HRVATSKA VERZIJA

There are two types of scientific activities at Department of Cardiac Surgery:

  • clinical research - routine collecting and analysis of clinical data concerning various topics in cardiac surgery
  • science research in Surgical Laboratory for Biomedical Research (SLBR)

Here is the list of ongoing clinical projects at Department of Cardiac Surgery:

 

ERA and PARMA projects

The ERA and the PARMA projects are conceived as prospective multicentric observational registers of 10 centres from Europe, Middle East, and Africa, organized and financed by the Medtronic firm. Our Department together with Department of Internal medicine, General Hospital in Slavonski Brod, has been chosen for representing the centres from Croatia. The main clinical investigator of both projects is prof. Sutlić.


ERA (Prospective observational registry of epicardial irrigated radiofrequency ablation procedure in patients with permanent atrial fibrillation undergoing a CABG procedure)
Short description: Most information regarding the efficiency of the RF-Maze procedure is collected after using a monopolar devices in an endocardial fashion. One of disadvantages of these monopolar devices is that the surgeon is never 100% taht the created lesion is transmural. Recently, bipolar devices have become available that are equipped with a transmurality indicator. Furthermore, these devices can be used to perform the RF-Maze procedure in epicardial fashion and even in an off-pump situation. However, little information is available on the efficiency and safety of the epicardial irrigated RF-Maze procedure. The goal of this study is to evaluate the efficiency and safety of the epicardial irrigated RF-Maze procedure in patients with permanent atrial fibrillation and coronary artery disease requiring surgical treatment. This study will enclose total of 200 patients with permanent atrial fibrillation and coronary artery disease requiring surgical treatment


PARMA (Prospective observational registry of patients with paroxysmal atrial fibrillation undergoing the irrigated radiofrequency Maze procedure as concomitant cardiac surgery)
Summary: Most information regarding the efficacy of the RF-Maze procedure is collected in patients with persistent or permanent atrial fibrillation (AF). Little information is available regarding the efficacy of this procedure in patients with paroxysmal AF. However, paroxysmal AF over time often converts to persistent or permanent AF. Therefore, it might be beneficial for patients with paroxysmal AF and cardiac disease requiring surgical treatment to undergo the RF-Maze procedure concomitantly in this early stage of AF. The goal of this registry is to evaluate the efficiency and safety of the irrigated RF-Maze procedure in patients with paroxysmal AF and cardiac disease requiring surgical treatment. This study will enclose total of 200 patients with paroxysmal atrial fibrillation and cardiac disease requiring surgical treatment.

Implantation of stentless aortic valves (Toronto SPV/ Shelhigh)

Main investigator: Ž.Sutlić/ B.Biočina (Toronto SPV/ Shelhigh)
Short description: The implantation of biological materials, specially of heart valves of biological origin, has started its trend in 1960s, but nearing the end of the 20th century it stopped because of its weak long-term results and frequent reoperations after the primoimplantations. During 1970s and 1980s a considerable effort was made in the research work and the technological production of biological valves. As a result of that, at the end of 1990s, stentless heart valves appeared with almost ideal anatomical look (similar to homografts); at the same time they were processed by a special decalcium method and fixed with minimal pressure.
In order to show a hemodynamic excellence of these implants in aortal position and to reproduce their longevity in our conditions (weak control of anti-coagulation therapy, less accessible long-term echocardiography and cardiologic control), we put the patients with implanted stentless heart valves under the clinical and echocardiography prospective observation. This project was launched in 2003 and will be continued in the next five, that is in the next ten years.

Topical use of fibrinolitics in cardiac surgery

Main investigator: B.Biočina
Short description: By double-blind randomized placebo controlled study with topical use of antifibrinolitics (aprotinin and tranexemic acid), we explore an ability of the mentioned fibrinolitics in controlling a postoperative bleeding of cardiac patients. In other words, the systematic application of antifibrinolitics, although effective in reducing a postoperative bleeding of cardiac patients, is potentially risky because of increased thrombosis incidence, specially a graft thrombosis in coronary surgery.
The purpose of this research is to find out the potential of local and therefore not risky application of antifibrinolitics in cardiac surgery, particularly because of the fewer absolute doses, and because of the lower price of such treatment. Preliminary results speak on the behalf of the high tranaxemic acid efficiency and of a little bit smaller aprotinin quantity as compared to placebo, in reducing a postoperative bleeding in cardiac patients.

