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Prevention of ischemic and bleeding complications in patiens with known cardiovascular disease in relation to interruption and re-administration of antithrombotic therapy during non-cardiac surgery
Ondráková, Martina ; Moťovská, Zuzana (advisor) ; Vojáček, Jan (referee) ; Miklík, Roman (referee)
Background. The analysis of the current approaches to antithrombotic treatment of cardiac patients in the perioperative period of major non-cardiac surgery was performed. The incidence of ischemic and bleeding complications in relation to the interrupted antithrombotic was observed. The study investigated the discharge antithrombotic medication in patients with atrial fibrillation (AF) after major non-cardiac surgery and the impact on one-year outcomes. Methods. The subanalysis of multicentre PRAGUE 14 study was performed. A subgroup of 366 patients (mean age 75.9±10.5 years, women 42.3%, acute surgery 42.9%) undergoing major non-cardiac surgery and having any form of AF (30.6% of the total population enrolled in the PRAGUE-14 study) was followed for 1 year. Results. Antithrombotics (interrupted due to surgery) were resumed until discharge in 51.8% of patients; less frequently in men (OR 0.6 (95% CI 0.95 to 0.35); p=0.029), and in patients undergoing elective surgery (OR 0.6 (95% CI 0.91 to 0.33); p=0.021). Patients with AF had significantly higher one-year mortality (22.1%) than patients without AF (14.1%, p=0.001). The causes of death were: ischaemic events (32.6% of deaths), bleeding events (8.1%), others (N = 51; 59.3%). Non-reinstitution of aspirin until discharge was associated with higher...
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Myocardial regeneration after intracoronary injection of autologous bone marrow-derived mononuclear cells in patients with large anterior acute myocardial infarction and late reperfusion
Skalická, Hana ; Horák, Jan (advisor) ; Vojáček, Jan (referee) ; Málek, Ivan (referee)
Myocardial regeneration after intracoronary injection of autologous bone marrow-derived mononuclear cells in patients with large anterior acute myocardial infarction and late reperfusion Objective and background: Despite the use of reperfusion therapies, outcomes in patients with large ST elevation myocardial infarction (STEMI), late reperfusion and left ventricular (LV) dysfunction is poor. We investigated longterm safety and efficacy of intracoronary injections of autologous bone marrow-derived mononuclear cells (BMNCs). Methods: 27 patients with anterior STEMI (age 59 ± 12 yrs, mean baseline LV ejection fraction (LVEF) 39±5%), who underwent percutaneous coronary intervention 4-24 hours after the onset of symptoms, were randomly assigned either to intracoronary BMNCs injection (n = 17, BMNCs group, out of which 14 underwent longterm follow-up), or to standard therapy (n = 10, Control group). The LVEF, the LV end-diastolic and end-systolic volumes (LVEDV, LVESV) and diastolic function (transmitral flow, pulmonary vein flow) were assessed by echocardiography at discharge, month 4 and 24. Myocardial perfusion was assessed using SPECT at baseline and month 4. Results: At 24-month, there was no difference in rates of serious clinical events (36% vs. 50%, p=0,54). At Month 4 LVEF improved to similar extent in...
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Aortocoronary bypass surgery with or without heartlung machine in high risk patients.
Hlavička, Jan ; Vaněk, Tomáš (advisor) ; Vojáček, Jan (referee) ; Rohn, Vilém (referee)
This dissertation entitled "Aortocoronary bypass surgery with or without heart-lung machine in high risk patients" is a summary of the findings of two published works by the author: Off-pump Versus On-Pump Coronary Artery Bypass Grafting Surgery in High-Risk Patients: PRAGUE-6 Trial at 30 Days and 1 Year, published in the journal Biomedical Papers in 2015 and Aspirin is insufficient in inhibition of platelet aggregation and thromboxane formation early after coronary artery bypass surgery, published in Journal of Thrombosis and Thrombolysis in 2009. The PRAGUE-6 study, which focused exclusively on patients with very high operative risk according to the EuroSCORE scoring system, confirmed the hypothesis of a higher incidence of combined endpoints up to the 30th day among patients operated with extracorporeal circulation, particularly acute myocardial infarctions. This significant difference was not maintained after one year after the surgery, mainly due to the increase in mortality between the 30th day and the 1st year in patients operated off-pump. The dissertation further discusses similar papers published on the topic in recent years, including the two very last meta- analyzes. The second part of the thesis follows the topic of myocardial revascularization in the field of antiaggregation therapy...
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Technical aspects of aortic root sparing surgery:Structural changes occurring during different thawingprotocols of cryopreserved human aortic root allografts and thereproducibility of external aortic root annuloplasty using Coroneo ring.
