BackgroundExtracorporeal membrane oxygenation (ECMO) is a recognized method of support in patient... more BackgroundExtracorporeal membrane oxygenation (ECMO) is a recognized method of support in patients with severe and refractory acute respiratory distress syndrome (ARDS) caused by SARS‐CoV‐2 infection. While veno‐venous (VV) ECMO is the most common type, some patients with severe hypoxemia may require modifications to the ECMO circuit. In this study, we aimed to investigate the effects of adding a second drainage cannula to the circuit in patients with refractory hypoxemia, on their gas exchange, mechanical ventilation, ECMO settings, and clinical outcomes.MethodsWe conducted an observational retrospective study based on a single‐center institutional registry including all consecutive cases of COVID‐19 patients requiring ECMO admitted to the Centre of Extracorporeal Therapies in Warsaw between March 1, 2020 and March 1, 2022. We selected patients who had an additional drainage cannula inserted. Changes in ECMO and ventilator settings, blood oxygenation, and hemodynamic parameters, as well as clinical outcomes were assessed.ResultsOf 138 VV ECMO patients, 12 (9%) patients met the inclusion criteria. Ten patients (83%) were men, and mean age was 42.2 ± 6.8. An addition of drainage cannula resulted in a significant raise in ECMO blood flow (4.77 ± 0.44 to 5.94 ± 0.81 [L/min]; p = 0.001), and the ratio of ECMO blood flow to ECMO pump rotations per minute (RPM), whereas the raise in ECMO RPM alone was not statistically significant (3432 ± 258 to 3673 ± 340 [1/min]; p = 0.064). We observed a significant drop in ventilator FiO2 and a raise in PaO2 to FiO2 ratio, while blood lactates did not change significantly. Nine patients died in hospital, one was referred to lung transplantation center, two were discharged uneventfully.ConclusionsThe use of an additional drainage cannula in severe ARDS associated with COVID‐19 allows for an increased ECMO blood flow and improved oxygenation. However, we observed no further improvement in lung‐protective ventilation and poor survival.
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, Mar 31, 2012
Infekcyjne zapalenie serca związane z wszczepianymi do serca urządzeniami elektrycznymi (ang. car... more Infekcyjne zapalenie serca związane z wszczepianymi do serca urządzeniami elektrycznymi (ang. cardiac device related infective endocarditis-CDRIE) stanowi coraz częstszy problem kliniczny. U przedstawionego chorego w ciągu kilkunastu lat doszczepiano kolejne elektrody do układu stymulującego serce, osiągając łączną liczbę pięciu. Po planowej ekstrakcji zęba doszło do rozwoju infekcji bakteryjnej wsierdzia z masywnymi wegetacjami na wszczepionych elektrodach, powikłanego zapalnym naciekiem w miejscu ujścia żyły głównej górnej (łac. vena cava superior-VCS) do prawego przedsionka. Ze względu na uwidaczniane w badaniu echokardiograficznym ogromne balotujące wegetacje podjęto decyzję o kardiochirurgicznym usunięciu zakażonych elektrod od strony jam serca. Operację wykonano w pełnym krążeniu pozaustrojowym przy zachowanej akcji serca. Jednoczasowo wykonano plastykę ujścia VCS za pomocą osierdzia własnego pacjenta oraz plastykę zastawki trójdzielnej. Przebieg pooperacyjny był niepowikłany. U chorego rozwinęło się trzepotanie przedsionków z częstością komór ok. 70/min i nie wymagało ono stymulacji serca. Słowa kluczowe: infekcyjne zapalenie wsierdzia, układ stymulujący serce. Summary Cardiac device related infective endocarditis (CDRIE) is a growing problem in daily practice. In the reported case, implantations of stimulation probes repeated over the years ended with the fifth. After planned extraction of a tooth, CDRIE with abundant vegetation on stimulation probes and inflammatory infiltration of the vena cava superior was observed. Surgical removal of the device was decided. On-pump beating heart stimulation probes were removed from heart ventricles. Simultaneously reconstruction of the vena cava superior and tricuspid valve plasty was performed. Postoperative course was uncomplicated. The patient presented atrial flutter about 70/min and did not require a pacemaker.
