OBJECTIVES:We report three-year safety and clinical outcomes in patients younger than 60 years undergoing bioprosthetic surgical aortic valve intervention. METHODS:The INSPIRIS RESILIA Durability Registry (INDURE) is a prospective, multicentre registry to assess clinical outcomes of patients under 60 years. Patients with planned surgical aortic valve replacement with or without concomitant replacement of the ascending aorta and/or coronary bypass surgery were included. Time-related valve safety, haemodynamic performance, and quality-of-life (QoL) at three years were assessed. RESULTS:The study cohort included 415 patients with a mean age of 53.5 years, 76.9% being male and 27.1% in New York Health Association (NYHA) class III/IV. Outcomes after three years included cardiovascular-related mortality (0.4%), thromboembolic events (0.6%), valve-related bleeding (0.0%) and new permanent pacemaker implantation (0.4%). QoL increased over the time course of the study from baseline to three-year follow-up. Three-year freedom from all-cause mortality was 95.4% (95% CI 93.3-97.6), and 84.5% were NYHA I versus 22.0% at baseline. No patient developed haemodynamic valve deterioration stage 3. The mean aortic pressure gradient was 13.7 mmHg at three years, and the mean effective orifice area was 1.8 cm. CONCLUSIONS:The three-year data from the INSPIRIS RESILIA valve demonstrate reassuring safety findings and stable haemodynamic performance as well as a high QoL.

Limited information is available regarding the impact of valve choice for patients with aortic stenosis (AS) undergoing surgical aortic valve replacement (SAVR) in Spain. Herein, we aimed to explore the potential cost-effectiveness of a new bioprosthetic valve with RESILIA tissue versus mechanical alternatives from a Spanish healthcare perspective. Health outcomes, including quality-adjusted life years (QALYs), adverse events, and costs were estimated for two cohorts of patients with severe AS (aged ≥ 65 or 55–64 years) over a lifetime horizon employing a UK cost-effectiveness model adapted to Spanish clinical practice to compare a novel bioprosthesis versus mechanical alternatives. This model included a decision tree to describe short-term outcomes and a partitioned survival model to evaluate mortality and long-term outcomes. A panel of clinical experts validated the model methodology, including parameters and assumptions considered. Sensitivity analyses were performed to account for uncertainty. The novel bioprosthetic valve led to cost savings for both cohorts (€6209/patient for age ≥ 65 years; €8289/patient for ages 55–64 years). These were mainly driven by a reduction in anticoagulation- and adverse event-associated resources, outweighing the costs derived from more reoperations estimated with the novel bioprosthetic valve. An observable increase in QALYs was detected in both age groups (0.0051 and 0.0191, respectively). Hence, the novel bioprosthetic valve is expected to be a dominant alternative for patients 55 years or older who are eligible for SAVR. It remained cost-effective in > 98

OBJECTIVES:This study investigated the gnder-based difference in three-year clinical outcomes, left ventricular (LV) regression, and quality-of-life (QoL) following surgical aortic valve replacement (SAVR) by propensity score matching (PSM). METHODS:A prospective multicentre study on combined data from two prospective registries, INDURE and IMPACT, resulted in 993 patients (735 males and 258 females). PSM yielded 689 patients: 442 males and 247 females undergoing first-time SAVR using Edwards INSPIRIS RESILIA. RESULTS:In the PSM cohort, females had lower body mass index (median 27.9 vs 28.6 kg/m2; P = 0.004), higher European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (2.4 ± 3.0 % vs 1.8 ± 1.9 %; P < 0.001), Society of Thoracic Surgeons (STS) score (1.8 ± 1.7 % vs 1.3 ± 2.0 %; P < 0.001) and were most often in New York Heart Association class III/IV (45.7 % vs 37.6 %; P < 0.021), angina CCS class III/IV (6.1 % vs 2.9 %; P < 0.001) than males. Post-SAVR clinical outcomes up to three years were similar between both genders. Significant differences existed for LV regression after surgery between genders at up to three years (P < 0.001) with better haemodynamic performance. Hypertension slowed the LV mass regression, mildly affecting LV restoration in females for up to three years. In both genders, New York Heart Association status was restored within one year (P < 0.001) and maintained for up to three years (P < 0.001). At three years, QoL significantly improved. CONCLUSIONS:Despite females presenting with a significantly higher surgical risk profile, three-year outcomes following SAVR were comparable between genders with significant improvement in functional status. However, the degree of QoL improvement differed between genders. CLINICAL TRIAL REGISTRATION NUMBER:ClinicalTrials.gov NCT04053088/-NCT03666741.

