Tomasz Płonek

In Situ Revascularisation with Silver-coated Polyester Prostheses and Arterial Homografts in Patients with Aortic Graft Infection – A Prospective, Comparative, Single-centre Study

OBJECTIVE The aim of our study was to evaluate the effectiveness of in situ revascularisation with the use of arterial homografts and silver-coated prostheses in the treatment of aortic graft infection. MATERIALS A total of 77 consecutive patients (74 males, three females, mean age: 58 years), hospitalised between 2001 and 2008, were enrolled into the study. Patients were assigned to three groups: group 1 (n = 24)--fresh arterial homograft with subsequent immunosuppression, group 2 (n = 26)--fresh arterial homograft without immunosuppression and group 3 (n = 27)--silver-coated prosthesis. METHODS The course of infection was assessed by scintigraphy with (99m)Technetium-labelled leucocytes, Duplex-Doppler ultrasound, angio-computed tomography (CT) and microbiological examination. RESULTS The mean follow-up was 22.8 (±10.1) months. There was a significant decrease in leucocyte accumulation around the graft among all groups (group 1: p = 0.012, group 2: p = 0.006 and group 3: p = 0.021). The postoperative mortality rate in groups 1,2 and 3 was 8%, 23% and 11%, respectively. The postoperative morbidity was 35% in group 2, 16% in group 1 and 7% in group 3. CONCLUSION Our study suggests that silver-coated prostheses can be as effective as arterial allografts in the treatment of infections of vascular prostheses.

Fate of the dissected aortic arch after ascending replacement in type A aortic dissection

OBJECTIVES To evaluate the fate of a dissected aortic arch after limited surgical repair of type A aortic dissection. METHODS Of the 271 patients operated for acute type A dissection between 2001 and 2015, 86 (age 57 ± 13 years, 74% men) with predischarge computed tomographic (CT) scans had a residual dissection in the arch. Aortic diameters, lengths, ellipticity and communications between lumina were assessed using predischarge and follow-up CT scans. The median CT scan follow-up was 31 months (first quartile 15, third quartile 52). RESULTS The largest increase in the total aortic diameter at follow-up was 20 mm distal to the left subclavian artery (median +4.0 mm; first quartile +1.5, third quartile +9.2 mm; P  = 0.004), with an average growth rate of 1.5 mm/year (first quartile 0.6, third quartile 3.9 mm). The true lumen diameter was unchanged at follow-up. At least 1 communication between the true and the false lumina was observed in 80% of patients on the predischarge CT scan, and 70% had communications at the distal aorta-graft anastomosis. Accelerated increase in the diameter of the dissected aorta was associated with the number of communications between the lumina, communication at the distal anastomosis and false lumen perfusion (all, P  < 0.001). CONCLUSIONS Dissection of the residual aortic arch leads to aortic growth that may result in an aneurysm requiring treatment. The number of communications between the lumina, communication at the distal anastomosis and false lumen perfusion are associated with the accelerated aortic growth. Endovascular repair may be difficult due to the small true lumen and the presence of many communications between the lumina.

Porphyromonas gingivalis in periodontal pockets and heart valves

Background There is evidence that advanced infectious chronic periodontal inflammatory disease may have an impact on general health including cardiovascular diseases. The aim of this clinical study was to evaluate the ability of Porphyromonas gingivalis to colonize heart valves and, subsequently, to assess whether there is an association between the presence of the DNA of Porphyromonas gingivalis in periodontal pockets and in degenerated heart valves. Materials and Methods Thirty patients were enrolled in the study and 31 valve specimens harvested during cardiac surgery operations were examined. All patients underwent a periodontal examination. To evaluate the periodontal status of the patients the following clinical parameters were recorded: the pocket depth, bleeding on probing (BOP) and aproximal plaque index (API). The presence of P. gingivalis in heart valve specimens and samples from periodontal pockets was analyzed using a single–step PCR method. Results P. gingivalis DNA was detected in periodontal pockets of 15 patients (50%). However, the DNA of this periopathogen was found neither in the aortic nor in the mitral valve specimens. Conclusions This study suggests that P. gingivalis may not have an influence on the development of the degeneration of aortic and mitral valves.

Lack of adenovirus DNA in mediastinal adipose tissue of obese/overweight adults with cardiovascular disorders?

