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Pulmonary arterial hypertension is a rare but progressive disease that leads to death. Modern drug treatment slows the progression of the disease and prolongs patients' lives, but often, even maximal treatment with parenteral prostacyclin does not prevent deterioration. In the case of inadequate clinical response to drug treatment, lung transplantation (LTx) should be considered. This article aims to analyze thoroughly indications to refer a patient for consultation with a transplant center, the optimal timing of listing for LTx, contraindications for the procedure, bridging techniques, as well as tests needed before and after transplantation. We outline the technique of the procedurę and evaluate psychological aspects of LTx.

Background: It was hypothesized that the time-appropriate return to a resting heart rate (HR) after cessation of exercise could be a marker for predicting outcomes in patients with heart failure (HF). We aimed to evaluate the prognostic value of HR recovery in functional improvement among adults with severe aortic stenosis undergoing percutaneous aortic valve implantation (TAVI). Methods: We performed a 6 min walk test (6MWT) in 93 individuals before TAVI and 3 months after the procedure. The change in walking distance was calculated. During the pre-TAVI 6MWT, we analyzed the differences between baseline HR, HR at the end of the test, and HR at the 1st, 2nd, and 3rd minute of recovery. Results: After 3 months, 6MWT distances improved by 39 ± 63 m and reached a total of 322 ± 117 m. Multiple linear regression proved the differences between HR after 2 min of recovery and baseline HR in pre-TAVI after a 6MWT was the only significant predictor of waking distance improvement during follow-up. Conclusions: Our study suggests that analysis of HR recovery after a 6MWT may be a helpful and easy parameter to assess improvements in exercise capacity after TAVI. This simple method can help to identify patients in whom no significant benefit in functional improvement can be expected despite successful valve implantation.

Frailty syndrome (FS) is one of the most important variables that have a proven impact on the increased risk of morbidity and mortality in cardiac surgery. However, FS assessment is not routinely incorporated into daily clinical practice or included in commonly used risk assessment models. The inclusion of FS in perioperative risk prediction models in cardiac surgery would not only allow for a more accurate assessment but could also assist in the selection of an appropriate treatment strategy while favoring the appropriate use of clinical resources. The identification of FS in the qualification process must not be seen as an absolute contraindication to cardiac surgery but as an opportunity to adequately prepare the patient for the procedure. However, the literature is heterogeneous in terms of the selection of an appropriate tool for identifying FS. Selected tools commonly used in the assessment of FS in patients with cardiovascular disease, including those of greatest relevance in cardiac surgery, are presented in this editorial.

OBJECTIVES This study presents the results of 17 years of experience with bicuspid aortic valve (BAV) repair and the analysis of factors associated with repair failure and early echocardiographic outcome. METHODS Between 2003 and 2020, a total of 206 patients [mean age: 44.5 ± 15.2 years; 152 males (74%)] with BAV insufficiency with or without aortic dilatation underwent elective aortic valve repair performed by a single surgeon with a mean follow-up of 5 ± 3.5 years. The transthoracic echocardiography examinations were reported. RESULTS There were no deaths during the hospital stay, and all but 1 patient survived the follow-up period (99.5%). Overall, 10 patients (5%) developed severe insufficiency and 2 (1%) developed aortic dilatation requiring reoperation. Freedom from reoperation at 7 years reached 91.8%. Type 2 BAV configuration [hazard ratio (HR) 3.9; 95% confidence interval (CI): 1.01–60; P = 0.049], no sinotubular junction remodelling (HR 7; 95% CI: 1.7–23; P = 0.005), no circumferential annuloplasty (HR 3.9; 95% CI: 1.01–64; P = 0.047) and leaflet resection (HR 5.7; 95% CI 1.2–13. P = 0.017) have been identified as a risk factor of redo operation. Parameters of the postoperative left ventricle reverse remodelling improved significantly early after the operation and later at 2 years evaluation. CONCLUSIONS The repair of BAV offers good short- and mid-term results providing a significant reverse left ventricular remodelling. Type 0 BAV preoperative configuration, circumferential annuloplasty and sinotubular junction remodelling are associated with better repair durability.

Introduction Indications for transcatheter aortic valve implantation (TAVI) are constantly expanding, including younger patients. Bicuspid aortic valves (BAV) often occur in this group. In order to achieve optimal treatment results in younger patients, it is necessary to develop an effective method for selecting the size of implanted valves. Aim To compare the results of TAVI with use of a self-expanding prosthesis in patients with a BAV and a tricuspid aortic valve (TAV) with valve selection based on annular sizing. Material and methods The diagnosis of BAV and TAV and measurements (annular sizing) were based on multi-slice computed tomography scans. Eighty-three patients received a self-expanding CoreValve or Evolut R prosthesis. In group I (BAV) there were 21 (25.3%) patients and in group II (TAV) there were 62 (74.7%) patients. Results The groups did not differ in terms of baseline clinical characteristics. Device success was achieved in 16 (76.2%) and 55 (88.7%) (p = NS) in group I and II respectively. Composite endpoints: early safety occurred in 5 (23.8%) and 11 (17.7%) patients (p =NS) in group I and II respectively; clinical efficacy occurred in 10 (47.6%) and 28 (45.2%) patients (p = NS) in group I and II respectively. 30-day mortality was 4.8% vs 9.7%, 1-year mortality was 28.6% vs 17.7% (p = NS) in group I and II respectively. Conclusions TAVI in patients with severe aortic stenosis and BAV is as effective as in patients with TAV using self-expanding prostheses if the valve selection is based on annular sizing.

