Background—Whether mitral valve repair during coronary artery bypass grafting (CABG) improves sur... more Background—Whether mitral valve repair during coronary artery bypass grafting (CABG) improves survival in patients with ischemic mitral regurgitation (MR) remains unknown. Methods and Results—Patients with ejection fraction 35 % and coronary artery disease amenable to CABG were randomized at 99 sites worldwide to medical therapy with or without CABG. The decision to treat the mitral valve during CABG was left to the surgeon. The primary end point was mortality. Of 1212 randomized patients, 435 (36%)
Aim: To assess early and late results of surgical ventricular re- construction (SVR). Material an... more Aim: To assess early and late results of surgical ventricular re- construction (SVR). Material and Methods: Over 8 years we operated on 102 patients (75 males) of mean age 63±7. Initial LVEDV was 219±65 ml, ESV 150±55 ml, and EF 32±8%. In 53 patients (52%) we used patches to perform SVR. On average 2.9±1.1 coronary artery bypass grafts were implanted per patient (min. 0 - max. 5). In 43 (42%) patients we performed MV repair, in 1 MVR, in 4 TV repair, in 1 post-infarction VSD repair, in 1 ASD repair, in 1 AVR and in 1 ascending aorta replacement. Results: There were 8 perioperative deaths (7.8%). One-, 2-, 3-, and 5-year survival was: 83±5%, 76±5%, 72±6% and 62±7% re- spectively. As a result of SVR EDV dropped to 172±52 ml (p<0.001), ESV to 112±50 ml (p<0.001) and EF increased to 37±11% (p=0.053) in the last echocardiographic follow-up. On the last visit NYHA class was 1.6±0.7 - significantly less than preop 2.1±0.9 (p=0.009), and CCS class 0.6±0.6, less than pre- operative 1.6...
INTROduCTION Epicardial fat (EF) is a visceral adipose tissue depot surrounding coronary ar terie... more INTROduCTION Epicardial fat (EF) is a visceral adipose tissue depot surrounding coronary ar teries that has the unique embryology, anato my, and functionality. 1 The increased volume of EF was found to be a risk factor for cardiovascu lar diseases. 2,3 As we described previously, among patients with advanced coronary artery disease (CAD), type 2 diabetes (T2D) was associated with
Background Valve-sparing aortic root replacement (VSARR) techniques are an alternative to the cla... more Background Valve-sparing aortic root replacement (VSARR) techniques are an alternative to the classic Bentall procedure when aortic root aneurysm is not accompanied by aortic valve stenosis, and the regurgitant aortic valve is amenable to repair. aims The aim of the study was to assess long-term outcomes of valve sparing aortic root replacement using the David technique and the Yacoub technique. methods A total of 101 consecutive, elective VSARR procedures were performed from January 2010 to April 2020 including 52 David procedures (51.5%) and 49 Yacoub procedures (48.5%). We analyzed mortality, freedom from reoperation, and freedom from aortic valve regurgitation. The analysis was performed for the entire study cohort and for 2 subgroups: the David technique and the Yacoub technique. results The mean (SD) age was 50.2 (16.1) years; 90 (89.1%) patients were male. The median (interquartile range [IQR]) EuroScore II was 3.7 (2.7-5.8). At 1, 5, and 8 years after surgery, survival (SE) was 98% (3%), 91.8% (8%), and 91.8% (8%), respectively, whereas freedom from reoperation (SE) was 100%, 97% (3%), and 97% (3%), respectively. Follow-up echocardiography performed at a median (IQR) of 18.7 (2.5-36.7) months postsurgery revealed freedom from aortic valve regurgitation in 90.8% of patients. No significant differences in mortality, freedom from reoperation, and freedom from aortic valve regurgitation were noted between the David and Yacoub subgroups. conclusions VSARR is a safe and effective surgical technique in patients with aortic root aneurysm, as the associated mortality, reoperation rate, and aortic valve regurgitation recurrence are low.
Levosimendan is a new inodilator which involves 3 main mechanisms: increases the calcium sensitiv... more Levosimendan is a new inodilator which involves 3 main mechanisms: increases the calcium sensitivity of cardiomyocytes, acts as a vasodilator due to the opening of potassium channels, and has a cardioprotective effect. Levosimendan is mainly used in the treatment of acute decompensated heart failure (class IIb recommendation according to the European Society of Cardiology guidelines). However, numerous clinical trials indicate the validity of repeated infusions of levosimendan in patients with stable heart failure as a bridge therapy to heart transplantation, and in patients with accompanying right ventricular heart failure and pulmonary hypertension. Due to the complex mechanism of action, including the cardioprotective and anti aggregating effect, the use of levosimendan may be particularly beneficial in acute coronary syndromes, preventing the occurrence of acute heart failure. There are data indicating that levosimendan administered prior to cardiac surgery may improve outcomes in patients with severely impaired left ventricular function. The multidirectional mechanism of action also affects other organs and systems. The positive effect of levosimendan in the treatment of cardio renal and cardio hepatic syndromes has been shown. It has a safe and predictable profile of action, does not induce tolerance, and shows no adverse effects affecting patients survival or prognosis. However, with inconclusive results of previous studies, there is a need for a welldesigned multicenter randomized placebo controlled study, including an adequately large group of outpatients with chronic advanced systolic heart failure.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-No... more This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives 4.0 International License (CC BY-NC-ND 4.0), allowing third parties to download articles and share them with others, provided the original work is properly cited, not changed in any way, distributed under the same license, and used for noncommercial purposes only.
