3288
Objectives: To establish the accuracy and reliability of cardiac dual-source CT (DSCT) and two-dimensional contrast-enhanced echocardiography (CE-Echo) in estimating left ventricular (LV) parameters with respect to cardiac magnetic resonance imaging (CMR) as the reference standard. Methods: Twenty-five consecutive heart transplant recipients (20 male, mean age 62.7 +/- 10.4 years, mean time since transplantation 8.1 +/- 5.9 years) were prospectively recruited. Two blinded readers independently assessed LV ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), and stroke volume (SV) for each patient after manual tracing of the endo-and epicardial contours in DSCT, CE-Echo and CMR cine images. Student's t-test for paired samples for differences, and Bland and Altman plots and Lin's concordance-correlation coefficients (CCC) for agreement were calculated. Results: There was no statistical difference between left ventricular parameters determined by DSCT and CMR. CE-Echo resulted in significant underestimation of left ventricular volumes (mean difference EDV: 15.94 +/- 14.19 ml and 17.1 +/- 17.06 ml, ESV: 8.5 +/- 9.3 and 7.32 +/- 9.14 ml with respect to DSCT and CMR), and overestimation of EF compared with the cross-sectional imaging modalities (3.78 +/- 8.47% and 2.14 +/- 8.35% with respect to DSCT and CMR). Concordance correlation coefficients for LV parameters using DSCT and CMR were higher (CCC >= 0.75) than CCC values observed between CE-Echo and DSCT- or CMR-derived data (CCC >= 0.54 and CCC >= 0.49, respectively). Interobserver agreement was higher for DSCT and CMR values (CCC >= 0.72 and CCC >= 0.87, respectively). Conclusion: In orthotopic heart transplantation cardiac DSCT allows accurate and reliable estimation of LV parameters compared with CMR, whereas CE-Echo seems to be insufficient to obtain precise measurements. (C) 2012 Elsevier Ireland Ltd. All rights reserved.
Autores: Garcia-Bolao, I; et al.
Revista: MEDICINA INTENSIVA
ISSN 0210-5691  Vol. 36  Nº 5  2012  págs. 377-9
Se trata por tanto de un caso particular debido a dos razones. La primera es la presentación temprana de una TA proveniente del donante que debuta con signos de IC. En el TC ortotópico con técnica bicava se conserva la aurícula derecha y se efectúa anastomosis de cada vena cava por separado. Por lo tanto, aunque esta técnica conlleva menores tasas de arritmias auriculares y menor necesidad de marcapasos6,7 que con la técnica clásica, en este caso concreto facilitó la preservación del foco responsable de la TA. En segundo lugar, el caso presenta como novedad la estrategia terapéutica escogida. Debido a la repercusión hemodinámica el arsenal terapéutico disponible para revertir las TSV presenta ciertos riesgos y las maniobras vagales no tienen utilidad en esta población particular. Por ende, la adenosina, en pacientes con taquicardias de QRS ancho, no está exenta de riesgos en caso de que se trate de una taquicardia ventricular. En este caso la simple sobreestimulación auricular con un catéter en la aurícula derecha yuguló la crisis de TA. Además el EEF proporcionó el diagnóstico certero a la par que la posibilidad de ablación del sustrato responsable
Autores: Bastarrika, Gorka; Arraiza, María; et al.
Revista: European Radiology
ISSN 0938-7994  Vol. 21  Nº 9  2011  págs. 1887 - 1894
Autores: Páramo, José Antonio; Rábago, Gregorio;
Revista: CIRUGIA CARDIOVASCULAR
ISSN 1134-0096  Vol. 18  Nº 1  2011  págs. 15 - 19
La trombosis es una de las causas de muerte más importante en los países industrializados. La trombosis arterial es responsable del infarto de miocardio y de los accidentes cerebrovasculares y se genera en zonas de daño arterial. Los antiplaquetarios y anticoagulantes desempeñan un papel fundamental en la prevención y tratamiento. La enfermedad tromboembólica venosa, a través de la trombosis venosa profunda y la embolia pulmonar, es la tercera causa de muerte después de los eventos arteriales. Ésta suele tratarse con anticoagulantes. En este trabajo se revisan los nuevos fármacos antiplaquetarios y anticoagulantes y su impacto en la cirugía cardiovascular. Thrombosis is the main cause of mortality in the industrialized countries. Arterial thrombosis, responsible of acute myocardial infarction and cerebrovascular accidents are characterized by the presence of rich clots in platelets and with scanty fibrin (called ¿white thrombus¿) that are generated in places of vascular injury. Under these circumstances antiplatelet agents are required for prevention and treatment. Nevertheless, as thrombin is the main enzyme of the coagulation system and is also a powerful platelet activator, anticoagulants are used to prevent arterial thrombosis. Venous tromboembolism, which includes deep venous thrombosis (DVT) and pulmonary embolism (PE), constitutes the third reason of cardiovascular mortality after myocardial infarction and stroke. Venous thrombi result from an activation of the coagulation and are constituted principally by fibrin, in which the red blood cells remain trapped together with scanty platelets (called ¿red thrombus¿); they are generally treated with anticoagulant agents. In this paper we will discuss the new antiplatelet and anticoagulant agents and their impact in cardiovascular surgery.