Balloon pulmonary angioplasty (BPA) has become a therapeutic option for inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Despite significant improvement in the technique, treatment of subtotal (STO) and total (TO) pulmonary artery occlusions with BPA may pose risk, but the efficacy is less known.We aimed to evaluate the safety and efficacy of BPA in STO/TO.We included consecutive patients with inoperable CTEPH, who underwent BPA treatment. To evaluate the efficacy and safety we grouped all BPA sessions into these in which recanalization of at least one STO or TO was performed and into those without. The primary efficacy outcome was a decrease of pulmonary vascular resistance (PVR) after BPA sessions with STO/TO recanalization as compared to those without.We analysed 169 BPA sessions in 50 CTEPH patients. Out of a total number of 831 lesions subjected for BPA, 169 were classified as STOs or TOs [123 (15,6%) and 39 (4,7%) respectively]. At least one STO/TO recanalization was successfully performed during 90 BPA sessions. Three (2,3%) STOs and 8 (20,5%) TOs were not recanalized despite repeated attempts. Recanalization of at least one STO/TO at the level of segmental pulmonary artery was associated with a significant PVR improvement as compared to subsegmental-only STO/TO recanalizations or no recanalizations (-126 ± 192 vs -38 ± 135 dyn·s·cm - 5, p = 0.007). The rate of complications was similar in STO/TO and non-STO/TO lesions (4.1% vs 2.4%, p = 0.22).The use of BPA for the recanalization of subtotal and total PA occlusions is safe and feasible. Recanalization of segmental occlusive lesions leads to a significant improvement in PVR as compared to dilatation of nonocclusive ones.

BACKGROUND: Balloon pulmonary angioplasty (BPA) is a promising therapy for patients with chronic thromboembolic pulmonary hypertension (CTEPH) who are ineligible for pulmonary endarterectomy. AIMS: The present study aimed to evaluate the safety and efficacy of BPA for CTEPH using the first multicentre registry of a single European country. METHODS: Data were obtained from the Database of Pulmonary Hypertension in the Polish Population (NCT03959748), a prospective, multicentre registry of adult and paediatric pulmonary arterial hypertension (PAH) and CTEPH, for a total of 236 patients with confirmed CTEPH (124 women; mean age 67 years) who underwent 1,056 BPA procedures at eight institutions in Poland. RESULTS: In 156 patients who underwent follow-up assessments after a median of 5.9 (IQR: 3.0-8.0) months after final BPA, the mean pulmonary arterial pressure decreased from 45.1±10.7 to 30.2±10.2 mmHg (p

Background Balloon pulmonary angioplasty (BPA) has become a therapeutic option for inoperable chronic thromboembolic pulmonary hypertension (CTEH). Despite significant improvement in the technique, treatment of subtotal (STO) and total (TO) pulmonary artery occlusions with BPA may pose risk, but the efficacy is unknown. Aim We aimed to study to assess safety and efficacy of BPA in STO/TO. Methods We included consecutive patients with inoperable CTEPH, who underwent BPA treatment. To evaluate the efficacy and safety we grouped all BPA sessions into those in which recanalization of at least one STO or TO was performed and into those without. The primary efficacy outcome was improvement in pulmonary vascular resistance (PVR) in BPA sessions with STO/TO recanalization as compared to those without. Results We analyzed 169 BPA sessions in 50 CTEPH patients. Out of a total number of 832 lesions subjected for BPA, 168 were classified as STOs or TOs [129 (15,5%) and 39 (4,7%) respectively]. Three (2,3%) STOs and 8 (20,5%) TOs were not recanalized despite repeated attempts. There were 90 BPA sessions with at least one STO/TO recanalization. Racanalization of at least one STO/TO was associated with a trend towards PVR improvement as compared to non-STO/TO BPAs (−69±162 vs −38±135 dyn s cm–5, p=0,19). Recanalization of STO/TO at the level of segmental pulmonary artery as compared to subsegmental-only STO/TO recanalizations or no-STO/TO recanalization was associated with significant PVR improvement (−126±192 vs −38±135 dyn s cm–5, p=0.007). The rate of complications was similar in STO/TO and non-STO/TO BPA sessions (14.4% vs 12.6%, p=0.56). Conclusions The use of BPA for the recanalization of subtotal and total PA occlusions is safe and effective. Recanalization of segmental STO/TOs leads to significant improvement in PVR. Funding Acknowledgement Type of funding sources: None.

Introduction The presence of coronary artery disease (CAD) in patients who underwent transcatheter aortic valve implantation (TAVI) may increase in-hospital and long-term mortality. Aim To evaluate the impact of CAD in patients who underwent TAVI. Material and methods The study group consisted of the first 142 patients treated with TAVI between 26 November 2008 and 31 December 2015. The patients were divided into two groups: group I comprised 103 (72.5%) patients with CAD, and group II comprised 39 (27.5%) patients without CAD. Results Group I was characterized by a significantly higher risk according to EuroSCORE – 11.2 ±2.5 vs. 9 ±2.3 in group II (p < 0.001) and Logistic EuroSCORE – 25.4 ±13.4 vs. 16.3 ±8.7 (p < 0.001). 30-day mortality was 8 (7.8%) vs. 2 (5.1%) (p = NS) and 1-year mortality was 22 (21.4%) vs. 6 (15.4%) (p = NS) in group I and II respectively. The composite endpoint evaluating the efficacy of TAVI was achieved in 82 (79.6%) vs. 31 (79.5%) (p = NS) in group I and II respectively. The composite endpoint, which involved 30-day observation, occurred in 39 (37.86%) vs. 12 (30.77%) (p = NS) and the composite endpoint, which involved 1-year evaluation of the clinical efficacy of TAVI, occurred in 48 (57.8%) vs. 13 (48.1%) (p = NS) in patients with and without CAD respectively. Conclusions The short- and mid-term outcomes of TAVI patients with CAD, despite higher risk profile, did not differ from the outcomes of treatment in patients without CAD.

