Publications by authors named "Jolanta Biernat"

38 Publications

Local electromechanical alterations determine the left ventricle rotational dynamics in CRT-eligible heart failure patients.

Sci Rep 2021 Feb 5;11(1):3267. Epub 2021 Feb 5.

Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland.

Left ventricle, LV wringing wall motion relies on physiological muscle fiber orientation, fibrotic status, and electromechanics (EM). The loss of proper EM activation can lead to rigid-body-type (RBT) LV rotation, which is associated with advanced heart failure (HF) and challenges in resynchronization. To describe the EM coupling and scar tissue burden with respect to rotational patterns observed on the LV in patients with ischemic heart failure with reduced ejection fraction (HFrEF) left bundle branch block (LBBB). Thirty patients with HFrEF/LBBB underwent EM analysis of the left ventricle using an invasive electro-mechanical catheter mapping system (NOGA XP, Biosense Webster). The following parameters were evaluated: rotation angle; rotation velocity; unipolar/bipolar voltage; local activation time, LAT; local electro-mechanical delay, LEMD; total electro-mechanical delay, TEMD. Patients underwent late-gadolinium enhancement cMRI when possible. The different LV rotation pattern served as sole parameter for patients' grouping into two categories: wringing rotation (Group A, n = 6) and RBT rotation (Group B, n = 24). All parameters were aggregated into a nine segment, three sector and whole LV models, and compared at multiple scales. Segmental statistical analysis in Group B revealed significant inhomogeneities, across the LV, regarding voltage level, scar burdening, and LEMD changes: correlation analysis showed correspondently a loss of synchronization between electrical (LAT) and mechanical activation (TEMD). On contrary, Group A (relatively low number of patients) did not present significant differences in LEMD across LV segments, therefore electrical (LAT) and mechanical (TEMD) activation were well synchronized. Fibrosis burden was in general associated with areas of low voltage. The rotational behavior of LV in HF/LBBB patients is determined by the local alteration of EM coupling. These findings serve as a strong basic groundwork for a hypothesis that EM analysis may predict CRT response.Clinical trial registration: SUM No. KNW/0022/KB1/17/15.
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http://dx.doi.org/10.1038/s41598-021-82793-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7865069PMC
February 2021

The influence of scar on the spatio-temporal relationship between electrical and mechanical activation in heart failure patients.

Europace 2020 05;22(5):777-786

Center for Computational Medicine in Cardiology, Università della Svizzera italiana, Via G. Buffi 13, CH-6900 Lugano, Switzerland.

Aims: The aim of this study was to determine the relationship between electrical and mechanical activation in heart failure (HF) patients and whether electromechanical coupling is affected by scar.

Methods And Results: Seventy HF patients referred for cardiac resynchronization therapy or biological therapy underwent endocardial anatomo-electromechanical mapping (AEMM) and delayed-enhancement magnetic resonance (CMR) scans. Area strain and activation times were derived from AEMM data, allowing to correlate mechanical and electrical activation in time and space with unprecedented accuracy. Special attention was paid to the effect of presence of CMR-evidenced scar. Patients were divided into a scar (n = 43) and a non-scar group (n-27). Correlation between time of electrical and mechanical activation was stronger in the non-scar compared to the scar group [R = 0.84 (0.72-0.89) vs. 0.74 (0.52-0.88), respectively; P = 0.01]. The overlap between latest electrical and mechanical activation areas was larger in the absence than in presence of scar [72% (54-81) vs. 56% (36-73), respectively; P = 0.02], with smaller distance between the centroids of the two regions [10.7 (4.9-17.4) vs. 20.3 (6.9-29.4) % of left ventricular radius, P = 0.02].

Conclusion: Scar decreases the association between electrical and mechanical activation, even when scar is remote from late activated regions.
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http://dx.doi.org/10.1093/europace/euz346DOI Listing
May 2020

Opioidergic conditioning of the human heart muscle in nitric oxide-dependent mechanism.

Adv Clin Exp Med 2018 Aug;27(8):1069-1073

Department of Cardiac and Vascular Diseases, the John Paul II Hospital, Jagiellonian University Medical College, Kraków, Poland.

Background: Opioidergic conditioning is well documented to trigger cardioprotection against ischemia/ reperfusion (I/R) injury. Previous studies on animal models have suggested that nitric oxide (NO) mediates the beneficial effect of opioids, but the role of NO in humans seems to be controversial.

Objectives: The aim of the study was to assess the influence of NO modulators on opioid-induced cardioprotection in the human myocardium.

Material And Methods: Trabeculae of the human right atria were electrically driven in an organ bath and subjected to simulated I/R injury. The non-selective inhibitor of nitric oxide synthase (NOS) - N-methyl-l-arginine (LNMMA), the donor of NO - S-Nitroso-N-acetylpenicillamine (SNAP) or morphine (in the amount of 10-4 M) were used at the time of re-oxygenation. The additional trabecula was subjected to the hypoxia protocol only (control). The contractility of the myocardium was assessed as the maximal force of a contraction (Amax), the rate of rise of the force of a contraction (Slope L) and the cardiac muscle relaxation - as the rate of decay of the force of a contraction (Slope T).

Results: The application of 100 μM LNMMA resulted in the decrease of Amax, Slope L and Slope T during the re-oxygenation period as compared to control. The application of 10-4 M morphine and/or 100 μM SNAP resulted in a partial reversal of the detrimental influence of LNMMA.

Conclusions: At the re-oxygenation period, the blockade of NO synthesis has a deleterious effect on the systolic and diastolic function of the human myocardium as well as attenuates the beneficial effect of morphine conditioning.
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http://dx.doi.org/10.17219/acem/70192DOI Listing
August 2018

Sex Difference in Patients With Ischemic Heart Failure Undergoing Surgical Revascularization: Results From the STICH Trial (Surgical Treatment for Ischemic Heart Failure).

Circulation 2018 02;137(8):771-780

Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (P.D.-N.).

