Kardiochirurgia I Torakochirurgia Polska最新文献

Introduction: Pulmonary large cell neuroendocrine carcinomas (LCNEC) are one of the rare malignant neoplasms of the lung. A standard management model for LCNEC has not yet been established and the poor prognostic factors and treatment modalities are still uncertain.

Aim: LCNEC are fairly rare and have a poor prognosis. Determination of the risk factors associated with survival can contribute to its management.

Material and methods: In this retrospective study, we analyzed the data of 42 patients. We obtained the data about the age, gender, smoking history, symptoms, tumor size, tumor location, pathological type, TNM stage, treatments, surgical modality, length of hospital stay, postoperative complications, disease-free survival and total survival from the hospital electronic files of the patients. Then we analyzed the relationship between these data and survival.

Results: 40 (95.24%) were male, and the mean age was 64.26 ±8.62. 12 (28.57%) patients were in stage I, 14 (33.3%) were in stage II, 15 (35.71%) were in stage III and only 1 (2.38%) patient was in stage IV. 15 (35.71%) had sublobar resection (wedge resection (n = 13) + segmentectomy (n = 2), 24 (57.14%) had lobectomy and 3 (7.14%) had pneumonectomy. The mean overall survival (OS) time was 34.86 ±30.11 months. 1-year, 3-year and 5-year survival rates of the patients were 73.80%, 47.61% and 19.04%, respectively. T stage (HR = 8.956, 95% CI: 1.521-11.034, p = 0.005) N stage (HR = 5.984, 95% CI: 1.127-7.982, p = 0.028) were independent risk factors for OS.

Conclusions: The overall survival in LCNEC was poor and the tumor size and the nodal stage were independent risk factors for overall survival.

Introduction: Infective endocarditis (IE) on the tricuspid valve usually requires the complete resection of the infected tissue and implantation of a valve prosthesis.

Aim: We assumed that total elimination of artificial material and implantation of the entirely patient-derived biological material would reduce the recurrence of IE.

Material and methods: The group consisted of 7 consecutive patients who underwent implantation of a cylindrical valve created from the patient's own pericardium in the tricuspid orifice. There were only men aged 43 to 73 years. Isolated tricuspid valve reimplantation with a pericardial cylinder was performed in 2 patients. Five (71%) patients needed additional procedures. The postoperative follow-up ranged from 2 to 32 months (median: 17 months).

Results: In patients who underwent isolated tissue cylinder implantation, the average extracorporeal circulation (ECC) time was 77.5 minutes and aortic cross-clamp time was 58 minutes. In cases where additional procedures were performed the ECC and X-clamp times were 197.4 and 156.2 minutes, respectively. The function of the implanted valve was examined after weaning from the ECC by transesophageal echocardiogram, followed by transthoracic echocardiogram on day 5-7 after surgery revealed normal function of the prosthesis in all patients. There was no operative mortality. Two late deaths were observed.

Conclusions: In the follow-up period none of the patients had a recurrence of IE within the pericardial cylinder. Degeneration with subsequent stenosis of the pericardial cylinder occurred in 3 patients. One patient was reoperated on; one had a transcatheter valve-in-valve cylinder implantation.

Aim: The aim of the study was to report our preliminary results and real-world experiences regarding the use of a novel paclitaxel-coated balloon catheter in a cohort of patients with lower extremity peripheral artery disease at different stages.

Material and methods: A prospective cohort pilot study was conducted and the study group was made up of a total of 20 patients with peripheral artery disease who underwent endovascular balloon angioplasty with BioPath 014 or 035, a novel paclitaxel-coated, shellac containing balloon catheter. Eleven patients had a total of 13 TASC II-A lesions, 6 patients had a total of 7 TASC II-B lesions, 2 patients had TASC II-C lesions, 2 patients had TASC II-D lesions.

Results: In 13 patients, a single attempt with a BioPath catheter was adequate to treat a total of 20 target lesions, whereas in 7 patients more than one attempt with a different sized BioPath catheter was necessary. In 5 patients, total or near-total occlusion in the target vessel was initially treated with an appropriate sized chronic total occlusion catheter. Thirteen (65%) patients had at least one categorical improvement in Fontaine classification and none had symptomatic worsening.

Conclusions: The BioPath paclitaxel-coated balloon catheter seems to offer a useful alternative to the similar devices for treatment of femoral-popliteal artery disease. These preliminary results warrant confirmation with further research to reveal the safety and efficacy of the device.

Introduction: During the last few years, many modifications in risk stratification of all cardiac surgical patients have been reported based on EuroSCORE.

Aim: In this study we aimed to interpret copeptin and NT-proBNP levels in patients who had undergone coronary surgery with respect to EuroSCORE.

Material and methods: We investigated the correlation between pre-operative copeptin and NT-proBNP levels with respect to mortality and post-operative complications via EuroSCORE II in the 484 enrolled patients. In terms of analyzing mortality the first 30 days were taken into account and duration of hospital stay was considered for prognosis. The statistical significance of copeptin and NT-proBNP with respect to EuroSCORE II ≥ 2 was studied.

Results: The critical threshold levels of mortality for NT-proBNP was 1296 pg/ml and for copeptin was 116 pmol/l in patients whose EuroSCORE II ≥ 2. Mortality increases 9.04-fold in cases with EuroSCORE ≥ 2, 5.04-fold when NT-proBNP level is > 1296 pg/ml. A dramatic outcome was observed in copeptin levels as mortality increased 138.17-fold when copeptin was > 116 pmol/l.

Conclusions: Increased levels of copeptin and NT-proBNP negatively affect mortality and complication rates in isolated cardiac surgery patients.

Introduction: Myocardial protection in reoperative cardiac surgery is extremely difficult in patients with previous coronary surgery and a working LAD-LIMA graft. We use the method of percutaneous angiographic balloon left internal mammary artery (LIMA) occlusion and cardioplegic arrest.

Aim: To compare the data of patients with angiographic balloon LIMA-occlusion and those without occlusion in operations related to prosthetic valve endocarditis (PVE), and determine the degree of safety and benefits of the method.

Material and methods: A total of 20 patients undergoing surgery for PVE with a patent LIMA-LAD graft were analyzed retrospectively. We divided the patients into 2 groups: group A - patients with LIMA occlusion; and group B - patients without LIMA occlusion. The pre-, intra- and postoperative results were compared and the degree of safety and benefits of the application of the method were studied.

Results: 80% of patients in group A needed only dopamine infusion and 20% needed the addition of a second catecholamine at the end of CPB. In group B, the need for double catecholamine maintenance was noted in 50% of patients. The need for implantation of an intra-aortic balloon pump due to refractory heart failure was registered in 10% of patients in group A and in 20% of patients in group B. In terms of survival, mortality in the group with LIMA occlusion was 0%, while in the group without LIMA occlusion it was 20%.

Conclusions: Our observations suggest that angiographic balloon LIMA occlusion is a reliable, easily applicable and relatively safe technique that improves the surgical results.