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Rzucidło-Resil JM, Stoliński J, Musiał R, Sobczyński R, Plicner D. Patients with aortic valve disease and coronary artery disease can benefit from a hybrid approach combining aortic valve replacement through right minithoracotomy and percutaneous coronary intervention. Kardiochir Torakochirurgia Pol 2023; 20:146-154. [PMID: 37937166 PMCID: PMC10626405 DOI: 10.5114/kitp.2023.131954] [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: 03/29/2023] [Accepted: 06/25/2023] [Indexed: 11/09/2023]
Abstract
Introduction Minimally invasive and hybrid procedures for patients with aortic valve pathology and coronary artery disease are innovative solutions. Aim To report the results of hybrid aortic valve replacement through right anterior minithoracotomy (RT-AVR)/percutaneous coronary intervention (PCI) and conventional aortic valve replacement (AVR)/coronary artery bypass grafting (CABG) surgery for patients with aortic valve and coronary artery disease. Material and methods Analysis of prospectively gathered data of 187 patients - 86 hybrid and 101 conventional procedures. For 21 patients, RT-AVR was followed by PCI during the same session, and for 65 patients RT-AVR was performed within 90 days of PCI. Results Hospital mortality in the AVR/CABG and RT-AVR/PCI groups was 3.0% and 1.2%, respectively (p = 0.237). Complications occurred in 18.6% of patients in the RT-AVR/PCI group and 33.7% in the AVR/CABG group (p = 0.020). Two-stage RT-AVR/PCI was performed due to ACS (100%); one-stage was due to the intention to perform a minimally invasive procedure instead of AVR/CABG (71.4%) or due to replacing CABG with PCI because of a lack of vascular grafts for CABG (19.1%). In 38.5% of patients from the two-stage subgroup, antiplatelet therapy was stopped before RT-AVR, 32.3% of patients from the two-stage subgroup were on single, and 29.2% on dual antiplatelet therapy until RT-AVR, which had no influence on postoperative blood requirements or postoperative myocardial infarction (p = 0.410 and p = 0.077, respectively). Conclusions The hybrid procedure presented in our series showed similar mortality and morbidity results and may be an alternative to conventional AVR and CABG through full sternotomy in selected patients.
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Affiliation(s)
| | - Jarosław Stoliński
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Robert Musiał
- Department of Anaesthesiology and Intensive Therapy, John Paul II Hospital, Krakow, Poland
| | - Robert Sobczyński
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
| | - Dariusz Plicner
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
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Trębacz J, Konstanty-Kalandyk J, Sobczyński R, Stąpór M, Okarski M, Mróz K, Kapelak B, Legutko J, Kleczyński P. Successful treatment of a severe ACURATE neo2 valve underexpansion in a setting of a severe aortic stenosis with massive calcifications. Kardiol Pol 2023:VM/OJS/J/94299. [PMID: 36871308 DOI: 10.33963/kp.a2023.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 02/19/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Jarosław Trębacz
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Janusz Konstanty-Kalandyk
- Clinical Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Kraków, Poland.,Jagiellonian University Medical College, Institute of Cardiology, Department of Cardiac Surgery and Transplantation, Kraków, Poland
| | - Robert Sobczyński
- Jagiellonian University Medical College, Institute of Cardiology, Department of Cardiac Surgery and Transplantation, Kraków, Poland
| | - Maciej Stąpór
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Michał Okarski
- Student Scientific Group of Modern Cardiac Therapy at the Department of Interventional Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Krystian Mróz
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Bogusław Kapelak
- Clinical Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Kraków, Poland.,Jagiellonian University Medical College, Institute of Cardiology, Department of Cardiac Surgery and Transplantation, Kraków, Poland
| | - Jacek Legutko
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland.,Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, Kraków, Poland
| | - Paweł Kleczyński
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland. .,Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, Kraków, Poland.
