Rana klinička iskustva sa dugoročnom potporom (Thoratec)

Despite recent advances in treatment, the number of people with heart failure continues to grow; this is associated with high mortality and morbidity rates. Heart transplantation is very limited due to the lack of the adequate number of heart donors, and medical therapy remains palliative. He use of ventricular assist devices (VADs) has led to improved survival rates for patients with severe heart failure. Originally introduced as a temporary bridge-to-recovery, and later as a bridge-to-transplantation, VADs have evolved to permanent or destination therapy for patients with terminal stage of congestive heart failure1. In this paper, we report of our patient with dilatative cardiomyopathy, to whom – due to the end-stage heart failure, and for the first time in Croatia – a device for paracorporeal long-term mechanical left ventricular support (pVAD) was implanted.Unatoč novijim dostignućima u liječenju kongestivnog zatajivanja srca, broj ljudi sa srčanim popuštanjem kontinuirano raste što dovodi do povećane stope mortaliteta i morbiditeta. Transplantacija srca je često ograničena zbog nedostatka broja adekvatnih donora, a medikamentozna terapija ostaje palijativna. Korištenje mehaničke cirkulacijske potpore (LVAD-left ventricular assist device), kao standardne terapije u liječenju završne faze zatajivanja srca značajno je poboljšalo ishod liječenja. Mehanička potpora lijevom ventriklu, prvotno primjenjena kao metoda privremenog premoštenja prema ozdravljenju (bridge-to-recovery), zatim kao premoštenja do transplantacije (bridge– to-transplantation), danas se primjenjuje kao trajna opcija liječenja bolesnika s terminalnom fazom srčanog zatajivanja. U ovom radu prikazan je slučaj bolesnika s dilatativnom kardiomiopatijom, kojem je po prvi puta, u Republici Hrvatskoj, zbog zatajivanja srca ugrađena parakorporalna mehanička potpora lijevom srcu

Postoperacijsko liječenje bolesnika s mehaničkom potporom srca u jedinici intenzivnog liječenja.

After the implantation of the left ventricular assisted device (LVAD), patients are admitted in intensive care unit (ICU). During the period of first several days, the goal of the postoperative care is to stabilize the patients’ hemodynamics. Monitoring the continuous cardiac output, filling volumes and outflow resistance is necessary for the proper functioning of the pump. The use of pulmonary artery catheter and the transesophageal echocardiography are primary procedures. During the operation of the left ventricular support, the measuring of proper ventricular function and the early recognition of its dysfunction is important for a positive outcome. Further potential complications in connection with these patients are an increased risk of hemorrhage and thromboembolism. The infection of drivelines and devices in the early postoperative period occurs in up to 40 % of these patients. In case of a cardiac arrest, a special procedure has to be performed in patients in whom LVAD was implanted. Finally, we have shown the anesthesiologic management in cases when patients with LVAD have to undergo noncardiac surgery.Nakon ugradnje lijevostrane srčane potpore (LSP), bolesnici se zaprimaju u jedinicu intenzivne medicine. Tijekom ovog razdoblja od nekoliko dana, osnovni cilj poslijeoperacijskog liječenja je stabilizacija bolesnikove hemodinamike. Praćenje kontinuiranog minutnog volumena, tlakova punjenja i sustavne rezistencije je neophodno za ispravno funkcioniranje LSP-a. Uporaba plućnog arterijskog katetera s kontinuiranim mjerenjem minutnog volumena te transezofagijska ehokardiografija su primarni postupci. Za vrijeme rada LSP, praćenje funkcije desne klijetke te rano uočavanje njene disfunkcije od krucijalnog su značaja za dobar ishod bolesnika. Daljnje moguće komplikacije u ovih bolesnika su povećani rizik od krvarenja, kao i od nastanka tromboembolija. Incidencija infekcija u ovih bolesnika je visoka, i kreće se do 40%, osobito infekcije kanila. U slučaju zastoja rada srca, primjenjuju se posebni postupci oživljavanja, koji se razlikuju od uobičajenih algoritama. Na kraju, prikazane su i specifičnosti anesteziološkog postupka u ovih bolesnika ukoliko postoji potreba za nekardijalnom operacijom