Wstęp: Stenoza aortalna to najpowszechniejsza choroba zastawek serca w Europie oraz Stanach Zjedn... more Wstęp: Stenoza aortalna to najpowszechniejsza choroba zastawek serca w Europie oraz Stanach Zjednoczonych i druga pod względem częstości występowania przyczyna interwencji kardiochirurgicznych. Skuteczne leczenie polega najczęściej na wymianie zastawki aortalnej na sztuczną zastawkę mechaniczną lub biologiczną. Prezentowane badanie pokazuje wczesne doświadczenia z nowym typem zastawki aortalnej Trifecta (St. Jude Medical, Inc.). Materiał i metody: Do badania włączono 38 kolejnych pacjentów, u których wykonano operację wymiany zastawki aortalnej (aortic valve replacement-AVR) lub AVR z operacją towarzyszącą. Przed zabiegiem, śródoperacyjnie i po operacji zbierano dane dotyczące: wyników badań biochemicznych krwi, zdarzeń niepożądanych, parametrów echokardiograficznych. U wszystkich pacjentów zastosowano profilaktykę zatorowo-zakrzepową antagonistami witaminy K w ciągu 3 miesięcy po operacji. Wyniki: U wszystkich pacjentów poddanych AVR (19 pacjentów) lub AVR z towarzyszącą wymianą aorty wstępującej (3 pacjentów) i dodatkową plastyką zatoki Valsalvy (1 pacjent) oraz operacją metodą Bentall de Bono z konduitem wykonanym śródoperacyjnie (1 pacjent) wybrano technikę małoinwazyjną. U wszystkich chorych skutecznie implantowano zastawkę aortalną Trifecta, w tym także u 14 pacjentów z inną niż wymieniona wyżej operacją towarzyszącą. Średni pooperacyjny gradient przez protezę wyniósł 13 mm Hg u pacjentów z małym ujściem aortalnym (rozmiar zastawki 19 mm i 21 mm). W przypadku rozmiaru 23 mm i większego średni gradient był liczbą jednocyfrową. Ogólna śmiertelność wynosiła 5,2% (2 pacjentów) i dotyczyła chorych wysokiego ryzyka z chorobami towarzyszącymi w złożonych operacjach serca. Wnioski: Wymiana zastawki aortalnej przy użyciu protezy biologicznej Trifecta jest wykonalna i bezpieczna. Niski pooperacyjny gradient w szczególności w małych ujściach aortalnych (19 mm i 21 mm) jest obiecujący. Niezbędne są dalsze badania,
Wstęp: Najczęstszym miejscem powstawania materiału zatorowo-zakrzepowego u pacjentów z migotaniem... more Wstęp: Najczęstszym miejscem powstawania materiału zatorowo-zakrzepowego u pacjentów z migotaniem przedsionków (AFib) jest uszko lewego przedsionka (LAA). Materiał jest uwidaczniany u ok. 1,6-2,1% pacjentów poddawanych ablacji. Obecnie rozwijanych jest coraz więcej metod mających na celu redukcję ryzyka wystąpienia powikłań zatorowo-zakrzepowych u pacjentów z AFib. Cel pracy: W niniejszym artykule opisano całkowicie torakoskopową, mało inwazyjną technikę usuwania LAA z zastosowaniem nowego staplera podczas ablacji samoistnego przetrwałego i przetrwałego długo trwającego migotania przedsionków. Materiał i metody: 19 pacjentów (12 mężczyzn, 7 kobiet) przyjętych pomiędzy listopadem 2011 a lutym 2013 z samoistnym przetrwałym i przetrwałym długo trwającym AFib zostało poddanych całkowicie torakoskopowej ablacji podłoża arytmii z usunięciem LAA. Średni wiek, czas trwania arytmii, EUROScore II, CHA2DS2-VASc score, wymiar lewego przedsionka i LVEF wyniosły odpowiednio: 57,
The assessed endpoints included in-hospital death, stroke, need for chest reoperation due to blee... more The assessed endpoints included in-hospital death, stroke, need for chest reoperation due to bleeding, and prolonged mechanical ventilation over 24 hours. Additionally, 5-year follow-up data were collected. The study was approved by the institutional review board. All patients provided written informed consent to participate in the study. Thoracoscopic periareolar access The thoracoscopic periareolar access was achieved through a periareolar incision around the right nipple. 7 After thoracotomy in the 4th intercostal space had been performed, a small, soft tissue silicone retractor was introduced into the patient's body. A thoracoscope and a Chitwood clamp were introduced through additional ports (FIGURE 1B). The endoscopic view was obtained using a standard 10-mm endoscope with a variable angle of view (EndoCAMeleon, KARL STORZ GmbH & Co. KG, Tuttlingen, Germany) or a 3-dimensional view system (EinsteinVision 3.0, B. Braun, Tuttlingen, Germany). Video-assisted minithoracotomy access The skin incision was performed over the 4th intercostal space, along the anterior axillary line.
Surgical and interventional treatment of coronary artery disease is still a developing part of ca... more Surgical and interventional treatment of coronary artery disease is still a developing part of cardiology and cardiac surgery. The development of new minimally invasive revascularization techniques that avoid access through classic sternotomy, such as MIDCAB or fully endoscopic-robotic coronary artery bypass graft (TECAB), ensure a very quick postoperative recovery period, shorten the hospitalization period and reduce postoperative pain. This is important in patients qualified for multi-stage treatment.Rozwój kardiologii interwencyjnej i kardiochirurgii sprawia, żewciąż powstają lub są doskonalone nowe techniki w chirurgicznymlub interwencyjnym leczeniu choroby wieńcowej. Rozwójnowych małoinwazyjnych technik rewaskularyzacji, które pozwalająuniknąć dostępu poprzez klasyczną sternotomię, takichjak MIDCAB czy całkowicie endoskopowe pomostowanie tętnicwieńcowych z zastosowaniem robota (TECAB), zapewniająkrótki okres rekonwalescencji pooperacyjnej chorego, skracająokres hospitalizacji oraz zmniejszają ból pooperacyjny. Ma toistotne znaczenie u pacjentów zakwalifikowanych do leczeniakilkuetapowego
Polish Journal of Thoracic and Cardiovascular Surgery, 2022
The main goal of minimally invasive surgery is to reduce the perioperative trauma, accelerate pat... more The main goal of minimally invasive surgery is to reduce the perioperative trauma, accelerate patient mobilization and reduce the length of hospital stay. Due to the development of modern technology, these treatments can be offered to a wider group of patients. For many years, aortic root surgery consisted of mechanical conduit implantation and, therefore, necessitated lifelong anticoagulation. At present, in patients with aortic root aneurysm and significant aortic valve regurgitation, it is possible to perform minimal-access valve sparing surgical procedures. The current paper is a brief description of the surgical technique for aortic root aneurysm surgery with preservation of the patient's own valve using the David procedure.
