Kardiochirurgia I Torakochirurgia Polska最新文献

The increasing trend of cardiac diseases is becoming a major threat globally. Cardiac activities are based on integrated action potential through electronic flux changes within intra- and extracellular molecular activities. Nicotinamide adenine dinucleotide (NAD) is a major electron carrier present in almost all living cells and creates gated potential by electron exchange from one chemical to another in terms of oxidation (NAD⁺) and reduction (NADH) reactions. NAD⁺ plays an important role directly or indirectly in protecting against various cardiovascular diseases, including heart failure, occlusion, ischemia-reperfusion (IR) injury, arrhythmia, myocardial infarction (MI), rhythmic disorder, and a higher order of cardiovascular complexity. Nicotinamide phosphoribosyl transferase (NAMPT) is well known as a rate-limiting enzyme in this pathway except for de-novo NAD synthesis and directly involved in the cardioprotective activity. There are two more enzymes - nicotinate phosphoribosyl transferase (NAPRT) and nicotinamide riboside kinase (NRK) - which also work as rate-limiting factors in the NAD+ synthesis pathway. This study concentrated on the role of NAMPT, NAPRT, and NRK in cardioprotective activity and prospective cardiac health.

Patients with cancer are prone to develop pulmonary embolism (PE) in the course of cancer-associated thrombosis. These patients have increased risk of both recurrent venous thromboembolism and major bleeding. Pulmonary embolism treatment in the cancer patient group is challenging. Selection of anticoagulants, duration of anticoagulation, decision of adjuvant therapy, and adjustment of the regimen in special situations are the major problems that need to be considered in the treatment of cancer-associated PE. Current first line treatment in long-term therapy following an episode of PE is low molecular weight heparin (LMWH), with direct oral anticoagulants (DOACs) and vitamin K antagonists (VKAs) listed as viable alternatives. This study aims to explore long-term oral anticoagulation therapy for cancer patients. Both VKAs and DOACs are compared to LMWH, which serves as a gold standard in anticoagulation therapy for cancer patients and has proven to be effective.

Angiotensin II (AT) is a potent vasoconstrictor and hypertensive drug that is registered for the treatment of severe hypotension in vasoplegic shock. Growing experience with the use of AT in cardiac surgery allows the first therapeutic algorithms to be created. This paper is a proposal for the use of AT in distributive shock after extracorporeal circulation.

Introduction: Hypothermic circulatory arrest (HCA) is useful to protect visceral organs during aortic operations. The degree of hypothermia and the influence of renal damage remain controversial.

Aim: To evaluate the incidence of acute kidney injury (AKI) comparing moderate HCA (MHCA) and deep HCA (DHCA) and determine risk factors and ability of urine neutrophil gelatinase associated lipocalin (u-NGAL) to predict AKI.

Material and methods: We prospectively enrolled 58 patients who underwent aortic replacement with HCA during May 2019-August 2021. Patients were divided into 2 groups: DHCA (15-20°C) and MHCA (20-25°C). The primary outcome was incidence of AKI. Secondary outcomes included risk factors of AKI.

Results: Baseline characteristics were not different between the 2 groups. There were 37 patients in the DHCA group and 21 patients in the MHCA group. Each group was mostly diagnosed with acute type A aortic dissection (60.3%). The operation was hemiarch replacement (51.7%). The overall incidence of AKI was 65.6% according to KDIGO criteria; there was no statistically significant difference between DHCA and MHCA groups. Urine NGAL level at cut-off point > 20 ng/ml at hour 0 and > 70 ng/ml at hour 6 could predict AKI. Operation time more than 360 minutes was found to be a risk factor for AKI. In hospital mortality rates and neurological outcomes were not statistically significantly different between DHCA and MHCA groups.

Conclusions: AKI is common in patients undergoing HCA with an overall incidence of more than 60%. Risk factors of AKI after aortic surgery include long operative time. U-NGAL in the early post-operative period can predict AKI.

Introduction: The outcomes of lung cancer surgery depend on the patients' nutritional status. Body fat percentage (BF%) is one of the indicators of body composition and nutritional status. Direct measurement of BF% is complicated, requires significant resources and is rarely performed. The CUN-BAE (Clínica Universidad de Navarra - Body Adiposity Estimator) index has been shown to accurately predict BF% is several clinical settings, but its relation to the outcomes of lung surgery has not been reported so far.

