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Trejnowska E, Skoczyński S, Swinarew AS, Tarczyńska-Słomian M, Armatowicz P, Cyprys P, Cieśla D, Zembala MO, Knapik P, Hryniewicz K. Value, time and outcomes of elevated lactate levels in adult patients on extracorporeal membrane oxygenation. Perfusion 2024; 39:124-133. [PMID: 36168831 DOI: 10.1177/02676591221130177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Lactate levels have been recognized as a reliable tool for monitoring critically ill patients requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) or venovenous extracorporeal membrane oxygenation (VV ECMO) but the reasons behind the overproduction of lactate are different and the influance for survival remains controversial. We analyzed the lactate values and lactate clearance in adult patients in these two forms of extracorporeal support. METHODS Patient demographics, ECMO duration, 30-day mortality, lactate values and lactate clearance at 24, 48 and 72 h from ECMO initiation of patients supported with VV and VA ECMO at Silesian Centre for Heart Deasese, between January 2011 and April 2020 were retrospectively analyzed. The changes in lactate levels were analyzed using the non-parametric U Mann-Whitney tests and Chi-square test. The ROC curves were draw and the area under the curve was calculated. RESULTS The study comprised 91 adult patients, Mortality in the first 30 days from initiation of VV and VA ECMO was 39% and 66%, respectively. Lactate levels were significantly higher in non-survivors that received VV and VA ECMO (p < .001), while lactate clearance was similar (p = .256 and p = 1.000, respectively). Survival curves for patients with elevated (>2.0 mmol/L) vs normal (≤2.0 mmol/L) lactate levels at 72 h were significantly different for VV ECMO (p = .007) and VA ECMO (p = .037) but in both groups of ECMO, lactate levels above 2.0 mmol/L at 72 h from ECMO initiation predicted 30 day-mortality. CONCLUSION This results emphasized the importance of lactate levels below 2.0 mmol/L at 72 h from both VV and VA ECMO initiation.
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Affiliation(s)
- Ewa Trejnowska
- Clinical Department of Cardioanesthesia and Intensive Care Unit, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Szymon Skoczyński
- Department of Pneumonology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Andrzej S Swinarew
- Faculty of Science and Technology, University of Silesia, Katowice, Poland
- Department of Individual Sports, Institute of Sport Science, The Jerzy Kukuczka Academy of Physical Education, Katowice, Poland
| | - Magda Tarczyńska-Słomian
- III Clinical Department of Cardiology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Paul Armatowicz
- Department of General and Endocrine Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Paweł Cyprys
- Doctoral School, Clinical Department of Cardioanesthesiology and Intensive Care Unit, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Daniel Cieśla
- Department of Science and New Technologies,Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Michał O Zembala
- Department of Cardiac Surgery, Heart and Lung Transplantation and Mechanical Circulatory Support, Silesian Center For Heart Diseases, Zabrze, Poland
- Pomeranian Medical University, Szczecin, Poland
| | - Piotr Knapik
- Clinical Department of Cardioanesthesia and Intensive Care Unit, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Katarzyna Hryniewicz
- Minneapolis Heart Institute Section of Advanced Heart Failure/MCS/ Heart Transplantation, Abbott Northwestern Hospital Minneapolis, MN, USA
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Surma S, Romańczyk M, Zembala MO, Filipiak KJ. Coffee and lipid profile: from theory to everyday practice. Folia Cardiologica 2023. [DOI: 10.5603/fc.a2022.0066] [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: 03/11/2023] Open
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Ratman K, Biełka A, Kalinowski ME, Herdyńska-Wąs MM, Przybyłowski P, Zembala MO. Permanent cardiac arrest in a patient with a left ventricular assist device support. Kardiol Pol 2022; 80:709-710. [PMID: 35485904 DOI: 10.33963/kp.a2022.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Katarzyna Ratman
- Department of Cardiac Surgery, Heart Transplantation and Mechanical Circulatory Support, Silesian Center For Heart Diseases, Zabrze, Poland.