Background: Female sex is conventionally considered a risk factor for coronary artery bypass grafting (CABG) and has been included as a poor prognostic factor in multiple cardiac operative risk evaluation scores. We aimed to investigate the association of sex and the long-term benefit of CABG in patients with ischemic left ventricular dysfunction enrolled in the prospective STICH trial (Surgical Treatment for Ischemic Heart Failure Study).

Methods: The STICH trial randomized 1212 patients (148 [12%] women and 1064 [88%] men) with coronary artery disease and left ventricular ejection fraction ≤35% to CABG+medical therapy (MED) versus MED alone. Long-term (10-year) outcomes with each treatment were compared according to sex.

Results: At baseline, women were older (63.4 versus 59.3 years; =0.016) with higher body mass index (27.9 versus 26.7 kg/m; =0.001). Women had more coronary artery disease risk factors (diabetes mellitus, 55.4% versus 37.2%; hypertension, 70.9% versus 58.6%; hyperlipidemia, 70.3% versus 58.9%) except for smoking (13.5% versus 21.8%) and had lower rates of prior CABG (0% versus 3.4%; all <0.05) than men. Moreover, women had higher New York Heart Association class (class III/IV, 66.2% versus 57.0%), lower 6-minute walk capacity (300 versus 350 m), and lower Kansas City Cardiomyopathy Questionnaire overall summary scores (51 versus 63; all <0.05). Over 10 years of follow-up, all-cause mortality (49.0% versus 65.8%; adjusted hazard ratio, 0.67; 95% confidence interval, 0.52-0.86; =0.002) and cardiovascular mortality (34.3% versus 52.3%; adjusted hazard ratio, 0.65; 95% confidence interval, 0.48-0.89; =0.006) were significantly lower in women compared with men. With randomization to CABG+MED versus MED treatment, there was no significant interaction between sex and treatment group in all-cause mortality, cardiovascular mortality, or the composite of all-cause mortality or cardiovascular hospitalization (all >0.05). In addition, surgical deaths were not statistically different (1.5% versus 5.1%; =0.187) between sexes among patients randomized to CABG per protocol as initial treatment.

Conclusions: Sex is not associated with the effect of CABG+MED versus MED on all-cause mortality, cardiovascular mortality, the composite of death or cardiovascular hospitalization, or surgical deaths in patients with ischemic left ventricular dysfunction. Thus, sex should not influence treatment decisions about CABG in these patients.

Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00023595.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.117.030526DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5896331PMC
February 2018

Ischemic conditioning of human heart muscle depends on opioid-receptor system.

Folia Med Cracov 2017;57(2):31-39

Medical University of Silesia, Department of Electrocardiology and Heart Failure, Katowice, Poland.

Background: Despite progress in the invasive treatment of ischemic heart disease, the ability to limit ischemia-reperfusion (I/R) injury remains largely unrealized. Ischemic pre-conditioning (IPC) and post-conditioning (POC) induce the protective mechanisms of resistance against I/R injury. Stimulation of opioid receptors mimic the protective effect of IPC or POC in an animal models. We tested the hypothesis, that IPC and POC provide cardioprotection in opioid-dependent mechanism in human myocardium.

Methods: Human atrial trabeculae were subjected to I/R injury. To achieve IPC, single hypoxia period preceded the applied lethal hypoxia, to achieve POC triple hypoxia periods followed lethal hypoxia. Naloxone was used at the onset of lethal hypoxia in IPC protocol, and at the time of re-oxygenation in POC protocol. Contractive function of the myocardium was assessed as maximal force of contraction (Amax), rate of rise of force of contraction (+dV/dT) and diastolic parameter - rate of decay of force of contraction (-dV/dT).

Results: Co-application of naloxone with IPC or POC resulted in decrease of Amax, +dV/dT and -dV/dT during re-oxygenation period as compared to IPC or POC only.

Conclusions: Naloxone abrogates beneficial effect of IPC and POC. IPC and POC in humans provide cardioprotection in opioid receptor system dependent mechanism.
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July 2019

'Opioidergic postconditioning' of heart muscle during ischemia/reperfusion injury.

Cardiol J 2017 13;24(4):419-426. Epub 2016 Oct 13.

John Paul II Hospital, Department of Cardiac and Vascular Diseases, Krakow..

Background: Ischemic preconditioning and postconditioning are the novel strategies of attaining cardioprotection against ischemia/reperfusion (I/R) injury. Previous studies suggested the role of opioid pathway, however the class of opioid receptors responsible for this effect in humans remains unknown. The aim of the study was to assess the influence of opioids on simulated I/R injury outcomes in the hu-man myocardium.

Methods: Trabeculae of the human right atrium were electrically driven in organ bath and subjected to simulated I/R injury. Morphine (10-4M, 10-5M, 10-6M) or d-opioid receptor agonist DADLE (10-8M, 10-7M, 10-6M) was used at the time of re-oxygenation. Additional trabecula was subjected to hypoxia protocol only (Control). Contractive force of the myocardium was assessed as the maximal force of a contraction (Amax), the rate of rise of the force of a contraction (Slope L) and relaxation as the rate of decay of the force of a contraction (Slope T).

Results: Application of morphine 10-4M resulted in increase of Amax, Slope L and Slope T during re-oxygenation period as compared to Control (77.99 ± 1.5% vs. 68.8 ± 2.2%, p < 0.05; 45.72 ± 2.9% vs. 34.12 ± 5.1%, p < 0.05; 40.95 ± 2.5% vs. 32.37 ± 4.3%, p < 0.05). Parameters were not significantly different in the lower morphine concentrations. Application of DADLE 10-6M resulted in decrease of Amax and Slope L as compared to Control (68.13 ± 5.5% vs. 76.62 ± 6.6%, p < 0.05; 28.29 ± 2.2 vs. 34.80 ± 3.9%, p < 0.05).

Conclusions: At re-oxygenation, morphine improves systolic and diastolic function of the human myo-cardium in the dose-dependent manner. Delta-opioid receptor stimulation attenuates systolic function of human heart muscle which remains in contrast to previous reports with animal models of I/R injury. (Cardiol J 2017; 24, 4: 419-425).
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http://dx.doi.org/10.5603/CJ.a2016.0090DOI Listing
May 2018

Frailty Syndrome in Heart Failure Patients who are Receiving Cardiac Resynchronization.

