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Hlavicka J, Janda D, Budera P, Tousek P, Maly M, Fojt R, Linkova H, Holubec T, Kacer P. Partial upper sternotomy for aortic valve replacement provides similar mid-term outcomes as the full sternotomy. J Thorac Dis 2022; 14:857-865. [PMID: 35572904 PMCID: PMC9096275 DOI: 10.21037/jtd-21-1494] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 02/26/2022] [Indexed: 11/15/2022]
Abstract
Background Minimally invasive aortic valve replacement via upper partial sternotomy (MiniAVR) provides very good short-term results and delivers certain advantages in the postoperative course. There is limited data regarding the mid-term mortality and morbidity following this minimally invasive surgery. Methods We provide a retrospective analysis of the patients, undergoing MiniAVR versus full sternotomy (FS) for aortic valve replacement with biological prosthesis. As the primary combined end-point the combination of death, stroke, and rehospitalization within 3 years postoperatively was defined. Data have been collected from National Cardiac Surgery Registry and insurance companies. Results Two hundred consecutive patients with aortic valve replacement (100 ministernotomy in MiniAVR group and 100 full sternotomy in FS group) with biological prosthesis were included in this study. Ministernotomy had longer cross-clamp and bypass times (median difference 6.5 min, P=0.005, and 8.5 min, P=0.002 respectively). Patients operated via upper partial sternotomy had a lower postoperative bleeding [300 mL (IQR, 290) vs. 365 mL (IQR, 207), P=0.031]. There was no difference in the 3-year mortality (14% vs. 11%, P=0.485). The mean number of readmission 3 years after surgery per capita was almost the same in both groups (1.65 vs. 1.60, P=0.836). Median time to the first readmission was longer in the MiniAVR group (difference 8.9 months). The incidence of combined end-point during 3 years postoperatively in both groups was not statistically different (P=0.148), as well as readmissions from cardio-vascular reasons (subhazard ratio 0.90, P=0.693). Conclusions Upper partial sternotomy can be performed safely for aortic valve replacement, without increased risk of death, stroke or re-admission in 3 years postoperatively.
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Affiliation(s)
- Jan Hlavicka
- Department of Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
- Department of Cardiac Surgery, Charles University in Prague, Third Faculty of Medicine and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - David Janda
- Department of Cardiac Surgery, Charles University in Prague, Third Faculty of Medicine and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - Petr Budera
- Department of Cardiac Surgery, Charles University in Prague, Third Faculty of Medicine and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - Petr Tousek
- Department of Cardiology, Charles University in Prague, Third Faculty of Medicine and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - Marek Maly
- National Institute of Public Health, Prague, Czech Republic
| | - Richard Fojt
- Department of Cardiac Surgery, Charles University in Prague, Third Faculty of Medicine and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - Hana Linkova
- Department of Cardiology, Charles University in Prague, Third Faculty of Medicine and Kralovske Vinohrady University Hospital, Prague, Czech Republic
| | - Tomas Holubec
- Department of Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt am Main, Germany
| | - Petr Kacer
- Department of Cardiac Surgery, Charles University in Prague, Third Faculty of Medicine and Kralovske Vinohrady University Hospital, Prague, Czech Republic
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Osmancik P, Herman D, Kacer P, Rizov V, Vesela J, Rakova R, Karch J, Susankova M, Znojilova L, Fojt R, Prodanov P, Kremenova K, Malikova H, Peisker T, Stros P, Curila K, Javurkova A, Raudenska J, Budera P. The Efficacy and Safety of Hybrid Ablations for Atrial Fibrillation. JACC Clin Electrophysiol 2021; 7:1519-1529. [PMID: 34217655 DOI: 10.1016/j.jacep.2021.04.013] [Citation(s) in RCA: 3] [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: 01/19/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study sought to comprehensively determine the procedural safety and midterm efficacy of hybrid ablations. BACKGROUND Hybrid ablation of atrial fibrillation (AF) (thoracoscopic ablation followed by catheter ablation) has been used for patients with nonparoxysmal AF; however, accurate data regarding efficacy and safety are still limited. METHODS Patients with nonparoxysmal AF underwent thoracoscopic, off-pump ablation using the COBRA Fusion radiofrequency system (Estech) followed by a catheter ablation 3 months afterward. The safety of the procedure was assessed using sequential brain magnetic resonance and neuropsychological examinations at baseline (1 day before), postoperatively (2-4 days for brain magnetic resonance imaging or 1 month for neuropsychological examination), and at 9 months after the surgical procedure. Implantable loop recorders were used to detect arrhythmia recurrence. Arrhythmia-free survival (the primary efficacy endpoint) was defined as no episodes of AF or atrial tachycardia while off antiarrhythmic drugs, redo ablations or cardioversions. RESULTS Fifty-nine patients (age: 62.5 ± 10.5 years) were enrolled, 37 (62.7%) were men, and the mean follow-up was 30.3 ± 10.8 months. Thoracoscopic ablation was successfully performed in 55 (93.2%) patients. On baseline magnetic resonance imaging, chronic ischemic brain lesions were present in 60% of patients. New ischemic lesions on postoperative magnetic resonance imaging were present in 44.4%. Major postoperative cognitive dysfunction was present in 27.0% and 17.6% at 1 and 9 months postoperatively, respectively. The probability of arrhythmia-free survival was 54.0% (95% CI: 41.3-66.8) at 1 year and 43.8% (95% CI: 30.7-57.0) at 2 years. CONCLUSIONS The thoracoscopic ablation is associated with a high risk of silent cerebral ischemia. The midterm efficacy of hybrid ablations is moderate.
