Jan Bialy

Medical University of Vienna, Wien, Vienna, Austria

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Publications (11)22.74 Total impact

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    ABSTRACT: Surgical methods for treatment of tricuspid valve (TV) endocarditis include complete TV excision, TV replacement, and the use of various reconstructive techniques even in cases of severe TV destruction and incompetence. This study summarizes our experience with TV reconstruction and replacement in patients with severe TV endocarditis. Between October 1997 and July 2004, TV reconstruction was performed in 18 patients (mean age, 38 +/- 17 years; 7 women, 11 men), and TV replacement in 4 patients (mean age, 48 +/- 22 years; 2 women, 2 men). All patients presented with active endocarditis and severe TV incompetence. Reconstructive techniques included debridement of vegetations, complete resection of infected or destroyed leaflet tissue, leaflet reconstruction with pericardial tissue, sliding plasty of residual valve tissue and bicuspid valve formation with construction of a new commissure, and consecutive ring annuloplasty in all patients. There were no perioperative deaths. Late mortality was 0% for patients with TV reconstruction and 25% (n = 1) in the TV replacement group. At the latest follow-up (78% complete; mean, 53 +/- 18 months), 11 patients had no recurrent TV incompetence. Three patients presented with TV incompetence grade I or II. Two patients with TV reconstruction had recurrent TV endocarditis between 3 and 18 month postoperatively, including new vegetations in both patients and an additional pleural empyema in one. In all cases, conservative treatment was successful and no reoperation was required. The results of our study clearly demonstrate that in patients with severe TV endocarditis, complex reconstructive techniques yield excellent midterm results with regard to freedom of recurrence of endocarditis and valvular competence and should be considered as the primary surgical option in these patients. Tricuspid valve replacement should only be performed in cases of severe TV destruction that renders reconstructive techniques impossible.
    The Annals of thoracic surgery 01/2008; 84(6):1943-8. · 3.45 Impact Factor
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    ABSTRACT: BACKGROUND: Only few reports have dealt with the issue of long-term efficacy of different annuloplasty techniques in patients with functional tricuspid valve insufficiency and its impact on outcome parameters. The goal of this retrospective study was to compare two widely used reconstructive techniques: prosthetic ring annuloplasty (PRA) and suture annuloplasty (SA). METHODS: The study included 194 patients, who underwent repair of functional tricuspid insufficiency > Grade II+ between 1984 and 2003. 144 patients received a PRA and 50 patients received a SA (median follow-up in both groups: 7.5 years). 30% of all patients had already undergone prior cardiac operations. RESULTS: At the latest follow-up, the occurrence of recurrent tricuspid insufficiency of at least Grade II+ (36% vs. 4.6%) and the occurrence of reoperation for recurrent tricuspid insufficiency (20% vs. 0%) were all substantially higher in the SA- than in the PRA-group. In addition, survival throughout the follow-up period was lower in patients receiving a SA (75% and 32% at 1 and 10 years) as compared to those receiving a PRA (82% and 66% at 1 and 10 years, p < 0.01). Significant risk factors for mortality throughout the follow-up period included absence of ring annuloplasty, left ventricular dysfunction and higher Euroscore. CONCLUSIONS: The results of this retrospective study demonstrate that in patients with functional tricuspid insufficiency, PRA is superior to SA with regard to survival, recurrence of tricuspid insufficiency and incidence of reoperation. It is therefore recommended as the method of choice in patients with functional tricuspid insufficiency. GRUNDLAGEN: Nur wenige Publikationen haben sich bis dato mit der Langzeiteffektivität unterschiedlicher Rekonstruktionstechniken bei Patienten mit funktioneller Trikuspidalklappeninsuffizienz befasst. Das Ziel dieser retrospektiven Analyse war es daher, die beiden am Häufigsten eingesetzten rekonstruktiven Techniken, Ringannuloplastie (RA) und Nahtannuloplastie (NA) zu vergleichen. METHODIK: Die Studie inkludierte 194 Patienten, die eine funktionelle Trikuspidalklappeninsuffizienz > Grad II+ hatten und zwischen 1984 und 2003 an unserer Abteilung operiert wurden. 