Pacing Clin Electrophysiol 2016 Apr 21;39(4):370-4. Epub 2016 Jan 21.

Department of Electrocardiology, Upper Silesian Heart Centre, Katowice, Poland.

Background: We hypothesized that patients with de novo cardiac resynchronization therapy (CRT) implantation had a more intense frailty syndrome when compared to the patients who qualified for a system upgrade.

Methods: One hundred and six patients aged ≥65 years were included. They were divided into two groups: de novo CRT implantation--74 patients and upgrade from standard right heart pacing--32 patients. A CRT was finally implanted in all of the patients. Frailty was evaluated using the Canadian Study of Health and Aging Clinical Frailty Scale (CSHA-CFS).

Results: The average results in CSHA-CFS were statistically higher (5.3 ± 0.8) in the de novo patients when compared to the patients who qualified for a system upgrade (4.9 ± 0.8); P = 0.027. Frailty syndrome was recognized in 81.1% of the patients in the de novo group and in 68.7% of the patients in the upgrade group; P = 0.164. Only one patient of the 106 had no attributes of frailty (or exposed ones) syndrome.

Conclusions: Frailty syndrome is a common phenomenon in patients with heart failure and over 65 years of age. The syndrome is most often recognized in patients who are de novo qualified for cardiac resynchronization.
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http://dx.doi.org/10.1111/pace.12800DOI Listing
April 2016

Socioeconomic status and cardiovascular health in the changing world.

Cardiol J 2015 ;22(5):477-8

Department of Electrocardiology and Hear t Failure, School of Health Sciences, Medical University of Silesia, Katowice, Poland.

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http://dx.doi.org/10.5603/CJ.2015.0066DOI Listing
August 2016

Implication of right ventricular dysfunction on long-term outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction.

J Thorac Cardiovasc Surg 2015 May 5;149(5):1312-21. Epub 2014 Oct 5.

Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.

Objective: Whether right ventricular dysfunction affects clinical outcome after coronary artery bypass grafting with or without surgical ventricular reconstruction is still unknown. The aim of the study was to assess the impact of right ventricular dysfunction on clinical outcome in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting with or without surgical ventricular reconstruction.

Methods: Of 1000 patients in the Surgical Treatment for Ischemic Heart Failure with coronary artery disease, left ventricular ejection fraction 35% or less, and anterior dysfunction, who were randomized to undergo coronary artery bypass grafting or coronary artery bypass grafting + surgical ventricular reconstruction, baseline right ventricular function could be assessed by echocardiography in 866 patients. Patients were followed for a median of 48 months. All-cause mortality or cardiovascular hospitalization was the primary end point, and all-cause mortality alone was a secondary end point.

Results: Right ventricular dysfunction was mild in 102 patients (12%) and moderate or severe in 78 patients (9%). Moderate to severe right ventricular dysfunction was associated with a larger left ventricle, lower ejection fraction, more severe mitral regurgitation, higher filling pressure, and higher pulmonary artery systolic pressure (all P < .0001) compared with normal or mildly reduced right ventricular function. A significant interaction between right ventricular dysfunction and treatment allocation was observed. Patients with moderate or severe right ventricular dysfunction who received coronary artery bypass grafting + surgical ventricular reconstruction had significantly worse outcomes compared with patients who received coronary artery bypass grafting alone on both the primary (hazard ratio, 1.86; confidence interval, 1.06-3.26; P = .028) and the secondary (hazard ratio, 3.37; confidence interval, 1.36-8.37; P = .005) end points. After adjusting for all other prognostic clinical factors, the interaction remained significant with respect to all-cause mortality (P = .022).

Conclusions: Adding surgical ventricular reconstruction to coronary artery bypass grafting may worsen long-term survival in patients with ischemic cardiomyopathy with moderate to severe right ventricular dysfunction, which reflects advanced left ventricular remodeling.
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http://dx.doi.org/10.1016/j.jtcvs.2014.09.117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4385741PMC
May 2015

Mechanisms of functional mitral regurgitation in cardiomyopathy secondary to anterior infarction.

Eur J Cardiothorac Surg 2014 Jun 20;45(6):1089-96. Epub 2014 Feb 20.

2nd Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland.

Objectives: It remains unclear why some patients with cardiomyopathy secondary to anterior infarction do, and others do not develop functional mitral regurgitation (MR).

Methods: Thirty-six patients after anterior infarction with ejection fraction (EF) below 35%, 18 with no/trivial and 18 with moderate/severe MR, underwent cardiac magnetic resonance imaging. Parameters describing the geometry of the mitral valve, subvalvular apparatus and left ventricle were measured.

Results: The septolateral and commissure-to-commissure mitral annular diameters were bigger in patients with MR. The odds ratio (OR) of developing regurgitation was 25.0 (95% confidence interval [95% CI] 4.3-144.3; P < 0.001) for end-systolic septolateral mitral annulus diameter above 20 mm/m(2). MR was less likely in patients with straighter posterior papillary muscle (OR 0.040, 95% CI 0.007-0.23; P < 0.001-for the angle between muscle axis and mitral annulus plane >81°), and more likely (OR 7.9, 95% CI 1.6-39.4; P = 0.008) with posterior papillary muscle tethering >23 mm/m(2). Regurgitation was less likely (OR 0.032, 95% CI 0.003-0.33; P = 0.001) with anterolateral papillary muscle tip to ipsilateral mitral annulus distance in end-diastole longer than 13 mm/m(2). Left ventricular EF, volumes and the overall end-systolic and end-diastolic wall thicknesses did not differ between the groups. Patients with MR had thinner myocardium proximal to the base of the anterior and distal to the base of the posterior papillary muscle.

Conclusions: Inferior extension of anterior infarction and more leaning posterior papillary muscle are the major components resulting in the development of ischaemic MR in patients with cardiomyopathy secondary to anterior infarction. Shorter chordae tendineae may constitute the anatomical background that makes the development of ischaemic MR more likely.
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http://dx.doi.org/10.1093/ejcts/ezt660DOI Listing
June 2014

The co-application of hypoxic preconditioning and postconditioning abolishes their own protective effect on systolic function in human myocardium.