Highlights • Mediastinal tumours may cause non-specific symptoms, associated with tumour growth. • Mediastinal teratoma is uncommon finding and most often present in young adults. • Total surgical excision is the treatment of choice for mediastinal teratoma. • Imaging study appears to be a sufficient tool to diagnose mediastinal teratoma., Introduction and importance The majority of mediastinal tumours develop asymptomatically and are often detected incidentally on a chest X-ray performed for another reason. Mediastinal tumours, although mostly asymptomatic, may cause non-specific symptoms associated with advanced tumour growth. Case presentation We present a case of a 30-year-old woman who presented with exhaustion and lower back pain accompanied by severe headaches with symptoms of visual disturbances, followed by the typical Horner syndrome. Computed tomography revealed a tumour measuring 12 × 11 × 10 cm in the right cavity with features suggestive of teratoma. The patient underwent mediastinal tumour resection and thymectomy. The pathomorphological examination confirmed the primary diagnosis of mediastinal teratoma, but rare somatic type malignancy was detected. Therefore, the patient was referred for further oncological treatment. Discussion Mediastinal teratoma is an uncommon finding and usually asymptomatic. Despite its slow growth, it can grow enough to compress adjacent structures, causing symptoms similar to those presented in our patient. Conclusion Radiologic imaging proves diagnostic in most cases. Despite the somatic type malignancy, surgical excision of the tumour using the en-bloc technique seems to be a sufficient option for the patient, and further oncological treatment is not always obligatory.

Triacylglycerols (TGs) are the most common compounds in food lipids, accounting for 95% of the weight of edible oils. The aim of this study was to scrutinize a procedure for quantitatively assessing possible adulteration of olive and rapeseed oil through GC-FID analysis of TGs. The recovery of TG standards ranged from 21% to 148%, and the relative response factor (RRF) ranged from 0.42 to 2.28. The limits of detection were in the range of 0.001 to 0.330 µg/mL, and the limits of quantitation from 0.001 to 1.000 µg/mL. The validated method was used to determine the TGs in olive oil (OO), refined rapeseed oil (RRO), and their blends. Eight TGs were detected in refined rapeseed oil, and 10 in olive oil. The addition of 1% of olive oil to rapeseed oil or vice versa can be detected using this method. Three triacylglycerols were pinpointed as indicators of adulteration of rapeseed oil with olive oil (PPO, PPL, PSO). The method described here can be used for controlling the quality of these oils.

BACKGROUND The objective of this study was to compare the impact of skeletonized versus pedicled left internal mammary artery (LIMA) harvesting on bleeding after coronary artery bypass grafting (CABG). METHODS In a randomized, single-blinded trial with a parallel group design and equal allocation, we randomly assigned 62 patients undergoing primary elective CABG in a tertiary cardiac center to skeletonized or pedicled LIMA dissection. Before surgery, all aspects of coagulation were assessed. Patients were blinded to LIMA dissection technique and monitored for cumulative drainage at 12 hours (primary outcome) as well as myocardial necrosis markers. RESULTS With recruitment complete, there were 31 patients in each group; all patients were analyzed. Median postoperative drainage was 395 mL at 12 hours in all patients; it was lower by 28% at 12 hours (P = .02) in patients with skeletonized LIMA (Cohen's d, 0.6; 95% confidence interval (CI), 0.09-1.11). Patients with a LIMA pedicle received more fresh-frozen plasma transfusions than did the skeletonized LIMA group (Median 3; interquartile range 3-5 versus median 3; interquartile range 3-3; P = .03). Study arms did not differ in blood coagulation. Left internal mammary artery skeletonization (odds ratio = 0.04; 95% CI, 0.003-0.44; P = .009) and higher body mass index (odds ratio = 0.63; 95% CI, 0.45-0.89; P = .008) decreased the odds of being in the top drainage quartile at 12 hours (≥550 mL). Creatine kinase was lower in skeletonized LIMA directly after surgery (median 218 U/L; interquartile range 175-310 U/L versus median 424 U/L; interquartile range 256-510 U/L; P < .001), at 6 hours (median 324 U/L; interquartile range 239-424 U/L versus median 529 U/L; interquartile range 374-707 U/L; P < .001), and 12 hours after surgery (median 351 U/L; interquartile range 277-552 U/L versus median 695 U/L; interquartile range 509-1067 U/L; P < .001). CONCLUSIONS Left internal mammary artery skeletonization results in lower mediastinal drainage after CABG than pedicled LIMA harvesting.

