Maciej Brzezinski - Academia.edu (original) (raw)
Papers by Maciej Brzezinski
Background: Coexistent lower extremity ischaemia in patients suffering from coronary disease is a... more Background: Coexistent lower extremity ischaemia in patients suffering from coronary disease is a very important independent negative prognostic factor in operative outcome of coronary surgery. Not only symptomatic peripheral artery stenosis but also subclinical ischaemia can increase perioperative risk. The aim of the study was the analysis of the lower limb ischaemia incidence in patients undergoing coronary artery bypass grafting and the evaluation of its influence on early postoperative outcome.
Advances in Interventional Cardiology, 2018
Introduction: Renal denervation (RD) can lead to a significant and sustained decrease in mean val... more Introduction: Renal denervation (RD) can lead to a significant and sustained decrease in mean values of arterial blood pressure (BP). However, there is still a subset of patients without a significant BP drop after RD (non-responders). Aim: To compare characteristics of RD responders to RD non-responders and to identify the clinical predictors of BP reduction. Material and methods: Thirty-one patients with diagnosed resistant hypertension underwent RD. Three years after RD the analysis of BP reduction was performed in regard to the baseline patient characteristics. Results: After 3 years' follow-up a 10% or more reduction of systolic baseline BP was observed in 74% of patients. Ten percent or more reduction of diastolic baseline BP was observed in 71% of patients. Among responders we observed the following risk factors: hypercholesterolemia in 70%, body mass index (BMI) > 30 kg/m 2 in 55%, diabetes mellitus in 35%, current smoking in 5%. Comorbidity included coronary artery disease (CAD) in 30%, cardiomyopathy in 10%, chronic obstructive pulmonary disease (COPD) in 10%, renal insufficiency in 10%, and ventricular arrhythmia in 5%. Among non-responders we observed the following risk factors: hypercholesterolemia in 38%, diabetes mellitus type 2 in 38% and BMI > 30 kg/m 2 in 86%. Comorbidity included CAD in 50% and cardiomyopathy in 13% of patients. Conclusions: A 10% reduction of systolic baseline BP was observed in 74% of patients 3 years after renal denervation. Clinical factors like COPD, chronic kidney disease 3a, female sex and hypercholesterolemia increase the chances of effective reduction of BP.
Journal of Cardiovascular Electrophysiology, 2019
BackgroundLeft atrial appendage closure (LAAC) with LARIAT has emerged as one of the alternatives... more BackgroundLeft atrial appendage closure (LAAC) with LARIAT has emerged as one of the alternatives to oral anticoagulation (OAC) in patients with nonvalvular atrial fibrillation (AF). Our aim was to study long‐term outcomes in patients undergoing LARIAT procedure.MethodsWe analyzed patients screened for LARIAT device in four centers between December 2009 and June 2012. Out of these, patients who didn't undergo LAAC with the LARIAT device due to unfavorable LAA morphology and other preprocedural contraindications were included in control group. We analyzed thromboembolism, bleeding events, and mortality between LAA and control group.ResultsAbout 153 patients were screened. Out of these, 108 (70.6%) patients underwent LARIAT placement (LAA arm) and 45 (29.4%) excluded patients were included in control arm. There were no differences in CHADS2 and CHA2DS2‐VASc score. Mean HAS‐BLED score was significantly higher in the LARIAT group (3.5 ± 1.06 vs 3.09 ± 1.22, P = .04). Mean follow‐up ...
In Vivo, 2019
Background/Aim: Coagulopathy can develop when hemostatic dressings are used to stop massive bleed... more Background/Aim: Coagulopathy can develop when hemostatic dressings are used to stop massive bleeding, even in patients without prior history of clotting disorders. The selection of procoagulants, which effectively control bleeding and prevent disseminated intravascular coagulation (DIC) and thrombosis, is a significant challenge. The aim of this study was to evaluate the effect of two prototypes of haemostatic dressing in the porcine haemostatic system. Materials and Methods: The total number of animals used in our experiments was 24. Group I: pigs were treated with the developed prototype of sponge dressing, made of Na-Ca chitosan/algal composite of microfibers and nanofibers. Group II: animals were treated with a seton gauze modified with a polymer mixture of Na-Ca chitosan/algal composite of microfibers and nanofibers. Group III: animals were treated with non-hemostatic dressing and this group was the control. Blood was sampled five times to determine changes in the coagulation and fibrinolytic profiles: before injury: i) at 1 h, ii) at 24 h, iii) at 7, and iv) at 14 days following injury. Results: Significant changes were observed in the coagulation parameters, in the total numbers of white blood cells and platelets in groups I and II, compared to controls. Conclusion: The modified haemostatic dressings used in this study produced a strong procoagulant effect in pigs. This, together with high fibrinogen concentrations, which can cause DIC, require further studying.
In Vivo, 2019
Background/Aim: Haemostatic dressings for the uniformed and rescue services are an integral part ... more Background/Aim: Haemostatic dressings for the uniformed and rescue services are an integral part of lifesaving equipment for controlling post-traumatic haemorrhage. The aim of this study was to assess the influence of active constituent substances and materials of haemostatic dressings on muscle tissue and muscle regeneration after traumatic injury. Materials and Methods: Three hemostatic dressing prototypes were analysed: OBR/G/S sponge: dressing material sponge made of Na-Ca chitosan/algal composite microfibers and nanofibers; OBR/MBT/S: tactic gauze modified with a polymer mixture of Na-Ca chitosan/algal composite microfibers and nanofibers, impregnated with a moderate amount of procoagulants (22.9 g/m 2); and OBR/MS/S: seton gauze modified with a polymer mixture of Na-Ca chitosan/algal composite microfibers and nanofibers, impregnated with a moderate amount of procoagulants (18.0 g/m 2), with chitosan (ChitoClearhqg 95) and sodium alginate (Protanal LF10/60 FT) as the coagulants. The experiment was conducted on 20 pigs which were euthanised 24 h, 7 or 14 days after wound dressing. Samples of porcine muscle tissue were subjected to qualitative histopathological analysis. Results: Histopathological analysis of muscle tissues from the experimental pigs revealed that the application of modified seton (OBR/MS/S) produced the most satisfactory results. The observed changes were similar on all dates that samples were collected and in all experimental groups, and minor differences in their extent were observed between groups. Regenerative processes were most advanced, and retrograde changes were least apparent in animals treated with OBR/MS/S. Conclusion: Modified seton (OBR/MS/S) induced the least tissue reaction and was most effective in promoting tissue regeneration after injury.