Introduction: Cortisol level affects the prognosis of patients after cardiac surgery. Meanwhile, ... more Introduction: Cortisol level affects the prognosis of patients after cardiac surgery. Meanwhile, there are no clear guidelines for steroid supplementation after a cardiac operation. The relationship between age and blood cortisol levels has not been finally clarified. Aim: Assessment of adrenal reserve and secretion of cortisol in patients over 60 years of age undergoing cardiac surgery. Material and methods: The study included 20 patients of both sexes referred for cardiac surgery. A short ACTH synthetic stimulation test was carried out. Assessment of cortisol secretion was carried out in the morning on the day of surgery and the 1 st , 2 nd and 4 th days after surgery in blood samples. Results: A result within the normal range for the adrenal reserve was found in 19 of the 20 patients enrolled in the study. The short Synacthen test predicted postoperative secretion of cortisol (p = 0.04, r = 0.047). A relationship between secretion of cortisol and patients' age was observed (p = 0.03, r = 0.48). The concentration of cortisol on the 1 st postoperative day was correlated with the total dose of dopamine (p = 0.006, r = 0.58) and adrenaline (p = 0.04, r = 0.47). The concentration of cortisol on the day of the surgery correlated with the lactate concentration on day 2 (p = 0.04, r = 0.45). The concentration of lactates on day 1 correlated with total dose of dopamine (p = 0.01, r = 0.54). Conclusions: A short Synacthen test allows one to predict secretion of cortisol after cardiac surgery. Greater secretion of cortisol after cardiac surgery may be associated with a more difficult postoperative course. There was no decrease in cortisol secretion with age.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-No... more This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives 4.0 International License (CC BY-NC-ND 4.0), allowing third parties to download articles and share them with others, provided the original work is properly cited, not changed in any way, distributed under the same license, and used for noncommercial purposes only.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-No... more This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA4.0), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited, distributed under the same license, and used for noncommercial purposes only.
Background: Aortic valve replacement (AVR) is one of the most common surgeries performed in cardi... more Background: Aortic valve replacement (AVR) is one of the most common surgeries performed in cardiac surgery operating rooms. We present actual, real life trends from the last 10 years for AVR interventions based on a multicentre National Registry of Cardiac Surgery Database. Methods: The study population consisted of all 50,846 consecutive adult patients who underwent AVR between January 2006 and August 2016 in all cardiac surgery units in Poland. The main outcome measures were changes in the number of valves, characteristics of valves, operative details, and in-hospital mortality. Analysis consisted of all aortic valve (AV) procedures, including isolated AV surgery, combination procedures and patients who had a prior valve operation. Results: In last 10 years, the number of procedures increased by 46%. Isolated surgical AVR was performed in 61.2%, AVR + coronary artery bypass grafting (CABG) in 23.9%, AVR + mitral valve replacement (MVR) in 7%, and transcatheter aortic valve implantation (TAVI) in 2.3% of patients. The mean patient age increased significantly from 61.4 years in 2006 to 66.1 years in 2016. Aortic stenosis was diagnosed in 73.4%, severe aortic insufficiency in 15.8% of cases. The most common valve pathology was calcification. Congenital valve dysfunction was diagnosed in 3.7% of cases. There was a 33.7% increase of bioprosthesis, and the most common implanted bioprosthesis was the Hancock II. The most common implanted mechanical prosthesis was the St. Jude Medical Mechanical Valve. In-hospital mortality decreased significantly over the 10-year period in all AV procedures from 10.9% in 2006 to 8.3% in 2016. Mean in-hospital mortality was: 4.0% in isolated surgical AVR, 5.4% in TAVI, 6.8% in AVR + CABG, 9.8% in AVR + MVR, 17.2% in AVR + MVR + CABG. Conclusions: In the last ten years, the number of AV procedure has doubled. Mortality was significantly lower with all types of AV procedure despite very rapid aging of AVR patients. TAVI procedure rapidly grew Study databases Data for this study was collected retrospectively based on the standardised form of the Polish National Database of Cardiac Surgery Procedures (KROK). The data collected included age, gender, body mass index (BMI), ejection fraction (EF), previous percutaneous coronary intervention (PCI), Canadian Cardiovascular Society (CCS) class, New York Heart Association (NYHA) class, smoking status, diabetes mellitus (DM), arterial hypertension, hypercholesterolaemia, asthma, chronic obstructive pulmonary disease (COPD). On the basis of the form of the National Database of Cardiac Surgery (KROK), a computer database was built for further statistical analysis. Missing data We excluded patients if records for outcomes (i.e., mortality/ survivors) were missing. The completeness of each record was counted: records were only analysed where the percentage of complete data was higher than 90%. Records that were lower than 90% were excluded from analysis. Almost all the data collected was more than 90% complete. in popularity. There is significant increase in the use of bioprosthesis.
Advances in clinical and experimental medicine : official organ Wroclaw Medical University, 2018
Opioidergic conditioning is well documented to trigger cardioprotection against ischemia/ reperfu... more Opioidergic conditioning is well documented to trigger cardioprotection against ischemia/ reperfusion (I/R) injury. Previous studies on animal models have suggested that nitric oxide (NO) mediates the beneficial effect of opioids, but the role of NO in humans seems to be controversial. The aim of the study was to assess the influence of NO modulators on opioid-induced cardioprotection in the human myocardium. Trabeculae of the human right atria were electrically driven in an organ bath and subjected to simulated I/R injury. The non-selective inhibitor of nitric oxide synthase (NOS) - N-methyl-l-arginine (LNMMA), the donor of NO - S-Nitroso-N-acetylpenicillamine (SNAP) or morphine (in the amount of 10-4 M) were used at the time of re-oxygenation. The additional trabecula was subjected to the hypoxia protocol only (control). The contractility of the myocardium was assessed as the maximal force of a contraction (Amax), the rate of rise of the force of a contraction (Slope L) and the ca...
