Wide-angle seismic reflection/refraction (WA) surveys provide data that can be modeled to obtain lithospheric-scale P-wave velocity (VP) models. The interpretation of these datasets is often ...performed as a laborious and time-consuming trial-and-error procedure, in which the relevant model parameters (layer thickness and VP) are manually adjusted until the forward modeling matches the observed travel-times. In this work, we present a fully automatic iterative nonlinear approach to invert WA datasets based on the simulated annealing technique. We test our proposed approach with data from the MARCONI-3 WA profile (southern Bay of Biscay) and compare the outcome with an existing detailed interpretation, discussing the similarities between the two models and the agreement between our model and the observed travel-times.
El desarrollo de derrames pleurales en el postoperatorio de pacientes sometidos a cirugía cardiaca es una complicación frecuente. Se han desarrollado diferentes sistemas de drenaje, entre los cuales, ...aquellos basados en el método Seldinger demuestran mayor seguridad y menor invasividad. La toracocentesis con catéter venoso central supone una maximización de estos aspectos, demostrándose eficaz en la evacuación de derrames pleurales en el contexto del postoperatorio de cirugía cardiaca. Describimos nuestra experiencia incorporando modificaciones técnicas al procedimiento con la utilización de aguja de Tuohy de 18G para la punción.
Pleural effusions are frequent complications in the postoperative period of patients undergoing cardiac surgery. Different drainage systems have been developed, and those based on the Seldinger method demonstrate greater safety and less invasiveness. Thoracentesis with a central venous catheter maximizes these aspects, providing effective evacuation of pleural effusions in the postoperative period of cardiac surgery. We describe our experience adding technical modifications based on puncture with 18G Tuohy needles.
Los injertos de vena safena (IVS) son los conductos más frecuentemente utilizados en la cirugía de revascularización. Sin embargo, su tasa de fallo es del 35-50% a 5-10años, debido en parte a la ...hiperplasia intimal secundaria al estrés parietal. Diferentes exostents han sido desarrollados a fin de paliar este efecto. Se realizó una búsqueda sistemática en Pubmed con diferentes combinaciones de palabras clave para identificar los estudios sobre el uso de exostents. Se realizaron dos metaanálisis, uno basado en la permeabilidad de los injertos y otro sobre el desarrollo de hiperplasia intimal patológica, correspondiéndose con los gradosII-III de la clasificación de Fitzgibbon. Se realizó una puesta al día de la evidencia en torno a los 5exostents disponibles. Se seleccionaron 10 trabajos comparativos controlados para los metaanálisis. La utilización de exostents resultó perjudicial en términos de permeabilidad (RR: 1,67; p=0,03). No obstante, en el análisis de subgrupos, los dispositivos VEST® no mostraron diferencias significativas respecto del grupo control (RR: 1,11; p=0,59). Además, estos dispositivos permitieron mantener un mayor porcentaje de injertos en gradoI de hiperplasia intimal frente a los injertos no soportados (RR: 0,53; p=0,02). Se concluyó que los exostents, globalmente considerados, no mejoran la permeabilidad de los IVS a corto-medio plazo. Con el seguimiento realizado, algunos dispositivos como VEST® han demostrado limitar el desarrollo de hiperplasia intimal, lo cual podría comportar beneficios en cuanto a permeabilidad de los injertos en la prolongación del seguimiento de los trabajos en curso.
Saphenous vein grafts (SVI) are the most common conduits used in revascularization surgery. However, its failure rate is 35-50% at 5-10years, partially due to intimal hyperplasia secondary to shear wall stress. Different exostents have been developed in order to amend this effect. A systematic review was performed in Pubmed with different combinations of keywords to identify all studies about the use of exostents. Two meta-analyses were performed, one based on the patency of the grafts and another focused on the development of pathological intimal hyperplasia, corresponding to gradesII-III of the Fitzgibbon classification. An update of the evidence was carried out regarding the 5 exostents already available. Ten controlled comparative studies were selected for the meta-analyses. The use of exostents was detrimental in terms of patency (RR: 1.67; P=.03). However, in the subgroup analysis, the VEST® devices did not show significant differences compared to the control group (RR: 1.11; P=.59). Furthermore, these devices allowed maintaining more grafts in gradeI of intimal hyperplasia, compared to unsupported grafts (RR: 0.53; P=.02). To conclude, exostents, globally considered, do not improve IVS patency in the mid-short term follow-up. However, some devices such as VEST®, have shown to limit the development of intimal hyperplasia, which may improve graft patency in the extension of the follow-up of ongoing studies.