Cardiology Journal, 2013
Background: Transcatheter aortic valve implantation (TAVI) has become a standard therapeutic opti... more Background: Transcatheter aortic valve implantation (TAVI) has become a standard therapeutic option for patients with severe aortic stenosis (AS) at high cardiac surgical risk. The aim of the NAUTILUS study was to investigate the safety and performance of the New Valve Technology (NVT) Allegra bioprosthesis in high-risk patients undergoing TAVI. Methods: 27 patients with severe, symptomatic AS at high surgical risk were prospectively enrolled, who underwent treatment using the novel self-expanding NVT Allegra bioprosthesis via transfemoral approach (TF-TAVI). The primary end-point was all-cause mortality at 30 days. Results: Patients were elderly (83 years, range 75-89 years), and predominantly female (70.4%, n = 19). All patients were deemed to be at high surgical risk, with a mean logistic EuroSCORE of 12.4% (range, 2.8-31.8%). The bioprosthesis was successfully implanted in 96% of the cases (n = 25). The echocardiographic assessment confirmed good hemodynamic profile after implantation of the NVT Allegra bioprosthesis. Complications included cardiac tamponade (4%, n = 1) and the need for permanent pacemaker implantation (8%, n = 2). The analysis of procedural aspects showed a short learning effect related to the precise placement of the valve. A significant improvement in clinical symptoms were observed, and no patients died in-hospital or within 30 days of post-discharge observation. Conclusions: This prospective observation shows that the NVT Allegra bioprosthesis was associated with a satisfactory safety profile and a remarkable hemodynamic performance after implantation.
Polish Journal of Cardio-Thoracic Surgery, 2018
Introduction: Aortic valve replacement (AVR) is the gold standard in treating symptomatic aortic ... more Introduction: Aortic valve replacement (AVR) is the gold standard in treating symptomatic aortic valve defects. To improve the healing process and limit the trauma, the minimally invasive approach was introduced. Aim: To compare the peri-and post-operative results of aortic valve replacement performed via conventional full sternotomy (con-AVR) and of AVR performed via partial upper sternotomy (mini-AVR). Material and methods: The total study population was divided into 2 demographically homogeneous groups: mini-AVR (n = 74) and con-AVR (n = 76). There were no statistically significant differences in preoperative echocardiography. Results: Aortic cross-clamp time and cardiopulmonary bypass time were significantly longer in the mini-AVR group. Shorter mechanical ventilation time, hospital stay and lower postoperative drainage were observed in the mini-AVR group (p < 0.05). Biological prostheses were more frequently implanted in the mini-AVR group (p < 0.05). Patients from the mini-AVR group reported less postoperative pain. No significant differences were found in the diameter of the implanted aortic prosthesis, the amount of inotropic agents and painkillers, postoperative left ventricular ejection fraction (LVEF), medium and maximum transvalvular gradient or the number of transfused blood units. There were no differences in the frequency of postoperative complications such as mortality, stroke, atrial fibrillation, renal failure, wound infection, sternal instability, or the need for rethoracotomy. Conclusions: Ministernotomy for AVR is a safe method and does not increase morbidity and mortality. It significantly reduces post-operative blood loss and shortens hospital stay. Ministernotomy can be successfully used as an alternative method to sternotomy.
Journal of Thoracic Disease, 2018
Background: Aortic stenosis (AS) is the most common valve disease in the adult population and its... more Background: Aortic stenosis (AS) is the most common valve disease in the adult population and its prevalence increases with age. Unfortunately, older age and comorbidities significantly increase mortality, operative risk and worsen prognosis. In recent years, sutureless bioprosthesis [sutureless-aortic valve replacement (SU-AVR)] has become an alternative to standard AVR or TAVI in high-risk patients. Compared to standard AVR, the advantages of SU-AVR include shorter valve implantation, shorter aortic cross clamp (ACC) and cardiopulmonary bypass (CPB) times and higher valve EOA with more favorable hemodynamic parameters. Good early clinical and hemodynamic outcomes have been reported in several studies. However, although early SU-AVR results reported in the literature are encouraging, there are few results of long term follow-up. The aim of this study is to present long term echocardiographic hemodynamic outcomes of the Enable sutureless bioprosthesis. Methods: The first human implantation of the Enable sutureless bioprosthesis was performed on the 13th January, 2005 by the authors of this manuscript. From that time until July 2008, 25 patients underwent isolated SU-AVR implantation. The median preoperative logistic EuroSCORE was 1.92±0.17 [standard deviation (SD)] and the STS score was 2.96±2.73. Preoperatively, 65.4% of patients were in NYHA class III or IV, the peak/mean gradient transaortic gradient was 84.6/52.1 mmHg. Results: After the SU-AVR procedure, the average peak/mean aortic gradients were respectively:
Acta biochimica Polonica, 2018
There is increasing evidence that genetic variability influences patients' early morbidity af... more There is increasing evidence that genetic variability influences patients' early morbidity after cardiac surgery performed using cardiopulmonary bypass (CPB). The use of mortality as an outcome measure in cardiac surgical genetic association studies is rare. We publish the 30-day and 5-year survival analyses with focus on pre-, intra-, postoperative variables, biochemical parameters, and genetic variants in the INFLACOR (INFLAmmation in Cardiac OpeRations) cohort. In a prospectively recruited cohort of 518 adult Polish Caucasians, who underwent cardiac surgery in which CPB was used, the clinical data, biochemical parameters, IL-6, soluble ICAM-1, TNFα, soluble E-selectin, and 10 single nucleotide polymorphisms were evaluated for their association with 30-day and 5-year mortality. The 30-day mortality was associated with: pre-operative prothrombin international normalized ratio, intra-operative blood lactate, postoperative serum creatine phosphokinase, and acute kidney injury req...
