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Background. Early defibrillation and high-quality chest compressions are crucial in treatment of sudden cardiac arrest (SCA) subjects. The aim of this study was to assess an impact of defibrillation methods on cardiopulmonary resuscitation (CPR) quality. Methods. A randomized simulation cross-study was designed, in which 100 two-person paramedical teams participated. Two 10-minute scenarios of SCA in the mechanism of ventricular fibrillation were analysed. In the first one, teams had at their disposal defibrillator with hard paddles (group C), whereas in the second one, adhesive electrodes were used (group MFE). The CPR quality was evaluated on the basis of the chest compression parameters (rate, depth, recoil, compression fraction (CCF), and no-flow time), airways patency achievement, and successful emergency drug administration. Results. Substituting standard hard paddles with adhesive electrodes led to an increase in CCF (77% vs 73%; p < 0.05 ), higher rate of complete chest recoil, and a decrease in no-flow time (6.0 ± 1.1 vs. 7.3 ± 1.1; p < 0.001 ). The airway patency was ensured sooner in group MFE (271 ± 118 s vs. 322 ± 106 s in group C; p < 0.001 ). All teams in scenario with adhesive electrodes were able to administer two doses of adrenaline, meanwhile only 74% of them in group C ( p < 0.001 ). Moreover, in 8% of group C scenarios, paramedics did not have enough time to administer amiodarone. Conclusion. Our simulation-based analysis revealed that use of adhesive electrodes during defibrillation instead of standard hard paddles may improve the quality of CPR performed by two-person emergency team.

Every procedural facilitation or a change in available equipment in treatment of out-of-hospital arrest (OHCA) by two-person teams may significantly enhance their performance quality. The aim of this study was to assess the impact of adrenaline in prefilled syringes on improving the adherence to Advanced Life Support protocol by understaffed teams. The research was based on a randomized cross-over high-fidelity simulation study. Two-person teams took part in two 10-minute simulation scenarios featuring sudden cardiac arrest in ventricular fibrillation (VF). The control group (group C) had at its disposal standard ampoules, whereas the experimental group (group E) prefilled syringes. The execution times of CPR start, defibrillation shocks, intravenous (IV) access, epinephrine and amiodarone doses were measured. Additionally, the chest compression fraction (CCF) was calculated. The designed two-minute loops were considerably prolonged in group C. Nineteen teams (31.1%) in group C but 49 (80.3%) in group E carried out the fifth defibrillation (P < 0.001). After two minutes of CPR nobody in group C switched to perform chest compressions. IV access was obtained significantly earlier in group E (114.7 ± 52.2 sec) than in group C (150.2 ± 68.6 sec)(P = 0.002). Two doses of adrenaline were administered in group E, whereas its second dose only by 12 teams in group C. The simulation study has proved that for understaffed teams a use of prefilled syringes not only did enhance the flow of ALS procedure, but it also improved the quality of cardiopulmonary resuscitation.

Introduction: The use of protocols reduces the risk of human error and increases healthcare professionals’ adherence to guidelines. In a team of only two providers, following Advanced Life Support (ALS) protocol might be challenging. Automated Chest Compressions Devices (ACCD) may increase the quality of chest compressions. The aim of this study was to evaluate if the use of ACCD in resuscitation by a two-paramedic crew improves adherence to the ALS protocol. Materials and Methods: This study was designed as a prospective randomized high-fidelity cross-over simulation trial. Fifty-two doubleperson teams were enrolled. Each team performed two full resuscitation scenarios: one with ACCD (the experimental group-ACC) and one with manual compressions (the control group-MAN). Results: ACC achieved shorter mean durations of resuscitation loops, being less prolonged in relation to recommended durations than MAN (13 vs. 23 sec over recommended respectively, P = 0.0003). ACC also achieved mean times for supraglottic airway completion significantly faster than MAN: 224 ± 66 s vs 122 ± 35 s (P < 0.0001). In ACC, the intravenous line was obtained earlier then in MAN (162 ± 35 s vs 183 ± 45 s, P = 0.0111). Moreover, the first and second doses of adrenaline (epinephrine) were administered earlier 272± 58 s vs 232 ± 57 s (P = 0.0014) for the first and 486 ± 96 s vs 424 ± 69 s (P = 0.0007) for the second doses, respectively. Mean chest compression fraction (CCF) in MAN group was significantly lower (74 ± 4%) than in ACC group (83 ± 2%) (P < 0.0001). Conclusions: In a simulated setting, ACCD used by two-person paramedic teams yielded earlier achievement of resuscitation endpoints and improved delivery time of compressions. which may have implications for effective clinical resuscitation.

Background: Although medical emergencies among dental patients are not frequent, several factors may provoke sudden cardiac arrests. Early initiation of high-quality chest compressions (CC) is of crucial importance for the safety and effectiveness of cardiopulmonary resuscitation (CPR). Aims: We aimed to evaluate the quality of chest compressions performed on a dental chair for the proposed procedure in case of cardiac arrest in a dental office. Methods: We designed a prospective, randomized, crossover simulation study. Sixty paramedic students were randomly assigned to the control group, in which resuscitation was performed on the floor (n = 30) or to the experimental group, in which compressions were performed on a dental unit (n = 30). We used a simulator that recorded number of compressions, rate, depth of compressions and chest recoil. Results: There were no significant differences in numbers, rate, depth of chest compressions or in chest recoil between groups. Conclusions: We proved that performing chest compressions on a dental chair might be as effective as on the floor. On this basis, we propose a procedure for safe and efficient performance of CPR in a dental office.

The implemented "ECMO for Greater Poland" program takes full advantage of the ECMO (extracorporeal membrane oxygenation) perfusion therapy to promote health for 3.5 million inhabitants in the region. The predominant subjects of implementation are patients with hypothermia, with severe reversible respiratory failure (RRF), and treatment of other critical states leading to heart failure such as sudden cardiac arrest, cardiogenic shock or acute intoxication. Finally, it promotes donation after circulatory death (DCD) strategy in selected organ donor cases. ECMO enables recovery of organs' function after unsuccessful lifesaving treatment. Because this organizational model is complex and expensive, we use advanced high-fidelity medical simulation to prepare for real-life implementation. During the first four months, we performed scenarios mimicking "ECMO for DCD," "ECMO for ECPR (extended cardiopulmonary resuscitation)," "ECMO for RRF" and "ECMO in hypothermia." It helped to create algorithms for aforementioned program arms. In the following months, three ECMO courses for five departments in Poznan (capitol city of Greater Poland) were organized and standardized operating procedures for road ECMO transportation within Medical Emergency System were created. Soon after simulation program, 38 procedures with ECMO perfusion therapy including five road transportations on ECMO were performed. The Maastricht category II DCD procedures were done four times on real patients and in two cases double successful kidney transplantations were carried out for the first time in Poland. ECMO was applied in two patients with hypothermia, nine adult patients with heart failure, and five with RRF, for the first time in the region. In the pediatric group, ECMO was applied in four patients with RRF and 14 with heart failure after cardiac surgery procedures. Additionally, one child was treated successfully following 200 km-long road transport on ECMO. We achieved good and promising results especially in VV ECMO therapy. Simulation-based training enabled us to build a successful procedural chain, and to eliminate errors at the stage of identification, notification, transportation, and providing ECMO perfusion therapy. We discovered the important role of medical simulation, not only to test the medical professional's skills, but also to promote ECMO therapy in patients with critical/life-threatening states. Moreover, it also resulted in increase of the potential organ pool from DCD in the Greater Poland region.

