Izolowana choroba pnia lewej tętnicy wieńcowej - przebieg kliniczny u 14 pacjentów

W niniejszej pracy opisano grupę 14 osób z izolowaną istotną stenozą pnia lewej tętnicy wieńcowej, rozpoznaną na podstawie koronarografii. Dominującym objawem klinicznym u pacjentów były nasilone bóle stenokardialne - u większości występowały objawy zwykle spotykane u osób z chorobą wieńcową. Obserwowano także przebieg nietypowy, w tym bezobjawowy. Żadne z przeprowadzonych badań nieinwazyjnych nie wyodrębniało pacjentów z izolowaną chorobą pnia lewej tętnicy wieńcowej. U wszystkich chorych zastosowano odpowiednie leczenie, w tym nowe metody - implantację stentu oraz chirurgiczną plastykę

Izolowana choroba pnia lewej tętnicy wieńcowej - przebieg kliniczny u 14 pacjentów

W niniejszej pracy opisano grupę 14 osób z izolowaną istotną stenozą pnia lewej tętnicy wieńcowej, rozpoznaną na podstawie koronarografii. Dominującym objawem klinicznym u pacjentów były nasilone bóle stenokardialne - u większości występowały objawy zwykle spotykane u osób z chorobą wieńcową. Obserwowano także przebieg nietypowy, w tym bezobjawowy. Żadne z przeprowadzonych badań nieinwazyjnych nie wyodrębniało pacjentów z izolowaną chorobą pnia lewej tętnicy wieńcowej. U wszystkich chorych zastosowano odpowiednie leczenie, w tym nowe metody - implantację stentu oraz chirurgiczną plastykę

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

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

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

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

Management of valvular heart disease in patients with cancer: Multidisciplinary team, cancer-therapy related cardiotoxicity, diagnosis, transcatheter intervention, and cardiac surgery. Expert opinion of the Association on Valvular Heart Disease, Association of Cardiovascular Interventions, and Working Group on Cardiac Surgery of the Polish Cardiac Society

The Association on Valvular Heart Disease, Association of Cardiovascular Interventions, and the Working Group on CardiacSurgery of the Polish Cardiac Society have released a position statement on risk factors, diagnosis, and management of patients with cancer and valvular heart disease (VHD). VHD can occur in patients with cancer in several ways, for example, it can exist or be diagnosed before cancer treatment, after cancer treatment, be an incidental finding during imaging tests, endocarditis related to immunosuppression, prolonged intravenous catheter use, or combination treatment, and nonbacterial thrombotic endocarditis. It is recommended to employ close cardiac surveillance for patients at high risk of complications during and after cancer treatment and for cancer treatments that may be cardiotoxic to be discussed by a multidisciplinary team. Patients with cancer and pre-existing severe VHD should be managed according to the 2021 European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) guidelines for VHD management, taking into consideration cancer prognosis and patient preferences

Erector Spinae Plane Block Decreases Chronic Postoperative Pain Severity in Patients Undergoing Coronary Artery Bypass Grafting

Up to 56% of patients develop chronic postsurgical pain (CPSP) after coronary artery bypass grafting (CABG). CPSP can affect patients’ moods and decrease daily activities. The primary aim of this study was to investigate CPSP severity in patients following off-pump (OP) CABG using the Neuropathic Pain Symptom Inventory (NPSI). This was a prospective cohort study conducted in a cardiac surgery department of a teaching hospital. Patients undergoing OP-CABG were enrolled in an erector spinae plane block (ESPB) group (n = 27) or a control (CON) group (n = 24). Before the induction of general anesthesia, ESPB was performed on both sides under ultrasound guidance using 0.375% ropivacaine. The secondary outcomes included cumulative oxycodone consumption, acute pain intensity, mechanical ventilation time, hospital length of stay, and postoperative complications. CPSP intensity was lower in the ESPB group than in the CON group 1, 3, and 6 months post-surgery (p < 0.001). Significant between-group differences were also observed in other outcomes, including postoperative pain severity, opioid consumption, mechanical ventilation time, and hospital length of stay, in favor of the ESPB group. Preemptive ESPB appears to decrease the risk of CPSP development in patients undergoing OP-CABG. Reduced acute pain severity and shorter mechanical ventilation times and hospital stays should improve patients’ satisfaction and reduce perioperative complications