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Background This observational analysis investigated in-hospital safety and efficacy of periprocedural antithrombotic/antiplatelet therapy used in TAVI patients included into the Polish Nationwide Cardiac Surgical and Cardiology Registry of Transcatheter Aortic Valve Implantation (POL-TAVI). Methods and results All patients who underwent TAVI in the participating centers between 2013 and 2014 were included. The primary endpoints were: severe bleeding, vascular complications, thromboembolic events, myocardial infarction, 30-days mortality, defined according to Valve Academic Research Consortium scale 2. A total of 827 patients were included; 35–93 years old (79.31 ± 7.53); 457 (55.29%) women. Endpoints noted: severe bleeding – 130 (15.72%) pts, vascular complications – 135 (16.32%) pts, thromboembolic events – 29 (3.5%) pts, myocardial infarction – 24 (2.90%) pts, deaths – 58 (7.01%) pts. Aspirin premedication, resulted in the least number of vascular complications (OR 0.56 95%CI [0.345–0.938]; p = 0.027). Aspirin after TAVI reduced the risk of vascular complications (OR 0.089 95%CI [0.0217–0.372]; p = 0.001) and bleeding (OR 0.138 95%CI [0.043–0.447]; p = 0.001) with no adverse impact on efficacy endpoints. Beneficial safety profile of postprocedural aspirin monotherapy remained significant in comparison to all other types of prophylaxis also in propensity score analysis: OR 0.068 95%CI [0.009–0.529]; p = 0.01 for vascular complications, OR 0.176 95%CI [0.049–0.627]; p = 0.007 for bleeding. NNT for vascular complications and bleeding with postprocedural aspirin prophylaxis was 5.5 and 6.42, respectively. Conclusion Aspirin after TAVI appears to be beneficial than currently recommended dual antiplatelet therapy; therefore, it might be considered as TAVI antithrombotic prophylaxis. [ABSTRACT FROM AUTHOR]

Abstract: Background: Several patients with acute coronary syndrome (ACS) are discharged home after the acute phase of ACS and are suitable for elective coronary artery bypass graft (CABG) surgery. The aim of the study was to assess the optimal timing for surgical revascularization and its effect on 12-month outcome in patients discharged from hospital after ACS and referred for elective CABG surgery. Methods: The analysis involved 2028 patients enrolled into the ongoing Polish Registry of Acute Coronary Syndromes (PL-ACS) who were discharged from hospital with the intention to undergo elective CABG surgery. Results: Among 2028 patients 1216 (60.0%) underwent surgery during 12months of follow-up. Patients who underwent surgical revascularization had a lower prevalence of mortality (5.7% vs 11.5%, p<0.0001). Patients who underwent surgery within the first month had a significantly higher prevalence of mortality than those who did not undergo surgery (5.7% vs 1.6%, p<0.0001). By the third month, the two cumulative mortalities were similar (4.2% vs 4.6%, p=0.65). From the beginning of the fourth month, the cumulative mortality was significantly higher among patients who did not undergo surgery. Conclusions: [1.] Only half of the survivors from ACS eligible for CABG surgery after hospital discharge have the procedure within 6months. [2.] Patients eligible for surgery and who do not undergo surgery have a twofold higher mortality twice at 12months. [3.] Surgical revascularization done during the first month after ACS is associated with a higher prevalence of mortality. The delay of CABG surgery should probably not exceed 3months. [Copyright &y& Elsevier]

Objectives: The aim of this study was to confirm the generalizability of the conclusions of the STICH (Surgical Treatment for Ischemic Heart Failure) trial. Background: Surgical ventricular reconstruction (SVR) added to coronary artery bypass grafting (CABG) did not decrease death or cardiac hospitalization in STICH patients randomized to CABG with (n = 501) or without (n = 499) SVR. Methods: Baseline clinical characteristics of 1,000 STICH SVR hypothesis patients and 1,036 STICH-eligible Society of Thoracic Surgeons (STS) National Cardiac Database patients undergoing CABG plus SVR were entered into a multivariate model equation to predict a mortality that placed these 2,036 patients in 1 of 32 risk at randomization (RAR) groups. The number of patients in each RAR group profiled the risk of STICH treatment arms and of STICH and STS STICH-eligible patients. Results: That 85% of the 1,000 STICH patients known to have no significant differences in baseline characteristics between the 2 treatment arms shared the same RAR group suggests that the RAR methodology has sufficient accuracy to compare RAR profiles of STICH and STS patients. RAR group was shared by 1,522 of 2,036 STICH and STS STICH-eligible patients (75%) who underwent CABG plus SVR. Differences in baseline characteristics responsible for more low-risk STICH patients and more high-risk STS patients were modest. Cox proportional hazard ratios of 1,000 STICH patients in 3 RAR groups suggested by STICH and STS RAR differences showed no differential treatment effect on survival across the low-, intermediate-, and high-risk groups. Conclusions: The STICH conclusion of no benefit from adding SVR to CABG applies to a broad spectrum of CABG-eligible patients with ischemic cardiomyopathy. (Comparison of Surgical and Medical Treatment for Congestive Heart Failure and Coronary Artery Disease; NCT00023595) [ABSTRACT FROM AUTHOR]

Abstract: Objective: The efficacy of percutaneous and surgical revascularization in acute coronary syndromes without ST-segment elevation is similar. Therefore, other factors, like health-related quality of life, should play an important role in choosing the revascularization method. Methods: We compared 12-month health-related quality of life for high-risk patients with acute coronary syndromes without ST-segment elevation assigned to percutaneous coronary intervention (group A) versus coronary artery bypass graft surgery (group B). Patients had an episode of rest angina within 24h prior to admission and had to fulfil at least one of the criteria: (1) ST-segment depression (≥0.05mV), (2) transient (&#60;20min) ST-segment elevation or T-wave inversion (≥0.1mV), (3) positive serum cardiac markers. Four hundred and ninety-six (91.34%) of 543 patients alive 12-months after index hospitalization completed a Short Form-36 (SF-36) health status survey. Group A comprised 392 patients and group B comprised 104 patients. We compared mental component summary (MCS) and physical component summary (PCS) scores from the SF-36 survey between analyzed groups. Results: There were no significant differences in MCS scores (47.21±12.30 vs. 46.60±11.3 in group A and group B, respectively, NS). PCS scores were lower in group A (38.30±11.10 vs. 42.64±9.76; p=0.003). Patients of group A had a higher rate of unstable angina (22.45 vs. 5.77%, p=0.0002) and repeated revascularization (12.76 vs. 1.92%, p=0.001) at 1 year. Patients of group A also had higher systolic and diastolic blood pressure during follow-up (138.17±20.41 vs. 133.47±19.21, p=0.04 and 82.48±11.32 vs. 77.25±16.17, p=0.0003, respectively). Systolic blood pressure was inversely associated with PCS scores in group A (Spearman''s R= −0.18 p=0.0007). Conclusions: This study has shown that there is a significant difference in health-related quality of life 12-months after percutaneous coronary intervention and coronary artery bypass graft surgery. This difference arises from better physical function (physical component summary) for coronary artery bypass graft surgery patients compared with percutaneous coronary intervention patients. Despite impairment of the physical health status (physical component summary), the mental health status (mental component summary) remained similar in both groups. [Copyright &y& Elsevier]

An obituary for American heart surgeon Denton Arthur Cooley is presented.

Numerous studies have shown that statin therapy initiated early after heart transplantation improves the short- and long-term prognosis, leading to a reduction in the incidence of cardiac allograft vasculopathy (CAV), acute rejection episodes and significantly lowers the incidence of cancer in this patient population. The molecular mechanisms responsible for the beneficial effects of statins in patients after heart transplantation are complex; the effectiveness of statins is associated not only with their hypolipemic action, but also with their pleiotropic properties. Statins have been shown to exert protective and therapeutic effects against cancer because they act as antiproliferative agents, promoting apoptosis and inhibiting angiogenesis. Moreover, they reduce the number of circulating monocytes, which inhibits the secretion of proinflammatory cytokines, growth factors, adhesion molecules, chemokines, and matrix metalloproteinases, preventing chronic rejection and CAV. For these reasons, statins should be used as part of standard therapy in patients after heart transplantation. [ABSTRACT FROM AUTHOR]

Background: Continuous‐flow left ventricular assist devices (LVADs) have been extensively used in a strategy of bridge to orthotopic heart transplant and destination therapy. The usage of LVAD, however, is not free from limitations such as device‐related adverse events, including pump thrombosis (PT). We aimed to develop an algorithm of early PT detection based on the maintenance parameters monitored by the implanted device. Methods: We analyzed log files of 101 patients implanted with HeartWare pump (HVAD) with 18 PT events among them. For signal processing, we used the open‐high‐low‐close format transformation and typical price (TP) technical analysis indicator. Model parameters were tuned with 5‐fold cross‐validation, and the final performance was measured on a separate group of patients. Results: Our algorithm achieved 100% sensitivity and 100% specificity of indications. In the final evaluation, alarms preceded the clinical acknowledgement of events by 2 days and 20 h on average. In the worst‐case scenario, an alarm was raised 1 day and 8 h prior to the event. Conclusions: The proposed algorithm could be installed to work directly with the device controller and provide clinicians with automatic readings analysis, raising an alarm when there is a high probability of thromboembolism. Early event detection could enable better thrombosis management and improve prognosis in patients implanted with HVAD. [ABSTRACT FROM AUTHOR]

