P M Mikus

Slovak Medical University in Bratislava, Presburg, Bratislavský, Slovakia

Are you P M Mikus?

Claim your profile

Publications (34)56.81 Total impact

  • S Krajcik · T Haniskova · P Mikus
    [Show abstract] [Hide abstract]
    ABSTRACT: Summary The incidence of pneumonia is higher in older than younger people, due to both an increase in factors facilitating entry of infectious agents into the lungs, and attenuated functioning of the immune system. Classic features of presentation of pneumonia may be absent. The most common signs of pneumonia in old age are tachypnoea and tachycardia. Aetiology is established in only 50% of older patients. The empirical treatment of community-aquired pneumonia (CAP) should be aimed at its most common cause, Streptococcus pneumoniae. The empirical treatment of health care-associated pneumonia (HCAP) should be targeted at Gram-negative agents. Choice of antibiotic must include consideration of potential drug interactions.
    No preview · Article · Jan 2011 · Reviews in Clinical Gerontology
  • P Mikus · E Mikus · I Stankovicova · S Krajcik

    No preview · Article · Jun 2010 · Journal of Hypertension

  • No preview · Article · Feb 2010 · The Journal of Heart and Lung Transplantation
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Owing to the shortage of donor hearts, the criteria for acceptance have been considerably expanded. Pharmacologic stress echocardiography is highly accurate in identifying prognostically significant coronary artery disease, but brain death and catecholamine storm in potential heart donors may substantially alter the cardiovascular response to stress. This study assessed correlates of an abnormal resting/stress echocardiography results in potential donors. From April 2005 to December 2007, 18 marginal candidate donors (9 men) aged 58 +/- 5 years were initially enrolled. After legal declaration of brain death, all marginal donors underwent bedside echocardiography, with baseline and (when resting echocardiography was normal) dipyridamole (0.84 mg/kg in 6 min) or dobutamine (up to 40 microg/kg/min) stress echo. Non-eligible hearts (with abnormal rest or stress echo findings) were excluded and underwent cardioautoptic verification. Resting echocardiography showed wall motion abnormalities in 5 patients (excluded from donation). Stress echocardiography was performed in the remaining 13 (dipyridamole in 11; dobutamine in 2). Results were normal in 7, of which 6 were uneventfully transplanted in marginal recipients. Results were abnormal in 6, and autoptic verification performed showed coronary artery disease in 5, and initial cardiomyopathy in 1. Bedside pharmacologic stress echocardiography can safely be performed in candidate heart donors, is able to unmask occult coronary artery disease or cardiomyopathy, and shows potential to extend donor criteria in heart transplantation. Further experience with using marginal donors is needed before exact guidelines can be established.
    Full-text · Article · Sep 2009 · The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation
  • Source
    G Arpesella · A Loforte · E Mikus · P.M. Mikus
    [Show abstract] [Hide abstract]
    ABSTRACT: Herein we have reported our experience concerning the usefulness of extracorporeal membrane oxygenation (ECMO) in heart transplant patients. Between July 2002 and March 2007, 11 heart transplant patients, namely, 8 men and 3 women of overall mean age of 49.4 +/- 13.9 years (range, 19-62 years) with primary graft failure underwent ECMO implantation. Two patients had pulmonary hypertension; 3 had been transplanted with hearts from marginal donors. At the time of implantation, all were in severe cardiogenic shock despite maximal inotropic support. In 6 patients, the ECMO was implanted centrally in the operating room when there was failure of weaning of cardiopulmonary bypass. Among the 5 remaining patients, ECMO was implanted peripherally in the intensive care unit, during the first 60 hours, including 3 cases of hemodynamic instability and 1 of irreversible cardiac graft arrest. The last patient was implanted on day 30 after transplantation because of acute rejection. Mean pump outflow was 2.7 +/- 0.4 L/min/m(2). One patient died on circulatory support due to a cerebral hemorrhage. Ten patients were weaned from ECMO after a mean duration of 9.1 +/- 6.9 days (range, 1-18 days). All of them were successfully discharged. No retransplantation occurred. Rapid operating room or bedside placement of ECMO allowed stabilization of hemodynamics with potential myocardial recovery in patients with cardiac graft failure.
    Full-text · Article · Jan 2009 · Transplantation Proceedings
