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J J Rufilanchas

Publications and source records attributed to J J Rufilanchas.

At least 19 recordsLinked to original sources
PubMed2006

Case-control study of risk factors for mediastinitis after cardiovascular surgery.

We report results of a case-control study in which we evaluated 41 risk factors potentially associated with the development of postsurgical mediastinitis. There were 163 case patients and 326 control patients. Independent risk factors kept in the final multivariate logistic regression model were obesity (defined as a body mass index of greater than 30), diabetes mellitus, chronic obstructive pulmonary disease, preoperative stay longer than 1 week, pulmonary hypertension, perioperative myocardial infarction, and reoperation.

Adult↗
PubMed2005

Accuracy of blood culture for early diagnosis of mediastinitis in febrile patients after cardiac surgery.

Postsurgical mediastinitis (PSM) remains a major cause of morbidity and mortality in patients undergoing cardiac surgery procedures. Although prompt diagnosis is crucial in these patients, neither clinical data nor imaging techniques have shown enough sensitivity or specificity for early diagnosis of PSM. The aim of the present study was to assess the validity of blood cultures as a diagnostic test for the early detection of PSM in patients who become febrile after cardiac surgery procedures. During a 4-year period (1999-2002), patients who developed fever (>37.8 degrees C) in the first 60 days after a cardiac surgery procedure were evaluated. Blood cultures were drawn from these patients. PSM was defined as deep infection involving retrosternal tissue and/or the sternal bone directly observed by the surgeon and confirmed microbiologically. Three criteria for positivity of blood cultures were applied: bacteremia, staphylococcal bacteremia, or Staphylococcus aureus bacteremia. For purposes of the analysis, a positive blood culture in patients with PSM was considered a true-positive test and a negative blood culture a false-negative test. Otherwise, in febrile patients without PSM in the postsurgery period, a positive blood culture was considered a false-positive test and a negative blood culture a true-negative test. Blood cultures were drawn from 266 febrile patients in the postsurgery period. PSM occurred in 38 patients (26 cases due to S. aureus, 8 to Staphylococcus epidermidis, 3 to gram-negative enteric bacteria, and one to Pseudomonas aeruginosa). Within the 60-day postsurgical period, blood culture as a diagnostic test was most accurate in patients with S. aureus bacteremia, providing 68% sensitivity, 98% specificity, a positive predictive value of 87%, and a negative predictive value of 95%. If the analysis was limited to the period during which patients are at maximum risk for PSM (day 7-20), the values in patients with S. aureus bacteremia were as follows: 73% sensitivity, 98% specificity, 90% positive predictive value, and 93% negative predictive value. Blood culture is an accurate test for the early diagnosis of PSM in febrile patients after cardiac surgery, particularly in institutions where S. aureus is prevalent in this context. A negative blood culture practically excludes PSM and, during the period of maximum risk for PSM, the presence of S. aureus bacteremia should compel early surgical management.

Bacteremia↗
PubMed2001

[Surgical reconstruction of intervalvular fibrous body in active infective endocarditis].

INTRODUCTION AND OBJECTIVES: Surgery for infective endocarditis with paravalvular abscesses and fibrous body destruction has the highest mortality and morbidity rates in this disease with high surgical risk. We report a new approach of radical resection of the abscess and affected tissues and reconstruction of the heart with pericardium as an alternative to conventional surgery. METHODS: In the last two years six patients with infective endocarditis, paravalvular abscesses and fibrous body destruction underwent surgery (five prostheses with infective endocarditis). The main indication for surgery was persistent sepsis despite adequate antibiotic treatment in five patients and congestive heart failure in one. After wide resection of the abscesses and fibrous body the heart was reconstructed with glutaraldehyde-fixed bovine pericardium. RESULTS: There was no hospital mortality. The median bypass and clamp times were 198 and 174 minutes, respectively. One patient presented complete AV block and a permanent transvenous pacemaker was implanted. Doppler echocardiographic studies performed in all the patients prior to discharge indicated that no patient had patch dehiscence or paravalvular leaks. Patients were followed a mean of 15 months with no deaths or other complications being reported. CONCLUSIONS: Resection of the abscesses and fibrous body, and reconstruction of the heart with glutaraldehyde-fixed bovine pericardial patch is a radical, feasible technique with all infected tissues being resected to thereby prevent reinfection or paravalvular leaks.

