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Aortic stenosis (AS) is the most common acquired valvular disease. There are two methods of interventional treatment: surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI). The choice between SAVR and TAVI depends on the assessment of individual perioperative risk and long-term treatment outcomes. It is essential to identify factors that may influence the outcomes of the treatment to minimize their negative effects.The study aimed to identify the most important risk factor which affects treatment outcomes in patients with AS undergoing SAVR/TAVI.This study reviewed retrospectively patients with AS who underwent SAVR or TAVI. The primary outcomes included incidences of major adverse cardiovascular events (MACE) defined as cardiovascular death, stroke, and hospitalization for cardiovascular issues assessed over a one-year follow-up period. An occurrence of postprocedural AKI (acute kidney injury) was identified as an independent predictor of MACE.The study included 78 patients, with the same number of subjects in each group (SAVR/TAVI [n = 39]). Twenty-nine patients developed AKI. It was similar in both groups (SAVR [n = 15]; TAVR [n = 14]). In the SAVR group, 13 (33%) patients developed at least one MACE compared to 5 (13%) patients in the TAVI group. AKI and the type of procedure (SAVR) were shown to be significantly and independently associated with the development of MACE (P = 0.01 and P = 0.03, respectively) as shown in the Cox multivariable regression model.Our study demonstrated that AKI is the strongest predictor of major adverse cardiovascular events after using both methods of aortic valve replacement (SAVR/TAVI).

The left internal thoracic artery to the left anterior descending artery graft is recognized as the gold standard for coronary revascularization. We compared quality of life (QoL) in patients who received bilateral internal thoracic arteries (BITA) and those with a single internal thoracic artery (SITA) graft.To assess QoL during a 10-year follow-up in patients who underwent coronary artery bypass grafting (CABG) with BITA vs. SITA.We recruited 300 patients with multivessel coronary artery disease who underwent CABG from January 2005 to October 2010. Mean duration (standard deviation - SD) of follow-up was 3568 ±409 days. QoL was measured subjectively using a Likert scale and objectively by the WHOQOL-BREF questionnaire. Patients were interviewed by telephone.BITA patients reported marked improvement and improvement more often than SITA patients (58% vs. 43.3%,Surgical coronary revascularization using BITA improves QoL, particularly when measured by a Likert scale.Zespolenie pomiędzy lewą tętnicą piersiową wewnętrzną a tętnicą przednią zstępującą lewą stało się złotym standardem w rewaskularyzacji naczyń wieńcowych. Porównaliśmy jakość życia pacjentów (QoL), którzy otrzymali dwie tętnice piersiowe wewnętrzne (BITA), z pacjentami z jedną tętnicą piersiową wewnętrzną (SITA).Ocena jakości życia pacjentów z jedną vs dwoma tętnicami piersiowymi wewnętrznymi po 10-letnim okresie od zabiegu pomostowania aortalno-wieńcowego (CABG).Do badania włączono 300 pacjentów, u których przeprowadzono CABG od stycznia 2005 do października 2010 r. Średni czas obserwacji wyniósł 3568 ±409 dni. Pacjentów oceniano subiektywnie przy zastosowaniu skali Likerta i obiektywnie, wykorzystując kwestionariusz WHOQOL-BREF, podczas rozmowy telefonicznej.Znacznie lepsza QoL wystąpiła stosunkowo częściej u pcjentów z BITA w porównaniu z SITA (58% vs 43,3%,Rewaskularyzacja z użyciem BITA zwiększa QoL, zwłaszcza gdy jest ona mierzona za pomocą skali Likerta.

