Impact of an Interleukin-1 Receptor Antagonist and Erythropoietin on Experimental Myocardial Ischemia/Reperfusion Injury

Background. Revascularization of infarcted myocardium results in release of inflammatory cytokines mediating myocardial reperfusion injury and heart failure. Blockage of inflammatory pathways dampens myocardial injury and reduces infarct size. We compared the impact of the interleukin-1 receptor antagonist Anakinra and erythropoietin on myocardial ischemia/reperfusion injury. In contrast to others, we hypothesized that drug administration prior to reperfusion reduces myocardial damage. Methods and Results. 12–15 week-old Lewis rats were subjected to myocardial ischemia by a 1 hr occlusion of the left anterior descending coronary artery. After 15 min of ischemia, a single shot of Anakinra (2 mg/kg body weight (bw)) or erythropoietin (5000 IE/kg bw) was administered intravenously. In contrast to erythropoietin, Anakinra decreased infarct size (P < 0.05, N = 4/group) and troponin T levels (P < 0.05, N = 4/group). Conclusion. One-time intravenous administration of Anakinra prior to myocardial reperfusion reduces infarct size in experimental ischemia/reperfusion injury. Thus, Anakinra may represent a treatment option in myocardial infarction prior to revascularization

Percutaneous aortic valve replacement: valvuloplasty studies in vitro

Objective: Valvuloplasty of the aortic valve is currently used in selected patients for severe calcified aortic valve disease, but clinical effectiveness is low and complication rate remains high. In this study, the total particle load after valvuloplasty and the embolization risk of calcific debris into the coronary arteries was analyzed in an in vitro model. Methods: Three highly calcified human aortic leaflets have been sutured into a porcine annulus (N=9). Both coronary arteries were separated and each was anastomized to a silicon line, which was drained off into a measuring beaker. Then valvuloplasty was performed (Thyshak II, 20mm, 1.5atm). After removal of the balloon, 100ml of sodium chloride solution irrigated the ascending aorta. After passing through the separated coronary arteries, the solution was filtered (filter size 0.45μm), dried, and the total amount of particles was analyzed microscopically. Results: Nine experiments were analyzed. After valvuloplasty, all hearts showed a median of 18 particles larger than 1mm in the coronary arteries (range 0-307). The amount of particles smaller than 1mm was 6574 (median, range 2207-14200). In five cases, coronary arteries were completely occluded by bulky particles. Conclusion: This study demonstrated a large amount of calcific particles after valvuloplasty with a consequently high risk for coronary embolic events in case of highly calcified aortic valves. In times of valvuloplasty rediscovering as part of transcatheter valve implantation, the risk of embolization should be taken into consideration and filtering techniques have to be develope

Разработка технологии сорбции солей урана с использованием композитных биоматериалов

Исследование сорбции радиоактивных ионов из водных сред с помощью композитного биосорбента, содержащего разные виды плесневых грибов и разработка установки для очистки сточной воды в промышленных условиях. В работе использовали такие плесневые грибы, как Aspergillus niger, Penicillium piniphilium и Mucor. Второй частью композитного биосорбента были наночастицы железа (Fe3O4).The aim of the research work is to analyze the sorption activity of different types of fungi, as a part of the composite biosorbent, and to create the machine to clean waste water in industrial conditions. In the work we used three different types of thebiosorbent – fungi Aspergillus niger, Penicillium piniphilium and Mucor. Nanoparticles of iron oxide (Fe3O4) were a second part of this composite biosorbent

Cardiac surgery with crystalloid cardioplegia: Improved functional recovery due to molecular adaptations in adult rat hearts

