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J M Caffarena Raggio

Publications and source records attributed to J M Caffarena Raggio.

At least 19 recordsLinked to original sources
PubMed1999

[Risk factors in the Glenn bidirectional shunt as an intermediate procedure before Fontan correction].

OBJECTIVE: The bidirectional Glenn shunt is the most common palliation before the Fontan repair, especially in high-risk patients. We studied the influence of certain risk factors in bidirectional Glenn results, with and without an additional source of pulmonary blood flow. METHODS: Between 1993 and 1998 twenty patients (6-53 months of age) underwent a bidirectional Glenn shunt as the intermediate repair for the Fontan procedure. Diagnoses were: 7 cases of double inlet single ventricle, 4 of tricuspid atresia, 3 of unbalanced AV septal defect, 4 of mitral atresia, 1 hypoplastic left heart syndrome and 1 TGA with hypoplasia of the right ventricle. 17 patients had undergone previous operations. Mean preoperative arterial oxygen saturation was 78.5%. In 6 patients an auxiliary source of pulmonary blood flow was added. RESULTS: Hospital mortality was 15%. In 4 patients the bidirectional Glenn failed. By univariate analysis low weight, preoperative functional status and high pulmonary pressure were factors associated with early death. In bidirectional Glenn failure only the duration of ventilatory support was significant. By multivariate analysis, preoperative functional status and pulmonary pressure were significant. Mean postoperative arterial oxygen saturation at a mean follow-up of 10 months was 84%. CONCLUSIONS: Bidirectional Glenn shunt is an effective and low-risk palliation for patients with univentricular hearts. Only low weight and high pulmonary pressure were significant in hospital mortality, and we advise the association of an additional source of pulmonary blood flow in these patients at the start. Early extubation provides correct performance of the shunt.

Anastomosis, Surgical↗
PubMed1996

[Palliative arterial switch].

We report the first case published in Spain of a palliative anatomic correction associated with aortic arch repair in a neonate with (S,D,L)-transposition of the great arteries, multiple ventricular septal defects, and severe hypoplasia of the right ventricle with subaortic obstruction and hypoplasic aortic arch with coarctation. A one stage palliative surgery on cardiopulmonary bypass was performed with reconstruction of the aortic arch and an arterial switch procedure which obtained a satisfactory result. The principle of this operation is to switch the subaortic obstruction into a subpulmonary obstruction and reconstruct a large natural aortic root from the principal ventricle. The right ventricle-pulmonary artery continuity may promote growth of the right ventricle with the possibility of a future biventricular repair. We conclude that this operation, when used by surgical teams experienced with arterial switch surgery, is the best treatment for the complex newborn group with single ventricles or severe ventricular disbalance, ventriculoarterial discordance and stablished subaortic stenosis.

Aorta, Thoracic↗
PubMed1995

[The anatomical correction of transposition of the great arteries in the neonatal period].

INTRODUCTION AND OBJECTIVES: Anatomic correction of transposition of the great arteries in simple and complex form is theoretically the only procedure which offers the possibility of real cure to the problem. We report there our operative results and mid-term follow-up with this approach. METHODS: From June 1989 to February 1994, anatomical surgical correction was performed in 41 patients in the neonatal period, 31 with simple TGA and 9 patients with transposition associated with ventricular septal defect. We report our preoperative management, anatomic findings and surgical technique. RESULTS: Our initial experience with the arterial repair was associated with a high operative mortality. The actuarial survival rate was 74% at 56 months. Hospital mortality of the last 31 patients was 12.9%. Intermediate-term follow-up was 18 months. No late deaths. One patient underwent reoperation for supravalvular pulmonary stenosis. All survivors are in functional class I. The only significant risk factor of in-hospital mortality was the time of surgery (learning curve). CONCLUSION: The initial experience with arterial repair is associated with a difficult learning curve. Primary repair must be performed during the newborn period in simple and complex transpositions. Mid-term results are very encouraging. Longer follow-up is necessary to secure this technique and to render obsolete all other types of repair.

Aortic Coarctation↗
PubMed1994

[Myocardial protection: antegrade cardioplegia versus mixed cardioplegia (with right atrial perfusion) in high risk elective coronary surgery. A prospective trial].

