Károly Gombocz

Influence of dextran-70 on systemic inflammatory response and myocardial ischaemia-reperfusion following cardiac operations

IntroductionExperimental studies have demonstrated that dextran-70 reduces the leukocyte–endothelium interaction, but clinical evidence is still lacking. Our objective was to justify the anti-inflammatory effect of dextran-70 following cardiac operations.MethodsForty patients undergoing coronary bypass surgery (n = 32) or aortic valve replacement (n = 8) were enrolled in this prospective, randomized, double-blind study. Two groups were formed. In group A (n = 20), dextran-70 infusion was administered at a dose of 7.5 ml/kg before the initiation of cardiopulmonary bypass and at a dose of 12.5 ml/kg after the cessation of cardiopulmonary bypass. Group B served as a control with identical amounts of gelatin infusion (n = 20). The plasma concentration of procalcitonin, C-reactive protein, IL 6, IL 6r, IL 8, IL 10, soluble endothelial leukocyte adhesion molecule-1, soluble intercellular adhesion molecule-1, cardiac troponin-I and various haemodynamic parameters were measured in the perioperative period. Multivariate methods were used for statistical analysis.ResultsIn group A, lower peak (median) plasma levels of procalcitonin (0.2 versus 1.4, p < 0.001), IL 8 (5.6 versus 94.8, p < 0.001), IL 10 (47.2 versus 209.7, p = 0.001), endothelial leukocyte adhesion molecule-1 (88.5 versus 130.6, p = 0.033), intercellular adhesion molecule-1 (806.7 versus 1,375.7, P = 0.001) and troponin-I (0.22 versus 0.66, p = 0.018) were found. There was no significant difference in IL 6, IL-6r and C-reactive protein values between groups. Higher figures of the cardiac index (p = 0.010) along with reduced systemic vascular resistance (p = 0.005) were noted in group A.ConclusionOur investigation demonstrated that the use of dextran-70 reduces the systemic inflammatory response and cardiac troponin-I release following cardiac operation.Trial registration numberISRCTN38289094.

Incisional negative pressure wound therapy in reconstructive surgery of poststernotomy mediastinitis

The efficacy of negative pressure wound therapy in the treatment of poststernotomy mediastinitis has been revealed in many reports. The present retrospective observational study examined the efficacy of incisional negative pressure wound therapy in the reconstructive surgery of poststernotomy mediastinitis. We retrospectively examined 1034 consecutive patients, who underwent median sternotomy in the period between October 2013 and September 2015. Mediastinitis developed in 21 patients (2%), who subsequently underwent surgical reconstruction. We applied incisional negative pressure wound therapy (iNPWT) after primary closure of the wound over redon drains in ten patients (iNPWT + redon group). In 11 patients, only redons were used (redons only group). We observed the time between the introduction and removal of redon drains, hospital stay until final wound closure and the rate of failure of treatment. Failure of treatment is defined as the need for further surgical reconstruction. In the iNPWT + redon group, the duration of redon drainage therapy was 6·9 ± 5·2 days versus 13·36 ± 11·58 in the redons only group. Hospital stay was 11·4 ± 8·6 versus 101·64 ± 89·2, and failure of treatment was 10% versus 45·5%, respectively. The primary results of this study appear to support the beneficial effect of iNPWT after radical wound reconstruction.

Is sternal rewiring mandatory in surgical treatment of deep sternal wound infections

Background Deep sternal wound infections (DSWIs) are a rare but serious complication after median sternotomy, and treatment success depends mainly on surgical experience. We compared treatment outcomes after conventional sternal rewiring and reconstruction with no sternal rewiring in patients with a sternal wound infection. Methods We retrospectively enrolled patients who developed a DSWI after an open-heart procedure with median sternotomy at the Department of Cardiac Surgery, at the St. Rafael Hospital, Zalaegerszeg, Hungary, between 2012 and 2016. All patients received negative pressure wound and antibiotic therapy before surgical reconstruction. Patients were divided into groups determined by the reconstruction technique and compared. Subjects were followed up for 12 months, and the primary end-points were readmission and 90-day mortality. Results Among 3,177 median sternotomy cases, 60 patients developed a DSWI, 4 of whom died of sepsis before surgical treatment. Fifty-six patients underwent surgical reconstruction with conventional sternal rewiring (23 cases, 41%) or another interventions with no sternal refixation (33 cases, 59%). Eighty-one percent of sternal wound infections followed coronary bypass surgery (alone or combinated with another procedures), and 60% were diagnosed after hospital discharge. Staphylococcus aureus was cultured in 30% of all wounds and, 56.5% of cases reconstructed by sternal rewiring vs. 26.5% with no sternal rewiring, (P=0.022). Hospital readmission occurred in 63.6% of the sternal rewiring group vs. 14.7% of the no sternal rewiring group. The rate of death before wound healing or the 90th postoperative day was 21.7% in the sternal rewiring group vs. 0% in the no sternal rewiring group. The median hospital stay was longer in the sternal rewiring group than in the other group (51 vs. 30 days, P=0.006). Conclusions Sternal rewiring may be associated with a higher rate of treatment failure than other forms of treatment for sternal wound infections.

