Mariusz Kowalewski

Central Clinical Hospital of the Ministry of Interior in Warsaw · Department of Cardiac Surgery

The incidence of postacute myocardial infarction ventricular septal rupture (post-AMI VSR) has decreased over the past two decades. Nevertheless, individuals who suffer from post-AMI VSR continue to represent a subgroup of patients with high morbidity and mortality. The care for these patients is complex and requires a multidisciplinary approach. H...

The main goal of minimally invasive surgery is to reduce the perioperative trauma, accelerate patient mobilization and reduce the length of hospital stay. Due to the development of modern technology, these treatments can be offered to a wider group of patients. For many years, aortic root surgery consisted of mechanical conduit implantation and, th...

Objective The left internal mammary artery (LIMA) is a common arterial graft in minimally invasive coronary surgery (MICS), such as minimally invasive coronary artery bypass grafting (MIDCAB) or totally endoscopic coronary artery bypass (TECAB). The aim of this study was to perform an analysis of the LIMA operative topography during MICS. Methods...

Background Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO duri...

Background: Extracorporeal membrane oxygenation (ECMO) has been widely used in patients with COVID-19, but uncertainty remains about the determinants of in-hospital mortality and data on post-discharge outcomes are scarce. The aims of this study were to investigate the variables associated with in-hospital outcomes in patients who received ECMO dur...

Objectives Transcatheter aortic valve implantation (TAVI) remains the preferred strategy for high-risk or elderly individuals with aortic valve (AV) stenosis who are not considered to be optimal surgical candidates. Recent evidence suggests that low-risk patients may benefit from TAVI as well. The current study evaluates mid-term survival in low-ri...

Introduction Atrial fibrillation (AF) is a prevalent disease considerably contributing to the worldwide cardiovascular burden. For patients at high thromboembolic risk (CHA 2 DS 2 -VASc ≥3) and not suitable for chronic oral anticoagulation, owing to history of major bleeding or other contraindications, left atrial appendage occlusion (LAAO) is indi...

Background: Atrial fibrillation (AF) is a relatively common comorbidity among patients referred for coronary artery bypass grafting (CABG) associated with poorer prognosis. However, little is known about how surgical technique influences survival in this population. Aim: The aim of the current analysis was to determine whether total arterial rev...

Background The effectiveness of veno-arterial extracorporeal life support (V-A ECLS) in treating neonatal and pediatric patients with complex congenital heart disease (CHD) and requiring cardio-circulatory assistance is well-known. Nevertheless, the influence of left ventricle (LV) distension and its countermeasure, namely LV unloading, on survival...

Background: Hypertrophic obstructive cardiomyopathy (HOCM) is a heterogeneous disease with different clinical presentations, albeit producing similar dismal long-term outcomes if left untreated. Several approaches are available for the treatment of HOCM; e.g., alcohol septal ablation (ASA) and surgical myectomy (SM). The objectives of the current...

Introduction Paravalvular leak (PVL) is a well‐recognized complication after mitral valve replacement (MVR). However, there are only a few studies analyzing leak occurrence and postoperative results after surgical MVR. The aim of this study was to assess the rate and determinants of early mitral PVL and to evaluate the impact on survival. Methods...

Background The aim of this study was to assess the impact of septal thickness on long-term outcomes of surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM) and correction of mitral subvalvular anomalies.Methods Sixty-six consecutive patients (58 ± 12 years, 56% female) undergoing extended septal myectomy and subvalvular mitral appa...

Objectives Although endorsed by international guidelines, complete revascularization (CR) with Coronary Artery Bypass Grafting (CABG) remains underused. In higher-risk patients such as those with pre-operative atrial fibrillation (AF), the effects of CR are not well studied.Methods We analyzed patients’ data from the HEIST (HEart surgery In AF and...

Introduction: There are gaps of knowledge regarding the impact of the COVID-19 pandemic on cardiac surgery hospitalization and treatment. Aim: To evaluate patient characteristics, patient morbidity, type of procedures, length of hospital stay, early mortality, and outcomes of surgical treatment for the heart diseases during one year after the CO...

