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Hasse B, Hannan MM, Keller PM, Maurer FP, Sommerstein R, Mertz D, Wagner D, Fernández-Hidalgo N, Nomura J, Manfrin V, Bettex D, Hernandez Conte A, Durante-Mangoni E, Tang THC, Stuart RL, Lundgren J, Gordon S, Jarashow MC, Schreiber PW, Niemann S, Kohl TA, Daley CL, Stewardson AJ, Whitener CJ, Perkins K, Plachouras D, Lamagni T, Chand M, Freiberger T, Zweifel S, Sander P, Schulthess B, Scriven JE, Sax H, van Ingen J, Mestres CA, Diekema D, Brown-Elliott BA, Wallace RJ, Baddour LM, Miro JM, Hoen B, Athan E, Bayer A, Barsic B, Corey GR, Chu VH, Durack DT, Fortes CQ, Fowler V, Hoen B, Krachmer AW, Durante-Magnoni E, Miro JM, Wilson WR. International Society of Cardiovascular Infectious Diseases Guidelines for the Diagnosis, Treatment and Prevention of Disseminated Mycobacterium chimaera Infection Following Cardiac Surgery with Cardiopulmonary Bypass. J Hosp Infect 2019; 104:214-235. [PMID: 31715282 DOI: 10.1016/j.jhin.2019.10.009] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 10/08/2019] [Indexed: 02/09/2023]
Abstract
Mycobacterial infection-related morbidity and mortality in patients following cardiopulmonary bypass surgery is high and there is a growing need for a consensus-based expert opinion to provide international guidance for diagnosing, preventing and treating in these patients. In this document the International Society for Cardiovascular Infectious Diseases (ISCVID) covers aspects of prevention (field of hospital epidemiology), clinical management (infectious disease specialists, cardiac surgeons, ophthalmologists, others), laboratory diagnostics (microbiologists, molecular diagnostics), device management (perfusionists, cardiac surgeons) and public health aspects.
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Affiliation(s)
- B Hasse
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Switzerland.
| | - M M Hannan
- Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - P M Keller
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - F P Maurer
- Diagnostic Mycobacteriology Group, National and WHO Supranational Reference Center for Mycobacteria, Research Center, Borstel, Germany
| | - R Sommerstein
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - D Mertz
- Departments of Medicine, Health Research Methods, Evidence and Impact, and Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - D Wagner
- Department of Internal Medicine II, Division of Infectious Diseases, Medical Center - University of Freiburg, Freiburg i.Br, Germany
| | - N Fernández-Hidalgo
- Servei de Malalties Infeccioses, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - J Nomura
- Kaiser Permanente Infectious Diseases, Los Angeles Medical Center, CA, USA
| | - V Manfrin
- Infectious and Tropical Diseases Department, San Bortolo Hospital, Vincenca, Italy
| | - D Bettex
- Institute of Anesthesiology, University Hospital Zurich, Switzerland
| | - A Hernandez Conte
- Department of Anaesthesiology, Kaiser Permanente, Los Angeles Medical Center, CA, USA
| | - E Durante-Mangoni
- Infectious and Transplant Medicine, University of Campania 'L. Vanvitelli', Monaldi Hospital, Naples, Italy
| | - T H-C Tang
- Division of Infectious Diseases, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - R L Stuart
- Monash Infectious Diseases, Monash Health, Australia
| | - J Lundgren
- Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Denmark
| | - S Gordon
- Department of Infectious Diseases, Cleveland Clinic, OH, USA
| | - M C Jarashow
- Acute Communicable Disease Control, Los Angeles Department of Public Health, LA, USA
| | - P W Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Switzerland
| | - S Niemann
- Molecular and Experimental Mycobacteriology Group, Research Center Borstel, Borstel, Germany and German Center for Infection Research (DZIF), partner site Hamburg - Lübeck - Borstel - Riems, Borstel, Germany
| | - T A Kohl
- Molecular and Experimental Mycobacteriology Group, Research Center Borstel, Borstel, Germany and German Center for Infection Research (DZIF), partner site Hamburg - Lübeck - Borstel - Riems, Borstel, Germany
| | - C L Daley
- Division of Mycobacterial and Respiratory Infections, National Jewish Health, Denver, CO, USA
| | - A J Stewardson
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, Australia
| | - C J Whitener
- Penn State Health, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - K Perkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, USA
| | - D Plachouras
- Healthcare-associated Infections, European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - T Lamagni
- National Infection Service, Public Health England, London, UK
| | - M Chand
- National Infection Service, Public Health England, London, UK; Guy's and St Thomas' NHS Foundation Trust, Imperial College London, UK
| | - T Freiberger
- Centre for Cardiovascular Surgery and Transplantation, Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - S Zweifel
- Ophthalmology Unit, University of Zurich, Switzerland
| | - P Sander
- National Center for Mycobacteria, Zurich, Switzerland, Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - B Schulthess
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - J E Scriven
- Department of Infection and Tropical Medicine, University Hospitals Birmingham, Birmingham, UK
| | - H Sax
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Switzerland
| | - J van Ingen
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C A Mestres
- Clinic for Cardiovascular Surgery, University Hospital and University of Zurich, Switzerland
| | - D Diekema
- Division of Infectious Diseases, University of Iowa, Carver College of Medicine, IA, USA
| | - B A Brown-Elliott
- Department of Microbiology, The University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - R J Wallace
- Department of Microbiology, The University of Texas Health Science Center at Tyler, Tyler, TX, USA
| | - L M Baddour
- Division of Infectious Diseases, Departments of Medicine and Cardiovascular Diseases, Mayo Clinic, College of Medicine and Science, Rochester, MN, USA
| | - J M Miro
- Infectious Diseases Service at the Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - B Hoen
- Department of Infectious Diseases and Tropical Medicine, University Medical Center of Nancy, Vandoeuvre Cedex, France.
| | | | | | - E Athan
- Infectious Diseases Department at Barwon Health, University of Melbourne and Deakin University, Australia
| | - A Bayer
- Geffen School of Medicine at UCLA Senior Investigator - LA Biomedical Research Institute at Harbor-UCLA, USA
| | - B Barsic
- Department for Infectious Diseases, School of Medicine, University of Zagreb, Croatia
| | - G R Corey
- Duke University Medical Center, Hubert-Yeargan Center for Global Health, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - V H Chu
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - D T Durack
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - C Q Fortes
- Division of Infectious Diseases, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - V Fowler
- Departments of Medicine and Molecular Genetics & Microbiology, Duke University Medical Center, Durham, NC, USA
| | - B Hoen
- Department of Infectious Diseases and Tropical Medicine, University Medical Center of Nancy, Vandoeuvre Cedex, France
| | - A W Krachmer
- Harvard Medical School, Division of Infectious Diseases at the Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - E Durante-Magnoni
- Infectious and Transplant Medicine of the 'V. Monaldi' Teaching Hospital in Naples, University of Campania 'L. Vanvitelli', Italy
| | - J M Miro
- Infectious Diseases at the Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - W R Wilson
- Division of Infectious Diseases, Department of Internal Medicine, Mayo Clinic, College of Medicine and Science, Rochester, MN, USA
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Pericàs JM, Moreno A, Almela M, García-de-la-Mària C, Marco F, Muñoz P, Peña C, de Alarcón A, Del Río A, Eworo A, Cruceta A, Paré JC, Mestres CA, Miró JM. Efficacy and safety of fosfomycin plus imipenem versus vancomycin for complicated bacteraemia and endocarditis due to methicillin-resistant Staphylococcus aureus: a randomized clinical trial. Clin Microbiol Infect 2018; 24:673-676. [PMID: 29408610 DOI: 10.1016/j.cmi.2018.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 02/05/2023]
Affiliation(s)
- J M Pericàs
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - A Moreno
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
| | - M Almela
- Microbiology Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - C García-de-la-Mària
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - F Marco
- Microbiology Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain; Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | - P Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - C Peña
- Infectious Diseases Service, Hospital de Bellvitge, IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - A de Alarcón
- Infectious Diseases Service, UGC de Enfermedades Infecciosas, Microbiología y Medicina Preventiva Grupo de Investigacion en Enfermedades Infecciosas, Instituto de Biomedicina de Sevilla (IBiS)/CSIC/HU Virgen del Rocío, Sevilla, Spain
| | - A Del Río
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - A Eworo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | - A Cruceta
- Clinical Trials Unit, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J C Paré
- Cardiology Department, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C A Mestres
- Department of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - J M Miró
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.
