Showing papers by "Jerzy Sadowski published in 2009"

Vernakalant hydrochloride for the rapid conversion of atrial fibrillation after cardiac surgery: a randomized, double-blind, placebo-controlled trial.

Abstract: Background— Postoperative atrial arrhythmias are common and are associated with considerable morbidity. This study was designed to evaluate the efficacy and safety of vernakalant for the conversion...

Transcatheter closure as an alternative and equivalent method to the surgical treatment of atrial septal defect in adults: comparison of early and late results.

Abstract: Background: The clinical efficacy of transcatheter atrial septal defect (ASD) closure with the Amplatzer Septal Occluder (ASO) can only be judged against the results of contemporaneous surgery. The present study compared early and late results of ASD closure using ASO versus open-heart surgery. Material/Methods: Forty-eight adult patients were found eligible for transcatheter closure in transesophageal echocardiography. The surgical group consisted of 52 patients with isolated ostium secundum ASD. All patients underwent standard ECG, 24-hour ECG recording, and transthoracic echocardiography pre-procedure at 1-month and at 1-year follow-up. Physical fitness was assessed by cardiopulmonary exercise testing (CPX) prior to ASD closure and at 1-year follow-up. Results: ASD closure was successful in all surgical patients and in 94% of the ASO group (0% mortality). The total complication rate for surgical vs. device closure was not significantly different (19.2% vs. 26.7%; p=0.383), despite more serious complications in the surgical group. Hospital stay was significantly shorter in the ASO group (5.4±2.2 vs. 9.1±1.2 days; p<0.001). Although echocardiographic parameters did not differ significantly between the respective groups at 1-year follow-up, CPX revealed a higher decrease in the VE/VCO 2 slope in the ASO group (-3.7±3.4 vs.-1.2±4.8; p=0.003). Conclusions: As surgical and device closure appear similarly effective in adults with ASD, avoidance of thoracotomy and cardiopulmonary bypass, in conjunction with a shorter hospital stay, argues in favour of device closure in selected patients.

Evidence for tissue factor expression in aortic valves in patients with aortic stenosis.

Abstract: Introduction The role of blood coagulation in the pathogenesis of aortic stenosis (AS) is unknown. Recently, tissue factor (TF) expression in stenotic aortic valves has been reported in animal model. Objectives The aim of the study was to investigate TF expression in valve leaflets obtained from AS patients and to determine its associations with circulating coagulation markers and echocardiographic variables. Patients and methods We studied 20 patients (10 men, 10 women) with dominant AS (age 62.9 +/-9.6, years, mean gradient 43.62 +/-14.62 mmHg), and 20 well-matched patients with dominant aortic insufficiency (AI) undergoing elective aortic valve replacement. Immunofluorescence was measured on decalcified leaflets using antibodies against human TF and macrophages. Prothrombin fragment 1+2 (F1+2) and circulating TF were determined in plasma prior to surgery. Results AS valves were characterized by an increased (all, p 75 mmHg, but not the aortic valve area, showed associations with percentage of TF-positive areas (r = 0.88, p = 0.0039). Conclusions This study is the first full-length report demonstrating the presence of TF associated with macrophage infiltration in human aortic valve leaflets in AS patients.

Original article Sutureless aortic valve bioprothesis ‘3F/ATS Enable’ – 4.5 years of a single-centre experience