Background: The effect of aging on functional recovery after a period of crystalloid cardioplegic arrest is still a matter of debate. We hypothesized that age-dependent differences in the polyamine metabolism may contribute to such differences. Methods: Hearts from juvenile and adult Wistar rats were placed in a perfused beating heart model and given Bretschneider's cardioplegia for an ischemia period of 60 min. During reperfusion, recovery of contractile function and coronary blood flow were measured for 90 min. In addition, adult hearts received putrescine to bypass polyamine metabolism during the 1st min of reperfusion. In comparison, the effect of putrescine was analyzed from hearts reperfused after 45-min flow arrest for 90 min. The rate-limiting enzyme of the polyamine metabolism, ornithine decarboxylase (ODC), the proapoptotic enzyme bax, and the relation between SR-calcium-ATPase (SERCA2a) and a natrium-calcium-exchanger enzyme were determined on mRNA-level through real-time polymerase chain reaction. Results: Adult hearts had lower basal performance and lower SERCA mRNA expression compared to juvenile hearts. However, after a 60-min aortic clamping period, recovery of left ventricular developed pressure (105.6 ± 39.7% of baseline) in the adult group was better than in the young group (61.3 ± 34.1% of baseline). ODC mRNA was significantly (P = 0.04228) lower in adult hearts (0.60 ± 0.09-fold vs. juvenile rats). Similar, bax mRNA was significantly (P = 0.01662) lower in adult hearts (0.22 ± 0.03-fold vs. juvenile rats). Addition of putrescine to adult hearts during reperfusion attenuated a better outcome of these hearts suggesting a detrimental effect of polyamine metabolism after cardioplegic arrest. In contrast, putrescine improved recovery in postischemic hearts without exposure to cardioplegic solution. Conclusion: Adult rat hearts tolerate cardioplegia-mitigated ischemia better than juvenile hearts because they express less ODC during resubstitution of normal calcium levels

Artykuł oryginalnyCzy &#8222;niedopasowanie pacjent-proteza&#8221; wpływa na wyniki operacji jednoczesnej wymiany zastawki aortalnej i pomostowania aortalno-wieńcowego?

Background: Combined aortic valve replacement and coronary revascularisation is becoming more frequent. Patient-prosthesis mismatch (PPM) as an additional risk factor may potentially affect the early and late outcome. Aim: To evaluate the impact of PPM on early and mid-term clinical results including quality of life in patients undergoing combined surgical treatment of coronary artery disease and aortic valve defects. Methods: Medical records of 309 consecutive patients referred for combined surgery were reviewed. Patients were divided into three groups according to the presence of moderate or severe PPM (defined by aortic valve effective orifice area index in the range 0.85-0.65 cm2/m2 and smaller than 0.65 cm2/m2, respectively) or absence of PPM. The demographic and perioperative data, and early and late survival, as well as quality of life (SF-36) were analysed. Results: The presence of severe PPM was found in 51 (16.5%) patients, whereas moderate PPM &#8211; in 153 (49.5%) patients. Patients from both PPM groups were significantly older than those without PPM. Subjects with severe PPM had higher weight and body mass index. They frequently had dyslipidaemia and both PPM groups received a biological valve more often than patients without PPM (94.1 and 77.1 vs. 19.1%, p < 0.0001). There was no significant difference between all groups regarding early or late mortality. Advanced age, renal insufficiency and arrhythmia were predictors of early death. Late survival was determined only by number of postoperative complications in a Cox regression model. There was no difference in any components of the SF-36 survey between all groups. Conclusions: PPM is a frequent phenomenon in older patients requiring aortic valve replacement and revascularisation. Severe PPM occurs rarely, predominantly in obese patients. However, its presence does not affect early and late survival or quality of life.Wstęp: Konieczność wykonania zabiegu wymiany zastawki aortalnej połączonego z jednoczesną rewaskularyzacją wieńcową jest zjawiskiem występującym coraz częściej we współczesnej populacji europejskiej, obciążonej wieloma chorobami dodatkowymi. &#8222;Niedopasowanie pacjent-proteza&#8221; (ang. patient-prosthesis mismatch, PPM) w takiej sytuacji może być dodatkowym czynnikiem ryzyka wpływającym niekorzystnie na wczesne i późne wyniki leczenia. Cel: Retrospektywna ocena wpływu PPM na wczesne i średnioterminowe wyniki kliniczne oraz na jakość życia (QoL) u chorych poddanych złożonemu zabiegowi na naczyniach wieńcowych oraz zastawce aortalnej. Metody: Do badania włączono 309 kolejnych pacjentów leczonych z powodu choroby wieńcowej oraz wady zastawki aortalnej. Przeanalizowano ich dokumentację medyczną. Chorzy zostali podzieleni na 3 grupy w zależności od braku lub obecności umiarkowanego lub ciężkiego PPM (zdefiniowanego poprzez wskaźnik efektywnej powierzchni ujścia zastawki aortalnej w granicach 0,85&#8211; &#8211;0,65 cm2/m2 i < 0,65 cm2/m2). Analizowano dane demograficzne, okołooperacyjne, a także wczesne i późne przeżycie oraz QoL (określoną za pomocą formularza SF-36). Wyniki: Obecność ciężkiego PPM obserwowano u 51 (16,5%) chorych, umiarkowanego u 153 (49,5%) chorych. Pacjenci z obydwu grup PPM byli znacząco starsi. Chorzy z ciężkim PPM charakteryzowali się większą masą ciała oraz wyższym indeksem masy ciała, częściej stwierdzano u nich dyslipidemię. U chorych z obydwu grup PPM znacznie częściej implantowano zastawki biologiczne w porównaniu z pozostałymi chorymi (94,1 i 77,1 vs 19,1%, p < 0,0001). Nie obserwowano istotnych statystycznie różnic między grupami we wczesnej i późnej śmiertelności. Zaawansowany wiek, niewydolność nerek oraz zaburzenia rytmu były czynnikami ryzyka wczesnej śmiertelności. Przeżycie późne było zdeterminowane tylko przez liczbę komplikacji pooperacyjnych (model regresji Coksa). Nie obserwowano istotnych statystycznie różnic między grupami w zakresie wszystkich komponentów oceny SF-36. Wnioski: &#8222;Niedopasowanie pacjent-proteza&#8221; jest częstym zjawiskiem wśród starszych chorych wymagających wymiany zastawki aortalnej połączonej z jednoczesnym pomostowaniem aortalno-wieńcowym. Ciężkie PPM pojawia się rzadko i dotyczy chorych otyłych. Jego obecność nie wpływa jednak znacząco na wczesne i późne przeżycie oraz nie wyklucza zadowalającej QoL

