Objectives: Rapid deployment Aortic valves have become an alternative for aortic valve stenosis treatment in recent years. Edwards Intuity was developed over Perimount Edwards Magna Ease design, with the addition of an infraannular ballon-expandable frame. So, we could hypothesize that outcomes should be similar between both protheses. Very few studies have compared these kinds of protheses. We communicate our experience with these prostheses.Methods: Retrospective observational study of 392 patients who receive aortic valve replacement in a single institution (175 Magna Ease, 117 Intuity). After adjustment through Propensity Score Matching (PSM), we obtained 65 couples of patients with equality in baseline characteristics.Results: Baseline values showed some differences between Intuity and Magna groups on terms of age (74.93 vs 73.21; p < 0.001), endocarditis (0 vs 8.1%; p < 0.001), diabetes (51 vs 30.3%; p < 0.001), Euroscore I (5.92 vs 6.82; p < 0.001), dyslipedemia (63.2% vs 47.3%; p < 0.005), previous cardiac surgery (0 vs 8.1%; p < 0.001) and combined cardiac procedure (12.8% vs 35.5%; p < 0.001). All baseline values were balanced after the employment of PSM. CBP (61.05± 17.18 vs 79.43± 21.78) and cross-clamp (42.38±11.44 vs 66.95± 17.05) times were lower in Intuity group (p < 0.001). There weren't differences in terms of morbi-mortality. Incidence of new onset left bundle branch block was higher in Intuity group (26.2% vs 7.7%; p < 0.001). Intuity prostheses showed an higher incidence of postoperative paravalvular leak (12.3% vs 6.2%; p = 0.022) and lower 2-year transvalvular mean gradients (8.47 ± 2.81 vs 16.50 ± 5.21; p < 0.001).Conclusions: Our findings suggest that Intuity implants are related with better hemodynamics and surgical times than Magna prostheses. These outcomes enhance our knowledge on aortic prothesis profiles. Further randomized investigations are needed to estimate real differences between prostheses.

IntroducciónLas prótesis aorticas de rápido despliegue aparecieron hace 10 años para tratar la estenosis aórtica. El sistema de válvula Edwards Intuity es una prótesis biológica basada en la válvula Edwards Magna con un marco infraanular. Presentamos los resultados clínicos y hemodinámicos a corto y largo plazo obtenidos con esta prótesis biológica.MétodosCiento diecisiete pacientes (65% varones, 75±4,5 años) con estenosis aórtica (gradiente medio preoperatorio de 49,6±12mmHg) recibieron una prótesis Edwards Intuity entre septiembre de 2012 y diciembre de 2019. Se incluyeron en una base de datos prospectiva que recogía diferentes variables. La media de seguimiento fue de 36±21meses.ResultadosMortalidad hospitalaria del 3,4%, supervivencia al año, a los 3 y 6 años del 95%, 90% y 81%, respectivamente. Se utilizó hemiesternotomía media superior en 78 pacientes (67%). La mediana de tiempos de isquemia miocárdica y de circulación extracorpórea de toda la serie fueron 40 (33-50) minutos y 59 (48-73) minutos. Gradientes medios al alta, al año y a los 2 años fueron 10±4mm, 9±3,5mm y 8,4±3,4mmHg. Ocho pacientes (7%) necesitaron marcapasos en el postoperatorio. Dos pacientes (0,6%) se reintervinieron en seguimiento por endocarditis y otro (0,3%) se reintervino por fuga periprotésica.ConclusiónEl sistema de válvula Edwards Intuity presenta buenos resultados clínicos y hemodinámicos a corto y largo plazo. Estas prótesis aórticas se pueden considerar una alternativa a las prótesis convencionales, sobre todo en cirugía de mínimo acceso y en intervenciones complejas.