Novotný, Róbert ; Hlubocký, Jaroslav (advisor) ; Vojáček, Jan (referee) ; Pirk, Jan (referee)
Aortic valve-sparing procedures treating patients with aortic root aneurysm with or without aortic insufficiency and patients with ascending aortic aneurysm and aortic insufficiency are no longer experimental and unproven procedures. A successful aortic valve-sparing or repair operation aims not only to correct the failing part of the aortic root but also to restore the intro- and the inter-component relationship of the aortic root elements to optimal dimensions and relations. The avoidance of anticoagulation therapy and prosthesis-related complications makes aortic valve repair a tempting procedure. Considering the increasing rate of cusp repair reported in scientific literature, conservative aortic valve surgery seems to be developing into aortic valve repair surgery. This Dissertation Theses are devoted to the study of some specific technical aspects of aortic root sparing surgery, namely to the study of structural changes occurring in cryopreserved human aortic root allografts and the reproducibility of Coroneo ring implantation procedure. The Introduction of these Dissertation Theses deals with the general review of aortic valve- sparing operations in the light of the historical aspects of used surgical technique, dynamic anatomy and the current situation. One part of the Introduction is...
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Comparison of Czech and world superfoods
Soldánová, Lucie ; Vojáček, Jan (advisor) ; Slimáková, Margit (referee)
v angličtině k bakalářské práci na téma "Srovnání českých a zahraničních superpotravin" ,Lucie Soldánová, Karlova Univerzita, 1. lékařská fakulta, obor Nutriční terapeut. This bachelor thesis focuses on the topic of superfoods and aims to discover how our crops differ from those from abroad. The work consists of a theoretical and practical part. In the theoretical part of my thesis, I firstly analyze five most well known foreign (avocado, soy, goji, chia seeds and quinoa) and Czech (various seeds, poppy seeds, walnuts, blueberries and vegetable juices) superfoods. Then I compare them on four levels- a nutritional, economical, ecological and ethical one. In the practical part I asked several questions related to the problematics of superfoods and with the use of sent out questionnaires investigated whether people know superfoods, what is their opinion on them, if they buy them and whether they think about their origin and deeper problematics of the import of exotic crops. I discovered that more than 75 percent of those questioned are aware of superfoods. Whole 40 percent of people were somewhat sceptical of these foods and only 18,5 percent expressed full trust in them. Almost 73 percent of respondents buy superfoods at least once a week, which reflects their more frequent consumption, while the...
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Clinical Manifestations of Infective Endocarditis Depending on Infectious Agent
Pazderník, Michal ; Vojáček, Jan (advisor) ; Táborský, Miloš (referee) ; Vítovec, Jiří (referee)
Introduction: Despite more recent advances in both medical and surgical therapies, the syndrome of infective endocarditis (IE) continues to be characterized by serious complications, and remains a life-threatening infection. According to data from the World Health Organization, the Czech Republic has one of the highest mortality rates due to this disease worldwide. Aims and methods: A study of local IE cases was conducted in two leading Cardiac centres in the Czech Republic. The main objective was to analyse the features of this disease and, at the same time, to identify predictors that are associated with the development of acute complications and worse survival of patients with IE. Results: Infection of the aortic prosthesis was a significant predictor of paravalvular spread of infection (OR 6.706). Infection caused by Staphylococcus aureus (OR 8.459) and smoking (OR 8.403) were associated with a more frequent development of septic shock (OR 8.403). The most potent risk factors of possible embolization were mitral valve vegetation ≥ 13 mm (OR 3.59) and IE caused by Staphylococcus aureus (OR 3.24). The size of the vegetation was not only associated with the risk of embolization itself but also with a local destructive effect in the form of a new prolapse/perforation of the valve (OR 1.055). The importance...
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Acute Myocardical Infarction with ST Elevation (STEMI), Direct PCI, Times and Lethality
Al Mawiri, Abdulwasya ; Vojáček, Jan (advisor) ; Mates, Martin (referee) ; Fiala, Martin (referee)
In ST-segment elevation myocardial infarction (STEMI), rapid revascularization is of paramount importance, and direct transport to a percutaneous coronary intervention (PCI)-capable center is recommended. Long-term follow-up data comparing both approaches are scarce. The purpose of this study was to compare the long-term outcomes of direct primary transfer (PT) and indirect secondary transfer (ST) in patients with STEMI. Method and study group: We enrolled consecutive patients referred for STEMI within 12 h of symptom onset. The primary endpoint was to compare long-term lethality of direct PT and indirect ST in patients with STEMI. During a two-year period (2008-2009), we prospectively recorded lethality and the door-to-balloon time (DBT) of 869 patients with STEMI from arrival at the first hospital until reperfusion by PCI in the catheterization laboratory. A total of 677 patients (77.9%) were enrolled for the final evaluation, with 192 (22.1%) patients excluded. We divided the patients into two groups: the first group (PT) had been transferred directly from the field to a catheterization laboratory, while the second group (ST) had been transferred from regional hospitals to a catheterization laboratory. The final analysis included 677 patients aged 20 to 96 years; the mean age was 64,04 years,...