Heart transplantation from donors after the circulatory determination of death is expanding worldwide. Thoraco-abdominal normothermic regional perfusion (TA-NRP) allows the validation and recovery of the donation after the circulatory determination of death (DCDD) heart, but there is limited evidence on the results of heart transplants performed with this approach. This multicenter, nationwide, prospective study describes the short-term outcomes of adult patients receiving a DCDD heart transplant obtained via TA-NRP followed by static cold storage in Spain. Recipients of hearts from donors after the neurologic determination of death were used as controls. The primary outcome was a composite of 1-year all-cause death or severe primary graft failure. During 2020-2023, 98 adult DCDD and 347 donations after the neurologic determination of death (DNDD) heart transplants were performed across 11 centers. The primary outcome was met by 21 (21.4%) and 77 (22.2%) patients, respectively (P = .87). Thirty-day and 1-year survival were 94.9% and 88.8% in the DCDD vs 93.7% and 87.3% in the DNDD group (P = .70), respectively. Severe primary graft failure was observed in 13 (13.3%) vs 52 (15.0%) patients (P = .67). By inverse probability weighting, the DCDD heart was not associated with the primary outcome (hazard ratio, 0.97; 95% confidence interval, 0.58-1.62; P = .91). In conclusion, adult DCDD heart transplantation based on TA-NRP and static cold storage provides similar short-term outcomes than DNDD heart transplants.

Background: Postoperative atrial fibrillation (POAF) is common after cardiac surgery and related to endothelial activation and systemic inflammation. Herein, we investigate the pathophysiological mechanisms of AF through endothelial activation and cell-cell interactions related to the development of POAF. Methods: Patients without previous AF undergoing cardiac surgery were studied. Permanent AF patients were included as positive controls. Interleukin (IL)-6, Von Willebrand factor (vWF), N-terminal pro-brain natriuretic peptide (NT-proBNP), and high sensitivity troponin T (hsTnT) were evaluated by electrochemiluminescence. Vascular cell adhesion molecule-1 (VCAM-1) and human Growth Differentiation Factor 15 (GDF-15) were assessed by ELISA. Connexins (Cxs) 40 and 43 were measured by tissue immunolabelling, and apoptosis by TUNEL assay. Results: We included 117 patients (median age 67: 27.8% female): 17 with permanent AF; 27 with POAF, and 73 with non-AF. Patients with permanent AF and POAF had higher levels of NT-proBNP, hs-TnT, apoptotic nuclei, and decreased Cx43 expression, compared to non-AF patients (all p-value <0.05). VCAM-1 and GDF-15 were significantly higher in permanent AF vs. non-AF (p = 0.013 and p = 0.035). Conclusions: Greater endothelial activation and inflammation in AF patients compared to those without AF were found. The proinflammatory state in AF patients, in addition to the lower expression of Cx43, seems to be associated with atrial remodeling processes occurring in AF.

