Search

Background: For over 40 years now orthotopic heart transplantation (OHT) has been the treatment of choice in patients with advanced heart failure. For many years patients undergoing OHT have been treated with the classical approach involving anastomosis of the donor atria with the recipient atria resulting in a heart in which the atria are enlarged. An alternative method for OHT is the bicaval anastomosis technique, which involves connecting both of the donor's venae cavae with the recipient's venae cavae., Aim: To assess left ventricular (LV) filling in patients undergoing OHT using the classical (biatrial) versus bicaval approach., Methods: We analysed 60 patients who had undergone OHT between 1 and 36 months before. Myocardial biopsy at echocardiography revealed grade 0 or 1A rejection in all the patients. All the patients were also in NYHA functional class I. The patients were divided in two groups: patients who had undergone biatrial anastomosis (Group 1, n = 40) and patients who had undergone bicaval OHT (Group 2, n = 20). In order to render the results independent of pre-OHT blood pressure values in the pulmonary circulation we assessed the values of right ventricular systolic pressure (RVSP), mean pulmonary artery pressure (PAP) and transpulmonary gradient (TPG) in all the patients before OHT. We assessed the following echocardiographic parameters: peak early filling velocity (E-wave), peak atrial filling velocity (A-wave), E-wave deceleration time, early diastolic mitral valve ring motion velocity (E'), E/E', isovolumetric relaxation time of the LV, duration of the A-wave, right atrial area and left atrial area, LV mass, LV mass index, LV end-diastolic and end-systolic dimension, and the severity of tricuspid regurgitation (TR)., Results: The values of RVSP, PAP and TPG in the study groups before OHT did not differ significantly. The values of E (86.5 ± 12.5 vs. 67.3 ± 8.5; p < 0.001), E' (11.9 ± 1.1 vs. 10.9 ± 0.9; p = 0.003) and E/E' (7.4 ± 1.5 vs. 6.1 ± 0.85; p = 0.006) differed between the groups and were significantly higher in the group undergoing surgery using the biatrial approach. The duration of the A-wave was significantly longer in the group undergoing surgery using the bicaval approach (129.0 ± 5.1 vs. 136.7 ± 10.0; p = 0.001). There were no significant differences in the other parameters of LV filling. Right atrial area was significantly lower in the group undergoing surgery using the bicaval approach (19.2 ± 3.0 vs. 14.0 ± 2.0; p < 0.001). LV size, LV mass and LV mass index did not differ significantly between the groups. The lack of TR was more commonly observed in the group undergoing surgery using the bicaval approach at the limit of p = 0.05. Pacemaker implantation was required in 12 (30%) patients from the group undergoing surgery using the classical method and 2 (10%) patients from the group undergoing OHT using the bicaval approach (p = 0.04)., Conclusions: Certain echocardiographic parameters suggest a better LV filling in patients undergoing OHT using the bicaval approach. Preservation of the right atrial geometry in patients undergoing OHT using the bicaval approach plays an important role in LV filling.

Background: Cardiogenic shock (CS) affects the prognosis in patients with myocardial infarction (MI). An additional factor affecting the prognosis is diabetes mellitus (DM)., Aim: To evaluate the impact of DM on in-hospital and long-term mortality in patients with MI complicated by CS, who were included in the Polish Registry of Acute Coronary Syndromes (PL-ACS). We also sought to demonstrate a relationship between treatment method and mortality in this group., Methods: 71,290 consecutive patients with non-ST elevation MI (NSTEMI; 33,392) and ST elevation MI (STEMI; 37,898) were included in the PL-ACS register. CS was diagnosed on admission in 4,144 patients. This group included 1,159 patients with DM., Results: The patients with DM were older, more frequently female and more frequently presented with hypertension, hypercholesterolaemia, obesity, suffered from multivessel coronary disease significantly more frequently (76.4% vs. 64.6%; p = 0.00003) and had lower coronary angioplasty efficacy (TIMI 3 flow) (67% vs. 75.8%; p = 0.001) compared to patients without DM. The mortality rate comparisons for patients with DM vs. those without DM, respectively, were as follows: inhospital mortality, 61.4% vs. 55.9%; p = 0.001 (revascularisation treatment: 45.7% vs. 39.5%; p = 0.03, conservative treatment: 69.3% vs. 64.6%; p = 0.02) and 3-year mortality 78.6% vs. 70.7%; p 〈 0.0001 (revascularisation treatment: 64.7% vs. 55.0%; p = 0.001, conservative treatment: 85.5% vs. 79.2%; p = 0.0001). In the multivariate analysis, DM was, with borderline statistical significance, an independent predictor of higher in-hospital mortality (OR = 1.16; 95% CI 1.00-1.35; p = 0.054] and 3-year mortality (HR = 1.11; 95% CI 1.02-1.20; p = 0.01). Interestingly, after excluding patients who died in the hospital, DM was still associated with significantly higher 3-year mortality (50.1% vs. 40.0%; p 〈 0.0001). Multivariate analysis revealed that DM was still an independent risk factor for higher 3-year mortality (HR = 1.21; 95% CI 1.04-1.41; p = 0.02)., Conclusions: Diabetes is associated with higher in-hospital and long-term mortality in patients with MI complicated by CS. Revascularisation treatment, compared to conservative treatment, reduces mortality in this group of patients.

