Kemešytė, Karolina

INTRODUCTION While heart transplantation remains the gold standard for end-stage heart failure (HF), its broad implementation in Europe faces limitations due to a stable donor base of approximately 2000 transplants annually. Left ventricular assisted devices (LVADs) have evolved from a temporary solution to a long-term therapeutic option, providing an alternative to transplantation. However, the relationship between laboratory and echocardiographic parameters and HF aetiology, especially in ischaemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM), remains uncertain.

AIM The aim of this study was to examine the clinical differences between ICM and DCM patients before HeartMate 3 (HM3) implantation at our institution.

METHODS This retrospective cohort study involved patients undergoing HM3 implantation at an academic center from March 2017 to November 2023. All necessary examinations were initiated following recent European Society of Cardiology guidelines. Prior to LVAD implantation, 2D transthoracic echocardiography and pulmonary artery catheterization for hemodynamic parameter measurement were conducted. Demographic information and laboratory data were systematically collected. Cardiopulmonary bypass time was obtained from surgical protocols. Patients were categorized based on the aetiology of heart failure into two groups: 1. ICM - 11 patients, and 2. DCM - 6 patients. Statistical analysis was conducted using SPSS statistical software.

RESULTS The study cohort comprised 94% men, with a mean age of 58 years (range: 27-67) at the time of HM3 implantation. Table 1 illustrates the distribution of preoperative and surgical parameters among the study groups. Laboratory parameters did not differ significantly between both groups, with patients exhibiting elevated NT-proBNP in both aetiologies. Echocardiography conducted before implantation revealed severely impaired left and right ventricular function, along with dilatation observed in all heart chambers for both groups. Notably, post-HM3 implantation echocardiography demonstrated a more significant increase in left ventricular ejection fraction in ICM patients compared to DCM patients (36 [16; 59] % vs. 9 [6; 14] %, respectively; p=0.036).

CONCLUSIONS While no significant differences were observed in preoperative laboratory parameters, both ischemic cardiomyopathy and dilated cardiomyopathy groups presented as end-stage heart failure patients eligible for HeartMate 3 implantation. The notable increase in left ventricular ejection fraction seen in ICM warrants further investigation in larger and more diverse cohorts to validate and expand upon these findings.

INTRODUCTION Global heart donor scarcity compels patients with advanced end-stage heart failure, ineligible or awaiting transplantation, to turn to mechanical circulatory support. Despite a nearly twofold increase in left ventricular assisted device (LVAD) adoption over the past decade, this group still faces elevated early postoperative mortality and morbidity rates. While LVAD therapy improves survival, the specific preoperative variables influencing outcomes remain unknown, necessitating comprehensive investigation.

AIM The aim of this study was to clarify the most likely preoperative echocardiographic, perioperative, and general patient characteristics that may predispose to postoperative mortality after the HeartMate 3 (HM3) implantation.

METHODS This retrospective cohort study involved patients undergoing HeartMate 3 (HM3) implantation at an academic centre between March 2017 and November 2023. All required examinations were initiated, and the decision to implant HM3 adhered to the recent guidelines outlined by the European Society of Cardiology (ESC). Prior to LVAD implantation, 2D transthoracic echocardiography, pulmonary artery catheterization to measure hemodynamic parameters were conducted. Demographic information, and laboratory data were systematically collected. Cardiopulmonary bypass time was extracted from surgical protocols. Patients were divided into two groups according survival status (non-survivors – 9 pts., survivors – 11 pts.).

RESULTS Of the patient cohort, 85% were male, and the mean age was 56 (27-67) years at the time of HM3 implantation. The distribution of preoperative and surgical parameters among the study groups are shown in Table 1. For non-survivors’ patients, the follow-up period was 40 days, there was four cases for in-hospital-mortality. Analysis revealed that individuals who did not survive exhibited higher body mass index (23.9 [22.6; 24.7] kg/m² vs. 29.4 [25.4; 31.5] kg/m²; p=0.007), elevated serum creatinine levels (83.0 [65; 115] μmol/L vs. 124.0 [110; 163] μmol/L; p=0.007), increased central venous pressure (9 [7; 17] mmHg vs. 27 [14; 30] mmHg; p=0.03), and prolonged cardiopulmonary bypass time (102 [82; 111] min vs. 123 [104; 128] min; p=0.011). No statistical significance was observed between the two groups in other parameters. Additionally, both groups exhibited severely impaired left and right ventricular function, with dilatation observed in all heart chambers. Notably, right ventricular diameter tended to be more elevated among non-survivors.

CONCLUSIONS Comorbidities such as renal impairment, obesity, congestion, and prolonged cardiopulmonary bypass time have emerged associated of mortality following LVAD implantation. Nevertheless, it is imperative to recognize limitations inherent in this research, notably its retrospective nonrandomized design and the analysis of a limited number of patients from a singular institution.

