Thoracoscopic removal of pericardial foreign body.
Explore the source record for details and available documents.
Aged↗
Biomedical subjects
Adam Szafranek
Publications and source records attributed to Adam Szafranek.
Plasma ANP and renin-angiotensin-aldosterone system as new parameters describing the hemodynamics of the circulatory system after implantation of stented or stentless aortic valves.
BACKGROUND AND AIM OF THE STUDY: Aortic valve replacement (AVR) in patients with a small aortic root involves the occurrence of patient-prosthesis mismatch (PPM). Recent reports have shown that a reduced effective orifice area index (EOAI) may not be the sole factor responsible for this complication. The study aim was to analyze the activity of atrial natriuretic peptide (ANP)/renin-angiotensin-aldosterone (RAA) after implantation of stented or stentless valves. METHODS: Between 2001 and 2003, a total of 30 patients operated on at the authors' institution received either a stentless Freestyle bioprosthesis (group A; n = 15) or a stented Mosaic bioprosthesis (group B; n = 15). The demographics of both groups were similar, and all patients underwent echocardiography preoperatively, and at one, six and 12 months postoperatively. The activity of the RAA system and plasma ANP level were measured in all patients preoperatively and at one and six months postoperatively. RESULTS: At one month after AVR, statistically significant inter-group differences were noted in plasma renin activity (group A, 3.7 +/- 2.1 ng/ml/h; group B, 5.6 +/- 0.8 ng/ml/h; p <0.05; control value 0.3-5.3 ng/ml/h). For ANP, statistically significant differences were present at one month after surgery (group A, 36.3 +/- 5.1 pg/ml; group B, 62.9 +/- 9.2 pg/ml; p <0.005; control value 27.3-37.2 pg/ml). On echocardiography, the ejection fraction, aortic valve gradient, EOAI and left ventricular mass index (LVMI) were assessed. A statistically significant difference was identified for the LVMI at 12 months postoperatively (group A, 216 +/- 13 g/m2; group B, 240 +/- 18 g/m2; p <0.05). In terms of other parameters both groups were similar. CONCLUSION: The implantation of an aortic valve prosthesis affects the hemodynamics of the entire circulatory system, and thus the activity of natriuretic systems. Whilst stentless valves allowed much more rapid normalization of circulatory system hemodynamics (one month), no difference compared to preoperative was identified after six months. Natriuretic peptides appear to provide more sensitive (long-term) but less specific (short-term) assessment of circulatory system behavior than echocardiography.
Aged↗
[Ischemic mitral regurgitation--surgical outcomes].
Explore the source record for details and available documents.
Adult↗
[Stentless aortic valve replacement].
Explore the source record for details and available documents.
Aged↗
Early experience with Shelhigh stentless composite valve. A complete biological replacement of ascending aorta.
BACKGROUND: Currently, Shelhigh Stentless Composite Valve (SSCV) is the only complete biological conduit available on the market for this purpose. SSCV has been used to avoid anticoagulation with the advantage of established haemodynamic benefits of stentless valves as well as for its surgeon-friendly surgical implantation. METHODS: Between August 1999 and January 2001, 11 patients (8 women, 3 men, mean age 71.5+/-9.3 years) underwent first time aortic root and ascending aorta replacement with SSCV in Leicester. Aortic regurgitation was found in seven patients and aortic stenosis was predominant in three. Mean preoperative NYHA functional class was 24+/-0.7 and mean Parsonnet score was 25.1+/-1.1. Mean preoperative aortic root diameter was 5.34+/-1.2 cm, left ventricular (LV) end-systolic diameter was 4.3+/-0.5, and end-diastolic diameter was 6.5+/-0.6 cm. Preoperative LV ejection fraction was less than 30% in 6 (55%) patients. One patient had additional aortic arch replacement and three patients had concomitant myocardial revascularisation. Seven patients received size 25 mm SSVC, and four patients received size 27 mm SSCV. All patients had Doppler echocardiographic studies before discharge from the hospital and current follow-up data are available for all patients. RESULTS: All patients survived the early postoperative period, however, one patient developed transient stroke. While no biological glue or teflon were used during surgery, no patient required re-operation for bleeding and there was no significant blood loss recorded postoperatively. Mean postoperative intensive care stay was 1.5+/-0.7 and hospital stay was 11.3+/-4.9 days. Postoperative mean gradients were 9.7+/-3.05 mmHg for 25 mm grafts, and 8.6+/-4.3 mmHg for 27 mm composite grafts. CONCLUSIONS: Early experience with the SSCV used for the replacement of ascending aorta is encouraging. Practical benefits include improved haemostatic suture line, established haemodynamic advantages of a stentless valve and surgeon-friendly implantation while avoiding long-term anticoagulation.