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Trębacz J, Sobczyński R, Konstanty-Kalandyk J, Musiał R, Stąpór M, Okarski M, Mróz K, Kapelak B, Legutko J, Kleczyński P. Transcarotid access for transcatheter aortic valve implantation with a Navitor device. Kardiol Pol 2023; 81:205-206. [PMID: 36573607 DOI: 10.33963/kp.a2023.0007] [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: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 03/04/2023]
Affiliation(s)
- Jarosław Trębacz
- Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Robert Sobczyński
- Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Kraków, Poland
| | - Janusz Konstanty-Kalandyk
- Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Kraków, Poland.,Department of Cardiac Surgery and Transplantation, Jagiellonian University Medical College, Institute of Cardiology, John Paul II Hospital, Kraków, Poland
| | - Robert Musiał
- Department of Intensive Medical Care, John Paul II Hospital, Kraków, Poland
| | - Maciej Stąpór
- Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Michał Okarski
- Student Scientific Group of Modern Cardiac Therapy at the Department of Interventional Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Krystian Mróz
- Student Scientific Group of Modern Cardiac Therapy at the Department of Interventional Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Bogusław Kapelak
- Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Kraków, Poland.,Department of Cardiac Surgery and Transplantation, Jagiellonian University Medical College, Institute of Cardiology, John Paul II Hospital, Kraków, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland.,Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Paweł Kleczyński
- Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland. .,Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland.
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Trębacz J, Wierzbicki K, Sobczyński R, Konstanty-Kalandyk J, Stąpór M, Okarski M, Kapelak B, Legutko J, Kleczyński P. Transcatheter aortic valve replacement in a patient with severe aortic regurgitation following left ventricular assist device implantation. Kardiol Pol 2023; 81:68-69. [PMID: 36106849 DOI: 10.33963/kp.a2022.0217] [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: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Jarosław Trębacz
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Karol Wierzbicki
- Clinical Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Kraków, Poland.,Jagiellonian University Medical College, Institute of Cardiology, Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Kraków, Poland
| | - Robert Sobczyński
- Clinical Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Kraków, Poland
| | - Janusz Konstanty-Kalandyk
- Clinical Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Kraków, Poland.,Jagiellonian University Medical College, Institute of Cardiology, Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Kraków, Poland
| | - Maciej Stąpór
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Michał Okarski
- Student Scientific Group of Modern Cardiac Therapy at the Department of Interventional Cardiology, Jagiellonian University Medical College, Kraków, Poland
| | - Bogusław Kapelak
- Clinical Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Kraków, Poland.,Jagiellonian University Medical College, Institute of Cardiology, Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Kraków, Poland
| | - Jacek Legutko
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland.,Department of Interventional Cardiology, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland
| | - Paweł Kleczyński
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland. .,Department of Interventional Cardiology, Jagiellonian University Medical College, Institute of Cardiology, Kraków, Poland.
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Wiewiórka Ł, Trębacz J, Sobczyński R, Stąpór M, Ostrowska-Kaim E, Konstanty-Kalandyk J, Musiał R, Gackowski A, Malinowski K, Kleczyński P, Żmudka K, Kapelak B, Legutko J. Computed tomography guided tailored approach to transfemoral access in patients undergoing transcatheter aortic valve implantation. Cardiol J 2023; 30:51-58. [PMID: 34031867 PMCID: PMC9987546 DOI: 10.5603/cj.a2021.0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/21/2021] [Accepted: 05/05/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Transfemoral approach (TFA) is the most common access route for transcatheter aortic valve implantation (TAVI). Percutaneous femoral access (PA) is preferred over the surgical approach (SA), however, may be associated with a higher risk of access site complications. Thus, we aimed to assess outcomes of computed tomography-guided tailored approach to percutaneous and surgical TFA in patients undergoing TAVI. METHODS We evaluated data of 158 patients, who underwent TAVI via femoral route between January 2017 and December 2018. In the PA group, vascular closure was performed with the use of two percutaneous suture devices and an additional mechanical seal device. We compared complications rate and outcomes. RESULTS Of the 158 patients (92%; mean age 79.6 years, 60.8% female), in 92 (61%) patients PA was performed and in 66 (39%) patients SA was used. Median (interquartile range) radiation exposure as well as contrast volume dose was higher in the PA group compared to the SA group 614.0 (410.0; 1104.0) mGy vs. 405 (240.5; 658.0) mGy (p < 0.001) and 150.0 (120.0; 180.7) mL vs. 130.0 (100.0; 160.0) mL (p = 0.04), respectively. Bleeding complications were similar in the PA group 11 (12.2%) compared to 5 (8.62%) in the SA group (p = 0.48). Median length of hospital stay was also similar in the PA and the SA group 6.00 (5.00; 8.00) days vs. 6.00 (4.00; 8.00) days, respectively (p = 0.31). CONCLUSIONS Computed tomography-guided PA in TAVI may provide comparable procedural outcomes compared to the SA, despite a higher radiation dose and the use of contrast dye, while being less invasive.
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Affiliation(s)
- Łukasz Wiewiórka
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland.
| | - Jarosław Trębacz
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | - Robert Sobczyński
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Krakow, Poland
| | - Maciej Stąpór
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | - Elżbieta Ostrowska-Kaim
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | - Janusz Konstanty-Kalandyk
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Krakow, Poland
| | - Robert Musiał
- Department of Anesthesiology and Intensive Therapy, John Paul II Hospital, Krakow, Poland
| | - Andrzej Gackowski
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Coronary Artery Diseases, John Paul II Hospital, Krakow, Poland
| | - Krzysztof Malinowski
- 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Kleczyński
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | - Krzysztof Żmudka
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | - Bogusław Kapelak
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Krakow, Poland
| | - Jacek Legutko
- Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
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Legutko J, Wiewiórka Ł, Piątek J, Trębacz J, Sobczyński R, Stąpór M, Konstanty-Kalandyk J, Kapelak B, Kleczyński P. Transcatheter aortic valve implantation and hybrid coronary revascularization in a patient with severe aortic stenosis, complex coronary artery disease, and porcelain aorta. Kardiol Pol 2021; 79:1286-1287. [PMID: 34472073 DOI: 10.33963/kp.a2021.0097] [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: 08/31/2021] [Accepted: 08/31/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Jacek Legutko
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland.
| | - Łukasz Wiewiórka
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Jacek Piątek
- Jagiellonian University Medical College, Institute of Cardiology, Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Kraków, Poland
| | - Jarosław Trębacz
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Robert Sobczyński
- Clinical Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Kraków, Poland
| | - Maciej Stąpór
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Janusz Konstanty-Kalandyk
- Jagiellonian University Medical College, Institute of Cardiology, Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Kraków, Poland
| | - Bogusław Kapelak
- Jagiellonian University Medical College, Institute of Cardiology, Department of Cardiac Surgery and Transplantation, John Paul II Hospital, Kraków, Poland
| | - Paweł Kleczyński
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
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Wiewiórka Ł, Trębacz J, Gackowski A, Sobczyński R, Stąpór M, Konstanty-Kalandyk J, Kleczyński P, Musiał R, Kapelak B, Legutko J. Complete transcatheter treatment of multiple heart valve diseases. Kardiol Pol 2021; 79:350-351. [PMID: 33591132 DOI: 10.33963/kp.15799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Stąpór M, Trębacz J, Wiewiórka Ł, Ostrowska-Kaim E, Nawara-Skipirzepa J, Sobczyński R, Konstanty-Kalandyk J, Musiał R, Trębacz O, Kleczyński P, Żmudka K, Kapelak B, Legutko J. Direct left ventricular wire pacing during transcatheter aortic valve implantation. Kardiol Pol 2020; 78:882-888. [PMID: 32567288 DOI: 10.33963/kp.15440] [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 Rapid ventricular pacing is used during balloon aortic valvuloplasty, balloon‑expandable transcatheter aortic valve implantation (TAVI), and for postdilatation. Right ventricular (RV) lead pacing has been regarded as a gold standard. Direct left ventricular (LV) wire pacing has recently been considered safe and effective in TAVI interventions. AIMS This study aimed to analyze procedural outcomes of direct LV pacing compared with RV stimulation in unselected patients undergoing TAVI. METHODS Direct LV wire pacing was provided via available preshaped guidewires and used only when no predictors of atrioventricular block were present. The primary study objective was the assessment of the efficacy of direct LV wire pacing. The secondary objectives included the evaluation of procedure duration and safety in comparison with the conventional method. A combined endpoint (major adverse cardiovascular event) was defined as the occurrence of death, stroke, venous puncture-related complications, and cardiac tamponade. RESULTS In 2017 and 2018, 143 patients underwent transfemoral TAVI. Of these, 114 (79.7%) had self‑ ‑expandable valves implanted. Direct LV wire pacing was the dominant method of pacing (82 patients [57.3%]), and its efficacy reached 97.6%. The median (interquartile range) procedure time was shorter in the direct LV wire pacing group (80 [70-90] min vs 85 [70-95] min; P = 0.02). Major adverse cardiovascular events were more frequent in the RV lead pacing group (11.5% vs 4.9%), but no statistical significance was achieved (P = 0.13). CONCLUSIONS Direct LV wire pacing during TAVI is a simple, reproducible, and safe technique, which provides reliable, sustained stimulation with a low complication rate and potential reduction of procedural time.
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Affiliation(s)
- Maciej Stąpór
- Department of Interventional Cardiology, Institute of Cardiology,Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland.
| | - Jarosław Trębacz
- Department of Interventional Cardiology, Institute of Cardiology,Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Łukasz Wiewiórka
- Department of Interventional Cardiology, Institute of Cardiology,Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Elżbieta Ostrowska-Kaim
- Department of Interventional Cardiology, Institute of Cardiology,Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Joanna Nawara-Skipirzepa
- Department of Interventional Cardiology, Institute of Cardiology,Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Robert Sobczyński
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology,Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Janusz Konstanty-Kalandyk
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology,Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Robert Musiał
- Department of Anesthesiology and Intensive Therapy, John Paul II Hospital, Kraków, Poland
| | - Oksana Trębacz
- Department of Interventional Cardiology, Institute of Cardiology,Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Paweł Kleczyński
- Department of Interventional Cardiology, Institute of Cardiology,Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Krzysztof Żmudka
- Department of Interventional Cardiology, Institute of Cardiology,Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Bogusław Kapelak
- Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology,Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology,Faculty of Medicine, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland
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Dudek D, Ebner A, Sobczyński R, Trębacz J, Vesga B, Granada J, Zembala M, Witkowski A, Van Mieghem NM, Sood P, Ochała A, Dziewierz A, Żmudka K. Efficacy and Safety of the HeartMate Percutaneous Heart Pump During High-Risk Percutaneous Coronary Intervention (from the SHIELD I Trial). Am J Cardiol 2018; 121:1524-1529. [PMID: 29655880 DOI: 10.1016/j.amjcard.2018.02.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 02/09/2018] [Accepted: 02/16/2018] [Indexed: 12/20/2022]
Abstract
This study aimed to evaluate the use of the HeartMate percutaneous heart pump, a catheter-based axial flow pump designed to provide partial left ventricular support, in patients who underwent high-risk percutaneous coronary intervention (PCI). Patients who are hemodynamically unstable, or at risk of being hemodynamically unstable, while undergoing PCI may require mechanical circulatory support. Fifty high-risk patients were enrolled in a prospective, nonrandomized, multicenter, open-label trial. Primary end points were freedom from hemodynamic compromise during PCI and a composite measure of major adverse events. Patients were followed for 30 days. No patient met the primary performance end point. Six safety end points in 5 patients occurred, including 1 access site complication requiring intervention, 1 cerebrovascular accident, 2 major bleeding complications, and 2 cases of new or worsening aortic insufficiency. No cardiac deaths, myocardial infarctions, or surgical interventions occurred. In conclusion, initial results of the HeartMate percutaneous heart pump for mechanical circulatory support during high-risk PCI are encouraging. Hemodynamic stability was achieved in all patients with a low incidence of adverse events.
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Affiliation(s)
- Dariusz Dudek
- Institue of Cardiology, Jagiellonian University, Krakow, Poland.
