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).

Changes in STIM isoforms expression and gender-specific alterations in Orai expression in human heart failure.

Store-operated calcium entry (SOCE) is one of regulatory mechanisms which regulates Ca2+ cycling in the heart. SOCE alterations in pathological conditions contribute to progression of heart failure and cardiac hypertrophy by multiple signaling pathways such as Cn/NFAT and CaMKII/MEF2. Several components mediating SOCE have been identified, such as STIM and Orai. Different isoforms of both Orai and STIM have been detected in animal studies, exhibiting distinct functional properties. This study is focused on the analysis of STIM and Orai isoforms expression in the end-stage human failing myocardium. Left ventricle samples isolated from 43 explanted hearts from patients undergoing heart transplant and from 5 healthy donor hearts were used to determine the mRNA levels of Orai1, Orai2 and Orai3, STIM1, STIM2 and STIM2.1 by qRT-PCR. The expression was further analyzed for connection with gender, related co-morbidities, pathoetiology, clinical data and biochemical parameters. We show that Orai1 expression is decreased by 30 % in failing myocardium, even though we detected no significant changes in expression of Orai2 or Orai3. Interestingly, this decrease in Orai1 was gender-specific and was present only in men, with no change in women. The ratio Orai1/Orai3 was significantly lower in males as well. The novel STIM2.1 isoform was detected both in healthy and failing human myocardium. In the end-stage heart failure, the expression of STIM2.1 was significantly decreased. The lower ratio of STIM2.1/STIM2 in failing hearts indicates a switch from SOCE-inhibiting STIM2.1 isoform to stimulatory STIM2.2. STIM1 mRNA levels were not significantly changed. These observed alterations in Orai and STIM expression were independent of functional heart parameters, clinical or biochemical patient characteristics. These results provide detailed insight into the alterations of SOCE regulation in human failing myocardium. Gender-specific change in Orai1 expression might represent a possible mechanism of cardioprotective effects of estrogens. The switch from STIM2.1 to STIM2.2 indicates an amplification of SOCE and could contribute to the hypertrophy development in the filing heart.

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).

Postpericardiotomy syndrome - post-cardiac injury syndrome.

INTRODUCTION: Postpericardiotomy syndrome is a non specific belated reaction of pericardium, epicardium and pleural cavity after cardiac or pericardial injury. It is considered to be a common complication in cardiosurgery with occurrence of 3 to 30 percent. Most likely, the primary cause is a common immunopathic process. It develops within days or even up to six months after either cardiac or pericardial injury or both. AIM: Echocardiography is the leading method in determination of postpericardiotomy syndrome due to the frequency of occurrence, non- specific clinical symptoms (fever, chest pain, cough, dizziness), inaccurate interpretation of examination methods (ECG, X-ray, laboratory tests). We would like to show how to determine the exactly diagnose, how to treat it and what is prognosis of this illness. RESULTS: We have performed a retrospective analysis of 1344 patients, who underwent cardiac surgery in the year 2009. The incidence of post- cardiac surgery syndrome was 12.4 %. In 2.6 % of the studied cases, surgical intervention was needed due to a cardiac tamponade. Int other cases similar to acute pericarditis, symptomatic treatment in duration of several weeks or months with non-steroid antireumatics, salicylic acid or colchicine is sufficient. Therapeutic options in refractory forms are long term oral corticoids or pericardiectomy. During our follow-up, pericardiectomy was necessary to perform in one patient. CONCLUSION: Postpericardiotomy syndrome, which occurs in early postoperative period, prolongs hospitalisation. In spite of non specific symptoms huge pericardial effusion might be present and can cause cardiac tamponade with haemodynamic failure in later periods. Transthoracic echocardiography is the golden standard in determination of accurate diagnosis (Fig. 6, Ref. 15).

Superposition of quantum and classical rotational motions in Sc2C2@C84 fullerite.

The superposition of the quantum rotational motion (tunneling) of the encapsulated Sc(2)C(2) complex with the classical rotational motion of the surrounding C(84) molecule in a powder crystal of Sc(2)C(2)@C(84) fullerite is investigated by theory. Since the quantum rotor is dragged along by the C(84) molecule, any detection method which couples to the quantum rotor (in casu the C(2) bond of the Sc(2)C(2) complex) also probes the thermally excited classical motion (uniaxial rotational diffusion and stochastic meroaxial jumps) of the surrounding fullerene. The dynamic rotation-rotation response functions in frequency space are obtained as convolutions of quantum and classical dynamic correlation functions. The corresponding Raman scattering laws are derived, and the overall shape of the spectra and the width of the resonance lines are studied as functions of temperature. The results of the theory are confronted with experimental low-frequency Raman spectra on powder crystals of Sc(2)C(2)@C(84) [M. Krause et al., Phys. Rev. Lett. 93, 137403 (2004)]. The agreement of theory with experiment is very satisfactory in a broad temperature range.

Fullerene quantum gyroscope.

We report the observation of quantized rotational states of a diatomic C2 unit in solid endohedral fullerene C(2)Sc(2)@C(84). The rotational transitions induce a periodic line pattern in the low energy Raman spectrum. The rotational constant B and the C-C distance were found to be 1.73 cm(-1) and 0.127 nm, respectively. Density functional calculations revealed an intrinsic rotational barrier of the order of only a few meV for the C2 unit. The Schrödinger equation involving the potential barrier was solved and the Raman tensor matrix elements were calculated, yielding good quantitative agreement with the experiment. To our best knowledge this is the first intrinsic rotational spectrum of a diatomic plane molecular rotor.

Periodic resonance excitation and intertube interaction from quasicontinuous distributed helicities in single-wall carbon nanotubes

Photoselective resonance Raman scattering from laser ablation grown single-wall carbon nanotubes is demonstrated to be consistent with a response from tubes with all geometrically allowed helicities. This information is drawn from an analysis of the resonance scattering by combining ab initio calculations for the mode frequencies with evaluations of the resonance cross sections for isolated tubes. The resonance excitation was found to exhibit an oscillatory behavior. To match the experiments and the calculations, the frequencies obtained from the latter must be up-shifted by 8.5% on the average. This stiffening is ascribed to the tube-tube interaction in the carbon nanotube bundles.

Triple valve surgery with triple aorto-coronary bypass and endarterectomy of the right coronary artery.

This paper presents the case report of a 50-year-old woman with a triple valve lesion of rheumatic origin and ischemic coronary disease. The patient underwent successful simultaneous triple valve surgery; the aortic and mitral valves were replaced by mechanical prostheses, and the tricuspid valve was repaired by annuloplasty, together with three aorto-coronary bypasses and endarterectomy of the right coronary artery. The peri- and postoperative courses were uneventful and the patient was discharged from hospital in good clinical condition 12 days after surgery.

[Endarterectomy of the coronary arteries]. / K problematike endarterektómie koronárnych artérií.

The authors analyze 50 patients with endarterectomy of the coronary arteries during the periods of 1972-1974 and 1988-1990. The results of endarterectomy of the right and left coronary artery provide evidence of its justification in indicated cases whereby contrary to some departments the results of endarterectomy of the left coronary artery are comparable with endarterectomy of the right coronary artery.