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Figuerola-Tejerina A, Bustamante E, Tamayo E, Mestres CA, Bustamante-Munguira J. Ability to predict the development of surgical site infection in cardiac surgery using the Australian Clinical Risk Index versus the National Nosocomial Infections Surveillance-derived Risk Index. Eur J Clin Microbiol Infect Dis 2017; 36:1041-1046. [PMID: 28105547 DOI: 10.1007/s10096-016-2889-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/22/2016] [Indexed: 12/01/2022]
Abstract
Surgical site infection (SSI) is a major infectious complication that increases mortality, morbidity, and healthcare costs. There are scores attempting to classify patients for calculating SSI risk. Our objectives were to validate the Australian Clinical Risk Index (ACRI) in a European population after cardiac surgery, comparing it against the National Nosocomial Infections Surveillance-derived risk index (NNIS) and analyzing the predictive power of ACRI for SSI in valvular patients. All the patients that who underwent cardiac surgery in a tertiary university hospital between 2011 and 2015 were analyzed. The patients were divided into valvular and coronary groups, excluding mixed patients. The ACRI score was validated in both groups and its ability to predict SSI was compared to the NNIS risk index. We analyzed 1,657 procedures. In the valvular patient group (n: 1119), a correlation between the ACRI score and SSI development (p < 0.05) was found; there was no such correlation with the NNIS index. The area under the receiver-operating characteristic curve (AUC) was 0.64 (confidence interval [CI] 95%, 0.5-0.7) for ACRI and 0.62 (95% CI, 0.5-0.7) for NNIS. In the coronary group (n: 281), there was a correlation between ACRI and SSI but no between NNIS and SSI. The ACRI AUC was 0.70 (95% CI, 0.5-0.8) and the NNIS AUC was 0.60 (95% CI, 0.4-0.7). The ACRI score has insufficient predictive power, although it predicts SSI development better than the NNIS index, fundamentally in coronary artery bypass grafting (CABG). Further studies analyzing determining factors are needed.
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Affiliation(s)
- A Figuerola-Tejerina
- Department of Prevention & Control of Infection, Hospital Universitario de La Princesa, Madrid, Spain
| | - E Bustamante
- Department of Critical Care, Hospital Can Misses, Balearic Island, Spain
| | - E Tamayo
- Department of Anesthesiology and Reanimation, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - C A Mestres
- Department of Cardiothoracic and Vascular Surgery, Heart & Vascular Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - J Bustamante-Munguira
- Department of Cardiovascular Surgery, Hospital Universitario de La Princesa, Madrid, 28006, Spain.
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Capdevila JA, Guembe M, Barberán J, de Alarcón A, Bouza E, Fariñas MC, Gálvez J, Goenaga MA, Gutiérrez F, Kestler M, Llinares P, Miró JM, Montejo M, Muñoz P, Rodríguez-Creixems M, Sousa D, Cuenca J, Mestres CA. 2016 Expert consensus document on prevention, diagnosis and treatment of short-term peripheral venous catheter-related infections in adult. Rev Esp Quimioter 2016; 29:230-238. [PMID: 27580009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The use of endovascular catheters is a routine practice in secondary and tertiary care level hospitals. Short peripheral catheters have been found to be associated with the risk of nosocomial bacteremia resulting in morbidity and mortality. Staphyloccus aureus is mostly associated with peripheral catheter insertion. This Consensus Document has been elaborated by a panel of experts of the Spanish Society of Cardiovascular Infections in cooperation with experts from the Spanish Society of Internal Medicine, Spanish Society of Chemotherapy and Spanish Society of Thoracic-Cardiovascular Surgery and aims at define and establish the norm for management of short duration peripheral vascular catheters. The document addresses the indications for insertion, catheter maintenance and registry, diagnosis and treatment of infection, indications for removal and stresses on continuous education as a driver for quality. Implementation of this norm will allow uniformity in usage thus minimizing the risk of infection and its complications.
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Affiliation(s)
- J A Capdevila
- Josep A. Capdevila, Internal Medicine, Consorcio Hospitalario de Mataró, Barcelona (Spain).
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5
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Agüero F, Castel MA, Cocchi S, Moreno A, Mestres CA, Cervera C, Pérez-Villa F, Tuset M, Cartañà R, Manzardo C, Guaraldi G, Gatell JM, Miró JM. An Update on Heart Transplantation in Human Immunodeficiency Virus-Infected Patients. Am J Transplant 2016; 16:21-8. [PMID: 26523614 DOI: 10.1111/ajt.13496] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 08/19/2015] [Accepted: 08/19/2015] [Indexed: 01/25/2023]
Abstract
Cardiovascular diseases have become a significant cause of morbidity in patients with human immunodeficiency virus (HIV) infection. Heart transplantation (HT) is a well-established treatment of end-stage heart failure (ESHF) and is performed in selected HIV-infected patients in developed countries. Few data are available on the prognosis of HIV-infected patients undergoing HT in the era of combined antiretroviral therapy (cART) because current evidence is limited to small retrospective cohorts, case series, and case reports. Many HT centers consider HIV infection to be a contraindication for HT; however, in the era of cART, HT recipients with HIV infection seem to achieve satisfactory outcomes without developing HIV-related events. Consequently, selected HIV-infected patients with ESHF who are taking effective cART should be considered candidates for HT. The present review provides epidemiological data on ESHF in HIV-infected patients from all published experience on HT in HIV-infected patients since the beginning of the epidemic. The practical management of these patients is discussed, with emphasis on the challenging issues that must be addressed in the pretransplant (including HIV criteria) and posttransplant periods. Finally, proposals are made for future management and research priorities.
