Cardiac Surgery Clinic Research Articles

Incidence and Prognostic Significance of Silent Coronary Disease in Asymptomatic Patients with Severe Aortic Stenosis.

Background and Objectives: The aim of this study was to estimate the prevalence of silent coronary artery disease (CAD) in asymptomatic patients with severe aortic stenosis (AS) and assess long-term prognosis in terms of major adverse cardiovascular event (MACE)-free survival. Materials and Methods: This was a prospective study conducted at the Clinic for Cardiac Surgery, University Clinical Center of Serbia, in asymptomatic patients with severe AS, normal LVEF and stress test without signs of myocardial ischemia. Adverse cardiovascular events (cardiac death, myocardial infarction and any hospitalization due to heart disease) was monitored during one year of follow up. Results: A total of 116 asymptomatic patients with severe AS were included in the study. The average age was 67.3 ± 9.6 years, and 56.9% of patients were men. The most common cause of AS was degenerative valvular disease (83.5%). The incidence of significant CAD was 30 out of 116 patients (25.9%). The median Society for Thoracic Surgeons (STS) predicted risk of mortality score was 1.62% (25th to 75th percentile: 1.15-2.76%). The overall mean gradient across aortic valve (Pmean) was 52.30 mmHg ± 12.16, and the mean indexed AVA (AVAi) was 0.37 ± 0.09 cm2/m2. The mean LVEF was 68.40% ± 8.01%. Early surgery for aortic valve replacement was performed in 55 patients (55.2%), while 52 (44.8%) patients received conservative treatment. Twenty-two patients (42.3%) in the conservative treatment group underwent surgery during follow up. There were a total of 44 (37.9%) patients with MACE during one year of follow up. Univariate Cox regression analyses identified the following significant risk factors for MACE-free survival: presence of CAD and early conservative treatment (p = 0.004), age (p = 0.003), diabetes mellitus (p = 0.016) and STS score (p = 0.039). According to multivariate analysis, the presence of CAD with early conservative treatment was the most important predictor of MACE-free survival in asymptomatic patients with severe aortic stenosis (p ≤ 0.001). Conclusions: Early surgery for aortic valve replacement in asymptomatic patients with severe AS and concomitant CAD is beneficial for long-term survival.

Intermittent hypoxic preconditioning reduces the risk of peri- and postoperative complications during on-pump cardiac surgery

Aim. To assess the effect of intermittent hypoxic-hyperoxic exposures (IHHE) on the outcomes of on-pump cardiac surgery.Material and methods. This prospective, single-center, randomized, controlled study was conducted in 110 patients with heart valve defects and/or aortic pathology from the cardiac surgery clinic of the I. M. Sechenov First Moscow State Medical University. The total sample was randomly divided into a group of patients who underwent IHHE (n=66) and a control group of patients who underwent placebo procedures with ambient air (n=44). The frequency and structure of intra-and postoperative complications were analyzed within 30 days after surgery. The presence of cognitive impairment, as well as serum troponin I and lactate concentrations were analyzed before and after surgery.Results. Peri- and early postoperative complications such as cardiac death, non-fatal infarction and acute heart failure occurred significantly less frequently in patients treated with IHHE compared with placebo group (1,6% vs 16,7%, p=0,009; 1,6% vs 16,7%, p=0,009; 6,3% vs 33,3%, p<0,001, respectively). The median troponin I values 24 hours after surgery were 1,068 ng/ml (0,388-1,397 ng/ml) in the IHHE group and were significantly lower compared to the control group (1,980 ng/ml (1,068-3,239 ng/ml)). The serum lactate level after surgery was 1,8±0,7 mmol/l in the IHHE group and was significantly lower compared to the control group — 2,4±1,2 (p=0,05). Cognitive function, assessed by MOCA and MMSE tests, turned out to be significantly higher in patients who underwent a preoperative IHHE. No significant complications or serious adverse events were observed during the IHHE procedures.Conclusion. The use of individually adapted hypoxic preconditioning procedures reduces the incidence of peri- and postoperative complications, which is accompanied by a lower ischemia-reperfusion myocardial injury during artificial circulation with preservation of cognitive functions. IHHE procedures ramp up prehabilitation of patients referred for on-pump surgery of heart defects and aortic pathology.

