Kardiochirurgia I Torakochirurgia Polska最新文献

Introduction: The Perceval sutureless biological prosthesis for aortic valve replacement has been introduced with the rationale for shortening surgical, extracorporeal circulation and aortic cross-clamping times, in order to reduce postoperative complications.

Aim: To evaluate early hemodynamic performance and immediate outcomes of implantation of the Perceval sutureless bioprosthesis in comparison with the St. Jude Trifecta sutured bioprosthesis for aortic valve replacement (Perfecta study).

Material and methods: Between December 2014 and June 2023, 281 patients underwent St. Jude Trifecta implantation (n = 220, mean age: 75.2 ±6.5 years) and Perceval implantation, when indicated (n = 61, mean age: 77.9 ±5.1 years). Concomitant CABG was performed in 73 (33%) and in 27 (44%) patients, respectively.

Results: Extracorporeal circulation and cross-clamp times were significantly shorter in Perceval patients in all aortic valve replacements (61 ±23 and 49 ±18 minutes vs. 96 ±36 and 67 ±21 minutes), and in isolated procedures (54 ±10 and 43 ±8 minutes vs. 84 ±28 and 66 ±21 minutes) (p < 0.0001, for all comparisons). Operative mortality was absent and 2.7%, respectively (p = 0.2). Postoperatively, low output cardiac syndrome (0% vs. 4.5%) and total rate of major cardiac and non-cardiac related complications (6.6% vs. 18.6%) were significantly lower in Perceval patients (p = 0.01). Echocardiography at discharge in comparison with preoperatively showed a relevant and similar decrease of mean and peak trans-aortic valve gradients for the Trifecta prosthesis (11.6 ±4.3 vs. 50 ±15.2 mm Hg; 21.6 ±7.3 vs. 78.8 ±24 mm Hg) and for the Perceval prosthesis (12.6 ±4.8 vs. 52 ±12.5 mm Hg; 22.6 ±7.9 vs. 77.8 ±16 mm Hg) (p < 0.00001, for all comparisons). Better global cardiac function was observed in Perceval patients. Concomitant multi-vessel and left main coronary artery disease (p = 0.046; HR = 4.6) and chronic pulmonary disease (p = 0.006; HR = 5.6) were detected as independent predictors of death and postoperative major complications.

Conclusions: Early hemodynamic performance appears to be satisfactory with the use of Trifecta sutured and Perceval sutureless bioprostheses. Perceval implantation allows reduction of surgical times, better preservation of myocardial contractile function and, consequently, reduction of the risk of postoperative complications.

Melanoma is an aggressive neoplasm mainly affecting the skin. It has a predisposition to metastasis and it presents the highest propensity to spread to the heart, mostly through the hematologic route. Cardiac metastases frequently remain asymptomatic, even though the metastatic process to other organs is described as an advanced stage of the melanoma. Treatment methods include conservative and surgical management. Surgeries should be preferably performed at the early stages of the disease, when physicians can achieve total resections with clear margins. In some cases palliative procedures are also implemented. In 26 patients analyzed in this review, eleven cases presented favorable results of the surgery. In majority of the patients the diffuse metastatic disease led to their decease despite the surgery.

Introduction: Primary percutaneous coronary intervention (PPCI) is an effective method for the clinical treatment of acute ST-segment elevation myocardial infarction (STEMI). For patients who miss the optimal time window, optimal management of these patients remains controversial.

Aim: To compare the effects of different timing of percutaneous coronary intervention on the long-term prognosis of elderly patients with acute ST-segment elevation myocardial infarction (STEMI) with time from symptom onset > 12 hours.

Material and methods: Elderly acute STEMI patients with time from symptom onset > 12 hours in the period from July 2021 to July 2022 in the Department of Cardiology, Affiliated Hospital of Hebei University, were randomly divided into four groups: group 1 (immediate invasive strategy, percutaneous coronary interventions (PCI) < 24 hours after symptoms onset, n = 80), group 2 (early invasive strategy, 24-< 72 hours after symptoms onset, n = 80), group 3 (delayed invasive strategy after symptoms onset, 72-< 168 hours after symptoms onset, n = 80), and group 4 (late PCI group after symptoms onset, ≥ 168 hours after symptoms onset, n = 80). Primary study end points were 12-month cardiac mortality, nonfatal myocardial infarction (MI), target-vessel revascularization, and heart failure-related rehospitalization.

Results: There were no significant differences between groups in cardiac mortality, nonfatal MI and target-vessel revascularization. During follow-up, heart failure-related rehospitalization was higher in group 1 than in the other groups (18.8% vs. 5.1% vs. 7.4% vs. 6.3%, p = 0.010). Compared with group 1, group 2, group 3 and group 4 had lower heart failure-related rehospitalization (HR = 0.250, 95% CI: 0.083-0.753, p = 0.014) (HR = 0.377, 95% CI: 0.146-0.971, p = 0.043) (HR = 0.320, 95% CI: 0.116-0.879, p = 0.027).

Conclusions: For acute STEMI patients who missed the optimal time of PCI, immediate PCI did not reduce adverse clinical outcomes.

Introduction: Myxoma is the most common benign primary cardiac tumor.

Aim: To present a single center's 35-year experience with myxoma surgery in terms of surgical technique and postoperative complications.

Material and methods: The data of 166 patients (56.7 ±12.6 years old, 68.1% female) with surgically removed myxoma were retrospectively analyzed. Information on blood transfusions, additional procedures and postoperative complications was collected.

Results: A median sternotomy was performed in 97.5% of patients. A right mini-thoracotomy was performed in 4 patients. Most (95.2%) patients were semi-urgent. The reason for truly urgent surgery was hemodynamic instability in 4.8% of patients. Crystalloid cardioplegia was used in 62% of cases. Postoperative complications were observed in 12% of patients. One death was observed on the first postoperative day. During hospitalization, 6 deaths (3.6%) were observed. The most common cause of death was multisystemic organ failure. There were no gender differences in mortality and complications.

Conclusions: Surgical treatment of myxomas is a relatively safe procedure with a mortality rate comparable to other types of cardiac surgery. The postoperative complication rate is low. Gender has no influence on the complication rate or type.

Introduction: Congenital diaphragmatic hernia, in which viscera herniate into the thoracic cavity, is one of the common causes of onset of respiratory distress in neonates and children. Developmentally they may have a sac in rare cases.

Aim: To analyse the clinical profile and the outcome of congenital diaphragmatic hernia with a sac in neonates and children in a paediatric referral centre.

Material and methods: All surgically repaired patients with a congenital diaphragmatic hernia with sac, admitted and treated over a period of sixteen years from January 2005 to December 2021 in a tertiary care referral neonatal and paediatric centre, were included in this study. Forty-three children including neonates were analysed by their clinical characteristics, risk factors and mode of surgical interventions. Congenital diaphragmatic eventration and diaphragmatic hernial defects were excluded from this study.

Results: Forty-three study subjects were grouped into two groups for clinical and statistical analysis, based on their pre-operative and intra-operative findings as well their final diagnosis. Cases of left-sided congenial diaphragmatic hernia with sac (LCDHS) were included in group I (n = 30) and cases of right-sided congenital diaphragmatic hernia with sac (RCDHS) were included in group II (n = 13). Each group was further subclassified into A, B, C according to the age of presentation and side of the lesion in order to determine the prognosis in each subgroup. Level of evidence IV.

Conclusions: Mere awareness and clinical suspicion of such a rare embryological defect - a congenital diaphragmatic hernia with sac - from the attending clinicians can improve the prognosis of affected babies, avoiding morbid consequences if referred early to a tertiary care paediatric and neonatal centre.