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Ondrusek M, Artemiou P, Bezak B, Gasparovic I, By TMD, Durdik S, Lesny P, Goncalvesova E, Hulman M. Temporal Analysis in Outcomes of Long-Term Mechanical Circulatory Support: Retrospective Study. Thorac Cardiovasc Surg 2024. [PMID: 38641334 DOI: 10.1055/s-0044-1782600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
BACKGROUND Mechanical assist device indications have changed in recent years. Reduced incidence of complications, better survival, and the third generation of mechanical support devices contributed to this change. In this single-center study, we focused on two time periods that are characterized by the use of different types of mechanical support devices, different patient characteristics, and change in the indications. METHODS The data were processed from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). We retrospectively defined two time intervals to reflect changes in ventricular assist device technology (period 1: 2007-2015; period 2: 2016-20222). A total of 181 patients underwent left ventricular assist device implantation. Device utilization was the following: HeartMate II = 52 (76.4%) and HeartWare = 16 (23.6%) in period 1 and HeartMate II = 2 (1.8%), HeartMate 3 = 70 (61:9%), HeartWare = 29 (25.7%), SynCardia TAH = 10 (8.8%), and BerlinHeart EXCOR = 2 (1.8%) in period 2. The outcomes of the time intervals were analyzed and evaluated. RESULTS Survival was significantly higher during the second time period. Multivariate analysis revealed that age and bypass pump time are independent predictors of mortality. Idiopathic cardiomyopathy, bypass time, and the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) score are independent predictors of adverse events. Furthermore, the first period was noted to be at an increased risk of the following adverse events: pump thrombosis, gastrointestinal bleeding, and bleeding events. CONCLUSION Despite the higher risk profile of the patients and persistent challenges, during the second period, there was a significant decrease in mortality and morbidity. The use of the HeartMate 3 device may have contributed to this result.
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Affiliation(s)
- Matej Ondrusek
- Faculty of Medicine of the Comenius University, National Institute of Cardiovascular diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Panagiotis Artemiou
- Faculty of Medicine of the Comenius University, National Institute of Cardiovascular diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Branislav Bezak
- Faculty of Medicine of the Comenius University, National Institute of Cardiovascular diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Ivo Gasparovic
- Faculty of Medicine of the Comenius University, National Institute of Cardiovascular diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Theo Mmh de By
- EUROMACS, European Association for Cardio-Thoracic Surgery (EACTS), Windsor, United Kingdom
| | - Stefan Durdik
- Faculty of Medicine, Comenius University, St. Elizabeth Oncology Institute, Clinic of Surgical Oncology, Bratislava, Slovakia
| | - Peter Lesny
- Faculty of Medicine of the Comenius University, National Institute of Cardiovascular Diseases, Clinic of Heart Failure, Bratislava, Slovakia
| | - Eva Goncalvesova
- Faculty of Medicine of the Comenius University, National Institute of Cardiovascular Diseases, Clinic of Heart Failure, Bratislava, Slovakia
| | - Michal Hulman
- Faculty of Medicine of the Comenius University, National Institute of Cardiovascular diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
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Schusterova I, Artemiou P, Gasparovic I, Poruban T, Vachalcova MB, Sieradzka KA, Gurbalova S, Zenuch P. The Association Between Ascending Aortic and Left Ventricular Dimensions in Patients After Aortic Valve Replacement. Braz J Cardiovasc Surg 2024; 39:e20230221. [PMID: 38426718 PMCID: PMC10903743 DOI: 10.21470/1678-9741-2023-0221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Aortic valve replacement (AVR) is often recommended for patients with severe aortic stenosis or chronic aortic regurgitation. These conditions result in remodeling of the left ventricle, including increased interstitial fibrosis that may persist even after AVR. These structural changes impact left ventricular (LV) mechanics, causing compromised LV diameter to occur earlier than reduced LV ejection fraction (LVEF). The aim of this study was to examine the effect of left ventricular end-diastolic diameter (LVEDD) and its role in aortic expansion one year after AVR. METHODS Sixty-three patients who underwent AVR were evaluated. All patients underwent standard transthoracic echocardiography, which included measurements of the ascending aorta, aortic root, LVEF, and LVEDD before the surgery and one year postoperatively. Correlations between these variables were calculated. RESULTS All patients underwent AVR with either a mechanical or biological prosthetic aortic valve. Following AVR, there was a significant decrease in the dimensions of the ascending aorta and aortic root (both P=0.001). However, no significant changes were observed in LVEDD and LVEF. Correlations were found between the preoperative ascending aortic size and the preoperative and one-year postoperative LVEDD (r=0.419, P=0.001 and r=0.320, P=0.314, respectively). Additionally, there was a correlation between the postoperative ascending aortic size and the preoperative and one-year postoperative LVEDD (r=0.320, P=0.003 and r=0.136, P=0.335, respectively). CONCLUSION The study findings demonstrate a significant correlation between the size of the aortic root and ascending aorta, before and after AVR. Additionally, a notable correlation was observed between postoperative LVEDD and the size of the aortic root.