Autores: Dell'Aquila, A. M.; et al.
Revista: ANNALI ITALIANI DI CHIRURGIA
ISSN 0003-469X  Vol. 82  Nº 6  2011  págs. 469 - 474
Early and late Troponin T determination after elective cardiac surgery. Two different meanings AIM: Although Troponins are demonstrated to be better predictors than CK-MB in quantification of myocardial damage, the relation between cut-off values for the diagnosis of perioperative myocardial infarction (PMI) and sample time is still not clear. In the present study we sought to analyse the clinical consequence of an early and late cTnt determinations after elective cardiac surgery. MATERIAL OF STUDY: Data of 117 patients undergone elective open heart surgery between January 2006 and June 2007 were prospectively collected. PMI was detected on the basis of postoperative electrocardiography/echocardiography and hemo-dynamic state. RESULTS: The in-hospital mortality was 1.7%. Eight patients (68%) presented PMI. Receiver-operating characteristic (ROC) analyses showed a cTnt cut-off of 1.22 mg/L (CI 0.94 to 0.99, P=0.0001, 100% sensitivity and 96% specificity) on arrival to ICU for the diagnosis of PMI. On the second post-operative day the cut-off value was 2.8 mg/L (CI 95% 0.84 to 0.98, P=0.0001) (sensitivity 66 % and specificity 100%). At this time the Pearson's test revealed the best correlation to ICU (P=0.008) and in-hospital (P=0.01) length of stay (LOS). DISCUSSION: A better sensibility of cTnt in diagnosis of PMI in the early postoperative period has been demonstrated to be associated to an increasing specificity in the late post-operative period. CONCLUSIONS: PMI must be suspected in patients with a cTnt > 1.22 mg/L. A second later assessment on the 2nd post-operative can exclude false positives and significantly predict the ICU and the in-hospital length of stay.
Autores: Alloway, R.; Vanhaecke, J.; Yonan, N.; et al.
Revista: JOURNAL OF HEART AND LUNG TRANSPLANTATION
ISSN 1053-2498  Vol. 30  Nº 9  2011  págs. 1003 - 1010
BACKGROUND: A prolonged-release formulation of tacrolimus for once-daily administration (tacrolimus QD) has been developed. This phase II, open-label, multicenter, prospective single-arm study compared the pharmacokinetics (PK) of tacrolimus in stable heart transplant patients before and after conversion from twice-daily tacrolimus (tacrolimus BID) to tacrolimus QD. METHODS: Heart transplant recipients (>= 6 months after transplant), previously maintained on tacrolimus BID based therapy, received tacrolimus BID from Days 1 to 7 and were converted on a I: I (mg/mg) basis to tacrolimus QD. Five 24-hour PK profiles were collected (Days 1, 7, 8, 14, 21). Safety parameters were also evaluated. RESULTS: Of 85 patients, 45 (50.6%) completed all 5 evaluable PK profiles. Steady-state tacrolimus area under the curve, 0 to 24 hours (AUC(0-24)) and minimum concentration (C-min) were comparable for both formulations, with treatment ratio means of 90.5% (90% confidence intervals [CI], 86.4%-94.6%) and 87.4% (95% CI, 82.9%-92.0%), respectively (acceptance interval, 80%-125%). There was good correlation between AUC(0-24) and C-min for tacrolimus QD (r = 0.94) and BID (r = 0.91). The relationship between these 2 parameters was also similar. CONCLUSIONS: This study provides evidence for successful conversion from tacrolimus BID to QD on a 1:1 (mg/mg) total doily dose basis. Approximately one-third of patients may require dose adjustments. Both formulations were well tolerated, with stable renal function during the study. Adverse events were reported by approximately one-tenth of patients receiving tacrolimus BID and a quarter of those who received QD. J Heart Lung Transplant 2011;30:1003-10 (C) 2011 International Society for Heart and Lung Transplantation. All rights reserved.
