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Background and Objectives: The combination of aortic valve stenosis (AS) and ischemic heart disease (IHD) is quite common and is associated with myocardial fibrosis (MF). The purpose of this study was to evaluate the association between the histologically verified left ventricular (LV) MF and its geometry and function in isolated AS and AS within IHD groups. Materials and Methods: In a single-center, prospective trial, 116 patients underwent aortic valve replacement (AVR) with/without concomitant surgery. The study population was divided into groups of isolated AS with/without IHD. Echocardiography was used, and LV measurements and aortic valve parameters were obtained from all patients. Myocardial tissue was procured from all study patients undergoing elective surgery. Results: There were no statistical differences between isolated AS and AS+IHD groups in LV parameters or systolic and diastolic functions during the study periods. The collagen volume fraction was significantly different between the isolated AS and AS+IHD groups and was 7.3 ± 5.6 and 8.3 ± 6.4, respectively. Correlations between MF and left ventricular end-diastolic diameter (LVEDD) (r = 0.59, p = < 0.001), left ventricular mass (LVM) (r = 0.42, p = 0.011), left ventricular ejection fraction (LVEF) (r = −0.67, p < 0.001) and an efficient orifice area (EOA) (r = 0.371, p = 0.028) were detected in isolated AS during the preoperative period; the same was observed for LVEDD (r = 0.45, p = 0.002), LVM (r = 0.36, p = 0.026), LVEF (r = −0.35, p = 0.026) and aortic annulus (r = 0.43, p = 0.018) in the early postoperative period; and LVEDD (r = 0.35, p ≤ 0.05), LVM (r = 0.43, p = 0.007) and EOA (r = 0.496, p = 0.003) in the follow-up period. In the group of AS and IHD, correlations were found only with LV posterior wall thickness (r = 0.322, p = 0.022) in the follow-up period. Conclusions: Histological MF in AS was correlated with LVM and LVEDD in all study periods. No correlations between MF and LV parameters were found in aortic stenosis in the ischemic heart disease group across all study periods.

BackgroundThe novel Vienna TAVI system is repositionable and retrievable, already pre-mounted on the delivery system, eliminating the need for assembly and crimping of the device prior to valve implantation.AimsThe purpose of this first-in-human feasibility study was to determine the safety, feasibility, clinical and hemodynamic performance of the Vienna TAVI system at 6-month follow-up. (ClinicalTrials.gov identifier NCT04861805).MethodsThis is a prospective, non-randomized, single-arm, single-center, first-stage FIH feasibility study, which is followed by a second-stage pivotal, multicenter, multinational study in symptomatic patients with severe aortic stenosis (SAS). The first-stage FIH study evaluated the safety and feasibility, clinical and hemodynamic performance of the device in 10 patients with SAS based on recommendations by the VARC-2.ResultsAll patients were alive at 3-month follow-up. 1 non-cardiovascular mortality was reported 5 months after implantation. There were no new cerebrovascular events, life-threatening bleeding or conduction disturbances observed at 6-month follow-up. The mean AV gradient significantly decreased from 48.7 ± 10.8 to 7.32 ± 2.0 mmHg and mean AVA increased from 0.75 ± 0.18 to 2.16 ± 0.42 cm2 (p

Introduction: The study aimed to evaluate the diagnostic value of global and regional myocardial deformation parameters derived from two-dimensional speckle-tracking echocardiography to detect functionally significant coronary artery stenosis. Methods: Dobutamine stress echocardiography and cardiac magnetic resonance myocardial perfusion imaging (CMR-MPI) were performed on 145 patients with a moderate and high probability of coronary artery disease (CAD) and LVEF≥55%. Significant CAD was defined as>50% stenosis of the left main stem,>70% stenosis in a major coronary vessel, or in the presence of intermediate stenosis (50-69%) validated as hemodynamically significant by CMRMPI. Patients were divided in two groups: non-pathological (48.3%) vs pathological (51.7%), according to CAG and CMR-MPI results. Afterwards, off-line speckle-tracking analysis was performed to analyse myocardial deformation parameters. Results: There were no differences in myocardial deformation parameters at rest between groups, except global longitudinal strain (GLS) and global radial strain (GRS) were significantly lower in the CAD (+) group: -21.3±2.2 vs.-16.3±2.3 (P

