Causes of death and morbidity in patients with atrial fibrillation after left atrial appendage occlusion.

BACKGROUND: Left atrial appendage occlusion (LAAO) is a safe and effective alternative for stroke prevention in patients with atrial fibrillation (AF). However, there is little literature on the exact causes of death and adverse events during follow­up after LAAO. AIMS: The primary aim of this study was to evaluate survival free of any serious adverse events and of any­cause death in midterm follow­up. The secondary aims were to analyze causes of mortality and further hospitalization as well as adverse events, thromboembolism, and bleeding risk reduction during follow­up. METHODS: A retrospective, single­center study was performed in 84 consecutive patients with AF who underwent LAAO with endocardial occluders. The mean (SD) CHADS2 score was 3.5 (1.1), CHA2DS2­VASc score, 5.0 (1.5), and HAS­BLED score, 4.4 (0.9). After LAAO, dual 6­month antiplatelet therapy and then lifelong aspirin monotherapy was recommended. Mean (SD) follow­up was 25.3 (13.2) months with an accumulated total follow­up of 174.6 patient­years. RESULTS: The annual mortality rate was 12.02%. More than half of deaths (57%) were due to noncardiovascular causes with leading malignancy. Survival at the end of the periprocedural period was 98.8%, at 3 months, 97.6%, at 6 months, 95.2%, at 12 months, 86.5%, at 18 months, 85.1%, and at 24 months, 80.6%. The average annual thromboembolic event rate was 2.87%. The most common adverse event was severe bleeding with an annual rate of 6.3% (3 cases while receiving dual antiplatelet therapy and 6 cases while receiving aspirin). CONCLUSIONS: The majority of deaths were not related to stroke in patients with AF after LAAO. Mortality in first 2 years following the procedure was predominantly from noncardiovascular causes.

Percutaneous left atrial appendage occlusion - treatment outcomes and 6 months of follow-up - a single-center experience.

AIM: To present the results of treatment and evaluate 6 months of follow-up in a group of patients with non-valvular atrial fibrillation, who underwent the procedure of percutaneous left atrial appendage occlusion (PLAAO). MATERIAL AND METHODS: Percutaneous left atrial appendage occlusion was performed in 34 patients with non-valvular atrial fibrillation and contraindications for oral anticoagulation therapy. The risk of thromboembolic and bleeding complications was determined based on the CHA2DS2VASc and HAS-BLED scales. The Amplatzer Amulet system from St. Jude Medical was used. On the first postoperative day, all patients were started on double antiplatelet therapy with 75 mg/day of acetylsalicylic acid (ASA) and 75 mg/day of clopidogrel (CLO). On the 30(th) postoperative day, the efficacy of the antiplatelet therapy was assessed with impedance aggregometry using a Multiplate analyzer (Roche). Echocardiographic examinations were performed intraoperatively and on the first postoperative day; subsequently, follow-up examinations were conducted 1 and 6 months after the implantation. RESULTS: In all patients, proper occluder position was observed throughout the follow-up. No leakage or thrombi around the implants were found. No strokes or bleeding complications associated with the antiplatelet therapy were observed. Multiplate assessment of platelet activity was conducted in 20 out of 34 patients. The efficacy of ASA treatment was demonstrated in all patients; no response to clopidogrel treatment was observed in 5 out of 20 patients. One patient suffered from cardiac tamponade, which required the performance of full sternotomy. Local complications (hematomas of the inguinal region) were observed in 3 patients. One of the patients died for reasons unrelated to the procedure. CONCLUSIONS: Percutaneous left atrial appendage occlusion is an effective procedure in patients with non-valvular atrial fibrillation and contraindications for chronic anticoagulation therapy. Further observation is necessary to evaluate the longterm results.

[Papillary fibroelastoma of the aortic valve in a 67-year-old patient after myocardial infarction]. / Fibroelastoma papillare zastawki aortalneju 67−letniej pacjentki po przebytym zawale serca.

We present a case of a 67-year-old female patient with diagnosed papillary fibroelastoma (PFE) of the aortic valve. Eight months before the tumour discovery a non-ST segment elevation myocardial infarction without essential coronary artery restriction was diagnosed. The tumour was excised (during the aortotomy under cardiopulmonary bypass at systemic hypothermia) without any aortic valve injury. The main symptoms of PFE along with diagnostic techniques and treatment were described.

[Endothelial parameters in blood plasma of patients suffering from ischaemic heart disease and undergoing surgery with extracorporeal circulation]. / Wskazniki sródblonkowe w osoczu chorych na chorobe wienicowa operowanych w krazeniu pozaustrojowym.

INTRODUCTION: The participation of disturbances of the vascular endothelial function in the pathogenesis of post perfusion syndrome is controversial. AIM: The aim of the study was the evaluation of the parameters of vascular endothelial injury in the blood plasma of patients undergoing surgery with extracorporeal circulation. METHODS: The study was performed in the group of 32 patients (M/F 23/9) with ischaemic heart disease, undergoing coronary artery bypass with extracorporeal circulation. In the blood plasma obtained in the couple of time points in the perioperative period the determinations were done as followed: the concentrations of von Willebrand factor antigen (vWf Ag), tissue plasminogen activator antigen (t-PA Ag), antigen of plasminogen activator inhibitor type 1 (PAI-1 Ag) and fibrinogen. The control group consisted of 29 healthy volunteers sex and age matched. RESULTS: In blood of patients suffering from ischaemic heart disease before surgery the increased concentrations of vWF Ag, t-PA Ag and fibrinogen were observed. The concentrations of t-PA Ag and vWf Ag hesitated in the perioperative period but always were significantly higher than observed in the control group. CONCLUSIONS: (1) In the blood of patients suffering from the ischemic heart disease undergoing bypass surgery with an extracorporeal circulation the increased concentrations of t-PA Ag and vWf Ag were observed what is the evidence of stimulation/ damage of the vascular endothelium. (2) High levels of t-PA and vWf is seemed to be connected with injury of vessels during coronary artery bypass.

[Does extracorporeal circulation during coronary artery bypass grafting damage vascular endothelium?]. / Czy krazenie pozaustrojowe podczas pomostowania aortalno-wiencowego uszkadza komórki sródblonka naczyn?

The aim of the work was to study the influence of extracorporal circulation (ECC) on the vascular endothelial markers: von Willebrand factor (vWf), tissue plasminogen activator (t-PA) and trombomodulin (TM) in patients with coronary heart disease (CHD) undergoing coronary artery bypass graft (CABG). Examined group consisted of 30 patients (22 men, 8 women) at mean age 58.0 +/- 8.0 years, among them 19--were operated with ECC, 11--without ECC. Before and during operation blood was drawn 6 times. Control group consisted of 23. healthy volunteers at similar age. In the plasma vWf, t-PA and TM were determined with immunoenzymatic methods. Before operation the examined parameters were significantly higher compared to controls. The concentration of vWf during ECC was higher than in operation without ECC, but not significant. Differences statistically significant in the blood collected during ECC and without it appeared in t-PA only on the 3. and in TM on the 1. and 3. day after operation. It seems that ECC does not damage vascular endothelium direct, only indirect trough proinflammatory factors released from activated during ECC granulocytes and platelets.