Anisocytosis predicts postoperative renal replacement therapy in patients undergoing heart valve surgery

Background: Acute kidney injury (AKI) is one of the serious postoperative complications in patients undergoing heart valve surgery. The aim of the present study was to identify selected biomarkers to predict AKI requiring renal replacement.Methods: A prospective study was conducted on a group of 751 patients undergoing heart valve surgery. The data on risk factors, preoperative complete blood count, course of operations and postoperative period was assessed. The primary endpoint at the 30-day follow-up was postoperative AKI requiring renal replacement therapy. The secondary end-point was death from all causes in patients with postoperative AKI requiring renal replacement.Results: The primary endpoint occurred in 46 patients. At multivariate analysis: age, red cell distribution width (RDW) and C-reactive protein remained independent predictors of the primary endpoint. Hemoglobin and RDW were associated with an increased risk of death.Conclusions: Elevated RDW is associated with a higher risk of postoperative AKI and death in patients with AKI

The usefulness of selected biomarkers in aortic regurgitation

Background: The aim of the study was to investigate the prognostic value of selected biomarkers inpatients with aortic regurgitation undergoing valve surgery. Methods: A prospective study was conducted on a group of consecutive patients with hemodynamically significant aortic regurgitation that underwent elective aortic valve surgery. The primary endpoint was 30-day mortality and any major adverse event within 30 days. Results: The study group included 205 consecutive patients who underwent replacement or repair of the aortic valve. The primary endpoint occurred in 72 patients. At multivariate analysis red cell distribution width (RDW; p = 0.03) and high-sensitivity troponin T (hs-TnT; p = 0.02) remained independent predictors of the major complications including death. Conclusions: Elevated preoperative RDW and hs-TnT were associated with a poorer outcome followingaortic valve surgery

The cardio-vascular safety of tyrosine kinase inhibitors

Przedstawiono aktualne dane dotyczące powikłań sercowo-naczyniowych u pacjentów z przewlekłą białaczką szpikową leczonych trzema najczęściej stosowanymi inhibitorami kinazy tyrozynowej, tj.: imatynibem, nilotynibem lub dazatynibem. Ponadto zaproponowano model monitorowania kardiologicznego w tej grupie chorych.A literature review is presented that focuses on cardiovascular complications on those patients suffering from chronic myelogenous leukemia that were treated with the 3 most commonly used tyrosine kinase inhibitors; imatinib, nilotinib or dasatinib. An appropriate scheme for their cardiac monitoring is also proposed

Postoperative high-sensitivity troponin T as a predictor of sudden cardiac arrest in patients undergoing cardiac surgery

Background: The usefulness of high-sensitivity troponin T (hs-TnT) as a predictor of sudden cardiacarrest (SCA) in patients undergoing valve surgery is currently unknown.Methods: A prospective study was conducted on a group of 815 consecutive patients with significantvalvular heart disease that underwent elective valve surgery. The primary end-point was postoperative SCA.Results: The postoperative SCA occurred in 26 patients. At multivariate analysis of hs-TnT measuredimmediately after surgery (hs-TnT I) and age remained independent predictors of the primary end-point.Conclusions: Elevated postoperative hs-TnT was associated with a higher risk of postoperative SCA

Pericardium: structure and function in health and disease

Normal pericardium consists of an outer sac called fibrous pericardium and an inner one called serous pericardium. The two layers of serous pericardium: visceral and parietal are separated by the pericardial cavity, which contains 20 to 60 mL of the plasma ultrafiltrate. The pericardium acts as mechanical protection for the heart and big vessels, and a lubrication to reduce friction between the heart and the surrounding structures. A very important role in all aspects of pericardial functions is played by mesothelial cells. The mesothelial cells form a monolayer lining the serosal cavity and play an important role in antigen presentation, inflammation and tissue repair, coagulation and fibrinolysis. The two major types of mesothelial cells, flat or cuboid, differ substantially in their ultrastructure and, probably, functions. The latter display abundant microvilli, RER, Golgi dense bodies, membrane-bound vesicles and intracellular vacuoles containing electron-dense material described as dense bodies. The normal structure and functions of the pericardium determine correct healing after its injury as a result of surgery or microbial infection. The unfavorable resolution of acute or chronic pericarditis leads to the formation of adhesions between pericardial leaflets which may lead to serious complications