Objective: Rapid deployment aortic valves appeared ten years ago to treat aortic stenosis. The Edwards Intuity Valve System is a biological prosthesis based on the Edwards Magna valve with an infra-annular framework. We present the short and intermediate-term clinical and hemodynamic results obtained with this biological prosthesis.Methods: One hundred twenty-two patients (63% male, 75 ± 4.5 years) with aortic stenosis (mean preoperative gradient of 49.4 ± 12.5 mm Hg) received an Edwards Intuity prosthesis between September 2012 and May 2020. They were included in a prospective database that collected different variables. The mean follow-up was 38 ± 23 months.Results: Hospital mortality was 3.3%. Survival at one, three, and seven years was 95%, 89%, and 84%, respectively. Upper hemisternotomy was used in 81 patients (66%). The median times of myocardial ischemia and extracorporeal circulation for the entire series were 39 (33-50) minutes and 58 (47-73) minutes. Average gradients at discharge, one year and two years were 10 ± 4 mm, 9 ± 3 mm, and 8.7 ± 4 mm Hg. Eight patients (7%) required pacemakers in the postoperative period. Two patients (0.52%) underwent surgery for endocarditis and another (0.26%) underwent surgery for a periprosthetic leak.Conclusions: The Edwards Intuity valve system presents good short- and intermediate-term clinical and hemodynamic results. These aortic prostheses can be considered an alternative to conventional prostheses, especially in minimal access surgery and complex interventions.

Objective: The Edwards Intuity valve is a rapid deployment biological aortic prosthesis. It is another option to treat aortic stenosis. It favors less aggressive approaches and shortens surgical times. Little is known about the hemodynamic and clinical behavior of their smaller sizes. We present our experience with Intuity prostheses Nos. 19 and 21.Methods: From September 2012 to May 2020, 122 Intuity prostheses were implanted, 54 (45%) were no. 19 or 21 (69% women, 76 (72-78) years).Results: One patient (1.8%) died in the hospital and six in the follow-up (3.4%). Mean pressure gradient at the discharge of 11.3 ± 4.3, at one year of 10.9 ± 3, and two years of 9.2 ± 3.5 mm Hg. Survival of 95% at 1 year and 83% at 5 years. Twenty-five patients (46%) had a prosthesis-patient mismatch, but with no impact on long-term survival (log-rank: 0.66). Three patients (6%) required a permanent pacemaker in the hospital. Patients with small Intuity prostheses did not present higher in-hospital mortality than patients with larger prostheses (1.8% vs 4.4%, p = 0.430) or higher mortality during follow-up (15% vs 10%; p = 0.430). Having a small prosthesis did not influence long-term survival (log-rank: 0.623).Conclusions: Edwards Intuity Aortic Prosthesis size 19-21 have shown excellent clinical and hemodynamic results with good medium-term survival. The patient prosthesis mismatch had no prognostic influence in this group. The Edwards Intuity aortic prosthesis is an option to consider in patients with a small aortic ring, especially if they are elderly.

Objective: Upper hemisternotomy in aortic valve surgery has been used for 20 years. Rapid deployment aortic prostheses facilitate the use of less invasive approaches and shorten surgical times. Our objective is to compare a series of patients who received the Edwards Intuity Rapid Deployment Aortic Prosthesis via hemisternotomy or full sternotomy.Methods: From September 2012 to December 2019, 109 patients with isolated severe aortic stenosis received the Edwards Intuity prosthesis (63% male, 75 ± 4.5 years).Results: Overall mortality was 2.8%, and 70% underwent surgery with upper hemisternotomy. This group had a greater baseline body surface area (1.86 ± 0.16 vs 1.8 ± 0.12; p = 0.048) and included more men (69% vs 48%; p = 0.042), but presented significantly shorter CPB time (58 ± 18 vs 68 ± 17 min; p = 0.006), less drainage in 24 h (315 ± 179 vs 468 ± 301; p = 0.001), lower rate of postoperative stroke (1.3 % vs 10%; p = 0.035), lower rate of packed red blood cell transfusions (45% vs 71%; p = 0.014), shorter stay in ICU (3 ± 8 vs 4 ± 7 days; p = 0.005) and hospital (10 ± 9 vs 14 ± 12 days; p = 0.001). There were no differences between the two groups in hospital mortality (2.6% vs 3.2%; p = 0.849), nor in the need for postoperative pacemaker (6.5% vs 6.5%; p = 0.994), nor in mortality at follow-up (12% vs 11.5%, p = 0.966).Conclusions: These results suggest that the benefits of upper mid hemisternotomy in aortic valve surgery exist even when using rapid deployment prostheses and would therefore be independent of the type of prosthesis implanted. Randomized studies are necessary to confirm these findings.

