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Background: The knowledge base regarding the pathogenesis of postoperative delirium is limited. The primary aim of this study is to investigate whether increased levels of IL-2 and TNF-α are associated with delirium in patients who underwent coronary-artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB). The secondary aim is to establish whether any association between raised cytokine levels and delirium is related to surgical and anesthetic procedures or mediated by pre-existing conditions associated with raised cytokine levels, such as major depressive disorder (MDD), cognitive impairment, or aging.Methods: Patients were examined and screened for MDD and cognitive impairment one day preoperatively, using the Mini International Neuropsychiatric Interview and The Montreal Cognitive Assessment and Trail Making Test Part B. Blood samples were collected postoperatively for cytokine levels.Results: Postoperative delirium screening was found positive in 36% (41 of 113) of patients. A multivariate logistic regression revealed that an increased concentration of pro-inflammatory cytokines is associated with delirium, and related to advancing age, preoperative cognitive decline of participants, and duration of CPB. According to receiver operating characteristic analysis, the most optimal cut-off for IL-2 and TNF-α concentrations in predicting the development of delirium were 907.5 U/ml and 10.95 pg/ml, respectively.Conclusions: The present study suggests that raised postoperative cytokine concentrations are associated with delirium after CABG surgery. Postoperative monitoring of pro-inflammatory markers combined with regular surveillance may be helpful in the early detection of postoperative delirium in this patient group. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesiology & Rescue Medicine / Anestezjologia i Ratownictwo is the property of Akademia Medycyny Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Degenerative aortic stenosis (AS) is an active inflammatory process similar to that in atherosclerosis plaque. The aim was to evaluate the atherosclerotic risk factors, concomitant diseases and risk of cardiovascular death using the SCORE system in degenerative AS-patients aged 60 and over with preserved left ventricle ejection fraction related to severity of AS. Material: The database contains retrospectively consecutive series of 126 patients (mean age 69). Patients were analyzed related to severity of AS: severe AS with mean gradient of 64.6±8.7mmHg (n=79) and non-severe AS with mean gradient of 24.4±8.4mmHg (n=47). There were analyzed: age, gender, BMI, laboratory data, presence of hypertension (HA), diabetes, CAD, smoking cigarettes, positive family history, results of 12-lead ECG and coronary arteriography. There was estimated 10 year risk of cardiovascular death using the SCORE system. Results: Both studied populations presented high 10-year risk of cardiovascular death with higher SCORE in non-severe AS (5.64+/-3.3% vs. 6.95+/-3.13%, P=0.006). Multivariate analysis revealed that only HA was an independent parameter determining higher SCORE in non-severe AS (P<0.05). Conclusions: The non-severe degenerative AS-population had higher 10 years risk of cardiovascular death based on SCORE system than severe AS-patients, what was probably resulted from arterial hypertension. [ABSTRACT FROM AUTHOR]

Copyright of Polish Surgery / Chirurgia Polska is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We present a case of a 51-year-old male patient hospitalized due to acute coronary syndrome requiring stent implantation to the left main stem. Double antiplatelet therapy was commenced. After 2-3 days, the patient presented with high fever, dyspnea on exertion, pain in the chest, myalgia, and general weakness. Transthoracic (TTE) and transesophageal (TEE) echocardiography revealed abnormal, turbulent flow across the aortic prosthesis, which was probably caused by the presence of a pathological smooth and mobile structure (10 × 9 × 5 mm) in front of the aortic annulus. Blood cultures were positive and staphylococcal prosthetic valve endocarditis (PVE) was diagnosed. Despite antibiotic treatment, the patient's condition deteriorated, and he was referred for prosthesis reimplantation. After being transferred to the Cardiac Surgery Clinic, he presented with nausea, vomiting, and abdominal pain. The results of imaging examinations suggested spleen hematoma. The patient underwent an urgent splenectomy. Histopathological examination revealed a spleen infarction consequent to an embolic event and subscapular hematoma. On the 10(th) day after the laparotomy, cardiac surgery was performed. No large vegetations were found on the aortic prosthesis. The mechanical valve, implanted 20 years earlier, was functioning properly; it was intact and well healed. Several fragments of a thrombus and fibrous tissue, resembling a pannus and covered with minor calcifications, were removed from the ventricular surface of the discs. A decision was reached to leave the aortic prosthesis in situ. The valvular material culture revealed the presence of Streptococcus anginosus, and the antibiotic scheme was modified. The postoperative period was uneventful.

