Preoperative and mid-term right ventricular systolic function assessment, at rest and during exercise, with speckle-tracking echocardiography after left ventricular assist device implantation.

OBJECTIVES: The study aimed to compare pre- and postoperative resting as well as postprocedural resting and exertional right ventricular speckle-tracking echocardiographic parameters at a mid-term follow-up after left ventricular assist device (LVAD) implantation. METHODS: Patients with implanted third-generation LVADs with hydrodynamic bearings were prospectively enrolled (NCT05063006). Myocardial deformation was evaluated before pump implantation and at least three months after the procedure, both at rest and during exercise. RESULTS: We included 22 patients, 7.3 months (IQR, 4.7-10.2) after the surgery. The mean age was 58.4 ± 7 years, 95.5% were men, and 45.5% had dilated cardiomyopathy. The RV strain analysis was feasible in all subjects both at rest and during exercise. The RV free wall strain (RVFWS) worsened from -13% (IQR, -17.3 to -10.9) to -11.3% (IQR, -12.9 to -6; p = 0.033) after LVAD implantation with a particular decline in the apical RV segment [-11.3% (IQR, -16.4 to -6.2) vs -7.8% (IQR, -11.7 to -3.9; p = 0.012)]. The RV four-chamber longitudinal strain (RV4CSL) remained unchanged [-8.5% (IQR, -10.8 to -6.9) vs -7.3% (IQR, -9.8 to -4.7; p = 0.184)]. Neither RVFWS (-11.3% (IQR, -12.9 to -6) vs -9.9% (IQR, -13.5 to -7.5; p = 0.077) nor RV4CSL [-7.3% (IQR, -9.8 to -4.7) vs -7.9% (IQR, -9.8 to -6.3; p = 0.548)] changed during the exercise test. CONCLUSIONS: In patients who are pump-supported, the right ventricular free wall strain tends to worsen after LVAD implantation and remains unchanged during a cycle ergometer stress test.

Clostridioides difficile infection after cardiac surgery: Assessment of prevalence, risk factors and clinical outcomes-retrospective study.

BACKGROUND: Clostridioides difficile infection (CDI) is the most common cause of hospital-acquired diarrhea. There is little available data regarding risk factors of CDI for patients who undergo cardiac surgery. The study evaluated the course of CDI in patients after cardiac surgery. METHODS: Of 6,198 patients studied, 70 (1.1%) developed CDI. The control group consisted of 73 patients in whom CDI was excluded. Perioperative data and clinical outcomes were analyzed. RESULTS: Patients with CDI were significantly older in comparison to the control group (median age 73.0 vs 67.0, P = 0.005) and more frequently received proton pump inhibitors, statins, ß-blockers and acetylsalicylic acid before surgery (P = 0.008, P = 0.012, P = 0.004, and P = 0.001, respectively). In addition, the presence of atherosclerosis, coronary disease and history of malignant neoplasms correlated positively with the development of CDI (P = 0.012, P = 0.036 and P = 0.05, respectively). There were no differences in the type or timing of surgery, aortic cross-clamp and cardiopulmonary bypass time, volume of postoperative drainage and administration of blood products between the studied groups. Relapse was more common among overweight patients with high postoperative plasma glucose or patients with higher C-reactive protein during the first episode of CDI, as well as those with a history of coronary disease or diabetes mellitus (P = 0.005, P = 0.030, P = 0.009, P = 0.049, and P = 0.025, respectively). Fifteen patients died (21.4%) from the CDI group and 7 (9.6%) from the control group (P = 0.050). Emergent procedures, prolonged stay in the intensive care unit, longer mechanical ventilation and high white blood cell count during the diarrhea were associated with higher mortality among patients with CDI (P = 0.05, P = 0.041, P = 0.004 and P = 0.007, respectively). CONCLUSIONS: The study did not reveal any specific cardiac surgery-related risk factors for development of CDI.

Applications of low-cost 3D printing in left atrial appendage closure using epicardial approaches - initial clinical experience.