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Affiliation(s)
- Ingrid Schusterova
- First Cardiological Clinic, East Slovak Institute of Cardiovascular
Diseases, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Panagiotis Artemiou
- Clinic of Cardiac Surgery, National Institute of Cardiovascular
Diseases, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Ivo Gasparovic
- Clinic of Cardiac Surgery, National Institute of Cardiovascular
Diseases, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Tibor Poruban
- First Cardiological Clinic, East Slovak Institute of Cardiovascular
Diseases, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Marianna Barbierik Vachalcova
- First Cardiological Clinic, East Slovak Institute of Cardiovascular
Diseases, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Karolina Angela Sieradzka
- First Cardiological Clinic, East Slovak Institute of Cardiovascular
Diseases, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Silvia Gurbalova
- First Cardiological Clinic, East Slovak Institute of Cardiovascular
Diseases, Pavol Jozef Safarik University, Kosice, Slovakia
| | - Pavol Zenuch
- First Cardiological Clinic, East Slovak Institute of Cardiovascular
Diseases, Pavol Jozef Safarik University, Kosice, Slovakia
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Gasparovic I, Artemiou P, Domonkos A, Bezak B, Gazova A, Kyselovic J, Hulman M. Multivessel Coronary Disease and Severe Atherosclerotic Aorta: Real-World Experience. Medicina (Kaunas) 2023; 59:1943. [PMID: 38003992 PMCID: PMC10672925 DOI: 10.3390/medicina59111943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Surgical revascularisation of patients with atherosclerosis of the ascending aorta remains a challenge. Different surgical strategies have been described in coronary surgical patients to offer alternative revascularisation strategies other than the conventional surgical revascularisation in patients unsuitable for it. The aim of this study is to compare the real-world outcomes between two groups of patients who underwent off-pump surgery (left internal mammary artery graft to the left anterior descending artery) or a hybrid with a percutaneous revascularisation procedure at a later stage. Materials and Methods: This is a single-centre retrospective observational study. Between the years 2010 and 2021, 91/6863 patients (1.33%) were diagnosed with severe atherosclerosis of the ascending aorta. All the patients were treated with off-pump revascularisation (91 patients), and the cardiologist would decide at a later stage whether the rest of the vessels would be treated with percutaneous revascularisation (25 patients). Results: There was no statistical difference in the various preoperative characteristics, except for coronary artery left main disease (30.30% vs. 64%; p = 0.0043). The two groups had no statistical differences in the perioperative characteristics and postoperative complications. The 1-, 5-, and 10-year mortality rates in the two groups were 6.1% vs. 0%, 59% vs. 80%, and 93.9% vs. 100%, respectively (off-pump vs. hybrid with percutaneous revascularisation procedure, p = 0.1958). Conclusions: Both strategies have high long-term comparable mortality. The off-pump surgery and the HCR procedure at a later stage may be solutions for these high-risk patients, but the target treatment should be complete HCR revascularisation during the index hospitalization.
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Affiliation(s)
- Ivo Gasparovic
- National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Medical Faculty, Comenius University, 813 72 Bratislava, Slovakia; (I.G.); (A.D.); (B.B.); (M.H.)
| | - Panagiotis Artemiou
- National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Medical Faculty, Comenius University, 813 72 Bratislava, Slovakia; (I.G.); (A.D.); (B.B.); (M.H.)
| | - Andrej Domonkos
- National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Medical Faculty, Comenius University, 813 72 Bratislava, Slovakia; (I.G.); (A.D.); (B.B.); (M.H.)
| | - Branislav Bezak
- National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Medical Faculty, Comenius University, 813 72 Bratislava, Slovakia; (I.G.); (A.D.); (B.B.); (M.H.)
| | - Andrea Gazova
- Department of Pharmacology and Clinical Pharmacology, Medical Faculty, Comenius University, 813 72 Bratislava, Slovakia;
| | - Jan Kyselovic
- 5th Department of Internal Medicine, Medical Faculty Comenius, Comenius University Bratislava, 813 72 Bratislava, Slovakia;
- Department of Pharmacology and Toxicology, University of Veterinary Medicine and Pharmacy in Kosice, 041 81 Kosice, Slovakia
| | - Michal Hulman
- National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Medical Faculty, Comenius University, 813 72 Bratislava, Slovakia; (I.G.); (A.D.); (B.B.); (M.H.)
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Kalocayova B, Kura B, Vlkovicova J, Snurikova D, Vrbjar N, Frimmel K, Hudec V, Ondrusek M, Gasparovic I, Sramaty R, Luptak J, Hulman M, LeBaron TW, Slezak J. Molecular hydrogen: prospective treatment strategy of kidney damage after cardiac surgery. Can J Physiol Pharmacol 2023; 101:502-508. [PMID: 37463517 DOI: 10.1139/cjpp-2023-0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Cardiac surgery-associated acute kidney injury is a common post-operative complication, mostly due to increasing oxidative stress. Recently, molecular hydrogen (H2 gas) has also been applied to cardiac surgery due to its ability to reduce oxidative stress. We evaluated the potential effect of H2 application on the kidney in an in vivo model of simulated heart transplantation. Pigs underwent cardiac surgery within 3 h while connected to extracorporeal circulation (ECC) and subsequent 60 min of spontaneous reperfusion of the heart. We used two experimental groups: T-pigs after transplantation and TH-pigs after transplantation treated with 4% H2 mixed with air during inhalation of anesthesia and throughout oxygenation of blood in ECC. The levels of creatinine, urea and phosphorus were measured in plasma. Renal tissue samples were analyzed by Western blot method for protein levels of nuclear factor erythroid 2-related factor 2 (Nrf2), Kelch-like ECH-associated protein 1 (Keap-1), and superoxide dismutase (SOD1). After cardiac surgery, selected plasma biomarkers were elevated. However, H2 therapy was followed by the normalization of all these parameters. Our results suggest activation of Nrf2/Keap1 pathway as well as increased SOD1 protein expression in the group treated with H2. The administration of H2 had a protective effect on the kidneys of pigs after cardiac surgery, especially in terms of normalization of plasma biomarkers to control levels.
