BACKGROUND:Cardiac arrest in children is associated with high morbidity and mortality, primarily due to neurological injury. Biomarkers linked to brain injury, released into circulation from compromised elements of the neurovascular unit, act as significant prognostic indicators in patients suffering from hypoxic-ischemic brain injury (HIBI) subsequent to the restoration of spontaneous circulation (ROSC) after pediatric cardiac arrest. The aim of this systematic review and meta-analysis is to evaluate the prognostic utility of brain injury biomarkers in predicting neurological outcomes and survival in patients following cardiac arrest in the pediatric population. METHODS:Bibliographic databases (PubMed, the Cochrane Library, and Embase) were searched from their inception to November 2024. A random-effect model was used for all analyses. RESULTS:Our meta-analysis demonstrates significant associations between various biomarkers and survival or neurological outcomes after cardiac arrest. Neuron-specific enolase (NSE) levels were consistently elevated in non-survivors and patients with unfavorable neurological outcomes, with pronounced differences observed on Days 2 and 3 (e.g., Day 3 mean difference: -88.48, 95%CI: -146.77 to -30.19, P = 0.003). Emerging biomarkers, including UCH-L1 and GFAP, showed striking differences, such as elevated UCH-L1 levels on Day 1 (mean difference: -415.41, 95%CI: -474.41 to -356.61, P < 0.001) and GFAP levels exceeding 4000 ng/mL in non-survivors on Day 2 (P < 0.001). CONCLUSIONS:Our findings underscore the significant prognostic value of biomarkers in predicting survival and neurological outcomes following cardiac arrest. Neuron-specific enolase (NSE) consistently demonstrated its reliability across multiple time points, while emerging biomarkers like UCH-L1 and GFAP showed promising potential for early outcome stratification.

This position paper, jointly authored by the Polish Society of Cardiothoracic Surgeons and the Heart Rhythm Association of the Polish Society of Cardiology, defines the role of hybrid approaches in the treatment of cardiac arrhythmias, particularly atrial fibrillation. We present a rationale for integrating epicardial and endocardial ablation strategies, summarize current evidence, and advocate for multidisciplinary planning, including arrhythmia treatment during cardiac surgery for other indications and atrial fibrillation treatment as a stand-alone procedure. The paper highlights the importance of minimally invasive approaches, the need for heart team-based planning, structured curricula, and postoperative referral pathways for comprehensive management of atrial fibrillation and non-atrial fibrillation arrhythmias.

Introduction: Malnutrition is a recognized risk factor for unfavorable clinical outcomes and complications in cardiovascular and surgical patients. Nutritional status can be assessed with various methods, and the phase angle (PA) derived from bioelectrical impedance analysis is one of the most reliable parameters for that purpose. Methods: The aim of this narrative review was to present the available data regarding PA application in cardiac surgery. After careful analysis of PubMed and Scopus databases, 21 articles were included in the final analysis. Results: PA is a parameter that can be used for nutritional status assessment in a cardiac surgery environment. It is suggested that it is more accurate than other criteria in malnutrition identification in this group of patients. The available data shows its association with mortality, length of intensive care unit stay, and hospital stay. It can also predict adverse events such as blood transfusion or mechanical ventilation. Conclusions: The available data underscores the usefulness of PA in preoperative risk assessment and post-procedural monitoring. PA could be introduced in everyday clinical assessment in cardiac surgery.

Graphical abstract of study design and major results.Image 1

Introduction Lactate levels have been recognized as a reliable tool for monitoring critically ill patients requiring venoarterial extracorporeal membrane oxygenation (VA ECMO) or venovenous extracorporeal membrane oxygenation (VV ECMO) but the reasons behind the overproduction of lactate are different and the influance for survival remains controversial. We analyzed the lactate values and lactate clearance in adult patients in these two forms of extracorporeal support. Methods Patient demographics, ECMO duration, 30-day mortality, lactate values and lactate clearance at 24, 48 and 72 h from ECMO initiation of patients supported with VV and VA ECMO at Silesian Centre for Heart Deasese, between January 2011 and April 2020 were retrospectively analyzed. The changes in lactate levels were analyzed using the non-parametric U Mann-Whitney tests and Chi-square test. The ROC curves were draw and the area under the curve was calculated. Results The study comprised 91 adult patients, Mortality in the first 30 days from initiation of VV and VA ECMO was 39% and 66%, respectively. Lactate levels were significantly higher in non-survivors that received VV and VA ECMO ( p < .001), while lactate clearance was similar ( p = .256 and p = 1.000, respectively). Survival curves for patients with elevated (>2.0 mmol/L) vs normal (≤2.0 mmol/L) lactate levels at 72 h were significantly different for VV ECMO ( p = .007) and VA ECMO ( p = .037) but in both groups of ECMO, lactate levels above 2.0 mmol/L at 72 h from ECMO initiation predicted 30 day-mortality. Conclusion This results emphasized the importance of lactate levels below 2.0 mmol/L at 72 h from both VV and VA ECMO initiation.