Patients with severe symptomatic aortic stenosis have a poor prognosis with medical management al... more Patients with severe symptomatic aortic stenosis have a poor prognosis with medical management alone, and surgical aortic valve replacement can improve symptoms and survival. In recent years, transcatheter aortic valve implantation (TAVI) has been demonstrated to improve survival in inoperable patients and to be an alternative treatment in patients in whom the risk of surgical morbidity or mortality is high or intermediate. A representative expert committee, summoned by the Association of Cardiovascular Interventions of the Polish Cardiac Society (ACVI) and the Polish Society of Cardio-Thoracic Surgeons, developed this Consensus Statement in transcatheter aortic valve implantation. It endorses the important role of a multidisciplinary "TAVI team" in selecting patients for TAVI and defines operator and institutional requirements fundamental to the establishment of a successful TAVI programme. The article summarises current evidence and provides specific recommendations on organisation and conduct of transcatheter treatment of patients with aortic valve disease in Poland.
Background: Ischaemic mitral regurgitation (IMR) may be surgically treated by isolated myocardial... more Background: Ischaemic mitral regurgitation (IMR) may be surgically treated by isolated myocardial revascularisation or in combination with valve repair. Dobutamine stress echocardiography (DSE) may be helpful in selecting an optimal surgical strategy. Aim: To develop the optimal surgical approach to patients (pts) with significant (ERO łO2 cm(2)) IMR on the basis of TEE-DSE. An attempt was undertaken to select patients in whom coronary revascularisation should be performed alone or in combination with reconstruction of mitral apparatus. Methods: The study group comprised 212 pts (M/F--134/78; mean age 65+/-10 years) with a history of Q-wave myocardial infarction qualified to elective surgical revascularisation on the basis of coronary angiography. In 25 pts with significant IMR (ejection fraction <40%, wall motion score index 1.8+/-0.3) TEE-DSE was performed. Based on TEE-DSE results pts were divided into the following groups: Group I--7 pts with significant reduction of MR and improvement of left ventricular contractility following dobutamine infusion and qualified to CABG; and Group II (n=18) without significant changes of IMR (9 pts) or with significant reduction of IMR without significant influence on WMSI (9 pts) who were qualified to CABG with mitral valve surgery. Results: In 4 pts from Group II valve replacement was performed and the remaining 14 pts had mitral annuloplasty. Echocardiographic assessments performed 2-7 days, 6 months and 12 months following the surgical procedure revealed IMR intensity as follows (number of patients is given): Group I--small 5/4/4, moderate 2/2/2, severe 0/0/0, Group II--small 15/14/13, moderate 2/3/3, severe 0/0/0. Conclusions: TEE-DSE seems to be a useful tool for optimal selection of surgical treatment in patients with significant IMR and qualification for CABG.
Atrial fibrillation (AF) remains the most common cardiac arrhythmia with increasing prevalence in... more Atrial fibrillation (AF) remains the most common cardiac arrhythmia with increasing prevalence in developed and aging countries. Pharmacological antiarrhythmic therapy has low effectiveness and is limited by its toxicity. Developed in 1987 by James Cox surgical ablation of AF called MAZE procedure was very effective, but due to its invasiveness and complexity was not widely adopted. Landmark research done by Haissaguerre in 1998 initiated a new approach for treatment namely percutaneous catheter ablation, which remains a class I/A indication in symptomatic paroxysmal AF refractory to optimal medical therapy. However, its efficacy in patients with persistent atrial fibrillation (PSAF) is far from satisfactory. Recent advancements in devices and techniques of minimally invasive surgical ablation show very good results in the treatment of PSAF. Current guidelines equate surgical with catheter ablation within the scope of efficacy indicating that both may be considered as an effective and safe treatment option for patients with persistent forms of arrhythmia. The higher efficacy of surgical ablation was confirmed at a 7-year follow-up of FAST trial with recurrence rate as high as 87% in catheter arm compared with 56% in thoracoscopic ablation arm. A new concept of the invasive treatment of AF consisting of combined surgical (epicardial) and electrophysiological (endocardial) was introduced in 2009. Recently experts' opinions and published data suggest that the proper hybrid treatment consisting of a planned combination of surgical and catheter ablation may give even better results. One of the most invaluable benefits of surgical ablations is the possibility of concomitant occlusion of the left atrial appendage. Recently good results have been reported for the novel epicardial clip for closing the left atrial appendage, which is placed in the deployment loop on a disposable holder.
Interactive Cardiovascular and Thoracic Surgery, Dec 6, 2021
OBJECTIVES: Most strokes associated with atrial fibrillation (AF) result from left atrial appenda... more OBJECTIVES: Most strokes associated with atrial fibrillation (AF) result from left atrial appendage thrombi. Oral anticoagulation can reduce stroke risk but is limited by complication risk and non-compliance. Left atrial appendage exclusion (LAAE) is a new surgical option to reduce stroke risk in AF. The study objective was to evaluate the safety and feasibility of standalone thoracoscopic LAAE in high stroke risk AF patients. METHODS: This was a retrospective, multicentre study of high stroke risk AF patients who had oral anticoagulation contraindications and were not candidates for ablation nor other cardiac surgery. Standalone thoracoscopic LAAE was performed using 3 unilateral ports access and epicardial clip. Periprocedural adverse events, long-term observational clinical outcomes and stroke rate were evaluated.
Advancements in modern healthcare result in a longer lifespan and increased prevalence of cardiov... more Advancements in modern healthcare result in a longer lifespan and increased prevalence of cardiovascular ailments in an aging society. The surging incidence of atrial fibrillation, the most common cardiac arrhythmia, creates strong demand for efficient diagnostic and effective treatment. Arrhythmia is often associated with other comorbidities and has a profound impact on heart function, physical and mental efficiency, and quality of life. However, more to the point is its impact on liability to thrombus formation and stroke hazardousness. While new treatment options for rhythm control as well as stroke prevention are emerging, the complexity of atrial fibrillation culprits imposes a multidisciplinary and holistic approach to its management. It also becomes expected to engage not only health professionals but also patients to be cognizant and active participants in a treatment course. New techniques and technologies in surgical and catheter ablation prove impressive results with high safety profiles. When joined together, they pave the way for an individualized, patient-oriented strategy. In recent 2020 European Society of Cardiology (ESC) guidelines, ablative treatment gained higher recognition with an increase in indication class from IIa to I in a growing number of cases. This Special Series endeavours to project future trends and possibilities for improving the diagnosis and treatment of atrial fibrillation. Our great privilege is to invite you to contribute your experience and perspective in the dynamic field of cardiac arrhythmia therapy.