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Affiliation(s)
- Barbora Kalocayova
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Branislav Kura
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Jana Vlkovicova
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Denisa Snurikova
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Norbert Vrbjar
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Karel Frimmel
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Vladan Hudec
- Department of Cardiac Surgery, Faculty of Medicine, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Matej Ondrusek
- Department of Cardiac Surgery, Faculty of Medicine, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Ivo Gasparovic
- Department of Cardiac Surgery, Faculty of Medicine, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Rastislav Sramaty
- Department of Cardiac Surgery, Faculty of Medicine, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Jaroslav Luptak
- Department of Cardiac Surgery, Faculty of Medicine, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Michal Hulman
- Department of Cardiac Surgery, Faculty of Medicine, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Tyler W LeBaron
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, Bratislava, Slovakia
- Department of Kinesiology and Outdoor Recreation, Southern Utah University, Cedar City, UT 84720, USA
- Molecular Hydrogen Institute, Cedar City, UT 84720, USA
| | - Jan Slezak
- Centre of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, Bratislava, Slovakia
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Bena M, Gasparovic I, Postulka J, Artemiou P, Hulman M. Concomitant transapical aortic and mitral valve transcatheter implantation in a patient with aortic stenosis and ischemic mitral regurgitation. Hellenic J Cardiol 2023; 72:72-73. [PMID: 37068640 DOI: 10.1016/j.hjc.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 04/19/2023] Open
Affiliation(s)
- Martin Bena
- Faculty of Medicine, Comenius University in Bratislava, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Ivo Gasparovic
- Faculty of Medicine, Comenius University in Bratislava, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Jan Postulka
- National Institute of Cardiovascular Diseases, Clinic of Cardiology, Bratislava, Slovakia
| | - Panagiotis Artemiou
- Faculty of Medicine, Comenius University in Bratislava, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia.
| | - Michal Hulman
- Faculty of Medicine, Comenius University in Bratislava, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
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Hulman M, Artemiou P, Bezak B, Hudec V, Glonek I, Bena M, Md RJ, Kiss M, Jancar M, Ondrusek M, Cikrai R, Charchoglhyan R, Domonkos A, Zembery M, Gasparovic I. Adult cardiac surgery report 2021: The annual report from the Registry of the National Institute of Cardiovascular Diseases. BRATISL MED J 2023; 124:170-174. [PMID: 36598306 DOI: 10.4149/bll_2023_027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Based on a longtime voluntary registry founded by the Ministry of Healthcare of the Slovak Republic in 2012 and endorsed by the National Institute of Cardiovascular Diseases, well-defined data of all adult cardiac surgery procedures performed during the year 2021 are analyzed. MATERIAL AND METHOD For this period, data on 947 procedures were submitted to the registry. RESULTS The unadjusted in-hospital survival rate for the 352 isolated coronary artery bypass grafting procedures including urgent and emergency procedures (relationship on-/off pump 3.8 : 1) was 96.3 %. For 331 isolated heart valve procedures (33 transcatheter interventions), it was 95.5 %. Concerning ventricular assist devices, 19 implantations were registered. In 2021 the number of isolated heart transplantations was 16, which is a decrease by 38.5 % as compared to the previous year. CONCLUSION These annually registered data are collected from voluntary public reporting and accumulate actual information on nearly all heart procedures carried out in the National Institute of Cardiovascular Diseases. These data capture advancements in heart medicine and represent the basis for quality management. In addition, the registry demonstrates that the provision of cardiac surgery in Slovakia is up to date, appropriate, and nationwide patient treatment is guaranteed all the time (Tab. 14, Fig. 2, Ref. 5). Text in PDF www.elis.sk Keywords: heart valve surgery, outcomes, coronary artery bypass grafting, aortic surgery, heart transplantation.
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Gasparovic I, Artemiou P, Bezak B, Michut S, Hulman M. Surgery for cardiac myxomas: 12-year experience. BRATISL MED J 2023; 124:635-638. [PMID: 37635659 DOI: 10.4149/bll_2023_098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
INTRODUCTION Cardiac myxoma is a rare benign cardiac tumor observed in approximately 0.5-1 case per 1 million people per year. The aim of this study is to review our 12-year experience in the surgical treatment of cardiac myxoma with an emphasis on the clinical, pathologic, diagnostic, and surgical features. METHODS AND PATIENTS From January 2010 to December 2022, 90 patients (0.67 %) with cardiac myxomas were surgically treated in our institute. Patients´ demographics, cardiac and surgical medical history, surgical procedures, and pre- and post-operative data were analyzed. The median follow-up time was 76 (1-216) months. RESULTS The mean age of the patients was 59.4 ± 13.5 years, with a higher prevalence of women. The most common preoperative symptoms were arterial embolism and dyspnea, and 35.6 % of patients were asymptomatic. Only 8.9 % of the patients had systemic and constitutional manifestations. The most common location of cardiac myxoma was in the left atrium, followed by the right atrium. Recurrent myxoma developed in 3 patients (2.7 %), and the mean time of recurrence was 55 ± 19.7. Hospital and long-term mortality were 2.2 % and 15.6 %, respectively. CONCLUSION Cardiac myxoma is the most common heart tumor with a low incidence. Surgical excision yields very good short and long-term outcomes with low recurrence rate after surgery, and remains the treatment of choice (Tab. 4, Fig. 2, Ref. 13). Text in PDF www.elis.sk Keywords: cardiac myxoma, cardiac tumor, recurrence, survival.
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Hulman M, Artemiou P, Hudec V, Olejarova I, Goncalvesova E, Gasparovic I. Successful support of biventricular heart failure in an adult patient by the Berlin Heart EXCOR system as a bridge to transplant: literature review. BRATISL MED J 2023; 124:309-312. [PMID: 36598326 DOI: 10.4149/bll_2023_047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Right heart failure is a huge challenge in left ventricular assist device therapy and its occurrence is associated with increased mortality and morbidity. Other options include the use od temporary right ventricular assist device, use of two continous flow biventricular assist devices, use of total artificial heart and the use of paracorporeal biventricular assist devices.In this report we described the successful use of the paracorporeal pulsatile Berlin Heart EXCOR system as a bridge to transplant in a 62 years old patient with end-stage biventricular heart failure (Tab. 1, Fig. 3, Ref. 22). Keywords: biventricular heart failure, mechanical circulatory support, biventricular assist device, Berlin Heart EXCOR system, heart transplantation.
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Gasparovic I, Artemiou P, Hulman M. Intimal aortic atherosclerosis in cardiac surgery: surgical strategies to prevent embolic stroke. Eur J Cardiothorac Surg 2022; 62:6551874. [PMID: 35323917 DOI: 10.1093/ejcts/ezac184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/09/2022] [Indexed: 01/07/2023] Open
Affiliation(s)
- Ivo Gasparovic
- Medical Faculty of the Comenious University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Panagiotis Artemiou
- Medical Faculty of the Comenious University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Michal Hulman
- Medical Faculty of the Comenious University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
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Artemiou P, Gasparovic I, Hudec V, Hulman M. Optimal therapeutic strategy for postinfarction ventricular septal defect. J Card Surg 2022; 37:2511. [PMID: 35477927 DOI: 10.1111/jocs.16583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/22/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Panagiotis Artemiou
- Department of Cardiac Surgery, Medical Faculty of the Comenious University, National Institute for Cardiovascular diseases, Bratislava, Slovakia
| | - Ivo Gasparovic
- Department of Cardiac Surgery, Medical Faculty of the Comenious University, National Institute for Cardiovascular diseases, Bratislava, Slovakia
| | - Vladan Hudec
- Department of Cardiac Surgery, Medical Faculty of the Comenious University, National Institute for Cardiovascular diseases, Bratislava, Slovakia
| | - Michal Hulman
- Department of Cardiac Surgery, Medical Faculty of the Comenious University, National Institute for Cardiovascular diseases, Bratislava, Slovakia
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Artemiou P, Gasparovic I, Hudec V, Hulman M. The efficiency of the preoperative extracorporeal membrane oxygenation in the setting of postinfarction ventricular septal defect and how to optimize outcomes: A single center case series. J Card Surg 2022; 37:1416-1421. [PMID: 35182446 DOI: 10.1111/jocs.16333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/13/2022] [Accepted: 02/01/2022] [Indexed: 11/27/2022]
Abstract
The mortality rate after the development of postinfarction ventricular septal defect remains high despite progress in pharmacologic therapy, invasive cardiology, and surgical techniques. We present a case series of six patients with preoperative venoarterial extracorporeal membrane oxygenation as a bridge to reparative surgical repair. Venoarterial extracorporeal membrane oxygenation allows to hemodynamically stabilize the patient, and safely delay the surgery. Delayed surgery might facilitate successful repair by allowing friable tissue to organize, strengthen, and become well-differentiated from surrounding healthy tissue; thus, definite repair can be performed safely. All patients were in cardiogenic shock and would otherwise require emergent cardiac surgery with associated risk. Three patients were discharged, with one hospital mortality of a patient who had a successful bridge to corrective surgery and died due to pulmonary artery rupture after a right ventricular assist device implantation. Two patients died before surgery while they were supported by venoarterial extracorporeal membrane oxygenation due to vascular complications. We discuss strategies how to optimize the management and function of the venoarterial extracorporeal membrane oxygenation to decrease the rate of adverse effects and optimize the outcomes of these patients.
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Affiliation(s)
- Panagiotis Artemiou
- National Institute of Cardiovascular Diseases, Medical Faculty of the Comenious University, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Ivo Gasparovic
- National Institute of Cardiovascular Diseases, Medical Faculty of the Comenious University, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Vladan Hudec
- National Institute of Cardiovascular Diseases, Medical Faculty of the Comenious University, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Michal Hulman
- National Institute of Cardiovascular Diseases, Medical Faculty of the Comenious University, Clinic of Cardiac Surgery, Bratislava, Slovakia
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Bezak B, Pindak D, Svajdler P, Gasparovic I, Artemiou P, Hulman M. Cardiac metastasis of a neuroendocrine tumor of the right colon extirpated without opening of the heart chambers. J Card Surg 2022; 37:673-674. [PMID: 34985159 DOI: 10.1111/jocs.16206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/16/2021] [Accepted: 12/24/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Branislav Bezak
- Clinic of Cardiac Surgery, Medical Faculty of the Comenious University, National Institute of Cardiovascular Diseases, Bratislava, Slovakia.,Medical Faculty of the Slovak Medical University, Bratislava, Slovakia
| | - Daniel Pindak
- Department of Surgical Oncology, Medical Faculty of Slovak Medical University, National Cancer Institute, Bratislava, Slovakia
| | | | - Ivo Gasparovic
- Clinic of Cardiac Surgery, Medical Faculty of the Comenious University, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Panagiotis Artemiou
- Clinic of Cardiac Surgery, Medical Faculty of the Comenious University, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | - Michal Hulman
- Clinic of Cardiac Surgery, Medical Faculty of the Comenious University, National Institute of Cardiovascular Diseases, Bratislava, Slovakia
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Schusterova I, Jakubova M, Vachalcova M, Sieradzka K, Gibarty C, Poruban T, Gasparovic I, Artemiou P. Three-dimensional transesophageal echocardiography in diagnosis of intermediate atrioventricular septal defect in the adult: case report and literature review. J Cardiothorac Surg 2021; 16:209. [PMID: 34330308 PMCID: PMC8325229 DOI: 10.1186/s13019-021-01596-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background Intermediate type atrioventricular septal defect is less frequent than complete or partial atrioventricular septal defect, and is rarely encountered in the elderly and the utility of three dimensional transesophageal echocardiography in the diagnosis has not been reported to date. Case presentation In this case report, we described a rare case of an intermediate atrioventricular septal defect in an adult patient and we showed the valuable utility of real time 3D transesophageal echocardiography in the diagnosis and future surgical planning. The patient was referred to a tertiary center for an elective surgical repair. Finally, we provided a detailed review of the literature concerning the intermediate type of atrioventricular septal defect. Conclusion Although 2D transthoracic and transesophageal echocardiography enables diagnosis of the intermediate type atrioventricular septal defect, precise assessment of anatomy of atrioventricular septal defects and common atrioventricular valve was enabled only by real time 3D echocardiography.
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Affiliation(s)
- Ingrid Schusterova
- Medical Faculty of University Pavel Jozef Safarik, First Cardiology Clinic, Eastern Slovakian Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Marta Jakubova
- Medical Faculty of University Pavel Jozef Safarik, First Cardiology Clinic, Eastern Slovakian Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Marianna Vachalcova
- Medical Faculty of University Pavel Jozef Safarik, First Cardiology Clinic, Eastern Slovakian Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Karolinska Sieradzka
- Medical Faculty of University Pavel Jozef Safarik, First Cardiology Clinic, Eastern Slovakian Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Claudia Gibarty
- Medical Faculty of University Pavel Jozef Safarik, First Cardiology Clinic, Eastern Slovakian Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Tibor Poruban
- Medical Faculty of University Pavel Jozef Safarik, First Cardiology Clinic, Eastern Slovakian Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Ivo Gasparovic
- Medical Faculty of the Comenious University, Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases, Pod Krasnou horkou 1, 83101, Bratislava, Slovakia
| | - Panagiotis Artemiou
- Medical Faculty of the Comenious University, Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases, Pod Krasnou horkou 1, 83101, Bratislava, Slovakia.
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Artemiou P, Gasparovic I, Bezak B, Hudec V, Glonek I, Hulman M. Mortality and risk factors after a surgical repair of postinfarction ventricular septal defect. ACTA ACUST UNITED AC 2021; 122:555-558. [PMID: 34282620 DOI: 10.4149/bll_2021_088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to present our experience in the treatment of post-myocardial infarction ventricular septal defect and examine the various risk factors. METHODS This is a retrospective study. From January 2010 to December 2018, 20 patients underwent an urgent /emergency surgical repair of post-myocardial infarction ventricular septal defect. RESULTS The mortality in our group of patients was 45 %. Non-survivors compared to the survivors were all in cardiogenic shock (p=0.0098), had an emergency/salvage operation (p=0.0055), preoperative mechanical ventilation (p=0.0081), shorter time between intraaortic balloon pressure insertion and surgery (p=0.0115), shorter median time between ventricular septal defect and surgery, postoperative renal replacement therapy (p=0.0498), and more patients had a residual effect (p=0.0022). In multivariate analysis, preoperative mechanical ventilation (p=0.0001), postoperative renal replacement therapy (p=0.0021) and residual defect (p=0.0000027) were shown to be strong predictors for hospital mortality. CONCLUSION This analysis showed that post-myocardial infarction ventricular septal defect repair is a devastating complication and preoperative mechanical ventilation, postoperative renal replacement therapy and residual defect were identified to be the predictors of mortality. Initial stabilization of the patients, when it is possible, and a delayed repair, may improve the outcome of these patients (Tab. 3, Ref. 17).
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Hulman M, Ondrusek M, de By TMMH, Antonides CFJ, Artemiou P, Hudec V, Gasparovic I, Lesny P, Goncalvesova E, Schonrath F, Gummert J. Single centre 12 year experience with durable mechanical circulatory support: comparison with the EUROMACS registry. ACTA ACUST UNITED AC 2021; 122:371-378. [PMID: 34002609 DOI: 10.4149/10.4149/bll_2021_062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Mechanical circulatory support is an established therapy in end-stage heart failure. The EUROMACS registry was created to promote research in these patients. The aim of this report was to present our 12 year experience with the durable mechanical circulatory support devices and compare it with the EUROMACS registry. METHODS Data from the entire EUROMACS registry from January 2011 to April 2019 were included (4704 implantations in 4410 patients). During the 12 years of our experience, until April 2019,125 mechanical support devices were implanted, in 122 patients. We compare patients´ characteristics, operative data and results with the EUROMACS registry and we report the major complications during the observational period. RESULTS Primary end-point (death) occurred in 40 (32.8 %) patients in our cohort during the follow-up period, representing the survival rate 75 %, 68 %, and 58 % for 6, 12, 24 months respectively, which compares favourably with the data, reported by the EUROMACS registry, the survival 66 % and 53 % after 1 and 2 years respectively. Cerebrovascular accident occurred in 7 %, a bleeding event in 32 %, significant infection (driveline) in 78 % and a device malfunction in 13 % of the patients. Forty- three patients underwent a heart transplant with hospital and long-term mortality of 11.6 % and 14 % respectively. CONCLUSION Mechanical circulatory support is a valuable therapeutic option with excellent survival rates, nevertheless it is associated with clinically significant complications rates. The direct comparison between our cohort and the EUROMACS registry showed that early implantation strategy and mini invasive approach may improve survival rates and decrease postoperative complications (Tab. 3, Fig. 3, Ref. 16).
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16
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Artemiou P, Gasparovic I, Hulman M. Reply from authors: Preoperative venoarterial extracorporeal membrane oxygenation for postinfarction ventricular septal defect. J Card Surg 2021; 36:1167. [PMID: 33506987 DOI: 10.1111/jocs.15383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Panagiotis Artemiou
- Department of Cardiac Surgery, Medical Faculty of the Comenious University, National Institute for Cardiovascular Diseases, Bratislava, Slovakia
| | - Ivo Gasparovic
- Department of Cardiac Surgery, Medical Faculty of the Comenious University, National Institute for Cardiovascular Diseases, Bratislava, Slovakia
| | - Michal Hulman
- Department of Cardiac Surgery, Medical Faculty of the Comenious University, National Institute for Cardiovascular Diseases, Bratislava, Slovakia
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Artemiou P, Gasparovic I, Bezak B, Hudec V, Glonek I, Hulman M. Preoperative extracorporeal membrane oxygenation for postinfarction ventricular septal defect: Case series of three patients with a literature review. J Card Surg 2020; 35:3626-3630. [DOI: 10.1111/jocs.15086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/02/2020] [Accepted: 09/21/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Panagiotis Artemiou
- Department of Cardiac Surgery, Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases Medical Faculty of the Comenius University Bratislava Slovakia
| | - Ivo Gasparovic
- Department of Cardiac Surgery, Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases Medical Faculty of the Comenius University Bratislava Slovakia
| | - Branislav Bezak
- Department of Cardiac Surgery, Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases Medical Faculty of the Comenius University Bratislava Slovakia
| | - Vladan Hudec
- Department of Cardiac Surgery, Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases Medical Faculty of the Comenius University Bratislava Slovakia
| | - Ivan Glonek
- Department of Cardiac Surgery, Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases Medical Faculty of the Comenius University Bratislava Slovakia
| | - Michal Hulman
- Department of Cardiac Surgery, Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases Medical Faculty of the Comenius University Bratislava Slovakia
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Gasparovic I, Artemiou P, Hulman M. Role of hybrid arch debranching in the treatment of newly diagnosed aortic arch malperfusion after repair of acute type A aortic dissection. Proc (Bayl Univ Med Cent) 2019; 32:557-558. [PMID: 31656418 DOI: 10.1080/08998280.2019.1631105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/10/2019] [Accepted: 06/10/2019] [Indexed: 10/26/2022] Open
Abstract
We present the case of a 41-year-old man who underwent repair of an acute DeBakey type A aortic dissection with a Bentall-De Bono operation and presented with an early aortic arch malperfusion. The malperfusion was successfully treated with a hybrid arch debranching procedure. In this setting, the hybrid arch debranching procedure offers a safe alternative for repair.
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Affiliation(s)
- Ivo Gasparovic
- Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases, Medical Faculty of the Slovak Medical UniversityBratislavaSlovakia
| | - Panagiotis Artemiou
- Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases, Medical Faculty of the Slovak Medical UniversityBratislavaSlovakia
| | - Michal Hulman
- Clinic of Cardiac Surgery, National Institute of Cardiovascular Diseases, Medical Faculty of the Slovak Medical UniversityBratislavaSlovakia
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Hulman M, Bena M, Artemiou P, Gasparovic I, Hudec V, Hasakova J. Transapical transcatheter aortic valve replacement with the balloon expandable aortic bioprosthetic valve in high risk patients with severe aortic stenosis: Intermediate-term results from the register of the clinic of cardiac surgery. ACTA ACUST UNITED AC 2019; 120:462-467. [PMID: 31223028 DOI: 10.4149/bll_2019_074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of this study is to report our experience in performing transapical (TA) TAVR with a balloon-expandable valve only by cardiac surgeons, with on site interventional cardiology support. METHODS A retrospective review of 97 consecutive patients that underwent TA TAVR due to severe symptomatic aortic stenosis was performed from 2012 to 2016. Median follow-up time was 20.5 months. Preoperative risk factors and postoperative outcomes were evaluated using Valve Academic Research Consortium-2 definitions. RESULTS All patients were high risk with a mean Euroscore of 7.28±7.77. Five year and 30-day mortality were 9.3 % and 1.1 %, respectively. Ninty six (98.9 %) of the patients had no or mild paravalvular leak seen by transesophageal echocardiography after implantation. Device success was 91.8%. Postoperatively there was a significant increase of the ejection fraction (50.8±7.1 % preoperatively vs 53.1±7.7 % postoperatively, p=0.009) and reverse remodeling of the left ventricle (left ventricular end-diastolic diameter preoperatively 50.8±7.1 mm vs 49.2±8.1 mm postoperatively, p=0.031). CONCLUSION Our experience demonstrates that TA TAVR can be performed only by cardiac surgeons, with on site interventional cardiology support safely and successfully with low and comparable postoperative mortality and rate of complications (Tab. 4, Fig. 1, Ref. 26).
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Hulman M, Artemiou P, Ondrusek M, Hudec V, Gasparovic I, Bena M, Glonek I. Short-term mechanical circulatory support for severe primary graft dysfunction following orthotopic heart transplant. Interact Cardiovasc Thorac Surg 2019. [PMID: 29514222 DOI: 10.1093/icvts/ivy050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Primary graft dysfunction (PGD) is a devastating complication and the most common cause of early death following a heart transplant. The goal of this study was to report our experience of using mechanical circulatory support to manage severe PGD. METHODS Following 208 heart transplants performed between January 2007 and May 2017, 14 (6.7%) patients presented with severe PGD. We provided haemodynamic support using the following approaches: a venoarterial extracorporeal membrane oxygenation device, left ventricular assist device, right ventricular assist device and biventricular assist device. Primary complications included severe PGD, which resulted in hospital deaths and late survival. The mean follow-up was 3.7 ± 2.7 years. RESULTS Fourteen (6.7%) heart transplant recipients presented with severe PGD. Seven patients received a venoarterial extracorporeal membrane oxygenation device; 1 patient received a left ventricular assist device; 4 patients received a right ventricular assist device; and 2 patients received a biventricular assist device. Mean device support and explantation times were 4.7 ± 2 and 6.3 ± 2 days, respectively. Weaning with cardiac recovery was successful in 57.1% of the patients. The hospital mortality rate was 50%. Postoperative causes of morbidity included renal failure that necessitated dialysis in 28.5%, surgical re-exploration due to postoperative bleeding in 57.1%, pneumonia in 28.5%, sepsis in 14.2%, sternal wound infection in 14.2% and mediastinitis in 7.1% of the patients, respectively. There were no deaths following hospital discharge or later follow-up appointments. CONCLUSIONS Mechanical support devices such as venoarterial extracorporeal membrane oxygenation specifically offer a reliable therapeutic approach. Recognizing the relatively high number of deaths in-hospital, patients who have cardiac recovery and a successful hospital discharge can expect a favourable late outcome.
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Affiliation(s)
- Michal Hulman
- Department of Cardiac Surgery, Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Panagiotis Artemiou
- Department of Cardiac Surgery, Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Matej Ondrusek
- Department of Cardiac Surgery, Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Vladan Hudec
- Department of Cardiac Surgery, Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Ivo Gasparovic
- Department of Cardiac Surgery, Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Martin Bena
- Department of Cardiac Surgery, Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Ivan Glonek
- Department of Cardiac Surgery, Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
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Gasparovic I, Artemiou P, Hudec V, Hulman M. Long-term outcomes following minimal invasive versus conventional aortic valve replacement: a propensity match analysis. BRATISL MED J 2017; 118:479-484. [PMID: 29050486 DOI: 10.4149/bll_2017_092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Minimal invasive aortic valve replacement has become a routine procedure. In this study, we compared the outcomes between conventional and minimal invasive aortic valve replacement via the partial upper sternotomy that were performed in our Institution. METHODS The 5 year survival and postoperative outcomes of 34 patients that underwent isolated MIAVR between the years 2010-2013 were compared with the outcomes of 34 randomly selected patients that underwent conventional AVR, after propensity match analysis. RESULTS There was no difference between the two groups concerning the early and late postoperative outcomes. MIAVR patients had a longer mean cross-clamp time (p = 0.002) and longer cardiopulmonary bypass time (p = 0.0005) compared to the AVR patients. 5 year mortality and survival were 4.17 % vs 16.67 % (p = 0.20) and 95.8 % vs 83.3 % (p = 0.37) in the MIAVR and AVR groups respectively. CONCLUSION This study showed a comparable 5 year survival and postoperative outcomes between the MIAVR and AVR groups. In our opinion, the minimal access aortic valve replacement can be performed safely with excellent long-term results in selected patients (Tab. 4, Fig. 1, Ref. 35).
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Gasparovic I, Artemiou P, Kiss M, Hulman M. Bentall operation in a patient with an anomalous left circumflex artery: Case report and review. J Saudi Heart Assoc 2017; 29:305-307. [PMID: 28983176 PMCID: PMC5623027 DOI: 10.1016/j.jsha.2017.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 02/07/2017] [Accepted: 03/02/2017] [Indexed: 11/25/2022] Open
Abstract
Anomalous origin of a left circumflex artery from the right coronary sinus represents a technical challenge in patients who require aortic valve/root procedures. This case report describes a patient who presented with bicuspid aortic valve, anomalous origin of the circumflex artery, severe aortic regurgitation, and aneurysm of the ascending aorta as well as aortic root that was safely managed following the Bentall procedure with the combined button technique.