The paper presents a case report of a patient with a superior vena cava occlusion and post-operational (after the implantation of the aortic valve) atrioventricular block, which required constant stimulation. An epicardial VVI pacemaker was implanted through mini-sternotomy in the lower part of the previous operation field with very satisfactory stimulation parameters. Implantation of a screw-in epicardial lead is in some cases the method of choice, which provides efficient and constant heart stimulation.

Introduction: Patients with severe aortic stenosis (AS), high mean gradient (HMG), and preserved left ventricular ejection fraction (LVEF) may present with paradoxical "low flow" (LF)., Objectives: The aim of the study was to assess the potential effect of cardiac collagen metabolism on the HMG/LF phenomenon in patients with severe AS and to determine a clinical and echocardiographic pattern of these patients., Patients and Methods: We assessed a clinical status of 89 patients, aged over 64 years, with severe AS, HMG, and preserved LVEF (≥50%). Cardiac structure and function as well as systemic arterial hemodynamics were assessed with echocardiography, conventional Doppler, and tissue Doppler imaging. Moreover, plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), procollagen III N-terminal propeptide (PIIINP), carboxyterminal telopeptide of collagen type I, matrix metallopeptidase 9, and inhibitor of matrix metalloproteinase type 1 were evaluated. We analyzed 2 groups of patients: with normal flow (stroke volume index [SVI], ≥35 ml/m²; n = 70) and with LF (SVI, <35 ml/m²; n = 19)., Results: Patients with LF were older, had a larger left atrium and left atrial volume index, smaller aortic valve area, lower energy loss index, stroke work, mitral flow E velocity, mitral annular E' and S' velocities and systemic arterial compliance, higher relative left ventricular wall thickness, E/E', systemic arterial resistance and valvulo-arterial impedance. We observed a correlation between SVI and NT-proBNP, PIIINP, and selected parameters of cardiac structure and function., Conclusions: In patients with severe AS, HMG and preserved LVEF, the LF is related to a more severe obstruction, altered aortic hemodynamics, cardiac dysfunction, and higher blood levels of NT-proBNP. An inverse association between PIIINP and SVI may indicate enhanced tissue fibrosis as an underlying pathology.

Introduction: Longitudinal bone growth ceases by the end of puberty, and it is thought to be a result, in both sexes, of increased pubertal oestrogen serum concentrations. Since peak bone mass is achieved by the third decade of life or later, the aim of this study was to relate sex steroid hormones and sex hormone binding globulin (SHBG) levels to bone quality in men during their third and fourth decades of life., Material and Methods: Eighty men, healthy volunteers aged between 18 and 39 years, were subjected to an interviewer-administered questionnaire, body mass index (BMI) measurement, blood sample and calcaneal quantitative ultrasound (QUS) (Hologic-SAHARA). Blood was assessed for testosterone (T), oestradiol (E2), dehydroepiandrosterone sulfate (DHEAS), SHBG, luteinising hormone (LH) and follicle stimulating hormone (FSH). Free and bioavailable T and E2 levels were calculated knowing SHBG and albumin levels., Results: While T, E2, DHEAS, LH and FSH levels were not related, free and bioavailable fractions of T and E2 were positively associated with QUS readings. SHBG level was associated negatively. After dichotomisation for age, the associations remained significant only for younger subjects (18-30 years, n = 47). After adjustment for other co-variants, only SHBG in younger subjects retained its negative association with QUS. Older subjects (31-39 years, n = 33) revealed higher BMI and lower serum concentrations of total (-17 %), free (-18.5%) and bioavailable (-22.5%) levels of E2 than younger subjects., Conclusion: Free and bioavailable fractions of sex steroids may influence bones in young men, depending on age and E2 level.

