The Journal of Thoracic and Cardiovascular Surgery
Variable functional class t III STJ, Siontubular junction; MV, mitral valve repair; TV, tricuspid... more Variable functional class t III STJ, Siontubular junction; MV, mitral valve repair; TV, tricuspid valve repair. *Univariable risk factor analysis suggested significance to variables. †Trends in those. ‡W. L. Gore and Associates, Flagstaff, Ariz.
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, Sep 27, 2007
A Ad dr re es s d do o k ko or re es sp po on nd de en nc cj ji i/ /C Co or rr re es sp po on nd ... more A Ad dr re es s d do o k ko or re es sp po on nd de en nc cj ji i/ /C Co or rr re es sp po on nd di in ng g a au ut th ho or r: : dr hab. n.
Wstęp: Badanie rezonansu magnetycznego serca (CMR) jest nową dyscypliną o olbrzymich możliwościac... more Wstęp: Badanie rezonansu magnetycznego serca (CMR) jest nową dyscypliną o olbrzymich możliwościach wynikających z wysokiej jakości i rozdzielczości obrazu, w połączeniu z bezinwazyjną częstotliwością zastosowanych fal radiowych. Cel: Wprowadzenie do badań rezonansu magnetycznego segmentarnego podziału mięśniówki lewej komory daje możliwość precyzyjnej oceny zmian masy lewej komory oraz regionalnej kurczliwości. Materiał i metody: Badaniem z randomizacją objęto 26 chorych z istotną stenozą aortalną, poddanych wymianie zastawki aortalnej na protezę bezstentową lub stentową. Chorych oceniano przed operacją oraz 6 miesięcy po operacji. Analizie poddano dane demograficzne oraz parametry CMR: masę lewej komory serca, EDD, ESV. W analizie segmentarnej lewą komorę podzielono na 3 równomiernie rozmieszczone poprzeczne płaszczyzny: płaszczyzna zastawki mitralnej (nr 1), środkowokomorowa (nr 2) i śródkomorowa – mięśnie brodawkowate (nr 3). Każdą z płaszczyzn podzielono na 17 segmentów (adaptac...
PURPOSE The aim of the presented work is to determine (i) mechanical properties of the ascending ... more PURPOSE The aim of the presented work is to determine (i) mechanical properties of the ascending aorta wall (DAA) and the wall of the ascending aortic aneurysm (DAAA), in which spontaneous dissection resulting from the evolving disease occurred, and (ii) the strength of the interface between the layers in the above-mentioned vessels. METHODS The mechanical tests were divided into two steps. In the first step the mechanical properties of the of DAA and DAAA walls were examined on the basis of uniaxial stretching until rapture. In the next step the mechanical parameters of the interface between layers of DAA and DAAA walls were determined by the peeling test. RESULTS Higher values of tensile strength ( max) and Young's modulus (E) were obtained for the DAAA group, to which the dissecting wall of the ascending aortic aneurysm was classified. For circumferential samples, the difference between the DAAA and DAA groups was 39% in the case of tensile strength and 70% in the case of t...
International Journal of Surgery Case Reports, 2021
INTRODUCTION AND IMPORTANCE: The majority of mediastinal tumours develop asymptomatically and are... more INTRODUCTION AND IMPORTANCE: The majority of mediastinal tumours develop asymptomatically and are often detected incidentally on a chest X-ray performed for another reason. Mediastinal tumours, although mostly asymptomatic, may cause non-specific symptoms associated with advanced tumour growth. CASE PRESENTATION: We present a case of a 30-year-old woman who presented with exhaustion and lower back pain accompanied by severe headaches with symptoms of visual disturbances, followed by the typical Horner syndrome. Computed tomography revealed a tumour measuring 12 × 11 × 10 cm in the right cavity with features suggestive of teratoma. The patient underwent mediastinal tumour resection and thymectomy. The pathomorphological examination confirmed the primary diagnosis of mediastinal teratoma, but rare somatic type malignancy was detected. Therefore, the patient was referred for further oncological treatment. DISCUSSION: Mediastinal teratoma is an uncommon finding and usually asymptomatic. Despite its slow growth, it can grow enough to compress adjacent structures, causing symptoms similar to those presented in our patient. CONCLUSION: Radiologic imaging proves diagnostic in most cases. Despite the somatic type malignancy, surgical excision of the tumour using the en-bloc technique seems to be a sufficient option for the patient, and further oncological treatment is not always obligatory.
We have read with great interest the article by Papakonstantinou et al. providing a single-center... more We have read with great interest the article by Papakonstantinou et al. providing a single-center analysis of the contemporary approach to tricuspid aortic valve (TAV) insufficiency with the use of HAART 300 annuloplasty ring [1].We believe that the presented concept of a robust circumferential aortic annuloplasty with separate sinus replacement, avoiding coronary re-implantations when allowed, can be successfully applied to many cases, including BAV.
Higher serum resistin levels were reported to be associated with increased mortality risk. We aim... more Higher serum resistin levels were reported to be associated with increased mortality risk. We aimed to assess the predictive value of resistin levels in perivascular adipose tissue (PVAT) around the left main coronary artery (LMCA) for mid-term survival of patients with advanced coronary artery disease (CAD). This was a prospective study including patients referred for elective coronary artery grafting in 2016 and 2017, performed using a standard approach. A sample of PVAT was harvested and resistin levels were measured using an enzyme-linked immunosorbent assay. Patients were followed from the day of the procedure until March 2021. In each patient, the SYNTAX score and EuroSCORE II were calculated. The study included 108 patients aged 68.1 ±7.9 years, including 83 men (76.9 %). The duration of follow-up was 731 (range, 275-1020) for nonsurvivors and 1418 median (range, 1174-1559) for survivors (p <0.001). Patients who died had a higher SYNTAX score, higher EuroSCORE II, and lowe...
