On-Pump vs Off-Pump coronary artery bypass surgery in atrial fibrillation : analysis from the polish national registry of cardiac surgery procedures (KROK)

BackgroundNo single randomized study has ever before addressed the safety of On-Pump coronary artery bypass grafting (CABG) vs Off-Pump CABG in the setting of atrial fibrillation (AF) and data from small observational samples remain inconclusive.Methods and findingsProcedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. Of initial 188,972 patients undergoing CABG, 7,913 presented with baseline AF (76.0% men, mean age 69.1±8.2) and underwent CABG without concomitant valve surgery between 2006-2019 in 37 reference centers across Poland. Mean follow-up was 4.7±3.5 years (median 4.3 IQR 1.7-7.4). Cox proportional hazards models were used for computations. Of included patients, 3,681 underwent On-Pump- (46.52%) as compared to 4,232 (53.48%) who underwent Off-Pump CABG. Patients in the latter group less frequently were candidates for complete revascularization (PConclusionsOff-Pump CABG offered 30-day survival benefit to patients undergoing CABG surgery and presenting with underlying AF. On-Pump CABG was associated with significantly improved survival at long term

Long-term survival following surgical ablation for atrial fibrillation concomitant to isolated and combined coronary artery bypass surgery-analysis from the polish national registry of cardiac surgery procedures (KROK)

The current investigation aimed to evaluate long-term survival in patients undergoing isolated and combined coronary artery bypass grafting (CABG) with concomitant surgical ablation for atrial fibrillation (AF). Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. Eleven thousand three hundred sixteen patients with baseline AF (72.4% men, mean age 69.6 ± 7.9) undergoing isolated and combined CABG surgery between 2006–2019 in 37 reference centers across Poland and included in the registry were analyzed. The median follow-up was four years (3.7 IQR 1.3–6.8). Over a 12-year study period, there was a significant survival benefit (Hazard Ratio (HR) 0.83; (95% Confidence Interval (CI): 0.73–0.95); p = 0.005) with concomitant ablation as compared to no concomitant ablation. After rigorous propensity matching (LOGIT model, 432 pairs), concomitant surgical ablation was associated with over 25% improved survival in the overall analysis: HR 0.74; (95% CIs: 0.56–0.98); p = 0.036. The benefit of concomitant ablation was maintained in the subgroups, yet the most benefit was appraised in low-risk patients (EuroSCORE < 2, p = 0.003) with the three-vessel disease (p < 0.001) and without other comorbidities. Ablation was further associated with significantly improved survival in patients undergoing CABG with mitral valve surgery (HR 0.62; (95% CIs: 0.52–0.74); p < 0.001) and in patients in whom complete revascularization was not achieved: HR 0.43; (95% CIs: 0.24–0.79); p = 0.006. View Full-Text

The impact of gender on in-hospital mortality and long-term mortality in patients undergoing surgical aortic valve replacement: SAVR and SEX Study

Background: Surgical aortic valve replacement (SAVR) is among the most commonly performed valve valvular surgeries. Despite many previous studies conducted in this setting, the impact of gender on outcomes in the patients undergoing SAVR is still unclear. Aims: To define gender differences in short- and long-term mortality in patients undergoing SAVR. Methods: We analyzed retrospectively all the patients undergoing isolated SAVR from January 2006 to March 2020 in the Department of Cardiovascular Surgery and Transplantology in John Paul II Hospital in Cracow. The primary end point was in-hospital and long-term mortality. Secondary end points included the length duration of hospital stay and perioperative complications. Groups of men and women with regard to the prosthesis type were compared. Propensity score matching was performed to adjust for differences in baseline characteristics. Results: A total number of 4 510 patients undergoing isolated surgical SAVR were analyzed. A follow-up median (interquartile range [IQR]) was 2120 (1000–3452) days. Females constituted 41.55% of the cohort and were  older, displayed more non-cardiac comorbidities and faced a higher operative risk. In both genders, bioprostheses were more often applied (55.5% vs. 44.5%; P &lt; 0.0001). In univariable analysis, gender was not associated linked to in-hospital fatality (3.7% vs. 3%; P = 0.15) and late mortality (rates) (23.37% vs. 23.52 %; P = 0.9). Upon adjustment for baseline characteristics (propensity score matching analysis) and considering 5-year survival, a long-term prognosis proved to be better in women with 86.8% comparing to 82.7% in men (P = 0.03). Conclusions: A key finding from this study suggests that the female gender was not associated with a higher in-hospital and late mortality rate compared to men. Further studies are needed to confirm long-term benefits  in women undergoing SAVR

Tricuspid intervention for less-than-severe regurgitation at time of minimally invasive mitral valve surgery in patients with AF