| | - Agnieszka Biełka
- Department of Cardiac Surgery, Heart Transplantation and Mechanical Circulatory Support, Silesian Center For Heart Diseases, Zabrze, Poland
| | - Mariusz E Kalinowski
- Department of Cardiac Surgery, Heart Transplantation and Mechanical Circulatory Support, Silesian Center For Heart Diseases, Zabrze, Poland
| | - Mirosława M Herdyńska-Wąs
- Department of Cardiac Surgery, Heart Transplantation and Mechanical Circulatory Support, Silesian Center For Heart Diseases, Zabrze, Poland
| | - Piotr Przybyłowski
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases in Zabrze, Poland
| | - Michał O Zembala
- Department of Cardiac Surgery, Heart and Lung Transplantation and Mechanical Circulatory Support, Silesian Center For Heart Diseases, Zabrze, Poland.,Pomeranian Medical University, Szczecin, Poland
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Trejnowska E, Drobiński D, Knapik P, Wajda-Pokrontka M, Szułdrzyński K, Staromłyński J, Nowak W, Urlik M, Ochman M, Goździk W, Serednicki W, Śmiechowicz J, Brączkowski J, Bąkowski W, Kwinta A, Zembala MO, Suwalski P. Extracorporeal membrane oxygenation for severe COVID-19-associated acute respiratory distress syndrome in Poland: a multicenter cohort study. Crit Care 2022; 26:97. [PMID: 35392960 PMCID: PMC8988534 DOI: 10.1186/s13054-022-03959-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/08/2021] [Accepted: 03/22/2022] [Indexed: 03/27/2023] Open
Abstract
Background In Poland, the clinical characteristics and outcomes of patients with COVID-19 requiring extracorporeal membrane oxygenation (ECMO) remain unknown. This study aimed to answer these unknowns by analyzing data collected from high-volume ECMO centers willing to participate in this project. Methods This retrospective, multicenter cohort study was completed between March 1, 2020, and May 31, 2021 (15 months). Data from all patients treated with ECMO for COVID-19 were analyzed. Pre-ECMO laboratory and treatment data were compared between non-survivors and survivors. Independent predictors for death in the intensive care unit (ICU) were identified. Results There were 171 patients admitted to participating centers requiring ECMO for refractory hypoxemia due to COVID-19 during the defined time period. A total of 158 patients (mean age: 46.3 ± 9.8 years) were analyzed, and 13 patients were still requiring ECMO at the end of the observation period. Most patients (88%) were treated after October 1, 2020, 77.8% were transferred to ECMO centers from another facility, and 31% were transferred on extracorporeal life support. The mean duration of ECMO therapy was 18.0 ± 13.5 days. The crude ICU mortality rate was 74.1%. In the group of 41 survivors, 37 patients were successfully weaned from ECMO support and four patients underwent a successful lung transplant. In-hospital death was independently associated with pre-ECMO lactate level (OR 2.10 per 1 mmol/L, p = 0.017) and BMI (OR 1.47 per 5 kg/m2, p = 0.050). Conclusions The ICU mortality rate among patients requiring ECMO for COVID-19 in Poland was high. In-hospital death was independently associated with increased pre-ECMO lactate levels and BMI.
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Affiliation(s)
- Ewa Trejnowska
- Clinical Department of Cardiac Anesthesia and Intensive Therapy, Medical University of Silesia, Silesian Centre for Heart Diseases, M.Curie-Sklodowskiej 9, 41-800, Zabrze, Poland
| | - Dominik Drobiński
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Piotr Knapik
- Clinical Department of Cardiac Anesthesia and Intensive Therapy, Medical University of Silesia, Silesian Centre for Heart Diseases, M.Curie-Sklodowskiej 9, 41-800, Zabrze, Poland.
| | - Marta Wajda-Pokrontka
- Clinical Department of Cardiac Anesthesia and Intensive Therapy, Medical University of Silesia, Silesian Centre for Heart Diseases, M.Curie-Sklodowskiej 9, 41-800, Zabrze, Poland
| | - Konstanty Szułdrzyński
- Department of Anesthesiology and Intensive Therapy, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Jakub Staromłyński
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Wojciech Nowak
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Maciej Urlik
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Marek Ochman
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Waldemar Goździk
- Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Wojciech Serednicki
- Department of Anesthesiology and Intensive Care, Jagiellonian University, Medical College, Cracow, Poland
| | - Jakub Śmiechowicz
- Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Jakub Brączkowski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland
| | - Wojciech Bąkowski
- Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Anna Kwinta
- Department of Anesthesiology and Intensive Care, Jagiellonian University, Medical College, Cracow, Poland
| | - Michał O Zembala
- Department of Cardiac Surgery, Heart and Lung Transplantation and Mechanical Circulatory Support, Silesian Center For Heart Diseases, Zabrze, Poland.,Pomeranian Medical University in Szczecin, Szczecin, Poland.,University of Technology, Katowice, Poland
| | - Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
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Adamczyk M, Wasilewski J, Niedziela JT, Zembala MO, Gąsior M. Baseline characteristics, management and long-term outcomes of different etiologies of cardiac tamponade evaluated in a cohort of 340 patients. Kardiochir Torakochirurgia Pol 2021; 18:216-220. [PMID: 35079262 PMCID: PMC8768860 DOI: 10.5114/kitp.2021.112187] [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] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 09/19/2021] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Studies on the etiology of cardiac tamponade (CT) are scarce or lacking follow-up, and usually include small or highly selected groups of patients. AIM To evaluate the various etiologies and outcomes of CT in a cohort of patients treated in a tertiary care hospital encompassing cardiology, cardiac surgery and intensive care units. MATERIAL AND METHODS We retrospectively analyzed all adult patients hospitalized in the Silesian Centre for Heart Diseases in Zabrze (Poland) between January 2008 and December 2018, who required therapeutic pericardiocentesis or pericardiotomy due to CT. All various etiologies of CT were presented and assigned to the main etiology groups. For each group basic characteristics, in-hospital management, in-hospital and up to 2-year mortality were analyzed. RESULT Among 340 patients with CT, 56% were men. The leading etiology groups included patients after invasive cardiac procedures, patients following postpericardiotomy (PCT) syndrome and the patients with neoplasm. Patients with end stage renal failure, PCT and iatrogenic CTs were the most disease burdened groups. The highest need for advanced therapy and in-hospital mortality were observed for the acute myocardial infarction group, in contrast to PCT. CONCLUSIONS Within our cohort of patients, the invasive cardiac procedures overtake neoplastic causation of cardiac tamponade. The worst in-hospital prognosis was noted for CT following acute myocardial infarction and both iatrogenic invasive cardiac and cardiac surgery procedures. The highest long-term mortality was recorded for patients with end stage renal failure and the neoplastic group.