Abscess↗
PubMed2001

[Incidence and dynamic behavior of spontaneous echocardiographic contrast and atrial thrombi in the transplanted heart].

BACKGROUND: Standard orthotopic heart transplantation produces important anatomic and functional atrial alterations with subsequent thrombotic risk. Therefore the aim of this study was to analyze the prevalence and evolution of spontaneous echocardiography, atrial thrombi and embolic events. PATIENTS AND METHOD: 52 consecutive transplanted patients were analyzed with transesophageal echocardiography and hemodynamic studies performed at 15 days and one year after transplantation. RESULTS: Spontaneous echocardiography contrast was present in 27 patients (52%). Ten atrial thrombi were observed (19.2%), 9 with spontaneous echocardiography contrast. Six atrial thrombi appeared on day 15 and 4 after one year (with spontaneous echocardiography contrast on the previous study). Using multiple logistic regression analysis left atrial size was the only independent predictor factor for spontaneous echocardiography contrast (OR = 1.27; 95% CI, 1.09-1.54) and was an important predictor factor of atrial thrombi formation (OR = 1.19; 95% CI, 1.04-1.42). Likewise, the main predictor of atrial thrombi was the presence of spontaneous echocardiography contrast (OR = 116; 95% CI, 8.4-999). The hemodynamic pattern did not predict either the presence of spontaneous echocardiography contrast or atrial thrombi. The global incidence of embolic events was 4% less than previously described. CONCLUSIONS: The incidence of atrial thrombi and spontaneous echocardiographic contrast after standard orthotopic heart transplantation was 19.2% and 52%, respectively. An enlarged atrium and/or spontaneous echocardiography contrast was found to increase the risk of atrial thrombi. Considering the dynamic nature of atrial thrombi formation, periodical transesophageal echocardiography studies are recommended after heart transplantation.

Analysis of Variance↗
PubMed2001

Impact of mild pulmonary hypertension on mortality and pulmonary artery pressure profile after heart transplantation.

BACKGROUND: Pulmonary hypertension is a risk factor for early mortality after transplantation, but the risk threshold is debated. Also, little is known about the evolution of pulmonary circulation after transplantation. The aim of this study was to determine the influence of current risk pulmonary pressure parameters on early post-operative mortality and to assess the time-related changes in pulmonary pressure after surgery. METHODS: One hundred twelve consecutive transplanted patients were studied retrospectively to determine the influence of trans-pulmonary gradient of >12 mm Hg and pulmonary vascular resistance of >2.5 Wood units, at baseline or after vasodilator test, on early mortality. A multivariate analysis was used to study the hemodynamic parameters associated with early mortality. The pulmonary pressures of all surviving patients were studied for up to 3 years after surgery. RESULTS: Early mortality in the groups with and without pulmonary hypertension were 24.4% and 5.6%, respectively (p =.009). The only variable that was independently associated with early mortality was the pulmonary vascular resistance index (odds ratio = 1.459). Mild pulmonary hypertension disappeared 1 year after heart transplantation. CONCLUSIONS: Mild pulmonary hypertension is a risk factor for early postoperative mortality. The hemodynamic parameter most closely associated with early mortality is pulmonary vascular resistance index. The hemodynamic profile of pulmonary circulation after heart transplantation is partially dependent on the level of pulmonary hypertension before transplantation, at least during the first year after surgery.

Adolescent↗
PubMed2000

[Early results with partial left ventriculectomy (the Batista operation)].