Background: In middle-aged patients undergoing aortic valve replacement (AVR), the selection of p... more Background: In middle-aged patients undergoing aortic valve replacement (AVR), the selection of prosthesis type is a complex process. Current guidelines do not unequivocally indicate the type of prosthesis (bioprosthetic or mechanical) recommended for patients between 60-70 years of age. The aim of the study was to present the trends in AVR prosthesis selection in borderline patients over a 10-year period, based on real-life registry data. Methods: The study population comprised of 9,616 consecutive patients aged between 60-70 years, who underwent isolated AVR between 2006 and 2016 in all cardiac surgery departments in Poland. Data were extracted from the Polish National Registry of Cardiac Surgery. Results: Among 27,797 consecutive AVR procedures, patients aged 60-70 years represented 34.6% of the population operated on. From 2006 to 2016, bioprosthetic valves (BVs) were implanted in 53.9% cases, (and) mechanical valves (MVs) in 42.1%. The proportion of different valve types changed in time: from 77.5% of MVs vs. 22.5% of BVs in 2006 to 23.2% of MVs vs. 76.8% of BVs in 2016 (P<0.001). The most commonly implanted BV was the Hancock II (used in 36.4% of BV implantations), the most commonly used MV was the Saint Jude Mechanical prosthesis (implanted in 36.4% of MV implantation cases). A multivariable model identified smaller annulus [OR (95% CI) 0.89 (0.86-0.92), P<0.001], atrial fibrillation [OR (95% CI) 1.32 (1.05-1.67), P=0.017], male sex [OR (95% CI) 1.47 (1.24-1.74), P<0.001] and year of implantation [OR (95% CI) 0.75 (0.71-0.79), P<0.001] as predictors of MV implantation. Conclusions: Patients aged 60-70 years represent more than one-third of all AVR patients. Between 2006 and 2016, the proportion of implanted prostheses has changed dramatically. In 2016 BVs were implanted in nearly 75% of AVR cases, three times more often than in 2006.
Advances in Clinical and Experimental Medicine, 2020
Background. Thoracic aortic aneurysm (TAA) formation is accompanied by degradation of extracellul... more Background. Thoracic aortic aneurysm (TAA) formation is accompanied by degradation of extracellular matrix components (EMC). Numerous matrix metalloproteinases (MMPs) have been implicated in the process, but the involvement of MMP-3 remains unclear. Additionally, the changes in proteoglycan (PG) structure can alter the signal transduction pathways in TAA, though the enzymatic systems which originate them are not fully understood. Objectives. To measure MMP-3 and sulfatase levels in aneurysmal tissue, comparing them with nonaneurysmal vessels, and to investigate possible correlations with patients' serum levels in order to evaluate their potential usefulness in aiding aneurysm detection and monitoring. Material and methods. The study included 74 patients (TAA: n = 42; control group: n = 32). Sulfatase activity was measured colometrically and MMP-3 levels were measured immunoenzymatically. Results. Sulfatase activities were higher (p = 0.03) and MMP-3 concentrations lower (p = 0.014) in aneurysmal tissue than in normal aortic tissue. Medium-sized dilatations were associated with lower tissue MMP-3 concentrations than small dilatations (p = 0.033). No differences in sulfatase activity or MMP-3 concentration in the serum of TAA patients were observed in comparison with the controls. The serum and tissue levels of MMP-3 were correlated (r = 0.41; p < 0.001). The serum levels of MMP-3 were significantly lower in the female patients than in the male patients (p = 0.006). Conclusions. Our studies confirmed the lower MMP-3 levels in aneurysmal tissue, but the lack of a statistically confirmed reduction of MMP-3 in the blood serum seems to preclude its usefulness for diagnostic purposes. Our study points to the differences in MMP-3 behavior between TAA and abdominal aortic aneurysms. Significantly higher sulfatase activity in TAA tissue suggests a possible impact of sulfatase on signal transduction pathways involved in aneurysm formation.
The Journal of Thoracic and Cardiovascular Surgery, 2020
This study complies with the Declaration of Helsinki and locally appointed ethics committees have... more This study complies with the Declaration of Helsinki and locally appointed ethics committees have approved the research protocol. Informed consent has been obtained from patients. Study Protocol and Consort Diagram The study protocol of the STICH trial including a consort diagram has been published before 25 .
OBJECTIVES Our goal was to evaluate early sequelae and long-term survival in patients undergoing ... more OBJECTIVES Our goal was to evaluate early sequelae and long-term survival in patients undergoing isolated coronary artery bypass grafting (CABG) with concomitant surgical ablation for atrial fibrillation (AF). METHODS Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were collected. A total of 7879 patients with underlying AF underwent isolated CABG between 2006 and 2018 in 37 reference centres across Poland. The mean follow-up was 4.7 ± 3.5 years [median (interquartile range) 4.3 (1.7–7.4)]. Propensity score matching and Cox proportional hazards models were used to compare isolated CABG + ablation with isolated CABG. RESULTS Of the included patients, 346 (4.39%) underwent surgical ablation. Patients in this group were significantly younger (66.4 ± 7.5 vs 69.2 ± 8.2; P < 0.001) but had a non-significant, different baseline surgical risk (EuroSCORE: 2.11 vs 2.50; P = 0.088). After a rigorous 1:3 propensity matching (LOGIT model: 306 cases of isolat...
