Szymon Kocańda

Objective: The aim of this study was to evaluate the impact of coronary bypass surgery (CABG) on long-term mortality, comparing survival rates to those of the general population in Poland. Methods: The study was based on the Polish National Register of Cardiothoracic Surgical Procedures (KROK). Between January 2009 and December 2019, 133,973 patients underwent CABG. The study included all patients who underwent primary CABG. After excluding reoperations and patients with missing key data, there were 132,760 remaining patients who participated in the study. In order to compare patients who underwent CABG with the general population, data from Polish life expectancy tables from the Central Statistical Office (CSO) were used. Results: In the general population (GP), there is a consistent decrease in survival for both women and men throughout the entire observation period. The decline in survivability is more pronounced in the male group. Unlike the CABG group, which is at risk of perioperative mortality, there is no initial drop in survivability in the GP. The early mortality rate in CABG group within 30 days was significantly higher in the group of women than in men (3.51% compared to 2.19%, p < 0.001). The annual mortality rate was higher in the group of women (6.7% vs. 5.14%), and survival time was shorter (345.5 ± 0.4 vs. 351.2 ± 0.2 days, p < 0.001). However, the total mortality over a 13-year period of observation did not differ significantly between the groups (30.17% for women vs. 29.6% for men, p = 0.996) with survival time 10.08 ± 0.02 years in men vs. 10.06 ± 0.03 in women, p = 0.996. Conclusions: CABG surgery equalizes the probability of survival between genders. In long-term observation men have a greater survival benefit than women if compared to the predicted survival of the general population. These observations may provide a new perspective on the choice of revascularization strategy in relation to gender.

Background: Valve-in-Valve (ViV) transcatheter aortic valve implantation (TAVI) has emerged as a viable therapeutic option for structural valve degeneration following surgical aortic valve replacement (SAVR) or prior TAVI. However, the understanding of long-term complications and their management remains limited. Case presentation: We present the case of a 69-year-old male with a history of ViV-TAVI, who presented with symptoms of non-ST elevation myocardial infarction (NSTEMI) and transient ischemic attack (TIA). Computed tomography (CT) revealed thrombosis of the ascending aortic graft and aortic valve prosthesis. Transthoracic echocardiography (TTE) further confirmed new valve dysfunction, indicated by an increase in the aortic valve mean gradient. Treatment with low-molecular-weight heparin (LMWH) resulted in partial thrombus resolution. The multidisciplinary Heart Team opted against coronary angiography and recommended the long-term administration of vitamin K antagonists (VKAs). Follow-up CT showed the complete resolution of the thrombus. Conclusions: Thrombosis of the aortic graft and aortic valve following ViV-TAVI may be attributed to alterations in blood flow or mechanical manipulations during the TAVI procedure, yet it can be effectively managed with VKA therapy. CT is a valuable tool in coronary assessment in patients with NSTEMI and aortic valve and/or aortic graft thrombosis.

Children constitute a special group in pain therapy. Single nucleotide polymorphisms that are associated with differences in postoperative, inflammatory pain perception and opioid requirement are the A118G SNP in the mu-opioid receptor 1 (OPRM1) gene and the rs1205 CRP. This study aimed to determine connection between OPRM1 and rs1205 CRP SNPs in pediatric patients postoperatively and pain intensity, the opioid dose needed to control pain after scoliosis correction, and other clinical aspects. Genotypes of rs1205 CRP and OPRM1 polymorphisms in a sample of 31 patients were specified, and statistical analysis was performed in terms of age, genotype frequency, pain assessment, sufentanil flow, post-anesthesia care unit stay, and the use of coanalgesics. The frequency of A/A and A/G genotypes in the OPRM1 gene was in line with 1000Genomes data for the European population. Patients from the AG group of OPRM1 SNP more frequently required coanalgesics for adequate pain control; however, it was of weak statistical significance. Other parameters measured in the study were not statistically significant in relation to OPRM1 and CRP polymorphisms. The effect of SNPs on postoperative pain management and opioid therapy in children was not confirmed by this study. An expansion of the study sample and other opioid-related SNPs is required.

Despite the impressive developments in modern medicine, the healthcare system is still associated with human death. Medicine has made great strides in the treatment of many diseases. The procedures are particularly advanced in, e.g., cardiac surgery, vascular surgery, and other fields. However, despite these efforts, not all patients are cured, and the use of aggressive treatment often contributes to their suffering. This does not mean that patients should be left unattended at the end of their lives.. Palliative medicine deals with patients coming to the end of their lives, concentrating on alleviating suffering and improving quality of life. It is a medical speciality focused on a wide range of interventions, including symptom management, communication, and psychosocial and spiritual support for patients. Patients undergoing highly qualified procedures, for whom causal treatment is not possible, should have the right to such care before death. However, according to medical practice and national legal regulations, it is not always possible to provide this care, despite the anticipated death. This article presents the legal and medical aspects of the end of life from the point of view of the European and Polish healthcare systems.