Early and midterm results of frozen elephant trunk operation with Evita open stent-graft in patients with Marfan syndrome: results of a multicentre study

Background: Endovascular treatment of patients with Marfan syndrome (MFS) is not recommended. Hybrid procedures such as frozen elephant trunk (FET), which combines stent-graft deployment with an integrated non-stented fabric graft for proximal grafting and suturing, have not been previously evaluated. The aim of this study was to assess the safety and feasibility of FET operation in patients with MFS. Methods: Patients enrolled in the International E-vita Open Registry (IEOR) who underwent FET procedure between January 2001 and February 2020 meeting Ghent criteria for MFS were included in the study. Early and midterm results were retrospectively analyzed. Preoperative, postoperative and follow-up computed tomography angiography scans were analysed. Results: We analyzed 37 patients [mean age 38 ± 11 years, 65% men]. Acute or chronic aortic dissection was present in 35 (95%) patients (14 and 21 patients respectively). Two (5%) patients had an aneurysm without dissection. Malperfusion syndrome was present in 4 patients. Twenty-nine (78%) patients had history of aortic surgical interventions. The 30-day and in-hospital mortality amounted to 8 and 14% respectively. False lumen exclusion was present in 73% in stented segment in last postoperative CT. The overall 5-year survival was 71% and freedom from reintervention downstream was 58% at 5 years. Of the nine patients who required reintervention for distal aortic disease, one patient died. Conclusions: FET operation for patients with MFS can be performed with acceptable mortality and morbidity. In long-term follow-up no reinterventions on the aortic arch were required. FET allows for easier second stage operations providing platform for surgical and endovascular reinterventions

Państwo, gospodarka, społeczeństwo w integrującej się Europie TOM 3

Ze wstępu: "1 maja 2004 przyniesie radykalną zmianą sytuacji dotychczasowych kandydatów do Unii Europejskiej. Z roli aplikanta i petenta przekształcą się we współdecydenta. Już dziś z przyszłymi członkami konsultuje się większość kwestii wymagających strategicznych decyzji. Przez ostatnie dziesięć lat wysiłek polityczny i intelektualny był skierowany na uzyskanie członkostwa Unii, a w ostatnim okresie negocjacji - na osiągnięcie najlepszych według polityków i ekonomistów warunków akcesji. 1 ten etap mamy już za sobą. Pora zacząć patrzeć przed siebie, lecz niejako petent, ale kraj współodpowiedzialny za dalsze funkcjonowanie i rozwój powiększonej Unii. Z tej perspektywy istotnajest analiza gospodarki europejskiej, z którąjuż dziś gospodarka państw kandydackich, także Polski, jest silnie powiązana. Wiedza na ten temat jest uboga i ograniczona do przeglądu bieżących wskaźników makroekonomicznych. Zarówno w ośrodkach rządowych, jak i pozarządowych dominuje podejście analizujące, co z konkretnego wydarzenia w innym kraju wynika dla gospodarki polskiej. Stanowczo nie wystarczy to do pełnienia odpowiedzialnej roli współdecydenta. Potrzebna jest pogłębiona wiedza na temat gospodarki europejskiej jako całości i poszczególnych krajów, a także najważniejszych partnerów handlowych i gospodarczych zjednoczonej Europy. Konieczne są pogłębione prace studialne dotyczące mechanizmów międzynarodowych, gdyż organy unijne będą się zajmować w najbliższych latach dalszym rozwojem europejskiego jednolitego Rynku, rywalizacją gospodarczą z USA i krajami azjatyckimi, liberalizacjąhandlu światowego."(...