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The current surgical technique for pulmonary endarterectomy (PEA) involves the use of deep hypothermia and circulatory arrest at 18 degrees C (DHCA). Our experience started in 2004 when we decided to use an original alternative strategy which consists of avoiding deep hypothermia and subsequent circulatory arrest by using moderate hypothermia at 26 degrees C, and maintaining a bloodless field. This can be achieved by means of negative pressure in the left heart chambers and appropriate pump flow modulation in order to maintain the mixed venous oxygen saturation (SVO(2)) higher than 65%. From June 2004 to June 2007, 40 consecutive patients were operated on in our department with this strategy. The aim of this article is to report the early results for all patients and the complete six-month follow-up for 30 subjects who have reached this end-point at the time of writing. The mean temperature during extracorporeal circulation was 25.9 degrees C; core temperature was lowered to 21 degrees C in only one patient and an 8 min DHCA was performed in order to complete the PEA. Two patients died (6.6%): one on the third postoperative day due to myocardial infarct, requiring an ECMO implantation. The other patient died from septic shock. The six-month follow-up, performed in all other patients, included clinical and hemodynamic evaluation. Pulmonary vascular resistance (PVR) decreased from 793.5+/-284 dyn/cm/s(-5) to 286+/-143 (p=0.000). A comparable reduction of mean pulmonary arterial pressure and an increase of cardiac output were also observed. Conclusions: The results confirm that adequate removal of pulmonary artery obstructive lesions can also be achieved with an operative procedure that avoids or reduces the use of DHCA while allowing a bloodless field during PEA interventions. This technique may limit the well known adverse effects of DHCA due to organ hypoperfusion, improving the postoperative recovery of the patients.
    Full-text · Article · Aug 2008 · European Journal of Cardio-Thoracic Surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: We retrospectively reviewed our experience in combined liver-kidney (L-KT) and heart-kidney (H-KT) transplantations. Between January 1997 and April 2007, we performed 25 L-KT and 5 H-KT. Patient mean age was 51+/-8 years in L-KT and 43+/-11 years in H-KT. The main cause of liver failure was chronic viral hepatitis (14 cases). Etiology of heart failure was dilated cardiomyopathy and hypertrophic cardiomyopathy (4 and 1 patients, respectively). The main causes of renal failure in L-KT were chronic glomerulonephritis (n=8) and polycystic disease (n=7). Etiology of renal failure in H-KT was interstitial nephropathy (n=2), vascular nephropathy (n=2), and chronic glomerulonephritis (n=1). Mean follow-up was 32+/-26 months in L-KT and 24+/-17 months in H-KT. Immunosuppression was cyclosporine-based (n=4) or tacrolimus-based (n=21) in L-KT and cyclosporine-based in H-KT. Acute rejection rate was 8% for both liver and kidney in L-KT; 80% (mild) for heart and 40% for kidney in H-KT. In the L-KT group, there was no primary graft nonfunction (PGNF). Two patients experienced liver delayed graft function (DGF); 1 patient required postoperative dialysis. One-year graft and patient survivals were both 84% and overall graft and patient survival was 76%. In the H-KT group, 3 patients needed postoperative dialysis and 1 required a cardiac assistance device for 48 hours; overall graft and patient survival was 100% with good cardiac and renal functions. Our experience confirmed that H-KT and L-KT are safe procedures, offering good long-term results.
    No preview · Article · Jul 2008 · Transplantation Proceedings
  • [Show abstract] [Hide abstract]
    ABSTRACT: Heart transplantation is a demonstrated successful and life-saving treatment for an increasing number of patients. The growth of heart transplantation surgery is limited by the relative lack of suitable donors, and the increasing demand has lead to the expansion of acceptance criteria. Patients succumbing to carbon monoxide (CO) poisoning are usually considered not suitable organ donors and they are routinely rejected in many centers. Although organs from CO poisoning donors have been occasionally used, cardiac transplantation in this scenario remains very uncommon. We report the successful heart transplantation from a CO intoxicated donor, who was previously refused by two other transplantation teams. Standard donor evaluation criteria, transplantation techniques and management were used. Limited cases are described in literature. The present case may increase awareness among emergency department physicians, as well as transplantations teams, that patients dying of CO exposure may be acceptable cardiac donors.
    No preview · Article · Jul 2008 · Transplantation Proceedings
  • Source

