Vladimir Svitek | Charles University, Prague (original) (raw)
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Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti
To evaluate the use of intra-aortic balloon pump (IABP) at the Department of Cardiac Surgery, Cha... more To evaluate the use of intra-aortic balloon pump (IABP) at the Department of Cardiac Surgery, Charles University, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové and identifying the complications of this method and their frequency in long-term follow-up. Retrospective analysis of the outcome of IABP use. From September 1994 to September 2007, 10,024 cardiosurgery operations were performed at the Department of Cardiac Surgery, University Hospital Hradec Králové, Czech Republic. IABP was applied in 363 cases (3.6%). Therapeutic indication for initiation of IABP at our department was the syndrome of low cardiac output in the postoperative period and during operation (difficulty in weaning from cardio-pulmonary bypass) and severe acute ischemic changes of myocardium refractory to pharmacotherapy. Prophylactic IABP was elective introduction of support before cardiac surgery in hemodynamically stable high risk patients. From the group of 363 counterpulsated patie...
Perfusion, 2010
Cardiotomy suction is used for preservation of autologous blood during on-pump cardiac surgery at... more Cardiotomy suction is used for preservation of autologous blood during on-pump cardiac surgery at present. Controversially, the exclusion of cardiotomy suction in some types of operations (coronary artery bypass surgery) is not necessarily associated with an increased transfusion requirement. On the other hand, the use of cardiotomy suction causes an amplification of systemic inflammatory response and a resulting coagulopathy, as well as exacerbation of the microembolic load and hemolysis. This leads to a tendency towards increased blood loss, transfusion requirement and organ dysfunction. On the basis of these facts, it is appropriate to reconsider routine use of cardiotomy suction in on-pump coronary artery surgery.
Perfusion, 2009
Current research is engaged in innovative technologies of extracorporeal circulation (ECC) system... more Current research is engaged in innovative technologies of extracorporeal circulation (ECC) systems in an effort to eliminate negative effects. Some studies have shown that, due to the complexity of technical settings of mini-ECC, they invoke a weaker immune response compared to classic ECC. The clinical benefits of using these systems have not been clearly proven yet. A group of 54 patients who were indicated for elective coronary surgery were randomised into two groups - Group A (patients operated on using classic ECC - open modification) and Group B (patients operated on using mini-ECC). The concentrations of IL-6, PMN elastase and MCP-1 in both groups were monitored per- and postoperatively, along with the postoperative clinical course. The groups did not differ in the basic pre- and peroperative characteristics. We recorded a lower priming for mini-ECC (p < 0.001) and significantly reduced hemodilution during ECC. There were no differences in the clinical outcome in either group. Serum concentrations of monitored markers of immune reaction towards ECC showed higher activity during standard ECC. New technologies used in mini-systems have proven to lower activation of the immune system, which can be monitored using kinetics of proinflammatory mediators. In spite of these comparable laboratory results, we did not find differences in short-term clinical results when comparing both these groups of low-risk patients.
Perfusion, 2009
The scavenger receptor for complexes hemoglobin-haptoglobin (CD163), which is expressed on monocy... more The scavenger receptor for complexes hemoglobin-haptoglobin (CD163), which is expressed on monocytes/ macrophages, is shed to the body fluids in a soluble form (sCD163). To evaluate the dynamics of sCD163 in the blood of patients undergoing cardiac surgery. Sixty-one adult patients who underwent coronary artery bypass grafting (CABG) were enrolled in the study. They were assigned to undergo CABG using either cardiopulmonary bypass (CPB), "on-pump", (22 patients), modified CPB, mini "on-pump", (17 patients) or without CPB, "off-pump", (22 patients) surgery. Serum levels of sCD163 in venous blood samples taken before and after surgery, and during an early postoperative period, were evaluated by Macro 163(TM) diagnostic kit (IQ Products, Groningen, NL). Compared to the preoperative levels ("on-pump"; 344 ng/mL, "off-pump"; 314.5 ng/mL, mini-invasive "on-pump"; 336.5 ng/mL) serum levels were elevated at the finish of surgery, reaching maximum at the 1(st) postoperative day ("onpump"; 658 ng/mL; p<0.05, "off-pump"; 810.5 ng/mL; p<0.01; mini-invasive "on-pump"; 663 ng/mL; non-significant).No significant differences regarding the serum levels of sCD163 between different surgical approaches were found. Serum level of sCD163 scavenger molecule for hemoglobin is elevated at the end of surgery and at the 1(st) postoperative day, being little influenced by cardiopulmonary bypass.
