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We have previously shown that cannabinoid CB1 and CB2 receptor antagonists, AM251 and AM630, respectively, modulate cardiostimulatory effects of isoprenaline in atria of Wistar rats. The aim of the present study was to examine whether such modulatory effects can also be observed (a) in the human atrium and (b) in spontaneously hypertensive rats (SHR) and normotensive Wistar Kyoto rats (WKY). Inotropic effects of isoprenaline and/or CGP12177 (that activate the high- and low-affinity site of β1 -adrenoceptors, respectively) were examined in paced human atrial trabeculae and rat left atria; chronotropic effects were studied in spontaneously beating right rat atria. AM251 modified cardiostimulatory effects more strongly than AM630. Therefore, AM251 (1 μM) enhanced the chronotropic effect of isoprenaline in WKY and SHR as well as inotropic action of isoprenaline in WKY and in human atria. It also increased the inotropic influence of CGP12177 in SHR. AM630 (1 μM) decreased the inotropic effect of isoprenaline and CGP12177 in WKY, but enhanced the isoprenaline-induced inotropic effect in SHR and human atria. Furthermore, AM251 (0.1 and 3 μM) and AM630 (0.1 μM) reduced the inotropic action of isoprenaline in human atria. In conclusion, cannabinoid receptor antagonists have potentially harmful and beneficial effects through their amplificatory effects on β-adrenoceptor-mediated positive chronotropic and inotropic actions, respectively.

Background: Left atrial appendage closure (LAAC) reduces the risk of stroke in patients with atrialfibrillation. It can be performed surgically from the inside of the left atrium or from the outside. Stapling or clipping devices can also be used from the outside. Despite providing an excellent interior view of the appendage, those techniques cannot be implemented during minimally invasive mitral valve surgery conducted through right‑sided minithoracotomy. Aims: This study aimed to assess the effectiveness of surgical closure of the left atrial appendage from the inside during minimally invasive mitral valve surgery. Methods: A total of 50 patients with mitral valve disease and atrial fibrillation who underwent minimallyinvasive mitral valve surgery and LAACbetween 2012 and 2017 were included in this study. The appendagewas closed from the inside using a continuous suture. After a median follow‑up of 1.6 years after surgery, 19 patients were examined by transthoracic and transesophageal echocardiography (TEE). Transesophageal echocardiography was performed to assess whether the appendage had been effectively closed. When any leakage was suspected, cardiac computed tomography was performed. Results: In 19 patients, TEE was performed at 0.5 to 5 years after the surgery. A single patient did not tolerate TEE, and minimal leakage was suspected in 2 patients. All 3 individuals underwent computed tomography examination, which confirmed leakage in a single patient. Conclusions: Surgical LAACduring minimally invasive mitral valve surgery through right minithoracotomyis an effective technique that provides durable results.

OBJECTIVES The incidence of diabetes mellitus in patients with ischaemic cardiomyopathy is increasing. To evaluate the impact of diabetes mellitus on contractility, we examined the calcium-induced force in left and right atrial myofilaments of patients with and without diabetes. METHODS We included 149 patients (106 without diabetes, 43 with diabetes), scheduled for elective coronary artery bypass grafting from August 2016 to June 2017. The left and right atria were excised and prepared for skinned fibre measurements (pCa-force curve). The unit for the force measurements is Millinewton (mN). Comprehensive demographic data as well as echocardiographic findings of the patients were collected. RESULTS We observed a significant decrease of left atrial force values in patients with diabetes, averaged over all calcium concentrations (patients with diabetes 0.50 ± 0.19 mN vs 0.68 ± 0.23 mN in patients without diabetes, P = 0.002) as well as in right atrial fibres (patients with diabetes 0.35 ± 0.17 mN vs 0.47 ± 0.21 mN in patients without diabetes, P = 0.005). There was a significant influence of repeated measurements (of the calcium concentrations) on force in left atrial myofilaments (P

