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Long Pentraxin 3 - a Putative Biomarker with Predictive Value to Identify the Adverse Inflammatory Response in Cardiac Surgical Patients?
Holubcová, Zdeňka ; Manďák, Jiří (advisor) ; Lonský, Vladimír (referee) ; Rohn, Vilém (referee)
(LONG PENTRAXIN 3 - A PUTATIVE BIOMARKER WITH PREDICTIVE VALUE TO IDENTIFY THE ADVERSE INFLAMMATORY RESPONSE IN CARDIAC SURGICAL PATIENTS?) INTRODUCTION. Cardiac surgery is well established for development of systemic inflammatory response. There are still no biomarkers with significant predictive value to identify patients at risk. AIM. The aim of this study was to compare the dynamics of pentraxin 3 (PTX3) and other inflammatory biomarkers (CRP, TLR2 and IL-8) after cardiac surgery with particular regards to different postoperative clinical manifestation of inflammatory response. Furthermore to evaluate the association between perioperative inflammatory biomarkers (PTX3, CRP, IL-8, IL-18, IL-18BP, TLR2, MMP7, MMP8, sFas a sFasL) and atrial fibrillation (AF) in cardiosurgical patients. METHODS. Forty-two patients undergoing open heart surgery with the use of cardiopulmonary bypass were included in the study and divided in 2 groups according to the extent of clinical manifestation of inflammatory response: Group A (n = 21) - patients with different severity of systemic inflammatory response syndrome (SIRS) and Group B (n = 21) - patients with uneventful postoperative period (no SIRS). The same group of 42 patient were divided in 3 groups according to occurrence of atrial fibrillation (AF): Group A...
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Inflammatory response induced by cardiac surgery with the use of cardio-pulmonary bypass; the impact of methylprednisolone
Koláčková, Martina ; Krejsek, Jan (advisor) ; Lonský, Vladimír (referee) ; Kročová, Zuzana (referee)
Most elderly people aged over 60 suffer from coronary artery disease (CAD), which can become very likely cause of death. Coronary artery bypass grafting (CABG) represents the standard way of treatment for CAD. CABG surgery is traditionally performed on an arrested heart with the use of cardiopulmonary bypass. The heart is usually accessed through a median sternotomy. Although this kind of surgery strongly stimulates both humoral and cell-mediated immunity, inflammatory response is self-terminating and only a small percentage of patients develop serious postoperative complications, such as organ failure, wound dehiscence, and sepsis. This work focuses on regulatory mechanisms controlling inflammatory response in cardiac surgical patients. It is a retrospective study that follows changes of humoral and cell-mediated immunity induced by cardiac surgery in two different groups of patients. Both groups were operated with the same surgical approach, when identical devices and types of equipment were used; the only difference was the content of 500 mg of methylprednisolone (MP) in priming solution of cardiopulmonary bypass. Blood samples were collected before surgery, after weaning from cardiopulmonary bypass, at the end of surgery, on the 1st , 3rd , and 7th postoperative day. Changes in number of...
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Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery
Mlejnský, František ; Lindner, Jaroslav (advisor) ; Lonský, Vladimír (referee) ; Vaněk, Tomáš (referee)
Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery Abstract Currently, the most commonly used technical solution for pumping blood during extracorporeal circulation during cardiac surgery, as well as for some types of ECMO (extracorporeal membrane oxygenation) are either a roller pump or centrifugal pump. Due to its advantages the centrifugal pump is mainly used for prolonged extracorporeal circulation in cardiac surgery and as a heart and / or lung support system. In current literature there is a lack of compelling scientific evidence that would clearly support its use in a routine cardiac surgery. The aim of our study was to compare both types of currently used blood pumps in longer cardiac procedures with deep hypothermic circulation arrest. In a randomized clinical study we had selected a group of patients that underwent a pulmonary endarterectomy (PEA) in order to demonstrate the positive effects of the centrifugal pump on the postoperative inflammatory reactions. There were no statistically significant differences between these two pumps when other clinical and laboratory parameters were observed. Based on the hypothesis that significant temperature changes during cardiac procedure with a deep hypothermia can affect sealing pressure of the endotracheal tube cuff, we performed a...