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Affiliation(s)
- F Agüero
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M A Castel
- Heart Failure and Heart Transplant Unit, Cardiology Department, Thorax Institut, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - S Cocchi
- Clinic of Infectious Diseases, Department of Internal Medicine and Medical Specialties, University of Modena and Reggio Emilia, Policlinico Hospital, Modena, Italy
| | - A Moreno
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C A Mestres
- Cardiovascular Surgery Department, Thorax Institute Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C Cervera
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - F Pérez-Villa
- Heart Failure and Heart Transplant Unit, Cardiology Department, Thorax Institut, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M Tuset
- Pharmacy Department, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - R Cartañà
- Cardiovascular Surgery Department, Thorax Institute Service, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C Manzardo
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - G Guaraldi
- Clinic of Infectious Diseases, Department of Internal Medicine and Medical Specialties, University of Modena and Reggio Emilia, Policlinico Hospital, Modena, Italy
| | - J M Gatell
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J M Miró
- Infectious Diseases Service, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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del Río A, Gasch O, Moreno A, Peña C, Cuquet J, Soy D, Mestres CA, Suárez C, Pare JC, Tubau F, Garcia de la Mària C, Marco F, Carratalà J, Gatell JM, Gudiol F, Miró JM, del Rio A, Moreno A, Pericas JM, Cervera C, Gatell JM, Marco F, de la Maria CG, Armero Y, Almela M, Mestres CA, Pare JC, Fuster D, Cartana R, Ninot S, Azqueta M, Sitges M, Heras M, Pomar JL, Ramirez J, Brunet M, Soy D, Llopis J, Gasch O, Suarez C, Pena C, Pujol M, Ariza J, Carratala J, Gudiol F, Cuquet J, Marti C, Mijana M. Efficacy and safety of fosfomycin plus imipenem as rescue therapy for complicated bacteremia and endocarditis due to methicillin-resistant Staphylococcus aureus: a multicenter clinical trial. Clin Infect Dis 2014; 59:1105-12. [PMID: 25048851 DOI: 10.1093/cid/ciu580] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND There is an urgent need for alternative rescue therapies in invasive infections caused by methicillin-resistant Staphylococcus aureus (MRSA). We assessed the clinical efficacy and safety of the combination of fosfomycin and imipenem as rescue therapy for MRSA infective endocarditis and complicated bacteremia. METHODS The trial was conducted between 2001 and 2010 in 3 Spanish hospitals. Adult patients with complicated MRSA bacteremia or endocarditis requiring rescue therapy were eligible for the study. Treatment with fosfomycin (2 g/6 hours IV) plus imipenem (1 g/6 hours IV) was started and monitored. The primary efficacy endpoints were percentage of sterile blood cultures at 72 hours and clinical success rate assessed at the test-of-cure visit (45 days after the end of therapy). RESULTS The combination was administered in 12 patients with endocarditis, 2 with vascular graft infection, and 2 with complicated bacteremia. Therapy had previously failed with vancomycin in 9 patients, daptomycin in 2, and sequential antibiotics in 5. Blood cultures were negative 72 hours after the first dose of the combination in all cases. The success rate was 69%, and only 1 of 5 deaths was related to the MRSA infection. Although the combination was safe in most patients (94%), a patient with liver cirrhosis died of multiorgan failure secondary to sodium overload. There were no episodes of breakthrough bacteremia or relapse. CONCLUSIONS Fosfomycin plus imipenem was an effective and safe combination when used as rescue therapy for complicated MRSA bloodstream infections and deserves further clinical evaluation as initial therapy in these infections.
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Affiliation(s)
- Ana del Río
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Oriol Gasch
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, Sabadell
| | - Asunción Moreno
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Carmen Peña
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat
| | - Jordi Cuquet
- Hospital General de Granollers, Universitat Internacional de Catalunya, Barcelona
| | - Dolors Soy
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Carlos A Mestres
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Cristina Suárez
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat
| | - Juan C Pare
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Fe Tubau
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat CIBERES (CIBER de Enfermedades Respiratorias), ISCIII, Madrid
| | | | - Francesc Marco
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona Barcelona Centre for International Health Research (CRESIB, Hospital Clínic-Universitat de Barcelona), Spain
| | - Jordi Carratalà
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat
| | - José M Gatell
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Francisco Gudiol
- Hospital de Bellvitge-Institut d'Investigació Biomèdica de Bellvitge, University of Barcelona, L'Hospitalet de Llobregat
| | - José M Miró
- Hospital Clínic-Institut d' Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
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Garcia-Valentin A, Mestres CA, Bernabeu E, Martin I, Rueda C, Domenech A, Valencia J, Fletcher D. 026 * VALIDATION AND QUALITY MEASUREMENTS FOR EUROSCORE AND EUROSCORE II IN THE SPANISH POPULATION: A PROSPECTIVE AND MULTICENTRE STUDY. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Delahaye F, Chu VH, Hoen B, Mestres CA, Pappas P, Santos M, Wang A. Association between type of valve prosthesis and one year mortality in IE: an analysis of 1467 patients from the International collaboration on endocarditis prospective cohort study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p4768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Czerny M, Bachet J, Bavaria J, Bonser RS, Borger MA, De Paulis R, DiBartolomeo R, Grabenwoger M, Lonn L, Loubani M, Mestres CA, Schepens MAAM, Weigang E, Carrel TP. The future of aortic surgery in Europe. Eur J Cardiothorac Surg 2012; 43:226-30. [DOI: 10.1093/ejcts/ezs413] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Mestres CA, Fita G, Parra VM, Pomar JL, Bernal JM. Tricuspid valve surgery. HSR Proc Intensive Care Cardiovasc Anesth 2012; 4:261-7. [PMID: 23439774 PMCID: PMC3563560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The tricuspid valve has been taken as a non-critical valve in terms of acute or late mortality in a number of conditions. Tricuspid functional regurgitation is a cause of late operations with an increased morbidity. A number of techniques have been described and used in clinical practice in the past forty years and include simple suture techniques and the use of support for annuloplasty with the use of different types of prosthetic rings. The experience accumulated over the years indicates that tricuspid annuloplasty is mandatory to improve late results, which are superior, in general, to replacement of the valve. METHODS The role of echocardiography in defining surgical planning, intraoperative results and follow-up is reviewed as echocardiography is a fundamental tool in cardiac surgery. Surgery for isolated lesions of the tricuspid valve has not received much attention and herein we report the results of the follow-up of a limited series of patients undergoing isolated tricuspid surgery. RESULTS The correlation between echocardiographic measurements and surgical measurements was confirmed and was helpful at the time of the confirmation of repair (r=0.53). Forty-seven patients (18 repair, 29 replacement) underwent isolated surgery. Results of isolated tricuspid repair seemed to be superior when compared to those of tricuspid replacement. Survival was 20.7% for tricuspid valve replacement (N=18) and 50% for tricuspid valve repair (N=29) (p=0.04). Freedom from reoperation was 94.4±5.4% for repair and 67.3±12.1% for replacement (p= 0.0011). CONCLUSIONS The tricuspid valve continues to be a surgical challenge.