Epicardial pulmonary vein isolation by cryoablation as treatment of nonmitral paroxysmal atrial f... more Epicardial pulmonary vein isolation by cryoablation as treatment of nonmitral paroxysmal atrial fibrillation. Is it effective?
Background In Poland, the clinical characteristics and outcomes of patients with COVID-19 requiri... more Background In Poland, the clinical characteristics and outcomes of patients with COVID-19 requiring extracorporeal membrane oxygenation (ECMO) remain unknown. This study aimed to answer these unknowns by analyzing data collected from high-volume ECMO centers willing to participate in this project. Methods This retrospective, multicenter cohort study was completed between March 1, 2020, and May 31, 2021 (15 months). Data from all patients treated with ECMO for COVID-19 were analyzed. Pre-ECMO laboratory and treatment data were compared between non-survivors and survivors. Independent predictors for death in the intensive care unit (ICU) were identified. Results There were 171 patients admitted to participating centers requiring ECMO for refractory hypoxemia due to COVID-19 during the defined time period. A total of 158 patients (mean age: 46.3 ± 9.8 years) were analyzed, and 13 patients were still requiring ECMO at the end of the observation period. Most patients (88%) were treated a...
Minimally-invasive surgery is more and more often considered to be an advisable treatment in case... more Minimally-invasive surgery is more and more often considered to be an advisable treatment in case of patients with mitral or triscupid valve dysfunctions, as well as those with heart tumor. The incision is reduced to minimum. As a result, the blood loss, postoperative pain and cardiorespiratory complications are also reduced. Minimally-invasive techniques are being developed dynamically all over the world, although they are not available yet in many medical centres. In this article, a case of a female patient in extremely severe condition is described. The women had been diagnosed with left atrial myxoma and underwent a minimally-invasive surgery with alternative access used for the purpose of extracorporeal circulation.
Wprowadzenie. Przezskorne wszczepienie zastawki aortalnej (TAVI) jest alternatywą dla chirurgiczn... more Wprowadzenie. Przezskorne wszczepienie zastawki aortalnej (TAVI) jest alternatywą dla chirurgicznej wymiany zastawki aortalnej. Cel. Ocena ryzyka okoloproceduralnego TAVI, skuteczności implantacji oraz wynikow leczenia bezpośredniego i 30-dniowej obserwacji pacjentow z Kliniki Kardiologii Inwazyjnej Centralnego Szpitala Klinicznego MSWiA. Materialy i metody. Analizą objeto 45 chorych zakwalifikowanych do przezskornego wszczepienia zastawki aortalnej. Średni wiek leczonej populacji wynosil 82 lata. Kobiety stanowily 55% chorych poddanych zabiegowi. Średni wynik EuroScore II wyniosl 4,78%. W badanej populacji dokonano analizy parametrow klinicznych (klasyfikacja NYHA, CCS), biochemicznych (miedzy innymi kreatynina, hemoglobina, NT-proBNP) oraz echokardiograficznych (LVEF, AVA). Badani chorzy przed zabiegiem TAVI mieli wykonaną rowniez 64-rzedową tomografie komputerową (ocena pierścienia zastawki oraz dostepu naczyniowego) oraz angiografie tetnic wiencowych. Zastawki CoreValve uzyto u ...
Maloinwazyjne pomostowanie naczyn wiencowych staje sie standardem postepowania u chorych ze zmian... more Maloinwazyjne pomostowanie naczyn wiencowych staje sie standardem postepowania u chorych ze zmianami w obrebie galezi przedniej zstepującej. Mimo to operacje typu MIDCAB wykonywane są jedynie w ośrodkach wyspecjalizowanych w technikach dostepu „przez dziurke od klucza”. W dziedzinie maloinwazyjnej chirurgii wiencowej zaproponowano rowniez rozwiązania dla chorych ze zmianami w wielu naczyniach wiencowych. W niniejszej pracy przedstawiono przypadek chorej przyjetej do Kliniki z niestabilną, wielonaczyniową chorobą wiencową, poddanej procedurze hybrydowej. W I etapie wykonano calkowicie endoskopowe pomostowanie galezi przedniej zstepującej oraz galezi diagonalnej z uzyciem tetnicy promieniowej oraz piersiowej wewnetrznej lewej pobranych calkowicie endoskopowo w technice 3D. W II etapie wykonano angiografie galezi okalającej oraz galezi pośredniej z pomiarami FFR. W kolejnym kroku przeprowadzono angioplastyke tetnicy okalającej.
ECMO (extracorporeal membrane oxygenation) is a method of extra-systemic blood oxygenation. It in... more ECMO (extracorporeal membrane oxygenation) is a method of extra-systemic blood oxygenation. It involves the oxygenation of venous blood in an oxygenator with the simultaneous elimination of carbon dioxide in the extracorporeal system. This method is used in the treatment of acute circulatory failure (veno-arterial configuration) as well as in acute respiratory failure (veno-venous configuration). The pandemic caused by the COVID-19 coronavirus resulted in the need to quickly gather and summarize knowledge and introduce new data to existing guidelines. One such document is the recommendations of ELSO (Extracorporeal Life Support Organization). The following paper presents the current summary of recommendations of both ELSO and polish national experts panel dealing with ECMO treatment.