Kwartalnik Historyczny, 2011
W dniu 1 października 2010 r. zmarł jeden z najwybitniejszych polskich mediewistów-Gerard Labuda.... more W dniu 1 października 2010 r. zmarł jeden z najwybitniejszych polskich mediewistów-Gerard Labuda. Urodził się 28 grudnia 1916 r. w Nowejhucie, niedaleko Kartuz, w rodzinie kaszubskiej, jako syn Stanisława i Anastazji z Baranowskich. Jego pierwszymi nauczycielami-jak sam pisał w swoich wspomnieniach-byli rodzice: "nauczyła mnie pisać moja Mama, i to od razu pięknym, kaligraficznym pismem gotyckim-bo tego nauczyła ją pruska szkoładając mi do przepisywania fragmenty niemieckiej książki kucharskiej; była bardzo wymagająca [-] Do czytania i pisania w latach późniejszych sposobił mnie mój Ojciec, który wszystkim sąsiadom bliższym i dalszym doradzał w sprawach sądowych i polubownych, zabierał głos na posiedzeniach gminnych i powiatowych, a ja pod jego dyktando pisałem odwołania, zażalenia, skargi i petycje" 1. Gdy w ósmym roku życia zaczął uczęszczać do czteroklasowej szkoły, umiał już pisać i czytać płynnie po niemiecku i polsku. Wybitne zdolności nie uszły uwagi nauczycieli w Luzinie. Po miesiącu przenieśli nowego ucznia z klasy pierwszej do drugiej, a po kilku tygodniach do klasy trzeciej. W tej klasie-jak sam wspominał-nauczył się poprawnego czytania i pisania po polsku: "język polski znany był mi tylko z kazań w kościele i z książki do nabożeństwa, gdyż każde słowo czytałem i wymawiałem po kaszubsku, a moja ortografia odbiegała mocno od prawideł polskiej pisowni" 2. W szkole powszechnej-jak sam pisze-był głównie samoukiem. Czytał właściwie wszystko, co wpadło Mu w ręce, począwszy od gazet, kalendarzy mariańskich i Żywotów Świętych Piotra Skargi, aż po poważniejsze lektury z Henrykiem Sienkiewiczem włącznie 3. W drodze do szkoły odwiedzał codziennie Feliksa Dampca 4 , który dostarczał Mu liczne lektury polskie. Przeczytał też cały księgozbiór miejscowego oddziału Towarzystwa Czytelni Ludowych. W 1928 r., po ukończeniu przez Gerarda Labudę szkoły powszechnej, nauczyciel Walerian Meier przekonał jego rodziców, że powinien On ze względu
Studia z Dziejów Rosji i Europy Środkowo-Wschodniej, 2013
Narodów na rzecz wsparcia życia intelektualnego w krajach Europy Środkowej i Wschodniej dotknięty... more Narodów na rzecz wsparcia życia intelektualnego w krajach Europy Środkowej i Wschodniej dotkniętych najdotkliwiej skutkami I wojny światowej. Ukazuje motywy i efekty aktywności profesora, wybitnego znawcy dziejów regionu środkowoeuropejskiego, w nawiązaniu i pogłębianiu współpracy intelektualnej krajów Europy Środkowej i Wschodniej z państwami zachodnimi. Zawiera charakterystykę koncepcji i metod działania Oskara Haleckiego służących temu celowi.
Postȩpy higieny i medycyny doświadczalnej, 2003
Adiponectin is an adipocyte-specific secretory protein, which seems to play a protective role in ... more Adiponectin is an adipocyte-specific secretory protein, which seems to play a protective role in different models of vascular injury. Adiponectin infiltrates in the subendothelial space of injured vascular walls and suppresses the expression of adhesion molecules on endothelial cells, thus inhibiting the inflammatory processes that occur during the early phases of atherosclerosis. Adiponectin also suppresses lipid accumulation in macrophages and macrophage-to-foam cell transformation. The ability of adiponectin to act as an anti-inflammatory and anti-atherogenic factor has made this novel adipocytokine a promising therapeutic tool for the future.
Folia cardiologica, Jan 28, 1954
Polish Journal of Surgery, 2007
The aim of the study was to evaluate the usefulness of continuous monitoring of regional cerebral... more The aim of the study was to evaluate the usefulness of continuous monitoring of regional cerebral oxygen saturation (rSO 2) for detection of brain ischemia during carotid endarterectomy. Material and methods. We performed 44 carotid endarterectomies using regional anesthesia, with simultaneous regional cerebral oxygen saturation monitoring in both hemispheres of the brain. Results. Oxygen saturation in the hemisphere ipsilateral to the operated carotid artery dropped from 65.1±8.1 to 58.2±10.7 after carotid artery cross-clamping. The difference was statistically significant (p<0.005). Oxygen saturation in the hemisphere contralateral to the operated artery did not demonstrate a difference between that before or after carotid artery closure (65.7±9.2 and 66.1±10.2, respectively, p=0.1). In five patients (11.4%) carotid artery clamping was associated with the appearance of neurological deficits. Shunt usage was necessary in four cases; the rSO 2 decreased by 19.2±14% in this group. In the group without neurological deficit during carotid clamping, the rSO 2 decreased by 9.7±10.3% (the difference between groups with and without neurological deficit was not statistically significant, p=0.5). In patients with a rSO 2 drop above 20%, the sensitivity of the cerebral oximetry was 20% and specificity 97.5%, while the negative predictive value was 90.7%. Conclusions. Continuous cerebral oximetry is a simple and non-invasive method of patient monitoring during carotid endarterectomy. The rSO 2 decreases significantly after the ICA clamping. The sensitivity of cerebral oximetry in prediction of neurological deficit during the procedure is low. Defining the threshold value of rSO 2 decrease after ICA clamping as an indication for shunt was not possible with the results of this study.