Background: Coronary artery bypass graft (CABG) surgery is an effective therapeutic strategy for ... more Background: Coronary artery bypass graft (CABG) surgery is an effective therapeutic strategy for coronary heart disease (CHD). Myocardial longitudinal strain echocardiography with 2D speckle tracking could obtain ventricular function with better accuracy and reliability than the left ventricular ejection fraction. The aim of the study was to assess changes in left ventricular function in patients before and after surgical revascularization for a 24-month period of observation, using echocardiography with speckle tracking strain imaging. We searched for echocardiographic predictors of poor early and long-term outcome after CABG. Methods: We enrolled 69 patients scheduled for elective coronary bypass grafting. Patients were divided into groups based on pre-operative systolic and diastolic parameters, depending on the GLS value and the E' Lat and E/E' value. The correlation between these parameters and early and long-term outcomes was analyzed. Results: Preoperative EF was preserved in 86, 95% (60) patients. Pre-operative reduced GLS was observed in 73.91% (51) of patients and severely reduced in 31.88% (22). In the first post-operative 6-month period, we observed a significant decrease in the GLS. The GLS was a predictor of early postoperative outcome for intubation time, the inotropes use and length of ICU stay. Diastolic dysfunction was a predictor of the greater inotrope requirements. Conclusions: Global longitudinal strain and diastolic dysfunction parameters are a good predictors of worse early outcome after CABG.
Background Recent scientific reports brought into light a new concept of goal-directed perfusion ... more Background Recent scientific reports brought into light a new concept of goal-directed perfusion (GDP) that aims to recreate physiological conditions in which the risk of end-organ malperfusion is minimalized. The aim of our study was to analyse patient’s interim physiology while on cardiopulmonary bypass based on the haemodynamic and tissue oxygen delivery measurements. We also aimed to create a universal formula that may help in the further implementation of the GDP concept. Methods We retrospectively analysed patients operated at Wroclaw University Hospital between June 2017 and December 2018. Since our observations provided a huge amount of data, including the patient's demographics, surgery details, and the perfusion-related data, the Data Science methodology was applied. Results A total of 272 (mean age 62.5±12.4, 74% male) cardiac surgery patients were included in the study. To study the relationship between haemodynamic and tissue oxygen parameters, the data for three di...
Background: The stress in the ascending aorta results from many biomechanical factors including t... more Background: The stress in the ascending aorta results from many biomechanical factors including the geometry of the vessel and its maximum dimensions, arterial blood pressure and longitudinal systolic stretching due to heart motion. The stretching of the ascending aorta resulting from the longitudinal displacement of the aortic annulus during the heart cycle has not been examined in the general population so far. The aim of the study is to evaluate this parameter using cardiovascular magnetic resonance (CMR) imaging in the general population in all age groups. Methods: The cardiac magnetic resonance images of 73 patients were evaluated. The maximum distance to which the ventriculo-aortic junction was pulled by the contracting heart (LDAAlongitudinal displacement of the aortic annulus) was measured in the cine coronal sequences. Moreover, the maximum dimensions of the aortic root and the ascending aorta were assessed. Results: The LDAA value was on average 11.6 ± 2.9 mm (range: 3-19 mm; 95% CI: 10.9-12.3 mm) and did not differ between males and females (11.8 ± 2.9 mm vs. 11.2 ± 2.9 mm, p = .408). The diameter of the ascending aorta was 32 ± 6.3 mm (range: 20-57 mm). The maximal dimension of the aortic root was 35 ± 5.1 mm (range: 18-42 mm). There was a statistically significant negative correlation between the LDAA and the age of patients (r = −.38, p = .001). There was no significant correlation between the LDAA and aortic root dimension (r = .1, p = .409) and between the LDAA and diameter of the ascending aorta (r = .16, p = .170). Conclusions: Human aortic root and ascending aorta are significantly stretched during systole and the distance to which the aorta is stretched decreases with age. The measurement of the longitudinal displacement of the aortic annulus using the CMR is feasible and reproducible.
Background: As the incidence of cardiovascular diseases increases, the use of antiplatelet therap... more Background: As the incidence of cardiovascular diseases increases, the use of antiplatelet therapy is widely recognized. This presents clinicians with the challenge of balancing the risk of thrombotic and bleeding complications. Platelet dysfunction is one of the causes of postoperative bleedings and their etiology is not fully understood. Platelets receptors point-of-care investigation is of a remarkable value in assessing patients risk of bleeding. Reliable assessment of platelet function can improve treatment. The aim of this study was to evaluate the activity of platelet receptors in patients qualified for cardiac surgery, taking into account organ dysfunctions and pharmacological therapy applied in these patients. Methods: Seventy-one cardiac surgical patients were analyzed before surgery using multiple electrode aggregometry with the use of the ADP test and ASPI test. The cutoff values were determined based on the manufacturer's recommendations. Patients were divided into four groups: Group I (33/71 patients, without platelet dysfunctions), Group II (6/71 patients, ADP < 710 AU x min), Group III (13/71 patients, ASPI < 570 AU x min) and Group IV (19 / 71 patients, ADP < 710 AU x min and ASPI < 570 AU x min). Biochemical data defining the efficiency of the liver and kidneys, the list of preoperative drugs used and the requirement for transfusion throughout the study group were collected. Results: The study group included 41 males (57.7%) and 30 females (42.3%), mean age 66 years. The majority of patients (94.4%) had platelet counts within the normal range, but platelet function was impaired in more than half of the studied patients (53.5%). No relationship was found between the biochemical markers of the kidneys and liver and the function of the ADP and ASPI receptors, while receptors activities were related (rs = 0.72, p < 0.001), and both associated with platelet count (rs = 0.55, p < 0.001 and rs = 0.42, p < 0.001, respectively). Platelet receptors activity was not related to the postoperative need for any type of transfusion as well as the applied preoperative pharmacological therapy. Conclusions: Early identification of patients at high risk of bleeding, using point-of-care platelet function assessment tests, enables a targeted therapeutic pathway. Due to the variety of factors affecting the activity of platelets, finding a specific cause of this pathology is extremely difficult. According to our study, the correlation between platelet receptor disorders and mild to moderate liver and kidney injury has not been demonstrated. However, platelet receptors dysfunction has been shown to be associated with a decreased number of platelets.