Journal of cardiothoracic and vascular anesthesia, Jun 1, 2018
The authors aimed to assess determinants of intubation time and evaluate its impact on 30-day and... more The authors aimed to assess determinants of intubation time and evaluate its impact on 30-day and 1-year postoperative survival in Surgical Treatment for Ischemic Heart Failure (STICH) trial patients. A multivariable Cox proportional hazards model was used among the 1,446 surgical patients from the STICH trial who survived 36 hours after operation, in order to identify perioperative factors associated with 30-day and 1-year postoperative mortality. A multivariable logistic regression model was used to determine risk factors associated with intubation time. At 36 hours post-operation, 1,298 (out of 1,446) were extubated and 148 (10.2%) still intubated. Median postoperative intubation time was 11.4 hours. Among patients surviving 36 hours, a multivariable model was developed to predict 30-day (c-index = 0.88) and 1-year (c-index = 0.78) mortality. Intubation time was the strongest independent predictor of 30-day (hazard ratio [HR] 5.50) and 1-year mortality (HR 3.69). Predictors of in...
Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery, 2016
We report on a 69-year-old woman who demonstrated native coronary artery and grafted vessel spasm... more We report on a 69-year-old woman who demonstrated native coronary artery and grafted vessel spasm following on-pump coronary artery bypass grafting (CABG). Despite intraaortic balloon pump (IABP) insertion, electrocardiogram (ECG) abnormalities did not disappear. Emergency coronary angiography (CAG) was performed. The patient was successfully treated with systemic and intracoronary injection of vasodilator agents. ECG changes disappeared, with normalized and stable hemodynamic function. Intraaortic balloon pump was maintained for 48 h. The patient was discharged in good clinical condition. Coronary artery spasm (CAS) may result in life-threatening arrhythmias, circulatory collapse or death. The etiology of CAS is multifactorial and includes heart manipulation, exogenous vasoconstrictors, stress-related catecholamine release, hypoxia and oxidative stress. Postoperative CAS is most commonly manifested by ST-segment elevation and circulatory collapse without specific causes. The gold s...
Interactive CardioVascular and Thoracic Surgery, 2016
A best evidence topic in cardiac surgery was written according to a structured protocol. The ques... more A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Do we have to operate on moderate functional mitral regurgitation (FMR) during aortic valve replacement (AVR) for aortic stenosis (AS)?' Altogether 325 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The current evidence obtained from these papers revealed that the significant predictors of improvement outcome include lower preoperative mitral regurgitation and lower preoperative left ventricle fractional area change. We also know that persistent atrial fibrillation, enlarged left atrium, increased indexed left ventricular mass, pulmonary hypertension and preoperative peak aortic valve gradient <60 mmHg are predictors of deterioration. Generally, we observed a trend towards improvement or non-progression of FMR following AVR for AS. In the six papers that suggest conservative treatment of FMR, the degree of mitral regurgitation (MR) improved in 45-95%, remained unchanged in 19-38% and deteriorated in 1-14%. In the three papers favoring surgical treatment of MR, the degree of MR improved in 46-69%, stay unchanged in 34-53% and deteriorated in 10%. The current evidence suggests that moderate or less grade of FMR without predictors of deterioration should be treated conservatively and moderate-severe and severe FMR warrants additional surgical procedure. A clearly randomized study, especially in patients with moderate and moderate-severe FMR for AS, seems appropriate to further elucidate surgical strategy.
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 30, 2015
Totally epicardial cardiac resynchronization therapy (CRT) is a novel treatment modality for pati... more Totally epicardial cardiac resynchronization therapy (CRT) is a novel treatment modality for patients with heart failure (HF) and systolic dyssynchrony undergoing coronary artery bypass grafting (CABG). In this study, we have prospectively evaluated the long-term outcomes of totally epicardial CRT. Between September 2007 and June 2009, one hundred and seventy-eight patients were randomly assigned to the CABG alone group (n = 87) and CABG with concomitant epicardial CRT implantation (n = 91). The primary end-point of the study was all-cause mortality in the two groups between the day of surgery and 13 August 2013 (common closing date). The secondary outcomes included mode of death, adverse cardiac events and lead performance. The mean follow-up was 55 ± 10.7 months. According to per-protocol analysis with treatment as a time-dependent variable to account for conversion from CABG to CABG + CRT, there were 24 deaths (35.8%) in the CABG group and 17 deaths (15.3%) in the CABG + CRT grou...
The Journal of Thoracic and Cardiovascular Surgery, 2015
Objectives: Advantages of aortic valve repair and root reconstruction include maintenance of natu... more Objectives: Advantages of aortic valve repair and root reconstruction include maintenance of natural valve hemodynamic parameters and avoidance of prosthetic valve-related complications. However, general acceptance of valve reconstruction may be limited by paucity of long-term follow-up data from only a few centers. This report is intended to supplement existing outcome information for aortic valve repair. Methods: Between 2003 and 2013, 200 consecutive patients (149 men, 51 women; mean age, 52.1 years) with significant aortic regurgitation and aortic root enlargement underwent aortic valve repair and associated root reconstruction. The same prospective selection criteria and systematic valve repair approaches were followed throughout the study. Root management consisted of either root remodeling or reimplantation with Dacron prostheses. Kaplan-Meier techniques were used to assess major end points of all-cause mortality, reoperation, and repair failure. Univariable log-rank testing was used to identify associations between risk factors and major events. Results: Early mortality was 2% (4 patients), and early repair failure was 3% (6 patients). New York Heart Association functional class was found to be a risk factor for early mortality and morbidity (odds ratio, 3.3; P ¼ .03), whereas crossclamp time and cardiopulmonary time were risk factors for early mortality (odds ratio, 1.04; 95% confidence interval, 1-1.07; P ¼ .01 and odds ratio, 1.02; 95% confidence interval, 1-1.03; P ¼ .02), respectively. Survival at a mean follow-up of 48.6 AE 34.3 months (median follow-up, 43.6 months; range, 17.8-78 months) was 94%, with a freedom from reoperation of 91%. Univariable risk factors for mortality were preoperative New York Heart Association functional class and requirement for root replacement. Repair failure and reoperation were associated with bicuspid valve anatomy, subcommissural annuloplasty, and complex leaflet repair. Freedom from repair failure was associated with aortic reimplantation. Conclusions: Data from a prospective cohort of patients undergoing aortic valve repair and root reconstruction reinforce the satisfactory medium-term results obtained with valve reconstruction. Further analysis of these patient outcomes is necessary to draw definitive conclusions on operative techniques.