Introduction: Angiographically visible plaques in patent vein grafts are usually detected years after surgery. Our aim was to examine early plaque formation in vein grafts. Methods: Bypass angiography and intravascular ultrasonography (IVUS) examination were performed on 77 aortocoronary saphenous vein grafts (SVGs) implanted in 36 patients during the first 2 years after CABG. In each graft, a good quality 25 mm ultrasound image was analyzed. We measured: plaque area, lumen area, external elastic membrane (EEM) area, graft area and wall area. For the comparative assessment of SVGs, the index plaque area/EEM area was calculated. Data were analyzed for the following 4 time periods: I – 0-4 months (22 grafts), II – 5-8 months (23 grafts), III – 9-12 months (19 grafts) and IV – 13-16 months (13 grafts) after CABG. Student’s t and Fisher-Snedecor tests were used for the purpose of statistical analysis in this retrospective study. Results: In period I, plaque formation (neointimal) was observed in 10 grafts (45%), with a mean plaque area of 1.59 mm., in 6 grafts (26%) in period II, with a mean plaque area of 1.03 mm. and in 15 grafts (71%) in period III, with a mean plaque area of 1.41 mm., and in all (100%) grafts in period IV, with mean plaque area of 2,3 mm.. Average index plaque area/EEM area in periods I, II, III and IV were 0.12, 0.08, 0.13 and 0.22. We have showed a significant plaque increase between periods II and IV(P=0.038). Conclusion: IVUS showed plaque in about 40% of venous grafts during the first year after CABG. Between 13-16 months plaque was visible in all studied grafts.

Surgical ablation for atrial fibrillation (AF) performed at the time of other valvular- or nonvalvular cardiac procedure is a mainstay of therapy; yet the data regarding its influence on remote survival are sparse. We aimed to evaluate late survival in patients undergoing mitral valve (MV) surgery with concomitant surgical ablation for AF.Procedure-related data from the Polish National Registry of Cardiac Surgery Procedures (Krajowy Rejestr Operacji Kardiochirurgicznych) were retrospectively collected. A total of 11,381 patients with baseline AF (46.6% men; mean age 65.6 ± 9.0 years) undergoing MV surgery between 2006 and 2017 in 37 reference centers across Poland and included in the registry were analyzed. Median follow-up was 5 years (mean, 4.6 years; interquartile range, 1.9-7.9 years). Cox proportional hazards models were used for computations. Propensity score matching for the comparison of MV + ablation versus MV alone was performed.Of included patients, 2449 (21.5%) underwent surgical ablation for AF. Patients in this group were significantly younger (63.8 ± 8.7 years vs 66.1 ± 9.0 years; P .001) and were at lower baseline surgical risk (EuroSCORE, 2.86 vs 3.69; P .001). During the 12-year study period, there was a significant survival benefit (hazard ratio, 0.71; 95% confidence interval, 0.63-0.79; P .001) for MV + ablation compared with MV alone. After rigorous propensity matching (logit model, 1784 pairs) surgical ablation was associated with nearly 20% improved survival (hazard ratio, 0.82; 95% confidence interval, 0.70-0.96; P = .011). Benefit of surgical ablation was maintained in subgroup analyses, yet most benefit was appraised in low-risk patients such as those with EuroSCORE of 2 to 5 or age 50 years.Concomitant surgical ablation for AF in patients undergoing mitral valve procedures is safe, feasible, and significantly improves late survival.

OBJECTIVES The study aimed to assess the magnitude and determinants of perioperative blood pressure (BP) variability in patients undergoing coronary artery bypass grafting (CABG) with the use of extracorporeal circulation (ECC). METHODS Two hundred patients were enrolled, 41 women (21%) and 159 men (79%), aged 6 1± 8 years. A direct method of intraoperative BP measurement was used with a cannula placed in the radial artery, and BP was recorded at intervals of 5 min at three stages of the CABG: from cannula placement to the start of ECC, during ECC, and post-ECC until the transfer of patient to the postoperative room. BP variability was assessed using coefficient of variation (in percentage) for systolic, diastolic, mean, and pulse pressures. Impact of sex, age, and comorbidities was determined. RESULTS Greater changes in BP during CABG were observed in diastolic BP (4/19%) than in systolic BP (11/15%) and the greatest BP variability was associated with pulse pressure (20/72%). The greatest variability of BP parameters was found during ECC (15/72%). Higher BP lability was found in women (13/83%), younger patients (11/78%), and those without diabetes (11/78%), hypertension (11/82%), or obesity (11/71%), and smoking habit increased the variability during CABG (11/89%). All trends were similar for all types of BP. CONCLUSION Special attention in perioperative anesthetic management should be given not only to elder patients with many comorbid conditions, but also to younger and healthier participants because the latter are characterized by greater variations of BP during CABG.