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Affiliation(s)
- Pavel Osmancik
- Department of Cardiology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
| | - Dalibor Herman
- Department of Cardiology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Kacer
- Department of Cardiac Surgery, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vitalii Rizov
- Department of Cardiac Surgery, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jana Vesela
- Department of Cardiology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Radka Rakova
- Department of Cardiology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jakub Karch
- Department of Cardiology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marketa Susankova
- Department of Cardiology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucie Znojilova
- Department of Cardiology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Richard Fojt
- Department of Cardiac Surgery, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petko Prodanov
- Department of Cardiac Surgery, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karin Kremenova
- Department of Radiology, University Hospital Kralovske Vinohrady Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hana Malikova
- Department of Radiology, University Hospital Kralovske Vinohrady Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Tomas Peisker
- Department of Neurology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Stros
- Department of Cardiology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karol Curila
- Department of Cardiology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alena Javurkova
- Department of Clinical Psychology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
| | - Jaroslava Raudenska
- Department of Clinical Psychology, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Psychology, Faculty of Arts, Charles University, Prague, Czech Republic
| | - Petr Budera
- Department of Cardiac Surgery, University Hospital Kralovske Vinohrady, Third Faculty of Medicine, Charles University, Prague, Czech Republic
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Prodanov P, Linkova H, Petr R, Fojt R, Motovska Z, Knot J, Rohac F, Koznar B, Majid M, Widimsky P, Kacer P. A contemporary approach to a young female patient with Loeys-Dietz syndrome and an uncomplicated type B aortic dissection: a case report. J Cardiothorac Surg 2020; 15:231. [PMID: 32867844 PMCID: PMC7457485 DOI: 10.1186/s13019-020-01274-0] [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: 06/07/2020] [Accepted: 08/24/2020] [Indexed: 11/20/2022] Open
Abstract
Background Aortic dissection is a relatively uncommon, but often catastrophic disease that requires early and accurate diagnosis. It often presents in patients with congenital connective tissue disorders. The current aortic surgical techniques are related with serious early and late complications. This case report emphasizes the importance of early diagnosis of aortic root dilatation and the risk of dissection, especially in patients with congenital connective tissue disorders. We present an alternative, contemporary and multidisciplinary approach based on the present state of knowledge. Case presentation We present a rare case of a young female patient with Loeys-Dietz syndrome who was admitted with an uncomplicated aortic dissection (Stanford type B / DeBakey type III) and a dilated aortic root. After a period of close surveillance and extensive vascular imaging, thoracic endovascular aortic repair was deemed to be technically not possible. Medical treatment was optimized and our patient successfully underwent a personalised external aortic root support procedure (PEARS) as a contemporary alternative to existing aortic root surgical techniques. Conclusions This case highlights the importance of interdisciplinary approach, close follow-up and multimodality imaging. The decision to intervene in a chronic type B aortic dissection is still challenging and should be made in experienced centers by an interdisciplinary team. However, if an acute complication occurs, thoracic endovascular aortic repair TEVAR is the method of choice. In all cases optimal medical treatment is important. There is increasing evidence that personalized external aortic root support procedure PEARS is effective in stabilizing the aortic root and preventing its dilatation and dissection not only in patients with Marfan syndrome, but also in other cases of aortic root dilation of other etiologies. Moreover, many publications have reported the additional benefit of reduction or even eradication of aortic regurgitation by improving coaptation of the aortic valve leaflets in dilated aortas.
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Affiliation(s)
- Petko Prodanov
- Department of Cardiac surgery, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic.