Background: In Poland, mortality and morbidity rates due to ischaemic heart disease (IHD) remain high and concern the whole population. An interesting issue is rapid development of IHD in some younger subjects and uncertain treatment outcomes in this patient subset. Premature cessation of professional activity, along with worsening of quality of life due to IHD in the population under 45 years of age is a huge medical, economic, and social problem. Only few studies evaluated early and long-term outcomes of coronary artery bypass grafting (CABG) used for the treatment of IHD in young patients, especially in premenopausal women., Aim: The purpose of the study was to analyse early and long-term outcomes of CABG in patients under 45 years of age., Methods: We studied 125 patients under 45 years of age who underwent a CABG procedure. The study group included 65 women aged 27-45 (mean 41.5 ± 3.5) years operated upon in 1990-1999, and 60 men aged 33-45 (mean 41 ± 3.2) years operated upon in 1993. We evaluated early postoperative outcomes. The two genders were compared in regard to survival free from death, recurrent angina, and repeated myocardial during long-term follow-up. We also evaluated other variables such as education level, professional activity, and exposure to IHD risk factors before and after the operation., Results: Seven women and two men died in hospital after CABG (p = 0.2). Analysis of major postoperative outcomes like myocardial infarction, low cardiac output syndrome requiring support with intra-aortic balloon pump (IABP), a lower limb amputation following the use of IABP, ischaemic stroke, and respiratory failure showed that these complications were significantly more frequent in women than in men (p < 0.01). Differences between the two groups regarding other adverse outcomes including atrial fibrillation, sternal instability, haemothorax, and pneumothorax were not significant. Analysis of long-term survival curves did not show any significant differences between men and women in regard to rates of death, recurrent angina, and the need for repeated myocardial revascularisation (p = 0.64, p = 0.93, and p = 0.13, respectively)., Conclusions: Young women who underwent CABG were burdened with higher early postoperative morbidity and mortality than young men. However, long-term outcomes (mortality, recurrent angina, and repeated myocardial revascularisation rates) did not differ significantly between the two groups. Regardless of gender, repeated myocardial revascularisation rate was significantly higher among those patients who continued to smoke after the surgery (p < 0.01).

We present a case of the left atrial myxoma 6 years after atrial fibrillation ablation. The initial diagnosis of the mass revealed on echocardiography was a thrombus. Failure of anticoagulant treatment and transesophageal echocardiography led to diagnosis of myxoma, confirmed intraoperatively and histologically.

Background: Cardiac rehabilitation (CR) is recommended after cardiac surgery. Secondary prevention through exercise training is one of the best scientifically-proven ways of decreasing mortality and enhancing quality of life in cardiovascular disorders. Studies into the use of CR in different groups of patients after cardiac surgery are limited., Aim: To find the factors determining the reasons for the lack of CR in cardiac surgery patients., Methods: The study group consisted of 82 patients (mean age 58.6 years, 80.7% male) in stable II/III NYHA class, who had undergone coronary artery bypass graft surgery, valvular surgery, or both. The following were analysed: age, gender, body mass index, basic laboratory results such as serum lipids level, cholesterol ratio LDL/HDL, creatinine and glucose levels, results of electrocardiography, echocardiography and coronary arteriography, presence of hypertension, diabetes, coronary artery disease, renal failure, previous stroke, obliteration of peripheral arteries, EuroSCORE and length of hospitalisation. Patients were divided into two groups: those referred for CR (n = 46, the CR group) and those referred for CR but who did not receive it (n = 36, non-CR group)., Results: From multiple logistic regression analysis with backward stepwise, only female gender (p = 0.0208, OR = 0.07) and length of hospitalisation (p = 0.0198, OR = 1.17) were significant for non-CR patients., Conclusions: We found a lower rate of use of CR after cardiac surgery in those patients hospitalised for longer periods, and in women.