| | | | | | | | - Boris Vesga
- Universidad Industrial de Santander, Colombia
| | - Juan Granada
- Cardiovascular Research Foundation, New York, New York
| | | | | | | | | | | | - Artur Dziewierz
- Institue of Cardiology, Jagiellonian University, Krakow, Poland
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Kleczyński P, Dziewierz A, Daniec M, Bagieński M, Rzeszutko Ł, Sorysz D, Trębacz J, Sobczyński R, Tomala M, Dudek D. Impact of post-dilatation on the reduction of paravalvular leak and mortality after transcatheter aortic valve implantation. Kardiol Pol 2017; 75:742-748. [DOI: 10.5603/kp.2017.0152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 03/17/2017] [Accepted: 03/30/2017] [Indexed: 11/25/2022]
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11
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Tokarek T, Siudak Z, Dziewierz A, Sobczyński R, Zasada W, Sorysz D, Olszewska-Wityńska K, Bryniarski K, Krawczyk-Ożóg A, Żabówka A, Sadowski J, Dudek D. Assessment of quality of life in patients after surgical and transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2016; 88:E80-8. [PMID: 26800644 DOI: 10.1002/ccd.26400] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 09/29/2015] [Accepted: 12/21/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Transcatheter aortic valve implantation (TAVI) and minimally invasive aortic valve replacement (mini-thoracotomy, mini-sternotomy, MIAVR) have become an appealing alternative to conventional surgical (SAVR) treatment of severe aortic stenosis (AS) in high-risk patients. BACKGROUND Aim of the study was to evaluate the quality of life (QoL) in patients with AS and treated with transfemoral TAVI, SAVR, mini-thoracotomy and mini-sternotomy. METHODS One hundred and seventy-three patients with symptomatic AS were enrolled in 2011-2013. TAVI group consisted of 39 patients (22.5%), mini-sternotomy was performed in 44 patients (25.5%), mini-thoracotomy in 50 (29%), and AVR in 40 patients (23%). QoL was assessed perioperatively, 12 and 24 months after aortic valve replacement (AVR) by Minnesota Living with Heart Failure Questionnaire (MLHFQ) and EQ-5D-3L. RESULTS Median follow-up was 583.5 (IQR: 298-736) days. Improvement of health status after procedure in comparison with pre-operative period was significantly more often reported after TAVI in perioperative period (90.3%; P = 0.004) and 12 months after procedure (100%, P = 0.02). Global MLHFQ, physical and emotional dimension score at 30-day from AVR presented significant improvement after TAVI in comparison with surgical methods (respectively: 8.3(±8.6), P = 0.003; 4.1(±5.9), P = 0.01; 1.5(±2.6), P = 0.005). Total MLHFQ score was significantly lower (better outcome) in TAVI patients 1 year after procedure (4.8(±6.8), P = 0.004), no differences in somatic and emotional component were found. No differences were found in MLHFQ score 24 months after AVR. Data from EQ-D5-3L questionnaire demonstrated significant improvement of QoL at 30-day follow-up after TAVI in comparison with surgical methods (1.2(±1.7), P = 0.0008). CONCLUSIONS TAVI improves QoL in perioperative and 12 months observation in comparison with mini-thoracotomy, mini-sternotomy and SAVR. Improvement in QoL was obtained in both generic and disease specific questionnaires. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Tomasz Tokarek
- Department of Interventional Cardiology at University Hospital, Jagiellonian University Medical College in Krakow, Poland.
| | - Zbigniew Siudak
- Department of Interventional Cardiology at University Hospital, Jagiellonian University Medical College in Krakow, Poland
| | - Artur Dziewierz
- 2nd Department of Cardiology, Jagiellonian University Medical College in Krakow, Poland
| | - Robert Sobczyński
- Department of Cardiovascular Surgery and Transplantology at University Hospital, Jagiellonian University Medical College in Kraków, Poland
| | - Wojciech Zasada
- 2nd Department of Cardiology, Jagiellonian University Medical College in Krakow, Poland
| | - Danuta Sorysz
- 2nd Department of Cardiology, Jagiellonian University Medical College in Krakow, Poland
| | - Katarzyna Olszewska-Wityńska
- Department of Interventional Cardiology at University Hospital, Jagiellonian University Medical College in Krakow, Poland
| | - Krzysztof Bryniarski
- Department of Interventional Cardiology at University Hospital, Jagiellonian University Medical College in Krakow, Poland
| | - Agata Krawczyk-Ożóg
- Department of Interventional Cardiology at University Hospital, Jagiellonian University Medical College in Krakow, Poland
| | - Anna Żabówka
- Department of Interventional Cardiology at University Hospital, Jagiellonian University Medical College in Krakow, Poland
| | - Jerzy Sadowski
- Department of Cardiovascular Surgery and Transplantology at University Hospital, Jagiellonian University Medical College in Kraków, Poland
| | - Dariusz Dudek
- Department of Interventional Cardiology at University Hospital, Jagiellonian University Medical College in Krakow, Poland