Objective: Myocardial damage occurs in up to 25% of coronavirus disease 2019 (COVID-19) cases. While veno-venous extracorporeal life support (V-V ECLS) is used as respiratory support, mechanical circulatory support (MCS) may be required for severe cardiac dysfunction. This systematic review summarizes the available literature regarding MCS use rat...

Objective Preoperative atrial fibrillation (AF) increases risk of stroke, heart failure, and all-cause mortality after cardiac surgery. Despite encouraging results and guideline recommendations, surgical ablation (SA) for AF concomitant to other heart surgery remains low. The current report aimed to address the long-term mortality after SA concomit...

Severe mitral regurgitation secondary to papillary muscle rupture is one of the mechanical complications after an acute myocardial infarction. Surgical strategies represent the cornerstone of treatment in this disease; in addition to surgical valve replacement, approaches involving surgical valve repair have been reported over time in different cli...

Background Data regarding management of patients with unprotected left main coronary artery in-stent restenosis (LM-ISR) are scarce.Objectives This study investigated the safety and effectiveness of percutaneous coronary intervention (PCI) vs. coronary artery bypass grafting (CABG) for the treatment of unprotected LM-ISR.Methods Consecutive patient...

Background Among patients referred for cardiac surgery, atrial fibrillation (AF) is a common comorbidity and a risk factor for postoperative arrhythmias (eg, sinus node dysfunction, atrioventricular heart block), including those requiring permanent pacemaker (PPM) implantation. Objective The purpose of this study was to evaluate the prevalence and...

Right ventricular failure after cardiac surgery is a complex disease that may impair the outcome after valve repair/replacement, bypass surgery, as well as left ventricular assist device implantations and heart transplant. This condition is associated with higher mortality and prolonged in-hospital stay as well as failure of the primary graft in ca...

Introduction: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has recently and rapidly emerged and developed into a global pandemic. Through the renin-angiotensin system, the virus may impact the lung circulation, but the expression on endothelium may conduct to its activation and further systemic damage. While precise...

Objectives The aim of this study was to quantify and understand the unloading effect of percutaneous balloon atrial septostomy (BAS) in acute cardiogenic shock (CS) treated with venoarterial (VA) extracorporeal membranous oxygenation (ECMO). Background In CS treated with VA ECMO, increased left ventricular (LV) afterload is observed that commonly...

Background Aortic valve (AV) stenosis can be treated either by surgical AV replacement (SAVR) or since 2002 by transcatheter aortic valve implantation (TAVI). Due to lower invasiveness, TAVI is a preferred approach in high- and prohibitive risk surgical candidates, yet outcome data is conflicting when lower risk patients are considered and in parti...

Background: Aortic valve (AV) stenosis can be treated either by surgical AV replacement (SAVR) or since 2002 by transcatheter aortic valve implan-tation (TAVI). Due to lower invasiveness, TAVI is a preferred approach in high-and prohibitive risk surgical candidates, yet outcome data is conflicting when lower risk patients are considered and in part...

OBJECTIVES Papillary muscle rupture (PMR) is a rare but potentially fatal complication of acute myocardial infarction. The aim of this study was to analyse the patient characteristics and early outcomes of the surgical management of post-infarction PMR from an international multicentre registry. METHODS Patients underwent surgery for post-infarcti...

Importance: Ventricular septal rupture (VSR) is a rare but life-threatening mechanical complication of acute myocardial infarction associated with high mortality despite prompt treatment. Surgery represents the standard of care; however, only small single-center series or national registries are usually available in literature, whereas internation...

Background Left ventricular free-wall rupture (LVFWR) is one of the most lethal complications after acute myocardial infarction (AMI). The optimal therapeutic strategy is controversial. The current meta-analysis sought to examine the outcome of patients surgically treated for post-AMI LVFWR. Methods A comprehensive literature review was performed...

Background: The NAUTILUS study aimed to evaluate the safety and performance of the Allegra bioprosthesis in high-risk recipients undergoing transcatheter aortic valve implantation and were reported on 30-day outcomes. Hence, are the presented 1-year results of the trial. Methods: Twenty-seven recipients with severe, symptomatic aortic valve sten...

