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Bratislava, Slovakia

Goncalvesova E.,National Cardiovascular Institute
Acta Facultatis Pharmaceuticae Universitatis Comenianae | Year: 2013

Pulmonary arterial hypertension (PAH) is a rare disease with average median survival rate about 3 years from the establishment of the diagnosis, except for PAH associated with congenital heart diseases. Diagnosis and management of PAH concentrate in the dedicated centres (reference centres, centres of expertise). The purpose of a reference centre is to undertake assessment and investigation of all causes of pulmonary hypertension, PAH-specific drug therapy, cooperation with other healthcare specialist, and to undertake research and education. In general, high volume centres achieve best outcomes, because of effective concentration of the specific experience and skills needed for rare disease management. The paper brings brief characteristic of the reference centre for PAH according the guideline of European Society of Cardiology as well as own experience in this field.

Goncalvesova E.,National Cardiovascular Institute
Cor et Vasa | Year: 2013

Growing population of advanced heart failure patients represents one of the major burden for health care system. Heart transplantation is the gold standard for a severe HF but contraindications and lack of donors are ultimate hurdles for its widespread use. Heart replacement using durable mechanical circulatory support, e.g. continuous-flow left ventricular assist devices (LVAD), has grown fast in recent years. It is reasonable to assume that the number of LVAD implantations will continue to grow and will soon exceed the number of HTx. The review is intended to provide essential information on the results of clinical trials with continuous flow left ventricular assist devices, indications and implantation timing. General and specific risks of LVAD surgery, short and long term courses are described, and risk assessment is outlined. © 2013 The Czech Society of Cardiology. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

Hlivak P.,Institute for Clinical and Experimental Medicine | Hlivak P.,National Cardiovascular Institute | Mlcochova H.,Institute for Clinical and Experimental Medicine | Peichl P.,Institute for Clinical and Experimental Medicine | And 3 more authors.
Journal of Cardiovascular Electrophysiology | Year: 2011

Robotic Navigation in Ablation of Paroxysmal AF. Introduction: Remote navigation systems represent a novel strategy for catheter ablation of atrial fibrillation (AF). The goal of this study is to describe a single-center experience with the electromechanical robotic system (Sensei, Hansen Medical) in treatment of patients with paroxysmal AF. Methods: Out of 200 patients who underwent robotically guided ablation for AF between 2007 and 2009 at our institute, 100 patients (29 women, age 56.5 ± 10 years) had paroxysmal AF refractory to antiarrhythmic drugs. Electroanatomic mapping using NavX system (St. Jude Medical) provided anatomical shell for subsequent circumferential ablation with robotic catheter (Artisan) loaded with a 3.5-mm, open-irrigation, cooled-tip ablation catheter. Results: A mean of 69 radiofrequency current applications (duration 2082 ± 812 seconds) were delivered to achieve circumferential electrical isolation of pulmonary venous antra. Total procedural time reached 222 ± 54 minutes. The mean fluoroscopic time was 11.9 ± 7.8 minutes. There were no major procedure-related complications. After a median follow-up of 15 months (range 3-28 months), 63% of the patients were free from any atrial arrhythmias ≥ 30 seconds after the single procedure. Success rate increased to 86% after 1.2 procedures. Multivariate analysis revealed that only predictor of recurrent AF/AT was shorter overall procedural time (207 ± 36 vs 236 ± 64 minutes in patients with and without recurrences, respectively, P = 0.0068). Conclusions: This study demonstrates feasibility and safety of robotic navigation in catheter ablation for paroxysmal AF. Midterm follow-up documents success rate comparable to other technologies and potential for improvement in more extensive ablation along the ridges with thicker myocardium. (J Cardiovasc Electrophysiol, Vol. 22, pp. 534-540 May 2011) © 2010 Wiley Periodicals, Inc.

HlivUk P.,Institute for Clinical and Experimental Medicine | HlivUk P.,National Cardiovascular Institute | Peichl P.,Institute for Clinical and Experimental Medicine | CihUk R.,Institute for Clinical and Experimental Medicine | And 2 more authors.
Journal of Cardiovascular Electrophysiology | Year: 2012

Catheter Ablation of Idiopathic Ventricular Tachycardia. We present a 34-year-old woman with idiopathic ventricular tachycardia that resisted 2 previous attempts for catheter ablation and was successfully ablated in the myocardial extension within the noncoronary aortic cusp. © 2011 Wiley Periodicals, Inc.

Klepanec A.,Slovak Medical University | Klepanec A.,National Cardiovascular Institute | Mistrik M.,Clinic of Haematology and Transfusiology | Altaner C.,Slovak Academy of Sciences | And 12 more authors.
Cell Transplantation | Year: 2012

Stem cell therapy has been proposed to be an alternative therapy in patients with critical limb ischemia (CLI), not eligible for endovascular or surgical revascularization. We compared the therapeutic effects of intramuscular (IM) and intra-arterial (IA) delivery of bone marrow cells (BMCs) and investigated the factors associated with therapeutic benefits. Forty-one patients (mean age, 66 ± 10 years; 35 males) with advanced CLI (Rutherford category, 5 and 6) not eligible for revascularization were randomized to treatment with 40 ml BMCs using local IM (n = 21) or selective IA infusion (n = 20). Primary endpoints were limb salvage and wound healing. Secondary endpoints were changes in transcutaneous oxygen pressure (tcpO2), quality-of-life questionnaire (EQ5D), ankle-brachial index (ABI), and pain scale (0-10). Patients with limb salvage and wound healing were considered to be responders to BMC therapy. At 6-month follow-up, overall limb salvage was 73% (27/37) and 10 subjects underwent major amputation. Four patients died unrelated to stem cell therapy. There was significant improvement in tcpO2 (15 ± 10 to 29 ± 13 mmHg, p < 0.001), pain scale (4.4 ± 2.6 to 0.9 ± 1.4, p < 0.001), and EQ5D (51 ± 15 to 70 ± 13, p < 0.001) and a significant decrease in the Rutherford category of CLI (5.0 ± 0.2 to 4.3 ± 1.6, p < 0.01). There were no differences among functional parameters in patients undergoing IM versus IA delivery. Responders (n = 27) were characterized by higher CD34+ cell counts in the bone marrow concentrate (CD34+ 29 ± 15×106 vs. 17 ± 12×106, p < 0.05) despite a similar number of total nucleated cells (4.3 ± 1.4×109 vs. 4.1 ± 1.2×109, p = 0.66) and by a lower level of C-reactive protein (18 ± 28 vs. 100 ± 96 mg/L, p < 0.05) as well as serum leukocytes (8.3 ± 2.1×109/L vs. 12.3 ± 4.5×109/L, p < 0.05) as compared with nonresponders (10 patients). Both IM and IA delivery of autologous stem cells are effective therapeutic strategies in patients with CLI. A higher concentration of CD34+ cells and a lower degree of inflammation are associated with better clinical therapeutic responses. © 2012 Cognizant Comm. Corp.

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