[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.

[Surgical revascularization in patients with acute coronary syndromes: early outcome]. / Chirurgiczna rewaskularyzacja serca u chorych z ostrymi zespolami wiencowymi: wyniki wczesne.

OBJECTIVE: Between January 1 2001 and June 30 2002, 2204 CABG procedures were performed in our institution. 110 patients underwent urgency CABG within six hours of ACS. We analyzed their short-term results. METHODS: 55 patients underwent CABG for UAP, 31 for STEMI and 24 for NSTEMI. In the control group, 55 patients underwent elective revascularization. Preoperative, intraoperative, and postoperative data were analyzed. RESULTS: Hospital mortality was 12.9%, 8.3%, 7.3% and 1.9% for groups with STEMI, NSTEMI, UAP and stable angina, respectively. Independent predictors of early mortality, in order of decreasing importance, were: preoperative extracardiac arteriopathy (p = 0.0002), cardiac arrest befor CABG (p = 0.0003), preoperative shock (p = 0.003), STEMI (p = 0.03) and LVEF < 40% (p = 0.03). CONCLUSIONS: CABG procedures should be a standard part of ACS treatment. Patients with UAP and NSTEMI can be safely operated during the early course of ACS. CABG can be performed with acceptable early-term risk in patients with STEMI and hemodynamic instability.