W pracy zaprezentowano rzadki przypadek tętniaka rzekomego u pacjenta po zawale ściany dolnej mię... more W pracy zaprezentowano rzadki przypadek tętniaka rzekomego u pacjenta po zawale ściany dolnej mięśnia sercowego. Zawał powikłany był ostrą niedomykalnością zastawki mitralnej, obrzękiem płuc i wstrząsem kardiogennym. W trybie pilnym wykonano pomostowanie aortalno-wieńcowe oraz implantowano zastawkę mechaniczną w pozycję mitralną. W ciągu kilku następnych miesięcy u chorego zaobserwowano pogorszenie tolerancji wysiłku i zaostrzenie niewydolności serca. Podczas ponownej hospitalizacji u pacjenta rozpoznano ogromnego tętniaka rzekomego ściany dolnej, którego z dobrym efektem leczono chirurgicznie. Słowa kluczowe: tętniak rzekomy, ostry zawał mięśnia sercowego.
Zaletą operacji naprawczych jest niemal idealny efekt hemodynamiczny i uniknięcie powikłań związa... more Zaletą operacji naprawczych jest niemal idealny efekt hemodynamiczny i uniknięcie powikłań związanych ze sztuczną protezą. Wprowadzenie funkcjonalnej klasyfikacji niedomykalności zastawki aortalnej umożliwiło systematyczne i powtarzalne podejście do plastyk kompleksu zastawki aortalnej i opuszki aorty. Brak wyników odległych uniemożliwia szerokie rekomendacje napraw aortalnych. Cel: Prospektywna ocena plastyk zastawki aortalnej i opuszki aorty podczas 10-letniej obserwacji. Analizie poddano pierwszych 100 pacjentów operowanych w ciągu pierwszych 7 lat od wprowadzenia metody. Materiał i metody: W latach 2003-2013 operowano 225 pacjentów z istotną niedomykalnością zastawki aortalnej, u których zaplanowano i wykonano operacje naprawcze. Analizie poddano śmiertelność wczesną i odległą, częstość reoperacji oraz czynniki wpływające na występowanie tych zdarzeń. W celu otrzymania wyników w 105-miesięcznej obserwacji, prospektywnej analizie poddano pierwszych 100 pacjentów operowanych w latach 2003-2009. Wyniki: W całej grupie 225 chorych, w okresie okołooperacyjnym: śmiertelność -5 chorych (2,2%), śródoperacyjna konwersja do wymiany zastawki -6 chorych (2,5%). W prospektywnej odległej analizie 100 chorych przeżycie wyniosło 93%, natomiast wolność od reoperacji -91,3. Czynnikami ryzyka dla przeżywalności były klasa NYHA i wymiana opuszki aorty, a dla reoperacji -zastawka dwupłatkowa i resekcja płatka. Wnioski: Przedstawione pierwsze odległe wyniki kliniczne uzasadniają możliwość skutecznej operacji naprawczej kompleksu zastawki aortalnej i aorty u wybranych chorych pod warunkiem przeprowadzenia precyzyjnej oceny echokardiograficznej umożliwiającej wybór metody operacji oraz jej obiektywną kontrolę. Słowa kluczowe: zastawka aortalna, operacja oszczędzająca zastawkę aortalną, reoperacja.
Background: Ischemic preconditioning (IPC) and postconditioning (POC) are well documented to trig... more Background: Ischemic preconditioning (IPC) and postconditioning (POC) are well documented to trigger cardioprotection against ischemia/reperfusion (I/R) injury, but the effect of their both co-application remains unclear in human heart. The present study sought to assess the co-application of IPC and POC on fragments of human myocardium in vitro. Methods: Muscular trabeculae of the human right atrial were electrically driven in the organ bath and subjected to simulated I/R injury-hypoxia/re-oxygenation injury in vitro. To achieve IPC of trabeculae the single brief hypoxia period preceded the applied lethal hypoxia, and to achieve POC triple brief hypoxia periods followed the lethal hypoxia. Additional muscular trabeculae were exposed only to the hypoxic stimulation (Control) or were subjected to the non-hypoxic stimulation (Sham). 10 µM norepinephrine (NE) application ended every experiment to assess viability of trabeculae. The contraction force of the myocardium assessed as a maximal amplitude of systolic peak (%A max) was obtained during the whole experiment's period. Results: Co-application of IPC and POC resulted in decrease in %A max during the re-oxygentaion period and after NE application, as compared to
The aim of this study was to compare cardiac magnetic resonance imaging (CMR) with 2-dimensional ... more The aim of this study was to compare cardiac magnetic resonance imaging (CMR) with 2-dimensional echocardiography (2D echo) in the assessment of left ventricle (LV) function parameters and mass in patients with ischemic heart disease and severely depressed LV function. Although 2D echo is commonly used to assess LV indices, CMR is the state-of-the-art technique. Agreement between these 2 methods in these patients has not been well established. Material/Methods: LV indexed end systolic and diastolic volumes (EDVi and ESVi), indexed mass (LVMi) and ejection fraction (EF) were assessed in 67 patients (12 women), using 2D echo and CMR.