Cystic fibrosis is an autosomal progressive disease affecting the lung, pancreas, and liver. Some patients develop end-stage respiratory and liver failure. For such patients, combined lung-liver transplantation remains the only therapeutic option. In this article we present the first simultaneous lung-liver transplantation in Poland, as well as in Central and Eastern Europe, with detailed clinical history, surgical aspects, and postoperative course. [ABSTRACT FROM AUTHOR]

Background: Data concerning the comparison between transcatheter aortic valve implantation and surgical aortic valve replacement in a real-world setting are scarce and in Central and Eastern Europe no such data exist. In this study, we aimed at analyzing retrospectively the characteristics and outcome of patients with aortic stenosis treated either with surgical aortic valve replacement or transcatheter aortic valve implantation between 2006 and 2016 in the Silesian Province, Poland in a representative real-world cohort. Methods: In the Silesian Cardiovascular Database we retrospectively identified 5186 patients who received either transcatheter aortic valve implantation or surgical aortic valve replacement in 1 of 3 tertiary cardiovascular centers. Baseline characteristics, including relevant clinical history, and outcomes were compared before and after propensity-score matching of both groups, with 348 pairs of patients constituting the propensity-matched study cohort. The primary end-point was 24-month all-cause mortality. Results: Preoperative characteristics of propensity-matched groups were similar. There was no difference between transcatheter aortic valve implantation and surgical aortic valve replacement groups with respect to the death rate at 2 years (19.9% vs. 15.6%; P = .479). In the transcatheter aortic valve implantation group, cardiac resynchronization therapy devices were more frequently implanted after the procedure (3.7% vs. 0.0, P < .001). The groups had similar rates of myocardial infarction, stroke, and re-hospitalization. Hospital stay in the matched groups was shorter after transcatheter aortic valve implantation: 14.1 versus 15.7 days (P < .001). Conclusions: At 24 months, transcatheter aortic valve implantation patients had similar outcomes as surgical aortic valve replacement except for a higher rate of cardiac resynchronization therapy device implantation and shorter hospital stay. [ABSTRACT FROM AUTHOR]

Introduction: Indications for transcatheter aortic valve implantation (TAVI) are constantly expanding, including younger patients. Bicuspid aortic valves (BAV) often occur in this group. In order to achieve optimal treatment results in younger patients, it is necessary to develop an effective method for selecting the size of implanted valves. Aim: To compare the results of TAVI with use of a self-expanding prosthesis in patients with a BAV and a tricuspid aortic valve (TAV) with valve selection based on annular sizing. Material and methods: The diagnosis of BAV and TAV and measurements (annular sizing) were based on multi-slice computed tomography scans. Eighty-three patients received a self-expanding CoreValve or Evolut R prosthesis. In group I (BAV) there were 21 (25.3%) patients and in group II (TAV) there were 62 (74.7%) patients. Results: The groups did not differ in terms of baseline clinical characteristics. Device success was achieved in 16 (76.2%) and 55 (88.7%) (p = NS) in group I and II respectively. Composite endpoints: early safety occurred in 5 (23.8%) and 11 (17.7%) patients (p =NS) in group I and II respectively; clinical efficacy occurred in 10 (47.6%) and 28 (45.2%) patients (p = NS) in group I and II respectively. 30-day mortality was 4.8% vs 9.7%, 1-year mortality was 28.6% vs 17.7% (p = NS) in group I and II respectively. Conclusions: TAVI in patients with severe aortic stenosis and BAV is as effective as in patients with TAV using self-expanding prostheses if the valve selection is based on annular sizing. [ABSTRACT FROM AUTHOR]

Cystic fibrosis is a congenital, progressive disease affecting many organs. It frequently leads to severe respiratory failure, which can be treated by means of a double lung transplantation. Single lung transplantation is justified only in certain cases. This is a case report describing a 20-year-old female patient who became the recipient of a single lung transplant as a result of cystic fibrosis. The transplant was performed during cardiothoracic surgery, which included an intervention in the right atrium. At the age of 14, the patient underwent left pneumonectomy. In addition, the patient had a percutaneous endoscopic gastrostomy placed and a vascular port implanted. During preoperative evaluation, she presented with clinical symptoms of chronic respiratory failure. The patient was approved for lung transplantation at the age of 16. After 2 years on the national lung transplant waiting list, in 2018, the patient underwent right lung transplantation and removal of numerous thrombi in the right atrium during 1 procedure. This surgery was accomplished with the use of extracorporeal circulation, which is an extracorporeal membrane oxygenator combined with cardiopulmonary bypass. The patient was discharged 3 weeks after the procedure in good general condition. Presently, her pulmonary function is excellent and she presents with normal respiratory capacity. Patients with cystic fibrosis often require double lung transplantation. Under normal circumstances, performing only a single lung transplantation would be considered medical malpractice. However, in certain cases, a single lung transplant is a life-saving procedure. • This case report describes a 20-year-old recipient of a single lung transplant as a result of end-stage pulmonary failure in the course of cystic fibrosis. • Cardiac surgery followed by single lung transplantation is achieved with proper implementation of cardiopulmonary bypass and extracorporeal membrane oxygenation. • Patients with cystic fibrosis can become single lung transplant recipients after pneumonectomy. [ABSTRACT FROM AUTHOR]

Background: According to the medical literature, both on-pump and off-pump coronary artery surgery is safe and effective in octogenarians. Objectives: The aim of our study was to examine the epidemiology, in-hospital outcomes and long-term follow-up results in octogenarians undergoing off-pump and on-pump coronary artery surgery utilizing nationwide registry data. Methods: All octogenarians (≥ 80 years) enrolled in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry), who underwent isolated coronary surgery between January 2006 and September 2017 were identified. Preoperative data, perioperative complications, hospital mortality and long-term mortality were analyzed. Unadjusted and propensity-matched comparisons were performed between octogenarians undergoing off-pump and on-pump coronary artery bypass surgery. Results: Octogenarians accounted for 4.1% of the total population undergoing coronary artery surgery in Poland during the analyzed period (n = 152,631) and this percentage is increasing. Among 6,006 analyzed patients, 2,744 (45.7%) were operated on-pump and 3,262 (54.3%) were operated off-pump. Propensity-matched analysis revealed that patients operated on-pump were more often reoperated due to postoperative bleeding and their in-hospital mortality was higher (6.6% vs 4.5%, p = 0.006 and 8.7% vs 5.8%, p = 0.001, respectively). Long-term all-cause mortality was lower among patients operated off-pump (p = 0.013). Conclusion: On the basis of our findings we suggest that off pump technique should be considered as perfectly acceptable in octogenarians. [ABSTRACT FROM AUTHOR]

Lung transplantation (LTx) is the only treatment for patients with end-stage lung disease. This procedure is associated with a risk of complications related to airway stenosis, which can be treated by means of bronchoscopic interventions (BI). Microbiological colonization may have an impact on airway complications. The aim of the study was to investigate the effect of presence of microbiological pathogens in graft among lung recipients and frequency of BI, considered as the indicator of severe complications. The study design was single-center retrospective cohort research; cases of 116 patients with complete microbiological data who underwent LTx from April 2013 to June 2019 were reviewed (70.3% of transplanted patients). All statistical analyses were performed with SPSS version 25.0 and R 3.5.3. For analyses involving the number of bronchoscopy interventions, univariate and multivariate Poisson regression were used. Interaction effect of variables in multivariate Poisson regression was assessed with partial response plot. The mean number of pathogens colonizing each patient was approximately 4.66 (range, 0 to 19) with Candida albicans (n = 42, 36.2%), Aspergillus spp. (n = 33, 28.4%), Pseudomonas aeruginosa (n = 32, 27.59%), and methicillin-sensitive Staphylococcus aureus (MSSA) (n = 29, 25%) being the most prominent. Microbiological agents causing the greatest increase in the risk of intervention are as follows: Proteus mirabilis by 3.84 times, Aspergillus spp. by 3.53 times, and Stenotrophomonas maltophilia by 3.09 times. Burkholderia multivorans , Enterococcus spp. , and Klebsiella spp. do not have a statistically significant impact on the number of BI. Some pathogens increase the frequency of complications, which are associated with deterioration of the general condition. Therefore, patients should be monitored for the presence of pathogens in the airways. • Some pathogens increase the frequency of complications, which is associated with deterioration of the general condition of patients. • Patients should be monitored for the presence of these pathogens in the airways. • This paper emphasizes the need and rationale for the thorough screening of fungal presence in the lung transplantation recipients' bronchial trees. [ABSTRACT FROM AUTHOR]