Cardiol J 2013 ;20(5):472-7

Department of Cardiology, Medical University of Silesia, Katowice, Poland.

Background: Ischemic preconditioning (IPC) and postconditioning (POC) are well documented to trigger cardioprotection against ischemia/reperfusion (I/R) injury, but the effect oftheir both co-application remains unclear in human heart. The present study sought to assessthe co-application of IPC and POC on fragments of human myocardium in vitro.

Methods: Muscular trabeculae of the human right atrial were electrically driven in the organbath and subjected to simulated I/R injury - hypoxia/re-oxygenation injury in vitro. To achieveIPC of trabeculae the single brief hypoxia period preceded the applied lethal hypoxia, and to achieve POC triple brief hypoxia periods followed the lethal hypoxia. Additional muscular trabeculae were exposed only to the hypoxic stimulation (Control) or were subjected to the non-hypoxic stimulation (Sham). 10 μM norepinephrine (NE) application ended every experiment to assess viability of trabeculae. The contraction force of the myocardium assessed as a maximal amplitude of systolic peak (%Amax) was obtained during the whole experiment's period.

Results: Co-application of IPC and POC resulted in decrease in %Amax during the re-oxygentaionperiod and after NE application, as compared to Control (30.35 ± 2.25 vs. 41.89 ± 2.25, 56.26 ± 7.73 vs. 65.98 ± 5.39, respectively). This was in contrary to the effects observed when IPC and POC were applied separately.

Conclusions: The co-application of IPC and POC abolishes the cardioprotection of either intervention alone against simulated I/R injury in fragments of the human right heart atria.
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http://dx.doi.org/10.5603/CJ.2013.0131DOI Listing
August 2014

Statistical agreement of left ventricle measurements using cardiac magnetic resonance and 2D echocardiography in ischemic heart failure.

Med Sci Monit 2012 Mar;18(3):MT19-25

Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland.

Background: The aim of this study was to compare cardiac magnetic resonance imaging (CMR) with 2-dimensional echocardiography (2D echo) in the assessment of left ventricle (LV) function parameters and mass in patients with ischemic heart disease and severely depressed LV function. Although 2D echo is commonly used to assess LV indices, CMR is the state-of-the-art technique. Agreement between these 2 methods in these patients has not been well established.

Material/methods: LV indexed end systolic and diastolic volumes (EDVi and ESVi), indexed mass (LVMi) and ejection fraction (EF) were assessed in 67 patients (12 women), using 2D echo and CMR.

Results: According to statistical analysis (Bland-Altman), 2D echo underestimated LV EDV and ESV and overestimated EF and LVMi compared to CMR. The highest correlation between 2D echo and CMR was found for EDVi (R2=0.73, p<0.0001) and ESVi (R2=0.69, p<0.0001) and the lowest for EF (R2=0.21, p=0.001) and LVMi (R2=0.20, p=0.002). The maximal differences between 2D echo and CMR were found for highest mesurements of LV volumes and mass, and for lowest EF values.

Conclusions: There is moderate to strong correlation between CMR and 2D echo in the assessment of LV function parameters and mass in patients with ischemic heart failure. Between-method agreement depends on the degree of LV dysfunction. The results of assessment of the severely damaged LV obtained by the use of 2D echo should be interpreted with caution.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3560747PMC
http://dx.doi.org/10.12659/msm.882507DOI Listing
March 2012

Core lab analysis of baseline echocardiographic studies in the STICH trial and recommendation for use of echocardiography in future clinical trials.

J Am Soc Echocardiogr 2012 Mar 9;25(3):327-36. Epub 2012 Jan 9.

Echocardiography Core Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.

Background: The Surgical Treatment for Ischemic Heart Failure (STICH) randomized trial was designed to identify an optimal management strategy for patients with ischemic cardiomyopathy. Baseline echocardiographic examinations were required for all patients. The primary aim of this report is to describe the baseline STICH Echocardiography Core Laboratory data. The secondary aim is to provide recommendations regarding how echocardiography should be used in clinical practice and research on the basis of the experience gained from echocardiography in STICH.

Methods: Between September 2002 and January 2006, 2,136 patients with ejection fractions (EFs) ≤ 35% and coronary artery disease amenable to coronary artery bypass grafting were enrolled. Echocardiography was acquired by 122 clinical enrolling sites, and measurements were performed by the Echocardiography Core Laboratory after a certification process for all clinical sites.

Results: Echocardiography was available for analysis in 2,006 patients (93.9%); 1,734 (86.4%) were men, and the mean age was 60.9 ± 9.5 years. The mean left ventricular end-systolic volume index, measureable in 72.8%, was 84.0 ± 30.9 mL/m(2), and the mean EF was 28.9 ± 8.3%, with 18.5% of patients having EFs > 35%. Single-plane measurements of left ventricular and left atrial volumes were similar to their volumes by biplane measurement (r = 0.97 and r = 0.92, respectively). Mitral regurgitation severity by visual assessment was associated with a wide range of effective regurgitant orifice area, while effective regurgitant orifice area ≥ 0.2 cm(2) indicated at least moderate mitral regurgitation by visual assessment. Deceleration time of mitral inflow velocity had a weak correlation with EF (r = 0.25) but was inversely related to estimated pulmonary artery systolic pressure (r = -0.49).

Conclusions: In STICH patients with ischemic cardiomyopathy, Echocardiography Core Laboratory analysis of baseline echocardiographic findings demonstrated a wide spectrum of left ventricular shape, function, and hemodynamics, as well as the feasibility and limitations of obtaining essential echocardiographic measurements. It is critical that the use of echocardiographic parameters in clinical practice and research balance the strengths and weaknesses of the technique.
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http://dx.doi.org/10.1016/j.echo.2011.12.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310914PMC
March 2012

Left ventricular aneurysm that grew to rupture.

Interact Cardiovasc Thorac Surg 2010 Aug 3;11(2):196-8. Epub 2010 May 3.