Introduction: Rapid deployment aortic valves appeared ten years ago to treat aortic stenosis. The Edwards Intuity Valve System is a biological prosthesis based on the Edwards Magna valve with an infra-annular framework. We present the short and long-term clinical and hemodynamic results obtained with this biological prosthesis. Methods: One hundred seventeen patients (65% male, 75 +/- 4.5 years) with aortic stenosis (mean preoperative gradient of 49.6 +/- 12 mm Hg) received an Edwards Intutiy prosthesis between September 2012 and December 2019. They were included in a prospective data base that collected different variables. The mean follow-up was 36 +/- 21 months. Results: Hospital mortality of 3.4%. Survival at one, three and six years of 95%, 90% and 81%, respectively. Upper hemisternotomy was used in 78 patients (67%). The median times of myocardial ischemia and extracorporeal circulation for the entire series were 40 (33-50) minutes and 59 (48-73) minutes. Average gradients at discharge, one year and two years were 10 +/- 4 mm, 9 +/- 3.5 mm and 8.4 +/- 3.4 mm Hg. Eight patients (7%) required pacemakers in the postoperative period. Two patients (0.6%) underwent surgery for endocarditis and another (0.3%) underwent surgery for periprosthetic leak. Conclusion: The Edwards Intutiy valve system presents good short and long term clinical and hemodynamic results. These aortic prostheses can be considered an alternative to conventional prostheses, especially in minimal access surgery and in complex interventions. (C) 2020 Sociedad Espanola de Cirugia Cardiovascular y Endovascular. Published by Elsevier Espana, S.L.U.

Objective: Patients with congenital heart disease (CHD) and valve dysfunction requiring surgery present a challenge for surgical treatment. Most of these patients have complex anatomy and have undergone previous cardiac procedures. Durability of bioprosthesis in any position has been reported to be suboptimal in this population. The INSPIRIS prosthesis (Edwards Lifesciences) with a new pericardial tissue (RESILIA) could improve hemodynamic performance and durability. It also has an expandable frame for future valve-in-valve procedures. Methods: This study reports our initial experience with The INSPIRIS valve in the aortic and pulmonary position in patients with CHD. Results: From June 2017 to October 2019, 44 patients (mean age of 44.3 ± 11 years, 70% male) with CHD received the INSPIRIS prosthesis (75% in aortic position and 25% in pulmonary position). One patient died (2.7%) on admission. Ten patients had previous surgeries (23%). All aortic patients had Bicuspid Aortic Valve. The majority of patients who had an INSPIRIS prosthesis implanted in the pulmonary position (82%) had pulmonary regurgitation after tetralogy of Fallot correction. The mean ischemia time was 62 ± 40 minutes and the mean CPB time was 88 ± 37 minutes. The median transprosthetic peak gradient at discharge was 20 (16-26) mm Hg. Conclusions: We report our series of patients with CHD having AVR and PVR with the new INSPIRIS valve. In-hospital and early outcomes are good with low morbidity and proper valve function for a median follow-up of 11±7 months. Longer follow-up is required to assess durability and feasibility of valve-in-valve procedures in this population. KEYWORD: e-PD-56 J. ARRIBAS declares a conflict of interest: Received speakers honorarium from Edwards Lifesciences.