The "ECMO for Greater Poland" program takes full advantage of the extracorporeal membrane oxygenation (ECMO) perfusion therapy opportunities to promote the health of the 3.5 million inhabitants in the region. The main implementation areas are treatment of patients with hypothermia; severe reversible respiratory failure (RRF); critical states resulting in heart failure, that is, cardiac arrest, cardiogenic shock, or acute intoxication; and promotion of the donor after circulatory death (DCD) strategy in selected organ donor cases, after unsuccessful life-saving treatment, to achieve organ recovery. This organizational model is complex and expensive, so we used advanced high-fidelity medical simulation tests to prepare for real-life experience. Over the course of 4 months we performed scenarios including "ECMO for DCD," "ECMO for extended cardiopulmonary resuscitation," "ECMO for RRF," and "ECMO in hypothermia." Soon after these simulations, Maastricht category II DCD procedures were performed involving real patients and resulting in 2 successful double kidney transplantations for the first time in Poland. One month later we treated 2 hypothermia patients (7 adult patients with heart failure and 5 patients with reversible respiratory failure) with ECMO for the first time in the region. Fortunately, we have discovered an important new role of medical simulation. It can be used not only for skills testing but also as a tool to create non-existing procedures and unavailable algorithms. The result of these program activities will promote the care and treatment of patients in critical condition with ECMO therapy as well as increase the potential organ pool from DCDs in the Greater Poland region of Poland.

Background: Optimal preservation of endothelial integrity of the vessels used as aortocoronary grafts is a crucial determinant of long-term clinical success of coronary artery bypass grafting (CABG). The purpose of this study was to evaluate an impact of two common techniques to harvest left internal thoracic artery (LITA) on endothelial integrity. Methods: One hundred twenty consecutive patients (84 males and 36 females) with a mean age of 64.9±8.8 years undergoing CABG were randomized to receive pedicled (group P; n=60) or skeletonized (group S; n=60) LITA grafts. During surgery LITA was harvested by the same experienced cardiac surgeon. The most peripheral surplus segments of LITA were obtained and then analysed histologically under light microscope. Additionally, endothelial expression of CD31, CD34, CD133 and nitric oxide synthase (eNOS) were evaluated by means of immunohistochemistry. Results: In both groups, no cases of major arterial wall damage such as disruption, dissection, thrombosis or subadventitial hematoma were noted on LITA cross sections. Immunohistochemical assessment of protein expression revealed no differences in endothelial expression of CD133, CD34 antigens (markers of regeneration potential) and eNOS (indicating preserved functional integrity) between studied groups. Contrary to them, endothelial immunoreactivity of CD31, a marker of the morphological integrity of the endothelium, was revealed to be stronger in group P. Conclusions: The skeletonized method of LITA harvesting may be associated with worse preservation of morphological integrity of endothelium but without compromising functional integrity and potential for tissue regeneration.

Background: Aortic stenosis and coronary artery disease (CAD) sharing similar risk factors are associated with aging of the human population. Aim: The purpose of this study was to examine whether age affects clinical presentation, intraoperative management, and outcomes of patients who undergo simultaneous operations of aortic valve replacement (AVR) and coronary artery bypass grafting (CABG). Methods: The study involved 452 consecutive patients aged 64.8 ± 8.2 years (range 38–79 years), who underwent combined AVR and CABG between 2005 and 2015. They were divided into three groups: Y (young; below the first quartile; n = 114), M (middle-aged; 58–71 years; n = 225) and E (elderly; above the third quartile; n = 113). Pre- and intraoperative variables were analysed. The deaths that occurred in hospital and throughout follow-up were defined as cardiac- or non-cardiac-related. The probability of survival was calculated with the use of Kaplan-Meier curves. Results: Coronary artery disease was more extensive in group E than in group Y (p < 0.05). Complete myocardial revasculari­sation was performed in 94.1%, 76.2%, and 62.8% in groups Y, M, and E, respectively (p < 0.05). In-hospital mortality was 2.0%, 5.3%, and 6.4%, in groups Y, M, and E, respectively. Early morbidity was significantly higher in group E than in groups M or Y. The 12- and 60-month freedom from cardiac-related death was higher in group Y (0.98 ± 0.02 and 0.94 ± 0.03) than in group E (0.93 ± 0.02 and 0.85 ± 0.03; p = 0.023, respectively). Left ventricular ejection fraction below 0.4 and incomplete revascularisation were associated with worse prognosis, particularly in group E. Conclusions: Elderly patients undergoing combined procedures of AVR and CABG having more extensive CAD less often receive complete revascularisation, are at higher risk of early organ failure, and present markedly reduced rates of freedom from cardiac-related deaths throughout follow-up than younger subjects.

Simple Summary Inflammatory processes are involved in the development and progression of coronary artery disease. Environmental factors, including hyperglycaemia, hyperlipidaemia, or smoking, promote endothelial disfunction. This process generates inflammation, which further exaggerates vascular wall injury. Immune cells migrate to the endothelium after its damage and promote platelets activation. Cardiac surgery activates inflammatory response. The knowledge on the intensity of immune cells activation may enable assessment of long-term consequences, including increased morbidity and mortality. The off-pump coronary artery bypass grafting technique allows to minimize systemic inflammatory reaction; however, some extent of the response still exists and may influence surgical results. The assessment of inflammatory response has undeniable value in coronary artery disease management. Several markers have been proposed; however, indices widely available from whole blood count are most valuable in daily practice. We evaluated and proposed the use of neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), and platelets to lymphocyte ratio (PLR) in the prognosis of the long-term outcomes after off-pump coronary artery bypass grafting. Patients who present with abnormally increased values of pre-operative and post-operative NLR, MLR, and PLR should undergo meticulous follow-up controls, as they are burdened with a higher risk of death. Abstract Background: Cardiovascular diseases, apart from commonly known risk factors, are related to inflammation. There are several simple novel markers proposed to present the relation between inflammatory reactions activation and atherosclerotic changes. They are easily available from whole blood count and include neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), and platelets to lymphocyte ratio (PLR). The RDW results were excluded from the analysis. Method and results: The study based on retrospective single-centre analysis of 682 consecutive patients (131 (19%) females and 551 (81%) males) with median age of 66 years (60–71) who underwent off-pump coronary artery bypass grafting (OPCAB) procedure. During the median 5.3 +/− 1.9 years follow-up, there was a 87% cumulative survival rate. The laboratory parameters including preoperative MLR > 0.2 (HR 2.46, 95% CI 1.33–4.55, p = 0.004) and postoperative NLR > 3.5 (HR 1.75, 95% CI 1.09–2.79, p = 0.019) were found significant for long-term mortality prediction in multivariable analysis. Conclusion: Hematological indices NLR and MLR can be regarded as significant predictors of all-cause long-term mortality after OPCAB revascularization. Multivariable analysis revealed preoperative values of MLR > 0.2 and postoperative values of NLR > 3.5 as simple, reliable factors which may be applied into clinical practice for meticulous postoperative monitoring of patients in higher risk of worse prognosis.

Surgical site infection (SSI) involving the mediastinum after cardiac surgical procedures carried out through median sternotomy is associated with significant mortality and morbidity [1]. Up to now a few methods have been describe to treat such severe adverse events in the early postoperative period [2]. One of them is negative pressure wound therapy (NPWT) [3]. Since its introduction by Argenta and Morykwas, NPWT has been an efficacious method, in terms of improved early and long-term outcomes, of managing SSI after cardiac surgical procedures [4]. This method was also proved to be of paramount importance in assisting wound healing in subjects at the highest risk for developing SSI, such as obese, insulin-treated diabetic and chronic obstructive pulmonary disease (COPD) patients [3]. In some individuals it may enable the infected wound to be closed definitely by playing the role of the intermediate stage before either placing mattress adapting skin sutures or transferring different local free cutaneous flaps with/without muscle tissue.

Altered function of platelets can lead to cardiovascular complications in numerous disorders. Various studies aimed to investigate mechanisms triggering platelets activation cascade show a significant role of reactive oxygen species (ROS) in this matter. Moreover, ROS are known causal factor of oxidative stress that can result in DNA, lipid and protein damage. This review aims to comprehensively present the variety of methods that are potentially useful in assessment of platelets redox balance, such as intracellular concentration of particular ROS, activity of antioxidant enzymes, reduced/oxidized glutathione ratio, level of lipid peroxidation, Cu/Zn ratio, and molecular oxygen consumption. They may help to establish the platelet-related etiological factors in different disorders and to evaluate the antiplatelet therapies. The advantages and limitations of these methods are also discussed. The present paper highlights that clinicians may benefit from implementation of such tools and further encourages developing interdisciplinary evidence-based practice.