Background: Systolic dyssynchrony is present in a considerable number of patients with heart failure (HF) undergoing coronary artery bypass grafting (CABG). Surgical revascularization offers an optimal setting for totally epicardial cardiac resynchronization therapy (CRT) system implantation. Aim: To assess the efficacy of totally epicardial CRT implantation during CABG, in patients with HF. Methods: Twenty three patients with HF and dyssynchrony underwent totally epicardial CRT system implantation during CABG. This randomised, single-blind, cross-over study compared clinical and echocardiographic parameters during two periods: 3 months of active CRT (CRT+) and 3 months of inactive CRT (CRT−) pacing. Results: Twenty two patients underwent randomisation and completed both study periods. In the CRT+ group more patients improved by two NYHA classes (p=0.028), had a longer 6-minute walk test distance (p=0.047) and better quality of life (p=0.003) compared with the CRT− group. Echocardiography revealed an improved LV ejection fraction (p

INTRODUCTION: The main limitation of coronary artery bypass grafting (CABG) is rapid neointimal hyperplasia leading to graft failure.AIM: To assess plaque formation in saphenous vein grafts (SVG) covered by an external Dacron stent in comparison with the classical technique.MATERIAL AND METHODS: In the study group vein grafts covered by external stent mesh made of Dacron were implanted. An intravascular ultrasonography (IVUS) study was performed in 35 aorto-coronary SVG covered by an external Dacron stent and in 64 normal SVG during the first year after CABG. In each SVG 25 mm of good quality IVUS image, volumes of lumen, plaque (neointima), outer border of the vein graft (external SVG) and adventitia were calculated in three time periods: 0-130 days, 130-260 days and 260-390 days.RESULTS: Between the first and second time period, lumen volume (mm3) was reduced from 10.33 ±4.4, to 6.80 ±2.23 in the second period and 5.69 ±1.26 in the third one. This effect was much less marked in normal grafts. The corresponding lumen volume (mm3) was: 10.90 ±3.9, 9.15 ±2.94 and 8.92 ±2.93 in consecutive time periods. Plaque volume (mm3) did not change in control grafts during the course of the study, but it increased very significantly in stented grafts from 0.86 ±1.24 in the first period to 2.70 ±1.58 in the second and 3.29 ±2.66 in the third one.CONCLUSIONS: The experimental technique of implanting SVG covered with an external elastic Dacron stent seems to be inferior to traditional ones. This is probably due to the more complicated process of vein implantation and higher micro-injury occurrence during the surgery.

Objective: The saphenous vein subjected to arterial pressure stretches to its elastic limits and constitutes intimal hyperplasia. Sheathing of the vein graft with pressure-resistant tubing might prolong vein graft patency. Methods: Twenty-one sheep received radial vein grafts or hybrid grafts composed of radial vein, collagen fibrin glue and highly flexible torlen/dacron mesh tubing transplanted into the carotid artery position. Veins were examined with the use of light and electron microscopy. Proliferating cell antigen (Ki-67) stains served as markers of proliferation. Results: The mean wall thickness of both intimal and medial layers was evaluated. The mean intimal wall thickness was 19 ^ 11 mm in hybrid grafts vs. 24 ^ 7 mm in unsheathed grafts (P , 0:001); 22 ^ 6 vs. 26 ^ 10 m m( P , 0:001); 23 ^ 8 vs. 52 ^ 15 mm (P , 0:001); 37 ^ 21 vs. 90 ^ 31 m m( P , 0:001); 57 ^ 31 vs. 104 ^ 28 m m( P , 0:001); 58 ^ 21 vs. 133 ^ 32 m m( P , 0:001); and 72 ^ 22 vs. 244 ^ 100 m m( P , 0:001) after respectively 5 days, 9 days, 4 weeks, 6 weeks, 8 weeks, 10 weeks and 12 weeks from implantation. Electronic microscope examination of hybrid grafts revealed a smooth endothelial layer with intact nuclei and an intima composed of layers of collagen and muscle fibers. In unsheathed grafts endothelial edema and nuclear destruction were observed. Conclusions: The external vein graft support with mesh tubing reduces intimal and medial layer thickening and cell proliferation in composite vein grafts transplanted in the arterial position. q 2002 Elsevier Science B.V. All rights reserved.