Polski przeglad chirurgiczny, 2014
The study presented a case of a 58-year-old male patient treated for retroperitoneal fibrosis, ri... more The study presented a case of a 58-year-old male patient treated for retroperitoneal fibrosis, right hydronephrosis, and right common iliac artery stenosis and saccular aneurysm of the above-mentioned vessel. The patient was qualified for endovascular treatment. Stentgraft implantation was performed with good long-term patency during more than 3 years of follow-up. Complete relief of intermittent claudication was observed. However, the endovascular exclusion of the aneurysm did not influence the course of retroperitoneal fibrosis.
Journal of the American Society of Echocardiography, 2010
Background: Aortic stenosis leads to left ventricular hypertrophy and accumulation of fibrillar c... more Background: Aortic stenosis leads to left ventricular hypertrophy and accumulation of fibrillar collagens. The analysis of integrated backscatter (IBS) parameters provides information on ultrasonic myocardial properties. Methods: The study population consisted of 58 patients with aortic stenosis. They were followed up for an average 18 6 5 months after aortic valve replacement (AVR). Traditional transthoracic echocardiography and analysis of IBS reflectivity were performed before AVR and during the control visit after AVR. Results: A significant reduction in left ventricular mass index, a significant increase in the mean cyclic variation of IBS, and a decrease in absolute end-diastolic IBS intensity were observed after AVR. Conclusions: These data suggest improvements in ultrasonic myocardial properties after AVR. Preoperative analysis of IBS parameters might provide additional information for predicting left ventricular reverse remodeling in patients a mean of 1.5 years after AVR for aortic stenosis.
Folia Cardiologica …, 2004
Background: Coexistent lower extremity ischaemia in patients suffering from coronary disease is a... more Background: Coexistent lower extremity ischaemia in patients suffering from coronary disease is a very important independent negative prognostic factor in operative outcome of coronary surgery. Not only symptomatic peripheral artery stenosis but also subclinical ischaemia can increase perioperative risk. The aim of the study was the analysis of the lower limb ischaemia incidence in patients undergoing coronary artery bypass grafting and the evaluation of its influence on early postoperative outcome. Material and methods: In 125 patients qualified for coronary surgery, ankle-brachial index (ABI) was measured. In this group, there were 95 men and 30 women. Patients with ABI £ 0.9 were classified to the first group (group I) and the rest to the second one (group II). Results: Out of 125 patients, 7 (5.6%) had symptoms of lower limb ischaemia. ABI £ 0.9 was found in 32 (25.6%) patients. In this group, 25 (78.2%) had no symptoms. Statistically significant differences between the groups were reported. In group I, higher incidence of perioperative infarction (p = 0.04), low output syndrome (p = 0.02), atrial fibrillation (p = = 0.01), sternal infection (p = 0.03) was found. Conclusions: Lower limb ischaemia was found in 25.6% of patients undergoing coronary surgery of whom 78,2% were asymptomatic. Peripheral vascular disease significantly increases number of postoperative complications in patients undergoing coronary artery bypass grafting. (Folia Cardiol. 2004; 11: 293-298) coronary artery bypass grafting, lower limb ischemia Wstęp Choroba niedokrwienna serca jest obecnie jednym z najpoważniejszych problemów zdrowotnych na całym świecie, a w krajach wysoko rozwiniętych jest główną przyczyną zgonów. W Polsce szacuje się, że liczba ostrych zespołów wieńcowych wynosi około 250 000 rocznie [1]. Wśród pacjentów z udokumentowaną chorobą wieńcową ok. 16-20% cierpi na chorobę niedokrwienną kończyn dolnych. U około 5% mężczyzn i 2,5% kobiet powyżej 60 rż. występują objawy niedokrwienia kończyn dolnych pod postacią chromania przestankowego. Liczby te okazują się co najmniej 3-krotnie wyższe, jeśli do diagnostyki niewydolności krążenia obwodowego użyje się nieinwazyjnych testów [2-4]. U około 50% osób przyjmowanych do szpitala z powodu zaburzeń ukrwienia kończyn dolnych występują ob-brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by Via Medica Journals
Current Problems in Cardiology, 2012
Atrial fibrillation (AF) remains the most common arrhythmia encountered in clinical practice. One... more Atrial fibrillation (AF) remains the most common arrhythmia encountered in clinical practice. One of its most devastating complication is the development of thromboembolism leading to stroke. The left atrial appendage (LAA) has been shown to be the site of thrombus formation in the majority of strokes associated with AF. Anticoagulation with warfarin has been the treatment of choice for prevention of embolic events in these patients, but it does have significant limitations including bleeding, need for continued follow-up blood tests, and drug-drug interactions. Although newer anticoagulants have been developed, they still have the potential side effect of causing significant bleeding. Closure or exclusion of the LAA has emerged as an alternative therapeutic approach to medical therapy. The aim of this article is to review the anatomy and physiology of the LAA, discuss the various treatment strategies for stroke prevention, review the current devices and technologies available for LAA occlusion, and discuss some of the more recent data available on these technologies.
