RJCS Nr 1 - 2 / 2010 - Academia Oamenilor de Stiinta din Romania

GLOBAL WARMING AND INTERNATIONAL SECURomanian 

Journal of Cardiovascular Surgery 

Revista Societăţii Române de Chirurgie Cardiovasculară 

Volum 9, Anul IX, nr. 1-2, 2010 

Editor-in Chief & Founding Editor: 

Vasile Cândea (Bucureşti) 

Associate Editors: 

Bârsan, M. (Cluj-Napoca) Deac, R. (Târgu-Mureş) 

Droc, I. (Bucureşti) 

Iliescu, V. (Bucureşti) Moldovan, H. (Bucureşti) 

Wendt, D. (Essen) 

Managing Editors: 

Luminiţa Iliuţă (Bucureşti) Vasilescu, A. (Bucureşti) 

Assistant Editors: 

Adriana Milea (Bucureşti) 

Editorial Board: 

Andercou, A., Cluj-Napoca, Romania Laufer, G., Vienna, Austria 

Bracale, G., Naple, Italy Mironiuc, A., Cluj-Napoca, Romania 

Băilă, S., Bucharest, Romania Mureşan, H., Bucharest, Romania 

Bloch, G., Paris, France Noirhomme, P., Brussels, Belgium 

Cerin, G., Novara, Italy Nottin, R., Paris, France 

Cormier, J. M., Paris, France Palombo, D., Genoa, Italy 

Dessouter, P., Paris, France Păcescu, Maria, Bucharest, Romania 

Di Donato, R., Rome, Italy Rădulescu, B., Bucharest, Romania 

Diena, M., Turin, Italy Raithel, D., Nurenberg, Germany 

Dobre, M., Lund, Sweden Scridon, T., Cluj-Napoca, Romania 

Droc, I., Bucharest, Romania Socoteanu, I., Timişoara, Romania 

Frigiola, A., Milan, Italy Suciu, H., Targu Mures, Romania 

Gaşpar, M., Timişoara, Romania Tinică, G., Iaşi, Romania 

Ginghină, Carmen, Bucharest, Romania Tschirkov, A., Sofia, Bulgary 

Goleanu, V., Bucharest, Romania Ţintoiu, I., Bucharest, Romania 

Iliescu, V., Bucharest, Romania Vasile, R., Bucharest, Romania 

Ionescu, M., Monte Carlo, Monaco Veith, F., New York, U.S.A. 

Iosifescu, A., Bucharest, Romania Vicol, C., Munich, Germany 

Lobonţiu, A., Paris, France Wölner, E., Vienna, Austria 

Revistă acreditată CNCSIS categoria C (cod 230) 

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Tehnoredactare computerizată: Mihai SINDILE (Academia Oamenilor de Ştiinţă din România) 

Volum 9, Anul IX, nr. 1-2, 2010 

Percutaneous tracheostomy in ICU patients under videolaryngoscopy 

Ion MICLEA, Violeta BERCAN, Şerban BUBENEK 

Institutul de Urgenţă pentru Boli Cardiovasculare, “Prof. Dr. C.C. Iliescu”, Bucharest 

Microsimulation and clinical outcomes analysis support a lower age threshold for 

use of biological valves. Microsimulation bioprostheses 

Serban Stoica 1, Kimberley Goldsmith 2, Nikolaos Demiris 2, Prakash Punjabi 3, 

Geoffrey Berg 4, Linda Sharples 2, Stephen Large 5 

1) Bristol Royal Children's Hospital; 2) Medical Research Council Biostatistics Unit, Cambridge; 

3) Hammersmith Hospital, London; 4) Golden Jubilee National Hospital, Glasgow; 

5) Papworth Hospital, Cambridge, UK 

The 23-rd Annual Meeting of the European Association for Cardio-Thoracic 

Surgery Vienna, Austria, 17-21 October 2009 

Grigore Tinică, Diana Ciurescu 

University of Medicine and Pharmacy “Gr. T. Popa” Iasi, Cardiovascular Institute Iasi 

Schema de program 21 

Programul susţinerii lucrărilor pe secţiuni 23 

VOLUMUL DE REZUMATE 34 

Grupul de lucrări « CORD » (vineri 1 octombrie) 34 

Grupul de lucrări « CHIRURGIE VASCULARĂ » 46 

Grupul de lucrări « CORD » (sâmbătă 2 octombrie) 60 

Simpozionul Societăţii Române de Anestezie-Terapie Intensivă Cardiacă şi 

Tehnologie Extracorporeală (SRATICTE) 

Grupul de lucrări « CONGENITALI » 81 

Grupul de lucrări « NURSING » 86 

2 

03 

08 

17 

21 

71

ISSN 1583-3534, Ion Miclea, Violeta Bercan, Şerban Bubenek ■ 2010, vol. 9, no. 1-2, pp. 3-7 

Percutaneous tracheostomy 

in ICU patients under videolaryngoscopy 

Dr. Ion MICLEA PhD. MD, Dr. Violeta BERCAN, MD, 

Conf. univ. dr. Şerban BUBENEK PhD, MD 

Institutul de Urgenţă pentru Boli Cardiovasculare 

“Prof. Dr. C.C. Iliescu”, Bucharest, Romania 

Modern intensive care involves a series of maneuvers that were formerly the exclusive 

preserve of surgery. Current technology provides special medical kits for percutaneous 

tracheostomy, pleural punctures, intra-aortic balloon pump, etc., facilitating these maneuvers, 

which have become common in intensive care units. Percutaneous tracheostomy occupies an 

important place in airway management of critical ill patient. 

The term “tracheostomy” derives from Greek, since 1649, from the words “tracheia artery” – 

“rough artery” and “stoma” – “open or mouth” 

� in 1500 B.C. the first reference related to this procedure was made, in Hindu book of 

medicine “Rig Veda” 

� in 400 B.C., Hippocrates condemned trahoestomia for fear of carotid artery injury 

� Alexander the Great had used “the sword to puncture soldier’s trachea to prevent 

suffocation” 

� in 100 B.C. Asclepiades of Bithynia made the first selective tracheostomy, but the patient 

did not survive 

� in 100 A.D., Galen and Antyluss described the incision between the third and fourth ring 

� in 1546, Antonio Musa Brasavolo made the first successful tracheostomy 

� in 1860, Evans Conway reported a mortality 68% 

� the one that establishes guidelines for making traheostomies was Dr. Chevalier Jackson, 

in 1909, describing a long incision, avoiding cricoids, the isthmus division, safe and slow 

surgery, and postoperative care. 

� in 1957, Shelton and associates described the first percutaneous tracheostomy, 

published in JAMA, which is used in a trocar inserted blindly into the trachea 

� in 1969, Toye and Weinstein described percutaneous Seldinger technique, published in 

the journal “Surgery” 

� in 1985, Pasquale Ciaglia published “percutaneous dilatative tracheostomy”, by 

Seldinger technique 

� in 1989, Paul and collaborators described the first percutaneous tracheostomy made 

under bronchoscopic control 

Nowadays, percutaneous tracheostomy became very important in comparision to 

conventional surgical traheostomy. Dilatation technique is considered the gold standard. There 

are more than 600 publications related to percutaneous tracheostomy that were mentioned after 

1985. 

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Romanian Journal of Cardiovascular Surgery ■ 2010, vol. 9, no. 1-2, pp. 4 

- Need for prolonged mechanical ventilation in cases of: 

� treatment refractory pneumonia 

� severe chronic obstructive pulmonary disease 

� acute respiratory distress syndrome 

� severe brain injury 

� multiple organ system dysfunction 

The Council on Critical Care of the American College of Chest Physicians 

recommends tracheostomy in patients who are expected to require 

mechanical ventilation for longer than 7 days. (1999) 

- Airway obstruction due to following: 

� inflammatory disease 

� congenital anomaly (laryngeal hypoplasia, vascular web) 

� foreign body that cannot be dislodged with Heimlich and basic cardiac life 

support maneuvers 

� supraglottic or glottic pathologic conditions (neoplasm, bilateral vocal cord 

paralysis) 

� laryngeal trauma or stenosis 

� facial fractures that may lead to upper airway obstruction 

� edema (trauma, burns, infection, anaphylaxis) 

- Need for improved pulmonary toilet 

- Inadequate caugh due to chronic pain or weakness 

- Aspiration and the inability to handle secretions 

- Prophylaxis (preparation for extensive head and neck procedures and the convalescent 

period) 

- Severe sleep apnea not amendable to continuous positive airway pressure devices 

- Absolute contraindications: 

� patients age younger than 8 years 

� necessity of emergency airway access because of acute airway compromise 

� gross distortion of the neck anatomy due to 

� hematoma 

� tumor 

� thyromegaly 

� high innominate artery 

- Relative contraindications 

� patient obesity with short neck that obscures neck landmarks 

� medically uncorectable bleeding diatheses 

� prothrombin time or activated partial thromboplastin time more than 1,5 times 

the reference range 

� platelet count less than 50.000/µl 

� bleeding time longer than 10 minutes 

� need for positive end-expiratory pressure of more than 20 cm of water 

� evidence of infection in the soft tissues of the neck at the prospective surgical 

site 

4

- Facilitates 

� weaning from positive pressure ventilation and sedation 

� removal of secretion by aspiration 

� long-term airway management 

- Prevents aspiration from the pharynx or gastrointestinal tract 

- Separates the oropharyngeal flora from the pulmonary flora 

� a relatively simple technique suitable for trained staff in the critical care setting 

� it does not require an operating theatre 

� minimal blood lost 

� infection rates for percutaneous tracheostomy range from 0 to 3,3%, whereas those 

for open tracheostomy have been reported to be as high as 36% 

� stenosis rates for percutaneous tracheostomy range from 0 to 9% 

� small and neat stoma of dilatational tracheostomy generally results in a more 

cosmetic scar 

- Emergency tracheostomy (controversial) 

- Difficult to palpate the anatomical landmarks: 

� Very obese patients 

� Short or bull neck 

� Enlarged thyroid 

� Nonpalpable cricoid cartilage 

� Gross deviation of trachea 

- Infection at or near the intended site for tracheostomy 

- In paediatric age group (controversial) 

- Previous neck surgery may distort the anatomy 

- Unstable cervical spine fracture 

- Required PEEP>15 cm H2O, as oxygenation may be compromised during the procedure 

- Malignancy at the site of tracheostomy 

- Uncontrolled coagulapathy, considered as a relative contraindication 

During percutaneous tracheostomy it is possible to puncture the endotracheal tube, or its 

cuff, with the needle, which can lead to airway depressurization, with the risk of difficult ventilation 

or gastric aspiration. To minimize this risk, there is the possibility of withdrawing the intubation tube 

under videolaryngoscopic control. The endotracheal tube is withdrawn until its cuff is seen 

between the vocal cords. The balloon is than inflated, and the percutaneous tracheostomy 

continues in the classical technique. Any reposition of the endotracheal tube, or patient’s 

intubation can be more easily controlled under videolaryngoscopy than with direct laryngoscopy. 

The anaesthetist position during videolaryngoscopy is more convenient than that of direct 

5

laryngoscopy. With the Glidescope Romanian Journal the of image Cardiovascular of the Surgery trachea ■ 2010, vol. and 9, no. the 1-2, vocal pp. 6 

cords is transmitted 

on the screen. 

Most of the tracheostomy kits used in ICU are manufactured by Portex. These include 

scalpel, needle with 14G flexula, 10-cc syringe, guide wire with introducing device, dilator, 

guidewire dilating forceps, tracheostomy tube with mandren, two bands for tube fixation. 

Tracheostomy tubes are of different sizes, varying according to the diameter and length. 

The patient should be adequately anesthetised, to avoid movements, and monitored 

using standard techniques. The neck is extended by placing a fluid bag, or a sandbag, or a pillow 

under the shoulders. The area around the intended site is cleaned with antiseptic solution and 

surrounded by sterile drapes. 

The anaesthetist that manages the airway of the patient prepares the videolaryngoscope. 

He also has aspiration equipment and different sizes of endotracheal tubes. The patient should be 

preoxygenated by ventilation with 100% oxygen for at least 5 minutes before starting the 

procedure. 

The anaesthetist that performs the tracheostomy is sterile equipped; he is the one that 

surrounds the area with sterile drapes. 

The anaesthetist that controls the airway should suction the pharynx, deflate the cuff of the 

endotracheal tube, with draw the tube under videolaryngoscopy, until the cuff is seen between 

the vocal cords. After that he reinflates with the cuff entirely above the vocal cords and continues 

the mechanical ventilation of the patient. 

The anaesthetist that performs the tracheostomy should locate the thyroid cartilage 

between thumb and forefinger, identify and mark the anatomical landmarks (thyroid cartilage, 

cricoid cartilage, tracheal rings, sternal notch, and possible insertion sites). The ideal site is 

between the second and third tracheal rings, although a space one higher or lower may be 

employed. After that he introduces the needle between the tracheal rings until the position of the 

needle tip in the trachea is confirmed (loss of resistance). The needle is withdrawn, the 14G 

cannula is left in place, the flexible guidewire is inserted through the cannula, and the position is 

checked using the videolaryngoscope. The 14G cannula is withdrawn, the guidewire is left in 

place. The dilator is slid over the wire, through the soft tissues into the trachea; with gentle 

sideways movements of the dilator, push the dilator forward to penetrate the anterior wall, dilating 

both the tissues and tracheal wall. The dilator is now withdrawn, and the guidewire dilating 

forceps is introduced. Using two hands, open the forceps to dilate the tracheal wall sufficiently to 

accept the tracheostomy tube. After that the forceps is withdrawn in the open position, and the 

tracheostomy cannula (tube) is slid over the guidewire into the trachea. If correct positioned, the 

guidewire and the obturator with lumen are withdrawn. He inflates the cuff of the tracheal tube, 

suctions the trachea and tracheostomy tube to establish a clear airway and transfers the 

breathing system to the tracheostomy tube. The procedure is finished after confirmation of 

successful tube placement. One should secure the tracheostomy tube with the supplied cotton 

tapes. The endotracheal tube is withdrawn after confirmation of correct placement of the 

tracheostomy tube under videolaryngoscopy. 

Early complications 

� Hypoxia during the procedure, due to failure of ventilation 

� Pneumothorax, pneumomediastinum, creation of false passage, and 

subcutaneous emphysema, due to the placement of the tracheostomy tube in the 

paratracheal space 

� Damage or injury to the posterior tracheal wall may lead to tracheo-oesophageal 

fistula 

� Major bleeding is unusual 

� Minor bleeding can usually be controlled by pressure or occasionally suture 

6

� Haemorrhage into the airway is potentially dangerous as it may result in a blood 

clot obstructing the airway 

� Needle puncture on the lateral wall of trachea may lead to stenosis 

� Secondary haemorrhage may occur from infection or erosion of vessels 

Late complications: 

� Subglottic stenosis – the incidence of subglottic stenosis is lower in percutaneous 

tracheostomy than that in open surgical procedure 

� Percutaneous tracheostomy is a safer maneuver the more trained the team is 

� The risk of infection and subglottic stenosis is lower for percutaneous tracheostomies 

� When made under videolaryngoscopy control. The maneuvre is safer, because it 

ensures a good ventilation of the patient 

1. Positioning the tracheal tube during percutaneous tracheostomy: another use for 

videolaryngoscopy - M. Gillies*, J. Smith and C. Langrish - British Journal of Anaesthesia 

2008 101(1):129 

2. Modification of percutaneous tracheostomy by direct visualisation of endotracheal tube 

positioning with Glidescope prior to performing procedure - Juan D. Pulido, MD*, Faisal 

Usman, MD, James D. Cury, MD, Abubakr A. Bajwa, MD, Kathryn Koch, MD and Luis Laos, 

MD - University of Florida, Jacksonville, FL - 2009 by the American College of Chest 

Physicians. 

3. Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients – 

Richard M. Cooper, John A. Pacey Michael J. Bishop and Stuart A. McCluskey – Canadian 

Journal of Anesthesia, 2005, 191-198 

7

ISSN 1583-3534, Şerban Stoica et al. ■ 2010, vol. 9, no. 1-2, pp. 8-16 

Microsimulation and clinical outcomes analysis support a lower age 

threshold for use of biological valves. Microsimulation bioprostheses 

Serban Stoica 1 , Kimberley Goldsmith 2 , Nikolaos Demiris 2 , Prakash Punjabi 3 , 

Geoffrey Berg 4 , Linda Sharples 2 , Stephen Large 5 

1) Bristol Royal Children's Hospital; 

2) Medical Research Council Biostatistics Unit, Cambridge; 

3) Hammersmith Hospital, London; 

4) Golden Jubilee National Hospital, Glasgow; 

5) Papworth Hospital, Cambridge, UK 

*Corresponding author. Tel: +44 1480 830541, Fax: +44 1480 831315, 

Email: stephen.large@papworth.nhs.uk 

Background: We aimed to characterize contemporary results of aortic valve 

replacement (AVR) in relation to type of prosthesis and subsequent competing hazards. 

Methods: 5470 consecutive AVR ± coronary artery bypass grafting (CABG) patients were 

studied. Microsimulation of survival and valve-related outcomes was performed based on 

meta-analysis and patient data inputs, with separate models for age, gender and CABG. 

Survival was validated against the United Kingdom Heart Valve Registry. 

Results: Patient survival at 1, 5 and 10 years was 90%, 78% and 57% respectively. The 

crossover points at which bio- and mechanical prostheses conferred similar life expectancy (LE) 

was 59 years for males and females (no significant difference between prosthesis types 

between the ages of 56-69 for men, and 58-63 for women). The improvement in event-free LE 

for mechanical valves is greater at younger ages with a crossover point of 66 years for males 

and 67 years for females. Long-term survival was independently influenced by age, male 

gender, and concomitant CABG, but not by type of prosthesis. In bioprostheses the most 

common long-term occurrence is structural deterioration. For men aged 55, 65 and 75 at initial 

operation it has a lifetime incidence of 50%, 30% and 13% respectively. The simulation output 

showed excellent agreement with registry data. 

Conclusion: For Bioprostheses can be implanted selectively in patients below 65 without 

significant long-term adverse effects. 

Keywords: Aortic valve, replacement; Heart valve, bioprostheses; Heart valve, 

mechanical 

Prosthesis choices for aortic valve replacement (AVR) between the ages of 50 and 70 

years are not standardized, even in the absence of other factors that reduce life expectancy. Of 

the two trials comparing mechanical vs. biological valves one found superior survival with 

mechanical valves [1]. In practice the trend is towards using more bioprostheses but the evidence 

for that is not strong. Thus it remains unclear how the bleeding hazard for mechanical valves 

compares long-term with the risk of structural degeneration of bioprostheses. Randomized trials for 

8

such few and remote outcomes, Şerban Stoica as well et al. ■ as 2010, longitudinal vol. 9, no. 1-2, pp. follow-up, 9 

are logistically difficult, 

particularly when the valve industry innovates constantly. 

Bioprostheses below the age of 65 are supported by some recent publications [2-4], 

discouraged by others [5], whereas another view is that patient factors are more important in 

determining long-term outcomes [6]. Some of the studies have used microsimulation of the 

patients’ course with point estimate inputs not allowing for variability (deterministic inputs) [2, 3]. 

The aim of this study was to analyse life expectancy and complication rates for United Kingdom 

(UK) patients undergoing AVR with bio- and mechanical prostheses. Age, gender, concomitant 

coronary artery bypass grafting (CABG) and other patient factors are examined using simulation 

of the lifetime after AVR surgery with non-deterministic inputs incorporating variability. 

5470 consecutive AVR ± coronary artery bypass grafting (CABG) procedures (5433 

patients) at 3 centers between 1993-2006 were studied. Patient data were used to study 

perioperative mortality. A microsimulation model was constructed to predict life histories for the 

study patients, using patient data wherever possible for inputs. Since detailed follow up 

information was not available for study patients this was supplemented with results from a metaanalysis 

of valve-related morbidity and mortality. Validation of the simulation results, including 

overall survival, was carried out against data from the UK Heart Valve registry (UKHVR). UKHVR 

contains reoperation and survival statistics for individual patients but no follow up on valve-related 

events. 