Percutaneous aortic valve replacement: valvuloplasty studies in vitro

Valvuloplasty of the aortic valve is currently used in selected patients for severe calcified aortic valve disease, but clinical effectiveness is low and complication rate remains high. In this study, the total particle load after valvuloplasty and the embolization risk of calcific debris into the coronary arteries was analyzed in an in vitro model

Coronary Artery Bypass Grafting in Patients with Acute Myocardial Infarction and Cardiogenic Shock

Objective: Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) remains associated with a high rate of mortality and disabling morbidity. Coronary artery bypass grafting (CABG) is seldom considered in this setting due to the fear of peri-operative complications. Here, we analysed the outcome of CS patients undergoing CABG within 48 hours after diagnosed with AMI. Methods: A single-center, retrospective data analysis was performed in 220 AMI patients with CS that underwent CABG within 48 hours between 01/2001 and 01/2018. Results: 141 patients were diagnosed with ST-elevation myocardial infarction (STEMI), 79 with non-STEMI (NSTEMI). Median age was 67 (60; 72) for STEMI, and 68 (60.8; 75.0) years for NSTEMI patients (p = 0.190). 52.5% of STEMI patients and 39.2% of NSTEMI patients had suffered from cardiac arrest (CA) pre-operatively (p = 0.049). Coronary 3-vessel disease was present in most patients (78.0% STEMI vs 83.5% NSTEMI; p = 0.381). Percutaneous coronary interventions (PCI) were performed in 32.6% STEMI and 27.8% NSTEMI patients (p = 0.543) prior to surgery. Time from diagnosis to surgery was shorter in STEMI patients (3.92 (2.67; 5.98) vs 7.50 (4.78; 16.74) hours; p < 0.001). A complete revascularization was achieved in 82.3% of STEMI and 73.4% of NSTEMI cases (p = 0.116). Post-operative low cardiac output occurred in 14.2% of STEMI vs 8.9% of NSTEMI patients (p = 0.289). The rate of cerebrovascular injury–including hypoxic brain damage was 12.1% for STEMI and 10.1% among NSTEMI patients. (p = 0.825). 30-day mortality was 32.6% after STEMI vs 31.6% in NSTEMI cases (p = 0.285). Conclusions: In contrast to the discouraging data concerning the role of PCI in AMI patients with CS and complex coronary artery disease, CABG may represent a treatment option worth considering