In SARS-CoV-2 patients with severe acute respiratory distress syndrome (ARDS), Veno-Venous Extracorporeal Membrane Oxygenation (V-V ECMO) was shown to provide valuable treatment with reasonable survival in large multi-centre investigations. However, in some patients, conversion to modified ECMO support forms may be needed. In this single-centre ret...

Background Historically, impaired glucose metabolism has been associated with early and late complicated clinical outcomes after cardiac surgery. Such a condition, however, is not specific to subjects with diabetes mellitus and involves larger patient population. Methods Databases were screened (January 2000-December 2020) to identify eligible arti...

Background Data regarding the clinical outcomes of covered stents (CSs) used to seal coronary artery perforations (CAPs) in the all-comer population are scarce. The aim of the CRACK Registry was to evaluate the procedural, 30-days and 1-year outcomes after CAP treated by CS implantation. Methods This multicenter all-comer registry included data of...

Study objective: Viscoelastic point-of-care (POC) tests are commonly used to provide prompt diagnosis of coagulopathy and allow targeted treatments in bleeding patients on ECMO. We evaluated the clinical effectiveness of point-of-care (POC) testing for anticoagulation management in patients on extracorporeal membrane oxygenation (ECMO). Design: Sy...

OBJECTIVES Surgical aortic valve replacement can be safely performed in people aged 80 years and older with early benefits on both symptomatic and prognostic ground. While new approaches are advocated to treat this elderly and frail population, data on long-term outcomes are not available. METHODS We conducted a retrospective analysis of 1870 pati...

Objectives: Refractory postcardiotomy cardiogenic shock complicating cardiac surgery yields nearly 100% mortality when untreated. Use of venoarterial extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock has increased worldwide recently. The aim of the current analysis was to outline the trends in use, changing patient profiles,...

Right ventricular failure (RVF) following left ventricular assist device (LVAD) implantation remains a major complication which may significantly impair patient outcome. The genesis of RVF is, however, multifactorial, and the mechanisms underlying such a condition have not been fully elucidated, making its prevention challenging and the course not...

Haemostatic unbalance is often observed in patients with coronavirus disease 2019 (COVID-19), and patients with severe disease are at high risk of developing thromboembolic complications. Viscoelastic methods (VEMs), including thrombelastography (TEG) and thromboelastometry (TEM), provide data on the nature of haemostatic disturbance. In this syste...

Background: Postoperative myocardial infraction (MI) is a serious complication among patients undergoing Coronary Artery Bypass Grafting (CABG). Data on the impact of postoperative MI on patients undergoing CABG, specifically with respect to their long term outcomes are sparse. Methods: We retrospectively analyzed all patients who underwent isol...

Introduction: Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has recently and rapidly emerged and developed into a global pandemic. In SARS-CoV-2 patients with refractory respiratory failure, there may be a role for veno-venous extracorporeal membrane oxygenation (V-V ECMO) as a life-saving rescue intervention. Method...

Background: Papillary muscle rupture (PMR) is a rare but potentially fatal complication following acute myocardial infarction (AMI). Surgical treatment is considered the standard of care. This systematic review and meta-analysis aims to evaluate the early outcomes after surgical correction of post-AMI PMR. Methods: Electronic databases were sear...

Aims: Because reported mortality on veno-arterial (V-A) extracorporeal life support (ECLS) substantially varies between centres, the aim of the current analysis was to assess the outcomes between units performing heart transplantation and/or implanting ventricular assist device (HTx/VAD) vs. non-HTx/VAD units in patients undergoing V-A ECLS for ca...

Background: Left ventricular free-wall rupture (LVFWR) is an uncommon but serious mechanical complication of acute myocardial infarction (AMI). Surgical repair, though challenging, is the only definitive treatment. However, given the rarity of this condition, results following surgery are still not well established. The aim of this study was to rev...

OBJECTIVES There is no consensus regarding the use of biological or mechanical prostheses in patients 50–69 years of age. Previous studies have reported a survival advantage with mechanical valves. Our goal was to compare the long-term survival of patients in the intermediate age groups of 50–59 and 60–69 years receiving mechanical or biological ao...

