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Rafał Drwiła

Publications and source records attributed to Rafał Drwiła.

8 recordsLinked to original sources
PubMed2004

[Low ejection fraction as risk factor after aortic valve replacement].

UNLABELLED: The aim of the study is to estimate the operative risk of aortic valve replacement for severe aortic valve stenosis in patients with distinctly impaired left ventricular function (ejection fraction below 40%). From the population of 2512 pts, who underwent aortic valve replacement in the years 1990 to 1999 because of acquired malformation, a group of 108 pts (4.3%), fulfilling the above mentioned conditions was selected. Between them prevailed men, 92 (85.2%), and the average age was 53.4 +/- 14.5. All pts remained in the NYHA functional class III/IV. The average ejection fraction was estimated 28.2 +/- 14.3%. The pts demonstrated concentric left ventricular hypertrophy, severe aortic valve calcifications, the average valvular area was 0.91 cm2, and the pressure gradient over the valve was 71 +/- 44 mmHg. The pts were operated on by different surgeons but after the same protocol of extracorporeal circulation and cardioplegia administration. Low output syndrome occurred in ca 40% of pts, and cardiac failure was the main cause of death. The hospital mortality was 8.6%, and it was over two times higher then the whole population of pts, who underwent aortic valve replacement. All survivors (91.4%) demonstrated clinical improvement already during the early observation. CONCLUSIONS: Low ejection fraction is an important risk factor of surgery for aortic valve stenosis. However, the elevated operative mortality, comparable to other institutions, may be accepted taking for consideration, that surgery is the only way of treatment and improvement may be expected in about 90% of pts, including anatomical and hemodynamic parameters, as well as life longevity and comfort. In the extreme cases the HTX should be considered.

Adult↗
PubMed2004

Indications for reoperation for valvular prosthesis dysfunction in urgent and elective patients.

OBJECTIVES: Comparison analysis of indications for operation, early clinical outcomes and hospital mortality between patients reoperated for valvular prosthesis dysfunction urgently and electively. MATERIAL AND METHODS: Retrospective data analysis of 94 patients (pts) reoperated for valve prosthesis dysfunction at Department of Cardiovascular Surgery and Transplantology in Kraków, Poland between January 1999 and December 2002. RESULTS: Valvular reoperation was elective procedure in 69 pts (73.4%)--group A: 46 males (M), 23 females (F), age 23-71 (av. 51.31 +/- 10.2). Urgent operation was performed in 25 pts--group B: 17 M, 8 F, age 29-77 years (av. 5.41 +/- 13.26). In group B: 9 patients underwent reoperation for dysfunction of aortic valve (2 allogenic, 7 mechanical), 13 pts for mitral valve dysfunction and 3 pts for both aortic and mitral valve dysfunction. In group A: 24 pts for mitral valve dysfunction, 37 pts for aortic valve dysfunction (25 allogenic, 12 mechanical) and 8 pts for both aortic and mitral valve dysfunction. In group B: 16 pts (64%) were operated in NYHA class IV; 8 in cardiogenic shock; on which 8 pts with active endocarditis, 3 pts with sepsis and 1 patient in septic shock. Average operative risk calculated as Euroscore was 30.86 in group B and 13.15 in group A (p<0.05). Overall hospital mortality was 12.6% (12 pts). In group B: 7 pts died (28%), 3 pts due to multiorgan failure, 1 patient due to sepsis, 2 pts due to aorta rupture and 1 due to left ventricle rupture during cardiopulmonary rescuscitation. In group B 5 pts died (7.2%). CONCLUSION: Patients reoperated urgently for valve prosthesis dysfunction were in worse preoperative state, had significantly higher preoperative risk and in hospital mortality than patients reoperated electively.

Adult↗
PubMed2004

[Early results of surgical treatment in acquired heart diseases during endocarditis in own material].

BACKGROUND: Endocarditis can concern natural as well as artificial heart valves. In conservative treatment mortality reaches 24-60%. Surgical procedure is the only way to save these patients in most cases. METHODS: Between 1998-2001, 114 patients underwent surgery because of valve endocarditis, 86 male and 28 female. 43 patients underwent mitral valve replacement (MVR), (13 MV reoperation), 51 aortic valve replacement (AVR), (16 AV reoperation) and 20 patients underwent MVR and AVR (3 both valves replacement). Three groups were similar regarding age, gender, emergency or elective procedures and NYHA class four. All patients underwent open heart surgery in ECC with hypothermia and crystalloid cardioplegia done by the same group of surgeons. RESULTS: Operative mortality in the MVR group was 11.6% (five of 43) compared to 3.9% (two of 51) AVR patients and 25% (five of 20) MVR and AVR group. The highest mortality rate was in both infected artificial valves procedures. There was growth of the bacteria in intraoperative material in 37.6% (33) of cases, mainly Staphylococcus epidermidis and Staphylococcus aureus. Incidence of postoperative sepsis, multiorgan failure, high grade atrio-ventricular block or low cardiac output was the highest in MVR and AVR patients. Independent predictors of operative mortality included increasing patient age, female gender, infected valve reoperation, and history of stroke. CONCLUSIONS: Our study suggests that patients with endocarditis and compromised hemodynamic status can be operated with acceptable morbidity and mortality. If echocardiography shows the cuspids perforations or vegetations, chords tendinous rupture or perivalvular leak, the patients should undergo cardiac surgery as soon as possible, in order to avoid severe embolic complications.