2nd Department of Cardiac Surgery, Medical University of Silesia, ul. Ziolowa 47, 40-635 Katowice, Poland.

We present the case of a 47-year-old man who presented with asymptomatic ischemic cardiomyopathy. His left ventricular end-diastolic volume (EDV) measured 302 ml, ejection fraction (EF) was 30%, and a large akinetic area with no typical aneurysm was present. He was managed medically but within three years his ventricle remodeled, developed an aneurysm and ruptured. He was operated on using our own modification of the Dor/Menicanti method and autoseptoplasty with no patch. The operation decreased EDV from 950 ml to 205 ml and improved EF from 5% to 55%. In addition, the ventricle became conical with no akinetic segments. This case shows that in some patients surgical ventricular reconstruction may be unavoidable. Good quality of proximal segments ensures a favorable outcome of surgery even in extremely enlarged ventricles with very low EF. The surgical technique presented may be used in cases of grossly enlarged ventricles.
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http://dx.doi.org/10.1510/icvts.2009.226118DOI Listing
August 2010

[Percutaneous treatment of periprosthetic valve leak in patients not suitable for reoperation].

Kardiol Pol 2010 Mar;68(3):369-73

Oddział Ostrych Zespołów Wieńcowych, Samodzielny Publiczny Szpital Kliniczny nr 7, Slaski Uniwersytet Medyczny, Katowice.

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March 2010

Diazoxide protects myocardial mitochondria, metabolism, and function during cardiac surgery: a double-blind randomized feasibility study of diazoxide-supplemented cardioplegia.

J Thorac Cardiovasc Surg 2009 Apr 20;137(4):997-1004, 1004e1-2. Epub 2009 Feb 20.

Second Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland.

Objectives: The study was designed to assess whether diazoxide-mediated cardioprotection might be used in human subjects during cardiac surgery.

Methods: Forty patients undergoing coronary artery bypass grafting were randomized to receive intermittent warm blood antegrade cardioplegia supplemented with either diazoxide (100 micromol/L) or placebo (n = 20 in each group). Mitochondria were assessed before and after ischemia and reperfusion in myocardial biopsy specimens. Myocardial oxygen and glucose and lactic acid extraction ratios were measured before ischemia and in the first 20 minutes of reperfusion. Hemodynamic data were collected, and troponin I, creatine kinase-MB, and N-terminal prohormone brain natriuretic peptide levels were measured. All outcomes were analyzed by using mixed-effects modeling for repeated measures.

Results: No deaths, strokes, or infarcts were observed. Patients received, on average, 36.2 +/- 1.2 mg of diazoxide and 37.3 +/- 1.9 mg of placebo (P = .6). Diazoxide added to cardioplegia prevented mitochondrial swelling (8899 +/- 474 vs 9273 +/- 688 pixels before and after the procedure, respectively; P = .6) compared with that seen in the placebo group (8474 +/- 163 vs 11,357 +/- 759 pixels, P = .004). No oxygen debt was observed in the diazoxide group. Glucose consumption and lactic acid production returned to preischemic values faster in the diazoxide group. The following hemodynamic parameters differed between the diazoxide and placebo groups, respectively, in the postoperative period: cardiac index, 3.0 +/- 0.09 versus 2.6 +/- 0.09 L . min(-1) . m(-2) (P = .002); left cardiac work index, 2.81 +/- 0.07 versus 2.31 +/- 0.07 kg/m(2) (P < .001); oxygen delivery index, 420 +/- 14 versus 377 +/- 13 mL . min(-1) . m(-2) (P = .03); and oxygen extraction ratio, 29.3% +/- 1.1% versus 32.6% +/- 1.1% (P = .02). Postoperative myocardial enzyme levels did not differ, but N-terminal prohormone brain natriuretic peptide levels were lower in the diazoxide group (120 +/- 27 vs 192 +/- 29 pg/mL, P = .04).

Conclusions: Supplementing blood cardioplegia with diazoxide is safe and improves myocardial protection during cardiac surgery, possibly through its influence on the mitochondria.
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http://dx.doi.org/10.1016/j.jtcvs.2008.08.068DOI Listing
April 2009

[Clinical significance of transesophageal and epiaortal echocardiography of ascending aorta in risk estimation of neurological complications in coronary artery by-pass patients].

Pol Merkur Lekarski 2008 Dec;25(150):447-50

Slaski Uniwersytet Medyczny w Katowicach, Katedra i Klinika Kardiologii.

Unlabelled: Advanced atherosclerotic changes in aortal wall are an important factor in taking decision to use minimal-invasive method of coronary artery by-pass grafting. There are some methods for diagnosing atherosclerotic changes in ascending aorta, i.e.: roentgenogram, computer tomography, magnetic resonance imaging, transthoracic echocardiography and especially transesophageal echocardiography and epiaortal echocardiography.

The Aim Of The Study: To define usefulness of transesophageal and epiaortal echocardiography as a method of prognosing neurological complications in patients during coronary artery by-pass grafting.

Material And Methods: Study group consisted of 32 consecutive patients who had coronary surgery in II Chair and Department of Cardiosurgery, Silesian Medical University in Katowice due to ischemic heart disease in whom before the surgery ascending aorta wall was evaluated with transesophageal and epiaortal echocardiography and then monitoring of microembolism was performed. Transesophageal examination was performed with Philips Sonos 7500 device with 5 MHz transducer in anesthetized patient. Ascending aorta from level of aortic valve to the aortic arch in long and short axis was evaluated. Epiaortal echocardiography was performer with 7.5 MHz vesseltransducer and Hewlett-Packard Sonos 100 CF H-P device immediately after chest opening. Transesophageal echocardiography of ascending aorta evaluated: intima-media complex thickness and presence of atherosclerotic plaques and calcifications. Microembolism monitoring was performed in 18 patients before and during surgery. Using 2 MHz transducer placed in left and right temporal region number of microembolic incidents were evaluated.

Results: Analysis of relationship between aortic wall thickness and microembolic signals during cardiopulmonary by-pass was performed. During cardiopulmonary by-pass microembolic signals (from 7 to 698 signals) were detected in 7 patients. During analysis number of microembolic signals was normalized to cardiopulmonary by-pass duration time.

