Single versus multiple arterial coronary artery bypass grafting in men and women: results from Polish National Registry of Cardiac Surgery Procedures.

BACKGROUND: The objective of this multicenter study aimed to investigate the impact of sex on long-term survival among patients with multivessel coronary artery disease undergoing coronary artery bypass grafting (CABG) using multiple arterial grafting (MAG) or a single artery with saphenous vein grafts. MATERIALS AND METHODS: Data were obtained from the Polish National Registry of Cardiac Surgery Procedures database. This study included 81 136 patients who underwent CABG for multivessel disease between January 2012 and December 2020 (22.9 were women and 77.1% were men). MAG was performed in 8.3 and 11.7% of female and male patients, respectively. A 1:1 propensity score (PS)-matching was performed. Long-term mortality was compared between matched groups of men and women. Subgroup analyses of patients aged <70 and ≥70 years, with an ejection fraction (EF) >40% and ≤40%, and with and without diabetes, obesity, peripheral artery disease (PAD), or chronic lung disease (CLD) were performed separately in women and men. RESULTS: MAG was associated with lower long-term mortality than saphenous vein grafts in 1528 PS-matched female pairs [hazard ratio (HR): 0.74; 95% CI: 0.59-0.92; P =0.007) and 7283 PS-matched male pairs (HR: 0.80; 95% CI: 0.72-0.88; P <0.001). Subgroup analyses confirmed the results among female patients aged <70 years, with diabetes and EF >40%, and without PAD or CLD, and of male patients aged <70 and ≥70 years; with EF >40%; with or without diabetes, obesity, or PAD; and without CLD. CONCLUSIONS: In patients undergoing CABG, MAG was associated with significantly improved survival in both sexes. The long-term benefits of MAG observed across subgroups of men and women support the consideration of a multiarterial revascularization strategy for a broader spectrum of patients.

Comparison of Femoral Component Rotation between Robotic-Assisted vs. Soft-Tissue Tensor Total Knee Arthroplasty with Anatomic Implants.

Background and Objectives: Total knee arthroplasty (TKA) is the most effective treatment method for end-stage osteoarthritis. One of the most important aspects of this surgery is adequate implant positioning, as it guarantees the desired outcome of restoring limb biomechanics. Surgical technique is being continuously improved along with hardware development. There are two novel devices designed to help establish proper femoral component rotation: soft-tissue tensor and robotic-assisted TKA (RATKA). This study compared the femoral component rotation achieved with the use of three methods: RATKA, soft tissue tensioner and the conventional measured-resection technique, all of them utilizing anatomical design prosthesis components. Materials and Methods: A total of 139 patients diagnosed with end-stage osteoarthritis underwent total knee arthroplasty between December 2020 and June 2021. After the surgery, they were divided into three groups depending on procedure technique and implant type: Persona (Zimmer Biomet) + Fuzion Balancer, RATKA + Journey II BCS or conventional TKA + Persona/Journey. Postoperatively, a computed tomography examination was performed in order to measure femoral component rotation. All three groups were compared independently during statistical analysis. Fisher's exact, Kruskal-Wallis and Dwass-Steel-Crichtlow-Fligner tests were used for particular calculations. Results: Statistically significant differences in femoral component rotation between groups were noticed. However, in terms of values other than 0° in external rotation, no significant variance was revealed. Conclusions: Additional total knee arthroplasty instruments seem to improve the outcomes of the surgery, providing better component positioning than in the conventional measured-resection technique based only on bone landmarks.

Platelet reactivity expressed as a novel platelet reactivity score is associated with higher inflammatory state after coronary artery bypass grafting.

