Papers by Prof. Stamenko Susak
Thoracic and Cardiovascular Surgeon, May 28, 2022
Objectives Acute kidney injury (AKI) is associated with higher perioperative mortality and morbid... more Objectives Acute kidney injury (AKI) is associated with higher perioperative mortality and morbidity. Oxidative stress has been proposed as a cause of postoperative AKI. Ascorbic acid (AA) supplementation was suggested as a novel and promising antioxidant. The aim of this study was to evaluate the capability of AA to reduce the incidence of postoperative AKI in cardiac surgery patients. Methods A prospective randomized trial was conducted in patients scheduled for onpump cardiac surgery. Subjects in the AA group received 2 g of AA intravenously during the induction of anesthesia, 2 g before aortic cross-clamp removal and 1 g every 8 hours for five postoperative days (the JERICA protocol). Postoperatively, the patients were monitored for AKI and other complications. Malondialdehyde levels were monitored in a subpopulation of 100 patients to evaluate the effect of AA on oxidative stress level. Results The AA and control group consisted of 163 and 169 patients, respectively. The groups were well matched for baseline demographics and had similar intraoperative characteristics. The incidence of AKI in the AA and control group was 20.9 and 28.4%, respectively (p ¼ 0.127). The estimated glomerular filtration rate did not differ between the study groups in the entire postoperative period. There was a trend toward higher malondialdehyde values with statistical significance on postoperative day 1 and lower in-hospital mortality in the AA group (0.6 vs. 4.1%, p ¼ 0.067). Conclusion Our results do not support the effectiveness of AA supplementation in reducing the incidence of postoperative AKI in on-pump cardiac surgery patients. Clinical Registration Number This study was registered with the ISRCTN Registry under the trial registration number ISRCTN98572043.
Scripta medica, 2019
A 45-year-old man was admitted to Clinic for the first time, with symptoms of chest pain and fati... more A 45-year-old man was admitted to Clinic for the first time, with symptoms of chest pain and fatigue. Computerised tomography (CT) diagnostics of the chest showed a soft tissue vegetation of approximately 5x5 mm on the left aortic coronary cusp. A double-vessel coronary disease was also diagnosed. The patient underwent surgery, a complete resection of the tumour was achieved, which was confirmed by postoperative transoesophageal echocardiography (TEE). Because of the risk of valve damage, it was decided to replace the aortic valve. A bypass from left internal mammary artery (LIMA) to left anterior descending (LAD) coronary artery (LAD-LIMA) and right coronary artery (RCA) was also performed. The patient was discharged on the 14th postoperative day with satisfactory results.
Thoracic and Cardiovascular Surgeon, Aug 25, 2009
Quadricuspid aortic valve, a rare congenital anomaly, is often related to severe aortic regurgita... more Quadricuspid aortic valve, a rare congenital anomaly, is often related to severe aortic regurgitation and has a significant morbidity. The first described case was reported in 1862. Quadricuspid aortic valve is, in most cases, an isolated malformation, but it can be associated with other concomitant anomalies. We present here the case of a quadricuspid aortic valve discovered by intraoperative transesophageal echocardiography and successfully replaced with a mechanical aortic valve.
Scripta medica, 2019
Medical staff that makes the initial contact with patient with aortic dissection has a goal to ri... more Medical staff that makes the initial contact with patient with aortic dissection has a goal to rise a suspicion and recognize aortic dissection, as well as to safely transport the patient to a health center capable of providing the definite treatment. First step in the prehospital management is providing oxygen support via breathing mask to prevent organ damage. It is important to monitor all vital functions during transport, including heart rhythm and diuresis, in order to have a continuous insight into the patient's current state and in case of a deterioration react appropriately. Blood pressure control is the main goal of the medical treatment in aortic dissection. Systolic blood pressure should be kept between 100-120 mmHg, whereas the target heart rate is 60 beats per minute. Therapy should be started with intravenous administration of beta-blocker or non-dihydropyridine calcium channel blocker, followed by a vasodilator infusion. For pain management intravenous administration of opiates is recommended. In case of shock, intravenous fluid replacement with crystalloids should be initiated immediately, along with vasopressor therapy with noradrenalin or phenylephrine. In case of shock, the patient should be intubated and mechanically ventilated with the appropriate sedation.
