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Background: Left atrial appendage occlusion (LAAO) is a safe and effective alternative for stroke prevention in patients with atrial fibrillation (AF). However, there is little literature on the exact causes of death and adverse events during follow‑up after LAAO. Aims: The primary aim of this study was to evaluate survival free of any serious adverse events and of any‑cause death in midterm follow‑up. The secondary aims were to analyze causes of mortality and further hospitalization as well as adverse events, thromboembolism, and bleeding risk reduction during follow‑up. Methods: A retrospective, single‑center study was performed in 84 consecutive patients with AF who underwent LAAO with endocardial occluders. The mean (SD) CHADS2 score was 3.5 (1.1), CHA2DS2‑VASc score, 5.0 (1.5), and HAS‑BLED score, 4.4 (0.9). After LAAO, dual 6‑month antiplatelet therapy and then lifelong aspirin monotherapy was recommended. Mean (SD) follow‑up was 25.3 (13.2) months with an accumulated total follow‑up of 174.6 patient‑years. Results: The annual mortality rate was 12.02%. More than half of deaths (57%) were due to noncardiovascular causes with leading malignancy. Survival at the end of the periprocedural period was 98.8%, at 3 months, 97.6%, at 6 months, 95.2%, at 12 months, 86.5%, at 18 months, 85.1%, and at 24 months, 80.6%. The average annual thromboembolic event rate was 2.87%. The most common adverse event was severe bleeding with an annual rate of 6.3% (3 cases while receiving dual antiplatelet therapy and 6 cases while receiving aspirin). Conclusions: The majority of deaths were not related to stroke in patients with AF after LAAO. Mortality in first 2 years following the procedure was predominantly from noncardiovascular causes.

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.

To present the results of treatment and evaluate 6 months of follow-up in a group of patients with non-valvular atrial fibrillation, who underwent the procedure of percutaneous left atrial appendage occlusion (PLAAO).Percutaneous left atrial appendage occlusion was performed in 34 patients with non-valvular atrial fibrillation and contraindications for oral anticoagulation therapy. The risk of thromboembolic and bleeding complications was determined based on the CHA2DS2VASc and HAS-BLED scales. The Amplatzer Amulet system from St. Jude Medical was used. On the first postoperative day, all patients were started on double antiplatelet therapy with 75 mg/day of acetylsalicylic acid (ASA) and 75 mg/day of clopidogrel (CLO). On the 30(th) postoperative day, the efficacy of the antiplatelet therapy was assessed with impedance aggregometry using a Multiplate analyzer (Roche). Echocardiographic examinations were performed intraoperatively and on the first postoperative day; subsequently, follow-up examinations were conducted 1 and 6 months after the implantation.In all patients, proper occluder position was observed throughout the follow-up. No leakage or thrombi around the implants were found. No strokes or bleeding complications associated with the antiplatelet therapy were observed. Multiplate assessment of platelet activity was conducted in 20 out of 34 patients. The efficacy of ASA treatment was demonstrated in all patients; no response to clopidogrel treatment was observed in 5 out of 20 patients. One patient suffered from cardiac tamponade, which required the performance of full sternotomy. Local complications (hematomas of the inguinal region) were observed in 3 patients. One of the patients died for reasons unrelated to the procedure.Percutaneous left atrial appendage occlusion is an effective procedure in patients with non-valvular atrial fibrillation and contraindications for chronic anticoagulation therapy. Further observation is necessary to evaluate the longterm results.Przedstawienie wyników leczenia oraz ocena sześciomiesięcznego okresu obserwacji w grupie chorych z niezastawkowym migotaniem przedsionków poddanych procedurze przezskórnego zamknięcia uszka lewego przedsionka.Zabieg przezskórnego zamknięcia uszka lewego przedsionka (U wszystkich chorych stwierdzono prawidłowe położenie okludera w całym okresie obserwacji. Nie stwierdzono przecieków i skrzeplin wokół implantu. Nie obserwowano udarów i powikłań krwotocznych związanych z leczeniem przeciwpłytkowym. Badanie aktywności płytek Multiplate przeprowadzono u 20 spośród 34 chorych. W badaniu wykazano skuteczność leczenia ASA u wszystkich chorych oraz brak odpowiedzi na leczenie KLO u 5 spośród 20 chorych. Wystąpiła 1 tamponada serca wymagająca wykonania pełnej sternotomii. U 3 chorych obserwowano powikłania miejscowe – krwiaki okolicy pachwinowej. Nastąpił 1 zgon pacjentki z przyczyn niezwiązanych z zabiegiem.Zabieg przezskórnego zamknięcia uszka lewego przedsionka u chorych z niezastawkowym migotaniem przedsionków i przeciwwskazaniami do przewlekłej terapii przeciwkrzepliwej jest procedurą skuteczną. Konieczna jest dalsza obserwacja chorych w celu oceny wyników odległych.

We present a case of a 67-year-old female patient with diagnosed papillary fibroelastoma (PFE) of the aortic valve. Eight months before the tumour discovery a non-ST segment elevation myocardial infarction without essential coronary artery restriction was diagnosed. The tumour was excised (during the aortotomy under cardiopulmonary bypass at systemic hypothermia) without any aortic valve injury. The main symptoms of PFE along with diagnostic techniques and treatment were described.

The aim of the work was to study the influence of extracorporal circulation (ECC) on the vascular endothelial markers: von Willebrand factor (vWf), tissue plasminogen activator (t-PA) and trombomodulin (TM) in patients with coronary heart disease (CHD) undergoing coronary artery bypass graft (CABG). Examined group consisted of 30 patients (22 men, 8 women) at mean age 58.0 +/- 8.0 years, among them 19--were operated with ECC, 11--without ECC. Before and during operation blood was drawn 6 times. Control group consisted of 23. healthy volunteers at similar age. In the plasma vWf, t-PA and TM were determined with immunoenzymatic methods. Before operation the examined parameters were significantly higher compared to controls. The concentration of vWf during ECC was higher than in operation without ECC, but not significant. Differences statistically significant in the blood collected during ECC and without it appeared in t-PA only on the 3. and in TM on the 1. and 3. day after operation. It seems that ECC does not damage vascular endothelium direct, only indirect trough proinflammatory factors released from activated during ECC granulocytes and platelets.