Background: Ventricular septal rupture (VSR) is a rare but life-threatening complication following acute myocardial infarction. Surgical correction, though challenging and associated with high mortality, remains the treatment of choice. This systematic review and meta-analysis aimed to evaluated the early outcome of surgical VSR repair. Methods: E...

The peripheral veno-arterial extracorporeal life support (V-A ECLS) in cardiogenic shock (CS) may lead to LV overload. The trans-aortic suction device (Impella, ABIOMED Inc., Danvers, Massachusets) was compared to the pulmonary artery (PA) drainage, for LV unloading efficacy during V-A ECLS in a porcine cardiogenic shock model. A dedicated CS model...

Observational studies suggest improved outcomes with multiple (MAG) as compared to single arterial grafting (SAG) in patients with multivessel coronary artery disease (MV-CAD) and undergoing coronary artery bypass grafting (CABG). Even though around 6% of CABG patients have pre-operative atrial fibrillation (AF), previous studies did not address MA...

Background: Minimally invasive aortic valve (AV) surgery has become widely accepted alternative to standard sternotomy. Despite possible reduction in morbidity, this approach is not routinely performed for aortic surgery. Current report aimed to demonstrate early and mid-term outcomes in patients undergoing minimally invasive aortic root- and asce...

Objectives: Since significantly higher mortality is observed in elderly patients undergoing venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock, decision-making in this setting is challenging. We aimed to elucidate predictors of unfavorable outcomes in these elderly (≥ 70 yr) patients. Design: Analysis of internationa...

Background: In middle-aged patients undergoing aortic valve replacement (AVR), the selection of prosthesis type is a complex process. Current guidelines do not unequivocally indicate the type of prosthesis (bioprosthetic or mechanical) recommended for patients between 60-70 years of age. The aim of the study was to present the trends in AVR prosth...

Objectives: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been recently considered and used for patients with post-acute myocardial infarction mechanical complications (post-AMI MC); however, information in this respect is scarce. The purpose of this study was to evaluate the in-hospital outcomes of patients with post-AMI MC subm...

Extracorporeal life support (ECLS) is indicated in refractory acute respiratory or cardiac failure. According to the need for anticoagulation, bleeding conditions (e.g., in trauma, pulmonary bleeding) have been considered a contraindication for the use of ECLS. However, there is increasing evidence for improved outcomes after ECLS support in hemorr...

Infection with severe acute respiratory syndrome coronavirus 2 (SARS–CoV–2) is a rapidly spreading and devastating global pandemic. Many researchers are attempting to clarify the mechanisms of infection and to develop a drug or vaccine against the virus, but there are still no proven effective treatments. The present article reviews the common pres...

Infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has presently become a rapidly spreading and devastating global pandemic. Veno-venous extracorporeal membrane oxygenation (V-V ECMO) may serve as life-saving rescue therapy for refractory respiratory failure in the setting of acute respiratory compromise such as that induce...

The association between blood levels of protein Z (PZ) and risk of ischemic stroke remains poorly understood. We aimed to assess this potential relationship through a meta-analysis of case–control studies. PubMed, Scopus, Web of Science Core Collection, and the Cochrane Library were searched from April 1984 to April 2019. We selected case–control s...

The current investigation aimed to evaluate long-term survival in patients undergoing isolated and combined coronary artery bypass grafting (CABG) with concomitant surgical ablation for atrial fibrillation (AF). Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. Eleven thousand three h...

Introduction Phaeochromocytoma is a catecholamine-secreting tumour associated with clinical presentation ranging from paroxysmal hypertension to intractable cardiogenic shock. Extracorporeal life support, in veno-arterial mode, application in refractory acute heart dysfunction is sharply increasing worldwide. However, its clinical utility in phaeoc...

Background: Extracorporeal membrane oxygenation (ECMO) use in patients with active bleedings or traumatic injuries may be challenging because of the risk of refractory haemorrhage related to systemic anticoagulation (SA). Technological advancements, especially heparin coated circuits, allowed ECMO application with a mild or no anticoagulation regi...

Background No single randomized study has ever before addressed the safety of On-Pump coronary artery bypass grafting (CABG) vs Off-Pump CABG in the setting of atrial fibrillation (AF) and data from small observational samples remain inconclusive. Methods and findings Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedure...