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Introduction Transcatheter aortic valve implantation (TAVI) although minimally invasive is still accompanied by changes in blood morphological parameters, some of them linked to unfavorable outcomes. Aim To find any association between changes in blood morphology reflecting an inflammatory response and acute kidney injury (AKI). Material and methods This study involved 176 consecutive transfemoral TAVI patients with a mean age of 78.4 ±7.0 years. Serum creatinine concentration (CREA) and blood morphology were analyzed in the blood samples taken before the procedure, then approximately 1, 24, 48 and 72 hours after the procedure, and lastly at the time of discharge. Post-procedural maximal or minimal values (max/min) and max/min-to-bs ratio of the laboratory parameters were also calculated. Results Leucocyte (WBC) and neutrophil (NEUT) counts increased significantly after the procedure whereas lymphocyte (LYMPH) counts declined markedly, reaching the highest or lowest values 24 hours after the procedure. A significant increase in neutrophil-to-lymphocyte ratio (NLR) was observed. Platelet count (PLT) dropped to a minimum at 72 hours after TAVI but at discharge did not return to the admission level. TAVI was associated with a marked increase in CREA with a peak at 48 hours after the procedure (135.7 ±75.9 μM/l). Patients with AKI (n = 65; 36.9%) presented more pronounced variations in relative changes in counts of all blood morphological parameters. A positive moderate (r = 0.412) correlation between maximal NLR and relative CREA changes was noted. Conclusions TAVI is associated with significant changes in blood morphological parameters that reflect an inflammatory response. They are more pronounced among subjects with post-procedural AKI.

IntroductionAccording to single institution studies, patients readmitted to the ICU (Intensive Care Unit) following cardiac surgery are at high risk of death. In our study, we primarily aimed to assess the impact of ICU readmission on postoperative results and to identify the independent risk factors of this complication among patients undergoing isolated coronary artery surgery.Material and methodsFollowing exclusions, we analyzed 89,958 consecutive patients in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry), scheduled for isolated coronary artery surgery between January 2010 and December 2019. Variables that independently influenced ICU readmission were identified by means of the multivariable logistic regression. Data of survivors and non-survivors among patients readmitted to the ICU were compared.ResultsIn the analyzed group, 1,003 patients underwent ICU readmission (1.1%). In-hospital mortality among patients readmitted and not readmitted to the ICU was 29.6% and 2.1%, respectively (p65 years and preoperative NYHA class III or IV were located on the top of this list. Patients who died following ICU readmission were older, more frequently classified NYHA IV, more frequently underwent non-elective surgery or MIDCAB (Minimally Invasive Coronary Artery Bypass).ConclusionsICU readmission following coronary artery surgery is associated with increased in-hospital mortality and the development of postoperative complications. There are many predictors of ICU readmission. Non-survivors of this complication were older, with more advanced heart failure and more frequently underwent non-elective surgery.

Introduction The video-assisted thoracic surgery (VATS) approach is widely used for pulmonary lobectomy, but its application for pneumonectomy is much less common and outcomes are ambiguous. Aim To evaluate the feasibility and outcomes of VATS pneumonectomy. Material and methods This retrospective study included 19 patients with the mean age of 62.6 ±5.5 years who were qualified for VATS pneumonectomy between September 1, 2010, and January 31, 2020. Indications and technical aspects were analyzed. Moreover, short- and long-term outcomes were assessed. Results There were no intraoperative deaths. Conversion to thoracotomy was necessary in 2 (10.5%) patients, because of bleeding in 1 patient and technical reasons in another. One patient died during the in-hospital period due to multi-organ failure as a result of bronchopleural fistula. Five other subjects developed postoperative complications, most often atrial fibrillation (n = 3). One patient was readmitted for empyema of the postpneumonectomy space without bronchopleural fistula. Histopathological examination revealed that the resection was complete (R0) in all cases and the most common type of cancer was squamous cell carcinoma (79%). Seven patients died during the follow-up: 1 because of surgical complications, 4 as a result of cancer progression, and 2 for non-cancer related reasons. Median survival was 47 months. One- and five-year probability of survival estimated by means of the Kaplan-Meier method was 0.88 ±0.07 and 0.43 ±0.15, respectively. Conclusions VATS pneumonectomy can be performed safely, without increased risk of intraoperative and postoperative complications. It enables a complete lung cancer resection and is likely to provide good short- and long-term outcomes.

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.

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.

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.

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.

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