BackgroundExtracorporeal membrane oxygenation (ECMO) is a recognized method of support in patient... more BackgroundExtracorporeal membrane oxygenation (ECMO) is a recognized method of support in patients with severe and refractory acute respiratory distress syndrome (ARDS) caused by SARS‐CoV‐2 infection. While veno‐venous (VV) ECMO is the most common type, some patients with severe hypoxemia may require modifications to the ECMO circuit. In this study, we aimed to investigate the effects of adding a second drainage cannula to the circuit in patients with refractory hypoxemia, on their gas exchange, mechanical ventilation, ECMO settings, and clinical outcomes.MethodsWe conducted an observational retrospective study based on a single‐center institutional registry including all consecutive cases of COVID‐19 patients requiring ECMO admitted to the Centre of Extracorporeal Therapies in Warsaw between March 1, 2020 and March 1, 2022. We selected patients who had an additional drainage cannula inserted. Changes in ECMO and ventilator settings, blood oxygenation, and hemodynamic parameters, as well as clinical outcomes were assessed.ResultsOf 138 VV ECMO patients, 12 (9%) patients met the inclusion criteria. Ten patients (83%) were men, and mean age was 42.2 ± 6.8. An addition of drainage cannula resulted in a significant raise in ECMO blood flow (4.77 ± 0.44 to 5.94 ± 0.81 [L/min]; p = 0.001), and the ratio of ECMO blood flow to ECMO pump rotations per minute (RPM), whereas the raise in ECMO RPM alone was not statistically significant (3432 ± 258 to 3673 ± 340 [1/min]; p = 0.064). We observed a significant drop in ventilator FiO2 and a raise in PaO2 to FiO2 ratio, while blood lactates did not change significantly. Nine patients died in hospital, one was referred to lung transplantation center, two were discharged uneventfully.ConclusionsThe use of an additional drainage cannula in severe ARDS associated with COVID‐19 allows for an increased ECMO blood flow and improved oxygenation. However, we observed no further improvement in lung‐protective ventilation and poor survival.
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery, Mar 31, 2012
Infekcyjne zapalenie serca związane z wszczepianymi do serca urządzeniami elektrycznymi (ang. car... more Infekcyjne zapalenie serca związane z wszczepianymi do serca urządzeniami elektrycznymi (ang. cardiac device related infective endocarditis-CDRIE) stanowi coraz częstszy problem kliniczny. U przedstawionego chorego w ciągu kilkunastu lat doszczepiano kolejne elektrody do układu stymulującego serce, osiągając łączną liczbę pięciu. Po planowej ekstrakcji zęba doszło do rozwoju infekcji bakteryjnej wsierdzia z masywnymi wegetacjami na wszczepionych elektrodach, powikłanego zapalnym naciekiem w miejscu ujścia żyły głównej górnej (łac. vena cava superior-VCS) do prawego przedsionka. Ze względu na uwidaczniane w badaniu echokardiograficznym ogromne balotujące wegetacje podjęto decyzję o kardiochirurgicznym usunięciu zakażonych elektrod od strony jam serca. Operację wykonano w pełnym krążeniu pozaustrojowym przy zachowanej akcji serca. Jednoczasowo wykonano plastykę ujścia VCS za pomocą osierdzia własnego pacjenta oraz plastykę zastawki trójdzielnej. Przebieg pooperacyjny był niepowikłany. U chorego rozwinęło się trzepotanie przedsionków z częstością komór ok. 70/min i nie wymagało ono stymulacji serca. Słowa kluczowe: infekcyjne zapalenie wsierdzia, układ stymulujący serce. Summary Cardiac device related infective endocarditis (CDRIE) is a growing problem in daily practice. In the reported case, implantations of stimulation probes repeated over the years ended with the fifth. After planned extraction of a tooth, CDRIE with abundant vegetation on stimulation probes and inflammatory infiltration of the vena cava superior was observed. Surgical removal of the device was decided. On-pump beating heart stimulation probes were removed from heart ventricles. Simultaneously reconstruction of the vena cava superior and tricuspid valve plasty was performed. Postoperative course was uncomplicated. The patient presented atrial flutter about 70/min and did not require a pacemaker.