Literature-based considerations regarding organizing and performing cardiac surgery against the backdrop of the coronavirus pandemic

Background: The ongoing coronavirus disease 2019 (Covid-19) pandemic presents challenges for surgeons of all disciplines, including cardiologists. The volume of cardiac surgery cases has to comply with the mandatory constraints of healthcare capacities. The treatment of Covid-19-positive patients must also be considered. Unfortunately, no scientific evidence is available on this issue. Therefore, this study aimed to offer some consensus-based considerations, derived from available scientific papers, regarding the organization and performance of cardiac surgery against the backdrop of the Covid-19 pandemic. Methods Key recommendations were extracted from recent literature concerning cardiac surgery. RESULTS: Reducing elective cardiac procedures should be based on frequent clinical assessment of patients on the waiting list (every one or two weeks) and the current local status of the Covid-19 pandemic. Screening tests at admission for every patient are broadly recommended. Where appropriate, alternative treatment methods can be considered, including percutaneous techniques and minimally invasive surgery, if performed by experienced cardiac surgery teams. Conclusions There is little evidence on the strategies to organize cardiac surgery in the Covid-19 pandemic. Most authors agree on reducing elective operations based on patients' clinical condition and the status of the Covid-19 pandemic. Admission screenings and the use of percutaneous or minimally invasive approaches should be preferred to reduce in-hospital stays

Mitral and aortic regurgitation following transcatheter aortic valve replacement

OBJECTIVE: To analyse the impact of postprocedural mitral regurgitation (MR), in an interaction with aortic regurgitation (AR), on mortality following transcatheter aortic valve implantation (TAVI). METHODS: To assess the interaction between MR and AR, we compared the survival rate of patients (i) without both significant MR and AR versus (ii) those with either significant MR or significant AR versus (iii) with significant MR and AR, all postprocedure. 381 participants of the Polish Transcatheter Aortic Valve Implantation Registry (166 males (43.6%) and 215 females (56.4%), age 78.8±7.4 years) were analysed. Follow-up was 94.1±96.5 days. RESULTS: Inhospital and midterm mortality were 6.6% and 10.2%, respectively. Significant MR and AR were present in 16% and 8.1% patients, including 3.1% patients with both significant MR and AR. Patients with significant versus insignificant AR differed with respect to mortality (log rank p=0.009). This difference was not apparent in a subgroup of patients without significant MR (log rank p=0.80). In a subgroup of patients without significant AR, there were no significant differences in mortality between individuals with versus without significant MR (log rank p=0.44). Significant MR and AR had a significant impact on mortality only when associated with each other (log rank p<0.0001). At multivariate Cox regression modelling concomitant significant MR and AR were independently associated with mortality (OR 3.2, 95% CI 1.54 to 5.71, p=0.002). CONCLUSIONS: Significant MR or AR postprocedure, when isolated, had no impact on survival. Combined MR and AR had a significant impact on a patient's prognosis

Izolacja żył płucnych wykonywana ablacją elektryczną jako metoda przywracania rytmu zatokowego w utrwalonym migotaniu przedsionków u chorych z wadą mitralną. Doniesienie wstępne