Chronic thromboembolic pulmonary hypertension (CTEPH) results from an obstruction of pulmonary arteries (PAs) by organized thrombi. The stenosed PAs are targeted during balloon pulmonary angioplasty (BPA). We aimed to evaluate the mechanism of BPA in inoperable patients with CTEPH. We analyzed stenosed PAs with intravascular grey-scale ultrasound (IVUS) to determine the cross-sectional area (CSA) of arterial lumen and of organized thrombi. The composition of organized thrombi was assessed using virtual histology. We distinguished two mechanisms of BPA: Type A with dominant vessel stretching, and type B with dominant thrombus compression. PAs were assessed before (n = 159) and after (n = 98) BPA in 20 consecutive patients. Organized thrombi were composed of dark-green (57.1 (48.0&ndash, 64.0)%), light-green (34.0 (21.4&ndash, 46.4)%), red (6.4 (2.9&ndash, 11.7)%, ) and white (0.2 (0.0&ndash, 0.9)%) components. The mechanism type depended on vessel diameter (OR = 1.09(1.01&ndash, 1.17), p = 0.03). In type B mechanism, decrease in the amount of light-green component positively correlated with an increase in lumen area after BPA (r = 0.50, p = 0.001). The mechanism of BPA depends on the diameter of the vessel. Dilation of more proximal PAs depends mainly on stretching of the vessel wall while dilation of smaller PAs depends on compression of the organized thrombi. The composition of the organized thrombi contributes to the effect of BPA.

Along with proteins and carbohydrates, fat is one of the three most important components of the human diet. For years, it was recommended that the intake of fats should be as low as possible due to their high calorific value. It is currently assumed that 30-35% of dietary energy should come from fat as it is a source of many bioactive compounds, such as essential unsaturated fatty acids (EUFAs), antioxidants and vitamins (A, D, E, K), which must be delivered to the body with food. Their content in vegetable fats and oils varies greatly, and the existing consumer opinions and beliefs often contradict scientific knowledge. Currently, a large body of evidence supporting the important role of fats in the human diet may be found in literature. This paper discusses the basic components of vegetable fats and oils in terms of their chemical structure and biological properties. A wide range of dietary fats were reviewed for their fatty acid, tocopherol and sterol profiles. Based on these facts, criteria to be taken into account in the selection of dietary fats and food products were identified.

Heart transplant is an accepted treatment modality in end-stage heart failure. The graft coronary artery vasculopathy is a main concern to explain the heterogeneity of the rejection process according to the gender of the donor and recipient.To assess the severity and type of mechanisms leading to failure of the graft.Experimental allogenic heart transplantation in the abdomen was performed on Wistar rats depending on the gender of the donor and recipient (F - female; M - male) in four groups (FF, FM, MM MF). The donor heart was implanted in the abdominal cavity of the recipient. Complete time of observation was 10 weeks. Bromodeoxyuridine was administered intraperitoneally to detect proliferating cells.There was 42.5% graft survival in all experiments. The mean time of graft survival was 60 ±18, 54 ±29, 58 ±23 and 64 ±18 days (FF, FM, MM and MF) and no significant difference was found in graft survival time among the four experimental groups (The use of an animal experimental model helps to understand the mechanisms leading to graft failure and to compare the changes that occur in rats to human hearts. The gender matching affects the survival of the transplanted heart and severity of the graft vasculopathy.Transplantacja serca jest uznaną metodą postępowania w krańcowym stadium kardiomiopatii o różnej etiologii, niewydolności oraz nieoperacyjnych wad wrodzonych serca. Choroba naczyń wieńcowych serca przeszczepionego stanowi główną przyczynę upośledzenia funkcji narządu. Zwraca uwagę niejednolitość przebiegu tego procesu w zależności od płci dawcy i biorcy.Ocena nasilenia i przyczyn niewydolności przeszczepionego serca.Zabieg dobrzusznego wszczepienia serca wykonywano w zależności od płci dawcy i biorcy (samica – F, samiec – M) w czterech grupach (FF, FM, MM MF). Okres obserwacji wynosił 10 tygodni. Podano dootrzewnowo bromodeoksyurydynę (BrdU) w celu wykrycia komórek proliferujących.Przeżywalność przeszczepionego narządu w eksperymencie wynosiła 42,5%. Średni czas przeżycia narządu wynosił 60 ±18, 54 ±29 58 ±23 oraz 64 ±18 dni, odpowiednio dla grup FF, FM, MM oraz MF. Nie stwierdzono istotnych statystycznie różnic pomiędzy grupami w zakresie długości przeżycia narządu (Zastosowanie modelu zwierzęcego pozwala zrozumieć mechanizmy prowadzące do niewydolności przeszczepionego narządu oraz odnieść zmiany zachodzące u szczurów do zmian występujących u ludzi. Dobór płci dawcy i biorcy wpływa na przeżywalność przeszczepionego narządu i nasilenie choroby naczyń wieńcowych przeszczepu.

Autotransplantation is a relatively rare method used in cardiac surgery. It gives the surgeon excellent opportunities for precise surgical treatment of hard-to-reach pathologies located in the heart cavities, which is especially important when the aim of procedure is to remove maximal amount of malignant neoplastic cells. In this article, we describe the use of autotransplantation in a 32-year-old man finally diagnosed with Undifferentiated Pleomorphic Sarcoma (UPS). The course of the disease, the operative strategy, and the most common pathologies will be described.

The consumption of plant sterols is reported to have a beneficial effects on human health, i.e. phytosterols are known for their cholesterol-lowering properties. Whereas, they are prone to oxidation and currently there is ongoing worldwide research aimed at the biological effect of phytosterol oxides. In this study volatile compounds formed during thermal degradation of stigmasteryl esters were identified. The research was conducted using standards of stigmasterol, fatty acids and stigmasteryl esters as well as fat enriched with stigmasteryl esters which were thermally treated at 60 °C and 180 °C for 12 h. Volatile compounds were characterised by SPME-GC-MS. Among the volatiles formed during heating of stigmasteryl esters aldehydes, ketones, alcohols and hydrocarbons were found. The mechanism of the formation of volatile compounds from sterol esters was related to oxidation of steryl and fatty acid moieties. In particular, 2-methyl-3-pentanone and 5-ethyl-6-methyl-3-hepten-2-one were identified as unique degradation products formed from degradation of the steryl moiety specifically, and a mechanism of their formation was suggested. Both volatiles could be a good indicator of thermo-oxidative degradation of functional food products enriched in phytosterols and their esters.