Wstęp: Stenoza aortalna to najpowszechniejsza choroba zastawek serca w Europie oraz Stanach Zjedn... more Wstęp: Stenoza aortalna to najpowszechniejsza choroba zastawek serca w Europie oraz Stanach Zjednoczonych i druga pod względem częstości występowania przyczyna interwencji kardiochirurgicznych. Skuteczne leczenie polega najczęściej na wymianie zastawki aortalnej na sztuczną zastawkę mechaniczną lub biologiczną. Prezentowane badanie pokazuje wczesne doświadczenia z nowym typem zastawki aortalnej Trifecta (St. Jude Medical, Inc.). Materiał i metody: Do badania włączono 38 kolejnych pacjentów, u których wykonano operację wymiany zastawki aortalnej (aortic valve replacement-AVR) lub AVR z operacją towarzyszącą. Przed zabiegiem, śródoperacyjnie i po operacji zbierano dane dotyczące: wyników badań biochemicznych krwi, zdarzeń niepożądanych, parametrów echokardiograficznych. U wszystkich pacjentów zastosowano profilaktykę zatorowo-zakrzepową antagonistami witaminy K w ciągu 3 miesięcy po operacji. Wyniki: U wszystkich pacjentów poddanych AVR (19 pacjentów) lub AVR z towarzyszącą wymianą aorty wstępującej (3 pacjentów) i dodatkową plastyką zatoki Valsalvy (1 pacjent) oraz operacją metodą Bentall de Bono z konduitem wykonanym śródoperacyjnie (1 pacjent) wybrano technikę małoinwazyjną. U wszystkich chorych skutecznie implantowano zastawkę aortalną Trifecta, w tym także u 14 pacjentów z inną niż wymieniona wyżej operacją towarzyszącą. Średni pooperacyjny gradient przez protezę wyniósł 13 mm Hg u pacjentów z małym ujściem aortalnym (rozmiar zastawki 19 mm i 21 mm). W przypadku rozmiaru 23 mm i większego średni gradient był liczbą jednocyfrową. Ogólna śmiertelność wynosiła 5,2% (2 pacjentów) i dotyczyła chorych wysokiego ryzyka z chorobami towarzyszącymi w złożonych operacjach serca. Wnioski: Wymiana zastawki aortalnej przy użyciu protezy biologicznej Trifecta jest wykonalna i bezpieczna. Niski pooperacyjny gradient w szczególności w małych ujściach aortalnych (19 mm i 21 mm) jest obiecujący. Niezbędne są dalsze badania,
Wstęp: Najczęstszym miejscem powstawania materiału zatorowo-zakrzepowego u pacjentów z migotaniem... more Wstęp: Najczęstszym miejscem powstawania materiału zatorowo-zakrzepowego u pacjentów z migotaniem przedsionków (AFib) jest uszko lewego przedsionka (LAA). Materiał jest uwidaczniany u ok. 1,6-2,1% pacjentów poddawanych ablacji. Obecnie rozwijanych jest coraz więcej metod mających na celu redukcję ryzyka wystąpienia powikłań zatorowo-zakrzepowych u pacjentów z AFib. Cel pracy: W niniejszym artykule opisano całkowicie torakoskopową, mało inwazyjną technikę usuwania LAA z zastosowaniem nowego staplera podczas ablacji samoistnego przetrwałego i przetrwałego długo trwającego migotania przedsionków. Materiał i metody: 19 pacjentów (12 mężczyzn, 7 kobiet) przyjętych pomiędzy listopadem 2011 a lutym 2013 z samoistnym przetrwałym i przetrwałym długo trwającym AFib zostało poddanych całkowicie torakoskopowej ablacji podłoża arytmii z usunięciem LAA. Średni wiek, czas trwania arytmii, EUROScore II, CHA2DS2-VASc score, wymiar lewego przedsionka i LVEF wyniosły odpowiednio: 57,
The assessed endpoints included in-hospital death, stroke, need for chest reoperation due to blee... more The assessed endpoints included in-hospital death, stroke, need for chest reoperation due to bleeding, and prolonged mechanical ventilation over 24 hours. Additionally, 5-year follow-up data were collected. The study was approved by the institutional review board. All patients provided written informed consent to participate in the study. Thoracoscopic periareolar access The thoracoscopic periareolar access was achieved through a periareolar incision around the right nipple. 7 After thoracotomy in the 4th intercostal space had been performed, a small, soft tissue silicone retractor was introduced into the patient's body. A thoracoscope and a Chitwood clamp were introduced through additional ports (FIGURE 1B). The endoscopic view was obtained using a standard 10-mm endoscope with a variable angle of view (EndoCAMeleon, KARL STORZ GmbH & Co. KG, Tuttlingen, Germany) or a 3-dimensional view system (EinsteinVision 3.0, B. Braun, Tuttlingen, Germany). Video-assisted minithoracotomy access The skin incision was performed over the 4th intercostal space, along the anterior axillary line.
Surgical and interventional treatment of coronary artery disease is still a developing part of ca... more Surgical and interventional treatment of coronary artery disease is still a developing part of cardiology and cardiac surgery. The development of new minimally invasive revascularization techniques that avoid access through classic sternotomy, such as MIDCAB or fully endoscopic-robotic coronary artery bypass graft (TECAB), ensure a very quick postoperative recovery period, shorten the hospitalization period and reduce postoperative pain. This is important in patients qualified for multi-stage treatment.Rozwój kardiologii interwencyjnej i kardiochirurgii sprawia, żewciąż powstają lub są doskonalone nowe techniki w chirurgicznymlub interwencyjnym leczeniu choroby wieńcowej. Rozwójnowych małoinwazyjnych technik rewaskularyzacji, które pozwalająuniknąć dostępu poprzez klasyczną sternotomię, takichjak MIDCAB czy całkowicie endoskopowe pomostowanie tętnicwieńcowych z zastosowaniem robota (TECAB), zapewniająkrótki okres rekonwalescencji pooperacyjnej chorego, skracająokres hospitalizacji oraz zmniejszają ból pooperacyjny. Ma toistotne znaczenie u pacjentów zakwalifikowanych do leczeniakilkuetapowego
Polish Journal of Thoracic and Cardiovascular Surgery, 2022
The main goal of minimally invasive surgery is to reduce the perioperative trauma, accelerate pat... more The main goal of minimally invasive surgery is to reduce the perioperative trauma, accelerate patient mobilization and reduce the length of hospital stay. Due to the development of modern technology, these treatments can be offered to a wider group of patients. For many years, aortic root surgery consisted of mechanical conduit implantation and, therefore, necessitated lifelong anticoagulation. At present, in patients with aortic root aneurysm and significant aortic valve regurgitation, it is possible to perform minimal-access valve sparing surgical procedures. The current paper is a brief description of the surgical technique for aortic root aneurysm surgery with preservation of the patient's own valve using the David procedure.