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Affiliation(s)
- C A Mestres
- Department of Cardiovascular Surgery, Hospital Clínico. University of Barcelona, Barcelona, Spain
| | - G Fita
- Department of Anesthesiology, Hospital Clinico, University of Barcelona, Barcelona, Spain
| | - V M Parra
- National Chest Institute and School of Medicine, University of Chile, Santiago, Chile
| | - J L Pomar
- Department of Cardiovascular Surgery, Hospital Clínico. University of Barcelona, Barcelona, Spain
| | - J M Bernal
- Department of Cardiovascular Surgery, Hospital Universitario Valdecilla, University of Cantabria, Santander, Spain
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Falces C, García de la Mària C, Mestres CA, del Río A, Marco F, Moreno A, Miró JM. [Antibiotic prophylaxis for infectious endocarditis: who needs it and when to recommend it]. Rev Esp Anestesiol Reanim 2009; 56:135-138. [PMID: 19408779 DOI: 10.1016/s0034-9356(09)70355-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
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13
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Lalani T, Kanafani ZA, Chu VH, Moore L, Corey GR, Pappas P, Woods CW, Cabell CH, Hoen B, Selton-Suty C, Doco-Lecompte T, Chirouze C, Raoult D, Miro JM, Mestres CA, Olaison L, Eykyn S, Abrutyn E, Fowler VG. Prosthetic valve endocarditis due to coagulase-negative staphylococci: findings from the International Collaboration on Endocarditis Merged Database. Eur J Clin Microbiol Infect Dis 2006; 25:365-8. [PMID: 16767483 DOI: 10.1007/s10096-006-0141-z] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Infective endocarditis due to coagulase-negative staphylococci is increasingly recognized as a difficult-to-treat disease associated with poor outcome. The aim of this report is to describe the characteristics and outcome of patients with prosthetic valve endocarditis (PVE) due to coagulase-negative staphylococci versus those of patients with PVE due to Staphylococcus aureus and viridans streptococci. Patients were identified through the International Collaboration on Endocarditis Merged Database. A total of 54 cases of coagulase-negative staphylococci PVE, 58 cases of S. aureus PVE, and 63 cases of viridans-streptococci-related PVE were available for analysis. There was no difference between the three groups with respect to the type of valve involved or the rate of embolization. However, heart failure was encountered more frequently with coagulase-negative staphylococci (54%) than with either S. aureus (33%; p=0.03) or viridans streptococci (32%; p=0.02). In addition, valvular abscesses complicated 39% of infections due to coagulase-negative staphylococci compared with 22% of those due to S. aureus (p=0.06) and 6% of those due to viridans streptococci (p<0.001). Mortality was highest in patients with S. aureus and coagulase-negative staphylococcal endocarditis (47 and 36%, respectively; p=0.22) and was considerably lower in patients with viridans streptococcal endocarditis (p=0.002 compared to patients with coagulase-negative staphylococcal endocarditis). The results of this analysis demonstrate the aggressive nature of coagulase-negative staphylococcal PVE and the substantially greater morbidity and mortality associated with this infection compared to PVE caused by other pathogens.
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Affiliation(s)
- T Lalani
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
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14
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Anguera I, Del Río A, Miró JM, Matínez-Lacasa X, Marco F, Gumá JR, Quaglio G, Claramonte X, Moreno A, Mestres CA, Mauri E, Azqueta M, Benito N, García-de la María C, Almela M, Jiménez-Expósito MJ, Sued O, De Lazzari E, Gatell JM. Staphylococcus lugdunensis infective endocarditis: description of 10 cases and analysis of native valve, prosthetic valve, and pacemaker lead endocarditis clinical profiles. Heart 2005; 91:e10. [PMID: 15657200 PMCID: PMC1768720 DOI: 10.1136/hrt.2004.040659] [Citation(s) in RCA: 137] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To evaluate the incidence and the clinical and echocardiographic features of infective endocarditis (IE) caused by Staphylococcus lugdunensis and to identify the prognostic factors of surgery and mortality in this disease. DESIGN Prospective cohort study. SETTING Study at two centres (a tertiary care centre and a community hospital). PATIENTS 10 patients with IE caused by S lugdunensis in 912 consecutive patients with IE between 1990 and 2003. METHODS Prospective study of consecutive patients carried out by the multidisciplinary team for diagnosis and treatment of IE from the study institutions. English, French, and Spanish literature was searched by computer under the terms "endocarditis" and "Staphylococcus lugdunensis" published between 1989 and December 2003. MAIN OUTCOME MEASURES Patient characteristics, echocardiographic findings, required surgery, and prognostic factors of mortality in left sided cases of IE. RESULTS 10 cases of IE caused by S lugdunensis were identified at our institutions, representing 0.8% (four of 467), 1.5% (two of 135), and 7.8% (four of 51) of cases of native valve, prosthetic valve, and pacemaker lead endocarditis in the non-drug misusers. Native valve IE was present in four patients (two aortic, one mitral, and one pulmonary), prosthetic valve aortic IE in two patients, and pacemaker lead IE in the other four patients. All patients with left sided IE had serious complications (heart failure, periannular abscess formation, or shock) requiring surgery in 60% (three of five patients) of cases with an overall mortality rate of 80% (four of five patients). All patients with pacemaker IE underwent combined medical treatment and surgery, and mortality was 25% (one patient). In total 59 cases of IE caused by S lugdunensis were identified in a review of the literature. The combined analysis of these 69 cases showed that native valve IE (53 patients, 77%) is characterised by mitral valve involvement and frequent complications such as heart failure, abscess formation, and embolism. Surgery was needed in 51% of cases and mortality was 42%. Prosthetic valve endocarditis (nine of 60, 13%) predominated in the aortic position and was associated with abscess formation, required surgery, and high mortality (78%). Pacemaker lead IE (seven of 69, 10%) is associated with a better prognosis when antibiotic treatment is combined with surgery. CONCLUSIONS S lugdunensis IE is an uncommon cause of IE, involving mainly native left sided valves, and it is characterised by an aggressive clinical course. Mortality in left sided native valve IE is high but the prognosis has improved in recent years. Surgery has improved survival in left sided IE and, therefore, early surgery should always be considered. Prosthetic valve S lugdunensis IE carries an ominous prognosis.
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Affiliation(s)
- I Anguera
- Department of Cardiology, Corporació Parc Taulí, Hospital de Sabadell, Sabadell, Spain
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15
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Jiménez-Expósito MJ, Torres G, Baraldés A, Benito N, Marco F, Paré JC, Moreno A, Claramonte X, Mestres CA, Almela M, García de la María C, Pérez N, Schell WA, Corey GR, Perfect J, Jiménez de Anta MT, Gatell JM, Miró JM. Native valve endocarditis due to Candida glabrata treated without valvular replacement: a potential role for caspofungin in the induction and maintenance treatment. Clin Infect Dis 2004; 39:e70-3. [PMID: 15472836 DOI: 10.1086/424018] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2004] [Accepted: 06/02/2004] [Indexed: 02/05/2023] Open
Abstract
Conventional antifungal therapy for fungal endocarditis has been associated with a poor cure rate. Therefore, combined medical and surgical therapy has been recommended. However, new potent antifungal agents, such as echinocandins, could increase the medical options and, in some cases, avoid the need for surgery. We report a case of Candida endocarditis treated successfully without valve replacement with intravenous liposomal amphotericin B (total dose, 4 g) and intravenous caspofungin (a 100-mg loading dose followed by 50 mg per day for 8 weeks) as induction therapy and intravenous caspofungin (100 mg 3 times per week for 12 weeks) as maintenance therapy.
