Publications by authors named "Krzysztof Greberski"

19 Publications

  • Page 1 of 1

[Lyell's syndrome complicated with multi-organ failure and patient's death after complex cardiac surgery - a case report].

Pol Merkur Lekarski 2020 12;48(288):449-451

Cardiac Surgery Department, J. Strus Municipal Hospital, Poznan, Poland; Department of Cardiovascular Diseases Prevention, Poznan University of Medical Sciences, Poland.

A complex cardiac surgery may be associated with a number of complications. The occurrence of toxic epidermal necrolysis (TEN) in the postoperative period in a patient who has already experienced other complications contributes to the worsening of his prognosis. Despite the regression of necrotic skin lesions TEN can lead to tragic complications.

A Case Report: A 48-year-old patient was admitted as scheduled to a cardiac surgery ward for a complex cardiac surgery. During the procedure, a mechanical aortic valve prosthesis, an ascending aorta prosthesis were implanted, and the left internal thoracic artery (LIMA) was grafted to the left anterior descending coronary artery (LAD). The intraoperative course was not complicated. In the postoperative period, some fluid was found in the left pleural cavity, which was decompressed. In the following days of the postoperative period an instability of the sternum and a serous-bloody discharge from the wound ocurred, these resulted in the reoperation and use of vacuum-assisted closure (VAC) therapy. Later, there were also haemorrhagic complications requiring surgical intervention and numerous transfusions of blood components. The patient was diagnosed with a very rare complication in the form of toxic epidermal necrolysis. Despite the therapy and regression of skin lesions an irreversible multi-organ failure developed in the patient which resulted in his death.

Conclusions: Toxic epidermal necrolysis turned out to be a complication significantly contributing to the patient's death.
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December 2020

[Cardiosurgical treatment of pneumomediastinum caused by polytrauma].

Pol Merkur Lekarski 2019 Mar;46(273):139-141

Cardiac Surgery Department, J.Strus Municipal Hospital, Poznan, Poland; Department of Cardiovascular Diseases Prevention, Medical University of Poznan, Poland.

Pneumomediastinum (also known as mediastinal emphysema) is defined as the presence of gas in the mediastinum. It can be spontaneous or arise as a result of trauma. Most cases can be effectively treated conservatively, however, if severe symptoms occur, cardiosurgical intervention is necessary.

A Case Report: A man 20 years old, a victim of a traffic accident resulting in polytrauma, was transported to the Municipal Hospital of Jozef Strus in Poznan. Rapid tests performed at the Hospital's Emergency Room speeded up the diagnosis of a life-threatening pneumomediastinum. The patient was transferred to the Operating Room of the Cardiosurgical Department, where during an urgent surgery, the pericardial sac was decompressed. Subsequently, the patient underwent another surgery in the Thoracic surgery Department of the Wielkopolskie Center of Pulmonology and Thoracic Surgery. Afterwards, the patient had to spend a couple of weeks at the Intensive Care Department of Municipal Hospital of Jozef. Ultimately, after 6 weeks of hospitalization, the patient was discharged from the hospital in a good condition.

Conclusions: The therapeutic success was an outcome of a quick diagnostic process, cooperation of doctors of various specialties and implementation of urgent surgical treatment. Mediastinal emphysema, which even though usually treated conservatively, may require lifesaving surgery in cardiothoracic surgery wards.
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March 2019

Takotsubo syndrome following mitral valve replacement and left anterior descending coronary artery bypass grafting.

Pol Merkur Lekarski 2019 Jan;46(271):36-41

Józef Struś Hospital, Poznań, Poland: Department of Cardiac Surgery.

Takotsubo syndrome (TTS) is rarely diagnosed following valvular and nonvalvular cardiac surgery. Only several such cases, including 12 after mitral valve replacement (MVR) or plasty (MVP) and 2 after coronary artery bypass grafting (CABG) have been reported so far.

A Case Report: The authors describe a case of a 75-year-old female in whom TTS occurred on the first postoperative day after elective combined surgery: MVR (with bioprosthesis) and CABG (of the left anterior descending coronary artery). Echocardiography revealed left ventricular (LV) dysfunction in the form of apical ballooning with markedly decreased ejection fraction (EF) and global longitudinal strain (GLS): 28 % and -9.3 %, respectively; there were no signs of prosthesis dysfunction. Due to circulatory and concomitant respiratory failure, she was transferred to the intensive care unit; however, an intra-aortic balloon pump was not necessary. Normalization of LV function (EF 60%, GLS -18.5%) was observed after 2 weeks. The authors compare the clinical data of the case presented with those of the remaining 14 TTS patients after MVR, MVP or CABG described in the literature and emphasize the coexistence of multiple triggering factors (e.g. additional procedures, catecholamines use, protamine use, pleural or pericardial drainage, blood transfusion, rapid heart rate). The authors suggest that TTS should be routinely included in differential diagnosis of post-cardiac surgery heart failure decompensation.
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January 2019

The use of an autologous fibrin sealant during a complex cardiac surgical procedure.

