Nikolaos A Papakonstantinou

Hospital Agioi Anargyroi, Kēfissia, Attica, Greece

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Publications (15)32.97 Total impact

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    ABSTRACT: Purpose: Primary cardiac tumors are uncommon but not extremely rare. Cardiac tumors, mostly intracavitary, include benign and malignant tumors that arise from the endocardium, heart valves or myocardium. This retrospective study summarizes the experience of the Cardiac Surgery Departments of three tertiary Hospitals in this field, and particularly in cardiac myxomas, over the last 29 years. Herein, we present the results of cardiac tumors excision in relation to postoperative morbidity and mortality. Methods: Between 1985 and 2014, 117 patients, aged from 16 to 82 years, underwent resection of a cardiac tumor. Results: Ninety one of the tumors (77.78%) were myxomas, 15 of them (12.82%) were other primary cardiac tumors, 7 of them (5.98%) were infra-diaphragmatic tumors and the remaining 4 tumors (3.42%) were benign intracavitary masses (thrombi). Patients operated on for a cardiac tumor had a 30-day mortality rate of 3.29%. Atrial fibrillation appeared in 21 out of 91 patients (23.07%) operated on for cardiac myxoma, while neurological complications were observed in 3 patients (3.29%). Re-exploration for bleeding was performed in 5 out of 91 cases (5.49%) and recurrence occurred in 4.39% of myxomas. Conclusions: Despite being rare, primary cardiac tumors require open heart intervention soon after their diagnosis in order to prevent complications and achieve low mortality rates.
    Journal of B.U.ON.: official journal of the Balkan Union of Oncology 07/2015; 20(4):1115-1123. · 0.74 Impact Factor

