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Ryszard Bachowski

Publications and source records attributed to Ryszard Bachowski.

12 recordsLinked to original sources
PubMed2005

Invasive treatment of coronary artery disease in octogenarians.

INTRODUCTION: There are many patients aged over 80 years among those hospitalised for coronary artery disease (CAD). The unanswered question is whether invasive treatment of such patients is effective and safe. AIM: To assess and compare one-year clinical outcomes after percutaneous coronary angioplasty (PTCA) and surgical coronary artery bypass grafting (CABG) in patients aged over 80 years and in younger patients. METHOD: There were 63 patients aged over 80 years suffering from CAD who underwent either PTCA or CABG. The control group consisted of 40 patients aged 60-65 years treated in the same way. Data on medical history, cardiovascular risk factors, and angiographic findings were analysed. The potential risks of the procedures, post-procedural complications as well as the clinical status at the end of one-year follow-up were evaluated. RESULTS: There were 24 surgical revascularisation procedures and 39 PCIs performed in the very old patients. Stable angina was found in 29 cases, unstable angina in 19 and acute myocardial infarction in 15 patients. There were three in-hospital deaths and 18 periprocedural complications were noted. During the one-year follow-up period six deaths occurred, persistent or recurrent angina was found in 11 patients after PCI and two after CABG. There were no deaths in the control group and the incidence of minor complications was similar to the senile group. In younger patients who underwent CABG, CCS class at one year was lower than in the very old ones. CONCLUSIONS: The invasive treatment of coronary artery disease in octogenarians is feasible with satisfactory results and acceptable procedural risks.

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PubMed2004

Total arterial revascularization for multiple vessel coronary artery disease: with or without cardiopulmonary bypass.

BACKGROUND: To assess the usefulness of off-pump technique for more technically demanding coronary artery bypass procedures using exclusively arterial conduits. METHODS: Analysis of perioperative data of 324 consecutive patients in whom total arterial revascularization for multiple- vessel coronary artery disease was performed--181 cases on-pump and 143 cases off-pump. RESULTS: On average in the on-pump group 2.7 +/- 0.8 (range, 2-5) grafts per patient were constructed versus 2.4 +/- 0.7 (range, 2-4) grafts per patient in the off-pump group (P < .001). Of the total number of 490 anastomoses performed on-pump, 83 (17%) were side-to-side and of 349 anastomoses performed off-pump, 51(15%) were side-to-side, a nonsignificant difference (P = .4). The aorta was used as a site for proximal anastomosis of 1 or more arterial conduits in 105 patients (58%) who underwent on-pump surgery and in 57 patients (40%) who underwent off-pump surgery (P = .002). In the off-pump group, the right internal thoracic artery (RITA) was rarely (12%) routed through the transverse sinus to circumflex branches compared with the on-pump group (34%) (P = .017). RITA in off-pump patients was more often used to revascularize the anterior wall (47% versus 29%; P = .08). We observed no difference in mortality (1.7% versus 0%; P = .3), incidence of perioperative myocardial infarction (8.8% versus 7.7%; P = .8), stroke (1.7% versus 1.4%; P = .8), or atrial fibrillation (24% versus 19%; P = .3). We observed less inotropic support and less blood-product use in off-pump patients. CONCLUSION: Total arterial revascularization for multiple-vessel coronary artery disease may be safely performed off-pump. We observed tendency to somewhat smoother postoperative course in the off-pump group.

Adult↗
PubMed2004

Minimally invasive mitral valve surgery -- first experience in Poland.

BACKGROUND: Minimally invasive cardiac surgery has been introduced to treat various cardiac disorders, predominantly ischaemic heart disease. Its usage in valvular disorders has been only recently proposed. AIM: To assess safety and efficacy of minimally invasive mitral valve surgery. METHODS: The procedure was performed in 10 patients (6 females, 4 males, mean age 59+/-7 years). All but one had preserved left ventricular ejection fraction. Two patients underwent mitral valvuloplasty, and mitral valve replacement was performed in all remaining cases. One procedure was a redo surgery following mitral commisurotomy. RESULTS: In all patients the procedure was effective. Prolongation of cardiopulmonary bypass and aorta cross-clamping time did not increase the complication rate which included one wound infection, one repeated cannulation of the femoral vessels and one minor stroke. Rehabilitation process seemed to be shorter than after standard procedures. CONCLUSIONS: Minimally invasive mitral valve surgery is a safe and alternative method of treatment, and is associated with excellent cosmetic results.