Lung transplant remains the only viable treatment for certain patients with end-stage lung diseases. Such patients can become either single or double lung recipients. The 2 procedures are associated with specific risks and benefits. The aim of the study was to assess the survival of patients after lung transplant in a single center. The retrospective study consists of 128 lung transplant recipients. Patients underwent transplant between 2004 and 2017 because of following diseases: chronic obstructive pulmonary disease (28.2%), cystic fibrosis (26.5%), and primary pulmonary hypertension (12.3%), including idiopathic pulmonary arterial hypertension and interstitial lung diseases (33%). Patients with idiopathic pulmonary arterial hypertension were not treated with postoperative extracorporeal membrane oxygenation as left heart conditioning. Regardless of underlying disease, 75% of DLT recipients and 51% of SLT recipients reached 5-year survival (P =.0066). A total of 87% of lung transplant recipients with cystic fibrosis reached 1-year survival. Among lung recipients with primary pulmonary hypertension who underwent DLT and SLT, 5-year survival was reached by 84% and 51%, respectively (P =.025). Among patients with chronic obstructive pulmonary disease, 82% of DLT recipients and 62% of SLT recipients reached 1-year survival (P =.22). Patients who received transplants because of primary pulmonary hypertension presented the worst short-term survival among all SLT recipients. Patients with CF have the best overall survival among all lung transplant recipients. Double lung transplant provides statistically significantly better outcomes than single lung transplant. This observation is also present among recipients who underwent transplant because of primary pulmonary hypertension, as single lung transplant is not recommended among such patients in particular. • Patients with cystic fibrosis have the best overall survival among all lung transplant recipients. • Double lung transplant provides statistically significantly better outcomes than single lung transplant. • This observation is also present among recipients who underwent transplants because of primary pulmonary hypertension. [ABSTRACT FROM AUTHOR]

Secondary pulmonary hypertension (PH) is a serious complication of end-stage lung disease and is associated with unfavorable prognosis. The aim of the study was to evaluate the incidence and severity of secondary PH among patients qualified for lung transplantation (LTx). The study population consisted of 143 patients qualified for LTx between 2004 and 2019. Analyzed medical records included results collected during the qualification process (eg, echocardiography parameters, right heart catherization [RHC]). There were 37.8% (n = 54) of patients with chronic obstructive pulmonary disease (COPD), 58.7% (n = 84) of patients with interstitial lung diseases (ILDs), and 3.5% (n = 5) of patients with combined pulmonary fibrosis and emphysema (CPFE). The inclusion criteria were ILDs, COPD or CPFE diagnosis, and the presence of RHC data preformed during qualification for LTx. The exclusion criteria were lack of RHC results and diagnosis of idiopathic pulmonary artery hypertension, pulmonary artery hypertension associated with connective tissue disease, cystic fibrosis, or bronchiectasis. PH was detected among 60.1% (n = 86) of patients qualified for LTx. The prevalence of PH was 39% (n = 18) vs 76.19% (n = 64) in the COPD vs ILDs groups, respectively. Both ILDs and COPD patients presented with similar mean artery pulmonary pressure (36.3 ± 9.61 vs 34.78 ± 11.47 mm Hg; not statistically significant). Severe PH was more frequent in the ILDs group than in the COPD group (60.94% vs 38.89%). PH is commonly diagnosed in patients with chronic lung diseases qualified for LTx and more often observed among patients qualified because of ILDs. It is important to assess the pulmonary pressure because of frequent occurrence of PH among patients referred for LTx. • Assessing of pulmonary hypertension is an integral part of examining patients with end-stage lung diseases during qualification for lung transplantation. • Pulmonary hypertension can influence survival of patients on the waiting list and after transplantation. • The presence of pulmonary hypertension affects the pre- and postoperative management of lung transplant recipients. [ABSTRACT FROM AUTHOR]

Long-term outcomes of airway complications (AC) after lung transplantation are unknown. The incidence of AC varies from 1.6% to 32% with the related mortality rate of 2% to 4%. The management of most AC is based on endobronchial methods, including balloon bronchoplasty, endobronchial stent placement, and ablative techniques. The aim of the study was to assess the connection between airway complications treated by bronchial intervention (BI) and the survival of lung transplant recipients. The single-center retrospective study reviewed the cases of 165 patients (63 women [38.18%], 103 men [61, 82%]; median age at referral for lung transplantations (LTx), 41 years [range, 15-68 years]). The cohort was stratified into 2 groups comprising those whose procedures were complicated by ACs and those without. The primary outcome measured was mortality, with survival endpoints calculated at 6 months. The comparison of the survival of recipients regarding underlying disease (cystic fibrosis [CF], chronic obstructive pulmonary disease [COPD], idiopathic pulmonary artery hypertension [IPAH], and others) with the use of the Kaplan-Meier estimator indicated that the only statistically significant (P =.0194) differences between patients who underwent BI and patients without BI performed were observed in CF patients (Fig 1). In any other diagnosis, the results were not statistically significant (P >.05). Bronchoscopic intervention because of airway complications after lung transplantation are often-used procedures, but they have no impact on the survival of patients with cystic fibrosis. • Bronchoscopic interventions due to airway complications after lung transplantation are frequent procedures. • They seem to have no impact on the short-term survival among patients transplanted due to chronic obstructive pulmonary disease, primary pulmonary hypertension, and interstitial lung diseases. • Lung transplant recipients due to cystic fibrosis seems to be the exception, as the number of BI influences their survival. [ABSTRACT FROM AUTHOR]

Interstitial lung diseases (ILDs) are a heterogeneous group of more than 200 diseases manifested by progressive exercise dyspnea, radiological lung changes, and ventilation restrictive disorders. ILDs are the second most common indication for lung transplantation (LTx). Our study group consisted of 139 patients who qualified for LTx at the Silesian Center for Heart Diseases between 2004 and 2018. Of the 139, 92 patients died while on the waiting list, and 47 patients underwent LTx. Medical records including laboratory test results, spirometry, and the 6-minute walk test (6MWT) were analyzed to determine eligibility for LTx. We also assessed quality of life post-LTx. Patients who qualified for LTx showed decreased values of parameters measured by spirometry (43.69 ± 19.05% of forced expiratory volume in the first second [FEV1] and 43.07 ± 20.55% of forced vital capacity [FVC] and severe desaturation during the 6MWT (SpO 2 = 88.78% before 6-minute walk test and 73.23% after the test). After LTx, longer distances were achieved in the 6MWT (235.47 ± 159.57 m during qualification vs 533.2 ± 34.15 m 12 months after LTx) and increased values of spirometry. On average, patients had stopped working 6 years prior to LTx. There is no effective medical treatment for patients with end-stage ILDs. Therefore, lung transplantation is a lifesaving procedure for patients that also extends patients' lives and improves their quality of life. • Studies assessing quality of life should be an integral part of control during postoperative visits after lung transplantation. • Quality of life tests enable the assessment of a full or incomplete return of a patient to a satisfying life after lung transplantation. • Lung transplantation (LTx) is the only effective method of treatment for patients with end-stage lung diseases with a purpose of improving their health and quality of life. [ABSTRACT FROM AUTHOR]

Lung transplantation (LTx) is the only effective method of treatment to improve the health and quality of life (QoL) of patients with end-stage lung diseases. After LTx, medical examination accompanied by quality of life assessment should be performed on routine follow-up visits. The aim of the study was to assess the QoL of patients after LTx. The study group consisted of 60 patients (29 women and 31 men); 20 patients received single lung transplantation (SLT), and 40 received double lung transplantation (DLT). To determine the patient's QoL, the General Health Questionnaire (GHQ), the World Health Organization Quality of Life Test–BREF (WHOQOL-BREF), and the Saint George Respiratory Questionnaire (SGRQ) were used. Spirometry and the 6-minute walk test were analyzed to examine efficiency of transplanted organs. In SGRQ there are differences between patients with cystic fibrosis and interstitial lung disease in symptom domain (20.28% vs 39.26%, P =.025) and total score (19.38% vs 32.47%, P =.028). As reported in the GHQ, men had worse overall results than women in sten scale (5.22 points vs 4.69 points). Patients after SLT achieved similar scores in every questionnaire. Studies assessing QoL should be an important addition to lung function tests and an integral part of control during postoperative follow-up visits. This study is one of the important contributions to understanding of how essential QoL is after LTx. The authors of this study realize that their work does not cover the whole issue, and further studies in this area are warranted. • Studies assessing quality of life should be an integral part of control during postoperative visits after lung transplantation. • Quality of life tests enable assessment of full or incomplete return of a patient to a satisfying life after lung transplantation. • Lung transplantation is the only effective method of treatment for patients with end-stage lung diseases with a purpose of improving their health and quality of life. [ABSTRACT FROM AUTHOR]