Patients and valves 

Patient information from the three centers was collected prospectively. Patients data were 

de-identified to maintain confidentiality. Table 1 shows a list of valves used in the study period 

(1993-2006) and Table 2 shows patient characteristics. Homografts and valve repairs were 

excluded. 

Perioperative survival 

Estimates of operative death from first and subsequent AVR were taken from the multiple 

variable analysis of perioperative mortality from the three participating centres. The effects of 

age, gender, prosthesis type, concomitant CABG, creatinine and reoperation on perioperative 

mortality were studied using logistic regression. Variables such as the New York Heart Association 

score for breathlessness (NYHA) and left ventricular (LV) function were not recorded consistently in 

the databases and so did not appear in the final model. Manual stepwise selection based on the 

likelihood ratio statistic was used to detect variables for the multivariable models. The Hosmer and 

Lemeshow statistic for the final model showed no evidence of poor fit (p = 0,53). For each age 

group, different survival probabilities were estimated for 4 subgroups defined by sex 

(male/female) and concomitant CABG surgery (yes/no), according to results from the logistic 

regression. 

Meta-analysis 

In the absence of long term follow up of valve-related events for UK patients, a systematic 

review of the literature and random effects meta-analysis were performed [7], while for other 

event rates we had similar inputs and model assumptions as Puvimanasinghe (2004) [3] (Table E1). 

PubMed was searched between 1990-2009 with the Boolean string “aorta OR aortic AND valve 

replacement”. The search was limited to articles on humans published in English in core clinical 

journals and resulted in 2085 hits. 

Inclusion criteria: 

1) outcomes of AVR listed in table E1 with prostheses listed in Table 1, size ≥ 19 mm; 

2) concomitant procedure, if present, CABG or mitral valve replacement (all mitral 

patients in combined series, with or without concomitant AVR, were subsequently excluded); 

3) guideline compliant, or in the spirit of published guidelines [8]; 

9

data; 

4) follow-up available in ≥ 95% of patients. 

Table 1. Types of valves inserted 

Type of valve Number inserted (%) 

Aortech 556 10,2 

Aspire/Elan 188 3,4 

ATS 477 8,7 

Bjork-Shiley 35 0,7 

Carbomedics 182 3,3 

Carpentier Edwards 959 17,5 

Carpentier Edwards Perimount 1.315 24,0 

Edwards Prima 144 2,6 

Edwards Mira 41 0,7 

Medtronic Mosaic 72 1,3 

Sorin Bicarbon 114 2,1 

St Jude mechanical 889 16,3 

St Jude tissue 139 2,5 

Starr Edwards 32 0,6 

Toronto stentless 195 3,6 

Other (Autologous pericardial, AorTech, Edwards Tekna, 

Shelhigh, Sorin Soprano, Sorin Pericarbon, TissueMed) 

42 0,7 

10 

Total 5.470 100 

Exclusion criteria: 

1) Absence of any morbidity data; 

2) Linearized occurrence rate of events unpublished or unobtainable from the published 

3) Specialized series (redo, small aortic root, extremes of age); 

4) Overlapping or previously published series, in which case the last report was chosen. 

Forty-seven articles met the criteria, containing 28,623 patients and 152,075 patient-years 

follow-up (Table E2). Where necessary linearized occurrence rates and their standard errors were 

calculated with the available data (see supplementary data). For embolism, valve thrombosis 

and non-structural dysfunction we used a random rate, simulated from a distribution obtained by 

meta-analysis. For endocarditis we assumed a constant rate for the first six months and a smaller 

constant rate thereafter. For structural valve deterioration we assumed an increasing rate over 

time for bioprostheses [3] and a zero event rate for mechanical valves. Finally, for haemorrhage 

we employed a constant rate over time for bioprostheses and an exponentially increasing rate for 

mechanical valves [9]. Estimates of reoperation and death rates associated with these events are 

from the literature [3]. 

Microsimulation 

Romanian Journal of Cardiovascular Surgery ■ 2010, vol. 9, no. 1-2, pp. 10 

Conditional on perioperative survival, the microsimulation for studying valve outcomes was 

similar to that described in detail by the Rotterdam group [2, 3, 10]. Briefly, after AVR a number of 

factors influence the trajectory between the states alive and deceased: background, additional 

and operative mortality, and valve-related events. Background mortality was taken from 

government life tables [11]. Additional mortality reflects the increased hazard of death for a 

patient undergoing AVR as compared to the general population [3]. Heart rhythm and function or 

type and severity of valve disease can contribute to this hazard. We used an accepted simulation 

method [10], with an additional loop to incorporate the uncertainty about event rates. Life 

histories of 50,000 individuals and 100 event rates for each age group were simulated using the 

following steps:

1. Random event rates Şerban were Stoica drawn et al. ■ 2010, for vol. valve-related 9, no. 1-2, pp. 11 

morbidity and its sequelae of 

reoperation and subsequent death. 

2. A random probability of death from operation/reoperation was drawn from its 

distribution. This was used to decide if a simulated individual survived the initial operation. If so, the 

main body of the simulation continued. 

3. Based on UK mortality tables, adjusted for the additional mortality related to AVR, a 

random age was sampled that became the age-at-death of the individual should no valverelated 

event occur. 

4. Using the occurrence rates in Table E1 and the event rates from step 1, a random age at 

which each event may occur was simulated. If all of these times were greater than the age-atdeath 

in step 3, the simulation ended and that was the age-at-death. Otherwise the event that 

corresponded to the shortest time was assumed to occur first. The mortality rate associated with 

each event was used to determine whether the individual died due to the event or not. In the 

former the age-at-death was (re)set to the time at which the event occurred. If the individual 

survived the event but required surgery because of the event, any additional surgical mortality 

was also simulated. Thereafter, the time to the next event was determined, possibly altering some 

event probabilities conditional on the simulated individual history. This procedure continued until 

the simulated individual died or reached the random age-at-death of step 3. 

5. Steps 2–4, were repeated 50,000 times for each valve type and life expectancy (LE), 

event free life expectancy (EFLE) and the probabilities of valve-related events were calculated 

from the simulated individual histories. In order to estimate the distributions of these outputs, steps 

1-4 were repeated for 100 draws from the event rate distributions. 

Validation 

Using UKHVR data from the three centers an observed (empirical) survival curve for the 

patients was constructed using Kaplan-Meier methods. Predicted survival curves from the 

simulation were compared with UKHVR observed survival curves. Estimates of uncertainty for the 

model resulted from probabilistic sensitivity analysis and are represented graphically in the output. 

The effects of age, gender, prosthesis type, concomitant CABG and creatinine levels on long-term 

survival were studied using Cox proportional hazards models. In addition to patient survival, 

prosthesis lifetimes were calculated. Patients were considered to have had the event (1st 

prosthesis failure or operative death) if they had a 2nd AVR operation, died perioperatively at 

initial surgery, or died of any valve-related or cardiovascular cause of death. Otherwise patients 

were censored. For second prosthesis lifetime only patients having had a 2nd AVR operation were 

included. 

Patients and valves 

Between 1993-2006 5470 consecutive AVR operations were performed in 5433 patients 

(2239 mechanical and 3231 biological valves). Table 2 shows patients' characteristics. Patients 

with tissue valves were older, more likely to be women and have concomitant CABG (all p < 

0.001). There were slightly more reoperations for which mechanical valves were implanted (2% of 

mechanical versus 1% of tissue, p < 0.001). Patients given tissue valves had higher NYHA scores, 

and were more likely to have non-insulin dependent diabetes, atrial fibrillation/flutter 

preoperatively, higher risk scores and lower creatinine clearance (all p < 0.001). 

In univariate analysis patients receiving bioprostheses had 1.6 times the odds of dying 

perioperatively as compared to mechanical valve patients (Table 3). In multiple variable analyses, 

type of prosthesis and gender were not associated with perioperative mortality when other 

characteristics were analysed. Concomitant CABG was associated with 1.4 higher odds of death 

(p = 0.05). Each 10 years increment in age had a 1.5 times increases in the odds of operative 

mortality (p < 0.001). A 10 unit increase in creatinine levels was associated with a 5% increase in 

the risk of death soon after the valve operation (p < 0.001). These results were taken to the next 

stage. 

11

Table 2. Patient characteristics by prosthesis type 

Characteristic 

12 

Mechanical 

prosthesis, 

n=2.239 

Tissue 

prosthesis, 

n=3.231 

p-value 

Peri-operative mortality, n (%) yes 82 (4) 188 (6) < 0.001 

Mean age (SD) 58,5 (11.6) 74.1 (7.5) < 0.001 

Male gender, n (%) 1.567 (70) 1.836 (57) < 0.001 

Concomitant CABG, n (%) 445 (20) 1.195 (38) < 0.001 

Greater than 1st operation, n (%) 49 (2) 22 (1) < 0.001 

NYHA, n (%) asymptomatic 77 (9) 30 (2) < 0.001 

n (%) I 132 (16) 130 (10) 

n (%) II 297 (35) 434 (33) 

n (%) III 287 (34) 612 (46) 

n (%) IV 61 (7) 116 (9) 

LV function, n (%) normal (>50%) 1.261 (60) 1899 (61) 0.64 

n (%) moderate impairment (30-50%) 655 (31) 917 (30) 

n (%) severe impairment (

CI Confidence Interval 

Microsimulation 

Figures 1 and 2 show differences in life expectancy (LE) and event-free life expectancy 

(EFLE) after AVR between bioprosthetic and mechanical valves for men and women with and 

without CABG. Men had a small but consistent survival benefit in receiving a mechanical valve for 

patients up to about age 59. Although this was the crossover point, there was no significant 

difference between bioprostheses and mechanical valves between the ages of 56 and 69. The 

improvement in EFLE was greater at younger ages and bioprostheses were favored after the age 

of 66, although there was no significant difference between the two types of valves between the 

ages of 62 and 68. For women, the crossover points at which the valve types conferred the same 

LE and EFLE were approximately the same as for men (59 and 67 respectively). Patients who had 

AVR and CABG had only slightly shorter LE and EFLE than those having AVR alone. The only 

difference in model inputs for the combined procedure was a small but significant increase in 

operative death rate. Fig. 3 illustrates valve-related complications for males. Table E3 summarizes 

valve-related complications for both sexes. The plots and tables for males show that prosthetic 

endocarditis had an estimated lifetime probability of 6-13% depending on age at first procedure. 

Although it was more common for mechanical valves the differences were small. Non-valve 

systemic thromboembolism had a slightly higher estimated incidence in recipients of bioprostheses 

compared to mechanical valves, in agreement with inputs from table E1. Haemorrhage, as 

expected, was significantly more common among mechanical valve patients. Structural valve 

disease was frequent for bioprostheses with a lifetime probability of 58%, 50%, 40%, 30%, 20% and 

13% for men aged 50, 55, 60, 65, 70 and 75 respectively at initial operation. Valve thrombosis was 

fairly uncommon, occurring with a lifetime probability of less than 8% in male mechanical valve 

patients and less than 0.2% in male bioprosthesis patients, in all age groups. Non-structural valve 

dysfunction was also uncommon, with a marginally higher occurrence for the mechanical group, 

with a lifetime probability of 3.6% and 4.3% for 50 year olds, decreasing to 1.8 and 2.0% for 75 year 

olds for the bioprosthesis and mechanical groups respectively. Event rates were slightly higher in 

general for females, probably related to their longer LE, but had a similar distribution (Table E3). 

Validation and long-term survival 

Şerban Stoica et al. ■ 2010, vol. 9, no. 1-2, pp. 13 

Model predicted patient survival at 1, 5 and 10 years was 90%, 78% and 57% (Fig. 4), 

whereas first valve survival was 91%, 85% and 71% respectively. These agreed well with registry 

data. In multiple variable analyses, long-term survival was adversely affected by increasing age, 

male gender and CABG but not tissue prosthesis, although there were clearly age-specific 

differences between valve types (Table 4). Redo AVR operations were captured via the UKHVR: 

there were 74 during the study period (68 first time and 6 second time). The most common causes 

of redos were intrinsic valve failure (22%), prosthetic endocarditis (12%) and dehiscence (9%). Fig. 

4 shows that the UKHVR actuarial survival curves for mechanical and valves compared with 

predicted survival from the simulation for a 65 year old man. The registry curves lie almost entirely 

within the confidence bounds for the model. 

Table 4. Relationship between survival and patient characteristics 

Characteristic 

Univariate HR (95% CI), 

p-value 

Multiple variable HR (95% CI), 

p-value 

Tissue prosthesis 

1.99 (1.76, 2.26) 

p

increments) (mmol/L) p

any mathematical modeling, is as good as its inputs. Oversimplifications are inevitable in places, 

for example by assuming that valve-related complications are constant over time and 

independent of patient age and time elapsed from surgery. 

An analysis of quality of life outcomes in middle-aged patients undergoing AVR highlighted 

some significant downsides of mechanical valves [12]. Our results support the notion that quality of 

life dividends are not associated with a decrease in quantity of life by implanting bioprostheses 

selectively below the age of 65. 

Acknowledgement 

Maria Benedicta Edwards, from the United Kingdom Heart Valve Registry, assisted in linking 

our data to the registry. 

Figure legends 1 

Figure 1. Mean difference (95% confidence limits) in life-expectancy between 

bioprostheses and mechanical valves by age. Values above 0 favour bioprostheses. 

Figure 2. Mean difference (95% confidence limits) in event-free life-expectancy between 

bioprostheses and mechanical valves by age. Values above 0 favour bioprostheses. 

Figure 3. Lifetime probability of valve-related complications for males, AVR only. 

A. Endocarditis 

B. Thromboembolism 

C. Hemorrhage 

Figure 4. Kaplan-Meier survival estimates from combined analysis of UK AVR patients 

compared to simulation predicted survival for 65 year old men with CABG The first curve 

from the top shows the UK general life expectancy for 65 year old men, and the second 

curve down shows background mortality after AVR as incorporated in the model. The 

model prediction is shown as dots and the solid lines are 95% confidence bands. All these 

hypothetical survival curves are extended to 100 years of age. The two shorter curves are 

Kaplan-Meier estimates for 65 year old men from the UK Heart Valve Registry data. 

1 Imaginile nu ne-au parvenit până la închiderea ediţiei, dar se vor insera în numărul viitor 

15

1. Bonow RO, Carabello BA, Kanu C, et al. ACC/AHA 2006 guidelines for the management 

of patients with valvular heart disease. Circulation 2006; 114:e84-231. 

2. Puvimanasinghe JP, Steyerberg EW, Takkenberg JJ, et al. Prognosis after aortic valve 

replacement with a bioprosthesis: predictions based on meta-analysis and 

microsimulation. Circulation 2001; 103:1535-1541. 

3. Puvimanasinghe JP, Takkenberg JJ, Edwards MB, et al. Comparison of outcomes after 

aortic valve replacement with a mechanical valve or a bioprosthesis using 

microsimulation. Heart 2004; 90:1172-1178. 

4. Rizzoli G, Mirone S, Ius P, et al. Fifteen-year results with the Hancock II valve: a multicenter 

experience. J Thorac Cardiovasc Surg 2006; 132:602-609. 

5. Brown ML, Schaff HV, Lahr BD, et al. Aortic valve replacement in patients aged 50 to 70 

years: improved outcome with mechanical versus biological prostheses. J Thorac 

Cardiovasc Surg 2008; 135:879-884. 

6. Lund O, Bland M. Risk-corrected impact of mechanical versus bioprosthetic valves on 

long-term mortality after aortic valve replacement. J Thorac Cardiovasc Surg 2006; 132:20- 

26. 

7. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7:177-188. 

8. Edmunds LH, Clark RE, Cohn LH, Grunkemeier GL, Miller DC, Weisel RD. Guidelines for 

reporting morbidity and mortality after cardiac valvular operations. Ann Thorac Surg 1996; 

62:932-935. 

9. van der Meer FJ, Rosendaal FR, Vandenbroucke JP, Briet E. Assessment of a bleeding risk 

index in two cohorts of patients treated with oral anticoagulants. Thromb Haemost 1996; 

76:12-16. 

10. Takkenberg JJ, Puvimanasinghe JP, Grunkemeier GL. Simulation models to predict 

outcome after aortic valve replacement. Ann Thorac Surg 2003; 75:1372-1376. 

11. Government Actuary Department. http://www.gad.gov.uk/Demography%5FData/ (9 

May 2008). 

12. Ruel M, Kulik A, Lam BK, et al. Long-term outcomes of valve replacement with modern 

prostheses in young adults. Eur J Cardiothorac Surg 2005; 27:425-33. 

16

The 23-rd Annual Meeting of the 

European Association for Cardio-Thoracic Surgery 

Vienna, Austria, 17-21 October 2009 

Grigore Tinică, Diana Ciurescu 

University of Medicine and Pharmacy “Gr. T. Popa” Iasi, Cardiovascular Institute Iasi 

The 2009 Meeting of the EACTS was held in the Austrian capital of Vienna. It was attended 

by more than 3800 delegates – approximately 1700 adult cardiac surgeons and over 500 cardiothoracic 

surgeons – form around the world, eager to learn about programs focusing on novel 

therapies in cardiac and thoracic surgery. The conference provided an invigorating programme 

with a great number of high- quality presentations that covered both cardiovascular and thoracic 

topics. 

As ever, the first day hosted the TechnoCollege, which featured significant talks on the 

evolving technologies cardio-thoracic surgeons are facing. It offered a rich programme of 

Cardiac (included aortic surgery, mitral valve surgery, heart failure and the future of coronary 

surgery), Thoracic (entitled “Advances in chest wall surgery and osteosynthesis”, focused on 

anterior chest wall deformities, chest wall tumors, reconstruction and traumas: flail chest) and, for 

the first time dedicated one track of TechnoCollege to Congenital surgery (concentrated on 

hybrid set-ups in congenital heart disease and on the role of imaging in congenital heart 

diseases). For the first time this year TechnoCollege included not only adult cardiac and thoracic 

surgery but also a paediatric surgery course. The adult cardiac course focuses on aortic surgery, 

minimally invasive and transcatheter valve surgery and surgery for heart failure. It was a lively 

debate on controversial topics for the treatment of aortic dissections such as the role of stenting of 

the descending aorta and hemi versus full arch replacement as the method of choice. 

New approaches for mitral valve repair dominate the second session including a 

technique for echo guided beating heart mitral valve repair presented by Nikolay Vasilyev from 

Boston Children Hospital and a new sutureless annuloplasty system presented by Per Wierup from 

Aarhus. 

A number of videos expanded the valve-in-valve transcatheter technique, the concepts 

for sutureless mitral valve repair and a radiofrequency adjustable mitral ring. 

The paediatric course focused on hybrid procedures and new imaging techniques such as 

DynaCT and 3D MRI for intraoperative guidance. 

This year were submitted 11 innovations and the 2009 TechnoCollege award went to Dr 

Edward Boyle, the founding CEO of Clear Catheter Systems and the co-inventor of the PleuraFlow 

Active Tube Clearance System. This novel device was developed by cardio-thoracic surgeons to 

keep chest drains clear after heart and lung surgery. It allows actively clearing of the internal 

diameter of a chest tube in a reproducible, sterile fashion, removing any obstructing or occluding 

material towards the drainage canister. A guide tube is connected between the implanted chest 

tube and a blood connection canister. Within the guide tube there is a guide wire with a loop set 

at 90 degrees that can be advanced in and out of the tube to clear any occluding material such 

as clot. The external and internal magnet coupling is the key innovation making this device very 

simple while maintaining this sterile environment within the tubing. A first in man feasibility testing is 

planned for late 2009 with an anticipated commercial launch in early, 2010. 