La endocarditis infecciosa (EI) es una enfermedad sistémica con afectación multiorgánica. Se trata de una entidad grave, que con frecuencia requiere de tratamiento quirúrgico, a pesar del cual las ...tasas de mortalidad pueden ser elevadas debido a complicaciones derivadas de una respuesta inflamatoria sistémica exacerbada y/o sepsis. Los sistemas de hemadsorción (HA) como Cytosorb® (Cytosorbents Corporation, Nueva Jersey, EE. UU.) permiten la eliminación de citocinas proinflamatorias y endotoxinas para poder mejorar el pronóstico de estos pacientes. Realizamos una búsqueda sistemática en PubMed y Cochrane para identificar trabajos comparativos controlados del uso perioperatorio de Cytosorb® en sujetos intervenidos de cirugía cardiaca por EI. Se efectuó un metaanálisis contrastando diferentes resultados clínicos en el que se incluyeron nueve documentos. La aplicación de la terapia con HA no redujo la mortalidad en el posoperatorio temprano (riesgo relativo RR=0,75; p=0,05). Tanto la duración de la ventilación mecánica (diferencia de medias DM=-6,91 h; p=0,01) como la del soporte vasopresor (DM=-34,47 h; p=0,03) fueron significativamente menores en el caso de los pacientes tratados con HA. Sin embargo, las estancias posoperatorias, la incidencia de fallo renal posoperatorio o la necesidad de revisión quirúrgica por sangrado no presentaron diferencias entre grupos. Como conclusión, la utilización del filtro de HA Cytosorb® en la cirugía cardiaca por EI permitió un mejor control de la actividad inflamatoria posoperatoria, con menores requerimientos de soporte vasoconstrictor y duración de la ventilación mecánica, pero sin impacto sobre la mortalidad perioperatoria ni otras complicaciones relacionadas.
Infective endocarditis (IE) is a systemic disease with multiorgan involvement. It is a severe disease, which frequently requires surgical treatment, despite which mortality rates can be high due to complications related to an uncontrolled systemic inflammatory response and/or sepsis. Hemadsorption systems such as Cytosorb® allow the removal of proinflammatory cytokines and endotoxins to improve the prognosis of these patients. We performed a systematic review in Pubmed and Cochrane to identify controlled comparative studies of the perioperative use of Cytosorb® in patients undergoing cardiac surgery for IE. A meta-analysis was performed comparing different clinical outcomes. 9 studies were finally included in the meta-analysis. The use of hemadsorption therapy did not reduce mortality in the early postoperative period (RR=0.75; p=0.05). Both, the duration of mechanical ventilation (mean difference=-6.91hours; p=0.01) and the duration of support with vasopressor drugs (mean difference=-34.47hours; p=0.03) were significantly shorter in the case of patients treated with hemadsorption. However, postoperative stays, the incidence of postoperative renal failure or the need for surgical revision due to bleeding did not show differences between groups. To conclude, the use of the Cytosorb® hemadsorption filter in cardiac surgery for IE allowed better control of postoperative inflammatory activity, with lower requirements for vasopressor support and duration of mechanical ventilation, but without impact on perioperative mortality or other related complications.
El fibroelastoma papilar es un tumor cardiaco primario benigno localizado normalmente en el endocardio valvular, aunque es posible encontrarlo en otras estructuras endocárdicas. Según estudios ...recientes, podría ser el tumor cardiaco primario benigno más común. En un número importante de casos es asintomático, se diagnostica de manera incidental y, en caso de presentar clínica acompañante, se asocia a eventos cerebrovasculares tromboembólicos. Mostramos nuestra experiencia en el tratamiento quirúrgico del fibroelastoma papilar y se lleva a cabo una revisión bibliográfica de la literatura.
Estudio retrospectivo unicéntrico mediante le revisión de las historias clínicas de todos los pacientes diagnosticados de fibroelastoma papilar y tratados quirúrgicamente en nuestro Servicio.
Desde enero de 2016 hasta octubre de 2022 se intervinieron 14 pacientes, predominantemente varones, con una edad media de 61±12,6 años. El diagnóstico se realizó en casi todos los casos mediante estudios previos a la cirugía. La mayoría de los tumores eran asintomáticos y se localizaron en la válvula aórtica. Ninguno precisó reemplazo o reparación valvular. En 5 casos (35,7%) se realizó crioablación concomitante del lecho tumoral. No hubo mortalidad quirúrgica. Tras 3,2±2,22 años de seguimiento dos pacientes fallecieron de causas no cardiacas. No se han objetivado recidivas.