Journal of the American College of Cardiology, 2015
for implantations in aortic position. Histological analyses showed a debris capture rate of 93% i... more for implantations in aortic position. Histological analyses showed a debris capture rate of 93% in any or both filters. Finding debris in the proximal filter was more common (100%) than in the distal filter (86%). Acute thrombus was the most common type of debris, captured in 64% of the filters. In 28%, valve and arterial wall tissue and calcification were also found, with the percentage of debris higher in the proximal filter. Organized thrombus was found in 7%; foreign material was also found in 7% of all cases, but only in the distal filter. CONCLUSIONS Histopathological analyses showed high overall debris capture rates, with higher prevalence of thrombus over valve and arterial wall tissue, calcification and foreign material. Procedural stroke rate was 0%. Further investigation (especially histopathological) is needed to investigate the characterization of the debris and to differentiate between valve-in-valve procedures in the aortic and mitral position. CATEGORIES ENDOVASCULAR: Stroke and Stroke Prevention TCT-688 Acute, 30 and 90-day results of the STASIS trial: a multi-center study on a novel apical closure device for transapical transcatheter aortic valve implantation
European Heart Journal - Cardiovascular Imaging, 2013
Purpose: Cardiac deconditioning due to immobilization is a risk factor for cardiovascular disease... more Purpose: Cardiac deconditioning due to immobilization is a risk factor for cardiovascular disease. The physiology of cardiac adaptation to deconditioning has not been fully elucidated. The purpose of the present study was to assess the effects of 21-days of strict headdown (-6 degrees) bed-rest (BR) deconditioning on left ventricular (LV) dimensions and mass measured by MRI. Methods: Ten healthy men (mean age 32+6) were enrolled; the experiment was conducted at DLR (Koln, Germany) as part of the European Space Agency BR studies. Steady-state free precession MRI images (7mm thickness, no gap, no overlap) were obtained (Symphony 1.5T, Siemens) in a stack of short-axis views from LV base to LV apex, before (PRE), at the end of BR (HDT20), and four days after the BR conclusion (POST). Endocardial and epicardial semi-automated contouring was performed using freely available software (Segment). Results: At HDT20, significant reductions in LV mass (16%), end-diastolic (26%) and endsystolic (27%) volumes and stroke volume (27%) were observed, while ejection fraction did not change. These changes were accompanied by a measured decrease (14%) in plasma and blood volume (by gas-rebreathing technique), as well as by a significant reduction (14%) in VO2max aerobic power, measured using a graded cycle ergometer test protocol to volitional fatigue, at one day after the BR conclusion, while expiratory exchange ratio did not change. At POST, LV volumes were restored, while LV mass was still trending towards control values. Conclusions: Cardiac adaptation to deconditioning affected LV mass and dimensions, as a combined result of LV remodeling and fluids loss, accompanied by worsening in aerobic power. This should be taken into account in patients with cardiovascular diseases, when immobilized in bed, to proper adjust the therapy, or to define appropriate physical exercises when possible, in order to avoid further complications.
Background: The STICH trial (Surgical Treatment for Ischemic Heart Failure) demonstrated a surviv... more Background: The STICH trial (Surgical Treatment for Ischemic Heart Failure) demonstrated a survival benefit of coronary artery bypass grafting in patients with ischemic cardiomyopathy and left ventricular dysfunction. The Society of Thoracic Surgeons (STS) risk score and the EuroSCORE-2 (ES2) are used for risk assessment in cardiac surgery, with little information available about their accuracy in patients with left ventricular dysfunction. We assessed the ability of the STS score and ES2 to evaluate 30-day postoperative mortality risk in STICH and a contemporary cohort (CC) of patients with a left ventricle ejection fraction ≤35% undergoing coronary artery bypass grafting outside of a trial setting. Methods and Results: The STS and ES2 scores were calculated for 814 STICH patients and 1246 consecutive patients in a CC. There were marked variations in 30-day postoperative mortality risk from 1 patient to another. The STS scores consistently calculated lower risk scores than ES2 (1.5...
Background: While tackling moderate tricuspid regurgitation (TR) simultaneously with left-side he... more Background: While tackling moderate tricuspid regurgitation (TR) simultaneously with left-side heart surgery is recommended by the guidelines, the procedure is still seldom performed, especially in the minimally invasive setting. Atrial fibrillation (AF) is a known marker of both mortality and TR progression after mitral valve surgery. Aims: This study aimed to investigatev the safety of performing tricuspid intervention and minimally invasive mitral valve surgery (MIMVS) in patients with preoperative AF. Methods: We retrospectively analyzed data from the Polish National Registry of Cardiac Surgery Procedures collected between 2006 and 2021. We included all patients who underwent MIMVS (mini-thoracotomy, totally thoracoscopic, or robotic surgery) and had presented with moderate tricuspid regurgitation and AF preoperatively. The primary endpoint was death from any cause at 30 days and at the longest available follow-up after MIMVS with tricuspid intervention vs. MIMVS alone. We used propensity score (PS) matching to account for baseline differences between groups. Results: We identified 1545 patients with AF undergoing MIMVS, 54.7% were men aged 66.7 (mean [standard deviation, SD], 9.2) years. Of those, 733 (47.4%) underwent concomitant tricuspid valve intervention. At 13 years of follow-up, the addition of tricuspid intervention was associated with 33% higher mortality as compared to MIMVS alone (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.05-1.69; P = 0.02). PS matching resulted in identifying 565 well-balanced pairs. Concomitant tricuspid intervention did not influence long-term follow-up (HR, 1.01; 95 CI, 0.74-1.38; P = 0.94). Conclusions: After adjusting for baseline confounders, the addition of tricuspid intervention for moderate tricuspid regurgitation to MIMVS did not increase perioperative mortality nor influence long-term survival.
The Journal of Thoracic and Cardiovascular Surgery
Variable functional class t III STJ, Siontubular junction; MV, mitral valve repair; TV, tricuspid... more Variable functional class t III STJ, Siontubular junction; MV, mitral valve repair; TV, tricuspid valve repair. *Univariable risk factor analysis suggested significance to variables. †Trends in those. ‡W. L. Gore and Associates, Flagstaff, Ariz.
Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, Sep 27, 2007
A Ad dr re es s d do o k ko or re es sp po on nd de en nc cj ji i/ /C Co or rr re es sp po on nd ... more A Ad dr re es s d do o k ko or re es sp po on nd de en nc cj ji i/ /C Co or rr re es sp po on nd di in ng g a au ut th ho or r: : dr hab. n.
Wstęp: Badanie rezonansu magnetycznego serca (CMR) jest nową dyscypliną o olbrzymich możliwościac... more Wstęp: Badanie rezonansu magnetycznego serca (CMR) jest nową dyscypliną o olbrzymich możliwościach wynikających z wysokiej jakości i rozdzielczości obrazu, w połączeniu z bezinwazyjną częstotliwością zastosowanych fal radiowych. Cel: Wprowadzenie do badań rezonansu magnetycznego segmentarnego podziału mięśniówki lewej komory daje możliwość precyzyjnej oceny zmian masy lewej komory oraz regionalnej kurczliwości. Materiał i metody: Badaniem z randomizacją objęto 26 chorych z istotną stenozą aortalną, poddanych wymianie zastawki aortalnej na protezę bezstentową lub stentową. Chorych oceniano przed operacją oraz 6 miesięcy po operacji. Analizie poddano dane demograficzne oraz parametry CMR: masę lewej komory serca, EDD, ESV. W analizie segmentarnej lewą komorę podzielono na 3 równomiernie rozmieszczone poprzeczne płaszczyzny: płaszczyzna zastawki mitralnej (nr 1), środkowokomorowa (nr 2) i śródkomorowa – mięśnie brodawkowate (nr 3). Każdą z płaszczyzn podzielono na 17 segmentów (adaptac...
PURPOSE The aim of the presented work is to determine (i) mechanical properties of the ascending ... more PURPOSE The aim of the presented work is to determine (i) mechanical properties of the ascending aorta wall (DAA) and the wall of the ascending aortic aneurysm (DAAA), in which spontaneous dissection resulting from the evolving disease occurred, and (ii) the strength of the interface between the layers in the above-mentioned vessels. METHODS The mechanical tests were divided into two steps. In the first step the mechanical properties of the of DAA and DAAA walls were examined on the basis of uniaxial stretching until rapture. In the next step the mechanical parameters of the interface between layers of DAA and DAAA walls were determined by the peeling test. RESULTS Higher values of tensile strength ( max) and Young's modulus (E) were obtained for the DAAA group, to which the dissecting wall of the ascending aortic aneurysm was classified. For circumferential samples, the difference between the DAAA and DAA groups was 39% in the case of tensile strength and 70% in the case of t...
International Journal of Surgery Case Reports, 2021
INTRODUCTION AND IMPORTANCE: The majority of mediastinal tumours develop asymptomatically and are... more INTRODUCTION AND IMPORTANCE: The majority of mediastinal tumours develop asymptomatically and are often detected incidentally on a chest X-ray performed for another reason. Mediastinal tumours, although mostly asymptomatic, may cause non-specific symptoms associated with advanced tumour growth. CASE PRESENTATION: We present a case of a 30-year-old woman who presented with exhaustion and lower back pain accompanied by severe headaches with symptoms of visual disturbances, followed by the typical Horner syndrome. Computed tomography revealed a tumour measuring 12 × 11 × 10 cm in the right cavity with features suggestive of teratoma. The patient underwent mediastinal tumour resection and thymectomy. The pathomorphological examination confirmed the primary diagnosis of mediastinal teratoma, but rare somatic type malignancy was detected. Therefore, the patient was referred for further oncological treatment. DISCUSSION: Mediastinal teratoma is an uncommon finding and usually asymptomatic. Despite its slow growth, it can grow enough to compress adjacent structures, causing symptoms similar to those presented in our patient. CONCLUSION: Radiologic imaging proves diagnostic in most cases. Despite the somatic type malignancy, surgical excision of the tumour using the en-bloc technique seems to be a sufficient option for the patient, and further oncological treatment is not always obligatory.
We have read with great interest the article by Papakonstantinou et al. providing a single-center... more We have read with great interest the article by Papakonstantinou et al. providing a single-center analysis of the contemporary approach to tricuspid aortic valve (TAV) insufficiency with the use of HAART 300 annuloplasty ring [1].We believe that the presented concept of a robust circumferential aortic annuloplasty with separate sinus replacement, avoiding coronary re-implantations when allowed, can be successfully applied to many cases, including BAV.
Higher serum resistin levels were reported to be associated with increased mortality risk. We aim... more Higher serum resistin levels were reported to be associated with increased mortality risk. We aimed to assess the predictive value of resistin levels in perivascular adipose tissue (PVAT) around the left main coronary artery (LMCA) for mid-term survival of patients with advanced coronary artery disease (CAD). This was a prospective study including patients referred for elective coronary artery grafting in 2016 and 2017, performed using a standard approach. A sample of PVAT was harvested and resistin levels were measured using an enzyme-linked immunosorbent assay. Patients were followed from the day of the procedure until March 2021. In each patient, the SYNTAX score and EuroSCORE II were calculated. The study included 108 patients aged 68.1 ±7.9 years, including 83 men (76.9 %). The duration of follow-up was 731 (range, 275-1020) for nonsurvivors and 1418 median (range, 1174-1559) for survivors (p <0.001). Patients who died had a higher SYNTAX score, higher EuroSCORE II, and lowe...
Background: In middle-aged patients undergoing aortic valve replacement (AVR), the selection of p... more Background: In middle-aged patients undergoing aortic valve replacement (AVR), the selection of prosthesis type is a complex process. Current guidelines do not unequivocally indicate the type of prosthesis (bioprosthetic or mechanical) recommended for patients between 60-70 years of age. The aim of the study was to present the trends in AVR prosthesis selection in borderline patients over a 10-year period, based on real-life registry data. Methods: The study population comprised of 9,616 consecutive patients aged between 60-70 years, who underwent isolated AVR between 2006 and 2016 in all cardiac surgery departments in Poland. Data were extracted from the Polish National Registry of Cardiac Surgery. Results: Among 27,797 consecutive AVR procedures, patients aged 60-70 years represented 34.6% of the population operated on. From 2006 to 2016, bioprosthetic valves (BVs) were implanted in 53.9% cases, (and) mechanical valves (MVs) in 42.1%. The proportion of different valve types changed in time: from 77.5% of MVs vs. 22.5% of BVs in 2006 to 23.2% of MVs vs. 76.8% of BVs in 2016 (P<0.001). The most commonly implanted BV was the Hancock II (used in 36.4% of BV implantations), the most commonly used MV was the Saint Jude Mechanical prosthesis (implanted in 36.4% of MV implantation cases). A multivariable model identified smaller annulus [OR (95% CI) 0.89 (0.86-0.92), P<0.001], atrial fibrillation [OR (95% CI) 1.32 (1.05-1.67), P=0.017], male sex [OR (95% CI) 1.47 (1.24-1.74), P<0.001] and year of implantation [OR (95% CI) 0.75 (0.71-0.79), P<0.001] as predictors of MV implantation. Conclusions: Patients aged 60-70 years represent more than one-third of all AVR patients. Between 2006 and 2016, the proportion of implanted prostheses has changed dramatically. In 2016 BVs were implanted in nearly 75% of AVR cases, three times more often than in 2006.
Advances in Clinical and Experimental Medicine, 2020
Background. Thoracic aortic aneurysm (TAA) formation is accompanied by degradation of extracellul... more Background. Thoracic aortic aneurysm (TAA) formation is accompanied by degradation of extracellular matrix components (EMC). Numerous matrix metalloproteinases (MMPs) have been implicated in the process, but the involvement of MMP-3 remains unclear. Additionally, the changes in proteoglycan (PG) structure can alter the signal transduction pathways in TAA, though the enzymatic systems which originate them are not fully understood. Objectives. To measure MMP-3 and sulfatase levels in aneurysmal tissue, comparing them with nonaneurysmal vessels, and to investigate possible correlations with patients' serum levels in order to evaluate their potential usefulness in aiding aneurysm detection and monitoring. Material and methods. The study included 74 patients (TAA: n = 42; control group: n = 32). Sulfatase activity was measured colometrically and MMP-3 levels were measured immunoenzymatically. Results. Sulfatase activities were higher (p = 0.03) and MMP-3 concentrations lower (p = 0.014) in aneurysmal tissue than in normal aortic tissue. Medium-sized dilatations were associated with lower tissue MMP-3 concentrations than small dilatations (p = 0.033). No differences in sulfatase activity or MMP-3 concentration in the serum of TAA patients were observed in comparison with the controls. The serum and tissue levels of MMP-3 were correlated (r = 0.41; p < 0.001). The serum levels of MMP-3 were significantly lower in the female patients than in the male patients (p = 0.006). Conclusions. Our studies confirmed the lower MMP-3 levels in aneurysmal tissue, but the lack of a statistically confirmed reduction of MMP-3 in the blood serum seems to preclude its usefulness for diagnostic purposes. Our study points to the differences in MMP-3 behavior between TAA and abdominal aortic aneurysms. Significantly higher sulfatase activity in TAA tissue suggests a possible impact of sulfatase on signal transduction pathways involved in aneurysm formation.
The Journal of Thoracic and Cardiovascular Surgery, 2020
This study complies with the Declaration of Helsinki and locally appointed ethics committees have... more This study complies with the Declaration of Helsinki and locally appointed ethics committees have approved the research protocol. Informed consent has been obtained from patients. Study Protocol and Consort Diagram The study protocol of the STICH trial including a consort diagram has been published before 25 .
OBJECTIVES Our goal was to evaluate early sequelae and long-term survival in patients undergoing ... more OBJECTIVES Our goal was to evaluate early sequelae and long-term survival in patients undergoing isolated coronary artery bypass grafting (CABG) with concomitant surgical ablation for atrial fibrillation (AF). METHODS Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were collected. A total of 7879 patients with underlying AF underwent isolated CABG between 2006 and 2018 in 37 reference centres across Poland. The mean follow-up was 4.7 ± 3.5 years [median (interquartile range) 4.3 (1.7–7.4)]. Propensity score matching and Cox proportional hazards models were used to compare isolated CABG + ablation with isolated CABG. RESULTS Of the included patients, 346 (4.39%) underwent surgical ablation. Patients in this group were significantly younger (66.4 ± 7.5 vs 69.2 ± 8.2; P < 0.001) but had a non-significant, different baseline surgical risk (EuroSCORE: 2.11 vs 2.50; P = 0.088). After a rigorous 1:3 propensity matching (LOGIT model: 306 cases of isolat...
Background: Coronary artery bypass graft (CABG) surgery is an effective therapeutic strategy for ... more Background: Coronary artery bypass graft (CABG) surgery is an effective therapeutic strategy for coronary heart disease (CHD). Myocardial longitudinal strain echocardiography with 2D speckle tracking could obtain ventricular function with better accuracy and reliability than the left ventricular ejection fraction. The aim of the study was to assess changes in left ventricular function in patients before and after surgical revascularization for a 24-month period of observation, using echocardiography with speckle tracking strain imaging. We searched for echocardiographic predictors of poor early and long-term outcome after CABG. Methods: We enrolled 69 patients scheduled for elective coronary bypass grafting. Patients were divided into groups based on pre-operative systolic and diastolic parameters, depending on the GLS value and the E' Lat and E/E' value. The correlation between these parameters and early and long-term outcomes was analyzed. Results: Preoperative EF was preserved in 86, 95% (60) patients. Pre-operative reduced GLS was observed in 73.91% (51) of patients and severely reduced in 31.88% (22). In the first post-operative 6-month period, we observed a significant decrease in the GLS. The GLS was a predictor of early postoperative outcome for intubation time, the inotropes use and length of ICU stay. Diastolic dysfunction was a predictor of the greater inotrope requirements. Conclusions: Global longitudinal strain and diastolic dysfunction parameters are a good predictors of worse early outcome after CABG.
Background Recent scientific reports brought into light a new concept of goal-directed perfusion ... more Background Recent scientific reports brought into light a new concept of goal-directed perfusion (GDP) that aims to recreate physiological conditions in which the risk of end-organ malperfusion is minimalized. The aim of our study was to analyse patient’s interim physiology while on cardiopulmonary bypass based on the haemodynamic and tissue oxygen delivery measurements. We also aimed to create a universal formula that may help in the further implementation of the GDP concept. Methods We retrospectively analysed patients operated at Wroclaw University Hospital between June 2017 and December 2018. Since our observations provided a huge amount of data, including the patient's demographics, surgery details, and the perfusion-related data, the Data Science methodology was applied. Results A total of 272 (mean age 62.5±12.4, 74% male) cardiac surgery patients were included in the study. To study the relationship between haemodynamic and tissue oxygen parameters, the data for three di...
Background: The stress in the ascending aorta results from many biomechanical factors including t... more Background: The stress in the ascending aorta results from many biomechanical factors including the geometry of the vessel and its maximum dimensions, arterial blood pressure and longitudinal systolic stretching due to heart motion. The stretching of the ascending aorta resulting from the longitudinal displacement of the aortic annulus during the heart cycle has not been examined in the general population so far. The aim of the study is to evaluate this parameter using cardiovascular magnetic resonance (CMR) imaging in the general population in all age groups. Methods: The cardiac magnetic resonance images of 73 patients were evaluated. The maximum distance to which the ventriculo-aortic junction was pulled by the contracting heart (LDAAlongitudinal displacement of the aortic annulus) was measured in the cine coronal sequences. Moreover, the maximum dimensions of the aortic root and the ascending aorta were assessed. Results: The LDAA value was on average 11.6 ± 2.9 mm (range: 3-19 mm; 95% CI: 10.9-12.3 mm) and did not differ between males and females (11.8 ± 2.9 mm vs. 11.2 ± 2.9 mm, p = .408). The diameter of the ascending aorta was 32 ± 6.3 mm (range: 20-57 mm). The maximal dimension of the aortic root was 35 ± 5.1 mm (range: 18-42 mm). There was a statistically significant negative correlation between the LDAA and the age of patients (r = −.38, p = .001). There was no significant correlation between the LDAA and aortic root dimension (r = .1, p = .409) and between the LDAA and diameter of the ascending aorta (r = .16, p = .170). Conclusions: Human aortic root and ascending aorta are significantly stretched during systole and the distance to which the aorta is stretched decreases with age. The measurement of the longitudinal displacement of the aortic annulus using the CMR is feasible and reproducible.
Background: As the incidence of cardiovascular diseases increases, the use of antiplatelet therap... more Background: As the incidence of cardiovascular diseases increases, the use of antiplatelet therapy is widely recognized. This presents clinicians with the challenge of balancing the risk of thrombotic and bleeding complications. Platelet dysfunction is one of the causes of postoperative bleedings and their etiology is not fully understood. Platelets receptors point-of-care investigation is of a remarkable value in assessing patients risk of bleeding. Reliable assessment of platelet function can improve treatment. The aim of this study was to evaluate the activity of platelet receptors in patients qualified for cardiac surgery, taking into account organ dysfunctions and pharmacological therapy applied in these patients. Methods: Seventy-one cardiac surgical patients were analyzed before surgery using multiple electrode aggregometry with the use of the ADP test and ASPI test. The cutoff values were determined based on the manufacturer's recommendations. Patients were divided into four groups: Group I (33/71 patients, without platelet dysfunctions), Group II (6/71 patients, ADP < 710 AU x min), Group III (13/71 patients, ASPI < 570 AU x min) and Group IV (19 / 71 patients, ADP < 710 AU x min and ASPI < 570 AU x min). Biochemical data defining the efficiency of the liver and kidneys, the list of preoperative drugs used and the requirement for transfusion throughout the study group were collected. Results: The study group included 41 males (57.7%) and 30 females (42.3%), mean age 66 years. The majority of patients (94.4%) had platelet counts within the normal range, but platelet function was impaired in more than half of the studied patients (53.5%). No relationship was found between the biochemical markers of the kidneys and liver and the function of the ADP and ASPI receptors, while receptors activities were related (rs = 0.72, p < 0.001), and both associated with platelet count (rs = 0.55, p < 0.001 and rs = 0.42, p < 0.001, respectively). Platelet receptors activity was not related to the postoperative need for any type of transfusion as well as the applied preoperative pharmacological therapy. Conclusions: Early identification of patients at high risk of bleeding, using point-of-care platelet function assessment tests, enables a targeted therapeutic pathway. Due to the variety of factors affecting the activity of platelets, finding a specific cause of this pathology is extremely difficult. According to our study, the correlation between platelet receptor disorders and mild to moderate liver and kidney injury has not been demonstrated. However, platelet receptors dysfunction has been shown to be associated with a decreased number of platelets.