Aim. Aortic valve diseases are associated with myocardial fibrosis. The relationship between severity of myocardial fibrosis and left ventricular mass reduction (LVMR) after aortic valve replacement (AVR) still needs to be elucidated. Methods. In a single-center, retrospective trial, 130 patients underwent AVR with/without concomitant surgery. The study population was divided by etiology into aortic stenosis (AS) and aortic regurgitation (AR) groups. LV end-diastolic diameter, LV septal and posterior thicknesses, LV mass, and aortic annulus were obtained in all study patients. Left ventricular mass regression index (iLVMR) was found by the difference between preoperative iLVM and follow-up iLVM. iLVMR in months was calculated by divided iLVMR on the number of months before follow-up visit. Myocardial tissue was embedded in paraffin, and sectioned into 4 µm slices for histological staining (picrosirius red) and scanning. The fraction of myocardial volume occupied by collagen tissue was determined. Results. The left ventricular remodeling of AS and AR patients is presented in Table 3. There was significant LV mass reduction in both aortic valve disease groups in the follow-up period (AS group, p < 0.001; AR group, p < 0.05). The number of LVH cases decreased in both groups in the follow-up period (AS group, p < 0.001; AR group, p < 0.05). In Post-AVR period the ejection fraction of LV did not improve in the AS group, compare to AR group (p We did not found correlations between MF and LVM in preoperative, and follow-up periods for AS and AR groups. Moreover, MF did not correlate significantly to iLVMR and iLVMR in months. A significant correlation exists in AS patients between MF and preoperative iLVEDD (r = 0.21, p = 0.04). Conclusion. The LVM reduction was observed in both AS and AR groups. LVM of AS group recovered more quickly than that of AR group. In our study MF does not affect LVM regression. Large cohort of patients with myocardial biopsies and long-term follow-up are needed to access the impact of the MF on the LVMR.

Background: This study aimed to assess the impact of the measurement of the degree of target coronary artery stenosis using the instantaneous wave-free ratio (iFR) on patency of attached grafts. Materials and Methods: A total of 86 grafts were assessed by computed tomography angiography (CTA) after coronary artery bypass grafting (CABG) in 24 patients with multivessel coronary artery disease (CAD). The iFR was evaluated for all target coronary arteries. The coronary artery stenoses were divided into three groups based on the iFR value: iFR < 0.86 (group 1); iFR 0.86–0.90 (group 2); and iFR > 0.90 (group 3). Results: CTA was performed at 192 ± 44 days (range: 80–318 days). The correlation coefficient (r) between iFR and failed grafts was 0.332 (p = 0.035). Graft failure was detected in three grafts (8.1%) for group 1, in two grafts (8.3 %) for group 2, and in four grafts (16%, all arterial grafts) for group 3. Statistically significant differences were found between groups 1 and 3 (p = 0.041) and between groups 2 and 3 (p = 0.044). No significant differences were found between groups 1 and 2 (p = 0.228). Conclusions: The degree of coronary artery stenosis measured by iFR is a risk factor for attached graft failure. In a coronary artery where the iFR was haemodynamically non-significant, a higher rate of graft failure was detected.

Abstract Background Aortic valve sparing surgery (AVS), in combination with aortic cusp repair (ACR), still raises many questions about the increased surgical complexity and applicability for patients with pure aortic valve regurgitation (AR). The aim of this study was to investigate our long-term outcomes and predictors of recurrent AR (> 2+) after AVS and reconstructive cusp surgery. Methods We reviewed data of 81 patients who underwent AVS (a reimplantation technique) with concomitant ACR for AR and or dilatation of the aortic root at our institution during the period from April 2004 to October 2016. On preoperative echocardiography, the majority of the patients, 70 (86.4%) presented with severe AR grade (> 3+) and 28 (34.5%) of the patients had the bicuspid phenotype. Time to event analysis (long-term survival, freedom from reoperation, and recurrence of AR > 2+) was performed with the Kaplan–Meier method. Multivariate Cox regression risk analysis was performed to identify independent predictors of recurrent AR (> 2+). The mean follow-up was 5.3 ± 3.3 years and 100% complete. Results The in-hospital (30-day) mortality rate after elective surgery was 1.2%. The overall actuarial survival rates were 92.9 ± 3.1% and 90.4 ± 3.9% at five and 10 years, respectively. Actuarial freedom from recurrent AR (> 2+) was 83.7 ± 4.5% within the cohort at five and 10 years. The cumulative freedom from all causes of cardiac reoperation was 94.2 ± 2.8% within the cohort at 10 years. Neither bleeding nor thromboembolic or permanent neurologic events were reported during follow-up. By multivariate analysis, independent predictors of reccurent AR (> 2+) were an effective height lower than 9 mm (p= 0.02) and intraoperative residual mild AR (p= 0.0001). Conclusions AVS with ACR, combined in a systematic fashion, is a safe and reproducible option with low risk of long-term valve related events and normal life expectancy for patients with pure aortic regurgitation. The competent aortic valve and effective height, not lower than 9 mm intraoperatively, are mandatory to achieve long-lasting AV competency.

Abstract Background Undifferentiated pleomorphic sarcoma is a very rare and aggressive type of primary cardiac tumors. Most cardiac sarcomas result in rapid growth and quick death. According to different sources the median survival is typically 6 to 12 months. We are presenting a case of primary cardiac sarcoma with 26 months disease free survival following cytoreductive surgery and chemotherapy. Case presentation A 48-year-old woman with progressing symptoms of dyspnea and palpitations for over 2 months was referred to a cardiologist. With the help of echocardiography and cardiovascular magnetic resonance cardiac sarcoma was suspected. Open biopsy and cytoreductive surgery were performed, complete resection of the tumor was not possible. Histology revealed undifferentiated pleomorphic sarcoma. Seven cycles of chemotherapy with Doxorubicine and Ifosfamide were completed. Cardiovascular magnetic resonance revealed a complete response – only signs of fibrosis without any signs of tumor were visible. Follow ups with echocardiography, cardiovascular magnetic resonance and chest, abdomen and pelvic computed tomography is performed every 3 months. Twenty-six months from initial diagnosis the patient is still free of recurrence of tumor with no compromises of the quality of life. Conclusion Standard chemotherapy together with cytoreductive surgery can have a complete response effect in undifferentiated pleomorphic sarcoma with unusual long-term survival.