The first day of meeting consisted of a series of post-graduated courses on a wide range of 

topics, including the key areas in adult cardiac – entitled “Cardiovascular interventions in the 

elderly”; in thoracic surgery, congenital surgery – which incorporated a multi-disciplinary panel 

that discussed the transposition of great arteries, tracheo bronchial stenosis and an interactive 

17

video session focusing on surgery for complete atrio-ventricular canal; in vascular surgery – with a 

specific focus on aortic disease, open and endovascular repair; in perfusion – where it examined 

the role of arterial embolism during cardiopulmonary bypass, haemostasis and anticoagulation; 

with a closer look at minimized bypass circuits, cardio-pulmonary bypass in non-cardiac surgery 

and left heart assist devices; in basic science – looking at the pathophysiology and metabolic 

aspects of heart failure, as well as the impact of stem cells in future of heart transplantation and 

myocardial restructuring. 

The congress officially opened on the following day with the presidential address by Enrino 

Rendina, the EACTS president (Rome, Italy), one of the keynote lectures “In the name of the 

muse” on “quality in education and education to quality” and the importance of continuing 

learning and spending a lifetime in a profession that never fails to rejuvenate one’s enthusiasm. 

The meeting honoured guest lecture was that of Luigi Frati, Rome, Italy, entitled 

“Regenerative medicine, a look to the future” – stem cell based regenerative therapy is 

undergoing experimental and clinical trials in order to prevent or limit the consequences of 

decreased contractile function and compliance of damaged ventricles/hearts following 

myocardial infarction or in patients presenting non ischaemic dilated cardiomyopathies. In fact, 

several technologies have been described over the past ten years to create a functional 

myocardium mainly by using bone-marrow derived cells, but they turn a fibroblastic not functional 

fate when are injected into the heart. This group described and patented a method to obtain 

contractile cardiospheres from adult mouse and human hearts: an increase of physiological 

functions has been observed following the injection of these cells into the heart of infracted mice. 

This year’s cardiac surgery sessions have been designed to bring the latest evidence and 

technological developments and issues affecting contemporary practice. 

The session grafts in cardiac surgery discussed the latest results from several cases series, 

scoring systems for predicting graft patency, as well as utilizing with MDCT for assessing graft 

patency. 

Michael Mack discussed the lessons learned from coronary surgery and future implications: 

After five years of steady decline, the number of coronary artery bypass procedures 

appears to have reached a plateau and in some areas of the world are actually increasing. 

The outcomes of a number of recent trials including SYNTAX, BARI 2D and the Endoscopic 

Vein Harvest substudy of the PREVENT IV Trial are likely to have some impact on the practice of 

coronary surgery. The results from FREEDOM Trial comparing CABG and PCI in multi-vessel disease 

in diabetics and a soon to be initiated trial in left main disease may also further define the role of 

surgery. 

The SYNTAX Trial enrolled 1800 patients in 83 centers in Western Europe and the US. The 

results at two years continue to favour CABG compared with PCI in patients with LM or 3VD. 

MACCE was 23.3% with PCI vs. 16.3% with CABG (p=0.0003). 

The BARI 2D trial compared a strategy of immediate revascularization by either CABG or 

PCI at investigator discretion to an initial approach of medical therapy in diabetic patients. 

The PREVENT IV study was a randomized study of 24000 patients undergoing CABG in 2002- 

3 treated with a decoy to prevent intimal hyperplasia in saphenous vein grafts. A recently 

published non-randomised substudy of this trial revealed that harvest of saphenous vein grafts by 

an Endoscopic technique was associated with a higher graft failure rate and death at three years 

compared with open harvest. This has not been confirmed in a randomized trial but all aspects of 

the Endoscopic harvest technique are now being re-examined. 

The FREEDOM trial of CABG vs. PCI with drug-eluting stent in diabetics is nearing 

completion of enrolment (December 2009). The primary endpoint of two-year death, stroke, 

myocardial infarction will be reached in 2011 with results available in 2012. 

18

Highlighted transfemoral and transapical aortic valve implantation, and the early results 

from the SOURCE registry and one-year follow-up results from the TRAVERCE clinical trial. 

Anson Cheung (St. Paul’s Hospital, Vancouver, Canada) showed that there is an 

expanding population of complex and high-risk elderly patients with prosthetic valve dysfunction 

who require redo procedures. The group from Vancouver had successfully treated patients with 

prosthetic valve dysfunctions in the aortic, mitral and tricuspid position, using Edwards Sapien 

transcatheter valve. They had successfully performed twelve transcatheter valve-in-valve 

implantations – five aortic, six mitral and one tricuspid. 

Saibal Kar (Cedars Sinai Medical Center, Los Angeles, USA) showed that the double orifice 

technique of mitral valve repair using the MitraClip system is effective in selected patients with 

functional or degenerative mitral regurgitation. Over 700 patients have been treated with the 

MitraClip system in North America and Europe. Data from the initial cohort and the high risk 

registry support safety, efficacy and sustained clinical benefit in majority of patients. In addition 

there is evidence of favourable remodeling of the left ventricle. Surgical options were preserved in 

patients who required a re-intervention following a MitraClip procedure. The EVEREST II 

randomised clinical trial has completed enrollment, and clinical results will be available next year. 

Robotic mitral valve repair of a complex bileaflet prolapse (Barlow’s), a new technique of 

chordal replacement for mitral valve plasty with multiple loops with one knot technique and mitral 

valve repair; ‘respect rather than resect’ technique. 

Ottavio Alfieri (S.Raffaele University Hospital, Milan, Italy) says that the radiofrequency 

adjustable mitral valve ring seems to be a useful new tool in the surgical armamentarium for mitral 

valve repair. The MiCardia adjustable ring is activated using a removable epicardial lead that 

delivers radiofrequency energy from an external generator. To date, it has been implanted in 31 

patients affected either by degenerative or ischaemic mitral insufficiency, enrolled in the DYNA 

study, which is currently ongoing. Six beating heart activations have been successfully carried out 

in humans to correct some degree of postoperative mitral incompetence. The concept of 

reversible adjustment is potentially of great utility, because the possibility of increasing the anteroposterior 

dimension of the prosthetic ring allows correction of post-operative SAM. 

Rafael Garcia Fuster (University General Hospital of Valencia, Spain) concluded that 

preservation of annulo-ventricular continuity through the chordae tendinae is an important 

determinant of post-operative left-ventricular function and survival after mitral valve surgery for 

mitral valve insufficiency. Valve repair is the procedure of choice, but when valve replacement is 

inevitable, every effort should be made to preserve both anterior and posterior chordopapillary 

apparatus. 

Antonio Grimaldi and Ottavio Alfieri (University Vita-Salute, San Raffaele, Scientific Institute, 

Milan, Italy) show that restrictive annuloplsty for functional mitral regurgitation can potentially 

reduce mitral leaflet opening without creating a clinically relevant mitral stenosis or an impaired 

cardiac adaptation to exercise and further studies will be necessary to test the clinical impact of 

undersized rings in larger populations. 

The session discussing the transposition of the great arteries and related lesions studied 

outcomes from double switch operations for atrio-ventricular discordance, and ask whether the 

length between the top of the interventricular septum and the aortic valve on indications for a 

biventricular repair impacts on outcomes; the delegates had the chance to learn about 

biventricular repair of complex left ventricular outflow tract obstruction in neonates and infants; 

the surgical management of congenital heart defects associated with heterotaxy syndrome; as 

well as the results from a 30-year, nationwide population-based study, examining mortality among 

Danish congenital heart defects patients diagnosed before one year of age. 

19

Assessing the technical evolution of acute-type A dissection, as well as technological 

enhancements such as MDCT- based intra-operative navigation system for thoraco-abdominal 

aortic aneurysm repair. The vascular section examined aortic dissection with a examination of 

branched open stent grafting technique for reoperation after repaired type A dissection and 

asses the long-term results of hybrid endovascular repair for thoracoabdominal aortic aneurysms. 

William Wang (Scripps Memorial Hospital, La Jolia, USA) concludede that significantly 

enlarged atria should be reduced by utilizing an aggressive biatrial reduction with reef imbricate 

suture technique concomitantly with a full Cox maze procedure for AF. 

Kazuo Yamanaka (Tenri Hospital, Nara, Japan) showed that left atrial appendage 

preservation contributed to improved total booster function of left atrium and left atrial 

appendage without stroke and systemic embolic events in patients with sinus rhythm after the 

Maze procedure for chronic AF and mitral valve disease. 

Interact CardioVasc Thorac Surg 2009; 9:S57-S119. 

doi:10.1510/icvts.2009.0000S7© 2009 Abstracts. Suppl. 2 to Vol. 9 (October 2009) 

20

Joi 30 septembrie 2010, 

Restaurant Hotel Hilton 

19:00 ��Deschiderea festivă 

Vineri 1 octombrie 2010 

Sala Diamond Sala Saphire Sala Ruby 

CORD CHIRURGIE VASCULARĂ 

SESIUNEA I: Transplant cardiac. 

Chirurgia valvelor cardiace 

Moderatori: Radu Deac, Marcus 

Kamler, Vlad Iliescu 

09:00 – 11:00 � 

SESIUNEA V 

Moderatori: Ş. Rădulescu, 

G. Szendro, J-Baptiste Ricco - 

10:45 – 11:00 – Discuţii 10:50 – 11:00 - Discuţii 

Sesiunea II: Tumorile Cardiace, 

complicaţii ale chirurgiei 

cardiace 

Moderatori: Traian Scridon, 

Reinhard Moidl, I. Maniţiu 

11:00-11:30, Pauza de cafea 

11:30 – 13:30 � 

Sesiunea VI: 

Moderatori: Marina Păcescu, F. 

Spineli, P. Bergeron - 

13:00 – 13:30 - Discuţii 13:15 – 13:30 - Discuţii 

13:30 – 14:30 Masa de prânz �� 

14:30-17:00 � 

Sesiunea III: 

Chirurgia valvei aortice 

Moderatori: Gelu Cerin, Gunter 

Laufer, Guido Lanzilo, M. Laskar 

16:30-17:00 Pauza de cafea 

17:00 – 18:00 - Sesiunea IV 

Chirurgia valvei mitrale, 

endocardita bacteriană 

14:30-15:30 Sesiunea VII: 

Moderator: I. Droc 

SIMPOZION VASAPROSTAN 

15:30 – 15:50 Sesiunea VII: 


15:50 – 16:00 - Discuţii 


16:30-17:00 - Sesiunea VIII: 

Moderatori: Ş. Rădulescu, I. Droc 

17:00-18:00 � 

Sesiunea VIII: 


21 

- 

Adunare Generală 

SRCCV

Moderatori: Grigore Tinică, 

Batrinac A., Moscalu V. 

18:00 – 18:30 - Sesiunea IV 

Chirurgia valvei mitrale, 

endocardita bacteriană 

Moderatori: Grigore Tinică, 

Batrinac A., Moscalu V. 

18:30 – 19:00 - Discuţii 

18:00-19:00 � 

22 

- - 

ORA 20:00 - �� Cina Festivă - Restaurant Hotel Hilton 

Sâmbătă 2 octombrie 2010 

Sala Diamond Sala Saphire Sala Ruby 

CORD 

Sesiunea IX: 

Chirurgia arterelor coronare 

Moderatori: Gerard Bloch, H. 

Moldovan, Tintoiu I. 

Simpozionul Societăţii 

Române de Anestezie-Terapie 

Intensivă Cardiacă şi 

Tehnologie Extracorporeală 

(SRATICTE) 

09:00 – 11:00 � 

Sesiunea XII: Anemia si transfuzia in 

chirurgia cardiaca 

Moderator: Ioan Vlad 

Sesiunea XIII 

Moderator: Victor Diaconescu 

CONGENITALI 

Sesiunea XVI 

Moderatori: Horaţiu Suciu, 

Andrei Iosifescu, Chira 

Manuel 

10:45 – 11:00 – Discuţii 10:50 – 11:00 - Discuţii 10:40 – 11:00 - Discuţii 

Sesiunea X 

Moderatori: Tintoiu I., 

R. Deac, G. Tinica 

11:00-11:30, Pauza de cafea 

11:30 – 13:30 � 

Sesiunea XIV: Siguranţa pacientului 

în timpul circulaţiei extracorporeale 

Moderatori: Dan Longrois (Paris) şi 

Daniela Filipescu 

Sesiunea XVII 

Moderatori: Chira Manuel, 

Mariana Andreica, Rodica 

Manasia, Angela Butnariu 

13:20 – 13:30 - Discuţii 13:00 – 13:30 - Discuţii 13:00 – 13:30 - Discuţii 

13:30 – 14:30 Masa de prânz �� 

Sesiunea XI 

Moderatori: Horia Mureşan, 

P. Bergeron, Şerban Stoica 

14:30-17:00 � 

Sesiunea XV 

Moderatori: 

Ion Miclea, Mihai Luchian 

16:15 – 17:00 - Discuţii 16:30 – 17:00 - Discuţii 


14:30-15:30 

NURSING 

ORA 17:30 - Îmbarcarea la Hotel Hilton, pentru plecarea la Baza de tratament Bazna 

ORA 19:00 - �� Cina Festivă - Restaurant Expro, Baza de tratament Bazna

Vineri 1 octombrie 2010 

Sala Diamond 

Grupul de lucrări « CORD » 

Sesiunea I 

Transplant cardiac. Chirurgia valvelor cardiace 

Moderatori: Radu Deac, Marcus Kamler, Vlad Iliescu 

ORA AUTORI TITLUL LUCRĂRII 

09.00 – Deac Radu, Suciu H. 

Actualităţi în transplantarea cardiacă - 2010. 

09.15 

IUBCVT Tg. Mureş. CCV I Update in cardiac transplantation - 2010 

Zece ani de transplantare cardiacă la IUBCVT Tg. 

09.15 – 

Mureş 1999-2010. 

09.30 

Ten years of heart transplantation at IUBCVT Tg. 

Mureş 1999-2010 

09.30 – 

09.40 

09.40 – 

10.00 

10.00 – 

10.15 

10.15 – 

10.30 

10.30 – 

10.45 

Suciu Horaţiu, Deac R., Mihaela Ispas, Anca 

Sin, Cotoi O., Matei M., Opriş C., Mihaela 

Melinte, Terezia Preda 

IUBCVT Tg. Mureş 

Vlad Iliescu 

Institutul de Boli Cardiovasculare “Prof Dr. 

C.C.Iliescu” Bucureşti 

Marian Gaspar 

Institutul de Boli Cardiovasculare Timişoara 

Markus Kamler 

Institutul Inimii Hilarion, Essen 

V. Saplacan, C. Ivascau, F. Dugenet, M 

Massetti 

University Hospital of Caen, France 

23 

Reconstrucţia valvelor atrioventriculare - între 

teorie şi practică 

Chirurgia valvulară: progres şi realitate 

Valvular surgery, between progres and reality. 

Chirurgia minim invazivă a valvei mitrale 

ECLS în şocul cardiogen şi stopul circulator 

ECLS in cardiogenic shock and cardiac arrest 

Baza de date a Societăţii Europene de Chirurgie 

Cardio-Toracică 

10.45 – 11.00 Discuţii 

11.00 – 11.30 Coffe Break 

Sesiunea II 

Tumorile Cardiace, complicaţii ale chirurgiei cardiace 

Moderatori: Traian Scridon, Reinhard Moidl, I. Maniţiu 


11.30 – 

11.45 

11.45 – 

12.00 

12.00 – 

12.10 

12.10 – 

12.20 

12.20 – 

12.30 

12.30 – 

12.40 

Traian Scridon 

Institutul Inimii “ N. Stăncioiu” Cluj-Napoca 

Manolache Gh, Batrinac A., Moscalu V, Ureche 

A., Morozan V., Turcanu G, Barnaciuc S., Ghicavii 

N. 

Institute of Cardiology, Republic of Moldova 

I. Maniţiu, Gabriela Eminovici, Minodora Teodoru, 

Rodica Moga, Ruxandra Dobrin, C. Balan 

Spitalul Clinic Judeţean Sibiu 

Lucian Stoica, Eugen Bitere, Laurenţiu Gafencu, 

Dumitrita-Alina Gafencu 

Clinica de Chirurgie Cardiovasculară, Institutul de Boli 

Cardiovasculare “ Prof Dr. George I.M. Georgescu”, Iaşi 

L.F. Dorobanţu, O. Stiru, A. Prodea, A. Georgescu, 

Daniela Filipescu, V.A. Iliescu 

Clinica de Chirurgie Cardiovascularã, Institutul de Boli 

Cardiovasculare "Prof. Dr. C.C. Iliescu", Bucureşti 

Minodora Teodoru, I. Maniţiu, Gabriela Eminovici, 

Rodica Moga, C. Balan, Raluca Matei, Cristina 

Chircu 

Spitalul Clinic Judeţean Sibiu 

Tumori cardiace 

The strategies in diagnosis and surgical 

treatment of heart tumors 

Rolul ecografiei în diagnosticul şi rezolvarea 

chirurgicală a tumorilor cardiace 

Chist hidatic cardio-pericardic. 

Cardiopericardic hydatid cyst 

Caz unic de histiocitom fibros malign de 

ventricul drept cu implantare la nivelul 

bandeletei moderatoare 

Particularităţi ale cazurilor de 

trombembolism pulmonar în experienţa 

Clinicii de Cardiologie Sibiu

12.40 – 

12.50 

12.50 – 

13.00 

Reinhard Moidl 

Department of Cardiothoracic Surgery, 

University of Vienna, Vienna, Austria 

Prisăcaru I, Ureche A., Turcanu G., Manolache 

Gh., Moscalu V., Batrinac A. 

Institute of Cardiology, Chişinău, Republic of Moldova 

24 

Treatment of deep sternal wound 

infections with V.A.C. Therapy 

Treatment of sternal dehiscence after heart 

operation 

13.00 – 13.30 Discuţii 

13.30 – 14.30 Pauza de prânz 

Sesiunea III 

Chirurgia valvei aortice 

Moderatori: Gelu Cerin, Gunter Laufer, Guido Lanzilo, M. Laskar 


14.30 – 

14.45 

Horia Muresian 

The University Hospital of Bucharest 

Anatomia chirurgicală a rădăcinii aortei 

14.45 – 

15.00 

15.00 – 

15.20 

15.20 – 

15.40 

15.40 – 

15.50 

15.50 – 

16.00 

16.00 – 

16.10 

16.10 – 

16.20 

16.20 – 

16.30 

Gelu Cerin 

Cardiology Unit in Cardiac Surgery Dpt. San Gaudenzio 

Clinic, Novara, Italy 

C. Lanzilo, Marco Diena 

Cardiac Surgery Dpt. San Gaudenzio Clinic, 

Novara, Italy, Novara, Italy 

Gunther Laufer 

Univ.-Klinik für Chirurgie, Klin, Viena- Austria 

Marian Gaspar, Gunther Laufer, Călin Jusca, 

Daniel Nica, Ionel Droc, Petre Deutsch 


M Laskar*, C. Eveno*, T. Bourguignon**, A. 

Piccardo***, L. Roussel***, E. Bergoend**, M. 

Aupart**, E. Cornu*, T. Caus***, M. Marchand**. 

* CHU Dupuytren, ** Hôpital Trousseau, 

*** Hôpital Sud 

Moscalu V., Batrinac A, Manolache gh., Ureche A, 

Turcan Gr., Morozan V., Barnaciuc S., Voitov S., 

Ghicavii N.,. Guzgan Iu. 

Institute of Cardiology, Cardiac Surgery Departament, 

Chisinau, Republic of Moldova 

Dumitraşcu George 

Spitalul Militar de Urgenţă Sibiu 

Wich patients for aortic valve repair? Role 

of Echocardiography 

Aortic valve repair – when and how to do 

it? 

