Long term outcomes after the off-pump coronary artery bypass grafting

Hirurška revaskularizacija miokarda (HRM) je postavila temelj za razvoj moderne kardiohirurgije, te do današnjeg dana ostaje najčešće izvođena operacija u opusu svakog kardiohirurga. Izbegavanjem upotrebe vantelesnog krvotoka izbegava se aktivacija koagulacione kaskade i generalizovanog inflamatornog odgovora do koga dolazi prilikom kontakta krvi bolesnika i sistema za vantelesni krvotok, koji je označen kao jedan od glavnih uzroka morbiditeta posle kardiohirurških operacija. Uprkos svim debatama o superiornosti i inferiornosti ove metode u odnosu na konvencionalnu koronarnu hirurgiju, hirurgija na kucajućem, srcu i dalje predstavlja značajan udeo u broju operacija u kardiohirurškim centrima, 15-30 % od svih hirurških revaskularizacija miokarda. Cilj: Ispitivanje i poređenje smrtnosti, postoperativnih komplikacija i dužine trajanja hospitalizacije grupe bolesnika operisanih na kucajućem srcu i bolesnika operisanih upotrebom vantelesnog krvotoka nakon dugoročnog perioda praćenja i učinjene ''propensity matching'' analize. Materijal i metode: Izvedena je retrospektivna opservaciona studija sa prospektivnim skupljanjem podataka i ''propensity matching'' analizom. U studiju je uključeno 302 bolesnika kod kojih je učinjena izolovana hirurška revaskularizacija miokarda od januara 2012 do maja 2013 godine. Grupu bolesnika operisanih metodom na kucajućem srcu čine 143 konsekutivna bolesnika operisana od strane četiri hirurga od kojih je svaki imao urađenih više od 250 operacija ovom metodom. Drugu grupu bolesnika čine 159 bolesnika operisanih metodom uz upotrebu vantelesnog krvotoka operisanih istog dana od strane ova četiri hirurga ili nekoga od još četiri iskusna hirurga koji više od 90% hirurških revaskularizacija izvode uz pomoć vantelesnog krvotoka...Coronary artery bypass grafting (CABG) laid out the foundation to modern cardiac surgery and remains to date most frequently performed cardiac surgical procedure. The extracorporeal circulation is ackonwledged as one of the main factors of postoperative comorbidity in cardiac surgery. Activation of the system of complement and the systemic inflammatory response by the heart-lung machine can be avoided by off-pump coronary artety bypass grafting (OPCAB). Despite the ongoing debates regarding the superiority or inferiority of OPCAB, it still comprises 15–30% of all CABG cases varying in different national registries. Aim: The aim of our study was to analyze survival,postoperative complications and MACCE, as well as the duration of the hospital stay between the two goups after propensity matching analysis and five year follow-up. Methods: We performed apropensity matched study of 302 consecutive CABG patients,143 off -pump cases performed by the four experienced off-pump surgeons and the on-pump CABG cases performed by those surgeons and four other experienced coronary surgeons. The five year follow up was performed and data collected comprised of mortality, rehospitalization due to cardiac origin, repeated revascularization, myocardial infarction and cerebrovascular accident. Propensity matching of OFF and ON group was performed 1:1 for the extent of disease with greedy, nearest neighbor matching without replacement and a caliper of 0.2. The variables used for propensity matching calculations were age, gender, chronic kidney disease, diabetes and ejection fraction..

La Croatie ou la terre promise des enfants de Bosnie‑Herzégovine 1917‑1919

Durant la Première Guerre mondiale a été organisée une action humanitaire d’envergure pour sauver les enfants menacés de famine dans les régions pauvres de la Monarchie austro‑hongroise (Bosnie‑Herzégovine, Dalmatie et Istrie). En Bosnie‑Herzégovine, dont les bordures ont été, au début de la guerre, le théâtre d’opérations militaires contre la Serbie et le Monténégro, cette action a été menée avec l’accord du gouvernement territorial et organisée par des associations humanitaires de Croatie qui s’occupaient traditionnellement de la défense des enfants, ainsi que par le Comité central pour la défense des familles mobilisées par la guerre et des soldats morts au combat. À cause des problèmes d’approvisionnement, le déplacement des enfants s’est fait de façon privée. Les autorités n’ont pas eu d’influence sur le choix des enfants déplacés, dont certains avaient perdu leur père sur le champ de bataille. Parmi eux on trouvait des catholiques, des orthodoxes et des musulmans, si bien qu’a dû être obtenu l’accord des représentants des trois communautés confessionnelles. Les petits rescapés ont été placés dans les régions fertiles de Slavonie. À la fin, les A. donnent un aperçu statistique et un regard sur le processus de retour des enfants chez leurs parents.During World War I a large-scale humanitarian action was organized for the sake of children threatened by starvation in the poor areas of the Austro‑Hungarian Monarchy (Bosnia‑Herzegovina, Dalmatia and Istria). In Bosnia‑Herzegovina, whose borders had been the theatre of military operations against Serbia and Monte-negro at the beginning of the war, this action was led in accordance with the Territorial government and organized by humanitarian agencies from Croatia that were traditionally involved in child-care and protection, as well as by the Central Committee for the Defence of Families mobilized in the War and of Soldiers who died in combat. Due to supply problems, the transfer of children was privately organized. The authorities did not have any influence on the choice of the displaced children, some of whom had lost their fathers on the battlefield. As they were Catholic, Orthodox and Muslim, the representatives of all three confessional communities were requested to agree. The young survivors were settled in fertile regions of Slavonia. At the end, the author presents some statistics and considerations about the process of returning children to their parents