ABSTRACT Background Cardiac surgery-associated acute kidney injury (CSA-AKI) is a serious complication in patients undergoing cardiac surgery with extracorporeal circulation (ECC) that increases postoperative complications and mortality. CSA-AKI develops due to a combination of patient- and surgery-related risk factors that enhance renal ischemia–reperfusion injury. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) such as empagliflozin reduce renal glucose reabsorption, improving tubulo-glomerular feedback, reducing inflammation and decreasing intraglomerular pressure. Preclinical studies have observed that SGLT2i may provide significant protection against renal ischemia–reperfusion injury due to their effects on inadequate mitochondrial function, reactive oxygen species activity or renal peritubular capillary congestion, all hallmarks of CSA-AKI. The VERTIGO (EValuating the Effect of periopeRaTIve empaGliflOzin) trial is a Phase 3, investigator-initiated, randomized, double-blind, placebo-controlled, multicenter study that aims to explore whether empagliflozin can reduce the incidence of adverse renal outcomes in cardiac surgery patients. Methods The VERTIGO study (EudraCT: 2021-004938-11) will enroll 608 patients that require elective cardiac surgery with ECC. Patients will be randomly assigned in a 1:1 ratio to receive either empagliflozin 10 mg orally daily or placebo. Study treatment will start 5 days before surgery and will continue during the first 7 days postoperatively. All participants will receive standard care according to local practice guidelines. The primary endpoint of the study will be the proportion of patients that develop major adverse kidney events during the first 90 days after surgery, defined as ≥25% renal function decline, renal replacement therapy initiation or death. Secondary, tertiary and safety endpoints will include rates of AKI during index hospitalization, postoperative complications and observed adverse events. Conclusions The VERTIGO trial will describe the efficacy and safety of empagliflozin in preventing CSA-AKI. Patient recruitment is expected to start in May 2024.

OBJECTIVES We investigated the sex-related difference in characteristics and 2-year outcomes after surgical aortic valve replacement (SAVR) by propensity-score matching (PSM). METHODS Data from 2 prospective registries, the INSPIRIS RESILIA Durability Registry (INDURE) and IMPACT, were merged, resulting in a total of 933 patients: 735 males and 253 females undergoing first-time SAVR. The PSM was performed to assess the impact of sex on the SAVR outcomes, yielding 433 males and 243 females with comparable baseline characteristics. RESULTS Females had a lower body mass index (median 27.1 vs 28.0 kg/m2; P = 0.008), fewer bicuspid valves (52% vs 59%; P = 0.036), higher EuroSCORE II (mean 2.3 vs 1.8%; P < 0.001) and Society of Thoracic Surgeons score (mean 1.6 vs 0.9%; P < 0.001), were more often in New York Heart Association functional class III/IV (47% vs 30%; P < 0.001) and angina Canadian Cardiovascular Society III/IV (8.2% vs 4.4%; P < 0.001), but had a lower rate of myocardial infarction (1.9% vs 5.2%; P = 0.028) compared to males. These differences vanished after PSM, except for the EuroSCORE II and Society of Thoracic Surgeons scores, which were still significantly higher in females. Furthermore, females required smaller valves (median diameter 23.0 vs 25.0 mm, P < 0.001). There were no differences in the length of hospital stay (median 8 days) or intensive care unit stay (median 24 vs 25 hours) between the 2 sexes. At 2 years, post-SAVR outcomes were comparable between males and females, even after PSM. CONCLUSIONS Despite females presenting with a significantly higher surgical risk profile, 2-year outcomes following SAVR were comparable between males and females.

Coronary artery bypass grafting (CABG) has shown an undeniable clinical benefit in patients with mul-tivessel and/or left main coronary artery disease. Nevertheless, the less invasive nature of percutaneous coronary intervention (PCI) has led many patients and cardiologists to consider this revascularization modality as a more attractive treatment.Minimally invasive CABG, with or without thoracoscopic or robotic assistance, arose as an alterna-tive surgical revascularization with the aim of offering a less invasive procedure while maintaining the prognostic clinical benefit over PCI.In this review, we describe the different existing techniques in minimally invasive CABG, indications and patient selection, as well as short and long-term outcomes.& COPY; 2022 Published by Elsevier Espan & SIM;a, S.L.U. on behalf of Sociedad Espan & SIM;ola de Cirugi & PRIME;a Cardiovascular y Endovascular. This is an open access article under the CC BY-NC-ND license (http://creativecommons. org/licenses/by-nc-nd/4.0/).