Background—Whether mitral valve repair during coronary artery bypass grafting (CABG) improves sur... more Background—Whether mitral valve repair during coronary artery bypass grafting (CABG) improves survival in patients with ischemic mitral regurgitation (MR) remains unknown. Methods and Results—Patients with ejection fraction 35 % and coronary artery disease amenable to CABG were randomized at 99 sites worldwide to medical therapy with or without CABG. The decision to treat the mitral valve during CABG was left to the surgeon. The primary end point was mortality. Of 1212 randomized patients, 435 (36%)
Aim: To assess early and late results of surgical ventricular re- construction (SVR). Material an... more Aim: To assess early and late results of surgical ventricular re- construction (SVR). Material and Methods: Over 8 years we operated on 102 patients (75 males) of mean age 63±7. Initial LVEDV was 219±65 ml, ESV 150±55 ml, and EF 32±8%. In 53 patients (52%) we used patches to perform SVR. On average 2.9±1.1 coronary artery bypass grafts were implanted per patient (min. 0 - max. 5). In 43 (42%) patients we performed MV repair, in 1 MVR, in 4 TV repair, in 1 post-infarction VSD repair, in 1 ASD repair, in 1 AVR and in 1 ascending aorta replacement. Results: There were 8 perioperative deaths (7.8%). One-, 2-, 3-, and 5-year survival was: 83±5%, 76±5%, 72±6% and 62±7% re- spectively. As a result of SVR EDV dropped to 172±52 ml (p<0.001), ESV to 112±50 ml (p<0.001) and EF increased to 37±11% (p=0.053) in the last echocardiographic follow-up. On the last visit NYHA class was 1.6±0.7 - significantly less than preop 2.1±0.9 (p=0.009), and CCS class 0.6±0.6, less than pre- operative 1.6...
INTROduCTION Epicardial fat (EF) is a visceral adipose tissue depot surrounding coronary ar terie... more INTROduCTION Epicardial fat (EF) is a visceral adipose tissue depot surrounding coronary ar teries that has the unique embryology, anato my, and functionality. 1 The increased volume of EF was found to be a risk factor for cardiovascu lar diseases. 2,3 As we described previously, among patients with advanced coronary artery disease (CAD), type 2 diabetes (T2D) was associated with
Background Valve-sparing aortic root replacement (VSARR) techniques are an alternative to the cla... more Background Valve-sparing aortic root replacement (VSARR) techniques are an alternative to the classic Bentall procedure when aortic root aneurysm is not accompanied by aortic valve stenosis, and the regurgitant aortic valve is amenable to repair. aims The aim of the study was to assess long-term outcomes of valve sparing aortic root replacement using the David technique and the Yacoub technique. methods A total of 101 consecutive, elective VSARR procedures were performed from January 2010 to April 2020 including 52 David procedures (51.5%) and 49 Yacoub procedures (48.5%). We analyzed mortality, freedom from reoperation, and freedom from aortic valve regurgitation. The analysis was performed for the entire study cohort and for 2 subgroups: the David technique and the Yacoub technique. results The mean (SD) age was 50.2 (16.1) years; 90 (89.1%) patients were male. The median (interquartile range [IQR]) EuroScore II was 3.7 (2.7-5.8). At 1, 5, and 8 years after surgery, survival (SE) was 98% (3%), 91.8% (8%), and 91.8% (8%), respectively, whereas freedom from reoperation (SE) was 100%, 97% (3%), and 97% (3%), respectively. Follow-up echocardiography performed at a median (IQR) of 18.7 (2.5-36.7) months postsurgery revealed freedom from aortic valve regurgitation in 90.8% of patients. No significant differences in mortality, freedom from reoperation, and freedom from aortic valve regurgitation were noted between the David and Yacoub subgroups. conclusions VSARR is a safe and effective surgical technique in patients with aortic root aneurysm, as the associated mortality, reoperation rate, and aortic valve regurgitation recurrence are low.
Levosimendan is a new inodilator which involves 3 main mechanisms: increases the calcium sensitiv... more Levosimendan is a new inodilator which involves 3 main mechanisms: increases the calcium sensitivity of cardiomyocytes, acts as a vasodilator due to the opening of potassium channels, and has a cardioprotective effect. Levosimendan is mainly used in the treatment of acute decompensated heart failure (class IIb recommendation according to the European Society of Cardiology guidelines). However, numerous clinical trials indicate the validity of repeated infusions of levosimendan in patients with stable heart failure as a bridge therapy to heart transplantation, and in patients with accompanying right ventricular heart failure and pulmonary hypertension. Due to the complex mechanism of action, including the cardioprotective and anti aggregating effect, the use of levosimendan may be particularly beneficial in acute coronary syndromes, preventing the occurrence of acute heart failure. There are data indicating that levosimendan administered prior to cardiac surgery may improve outcomes in patients with severely impaired left ventricular function. The multidirectional mechanism of action also affects other organs and systems. The positive effect of levosimendan in the treatment of cardio renal and cardio hepatic syndromes has been shown. It has a safe and predictable profile of action, does not induce tolerance, and shows no adverse effects affecting patients survival or prognosis. However, with inconclusive results of previous studies, there is a need for a welldesigned multicenter randomized placebo controlled study, including an adequately large group of outpatients with chronic advanced systolic heart failure.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-No... more This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives 4.0 International License (CC BY-NC-ND 4.0), allowing third parties to download articles and share them with others, provided the original work is properly cited, not changed in any way, distributed under the same license, and used for noncommercial purposes only.