144 Patienten erhielten eine RA und 50 eine NA (medianer Nachuntersuchungszeitraum in beiden Gruppen: 7,5 Jahre). 30 % aller Patienten hatten bereits eine frühere Herzoperation. ERGEBNISSE: Zum Zeitpunkt der letzten Nachuntersuchung waren sowohl das Auftreten einer neuerlichen Trikuspidalinsuffizienz Grad II+ (36 % vs. 4,6 %) als auch die Häufigkeit einer notwendigen Trikuspidalklappenreoperation (20 % vs. 0 %) in der Gruppe mit NA deutlich höher als bei den Patienten, die eine RA erhielten. Zusätzlich hatten die Patienten mit RA ein deutlich besseres Langzeitüberleben (82 % und 66 % nach 1 und 10 Jahren) als diejenigen, die eine NA hatten (75 % und 32 % nach 1 und 10 Jahren, p < 0,01). Als Risikofaktoren einer kürzeren Überlebenszeit wurden sowohl die NA als auch eine reduzierte linksventrikuläre Funktion und ein höherer Euroscore identifiziert. SCHLUSSFOLGERUNGEN: Die Ergebnisse dieser retrospektiven Studie zeigen eindeutig, dass die RA bei Patienten mit funktioneller Trikuspidalklappeninsuffizienz bezüglich Langzeitüberleben, Wiederauftreten einer Trikuspidalklappeninsuffizienz und Notwendigkeit einer Reoperation der NA deutlich überlegen ist. Diese Methode sollte daher die "Technik der Wahl" bei Patienten mit funktioneller Trikuspidalinsuffizienz sein.
    European Surgery 01/2006; 38(5):330-337. · 0.15 Impact Factor
  • European Surgery-acta Chirurgica Austriaca - EUR SURG. 01/2006; 38(5):330-337.
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    ABSTRACT: This study describes the technique of triangular plication in patients with mitral valve incompetence that is due to segmental anterior leaflet prolapse. A nonabsorbable suture plicates the prolapsed leaflet area towards the ventricular aspect in a triangular fashion by decreasing the suture width towards the leaflet base. Because no leaflet tissue is resected, this technique allows for the intraoperative correction of an imperfect plication. Triangular plication was successful in all except one patient. In this patient, a failed repair was corrected with mitral valve replacement. Freedom from mitral valve incompetence of more than grade 0-I was 100% at 12 months and 86% at 36 months postoperatively.
    The Annals of thoracic surgery 09/2004; 78(2):e36-7. · 3.45 Impact Factor
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    ABSTRACT: EuroSCORE is widely used to assess operative risk. Combined cardiac procedures carry increased perioperative mortality, but the influence of preoperative factors on mid-term outcome is not well known for these patients. The study aim was to determine if EuroSCORE risk influences mid-term survival after combined coronary artery bypass grafting (CABG) and valve surgery. Follow up (mean 23.7 months) was obtained in 258 consecutive hospital survivors (148 males, 110 females; median age 72.29 years; mean EuroSCORE 7 points) operated on between January 1998 and March 2001. CABG + aortic valve replacement (AVR) was performed in 171 patients, CABG + mitral surgery in 72, and CABG + double valve surgery in 15. Kaplan-Meier estimates were calculated for survival and combined freedom from death and NYHA class III/IV. The Cox regression model was applied to prove the influence of EuroSCORE risk and a number of preoperative and operative variables on mid-term outcome. Thirty patients (11.63%) died during follow up, and 34 (13.17%) were in NYHA class III/IV. Freedom from death and NYHA class III/IV was 89.3%, 74.7% and 55.2% at 12, 24 and 36 months, respectively. The significant predictor for combined death and NYHA class III/IV was EuroSCORE risk (p = 0.0004). In the subgroup of patients with CABG + mitral valve surgery, age was identified as a significant risk factor for death (p = 0.0346), whereas in the subgroup of patients with CABG + AVR EuroSCORE was detected as significant risk factor for combined death and NYHA class III/IV. EuroSCORE is an important predictor for poor mid-term outcome after combined CABG and valve surgery.
