Tratamiento endovascular percutáneo de un síndrome de vena cava superior en el postoperatorio inmediato de recambio valvular mitroaórtico / Percutaneous endovascular treatment of an iatrogenic superior cava vein syndrome during the immediate post-operative period after mitral-aortic valve replacement

El síndrome de vena cava superior (SVCS) resulta de la obstrucción de la vena cava superior, que origina una disminución del retorno venoso procedente de cabeza, cuello y extremidades superiores. Aunque la causa más frecuente siguen siendo procesos tumorales malignos, en los últimos años hemos visto un aumento de causas no tumorales, como trombosis de dispositivos intravasculares permanentes o causas iatrogénicas durante la cirugía cardiaca. Presentamos un caso de SVCS tras cirugía cardiaca tratado de forma satisfactoria mediante técnica endovascular y anticoagulación sistémica

Superior vena cava syndrome (SVCS) results from superior vena cava obstruction, causing a decrease in venous return from the head, neck, and upper extremities. Although the most frequent cause is still malignant tumour processes, in recent years an increase has been observed in non-tumour causes, such as thrombosis of intravascular devices or iatrogenic causes during cardiac surgery. A case is presented of SVCS after cardiac surgery treated satisfactorily by an endovascular technique and systemic anticoagulation

Percutaneous endovascular treatment of an iatrogenic superior cava vein syndrome during the immediate post-operative period after mitral-aortic valve replacement. / Tratamiento endovascular percutáneo de un síndrome de vena cava superior en el postoperatorio inmediato de recambio valvular mitroaórtico.

Superior vena cava syndrome (SVCS) results from superior vena cava obstruction, causing a decrease in venous return from the head, neck, and upper extremities. Although the most frequent cause is still malignant tumour processes, in recent years an increase has been observed in non-tumour causes, such as thrombosis of intravascular devices or iatrogenic causes during cardiac surgery. A case is presented of SVCS after cardiac surgery treated satisfactorily by an endovascular technique and systemic anticoagulation.

Real world comparison of the MGuard Stent versus the bare metal stent for ST elevation myocardial infarction (the REWARD-MI study).

AIM: The MGuard Stent (MGS) was designed to prevent distal embolization of thrombus and has been shown to improve microcirculation in ST-elevation myocardial infarction (STEMI). However, there are no real world data comparing it with the bare metal stent (BMS). The aim of this study is to determine the efficacy and safety of the MGS in STEMI in the real world compared to the BMS. METHODS AND RESULTS: In total, 262 patients were included from a single centre, of which 35.9% had an MGS implanted. Two groups of 79 patients were established after propensity score matching, and they were similar in terms of baseline and periprocedural variables. The mean follow-up was 321 ± 12.94 days. There was no difference in mortality (7.6% in both groups), major adverse cardiac events (20.3% vs. 12.7%, P = 0.198), non-cardiac mortality, or non-fatal myocardial infarction (6.3% in both groups). Target lesion revascularization (TLR) was significantly higher in the MGS group (11.4% (9) vs. 1.3% (1) P < 0.01; RR 10.02 [1.23-81.16]). CONCLUSION: Our study is the first to compare the MGS with the BMS in STEMI in the real world, and it also appears to confirm that although the MGS is a safe device in STEMI that is not associated with increased mortality, it is associated with a higher long-term TLR rate. © 2014 Wiley Periodicals, Inc.

[Myocardial revascularization in patients with chronic renal failure]. / Revascularización miocárdica en pacientes con insuficiencia renal crónica.

The incidence of chronic renal failure has increased in the last years in industrialized countries. In Spain the prevalence of this pathology is estimated at 10-12% of the population, and the stages III-V of the disease, corresponding to the estimated glomerular filtration rate less than 60 ml/min/m2, represent the 5%. From the cardiovascular point of view, both chronic and acute coronary syndrome is a very important subgroup of patients because of the increased association between chronic renal failure and coronary artery disease. In fact, ACS is the main cause of death in patients with advanced chronic renal failure. Frequently, this kind of patients are excluded from prospective randomized clinical trials, consequently scientific evidence is not available to guide the therapy of coronary revascularization.

Revascularización miocárdica en pacientes con insuficiencia renal crónica / Myocardial revascularization in patients with chronic renal failure

En los últimos años, la insuficiencia renal crónica ha experimentado un importante aumento en los países occidentales. Se estima que en España la prevalencia de esta enfermedad oscila entre el 10 y el 12% de la población, de la cual el 5% se halla entre los estadios III-V, que es la que se corresponde con un índice de filtrado glomerular estimado menor de 60 ml/min/m2. Desde el punto de vista cardiovascular, se trata de un subgrupo de pacientes muy importante, dada la asociación elevada existente entre la insuficiencia renal crónica y la enfermedad arterial coronaria, tanto en su forma crónica, como en forma de episodio coronario agudo. Esta última es la causa más frecuente de muerte en los pacientes con insuficiencia renal crónica avanzada. Con frecuencia, se excluye a estos pacientes de los ensayos clínicos aleatorizados y prospectivos, por lo que actualmente no disponemos de una evidencia científica contundente que nos indique cuál es el mejor tratamiento de revascularización en estos pacientes (AU)

The incidence of chronic renal failure has increased in the last years in industrialized countries. In Spain the prevalence of this pathology is estimated at 10-12% of the population, and the stages III-V of the disease, corresponding to the estimated glomerular filtration rate less than 60 ml/min/m2, represent the 5%. From the cardiovascular point of view, both chronic and acute coronary syndrome is a very important subgroup of patients because of the increased association between chronic renal failure and coronary artery disease. In fact, ACS is the main cause of death in patients with advanced chronic renal failure. Frequently, this kind of patients are excluded from prospective randomized clinical trials, consequently scientific evidence is not available to guide the therapy of coronary revascularization (AU)

Revascularización miocárdica en pacientes con diabetes: estado actual y perspectivas / Myocardial revascularization in diabetic patients: current state and future perspectives

La diabetes mellitus constituye un factor de riesgo importante de padecerenfermedades cardiovasculares, como la enfermedad arterial coronaria,la enfermedad cerebrovascular o la enfermedad arterial periférica. Así,con respecto a la población general, los pacientes con diabetes presentanuna prevalencia hasta 10 veces superior de aterosclerosis con enfermedadarterial coronaria signifi cativa asociada, y un riesgo de padeceralgún episodio cardiovascular de 2 a 4 veces también superior. En consecuencia,las enfermedades cardiovasculares, en especial la enfermedadarterial coronaria, son la principal causa de muerte de los pacientes condiabetes. Por ello, es muy importante la prevención y el correcto tratamientode la enfermedad cardiovascular en este tipo de pacientes. En este artículose revisan las indicaciones actuales sobre las distintas técnicas derevascularización miocárdica y sus perspectivas futuras en el tratamientode la enfermedad arterial coronaria del paciente con diabetes(AU)

Diabetes mellitus represents an important risk factor to develop cardiovasculardiseases as coronary artery disease, cerebral vasculardisease or peripheral artery disease. Diabetic patients have a prevalenceof atherosclerosis with significant coronary artery disease tentimes higher than in the general population, and the risk of cardiovascularadverse events is two to four times greater. Consequently,cardiovascular diseases and specifically, significant coronary arterydisease, are the main cause of death in people with diabetes. Preventionand optimal treatment are especially important in this particularpopulation. In this article we have reviewed the current indicationsfor the different techniques of myocardial revascularization, andthe future perspectives of these techniques in the treatment of thecoronary artery disease in the diabetic patient(AU)