Progres in aortic valve surgery 

“Homograft – ROSS operation, Timişoara, 

experience 1997 – 2010” 

Remplacement valvulaire aortique 

conventionnel chez le sujet de plus de 85 

ans. Resultants a court et long terme a 

propos d’une serie de 164 patients operes. 

Conventional aortic valvular replacement 

in patients over 85. Short and long term 

results about 164 patients 

Functional principle in determining the 

assessment criteria for valvular aortic 

reconstructive correction 

Cătălin Constantin Badiu, Walter Eichinger, Sabine 

Stenoza aortică severă asimptomatică – 

festina lente? 

Should root replacement with aortic valve- 

Bleiziffer, Grit Hermes, Ina Hettich, Bernhard Voss, sparing be offered to patients with severe 

Robert Bauernschmitt, Rudiger Lange. 

aortic regurgitation or bicuspid aortic 

German Heart Centre Munich, Munich, Germany valves? 

16.30 – 17.00 Coffe Break 

Sesiunea IV 

Chirurgia valvei mitrale, endocardita bacteriană 

Moderatori: Grigore Tinică, Batrinac A., Moscalu V. 


17.00 – 

17.15 

17.15 – 

17.30 

B. Radulescu, R. Vasile, A. Vasilescu, Luminiţa 

Iliuta, Y. Hashem, A. Mărginean, D. Filipescu, H. 

Moldovan, V. Iliescu 

Boli Cardiovasculare « Prof. Dr. C.C. Iliescu », Bucureşti 

Batrinac Aureliu, Moscalu V, Manolache gh., 

Ureche A, Morozan V., Guzgan Iu., Voitov S., 

Tratamentul chirurgical al endocarditei 

bacteriene de rădăcină aortică 

Correction of ischemic mitral valve 

regurgitation with a new method of

17.30 – 

17.45 

17.45 – 

18.00 

18.00 – 

18.10 

18.10 – 

18.20 

18.20 – 

18.30 

Barnaciuc S., Vitalie V. Moscalu 


Chişinău, Republic of Moldova 

Moscalu Vitalie, Batrinac A., Manolache Gh., 

Ureche A, Ghicavii N., Manolache S., Moscalu V. 

Institute of Cardiology, Heart Surgery Department, 


Dumitrasciuc G., Nica D., Feier H., Jusca C., 

Cioata D., Ionac A,. Merce A., Gaspar M. 


Grigore Tinică, Mihail Enache, Diana Ciurescu, 

Alexandru Ciucu, Oana Bartoş, Daniel 

Dăscălescu, Victor Diaconescu, Sânziana 

Patrulea, Bogdan Aparaschivei 


Cardiovasculare “ Prf Dr. George I. M. Georgescu”, Iaşi 

Kovacs Judit, Jung Janos, Simona Gurzu, Azamfirei 

L., Sanda-Maria Copotoiu, Baloş Sorin, Suciu H., 

Ruxandra Copotoiu, Mezei T. 

IUBCVT, Morphopathology, SCJM, Tg. Mureş 

Batrinac A., Morozan V., Ureche A., Manolache 

Gh., Voitov S., Barnaciuc S., Ghicavii N., Guzgan 

Iu., Moscalu V. 



25 

annuloplasty 

18.30 – 19.00 Discuţii 

Prevention of systolic anterior motion (SAM) 

after mitral valve repair 

Aspecte ale chirurgiei valvei mitrale la 

pacienţii cu disfuncţie sistolică a 

ventriculului stâng 

Mitral valve surgery in patients with left 

ventricular systolic disfunction. 

Sala Saphire 

Grupul de lucrări « CHIRURGIE VASCULARĂ » 

Revascularizarea arterei coronare drepte. 

Certitudini şi controverse. 

Right coronary artery revascularization. 

Certainty and controversy. 

Pancreatita acută după intervenţii 

chirurgicale cardiace. 

Acute pancreatitis after cardiac surgery 

An adjunctive procedure for surgical left 

ventricular remodeling using papillary 

muscle sling 

Sesiunea V 

Moderatori: Ş. Rădulescu, G. Szendro, J-Baptiste Ricco 

ORA AUTORI TITLU 

09.00 – 

09.15 

09.15 – 

09.30 

09.30 – 

09.45 

09.45 – 

10.00 

10.00 – 

10.10 

10.10 – 

10.20 

10.20 – 

10.35 

10.35 – 

10.50 

Rădulescu Şerban 

Spitalul Clinic Judeţean de Urgenţă, Universitatea de 

Medicină şi Farmacie "Iuliu Haţieganu", Cluj-Napoca, 

Chirurgie II 

Gabriel Szendro - Conferinţă 

Department of Vascular Surgery, Soroka Medical 

Center, Beer Sheva, Israel 

Sorin Băilă 

Institutul de Boli Cardiovasculare “C.C. Iliescu” 

Bucureşti 

Horia Mureşian 






Jean-Baptiste Ricco 

University of Poitiers, France 



10.50 – 11.00 Discuţii 

Chirugia vasculară – Tendinţe actuale în 

Romania 

Minimally invasive new technique for fempop 

bypass 

Locul endarterectomiei de artera carotidă 

în tratamentul stenozelor critice carotidiene 

simptomatice şi asimptomatice 

Aneurysm of aberrant right subclavian 

artery, Kommerell diverticulum and common 

carotid trunk-single stage surgical repair 

without cardiopulmonary bypass 

Simultaneous bilateral carotid 

endarterectomy personal experience in 90 

patients 

The surgery for vertebro-basilar arterial 

insufficiency 

Carotid surgery: actual strategy 

How to write a paper in cardiovascular 

surgery

11.00 – 11.30 Coffe Break 

Sesiunea VI 

Moderatori: Marina Păcescu, F. Spineli, P. Bergeron 


11.30 – 

11.45 

11.45 – 

12.00 

12.00 – 

12.10 

12.10 – 

12.20 

12.20 – 

12.30 

12.30 – 

12.40 

12.40 – 

12.50 

12.50 – 

13.00 

13.00 – 

13.15 

Francesco Spinelli, Francesco Stilo, Filippo 

Benedetto, Giovanni De Caridi, Michele La 

Spada. 

Unit of Vascular Surgery, Department of 

Cardiovascular and Thoracic Surgery, University of 

Messina, Italy 

Marina Păcescu, S. Băilă, DF Barzoi, R. Halpern, 

Mădălina Gavanescu 

Department of Vascular Surgery, “C.C. Iliescu” 

Emergency Institute of Cardiovascular Disease, 

Bucharest 

Claudia Gherman, H. Silaghi, Anca Cristea B. 

Olaru, F. Deme, A. Oprea, S. Rădulescu, A. 

Mironiuc 

Second Surgical Clinic, University of Medicine and 

Pharmacy “Iuliu Haţieganu”, Cluj Napoca 

Claudia Gherman, Ioana Constantinescu, H. 

Silaghi, B. Stancu, B. Olaru, F. Deme, A. Eni, S. 

Rădulescu, A. Mironiuc, D. Pamfil, Ioana 

Petricele, Iulia Pop 



I. Droc, Pinte Fl., Călinescu F., Deaconu St., Niţă 

A, Dumitraşcu M., Popovici A. 

Centrul clinic de urgenţă de boli cardiovasculare “Dr. 

Constantin Zamfir”, Bucureşti 

S. Rădulescu, A. Zanfir, C Gherman 



NJ Tesoiu, Marina Păcescu, SL Băilă, DF Barzoi, I. 

Diaconescu, F Coşa, R. Halpern, Isabella Oprea, 

Mirela Marcu, Adina Stoica, M. Croitoru, Daniela 

Mitcov 

Institutul de Boli Cardiovasculare “C. C. Iliescu” 

Bucureşti 

Grigore Tinică*, Mihail Enache*, Diana 

Ciurescu**, Vasile Cepoi***, Andrei Dumbravă**, 

Vasile Astarastoae* 

*University of Medicine 

and Pharmacy “Gr. T. Popa” Iaşi 

**Cardiovascular Institute, Iaşi 

***Clinical and Experimental Cardiovascular Research 

Foundation 

D. Trandafir, Silvia Condu, R. Nechifor*, B. 

Dorobat*, Cristina Tudor**, Ana Filimon 

Department of Cardiovascular Surgery 

* Department of Radiology 

** Department of Anesthesiology University Hospital of 

Bucharest 

13.15 – 13.30 Discuţii 

26 

An aggressive treatment improves midterm 

survival and amputation- free survival in CLI 

patient 

Standard of care for popliteal Artery 

Aneurysm 

Aprecieri asupra rolului adipocitokinelor 

“cheie” în iniţierea şi progresia leziunilor 

ateromatoase din afecţiunile vasculare 

periferice. 

Considerations on the role of the “key” 

adipocytokines in the initiation and 

pregression of atherosclerotic lesions on 

peripheral arterial disease 

Aportul genomilor în studiul aplicării unor 

gene în afecţiuni arteriale periferice. 

Contribution of genomics in studies that 

involves the gehes in peripheral arterial 

disease 

Management of critical limb ischemia 

Complicaţii postoperatorii în chirurgia 

convenţională a bolii varicoase. 

Postoperative complications in the 

conventional surgery of varicose vein 

disease 

Patologia cardiovasculară asociată şi 

rezultatele imediate în trombembolectomia 

arterială chirugicală pentru ischemia acută 

a membrului superior – 10 ani de 

experienţă. 

Cardiovascular Underlying pathology and 

early results în surgical arterial 

thromboembolectomy for upper limb acute 

ischemia - 10 years experience 

Educarea interesului pentru chirurgia 

cardiovasculară la studenţii medicinişti la 

şcoala de vară. 

Raising medical students interest in 

cardiovascular surgery through surgery 

summer school 

The use of aortic iliac endovascular 

prothesis for infrarenal abdominal aortic 

aneurysm – case report

13.30 – 14.30 Pauza de masă 

Sesiunea VII 



14.30 – 

15.30 

15.30– 

15.40 

15.40 – 

15.50 

Simpozion Vasaprostan 

I. Droc, Pinte Fl, Cristian G, Dumitraşcu M., 

Deaconu St., Călinescu F, Murgu V. 

Centrul clinic de urgenţă de boli cardiovasculare “Dr. 

Constantin Zamfir”, Bucureşti 

Daniel Nica, M. Gaşpar, P. Deutsch, D. Cioata, 

C. Juşca, G. Dumitraşciuc, H. Feier, A. Merce, A. 

Ionescu 

Institutul de Boli Cardiovasculare Timişoara, Clinica de 

Chirurgie Cardiovasculară II 

27 

Chirurgie clasică versus endovasculară în 

tratamentul anevrismului de aortă 

abdominală. 

Open Surgery versus endovascular 

treatment for abdominal aortic aneurysms 

Abordarea chirurgicală a anevrismelor de 

aortă abdominală: experienţa clinică ian. 

2003- dec. 2009. Surgical approach of 

abdominal aortic aneurysms: clinical 

experience ian 2003- dec 2009 

15.50 – 16.00 Discuţii 

16.30 – 17.00 Coffe Break 

Sesiunea VIII 



16.30 – 

16.40 

16.40 – 

16.50 

16.50 – 

17.00 

17.00 – 

17.10 

17.10 - 

17.20 

17.20 – 

17.30 

17.30 - 

17.35 

17.35 – 

17.40 

Silaghi H, Magnan PE, Branchereau A, Gherman 

C, Mironiuc A 



Alina Silaghi, H. Silaghi, T. Scridon, A. Mironiuc, Ş. 

Rădulescu, M. Grino 




Jerzicska E., Balos S., Suciu H., Deac R. 

IUBCVT, Tg. Mureş 

NJ Tesoiu 

Institutul de Urgenţă pentru Boli Cardiovasculare “ Prof. 

Dr. C.C. Iliescu”, Bucureşti 

Silvia Condru, D. Trandafir*, S. Rurac*, Cristina 

Tudor**, Florentina Mihăescu** 

*Department of Cardio-Vascular Surgery, University 

Hospital Bucharest 

**Department of Anaesthesia and Intensive Care 

University Hospital Bucharest 

A. Oprea, A. Eni, O. Andercou, A. Buleandră, 

Diana Turcu, S. Rădulescu 



Dr. Mihălcescu Daniel, Dr. Creţu Magdalena, Dr. 

Radu Mădălina, dr. Lazar Ovidiu, Dr. Cârjaliu 

Ionuţ, Dr. Tica Talida, Dr. Stanciu Crina, Dr. Popa 

Cherecheanu Matei, Dr. Lazăr Mihaela, Dr. 

Goleanu Viorel, Dr. Buica Dana 

Centrul de boli cardiovasculare « Agrippa Ionescu » 


Radu Mădălina, dr. Lazăr Ovidiu, Dr. Carjaliu 


Tratamentul endovascular în 

pseudoanevrismele aortei abdominale. 

Endovascular procedures for abdominal 

aorta false aneurysms 

Expresia citokinelor inflamatorii la nivelul 

ţesutului adipos epicardic şi relaţia cu 

boala aterosclerotică coronariană 

Răsunetul revascularizaţiei carotidiene 

asupra parenchimului cerebral – sindromul 

de hiperperfuzie cerebrală 

125 ani de la naşterea lui Nicolae 

Hortolomei - moştenirea în domeniul 

chirurgiei vasculare. 

125 years from the birth of Nicolae 

Hortolomei - vascular surgery heritage 

Popliteal Artery Entrapment Syndrome 

Giant External Carotid Aneurysm: case 

report. 

Anevrism gigant de arteră carotidă 

externă 

Tratamentul stenozelor, fistulelor arteriovenoase 

pentru hemodializa 

Sindromul de furt sangvin post FAV - abord 

chirurgical

17.40 – 

17.50 




D.F. Bărzoi, M. Păcescu, I. Diaconescu, N. J. 

Teşoiu, R. Halpern, I. Oprea, E. Mărginean, O. 

Moraru, O. Udrică, A. D. Iancu, A. Stoica, S.L. 

Băilă 

Vascular Surgery Department, “C. C. Iliescu” 

Cardiovascular Diseases Institute, Bucharest, Romania 


Sala Diamond 


Sesiunea IX 


Moderatori: Gerard Bloch, H. Moldovan, Tintoiu I. 

28 

Reconstrucţii arteriale in Boala Ocluzivă 

Infrainghinală- experienţa secţiei în 13 ani 

Arterial reconstructions in Infrainguinal 

Occlusive Disease- our department’s 

experience over 13 years 


9.00 – 

9.15 

9.15 – 

9.30 

9.30 – 

9.45 

9.45 – 

10.00 

10.00 – 

10.15 

10.15 – 

10.30 

10.30 – 

10.45 

Deac Radu 


Gerard Bloch 

Spitalul American din Paris 

Horaţiu Moldovan 

Institutul de Boli Cardiovasculare “ Prof. Dr. C.C. Iliescu” 

Bucureşti 

Grigore Tinică 


Cardiovasculare, Iaşi 

Grigore Tinică, Diana Ciurescu, Igor Nedelciuc, 

Mihail Enache, Vasile Astarastoae. 

Clinica de Chirurgie Cardiovasculara, Institutul de Boli 


Ţintoiu Ion 

Spitalul Militar Bucureşti 

Adrian Molnar 


10.45 – 11.00 Discuţii 

11.00 – 11.30 Coffe Break 

Sesiunea X 

Moderatori: I. Ţintoiu I., R. Deac, G. Tinică 

Revascularizarea miocardică – ghidul ESC 

2010. 

Myocardial revascularization – Guidelines 

ESC 2010 

Actual indications for CABG (coronary 

artery bypass grafting 

Ruptura de sept interventricular post 

infarct miocardic acut 

Revascularizarea chirurgicală coronariană 

total arterială. Argumente şi fapte. Totally 

arterial coronary revascularization. 

Argument and facts. 

Organizarea sălii de operaţie hibride 

cardiovasculare. 

Making of the cardiovascular hybrid 

operating room 

Rezistenţa la tratamentul antiplachetar şi 

restenoza în stent sau graft 

Chirurgia off pump versus on pump în 

revascularizarea miocardică 


11.30 – 

11.45 

11.45 – 

12.00 

I. Droc, Tintoiu I. 

Centrul clinic de urgenţă de boli cardiovasculare 

“Dr. Constantin Zamfir”, Spitalul Militar Bucureşti 

Clara Alexandrescu 

Centre Cardio-Thoracique du Monaco, Monte 

Carlo 

CABG after instent restenosys 

Care este cea mai bună modalitate imagistică 

înainte de chirurgia aortei?. What is the best 

imagistic modality before surgery for aortic 

valve and aortic root? 

12.00 – L. Stoica, E. Bitere, E. Ciobanu, G. Tinica Ruptura cardiacă postinfarct miocardic acut-

12.10 Clinica de Chirurgie Cardiovasculară, Institutul de 

Boli Cardiovasculare “ Prof Dr. George I. M. 

Georgescu”, Iaşi 

12.10 – 

12.20 

12.20 – 

12.30 

12.30 – 

12.40 

12.40 – 

12.50 

12.50 – 

13.00 

13.00 – 

13.10 

13.10 – 

13.20 

R.Vasile, B.Rădulescu, A.Mărginean, 

S.Marin, O.Ghenu, H.Moldovan, V.Iliescu 



Raicea V., Moraru L., Serban V., Deac R 


Grigore Tinica, Mihail Enache, Diana 

Ciurescu, Alexandru Ciucu, Flavia Antoniu, 

Oana Bartoş, Victor Prisacari. 

Clinica de Chirurgie Cardiovasculară, Institutul de 

Boli Cardiovasculare “ Prof Dr. George I. M. 


Diana Ciurescu, Igor Nedelciuc, Mihail 

Enache, Dumitriţa Gafencu, Grigore Tinica 

Clinica de Chirurgie Cardiovasculară, 

Institutul de Boli Cardiovasculare 

“Prof Dr. George I. M. Georgescu”, Iaşi 

Moraru L., Raicea V., Şerban V., Bica Lucia, 

Raicea C., Deac R. 

IUBCVT Tg. Mureş CCV I 

Deac R., Raicea V, Moraru L., Suciu H. 


R. Vasile, B. Rădulescu, A. Vasilescu, 

Luminiţa Iliuţă, H. Moldovan, V. Iliescu 

Institutul de Boli Cardiovasculare “ Prof Dr. 


29 

prezentare de caz.. Cardiac rupture after 

myocardial infarction- case study 

Infarct miocardic acut postoperator,prin spasm 

de artera coronara dreaptă indemnă 

Complicaţii mecanice ale infarctului miocardic 

acut: defectul septal ventricular. 

Mechanical complication of acute myocardial 

infarction: Ventricular septal defect 

Revascularizarea miocardică concomitentă 

tratamentului chirurgical al altor patologii 

cardiace. Comparaţie cu EACTS adult cardiac 

Surgical Database report. 

Miocardial revascularization combined with 

surgical treatment of other cardiac 

pathologies. Comparation with EACTS adult 

cardiac Surgical Database report 

Revascularizarea hibridă – un pas înainte în 

medicina cardiovasculară. 

Hybrid revascularisation – one step forward in 

cardiovascular medicine 

Recoltarea chirurgicală a arterei radiale – 

comparaţie între tehnica scheletizată şi cea 

pediculată 

Utilizarea arterei radiale în revascularizarea 

arterială miocardică. 

Use of radial artery in myocardial arterial 

revascularization 

Revascularizare miocardică folosind arterele 

mamare scheletizate 

13.20 – 13.30 Discuţii 


Sesiunea XI 

Moderator: Horia Mureşan, P. Bergeron, Şerban Stoica 

ORA AUTOR TITLU 

14.30 – 

14.40 

14.40 – 

14.50 

Grigore Tinica, Alexandru Ciucu, Mihail Enache, 

Diana Ciurescu, Flavia Antoniu, Mihalea Grecu, 

Oana Bartoş, Victor Prisacari, Daniel Dăscălescu. 