Introduction: Cortisol level affects the prognosis of patients after cardiac surgery. Meanwhile, ... more Introduction: Cortisol level affects the prognosis of patients after cardiac surgery. Meanwhile, there are no clear guidelines for steroid supplementation after a cardiac operation. The relationship between age and blood cortisol levels has not been finally clarified. Aim: Assessment of adrenal reserve and secretion of cortisol in patients over 60 years of age undergoing cardiac surgery. Material and methods: The study included 20 patients of both sexes referred for cardiac surgery. A short ACTH synthetic stimulation test was carried out. Assessment of cortisol secretion was carried out in the morning on the day of surgery and the 1 st , 2 nd and 4 th days after surgery in blood samples. Results: A result within the normal range for the adrenal reserve was found in 19 of the 20 patients enrolled in the study. The short Synacthen test predicted postoperative secretion of cortisol (p = 0.04, r = 0.047). A relationship between secretion of cortisol and patients' age was observed (p = 0.03, r = 0.48). The concentration of cortisol on the 1 st postoperative day was correlated with the total dose of dopamine (p = 0.006, r = 0.58) and adrenaline (p = 0.04, r = 0.47). The concentration of cortisol on the day of the surgery correlated with the lactate concentration on day 2 (p = 0.04, r = 0.45). The concentration of lactates on day 1 correlated with total dose of dopamine (p = 0.01, r = 0.54). Conclusions: A short Synacthen test allows one to predict secretion of cortisol after cardiac surgery. Greater secretion of cortisol after cardiac surgery may be associated with a more difficult postoperative course. There was no decrease in cortisol secretion with age.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-No... more This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives 4.0 International License (CC BY-NC-ND 4.0), allowing third parties to download articles and share them with others, provided the original work is properly cited, not changed in any way, distributed under the same license, and used for noncommercial purposes only.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-No... more This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA4.0), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited, distributed under the same license, and used for noncommercial purposes only.
Background: Aortic valve replacement (AVR) is one of the most common surgeries performed in cardi... more Background: Aortic valve replacement (AVR) is one of the most common surgeries performed in cardiac surgery operating rooms. We present actual, real life trends from the last 10 years for AVR interventions based on a multicentre National Registry of Cardiac Surgery Database. Methods: The study population consisted of all 50,846 consecutive adult patients who underwent AVR between January 2006 and August 2016 in all cardiac surgery units in Poland. The main outcome measures were changes in the number of valves, characteristics of valves, operative details, and in-hospital mortality. Analysis consisted of all aortic valve (AV) procedures, including isolated AV surgery, combination procedures and patients who had a prior valve operation. Results: In last 10 years, the number of procedures increased by 46%. Isolated surgical AVR was performed in 61.2%, AVR + coronary artery bypass grafting (CABG) in 23.9%, AVR + mitral valve replacement (MVR) in 7%, and transcatheter aortic valve implantation (TAVI) in 2.3% of patients. The mean patient age increased significantly from 61.4 years in 2006 to 66.1 years in 2016. Aortic stenosis was diagnosed in 73.4%, severe aortic insufficiency in 15.8% of cases. The most common valve pathology was calcification. Congenital valve dysfunction was diagnosed in 3.7% of cases. There was a 33.7% increase of bioprosthesis, and the most common implanted bioprosthesis was the Hancock II. The most common implanted mechanical prosthesis was the St. Jude Medical Mechanical Valve. In-hospital mortality decreased significantly over the 10-year period in all AV procedures from 10.9% in 2006 to 8.3% in 2016. Mean in-hospital mortality was: 4.0% in isolated surgical AVR, 5.4% in TAVI, 6.8% in AVR + CABG, 9.8% in AVR + MVR, 17.2% in AVR + MVR + CABG. Conclusions: In the last ten years, the number of AV procedure has doubled. Mortality was significantly lower with all types of AV procedure despite very rapid aging of AVR patients. TAVI procedure rapidly grew Study databases Data for this study was collected retrospectively based on the standardised form of the Polish National Database of Cardiac Surgery Procedures (KROK). The data collected included age, gender, body mass index (BMI), ejection fraction (EF), previous percutaneous coronary intervention (PCI), Canadian Cardiovascular Society (CCS) class, New York Heart Association (NYHA) class, smoking status, diabetes mellitus (DM), arterial hypertension, hypercholesterolaemia, asthma, chronic obstructive pulmonary disease (COPD). On the basis of the form of the National Database of Cardiac Surgery (KROK), a computer database was built for further statistical analysis. Missing data We excluded patients if records for outcomes (i.e., mortality/ survivors) were missing. The completeness of each record was counted: records were only analysed where the percentage of complete data was higher than 90%. Records that were lower than 90% were excluded from analysis. Almost all the data collected was more than 90% complete. in popularity. There is significant increase in the use of bioprosthesis.
Advances in clinical and experimental medicine : official organ Wroclaw Medical University, 2018
Opioidergic conditioning is well documented to trigger cardioprotection against ischemia/ reperfu... more Opioidergic conditioning is well documented to trigger cardioprotection against ischemia/ reperfusion (I/R) injury. Previous studies on animal models have suggested that nitric oxide (NO) mediates the beneficial effect of opioids, but the role of NO in humans seems to be controversial. The aim of the study was to assess the influence of NO modulators on opioid-induced cardioprotection in the human myocardium. Trabeculae of the human right atria were electrically driven in an organ bath and subjected to simulated I/R injury. The non-selective inhibitor of nitric oxide synthase (NOS) - N-methyl-l-arginine (LNMMA), the donor of NO - S-Nitroso-N-acetylpenicillamine (SNAP) or morphine (in the amount of 10-4 M) were used at the time of re-oxygenation. The additional trabecula was subjected to the hypoxia protocol only (control). The contractility of the myocardium was assessed as the maximal force of a contraction (Amax), the rate of rise of the force of a contraction (Slope L) and the ca...