We describe a 73 year-old patient with mitral valve pericardial bioprosthesis Carpentier-Edwards 29M implanted due to the rheumatic mitral stenosis 21 years ago. Hemodynamic destabilisation had emerged 18 months before the admission. Echocardiography revealed significant bioprosthesis degeneration with calcification of its leaflets, small pannus on the bioprosthetic ring, moderate mitral stenosis, severe mitral and tricuspid regurgitation with high pulmonary hypertension and moderate aortic regurgitation. Redo valve surgery with mechanical Medtronic 27M valve implantation and tricuspid suture annuloplasty was successfully performed. The postoperative course was complicated by bleeding and severe respiratory insufficiency and the patient died 3 weeks after the surgery.

Background: Preoperative atrial fibrillation (AF) increases the risk of cardiac surgery and the occurrence of postoperative complications, including arrhythmias, low-output syndrome, delirium, and death. The aim was to evaluate its direct influence on prognosis of patients subjected to cardiac surgery., Material/methods: This is a pilot study of the CODACS trial (COnsciousness Disorders After Cardiac Surgery). Two hundred sixty patients admitted for open-heart surgery were prospectively included in the study. Preoperative AF was diagnosed on the basis of multiple electrocardiographic examinations and confirmed by 24-h Holter monitoring. Diagnosis of delirium following surgical intervention was based on DSM-IV criteria., Results: Preoperative AF was diagnosed in 23 patients (8.8%): in 15 patients in the nondelirious group (7%) and 8 (27.0%) in the delirious group. Preoperative AF was an independent predictor of postoperative delirium (p<0.001), increasing its risk of occurrence over sevenfold (OR=7.2). AF also increased the risk of such postoperative complications as supraventricular arrhythmia (AF: 78.3% vs. non-AF: 22.8%, p<0.001), stroke (8.7% vs. 1.3%, p<0.001), and low-output syndrome (21.7% vs. 17.3%, p=0.033) and worsened prognosis, significantly increasing the risk of death (8.7% vs. 0.8%, p<0.001)., Conclusions: Preoperative AF was an independent risk factor of postoperative delirium (OR=7.2). It was also associated with significantly worse postoperative outcome (supraventricular arrhythmia, stroke, low-output syndrome, and risk of death). These results and data from available studies suggest that preoperative AF should be considered as an important predictor of postoperative outcome. This problem should be the subject of future research to establish beneficial treatment options.

Background: Acute aortic dissection is one of the most serious life-threatening conditions, with mortality during the first 48 hours reaching 50%., Aim: To assess short and long-term effects as well as safety of surgical treatment of aortic dissection combined with aortic valve repair., Methods: The study group consisted of 57 patients (38 males, 19 females, mean age 47.9 +/- 13 years) with dissection of the ascending part of the aorta (type A aortic dissection) who underwent surgery in our institution between 1985 and 1999. Follow-up duration ranged from 2 to 16 years -- mean 6 years. Control transthoracic or transesophageal echocardiography was performed in 37 patients., Results: Early mortality was 21%. There were 12 perioperative deaths and 3 late non-cardiovascular deaths. Three patients underwent repeated surgery due to (1) aortic valve insufficiency, (2) pseudoaneurysm at the site of the anastomosis between proximal part of the vascular prosthesis and the aorta, and (3) fistula between aorta and right atrium., Conclusions: Aortic dissection type A is more frequent in males than females. The main causative factor is hypertension. Early mortality is significantly higher in patients undergoing emergency surgery compared with elective procedures. Heart failure symptoms (NYHA class) improve postoperatively in the majority of patients. Aortic valve repair is effective and relatively safe, and is an alternative to the aortic valve replacement with coronary arteries reimplantation.