Kardiochir Torakochirurgia Pol 2018 Mar 28;15(1):62-64. Epub 2018 Mar 28.

Department of Cardiac Surgery, J. Struś Municipal Hospital, Poznan, Poland.

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http://dx.doi.org/10.5114/kitp.2018.74680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5907620PMC
March 2018

Impact of previous percutaneous coronary interventions on the course and clinical outcomes of coronary artery bypass grafting.

Kardiol Pol 2018 5;76(6):953-959. Epub 2018 Feb 5.

Uniwersytet Medyczny w Poznaniu Centrum Medyczne HCP.

Background: Despite the increasing number of patients after percutaneous coronary intervention (PCI) requiring coronary artery bypass grafting (CABG), studies on the impact of these procedures on surgical revascularisation outcomes are sparse. Furthermore, advances in cardiology require reassessment of their potential prognostic significance.

Aim: We sought to assess the influence of previous PCI on CABG outcomes.

Methods: A total of 211 consecutive patients scheduled for CABG were enrolled into this prospective study. Patients after PCI (group 1, n = 99) were compared with subjects with no history of PCI (group 2, n = 112) in terms of preoperative, operative, and postoperative data. All the patients were followed-up for the incidence of in-hospital (cardiogenic shock, myocardial infarction, stroke, acute renal failure, reoperation, death) and long-term (overall mortality, occlusion of at least one graft in 64-row computed tomography) clinical endpoints.

Results: Group 1 had more advanced heart failure and coronary artery disease as reflected by New York Heart Association (2.43 ± 0.57 vs. 2.17 ± 0.68; p < 0.001) and Canadian Cardiovascular Society (2.44 ± 0.59 vs. 2.03 ± 0.65; p < 0.001) scales, respectively. Compared with group 2, longer aortic cross-clamp (33.5 ± 9.9 vs. 29.5 ± 8.4; p < 0.05) and cardiopul-monary bypass (67.5 ± 28.2 vs. 56.5 ± 17.9; p < 0.001) times were observed as well as a higher number of implanted grafts (3.0 ± 0.7 vs. 2.8 ± 0.70; p < 0.05). No significant differences were observed in terms of in-hospital clinical endpoints. During 12 ± 3.41 months of follow-up group 1 had higher mortality (5.05% vs. 0%; p < 0.05) but similar graft patency.

Conclusions: "Stent-loaded" patients undergo more time-consuming CABG with a higher number of grafts. Furthermore, they have higher long-term mortality but similar graft patency and in-hospital mortality/morbidity.
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http://dx.doi.org/10.5603/KP.a2018.0039DOI Listing
November 2018

Implantation of mitral, aortic, and tricuspid bioprostheses due to infective endocarditis with necessary reimplantation of the bioprosthetic aortic valve.

Kardiochir Torakochirurgia Pol 2016 Sep 30;13(3):248-250. Epub 2016 Sep 30.

Cardiac Surgery Department, J. Strus Community Hospital, Poznan, Poland; Cardiac Surgery Department, J. Strus Community Hospital, Poznan, Poland.

The patient was admitted to the Department of Cardiac Surgery of the J. Struś City Hospital in Poznan due to infective endocarditis involving the aortic, mitral, and tricuspid valves. Implantation of three biological valve prostheses proceeded without complications. Starting on day 23, the patient's general condition deteriorated, with high fever. Despite postoperative antibiotic therapy, transesophageal echocardiography revealed the presence of vegetation on the bioprosthetic aortic valve. On the 46 day after the initial surgery, the patient required replacement of the aortic bioprosthesis, which exhibited the presence of numerous vegetations. The bioprosthetic mitral and tricuspid valves were not affected by the degenerative process. On the 12 day after the reimplantation of the bioprosthetic aortic valve, the patient was discharged from the hospital in good general condition.
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http://dx.doi.org/10.5114/kitp.2016.62615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5071593PMC
September 2016

[Septic shock in 23 year old female patient after surgical correction of the nasal septum effectively treated in the intensive care unit].

