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Aortic valve conserving surgery in patients with aortic regurgitation
Holubec, Tomáš ; Žáček, Pavel (advisor) ; Lonský, Vladimír (referee) ; Tláskal, Tomáš (referee)
INTRODUCTION. In the last two decades, the vlave-conserving surgery of regurgitant heart valves has been evolving. The aortic valve-sparing operations have been developing rather over the last decade, despite the clear benefit of mitral valve repair has been shown. There is an indisputable advantage of valve-sparing operations attributed to the elimination of certain risks related to aortic valve replacement. Conversely, aortic valve repair is technically more demanding and there is a substantial risk of repair failure. AIM: The aim of this study is to analyze and assess short- and mid-term results of aortic valve-sparing operations in patients with aortic regurgitation, to examine the impact of aortic valve cuspidity (bicuspid or tricuspid) and different type of aortic repair (without and with root replacement) on the short- and mid-term results with regards to survival, reoperation and recurrence of aortic regurgitation (AR). Another aim is to assess the effectiveness and pulsatility of the external aortic ring annuloplasty in the patients' subgroup using cardiac-CT. METHODS. One hundred patients with aortic regurgitation (24 females; median age 52 years; range 23-77 years) underwent aortic valve-sparing operation between November 2007 and October 2012. Sixty patients had bicuspid aortic valve and...
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Elective MIDCAB: Shunt or tournique occlusion? Assessment of a protective role of perioperative intraluminal shunting on myocardial damage
Šorm, Zdeněk ; Harrer, Jan (advisor) ; Straka, Zbyněk (referee) ; Lonský, Vladimír (referee)
1 Summary Elective MIDCAB: Shunt or Tournique Occlusion? Assessment of a Protective Role of Perioperative Intraluminal Shunting on Myocardial Damage. Background: To determine impact of intraluminal-left anterior descending (LAD) shunt to prevent myocardial damage in minimally invasive coronary artery bypass (MIDCAB). Methods: 38 patients were randomly assigned to external tournique occlusion (TO, n = 19) or intraluminal-LAD shunt group (ILS, n = 19). Blood samples for cardiac troponin T (cTnT), Creatine Kinase (CK), CK-MB, myoglobin and aspartate aminotransferase (AST) were collected at 30 min. prior to, 6 and 24 hours after surgery. Results: 1 patient in TO and 2 in ILS group were excluded from futher analysis due to preoperative cTnT level above the 99th-percentile (≥ 0,01 μg/l). The anastomotic time in TO group was significantly shorter than in ILS group (13.44 ± 5.06 vs 18.9 ± 6.56 min., p = 0.0094). Postoperatively, each six patients in TO (33.3%) and ILS (35.3 %) group were above the 99th-percentile. 2 patients from each group (TO 11.1 % and ILS 11.8 %) had peak values above 10-% CV cutoff (p = 1). The differences in postoperative plasma concentrations of CK, CK-MB, myoglobin and AST between groups were similar. There were no significant differences in between both groups at all studied timepoints....
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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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