Kardiologia polska最新文献

Background: Transseptal puncture (TSP) is a crucial step during cryoballoon ablation (CBA) allowing for left atrium access. During the procedure an over-the-wire sheath exchange is required, which brings concerns about the exchange-related complications. An alternative option is performing the TSP through a steerable sheath and thus avoiding the exchange.

Aims: We aimed to evaluate the feasibility, efficacy and safety of a simplified zero-exchange workflow for CBA procedure.

Methods: Patients undergoing CBA (with Arctic Front Advance Pro, Medtronic) at 3 centers in Poland were prospectively enrolled and assigned to the standard approach (N=62) or the no-exchange group (N=62). The TSP in the standard approach group was performed through a fixed-curve sheath that was exchanged for a 15F steerable sheath (FlexCath Advance, Medtronic). In the no-exchange group the puncture was performed through the steerable sheath.

Results: TSP was successfully performed in all patients. In the no-exchange group compared to the standard approach group the median (IQR) procedure time and left atrium dwell time were significantly shorter (75.0 (60.0 - 90.0) min vs 80.5 (70.0 - 100.0) min; P = 0.02 and 47 (40.0 - 56.0) min vs 51.5 (43.25 - 64.5) min, P = 0.04 , respectively) with comparable median (IQR) fluoroscopy time (14.0 (8.5 - 20.4) min vs 12.25 (10.0 - 17.6) min, P = 0.74). Only one potentially TSP-related complication has occurred in each group.

Conclusion: A direct TSP with the FlexCath Advance sheath is a feasible, safe and efficient alternative to the standard approach.

Air pollution is an important environmental risk factor and according to the Global Burden of Disease Study a leading contributor to global morbidity and mortality. Hypertension, a major risk factor for cardiovascular diseases, has been increasingly associated with exposure to various air pollutants. This review aims to highlight key mechanistic and epidemiological findings underlying the relationship between air pollution and hypertension. On a mechanistic level, air pollution contributes to oxidative stress, systemic inflammation, endothelial dysfunction, and activation of the sympathetic nervous system, leading to impaired vascular function and elevated blood pressure. Epidemiological findings consistently demonstrate that both short- and long-term exposure to solid and gaseous pollutants are associated with increased blood pressure and a higher risk of hypertension. These findings are confirmed by meta-analyses across diverse populations, with evidence suggesting greater susceptibility among vulnerable groups, including the elderly and those with pre-existing cardiovascular conditions. Despite emerging evidence, important knowledge gaps remain regarding precise exposure assessment, the impact of specific air pollutants, and the synergy between air pollution and other environmental stressors. Targeting these gaps in future is necessary for effective development of public health interventions and policy measures to reduce the adverse health effects of air pollution on blood pressure regulation and hypertension risk.

Background: Coronary artery revascularization is vital for managing coronary artery disease, especially in elderly patients with multiple comorbidities.

Aims: To evaluate the outcomes of coronary artery bypass surgery in patients aged ≥75 years, focusing on the survival benefits of different surgical techniques and graft types.

Material and methods: This retrospective cohort study analyzed data from the Polish National Registry of Cardiac Surgery Procedures (2012-2022) for patients aged ≥75 years undergoing isolated coronary artery bypass surgery.

Results: We analysed 18 215 patients: 12 843 patients were under 80 years; 4689 were between 80 and 84 years; and 683 were ≥85 years. Key preoperative risk factors associated with increased hospital mortality included extracardiac arteropathy, atrial fibrillation, chronic renal failure, recent myocardial infarction, and poor mobility. The median follow-up time was 4.8 years (interquartile range 2.37-7.27). On-pump coronary artery bypass grafting (ONCAB)demonstrated a significant long-term benefit in patients aged <80 years. The use of internal mammary artery graft provided significant survival advantages for those <85 years, but this benefit was not observed in patients aged ≥85 years (P = 0.73). Multiarterial grafting did not demonstrate a significant survival advantage across all age groups.

Conclusions: In patients ≥80 years, there was no survival benefit between ONCAB and off-pump coronary bypass grafting. However, ONCAB was associated with significantly improved survival outcomes in younger patients. The internal mammary artery graft improved long-term survival in patients <85 years, while additional arterial grafts did not confer a survival benefit in the elderly population.