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Prevention of ischemic and bleeding complications in patiens with known cardiovascular disease in relation to interruption and re-administration of antithrombotic therapy during non-cardiac surgery
Ondráková, Martina ; Moťovská, Zuzana (advisor) ; Vojáček, Jan (referee) ; Miklík, Roman (referee)
Background. The analysis of the current approaches to antithrombotic treatment of cardiac patients in the perioperative period of major non-cardiac surgery was performed. The incidence of ischemic and bleeding complications in relation to the interrupted antithrombotic was observed. The study investigated the discharge antithrombotic medication in patients with atrial fibrillation (AF) after major non-cardiac surgery and the impact on one-year outcomes. Methods. The subanalysis of multicentre PRAGUE 14 study was performed. A subgroup of 366 patients (mean age 75.9±10.5 years, women 42.3%, acute surgery 42.9%) undergoing major non-cardiac surgery and having any form of AF (30.6% of the total population enrolled in the PRAGUE-14 study) was followed for 1 year. Results. Antithrombotics (interrupted due to surgery) were resumed until discharge in 51.8% of patients; less frequently in men (OR 0.6 (95% CI 0.95 to 0.35); p=0.029), and in patients undergoing elective surgery (OR 0.6 (95% CI 0.91 to 0.33); p=0.021). Patients with AF had significantly higher one-year mortality (22.1%) than patients without AF (14.1%, p=0.001). The causes of death were: ischaemic events (32.6% of deaths), bleeding events (8.1%), others (N = 51; 59.3%). Non-reinstitution of aspirin until discharge was associated with higher...
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Morphological changes in pulmonary vascular bed after pulmonary embolism
Vavera, Zdeněk ; Vojáček, Jan (advisor) ; Staněk, Vladimír (referee) ; Vítovec, Jiří (referee)
Introduction: Chronic thromboembolic pulmonary hypertension (CTEPH) is a relatively common long-term complication of acute pulmonary embolism (PE) with severely negative impact on the patient's quality of life and prognosis. Specific pharmacotherapy and especially mastery of pulmonary endarterectomy (PEA) offer to our patients a hope for eventual full recovery. Early diagnosis determination is crucial. Objective: The aim of our prospective study was to determinate CTEPH incidence in a population of patients after acute pulmonary embolism as the first venous thromboembolic event in the patient`s history, to assess morphological changes in the pulmonary vascular bed with regard to risk of CTEPH development and try to identify some risk factors of CTEPH development. Methods: 120 consecutive patients with acute PE were followed-up for 2 years. On admission patients underwent CT pulmonary angiography (CTA), echocardiography and troponin-T, NT-proBNP and D-dimer assessement. At the time of hospital discharge we performed echocardiography and biomarkers reassessement whether they were elevated initially. After 6 months patients underwent pulmonary CTA, echocardiography and during 12- and 24-months visits echocardiography was performed again. In case of pulmonary hypertension detection CTEPH was confirmed...
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Resistance to antiplatelet therapy in cardiovascular diseases management
Ševčíková, Hana ; Vojáček, Jan (advisor) ; Šochman, Jan (referee) ; Vítovec, Jiří (referee)
Summary: Introduction: Antiplatelet therapy is a cornerstone in the management of cardiovascular diseases. With regard to interindividual variability in platelet reactivity and recurrence of thrombotic events despite therapy the importance of platelet function monitoring seems to be much higher. Objectives: The aim of our study was to describe the prevalence of high on treatment platelet reactivity in our study population. We were looking for the potential relationship between platelet reactivity and comorbidities or medication and tried to assess measurement reproducibility. Methods and results: 207 patients with cardiovascular diseases on ASA treatment (daily dose 100mg) were enrolled. Platelet functions were monitored by optic aggregometry (LTA) with cationic propylgallate as inductor. Residual platelet reactivity was assessed initially and afterwards (median value 9 months) without changes in ASA dose. In 82,1% suppression of platelet reactivity was adequate in both assessments, in 16,9% suppression of platelet reactivity was inadequate in at least one of the measurements. Our results show wide variability in platelet reactivity in time (p=0,67). No statistically significant differences in platelet reactivity were found in subpopulation with acute coronary syndromes (p=0,37), with chronic stable...
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