BACKGROUND: Patients with severe aortic stenosis present frequently (∼50%) with concomitant obstructive coronary artery disease. Current guidelines recommend combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG) as the preferred treatment. Transcatheter aortic valve implantation (TAVI) and fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) represent a valid treatment alternative. We aimed to test the non-inferiority of FFR-guided PCI plus TAVI versus SAVR plus CABG in patients with severe aortic stenosis and complex coronary artery disease. METHODS: This international, multicentre, prospective, open-label, non-inferiority, randomised controlled trial was conducted at 18 tertiary medical centres across Europe. Patients (aged ≥70 years) with severe aortic stenosis and complex coronary artery disease, deemed feasible for percutaneous or surgical treatment according to the on-site Heart Team, were randomly assigned (1:1) to FFR-guided PCI plus TAVI or SAVR plus CABG according to a computer-generated sequence with random permuted blocks sizes stratified by site. The primary endpoint was a composite of all-cause mortality, myocardial infarction, disabling stroke, clinically driven target-vessel revascularisation, valve reintervention, and life-threatening or disabling bleeding at 1 year post-treatment. The trial was powered for non-inferiority (with a margin of 15%) and if met, for superiority. The primary and safety analyses were done per an intention-to-treat principle. This trial is registered with ClinicalTrials.gov (NCT03424941) and is closed. FINDINGS: Between May 31, 2018, and June 30, 2023, 172 patients were enrolled, of whom 91 were assigned to the FFR-guided PCI plus TAVI group and 81 to the SAVR plus CABG group. The mean age of patients was 76·5 years (SD 3·9). 118 (69%) of 172 patients were male and 54 (31%) patients were female. FFR-guided PCI plus TAVI resulted in favourable outcomes for the primary endpoint (four [4%] of 91 patients) versus SAVR plus CABG (17 [23%] of 77 patients; risk difference -18·5 [90% CI -27·8 to -9·7]), which was below the 15% prespecified non-inferiority margin (pnon-inferiority<0·001). FFR-guided PCI plus TAVI was superior to SAVR plus CABG (hazard ratio 0·17 [95% CI 0·06-0·51]; psuperiority<0·001), which was driven mainly by all-cause mortality (none [0%] of 91 patients vs seven (10%) of 77 patients; p=0·0025) and life-threatening bleeding (two [2%] vs nine [12%]; p=0·010). INTERPRETATION: The TCW trial is the first trial to compare percutaneous treatment versus surgical treatment in patients with severe aortic stenosis and complex coronary artery disease, showing favourable primary endpoint and mortality outcomes with percutaneous treatment. FUNDING: Isala Heart Centre and Medtronic.
- MeSH
- aortální stenóza * chirurgie komplikace MeSH
- chirurgická náhrada chlopně metody MeSH
- frakční průtoková rezerva myokardu * MeSH
- koronární angioplastika * metody MeSH
- koronární bypass * metody MeSH
- lidé MeSH
- nemoci koronárních tepen * chirurgie komplikace terapie MeSH
- prospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- transkatetrální implantace aortální chlopně * metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnocení ekvivalence MeSH
- multicentrická studie MeSH
- srovnávací studie MeSH