The importance and prognostic effect of thyroid hormones in patients with transposition of the great arteries

Objectives: Transposition of the great arteries (TGA) is a rare congenital heart disease that occurs in 3 in 10,000 newborns and is rapidly fatal (90%) within one year if left untreated. The prognosis of this pathology changed after introducing an early arterial switch operation (ASO), while the left ventricle could still adapt to systemic high-pressure conditions. Appropriate regulation of thyroid hormones positively impacts metabolism, cardiac function, and postoperative recovery. Therefore, regular thyroid hormone monitoring and thyroid function monitoring of TGA patients may help to improve the health status and prognosis of this group of postoperative patients. Methods: In our study, 127 patients who underwent ASO at our pediatric cardiac surgery clinic between 01.01.2014 and 18.09.2021 were retrospectively analyzed and included. Among the patients, 43% (n=54) were females, and 57% (n=73) were males. Results: The coronary arteries were normal in 89.7% (n=114) and abnormal in 10.3% (n=13) of the patients. Twenty-one of the patients exited, and mortality was calculated to be 16.5%. There were no significant differences in mortality or thyroid stimulating hormone (TSH), free thyroxine (T4), or free triiodothyronine (T3) values (P=0.674, P=0.345, P=0.478). In our study, in which we investigated the effect of thyroid hormone levels on prognosis in neonatal patients with TGA with normal free T3, T4, and TSH values, we found that TSH levels were greater in the group with advanced aortic regurgitation and exitus, although the effect of thyroid hormones on postoperative results was not statistically significant. Conclusions: Congenital hypothyroidism is a common disease with cardiac effects. During the neonatal period, this disease may conceal itself. Careful, expert clinical follow-up and clinical trials are crucial to improve outcomes in the surgical treatment of transposition of the great arteries, a complex congenital heart disease.

Acquired von Willebrand syndrome and post-operative drainage: a comparison of patients with aortic stenosis versus coronary artery disease.

Degenerative aortic stenosis and coronary artery disease are considered to be the most prevalent cardiovascular diseases in industrialized countries. This study aims to determine the change over time in von Willebrand factor antigen, von Willebrand factor activity, and factor VIII and where there is a correlation with total post-operative drainage. The single-center retrospective study included 203 consecutive patients (64.5% male), undergoing coronary artery bypass surgery between March 1, 2019 and June 30, 2020 at the University Clinical Center of Serbia in the Clinic for Cardiac Surgery in Belgrade, Serbia. All patients 18years or older who presented with isolated, hemodynamically significant aortic stenosis were included. The control group consisted of patients who presented with only coronary artery disease. Between patients with only coronary artery disease and patients with coronary artery diseases and aortic stenosis, there was a statistically significant difference between pre-op and 1-month post-op fibrinogen, factor VIII, von Willebrand factor antigen, and von Willebrand factor (p < 0.001), post-op drainage, with overall lower drainage in coronary artery disease patients, and consistent increase in von Willebrand factor antigen, von Willebrand factor activity, and Factor VIII post-operatively in patients with coronary artery diseases and aortic stenosis. This study has shown that there is a correlation between von Willebrand factor antigen, von Willebrand factor activity and total drainage to the level of statistical significance in aortic stenosis patients and in the overall study population.