Institutul de Boli Cardiovasculare, Iaşi 

Raicea V., Moraru L., Serban V., Deac R. 


Aportul chirurgical în controlul furtunii 

electrice la pacient cu defibrilator 

implantabil şi anevrism gicant de ventricul 

stang. 

The importance of surgery in controlling 

the electrical storm in a patient with an 

implantable cardioverter and left 

ventricular anevrysm 

Disecţie acută de aortă ascendentă 

asociată cu disecţie carotidiană bilaterală 

- prezentare de caz. 

Acute dissection of ascending aorta with 

bilateral disection of carotid arteries - case 

report 

14.50 – 

15.00 



Surgical choices for aortic arch syndrome 

Feier Horea, Gaşpar M, Merce A., Nica D., Opţiuni de tratament ale rupturii 

15.00 – Deutsch P., Milovan Slovenski 

posttraumatice de aortă. 

15.10 

Treatment options for traumatic aortic 

Institutul de Boli Cardiovasculare Timişoara transection 

15.10 – O.Stiru, L.F. Dorobantu, O.Ghenu, Daniela Pseudonaevrism rupt de aortă ascedentă

15.20 Filipescu, V.A.Iliescu 

15.20 – 

15.30 

15.30 – 

15.40 

15.40 – 

16.00 

16.00 – 

16.15 

16.15 - 

17.00 


“Prof Dr. C.C.Iliescu” Bucureşti 

B. Rădulescu, R.Vasile, A.Vasilescu, Luminiţa 

Iliuţă, Y.Hashem, A.Mărginean, Mihaela Crăciun, 

S.Bubenek, H.Moldovan, V.Iliescu 


Medicină şi Farmacie "Iuliu Haţieganu", 

Cluj-Napoca, Chirurgie II 

Institutul de Boli Cardiovasculare “ Prof Dr. C.C.Iliescu” 

Bucureşti 

P. Bergeron*, A. Petrosyan *, J. Bellos**, F. 

Markatis**, T. Abdulamit*, A. El Shazly, J.C. 

Tratour*. 

* Saint-Joseph Hospital, Marseille, France 

** 1st surgical clinic Laikon Hospital University of Athens 

Medical School 

Şerban Stoica*, Kimberley Goldsmith**, Nicolaos 

Demiris**, Prakash Punjabi***, Geoffrey Berg****, 

Linda Sharples**, Stephen Large***** 

* Bristol Royal Children’s Hospital, USA 

** Medical Research Council Biostatistics Unit, 

Cambridge 

*** Hammersmith Hospital, London 

****Golden Jubilee National Hospital, Glasgow 

***** Papworth Hospital, Cambridge, UK 

I Droc, I. Mocanu, Murgu V., Deaconu St., Pinte Fl 

Discutii 


“Dr. Constantin Zamfir” 

16.15 – 17.00 Discuţii 

30 

dupa proteazre aortică – rezolvare 

chirurgicală. 

Anevrism gigant de crosă aortică – 

rezolvare chirurgicală. 

New approach for extend Type II TAAA in 

High risk patients" 

Microsimulation of clinical outcomes 

analysis support a lower age threshold for 

use of biological valves 

Chirurgia carotidiană şi coronariană: 

strategie actuală. 

Carotid and Coronary Surgery - actual 

strategy. 

SALA Saphire 

Simpozionul Societăţii Române de Anestezie-Terapie Intensivă 

Cardiacă şi Tehnologie Extracorporeală (SRATICTE) 

Sesiunea XII 

Anemia si transfuzia in chirurgia cardiaca 

Moderator: Ioan Vlad 


09.00 - 

09.15 

09.15 - 

09.35 

09.35 - 

09.50 

Daniela Filipescu (Bucureşti) 

Ioana Grigoraş (Iaşi) 

Stanca Asztalos, Antonela Mureşan, Sanda 

Negruţiu, Luminiţa Slabu, Carmen Steiu, Ioan 

Vlad (Cluj Napoca) 

09.50 - 10.00 Discuţii 

Paradoxul anemie-transfuzie în chirurgia 

cardiacă 

Este administrarea perioperatorie de fier o 

soluţie ? Metabolismul fierului la pacientul 

critic 

Reducerea necesarului transfuzional în 

chirurgia cardiacă 

How to reduce allogenic blood transfusion 

in cardiac surgery

Sesiunea XIII 

Moderator: Victor Diaconescu 


10.00 - 

10.10 

10.10 - 

10.20 

10.20 - 

10.30 

10.30 - 

10.40 

10.40 - 

10.50 

Carmen Movileanu, Roxana Toma, Mihaela 

Melinte, Horatiu Suciu (Tg. Mureş) 

Gabriela Olaru, Pavel Morar, Irina Modrigan, 

Horaţiu Suciu (Tg. Mureş) 

S. Balos, Judit Kovacs, Radu Deac, Horaţiu Suciu 

(Tg. Mureş) 

S. Baloş, Judit Kovacs, Horaţiu Suciu (Tg. Mures) 

Anca Prodea, Mihail Luchian, Oana Ghenu, 

Ioana Marinică, Alina Păunescu, Simona Marin, 

Laura Dima, Daniela Filipescu, Cezar Macarie 

10.50 - 11.00 Discuţii 

31 

Probleme curente în practica 

transfuzională pediatrică 

Particularităţi hematologice în patologia 

cianogenă postoperatorie 

Factori de risc ai disfuncţiei renale după 


Clasificarea AKI sau RIFLE în evaluarea 

prognosticului insuficienţei renale acute 

asociate chirurgiei cardiace 

N-GAL-marker precoce al disfuncţiei 

renale în chirurgia cardiacă? 

Sesiunea XIV 

Siguranţa pacientului în timpul circulaţiei extracorporeale 

Moderatori: Dan Longrois (Paris) şi Daniela Filipescu 


11.30 - 

11.50 

11.50 - 

12.00 

12.00 - 

12.20 

12.20 - 

12.30 

12.30 - 

12.40 

12.40 - 

12.50 

12.50 - 

13.00 

Dan Longrois (Paris) 

Oana Ghenu, Mihai Luchian, Victor Pavel, Gabi 

Olteanu, Horaţiu Moldovan, Vlad Iliescu, Daniela 

Filipescu (Bucureşti) 

Monitoring and Safety Issues in 

Cardiopulmonary Bypass 

Locul ECMO în chirurgia cardiacă 

Dan Longrois (Paris) Experienţa clinica cu ECMO 

Victor Diaconescu (Iaşi) 

Vasile Murgu, Cristian Gabriel, Laura Vămanu, 

Andreea Teoderescu, Andreea Tifrea, Anca Filip, 

Ionel Droc, Ion Tintoiu (Bucureşti) 

Jozsef Budai (Tg. Mures) 

Iu. Guzgan, E. Vîrlan, I. Matcovschi, V. Moscalu, 

S. Manolache, A. Batrinac (Republica Moldova) 

Circulaţia extracorporeală de la disfuncţia 

neurocognitivă în trecut, la 

postcondiţionare în viitor? 

Filtrarea leucocitară selectivă a 

cardioplegiei cu sânge şi a celei terminale 

(Hot shot) - strategie de protecţie 

miocardică în timpul CEC 

Rezistenţa la heparină - importanţa 

problemei pentru circulaţia 

extracorporeală 

The advantages of intermittent warm 

blood cardioplegia supplemented with 

Mg ++ 

13.00 – 13.30 Discuţii 


Sesiunea XV 

Moderatori: Ion Miclea, Mihai Luchian 


14.30 - 

14.40 

14.40 - 

14.50 

Ion Miclea, Violeta Bercan, Serban Bubenek 

(Bucuresti) 

Ovidiu Lazar, Tica Talida, Crina Stanciu, Adina 

Mitulescu, IonCarjaliu, Marian Butusina, Viorel 

Goleanu (Bucureşti) 

Traheostomia percutană în terapia 

intensivă sub control videolaringoscopic 

Proteina C reactivă înalt specifică în 

optimizarea predicţiei morbidităţii şi 

mortalităţii în chirurgia de revascularizare 

miocardică faţă de scorurile clasice

14.50 - 

15.00 

15.00 - 

15.10 

15.10 - 

15.20 

15.20 - 

15.30 

15.40 - 

15.50 

15.50 - 

16.00 

16.00 – 

16.10 

16.10 – 

16.20 

16.20 – 

16.30 

Ioan Vlad (Cluj-Napoca) 

Mihai Luchian, Ioana Marinică, Alina Păunescu, 

Oana Ghenu, Simona Marin, Anca Prodea, 

Ovidiu Chioncel, Luminiţa Iliuţă, Oana 

Mihăilescu, Horaţiu Moldovan, Vlad Iliescu, 

Daniela Filipescu (Bucureşti) 

Roxana Toma, Sorin Păşcanu, Mihai Chiloflischi, 


D. Dăscălescu, V. Diaconescu, S. Patrulea, B. 

Aparaschivei, A. Ciucu, L. Stoica, G. Tinica (Iasi) 

Victor Diaconescu (Iaşi) 

Radu Mihai Dumitrescu, Cristina Anca Tudor, 

Elena Copaciu (Bucureşti) 

Oana Mihăilescu, Alina Păunescu, Mihai 

Luchian, Anca Prodea, Oana Ghenu, Ioana 

Marinică, Simona Marin, Laura Dima, Ovidiu 

Chioncel, Luminiţa Iliuţă, Sorin Maximeasa, 

Horaţiu Moldovan, Vlad Iliescu, Daniela Filipescu 

(Bucureşti) 

Daniela Manea, Mihai Luchian, Alina Păunescu, 

Ioana Marinică, Anca Prodea, Oana Ghenu, 

Simona Marin, Daniela Filipescu (Bucureşti) 

Cristina Ciochină, Mihai Luchian, Oana Ghenu, 


Anca Prodea, Ovidiu Chioncel, Luminiţa Iliuţă, 

Oana Mihăilescu, Daniela Filipescu (Bucureşti) 

SALA Ruby 

Grupul de lucrări « CONGENITALI » 

32 

Levosimendan în chirurgia cardiacă 

pediatrică 

Levosimendan la pacienti hemofiltrati 

postoperator 

Levosimendan in patients with 

postoperative haemofiltration 

Terlipresina - terapie "de salvare" în socul 

cardiogen postoperator 

Doza stress de hidrocortizon în timpul 

operaţiei la pacienţii cu risc crescut în 


Efecte antiinflamatorii ale combinaţiei 

xilină-morfină 

Anestezia loco-regională (blocul cervical) 

în chirurgia carotidiană - evaluare 

retrospectivă a experienţei din Clinica de 

Chirurgie Vasculară SUUB" 

Este troponina predictivă post chirurgie 

cardiacă? 

Is Troponin a predictive biomarker in 

cardiac surgery? 

Rolul ROTEM în sângerarea post chirurgie 

cardiacă 

Ce aduce nou ghidul de resuscitare în 

chirurgia cardiacă? 

Sesiunea XVI 

Moderatori: Horaţiu Suciu, Andrei Iosifescu, Chira Manuel 


9.00 – 

9.15 

9.15 – 

9.30 

9.30 – 

9.45 

9.45 – 

10.00 

10.00 – 

10.15 

10.15 – 

10.30 

Suciu Horaţiu 


Andrei Iosifescu, Lucian Dorobantu, Sorin 

Maximeasa, Traian Anca, Cristian Boroş, Vlad 

Iliescu 


Andrei Iosifescu, Alexandru Cornea, Traian Anca, 

Ioana Ghiorghiu, Platon Pavel, Ioana Marinică, 

Vlad Iliescu 


Bucureşti 

Dr. Ilona Cucu, dr. Vasile Sirbu, dr. Liviu Maniuc, 

dr. Oleg Repin 


Şerban Stoica*, Esther Carpenter**, Eduardo da 

Cruz**, James Todd**, Thomas Fagan**, Max 

Mitchell**, David Campbell**, Dunbar Ivy**, 

Francois Lacour- Gayet*** 

*Bristol Royal Children’s Hospital, USA 

** Denver Children’s Hospital, USA 

***Montefiore Hospital, New York, USA 

Suciu H., Paşcanu S., Matei M., Roxana Toma, 

Anca Sglimbea, Opris C., Deac R. 

Actualităţi în chirurgia pediatrică 

Update in pediatric cardiac surgery 

Tratamentul chirurgical al afecţiunilor 

congenitale ale căii de ieşire din ventriculul 

stâng 

Stenoza infundibulară pulmonară extrinsecă 

secundară pericarditei constrictive la copil– 

prezentarea unui caz tratat chirurgical 

Baloon angioplasty of pulmonary artery 

valve 

Outcomes of the complex arterial switch 

operation 

Corecţia chirurgicală a transpoziţiei marilor 

vase - experienţa a 80 de cazuri.

10.30 – 

10.40 

IUBCVT, Tg. Mureş Surgical correction of Transposition of Great 

Arteries - experience of 80 cases 

Lucian Stoica, Eugen Bitere, Dumitriţa-Alina 

Gafencu, Laurentiu Gafencu, Grigore Tinica 



“Prof. Dr. George I. M. Georgescu”, Iaşi 

Originea anormală a arterei coronare stângi 

din artera pulmonară asociată cu 

regurgitare mitrală. 

Anomalous origin of left coronary artery from 

the pulmonary artery in associatin with mitral 

regurgitation 

10.40 – 11.00 Discuţii 

11.00 – 11.30 Coffe Break 

Sesiunea XVII 

Moderatori: Chira Manuel, Mariana Andreica, Rodica Manasia, Angela Butnariu 


11.30 – 

11.45 

11.45 – 

12.00 

12.00 – 

12.15 

12.15 – 

12.30 

12.30 – 

12.40 

12.40 – 

13.00 

Chira Manuel, Simona Opriţa 

Institutul Inimii “ Niculae Stăncioiu” Cluj 

Cecilia Lazea*, Rodica Manasia,* Simona 

Opriţa**, Mircea Bârsan**, Svetlana Encica** 

* Clinica Pediatrie I “Axente Iancu” Cluj 

**Institutul Inimii “ Niculae Stăncioiu” Cluj 

Angela Butnariu, Daniela Iacob 

Clinica Pediatrie III, Universitatea de Medicină şi 

Farmacie “Iuliu Haţieganu” Cluj-Napoca 

Mariana Andreica*, Simona Cainap*, Andreea 

Răchişan*, Simona Opriţa**, Cecilia Lazea**, 

Manuel Chira**, Nicolae Miu* 

* Clinica Pediatrie II Cluj-Napoca 

** Institutul Inimii “Niculae Stăcioiu” Cluj-Napoca 

*** Clinica Pediatrie I Cluj-Napoca 

Popa Cherecheanu Matei, Goleanu Viorel, 

Butusina Marian, Lazar Ovidiu, Lazar Mihaela, 

Mihalcescu Daniel, Creţu Magdalena, Radu 

Mădălina, Tănăsescu Dragoş. 

Spitalul Clinic de Urgenţă Militar, Bucureşti 

Rodica Manasia, Cecilia Lazea 

Clinica Pediatrie I “Axente Iancu” Cluj 

33 

Intervenţii chirurgicale vs cardiologie 

intervenţională în tratamentul 

malformaţiilor chirurgicale" 

Tumori cardiace în practica cardiacă 

Aspecte pediatrice ale îngrijirii 

perioperatorii la copilul mic cu 

malformaţie cardiacă congenitală 

Abordarea clinică şi terapeutică a 

malformaţiilor cardiace congenitale – 

cazuistica Clinicii Pediatrie II Cluj-Napoca 

Chilotorax post cură chirurgicală a 

defectului septal interatrial 

Aspecte din viaţa copilului cardiac 

13.00 – 13.30 Discuţii 


SALA Ruby 

Grupul de lucrări « NURSING » 


14.30 – 

14.40 

14.40 – 

14.50 

14.50 – 

15.00 

15.00 – 

15.10 

15.10 – 

15.20 

15.20 – 

15.30 

As. Aurica Farcane, Prof Dr. Petru Deutsch. 


As Daniela Demea, Prof. Dr. Marian Gaspar 


As Georgeta Teuca 

Anestezie şi Terapie Intensivă, Institutul Inimii 

“N. Stăncioiu”, Cluj-Napoca 

As. Alina Ganea 

Bloc operator 

Cătinean Mihaela Carmen, dr. Vlad Horea Ioan 

Institutul Inimii de urgenţă pentru boli cardiovasculare” 

Nicolae Stăncioiu” Cluj-Napoca, Clinca de anestezie şi 

terapie intensivă 

As. Szabo Noemi, dr. A. Molnar 


Concentratul trombocitar obţinut prin 

afereza, tehnologie de interes pentru 

hematologia transfuzională 

Rolul bancii de celule si tesuturi in 

cresterea eficientizarii transplantului 

Transpozitia de vase mari – indicaţii şi risc 

operator 

Rezultate imediate în protezarea valvei 

aortice pentru stenoză. 

Protocol de reducere necesarului de 

transfuzii alogene în chirurgie cardiacă 

Chirurgia coronariană off pump, avantaje 

şi dezavantaje.



Vineri 1 octombrie 2010, Sala Diamond 


Sesiunea I - Transplant cardiac. Chirurgia valvelor cardiace 

Update in cardiac transplantation – 2010 

Prof. dr. Deac R., conf. dr. Suciu H., 

IUBCVT, Targu Mures 

International Society of Heart and Lung Transplantation with its database updates the 

medical community with progress in the domain. The main reason of this activity is the increased 

number of heart transplant patients who need follow up or medical asistance outside the 

specialized centers and thus the medical community should be kept informed. More than that, 

the procedure of heart trasplantation is no longer an experimental technique but a method of 

treatment for terminal heart diseases above the medico - surgical armamentarium so far. The 

surgical technique most commonly used is the orthotopic heart transplantation, bicaval 

technique. A modification of this technique by performing the aortic anastomosis first shortens the 

ischemia by one hour. Utilisation of a blood artificial perfusion system to keep the donor heart 

beating extends the duration of the transfer to recipient for more than 5 hours. Immunosuppresive 

medication more efficient and with less side-effects (everolimus, sirolimus) is already under clinical 

trials. Blood assays of rejection related gene expression proved already ”noninferior” to 

myocardial biopsy,which still remains ”the gold standard”. 

Utilization of statins 1-2 weeks after the transplant is recommended disregarding the level 

of cholesterol. Male recipients who receive male donor hearts have a longer survival in 

comparison with female recipients who have a survival with 3,6 % less at 5 years. Males who 

receive female donor hearts have a mortality risk of 15% higher. 

Median survival after heart transplantation is now 10 years.The longevity after heart 

transplantation has reached 31 years with good quality of life. A case of a child transplanted at 6 

month of age at Stanford University, USA, is now 28 years old without immunossupresive therapy, 

acquiring imunological tolerance, the golden dream of transplantation 

Actualităţi în transplantarea cardiacă – 2010 

Societatea Internaţională de Transplantare a Inimii şi Plămânilor prin baza sa de date 

actualizată anual documentează progresele înregistrate în domeniu şi susţin procedeul de 

transplantare cardiacă ortotopică ca o metodă de tratament a bolior cardiace incurabile pînă în 

anii din urmă. Principalul scop al acestei actualizări este numărul crescut al pacienţilor cu 

transplant cardiac care necesită dispensarizare sau asitenţă medicală înafara centrelor 

specializate despre care comunitatea medicală trebuie informată. Tehnica chirurgicală cea mai 

des efectuată este transplantarea ortotopică a inimii de tip bicav. Menţinerea inimii în stare de 

perfuzie con-tinuă într-un sistem de perfuzie artificială cu sânge permite prelungirea duratei de 

transfer de la donator la receptor peste 5 ore în bună stare de funcţionare. O modificare tehnică 

constând în efectuarea iniţială a anasto-mozei aortice scurtează ischemia cordului donator cu 1 

oră. Medicaţie imunosupresivă mai eficientă şi cu mai puţine efecte secundare (everoli-mus, 

sirolimus) se află în trialuri clinice. Teste serice de rejecţie ”gene expression related” s-au dovedit 

non-inferioare supravegherii imunosu-presiei prin biopsia miocardică invazivă, deşi aceasta 

rămâne ”standardul de aur”. Utilizarea statinelor de la 1-2 săptămâni după transplant este 

recomandată indiferent de nivelul colesterolului. Receptorii bărba i care primesc inimi de 

donatori bărbaţi au o supravieţuire mai lungă decât femeile care indiferent de genul donatorului 

au o supravieţuire cu 3,6% mai mică la 5 ani. Bărbaţii care primesc inimi de femei au un risc de 

mortalitate cu 15% mai mare. Supravieţuirea mediană după transplantarea cardiacă este acum 

de 10 ani. Longevitatea după transplantare cardiacă a atins 31 de ani în bună stare de sănătate. 

