Publications by authors named "Piotr Mazur"

54 Publications

Diabetes concomitant to aortic stenosis is associated with increased expression of NF-κB and more pronounced valve calcification.

Diabetologia 2021 Sep 7. Epub 2021 Sep 7.

John Paul II Hospital, Kraków, Poland.

Aims/hypothesis: Type 2 diabetes has been demonstrated to predispose to aortic valve calcification. We investigated whether type 2 diabetes concomitant to aortic stenosis (AS) enhances valvular inflammation and coagulation activation via upregulated expression of NF-κB, with subsequent increased expression of bone morphogenetic protein 2 (BMP-2).

Methods: In this case-control study, 50 individuals with severe isolated AS and concomitant type 2 diabetes were compared with a control group of 100 individuals without diabetes. The median (IQR) duration of diabetes since diagnosis was 11 (7-18) years, and 36 (72%) individuals had HbA ≥48 mmol/mol (≥6.5%). Stenotic aortic valves obtained during valve replacement surgery served for in loco NF-κB, BMP-2, prothrombin (FII) and active factor X (FXa) immunostaining. In vitro cultures of valve interstitial cells (VICs), isolated from obtained valves were used for mechanistic experiments and PCR investigations.

Results: Diabetic compared with non-diabetic individuals displayed enhanced valvular expression of NF-κB, BMP-2, FII and FXa (all p ≤ 0.001). Moreover, the expression of NF-κB and BMP-2 positively correlated with amounts of valvular FII and FXa. Only in diabetic participants, valvular NF-κB expression was strongly associated with serum levels of HbA, and moderately with fructosamine. Of importance, in diabetic participants, valvular expression of NF-κB correlated with aortic valve area (AVA) and maximal transvalvular pressure gradient. In vitro experiments conducted using VIC cultures revealed that glucose (11 mmol/l) upregulated expression of both NF-κB and BMP-2 (p < 0.001). In VIC cultures treated with glucose in combination with reactive oxygen species (ROS) inhibitor (N-acetyl-L-cysteine), the expression of NF-κB and BMP-2 was significantly suppressed. A comparable effect was observed for VICs cultured with glucose in combination with NF-κB inhibitor (BAY 11-7082), suggesting that high doses of glucose activate oxidative stress leading to proinflammatory actions in VICs. Analysis of mRNA expression in VICs confirmed these findings; glucose caused a 6.9-fold increase in expression of RELA (NF-κB p65 subunit), with the ROS and NF-κB inhibitor reducing the raised expression of RELA by 1.8- and 3.2-fold, respectively.

Conclusions/interpretation: Type 2 diabetes enhances in loco inflammation and coagulation activation within stenotic valve leaflets. Increased valvular expression of NF-κB in diabetic individuals is associated not only with serum HbA and fructosamine levels but also with AVA and transvalvular gradient, indicating that strict long-term glycaemic control is needed in AS patients with concomitant type 2 diabetes. This study suggests that maintaining these variables within the normal range may slow the rate of AS progression.
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http://dx.doi.org/10.1007/s00125-021-05545-wDOI Listing
September 2021

Influence of Graphite Layer on Electronic Properties of MgO/6H-SiC(0001) Interface.

Materials (Basel) 2021 Jul 27;14(15). Epub 2021 Jul 27.

Institute of Experimental Physics, University of Wroclaw, pl. M. Borna 9, 50-204 Wrocław, Poland.

This paper concerns research on magnesium oxide layers in terms of their potential use as a gate material for SiC MOSFET structures. The two basic systems of MgO/SiC(0001) and MgO/graphite/SiC(0001) were deeply investigated in situ under ultrahigh vacuum (UHV). In both cases, the MgO layers were obtained by a reactive evaporation method. Graphite layers terminating the SiC(0001) surface were formed by thermal annealing in UHV. The physicochemical properties of the deposited MgO layers and the systems formed with their participation were determined using X-ray and UV photoelectron spectroscopy (XPS, UPS). The results confirmed the formation of MgO compounds. Energy level diagrams were constructed for both systems. The valence band maximum of MgO layers was embedded deeper on the graphitized surface than on the SiC(0001).
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http://dx.doi.org/10.3390/ma14154189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8347823PMC
July 2021

The efficiency of continuous renal replacement therapy for rewarming of patients in accidental hypothermia--An experimental study.

Artif Organs 2021 Jul 4. Epub 2021 Jul 4.

Department of Anaesthesiology and Intensive Care, Medical University of Silesia, Katowice, Poland.

Severe accidental hypothermia carries high mortality and morbidity and is often treated with invasive extracorporeal methods. Continuous veno-venous hemodiafiltration (CVVHDF) is widely available in intensive care units. We sought to provide theoretical basis for CVVHDF use in rewarming of hypothermic patients. CVVHDF system was used in the laboratory setting. Heat balance and transferred heat units were evaluated for the system without using blood. We used 5L of crystalloid solution at the temperature of approximately 25°C, placed in a thermally insulated tank (representing the "central compartment" of a hypothermic patient). Time of warming the central compartment from 24.9 to 30.0°C was assessed with different flow combinations: "blood" (central compartment fluid) 50 or 100 or 150 mL/min, dialysate solution 100 or 1500 mL/h, and substitution fluid 0 or 500 mL/h. The total circulation time was 1535 minutes. There were no differences between heat gain values on the filter depending on blood flow (P = .53) or dialysate flow (P = .2). The mean heating time for "blood" flow rates 50, 100, and 150 mL/min was 113.7 minutes (95% CI, 104.9-122.6 minutes), 83.3 minutes (95% CI, 76.2-90.3 minutes), and 74.7 minutes (95% CI, 62.6-86.9 minutes), respectively (P < .01). The respective median rewarming rate for different "blood" flows was 3.6°C/h (IQR, 3.0-4.2°C/h), 4.8 (IQR, 4.2-5.4°C/h), and 5.4 (IQR, 4.8-6.0°C/h), respectively (P < .01). The dialysate flow did not affect the warming rate. Based on our experimental model, CVVHDF may be used for extracorporeal rewarming, with the rewarming rates increasing achieved with higher blood flow rates.
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http://dx.doi.org/10.1111/aor.14032DOI Listing
July 2021

Natural community of macroalgae from chromium-contaminated site for effective remediation of Cr(VI)-containing leachates.