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Affiliation(s)
- Mária Adamczyk
- 3 Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Jarosław Wasilewski
- 3 Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Jacek T. Niedziela
- 3 Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Michał O. Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantation, Silesian Center for Heart Diseases, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Mariusz Gąsior
- 3 Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
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Biełka A, Kalinowski M, Pacholewicz J, Małyszek-Tumidajewicz J, Waszak J, Copik I, Kowalczuk-Wieteska A, Zakliczyński M, Przybyłowski P, Zembala M, Zembala MO. Short- and long-term outcomes of continuous-flow left ventricular assist device therapy in 79 patients with end-stage heart failure. Pol Arch Intern Med 2020; 130:589-597. [PMID: 32420709 DOI: 10.20452/pamw.15362] [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: 11/23/2022]
Abstract
INTRODUCTION An increasing number of patients with end‑stage heart failure, along with a shortage of heart donors, necessitates the use of mechanical circulatory support. OBJECTIVES This single‑center retrospective study evaluated short- and long term outcomes of continuous‑flow left ventricular assist device (CF LVAD) therapy in patients with end stage heart failure. PATIENTS AND METHODS We collected and assessed data of 79 patients (77 men, 2 women; mean age, 50.3 years; mean INTERMACS profile, 3.1) implanted with a CF‑LVAD between 2009 and 2017 (HeartMate 3 in 19 patients [24%]; HeartMate 2 in 9 [11.4%]; and HeartWare in 51 [64.6%]). RESULTS The mean time on CF-LVAD support was 604 days (range, 1–1758 days). There were 2 device exchanges due to pump thrombosis and 1 explantation due to heart regeneration; 9 patients (11.4%) underwent heart transplant. Stroke (nondisabling, 48%) occurred in 27.8% of patients (ischemic in 9 patients; hemorrhagic, in 14; both types, in 1) despite the standardized anticoagulation regimen. Major gastrointestinal bleeding and pump thrombosis were reported in 13 patients (16.5%), while 18 patients (22.8%) developed driveline infections (recurrent in 15 patients [19%]). Hemorrhagic stroke and bacteremia had a negative impact on survival. Hemorrhagic stroke was the main cause of death. Survival probability was 0.9 at 1 month and 0.81, 0.71, 0.61, and 0.53 at 1, 2, 3, and 4 years, respectively. CONCLUSIONS Although CF‑LVAD support is associated with substantial adverse events, they do not significantly affect mortality (except hemorrhagic stroke and bacteremia). Novel devices seem to overcome these limitations, but larger studies are needed to support these findings.
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Affiliation(s)
- Agnieszka Biełka
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Silesian Centre for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland.
| | - Mariusz Kalinowski
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Silesian Centre for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Jerzy Pacholewicz
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Silesian Centre for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Justyna Małyszek-Tumidajewicz
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Silesian Centre for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Jacek Waszak
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Silesian Centre for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Izabela Copik
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Silesian Centre for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Anetta Kowalczuk-Wieteska
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Silesian Centre for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Michał Zakliczyński
- Cardiac Transplantation and Mechanical Circulatory Support Unit, Department of Heart Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wrocław, Poland
| | - Piotr Przybyłowski
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Silesian Centre for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland; 1st Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Marian Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Silesian Centre for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Michał O Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Silesian Centre for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland
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Biełka A, Kalinowski M, Hawranek M, Małyszek-Tumidajewicz J, Pacholewicz J, Kowalczuk-Wieteska A, Ratman K, Kubiak G, Król B, Przybyłowski P, Zembala M, Zembala MO. Mechanical circulatory support restores eligibility for heart transplant in patients with significant pulmonary hypertension. Kardiol Pol 2020; 78:1008-1014. [PMID: 32692025 DOI: 10.33963/kp.15518] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND An increasing number of patients with end‑stage heart failure implies a wider use of left ventricular assist devices (LVADs). Irreversible pulmonary hypertension (PH) is a predictor of unfavorable prognosis and a contraindication to orthotopic heart transplant (OHT). AIMS The aim of this study was to evaluate the effect of continuous‑flow LVAD (CF‑LVAD) support on pulmonary pressure and pulmonary vascular resistance (PVR) as well as the impact of pre‑LVAD hemodynamic parameters on survival during LVAD support. METHODS Data collected from 106 patients who underwent CF‑LVAD implantation in the years 2009 to 2018 (men, 95.3%; mean [SD] age, 51.8 [12] years; mean [SD] INTERMACS profile, 2.9 [1.6]; mean [SD] LVAD support time, 661 [520] days; follow‑up until May 2019) were retrospectively analyzed. RESULTS Right heart catheterization was performed before LVAD implantation in 94 patients (88.7%), after implantation-in 31 (29.2%), and before and after implantation-in 28 (26.4%). We observed mean pulmonary artery pressure (mPAP) >25 mm Hg in 65 patients (61.3%) and PVR >2.5 Wood units in 33 patients (31.1%) before LVAD implantation. A significant improvement after CF‑LVAD implantation was noted in mPAP, pulmonary capillary wedge pressure, transpulmonary gradient, PVR, cardiac output (P <0.001 for all parameters), and cardiac index (P = 0.003). All patients with initially irreversible PH became eligible for OHT during LVAD support. Survival during LVAD support did not depend on initial mPAP and PVR. CONCLUSIONS In patients with end‑stage heart failure, CF‑LVAD support leads to a significant reduction of pre‑ and postcapillary PH. Survival on CF‑LVAD support is independent of elevated mPAP and PVR before implantation, which suggests that LVADs decrease the risk associated with PH.