Objective: Postoperative atrial fibrillation is the most frequent complication in cardiac surgery. Its cause is not determined and its presence increases the complications and the economic cost. Rapid deployment aortic prostheses are a novelty in cardiac surgery and they allow surgical times to be reduced. We conducted a study to determine the incidence and predictors of postoperative atrial fibrillation in aortic valve surgery with these prostheses. Methods: Patients operated on for aortic valvular surgery who were implanted with an Edwards Intuity rapid-deployment biological prosthesis were included. Logistic regression was performed to determine independent predictors of postoperative atrial fibrillation. Results: Seventy-two patients were included (68% males, average age of 75.6 ± 4.8 years, mean logistic average 7.7 ± 4.9). A total of 28 patients (38%) developed postoperative atrial fibrillation. The patients with postoperative fibrillation stayed more days in hospital (11.1 ± 6 vs. 9.9 ± 6.3) and had more episodes of postoperative stroke (7% vs 0%). Only a shorter duration of the preoperative PR interval was an independent predictor of postoperative atrial fibrillation, p = 0.044; 1.03 (95% CI 1.01 - 1.04). An ROC curve was performed with AUC of 0.67, p = 0.035; 95% CI 0.52 - 0.82 with best cut-off point ≤177 msg. Conclusions: Postoperative atrial fibrillation presents a high frequency (38%) in aortic valvular surgery with rapid deployment biological prosthesis. These patients have a higher risk of postoperative stroke and spend more time in hospital. A shorter preoperative PR interval was the only independent predictor of postoperative atrial fibrillation.

Background Aortic stenosis is currently the most frequently occurring valve pathology. Developments, such as transcatheter prostheses and rapid deployment prostheses, allow for the offer of a valve replacement to higher risk patients, but these techniques are linked with a higher need for a permanent pacemaker during the immediate postoperative period. Methods We studied the incidence and the factors associated with permanent pacemaker implantation after aortic valve replacement with Edwards Intuity rapid deployment prosthesis. Results Between October 2012 and December 2016, the Edwards Intuity prosthesis was implanted in 71 patients (68% male, 75.3 +/- 5 years old). Six patients (8%) required a permanent pacemaker during immediate postoperative period. Univariate analysis showed that a history of acute myocardial infarction (AMI) (P = .046, B = 7.5, 95% CI [1.039-54.1]) and preoperative amiodarone (P = .009, B = 31.5; 95% CI [2.32-426]) were associated with a higher need for a pacemaker during the postoperative period. Conclusions The incidence of permanent pacemaker implantation during the immediate postoperative period of aortic valve replacement with Edwards Intuity prosthesis was 8%, a value which is within the limits reported for conventional aortic prostheses. Preoperative amiodarone treatment and previous AMI may increase the need for a pacemaker during the postoperative period of these aortic prostheses.

Objective: Modern medicine restricts the transfusion of RBC concentrates. Valvular heart surgery is one of the first clients of blood banks. We performed an analysis to determine perioperative factors associated with the transfusion of autologous red blood cell concentrates in patients undergoing aortic valve replacement with Edwards Intuity prostheses. Methods: Patients undergoing aortic valve replacement who underwent an Edwards Intuity aortic prosthesis were studied. Logistic regression was performed to determine the independent factors associated with perioperative transfusion Results: Seventy-two patients (68% males, 75.6 ± 4.8 years) were included. Thirteen (18%) were urgent. Forty (55%) received red cell concentrates, with an average of 1.9 ± 2.2 concentrates per patient. The transfused patients had a greater logistic EuroScore (9.4 ± 5.8 vs 5.6 ± 2.2, p <0.001). In the multivariate analysis, variables associated with the transfusion of red cell concentrates were found: smaller size: p = 0.010 (1.13 95% CI: 1.03-1.25) and lower baseline hemoglobin: p = 0.001 (2.6; 95% CI: 1.5-4.5). Using ROC curves, the best cut-off point for transfusions of packed red blood cells in aortic valve surgery with Edwards Intuity prosthesis was determined: height below 164 cm and preoperative hemoglobin less than 12 g/dl. Conclusions: The transfusion rate of red blood cell concentrates in aortic valvular surgery even with rapid deployment prostheses was high (55%). The patients with the highest risk of transfusion of autologous red blood cell concentrates were those with a height of less than 164 cm and/or with a preoperative hemoglobin of less than 12 g/dl.

Objective: Aortic prostheses with rapid deployment have recently emerged with shorter surgical times and less invasive approaches for the treatment of aortic stenosis. The appearance of the treatme...