Perfusion, 2011
Regional hypoperfusion has been associated with the development of postoperative organ dysfunctio... more Regional hypoperfusion has been associated with the development of postoperative organ dysfunction in cardiac surgery involving cardiopulmonary bypass (CPB). Direct tissue oxymetry is a potentially new method for monitoring the quality of the peripheral tissue perfusion during CPB. The aim of this study was to assess the effects of CPB in skeletal muscle oxygenation when measured in the deltoid muscle by direct oxymetry during perioperative period. Seven patients underwent on-pump coronary artery bypass grafting. Direct oxymetry was performed by an optical cathether introduced into the deltoid muscle. Continuous measurement was made during the surgical procedure and the postoperative period. Mean arterial blood pressure, blood flow during CPB, laboratory markers of tissue hypoperfusion, blood gases and body temperature were also recorded. Interstitial muscle tissue oxygen tension (pO(2)) decreased after the introduction to anaesthesia and, more significantly, during CPB. After the disconnection from CPB at the end of the operation, the pO(2) returned to pre-anaesthetic values. During the first hours after admission of the patients to the intensive care unit, the pO(2) progressively decreased, reached a minimum value after four hours, and increased slowly thereafter. There was a significant correlation of pO(2) with mean arterial blood pressure and blood flow during that time. The result of this first measurement seems to demonstrate that the standard technique of conducting cardiopulmonary bypass produces low muscle oxygen tension and, thus, little perfusion of skeletal muscle. The data also indicate that both high mean arterial blood pressure and high flow are necessary during CPB to ensure skeletal muscle perfusion. The investigation is continuing.
Perfusion, 2010
Aims: Cardiac surgical operation is inseparably linked to the induction of an inflammatory respon... more Aims: Cardiac surgical operation is inseparably linked to the induction of an inflammatory response. Both humoral and cellular regulatory mechanisms are operating to maintain body homeostasis. We followed the changes in the expression of CD200/CD200R regulatory molecules on monocytes and granulocyte of cardiac surgical patients operated on using either standard (OP) or modified "mini-invasive" cardiopulmonary bypass (MOP). Methods: Expression of CD200/CD200R regulatory molecules was determined by flow cytometry. Results: The expression of CD200R on granulocytes was increased after surgery in both groups of patients, but the increase was statistically significant only in OP patients (p<0.01). At this time point, there was a significant difference in CD200R expression on granulocytes when comparing OP to MOP patients, being higher in the former group (p<0.01). The expression of CD200R on monocytes was diminished after surgery and during an early postoperative period in both groups of patients. The expression of CD200 on monocytes was significantly diminished after surgery in both groups (p<0.01). Nonetheless, we observed an increase in CD200 expression in OP patients at the 3 rd postoperative day. There was a statistically significantly increased CD200 expression on monocytes of OP patients (p<0.001) at the 3 rd postoperative day when we compared OP and MOP groups. The expression of CD200 on granulocytes was significantly higher after surgery and at the 3 rd postoperative day in OP when compared to MOP patients. Conclusions: CD200R expression on granulocytes was significantly increased, while CD200 and CD200R expression on monocytes was decreased after cardiac surgery.