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Affiliation(s)
- M J Jiménez-Expósito
- Institut d'Investigacions Biomediques August Pi i Sunyer-Hospital Clinic, University of Barcelona, Barcelona, Spain
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16
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Devyatko E, Laczkovits A, Oster H, Moritz A, Roth M, Rohn V, Mestres CA, Simon P. Does complete arterial revascularisation increase the risk of perioperative complications? (Complete Arterial Revascularusation And Conventional Coronary Artery Surgery Study – CARACCASS data). Thorac Cardiovasc Surg 2004. [DOI: 10.1055/s-2004-816575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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17
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Losa JE, Miro JM, Del Rio A, Moreno-Camacho A, Garcia F, Claramonte X, Marco F, Mestres CA, Azqueta M, Gatell JM. Infective endocarditis not related to intravenous drug abuse in HIV-1-infected patients: report of eight cases and review of the literature. Clin Microbiol Infect 2003; 9:45-54. [PMID: 12691542 DOI: 10.1046/j.1469-0691.2003.00505.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To add to the limited information on infective endocarditis (IE) not related to intravenous drug abuse (IVDA) in HIV-1-infected patients. METHODS We have reviewed the characteristics of eight cases of IE in non-IVDA HIV-1 infected patients diagnosed in our institution between 1979 and 1999 as well as cases in the literature. RESULTS All our patients were male, and the mean age was 44 years (range 29-64). HIV-1 risk factors were: homosexuality in five, heterosexuality in two, and the use of blood products in one. HIV stage C was found in six cases, and the median (range) CD4 cell count was 22/microL (4-274 cells/microL). IE was caused by Enterococcus faecalis in three cases, staphylococci in two cases, and Salmonella enteritidis, viridans group streptococci and Coxiella burnetii in one case each. Three patients acquired IE while in the hospital. All IE cases involved a native valve, and underlying valve disease was found in three patients. The aortic valve was the most frequently affected (five cases). Two patients underwent surgery, with a good outcome, and one patient died. Fourteen cases of IE not related to IVDA in HIV-1-infected patients were found in the literature review. The most common causative agents were Salmonella spp. and fungi (four cases each). Two patients had prosthetic valve IE, and the mitral valve was the most frequently affected (10 cases). The remaining clinical characteristics and the outcome were similar to those in the present series. CONCLUSIONS IE not related to IVDA is rare in HIV-1-infected patients. In more than half of the cases, IE develops in patients with advanced HIV-1 disease. A wide etiologic range is found, reflecting different clinical and environmental conditions. None of the patients who underwent surgery died, and the overall mortality rate was not higher than in non-HIV-1-infected patients with IE.
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Affiliation(s)
- J E Losa
- Fundación Hospital de Alcorcón, Madrid, Spain
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18
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Anguera I, Quaglio G, Miró JM, Paré C, Azqueta M, Marco F, Mestres CA, Moreno A, Pomar JL, Mezzelani P, Sanz G. Aortocardiac fistulas complicating infective endocarditis. Am J Cardiol 2001; 87:652-4, A10. [PMID: 11230858 DOI: 10.1016/s0002-9149(00)01449-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study sought to determine the clinical and echocardiographic features, surgical approach, and outcome of patients with infective endocarditis complicated with aortocardiac fistulas among a series of 346 consecutive cases between 1988 and 1998. Nine patients (2%) were found to have aortocardiac fistulas complicating infective endocarditis caused by highly pyogenic pathogens (4 patients had ruptured abscesses of the right sinus of Valsalva, 3 had fistulous communications from the left coronary sinus, and 1 had a fistulized abscess in the noncoronary sinus). Mortality in these patients was very high (55%), even when surgery was attempted early in the course of the disease and reconstructive procedures were implemented.
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Affiliation(s)
- I Anguera
- Cardiovascular Institute, Department of Microbiology, Institut d'Investigacions Biomèdiques August Pi I Sunyer-Hospital Clinic, University of Barcelona, Spain
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19
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Mestres CA, Agusti E, Martinez A, Cabrer C, Manyalich M, Cartaña R, Pomar JL. Cardiovascular tissue banking in the non-cadaveric setting: ten-year experience of a university hospital-based bank with active organ donation program. J Heart Valve Dis 2000; 9:523-9. [PMID: 10947045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Today, transplantation of cardiovascular tissues is common practice, and tissue banking has become routine. Consequently, many institutions exist which carry out high-quality tissue banking. METHODS The Hospital Clinico of the University of Barcelona established its cardiovascular tissue bank in 1989. The bank follows international and national regulations, and functions as a non-profit-making organization. Organ and tissue donors are recruited by the Transplant Coordination unit, which works closely with the Catalonian Organ Transplant Network (OCAT) and the Spanish National Organ Transplantation Network (ONT). The hearts are removed during multi-organ donation and processed using aseptic techniques in a laminar flow hood. Hearts are only accepted from brain-dead multiorgan and non-beating-heart donors. The heart valves are dissected, decontaminated, cryopreserved in specific media and stored in liquid nitrogen at -196 degrees C under strict bacteriological and serological control. RESULTS Between 1989 and 1999, a series of 1,005 cardiovascular donors from within Spain was identified, from which 840 hearts were processed. After evaluation, 1,099 (65.4%) valves were cryopreserved, and 1,023 (61.5%) given clearance for implantation. In total, 534 aortic, 530 pulmonary, 33 mitral and two tricuspid valves were processed; ultimately 92.8% of aortic and 93.9% of pulmonary valves were accepted for clinical implantation. The rejection rate was 39.1%. Homografts were transported to their destination in dry ice in a cryogenic container. Overall, 608 valves were implanted at our own institution and at hospitals in Barcelona and Europe. Only two cases of complaint were received from implanting surgeons. CONCLUSION After ten years' experience, the degree of satisfaction of implanting surgeons appears to be adequate. Strict control of the entire tissue banking process has permitted the availability of high-quality homografts for clinical implantation.
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Affiliation(s)
- C A Mestres
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Spain
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20
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Mestres CA, Josa M. Transmyocardial jet after percutaneous transmyocardial revascularization. Eur J Cardiothorac Surg 2000; 17:620. [PMID: 10814931 DOI: 10.1016/s1010-7940(00)00393-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- C A Mestres
- Cardiovascular Surgery, The Institute of Cardiovascular Diseases, Hospital Clinico, University of Barcelona, Barcelona, Spain.
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21
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Mestres CA, Pomar JL. Mitral valve replacement with a pulmonary autograft: initial experience. J Heart Valve Dis 2000; 9:169. [PMID: 10678393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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22
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Abstract
Left ventricular myxoma is a rare benign cardiac tumor. Surgical excision is the treatment of choice and completeness of removal is mandatory to avoid late recurrence. A case is presented in which aortic transvalvular video-assisted cardioscopy was used to facilitate removal.
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Affiliation(s)
- E Greco
- Cardiovascular Surgery, The Institute of Cardiovascular Diseases, Hospital Clinic, University of Barcelona, Spain
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23
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Mestres CA, Miro JM, Pare JC, Pomar JL. Six-year experience with cryopreserved mitral homografts in the treatment of tricuspid valve endocarditis in HIV-infected drug addicts. J Heart Valve Dis 1999; 8:575-7. [PMID: 10517401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY In the past, valve homografts have been used in the treatment of aortic endocarditis. This report details our experience in tricuspid valve replacement using cryopreserved mitral homografts in HIV-positive drug addicts with infective endocarditis. METHODS Five HIV-1-infected drug addicts with active uncontrollable tricuspid valve endocarditis underwent tricuspid valve replacement with a cryopreserved mitral homograft. RESULTS There was no early mortality, and median follow up was 5 years (range: 1 to 6 years). One late mortality occurred as a result of heroin overdose. Three of the five patients developed six episodes of recurrent bacterial tricuspid endocarditis on the homograft; these were cured successfully with antibiotics. All survivors remain in NYHA functional class I. The latest transthoracic echocardiography examination showed mild, moderate or severe regurgitation in one, two and two patients, respectively. To date, neither homograft calcification nor rupture of the papillary muscle has been detected. CONCLUSIONS This novel technique is considered to be an adequate approach to these cases of uncontrollable infectious disease. Further episodes of valvular infection can be managed medically.