Srce i krvni sudovi, 2018
Journal of Hypertension, Sep 1, 2016
(30 g per day) and placebo (obtained with fl avored bread mixed with fats and salts in concentrat... more (30 g per day) and placebo (obtained with fl avored bread mixed with fats and salts in concentrations equal to those of the cheese), in cross-over fashion. BP was evaluated at baseline and at the end of the active and placebo treatment (2 months each) by:-Offi ce BP (OBP) and Automated Offi ce BP using the BpT-RU, (VSM MedTech Ltd, Vancouver, Canada), an automated oscillometric device that provides the average of multiple (6) blood pressure measurements. Results: The dietary integration with Grana Padano cheese resulted in a signifi cant decrease in systolic and diastolic Offi ce and Automated Offi ce BP (BpTRU) mean values. The mean decrease (versus plaebo) was-6 mmHg for systolic and-5 mmHg for diastolic BP (Student's t test: p < 0.025 and p < 0.05 rispectively) Conclusions: Dietary integration with milk derivatives containing valyl-prolylproline and isoleucil-prolyl-proline (such as Grana Padano DOP cheese) may be helpful to reach BP target in mild-to-moderate hypertensive patients.
PubMed, Apr 24, 2010
Purpose: To analyse the clinical characteristics and patterns of cardiac myxomas and to evaluate ... more Purpose: To analyse the clinical characteristics and patterns of cardiac myxomas and to evaluate the clinical course and surgical treatment results. Methods: In this retrospective study we evaluated the clinical presentation, diagnostic methods and surgical treatment outcome in all patients (n=17) with cardiac myxoma treated at the Institute of Cardiovascular Diseases of Vojvodina between the 1.1.2006-31.1.2009. Results: Patients with cardiac myxoma constituted 0.52% of all patients having had heart operations for different reasons. The average patient age was 56.59 years and 12 (70.88%) patients were female and 5 (29.12%) male. Left atrial myxomas were by far more frequent (16 patients, 94.11%) than right atrial myxomas (1 patient, 5.88%). The average time of symptom presence was around 12 months while 4 patients (23.53%) were asymptomatic. The most common symptom was dyspnoea (53%) and fatigue (41%). Total extirpation of tumor mass was achieved in all cases. The tumor size ranged from 1.7x1 cm to 9.5x3.3 cm (average of 2x2.86) and histological examination confirmed the diagnosis of cardiac myxoma in every instance. The 30-day mortality after surgical extirpation of atrial myxomas was 0%. Conclusion: Cardiac myxoma may mimic a huge variety of other cardiac diseases. Echocardiography plays an important role in diagnosing this disease. Because of relatively low risk, surgical treatment is recommended for most patients with excellent postoperative prognosis.
We report the case of a 62-year-old male patient, admitted for aortic valve replacement. Bilatera... more We report the case of a 62-year-old male patient, admitted for aortic valve replacement. Bilateral common carotid artery occlusion and bilateral internal carotid artery occlusion have been reported, as well as right vertebral artery occlusion. Aortic valve replacement was performed in the standard fashion using the cardiopulmonary bypass. No neurological deficit was apparent on emergence from anesthesia.
Srce i krvni sudovi, 2017
Several studies have compared outcome of coronary artery bypass grafting (CABG) and percutaneous ... more Several studies have compared outcome of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in the treatment of multivessel coronary disease, but a few were focused on patients with reduced left vetricular function. The aim of the study was to compare effectiveness of PCI and CABG in patients with iscaaemic cardiomyopathy and multivessel coronary disease Methods: This single-center study, included 178 patients, admitted because of symptomatic multivessel coronary disease, ejection fraction of left ventricle (EF) ≤50%, who underwent PCI or CABG, with two-years follow up of adverse cardiac and cerebrovascular events (MACCE), which included mortality, myocardial infarction (MI), target lesion/vessel revascularisation (TLR/TVR) and stroke. Results: There was higher incidence of MACCE in PCI group (18.1% vs. 9.5%, p=0.145). That was mainly because of higher incidence of MI (6% vs. 0%, p=0.021) and TLR/TVR (6% vs. 0%, p=0.021) in PCI group. There was no difference in mortality rate (9.6% in PCI group vs. 9.5% in CABG group, p>0.05). Age, fibrinogen, C-reactive protein were predictors of stent thrombosis, while left ventricular dilatation, EuroSCORE and SYNTAXscore were predictors of mortality in our study. Conclusion: There was no difference in mortality rate during 2-year follow-up after PCI and CABG in studied patients. Incidence of MI and TLR/TVR was higher after PCI comparing with CABG.