Aged↗
[Management of purulent mediastinitis with sternal dehiscence - a case report].
The authors report the case of 70-year-old female who underwent urgent CABG for unstable angina. The post-operative course was complicated by Staphylococcal mediastinitis, which was treated with chest irrigation system and antibiotics. Because of extensive tissue destruction caused by the infection, the steel sternal wires were not placed. Interestingly, one year after surgery the sternal wound was completely healed and there were no paradoxical respiratory movements.
Aged↗
Primary OPCAB as a strategy for acute coronary syndrome and acute myocardial infarction.
BACKGROUND: Conventional coronary artery bypass graft (CABG) surgery using cardiopulmonary bypass (CPB) carries higher mortality and morbidity for patients undergoing surgery during acute coronary syndrome (ACS). The aim of this retrospective study was to evaluate potential benefits of avoiding CPB by instead performing off-pump CAB (OPCAB) during surgery on patients in ACS. METHODS: Among 624 patients who underwent OPCAB between January 1999 and June 2001, 143 underwent surgery during ACS (group 1). The ACS patients in group 1 were divided into 2 subgroups: 66 underwent surgery during acute myocardial infarction (AMI group) and 77 during unstable angina classified as class III or IV according to the Braumwald classification (unstable coronary artery disease [CAD] group). Group 2 (the elective CAD group) consisted of 481 patients who underwent isolated elective OPCAB during the same time period. RESULTS: Overall 30-day mortality was 4.9% (n = 7) for the ACS group and 0.83% (n = 4) for the elective CAD group (P < .0001). Differences between groups were found in use of inotropes, intraaortic balloon pump, and subsequent conversion of OPCAB to CPB (P < .0001, P < .01, and P < .03, respectively), as well as use of blood transfusion (P < .0003). Multivariate logistic regression analysis for 641 patients revealed ACS (P < .015), AMI (P < .019), renal failure (P < .017), and left ventricle aneurysm (P < .028) as independent risk factors for 30-day mortality in ACS reoperation (P = .02), whereas in AMI renal failure (P = .02) appeared to be an independent risk factor. CONCLUSIONS: OPCAB is a valuable treatment strategy in ACS patients; however, it carries significant mortality and morbidity. Careful preselection and timing of intervention are required in order for patients to fully benefit from the OPCAB strategy.
Analysis of Variance↗
Dysfunction of left ventricle as an indication for off-pump coronary artery bypass grafting.
BACKGROUND: Coronary artery bypass grafting (CABG) with cardiopulmonary bypass carries significant risk for patients with severe left ventricular (LV) dysfunction. METHODS: Between 1997 and 2000, 240 patients underwent OPCAB. The patients were retrospectively divided into 2 groups with regard to LV function. Group 1 consisted of 90 patients with ejection fraction (EF) <35% and grou p 2 of 150 patients without severe LV impairment and EF >35%. Patients were compared for preoperative risk factors, perioperative mortality, and postoperative complications. RESULTS: Preoperative expected mortality according to EuroSCORE was higher in group 1, 5.95, compared with group 2, 2.66 (P =.0005). A few preoperative risk factors were more common in group 1: urgent operation (P =.00001), unstable angina (P =.0018), Canadian Cardiovascular Society class (P =.001), myocardial infarction (P =.0001), and peripheral arteriopathy (P =.0006). Mean number of grafts was 1.51 in group 1 and 1.55 in group 2 with the same internal thoracic artery utilization. Perioperative drainage, anesthesia and intubation time, transfusion rate, and use of inotropes were comparable. Actual, nonadjusted mortality was 2.5% in group 1 and 1.4% in group 2 (P = not significant). Overall rates of postoperative complications were comparable; only use of an intraoperative balloon pump was more frequent in group 1 (P =.006). Postoperative stay was shorter in group 1 (P equals). CONCLUSIONS: Off-pump CABG for patients with LV impairment is associated with surgical outcome similar to that among patients with normal LV function, in spite of the presence of unfavorable risk factors. Off-pump surgery with selective anterior (including right main) arterial revascularization can be indicated in the presence of poor LV function.
Aged↗
Use of stentless xenografts in the aortic position: determinants of early and late outcome.