El tratamiento quirúrgico del fibroelastoma papilar es seguro y ofrece buenos resultados. La crioablación concomitante podría ser útil para conseguir una eliminación tumoral completa sin necesidad de recambio valvular, aunque es necesaria más evidencia. La realización de un registro multicéntrico permitiría un mayor conocimiento de esta patología.
Papillary fibroelastoma is a benign primary cardiac tumor normally located in the valvular endocardium, although it can be found in other endocardial structures. According to recent studies, it could be the most common benign primary cardiac tumor. In a significant number of cases it is asymptomatic, diagnosed incidentally and, in symptomatic cases, usually they present as thromboembolic neurological events. We show our experience in the surgical treatment of papillary fibroelastoma and a review of the literature is performed.
Single-center retrospective study by reviewing the medical records of all patients diagnosed with papillary fibroelastoma and surgically treated in our department.
From January 2016 to October 2022, 14 patients were operated on, predominantly men, with a mean age of 61±12.6 years. The diagnosis was made mostly in almost all cases during the preoperative study for other indications. Most of the tumors were asymptomatic and were located in the aortic valve. No patient required valve replacement or repair. In 5 cases (35.7%) concomitant cryoablation was performed. There was no surgical mortality. After 3.2±2.22 years of follow-up, two patients died of non-cardiac causes. No tumoral recurrences have been found.
Surgical treatment of papillary fibroelastoma is safe and offers good short and mid-term results. Concomitant cryoablation might be useful to achieve complete tumor removal without the need for valve replacement, however more evidence is mandatory. The realization of a multicenter registry would allow a better knowledge of this tumors.
A 78-year-old woman with a history of transient ischemic attack was admitted for sudden aphasia. In order to assess the potential cardioembolic source an echocardiogram was performed, which revealed ...a large mass consistent with a thrombus in transit through a patent foramen ovale. Because of the high risk of systemic embolism, emergent surgical thrombectomy was performed with the intention to discharge the patient safely without any new embolic events. This case report highlights the importance of echocardiography in the evaluation of cardioembolic stroke and the requirement of an emergent approach in case of impending paradoxical embolism.
Acute beetroot juice (BJ) intake has shown to enhance aerobic and anaerobic performance. However, no studies have evaluated the effects of BJ intake on CrossFit (CF) performance by linking hormonal, ...metabolic, and mechanical responses. The purpose of this study was to determine the causal physiological association between hormonal, metabolic and mechanical responses, and CF workouts performance after acute BJ intake. Twelve well-trained male practitioners undertook a CF workout after drinking 140 mL of BJ (~ 12.8 mmol NO.sub.3.sup.-) or placebo. The two experimental conditions (BJ or placebo) were administered using a randomized, double-blind, crossover design. The CF workout consisted of repeating the same exercise routine twice: Wall ball (WB) shots plus full back squat (FBS) with 3-min rest (1st routine) or without rest (2nd routine) between the two exercises. A 3-min rest was established between the two exercise routines. An interaction effect was observed in the number of repetitions performed (p = 0.04). The Bonferroni test determined a higher number of repetitions after BJ than placebo intake when a 3-min rest between WB and FBS (1st routine) was established (p = 0.007). An interaction effect was detected in cortisol response (p = 0.04). Cortisol showed a higher increase after BJ compared to placebo intake (76% vs. 36%, respectively). No interaction effect was observed in the testosterone and testosterone/cortisol ratio (p > 0.05). A significant interaction effect was found in oxygen saturation (p = 0.01). A greater oxygen saturation drop was observed in BJ compared to placebo (p < 0.05). An interaction effect was verified in muscular fatigue (p = 0.03) with a higher muscular fatigue being observed with BJ than placebo (p = 0.02). BJ intake improved anaerobic performance only after the recovery time between exercises. This increase in performance in the first routine probably generated greater hypoxia in the muscle mass involved, possibly conditioning post-exercise performance. This was observed with a fall in oxygen saturation and in muscle fatigue measured at the end of the CF workout. The greatest perceived changes in cortisol levels after BJ intake could be attributed to the nitrate-nitrite-nitric oxide pathway.
