Jan Vojacek

Charles University in Prague | CUNI · Department of Cardiosurgery (Hradec Králové)

OBJECTIVES Both aortic root remodelling and aortic valve (AV) reimplantation have been used for valve-sparing root replacement in patients with aortic root aneurysm with or without aortic regurgitation. There is no clear evidence to support one technique over the another. This study aimed to compare remodelling with basal ring annuloplasty versus r...

Background. Aortic root replacement with a composite mechanical valve graft (Bentall procedure) has been a recommended strategy in patients with aortic root aneurysm with or without aortic regurgitation. Aortic root remodeling (Yacoub procedure) has emerged as a valve-sparing alternative although there is only scarce multicenter evidence. The aim o...

Background The optimal treatment of patients with severe symptomatic aortic regurgitation (AR) is state-of-the-art surgery. Asymptomatic patients with advanced left ventricular (LV) dilatation and/or impaired ejection fraction should undergo surgical treatment, but there is no guidelines consensus on cut-off values for this recommendation. Multimod...

Pure aortic regurgitation and dilation of aortic annulus are the most significant risk factors for the failure of pulmonary autograft after the Ross procedure. Aortic annuloplasty has a positive effect on the durability of the autograft. Previously, we described a technique for external annuloplasty with dedicated CORONEO ring. In the present manus...

Prophylactic left atrial appendage occlusion has been suggested as a means of reducing cardioembolism risk in patients with atrial fibrillation. Its clinical benefits have been discussed together with potential endocrine or hemodynamic adverse effects, with conflicting conclusions. We aimed to provide a thorough overview of the current literature a...

Background and objectives: Class I triggers for severe and chronic aortic regurgitation (AR) surgery rely mainly on symptoms or systolic dysfunction, resulting in a negative outcome despite surgical correction. Therefore, US and European guidelines now advocate for earlier surgery. We sought to determine whether earlier surgery leads to improved p...

Background Invasive double-valve endocarditis with structural damage (abscess or perforation) of the aorto-mitral curtain is a relatively rare but fatal diagnosis requiring complex surgical reconstruction. This study presents the short-term and mid-term outcomes from a single center. Methods From 2014 to 2021, 20 patients with double-valve endocar...

Background Renal cell carcinoma (RCC) with tumor thrombus extension into the right atrium (level IV) is a rare life-threatening clinical condition that can only be managed by means of a combined urological and cardiac surgical approach. The early and late outcomes of this radical treatment were analyzed in a large single-institution series over a p...

Background: Tobacco smoking has been associated with an increased risk of complications after conventional coronary surgery. However, the impact of smoking on the risk of postoperative complications in minimally invasive coronary surgery is yet to be studied. We aimed to analyze the impact of the preoperative smoking status on the short- and long-...

Background Use of the current echocardiography-based indications for aortic regurgitation (AR) surgery might result in late valve replacement at the stage of irreversible myocardial damage. Therefore, we aimed to identify simple models combining multiple echocardiography or magnetic resonance imaging (MRI)–derived indices and natriuretic peptides (...

Background Until 2021, the strongest guidelines on surgical correction of severe aortic regurgitation (AR) focused on the left ventricular systolic function (LVEF) and the presence of symptoms. However, those situations lead to an outcome penalty, even after surgical correction. Left ventricle end-systolic diameter (LVESD) gained in strength in 202...

Unroofed coronary sinus is a rare congenital heart disease caused by the partial or complete absence of the common wall between the coronary sinus and left atrium. When indicated for repair, it is done either percutaneously or surgically. Repair using a totally endoscopic robotic procedure is rarely performed nor reported in the literature. We repo...

Over the last 2 decades, there has been a growing interest in aortic valve repair and aortic valve-sparing procedures. Deep understanding of the mechanisms of aortic regurgitation in different valve phenotypes has enabled to proceed from valve-sparing aortic root replacement to a modern and complex concept of aortic valve repair including bicuspid...

Background Unicuspid aortic valve (UAV) is the second most common underlying cause of aortic valve dysfunction in young adults after the bicuspid valve. The valve may be replaced (for example by pulmonary autograft) or repaired using the bicuspidization technique. The aim of our study was to compare short- and mid-term outcomes of Ross procedure wi...

Background The mechanism underlying aortic dilatation is still unknown. Vascular dilatation is thought to be the result of progressive aortic media degeneration caused by defective vascular matrix hemostasis, including TGF-β1 dysregulation. The goal of this study is to draw attention to the potential utility of TGF-β1 as a diagnostic marker in non-...