Maintaining the viability of organs from donors after circulatory death (DCD) for transplantation is a complicated procedure, from a time perspective in the absence of appropriate organizational capabilities, that makes such transplantation cases difficult and not yet widespread in Poland. We present the procedural preparation for Poland’s first case of organ (kidney) transplantation from a DCD donor in which perfusion was supported by extracorporeal membrane oxygenation (ECMO). Because this organizational model is complex and expensive, we used advanced high-fidelity medical simulation to prepare for the real-life implementation. The real time scenario included all crucial steps: prehospital identification, cardiopulmonary resuscitation (CPR), advanced life support (ALS); perfusion therapy (CPR-ECMO or DCD-ECMO); inclusion and exclusion criteria matching, suitability for automated chest compression; DCD confirmation and donor authorization, ECMO organs recovery; kidney harvesting. The success of our first simulated DCD-ECMO procedure in Poland is reassuring. Soon after this simulation, Maastricht category II DCD procedures were performed, involving real patients and resulting in two successful double kidney transplantations. During debriefing, it was found that the previous simulation-based training provided the experience to build a successful procedural chain, to eliminate errors at the stage of identification, notification, transportation, donor qualifications and ECMO organ perfusion to create DCD-ECMO algorithm architecture.

The number of people waiting for a kidney or liver transplant is growing systematically. Due to the latest advances in transplantation, persons after irreversible cardiac arrest and confirmation of death have become potential organ donors. It is estimated that they may increase the number of donations by more than 40%. However, without good organization and communication between pre-hospital care providers, emergency departments, intensive care units and transplantation units, it is almost impossible to save the organs of potential donors in good condition. Various systems, including extracorporeal membrane oxygenation (ECMO), supporting perfusion of organs for transplantation play a key role. In 2016 the "ECMO for Greater Poland" program was established. Although its main goal is to improve the survival rate of patients suffering from life-threatening cardiopulmonary conditions, one of its branches aims to increase the donation rate in patients with irreversible cardiac arrest. In this review, the role of ECMO in the latter group as the potential organ donors is presented.Liczba osób czekających na przeszczep nerki czy wątroby stale wzrasta. Dzięki postępowi w transplantologii osoby z nieodwracalnym zatrzymaniem krążenia, które uznaje się za zmarłe, mogą zostać potencjalnymi dawcami narządów. Wykazano, że grupa ta może zwiększyć aktywność donacyjną o 40%. Jednak bez odpowiedniej organizacji lokalnego systemu ochrony zdrowia oraz komunikacji między strukturami ratownictwa przedszpitalnego, szpitalnymi oddziałami ratunkowymi, oddziałami intensywnej terapii oraz specjalistami z dziedziny transplantologii prawie niemożliwe jest uzyskanie organów dobrej jakości. Różne systemy wspomagania krążenia, w tym pozaustrojowa oksygenacja membranowa (ECMO), które jednocześnie wspierają funkcje narządów przeznaczonych do transplantacji, odgrywają dużą rolę. W 2016 r. w Poznaniu utworzono program „ECMO dla Wielkopolski”. Jego głównym zadaniem jest poprawa przeżywalności osób w stanie zagrożenia życia z powodu nagłej dysfunkcji układów sercowo-naczyniowego oraz oddechowego. Jedną z gałęzi programu jest zwiększenie donacji narządów od pacjentów po nieodwracalnym zatrzymaniu krążenia. W pracy przedstawiono możliwości wykorzystania ECMO w tej grupie chorych – potencjalnych dawców organów.

Objective: Transcatheter aortic valve-in-valve (TAVI-ViV) implantation is an established method to treat high risk patients with failed bioprosthesis. However, it can be associated with unfavorable...

Surgical reoperation is still a standard procedure performed for degenerated aortic bioprostheses. On the other hand femoral minimally invasive valve-in-valve implantation (femTAVI-VIV) is an intriguing alternative. This clinical study was design to compare the early and late outcomes of redo-surgery (Redo-AVR) and femTAVI-VIV procedures for failed aortic bioprostheses.We retrospectively reviewed 108 patients with degenerated aortic bioprostheses qualified for isolated Redo-AVR (n = 40) or femTAVI-VIV (n = 68) between 2003 and 2018. Both cohorts were divided into intermediate and high-risk groups according to the EuroSCORE II (4-9% and9%). Propensity score matching selected 20 pairs in Intermediate-risk group and 10 pairs in High-risk group for the final comparison.Patients qualified for femTAVI-VIV were older (79.2 vs 72.9 years, p 0.001) and at higher risk (EuroSCORE II 10.9 vs 7.8%, p = 0.005) than Redo-AVR subjects. Overall survival in femTAVI-VIV and Redo-AVR was comparable at 30-days, 1- and 5-years, respectively (92.6% vs 92.5%, 85.2% vs 85.0% and 62.9% vs 72.5%, p = 0.287). After PSM no differences in mortality, myocardial infarction, pacemaker implantation, stroke or acute renal insufficiency were found. Transcatheter procedure was associated with shorter hospital stay, lower rate of blood products transfusions and higher incidence of mild paravalvular leaks.Our study supports the opinion that transcatheter approach for treatment of patients with degenerated aortic bioprostheses is a safe alternative to Redo-AVR procedures particularly for those at high-risk.

Background: Introduction of invasive endovascular techniques constituted a real a breakthrough in the treatment of aortic aneurysm dissection and rupture. We assessed the effectiveness and safety of thoracic endovascular aortic repair (TEVAR) in patients with thoracic aortic pathologies. Methods: Between 2007 and 2017, 118 patients with thoracic aortic pathology underwent TEVAR. Among them, 20 (16.9%) patients required hybrid procedures. Stent grafts indication were thoracic aortic aneurysm in 46 (39.0%) patients, type B dissection in 68 (57.6%) patients and other indications in 4 (3.3%). Procedural success rate, in-hospital and late mortality and morbidity were evaluated. Results: The patients were followed-up for a mean of 55 months (range, 6-118 months). The technical success rate was 96%. Five patients died during the first 30 days after procedure (mortality 4.2%), four due to ischemic stroke followed by multi-organ failure and another one hemodynamically significant type I endoleak. Most of them were noted in the first years of our study. Five others died during post-discharged period. Four patients developed neurological complications, including stroke (n=2; 1.7%) and paraparesis (n=2; 1.7%). There were 6 (5.1%) primary (5 type I and 1 type II) and 3 (2.5%) secondary endoleaks (1 type I and 2 type III). Secondary interventions were required in 8 subjects. There was one case of stent collapse and two retrograde aortic dissection. Conclusions: Treatment of descending aortic diseases by using stent graft implantation has become the method of choice, decreasing the risk of open surgery, especially in patients with severe clinical state and comorbidities. However, effectiveness and safety may be achieved by experience team.

While the use of statins in treating patients with atherosclerosis is an undisputed success, the questions regarding an optimal starting time for treatment and its strength remain open. We proposed in our earlier paper published in Int. J. Mol. Sci. (2019, 20) that the growth of intima-media thickness of the carotid artery follows an S-shape (i.e., logistic) curve. In our subsequent paper in PLoS ONE (2020, 15), we incorporated this feature into a logistic control-theoretic model of atherosclerosis progression and showed that some combinations of patient age and intima-media thickness are better suited than others to start treatment. In this study, we perform a new and comprehensive calibration of our logistic model using a recent clinical database. This allows us to propose a procedure for inferring an optimal age to start statin treatment for a particular group of patients. We argue that a decrease in the slope of the IMT logistic growth curve, induced by statin treatment, is most efficient where the curve is at its steepest, whereby the efficiency means lowering the future IMT levels. Using the procedure on an aggregate group of severely sick men, 38 years of age is observed to correlate with the steepest point of the logistic curve, and, thus, it is the preferred time to start statin treatment. We believe that detecting the logistic curve’s steepest fragment and commencing statin administration on that fragment are courses of action that agree with clinician intuition and may support decision-making processes.