Lipoprotein(a) is a recognized risk factor for ASCVD. There is still no targeted therapy for Lp(a), however, drugs such as pelacarsen, olpasiran, zerlasiran, lepodisiran and muvalaplin are in clinical trials and have been shown to be effective in significantly reducing Lp(a) levels. Moreover, elevated Lp(a) levels significantly affect the prognosis of patients after aortic valve replacement (AVR) and heart transplantation (HTx). Therefore, the assessment of Lp(a) concentration in these patients will allow for a more accurate stratification of their cardiovascular risk, and the possibility of lowering Lp(a) will allow for the optimization of this risk. In this article, we summarized the most important information regarding the role of Lp(a) and lipid-lowering treatment in patients after AVR and HTx.

Heart failure is a multifaceted and life-threatening syndrome characterized by significant morbidity and mortality, low functional capacity and quality of life, and high costs. Despite the numerous limitations and imperfections of immunosuppression, heart transplantation allows patients to return to full physical, family and professional activity, prolonging life on average by over 14 years. Unfortunately, the growing number of patients waiting for a new organ is disproportionately greater than the number of reported heart donors — hence the constant search for alternative solutions for the most severely ill patients. Statins, which are the basis of pharmacological primary and secondary cardiovascular prevention, significantly improve the prognosis of patients after heart transplantation and prolong their life. Recently, there has been a renewed interest in heart xenotransplantation and the use of various genetic modifications to extend the life of the xenograft. This article discusses the current state of knowledge in the field of heart transplantation, the role of statins in this group of patients, mechanical circulatory support and the advantages and disadvantages of xenotransplantation of this organ.

Lipid disorders have been the most common cause of atherosclerotic cardiovascular diseases in Poland for years. The latest data indicate that about 20 million people in Poland have hypercholesterolemia. Nutritional habits have a very significant impact on the lipid profile. Therefore, taking into account the fact that coffee is an important component of the diet of Poles (on average, 1–2 cups of coffee are consumed in our country per inhabitant per day, and 66% of Poles declare regular consumption), its impact on the lipid profile cannot be overlooked. Coffee contains over 1000 chemical compounds, of which kahweol and cafestol are the most important in the context of lipidology. These are compounds that can have a hyperlipidemic effect. On the other hand, compounds such as caffeine, chlorogenic acid, trigonelline, and melanoidins are characterized by antioxidant activity, which can limit lipid peroxidation. The effect of consuming coffee prepared in different ways has been analyzed in numerous clinical studies. This article summarizes the current knowledge on the effects of coffee on the lipid profile and risk of atherosclerosis.

Nadciśnienie tętnicze i demencja stanowią istotny problem współczesnej medycyny. Wśród wielu czynników ryzyka rozwoju zaburzeń funkcji poznawczych, szczególnie u osób w średnim wieku, znajduje się nadciśnienie tętnicze. Związek między nadciśnieniem tętniczym a zaburzeniami funkcji poznawczych jest złożony i nie ogranicza się jedynie do zwiększonego ciśnienia tętniczego, ale obejmuje także ciśnienie tętna, prędkość fali tętna, zmienność ciśnienia tętniczego oraz hipotonię ortostatyczną. Leki przeciwnadciśnieniowe są jedynymi znanymi lekami, które mogą zmniejszać ryzyko wystąpienia demencji. Szczególną rolę w prewencji zaburzeń funkcji poznawczych pełnią antagoniści wapnia (amlodipina) oraz sartany (walsartan). Leki te charakteryzują się korzystnym wpływem na wszystkie istotne w prewencji demencji czynniki związane z kontrolą ciśnienia tętniczego. Co więcej, są korzystne w prewencji udaru mózgu, który jest ważnym czynnikiem ryzyka demencji. Możliwość stosowania amlodipiny w połączeniu z walsartanem w postaci jednej tabletki dodatkowo zwiększa przestrzeganie zaleceń terapeutycznych, co przekłada się na lepszą kontrolę ciśnienia tętniczego i w konsekwencji na lepszą prewencję zaburzeń funkcji poznawczych. W niniejszym artykule podsumowano związek między nadciśnieniem tętniczym i jego leczeniem, ze szczególnym uwzględnieniem amlodipiny i walsartanu, a ryzykiem zaburzeń funkcji poznawczych.