Este descris cazul unui copil de 6 luni operat la Universitatea Stanford, SUA, care a împlinit 28 de 

ani fără terapie imuno-supresivă dobândind toleranţă imunologică visul de aur al transplantării. 

34

Ten years of heart transplantation at IUBCVT Târgu Mureş 1999 – 2010 

Zece ani de transplantare cardiacă la IUBCVT Tg. Mureş 1999-2010 

Conf. dr. Suciu H., prof. dr. Deac R., dr. Mihaela Ispas, dr. Paşcanu S., 

dr. Roxana Toma, prof. dr. Anca Sin, dr. Cotoi O., dr. Matei M., 

dr. Opris C., dr. Mihaela Melinte, asist. med. Terezia Preda 


Heart transplantation became a method of treatment of terminal heart diseases above 

the medico-surgical armamentarium. The database of International Society of Heart and Lung 

Transplantation witnesses the progress in the domain. The procedure was introduced in the 

Emergency Institute of Cardiovascular Disease and Transplantation Targu Mures in 1999 when the 

first heart transplantation was performed. Between 1999 and 2010 there were transplanted 38 

patients with the ortothopic bicaval heart transplantation. The patients were HLA tested 

retrospectively. The immunosuppresion used consisted in triple drug therapy (calineurin inhibitors – 

Cyclosporine or Prograf, MMF and corticoids) after induction with Thymoglobulin. Cytomegalovirus 

prophilaxis with Gancylovir and Valgancyclovir was performed. The first 2 patients reached 1o 

years of longevity in good health. The number of heart transplantation performed annually 

increased with the number of donors available. In 2010, 7 cardiac transplants were performed. 

The early and late complications are presented. The results and quality of life of the transplanted 

patients justify the continuation of heart transplantation program in our unit. 

Zece ani de transplantare cardiacă la IUBCVT Tg. Mureş 1999-2010 

Transplantarea ortotopică a inimii a devenit o metodă de tratament a bolilor cardiace 

terminale care se află deasupra resurselor de tratament medico-chirurgicale clasice. Baza de 

date a Societăţii Internaţionale de Transplantare a Inimii şi Plămânilor documentează anual 

progresele înregistrate în domeniu. In Institutul de Urgenţă pentru Boli Cardiovascu-lare şi 

Transplant acest procedeu a fost introdus în 1999, când a fost transplantat primul pacient. Intre 

1999 şi 2010 au fost transplantaţi 38 de pacienţi cu procedeul de transplant cardiac ortotopic tip 

bicav. Pacienţii a fost testaţi HLA retrospectiv. Terapia imunosupresivă aplicată a con-stat în 

inducţie cu Timoglobulină şi corticoizi, apoi terapia de întreţinere cu inhibitori de calcineurină 

(Ciclosporină, Prograf) şi MMF (mycofenolat mofetil). Profilaxia infecţiei cu Cytomegalovirus a fost 

efectuată cu Gan-ciclovir şi Valganciclovir. Primii 2 pacienţi au depăşit longevitatea de 10 ani. 

Numărul transplantelor cardiace efectuate anual a crescut cu numă-rul donatorilor disponibili. In 

anul 2010 au fost efectuate 7 transplante cardiace. Sunt prezentate complicaţiile imediate şi 

tardive înregistrate. Rezultatele obţinute şi calitatea vieţii pacienţilor operaţi justifică continu-area 

transplantării cardiace în unitatea noastră. 

Vlad Iliescu 



Marian Gaspar 


Markus Kamler 

Institutul Inimii Hilarion, Essen 

Reconstrucţia valvelor atrioventriculare - între teorie 

şi practică 

Chirurgia valvulară: progres şi realitate 

Valvular surgery, between progres and reality. 

Chirurgia minim invazivă a valvei mitrale 

ECLS in cardiogenic shock and cardiac arrest 

V. Saplacan, C. Ivascau, F. Dugenet, M. Massetti 

University Hospital of Caen, France - Spitalul Univesitar Caen, Franta 

Frequently the patients in cardiogenic shock or refractory cardiac arrest need 

mechanicals assistance like ECLS (Extra-Corporal Life Support) for having a chance of survival. 

The implant decision is a complex one and must evaluate multiple parameters like the 

gravity of the patient status, the treatments already administrated, the possibility of myocardial 

recovery, the possible of cardiac transplantation and the operating risks. 

The advantages of ECLS make of this type of mechanical assistance a first line choice for 

the treatment of ineluctable heart failure. 

We present a literature review of the results of ECLS in cardiogenic shock and cardiac 

arrest and we will discuss the results of ECLS assistance at University Hospital of Caen. 

35

ECLS in socul cardiogen si stopul circulator 

In mod frecvent, pacientii aflati in soc cardiogenic grav sau in stop cardiac refractar 

manevrelor de resuscitare au nevoie de asistenta circulatorie mecanica de tip ECLS (Extra- 

Corporal Life Support) pentru a reusi sa supravietuiasca. 

Decizia de implantare a ECLS e complexa si ia in calcul multipli parametri, precum 

gravitatea cazului, tratamentele deja administrate, posibilitatea recuperarii miocardice sau a 

transplantului cardiac precum si riscurile operatorii. 

Avantajele asistentei de tip ECLS fac din acest dispozitiv o alegere de prima intentie in 

tratamentul insuficientei cardiace refractare. 

Prezentarea noastra face o analiza a literaturii in ceea ce priveste asistenta ECLS in socul 

cardiogen si stopul cardiac refractar, asociata discutiei rezulatelor ECLS din cadrul Spitalului 

Universitar din Caen. 

Baza de date a Societăţii Europene de Chirurgie Cardio-Toracică 

Sesiunea II - Tumorile Cardiace, complicaţii ale chirurgiei cardiace 

Traian Scridon 


Tumori cardiace 

The strategies in diagnosis and surgical treatment of heart tumors 

Manolache Gh., Batrînac A., Moscalu V., Ureche A., 

Morozan V., Ţurcanu G., Barnaciuc S., Ghicavii N. 

Institute of Cardiology, Chisinau, Republic of Moldova 

Primary and secondary heart tumors can develop within any level of heart structure 

myocardium, endocardium or pericardium. 

The incidence of heart tumors is very little. It can be probably based on the peculiarities of 

metabolism within the myocardium, the coronary blood circuit and the reduced system of 

lymphatic connections. 

The objective of the work paper: The prior choice of pre-operative methods of diagnosis 

and the determination of the surgical approach depends on the localization and on the clinical 

and morphological shape of the heart neoplasm. 

Materials and methods: Records on surgical interventions in 69 patients with cardiac tumors 

subjected to treatment during 1983-2009 were analyzed. The age of patients ranged 15-73 (the 

average age was 53,2) including 20 (30%) men and 49 (70%) women. In 64 (92,8%) patients the 

tumors were benign and in 5 patients (7,2%) – malignant. 

The diagnosis and the localization of cardiac tumors are performed by the contemporary 

methods of research, EcoCG, nuclear-magnetic resonance, selective coronary angiography, 

myocardial scintigraphy. 

Displaying the same clinical symptoms as the rheumatic valve disease, primary cardiac 

tumors are characterized by a short-term evolution of the disease and by a progressive cardiac 

decompensation, refractory to medical treatment. 

Results: All the patients have been operated upon in conditions of cardio-pulmonary 

bypass with radical removal of benign cardiac tumor, simultaneously in some cases was 

performed the mitral valvuloplasty with or without tricuspid valve annuloplasty. In the case of 

malign tumors, the approach and the volume of operations varied depending on the localization, 

on the stage of the disease and on the possibilities of neoplasm-removal. The left atrial myxoma 

has been most frequently met, in 56 (81,2%) patients, rhabdomyoma - 2 cases, mesothelioma - 2 

patients, the fibroma and hemangioma respectively 1 case, leimyoma - 2 cases. The cardiac 

sarcoma has been met in 5 (7,2%) cases. The post operative lethality has constituted 8,7% (6 

cases). 63 patients were supervised during the long-term post operative period. A favorable 

evolution of all clinical symptoms has been observed, as well as the data on hemodynamics, 

determined by the use of echocardiography. The surgery has been successfully undergone in 2 

36

cases (2,9%) of tumor relapse which have been identified (1 LA myxoma and 1 RA, RV 

leiomyoma). 

Conclusions: Once identified, primary cardiac tumors must be surgically removed. 

Patients’ age and the severity of heart failure cannot be regarded as a counter-indication for 

surgery. Since malign cardiac tumors are given an unfavorable forecast, the surgical treatment is 

combined with the specific treatment including chemotherapy and X-Ray treatment for the sake 

of patient’s life prolongation. 

Rolul ecocardiografiei in diagnosticul si rezolvarea chirurgicala a tumorilor cardiace 

I. Manitiu, Gabriela Eminovici, Minodora Teodoru, 

Rodica Moga, Ruxandra Dobrin, C. Balan 

Spitalul Clinic Judetean Sibiu 

Introducere: Tumorile cardiace reprezinta o patologie rara evoluand cu manifestari 

sistemice si cardiace, in momentul cand simptomatologia devine evidenta tumora atingand 

dimensiuni importante. 

Material si metoda: Am studiat un numar de 12 cazuri diagnosticate cu tumori 

intracardiace in Clinica Cardiologie Sibiu intre anii 2000-2009, observand tipul tumorii, tabloul 

clinic, evolutia si tratamentul chirurgical urmat. 

Rezumat: Majoritatea tumorilor erau mixoame atriale solitare, intalnindu-se si un caz de 

tumora maligna. S-au studiat anumite caracteristici ecocardiografice specifice diferitelor tipuri de 

tumori, localizarea intracardiaca fiind in majoritatea cazurilor atriul stang, importanta 

diagnosticului precoce precum si a tratamentului corect chirurgical care a fost realizat in 8 

(66,66% ) cazuri cu evolutie favorabila ulterioara si aparitia complicatiilor in 4 (33,33%) cazuri. 

Concluzii: Rezolvarea chirurgicala a tumorilor cardiace este favorabila si minime 

complicatii atunci cand ea este efectuata de catre o echipa cu experienta. 

Cardiopericardic hydatid cyst with anaphylactic shock 

Lucian Stoica, Eugen Bitere, Laurenţiu Gafencu, Dumitriţa-Alina Gafencu, Grigore Tinică 

Clinica de Chirurgie Cardiovasculara, Institutul de Boli Cardiovasculare 

“Prof. Dr. George I.M. Georgescu”, Iaşi 

Cardiovascular Surgery Clinic, Cardiovascular Diseases Institute 

“Prof. Dr. George I.M. Georgescu”, Iaşi 

Of all the parasitic diseases that can affect the heart and pericardium (Trypanosoma, 

Toxoplasmosis, Schistosomiasis, Trichinosis), the echinococosis is the only one which requires 

(sometimes in emergency) surgical treatment. The cardiac and pericardial localization are very 

rare, seen in about 1-1,5% of patients with echinococcosis. 

In this paper we will present the case of a 20 year old man, with no medical history, who 

was admitted to the hospital after being resuscitaded from anaphylactic shock. 

The imagistic exams (echocardiography, CT-scan) showed multiple cystic structures inside 

the pericardium (extracardiac) with no other sites and he was transferred in emergency to 

hospital IBCV "Prof. Dr. George. I.M. Georgescu" from Iasi. The surgical procedure included total 

and partial resection of multiple hydatid cysts with extracorporeal circulation (without crossclamping). 

The pathologic exam confirmed the diagnose. 

In the postoperative period the patient began the treatment with albendazol and hepatic 

protectors. He went home 10 days after the procedure with very good status. Clinical control after 

6 mouths shows very good evolution and no recidive. 

Keywords: cardiopericardic hydatid cyst, echinococosis 

Chist hidatic cardio-pericardic manifestat prin şoc anafilactic 

Dintre parazitozele ce pot afecta cordul şi pericardul (trypanosoma, toxoplasmoza, 

malaria, schistostomiaza, trichinoza etc.), echinococoza este singura care impune, cel mai 

frecvent, tratament chirurgical (uneori de urgenţă) iar localizarea cardio-pericardică reprezintă 

doar 1-1,5% din totalul localizărilor chisturilor hidatice, cu variaţii în funcţie de statistici. 

Lucrarea are scopul de a prezenta cazul unui pacient în varsta de 20 ani, fără 

antecedente patologice semnificative, resuscitat după un şoc anafilactic, la care explorările 

37

imagistice (ecocardiografie şi CT toracoabdominal) decelează multiple formaţiuni chistice 

intrapericardice extracardiace fara alte localizari. Pacientul este transferat de urgenţă în clinica 

noastra şi se intervine chirurgical practicându-se rezecţia chiştilor pericardici multipli şi chistectomii 

parţiale sub circulaţie extracorporeală de asistare. Examenul anatomopatologic a confirmat 

diagnosticul. Postoperator se iniţiaza tratament cu albendazol şi protectoare hepatice. Pacientul 

se externează la 10 zile postoperator cu stare generală bună, controlul clinic la 6 luni aratnad 

absenta recidivelor. 

Cuvinte cheie: chist hidatic pericardic, echinococoză 

L.F. Dorobanţu, O. Stiru, A. Prodea, A. Georgescu, 

Daniela Filipescu, V.A. Iliescu 

Clinica de Chirurgie Cardiovascularã, Institutul de Boli 

Cardiovasculare "Prof. Dr. C.C. Iliescu", Bucureşti 

Caz unic de histiocitom fibros malign de ventricul 

drept cu implantare la nivelul bandeletei 

moderatoare 

Particularitati ale cazurilor de trombembolism pulmonar 

in experienta Clinicii de Cardiologie Sibiu 

Minodora Teodoru, I. Manitiu, Gabriela Eminovici, 

Rodica Moga, C. Balan, Raluca Matei, Cristina Chircu 

Spitalul Clinic Judetean Sibiu 

Introducere: Trombembolismul pulmonar reprezinta o patologie cu un tablou clinic si o 

evolutie cu mare diversitate ce necesita rezolvare terapeutica diferita si adaptata fiecarui caz. 

Materiale si metode: Au fost studiate 72 cazuri de trombembolism pulmonar internate in 

Clinica Cardiologie Sibiu in perioada anilor 2007-2009. 

Rezultate: S-au studiat prevalenta trombembolismului pulmonar in perioada mentionata, 

atitudinea terapeutica, ce a constat in tratament medicamentos in 93% (67 pacienti) cazuri, si 

chirurgical in 7% (5 pacienti) cazuri, observandu-se mai ales corelatia cu factorii prognostici. 

Concluzii: Tratamentul trombembolismului pulmonar este unul complex si presupune o 

colaborare interdisciplinara intre cardiolog si chirurg, cu evolutie favorabila atunci cand 

interventia chirurgicala este efectuata in cazuri selectate. 

Treatment of sternal dehiscence after heart operation 

38 

Reinhard Moidl 

Department of Cardiothoracic Surgery, 

University of Vienna, Vienna, Austria 

Objective: Post-sternotomy wound complications are a major cause of cardiac surgical 

morbidity, resulting in increased average hospital cost of this contingent of patients. 

It was developed a protocol for care and treatment of patients with such a complication. 

Method. From January 2000 to April 30, 2010 (10 years 4 months) were treated 34 patients 

(22 men and 12 women) with sternal dehiscence. Of them with mediastinitis clinic were 24 

patients, and no signs of infectious -10. The diagnosis was established at 5-17 days after surgery. 

The mean age was 60 years (40-71ani) 14 were obese, and only two had diabetes. Treatment is 

carried out in two stages: (1) postoperative wound early processing, including removal of metal 

sutures, with daily dressings until complete removal of infected tissue (2) Operation a) mobilizing 

the subcutaneous tissue and muscle layers separated, b) recovery the wound by applying a 

retrosternal irrigation, c) applying sternum osteosynthesis - Robiscek technique, d) application 

lavage system, e) - wound closure in layers. In acute cases of dehiscence, osteosynthesis is carried 

out urgently. 

Results: The cure rate was 98%, the stay in hospital for 14 days (range 12-16 days), with only 

one death caused by hepatorenal failure. In two patients developed sternal osteomyelitis, which 

required long-term treatment (3-6 months) 

Conclusion: Using this protocol is effective and saves the patient from using adjacent 

tissues (muscles of the abdomen, chest, or even omentum) to cure the infection, and leaves the 

patient without cosmetic consequences.

Treatment of sternal dehiscence after heart operation 

Prisacaru I., Ureche A., Turcanu G., Manolache Gh., Moscalu V., Batrinac A. 

Insitute of Cardiology, Chisinau, Republic of Moldova 

Objective: Postoperative sternal wound infection with dehiscence carries a high morbidity 

rate, resulting in increased average hospital cost of this group of patients. We developed a 

standard protocol of care to treat this complication, achieving primary closure and cure of the 

infection. 

Method: During the period of 10 years (from January 2000 to April 30, 2010), 2450 patients 

had been operated on heart and great vessels, trough a median sternotomy approach 34 (1,38%) 

of them (22 men and 12 women) with sternal dehiscence. 24 patients had a clinical manifestation 

of mediastinitis, another 10 patients had no signs of infections. The diagnosis had been established 

between 5th to 17th days after surgery. The mean age was 60 years (40-71 ages): 14 being obese, 

and only two had diabetes. Treatment entailed (1) debridement without removal of bone, (2) 

bilateral dissection of skin and subcutaneous tissue as one layer, (3) the wound recovery by 

applying a retrosternal irrigation-suction system posterior and another one anterior to the sternum, 

(4) applying sternum osteosynthesis - Robiscek technique, (5) a single-layer closure of the 

subcutaneous tissue and skin. 

Results: The rate of recovery was 98% (32/34); hospital stay was 14 days (range, 12-16 days), 

with only one death caused by hepatorenal failure. At two patients had developed sternal 

osteomelitis, which had required long-term treatment almost (3-6 months). 

Conclusion: Our protocol aims to cure the infection and to re-establish normal chest 

stability without the use of muscle or omental flaps, sparing the sternum and leaving the patient 

anatomically intact and fit for normal activities. 

Sesiunea III - Chirurgia valvei aortice 

Surgical Choices For Aortic Arch Syndrome 

Anatomia chirurgicală a rădăcinii aortei 

Horia MURESIAN 

Cardiovascular Surgery, The University Hospital of Bucharest 

Background. Severe and symptomatic stenotic-occlusive lesions of one or more arch 

vessels ask for an elaborate clinical and imagistic diagnosis and for varied but individually-applied 

surgical techniques, especially in patients having a life expectancy of 15 years or more. 

Materials and methods. The author presents his personal experience with 28 consecutive 

patients admitted for cerebrovascular insufficiency (including major stroke) and/or upper limb 

ischemia over a 4 year period. The following bypasses were used: ascending aorta-to-bilateral 

carotid artery: 4 cases; ascending aorta-to-carotid and subclavian artery: 4 cases; 

brachiocephalic trunk-to-carotid and subclavian artery: 1 case; subclavian-to-bilateral carotid 

artery: 1 case; subclavian-to-carotid artery: 3 cases; carotid-to-subclavian or axillary artery: 15 

cases. 