SOME ASPECTS OF CORONARY ARTERY BYPASS GRAFTING IN MYOCARDIAL INFARCTION WITHOUT ST ELEVATION

HighlightsThe frequency of coronary artery bypass grafting in patients with non-ST-elevation myocardial infarction (NonSTEMI) in the Research Institute of Cardiology “Tomsk National Research Medical Center of the Russian Academy of Sciences” is equal to 10%, hospital mortality is 4.3%, which corresponds to the literature data. Patients with NonSTEMI who undergo coronary artery bypass grafting in cardiac surgery centers in Tomsk, Kemerovo and Chelyabinsk do not differ in main clinical and anamnestic characteristics. Patients with NonSTEMI who undergo CABG in cardiac surgery centers in Leipzig and Kiel (Germany), have a higher surgical risk compared with patients in Russian centers, while they are operated on much earlier than in Russian centers, and there are no statistically significant differences in hospital mortality between clinics. AbstractAim. To perform a comparative analysis of clinical and anamnestic characteristics and treatment outcomes in NonSTEMI patients who underwent CABG in 2020 at the Research Institute of Cardiology “Tomsk National Research Medical Center of the Russian Academy of Sciences” and in other domestic and foreign clinics.Methods. The retrospective study involved 23 NonSTEMI patients/ The patients clinical and anamnestic characteristics after CABG and the main outcome of treatment were analyzed. The obtained results were compared with the data of 4 other cardiac surgery clinics that were found in the literature.Results. The frequency of CABG in NonSTEMI patients is 10%, which corresponds to the literature data. The mean age of these patients was 64.8±8.4 years, LVEF – 55.5±9.2%, the risk according to the GRACE score – 4.9±5.6%, according to the EuroSCORE – 7.3±2.1%. There were no patients with cardiogenic shock or dialysis. The duration of hospitalization prior to surgery was 7.4±5.3 days. The hospital mortality was 4.3%. The clinical and anamnestic characteristics of NonSTEMI patients who underwent CABG surgery in the clinics of Tomsk, Kemerovo (n = 66), Chelyabinsk (n = 101), Leipzig (n = 758) and Kiel (n = 461) were compared. The characteristics of patients of the Russian clinics did not differ. It was found that in Russian clinics these patients were younger, and had less severe complications of the disease, and less severe comorbid diseases in comparison with patients of the German clinics. In particular, in the Russian clinics, CABG was not performed in patients with cardiogenic shock, unlike in the German clinics. At the same time, the German clinics conduct surgery on NonSTEMI patients much earlier than in the Russian clinics: only 10–20% of patients are operated on in the Russian clinics in the first 3 days of the disease, whereas in Leipzig – 42% of patients, and in Kiel almost all patients – on the first day of the disease; there were no statistically significant differences in hospital mortality between clinics.Conclusion. According to the results of the analysis, clinical and anamnestic characteristics of NonSTEMI patients who undergo CABG in Russian cardiac surgery centers (Tomsk, Kemerovo and Chelyabinsk) do not differ. Compared with the patients of the German cardiac surgery centers of Leipzig and Kiel, Russian patients have a lower surgical risk, they are operated on much later, there were no statistically significant differences in hospital mortality between clinics.

РИСК-ОРИЕНТИРОВАННЫЙ ПОДХОД В УПРАВЛЕНИИ МЕДИЦИНСКИМ ОБОРУДОВАНИЕМ В ОКАЗАНИИ

Introduction. The use of equipment in the provision of medical care is associated with risks of harm to health and life with the likelihood of adverse events, for this reason, a risk-based approach is a prerequisite in modern realities. The goal is to identify the risks of operating medical equipment (MO) in a cardiac surgery clinic. Material and methods. The Research Institute for Complex Problems of Cardiovascular Diseases (NII KPSSZ) used the technique of failure cause and effect analysis (FMEA) to identify risks. By the number of points of the generalized quantitative characteristic of the risk of non-compliance (priority risk number - RPR), all risks are divided into levels: low, medium, high and catastrophic. The obtained data were systematized in the "Risk Passport", including: the definition of risk, its indicator, indicator, level, source. The cause and consequences of the risk, as well as measures to manage them are indicated. The whole process is formalized within the framework of the Quality Manual and documented QMS procedures. Results. Indicators of the equipment of the Ministry of Defense and the performance of the engineering service of the Research Institute of the KPSS for the period from 2012 to 2022 indicate a high load on the management system of the Ministry of Defense, in particular, an increase in the number of units of the Ministry of Defense (from 976 units to 2520 units, the average annual (chain) growth rate was 13%), carried out Maintenance (from 555 to 2361) and repair of the Ministry of Defense (335-897). In the process, 8 risks were identified, including two high levels (purchase of low-quality spare parts, consumables and improper operation of the MO). The consequences of high risks include: violations in the operation of medical equipment, reduction of service life, deterioration of performance, downtime, unscheduled maintenance, repairs and the risk of obtaining erroneous diagnostic results, injury hazard for personnel and patients. Consequence management includes: compliance with the procedure for acceptance of consumables and spare parts, organization of claims work, timely repairs, internal investigation of cases of violations. The medium level of risk includes “improper maintenance of the MO by the outsourcer’s personnel”, the consequences of which may also be a decrease in the resource and deterioration in performance, downtime for repairs. Measures to manage the causes of this risk were the development of technical specifications for the conclusion of a contract with qualification requirements. The low level of risk includes: delay in the procedure for preparing documents for write-off, the reasons for which are the short deadlines for completing the task, the limited horizontal links with related services, difficulties in identifying by the departments allowing the write-off; violation of the requirements for the terms of delivery of MO (the reason is the violation by the supplier of the manufacturer's requirements for the conditions of storage and transportation, violation of the delivery time); lack of conditions for launching a new MO (the reason is non-compliance with the procedure for organizing the purchase of equipment); MOs requiring verification may not be included in the lists, and some of the already verified equipment may mistakenly be included in the lists of verified measuring instruments (the reason is errors made in the preparation and approval of statements according to F3.5-15, F3.5-17); refusal of the CMS to verify the MO due to a malfunction or incompleteness (the reason is a violation of the procedure for preparing equipment for verification of the measuring instruments) - the control measure is the introduction of a pre-verification control of the technical condition. Conclusion. A risk-based approach when working with MO allows medical organizations to prevent, identify and prevent risks that pose a threat to the life and health of both patients and staff, to minimize the consequences of their occurrence by improving approaches to the implementation of medical activities.

