Redo surgery risk in patients with cardiac prosthetic valve dysfunction.

INTRODUCTION: The aim of the study was to analyse the risk factors of early and late mortality in patients undergoing the first reoperation for prosthetic valve dysfunction. MATERIAL AND METHODS: A retrospective observational study was performed in 194 consecutive patients (M = 75, F = 119; mean age 53.2 ±11 years) with a mechanical prosthetic valve (n = 103 cases; 53%) or bioprosthesis (91; 47%). Univariate and multivariate Cox statistical analysis was performed to determine risk factors of early and late mortality. RESULTS: The overall early mortality was 18.6%: 31.4% in patients with symptoms of NYHA functional class III-IV and 3.4% in pts in NYHA class I-II. Multivariate analysis identified symptoms of NYHA class III-IV and endocarditis as independent predictors of early mortality. The overall late mortality (> 30 days) was 8.2% (0.62% year/patient). Multivariate analysis identified age at the time of reoperation as a strong independent predictor of late mortality. CONCLUSIONS: Reoperation in patients with prosthetic valves, performed urgently, especially in patients with symptoms of NYHA class III-IV or in the case of endocarditis, bears a high mortality rate. Risk of planned reoperation, mostly in patients with symptoms of NYHA class I-II, does not differ from the risk of the first operation.

Obesity and adiponectin in acute myocardial infarction.

BACKGROUND: Low plasma concentration of adiponectin, a hormone-like peptide secreted by adipose tissue, is detected in obesity and in coronary artery disease. The aim of the study was to assess the impact of obesity on adiponectin and the relation of adiponectin to the anthropometric parameters and cardiovascular risk factors in men with acute myocardial infarction. METHODS: Two groups of patients with first acute myocardial infarction were analyzed: 40 obese and 40 non-obese men. Waist and hip circumferences and waist-to-hip ratio, C-reactive protein (CRP), uric acid, fasting glucose, lipid profile and adiponectin were measured. RESULTS: Mean level of adiponectin was significantly lower in obese than non-obese patients (6.80 mug/ml +/- 4.31 vs. 11.18 mug/ml +/- 7.19; p < 0.01). Adiponectin levels correlated negatively with all anthropometric measurements, the most significantly with waist circumference, with systolic blood pressure, fasting glucose, triglyceride levels, CRP, uric acid and positively with age and HDL-cholesterol. Adiponectin level was significantly associated with HDL-cholesterol, waist circumference and with trigliceryde levels and these independent variables explained 39% of the plasma adiponectin variability. CONCLUSIONS: In patients with acute myocardial infarction obesity is related to decreased adiponectin. Low adiponectin level is associated with atherogenic lipid profile and higher levels of inflammatory markers. (Cardiol J 2007; 14: 29-36).

[Heart condition before and after surgical treatment of atrial septal defect type II in adults]. / Wydolnosc serca przed oraz po chirurgicznym zamknieciu ubytku w przegrodzie miedzyprzedsionkowej typu II (ASD t. II) u doroslych.

UNLABELLED: ASD t. II is one of the common congenital heart abnormalities in adults. Early surgical or percutaneous correction in childhood is recommended, but in adults indications to surgical treatment are still controversial. With age physical functional class (NYHA) deteriorating is observed. In the natural course of the defect some patients could be asymptomatic up to third or fourth decade of life and in the middle aged we can observe clinical symptoms. PURPOSE: The aim of the study was to assess a condition of the heart and analyse some dependences between a value of PASP and degree of NYHA class and other echocardiographic parameters in patients before and after surgical repair of ASD t.ll. MATERIAL AND METHODS: 93 patients were involved in research (24.7% male, mean age 43.8+/-11 years ) with history of isolated ASD t.II. All patients were observed in follow-up (mean range--6.6+/-3.1 years). In all pts. before and after surgery the history of the specific symptoms of dyspnea on exertion, level of fatigue, physical examination with assessment a degree of heart failure (NYHA class), a value of PASP (mmHg), the pulmonary to systemic ratio (Qp/Qs) were performed. The patients were divided into two groups according to their age at the time of surgical correction: I group < 40 years and II group > 40 years. In statistic analysis Chp test, Fisher test, t-Student test and logistic regression model were performed. RESULTS: In our study we observe a significant improvement of NYHA class in both groups. A marked recovery from class III or IV to class I or II after operation was documented in 24 pts. (47%) in I group (p<0.00001) and 14 pts. (33%) in group II. (p<0.0001). The pulmonary artery pressure decreased significantly after surgery in both groups (33.1+/-7.7 vs 21.9+/-5.1 mmHg; (p<0.0001--I group) and 41.3+/-11.5 vs 23.4+/-6.2 mmHg; (p<0.0001--II group). We did not observe any significant correlations between NYHA class and PASP and also between PASP and Qp/Qs ratio before surgery in studied groups. (p>0.05). CONCLUSIONS: 1. Surgical repair of ASD t.II is an useful treatment in adult pts. because it improves hemodynamic status and normalise PASP independently of age at the time of repair. 2. More intensive symptoms of dyspnea or fatigue assessed by NYHA class do not correspondence with value of PASP in any age before repair. 3. With advanced age a higher degree of NYHA class correlates with increased value of Qp/Qs ratio. 4. Age over 40 years is not a contraindication to surgical treatment.

[Prevention and treatment of atrial fibrillation following cardiac surgery]. / Zapobieganie i leczenie migotania przedsionków po operacjach serca.

Atrial fibrillation is the most common complications after cardiac surgery, occurring in 20-60% of patients depending on definition and diagnostic methods. Usually appears between 2 and 4 day after operation and often turns back during first 30 days in postoperative time. Treatment of this complication is often protracted, requiring increased monitoring and hospital resources, and extending hospital length of stay Clinical consequences can be significant and include hemodynamic instability and stroke. Recently we can see the increase of atrial fibrillation's frequency occurrence. It is related both with enlargement of patients qualified to cardiac operations and with more and more severe conditions of patients subjected to surgery. Despite of existence unique guidelines there are still many doubts, regarding to choice of antiarrhythmic agent, optimal time of therapy initiation or performing invasive treatment. Atrial fibrillation influences the worsening of patient's postoperative condition (e.g. significantly increasing postoperative mortality) and considerably increases the costs of hospitalization. Therefore competent prevention and suitable treatment of postoperative atrial fibrillation is one of the most important tasks for cardiac surgeons or clinicians who manage the patients after cardiosurgical operations.