Decision Making in Patients Undergoing Coronary Artery Revascularization : A New Era in Clinical Trial Design and Evidence-Based Practice

The clinical goals for the care of each patient with complex coronary artery disease are to ensure that the most appropriate treatment is selected, and the best available evidence is used to guide procedural techniques and modify risk factors that could impact life expectancy and health-related quality of life. In this thesis, ef

Comparative study of male and female patients undergoing surgical aortic valve replacement

BACKGROUND: Sex does have an effect on disease perception and outcomes after cardiac surgery. OBJECTIVES: The aim of this study was to quantify the differences in cardiovascular risk profiles within an age-matched cohort and assess the long-term survival differences in males and females who underwent surgical aortic valve replacement (SAVR) with or without concomitant coronary artery bypass surgery. METHODS: All-comers patients who underwent SAVR with or without coronary artery bypass surgery were included. Characteristics, clinical features and survival up to 30 years were compared between female and male patients. Propensity matching and age matching using propensity scores were used to compare both groups. RESULTS: During the total study period between 1987 and 2017, there were 3462 patients {mean age 66.8 [standard deviation (SD): 11.1] years, 37.1% female} who underwent SAVR with or without coronary artery bypass surgery at our institution. In general, female patients were older than male patients (69.1 (SD: 10.3) versus 65.5 (SD: 11.3), respectively). In the age-matched cohort, female patients were less likely to have multiple comorbidities and undergo concomitant coronary artery bypass surgery. Twenty-year survival following the index procedure was higher in age-matched female patients (27.1%) compared to male patients (24.4%) in the overall cohort (P = 0.018). CONCLUSIONS: Substantial sex differences in cardiovascular risk profile exist. However, when SAVR with or without coronary artery bypass surgery is performed, extended long-term mortality is comparable between males and females. More research regarding sex-dimorphic mechanisms of aortic stenosis and coronary atherosclerosis would promote more awareness in terms of sex-specific risk factors after cardiac surgery and contribute to more guided personalized surgery in the future.</p

Proizvodnja destilata šljive sorte Stenlej

This paper shows the distillation process of the husk obtained from Stanley plum and the redistillation of the basic distillate performed on the brandy boiler used for the household production in Serbia. Ethanol concentrations in fractions, distillate and liquid mixture in boiler versus distillate volume were shown.U radu je prikazan proces destilacije komine šljive sorte Stenlej (Stanley) i redestilacije osnovnog destilata na aparaturi kazanskog tipa koja se koristi za proizvodnju rakije u domaćinstvima u Srbiji. Predstavljeni su koncentracioni profili etanola u frakcijama, destilatu i tečnoj smeši u kazanu u zavisnosti od zapremine destilata

Mastering the Best Practices:A Comprehensive Look at the European Guidelines for Cardiopulmonary Bypass in Adult Cardiac Surgery

The successful outcome of a cardiac surgery procedure is significantly dependent on the management of cardiopulmonary bypass (CPB). Even if a cardiac operation is technically well-conducted, a patient may suffer CPB-related complications that could result in severe comorbidities, reduced quality of life, or even death. However, the role of clinical perfusionists in perioperative patient care, which is critical, is often overlooked. Therefore, the European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Cardiothoracic Anaesthesiology (EACTA), and the European Board of Cardiovascular Perfusion (EBCP) have agreed to develop joint clinical practice guidelines (CPGs) for CPB due to its significant impact on patient care and significant variations in practice patterns between countries. The European guidelines, based on the EACTS standardized framework for the development of CPGs, cover the entire spectrum of CPB management in adult cardiac surgery. This includes training and education of clinical perfusionists, machine hardware, disposables, preparation for initiation of CPB, a complete set of procedures during CPB to help maintain end-organ function and anticoagulation, weaning from CPB, and the gaps in evidence and future research directions. This comprehensive coverage ensures that all aspects of CPB management are addressed, providing clinicians with a standardized approach to CPB management based on the latest evidence and best practices. To ensure better integration of these evidence-based recommendations into daily practice, this review aims to provide a general understanding of guideline development and an overview of essential treatment recommendations for CPB management.</p