    Full-text · Article · Dec 2007 · Liver Transplantation
  • Source
    Giorgio Arpesella · Elisa Mikus · Antonino Loforte · Piero Maria Mikus
    [Show abstract] [Hide abstract]
    ABSTRACT: Chronic functional pulmonary hypertension (FPH) secondary to end-stage cardiomyopathy constitutes a risk factor for graft right ventricular failure (RVF) after orthotopic heart transplantation (HTx). A novel form of mechanical assist circuit, the extracorporeal right to left atrium bypass (ECRLAB), has been proposed. Since 1998, at our institution, a total of six patients with FPH who experienced graft RVF after HTx, as ischemic end-stage cardiomyopathy, during the effort to wean from cardiopulmonary bypass, underwent ECRLAB support. There were five men and one woman with a mean age of 55 ± 3.5 years (49–59 years). The Jostra Rota Flow pump was used in five patients and the Bio-Medicus in one. Mean duration of support was 94.3 ± 17.5 h (75–126 h). All (100%) patients were successfully weaned from ECRLAB support. Hemodynamic parameters improved in all patients. Two patients died from cerebral haemorrhage. Four (66.6%) patients were successfully discharged home. ECRLAB could be proposed during HTx in patients with increased preoperative transpulmonary gradient to promote the functional adaptation of the graft and avoid graft RVF, until the decline of pulmonary resistances.
    Full-text · Article · Nov 2007 · European Journal of Cardio-Thoracic Surgery
  • Source
    G Arpesella · E Mikus · M Arabia · A Loforte · P M Mikus
    [Show abstract] [Hide abstract]
    ABSTRACT: Mechanical circulatory support is an essential issue in the management of patients with end-stage cardiac failure. The aim of this study is to evaluate the efficacy of temporary support with a centrifugal blood pump as bridge to heart function recovery or bridge to transplantation. Heart recovery is achieved by improving ventricular mechanical working conditions with proper modifications of preload and afterload. This article assesses the advantages of a novel 'cardiac chambers' cannulation setting versus the traditional one, in the case of biventricular or isolated right ventricular failure. The study was conducted using a numerical computer model based on the work by Guyton, Sagawa, Westerhof, and Noordergraaf. Simulation of the planned trials was achieved by changing the model parameters, the pump angular velocity, and the inflow and outflow settings.
    Full-text · Article · Aug 2007 · The International journal of artificial organs
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cardiac lipomas are very rare neoplasms. We describe herein a case of giant intrapericardial extracavitary lipoma in a 67-year-old man who has been previously treated for prostate and kidney cancers. The patient underwent successful resection of the tumor through right anterolateral thoracotomy.
    No preview · Article · Mar 2007 · Cardiovascular Pathology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The current surgical strategy for pulmonary endarterectomy (PEA) involves the use of extracorporeal circulation and hypothermic circulatory arrest (HCA). The aim of the present study was to test the feasibility of a different strategy of extracorporeal circulation, which could prevent bronchial back bleeding and allow a bloodless operating field, avoiding the risks associated with HCA in patients undergoing pulmonary endarterectomy. Between June 2004 and September 2005, eight patients underwent PEA without HCA. We introduced a double venting of the left heart sections, utilizing two cannulas placed in the left ventricle and atrium. Both vent cannulas are connected with vacuum device to prevent back-bleeding and left heart distension from the large amount of bronchial flow. We were able to perform pulmonary endarterectomy avoiding circulatory arrest and deep hypothermia without sacrificing the effectiveness of the procedure. The initial encouraging results have convinced us to apply systematically this technique in the cases operated in our center, even though further investigations are necessary to fully examine this technique.
    Full-text · Article · Oct 2006 · European Journal of Cardio-Thoracic Surgery
  • [Show abstract] [Hide abstract]
    ABSTRACT: We report a series of patients who underwent combined heart-kidney transplantation (CHKT) and combines liver-kidney transplantation (CLKT) at a single center. From January 1997 to October 2004, 13 CLKT and 2 CHKT were performed. The CLKT indications were as follows: polycystic disease (2), kidney polycystic disease associated with Caroli (1) and cirrhosis-hepatitis C virus (HCVs) (1), chronic glomerulonephritis with cirrhosis-HCV (4), and other diseases (5). From December 2003 to October 2004, 2 patients underwent CHKT for idiopathic cardiomyopathy plus glomerulonephritis and ischemic cardiomyopathy associated with vascular nephritis. In the CLKT group, 1 patient had acute rejection involving both liver and kidney grafts, whereas 1 patient had liver rejection and another 1 had kidney rejection alone. Of the 13 patients, 10 are alive with a mean survival of 583 days (range, 36-2688 days); 2 patients died within 1 month of transplantation (both with polycystic disease) due to ARDS and MOF. Another patient died 6 years and 9 months after CLKT of metastasis from a de novo tumor. In the CHKT group, no patient suffered heart-kidney rejection. They are all alive at 333 and 116 days, with heart and kidney allografts functioning well. In the CLKT group, the worst results were for patients with polycystic disease, in whom a more rigorous selection is necessary because of greater technical difficulties. For the remaining patients we had acceptable complications and excellent long-term results. In selected cases, CHKT can provide long-term graft function and patient survival. Our experience indicates that end-stage kidney failure combined with liver or heart failure does not necessarily preclude dual-organ transplantation.
    No preview · Article · Jul 2005 · Transplantation Proceedings
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: J Thorac Cardiovasc Surg 2003;125:1165-6
    Preview · Article · Jun 2003 · Journal of Thoracic and Cardiovascular Surgery