Mediators of Inflammation, 2012
Interleukin-10 (IL-10) is considered to be a cytokine with potent anti-inflammatory properties, w... more Interleukin-10 (IL-10) is considered to be a cytokine with potent anti-inflammatory properties, which have been previously linked to increased incidence of sepsis. The level of IL-10 is elevated by cardiac surgery when cardiopulmonary bypass (CPB) and methylprednisolone are used. In our study, we compare the level of IL-10, IL-10 Receptor (IL-10R), and percentage of neutrophils between two groups of cardiac surgical patients undergoing Coronary Artery Bypass Grafting, both of which were not given methylprednisolone. The first group was operated with conventional CPB, while the second group was operated with minimally invasive CPB (mini-CPB). We detected enhanced level of IL-10 during surgery and at the end of surgery in both groups of patients. While no correlation between IL-10 and IL10R was found, IL-10 was positively correlated with increased percentage of neutrophils at the time points when the level of IL-10 peaked.
Biomedical Papers, 2013
Aim. The aim of this study was to compare the impact of standard cardiopulmonary bypass (CPB) wit... more Aim. The aim of this study was to compare the impact of standard cardiopulmonary bypass (CPB) with mini CPB on peripheral tissue perfusion. Methods. 24 patients with ischemic heart disease scheduled for CPB were randomised to two groups: Group A (12 patients, standard CPB) and Group B (12 patients, mini CPB). Oxygen tension was measured with an optical multiparametric sensor inserted into the patient's deltoid muscle. Results. Lower priming in Group B (870 ± 221 ml) vs. Group A (1502 ± 48 ml) and significantly reduced hemodilution during mini CPB (Group B 25.3 ± 1.1% vs. Group A 30.1 ± 2.3%) were recorded. Higher and continuous blood flow during perfusion was analysed in Group A (4.58 ± 0.34 l.min -1 ) and lower than calculated blood flow was found in Group B (3.49 ± 0.51 l.min -1 vs. 4.66 ± 0.38 l.min -1 ). There was a direct correlation between mean arterial pressure (MAP) and ptO 2 in Group A during CPB and a direct correlation between pump blood flow and MAP during CPB in Group B. Higher levels of ptO 2 during CPB and surgery after CPB in comparison with initial levels were found in Group B. Decreased ptO 2 levels after surgery were found in both groups. Conclusion. Mini CPB enables perfusion with a relatively low flow. The results of this study suggest that a flow decrease in mini CPB is well tolerated by the organism.
Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti
To evaluate the use of intra-aortic balloon pump (IABP) at the Department of Cardiac Surgery, Cha... more To evaluate the use of intra-aortic balloon pump (IABP) at the Department of Cardiac Surgery, Charles University, Faculty of Medicine in Hradec Králové, University Hospital Hradec Králové and identifying the complications of this method and their frequency in long-term follow-up. Retrospective analysis of the outcome of IABP use. From September 1994 to September 2007, 10,024 cardiosurgery operations were performed at the Department of Cardiac Surgery, University Hospital Hradec Králové, Czech Republic. IABP was applied in 363 cases (3.6%). Therapeutic indication for initiation of IABP at our department was the syndrome of low cardiac output in the postoperative period and during operation (difficulty in weaning from cardio-pulmonary bypass) and severe acute ischemic changes of myocardium refractory to pharmacotherapy. Prophylactic IABP was elective introduction of support before cardiac surgery in hemodynamically stable high risk patients. From the group of 363 counterpulsated patie...
Perfusion, 2010
Cardiotomy suction is used for preservation of autologous blood during on-pump cardiac surgery at... more Cardiotomy suction is used for preservation of autologous blood during on-pump cardiac surgery at present. Controversially, the exclusion of cardiotomy suction in some types of operations (coronary artery bypass surgery) is not necessarily associated with an increased transfusion requirement. On the other hand, the use of cardiotomy suction causes an amplification of systemic inflammatory response and a resulting coagulopathy, as well as exacerbation of the microembolic load and hemolysis. This leads to a tendency towards increased blood loss, transfusion requirement and organ dysfunction. On the basis of these facts, it is appropriate to reconsider routine use of cardiotomy suction in on-pump coronary artery surgery.
