Mortality and risk factors after a surgical repair of postinfarction ventricular septal defect.

BACKGROUND: The aim of this study was to present our experience in the treatment of post-myocardial infarction ventricular septal defect and examine the various risk factors. METHODS: This is a retrospective study. From January 2010 to December 2018, 20 patients underwent an urgent /emergency surgical repair of post-myocardial infarction ventricular septal defect. RESULTS: The mortality in our group of patients was 45 %. Non-survivors compared to the survivors were all in cardiogenic shock (p=0.0098), had an emergency/salvage operation (p=0.0055), preoperative mechanical ventilation (p=0.0081), shorter time between intraaortic balloon pressure insertion and surgery (p=0.0115), shorter median time between ventricular septal defect and surgery, postoperative renal replacement therapy (p=0.0498), and more patients had a residual effect (p=0.0022). In multivariate analysis, preoperative mechanical ventilation (p=0.0001), postoperative renal replacement therapy (p=0.0021) and residual defect (p=0.0000027) were shown to be strong predictors for hospital mortality. CONCLUSION: This analysis showed that post-myocardial infarction ventricular septal defect repair is a devastating complication and preoperative mechanical ventilation, postoperative renal replacement therapy and residual defect were identified to be the predictors of mortality. Initial stabilization of the patients, when it is possible, and a delayed repair, may improve the outcome of these patients (Tab. 3, Ref. 17).

Single centre 12 year experience with durable mechanical circulatory support: comparison with the EUROMACS registry.

OBJECTIVES: Mechanical circulatory support is an established therapy in end-stage heart failure. The EUROMACS registry was created to promote research in these patients. The aim of this report was to present our 12 year experience with the durable mechanical circulatory support devices and compare it with the EUROMACS registry. METHODS: Data from the entire EUROMACS registry from January 2011 to April 2019 were included (4704 implantations in 4410 patients). During the 12 years of our experience, until April 2019,125 mechanical support devices were implanted, in 122 patients. We compare patients´ characteristics, operative data and results with the EUROMACS registry and we report the major complications during the observational period. RESULTS: Primary end-point (death) occurred in 40 (32.8 %) patients in our cohort during the follow-up period, representing the survival rate 75 %, 68 %, and 58 % for 6, 12, 24 months respectively, which compares favourably with the data, reported by the EUROMACS registry, the survival 66 % and 53 % after 1 and 2 years respectively. Cerebrovascular accident occurred in 7 %, a bleeding event in 32 %, significant infection (driveline) in 78 % and a device malfunction in 13 % of the patients. Forty- three patients underwent a heart transplant with hospital and long-term mortality of 11.6 % and 14 % respectively. CONCLUSION: Mechanical circulatory support is a valuable therapeutic option with excellent survival rates, nevertheless it is associated with clinically significant complications rates. The direct comparison between our cohort and the EUROMACS registry showed that early implantation strategy and mini invasive approach may improve survival rates and decrease postoperative complications (Tab. 3, Fig. 3, Ref. 16).

Transapical transcatheter aortic valve replacement with the balloon expandable aortic bioprosthetic valve in high risk patients with severe aortic stenosis: Intermediate-term results from the register of the clinic of cardiac surgery.

BACKGROUND: The purpose of this study is to report our experience in performing transapical (TA) TAVR with a balloon-expandable valve only by cardiac surgeons, with on site interventional cardiology support. METHODS: A retrospective review of 97 consecutive patients that underwent TA TAVR due to severe symptomatic aortic stenosis was performed from 2012 to 2016. Median follow-up time was 20.5 months. Preoperative risk factors and postoperative outcomes were evaluated using Valve Academic Research Consortium-2 definitions. RESULTS: All patients were high risk with a mean Euroscore of 7.28±7.77. Five year and 30-day mortality were 9.3 % and 1.1 %, respectively. Ninty six (98.9 %) of the patients had no or mild paravalvular leak seen by transesophageal echocardiography after implantation. Device success was 91.8%. Postoperatively there was a significant increase of the ejection fraction (50.8±7.1 % preoperatively vs 53.1±7.7 % postoperatively, p=0.009) and reverse remodeling of the left ventricle (left ventricular end-diastolic diameter preoperatively 50.8±7.1 mm vs 49.2±8.1 mm postoperatively, p=0.031). CONCLUSION: Our experience demonstrates that TA TAVR can be performed only by cardiac surgeons, with on site interventional cardiology support safely and successfully with low and comparable postoperative mortality and rate of complications (Tab. 4, Fig. 1, Ref. 26).

