Blockage of extracorporeal circulation during emergency surgery for fulminant infective endocarditis.

A 37-years-old man with a history of alcohol abuse and pancreatitis, presented to the emergency department with a 1-week history of progressively worsening dyspnoea with a fever up to 39°C. Echocardiography revealed bicuspid aortic valve with additional mobile structure and perforation of leaflet with acute aortic regurgitation. Due to rapidly deteriorating condition of the patient, a decision about immediate surgery was made. In the operating room, cardiac arrest in the asystole mechanism occurred. Extracorporeal circulation was turned on during direct heart massage. After opening of the aorta, the circulation was blocked by total clogging of the arterial line filter by fibrine deposits. The oxygenator was replaced which resulted a break in extracorporeal circulation lasting about 10 min. Patients survived surgery and was discharged after 6 week antibiotic therapy.

Tumors of the right atrium and the inferior vena cava operated in deep hypothermic circulatory arrest.

<b>Introduction:</b> Tumors which most frequently metastasize to the heart include: malignant melanoma, lung cancer, breast cancer, ovarian cancer, kidney cancer, leukemia, lymphomas and esophageal cancer. <br><b>Purpose:</b> The purpose of this paper was clinical analysis of a group of patients operated in deep hypothermic circulatory arrest due to tumors of the right atrium and the inferior vena cava. <br><b>Material and method:</b> The study covered 7 patients operated at the Cardiac Surgery Clinic with a cardiac tumor diagnosed on the basis of an echocardiographic assessment in the years 2012-2019. Before qualifying for surgical treatment, each patient underwent: thorough interview and physical examination, 12-lead ECG, laboratory tests and echocardiography. Patients additionally underwent: computed tomography of the chest or abdomen, magnetic resonance imaging and coronary angiography on the basis of which patients with significant coronary artery changes underwent simultaneous coronary artery bypass graft. After preparation, the tumor was excised from the vena cava and right atrium with simultaneous removal of the primary tumor, most often kidney cancer. Early and distant results of treatment were analyzed in the examined group of patients to determine the following endpoints: hospital mortality and survival after surgery: after 3 months and 12 months. <br><b>Results:</b> Of all operated patients: 2 individuals died in the early postoperative period due to hemorrhagic complications (hospital mortality - 28.6%), and 5 patients (71.4%) were discharged from the Clinic in a good general condition. In total, 3-month survival was 71.4%, and 12-month survival amounted to 28.6%. <br><b>Conclusions:</b> Surgeries are very complex and challenging, and usually take on average 8-10 hours. It can improve the outcomes of palliative oncological treatment, better physical function (cardiovascular fitness) and extend life from several months to several years in more than ²/3 patients.

Off-pump versus on-pump coronary artery surgery in octogenarians (from the KROK Registry).

BACKGROUND: According to the medical literature, both on-pump and off-pump coronary artery surgery is safe and effective in octogenarians. OBJECTIVES: The aim of our study was to examine the epidemiology, in-hospital outcomes and long-term follow-up results in octogenarians undergoing off-pump and on-pump coronary artery surgery utilizing nationwide registry data. METHODS: All octogenarians (≥ 80 years) enrolled in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry), who underwent isolated coronary surgery between January 2006 and September 2017 were identified. Preoperative data, perioperative complications, hospital mortality and long-term mortality were analyzed. Unadjusted and propensity-matched comparisons were performed between octogenarians undergoing off-pump and on-pump coronary artery bypass surgery. RESULTS: Octogenarians accounted for 4.1% of the total population undergoing coronary artery surgery in Poland during the analyzed period (n = 152,631) and this percentage is increasing. Among 6,006 analyzed patients, 2,744 (45.7%) were operated on-pump and 3,262 (54.3%) were operated off-pump. Propensity-matched analysis revealed that patients operated on-pump were more often reoperated due to postoperative bleeding and their in-hospital mortality was higher (6.6% vs 4.5%, p = 0.006 and 8.7% vs 5.8%, p = 0.001, respectively). Long-term all-cause mortality was lower among patients operated off-pump (p = 0.013). CONCLUSION: On the basis of our findings we suggest that off pump technique should be considered as perfectly acceptable in octogenarians.

Predictors of post-operative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting.