Supracardiac Total Anomalous Pulmonary Venous Return Repair in a 7-Month-Old Infant

Total anomalous pulmonary venous return is a congenital heart malformation characterized by anomalous pulmonary venous inflow to the right atrium. Surgical repair typically occurs during the first month of life, and survival beyond that age in untreated patients is unlikely. We report an extreme case of supracardiac total anomalous pulmonary venous return in an infant who survived 7 months despite atypical anomalous inflow without atrial-level communication and with right-to-left shunting only through a patent ductus arteriosus. We stabilized the patient\u27s left-sided heart function before surgically repairing the anomalous venous return 2 months later. Three years postoperatively, the patient was well

Resveratrol kao antioksidans u kardijalnoj kirurgiji – ima li potencijala u kliničkoj primjeni?

Cardiopulmonary bypass (CPB) is an essential technique in cardiac surgery but is also associated with adverse effects, including the systemic inflammatory response syndrome that manifests itself as ischaemia-reperfusion injury and multi-organ dysfunction. The aim of this mini review is to take a look at the current knowledge of resveratrol, a stilbenoid and natural antioxidant believed to have many cardioprotective effects including vasodilation, lowering of blood pressure and reactive oxygen species levels, suppression of low-density lipoprotein peroxidation, and mitigation of ischaemia/-reperfusion injury. We mostly focus on its cardioprotective potential in patients undergoing cardiac surgery supported by CPB. Current findings, however, are still inconclusive and call for further research, including clinical trialsKardijalna kirurgija je kirurška struka koja se vrlo brzo razvija, a u kojoj se pri radu koristi uređaj za izvantjelesni krvotok. Njegovo korištenje dovodi do sustavnog upalnog odgovora koji se prezentira kao ishemijsko-reperfuzijska ozljeda i multiorganska disfunkcija. Resveratrol, stilbenoid iz skupine fenola, prirodni je antioksidans koji se nalazi u grožđu, borovnicama, malinama, murvi i kikirikiju, a smatra se da ima neuroprotektivna, antidijabetička, antikarcinogena i kardioprotektivna svojstva. Prema dosadašnjim znanstvenim istraživanjima, resveratrol je moguće glavni čimbenik kardioprotektivnoga djelovanja vina, koje se očituje vazodilatacijom, smanjenjem količine reaktivnih radikala kisika i arterijskoga krvnog tlaka, zatim smanjenjem peroksidacije lipoproteina male gustoće i ublažavanjem ishemijsko-reperfuzijske ozljede. Cilj je ovoga pregleda sažeti trenutačno znanje o potencijalnim kardioprotektivnim svojstvima resveratrola u bolesnika koji se podvrgavaju kardiokirurškom zahvatu pri kojem se koristi uređaj za izvantjelesni krvotok. Resveratrol ima razne učinke na ljudsku kardiovaskularnu fiziologiju, od kojih mnogi još moraju biti istraženi

Dugotrajna mehanička potpora cirkulaciji: kirurške tehnike

Long-term mechanical circulatory support has become a valid treatment option for end stage heart failure. In selected patients’ cases, this therapeutic option has been proven to improve survival, both as a bridge to transplant and as a destination therapy. In this article, we address implantation technique, strategies to prevent excessive bleeding, right heart failure, and driveline and pocket infection.Dugotrajna mehanička potpora cirkulaciji postala je provjerena metoda u liječenju završne faze srčanog zatajenja. Kod odabranih bolesnika, dokazano je da poboljšava preživljenje, bilo kao potpora do transplantacije ili destinacijske terapije. U članku opisujemo tehnike ugradnje, strategije u cilju smanjenja prekomjernog krvarenja, zatajenja desnog srca te infekcije oko mjesta izlaska kabela za napajanje

Rana klinička iskustva sa dugoročnom potporom (Heart Mate II)