Background Robotic assistance (RA) in the harvesting of internal thoracic artery during minimally invasive direct coronary artery bypass grafting (MIDCAB) provides several potential benefits for surgeon and patient in comparison with conventional MIDCAB. The two technical options have not been thoroughly compared in the literature yet. We aimed to...

Introduction Until 2021, the strongest guidelines on surgical correction of severe aortic regurgitation (AR) focused on the left ventricular systolic function (LVEF) and the presence of symptoms. However, those situations lead to an outcome penalty, even after surgical correction. Recommendations on left ventricular end-systolic diameter (LVESD) ga...

We read the letter to the editor written by Chen et al. [1] regarding our published study [2] with great interest. We agree that the reintervention rate on both valves is of utmost importance. Therefore, we described the need for reintervention separately as follows: 9 patients (3.1%) in the Ross group had to undergo a reoperation due to autograft...

Background The prevalence and outcomes of the unicuspid aortic valve (UAV) in patients undergoing the Ross procedure have been strongly underreported in the current literature. We sought to evaluate this in comparison with bicuspid (BAV) and tricuspid valve (TAV) in our Ross cohort. Methods This was a retrospective observational study of patients...

Introduction: Primary cardiac tumors are a rare condition presenting with a variety of symptoms. The outcomes of their surgical treatment in the modern era from central Europe have not been recently reported. Aim: To evaluate the short- and long-term outcomes of the cardiac tumor operations at our department throughout the last 20 years. Materi...

Objectives Conventional mitral valve surgery through median sternotomy improves long-term survival with acceptable morbidity and mortality. However, less-invasive approaches to mitral valve surgery are now increasingly employed. Whether minimally invasive mitral valve surgery is superior to conventional surgery is uncertain. Methods A retrospectiv...

Objectives. The One-minute Sit-To-Stand Test (STST) is a relatively novel physical performance test in the field of pulmonology. It measures the exercise tolerance of the patient. In this pilot study, we evaluated its predictive value for the postoperative course in cardiac surgery patients. Design. This was a prospective observational cohort study...

OBJECTIVES Patients with a bicuspid aortic valve (BAV) often present with a dilated ascending aorta. However, the underlying pathogenesis for the observed changes in the aortic wall and the resulting aneurysmal dilation remains a subject of debate. This study aims to compare the histological abnormalities of the ascending aorta in BAV and tricuspid...

Patients with a bicuspid aortic valve (BAV) frequently require surgical intervention for aortic regurgitation (AR) and/or aneurysm. Valve-preserving surgery and repair of regurgitant BAVs have evolved into an increasingly used alternative to replacement. Anatomic predictors of possible repair failures have been identified and solutions developed. U...

We report a case of a 51-year-old male with complicated acute type A aortic dissection who initially underwent a supracoronary and aortic arch replacement using frozen elephant trunk technique. False-lumen perfusion was revealed later which resulted in the collapse of the true lumen. Endovascular fenestration of the dissection flap was performed. T...

Aortic valve surgery in non-elderly patients represents a very challenging patient population. The younger the patient is at the point of aortic valve intervention, the longer their anticipated life expectancy will be, with longer exposure to valve-related complications and risk for re-operation. Although the latest international guidelines recomme...

Acute type A aortic dissection (DAA) is a life-threatening condition which affects ascending aorta but may extend into the arch and descending aorta. Most patients with type A dissection are managed surgically. The standard treatment is open surgical repair through median sternotomy and involves segmental resection of the primary intimal tear and r...

Objectives: Current national registries are lacking detailed pathology-driven analysis and long-term patients outcomes. The Heart Valve Society (HVS) aortic valve (AV) repair research network started the Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (AVIATOR) to evaluate long-term patient outcomes of AV repair and...

Background: To report single-institution experience with minimally invasive mitral valve operations through the right minithoracotomy over a 5-year period. Methods: Patients who underwent minimally invasive mitral valve surgery (MIMVS) between January 2012 and December 2016 were included. Clinical follow-up data were collected in a prospective data...

Background: We evaluated the feasibility and effectiveness of thoracoscopic and a staged surgical and transcatheter ablation technique to treat stand-alone atrial fibrillation (AF). Methods: . Between 2009 and 2016, a cohort of 65 patients underwent bilateral totally thoracoscopic ablation of symptomatic paroxysmal AF (n=30; 46%), persistent AF...

Aortic valve repair and valve sparing procedures enable restoration of competence in a regurgitant aortic valve, thus avoid the risks related to valve replacement. Successful aortic valve repair requires profound understanding of static and dynamic geometry of the aortic valve and aortic root. Aortic regurgitation originates from a malposition of t...

