Background Conventional fluoroscopy guided catheter ablation (CA) is an established treatment option for ventricular arrhythmias (VAs). However, with the complex nature of most procedures, patients and staff bare an increased radiation exposure. Near-zero or zero-fluoroscopy CA is an alternative method which could substantially reduce or even eliminate the radiation dose. Our aim was to analyse procedural outcomes with fluoroscopy minimising approach for treatment of VAs in patients with structurally normal hearts (SNH) and structural heart disease (SHD). Methods Fifty-two (age 53.4 ± 17.8 years, 38 male, 14 female) consecutive patients who underwent CA of VAs in our institution between May 2018 and December 2019 were included. Procedures were performed primarily with the aid of the three-dimensional electro-anatomical mapping system and intra-cardiac echocardiography. Fluoroscopy was considered only in left ventricular (LV) summit mapping for coronary angiography and when epicardial approach was planned. Acute and long-term procedural outcomes were analysed. Results Sixty CA procedures were performed. Twenty-five patients had SHD-related VAs (Group 1) and 27 patients had SNH (Group 2). While Group 1 had significantly higher total procedural time (256.9 ± 71.7 vs 123.6 ± 42.2 min; p < 0.001) compared to Group 2, overall procedural success rate [77.4% (24/31) vs 89.7% (26/29); p = 0.20)] and recurrence rate after the first procedure [8/25, (32%) vs 8/27, (29.6%); p = 0.85] were similar in both groups. Fluoroscopy was used in 3 procedures in Group 1 where epicardial approach was needed and in 4 procedures in Group 2 where LV summit VAs were ablated. Overall procedure-related major complication rate was 5%. Conclusions Fluoroscopy minimising approach for CA of VAs is feasible and safe in patients with SHD and SNH. Fluoroscopy could not be completely abolished in VAs with epicardial and LV summit substrate location.

Summary Background Wound healing deficits and subsequent surgical site infections are potential complications after surgical procedures, resulting in increased morbidity and treatment costs. Closed-incision negative-pressure wound therapy (ciNPWT) systems seem to reduce postoperative wound complications by sealing the wound and reducing tensile forces. Materials and methods We conducted a collaborative English literature review in the PubMed database including publications from 2009 to 2020 on ciNPWT use in five surgical subspecialities (orthopaedics and trauma, general surgery, plastic surgery, cardiac surgery and vascular surgery). With literature reviews, case reports and expert opinions excluded, the remaining 59 studies were critically summarized and evaluated with regard to their level of evidence. Results Of nine studies analysed in orthopaedics and trauma, positive results of ciNPWT were reported in 55.6%. In 11 of 13 (84.6%), 13 of 15 (86.7%) and 10 of 10 (100%) of studies analysed in plastic, vascular and general surgery, respectively, a positive effect of ciNPWT was observed. On the contrary, only 4 of 12 studies from cardiac surgery discovered positive effects of ciNPWT (33.3%). Conclusion ciNPWT is a promising treatment modality to improve postoperative wound healing, notably when facing increased tensile forces. To optimise ciNPWT benefits, indications for its use should be based on patient- and procedure-related risk factors.

During cardiac surgery local hypothermia of the heart is used to slow down cellular metabolism. It has been shown by computer simulation that heart muscle is not uniformly cooled to the desired temperatures. The aim of our work was to find out a way for measuring the temperatures of the ventricular wall and the septum with ± 0.1^C accuracy. The measurement protocol should be applicable during operations on the human heart, during which disturbing factors should be minimized. We have tested the protocol and the equipment on porcine hearts. Two types of probes were tested, the contact-probe, which can be attached to the heart-wall surface, and the needle-probe, which can be inserted into the heart tissue. Before experiments the probes were calibrated and their heat transfer characteristics determined. We conclude that the probes and the protocol are suitable for studying the effects of cardioplegia, and for checking the results previously obtained by computer simulation.

Cardiogenic shock represents the leading cause of death in hospitalized patients with acute coronary syndromes. Immediate revascularization, either percutaneous or surgical, currently represents the only intervention of proven benefit. Despite the lack of such proof, intraaortic balloon pump (IABP) and vasoactive drugs are typically used to improve hemodynamic stability on top of revascularization. Mechanical circulatory support devices beyond IABP such as Impella, TandemHeart and venoarterial extracorporeal membrane oxygenation (VA ECMO) are hemodynamically even more effective. Despite the lack of proven survival benefit, this technology might be lifesaving in case of profound hemodynamic deterioration in the catheterization laboratory. We describe a case of profound cardiac shock due to complicated coronary artery disease, recurrent cardiac arrest during PCI, intraarrest PCI intra-aortic balloon pump insertion and successful resuscitation after venoarterial ECMO placement. Complete revascularization was achieved following ECMO insertion and patient was discharged home on day 29 with no neurological sequelae with ejection fraction of 40%. (C) 2014 The Czech Society of Cardiology. Published by Elsevier Urban & Partner Sp.zo.o. All rights reserved.

a b s t r a c t Cardiogenic shock represents the leading cause of death in hospitalized patients with acute coronary syndromes. Immediate revascularization, either percutaneous or surgical, currently represents the only intervention of proven benefit. Despite the lack of such proof, intraaortic balloon pump (IABP) and vasoactive drugs are typically used to improve hemodynamic stability on top of revascularization. Mechanical circulatory support devices beyond IABP such as Impella, TandemHeart and venoarterial extracorporeal membrane oxygenation (VA ECMO) are hemodynamically even more effective. Despite the lack of proven survival benefit, this technology might be lifesaving in case of profound hemodynamic deterioration in the catheterization laboratory. We describe a case of profound cardiac shock due to complicated coronary artery disease, recurrent cardiac arrest during PCI, intraarrest PCI intra-aortic balloon pump insertion and successful resuscitation after venoarterial ECMO placement. Complete revascularization was achieved following ECMO insertion and patient was discharged home on day 29 with no neurological sequelae with ejection fraction of 40%.