The aim of this study was to identify associations of the parameters of heart rate variability (HRV) with the variations in geomagnetic activity (GMA), solar wind, and cosmic ray intensity (CRI) in patients after coronary artery bypass grafting or valve surgery in Kaunas, Lithuania, during 2008–2012. The data from 5-minute electrocardiograms (ECGs) in 220 patients were used. ECGs were carried out at 1.5 months, 1 year, and 2 years after the surgery (N = 495). A lower (higher) very-low-frequency-band (VLF) and a higher (lower) high-frequency band (HF) in normalised units (n.u.) were associated with a low maximal daily 3-hourly ap (the DST index > 1). A lower mean standard deviation of beat-to-beat intervals (SDNN) and VLF, LF, and HF powers were lower in patients when Ap < 8 occurred two days after the surgery, and a low solar wind speed (SWS) occurred two days before the ECG. The effect of CRI was non-significant if the linear trend was included in the model. Low GMA and a low SWS may effect some HRV variables in patients after open-heart surgery. The GMA during the surgery may affect the SDNN in short-term ECG during the longer period.

Abstract Indocyanine green (ICG) fluorescent dye has been approved by the FDA for use in medical diagnostics. Recently, we demonstrated that ICG dye has voltage-sensitive properties with a dual-component (fast and slow) response in the Langendorff-perfused rabbit heart. Here, we extended our studies by showing the different spectral properties of both components for analysis of the fractional change in ICG fluorescence in response to voltage changes. We used light from four LEDs to obtain excitation; emission was measured using an EMCCD camera with band-pass filters and a spectrometer. We applied a graphical model with Gaussian functions to construct and evaluate the individual emission curves and calculated the voltage-sensitive portion of each component of the ICG fluorescence in the rabbit heart. The results revealed that each isolated component (fast and slow) emanates from a unique ICG pool in a different environment within the cell membrane and that each component is also composed of two constituents (ICG-monomeric and ICG-aggregated). We propose the existence of different voltage-sensitive mechanisms for the components: (I) electrochromism and field-induced reorientation for the fast component; and (II) field-induced dye squeezing that amplifies intermolecular interactions, resulting in self-quenching of the dye fluorescence, for the slow component.

Background and objective: Left atrium (LA) is an important biomarker of adverse cardiovascular outcomes and cerebrovascular events. This study aimed to evaluate LA myocardial deformation using cardiac magnetic resonance feature tracking (CMR-FT) in patients with acute ST-segment elevation myocardial infarction (STEMI) and secondary mitral regurgitation (MR). Additionally, to assess interobserver and intraobserver variability of the technique. Materials and methods: Twenty patients with STEMI underwent CMR with a 1.5 Tesla MRI scanner. According to the presence of MR patients were divided into two groups: MR(+) and MR(−). Total LA strain (ɛs), passive LA strain (ɛe), and active LA strain (ɛa) were obtained. Additionally, total, passive and active strain rates (SRs, SRe, and SRa) were calculated. To assess interobserver agreement data analysis was performed by second independent observer. Results: LA volumetric and functional parameters were similar in both groups. All LA strain values were significantly higher in patients with MR: ɛs (27.67 ± 10.25 for MR(−) vs. 32.80 ± 6.95 for MR(+); P = 0.01), ɛe (15.29 ± 7.30 for MR(−) vs. 19.22 ± 6.04 for MR(+); P = 0.01) and ɛa (12.38 ± 4.23 for MR(−) vs. 14.44 ± 5.19 for MR(+); P = 0.03). Only SRe significantly increased in patients with MR (−0.57 ± 0.24 for MR(−) vs. −0.70 ± 0.20 for MR(+); P = 0.01). All LA deformation parameters demonstrated high interobserver and intraobserver agreement. Conclusions: Conventional volumetric and functional LA parameters do not detect early changes in LA performance in patients with STEMI and secondary MR. In contrast, LA reservoir, passive and active strain are significantly higher in patients with MR. Only peak early negative strain rate substantially increases during secondary MR. LA deformation parameters derived from conventional cine images using CMR-FT technique are highly reproducible.