Background: Transcatheter aortic valve implantation (TAVI) is presently a recognized treatment mo­dality for patients with severe aortic stenosis ineligible for surgery. It reduces mortality as compared to the conservative treatment. It is further expected from this therapy to improve quality of life by improving of the cardiovascular function performance. The aim of this study is to compare patients’ cardiovascular system efficiency in the 6-minute walk test (6MWT) made before and after TAVI and at the 6–12-month follow-up. Methods: From January 2009 until February 2012, in the Silesian Center for Heart Diseases in Zabrze, TAVI was performed in 104 patients. Eighty-two patients who underwent 6MWT before surgery were qualified for the analysis. The average age of the patients was 76.0 ± 9.17 years, women made 45.1%. The risk of surgical treatment according to the Logistic Euroscore averaged 22.76 ± 12.63%, and by the Society of Thoracic Surgeons — 5.55 ± 3.34%. The 6MWT was performed within 1 month before the TAVI procedure, up to a month after the procedure and during the 6–12-month follow-up. Results: The 6-minute walk test after TAVI was performed by 64 patients, and after 6–12 month follow-up by 46 patients. The average distance in 6MWT increased from 268.4 ± 89.0 m before treat­ment to 290.0 ± 98.2 m after the procedure (p = 0.008) and 276.1 ± 93.5 m to 343.1 ± 96.7 m after 6–12 months (p < 0.0001). Conclusions: Transcatheter aortic valve implantation procedures significantly improve function of the cardiovascular system evaluated by the 6MWT in 1- and 6–12-month observations. (Cardiol J 2017; 24, 2: 167–175)

A 35-year-old man with no significant past medical history was admitted to the cardiology department with inferolateral ST-elevation myocardial infarction. Coronary angiogram performed immediately after admission (approximately 11–12 hours after the onset of chest pain) revealed right coronary artery occlusion, which was successfully revascularized by percutaneous coronary intervention (PCI) with drug-eluting stent implantation. Postprocedural transthoracic echocardiography showed left ventricular (LV) function abnormalities with ejection fraction reduced to 38%, akinesis of inferior, inferolateral and lateral segments, as well as an aneurysmatic bulge in the inferolateral wall, with wall thickness decreased to 3–4 mm. No pericardial effusion or evidence of cardiac tamponade were found. In view of these findings, urgent cardiac magnetic resonance (CMR) imaging was performed to further explore the morphology of LV wall thinning. This examination revealed incomplete free wall rupture (FWR) encompassing mid inferior, inferolateral and lateral segments (Figures 1 A, B).

OBJECTIVES On-pump coronary artery bypass grafting (CABG) is associated with elevated bleeding risk. Our aim was to evaluate the role of surgical experience in postoperative blood loss. METHODS A propensity score-matched analysis was employed to compare on-pump CABG patients operated on by residents and specialists. End points included drainage volume and bleeding severity, as assessed by the Universal Definition of Perioperative Bleeding in cardiac surgery and E-CABG scale. RESULTS A total of 212 matched pairs (c-statistics 0.693) were selected from patients operated on by residents (n = 294) and specialists (n = 4394) between October 2012 and May 2018. Patients did not differ in bleeding risk. There were no statistically significant differences in postoperative 6-, 12- and 24-h drainages between subjects operated on by residents and specialists, and there was no between-group difference in rethoracotomy or transfusion rate. There were no differences in Universal Definition of Perioperative Bleeding or E-CABG grades. In June 2018, after a median follow-up of 2.8 years (range 0.1–5.7 years), the overall survival was 94%, with no differences between the patients operated on by residents (95%) and specialists (92%) (P = 0.27). CONCLUSIONS Patients undergoing on-pump CABG, when operated on by a resident, are not exposed to an elevated bleeding risk, as compared with patients operated on by experienced surgeons.

Pulmonary Embolism Response Team (PERT) is a multidisciplinary team established to stratify risk and choose optimal treatment in patients with acute pulmonary embolism (PE). Established for the first time at Massachusetts General Hospital in 2013, PERT is based on a concept combining a Rapid Response Team and a Heart Team. The growing role of PERTs in making individual therapeutic decisions is identified, especially in hemodynamically unstable patients with contraindications to thrombolysis or with co-morbidities, as well as in patients with intermediate-high risk in whom a therapeutic decision may be difficult. The purpose of this document is to define the standards of PERT under Polish conditions, based on the experience of teams already operating in Poland, which formed an agreement called the Polish PERT Initiative. The goals of Polish PERT Initiative are: improving the treatment of patients with PE at local, regional and national levels, gathering, assessing and sharing data on the effectiveness of PE treatment (including various types of catheter-directed therapy), education on optimal treatment of PE, creating expert documents and supporting scientific research, as well as cooperation with other communities and scientific societies.