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Affiliation(s)
- Agnieszka Biełka
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland.
| | - Mariusz Kalinowski
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Michał Hawranek
- 3rd Department of Cardiology, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Justyna Małyszek-Tumidajewicz
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Jerzy Pacholewicz
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Anetta Kowalczuk-Wieteska
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Katarzyna Ratman
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Grzegorz Kubiak
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Bogumiła Król
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland; Office ofTransplant Coordination, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Piotr Przybyłowski
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantologyin Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland; 1st Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Marian Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Michał O Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases, Zabrze, Poland
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Nadziakiewicz P, Grochla M, Krauchuk A, Szyguła-Jurkiewicz B, Lorek J, Barańska A, Zembala MO, Przybyłowski P. Tacrolimus and Mycophenolic Acid Blood Concentration and Cellular Rejection After Heart Transplantation in First Endomyocardial Biopsy. Transplant Proc 2020; 52:2094-2097. [PMID: 32571700 DOI: 10.1016/j.transproceed.2020.03.006] [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] [Received: 01/15/2020] [Revised: 02/19/2020] [Accepted: 03/12/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tacrolimus and mycophenolic acid (MPA) are the most important immunosuppressive drugs in modern heart transplantation. The pharmacokinetics of tacrolimus are best described by a 2-compartment model. MPA has very variable pharmacokinetics. The aim of this research was to compare kinetics of the immunosuppressants' blood levels in a group of patients with and without graft rejection. MATERIALS AND METHODS The study was a retrospective analysis of 39 consecutive adult orthotopic heart transplantations (OHT): 10 (9 men and 1 woman) in group R had graft rejection (ISHLT >2) in the first biopsy and 29 (22 men and 7 women) in group C were without rejection. Ischemic cardiomyopathy occurred in 2 of 7 and nonischemic cardiomyopathy in 8 of 22 (group R and group C, respectively). RESULTS Patients did not differ between groups except diabetes, which occurred more often in group R. Immunosuppressive drug levels were: group R and group C, respectively, 2.13 ± 0.49 and 2.11 ± 0.72 μg/mL; P = .93 for mycophenolate mofetil (MMF) and 9.42 ± 1.76 and 9.63 ± 2.30 ng/mL; P = .75 for tacrolimus. ICU stay was 14 ± 11 vs 15 ± 15 days; P = .76. There were 2 of 6 primary graft failures, 1 of 1 neurologic complications, and 0 of 6 reoperations (P < .05) in group R and group C, respectively. One patient died from group C in 30 days. During the hospital stay the incidence of graft rejection was diagnosed in 20 patients (16men and 4 women) (ISHLT >2 in endomyocardial biopsy) in the study population. CONCLUSIONS Monitoring of tacrolimus concentration in the early post--heart transplant period does not identify patients with rejection in the authors' study. Monitoring concentration of MMF does not identify patients with rejection. Further investigation is needed to evaluate factors responsible for post--heart transplant rejection in the early phase.
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Affiliation(s)
- Paweł Nadziakiewicz
- Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
| | - Marek Grochla
- Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Alena Krauchuk
- Department of Anaesthesiology, Medical University of Silesia, Szpital Specjalistyczny, Zabrze, Poland
| | - Bozena Szyguła-Jurkiewicz
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Joanna Lorek
- Students' Scientific Society, Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Adrianna Barańska
- Students' Scientific Society, Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Michał O Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Piotr Przybyłowski
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland; General Surgery, Medical College, Jagiellonian University, Cracow, Poland
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Świerad M, Dyrbuś K, Szkodziński J, Zembala MO, Kalarus Z, Gąsior M. Telehealth visits in a tertiary cardiovascular center as a response of the healthcare system to the severe acute respiratory syndrome coronavirus 2 pandemic in Poland. Pol Arch Intern Med 2020; 130:700-703. [PMID: 32426953 DOI: 10.20452/pamw.15370] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Marcin Świerad
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Krzysztof Dyrbuś
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland.
| | - Janusz Szkodziński
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
| | - Michał O Zembala
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Zbigniew Kalarus
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, School of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
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10
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Nadziakiewicz P, Grochla M, Krauchuk A, Pióro A, Szyguła-Jurkiewicz B, Baca A, Zembala MO, Przybyłowski P. Procalcitonin Kinetics After Heart Transplantation and as a Marker of Infection in Early Postoperative Course. Transplant Proc 2020; 52:2087-2090. [PMID: 32305202 DOI: 10.1016/j.transproceed.2020.02.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/13/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Procalcitonin (PCT) is a biomarker of systemic infection. Specificity of PCT is decreased because PCT is also elevated after heart transplantation (HTx). There is no established normal range of serum PCT concentrations after HTx yet. Our aim was to determine the course of PCT concentrations in patients after HTx in the early postoperative period, if we can discriminate postoperative increase in values from infectious complications. RESULTS Of 39 patients we diagnosed infection in 11. These patients develop acute kidney injury significantly more often than in control group (group C) (5 in infection group [group I] and 2 in group C, P < .05), and 1 patient died within 30 days in group C. Seven patients developed primary graft dysfunction (3/4 + ECMO [extracorporeal membrane oxygenation], respectively, group I/group C) and 2 neurologic disorders in group I. Reoperation due to bleeding was 3 in each group. During the 14 days after HTx, serum PCT concentrations increased with maximum on the second postoperative day (group C: 30.6 ± 15.3 ng/mL; group I: 24.9 ± 44.3 ng/mL). Normal values for PCT were reached on day 8 in group C and 11 in group I. Mean PCT levels were similar: 8.7 ± 5.7 ng/mL vs 11.9 ± 13.1 ng/mL in group I vs group C, respectively. Patients in group I stayed longer in the intensive care unit. CONCLUSIONS Despite increase in serum concentration of PCT in early postoperative course after HTx there is no marker of infection. Trends in PCT serum concentration may be a valuable tool in diagnosis of infection in patients after HTx, but further investigation is needed.