BACKGROUND: Whether to perform a stentless aortic valve replacement (AVR) is not well established. Our aim was to determine the outcome after AVR with stentless xenograft valves. METHODS: Between 1996 and 2001, a total of 404 patients (mean age 70.4 years) underwent a stentless AVR by one surgeon in our unit. Concomitant procedures were performed in 132 patients (33%). Twenty patients (6.4%) had undergone previous AVR. Eleven types of stentless xenograft valves were implanted: Medtronic Freestyle in 221 patients (55%), Shelhigh in 55 (14%), Shelhigh composite conduit in 33 (8%), Sorin in 26 (6%), Cryolife O'Brien in 25 (6%), Aortech-Elan in 17 (4%), Edwards Prima in 14 (4%), Toronto SPV in 7 (2%), and other valves in 6 (1%). A subcoronary implantation technique was used in 302 cases (76%), complete root replacement in 62 (15%), and a modified Bentall-De Bono procedure in 33 (8%). Mean follow-up was 19.4 months (range, 1.2 to 60.6 months). RESULTS: Overall hospital mortality was 4.2%. This was 2.4% for isolated AVR, 3.6% for AVR and coronary artery bypass grafting, 5.5% for replacement of two or more valves, and 12% for the modified Bentall procedure. On multiple logistic regression redo cardiac operation (p = 0.0006), cardiogenic shock (p = 0.001), left ventricular ejection fraction less than 0.30 (p = 0.01), modified Bentall procedure (p = 0.03), and endocarditis (p = 0.04) were predictors of in-hospital death. Five-year freedom from thromboembolism, hemorrhage, prosthetic endocarditis, structural valve deterioration, and reoperation was 97%, 99%, 99%, 98%, and 96%, respectively. Kaplan-Meier survival at 5 years was 88%. On Cox regression, cardiogenic shock (p = 0.001) and older age (p = 0.03) were adverse predictors of survival. At echocardiographic examination within 6 months from the operation, mean aortic valve gradients were 15 +/- 6 mm Hg, 12.8 +/- 3 mm Hg, 10.8 +/- 4 mm Hg, 9.3 +/- 3 mm Hg, 9.1 +/- 4 mm Hg, and 8.2 +/- 3 mm Hg for valve sizes of 19, 21, 23, 25, 27, and 29 mm, respectively. CONCLUSIONS: The availability of several stentless valve designs facilitates the surgical treatment of diverse aortic valve or root diseases with encouraging early and mid-term results. Patients requiring concomitant procedures may also benefit from the excellent hemodynamic characteristics of a stentless valve. We consider stentless AVR the treatment of choice for patients older than 60 years and those having small aortic roots.
Adult↗
Mitral valve relpair and revascularization for ischemic mitral regurgitation: predictors of operative mortality and survival.
BACKGROUND AND AIMS OF THE STUDY: Surgery for ischemic mitral regurgitation (IMR) is required in 4-5% of patients subjected to coronary artery surgery, and may be challenging. The study aim was to determine outcome following mitral valve repair and myocardial revascularization for moderate-to-severe IMR. METHODS: A total of 102 patients (mean age 68+/-7 years) underwent mitral valve repair for IMR between 1998 and 2001 at the authors' unit. Among patients, 28 had acute and 74 chronic mitral regurgitation (MR). Valve repair was achieved with an annuloplasty ring in all 102 patients, while 99 underwent concomitant myocardial revascularization. Preoperatively, 69 patients had MR grade III-IV, 62 had CCS angina class III-IV, 59 were in NYHA class II-IV, 81 had impaired left ventricular function, and 10 were in cardiogenic shock. Follow up was 100% complete (mean 14+/-7 months; range: 0-38 months). RESULTS: Overall operative mortality was 8.8% (n = 9) (17.8% for acute IMR, 5.4% for chronic, p = 0.048). On multiple logistic regression analysis, cardiogenic shock (p = 0.028) was the only significant risk factor for operative death. There were 11 late deaths. Kaplan-Meier survival at one and three years was 82+/-4% and 79+/-4%, respectively. On Cox proportional hazards regression model, preoperative left ventricular end-systolic diameter (LVESD) >4.5 cm (p = 0.01) and NYHA class III-IV (p = 0.02) were independent adverse predictors of survival. Three patients required reoperation. Kaplan-Meier three-year freedom from reoperation was 97+/-2%. CONCLUSION: Surgery for IMR carries a considerable, but acceptable, operative risk and provides satisfactory freedom from reoperation and mid-term survival. Cardiogenic shock before surgery is the major determinant of an unfavorable in-hospital outcome. LVESD >4.5 cm and poor preoperative NYHA status limit the probability of late survival. The study results support early surgical intervention for IMR, before ventricular dilatation occurs.
Aged↗