Oxidative Stress in Patients before and after On-Pump and Off-Pump Coronary Artery Bypass Grafting: Relationship with Syntax Score

Objective. Coronary artery bypass grafting (CABG) represents the significant source of increased oxidative stress (OS). We aimed to follow the OS status parameters (i.e., ischemia-modified albumin (IMA), malondialdehyde (MDA), superoxide anion, prooxidantantioxidant balance (PAB), total oxidant status (TOS), total antioxidant status (TAS), and superoxide-dismutase (SOD)) change through the predefined study times in two different surgical procedures, i.e., cardiopulmonary bypass (CPB) and off-pump coronary artery bypass grafting (OPCAB). Additionally, we aimed to investigate those OS status parameters in specific study times according to SYNTAX score (SS), an established angiographic score for evaluating the extensity and severity of coronary artery disease. Patients and Methods. A total of 107 patients that were planned to undergo CABG were included (i.e., 47 patients in OPCAB and 60 patients in CPB group). Blood samples were taken at 6 time intervals: before surgery (t1), immediately after intervention (t2), 6 h (t3), 24 h (t4), 48 h (t5), and 96 h after termination of the operation (t6). Results. IMA levels were higher in CPB than that in OPCAB baseline and rose in CPB group in t2 point. TOS decreased in both study groups, compared to baseline values, but without statistical significance. Superoxide anion and PAB significantly increased in t3-t6 study times, in both groups. MDA significantly increased only in CPB group in t5 and t6 interval. MDA was significantly higher in CPB group compared to OPCAB in t6 study point. CPB patients had significantly lower TAS compared to OPCAB patients at the beginning and in t2 and t3 study points. They also had significantly lower SOD activities compared to OPCAB, baseline, and in several study points. Moreover, TAS, SOD, and TAS/TOS ratio were significantly lower, whereas PAB and TOS/TAS were significantly higher in patients with high SS compared to corresponding groups. SOD activity, IMA, and TAS level were the best predictors of high SS. Conclusion. CPB patients were in more severe ischemia baseline than OPCAB group and IMA rose in CPB patients immediately after the surgery end, but not later. Also, the antioxidant status was significantly lower, whereas the prooxidant status was significantly higher in patients with high SS compared to corresponding groups. SOD activity, IMA, and TAS level were the best predictors of CAD (as determined with SS), showing that SOD and IMA had very good discriminatory capability towards higher SS status

Paraoxonase 1 low activity and SYNTAX score may predict postoperative complications after coronary artery surgery

OBJECTIVE: Coronary artery bypass grafting (CABG) seems to present a powerful trigger of oxidative stress (OS) and acute inflammatory response. This study aimed to estimate the effects of off-pump coronary artery bypass (OPCAB) grafting on the OS that is commonly observed in patients undergoing operation under cardiopulmonary bypass (CPB). Additionally, we aimed to examine the relationship between and paraoxonase 1 (PON1) activity and the degree of stenosis, severity and complexity of the atherosclerotic lesions, estimated by SYNTAX score (SS). PATIENTS AND METHODS: Study group of 107 patients scheduled for CABG were divided into CPB and OPCAB group. Blood samples for OS markers measurement were collected at six-time intervals: before skin incision (t1), immediately after surgery (t2), 6h (t3), 24h (t4), 48h (t5) and 96h after cessation of the operation and surgical trauma (t6). SS was calculated. RESULTS: A significant decrease in lipid hydroperoxides (LOOH) and advanced oxidation protein products (AOPP) levels after both types of surgeries were observed, whereas PON1 reduction was observed higher in the CPB than in the OPCAB group. A significant inverse correlation between SS values and PON1 activity, preoperatively and during the early postoperative hours after surgery [in t2, t3 time intervals (p<0.05 for all)] was found. ROC analysis showed that for CPB patients, Model with all OS parameters showed excellent accuracy (AUC=0.957, p<0.001) for prediction postoperative complications. CONCLUSIONS: Decrease in PON1 activity during the early post-operative phases was related to higher SS. This relationship was more convincing in CPB, compared with OPCAB patients. Moreover, integrated models of OS status parameters have the capability to predict the development of postoperative complications

