Search

Background: The benefits of oral anticoagulation (OAC) therapy are undeniable. However, such treatment is contraindicated in 2%-10% of patients. According to the latest guidelines, percutaneous left atrial appendage occlusion (LAAO) may be considered in stroke prevention., Aims: We analyzed the data of patients from the Polish population, who had undergone LAAO procedures in the Silesian Province based on limited reports., Methods: The data from the SILCARD database of all patients who underwent LAAO between 2006 and 2019, and the data from the databases of the centers performing the procedures in the Silesian Province were included in the LAAO SILESIA registry. We analyzed the efficacy and safety of the procedure and its relationship with the occurrence of stroke and bleeding in the post-hospital follow-up., Results: We analyzed 649 patients with the mean values of CHA2DS2-VASc and HAS-BLED scores of 4.1 and 3.2, respectively. The predominant indication for LAAO was a history of bleeding during OAC. The most frequent in-hospital major adverse cardiac events were anemia, which required blood transfusion (5.5%), and pericardial effusion, which was treated either conservatively (0.9%) or interventionally (1.2%). During hospitalization, stroke was detected in 4 patients and three patients died of any cause. LAAO reduced the annual risk of stroke by 84% and the annual risk of bleeding by 27%., Conclusions: Based on a "real-life" cohort of patients from the Silesian Province, we concluded that LAAO is related to low in-hospital major cardiovascular adverse events. In the long-term follow-up, LAAO reduced the rates of stroke and bleeding.

Background: Anxiety is a common and serious problem in ischaemic heart disease. Anxiety-associated somatisation disorders may imitate symptoms of coronary artery disease or coexist with ischaemic heart disease. Despite multiple visits to various specialists, patients with somatisation are frequently misdiagnosed and therefore mistreated. Identification of patients with anxiety disorders among patients complaining of chest pain is a prerequisite for appropriate management. By its nature, coronary angiography is a diagnostic test that can give rise to anxiety. However, dynamics of anxiety in this setting may be variable depending on coexisting mental disorders., Aim: The purpose of this study was to determine whether the presence of significant atherosclerotic lesions in coronary arteries affects anxiety level changes following coronary angiography., Methods: A group of 90 female patients who underwent coronary angiography was divided into two groups: the first one included 48 patients without significant coronary stenoses, and the other one included 42 patients with confirmed significant atherosclerotic lesions. Dynamics of anxiety level changes from the hospital admission, through the post-examination period, until 6 to 9 months after coronary angiography was evaluated with three-time measurement of anxiety using the Spielberger's State-Trait Anxiety Inventory. In addition, intensity of anxiety as a trait was measured twice (at the first and the third examination)., Results: The highest intensity of anxiety as a state was noted in both groups at the first measurement. A significant reduction in anxiety was observed at the second measurement, more pronounced in the group without significant coronary lesions. At the third measurement, women with confirmed significant coronary lesions showed the lowest level of anxiety, while the level of anxiety increased compared to the second measurement in the group of patients without significant coronary lesions. At the third measurement, women without significant coronary lesions showed a significantly higher level of anxiety compared to the group with significant coronary lesions. Intensity of anxiety as a trait was significantly lower at the final measurement in the group of patients with confirmed significant coronary stenoses., Conclusions: In women demonstrating no significant atherosclerotic lesions in coronary angiography, anxiety does not resolve permanently but reappears after several months. In this group, is seems justified to consider a diagnosis of an anxiety disorder in the form of a somatoform disorder. Those patients should be offered psychiatric therapy.

Background: Transcatheter aortic valve replacement (TAVR) has proven to be a valuable alternative to conventional surgical aortic valve replacement in high risk and surgically in operable patients who suffer from severe symptomatic aortic stenosis. However, a significant number of complications, associated with both the learning curve and device specificity, have required attention and subsequent improvement. The Symetis transapical TAVR system is a self-positioning bioprosthesis composed of a non-coronary leaflet of surgical quality porcine tissue valve sewn into a self-expanding nitinol stent that iscovered with a PET-skirt., Methods: From June to September 2013 six patients have been operated on severe aortic stenosis using the new TAVR device. All patients have undergone critical assessment of a local Heart Team and have been disqualified from conventional AVR. Five were woman. Mean age was 82.3 ± 2.0 (mean LogEuroScore 23.9 ± 14.3). Four patients suffered from coronary artery disease - two had history of previous percutaneous coronary intervention with intracoronary stents, while the next two had history of coronary artery bypass grafting. Diabetes was frequent (n = 3) as well as chronic obstructive pulmonary disease (n = 4). Carotid artery disease was encountered in three patients similarly to atrial fibrillation. Mean left ventricular ejection fraction (LVEF) was 51.5 ± 11.8%, but one patient had suffered from low-flow-low-gradient aortic stenosis with LVEF of 29%., Results: The procedure was carried out successfully in all six cases. Two patients have received the valve sized L, three - M and one - S. Mean procedure time was 180 ± 19 min, mean cine 7.2 ± 1.2 min. Mean X-ray dose 930 ± 439 mGy, while mean volume of contrast given was 135 ± 61 mL. In all patients but one perivalvular leak (PVL) was not present. One patient had trace of PVL. Also, good LVEF was noted in all patients. Similar findings were obtained 30 days post procedure. No strokes, transient ischaemic attack or other cerebrovascular incidents were observed., Conclusions: This brief clinical communication reports the first Polish experience with the second generation of TAVR device - the Symetis Acurate Transapical Aortic Valve. While it lacks large patient population and longer follow-up, it reveals that TAVR procedure can be performed safely, with minimal X-ray exposure time and contrast given and successfully - with almost nonexistent PVL and no cerebrovascular incidents or heart rhythm disturbances. Heart Team approach is vital, and transapical access should not be treated inferiorly, but rather as an equally appealing TAVR option.

Background: Although the introduction of primary percutaneous coronary interventions (PCI) improved the outcome of patients with acute myocardial infarction (MI), diabetes remains a significant factor which worsens prognosis., Aim: To compare the immediate and in-hospital results of PCI in patients with acute MI with or without diabetes., Methods: The outcome of 139 patients with diabetes and 528 patients without diabetes was compared. Thrombolytic therapy was administered prior to PCI to 43.2% of patients with diabetes and 42.4% of patients without diabetes., Results: Patients with diabetes were older, more frequently of female gender and had higher incidence of hypertension as well as multi-vessel coronary artery disease. PCI was effective in 85.6% of diabetics and 90.2% of non-diabetic patients (NS). The reocclusion rate was significantly higher in diabetics than in non-diabetics (11.5% vs 5.5%, p=0.012) whereas the incidence of haemorrhagic complications was similar. Mortality rates were comparable in both groups (7.2% in diabetics vs 5.9% in non-diabetics, NS)., Conclusions: 1) Immediate efficacy of primary PCI for acute MI is similar in diabetics and non-diabetics, however, the in-hospital reocclusion rate is higher in the former group of patients. 2) In-hospital mortality is not affected by the presence of diabetes. 3) Thrombolytic and invasive treatment of diabetic patients with acute MI is not associated with an increased risk of bleeding.