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Affiliation(s)
- C A Mestres
- Department of Cardiovascular Surgery, Hospital Clinic, University of Barcelona, Spain
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24
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Mestres CA, Aramendi JI. [Minimal access and minimally invasive coronary surgery]. Rev Esp Cardiol 1998; 51 Suppl 3:99-105. [PMID: 9717411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
After almost three decades of coronary artery surgery, there is a new interest in certain types of surgical interventions that may reduce the biological trauma through the elimination of cardiopulmonary bypass (CPB) and by practising through smaller thoracic incisions. Attempts are being made to demonstrate which operations can be performed without CPB or through minimal incisions. The operations without CPB are as old as coronary surgery itself, however they were abandoned because of the reliability and efficacy of doing coronary surgery in a bloodless and quiet field. Today a few series are already available showing that single-vessel coronary artery disease and an adequate patient selection seem to be, for the moment, fundamental issues in obtaining results as good as those obtained using conventional techniques and accesses. The main problem continues to be the quality of the anastomoses done with the heart beating or through small incisions that can make the work of the surgeon uncomfortable. Therefore, it is of utmost importance to collect postoperative angiographic data. In any case, we are in a very important moment in the history of coronary artery surgery as everybody is interested in evaluating the alternatives to reduce biological trauma by avoiding CPB and reducing the size of the incisions. These facts can have a positive influence on future results and in the reduction of the comprehensive costs of coronary artery surgery and therefore the actual impact of minimal invasive surgery.
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Affiliation(s)
- C A Mestres
- Servicio de Cirugía Cardiovascular, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia
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25
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Mestres CA, Sánchez-Martos A, Rodríguez-Ribó A, Dávalos R, Galcerá J, Fuentes M. Long-distance transportation of patients with a paracorporeal left ventricular assist device. Int J Artif Organs 1998; 21:425-8. [PMID: 9745999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Patients in cardiogenic shock refractory to basic medical therapy may require specialised assistance in a multispeciality environment distant to the institution where they are first admitted. In such situations, transportation of these critical patients may be difficult and involve many risks. Here we describe the case histories of two patients who underwent implantation of a paracorporeal left ventricular assist device and were transferred to specialised institutions for extended treatment. The distance of transportation was 400 km and the patients were transported by ambulance and helicopter. Some aspects of logistics and complexity of long-distance transportation are also commented on.
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Affiliation(s)
- C A Mestres
- Cardiovascular Surgery Department, Hospital Universitario Virgen de la Arrixaca, University of Murcia, Spain
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26
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Mestres CA, Fuentes M. [Minimally invasive surgery of the mitral valve]. Rev Esp Cardiol 1998; 51:161-3. [PMID: 9542440 DOI: 10.1016/s0300-8932(98)74727-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The technique of minimal access for mitral valve operations is commented on. A small right mediastinotomy is performed, which is a small right parasternal incision with resection of two costal cartilages. A correct exposure of the mitral valve is achieved through the right atrium and interatrial septum, allowing for adequate surgical correction.
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Affiliation(s)
- C A Mestres
- Servicio de Cirugía Cardiovascular, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia
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27
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Talbot-Wright R, Mestres CA, Campistol JM, Alcaraz A, Oppenheimer F, Carretero P. Simultaneous aortic bifurcation graft and kidney transplantation from the same multi-organ donor: a new therapeutic tool in complex renal transplantation. J Urol 1996; 156:2000-1. [PMID: 8911375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- R Talbot-Wright
- Department of Urology, Hospital Clinic i Provincial, University of Barcelona, Spain
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28
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Mestres CA, Talbot-Wright R, Carretero P. Simultaneous aortorenal homograft transplantation: expanding the indications for renal and vascular replacement. Br J Surg 1996; 83:918. [PMID: 8813774 DOI: 10.1002/bjs.1800830711] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- C A Mestres
- Department of Cardiovascular Surgery, Hospital Clinico Provincial, University of Barcelona, Spain
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29
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Abstract
Between October 1992 and June 1994, 16 patients (mean age, 55.6 years) underwent vascular reconstruction using cryopreserved arterial allografts. Aortoiliac aneurysms, vascular infections, and trauma accounted for the majority of case diagnoses. Twenty allografts were implanted. Two patients died in the hospital (12.5%) and 1 patient died 9 months after the operation. Early patency rate on angiography is 92.9%. Follow-up averages 8.2 months. Large-caliber cryopreserved arterial vascular allografts seem to provide satisfactory clinical results.
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Affiliation(s)
- C A Mestres
- Department of Cardiovascular Surgery, Hospital Clinico y Provincial, Universidad de Barcelona, Spain
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30
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Abstract
Five patients with suprarenal aortic thrombosis were diagnosed and treated over the past 6 years. Attempts were made to establish aggressive medical and surgical treatment promptly. Three patients died in spite of immediate therapeutic measures. Two patients survived operation but one died 9 months later from myocardial infarction. The syndrome of high acute aortic occlusion is considered; attention is focused towards immediate diagnosis and treatment.
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Affiliation(s)
- C A Mestres
- Department of Cardiovascular Surgery, Hospital Clínic i Provincial, University of Barcelona, Spain
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31
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Hernández MV, Antonio del Olmo J, Orellana C, Mestres CA, Mũnoz-Gómez J. Monomelic hypertrophic osteoarthropathy secondary to aortic prosthesis infection. J Rheumatol Suppl 1995; 22:183-5. [PMID: 7699670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We describe a case of hypertrophic osteoarthropathy (HOA), exclusively located in the left lower leg and secondary to vascular prosthesis infection. Four years before, the patient underwent aortofemoral bifurcation grafting because of a ruptured aortic aneurysm. The investigations revealed prosthesis infection by Pseudomona aeruginosa and Bacteroides thetaiotamicron. The onset of HOA in a patient with a vascular prosthesis can help to achieve an early diagnosis of graft infection. The literature on this uncommon association is reviewed.
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Affiliation(s)
- M V Hernández
- Department of Rheumatology, Hospital Clínic i Provincial, University of Barcelona, Spain
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Mestres CA, Miro JM, Pomar JL. Cryopreserved homografts in the treatment of relapsing fungal cardiovascular infections. J Thorac Cardiovasc Surg 1994; 108:990-1. [PMID: 7967687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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33
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Pera M, Mestres CA, Pomar JL. [Cardiac surgery in patients over 70. Its incidence and trends in Spain]. Rev Esp Cardiol 1994; 47:678-81. [PMID: 7991921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION AND OBJECTIVES During the last years elderly population has been growing in all the occidental world. Consequently the number of elderly patients undergoing cardiac surgery has increased. The aim of this work is to know whether this increase has also taken place in Spain. METHODS A survey among the different Units in the country was performed. The number and percentages of patients older than 70 years with coronary and valvular heart disease operated among 1991 and 1992 was analysed. Twenty-one of the 28 units replied (74%). RESULTS The percentage of coronary patients older than 70 years operated in 1991 was 15.61% and 19.20% in 1992, a statistically significant increase of 21.84% (p < 0.001). However, there was no significant increase in the number of elderly patients undergoing valvular surgery. CONCLUSIONS The influence of the elderly population on the activity in cardiac surgery is known to be significant; thus, a careful analysis of the health, social and economic implications seems to be mandatory.