Pranje i dezinfekcija vodovodne mreže na poligonu nacionalne vozačke akademije NAVAK u Subotištu

Simply and cheap cleaning/disinfection procedure for treatment of aqueduct network from car testing polygon in Subotište was shown. Aqueduct network was exploited for three years without any water treatment. High water temperature up to 28°C and absence of disinfection, resulted in biofilm formation at pipe surface. Pipe-line was improved by cleaning and washing, neutralization, hyperchlorination and application of peroxide and silver. The effect of the process parameters (concentration and type of agent) on cleaning, washing and disinfection of pipe-line was investigated. A new, low-cost method for the use of tested chemicals based on frontal release of "plugs" was established. The results showed that prior to the treatment there was bacteriological contamination of the pipeline with Pseudomonas aeruginosa. However, after the performed cleaning, wash and water disinfection process at all points in the business premises and hydrant network, the quality of water was according to Rulebook on the bacteriological correctness of drinking water. The most effective oxidation and disinfection agent has been shown to be a composite solvent based on hydrogen peroxide and colloidal silver "Silosone" at a concentration of up to 20 mg/L.U radu je prikazan jednostavan i jeftin postupak za čišćenje i dezinfekciju vodovodnog sistema na poligonu za ispitivanje automobila u Subotištu. Vodovodni sistem je bio u eksploataciji tri godine bez ikakvog tretmana vode. Povećana temperatura vode do čak 28°C i odsustvo dezinfekcionog sredstva uzrok je pojave biofilma u cevovodu. Cevovod je saniran čišćenjem i ispiranjem, neutralizacijom, hiperhlorisanjem i primenom peroksida i srebra. Ustanovljen je efekat operativnih parametara (koncentracija i vrsta sredstva) za proces čišćenja, pranja i dezinfekcije cevovoda. Prikazan je i novi metod frontalnog puštanja „čepova“ testiranih sredstava za čišćenje i pranje, a uz minimalnu potrošnju kako bi troškovi procesa bili što niži. Rezultati su pokazali da je pre tretmana postojalo bakteriološko zagađenje cevovoda bakterijom Pseudomonas aeruginosa. Međutim, posle izvršenih procesa čišćenja, pranja i dezinfekcije voda na svim točećim mestima u poslovnim objektima i hidrantskoj mreži, bila po Pravilniku o bakteriološkoj ispravnosti pijaće vode. Pokazano je da je najefikasnije sredstvo za oksidaciju i dezinfekciju kompozitno sredstvo na bazi vodonik peroksida i koloidnog srebra „Silozon“ u koncentraciji do 20 mg/L

Acute aortic dissection in a patient with Marfan syndrome during advanced pregnancy

Pregnant patients with Marfan syndrome (MFS) are at high risk of developing aortic dissection or rupture during the third trimester and early postpartum period. This increased likelihood is the consequence of the hyperdynamic and hypervolemic cardiocirculatory state and/or pregnancy-mediated structural changes of the arterial wall in response to hemodynamic and hormonal changes. In this article, we report on the case of a 26-year-old pregnant woman with MFS in the 30th gestation w

2022 Joint ESC/EACTS review of the 2018 guideline recommendations on the revascularization of left main coronary artery disease in patients at low surgical risk and anatomy suitable for PCI or CABG