Aim: To evaluate medium to long-term outcomes of aortic valve-sparing procedures and identify risk factors for procedure failure. Methods: From 11/2007 to 10/2017, a total of 198 aortic valve sparing operations were performed at our department. The mean age of patients was 48.4±13.5 years. Preoperatively, the mean grade of aortic regurgitation was...

An aggressive periaortic lymphoma could very rarely invade the aortic wall. We present a unique case of a patient with symptomatic thoracic aneurysm and imminent rupture due to the periaortic lymphoma, in which endovascular treatment using stent graft was applied. After stabilization of the aorta and histological confirmation of aggressive B-cell l...

OBJECTIVES: Postinfarction ventricular septal defect is a serious mechanical complication of acute myocardial infarction associated with high postoperative mortality. The aim of this study was to review our experience with surgical repair of postinfarction ventricular septal defect and to identify predictors of early and late outcomes. METHODS: Thi...

Objectives: Postinfarction ventricular septal defect is a serious mechanical complication of acute myocardial infarction associated with high postoperative mortality. The aim of this study was to review our experience with surgical repair of postinfarction ventricular septal defect and to identify predictors of early and late outcomes. Methods:...

Aortic valve repair and valve sparing procedures enable restoration of competence in regurgitant aortic valve, and thus to avoid the risks related to valve replacement. Successful aortic valve repair requires deep understanding of the static and dynamic geometry of the aortic valve and aortic root. Aortic regurgitation originates from malapposition...

Aortic valve repairs are interventions correcting aortic regurgitation without the use of artificial heart valves. Avoiding of aortic valve replacement eliminates valve related risks but is, however, associated with uncertain long-term durability of the repair. A task for preoperative and especially intraoperative echocardiography is to detect the...

Background: In patients after aortic valve surgery, the quality of life is hypothesized to be influenced by the type of the valve procedure. A cross-sectional study on the postoperative quality of life was carried out in patients after aortic valve-sparing surgery (with regards to the age of the patient), Ross procedure and mechanical aortic valve...

Aortic valve sparing strategies have a valuable potential to treat the patient's valvular disease. In contrast to the mitral and tricuspid valve, aortic repair is more difficult with respect to specific valve features. Authors give a historical overview of the evolution of surgical concepts to achieve the valve competency. Over the period of 70 yea...

Aim: Retrospective analysis of results of endovascular treatment of complicated aortic dissection type B using thoracic stent grafts (SG) and stent s. Material and Methods: We treated 34 patients (7 women, 27 men, mean age 60.4 years) endovascularly due to complicated dissection B of thoracic aorta from February 2001 to August 2014. Indication to t...

Purpose: To evaluate the influence of endovascular therapy of ruptured abdominal or iliac aneurysms on total mortality. Materials and methods: We analyzed the mortality of 40 patients from 2005 to 2009, when only surgical treatment was available. These results were compared with the period 2010 to 2013, when endovascular aneurysm repair (EVAR) w...

Background We report the feasibility and outcomes of box-lesion ablation technique to treat stand-alone atrial fibrillation (AF).Methods There were 41 patients with a mean age of 57.6 ± 8.0 years who underwent bilateral totally thoracoscopic ablation of symptomatic paroxysmal AF (n = 24; 58.5%), persistent AF (n = 9; 22.0%), or long-standing persis...

Background The aim of this study was to analyze short- and mid-term results after aortic valve (AV) repair with particular regard to the impact of valve cuspidity (bicuspid versus tricuspid aortic valve). Methods One hundred patients with aortic regurgitation (AR) undergoing aortic valve repair between November 2007 and October 2012 were included i...

A one-step supraclavicular approach for the surgical treatment of the aberrant right subclavian artery is described in a case of dysphagia lusoria in a 38-year-old female. The approach allows for safe division of the arteria lusoria and its re-anastomosis to the common carotid artery while the patient benefits from a mini-invasive extrathoracic pro...

The issue of valvular defects represents an important part of modern cardiology. Valvular defects aggravate the quality of life of the patients, and based on the level of severity, they worsen their survival rate. Together with the ageing of the population, improvement in the care of the patients suffering from IHD and chronic heart failures, there...

Isolated thoracic aortitis is a new pathological entity. We review the histopathological features of this disease, the role of imaging, and diagnostic modalities necessary to make the diagnosis of aortitis and discuss the management of patients with an established diagnosis of isolated thoracic aortitis.

Introduction: Minimally invasive surgical access for the treatment of mitral and tricuspid valves has become an alternative method to the conventional approach via median sternotomy. The aim of this paper is to evaluate our experience and results with minimally invasive approach in cardiac surgery at our institution. Material and methods: A tota...