Unlabelled: The aim of the thesis is the evaluation of efficacy of surgical treatment for complex valvular heart diseases. An inclusion criterion to this analysis was the performance of a mitral valve replacement (MVR) and aortic valve replacement (AVR) for an artificial valve and a tricuspid valve replacement or plastic operation (TVR or pl. TV). Such operative procedures were carried out simultaneously. Twenty five operations were performed from 1995 to 1999. TVR was carried out in 2 patients, pl. TV in 21 patients and the Revuelt method was adopted for this purpose, whereas in two cases a tricuspid valve plastic operation was performed sewing in the annulus. In the two cases the revascularization of the right coronary artery was carried out simultaneously. In another case a myxoma removal from the left atrium was additionally carried out. One patient died due to renal failure during hospitalization on the 9th day after the operation. Three patients died subsequently in the first, second and third year after operation. The causes of subsequent deaths among the patients examined in the period of five years after the operation were thrombotic-embolic complications., Conclusions: Early and subsequent results of simultaneous tri-valvular operations are good. The most frequent and difficult postoperative complication in this group of patients is a low output syndrome. Subsequent complications and deaths are most often due to thromboembolic complications, therefore a particular attention should be paid to the anticoagulant treatment in this group of patients.

Unlabelled: The aim of the study was to analyze the risk and operative results in bypassed patients with ischemic heart disease (IHD) older than 65 years., Material: The study group was 117 patients over 65 years old (66-87, mean 71 years) and the controls were 233 patients below 65 years old (31-64, mean 51 years), who underwent coronary artery grafting., Methods: The frequency of such risk factors as diabetes, smoking, hypertension and IHD and myocardial infarction (MI) family history were performed. Theoretical operative risk in study group and in control group were estimated using: Parsonnette, The Cleveland Clinic Foundation and Euro Score scales. The number of anastomoses, the frequency of using the internal mammary artery (IMA) graft to left anterior descending (LAD) coronary artery and perfusion, aorta clamping and repercussion times were compared in both groups. The operative mortality, Q wave MI and stroke were analysed in study and control groups as the operative results., Results: There was the higher percent of women and patient with hypertension and lower percent of smokers in the study group. The total cholesterol, HDL-cholesterol, LDL-cholesterol, PAI-1, fibrinogen, creatinine levels and the number of the patients with cerebral or peripheral atherosclerosis were similar in both groups. The triglycerides level was higher in the study group. In the study group the use of IMA, as the conduit was lower. There was no difference in the perfusion time, aorta clamping time and reperfusion time. An operative mortality was higher in the older group (8.5% vs 2.6%; p < 0.05). The perioperative Q wave MI rate was 7.7% and 4.3% (ns) and stroke rate was 3.4% and 2.6% (ns). Estimated in our patients, theoretical operative mortality in the study group was 6.5-8.7% and in the control group was 2.1-2.7%, and there was no statistical differences compare to real operative mortality. The most adequate to real mortality was theoretical mortality estimated using EuroScore scale., Conclusions: 1. Coronary bypass surgery mortality was higher in the patients over 65 years old and the myocardial infarction was the main reason of death. 2. Using operative risk scales, the prognosis individual operative risk mortality to every patient can be estimated and if this risk is too high it is possible to eliminate some risk factors or desist from operative treatment.

Background: In survivors of acute myocardial infarction (AMI), an occluded infarct-related artery (IRA) is an important predictor of cardiac death (CD) and sudden death (SD). Early reperfusion of the IRA was associated with improved survival rate. The purpose of the present study was to assess if late IRA revascularization, performed 10-30 days after AMI, also has a beneficial effect on the incidence of CD and SD during an 18-month follow-up., Material/methods: The study population consisted of 93 post-MI patients with occluded IRA on coronary angiography. The patients were divided into 2 groups according to IRA status at discharge -- revascularized (47 patients) or occluded (46 patients) -- and followed. Before revascularization, the two groups of patients did not differ in the prevalence of clinical and angiographic variables, or in the incidence of risk factors for SD. In patients who underwent angioplasty or bypass graft surgery of closed IRA, the markers of electrical instability demonstrated no significant improvement after revascularization., Results: During the 18-month follow-up a significantly lower incidence of CD (0% vs 15%, p<0.01) and SD (0% vs 11%, p<0.03) was observed in the group of patients with revascularized IRA than in the group of patients with occluded IRA., Conclusions: In survivors of AMI, late reperfusion of occluded IRA is associated with reduced 18-month cardiac mortality. The beneficial effect of this procedure on the incidence of sudden death, not associated with improvement in myocardial electrical stability, suggests that ischemia can be considered an important factor modulating the arrhythmogenic substrate.