OBJECTIVES: We report 1-year safety and clinical outcomes in patients <60 years undergoing bioprosthetic surgical aortic valve intervention.METHODS: The INSPIRIS RESILIA Durability Registry is a prospective, multicentre registry to assess clinical outcomes of patients <60 years. Patients with planned SAVR with or without concomitant replacement of the ascending aorta and/or coronary bypass surgery were included. Time-related valve safety, haemodynamic performance and quality of life (QoL) at 1 year were assessed.RESULTS: A total of 421 patients were documented with a mean age of 53.5 years, 76.5% being male and 27.2% in NYHA class III/IV. Outcomes within 30 days included cardiovascular-related mortality (0.7%), time-related valve safety (VARC-2; 5.8%), thromboembolic events (1.7%), valve-related life-threatening bleeding (VARC-2; 4.3%) and permanent pacemaker implantation (3.8%). QoL was significantly increased at 6 months and sustained at 1 year. Freedom from all-cause mortality at 1 year was 98.3% (95% confidence interval 97.1; 99.6) and 81.8% were NYHA I versus 21.9% at baseline. No patient developed structural valve deterioration stage 3 (VARC-3). The mean aortic pressure gradient was 12.6 mmHg at 1 year and the effective orifice area was 1.9 cm2.CONCLUSIONS: The 1-year data from the INSPIRIS RESILIA valve demonstrate good safety and excellent haemodynamic performance as well as an early QoL improvement.

Obstructive sleep apnea (OSA) promotes atrial remodeling and fibrosis, providing a substrate for atrial fibrillation (AF). Herein, we investigate the pathophysiological mechanisms of AF in association with OSA in a cohort of cardiac surgery patients. A prospective study including patients undergoing cardiac surgery. Biomarkers reflective of AF pathophysiology (interleukin [IL-6], C-reactive protein [CRP], von Willebrand factor [vWF], N-terminal pro-brain natriuretic peptide [NT-proBNP], high-sensitivity Troponin T [hs-TnT], and Galectin-3 [Gal-3]) was assessed by functional or immunological assays. miRNAs involved in AF were analyzed by reverse transcription-polymerase chain reaction (RT-PCR). Using atrial tissue samples, fibrosis was assessed by Masson's trichrome. Connexin 40 and 43 (Cx40; Cx43) were evaluated by immunolabeling. Fifty-six patients (15 with OSA and 41 non-OSA) were included in this hypothesis-generating pilot study. OSA group had a higher incidence of postoperative AF (POAF) (46.7% vs. 19.5%; p = .042), presented an increased risk of POAF (OR 3.61, 95% CI 1.01-12.92), and had significantly higher baseline levels of NT-proBNP (p = .044), vWF (p = .049), Gal-3 (p = .009), IL-6 (p = .002), and CRP (p = .003). This group presented lower levels of miR-21 and miR-208 (both p < .05). Also, lower Cx40 levels in POAF and/or OSA patients (50.0% vs. 81.8%, p = .033) were found. The presence of interstitial fibrosis (according to myocardial collagen by Masson's trichrome) was raised in OSA patients (86.7% vs. 53.7%, p = .024). Several biomarkers and miRNAs involved in inflammation and fibrosis were dysregulated in OSA patients, which together with a higher degree of interstitial fibrosis, altered miRNA, and Cxs expression predisposes to the development of a substrate that increases the AF risk.