Background: Coexistent lower extremity ischaemia in patients suffering from coronary disease is a... more Background: Coexistent lower extremity ischaemia in patients suffering from coronary disease is a very important independent negative prognostic factor in operative outcome of coronary surgery. Not only symptomatic peripheral artery stenosis but also subclinical ischaemia can increase perioperative risk. The aim of the study was the analysis of the lower limb ischaemia incidence in patients undergoing coronary artery bypass grafting and the evaluation of its influence on early postoperative outcome.
Advances in Interventional Cardiology, 2018
Introduction: Renal denervation (RD) can lead to a significant and sustained decrease in mean val... more Introduction: Renal denervation (RD) can lead to a significant and sustained decrease in mean values of arterial blood pressure (BP). However, there is still a subset of patients without a significant BP drop after RD (non-responders). Aim: To compare characteristics of RD responders to RD non-responders and to identify the clinical predictors of BP reduction. Material and methods: Thirty-one patients with diagnosed resistant hypertension underwent RD. Three years after RD the analysis of BP reduction was performed in regard to the baseline patient characteristics. Results: After 3 years' follow-up a 10% or more reduction of systolic baseline BP was observed in 74% of patients. Ten percent or more reduction of diastolic baseline BP was observed in 71% of patients. Among responders we observed the following risk factors: hypercholesterolemia in 70%, body mass index (BMI) > 30 kg/m 2 in 55%, diabetes mellitus in 35%, current smoking in 5%. Comorbidity included coronary artery disease (CAD) in 30%, cardiomyopathy in 10%, chronic obstructive pulmonary disease (COPD) in 10%, renal insufficiency in 10%, and ventricular arrhythmia in 5%. Among non-responders we observed the following risk factors: hypercholesterolemia in 38%, diabetes mellitus type 2 in 38% and BMI > 30 kg/m 2 in 86%. Comorbidity included CAD in 50% and cardiomyopathy in 13% of patients. Conclusions: A 10% reduction of systolic baseline BP was observed in 74% of patients 3 years after renal denervation. Clinical factors like COPD, chronic kidney disease 3a, female sex and hypercholesterolemia increase the chances of effective reduction of BP.
Journal of Cardiovascular Electrophysiology, 2019
BackgroundLeft atrial appendage closure (LAAC) with LARIAT has emerged as one of the alternatives... more BackgroundLeft atrial appendage closure (LAAC) with LARIAT has emerged as one of the alternatives to oral anticoagulation (OAC) in patients with nonvalvular atrial fibrillation (AF). Our aim was to study long‐term outcomes in patients undergoing LARIAT procedure.MethodsWe analyzed patients screened for LARIAT device in four centers between December 2009 and June 2012. Out of these, patients who didn't undergo LAAC with the LARIAT device due to unfavorable LAA morphology and other preprocedural contraindications were included in control group. We analyzed thromboembolism, bleeding events, and mortality between LAA and control group.ResultsAbout 153 patients were screened. Out of these, 108 (70.6%) patients underwent LARIAT placement (LAA arm) and 45 (29.4%) excluded patients were included in control arm. There were no differences in CHADS2 and CHA2DS2‐VASc score. Mean HAS‐BLED score was significantly higher in the LARIAT group (3.5 ± 1.06 vs 3.09 ± 1.22, P = .04). Mean follow‐up ...
In Vivo, 2019
Background/Aim: Coagulopathy can develop when hemostatic dressings are used to stop massive bleed... more Background/Aim: Coagulopathy can develop when hemostatic dressings are used to stop massive bleeding, even in patients without prior history of clotting disorders. The selection of procoagulants, which effectively control bleeding and prevent disseminated intravascular coagulation (DIC) and thrombosis, is a significant challenge. The aim of this study was to evaluate the effect of two prototypes of haemostatic dressing in the porcine haemostatic system. Materials and Methods: The total number of animals used in our experiments was 24. Group I: pigs were treated with the developed prototype of sponge dressing, made of Na-Ca chitosan/algal composite of microfibers and nanofibers. Group II: animals were treated with a seton gauze modified with a polymer mixture of Na-Ca chitosan/algal composite of microfibers and nanofibers. Group III: animals were treated with non-hemostatic dressing and this group was the control. Blood was sampled five times to determine changes in the coagulation and fibrinolytic profiles: before injury: i) at 1 h, ii) at 24 h, iii) at 7, and iv) at 14 days following injury. Results: Significant changes were observed in the coagulation parameters, in the total numbers of white blood cells and platelets in groups I and II, compared to controls. Conclusion: The modified haemostatic dressings used in this study produced a strong procoagulant effect in pigs. This, together with high fibrinogen concentrations, which can cause DIC, require further studying.
In Vivo, 2019
Background/Aim: Haemostatic dressings for the uniformed and rescue services are an integral part ... more Background/Aim: Haemostatic dressings for the uniformed and rescue services are an integral part of lifesaving equipment for controlling post-traumatic haemorrhage. The aim of this study was to assess the influence of active constituent substances and materials of haemostatic dressings on muscle tissue and muscle regeneration after traumatic injury. Materials and Methods: Three hemostatic dressing prototypes were analysed: OBR/G/S sponge: dressing material sponge made of Na-Ca chitosan/algal composite microfibers and nanofibers; OBR/MBT/S: tactic gauze modified with a polymer mixture of Na-Ca chitosan/algal composite microfibers and nanofibers, impregnated with a moderate amount of procoagulants (22.9 g/m 2); and OBR/MS/S: seton gauze modified with a polymer mixture of Na-Ca chitosan/algal composite microfibers and nanofibers, impregnated with a moderate amount of procoagulants (18.0 g/m 2), with chitosan (ChitoClearhqg 95) and sodium alginate (Protanal LF10/60 FT) as the coagulants. The experiment was conducted on 20 pigs which were euthanised 24 h, 7 or 14 days after wound dressing. Samples of porcine muscle tissue were subjected to qualitative histopathological analysis. Results: Histopathological analysis of muscle tissues from the experimental pigs revealed that the application of modified seton (OBR/MS/S) produced the most satisfactory results. The observed changes were similar on all dates that samples were collected and in all experimental groups, and minor differences in their extent were observed between groups. Regenerative processes were most advanced, and retrograde changes were least apparent in animals treated with OBR/MS/S. Conclusion: Modified seton (OBR/MS/S) induced the least tissue reaction and was most effective in promoting tissue regeneration after injury.