The incidence of accidental hypothermia (core temperature ≤35 °C) is difficult to estimate, as the affected population is heterogeneous. Both temperature and clinical presentation should be considered while determining severity, which is difficult in a prehospital setting. Extracorporeal rewarming is advocated for all Swiss Staging System class IV (hypothermic cardiac arrest) and class III (hypothermic cardiac instability) patients. Veno-arterial extracorporeal membrane oxygenation (ECMO) is the method of choice, as it not only allows a gradual, controlled increase of core body temperature, but also provides respiratory and hemodynamic support during the unstable period of rewarming and reperfusion. This poses difficulties with the coordination of patient management, as usually only cardiac referral centers can deliver such advanced treatment. Further special considerations apply to subgroups of patients, including drowning or avalanche victims. The principle of ECMO implantation in severely hypothermic patients is no different from any other indication, although establishing vascular access in a timely manner during ongoing resuscitation and maintaining adequate flow may require modification of the operating technique, as well as aggressive fluid resuscitation. Further studies are needed in order to determine the optimal rewarming rate and flow that would favor brain and lung protection. Recent analysis shows an overall survival rate of 40.3%, while additional prognostic factors are being sought for determining those patients in whom the treatment is futile. New cannulas, along with ready-to-use ECMO sets, are being developed that would enable easy, safe and efficient out-reach ECMO implantation, thus shortening resuscitation times. Moreover, national guidelines for the management of accidental hypothermia are needed in order that all patients that would benefit from extracorporeal rewarming would be provided with such treatment. In this perspective article, we discuss burning problems in ECMO therapy in hypothermic patients, outlining the important research goals to improve the outcomes.

Background and aim: Transcatheter aortic valve implantation (TAVI) has proven to be a valuable alternative to conventional surgical aortic valve replacement in high-risk and surgically inoperable patients who suffer from severe symptomatic aortic stenosis. With the second generation of TAVI devices improvements in both handling and performance are highly demanded. This brief clinical communication reports the first Polish experience with the second generation of transfemoral TAVI device — Symetis Acurate Neo. Methods: From November 19th 2014 until February 18th 2015 nine (n = 9) patients with severe symptomatic aortic stenosis have been operated on using the Symetis Acurate Neo. Patients were subject to seven-day evaluation and 30-day phone follow-up. Results: The procedure was safely and successfully performed in all patients. A SMALL (S) valve (21–23 mm equivalent) was used in two patients, MEDIUM valve (M; 23–25 mm equivalent) in five patients, and a LARGE valve (L; 25–26 mm equivalent) in two patients. In three cases post-release balloon dilatation was required. There were no intraoperative complications and no major adverse events (as per VARC classification) during initial hospitalisation, including conduction or rhythm disturbances. In all cases, the mean gradient on the prosthetic valves was 7.8 mm Hg (10.2 mm Hg on the “S” valves). Rapid improvement in patients’ functional class was noted. Perivalvular leak was evaluated as “mild” in three cases, “trace” in one, and “not existing” in five. Conclusions: This initial experience with the Symetis Acurate Neo demonstrates its good safety profile and excellent hae­modynamics. Low radial stress of the valve results in minimal incidence of atrioventricular rhythm disturbances, and a sealing crown for nearly non-existent paravalvular leak.

Anomalous origin of the left coronary artery from the pulmonary artery (Bland-White-Garland syndrome – BWG) is a serious congenital cardiac anomaly leading to myocardial ischemia with severe heart failure. Immediate surgical correction is the treatment of choice, and the risk of postoperative complications depends on the degree of myocardial injury. The authors present two cases of infants with BWG, in whom long-term (175 and 26 days) left ventricular assistance with a Berlin Heart device was used, resulting in successful weaning from the support and subsequent hospital discharge. Because of serious hemorrhagic complications and their neurological consequences observed in the first patient, the anticoagulation protocol was modified in the second patient, providing more stable support and allowing the device to be removed after a shorter period of time. The Berlin Heart left ventricular assist device may be treated not only as a bridge for transplantation but also, considering the shortage of donors in this age group, as a bridge to recovery.

Background Canadian prairies are a habitat for unique wild plants. The main object of the present study was to investigate phytochemicals content and antioxidant activity in seven wild Canadian prairie fruits. Methods The presence of total phenolics, flavonoids, anthocyanins and antioxidant activity were identified in the extracts according to standard procedure. Results Wild rose had the highest amounts of total phenolics and total flavonoids, whereas elderberry exhibited the highest amount of anthocyanins. All extracts showed good scavenging activities towards DPPH radicals. The results showed a good linear relationship between oxygen radical absorbance capacity and total phenolics indicating that radicals are scavenged at a greater rate as the total phenolics content increases. Additionally, all extracts when applied at concentration of 800 ppm, showed ability to inhibit oxidation of canola oil. In SOT test the best results were obtained when extract of American mountain ash was used. In general, wild rose followed by American mountain ash demonstrated the highest antioxidant activity among assessed Canadian prairie fruits. Conclusions From the results it can be concluded that prairie fruit extracts are a rich source of phenolic compounds and poses a high antioxidant activity, confirmed by assessment with different type of radicals employed.

Thermo-oxidative changes were assessed during simulated storage and frying of refined rapeseed oil (RRO). When RRO was heated at 60 and 180 °C for 8h phytosterols content decreased by 10 and 40%, however tocopherols disappeared by 7 and 30%, respectively. The oxyphytosterols content increased during first 2 h of heating at both temperatures to 55 and 211 μg/g, however extended heating resulted in reduction of these compounds to 38 and 169 μg/g, respectively. Total polar compounds were observed in RRO heated at 60 and 180 °C for 8 h at 12 and 42%, respectively. Polar compounds were consisted by: free fatty acids (FFA), low molecular weight (LMW) compounds including monomers, while non-polar fraction contained LMW and monomers formed during heating at 60 °C. Non-polar fraction formed during heating of RRO at 180 °C for 8h which contained monomers and LMW compounds. Among volatile compounds, four carbonyls and an alcohol were detected in heated RRO.