Background and objectives: The aims of this study were to investigate changes in the hemodynamics associated with different types of aortic prostheses and to evaluate patient-prosthesis mismatch (PPM) at rest and after exercise. Materials and Methods: We retrospectively analyzed 150 patients who presented with indications for aortic valve replacement (AVR) with/without concomitant surgery from March 2019 to January 2020. The study population included 90 (60%) men and 60 (40%) women (mean age, 67.33 ± 10.22 years; range, 37–88 years). Echocardiography data such as peak and mean transprosthetic pressure gradients (Gmax, Gmean), velocity (V), effective orifice area (EOA), and indexed EOA (iEOA) were derived at rest and after exercise at baseline and before discharge. The study patients performed the six-minute walk test (6MWT) on the 5th–7th postoperative day. Results: Stented tissue valves showed excellent performance at rest and after exercise in comparison with mechanical valves, which showed favorable hemodynamics at rest only. At the time of discharge, moderate PPM was observed in 7/74 patients (9.5%) at rest and 5/98 (3.3%) patients after exercise. None of the patients showed severe PPM. EOA and iEOA were not significantly different between the groups. However, the stented group showed more pronounced changes in EOA and iEOA after exercise, whereas the changes in the mechanical valve group did not reach significance. Conclusions: In the early postoperative period, mechanical valves and stented valves showed favorable resting hemodynamics. The PPM rate measured after exercise was lower than that at rest.

Background and Objectives: To assess the correlation between the degree of target coronary artery stenosis measured by instantaneous wave-free ratio (iFR) and the intraoperative transit time flow measurement (TTFM) of attached grafts as well as evaluate flow competition between the native coronary artery and the attached graft according to the severity of stenosis. Materials and Methods: In total, 89 grafts were subjected to intraoperative transit time flow measurement after coronary artery bypass grafting (CABG) in 25 patients with multivessel coronary artery disease (CAD). The iFR was evaluated for all coronary arteries with grafts. The coronary artery stenoses were divided into three groups based on the iFR value: iFR < 0.86 (group 1); iFR 0.86–0.90 (group 2); and iFR > 0.90 (group 3). Results: The mean graft flow (MGF) was 46.9 ± 18.4 mL/min for group 1, 45.3 ± 20.9 mL/min for group 2, and 31.3 ± 18.5 mL/min for group 3. A statistically significant difference was confirmed between groups 1 and 3 (p = 0.002) and between groups 2 and 3 (p = 0.025). The pulsatility index (PI) was 2.49 ± 1.20 for group 1, 2.66 ± 2.13 for group 2, and 4.70 ± 3.66 for group 3. A statistically significant difference was found between groups 1 and 3 (p = 0.006) and between groups 2 and 3 (p = 0.032). Backward flow was detected in 7.5% of grafts for group 1, in 16.6% of grafts for group 2, and in 16% of grafts for group 3. A statistically significant difference was found between groups 1 and 2 (p = 0.025) and between groups 1 and 3 (p = 0.029). Conclusions: The iFR is a useful tool for predicting the impact of competitive flow observed between a native artery and an attached graft. The effect of competitive flow significantly increases when the graft is attached to a vessel with mild coronary stenosis. In a coronary artery where the iFR was not hemodynamically significant, the MGF was lower, the PI was higher, and a larger proportion of grafts with backward flow (BF) was detected compared to when there was significant stenosis (iFR < 0.86).

Optical mapping is recognized as a promising tool for the registration of electrical activity in the heart. Most cardiac optical mapping experiments are performed in ex vivo isolated heart models. However, the electrophysiological properties of the heart are highly influenced by the autonomic nervous system as well as humoral regulation; therefore, in vivo investigations of heart activity in large animals are definitely preferred. Furthermore, such investigations can be considered the last step before clinical application. Recently, two comprehensive studies have examined optical mapping approaches for pig hearts in situ (in vivo), likely advancing the methodological capacity to perform complex electrophysiological investigations of the heart. Both studies had the same aim, i.e., to develop high-spatiotemporal-resolution optical mapping suitable for registration of electrical activity of pig heart in situ, but the methods chosen were different. In this brief review, we analyse and compare the results of recent studies and discuss their translational potential for in situ cardiac optical mapping applications in large animals. We focus on the modes of blood circulation that are employed, the use of different voltage-sensitive dyes and their loading procedures, and ways of eliminating contraction artefacts. Finally, we evaluate the possible scenarios for optical mapping (OM) application in large animals in situ and infer which scenario is optimal.