Background: While to address moderate tricuspid regurgitation (TR) at time of left-side heart surgery is recommended by the guidelines, the procedure is still seldom performed and especially in the minimally invasive setting. Atrial fibrillation (AF) is known marker of both mortality and TR progression after mitral valve surgery. Aims: The current study aimed to address the safety of adding a tricuspid intervention to minimally invasive mitral valve surgery (MIMVS) in patients with preoperative AF. Methods: We retrospectively analyzed data from Polish National Registry of Cardiac Surgery Procedures between 2006 and 2021. We included all patients who underwent MIMVS (mini-thoracotomy-, totally thoracoscopic- or robotic surgery) and presented with moderate tricuspid regurgitation and AF preoperatively. The primary endpoint was death from any cause at 30 days and at longest available follow between MIMVS with tricuspid intervention vs MIMVS alone. We used propensity score matching to account for baseline differences between groups. Results: We identified 1,545 patients with AF undergoing MIMVS, 54.7% were men aged 66.7±9.2years. Of those, 733 (47.4%) underwent concomitant tricuspid valve intervention. At 13 years, addition of tricuspid intervention was associated with 33% higher mortality as compared to MIMVS alone. HR 1.33; 95 CIs (1.05-1.69); P=0.02. PS matching resulted in 565 well-balanced pairs. Concomitant tricuspid intervention did not influence long-term follow-up: HR, 1.01; 95 CIs (0.74-1.38); P=0.94. Conclusions: After adjusting for baseline cofounders the addition of tricuspid intervention for moderate tricuspid regurgitation to MIMVS did not increase perioperative mortality nor influence long-term survival

ARTEFACTS: How do we want to deal with the future of our one and only planet?

The European Commission’s Science and Knowledge Service, the Joint Research Centre (JRC), decided to try working hand-in-hand with leading European science centres and museums. Behind this decision was the idea that the JRC could better support EU Institutions in engaging with the European public. The fact that European Union policies are firmly based on scientific evidence is a strong message which the JRC is uniquely able to illustrate. Such a collaboration would not only provide a platform to explain the benefits of EU policies to our daily lives but also provide an opportunity for European citizens to engage by taking a more active part in the EU policy making process for the future. A PILOT PROGRAMME To test the idea, the JRC launched an experimental programme to work with science museums: a perfect partner for three compelling reasons. Firstly, they attract a large and growing number of visitors. Leading science museums in Europe have typically 500 000 visitors per year. Furthermore, they are based in large European cities and attract local visitors as well as tourists from across Europe and beyond. The second reason for working with museums is that they have mastered the art of how to communicate key elements of sophisticated arguments across to the public and making complex topics of public interest readily accessible. That is a high-value added skill and a crucial part of the valorisation of public-funded research, never to be underestimated. Finally museums are, at present, undergoing something of a renaissance. Museums today are vibrant environments offering new techniques and technologies to both inform and entertain, and attract visitors of all demographics.JRC.H.2-Knowledge Management Methodologies, Communities and Disseminatio

Spectroscopy and physicochemical properties of ruthenium(II) polypyridine complexes in free solutions and entrapped in zeolites

Ru(II) polypyridine complexes have attracted wide interest in view of their potential utility in solar energy conversion devices. The experimental efforts have been directed towards understanding the basic physicochemical properties of these complexes and improvement of their performance as photosensitizers. In the latter case the major goals are: increasing the lifetime of the excited electronic states, eliminating photodegradation and preventing rapid back-electron-transfer processes. In order to achieve these goals two routes can be followed. One involves modification of coordinated ligands while in the other investigated molecules are incorporated into organized media. Y-zeolites are particularly attractive because their large supercages can accommodate ruthenium tris-polypyridine complexes. Several zeolite-Y-entrapped homo and heteroleptic tris polypyridine complexes of Ru(II) have been synthesized. Several synthetic aspects, peculiar to the intra-zeolite chemistry, have been observed. These include ligand exchange and formation of the zeolite-bound ruthenium species. The electronic absorption and emission spectra of the free and zeolite-entrapped complexes have been obtained. In order to investigate possible structural alterations in both ground and excited electronic states of the entrapped compounds, resonance Raman and time-resolved resonance Raman spectra have been acquired. Excited electronic state lifetimes have been measured and compared with the results for aqueous solutions. While relatively small electronic and structural perturbations are induced by zeolite supercages, substantial modifications of the excited state lifetimes in zeolite matrices have been observed. These effects are attributed to the zeolite-induced modifications of the excited state decay occurring via thermally populated \sp3dd metal-localized states. In order to investigate mechanisms of the excited state energy dissipation in the Ru(bpy)\sb3\sp{2+} system the excited state lifetimes of several selectively deuteriated bipyridine analogues were obtained. These results indicate position-dependence of deuteration on the observed lifetimes. The changes in the excited state lifetimes observed upon deuteration of bpy in Ru(bpy)\sb3\sp{2+} were explained in terms of shifts of vibrational frequencies of the critical acceptor mode