Background: Surgery of the aortic arch is challenging. Aim: To assess the results of aortic arch surgery. Methods: Analysis of 172 patients operated on arch dissection (emergency group: 97 patients) or aneurysm (elective group: 75 patients) between 2007 and 2014. Arch surgery was defined as a procedure requiring circumferential anastomosis at the level of the aortic arch or the descending aorta with the use of techniques of brain protection (deep hypothermic circulatory arrest [DHCA] or selective antegrade cerebral perfusion [SACP]) and/or debranching of at least one supra-aortic vessel. Results: Men predominated in both groups (> 70%). Men were younger in the emergency group (55 vs. 66 years; p < 0.008). The operative risk was higher in the emergency group (19.2% vs. 12.5%; p < 0.001). Forty-nine per cent of the patients from the emergency group and 5% from the elective group were operated with antiplatelet therapy (p < 0.001). Extended hemiarch procedure was performed in 79% (n = 77) in the emergency and 76% (n = 57) in the elective group. Total arch replacement was performed in 19 (21%) patients from the emergency and 18 (24%) patients from the elective group. In these patients debranching was performed in 68% of the emergency patients group and in 67% of the elective group. Elephant trunk procedure (classic/frozen) was performed in 53% (n = 10) from the emergency and in 78% (n = 14) of patients from the elective group. Aortic valve sparing surgery was performed in 20% of patients from the emergency and 9% from the elective group (p = 0.063). DHCA was performed in 58% (n = 43) of patients from the elective group and 39% (n = 37) from the emergency group. SACP was performed in 61% (n = 58) of patients from the emergency and 42% (n = 31) from the elective group. Thirty-day mortality in the emergency group reached 33% (n = 32), and in the elective group 15% (n = 11; p = 0.007). In multivariate analysis, predictors of death in the emergency group were: Logistic EuroSCORE above 19.5%, extracorporeal circulation time above 228 min, and postoperative acute renal failure (ARF); and in the elective group: DHCA time above 26 min, rethoracotomy due to bleeding, and ARF. Follow-up was completed in 100% of patients in terms of vital status. The mean follow-up time of the patients from the emergency group was 24.3 ± 27.10 (min 0, max 92) months, and from the elective group 30.3 ± 24.5 (min 0, max 99) months. During the follow-up period all-cause mortality in the emergency group was 43% (n = 42/97), and in the elective group it was 36% (n = 27/75). Conclusions: Early mortality in the emergency group was higher, while long-term mortality did not differ among the groups. Postoperative ARF is a critical predictor of mortality in both groups.

Background: Transcatheter mitral valve (MV) repair is of increasing interest facing however questionable mid term results. We herein report MV reference center experience of 18 patients who underwent MV surgery after failed percutaneous MV repair with MitraClip device (Evalve, Menlo Park, CA). Methods: Between June 2010 and October 2013, a total of 141 patients with severe mitral regurgitation (MR) underwent MitraClip procedure at Heart Center Leipzig. 11 patients (7.8%) needed surgical treatment for failed MV repair with the MitraClip device. For the same reasons we admitted 7 patients who underwent MitraClip procedure in other cardiac surgery centers. Mean EuroScore II of the patients was 23,51 (5,17-60,14). Results: From the group of 18 patients undergoing surgical treatment after MitraClip repair, 14 patients (77.7%) received one or more clip-implants and 4 patients (22.2%) suffered from failed MitraClip implantation. All patient were symptomatic (n=9, 50% - NYHA III; n=9, 50% - NYHA IV). The primary indications for surgery were: partial clip detachment (n=11, 61.1%), failed MitraClip implantation (n=4, 22.2%), recurrent MR greater than moderate (2+) (n=3, 16.6%), acute mitral valve endocarditis (n=1, 5.5%), mitral ring and clip detachment (n=1, 5.5%). 13 patients (72.2%) underwent MV replacement, 3 patients (16.6%) received left-ventricular assist device (LVAD), 2 patients (11.1%) underwent MV repair. One-month mortality reached 27,8% (n=5), and the overall mortality reached 50% (n=9). Conclusions: MV repair was feasible in only 2 cases (11.1%). Despite the high operative risk, surgical treatment after percutaneous MV repair failure with the MitraClip device is an option to be considered.

Background : Freedom Solo (FS) stentless bioprostheses have superior haemodynamic performance compared to stented valves; however, the data of thrombocytopenia after FS implantations is disturbing. Aim: To compare platelet count and perioperative complications between stentless and stented biological valves in patients undergoing aortic valve replacement. Methods: In 29 patients, FS bovine valves (Sorin Group, Saluggia, Italy) were implanted. Platelet counts were analysed before surgery, on the day of operation, on four consecutive postoperative days (POD) as well as at discharge, and compared to 29 control patients with biological stented porcine valves (Labcor Laboratorios TLBP-A Supra). The analysis of the perioperative variables extracorporeal circulation (ECC), aortic cross clamping (XC) and mechanical ventilation times, as well as blood supply, was performed. Results: Initial platelet counts were comparable in both groups. In the FS group, platelet levels on the four consecutive POD were significantly lower. The lowest platelet value (13 × 103/μL), related to fatal thrombotic thrombocytopenic purpura, was found in one patient from the FS group. ECC as well as XC and mechanical ventilation times, were significantly longer in the FS group, and more blood transfusions in these patients were required. In multiple regression analysis, ECC and XC times did not correlate with platelet count. Conclusions: Implantations of FS stentless bioprostheses are related to significantly lower platelet counts. Severe perioperative complications and their relation to thrombocytopenia need further evaluation.

A case of a 73-year-old patient with critical aortic stenosis, porcelain aorta and occluded femoral arteries is presented. We performed apico-aortic valved conduit (A-AVC) without cardiopulmonary bypass (CPB). Hegar dilator inserted through the apex into the left ventricle allowed anastomosis of dacron tube to the apex. Valved conduit was anastomosed to the descending aorta. Both tubes were connected. Before the operation, maximal gradient through the valve was 95, after operation dropped to 33 mmHg. This method of apical anastomosis allowed to perform A-AVC without CPB in a patient with extremely high peri-operative risk while using CPB.