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Haemolysis and other biochemical evaluations of vacuum-assisted venous drainage in cardiac surgery
Škorpil, Jiří ; Tošovský, Jan (advisor) ; Lonský, Vladimír (referee) ; Semrád, Michal (referee)
Haemolysis and other biochemical evaluations of vacuum-assisted venous drainage in cardiac surgery Aims of the study: Vacuum-assisted venous drainage (VAVD) improves the quality of venous return in procedures using extracorporeal circulation systems (ECC). Nevertheless, there is not an evidence that such high negative pressure applied to ECC in combination with selective bicaval cannulation due to open heart surgery cause a trauma to blood elements and deteriorates organ function. A prospective randomised study was designed to demonstrate that negative pressure of -20 mm Hg to -80 mm Hg does not cause a significant haemolysis and organ deterioration in such procedures. Materials and methods: 85 consecutive patients undergoing combined cardiac surgery procedure with two separate venous cannulas were randomised in three groups A, B and C. VAVD with negative pressure of -20 to -45 mm Hg was applied to 28 patients in group A and negative pressure of -45 mm Hg to -80 mmHg was applied to 28 patients in group B. There was zero negative pressure applied to 29 patients in group C. Six blood samples were taken from each patient and examinated for haemolysis and other indicators of organ deterioration such as hemoblobin, platelet count, free hemoglobin, aptoglobin, lactate-dehydrogenase, aspartate-amino-transferase,...
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Echocardiographic Criteria for Aortic Valve-sparing Procedures
Tuna, Martin ; Šťásek, Josef (advisor) ; Lonský, Vladimír (referee) ; Linhartová, Irena (referee)
Risk factors for failure of aortic valve-sparing procedures Introduction: Valve- sparing procedures restore correct function of the aortic valve without the usage of a valve replacement and thus eliminates the risks of its presence. Their disadvantage is the uncertainty of long-term correct function of the valve and the risk of recurrence of the defect. Aim: To evaluate medium to long-term outcomes of aortic valve-sparing procedures with focus on patient survival, reoperation and recurrence of aortic regurgitation. In the analysis of the results of operations identify the risk factors of failure of the aortic valve. To determine the effect of various surgical techniques used in aortic annuloplasty on the risk of aortic annulus re-dilation and the failure of aortic valve-sparing procedure in long-term follow-up. To evaluate the results of valve-sparing procedures in frequency of failure with recurrence of defect and frequency of reoperations between groups of patients with tricuspid and bikuspid aortic valve. Methods: From 11/2007 to 10/2017 was a total of 198 aortic valve sparing operations performed at our department. Patients' mean age was 48.4 ± 13.5 years. Of the total, 74 (37%) patients had tricuspid valve, 121 (61%) had bikuspid valve and 3 (2%) patients had unicuspid aortic valve. Dilatation...
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Comparison between Flow in the Left Internal Mammary Artery Harvested via Sternotomy and via a Left Anterior Small Thoracotomy with Clinical Impact for the Patient
Voborník, Martin ; Harrer, Jan (advisor) ; Lonský, Vladimír (referee) ; Rohn, Vilém (referee)
Comparison between flow in the left internal mammary artery harvested via sternotomy and via a left anterior small thoracotomy with clinical impact for the patient Introduction: In the treatment of coronary artery disease (CAD), in addition to conservative therapy and percutaneous interventions, is irreplacebly belong coronary artery bypass grafting (CABG). The gold standard in the surgical treatment of CAD is CABG from a median sternotomy access using cardiopulmonary bypass (on-pump CABG). A less invasive and economically advantageous is CABG from a median sternotomy access without cardiopulmonary bypass (off-pump CABG) and last but not least CABG through a left anterior small thoracotomy (LAST) approach (MIDCAB - "minimally invasive direct coronary artery bypass"). Although the final technical implementation anastomoses is essentially identical in off-pump CABG and MIDCAB, the difference is very important during left internal mammary artery (LIMA) harvesting, especially through a LAST approach, which can be difficult for the surgeon. Aim of the study: The aim of these two studies is to assess the effect of surgical approach on the mean flow in LIMA, including short and long term clinical impact for the patient. Methods: Study 1 (nonrandomized, prospective): In our study we included 60 patients,...
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Long Pentraxin 3 - a Putative Biomarker with Predictive Value to Identify the Adverse Inflammatory Response in Cardiac Surgical Patients?