Phytosterols and their esters are often used as functional ingredients in food products due to its lowering blood cholesterol properties. Products containing phytosterols and its esters are recommended for direct consumption, cooking, baking and frying, however during food preparation it is possible thermo-oxidative degradation is possible. Unsaturation of fatty acid present in steryl ester may further stimulates degradation. Free stigmasterol degraded faster than its esters, even with linoleic acid attached. The highest amount of degradation products was observed for free stigmasterol, followed by esters with linoleic and oleic acids. Polar dimers were fund in all heated samples, although for free stigmasterol heated at 60 °C were not detected. Whereas non-polar dimers were observed only in heated stigmasterol. Degradation of esterified stigmasterol generated degradation products with lower cytotoxicity.

Surgical treatment of severe aortic stenosis offers good early and long-term results, even in elderly patients. Despite the implementation of percutaneous methods for the very high-risk group, surgical valve replacement remains the gold standard. The advanced age of patients should not be the only indicator limiting the possibility of surgery. In this review we present the most important information on the results of aortic stenosis surgical treatment in the groups of older patients. New methods such as percutaneous and minimally invasive methods of surgery are also discussed. Additionally, the presented information is referred to current guidelines for the treatment of severe aortic stenosis.Chirurgiczne leczenie ciężkiej stenozy aortalnej przynosi dobre wyniki zarówno krótko-, jak i długoterminowe, nawet u pacjentów w podeszłym wieku. Pomimo wprowadzenia metod przezskórnych przeznaczonych dla pacjentów z grupy wysokiego ryzyka, chirurgiczna wymiana zastawki aortalnej jest złotym standardem. Zaawansowany wiek pacjentów nie powinien być jedynym czynnikiem ograniczającym możliwość wykonania operacji. W artykule zaprezentowano najważniejsze informacje na temat wyników chirurgicznej (klasycznej) wymiany zastawki aortalnej u starszych pacjentów. Omówiono również leczenie przezcewnikowe oraz małoinwazyjną metodę chirurgicznej wymiany zastawki aortalnej. Przedstawione dane odnoszą się do obowiązujących wytycznych dotyczących leczenia ciężkiej stenozy aortalnej.

Mitral regurgitation (MR) is common in ischemic heart disease and contributes to symptoms and mortality. This report compares the results of baseline transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) imaging of the mechanism and severity of functional MR in patients with ischemic cardiomyopathy in the Surgical Treatment for Ischemic Heart Failure (STICH) trial. Independent core laboratories measured both TTE and TEE images on 196 STICH participants. Common measurements to both models included MR grade, mitral valve tenting height and tenting area, and mitral annular diameter. For each parameter, correlations were assessed using Spearman rank correlation coefficients. A modest correlation was present between TEE and TTE for overall MR grade (n = 176, r = 0.52). For mechanism of MR, modest correlations were present for long-axis tenting height (n = 152, r = 0.35), tenting area (n = 128, r = 0.27), and long-axis mitral annulus diameter (n = 123, r = 0.41). For each measurement, there was significant scatter. Potential explanations for the scatter include different orientation of the imaging planes between TEE and TTE, a mean temporal delay of 6 days between TEE and TTE, and statistically significant differences in heart rate and blood pressure and weight between studies. In conclusion, TEE and TTE measurements of MR mechanism and severity correlate only modestly with enough scatter in the data that they are not interchangeable.

Conditions applied during frying require antioxidant which is stable at these conditions and provides protection for frying oil and fried food. Novel structured lipids containing nutraceuticals and antioxidants were formed by enzymatic transesterification, exploring canola oil and naturally occurring antioxidants such as ascorbic and selected phenolic acids as substrates. Lipozyme RM IM lipase from Rhizomucor miehei was used as biocatalyst. Frying performance and oxidative stability of the final transesterification products were evaluated. The novel lipids showed significantly improved frying performance compared to canola oil. Oxidative stability assessment of the structured lipids showed significant improvement in resistance to oxidative deterioration compared to original canola oil. Interestingly, the presence of ascorbic acid in an acylglycerol structure protected α-tocopherol against thermal degradation, which was not observed for the phenolic acids. Developed structured lipids containing nutraceuticals and antioxidants may directly affect nutritional properties of lipids also offering nutraceutical ingredients for food formulation.

