Biomedical subjects

Manuel Concha

Publications and source records attributed to Manuel Concha.

6 recordsLinked to original sources

PubMed2005

Prospective evaluation of aortic valve replacement in young adults and middle-aged patients: mechanical prosthesis versus pulmonary autograft.

BACKGROUND AND AIM OF THE STUDY: The best option for aortic valve replacement (AVR) in young adults and middle-aged patients remains controversial. A longitudinal comparison between the Ross procedure (RP) and mechanical prosthesis (MP) was conducted in this group of patients. METHODS: Between January 1997 and January 2003, 125 consecutive patients (age range: 20-50 years) were submitted for AVR; 62 patients (mean age 37.73+/-7.28 years) were included in the MP group, and 63 (mean age 35.33+/-7.63 years) in the RP group. Gender, etiology, NYHA functional class and other preoperative data were comparable between the two groups. RESULTS: The operative mortality was four (6.5%) in the MP group, and one (1.6%) in the RP group (p = NS). The postoperative complication rate was similar in both groups. Two RO patients required early autograft replacement due to severe regurgitation. There were no late deaths during the follow up period. In the MP group, three patients (4.8%) suffered major bleeding, three (4.8%) were diagnosed with prosthetic endocarditis (one required reoperation), and three (4.8%) suffered valve- or coumarin-related thromboembolic complications. All RP patients were free from bleeding, thromboembolic, or infectious complications, but three suffered severe pulmonary homograft stenosis (one re-replacement, one Palmaz stent, and one under clinical surveillance). The combined freedom from death or major complications was 64.72+/-4.3% in the MP group, and 87.92+/-9.65% in the RP group (p = 0.068). CONCLUSION: Intraoperative and early postoperative morbidity and mortality rates were similar among RP and MP patients, despite a steep learning curve during the early RP cases. Although the follow up was limited, and homograft-related morbidity was seen in the RP group, the overall five-year major complication rate supported use of the pulmonary autograft for AVR in patients aged between 20 and 50 years.

Adult↗

PubMed2004

[Short-term results with the ross procedure. Does the etiology of aortic valvulopathy affect the outcome?].

INTRODUCTION: The Ross procedure has become established as an appropriate method for aortic valve replacement in children and young adults. There is controversy regarding the results of this surgical technique depending on whether the aortic valve disorder is congenital or acquired. The objective of this study was to analyze the outcome of this technique in different etiologies. PATIENTS AND METHOD: We analyzed 61 patients who underwent the Ross procedure between November 1997 and November 2001. Age range was 6 to 54 years, and 44 patients (72%) were male. The mean duration of follow-up was 15.6 (10.6) months. The aortic valve lesion was stenosis in 17 patients, regurgitation in 22 and both in 22. The patients were divided into two groups: etiology was congenital in group I (40 patients) and acquired in group II (21 patients: 14 rheumatic, 2 degenerative, 2 endocarditis and 3 other). RESULTS: Pre-intervention data showed significant differences in age, functional class and percentage of patients with previous cardiac surgery. In the last follow-up examination, autograft gradient and homograft gradient were similar in both groups. Diastolic and systolic diameters and left ventricle ejection fraction were normal in both groups and did not differ between groups. Major events during follow-up were: 1 patient died, 1 patient had endocarditis, and 2 patients needed stent implantation in the homograft in group I; 2 patients in group II underwent reoperation because of severe autograft dysfunction. There were no statistically significant differences between groups. CONCLUSION: Short-term morbidity and mortality associated with the Ross procedure are low in patients with either congenital or acquired aortic valvulopathy.

Adolescent↗

PubMed2003

Comprehensive experience with the Ross operation in Spain.

OBJECTIVE: Although the first pulmonary autograft operations were performed in Spain in 1991, this procedure has gained substantial interest and has been consolidated since 1997. The establishment of the Spanish Registry of the Ross Operation pretends to evaluate the results of this option in aortic valve disease patients in our setting. METHODS: In a yearly fashion, the cardiac surgery departments in Spain currently performing this intervention send data from new patients or follow-ups to the reference center. Preoperative, intraoperative and postoperative data are included in the registry, with special attention to morbidity, mortality, autograft and homograft dysfunction and need for reintervention. RESULTS: Since February 1991 to May 2002, 169 patients have been treated with this technique. The most prevalent aortic disease was regurgitation (72; 42.59%), congenital being the most frequent etiology (108; 63.9%). Four (2.36%) patients required intraoperative aortic counterpulsation. Operative mortality was 2.36% (n=4). Follow-up is 98.7% complete, with an average of 36.08+/-31.09 months (range 1-135), 84 patients (49.7%) were followed for more than 2 years. The autograft remains competent or with trivial to mild regurgitation in 161 patients (95.6%), presenting two (1.18%) with severe regurgitation. The homograft was normal or with mild stenosis in 159 patients (94.07%), presenting five (2.95%) with severe stenosis. Three (1.77%) required reintervention (surgical or interventional) on the right ventricular outflow tract and four (2.36%) required autograft replacement for a mechanical prosthesis. Actuarial survival is 95.99+/-1.65% at 36 months, remaining 92.44+/-2.55% free from reintervention in the same period. CONCLUSIONS: The Ross operation is an increasingly popular surgical option in Spain, and although the number of patients and length of follow-up are still limited, initial results are at least as good as those reported internationally. It is important to continue a close follow-up of these patients to assess the long-term function of auto and homograft. With the available data, we believe that this therapeutic approach is a valid option for selected groups of patients with surgical aortic valve disease in Spain.