| | - Hana Linkova
- 3rd Department of Internal Medicine - Cardiology, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
| | - Robert Petr
- 3rd Department of Internal Medicine - Cardiology, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
| | - Richard Fojt
- Department of Cardiac surgery, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
| | - Zuzana Motovska
- 3rd Department of Internal Medicine - Cardiology, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
| | - Jiri Knot
- 3rd Department of Internal Medicine - Cardiology, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
| | - Filip Rohac
- 3rd Department of Internal Medicine - Cardiology, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
| | - Boris Koznar
- 3rd Department of Internal Medicine - Cardiology, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
| | - Mariwan Majid
- Department of Cardiac surgery, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
| | - Petr Widimsky
- 3rd Department of Internal Medicine - Cardiology, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
| | - Petr Kacer
- Department of Cardiac surgery, Faculty Hospital Královské Vinohrady, Srobarova 50, 10034, Praha, Czech Republic
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Pavlusova M, Jarkovsky J, Benesova K, Vitovec J, Linhart A, Widimsky P, Spinarova L, Zeman K, Belohlavek J, Malek F, Felsoci M, Kettner J, Ostadal P, Cihalik C, Spac J, Al-Hiti H, Fedorco M, Fojt R, Kruger A, Malek J, Mikusova T, Monhart Z, Bohacova S, Pohludkova L, Rohac F, Vaclavik J, Vondrakova D, Vyskocilova K, Bambuch M, Dostalova G, Havranek S, Svobodová I, Dusek L, Spinar J, Miklik R, Parenica J. Hyperuricemia treatment in acute heart failure patients does not improve their long-term prognosis: A propensity score matched analysis from the AHEAD registry. Clin Cardiol 2019; 42:720-727. [PMID: 31119751 PMCID: PMC6671780 DOI: 10.1002/clc.23197] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/22/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hyperuricemia is associated with a poorer prognosis in heart failure (HF) patients. Benefits of hyperuricemia treatment with allopurinol have not yet been confirmed in clinical practice. The aim of our work was to assess the benefit of allopurinol treatment in a large cohort of HF patients. METHODS The prospective acute heart failure registry (AHEAD) was used to select 3160 hospitalized patients with a known level of uric acid (UA) who were discharged in a stable condition. Hyperuricemia was defined as UA ≥500 μmoL/L and/or allopurinol treatment at admission. The patients were classified into three groups: without hyperuricemia, with treated hyperuricemia, and with untreated hyperuricemia at discharge. Two- and five-year all-cause mortality were defined as endpoints. Patients without hyperuricemia, unlike those with hyperuricemia, had a higher left ventricular ejection fraction, a better renal function, and higher hemoglobin levels, had less frequently diabetes mellitus and atrial fibrillation, and showed better tolerance to treatment with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and/or beta-blockers. RESULTS In a primary analysis, the patients without hyperuricemia had the highest survival rate. After using the propensity score to set up comparable groups, the patients without hyperuricemia had a similar 5-year survival rate as those with untreated hyperuricemia (42.0% vs 39.7%, P = 0.362) whereas those with treated hyperuricemia had a poorer prognosis (32.4% survival rate, P = 0.006 vs non-hyperuricemia group and P = 0.073 vs untreated group). CONCLUSION Hyperuricemia was associated with an unfavorable cardiovascular risk profile in HF patients. Treatment with low doses of allopurinol did not improve the prognosis of HF patients.
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Affiliation(s)
- Marie Pavlusova
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Klara Benesova
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Vitovec
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,First Department of Internal Medicine, Cardiology and Angiology, St Anne's University Hospital Brno, Brno, Czech Republic
| | - Ales Linhart
- Second Department of Internal Medicine, Department of Cardiology and Angiology, First Faculty of Medicine of the Charles University, Prague, and General University Hospital in Prague, Czech Republic
| | - Petr Widimsky
- University Hospital Kralovske Vinohrady and the Third Faculty of Medicine of the Charles University, Prague, Czech Republic
| | - Lenka Spinarova
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,First Department of Internal Medicine, Cardiology and Angiology, St Anne's University Hospital Brno, Brno, Czech Republic
| | - Kamil Zeman
- Department of Internal Medicine, Hospital Frydek-Mistek, Frydek-Mistek, Czech Republic
| | - Jan Belohlavek
- Second Department of Internal Medicine, Department of Cardiology and Angiology, First Faculty of Medicine of the Charles University, Prague, and General University Hospital in Prague, Czech Republic
| | - Filip Malek
- Department of Cardiology, Hospital Na Homolce, Prague, Czech Republic
| | - Marian Felsoci
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Kettner
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Ostadal
- Department of Cardiology, Hospital Na Homolce, Prague, Czech Republic
| | - Cestmir Cihalik
- Department of Internal Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jiri Spac
- Faculty of Medicine, Masaryk University, Brno, Czech Republic.,Second Department of Internal Medicine, St Anne's University Hospital Brno, Brno, Czech Republic