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Affiliation(s)
- Paweł Nadziakiewicz
- Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Marek Grochla
- Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
| | - Alena Krauchuk
- Department Anaesthesiology, Szpital Specjalistyczny, Zabrze, Poland
| | - Anna Pióro
- Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | | | - Aleksandra Baca
- Students' Scientific Society, Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Michał O Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Piotr Przybyłowski
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland; First Chair of General Surgery, Jagiellonian University, Medical College, Krakow, Poland
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11
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Pyka Ł, Hawranek M, Szyguła-Jurkiewicz B, Desperak P, Szczurek W, Lekston A, Gąsior M, Zembala MO, Pawlak S, Zembala M, Przybyłowski P. Everolimus-Eluting Second-Generation Stents for Treatment of De Novo Lesions in Patients with Cardiac Allograft Vasculopathy. Ann Transplant 2020; 25:e921266. [PMID: 32253369 PMCID: PMC7163333 DOI: 10.12659/aot.921266] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Indexed: 11/09/2022] Open
Abstract
Background Cardiac allograft vasculopathy is a major cause of cardiac allograft rejection. Percutaneous coronary intervention has become the main form of treatment of significant focal lesions. Despite the significance of the problem, data remain scarce. With a large population of transplant recipients undergoing coronary angiography at our center, we decided to analyze the implications of the use of everolimus-eluting second-generation stents by performing 6-month clinical and angiographic follow-up. Material/Methods From December 2012 and August 2019, 319 patients after heart transplantation undergoing coronary angiography at our institution were analyzed. Subsequently, 22 patients underwent de novo angioplasty with second-generation everolimus-eluting stents. The primary study endpoint was angiographic restenosis as evaluated by quantitative coronary angiography. Secondary outcomes included binary restenosis, target lesion revascularization, and cardiac death during the follow-up period (6 months). Results Patient comorbidities included hypertension (77.3%), type 2 diabetes mellitus (68.2%), dyslipidemia (68.2%), and obesity (31.8%). Primary success was obtained in all of the treated lesions. The analysis of quantitative coronary angiography after 6-month follow-up revealed low late lumen loss (0.22±0.40). Significant restenosis was observed in 1 of the cases. There were no deaths in the 6-month observation period. Conclusions In the analyzed population, invasive strategy with second-generation everolimus-eluting stents for de novo lesions in cardiac allograft vasculopathy resulted in a low rate of binary restenosis, low late lumen loss, and no deaths during the 6-month follow-up.
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Affiliation(s)
- Łukasz Pyka
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Michał Hawranek
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Bożena Szyguła-Jurkiewicz
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Piotr Desperak
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Wioletta Szczurek
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Andrzej Lekston
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Mariusz Gąsior
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Michał O Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Szymon Pawlak
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Marian Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Piotr Przybyłowski
- Silesian Center for Heart Diseases, Zabrze, Poland.,First Department of General Surgery, Jagiellonian University, Medical College, Cracow, Poland
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12
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Nadziakiewicz P, Grochla M, Krauchuk A, Szyguła-Jurkiewicz B, Cymerys M, Zembala MO, Przybyłowski P. Prognostic Value of Creatinine Concentration and Glomerular Filtration Rate in Acute Kidney Injury Development in the Early Postoperative Period After Heart Transplantation. Transplant Proc 2020; 52:2091-2093. [PMID: 32222396 DOI: 10.1016/j.transproceed.2020.02.102] [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] [Received: 01/15/2020] [Accepted: 02/05/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Recipients of nonrenal organ transplants, including the heart, are at risk for developing acute kidney injury (AKI). This situation significantly jeopardized the outcome of patients. The most effective treatment is continuous renal replacement therapy (CRRT) AIM: The goal of this project is to verify the prognostic value of preoperative serum creatinine concentration and glomerular filtration rate (GFR), calculated by the Modification of Diet in Renal Disease formula, to determine the risk of renal failure after grafting RESULTS: In the group of 39 patients, CRRT was needed in 7 patients (17.9%; group K); 32 patients were in the control group (group C). The pretransplant creatinine level in group K was 133.7 ± 31.3 μmol/L and in group C was 160.8 ± 97.6 μmol/L; P = .47. We did not find a difference between groups in GFR: group K 51 ± 6mL/min/1.73 m2 versus group C 43 ± 20 mL/min/1.73 m2; P = .65. Demographic data differed between groups. Patients in group C had significantly more often hypertension, diabetes mellitus, ischemic cardiomyopathy, and previous neurologic disorders and were male. Patients with CRRT had longer intensive care unit (ICU) stays after transplantation than the control population: 25 ± 19 versus 12 ± 10 days; P = .02. Other results showed that primary graft dysfunction occurred in 2 patients in group K and 6 in the control group; 1 needed extracorporeal membrane oxygenation support, and he died on the 12th day. The mean duration of renal replacement therapy was 9.8 days. There were 2 neurologic disorders-1 in each group-and 6 reoperations due to bleeding. CONCLUSIONS Developing AKI requiring CRRT after heart transplantation prolonged the length of ICU stays. Preoperative creatinine concentration and glomerular filtration rate do not predict AKI.