Journal of Cardiac Surgery, Mar 16, 2022
Cardiovascular diseases are the leading cause of morbidity and mortality in pregnant women. On th... more Cardiovascular diseases are the leading cause of morbidity and mortality in pregnant women. On the other hand, cardiac surgery is not so common for pregnant women.
Archives of Toxicology, Aug 23, 2022
Eutrophicated waters frequently support bloom-forming cyanobacteria, many of which produce potent... more Eutrophicated waters frequently support bloom-forming cyanobacteria, many of which produce potent cyanobacterial toxins (cyanotoxins). Cyanotoxins can cause adverse health effects in a wide range of organisms where the toxins may target the liver, other internal organs, mucous surfaces and the skin and nervous system. This review surveyed more than 100 studies concerning the cardiovascular toxicity of cyanotoxins and related topics. Over 60 studies have described various negative effects on the cardiovascular system by seven major types of cyanotoxins, i.e. the microcystin (MC), nodularin (NOD), cylindrospermopsin (CYN), anatoxin (ATX), guanitoxin (GNTX), saxitoxin (STX) and lyngbyatoxin (LTX) groups. Much of the research was done on rodents and fish using high, acutely toxin concentrations and unnatural exposure routes (such as intraperitoneal injection), and it is thus concluded that the emphasis in future studies should be on oral, chronic exposure of mammalian species at environmentally relevant concentrations. It is also suggested that future in vivo studies are conducted in parallel with studies on cells and tissues. In the light of the presented evidence, it is likely that cyanotoxins do not constitute a major risk to cardiovascular health under ordinary conditions met in everyday life. The risk of illnesses in other organs, in particular the liver, is higher under the same exposure conditions. However, adverse cardiovascular effects can be expected due to indirect effects arising from damage in other organs. In addition to risks related to extraordinary concentrations of the cyanotoxins and atypical exposure routes, chronic exposure together with co-existing diseases could make some of the cyanotoxins more dangerous to cardiovascular health.
Srpski Arhiv Za Celokupno Lekarstvo, 2016
Introduction Intramural hematoma of the aorta presents potentially fatal condition developing as ... more Introduction Intramural hematoma of the aorta presents potentially fatal condition developing as a result of a vasa vasorum rupture. It is a major risk factor for developing a frank aortic dissection. Case Outline A 65-year-old woman was admitted to our clinic for the second time, after her symptoms of chest pain and vertigo (with no electrocardiographic signs of myocardial infarction) hadn't disappeared after several months of medicament treatment (indicated in the first hospitalization). Computed tomography arteriography of the aorta showed no sign of acute aortic dissection, but revealed a contrast depo in the aortic wall of 8 × 14 mm dimensions, with no extravasation of contrast. Also, massive pericardial effusion was observed (10-30 mm in thickness). Transesophageal echocardiography confirmed these findings completely. The patient underwent surgery, in which plaque exulceration was detected on the convex side of the ascending aorta, 3 cm above the aortic valve, 1 cm in diameter, with no signs of intimal tear. A resection of the ascending aorta was performed, and the aorta was reconstructed with a 30 mm Dacron tube graft. The patient was discharged on the 14th postoperative day with satisfactory results. Conclusion Intramural hematoma is not a common event, but it is potentially a fatal one. Open surgery in patients with an intramural hematoma is an effective treatment strategy, although percutaneous endovascular treatment options are being described.
Atherosclerosis Supplements, 2006
InTech eBooks, Dec 9, 2011
InTech eBooks, Jun 12, 2013
John Wiley & Sons, Ltd eBooks, Feb 11, 2017
Interactive Cardiovascular and Thoracic Surgery, Feb 25, 2016
An isolated atrial septal defect (ASD) can occasionally go unrecognized for decades and accounts ... more An isolated atrial septal defect (ASD) can occasionally go unrecognized for decades and accounts for 25-30% of congenital heart disease cases diagnosed in adulthood. Pulmonary hypertension often develops as a result of a long-lasting, left-to-right shunt and may ultimately be associated with a fixed increase of pulmonary vascular resistance, sometimes rendering these patients inoperable. To reduce the risk of developing postoperative morbidity and possible mortality, we employed our technique of a unidirectional valved patch for the closure of ASD.
Infection, 2022
Purpose High mortality and a limited performance of valvular surgery are typical features of infe... more Purpose High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE. Methods Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age. Results As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive (HR 2.98 [2.43-3.66]). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06-2.13], p = 0.0210; 1-yr: HR 1.58[1.21-2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176). Conclusion Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients.
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Papers by Prof. Stamenko Susak