The concept of hybrid room is to combine capabilities of cardiosurgery operating room and fully equipped cathlab. Since May 2011, an ultramodern hybrid room has been working, in our center. The cases reported in this article show the possibilities of cooperation of cardiosurgeons, anaesthesiologists and invasive cardiologists in performing difficult, complex cardiovascular interventions. In near future the capabilities of hybrid room will allow to perform simultaneously a number of complex cardiovascular procedures. It should not only shorten the time of hospitalisation but also substantially improve the patients comfort.

Background: The concept of a hybrid approach, combining the most effective techniques of surgical and endocardial catheter ablation has resulted in the creation of the convergent ablation procedure. This novel, pericardioscopic, hybrid approach can be an effective option for highly symptomatic patients with persistent atrial fibrillation (PSAF) and longstanding persistent atrial fibrillation (LSPAF) for whom standalone surgical or endocardial ablation procedures offer sometimes unsatisfactory outcomes., Aim: To assess the safety, efficacy and effectiveness of a hybrid epicardial and endocardial radiofrequency ablation for the treatment of PSAF and LSPAF., Methods: Single-centre, prospective, non-randomised clinical study. Between August 2009 and December 2011, 27 patients with PSAF (n = 5) and LSPAF (n = 22) underwent hybrid ablation (HABL). Mean age was 52.52 ± 11.27 years, and the mean EHRA class was 2.5; 14 (51.8%) patients had a history of electrical cardioversion (n = 6) or catheter ablation (n = 8). Five patients had left ventricular ejection fraction (LVEF) of less than 35%. Mean AF duration for all patients was 3.46 ± 2.5 years. All patients were on antiarrhythmic drugs (AAD) and oral anticoagulation. Patients were scheduled for three, six and 12 month follow-up with seven day Holters, REVEAL® XT and ECHO measurements., Results: The HABL procedure was feasible in all patients. At six months post procedure, 72.2% (13/18) of patients were in SR, and 66.5% (12/18) were off class I/III AADs. Four patients were in AF and one patient developed right atrial flutter. At one year post procedure, 80% (8/10) of patients were in SR and off class I/III AADs. At two year post procedure, 100% (6/6) of patients were in SR and off class I/III AADs. Rapid change in left ventricular function was noted in patients with low LVEF (≤ 35%) prior to the procedure. Patients with LVEF +40% had less apparent improvement., Conclusions: Hybrid, epicardial and endocardial, radiofrequency ablation is feasible and safe, effectively restoring sinus rhythm in the vast majority of patients with PSAF and LSPAF.