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Affiliation(s)
- Paweł Nadziakiewicz
- Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland.
| | - Marek Grochla
- Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Alena Krauchuk
- Department of Anaesthesiology, Szpital Specjalistyczny, Zabrze, Poland
| | - Bożena Szyguła-Jurkiewicz
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Marcin Cymerys
- Students' Scientific Society, Department of Cardiac Anesthesia and Intensive Therapy, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Michał O Zembala
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Piotr Przybyłowski
- Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland; General Surgery Department, Jagiellonian University, Medical College, Krakow, Poland
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13
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Walas RL, Kukulski L, Rychter J, Jaźwiec T, Gąska M, Hawranek M, Zembala M, Gąsior M, Zembala MO. Vascular access site complications after transfemoral transcatheter aortic valve implantation in the POL-TAVI Registry: surgical versus percutaneous approach. J Cardiovasc Surg (Torino) 2019; 61:117-122. [PMID: 31815374 DOI: 10.23736/s0021-9509.19.11087-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Transfemoral transcatheter aortic valve implantation (TF TAVI) has recently become an established treatment option for intermediate and high-risk surgical patients with severe aortic stenosis. Despite significant reduction in diameter of valvular delivery systems, access related vascular complications remain a major safety concern. The aim of this study was to evaluate impact of femoral access techniques: surgical versus percutaneous on in-hospital outcomes. METHODS Polish National TAVI Registry (POL-TAVI) was used as a data source. The analysis included 1680 patients treated with TF TAVI in years 2013-2016. 677 patients were treated using percutaneous technique (Group PC) and 1003 using open surgical access (Group S). The two groups were matched and compared. All-cause mortality, length of hospital stay, procedure time and potential risk factors for vascular access site complications after TF TAVI were analyzed. RESULTS Vascular access site complications were reported in 162 (9.64%) of 1680 patients and were found significantly more often in PC group (13.15% vs. 7.28% P>0.001). There was a significant difference between groups regarding Body Mass Index, arterial hypertension, transient ischemic attack history and NYHA classification. The data analysis showed that increased probability of all vascular complications was associated with percutaneous access. In addition, left-side access and female sex were independent risk factors for all vascular complications. CONCLUSIONS Surgical cut-down in the groin with exposure of the artery and manual suture after the procedure seems to be a safer option for TF TAVI patients.
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Affiliation(s)
- Ryszard L Walas
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantation, Silesian Center for Heart Diseases, School of Medicine and Dentistry, Medical University of Silesia, Zabrze, Poland
| | - Leszek Kukulski
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantation, Silesian Center for Heart Diseases, School of Medicine and Dentistry, Medical University of Silesia, Zabrze, Poland -
| | - Jan Rychter
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantation, Silesian Center for Heart Diseases, School of Medicine and Dentistry, Medical University of Silesia, Zabrze, Poland
| | - Tomasz Jaźwiec
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantation, Silesian Center for Heart Diseases, School of Medicine and Dentistry, Medical University of Silesia, Zabrze, Poland
| | - Mateusz Gąska
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantation, Silesian Center for Heart Diseases, School of Medicine and Dentistry, Medical University of Silesia, Zabrze, Poland
| | - Michał Hawranek
- Tird Department of Cardiology, Silesian Center for Heart Diseases, School of Medicine and Dentistry, Medical University of Silesia, Zabrze, Poland
| | - Marian Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantation, Silesian Center for Heart Diseases, School of Medicine and Dentistry, Medical University of Silesia, Zabrze, Poland
| | - Mariusz Gąsior
- Tird Department of Cardiology, Silesian Center for Heart Diseases, School of Medicine and Dentistry, Medical University of Silesia, Zabrze, Poland
| | - Michał O Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantation, Silesian Center for Heart Diseases, School of Medicine and Dentistry, Medical University of Silesia, Zabrze, Poland
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14
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Knapik P, Cieśla D, Saucha W, Knapik M, Zembala MO, Przybyłowski P, Kapelak B, Kuśmierczyk M, Jasiński M, Tobota Z, Maruszewski BJ, Zembala M. Outcome Prediction After Coronary Surgery and Redo Surgery for Bleeding (From the KROK Registry). J Cardiothorac Vasc Anesth 2019; 33:2930-2937. [DOI: 10.1053/j.jvca.2019.04.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/29/2019] [Accepted: 04/29/2019] [Indexed: 11/11/2022]
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15