Introduction: Despite therapy, patients operated using a cardiopulmonary bypass demonstrate increased platelet aggregation, which rebounds to above preoperative levels. The aim of the study was to test the interaction between platelet reactivity/activation and selected inflammatory markers in the post-operative period. Material and methods: In total, 103 patients with non-ST elevation acute coronary syndrome (NSTE-ACS) who were not eligible for percutaneous coronary interventions (PCI), and required urgent revascularization, were included. Platelet reactivity was measured using the PFA-100 platelet analyser, multiple electrode aggregometry, and was expressed as a novel platelet reactivity score (PRS). Patients were divided using their PRS scores into high platelet relativity or low platelet reactivity subgroups (HPR or LPR). Platelet basal activation was measured using immunoassays for soluble P-selectin and soluble CD40L. We measured high-sensitivity C-reactive protein (CRP), and used immunoassays for tumour necrosis factor α (TNF-α) and interleukin 6 (IL-6) as inflammation markers. Results: Significant differences between HPR and LPR groups were found for CRP (mg/l): 81.5 vs. 44.6, p < 0.02; and TNF-α (pg/l): 3.51 vs. 2.37, p < 0.02. A significant association was found between CRP, TNF-α, IL-6 and platelet reactivity (platelet reactivity score). Cohen's k showed: CRP = 0.49, p < 0.0001, TNF-α = 0.37, p < 0.002. Perioperative myocardial infarction and rhythm disturbances occurred more frequently in the high platelet reactivity group: 7 (16.3%) vs. 2 (3.3%), p < 0.04, and 9 (20.9%) vs. 4 (6.7%), p < 0.04, respectively. Conclusions: Inflammatory parameters CRP and TNF-α are strongly associated with platelet reactivity (expressed as PRS) in cardiopulmonary bypass graft patients. Platelet hyperreactivity in the early post-operative period combined with a systemic inflammatory state correlates with a higher risk of post-operative rhythm disturbances and myocardial infarction.

Continuous glycemia monitoring in perioperative period in patients undergoing total knee or hip arthroplasty: A protocol for a prospective observational study.

In every surgical subspecialty surgical site infection (SSI) or implant infections, although occur seldom, pose a threat to patients' health. Risk factors of such states is diabetes mellitus (DM), considered one of the most widespread health-related problems of the 21st century. Orthopedists perform big joint replacements that usually concern older adults and therefore often deal with patients suffering from comorbidities. DM is frequently one of them and can furthermore often remain underdiagnosed. The other risk for complication is a rapid beginning of the rehabilitation which starts on the day following the surgery. To eliminate the debilitating impact of DM and hypoglycemia on surgical patients, we aim to investigate the relationship between the glycemia values and the postoperative outcomes in certain periods of time in patients undergoing orthopedic surgeries. Participants meeting inclusion criteria will have inserted a glycemia measuring device (Dexcom G5, Inc., San Diego, CA) in the periods of time. First time it will take place 14 days prior to the surgery and right after the surgery for the second time for the period of another 14 days. All patients will undergo standard total knee arthroplasty or total hip arthroplasty procedures. Patients will be assessed preoperatively and 14 days, 1, 3, 6, 12, and 24 months postoperatively. The assessment of the joint condition will consist of: patient-reported outcomes (The Knee injury and Osteoarthritis Outcome Score, Harris Hip Score, the Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]); assessment of potential SSI and cardiovascular complications (the Finnish Diabetes Risk Score [FINDRISC], the Systematic Coronary Risk Evaluation [SCORE]) and the clinical examination. To investigate the influence of orthopedic surgery (anesthesia) on glycemia and the significance and safety of early patients mobilization after the big joints surgeries. To investigate changes of glycemia in patients with normal glycemia metabolism, potentially protecting them from hypoglycemia during hospital stay and increasing their awareness of potential development of DM in the future. Additionally, this study will correlate perioperative glycemic levels with risk of cardiovascular events in one year follow-up, and its influence on SSI and implant complications.