| | - Hikmet Al-Hiti
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Marian Fedorco
- Department of Internal Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Richard Fojt
- University Hospital Kralovske Vinohrady and the Third Faculty of Medicine of the Charles University, Prague, Czech Republic
| | - Andreas Kruger
- Department of Cardiology, Hospital Na Homolce, Prague, Czech Republic
| | - Josef Malek
- Department of Internal Medicine, Hospital Havlickuv Brod, Havlickuv Brod, Czech Republic
| | - Tereza Mikusova
- First Department of Internal Medicine, Cardiology and Angiology, St Anne's University Hospital Brno, Brno, Czech Republic
| | - Zdenek Monhart
- Department of Internal Medicine, Hospital Znojmo, Znojmo, Czech Republic
| | - Stanislava Bohacova
- Department of Cardiology, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Lidka Pohludkova
- Department of Internal Medicine, Hospital Frydek-Mistek, Frydek-Mistek, Czech Republic
| | - Filip Rohac
- University Hospital Kralovske Vinohrady and the Third Faculty of Medicine of the Charles University, Prague, Czech Republic
| | - Jan Vaclavik
- Department of Internal Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Dagmar Vondrakova
- Department of Cardiology, Hospital Na Homolce, Prague, Czech Republic
| | - Klaudia Vyskocilova
- First Department of Internal Medicine, Cardiology and Angiology, St Anne's University Hospital Brno, Brno, Czech Republic
| | - Miroslav Bambuch
- Department of Cardiology, Tomas Bata Regional Hospital, Zlin, Czech Republic
| | - Gabriela Dostalova
- Second Department of Internal Medicine, Department of Cardiology and Angiology, First Faculty of Medicine of the Charles University, Prague, and General University Hospital in Prague, Czech Republic
| | - Stepan Havranek
- Second Department of Internal Medicine, Department of Cardiology and Angiology, First Faculty of Medicine of the Charles University, Prague, and General University Hospital in Prague, Czech Republic
| | - Ivana Svobodová
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ladislav Dusek
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jindrich Spinar
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Roman Miklik
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.,Department of Internal Medicine, Military Hospital Brno, Brno, Czech Republic
| | - Jiri Parenica
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic.,Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Osmancik P, Budera P, Zdarska J, Herman D, Petr R, Fojt R, Straka Z. Residual echocardiographic and computed tomography findings after thoracoscopic occlusion of the left atrial appendage using the AtriClip PRO device. Interact Cardiovasc Thorac Surg 2019; 26:919-925. [PMID: 29360987 DOI: 10.1093/icvts/ivx427] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 12/14/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Thoracoscopic occlusion of the left atrial appendage (LAA) has become a routine part of thoracoscopic ablation for the treatment of atrial fibrillation (AF). Evaluation of residual findings of the occluded LAA by echocardiography has yet to be described. METHODS Patients with AF indicated for hybrid ablation (thoracoscopic procedure followed by catheter ablation) were enrolled in this study. LAA was occluded as a routine part of the thoracoscopic procedure. Follow-up transoesophageal echocardiography was performed at the end of the procedure, 2-5 days and 2-3 months after the procedure (before the endocardial stage). The residual pouches of the LAA were measured in the mitral valve view (30-110°) and in the perpendicular view. The depth of the residual pouch was measured from the ostial plane (connecting the Coumadin ridge and the circumflex artery) to the deepest part of the residuum. The volume of the residual pouch and the distance from the circumflex artery to the proximal and the distal ends of the AtriClip were measured using computed tomography. RESULTS Forty patients were enrolled in this study. The success rate for the occlusion of the LAA, assessed on transoesophageal echocardiography 2-5 days after surgery, was 97.5%. Regarding the residual findings, no reperfused LAAs were found, and only residual stumps remained. The depth of the stump was 12.9 ± 5.9 mm, the area was 2.2 ± 1.1 cm2, and the volume was 3.6 ± 1.9 ml (all data are shown as mean ± standard deviation). CONCLUSIONS The occlusion of the LAA using an AtriClip PRO device was a clinically safe procedure with high efficacy and was associated with the presence of a small residual pouch after occlusion. Clinical trial registration NCT02832206.
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Affiliation(s)
- Pavel Osmancik
- Cardiology Clinic, Third Department of Internal Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Petr Budera
- Clinic of Cardiac Surgery, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Jana Zdarska
- Cardiology Clinic, Third Department of Internal Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Dalibor Herman
- Cardiology Clinic, Third Department of Internal Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Robert Petr
- Cardiology Clinic, Third Department of Internal Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Richard Fojt
- Clinic of Cardiac Surgery, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Zbynek Straka
- Clinic of Cardiac Surgery, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