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Knapik P, Knapik M, Zembala MO, Przybyłowski P, Nadziakiewicz P, Hrapkowicz T, Cieśla D, Deja M, Suwalski P, Jasiński M, Tobota Z, Maruszewski BJ, Zembala M, Anisimowicz L, Biederman A, Borkowski D, Brykczyński M, Bugajski P, Cholewiński P, Cichoń R, Cisowski M, Deja M, Dziatkowiak A, Gryszko LA, Gburek T, Haponiuk I, Hendzel P, Hirnle T, Jabłonka S, Jarmoszewicz K, Jasiński M, Jaszewski R, Jemielity M, Kalawski R, Kapelak B, Kaperczak J, Karolczak MA, Krejca M, Kustrzycki W, Kuśmierczyk M, Kwinecki P, Maruszewski B, Missima M, Ogorzeja JJMW, Pająk J, Pawliszak W, Pietrzyk E, Religa G, Rogowski J, Różański J, Sadowski J, Sharma G, Skalski J, Skiba J, Stążka J, Stępiński P, Suwalski K, Suwalski P, Tobota Z, Tułecki Ł, Widenka K, Wojtalik M, Woś S, Zembala M, Żelazny P. In-hospital and mid-term outcomes in patients reoperated on due to bleeding following coronary artery surgery (from the KROK Registry). Interact Cardiovasc Thorac Surg 2019; 29:237–243. [PMID: 30968119 DOI: 10.1093/icvts/ivz089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/18/2019] [Accepted: 03/01/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Surgical re-exploration due to postoperative bleeding that follows coronary artery surgery is associated with significant morbidity and mortality. The aim of this study was to assess a relationship between re-exploration, major postoperative complications, in-hospital mortality and mid-term outcomes in patients following coronary surgery, on the basis of nationwide registry data. METHODS We identified all consecutive patients enrolled in Polish National Registry of Cardiac Surgical Procedures (KROK Registry) who underwent isolated coronary surgery between January 2012 and December 2014. Preoperative data, major postoperative complications, hospital mortality and mid-term all-cause mortality were, respectively, analysed. Comparisons were performed in all patients, low-risk patients (EuroSCORE II < 2%, males, aged 60-70 years) and propensity-matched patients. The starting point for follow-up was the date of hospital discharge. RESULTS Among 41 353 analysed patients, 1406 (3.4%) underwent re-exploration. Reoperated patients had more comorbidities, more frequent major postoperative complications, higher in-hospital mortality (13.2% vs 1.8%, P < 0.001) and higher mid-term mortality in survivors (P < 0.001). In the low-risk population, 3.0% of patients underwent re-exploration. Reoperated low-risk patients and propensity-matched patients also had more frequent major postoperative complications and higher in-hospital mortality, but mid-term mortality in survivors was similar. In a multivariable analysis, re-exploration was an independent predictor of death and all major postoperative complications. CONCLUSIONS Surgical re-exploration due to postoperative bleeding following coronary artery surgery carries a high risk of perioperative mortality and is linked to major postoperative complications. Among patients who survive to hospital discharge, mid-term mortality is associated primarily with preoperative comorbidities.
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Affiliation(s)
- Piotr Knapik
- Department of Anaesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Małgorzata Knapik
- Department of Anaesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Michał O Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Piotr Przybyłowski
- Division of Cardiac Surgery, Heart and Lung Transplantation and Mechanical Circulatory Support, Silesian Centre for Heart Diseases, Zabrze, Poland.,First Department of General Surgery, Jagiellonian University, Medical College, Cracow, Poland
| | - Paweł Nadziakiewicz
- Department of Anaesthesiology, Intensive Therapy and Emergency Medicine, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Tomasz Hrapkowicz
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | - Daniel Cieśla
- Department of Science and New Technologies, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Marek Deja
- Department of Cardiac Surgery, Upper-Silesian Medical Centre, Medical University of Silesia, Katowice, Poland
| | - Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland.,Department of Cardiac Surgery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Marek Jasiński
- Department of Cardiac Surgery, University Teaching Hospital, Wrocław, Poland
| | - Zdzisław Tobota
- Department of Paediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Bohdan J Maruszewski
- Department of Paediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Marian Zembala
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Silesian Centre for Heart Diseases, Medical University of Silesia, Zabrze, Poland
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Desperak P, Hawranek M, Hrapkowicz T, Zembala MO, Gąsior M. Comparison of multivessel percutaneous coronary intervention and coronary artery bypass grafting in patients with severe coronary artery disease presenting with non-ST-segment elevation acute coronary syndromes. Kardiol Pol 2018; 76:1474-1481. [DOI: 10.5603/kp.a2018.0151] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 06/22/2018] [Accepted: 07/18/2018] [Indexed: 11/25/2022]
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17
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Tajstra M, Hrapkowicz T, Hawranek M, Filipiak K, Gierlotka M, Zembala M, Gasior M, Zembala MO. 1465Hybrid coronary revascularization in selected patients with multivessel disease - 5 year clinical outcomes of the prospective randomized pilot study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Tajstra
- Slaskie Centrum Chorob Serca, Zabrze, Poland
| | | | - M Hawranek
- Slaskie Centrum Chorob Serca, Zabrze, Poland
| | - K Filipiak
- Slaskie Centrum Chorob Serca, Zabrze, Poland
| | - M Gierlotka
- Slaskie Centrum Chorob Serca, Zabrze, Poland
| | - M Zembala
- Slaskie Centrum Chorob Serca, Zabrze, Poland
| | - M Gasior
- Slaskie Centrum Chorob Serca, Zabrze, Poland
| | - M O Zembala
- Slaskie Centrum Chorob Serca, Zabrze, Poland
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18
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Kubiak GM, Kwieciński R, Zakliczyński M, Hawranek M, Nożyński J, Król B, Przybyłowski P, Suchodolski A, Zembala MO. Cardiac retransplantation as a promising treatment option for late graft failure - Zabrze experience. Kardiol Pol 2018; 76:1015-1017. [PMID: 29905366 DOI: 10.5603/kp.2018.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 05/19/2018] [Accepted: 05/23/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Grzegorz M Kubiak
- Department of Cardiac Surgery and Transplantation, Medical University of Silesia in Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Center for Heart Diseases, Zabrze, Poland, Curie-Skłodowskiej 9, 41-800 Zabrze, Poland; Department of Heavy Cardiopulmonary Respiratory Failure and Mechanical Circulatory Support, Silesian Center for Heart Diseases, Zabrze, Poland, Curie-Skłodowskiej 9, 41-800 Zabrze, Poland.