The rollout of COVID-19 vaccines brings hope for successful pandemic mitigation and getting the transmission of SARS-CoV-2 under control. The vaccines authorized in Europe displayed a good safety profile in the clinical trials. However, during their post-authorization use, unusual thrombotic events associated with thrombocytopenia have rarely been reported for vector vaccines. This led to the temporary suspension of the AZD1222 vaccine (Oxford/AstraZeneca) in various European countries and the Ad26.COV2 vaccine (Janssen/Johnson&Johnson) in the United States, with regulatory bodies launching investigations into potential causal associations. The thromboembolic reactions were also rarely reported after mRNA vaccines. The exact cause of these adverse effects remains to be elucidated. The present paper outlines the hypotheses on the mechanisms behind the very rare thrombotic thrombocytopenia reported after the COVID-19 vaccination, along with currently existing evidence and future research prospects. The following are discussed: (i) the role of antibodies against platelet factor 4 (PF4), (ii) the direct interaction between adenoviral vector and platelets, (iii) the cross-reactivity of antibodies against SARS-CoV-2 spike protein with PF4, (iv) cross-reactivity of anti-adenovirus antibodies and PF4, (v) interaction between spike protein and platelets, (vi) the platelet expression of spike protein and subsequent immune response, and (vii) the platelet expression of other adenoviral proteins and subsequent reactions. It is also plausible that thrombotic thrombocytopenia after the COVID-19 vaccine is multifactorial. The elucidation of the causes of these adverse events is pivotal in taking precautionary measures and managing vaccine hesitancy. It needs to be stressed, however, that the reported cases are currently sporadic and that the benefits of COVID-19 vaccines vastly outweigh their potential risks.

Chronic kidney disease (CKD) is characterized by the progressive loss of functional nephrons. Although cardiovascular disease (CVD) complications and atherosclerosis are the leading causes of morbidity and mortality in CKD, the mechanism by which the progression of CVD accelerates remains unclear. To reveal the molecular mechanisms associated with atherosclerosis linked to CKD, we applied a shotgun lipidomics approach fortified with standard laboratory analytical methods and gas chromatography-mass spectrometry technique on selected lipid components and precursors to analyze the plasma lipidome in CKD and classical CVD patients. The MS-based lipidome profiling revealed the upregulation of triacylglycerols in CKD and downregulation of cholesterol/cholesteryl esters, sphingomyelins, phosphatidylcholines, phosphatidylethanolamines and ceramides as compared to CVD group and controls. We have further observed a decreased abundance of seven fatty acids in CKD with strong inter-correlation. In contrast, the level of glycerol was elevated in CKD in comparison to all analyzed groups. Our results revealed the putative existence of a functional causative link-the low cholesterol level correlated with lower estimated glomerular filtration rate and kidney dysfunction that supports the postulated ""reverse epidemiology"" theory and suggest that the lipidomic background of atherosclerosis-related to CKD is unique and might be associated with other cellular factors, i.e., inflammation. Chronické onemocnění ledvin (CKD) je charakterizováno postupnou ztrátou funkčních nefronů. Ačkoli jsou komplikace kardiovaskulárních onemocnění (CVD) a ateroskleróza hlavními příčinami morbidity a mortality u CKD, mechanismus, jakým se zrychluje progrese CVD, zůstává nejasný. Abychom odhalili molekulární mechanismy spojené s aterosklerózou spojenou s CKD, použili jsme shotgun lipidomiku obohacenou standardními laboratorními analytickými metodami a technikou plynové chromatografie a hmotnostní spektrometrie na vybraných lipidových složkách a prekurzorech k analýze lipidomu v plazmě u pacientů s CKD a klasickými CVD. Lipidomový profil založený na MS odhalil zvýšenou regulaci triacylglycerolů u CKD a sníženou regulaci cholesterol/cholesterylesterů, sfingomyelinů, fosfatidylcholinů, fosfatidylethanolaminů a ceramidů ve srovnání s CVD skupinou a kontrolami. Dále jsme u CKD se silnou interkorelací zaznamenali snížený výskyt sedmi mastných kyselin. Naopak hladina glycerolu byla zvýšena u CKD ve srovnání se všemi analyzovanými skupinami. Naše výsledky odhalily domnělou existenci funkční příčinné souvislosti – nízká hladina cholesterolu korelovala s nižší odhadovanou glomerulární filtrací a dysfunkcí ledvin, která podporuje postulovanou teorii „obrácené epidemiologie“ a naznačuje, že lipidomické pozadí aterosklerózy související s CKD je jedinečné a může být spojeno s jinými buněčnými faktory, tj. zánět.

Introduction: We present the case of a 33-year-old man with middle aortic syndrome. The final diagnosis was established with magnetic resonance imaging. He underwent a successful aorto-aortic bypass. Two-year follow-up imaging showed the new graft was patent, with no abnormalities at the anastomosis sites. At the last follow-up examination he was asymptomatic with no neurological dysfunction.

Background: An imbalance in activity between matrix metalloproteinases (MMPs), particularly gelatinases, and tissue inhibitors (TIMPs) is considered as one of the mechanisms leading to aortocoronary graft failure. Aim: To assess variability of gelatinase expression in the walls of aortocoronary conduits and to check its impact on coronary artery bypass graft (CABG) outcomes. Methods: This study involved 101 consecutive patients (61 men and 40 women) who underwent CABG. An immunohistochemical analysis of MMP2, MMP9, TIMP1 and TIMP2 expression was performed on the cross-sections of internal thoracic artery (ITA), radial artery (RA) and saphenous vein (SV). The histological findings concerning patients who had occluding lesions in SV grafts (SVGD(+) group) were compared to the remainders (SVGD(-) group). Results: Median expression of both MMPs and TIMPs was the weakest in the ITA wall. MMP expression in the RA and SV cross-sections was comparable (RA=SV) whereas expression of TIMPs was stronger in the RA than SV wall (RA>SV). In the majority of the SV segments, but not in the arteries, MMP immunostaining intensity was comparable or stronger than TIMPs. In the veins harvested from SVGD(+) individuals, tissue expression of both MMPs was more pronounced than in SVGD(-) subjects. In the same time, TIMP levels were found to be comparable. Conclusions: Tissue imbalance in metalloproteinase-to-inhibitor expression in the wall of vessels might predispose to graft failure. Stronger expression of tissue inhibitors than gelatinases in the arterial grafts might be the explanation of the favorable long-term outcomes.

Posterolateral thoracotomy was the access of choice in surgical treatment of patent ductus arteriosus (PDA) for many years before the introduction of video-assisted thoracoscopic surgery (VATS). The latter is thought to reduce postoperative pain and improve musculoskeletal system status. However, it carries a potential risk of conversion to thoracotomy.To evaluate the rate, reasons and outcomes of VATS conversion to thoracotomy in surgical PDA patients.From 2012 to 2017, 112 children were qualified for VATS closure of symptomatic PDA. Among them, 19 (16.9%) with the median age of 19.4 months required conversion to thoracotomy. The predominant reasons for conversion, early mortality and morbidity as well as late survival were evaluated.The overall conversion rate was 16.9% with an evident learning curve as it decreased significantly from more than 20% at the beginning to approximately 10% in the last 2 years. The predominant reasons were incomplete PDA closure (The rate of VATS PDA closure conversion to standard thoracotomy features a learning curve. Although it must be considered as a serious complication, probably it does not negatively affect either early the mortality rate or long-term survival.Tylno-boczna torakotomia przez wiele lat była dostępem z wyboru w chirurgicznym zamknięciu przetrwałego przewodu tętniczego (PDA), do czasu wprowadzenia techniki wideotorakoskopowej (VATS). Uważa się, że tę ostatnią cechują mniejsze dolegliwości bólowe i lepiej zachowany stan układu mięśniowo-szkieletowego, ale niesie ona ze sobą ryzyko konieczności konwersji do torakotomii.Ocena częstości i przyczyn konwersji VATS do torakotomii i wyników klinicznych takiego leczenia u pacjentów z PDA.W latach 2012–2017 do torakoskopowego leczenia objawowego zakwalifikowano 112 dzieci z PDA. U 19 z nich (16,9%), mediana wieku 19,4 miesiąca, konieczna była konwersja do torakotomii. W badaniu analizowano główne jej przyczyny oraz wyniki wczesne i odległe.Częstość konwersji dla całego czasu badania wyniosła 16,9%. Obserwowano krzywą uczenia, gdyż wskaźnik ten zmniejszył się z ponad 20% na początku do ok. 10% w 2 ostatnich latach. Głównymi przyczynami były: niezupełne zamknięcie przewodu (Częstość konwersji VATS do torakotomii podczas zamknięcia PDA cechuje krzywa uczenia. Choć konwersję należy traktować jako poważne powikłanie, to jednak nie wpływa ona niekorzystnie na wczesną śmiertelność lub przeżycie odległe.