Giant myxoma of the right sections of the heart obstructing the inferior vena cava: A case report

Objective: We present a rare case of surgical management of giant myxoma of the right heart with obstruction of the orifice of the inferior vena cava (IVC), obstruction of the right atrioventricular orifice, with the development of high pulmonary hypertension, and severe heart failure. Case presentation: A 39 years old male patients applied to the consultative polyclinic with typical complaints of severe shortness of breath, palpitations, severe weakness, almost bed rest, severe swelling of the lower extremities, with a transition to the anterior abdominal wall (edema). On physical examination signs of severe heart failure NYHA class IV were revealed. Imaging demonstrated giant right atrial myxoma obstructing IVC with base originated in fossa ovalis, obstructing tricuspid valve and protruding in the right ventricle occupying 50% of its cavity. The surgical removal of the giant RA myxoma protruding the right ventricle and obstructing IVC and tricuspid valve was performed under cardiopulmonary bypass and hemodynamic support. The patient was discharged on the 10th day after surgery and only residual minimal tricuspid regurgitation was revealed on follow-up examination. Conclusion: The described case from our practice proves the possibility of a severe course of giant myxomas of the right heart, with the development of deep hemodynamic complications of systemic and pulmonary circulation. The chosen correct tactics of surgical treatment provided a favorable result, despite the severity of the initial condition and the degree of hemodynamic disturbance. Intraoperative tactics and technique for performing the stages of urgent surgery were chosen based on the situation, the features of the anatomical structure of the tumor, and the severe complications that arose. Our case proves the possibility of adequate implementation of such interventions, when choosing the right tactics of surgical treatment. Take home message: If clinical signs of circulatory failure, heart failure are detected, it is necessary to perform echocardiography. If mass formations of the heart chambers are detected, immediately refer the patient to specialized cardiac surgery clinics to resolve the issue of surgical correction of pathology.

P476 TOLERATED SUSTAINED VENTRICULAR FIBRILLATION IN LVAD RECIPIENT: THE WALKING DEAD

Abstract A 73–year–old man comes to the cardiac surgery clinic, due to the onset of an arrhythmic storm. In 1999, the patient was diagnosed with dilated cardiomyopathy with finding of a pathogenic mutation of the MYH7 gene by NGS panel analysis. Because of severely reduced systolic function despite OMT and left conduction delay, he underwent CRT–D implant in class IA. The patient‘s course was characterized by multiple exacerbations and a worsening course of ventricular dysfunction (EF 20%), such as to configure a picture of advanced heart failure, INTERMACS III (frequent flyer). Approximately 6 months later, the patient was admitted with signs of hypoperfusion refractory to inotrope therapy and significant congestion. In consideration of age, frailty and irreversible renal dysfunction, the patient was excluded from the transplant list. Therefore, he was a candidate for mechanical support as destination therapy, through the implantation of the Heart Mate III. At admission, the patient was monitored with evidence of ventricular fibrillation (image 1) and relative hemodynamic stability. The vital parameters reported a BP of 90/76 mmHg, FC not evaluable and SpO2 of 80%. For this reason, in anesthesiological assistance, asynchronous external defibrillation (200 J) was performed with restoration of the pacing rhythm. The monitoring of the LVAD showed a series of alerts: a reduction of the Pump Flow and phases of reduction of the Pulse Index (image 2). Event monitoring of the CRT–D revealed that the patient developed an arrhythmic storm, with appropriate but ineffective several shocks. The 8 shocks were followed by the interruption of the device therapies, but the patient, despite the ventricular fibrillation, had preserved perfusion. Medical therapy was optimized (mexiletine add–on) and CRT–D was rescheduled. Conclusions The presence of LVAD ensures a satisfactory cardiac output during arrhythmias that would lead to hemodynamic compromise. For this reason it is possible to identify patients who autonomously come to our observation in "cardiac arrest".

