Short- and mid-term outcome of transcatheter aortic valve implantation in patients with advanced age

Background: In patients treated with transcatheter aortic valve implantation (TAVI), age is recognized as one of the most important risk factors. The aim of our study was to evaluate whether early and mid-term results of TAVI were worse in patients over 85 year old compared with the younger population. Methods: From September 2010 to November 2015, 162 consecutive patients (mean age 78.4 ± 7.1 years, 47.5% females) underwent TAVI in our Institution. Patients were divided into two groups: 1) elderly (≥ 85 year old) and 2) younger patients (< 85 year old). Primary clinical study endpoints were the fol­lowing: death, myocardial infarction, stroke, major and minor access site, and bleeding complications. The secondary endpoints included: pacemaker implantation rate, paravalvular leakage, acute kidney injury, and duration of hospitalization. Results: Twenty-six patients were 85 or older (mean 87.5 ± 2.1). In the remaining 136 (84%), the average age was 76.7 ± 6.4. Baseline clinical profiles were similar in both groups, though history of pre­vious cardiac surgery (p = 0.0047) and chronic obstructive pulmonary disease (p = 0.0099) were more common in the younger group, and glomerular filtration rate was lower in the older group (p = 0.045). Major, life threatening and minor bleeding complications, as well as vascular access site complications did not differ between the two groups. Rates of myocardial infarction and stroke were comparably low in both groups. Similar results were also found in the incidence of secondary endpoints. In-hospital mortality and 1-year mortality did not differ between groups. Conclusions: TAVI in patients aged 85 and older is still a relatively safe procedure and age itself should not be a discriminatory factor in TAVI qualification. (Cardiol J 2017; 24, 4: 358–363

Computer tomography guided transthoracic periaortic abscess needle biopsy in late mediastinitis after heart surgery

Mediastinitis is a well-known complication of open heart surgery. Abscess as late complication, presenting years after heart surgery, is adegnotical. Transthoracic needle biopsies of lung parenchyma guided by computer tomography are widely accepted. The puncture of periaortic masses is not routinely performed. We report the case of an encapsulated mediastinal abscess localized next to ascending vascular graft. The febrile 47-year-old white male patient with history of Bentall operation was admitted to Cardiac Surgery Department. He was transferred for urgent chest tomography after International Normalization Ratio was reversed by prothrombin complex concentrate. Tomography revealed 7 × 5 × 4 cm mass between the sternum and ascending aorta, that was punctured by the needle. After biopsy specimen was sent for microbiology, the patient was transferred for surgery. There was no vascular graft invasion by the mass. The surgery was limited to abscess removal with postoperative drainage of periaortic area. The 6-week antibiotic therapy was applied. Patient recovered uneventfully

Zwężenie pnia lewej tętnicy wieńcowej w badaniu koronarograficznym — ostre rozwarstwienie aorty w rozpoznaniu śródoperacyjnym

Acute aortic dissection occurs in 0.5–2.95 cases per 100,000 citizens-year. Although the modern diagnostic tools help in more accurate diagnosis, the missleading findings still occure. We present a case of a 72-year-old man who was admitted to cardiology ward due to persistent chest pain. Initial diagnosis of acute coronary syndrome was confirmed by electrocardiography (ST segment depression in V1–V5 leads), transthoracic echocardiography (anterior wall dyskinesis) and laboratory tests (Tn-I: 6.92 μ/L, CK-MB: 226.24 ng/mL). Due to aortic aneurysm history, computer tomography (CT) was performed. Neither CT nor transthoracic echocardiography were negative for aortic dissection. Intraoperatively aortic dissection limited to Valsalva sinuses was found. Left main orifice was blindly closed followed by Bentall procedure and coronary artery revascularisation.Acute aortic dissection occurs in 0.5–2.95 cases per 100,000 citizens-year. Although the modern diagnostic tools help in more accurate diagnosis, the missleading findings still occure. We present a case of a 72-year-old man who was admitted to cardiology ward due to persistent chest pain. Initial diagnosis of acute coronary syndrome was confirmed by electrocardiography (ST segment depression in V1–V5 leads), transthoracic echocardiography (anterior wall dyskinesis) and laboratory tests (Tn-I: 6.92 μ/L, CK-MB: 226.24 ng/mL). Due to aortic aneurysm history, computer tomography (CT) was performed. Neither CT nor transthoracic echocardiography were negative for aortic dissection. Intraoperatively aortic dissection limited to Valsalva sinuses was found. Left main orifice was blindly closed followed by Bentall procedure and coronary artery revascularisation

Asymptomatic thoracic stentgraft collapse treated conservatively

W pracy przedstawiono przypadek 58-letniego mężczyzny przyjętego do szpitala z ostrym rozwarstwieniem aorty (typ B według klasyfikacji Stanforda), który zaopatrzono stentgraftem piersiowym Cook Zenith. Trzy miesiące po zabiegu, podczas pierwszej rutynowej kontroli, przeprowadzono badanie angiografii tomografii komputerowej (CTA), w którym wykazano proksymalne zamknięcie się stentgraftu. Próba ponownego otwarcia protezy okazała się nieskuteczna. Pacjenta poinformowano o potrzebie przeprowadzenia zabiegu kardiochirurgicznego oraz o ewentualnym związanym z nim ryzyku. Chory odmówił poddania się operacji. Do tej pory, 3 lata po zdiagnozowaniu zamkniętego stentgraftu, u pacjenta nie występują żadne objawy. W systematycznie przeprowadzanych co 6–9 miesięcy kontrolnych badaniach CTA nie stwierdza się dalszego poszerzania aorty piersiowej. Acta Angiol 2010; 16, 3: 138–143We describe a case of 58-year-old male with complicated acute type B aortic dissection that was treated with a Cook Zenith thoracic stentgraft. Three months after the procedure, the first routine follow-up computed tomography angiography (CTA) revealed proximal collapse of the stentgraft. An attempt to reopen the endograft from the distal part in a retrograde manner followed by second device implantation failed. After the patient was informed about the need for an open surgical procedure and its related risk, he refused to be operated upon. Up to now, 3 years after diagnosis of stentgraft collapse, he has remained asymptomatic and in serial follow-up CTA scans carried out every 6 to 9 months no further thoracic aortic dilatation has been noted. Acta Angiol 2010; 16, 3: 138–14