    The Journal of heart valve disease 06/2004; 13(3):439-43. · 1.07 Impact Factor
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    ABSTRACT: The outcome of patients undergoing aortic valve replacement (AVR) may be affected by the influence of prosthesis-patient mismatch on left ventricular mass regression. However, due to the discrepancies in labeled valve size, size of sizer and actual valve dimension, it is difficult to compare different valve types. In order to perform an objective comparison, this study was designed to compare the hemodynamics of the Edwards Lifescience pericardial (ELP) and the Medtronic Mosaic porcine (MM) bioprosthesis between patients receiving the same valve size and between patients with the same aortic annulus diameter. This prospective, randomized study was performed on 81 hospital survivors out of 86 patients undergoing AVR with either the ELP (n=39) or the MM (n=42) bioprosthesis. Intra-operative randomization was performed after the surgeon had excised the aortic valve, measured the size of the aortic annulus with three different sizers (ELP, MM and a set of metric sizers), and decided which size he would implant for either of the valve types. All valves were implanted in supra-annular position with the same implantation technique. Echocardiographic follow-up was performed early postoperatively and 6 months thereafter. In 12 (31%) of the patients receiving the ELP-valve, as compared to 3 (7.1%) of the patients receiving the MM-valve, the labeled valve size was smaller than the aortic annulus diameter (P<0.05). Early postoperatively, mean (17.4+/-3.1 vs 20.3+/-3.6 mmHg) and peak gradients (30.1+/-4.8 vs 37.6+/-9.6 mmHg) for the 21 mm ELP-valve were lower than for the 21 mm MM-valve (P<0.05). All other hemodynamic parameters did not show significant differences at any time point. When the same aortic annulus diameter was taken as a reference, there were no significant hemodynamic differences between either valve type at any time point, regardless of the valve size implanted. This study demonstrates that the hemodynamic performance of the ELP and the MM bioprosthesis are comparable when the same aortic annulus diameter is taken as a reference. The significant variabilities between different valve types with regard to labeled valve size, valve-sizer size and actual valve size have to be taken into account, when hemodynamic comparisons are performed.
    European Journal of Cardio-Thoracic Surgery 04/2004; 25(3):358-63. · 2.67 Impact Factor
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    ABSTRACT: The surgical management of a 56-year-old patient with a single thoracic stab wound penetrating the left innominate vein and the aortic arch is described. Repair was successfully achieved using extracorporal circulation and circulatory arrest during deep hypothermia. Clinical features and surgical approach are described and discussed in detail.