Cardiopulmonary arrest in acute type A aortic dissection-the call for a treatment algorithm!

Journal Article Accepted manuscript Cardiopulmonary arrest in acute type A aortic dissection—the call for a treatment algorithm! Get access Julia Dumfarth, MD, Julia Dumfarth, MD University Clinic for Cardiac Surgery, Medical University Innsbruck, Austria Corresponding author: Julia Dumfarth, MD, PhD, University Clinic for Cardiac Surgery, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria. Phone: +43 512 504 82500 Julia.Dumfarth@i-med.ac.at Search for other works by this author on: Oxford Academic PubMed Google Scholar Lukas Stastny, MD, Lukas Stastny, MD University Clinic for Cardiac Surgery, Medical University Innsbruck, Austria Search for other works by this author on: Oxford Academic PubMed Google Scholar Simone Gasser, MD, Simone Gasser, MD University Clinic for Cardiac Surgery, Medical University Innsbruck, Austria Search for other works by this author on: Oxford Academic PubMed Google Scholar Michael Grimm, MD Michael Grimm, MD University Clinic for Cardiac Surgery, Medical University Innsbruck, Austria Search for other works by this author on: Oxford Academic PubMed Google Scholar European Journal of Cardio-Thoracic Surgery, ezad123, https://doi.org/10.1093/ejcts/ezad123 Published: 05 April 2023 Article history Received: 21 March 2023 Accepted: 04 April 2023 Published: 05 April 2023

Evaluation of Complications Predictors in the Performance of Coronary Artery Bypass Grafting Surgery in the Cardiac Surgery Clinic "Bicard"

Hlavním cílem práce byl komplexní výzkum a stratifikace klinických, funkčních a chirurgických rizikových faktorů z hlediska vzniku komplikací koronárního bypassu v předoperačním období. Materiály a metody: Byly analyzovány údaje 97 pacientů ve věku 31-84 let (průměrný věk 62,9 &#177; 8,4) s ischemickou chorobou srdeční po koronárním bypassu (v mimotělním oběhu). Za prognostická kritéria posloužil věk pacienta, přítomnost akutního infarktu myokardu v anamnéze, délka hospitalizace, počet zkratů, délka komprese aorty i trvání mimotělního oběhu. Mezi sledované parametry patřily rozměry levé komory na konci diastoly a systoly, anteroposteriorní rozměr levé síně, tloušťka mezikomorového septa a spodní stěny levé komory, ejekční frakce levé komory, přítomnost a rozsah mitrální regurgitace a dysfunkce levé komory v diastole. Výsledky: Sledování klinických, funkčních a chirurgických rizikových faktorů pro rozvoj komplikací koronárního bypassu prokázalo nejvyšší senzitivitu akutního infarktu myokardu (v anamnéze i těsně před výkonem) a nejvyšší specificitu diastolické dysfunkce levé komory. Závěr: Jako nejvýznamnější prediktory vzniku komplikací koronárního bypassu v pooperačním období byly identifikovány akutní infarkt myokardu, ejekční frakce levé komory &lt; 40 %, přítomnost diastolické dysfunkce levé komory a délka použití mimotělního oběhu. &#169; 2023, ČKS.

Attitude of cardiac surgery patients to the problems of organ donation and transplantation (based on the materials of a survey of patients)

The aim – to conduct a study among patients of the cardiac surgery clinics and determine their attitude towards organ donation and transplantation.Materials and methods. To achieve this goal, a study was conducted and empirical information was obtained from a representative sample of 411 patients. The study used general scientific methods of analysis, synthesis, generalization, interpretation of scientific data, as well as a systematic approach.Results. As a result of the study, the attitude of patients of the cardiac surgery clinics to organ donation and transplantation was determined. It was found that at the level of patients of the cardiac surgery clinics the cultural understanding of society in relation to organ donation and transplantation has not been formed.Conclusions. The existing cultural views of the patients in Ukraine doesn’t provide positive precedents for development of organ donation based on the system of «organ testament». The analysis of the data obtained from the survey showed that the topic of organ donation and transplantation is not sufficiently familiar to the respondents.