Long term outcomes after the off-pump coronary artery bypass grafting

Hirurška revaskularizacija miokarda (HRM) je postavila temelj za razvoj moderne kardiohirurgije, te do današnjeg dana ostaje najčešće izvođena operacija u opusu svakog kardiohirurga. Izbegavanjem upotrebe vantelesnog krvotoka izbegava se aktivacija koagulacione kaskade i generalizovanog inflamatornog odgovora do koga dolazi prilikom kontakta krvi bolesnika i sistema za vantelesni krvotok, koji je označen kao jedan od glavnih uzroka morbiditeta posle kardiohirurških operacija. Uprkos svim debatama o superiornosti i inferiornosti ove metode u odnosu na konvencionalnu koronarnu hirurgiju, hirurgija na kucajućem, srcu i dalje predstavlja značajan udeo u broju operacija u kardiohirurškim centrima, 15-30 % od svih hirurških revaskularizacija miokarda. Cilj: Ispitivanje i poređenje smrtnosti, postoperativnih komplikacija i dužine trajanja hospitalizacije grupe bolesnika operisanih na kucajućem srcu i bolesnika operisanih upotrebom vantelesnog krvotoka nakon dugoročnog perioda praćenja i učinjene ''propensity matching'' analize. Materijal i metode: Izvedena je retrospektivna opservaciona studija sa prospektivnim skupljanjem podataka i ''propensity matching'' analizom. U studiju je uključeno 302 bolesnika kod kojih je učinjena izolovana hirurška revaskularizacija miokarda od januara 2012 do maja 2013 godine. Grupu bolesnika operisanih metodom na kucajućem srcu čine 143 konsekutivna bolesnika operisana od strane četiri hirurga od kojih je svaki imao urađenih više od 250 operacija ovom metodom. Drugu grupu bolesnika čine 159 bolesnika operisanih metodom uz upotrebu vantelesnog krvotoka operisanih istog dana od strane ova četiri hirurga ili nekoga od još četiri iskusna hirurga koji više od 90% hirurških revaskularizacija izvode uz pomoć vantelesnog krvotoka...Coronary artery bypass grafting (CABG) laid out the foundation to modern cardiac surgery and remains to date most frequently performed cardiac surgical procedure. The extracorporeal circulation is ackonwledged as one of the main factors of postoperative comorbidity in cardiac surgery. Activation of the system of complement and the systemic inflammatory response by the heart-lung machine can be avoided by off-pump coronary artety bypass grafting (OPCAB). Despite the ongoing debates regarding the superiority or inferiority of OPCAB, it still comprises 15–30% of all CABG cases varying in different national registries. Aim: The aim of our study was to analyze survival,postoperative complications and MACCE, as well as the duration of the hospital stay between the two goups after propensity matching analysis and five year follow-up. Methods: We performed apropensity matched study of 302 consecutive CABG patients,143 off -pump cases performed by the four experienced off-pump surgeons and the on-pump CABG cases performed by those surgeons and four other experienced coronary surgeons. The five year follow up was performed and data collected comprised of mortality, rehospitalization due to cardiac origin, repeated revascularization, myocardial infarction and cerebrovascular accident. Propensity matching of OFF and ON group was performed 1:1 for the extent of disease with greedy, nearest neighbor matching without replacement and a caliper of 0.2. The variables used for propensity matching calculations were age, gender, chronic kidney disease, diabetes and ejection fraction..

Minithoracotomy as the primary alternative for left ventricular lead implantation during cardiac resynchronization therapy: Can the cardiac surgeon reduce the number of nonresponders