Conflict of interest: none declared Figure 1. Fluoroscopy and echocardiography; A. Severe aortic bioprosthesis stenosis; B. Corevalve positioned at bioprosthesis level. Visible bioprosthetic ring (white arrow); C. Partially released Corevalve prosthesis (white arrow). Inappropriate position over bioprosthetic ring; D. Recaptured Corevalve prosthesis; E. Early phase of second deployment; F. Corevalve completely released; G. Visible Corevalve prosthesis in left ventricular outflow track and ascending aorta (white arrows) A A next-generation self-expandable valve implantation in a patient with failed aortic bioprosthesis

Objective: Troponin T is a unique marker which might be particularly useful in assessing myocardial cell damage in patients undergoing cardiac surgery. The aim of the study was a comparison between intra-operative release of troponin T (TnT) during three different myocardial protection strategies. Methods: Thirty-eight PTS undergoing myocardial revascularization were randomised into 3 groups in whom procedure was performed with intermittent cross-clamp (Group I; na 13), beating-heart on pump without aortic cross-clamp (Group II; na 12), beating-heart without use of extracorporeal circulation (Group III; na 13). Serial venous blood samples were collected for TnT measurement prior surgery, 1, 4, 12, 24, 48, 72 h after the procedure. Haemodynamic measurements were made using a thermodilution PA catheter. Results: The groups were similar with respect to age, sex, preoperative LV function, number of grafts, potential risk factors. There were no hospital deaths and no myocardial infarction (MI) in three groups, postoperative haemodynamic measurements showed no significant differences. TnT serum levels were significantly higher in group I when compared to groups II and III. TnT levels were significantly lower in group III when compared to group II following 48-h post-operation. Conclusions: Coronary bypass grafting without aortic crossclamping and without CPB offers superior myocardial protection. q 1999 Elsevier Science B.V. All rights reserved.

Objectives Totally epicardial cardiac resynchronization therapy (CRT) is a novel treatment modality for patients with heart failure (HF) and systolic dyssynchrony undergoing coronary artery bypass grafting (CABG). In this study, we have prospectively evaluated the long-term outcomes of totally epicardial CRT. Methods Between September 2007 and June 2009, one hundred and seventy-eight patients were randomly assigned to the CABG alone group (n = 87) and CABG with concomitant epicardial CRT implantation (n = 91). The primary end-point of the study was all-cause mortality in the two groups between the day of surgery and 13 August 2013 (common closing date). The secondary outcomes included mode of death, adverse cardiac events and lead performance. Results The mean follow-up was 55 ± 10.7 months. According to per-protocol analysis with treatment as a time-dependent variable to account for conversion from CABG to CABG + CRT, there were 24 deaths (35.8%) in the CABG group and 17 deaths (15.3%) in the CABG + CRT group. When compared with CABG alone, concomitant CRT was associated with reduced risk of both all-cause mortality [hazard ratio (HR) 0.43, 95% confidence interval (CI) 0.23-0.84, P = 0.012] and cardiac death (HR 0.39, 95% CI 0.21-0.72, P = 0.002). Eleven (12.6%) sudden deaths were observed in the CABG group in comparison with 4 (4.4%) in the CABG + CRT group (P = 0.048). Hospital readmission was required for 9 (9.9%) patients in CABG + CRT group and for 25 (28.7%) patients in the CABG group (P = 0.001). There were 4 (1.5%) epicardial lead failures. Conclusions The results of our study suggest that the procedure of CABG and totally epicardial CRT system implantation is safe and significantly improves the survival of patients with HF and dyssynchrony during long-term follow-up. Clinical trial registration NCT 00846001 (http://www.clinicaltrials.gov).