The cold ischemia time (CIT) is a period of time between harvesting an organ for transplant and its reperfusion just after implantation. CIT may have an impact on frequency of complications after lung transplant that can be treated by means of bronchoscopic intervention. The aim of the study was to investigate the correlation between CIT and frequency of bronchoscopic intervention. The retrospective study consists of 91 patients: 22 single lung recipients (24%) and 69 double lung recipients (76%) who underwent lung transplant from March 2012 to June 2019. All statistical analyses were performed in SPSS 25.0 and R 3.5.3. The P levels less than.05 were deemed statistically significant. The average CIT in single lung transplant was 5.91 hours, and in double lung transplant it was 8.61 hours. For the 4- to 8-hour CIT the percentages were 80.95% for single lung recipients and 46.38% for double lung recipients. For CIT longer than 8 hours, the following percentages were observed: 9.53% in single lung transplant and 53.62% in double lung transplant. Each subsequent hour of CIT exponentially increases the risk of intervention 1505 times (50.05%). Prolonged CIT seems to be a risk factor for airway complication, especially in the double lung recipient group. • Cold ischemia time (CIT) influences the number of airway complications that require bronchoscopic interventions. • The effect of CIT on the frequency of bronchoscopic interventions is particularly clear among recipients with lungs from young donors. • In the group of patients whose lungs were procured from older donors, the number of interventions is not as influenced by CIT. • The study requires further investigations, as authors are aware of its limitations. [ABSTRACT FROM AUTHOR]

Primary pulmonary hypertension can lead to hypertrophy of the right ventricle and ultimately to its insufficiency. Lung transplantation remains the only viable treatment for patients with certain forms of this disease. Usage of extracorporeal membrane oxygenation in veno-arterial form (VA-ECMO) after transplantation is both protective for left ventricle (enables adaptation to increased blood flow) and right ventricle (provides time to return to appropriate dimensions and in some cases to correct tricuspid regurgitaion). The case study describes 4 patients who were treated with VA-ECMO as a perioperative support. Three patients were diagnosed with idiopathic form of precapillary primary pulmonary hypertension. A fourth patient was a 49-year old woman diagnosed with hypoplastic pulmonary veins representing the postcapillary form of pulmonary hypertension. In all of the cases, VA-ECMO was introduced during the surgery (femoral vein/internal jugular vein and femoral artery) and maintained for several days after the transplantation. Regular echocardiographic and biochemical assessment in postoperative course revealed that cardiac function improved during and after such treatment among all patients. They were successfully weaned off ECMO and finally surgically explanted without any local complications. One patient was treated with awake ECMO protocol. VA-ECMO was proved to be a useful tool during the transplantation and postoperative period. It helps to restore proper cardiac function, as well as prevent adverse effects of aforementioned pathologic changes of a heart. • This study describes the first Polish experience with consecutive intra- and postoperative prolonged VA-ECMO as a tool of heart conditioning. • Postoperative prolonged VA-ECMO among sedated and mechanically ventilated patients provides satisfactory heart conditioning. Nevertheless, it is accompanied by certain neurologic complications. • Awake postoperative prolonged VA-ECMO in extubated patients provides desirable results. • Lung transplant recipients due to severe pulmonary primary hypertension undeniably require intraoperative and, what is of utmost importance, postoperative prolonged VA-ECMO support. [ABSTRACT FROM AUTHOR]

Lung transplant (LTx) is a procedure associated with risk of complications related to airway stenosis that can be treated with bronchoscopic interventions (BIs). The aim of the study was to assess the frequency and risk factors associated with increased need of bronchial interventions in the post-transplant period. The retrospective study reviewed cases of 165 patients (63 women) who underwent LTx from April 2013 to June 2019. For dichotomous discrete variables (occurrence or lack of intervention) multivariate logistic regression analysis was performed to assess the aforementioned risk factors. BIs were required among 38.55% of lung recipients (n = 65). The number of interventions/patient/y decreases between years 1 and 2 (P <.001), 2 and 3 (P =.013), and 3 and 4 (P <.001); after the fourth year post LTx the differences are not statistically significant. Each 1 mm Hg above 25 mm Hg of mean pulmonary arterial pressure causes statistically significant elevation in the number of interventions by 0.7% in the first year after the procedure. The number of BIs per patient among lung recipients who received a transplant because of idiopathic pulmonary arterial hypertension was statistically significantly higher compared with patients with another underlying lung disease. Airway complications developed in the post-transplant period caused a significant number of patients to be in need of BI, especially balloon bronchoplasty. The highest number of interventions occurred within the first year after LTx, and BI decreases over time. Mean pulmonary arterial pressure measured during qualification may have the ability to predict whether the patient would require BI after LTx. • The number of bronchoscopic interventions (BIs) decreases over time, and improvement of surgical technique is associated with lesser need for BI. • Cold ischemia time as well as body mass index impacts whether the patient will require the intervention. • Pulmonary hypertension evaluated at qualification for lung transplant can anticipate later airway complications. • The higher the mean pulmonary arterial pressure is above 25 mm Hg, the greater the chances for future airway complications. • Patients with idiopathic pulmonary arterial hypertension would require more BI per patient, provided they need BI. [ABSTRACT FROM AUTHOR]

Lung transplant is a surgical procedure for end-stage lung disease. Many factors related to lung donors influence the outcome of transplant. The main aim of this single-center study was to assess which donor-related and procedure-related factors would influence the 30-day or hospital mortality of the recipients. This retrospective study group consisted of 110 donor-recipient pairs undergoing lung transplant between 2012 and 2017 (group 1) and 2018 and 2019 (group 2) in Silesian Center for Heart Diseases. Both groups of donor- and procedure-related factors were included in the analysis: oxygenation index at reporting of the donor, time donor spent in the intensive care unit (ICU), presence of cardiac arrest while being in the ICU, donor age, type of transplant, cumulative ischemia time, duration of the operation, and time of mechanical ventilation. The type of surgery was significantly associated with an increase in the chance of death within 30 days. Patients who underwent single lung transplant had a 20.217 times greater chance of dying within 30 days than patients after double lung transplant (interquartile range, 2.116-193.125). Single lung transplant increases the risk of death during the first 30 days after lung transplant, and using lungs from older donors may increase the rate of hospital mortality. Oxygenation index, sudden cardiac arrest of the donors, and donor time spent in the ICU do not impact the short-term mortality of lung graft recipients. • Single lung transplant increases the risk of death during the first 30 days after lung transplant. • It is important that oxygenation index, sudden cardiac arrest of the donors, and time spent in the intensive care unit does not impact the short-term mortality of lung graft recipients. • These findings support the idea of the donor pool extension by applying more liberal criteria. [ABSTRACT FROM AUTHOR]

Model for End-Stage Liver Disease (MELD) score is used to assess the severity of chronic liver disease. It is implemented in transplantology in the process of qualification for urgent liver transplant. The aim of our study was to assess the liver function of patients qualified for lung transplant using MELD score, taking under consideration mean pulmonary artery pressure as an important risk factor of death. The study group consisted of 123 patients qualified for lung transplant in Silesian Center for Heart Diseases between 2004 and 2017. Data relevant for MELD score calculations and medial pulmonary artery pressure were acquired from medical records. The average MELD score among patients qualified for lung transplant was 8.24 points, and mean pulmonary pressure (mPAP) was 35.02 mm Hg. Patients with idiopathic pulmonary artery hypertension acquired the highest MELD and highest mPAP results (13.1 points and 57.7 mm Hg, respectively). Patients with idiopathic pulmonary fibrosis presented higher mean MELD-Na score among those with pulmonary arterial hypertension than those without pulmonary arterial hypertension (36.59 mm Hg; 7.74 points vs 18 mm Hg; 6.5 points). There is strong positive correlation between MELD-Na and mPAP among patients who underwent lung transplant because of idiopathic pulmonary fibrosis. This is the first study in the worldwide literature assessing MELD-Na as a predictor of survival among patients qualified for lung transplant and those who already are recipients. Further studies regarding this issue are required as authors will explore this issue in the future. • Model for End-Stage Living Disease (MELD)-Na can be a predictor of survival among patients qualified for lung transplant. • MELD-Na as well as mean pulmonary artery pressure (mPAP) are the outcome predictors after lung transplant regardless of underlying disease. • There is a strong positive correlation between mPAP and MELD-Na among patients who underwent lung transplant because of idiopathic pulmonary fibrosis. • In lung transplant recipients with idiopathic pulmonary arterial hypertension, there a strong negative correlation between mPAP and MELD-Na. [ABSTRACT FROM AUTHOR]