El recambio valvular aórtico (RVAo) quirúrgico puede modificar la historia natural de la estenosis aórtica grave (EAoG). Sin embargo, comparado con la población general, estos pacientes tienen una pérdida en su esperanza de vida. La esperanza de vida de los pacientes intervenidos de RVAo debido a EAoG de bajo gradiente con fracción de eyección del ventrículo izquierdo (FEVI) conservada se desconoce. Se incluyó a todos los pacientes entre 50 y 65 años sometidos a RVAo quirúrgico aislado en 27 centros durante 18 años. Analizamos la supervivencia observada y esperada a los 18 años de pacientes con EAoG de bajo gradiente con FEVI conservada y todos los otros tipos de EAoG. Mediante emparejamiento basado en índice de propensión, comparamos la esperanza de vida de los pacientes con EAoG de bajo gradiente con FEVI conservada vs EAoG de alto gradiente con FEVI conservada. Se analizó a 5.084 pacientes, 413 con EAoG de bajo gradiente con FEVI conservada. En estos pacientes, la supervivencia observada a 10, 15 y 18 años fue 86,6% (IC95%, 85,3-87,8), 75% (IC95%, 72,7-77,2) y 63,5% (IC95%, 58,8-67,8). La supervivencia esperada a 10, 15 y 18 años fue 90,2%, 82,1% y 75,7%. En la muestra emparejada, la supervivencia de los pacientes con EAoG de bajo gradiente con FEVI conservada fue similar a la de aquellos con EAoG de alto gradiente con FEVI conservada, test de log-rank p = 0,95, HR = 1 (IC95%, 0,7–1,4; p = 0,95). Existe una pérdida en la esperanza de vida en todos los tipos de EAoG después del RVAo. Esta pérdida es mayor en los pacientes con disfunción ventricular y menor en los pacientes con EAoG de bajo gradiente o alto gradiente con FEVI conservada. El beneficio de la cirugía es similar entre estos 2 últimos grupos. Surgical aortic valve replacement (SAVR) can modify the natural history of severe aortic stenosis (SAS). However, compared with the general population, these patients have a loss of life expectancy. The life expectancy of patients who undergo SAVR due to low-gradient SAS with preserved left ventricular ejection fraction (LVEF) is unknown. We included all patients between 50 and 65 years who underwent isolated SAVR in 27 Spanish centers during an 18-year period. We analyzed observed and expected survival at 18 years in patients with low-gradient SAS with preserved LVEF and all other types of SAS. We used propensity score matching to compare the life expectancy of patients with low-gradient SAS with preserved LVEF vs those with high-gradient SAS with preserved LVEF. We analyzed 5084 patients, of whom 413 had low-gradient SAS with preserved LVEF. For these patients, observed survival at 10, 15 and 18 years was 86.6% (95%CI, 85.3-87.8), 75% (95%CI, 72.7-77.2), and 63.5% (95%CI, 58.8-67.8). Expected survival at 10, 15 and 18 years was 90.2%, 82.1%, and 75.7%. In the matched sample, survival of patients with low-gradient SAS with preserved LVEF was similar to that of patients with high-gradient with preserved LVEF, log-rank test, P = .95; HR = 1 (95%CI, 0.7–1.4; P = .95). There is a loss of life expectancy in patients with all types of SAS undergoing SAVR. This loss is higher in patients with left ventricular dysfunction and lower in patients with low-gradient or high-gradient aortic stenosis with preserved LVEF. The benefit of surgery is similar between these last 2 groups.

La cirugía de revascularización miocárdica (CRM) ha demostrado un beneficio clínico incuestionable en pacientes con enfermedad coronaria con afectación multivaso y/o del tronco coronario. No obstante, el carácter menos invasivo del intervencionismo coronario percutáneo (ICP) ha provocado que este sea considerado como una opción de revascularización más atractiva para el cardiólogo y para muchos pacientes.

