Characterisation and validity of inflammatory biomarkers in the prediction of post-operative atrial fibrillation in coronary artery disease patients.

Atrial fibrillation (AF) is a common complication of coronary artery bypass grafting (CABG). We sought to determine the diagnostic validity of plasma biomarkers of i) inflammation (marked by interleukin-6 [IL-6] and high-sensitivity C-reactive protein [hs-CRP]), ii) extracellular matrix remodelling (matrix metalloproteinase [MMP-9], tissue inhibitor of matrix metalloproteinase [TIMP-1]) and iii) the prothrombotic state (tissue factor and von Willebrand factor [vWF]) in the risk prediction of post-operative AF. Samples were obtained preoperatively from peripheral/femoral vein and from intracardiac chambers (right atrium [RA], the right atrial appendage [RAA], the left atrium [LA] and the left atrial appendage [LAA]) amongst 100 consecutive patients free of AF and inflammatory disease undergoing elective CABG. Biomarker concentrations were related to incident AF (30 days). At 30 days post CABG, 30 patients were proven to have had AF. Concentrations of tissue factor (TF) and vWF were unrelated to postoperative AF. Peripheral (p=0.018), and intracardiac levels (RAA (p=0.029) and LA (p=0.026)) of hs-CRP were associated with the presence of AF after CABG. Intracardiac levels of IL-6 in samples from the RAA (p=0.031), LA (p=0.042) and LAA (p=0.006), and MMP-9 in the LAA sample were also associated with AF (p=0.007). Our data suggest that an intra-cardiac inflammatory environment that is manifest peri-operatively may predispose to the development of post-operative AF. This intracardiac inflammatory state was reflected by increased peripheral hs-CRP levels. These differences may indicate local substrate abnormalities contributing to the development of AF post-operatively.

[Extra-anatomic thoracic aortic bypass operations]. / Krutines aortos apeinamuju jungciu suformavimo operacijos.

OBJECTIVE: When the patient condition contraindicates major surgery for descending thoracic aneurysms, the surgeon should consider using an ascending aorta to abdominal aorta bypass graft, leaving the diseased segment undisturbed. Our experience with eight patients is presented. MATERIAL AND METHODS: Between 1988 and 2008, eight patients were treated for the following indications: reoperation for coarctation (two patients), complicated descending aortic aneurysms (five patients), and posttraumatic descending aorta dissection (one patient). The mean age of the patients was 44+/-8 years (range, 27-53 years). There were 6 (75%) males and 2 (25%) females. Emergency operations were performed in three patients (two with aortic recoarctation, one with posttraumatic aortic dissection). Two cases were reoperations (both after recoarctation). Descending aorta was ligated in seven cases. Distal anastomosis was connected with abdominal aorta in four cases and with iliac arteries in four patients. RESULTS: Three early deaths occurred. Two patients died after emergency operation after recoarctation and posttraumatic aortic dissection, and one patient died after descending aorta aneurysm correction because of bleeding. CONCLUSIONS: In complex aortic coarctation, extra-anatomic bypass operation remains an effective procedure. The usage of these procedures in patients with descending aortic aneurysms remains complicated.

[Total and partial arterial revascularization]. / Visiska ir daline arterine revaskulizacija.

UNLABELLED: It was shown in a long-term studies that internal thoracic arteries have higher patency, rate compared with saphenous veins grafts. The study was designed to evaluate the late results (1-4 years) of arterial (internal thoracic arteries and radial artery) and venous grafts in a patients referred to coronary revascularization. From April 1997 to June 2002, 405 patients were operated upon using radial artery and internal thoracic arteries and saphenous veins grafts in Vilnius University Heart surgery clinic and Heart Surgery center. One hundred twenty two patients were controlled at 3-36 months. 93% of patients were in CCS f. cl. 0 or 1. Twenty seven symptomatic patients were investigated angiografically at 17,6+/-10 months, and was found patent internal thoracic arteries - 93%, radial artery - 79% and saphenous veins grafts - 62%. CONCLUSION: Arterial grafts tends to be superior than veins grafts in the midterm period.

[Coronary reoperations]. / Pakartotine miokardo revaskulizacija.

BACKGROUND: We report our experience with 85 patients undergoing a second time CABG in our institution, highlighting surgical techniques and results. METHODS: Eighty five patients underwent a second coronary artery revascularization between 1971 and 2002 at Vilnius University Hospital Santariskiu Clinics. There were 78 men (91.8%); the mean age was 56.5 years (range 40-75). The reason for the second operation was graft failure in 89.4% of the cases. RESULTS: Direct myocardial revascularization was performed in all patient with a mean of 2.4 graft per patient (range 1-4). The internal mammary artery was utilized 17.6%. Hospital mortality was 1.1%. CONCLUSION: Our data suggest that a second - time coronary revascularization can be justified, with gratifying operative success and good results.

[Coronary artery revascularization without cardiopulmonary bypass]. / Vainikiniu arteriju revaskulizacija nenaudojant dirbtines kraujo apytakos.

OBJECTIVE: We sought to report our recent experience with off-pump coronary artery revascularization. MATERIAL AND METHODS: Between July 1998 and July 2002, 80 off-pump beating heart operations were performed at Vilnius University Hospital Heart Surgery Clinic, representing 4.05% of all coronary artery revascularization. This cohort of patients was compared with 241 patients operated on with cardiopulmonary by pass. RESULTS: Mean age and preoperative risk factors were comparable for the two groups. On average, 2.02+/-0.86 and 4.09+/-1.09 grafts per patient were completed in the beating and cardiopulmonary bypass groups, respectively. Operation time was shorter in the beating heart group (169+/-41 vs. 215+/-59 minutes). Similarly, the need for transfusion was significantly smaller in the beating heart group (beating heart operations, 10%; cardiopulmonary bypass, 28%; p<0.001). CONCLUSIONS: In majority of patients, off-pump coronary artery revascularization is an acceptable alternative to conventional operations with good results.

[Myocardial revascularization combined with mitral valve surgery in case of ischemic mitral valve insufficiency]. / Miokardo revaskulizacija ir mitralinio voztuvo operacija esant iseminiam mitralinio voztuvo nesandarumui.

BACKGROUND: The aim of the study was to evaluate the possibility of mitral valve surgery in patients with mitral valve insufficiency and short time outcomes following mitral valve correction combined with coronary artery bypass grafting. METHODS: Thirty one combined coronary artery bypass grafting with mitral valve correction procedures were performed from 1994 to 2002. Mean age was 65.4+/-6 years. 29 pts were in NYHA IV-V functional class. 84% of pts were with impaired left ventricle function. RESULTS: Mitral valve replacement was performed in 16 patients and correction of mitral valve in 15 cases. Mitral valve replacement was performed in cases with significant lesions of the papillary muscles. The mean of 3.05+/-1.8 graft per patient was performed and total coronary revascularisation for 84% of patients. Hospital mortality was 32.2% (10/31). CONCLUSION: In cases of coronary artery bypass grafting for patients with moderate and significant mitral insufficiency after myocardial infarction, mitral valve correction must be performed.