Conclusions: There was found correlation between number of microembolic signals during cardiopulmonary by-pass and thickness of aortic posterior wall in all of it's levels, using epiaortal method in short axis. This same was found using lateral wall measurements. There was no correlation between aortic wall thickness evaluated with transesophageal echocardiography and numbers of microembolic signals.
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December 2008

Perivascular tissue of internal thoracic artery releases potent nitric oxide and prostacyclin-independent anticontractile factor.

Eur J Cardiothorac Surg 2008 Feb 20;33(2):225-31. Epub 2007 Dec 20.

2nd Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland.

Objective: It has been recently suggested that perivascular tissue (PVT) releases hypothetic adipocyte- or adventitia-derived relaxing factor. The aim of the study was to assess anticontractile properties of perivascular tissue of human internal thoracic artery (ITA) and to check if this activity is nitric oxide (NO)- or prostacyclin-dependent. We also analyzed the influence of pleural adipose tissue on ITA reactivity.

Methods: Human ITA rings were studied in vitro. First, skeletonized and pedicled ITA reactivity to serotonin and angiotensin II was compared. In subsequent experiments fragments of ITA were skeletonized and divided into two preparations. One was incubated alone, the other together with PVT or pleural adipose tissue floating freely in the bath. First, concentration-response curves to either serotonin or angiotensin II were constructed. Tissue was then transferred from one bath to the other and concentration-response curves were reconstructed. The same protocol was applied with the inhibition of NO synthase with L-NMMA (10(-4)M) and cyclooxygenase with indomethacin (10(-5)M).

Results: Skeletonization augmented contractile response to serotonin (E(max) 16.6+/-1.85 mN vs 43.8+/-3.87 mN; pedicled vs skeletonized ITA, respectively; p<0.001) and angiotensin II (E(max) 10.9+/-1.07 mN vs 26.6+/-1.45 mN, respectively; p<0.001). PVT presence in the bath caused decrease of E(max) from 40.8+/-5.01 to 20.1+/-2.69 mN for serotonin; p<0.001 and from 31.4+/-3.75 to 13.0+/-1.60 mN for angiotensin II, p<0.001 (PVT(-) vs PVT(+), respectively). PVT did not change ITA sensitivity (EC(50)) to serotonin or angiotensin II. Pleural adipose tissue did not change the contractile response of ITA to serotonin (E(max) 37.2+/-4.95 mN vs 36.3+/-4.83 mN, pleural fat+and pleural fat-, respectively; p=0.9). NO and prostacyclin inhibition failed to abolish anticontractile properties of perivascular tissue. PVT with cyclooxygenase and NO synthase inhibition decreased E(max) of serotonin from 46.6+/-3.03 to 28.2+/-4.02 mN, p<0.001 and E(max) of angiotensin II from 27.2+/-2.00 to 16.4+/-2.10 mN, p<0.001.

Conclusions: Perivascular tissue of ITA releases potent, soluble, nitric oxide and prostacyclin-independent anticontractile factor. The pleural adipose tissue does not influence ITA reactivity to vasoconstrictors. Preservation of perivascular tissue may protect against vasospasm of ITA graft in clinical settings.
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http://dx.doi.org/10.1016/j.ejcts.2007.11.007DOI Listing
February 2008

[Mitral annuloplasty ring dehiscence after blunt chest trauma].

Kardiol Pol 2007 May;65(5):575-6

II Katedra i Klinika Kardiochirurgii Slaskiej Akademii Medycznej, ul Ziołowa 47, 40-635 Katowice, Poland.

A case of recurrent severe mitral regurgitation following blunt chest trauma with deceleration injury in a 61-year-old woman is presented. The patient had undergone previous CABG and mitral annuloplasty with the use of a flexible (Duran) ring. At reoperation, partial dehiscence of the annuloplasty ring, which had become rigid, was found. This was successfully repaired.
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May 2007

[Natriuretic peptides: anything new in cardiology?].

Kardiol Pol 2006 Oct;64(10 Suppl 6):S578-85

ll Katedra i Klinika Kardiochirurgii, Slaska Akademia Medyczna, Katowice.

Twenty-five years after the first publication of the strong natriuretic effect of rat cardiac atria extract, natriuretic peptides play an important part in everyday, not only cardiological, practice. In the current review the authors briefly describe the role of natriuretic peptides (ANP, BNP, and CNP) in clinical practice, concentrating on the possibilities of their therapeutic use. They also summarize their role in the mechanisms of endogenous cardioprotection and regulation of LVH, which is the endpoint of many cardiovascular pathologies.
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October 2006

[Ruptured aneurysm of the sinus of Valsalva].

Kardiol Pol 2006 May;64(5):532-5

Katedra i Klinika Kardiologii SlAM, ul. Ziołowa 47, 40-635 Katowice.

Aneurysm of the sinus of Valsalva is a rare cardiac disease. It is usually an asymptomatic anomaly, however when it ruptures, symptoms appear and patient's condition deteriorates rapidly. We describe a case of a 24-year female with a ruptured aneurysm of the non-coronary sinus of Valsalva. The aneurysm ruptured in the right atrium causing severe hemodynamic complications. The diagnosis was made by transthoracic and transesophageal echocardiography.
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May 2006

Diazoxide provides maximal KATP channels independent protection if present throughout hypoxia.

Ann Thorac Surg 2006 Apr;81(4):1408-16

Second Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland.

Background: It is not clear what the optimal timing of diazoxide administration for cardioprotection in human myocardium is. We aimed to establish it. We next checked whether protection depended on adenosine triphosphate (ATP)-inhibited potassium (KATP) channels.

Methods: Isolated human right atrial trabeculae were subjected to 90-minute hypoxia and 120-minute reoxygenation in vitro, followed by adding 10(-4) M norepinephrine. Diazoxide (100 microM) was added (1) as a 10-minute preconditioning signal with 10-minute washout before hypoxia or (2) 10-minute pretreatment without washout before hypoxia or (3) throughout hypoxia or (4) 10 minutes before and throughout hypoxia or (5) during the first 20 minutes of reoxygenation only. In the control, no diazoxide was added. In another set of experiments, diazoxide (100 microM) was present throughout hypoxia in control, while we tried to inhibit its protective effect with glibenclamide (1, 10, 100 microM) or 5-hydroxydecanoate (100 microM).