INTRODUCTION AND OBJECTIVES: The shortage of donors as well as the morbidity and mortality associated with transplantation have led to development of other surgical options for end-stage dilated cardiomyopathy. Partial left ventriculectomy reducing ventricular diameter and mass has been proposed. We here in report the initial experience (not only limited to the alternative of transplantation) and immediate results obtained with this technique in our institution. METHODS: Six patients with dilated cardiomyopathy underwent surgery: 4 of idiopathic origin with exclusion criteria for heart transplantation and 2 of valvular or mixed etiology. Resection of a slice of the left ventricle was performed between the two papillary muscles, from the apex of the heart to the mitral annulus, and closure was carried out with a single suture with mitral annuloplasty in 5 cases (tricuspid repair in one and aortic valve replacement in two). RESULTS: An intraaortic balloon pump was required in two patients; one died from cardiogenic shock and the other died after several ventricular arrhythmias fifteen days after surgery. Intraoperative echocardiographic studies showed a significant reduction in both diastolic diameter (8.7 to 6.8 cm; p = 0.02) and mitral insufficiency and an increase in the ejection fraction (17 to 27%; p = 0.09) which were maintained on echography 10 days after surgery. CONCLUSIONS: This technique is a feasible, suitable therapeutic option for refractory congestive heart failure. Appropriate patient selection, the perioperative management and long-term support remain to be defined.

Adult↗
PubMed1999

Living anatomy of the atrioventricular junctions. A guide to electrophysiologic mapping. A Consensus Statement from the Cardiac Nomenclature Study Group, Working Group of Arrhythmias, European Society of Cardiology, and the Task Force on Cardiac Nomenclature from NASPE.

Current nomenclature for the atrioventricular (AV) junctions derives from a surgically distorted view, placing the valvar rings and the triangle of Koch in a single plane with antero-posterior and right-left lateral coordinates. Within this convention, the aorta is considered to occupy an anterior position, although the mouth of the coronary sinus is shown as being posterior. Although this nomenclature has served its purpose for the description and treatment of arrhythmias dependent on accessory pathways and atrioventricular nodal reentry, it is less than satisfactory for the description of atrial and ventricular mapping. To correct these deficiencies, a consensus document has been prepared by experts from the Working Group of Arrhythmias of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. It proposes a new anatomically sound nomenclature that will be applicable to all chambers of the heart. In this report, we discuss its value for description of the AV junctions, establishing the principles of this new nomenclature.

Atrioventricular Node↗
PubMed1999

Living anatomy of the atrioventricular junctions. A guide to electrophysiological mapping. A Consensus Statement from the Cardiac Nomenclature Study Group, Working Group of Arrythmias, European Society of Cardiology, and the Task Force on Cardiac Nomenclature from NASPE. North American Society of Pacing and Electrophysiology.

Current nomenclature for atrioventricular junctions derives from a surgically distorted view, placing the valvar rings and the triangle of Koch in a single plane with antero-posterior and right-left lateral coordinates. Within this convention, the aorta is considered to occupy an anterior position, while the mouth of the coronary sinus is shown as being posterior. While this nomenclature has served its purpose for the description and treatment of arrhythmias dependent on accessory pathways and atrioventricular nodal re-entry, it is less than satisfactory for the description of atrial and ventricular mapping. To correct these deficiencies, a consensus document has been prepared by experts from the Working Group of Arrhythmias of the European Society of Cardiology, and the North American Society of Pacing and Electrophysiology. It proposes a new, anatomically sound, nomenclature that will be applicable to all chambers of the heart. In this report, we discuss its value as regards the description of the atrioventricular junctions, establishing the principles of this new nomenclature.

Atrioventricular Node↗
PubMed1999

ESCWGA/NASPE/P experts consensus statement: living anatomy of the atrioventricular junctions. A guide to electrophysiologic mapping. Working Group of Arrhythmias of the European Society of Cardiology. North American Society of Pacing and Electrophysiology.