BACKGROUND: Post-operative atrial fibrillation (POAF) is the most common cardiac arrhythmia occurring after coronary artery bypass grafting (CABG). Arrhythmia leads to prolonged hospitalisation and may have an impact on both short-term and long-term prognoses. AIM: The aim of this paper was to evaluate the incidence of POAF in patients after CABG as well as to identify its predictors. METHODS: The study was performed on 791 patients (selected from a group of 1031 patients who underwent CABG in the Clinical Department of Cardiology in the years 2009-2011) who did not suffer from atrial fibrillation (AF) prior to isolated CABG. Data on co-existing diseases, as well as data collected at the time of surgery and in the post-operative period, were evaluated. RESULTS: The average age of patients in the examined group was 64.6 ± 9.1 years. Emergency CABG was performed on 38% of patients, whereas 75.1% of patients underwent CABG with the use of extracorporeal circulation. Based on the incidence of POAF, the post-CABG patients were classified into a POAF(+) group that comprised 166 (21%) patients, and a POAF(-) group involving 625 (79%) patients. The first occurrence of arrhythmia during the first three days after surgery was observed in 76.5% of patients. The average age of POAF(+) and POAF(-) patients was 68.7 ± 8.8 years and 63.5 ± 8.9 years, respectively (p < 0.0001). The respective incidence rates of co-existing diseases in patients with POAF and those without POAF were as follows: arterial hypertension, 80.1% vs. 75.8% (p = 0.29); heart failure, 18.7% vs. 21.1% (p = 0.56); type 2 diabetes, 24.1% vs. 26.2% (p = 0.64). Stable angina pectoris was diagnosed in 22.3% of patients with POAF and 15% of patients without POAF (p = 0.034). The following conditions were more frequently observed in patients with POAF compared with those without POAF: low cardiac output syndrome, 28.9% vs. 14.2% (p < 0.0001) and cardiac tamponade, 9% vs. 4.6% (p = 0.044), respectively. Red blood cell transfusions were performed more often in patients with POAF compared to those without POAF (70.5% vs. 55.7%, respectively, p = 0.0008). Multivariate analysis revealed the following potential predictors of POAF: age ≥ 70 years (HR 2.3), preoperative stable angina pectoris (HR 1.7), and post-CABG low cardiac output syndrome (HR 1.8). CONCLUSIONS: POAF was diagnosed in 21% of post-CABG patients, and the major predictors were: age ≥ 70 years, preoperative stable angina, as well as low cardiac output syndrome following CABG.

Simultaneous removal of a tumour of the right atrium and inferior vena cava and coronary bypass-grafting in a patient with recurrent clear renal cell carcinoma.

Metastatic cardiac tumours are the most common malignant cardiac tumours. In the early stages they are usually asymptomatic, but their consequences can be very serious, and the prognosis is poor. We present a patient with recurrent renal cell carcinoma as a tumour of the right atrium and the vena cava inferior in whom cancerous masses were removed with simultaneously coronary artery bypass-grafting.

Coronary artery bypass grafting in patients over 80 years of age: a single-centre experience.

BACKGROUND: Extended length of human life leads to an increased number of the elderly with coronary artery disease. Advanced age does not constitute a contra indication for surgical revascularisation. However, as reflected by the available risk scores, mortality risk associated with operating patients in the 9th decade of life is increased. AIM: To characterise patients over 80 years of age undergoing coronary artery bypass grafting (CABG) and to evaluate in-hospital mortality in the study group. METHODS: We retrospectively analysed medical records of 51 patients over 80 years of age who underwent CABG in a cardiacsurgical department of a regional cardiology centre in 2008-2011. The following factors were taken into consideration: coexisting diseases, laboratory test results, echocardiographic findings, surgical data, and in-hospital mortality. EuroSCORE (European System for Cardiac Operative Risk Evaluation) I and EuroSCORE II risk scores were used for preoperative risk assessment. RESULTS: The mean age in the study group was 81.7 years. Coexisting diseases included hypertension in 76.5% of patients, impaired renal function in 62.7% of patients, heart failure in 31.4% of patients, atrial fibrillation (AF) in 21.6% of patients, and diabetes mellitus in 15.7% of patients. Most patients had a history of myocardial infarction (MI). CABG was performed using cardiopulmonary bypass in 51.6% of patients. The most frequent complications were new onset AF which occurred in 41.2% of operated patients and low cardiac output syndrome which was observed in 37.3% of patients. In-hospital mortality rate among patients over 80 years of age undergoing CABG was 3.9%, lower than predicted by the logistic EuroSCORE I (9.1%) and EuroSCORE II (7.3%). Two patients died during the postoperative period, including one operated with the use of cardiopulmonary bypass. CONCLUSIONS: The most common concomitant conditions in the elderly patients undergoing cardiac surgery are hypertension and impaired renal function. The majority of operated patients already suffered a MI. AF and low cardiac output syndrome are the most common postoperative complications. Among patients above 80 years of age, operative mortality risk predicted using the EuroSCORE I and EuroSCORE II may be overestimated. Patient selection for cardiac surgery must be based on individual factors, taking into account the feasibility of postoperative rehabilitation and the potential for improved survival and quality of life.

[Depression in patients after coronary artery bypass grafting]. / Depresja u chorych po pomostowaniu aortalno-wienowym.

Surgical revascularization is a recognized method of treatment ofischaemic heart disease. The number of patients undergoing coronary artery bypass grafting (CABG) is constantly increasing, both in a population of young patients with coronary heart disease and in elderly patients. It is estimated that even one out of three patients undergoing CABG in the perioperative period can develop symptoms of depression. Numerous individual factors as well as factors related to the surgery have an impact on the occurrence of depression. The most common factors are: age, sex, socio-economic status, co-existing diseases, and the occurrence ofpreoperative depression. Researchers are currently looking for biochemical markers concentration of which before surgery could serve as a predicator for the occurrence of post-CABG depression. It is suggested that inflammatory response, particularly intense in the perioperative period, is linked to the occurrence of depression after surgical revascularization. Recognizing these factors is of utmost importance since it will help develop a stratification aiming at the identification of patients who are particularly prone to the occurrence of postoperative depression. Due to the fact that depression not only lowers the quality of life but also affects the short-term and long-term prognosis, identifying patients at risk is significantly important.