Artykuł oryginalnyEkonomiczna ocena miniaturyzacji urządzenia do krążenia zewnątrzustrojowego stosowanego u noworodków i niemowląt poddanych operacjom wrodzonych wad serca

Background and aim: Miniaturisation of the extracorporeal circuit is a current trend in modern paediatric cardiac surgery. Many investigators stress that reduction of priming volume and artificial surface area of extracorporeal circulation could lead to clinical and economic benefits. The aim of this paper was to evaluate the costs of mini-circuit use in infants undergoing open heart surgery. Methods: We assessed post-operative course and cost of treatment in 60 infants undergoing open heart surgery. This group was prospectively randomised and divided into 2 equal subgroups: with miniaturised (group M) and conventional cardio pulmonary bypass circuits (group C). The study groups were clinically comparable. Surgical complications, duration of hospitalisation and cost of postoperative treatment were assessed in both groups. Results: Miniaturisation of the extracorporeal circuit led to a significant reduction of priming volume and artificial surface area (by 46.6% and 68.8% respectively, p=0.0000001). Post-operative cardio-respiratory insufficiency (2 vs. 8, p=0.038), and infection (3 vs. 9, p=0.049) occurred less often in children from group M. Hospital stay was significantly shorter in group M. Total cost of treatment was significantly lower in children from group M (median: 4361.4 vs. 6660.5 &#8364;, p=0.037). Conclusions: Miniaturisation of the extracorporeal circulation significantly improve post-operative outcome in infants undergoing open heart surgery. The mini-circuit significantly reduces cost of treatment in small children undergoing open heart surgery.Wstęp: We współczesnej kardiochirurgii wrodzonych wad serca istnieje tendencja do miniaturyzacji urządzenia do krążenia zewnątrzutrojowego. Rosnące oczekiwania społeczeństwa przy stałym rozwoju technologii wyznaczają zadania, którym powinny sprostać współczesne ośrodki medyczne. Z drugiej strony, wobec ograniczonych nakładów na służbę zdrowia, jednym z głównych problemów placówek medycznych na całym świecie stała się racjonalna polityka finansowa. Ta pozorna sprzeczność wymusza konieczność stosowania technik i technologii przynoszących maksymalne korzyści zarówno kliniczne, jak i ekonomiczne. Wielu badaczy podkreśla, że mniejsza objętość wypełnienia wstępnego i powierzchni sztucznej urządzenia może przynieść wymierne korzyści zarówno ekonomiczne, jak i kliniczne. Cel: Celem pracy było porównanie kosztów leczenia u dzieci z zastosowaniem zminiaturyzowanego i konwencjonalnego urządzenia. Materiał i metody: Grupę 60 dzieci do 1. roku życia podzielono w sposób prospektywny, randomizowany na 2 podgrupy: podgrupę M, w której zastosowano układ zminiaturyzowany, i podgrupę K, w której zastosowano układ konwencjonalny. Obie podgrupy nie różniły się istotnie pod względem wieku, masy ciała, typu operowanej wady oraz zastosowanej techniki perfuzji. Operacje zostały wykonane w jednym ośrodku, przez ten sam zespół chirurgiczny i anestezjologiczny. Oceniono powikłania pooperacyjne, czas leczenia szpitalnego oraz koszty leczenia. Ocenę statystyczną przeprowadzono metodą statystyki opisowej. Wyniki: Miniaturyzacja urządzenia umożliwiła zmniejszenie objętości wypełnienia wstępnego o 46,6% (p=0,000001) i powierzchni kontaktującej się z krwią chorego o 68,8% (p=0,0000001). W grupie, w której zastosowano układ zminiaturyzowany, rzadziej wystąpiła niewydolność krążeniowo-oddechowa (2 vs 8, p=0,038) oraz powikłania infekcyjne (3 vs 9, p=0,049). Czas leczenia pooperacyjnego był istotnie krótszy u dzieci z podgrupy M (mediana: 20,8 vs 25,48 dnia, p=0,042). W grupie M koszty leczenia pooperacyjnego były istotnie niższe (mediana: 17 375,67 vs 26 535,38 zł, p=0,037). Wnioski: Miniaturyzacja urządzenia do krążenia zewnątrzustrojowego w istotny sposób poprawia pooperacyjny stan kliniczny noworodków i niemowląt. Zastosowanie zminiaturyzowanego urządzenia znacząco zmniejsza koszty leczenia dzieci poddanych operacjom wad serca