The implemented "ECMO for Greater Poland" program takes full advantage of the ECMO (extracorporeal membrane oxygenation) perfusion therapy to promote health for 3.5 million inhabitants in the region. The predominant subjects of implementation are patients with hypothermia, with severe reversible respiratory failure (RRF), and treatment of other critical states leading to heart failure such as sudden cardiac arrest, cardiogenic shock or acute intoxication. Finally, it promotes donation after circulatory death (DCD) strategy in selected organ donor cases. ECMO enables recovery of organs' function after unsuccessful lifesaving treatment. Because this organizational model is complex and expensive, we use advanced high-fidelity medical simulation to prepare for real-life implementation. During the first four months, we performed scenarios mimicking "ECMO for DCD," "ECMO for ECPR (extended cardiopulmonary resuscitation)," "ECMO for RRF" and "ECMO in hypothermia." It helped to create algorithms for aforementioned program arms. In the following months, three ECMO courses for five departments in Poznan (capitol city of Greater Poland) were organized and standardized operating procedures for road ECMO transportation within Medical Emergency System were created. Soon after simulation program, 38 procedures with ECMO perfusion therapy including five road transportations on ECMO were performed. The Maastricht category II DCD procedures were done four times on real patients and in two cases double successful kidney transplantations were carried out for the first time in Poland. ECMO was applied in two patients with hypothermia, nine adult patients with heart failure, and five with RRF, for the first time in the region. In the pediatric group, ECMO was applied in four patients with RRF and 14 with heart failure after cardiac surgery procedures. Additionally, one child was treated successfully following 200 km-long road transport on ECMO. We achieved good and promising results especially in VV ECMO therapy. Simulation-based training enabled us to build a successful procedural chain, and to eliminate errors at the stage of identification, notification, transportation, and providing ECMO perfusion therapy. We discovered the important role of medical simulation, not only to test the medical professional's skills, but also to promote ECMO therapy in patients with critical/life-threatening states. Moreover, it also resulted in increase of the potential organ pool from DCD in the Greater Poland region.

Endovascular treatment offering minimally invasive access has become a method of choice in treatment of thoracic and abdominal pathologies in both elective and urgent cases. Unfortunately, long-term follow-up revealed that not uncommonly patients required repeat intervention because of stent graft–related serious adverse events, including endoleaks. They are classified into five types. Type I endoleak dominates after thoracic endovascular procedures (thoracic endovascular aortic repair), whereas type II endoleak occurs following interventions on the abdominal aorta (endovascular aortic repair). Currently, the other subtypes are diagnosed less frequently. In this chapter, prevalence, diagnostic management, and therapeutic strategies are described in detail. It is also stressed that both appropriate diagnosis and treatment may be challenging. In many available reports dealing with endoleak treatment, late outcomes are markedly worse than those observed soon after reintervention.

Traumatic aortic injury is not common but a severe complication of the accidents associated with rapid deceleration, predominantly motor vehicle crushes. Despite progress in medicine, only a minority of patients reach the hospital alive. Computed tomographic angiography is a first-line examination to detect location and extent of aortic injury. Subjects with minor injuries may be treated medically. The others should undergo interventions. In the past, the only available open surgical repair was associated with marked mortality and morbidity. Introduction of endovascular methods has changed significantly the management in this particular group of patients. The early and mid-term results of these novel and minimally invasive procedures with stent graft implantation are very promising. Thus, recently, they have become the methods of choice in the treatment of individuals with traumatic aortic injuries.

Several techniques of aortic valve repair have been described. These procedures are usually performed in young and middle-aged rather low-risk individuals with severe aortic insufficiency. Unfortunately, they accounted for a minority of patients with aortic valve disease treated in adult cardiac surgical departments. Reconstructive procedures, due to their complexity and unknown long-term results, are performed only in the selected centers and by the most experienced cardiac surgeons. Although the middle-term outcomes are promising in the experienced hands, there are doubts if they will be applied commonly in the future. An exception may be Ozaki's procedure that can be carried out even in patients with severe aortic stenosis with extent calcifications and concomitant disorders. However, it will have to compete with minimally invasive interventions.

Treatment of choice for the internal carotid artery dissection (ICAD) is anticoagulation for three to 6 months. Endovascular procedures may be a promising alternative for patients (pts) with haemodynamic impairment, recurrent ischaemic symptoms or symptomatic pseudoaneurysms. Thus, the purpose of this study was to evaluate the efficacy and safety of carotid artery stenting in treatment of selected pts with extracranial ICAD. This study involved 18 symptomatic pts with the mean age of 44.6 ± 10.4 years with ICAD treated with the use of self-expandable stents. Six months after primary procedures, pts were readmitted to hospital and physical examination followed by cerebral angiography was performed. In the late follow-up period, clinical evaluations completed by duplex Doppler ultrasonography were carried out every 6 months and at the end of the follow-up period. Nobody died and no life-threatening adverse events were observed during either the in-hospital stay or post-discharge follow-up period (median 21 months). Stent deployment immediately restored flow in the true lumen of ICA in all cases. However, residual blood flow through the false lumen was observed in one pt. Complete resolution of clinical symptoms was observed in 14 pts (78 %), partial improvement in 2 (11 %) and persistence of neurological deficit in 2 (11 %). Implantation of self-expandable stents in treatment of selected extracranial ICAD cases is safe. This method may enable us to restore immediately and usually permanently proper arterial blood flow in the ICA and in consequence lead to significant clinical improvement in the late follow-up period.

Conventional open surgical repair of thoracoabdominal aortic aneurysm (TAAA) is associated with high perioperative mortality and morbidity risk. Our report of successful treatment of a 56-year-old patient with TAAA involving all visceral arteries and with many comorbidities with a fenestrated stent graft supports its application in high-risk TAAA patients.