[Post-traumatic isolated aneurysm of aortic arch surgically repaired]. / Pourazowy tetniak luku aorty leczony operacyjnie.

An aneurysm is a permanent localized dilatation of an artery. A trauma is a rare cause of aortic aneurysm. The prognosis of untreated thoracic aneurysm is poor, with 3-year survival rates as low as 25%. Factors that seem to worsen the prognosis are female gender, size greater than 6cm, and traumatic origin. Because of the poor prognosis for the untreated patient and inability to predict rupture, surgical treatment of thoracic aortic aneurysms that result from trauma, even when asymptomatic is justified. The case of a 29 year-old patient, with post-traumatic aortic arch aneurysm qualified for delayed surgery treatment, is presented.

[Chronic type A aortic dissection incidentally detected in a 71 year-old woman]. / Przewlekle rozwarstwienie aorty typu A przypadkowo wykryte u 71-letniej kobiety.

Aortic dissection is a sudden event when the intimal tear occurs, blood penetrates the aortic wall through and the dissection propagates. Acute aortic dissection presents with chest pain, hemodynamic instability, absent or unequal peripheral pulses, various neurologic complications and aortic regurgitation. Noninvasive testing (echocardiography, computed tomography or magnetic resonance imaging) allows an accurate diagnosis to be made. Ascending aortic dissection often require surgery or stent-grafts, depending on their size and location. We present a case of a 71 year-old woman with an asymptomatic chronic type "A" dissection of aorta of total length, incidentally detected during ultrasonographic imaging, qualified for surgery treatment.

[Ventricular septum and free wall rupture in a 56-year-old male with myocardial infarction. A case report with follow-up of 7 years]. / Pekniecie przegrody miedzykomorowej i wolnej sciany lewej komory jako powiklanie mechaniczne zawalu serca u 56-letniego mezczyzny. Opis przypadku, obserwacja 7-letnia.

A case of a 56-year-old male who had unrecognised acute myocardial infarction complicated by a combination of ventricular septum and free wall rupture is presented. He developed symptoms of overt heart failure but initially he was treated out of hospital due to pneumonia. An echocardiographic study disclosed a ventricular septum rupture and ventricular free wall rupture with concomitant formation of pseudoaneurysm. He underwent surgical correction of the double myocardial rupture and successful re-operation due to recanalisation on the 5th day after the surgery. He underwent right coronary artery angioplasty 5 years after cardiac surgery.

[Acute myocardial infarction--multivessel coronary artery disease in a 37-year-old postpartum women]. / Zawal serca bez uniesienia odcinka ST--wielonaczyniowa choroba wiencowa u 37-letniej kobiety w okresie pologu.

Acute myocardial infarction (MI) in the postpartum period is rare. We present a case of a 37-year-old women with acute MI which occurred 15 days after delivery. Coronary angiography revealed multivessel coronary artery disease and she underwent successful surgical revascularisation.

[Early results of surgical treatment in acquired heart diseases during endocarditis in own material]. / Wczesne wyniki chirurgicznego leczenia nabytych wad serca w przebiegu infekcyjnego zapalenia wsierdzia w materiale wlasnym.

BACKGROUND: Endocarditis can concern natural as well as artificial heart valves. In conservative treatment mortality reaches 24-60%. Surgical procedure is the only way to save these patients in most cases. METHODS: Between 1998-2001, 114 patients underwent surgery because of valve endocarditis, 86 male and 28 female. 43 patients underwent mitral valve replacement (MVR), (13 MV reoperation), 51 aortic valve replacement (AVR), (16 AV reoperation) and 20 patients underwent MVR and AVR (3 both valves replacement). Three groups were similar regarding age, gender, emergency or elective procedures and NYHA class four. All patients underwent open heart surgery in ECC with hypothermia and crystalloid cardioplegia done by the same group of surgeons. RESULTS: Operative mortality in the MVR group was 11.6% (five of 43) compared to 3.9% (two of 51) AVR patients and 25% (five of 20) MVR and AVR group. The highest mortality rate was in both infected artificial valves procedures. There was growth of the bacteria in intraoperative material in 37.6% (33) of cases, mainly Staphylococcus epidermidis and Staphylococcus aureus. Incidence of postoperative sepsis, multiorgan failure, high grade atrio-ventricular block or low cardiac output was the highest in MVR and AVR patients. Independent predictors of operative mortality included increasing patient age, female gender, infected valve reoperation, and history of stroke. CONCLUSIONS: Our study suggests that patients with endocarditis and compromised hemodynamic status can be operated with acceptable morbidity and mortality. If echocardiography shows the cuspids perforations or vegetations, chords tendinous rupture or perivalvular leak, the patients should undergo cardiac surgery as soon as possible, in order to avoid severe embolic complications.