  • 03/2015; 56(2):169-80.
  • Efstratios Apostolakis · Nikolaos A Papakonstantinou · Nikolaos G Baikoussis · George Papadopoulos ·
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    ABSTRACT: Thirty to fifty percent of critically ill patients admitted to the intensive care unit suffer from generalized neuromuscular weakness due to critical illness polyneuropathy, critical illness myopathy, or a combination of them, thus prolonging mechanical ventilation and their intensive care unit stay. A distinction between these syndromes and other neuromuscular abnormalities beginning either before or after ICU admission is necessary. These intensive care unit-related diseases are associated with both elevated mortality rates and increased morbidity rates. Generally, over 50 % of patients will completely recover. Most of them recover after 4-12 weeks, but some patients have been reported to keep on suffering from muscle weakness for at least 4 months. Prevention has a key role in the management of critical illness neuromuscular disorders, as no specific therapy has been suggested. Either prevention or aggressive treatment of sepsis can prevent critical illness polyneuropathy and critical illness myopathy. The dose and duration of the administration of neuromuscular blocking drugs should be limited, and their concurrent administration with corticosteroids should be avoided. Intensive insulin therapy has also been proven to reduce their incidence. Finally, early mobilization via active exercise or electrical muscle stimulation plays a significant role in their prevention.
    Journal of Anesthesia 07/2014; 29(1). DOI:10.1007/s00540-014-1875-x · 1.18 Impact Factor
  • Efstratios Apostolakis · Nikolaos A Papakonstantinou · Serafeim Chlapoutakis · Christos Prokakis ·
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    ABSTRACT: Ligation and dissection of internal mammary vessels is the most under-estimated complication of anterior mediastinotomy. However, patients requiring anterior mediastinotomy may experience long survival that makes the development of ischemic heart disease throughout their life possible. Therefore, the un-judicial sacrifice of the internal mammary pedicle may deprive them from the benefit to have their internal mammary artery used as a graft in order to successfully bypass severe left anterior descending artery stenoses. We recommend the preservation of the internal mammary pedicle during anterior mediastinotomy, which should be a common message among our colleagues from the beginning of their training.
    Annals of Thoracic Medicine 07/2014; 9(3):138-43. DOI:10.4103/1817-1737.134067 · 1.80 Impact Factor
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    Nikolaos A. Papakonstantinou · Nikolaos G. Baikoussis · Efstratios Apostolakis ·
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    ABSTRACT: Coronary endarterectomy is an old surgical procedure against coronary artery disease first described by Baily et al. in 1957. Despite its first adverse results, several current publications have shown that coronary endarterectomy with on-pump or off-pump coronary artery bypass grafting can be safely performed with acceptable mortality, morbidity, and angiographic patency rates. Coronary endarterectomy can assure complete revascularization supplying the myocardium with satisfactory blood flow in cases of a diffusely diseased left anterior descending artery or diffuse calcification, thus preventing residual ischemia. Hence, it is important to evaluate current results, rethink this old recipe, and redefine its indications.
    Journal of Cardiology 06/2014; 63(6). DOI:10.1016/j.jjcc.2014.02.005 · 2.78 Impact Factor
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    Nikolaos G. Baikoussis · Nikolaos A. Papakonstantinou · Efstratios Apostolakis ·
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    ABSTRACT: Mini-extracorporeal circulation (MECC) constitutes a novel miniaturized cardiopulmonary bypass (CPB) circuit, heparin-coated and primed with aprotinin. Its membrane oxygenation is similar to conventional cardio-pulmonary bypass (CCPB), but it is a completely closed-volume system due to the lack of the venous reservoir which has been removed. In a mini circuit, the reservoir is the patient himself. Consequently, air entering the venous cannula is avoided. Nevertheless, the capabilities of MECC have been expanded either by the inclusion of a suction device that is only activated on direct contact with liquid in some circuits or by postoperative autotransfusion of the wrecked erythrocytes by a separate suction device with a cell-saver. Although the tubing diameter is similar between the two systems, the tubing length of the MECC is around half that of the CCPB, resulting in the restriction of priming volume. As a consequence, a higher hematocrit thus a limited need for perioperative blood transfusion is achieved due to less hemodilution. In addition, the inflammatory response is also diminished as a result of less artificial surface area interacting with blood. Finally, a lower dose of heparin is required prior to MECC than prior to CCPB.
    Journal of Cardiology 06/2014; 63(6). DOI:10.1016/j.jjcc.2013.12.014 · 2.78 Impact Factor
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    Nikolaos G. Baikoussis · Nikolaos A. Papakonstantinou · Efstratios Apostolakis ·
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    ABSTRACT: Radial artery (RA) is the most popular arterial graft after the left internal thoracic artery in both low- and high-risk patients undergoing coronary artery bypass grafting. Various arterial grafts such as the right internal thoracic artery, the right gastroepiploic artery, and the inferior epigastric artery have also gained ground over the past 30 years because of the intimal hyperplasia and atherosclerosis of the saphenous vein leading to late graft occlusion. In this review article we would like to present the utility of the RA as a graft, focused mainly on its structural and biological characteristics.
    Journal of Cardiology 05/2014; 63(5). DOI:10.1016/j.jjcc.2013.11.016 · 2.78 Impact Factor
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    Nikolaos A Papakonstantinou · Maria I Stamou · Nikolaos G Baikoussis · John Goudevenos · Efstratios Apostolakis ·
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    ABSTRACT: Coronary artery disease was considered a male disease for many years. However, nowadays, coronary artery disease constitutes the leading cause of death in women, although there are a lot of gender-related differences regarding the presentation of acute myocardial infarction, its diagnosis, its treatment, short- and long-term mortality rates, and post-acute myocardial infarction complications. Generally, women have smaller and stiffer hearts and cardiac vessels, suffering a greater extent of atherosclerosis and endothelial and smooth muscle dysfunction. They are usually older than men and they have more comorbidities such as hypertension, renal impairment, and diabetes mellitus. Moreover, female coronary artery disease, the diagnosis of which is more complicated due to more false negative results of some diagnostic methods in women, is more often presented with atypical symptoms and women's symptoms of typical or atypical angina are more severe. Furthermore, women delay significantly more in seeking care and they are more frequently undertreated. Finally, women are associated with generally poorer in-hospital and long-term prognosis having almost two-fold higher early mortality and they are more prone to complications such as bleeding complications, shock, and heart failure, as well as to post-myocardial infarction depression and poorer physical function and mental health. In this review, we discuss these sex-related differences according to current literature.
    Journal of Cardiology 04/2013; 62(1). DOI:10.1016/j.jjcc.2013.03.001 · 2.78 Impact Factor
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    ABSTRACT: In patients with chronic atrial fibrillation, 90% of clots are located in the left atrial appendage (LAA). Therefore, LAA exclusion is a means of preventing thrombus formation and subsequent thromboembolic events in these patients. The LAA can be excluded from the systemic circulation via surgical, percutaneous, or thoracoscopic approaches. The surgical aim is complete obliteration of the appendage without a significant increase in either postoperative complications (bleeding, arrhythmias) or recurrence. We discuss the current surgical techniques available for LAA obliteration and review their results.
    Journal of Cardiac Surgery 01/2013; 28(2):1-8. DOI:10.1111/jocs.12055 · 0.89 Impact Factor
  • Nikolaos G. Baikoussis · Nikolaos A. Papakonstantinou · Efstratios Apostolakis ·