Mediastinal adipose tissue can be found on the anterior surface of pericardial sac below the remnants of the thymus. On the basis of previous studies describing adenoviruses (AdVs) as a causative factor of obesity, the causative relation between the presence of AdVs and an increased accumulation of mediastinal adipose tissue was studied. The study included 25 obese/overweight subjects with cardiac disorders. Specimens from fat deposits from the anterior mediastinum were collected during cardiac surgery procedures. Afterwards, PCR was used to detect AdV‐DNA. No AdV‐DNA could be detected in adipose tissue. An association between an excessive accumulation of mediastinal adipose tissue and an AdV‐infection in the development of accompanying cardiac disorders was excluded. J. Med. Virol. 86:802–805, 2014.

Inaccurate aortic stent graft deployment in the distal landing zone: incidence, reasons and consequences†

OBJECTIVES The aim of this study was to investigate the accuracy of stent graft deployment in the distal landing zone (LZ) during thoracic endovascular aortic repair (TEVAR). Currently, TEVAR focuses on accurate stent graft deployment in the proximal LZ. Data on landing in the distal LZ are lacking. METHODS Of 195 TEVAR patients (2005-16) with a non-dissected aortic pathology, 59 [median age 73 years (first quartile 68; third quartile 77), 20 women] patients had a distal LZ shorter than 40 mm. In all, the aim was to deploy the stent graft just above the target vessel (coeliac trunk, mesenteric superior or renal artery). Patients were divided into the accurate landing (n = 10) and inaccurate landing (IAL, n = 49) groups according to the distance to the target vessel ≤ 5 mm or > 5 mm after TEVAR, target vessel coverage and the need for a second stent graft in the distal LZ. We assessed the distal LZ, stent graft distance to the target vessel, apposition, migration and endoleak Ib on computed tomography. Median follow-up period was 23 months (5; 48). RESULTS Distal LZ anatomy did not differ between groups. Overall stent graft distance to the target vessel was 10.0 mm (6.5 mm; 16.0 mm). Three patients required a second stent graft in the distal LZ, and in 3 others, the target vessel was accidentally covered. In patients of the accurate landing group primary endoleak Ib occurred less frequently than those in the IAL group (0% vs 33%; P = 0.049). Three (30%) accurate landing and 19 (39%) IAL patients (P = 0.73) presented with substantial stent graft wedge apposition. CONCLUSIONS Accurate stent graft implantation in the distal LZ with the currently available deployment mechanism is often challenging. An inaccurate landing is associated with a higher incidence of endoleak Ib.

The use of minimally invasive videoscopic technique in large vessel and cardiac surgery. Does the potentially increased difficulty bring benefits to the patient

We present the clinical case of a 63-year-old patient who underwent in the Department of Cardiac Surgery implantation of an aorto-bifemoral graft prosthesis and coronary artery bypass revascularization with application of less invasive off-pump technique. Graft selection (arterial grafts, venous grafts) is very important during qualification for coronary artery bypass revascularization. Minimally invasive saphenous vein harvesting was performed during the presented case. The endoscopic technique of vein harvesting is a relatively rarely applied technique during myocardial revascularization surgery. The concept of minimally invasive videoscopic technique is presented. There is a discussion on why the team decided to prolong duration of the case consisting of two major operations performed simultaneously. Minimally invasive videoscopic technique may have a significant positive impact on postoperative outcome in a selected group of patients.

A comparison of aortic root measurements by echocardiography and computed tomography

Objectives The aim of the study is to evaluate an optimal way to assess the dimensions of the aortic root and each of the sinuses of Valsalva and examine how a single measurement in 1 plane (echocardiography or 2‐dimensional computed tomography) can underestimate the maximum dimension of the aortic root. Methods Computed tomography and transthoracic echocardiography images of the aortic root and ascending aorta of 112 patients were analyzed. The minimum and maximum aortic root dimensions, the root perimeter, and the total area of all 3 sinuses of Valsalva were measured on a plane perpendicular to the long axis of the aorta using 3‐dimensional multiplanar reconstruction. Moreover, the maximum root dimension was compared with the measurements obtained from the echocardiography and 2‐dimensional computed tomography angiography measurements. Results The difference in the measurements of the minimum and maximum root dimension was 5.4 ± 3.2 mm (range, 0‐21 mm, P < .0001) and was significantly larger in patients with bicuspid aortic valves compared with those with tricuspid valves (6.3 ± 4 mm, range, 0‐21 mm vs 4.9 ± 2.6 mm, range, 0‐15 mm, P = .036). The maximum root dimension measured in 3‐dimensional multiplanar reconstruction (49.1 ± 9.0 mm) differed significantly from the root dimension measured in transthoracic echocardiography in the parasternal long‐axis view (44.8 ± 8.4 mm) and 2‐dimensional computed tomography (axial plane: 45.5 ± 9.0 mm, coronal plane: 46.1 ± 8.8 mm, sagittal plane: 45.1 ± 8.9 mm) (P < .001). Conclusions The difference in the measurements of the minimum and maximum aortic root dimensions is significant and may exceed 20 mm, especially in patients with bicuspid aortic valves. Therefore, aortic root dimensions can be significantly underestimated with the measurement (echocardiography, computed tomography angiography) performed in only 1 plane.

