Incidence and factors associated with pericardial effusion after cardiac valve surgery

Introduction: Pericardial effusion (PE) is a postoperative complication of cardiac valve surgery, related to early hospital readmissions and death. We aimed to describe its incidence and to identify predictive factors of moderate-to-severe PE in a contemporary cohort. Methods: We retrospectively reviewed medical records of all consecutive patients submitted to cardiac valve surgery in a tertiary teaching hospital from January 2012 to July 2014, where echocardiography was routinely performed before patient discharge. Moderate-to-severe PE was defined as ≥ 10 mm of thickness, or signs of cardiac tamponade on echocardiography. Additional clinical and perioperative data were extracted from medical records using a standardized protocol. Results: Of 353 patients, 335 underwent a predischarge echocardiography. From these, 27 patients (8%; mean age: 62 years; standard deviation 12 years; 70% male) had moderate-to-severe PE. These patients had a higher prevalence of previous stroke (22% vs. 8%; p = 0.009) and oral anticoagulation (international normalized ratio > 2) prior to the surgery (11 vs. 2%; P = 0.002). In patients with moderate-to-severe PE, surgeries had longer ischemia (p < 0.001) and cardiopulmonary bypass (p < 0.001) times, and the prevalence of postoperative atrial fibrillation was higher (56% vs. 32%; p = 0.011) than in patients with absent or small PE. Hospital mortality was also higher (15% vs. 3%; p = 0.002) in patients with moderate-to-severe PE. Conclusions: Eight percent of patients submitted to cardiac valve surgery developed moderate-to-severe PE. Moreover, PE was associated with pre- and post-surgery conditions likely related to the coagulation state, though a cause-effect relationship could not be inferred. Noteworthy, this condition was associated with higher in-hospital morbidity and mortality(AU)

Ovarian tissue vitrification: the use of a novel metal closed system for clinical grade cryopreservation.

OBJECTIVE: To investigate whether a metal chamber is an appropriate system for vitrification of ovarian tissue under clinical grade. METHODS: Experimental study, control versus treatment. Bovine ovarian cortices cut in 1x1x1 mm fragments were vitrified using ethylene glycol and dimethyl sulfoxide inside steel cryovials, whose bases were in touch with Liquid Nitrogen (LN2). Screw caps closed the cryovials before plunging into LN2. Primordial (n=356) and primary (n=327) follicles and the stroma were analyzed after histological preparation using light microscopy. RESULTS: High rate of primordial (93%) and primary (80%) follicles presented normal morphology in the rewarmed fragments. There was not a significant difference between controls and primordial follicles morphology (P=0.1519). Significant difference was observed for the primary follicles (P=0.0097). Important to point out that stromal cells and collagen fibers presented a remarkable integrity, without major alterations in the cryopreserved tissues. CONCLUSIONS: The steel cryovial seems to be a safe means of vitrification under clinical grade conditions, with very fast cooling rates and no direct contact of the biological material with the liquid nitrogen (LN2). Ovarian reserve represented by primordial and primary follicles and stroma are very well preserved in this vitrification system.