Left ventricular assist systems (LVAS) are widely accepted nowadays as a successful tool for bridging the patients with end-stage heart failure to heart transplantation (BTT). The second generations of axial-flow devices, such as the HeartMate II, provide a safe and reliable, as well as an effective hemodynamic support in such patients, offering them an improved quality of life; they are furthermore associated with a very low rate of device malfunction or infection requiring device change. We report here of our first three patients with the implanted HM II LVAS as a BTT .Uređaji za potporu lijevom srcu (LVAS – left ventricular assist system) su danas prihvaćeni kao uspiješno sredstvo za premoštenje bolesnika u završnom stadiju zatajivanja srca do transplantacije. Druga generacija aksijalnih pumpi, kao što je HeartMate II , pruža sigurnu i učinkovitu hemodinamsku potporu takvim bolesnicima, poboljšavajući kvalitetu života. Danas su ti uređaji povezani sa niskom inicidencijom malfunkcije ili infekcije koje bi zahtijevale zamjenu. Prikazujemo naša tri bolesnika kojima je ugrađen HeartMate II LVAS kao premoštenje do transplantacije

Pregled novijih uređaja za asistirano srce i asistiranu cirkulaciju

Continuous-flow left-ventricular assist devices (LVADs) have emerged as the standard of care for advanced heart failure patients, who require long-term mechanical circulatory support. In this review, we describe in brief the basics of the development of various devices, both the old (pulsatile-flow) and the new (continuous-flow) devices. A clinical review of modern devices and their today’s relevance are given in a brief outline.Uređaji za asisitirano srce i asistiranu cirkulaciju postali su standard u liječenju pacijenata s kroničnim zatajenjem srca, kojima je neophodna dugoročna mehanička potpora srcu i cirkulaciji. U ovom članku ukratko su opisane povijest razvoja različitih starijih (pulsatilnih) i novijih (kontinuirani tok) uređaja te važnost kliničke primjene ovih modernih uređaja

Our experience with aortic valve repair with a remodeling technique, extraaortic ring implantation and root replacement

Objective: Aortic valve replacement (AVR) is still the most commonly used therapeutic option for patients suffering from AR. Aortic valve repair (AVRep) is an attractive alternative method, since it avoids the risks of prosthesis-related complications.1-3 We would like to present our experience with the Yacoub root remodeling, valve sparing technique with the extraaortic expansible ring. Patients and Methods: Between November 2014 and July 2019, a total of 79 patients (52.6±13.3 years; 15.2% female, EuroScore II of 3.15%±2) underwent AVRep, 12 due to isolated cusp malcoaptation and 67 associated with aortic root dilatation. Reconstruction was done with the Coroneo Extraaortic Ring (27 (25-31)), and the Gelweave graft (28 (26-32)). 44 patients had a tricuspid valve, 33 patients had a bicuspid valve, and 2 patients had an unicuspid valve. Concomitant procedures included Mvrep and TVrep in 4 patients, CABG in two patents. Aortic arch was replaced in two patients, two patients underwent hemiarch replacement, and two patients had aortic arch replacement with stented conduit and placement of stent in descending thoracic aorta (EVITA stent graft Jotec GmbH). Echocardiography was used to determine AR severity grade preoperatively, during immediate post-operative period (within 7 days from operation) and at early follow-up. Results: In postoperative follow-up no patients died. Freedom from reoperation was 88% (10/79) and there were 2 patients reoperated due to early postoperative regurgitation, one patient was reoperated due to AI after two years, and one was operated due to pseudoaneurysm formation after 2.5 years. A significant decrease in LV end-diastolic diameter was observed (LVEDD) (60mm preoperatively, 53 mm postoperatively) with further decrease at early follow-up. At follow up none of the patients had major AR (AR0=61, AR1+=14, AR2+=4). Conclusions: We have proved that AVRep is a good alternative for patients with aortic insufficiency and leads to LV reverse remodeling with comparable results in terms of LVEDD and LVEF immediately post-operatively and at early follow up. It is feasible to use this technique in tricuspid, bicuspid, as well as unicuspid valves with excellent results