Arrhythmias in Pregnancy. Experience of the Multidisciplinary Team

Arrhythmia is the main cause of pregnancy-related hospitalizations. Potential risk of arrhythmias during pregnancy is associated with hypercoagulation and increased risk of thromboembolism.&#x0D; The aim. To increase patients’ safety and to improve maternal and perinatal outcomes by choosing the optimal medical strategy.&#x0D; Methods. We present the experience of multidisciplinary care for 54 pregnant and parturient women (32 with tachy-, 20 with bradyarrhythmia and 2 with ventricular asynchrony) who were admitted to the cardiac surgery facility from December 2013 to February 2022. Pacemakers were implanted in 15 cases of complete atrioventricular block radiofrequency ablation was performed in 12 cases.&#x0D; Results. There were no near misses and maternal losses in our group of patients. Two programmed perinatal losses were provided in patients with rhythm disorders and complex congenital heart defects. Type and place of delivery were chosen by the multidisciplinary team. There were nine childbirths at a specialized cardiac surgery clinic. There were no perinatal losses among patients who underwent rhythm interventions. In our group of patients, electrical cardioversion was performed in three cases, the pregnancies ended successfully with the birth of healthy newborns.&#x0D; Conclusions. Arrhythmias in all trimesters of pregnancy and the postpartum period are a common reason for seeking medical attention and hospitalization during pregnancy.Most of the arrhythmias are hemodynamically insignificant and don’t require hospitalization. Maternal risk stratification of major cardiac events during pregnancy, childbirth and the postpartum period is the cornerstone for choosing a strategy of medical care for pregnant women with arrhythmias. Patients with hemodynamic manifestations of tachy- and bradyarrhythmias, as well as patients with life-threatening types of rhythm disturbances are in the focus of attention of pregnancy heart team. Preconceptional management of patients with life threating arrhythmias is the best type of care in these patients. Pregnancy and delivery in high-risk class patients should be managed in an experienced center with on-site interventional electrophysiology techniques. Rhythm interventions have extremely limited indications and can be conducted when less invasive treatment strategy is unsuccessful.

MO423: Does Renal Dysfunction Improve the Predictive Value of Hatch Score for Postoperative Atrial Fibrillation?

Abstract BACKGROUND AND AIMS Postoperative atrial fibrillation (POAF) is a frequent arrhythmic complication in cardiac surgery. Studies of this potential complication have not been able to elucidate its aetiology nor to identify the predictors of its occurrence. The aim of this study was to evaluate the predictive role of a renal dysfunction for POAF in patients undergoing cardiac surgery interventions. We also aimed to determine the role of renal dysfunction in improving the diagnostic accuracy of hypertension, age, transitory attack/stroke, chronic obstructive pulmonary disease, heart failure (HATCH) score for POAF. METHOD This prospective monocentric observational study included 178 consecutive patients who underwent cardiac surgery interventions in the State University Clinic for Cardiac Surgery of Skopje, Republic of North Macedonia, between September 2017 and September 2018. Patients were divided into two groups, according to the absence or occurrence of POAF. HATCH score was calculated and recorded for each patient. A new R-HATCH score was derived by the addition of renal dysfunction to the existing HATCH score and its predictive value for POAF was tested and compared to HATCH. RESULTS POAF occurred in 90/178 patients (50.56%). The average estimated glomerular filtration rate (eGFR) in the group developing POAF was significantly lower, 78.4 ± 26.9 versus 93.0 ± 29.0 mL/min/1,73m2 (P = 0.0005). Patients with GFR &amp;lt; 60mL/min/1.73m2 had almost a 5 times greater risk of developing POAF. The addition of renal dysfunction to HATCH score improved its predictive accuracy in our study. The area under the receiver operating characteristic curve increased from 0.73 to 0.76 (P &amp;lt; 0.001). CONCLUSION The addition of preoperative renal dysfunction could improve the diagnostic accuracy of HATCH score for POAF.

Heart transplant rejection pathology

Background/Aim. Heart transplantation is the most effective way to treat patients in the terminal stage of heart failure. Endomyocardial biopsy has proven to be a safe and appropriate technique, with little sampling error, and remains, to this day, one of the most commonly used methods for diagnosing acute rejection. In 1990, the International Society of Heart and Lung Transplantation defined a standardized system for grading the severity of acute transplant rejection regarding endomyocardial sampling histopathological analysis. The aim of the study was to assess the morphological, immunohistochemical, and immunofluorescent markers of cell- and antibody-mediated rejection of heart transplants in patients monitored during 2020. Methods. From 31 patients transplanted at the Clinic for Cardiac Surgery of the University Clinical Center of Serbia, endomyocardial biopsy material was obtained, then processed and analyzed at the Institute of Pathology of the Faculty of Medicine, University of Belgrade. Results. The average Transplant Rejection Score (TRS) value was 0.42. The Spearman's correlation test did not show a statistically significant relationship between the TRS value and the difference between the ejection fraction values three and twelve months after transplantation. Conclusion. The mean TRS value obtained in this study suggests dominant cell-mediated graft rejection.