Background and Objectives: The aim of this study is to identify risk factors for the development of delayed neurocognitive recovery (dNCR). Materials and Methods: 140 patients underwent neurocognitive evaluations (Adenbrooke, MoCa, trial making, and CAM test) and middle cerebral artery (MCA) blood flow velocity (BFV) measurements, one day before cardiac surgery. BFV was re-evaluated after anesthesia induction, before the beginning, middle, end, and after cardiopulmonary bypass (CPB) and postsurgery. To measure glial fibrillary acidic protein (GFAP) and neurofilament heavy chain (Nf-H), blood samples were collected after anesthesia induction, 24 and 48 h after the surgery. Neurocognitive evaluation was repeated 7–10 days after surgery. According to the results, patients were divided into two groups: with dNCR (dNCR group) and without dNCR (non-dNCR group). Results: 101 patients completed participation in this research. GFAP increased in both the non-dNCR group (p < 0.01) and in the dNCR group (p < 0.01), but there was no difference between the groups (after 24 h, p 0.342; after 48 h, p 0.273). Nf-H increased in both groups (p < 0.01), but there was no difference between them (after 24 h, p = 0.240; after 48 h, p = 0.597). MCA BFV was significantly lower in the dNCR group during the bypass (37.13 cm/s SD 7.70 versus 43.40 cm/s SD 9.56; p = 0.001) and after surgery (40.54 cm/s SD 11.21 versus 47.6 cm/s SD 12.01; p = 0.003). Results of neurocognitive tests correlated with CO2 concentration (Pearson’s r 0.40, p < 0.01), hematocrit (r 0.42, p < 0.01), MCA BFV during bypass (r 0.41, p < 0.01), and age (r −0.533, p < 0.01). The probability of developing dNCR increases 1.21 times with every one year of increased age (p < 0.01). The probability of developing dNCR increases 1.07 times with a decrease of BFV within 1 cm/s during bypass (p = 0.02). Conclusion: Risk factors contributing to dNCR among the tested patients were older age and middle cerebral artery blood flow velocity decrease during bypass.

Objective This study was performed to investigate the correlation among decreased regional cerebral oxygen saturation (rSO 2 ), blood levels of brain injury biomarkers, and postoperative cognitive disorder (POCD) after cardiac surgery with cardiopulmonary bypass (CPB). Methods This prospective observational study included 59 patients undergoing coronary artery bypass graft surgery with CPB. All patients underwent neuropsychological tests (Mini Mental State Evaluation, Rey Auditory Verbal Learning Test, digit span test, digit symbol substitution test, and Schulte table) the day before and 10 days after the surgery. The blood levels of two brain injury biomarkers, neuron-specific enolase (NSE) and glial fibrillary acidic protein (GFAP), were measured before and 1 day after the surgery. Results The rSO 2 decreased during surgery in 21 (35%) patients. POCD was detected in 22 (37%) patients. After the surgery, no significant changes in the GFAP blood level occurred in any patients. No significant correlations were found among the decreased rSO 2 , increased NSE blood level, and rate of POCD. Conclusion These results suggest that a decrease in rSO 2 during cardiac surgery is not necessarily related to the development of POCD or an increased blood level of the brain injury biomarker NSE.

Background and objective: The purpose of our study was to evaluate 1- and 2-year results and the influence of risk factors on the outcome in the patients undergoing iliac artery stenting for TASC II type B, C, and D iliac lesions. Materials and methods: In this prospective nonrandomized study conducted between April 15, 2011, and April 15, 2013, 316 patients underwent angiography with a diagnosis of aortoiliac atherosclerotic disease. Of these, 62 iliac endovascular procedures (87 stents) were performed in 54 patients. Results: The indications for revascularization were disabling claudication (Rutherford 2, 5.9%; Rutherford 3, 35.2%), rest pain (Rutherford 4, 22.2%), and gangrene (Rutherford 5, 16.7%). The overall complication rate was 9.2%. The cumulative primary stent patency at 1 and 2 years was 83.0% ± 5.2% and 79.9% ± 5.8%, respectively. Early stent thrombosis in ≤30 days was detected in two patients (3.7%). The primary patency rates for the stents ≤61 mm at 12 and 24 months were 90.6% ± 4.5% and 86.6% ± 5.8%, respectively; those for the stents >61 mm were 67.7% ± 10.9% and 60.2% ± 12.0%, respectively (P = 0.016). The multivariate Cox regression analysis enabled the localization of a stent in both the CIA and the EIA (hazard ratio [HR], 3.3; 95% confidence interval [CI], 1.1–9.5; P = 0.021) and poor runoff (HR, 3.2; 95%, CI 1.0–10.0; P = 0.047) as independent predictors of decreased stent primary patency. Conclusions: The localization of a stent in both iliac (CIA and EIA) arteries and poor runoff significantly reduce the primary stent patency. Patients with stents >61 mm have a higher risk of stent thrombosis or in-stent restenosis development.

The aim of the study was to assess the effect of vitamin D-binding protein (DBP) polymorphism on coronary artery disease (CAD). DBP phenotypes were identified in the groups: control (n=306), men suffering from CAD (n=154), and long-lived individuals (n=108). Isoelectric focusing of DBP phenotypes in serum was performed on polyacrylamide gel. Distribution of DBP phenotypes in the study groups was found to be in Hardy-Weinberg equilibrium. Gc1s-1s phenotype and Gc1s allele frequency in CAD groups were significantly higher than in control, and Gc1s allele frequency was found significantly more often in CAD compared with long-lived group (p