Patients with severe symptomatic aortic stenosis have a poor prognosis with medical management al... more Patients with severe symptomatic aortic stenosis have a poor prognosis with medical management alone, and surgical aortic valve replacement can improve symptoms and survival. In recent years, transcatheter aortic valve implantation (TAVI) has been demonstrated to improve survival in inoperable patients and to be an alternative treatment in patients in whom the risk of surgical morbidity or mortality is high or intermediate. A representative expert committee, summoned by the Association of Cardiovascular Interventions of the Polish Cardiac Society (ACVI) and the Polish Society of Cardio-Thoracic Surgeons, developed this Consensus Statement in transcatheter aortic valve implantation. It endorses the important role of a multidisciplinary "TAVI team" in selecting patients for TAVI and defines operator and institutional requirements fundamental to the establishment of a successful TAVI programme. The article summarises current evidence and provides specific recommendations on organisation and conduct of transcatheter treatment of patients with aortic valve disease in Poland.
Background: Ischaemic mitral regurgitation (IMR) may be surgically treated by isolated myocardial... more Background: Ischaemic mitral regurgitation (IMR) may be surgically treated by isolated myocardial revascularisation or in combination with valve repair. Dobutamine stress echocardiography (DSE) may be helpful in selecting an optimal surgical strategy. Aim: To develop the optimal surgical approach to patients (pts) with significant (ERO łO2 cm(2)) IMR on the basis of TEE-DSE. An attempt was undertaken to select patients in whom coronary revascularisation should be performed alone or in combination with reconstruction of mitral apparatus. Methods: The study group comprised 212 pts (M/F--134/78; mean age 65+/-10 years) with a history of Q-wave myocardial infarction qualified to elective surgical revascularisation on the basis of coronary angiography. In 25 pts with significant IMR (ejection fraction <40%, wall motion score index 1.8+/-0.3) TEE-DSE was performed. Based on TEE-DSE results pts were divided into the following groups: Group I--7 pts with significant reduction of MR and improvement of left ventricular contractility following dobutamine infusion and qualified to CABG; and Group II (n=18) without significant changes of IMR (9 pts) or with significant reduction of IMR without significant influence on WMSI (9 pts) who were qualified to CABG with mitral valve surgery. Results: In 4 pts from Group II valve replacement was performed and the remaining 14 pts had mitral annuloplasty. Echocardiographic assessments performed 2-7 days, 6 months and 12 months following the surgical procedure revealed IMR intensity as follows (number of patients is given): Group I--small 5/4/4, moderate 2/2/2, severe 0/0/0, Group II--small 15/14/13, moderate 2/3/3, severe 0/0/0. Conclusions: TEE-DSE seems to be a useful tool for optimal selection of surgical treatment in patients with significant IMR and qualification for CABG.
Atrial fibrillation (AF) remains the most common cardiac arrhythmia with increasing prevalence in... more Atrial fibrillation (AF) remains the most common cardiac arrhythmia with increasing prevalence in developed and aging countries. Pharmacological antiarrhythmic therapy has low effectiveness and is limited by its toxicity. Developed in 1987 by James Cox surgical ablation of AF called MAZE procedure was very effective, but due to its invasiveness and complexity was not widely adopted. Landmark research done by Haissaguerre in 1998 initiated a new approach for treatment namely percutaneous catheter ablation, which remains a class I/A indication in symptomatic paroxysmal AF refractory to optimal medical therapy. However, its efficacy in patients with persistent atrial fibrillation (PSAF) is far from satisfactory. Recent advancements in devices and techniques of minimally invasive surgical ablation show very good results in the treatment of PSAF. Current guidelines equate surgical with catheter ablation within the scope of efficacy indicating that both may be considered as an effective and safe treatment option for patients with persistent forms of arrhythmia. The higher efficacy of surgical ablation was confirmed at a 7-year follow-up of FAST trial with recurrence rate as high as 87% in catheter arm compared with 56% in thoracoscopic ablation arm. A new concept of the invasive treatment of AF consisting of combined surgical (epicardial) and electrophysiological (endocardial) was introduced in 2009. Recently experts' opinions and published data suggest that the proper hybrid treatment consisting of a planned combination of surgical and catheter ablation may give even better results. One of the most invaluable benefits of surgical ablations is the possibility of concomitant occlusion of the left atrial appendage. Recently good results have been reported for the novel epicardial clip for closing the left atrial appendage, which is placed in the deployment loop on a disposable holder.
Interactive Cardiovascular and Thoracic Surgery, Dec 6, 2021
OBJECTIVES: Most strokes associated with atrial fibrillation (AF) result from left atrial appenda... more OBJECTIVES: Most strokes associated with atrial fibrillation (AF) result from left atrial appendage thrombi. Oral anticoagulation can reduce stroke risk but is limited by complication risk and non-compliance. Left atrial appendage exclusion (LAAE) is a new surgical option to reduce stroke risk in AF. The study objective was to evaluate the safety and feasibility of standalone thoracoscopic LAAE in high stroke risk AF patients. METHODS: This was a retrospective, multicentre study of high stroke risk AF patients who had oral anticoagulation contraindications and were not candidates for ablation nor other cardiac surgery. Standalone thoracoscopic LAAE was performed using 3 unilateral ports access and epicardial clip. Periprocedural adverse events, long-term observational clinical outcomes and stroke rate were evaluated.
Advancements in modern healthcare result in a longer lifespan and increased prevalence of cardiov... more Advancements in modern healthcare result in a longer lifespan and increased prevalence of cardiovascular ailments in an aging society. The surging incidence of atrial fibrillation, the most common cardiac arrhythmia, creates strong demand for efficient diagnostic and effective treatment. Arrhythmia is often associated with other comorbidities and has a profound impact on heart function, physical and mental efficiency, and quality of life. However, more to the point is its impact on liability to thrombus formation and stroke hazardousness. While new treatment options for rhythm control as well as stroke prevention are emerging, the complexity of atrial fibrillation culprits imposes a multidisciplinary and holistic approach to its management. It also becomes expected to engage not only health professionals but also patients to be cognizant and active participants in a treatment course. New techniques and technologies in surgical and catheter ablation prove impressive results with high safety profiles. When joined together, they pave the way for an individualized, patient-oriented strategy. In recent 2020 European Society of Cardiology (ESC) guidelines, ablative treatment gained higher recognition with an increase in indication class from IIa to I in a growing number of cases. This Special Series endeavours to project future trends and possibilities for improving the diagnosis and treatment of atrial fibrillation. Our great privilege is to invite you to contribute your experience and perspective in the dynamic field of cardiac arrhythmia therapy.