Abstract: Background: Management of patients with acquired heart malformations, including aortic valve disease, is still challenging. Due to ageing of population, patients undergoing valve surgery are older than in the past. The 3F Therapeutics, conducting a programme of construction of heart valves for transarterial or transapical implatation, prepared the ‘Enable’ bioprosthetic valve for sutureless insertion in the aortic position. The first world implantation was performed in our Department on 13 January 2005. Aim: To present our experience, qualification criteria and methods of implantation of sutureless bioprosthesis of aortic valve – ‘Enable’. Methods: The ‘Enable’ valve is a tubular structure, tailored and sutured of equine pericardium, treated with glutaraldehyde, and mounted on an openwork Nitinol™ alloy stent. It consists of two distal rings connected with three vertical sticks. The characteristic property of nitinol is thermoplaticity: due to refrigeration it becomes elastic and easy to bend, after rewarming returns to the initial dimensions and shape, remaining stable at the body temperature. Distension of the nitinol ring make possible strong mounting of the valve in aortic annulus. The examined group consised of 27 patients (16 males, 11 females), aged 60-78 years (average 69.5), with advanced aortic valve disease, left ventricular hypertrophy, and aortic gradient up to 102 mmHg. Exclusion criteria were: severe annular deformations or bicuspid aortic valve, other valves’ malformations, coronary disease, severe other comorbidities or no agreement for ‘Enable’ valve implantation. The patients were operated using extracorporeal circulation, general moderate hypothermia and cold crystalloid cardioplegia. Care was taked to remove calcifications, estimate of aortic annulus geometry, valve size selection, and orientation of the valve toward coronary ostia. The mounting time was approximately one min, and the aorta cross-clamp time was reduced to 26-56 min, mean 30 min. Results: There was no mortality in the perioperative period, and during 3 months to 4.5 years of follow-up. No severe complications were present after surgery. One patient needed reoperation on post operative day 4 due to severe perivalvular leak. One other patient presented discrete leak with no need for intervention. The clinical improvement of one to three NYHA classes was observed. Echocardiographic and MSCT examinations confirmed adequate position of the valves, no structural deteriorations, normal movement and coaptation of the leaflets. The average maximal transvalvular gradient was 11.6 mmHg and the mean gradient – 6.8 mmHg, which remained stable during the follow-up period. No thromboembolic or infective complications were present. Conclusions: 1. The ‘Enable’ aortic bioprosthetic valve has very good hemodynamic properties. 2. Self-expanding thermoplastic nitinol-made ring allows permanent stable mounting. 3. The quick fixation (about 1 min) significantly shortens the operation time. 4. The ‘Enable’ valve seems to be suitable for patients with increased periopertive risk.

Flow reversal for proximal neuroprotection during endovascular management of critical symptomatic carotid artery stenosis coexisting with ipsilateral external carotid artery occlusion.

Abstract: PURPOSE To report the utility of proximal brain protection by flow reversal in endovascular management of critical internal carotid artery (ICA) stenosis coexisting with ipsilateral external carotid artery (iECA) occlusion. CASE REPORT Four patients with a symptomatic, critical ICA stenosis (in-stent restenosis in one) and iECA occlusion were admitted for carotid artery stenting (CAS). In all cases, the stenosis severity and high-risk lesion morphology precluded the use of filter protection. The "tailored" CAS algorithm indicated that a proximal anti-embolism system should be used to maximize the potential for effective neuroprotection. The flow reversal system, which consists of an independent guiding sheath balloon positioned in the common carotid artery (CCA) and an iECA balloon-wire, was employed, using the CCA balloon only. The system was well-tolerated, and the CAS procedures were uneventful. CONCLUSION Due to a unique design with separate CCA and iECA balloons, the flow reversal system can be used for proximal neuroprotection during CAS in severe, symptomatic ICA lesions coexisting with iECA occlusion.

Cardiac surgery and cardiology POL-TAVI FIRST – Polish report on transcatheter aortic valve implantation (TAVI) of Edwards- -Sapien prosthesis in the first 19 high risk patients with severe aortic stenosis and comorbidities

Abstract: Patients with severe symptomatic aortic stenosis, who from November 2008 to March 2009 were treated with Edwards-Sapien transcatheter aortic valve implantation (TAVI) within the POL-TAVI First Polish Registry, were included in the analysis. Nineteen patients aged 78±4,8 years with high operation risk and Logistic EuroSCORE 25 ± 7.6% were reported (74% were females). In 15 (79%) patients the valve was implanted transapically (TA), in the other four (21%) – via the femoral arterial access (TF). The valve was successfully implanted in 16 (84%) patients, in one patient aortic valvuloplasty alone was performed. During in-hospital period two patients died (one during periprocedural period and another one – two months after the implantation). During the mean follow-up of 5 ± 1.5 months (except for one patient who is still in hospital) all patients are in NYHA class I or II. Results of the initial series of 19 TAVI patients in Poland are satisfactory, and the trial will be continued with careful medical and economical analysis.

Heyde's syndrome without a decrease in large von Willebrand factor multimers: a case of intestinal bleedings reversed by valve replacement in a patient with aortic stenosis.