Current nomenclature for the AV junctions derives from a surgically distorted view, placing the valvar rings and the triangle of Koch in a single plane with anteroposterior and right-left lateral coordinates. Within this convention, the aorta is considered to occupy an anterior position, whereas the mouth of the coronary sinus is shown as being posterior. Although this nomenclature has served its purpose for the description and treatment of arrhythmias dependent on accessory pathways and AV nodal reentry, it is less than satisfactory for the description of atrial and ventricular mapping. To correct these deficiencies, a consensus document has been prepared by experts from the Working Group of Arrhythmias of the European Society of Cardiology and from the North American Society of Pacing and Electrophysiology. It proposes a new, anatomically sound, nomenclature that will be applicable to all chambers of the heart. In this report, we discuss its value for description of the AV junctions and establish the principles of this new nomenclature.

Atrioventricular Node↗
PubMed1999

Neurological complications after cardiopulmonary bypass: An update.

INTRODUCTION: Neurological complications are, at the present time, considered among the most important causes of morbidity and mortality after heart surgery. We evaluated their importance and risk factors. PATIENTS AND METHODS: We retrospectively reviewed 2, 528 consecutive patients who underwent cardiopulmonary bypass in a single center. In each one, we attended to previous vascular risk factors, such as surgical and postoperative events. We considered four categories of neurologic outcome: (1) persistent neurological focal deficits, (2) stupor or coma, (3) temporary neurological focal deficits, and (4) seizures. We carried out univariant and multivariant statistical analysis, looking for predictors of adverse neurologic events. RESULTS: Neurological complications occurred in 76 patients (3%); 36 of them (47%) had persistent neurological focal deficits, 18 (24%) stupor or coma, 18 (24%) temporary neurological focal deficits, and 27 (36%) seizures. Twenty-two patients with cerebral adverse outcomes died (29%), the overall mortality among the 2,528 cases being 5%. Predictors of risk were aortic aneurysm and aortic valve surgery, advanced age, female sex, and the use of intra-aortic balloon pump. A longer hospitalization time was noticed among patients with neurological side effects. DISCUSSION: Neurological complications are common and serious after heart surgery, as we have noticed with this series, the largest up to now, according to our review of the literature. They increase perioperative mortality and hospitalization time. Neurological morbidity and risk factors in our study are similar to those previously published.

Cardiopulmonary Bypass↗
PubMed1998

[Agenesis of the left coronary trunk. A case report and bibliographic review].

Clinical and angiographic features are described in a fifty-five years old man, with long-standing clinical manifestations of ischemic heart disease. In addition to severe coronary atherosclerosis, congenital atresia of the left main coronary was present. A description of the coronary anomaly found and a discussion of its meaning and significance are presented.

Coronary Angiography↗
PubMed1998

A new approach to cardiac valve replacement through a small midline incision and inverted L shape partial sternotomy.

OBJECTIVE: Minimally invasive cardiac surgery is becoming more popular as an alternative technique in some cardiac operations. We report our experience with an inverted 'L' ministernotomy in 25 patients and describe the technical details of this new approach. METHODS: From June 1996 to February 1997 we performed 25 ministernotomy approaches for cardiac surgery, 17 aortic and 7 mitral valve replacements and 1 atrial septal defect closure. A comparison group included all patients (n = 126) operated on for mitral or aortic valve replacement through a median sternotomy since June 1996. RESULTS: Ventilatory support, Intensive Care Unit stay and hospital stay were 8.3 h (SD = 4 h), 25 h (SD = 8 h) and 5.5 days (SD = 3 days) in the L ministernotomy group and 11.5 h (SD = 5), 53 h (SD = 11) and 9.1 days (SD = 4 days) in the median sternotomy group (P < 0 05). Mortality and morbidity are similar to conventional sternotomy (hospital mortality 4% vs. 5.5%; P not significant). CONCLUSIONS: We conclude that inverted L ministernotomy for cardiac surgery is a safe approach and can offer some advantages over the conventional approach.

Aortic Valve↗
PubMed1998

[Scales of risk assessment in coronary surgery and their usefulness].