Transforming growth factor β1 (TGF- β1) is a cytokine that participates in a broad range of cellular regulatory processes and is associated with various diseases including aortic aneurysm. Increased TGF- β1 levels are associated with Marfan syndrome (MFS) caused by FBN1 mutations and subsequent defects in signaling system. We studied TGF- β1 levels in 62 patients with sporadic, non syndromic, dilatative pathology of ascending aorta (DPAA) and in reference group subjects (n = 212). An initial screening of 212 reference individuals identified TGF- β1 gender discrepancies and age-dependent cytokine increase in women. Patients with DPAA had increased levels of TGF- β1 in comparison to reference group subjects (median 7.7 ng/ml, range 2.1-25.3, and median 6.2 ng/ml, range 1.0-33.1, respectively). There is a significant association between TGF-β1 concentration and DPAA (OR 1.084, CI 1.027-1.144, p = 0.004) but the mechanisms of cause and effect have not been established yet. Slightly increased TGF-β1 concentrations in patients with sporadic DPAA in comparison to the reference subjects show a potential use of TGF-β1 as a biomarker for the disease. However, cytokine dependence on age, gender, and other unknown factors among individuals with no cardiovascular complains reduces its specificity for DPAA. We would also like to raise awareness regarding the choice of methods when measuring TGF-β1 levels with an emphasis on preanalytical phase and the choice of sample.

Because of the optical features of heart tissue, optical and electrical action potentials are only moderately associated, especially when near-infrared dyes are used in optical mapping (OM) studies.By simultaneously recording transmural electrical action potentials (APs) and optical action potentials (OAPs), we aimed to evaluate the contributions of both electrical and optical influences to the shape of the OAP upstroke.A standard glass microelectrode and OM, using an near-infrared fluorescent dye (di-4-ANBDQBS), were used to simultaneously record transmural APs and OAPs in a Langendorff-perfused rabbit heart during atrial, endocardial, and epicardial pacing. The actual profile of the transmural AP upstroke across the LV wall, together with the OAP upstroke, allowed for calculations of the probing-depth constant (k ~2.1 mm, n = 24) of the fluorescence measurements. In addition, the transmural AP recordings aided the quantitative evaluation of the influences of depth-weighted and lateral-scattering components on the OAP upstroke. These components correspond to the components of the propagating electrical wave that are transmural and parallel to the epicardium. The calculated mean values for the depth-weighted and lateral-scattering components, whose sum comprises the OAP upstroke, were (in ms) 10.18 ± 0.62 and 0.0 ± 0.56 for atrial stimulation, 9.37 ± 1.12 and 3.01 ± 1.30 for endocardial stimulation, and 6.09 ± 0.79 and 8.16 ± 0.98 for epicardial stimulation; (n = 8 for each). For this dye, 90% of the collected fluorescence originated up to 4.83 ± 0.18 mm (n = 24) from the epicardium.The co-registration of OM and transmural microelectrode APs enabled the probing depth of fluorescence measurements to be calculated and the OAP upstroke to be divided into two components (depth-weighted and lateral-scattering), and it also allowed the relative strengths of their effects on the shape of the OAP upstroke to be evaluated.