SynCardia, total artificial heart, as a bridge to transplant.

INTRODUCTION: Implantation of a total artificial heart is an alternative to durable biventricular assist device support in selected patients. We present our initial experience with the implantation of the SynCardia total artificial heart (TAH) in three patients. The first patient, was the first SynCardia (TAH) implantation in the Visegrad Four (V4) countries METHOD: Three patients with severe refractory end stage biventricular heart failure listed for heart transplant were indicated for SynCardia TAH implantationRESULTS: We present in details the perioperative and postoperative outcomes of these patients. The first and the third patient, after 195 and 126 days of TAH support respectively, had a successful heart transplants, the second patient died on 11th postoperative day. The cause of death was brain bleeding due to ruptured undiagnosed brain aneurysm. CONCLUSION:   SynCardia TAH is an alternative therapy in patients with end-stage biventricular heart failure waiting for heart transplantation. The SynCardia TAH with pulsatility resembles the physiologic circulation, improves the condition of the patients and increases survival compared to the biventricular assist devices. It is an intermediate step until the development of genetically modified animal hearts, engineered bioartificial hearts or hearts from induced pluripotent stem cells that would replace the failing heart in the patients with end-stage heart disease (Tab. 2, Fig. 1, Ref. 27).

Long-term outcomes following minimal invasive versus conventional aortic valve replacement: a propensity match analysis.

INTRODUCTION: Minimal invasive aortic valve replacement has become a routine procedure. In this study, we compared the outcomes between conventional and minimal invasive aortic valve replacement via the partial upper sternotomy that were performed in our Institution. METHODS: The 5 year survival and postoperative outcomes of 34 patients that underwent isolated MIAVR between the years 2010-2013 were compared with the outcomes of 34 randomly selected patients that underwent conventional AVR, after propensity match analysis. RESULTS: There was no difference between the two groups concerning the early and late postoperative outcomes. MIAVR patients had a longer mean cross-clamp time (p = 0.002) and longer cardiopulmonary bypass time (p = 0.0005) compared to the AVR patients. 5 year mortality and survival were 4.17 % vs 16.67 % (p = 0.20) and 95.8 % vs 83.3 % (p = 0.37) in the MIAVR and AVR groups respectively. CONCLUSION: This study showed a comparable 5 year survival and postoperative outcomes between the MIAVR and AVR groups. In our opinion, the minimal access aortic valve replacement can be performed safely with excellent long-term results in selected patients (Tab. 4, Fig. 1, Ref. 35).

Wound infections after median sternotomy treated by VAC therapy, summary of results, and risk factor analysis.

INTRODUCTION: The aim of this study is to summarize results and analyze risk factors for the development of wound infection in heart surgery patients after median sternotomy. METHOD: In this retrospective analysis with assessment of multiple risk factors, we examined 143 patients with infection after median sternotomy treated with VAC therapy from total of 4,650 patients operated in our department from 2012 to 2015. RESULTS: Total of 143 patients developed significant SSI treated by VAC therapy following cardiac surgery. Of these, only 14 patients developed DSWI and one patient was diagnosed with suspected osteomyelitis. BMI, female gender, and use of BIMA proved to be statistically significant risk factors in our study (p < 0.001). The acuteness of operations did not have a statistically significant effect. However, it had a significant effect on the severity of infection (p < 0.01). The severity of infection proved to be a significant prognostic factor for patients' outcome (p < 0.01). CONCLUSION: In our study, BMI, female gender, and use of BIMA (bilateral internal mammary artery) in patients with DM were predictors for the development of SWI. The acuteness of operation did not have a statistically significant effect. However, it had a statistically significant effect on the severity of infection (Tab. 3, Ref. 30).

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).

Repair of aortic regurgitation caused by spontaneous avulsion of aortic valve commissure in a patient with idiopathic thrombocytopenic purpura.

We describe a case of severe acute aortic regurgitation in a 60-year-old woman due to spontaneous avulsion of an aortic valve commissure. She presented with spontaneous bleeding and a platelet count of 4 000/microl caused by idiopathic thrombocytopenic purpura and developed acute heart failure and respiratory insufficiency. Preoperative transesophageal echocardiography was not diagnostic for the exact mechanism of aortic regurgitation. She received a 2-day course of intravenous immunoglobulin (0.5 mg/kg/d) to increase platelet count. At operation detachment (avulsion) of the commissure between the left and the right coronary cusp was evident. Aortic valve repair was performed with resuspension of the commissure. The postoperative course was uneventful. During a 24-month follow-up period, the patient has remained in NYHA class I.