Epicardial pulmonary vein isolation by cryoablation as treatment of nonmitral paroxysmal atrial f... more Epicardial pulmonary vein isolation by cryoablation as treatment of nonmitral paroxysmal atrial fibrillation. Is it effective?
Background In Poland, the clinical characteristics and outcomes of patients with COVID-19 requiri... more Background In Poland, the clinical characteristics and outcomes of patients with COVID-19 requiring extracorporeal membrane oxygenation (ECMO) remain unknown. This study aimed to answer these unknowns by analyzing data collected from high-volume ECMO centers willing to participate in this project. Methods This retrospective, multicenter cohort study was completed between March 1, 2020, and May 31, 2021 (15 months). Data from all patients treated with ECMO for COVID-19 were analyzed. Pre-ECMO laboratory and treatment data were compared between non-survivors and survivors. Independent predictors for death in the intensive care unit (ICU) were identified. Results There were 171 patients admitted to participating centers requiring ECMO for refractory hypoxemia due to COVID-19 during the defined time period. A total of 158 patients (mean age: 46.3 ± 9.8 years) were analyzed, and 13 patients were still requiring ECMO at the end of the observation period. Most patients (88%) were treated a...
Minimally-invasive surgery is more and more often considered to be an advisable treatment in case... more Minimally-invasive surgery is more and more often considered to be an advisable treatment in case of patients with mitral or triscupid valve dysfunctions, as well as those with heart tumor. The incision is reduced to minimum. As a result, the blood loss, postoperative pain and cardiorespiratory complications are also reduced. Minimally-invasive techniques are being developed dynamically all over the world, although they are not available yet in many medical centres. In this article, a case of a female patient in extremely severe condition is described. The women had been diagnosed with left atrial myxoma and underwent a minimally-invasive surgery with alternative access used for the purpose of extracorporeal circulation.
Wprowadzenie. Przezskorne wszczepienie zastawki aortalnej (TAVI) jest alternatywą dla chirurgiczn... more Wprowadzenie. Przezskorne wszczepienie zastawki aortalnej (TAVI) jest alternatywą dla chirurgicznej wymiany zastawki aortalnej. Cel. Ocena ryzyka okoloproceduralnego TAVI, skuteczności implantacji oraz wynikow leczenia bezpośredniego i 30-dniowej obserwacji pacjentow z Kliniki Kardiologii Inwazyjnej Centralnego Szpitala Klinicznego MSWiA. Materialy i metody. Analizą objeto 45 chorych zakwalifikowanych do przezskornego wszczepienia zastawki aortalnej. Średni wiek leczonej populacji wynosil 82 lata. Kobiety stanowily 55% chorych poddanych zabiegowi. Średni wynik EuroScore II wyniosl 4,78%. W badanej populacji dokonano analizy parametrow klinicznych (klasyfikacja NYHA, CCS), biochemicznych (miedzy innymi kreatynina, hemoglobina, NT-proBNP) oraz echokardiograficznych (LVEF, AVA). Badani chorzy przed zabiegiem TAVI mieli wykonaną rowniez 64-rzedową tomografie komputerową (ocena pierścienia zastawki oraz dostepu naczyniowego) oraz angiografie tetnic wiencowych. Zastawki CoreValve uzyto u ...
Maloinwazyjne pomostowanie naczyn wiencowych staje sie standardem postepowania u chorych ze zmian... more Maloinwazyjne pomostowanie naczyn wiencowych staje sie standardem postepowania u chorych ze zmianami w obrebie galezi przedniej zstepującej. Mimo to operacje typu MIDCAB wykonywane są jedynie w ośrodkach wyspecjalizowanych w technikach dostepu „przez dziurke od klucza”. W dziedzinie maloinwazyjnej chirurgii wiencowej zaproponowano rowniez rozwiązania dla chorych ze zmianami w wielu naczyniach wiencowych. W niniejszej pracy przedstawiono przypadek chorej przyjetej do Kliniki z niestabilną, wielonaczyniową chorobą wiencową, poddanej procedurze hybrydowej. W I etapie wykonano calkowicie endoskopowe pomostowanie galezi przedniej zstepującej oraz galezi diagonalnej z uzyciem tetnicy promieniowej oraz piersiowej wewnetrznej lewej pobranych calkowicie endoskopowo w technice 3D. W II etapie wykonano angiografie galezi okalającej oraz galezi pośredniej z pomiarami FFR. W kolejnym kroku przeprowadzono angioplastyke tetnicy okalającej.
ECMO (extracorporeal membrane oxygenation) is a method of extra-systemic blood oxygenation. It in... more ECMO (extracorporeal membrane oxygenation) is a method of extra-systemic blood oxygenation. It involves the oxygenation of venous blood in an oxygenator with the simultaneous elimination of carbon dioxide in the extracorporeal system. This method is used in the treatment of acute circulatory failure (veno-arterial configuration) as well as in acute respiratory failure (veno-venous configuration). The pandemic caused by the COVID-19 coronavirus resulted in the need to quickly gather and summarize knowledge and introduce new data to existing guidelines. One such document is the recommendations of ELSO (Extracorporeal Life Support Organization). The following paper presents the current summary of recommendations of both ELSO and polish national experts panel dealing with ECMO treatment.
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Papers by Piotr Suwalski