  • No preview · Article · Oct 2000 · Italian heart journal: official journal of the Italian Federation of Cardiology
  • [Show abstract] [Hide abstract]
    ABSTRACT: Graft right ventricular failure after heart transplantation, secondary to preoperative functional pulmonary hypertension, was successfully managed in a 49-year-old patient using an extracorporeal right to left atrial bypass. We comment on the case and discuss the type of mechanical assistance used.
    No preview · Article · Feb 1999 · The Annals of Thoracic Surgery
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In dynamic cardiomyoplasty electro-stimulation achieves full transformation of the latissimus dorsi (LD); therefore, its slowness limits the systolic support. Daily activity-rest could maintain partial transformation of the LD. Sheep LD were burst-stimulated either 10 or 24 hours/day. Before and 2, 4, 6, and 12 months after stimulation, LD power output, fatigue resistance, and tetanic fusion frequency were assessed. Latissimus dorsi were biopsied at 6 months, and sheep sacrificed at 12 months. After 1 year of 10 hours/day stimulation LD was substantially conserved and contained large amounts of fast type myosin. From 2 months to 1 year of stimulation the power per muscle of the daily rested LD was greater than that of the left ventricle, being three to four times higher than in the 24-hour/day stimulation. If extended to humans, these results could be the rationale for the need of a cardiomyostimulator, whose discontinuous activity could offer to patients the long-standing advantage of a faster and powerful muscle contraction.
    Full-text · Article · Jan 1999 · The Annals of Thoracic Surgery