276 patients aged 65 years or more, who underwent coronary artery bypass grafting in the Department of Cardiac Surgery, Medical University of Łódź in 1999 and 2000, were assessed. The analyzed group consisted of 193 men (69.93%) and 83 women (30.07%). The mean age of the patients was 69.14 years (+/- 3.42, age range from 65 to 79 years), 18 (6.52%) patients were in the first functional class of CCS classification, 55 pts (19.93%) in the second, 106 pts (38.41%) in the third and 97 pts (35.14%) in the fourth class. 87 patients (31.52%) had no history of myocardial infarction, 137 pts (49.28%) had a history of 1 infarction and 53 pts (19.2%) of 2 or more myocardial infarctions. 68.12% of patients smoked cigarettes. Arterial hypertension was observed in 176 pts (63.77%), diabetes mellitus in 50 pts (18.11%), chronic renal failure in 10 pts (3.62%), a history of stroke in 8 pts (2.9%), peptic ulcer in 42 pts (15.22%). Left ventricular ejection fraction below 30% was observed in 16 (5.8%) patients. 10 pts (3.62%) underwent coronary angioplasty and in 26 pts (9.42%) critical stenosis of the left main stem was observed. All patients were operated on cardiopulmonary bypass and myocardial protection was obtained by the use of cold crystalloid cardioplegy solution based on St. Thomas Hospital formula. 224 patients (81.16%) were operated electively. In early postoperative period the following complications were observed: death--35 (12.68%), low cardiac output syndrome--84 (30.43%), need of use of intraaortic contrapulsation--31 (11.23%), perioperative myocardial infarction--44 (15.94%). Respiratory complications were observed in 83 pts (30.07%), neurological complications in 7 pts (2.54%), acute renal failure in 25 pts (9.06%), intestinal bleeding in 5 pts (1.81%). Rethoracotomy was necessary in 12 of the operated (4.35%). Currently the age of a patient is considered as one of many risk factors and should not be treated as a contraindication to surgical revascularization procedure. In the analyzed material mortality correlated with a number of risk factors. It is to remember that the elderly have higher prevalence of coexisting diseases and that is why their exposure to the perioperative complications is also higher.

36 patients aged 65 years or more, who underwent mitral valve replacement in the Department of Cardiac Surgery, Medical University of Łódź in 2000, were assessed. This group consisted of 22 women (61.1%) and 14 men (38.9%). The mean age of the patients was 68.5 years (+/- 2.96, age range from 65 to 76 years). The analysis of preoperative clinical state of the patients revealed prevalence of diabetes mellitus in 19 pts (52.78%), chronic bronchitis in 9 pts (25%), arterial hypertension in 14 (38.89%), pulmonary hypertension in 21 pts (58.33%), atrial fibrillation in 25 pts (69.44%), ventricular arrhythmia in 2 pts (5.56%) and cigarette smoking in 15 pts (41.67%). The mean left ventricular ejection fraction was 48.89% (+/- 9.26, from 30% to 70%). All patients were operated on cardiopulmonary by-pass and cardioprotection was obtained by the use of cold crystalloid cardioplegy solution based on St. Thomas Hospital formula. 6 patients (16.67%) underwent myocardial revascularization procedure simultaneously. In early postoperative period the following complications were observed: death--6 (16.67%), low cardiac output syndrome--5 (13.89%), need of use of intraaortic contrapulsation--2 (5.56%), need of use of inotropic agents--9 (25%), respiratory failure with the need of prolonged intubation--4 (11.11%), acute renal failure--4 (11.11%), stroke--2 (5.56%), need of temporary cardiac pacing--5 (13.89%), need of rethoracotomy--1 (2.78%). The results of mitral valve replacement procedures in patients over 65 years are less satisfactory than those of aortic valve replacement procedures in the same age group, however deaths considered patients with number of risk factors. The older age of the patients should not be treated at the moment as a contradiction to the cardiac surgery, but should be considered as a one of many risk factors.