Adult↗
PubMed2004

Dysfunction of primary aortic valve prosthesis--allogenic versus mechanical--preoperative differences.

OBJECTIVES: Comparison of preoperative characteristics between patients reoperated for allogenic and mechanical aortic valve prosthesis dysfunction. METHODS: Retrospective data analysis of 47 patients reoperated for aortic valve prosthesis dysfunction at Department of Cardiovascular Surgery and Transplantology in Kraków, Poland between January 1999 and December 2002. RESULTS: In analyzed group 27 patients were operated for dysfunction of allogenic valve (Gr. A), 20 pts for mechanical valve (Gr. B). Group A: 21 males (M), 6 females (F), age 23-68 years old (av. 47.10 +/- 11.71); Group B: 18 M, 2 F, age 38-77 (av. 54.73 +/- 11.03), p<0.05. Time between operations in group A was 69-258 months (av. 164.34 +/- 66.02) months and in group B 0.5-348 months (av. 77.27 +/- 98.29) p<0.01. In group A, 5 pts and in group B, 7 pts were in NYHA group IV preoperatively. Echocardiography revealed that diastolic left ventricular dimension (LVDD) was larger in group A: av. 6.7 cm and 5.36 cm in group B, p<0.05. 2 pts from group A and 7 pts from group B were operated urgently (p<0.05), including 3 pts with aortic dissection. Definite infective endocarditis was diagnosed in 6 pts from group A and 11 pts from group B, p<0.05. In group A, 1 patient was urgently operated for infective endocarditis with vegetations, he died due to multiorgan failure. In group B, 6 pts died including all 3 with aortic dissection. CONCLUSIONS: Patients reoperated for allogenic aortic valve prosthesis dysfunction are: younger, reoperated after a much longer period of time with slower valve dysfunction progress (larger LVDD), most frequently reoperated electively, less frequently with endocarditis as the cause of valve dysfunction than in patients reoperated for mechanical aortic valve dysfunction.

Adult↗
PubMed2004

[Patients history following artificial aortic valve and pacemaker implantation].

UNLABELLED: The follow-up of 22 patients (out of 31 patients after artificial aortic valve and pacemaker implantation between 1982 and 2001) have been evaluated. There were 15 men aged 30-76 (x=55) and 7 women aged 43-69 (x=59). Aortic valve replacement (AVR) was subsequently followed by pacemaker implantation (PI) after approximately 16 days. Indication for permanent stimulation were: atrio-ventricular complete block in 18 patients and atrial fibrillation with slow ventricular response in the remaining 4. There were implanted 15 devices of VVI type and 7 of VDD type. The duration of follow up was 9-196 (x=56) months. All these patients remained in good general state (II degree--19 patients or II/III degree--3 patients acc. to NYHA classification). In 21 out of 22 patients, atrioventricular conduction disturbances and bradyarrhythmia remained for the entire follow-up duration with permanent stimulation (VVI or VAT). In one patient the postoperative complete atrio-ventricular block disappeared during follow up, 24 months after AVR. CONCLUSIONS: 1. The main indication for PI after AVR was complete atrio-ventricular block, persisting 2-3 weeks after surgery, without accompanying atrial fibrillation. 2. In long term follow up after AVR and PI (VVI or VDD) the dominance of 100% capture ventricular pacing have been recorded in almost all cases, which holds the decision of early postoperative PI.

Adult↗
PubMed2003

Air-blood barrier injury during cardiac operations with the use of cardiopulmonary bypass (CPB). An old story? A morphological study.

OBJECTIVE: In spite of the advances in technology and surgical techniques, cardiac surgical operations with the use of cardiopulmonary bypass (CPB) are still associated with pulmonary morbidity and mortality. The purpose of this study is to morphologically analyze the structure of air-blood barriers in patients who underwent coronary artery bypass grafting (CABG) with use of CPB. DESIGN: The investigation involved 50 patients aged 48-75 who underwent CABG with the use of extracorporeal circulation (ECC). Lung tissue specimens, which were taken before and after CPB, were observed with light and electron microscopy. RESULTS: Both light and electron microscopic observations of pre-pump specimens did not show any pathological changes within the terminal part of the respiratory system. Morphological observations of tissue samples obtained after CPB revealed features of air-blood barrier injury and presence of surfactant within the alveolar capillaries. CONCLUSION: Whatever the mechanism of the aforementioned changes one should be aware that the presented results indicate that air-blood barriers become leaky after CABG is performed with the aid of ECC.

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