OBJECTIVES: Current recommendations support surgical treatment of atrial fibrillation (AF) in patients indicated for cardiac surgery. These procedures are referred to as concomitant and may be carried out using radiofrequency energy or cryo-ablation. This study aimed to assess the electrophysiological findings in patients undergoing concomitant cryo-ablation. METHODS: Patients with non-paroxysmal AF undergoing coronary artery bypass grafting and/or valve repair/replacement were included in the trial if concomitant cryo-ablation was part of the treatment plan according to current guidelines. The patients reported in this study were assigned to undergo staged percutaneous radiofrequency catheter ablation (PRFCA), i.e., hybrid treatment, as a part of the SURHYB trial protocol. RESULTS: We analyzed 103 patients who underwent PRFCA 105 ± 35 days after surgery. Left and right pulmonary veins (PVs) were found isolated in 65 (63.1%) and 63 (61.2%) patients, respectively. The LA posterior wall isolation and mitral isthmus conduction block were found in 38 (36.9%) and 18 (20.0%) patients, respectively. Electrical reconnections (gaps) in the left PVs were more often localized superiorly than inferiorly (57.9% vs. 26.3%, P = 0.005) and anteriorly than posteriorly (65.8% vs. 31.6%, P = 0.003). Gaps in the right PVs were more equally distributed anteroposteriorly but dominated in superior segments (72.5% vs. 40.0%, P = 0.003). There was a higher number of gaps on the roof line compared to the inferior line (131 (67.2%) vs. 67 (42.2%), P < 0.001). Compared to epicardial cryo-ablation, endocardial was more effective in creating PVs and LA posterior wall isolation (P < 0.05). Cryo-ablation using nitrous oxide (N20) or argon (Ar) gas as cooling agents was similarly effective (P = NS). CONCLUSIONS: The effectiveness of surgical cryo-ablation in achieving transmural and durable lesions in the left atrium is surprisingly low. Gaps are located predominantly in the superior and anterior portions of the PVs and on the roof line. Endocardial cryo-ablation is more effective than epicardial ablation, irrespective of the cooling agent used.
- MeSH
- fibrilace síní * chirurgie MeSH
- katetrizační ablace * metody MeSH
- koronární bypass metody MeSH
- kryochirurgie * metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- venae pulmonales * chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Aims: We aimed to compare patients' quality of life (QoL) after two types of atrial fibrillation (AF) treatment: a hybrid ablation strategy and a surgical CryoMaze procedure alone. Methods and results: Patients with non-paroxysmal AF undergoing coronary artery bypass grafting and/or valve repair/replacement with concomitant CryoMaze procedure were randomly assigned to undergo either radiofrequency catheter ablation after three months (Hybrid Group) or no further treatment (Surgery Group). QoL was compared using the Atrial Fibrillation Effect on Quality of Life (AFEQT) questionnaire. The AFEQT score was converted to the scale of 0 to 100 per cent points, i.e., a score of 0 corresponds to complete disability (or responding "extremely" limited, difficult, or bothersome to all questions answered), and a score of 100 corresponds to no disability (or responding "not at all" limited, difficult, or bothersome to all questions answered). In 106 Hybrid Group patients and 109 Surgery Group patients, both baseline and 12-month AFEQT data were available for final analysis. Patients' QoL did not differ between the Hybrid and Surgery Groups at baseline. At 12 months post-procedure, QoL improved significantly in both groups (from 61.9 ± 16.3 to 86.5 ± 13.4 and from 58.6 ± 14.9 to 81.5 ± 16.7 in the Hybrid Group and Surgery Group, respectively, P < 0.001). The 12-month AFEQT score was significantly higher in the Hybrid Group compared to the Surgery Group (P = 0.017). In an analysis based on AF recurrence, the QoL at 12 months was significantly higher in patients without AF recurrences compared to patients with AF recurrences (86.2 ± 14.0 vs 80.2 ± 16.8, P = 0.005). Conclusion: Compared to the CryoMaze procedure alone, the hybrid ablation strategy was associated with higher QoL 12 months post-procedure in patients with non-paroxysmal AF undergoing cardiac surgery for structural heart disease. Arrhythmia recurrence was the most significant denominator of the QoL after concomitant AF surgery.