INTRODUCTION: It is unclear after review the literature, whether the techniques of retrograde cardioplegia provides more optimal myocardial protection in the setting of coronary surgery that is possible with conventional antegrade cardioplegia, due to inhomogeneous patient subset that appears in clinical trials. PATIENTS AND METHODS: The present clinical study, prospective and randomized was undertaken in 40 patients undergoing high risk myocardial revascularization to compare the efficacy of both techniques. Inclusion criterias were: age > 65 years, unstable angor, multivessel disease and impaired ventricular function. One control group received cardioplegia through the aortic root, and the study group received combined antegrade-retrograde cardioplegia with perfusion into the right atrium. In both groups the vehicle of cardioplegia was oxygenated blood. RESULTS: There were 3 deaths, two in the control group and another one in the study group. Overall operative mortality was 7.3%. Left main coronary stenosis was present in the 2 patients dying in the control group. There were no significant differences between the two groups with regard to the operative and postoperative parameters analyzed; trials to wean off cardiopulmonary bypass, inotropic support, intra-aortic balloon counterpulsation, perioperative myocardial infarction, and levels of myocardial enzymes. There were higher incidence of temporal heart block in patients in study group. CONCLUSIONS: It was difficult to identify any appreciable difference in the clinical efficacy of these two methods of myocardial protection. We review the literature, trying to identify the "better" alternative in the setting of coronary revascularization and different patient subset.

Aged↗
PubMed1992

[Anomalous origin of the right pulmonary artery from the ascending aorta. Its surgical correction in early infancy].

Anomalous origin of the right pulmonary artery from the ascending aorta is a rare congenital malformation associated with a high mortality during the first year of life. Up to 1990, 75 cases have been reported in the literature. We are reporting 2 cases diagnosed and operated before 3 months of age. Repair was facilitated by the use of deep hypothermic circulatory arrest. The duration of follow up is 5 and 6 years, respectively. Pre and postoperative cardiac catheterization pressure data and angiograms are shown. We review the literature, presenting the physiopathological, embryological and surgical features of this rare congenital anomaly.

Aorta↗
PubMed1989

The Omni design: evolution of a valve.

The Lillehei-Kaster prosthesis has been the subject of an engineering evolution to close the gap between engineering expectations and clinical performance. Advanced engineering development in response to users has narrowed this gap with the Omni design (Omniscience titanium and omnicarbon Pyrolite cages). Our studies on mitral Omniscience valves demonstrated that because anatomic and surgical variations, the anterior orientation was more forgiving than the posterior orientation, resulting in lower thrombotic complications (0.5% versus 3.3% patient-year). A subsequent thicker cuff was used to reduce the probability of anatomic interference and incomplete opening after cardiac recovery. Such findings were also incorporated in the Omnicarbon design. Five European centers implanted 354 patients (198 atrial valve replacement, 115 mitral valve replacement, and 41 double valve replacement with Omniscience valves between August 1984 and January 1986. No restrictive patient selection criteria were used. As of June 1987, 96% of the patients at risk were accounted for. Average follow-up was 1.7 +/- 0.4 years (range, 0.3 to 2.8 years), with a total follow-up of 555 years. There were no cases of structural failure or clinically significant hemolysis. Ninety-one percent of the patients improved one or more functional classes. Actuarial analysis of survival probability at 3 years is 92.5% for atrial valve replacement, 97.9% for mitral valve replacement, and 93.6% overall. There were no late deaths from valve thrombosis or thromboembolism. The actuarial freedom from all thromboembolic events (valve thrombosis, thromboembolism, and transient ischemia) is 97.8% at 2 1/2 years. Through close rapport between user surgeons and designers, the evolution of a valve with improved performance becomes a reality.

Actuarial Analysis↗
PubMedDate not supplied

[The surgical treatment of aneurysms of the ascending aorta with associated aortic insufficiency. Total replacement with reimplantation of the coronary arteries].

We reviewed our experience with replacement of the ascending aorta and aortic valve with a composite graft and reimplantation of coronary arteries to the tube graft during 8 years interval from April, 1982, to April 1990. 24 patients underwent repair, the mean age was 49.83 years. Annuloaortic ectasia was the most common indication (58.33%), followed by aortic dissection (acute or chronic). Emergency operation was carried out in nine patients with aortic dissection (37.5%) and elective in 15. The mean duration of cardiopulmonary bypass was 118 +/- 4 minutes and of aortic clamping 83.85 +/- 2 minutes. Hospital mortality was 4.17%, reoperation for hemorrhage was 12.5% and perioperative morbidity for other causes was 34.7%. There were one late death. 20 patients were follow-up with a total of 638 patients-months (two patients excluded with insufficient follow-up and one late death). At last follow-up 14 patients were in functional class I. Eight year actuarial survival for the 24 patients was 91%. We believe that replacement of the ascending aorta and aortic valve with a composite graft and coronary arteries reimplantation to the tube graft is more than one satisfactory alternative to supracoronary graft replacement and aortic valve replacement. It offers the advantage of excluding all abnormal aortic tissue, eliminating the risk for later development of complications in the non excluded disease aorta. It supposes the method of choice for patients with anuloaortic-ectasia, aneurysms of the sinuses of Valsalva with aortic insufficiency, and aortic dissection with proximal affectation of coronary arteries and aortic valve.

Adult↗