Abstract: Heyde’s syndrome without a decrease in large von Willebrand factor multimers: A case of intestinal bleedings reversed by valve replacement in a patient with aortic stenosis -

The +405 GG variant of vascular endothelial growth factor polymorphism is associated with poor prognosis in patients undergoing coronary artery bypass graft surgery.

Abstract: INTRODUCTION Coronary artery bypass graft (CABG) surgery is associated with systemic response and increased concentrations of numerous cytokines. Vascular endothelial growth factor (VEGF) related pathway also seems to be involved in inflammatory response induced by CABG. OBJECTIVES The aim of this study was to analyze the association between the VEGF gene +405 G>C polymorphism (linked to serum VEGF production), and the short-term clinical outcome during the in-hospital period (30 days) in patients undergoing CABG. PATIENTS AND METHODS Genotyping for VEGF gene +405 G>C polymorphism was performed in 64 patients with coronary artery disease at a mean age of 66 years (76.6% males), with a mean EuroSCORE (European System for Cardiac Operative Risk Evaluation) of 2.5 (0-2 points: 50% patients, 3-4: 25%, > or =5 points: 25%), who underwent CABG surgery. RESULTS Twenty-one (33%) patients were homozygous for the +405 G allele, 40 (63%) were heterozygous, and 3 were homozygous for the +405 C allele. Ten patients died during the 30-day follow-up (7 subjects with +405 GG genotype, and the other 3 carriers of the +405 C allele). Using multivariate logistic regression analysis, the risk of death after CABG was increased in patients with +405 GG genotype (odds ratio [OR] = 6.7; 95% confidence interval [CI] 1.5-29.4) and with EuroSCORE > or =5 points (OR = 4.4; 95% CI 1.1-18.1). CONCLUSIONS The VEGF gene +405 G>C polymorphism might be a prognostic factor of an adverse postoperative course in patients undergoing CABG surgery. Apart from its proangiogenic action, VEGF may have additional, possibly proinflammatory properties.

Factor XIII Val34Leu polymorphism as a modulator of fibrin clot permeability and resistance to lysis in patients with severe coronary artery disease.

Abstract: BACKGROUND: A common G to T transition in codon 34 with the subsequent valine with leucine replacement in the factor (F) XIII A-subunit affects fibrin formation and stabilisation in vitro. Data on the effects of Leu34 allele on cardiovascular thromboembolic events in vivo are conflicting. AIM: We investigated whether FXIII Val34Leu polymorphism is potent enough to affect fibrin clot properties in patients with advanced coronary artery disease (CAD). METHODS: We studied 113 patients, aged 62.8 +/- 6.1 years, who were scheduled for elective isolated coronary artery bypass grafting surgery (CABG). Patients were compared with 98 healthy age-matched controls. Ex vivo fibrin clot permeability and lysis time (t5oo/o) were determined in citrated plasma. RESULTS: Patients scheduled for CABG had lower clot permeability (9.14 + 1.64 vs. 10.02 + 1.12 x 10(-9) cm2; p = 0.0002) and longer t50%, (8.45 +/- 1.94 vs. 7.63 +/- 1.24 min; p < 0.0001) than controls. The Leu34 carriers, i.e. 9 (8%) Leu34Leu homozygous and 23 (20%) Val34Leu heterozygous subjects, had lower permeability by 23% in the CAD group compared with 81 (72%) patients with Val34Val genotype. A similar intergroup difference was observed for t50%, which was longer in Leu34 carriers (p < 0.0001). The FXIII Leu34 allele frequency in the control group was similar as well as the impact of Leu34 allele on fibrin properties. The effect of FXIII Leu34 allele on permeability and t50%, was not affected by homocysteine, C-reactive protein and fibrinogen levels in CAD patients and controls. CONCLUSIONS: Like in healthy subjects, in patients scheduled for CABG, the FXIII Leu34 allele is associated with decreased fibrin clot permeability and efficiency of lysis.

Case report Ventricular septum and free wall rupture in a 56-year-old male with myocardial infarction. A case report with follow-up of 7 years

Abstract: A case of a 56-year-old male who had unrecognised acute myocardial infarction complicated by a combination of ventricular septum and free wall rupture is presented. He developed symptoms of overt heart failure but initially he was treated out of hospital due to pneumonia. An echocardiographic study disclosed a ventricular septum rupture and ventricular free wall rupture with concomitant formation of pseudoaneurysm. He underwent surgical correction of the double myocardial rupture and successful re-operation due to recanalisation on the 5th day after the surgery. He underwent right coronary artery angioplasty 5 years after cardiac surgery.