Xiphoid-sparing midline sternotomy reduces wound infection risk after coronary bypass surgery

Background Because of its advantages, full midline sternotomy has remained the main approach for cardiac surgery. However, the development of post-sternotomy wound infections is its primary disadvantage. We evaluated the impact of xiphoid process (XIP)-sparing midline sternotomy regarding reducing the risk of deep sternal wound infections (DSWIs). Methods Data from 446 patients who underwent coronary artery bypass grafting by one surgeon, from January 2007 through May 2017, were retrospectively analyzed. Patients were divided into preliminary (from 2007-2011; n=202) and contemporary (January 2012-May 2017; n=244) groups. Traditional midline sternotomy was performed in the preliminary group, while xiphoid-sparing midline sternotomy was performed in the contemporary group. To adjust for differences in baseline and operative characteristics, the inverse probability of treatment weighting (IPTW) was applied. The generalized linear model was used to compare xiphoid-sparing and conventional sternotomy regarding the development of sternal wound infections. Results The sternal infection rates were 0.8% and 4.5% in the xiphoid-sparing and standard sternotomy groups, respectively (P=0.014). After adjustment for the IPTW, the xiphoid-sparing group showed a decreased risk for DSWIs (odds ratio 0.171, 95% confidence interval, 0.036-0.806, P=0.026) compared to the traditional sternotomy group. Conclusions XIP-sparing midline sternotomy may be an alternative approach in coronary artery bypass surgery and seemed to reduce the risk of post-sternotomy wound infections in this study.

Total proximal anastomosis detachment after classical bentall procedure

Highlights • Total proximal anastomosis detachment after classical Bentall procedure is very rare and life-threatrning complication.• Elongation of the left ventricle tract may serve a surgical solution to treat this complication.• Surgeons performing the Bentall procedure must be familiar with all existing modifications.

A mitralis elégtelenség sebészi kezelésének új megközelítése: transapicalis ínhúrpótlás dobogó szíven

Absztrakt A mitralis billentyű prolapsusa kovetkezteben fennallo sulyos billentyűelegtelenseg mielőbbi sebeszi kezelese szukseges. A modern korrekcio soran az inhurpotlas reszesitendő előnyben, amely műtethez azonban jelenleg a sziv megallitasa es extracorporalis keringes alkalmazasa szukseges a bal pitvar megnyitasa mellett. A transoesophagealis szivultrahanggal vezerelt transapicalis inhurpotlas innovativ technikaja egy specialis, bal kamraba vezetett eszkoz hasznalataval bal oldali minithoracotomian keresztul dobogo sziven vegezhető. A beavatkozasok soran elert intraoperativ siker aranya centrumonkent 86 es 100% kozott valtozik, es egyes kozlemenyek szerint 3 honap elteltevel a betegek 92%-anak nincs szuksege ujabb sebeszi korrekciora. A tapasztalatok folyamatos integralasanak koszonhető biztato eredmenyek a jelentősen kisebb műteti megterheles lehetőseget igerő technika szeles korű elterjedesenek iranyaba mutatnak. Orv. Hetil., 2016, 157(18), 700–705.

Early Results of a Novel Mitral Valve Repair Procedure: The Interpapillary Polytetrafluoroethylene Bridge Formation.

BACKGROUND Surgical repair of ischemic mitral regurgitation (IMR) associated with chordal rupture in patients with ischemic cardiomyopathy is challenging as it aims to correct several structural pathologies at once. There are ongoing studies evaluating multiple approaches, however long term results are still scarce. METHODS AND RESULTS 19 patients with IMR underwent mitral valve repair with interpapillary polytetrafluoroethylene (PTFE) bridge and neochordae formation at the Zala County Teaching Hospital. Concomitant coronary artery bypass grafting was performed in all patients. Post-procedural Transesophageal Echocardiogram (TEE) showed no mitral regurgitation (MR) in eighteen (94.7%) patients, with a leaflet coaptation mean height of 8 ± 3 mm. No operative mortality was observed. At the follow up (mean 17.7 ± 4.6 months; range 9 to 24 months), 17 (89%) patients showed no leakage and 2 had regurgitation grade ≤1, with documented NYHA functional class I or II in all patients. CONCLUSION This retrospective study presents the first results of a novel surgical approach to treating ischemic mitral regurgitation. The interpapillary PTFE bridge formation is a safe and feasible surgical procedure that is reproducible, time sparing and effectively eliminates mitral valve regurgitation with promising long-term results.

