To assess the economical impact of vancomycin use versus teicoplanin use as antibiotic prophylaxi... more To assess the economical impact of vancomycin use versus teicoplanin use as antibiotic prophylaxis for patients undergoing cardiac surgery for valve replacement (VR) and coronary artery by-pass (CABS) procedures. This is an ancillary cost minimization analysis of a double blinded, parallel groups, randomised clinical trial (RCT), with the main objective of comparing the safety and efficacy of these antibiotics. 500 patients were included in the study; 267 in the CABS group and 233 in the VR group. The CABS patients received 1 g vancomicin or 400 mg teicoplanin, plus 150 mg netilmicin. The VR group received a second dose of each drug after extracorporeal circulation. In order to calculate the costs we considered the direct cost of the drug, the i.v. mix and the administration costs, together with personnel and structure costs. We considered two different situations: the administration of drugs within the surgical room theatre and in the medical ward. The demographic data of both grou...
The case is presented of a 55-year-old male implanted with a mitral valve homograft (MVH) in the ... more The case is presented of a 55-year-old male implanted with a mitral valve homograft (MVH) in the tricuspid position. The MVH has remained in place for 21 years, but underwent repair during the 13th postoperative year. The explant findings of this surgical anecdote are discussed, with emphasis placed on reoperation and late clinical events. The extreme long-term performance of this MVH was unexpected.
The biodegradable ring was recently developed for mitral and tricuspid annuloplasty. The study ai... more The biodegradable ring was recently developed for mitral and tricuspid annuloplasty. The study aim was to assess the histological biocompatibility of the biodegradable ring and orifice area growth in a porcine model. The smallest (size 16) biodegradable ring was implanted into the tricuspid annulus of 16 juvenile pigs. All animals were followed up by transthoracic echocardiography to evaluate tricuspid valve function. Animals were sacrificed at one, three, six, nine and 12 months after implantation. Macroscopic and histological analyses were performed on three sections per ring implantation site. Parameters from the study group were compared to those obtained from control animals that underwent cardiopulmonary bypass without ring implantation. Histological examination showed that the biodegradable ring was gradually replaced by fibrous tissue, with complete hydrolytic degradation within six months. The thickness of the dense fibrous tissue reached that of the initial ring at 12 mont...
To critically review the available transcatheter aortic valve implantation techniques and their r... more To critically review the available transcatheter aortic valve implantation techniques and their results, as well as propose recommendations for their use and development. A committee of experts including European Association of Cardio-Thoracic Surgery and European Society of Cardiology representatives met to reach a consensus based on the analysis of the available data obtained with transcatheter aortic valve implantation and their own experience. The evidence suggests that this technique is feasible and provides haemodynamic and clinical improvement for up to 2 years in patients with severe symptomatic aortic stenosis at high risk or with contraindications for surgery. Questions remain mainly concerning safety and long-term durability, which have to be assessed. Surgeons and cardiologists working as a team should select candidates, perform the procedure, and assess the results. Today, the use of this technique should be restricted to high-risk patients or those with contraindications for surgery. However, this may be extended to lower risk patients if the initial promise holds to be true after careful evaluation. Transcatheter aortic valve implantation is a promising technique, which may offer an alternative to conventional surgery for high-risk patients with aortic stenosis. Today, careful evaluation is needed to avoid the risk of uncontrolled diffusion.
Objective: Percutaneous coronary intervention with drug-eluting stents is challenging coronary ar... more Objective: Percutaneous coronary intervention with drug-eluting stents is challenging coronary artery bypass grafting (CABG) as the gold standard for treatment of three-vessel and left main coronary disease. We evaluated the current practice pattern in hospitals throughout Europe and USA. Methods: To qualify for participation in the SYNTAX (Synergy between PCI with TAXUS drug-eluting stent and Cardiac Surgery) study, a randomized
ABSTRACT Cardiovascular surgery has an uncertain future ahead. There is a major concern with rega... more ABSTRACT Cardiovascular surgery has an uncertain future ahead. There is a major concern with regards to this in the US and Europe. This feeling of uncertainty is even stronger in Spain due to the delay and differences accumulated in our country by our specialty in comparison to other countries of Western Europe. With the aim of looking for possible solutions to avoid a further deterioration of our profession, the factors that may influence on this currently deteriorated situation are analyzed. The results lead to a strategy that includes the development of new technologies, education, changes in the patient referral pattern, new applications of extracorporeal circulation, the integration of surgeons in endovascular techniques and the development of innovative departments.
1. Med Clin (Barc). 2003 Jun 14;121(2):68-73. [Ankle brachial index and cardiovascular risk] [Art... more 1. Med Clin (Barc). 2003 Jun 14;121(2):68-73. [Ankle brachial index and cardiovascular risk] [Article in Spanish] Mostaza JM, Vicente I, Cairols M, Castillo J, González-Juanatey JR, Pomar JL, Lahoz C. Unidad de Arteriosclerosis. Hospital Carlos III. Madrid. Spain. ...
Objectives: To evaluate whether the application of heparin treated circuits for elective coronary... more Objectives: To evaluate whether the application of heparin treated circuits for elective coronary artery surgery improves postoperative recovery, a European multicenter randomised clinical trial was carried out. Methods: In 11 European heart centers, 805 low-risk patients underwent cardiopulmonary bypass (CPB) with either an untreated circuit (n 407) or an identical but heparin treated circuit (n398, Duraflo®II). Results: Significant differences were
The purpose of this study was to carry out a current assessment of the Mitroflow pericardial biop... more The purpose of this study was to carry out a current assessment of the Mitroflow pericardial bioprosthesis (model 11) according to the durability of the prosthesis after 15 years in patients aged 60 years or older. This bioprosthesis was implanted in 161 patients (mean age 69.5 +/- 6.3 years; range 60 - 94 years) undergoing aortic valve replacement (AVR) between 1982 and 1992. There were 84 patients aged 60 - 69 years (mean 64.5 +/- 3.1years) and 77 patients aged 70 years or older (mean 74.8 +/- 4.3 years). Of the total population, concomitant procedures were performed in 63 patients (39.1 %); of these, coronary artery bypass grafting was performed in 39 (24.2 %). Early mortality was 4.8 % (4 patients) in the 60 - 69 year age group and 10.4 % (8) in patients aged 70 years or older ( P = 0.290). Late mortality was 4.5 %/patient-year (35) for those aged 60 - 69 years and 8.1 %/patient-year (49) for those aged 70 years or older ( P = 0.007). Patient survival at 15 years of patients aged 60 - 69 years was 47.6 +/- 6.3 % and of patients aged 70 years or older was 20.9 +/- 5.4 % ( P = 0.003) ( ). Freedom from valve-related mortality for patients in the 60 - 69 year age group was 92.1 +/- 3.5 % at 15 years (0.6 %/patient-year [5]), and in the patient group aged 70 years or older it was 84.4 +/- 5.3 % (1.3 %/patient-year [8]; P = 0.194). Freedom from reoperation for patients in the 60 - 69 year age group was 73.9 +/- 5.0 % (2.6 %/patient-year [20]), and for patients aged 70 years or older it was 91.4 +/- 3.4 % (1.0 %/patient-year [6]; P = 0.029). The structural valve deterioration (SVD) rate for patients in the 60 - 69 year age group was 2.4 %/patient-year (19), and for patients aged 70 years or older it was 1.0 %/patient-year (6) ( P = 0.041). Actuarial freedom from structural valve deterioration at 15 years for patients aged 60 - 69 years was 62.0 +/- 7.3 %, and 80.8 +/- 7.9 % for patients aged 70 years and older ( P = 0.049) (actual freedom 73.9 +/- 5.2 % and 91.4 +/- 3.4 %, respectively). The Mitroflow pericardial bioprosthesis can still be recommended for aortic valve replacement in patients 70 years and older.
To assess the economical impact of vancomycin use versus teicoplanin use as antibiotic prophylaxi... more To assess the economical impact of vancomycin use versus teicoplanin use as antibiotic prophylaxis for patients undergoing cardiac surgery for valve replacement (VR) and coronary artery by-pass (CABS) procedures. This is an ancillary cost minimization analysis of a double blinded, parallel groups, randomised clinical trial (RCT), with the main objective of comparing the safety and efficacy of these antibiotics. 500 patients were included in the study; 267 in the CABS group and 233 in the VR group. The CABS patients received 1 g vancomicin or 400 mg teicoplanin, plus 150 mg netilmicin. The VR group received a second dose of each drug after extracorporeal circulation. In order to calculate the costs we considered the direct cost of the drug, the i.v. mix and the administration costs, together with personnel and structure costs. We considered two different situations: the administration of drugs within the surgical room theatre and in the medical ward. The demographic data of both grou...
The case is presented of a 55-year-old male implanted with a mitral valve homograft (MVH) in the ... more The case is presented of a 55-year-old male implanted with a mitral valve homograft (MVH) in the tricuspid position. The MVH has remained in place for 21 years, but underwent repair during the 13th postoperative year. The explant findings of this surgical anecdote are discussed, with emphasis placed on reoperation and late clinical events. The extreme long-term performance of this MVH was unexpected.
The biodegradable ring was recently developed for mitral and tricuspid annuloplasty. The study ai... more The biodegradable ring was recently developed for mitral and tricuspid annuloplasty. The study aim was to assess the histological biocompatibility of the biodegradable ring and orifice area growth in a porcine model. The smallest (size 16) biodegradable ring was implanted into the tricuspid annulus of 16 juvenile pigs. All animals were followed up by transthoracic echocardiography to evaluate tricuspid valve function. Animals were sacrificed at one, three, six, nine and 12 months after implantation. Macroscopic and histological analyses were performed on three sections per ring implantation site. Parameters from the study group were compared to those obtained from control animals that underwent cardiopulmonary bypass without ring implantation. Histological examination showed that the biodegradable ring was gradually replaced by fibrous tissue, with complete hydrolytic degradation within six months. The thickness of the dense fibrous tissue reached that of the initial ring at 12 mont...
To critically review the available transcatheter aortic valve implantation techniques and their r... more To critically review the available transcatheter aortic valve implantation techniques and their results, as well as propose recommendations for their use and development. A committee of experts including European Association of Cardio-Thoracic Surgery and European Society of Cardiology representatives met to reach a consensus based on the analysis of the available data obtained with transcatheter aortic valve implantation and their own experience. The evidence suggests that this technique is feasible and provides haemodynamic and clinical improvement for up to 2 years in patients with severe symptomatic aortic stenosis at high risk or with contraindications for surgery. Questions remain mainly concerning safety and long-term durability, which have to be assessed. Surgeons and cardiologists working as a team should select candidates, perform the procedure, and assess the results. Today, the use of this technique should be restricted to high-risk patients or those with contraindications for surgery. However, this may be extended to lower risk patients if the initial promise holds to be true after careful evaluation. Transcatheter aortic valve implantation is a promising technique, which may offer an alternative to conventional surgery for high-risk patients with aortic stenosis. Today, careful evaluation is needed to avoid the risk of uncontrolled diffusion.
Objective: Percutaneous coronary intervention with drug-eluting stents is challenging coronary ar... more Objective: Percutaneous coronary intervention with drug-eluting stents is challenging coronary artery bypass grafting (CABG) as the gold standard for treatment of three-vessel and left main coronary disease. We evaluated the current practice pattern in hospitals throughout Europe and USA. Methods: To qualify for participation in the SYNTAX (Synergy between PCI with TAXUS drug-eluting stent and Cardiac Surgery) study, a randomized
ABSTRACT Cardiovascular surgery has an uncertain future ahead. There is a major concern with rega... more ABSTRACT Cardiovascular surgery has an uncertain future ahead. There is a major concern with regards to this in the US and Europe. This feeling of uncertainty is even stronger in Spain due to the delay and differences accumulated in our country by our specialty in comparison to other countries of Western Europe. With the aim of looking for possible solutions to avoid a further deterioration of our profession, the factors that may influence on this currently deteriorated situation are analyzed. The results lead to a strategy that includes the development of new technologies, education, changes in the patient referral pattern, new applications of extracorporeal circulation, the integration of surgeons in endovascular techniques and the development of innovative departments.