Introduction The aim of this study was to analyze short- and mid-term results of aortic valve repair. Material and methods One hundred consecutive patients (24 females; mean age 50.3 years, range 23–77 years) with aortic regurgitation underwent aortic valve repair between November 2007 and October 2012. Sixty patients had bicuspid aortic valve, an...

A hybrid approach to elephant trunk technique for treatment of thoracic aortic aneurysms combines a conventional surgical and endovascular therapy. Compared to surgery alone, there is a presumption that mortality and morbidity is reduced. We present a case report of a 42-year-old man with a giant aneurysm of the entire thoracic aorta, significant a...

Cardiac sarcoidosis is a rare entity and may be difficult to diagnose prior to cardiac surgery. We review the imaging and diagnostic studies necessary to make the diagnosis and discuss therapeutic algorithms to manage this disease.

Background To review single centre experience of endovascular treatment of descending thoracic aorta. Methods Between May 1999 and September 2012, 72 patients were treated overall (53 men, 19 women, mean age 60.1 years) for degenerative aneurysms (n = 5), ruptured aneurysms (n = 4), aortic ulcers (n = 8), infected aneurysms (n = 4), type B aortic...

The aim of the study: Report's target was to compare the quality of life of two patients groups: First - 23 Ross patients, and second - 29 mechanical valve prostheses owners. Material and methods: Ross procedure was performed in 28 patients at our Institution since 2009. Perioperative mortality was 0%, survival rate 100%, pulmonary autograft and pu...

The Ross procedure is an alternative technique to mechanical prosthesis and recent evidence suggests that it is associated with improved long-term survival and quality of life. However, late pulmonary autograft failure can occur more frequently in patients with significant dilation of the aortic annulus. Here, we present a technical modification of...

What's known on the subject? and What does the study add? Surgical treatment of renal cell carcinoma (RCC) with tumour thrombus extending into the right atrium remains, despite its complexity and specific technical aspects, the only radical therapeutic option. This single-centre study, unique in size for this rare condition, reports early and late...

Background To determine impact of intraluminal-left anterior descending shunt to prevent myocardial damage in minimally invasive coronary artery bypass. Methods 38 patients were randomly assigned to external tournique occlusion (n = 19) or intraluminal-left anterior descending shunt group (n = 19). Blood samples for cardiac troponin T were collect...

Isolated thoracic aortitis (ITA) is a newly-defined pathological entity with a still-unknown etiopathology and with some potential relationship to IgG4-related systemic disease. We investigated patients on whom the ascending aorta was operated to identify the clinical and histopathological features of ITA and its relationship to IgG4-related system...

Introduction: The history of mitral valve surgery is presented followed by an analysis of the aetiology of mitral valve disease. Methods: The principles of valve preserving procedures are discussed, with an emphasis placed on professor Carpentier's school of mitral valve preserving surgery, and the classification of mitral regurgitation established...

Cardiac resynchronization therapy is a therapeutic option in patients with chronic heart failure. Epicardial lead implantation for biventricular pacing is usually the method of second choice after failed coronary sinus cannulation. The present study describes an initial experience with minimally invasive surgical lead implantation using thoracoscop...

Objective Cardiac resynchronization therapy is a therapeutic option in patients with chronic heart failure. Epicardial lead implantation for biventricular pacing is usually the method of second choice after failed coronary sinus cannulation. The present study describes an initial experience with minimally invasive surgical lead implantation using t...

Aim. Retrospective analysis of efficacy and safety of endovascular treatment of diseases of the descending thoracic aorta and distal aortic arch with thoracic stent-graft. Method. From May 1999 to December 2010 we treated 58 patients (44 men, 14 women, mean age 59.5 years). These were degenerative aneurysms (n = 5), bleeding degenerative aneurysms...

Cíl: Retrospektivní analýza efektivity a bezpečnosti endovaskulární léčby onemocnění sestupné hrudní aorty a distálního aortálního oblouku pomocí hrudních stentgraftů. Materiál a metodika: V období od května 1999 do března 2011 jsme na našem pracovišti léčili celkem 62 pacientů (46 mužů, 16 žen, průměrný věk 59,5 let). Jednalo se o symptomatickou d...

A mitral allograft is used exceptionally in the mitral, as well as in the tricuspid position, mostly as an experimental surgical procedure. The authors decided to evaluate the possibility of inserting a cryopreserved mitral allograft into the tricuspid position in a sheep experimental model. Within the framework of this experimental project the mec...

Standard (conventional) coronary artery bypass grafting (CABG) is an invasive procedure which requires full median sternotomy and is performed with extracorporeal circulation (ECC), which can lead to serious complications. To analyse the results of minimally invasive CABG (MIDCAB) in elderly patients. Between 1999 and 2007, a total of 698 MIDCAB pr...