Aim: To determine the relation of the BF% to the outcomes of thoracoscopic lobectomy.

Material and methods: This retrospective study included 1,183 patients who underwent thoracoscopic lobectomy for non-small cell lung cancer between June 1999, and September 2019 at one department. BF% was calculated according to the Clínica Universidad de Navarra - Body Adiposity Estimator equation. The primary endpoints were postoperative complications and long-term survival.

Results: Univariate analysis showed that higher BF% was related to lower incidence of complications (p = 0.001), including prolonged air leak (p < 0.001), atelectasis (p < 0.05), psychosis (p < 0.001), reoperations (p < 0.05), and shorter chest drainage (p = 0.001) and hospitalization duration (p < 0.001). Multivariate analysis showed that higher BF% was correlated with lower risk of complications (p = 0.005; OR = 0.964; 95% CI: 0.940 to 0.989), including prolonged air leak (p < 0.001; OR = 0.923; 95% CI: 0.886 to 0.962), and shorter duration of chest drainage (p < 0.001; B = -0.046; 95% CI: -0.069 to -0.023) and hospitalization (p < 0.001; B = -0.112; 95% CI: -0.176 to -0.048). Cox proportional hazards regression analysis showed that BF% was not related to long-term survival.

Conclusions: Body fat percentage is a valuable tool that can help predict the short-term outcomes of minimally lobectomy for lung cancer.

Introduction: Atrial fibrillation (AF) presents a growing health concern, often requiring stroke prevention measures, primarily through oral anticoagulation (OAC). Surgical interventions such as left atrial appendage occlusion (LAAO) offer alternatives when OAC is contraindicated. In recent years, percutaneous procedures have gained traction as minimally invasive options, demanding precise anatomical insights. Fusion imaging (FI), which combines transesophageal echocardiography (TEE) and fluoroscopy, has emerged as a potential game-changer in transcatheter interventions.

Aim: This study introduces FI to LAAO procedures in Poland, assessing its role in guiding interventions, highlighting advantages, and exploring its potential to reshape cardiovascular interventions.

Material and methods: We conducted a retrospective study involving LAAO procedures from March 2015 to December 2018, all utilizing FI. Patient indications, procedural specifics, and safety metrics were collected and analyzed. Follow-ups were conducted at 3 and 6 months.

Results: A cohort of 83 patients (mean age: 72.1 ±8.4 years) underwent successful LAAO procedures. FI provided precise device placement and anatomical assessment. Mean procedure time was 54.9 ±34.3 min, contrast medium usage averaged 33.7 ±22.7 ml, and creatinine levels remained stable. Patients were discharged in about 4.2 ±3.4 days. Adverse effects were rare, including minimal bleeding and cardiac tamponade. Follow-ups demonstrated favorable outcomes with low adverse event rates.

Conclusions: This study marks the inaugural application of FI in Polish LAAO procedures. FI, offering enhanced visualization and reduced procedure times, holds promise in improving patient safety and treatment efficacy. We recommend its consideration as a standard visualization technique for LAAO procedures.

The perioperative management of patients undergoing mediastinal mass operations presents a persistent challenge across multiple clinical specialties. General anesthesia administration further increases the risk of perioperative cardiorespiratory decompensation. The interdisciplinary team plays a crucial role in ensuring a safe perioperative period. However, due to the rarity and variability of mediastinal mass syndromes, specific management protocols are lacking. This review aims to outline the multitude of challenges and pitfalls encountered during perioperative management in patients with the mediastinal mass syndrome. We describe diagnostic evaluation, preoperative optimization, intraoperative considerations, and postoperative care strategies, emphasizing the paramount significance of a multidisciplinary approach and personalized treatment plans. Preoperative multidisciplinary discussions, meticulous anesthetic management, and well-established protocols for emergency situations are pivotal to ensuring patient safety. Healthcare providers involved in the care of patients with mediastinal mass syndrome must grasp these challenges and pitfalls, enabling them to deliver safe and effective perioperative management.