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Surgical treatment of atrial fibrillation: prospective randomized study PRAGUE-12 and EndoMAZE procedure (toracoscopic ablation of atrial fibrillation)
Budera, Petr ; Straka, Zbyněk (advisor) ; Táborský, Miloš (referee) ; Šetina, Marek (referee)
Surgical treatment of atrial fibrillation: prospective randomized study PRAGUE-12 and EndoMAZE procedure (toracoscopic ablation of atrial fibrillation) Abstract (English) First part of our research project is focused on surgical treatment of atrial fibrillation in patients who undergo a cardiac surgery for some other primary diagnosis (ischaemic heart disease and/or valve disease). Concomitant surgical ablation procedures are widely used with expected positive long-term clinical impact on patients. However, this assumption has never been confirmed by enough powerful randomized studies with long-term follow up. Our PRAGUE-12 trial is the biggest, prospective, multicenter, randomized trial conducted to date. Its results demonstrated that surgical ablation improves the likelihood of SR presence post-operatively without increasing peri-operative complications. However, the higher prevalence of SR did not translate to improved clinical outcomes at 1 year. Related publications describe in detail its design and its one-year results. Second part of our research project is focused on surgical ablation of lone atrial fibrillation. In 2006, as a first cardiac surgery clinic in the Czech republic, we performed a completely toracoscopic ablation of this arrhythmia. More than thirty patients underwent this procedure in...
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Oxygen consumption in awake cardiac surgical patients
Pořízka, Michal ; Stříteský, Martin (advisor) ; Szárszoi, Ondrej (referee) ; Šetina, Marek (referee)
OBJECTIVES: Standard blood flow rates for cardiopulmonary bypass have been assumed to be the same for awake cardiac surgery with thoracic epidural anesthesia as for general anesthesia. However, compared to general anesthesia, awake cardiac surgery with epidural anesthesia may be associated with higher oxygen consumption due to missing effect of general anesthetics. This may result in insufficient oxygen delivery and lactic acidosis when standard blood flow rates were used. The primary aim of our study was to investigate if standard blood flow rates are adequate in awake cardiac surgery. The secondary aim was to evaluate postoperative clinical outcomes of patients undergoing awake cardiac surgery. METHODS: Forty-seven patients undergoing elective on-pump cardiac surgery were assigned to receive either epidural (Group TEA, n=17), combined (Group TEA-GA, n=15) or general (Group GA, n=15) anesthesia. To monitor adequacy of standard blood flow rates, arterial lactate, acid base parameters, central venous and jugular bulb saturation were measured at six time points during in all groups. Blood flow rates were adjusted when needed. Subsequently, early and late postoperative outcome data including hospital and 3-year mortality was recorded and compared among the study groups RESULTS: No lactic acidosis has...
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Surgical treatment of atrial fibrillation: prospective randomized study PRAGUE-12 and EndoMAZE procedure (toracoscopic ablation of atrial fibrillation)
Budera, Petr ; Straka, Zbyněk (advisor) ; Táborský, Miloš (referee) ; Šetina, Marek (referee)
Surgical treatment of atrial fibrillation: prospective randomized study PRAGUE-12 and EndoMAZE procedure (toracoscopic ablation of atrial fibrillation) Abstract (English) First part of our research project is focused on surgical treatment of atrial fibrillation in patients who undergo a cardiac surgery for some other primary diagnosis (ischaemic heart disease and/or valve disease). Concomitant surgical ablation procedures are widely used with expected positive long-term clinical impact on patients. However, this assumption has never been confirmed by enough powerful randomized studies with long-term follow up. Our PRAGUE-12 trial is the biggest, prospective, multicenter, randomized trial conducted to date. Its results demonstrated that surgical ablation improves the likelihood of SR presence post-operatively without increasing peri-operative complications. However, the higher prevalence of SR did not translate to improved clinical outcomes at 1 year. Related publications describe in detail its design and its one-year results. Second part of our research project is focused on surgical ablation of lone atrial fibrillation. In 2006, as a first cardiac surgery clinic in the Czech republic, we performed a completely toracoscopic ablation of this arrhythmia. More than thirty patients underwent this procedure in...
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Oxygen consumption in awake cardiac surgical patients
Pořízka, Michal ; Stříteský, Martin (advisor) ; Szárszoi, Ondrej (referee) ; Šetina, Marek (referee)
OBJECTIVES: Standard blood flow rates for cardiopulmonary bypass have been assumed to be the same for awake cardiac surgery with thoracic epidural anesthesia as for general anesthesia. However, compared to general anesthesia, awake cardiac surgery with epidural anesthesia may be associated with higher oxygen consumption due to missing effect of general anesthetics. This may result in insufficient oxygen delivery and lactic acidosis when standard blood flow rates were used. The primary aim of our study was to investigate if standard blood flow rates are adequate in awake cardiac surgery. The secondary aim was to evaluate postoperative clinical outcomes of patients undergoing awake cardiac surgery. METHODS: Forty-seven patients undergoing elective on-pump cardiac surgery were assigned to receive either epidural (Group TEA, n=17), combined (Group TEA-GA, n=15) or general (Group GA, n=15) anesthesia. To monitor adequacy of standard blood flow rates, arterial lactate, acid base parameters, central venous and jugular bulb saturation were measured at six time points during in all groups. Blood flow rates were adjusted when needed. Subsequently, early and late postoperative outcome data including hospital and 3-year mortality was recorded and compared among the study groups RESULTS: No lactic acidosis has...
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