The proportion of valve repair procedures is increasing in experienced centers. The aim of the study was to assess the clinical and echocardiographic outcomes after aortic valve reconstruction with a novel surgical technique.The study group consisted of 30 patients (23 male and 7 female) at a mean age of 35 ± 14 years. In patients with aortic root aneurysm the reimplantation or Florida sleeve technique was used. A sub-commissural annuloplasty, plication of the free edge of the cusp, shaving, and commissurotomy were performed. At this stage of surgery aortic repair was then attempted by cusp extension. Since 2013 the strips have been tailored from extracellular matrix.The mean aortic cross-clamp time was 90 ± 32 min. The mean cardiopulmonary bypass time was 126 ± 38 min. There was no in-hospital death. Re-exploration for bleeding was required in 1 patient. During follow-up, 1 patient needed reoperation at 1 year due to endocarditis. All patients remained alive in New York Heart Association (NYHA) functional class I. The echocardiographic findings remained unchanged in all cases during follow-up.Our modification of aortic valve repair results in a good outcome.W doświadczonych ośrodkach zwiększa się liczba wykonywanych plastyk zastawki aortalnej. Celem pracy była ocena wyników klinicznych i echokardiograficznych po rekonstrukcji zastawki aortalnej z użyciem nowej techniki operacyjnej.Badaniami objęto 30 chorych (23 mężczyzn i 7 kobiet) w średnim wieku 35 ± 14 lat. U chorych z tętniakiem opuszki aorty wykonywano reimplantację albo egzoprotetyczną naprawę. Następnie wykonywano podspoidłową plastykę, plikację płatka, ścięcie zwłókniałego wolnego brzegu płatka, komisurotomię. Powiększano płatki zastawki łatkami. Od 2013 r. łatki były wycinane z macierzy zewnątrzkomórkowej.Średni czas zakleszczenia aorty wyniósł 90 ± 32 minuty. Średni czas krążenia pozaustrojowego wyniósł 126 ± 38 minut. Nie było zgonów szpitalnych. Reoperacja z powodu zwiększonego drenażu była konieczna u 1 pacjenta. W dalszym przebiegu, po roku, jednego pacjenta reoperowano z powodu zapalenia wsierdzia. Wszyscy pacjenci żyją i pozostają w klasie NYHA I. Wyniki badań echokardiograficznych potwierdzają dobrą funkcję naprawionych zastawek aortalnych.Wprowadzona nowa technika operacyjna cechuje się dobrym wynikiem krótkoterminowym.

Patients with severe symptomatic aortic stenosis have a poor prognosis with medical management alone, and surgical aortic valve replacement can improve symptoms and survival. In recent years, transcatheter aortic valve implantation (TAVI) has been demonstrated to improve survival in inoperable patients and to be an alternative treatment in patients in whom the risk of surgical morbidity or mortality is high or intermediate. A representative expert committee, summoned by the Association of Cardiovascular Interventions of the Polish Cardiac Society (ACVI) and the Polish Society of Cardio-Thoracic Surgeons, devel-oped this Consensus Statement in transcatheter aortic valve implantation. It endorses the important role of a multi-disciplinary "TAVI team" in selecting patients for TAVI and defines operator and institutional requirements fundamental to the establish-ment of a successful TAVI programme. The article summarises current evidence and provides specific recommendations on organisation and conduct of transcatheter treatment of patients with aortic valve disease in Poland.

The prevailing stigmatization of synthetic antioxidants and the inefficiency of endogenous antioxidants like tocopherols during high temperature processing of edible oils necessitate the search for effective natural antioxidants. Here, polyphenolic extracts from chokecherry and hawthorn fruits were screened for possible antioxidative application in fats/oils. Extracts were successively partitioned on sephadex columns and fractions were screened for radical scavenging activity using DPPH and beta-carotene assays. Furthermore, sunflower oil fortified with extracts was assessed for stability using accelerated storage at 65 degrees C, Rancimat at 120 degrees C. and frying at 180 degrees C. Phenolic extracts showed significantly high radical scavenging and antioxidant activity in the oil. At the end of storage, hydroperoxide formation in sunflower oil was reduced by up to 50%, and the induction period significantly increased in the presence of extracts. Similarly, a significantly high frying stability was observed for the fortified samples, suggesting that the phenolic extracts can offer effective natural alternative to synthetic antioxidants during frying. (C) 2014 Elsevier Ltd. All rights reserved.

Purpose Despite coronary angiography (CAG) underestimates coronary allograft vasculopathy (CAV), it remains a frame for ISHLT CAV classification. We performed a retrospective analysis to assess a prognostic value of CAG findings. Methods and Materials Among 311 pts. with, at least, 2 CAGs performed in 2 year interval after heart transplantation, we identified 197 pts. (146M/41F, 55±13y/o) without lesions in all CAGs (Group 0), 27 pts. (15M/12F, 58±8y/o) in whom mild changes were observed and remained in consecutive CAGs (Group 1), 29 pts. (25M/4F, 58±10y/o) in whom mild lesions was diagnosed in at least 1 CAG, but decreased in consecutive CAGs (Group 1REG), and 58 pts. (53M/5F, 56±10y/o) in whom stenosis criteria of ISHLT CAV2 or 3 were covered in at least 1 CAGs (Group2). We compared survival and other clinical variables among groups. Results Average follow-up was 10±4 years. 41(21%) deaths occurred in Group 0, 15(56%) in Group 1, 9(31%) in Group 1REG, and 26(46%) in Group 2. Differences between Group 0 vs. 1, and 0 vs. 2 were significant (p=0.002 and p=0.004, respectively, chi-square test). Time free from all-cause death was significantly longer in Group 0 (T1/2=15.5y, p=0.0151), and shorter in Group 1 (T1/2=8y, p=0.0012, both compared with all remaining pts. using log-rank test). Group 1 confronted with Group 0 was characterized by significantly higher number of rejection episodes (3.0±1.7 vs. 2.1±2.0), diabetes (48 vs. 24%), obesity (33 vs. 15%), creatinine serum concentration (176±146 vs. 136±90umol/L), and lower LVEF (47±13 vs. 56±7%), at the end of the follow-up. None of these differences was observed for Group 1REG vs. Group 0 comparison. Multivariate analysis using Cox proportional hazards model revealed 12 independent variables influencing survival (including older age, male sex, and lower LVEF), however CAG result was note among them. Conclusions Persisting mild coronary lesions observed in CAG predict shorter survival of heart transplant recipients, especially in the presence of LVEF drop.