Right ventricular outflow tract reconstruction with the Labcor® stentless valved pulmonary conduit

OBJECTIVES The right ventricular outflow tract reconstruction is a common necessity in congenital cardiac surgery. As homograft availability is limited, alternatives need to be evaluated. The Labcor® conduit consists of a porcine tricomposite valve assembled inside a bovine pericardium tube. This study presents intermediate-term results for its utilization for right ventricular outflow tract reconstruction. METHODS Labcor conduits were implanted in 53 patients (February 2009-July 2016). We analysed perioperative data, freedom from conduit failure and risk factors for conduit dysfunction. RESULTS The most common diagnosis was Tetralogy of Fallot (n = 20, 37.7%). The median age at surgery was 10.0 [interquartile range (IQR) 4.9-14.3] years. Pulmonary artery plasty (n = 37, 69.8%) and augmentation of the right ventricular outflow tract (n = 16, 30.2%) were often part of the procedure. The median conduit size was 21 (range 11-25) mm. There was no in-hospital death. The median follow-up after surgery was 4.6 (IQR 3.4-5.6) years. Fourteen patients (27.5%) developed conduit failure with stenosis being the main cause. Freedom from conduit failure was 98.0% at 2 and 80.5% at 5 years. The median longevity of the conduit was 7.4 years (95% confidence interval 5.1-9.8 years). Younger age and smaller conduit size were related to conduit failure. CONCLUSIONS Utilization of the Labcor conduit revealed acceptable intermediate-term results. The conduit appeared to be functioning sufficiently well within the first 5 years in the majority of patients. The higher rate of failure concerning smaller conduits might be associated with somatic outgrowth; however, conduit degeneration as common and long-term outcome still needs to be evaluated

Long-term follow-up of patients with complex coronary artery disease treated with minimally invasive direct coronary artery bypass

Background: Patients with complex coronary artery disease (CAD) may benefit from surgical myocardialrevascularization but weighing the risk of peri-operative complications against the expected meritis difficult. Minimally invasive direct artery bypass (MIDCAB) procedures are less invasive, providethe prognostic advantage of operative revascularization of the left anterior descending artery and maybe integrated in hybrid strategies. Herein, the outcomes between patients with coronary 1-vessel disease(1-VD) and patients with 2-VD and 3-VD after MIDCAB procedures were compared in this single-centerstudy.Methods: Between 1998 and 2018, 1363 patients underwent MIDCAB at the documented institution.628 (46.1%) patients had 1-VD, 434 (31.9%) patients 2-VD and 300 (22.0%) patients suffered from3-VD. Data of patients with 2-VD, and 3-VD were pooled as multi-VD (MVD).Results: Patients with MVD were older (66.2 ± 10.9 vs. 62.9 ± 11.2 years; p &lt; 0.001) and presentedwith a higher EuroScore II (2.10 [0.4; 34.2] vs. 1.2 [0.4; 12.1]; p &lt; 0.001). Procedure time was longerin MVD patients (131.1 ± 50.3 min vs. 122.2 ± 34.5 min; p &lt; 0.001). Post-operatively, MVD patientshad a higher stroke rate (17 [2.3%] vs. 4 [0.6%]; p = 0.014). No difference in 30-day mortality wasobserved (12 [1.6%] vs. 4 [0.6%]; p = 0.128). Survival after 15 years was significantly lower in MVDpatients (p &lt; 0.01). Hybrid procedures were planned in 295 (40.2%) patients with MVD and realizedin 183 (61.2%) cases. MVD patients with incomplete hybrid procedures had a significantly decreasedlong-term survival compared to cases with complete revascularization (p &lt; 0.01).Conclusions: Minimally invasive direct coronary artery bypass procedures are low-risk surgical procedures.If hybrid procedures have been planned, completion of revascularization should be a major goal