OBJECTIVES: Long-term evidence about bioprosthetic tricuspid valve replacement is scarce. This study aims to investigate the long-term clinical outcomes of patients who underwent tricuspid valve replacement with bioprostheses. METHODS: This multicentre retrospective study included patients from 10 high-volume centres in 7 different countries, who underwent tricuspid valve replacement with bioprostheses. Echocardiographic and clinical data were reviewed. Long-term outcomes were investigated using Kaplan-Meier estimates, Cox regression, and competing risk analysis. RESULTS: Of 675 patients, isolated tricuspid valve replacement was performed in 358 patients (53%), while 317 (47%) underwent concomitant procedures. Between these 2 groups, patients who underwent combined procedures reported a significantly higher incidence of infection, atrioventricular block, multi-organ failure, longer intensive care unit and hospital stay and higher 30-day mortality over patients who underwent isolated procedure. The overall 30-day mortality occurred in 70 patients (10.4%) [46 (14.6%) combined vs 24 (6.74%) isolated, P = 0.001]. During the follow-up, there was a continuous rate of attrition due to death, with cumulative incidences of death at 5, 10 and 15 years being 27.2%, 46.2% and 60.6%, respectively. In contrast, the risk of reintervention starts to significantly increase after 10 years of follow-up, with cumulative incidences of reintervention being 6.1%, 10.8% and 23.3%, respectively. Freedom from tricuspid valve reintervention, pacemaker implantation, tricuspid valve endocarditis and major thromboembolic events at 15 years were 56.5%, 77.3%, 84.0% and 86.4%, respectively. CONCLUSIONS: Tricuspid valve replacement with bioprostheses is an effective treatment for valvular disease, despite being associated with relatively high early and long-term mortality. However, the risk of structural valve degeneration rises significantly after 10 years.

• MeSH
• bioprotézy * škodlivé účinky   MeSH
• chirurgická náhrada chlopně * mortalita   škodlivé účinky   metody   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• nemoci srdečních chlopní * chirurgie   mortalita   MeSH
• pooperační komplikace epidemiologie   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• srdeční chlopně umělé * škodlivé účinky   MeSH
• trikuspidální chlopeň * chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH

• Klíčová slova
• Rossova operace,
• MeSH
• aortální chlopeň chirurgie   MeSH
• centra terciární péče MeSH
• chirurgická náhrada chlopně * metody   MeSH
• homologní transplantace MeSH
• kardiochirurgické výkony metody   MeSH
• plicní chlopeň chirurgie   MeSH
• pooperační komplikace MeSH
• výběr pacientů MeSH
• Publikační typ
• novinové články MeSH
• rozhovory MeSH

Akutní plicní embolie je onemocnění, které je pořád zatíženo značnou mortalitou. V době moderní medicíny bylo vyvinuto několik metod řešení. Chirurgická léčba zůstává, ve světle dnešních doporučení, rezervována pro ty nejtěžší pacienty projevující se hemodynamickou nestabilitou. Operační postupy a výsledky chirurgické léčby spolu s použitím mechanických srdečních podpor přinášíme v tomto sdělení.

Acute pulmonary embolism is still marked with a relatively high mortality burden. In the era of modern medicine, several approaches have been developed. Surgical treatment, in the light of current guidelines, is reserved for the highest-risk patients with hemodynamic instability. Surgical procedures and results along with the use of mechanical circulatory support results have been discussed in this text.

• MeSH
• lidé MeSH
• mechanická trombolýza MeSH
• plicní embolie * chirurgie   MeSH
• podpůrné srdeční systémy MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Aminophylline, a bronchodilator mainly used to treat severe asthma attacks, may induce arrhythmias. Unfortunately, the underlying mechanism is not well understood. We have recently described a significant, on average inhibitory effect of aminophylline on inward rectifier potassium current IK1, known to substantially contribute to arrhythmogenesis, in rat ventricular myocytes at room temperature. This study was aimed to examine whether a similar effect may be observed under clinically relevant conditions. Experiments were performed using the whole cell patch clamp technique at 37°C on enzymatically isolated healthy porcine and failing human ventricular myocytes. The effect of clinically relevant concentrations of aminophylline (10-100 μM) on IK1 did not significantly differ in healthy porcine and failing human ventricular myocytes. IK1 was reversibly inhibited by ∼20 and 30 % in the presence of 30 and 100 μM aminophylline, respectively, at -110 mV; an analogical effect was observed at -50 mV. To separate the impact of IK1 changes on AP configuration, potentially interfering ionic currents were blocked (L-type calcium and delayed rectifier potassium currents). A significant prolongation of AP duration was observed in the presence of 100 μM aminophylline in porcine cardiomyocytes which well agreed with the effect of a specific IK1 inhibitor Ba2+ (10 μM) and with the result of simulations using a porcine ventricular cell model. We conclude that the observed effect of aminophylline on healthy porcine and failing human IK1 might be involved in its proarrhythmic action. To fully understand the underlying mechanism, potential aminophylline impact on other ionic currents should be explored.