Journal of cardiothoracic and vascular anesthesia, Jun 1, 2018
The authors aimed to assess determinants of intubation time and evaluate its impact on 30-day and... more The authors aimed to assess determinants of intubation time and evaluate its impact on 30-day and 1-year postoperative survival in Surgical Treatment for Ischemic Heart Failure (STICH) trial patients. A multivariable Cox proportional hazards model was used among the 1,446 surgical patients from the STICH trial who survived 36 hours after operation, in order to identify perioperative factors associated with 30-day and 1-year postoperative mortality. A multivariable logistic regression model was used to determine risk factors associated with intubation time. At 36 hours post-operation, 1,298 (out of 1,446) were extubated and 148 (10.2%) still intubated. Median postoperative intubation time was 11.4 hours. Among patients surviving 36 hours, a multivariable model was developed to predict 30-day (c-index = 0.88) and 1-year (c-index = 0.78) mortality. Intubation time was the strongest independent predictor of 30-day (hazard ratio [HR] 5.50) and 1-year mortality (HR 3.69). Predictors of in...
Kardiochirurgia i torakochirurgia polska = Polish journal of cardio-thoracic surgery, 2016
We report on a 69-year-old woman who demonstrated native coronary artery and grafted vessel spasm... more We report on a 69-year-old woman who demonstrated native coronary artery and grafted vessel spasm following on-pump coronary artery bypass grafting (CABG). Despite intraaortic balloon pump (IABP) insertion, electrocardiogram (ECG) abnormalities did not disappear. Emergency coronary angiography (CAG) was performed. The patient was successfully treated with systemic and intracoronary injection of vasodilator agents. ECG changes disappeared, with normalized and stable hemodynamic function. Intraaortic balloon pump was maintained for 48 h. The patient was discharged in good clinical condition. Coronary artery spasm (CAS) may result in life-threatening arrhythmias, circulatory collapse or death. The etiology of CAS is multifactorial and includes heart manipulation, exogenous vasoconstrictors, stress-related catecholamine release, hypoxia and oxidative stress. Postoperative CAS is most commonly manifested by ST-segment elevation and circulatory collapse without specific causes. The gold s...
Interactive CardioVascular and Thoracic Surgery, 2016
A best evidence topic in cardiac surgery was written according to a structured protocol. The ques... more A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Do we have to operate on moderate functional mitral regurgitation (FMR) during aortic valve replacement (AVR) for aortic stenosis (AS)?' Altogether 325 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The current evidence obtained from these papers revealed that the significant predictors of improvement outcome include lower preoperative mitral regurgitation and lower preoperative left ventricle fractional area change. We also know that persistent atrial fibrillation, enlarged left atrium, increased indexed left ventricular mass, pulmonary hypertension and preoperative peak aortic valve gradient <60 mmHg are predictors of deterioration. Generally, we observed a trend towards improvement or non-progression of FMR following AVR for AS. In the six papers that suggest conservative treatment of FMR, the degree of mitral regurgitation (MR) improved in 45-95%, remained unchanged in 19-38% and deteriorated in 1-14%. In the three papers favoring surgical treatment of MR, the degree of MR improved in 46-69%, stay unchanged in 34-53% and deteriorated in 10%. The current evidence suggests that moderate or less grade of FMR without predictors of deterioration should be treated conservatively and moderate-severe and severe FMR warrants additional surgical procedure. A clearly randomized study, especially in patients with moderate and moderate-severe FMR for AS, seems appropriate to further elucidate surgical strategy.
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, Jan 30, 2015
Totally epicardial cardiac resynchronization therapy (CRT) is a novel treatment modality for pati... more Totally epicardial cardiac resynchronization therapy (CRT) is a novel treatment modality for patients with heart failure (HF) and systolic dyssynchrony undergoing coronary artery bypass grafting (CABG). In this study, we have prospectively evaluated the long-term outcomes of totally epicardial CRT. Between September 2007 and June 2009, one hundred and seventy-eight patients were randomly assigned to the CABG alone group (n = 87) and CABG with concomitant epicardial CRT implantation (n = 91). The primary end-point of the study was all-cause mortality in the two groups between the day of surgery and 13 August 2013 (common closing date). The secondary outcomes included mode of death, adverse cardiac events and lead performance. The mean follow-up was 55 ± 10.7 months. According to per-protocol analysis with treatment as a time-dependent variable to account for conversion from CABG to CABG + CRT, there were 24 deaths (35.8%) in the CABG group and 17 deaths (15.3%) in the CABG + CRT grou...
The Journal of Thoracic and Cardiovascular Surgery, 2015
Objectives: Advantages of aortic valve repair and root reconstruction include maintenance of natu... more Objectives: Advantages of aortic valve repair and root reconstruction include maintenance of natural valve hemodynamic parameters and avoidance of prosthetic valve-related complications. However, general acceptance of valve reconstruction may be limited by paucity of long-term follow-up data from only a few centers. This report is intended to supplement existing outcome information for aortic valve repair. Methods: Between 2003 and 2013, 200 consecutive patients (149 men, 51 women; mean age, 52.1 years) with significant aortic regurgitation and aortic root enlargement underwent aortic valve repair and associated root reconstruction. The same prospective selection criteria and systematic valve repair approaches were followed throughout the study. Root management consisted of either root remodeling or reimplantation with Dacron prostheses. Kaplan-Meier techniques were used to assess major end points of all-cause mortality, reoperation, and repair failure. Univariable log-rank testing was used to identify associations between risk factors and major events. Results: Early mortality was 2% (4 patients), and early repair failure was 3% (6 patients). New York Heart Association functional class was found to be a risk factor for early mortality and morbidity (odds ratio, 3.3; P ¼ .03), whereas crossclamp time and cardiopulmonary time were risk factors for early mortality (odds ratio, 1.04; 95% confidence interval, 1-1.07; P ¼ .01 and odds ratio, 1.02; 95% confidence interval, 1-1.03; P ¼ .02), respectively. Survival at a mean follow-up of 48.6 AE 34.3 months (median follow-up, 43.6 months; range, 17.8-78 months) was 94%, with a freedom from reoperation of 91%. Univariable risk factors for mortality were preoperative New York Heart Association functional class and requirement for root replacement. Repair failure and reoperation were associated with bicuspid valve anatomy, subcommissural annuloplasty, and complex leaflet repair. Freedom from repair failure was associated with aortic reimplantation. Conclusions: Data from a prospective cohort of patients undergoing aortic valve repair and root reconstruction reinforce the satisfactory medium-term results obtained with valve reconstruction. Further analysis of these patient outcomes is necessary to draw definitive conclusions on operative techniques.
W pracy zaprezentowano rzadki przypadek tętniaka rzekomego u pacjenta po zawale ściany dolnej mię... more W pracy zaprezentowano rzadki przypadek tętniaka rzekomego u pacjenta po zawale ściany dolnej mięśnia sercowego. Zawał powikłany był ostrą niedomykalnością zastawki mitralnej, obrzękiem płuc i wstrząsem kardiogennym. W trybie pilnym wykonano pomostowanie aortalno-wieńcowe oraz implantowano zastawkę mechaniczną w pozycję mitralną. W ciągu kilku następnych miesięcy u chorego zaobserwowano pogorszenie tolerancji wysiłku i zaostrzenie niewydolności serca. Podczas ponownej hospitalizacji u pacjenta rozpoznano ogromnego tętniaka rzekomego ściany dolnej, którego z dobrym efektem leczono chirurgicznie. Słowa kluczowe: tętniak rzekomy, ostry zawał mięśnia sercowego.
Zaletą operacji naprawczych jest niemal idealny efekt hemodynamiczny i uniknięcie powikłań związa... more Zaletą operacji naprawczych jest niemal idealny efekt hemodynamiczny i uniknięcie powikłań związanych ze sztuczną protezą. Wprowadzenie funkcjonalnej klasyfikacji niedomykalności zastawki aortalnej umożliwiło systematyczne i powtarzalne podejście do plastyk kompleksu zastawki aortalnej i opuszki aorty. Brak wyników odległych uniemożliwia szerokie rekomendacje napraw aortalnych. Cel: Prospektywna ocena plastyk zastawki aortalnej i opuszki aorty podczas 10-letniej obserwacji. Analizie poddano pierwszych 100 pacjentów operowanych w ciągu pierwszych 7 lat od wprowadzenia metody. Materiał i metody: W latach 2003-2013 operowano 225 pacjentów z istotną niedomykalnością zastawki aortalnej, u których zaplanowano i wykonano operacje naprawcze. Analizie poddano śmiertelność wczesną i odległą, częstość reoperacji oraz czynniki wpływające na występowanie tych zdarzeń. W celu otrzymania wyników w 105-miesięcznej obserwacji, prospektywnej analizie poddano pierwszych 100 pacjentów operowanych w latach 2003-2009. Wyniki: W całej grupie 225 chorych, w okresie okołooperacyjnym: śmiertelność -5 chorych (2,2%), śródoperacyjna konwersja do wymiany zastawki -6 chorych (2,5%). W prospektywnej odległej analizie 100 chorych przeżycie wyniosło 93%, natomiast wolność od reoperacji -91,3. Czynnikami ryzyka dla przeżywalności były klasa NYHA i wymiana opuszki aorty, a dla reoperacji -zastawka dwupłatkowa i resekcja płatka. Wnioski: Przedstawione pierwsze odległe wyniki kliniczne uzasadniają możliwość skutecznej operacji naprawczej kompleksu zastawki aortalnej i aorty u wybranych chorych pod warunkiem przeprowadzenia precyzyjnej oceny echokardiograficznej umożliwiającej wybór metody operacji oraz jej obiektywną kontrolę. Słowa kluczowe: zastawka aortalna, operacja oszczędzająca zastawkę aortalną, reoperacja.
Background: Ischemic preconditioning (IPC) and postconditioning (POC) are well documented to trig... more Background: Ischemic preconditioning (IPC) and postconditioning (POC) are well documented to trigger cardioprotection against ischemia/reperfusion (I/R) injury, but the effect of their both co-application remains unclear in human heart. The present study sought to assess the co-application of IPC and POC on fragments of human myocardium in vitro. Methods: Muscular trabeculae of the human right atrial were electrically driven in the organ bath and subjected to simulated I/R injury-hypoxia/re-oxygenation injury in vitro. To achieve IPC of trabeculae the single brief hypoxia period preceded the applied lethal hypoxia, and to achieve POC triple brief hypoxia periods followed the lethal hypoxia. Additional muscular trabeculae were exposed only to the hypoxic stimulation (Control) or were subjected to the non-hypoxic stimulation (Sham). 10 µM norepinephrine (NE) application ended every experiment to assess viability of trabeculae. The contraction force of the myocardium assessed as a maximal amplitude of systolic peak (%A max) was obtained during the whole experiment's period. Results: Co-application of IPC and POC resulted in decrease in %A max during the re-oxygentaion period and after NE application, as compared to
The aim of this study was to compare cardiac magnetic resonance imaging (CMR) with 2-dimensional ... more The aim of this study was to compare cardiac magnetic resonance imaging (CMR) with 2-dimensional echocardiography (2D echo) in the assessment of left ventricle (LV) function parameters and mass in patients with ischemic heart disease and severely depressed LV function. Although 2D echo is commonly used to assess LV indices, CMR is the state-of-the-art technique. Agreement between these 2 methods in these patients has not been well established. Material/Methods: LV indexed end systolic and diastolic volumes (EDVi and ESVi), indexed mass (LVMi) and ejection fraction (EF) were assessed in 67 patients (12 women), using 2D echo and CMR.
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