High Residual Gradient Following a Self-Expandable Transcatheter Aortic Valve-in-Valve Implantation — Risk Factor Analysis, Outcomes, and Survival

Abstract Introduction: Transcatheter aortic valve-in-valve implantation (TAVI-ViV) can be associated with unfavorable hemodynamic outcomes. This study aimed to estimate the prevalence, identify the risk factors, and evaluate the outcomes and survival of patients with high residual gradients after TAVI-ViV. Methods: A total of 85 patients were included in the study. The cohort was divided into group A, with postprocedural mean pressure gradient (PG) ≥ 20 mmHg, and group B, with mean PG < 20 mmHg. Results: Postprocedural PG ≥ 20 mmHg was observed in 24.7% of the patients. In a univariate analysis, preoperative gradient, pre-existing patient-prosthesis mismatch (PPM), deep valve implantation, small degenerated valves, and an older generation of transcatheter aortic valves were found to be risk factors for high residual gradient. Multivariate analysis showed that preexisting maxPG > 60 mmHg, implantation level of 4 mm below neo-annulus, and degenerated valve size ≤ 23 mm were independent predictors of high residual gradient. There were no differences in early morbidity (myocardial infarction, pacemaker implantation, stroke, acute renal insufficiency) between groups. Kaplan-Meier estimated that the survival rate was comparable at one and five years regardless of postoperative gradient. Survivors with high residual mean gradient were significantly affected by a high New York Heart Association (NYHA) class. Conclusion: High residual transvalvular gradient after TAVI-ViV is not rare, but it does not significantly affect mortality. High residual mean gradient has a negative impact on NYHA functional class improvement after the procedure. High preoperative gradient, implantation level, and small failed bioprosthesis may predispose to increased residual gradient.

Comparison of Biomechanical Gait Parameters and Patient-Reported Outcome in Patients After Total Knee Arthroplasty With the Use of Fixed-Bearing Medial Pivot and Multi-radius Design Implants-Retrospective Matched-Cohort Study.

BACKGROUND: Total knee arthroplasty (TKA) is considered to be highly successful in treatment of end-stage osteoarthritis. There are multiple implant designs available on the market, and it is difficult to point which one is the best. The aim of this study was to compare the clinical and functional outcomes and gait pattern after TKA with the use of fixed-bearing medial pivot (K-Mod) vs multi-radius design (NexGen) implants and to compare them to norms for healthy patients with no osteoarthritis or arthroplasty procedure in anamnesis. METHODS: A group of 30 patients who received the medial pivot (MP) TKA and 33 patients who received the posterior-stabilized (PS) TKA between May and August of 2018 were included. All surgeries were performed in the level III academic hospital by a single surgeon. Every patient was asked to fulfill the The Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire preoperatively and 2 years postoperatively. Standard X-ray, biomechanical gait analysis using a motion capture system, and statistical analysis were performed at 2 years postoperatively. RESULTS: A total of 28 patients from either MP cohort (93%) or PS (85%) matched-control cohort completed the whole assessment at the final follow-up. There were statistically significant differences in a few gait parameters such as shorter mean step length both in operated and healthy limb, lower mean gait velocity, and lower mean walking cadence than the norm in both MP and PS groups. As to the WOMAC score, there was statistically significant improvement in both groups comparing preoperative and postoperative outcomes. Nevertheless, in the MP group, there was a significantly higher score, indicating worse outcomes, in the stiffness part of the WOMAC score than in the PS group. No significant differences were found between groups during radiological evaluation. CONCLUSIONS: There were satisfying and promising clinical, radiographic, and patient-reported outcomes in both MP and PS groups with very little difference in relation to norm values. However, both implants failed in fully restoring gait patterns similar to the healthy limb of the same patient.

High Residual Gradient Following a Self-Expandable Transcatheter Aortic Valve-in-Valve Implantation - Risk Factor Analysis, Outcomes, and Survival.