• MeSH
• akční potenciály účinky léků   MeSH
• aminofylin * farmakologie   MeSH
• draslíkové kanály dovnitř usměrňující * metabolismus   MeSH
• kardiomyocyty * účinky léků   metabolismus   MeSH
• lidé MeSH
• metoda terčíkového zámku MeSH
• prasata MeSH
• srdeční komory účinky léků   metabolismus   MeSH
• srdeční selhání metabolismus   farmakoterapie   MeSH
• vztah mezi dávkou a účinkem léčiva MeSH
• zvířata MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• zvířata MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• kardiologie * dějiny   MeSH
• lidé MeSH
• významné osobnosti MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• biografie MeSH

• O autorovi
• Němec, Petr, 1954- Autorita

OBJECTIVES: Both aortic root remodelling and aortic valve (AV) reimplantation have been used for valve-sparing root replacement in patients with aortic root aneurysm with or without aortic regurgitation. There is no clear evidence to support one technique over the another. This study aimed to compare remodelling with basal ring annuloplasty versus reimplantation on a multicentre level with the use of propensity-score matching. METHODS: This was a retrospective international multicentre study of patients undergoing remodelling or reimplantation between 2010 and 2021. Twenty-three preoperative covariates (including root dimensions and valve characteristics) were used for propensity-score matching. Perioperative outcomes were analysed along with longer-term freedom from AV reoperation/reintervention and other major valve-related events. RESULTS: Throughout the study period, 297 patients underwent remodelling and 281 had reimplantation. Using propensity-score matching, 112 pairs were selected and further compared. We did not find a statistically significant difference in perioperative outcomes between the matched groups. Patients after remodelling had significantly higher reintervention risk than after reimplantation over the median follow-up of 6 years (P = 0.016). The remodelling technique (P = 0.02), need for decalcification (P = 0.03) and degree of immediate postoperative AV regurgitation (P < 0.001) were defined as independent risk factors for later AV reintervention. After exclusion of patients with worse than mild AV regurgitation immediately after repair, both techniques functioned comparably (P = 0.089). CONCLUSIONS: AV reimplantation was associated with better valve function in longer-term postoperatively than remodelling. If optimal immediate repair outcome was achieved, both techniques provided comparable AV function.

• MeSH
• anuloplastika srdeční chlopně metody   MeSH
• aortální chlopeň * chirurgie   MeSH
• aortální insuficience * chirurgie   MeSH
• chirurgická náhrada chlopně metody   MeSH
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• reoperace statistika a číselné údaje   MeSH
• replantace * metody   MeSH
• retrospektivní studie MeSH
• senioři MeSH
• tendenční skóre * MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• srovnávací studie MeSH

• MeSH
• aneurysma aortálního oblouku chirurgie   terapie   MeSH
• aneurysma hrudní aorty * chirurgie   etiologie   patofyziologie   terapie   MeSH
• aneurysma vzestupné aorty chirurgie   diagnóza   etiologie   patologie   MeSH
• aorta thoracica chirurgie   patologie   MeSH
• aortální chlopeň chirurgie   patologie   MeSH
• kardiovaskulární chirurgické výkony klasifikace   metody   škodlivé účinky   MeSH
• lidé MeSH
• perfuze metody   MeSH
• replantace metody   MeSH
• thorakoabdominální aortální aneurysma chirurgie   etiologie   patofyziologie   patologie   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

• MeSH
• akutní koronární syndrom * diagnóza   komplikace   prevence a kontrola   terapie   MeSH
• antihypertenziva aplikace a dávkování   terapeutické užití   MeSH
• antikoagulancia aplikace a dávkování   terapeutické užití   MeSH
• biologické markery krev   MeSH
• elektrokardiografie MeSH
• fibrinolýza MeSH
• infarkt myokardu diagnóza   komplikace   terapie   MeSH
• inhibitory agregace trombocytů aplikace a dávkování   terapeutické užití   MeSH
• koronární angioplastika metody   MeSH
• lidé MeSH
• revaskularizace myokardu metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• směrnice pro lékařskou praxi MeSH

BACKGROUND: The optimal treatment of patients with severe symptomatic aortic regurgitation (AR) is state-of-the-art surgery. Asymptomatic patients with advanced left ventricular (LV) dilatation and/or impaired ejection fraction should undergo surgical treatment, but there is no guidelines consensus on cut-off values for this recommendation. Multimodality imaging has brought new tools for the accurate selection of asymptomatic patients at risk of early clinical deterioration, however, prospective and randomized data are pending. Cardiac magnetic resonance (CMR)-derived AR quantification along with LV remodeling assessment appears to be the most accurate tool for a selection of such patients at risk. TRIAL DESIGN: The objective of our prospective and multicenter study is to determine whether patients at risk of early clinical deterioration as per CMR assessment will benefit from early surgical treatment. The study is designed as a superiority trial to demonstrate that early surgical treatment is safe and more effective than the standard treatment. A total of 217 asymptomatic patients with severe AR, but without current guidelines-based surgical indication, will be enrolled across all centers. We expect 24 % of patients identified as high clinical risk and therefore eligible for 1:1 randomization to early surgical treatment within 3 months or a watchful waiting strategy. Follow-up will be annual. We expect a complete restoration of LV size and function along with improved quality of life and physical performance in a short-term follow-up of 12 months. The primary endpoint will be a composite safety and efficacy with all criteria mandatory: 15 % or larger reduction of baseline CMR-derived LV end-diastolic volume index, LV ejection fraction >50 %, and no major adverse cardiovascular events. The annual follow-up will continue for a minimum of 4 years until the required number of endpoints is achieved to show a statistically significant difference in cardiovascular morbidity and mortality in early surgically treated patients. CONCLUSION: The ELEANOR trial is the first multicenter randomized controlled study to compare early surgical treatment with a watchful waiting strategy in asymptomatic patients with chronic severe AR at high risk of early clinical deterioration as per CMR assessment but without guidelines-based indications for surgical treatment.

• Publikační typ
• časopisecké články MeSH