Audronė Veikutienė1, Rimantas Benetis1, Edmundas Širvinskas2, Pranas Grybauskas3, Judita Andrejaitienė2, Vincentas Veikutis2, Jonas Šurkus4 1 Kauno medicinos universiteto klinikų Širdies, krūtinės ir kraujagyslių chirurgijos klinika, Eivenių g. 2, LT-50009 Kaunas 2 Kauno medicinos universiteto Biomedicininių tyrimų institutas, Eivenių g. 2, LT-50009 Kaunas 3 Kauno medicinos universiteto Kardiologijos institutas, Eivenių g. 2, LT-50009 Kaunas 4 Kauno medicinos universiteto klinikų Nefrologijos klinika, Eivenių g. 2, LT-50009 Kaunas El paštas: aveikutiene@gmail.com Įvadas / tikslas Įvairūs metodai yra siūlomi alogeninio kraujo poreikiui po širdies operacijų sumažinti. Šio darbo tikslas – nustatyti, ar tikslinga naudoti reinfuzijai autologinį kraują, ištekėjusį ankstyvuoju pooperaciniu laikotarpiu, atsižvelgiant į reinfuzijos įtaką ligos pooperacinei eigai. Ligoniai ir metodai Ištirta 90 ligonių, kuriems atliktos širdies operacijos naudojant dirbtinę kraujo apytaką. Tiriamieji suskirstyti į dvi grupes. Pirmą grupę (n = 41) sudarė ligoniai, kuriems po operacijos per 4 valandas į kardiotominį rezervuarą išsiskyręs kraujas buvo surenkamas į sterilius plastikinius maišelius, centrifuguojamas, o gauti autologiniai eritrocitai grąžinami ligoniui. Antros grupės (n = 49) ligoniams išsiskyręs autologinis kraujas nebuvo grąžinamas. Palyginome hemoglobino, hematokrito, leukocitų, C reaktyviojo baltymo vertes prieš operaciją, po operacijos praėjus 4 val., 20 val. ir penktą parą. Tyrėme prokalcitonino koncentraciją serume praėjus 4 val. ir 20 val. po operacijos. Įvertinome netekto kraujo kiekį per 20 val. laikotarpį. Rezultatai Grupių demografiniai, intraoperaciniai duomenys, kairiojo skilvelio išstūmimo frakcija, NYHA funkcinė klasė nesiskyrė. Prieš operaciją ir praėjus 4 val. po operacijos hemoglobino, hematokrito, leukocitų, C reaktyviojo baltymo, prokalcitonino vertės grupėse buvo panašios. Hemoglobino, hematokrito vertės, leukocitų skaičius tarp grupių reikšmingai nesiskyrė ir po 20 val. bei penktą parą. Praėjus 20 val. po operacijos, prokalcitonino koncentracijos padidėjimas (> 0,5–2 ng/ml) dažniau pasitaikė II grupės ligoniams (58,3% / 33,3%). Penktą parą C reaktyviojo baltymo vertė buvo mažesnė I grupėje (70,63 ± 34,23), palyginti su II grupe (93,53 ± 45,48; p < 0,05). Pooperacinis kraujo netekimas per pirmąsias 20 val. tarp grupių reikšmingai nesiskyrė. Alogeninio kraujo transfuzijų poreikis buvo reikšmingai mažesnis I grupės ligoniams: 14,6% / 38,8% (p < 0,05). Infekcinės komplikacijos registruotos I grupės 2,4% ligonių ir II grupės 10,2% ligonių (p < 0,05) Pooperacinio hospitalizavimo trukmė 35,19% buvo trumpesnė I grupės tiriamųjų (p < 0,05). Išvada Ankstyva po širdies operacijos ištekėjusio autologinio, centrifuguoto kraujo reinfuzija nedidino kraujavimo bei sisteminio uždegiminio atsako. Autologinių eritrocitų ankstyvos reinfuzijos grupėje mažėjo alogeninio kraujo transfuzijų poreikis, infekcinių komplikacijų rizika, buvo trumpesnė pooperacinio hospitalizavimo trukmė. Pagrindiniai žodžiai: autologinis kraujas, alogeninis kraujas, dirbtinė kraujo apytaka Benefit of early reinfusion of autologous shed mediastinal blood after cardiac surgery Audronė Veikutienė1, Rimantas Benetis1, Edmundas Širvinskas2, Pranas Grybauskas3, Judita Andrejaitienė2, Vincentas Veikutis2, Jonas Šurkus4 1 Kaunas University of Medicine Hospital, Department of Cardiothoracic and Vascular Surgery, Eivenių str. 2, LT-50009 Kaunas, Lithuania 2 Kaunas University of Medicine, Institute for Biomedical Research, Eivenių str. 2, LT-50009 Kaunas, Lithuania 3 Kaunas University of Medicine, Institute of Cardiology, Eivenių str. 2, LT-50009 Kaunas, Lithuania 4 Kaunas University of Medicine Hospital, Department of Nefrology, Eivenių str. 2, LT-50009 Kaunas, Lithuania E-mail: aveikutiene@gmail.com Background / objective Various strategies have been proposed to decrease allogeneic transfusion requirements after cardiac surgery. The aim of the study was to evaluate the efficacy of collected and reinfused autologous shed mediastinal blood on the postoperative cource. Patients and methods We investigated 90 patients who underwent cardiac surgery with cardiopulmonary bypass. The patients were divided into two groups: group I (n = 41) received the centrifuged autologous shed mediastinal blood collected from the cardiotomy reservoir following 4 hours after surgery; in group II (n = 49) all shed mediastinal blood was discarded (control group). Haemoglobin, haematocrit, C-reactive protein values, leucocyte count were compared before surgery, 4 h, 20 h after surgery and on the fifth postoperative day. We have measured serum procalcitonin concentration at 4 h and 20 h after cardiopulmonary bypass. We assessed drained blood loss within 20 postoperative hours. Results There were no significant differences in patients’ demographic, operative data, left ventricle ejection fraction, NYHA functional class between the two groups. C-reactive protein, procalcitonin concentration, haemoglobin, haematocrit values, leucocyte count did not differ between the groups before and at 4 hours after surgery. Haemoglobin, haematocrit level, leucocyte count were similar at 20 hours and on the fifth day after surgery. At 20 hours after surgery, an increase of serum procalcitonin concentration (> 0.5–2 ng/ml) was more frequent in group II (58.3% vs 33.3%). On the fifth postoperative day, the C-reactive protein value was lower in group I (70.63 ± 34.23; p < 0.05), compared to group II (93.53 ± 45.48). Postoperative blood loss did not differ between the groups. Requirement for allogeneic transfusion was significantly lower in group I (14.6% vs 38.8%; p < 0.05). Patients in group I developed less infective complications as compared with the group II (2.4% and 10.2%, respectively; p < 0.05). The length of postoperative in-hospital stay was shorter by 35.19% in group I (p < 0.05) as compared with group II. Conclusions Reinfusion of centrifuged autologous shed mediastinal blood did not increase bleeding tendency and systemic inflammatory response. Requirement for allogeneic transfusion, the risk of postoperative infection and the length of postoperative in-hospital stay was lower in autotransfused patients (group I). The estimation of serum procalcitonin concentration is a usable and rather informative test for evaluating inflammatory response activity after cardiac surgery. Key words: autologous blood, allogeneic blood, cardiopulmonary bypass