Introduction/Objective. Numerous anomalies of the cardiac venous system prevent the optimal endovascular implantation of the left ventricular (LV) lead in more than 15% of patients with indication for cardiac resynchronization therapy (CRT). The endovenous approach in these patients can be one of the potential reasons for the large number of nonresponders reported in the literature. The purpose of this study was to analyze the results of an alternative myoepicardial approach to the stimulation of the left ventricle in CRT. Methods. From June 2014 to December 2015 at the Department of Cardiac Surgery of the Clinical Centre of Serbia, 15 myoepicardial LV leads for CRT were implanted. Coronary sinus venography revealed thrombosis of the coronary sinus in nine patients, and unfavorable anatomy of the coronary venous system in six patients. In all patients, limited left thoracotomy was used as an approach to the lateral wall of the heart. Results. There were no major surgical complications and no lethal hospital outcomes. In a six-month follow-up period we registered a significant increase in the length of the six-minute walk test (for an average of 57.9 m), reduction of the QRS complex width (to 26.25 ms), increase in left ventricular ejection fraction (12.2%), and reduction of mitral regurgitation for 1+. Based on all the parameters, it was concluded that all patients responded favorably to the applied CRT. Conclusion. Closer cooperation between cardiologists and cardiac surgeons in identifying patients who would benefit the most from a myoepicardial approach for LV stimulation is necessary in order to attempt to reduce the nonresponder rate

Aleksandar Mošić - Život jevrejskog heroja

This is an amateur, student film about Jewish people's lives in Belgrade before, during and after World War II. The film is about Avram Aleksandar Mosic's life, made by XIII Belgrade High School students for the Centropa organization.Ovo je amaterski, studentski film o životu Jevreja u Beogradu pre, za vreme i posle Drugog svetskog rata. Film koji su snimili učenici XIII beogradske gimnazije za organizaciju Centropa, govori o životu Avrama Aleksandra Mošića.Trajanje 15:35 minuta (duration 15:35 minutes).YouTube link [https://www.youtube.com/watch?v=hOGHCYuVSus

Long-term stability of graphene/c-Si Schottky-junction solar cells

A long operational lifetime is required for the use of solar cells in real-life photovoltaic applications. The optimization of operational lifetimes is achieved through understanding the inherent degradation phenomena in solar cells. In this study, graphene/Si Schottky-junction solar cells were produced, utilizing liquid-phase-exfoliated graphene as an active surface. The operational and interface stability of these solar cells over a period of 5 years in ambient conditions (following ISOS-D protocols: dark storage/shelf life) was examined, and the origin of their degradation was reported. It was found that the dominant degradation mechanism could be attributed to the degradation of silver contacts. This was indicated by a decrease in shunt resistance, an increase in the ideality factor (due to a higher carrier recombination), and a constant defect density in graphene films for up to 4 years. Measurements across the solar cell's active area during the 5-year period revealed neither significant spatial inhomogeneity, nor shunt channel defects.This is the peer-reviewed version of the manuscript: Jovanović, Djordje, Petrović, Miloš, Tomašević-Ilić, Tijana, Matković, Aleksandar, Bokalič, Matevž, Spasenović, Marko, Rogdakis, Konstantinos, Kymakis, Emmannuel, Knežević, Dragan, Cina, Lucio, Gajić, Radoš, "Long-term stability of graphene/c-Si Schottky-junction solar cells" in Solar Energy Materials and Solar Cells, 258 (2023):112414, [https://doi.org/10.1016/j.solmat.2023.112414]Published version: [https://cer.ihtm.bg.ac.rs/handle/123456789/6491

Percutaneous implantation of self-expandable aortic valve in high risk patients with severe aortic stenosis: The first experiences in Serbia

Background/Aim. Aortic stenosis (AS) is the most common valvular heart disease in elderly people, with rather poor prognosis in symptomatic patients. Surgical valve replacement is the therapy of choice, but a significant number of patients cannot undergo surgical procedure. We presented initial experience of transcatheter aortic valve implantation (TAVI) performed in Catheterization Laboratory of the Clinic for Cardiology, Clinical Center of Serbia. Methods. The procedures were performed in 5 patients (mean age 76 ± 6 years, 2 males, 3 female) with severe and symptomatic AS with contraindication to surgery or high surgical risk. The decision to perform TAVI was made by the heart team. Pre-procedure screening included detailed clinical and echocardiographic evaluation, coronary angiography and computed tomography scan. In all the patients we implanted a self-expandable aortic valve (Core Valve, Medtronic, USA). Six months follow-up was available for all the patients. Results. All interventions were successfully performed without significant periprocedural complications. Immediate hemodynamic improvement was obtained in all the patients (peak gradient 94.2 ± 27.6 to 17.6 ± 5.2 mmHg, p < 0.001, mean pressure gradient 52.8 ± 14.5 to 8.0 ± 2.1 mmHg, p < 0.001). None of the patients developed heart block, stroke, vascular complication or significant aortic regurgitation. After 6 months, the survival was 100% with New York Heart Association (NYHA) functional improvement in all the patients. Conclusion. This successful initial experience provides a solid basis to treat larger number of patients with symptomatic AS and high surgical risk who are left untreated. [Projekat Ministarstva nauke Republike Srbije, br. ON 175 020