Task Force structure and summary of clinical evidence of 2022 ESC/EACTS review of the 2018 guideline recommendations on the revascularization of left main coronary artery disease. CABG, coronary artery bypass grafting; PCI, percutaneous coronary intervention; LM, left main; SYNTAX, Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery. a'Event' refers to the composite of death, myocardial infarction (according to Universal Definition of Myocardial Infarction if available, otherwise protocol defined) or stroke. In October 2021, the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) jointly agreed to establish a Task Force (TF) to review recommendations of the 2018 ESC/EACTS Guidelines on myocardial revascularization as they apply to patients with left main (LM) disease with low-to-intermediate SYNTAX score (0-32). This followed the withdrawal of support by the EACTS in 2019 for the recommendations about the management of LM disease of the previous guideline. The TF was asked to review all new relevant data since the 2018 guidelines including updated aggregated data from the four randomized trials comparing percutaneous coronary intervention (PCI) with drug-eluting stents vs. coronary artery bypass grafting (CABG) in patients with LM disease. This document represents a summary of the work of the TF; suggested updated recommendations for the choice of revascularization modality in patients undergoing myocardial revascularization for LM disease are included. In stable patients with an indication for revascularization for LM disease, with coronary anatomy suitable for both procedures and a low predicted surgical mortality, the TF concludes that both treatment options are clinically reasonable based on patient preference, available expertise, and local operator volumes. The suggested recommendations for revascularization with CABG are Class I, Level of Evidence A. The recommendations for PCI are Class IIa, Level of Evidence A. The TF recognized several important gaps in knowledge related to revascularization in patients with LM disease and recognizes that aggregated data from the four randomized trials were still only large enough to exclude large differences in mortality.</p

Enhancing predictive accuracy of the cardiac risk score in open abdominal aortic surgery: the role of left ventricular wall motion abnormalities

BackgroundOpen abdominal aortic surgery carries many potential complications, with cardiac adverse events being the most significant concern. The Vascular Study Group Cardiac Risk Index (VSG-CRI) is a commonly used tool for predicting severe cardiac complications and guiding clinical decision-making. However, despite the potential prognostic significance of left ventricular wall motion abnormalities (LVWMAs) and reduced LV ejection fraction (LVEF) for adverse outcomes, the VSG-CRI model has not accounted for them. Hence, the main objective of this study was to analyze the added value of LV wall motion on the discriminatory power of the modified VSG-CRI in predicting major postoperative cardiac complications.MethodsA prospective study was conducted involving 271 patients who underwent elective abdominal aortic surgery between 2019 and 2021. VSG-CRI scores were calculated, and preoperative transthoracic echocardiography was conducted for all patients. Subsequently, a modified version of the VSG-CRI, accounting for reduced LVEF and LVWMAs, was developed and incorporated into the dataset. The postoperative incidence of the composite endpoint of major adverse cardiac events (MACEs), including myocardial infarction, clinically relevant arrhythmias treated with medicaments or by cardioversion, or congestive heart failure, was assessed at discharge from the index hospitalization, with adjudicators blinded to events. The predictive accuracy of both the original and modified VSG-CRI was assessed using C-Statistics.ResultsIn total, 61 patients (22.5%) experienced MACEs. Among these patients, a significantly higher proportion had preoperative LVWMAs compared to those without (62.3% vs. 32.9%, p &lt; 0.001). Multivariable regression analysis revealed the VSG-CRI [odds ratio (OR) 1.46, 95% confidence interval (CI) 1.21–1.77; p &lt; 0.001] and LVWMA (OR 2.76; 95% CI 1.46–5.23; p = 0.002) as independent predictors of MACEs. Additionally, the modified VSG-CRI model demonstrated superior predictability compared to the baseline VSG-CRI model, suggesting an improved predictive performance for anticipating MACEs following abdominal aortic surgery [area under the curve (AUC) 0.74; 95% CI 0.68–0.81 vs. AUC 0.70; 95% CI 0.63–0.77; respectively].ConclusionThe findings of this study suggest that incorporating preoperative echocardiography can enhance the predictive accuracy of the VSG-CRI for predicting MACEs after open abdominal aortic surgery. Before its implementation in clinical settings, external validation is necessary to confirm the generalizability of this newly developed predictive model across different populations