- Klíčová slova
- CryoMaze,
- MeSH
- fibrilace síní * chirurgie MeSH
- kardiochirurgické výkony metody MeSH
- katetrizační ablace metody škodlivé účinky MeSH
- koronární bypass metody MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- maze procedura * metody MeSH
- průzkumy a dotazníky MeSH
- senioři MeSH
- statistika jako téma MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
- srovnávací studie MeSH
- MeSH
- dospělí MeSH
- koronární angiografie metody MeSH
- koronární bypass metody MeSH
- lidé MeSH
- rodina MeSH
- sportovci MeSH
- stenóza arteria carotis * chirurgie diagnóza MeSH
- výkony cévní chirurgie metody MeSH
- výsledek terapie MeSH
- vztahy mezi rodiči a dětmi MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Kontext: Kardiovaskulární onemocnění jsou nejčastější příčinou mortality a morbidity u pacientů po transplantaci ledvin. Byla publikována řada kazuistik i popisy malých skupin pacientů a kontrol s koronárním bypassem po transplantaci ledvin. Cílem naší studie bylo zhodnotit stav pacientů, u nichž byl po transplantaci ledvin proveden koronární bypass. Metody: Mezi 4 330 pacienty, u nichž byl v období od ledna 2012 do prosince 2021 proveden koronární bypass, bylo 11 příjemců renálního štěpu. Sedm z těchto pacientů (64,6 %) byli muži a čtyři (35,4 %) ženy. Medián věku zařazených pacientů byl 52 (42-66) let. Výsledky: Z uvedeného počtu byl koronární bypass v deseti případech (90,9 %) plánovaný, u jednoho pacienta (9,1 %) se jednalo o urgentní výkon. U pacienta s urgentním výkonem se předoperačně prováděla intraaortální balonková kontrapulsace. Koronární bypass byl proveden s použitím systému pro mimotělní oběh u šesti pacientů, bez tohoto systému u čtyř a koronární bypass bez mimotělního oběhu na bijícím srdci byl proveden při urgentním výkonu. V pooperační době došlo u tří pacientů (27,3 %) k rozvoji fibrilace síní. Délka pobytu na jednotce intenzivní péče byla 3 ± 1,6 dne při hospitalizaci v délce 8 ± 3 dny. Závěr: Ukázalo se, že transplantace ledviny nijak nezvyšuje riziko z hlediska mortality a morbidity v souvislosti s koronárním bypassem. U pacientů po transplantaci ledviny je nutno provádět imunosupresivní léčbu a jejich ledvinné funkce důsledně monitorovat. U této skupiny pacientů nabývá multidisciplinární přístup ještě více na významu.
Background: Cardiovascular disease is the most common cause of mortality and morbidity in kidney transplant patients. Many case reports and case series about coronary artery bypass grafting operation after renal transplantation have been presented. In this article, we aim to evaluate the patients undergoing coronary artery bypass surgery after renal transplantation. Methods: Among the 4330 patients who underwent CABG between January 2012 and December 2021, there were 11 patients who had a previous renal transplant. Seven patients (64.6%) were male and four (35.4%) were female. The median age of the included patients was 52 (42-66). Results: While ten patients (90.9%) received CABG electively, one patient (9.1%) underwent emergency surgery. Intra-aortic balloon pump was used preoperatively to the urgent patient. On-pump CABG was applied in six patients, off-pump CABG was applied in four patients and beating CABG procedure was applied in one patient who was urgent. Atrial fibrillation developed in three patients (27.3%) in the postoperative period. The length of stay in the intensive care unit was 3±1.6 days , and the length of hospitalization was 8±3 days. Conclusion: It showed that having a renal transplant does not carry an extra risk in terms of mortality and morbidity when performing CABG. Renal transplant patients should receive immunosuppressive therapy and should be monitored closely in terms of renal function. In these patients, the multidisciplinary approach becomes even more important.
