Dr. Alvarado-Livacic, Cristóbal

Introduction: The use of biological valves in the aortic position has become more liberal in recent years due to improvements in prostheses and the possibility of performing valve-in-valve procedures, thus avoiding anticoagulation. Methods: We retrospectively evaluated 246 adults in whom the Crown PRTTM biological valve was used in the aortic position, including elective and emergency cases, isolated and combined surgeries (CS). We also evaluated mortality at 1, 3, and 5 years of follow-up. Results: In this study, CS involved 94 patients (38%), while 39 patients (16%) underwent urgent or emergency procedures, which included cases of aortic dissection and endocarditis. Approximately 69% of the patients received a valve more significant than 21 mm. A minimally invasive surgical approach was employed in 42 patients (17%). The in-hospital mortality for the entire patient population was 3.6% (n = 9), with isolated aortic valve replacement (AVR) accounting for 3.3% (n = 5) and CS for another 4.3% (n = 4). The mortality for isolated AVR and CS in elective situations was n = 2 (1.3%) and n = 1 (1.1%), respectively. During the follow-up period, only seven patients required reoperation, with two patients (0.8%) experiencing structural valve deterioration and five other patients (2.1%) requiring reoperation due to prosthetic valve endocarditis. Conclusion: The use of the Crown valve in the aortic position appears to be safe regarding postoperative morbidity and mortality. Further studies are necessary to assess its applicability in younger patients and predict its performance in the event of a valve-in-valve procedure.

Introduction: Extracorporeal membrane oxygenation (ECMO) is the first-line therapy for temporary mechanical circulatory support allowing cardiac and pulmonary recovery or as a bridge to further therapeutic alternatives. The aim of this study was to report clinical outcomes in adult patients with refractory cardiac failure after open-heart surgery undergoing ECMO in a single center with an ECMO unit in Chile. Methods: We retrospectively analyzed adults with refractory cardiac failure after open-heart surgery who required a venoarterial (VA) ECMO between 2016 and 2021. Results: Of 16 patients with VA ECMO, 60% were men (n=10), 90% had hypertension (n=14), 69% had < 30% of left ventricular ejection fraction (n=11), and the mean European System for Cardiac Operative Risk Evaluation II score was 12 ± 11%. ECMO support with central cannulation accounts for 81% (n=13), and an intra-aortic balloon pump was used in nine patients (56%). The mean time of support was 4.7 ± 2.6 days (1.5 – 12 days). ECMO weaning was achieved in 88% of patients, and in-hospital mortality was 44% (n=7) after discharge. The freedom from all-cause mortality at one year of follow-up of the entire cohort was 38% (n=6). Conclusion: VA ECMO is now a well-known life-saving therapeutic option, but mortality and morbidity remain high. Implementation of an ECMO program with educational training is mandatory in order to find the proper balance between patient benefits, ethical considerations, and public health financial input in South America