Papers by Antonio Garcia-valentin
Investigative Ophthalmology & Visual Science, May 1, 2003
European Journal of Cardio-Thoracic Surgery, Mar 11, 2015
Since its development in the late 1990s, the European System for Cardiac Operative Risk Evaluatio... more Since its development in the late 1990s, the European System for Cardiac Operative Risk Evaluation (EuroSCORE) has been the predictive model of choice for estimating mortality after cardiac surgery. As outcomes from cardiac surgery improved, the EuroSCORE showed a loss of calibration, and a revised version of the model was developed, EuroSCORE II. The objectives of this study were to examine the validity of both scores in the Spanish population, and to depict the performance of both models on a funnel plot. METHODS: A prospective multicentre study was performed, with requests to participate sent to all centres in Spain. Participating centres reported the EuroSCORE, EuroSCORE II and the actual mortality of each patient. Incomplete data were requested to get a zero incidence of lost data. Calibration of models was evaluated with the Hosmer-Lemeshow goodness-of-fit test, and discrimination with the areas under the receiver operating characteristic (ROC) curve. A funnel plot was constructed using mortality data from the 2010 European Registry, to represent risk-adjusted mortality. RESULTS: Twenty Spanish centres participated in the study; 4034 patients undergoing cardiac surgery between 1 October 2012 and 31 March 2013 were collected. Prevalence of risk factors was analysed. The observed mortality rate was 6.5%. The mean additive EuroSCORE was 6.5. The mean expected mortality rate was 9.8% for the logistic EuroSCORE, and 5.7% for EuroSCORE II. Areas under the ROC curves were EuroSCORE: 0.77 [95% confidence interval (CI): 0.75-0.80], EuroSCORE II: 0.79 (95% CI: 0.76-0.82). Results for the goodness-of-fit test were EuroSCORE: 33.02 (P < 0.001), EuroSCORE II: 38.98 (P < 0.001). Risk-adjusted mortality is far beyond the lower bound of the CI if EuroSCORE is used as the reference model, and is between the confidence limits, but near to the upper bound when EuroSCORE II is used. CONCLUSIONS: Spanish cardiac surgical patients have a high-risk profile. Areas under the ROC curve show good discrimination for both models. Predicted mortality using EuroSCORE II more closely matches actual mortality than that predicted by the original EuroSCORE. Both models show statistically significant differences from the actual mortality rate, with EuroSCORE overpredicting and EuroSCORE II underpredicting mortality. The funnel plot illustrates risk-adjusted mortality clearly out of boundaries when EuroSCORE is used, and near underprediction when the reference is EuroSCORE II.
Interactive Cardiovascular and Thoracic Surgery, Sep 23, 2014
The Journal of Thoracic and Cardiovascular Surgery, Aug 1, 2008
This study analyzes the anatomic structure of the mitral and tricuspid annuli, their relationship... more This study analyzes the anatomic structure of the mitral and tricuspid annuli, their relationship with the coronary arteries and veins, and how this anatomic distribution may affect atrial ablation with bipolar radiofrequency clamps, the only technology that ensures transmurality.
European Journal of Cardio-Thoracic Surgery, May 28, 2015
Lemeshow test, which the authors correctly highlight as being problematic. The Hosmer-Lemeshow te... more Lemeshow test, which the authors correctly highlight as being problematic. The Hosmer-Lemeshow test has limited power to evaluate calibration, affected by sample size and grouping and gives no indication on the direction and magnitude of (mis)calibration [2]. Unfortunately, the authors disappointingly proceeded to use this test to judge calibration on the premise that this was used in the original model development study [3]. Repeating an incorrect and uninformative analysis on the grounds that it was done in the original study is flawed logic and if methodological concerns are raised, then alternative and correct analyses should be carried out. Knowingly repeating a flawed analysis even if concerns are raised, incorrectly supports and justifies its use by other investigators and the cycle is never broken. The study by Garcia-Valentin et al. raised concerns of the approach but only in the 'Discussion' section, which is often not read as closely as the 'Methods' or 'Results' section of a manuscript. In accordance with recent recommendations on the reporting of prediction model studies [2, 4], calibration should be assessed graphically by plotting predicted outcome probabilities (x-axis) against observed outcomes (y-axis) using a high-resolution smoothed (loess) line. The direction and magnitude of any miscalibration can then be examined across the entire probability range. The calibration plot can also be supplemented with a numerical quantification of calibration by examining the calibration slope and intercept and the 0.9 quantile of the absolute prediction error [5, 6]. We recommend investigators, peer reviewers and editors to read the recent guidance from the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) Initiative (www. tripod-statement.org). The TRIPOD reporting guideline for clinical prediction models, discusses key issues in the development and validation of a prediction model [4]. The TRIPOD guideline is similar to other well-known reporting guidelines (e.g. CONSORT, STROBE and PRISMA) designed to help authors, peer reviewers and journal editors in ensuring that the essential items describing the development or validation of a clinical prediction model are clearly reported. Accompanying the reporting guideline is an extensive Explanation and Elaboration article describing the rationale for the checklist item but also highlighting many methodological considerations when developing or validating a clinical prediction model [2].