Introduction and objectives: Surgical aortic valve replacement (SAVR) can modify the natural history of severe aortic stenosis (SAS). However, compared with the general population, these patients have a loss of life expectancy. The life expectancy of patients who undergo SAVR due to low-gradient SAS with preserved left ventricular ejection fraction (LVEF) is unknown.Methods: We included all patients between 50 and 65 years who underwent isolated SAVR in 27 Spanish centers during an 18-year period. We analyzed observed and expected survival at 18 years in patients with low-gradient SAS with preserved LVEF and all other types of SAS. We used propensity score matching to compare the life expectancy of patients with low-gradient SAS with preserved LVEF vs those with high-gradient SAS with preserved LVEF.Results: We analyzed 5084 patients, of whom 413 had low-gradient SAS with preserved LVEF. For these patients, observed survival at 10, 15 and 18 years was 86.6% (95%CI, 85.3-87.8), 75% (95%CI, 72.7-77.2), and 63.5% (95%CI, 58.8-67.8). Expected survival at 10, 15 and 18 years was 90.2%, 82.1%, and 75.7%. In the matched sample, survival of patients with low-gradient SAS with preserved LVEF was similar to that of patients with high-gradient with preserved LVEF, log-rank test, P = .95; HR = 1 (95%CI, 0.7-1.4; P = .95).Conclusions: There is a loss of life expectancy in patients with all types of SAS undergoing SAVR. This loss is higher in patients with left ventricular dysfunction and lower in patients with low-gradient or high -gradient aortic stenosis with preserved LVEF. The benefit of surgery is similar between these last 2 groups.(C)2022 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.

INTRODUCTION:Accessory left atrial cords are fibroelastic structures found in the left atrium. Left atrial cords may be associated with mitral valve disease, atrial fibrillation, stroke, and other congenital left-side anomalies.METHODS:We presented the case of a man with severe Mitral Regurgitation and two accessories left atrial cords attached to P2 scallop by a single tendon and performed a literature review using PUBMED/MEDLINE, Web of Science, and EMBASE databases on December 4, 2021.RESULTS:According to our review, accessory left atrial cords were found more frequently in women (36 patients, 62%), more frequently attached to the mitral valve (66% of reports) and mitral regurgitation was the most frequently reported pattern of mitral valve disease (64.2%). No other cases of double left atrial cords attached to P2 segment were found.CONCLUSION:Accessory left atrial chords may be related to mitral valve disease and other left-side congenital abnormalities. These structures were found more frequently in females and A2 insertion was the most frequently observed pattern in the review.

Background and aim: COVID-19 patients with severe heart or respiratory failure are potential candidates for extracorporeal membrane oxygenation (ECMO). Indications and management of these patients are unclear. Our aim is to describe the results of a prospective registry of COVID-19 patients treated with ECMO. Methods: An anonymous prospective registry of COVID-19 patients treated with veno-arterial (V-A) or veno-venous (V-V) ECMO was created on march 2020. Clinical, analytical and respiratory preimplantation variables, implantation data and post-implantation course data were recorded. The primary endpoint was all cause in-hospital mortality. Secondary events were functional recovery and the combined endpoint of mortality and functional recovery in patients followed at least 3 months after discharge. Results: Three hundred and sixty-six patients from 25 hospitals were analyzed, 347 V-V ECMO and 18 V-A ECMO patients (mean age 52.7 and 49.5 years respectively). Patients with V-V ECMO were more obese, had less frequently organ damage other than respiratory failure and needed less inotropic support; Thirty three percent of V-A ECMO and 34.9% of V-A ECMO were discharged (P = NS). Hospital mortality was non-significantly different, 56.2% versus 50.9% respectively, mainly during ECMO therapy and mostly due to multiorgan failure. Other 51 patients (14%) remained admitted. Mean follow-up was 196 +/- 101.7 days (95%CI: 170.8-221.6). After logistic regression, body weight (OR 0.967, 95%CI: 0.95-0.99, P = 0.004) and ECMO implantation in the own centre (OR 0.48, 95%CI: 0.27-0.88, P = 0.018) were protective for hospital mortality. Age (OR 1.063, 95%CI: 1.005-1.12, P = 0.032), arterial hypertension (3.593, 95%CI: 1.06-12.19, P = 0.04) and global (2.44, 95%CI: 0.27-0.88, P = 0.019), digestive (OR 4,23, 95%CI: 1.27-14.07, P = 0.019) and neurological (OR 4.66, 95%CI: 1.39-15.62, P = 0.013) complications during ECMO therapy were independent predictors of primary endpoint occurrence. Only the post-discharge day at follow-up was independent predictor of both secondary endpoints occurrence. Conclusions: Hospital survival of severely ill COVID-19 patients treated with ECMO is near 50%. Age, arterial hypertension and ECMO complications are predictors of hospital mortality, and body weight and implantation in the own centre are protective. Functional recovery is only predicted by the follow-up time after discharge. A more homogeneous management of these patients is warranted for clinical results and future research optimization. (C) 2022 Sociedad Espanola de Cirugia Cardiovascular y Endovascular. Published by Elsevier Espana, S.L.U.

