Martín Rosas

Bio: Martín Rosas is an academic researcher from Yahoo!. The author has contributed to research in topics: Population & Medicine. The author has an hindex of 10, co-authored 26 publications receiving 741 citations.

The adult patient with native coarctation of the aorta: balloon angioplasty or primary stenting?

Abstract: Objective: To compare results of dilatation of native coarctation of the aorta with and without stent implantation. Design: Open, observational, non-randomised study. Patients: 54 consecutive adult patients: 32 with balloon angioplasty alone (group 1) and 22 with stent placement (group 2). Interventions: Balloon dilatation from 1995 to 1997; dilatation with Palmaz stent placement from 1997 to 1999. Main outcome measures: The primary end point was a composite index of failure including heart related death, a residual gradient of > 20 mm Hg, the need of reintervention, and aneurysm formation. Results: Peak systolic gradient (mean (SD)) was reduced both in group 1 (from 63.3 (22.8) to 10.7 (10.8) mm Hg, p 10 mm Hg was shown to be the best cut off point to separate risk groups, representing a hazard ratio (HR) of 9.59 compared with a residual gradient of ≤ 10 mm Hg (95% confidence interval (CI) 1.92 to 47.8). From multivariate Cox regression analysis, the only risk marker was the residual gradient (HR 8.9, 95% CI 1.2 to 63.0). The type of the coarctation and the use of stent were the factors associated with a residual gradient of ≤ 10 mm Hg. Conclusions: Mid term outcome in adult patients with native aortic coarctation receiving percutaneous treatment is strongly related to the immediate residual gradient. When treating these cases, efforts should be made to obtain gradients under 10 mm Hg, either by angioplasty alone or by placing a stent. Patients with discrete aortic coarctation have similar mid term results when the immediate residual gradient is ≤ 10 mm Hg despite the implantation of a stent. To achieve these gradients, patients with hypoplastic isthmus or tubular coarctation should be treated with primary stenting. Further studies including exercise tests and non-invasive imaging are still needed before definitive conclusions can be drawn.

Transcatheter versus surgical closure of secundum atrial septal defect in adults: impact of age at intervention. A concurrent matched comparative study.

Abstract: Objectives. To compare the short- and mid-term outcomes of surgical (SUR) vs. transcatheter closure of secundum atrial septal defect (ASD) using Amplatzer septal occluder (ASO) in adults with a very similar spectrum of the disease; and to identify predictors for the primary end point. Design. Single-center, concurrent comparative study. Surgically treated patients were randomly matched (2:1) by age, sex, date of procedure, ASD size, and hemodynamic profile. Setting. Tertiary referral center. Patients. One hundred sixty-two concurrent patients with ASD submitted to ASO (n = 54) or SUR closure (n = 108) according with their preferences. Main Outcome Measures. Primary end point was a composite index of major events including failure of the procedure, important bleeding, critical arrhythmias, serious infections, embolism, or any major cardiovascular intervention-related complication. Predictors of these major events were investigated. Results. Atrial septal defects were successfully closed in all patients, and there was no mortality. The primary event rate was 13.2% in ASO vs. 25.0% in SUR (P = .001). Multivariate analysis showed that higher rate of events was significantly associated with age >40 years; systemic/pulmonary output ratio 50 mm Hg; while in the ASO group the event rate was only associated with the ASD size (>15 cm2/m2; relative risk = 1.75, 95% confidence interval 1.01–8.8). There were no differences in the event-free survival curves in adults with ages <40 years. Conclusions. The efficacy for closure ASD was similar in both groups. The higher morbidity observed in SUR group was observed only in the patients submitted to the procedure with age >40 years. The length of hospital stay was shorter in the ASO group. Surgical closure is a safe and effective treatment, especially in young adults. There is certainly nothing wrong with continuing to do surgery in countries where the resources are limited.

Hipercolesterolemia e hipertensión arterial en México. Consolidación urbana actual con obesidad, diabetes y tabaquismo

Abstract: Resumen Se llevo a cabo una encuesta en los estados dela Republica Mexicana, donde existe la mayor con-centracion poblacional, con el proposito de pro-fundizar en el conocimiento de la prevalencia y laforma de interaccion de factores de riesgo cardio-vascular como hipercolesterolemia (HCL), hiper-tension arterial sistemica (HTA), obesidad, tras-tornos del metabolismo de carbohidratos ytabaquismo. La encuesta es de caracter transver-sal, tipo III de la OMS e incluyo a 120,005 perso-nas, de 6 centros urbanos de gran poblacion(Mexico, D. F., Guadalajara, Leon, Puebla, Mon-terrey y Tijuana). A cada persona se le extrajo unamuestra de sangre para la determinacion capilarde glucosa y colesterol. La presion arterial, laestatura y el peso se midieron con sistemas vali-dados previamente. Los datos recabados se so-metieron a analisis multicategorico mediante elmetodo de consolidacion conjuntiva y tambien aun modelo analitico de regresion multiple. La pre-valencia global de HCL (colesterol > 200 mg/dL)resulto ser de un 43.3% para una poblacion conedad promedio de 44.1 anos. El genero femeninomostro una prevalencia de HCL ligeramente ma-yor que en el genero masculino (44% vs 42.2%)pero estadisticamente significativa. El 33.2% delas mujeres encuestadas declararon ser meno-pausicas y en este grupo, la prevalencia de HCLse incremento en forma significativa al 59.7% (p< .05). La prevalencia de HCL se encontr o en re-

ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

Abstract: PREAMBLE......e4 APPENDIX 1......e121 APPENDIX 2......e122 APPENDIX 3......e124 REFERENCES......e124 It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced in the detection, management,

ESC Guidelines for the management of grown-up congenital heart disease (new version 2010).

Abstract: Guidelines summarize and evaluate all currently available evidence on a particular issue with the aim of assisting physicians in selecting the best management strategies for an individual patient, suffering from a given condition, taking into account the impact on outcome, as well as the risk–benefit ratio of particular diagnostic or therapeutic means. Guidelines are no substitutes for textbooks, and their legal implications have been discussed previously. Guidelines and recommendations should help physicians to make decisions in their daily practice. However, the ultimate judgement regarding the care of an individual patient must be made by his/her responsible physician(s). A large number of Guidelines have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organizations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines can be found on the ESC Web Site (http://www.escardio.org/guidelines/rules). Members of this Task Force were selected by the ESC to represent all physicians involved with the medical care of patients in this pathology. In brief, experts in the field are selected and undertake a comprehensive review of the published evidence for management and/or prevention of a given condition. A critical evaluation of diagnostic and therapeutic procedures is performed, including assessment of the risk–benefit ratio. Estimates of expected health outcomes for larger populations are included, where data exist. The level of evidence and the strength of recommendation of particular treatment options are weighed and graded according to pre-defined scales, as outlined in Tables 1 and 2 . View this table: Table 1 Classes of recommendations View this table: Table 2 Levels of evidence The experts of the writing and reviewing panels have provided disclosure statements of all relationships they may have which …

ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: Executive summary - A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease)

Abstract: It is important that the medical profession play a central role in critically evaluating the use of diagnostic procedures and therapies introduced and tested for detection, management, or prevention of disease. Rigorous, expert analysis of the available data documenting absolute and relative