INTRODUCTION: Transcatheter aortic valve-in-valve implantation (TAVI-ViV) can be associated with unfavorable hemodynamic outcomes. This study aimed to estimate the prevalence, identify the risk factors, and evaluate the outcomes and survival of patients with high residual gradients after TAVI-ViV. METHODS: A total of 85 patients were included in the study. The cohort was divided into group A, with postprocedural mean pressure gradient (PG) ≥ 20 mmHg, and group B, with mean PG < 20 mmHg. RESULTS: Postprocedural PG ≥ 20 mmHg was observed in 24.7% of the patients. In a univariate analysis, preoperative gradient, pre-existing patient-prosthesis mismatch (PPM), deep valve implantation, small degenerated valves, and an older generation of transcatheter aortic valves were found to be risk factors for high residual gradient. Multivariate analysis showed that preexisting maxPG > 60 mmHg, implantation level of 4 mm below neo-annulus, and degenerated valve size ≤ 23 mm were independent predictors of high residual gradient. There were no differences in early morbidity (myocardial infarction, pacemaker implantation, stroke, acute renal insufficiency) between groups. Kaplan-Meier estimated that the survival rate was comparable at one and five years regardless of postoperative gradient. Survivors with high residual mean gradient were significantly affected by a high New York Heart Association (NYHA) class. CONCLUSION: High residual transvalvular gradient after TAVI-ViV is not rare, but it does not significantly affect mortality. High residual mean gradient has a negative impact on NYHA functional class improvement after the procedure. High preoperative gradient, implantation level, and small failed bioprosthesis may predispose to increased residual gradient.

Analysis of biomechanical gait parameters in patients after total hip replacement operated via anterolateral approach depending on size of the femoral head implant: retrospective matched-cohort study.

INTRODUCTION: Total hip replacement (THR) is considered one of the most effective medical procedures in treatment of osteoarthritis. Since its introduction, there has been a worldwide debate over proper implant selection in terms of size, bearing type and shape. Following study was designed to assess the importance of femoral head size in long-term follow-up. MATERIALS AND METHODS: A cohort of 30 patients with primary end stage osteoarthritis who underwent total hip replacement was analysed retrospectively. A homogenous group was chosen with no major differences in BMI. Patients' gait parameters were measured in a biomechanics laboratory using the 3D BTS Smart system. WOMAC and VAS questionnaires were used to assess patient reported outcome. RESULTS: The subgroup with larger implant head size had several outcomes significantly superior to the subgroup with standard head size and non-inferior to healthy hips. Following variables were measured during this study: time of support phase, time of swing phase, double support time, walking hip extension angle. CONCLUSIONS: Use of larger sized femoral heads during THR gives better results in terms of gait pattern. Since restoring the gait pattern is one of the aspects of rehabilitation and returning to daily activities it seems to be an important observation.

Does the anatomic design of total knee prosthesis allow for a better component fit than its nonanatomic predecessor? A matched cohort Study.

BACKGROUND: Total knee arthroplasty (TKA) is considered the most efficient treatment of end-stage osteoarthritis. There is an ongoing debate about proper implant designs and articulation types. One of the considered causes of unsatisfactory outcome and patients' dissatisfaction is femoral or tibial component overhanging, which can lead to chronic knee pain and restricted motion. The aim of this study is to compare radiological outcomes of TKA using an anatomic PERSONA Posterior-Stabilized (PS) knee design with its nonanatomic predecessor, the NexGen LPS. METHODS: A group of 39 patients who received the PERSONA PS system and 33 patients who received the NexGen LPS was included. PERSONA patients were matched to NexGen patients using a 0.1 propensity score threshold with priority given to exact matches. Anteroposterior, lateral, and long-leg radiographs were taken preoperatively and at 6 weeks postoperatively to perform radiological and statistical analysis. RESULTS: The PERSONA subgroup had statistically higher posterior condylar offset. There is no statistically significant difference in posterior condylar offset ratio. There were less cases of femoral notching, femoral overhang, and placing tibial baseplate in the medial overhang in the PERSONA PS subgroup than in the NexGen subgroup (each statistically significant). Occurrence of tibial underhang was not statistically significant. CONCLUSION: Radiological assessment in short-term follow-up showed excellent results for PERSONA knee design with better fit to native femur and tibia. In comparison to its predecessor, it also spares more bone tissue. As the aforementioned parameters are risk factors of lesser clinical outcomes, the PERSONA design gives high hopes for improvement of TKA satisfaction rate.