Objective: Aortic prostheses of rapid deployment have recently emerged for the treatment of aortic stenosis. They reduce surgical times and facilitate less invasive approaches. However, these prostheses seem to have a higher risk of permanent pacemaker implantation in the immediate postoperative period. We conducted a study to determine the incidence and predictors of pacemakers in patients with rapid deployment aortic prostheses. Methods: All patients who were implanted consecutively with an Edwards Intuity aortic prosthesis were recruited. Logistic regression was performed to determine the independent factors associated with the pacemaker implant in the postoperative period Results: Seventy-two patients (68% males, 75.6 ± 4.8 years) were included. Fourteen patients (20%) had preoperative conduction disturbances (10 RBBB and 4 LBBB). Six patients (8%) had a pacemaker implanted in the postoperative period. In the multivariate analysis, the only independent variable associated with a pacemaker implant in the postoperative period was preoperative amiodarone treatment, p = 0.0005; 52 (95% CI 3-1000), whereas the presence of a preoperative myocardial infarction showed a tendency to significance: p = 0.067; 13.5 (95% CI 0.83-200). The preoperative alterations in conduction did not achieve significance. Conclusions: In our series, the rate of definitive pacemakers following the implantation of rapid deployment biological aortic prosthesis Edwards Intuity is at the high limit of that described in the literature for conventional aortic prostheses (8%). Preoperative treatment with amiodarone was the only independent factor associated with the need for a pacemaker in the postoperative period.

HomeCirculation: Cardiovascular InterventionsVol. 11, No. 12Bleeding Risk Prediction in Patients With Dual Antiplatelet Therapy Undergoing Coronary Artery Bypass Grafting Surgery Using a Rapid Point-of-Care Platelet Function Test Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBBleeding Risk Prediction in Patients With Dual Antiplatelet Therapy Undergoing Coronary Artery Bypass Grafting Surgery Using a Rapid Point-of-Care Platelet Function Test Antonio Tello-Montoliu, MD, PhD, Paula Albaladejo, MD, Diana Hernández-Romero, PhD, Ruben Taboada, MD, Carlos L. Albacete, MD, José María Arribas, MD, PhD, Ruben Jara, MD, PhD, Andrea Veliz, RN, Cecilia López-García, RN, PhD, Sergio Cánovas, MD, PhD, Mariano Valdés, MD, PhD, José Miguel Rivera-Caravaca, RN, PhD and Francisco Marín, MD, PhD Antonio Tello-MontoliuAntonio Tello-Montoliu Antonio Tello-Montoliu, MD, PhD, Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena s/n, 30120, El Palmar, Murcia, Spain. Email E-mail Address: [email protected] Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain (A.T.-M., D.H.-R., A.V., C.L.-G., M.V., J.M.R.-C., F.M.). , Paula AlbaladejoPaula Albaladejo Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (P.A., R.T., J.M.A., A.V., S.C.). , Diana Hernández-RomeroDiana Hernández-Romero Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain (A.T.-M., D.H.-R., A.V., C.L.-G., M.V., J.M.R.-C., F.M.). , Ruben TaboadaRuben Taboada Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (P.A., R.T., J.M.A., A.V., S.C.). , Carlos L. AlbaceteCarlos L. Albacete , José María ArribasJosé María Arribas Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (P.A., R.T., J.M.A., A.V., S.C.). , Ruben JaraRuben Jara Intensive Care Unit, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain (C.L.A., R.J.). , Andrea VelizAndrea Veliz Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain (A.T.-M., D.H.-R., A.V., C.L.-G., M.V., J.M.R.-C., F.M.). Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (P.A., R.T., J.M.A., A.V., S.C.). , Cecilia López-GarcíaCecilia López-García Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain (A.T.-M., D.H.-R., A.V., C.L.-G., M.V., J.M.R.