Introduction Stanford A acute aortic dissection is a life-threatening condition. The severity of the disease and delayed diagnosis or surgery contribute to high mortality rates. However, improvements in the diagnostic process and treatment process have been introduced in recent years. Aim of the research This study aims to evaluate recent results of treatment and clinical characteristics of patients hospitalised due to acute aortic dissection type A, classified according to the Stanford classification. Material and methods A retrospective analysis of a single-centre registry was performed, involving 55 patients admitted with acute aortic dissection type A as per the Stanford classification. Clinical characteristics of admitted patients and in-hospital outcomes were assessed. Results Men accounted for 74.5% of the analysed population. Admitted women were older than men (median: 70.5 vs. 58 years; p = 0.010). The median ascending aortic diameter was 48 mm. Arterial hypertension (HA) was reported in 30.9% of patients, and 41.2% of them were on pharmacotherapy for HA. Elevated blood pressure values at admission were observed in 27.3% of patients, of whom only 26.7% had a documented history of hypertension. All admitted patients were qualified for emergency cardiac surgery. Supracoronary aortic grafting procedure was performed in 57.4% of patients, and the Bentall procedure was performed in 42.6%. In-hospital mortality was recorded at 21.8% of cases, of which 58.3% were intraoperative deaths. Conclusions The perioperative mortality for acute aortic dissection type A, as per Stanford classification, remains high despite diagnostic and surgical advancements. Uncontrolled arterial hypertension is associated with dissection risk even in moderately enlarged aortas.
Aims The aim of the Jurasz Lipid Study was to provide real-world evidence on lipid profile testing, as well as the prevalence of lipid-lowering therapy (LLT) in consecutive patients hospitalized in a tertiary multi-specialist hospital in Poland. Methods and Results A total of 40,646 patients were hospitalized across all analyzed departments. The majority of patients hospitalized in the cardiology and neurology departments underwent lipid profile evaluation (93.6% and 95.0%, respectively), while it was rarely performed in surgical department (14.9%). Patients receiving LLT, compared with untreated patients, more frequently had a history of atherosclerotic cardiovascular disease (ASCVD) and lipid profile testing. The prevalence of LLT use ranged from 0.1% in pediatrics to 35.1% in vascular surgery, 37.1% in neurology, up to 65.7% in cardiology and 69.1% in the cardiac surgery department. Statin monotherapy remained the standard of care, with atorvastatin and rosuvastatin being the most frequently used agents. The proportion of patients receiving high-intensity statin therapy ranged from 29.2% in neurology to 71.7% among ASCVD patients in cardiology. The combination of a statin with ezetimibe was used in up to 36.1% of ASCVD patients hospitalized in cardiology. Other LLT combinations were rarely observed. Conclusion Lipid profile evaluation was routinely performed by cardiologists and neurologists, but rarely ordered by surgeons. The majority of patients with ASCVD were treated with LLT, but only up to 29.4% achieve treatment goals. Statin monotherapy remained the cornerstone of LLT. Statin with ezetimibe was the most common therapeutic combination.
Background:We conducted a technical feasibility and safety study of intraureteric renal negative pressure treatment (rNPT) in patients with chronic kidney disease undergoing elective cardiac surgery with cardiopulmonary bypass. Methods:After written informed consent, 10 patients with preoperative estimated glomerular filtration rate of 15 to 59 mL/min per 1.73 m2 were enrolled at 3 sites. At the end of surgery, a urologist advanced a specialized ureteral catheter into each renal pelvis under radiographic guidance. Intra.renal negative pressure of -15 mm Hg was initiated postoperatively and continued for 24 hours. Patients were followed up on postoperative days 14 and 28. Results:Three patients had major protocol deviations with primary catheter misplacement; acute kidney injury developed in 1 of these. Bilateral renal pelvis catheters were deployed per protocol in 7 patients. All patients had microhematuria; 2 had transient hematuria. In the per-protocol group, acute kidney injury developed in 1 patient with stage 4 chronic kidney disease. No patient suffered any other major adverse event. Serum creatinine concentration remained normal in 6 patients at 72 hours; and in 5 patients, estimated glomerular filtration rate had improved from baseline at 28 days. Conclusions:rNPT is feasible after cardiac surgery. If catheter placement protocol is strictly followed, it is associated with minimal patient risk and potential benefit. A controlled study (NCT07017933) is in progress to evaluate rNPT started before cardiopulmonary bypass and continued postoperatively. ClinicalTrialsgov identifier:NCT05990660.
Introduction:Heart rate variability (HRV) is widely used to assess parasympathetic influence on cardiac function and has proven useful in evaluating long-term autonomic effects of cardioneuroablation (CNA). However, HRV has not yet been used intraoperatively to quantify dynamic, short-term changes in parasympathetic tone. Rapid atrial pacing (AP) is expected to provoke a brief parasympathetic reaction, but no standardized method exists to assess this response in real time during electrophysiological procedures. Aims:To evaluate HRV changes induced by rapid AP using RMSSD and the maximal-minimal PP interval difference (ΔPP), and to assess the feasibility of repeated intraoperative monitoring. Methods:This prospective observational study enrolled 50 patients (median age 39 years [IQR 31-52]) without structural heart disease referred for electrophysiological study. RMSSD and ΔPP were calculated from four PP intervals before pacing and reassessed immediately after 30-s atrial pacing at 100 bpm. Heart rate, Sinus node recovery time, cSNRT and Wenckebach point were also measured. All measurements were repeated 2 minutes later. Results:Rapid AP produced a significant increase in RMSSD (15.7 ms [9.7-23.7] vs. 41.7 ms [25.6-59.6], p < 0.001) and ΔPP (33 ms [19-56] vs. 90 ms [60-152], p < 0.001). The response was reproducible in the second pacing sequence (RMSSD 13.6→41.0 ms; ΔPP 24→107 ms; both p < 0.001; Wilcoxon signed-rank test with Bonferroni correction). HRV changes occurred independently of sinus cycle length modifications. No significant differences were observed in SNRT, cSNRT, or Wenckebach point. Conclusion:Rapid AP evokes a robust, repeatable parasympathetic response detectable using ultra-short HRV metrics-expressed as an increase in RMSSD and ΔPP. These parameters allow real-time intraoperative assessment of parasympathetic influence on the sinus node. This approach warrants validation in future studies involving CNA, atropine challenge, and ECVS.
Matrix metalloproteinase-8 (MMP-8), a neutrophil-derived collagenase responsible for the degradation of type I and III collagen, is involved in extracellular matrix remodeling, which may contribute to the destabilization of atherosclerotic plaques and thereby promote the development and progression of coronary artery disease (CAD). Single-nucleotide polymorphisms (SNPs) in the MMP-8 gene may influence the expression and activity of this enzyme, potentially affecting disease risk, clinical manifestation, and long-term prognosis. The study group included 259 patients diagnosed with CAD and 239 control blood donors. Genotyping of MMP-8 polymorphisms (rs1940475 and rs11225395) was performed using TaqMan PCR. MMP-8 gene polymorphisms showed no association with CAD risk, disease severity, or patient survival at the 5- or 10-year follow-up. All studied polymorphisms are located within the same haplotype block, where commonly co-inherited alleles (T rs1940475 and A rs11225395) may exert opposing functional effects. In conclusion, these findings suggest no significant role of the analyzed MMP-8 gene variants in CAD susceptibility or prognosis in the studied group.