ОСНОВЫ ПЕРСОНАЛИЗИРОВАННОГО ПОДХОДА ПРИ МЕДИКО-ПСИХОЛОГИЧЕСКОМ СОПРОВОЖДЕНИИ КАРДИОХИРУРГИЧЕСКИХ ПАЦИЕНТОВ

The concept of a personalized approach is becoming more and more popular in modern medicine. Today it is often understood as a multidisciplinary approach designed to improve therapeutic options, as well as help diagnose diseases at an early stage. In a cardiac surgery clinic, such an approach can take into account not only biological, but also psychological risk factors for the disease, especially its history, clinical condition, mental and psychological status to create an individual route within the framework of medical and psychological support for the patient at the stages of treatment and rehabilitation. The aim of the work was to develop, based on the analysis of the literature and the authors' own work experience, the organizational and psychological foundations for the implementation of a personalized approach in medical and psychological support of cardiac patients. The fundamental principles of support in the work include the following: the principle of accessibility, the principle of openness, the principle of continuity, the principle of complexity, the principle of integrativity, the principle of differentiation, the principle of variability, the principle of participativeness, the principle of awareness, the principle of prevention. In the process of medical and psychological support of cardiac surgical patients within the framework of a personalized approach, the most optimal was the identification of the following clinical stages, different in duration and content, corresponding to the periods of outpatient and inpatient treatment and rehabilitation of patients: preoperative outpatient, preoperative inpatient, early postoperative, postoperative inpatient, postoperative rehabilitation and rehabilitation outpatient stages. For each of the clinical stages of medical and psychological support, a differentiation of goals, objectives, duration and expected results of the impact was carried out, which makes it possible to personalize the programs for accompanying a cardiac patient and individualize the route for each patient, taking into account the specificity and relevance of the influence of biologi cal, psychological and social factors.

A gray zone in the literature: indications, options, and outcomes for surgical repair of pulmonary artery aneurysms.

Pulmonary artery aneurysms are rare. They are characterised by an aneurysmatic dilatation of the pulmonary vascular bed, including the main pulmonary artery or the accompanying pulmonary artery branches. Increases in pulmonary flow and pulmonary artery pressure increase the risk of rupture: when these conditions are detected, surgical intervention is necessary.This study is a retrospective analysis of 33 patients treated in our paediatric cardiac surgery clinic from 2012 to 2020. Aneurysms and pseudoaneurysms in patients who were patched for right ventricular outflow tract reconstruction and corrected with a conduit were excluded from the study. Seventeen (51.5%) of the patients included in the study were female and 16 (48.5%) were male. The patients were aged between 23 and 61 years (mean 30.66 ± 12.72 years). Graft interpositions were performed in 10 patients (30.3%) and pulmonary artery plications were performed in 23 patients (69.7%) to repair aneurysms. There was no significant difference in mortality between the two groups (p > 0.05).Pulmonary artery aneurysm interventions are safe, life-saving treatments that prevent fatal complications such as ruptures, but at present there is no clear guidance regarding surgical timing or treatment strategies. Pulmonary artery interventions should be performed in symptomatic patients with dilations ≥5 cm or asymptomatic patients with dilations ≥8 cm; pulmonary artery pressure, right ventricular systolic pressure, and pulmonary artery aneurysm diameter must be considered when planning surgeries, their timing, and making decisions regarding indications. Experienced surgical teams can achieve satisfactory results using one of the following surgical techniques: reduction pulmonary arterioplasty, plication, or graft replacement.