Sci Total Environ 2021 Sep 4;786:147501. Epub 2021 May 4.

Department of Physical Geography, University of Wrocław, ul. W. Cybulskiego 34, 50-205 Wrocław, Poland.

The natural macroalgal community, which developed in the unique and extremely Cr(VI)-polluted aquatic reservoir situated near a historical chromium-waste landfill, was studied in order to recognize the main mechanisms of Cr(VI) detoxification by the algal species. The conducted taxonomic analysis revealed mixed composition of the filamentous forms of algae and showed that three species of Tribonema, namely T. vulgare, T. microchloron and T. viride, which have not been studied before with regard to the mechanisms of Cr(VI) removal, are likely responsible for the effective bioremediation of this highly Cr(VI)-polluted habitat. The studied algal community, with the ability to grow in extremely high concentrations of Cr(VI), i.e. up to ca. 6150 times the upper limit for surface water, exhibited hyperaccumulative properties for chromium (max 16230 mg/kg dry weight) under the given environmental conditions. We found that the main mechanism of Cr(VI) detoxification was reduction followed by Cr(III) biosorption - feasibly by ion exchange and complexation mechanisms - and that the excellent efficiency of chromium reduction under the given, unfavorable weakly alkaline conditions indicates the biological origin of this process. It was concluded that the examined reservoir inhabited by the algal community can be used, after some modifications, as a simple cost-effective "bioreactor" allowing the reduction of chromium concentration to the desired level. Moreover, the conducted studies are also essential to obtain in-depth knowledge and should also be helpful in the relevance of the community for its further application as a potential biosorbent of Cr(VI) on a global scale.
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http://dx.doi.org/10.1016/j.scitotenv.2021.147501DOI Listing
September 2021

Hybrid coronary revascularization in multivessel coronary artery disease: who can benefit most? A pilot study.

Kardiol Pol 2021 04 19;79(4):449-451. Epub 2021 Mar 19.

Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland

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http://dx.doi.org/10.33963/KP.15883DOI Listing
April 2021

Total arterial myocardial revascularization in octogenarians.

Postepy Kardiol Interwencyjnej 2020 Sep 2;16(3):336-339. Epub 2020 Oct 2.

Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, John Paul II Hospital, Krakow, Poland.

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http://dx.doi.org/10.5114/aic.2020.99270DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7863797PMC
September 2020

Von Willebrand factor in aortic or mitral valve stenosis and bleeding after heart valve surgery.

Thromb Res 2021 02 16;198:190-195. Epub 2020 Dec 16.

Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland; The John Paul II Hospital, Krakow, Poland.

Objectives: Low von Willebrand factor (VWF) increases the risk of bleeding. The objective was to assess the influence of VWF on bleeding after valvular surgery.

Methods: We studied 82 consecutive patients in median age of 65.5 years with severe isolated aortic stenosis (AS, n = 62) or mitral stenosis (MS, n = 20), undergoing heart valve surgery in extracorporeal circulation. Preoperatively, we assessed VWF antigen (VWF:Ag) and activity (VWF:RCo), a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13), and fibrinolysis inhibitors.

Results: Compared with AS, MS patients were more frequently female (80 vs. 55%, p = 0.045) with atrial fibrillation (AF) (80 vs. 8%, p < 0.0001), with no difference in age or comorbidities. Median postoperative drainage was 420 ml for AS, and 425 ml for MS (p = 0.37). Patients with AS had lower VWF:RCo (125.8 [88.5-160.8] vs. 188.0 [140.3-207.3] IU/dl, p = 0.003) and VWF:Ag (135.8 [112.0-171.2] vs. 191.7 [147.3-236.4] IU/dl, p = 0.01) than MS patients. Mean VWF:RCo/Ag ratio was 0.88 ± 0.17, with no intergroup differences. ADAMTS13 levels and activity were similar in both groups. In AS, both VWF:RCo and VWF:Ag correlated inversely with maximal (r = -0.39, p = 0.0003 and r = -0.39, p = 0.0004, respectively) and mean (r = -0.40, p = 0.0004 and r = -0.39, p = 0.0006, respectively) transvalvular pressure gradients. There was no difference in perioperative bleeding between patients following mitral and aortic valve surgery, and bleeding was not associated with VWF:Ag or VWF:RCo.

Conclusions: In severe AS, VWF levels and activity correlate inversely with transvalvular pressure gradients, and are lower than in severe degenerative MS, but do not affect blood loss after valvular surgery in extracorporeal circulation.
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http://dx.doi.org/10.1016/j.thromres.2020.12.005DOI Listing
February 2021

ECLS for Patients With Accidental Hypothermia: A Reason for HOPE: Reply.

Ann Thorac Surg 2021 04 27;111(4):1408-1409. Epub 2020 Nov 27.

Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.

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http://dx.doi.org/10.1016/j.athoracsur.2020.08.109DOI Listing
April 2021

Bioprosthetic or mechanical heart valves: prosthesis choice for borderline patients?-Results from 9,616 cases recorded in Polish national cardiac surgery registry.

J Thorac Dis 2020 Oct;12(10):5869-5878

Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland.

Background: In middle-aged patients undergoing aortic valve replacement (AVR), the selection of prosthesis type is a complex process. Current guidelines do not unequivocally indicate the type of prosthesis (bioprosthetic or mechanical) recommended for patients between 60-70 years of age. The aim of the study was to present the trends in AVR prosthesis selection in borderline patients over a 10-year period, based on real-life registry data.

Methods: The study population comprised of 9,616 consecutive patients aged between 60-70 years, who underwent isolated AVR between 2006 and 2016 in all cardiac surgery departments in Poland. Data were extracted from the Polish National Registry of Cardiac Surgery.

Results: Among 27,797 consecutive AVR procedures, patients aged 60-70 years represented 34.6% of the population operated on. From 2006 to 2016, bioprosthetic valves (BVs) were implanted in 53.9% cases, (and) mechanical valves (MVs) in 42.1%. The proportion of different valve types changed in time: from 77.5% of MVs 22.5% of BVs in 2006 to 23.2% of MVs 76.8% of BVs in 2016 (P<0.001). The most commonly implanted BV was the Hancock II (used in 36.4% of BV implantations), the most commonly used MV was the Saint Jude Mechanical prosthesis (implanted in 36.4% of MV implantation cases). A multivariable model identified smaller annulus [OR (95% CI) 0.89 (0.86-0.92), P<0.001], atrial fibrillation [OR (95% CI) 1.32 (1.05-1.67), P=0.017], male sex [OR (95% CI) 1.47 (1.24-1.74), P<0.001] and year of implantation [OR (95% CI) 0.75 (0.71-0.79), P<0.001] as predictors of MV implantation.

Conclusions: Patients aged 60-70 years represent more than one-third of all AVR patients. Between 2006 and 2016, the proportion of implanted prostheses has changed dramatically. In 2016 BVs were implanted in nearly 75% of AVR cases, three times more often than in 2006.
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http://dx.doi.org/10.21037/jtd-19-3586DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7656432PMC
October 2020

Fibrin clot susceptibility to lysis is impaired after on-pump coronary artery by-pass grafting with tranexamic acid: clinical implications.

Blood Coagul Fibrinolysis 2021 Jan;32(1):29-36

Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.

Coronary artery bypass grafting (CABG) done on-pump may cause a significant blood loss. Low fibrinogen is associated with perioperative bleeding. The influence of cardiopulmonary bypass on fibrin clot properties is poorly investigated. We studied 55 patients with isolated coronary artery disease on aspirin undergoing on-pump CABG with tranexamic acid. Fibrinogen levels, fibrinolytic capacity expressed as clot lysis time (CLT), thrombin generation potential and platelet count were assessed before and after the surgery (prior to admission to the intensive care unit). A postoperative drop in haemoglobin (-30% from baseline), haematocrit (-31% from baseline) and platelet count (-42% from baseline) was observed (all, P < 0.0001). Postoperative fibrinogen level was lower by 57%, compared with preoperative value (1.5 [1.3-1.8] vs. 3.5 [2.8-3.9] g/l, P < 0.0001). Postoperative CLT was longer by 48 min, compared with preoperative (182 [170-218] vs. 134 [122-165] min, P < 0.0001). Thrombin generation was impaired postoperatively: both lag time and time to peak thrombin were prolonged by 44 and 45%, respectively, whereas endogenous thrombin potential and peak thrombin generation decreased by 45 and 78%, respectively (all P < 0.0001). Median postoperative drainage at 12 h was 400 [290-570] ml. Predictors of blood loss at 12 h identified in multivariable linear regression model adjusted for sex and preoperative fibrinogen level were: BMI (b = -23.4, P = 0.048) and postoperative CLT (b = -2.4, P = 0.042). Despite decreased fibrinogen levels after on-pump CABG with tranexamic acid, fibrin clot susceptibility to lysis is impaired, as reflected by prolonged CLT. Postoperative CLT is associated with mediastinal drainage at 12 h.
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http://dx.doi.org/10.1097/MBC.0000000000000980DOI Listing
January 2021

Left Internal Mammary Artery Skeletonization Reduces Bleeding-A Randomized Controlled Trial.

Ann Thorac Surg 2021 09 7;112(3):794-801. Epub 2020 Nov 7.

Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland; Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.

Background: The objective of this study was to compare the impact of skeletonized versus pedicled left internal mammary artery (LIMA) harvesting on bleeding after coronary artery bypass grafting (CABG).

Methods: In a randomized, single-blinded trial with a parallel group design and equal allocation, we randomly assigned 62 patients undergoing primary elective CABG in a tertiary cardiac center to skeletonized or pedicled LIMA dissection. Before surgery, all aspects of coagulation were assessed. Patients were blinded to LIMA dissection technique and monitored for cumulative drainage at 12 hours (primary outcome) as well as myocardial necrosis markers.

Results: With recruitment complete, there were 31 patients in each group; all patients were analyzed. Median postoperative drainage was 395 mL at 12 hours in all patients; it was lower by 28% at 12 hours (P = .02) in patients with skeletonized LIMA (Cohen's d, 0.6; 95% confidence interval (CI), 0.09-1.11). Patients with a LIMA pedicle received more fresh-frozen plasma transfusions than did the skeletonized LIMA group (Median 3; interquartile range 3-5 versus median 3; interquartile range 3-3; P = .03). Study arms did not differ in blood coagulation. Left internal mammary artery skeletonization (odds ratio = 0.04; 95% CI, 0.003-0.44; P = .009) and higher body mass index (odds ratio = 0.63; 95% CI, 0.45-0.89; P = .008) decreased the odds of being in the top drainage quartile at 12 hours (≥550 mL). Creatine kinase was lower in skeletonized LIMA directly after surgery (median 218 U/L; interquartile range 175-310 U/L versus median 424 U/L; interquartile range 256-510 U/L; P < .001), at 6 hours (median 324 U/L; interquartile range 239-424 U/L versus median 529 U/L; interquartile range 374-707 U/L; P < .001), and 12 hours after surgery (median 351 U/L; interquartile range 277-552 U/L versus median 695 U/L; interquartile range 509-1067 U/L; P < .001).

Conclusions: Left internal mammary artery skeletonization results in lower mediastinal drainage after CABG than pedicled LIMA harvesting.
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http://dx.doi.org/10.1016/j.athoracsur.2020.10.024DOI Listing
September 2021

Endocardial versus epicardial left atrial appendage exclusion for stroke prevention in patients with atrial fibrillation: Midterm follow-up.

J Cardiovasc Electrophysiol 2021 01 11;32(1):93-101. Epub 2020 Nov 11.

Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.

Background: Left atrial appendage closure (LAAC) became an alternative method for stroke prevention in patients with non-valvular atrial fibrillation (AF) intolerant to long term oral anticoagulation therapy. This study aimed to compare endocardial (Amulet and LAmbere occluders) and epicardial (Lariat) LAAC techniques.

Methods: A retrospective, observational case-control study included 223 consecutive CHA DS -VAS score-matched patients with AF who underwent LAAC in two centers.

Results: There were 55 matched cases with the mean CHA2DS2-VASs score 4.4 ± 1.22 (p = 1). Overall follow-up was 308.2 patient-years. The Endocardial group patients were older and more often females with congestive heart failure and peripheral vascular disease. The epicardial group more frequently had a stroke/transient ischemic attack history. There were no differences in hypertension, diabetes mellitus, and indications for procedure between both groups. The mean HAS-BLED score was significantly higher in the endocardial group than in the epicardial group (4.3 ± 0.9 vs. 3.7 ± 1.3, p = .011). There were no differences in annual rates of thromboembolic events (2.6% vs 0.5%) and annual stroke (0.87% vs. 0%) between the endocardial and epicardial groups.

Conclusion: Endocardial and Epicardial LAAC techniques show comparable implantation outcomes and safety profile and stroke prevention in patients with AF. Future randomized studies are needed to corroborate these initial results and assess long term mortality.
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http://dx.doi.org/10.1111/jce.14802DOI Listing
January 2021

Why should cardiac surgeons occlude the left atrial appendage percutaneously?

J Card Surg 2020 Dec 16;35(12):3458-3464. Epub 2020 Sep 16.

Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, Kraków, Poland.

Objectives: Percutaneous left atrial appendage (LAA) occlusion (LAAO) is a procedure dominated by cardiologists. The aim of our study was to present the results of percutaneous LAAO performed solely by cardiac surgeons.

Methods: Two hundred twenty-three consecutive patients with nonvalvular atrial fibrillation underwent percutaneous LAAO in two cardiac surgery sites. In the first center, all 84 LAAO procedures were performed with the endocardial LAA occluders: 60 cases with the Amulet and 24 cases with the LAmbre. In the second center, all 139 LAAO procedures were performed with the LARIAT epicardial device.

Results: The mean CHA DS -VASc-score was 3.7 ± 1.8 points, and mean HAS-BLED score was 3.6 ± 1.2 points. The procedure was successful in 97.3% of cases. Procedural or device-related adverse events were noted in 4.4% (n = 10) of cases: one periprocedural cardiac arrest, one aortic injury, one gastrointestinal bleeding, three cases of vascular access complications, and four cardiac tamponades. After a follow-up of 40.3 ± 17.3 months, 78.4% of patients were alive, with the annual mortality rate of 5.3%. Compared to the predicted risk, the observed incidence of thromboembolism was lower by 71%, and the bleeding incidence was lower by 69%.

Conclusions: Percutaneous LAAO procedures can be safely performed by cardiac surgeons, with no cardiological assistance. LAAO done by surgeons is safe and effective, and periprocedural and long-term outcomes are excellent. Cardiac surgeons should be trained in both types of LAAO: endocardial and epicardial.
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http://dx.doi.org/10.1111/jocs.14991DOI Listing
December 2020

Intraoperative Thrombophilia-Associated Thrombosis of Both Saphenous Veins during Harvesting for Coronary Artery Bypass Grafting.

TH Open 2020 Jul 23;4(3):e197-e202. Epub 2020 Aug 23.

Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.

 Intraoperative thrombosis of saphenous veins (SV) during open harvesting is very rare.  We present a case of a 60-year-old male patient with multivessel coronary artery disease and a history of a non-ST elevation acute coronary syndrome, and type-2 diabetes mellitus admitted for coronary artery bypass grafting, in whom bilateral intraoperative SV thrombosis occurred during graft harvesting. Routine thrombophilia screening showed no abnormalities and cancer was excluded. Compared with healthy controls, we observed prolonged fibrin clot lysis time and increased thrombin generation reflected by endogenous thrombin potential. Scanning electron microscopy of the thrombosed material revealed compact and thick fibrin layer on the clot surface with a solid mass of unusually compressed platelets and erythrocytes underneath. The patient was tested for fibrinogen and factor (F) XIII polymorphisms, and was found to be heterozygous for β-fibrinogen HaeIII (-455G > A) and FXIII Val34Leu (100G > T).  β-fibrinogen HaeIII and FXIII Val34Leu polymorphisms are reflected in reduced clot permeability and susceptibility to lysis, and might contribute to intraoperative SV thrombosis during vascular grafting procedures. Carriers of those are at risk of primary venous graft failure after bypass procedures.
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http://dx.doi.org/10.1055/s-0040-1715657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443364PMC
July 2020

Outcomes of tetralogy of Fallot reoperation in adults: a single-center experience with bioprosthetic pulmonary valve replacement.

Kardiol Pol 2020 09 21;78(9):922-925. Epub 2020 Jul 21.

Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland

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http://dx.doi.org/10.33963/KP.15521DOI Listing
September 2020

Accumulation of advanced glycation end products (AGEs) is associated with the severity of aortic stenosis in patients with concomitant type 2 diabetes.

Cardiovasc Diabetol 2020 06 17;19(1):92. Epub 2020 Jun 17.

John Paul II Hospital, Kraków, Poland.

Background: Accumulation of advanced glycation end products (AGEs) leads to chronic glycation of proteins and tissue damage, particularly in patients with diabetes mellitus (DM). We aimed to evaluate whether increased accumulation of AGEs in patients with aortic stenosis (AS) and concomitant type 2 diabetes (DM) is associated with AS severity.

Methods: We prospectively enrolled 76 patients with severe AS (47.1% males; nonDM), aged 68 [66-72] years, and 50 age-matched DM patients with a median blood glucose level of 7.5 [5.9-9.1] mM and glycated hemoglobin (HbA1c) of 6.8 [6.3-7.8]%, scheduled for aortic valve replacement. Valvular expression of AGEs, AGEs receptor (RAGE), interleukin-6 (IL-6), and reactive oxygen species (ROS) induction were evaluated ex vivo by immunostaining and calculated as the extent of positive immunoreactive areas/total sample area. Plasma levels of AGEs and soluble RAGE (sRAGE) were assessed by ELISAs.

Results: Subjects with DM had increased valvular expression of both AGEs (6.6-fold higher, 15.53 [9.96-23.28]%) and RAGE (1.8-fold higher, 6.8 [4.9-8.45]%) compared to nonDM patients (2.05 [1.21-2.58]% and 2.4 [1.56-3.02]%, respectively; both p < 0.001). Plasma levels of AGEs (12-fold higher) and sRAGE (1.3-fold higher) were elevated in DM patients, compared to nonDM (both p < 0.0001). The percentage of valvular ROS-positive (2.28 [1.6-3.09] vs. 1.15 [0.94-1.4]%, p < 0.0001) but not IL-6-positive areas was higher within DM, compared to nonDM valves. In DM patients, the percentage of valvular AGEs- and RAGE-positive areas correlated with HbA1c (r = 0.77, p < 0.0001 and r = 0.30, p = 0.034). Similarly, plasma AGEs and sRAGE levels were associated with HbA1c in the DM group (r = 0.32, p = 0.024 and r = 0.33, p = 0.014, respectively). In all DM patients, we found an association between the amount of valvular AGEs and the disease severity measured as aortic valve area (AVA; r = 0.68, p < 0.0001). Additionally, in DM patients with HbA1c > 7% (n = 24, 48%) we found that valvular expression of AGEs correlated with mean transvalvular pressure gradient (PG; r = 0.45, p = 0.027). Plasma AGEs levels in the whole DM group correlated with AVA (r = - 0.32, p = 0.02), PG (r = 0.31, p = 0.023), and PG (r = 0.30, p = 0.03).

Conclusions: Our study suggests that poorly-controlled diabetes leads to increased AGEs and RAGE valvular accumulation, which at least partially, might result in AS progression in DM patients.
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http://dx.doi.org/10.1186/s12933-020-01068-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301463PMC
June 2020

Outcomes of Extracorporeal Life Support Use in Accidental Hypothermia: A Systematic Review.

Ann Thorac Surg 2020 12 3;110(6):1926-1932. Epub 2020 Jun 3.

Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania. Electronic address:

Background: Extracorporeal life support (ECLS) has been used in the treatment of accidental hypothermia with hemodynamic instability, with promising outcomes. This systematic review examines ECLS treatment of accidental hypothermia to assess outcomes.

Methods: An electronic search was performed to identify articles reporting ECLS use for treatment of accidental hypothermia. Only reports describing patients aged more than 16 years after January 1, 2005, were included. Nineteen studies were identified comprising 47 patients. Demographic information, perioperative variables, and outcomes were extracted for analysis.

Results: Median patient age was 48 years (interquartile range (IQR), 29 to 56), and 72.3% (34 of 47) were male. On presentation, median body temperature was 24.6°C (IQR, 22.2° to 26°C), median potassium level 4.3 mmol/L (IQR, 3.4 to 4.6 mmol/L), and median Glasgow Coma Scale score 3 (IQR, 3 to 7). Cardiac arrest occurred in 35 of 47 patients (74.5%). Median time to ECLS initiation from scene was 155 minutes (IQR, 113 to 245). Median ECLS duration was 18 hours (IQR, 4 to 27), with median rewarming rate of 2°C per hour (IQR, 1.5° to 4°). Median intensive care unit stay and hospital length of stay were 8 days (IQR, 2 to 16) and 17 days (IQR, 10 to 36), respectively. Inhospital mortality was 19.1% (9 of 47). Median discharge Glasgow Coma Scale score was 15 (IQR, 15 to 15) with minor long-term cognitive impairments noted in 6 of 47 patients (19.4%). Survival was significantly associated with potassium on presentation (P < .001), initial body temperature (P < .001), and ECLS rewarming rate (P < .001).

Conclusions: Extracorporeal life support is a viable cardiac support option for rewarming patients with accidental hypothermia, and initial potassium level, initial body temperature, and ECLS rewarming rate appear to be significantly associated with survival.
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http://dx.doi.org/10.1016/j.athoracsur.2020.04.076DOI Listing
December 2020

Effects of rivaroxaban and dabigatran on local expression of coagulation and inflammatory factors within human aortic stenotic valves.

Vascul Pharmacol 2020 07 7;130:106679. Epub 2020 May 7.

John Paul II Hospital, Cracow, Poland; Institute of Cardiology, Jagiellonian University Medical College, Cracow, Poland.

Background: Treatment with non-vitamin K antagonist oral anticoagulants (NOACs) such as dabigatran (a direct thrombin inhibitor) or rivaroxaban (a direct inhibitor of factor [F] Xa) attenuates atherosclerotic plaque progression in hypercholesterolemic mice.

Purpose: To evaluate the effect of NOACs application on the expression of coagulation proteins in loco within stenotic aortic valves and in valve interstitial cells (VICs) from patients with severe aortic stenosis (AS).

Methods: Primary cultures of VICs obtained from 90 patients undergoing aortic valve replacement were stimulated with TNF-α (50 ng/mL) and pre-treated with rivaroxaban (1 and 10 ng/mL) or dabigatran (25 and 250 ng/mL). The expression of coagulation proteins was analyzed by immunofluorescence. Cytokine levels were measured by ELISA.

Results: FX, FXa, FVII, thrombin and PAR1/2 were present in loco within human aortic stenotic valves. Cultured VICs exhibited constant expression of FX, TF, PAR1/2. Exposure of VICs to TNF-α caused the upregulated expression of TF, PAR1/2 and induced expression of thrombin, FVII and FXa. FX was expressed by 80% of VICs, regardless of stimulation. Cultured VICs were able to synthesize metalloproteinases 1-3, IL-6, IL-32, IL-34, osteopontin and osteocalcin, the levels of which increased under TNF-α stimulation. NOACs added to culture inhibited coagulation factor and PAR1/2 expression. Moreover, NOACs down-regulated VIC-derived proteins responsible for valve calcification and extracellular matrix remodeling.

Conclusions: NOACs at therapeutic concentrations may inhibit the effects of FXa and thrombin at in vitro level. It might be speculated that long-term treatment with rivaroxaban or dabigatran could attenuate the progression of AS in humans.
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http://dx.doi.org/10.1016/j.vph.2020.106679DOI Listing
July 2020

Different MAF translocations confer similar prognosis in newly diagnosed multiple myeloma patients.

Leuk Lymphoma 2020 08 19;61(8):1885-1893. Epub 2020 Apr 19.

Division of Hematology/Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.

The MAF translocations, t(14;16) and t(14;20), are considered as adverse prognostic factors based on few studies with small sample sizes. We report on their prognostic impact in a large group of 254 patients - 223 (87.8%) with t(14;16) and 31 (12.2%) with t(14;20). There were no intergroup differences in survival estimates. Median progression-free survival was 16.6 months for t(14;16) and 24.9 months for t(14;20) ( = 0.28). Median overall survival (OS) was 54.0 months and 49.0 months, respectively ( = 0.62). Median OS in patients who underwent double autologous stem cell transplantation (ASCT) was 107.0 months versus 60.0 months in patients who received single ASCT ( < 0.001). ISS 3 was associated with shorter OS (HR = 1.89; 95% CI 1.24-3.19;  = 0.005) in Cox analysis. Our study suggests that t(14;20) should be considered as an adverse factor of equal prognostic implication to t(14;16).
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http://dx.doi.org/10.1080/10428194.2020.1749605DOI Listing
August 2020

Cu(II)-Fe(III) oxide doped anion exchangers - Multifunctional composites for arsenite removal from water via As(III) adsorption and oxidation.

J Hazard Mater 2020 Jul 12;394:122527. Epub 2020 Mar 12.

Department of Industrial Chemistry, Wroclaw University of Economics and Business, Ul. Komandorska 118/120, 53-345, Wrocław, Poland.

The aim of the present study was to investigate As(III) oxidation and adsorption on the surface of hybrid anion exchangers containing Cu(II)-Fe(III) binary oxide deposited in their porous structure with the same Cu:Fe ratio of 1:2 but with different amounts and distribution of inorganic deposit within polymeric beads. The equilibrium studies confirmed high adsorption capacity of the best hybrid polymer: 94.4 mg As/g. Moreover, the adsorption was effective over a wide pH range, selective in the presence of interfering ions, and the material was effectively regenerated. The performance of the hybrid polymer was also confirmed in the column process which enabled both As(III) and As(V) concentrations to be lowered from 500 μg/L to below 10.0 μg/L in a solution with a composition similar to natural groundwater. The breakthrough point of the bed was reached after the solution amounting to 1833 bed volumes passed through the column. Desorbed As speciation, FTIR and XPS studies showed that As(III) was mainly adsorbed on the surface of Cu-Fe oxides followed by its oxidation to As(V). In the oxidation reaction metal oxides acted as catalysts and adsorbents, while the oxidant was probably oxygen dissolved in solution.
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http://dx.doi.org/10.1016/j.jhazmat.2020.122527DOI Listing
July 2020

Highly efficient arsenic sorbent based on residual from water deironing - Sorption mechanisms and column studies.

J Hazard Mater 2020 01 21;382:121062. Epub 2019 Aug 21.

Institute of Experimental Physics, University of Wrocław, Pl. Maxa Borna 9, 50-204, Wrocław, Poland. Electronic address:

The hybrid polymer obtained by entrapment of Fe-Mn waste oxides from water deironing into a chitosan matrix was evaluated as an As(III) and As(V) sorbent. Its maximum adsorption capacity determined from a Langmuir isotherm model was 44.17 mg As(III)/g or 26.80 mg As(V)/g and 50.73 mg As(III)/g or 82.99 mg As(V)/g under neutral and acidic conditions, respectively. The pH markedly influenced the efficiency and the rate of As(V) adsorption, whereas its impact on As(III) removal was slight. The sorbent was simply regenerated using NaOH solution, and no drop in adsorption capacity was observed after 6 cycles. The physical form and the durability of the sorbent enabled continuous work in a fixed-bed system without clogging of the bed. Arsenic concentration in the effluent exceeded 0.01 mg As/L only after passing about 2700 bed volumes. Arsenates formed surface complexes with iron oxides and were bounded by the imine groups of cross-linked chitosan. Arsenites were oxidized by MnO before adsorption but, because of the low Mn:Fe ratio, a fraction of them were also directly bound to the iron oxides, especially at neutral pH. The conducted studies confirmed the usability of the examined material as a highly efficient sorbent for arsenic removal from water.
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http://dx.doi.org/10.1016/j.jhazmat.2019.121062DOI Listing
January 2020

Absence of perioperative excessive bleeding in on-pump coronary artery bypass grafting cases performed by residents.

Interact Cardiovasc Thorac Surg 2019 12;29(6):836-843

Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland.

Objectives: On-pump coronary artery bypass grafting (CABG) is associated with elevated bleeding risk. Our aim was to evaluate the role of surgical experience in postoperative blood loss.

Methods: A propensity score-matched analysis was employed to compare on-pump CABG patients operated on by residents and specialists. End points included drainage volume and bleeding severity, as assessed by the Universal Definition of Perioperative Bleeding in cardiac surgery and E-CABG scale.

Results: A total of 212 matched pairs (c-statistics 0.693) were selected from patients operated on by residents (n = 294) and specialists (n = 4394) between October 2012 and May 2018. Patients did not differ in bleeding risk. There were no statistically significant differences in postoperative 6-, 12- and 24-h drainages between subjects operated on by residents and specialists, and there was no between-group difference in rethoracotomy or transfusion rate. There were no differences in Universal Definition of Perioperative Bleeding or E-CABG grades. In June 2018, after a median follow-up of 2.8 years (range 0.1-5.7 years), the overall survival was 94%, with no differences between the patients operated on by residents (95%) and specialists (92%) (P = 0.27).

Conclusions: Patients undergoing on-pump CABG, when operated on by a resident, are not exposed to an elevated bleeding risk, as compared with patients operated on by experienced surgeons.
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http://dx.doi.org/10.1093/icvts/ivz195DOI Listing
December 2019

Outcomes of emergency coronary angiography after cardiac surgery.

Eur J Prev Cardiol 2020 08 25;27(12):1339-1342. Epub 2019 Jun 25.

Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.

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http://dx.doi.org/10.1177/2047487319859972DOI Listing
August 2020

Extracorporeal membrane oxygenation for accidental deep hypothermia-current challenges and future perspectives.

Ann Cardiothorac Surg 2019 Jan;8(1):137-142

Department of Anesthesiology and Intensive Care Medicine, Medical University of Silesia, Katowice, Poland.

The incidence of accidental hypothermia (core temperature ≤35 °C) is difficult to estimate, as the affected population is heterogeneous. Both temperature and clinical presentation should be considered while determining severity, which is difficult in a prehospital setting. Extracorporeal rewarming is advocated for all Swiss Staging System class IV (hypothermic cardiac arrest) and class III (hypothermic cardiac instability) patients. Veno-arterial extracorporeal membrane oxygenation (ECMO) is the method of choice, as it not only allows a gradual, controlled increase of core body temperature, but also provides respiratory and hemodynamic support during the unstable period of rewarming and reperfusion. This poses difficulties with the coordination of patient management, as usually only cardiac referral centers can deliver such advanced treatment. Further special considerations apply to subgroups of patients, including drowning or avalanche victims. The principle of ECMO implantation in severely hypothermic patients is no different from any other indication, although establishing vascular access in a timely manner during ongoing resuscitation and maintaining adequate flow may require modification of the operating technique, as well as aggressive fluid resuscitation. Further studies are needed in order to determine the optimal rewarming rate and flow that would favor brain and lung protection. Recent analysis shows an overall survival rate of 40.3%, while additional prognostic factors are being sought for determining those patients in whom the treatment is futile. New cannulas, along with ready-to-use ECMO sets, are being developed that would enable easy, safe and efficient out-reach ECMO implantation, thus shortening resuscitation times. Moreover, national guidelines for the management of accidental hypothermia are needed in order that all patients that would benefit from extracorporeal rewarming would be provided with such treatment. In this perspective article, we discuss burning problems in ECMO therapy in hypothermic patients, outlining the important research goals to improve the outcomes.
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http://dx.doi.org/10.21037/acs.2018.10.12DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6379186PMC
January 2019

Phthalocyanine arrangements on Ag(100): From pure overlayers of CoPc and FCuPc to bimolecular heterostructure.

J Chem Phys 2018 Oct;149(14):144702

Department of Physics and Astronomy, Institute of Experimental Physics, University of Wrocław, Wrocław, Poland.

We have utilized scanning tunneling microscopy (STM) and low energy electron diffraction to determine the structural properties of two types of metal-phthalocyanines (MPcs), i.e., cobalt-phthalocyanine (CoPc) and hexadecafluorinated copper-phthalocyanine (FCuPc) on the Ag(100) surface. For coverage close to one monolayer, both systems form long-range ordered structures with square unit cells. The size and rotation of the unit cell with respect to the silver lattice depend on the chemical composition of MPc. Both types of molecules prefer adsorption with around a 30° angle between the molecular axis and the [011] silver direction. The CoPcs mainly arrange in a (5 × 5)R0 phase; however, two additional local arrangements, a and a (7 × 7)R0, were detected by STM. The FCuPcs form a structure. The co-adsorption of CoPc and FCuPc on the Ag(100) surface in a 1:1 ratio leads to the formation of a compositionally ordered chessboard-like structure. During filled states imaging, the different appearance of the central part of each MPc allows us to distinguish CoPcs from FCuPcs. Regardless of the applied voltage polarity, the ligands of FCuPcs appear brighter than the ligands of CoPcs.
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http://dx.doi.org/10.1063/1.5050377DOI Listing
October 2018

Evaluation of hybrid anion exchanger containing cupric oxide for As(III) removal from water.

J Hazard Mater 2019 05 25;370:117-125. Epub 2018 Jul 25.

Department of Industrial Chemistry, Wrocław University of Economics, ul. Komandorska 118/120, 53-345 Wrocław, Poland.

The aim of this study was investigate of arsenite adsorption on a hybrid polymer based on a polystyrene/divinylbenzene macroporous anion exchanger containing cupric oxide deposited within its porous structure. The study included batch kinetic and equilibrium experiments, and investigation of influence of the pH, regeneration of spent adsorbent and the column process on arsenic(III) adsorption. The experimental data were evaluated using kinetic, isotherm and fixed-bed column models. The adsorption capacity calculated from the Langmuir model was 6.61 mg As(III) g. The adsorption rate was controlled by both chemisorption of arsenic on the adsorbent surface and external diffusion, and at a higher initial As(III) concentration also by intraparticle diffusion. The spent adsorbent was easily regenerated with 1.0 M NaOH solution. Based on batch adsorption studies and X-ray photoelectron spectroscopic analyses a mechanism of As(III) adsorption was proposed. Arsenite removal proceeded in two stages: oxidation to arsenate on the CuO surface, followed by an ion exchange reaction. The studied hybrid polymer also showed very good adsorption characteristics under the dynamic regime. The S-shape of breakthrough curves and insignificant influence of bed height, initial concentration and flow rate on the adsorption capacity confirmed its applicability in water treatment.
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http://dx.doi.org/10.1016/j.jhazmat.2018.07.094DOI Listing
May 2019

Sternal wound infections following cardiac surgery and their management: a single-centre study from the years 2016-2017.

Kardiochir Torakochirurgia Pol 2018 Jun 25;15(2):79-85. Epub 2018 Jun 25.

Center for Innovative Laboratory Diagnostics, John Paul II Hospital, Krakow, Poland.

Introduction: Despite improvements in surgical management, sternal wound infection (SWI) following cardiac surgery remains a significant complication.

Aim: To evaluate pathogens involved in SWI following median sternotomy.

Material And Methods: We enrolled 164 patients who experienced prolonged sternal wound healing following open-heart surgery. The inclusion criteria were as follows: prolonged sternal wound healing following cardiac surgery via median sternotomy and complete results of microbiological culture obtained from the sternal swab. The exclusion criteria were as follows: partial sternotomy, patients with mechanical sternum dehiscence and incomplete clinical data. Swabs provided information on the type of microorganism present in the wound and the susceptibility of the microorganism to specific antibiotics.

Results: One hundred and fourteen (69.5%) patients aged 68 (interquartile range: 60-76) years developed SWI with positive culture. The in-hospital mortality rate was 21.0% in this group. The most common pathogens included (26.6%), (12.2%), (11.4%), (8.4%), and (6.8%). In most of the cases the isolated was methicillin-resistant ( = 57, 43.5%). was vancomycin-resistant in 11 (8.3%) cases and high-level aminoglycoside resistant (HLAR) in 13 (9.9%) cases. had the extended-spectrum β-lactamase (ESBL) mechanism in 14 (10.6%) cases. Among 114 culture-positive patients, 48 (42.1%) had polymicrobial infection of the sternal wound.

Conclusions: Microorganisms associated with SWI in our study were mainly commensals, with the most common pathogen being
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http://dx.doi.org/10.5114/kitp.2018.76472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6066679PMC
June 2018

Plasma fibrin clot properties affect blood loss after surgical aortic valve replacement for aortic stenosis.

Eur J Cardiothorac Surg 2019 02;55(2):224-231

Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland.

Objectives: Cardiac surgery is associated with elevated bleeding risk. We sought to study whether fibrin clot phenotype influences postoperative blood loss after surgery for aortic stenosis (AS).

Methods: We studied 77 isolated AS patients, including 62 who underwent aortic valve replacement and 15 who underwent the Bentall procedure due to post-stenotic aortic dilation. Plasma clot properties, including the tPA-induced clot lysis time (CLT) and clot permeability (Ks), along with fibrinolysis inhibitors, a calibrated automated thrombogram and platelet activation markers, were assessed preoperatively.

Results: In the whole AS group, the median chest tube output after 12 h was 360 ml (range of 110-2290 ml). Patients with drainage in the top quartile after 12 h (≥600 ml) had lower fibrinogen, shorter CLT, higher Ks, lower plasma plasminogen activator inhibitor-1 antigen, peak thrombin generation and β-thromboglobulin levels than those in the lowest drainage quartile (≤260 ml) with no difference in platelets or von Willebrand factor. A multivariable model that was built after the exclusion of Bentall patients, adjusted for age, sex, body mass index and fibrinogen, showed that high drainage, which was defined as the top quartile after 12 h postaortic valve replacement (≥460 ml), was predicted by β-thromboglobulin [odds ratio (OR) 0.94, 95% confidence interval (CI) 0.90-0.99, P = 0.03], fibrinogen (OR 0.13, 95% CI 0.00-0.47, P = 0.02) and the CLT (OR 0.95, 95% CI 0.91-0.99, P = 0.02). The CLT was inversely related to the number of transfused platelet units (r = -0.27, P = 0.04).

Conclusions: Fibrin clot susceptibility to lysis is a modulator of postoperative blood loss after cardiac surgery for AS, which may have practical implications.
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http://dx.doi.org/10.1093/ejcts/ezy226DOI Listing
February 2019

Impaired fibrinolysis in degenerative mitral and aortic valve stenosis.

J Thromb Thrombolysis 2018 Aug;46(2):193-202

Institute of Cardiology, Jagiellonian University Medical College, 80 Pradnicka St., 31-202, Krakow, Poland.

Valvular heart disease is associated with an increased thromboembolic risk. Impaired fibrinolysis was reported in severe aortic stenosis (AS). Little is known about fibrinolysis in mitral stenosis (MS). We sought to compare fibrinolysis impairment in AS and MS. We studied 121 individuals scheduled for elective aortic valve (AV) or mitral valve (MV) surgery for AS (n = 76) or MS (n = 45), in order to compare fibrinolysis impairment. Fibrinolytic capacity was assessed by determination of clot lysis time (t) and fibrinolysis inhibitors, including plasma plasminogen activator inhibitor-1 (PAI-1) antigen (PAI-1:Ag) and activity, thrombin-activatable fibrinolysis inhibitor (TAFI) antigen and activity. Prolonged t (+ 29%), elevated TAFI activity (+ 12%), TAFI:Ag (+ 21%), and PAI-1:Ag (+ 84%) were observed in patients with MS, compared with those with AS. t Correlated with mean and maximal MV gradients (r = 0.43, p < 0.0001 and r = 0.39, p < 0.0001, respectively), but not with AV gradients. Mean and maximal MV gradients correlated with TAFI activity and PAI:Ag. Patients with permanent atrial fibrillation (AF; 35 with MS and 5 with AS) had longer t (by 22%, p = 0.0002) and higher PAI-1:Ag (by 74%, p < 0.0001) than the remainder. In the whole group, postoperative drainage volumes correlated inversely with PAI-1:Ag (r = - 0.22, p = 0.02). MS is associated with more pronounced impairment of global fibrinolytic capacity than AS at the stage of surgical intervention, which is in part driven by AF. Our findings suggest that hypofibrinolysis might be implicated in the progression of MS and its thromboembolic complications.
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http://dx.doi.org/10.1007/s11239-018-1687-1DOI Listing
August 2018
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