Search

In the group of 450 patients operated in the Cardiosurgical Department of the Faculty Hospital in Plzen during the period from III/2003 till XI/2003, 1451 samples were collected to examine the following-procalcitonin levels (PCT), white blood cell counts (Leu) and C-reactive protein levels (CRP). The findings were assessed with respect to the respective patient's clinical status, and any correlation between procedures with extracorporeal circulation (MO), signs of inflammation, septic and non-septic serious complications and between the above mentioned markers levels, was searched. It was detected, that the PCT levels correlated well with the clinical signs of inflammation and sepsis, as well as with the non-inflammatory complications. The CRP and Leu changes were not statistically significant and their levels are commonly increased by the surgical procedure itself.

Extracorporeal circulation is nowadays part of the standard technique of aortocoronary reconstruction. The authors summarize in their paper their experience with operations in 45 patients where an aortocoronary bypass was made on the beating heart without the use of extracorporeal circulation. None of the patients died. The incidence of postoperative complications was low. Rapid rehabilitation of the patients and a shorter period of hospitalization makes this method an alternative standard technique of aortocoronary reconstruction.

Thanks to the co-operation with Czech and Slovak Transplant Centres and with some of the Departments of Pathology and Forensic Medicine 274 hearts were collected for allograft heart valves (AHV) processing during 1992-1995. The Cardiac surgeon dissected the aortic valve with the root and the pulmonary artery trunk with the valve. Tissues were antibiotically (ATB) sterilised in cultivation medium E 199 (24 hours at 37 degrees C). ATB concentrations (mg/ml): Cepharin 0.2, Azlocilin 0.2, Tobramycin 0.08 and Amphotericin B 0.1 for harvesting at post-mortem (P) or Miconazol 0.05 for sterile retrieval during multiorgan harvesting (MOH). After sterilisation AHV were stored at 4 degrees C. 49 AHV were infected even after ATB treatment-15 of 35 collected at P (43%) and 35 of 218 procured during MOH (16%)-(p0.01-ch2 test). After serological screening of the donor and microbiological testing the AHV were released for clinical use. Most AHV were programmed cooled to the temperature of liquid nitrogen (-196 degrees C), in which they were stored at the Allograft Heart Valves Cryobank. Cryoprotection was achieved by 10% dimethylsulphidoxide.A technology of harvesting, processing, storage and transportation of AHV, was introduced. It enabled the routine use in many cardiac surgical units. The AHV Cryobank was established. 131 AHV were used clinically between 1992 and 1995 (transportation as far as 1300 km). 108 AHV (82.4%) were used for repair of complex congenital heart defects, while 23 (17.6%) were used for aortic valve and/or root replacement.

The authors present an account on the first phase of application of minimally invasive techniques of revascularization of the heart into clinical practice at their department. Since December 1994 to the end of January 1995 in selected 15 patients from a total of 240 patients with IHD 16 arterial and 8 venous grafts were sutured on the beating heart from median sternotomy. None of the patients died and none need reoperation. All patients are free from anginous complaints after operation and their clinical condition is satisfactory. Revascularization of the heart by means of arterial and venous grafts on the beating heart from median sternotomy is a technically reproducible method which enables us to elaborate further minimally invasive procedures for the treatment of IHD. The presented paper is a preliminary communication without claims of statistical validity of the achieved results.

The authors describe their own modification of closure of an atrial septal defect (ASD) from right anterolateral minothoracotomy. This minimally invasive approach was selected in girls and women. Right anterolateral thoracotomy was used in 1987 to 1994 in twelve female patients. With regard to the general trend towards aesthetic surgery the authors use at present minimal anterolateral right-sided thoracotomy which with regard to its close relationship with the right atrium makes a safe surgical access to the atrial septum possible. Extracorporeal circulation is implemented by cannulation of the iliac artery in the groin, venous return is ensured by cannulas inserted into the venae cavae in the surgical field (by the auricle of the right atrium into the vena cava superior and the right atrial wall into the vena cava inferior). The operation itself is performed with electric fibrillation of the heart and tightening of the venous tourniquets. Between January 1995 till March 1996 the authors made by the thus modified approach a closure of the ASD type secundum in four female patients age 17, 29, 35 and 40 years. ASD was located always in the fossa ovalis and was repaired by direct suture. The duration of the extracorporeal circulation was on average 30 minutes. The length of the skin incision was 8-10 cm. The operation was free from complications. The cosmetic result is excellent and is consistent with principles of aesthetic surgery. If an arterial cannula is inserted into the groin minithoracotomy can be recommended for closure of ASD with extracorporeal circulation as a safe method.

Allograft heart valves (AHV) are believed to be optimal prosthetic material for surgical aortic valve and/or root replacement and an ideal valved conduit for repair of some complex congenital heart defects. At the University Hospital Motol AHV were clinically used since 1983 (annually no more than twenty were collected). 1991 the Paediatric Transplant Centre was established and was entrusted to organise cadaveric hearts harvesting and to introduce the standard technology of AHV processing and banking. The results of co-operation with other Transplants Centres, as well as with coroners and forensic medicine specialists in 1992-1995 are presented. For the AHV processing 274 cadaveric hearts were collected in the Czech and Slovak Republics, 32 of them (11.7%) came from routine post-mortem and 242 (88.3%) were retrieved from multiorgan harvesting, 14 hearts were excluded for technical reasons and another five for the seropositivity of the donor (three HBSAg, one HCV and one VDRL). Another 14 AHV were not suitable for clinical use because of a congenital lesion (bicuspid aortic valve) or acquired pathology found during the AHV processing (advanced atherosclerosis) or retrospectively diagnosed at donors post-mortem (in vivo undiagnosed malignancy). The technology of processing, cryopreservation and banking of AHV as well as the clinical use of the tissue will be discussed separately.

The authors give an account of 16 cases where they used the right gastroepiploic artery (GEA) for revascularization of the heart muscle. Their own findings are based on the author's experience at a department with the greatest number of thus operated patients (Groningen, Netherlands). These data were already published. GEA was used during the revascularization operation in 16 of 112 patients operated after 1994 (14%). All operated patients were males aged 30 to 58 years (mean age 47 years). None of the patients died. The use of GEA did not cause any postoperative complications. During the short-term follow up there was no reason to doubt the patency of the graft and an invasive examination was not indicated so far. According to the authors' experience the GEA graft can be used for anastomosis with the right coronary artery or its branch almost in all patients indicated for revascularization. It is thus possible to obtain a high-standard arterial graft where long-term patency can be assumed. The authors discuss in detail the indications and technique of the operation.