Cirugía Cardiovascular, Oct 1, 2010
Cirugía Cardiovascular, May 1, 2017
Imágenes en Cirugía Torácica y Cardiovascular Deterioro estructural precoz por rotura protésica a... more Imágenes en Cirugía Torácica y Cardiovascular Deterioro estructural precoz por rotura protésica aórtica Early structural deterioration due to rupture of aortic prosthesis
Asian Cardiovascular and Thoracic Annals, Dec 1, 2008
For reprint information contact: C.A. Mestres, MD Tel: 34 93 227 5515 Fax: 34 93 227 5749 Email: ... more For reprint information contact: C.A. Mestres, MD Tel: 34 93 227 5515 Fax: 34 93 227 5749 Email: [email protected] Cardiovascular Surgery Department, Hospital Clinic, University of Barcelona, C/Villarroel, 170; Barcelona (E-08036), Spain. ASIAN CARDIOVASCULAR & THORACIC ANNALS 512 2008, VOL. 16, NO. 6 Figure 1. Coronary angiography suggests false left ventricular aneurysm during ventriculography.
Cirugía Cardiovascular, May 1, 2015
El abordaje quirúrgico adecuado es un aspecto esencial en la cirugía de aorta. Tras realizar múlt... more El abordaje quirúrgico adecuado es un aspecto esencial en la cirugía de aorta. Tras realizar múltiples accesos quirúrgicos en cadáveres en fresco para un curso de formación de residentes y revisar la literatura, se desarrolla de forma didáctica y práctica una visión anatómica y quirúrgica de las diferentes vías de acceso a la aorta.
Cirugía Cardiovascular, Sep 1, 2015
El arco aórtico es un segmento fundamental de la aorta. Se describe la enfermedad quirúrgica que ... more El arco aórtico es un segmento fundamental de la aorta. Se describe la enfermedad quirúrgica que afecta al mismo, así como la epidemiología y la historia natural de los aneurismas torácicos, que son la condición que más frecuentemente lo afectan. Se revisan las manifestaciones clínicas de estos y las técnicas empleadas para su diagnóstico. Finalmente, se expone una panorámica de las indicaciones quirúrgicas y las técnicas de cirugía abierta empleadas.
Journal of Cardiothoracic Surgery, Dec 1, 2015
Background/Introduction Antegrade intermittent 4:1 blood cardioplegia with Buckberg solution is w... more Background/Introduction Antegrade intermittent 4:1 blood cardioplegia with Buckberg solution is widely used in elective aortic valve replacement. Use of miniplegia could simplify myocardial protection in this setting. Aims/Objectives Our objective was to compare both strategies in terms of non-inferiority.
The Annals of Thoracic Surgery, Apr 1, 2007
Wiskott-Aldrich syndrome is a primary immunodeficiency characterized by infections, thrombocytope... more Wiskott-Aldrich syndrome is a primary immunodeficiency characterized by infections, thrombocytopenia, and eczema. We present a 33-year-old man with this syndrome who underwent a one-stage ascending aorta, aortic arch and descending aortic aneurysm repair under moderate hypothermia and continuous visceral and cerebral perfusion. Histologic examination showed the presence of an aortitis with granulomatous inflammatory response and multinucleated cells.
Nutrients, Apr 19, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
European Journal of Cardio-Thoracic Surgery, 2006
The Journal of Thoracic and Cardiovascular Surgery, Feb 1, 2023
OBJECTIVES Long-term real-world outcomes are critical for informing decisions about biological (B... more OBJECTIVES Long-term real-world outcomes are critical for informing decisions about biological (Bio) or mechanical (Mech) prostheses for aortic valve replacement, particularly in patients aged between 50 and 65 years. The objective was to compare long-term survival and major adverse cardiac and cardiovascular events (ie, stroke, reoperation, and major bleeding) within this population. METHODS This was a multicenter observational study including all patients aged between 50 and 65 years who underwent an aortic valve replacement because of severe isolated aortic stenosis between the years 2000 and 2018. A total of 5215 patients from 27 Spanish hospitals were registered with a follow-up of 15 years. Multivariable analyses, including a 2:1 propensity score matching (1822 Mech and 911 Bio) and competing risks analyses were applied. RESULTS Bio prostheses were implanted in 19% of patients (n = 992). No significant differences were observed between matched groups in long-term survival (hazard ratio [HR], 1.14; 95% confidence interval [CI], 0.88-1.47; P = .33). Stroke rates were higher for Mech prostheses, but not significant (HR, 0.72; 95% CI, 0.50-1.03; P = .07). Finally, higher rates of major bleeding were found in the Mech group (HR, 0.65; 95% CI, 0.49-0.87; P = .004), whereas reoperation was more frequent among the Bio group (HR, 3.04; 95% CI, 1.80-5.14; P < .001). Bio prostheses increased from 13% in the period from 2000 to 2008 to 24% in 2009 to 2018. CONCLUSIONS Long-term survival was comparable among groups in patients between 50 and 65 years of age. Mech prostheses were associated with a higher risk of major bleeding, whereas Bio prostheses entailed higher reoperation rates. Bio prostheses seem a reasonable choice for patients between 50 and 65 years in Spain.
Cirugía Cardiovascular, Apr 1, 2012
Cirugía Cardiovascular, Mar 1, 2016
La disección de aorta tipo B de Stanford es aquella que no afecta a la aorta ascendente, pudiendo... more La disección de aorta tipo B de Stanford es aquella que no afecta a la aorta ascendente, pudiendo afectar al resto de segmentos aórticos en distinta medida. En ausencia de complicaciones, el tratamiento establecido actualmente es el médico, aunque nuevos estudios sugieren una mejoría pronóstica en aquellos pacientes tratados precozmente con terapia endovascular. El 20% de las disecciones tipo B se complican con hipertensión o dolor refractario, rotura aórtica o síndromes de malperfusión, requiriendo tratamiento urgente abierto o endovascular. Este artículo es una introducción al resto de artículos relacionados con el tratamiento de la disección tipo B, y desarrolla brevemente las características clínicas, diagnósticas y enfoque terapéutico en cada caso, que será desarrollado en las siguientes revisiones.
Cirugía Cardiovascular, Jul 1, 2008
Objetivo. Comunicar nuestra experiencia con endoprótesis integradas anterógradas en el tratamient... more Objetivo. Comunicar nuestra experiencia con endoprótesis integradas anterógradas en el tratamiento de la disección del arco y aorta torácica descendente. Material y métodos. Entre marzo de 2006 y abril de 2008 se implantó en 12 pacientes por disección aórtica. Resultados. La mediana de edad fue 60,6 años (33,2-71,1), todos bajo parada circulatoria e hipotermia (mediana: 20 °C). Diez por disección tipo A (cuatro agu das) y 2 tipo B (una aguda), completándose en todos los casos. La mortalidad hospitalaria es de cuatro pacientes (dos intraoperatorias). El seguimiento medio es 12,03 meses (IC 95%: 6,72-17,34), presentando una muer te más (sin complicaciones en la aorta). En todos los casos se observó trombosis de la falsa luz hasta el nivel cu bierto. No se ha observado crecimiento. No hay casos de migración, endofuga, accidente cerebrovascular o paraplejía. Discusión. La técnica estándar en dos tiempos acarrea considerable morbimortalidad en ambos. Esta técnica ofrece una alternativa permitiendo el tratamiento com pleto de la aorta torácica en un tiempo a través de es ternotomía. Los resultados publicados muestran una mortalidad y complicaciones similares a las técnicas clá sicas a medio plazo. Conclusiones. Es posible el tratamiento completo de la aorta torácica sin aumentar la complejidad ni el tiempo de parada circulatoria, con una mor-Short-term results of one-stage treatment of the aortic arch and descending thoracic aorta with antegrade integrated stent-graft Objective. To report our experience with antegrade integrated stent-grafts in the treatment of aortic dissection involving the arch and the descending thoracic aorta. Material and methods. Between March-2006 and April-2008 the stent-graft was implanted in twelve patients with aortic dissection. Results. Median age was 60.6 years (33.2-71.1), all under hypothermic circulatory arrest (median: 20 °C). Ten patients had type A aortic dissection (4 acute) and 2 type B (1 acute). All procedures we re completed. Hospital mortality was 4 patients (2 intraoperatively). Mean follow-up was 12.03 months (CI 95%: 6.72-17.34) and one additional death occurred (not for aortic complications). False lumen thrombosis was observed in all cases in the covered seg ment. No aortic growth was observed. There were no cases of migration, endoleak, stroke or paraplegia. Discussion. The standard two-stage approach carries significant morbidity and mortality. This technique offers a one-stage solution for the entire thoracic aorta through median sternotomy. Published results show similar mortality and mid-term results compared with standard management. Conclusions. Complete treatment of the thora cic aorta without increasing complexity or circulatory
Nutrients
The main source of vitamin D results from skin sunlight exposure. Vitamin D deficiency (VDD) is l... more The main source of vitamin D results from skin sunlight exposure. Vitamin D deficiency (VDD) is linked to several adverse events during pregnancy. While performing a cross-sectional study with 886 pregnant women in Elda (Spain) from September 2019 to July 2020 to determine the association of VDD with gestational diabetes mellitus in relation to body mass index, a strict lockdown (SL) due to the COVID-19 pandemic was declared from 15 March 2020 to 15 May 2020. To determine if VDD prevalence in the local population of pregnant women was influenced by SL, a retrospective cross-sectional study was conducted to estimate the prevalence odds ratio (POR) for the association of VDD and SL. A crude logistic regression model was calculated, and then further adjusted by the biweekly measured vitamin D-specific UVB dose in our geographical area. The POR during SL was 4.0 (95%CI = 2.7–5.7), with a VDD prevalence of 77.8% in the quarantine period. Our results revealed that VDD prevalence in pregna...
Revista Española de Cardiología
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Papers by Antonio Garcia-valentin