Results. Global mortality was 3,57%. One major hemispheric stroke occurred (3,57%). No 

postoperative cranial nerve palsies were encountered. 

Conclusions. Different surgical techniques can be applied for the treatment of the aortic 

arch syndrome. The ascending aorta represents a valuable donor vessel; alternatively, the 

brachiocephalic trunk, the subclavian or the carotid artery – can be used as well, especially in 

severely diseased patients. Doppler ultrasound examination doubled by arch and 4-vessel 

angiogram, represent the major steps in a thorough and efficient diagnostic workup. The 

complete revascularization can be contemplated even in patients with associated diseases but 

otherwise with a longer life expectancy. 

Gelu Cerin 

Cardiology Unit in Cardiac Surgery Dpt. San Gaudenzio 

Clinic, Novara, Italy 

C. Lanzilo, Marco Diena 

Cardiac Surgery Dpt. San Gaudenzio Clinic, 

Novara, Italy, Novara, Italy 

Wich patients for aortic valve repair? Role of 

Echocardiography 

Aortic valve repair – when and how to do it? 

39

Gunther Laufer 

Univ.-Klinik für Chirurgie, Klin, Viena- Austria 

Marian Gaspar, Gunther Laufer, Călin Jusca, 

Daniel Nica, Ionel Droc, Petre Deutsch 


Progres in aortic valve surgery 

“Homograft – ROSS operation, Timişoara, 

experience 1997 – 2010” 

Remplacement valvulaire aortique conventionnel chez le sujet de plus de 85 ans. 

Résultats à court et long terme à propos d’une série de 164 patients opérés. 

M. Laskar (1), C. Eveno (1), T. Bourguignon (2), A. Piccardo (3), 

L. Roussel (3), E. Bergoend (2), M. Aupart (2), E. Cornu (1), 

T. Caus (3), M. Marchand (2) 

(1) CHU Dupuytren, 87042 Limoges 

(2) Hôpital Trousseau, 37044 Tours 

(3) Hôpital Sud, 80054 Amiens 

Objectifs: Le remplacement valvulaire aortique chez le sujet très âgé bénéficie de deux 

innovations thérapeutiques importantes, la chirurgie endovalvulaire et l’apparition des valves 

« sans suture ». Pour évaluer correctement le bénéfice de ces nouvelles techniques il nous paraît 

important d’évaluer la qualité des résultats de la chirurgie conventionnelle. Dans ce but nous 

avons mené une étude rétrospective multicentrique réunissant l’expérience de trois centres de 

chirurgie cardiaque français sur les résultats à court et long terme de la chirurgie conventionnelle 

chez les sujets de plus de 85 ans. 

Matériel et méthode: Cette étude a porté sur 164 patients consécutifs opérés dans trois 

centres de chirurgie cardiaque de janvier 1987 à décembre 2009. Il s’agissait de 87 femmes (53%) 

et de 77 hommes (47%). L’âge moyen de la cohorte était de 86,5 ans avec des extrêmes de 85 à 

91 ans. L’Euroscore logistique moyen était de était de 13,5 et l’Euroscore inférieur à 10 chez 50% 

des patients, entre 10 et 20 chez 35% et supérieur à 20 chez 15%. 53 pts (32%) ont bénéficié de 

geste revascularisation coronaire associée. 

Résultats: La mortalité hospitalière a été de 9,8%. Le délai moyen de séjour en soins intensifs 

a été de 6,64 jours et le délai moyen de séjour dans le service a été de 9,74 jours. Le taux de 

survie, mortalité hospitalière incluse est de 84% à 6 mois, 79% à un an, 75% à deux ans, 62% à 4 ans 

et 52% à 5 ans. Aucun patient n’a dû être réopéré pour sa pathologie valvulaire. 

Conclusion: Le remplacement valvulaire aortique conventionnel donne un résultat 

durable au prix d’une mortalité et d’une morbidité péri-opératoire faible même chez les sujets très 

âgés. La place de chacune des techniques alternatives reste à évaluer en fonction du statut des 

patients surtout s’il s’avère que la qualité du résultat n’est pas aussi pérenne que celui de la 

chirurgie conventionnelle. 

Conventional aortic valvular replacement in patients over 85. 

Short and long term results about 164 patients. 

Objectives: New technologies such as endovlaves and sutureless valves are changing the 

perspective of aortic valve replacement in elderly patients. It seems necessary to have a good 

evaluation of the results of the conventional surgery to evaluate in the future the results of these 

technologies. The aim of this retrospective study was to collect the experience of three French 

cardiac surgery centers to evaluate the short and long term results of conventional aortic valve 

replacement in patients over 85. 

Methods: The survey collects the experience of 164 patients operated from January 1987 

to December 2009. The patients were 87 female (53%) and 77 male (47%). The mean age was 86. 

5 (from 85 to 91). The mean logistic Euroscore was 13. 5 and the Euroscore was less than 10 in 50% 

of the pts, between 10 and 20 in 35% and over 20 in 15%. 53% had an associated coronary 

revascularization. 

Results: Hospital mortality was 9,8%. The mean ICU stay was 6,64 days and the mean 

hospital stay was 9,7 days. The overall survival rate was 84% at 6 months, 79% at one year, 75% at 

two years, 62% at four years, and 52% at five years. No patient had to be reoperated for the 

valvular pathology 

Conclusion: Conventional aortic valvular replacement has a low hospital mortality and 

morbidity even in elderly patients and gives a long-lasting good result. The place of the new 

technologies has to be evaluated regarding the patient condition moreover if the result is not as 

reliable as the conventional surgery. 

40

"Functional principle" in determining the assessment criteria 

for valvular aortic reconstructive correction 

V. Moscalu, A. Batrînac, Gh. Manolache, A. Ureche, Gr. Ţurcan, 

V. Morozan, S. Barnaciuc, S. Voitov, N. Ghicavîi, Iu. Guzgan 

Institut of Cardiology, Cardiac Surgery Department, Chişinău, Republic of Moldova 

The functional approach of the aortic valve is based on better knowledge of anatomy of 

aortic valve and pathophysiology of aortic regurgitation. 

The difficulty of aortic valve plasties lies in recognizing precise lesions responsible for aortic 

regurgitation and selection of suitable operation techniques. 

Material and methods: The study group included 185 polivalvular patients, whom were 

performed reconstructive techniques of operation in the aortic position. Etiology of aortic 

pathologies was of "rheumatic, degenerative diseases, infective endocarditis and trauma”. In 

most of cases there was settled by ECO-cardiography a complex mechanism of aortic 

insufficiency. As a starting point for choosing of operation techniques was used the reconstructive 

oriented classification published by G. El. Khoury and co-authors (2009). 

Thus, in the type I lesion various annuloplasty techniques were performed; in type II – tissues 

redundancy and cusps’ prolapse was corrected through cusp plicaţion, triangular resection and 

free margin resuspension; type III was managed by comissurotomy, parietal resection of cusps. 

Results: Postoperative mortality comprised 3,2% (6 patients). Eco-cardiography has been 

stated an obvious dramatic evolution in transvalvular gradient decreasing, also significantly 

decreased the degree of aortic insufficiency after reconstructive correction. A minimal residual 

regurgitation was registered in 44 (23,8%) patients. A follow up study was managed at 5 to 10 

years postoperatively; recurrence of pathologies was detected in 19 (10,6%) cases. Eight (4,4%) 

patients required reoperaţions. Survival was 81. 6±4,8% at 10 years after aortic valve 

reconstruction, much higher compared to patients who underwent its prosthesis. 

Conclusions: Ao valve reconstructive techniques are an accepted alternative to valvular 

prosthesis. There is a series of mandatory conditions in carrying out these operations: 

� Presence of an acceptable anatomy for applying reconstructive procedures; 

� Knowledge of developmental mechanism of valvular incompetence; 

� Equipped with supplies, materials and devices specially designed for this operations; 

� Accumulation of surgical experience by a dedicated team, including a cardiologist, 

specializing in eco-cardiography and an expert surgeon, which might make surgical 

planning before entering the operating room. 

Stenoza aortica severa asimptomatica – festina lente? 

Dumitraşcu George, 

Spitalul Militar de Urgenta Sibiu 

Pacientii cu stenoza aortica severa simptomatici beneficiaza de tratament chirurgical de 

protezare valvulara. Se estimeaza ca fiecare al treilea pacient cu stenoza aortica severa este 

asimptomatic iar managementul acestuia este controversat si deseori reprezinta o provocare. La 

pacientii neselectati protezarea valvulara aortica prematura este grevata de riscul chirurgical, iar 

protezarea intarziata datorata nerecunoasterii simptomelor poate agrava prognosticul, de aceea 

estimarea riscului, a indicatiilor si momentului operator devine foarte importanta. Ecocardiografia 

reprezinta examenul standard pentru evaluarea si urmarirea pacientilor insa parametrii actuali 

folositi sunt limitati in a estima debutul simptomelor si a prognosticului clinic, aceeasi limitare 

aplicandu-se si parametrilor clinici, testelor de stress si altor metode imagistice. Aceasta lucrare 

trece in revista cele mai relevante studii clinice si ghidurile actuale pentru managementul stenozei 

aortice asimptomatice subliniind importanta identificarii pacientilor cu risc inalt. 

41

Should root replacement with aortic valve-sparing be offered to patients with severe 

aortic regurgitation or bicuspid aortic valves? 

Catalin Constantin Badiu, Walter Eichinger, Sabine Bleiziffer, Grit Hermes, 

Ina Hettich, Bernhard Voss, Robert Bauernschmitt, Rüdiger Lange 

Objective: To examine the results of root replacement with aortic valve-sparing in patients 

with bicuspid aortic valve (BAV) or severe aortic regurgitation (AR). 

Methods: Between 2000 and 2010 one hundred forty patients (mean age 47±17,5 years) 

underwent aortic valve-sparing procedures for ascending aortic aneurysm or dissection. Patients 

were assigned to three different groups according to the aortic valve pathology: BAV (n=19), 

tricuspid aortic valve (TAV) with AR < severe (n=65), and TAV with severe AR (n=56). Remodeling of 

the aortic root was performed in 29 (20. 7%) patients, reimplantation of the aortic valve in 111 

(79,3%) and a concomitant cusp repair in 59 (42%). All patients were prospectively studied with 

annual clinical assessment and echocardiography. 

Results: Overall actuarial five years survival was 97. 8±1. 5% without differences between 

the groups. Actuarial five years freedom from aortic valve related reoperation was 92. 2±3. 2% in 

all patients, 100% in patients with a BAV, 98±1,9% in patients with a TAV and AR

aorto-coronaries by-passes - 145 (mean average 3,2 per patient). In 5 cases it was used aortic 

valve prosthesis, and tricuspid annuloplasty in 4 cases. 

Results: Post operative lethality constitutes 6,5% (3 cases). As a result EchoCG showed a 

decreased grade of IMI, averagely from 2, 76, before surgery, through 1, 13 - after. In all of the 

cases was mentioned a good mobility of the valve cusps with an average transvalve gradient at 

5, 77±1, 06 mmHg. Fibrous ring diameter decreased from 37, 8±2,2 till 29, 59±1,1 mm. 

Hemodynamic effect of annuloplasty was confirmed through considerable diminishing of the 

heart cavities and with an spectacular increase of the LVEF from 39, 42±2,6% till 54, 28±3,3%. The 

relapse of mitral insufficiency was not registered during long follow-up period. 

Conclusion: Mitral valve annuloplasty with “3 sutures” is an effective and time sustainable 

procedure. Selective application of sutures on the annulus fibrosis leads to good cusps cooptation 

and removal of the tensioned cordage phenomenon, i. e. to a complex correction of valvular 

insufficiency. Its simplicity and possibility of performing through different surgical approaches 

reduces aortal clamping time. 

Dumitrasciuc G., Nica D., Feier H., Jusca C., 

Cioata D., Ionac A,. Merce A., Gaspar M. 


Aspecte ale chirurgiei valvei mitrale la pacienţii cu 

disfuncţie sistolică a ventriculului stâng 

Mitral valve surgery in patients with left ventricular 

systolic disfunction. 

Prevention of systolic anterior motion (SAM) after mitral valve repair 

V. Moscalu, A. Batrînac, Gh. Manolache, A. Ureche, N. Ghicavîi, S. Manolache, V. V. Moscalu 

Institute of Cardiology, Heart Surgery Department, Chişinău, Moldova 

Objective: The purpose of this study was to explore the geometric changes that predispose 

to left ventricular outflow (LVOT) obstruction after mitral valve repair 

Methods: Between January 2005 and December 2009 were performed 114 operations of 

mitral valve repair. Etiologies included myxomatous degeneration, endocarditis, ischemia and 

rheumatic valve disease. All the cases were assessed by Eco-cardiography the mechanism of 

mitral regurgitations, the dimensions of anterior and posterior mitral valve leaflet (AMVL and 

PMVL), the distance between the leaflet coaptation point and the annular plane, also the risk 

factors for SAM. The incidence of SAM was 2. 6% (3 cases). 

Results: We note that the patients with SAM and LVOT obstruction had the elongation 

AMVL ≥ 2,7 cm, elongated PMVL > 1,5 cm and annular dilatation > 3,8 cm. The LV diastolic volume 

ranged from 118 till 165 ml (small ventricle), in 1 case was assessed the hypertrophic septum. 

Extensive posterior leaflet resection without sliding plasty was performed in 2 cases. The size of 

implanting semirigid ring was 28, 30 mm, 1 patient received paraannular suture annuloplasty. The 

fluid challenge and inotrop withdrawal solve the SAM and LVOT obstruction in 2 cases, 1 patient 

needed reoperation. 

Conclusion: The oversized rigid ring annuloplasty in degenerative mitral insufficiency may 

cause an anterior shift of the coaptation point and increases the displacement of the redundant 

leaflet tissue in the LVOT. The resection of PMVL, sliding valvuloplasty and large ring annuloplasty 

help to minimize the risk of SAM. 

Right Coronary Artery Revascularization. Certainty and Controversy 

Grigore Tinică, Mihail Enache, Diana Ciurescu, Alexandru Ciucu, Oana Bartos, Victor Prisacari, 

Daniel Dăscălescu, Victor Diaconescu, Sânziana Patrulea, Bogdan Aparaschivei 

Cardiovascular Surgery Department, 

Cardiovascular Institute, “Prof. Dr. George I. M. Georgescu”, Iasi 

Aim: The current study is oriented towards the statistical processing and interpretation of 

the coronary artery by-pass grafting procedures in which the radial artery was used as a graft on 

the right coronary artery. 

Materials and method: We studied retrospectively all the patients undergoing a CABG 

procedure at IBCV “Prof. Dr. George I. M. Georgescu” Iasi during 2000-august 2010. Out of a total 

of 963 patients, we selected a group of 181 patients in which the radial artery was used as a graft 

for the right coronary artery. 

43

Results: In 163 (90,05%) patients there was only one graft on the right coronary artery, and 

in 18 (9,94%) patients there were two grafts on the right coronary artery (in 16 patients the radial 

artery was mounted sequentially and in 2 patients the radial artery was used alongside the right 

internal mammary artery). In our study group 12,70% of patients underwent complex surgical 

procedures (CABG concurrent with other intra- and extracardiac procedures). The overall 

mortality was 1,65%. 

Conclusions: This study reveals an ascending trend in the incidence of the CABG 

procedures that incorporate the radial artery as a graft for the right coronary artery in the period 

2000-august 2010 in our clinic. The overall mortality was 1,65%, results that are superior to those 

quoted in the reference literature. Our experience proves that the radial artery is indeed a graft 

that can be mounted successfully on the right coronary artery and therefore disputes the studies 

that disregard this arterial graft’s patency. 

Revascularizarea arterei coronare drepte. Certitudini şi controverse 

Obiective: Prezenta lucrare urmareste prelucrarea si interpretarea statistica a pacientilor 

supusi unei interventii de revascularizare miocardica chirurgicala, la care s-a utilizat artera radiala 

drept graft pentru artera coronara dreapta. 

Materiale si metode: Am realizat un studiu retrospectiv asupra tuturor pacientilor supusi 

unei interventii chirurgicale de revascularizare miocardica la IBCV Iasi in perioada 2000-august 

2010. Astfel, dintr-un total de 963, am selectat un lot de 181 de pacienti la care s-a utilizat artera 

radiala drept graft pentru artera coronara dreapta. 

Rezultate: La 163 (90.05%) de pacienti s-a montat un singur graft pe ACD, iar la 18 pacienti 

(9.94%) s-au realizat doua pontaje in sistemul coronarian drept (la 16 pacienti artera radiala a fost 

dispusa secvential, iar la 2 pacienti s-a utilizat artera radiala impreuna cu artera mamara interna 

dreapta). Din acest lot de pacienti, 12.70% au necesitat cura chirurgicala a altor patologii intra- si 

extracardiace. Mortalitatea globala inregistrata a fost de 1,65%. 

Concluzii: Incidenta utilizarii arterei radiale drept graft pentru artera coronara dreapta a 

cunoscut un trend ascendent in perioada 2000-august 2010 in clinica noastra. Mortalitatea 

globala inregistrata a fost de 1,65%, cu mult sub datele citate in literatura de specialitate. 

Experienta clinicii noastre dovedeste astfel ca artera radiala reprezinta un graft ce poate fi folosit 

cu succes la nivelul arterei coronare drepte si combate studiile ce desconsidera patenta acestui 

graft arterial. 

Acute pancreatitis after cardiac surgery: a morphologic study 

Dr. Kovacs Judit, prof. dr. Jung J., dr. Gurzu Simona, prof. dr. Azamfirei L., 

prof. dr. Copotoiu Sanda-Maria, dr. Balos S., conf. dr. Suciu H., dr. Copotoiu Ruxandra, dr. Mezei T. 

UMF Târgu Mureş, IUBCVT Târgu Mureş 

Etiology of pancreatitis is well known and although the enzymatic lesion is the key point in 

its development, pancreatic ischemia caused by hypoperfusion in cardiogenic shock is an 

important etiological factor. 

Materials and methods. We conducted a retrospective study which included patients who 

underwent cardiac surgery at IUBCVT Targu-Mures between 2004-2009, to determine the 

incidence and risk factors for acute pancreatitis. Patients with known pancreatic lesions were 

excluded. 

Results and discussion. During this period acute pancreatitis was suspected in 2 patients, 

but this was not confirmed in any of them after the clinical examination and laboratory tests. 

However, in 12 patients who underwent cardiac surgery, post mortem we found pancreatic 

necrosis. It is interesting that no patient had clinical or laboratory signs suggestive for an acute 

pancreatitis. All patients had unfavorable postoperative evolution, with hemodynamic instability, 

high doses of inotropics and developed multiple organ dysfunction and sepsis during 

hospitalization in intensive care. 

Conclusion: Acute pancreatitis is a rare complication after cardiac surgery, but if it 

develops, most often lead to patients death. The main risk factors were cardiogenic shock and 

systemic inflammatory syndrome of sepsis. 

Pancreatita acută după intervenţii chirurgicale cardiace 

44

Etiologia pancreatitei este bine cunoscută şi cu toate că leziunea enzimatică este factorul 

principal în dezvoltarea ei, ischemia pancreatică cauzată de hipoperfuzia din stările de şoc 

cardiogen este un factor cauzal important. 

Materiale şi metode. Am efectuat un studiu retrospectiv care a cuprins pacienţii operaţi 

pe cord deschis la IUBCVT Tg-Mureş în perioada 2004-2009, pentru a determina incidenţa şi factorii 

de risc ai pancreatitei acute. Au fost excluşi pacienţii cu leziuni pancreatice cunoscute. 