Surgical approximation of the posterior papillary muscle in chronic ischemic mitral regurgitation – presentation of a new method of mitral valve repair

Background The optimal surgical management of the chronic ischemic mitral regurgitation remains controversial and the negative effect of the displacement of the papillary muscles is evident. To emerge this effect we performed a new method to approximate the papillary muscles as adjunct procedure to ring annuloplasty. The purpose of this study was to evaluate the early outcome and the effect of this method.

Evaluation of the EuroSCORE model in the patient population of our department of cardiac surgery

Bevezetes: Celunk a EuroSCORE-modell pontossaganak es precizitasanak vizsgalata az osztalyunkon operalt betegek populaciojaban. Anyag es modszer: 2003. 01. 01. es 2005. 12. 31. kozott operalt 1839, egymast kovető beteg adatait vizsgaltuk. A műtet előtt meghatarozott additiv es logisztikus EuroSCORE altal josolt mortalitasi erteket hasonlitottuk ossze a tenyleges 30 napos halalozassal. A statisztikai elemzes soran a modszer diszkriminativ pontossagat a C-statisztika alkalmazasaval hataroztuk meg. A modellek kalibraciojat, illetve precizitasat a Hosmer–Lemeshow-statisztikaval elemeztuk. Eredmenyek: A fenti időszakban a műteti mortalitas 3,3% volt. Az additiv, illetve a logisztikus EuroSCORE atlagerteke 4,1 ± 2,8, illetve 4,5 ± 6,1% volt. A C-statisztika alapjan a gorbe (Receiver Operating Caracteristic curve) alatti terulet sorrendben 0,699 (0,629–0,769), illetve 0,711 (0,642–0,779). A Hosmer–Lemeshow-statisztika κ 2 -erteke 6,5 ( p = 0,475), illetve 12,5 ( p = 0,131). Kovetkeztetes: A logisztikus EuroSCORE-modell diszkriminativ ereje jo, kielegitő precizitas mellett, mig az additiv EuroSCORE pontossaga csak megkozeliti az elfogadhato szintet, ugyanakkor a kalibracioja megfelelő. Eredmenyeink alapjan a logisztikus EuroSCORE alkalmasabb a betegek preoperativ rizikobecslesere. | Introduction: The objective of current study is the evaluation of the accuracy and precision of EuroSCORE in the population of those patients undergone cardiac surgery in our department. Material and methods: We have analyzed the data of 1839 consecutive patients who had their operations between 1/January 2003 and 31/December 2005. We have compared the mortality rates predicted preoperatively by additive and logistic EuroSCORE with the actual 30-day mortality figures. On statistical analysis the discriminative accuracy of the methods has been defined with the use of C-statistics. The calibration and precision of the methods have been checked by the Hosmer–Lemeshow statistics. Results: The overall mortality rate in the above period was 3.3%. Additive and logistic EuroSCORE predicted 4.1 ± 2.8 and 4.5 ± 6.1%, consecutively. Based on the C-statistics the area below the Receiver Operating Characteristic curve has measured 0.699 (0.629–0.769) and 0.711 (0.642–0.779). The κ 2 value for the Hosmer-Lemeshow statistics has proved 6.5 ( p = 0.475) and 12.5 ( p = 0.131). Conclusion: Logistic EuroSCORE has appropriate discriminative power and satisfactory precision, whilst the accuracy of additive EuroSCORE only comes near to the acceptable level, but at the same time it has an adequate calibration value. These results suggest that logistic EuroSCORE is more suitable for the preoperative risk assessment of these patients.INTRODUCTION The objective of current study is the evaluation of the accuracy and precision of EuroSCORE in the population of those patients undergone cardiac surgery in our department. MATERIAL AND METHODS We have analyzed the data of 1839 consecutive patients who had their operations between 1/January 2003 and 31/December 2005. We have compared the mortality rates predicted preoperatively by additive and logistic EuroSCORE with the actual 30-day mortality figures. On statistical analysis the discriminative accuracy of the methods has been defined with the use of C-statistics. The calibration and precision of the methods have been checked by the Hosmer-Lemeshow statistics. RESULTS The overall mortality rate in the above period was 3.3%. Additive and logistic EuroSCORE predicted 4.1 +/- 2.8 and 4.5 +/- 6.1%, consecutively. Based on the C-statistics the area below the Receiver Operating Characteristic curve has measured 0.699 (0.629-0.769) and 0.711 (0.642-0.779). The kappa 2 value for the Hosmer-Lemeshow statistics has proved 6.5 ( p = 0.475) and 12.5 ( p = 0.131). CONCLUSION Logistic EuroSCORE has appropriate discriminative power and satisfactory precision, whilst the accuracy of additive EuroSCORE only comes near to the acceptable level, but at the same time it has an adequate calibration value. These results suggest that logistic EuroSCORE is more suitable for the preoperative risk assessment of these patients.