BACKGROUND AND AIM OF THE STUDY The study aim was to monitor serum troponin and plasma lactate concentrations in conventional aortic valve replacement compared to a beating-heart technique, perfused via the coronary sinus. METHODS In this prospective, non-randomized study, which was conducted between 2003 and 2009, a total of 35 patients was allocated to two groups, based on the method of myocardial protection. The groups did not differ significantly in terms of preoperative parameters. Levels of lactate were measured in all 35 patients, and of troponin I in 20 patients, in consecutive samples during and after surgery. RESULTS There was no in-hospital mortality and no serious complications among patients. The cardiopulmonary bypass and aortic cross-clamp times were each significantly shorter and lactate and troponin I concentrations higher, in the beating-heart group. No perioperative myocardial infarction was observed. CONCLUSION Although good clinical results were observed in patients operated when using the beating-heart technique with retrograde coronary sinus perfusion, postoperative serum levels of troponin I were higher than in patients operated on using a conventional technique. Although troponin I is considered a prognostic factor for postoperative mortality, this parameter applies only to selected patients rather than for widespread use.

Objectives: Aortic occlusion is one of the most important open discussions in minimally invasive cardiac surgery. Different techniques can be employed, and all have benefits and drawbacks. The objective of our work is to improve the safety of internal aortic occlusion with the Port Access technique, which employs an endoclamp balloon catheter. We propose a combined information and positioning system based on augmented reality technology and robotics in which the position of the balloon can be seen at all times and can be automatically controlled by a robotic actuator.Methods: The system was designed by a multidisciplinary team of engineers, medical doctors, and human factor specialists in a human-centered design approach. We measure the balloon position in real time with a magnetic tracking system. This position is superimposed on a 3-dimensional scan of the patient's thorax, with the balloon in the artery shown at all times. The position measurement is also used to control the robotic catheter inserter that places and maintains the balloon position at a specified target. The system was evaluated in 2 user studies that compared it with other visual aids.Results: The user tests have shown that the system effectively supports the surgeon in the placement task, with an increase in placement accuracy and a reduction in time compared with the current visualization technique. The users also rated the system as supporting them well.Conclusions: The clinical feasibility of the system was proved. The system provides better visualization and position control and can effectively increase the safety of the procedure. This system has the potential of making Port Access a more attractive technique.

S100B protein has been proposed to be a serum marker of cerebral injury in patients undergoing cardiac surgery. The question to be answered in the present study was whether an increase in serum S100B concentration after the surgery correlated with the length of hospital stay in patients undergoing coronary artery bypass grafting. To answer this question we measured serum S100B concentration preoperatively, at the end of the operation, and on day 1 and day 5 of the surgery in 32 patients undergoing coronary artery bypass grafting. The median (min; max) hospital stay was 7 days (5; 34), and serum S100B concentration was 0.075 mg/L (0.050;0. 095) preoperatively, 0.840 mg/L (0.390; 1.500) immediately after the operation, 0.180 mg/L (0.150;0. 280) on day 1 and 0.100 mg/L (0.080;0. 120) on day 5 of the operation. None of the patients had clinical signs of cerebral injury. Multivariate linear regression analysis indicated serum S100B concentration on day 1 (p = 0.0296) and day 5 (p = 0.0021) of the operation to correlate with the length of hospital stay independently of the type of operation (with or without the use of cardiopulmonary bypass) and patient clinical characteristics. Our data suggest that serum S100B concentration on day 1 and day 5 of the operation may have prognostic value in patients without clinical signs of cerebral injury. However, this pilot study should be extended to a larger group of patients to confirm this observation.

For a satisfactory computer simulation, a model, which imitates a natural situation, is needed. The Human heart is an irregular 3D object and thus difficult to reproduce. Basic data was taken from Visible Human Dataset (VHD), National Library of Medicine. The heart area was cut out of the original cross-sections and different tissues segmented. All the slices also had to be aligned to assure precise overlapping of the structures. A 3D computer heart model with the resolution of 1mm was designed. The heart model was dedicated to simulations of heat transfer during heart surgery however, it is applicable also to other medical simulations.

Topical cardiac cooling (TC) is often used in cardiac surgery. We used a computer simulation to study temperature changes in the heart, especially in the right ventricular wall. A three-dimensional computer heart model, derived from Visible Human Data set, National Library of Medicine was used. The model is made from cubes, with spatial resolution of 1mm. Explicit Finite Different method and temperature diffusion equation were used to calculate new temperatures. Three different simulations were performed and simulated temperatures were drawn on a cross-section of heart model in different colors. The results show that areas not immersed into TC solution are less protected against ischemia. It is important not to rely solely on topical cooling but use appropriate method of myocardial protection technique.

A local hypothermia is often used during cardiac operations to slow down the tissue metabolism. The heart is cooled down with cold cardioplegic solution. Sometimes even the topical cooling with or without ice slush is used. Different heart models have been used earlier to simulate heart temperature distribution, but the resolution of the model has always been limited by the speed of the computer. We used the computer heart model derived from Visible Human Dataset with the spatial resolution of 1 mm. In this article, the step-by-step generation of 3D computer heart model is described. The heat transfer was modeled by a diffusion equation that was discretised in space and time and solved by a parallel algorithm. Finally, the cooling of heart during an operation, with and without topical ice slush, was simulated on a cluster of 9 PC-based computers, which assured sufficient computing power. The simulated results are presented as images of cross sections in different planes with temperatures shown by different colors.