Autores: Gavira, Juan José; et al.
Revista: REVISTA ESPAÑOLA DE CARDIOLOGIA
ISSN 0300-8932  Vol. 64  Nº 8  2011  págs. 727-728
Autores: Rincón, Aníbal ; Zudaire, Juan Javier; et al.
Revista: UROTODAY INTERNATIONAL JOURNAL
ISSN 1939-4810  Vol. 3  Nº 4  2010  págs. 1 - 8
INTRODUCTION: The objectives were to: (1) analyze clinical and pathological features of renal cell carcinoma (RCC) with caval thrombosis in order to indentify independent prognostic factors, and (2) analyze perioperative morbidity and mortality. METHODS: The authors retrospectively analyzed clinical and pathological data of 56 patients treated for RCC with caval thrombosis during a 20-year period. The surgical procedure was essentially unchanged. Independent variables were: TNM, creatinine value, age, histological extent, histological type, adjuvant treatment, and surgical technique; the dependent variable was overall survival. Contingency and logistic regression tables were used. Kaplan-Meier method, log-rank, and Cox models were used to analyze survival rates. RESULTS: There were complications in 15 patients and 2 perioperative deaths. Overall mean (SD) survival rates were 32% (7%) and 24% (6%) at 3 and 5 years, respectively. Multivariate results showed that the significant prognostic indicators of survival were: the size of the tumor > 8 cm (P < .01), the presence of metastasis (P < .04), and lymph node invasion (P < .009). These were also regarded as the relevant variables, independent of patient survival. CONCLUSIONS: The surgical approach for this disorder is challenging and not exempt of complications. Nodal involvement, tumor size, and distant metastases are the most important prognostic factors; thrombus extension has a clear impact on surgical planning and performance.
Autores: Bastarrika, Gorka; Zudaire, Beatriz; et al.
Revista: Investigative Radiology
ISSN 0020-9996  Vol. 45  Nº 2  2010  págs. 72 - 76
Introduction: To compare left atrial performance with dual-source CT (DSCT) with respect to magnetic resonance imaging (MRI) in orthotopic heart transplant recipients. Methods: Twenty-nine consecutive heart transplant recipients (27 male,mean age 64.1 +/- 13 years; mean time from transplantation 122.8 +/- 69.7 months) referred for exclusion of cardiac allograft vasculopathy underwent cardiac DSCT and MRI. Standard biatrial technique was employed in 13 subjects whereas 16 were transplanted after the bicaval technique. Axial 5-mm slice-thickness DSCT datasets reconstructed in 5% steps of the cardiac cycle and axial 5-mm SSFP-MRI images were analyzed. Two blinded readers manually traced left atrial contours in random order to estimate end-diastolic volume (EDV), end-systolic volume (ESV), and ejection fraction (EF). Parameters were compared with a paired sample Student t test. Concordance correlation coefficient (CCC) was calculated to determine measurement agreement between techniques and observers. Results: Left atrial volumes were significantly higher with cardiac DSCT (EDV: 170.9 +/- 78.1 mL; ESV: 139.5 +/- 76.6 mL) than with MRI (EDV: 158.2 +/- 72.5 mL; ESV: 124.2 +/- 68.2 mL), whereas left atrial EF was lower with DSCT (EF: 20.8% +/- 7.5% vs. 23.6% +/- 7.7%) (P < 0.05). Measurement agreement between DSCT and MRI was excellent for all parameters (CCC >= 0.82). Individuals operated with the biatrial anastomosis technique presented significantly higher left atrial volumes and lower EF compared with subjects with bicaval anastomosis. Interobserver agreement was excellent for all parameters (CCC >= 0.80). Conclusion: Even if DSCT slightly overestimates left atrial volumes with respect to MRI, results remain clinically valid. Bicaval surgical technique offers improved left atrial performance compared with standard biatrial anastomosis. DSCT may be used as a reliable tool to estimate left atrial parameters in orthotopic heart transplant recipients.
Autores: Levy Praschker , BG; Bastarrika, Gorka; Dell'Aquila, A; et al.
Revista: INTERACTIVE CARDIOVASCULAR AND THORACIC SURGERY
ISSN 1569-9293  Vol. 11  Nº 4  2010  págs. 499 - 500
Autores: Martínez, Fernando; et al.
Revista: Revista española de enfermedades digestivas
ISSN 1130-0108  Vol. 102  Nº 5  2010  págs. 338 -339