INTRODUCTION Transcatheter aortic valve-in-valve implantation (ViV-TAVI) has emerged as an alternative to redo surgery in patients with failed surgical aortic bioprosthesis. OBJECTIVES We evaluated the safety and efficacy of ViV-TAVI in Polish patients after surgical aortic valve replacement. PATIENTS AND METHODS This was a nationwide multicenter registry of ViV-TAVI procedures. Data were collected using an online form, and the clinical follow-up lasted 1 year. RESULTS From 2008 to 2020, 130 ViV-TAVI procedures were performed (1.9% of all transcatheter aortic valve implantation [TAVI] cases). A considerable increase in ViV-TAVI procedures since 2018 has been observed (n = 59, 45% of ViV-TAVI cases). Hancock II, Freestyle, and homograft were the most frequently treated bioprostheses. The self-expanding supra-annular Corevalve / Evolut valve was used in 76% of cases. In 21% of cases, the mean postprocedural pressure gradient (PG) exceeded 20 mm Hg. All-cause mortal-ity at 1 year was 10.8%. Aortic valve stenosis was associated with a higher mean PG than aortic valve regurgitation or mixed disease (P = 0.004). Supra-annular transcatheter aortic valves were associated with lower mean PGs than intra-annular valves (P = 0.004). Second-generation devices were associated with shorter procedure time (120 min vs 135 min, P = 0.04), less frequent need for additional TAVI (2% vs 10%, P = 0.04), and lower 1 -year cardiovascular mortality (95% vs 82.8%, P = 0.03) than first-generation valves. CONCLUSIONS Transcatheter treatment of failed bioprostheses is increasingly common, with the best hemodynamic effect shown for supra-annular valves. The introduction of second-generation valves has improved procedural and clinical outcomes.

Background Data concerning the comparison between transcatheter aortic valve implantation and surgical aortic valve replacement in a real-world setting are scarce and in Central and Eastern Europe no such data exist. In this study, we aimed at analyzing retrospectively the characteristics and outcome of patients with aortic stenosis treated either with surgical aortic valve replacement or transcatheter aortic valve implantation between 2006 and 2016 in the Silesian Province, Poland in a representative real-world cohort. Methods In the Silesian Cardiovascular Database we retrospectively identified 5186 patients who received either transcatheter aortic valve implantation or surgical aortic valve replacement in 1 of 3 tertiary cardiovascular centers. Baseline characteristics, including relevant clinical history, and outcomes were compared before and after propensity-score matching of both groups, with 348 pairs of patients constituting the propensity-matched study cohort. The primary end-point was 24-month all-cause mortality. Results Preoperative characteristics of propensity-matched groups were similar. There was no difference between transcatheter aortic valve implantation and surgical aortic valve replacement groups with respect to the death rate at 2 years (19.9% vs. 15.6%; P = .479). In the transcatheter aortic valve implantation group, cardiac resynchronization therapy devices were more frequently implanted after the procedure (3.7% vs. 0.0, P < .001). The groups had similar rates of myocardial infarction, stroke, and re-hospitalization. Hospital stay in the matched groups was shorter after transcatheter aortic valve implantation: 14.1 versus 15.7 days (P < .001). Conclusions At 24 months, transcatheter aortic valve implantation patients had similar outcomes as surgical aortic valve replacement except for a higher rate of cardiac resynchronization therapy device implantation and shorter hospital stay.

Objectives:Although endorsed by international guidelines, complete revascularization (CR) with Coronary Artery Bypass Grafting (CABG) remains underused. In higher-risk patients such as those with pre-operative atrial fibrillation (AF), the effects of CR are not well studied. Methods:We analyzed patients' data from the HEIST (HEart surgery In AF and Supraventricular Tachycardia) registry. Between 2012 and 2020 we identified 4770 patients with pre-operative AF and multivessel coronary artery disease who underwent isolated CABG. We divided the cohort according to the completeness of the revascularization and used propensity score matching (PSM) to minimize differences between baseline characteristics. The primary endpoint was all-cause mortality. Results:Median follow-up was 4.7 years [interquartile range (IQR) 2.3-6.9]. PSM resulted in 1,009 pairs of complete and incomplete revascularization. Number of distal anastomoses varied, accounting for 3.0 + -0.6 vs. 1.7 + -0.6, respectively. Although early (< 24 h) and 30-day post-operative mortalities were not statistically different between non-CR and CR patients [Odds Ratio (OR) and 95% Confidence Intervals (CIs): 1.34 (0.46-3.86); P = 0.593, Hazard Ratio (HR) and 95% CIs: 0.88 (0.59-1.32); P = 0.542, respectively] the long term mortality was nearly 20% lower in the CR cohort [HR (95% CIs) 0.83 (0.71-0.96); P = 0.011]. This benefit was sustained throughout subgroup analyses, yet most accentuated in low-risk patients (younger i.e., < 70 year old, with a EuroSCORE II < 2%, non-diabetic) and when off-pump CABG was performed. Conclusion:Complete revascularization in patients with pre-operative AF is safe and associated with improved survival. Particular survival benefit with CR was observed in low-risk patients undergoing off-pump CABG.