Lung transplant remains the only viable treatment for most of the end-stage lung diseases. It is believed that extending criteria for donor lungs would increase the number of lung transplants. The aim of the study was to compare the graft function by means of oxygenation index among recipients who received the lungs from donors of extended criteria with those whose received lungs from donors who met the standard criteria. This retrospective study analyzed 71 donors whose lungs where transplanted into 71 first-time double lung recipients of 2 groups: patients who received transplants before and after 2018. The objective was to assess whether there is a significant difference in quality of the donor pool after applying extended criteria. The second objective was to compare results of recipients with lungs from donors of oxygenation index > 400 mm Hg with those obtained among recipients with this parameter < 400 mm Hg. In the case of transplants performed in 2018 to 2019, oxygenation indices were significantly lower in donors but significantly higher in recipients on the first day than those observed in 2015 to 2017. The number of transplants increased from 9 per year to 22 per year. Irrespective of whether the donor had Pa O 2 /fraction of inspired oxygen above or below 400 mm Hg, recipients showed similar oxygenation index values after transplant (mean oxygenation index, 462 vs 412 mm Hg, respectively). Short-term mortality did not differ either. Extended criteria of lungs suitability as a potential grafts not only increases the donor pool but also proves that suboptimal donors are not associated with producing inferior results of the recipients. • Suboptimal donors are not associated with inferior short-term survival of double lung transplant recipients. • Donor pool increased after extending the lower limit of admissible oxygenation index. • Postoperative oxygenation index of first-time graft recipients receiving lungs of Pa O 2 /Fio2 < 400 mm Hg at donor reporting does not differ from those with PaO 2 /Fio2 > 400 mm Hg among double lung transplant recipients. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death worldwide. Lung transplantation (LTx) is often the only therapeutic option for patients with end-stage COPD. The aim of the study was to establish whether patients with end-stage COPD benefited from lung transplantation and assess the pulmonary function by the 6-Minute Walk Test (6MWT) and forced expiratory volume in 1 second (FEV1). A retrospective study was carried out in the group of 69 patients (40 recipients, 18 patients currently waiting, and 11 patients who died while waiting for a lung graft) diagnosed with end-stage COPD, referred to the Silesian Center for Heart Diseases' Lung Transplant Ward, and qualified to be treated by means of lung transplantation between 2006 and 2018. The beginning of the observation for all 69 patients was a qualification date. Kaplan-Meier estimation determined that graft recipients noted 50% probability of survival at approximately 5.5 years, whereas patients from the other group had such parameters at about 1.4 years. The average results FEV1 obtained at qualification were 23.69% for single lung transplantation (SLT); and 22.06% for double lung transplantation (DLT). Average patient acquired 158.07m in the 6MWT. One year after procedure the average values of FEV1 were SLT, 55.83%; DLT, 79.54%; and 430.7 m in the 6MWT overall. Qualified patients who underwent lung transplantation lived longer than those who did not undergo such a procedure. We observed a difference in SLT and DLT recipients. • Lung transplantation extends the life of a patient with end-stage chronic obstructive pulmonary disease (COPD). • In addition to survival time, respiratory efficiency is also improved, as demonstrated by the results of functional tests. • Double lung transplantation is more beneficial for patients with end-stage COPD than single lung transplantation in terms of pulmonary function. [ABSTRACT FROM AUTHOR]

The qualification of new knowledge is one of the oldest problems in experimental medicine that provides a link between fundamental discovery, hypothesis, 'proof of concept' preclinical studies and development of clinical trials. The biggest challenge in animal models is the proper evaluation of all the aspects that are crucial in specific studied pathologies as well as the prediction of their progression. The aim of this review was to describe and discuss the rat animal model of heart transplant. The rat model of heart transplantation is an excellent yet underestimated method of research of prevention, monitoring and treatment of acute and chronic, immune and nonimmune response to organ transplantation. Despite being a technically and logistically demanding model, it provides a tool for reproducible experiments with longterm animal survival and excellent graft survival. [ABSTRACT FROM AUTHOR]

Introduction: Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive disease. Pharmacological treatment can only slow its progression. However, lung transplantation (LTx) is the only treatment for patients with its end-stage form. This study analysed the long-term results of the qualification process of patients with IPF recruited for LTx in a single centre.Material and Methods: Retrospective analysis of 84 patients (56 patients who died while on the waiting list and 28 patients who underwent LTx) with end-stage IPF who were qualified for LTx between 2006 and 2017 at the Silesian Centre for Heart Diseases (Zabrze, Poland).Results: Cox proportional hazard analysis showed that the only parameter was 6-minute walk test (6MWT) distance, which statistically significantly impacted the probability of receiving a graft (parameter assessment, 0.00523; p = 0.006; 95% confidence interval (CI): 0.0015-0.009; hazard ratio (HR) = 1.005) as well as that of death while on the waiting list (parameter assessment, -0.0054; p = 0.003; 95% CI: -0.009- (-0.0017); HR = 0.995). Patients with a 253-350-m 6MWT distance had 3 times greater risk of dying while on the waiting list than those who walked more than 350 m. Other factors, such as height, sex, and blood group, also influenced the outcome.Conclusions: The 6-minute walk test distance is an independent predictor of mortality on the lung transplant waiting list. Blood type and height also play a significant role in becoming a lung recipient. [ABSTRACT FROM AUTHOR]

Background: No single randomized study has ever before addressed the safety of On-Pump coronary artery bypass grafting (CABG) vs Off-Pump CABG in the setting of atrial fibrillation (AF) and data from small observational samples remain inconclusive. Methods and findings: Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. Of initial 188,972 patients undergoing CABG, 7,913 presented with baseline AF (76.0% men, mean age 69.1±8.2) and underwent CABG without concomitant valve surgery between 2006–2019 in 37 reference centers across Poland. Mean follow-up was 4.7±3.5 years (median 4.3 IQR 1.7–7.4). Cox proportional hazards models were used for computations. Of included patients, 3,681 underwent On-Pump- (46.52%) as compared to 4,232 (53.48%) who underwent Off-Pump CABG. Patients in the latter group less frequently were candidates for complete revascularization (P<0.001). In an unadjusted comparison, On-Pump surgery was associated with significantly worse survival at 30 days: HR: 1.28; 95%CIs: (1.07–1.53); P = 0.007. Along the 13-year study period, the trend shifted in favor of On-Pump CABG: HR: 0.92; 95%CIs: (0.83–0.99); P = 0.005. After rigorous propensity matching, 636 pairs were identified. The direction and magnitude of treatment effects was sustained with HRs of 3.58; (95%CIs: 1.34–9.61); p = 0.001 and 0.74; [95%CIs: 0.56–0.98]; p = 0.036) for 30-day and late mortality respectively. Conclusions: Off-Pump CABG offered 30-day survival benefit to patients undergoing CABG surgery and presenting with underlying AF. On-Pump CABG was associated with significantly improved survival at long term. [ABSTRACT FROM AUTHOR]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES Our goal was to evaluate early sequelae and long-term survival in patients undergoing isolated coronary artery bypass grafting (CABG) with concomitant surgical ablation for atrial fibrillation (AF). METHODS Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were collected. A total of 7879 patients with underlying AF underwent isolated CABG between 2006 and 2018 in 37 reference centres across Poland. The mean follow-up was 4.7 ± 3.5 years [median (interquartile range) 4.3 (1.7–7.4)]. Propensity score matching and Cox proportional hazards models were used to compare isolated CABG + ablation with isolated CABG. RESULTS Of the included patients, 346 (4.39%) underwent surgical ablation. Patients in this group were significantly younger (66.4 ± 7.5 vs 69.2 ± 8.2; P  < 0.001) but had a non-significant, different baseline surgical risk (EuroSCORE: 2.11 vs 2.50; P  = 0.088). After a rigorous 1:3 propensity matching (LOGIT model: 306 cases of isolated CABG + ablation vs 918 of isolated CABG alone), surgical ablation was associated with a lower 30-day risk of death [risk ratio 0.37, 95% confidence interval (CI) 0.15–0.91; P  = 0.032] and multiorgan failure (risk ratio 0.29, 95% CI 0.10–0.94; P  = 0.029). In the long term, surgical ablation was associated with a significant 33% improved overall survival rate: hazard ratio 0.67, 95% CI 0.49–0.90; P  = 0.008. The benefit of ablation was sustained in the subgroups but was most pronounced in lower risk older patients (age >70 years, P  = 0.020; elective status, P  = 0.011) with 3-vessel disease (P  = 0.036), history of a cerebrovascular accident (P  = 0.018) and preserved left ventricular function [left ventricular ejection fraction >50%; P  = 0.017; no signs of heart failure (per New York Heart Association functional class); P  = 0.001] and those undergoing on-pump CABG (P  < 0.001). CONCLUSION Surgical ablation for AF in patients undergoing isolated CABG is safe and associated with significantly improved long-term survival. [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate the serum concentration of cytokines and biochemical markers of malnutrition in correlation with frailty syndrome in patients qualified for lung transplantation (LTx). The study population comprised 31 potential lung recipients, including 18 patients with idiopathic lung disease, 12 patients with chronic obstructive pulmonary disease, and 1 patient with bronchiectasis who qualified for a LTx. Cytokine serum levels were assessed using commercially available enzyme-linked immunosorbent assay kits and the Luminex 200 platform (ProcartaPlex Hu Cytokine/Chemokine Panel 1A 34plex, Invitrogen, Carlsbad, Calif., United States). The patients were also asked to complete a questionnaire, the Clinical Frailty Scale. All patients were found to have higher cytokine concentrations (IL6, IL 2,IL18, IL23, IL 12p70, IL 10, IL 7). No statistically significant differences in the analyzed cytokines were noted when the men's results were compared to those of the women. There were no significant differences between patients who scored 6 vs 7 points on the Canadian Study of Health and Aging Function Scale. In comparing chronic obstructive pulmonary disease to idiopathic lung disease patients, no significant differences were observed in the analyzed cytokine values. Significant correlations were observed between the analyzed cytokines and age of the patients, C-reactive protein, triglycerides, transferrin, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol. Our findings indicate that cytokines may not have a statistically significant effect on the parameters of the frailty syndrome. The results require further investigations on larger study groups. The findings suggest that the analyzed cytokines may play a proinflammatory role in the end stages of lung diseases, but further studies are needed to evaluate whether these cytokines could be used as biomarkers in this group of patients. [ABSTRACT FROM AUTHOR]