Results: The presence of diazoxide throughout hypoxia improved recovery of contractility during reoxygenation, allowed for significant response to norepinephrine at the end of reoxygenation, prevented "ischemic contracture" development, and reduced release of troponin I to tissue bath during hypoxia. Adding diazoxide 10 minutes before hypoxia conferred significantly weaker protective effects in all the above respects. We failed to show a protective effect of diazoxide used as a preconditioning signal or during reoxygenation. Neither 5-hydroxydecanoate nor glibenclamide significantly influenced protective effects of diazoxide added during hypoxia.

Conclusions: Administration of diazoxide throughout hypoxia provided maximal protective effect, suggesting that diazoxide may be an important adjunct to cardioplegic solution. The protection offered by diazoxide used during hypoxia appears independent of its influence on KATP channels.
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http://dx.doi.org/10.1016/j.athoracsur.2005.11.045DOI Listing
April 2006

Left internal mammary artery improves 5-year survival in patients under 40 subjected to surgical revascularization.

Heart Surg Forum 2006 ;9(1):E493-7; discussion E497-8

2nd Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland.

Background: The population of young patients under 40 requiring coronary bypass surgery is characterized by an extremely and unusually rapid progression of coronary heart disease. The aim of the present study was to assess the clinical status and quality of life in these patients after surgery in relation to the type of conduit used to revascularize the left anterior descending artery (LAD).

Methods: One hundred seventeen patients under 40 (range, 30-40 years) underwent coronary artery bypass grafting (CABG) at our institution between 1991 and 1999. Ninety-one patients received LIMA to LAD graft (group A), and in 26 patients the saphenous vein was used to graft this vessel (group B). Seventy-eight patients (63 in group A and 15 in group B) were assessed after a mean time of 71 +/- 26 months. They were asked to fill out a questionnaire aimed at their subjective assessment of their quality of life as compared with their preoperative status.

Results: Five-year actuarial survival was higher in patients with LIMA to LAD graft (log rank test: P < .004). The functional status of patients in group B was significantly worse in comparison to group A: respectively, CCS 2.2 +/- 1.1 versus 1.5 +/- 0.7; (P = .02), NYHA 2.2 +/- 1.1 versus 1.3 +/- 0.5; (P = .002). Patients in group B more frequently required reinstitution of nitroglycerine treatment (93% versus 56%; P = .025). We failed to show differences between the 2 groups as far as subjective quality of life is concerned. In summary, 63% of patients perceived it to be worse, 29% to be better, and 8% felt it had not changed.

Conclusion: The use of LIMA is crucial in patients undergoing CABG under the age of 40 in order to achieve the best possible surgical results. Quicker recurrence of coronary disease symptoms is observed when a vein is used to graft the LAD. It may reflect an earlier progress of atherosclerosis in venous grafts.
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http://dx.doi.org/10.1532/HSF98.20041182DOI Listing
December 2006

[New face of modified reperfusion: postconditioning].

Kardiol Pol 2005 Oct;63(4 Suppl 2):S450-6

II Klinika Kardiologii, Slaska Akademia Medyczna, Katowice.

In this review authors describe the mechanisms and possibilities of attenuation of ischaemia reperfusion injury in the myocardium. They describe modified reperfusion (postconditioning) and discuss its use in basic and clinical research. The proposed effects of modified reperfusion on the reperfusion injury were also depicted and compared to the mechanisms and action of ischemic preconditioning.
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October 2005

[Mediastinal abscess as a remote complication of CABG combined with temporary cardiac pacing--a case report].

Kardiol Pol 2005 Jul;63(7):70-2

II Klinika Kardiochirurgii, Sl AM, Katowice.

A case of a 74 year old patient with a history of CABG with temporary epicardial cardiac pacing, is described. Five years later the patient developed wound infection. Computerised tomography revealed the presence of mediastinal abscess containing surgical material. The patients underwent surgical removal of the abscess with a distal part of an epicardial pacing lead which was left after CABG and was the most probable cause of infection.
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July 2005

Skeletonization of internal thoracic artery affects its innervation and reactivity.

Eur J Cardiothorac Surg 2005 Oct;28(4):551-7

2nd Department of Cardiac Surgery, Medical University of Silesia, Ul. Ziołowa 47, 40-635 Katowice, Poland.

Objective: The studies showing the superior characteristics of ITA graft and its impact on the clinical results of coronary artery surgery were performed with ITA harvested almost exclusively as a pedicle. This study assesses the impact of ITA skeletonization on its innervation and reactivity.

Methods: Segments of skeletonized and non-skeletonized ITA were stained with antibodies against protein S-100 to look for the presence of sympathetic nerve fibers. The functional studies were performed on segments of discarded human pedicled ITA that were divided into two 3mm rings, one skeletonized and another non-skeletonized. We compared concentration-effect relationships for the contraction to norepinephrine and endothelium-dependent relaxation to acetylcholine and bradykinin, as well as endothelium-independent relaxation to sodium nitroprusside in skeletonized and non-skeletonized segments of the same ITA.

Results: Skeletonized ITA was devoid of protein S-100 positive nerve fibers. It contracted stronger (maximal response 37.0+/-2.04 vs. 25.4+/-1.83mN (P<0.001)) and was twice as sensitive to norepinephrine: pD(2) 6.03+/-0.10 vs. 5.70+/-0.12 (P=0.035). The endothelium-dependent relaxation responses did not differ between skeletonized and non-skeletonized ITA rings. The skeletonized ITA rings appeared over 10 times more sensitive to sodium nitroprusside: pD(2) 6.66+/-0.20 vs. 5.59+/-0.37 (P=0.012)-potency ratio 11.61. The maximal responses did not differ significantly: 112.0+/-6.71 vs. 129.4+/-16.4% (P=0.33).

