Short and long-term results of endoscopic atraumatic coronary artery off-pump bypass grafting in patients with left anterior descending artery stenosis

Background: To perform a retrospective analysis of patients who underwent endoscopic atraumaticcoronary artery off-pump bypass grafting (EACAB) in a single center over a period of 11 years.Methods: Data was acquired from the hospital registry and patient medical records. In order to determine changes in clinical profile, patients were subdivided into three groups regarding year of surgery: 1998–2002 (group 1), 2003–2005 (group 2), 2006–2009 (group 3). In-hospital analysis up to 30 days and long-term observation were conducted.Results: The study cohort consisted of 714 patients (581 male). Procedural success accounted for 99%of all patients. No mortality was observed up to 30 days. Complications in the early period includedpleural effusion (7.6%), cardiac arrhythmias (3.6%), bleeding related revision (2.7%) and woundinfection (1.6%). Mean follow-up was 6 years (2132 ± 1313 days; median: 1918.5). Nineteen (2.7%)patients died, of which 52.6% (10 patients) were due to heart related conditions. Overall frequency ofmajor adverse cerebral and cardiovascular events (MACCE) was 10.8% (77 patients). The Kaplan-Meyer analysis defined survival rate and event-free survival in long-term observation of 96.1% and85.3%, respectively. Ejection fraction (EF) < 50% was the only independent factor of mortality (OR:3.35). Regarding cumulative MACCE, older age (OR: 1.72), lower EF (OR: 3.03), the history of percutaneous coronary intervention (OR: 2.13) and higher New York Heart Association class (OR: 2.63)influenced the incidence rate.Conclusions: The presented short and very long-term results confirm that EACAB is an efficient alternative for patients requiring revascularization of the left anterior descending artery. The eliminationof cardiopulmonary bypass significantly reduces the number of complications

Long‑term outcomes of transcatheter self-expanding aortic valve implantations in inoperable and high surgical–risk patients with severe aortic stenosis: a single-center single-valve registry

Background: Transcatheter aortic valve implantation (TAVI) is being increasingly used in patients with longer life expectancy. Data on long‑term outcomes are still limited. Aims: The aim of the study was to assess the clinical outcomes of patients treated with TAVI and identify baseline and procedure‑related factors influencing long‑term survival. Methods: Symptomatic patients with critical aortic stenosis who were inoperable or had high surgical risk were qualified for TAVI. Between August 2012 and December 2017, 248 consecutive patients treated with self ‑expanding Medtronic valve implantation at American Heart of Poland in Bielsko‑Biała were prospectively enrolled. Patients were followed for 30 days after the procedure and subsequently annually. All events were classified according to the Valve Academic Research Consortium‑2 (VARC‑2) criteria and assessed. Survival was compared between the subgroups defined by the EuroSCORE II (European System for Cardiac Operative Risk Evaluation II) and with matched representatives from the general population. Results: The median (interquartile range) follow‑up was 3.4 (2.5–4.6) years, and the longest follow‑up lasted 7.8 years. A total of 92 patients (37.1%) died during the follow‑up. The Kaplan–Meier estimates for cumulative mortality at 1, 3, 5, and 7 years were: 11.3%, 26.8%, 42.1%, and 60.6%. Patients with EuroSCORE II greater than 6% experienced worse survival compared with those with EuroSCORE II 6% or less (P = 0.008). Patients with EuroSCORE II 6% or less had similar survival to the general population. Male sex, baseline eGFR of less than 50 ml/min/1.73 m2, chronic obstructive pulmonary disease, moderate / severe paravalvular leak, absence of postdilatation, major vascular complication, and stroke at 30 days were independently associated with long‑term mortality. Conclusions: TAVI with a self‑expanding Medtronic valve implantation according to a consistent protocol was associated with favorable outcomes. Patients with lower EuroSCORE II scores had the same prognosis as the actuarial survival of the general population