- MeSH
- imunosupresivní léčba MeSH
- kardiovaskulární nemoci etiologie komplikace MeSH
- koronární bypass * metody mortalita MeSH
- lidé MeSH
- pooperační komplikace prevence a kontrola MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- transplantace ledvin * metody mortalita MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
OBJECTIVES: Relative rates of early graft failure and conduit selection in coronary artery bypass grafting (CABG) surgery remain controversial. Therefore, we sought to determine the incidence and determinants of graft failure of the left internal mammary artery (LIMA), radial artery, saphenous vein, and right internal mammary artery (RIMA) 1 year after CABG surgery. METHODS: A post hoc analysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) CABG study, involving patients from 83 centers in 22 countries. We completed an analysis of 3480 grafts from 1068 patients who underwent CABG surgery with complete computed tomography angiography data. The primary outcome was graft failure as diagnosed by computed tomography angiography 1 year after surgery. RESULTS: Graft failure occurred in 6.4% (68/1068) for LIMA, 9.9% (9/91) for radial artery, 10.4% (232/2239) for saphenous vein, and 26.8% (22/82) for RIMA grafts. The RIMA had a greater rate of graft failure (26.8%) than radial artery (9.9%) and veins (10.4%) (adjusted odds ratio, 2.69; 95% confidence interval, 1.30-5.57; P = .008 and adjusted odds ratio, 2.07; 95% confidence interval, 1.33-3.21; P = .001, respectively). CONCLUSIONS: In this international trial dataset, LIMA and radial artery performed as expected, whereas vein grafts performed better. However, high rates of RIMA failure are worrisome and highlight the need for a thorough evaluation of the patency and safety of the RIMA in CABG surgery.
- MeSH
- antikoagulancia škodlivé účinky MeSH
- arteria radialis diagnostické zobrazování transplantace MeSH
- CT angiografie MeSH
- kardiovaskulární systém * MeSH
- koronární angiografie MeSH
- koronární bypass * škodlivé účinky metody MeSH
- lidé MeSH
- průchodnost cév MeSH
- vena saphena transplantace MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Kontext: Iatrogenní disekce koronární tepny během diagnostické nebo terapeutické katetrizace představuje vzácnou a smrtelnou komplikaci, která může vést k rozvoji dalšího infarktu myokardu. Cílem této studie je podělit se o výsledky léčby koronárním bypassem (coronary artery bypass grafting, CABG) u pacientů s iatrogenní disekcí koronární tepny po koronarografickém vyšetření (coronary angiography, CAG) na naší klinice. Metody: Retrospektivně byly analyzovány údaje všech pacientů, u nichž byla v období mezi lednem 2014 a prosincem 2021 v naší nemocnici provedena CAG nebo perkutánní koronární intervence (PCI); do studie byli zahrnuti i pacienti s CABG po iatrogenní disekci koronární tepny. Disekce se hodnotila pomocí klasifikace National Heart, Lung and Blood Institute (NHLBI). Výsledky: Během uvedených osmi let byla CAG provedena u 20 398 pacientů a PCI u 9 583 pacientů. Koronární bypass pro iatrogenní disekci koronární tepny bylo nutno provést u 17 pacientů (0,06 %). K disekci kmene levé věnčité tepny došlo u 6 (35,3 %) pacientů, přední sestupné větve u 6 (35,3 %), circumflex tepny u 2 (11,8 %) a pravé věnčité tepny u 3 (17,6 %). U 3 pacientů (17,6 %) překročila doba intubace 48 hodin. Jeden z těchto pacientů nedávno předtím prodělal onemocnění covid. U dalšího pacienta došlo k rozvoji otoku plic. Jiný pacient zemřel 4 dny po operaci v důsledku nízkého srdečního výdeje. Doba pobytu na jednotce intenzivní péče činila 2 (min.: 1 - max.: 13) dní; celkově v nemocnici 6 (min.: 4 - max.: 20) dní. Závěr: Vývoj kritického klinického stavu před chirurgickým výkonem těsně souvisí s vyšší pravděpodobností úmrtí v časné a pozdní pooperační době. Z toho jasně vyplývá, že jakákoli léčba v každém období před operací, během ní a po ní představuje nejdůležitější determinantu konečného výsledku.