  • No preview · Article · Aug 1997 · Cardiovascular Surgery
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: A prudent explanation of the clinical effect of dynamic cardiomyoplasty is that a minimal systolic assistance enhances the chronic elastic girdle effect of the transposed Latissimus Dorsi (LD). Slowness of the contraction-relaxation cycle and reduced power output of a fully conditioned LD limit its systolic support. Steady partial transformation of LD could increase power output by taking advantage of a faster contraction-relaxation cycle. To avoid full fast-to-slow transformation of LD, we chronically tested a daily activity-rest regimen of muscle stimulation in a simplified experimental model. To mimic loss of resting tension which occurs in cardiomyoplasty, sheep LD after tenotomy of distal aponeurosis were resutured in shortened position and ITREL neurostimulators (Medtronic) connected to intramuscular electrodes were implanted according to the Medtronic Protocol. From two weeks after surgery shortened LD were burst-stimulated either 10 or 24 hr per day, the stimulators being programmed to the settings that elicited just fatiguing contractions in the shortened LD. Full-day activated LD were stimulated six months and then left unstimulated for additional six months, while the half-day activated muscles were stimulated up to one year. Two weeks after surgery and two, four, six and twelve months after stimulation, fusion frequency of tetanic contraction, power output, and fatigue resistance of LD were assessed. To allow histological and molecular characterization of the two groups of stimulated muscles, LD were biopsied at six months of stimulation, and sheep sacrificed at twelve months to collect macrosopic anatomical records and perform molecular and histological analyses of proximal, intermediate and distal muscle specimens. After one year of 10 hr/day electrostimulation the gross anatomy of the LD were substantially conserved in comparison with contralateral, normal muscles (about 10% atrophy accompanied by minor fat infiltration and fibrosis). Isomyosin analysis shown that even after one year of stimulation the 10 hr/day stimulated LD contained large amounts of fast type myosin, in particular MHC2A, the isoform of fast-oxidative fibers, less prone to fatigue than the type 2B fibers of which normal LD of adult sheep is very rich. Though after six months of 24 hr/day stimulation LD were fully converted to type 1 myosin, after additional six months of resting these LD were white in appearance, atrophic (about 40%), fibrotic, and their isomyosin pattern as mixed as the LD stimulated 10 hr/day for twelve months. Accordingly, after four and six months of stimulation the frequency of tetanic fusion was higher (i.e., the contraction-relaxation cycle was faster) in 10 hr/day stimulated LD than in 24 hr/day stimulated LD; the difference disappeared at one year since the fusion frequency of the rested LD recovered to values of the one-year 10 hr/day stimulated LD. Of foremost importance is the fact that from two-month up to one-year of stimulation the sustained power output per muscle of the 10 hr /day stimulated LD (that is of the daily rested muscle) is three to four times higher than that of the 24 hr/day activated LD. From two and at least up to twelve months of stimulation the sustained power of the "daily-rested" LD become higher than that of the heart at rest. In conclusion, results of our activity-rest daily regimen are encouraging: sheep LD loses very low contractile mass, and its power is equal or bigger than that of the left ventricle, since it seems to achieve a stable intermediate state of fast-to-slow transformation when stimulated -45-Activity-rest stimulation for cardiomyoplasty If these results will be confirmed and extended to human muscle, we are confident that they could be the experimental basis for a demand cardiomyostimulator, whose discontinuous activity could offer to cardiomyoplasty patients the long-standing advantage of a faster and more efficacious muscle contraction.
    Full-text · Article · Jan 1997

Publication Stats

200 Citations
56.81 Total Impact Points

Institutions

  • 2011
    • Slovak Medical University in Bratislava
      Presburg, Bratislavský, Slovakia
  • 2006-2010
    • Policlinico S.Orsola-Malpighi
      Bolonia, Emilia-Romagna, Italy
  • 1990-2009
    • University of Bologna
      • • Department of Experimental, Diagnostic and Specialty Medicine DIMES
      • • Institute of Cardiology
      Bolonia, Emilia-Romagna, Italy
  • 1991
    • University of Padova
      Padua, Veneto, Italy