Adolescent↗

PubMed2003

The apo A-I gene promoter region polymorphism determines the severity of hyperlipidemia after heart transplantation.

BACKGROUND: To study whether the Apolipoprotein A-I (apo A-I) promoter region gene polymorphism produces changes in the lipid profile of heart transplant recipients. METHODS: One hundred and three heart transplant recipients (93 men and 10 women, with a mean age of 47 +/- 13 yr) receiving triple immunosuppressive therapy were submitted to a genetic study of the apo A-I gene promoter region. Anthropometric and analytical data, including lipid profile, arterial blood pressure, were collected prior to transplantation and 3, 6, 12, and 24 months after transplantation. RESULTS: Sixty-three subjects had the GG genotype and 40 the GA genotype. Carriers of the GA genotype had higher triglyceride levels at 6 months and 2 yr (2.50 +/- 1.20 versus 1.93 +/- 0.98 mmol/L and 2.46 +/- 1.58 versus 1.60 +/- 0.68 mmol/L, respectively, p < 0.001), and a greater rise in LDL-cholesterol at 1 yr than the GG subjects (4.57 +/- 1.16 versus 4.16 +/- 1.18 mmol/L, p < 0.05). Multiple regression analyses showed that genetic variants at the apo A-I promoter region are responsible for 11% of the variability in triglyceride levels at 6 months (p = 0.005). CONCLUSIONS: The GA genotype of the apo A-I promoter region produces a greater rise in plasma triglyceride and LDL-cholesterol levels in heart transplant patients.

Apolipoprotein A-I↗

PubMed2003

Mitral homograft in the tricuspid position, aortic homograft and mitral plasty in a drug addict with multiple valve endocarditis.

The case is reported of multiple valve surgery using as little prosthetic material as possible in a drug addict with recurrent right and left bacterial endocarditis. The patient underwent aortic valve replacement with a cryopreserved aortic homograft, mitral repair and tricuspid valve replacement with a mitral homograft, using a modified technique. The indications and surgical options for tricuspid valve endocarditis in this patient group are discussed, with particular focus on technical aspects of using mitral homografts in the tricuspid position.

Adult↗

PubMedDate not supplied

The Ross procedure.

BACKGROUND: The search for the ideal substitute for the aortic valve led Donald Ross to develop the pulmonary autograft concept in 1967. A historical, technical, and scientific review of this surgical option is presented together with our clinical experience. MATERIALS AND METHODS: The literature is reviewed to identify the advantages and pitfalls of the Ross procedure over the last decades. We also present our clinical experience with 92 patients operated between 1997 and May 2003. RESULTS: Of the total, 70.65% (n = 65) were males, mean age was 29.32 +/- 11.9 years, with 20 patients under 16 and 6 patients under 10 years. Twenty-five patients (27.17%) had 31 previous interventions. There were 41 associated procedures in 34 patients. Perioperative mortality was 2.17% (two patients). Eight patients required reexploration for bleeding, one required an aortocoronary bypass, and one a permanent pacemaker. Follow-up was 97% with 2.71 patients/year (average 32.55 +/- 19.01 months). Two patients required autograft replacement, one suffered a 44-mm dilatation of the autograft, and one 13-year-old girl developed autograft endocarditis. Six patients suffered severe homograft stenosis (>50 mmHg), two were treated percutaneously, and one required replacement. Combined freedom from reintervention is 93.56 +/- 2.81% at 5 years. CONCLUSIONS: The Ross procedure is a mature concept with thousands of patients operated worldwide and a cumulative experience of over 30 years. Although we believe that it is the procedure of choice in the pediatric population, women in child-bearing age, and substantial subgroups of adult patients, efforts must continue to minimize the incidence of auto- and homograft failure in the long term.

Adolescent↗