Abstract Background In Poland, the clinical characteristics and outcomes of patients with COVID-19 requiring extracorporeal membrane oxygenation (ECMO) remain unknown. This study aimed to answer these unknowns by analyzing data collected from high-volume ECMO centers willing to participate in this project. Methods This retrospective, multicenter cohort study was completed between March 1, 2020, and May 31, 2021 (15 months). Data from all patients treated with ECMO for COVID-19 were analyzed. Pre-ECMO laboratory and treatment data were compared between non-survivors and survivors. Independent predictors for death in the intensive care unit (ICU) were identified. Results There were 171 patients admitted to participating centers requiring ECMO for refractory hypoxemia due to COVID-19 during the defined time period. A total of 158 patients (mean age: 46.3 ± 9.8 years) were analyzed, and 13 patients were still requiring ECMO at the end of the observation period. Most patients (88%) were treated after October 1, 2020, 77.8% were transferred to ECMO centers from another facility, and 31% were transferred on extracorporeal life support. The mean duration of ECMO therapy was 18.0 ± 13.5 days. The crude ICU mortality rate was 74.1%. In the group of 41 survivors, 37 patients were successfully weaned from ECMO support and four patients underwent a successful lung transplant. In-hospital death was independently associated with pre-ECMO lactate level (OR 2.10 per 1 mmol/L, p = 0.017) and BMI (OR 1.47 per 5 kg/m2, p = 0.050). Conclusions The ICU mortality rate among patients requiring ECMO for COVID-19 in Poland was high. In-hospital death was independently associated with increased pre-ECMO lactate levels and BMI.

IntroductionAccording to single institution studies, patients readmitted to the ICU (Intensive Care Unit) following cardiac surgery are at high risk of death. In our study, we primarily aimed to assess the impact of ICU readmission on postoperative results and to identify the independent risk factors of this complication among patients undergoing isolated coronary artery surgery.Material and methodsFollowing exclusions, we analyzed 89,958 consecutive patients in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry), scheduled for isolated coronary artery surgery between January 2010 and December 2019. Variables that independently influenced ICU readmission were identified by means of the multivariable logistic regression. Data of survivors and non-survivors among patients readmitted to the ICU were compared.ResultsIn the analyzed group, 1,003 patients underwent ICU readmission (1.1%). In-hospital mortality among patients readmitted and not readmitted to the ICU was 29.6% and 2.1%, respectively (p<0.001). All postoperative complications were more frequent among patients readmitted to the ICU. Overall, 15 independent predictors of ICU readmission were identified, and conversion to on-pump procedure, age>65 years and preoperative NYHA class III or IV were located on the top of this list. Patients who died following ICU readmission were older, more frequently classified NYHA IV, more frequently underwent non-elective surgery or MIDCAB (Minimally Invasive Coronary Artery Bypass).ConclusionsICU readmission following coronary artery surgery is associated with increased in-hospital mortality and the development of postoperative complications. There are many predictors of ICU readmission. Non-survivors of this complication were older, with more advanced heart failure and more frequently underwent non-elective surgery.

BACKGROUND:This study aimed to assess long-term results after surgical AVR (sAVR) depending on the used surgical technique (ministernotomy vs. full sternotomy) and to determine which patient- and treatment-related attributes were most associated with shorter time to the main endpoint.METHODS:Out of 2147 patients, who underwent sAVR from January 2006 to December 2017, 615 patients were treated minimally invasively (MIAVR) and 1532 patients received conventional full sternotomy aortic valve replacement (FSAVR). Multiple Cox regressive models corresponding to the four major endpoints were developed. Long-term survival and a time to re-hospitalization for acute coronary syndrome, stroke, and heart failure (HF) were analyzed independently. Kaplan-Meier actuarial analysis was performed for univariate comparison.RESULTS:The median follow-up time was 71.9 months. No significant difference in terms of long-term survival was found between MIAVR and FSAVR (hazard ratio [HR], 0.99; P = 0.91). Novel advantages of MIAVR in preventing re-hospitalization for late cerebrovascular events and the progression of HF were observed (HR, 0.53; P = 0.03; HR, 0.64, P = 0.005; respectively). Importantly, for the late mortality risk, early in-hospital complications dominated. However, the baseline atrial fibrillation (AF), diabetes, pulmonary disease, and impaired mobility showed the strongest patient-specific prediction for the other three long-run models.CONCLUSIONS:MIAVR through ministernotomy provides at least as good long-term survival as FSAVR. Nevertheless, it should be recommended for diabetic, poor-mobility patients with pre-existing AF to reduce their high cerebrovascular risk and to limit the progression of HF. MIAVR also needs to be considered in patients with chronic lung diseases to improve their extremely poor survival prognosis.