INTRODUCTION: Left atrial appendage occlusion procedure (LAAO) became an alternative method for stroke prevention in atrial fibrillation (AF) patients with contraindication or intolerance for oral anticoagulation therapy. However, LAA anatomy is complex with several different types of LAA morphology. Therefore matching the correct size of a delivery device to LAA morphology is difficult. In such circumstances, the 3D-printed model of LAA closure may be useful for preoperative planning which increases the efficacy of LAAO procedure. MATERIAL AND METHODS: We report as a first 2 cases of LAA occlusion procedure using 2 different systems: thoracoscopic AtriClip and the LARIAT device in which a 3D printed LAA model was used in preoperative planning. RESULTS: In the first patient, preoperative measurements of 3D LAA model were performed using a dedicated selection guide for AtriClip device were comparable with the intraoperative examination. Left atrial appendage was closed epicardial using 40 mm size AtriClip. In second patients, LAA closure was performed completely percutaneously using LARIAT device. For better visualization of LAA shape on fluoroscopy and TEE examination, intraoperatively sterilized 3D LAA model was used during the procedure. In both cases, intraoperative TEE examination confirmed complete LAA closure with no leak. CONCLUSIONS: Left atrial appendage 3D model is a useful tool in preoperative planning of a left atrial appendage occlusion using epicardial approaches with thoracoscopic or percutaneous access using LARIAT device. The quality of low-cost 3D printed LAA model is sufficient in planning minimally invasive procedure.

Minimally invasive direct coronary artery bypass (MIDCAB) ­ safety assessment in own material.

Introduction: Minimally invasive direct coronary artery bypass (MIDCAB) allows achieving similar safety and efficacy, with markedly reduced post-operative length of stay when compared to conventional surgical revascularization. Despite promising results, a small number of minimally invasive procedures are performed in Poland. The aim of the study is to assess short- and long-term outcome of MIDCAB revascularization in order to evaluate the safety of the procedure. Materials and Methods: Retrospective observational study analyzing 38 consecutive patients who underwent MIDCAB procedure between 2014 to 2016 in the Department of Cardiovascular Surgery and Transplantology at the John Paul II Hospital, Kraków. Perioperative data was obtained from patient medical records and the median follow-up period valued 17.3 months. Results: No postoperative deaths and only 1 case of postoperative myocardial infarction were observed. Throughout the follow-up period, the survival rate and freedom from MACCE rate valued 100%, with only 1 case of repeated revascularization. Conclusions: Minimally invasive revascularization is a safe procedure which can be performed with excellent short- and long-term outcome in low-risk patients.

[Prospective assessment of circulatory sufficiency of the patients after 3F equine pericardial stentless bioprosthesis replacement]. / Prospektywna ocena zmiany wydolnosci serca u pacjentów z wszczepiona bezstentowa, biologiczna zastawka aortalna wykonana z osierdzia konskiego.

INTRODUCTION: During years more and more advanced Technologies are used for treatment of severe aortic stenosis. One of them is equine pericardial stentless bioprothesis. AIM OF THE STUDY: the aim of the study was prospective assessment of circulatory sufficiency of the patients after 3F equine pericardial stentless bioprothesis replacement (ATS-Medtronic, Inc, Minneapolis, USA). PATIENTS AND METHODS: Patients qualified to valve replacement were qualified to the study. The procedures were performed in general anesthesia and medial thoracothomy. The New York Heart Association (NYHA) scale was analyzed to estimate clinical results of the procedures. RESULTS: 45 patients (10 women and 35 men) aged 23-78 (mean 54 (+/- SD 12.7) were included into the study. Patients were observed during one-year follow up (FU). At the baseline three pts had NYHA II stage, 35 - III and 7 - IV. There was no pts in NYHA I stage. After 3-6 months FU 34 pts were at NYHA I stage (79%) and 9 at NYHA II. After 11-14 FU 33 pts were at NYHA I (80.4%) and 8 NYHA II (19.5%). There was no pts at NYHA IV during 12 months FU (differences between observational periods statistically significant p < 0.001). CONCLUSIONS: During one-year FU after equine pericardial stentless bioprothesis implantation the improvement of NYHA grade was observed.