Unlabelled: We have used hypothermic retrograde brain perfusion (RBP) as a cerebral protection concurrently with hypothermic circulatory arrest (HCA) since September 1994. Till January 2000, 59 patients with ascending and arch aortic aneurysms were operated on (32 emergency cases with acute aortic dissection, 27 elective, including 5 with the chronic dissection). Cardio-pulmonary bypass (CPB) was established, using a common femoral artery and two venous caval cannulae, general hypothermia, aorta cross-clamping, and cold crystalloid intermittent cardioplegia via the coronary orifices. In 10 patients with De Bakey type I dissection, in whom the intimal tear was localised either in the arch or high in the ascending aorta near the orifice of the brachiocephalic trunk, and in 1 patient without dissection, after implementing HCA, continuous RBP was carried on with cold oxygenated blood via the superior caval cannula from its additional connection with the arterial line. After accomplishing the distal anastomosis (in 6 cases with the top of the arch containing the orifices of the brachiocephalic arteries and upper descending thoracic aorta, in 1 case using artificial arch, in 4 cases before the orifice of the brachiocephalic trunk) RBP was finished and CPB re-established. The incompetent aortic valve was repaired by suspension of its commissures and the prosthesis was anastomosed proximally above the coronary orifices. Seven patients died, one (with megaaorta syndrome) during the operation, 2 of myocardial failure on the 2nd postoperative day, and 3 of multiple organ disorder (including stroke with hemiparesis in 2) in the 2nd postoperative week (all but one after regaining consciousness). One patient died suddenly at home six weeks after the operation. Four patients are alive, without any neurological damage., Conclusion: This simple and economical method effectively protects the brain against ischaemia and emboli, without technically prolonging or complicating the operation.

30 patients aged 65 years or more, who underwent aortic valve replacement in the Department of Cardiac Surgery, Medical University of Łódź in 2000, were assessed. This group consisted of 19 women (63.3%) and 11 men (36.7%). The mean age of the patients was 71.83 years +/- 3.76, age range from 66 to 78 years. The analysis of preoperative clinical state of the patients revealed prevalence of diabetes mellitus in 23 pts (76.7%), chronic bronchitis in 4 pts (13.3%), arterial hypertension in 8 pts (26.7%), pulmonary hypertension in 8 pts (26.7%), atrial fibrillation in 4 pts (13.3%), ventricular arrhythmia in 13 pts (43.3%) and cigarette smoking in 8 pts (26.7%). The mean left ventricular ejection fraction was 50.8% (+/- 8.12%, from 31% to 64%). All patients before aortic valve replacement procedure underwent coronary angiography. All patients were operated on cardiopulmonary by-pass and myocardial protection was obtained by the use of cold crystalloid cardioplegy solution based on St. Thomas Hospital formula. 7 patients (23.3%) underwent myocardial revascularization procedure simultaneously. In early postoperative period the following complications were observed: death--2 (6.67%), low cardiac output syndrome--4 (13.33%), need of use of intraaortic contrapulsation--3 (10%), need of use of inotropic agents--13 (43.33%), respiratory failure with the need of prolonged intubation--8 (26.67%), acute renal failure--2 (6.67%), stroke--1 (3.33%), need of temporary cardiac pacing--4 (13.33%), need of rethoracotomy--2 (6.67%). The results of aortic valve replacement procedures in patients over 65 years age good, in spite of prevalence of number risk factors in these patients. The high rate (23.3%) of patients requiring simultaneous myocardial revascularization is remarkable. The age of a patient should not be treated as a contradiction to the cardiac surgery.