Multidisciplinary aortic arch procedures within the "Aortic Team".

Introduction and aim: The European societies EACTS (European Association for Cardio-Thoracic Surgery) and ESVS (European Society for Vascular Surgery) recommend the establishment of "Aortic Teams" from 2019. In Poland, the first such team was officially established in Specialist University Hospital no. 2 in Szczecin in 2021. Material and methods: Sixty-four patients were treated for aortic arch pathology using frozen elephant trunk (n = 3), branch custom made devices (n = 12), physician-modified endo-grafts (PMEG; n = 30) and the thoracic endovascular aortic repair "plus" technique (n = 19). Results: Among thoracic endovascular aortic repair (TEVAR) plus (chimneys/periscopes, n = 7, extra-anatomical bypasses, n = 12) there was 100% technical success and 4% bad outcomes (stroke or death). Among "customized" stent grafts there were Bolton Relay (n = 8), Brail Endo-Branch (n = 1) and Castor branched stent graft (n = 3) with 91% technical success and 18% bad outcomes. In the group of PMEG there were 14 cases with one fenestration, 5 cases with two fenestrations and 11 cases with triple fenestration to all vessels of the aortic arch. In this group, technical success was achieved in 91% and poor outcome ended treatment in 11%. In total we noted a 91% technical success rate and a good treatment outcome was achieved in 89%. The cooperation of cardiac surgeons and vascular surgeons in one team brought competence benefits for both specialties. It allowed for good clinical and economic results despite new logistical complexities and fits into the currently changing perspective of cardiac surgery development worldwide. Conclusions: Implementation of the recommendation to create aortic teams within cardiac surgery departments is possible and may be cost-effective in Polish conditions.

Glycated hemoglobin HbA1c - a new risk marker for the outcome of cardiac surgery?

INTRODUCTION: About 30% of patients undergoing cardiac surgery are diabetic, and glycated hemoglobin (HbA1c) is a reliable marker for long-term glucose control. The aim of our study was to examine whether tight glucose control before a cardiac operation results in a better outcome of the surgical treatment. MATERIAL AND METHODS: We performed a retrospective record review of 350 diabetic patients undergoing cardiac surgery in our institution. Preoperative glycemia control was assessed by measurement of the glycated hemoglobin level. The patient population was divided into three groups: group I - patients with HbA1c below 7% (n = 195); group II - patients with HbA1c between 7% and 8% (n = 88); and group III - patients with HbA1c above 8% (n = 67). RESULTS: The demographic data and operating risk in all groups of patients were similar. There were 2 deaths (1.02%) in group I, 2 deaths (2.27%, p = 0.78) in group II and 3 deaths (4.47%, p = 0.20) in group III. Cardiac accidents occurred in 9 patients (4.60%) from group I, 7 patients (7.95%, p = 0.20) from group II, and in 6 patients (9.05%, p = 0.40) from group III. Cerebrovascular accidents (CVA) occurred in 7 (3.58%), 5 (5.68%, p = 0.67) and 5 (7.46%, p = 0.61) patients, respectively. Acute renal dysfunction requiring renal replacement therapy occurred in 4 patients from group I (2.05%), 3 patients from group II (3.40%, p = 0.78) and 4 patients from group III (5.97%, p = 0.23). CONCLUSIONS: A large percentage of diabetic patients referred for cardiac operations have poorly controlled glycemia. Optimal preoperative glycemia control results in lower postoperative mortality and morbidity. In addition, the preoperative HbA1c level is a good indicator of the risk of postoperative complications in diabetic patients undergoing cardiac operations.

The Gerbode defect - a frequent echocardiographic pitfall.

We present a case of Gerbode type defect (left ventricular to right atrial communication) discovered in a 52 year-old man with atrial and ventricular septal defects. The patient was diagnosed using two-dimensional colour Doppler and transoesophageal echocardiography. We describe the echocardiographic features and review the anatomical consequences of such defects. Our aim was to remind readers about this rare organic heart disease that an inexperienced echocardiography specialist might easily mistake for a recoil wave of tricuspid valve incompetence and thus diagnose pulmonary hypertension.

Evaluation of the level of antibodies against Chlamydophila (Chlamydia) pneumoniae in post-surgery heart ischaemia patients and their clinical conditions - a six-year study.

INTRODUCTION: Inflammatory conditions modulated by Chlamydophila (Chlamydia) pneumoniae are considered to play an important role in the onset of atherosclerosis. In this paper we present the results of progressive observation of C. pneumoniae antibody titres in patients who underwent coronary artery bypass graft (CABG). MATERIAL AND METHODS: The objective of our research was a prospective observation of antibody titres in IgA and IgG class antibodies against C. pneumoniae using indirect immunofluorescence in a group of 155 post-surgery CABG patients suffering from heart ischaemia. The microbiological test results were compared with patients' present coronary complaints evaluated on the CCS scale during a six-year period. RESULTS: Six years after CABG, 128 patients (82.6%) are still alive. During the study a positive serological conversion of antibody titres was observed in 36 patients in the IgA class antibodies, and in 26 patients in the IgG class. The group of patients with no antibodies against C. pneumoniae decreased from 23.2 to 3.4%, while the group of patients with antibodies in both IgG and IgA classes increased from 52.3 to 83.9%. The average CCS degree decreased from 3.18 before CABG to 1.65 in the present study. CONCLUSIONS: These results show no connection between the serological symptoms of chronic C. pneumoniae infection and coronary complaints evaluated on the CCS scale during a six-year study on post-CABG patients suffering from heart ischaemia. The surgical treatment of heart ischaemia brought about long-term improvement in the coronary condition of the observed group of patients.