Cardiology Journal, 2013
Background: Transcatheter aortic valve implantation (TAVI) has become a standard therapeutic opti... more Background: Transcatheter aortic valve implantation (TAVI) has become a standard therapeutic option for patients with severe aortic stenosis (AS) at high cardiac surgical risk. The aim of the NAUTILUS study was to investigate the safety and performance of the New Valve Technology (NVT) Allegra bioprosthesis in high-risk patients undergoing TAVI. Methods: 27 patients with severe, symptomatic AS at high surgical risk were prospectively enrolled, who underwent treatment using the novel self-expanding NVT Allegra bioprosthesis via transfemoral approach (TF-TAVI). The primary end-point was all-cause mortality at 30 days. Results: Patients were elderly (83 years, range 75-89 years), and predominantly female (70.4%, n = 19). All patients were deemed to be at high surgical risk, with a mean logistic EuroSCORE of 12.4% (range, 2.8-31.8%). The bioprosthesis was successfully implanted in 96% of the cases (n = 25). The echocardiographic assessment confirmed good hemodynamic profile after implantation of the NVT Allegra bioprosthesis. Complications included cardiac tamponade (4%, n = 1) and the need for permanent pacemaker implantation (8%, n = 2). The analysis of procedural aspects showed a short learning effect related to the precise placement of the valve. A significant improvement in clinical symptoms were observed, and no patients died in-hospital or within 30 days of post-discharge observation. Conclusions: This prospective observation shows that the NVT Allegra bioprosthesis was associated with a satisfactory safety profile and a remarkable hemodynamic performance after implantation.
Polish Journal of Cardio-Thoracic Surgery, 2018
Introduction: Aortic valve replacement (AVR) is the gold standard in treating symptomatic aortic ... more Introduction: Aortic valve replacement (AVR) is the gold standard in treating symptomatic aortic valve defects. To improve the healing process and limit the trauma, the minimally invasive approach was introduced. Aim: To compare the peri-and post-operative results of aortic valve replacement performed via conventional full sternotomy (con-AVR) and of AVR performed via partial upper sternotomy (mini-AVR). Material and methods: The total study population was divided into 2 demographically homogeneous groups: mini-AVR (n = 74) and con-AVR (n = 76). There were no statistically significant differences in preoperative echocardiography. Results: Aortic cross-clamp time and cardiopulmonary bypass time were significantly longer in the mini-AVR group. Shorter mechanical ventilation time, hospital stay and lower postoperative drainage were observed in the mini-AVR group (p < 0.05). Biological prostheses were more frequently implanted in the mini-AVR group (p < 0.05). Patients from the mini-AVR group reported less postoperative pain. No significant differences were found in the diameter of the implanted aortic prosthesis, the amount of inotropic agents and painkillers, postoperative left ventricular ejection fraction (LVEF), medium and maximum transvalvular gradient or the number of transfused blood units. There were no differences in the frequency of postoperative complications such as mortality, stroke, atrial fibrillation, renal failure, wound infection, sternal instability, or the need for rethoracotomy. Conclusions: Ministernotomy for AVR is a safe method and does not increase morbidity and mortality. It significantly reduces post-operative blood loss and shortens hospital stay. Ministernotomy can be successfully used as an alternative method to sternotomy.
Journal of Thoracic Disease, 2018
Background: Aortic stenosis (AS) is the most common valve disease in the adult population and its... more Background: Aortic stenosis (AS) is the most common valve disease in the adult population and its prevalence increases with age. Unfortunately, older age and comorbidities significantly increase mortality, operative risk and worsen prognosis. In recent years, sutureless bioprosthesis [sutureless-aortic valve replacement (SU-AVR)] has become an alternative to standard AVR or TAVI in high-risk patients. Compared to standard AVR, the advantages of SU-AVR include shorter valve implantation, shorter aortic cross clamp (ACC) and cardiopulmonary bypass (CPB) times and higher valve EOA with more favorable hemodynamic parameters. Good early clinical and hemodynamic outcomes have been reported in several studies. However, although early SU-AVR results reported in the literature are encouraging, there are few results of long term follow-up. The aim of this study is to present long term echocardiographic hemodynamic outcomes of the Enable sutureless bioprosthesis. Methods: The first human implantation of the Enable sutureless bioprosthesis was performed on the 13th January, 2005 by the authors of this manuscript. From that time until July 2008, 25 patients underwent isolated SU-AVR implantation. The median preoperative logistic EuroSCORE was 1.92±0.17 [standard deviation (SD)] and the STS score was 2.96±2.73. Preoperatively, 65.4% of patients were in NYHA class III or IV, the peak/mean gradient transaortic gradient was 84.6/52.1 mmHg. Results: After the SU-AVR procedure, the average peak/mean aortic gradients were respectively:
Acta biochimica Polonica, 2018
There is increasing evidence that genetic variability influences patients' early morbidity af... more There is increasing evidence that genetic variability influences patients' early morbidity after cardiac surgery performed using cardiopulmonary bypass (CPB). The use of mortality as an outcome measure in cardiac surgical genetic association studies is rare. We publish the 30-day and 5-year survival analyses with focus on pre-, intra-, postoperative variables, biochemical parameters, and genetic variants in the INFLACOR (INFLAmmation in Cardiac OpeRations) cohort. In a prospectively recruited cohort of 518 adult Polish Caucasians, who underwent cardiac surgery in which CPB was used, the clinical data, biochemical parameters, IL-6, soluble ICAM-1, TNFα, soluble E-selectin, and 10 single nucleotide polymorphisms were evaluated for their association with 30-day and 5-year mortality. The 30-day mortality was associated with: pre-operative prothrombin international normalized ratio, intra-operative blood lactate, postoperative serum creatine phosphokinase, and acute kidney injury req...