Spinopelvic Alignment and Its Use in Total Hip Replacement Preoperative Planning-Decision Making Guide and Literature Review.

Worldwide tendencies to perform large numbers of total hip arthroplasties in the treatment of osteoarthritis are observable over a long period of time. Every year, there is an observable increase in the number of these procedures performed. The outcomes are good but not ideal, especially in groups of patients with spine problems. In recent years, a growing interest in this field may be observed, since spinopelvic alignment seems to have a significant impact on total hip replacement (THR) results. The aim of this study is to describe relations between spine and pelvic alignment and provide practical information about its impact on total hip replacement. The authors performed a literature review based on PubMed, Embase, and Medline and provide practical guidelines based on them and their own experience.

The Direct Anterior Approach to Primary Total Hip Replacement: Radiological Analysis in Comparison to Other Approaches.

Total hip arthroplasty (THA) is currently considered the most effective treatment for end-stage hip osteoarthritis (OA). The surgery can be performed via a number of different approaches, including direct anterior (DAA; Smith-Petersen; Hueter), anterolateral (ALA; Watson-Jones), direct lateral (LA; Bauer), posterior (PA; Kocher-Langenbeck), and posterolateral (PLA). There is still a dispute over the optimal technique. The aim of this systematic review was to assess how different surgical approaches toward a THA influence the prosthesis elements' positioning. We conducted a literature search of Scopus, ScienceDirect, PubMed, Embase, and The Cochrane Library. We evaluated studies in terms of the first author's name, country, publication year, type of surgical approach being compared to the direct anterior approach, any significant differences at baseline, sample size, and radiographic analysis. A subanalysis of each approach in comparison to the DAA revealed differences in terms of all analyzed implant positioning radiographic parameters. There is still an insufficient number of randomized controlled studies that include radiological analyses comparing THRs (total hip replacements) performed using DAA with other approaches. Implant placement is a crucial step during a THR and surgeons must be aware that the approach they use might impact their judgment on angles and spaces inside the joint and thus alter the implant positioning.

Peripartum Pubic Symphysis Diastasis-Practical Guidelines.

Optimal development of a fetus is made possible due to a lot of adaptive changes in the woman's body. Some of the most important modifications occur in the musculoskeletal system. At the time of childbirth, natural widening of the pubic symphysis and the sacroiliac joints occur. Those changes are often reversible after childbirth. Peripartum pubic symphysis separation is a relatively rare disease and there is no homogeneous approach to treatment. The paper presents the current standards of diagnosis and treatment of pubic diastasis based on orthopedic and gynecological indications.

Heterotopic ossification and clinical results after total hip arthroplasty using the anterior minimally invasive and anterolateral approaches.

INTRODUCTION: Total hip arthroplasty (THA) is considered the gold standard in the treatment of advanced osteoarthritis of the hip. The aim of this study was to compare the incidence of heterotopic ossification (HO), the quality of life and the function in two groups of patients who underwent total hip arthroplasty (THA), performed using the anterior minimally invasive (MIS) and the anterolateral approaches. MATERIAL AND METHODS: Retrospective analysis of 597 patients who underwent THA in 2009-2013 was performed. In all 597 cohort data on medical history were retrieved. HO occurrence was recorded for 331 patients and was evaluated based on Brooker's scale in the X-ray scan. Functional and quality of life scores were obtained for 238 patients. The following scales were used for the survey: Harris Hip Score, Western Ontario and McMaster Universities Osteoarthritis Index, Visual Analogue Scale, and Hip and Knee Arthroplasty Satisfaction Scale. RESULTS: Patients operated on from the MIS approach had statistically significantly (p < 0.05) better results with all the clinical scales used, except the Visual Analogue Scale (p > 0.05). HO was slightly more common after the MIS approach (52.5%) compared to the anterolateral approach (49.76%), though the difference was not statistically significant (p > 0.05). CONCLUSIONS: The MIS approach was associated with better clinical and functional outcomes. In the aspect of HO, we were not able to show the superiority of the MIS approach in terms of incidence.