Application of valve transplants (homografts) in cardiac surgery

Main investigator: B.Biočina
Short description: Although the implantation of valve transplants (homografts) in cardiac surgery as a superior method for certain categories of valve patients has been known since the 1960s, explantation, preservation and clinical application of this method have not been used in Croatia until recently.
In collaboration with the Foundation for the development of cardiac surgery and Cardiac surgical Centre, from Zabrz, Poland, a new technology has been brought - the technology of short-term (up to 6 weeks) preservation of transplants in nutritious medium as well as a preparatory technique for transplants, and a formed core of a laboratory for homografts, which is supposed to become in the future a beginning of a valve bank. The first two clinical implantations of homografts in Croatia have already been done, and a vitality of the valve matrix and epitel covering for this way of preservation have been tested. Considering quite big logistical problems concerning short-term preservation, for now the project is at a standstill until the possible realization of a possibility for freezing of homografts and setting a valve bank.

Application of the "hemivalve concept" in mitral valve repair

Main investigator: B.Biočina
Short description: Degenerative and ischemic mitral insufficiency take an increasing part in cardiac pathology today. On the other hand, the lack of the artificial valves, whether mechanical or biological, is leading to the higher necessity for the application of a valves reparation technique in such patients. The existing valves reparation techniques require a relatively long period of learning and they are characterized as having a bad reproducibility, which means that it is not possible to predict the results of a reparation before activating a heart again.
According to the dr Shlomo Gabbay (New Jersey Medical School, New Jersey, USA) and Shelhigh Company's original idea and patent, for the first time in the world usage an innovative hemivalve concept has been introduced in the practice of mitral valve repair..
The idea of this method is in covering the posterior cusp of a mitral valve with a special added piece of a reparation ring (so-called a mitral valve stent) and on that occasion the further valve function depends on/is built upon the function of an undamaged anterior cusp. Specially designed gauge provides a possibility of the complete verification of a valve function before activating a heart. Clinical implantation has been done within ten patients, with excellent clinical result. This method could considerably contribute to mitral valve repair techniques in cardiac surgery.

Endoscopic preparation of a radial artery (ERA) with the use of an ultracision knife

Main investigator: I.Rudež
Short description: The advantages of a complete myocardial artery revascularization have been confirmed in many studies. However, many patients, specially women, still refuse to take a radial artery as a transplant because of the non-aesthetic scar along the forearm. The ERA offers an alternative possibility and, although being technically very demanding, it can be done with a high level of confidence, an excellent cosmetic result and no evident dammage to the graft harvested primarily thanks to the usage of endoscopic instruments and optics as well as usage of an ultracision knife. This project was launched in January, 2002. Till now, it has included about 40 patients with a coronary disease who needed artery bypass. Based on the attained results, in September, 2004, the Department became the European educational centre for this surgical technique.

Cardiac resynchronization therapy - CRT

Main investigator: I.Rudež
Short description: Endovenous lead implantation in biventricular pacing for cardiac resynchronization therapy (CRT) in patients with chronic heart failure (CHF) is often followed by prolonged implantation time, long-lasting exposure to extended fluoroscopy of a patient and personnel and possible complications (coronary sinus rupture or thrombosis, improper lead placement, etc.). Through the left mini-thoracotomy (4-6 cm) in 3 i.c. space you come directly up to the heart and then you use special instrument for epicardial fastening of LV lead while the "right-side" leads (for DA and DV) are put in the usual endovenous way. Thus, the time for the implantation and radiation is considerably shortened; in case of unfavourable electrophysiological LV lead position, the same one can be put in more favourable position on LV, and the whole procedure is done under general anaesthesia without traumatizing the patient with long-lasting lying in operating room. The beginning of this project was in September, 2002. Till now, it has included 8 patients with a chronic heart failure.

Aortoraphy

Main investigator: I.Rudež
Short description: Surgery of the aneurysms of the ascending aorta still presents a challenge, both due to complexity of surgical intervention and due to potential complications. By this operative modification of till now usual techniques, surgery of the ascending aorta has been in many simplified and late complications prevented. Technique consists of usual surgery of the aortic valve and main characteristic relates to stitching of the ascending aorta, adapting the edges and placing the graft on the outer side of the aorta, making it an outer "armature", a layer which gives the aorta an extra solidity. In that way continuity of endothelium is kept, later dilatation of the aorta disabled (especially in patients with native, bicuspidal valve) and late aortic dissection prevented, in ascending part at least. Beginning of this project was in October, 2002. Till now, it has included 7 patients with ascending aorta aneurysms (diameter > 45 mm) with or without co morbidity (aortic valve, coronary disease).


 
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