1. Med Clin (Barc). 2003 Jun 14;121(2):68-73. [Ankle brachial index and cardiovascular risk] [Art... more 1. Med Clin (Barc). 2003 Jun 14;121(2):68-73. [Ankle brachial index and cardiovascular risk] [Article in Spanish] Mostaza JM, Vicente I, Cairols M, Castillo J, González-Juanatey JR, Pomar JL, Lahoz C. Unidad de Arteriosclerosis. Hospital Carlos III. Madrid. Spain. ...
Objectives: To evaluate whether the application of heparin treated circuits for elective coronary... more Objectives: To evaluate whether the application of heparin treated circuits for elective coronary artery surgery improves postoperative recovery, a European multicenter randomised clinical trial was carried out. Methods: In 11 European heart centers, 805 low-risk patients underwent cardiopulmonary bypass (CPB) with either an untreated circuit (n 407) or an identical but heparin treated circuit (n398, Duraflo®II). Results: Significant differences were
The purpose of this study was to carry out a current assessment of the Mitroflow pericardial biop... more The purpose of this study was to carry out a current assessment of the Mitroflow pericardial bioprosthesis (model 11) according to the durability of the prosthesis after 15 years in patients aged 60 years or older. This bioprosthesis was implanted in 161 patients (mean age 69.5 +/- 6.3 years; range 60 - 94 years) undergoing aortic valve replacement (AVR) between 1982 and 1992. There were 84 patients aged 60 - 69 years (mean 64.5 +/- 3.1years) and 77 patients aged 70 years or older (mean 74.8 +/- 4.3 years). Of the total population, concomitant procedures were performed in 63 patients (39.1 %); of these, coronary artery bypass grafting was performed in 39 (24.2 %). Early mortality was 4.8 % (4 patients) in the 60 - 69 year age group and 10.4 % (8) in patients aged 70 years or older ( P = 0.290). Late mortality was 4.5 %/patient-year (35) for those aged 60 - 69 years and 8.1 %/patient-year (49) for those aged 70 years or older ( P = 0.007). Patient survival at 15 years of patients aged 60 - 69 years was 47.6 +/- 6.3 % and of patients aged 70 years or older was 20.9 +/- 5.4 % ( P = 0.003) ( ). Freedom from valve-related mortality for patients in the 60 - 69 year age group was 92.1 +/- 3.5 % at 15 years (0.6 %/patient-year [5]), and in the patient group aged 70 years or older it was 84.4 +/- 5.3 % (1.3 %/patient-year [8]; P = 0.194). Freedom from reoperation for patients in the 60 - 69 year age group was 73.9 +/- 5.0 % (2.6 %/patient-year [20]), and for patients aged 70 years or older it was 91.4 +/- 3.4 % (1.0 %/patient-year [6]; P = 0.029). The structural valve deterioration (SVD) rate for patients in the 60 - 69 year age group was 2.4 %/patient-year (19), and for patients aged 70 years or older it was 1.0 %/patient-year (6) ( P = 0.041). Actuarial freedom from structural valve deterioration at 15 years for patients aged 60 - 69 years was 62.0 +/- 7.3 %, and 80.8 +/- 7.9 % for patients aged 70 years and older ( P = 0.049) (actual freedom 73.9 +/- 5.2 % and 91.4 +/- 3.4 %, respectively). The Mitroflow pericardial bioprosthesis can still be recommended for aortic valve replacement in patients 70 years and older.
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