Pol Merkur Lekarski 2015 Dec;39(234):377-8

Medical University of Poznań, Poland, Multidisciplinary Municipal Hospital: Department of Cardiac Surgery.

A female patient 23 years old was admitted to the medical intensive care unit due to sudden loss of consciousness and seizures. At the time of admition observed lack of consciousness, seizures and severe critical condition was observed. Meningitis and septic shock were diagnosed. Based on computed tomography performed on the first day--inflammation of the sinuses soft tissues was diagnosed. Suspected cause of infection was performed 6 weeks earlier surgical correction of the nasal septum. In the next stage of treatment on the seventh day after admission the functional endoscopic sinus surgery was performed. Due to massive tissue hypoperfusion the necrosis in the skin of the lower limbs occurred. Due to the lack of effectiveness antimicrobial therapy use of intravenous ceftaroline was administrated. Effective treatment allowed in day 11 to wean the patient from the ventilator. At the day 26 the patient was transferred to a hospital in the place of residence.
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December 2015

[Septic shock in 23 year old female patient after surgical correction of the nasal septum effectively treated in the intensive care unit].

Pol Merkur Lekarski 2015 Dec;39(234):377-8

Medical University of Poznań, Poland, Multidisciplinary Municipal Hospital: Department of Cardiac Surgery.

A female patient 23 years old was admitted to the medical intensive care unit due to sudden loss of consciousness and seizures. At the time of admition observed lack of consciousness, seizures and severe critical condition was observed. Meningitis and septic shock were diagnosed. Based on computed tomography performed on the first day--inflammation of the sinuses soft tissues was diagnosed. Suspected cause of infection was performed 6 weeks earlier surgical correction of the nasal septum. In the next stage of treatment on the seventh day after admission the functional endoscopic sinus surgery was performed. Due to massive tissue hypoperfusion the necrosis in the skin of the lower limbs occurred. Due to the lack of effectiveness antimicrobial therapy use of intravenous ceftaroline was administrated. Effective treatment allowed in day 11 to wean the patient from the ventilator. At the day 26 the patient was transferred to a hospital in the place of residence.
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December 2015

[Infective endocarditis in patient with implantable cardiac pacemaker successful antibiotic treatment: two-year follow-up].

Kardiol Pol 2014 ;72(4):386

Oddział Kardiologii, Wielospecjalistyczny Szpital Miejski im. Józefa Strusia, Poznań; "Medicor", Poradnie Specjalistyczne, Poznań.

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http://dx.doi.org/10.5603/KP.2014.0076DOI Listing
December 2016

[Large asymptomatic cardiac lipoma localised in superior vena cava inflow: three-year follow-up].

Kardiol Pol 2014 ;72(3):285

Oddział Kardiologii, Wielospecjalistyczny Szpital Miejski im. Józefa Strusia, Poznań; "Medicor", Poradnie Specjalistyczne, Poznań.

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http://dx.doi.org/10.5603/KP.2014.0056DOI Listing
December 2016

Readmission to an intensive care unit after cardiac surgery: reasons and outcomes.

Kardiol Pol 2014 27;72(8):740-7. Epub 2014 Mar 27.

Oddział Kardiochirurgii, Wielospecjalistyczny Szpital Miejski im. Józefa Strusia, Poznań.

Background: Intensive care unit (ICU) readmission after cardiac surgery is believed to be associated with higher in-hospital mortality and may predict poor outcomes. ICU readmissions use resources and increase treatment costs.

Aim: To determine reasons for readmission to ICU, evaluate outcomes in these patients, and identify factors predisposing to the need for readmission to ICU.

Methods: We retrospectively investigated a total of 2076 consecutive adult patients who underwent either isolated coronary artery bypass grafting or a valve procedure or combination of both and were discharged from our ICU between January 2008 and December 2010. To identify the factors that increase the risk of readmission to ICU, we used the dominance-based rough set approach (DRSA) which is a methodology of knowledge discovery from data. The knowledge has the form of "if... then..." decision rules relating patient characteristics to the risk of readmission to ICU.

Results: Of 2076 patients discharged from ICU, 56 (2.7%) required a second stay in the ICU (study group) while 2020 patients needed no readmission to ICU (control group). The main causes of readmission were haemodynamic instability (28.6%, n = 16), respiratory failure (23.2%, n = 13), and cardiac tamponade or bleeding (23.2%, n = 13). The mean length of stay (LOS) in the general cardiac ward after primary discharge from ICU until readmission was 3.5 ± 4.2 days. The mean LOS in ICU after readmission was 12.5 ± 21.2 days. Postoperative complications occurred more frequently in readmitted patients (10.2% vs. 48.2%, p < 0.0001). In-hospital mortality was significantly higher in the study group (15 [26.8%] vs. 23 [1.1%] patients, p < 0.0001). As a result of applying the DRSA methodology, the algorithm generated decision rules categorizing patients into high and low ICU readmission risk. Advanced age, non-elective surgery and the length of initial ICU stay after the surgery were the factors of greatest importance for the correct categorisation of patients in the study group.