Perfusion, 2009
Current research is engaged in innovative technologies of extracorporeal circulation (ECC) system... more Current research is engaged in innovative technologies of extracorporeal circulation (ECC) systems in an effort to eliminate negative effects. Some studies have shown that, due to the complexity of technical settings of mini-ECC, they invoke a weaker immune response compared to classic ECC. The clinical benefits of using these systems have not been clearly proven yet. A group of 54 patients who were indicated for elective coronary surgery were randomised into two groups - Group A (patients operated on using classic ECC - open modification) and Group B (patients operated on using mini-ECC). The concentrations of IL-6, PMN elastase and MCP-1 in both groups were monitored per- and postoperatively, along with the postoperative clinical course. The groups did not differ in the basic pre- and peroperative characteristics. We recorded a lower priming for mini-ECC (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001) and significantly reduced hemodilution during ECC. There were no differences in the clinical outcome in either group. Serum concentrations of monitored markers of immune reaction towards ECC showed higher activity during standard ECC. New technologies used in mini-systems have proven to lower activation of the immune system, which can be monitored using kinetics of proinflammatory mediators. In spite of these comparable laboratory results, we did not find differences in short-term clinical results when comparing both these groups of low-risk patients.
Perfusion, 2009
The scavenger receptor for complexes hemoglobin-haptoglobin (CD163), which is expressed on monocy... more The scavenger receptor for complexes hemoglobin-haptoglobin (CD163), which is expressed on monocytes/ macrophages, is shed to the body fluids in a soluble form (sCD163). To evaluate the dynamics of sCD163 in the blood of patients undergoing cardiac surgery. Sixty-one adult patients who underwent coronary artery bypass grafting (CABG) were enrolled in the study. They were assigned to undergo CABG using either cardiopulmonary bypass (CPB), &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;on-pump&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;, (22 patients), modified CPB, mini &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;on-pump&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;, (17 patients) or without CPB, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;off-pump&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;, (22 patients) surgery. Serum levels of sCD163 in venous blood samples taken before and after surgery, and during an early postoperative period, were evaluated by Macro 163(TM) diagnostic kit (IQ Products, Groningen, NL). Compared to the preoperative levels (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;on-pump&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;; 344 ng/mL, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;off-pump&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;; 314.5 ng/mL, mini-invasive &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;on-pump&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;; 336.5 ng/mL) serum levels were elevated at the finish of surgery, reaching maximum at the 1(st) postoperative day (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;onpump&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;; 658 ng/mL; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05, &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;off-pump&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;; 810.5 ng/mL; p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01; mini-invasive &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;on-pump&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;; 663 ng/mL; non-significant).No significant differences regarding the serum levels of sCD163 between different surgical approaches were found. Serum level of sCD163 scavenger molecule for hemoglobin is elevated at the end of surgery and at the 1(st) postoperative day, being little influenced by cardiopulmonary bypass.
Perfusion, 2011
Regional hypoperfusion has been associated with the development of postoperative organ dysfunctio... more Regional hypoperfusion has been associated with the development of postoperative organ dysfunction in cardiac surgery involving cardiopulmonary bypass (CPB). Direct tissue oxymetry is a potentially new method for monitoring the quality of the peripheral tissue perfusion during CPB. The aim of this study was to assess the effects of CPB in skeletal muscle oxygenation when measured in the deltoid muscle by direct oxymetry during perioperative period. Seven patients underwent on-pump coronary artery bypass grafting. Direct oxymetry was performed by an optical cathether introduced into the deltoid muscle. Continuous measurement was made during the surgical procedure and the postoperative period. Mean arterial blood pressure, blood flow during CPB, laboratory markers of tissue hypoperfusion, blood gases and body temperature were also recorded. Interstitial muscle tissue oxygen tension (pO(2)) decreased after the introduction to anaesthesia and, more significantly, during CPB. After the disconnection from CPB at the end of the operation, the pO(2) returned to pre-anaesthetic values. During the first hours after admission of the patients to the intensive care unit, the pO(2) progressively decreased, reached a minimum value after four hours, and increased slowly thereafter. There was a significant correlation of pO(2) with mean arterial blood pressure and blood flow during that time. The result of this first measurement seems to demonstrate that the standard technique of conducting cardiopulmonary bypass produces low muscle oxygen tension and, thus, little perfusion of skeletal muscle. The data also indicate that both high mean arterial blood pressure and high flow are necessary during CPB to ensure skeletal muscle perfusion. The investigation is continuing.