Background: Major vessel stenoses are currently successfully treated with stent implantation. Recently, new cobalt-chromium stents (Andrastents XL and XXL, Andramed, Germany) have been introduced into clinical practice. This alloy combines high biocompatibility with radial strength and flexibility., Aim: To present our experience with the use of Andrastents XL and XXL for the dilatation of stenosed pulmonary arteries, coarctation of the aorta (CoA), and a stenosed superior vena cava (SVC)., Methods: The study group included 24 patients treated with 26 Andrastents. In 7 patients aged 23.3 (range 18-27) years, with the mean body weight of 64.7 (range 50-77) kg, prestenting of a calcified pulmonary homograft was performed using 9 Andrastents XL or XXL (length of 30, 39, or 48 mm) before the Melody valve implantation. In one patient with a long and stiff stenosis, 3 stents were necessary. In 12 patients with native CoA aged 30.1 (range 9-55) years, with the mean body weight of 60 (range 25-105) kg, twelve Andrastents XL or XXL (length of 30, 39, or 48 mm) were implanted. In 4 patients with the right or left pulmonary artery stenosis close to the bifurcation (age 8.5 [range 6-10] years, body weight 27.3 [range 17-33] kg), 4 Andrastents 30 XL were implanted. In one child (age 7.5 years, body weight 21.7 kg) with a iatrogenic SVC stenosis (after 2 venous cannulations necessary for 2 surgical corrections of his double-outlet right ventricle), the stenosed site was dilated using Andrastent 21 XL., Results: All procedures were performed successfully. No stent fractures were observed during the follow-up. The mean pressure gradient was reduced from 42.4 to 18 mm Hg (RVOT) in patients who underwent Andrastent and Melody valve implantation, from 54.1 to 13.2 mm Hg in patients with CoA, and from 49 to 21.7 mm Hg in patients with pulmonary artery stenosis. No aneurysm formation, stent migration, or rupture of the treated vessel during stent implantation were observed in any patient. The mean fluoroscopy time during stent implanatation was 6.6 min in CoA, 8.8 min in pulmonary artery stenosis, 24.8 min during implantation of Melody valve (with prestenting of RVOT with Andrastents) and 17.6 min during SVC dilation. Procedural outcomes (evaluated using noninvasive methods) remained favourable during the follow-up (0.5-21 months), with no complications observed., Conclusions: Implantation of Andrastents XL or XXL is a very good therapeutic option in the treatment of major vessel stenoses.

Background: Hybrid coronary artery revascularisation (HCR) is a combination of minimally invasive left internal mammary artery bypass grafting to the left anterior descending artery (LAD) and percutaneous coronary interventions (PCI) with drug eluting stent implantation to other coronary arteries. Due to the paucity of data from large, prospective randomised trials comparing HCR to standard surgical revascularisation, the POLMIDES study has been designed to assess the safety and efficacy of HCR in patients with multivessel coronary artery disease (CAD) referred for standard coronary artery bypass grafting (CABG)., Aim: The primary objective is evaluating the feasibility and safety of HCR., Methods: Feasibility has been defined by means of the percentage of patients with a complete hybrid procedure according to the study protocol and a percentage of conversion to standard CABG. Safety has been defined as the occurrence of major adverse cardiac events such as death, myocardial infarction, stroke, repeat revascularisation and major bleeding within the 12 month period after randomisation. All consecutive patients with angiographically confirmed multivessel CAD involving LAD and a critical (> 70%) lesion in at least one major epicardial vessel (except LAD) amenable to both PCI and CABG referred for conventional surgical revascularisation, will be randomised in a 1:1 fashion for HCR or standard surgical revascularisation., Conclusions: The POLMIDES is a prospective, randomised pilot trial designed to determine whether HCR in patients with multivessel CAD referred for conventional CABG is safe, feasible and efficacious (ClinicalTrials.gov number, NCT01035567). Kardiol Pol 2011; 69, 5: 460-466.

A large fistula from the left coronary artery to the right ventricle was successfully closed percutaneously in a 40 year-old patient using a patent ductus arteriosus occluder. The device was positioned and deployed via the venous system using a guidewire that had been advanced via the aorta, coronary artery and fistula to the venous circulation (arterio-venous loop creation). No complications were reported at follow-up.