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Sobczyński R, Golabek T, Przydacz M, Wiatr T, Bukowczan J, Sadowski J, Chłosta P. Modified technique of cavoatrial tumor thrombectomy without cardiopulmonary by-pass and hypothermic circulatory arrest: a preliminary report. Cent European J Urol 2015; 68:311-7. [PMID: 26568872 PMCID: PMC4643704 DOI: 10.5173/ceju.2015.588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 03/04/2015] [Revised: 04/15/2015] [Accepted: 05/07/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction Traditionally, tumor thrombi extending into the right atrium have been managed by open surgery with sternotomy, cardiopulmonary bypass circulation and hypothermic circulatory arrest, and are associated with significant morbidity and mortality rates. Here, we evaluate the results of cavoatrial thrombectomy using our own, Foley catheter assisted-technique, obviating the need for thoracotomy, extracorporeal circulation, and/or hypothermic circulatory arrest. Material and methods Between June 2013 and January 2015, 4 consecutive patients underwent cavoatrial thrombectomy performed with our own, Foley catheter assisted technique, via Chevron incision, with no need for extracorporeal circulation or hypothermy for renal cell carcinoma with tumor thrombus extending into the right atrium. Analyses of patients’ data from a prospectively maintained database with respect to perioperative characteristics, morbidity and mortality were performed. Results The total mean duration of surgery was 255 minutes. The mean time of total IVC (inferior vena cava) occlusion was 90 seconds. The average blood loss volume, timed from the beginning of cavotomy incision until its closure, was 1200 ml. The total mean intraoperative blood loss was 3,150 ml. There was no perioperative death. Postoperative complications included one transient acute kidney injury requiring one-off hemodialysis and one re-operation due to bleeding. The follow-up time ranged between 12 to 17 months. None of the patients developed disease recurrence. All patients were still alive at the time of study completion. Conclusions Obtained results support the validity of our own, Foley catheter assisted technique, without cardiopulmonary bypass and hypothermic circulatory arrest for the treatment of renal cell carcinoma with tumor thrombus extending into the right atrium.
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Affiliation(s)
- Robert Sobczyński
- Department of Cardiovascular Surgery and Transplantology, the John Paul II Hospital, Cracow, Poland
| | - Tomasz Golabek
- Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland
| | - Mikolaj Przydacz
- Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland
| | - Tomasz Wiatr
- Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland
| | - Jakub Bukowczan
- Department of Endocrinology and Diabetes Mellitus, Diabetes Resource Centre, North Tyneside General Hospital, North Shields, United Kingdom
| | - Jerzy Sadowski
- Department of Cardiovascular Surgery and Transplantology, the John Paul II Hospital, Cracow, Poland
| | - Piotr Chłosta
- Department of Urology, Collegium Medicum at the Jagiellonian University, Cracow, Poland
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Tokarek T, Sobczyński R, Dziewierz A, Siudak Z, Zasada W, Sorysz D, Pfitzner R, Sadowski J, Dębski G, Dziewięcka E, Gruszka K, Dudek D. Clinical outcomes in patients after surgical and transcatheter aortic valve replacement. ACTA ACUST UNITED AC 2015; 125:755-64. [PMID: 26397310 DOI: 10.20452/pamw.3117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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 Transcatheter aortic valve implantation (TAVI) and minimally invasive aortic valve replacement (minithoracotomy and ministernotomy) have become a valuable alternative to conventional surgical treatment of severe aortic stenosis (AS) in high-risk patients. OBJECTIVES The aim of the study was to evaluate long-term results and complications in patients with symptomatic AS treated with TAVI, surgical aortic valve replacement (SAVR), minithoracotomy, or ministernotomy. PATIENTS AND METHODS A total of 173 patients with symptomatic AS were enrolled to the study between the years 2011 and 2013. Propensity scores were calculated for TAVI and each surgical method separately. Differences in clinical outcomes between patients treated with TAVI and those treated with surgical methods were adjusted for propensity scores using a logistic regression analysis and presented as adjusted odds ratios with 95% confidence intrervals. RESULTS A median follow-up was 583.5 days (interquartile range, 298-736 days). Before aortic valve replacement (AVR), no significant differences in ejection fraction (EF) were observed between the groups. At 1 week after AVR, mean EF values were significantly higher in patients after TAVI in comparison with the other groups (TAVI, 50.2% ±13.1%; minithoracotomy, 44.1% ±13.4%; ministernotomy, 37.8% ±12.8%; SAVR, 40.3% ±12.5%; P = 0.001). There were no differences in the longest available follow-up mortality between the analyzed groups (P = 0.8). To our best knowledge, this is the first study comparing minithoracotomy, ministernotomy, and SAVR with TAVI in terms of long-term outcomes such as the longest available follow-up mortality, left ventricular (LV) function, complications after the procedure, and conduction disturbances and arrhythmias after the procedure. CONCULSIONS Patients undergoing TAVI show more beneficial long-term outcomes in comparison with patients undergoing minithoracotomy, ministernotomy, and SAVR and do not differ in terms of the longest available follow-up mortality. TAVI seems to have a more favorable effect on LV function and an increase in EF in comparison with the surgical methods.