Background: Iatrogenic coronary artery dissection during diagnostic or therapeutic catheterization is a rare and mortal complication that may result in a newly developed myocardial infarction. In this study, we aimed to share the results of CABG treatment of patients with iatrogenic coronary artery dissection after coronary angiography (CAG) in our clinic. Methods: All patients who underwent CAG or percutaneous coronary intervention (PCI) in our hospital between January 2014 and December 2021 were analyzed retrospectively and patients who underwent CABG after iatrogenic coronary artery dissection were included in the study. The dissection classification was achived according to the National Heart, Lung and Blood Institute (NHLBI) classification. Results: During the eight years, CAG was applied to 20,398 patients and PCI to 9583 patients. Needed to treat CABG in iatrogenic coronary artery dissection developed in 17 of the patients (0.06%). LMCA was dissected in 6 (35.3%) patients and LAD in 6 (35.3%), CX in 2 (11.8%) and RCA dissection in 3 (17.6%). 3 pa- tients (17.6%) had an intubation time longer than 48 hours. One of them has recently had a COVID infection. Another was suffering from pulmonary edema. The other patient died on the 4th postoperative day due to low cardiac output. The length of stay in the intensive care unit was 2 (min: 1 - max: 13) days. The hospital stay was 6 (min: 4 - max: 20) days. Conclusion: The development of a critical clinical condition prior to surgery is strongly associated with a higher probability of early and late postoperative death. For this reason, it is clear that the treatments applied at every stage of the pre-, per-, and postoperative period are the most important determinants of the results.
- MeSH
- chybná zdravotní péče MeSH
- disekce cévy * chirurgie etiologie komplikace patologie MeSH
- koronární angiografie škodlivé účinky statistika a číselné údaje MeSH
- koronární angioplastika škodlivé účinky statistika a číselné údaje MeSH
- koronární bypass * metody statistika a číselné údaje MeSH
- koronární cévy zranění MeSH
- lidé středního věku MeSH
- lidé MeSH
- retrospektivní studie MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinická studie MeSH
BACKGROUND: Tobacco smoking has been associated with an increased risk of complications after conventional coronary surgery. However, the impact of smoking on the risk of postoperative complications in minimally invasive coronary surgery is yet to be studied. We aimed to analyze the impact of the preoperative smoking status on the short- and long-term outcomes of minimally invasive direct coronary artery bypass grafting (MIDCAB) in the context of isolated surgical revascularization or in association with percutaneous coronary intervention. METHODS: This was a retrospective observational study of all patients undergoing MIDCAB at our institution between 2006 and 2020. Patients were divided into three groups: active smokers, ex-smokers who have quit smoking for at least 1 month before surgery, and non-smokers. The groups were compared using conventional statistical methods. Multivariate analysis was then performed where significant differences were found to eliminate bias. RESULTS: Throughout the study period, 541 patients underwent MIDCAB, of which 135 (25%) were active smokers, 183 (34%) were ex-smokers, and 223 (41%) were non-smokers. Smokers presented for surgery at a younger age (p < 0.0001), more frequently with a history of myocardial infarction (p < 0.001), peripheral artery disease (p < 0.001) and chronic obstructive pulmonary disease (p < 0.0001). Using multivariate analysis, active smoking was determined to be a significant risk factor for the need of urgent revascularization (odds ratio 2.36 [1.00-5.56], p = 0.049) and the composite of pulmonary complications (including pneumothorax, respiratory infection, respiratory dysfunction, subcutaneous emphysema and exacerbation of chronic obstructive pulmonary disease; odds ratio 2.84 [1.64-4.94], p < 0.001). Preoperative smoking status did not influence the long-term survival (p = 0.83). CONCLUSIONS: In our study, active smokers presented for MIDCAB at a younger age and more often with signs of atherosclerotic disease (history of myocardial infarction and peripheral artery disease). Active smoking was found to be the most significant risk factor for postoperative pulmonary complications, and is also associated with a more frequent need for urgent surgery at diagnosis. Long-term postoperative survival is not affected by the preoperative smoking status.