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Budera P, Osmančík P, Talavera D, Kraupnerová A, Rizov V, Fojt R, Straka Z. Thoracoscopic ablation of atrial fibrillation - Should we still be concerned about periprocedural complications? Cor Vasa 2017. [DOI: 10.1016/j.crvasa.2017.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Budera P, Osmancik P, Talavera D, Kraupnerova A, Fojt R, Zdarska J, Vanek T, Straka Z. Two-staged hybrid ablation of non-paroxysmal atrial fibrillation: clinical outcomes and functional improvements after 1 year. Interact Cardiovasc Thorac Surg 2017; 26:77-83. [DOI: 10.1093/icvts/ivx248] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 07/03/2017] [Indexed: 12/23/2022] Open
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Osmancik P, Budera P, Petr R, Herman D, Petr R, Zdarska J, Fojt R, Straka Z. P917Residual findings after thoracoscopic occlusion of the left atrial appendage using an Atri Clip PRO device. Europace 2017. [DOI: 10.1093/ehjci/eux151.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Budera P, Osmančík P, Talavera D, Fojt R, Kraupnerová A, Žďárská J, Vaněk T, Straka Z. [Thoracoscopic, epicardial ablation of atrial fibrillation using the COBRA Fusion system as the first part of hybrid ablation]. Rozhl Chir 2017; 96:203-208. [PMID: 28758758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Treatment of persistent and long-standing persistent atrial fibrillation is not successfully managed by methods of catheter ablation or pharmacotherapy. Hybrid ablation (i.e. combination of minimally invasive surgical ablation, followed by electrophysiological assessment and subsequent endocardial catheter ablation to complete the entire intended procedure) presents an ever more used and very promising treatment method. METHOD Patients underwent thoracoscopic ablation of pulmonary veins and posterior wall of the left atrium (the box-lesion) with use of the COBRA Fusion catheter; thoracoscopic occlusion of the left atrial appendage using the AtriClip system was also done in later patients. After 23 months, electrophysiological assessment and catheter ablation followed. In this article we summarize a strategy of the surgical part of the hybrid procedure performed in our centre. We describe the surgery itself (including possible periprocedural complications) and we also present our short-term results, especially with respect to subsequent electrophysiological findings. RESULTS Data of the first 51 patients were analyzed. The first 25 patients underwent unilateral ablation; the mean time of surgery was 102 min. Subsequent 26 patients underwent the bilateral procedure with the mean surgery time of 160 min. Serious complications included 1 stroke, 1 phrenic nerve palsy and 2 surgical re-explorations for bleeding. After 1 month, 65% of patients showed sinus rhythm. The box-lesion was found complete during electrophysiological assessment in 38% of patients and after catheter ablation, 96% of patients were discharged in sinus rhythm. CONCLUSION The surgical part of the hybrid procedure with use of the minimally invasive approach and the COBRA Fusion catheter is a well-feasible method with a low number of periprocedural complications. For electrophysiologists, it provides a very good basis for successful completion of the hybrid ablation.Key words: atrial fibrillation hybrid ablation - thoracoscopy catheter ablation electrophysiology assessment.
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Fojt R, Moťovská Z, Budera P, Malý M, Straka Z. Prognostic impact and change of concomitant mitral regurgitation after surgical or transcatheter aortic valve replacement for aortic stenosis. J Cardiol 2016; 67:526-30. [PMID: 26972342 DOI: 10.1016/j.jjcc.2016.02.001] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/10/2016] [Accepted: 02/05/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Significant aortic stenosis (AS) is frequently associated with mitral regurgitation (MR) of varying degrees. We sought to assess the change in MR grade after the aortic valve procedure, to find predictors of MR improvement and finally to determine the prognostic impact of persistent MR. METHODS We retrospectively analyzed a group of 101 AS patients who underwent aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI) at our institution between January 2007 and March 2014 and who presented with MR grade 2 or higher on preoperative echocardiogram - 35 patients underwent an isolated AVR, 18 underwent TAVI, and the rest underwent a combined procedure, which included coronary artery bypass grafting. The mean follow-up was 28.5±21 months. RESULTS MR improved significantly after the procedures (2.4±0.5 vs. 1.9±0.9, p<0.001) and a decline in the severity of MR was observed regardless of etiology (degenerative/post-rheumatic, functional/ischemic, combined) without significant changes between groups (p=0.667). Downgrading of MR severity was associated with improvement in ejection fraction (p=0.021) and reduction in the size of cardiac chambers, especially the left atrium (left atrial diameter, p<0.001). None of the preoperatively evaluated factors (severity of AS, MR etiology, ejection fraction, cardiac chamber dimensions, coronary artery disease, and New York Heart Association functional class) was a significant predictor of MR improvement. Persistence of higher degrees of MR was associated with a more frequent need for cardiovascular hospitalization, while the survival rate 3 years after procedure was not affected (p=0.146). CONCLUSIONS In the majority of AS patients, an aortic valve procedure leads to reduction in coexistent MR. A significant decrease in the severity of MR in our study was observed regardless of etiology and preoperative grade of MR. Persistence of higher degrees of MR was associated with increased patient morbidity.