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Sobczyński R, Dudek D, Mazur P, Rzeszutko Ł, Sadowski J. First transapical implantation in Poland of the aortic valve bioprosthesis registered both for aortic stenosis and insufficiency. Kardiol Pol 2015; 73:133. [PMID: 25706783 DOI: 10.5603/kp.2015.0022] [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: 10/31/2014] [Revised: 11/16/2014] [Accepted: 11/27/2014] [Indexed: 11/25/2022]
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Kleczyński P, Sorysz D, Tomala M, Sobczyński R, Dudek D. Third generation balloon expandable valve implantation in a patient with severe aortic stenosis. Kardiol Pol 2014. [DOI: 10.5603/kp.2014.0222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kleczyński P, Bagieński M, Sorysz D, Rzeszutko L, Trębacz J, Tomala M, Sobczyński R, Dziewierz A, Surdacki A, Dudek D. Short- and intermediate-term improvement of patient quality of life after transcatheter aortic valve implantation: a single-centre study. Kardiol Pol 2014; 72:612-6. [PMID: 24671914 DOI: 10.5603/kp.a2014.0065] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 01/22/2014] [Accepted: 03/06/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is a treatment option for elderly high-risk patients with symptomatic severe aortic stenosis. Improvement of quality of life (QoL) is a relevant issue in this group of patients. AIM To assess changes in QoL after TAVI. METHODS Forty patients who underwent TAVI in our institution were included in this QoL study. All subjects were screened for TAVI in a standard fashion, including QoL assessment with the EQoL (EQ-5D-3L). The pre- and postprocedural scores obtained up to a 12-month follow-up were assessed. RESULTS Median of logistic EuroScore I was 21.5% (13.5-26.75%), and Society of Thoracic Surgeons score was 5.5% (4.0-10.75%). Comparison of baseline values with follow-up data at one, six and 12 months after TAVI showed significant improvement of QoL (p < 0.001). Visual Analogue Scale score (VAS score) was assessed. There was an incremental increase in VAS score during follow-up (p < 0.001). Median of six-minute walk test distance at baseline was 200 m (IQR 150-300) and 325 m (IQR 250-400) 12 months after TAVI (p < 0.001). CONCLUSIONS TAVI provides improved QoL and effectively relieves symptoms.
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Kleczyński P, Sorysz D, Tomala M, Sobczyński R, Dudek D. Third generation balloon expandable valve implantation in a patient with severe aortic stenosis. Kardiol Pol 2014; 72:1167. [PMID: 25671232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Kleczyński P, Witkowski A, Trębacz J, Sorysz D, Rzeszutko Ł, Sobczyński R, Dziewierz A, Żmudka K, Sadowski J, Dudek D. Acute left main occlusion during transcatheter aortic valve implantation. Kardiol Pol 2013; 71:653-5. [DOI: 10.5603/kp.2013.0138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 05/14/2013] [Indexed: 11/25/2022]
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Kleczyński P, Sorysz D, Rzeszutko Ł, Trębacz J, Tomala M, Sobczyński R, Bagieński M, Bobrowska B, Sadowski J, Dudek D. Current approach to transfemoral aortic valve replacement. Kardiol Pol 2013; 71:203-4. [PMID: 23575719 DOI: 10.5603/kp.2013.0019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Indexed: 11/25/2022]
Abstract
We present a case of a 73 year-old male with severe aortic stenosis and high perioperative risk who was considered as candidate for percutaneous valve treatment. After precise clinical assessment, the subject underwent successful transfemoral aortic valve replacement with 29 mm device in analgosedation.