Currently, there is an increasing interest in the fields of cardiology and cardiac surgery related to systems of risk assessment of cardiac surgery procedures. The main benefit of these systems is quality control of results obtained. Nevertheless, there are other interesting implications. Currently, most of the available scales make estimations of mortality risk with a defined operative technique, using preoperative variables. Other systems can make predictions on postoperative length of stay. Scales are built using the results of a large series, processed with different mathematical models. An important condition is the simplicity of use. There is a wide range of available systems originating from clinical experience in Europe and North-America. All of them include a common number of predictive factors, although the assigned weight can vary significantly. We recommend the routine use of these scales as a quality control system and as a method of characterization of our populations in order to make adequate comparisons among different groups.

Cardiac Surgical Procedures↗
PubMed1998

[Neurological complications of aortic artery surgery].

INTRODUCTION: Improvement in cardiac surgery techniques has led to a considerable reduction in mortality following surgery of the aorta, dissection of the aorta and for aortic aneurysms. Although there are satisfactory vascular results following surgical repair, morbi-mortality related to neurological complications, both cerebral and spinal, is still very high. Repair of aortic lesions may lead to damage by two main mechanisms: ischemia secondary to prolonged obstruction of the aorta or to neurological lesions due to total circulatory arrest. DEVELOPMENT: After description of the mechanisms leading to cerebral and spinal lesions and the risk factors involved, we discuss methods of vascular protection and other means of neuro-protection, both spinal and cerebral. Of the vascular techniques for spinal protection, the most useful ones are short-circuits, or active or passive shunts, and cardiopulmonary by-pass. Amongst the vascular techniques for cerebral protection we describe total circulatory arrest and methods of anterograde and retrograde cerebral perfusion, and when these may be used. As general measures for nervous system protection, we describe the use of hypothermia and drugs such as corticosteroids, free radical blockers, antagonists of the excitatory amino-acids etc. CONCLUSIONS: In spite of the number of studies done, the extreme sensitivity of the nervous system to ischemia has meant that in few cases have encouraging results been seen. Neurological damage continues to be the main cause of morbi-mortality in patients with dissection or aneurysm of the aorta.

Aortic Dissection↗
PubMed1997

Calcitonin, etidronate, and calcidiol treatment in bone loss after cardiac transplantation.

Cardiac transplantation is associated with severe bone loss caused by glucocorticoids, immunosuppressive treatment, and other factors. Treatment protocols for the prevention of bone loss is being studied. Forty patients who underwent cardiac transplantation were randomly given calcitonin (n = 13; 100 UI/d, nasal route), etidronate (n = 14; cyclical treatment 400 mg p.o./d/2 weeks/3 months), or calcidiol (n = 13; 32,000 IU/weekly) therapy for at least 18 months. Serum parameters (Ca, P, alkaline phosphatase, osteocalcin, intact PTH), urinary calcium, and vertebral mineral density (VMD; L2-L4, DXA Hologic QDR 1000) were measured immediately before treatment and after 6, 12, and 18 months of therapy after cardiac transplantation. Patients with cardiac transplantation had a VMD significantly lower than age and sex-matched Spanish controls. Prevalence of osteoporosis (Z-score below -2 SD) was 30%. Osteocalcin levels increased at 6, 12, and 18 months of treatment in the three groups. After 18 months of treatment, VMD increased significantly in the calcidiol 4.9%, vs. -1.19% and -0.19% in the calcitonin and etidronate groups, respectively. A lower incidence of fracture was found in patients treated with calcidiol during the study. In summary, we have found in this open randomized study that calcidiol was the most effective drug in the prevention and treatment of bone loss in patients after cardiac transplantation.

Alkaline Phosphatase↗
PubMed1997

Intracardiac thrombus trapped in a patent foramen ovale.

We describe a case of impending paradoxical embolism due to a thrombus trapped in a patent foramen ovale in a 22-year-old woman. Transthoracic and transesophageal echocardiography detected the thrombus. She was operated on and discharged asymptomatic.

Adult↗