Objectives: Lung transplantation not only saves a patient's life but also creates the opportunity for becoming more self-reliant and getting back to work. The aim of this single center study was to assess the prospects of employment, as well as its influence on the quality of life and physical activity, of the lung transplant recipients of the Silesian Center for Heart Diseases in Zabrze, Poland.Material and Methods: A retrospective study covered 67 lung transplant recipients of the Silesian Center of Heart Diseases. Only patients with ≥ 6-month follow-up were included. All of the patients gave their written consent to be included in the study before filling out the questionnaire containing questions about employment, income, education and how work affected their quality of life before and after lung transplantation. A physical capability assessment was performed by climbing flights of stairs and by means of a 6-min walk test, and spirometry parameters were also measured.Results: Twenty of the patients included in the study (31.7%) were employed after lung transplantation, 63.2% of whom worked full-time. Profession was changed by 2 patients (14.3%). The patients diagnosed with cystic fibrosis were found to have the highest chance of finding employment after lung transplantation. The statistical analysis revealed that the employed patients were able to cover longer distances during the 6-min walk test (556 m, on average) than the unemployed ones (494 m, on average).Conclusions: One in 3 patients finds employment after lung transplantation. Work improves the quality of life of the majority of lung transplant recipients. The patients who are employed are also in a better physical condition, and they are more self-reliant in comparison to those who remain unemployed. Lung transplant recipients with cystic fibrosis are most likely to find employment, and so are patients with higher education. Int J Occup Med Environ Health. 2019;32(3):379-86. [ABSTRACT FROM AUTHOR]

Introduction: Idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD) show poor prognosis. The importance of left (LV) and right (RV) ventricular morphology and function in patients with end‐stage lung diseases referred for lung transplantation (LT) is not well established. Objectives: To assess whether LV and RV echocardiographic parameters influence survival of patients with IPF, COPD and other interstitial lung diseases (ILD) awaiting LT. Methods: In 65 patients (20 patients with COPD, 37 with IPF and 8 with other ILD), we performed transthoracic echocardiography and right heart catheterization. Echocardiographic parameters were assessed with regard to 1‐year all‐cause mortality. Results: The mortality rate was higher in patients with smaller dimensions of LV end‐systolic (LVESD) and end‐diastolic (LVEDD) diameter (HR 3.03, 95% CI 1.16‐7.69, P = .023; and HR 2.9, 95% CI 1.16‐7.14, P = .022; respectively), higher RV‐to‐LV (RV/LV‐4CH) ratio (HR 7.6, 95% CI 1.6‐29.5, P = .009) and RV proximal outflow tract (RVOT‐PLAX) dilatation (HR 2.69, 95% CI 1.22‐5.96, P = .015). These associations were independent of age, gender, body mass index, VC, FEV1% and pulmonary diagnosis. The subanalysis of IPF patients demonstrated that the smaller LVESD and LVEDD increased mortality rate (HR 15.0, 95% CI 2.87‐89.72, P = .003; HR 4.95, 95% CI 1.5‐15.5, P = .006; respectively). No such associations were found in the COPD patients. Conclusion: LV echocardiographic parameters (LVESD or LVEDD) are useful in predicting survival in patients with end‐stage lung diseases, mainly in IPF patients awaiting LT. Other parameters (RV/LV‐4CH and RVOT‐PLAX dilatation) may also influence survival. [ABSTRACT FROM AUTHOR]

Introduction: The presence of coronary artery disease (CAD) in patients who underwent transcatheter aortic valve implantation (TAVI) may increase in-hospital and long-term mortality. Aim: To evaluate the impact of CAD in patients who underwent TAVI. Material and methods: The study group consisted of the first 142 patients treated with TAVI between 26 November 2008 and 31 December 2015. The patients were divided into two groups: group I comprised 103 (72.5%) patients with CAD, and group II comprised 39 (27.5%) patients without CAD. Results: Group I was characterized by a significantly higher risk according to EuroSCORE - 11.2 ±2.5 vs. 9 ±2.3 in group II (p < 0.001) and Logistic EuroSCORE - 25.4 ±13.4 vs. 16.3 ±8.7 (p < 0.001). 30-day mortality was 8 (7.8%) vs. 2 (5.1%) (p = NS) and 1-year mortality was 22 (21.4%) vs. 6 (15.4%) (p = NS) in group I and II respectively. The composite endpoint evaluating the efficacy of TAVI was achieved in 82 (79.6%) vs. 31 (79.5%) (p = NS) in group I and II respectively. The composite endpoint, which involved 30-day observation, occurred in 39 (37.86%) vs. 12 (30.77%) (p = NS) and the composite endpoint, which involved 1-year evaluation of the clinical efficacy of TAVI, occurred in 48 (57.8%) vs. 13 (48.1%) (p = NS) in patients with and without CAD respectively. Conclusions: The short- and mid-term outcomes of TAVI patients with CAD, despite higher risk profile, did not differ from the outcomes of treatment in patients without CAD. [ABSTRACT FROM AUTHOR]

Introduction: Before the operation each cardiosurgery geriatric patient is assessed by the Vulnerable Elders-13 Survey (VES-13) and European System for Cardiac Operative Risk Evaluation (EuroSCORE) scales. Aim: To compare the applicability of the VES-13 and EuroSCORE scale in the assessment of postoperative risk among operated patients > 60 years old qualified most often for coronary artery bypass grafting. Material and methods: VES-13 is a questionnaire containing 13 questions, including patient's age and a health self-assessment. The EuroSCORE includes age, sex and cardiological assessment and vascular changes, respiratory diseases, neurological and nephrological disorders. In both scales the risk of death is high when the patient has > 6 points. The study included 100 patients = 60 (60.83 ±6.18) years old who were divided into subgroups with < 6 points and = 6 points. Results: The number of VES-13 points = 3.06 ±2.25, EuroSCORE = 5.50 ±3.19. In patients > 75 years old VES score was 4.32 ±2.6 vs. 2.707 ±2.02 and EuroSCORE 8.09 ±3.02 vs. 4.77 ±2.83. The most frequent postoperative complication was atrial fibrillation. The most frequent complications were the following: death (5%), delirium (3.64%), bleeding (3.54%), stroke (3.54%), renal failure (3.32%), pacemaker implantation (3.28%), difficult healing of the wound (2.64%), intestinal ischemia (2.56%). The correlation between the VES-13 and EuroSCORE was moderate. Conclusions: In cardiosurgery patients who obtained before the operation = 6 points on the VES-13 or EuroSCORE the risk of postoperative complications is high. VES-13 and EuroSCORE cannot be used interchangeably because the correlation is at a medium level. [ABSTRACT FROM AUTHOR]

Introduction: Off-pump coronary artery bypass grafting is considered potentially more effective than on-pump surgery in elderly patients. Aim: To compare the early and long-term results of these techniques in patients = 80 years of age with left main coronary artery disease. Material and methods: All patients = 80 years of age (N = 3648) who were reported to the Polish National Registry of Cardiac Surgery Procedures between 2006 and 2016 and underwent primary, isolated coronary artery bypass surgery were included in the study. The patients were divided into 2 groups: group A - without significant left main stenosis (LMS) (n = 2094) and B group - with LMS = 50% (n = 1524). The groups were compared according to the type of surgery: on-pump (A = 1107 vs. B = 891), off-pump (A = 908 vs. B = 616) and MIDCAB (A = 79 vs. B = 17). Results: There were significant differences in preoperative status between the groups in the whole cohort, which were not observable after propensity score matching. The in-hospital mortality was significantly higher in the LMS group operated on-pump (10.5% vs. 7.0%; p = 0.01) and non-significant in the off-pump group (5.1% vs. 5.7%; p = 0.78), as well as in the MIDCAB subgroup (5.9% vs. 5.1%; p = 0.64). 10-year survival in all subgroups was comparable and remained at a level of 50-60%. The mean entire cohort follow-up was 3.4 ±2.7 vs. 3.7 ±2.8 years (p = 0.2). Conclusions: Off-pump coronary bypass grafting may optimize the outcomes in elderly patients with significant left main stenosis. Octogenarians surgically treated for coronary artery disease, despite increased post-operative risks, present encouraging long-term survival. [ABSTRACT FROM AUTHOR]