Background: A substantial progress has been made in Poland in the field of acute coronary syndromes (ACS) management over the last 10 years., Aim: To present the data from the Polish Registry of Acute Coronary Syndromes (PL-ACS) collected between 2003 and 2009. Changes in treatment strategies and outcomes in ST-segment myocardial infarction (STEMI) were analysed., Methods: We analysed patients enrolled to the PL-ACS Registry - a nationwide multicenter, prospective observational study of consecutive patients hospitalised with ACS in Poland., Results: Overall, 284,162 patients with ACS were enrolled in 512 centres including 88 invasive cardiology centres. The STEMI was diagnosed in 35-36% of these patients in 2003-2005, and this proportion remained stable at 30% to 32% in 2006-2009. The mean age of STEMI patients increased from 62.5 years in 2003 to 64.5 in 2009. During this period, women represented 32.7% to 34.6% of the STEMI patients. Proportion of patients presenting with pulmonary oedema or cardiogenic shock decreased with time, from 15.5% in 2003 to 8% in 2009. Delays to reperfusion tended to reduce over time: pain-to- -admission time was 240 min in 2005 and 229 min in 2009 and door-to-balloon time was 32 and 25 min in 2005 and 2009, respectively, with the delay being longer in the elderly population. The proportion of patients undergoing coronary angiography showed a constant increase, from 55% in 2003 to 84% in 2009. Percutaneous coronary intervention was performed in 51% and 78% of patients in 2003 and 2009, respectively. At the same time, the proportion of patients undergoing thrombolysis declined from 14% to 1%. Aspirin, beta-blocker, statin and ACE inhibitor use was constantly high, while nitrate use declined from 82% to 15%. The proportion of patients receiving clopidogrel increased from 40% to 97% over the analysed period. Significant reductions in mortality rates were observed: in-hospital mortality decreased from 11.9% to 6.4%; 30-day mortality from 13.5% to 9.6%; and 12-month mortality from 19.8% to 15.4% in 2003 and 2009, respectively. Invasive treatment strategy was associated with better in-hospital and long-term patient survival., Conclusions: The PL-ACS Registry results demonstrate low short- and long-term mortality rates in STEMI patients, mainly due to frequent use of interventional strategy, satisfactory logistics and appropriate drug therapy used. As a consequence, hospitalisation time has shortened. However, there are several issues that need to be improved such as shortening of pre- -hospital delays and increasing the rate of invasive treatment in patients presenting with cardiogenic shock.

Background: Multivessel coronary disease (MVD) occurs in approximately 40-65% of patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI), and is associated with significantly increased morbidity and mortality rates., Aim: To evaluate the impact of MVD on in-hospital and long-term clinical outcomes in patients with STEMI and PCI, and to compare these results with those from a group of patients with a single coronary vessel disease (SVD)., Methods: Consecutive patients with STEMI treated with PCI were included in the analysis. Patients were divided into two groups: patients with SVD (n = 828, 46.6%) and patients with MVD (n = 948, 53.4%). Clinical follow-up was performed at 12 months, and five-year mortality was assessed. Major adverse cardiac events (MACE) at 12-month follow-up were defined as death (from any cause), stroke, need for percutaneous or any surgical coronary artery revascularisation, and non-fatal myocardial infarction., Results: The in-hospital mortality was 2.9% vs 9.5% (p < 0.0001) and the five-year mortality was 11.9% vs 23.8% (p < 0.0001), for SVD vs MVD patients, respectively. The cumulative incidence of MACE during 12-month follow-up was significantly higher in patients with MVD (32.5% vs 14.5%, p 〈 0.0001). Moreover, multivariate analysis revealed that after a correction for baseline differences, the presence of MVD was a strong and independent predictor for five-year mortality in patients treated with PCI (hazard ratio 1.45, 95% confidence interval 1.13-1.88, p = 0.004)., Conclusions: The presence of MVD in patients with STEMI is a strong and independent risk factor for higher long-term mortality.

Percutaneous epicardial catheter ablation of ventricular tachycardia (VT) is used when ablation by a conventional endocardial access has been unsuccessful. In patients after cardiac surgery operations, due to high risk, an open chest approach for ablation is usually used. We report a case of 66 year-old man after bypass surgery operation admitted to the hospital with incessant VT, which was successfully ablated from the epicardial aspect achieved by subxyphoidal approach.

We report the case of a 49 year-old-man with congenital coarctation of the aorta (CoA), admitted in a critical clinical condition due to advanced secondary cardiomyopathy and chronic heart failure. An Andrastent XL was implanted successfully in the CoA. The procedure resulted in an almost completely resolved CoA and prompt clinical improvement in the patient.