Conclusions: Skeletonization results in sympathectomy of ITA. It has no effect on endothelium-dependent relaxation but increases reactivity of ITA to norepinephrine. This augmented response to alpha-agonist is small, in comparison with over a ten-fold increase in sensitivity to sodium nitroprusside. Pedicled and skeletonized ITA are functionally significantly different vessels when studied in vitro.
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http://dx.doi.org/10.1016/j.ejcts.2005.06.037DOI Listing
October 2005

Angiotensin-converting enzyme inhibitors reveal non-NO-, non-prostacycline-mediated endothelium-dependent relaxation in internal thoracic artery of hypertensive patients.

Int J Cardiol 2005 Jul;102(3):455-60

2nd Department of Cardiac Surgery, Medical University of Silesia, Ul. Ziołowa 47, 40-635 Katowice, Poland.

Background: We have shown that treatment of hypertension with ACE inhibitors (ACE-I) enhances relaxation to acetylcholine in human internal thoracic artery (ITA) above this in nonhypertensive patients receiving no ACE-I. Present study assesses the endothelium-dependent responses mediated by neither NO nor prostacyclin in human ITA.

Methods: We compared isolated ITA rings from hypertensive patients treated with ACE-I (ACE-I group) with those from normotensive patients on no ACE-I (control group). Relaxation to acetylcholine was assessed before and after inhibition of NO synthase and cyclooxygenase with L-NMMA and indomethacin, respectively.

Results: The maximal relaxation in ACE-I group was 79+/-3.3% and was depressed by incubation with L-NMMA and indomethacin to 41+/-2.7% (p<0.001); pD(2)=7.7+/-0.1 vs. 7.4+/-0.8 (p=0.265). The maximal relaxation to acetylcholine was lower in the control group: 65+/-3.3% (p=0.01); pD(2)=7.5+/-0.1 (p=0.07). Incubation with L-NMMA and indomethacin produced contraction to acetylcholine with a maximum of 43+/-7% (p<0.001); pD(2)=5.3+/-0.3 (p<0.001). The area under the concentration-response curve for acetylcholine-induced relaxation in ACE-I group equaled [arbitrary units] 596+/-71 and after incubation with L-NMMA and indomethacin 281+/-40 (p=0.002). Estimated LNMMA- and indomethacin-resistant relaxation, absent in control group, accounted for 47+/-4% of relaxation to acetylcholine in ACE-I group. Estimated NO- and prostacyclin-mediated relaxation was higher in control group than ACE-I group: 628+/-74 vs. 315+/-47 (p=0.009).

Conclusions: The results suggest that therapy with ACE-I improves endothelial function of hypertensive patients mainly by enhancing the endothelium-derived hyperpolarizing factor (EDHF) (and not NO)-mediated responses. It seems that it reveals measurable non-NO- non-PGI-mediated endothelium-dependent relaxation otherwise absent in conduit arteries.
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http://dx.doi.org/10.1016/j.ijcard.2004.05.050DOI Listing
July 2005

Total arterial revascularization for multiple vessel coronary artery disease: with or without cardiopulmonary bypass.

Heart Surg Forum 2004 ;7(5):E493-7

2nd Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland.

Background: To assess the usefulness of off-pump technique for more technically demanding coronary artery bypass procedures using exclusively arterial conduits.

Methods: Analysis of perioperative data of 324 consecutive patients in whom total arterial revascularization for multiple- vessel coronary artery disease was performed--181 cases on-pump and 143 cases off-pump.

Results: On average in the on-pump group 2.7 +/- 0.8 (range, 2-5) grafts per patient were constructed versus 2.4 +/- 0.7 (range, 2-4) grafts per patient in the off-pump group (P < .001). Of the total number of 490 anastomoses performed on-pump, 83 (17%) were side-to-side and of 349 anastomoses performed off-pump, 51(15%) were side-to-side, a nonsignificant difference (P = .4). The aorta was used as a site for proximal anastomosis of 1 or more arterial conduits in 105 patients (58%) who underwent on-pump surgery and in 57 patients (40%) who underwent off-pump surgery (P = .002). In the off-pump group, the right internal thoracic artery (RITA) was rarely (12%) routed through the transverse sinus to circumflex branches compared with the on-pump group (34%) (P = .017). RITA in off-pump patients was more often used to revascularize the anterior wall (47% versus 29%; P = .08). We observed no difference in mortality (1.7% versus 0%; P = .3), incidence of perioperative myocardial infarction (8.8% versus 7.7%; P = .8), stroke (1.7% versus 1.4%; P = .8), or atrial fibrillation (24% versus 19%; P = .3). We observed less inotropic support and less blood-product use in off-pump patients.

Conclusion: Total arterial revascularization for multiple-vessel coronary artery disease may be safely performed off-pump. We observed tendency to somewhat smoother postoperative course in the off-pump group.
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http://dx.doi.org/10.1532/HSF98.20041089DOI Listing
December 2006

Minimally invasive mitral valve surgery -- first experience in Poland.

Kardiol Pol 2004 May;60(5):481-8

Department of Cardiac Surgery, Silesian Medical School, Katowice, Poland.

Background: Minimally invasive cardiac surgery has been introduced to treat various cardiac disorders, predominantly ischaemic heart disease. Its usage in valvular disorders has been only recently proposed.

Aim: To assess safety and efficacy of minimally invasive mitral valve surgery.

Methods: The procedure was performed in 10 patients (6 females, 4 males, mean age 59+/-7 years). All but one had preserved left ventricular ejection fraction. Two patients underwent mitral valvuloplasty, and mitral valve replacement was performed in all remaining cases. One procedure was a redo surgery following mitral commisurotomy.

Results: In all patients the procedure was effective. Prolongation of cardiopulmonary bypass and aorta cross-clamping time did not increase the complication rate which included one wound infection, one repeated cannulation of the femoral vessels and one minor stroke. Rehabilitation process seemed to be shorter than after standard procedures.

Conclusions: Minimally invasive mitral valve surgery is a safe and alternative method of treatment, and is associated with excellent cosmetic results.
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May 2004