Donatas Inčiūra1, Rimantas Benetis1,2, Šarūnas Kinduris1,3 1 Kauno medicinos universiteto klinikų Širdies, krūtinės ir kraujagyslių chirurgijos klinika, Eivenių g. 2, LT-50009 Kaunas 2 Kardiologijos institutas, Sukilėlių g. 17, LT-50009 Kaunas 3 Kauno medicinos universiteto Biomedicininių tyrimų institutas, Eivenių g. 4, LT-50009 Kaunas El paštas: inciura@takas.lt Įvadas / tikslas Nustatyti vienmomenčių vainikinių jungčių suformavimo ir miego arterijų endarterektomijų operacijų įtaką bendriems pooperaciniams rezultatams, ligonių išgyvenamumui ir vėlyvam insultui lyginant su izoliuotomis miokardo revaskulizacijos operacijomis. Ligoniai ir metodai KMUK Širdies, krūtinės ir kraujagyslių klinikoje per pastaruosius penkerius metus atliktos 49 vienmomentės miokardo revaskulizacijos ir miego arterijų endarterektomijų operacijos. Rezultatai Palyginti su izoliuotų miokardo revaskulizacijos operacijų grupe, kompleksinės miego arterijų pažeidimo grupės ligoniai buvo vyresni (atitinkamai 69,9 m. (6,54) ir 65,46 m. (9,60), p < 0,01), daugiau jų sirgo cukriniu diabetu (16 (32,7%) ir 14 (16,7%), p < 0,05) ir periferinių kraujagyslių ateroskleroze (16 (32,7%) ir 8 (9,5%), p < 0,01). Vienmomenčių operacijų trukmė (254,39 (76,21) min. ir 217,50 min. (65,66), p < 0,01) ir kompleksiškai operuotų ligonių hospitalizacijos laikas (34,98 paros (14,78) ir 26,79 paros (15,37), p < 0,01) buvo ilgesni. Nors kompleksiškai operuotiems ligoniams nustatyti reikšmingi operacinės rizikos veiksniai, kompleksinės miego arterijų pažeidimo grupės ligonių pooperacinių komplikacijų dažnis ir mirštamumas reikšmingai nesiskyrė nuo kontrolinės miokardo revaskulizacijos operacijų grupės. Vienmomentiškai operuotų ligonių išgyvenamumo ir vėlyvo insulto tikimybė nesiskiria nuo izoliuotų miokardo revaskulizacijos operacijų stebėjimo laikotarpiu iki 62 mėnesių. Išvados Kompleksinės išeminės širdies ligos ir kaklo kraujagyslių vienmomentės operacijos rezultatai nesiskiria nuo izoliuotos miokardo revaskulizacijos operacijų rezultatų, todėl atlikti jas vienmomentiškai yra saugu. Pagrindiniai žodžiai: išeminė širdies liga, miego arterijų pažeidimas, kompleksinės operacijos Early and late clinical outcomes of simultaneous coronary and carotid artery operations Donatas Inčiūra1, Rimantas Benetis1,2, Šarūnas Kinduris1,3 1 Kaunas University of Medicine Hospital, Department of Cardiothoracic and Vascular Surgery, Eivenių str. 2, LT-50009 Kaunas, Lithuania 2 Institute of Cardiology, Sukilėlių str. 17, LT-50009 Kaunas, Lithuania 3 Institute for Biomedical Research, Eivenių str. 4, LT-50009 Kaunas, Lithuania E-mail: inciura@takas.lt Background / objective The optimal management of patients with significant carotid and coronary artery disease remains controversial. The aim of the study was to compare the early and late clinical outcomes of simultaneous coronary and carotid artery operations versus isolated coronary artery bypass grafting operations. Patients and methods From 2000 through 2005, 45 patients underwent simultaneous carotid endarterectomy following coronary artery bypass grafting. Results Patients that underwent simultaneous operations were older (69.9 y. (6.54) vs. 65.46 y. (9.60), p < 0.01), had more diabetes mellitus (16 (32.7%) vs. 14 (16.7%.), p < 0.05) and peripheral artery disease (16 (32.7%) vs. 8 (9.5%), p < 0.01). Duration of combined operations (254.39 (76.21) min vs. 217.50 min (65.66), p < 0.01) and hospitalization (34.98 days (14.78) vs. 26.79 days (15.37), p < 0.01) was longer in the simultaneous group. The frequency of postoperative complications and mortality in the carotid artery group did not reliably differ as compared with the control group. In the combined carotid artery group, the survival and late stroke probability did not differ as compared with the control isolated coronary artery bypass grafting group in the follow-up period (62 months). Conclusions Simultaneous carotid endarterectomy and coronary artery bypass grafting operations resulted in a low perioperative mortality and morbidity rates in high-risk patients and are safe to be performed on patients with concomitant carotid artery disease. Key words: ischemic heart disease, carotid artery stenosis, simultaneous operation