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Affiliation(s)
- M Pera
- Servicio de Cirugía Cardiovascular, Hospital Clínico y Provincial, Universidad de Barcelona
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34
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Pomar JL, Mestres CA, Pare JC, Miro JM. Management of persistent tricuspid endocarditis with transplantation of cryopreserved mitral homografts. J Thorac Cardiovasc Surg 1994; 107:1460-3. [PMID: 8196388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Transplantation of the human mitral valve in the tricuspid position for intractable infective endocarditis has been successfully performed in three young patients who were addicted to drugs. The maximum follow-up is 20 months. The rationale and historical basis for using this approach in the surgical treatment of patients with right-sided infective endocarditis is discussed and the appropriate literature reviewed. Because the technical aspects have been previously reported, this article can be considered an argument to renew past interest in atrioventricular valve replacement with fully biologic tissue of human origin.
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Affiliation(s)
- J L Pomar
- Department of Cardiovascular Surgery, Hospital Clinico y Provincial, University of Barcelona, Spain
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35
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Barriuso C, Ninot S, Naja I, Cartañá R, Acosta M, Mestres CA, Mulet J. [Postinfarction ventricular septal defect. Surgical approach by right ventriculotomy in 4 patients]. Rev Esp Cardiol 1994; 47:60-3. [PMID: 8128087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Ventricular septal defect secondary to myocardial infarction still have high mortality. Early and swift surgical repair is needed to obtain adequate results. Surgical exposure of defect through the infarcted left ventricle wall is the usual technique. Nevertheless right ventricular access to the interventricular septum has given excellent results on 4 of our patients. Our results are analyzed.
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Affiliation(s)
- C Barriuso
- Servicio de Cirugía Cardiovascular, Hospital Clínic i Provincial de Barcelona, Facultad de Medicina, Universidad de Barcelona
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36
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Mestres CA, Ginel A, Cartana R, Pomar JL. Cryopreserved homografts in aortic and mitral prosthetic endocarditis: expanding the use of biological tissues in complex cardiac infections. J Heart Valve Dis 1993; 2:679-83. [PMID: 7719510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The case of a 27-year-old male heroin addict suffering from mitral and aortic prosthetic valve endocarditis is presented. Double valve re-replacement was performed using cryopreserved aortic homografts. Aortic root replacement with coronary re-implantation and intra-atrial valve implantation for mitral valve replacement were the techniques used. Despite the fatal outcome of this case, it clearly illustrates the possibilities of expanding the indications for combined complex replacement of heart valves by using fully biological tissue of human origin.
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Affiliation(s)
- C A Mestres
- Department of Cardiovascular Surgery, Hospital Clinicoy Provincial, University of Barcelona, Spain
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37
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Pomar JL, Mestres CA. Tricuspid valve replacement using a mitral homograft. Surgical technique and initial results. J Heart Valve Dis 1993; 2:125-8. [PMID: 8261148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Tricuspid valve replacement using a cryopreserved mitral valve homograft was carried out with success in three HIV positive drug addicts suffering from fungal or bacterial endocarditis. All three patients are alive and symptomless up to 16 months after surgery. This procedure is considered to be an alternative to other methods of tricuspid valve replacement if repair is not feasible. Further experience is needed to assess the long term performances of mitral homografts in the tricuspid position.
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Affiliation(s)
- J L Pomar
- Department of Cardiovascular Surgery, Hospital Clinico y Provincial, University of Barcelona, Spain
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38
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Soo CS, Choo MH, Lee CN, Tay M, Mestres CA, Lim M. Overestimation of severity of mitral stenosis during cardiac catheterization due to a large left atrial thrombus. Singapore Med J 1992; 33:530-1. [PMID: 1455287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We report a case of mitral stenosis with a large left atrial thrombus which was obstructing pulmonary venous inflow where the conventional use of the pulmonary capillary wedge pressure as an approximation of the left atrial pressure during diagnostic cardiac catheterisation led to the over-estimation of the severity of mitral stenosis.
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Affiliation(s)
- C S Soo
- Cardiac Department, National University Hospital, Singapore
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39
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Sim EK, Lee CN, Mestres CA, Adebo OA. Ectopic thymoma: a case for median sternotomy for complete thymectomy. Singapore Med J 1992; 33:407-8. [PMID: 1411677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Thymomas are normally found in the superior mediastinum or the upper part of the anterior mediastinum. We report a case of thymoma arising in the inferior aspect of the anterior mediastinum. This case illustrates that thymic tissue may be found low in the anterior mediastinum and supports the practice of a median sternotomy approach for thorough mediastinal exploration in all cases of thymectomy.
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Affiliation(s)
- E K Sim
- Division of Cardiothoracic Surgery, National University Hospital, Singapore
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40
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Abstract
Coronary atherosclerosis is being increasingly observed in young patients. However results of surgery in such patients have so far been disappointing both in terms of operative mortality, symptomatic relief and long-term survival. Reasons given for this include the increased prevalence of risk factors in young patients and a higher incidence of graft occlusion. In the treatment of Asian patients, a further negative factor is the belief that coronary artery disease is more often diffuse and the vessels smaller. Between January 1987 and May 1991, a total of 66 patients under the age of 45 years at the time of surgery had coronary artery bypass grafting performed. The demographic, clinical, angiographic and operative data were analysed. Eighty-nine per cent of the patients were male and their racial distribution was 63% Chinese, 8% Malays, 26% Indians and 3% Others. Their mean age was 40.8 years. The presence of risk factors was high: 45.6% had hypertension; 34.8% were smokers; 21.2% had diabetes mellitus; and 12.1% had hyperlipidaemia. The main indication in these patients was either angina or a previous myocardial infarction (53%). There were no patients with perioperative infarction diagnosed by the presence of new Q wave. There was no hospital death. The stay of the patients ranged from 6 to 28 days with a mean of 10 days. Follow-up ranged from 3 to 54 months. There were no late deaths. It was concluded that there is a high incidence of risk factors among young patients with coronary artery disease, which follows the pattern of many other studies. The operative risk in these patients is low and morbidity is minimal.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- E K Sim
- Division of Cardiothoracic Surgery, National University Hospital, Singapore
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41
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Sim EK, Mestres CA, Lim MC, Adebo OA, Lee CN. Early experiences of intra-operative trans-oesophageal echocardiography (TEE) in mitral valve repair. Med J Malaysia 1992; 47:77-80. [PMID: 1387456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Whenever possible Mitral valve repair should be performed instead of Mitral valve replacement. It is important to assess the adequacy of the repair during the operation so that any corrective steps may be taken immediately. We present three cases of Mitral valve repair in which the intraoperative TEE was used to assess the adequacy of the repair. There was good correlation of the immediate post bypass TEE findings and early post operative transthoracic echocardiographic findings. Intraoperative TEE is a useful tool in the early assessment of Mitral Valve Repair.
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Affiliation(s)
- E K Sim
- Division of Cardiothoracic Surgery, National University Hospital, Singapore
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42
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Abstract
Two cases of successful mitral valve repair in patients on chronic hemodialysis are presented. We stress that valve repair is preferable to valve replacement whenever feasible because of improved left ventricular function, reduced complication rate, and freedom from anticoagulation. This especially applies to patients on chronic hemodialysis as they have impaired immunological function, are subjected to repeated fistula punctures with possible bacteremia, and are more susceptible to early calcification and degeneration of tissue valves.