Femoral transcatheter valve-in-valve implantation as alternative strategy for failed aortic bioprostheses: A single-centre experience with long-term follow-up.

BACKGROUND: Surgical reoperation is still a standard procedure performed for degenerated aortic bioprostheses. On the other hand femoral minimally invasive valve-in-valve implantation (femTAVI-VIV) is an intriguing alternative. This clinical study was design to compare the early and late outcomes of redo-surgery (Redo-AVR) and femTAVI-VIV procedures for failed aortic bioprostheses. METHODS: We retrospectively reviewed 108 patients with degenerated aortic bioprostheses qualified for isolated Redo-AVR (n = 40) or femTAVI-VIV (n = 68) between 2003 and 2018. Both cohorts were divided into intermediate and high-risk groups according to the EuroSCORE II (4-9% and >9%). Propensity score matching selected 20 pairs in Intermediate-risk group and 10 pairs in High-risk group for the final comparison. RESULTS: Patients qualified for femTAVI-VIV were older (79.2 vs 72.9 years, p < 0.001) and at higher risk (EuroSCORE II 10.9 vs 7.8%, p = 0.005) than Redo-AVR subjects. Overall survival in femTAVI-VIV and Redo-AVR was comparable at 30-days, 1- and 5-years, respectively (92.6% vs 92.5%, 85.2% vs 85.0% and 62.9% vs 72.5%, p = 0.287). After PSM no differences in mortality, myocardial infarction, pacemaker implantation, stroke or acute renal insufficiency were found. Transcatheter procedure was associated with shorter hospital stay, lower rate of blood products transfusions and higher incidence of mild paravalvular leaks. CONCLUSION: Our study supports the opinion that transcatheter approach for treatment of patients with degenerated aortic bioprostheses is a safe alternative to Redo-AVR procedures particularly for those at high-risk.

The Use of Type I Collagen Cross-Linked C-Telopeptide (CTX-1) as a Biomarker Associated with the Formation of Periprosthetic Ossifications Following Total Hip Joint Arthroplasty.

The aim of this study was to determine the co-occurrence of heterotopic ossifications (HO) and elevated bone biomarkers level (urine type I collagen cross-linked C-telopeptide - CTX-1, serum alkaline phosphatase - ALP) and assess the effectiveness of pharmacological prophylaxis of HO. The study group consisted of (N=54) patients qualified for total hip arthroplasty. In N=19 (35%) patients new HO were formed (48th week vs to baseline). On baseline, the mean CTX-1 value in the HO (-) patients was 8.60+/-5.37 ug/mmol vs HO (+) 11.73+/-6.02 ug/mmol (p<0,05). On the 5th day after the surgery, the mean value in HO (-) patients was 8.45+/-4.04 ug/mmol vs HO (+)14.46+/- 5.91 ug/mmol (p<0,05). The mean increase in CTX-1 levels in HO (+) patients' vs HO (-) compared to the initial value was 21% vs 47%. Correlation between CTX-1 concentration on the 5th day and the appearance of new ossifications (r=0.48, p<0.05) was demonstrated. In group covered by prophylaxis diclofenac 150 mg for 6 weeks, HO assessment in Brooker's scale was on average 0.78 points lower than in the group without prophylaxis and 0.89 points lower than in the group without prophylaxis and no risk factors of HO (p<0,05). The study also reported a correlation between the corrected ALP concentration in the 12th week and HO (r=0.59, p<0.05).

Thromboembolic complications after an ankle joint open fracture in a patient with a history of deep vein thrombosis in the lower limbs.

A 55-year-old patient was admitted to the Department of Orthopedics due to an open fracture in the right ankle joint. On the seventh day of hospitalization the patient experienced a transient ischemic attack. During the next day, dyspnea, chest pain and a 'rider' type pulmonary embolism in the pulmonary trunk occluding both pulmonary arteries and its branches were diagnosed. The patient was transferred to the Department of Cardiac Surgery. He underwent pulmonary embolectomy for massive pulmonary, right and left atrial embolism, and left ventricular embolism. ASD II was closed during this procedure. Ultrasonography with Doppler was performed 6 days after the surgery and revealed deep vein thrombosis, so the patient was transferred to the Department of Vascular Surgery for temporary inferior vena cava filter placement at the time of orthopedic surgery. The next day after implantation of the filter, the lower limb was operated on, and 14 days after orthopedic surgery, the vena cava filter was removed.

Forearm and Hand Function after Radial Artery Harvest for Coronary Artery Bypass Grafting: Subjective Patients' Assessment.

BACKGROUND: As arterial myocardial revascularization is proved to provide great results, radial artery use as a graft and its consequences remain an important issue. OBJECTIVES: The aim of the study was to evaluate how patients assess their forearm and hand function after radial artery harvest for coronary artery bypass grafting (CABG). METHODS: 50 patients (mean age 52.2 ± 7.4 years) who underwent CABG at least 6 months (median follow up 11.75 months) earlier filled in a questionnaire concerning hand and forearm efficiency and discomfort. RESULTS: The global efficiency of the operated upper extremity was scored mean 8.87 ± 1.26 points on a 10-point scale and it was worse in patients who noticed at least one sort of disorder than in patients with no problems (8.6 ± 1.4 versus 9.4 ± 0.7 points; P = .04). Paresthesias were the most often reported disorders; 21 patients felt some tingling and/or numbness, but in only 14 (28%) could the symptoms be considered as related to the operation. 20 patients (40%) declared that they felt some scar-related discomfort. Reduced grip strength and excessive hand fatigue were reported by 20% and 10% of patients, respectively. None of those interviewed answered that symptoms reported affected his or her life activity on any level. CONCLUSION: The hand and forearm efficiency after radial artery harvest for CABG was highly evaluated by the majority of patients. Despite the fact that many patients reported some surgery-related problems, they did not notice extremity dysfunction that could limit their life activity.

Combined mitral valve replacement associated with the Bentall procedure, diaphragmatic hernia repair and reconstruction of the pectus excavatum in a 26-year-old patient with Marfan syndrome.

A 26-year-old man with Marfan syndrome was admitted as an emergency patient with ascending aorta aneurysm, severe mitral and aortic regurgitation, diaphragmatic hernia and pectus excavatum. After completion of diagnostics a combined surgical procedure was performed.

[Incidence of factor VII and C3 in vascular anastomosis]. / Wystepowanie czynnika VII krzepniecia krwi oraz czynnika C3 ukladu dopelniacza w zespoleniach naczyniowych.

In order to study pathogenesis of vascular prosthesis healing process the following experiment was designed. 16 dogs underwent implantation of unilateral straight aorto-femoral teflon (PTFE, polytetrafluoroethylene) by-pass. After 6 months all dogs were killed, dissected and vascular prostheses with margin of adjacent aorta and femoral artery were collected for further study. Areas of proximal and distal anastomosis were examined immunohistochemically. Presence of coagulation factor VII, and C3 complement factor were studied. The obtained results were analyzed statistically by means of t-Student test. Factor VII as well C3 were found in areas of both proximal and distal anastomosis. Concentration of all two substances in proximal and distal anastomosis was compared. No statistically valid differences in factor VII concentration in proximal and distal anastomosis were found, whereas amounts of C3 factor as well as degree of extracellular matrix infiltration were markedly higher in distal anastomosis.