Journal of the American College of Cardiology, 2015
for implantations in aortic position. Histological analyses showed a debris capture rate of 93% i... more for implantations in aortic position. Histological analyses showed a debris capture rate of 93% in any or both filters. Finding debris in the proximal filter was more common (100%) than in the distal filter (86%). Acute thrombus was the most common type of debris, captured in 64% of the filters. In 28%, valve and arterial wall tissue and calcification were also found, with the percentage of debris higher in the proximal filter. Organized thrombus was found in 7%; foreign material was also found in 7% of all cases, but only in the distal filter. CONCLUSIONS Histopathological analyses showed high overall debris capture rates, with higher prevalence of thrombus over valve and arterial wall tissue, calcification and foreign material. Procedural stroke rate was 0%. Further investigation (especially histopathological) is needed to investigate the characterization of the debris and to differentiate between valve-in-valve procedures in the aortic and mitral position. CATEGORIES ENDOVASCULAR: Stroke and Stroke Prevention TCT-688 Acute, 30 and 90-day results of the STASIS trial: a multi-center study on a novel apical closure device for transapical transcatheter aortic valve implantation
European Heart Journal - Cardiovascular Imaging, 2013
Purpose: Cardiac deconditioning due to immobilization is a risk factor for cardiovascular disease... more Purpose: Cardiac deconditioning due to immobilization is a risk factor for cardiovascular disease. The physiology of cardiac adaptation to deconditioning has not been fully elucidated. The purpose of the present study was to assess the effects of 21-days of strict headdown (-6 degrees) bed-rest (BR) deconditioning on left ventricular (LV) dimensions and mass measured by MRI. Methods: Ten healthy men (mean age 32+6) were enrolled; the experiment was conducted at DLR (Koln, Germany) as part of the European Space Agency BR studies. Steady-state free precession MRI images (7mm thickness, no gap, no overlap) were obtained (Symphony 1.5T, Siemens) in a stack of short-axis views from LV base to LV apex, before (PRE), at the end of BR (HDT20), and four days after the BR conclusion (POST). Endocardial and epicardial semi-automated contouring was performed using freely available software (Segment). Results: At HDT20, significant reductions in LV mass (16%), end-diastolic (26%) and endsystolic (27%) volumes and stroke volume (27%) were observed, while ejection fraction did not change. These changes were accompanied by a measured decrease (14%) in plasma and blood volume (by gas-rebreathing technique), as well as by a significant reduction (14%) in VO2max aerobic power, measured using a graded cycle ergometer test protocol to volitional fatigue, at one day after the BR conclusion, while expiratory exchange ratio did not change. At POST, LV volumes were restored, while LV mass was still trending towards control values. Conclusions: Cardiac adaptation to deconditioning affected LV mass and dimensions, as a combined result of LV remodeling and fluids loss, accompanied by worsening in aerobic power. This should be taken into account in patients with cardiovascular diseases, when immobilized in bed, to proper adjust the therapy, or to define appropriate physical exercises when possible, in order to avoid further complications.
Background: The STICH trial (Surgical Treatment for Ischemic Heart Failure) demonstrated a surviv... more Background: The STICH trial (Surgical Treatment for Ischemic Heart Failure) demonstrated a survival benefit of coronary artery bypass grafting in patients with ischemic cardiomyopathy and left ventricular dysfunction. The Society of Thoracic Surgeons (STS) risk score and the EuroSCORE-2 (ES2) are used for risk assessment in cardiac surgery, with little information available about their accuracy in patients with left ventricular dysfunction. We assessed the ability of the STS score and ES2 to evaluate 30-day postoperative mortality risk in STICH and a contemporary cohort (CC) of patients with a left ventricle ejection fraction ≤35% undergoing coronary artery bypass grafting outside of a trial setting. Methods and Results: The STS and ES2 scores were calculated for 814 STICH patients and 1246 consecutive patients in a CC. There were marked variations in 30-day postoperative mortality risk from 1 patient to another. The STS scores consistently calculated lower risk scores than ES2 (1.5...
Background: While tackling moderate tricuspid regurgitation (TR) simultaneously with left-side he... more Background: While tackling moderate tricuspid regurgitation (TR) simultaneously with left-side heart surgery is recommended by the guidelines, the procedure is still seldom performed, especially in the minimally invasive setting. Atrial fibrillation (AF) is a known marker of both mortality and TR progression after mitral valve surgery. Aims: This study aimed to investigatev the safety of performing tricuspid intervention and minimally invasive mitral valve surgery (MIMVS) in patients with preoperative AF. Methods: We retrospectively analyzed data from the Polish National Registry of Cardiac Surgery Procedures collected between 2006 and 2021. We included all patients who underwent MIMVS (mini-thoracotomy, totally thoracoscopic, or robotic surgery) and had presented with moderate tricuspid regurgitation and AF preoperatively. The primary endpoint was death from any cause at 30 days and at the longest available follow-up after MIMVS with tricuspid intervention vs. MIMVS alone. We used propensity score (PS) matching to account for baseline differences between groups. Results: We identified 1545 patients with AF undergoing MIMVS, 54.7% were men aged 66.7 (mean [standard deviation, SD], 9.2) years. Of those, 733 (47.4%) underwent concomitant tricuspid valve intervention. At 13 years of follow-up, the addition of tricuspid intervention was associated with 33% higher mortality as compared to MIMVS alone (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.05-1.69; P = 0.02). PS matching resulted in identifying 565 well-balanced pairs. Concomitant tricuspid intervention did not influence long-term follow-up (HR, 1.01; 95 CI, 0.74-1.38; P = 0.94). Conclusions: After adjusting for baseline confounders, the addition of tricuspid intervention for moderate tricuspid regurgitation to MIMVS did not increase perioperative mortality nor influence long-term survival.
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Papers by Marek Jasiński