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Foik J, Brzęk A, Gierlotka MJ, Zembala MO, Gąsior M, Zembala M. Effect of hybrid treatment on rehabilitation and clinical condition of patients with multivessel coronary artery disease. Pol Arch Intern Med 2018; 128:77-88. [PMID: 29297472 DOI: 10.20452/pamw.4179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Rehabilitation after coronary revascularization procedures is an intrinsic part of treatment during the in‑hospital period. OBJECTIVES We aimed to compare the course and effects of rehabilitation in patients receiving hybrid treatment (minimally invasive direct coronary artery bypass / percutaneous coronary intervention) or classic treatment (coronary artery bypass grafting / off‑pump coronary artery bypass) during hospitalization. PATIENTS AND METHODS The study included 200 patients participating in a prospective randomized clinical trial (POLMIDES) that assessed the effect of hybrid treatment on in‑hospital outcomes and long‑term results in patients with multivessel coronary artery disease. Patients were divided into the classic and hybrid groups. RESULTS The classic group showed a higher perioperative risk than the hybrid group (mean [SD] EuroSCORE, 3.54 [2.12] and 2.89 [1.97], respectively). During all the rehabilitation cycles, lower arterial oxygen saturation (SaO2) was reported in the hybrid group (P = 0.002). The classic group showed lower systolic blood pressure (P <0.001), lower diastolic blood pressure (P = 0.029), and a higher rate of blood pressure drops during rehabilitation (P = 0.02). Patients from the classic group were able to sit (P <0.001), assume a vertical position (P <0.001), and walk (P = 0.01) earlier than those from the hybrid group. In the hybrid group, earlier completion of rehabilitation and discharge from the hospital were noted (P = 0.001). CONCLUSIONS Patients receiving hybrid coronary revascularization less often suffer from hypotonia events but show lower SaO2 values than patients receiving classic treatment. Mobilization of patients receiving the hybrid treatment is slower during the initial days and cycles of rehabilitation, but they achieve full self‑reliance earlier, which enables a shorter hospitalization period.
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Parma R, Zembala MO, Dąbrowski M, Jagielak D, Witkowski A, Suwalski P, Dudek D, Olszówka P, Wojakowski W, Przybylski R, Gil R, Kuśmierczyk M, Lesiak M, Sadowski J, Dobrzycki S, Ochała A, Hoffman P, Kapelak B, Kaźmierczak J, Jasiński M, Stępińska J, Szymański P, Hryniewiecki T, Kochman J, Grygier M, Zembala M, Legutko J, Różański J. Transcatheter aortic valve implantation. Expert Consensus of the Association of Cardiovascular Interventions of the Polish Cardiac Society and the Polish Society of Cardio-Thoracic Surgeons, approved by the Board of the Polish Cardiac Society…. Kardiol Pol 2017; 75:937-964. [PMID: 28895996 DOI: 10.5603/kp.2017.0175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 06/06/2017] [Revised: 08/11/2017] [Accepted: 08/24/2017] [Indexed: 11/25/2022]
Abstract
Patients with severe symptomatic aortic stenosis have a poor prognosis with medical management alone, and surgical aortic valve replacement can improve symptoms and survival. In recent years, transcatheter aortic valve implantation (TAVI) has been demonstrated to improve survival in inoperable patients and to be an alternative treatment in patients in whom the risk of surgical morbidity or mortality is high or intermediate. A representative expert committee, summoned by the Association of Cardiovascular Interventions of the Polish Cardiac Society (ACVI) and the Polish Society of Cardio-Thoracic Surgeons, devel-oped this Consensus Statement in transcatheter aortic valve implantation. It endorses the important role of a multi-disciplinary "TAVI team" in selecting patients for TAVI and defines operator and institutional requirements fundamental to the establish-ment of a successful TAVI programme. The article summarises current evidence and provides specific recommendations on organisation and conduct of transcatheter treatment of patients with aortic valve disease in Poland.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jacek Legutko
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
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Wojtaszczyk A, Buchta P, Myrda K, Gąsior M, Kowalski O, Kalarus Z, Filipiak K, Zembala M, Zembala MO. Hybrid dual stage closed chest ablation of persistent atrial fibrillation. Cor Vasa 2017. [DOI: 10.1016/j.crvasa.2017.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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