Cardiac tamponade is a life-threatening clinical entity that requires emergent treatment. A variety of therapeutic methods have been applied. The purpose of this retrospective analysis was to study the efficacy of emergent surgical pericardiotomy in both the relief of cardiac tamponade and in the prevention of recurrence of pericardial effusion.This study involved 90 consecutive patients (58 males and 32 females) with a mean age of 57.4 ± 14.1 years, who underwent emergent pericardiotomy in the years 2006 to 2011 due to symptomatic primary cardiac tamponade. At the end of the follow-up period all living subjects had control echocardiographic examination. Survival analysis was performed with the use of the Kaplan-Meier method.The mean duration time of surgery was 14.2 ± 4.5 minutes. All patients survived surgery but one died during in-hospital stay. During the post-discharge follow-up period (median 49 months) 32 patients died for any reason. One-year and four-year probability of survival was 0.68 ± 0.05 and 0.64 ± 0.05, respectively. Malignancy diagnosis was associated with significant negative impact on survival. One-year and four-year probability of survival was 0.56 ± 0.06 and 0.53 ± 0.06 for cancer patients while it was 0.93 ± 0.05 and 0.89 ± 0.06 for the others, respectively. In two cases, only cancer patients, re-intervention due to effusion recurrence was necessary.Pericardiotomy, although invasive, is a safe method to relieve cardiac tamponade. It is also very efficient in the prevention of recurrence of pericardial effusion, even in cancer patients.Tamponada serca jest stanem zagrożenia życia, który wymaga leczenia w trybie nagłym. W leczeniu tamponady stosuje się wiele metod. Celem retrospektywnego badania była analiza skuteczności nacięcia worka osierdziowego w trybie nagłym pod względem zarówno uwolnienia tamponady serca, jak i zapobiegania nawrotowi płynu w worku osierdziowym.Badaniem objęto 90 kolejnych chorych (58 mężczyzn i 32 kobiety) średnio w wieku 57,4 ± 14,1 roku, których w latach 2006–2011 poddano perikardiotomii w trybie nagłym z powodu objawowej pierwotnej tamponady serca. Na zakończenie okresu obserwacji u wszystkich chorych wykonano kontrolne badanie echokardiograficzne. Analizę przeżycia przeprowadzono z zastosowaniem metody Kaplana-Meiera.Średni czas trwania zabiegu wyniósł 14,2 ± 4,5 minuty. Wszyscy chorzy przeżyli operację. Jedna osoba zmarła we wczesnym okresie pooperacyjnym. W okresie obserwacji poszpitalnej (mediana 49 miesięcy) 32 chorych zmarło z jakiejkolwiek przyczyny. Prawdopodobieństwo przeżycia 1 roku i 4 lat po operacji wyniosło, odpowiednio, 0,68 ± 0,05 i 0,64 ± 0,05. Rozpoznanie nowotworu złośliwego miało negatywny wpływ na przeżycie. I tak, oszacowane prawdopodobieństwo przeżycia 1 roku i 4 lat po operacji wyniosło 0,56 ± 0,06 i 0,53 ± 0,06 dla chorych z nowotworem złośliwym oraz 0,93 ± 0,05 i 0,89 ± 0,06 dla pozostałych. W dwóch przypadkach, i to tylko z nowotworem złośliwym, zaszła konieczność reinterwencji w okresie poszpitalnym ze względu na nawrót płynu w worku osierdziowym.Perikardiotomia, choć jest zabiegiem inwazyjnym, jest bezpieczną metodą leczenia tamponady serca. Skutecznie zapobiega również nawrotom płynu w worku osierdziowym, w tym również u chorych z nowotworem złośliwym.

We describe a case of a 76-year-old woman who underwent emergent surgery for ruptured thoracoabdominal aneurysm with the use of partial left heart bypass. Dacron prosthesis was implanted into the thoracic and abdominal aorta (up to its bifurcation), and four visceral arteries were reimplanted into the prosthesis. The procedure of implanting the prosthesis into the thoracic part of the descending aorta was supported by left heart bypass. The patient’s postoperative course was complicated by spinal cord ischaemia-induced lower extremities paraparesis. On the 26th postoperative day, she was referred to the regional neurological rehabilitation centre.

Background: Patent ductus arteriosus (PDA) occurs more frequently in premature infants. Depending on the degree of prematurity, these children often have other serious comorbidities that could have a significant impact on surgical outcome. Aim: This study aimed to evaluate the clinical results of surgical ligation of PDA in extremely low body weight preterm infants with birth weight below 750 g, and to identify risk factors of mortality. Methods: A total of 31 preterm infants with birth weight below 750 g and significant PDA were operated between 2006 and 2016 through posterolateral thoracotomy (n = 16) or with the use of video-assisted thoracoscopic method (n = 15). Mean weight at the time of surgery was 750.8 ± 104.7 g. The gestational age ranged from 22 to 32 weeks. Data were retrospectively analysed, and prospective 100% follow-up was performed. Results: In-hospital mortality was 25.8% (n = 8). The type of surgery had no influence on the results. During the follow-up period lasting 5.2 ± 2.5 years, two other patients died. One-year and five-year probability of survival was 77.4% and 74.2%, respectively. The predominant cause of death was acute heart failure. All patients with preoperative renal dysfunction died in the postoperative period. Moreover, Cox regression analysis revealed renal dysfunction as an independent risk factor of early death. Conclusions: Preterm infants with birth weight less than 750 g and significant PDA are highly challenging patients. Despite the recent advances in perioperative management with neonates, surgery is still associated with a high early mortality rate irrespective of the applied method.

Aortic valve replacement (AVR) with a mechanical prosthesis is not free from late complications.To evaluate the prevalence of subclinical hemolysis after AVR with On-X prostheses and assess its impact on long-term outcomes.The prospective study included 84 consecutive patients aged 58.3 ±10.3 years who underwent AVR. They were retrospectively split into group H (The rate of subclinical hemolysis in patients with properly working prostheses was 14.3% and it was the highest (33.3%) for the smallest valves. Although an improvement in functional status was noted in both groups, it was less evident in group H than in group C (Our study proved that prosthesis-induced subclinical hemolysis is seen even after implantation of the latest generation mechanical prostheses, particularly of small diameter, and its degree may impact late outcome.Wymiana zastawki aortalnej (AVR) na protezę mechaniczną nie jest pozbawiona późnych powikłań.Ocena częstości występowania późnej hemolizy po zabiegach AVR z zastosowaniem protez On-X i jej wpływu na odległe wyniki kliniczne.Prospektywnym badaniem objęto 84 kolejnych chorych w wieku 58,3 ±10,3 roku, których poddano zabiegom AVR. Podzielono ich retrospektywnie na grupę H (Zjawisko subklinicznej hemolizy obserwowano u 14,3% osób z prawidłowo funkcjonującymi protezami mechanicznymi, przy czym najczęściej u ludzi z zastawkami o najmniejszej średnicy (33,3%). Poprawę wydolności układu krążenia obserwowano w obu grupach, jednak w grupie H była ona mniej wyraźna niż w grupie C (Badanie dowiodło, że nawet w najnowszej generacji protez mechanicznych, szczególnie o małej średnicy, stwierdza się zależną od zastawek subkliniczną hemolizę, a jej nasilenie może mieć wpływ na odległe wyniki kliniczne.

Saphenous vein segments are frequently used as aortocoronary bypass grafts, particularly in patients over 65 years of age. In the majority of patients, venous grafts maintain their patency for 5–6 years; however, some become occluded within 12 months after surgery. There are some defined predictive biological factors used to assess saphenous vein graft long-term patency rates, but little is known about molecular parameters for estimating the risk of early vein occlusion. The pathogenesis of this process involves the proliferation of stem cells, as well as progenitor cells, in the graft wall. Histologically, this is reflected by CD34 and CD133 expression in endothelial and smooth muscle cells. Thus, the aim of present work was to perform a multivariate analysis of stem cell and progenitor cell markers in saphenous vein graft walls before transplantation to arterial circulation and correlate these results with early graft occlusion. A total of 718 patients, who underwent coronary artery bypass grafting using a saphenous vein graft, were enrolled in this prospective study. CD34, CD133 and von Willebrand factor expression was evaluated via immunohistochemistry. A multivariate analysis revealed that strong CD133 expression in smooth muscle cells can be considered a risk factor for early graft failure. Our findings suggest that CD133 expression in smooth muscle cells of the tunica media in saphenous vein grafts obtained from coronary artery bypass graft patients before graft transplantation to coronary circulation might predict the possibility of early graft occlusion.

Background: “ECMO for Greater Poland” is a program being developed to serve the 3.5 million inhabitants of the Greater Poland region (Wielkopolska) based on an approach already implemented in the USA1 or Qatar.2,3Method: The program is complex and takes full advantage of the ECMO perfusion therapy opportunities to save the life of patients in the Greater Poland region. The main implementation areas are: – treatment of patients with hypothermia;4 – treatment of reversible severe respiratory failure;5 – treatment of acute intoxication resulting in cardiorespiratory failure6 or other critical conditions resulting in heart failure; – in the absence of response to treatment and eventual death, and with donor authorization, there is possible organ transplantation from a non-heart beating donor (NHBD) to another patient.7 This led to the development of a program for donation after circulatory death (DCD). Study: The program will help to put in place a Medical Rescue System including ECMO (Figure 1). It requires training in specialized resuscitation, perfusion, and transplantation teams in the implementation of this “ECMO rescue chain”. The main strength of the program is the widespread use of extracorporeal perfusion. All program arms in the use of ECMO should be implemented in parallel to maximize its positive impact.Figure 1. Organizational model of “ECMO for Greater Poland” – “ECMO rescue chain” scheme divided into three stages: prehospital, hospital/perfusion, and transplantation. As this organizational model is complex and expensive, we used high-fidelity medical simulation to prepare for the real-life implementation of our ECMO program. During 4 months, we performed scenarios including: – “ECMO for DCD” which includes: prehospital identification, CPR ALS (cardiopulmonary resuscitation advanced life support), perfusion therapy (CPR-ECMO or DCD-ECMO), inclusion and exclusion criteria matching, mechanical chest compression, transport, DCD confirmation, and donor authorization, the veno-arterial (VA) cannulation of a mannequin's artificial vessels, and starting on-scene organ perfusion.7 – “ECMO for INTOXICATION” which includes: hospital identification (Department of Toxicology), poisoning treatment, CPR ALS, mechanical chest compression, VA cannulation, for the implementation of ECMO therapy and transport to another hospital (Department of Cardiac Surgery).6 – “ECMO for RRF” (reversible respiratory failure) which includes: hospital identification (Regional Department of Intensive Care) – inclusion and exclusion criteria matching, ECMO team transport (80 km), therapy confirmation, veno-venous cannulation for the implementation of perfusion therapy, and return transport (80 km) with ECMO to another hospital in a provincial city (Clinical Department of Intensive Care), where the veno-venous (VV) ECMO therapy was continued for the next 48 hours.5 The training programs, in a short time, resulted in a team being appropriately trained to successfully undertake the complex procedures. Soon after these simulations, Maastricht category II DCD procedures were performed involving real patients and resulting in two double successful kidney transplantations, for the first time in Poland. One month later, we treated two hypothermia patients and, for the first time in the region, also treated on ECMO an adult patient with reversible respiratory failure. Conclusions: The “ECMO for Greater Poland” program will allow the use of perfusion therapy for the inhabitants of Wielkopolska in a comprehensive manner, covering all critical disease states, by what appears to be a unique regional program in Poland. The full-scale, high-fidelity simulation enabled standardized training and testing of new, commonly, and rarely used procedures, and facilitated clinicians’ skills development.

Introduction: In recent years, patients over 80 years of age have been a growing group of individuals referred to cardiac surgeons. They pose a serious challenge and usually require a multidisciplinary approach. Aim: The aim of this study was to evaluate the early and late outcomes of cardiosurgical treatment of patients over 80 years of age suffering from coronary artery disease and aortic stenosis. Material and methods: The study involved 96 patients aged over 80 years treated between January, 2004 and December, 2012. The mortality and morbidity in the early postoperative period, as well as throughout the follow-up period, were analyzed. Results: The majority of patients underwent isolated coronary artery bypass grafting (CABG) (58.3%; Group I), while 29.2% of them underwent an isolated aortic valve replacement (AVR) (Group II). Combined procedures (CABG + AVR) were carried out in 12.5% of patients (Group III). The mean operational risk calculated according to the logistic EuroSCORE was 11.6%, 11.9%, and 9.5%, respectively in Group I, Group II and in Group III. In the early postoperative period, 4 patients died (all from Group I). The 30-day mortality rate was 4.2% and the morbidity rate was 56.3%. During the post-discharge follow-up period that lasted from 1 to 100 months, 4 patients died (2 from Group I and 2 from Group III). The 2-year probability of survival was 91.9 ± 3.0%. During the last follow-up clinical assessment, half of the patients were asymptomatic. Conclusions: The perioperative mortality of the patients is acceptably and markedly lower than that predicted by the logistic EuroSCORE calculator. However, the complication rate, particularly in the early postoperative period, is relatively high.

Background: Neurological complications occur in 30‐80% of patients following heart transplantation, and seizures account for 2‐20% of these sequelae. The main risk factors are toxicity due to immunosuppression, infections, and brain lesions. We present 2 cases of grand mal type attacks that occurred on the 7 th and 15 th postoperative days. The origin of the attacks was an unusual interaction between 2 non-immunosuppressive drugs (metoclopramide and theophylline). Case Reports: We present 2 cases of seizure episodes during the early postoperative period in young heart transplant recipients (a 26-year-old female and a 33-year-old man). Grand mal type attacks occurred on the 7 th and 15 th postoperative day, respectively. Both patients were treated with standard triple immunosuppressive therapy including tacrolimus, mycophenolate mofetil, and steroids. Therapy with metoclopramide was started because the patients reported gastrointestinal disturbances. Theophylline was administered due to postoperative bradycardia. Serum theophylline levels were 33 and 34 mcg/ml, respectively. There were no neurological deficits noticed thereafter. The magnetic resonance imaging (MRI) was negative for stroke and central nervous system infection in both cases. Conclusions: We conclude that theophylline overdose combined with metoclopramide may provoke new-onset seizures, especially in young patients following heart transplantation.

The severity of coronary artery disease (CAD) may have an impact on the outcomes of patients (pts) after aortic valve replacement (AVR) and coronary artery bypass grafting (CABG).The aim of the study was to analyze survival after simultaneous AVR and CABG with respect to CAD severity.The study involved 143 consecutive pts (40 women and 103 men) with a mean age of 65.1 ± 7.7 years treated between 2006 and 2009. The indication for surgery was aortic stenosis accompanied by left main or three-vessel disease (group A; n = 43) and by single- or two-vessel disease (group B; n = 100). In-hospital and late mortality were analyzed. Post-discharge survival was estimated using the Kaplan-Meier method. Moreover, selected preoperative clinical and echocardiographic data as well as intraoperative variables were compared between the groups.In-hospital mortality was 4.7% in group A and 3.0% in group B (NS). The 12-month and 48-month survival probability rates were 0.88 ± 0.05 and 0.83 ± 0.06 in group A, and 0.97 ± 0.01 and 0.92 ± 0.03 in group B, respectively (p0.05). Patients in group A and B differed (p0.05) with respect to the preoperative prevalence of arterial hypertension (65.1% vs. 42.0%) and atrial fibrillation (18.6% vs. 6.0%) as well as with regard to the rate of complete revascularization (20.9% vs. 85.0%, group A and B, respectively).Coronary artery disease severity impacts long-term survival after combined AVR and CABG. Patients with left main or three-vessel disease more often undergo incomplete surgical revascularization, and this fact may be one of the predictors of an unfavorable outcome.Zaawansowanie choroby wieńcowej może mieć wpływ na wyniki kliniczne leczenia chorych poddanych jednoczesnej wymianie zastawki aortalnej (Analiza przeżycia chorych po jednoczesnych zabiegach AVR i CABG zależnie od zaawansowania choroby wieńcowej.Badaniem objęto 143 kolejnych chorych (40 kobiet i 103 mężczyzn) w wieku 65,1 ± 7,7 roku leczonych w latach 2006–2009. Wskazaniem do operacji było zwężenie zastawki aortalnej ze współistniejącym zwężeniem pnia i chorobą trzech tętnic wieńcowych (grupa A;Śmiertelność szpitalna wyniosła 4,7% w grupie A oraz 3,0% w grupie B (NS). Prawdopodobieństwo przeżycia 12 i 48 miesięcy oszacowano odpowiednio na 0,88 ± 0,05 i 0,83 ± 0,06 w grupie A oraz 0,97 ± 0,01 i 0,92 ± 0,03 w grupie B (Zaawansowanie choroby wieńcowej ma wpływ na przeżycie w obserwacji odległej u chorych poddanych jednoczesnym zabiegom AVR i CABG. U pacjentów z chorobą pnia i trzech tętnic wieńcowych częściej wykonuje się niepełną rewaskularyzację serca i ten fakt może być jednym z niekorzystnych czynników rokowniczych wyników odległych.

Introduction: Monitoring the central nervous system during aortic dissection repair may improve the understanding of the intraoperative changes related to its bioactivity. Aim: The aim of the study was to evaluate the influence of deep hypothermia on intraoperative brain bioactivity measured by the compressed spectral array (CSA) method and to assess the influence of the operations on postoperative cognitive function. Material and methods: The study enrolled 40 patients (31 men and 9 women) at the mean age of 60.2 ± 8.6 years, diagnosed with acute aortic dissection. They underwent emergency operations in deep hypothermic circulatory arrest (DHCA). During the operations, brain bioactivity was monitored with the compressed spectral array method. Results: There were no intraoperative deaths. Electrocerebral silence during DHCA was observed in 31 patients (74%). The lowest activity was observed during DHCA: it was 0.01 ± 0.05 nW in the left hemisphere and 0.01 ± 0.03 nW in the right hemisphere. The postoperative results of neurological tests deteriorated statistically significantly (26.9 ± 1.7 points vs. 22.0 ± 1.7 points; p < 0.001), especially among patients who exhibited brain activity during DHCA. Conclusions: The compressed spectral array method is clinically useful in monitoring brain bioactivity during emergency operations of acute aortic dissections. Electrocerebral silence occurs in 75% of patients during DHCA. The cognitive function of patients deteriorates significantly after operations with

We propose a control-theoretic aggregate model of the progression of atherosclerosis plaque, a chronic inflammatory disease of the arterial wall, to study the basic features of this disease. In the model, we exploit the role of inflammation in the disease progression, and use statins&mdash, drugs commonly recommended in atherosclerosis&mdash, to control this progression. We use a logistic function to allow for constrained growth of plaque. In the model, both the patient&rsquo, s age and overall health impact the plaque growth and its sensitivity to statins. The model parameters are estimated using original data, or calibrated using published research as well as our own clinical and laboratory studies. We contend that our model helps to gauge the statins&rsquo, impact on a patient&rsquo, s plaque thickness, hence the disease&rsquo, s progression and cardiovascular risk, without requiring artery scans.

Patients with ascending aortic aneurysm undergoing complex surgical procedures are at increased risk of early postoperative excessive blood loss. The aim of this study was to analyze safety and efficacy of routine transfusions of platelet (PLT) concentrates in reduction of hemorrhagic postoperative complications. The study involved 396 consecutive patients (289 males and 107 females) with the mean age of 55.9 ± 13.6 years who underwent elective operations for aortic aneurysms. They were divided retrospectively into two groups, without (group A; n = 123) or with the routine use of PLTs (group B; n = 273). PLTs were transfused intraoperatively just after completion of cardiopulmonary bypass. Twelve patients in group A (9.8%) and 10 (3.7%) in group B required re-thoracotomy due to hemorrhage (p = 0.027). Routine transfusions of PLT concentrates reduced postoperative incidence of excessive pericardial effusion from 24.1% in group A to 2.1% in group B (p = 0.002). In a consequence, significantly less units (p < 0.0001) of red blood concentrates and fresh frozen plasma were transfused in group B than in group A. The rates of other adverse events in the early postoperative period did not differ between groups. Patients with pericardial effusion required 6.3 ± 2.7 additional days of hospitalization due to surgical re-intervention. Neither blood transfusion-related infections nor adverse reactions were noted. In conclusion, routine intraoperative transfusions of PLT concentrates in patients with ascending aortic aneurysms significantly reduced a need for re-intervention due to both early bleeding and late cardiac tamponade.

Aims To assess the safety and efficacy of transendocardial delivery of muscle-derived stem/progenitor cells with connexin-43 overexpression (Cx-43-MDS/PC) in advanced heart failure (HF). Methods and results Thirteen subjects with advanced HF, New York Heart Association (NYHA) class II–III were enrolled and treated with targeted injection of Cx-43-MDS/PCs and then monitored for at least 6 months. Overexpression of Cx43 (Cx43+) was significantly higher in all but one subject (Cx43–). Injection of MDS/PCs was associated with significant improvement of exercise capacity: NYHA (3 ± 0 vs. 1.8 ± 0.7, P = 0.003), exercise duration (388.69 ± 141.83 s vs. 462.08 ± 176.69 s, P = 0.025), peak oxygen consumption (14.38 ± 3.97 vs. 15.83 ± 3.74 ml/kg.min, P = 0.022) and oxygen pulse (10.58 ± 2.89 vs. 18.88 ± 22.63 mLO2/heart rate, P = 0.012). Levels of BNP, left ventricular (LV) ejection fraction and LV end-diastolic volumes tended to improve. There was a significant improvement of the mean unipolar voltage amplitudes measured for the injected segments and the entire left ventricle (9.62 ± 2.64 vs. 11.62 ± 3.50 mV, P = 0.014 and 8.83 ± 2.80 vs. 10.22 ± 3.41 mV, P = 0.041, respectively). No deaths were documented, Cx43+ (n = 12) subjects presented no significant ventricular arrhythmia; one Cx43– subject suffered from ventricular tachycardia (successfully treated with amiodarone). Conclusions Injection of Cx-43-MDS/PCs in patients with severe HF led to significant improvement in exercise capacity and myocardial viability of the injected segments while inducing no significant ventricular arrhythmia. This may arise from improved electrical coupling of the injected cells and injured myocardium and thus better in-situ mechanical cooperation of both cell types. Therefore, further clinical studies with Cx43+ MDS/PCs are warranted.

Patients with clinical post- coronary artery bypass grafting (CABG) deterioration manifest angiographic disease progression in both the native coronary arteries and aortocoronary conduits. Although clinical results suggest more pronounced impact of failed revascularization in comparison to progression in the native coronary circulation, the latter one is also of clinical importance. Coronary artery disease (CAD) progression in the ungrafted coronaries mimics pathophysiology of atherosclerosis, thus strict control of the commonest risk factors for its development is the therapeutic target. Otherwise, angiographic disease deterioration in the target coronary arteries is a net result of negative remodeling and plaque progression. Analysis of the angiographic post-CABG follow-up indicates that vessel shrinkage (i.e., negative remodeling) dominates. Low endothelial shrear stress resulted from diminished blood flow seems to be the most powerful pathogenetic factor of negative remodeling.

Graft disease leads to graft failure. From the clinical point of view, graft failure could be acute, subacute, and chronic. Acute failure is related to thrombosis, and subacute and chronic to neointima development and atherosclerotic degeneration, respectively. Histological studies evaluating vessel wall morphological, functional, and regenerative integrity may, at least to some extent, predict the risk of graft failure. Transplantation of venous segments into the coronary arterial circulation initiates an inevitable process of arterialization with occluding atherosclerotic plaques as a net final result. Plaques in venous grafts differ from atherosclerotic lesions found in the native coronary arteries and these morphological differences have impact on their mechanical properties. More fragile vein graft atherosclerotic lesions are very prone to rupture and subsequent thrombosis and consequently acute coronary syndrome. Up to now, some preventative measures against atherosclerosis development have been proposed and their results in histological studies are presented in this chapter.

Coronary artery bypass grafting (CABG) is relatively safe procedure with estimated mortality rate ranging 1 % through 5 %. Early and late results of CABG are determined by performance of bypass grafts and progression rate in the native coronary arteries. Although perioperative myocardial infarction (PMI) noted in approximately 2.5 % of CABG patients may be either graft or non-graft-related, the latter one dominates. Predominant reason of graft-related PMI is thrombus formation. In this chapter, mechanisms promoting the development of thrombus in bypass grafts and strategies to prevent it are described.

Atherosclerosis commonly affects the arteries harvested from patients 70 years of age or older. Saphenous vein grafts appear to maintain a higher patency rate after coronary artery bypass grafting in these subjects. The infiltration of macrophages is an early step in saphenous vein graft atherosclerosis; however, little is known regarding the underlying mechanisms of infiltration. The objective of the present report is to evaluate the presence of CD68-positive cells in the saphenous vein wall and correlate initial CD68-positive infiltration to specific clinical and biochemical parameters and the graft patency rate as estimated in patients undergoing coronary artery bypass grafting. A total of 309 patients were allocated into two groups: A1 patients, who were between 50 and 70 years of age, and A2 patients, who were 70 years or older at the time of vein harvesting. CD68 expression was evaluated by immunohistochemistry. There were no significant differences between A1 and A2 patients regarding macrophage expression within any of the analyzed vascular regions. Saphenous vein macrophages were never present in the tunica intima unless they were also expressed in the media or the adventitia. The patients with CD68-positive cells in the tunica intima had a significantly higher number of bypass stenoses when compared with the subjects who did not have CD68-positive cells in this layer. These findings suggest that the CD68-positive cells (those that have not yet developed into foam cells) present in the intima of saphenous vein grafts might serve as a very early marker of graft occlusion.