Surgical Treatment of Heart Mixomas: the Analysis of 10 Years’ Experience

Introduction. Primary cardiac tumors are rare, and the autopsy detection rate does not exceed 0.003%. Approximately 80% of primary heart tumors are benign, 50% of them are myxomas. Diagnosis of cardiac tumors at present in the presence of transesophageal echocardiography is not difficult in most cases. Surgical treatment of mixomas became possible after the introduction of open-heart surgery under cardiopulmonary bypass into clinical practice. After verification of the tumor, its surgical removal is indicated. In the practice of large cardiac surgery clinics, the experience of radical treatment of heart neoplasms is relatively small; therefore, the analysis of tactical approaches and results of operations in this pathology is of absolute interest.Aim of study. To present an analysis of 10 years’ experience in surgical treatment of cardiac mixomas. Material and methods The results of treatment of 58 patients with myxomas who underwent surgical removal of the neoplasm of the heart are presented.Results. Hospital mortality after surgical removal of myxoma was 1.7%, 1 patient died. All patients, we have the long-term period data about, noted a significant improvement in well-being, a decrease or disappearance of dyspnea at rest and/or during exertion, and no recurrence of myxoma was noted. Conclusion. The data obtained indicate, on the whole, good immediate results and high quality of life of patients in the long-term period operated on for heart mixomas.

Influence of frailty syndrome on patient prognosis after coronary artery bypass grafting.

Frailty syndrome and cardiovascular diseases are closely related because of the shared physiological pathway of chronic, low-intensity inflammation. Frailty syndrome may be an adverse factor in the prognosis of patients with cardiovascular disease (CVD). To assess the influence of frailty syndrome on patient prognosis after coronary artery bypass grafting (CABG). The study was conducted at the Clinic of Cardiac Surgery in Katowice and involved 180 patients (56 women, 31.11%) over 60 years of age who qualified for CABG surgery. The Tilburg Frailty Indicator (TFI) was used to assess frailty syndrome and the The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire was used to assess quality of life. Statistical analysis was performed using R software. Frailty syndrome was diagnosed in 42 patients (23.3%), including 24 men and 18 women. More than 1/3 of patients had complications during or after surgery, including 34.6% of patients without frailty syndrome and 28.6% of patients with frailty features. All of the complications occurred in 57 (31.6%) patients. Early complications accounted for 89.5% of all events - 93.3% of which occurred in patients without frailty syndrome and 75% in patients with frailty features (p = 0.289). More than 1/3 of patients experienced complications during or after the CABG procedure. Early postoperative complications accounted for almost all of the adverse events in patients with frailty. However, frailty syndrome was a poor predictor of rehospitalization.

Preoperative monocytosis is predictable at diagnosis for RT-PCR negative COVİD-19 paediatric cardiac surgery patients.

Other markers investigated in this population have gained importance in the diagnosis of the disease since the course of COVID-19 disease is atypical in the paediatric population and PCR may be misleading. The leukocyte profile is one of these biochemical tests. Children did not have lymphopenia in hemogram count, whereas relatively neutropenia and monocytosis were detected, unlike the adult population. The reason why children do not have lymphopenia is thought to be due to the fact that the thymus is more active in the first years of life.Two-hundred and four patients operated in our paediatric cardiac surgery clinic from 11March, 2020 to 1 April, 2021 were retrospectively examined and 11 patients with preoperative asymptomatic and PCR (-), but with PCR (+) in the post-operative period (patients with incubation period or false PCR negativity) were included in our study. Patients requiring emergency operation and operated from PCR (+) patients in the preoperative period were excluded from the study.The neutrophil ratio in the lymphocytic series of 7 patients out of 11 patients was slightly below the normal range in the preoperative period, the lymphocyte ratio of 3 patients was slightly above the normal range, and the relative monocyte ratio of 10 patients was slightly above the normal range.We think that evaluating the leukocyte profile combined with RT-PCR will give more accurate results in the diagnosis of incubation period and false RT-PCR negative patients. In addition, we believe that the algorithms for non-complex paediatric cardiac surgery procedures and timing in the paediatric population with a better course of COVID-19 disease with a positive post-operative course.

Diagnostic Features Abnormal Drainage of Pulmonary Vines

The incidence of abnormal drainage of the pulmonary veins (ADPV), has been described. Despite the success in the surgical treatment of abnormal pulmonary vein drainage some issues of the clinical diagnosis of this defect remain unresolved. In this regard, the study of the clinical course and diagnostic methods of ADPV, is relevant, which makes it possible to timely identify the defect, rational planning of the examination and choosing the optimal method of correction. In specialized cardiac surgery clinics Andijan State medical institute (ASMI) and Republican Specialized Scientific Practical Center for Surgery (RSSPCS) them. Acad. V.V.Vakhidov, 214 patients with various types of ADPV were examined, in 173 cases there was a partial ADPV and in 41 - TADPV. The diagnosis of the defect was based on the analysis of a set of data from traditional and special research methods, including echocardiography, catheterization of the cardiac cavities with angiocardiography, and MSCT with angiography was performed in 18 patients.