- MeSH
- chronická obstrukční plicní nemoc * MeSH
- infarkt myokardu * etiologie MeSH
- koronární bypass metody MeSH
- kouření tabáku MeSH
- kouření škodlivé účinky MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony škodlivé účinky MeSH
- onemocnění periferních arterií * MeSH
- pooperační komplikace etiologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- MeSH
- aneurysma hrudní aorty chirurgie diagnóza klasifikace patologie MeSH
- bolesti na hrudi diagnóza etiologie patologie MeSH
- disekce hrudní aorty chirurgie diagnóza klasifikace patologie MeSH
- ischemická choroba srdeční chirurgie diagnóza klasifikace patologie MeSH
- koronární bypass metody MeSH
- lidé MeSH
- mitrální insuficience chirurgie diagnóza patofyziologie patologie MeSH
- nádory srdce chirurgie diagnóza klasifikace patologie MeSH
- nemoci srdce * chirurgie diagnóza klasifikace patologie MeSH
- revaskularizace myokardu metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Coronary artery bypass grafting (CABG) is a common cardiac surgery. Manufacturing small-diameter (2-5 mm) vascular grafts for CABG is important for patients who lack first-choice autologous arterial, or venous conduits. Ovine and porcine common carotid arteries (CCAs) are used as large animal models for in vivo testing of newly developed tissue-engineered arterial grafts. It is unknown to what extent these models are interchangeable and whether the left and right arteries of the same subjects can be used as experimental controls. Therefore, we compared the microscopic structure of paired left and right ovine and porcine CCAs in the proximodistal direction and compared these animal model samples to samples of human coronary arteries (CAs) and human internal thoracic arteries (ITAs). METHODS: We compared the histological composition of whole CCAs of sheep (n = 22 animals) with whole porcine CCAs (n = 21), segments of human CAs (n = 21), and human ITAs (n = 21). Using unbiased sampling and stereological methods, we quantified the fractions of elastin, total collagen, type I collagen, type III collagen, smooth muscle actin (SMA) and chondroitin sulfate (CS) A, B, and C. We also quantified the densities and distributions of nuclear profiles, nervi vasorum and vasa vasorum as well as the thickness of the intima-media and total wall thickness. RESULTS: The differences between the paired samples of left and right CCAs in sheep were substantially greater than the differences in laterality in porcine CCAs. The right ovine CCAs had a smaller fraction of elastin (p < 0.001), greater fraction of SMA (p < 0.01), and greater intima-media thickness (p < 0.001) than the paired left side CCAs. In pigs, the right CCAs had a greater fraction of elastin (p < 0.05) and a greater density of vasa vasorum in the media (p < 0.001) than the left-side CCAs. The fractions of elastin and CS decreased and the fraction of SMA increased in the proximodistal direction in both the ovine (p < 0.001) and porcine (p < 0.001) CCAs. Ovine CCAs had a muscular phenotype along their entire length, but porcine CCAs were elastic-type arteries in the proximal segments but muscular type arteries in middle and distal segments. The CCAs of both animals differed from the human CAs and ITAs in most parameters, but the ovine CCAs had a comparable fraction of elastin and CS to human ITAs. CONCLUSIONS: From a histological point of view, ovine and porcine CCAs were not equivalent in most quantitative parameters to human CAs and ITAs. Left and right ovine CCAs did not have the same histological composition, which is limiting for their mutual equivalence as sham-operated controls in experiments. These differences should be taken into account when designing and interpreting experiments using these models in cardiac surgery. The complete morphometric data obtained by quantitative evaluation of arterial segments were provided to facilitate the power analysis necessary for justification of the minimum number of samples when planning further experiments. The middle or distal segments of ovine and porcine CCAs remain the most realistic and the best characterized large animal models for testing artificial arterial CABG conduits.
- MeSH
- arteriae carotides chirurgie MeSH
- intimomediální šíře tepenné stěny * MeSH
- koronární bypass metody MeSH
- lidé MeSH
- mamární tepny * MeSH
- modely u zvířat MeSH
- ovce MeSH
- prasata MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH