Synergism between obesity and HFpEF on neutrophils phenotype and its regulation by adipose tissue-molecules and SGLT2i dapagliflozin.

The adiposity invokes innate immune activity, coronary microvascular dysfunction and consequently heart failure preserved ejection fraction (HFpEF). Our aim was to study the neutrophils profile on obesity and cardiovascular disease and its regulation by adipose tissue-secretome and dapagliflozin. We have isolated neutrophils from patients undergoing open heart surgery (19 women and 51 men). Its migration activity was performed with culture-transwell, transcriptional studies of proteolytic enzymes, adhesion molecules or receptors were analysed by real-time PCR and proteomics (from 20 patients) analysis by TripleTOF mass spectrometer. Differentiated HL-60 (dHL-60) was used as a preclinical model on microfluidic for endothelial cells attaching assays and genes regulation with epicardial and subcutaneous fat secretomes from patients (3 women and 9 men) or dapagliflozin 1-10 µM treatments. The transcriptional and proteomics studies have determined higher levels of adhesion molecules in neutrophils from patients with obesity. The adhesion molecule CD11b levels were higher in those patients with the combined obesity and HFpEF factors (1.70 ± 0.06 a.u. without obesity, 1.72 ± 0.04 a.u. obesity or HFpEF without obesity and 1.79 ± 0.08 a.u. obesity and HFpEF; p < .01). While fat-secretome induces its upregulation, dapagliflozin can modulated it. Because CD11b upregulation is associated with higher neutrophils migration and adhesion into endothelial cells, dapagliflozin might modulate this mechanism on patients with obesity and HFpEF.

Asistencia combinada con oxigenador extracorpóreo de membrana venoarterial e Impella para el espasmo coronario difuso después de revascularización miocárdica / Combined venoarterial extracorporeal membrane oxygenation and impella for diffuse coronary spasm after surgical myocardial revascularization

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Leiomiomatosis intravascular con extensión intracardiaca: cirugía abdominal y cardíaca en un solo tiempo / Intravascular leiomyomatosis with cardiac extension: Simultaneous abdominal and cardiac surgery

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High intensity focused ultrasound ablation for atrial fibrillation: results from the National Spanish Registry.

BACKGROUND: A National Spanish Registry to compile all patients treated with high intensity focused ultrasound (HIFU) energy for atrial fibrillation (AF) was created to evaluate the safety and efficacy of AF surgical ablation. METHODS: A national Spanish registry was created, and ten hospitals using HIFU to ablate AF joined it. A total of 412 patients undergoing cardiac surgery between 2006 and February 2013 were included. AF was divided between paroxysmal AF (33%) and persistent AF (67%) with a mean AF duration of 29.3±108.2 months. Mean left atrial diameter was 51.2±6.5 mm. Mean underlying heart disease were aortic valve disease (49.3%), ischemic disease (25.2%) and mitral disease (33.2%) Clinical follow-up of patients and a 6 months postoperative echocardiogram were performed in all patients. RESULTS: A pacemaker implantation was needed in 4.9% of patients with a perioperative stroke in 2.5%. Rhythm at discharge from hospital was sinus rhythm in 58%, AF in 35.9% and atrial flutter in 0.8% of patients. Sinus rhythm restoration at 6, 12, 24 and 36 months follow-up was achieved in 66.1%, 63.8%, 63.9% and 45.9% of patients respectively. Multivariate analysis showed paroxysmal AF and sinus rhythm restoration in the operating theatre as factors related to sinus rhythm long term restoration. CONCLUSIONS: The Spanish national registry showed an efficacy of AF ablation with the HIFU Epicor system of 66.1%, 63.8%, 63.9% and 45.9% at 6, 12, 24 and 36 months follow-up. There were no device-related complications.

The Adipokine Chemerin Induces Apoptosis in Cardiomyocytes.