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PubMed2003

Primary OPCAB as a strategy for acute coronary syndrome and acute myocardial infarction.

BACKGROUND: Conventional coronary artery bypass graft (CABG) surgery using cardiopulmonary bypass (CPB) carries higher mortality and morbidity for patients undergoing surgery during acute coronary syndrome (ACS). The aim of this retrospective study was to evaluate potential benefits of avoiding CPB by instead performing off-pump CAB (OPCAB) during surgery on patients in ACS. METHODS: Among 624 patients who underwent OPCAB between January 1999 and June 2001, 143 underwent surgery during ACS (group 1). The ACS patients in group 1 were divided into 2 subgroups: 66 underwent surgery during acute myocardial infarction (AMI group) and 77 during unstable angina classified as class III or IV according to the Braumwald classification (unstable coronary artery disease [CAD] group). Group 2 (the elective CAD group) consisted of 481 patients who underwent isolated elective OPCAB during the same time period. RESULTS: Overall 30-day mortality was 4.9% (n = 7) for the ACS group and 0.83% (n = 4) for the elective CAD group (P < .0001). Differences between groups were found in use of inotropes, intraaortic balloon pump, and subsequent conversion of OPCAB to CPB (P < .0001, P < .01, and P < .03, respectively), as well as use of blood transfusion (P < .0003). Multivariate logistic regression analysis for 641 patients revealed ACS (P < .015), AMI (P < .019), renal failure (P < .017), and left ventricle aneurysm (P < .028) as independent risk factors for 30-day mortality in ACS reoperation (P = .02), whereas in AMI renal failure (P = .02) appeared to be an independent risk factor. CONCLUSIONS: OPCAB is a valuable treatment strategy in ACS patients; however, it carries significant mortality and morbidity. Careful preselection and timing of intervention are required in order for patients to fully benefit from the OPCAB strategy.

Analysis of Variance↗
PubMed2003

Dysfunction of left ventricle as an indication for off-pump coronary artery bypass grafting.

BACKGROUND: Coronary artery bypass grafting (CABG) with cardiopulmonary bypass carries significant risk for patients with severe left ventricular (LV) dysfunction. METHODS: Between 1997 and 2000, 240 patients underwent OPCAB. The patients were retrospectively divided into 2 groups with regard to LV function. Group 1 consisted of 90 patients with ejection fraction (EF) <35% and grou p 2 of 150 patients without severe LV impairment and EF >35%. Patients were compared for preoperative risk factors, perioperative mortality, and postoperative complications. RESULTS: Preoperative expected mortality according to EuroSCORE was higher in group 1, 5.95, compared with group 2, 2.66 (P =.0005). A few preoperative risk factors were more common in group 1: urgent operation (P =.00001), unstable angina (P =.0018), Canadian Cardiovascular Society class (P =.001), myocardial infarction (P =.0001), and peripheral arteriopathy (P =.0006). Mean number of grafts was 1.51 in group 1 and 1.55 in group 2 with the same internal thoracic artery utilization. Perioperative drainage, anesthesia and intubation time, transfusion rate, and use of inotropes were comparable. Actual, nonadjusted mortality was 2.5% in group 1 and 1.4% in group 2 (P = not significant). Overall rates of postoperative complications were comparable; only use of an intraoperative balloon pump was more frequent in group 1 (P =.006). Postoperative stay was shorter in group 1 (P equals). CONCLUSIONS: Off-pump CABG for patients with LV impairment is associated with surgical outcome similar to that among patients with normal LV function, in spite of the presence of unfavorable risk factors. Off-pump surgery with selective anterior (including right main) arterial revascularization can be indicated in the presence of poor LV function.

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