    The Annals of Thoracic Surgery 03/2012; 93(3):1019-1020. · 3.85 Impact Factor
  • Article: Reply.
    Nikolaos G Baikoussis · Nikolaos A Papakonstantinou · Efstratios Apostolakis ·

    The Annals of thoracic surgery 03/2012; 93(3):1019-20. DOI:10.1016/j.athoracsur.2011.12.012 · 3.85 Impact Factor
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    Efstratios Apostolakis · Nikolaos G Baikoussis · Nikolaos A Papakonstantinou ·
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    ABSTRACT: Short periods of ischaemia consecutive to reperfusion periods before a sustained ischaemic condition, the so-called ischaemic preconditioning (IP), aim to protect myocardial cells against prolonged ischaemia. IP appears as a considerable endogenous cardioprotective mechanism decreasing the infarct size after total occlusion in either experimental models or humans. Angina periods before an acute coronary syndrome limit the myocardial infarction being protective for the myocardium. Our report aims to review the international bibliography of the IP during off-pump coronary artery bypass grafting.
    Interactive Cardiovascular and Thoracic Surgery 11/2011; 14(1):68-71. DOI:10.1093/icvts/ivr024 · 1.16 Impact Factor
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    ABSTRACT: Magnetic resonance imaging (MRI) in patients with implanted cardiac prostheses and metallic cardiovascular electronic devices is sometimes a risky procedure. Thus MRI in these patients should be performed when it is the only examination able to help with the diagnosis. Moreover the diagnostic benefit must outweigh the risks. Coronary artery stents, prosthetic cardiac valves, metal sternal sutures, mediastinal vascular clips, and epicardial pacing wires are not contraindications for MRI, in contrast to pacemakers and implantable cardioverter-defibrillators. Appropriate patient selection and precautions ensure MRI safety. However it is commonly accepted that although hundreds of patients with pacemakers or implantable cardioverter-defibrillators have undergone safe MRI scanning, it is not a safe procedure. Currently, heating of the pacemaker lead is the major problem undermining MRI safety. According to the US Food and Drug Administration (FDA), there are currently neither "MRI-safe" nor "MRI-compatible" pacemakers and implantable cardioverter-defibrillators. In this article we review the international literature in regard to safety during MRI of patients with implanted cardiac prostheses and metallic cardiovascular electronic devices.
    The Annals of thoracic surgery 06/2011; 91(6):2006-11. DOI:10.1016/j.athoracsur.2011.02.068 · 3.85 Impact Factor
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    ABSTRACT: Vasa vasorum (VV) are microscopic vases that perfuse the vessel's wall; arteries and veins. Many recent researches support the opinion that VV have a significant role in aortic pathology. The VV, or 'the vessels of the vessels', form a network of microvessels that lie in the adventitia and penetrate the outer media of the host vessel wall. Although the importance of the VV in providing nutritional support is not well known, obstruction of blood flow through these vessels has been implicated in the pathogenesis of many cardiovascular diseases such as aortic intramural hematoma, aortic aneurysm, and acute or chronic aortic dissection. Although the proliferation of VV due to atherogenic stimuli is controversial, experimental and clinical studies strongly suggest the potential of VV in vascular proliferative disorders. It seems that the rupture of VV is implicated in intramural hematoma, which can develop in acute aortic dissection. In this review article, we would like to stress the anatomy and mainly the pathophysiology, and the implication of VV in the acute and chronic aortic pathologies.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 01/2011; 40(2):412-7. DOI:10.1016/j.ejcts.2010.11.045 · 3.30 Impact Factor
  • Source
    Efstratios Apostolakis · Nikolaos G Baikoussis · Nikolaos A Papakonstantinou · John Goudevenos ·

    Hellenic journal of cardiology: HJC = Hellēnikē kardiologikē epitheōrēsē 01/2011; 52(1):41-51. · 1.23 Impact Factor

Publication Stats

64 Citations
32.97 Total Impact Points


  • 2014-2015
    • Hospital Agioi Anargyroi
      Kēfissia, Attica, Greece
  • 2012-2014
    • University Hospital of Ioannina
      Yannina, Epirus, Greece
  • 2011-2014
    • University of Ioannina
      • Division of Cardiac Surgery
      Yannina, Epirus, Greece
    • University of Patras
      Rhion, West Greece, Greece