Conclusions: The most common cause of readmission to ICU is haemodynamic instability. Postoperative complication and in-hospital mortality rates are significantly higher in patients readmitted to ICU. Factors most commonly predisposing to readmission to ICU after cardiac surgery included advanced patient age, non-elective surgery, and longer initial stay in ICU after the surgery.
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http://dx.doi.org/10.5603/KP.a2014.0062DOI Listing
December 2016

Gigantic aneurysm of a venous bypass graft causing superior vena cava syndrome.

Kardiochir Torakochirurgia Pol 2014 Mar 27;11(1):71-5. Epub 2014 Mar 27.

Oddział Kardiochirurgii z Salami Intensywnego Nadzoru Kardiologicznego, Wielospecjalistyczny Szpital Miejski im. J. Strusia w Poznaniu ; Zakład Profilaktyki Chorób Układu Krążenia, Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu.

A case of a 66-year-old patient 13 years after coronary artery bypass grafting (CABG) admitted to hospital with typical ischemic chest pain and symptoms of superior vena cava syndrome (SVCS) is described. Non-invasive diagnostics confirmed acute coronary syndrome: non-ST-elevated myocardial infarction (ACS NSTEMI). Trans-thoracic echocardiography (TTE) revealed a gigantic tumor mass modeling the right atrium, causing chronic cardiac tamponade. Angiography showed that the tumor mass was in fact the aneurysmatically changed venous bypass graft to the right coronary artery (RCA). Computed tomography angiography (CT-angio) confirmed venous aneurysm size (the longest diameters were 10.2 cm × 8.7 cm). We also present treatment planning and the aneurysmal surgical removal procedure of this very rare case.
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http://dx.doi.org/10.5114/kitp.2014.41936DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283900PMC
March 2014

[Debranching of aortic arch as part of a complex cardiac surgery].

Kardiol Pol 2013 ;71(5):502-4

Oddział Kardiochirurgii, Szpital im. Józefa Strusia, Poznań

We present 54 year-old man diagnosed with an aneurysm of the ascending aorta and arch with aortic regurgitation and coronary artery disease. Surgery consisted of removing an aneurysm of the ascending aorta and arch of subtraction (debranching)cephalic brachiocephalic trunk and the common carotid artery and anastomosis of the descending aorta with vascular prosthesis and coronary artery bypass grafting. Postoperative course was uneventful. In 14 days after surgery the patient was discharged from the unit. Debranching method allowed avoiding hypothermia during surgery and shortening the time of cardio pulmonary bypass.
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http://dx.doi.org/10.5603/KP.2013.0097DOI Listing
October 2013

[Intraventricular septum rending from inferoposterior left ventricular wall during myocardial infarction].

Kardiol Pol 2010 Dec;68(12):1380-3; discussion 1384

Oddział Kardiologiczny, Szpital im. Józefa Strusia, Poznań.

Intraventricular septum (IVS) rending from left ventricular wall after acute myocardial infarction is a rare and dramatic mechanical complication. We describe a patient, who survived after rending of IVS from left ventricular inferoposterior wall after acute myocardial infarction. This complication was diagnosed using transthoracic and transesophageal echocardiography and confirmed by 64 MSCT. The patient underwent successful IVS repair plus three coronary artery bypass grafts and inferoposterior wall aneurysm plasty.
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December 2010

Takayasu's arteriopathy with associated occlusion of right coronary artery, brachiocephalic trunk and left subclavian artery and aortic regurgitation. Cardiovascular approach leading to a successful outcome - a case presentation.

Kardiol Pol 2010 Oct;68(10):1189-91

Department of Cardiac Surgery, J. Struś Hospital, Poznań, Poland.

In a 37 year-old woman with Takayasu's arteriopathy angiography revealed occlusion of right coronary artery (RCA), brachiocephalic trunk and left carotid artery (LCA), as well as aortic regurgitation. She underwent a complex cardiovascular surgery consisting of aortic valve implantation, RCA grafting and implantation of vascular bifurcated graft anastomosed between ascending aorta and brachiocephalic trunk and LCA. The multi-slice computed tomography performed two weeks after the operation revealed preserved grafts patency.
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October 2010

[Massive infective endocarditis treated with triple bioprostheses implantation].