Dilatation of aortic root in patients after kidney transplantation

INTRODUCTION Aortic root (AoR) dilation is associated with cardiac damage and higher cardiovascular risk. Cardiovascular disease is the most common cause of death in patients after kidney transplantation (KTx ). OBJECTIVES The aim of this study was to assess the prevalence of enlarged AoR diameter in KTx recipients. Patients with bicuspid aortic valve, significant valvular disease, or evidence of connective tissue disorder were excluded. PATIENTS AND METHODS A total of 87 KTx recipients were divided into 2 groups depending on immunosuppressive regimen: 41 patients receiving mammalian target of rapamycin inhibitors (mTORi) and 46 patients treated with calcineurin inhibitors (CNIs). In all patients, echocardiography was performed, laboratory and clinical markers of cardiovascular risk were assessed, and the AoR diameter was calculated. RESULTS There were no differences between groups in age, sex, body surface area, body mass index, frequency of diabetes, hypertension, dyslipidemia, time after replacement therapy, creatinine levels, and estimated glomerular filtration rate. In the CNI group, the observed and calculated AoR diameters were similar (P = 0.8). In the mTORi group, the observed AoR diameter was higher than the calculated one (P = 0.002). The concentric and eccentric left ventricular hypertrophy was similar in both groups (P = 0.12 and P = 0.69, respectively). In the stepwise regression analysis, the AoR diameter was associated with body surface area and mTORi treatment. CONCLUSIONS KTx recipients have a high prevalence of AoR dilation. Immunosuppressive regimen based on mTORi increases the incidence of AoR enlargement.

Wall stress correlates with intimal entry tear localization in Type A aortic dissection

OBJECTIVES The risk of aortic dissection should be assessed based not only on the aortic diameter, but also on other biomechanical parameters that have an impact on the stress in the aortic wall. This study evaluates very rare clinical scenarios of patients with both pre- and post-dissection computed tomography (CT) images and evaluates whether an increased wall stress correlates with the localization of an intimal entry tear in Type A aortic dissection. METHODS CT-angiography images of 4 patients performed shortly prior to and after developing Type A aortic dissection were evaluated. The stress distribution in the pre-dissection aortas was evaluated using the finite elements method. Then, the areas of high stress in the pre-dissection aortas were compared to the localization of the intimal entry tears in the dissected vessels. RESULTS In all the patients, the pre-dissection areas of high wall stress correlated with the location of the intimal tears. The highest stress was not observed in the most dilated segments of the aorta but was predominantly found in the areas of an abrupt change in the geometry of the aorta. CONCLUSIONS Wall stress can indicate the areas susceptible to the formation of an intimal tear and subsequent aortic dissection. Stress analysis may be a valuable tool to predict the risk of aortic dissection in patients with aortic dilatation.

Role of vascular endothelial growth factor in inducing production of angiopoetin-1 - in vivo study in Fisher rats

The aim of the study was to investigate how an intramuscular injection of plasmids with genes coding various pro-angiogenic factors: angiopoetin-1 (ANGPT1), vascular endothelial growth factor (VEGF165) and hepatic growth factor (HGF), influences the production of ANGPT1. 40 Healthy Fisher rats received i.m. injections containing plasmids encoding pro-angiogenic genes in thigh muscles. They were divided into four equal groups. The first group received the plANGPT1 plasmid and the second group- the pIRES/ANGPT1/VEGF165 bicistronic plasmid. The pIRES/VEGF165/HGF bicistronic plasmid was administered to the third group and an empty plasmid (control group) to the fourth group. The animals were euthanized after 12 weeks. In each group, the number of vessels stained with the anti-ANGPT1 antibody was assessed under an optical microscope. The anti-ANGPT1 antibodies stained the vessels in all the groups. There were on average 14.1 ±2.3 vessels in the the plANGPT1 group, 32.5 ±10.5 in the pl/RESANGPT1/VEGF group and 30.8 ±13.3 in the plRES/HGV/VEGF group. There were on average 7.3 ±2.3 stained vessels (p < 0.0001) in the control group . The VEGF plays a role in the induction of the production of ANGPT1. The administration of plasmids only encoding ANGPT1 does not induce its production.