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Background Frailty is a geriatric syndrome that diminishes potential functional recovery after any surgical procedure. Preoperative surgical risk assessment is crucial to calibrate the risk and benefit of cardiac surgery. The aim of this study was to test usefulness of FRAIL Scale and other surgical-risk-scales and individual features of frailty. Methods: Prospective study. From May-2014 to February-2016, we collected 200 patients who underwent aortic valve replacement, either surgically or transcatheter. At 1-year follow-up, quality of life measurements were recorded using the EQ-5D (EuroQol). Univariate and multivariate analyses correlated preoperative condition, features of frailty and predicted risk scores with mortality, morbidity and quality of life at 1 year of follow-up. Results: Mean age 78.2y, 56%male. Mean-preoperative-scores: FRAIL scale 1.5(SD 1.02), STS 2.9(SD 1.13), BI 93.8(SD 7.3), ESlog I 12.8(SD 8.5) and GS 7.3s (SD 1.9). Morbidity at discharge, 6 m and 1 year was 51%, 14% and 28%. Mortality 4%. Survival at 6m/ 1-y was 97% / 88%. Complication-rate was higher in TAVI group due to-vascular complications. Renal dysfunction, anemia, social dependence and GS slower than 7 seconds were associated with morbidity. On multivariate analysis adjusted STS, BI and GS speed were statistically significant. Quality of life at 1-year follow-up adjusted for age and prosthesis type showed a significant association with STS and FRAIL scale scores. Conclusions: Frailty increases surgical risk and is associated with higher morbidity. Preoperative GS slower 7 s, and STS and FRAIL scale scores seem to be reliable predictors of quality of life at 1-year follow-up.

This article describes from a constructivist perspective a Natural History expedition put together by the Spanish government and navy to visit territories in the Pacific in the 1860s. Right from the start the expedition ran into problems and barely made it back. However, it managed to compile an admiringly large assortment of specimens: extensive collections of shells, mammals, skulls, and photographs. The expedition was rooted in colonialism. Patrons and organizers of the expedition sought to recreate in Spain discourses and practices then dominant in France, particularly the colonial agenda of the Société Impériale Zoologique d'Acclimatation. The collection assembled by the Comisión Científica del Pacífico had a life of its own. Years after the expedition folded, the collection kept on circulating and inspiring local and foreign scientists to identify new species and draw lessons from anthropology to history. The study of this collection was always discontinuous, a fact that proves the guadianización of science in Spain. The collection has been revived after a number of serendipitous discoveries in various Spanish archives, particularly caches of old photographs. Presently, the website www.pacifico.csic.es is expected to contribute to the circulation of the inscriptions generated by this scientific expedition.

OBJECTIVES This study reports long-term clinical outcomes—up to 17 years—among patients undergoing mitral valve replacement with the On-X bileaflet mechanical valve. Prior data regarding long-term outcomes with the On-X mitral valve have been limited. METHODS This retrospective observational study included all patients who underwent mitral valve replacement with the On-X (Standard or Conform-X) valve at 2 major Spanish cardiac surgery centres between 2001 and 2018. The primary study end point was freedom from death. The secondary study end points included surgical mortality and freedom from any valve-related events. Data were obtained from an institutional database, medical records review, direct telephone interviews or the Spanish population registry. Statistical and Kaplan–Meier analyses were performed. RESULTS A total of 661 patients (mean age 63.1 ± 10.9 years, 63% female) were followed for a mean of 5.6 years (range, 0–17.4 years). Survival at 5, 10 and 15 years was 85%, 71% and 63%, respectively. Surgical mortality was 7.3% (48/661). The linearized rate of global mortality was 1.3% patient-year. Freedom from reoperation was 97%, 95% and 92% at 5, 10 and 15 years, respectively; freedom from anticoagulation-related events was 94%, 89% and 89%, respectively. Multivariable analysis showed that mortality increased with total length of stay, age, smoking history, severe pulmonary hypertension and a permanent pacemaker. Patients who received the On-X 25 -mm valve had decreased long-term survival relative to patients who received other On-X valve sizes, possibly due to underlying risk factors. CONCLUSIONS Patients in this study showed good long-term survival and freedom from valve-related events.