Kwartalnik Historyczny, 2011
W dniu 1 października 2010 r. zmarł jeden z najwybitniejszych polskich mediewistów-Gerard Labuda.... more W dniu 1 października 2010 r. zmarł jeden z najwybitniejszych polskich mediewistów-Gerard Labuda. Urodził się 28 grudnia 1916 r. w Nowejhucie, niedaleko Kartuz, w rodzinie kaszubskiej, jako syn Stanisława i Anastazji z Baranowskich. Jego pierwszymi nauczycielami-jak sam pisał w swoich wspomnieniach-byli rodzice: "nauczyła mnie pisać moja Mama, i to od razu pięknym, kaligraficznym pismem gotyckim-bo tego nauczyła ją pruska szkoładając mi do przepisywania fragmenty niemieckiej książki kucharskiej; była bardzo wymagająca [-] Do czytania i pisania w latach późniejszych sposobił mnie mój Ojciec, który wszystkim sąsiadom bliższym i dalszym doradzał w sprawach sądowych i polubownych, zabierał głos na posiedzeniach gminnych i powiatowych, a ja pod jego dyktando pisałem odwołania, zażalenia, skargi i petycje" 1. Gdy w ósmym roku życia zaczął uczęszczać do czteroklasowej szkoły, umiał już pisać i czytać płynnie po niemiecku i polsku. Wybitne zdolności nie uszły uwagi nauczycieli w Luzinie. Po miesiącu przenieśli nowego ucznia z klasy pierwszej do drugiej, a po kilku tygodniach do klasy trzeciej. W tej klasie-jak sam wspominał-nauczył się poprawnego czytania i pisania po polsku: "język polski znany był mi tylko z kazań w kościele i z książki do nabożeństwa, gdyż każde słowo czytałem i wymawiałem po kaszubsku, a moja ortografia odbiegała mocno od prawideł polskiej pisowni" 2. W szkole powszechnej-jak sam pisze-był głównie samoukiem. Czytał właściwie wszystko, co wpadło Mu w ręce, począwszy od gazet, kalendarzy mariańskich i Żywotów Świętych Piotra Skargi, aż po poważniejsze lektury z Henrykiem Sienkiewiczem włącznie 3. W drodze do szkoły odwiedzał codziennie Feliksa Dampca 4 , który dostarczał Mu liczne lektury polskie. Przeczytał też cały księgozbiór miejscowego oddziału Towarzystwa Czytelni Ludowych. W 1928 r., po ukończeniu przez Gerarda Labudę szkoły powszechnej, nauczyciel Walerian Meier przekonał jego rodziców, że powinien On ze względu
Studia z Dziejów Rosji i Europy Środkowo-Wschodniej, 2013
Narodów na rzecz wsparcia życia intelektualnego w krajach Europy Środkowej i Wschodniej dotknięty... more Narodów na rzecz wsparcia życia intelektualnego w krajach Europy Środkowej i Wschodniej dotkniętych najdotkliwiej skutkami I wojny światowej. Ukazuje motywy i efekty aktywności profesora, wybitnego znawcy dziejów regionu środkowoeuropejskiego, w nawiązaniu i pogłębianiu współpracy intelektualnej krajów Europy Środkowej i Wschodniej z państwami zachodnimi. Zawiera charakterystykę koncepcji i metod działania Oskara Haleckiego służących temu celowi.
Postȩpy higieny i medycyny doświadczalnej, 2003
Adiponectin is an adipocyte-specific secretory protein, which seems to play a protective role in ... more Adiponectin is an adipocyte-specific secretory protein, which seems to play a protective role in different models of vascular injury. Adiponectin infiltrates in the subendothelial space of injured vascular walls and suppresses the expression of adhesion molecules on endothelial cells, thus inhibiting the inflammatory processes that occur during the early phases of atherosclerosis. Adiponectin also suppresses lipid accumulation in macrophages and macrophage-to-foam cell transformation. The ability of adiponectin to act as an anti-inflammatory and anti-atherogenic factor has made this novel adipocytokine a promising therapeutic tool for the future.
Folia cardiologica, Jan 28, 1954
Polish Journal of Surgery, 2007
The aim of the study was to evaluate the usefulness of continuous monitoring of regional cerebral... more The aim of the study was to evaluate the usefulness of continuous monitoring of regional cerebral oxygen saturation (rSO 2) for detection of brain ischemia during carotid endarterectomy. Material and methods. We performed 44 carotid endarterectomies using regional anesthesia, with simultaneous regional cerebral oxygen saturation monitoring in both hemispheres of the brain. Results. Oxygen saturation in the hemisphere ipsilateral to the operated carotid artery dropped from 65.1±8.1 to 58.2±10.7 after carotid artery cross-clamping. The difference was statistically significant (p<0.005). Oxygen saturation in the hemisphere contralateral to the operated artery did not demonstrate a difference between that before or after carotid artery closure (65.7±9.2 and 66.1±10.2, respectively, p=0.1). In five patients (11.4%) carotid artery clamping was associated with the appearance of neurological deficits. Shunt usage was necessary in four cases; the rSO 2 decreased by 19.2±14% in this group. In the group without neurological deficit during carotid clamping, the rSO 2 decreased by 9.7±10.3% (the difference between groups with and without neurological deficit was not statistically significant, p=0.5). In patients with a rSO 2 drop above 20%, the sensitivity of the cerebral oximetry was 20% and specificity 97.5%, while the negative predictive value was 90.7%. Conclusions. Continuous cerebral oximetry is a simple and non-invasive method of patient monitoring during carotid endarterectomy. The rSO 2 decreases significantly after the ICA clamping. The sensitivity of cerebral oximetry in prediction of neurological deficit during the procedure is low. Defining the threshold value of rSO 2 decrease after ICA clamping as an indication for shunt was not possible with the results of this study.