Development of mature lamellar bone with a hematopoietic compartment in an aortic valve homograft.

Abstract: Two foci of mature lamellar bone with features of remodeling and with an adjacent hematopoietic compartment were revealed for the first time in an aortic valve homograft by hematoxylin and eosin staining and polarized light microscopy. The valve had been obtained originally from a 52-year-old non-beating-heart donor and implanted as 'fresh antibiotic-preserved' into the left ventricular outflow tract of a 21-year-old man, but was explanted after six years due to valvular insufficiency. The areas close to bone showed the presence of cells resembling osteoblasts, osteoclasts and degenerating chondrocytes. Von Kossa staining disclosed a small area of dystrophic calcification in the vicinity of one bone fragment, whereas the second fragment was accompanied by only weak, diffuse calcification. These findings shows that the formation of ectopic mature bone with secondary development of the hematopoietic compartment can occur in a relatively short time, and suggest that initiators of the process may be present in the grafted valve.

Invasive electrophysiology Thoracoscopic Ex-Maze III procedure and radiofrequency catheter ablation – a hybrid therapy for permanent atrial fibrillation. A case report

Abstract: We desribe a case of a 57-year-old patient with persistent longstanding atrial fibrillation (AF) in whom paracardioscopic Ex-Maze III procedure converted AF to typical counterclockwise atrial flutter Subsequent catheter RF ablation of cavo-tricuspid isthmus restored sinus rhythm We propose that the hybrid therapy including thoracoscopic maze procedure and catheter RF ablation of flutter isthmus might be effective in some patients with permanent AF To the best of our knowledge this approach was never published before

Residual iliofemoral thrombosis in a 31-year-old woman on oral contraceptives possessing heterozygous factor V Leiden, factor XIII Val34Leu allele and alpha-fibrinogen Thr312Ala allele: case report.

Abstract: We present the case of a 31-year-old woman on oral contraceptives with a 3-year history of iliofemoral thrombosis resistant to recanalization despite satisfactory anticoagulation therapy and absence of concomitant diseases. Thrombophilia screening revealed heterozygous factor V Leiden mutation. We also detected the presence of factor XIII (FXIII) Leu34 allele and alpha-chain fibrinogen 312Ala allele which are known to adversely affect fibrin clot structure and lysis. It might be speculated that the presence of 3 polymorphisms in this patient could contribute to proximal thrombosis resistant to treatment. We postulate that determination of FXIII and alpha-fibrinogen polymorphisms can be useful in the evaluation of some young patients with deep vein thrombosis.

Original article Factor XIII Val34Leu polymorphism as a modulator of fibrin clot permeability and resistance to lysis in patients with severe coronary artery disease

Abstract: Background: A common G to T transition in codon 34 with the subsequent valine with leucine replacement in the factor (F) XIII A-subunit affects fibrin formation and stabilisation in vitro . Data on the effects of Leu34 allele on cardiovascular thromboembolic events in vivo are conflicting. Aim: We investigated whether FXIII Val34Leu polymorphism is potent enough to affect fibrin clot properties in patients with advanced coronary artery disease (CAD). Methods: We studied 113 patients, aged 62.8 ± 6.1 years, who were scheduled for elective isolated coronary artery bypass grafting surgery (CABG). Patients were compared with 98 healthy age-matched controls. Ex vivo fibrin clot permeability and lysis time (t50%) were determined in citrated plasma. Results: Patients scheduled for CABG had lower clot permeability (9.14 ± 1.64 vs. 10.02 ± 1.12 × 10-9 cm 2 ; p = 0.0002) and longer t50% (8.45 ± 1.94 vs. 7.63 ± 1.24 min; p Conclusions: Like in healthy subjects, in patients scheduled for CABG, the FXIII Leu34 allele is associated with decreased fibrin clot permeability and efficiency of lysis.

The influence of the recipient’s body weight on the probability to obtain a heart transplant – POLKARD HF registry

Abstract: INTRODUCTION The aim of the study was to analyze the influence of body weight of the adult heart recipient on the chance to obtain a transplant. METHODS We analyzed the data from all 658 patients listed for heart transplantation. RESULTS During the follow-up period, 325 (49%) of listed patients underwent transplantation with 102 (15%) succumbing before heart transplantation. The mean weight of transplanted patients was 73.7 +/- 13.7 kg and 81.2 +/- 15.4 kg for those not transplanted (P < .00001). Patients were divided according to body weight in two groups: light = below 80 kg (n = 360) or heavy > or = 80 kg or above (n = 297). On the transplant list, 111 heavy patients (37%) versus 213 light patients (59%) underwent the procedure, a significant difference. The waiting time among light patients was 255 versus heavy patients of 395 days (P < .005). There was a similar number of deaths before transplantation among the light (n = 56 360 patients; 15.5%) versus the heavy group (49/297; 16%). Upon multivariate Cox mode analysis independent factors related to not receiving a heart transplant were greater weight, systolic blood pressure, pulmonary vascular resistance, Heart Failure Survival Score (HFSS) score and lower N-terminal pro-brain natriuretic peptide (NTproBNP) levels. CONCLUSIONS Among adult heart transplant candidates, the chance to receive a heart transplant significantly decreased when the recipient's weight exceeded 80 kg. Patients with a body weight more than 110 kg had a poor chance to receive a heart transplantation.

Pęknięcie przegrody międzykomorowej i wolnej ściany lewej komory jako powikłanie mechaniczne zawału serca u 56-letniego mężczyzny. Opis przypadku, obserwacja 7-letnia Ventricular septum and free wall rupture in a 56-year-old male with myocardial infarction. A case report with follow-up of 7 years

Abstract: A case of a 56-year-old male who had unrecognised acute myocardial infarction complicated by a combination of ventricular septum and free wall rupture is presented. He developed symptoms of overt heart failure but initially he was treated out of hospital due to pneumonia. An echocardiographic study disclosed a ventricular septum rupture and ventricular free wall rupture with concomitant formation of pseudoaneurysm. He underwent surgical correction of the double myocardial rupture and successful re-operation due to recanalisation on the 5th day after the surgery. He underwent right coronary artery angioplasty 5 years after cardiac surgery.

Raport POL-TAVI FIRST z zastosowania przezcewnikowej implantacji zastawki aortalnej typu Edwards-Sapien u pierwszych w Polsce 19 chorych z grupy bardzo dużego ryzyka, z ciężką stenozą aortalną i chorobami obciążającymi rokowanie POL-TAVI FIRST - Polish report on transcatheter aortic valve implantation (TAVI) of Edwards- -Sapien prosthesis in the first 19 high risk patients with severe aortic stenosis and comorbidities

Abstract: Patients with severe symptomatic aortic stenosis, who from November 2008 to March 2009 were treated with Edwards-Sapien transcatheter aortic valve implantation (TAVI) within the POL-TAVI First Polish Registry, were included in the analysis. Nineteen patients aged 78±4,8 years with high operation risk and Logistic EuroSCORE 25 ± 7.6% were reported (74% were females). In 15 (79%) patients the valve was implanted transapically (TA), in the other four (21%) - via the femoral arterial access (TF). The valve was successfully implanted in 16 (84%) patients, in one patient aortic valvuloplasty alone was performed. During in-hospital period two patients died (one during periprocedural period and another one - two months after the implantation). During the mean follow-up of 5 ± 1.5 months (except for one patient who is still in hospital) all patients are in NYHA class I or II. Results of the initial series of 19 TAVI patients in Poland are satisfactory, and the trial will be continued with careful medical and economical analysis.

Thoracic aortic aneurysm repair in three patients after heart transplantation: a case series

Abstract: Thoracic aortic aneurysm after heart transplantation is a rare but serious complication. The authors describe 3 cases (0.6%) of thoracic aortic aneurysm during 20 years of follow-up on 485 heart transplant patients at their institution. Dissected and non-dissected thoracic aortic aneurysms, diagnosed 23 to 38 months post transplantation, were treated with surgical repair or repeat transplantation. Two patients died postoperatively of multiorgan failure, including one with septic shock. One patient was discharged in good health. Surgical repair of aortic lesions in cardiac allograft patients, including repeat transplantation in cases of allograft vasculopathy, continue to carry substantial risk to the patient.