Background— Whether mitral valve repair during coronary artery bypass grafting (CABG) improves survival in patients with ischemic mitral regurgitation (MR) remains unknown. Methods and Results— Patients with ejection fraction ≤35% and coronary artery disease amenable to CABG were randomized at 99 sites worldwide to medical therapy with or without CABG. The decision to treat the mitral valve during CABG was left to the surgeon. The primary end point was mortality. Of 1212 randomized patients, 435 (36%) had none/trace MR, 554 (46%) had mild MR, 181 (15%) had moderate MR, and 39 (3%) had severe MR. In the medical arm, 70 deaths (32%) occurred in patients with none/trace MR, 114 (44%) in those with mild MR, and 58 (50%) in those with moderate to severe MR. In patients with moderate to severe MR, there were 29 deaths (53%) among 55 patients randomized to CABG who did not receive mitral surgery (hazard ratio versus medical therapy, 1.20; 95% confidence interval, 0.77–1.87) and 21 deaths (43%) among 49 patients who received mitral surgery (hazard ratio versus medical therapy, 0.62; 95% confidence interval, 0.35–1.08). After adjustment for baseline prognostic variables, the hazard ratio for CABG with mitral surgery versus CABG alone was 0.41 (95% confidence interval, 0.22–0.77; P =0.006). Conclusion— Although these observational data suggest that adding mitral valve repair to CABG in patients with left ventricular dysfunction and moderate to severe MR may improve survival compared with CABG alone or medical therapy alone, a prospective randomized trial is necessary to confirm the validity of these observations. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00023595.

Precise measurements of aortic complex diameters are essential for preoperative examinations of patients with aortic stenosis (AS) scheduled for aortic valve (AV) replacement. We aimed to prospectively compare the accuracy of transthoracic echocardiography (TTE), transoesophageal echocardiography (TEE) and multi-slice computed tomography (MSCT) measurements of the AV complex and to analyze the role of the multi-modality aortic annulus diameter (AAd) assessment in the selection of the optimal prosthesis to be implanted in patients surgically treated for degenerative AS. 20 patients (F/M: 3/17; age: 69 ± 6.5 years) with severe degenerative AS were enrolled into the study. TTE, TEE and MSCT including AV calcium score (AVCS) assessment were performed in all patients. The values of AAd obtained in the long AV complex axis (TTE, TEE, MSCT) and in multiplanar perpendicular imaging (MSCT) were compared to the size of implanted prosthesis. The mean AAd was 24 ± 3.6 mm using TTE, 26 ± 4.2 mm using TEE, and 26.9 ± 3.2 in MSCT (P = 0.04 vs. TTE). The mean diameter of the left ventricle out-flow tract in TTE (19.9 ± 2.7 mm) and TEE (19.5 ± 2.7 mm) were smaller than in MSCT (24.9 ± 3.3 mm, P

A 72-year-old male diagnosed with heart failure and dyspnea was found to have a lesion in his right atrium. Histological examination of the tumor revealed it to be a malignant fibrous histiocytoma. The patient's management and subsequent follow-up are presented.

We report on three cases of cardiac resynchronization therapy (CRT) system implantation during coronary artery bypass grafting (CABG) procedure. All 3 patients were men with coronary artery disease and postinfarction congestive heart failure in NYHA class III despite optimal medical treatment and without classical indications for permanent pacing. In echocardiography, intraventricular dyssynchrony was present in all patients. Methods During on-pump CABG epicardial bipolar leads (Medtronic CapSure Epi) were fixed on the right atrium, the right and left ventricle and connected to the CRT pacemaker (Medtronic InSync III) located in the left subclavicular portion. Postoperative period was uncomplicated. After 2 months pacing and sensing parameters remained excellent and significant clinical improvement was observed in all patients. Patients' characteristics and results (b=before, a=2 months after CABG + CRT) View this table: View this table: Conclusion CRT can be regarded as important supplement to surgical revascularization in still growing population of patients with severe heart failure and systolic dyssynchrony, for optimization of treatment results.

Endocarditis related to a transvenously implanted cardiac resynchronization therapy (CRT) system is a rare but serious therapeutic challenge, particularly in those patients in whom interruption of biventricular stimulation induces dramatic deterioration of their hemodynamic status.