Wstęp: Ablację elektryczną prądem o wysokiej częstotliwości linii oddzielającej ujście żył płucnych od mięśnia przedsionka można traktować jako modyfikację stosowanej od ponad 10 lat metody "labiryntu". Jednak powoduje ona mniejsze uszkodzenie mięśnia przedsionka oraz niewielkie wydłużenie czasu operacji. Szczególnie interesująca wydaje się u chorych z utrwalonym migotaniem przedsionków (AF) i z wykonywaną jednocześnie korekcją wady mitralnej. Cel pracy: Wstępna ocena skuteczności izolacji żył płucnych wykonanej ablacją prądem o wysokiej częstotliwości w leczeniu utrwalonego AF u chorych z wadą zastawki mitralnej. Materiał i metody: Izolację żył płucnych ablacją prądem o wysokiej częstotliwości wykonano u 10 pacjentek. U wszystkich chorych stwierdzano AF w okresie minimum 3 miesięcy przed planowaną operacją i wykluczono współistnienie innych czynników mogących wywoływać AF. U wszystkich 10 pacjentek wszczepiono mechaniczne protezy zastawkowe w ujście mitralne. Chorych dobrano losowo. Wyniki: U wszystkich pacjentów przed leczeniem operacyjnym rejestrowano utrwalone AF przez okres od 6 miesięcy do 14 lat. U 7 chorych poddanych izolacji żył płucnych obserwowano śródoperacyjnie powrót rytmu zatokowego. W czasie dalszej obserwacji (w ciągu 4 tygodni od operacji) rytm zatokowy utrzymał się u 2 pacjentek, u 3 chorych występowały napady nadkomorowych arytmii, u 3 osób rejestrowano migotanie przedsionków, a u 2 pacjentek - ze względu na okresowo pojawiający się rytm węzłowy z wolną czynnością komór - konieczne było wszczepienie układu stymulującego serce. W okresie 3-6 miesięcy od operacji u 6 chorych rejestrowano rytm zatokowy, u 2 - utrwalone AF, a w 2 przypadkach obserwowano skuteczną stymulację serca. Wnioski: Wykonanie izolacji żył płucnych ablacją prądem o wysokiej częstotliwości pozwoliło na przywrócenie rytmu zatokowego bezpośrednio po operacji u 60% pacjentów. W trakcie dalszej obserwacji rytm zatokowy rejestrowano trwale u 60% chorych, natomiast u 20% - utrwalone AF. U 2 spośród 10 pacjentów po izolacji żył płucnych ujawnił się rytm zastępczy z węzła przedsionkowo-komorowego z wolną czynnością komór, wymagający wszczepienia układu stymulującego serce

Risk factors for bleeding complications in patients undergoing transcatheter aortic valve implantation (TAVI)

Background: The risk of bleedings in transcatheter aortic valve implantation (TAVI) patientsincreases due to age and concomitant diseases. The aim of the study was to assess the risk ofbleedings, their influence on early prognosis of TAVI patients and utility of the TIMI andGUSTO scales in the evaluation of bleeding and in prediction of blood transfusion.Methods: This was a single center study of in-hospital bleedings in 56 consecutive TAVIpatients. Bleedings were classified according to the GUSTO and TIMI scales. HASBLED‘sscale risk factors, diabetes mellitus, female sex, the route of bioprosthesis implantation and inhospitalantithrombotic treatment were analyzed. Statistical analysis consisted of c2, Fisher’sexact, Wilcoxon tests and logistic regression analysis.Results: Serious bleedings occurred in 35 (62.5%) patients. There was no significantcorrelation with HASBLED score. History of anemia was a significant predictor of bleeding inGUSTO (p = 0.0013) and TIMI (p = 0.048) scales. No bleedings in patients receivingvitamin K antagonists (VKA) pre- and VKA plus clopidogrel post intervention were observed.Patients with bleedings according to the GUSTO scale more often required blood tranfusionthan in TIMI scale (p = 0.03).Conclusions: History of anemia is the strongest predictor of serious bleedings. VKA beforeand VKA with clopidogrel after TAVI are safer than dual antiplatelet or triple therapy. TheTIMI and GUSTO scales can adequately classify bleeding after TAVI, however the GUSTObetter predicts transfusions