Cardiac Arrest as an Uncommon Manifestation of Late Type A Aortic Dissection Associated with Transcatheter Aortic Valve Replacement.

Transcatheter aortic valve replacement (TAVR) is a minimally invasive therapeutic procedure with a consistent, linear increase in the number of implantations worldwide. Recently, TAVR has been rapidly expanding into lower-risk populations. Sporadic cases of late prosthesis-related Stanford type A dissection have been documented in self-expanding, as well as balloon-expandable TAVR valves, manifested primarily as acute aortic syndrome. We present the case of a 76-year-old male, who experienced refractory in-hospital cardiac arrest with non-shockable rhythm due to the obstruction of coronary flow caused by aortic dissection type A, with entry directly adjacent to the aortic prosthesis according to autopsy. The patient died despite the engagement of extracorporeal cardiopulmonary resuscitation. Aortic dissection developed one year after a transfemoral TAVR procedure using an Edwards SAPIEN 3 29 mm self-expanding valve. TAVR-associated late aortic dissection type A represents a rare, life-threatening condition with various clinical manifestations. The risk factors have not been well described and the differential diagnosis may be challenging. As the number of TAVR recipients and their life expectancy is increasing, we may face this complication more often in future.

[Renal cell carcinoma in the coming era of robotic technology]. / Karcinom ledviny v ére nastupujících robotických technologií.

Renal cell carcinoma is the most malignant urological tumour and the incidence in the Czech Republic is currently highest in the world. Kidney cancer is associated with seven different genes and is characterized nowadays as metabolic disease. Authors present some current facts about advances in diagnosis and new treatment methods. Different findings required individual approach. Diagnosis improved with more sophisticated ultrasonography, computed tomography, magnetic resonance imaging and positron emission tomography etc. Apart from standard surgery new alternative methods of minimally invasive procedures also assert (laparoscopy, robotic surgery, radiofrequency ablation, kryoablation) and are incorporated in current complex treatment strategies. Systemic therapy with new targeted antiangiogenics drugs is a new standard of treatment for metastatic kidney cancer Complex care with integration of local treatment (surgery, radiotherapy, selective embolization, radiosurgery, cementoplasty, vetrebroplasty etc.) and systemic medication with best supportive care is optimal for a metastatic kidney cancer. More accurate diagnostic methods and complex interdisciplinary approach with integration of systemic therapy with new targeted drugs and new minimally invasive procedures represent new possibilities for patients with kidney cancer.