Pandemic influenza particularly often is associated with symptoms of acute respiratory failure, and in case of refractory hypoxemia patients may have indications for the extracorporeal membrane oxygenation (ECMO). The paper presents a case of a pandemic influenza virus infection, where classical indications for veno-venous ECMO occured. Practical aspects of this kind of treatment in the intensive care unit are discussed.

According to current guidelines surgical revascularisation is a gold standard of treatment in patients with multivessel and left main coronary disease. Hybrid revascularisation, in two stages: first - minimally invasive direct coronary artery bypass grafting procedure with left internal mammary artery conduit to left anterior descending artery and second stage - percutaneus coronary intervention with drug eluting stent in non-left anterior descending vessels may be safe and effective alternative in patients with multivessel and left main coronary disease.

Chronic thromboembolic pulmonary hypertension (CTEPH) can be defined as pulmonary hypertension with persistent pulmonary perfusion defects causes by unresolved thrombi. All symptomatic CTEPH patients with documented pulmonary vascular resistance > 300 dyn*sec*cm(-5) and proximal lesions should be considered for surgical treatment--pulmonary endarterectomy. The role of pharmacological treatment remains controversial and should be restricted to inoperable cases and persistent pulmonary hypertension after pulmonary endarterectomy. Every year about 30 procedures is performed in two specialised centers in Poland with 1 year mortality at 8-9%. Number of procedures done gives the frequency of pulmonary endarterectomy at 0.7/million of population/year. Current data from UK indicate the actual ratio of surgical treatment of CTPH at 2/million/year. The article discusses reasons for CTEPH is underdiagnosed and why rate of surgical therapy in Poland is too low.

Background: severe symptomatic aortic valve stenosis is an unequivocal indication for surgical valve replacement, assuring symptoms relief and increasing survival. About one third of elderly patients is not being operated due to, among others, high peri-procedural risk and comorbidities. Transcatheter aortic valve implantation (TAVI) has recently become a valuable therapeutic option for these patients., Aim: to present early results of first TAVI Edwards-Sapien procedures in our hospital, performed in symptomatic patients with high operational risk or other contraindications for conventional surgery, as well as the results of 6-month follow-up., Method: twelve patients referred for TAVI were included in the analysis. The valve was implanted in 11 patients and in 1 patient the procedure was finished with aortic valve valvuloplasty. Eight (72.7%) patients underwent transapical (TA) and 3 (27.3%) patients transfemoral (TF) TAVI. Seven (63.6%) 26 mm valves and 4 (34.4%) 23 mm valves were implanted., Results: the efficacy of the procedure was 92%: 100% in the TA group, and 75% in the TF group. During the procedure 1 patient developed ventricular fibrillation. Atrial fibrillation and right ventricle perforation by the endocavitary electrode was observed in another patient. Prolonged wound healing occurred in 4 patients and contrast-induced renal failure occurred in 2 patients. There were no deaths at 30-days. Two patients had a pacemaker implanted during hospitalisation. A significant improvement of echocardiographic parameters was observed: maximum gradient across the aortic valve was 104.4 ± 23.9 mm Hg before vs 25.2 ± 6.1 mm Hg after the intervention, p = 0.000001, mean gradient - 63.8 ± 18.3 vs 12.7 ± 3.7 mm Hg, p = 0.000004, and valvular surface - 0.7 ± 0.2 vs 1.5 ± 0.2 cm2, p = 0.000106, respectively. During the 6-month follow-up period 1 patient died of multiorgan failure and 6 patients required another hospitalisation. After 6 months an improvement in physical capacity was observed in all but one patients (NYHA II - 9 patients, NYHA III - 1 patient)., Conclusions: 1. The authors' initial experiences with TAVI Edwards-Sapien procedure confirm its efficacy and safety in patients with symptomatic aortic stenosis and high surgical risk. 2. Echocardiographic parameters of the implanted valves, assessed during hospitalisation and 6 month later, are satisfactory. 3. Due to the risk of complications, patients require careful observation in the postoperative period and during short-term follow-up.

The authors present the results of minimally invasive transvascular reduction of severe mitral insufficiency in the first three patients with extensive postinfarction cardiac injury treated in Poland. The positive early in-hospital outcomes in the first three patients encourage further implementation of this treatment method in patients with postinfarction cardiomyopathy and high perioperative risk.