Evaluation of the EuroSCORE model in the patient population of our Department

Bevezetes: Celunk a EuroSCORE-modell pontossaganak es precizitasanak vizsgalata az osztalyunkon operalt betegek populaciojaban. Anyag es modszer: 2003. 01. 01. es 2005. 12. 31. kozott operalt 1839, egymast kovető beteg adatait vizsgaltuk. A műtet előtt meghatarozott additiv es logisztikus EuroSCORE altal josolt mortalitasi erteket hasonlitottuk ossze a tenyleges 30 napos halalozassal. A statisztikai elemzes soran a modszer diszkriminativ pontossagat a C-statisztika alkalmazasaval hataroztuk meg. A modellek kalibraciojat, illetve precizitasat a Hosmer–Lemeshow-statisztikaval elemeztuk. Eredmenyek: A fenti időszakban a műteti mortalitas 3,3% volt. Az additiv, illetve a logisztikus EuroSCORE atlagerteke 4,1 ± 2,8, illetve 4,5 ± 6,1% volt. A C-statisztika alapjan a gorbe (Receiver Operating Caracteristic curve) alatti terulet sorrendben 0,699 (0,629–0,769), illetve 0,711 (0,642–0,779). A Hosmer–Lemeshow-statisztika κ 2 -erteke 6,5 ( p = 0,475), illetve 12,5 ( p = 0,131). Kovetkeztetes: A logisztikus EuroSCORE-modell diszkriminativ ereje jo, kielegitő precizitas mellett, mig az additiv EuroSCORE pontossaga csak megkozeliti az elfogadhato szintet, ugyanakkor a kalibracioja megfelelő. Eredmenyeink alapjan a logisztikus EuroSCORE alkalmasabb a betegek preoperativ rizikobecslesere. | Introduction: The objective of current study is the evaluation of the accuracy and precision of EuroSCORE in the population of those patients undergone cardiac surgery in our department. Material and methods: We have analyzed the data of 1839 consecutive patients who had their operations between 1/January 2003 and 31/December 2005. We have compared the mortality rates predicted preoperatively by additive and logistic EuroSCORE with the actual 30-day mortality figures. On statistical analysis the discriminative accuracy of the methods has been defined with the use of C-statistics. The calibration and precision of the methods have been checked by the Hosmer–Lemeshow statistics. Results: The overall mortality rate in the above period was 3.3%. Additive and logistic EuroSCORE predicted 4.1 ± 2.8 and 4.5 ± 6.1%, consecutively. Based on the C-statistics the area below the Receiver Operating Characteristic curve has measured 0.699 (0.629–0.769) and 0.711 (0.642–0.779). The κ 2 value for the Hosmer-Lemeshow statistics has proved 6.5 ( p = 0.475) and 12.5 ( p = 0.131). Conclusion: Logistic EuroSCORE has appropriate discriminative power and satisfactory precision, whilst the accuracy of additive EuroSCORE only comes near to the acceptable level, but at the same time it has an adequate calibration value. These results suggest that logistic EuroSCORE is more suitable for the preoperative risk assessment of these patients.INTRODUCTION The objective of current study is the evaluation of the accuracy and precision of EuroSCORE in the population of those patients undergone cardiac surgery in our department. MATERIAL AND METHODS We have analyzed the data of 1839 consecutive patients who had their operations between 1/January 2003 and 31/December 2005. We have compared the mortality rates predicted preoperatively by additive and logistic EuroSCORE with the actual 30-day mortality figures. On statistical analysis the discriminative accuracy of the methods has been defined with the use of C-statistics. The calibration and precision of the methods have been checked by the Hosmer-Lemeshow statistics. RESULTS The overall mortality rate in the above period was 3.3%. Additive and logistic EuroSCORE predicted 4.1 +/- 2.8 and 4.5 +/- 6.1%, consecutively. Based on the C-statistics the area below the Receiver Operating Characteristic curve has measured 0.699 (0.629-0.769) and 0.711 (0.642-0.779). The kappa 2 value for the Hosmer-Lemeshow statistics has proved 6.5 ( p = 0.475) and 12.5 ( p = 0.131). CONCLUSION Logistic EuroSCORE has appropriate discriminative power and satisfactory precision, whilst the accuracy of additive EuroSCORE only comes near to the acceptable level, but at the same time it has an adequate calibration value. These results suggest that logistic EuroSCORE is more suitable for the preoperative risk assessment of these patients.