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Affiliation(s)
- Ivo Gasparovic
- Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Panagiotis Artemiou
- Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Mikulas Kiss
- Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Michal Hulman
- Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
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Hudec V, Bena M, Artemiou P, Gasparovic I, Hulman M. Reversible thrombotic mitral valve stenosis after transcatheter mitral valve replacement (TMVR): Is life-long anticoagulation therapy necessary? J Card Surg 2017; 32:190-192. [PMID: 28222495 DOI: 10.1111/jocs.13109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We describe a case of reversible thrombotic mitral valve stenosis following a valve-in-ring transcatheter mitral valve replacement. Life-long oral anticoagulation in patients who underwent transcatheter mitral valve replacement might be beneficial.
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Affiliation(s)
- Vladan Hudec
- Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Martin Bena
- Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Panagiotis Artemiou
- Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Ivo Gasparovic
- Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Michal Hulman
- Medical Faculty of the Slovak Medical University, National Institute of Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
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Hulman M, Bena M, Artemiou P, Gasparovic I, Hudec V, Rajani R, Bapat V. Iterative Learning of Transcatheter Mitral Valve Replacement in Mitral Valve Annulus Calcification: Management and Prevention of Transcatheter Mitral Valve Replacement Dislocation. Ann Thorac Surg 2016; 102:e287-90. [DOI: 10.1016/j.athoracsur.2016.02.061] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 01/12/2016] [Accepted: 02/16/2016] [Indexed: 11/29/2022]
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Gasparovic I, Artemiou P, Hudec V, Hulman M. Recurrence of coronary arteriovenous fistulae in a rare case of bilateral right coronary and circumflex artery arteriovenous fistulae to the pulmonary artery. Hellenic J Cardiol 2016; 58:226-227. [PMID: 27663960 DOI: 10.1016/j.hjc.2016.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 07/27/2016] [Accepted: 08/08/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ivo Gasparovic
- Medical Faculty of the Slovak Health University, National Institute for Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Panagiotis Artemiou
- Medical Faculty of the Slovak Health University, National Institute for Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia.
| | - Vladan Hudec
- Medical Faculty of the Slovak Health University, National Institute for Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
| | - Michal Hulman
- Medical Faculty of the Slovak Health University, National Institute for Cardiovascular Diseases, Clinic of Cardiac Surgery, Bratislava, Slovakia
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Hulman M, Bena M, Artemiou P, Gasparovic I, Hudec V. Transaortic approach for transcatheter aortic valve replacement with other concomitant cardiac procedures in high-risk patients. J Card Surg 2016; 31:493-7. [PMID: 27388782 DOI: 10.1111/jocs.12796] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The transaortic (TAo) approach has been proposed as an alternative to the transapical approach and can be used in concomitant procedures. We use the TAo transcatheter aortic valve replacement (TAVR) with other simultaneous cardiac procedures in high-risk patients who needed surgical management. MATERIALS AND METHODS Between September 2013 and September 2015, nine consecutive high-risk patients with severe aortic valve stenosis (AR) and combined tricuspid valve disease or coronary artery disease were treated with TAo TAVR and simultaneous tricuspid valve repair or coronary artery bypass grafting. RESULTS Mean postoperative pressure gradient at discharge was 13.4 ± 3.2 mmHg and AR grade >2/4 was observed in one case (11.1%). New pacemaker implantation was required in one case (11.1%). Device success was achieved in 88.9% (n = 8), 30-day mortality was in 11.1% (n = 1), and intermediate mortality was in 33.3% (n = 3). CONCLUSION TAo-TAVR approach offers definitive treatment to high-risk patients with coexisting complex cardiac lesions. Despite the relatively high 30-day and intermediate mortality, it is an option for selected high-risk patients.
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Affiliation(s)
- Michal Hulman
- Medical Faculty of the Slovak Health University, Clinic of Cardiac Surgery, National Institute for Cardiovascular Diseases, Bratislava, Slovakia
| | - Martin Bena
- Medical Faculty of the Slovak Health University, Clinic of Cardiac Surgery, National Institute for Cardiovascular Diseases, Bratislava, Slovakia
| | - Panagiotis Artemiou
- Medical Faculty of the Slovak Health University, Clinic of Cardiac Surgery, National Institute for Cardiovascular Diseases, Bratislava, Slovakia
| | - Ivo Gasparovic
- Medical Faculty of the Slovak Health University, Clinic of Cardiac Surgery, National Institute for Cardiovascular Diseases, Bratislava, Slovakia
| | - Vladan Hudec
- Medical Faculty of the Slovak Health University, Clinic of Cardiac Surgery, National Institute for Cardiovascular Diseases, Bratislava, Slovakia
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Bucuk M, Gasparovic I, Braut T, Tomic Z, Sonnenschein I. Bilaterale Fazialisparese nach Lungeninfektion – eine mögliche Variante einer akuten inflammatorischen Polyradikuloneuropathie. Dtsch Med Wochenschr 2014; 139:2386-9. [DOI: 10.1055/s-0034-1374699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- M. Bucuk
- Department of Neurology, University Hospital Centre of Rijeka, Rijeka, Croatia
| | - I. Gasparovic
- Department of Neurology, University Hospital Centre of Rijeka, Rijeka, Croatia
| | - T. Braut
- Department of Neurology, University Hospital Centre of Rijeka, Rijeka, Croatia
| | - Z. Tomic
- Department of Neurology, University Hospital Centre of Rijeka, Rijeka, Croatia
| | - I. Sonnenschein
- Department of Neurology, University Hospital Centre of Rijeka, Rijeka, Croatia
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