BACKGROUND: The adipokine chemerin has been associated with cardiovascular disease. We investigated the effects of chemerin on viability and intracellular signalling in murine cardiomyocytes, and the effects of insulin and TNF-α on cardiomyocyte chemerin production. METHODS: Hoechst dye vital staining and cell cycle analysis were used to analyse the viability of murine cardiac cells in culture. Western blot was used to explore the phosphorylation of AKT and caspase-9 activity in neonatal rat cardiomyocytes and HL-1 cells. Finally, RT-qPCR, ELISA and western blot were performed to examine chemerin and CMKLR1 expression after insulin and TNF-α treatment in cardiac cells. RESULTS: Chemerin treatment increased apoptosis, reduced phosphorylation of AKT at Thr308 and increased caspase-9 activity in murine cardiomyocytes. Insulin treatment lowered chemerin and CMKLR1 mRNA and protein levels, and the amount of chemerin in the cell media, while TNF-α treatment increased chemerin mRNA and protein levels but decreased expression of the CMKLR1 gene. CONCLUSION: Chemerin induces apoptosis, reduces AKT phosphorylation and increases the cleavage of caspase-9 in murine cardiomyocytes. The expression of chemerin is regulated by important metabolic (insulin) and inflammatory (TNF-α) mediators at cardiac level. Our results suggest that chemerin could play a role in the physiopathology of cardiac diseases.

Leaflet tear in a Trifecta aortic bioprosthesis 34 months after implantation.

Bioprosthetic valves are used in aortic valve replacement to avoid lifelong anticoagulation. Bovine pericardial valves have excellent haemodynamics and equivalent freedom from reoperation compared with a porcine bioprosthesis [ 1]. However, early failure (parastent post-cusp tear) can take place due to mechanical stress. We report an acute structural failure on a Trifecta pericardial valve (St Jude Medical, Inc.) explanted after 34 months from a 71-year old woman.

Relation of Skin Flora of Hands with Glove Perforation and Contamination in Cardiac Surgery.

BACKGROUND AND OBJECTIVES: Surgical scrub reduces the number of microorganisms, but fails to sterilize hands, and therefore the use of sterile gloves is recommended. Glove perforation allows bacteria passage from the surgeons´ hands to the patient´s tissues. We analyze the relationship between skin flora of hands, glove perforation and contamination. METHODS: A prospective study comprising 139 patients undergoing open heart surgery through a median sternotomy was conducted. Surgeons´hands were studied. Gloved and ungloved fingertips were placed on culture plates after scrubbing and before sternal closure. Removed gloves were evaluated for perforations. Samples from the surgical wound were taken for culture. Identification of isolated microorganisms was performed by conventional biochemical tests. RESULTS: Culture of fingertips after scrubbing resulted positive in 29.13% of the samples and increased to 34.53% at the end of the procedure. Culture of gloved fingertips before closing the sternum demonstrated contamination of the outer surface in 11.87% of samples. Gloves removed before sternal closure showed perforations in 23.02% of samples. Holes were observed in 33% of contaminated gloves. No relationship between perforation and contamination of gloves was observed. The culture of the sternal wound resulted positive in 7.91% of cases. A significant relationship between the presence of microorganisms in the wound and glove contamination was demonstrated. (P<0,001). CONCLUSIONS: Perforation does not cause significant contamination of the outer surface of surgical gloves. The statistical correlation between glove contamination and surgical wound colonization could be explained by the presence of other sources of contaminating microorganisms.

Comparison of drug-eluting stents versus surgery for unprotected left main coronary artery disease.

This study was conducted to compare the clinical outcomes of drug-eluting stents (DESs) with those of standard bypass surgery for the treatment of patients with left main lesions in a single-center experience. From January 2000 to October 2005, a total of 96 patients with significant unprotected left main disease were treated with DES implantation, and 245 with bypass surgery. Baseline features, such as Euroscore, were similar between groups, except for diabetes and hypertension, which were more frequent in the surgical group. The combination of death, Q-wave myocardial infarction, stroke, and repeated revascularization (major adverse cardiac and cerebrovascular events [MACCEs]) at 30 days occurred in 2.1% after DES implant and 9.0% after surgery (p=0.03). At 1 year, DES-treated patients more frequently needed repeat revascularization (5.2% vs 0.8%; p=0.02), although combined MACCE rates were similar (10.4% for DES, 11.4% for surgery; p=0.50). Moreover, after a mean follow-up of 1.3+/-0.8 and 3.2+/-1.6 years for the DES and surgical groups, there were no significant differences in MACCEs, respectively. In conclusion, in our experience, percutaneous treatment of patients with unprotected left main disease with DESs provided similar clinical results compared with surgical revascularization at a midterm follow-up.