-C., F.M.). Intensive Care Unit, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain (C.L.A., R.J.). , Sergio CánovasSergio Cánovas Department of Cardiovascular Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, Murcia, Spain (P.A., R.T., J.M.A., A.V., S.C.). , Mariano ValdésMariano Valdés Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain (A.T.-M., D.H.-R., A.V., C.L.-G., M.V., J.M.R.-C., F.M.). , José Miguel Rivera-CaravacaJosé Miguel Rivera-Caravaca Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain (A.T.-M., D.H.-R., A.V., C.L.-G., M.V., J.M.R.-C., F.M.). and Francisco MarínFrancisco Marín Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain (A.T.-M., D.H.-R., A.V., C.L.-G., M.V., J.M.R.-C., F.M.). Originally published11 Dec 2018https://doi.org/10.1161/CIRCINTERVENTIONS.118.007264Circulation: Cardiovascular Interventions. 2018;11:e007264The proportion of acute coronary syndrome patients receiving dual antiplatelet therapy undergoing coronary artery bypass grafting (CABG) surgery is not negligible. The Society of Thoracic Surgeons suggests that for patients on dual antiplatelet therapy, it is reasonable to make decisions about surgical timing based on platelet inhibition tests, rather than applying a prespecified period of surgical delay.1 However, a validated cutoff of platelet reactivity predicting bleeding is still under debate. The aim of this study was to investigate the predictive ability for bleeding risk of a rapid point-of-care platelet function testing in acute coronary syndrome patients on dual antiplatelet therapy undergoing CABG surgery.This is a prospective, observational study in which acute coronary syndrome patients accepted for CABG surgery under dual antiplatelet therapy with aspirin and a P2Y12 receptor inhibitor were recruited. Patients undergoing CABG in addition to other cardiac surgery were not eligible. This study was performed using one fasting blood sample obtained between 8:00 and 9:00 am in the morning of the CABG surgery, independently of the number of days that the P2Y12 receptor inhibitor was interrupted before the surgery. Platelet function testing was performed by VerifyNow P2Y12 assay, and results were reported as P2Y12 reaction units (PRU). The primary end point was the occurrence of major bleeding defined as any of the following (1) reoperation after closure of sternotomy for controlling bleeding; (2) transfusion of ≥5 units of packed red bloods cells or ≥2 units of packed platelet concentrate within a 48-hour period; (3) hemoglobin drop ≥5 g/dL; or (4) chest tube output ≥1000 mL within a 24-hour period. An arbitrary sample size was selected after the last evidence published with the same point-of-care assay.2,3 The study complied with the Declaration of Helsinki and was approved by the Ethics Committee of our Institution. All subjects gave informed consent.From January 2015 to March 2017, 118 acute coronary syndrome patients were available for the analysis. Most patients were males (102, 86.4%), with a mean age of 63.2±10.6 years, and all received aspirin (100–150 mg daily). Clopidogrel was the perioperative treatment in 99 (83.9%) patients and ticagrelor in 19 (16.1%) patients. No patient was on prasugrel therapy. These antiplatelets were discontinued before surgery a median of 5 (interquartile range, 4–8) days. Mean platelet reactivity as assessed with VerifyNow P2Y12 was PRU 239.2±58.1. Major bleeding was reported in 17 (14.4%) patients. There were no differences in P2Y12 receptor inhibitors discontinuation days between patients who suffered major bleeding and patients who did not (6 [interquartile range, 4–10.5] days versus 5 [interquartile range, 4–8] days; P=0.824; Figure [A]). However, lower platelet reactivity was found in patients presenting with major bleeding (no major bleeding: PRU 245.8±52.4 versus major bleeding: PRU 197.1±75; P=0.002; Figure [B]).Download figureDownload PowerPointFigure. Relation of discontinuation days, P2Y12 reaction units, and clinical/laboratory parameters with major bleeding events.A, Major bleeding events according to discontinuation days. B, Major bleeding events according to P2Y12 reaction units (PRU). C, Clinical and laboratory parameters