Perfusion, 2010
Aims: Cardiac surgical operation is inseparably linked to the induction of an inflammatory respon... more Aims: Cardiac surgical operation is inseparably linked to the induction of an inflammatory response. Both humoral and cellular regulatory mechanisms are operating to maintain body homeostasis. We followed the changes in the expression of CD200/CD200R regulatory molecules on monocytes and granulocyte of cardiac surgical patients operated on using either standard (OP) or modified "mini-invasive" cardiopulmonary bypass (MOP). Methods: Expression of CD200/CD200R regulatory molecules was determined by flow cytometry. Results: The expression of CD200R on granulocytes was increased after surgery in both groups of patients, but the increase was statistically significant only in OP patients (p<0.01). At this time point, there was a significant difference in CD200R expression on granulocytes when comparing OP to MOP patients, being higher in the former group (p<0.01). The expression of CD200R on monocytes was diminished after surgery and during an early postoperative period in both groups of patients. The expression of CD200 on monocytes was significantly diminished after surgery in both groups (p<0.01). Nonetheless, we observed an increase in CD200 expression in OP patients at the 3 rd postoperative day. There was a statistically significantly increased CD200 expression on monocytes of OP patients (p<0.001) at the 3 rd postoperative day when we compared OP and MOP groups. The expression of CD200 on granulocytes was significantly higher after surgery and at the 3 rd postoperative day in OP when compared to MOP patients. Conclusions: CD200R expression on granulocytes was significantly increased, while CD200 and CD200R expression on monocytes was decreased after cardiac surgery.
Mediators of Inflammation, 2012
Interleukin-10 (IL-10) is considered to be a cytokine with potent anti-inflammatory properties, w... more Interleukin-10 (IL-10) is considered to be a cytokine with potent anti-inflammatory properties, which have been previously linked to increased incidence of sepsis. The level of IL-10 is elevated by cardiac surgery when cardiopulmonary bypass (CPB) and methylprednisolone are used. In our study, we compare the level of IL-10, IL-10 Receptor (IL-10R), and percentage of neutrophils between two groups of cardiac surgical patients undergoing Coronary Artery Bypass Grafting, both of which were not given methylprednisolone. The first group was operated with conventional CPB, while the second group was operated with minimally invasive CPB (mini-CPB). We detected enhanced level of IL-10 during surgery and at the end of surgery in both groups of patients. While no correlation between IL-10 and IL10R was found, IL-10 was positively correlated with increased percentage of neutrophils at the time points when the level of IL-10 peaked.
Biomedical Papers, 2013
Aim. The aim of this study was to compare the impact of standard cardiopulmonary bypass (CPB) wit... more Aim. The aim of this study was to compare the impact of standard cardiopulmonary bypass (CPB) with mini CPB on peripheral tissue perfusion. Methods. 24 patients with ischemic heart disease scheduled for CPB were randomised to two groups: Group A (12 patients, standard CPB) and Group B (12 patients, mini CPB). Oxygen tension was measured with an optical multiparametric sensor inserted into the patient's deltoid muscle. Results. Lower priming in Group B (870 ± 221 ml) vs. Group A (1502 ± 48 ml) and significantly reduced hemodilution during mini CPB (Group B 25.3 ± 1.1% vs. Group A 30.1 ± 2.3%) were recorded. Higher and continuous blood flow during perfusion was analysed in Group A (4.58 ± 0.34 l.min -1 ) and lower than calculated blood flow was found in Group B (3.49 ± 0.51 l.min -1 vs. 4.66 ± 0.38 l.min -1 ). There was a direct correlation between mean arterial pressure (MAP) and ptO 2 in Group A during CPB and a direct correlation between pump blood flow and MAP during CPB in Group B. Higher levels of ptO 2 during CPB and surgery after CPB in comparison with initial levels were found in Group B. Decreased ptO 2 levels after surgery were found in both groups. Conclusion. Mini CPB enables perfusion with a relatively low flow. The results of this study suggest that a flow decrease in mini CPB is well tolerated by the organism.