Holubcová, Zdeňka ; Manďák, Jiří (advisor) ; Lonský, Vladimír (referee) ; Rohn, Vilém (referee)
(LONG PENTRAXIN 3 - A PUTATIVE BIOMARKER WITH PREDICTIVE VALUE TO IDENTIFY THE ADVERSE INFLAMMATORY RESPONSE IN CARDIAC SURGICAL PATIENTS?) INTRODUCTION. Cardiac surgery is well established for development of systemic inflammatory response. There are still no biomarkers with significant predictive value to identify patients at risk. AIM. The aim of this study was to compare the dynamics of pentraxin 3 (PTX3) and other inflammatory biomarkers (CRP, TLR2 and IL-8) after cardiac surgery with particular regards to different postoperative clinical manifestation of inflammatory response. Furthermore to evaluate the association between perioperative inflammatory biomarkers (PTX3, CRP, IL-8, IL-18, IL-18BP, TLR2, MMP7, MMP8, sFas a sFasL) and atrial fibrillation (AF) in cardiosurgical patients. METHODS. Forty-two patients undergoing open heart surgery with the use of cardiopulmonary bypass were included in the study and divided in 2 groups according to the extent of clinical manifestation of inflammatory response: Group A (n = 21) - patients with different severity of systemic inflammatory response syndrome (SIRS) and Group B (n = 21) - patients with uneventful postoperative period (no SIRS). The same group of 42 patient were divided in 3 groups according to occurrence of atrial fibrillation (AF): Group A...
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Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery
Mlejnský, František ; Lindner, Jaroslav (advisor) ; Lonský, Vladimír (referee) ; Vaněk, Tomáš (referee)
Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery Abstract Currently, the most commonly used technical solution for pumping blood during extracorporeal circulation during cardiac surgery, as well as for some types of ECMO (extracorporeal membrane oxygenation) are either a roller pump or centrifugal pump. Due to its advantages the centrifugal pump is mainly used for prolonged extracorporeal circulation in cardiac surgery and as a heart and / or lung support system. In current literature there is a lack of compelling scientific evidence that would clearly support its use in a routine cardiac surgery. The aim of our study was to compare both types of currently used blood pumps in longer cardiac procedures with deep hypothermic circulation arrest. In a randomized clinical study we had selected a group of patients that underwent a pulmonary endarterectomy (PEA) in order to demonstrate the positive effects of the centrifugal pump on the postoperative inflammatory reactions. There were no statistically significant differences between these two pumps when other clinical and laboratory parameters were observed. Based on the hypothesis that significant temperature changes during cardiac procedure with a deep hypothermia can affect sealing pressure of the endotracheal tube cuff, we performed a...
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Nanofibrous vascular grafts
Horáková, Jana ; Lonský, Vladimír (referee) ; Tonar, Zbyněk (referee)
There is a pressing need to develop vascular graft since no clinically available appropriate prosthesis with inner diameter less than 6 mm works in a long term after implantation. In the thesis, blood vessel substitutes made from biodegradable polymers were created and characterized as potential candidates for such a medical device. The idea of tissue engineering scaffolds is based on mimicking natural environment - extracellular matrix therefore ideal bypass graft was designed as double layered structure with defined morphology of each layer. The proposed structure was created by electrospinning of polycaprolactone (PCL). The morphology of the resulting fibers resembled inner and medial layer of native arteries suggesting that this similarity will help body to regenerate functional tissue after implantation. Besides PCL, novel polymer from the same group of polyester - copolymer polylactide-polycaprolactone (PLC 70/30) was electrospun into a tubular form. Vascular graft made from copolymer PLC created only single layered prosthesis. Further tests were conducted with both presented electrospun materials in order to compare their bulk and surface properties. Copolymer PLC was slightly more hydrophilic than polycaprolactone. Thermal behavior revealed that copolymer is mostly amorphous with melting...
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Inflammatory response induced by cardiac surgery with the use of cardio-pulmonary bypass; the impact of methylprednisolone
Koláčková, Martina ; Krejsek, Jan (advisor) ; Lonský, Vladimír (referee) ; Kročová, Zuzana (referee)
Most elderly people aged over 60 suffer from coronary artery disease (CAD), which can become very likely cause of death. Coronary artery bypass grafting (CABG) represents the standard way of treatment for CAD. CABG surgery is traditionally performed on an arrested heart with the use of cardiopulmonary bypass. The heart is usually accessed through a median sternotomy. Although this kind of surgery strongly stimulates both humoral and cell-mediated immunity, inflammatory response is self-terminating and only a small percentage of patients develop serious postoperative complications, such as organ failure, wound dehiscence, and sepsis. This work focuses on regulatory mechanisms controlling inflammatory response in cardiac surgical patients. It is a retrospective study that follows changes of humoral and cell-mediated immunity induced by cardiac surgery in two different groups of patients. Both groups were operated with the same surgical approach, when identical devices and types of equipment were used; the only difference was the content of 500 mg of methylprednisolone (MP) in priming solution of cardiopulmonary bypass. Blood samples were collected before surgery, after weaning from cardiopulmonary bypass, at the end of surgery, on the 1st , 3rd , and 7th postoperative day. Changes in number of...
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