Aortic valve-sparing operation versus Bentall and mechanical aortic valve replacement--midterm results.

OBJECTIVES: The primary aim of this retrospective study was to evaluate short-term (one-to-six months) and mid-term (six-to-forty-eight months) results of aortic valve-sparing procedures. The second endpoint was to compare the results with the group of patients undergoing mechanical aortic valve replacement during the same period. METHODS: Between April 2008 and May 2012 at our institution, we treated 76 patients either with ascending aorta/root aneurysm/dissection or with isolated aortic regurgitation. A total of seventy-six patients undergoing aortic valve surgery. RESULTS: Analyzed parameters were divided into two parts as function of time. In the first part, i.e. during hospitalization, the mortality, duration of hospitalization, duration of extra corporeal circulation (ECC), and duration of cardiac arrest (CA) were compared and assessed. In the second part, i.e. during monitoring of the patients after their discharge from hospital (one-to-six months, and six-to-forty-eight months), the grade of postoperative AR aimed mainly at the group of aortic valve-sparing operations (subgroups A1, A2, A3), postoperative peak gradient, presence of thromboembolic and bleeding complications, postoperative endocarditis and need for reoperation or hospitalization due to cardiac reasons were analyzed. CONCLUSION: Based on our first experience, we believe that in spite of higher technical difficulty, the aortic valve-sparing operations can be possibly performed with the same or respectively lower rate of postoperative morbidity and mortality. Presented results show that compared with the aortic valve replacement, the aortic valve-sparing operation is a promising method, and an interesting therapeutic alternative for patients. After proper indications, we consider it to be a method of choice (Tab. 6, Fig. 7, Ref. 28).

[Is there a relationship between inflammatory markers, oxidative stress and postoperative atrial fibrillation?]. / Existuje vztah medzi zápalovými markermi, oxidacným stresom a pooperacnou fibriláciou predsiení?

INTRODUCTION: Atrial fibrillation (AF) is one of the most common complications following heart surgery. The aim of this work was to verify the relationship between inflammatory markers, oxidative stress and postoperative arrhythmia. METHODS: 45 patients with ischemic heart disease (12 women and 33 men, mean age 62.3 ± 9.4 years) underwent surgical myocardial revascularization. The extracorporeal circulation (ECC) was used in 30 patients, without ECC was 15 patients. During the first 3 postoperative days was determining the incidence and duration of the AF, laboratory markers of inflammation (CRP, leukocytes, TNFα), malondialdehyde (MDA). RESULTS: Demographic data and associated disease were in this patients similar. The incidence of AF we documented in 30 patients (66.7%). In patients with postoperative AF were significantly higher levels of inflammatory markers (leukocytes 13.6 ± 3.6 vs 11.3 ± 3.6; 14.7 ± 3.9 vs 12.5 ± 2.9; 13.7 ± 4.1 vs 11.4 ± 13.7; p 0.05; CRP 138.1 ± 41.1 vs 69.9 ± 25.8; p 0.001; TNFα 11.3 ± 14.3 vs 8.7 ± 3.6; 12.1 ± 14.5 vs 8.7 ± 3.1; p 0.05) compared with patients who were free from AF. Values of MDA were not significantly different. CONCLUSION: Patients with post-operative atrial fibrillation were higher levels of inflammatory markers compared with patients with sinus rhythm but no significant differences in the levels of oxidative stress.

[Recurrent prosthetic endocarditis in a 21-year old patient with renal transplantation treated with allogeneic homograft]. / Recidivujúca protetická endokarditída u 21-rocného pacienta s transplantovanou oblickou riesená alogénnym homograftom.

Prosthetic infective endocarditis is a possible complication of implantation of a prosthetic cardiac valve. Without early and effective treatment, it can have fatal consequences. One treatment option is use of an allogeneic cryopreserved homograft. This case report presents a 21-year old patient after kidney transplantation due to hereditary nephrotic syndrome and aortic valve replacement with aortic conduits. After fever was noted in the patient, prosthetic infective endocarditis was diagnosed by echocardiography and also confirmed by CT-3D examination. The cryopreserved aortic homograft was implanted at the Department of Cardiac Surgery. This along with additional conservative management effectively treated the infection. Based on literature data and our own experience, we believe that the treatment of prosthetic endocarditis after aortic valve replacement with cryopreserved homograft can be a method of choice.

[Clinical implications of enlargement of left atrium]. / Klinické dôsledky zväcsenia lavej predsiene.

Enlargement of left atrium (LA) has been shown to be a barometer of diastolic burden and a predictor of common cardiovascular outcomes such as atrial fibrillation, stroke, congestive heart failure, and cardiovascular death. Different methods exist for the assessment of LA size. The American Society of Echocardiography recommended LA volume and its indexed value assessed by 2-dimensional echocardiography, to measure LA size. Current findings suggest that echocardiographically determined LA size may become an important clinical risk identifier in preclinical cardiovascular disease and should be assessed as a part of routine echocardiographic evaluation.

[Why there is atrial fibrillation after cardiac operations?]. / Preco vzniká fibrilácia predsiení po kardiochirurgických operáciách?

Atrial fibrillation (AF) is the most frequent arrhythmias after cardiac operations. Its incidence ranges from 10-65%. Often there is a patient discomfort, prolongs hospitalization, increases costs of operation and may be permanent or recurrent course. The cause of postoperative AF is multifactorial. The prevention of non-pharmacological and pharmacological interventions. The conventional treatment strategies include monitoring ventricular rate, restoration of sinus rhythm and prevention of thromboembolic events. The development of effective therapies designed to decrease the high incidence of postoperative AF may be important in the future.