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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., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2021 Termedia Sp. z o. o.)

Competing Interests: Authors report no conflict of interest.

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., Competing Interests: The authors declare no conflict of interest.

Transcatheter aortic valve implantation (TAVI) is still developing and changing our approach to treating patients with severe symptomatic aortic stenosis. Aortic stenosis frequently coexists with coronary artery disease. Both diseases have similar risk factors for their development and one should expect a future progression of coronary artery disease. The current guidelines have expanded TAVI indications to include intermediate-risk patients, and perhaps they will be expanded to include low-risk patients in the future. Survival after TAVI in younger patients will depend on the durability of the aortic valves and methods of coronary artery disease treatment. This paper presents some aspects of performing coronary angiography and percutaneous coronary intervention in patients who had TAVI performed using the two most popular aortic valves - balloon expandable aortic valves (Edward Sapien/Edward Sapien XT/Sapien 3) and self-expandable aortic valves (CoreValve/Evolut R) - on the basis of several examples. This paper also focuses on technical aspects associated with a proper implantation of aortic valves to ensure easy access to coronary arteries, as well as on possible problems when the implantation is not optimal. We discuss interactions between the structure of the aortic valve stent, catheters, commissures of new aortic valves, and coronary ostia., Competing Interests: Piotr Chodór is a Balton consultant and is an author of the patent application WO2018080328. The other authors declare no conflict of interest., (Copyright: © 2019 Termedia Sp. z o. o.)

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.

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.

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.

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.

Introduction: The proportion of valve repair procedures is increasing in experienced centers. The aim of the study was to assess the clinical and echocardiographic outcomes after aortic valve reconstruction with a novel surgical technique., Material and Methods: The study group consisted of 30 patients (23 male and 7 female) at a mean age of 35 ± 14 years. In patients with aortic root aneurysm the reimplantation or Florida sleeve technique was used. A sub-commissural annuloplasty, plication of the free edge of the cusp, shaving, and commissurotomy were performed. At this stage of surgery aortic repair was then attempted by cusp extension. Since 2013 the strips have been tailored from extracellular matrix., Results: The mean aortic cross-clamp time was 90 ± 32 min. The mean cardiopulmonary bypass time was 126 ± 38 min. There was no in-hospital death. Re-exploration for bleeding was required in 1 patient. During follow-up, 1 patient needed reoperation at 1 year due to endocarditis. All patients remained alive in New York Heart Association (NYHA) functional class I. The echocardiographic findings remained unchanged in all cases during follow-up., Conclusions: Our modification of aortic valve repair results in a good outcome.

The following paper presents a patient with severe aortic stenosis and severely reduced left ventricular ejection fraction with intra-aortic balloon pump counterpulsation support, who underwent transfemoral aortic valve implantation of a CoreValve prosthesis.

The frozen elephant trunk (FET) technique is a modification of the traditional elephant trunk method, which was introduced by Borst in 1983 in order to treat extensive thoracic aortic aneurysms. The crux of the new method is the different type of aortic prosthesis, consisting of a Dacron part (with or without branches leading to the arterial vessels which exit the aortic arch) and a port for extracorporeal circulation with a self-expanding nitinol stentgraft. This combination enables a complete one-stage treatment of the pathologies within the arch and the proximal segment of the descending aorta; moreover, it facilitates the performance of a two-stage hybrid treatment of extensive thoracic aortic aneurysms involving a significant part of the descending aorta. This article presents the cases of four patients with extensive aortic disease, who were implanted with Thoraflex prostheses (Vascutek, Scotland).

Cardiogenic shock (CS) remains the main cause of death in patients with myocardial infarction. Conservative treatment alone does not sufficiently improve prognosis. Mortality in CS can only be significantly reduced with revascularization, both surgical and percutaneous. However some patients present with haemodynamic instability despite optimal medical treatment and complete revascularization, resulting in very high mortality rates. These patients require the implementation of mechanical circulatory support in order to increase systemic blood flow, protect against organ hypoperfusion and protect the myocardium through a decrease in oxygen consumption. In contemporary interventional cardiology it seems that every operator should be aware of all available mechanical circulatory support methods for their patients. This article aims to present the current state of knowledge and technical possibilities in this area.