associated with major bleeding events by logistic regression analysis. VN-PRU indicates VerifyNow P2Y12 reaction units.Decreasing values of PRU were associated with a higher risk of major bleeding (C index: 0.707 [95% CI, 0.617–0.787], P=0.003), and the cutoff point showing the best results was PRU <204 (sensitivity of 58.8%, specificity of 79.2%, positive predictive value of 32.3%, and negative predictive value of 92.0%). In fact, a higher proportion of patients with PRU <204 suffered a major bleeding (58.8% versus 41.2%, P=0.001). The risk of suffering major bleeding in patients presenting with PRU <204 was 5-fold higher (odds ratio, 5.44; 95% CI, 1.85–16.01; P=0.002). Additionally, logistic regression analyses were performed to investigate the association of other clinical and laboratory parameters with the risk of major bleeding (Figure [C]).Although the discontinuation interval has been verified using data from clinical trials, there is no dedicated study designed to explore safer discontinuation interval. Despite that the median interval was the recommended in this study, no differences in discontinuation days were found in the occurrence of major bleeding events. CABG-based observational studies reported an association of impaired response to clopidogrel with lower bleeding events, decrease in hemoglobin levels, and more blood-product transfusions.2–4 These evidences have leaded the Society of Thoracic Surgeons guidelines to recommend the use of platelet function tests in this setting.1 Nevertheless, there are some questions to solve before spread their use in clinical practice. First, there are many platelet function assay devices available, but there is no clear recommendation for using a specified one.4,5 Second, there is still a search for the correct cutoff point for addressing when is safer to undergo the intervention.5 In the present investigation, the VerifyNow P2Y12 assay has been used not only for the really easy and quick management but also for its simple interpretation. The use of cutoff points in daily practice could be clinically relevant. A PRU >204 might allow clinicians to rule-out those patients who are not at high risk of bleeding and, therefore, it is safer to perform the surgery. The main limitation of the present study is the small sample size. Thus, further studies with higher sample size are warranted for clarifying the usefulness of platelet function tests as practical tools in the decision-making process for CABG surgery indication.Sources of FundingThis study was supported by a Clinical Research Grant from Sociedad Española de Cardiología.DisclosuresNone.Footnotes*Drs Tello-Montoliu and Albaladejo contributed equally to this work.Antonio Tello-Montoliu, MD, PhD, Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, Ctra. Madrid-Cartagena s/n, 30120, El Palmar, Murcia, Spain. Email [email protected]comReferences1. Ferraris VA, Saha SP, Oestreich JH, Song HK, Rosengart T, Reece TB, Mazer CD, Bridges CR, Despotis GJ, Jointer K, Clough ER; Society of Thoracic Surgeons. 2012 update to the Society of Thoracic Surgeons guideline on use of antiplatelet drugs in patients having cardiac and noncardiac operations.Ann Thorac Surg. 2012; 94:1761–1781. doi: 10.1016/j.athoracsur.2012.07.086CrossrefMedlineGoogle Scholar2. Rosengart TK, Romeiser JL, White LJ, Fratello A, Fallon E, Senzel L, Shroyer AL. Platelet activity measured by a rapid turnaround assay identifies coronary artery bypass grafting patients at increased risk for bleeding and transfusion complications after clopidogrel administration.J Thorac Cardiovasc Surg. 2013; 146:1259–1266, 1266.e1; discussion 1266. doi: 10.1016/j.jtcvs.2013.06.029CrossrefMedlineGoogle Scholar3. Reed GW, Kumar A, Guo J, Aranki S, Shekar P, Agnihotri A, Maree AO, McLean DS, Rosenfield K, Cannon CP. Point-of-care platelet function testing predicts bleeding in patients exposed to clopidogrel undergoing coronary artery bypass grafting: verify pre-op TIMI 45–a pilot study.Clin Cardiol. 