An estimation of influence of different doses of aprotynin on bleeding, coagulation parameters and safety of its use after coronary artery bypass grafting (CABG) in pts without coagulation disorders.91 patients underwent CABG, 73 men, 18 women in age 37 to 76 +/- 56.5 years. Patients were randomly assigned to 3 groups; Group I; 38 pts. 6.5 mln KIU aprotynin. Group II; placebo--30 pts. Group III; 23 pts. 2 mln. KIU. There were 4 measurements 1.--before operation, 2. after discontinuing CPB, 3.--6 h after operation, 4.--24 h after operation. We measured Hb, Ht, PLT Glucose, D-dimers, APTT, TT Fibrynogen, INR, AT3, Ca2+, factor V, VIII, GOT GPT CK, CK-MB, CRP, ACT concentration of Hb in drainage 6 h after operation. There were estimated: renal function profile, drainage loss, perioperative MI, mortality, reoperation rate due to bleeding.The level of blood count and coagulation parameters did not differ between the groups in any test periods. D-dimer levels were significantly higher in the placebo group than in group I and III. The decrease of fibrin degradation was not related to the dose of aprotynin. Drainage was insignificantly higher in placebo group. Renal function was impaired in neither group. Reoperation rate perioperative infarction and mortality did not differ between the groups, however was highest in group I.Aprotynin reduces blood loss after operation in CPB and decrease fibrin degradation independently to the dose of the drug. The high-dose of aprotynin may increase the risk of early graft occlusion in patients without coagulation disorders.

Heart failure is currently one of the biggest problems of all heath care systems in the world and will become even more important. In about 50% of the patients, heart failure is a consequence of myocardial infarction. The surgical reconstruction of the left ventricle after anterior myocardial infarction became the first effective method of treatment which can be applied in many patients. After anterior myocardial infarction the apical part of the ventricle dilates, becomes more spherical with thinned wall. Dilated, spherical apex results in rise of wall tension of the transition zone between the apex and the proximal part of the left ventricle. This increases oxygen demand and reduces coronary blood flow. This phenomenon is responsible for severe angina pectoris and explains why myocardial infarction is the most common cause of death of patients with LV aneurysm. Increased wall tension of the transition zone leads to fibrosis, further dilatation and decrease of contractility of the left ventricle. Only surgical reconstruction of the left ventricle can stop this progressive process. The aim of surgery is to decrease the wall tension by restoring the normal elliptical shape, geometry and volume of the left ventricle. Results of this operation are very promising. Perioperative mortality is about 5% and 5-year survival 80%.

Coronary Artery Bypass Grafting (CABG) is widely accepted as an effective and durable method of treatment of Coronary Artery Disease. In some patients however, recurrent angina and the necessity of reoperation (RE-CABG) occurs.The aim of the study is the estimation of the results of RE-CABG in own material.In years 1995-2002 CABG operations were performed in 3452 patients (CABG group) and RE-CABG in 37 pts (1.07%) (RE-CABG group). Patients were considered for operation on condition of the presence of symptomatic CAD confirmed by coronarography in standard projections. Operations were performed using Cardiopulmonary Bypass.The CABG group consisted of 3452 pts in mean age 57.9 years, including 2693 men (78%) and 759 (22%) women. The RE-CABG group was composed of 37 pts in mean age 60.7 years, comprising 22 (59.5%) men and 15 (40.5%) women. The percentage of women in CABG group was significantly higher than in CABG group. The mean age in RE-CABG group was insignificantly higher than in CABG group. In the CABG group 3.1 anastomosis/pt were performed, including anastomosis IMA to LAD in 2779 pts (80.5%). From this group only in 2 pts (0.07%) coronary reoperations were performed. In the remaining 673 pts from CABG group during the first operation, only saphenous vein graft were performed and in 35 (5.2%) coronary reoperation was necessary. This difference is statistically significant. In-hospital mortality in CABG group was 5%, the IABP was used in 7.8% of pts. Mortality in the RE-CABG group reached 8.1% (3/37), the IABP was used in 16.2% (6/37).1. The use of arterial grafts during the first coronary operation decreases the reoperation rate. 2. RE-CABG are performed in the older patient rather than CABG. 3. RE-CABG are performed more frequently in women than in men as compared to CABG. 4. RE-CABG are burdened with twice as high mortality rate and the necessity of use of IABP than CABG.

An 80-year old patient underwent a transapical aortic valve implantation. On the 28th postoperative day, the patient developed acute mitral valve endocarditis. Initially, the patient was unsuccessfully treated conservatively. After 71 days, the patient was operated on with mitral valve replacement. In this report, we discuss the potentially growing problem of complications related to transcatheter valve implantation.