El hematoma intramural agudo tipo A (HIM-A) constituye una entidad de elevada letalidad, subsidiaria de intervención quirúrgica emergente. No obstante, casos seleccionados (estabilidad ...clínica/hemodinámica, diámetro<50mm, espesor<11mm) pueden presentar mejor pronóstico, proponiéndose el manejo conservador como alternativa en estudios asiáticos. Por ello, planteamos realizar un metaanálisis comparando la mortalidad hospitalaria del manejo conservador vs. quirúrgico del HIM-A, así como tendencias temporales y diferencias geográficas. Realizamos una búsqueda en Medline® por palabras clave: «aortic intramural hematoma». Se incluyeron estudios comparativos de ambas alternativas terapéuticas con resultados de mortalidad hospitalaria de pacientes con HIM-A. Se valoró el tamaño del efecto, expresado como riesgo relativo (RR), mediante el test de Mantel-Haenszel y un modelo de efectos fijos o aleatorios según el nivel de heterogeneidad I2<o≥25%, respectivamente. Se incluyeron 46 estudios con 890 pacientes para manejo conservador y 1.071 para quirúrgico. Globalmente, el tratamiento quirúrgico fue superior (RR=0,65, p=0,04), y también lo fue en estudios occidentales (RR=0,57, p=0,02). Cuando se excluyeron los estudios que asignaron el tratamiento conservador a enfermos rechazados para cirugía, ambas estrategias terapéuticas fueron equivalentes, globalmente (RR=1,31, p=0,11) y en el medio occidental (RR=1,06, p=0,78), siendo el tratamiento conservador superior en estudios orientales (RR=2,00, p=0,03). El análisis de tendencias temporales mostró una progresiva superioridad del manejo conservador electivo, independientemente del medio considerado. Podemos concluir que, aunque el tratamiento de primera elección del HIM-A en nuestro medio es quirúrgico, determinados grupos de pacientes pueden beneficiarse de una estrategia conservadora como puente a una intervención quirúrgica diferida, e incluso como terapia definitiva.
Type A intramural hematoma (IMH-A) is a highly lethal entity where emergent surgical intervention is usually indicated. However, selected cases (clinical/hemodynamic stability, diameter<50mm, thickness<11mm) may have a better prognosis, and a conservative management as an alternative has been suggested in Asian studies. Thus, we sought to perform a meta-analysis study comparing the hospital mortality of conservative vs. surgical management of HIM-A as well as temporal and geographical trends. We searched studies in Medline® by keywords: “aortic intramural hematoma”. Comparative studies of both therapeutic alternatives that reported hospital mortality of IMH-A patients were included. The effect size, expressed as relative risk (RR), was assessed using the Mantel-Haenszel test using a fixed or random effects model according to the level of heterogeneity I2<or≥25%, respectively. Forty-six studies comprising 890 patients for conservative management and 1,071 for surgery were included. The surgical treatment was superior in the global series (RR=0.65, P=.04), as well as in western studies (RR=0.57, P=.02). When the studies that assigned conservative treatment to patients rejected for surgery were excluded, both therapeutic strategies were equivalent, globally (RR=1.31, P=.11) and in the western environment (RR=1.06, P=.78). Conversely, conservative treatment was superior in oriental studies (RR=2.00, P=.03). Temporal trends analysis showed a progressive superiority of elective conservative management regardless of its geographical origin. We can conclude that, although the surgical treatment of IMH-A is the first treatment choice in our environment, selected groups of patients can benefit from a conservative strategy as a bridge to a delayed surgical intervention or even as definitive therapy.
La gestión de las listas de espera de los diferentes sistemas de salud autonómicos para procedimientos de cirugía cardiaca constituye una importante preocupación entre los profesionales, de la que ...nuestra Sociedad científica no es ajena. En el año 2000 fue publicada la primera iniciativa de ordenación temporal de los pacientes con patología cardiovascular incluidos en lista de espera quirúrgica. Con los cambios en el manejo y en la concepción de algunas patologías, un nuevo marco normativo vigente y la coyuntura asistencial actual, se hace necesaria una revisión de los mencionados criterios para ofrecer una actualización adecuada al contexto clínico-asistencial presente. Por ello, se ha elaborado un documento basado en la revisión de la literatura científica disponible y en el consenso de un grupo de trabajo dentro de la Sociedad Española de Cirugía Cardiovascular y Endovascular, para actualizar en nuestro país las recomendaciones de prioridad de estas patologías en las listas de espera.
Waiting list management of cardiac surgical procedures is a main concern for all the Spanish autonomic health systems and for our scientific Society. The first statement for optimal timing of patients waiting for cardiac surgery was published in 2000. Since then, after significant changes in the management of some pathologies, new normative frameworks and the current healthcare situation, a review of the timing criteria to offer an adequate and updated standard of care is needed. In this document we aim to review the available literature in the field and stablish a consensus within a working group of the Spanish Society of Cardiovascular and Endovascular Surgery to optimize the priority recommendations in cardiac surgical waiting lists in our country.
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