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Affiliation(s)
- Paweł Kleczyński
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
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Bartuś K, Kiser AC, Majewski J, Kapelak B, Konstanty-Kalandyk J, Lelakowski J, Bednarek J, Bartuś S, Wierzbicki K, Sobczyński R, Sadowski J. Thoracoscopic epicardial ablation of the left and right atrium. Beating heart procedure in patients with atrial fibrillation. Pol Arch Intern Med 2012; 122:189-94. [PMID: 22495053 DOI: 10.20452/pamw.1216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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 Atrial fibrillation (AF) is a common arrhythmia affecting approximately 1% to 2% of the general population. OBJECTIVES The aim of the study was to evaluate the efficacy and safety of thoracoscopic ablation in patients with AF. PATIENTS AND METHODS A total of 25 patients aged from 42 to 77 years (mean 56.4 years) with persistent or long-standing persistent AF were scheduled for the procedure. Thoracoscopic epicardial ablation of the right atrium, pulmonary veins, and left atrium was performed on the beating heart using the Cox MAZE III-based diagram, via 3 ports and 2 cm incision below the xiphoid. Exit block was always assessed. Patients were prospectively followed for 12 months after the procedure. 24-hour electrocardiography (Holter monitoring) was used to confirm the results. RESULTS Conduction block across ablation lines was achieved in 21 patients (84%). At 1 month of follow-up, the sinus rhythm (SR) was observed in 18 of 20 patients. At 3 months, the SR was observed in 19 patients (76%). Two patients had atrial flutter, while 3 still experienced AF. At 6 months, the SR was observed in 21 patients (84%); 2 patients still had AF, 1 patient atrial flutter, and 1 patient had a pacemaker implanted. Results of follow-up at 1 year did not differ from those at 6 months. No changes in the size of the left atrium and left ventricular ejection fraction, no deaths, stroke, transient ischemic attack, or infectious complications were observed. CONCLUSIONS The efficacy of epicardial thoracoscopic ablation of the left and right atrium was high, reaching 84% during 1-year follow-up. No serious complications were observed in the postoperative period (except for the need for pacemaker implantation in 1 patient).
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Affiliation(s)
- Krzysztof Bartuś
- Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Kraków, Poland.
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Stępień E, Krawczyk S, Kapelak B, Sobczyński R, Stoliński J, Wypasek E, Undas A, Sadowski J. Effect of the E-selectin Gene Polymorphism (S149R) on Platelet Activation and Adverse Events After Coronary Artery Surgery. Arch Med Res 2011; 42:375-81. [DOI: 10.1016/j.arcmed.2011.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2011] [Accepted: 07/21/2011] [Indexed: 11/28/2022]
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Bartoszcze A, Rudziński P, Sobczyński R, Andres J, Sadowski J. [Early, recurrent bypass of coronary vessels after OPCAB operations--investigations from Central Krakow]. Kardiol Pol 2003; 58 Suppl 1:I56-I58. [PMID: 20527108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Artur Bartoszcze
- Klinika Chirurgii Serca, Naczyń i Transplantologii Instytutu Kardiologii CM UJ, Kraków
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Sobczyński R, Sadowski J, Pfitzner R, Kapelak B, Kopacz J, Rudziński P, Bartoszcze A, Drop D, Dziatkowiak A. [Post-infarction rupture of the heart septum]. Kardiol Pol 2003; 58 Suppl 1:I51-I55. [PMID: 20527107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Robert Sobczyński
- Klinika Chirurgii Serca, Naczyń i Transplantologii Instytutu Kardiologii CM UJ, Kraków
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Sobczyński R, Hawryłkiewicz I, Pawlicka L. [Intralobar pulmonary sequestration treated surgically in a patient with sarcoidosis]. Pneumonol Alergol Pol 1997; 65:71-6. [PMID: 9289306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Pulmonary sequestration is an uncommon but clinically significant congenital malformation characterised by the presence of nonfunctioning lung tissue that receives its blood supply from anomalous systemic arteries and has no communication with the normal bronchial tree. We describe a patient with an intralobar pulmonary sequestration of the left lower lobe associated with sarcoidosis. The patient was treated successfully by resection of the lesion. The postoperative period was uneventful. We found no report where a pulmonary sequestration was associated with sarcoidosis.
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