Polski przeglad chirurgiczny, 2014
The study presented a case of a 58-year-old male patient treated for retroperitoneal fibrosis, ri... more The study presented a case of a 58-year-old male patient treated for retroperitoneal fibrosis, right hydronephrosis, and right common iliac artery stenosis and saccular aneurysm of the above-mentioned vessel. The patient was qualified for endovascular treatment. Stentgraft implantation was performed with good long-term patency during more than 3 years of follow-up. Complete relief of intermittent claudication was observed. However, the endovascular exclusion of the aneurysm did not influence the course of retroperitoneal fibrosis.
Journal of the American Society of Echocardiography, 2010
Background: Aortic stenosis leads to left ventricular hypertrophy and accumulation of fibrillar c... more Background: Aortic stenosis leads to left ventricular hypertrophy and accumulation of fibrillar collagens. The analysis of integrated backscatter (IBS) parameters provides information on ultrasonic myocardial properties. Methods: The study population consisted of 58 patients with aortic stenosis. They were followed up for an average 18 6 5 months after aortic valve replacement (AVR). Traditional transthoracic echocardiography and analysis of IBS reflectivity were performed before AVR and during the control visit after AVR. Results: A significant reduction in left ventricular mass index, a significant increase in the mean cyclic variation of IBS, and a decrease in absolute end-diastolic IBS intensity were observed after AVR. Conclusions: These data suggest improvements in ultrasonic myocardial properties after AVR. Preoperative analysis of IBS parameters might provide additional information for predicting left ventricular reverse remodeling in patients a mean of 1.5 years after AVR for aortic stenosis.
Folia Cardiologica …, 2004
Background: Coexistent lower extremity ischaemia in patients suffering from coronary disease is a... more Background: Coexistent lower extremity ischaemia in patients suffering from coronary disease is a very important independent negative prognostic factor in operative outcome of coronary surgery. Not only symptomatic peripheral artery stenosis but also subclinical ischaemia can increase perioperative risk. The aim of the study was the analysis of the lower limb ischaemia incidence in patients undergoing coronary artery bypass grafting and the evaluation of its influence on early postoperative outcome. Material and methods: In 125 patients qualified for coronary surgery, ankle-brachial index (ABI) was measured. In this group, there were 95 men and 30 women. Patients with ABI £ 0.9 were classified to the first group (group I) and the rest to the second one (group II). Results: Out of 125 patients, 7 (5.6%) had symptoms of lower limb ischaemia. ABI £ 0.9 was found in 32 (25.6%) patients. In this group, 25 (78.2%) had no symptoms. Statistically significant differences between the groups were reported. In group I, higher incidence of perioperative infarction (p = 0.04), low output syndrome (p = 0.02), atrial fibrillation (p = = 0.01), sternal infection (p = 0.03) was found. Conclusions: Lower limb ischaemia was found in 25.6% of patients undergoing coronary surgery of whom 78,2% were asymptomatic. Peripheral vascular disease significantly increases number of postoperative complications in patients undergoing coronary artery bypass grafting. (Folia Cardiol. 2004; 11: 293-298) coronary artery bypass grafting, lower limb ischemia Wstęp Choroba niedokrwienna serca jest obecnie jednym z najpoważniejszych problemów zdrowotnych na całym świecie, a w krajach wysoko rozwiniętych jest główną przyczyną zgonów. W Polsce szacuje się, że liczba ostrych zespołów wieńcowych wynosi około 250 000 rocznie [1]. Wśród pacjentów z udokumentowaną chorobą wieńcową ok. 16-20% cierpi na chorobę niedokrwienną kończyn dolnych. U około 5% mężczyzn i 2,5% kobiet powyżej 60 rż. występują objawy niedokrwienia kończyn dolnych pod postacią chromania przestankowego. Liczby te okazują się co najmniej 3-krotnie wyższe, jeśli do diagnostyki niewydolności krążenia obwodowego użyje się nieinwazyjnych testów [2-4]. U około 50% osób przyjmowanych do szpitala z powodu zaburzeń ukrwienia kończyn dolnych występują ob-brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by Via Medica Journals
Current Problems in Cardiology, 2012
Atrial fibrillation (AF) remains the most common arrhythmia encountered in clinical practice. One... more Atrial fibrillation (AF) remains the most common arrhythmia encountered in clinical practice. One of its most devastating complication is the development of thromboembolism leading to stroke. The left atrial appendage (LAA) has been shown to be the site of thrombus formation in the majority of strokes associated with AF. Anticoagulation with warfarin has been the treatment of choice for prevention of embolic events in these patients, but it does have significant limitations including bleeding, need for continued follow-up blood tests, and drug-drug interactions. Although newer anticoagulants have been developed, they still have the potential side effect of causing significant bleeding. Closure or exclusion of the LAA has emerged as an alternative therapeutic approach to medical therapy. The aim of this article is to review the anatomy and physiology of the LAA, discuss the various treatment strategies for stroke prevention, review the current devices and technologies available for LAA occlusion, and discuss some of the more recent data available on these technologies.