Introducción y objetivosSe desconoce si los pacientes jóvenes con estenosis aórtica grave tienen una esperanza de vida restaurada tras el reemplazo de la válvula aórtica (RVAo).MétodosSe incluyó a todos los pacientes entre 50 y 65 años sometidos a RVAo en 27 centros españoles durante 18 años. Se comparó la supervivencia observada y la esperada a los 15 años de seguimiento. Se repitieron todos los análisis con los pacientes sin complicaciones durante el posoperatorio inmediato.ResultadosSe analizó a 5.084 pacientes. En la muestra total, la supervivencia observada a los 10 y los 15 años fue del 85,3% (IC95%, 84,1-86,4%) y el 73,7% (IC95%, 71,6-75,6%). Las supervivencias esperadas fueron del 90,1 y el 82,1%. La supervivencia relativa acumulada a 1, 5, 10 y 15 años de seguimiento fue del 97,4% (IC95%, 96,9-97,9%), el 96,5% (IC95%, 95,7-97,3%), el 94,7% (IC95%, 93,3-95,9%) y el 89,8% (IC95%, 87,3-92,1%). Para los pacientes sin complicaciones, la supervivencia relativa acumulada a 1, 5, 10 y 15 años fue del 100,3% (IC95%, 99,8-100,5%), el 98,9% (IC95% 97,6-99,9%), el 97,3% (IC95%, 94,9-99,4%) y el 91,9% (IC95%, 86,5-96,8%).ConclusionesLa esperanza de vida de los pacientes jóvenes con estenosis aórtica grave intervenidos para RVAo es menor que la de la población general. La esperanza de vida de los pacientes sin complicaciones durante el posoperatorio inmediato también está reducida. Por lo tanto, las características basales probablemente sean los principales factores que explican la reducción de la esperanza de vida.

We present the unusual case of an adult patient with a diagnosis of intermediate atrioventricular canal and left atrioventricular valve with potentially parachute single papillary muscle, so named because, prior to repair, the inlet to the left ventricle is preserved through the cleft or zone of apposition. The incidence of this combination varies between 3.8% and 14% in different series of patients repaired in childhood. The tendency in most groups is partial or complete closure of the cleft. Depending on the associated anomalies in the left atrioventricular valve, different techniques are described, such as split of the papillary muscle, enlargement of the left lateral leaflet with a patch, posterior annuloplasty, resection of chordae tendineae, etc. In our patient, due to potential stenosis after the repair, we decided to perform a horizontal split of the single papillary muscle, followed by a vertical one to divide the muscle that gave tendinous chords to the free edge of the upper and lower bridge leaflets into two heads. After this, we considered that the entrance to the left ventricle was enough to perform complete closure of the cleft. In addition, the posterior leaflet was poorly developed and presented short cords, so we decided to perform a posterior annuloplasty to raise the posterior leaflet and decrease the distance with the anterior leaflet. The postoperative evolution was good. At discharge, the left atrioventricular valve had a mean gradient of 3 mmHg and mild insufficiency.(c) 2021 Sociedad Espanola de Cirugia Cardiovascular y Endovascular. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

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.