2015; 38:92–98. doi: 10.1002/clc.22357CrossrefMedlineGoogle Scholar4. Kwak YL, Kim JC, Choi YS, Yoo KJ, Song Y, Shim JK. Clopidogrel responsiveness regardless of the discontinuation date predicts increased blood loss and transfusion requirement after off-pump coronary artery bypass graft surgery.J Am Coll Cardiol. 2010; 56:1994–2002. doi: 10.1016/j.jacc.2010.03.108CrossrefMedlineGoogle Scholar5. Malm CJ, Hansson EC, Åkesson J, Andersson M, Hesse C, Shams Hakimi C, Jeppsson A. Preoperative platelet function predicts perioperative bleeding complications in ticagrelor-treated cardiac surgery patients: a prospective observational study.Br J Anaesth. 2016; 117:309–315. doi: 10.1093/bja/aew189CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Williams B, Henderson R, Reformato V, Pham T, Taylor B and Tanaka K (2020) Hemostasis Management of Patients Undergoing Emergency Cardiac Surgery After Ticagrelor Loading, Journal of Cardiothoracic and Vascular Anesthesia, 10.1053/j.jvca.2019.06.028, 34:1, (168-174), Online publication date: 1-Jan-2020. Bonanad C, Esteve-Claramunt F, García-Blas S, Ayesta A, Díez-Villanueva P, Pérez-Rivera J, Ferreiro J, Cánoves J, López-Fornás F, Ariza Solé A, Raposerias S, Vivas D, Blanco R, Bompart Berroterán D, Cordero A, Núñez J, Fácila L, Núñez-Gil I, Górriz J, Bodí V, Martínez-Selles M, Ruiz Nodar J and Chorro F (2022) Antithrombotic Therapy in Elderly Patients with Acute Coronary Syndromes, Journal of Clinical Medicine, 10.3390/jcm11113008, 11:11, (3008) December 2018Vol 11, Issue 12 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/CIRCINTERVENTIONS.118.007264PMID: 30525983 Originally publishedDecember 11, 2018 Keywordsacute coronary syndromeplatelet aggregation inhibitorsaspirinplatelet function testscoronary artery bypassPDF download Advertisement SubjectsCardiovascular SurgeryPharmacologyRevascularization

ObjetivoDisponemos de una nueva clase de prótesis aórticas de despliegue rápido para tratamiento quirúrgico de la estenosis aórtica. Permitirían disminuir los tiempos quirúrgicos y facilitarían la cirugía mínimamente invasiva. Presentamos nuestra experiencia inicial con la válvula Edwards Intuity en el contexto del estudio multicéntrico Foundation.Pacientes y métodosEntre septiembre de 2012 y febrero de 2014 se implantaron 25 prótesis aórticas Edwards Intuity en 26 pacientes (77±4,3años; 52% varones). Veinticuatro (96%) fueron reemplazo valvular aislado, y 9 pacientes (36%) tuvieron abordaje mínimamente invasivo. Los pacientes fueron estudiados al alta, a los 3meses y al año de la intervención.ResultadosHubo éxito en el implante en el 96,2% de los pacientes (25/26). No hubo mortalidad hospitalaria. Seguimiento medio de 11±5,4meses, supervivencia acumulada del 96%. Un paciente falleció a los 11meses por un ictus isquémico. El tiempo medio de pinzamiento aórtico fue de 38,2±10,1min y el tiempo medio de circulación extracorpórea, de 62,4±11,1min. A los 3meses, el área valvular efectiva media fue de 1,70±0,42cm2. El 91% de los pacientes (23/25) estaban en grado funcionali en el seguimiento.ConclusionesEl implante de la válvula Edwards Intuity para el tratamiento de la estenosis aórtica ha sido factible, seguro y eficaz. Los tiempos de isquemia miocárdica y de circulación extracorpórea parecen reducirse en comparación con la cirugía valvular aórtica habitual. El comportamiento hemodinámico inicial de la prótesis Edwards Intuity es excelente.

Chyloperitoneum is a rare but life-threatening complication with no uniformity concerning the treatment. We present a 77-year-old male with chylous ascites after open abdominal aneurysmectomy refractory to conservative and surgical strategies. After failure of re-exploration with periaortic lymphatic cauterization and drainage, he was treated with five cycles of retroperitoneal radiotherapy. At 12 months of follow-up, the patient remains asymptomatic without any objective evidence of chyloperitoneum relapse. Periaortic radiotherapy may be a feasible alternative in the management of the chylous ascites following abdominal aortic aneurysm surgery.