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Affiliation(s)
- Richard Fojt
- Third Medical Faculty Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Zuzana Moťovská
- Third Medical Faculty Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
| | - Petr Budera
- Third Medical Faculty Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Marek Malý
- National Institute of Public Health, Prague, Czech Republic
| | - Zbyněk Straka
- Third Medical Faculty Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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11
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Fojt R, Pirk J, Kamenický P, Karpíšek M, Straka Z, Malý M, Moťovská Z. Values of osteoprotegerin in aortic valve tissue in patients with significant aortic stenosis depend on the existence of concomitant coronary artery disease. Cardiovasc Pathol 2015; 25:181-184. [PMID: 26874038 DOI: 10.1016/j.carpath.2015.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 11/30/2015] [Accepted: 12/23/2015] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Calcific aortic valve stenosis (CAVS) is a serious clinical problem. The strongest predictor of CAVS progression is the amount of calcium in the aortic valve. The pathogenesis of CAVS is largely consistent with the pathogenesis of atherosclerosis; however, about 50% of patients with CAVS do not exhibit significant atherosclerosis. Cardiovascular calcification is currently considered an actively regulated process, in which the important role is attributed to the RANKL/RANK/OPG (receptor activator of nuclear factor κB ligand/RANK/osteoprotegerin) axis. We measured OPG levels in the tissue of calcified, stenotic aortic valves in relation to the presence or absence of coronary artery disease (CAD). MATERIALS AND METHODS Aortic valve samples were collected from 105 patients with calcified, mainly severe aortic stenosis, who were divided into two groups according to the presence of CAD. In Group A (n=44), there were normal coronary artery findings, while in Group B (n=61), there was angiographically demonstrated >50% stenosis of at least one coronary artery. The control Group C (n=21) consisted of patients without aortic stenosis and with normal angiographic findings on coronary arteries. RESULTS The highest tissue concentrations of OPG [median (pmol/L), 25th-75th percentile] were found in Group A [6.95, 3.96-18.37], which was significantly different compared to the other two groups (P=.026 and .001, respectively). The levels of OPG in Group B [4.15, 2.47-9.16] and in Group C [2.25, 1.01-5.08] did not differ significantly (P=.078); however, the lowest concentrations of OPG were found in Group C. Neither age nor gender in our study had effect on tissue levels of OPG (P=.994 for gender; P=.848 for age). CONCLUSION Calcified and narrowed aortic valves, compared to the normal valves, were accompanied by a change in tissue concentrations of OPG, which is, in addition, dependent on the presence or absence of CAD. The highest tissue concentrations of OPG in our work were found in patients with significant aortic stenosis without concomitant CAD.
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Affiliation(s)
- Richard Fojt
- Cardiocentre, Third Medical Faculty Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jan Pirk
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Peter Kamenický
- Assistance Publique - Hôpitaux de Paris and Service d'Endocrinologie et des Maladies de la Reproduction, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Zbyněk Straka
- Cardiocentre, Third Medical Faculty Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Marek Malý
- National Institute of Public Health, Prague, Czech Republic
| | - Zuzana Moťovská
- Cardiocentre, Third Medical Faculty Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
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Littnerova S, Parenica J, Spinar J, Vitovec J, Linhart A, Widimsky P, Jarkovsky J, Miklik R, Spinarova L, Zeman K, Belohlavek J, Malek F, Felsoci M, Kettner J, Ostadal P, Cihalik C, Spac J, Al-Hiti H, Fedorco M, Fojt R, Kruger A, Malek J, Mikusová T, Monhart Z, Bohacova S, Pohludkova L, Rohac F, Vaclavik J, Vondrakova D, Vyskocilova K, Bambuch M, Dusek L. Positive influence of being overweight/obese on long term survival in patients hospitalised due to acute heart failure. PLoS One 2015; 10:e0117142. [PMID: 25710625 PMCID: PMC4339191 DOI: 10.1371/journal.pone.0117142] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/19/2014] [Indexed: 11/28/2022] Open
Abstract
Background Obesity is clearly associated with increased morbidity and mortality rates. However, in patients with acute heart failure (AHF), an increased BMI could represent a protective marker. Studies evaluating the “obesity paradox” on a large cohort with long-term follow-up are lacking. Methods Using the AHEAD database (a Czech multi-centre database of patients hospitalised due to AHF), 5057 patients were evaluated; patients with a BMI <18.5 kg/m2 were excluded. All-cause mortality was compared between groups with a BMI of 18.5–25 kg/m2 and with BMI >25 kg/m2. Data were adjusted by a propensity score for 11 parameters. Results In the balanced groups, the difference in 30-day mortality was not significant. The long-term mortality of patients with normal weight was higher than for those who were overweight/obese (HR, 1.36; 95% CI, 1.26–1.48; p<0.001)). In the balanced dataset, the pattern was similar (1.22; 1.09–1.39; p<0.001). A similar result was found in the balanced dataset of a subgroup of patients with de novo AHF (1.30; 1.11–1.52; p = 0.001), but only a trend in a balanced dataset of patients with acute decompensated heart failure. Conclusion These data suggest significantly lower long-term mortality in overweight/obese patients with AHF. The results suggest that at present there is no evidence for weight reduction in overweight/obese patients with heart failure, and emphasize the importance of prevention of cardiac cachexia.