Introduction: Cardiocyte myofibrillolysis and interstitial fibrosis belong to histopathological changes in cardiomyopathies, leading to heart failure. Aim: To evaluate these changes in apical resection during left ventricular assist device (LVAD) implantation. Material and methods: The studied group consisted of 40 patients with cardiomyopathy, and apical samples excised during left ventricular assist device implantation were studied (CM/ VAD group, mean: 48.1 ±10 y/o). A control group consisted of 6 apical samples from healthy heart graft donors (mean: 29 ±2.3 years old). Area fraction (AF) was calculated for: fibrosis, cardiocytes with myofibrillolysis (MFL), non-myofibrillolytic cardiocytes (non-MFL). Results: Single lymphocytes were seen in 18 (45%) cases in the CM/VAD group. Cardiomyopathy grade evaluated semiquantitatively in CM/VAD was: slight (25% of a group), moderate (35.5%), advanced (35.5%). CM/VAD cases showed nearly ten times higher fibrosis than the control group. The MFL cells occupied nearly a five times larger area in CM/VAD than in the control group, whereas non-MFL cells were found in the control group, as a predominant pattern. The linear regression calculated between fibrosis AF and types of cardiocytes indicated the depletion of cardiomyocytes with fibrosis increase. The control group presented insignificant dependency between fibrosis and MFL cells, suggesting the lack of replacement fi- brosis. Significant negative dependence between fibrosis and non-MFL cardiocytes suggested remodeling in controls. Correlation analysis showed a strong relation between depletion of normal cardiocytes and progression of fibrosis. Conclusions: Progression of cardiomyopathy and fibrosis depends on the loss of cardiocytes rather than degeneration of these cells. [ABSTRACT FROM AUTHOR]

Introduction: Minimally invasive mitral repair is less traumatic and more acceptable for the patient than traditional surgery. However, it is a challenging procedure that requires effort from all the personnel involved. Aim: To investigate the results of the minimally invasive mitral valve repair learning curve at the institution. Material and methods: The indication for the surgery was severe mitral regurgitation. Patients with other valvular insufficiency, body mass index (BMI) > 30 kg/m2, ejection fraction (EF) < 45%, aortic dilatation, reoperation, pleural adhesions, coronary artery disease requiring invasive treatment, and pregnant women were disqualified. The patients were assigned to one of three groups regarding their surgery date - group 1 (2012- 2013), group 2 (2014-2015) and group 3 (2016-2017). The primary endpoints were death, myocardial infarction, stroke, an reoperation for mitral dysfunction. The investigation was performed to determine preoperative parameters (EuroSCORE, age, sex, BMI, arrhythmias, EF), intraoperative parameters (procedure, cross-clamp, extracorporeal circulation), and postoperative parameters (chest revision, transfusion, drainage, ventilation time, pleurocentesis, hospitalization time). Results: There were 173 patients in total. One patient from group 1 (0.6% overall) died. No myocardial infarction or stroke was observed in any of the three groups. Chest revision count (5 vs. 1 vs. 1; p = 0.0004), total drainage (797.20 vs. 517.92 vs. 449.69; p = 0.0018) and hospitalization time (7.89 vs. 7.18 vs. 6.73; p = 0.0005) were significantly different among the groups. The ventilation time, transfusion number and pleurocentesis count did not differ significantly. Conclusions: The procedure is safe and ensures optimal perioperative results. The number of complications is low and acceptable.q [ABSTRACT FROM AUTHOR]

Objective: To compare the safety and efficacy of transcathether aortic valve-in-valve implantation (ViV-TAVI) in degenerated stentless bioprostheses with failed stented valves and degenerated native aortic valves.Introduction: Little is known about ViV-TAVI in degenerated stentless valves.Methods: Out of 45 ViV-TAVI procedures reported in the POL-TAVI registry, 20 failed stentless valves were compared with 25 stented prostheses and propensity-matched with 45 native TAVI cases. The mean follow-up was 633 (95% confidence interval [CI], 471-795) days and Valve Academic Research Consortium-2 (VARC-2) definitions were applied.Results: Patients with degenerated stentless valves were younger (65.6, CI 58-73.1 years vs 75.6, CI 72.2-78 [stented] vs 80.1, CI 78.7-81.6 y. [native], P < 0.001). Implantation was required later after surgery (11.5, CI 8-14.9 years) in the stentless cohort as compared with the stented one (6.2, CI 4.7-7.6 years, P = 0.006). ViV-TAVI in the stentless group was also associated with larger amount of contrast (211, CI 157-266 mL vs 135, CI 104-167 mL [stented] vs 132 (119-145) mL [native], P = 0.022). Using VARC-2 composite endpoints, ViV-TAVI in stentless prostheses was characterized by a lower device success (50% vs 76% in stented vs 88.9% in native TAVI, P < 0.001), but comparable early safety up to 30 days (73.7% vs 84% vs 81.8%, respectively, log-rank P = 0.667) and long-term clinical efficacy beyond 30 days (72.2% vs 72% vs 73.8%, respectively, log-rank P = 0.963).Conclusions: Despite technical challenges and a lower device success, ViV-TAVI in stentless aortic bioprostheses achieves similar safety, efficacy, and functional improvement as in stented or degenerated native valves. [ABSTRACT FROM AUTHOR]

Lung transplantation remains the only viable option for patients with end-stage lung diseases. However, due to an insufficient number of lung donors, many potential candidates die without undergoing the procedure. In the cases of some patients, bridges to transplantation can be implemented. One such method is extracorporeal membrane oxygenation (ECMO), which, depending on the type, has the ability to replace patients' circulatory and respiratory function. This case study describes 4 cases of patients, who were successfully bridged to lung transplantation. The first patient developed respiratory failure as a result of acute pulmonary embolisms. His respiratory function was insufficient and he had ECMO implanted for 84 days until he was transplanted. Another patient presented respiratory failure due to massive bleeding, which occurred during transbronchial lung biopsy. Such event led to extensive exacerbation, which resulted in using ECMO as a bridge to recovery at first, but later a bridge to lung transplantation. The patient became a lung graft recipient after 14 days on ECMO. The third patient was a woman who developed severe respiratory failure during the course of the progression of her underlying disease. She was treated with ECMO for 14 days as well, and she also underwent lung transplantation. The fourth patient was qualified for retransplantation. She was bridged to retransplantation via veno-venous ECMO. ECMO can be used a bridge to lung transplantation for suitable patients even for a long period of time, given that it is maintained in accordance with the guidelines. • This case series reports the first 4 successful cases of bridging to lung transplantation via extracorporeal membrane oxygenation in Poland. • As the experience of this lung transplant program grows, we are encouraged by results of the high-volume programs to continue this way of bridging to lung transplantation. • Extracorporeal membrane oxygenation should be carefully managed in accordance to the established guidelines in order to prevent complications. [ABSTRACT FROM AUTHOR]

The aim of the study was to investigate the serum concentration of cytokines (interleukin 6 [IL-6] and IL-10) in patients before and after lung transplantation (LTx). The studied groups consisted of 14 patients (9 men and 5 women aged 47.7 ± 11.4; body mass index [BMI] 21.9 ± 2.3) followed for up to 6 months after LTx and 29 patients (15 men and 14 women, age 49.2 ± 9.4; BMI 23.1 ± 3.7) who were considered for LTx. The study population consisted of patients with idiopathic lung disease (ILD; 8 vs 17) and patients with chronic obstructive pulmonary disease (COPD; 6 vs 12). Cytokine serum levels were assessed using commercially available enzyme-linked immunosorbent assay kits. Significantly lower levels of IL-10 were observed in the group of patients considered for LTx compared to those in recipients (1.8 ± 0.99 vs 5.1 ± 1.44; P =.000726). Significantly lower levels of IL-10 were observed in the group of patients with ILD considered for LTx compared to recipients (1.8 ± 0.95 vs 3.4 ± 1.16; P =.005984). There were no differences in levels of IL-10 in the group of patients with COPD. There were no differences in levels of IL-6 when the studied groups were compared. The present results introduce the cytokines IL-6 and IL-10 in patients before and after LTx. The procedure of LTx influenced increasing of plasma concentration of IL-10. Immunosuppressive drugs may affect IL-10 serum levels. Further studies are needed to evaluate whether analyzed cytokines could be used as biomarkers of clinical status in patients before and after LTx. • The analyzed cytokines might have a proinflammatory role in end-stage lung diseases. • The procedure of lung transplantation influenced increasing of plasma concentration of interleukin 10 (IL-10). • Immunosuppressive drugs may affect IL-10 serum levels. [ABSTRACT FROM AUTHOR]

Surgical treatment of severe aortic stenosis offers good early and long-term results, even in elderly patients. Despite the implementation of percutaneous methods for the very high-risk group, surgical valve replacement remains the gold standard. The advanced age of patients should not be the only indicator limiting the possibility of surgery. In this review we present the most important information on the results of aortic stenosis surgical treatment in the groups of older patients. New methods such as percutaneous and minimally invasive methods of surgery are also discussed. Additionally, the presented information is referred to current guidelines for the treatment of severe aortic stenosis. [ABSTRACT FROM AUTHOR]

Introduction: Heart transplant is an accepted treatment modality in end-stage heart failure. The graft coronary artery vasculopathy is a main concern to explain the heterogeneity of the rejection process according to the gender of the donor and recipient. Aim: To assess the severity and type of mechanisms leading to failure of the graft. Material and methods: Experimental allogenic heart transplantation in the abdomen was performed on Wistar rats depending on the gender of the donor and recipient (F - female; M - male) in four groups (FF, FM, MM MF). The donor heart was implanted in the abdominal cavity of the recipient. Complete time of observation was 10 weeks. Bromodeoxyuridine was administered intraperitoneally to detect proliferating cells. Results: There was 42.5% graft survival in all experiments. The mean time of graft survival was 60 ±18, 54 ±29, 58 ±23 and 64 ±18 days (FF, FM, MM and MF) and no significant difference was found in graft survival time among the four experimental groups (p = 0.73). None of the heart weight changes reached statistical significance. Conclusions: The use of an animal experimental model helps to understand the mechanisms leading to graft failure and to compare the changes that occur in rats to human hearts. The gender matching affects the survival of the transplanted heart and severity of the graft vasculopathy. [ABSTRACT FROM AUTHOR]