Introduction (case reports only) Lyme carditis is a rare complication of Lyme disease with a prevalence of 0.3- 4.0 percent in untreated adults. Clinical signs of Lyme carditis can be observed approximately after 1-2 months following the manifestation of the erythema migrans rash. Most commonly Lyme carditis presents with some degree of AV block. Case description (case reports only) A 57 year old female was admitted to LUHS Kaunas Clinics with the heart rate ~ 40 beats per minute. Patient had 1 week history of dyspnea on exertion, chest and epigastric pain, heart palpitations. Laboratory tests were in normal range including troponin. ECG showed a 2nd degree, type II AV block and 0,5 mm ST elevation in III, Avf (nonspecific). Treatment with sol. Salbutamoli 1000 mcg iv was started. Patient was investigated for possible causes of the blockade: heart ultrasound showed II° mitral regurgitation and IIº tricuspid regurgitation; coronarography showed no stenosis in the coronary arteries. Women revealed that 2 months ago she spotted a dynamically spreading rash on her thigh, according to photo - rash was similar to erythema migrans. Suspecting Lyme disease, antibodies were taken and empiric treatment with ceftriaxone was initiated. Several days later antibodies against Borrelia burgdorferi in blood serum came positive confirming the diagnosis. The treatment was continued until changes in the ECG reverted, then it was switched to oral doxycycline to complete cycle for 21 days. Summary (case reports only) A 57 year old patient with 2nd degree AV block was diagnosed with Lyme carditis. The patient recovered after antibacterial treatment and left the hospital without a pacemaker. Conclusions In patients with an AV block of an unknown etiology, Lyme carditis should be considered as a differential diagnosis to start early empiric treatment.

Įvadas. Žinios apie miokardo infarkto (MI) simptomus ir gebėjimas juos identifikuoti padeda pasiekti medicinos įstaigas greičiau. Tikslas. Mūsų tikslas buvo išsiaiškinti Lietuvos hospitalizuotų pacientų žinias apie miokardo infarktą ir palyginti žinių lygį skirtingose amžiaus, lyties ir išsilavinimo grupėse. Metodika. Tyrimas įtraukė 101 pacientą jo hospitalizacijos laikotarpiu Lietuvos Sveikatos Mokslų Universiteto (LSMU) Kauno ligoninės kardiologijos skyriuje 2020 metų vasario-kovo mėnesiais. Apklausa vykdyta remiantis originaliu klausimynu, kurį sudarė bendriniai klausimai, daugybinio pasirinkimo klausimai apie miokardo infarktą ir pacientų nuomonė, kokios priemonės padėtų sumažinti mirtingumą dėl MI. Tyrėjai apklausė pacientus jų hospitalizacijos metu. Rezultatai. Iš viso 70 % respondentų identifikavo pagrindinį MI simptomą – skausmą už krūtinkaulio. Be to, 62,4 % respondentų žinojo, kad MI skausmas gali plisti; daugiausiai žinomos plitimo sritys buvo kairė ranka (26,3 %), mentė bei tarpumentė (19,6 %). Didžioji dalis respondentų (36,7 %) daugiau sužinoti apie MI simptomus norėtų iš savo šeimos gydytojo. Išvados. Pacientų žinios apie MI simptomus ir rizikos faktorius nesiskyrė tarp skirtingų amžiaus, lyties ir išsilavinimo grupių. Pacientai turi ribotą žinių kiekį apie MI: nors daugiau nei pusė pacientų teisingai identifikuoja tipinius MI simptomus, jų žinios apie kitus simptomus yra nepakankamos. Tai gali būti pagerinta šviečiant visuomenę apie šį susirgimą.

Background: This study aims to evaluate the impact of the novel coronavirus disease 2019 (COVID-19) pandemic on cardiac surgery in a single cardiac surgery center in Lithuania. Methods: Between November 2018 and March 2021, the data of male COVID-19-negative patients (n=81; mean age: 65.5±8.5 years; range, 46 to 87 years) operated during the pandemic were compared with the data of male COVID-19-positive patients operated during the same period (n=14; mean age: 65.2±10.6 years). The number of patients, demographic and perioperative data were compared between the patients operated during the pandemic (2020/2021 years; pandemic group) and the prepandemic period (2018/2019 years; control group). Results: A statistically significant difference between the COVID-19-positive and COVID-19-negative patients was found in terms of the frequency of wound infection (n=3, 21.4% vs. n=12, 14.8%; p=0.013), resternotomy due to bleeding (n=2, 14.3% vs. n=0, 0%; p=0.018), and duration of hospitalization after surgery (26.4±20.4 days vs. 15.3±8.9 days; p=0.008). Comparing data of patients who had surgery before and during the pandemic, a significant decrease in the number of cardiac operations (166 vs. 95) was observed. There was significantly increased body mass index (p=0.01) and incidence of diabetes mellitus type 2 (p=0.021) in the pandemic group. Conclusion: Despite a significantly higher rate of complications in patients infected with COVID-19, planned cardiac surgery with the utilization of adequate protective measures during quarantine is still a better option than a complete cessation of elective cardiac surgery.

Introduction The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had been declareda worldwide pandemic by the World Health Organization and had caused a large worldwide impact on health system work.(1-2) All patients before elective surgeries were tested by mandatory order and even though these precautions were strictly followed, it was impossible to prevent Covid 19 infection between patients after surgery. Aim The purpose of this study is to compare non infected patients preoperative, intraoperative and postoperative data with those who got infected with Covid 19 after cardiac surgery in HLUHS. Methods Retrospective study was performed by observing the patientʻs case history data: 95 men underwent cardiac surgery during the emergency quarantine period from 2020-11-06 to 2021- 02-25 and 14 of them became infected with Covid 19. Inclusion criteria were male gender, because there were no females infected with Covid-19 during our chosen period of time. The analysis included general characteristics, preoperative, intraoperative and postoperative data, Covid-19 infection clinical symptoms and treatment. Statistical analyses were performed using the SPSS 20.0 software. The value of p<0.05 was considered as statistically significant. Results 14 (14.7%) of 95 patients were diagnosed with the Covid 19 virus after surgery, the average time of diagnosis of the Covid- 19 virus was 13 days after surgery. Covid 19 infected patients mean age was 67±7.7 years. […].