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Affiliation(s)
- Simona Littnerova
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiri Parenica
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Medical Faculty, Masaryk University, Brno, Czech Republic; Department of Cardiovascular Disease, International Clinical Research Center, University Hospital St Anne's, Brno, Czech Republic
| | - Jindrich Spinar
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Medical Faculty, Masaryk University, Brno, Czech Republic; Department of Cardiovascular Disease, International Clinical Research Center, University Hospital St Anne's, Brno, Czech Republic
| | - Jirí Vitovec
- Medical Faculty, Masaryk University, Brno, Czech Republic; First Department of Cardiovascular Internal Medicine, University Hospital St Anne's, Brno, Czech Republic
| | - Ales Linhart
- 2nd Department of Cardiovascular Internal Medicine, First Medical Faculty, Charles University, Prague and General Teaching Hospital of Prague, Prague, Czech Republic
| | - Petr Widimsky
- Kralovske Vinohrady University Hospital and the 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Roman Miklik
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Department of Cardiovascular Disease, International Clinical Research Center, University Hospital St Anne's, Brno, Czech Republic
| | - Lenka Spinarova
- Medical Faculty, Masaryk University, Brno, Czech Republic; First Department of Cardiovascular Internal Medicine, University Hospital St Anne's, Brno, Czech Republic
| | - Kamil Zeman
- Department of Internal Medicine, Hospital Frydek-Mistek, Frydek-Mistek, Czech Republic
| | - Jan Belohlavek
- 2nd Department of Cardiovascular Internal Medicine, First Medical Faculty, Charles University, Prague and General Teaching Hospital of Prague, Prague, Czech Republic
| | - Filip Malek
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Marian Felsoci
- Department of Cardiology, University Hospital Brno, Brno, Czech Republic; Department of Cardiovascular Disease, International Clinical Research Center, University Hospital St Anne's, Brno, Czech Republic
| | - Jiri Kettner
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Ostadal
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Cestmir Cihalik
- Department of Internal Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Jiri Spac
- Medical Faculty, Masaryk University, Brno, Czech Republic; 2nd Department of Internal Medicine, University Hospital St Anne's, Brno, Czech Republic
| | - Hikmet Al-Hiti
- Department of Cardiology, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Marian Fedorco
- Department of Internal Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Richard Fojt
- Kralovske Vinohrady University Hospital and the 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Andreas Kruger
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Josef Malek
- Department of Internal Medicine, Hospital Havlickuv Brod, Havlickuv Brod, Czech Republic
| | - Tereza Mikusová
- First Department of Cardiovascular Internal Medicine, University Hospital St Anne's, Brno, Czech Republic
| | - Zdenek Monhart
- Department of Internal Medicine, Hospital Znojmo, Znojmo, Czech Republic
| | | | - Lidka Pohludkova
- Department of Internal Medicine, Hospital Frydek-Mistek, Frydek-Mistek, Czech Republic
| | - Filip Rohac
- Kralovske Vinohrady University Hospital and the 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Vaclavik
- Department of Internal Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Dagmar Vondrakova
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Klaudia Vyskocilova
- First Department of Cardiovascular Internal Medicine, University Hospital St Anne's, Brno, Czech Republic
| | - Miroslav Bambuch
- Department of Cardiology, T.Bata Hospital Zlin, Zlin, Czech Republic
| | - Ladislav Dusek
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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13
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Motovska Z, Fojt R, Kamenicky P, Straka Z, Karpisek M, Maly M, Widimsky P, Pirk J. Values of osteoprotegerin in aortic valve tissue differ significantly between calcified aortic valve stenosis and normal aortic valve and are influenced by the presence of coronary atherosclerosis. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Budera P, Straka Z, Osmančík P, Vaněk T, Jelínek Š, Hlavička J, Fojt R, Červinka P, Hulman M, Šmíd M, Malý M, Widimský P. Comparison of cardiac surgery with left atrial surgical ablation vs. cardiac surgery without atrial ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation: final results of the PRAGUE-12 randomized multicentre study. Eur Heart J 2012; 33:2644-52. [PMID: 22930458 PMCID: PMC3485575 DOI: 10.1093/eurheartj/ehs290] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aims Surgical ablation procedure can restore sinus rhythm (SR) in patients with atrial
fibrillation (AF) undergoing cardiac surgery. However, it is not known whether it has
any impact on long-term clinical outcomes. Methods and results This multicentre study randomized 224 patients with AF scheduled for valve and/or
coronary surgery: group A (left atrial surgical ablation, n =
117) vs. group B (no ablation, n = 107). The primary efficacy
outcome was the SR presence (without any AF episode) during a 24 h electrocardiogram
(ECG) after 1 year. The primary safety outcome was the combined endpoint of
death/myocardial infarction/stroke/renal failure at 30 days. A Holter-ECG after 1 year
revealed SR in 60.2% of group A patients vs. 35.5% in group B
(P = 0.002). The combined safety endpoint at 30 days occurred
in 10.3% (group A) vs. 14.7% (group B, P = 0.411).
All-cause 1-year mortality was 16.2% (A) vs. 17.4% (B, P
= 0.800). Stroke occurred in 2.7% (A) vs. 4.3% (B) patients
(P = 0.319). No difference (A vs. B) in SR was found among
patients with paroxysmal (61.9 vs. 58.3%) or persistent (72 vs. 50%) AF,
but ablation significantly increased SR prevalence in patients with longstanding
persistent AF (53.2 vs. 13.9%, P < 0.001). Conclusion Surgical ablation improves the likelihood of SR presence post-operatively without
increasing peri-operative complications. However, the higher prevalence of SR did not
translate to improved clinical outcomes at 1 year. Further follow-ups (e.g. 5-year) are
warranted to show any potential clinical benefit which might occur later.