Introduction: High pulmonary vascular resistance (PVR) in orthotopic heart transplantation (OHT) candidates is a risk factor of right ventricle failure after the procedure. However, the increase of PVR may be a consequence of the life-threatening deterioration of the left ventricle function. The use of mechanical circulatory support (MCS) seems to be the best solution, but it is reimbursed only in active OHT candidates. Aim: We performed a retrospective analysis of MCS effectiveness in maintaining PVR at values accepted for OHT. Material and methods: Starting from the year 2008 we identified 6 patients (all males, 42.8 ±17 years old) with dilated (n = 3), ischemic (n = 2), and restrictive cardiomyopathy (n = 1) in whom MCS - pulsatile left ventricle assist device (LVAD, n = 4), continuous flow LVAD (n = 1), and pulsatile biventricular assist device (BIVAD, n = 1) - was used at a time when PVR was unacceptable for OHT, and the reversibility test with nitroprusside was negative. After an average time of support of 261 ±129 days they were all transplanted. Results: Right heart catheterization (RHC) results before MCS implantation were as follows: pulmonary artery systolic, diastolic, and mean pressure (PAPs/d/m) 60 ±20/28 ±7/40 ±11 mm Hg, pulmonary capillary wedge pressure (PCWP) 21 ±7 mm Hg, transpulmonary gradient (TPG) 19 ±7 mm Hg, cardiac output (CO) 3.6 ±0.8 l/min, PVR 5.7 ±2.1 Wood units (WU). Right heart catheterization results during MCS therapy were as follows: PAPs/d/s 27 ±11/12 ±4/17 ±6 mm Hg, PCWP 10 ±4 mm Hg, TPG 7 ±4 mm Hg, CO 5.1 ±0.7 l/min, PVR 1.4 ±0.6 WU. None of the patients experienced right ventricle failure after OHT with only one early loss due to multiorgan failure. Conclusions: Mechanical circulatory support is an effective method of pulmonary hypertension treatment for patients disqualified for OHT due to high PVR. [ABSTRACT FROM AUTHOR]

Introduction: Epiaortic ultrasound scanning (EAS) extended the use of ultrasound to the intraoperative diagnosis of aortic pathology. Surgical palpation of the ascending aorta underestimates the presence and severity of atherosclerotic plaques. Epiaortic ultrasound scanning has been used as an adjunct to transesophageal echocardiography (TEE) or as a primary direct diagnostic tool for imaging the ascending aorta as well as the aortic arch, which gained prominence as part of a multipronged intraoperative strategy to reduce atherosclerotic emboli. Aim: To compare the epiaortic examination with transthoracic and transesophageal echo (transthoracic echocardiography (TTE) and TEE), X-ray, surgical intraoperative palpation, and postoperative neurological status. Material and methods: The analyzed group consisted of 35 patients (mean age: 81.3 years) treated with aortic valve replacement (AVR), either alone (60%) or combined with coronary artery bypass grafting (CABG; 22.8%) or aortic aneurysm replacement (11.42%). In 2 patients, only CABG was performed because intraoperatively reevaluated strategy. Thierteen patients have got a history of diabetes, 10 chronic renal failure and 3 of cerebral stroke. Results: In more than 80% of patients, positive EAS results had an influence on the choice of aortic clamping site and in 50% of patients on the site of cannulation. Female sex, peripheral vascular disease, history of previous stroke, and calcifications in the ascending aorta in TTE have significant predictive value for recognizing atherosclerotic changes in EAS and the risk of postoperative neurological complications in octogenarians treated with AVR. Conclusions: Epiaortic ultrasound scanning imaging is superior to TTE and manual palpation in the detection and localization of ascending atherosclerosis. This technique should be introduced as a standard perioperative examination in older patients at risk of neurological complications. [ABSTRACT FROM AUTHOR]

Introduction: Hybrid ablation (HABL) of atrial fibrillation combining endoscopic, minimally invasive, closed chest epicardial ablation with endocardial CARTO-guided accuracy was introduced to overcome the limitations of current therapeutic options for patients with persistent (PSAF) and longstanding persistent atrial fibrillation (LSPAF). The purpose of this study was to evaluate the procedural safety and feasibility as well as effectiveness of HABL in patients with PSAF and LSPAF 1 year after the procedure.Material and Methods: The study is a single-center, prospective clinical registry. From 07/2009 to 12.2014, 90 patients with PSAF (n = 39) and LSPAF (n = 51), at the mean age of 54.8 ±9.8, in mean EHRA class 2.6, underwent HABL. 64.4% of patients had a history of prior cardioversion or catheter ablation. Thirteen patients had LVEF less than 35%. Mean AF duration was 4.5 ±3.7 years. Patients were scheduled for 3-, 6- and 12-month follow-up with 7-day Holter monitoring.Results: At 6 months after the procedure 78% (54/69) of patients were in SR. At 12 months after the procedure 86% (59/69) were in SR and 62.3% (43/69) in SR and off class I/III antiarrhythmic drugs (AADs). Only 1% (1/69) of patients required a repeat ablation for atrial flutter. A significant decrease in LA dimension and an increase in LVEF were noted.Conclusions: A combination of epicardial and endocardial RF ablation should be considered as a treatment option for patients with persistent and long-standing persistent atrial fibrillation as it is safe and effective in restoring sinus rhythm. [ABSTRACT FROM AUTHOR]

Introduction: Various modifications of standard endovascular aortic aneurysm repair (EVAR) have been developed to solve the problem of difficult neck anatomy. Aim: The authors propose the implantation of a predeployed extension cuff (kilt) using on-shelf Endurant II elements. In a vast majority of cases, the proposed method provides a solution for the hostile neck problem using standard Endurant II elements available in all centers performing subrenal EVAR procedures. Material and methods: The early outcomes of kilt implantation were evaluated in 11 patients (three with ruptured abdominal aortic aneurysms, one symptomatic) in 2 vascular centers in Silesia (Poland). All patients presented with hostile neck anatomy defined as neck length < 10 mm, diameter > 28 mm, angulation > 60°, mural thrombus or calcium > 2 mm in thickness or > 180° circumference. Results: No intraoperative type I endoleak or device migration was observed. Two perioperative deaths occurred in patients in a severe condition with ruptured aneurysms. One case of type III endoleak was managed by the implantation of an additional iliac extension with complete endoleak sealing. Conclusions: The proposed method seems to be effective in early endoleak prevention in patients with hostile neck anatomy undergoing EVAR procedures; however, studies with longterm follow-up are needed. [ABSTRACT FROM AUTHOR]

Introduction: Surgery is an extreme physiological stress for the elderly. Aging is inevitably associated with irreversible and progressive cellular degeneration. Patients above 75 years of age are characterized by impaired responses to operative stress and a very narrow safety margin. Aim: To evaluate perioperative complications in patients aged ≥ 75 years who underwent cardiac surgery in comparison to outcomes in younger patients. Material and methods: The study was conducted at the Silesian Centre for Heart Diseases in Zabrze in 2009-2014 after a standard of perioperative care in seniors was implemented to reduce complications, in particular to decrease the duration of mechanical ventilation and reduce postoperative delirium. The study group included 1446 patients. Results: The mean duration of mechanical ventilation was 13.8 h in patients aged ≥ 75 years and did not differ significantly compared to younger patients. In-hospital mortality among seniors was 3.8%, a value significantly higher than that observed among patients younger than 75 years of age. Patients aged ≥ 75 years undergoing cardiac surgery have significantly more concomitant conditions involving other organs, which affects treatment outcomes (duration of hospital stay, mortality). Conclusions: The implementation of a standard of perioperative care in this age group reduced the duration of mechanical ventilation and lowered the rate of postoperative delirium. [ABSTRACT FROM AUTHOR]

Aortic stenosis (AS) is the most common valvular heart disease in adults in Europe and North America. Management of AS patients depends on accurate diagnosis of the cause and stage of the disease process: the first and definitive therapeutic choice for a growing number of elderly patients with symptomatic AS is surgical treatment. In patients not eligible for surgery, transcatheter aortic valve implantation (TAVI) constitutes a safe and effective alternative. As an innovative, costly method of treatment, it requires however careful monitoring of its course, documenting its early and long-term results, and assessment of its safety and medical-economic cost-effectiveness. A medical registry seems to be an excellent tool to perform such analysis. The aim of this paper is to present the design and rationale for creation of the first National Cardiac-Cardiac Surgical Registry of Percutaneous Aortic Valve Treatment POL-TAVI, to describe its genesis and to highlight its key assumptions and aims. Despite its recent beginnings, the POL-TAVI Registry has already demonstrated its value and usability in monitoring and assessment of TAVI procedures, leading to further improvement and development of this new method in Poland. It constitutes an important and valuable tool for patients, the medical community and the payer. [ABSTRACT FROM AUTHOR]