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Affiliation(s)
- E K Sim
- Division of Cardiothoracic Surgery, National University Hospital, Singapore
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43
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Abstract
The case of a young patient who presented with severe hemolysis after mitral valve repair is presented. Valve repair included chordal shortening, transposition of chordae tendinae, and annular remodelling using a Duran flexible ring. Reoperation and valve replacement were required to control hemolytic anemia. The possible mechanisms leading to such an uncommon complication after plastic repair of the mitral valve are commented on. The scanty literature concerned is reviewed.
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Affiliation(s)
- C A Mestres
- Division of Cardiothoracic Surgery, National University Hospital, National University of Singapore
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44
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Mestres CA, Acosta M, Paré C, Cartañá R, Martínez A, Pomar JL. [Aortic valve replacement by a pulmonary homograft]. Rev Esp Cardiol 1991; 44:408-10. [PMID: 1924956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Minor experience still exists in our country with regard to the use of valve homografts in cardiac surgery. Only a few implantations have been performed in cases of right ventricular outflow tract reconstruction in addition to our own experience in cases of infective endocarditis of the aortic valve. We present a case of aortic valve replacement by using an antibiotic-sterilized fresh pulmonary valve autograft. The case is described and the possible advantages of the use of pulmonary allografts in the aortic position are discussed.
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Affiliation(s)
- C A Mestres
- Servicio de Cirugía Cardiovascular, Hospital Clínic i Provincial, Barcelona
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45
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Abstract
Over a 7-year-period, 25 patients had delayed sternal closure after open heart operations out of 34 patients whose sternum was not closed. The indications were extreme cardiac dilatation and uncontrollable mediastinal hemorrhage. This represented a 1.79% incidence in the overall open heart surgical experience at our unit. Sternal closure was performed at a mean of 2.64 days after the initial operation. Eighteen patients (52.9%) left the hospital alive and well, representing a 72% survival rate among patients undergoing delayed sternal closure. No mediastinal or fatal infection developed and only 1 patient had late superficial wound infection after delayed sternal closure. We conclude that delayed sternal closure is an effective method to treat severe complications after cardiac operations.
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Affiliation(s)
- C A Mestres
- Department of Cardiovascular Surgery, Hospital Clinico y Provincial, Barcelona, Spain
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46
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Mestres CA, Martínez A, Cartañá R, Pomar JL. [An alternative approach in the surgical treatment of infectious endocarditis. The fresh antibiotic-sterilized aortic valve homograft]. Rev Esp Cardiol 1991; 44:273-6. [PMID: 2068371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Following the pioneering work of Ross and Barratt-Boyes, there is currently a strong evidence based on long-term follow-up data that valve homografts are the best valve substitutes in the aortic position. Currently there exists a renewed interest in the use of fresh and cryopreserved homografts as we know that homografts show a prolonged durability together with the lack of thromboembolic complications. Here we present the case histories of 3 patients undergoing aortic valve replacement by fresh homografts sterilized in antibiotic solution. The underlying pathology was infective endocarditis in all 3 patients, a disease that is considered the ideal indication for homograft implantation. Technical details at the time of implantation, their advantages with regard to other replacements devices and the whole process of procurement, manipulation and preservation are commented on.
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Affiliation(s)
- C A Mestres
- Cirugía Cardiovascular, Universidad de Barcelona
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47
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Adebo OA, Lee CN, Mestres CA. Myocardial revascularisation in patients with carotid artery disease. Ann Acad Med Singap 1991; 20:228-30. [PMID: 1883181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
From January 1987 to December 1989, 80 patients with carotid bruit and/or history of transient ischaemic attack/stroke underwent digital subtraction angiography (DSA) prior to consideration for coronary artery bypass graft. Thirty-eight patients (Group I) out of the 80 had coronary artery bypass graft done with postoperative stroke in five (13.2%); this contrasted with a group of 320 patients (Group II) without cerebrovascular disease who underwent coronary artery bypass graft during the same period with postoperative stroke in two cases (0.63%) (p less than 0.0005). Carotid artery stenosis was noted on the DSA in 66% of Group I patients, with significant disease (greater than 70% occlusion) in 15%, while the study was normal in 34% of cases. Combined carotid endarterectomy and coronary artery bypass graft was done in five of Group I patients, with postoperative stroke in one; this was the only one among the stroke patients with significant carotid disease. All strokes, except in one patient, resolved within one to 6 1/2 months. These results suggest that the risk of stroke after coronary artery bypass graft is increased in patients with carotid bruit or history of transient ischaemic attack/stroke and in the presence of established carotid artery disease. The place of combined carotid endarterectomy and coronary artery bypass graft in these cases remains to be determined.
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Affiliation(s)
- O A Adebo
- Department of Surgery, National University Hospital, Singapore
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48
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Mestres CA, Cartañá R, Acosta M, Martínez A, Pomar JL. [Replacement of the aortic root and ascending aorta with a fresh antibiotic-sterilized homograft]. Rev Esp Cardiol 1991; 44:137-9. [PMID: 2068361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The case of a 53-year-old male suffering from aortic stenosis and aneurysm of the ascending aorta treated by aortic root replacement with a fresh antibiotic-sterilized aortic homograft is presented. The technique and indications are commented on, focusing attention in the scanty results available in the literature with regard to this technique. We support the use of homografts in aortic root replacement in selected cases.
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Affiliation(s)
- C A Mestres
- Servicio de Cirugía Cardiovascular, Hospital Clínico y Provincial, Barcelona
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49
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Alcaraz A, Vinaixa F, Tejedo-Mateu A, Forés MM, Gotzens V, Mestres CA, Oliveira J, Carretero P. Obstruction and recanalization of the ureter during embryonic development. J Urol 1991; 145:410-6. [PMID: 1988740 DOI: 10.1016/s0022-5347(17)38354-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Major controversies still exist regarding the terminology, the etiology and the pathogenesis of congenital obstructive diseases of the ureter. To try to provide some additional information to this controversial subject, a comparative study of ureteral development in rat and human embryos, using light and electron microscopy, has been performed. During fetal development we observed and demonstrated the existence of obstructive phenomena, both at the level of the ureterovesical junction (Chwalla's membrane) and along the ureter. At the end of the embryonic period, the ureter undergoes a physiologic recanalization process.
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Affiliation(s)
- A Alcaraz
- Department of Urology, Hospital Clinico, University of Barcelona, Spain
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50
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Mestres CA, Prabhakaran K, Adebo OA, Kum CK, Lee CN. Combined resection of hepatoblastoma and intracaval right atrial extension with profound hypothermia and circulatory arrest. Eur J Cardiothorac Surg 1991; 5:657-9. [PMID: 1663379 DOI: 10.1016/1010-7940(91)90123-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Hepatoblastoma is an uncommon liver neoplasm in children but its intraatrial extension through the inferior vena cava is extremely rare. The case described is a 3-year-old boy in whom profound hypothermia and circulatory arrest were used to resect a hepatoblastoma and its extension to the right atrium. This technique allows maximal resection and relief of venous obstruction from atrial extension of hepatoblastoma.
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Affiliation(s)
- C A Mestres
- Division of Cardiothoracic Surgery, National University Hospital, National University of Singapore
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