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Affiliation(s)
- Petr Budera
- Cardiocenter, Third Faculty of Medicine, Charles University Prague, Czech Republic.
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15
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Motovska Z, Odvodyova D, Fojt R, Karpisek M, Vichova T, Tousek P, Kocka V, Widimsky P. Abstract 396: Serum Osteoprotegerin (OPG) Differs Significantly in Patients with Calcified Aortic Valve Stenosis in Relation to the Presence of Coronary Atherosclerosis. Arterioscler Thromb Vasc Biol 2012. [DOI: 10.1161/atvb.32.suppl_1.a396] [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: 11/16/2022]
Abstract
Background.
We concentrated on OPG/RANKL in patients with symptomatic calcified AoS of the trileaflet valve, who were being considered for aortic valve replacement (AVR).
Methods.
Serum levels of cytokines were measured in: Group A (N = 101) patients with AoS and normal coronary arteries (assessed using coronary angiography), Group B (N = 105) patients with AoS and significant (stenosis > 50%) coronary atherosclerosis. Control groups consisted of patients without AoS and with normal coronary arteries (group C, N = 39) or with significant coronary atherosclerosis (Group D, N = 30).
Results.
Values of OPG were significantly higher in patients with AoS and normal coronary arteries compared to controls with normal coronary arteries and without AoS. No difference was observed between levels of OPG in patients with AoS and CAD and control group of patients with CAD and without AoS. Multivariable analyses underscored these results (table). Serum levels of RANKL did not differ significantly between groups A vs. C. Serum OPG did not change significantly in patients after AVR (Group A). The difference in serum concentration of OPG in patients after AVR and CABG (Group B) was significant (p<0.001).
Conclusion.
Serum OPG differs significantly in patients with calcified aortic stenosis in relation to the presence of significant coronary atherosclerosis. Our results suggest that OPG plays and important role in pathomechanism of calcified aortic valve disease in patients without coronary atherosclerosis
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Affiliation(s)
- Zuzana Motovska
- Third Faculty of Medicine Charles Univ, Prague, Czech Republic
| | | | - Richard Fojt
- Univ Hosp Royal Vineyards, Prague, Czech Republic
| | | | | | - Petr Tousek
- Third Faculty of Medicine Charles Univ, Prague, Czech Republic
| | - Viktor Kocka
- Third Faculty of Medicine Charles Univ, Prague, Czech Republic
| | - Petr Widimsky
- Third Faculty of Medicine Charles Univ, Prague, Czech Republic
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Penicka M, Linkova H, Lang O, Fojt R, Kocka V, Vanderheyden M, Bartunek J. Predictors of improvement of unrepaired moderate ischemic mitral regurgitation in patients undergoing elective isolated coronary artery bypass graft surgery. Circulation 2009; 120:1474-81. [PMID: 19786637 DOI: 10.1161/circulationaha.108.842104] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The persistence of moderate ischemic mitral regurgitation (IMR) after isolated coronary artery bypass graft surgery is an important independent predictor of long-term mortality. The aim of the present study was to identify predictors of postoperative improvement in moderate IMR in patients with ischemic heart disease undergoing elective isolated coronary artery bypass graft surgery. METHODS AND RESULTS The study population consisted of 135 patients with ischemic heart disease (age, 65+/-9 years; 81% male) and moderate IMR undergoing isolated coronary artery bypass graft surgery. Fourteen patients died before the 12-month follow-up echocardiography and were excluded. At the 12-month follow-up, 57 patients showed no or mild IMR (improvement group), whereas 64 patients failed to improve (failure group). Before coronary artery bypass graft surgery, the improvement group had significantly more viable myocardium and less dyssynchrony between papillary muscles than the failure group (P<0.001). All other preoperative parameters were similar in both groups. Large extent (> or =5 segments) of viable myocardium (odds ratio, 1.45; 95% confidence interval, 1.22 to 1.89; P<0.001) and absence (<60 ms) of dyssynchrony (odds ratio, 1.49; 95% confidence interval, 1.29 to 1.72; P<0.001) were independently associated with improvement in IMR. The majority (93%) of patients with viable myocardium and an absence of dyssynchrony showed an improvement in IMR. In contrast, only 34% and 18% of patients with dyssynchrony and nonviable myocardium, respectively, showed an improvement in IMR, whereas 32% and 49%, respectively, of these patients showed worsening of IMR (P<0.001). CONCLUSIONS Reliable improvement in moderate IMR by isolated coronary artery bypass graft surgery was observed only in patients with concomitant presence of viable myocardium and absence of dyssynchrony between papillary muscles.
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Affiliation(s)
- Martin Penicka
- Department of Cardiology, Third Faculty of Medicine Charles University in Prague, Ruska 87, 10004 Prague, Czech Republic.
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