Kardiol Pol 2010 Mar;68(3):322-5; discussion 326

Oddział Kardiochirurgii, Szpital im. J. Strusia, 61-833 Poznań.

A case of a 50-year-old man admitted to the cardiology department due to massive infective endocarditis is presented. Diagnosis was confirmed by further investigations and patient was referred to cardiosurgery department. The surgery revealed destruction of mitral, tricuspid and aortic valve, thus three bioprostheses were implanted. The treatment was successful and six months after surgery patient was in good overall condition.
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March 2010

Prospective evaluation of glucose metabolism in patients undergoing coronary artery bypass grafting.

Kardiol Pol 2006 Nov;64(11):1187-93; discussion 1194-5

Oddział Kardiochirurgii, Szpital im. J. Strusia, ul. Szkolna 8/12, 61-833 Poznań.

Introduction: Disturbances of glucose metabolism are associated with increased risk of ischaemic heart disease (IHD). It is not uncommon that IHD and its complications precede diagnosis of glucose metabolism disturbances. Since publication of the American Diabetes Association's 2004 Guidelines for the assessment of glucose metabolism, no prospective evaluation of prevalence of carbohydrate metabolism disorders in patients referred for coronary artery bypass grafting (CABG) has been performed.

Aim: Evaluation of prevalence of glucose balance disturbances in consecutive patients with stable IHD who underwent elective CABG procedures.

Methods: Prospective analysis of glucose metabolism was carried out on a group of 117 consecutive IHD patients (including 31 women) aged below 80 years, selected for elective CABG surgery. In all patients, history assessment and physical examination as well as basic biochemical studies and resting echocardiography were performed. Additionally, in all individuals without previous diagnosis of diabetes mellitus, oral glucose tolerance test (OGTT) was carried out.

Results: History analysis revealed glucose balance disturbances in 35 (29.9%) patients, including diabetes mellitus in 33 (28.2%) subjects and impaired glucose tolerance in 2 (1.7%) individuals. Based on OGTT results, among the remaining 82 (70.1%) subjects without previously known glucose metabolism disturbances 4 (3.4%) patients had abnormal fasting glycaemia, 32 (27.4%) subjects had impaired glucose tolerance, and diabetes mellitus was diagnosed in 12 (10.3%) individuals. No impaired glucose balance was found in only 34 (29.1%) examined subjects.

Conclusions: Over 70% of all patients undergoing elective CABG procedure presented various forms of carbohydrate metabolism disturbances that were not diagnosed previously. Thus, it seems that the assessment of glucose regulation should be mandatory in all patients undergoing elective CABG surgery.
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November 2006

[Assessment of arterial compliance and elasticity during graded head-up tilt in healthy people].

Pol Merkur Lekarski 2005 Jan;18(103):36-40

Katedra i Klinika Intensywnej Terapii Kardiologicznej i Chorób Wewnetrznych Akademii Medycznej w Poznaniu.

Unlabelled: Head-up tilting causes many changes in cardiovascular system (CVS), and stimulates sympathetic nervous system, which leads to increase of total peripheral resistance (TPR) and acceleration of heart rate (HR). The hemodynamic changes influence pulse wave shape and mechanical properties of the arterial system. Arterial compliance (C) and elastance (Ea) are parameters used to describe mechanical properties of the arterial system. The study aim was to evaluate arterial stiffness by evaluation of arterial elastance and compliance during graded head-up tilting and assessment of the relationship between the change of the tilt angle and those parameters in healthy young subjects.

Material And Methods: The study was conducted in 32 healthy volunteers (21-30 years old, 17 female). After 20 minutes of supine rest, the head-up tilting was performed with the use of a tilt-table with electrical engine. The tilt-table was stopped for 1 minute after reaching the angle of 15 degrees and its multiples (i.e. 30, 45, 60, 75 and 90 degrees). Hemodynamic parameters were measured by means of chest bioelectrical impedance method (BioZcom monitor, CardioDynamics, USA). The association of the sine of the tilt angle with Ea and C was calculated with the use of Pearson correlation.

Results: A strong positive correlation between the sine of the tilt angle and Ea was noted (r = 0. 5084; p < 0.0001). A negative correlation between the change of the tilt angle during head-up tilting and C was found (r = -0.4608; p < 0.0001).

Conclusion: During graded head-up tilting, arterial stiffness increases in young healthy people.
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January 2005