    The Annals of Thoracic Surgery 03/2004; 77(2):703-4. · 3.45 Impact Factor
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    ABSTRACT: In murine and rat cardiac myocytes the gp130 system transduces survival as well as hypertrophic signals and via induction of the expression of the potent angiogenic factor VEGF in these cells also indirectly contributes to cardiac repair processes through the development of new blood vessels. There are, however, species differences in receptor specificity and receptor crossreactivity in the gp130-gp130 ligand system. We asked whether gp130 signaling is also involved in the regulation of VEGF in human cardiac myocytes and if so which gp130 ligands are critical for such an effect. Human adult cardiac myocytes (HACMs) were isolated from myocardial tissue and characterised by positive staining for myocardial actin, troponin-I and cardiotin. HACMs were treated with the gp130 ligands CT-1, IL-6, LIF or OSM and VEGF-1 was determined by a specific ELISA in the conditioned media of these cells. RT-PCR and Western blot analysis was used in order to detect gp130, IL-6-receptor, LIF-receptor or OSM-receptor specific protein and mRNA in human adult cardiac myocytes and for detection of VEGF-1 specific mRNA in cardiac myocytes after incubation with OSM. Pieces of myocardial tissue were incubated ex vivo in the presence and absence of OSM and VEGF was determined in supernatants of these cultures and immunohistochemistry was performed on the tissue using specific antibodies for VEGF-1. Immunohistochemistry was also employed to detect VEGF in sections from a healthy human heart and in a heart from a patient suffering from acute myocarditis. OSM, but not CT-1, IL-6 or LIF increased VEGF-1 production in human adult cardiac myocytes dose-dependently derived from five different donors. This selective stimulation of VEGF by gp130 ligands was also reflected by a specific receptor expression on these cells. We detected high levels of mRNA for gp130 and the OSM receptor in freshly isolated human cardiac myocytes but only low amounts of mRNA for the IL-6 receptor whereas mRNA for the LIF receptor was hardly detectable by RT-PCR. OSM receptor and IL-6 receptor were also detectable by Western blotting whereas LIF receptor was only present as a faint band. OSM also increased the expression of VEGF-1 mRNA in cardiac myocytes. When pieces of human myocardial tissue were incubated with the gp130 ligands in an ex vivo model only OSM resulted in an increase in VEGF-1 in the supernatants of these cultures. Furthermore, VEGF increased in tissue samples treated with OSM in cardiac myocytes as evidenced by immunohistochemistry. In addition, we found increased VEGF-1 expression in myocardial tissue from a patient suffering from acute myocarditis. The gp130-gp130 ligand system is also involved in VEGF regulation in human cardiac myocytes and OSM is the gp130 ligand responsible for this effect in the human system whereas LIF and CT-1 which had been shown to regulate VEGF expression in mouse and rat cardiac myocytes had no effect. Thus we have added OSM, which is produced by activated T lymphocytes and monocytes, to the list of regulatory molecules of VEGF production in the human heart. Our results lend further support to the notion that besides hypoxia, inflammation via induction of VEGF through autocrine or paracrine pathways plays a key role in (re)vascularisation of the myocardium.
    Cardiovascular Research 10/2003; 59(3):628-38. · 5.81 Impact Factor
  • Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/2003; 41(6):240-241.
  • Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/2003; 41(6):275-275.
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    ABSTRACT: Structural differences of the pulmonary root may predispose it to progressive dilatation in the systemic circulation after the Ross operation. We identified the incidence and risk factors of pulmonary autograft root dilatation. One hundred and seven adult patients (mean age of 36+/-11 years) were followed after the Ross operation since 1991 including an echocardiogram within 3 months of surgery and yearly clinical assessment and echocardiography. The autograft was measured at the maximum diameter of the sinus (SV) and aortic insufficiency (AI) assessed. A SV of >37 mm was considered as root dilatation and the incidence over time was calculated using the Kaplan-Meier method. Clinically relevant dilatation was defined as a root diameter of >42 mm. In addition, we determined the percentage change of the sinus diameter between the early and latest echocardiogram. Furthermore we tested the influence of patient variables and risk factors on dilatation. By 1 year, dilatation was found in 21 patients (20%). The SV was >42 mm in eight patients (7%). By 7 years, only 45% of patients were free of dilatation. Eleven patients (10%) had a SV of >42 mm. Increase in SV was time related and linear. However, 90% of patients showed <25% dilatation during follow-up. Time from operation, early SV diameter, male gender and surgical technique were identified as significant risk factors of dilatation. However, dilatation has not lead to reoperation due to aneurysm formation or development of significant AI. We conclude that time dependent autograft root dilation occurs but does not cause an increase in AI and need for reoperation up to 7 years. These findings warrant the pursuit of the concept of the Ross operation in young patients who regain excellent functional status and life style without anticoagulation.
    European Journal of Cardio-Thoracic Surgery 03/2002; 21(3):470-3. · 2.67 Impact Factor