Llorens, R. (Rafael)
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- Aneurisma de aorta ascendente en pacientes con sustitución valvular aórtica previa(Elsevier España, 1993) Herreros, J. (Jesús); Alava, E. (Enrique) de; Gil, O. (O.); Calabuig, J. (José); Martin-Trenor, A. (Alejandro); Llorens, R. (Rafael); Gonzalez-Fernandez, A.L. (A. L.)We conclude that an aggressive surgical approach should be adopted in patients with degenerative aortic regurgitation and moderate dilatation of the ascending aorta because of the rapid progression of the aortic disease. We advise complete replacement of the aortic root.
- Hematoma pericárdico dos años después de cirugía coronaria(Elsevier España, 1997) Stefano, S. (Salvatore) di; Legarra, J.J. (Juan José); Alegria, E. (Eduardo); Barba, J. (Joaquín); Garcia-Fuster, R. (Rafael); Llorens, R. (Rafael); Melero, J.M. (José María)Cardiac tamponade is a life-threatening complication after cardiac surgery which may develop in the early or late postoperative period. The latest have been defined arbitrarily as the ones ocurring after the 7th postoperative day. They are less common than the early ones and most of the cases have been reported up to six months after the operation. They usually determine diagnostic difficulties that can negatively influence the prognosis. Because of its atypical late appearance, a case of a 65 year old man is presented who developed a postpericardiotomy syndrome and subsequently a pericardial clot nearly two years after aortocoronary bypass grafting.
- Experimental heart preservation for 24 hours: benefits of PGE1 in a nonpulsatile coronary perfusion solution(Elsevier, 1988) Herreros, J. (Jesús); Ponz, L. (L.); Arcas, R. (R.); Abaya, A.R. (A. R.); Errasti, P. (Pedro); Gil, J.M. (J. M.); Llorens, R. (Rafael)The increase in activity of centers with cardiac transplant programs has been limited because of the unavailability of high quality donor organs. Nonpulsatile coronary perfusion (NPCP) with hypothermia has allowed long-term cardiac preservation in various experimental models.1-4 This experiment was designed to study the effects of PGE1 in an experimental NPCP.
- Xenoinjerto de Carpentier-Edwards: evolución a los 13 años(Elsevier España, 1985) Herreros, J. (Jesús); Casillas, J.A. (J. A.); Arcas, R. (R.); Martin-Trenor, A. (Alejandro); Llorens, R. (Rafael)
- Does desmopressin acetate reduce blood loss after surgery in patients on cardiopulmonary bypass?(Lippincott, Williams & Wilkins, 1988) Paramo, J.A. (José Antonio); Arcas, R. (R.); Rocha, E. (Eduardo); Cuesta, B. (Braulia); Martin-Trenor, A. (Alejandro); Llorens, R. (Rafael)It has been suggested that desmopressin acetate (DDAVP) administration reduces blood loss after cardiac surgery. We have investigated the effect of DDAVP administration in a double-blind, randomized, prospective trial including 100 patients placed on cardiopulmonary bypass during surgery. Fifty patients received 0.3 micrograms/kg DDAVP and 50 patients received a placebo administered in a 50 ml saline solution over 15 min when cardiopulmonary bypass had been concluded. Results showed no significant differences either in total blood loss per square meter (458 +/- 206 ml in the DDAVP group vs 536 +/- 304 ml in the placebo group) or in necessity for red cell transfusions (1642 +/- 705 ml in the DDAVP group vs 1574 +/- 645 ml in the placebo group) in the first 72 hr after surgery. Only intraoperative blood loss per square meter was significantly lower (p less than .02) in the DDAVP group (131 +/- 106 ml) as compared with the placebo group (193 +/- 137 ml). The prolongation of bleeding time and the decrease of factor VIII:C and factor VIII:von Willebrand factor 90 min after treatment were significantly lower (p less than .001) in the DDAVP group as compared with the placebo group. We conclude that the administration of DDAVP in patients placed on cardiopulmonary bypass during surgery does not reduce total blood loss and is only effective in reducing intraoperative bleeding.
- Randomized study of aprotinin and DDAVP to reduce postoperative bleeding after cardiopulmonary bypass surgery(Lippincott, Williams & Wilkins, 1994) Arroyo, J.L. (José L.); Paramo, J.A. (José Antonio); Rocha, E. (Eduardo); Hidalgo, F. (Francisco); Llorens, R. (Rafael); Melero, J.M. (José María)BACKGROUND: Patients on cardiopulmonary bypass (CPB) have an increased susceptibility to postoperative bleeding. Previous reports using desmopressin acetate (DDAVP) for the prevention of postoperative bleeding have given contradictory results, whereas the protease inhibitor aprotinin has been shown to reduce blood loss after this type of surgery. This randomized study was performed to assess the efficacy of DDAVP versus aprotinin in the prevention of bleeding after CPB. METHODS AND RESULTS: One hundred nine of 122 eligible patients were randomized to four different groups: Group A (n = 28) received aprotinin starting with a bolus of 2 x 10(6) KIU followed by a continuous infusion of 0.5 x 10(6) KIU/h until the end of surgery; group B (n = 25) received of DDAVP 0.3 micrograms/kg i.v. on completion of CPB; group C (n = 28) received two doses of DDAVP, the first as in group B and an additional dose 6 hours after surgery; group D (n = 28) received no treatment. There was a marked reduction of postoperative blood loss either at 12 hours (P < .01) or 72 hours (P < .02) in the aprotinin group compared with all other groups, whereas no significant effect was observed in either of the two DDAVP regimens. A significant reduction in the amount of blood used was observed only in the aprotinin group (P < .01). Of the plasma fibrinolytic components assayed, there was a significant reduction of the fibrin degradation product generation in the aprotinin group (P < .001), whereas a significant systemic hyperfibrinolysis was observed in both DDAVP-treated groups and the control group. No side effects related to the study drugs were observed in any patient. CONCLUSIONS: Aprotinin inhibited fibrinolysis; this correlated with a significant reduction of postoperative blood loss and need for blood replacement after CPB. Neither one nor two doses of DDAVP had a beneficial effect. Aprotinin offers a better alternative than DDAVP in the prevention of bleeding after CPB.
- Influencia del sexo sobre la indicación de revascularización coronaria quirúrgica. Peculiaridades técnicas y resultados en la mujer(Elsevier España, 1994) Llorens, R. (Rafael)