Balancing intubation time with postoperative risk in cardiac surgery patients – a retrospective cohort analysis

Katarzyna Kotfis,1 Aleksandra Szylińska,2 Mariusz Listewnik,3 Kacper Lechowicz,1 Monika Kosiorowska,3 Sylwester Drożdżal,1 Mirosław Brykczyński,3 Iwona Rotter,2 Maciej Żukowski1 1Department of Anesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University, Szczecin, Poland; 2Department of Medical Rehabilitation and Clinical Physiotherapy, Pomeranian Medical University, Szczecin, Poland; 3Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland Introduction: Intubation time in patients undergoing cardiac surgery may be associated with increased mortality and morbidity. Premature extubation can have serious adverse physiological consequences. The aim of this study was to determine the influence of intubation time on morbidity and mortality in patients undergoing cardiac surgery.Methods: We performed a retrospective analysis of data on 1,904 patients undergoing isolated coronary artery bypass grafting (CABG) and stratified them by duration of intubation time after surgery – 0–6, 6–9, 9–12, 12–24 and over 24 hours. Postoperative complications risk analysis was performed using multivariate logistic regression analysis for patients extubated ≤12 and >12 hours.Results: Intubation percentages in each time cohort were as follows: 0–6 hours – 7.8%, 6–9 hours – 17.3%, 9–12 hours – 26.8%, 12–24 hours – 44.4% and >24 hours – 3.7%. Patients extubated ≤12 hours after CABG were younger, mostly males, more often smokers, with lower preoperative risk. They had lower 30-day mortality (2.02% vs 4.59%, P=0.002), shorter hospital stay (7.68±4.49 vs 9.65±12.63 days, P<0.001) and shorter intensive care unit stay (2.39 vs 3.30 days, P<0.001). Multivariate analysis showed that intubation exceeding 12 hours after CABG increases the risk of postoperative delirium (OR 1.548, 95% CI 1.161–2.064, P=0.003) and risk of postoperative hemofiltration (OR 1.302, 95% CI 1.023–1.657, P=0.032).Conclusion: Results indicate that risk of postoperative complications does not increase until intubation time exceeds 12 hours. Shorter intubation time is seen in younger, men and smokers. Intubation time >12 hours is a risk factor for postoperative delirium and hemofiltration after cardiac surgery. Keywords: intubation, cardiac surgery, CABG, mortality, complications, delirium&nbsp

Evaluating the diagnostic accuracy of maximal aortic diameter, length and volume for prediction of aortic dissection

Objective Management of thoracic aortic aneurysms (TAAs) comprises regular diameter follow-up until the indication criterion for prophylactic surgery is reached. However, this approach is unable to predict the majority of acute type A aortic dissections (ATAADs). The current study aims to evaluate the diagnostic accuracy of ascending aortic diameter, length and volume for occurrence of ATAAD. Methods This two-centre observational cohort study retrospectively screened 477 consecutive patients who presented with ATAAD between 2009 and 2018. Of those, 25 (5.2%) underwent CT angiography (CTA) within 2 years before dissection onset. Aortic diameter, length and volume of these patients ('pre-ATAAD') were compared with those of TAA controls (n=75). Receiver operating curve analysis was performed to evaluate the predictive accuracy of the three different measurements. Results 96% of patients with pre-ATAAD did not meet the surgical diameter threshold of 55 mm before dissection onset. Maximal aortic diameters (45 (40-49) mm vs 46 (44-49) mm, p=0.075) and volume (126 (95-157) cm(3) vs 124 (102-136) cm(3), p=0.909) were comparable between patients with pre-ATAAD and TAA controls. Conversely, ascending aortic length (84 +/- 9 mm vs 90 +/- 16 mm, p=0.031) was significantly larger in patients with pre-ATAAD. All three parameters had an area under the curve of >0.800. At the 55 mm cut-off point, the maximal diameter yielded a positive predictive value (PPV) of 20%. While maintaining same specificity levels, measurements of aortic volume and length showed superior diagnostic accuracy (PPV 55% and 70%, respectively). Conclusion Measurements of aortic volume and length have superior diagnostic accuracy compared with the maximal diameter and could improve the timely identification of patients at risk for ATAAD