Rezultate şi discuţii. În această perioadă s-a ridicat suspiciunea de pancreatită acută la 2 

pacienţi, dar acesta nu a fost confirmat la nici unul dintre ei în urma examenului clinic şi 

paraclinic. Cu toate acestea, la 12 pacienţi operaţi pe cord, decedaţi şi autopsiaţi am constatat 

leziuni pancreatice necrotico-hemoragice. Este interesant, că nici un pacient nu a avut semne 

clinice sau paraclinice sugestive pentru o pancreatită acută. Toţi pacienţii au avut o evoluţie 

postoperatorie nefavorabilă, cu instabilitate hemodinamică, doze mari de inotropice şi au 

dezvoltat disfuncţie multiplă de organe şi sepsis în cursul internării în terapie intensivă. 

Concluzii: Pancreatita acută este o complicaţie rară după chirurgia cardiacă, dar dacă 

se dezvoltă, de cele mai multe ori duce la decesul pacientului. Ca factori de risc principali putem 

aminti şocul cardiogen şi sindromul inflamator generalizat din sepsis. 

An adjunctive procedure for surgical left ventricular 

remodeling using papillary muscle sling 

A. Batrînac, V. Morozan, A. Ureche, Gh. Manolache, 

S. Voitov, S. Barnaciuc, N. Ghicavîi, Iu. Guzgan, V. Moscalu 

Institute of Cardiology, Cardiac Surgery Department, Moldova, Chisinau 

Objectives: The aim of the study was to evaluate the left ventricular hemodinamic 

parameters after the remodeling of left ventricle using papillary muscle sling technique according 

to Hvass and possibility of improving mitral valve competence. 

Materials and methods: Since January 2006 to March 2010 there were done 32 cases of left 

ventricular remodeling according to Hvass technique and 1 case of right ventricle papillary 

muscle approximation in tricuspid valve insufficiency. There were 29 men and 3 women. Mean 

age of patients was 54 ± 8 (39 - 66) years old, 26 patients underwent the intervention for ischemic 

heart disease (left ventricular aneurism) and 6 - for cardiac valvulopathies of diverse etiology. 

All the patients had NYHA III-IV, pulmonary hypertension (SPRV 50–70 mmHg), mitral 

insufficiency (II-IV gr.), and dilated fibrous annulus of mitral valve (38 – 46 mm). 

To perform papillary muscle sling was used a piece of Gor-Tex 4-0 vascular prosthesis. In 26 

patients with ischemic cardiomiopathy where performed following surgical techniques: CABG + 

left ventricular aneurysmoplasty + left ventricular remodeling according to Hvass + mitral valve 

annuloplasty (12); CABG + left ventricular remodeling according to Hvass + mitral and tricuspid 

valve annuloplasty (4); CABG + left ventricular aneurysmoplasty + left ventricular remodeling 

according to Hvass (10). 

Six patients with valvular diseases underwent: Bentall operation + mitral and tricuspid 

valvuloplasty + Hvass procedure (2); mitral valve replacement + tricuspidal valve annuloplasty + 

MAZE III procedure + Hvass procedure for left ventricle (1); mitral valve replacement + tricuspid 

valvuloplasty + Hvass procedure (2); David operation + mitral and tricuspid valvuloplasty + Hvass 

procedure (1). 

Results: In all patients, which underwent left ventricular remodeling according to Hvass 

procedure, the ejection fraction increased from 39 ± 8% (mean average before the intervention) 

till 49 ± 5% after the surgery. Left ventricular diastolic volume decreased from 254 ± 81 ml prior to 

the intervention to 173 ± 40 ml after. There was obtained the regression of the mitral valve 

insufficiency up to I – II grade and the decreasing of annulus fibrosis diameter to 28, 6 mm. 

One patient developed on the 11 th day after the intervention the rupture of the posteromedial 

papillary muscle followed by an urgent reintervention – mitral valve replacement, which 

successfully was performed. 

In a patient with right ventricular remodeling through muscular pillars approximation, the 

cavity dropped to 28 mm. (prior to operation right ventricular size was 40 mm). Also was practiced 

De Vega – Cabrol annuloplasty, which allowed the complete treatment of the tricuspid valve 

regurgitation. 

In the early postoperative period one patient died due to cardiac and renal failure. 

45

Conclusions: Using of Hvass technique with the approximation of papillary muscles for left 

ventricular remodeling offers benefits by decreasing its diastolic volume, considerable 

improvement of cooptation and regression of mitral regurgitation, with increasing ejection fraction 

of the left ventricle. 

Sala Saphire 

Grupul de lucrări « CHIRURGIE VASCULARĂ » 

Rădulescu Şerban 


Medicină şi Farmacie "Iuliu Haţieganu", Cluj-Napoca, 

Chirurgie II 

Gabriel Szendro - Conferinţă 

Department of Vascular Surgery, Soroka Medical 

Center, Beer Sheva, Israel 

Sorin Băilă 

Institutul de Boli Cardiovasculare “C.C. Iliescu” 

Bucureşti 

Sesiunea V 

Chirugia vasculară – Tendinţe actuale în Romania 

Minimally invasive new technique for fem-pop bypass 

Locul endarterectomiei de artera carotidă în 

tratamentul stenozelor critice carotidiene 

simptomatice şi asimptomatice 

Aneurysm of Aberrant Right Subclavian Artery, 

Kommerell Diverticulum and Common Carotid Trunk-Single-Stage Surgical Repair without 

Cardiopulmonary Bypass 


Cardiovascular Surgery, University Hospital of Bucharest 

Background. The most common anomaly of the aortic arch and branches, is an aberrant 

right subclavian artery (ARSA) that arises from the proximal descending thoracic aorta, occurring 

in 0, 5% of the population. Mostly asymptomatic, ARSA can become symptomatic in older age 

due to atherosclerotic stiffening of the arterial walls, aneurysmal dilatation or to the presence of a 

common carotid trunk – leading to the so-called dysphagia lusoria. The aortic origin may be 

dilated in the form of the Kommerell diverticulum, contributing to a greater extent to the clinical 

symptoms. Surgical repair usually include a two-stage operation with right subclavian and 

vertebral artery reimplantation and respectively, resection of the aneurysm – the latter step being 

performed under cardiopulmonary bypass. 

Materials and methods. We present the case of a 70 years old patient admitted with 

severe dysphagia and hoarseness from left vocal cord paresis produced by the association of a 

Kommerell diverticulum, atherosclerotic aneurysm of ARSA and common carotid trunk. A singlestage 

operation without the use of cardiopulmonary bypass, through a median sternotomy was 

performed: resection of the diverticulum and ARSA aneurysm, ascending aorta-to-right subclavian 

prosthetic bypass. 

Results. The patient recovered uneventfully, being discharged on the sixth postoperative 

day without any complications and free of dysphagia. The vocal cord paresis remitted by the 

fourth week postoperatively. 

Conclusions. This is the first report of a single-stage surgical repair without the aid of 

cardiopulmonary bypass of an ARSA, Kommerell diverticulum and common carotid trunk through 

a median sternotomy approach. Various other surgical and combined procedures are critically 

analysed. 

46

Simultaneous Bilateral Carotid Endarterectomy Personal Experience In 90 Patients 



Background. Although rarely performed the simultaneous bilateral carotid endarterectomy 

(SBCE) is generally indicated for bilateral symptomatic stenosis > 70% with intraplaque 

hemorrhage, ipsilateral symptomatic stenosis > 70% with contralateral severe asymptomatic 

stenosis and plaque hemorrhage, or bilateral > 80% stenosis. 


patients with SBCE performed either as a singular procedure or combined with vertebral or 

subclavian artery revascularization. Thirty nine patients were operated under general anesthesia, 

while 51 patients under loco-regional anesthesia (double cervical plexus block) allowing for a 

safer monitoring of the patients during the procedure and for selective shunting. 

Results. Global mortality was 1,1%. One minor hemispheric one major hemispheric stroke 

occurred. No postoperative cranial nerve palsies were encountered. 

Conclusions. SBCE represents a valuable surgical alternative in selected groups of patients. 

Loco-regional anesthesia enables a more precise monitoring of the patients and facilitates the use 

of this procedure in individuals with multiple and/or severe associated diseases: diabetes, chronic 

renal failure, cardiac failure and chronic lung disease. 

The Surgery for Vertebro-Basilar Arterial Insufficiency 



Background. When compared with the carotid system arterial diseases in the vertebrobasilar 

system are more difficult to diagnose and treat. Moreover, there is no unanimous opinion 

between centers and specialists, regarding the timing of surgical treatment in the vertebro-basilar 

system and the necessary procedures to be applied. Concomitant lesions in the carotid arteries 

and their branches render the clinical picture even more protean and more difficult to interpret. 

Materials and methods. A number of 38 consecutive patients with lesions affecting either 

solely the vertebro-basilar system or with associated lesions in the carotid system were operated 

over a three-year period. The surgical techniques were multiple and generally complex – as 

required by the severity of the arterial lesions or by the clinical manifestations. The main diagnostic 

elements and the resultant surgical procedures are extensively presented. 

Results. Revascularization of the vertebro-basilar system was highly-successful in the series 

studied with no mortality and with only a minor postoperative stroke in the carotid territory. In spite 

of their complexity the surgical manoeuvres did not complicate the intra- and the postoperative 

course of the patients. Intraoperative monitorization was facilitated by the use of loco-regional 

anesthesia. 

Conclusions. The detailed diagnostic workup and a rich armamentarium of surgical 

techniques addressing the vertebro-basilar system represent necessary conditions for a proper 

and efficient approach to the patient with cerebrovascular disease. The author’s experience with 

a number of 38 cases draws attention toward this particular anatomic district, clinically 

manifesting mostly in non-characteristic ways, a system with a particular physiology, requiring 

individualized surgical indications and techniques. 



Carotid surgery: actual strategy 

How to write a paper in cardiovascular surgery 

47

Sesiunea VI 

An aggressive treatment improves midterm survival 

and amputation-free survival in CLI patients 

Francesco Spinelli, Francesco Stilo, Filippo Benedetto, Giovanni De Caridi, Michele La Spada 

Unit of Vascular Surgery, Department of Cardiovascular and Thoracic Surgery, 

University of Messina, Italy. 

Background: CLI is a serious diseases leading to 44% of limb loss in 1 year. Previous reports 

have been principally focused on patency rate and technical success. The aim of this study was 

to underline the midterm results of surgical and endovascular treatment of CLI patients in term of 

functional results and impact on survival. 

Methods: We retrospectively analyzed the clinical data of 284 consecutive patients with 

CLI, who underwent primary treatment, between February 2004 and August 2008. A total of 201 

male (average age 71,08 years) and 83 female (average age 73,15 years) underwent 340 

operations: 80 EV procedures (23,5%), 160 tibial or plantar bypass graft (47%), and 100 hybrid 

procedures (29,4%). The indications to the type of treatment have been evaluated clinically and 

by ultrasound. In 56 patients (16. 4%) the procedures were bilateral. Sixty-five percent of the 

patients were diabetic, 13% had mild renal insufficiency (serum creatinine level > 2 mg/dL), and 

15% were in ESRD. Fifty-height percent had relevant cardiovascular comorbidities. The follow-up 

was performed by clinical and echo-duplex evaluation at 1-3-6-12 months and then every 6 

months up to 5 years. We retrospectively analyzed midterm results in terms of survival and 

amputation-free survival, and valued the predictive factors on death and limb loss. 

Results: All patients were revascularized; we didn't perform any primary amputation for CLI. 

The in-hospital survival and amputation-free survival were respectively 96,1% vs. 93%. The mean 

follow-up was 22. 25 months. During the follow-up 143 addition procedures (42%) were performed 

to assist the patency in 105 limbs (30,8%). Only 5 patients (1,8%) were lost of follow-up. Ninety-one 

deaths were recorded (32,6%) and 36 limbs were amputated. Overall survival and amputationfree 

survival were 83,3% vs. 75,6%, 68,4% vs. 56,1%, 60,9% vs. 45,6% respectively at 1-, 3- and 5-years. 

The analysis showed that diabetes and dialysis are a prognostic factor for minor amputation and 

death respectively. 

Conclusion: Ev procedures and pedal bypass grafting determined good functional limb 

salvage. The final end point of these procedures in CLI patients with advanced diseases has to be 

considered the survival and not only the patency. The precise selection of treatment based both 

on clinical and on morphological evaluation of patients allowed good early results. The good 

midterm results in term of survival and amputation-free survival were due to a strict follow-up that 

determined multiple procedures of assistance. The aggressive and well-timed use of this two 

therapeutical options on CLI patients was the key point of this experience. 

Standard of Care for Popliteal Artery Aneurysm 

Marina Pacescu, SL Baila, DF Barzoi, R Halpern, Madalina Gavanescu 

Departement of Vascular Surgery, 

“C. C. Iliescu” Emergency Institute of Cardiovascular Disease, Bucharest, Romania 

Popliteal artery aneurysms are the most common peripheral aneurysms. The aim of this 

study is to compare the standard of care in vascular patients with popliteal aneurysms between 

two periods: 1980-2004 (PI) and 2004 – 2009 (PII). 

Material and method: All file records of patients with popliteal aneurysm treated in our 

Clinic between 1980 and 2009 were retrospectively analyzed. 

Results: 26 patients (22 males and 4 females) with 26 popliteal aneurysms were in PI (1,04 

patients / year), and 15 patients (all males) with 17 politeal aneurysm were treated in PII (3 

patients / year). Mean age was 53 and 65. 8 in PI and PII respectively. All treated popliteal 

aneurysms had a diameter above 2,5 cm. 

0% (PI) and 6% (PII) of patients were asymtomatic, 19% (PI) and 35% (PII) were claudicants, 

27% (PI) and 35% (PII) had chronic rest pain, 0% (PI) and 18% (PII) had distal necrosis. 19% (PI) and 

0% (PII) of popliteal aneurysms were ruptured. 

48

All patients had digital substraction angiography. 46% (PI) and 18% (PII) had CT, 29% (PI) 

and 27% (PII) had MRI and 0% (PI) and 65% (PII) had Duplex echography. 

The procedure of choice was bypass of the aneurysm with vein or prosthetic graft 

associated by exclusion of aneurysm by proximal and distal ligature (50% (PI) and 71% (PII)), 

complete resection of aneurysm (19% (PI) and 12% (PII)), or partial resection of aneurysm with 

endo-suture of collaterals (23% (PI) and 6% (PII)). 

Distal thrombolysis for thrombosis of distal arterial trunks was performed in 3 cases (PI) with 

one good result. Distal thrombectomy was performed in 15% of cases (PI) and 29% of cases (PII). 

Primary amputation for irreversible ischemia was performed in 2 cases (8%) (PI). 

Secondary amputation after bypass thrombosis was performed in 3 cases (12%) (PI). 

Limb salvage was 81% in PI and 100% in PII. 

Conclusion: Early detection and open repair of popliteal aneurysms can be done with 

good results. 

Aprecieri asupra rolul adipocitokinelor ”cheie” în iniţierea şi progresia leziunilor 

ateromatoase din afectiunile vasculare periferice 

Claudia Gherman 1, H. Silaghi 1, Anca Cristea 2, B. Olaru 1, 

F. Deme 1, A. Oprea 1, S. Rădulescu 1, A. Mironiuc 1 

1 Clinica Chirurgie II, 2Clinica Medicală I, U. M. F. “Iuliu Hatieganu" Cluj-Napoca 

Introducere. Arteriopatia cronică obliterantă a membrelor inferioare constituie un domeniu 

cu răspândire largă dar putin studiat, comparativ cu afectiunile cardio-metabolice. 

Ipoteza de cercetare. Scopul studiului l-a constituit extinderea caracteristicilor clinice la 

pacientii cu arteriopatie cronica obliteranta de natură aterosclerotică prin posibila determinare 

de noi markeri ai aterogenezei. 

Material si metoda. S-a luat in studiu un lot de 85 de pacienţi cu arteriopatie cronică 

obliterantă ateroscleotică a membrelor inferioare care au fost internati si tratati în Clinica 

Chirurgie II Cluj-Napoca şi un lot martor de un număr egal de pacienţi sănătoşi. Evaluarea 

factorilor de risc a fost facută întrebuinţând metodele anamnestice şi examinările paraclinice. 

Factorilor de risc tradiţionali enunţaţi li s-au adăugat aprecieri ale nivelurilor serice ale rezistinei, 

adiponectinei, leptinei si α-TNF. 

Rezultate. In urma studiului efectuat s-a constatat diferenţă distinct semnificativă în ceea 

ce priveşte valoarea adiponectinei la arteriopaţi comparativ cu lotul martor. Diferenţă 

semnificativ statistic în ceea ce priveşte valoarea rezistinei s-a constatat pe loturile luate in studiu – 

media la arteriopaţi fiind distinct semnificativ mai mare decât media coronarienilor fumători. TNFα, 

citokină inflamatorie eliberată în cantităţi mari la pacienţii obezi sau diabetici, are rol în iniţierea 

şi propagarea leziunilor aterosclerotice, dar nu a suferit variatii semnificative in studiul nostru. 

Concluzii. Corelând datele studiului nostru am putea trage concluzia conform căreia unii 

dintre parametrii urmăriţi pot fi corelaţi cu severitatea leziunilor din arteriopatia aterosclerotică. 

Dacă acest lucru se confirmă, aceşti factori pot fi eventual consideraţi ca posibili factori 

predictivi, care deschid noi perspective de cercetare în domeniu. 

Aportul genomicii in studiul implicarii unor gene in afectiunile arteriale periferice 

Claudia Gherman 1, Ioana Constantinescu1, B. Stancu 1, B. Olaru 1, F. Deme 1, A. Eni 1, S. 

Rădulescu 1, A. Mironiuc 1, D. Pamfil 2, Ioana Petricele 2, Iulia Pop 2 

1 Clinica Chirurgie II, U. M. F. “Iuliu Ha ieganu" Cluj-Napoca, 

2 Platforma de Biotehnologie, USAMV Cluj-Napoca 

Introducere. Elucidarea importanţei geneticii moleculare în procesul aterosclerotic 

reprezintă o sarcină importantă aflată încă în stadiu incipient. 

Ipoteza de cercetare. Gena adiponectinei umane, cunoscută şi sub denumirile: ACDC; 

ADPN; APM1; APM-1; GBP28; ACRP30; adiponectin; ADIPOQ, este localizată pe cromozomul 3q27, 

la un locus cu susceptibilitate pentru sindromul metabolic şi diabetul de tip 2. Nivelele plasmatice 

ale adiponectinei s-au dovedit a fi scăzute în cazul diabetului de tip 2 şi a obezităţii, iar studii mai 

recente o implica si in ateroscleroza cu diferitele sale localizari. Aceste argumente ne-au 

determinat sa intreprindem studiul de fata. 

49

Material si metoda Pentru a genotipiza cei 65 de pacienţi cu afectiuni arteriale periferice 

de natura aterosclerotica ai lotului luat in studiu, pe lângă metoda bazată pe secvenţierea ADNului 

de interes, s-a utilizat şi metoda PCR-RFLP, aceasta prezentând costuri mai scăzute şi o uşurinţă 

mai mare de realizare. Pentru a fi validată metoda PCR-RFLP, rezultatele acesteia au fost 

comparate cu cele obţinute în urma secvenţierii probelor. 

Rezultate. Analizele de tip BLASTN au confirmat faptul că secventa produsului PCR 

corespunde cu secventa ADN identificată în banca de gene a NCBI. Analizarea 

cromatogramelor a permis identificarea unui singur polimorfism în poziţia 156, corespunzător 

rs1501299, respectiv în poziţia 7448975 a ADN genomic al ADIPOQ NC_000003. 10. 

Concluzii. Datele obtinute confirmă că strategia experimentală aplicată pentru 

identificarea polimorfismelor la nivelul genei adiponectinei umane este corectă si permite 

evidentierea cu o precizie ridicată a tuturor modificărilor la nivel de secventă nucleotidică. 

Management of critical limb ischemia 

I. Droc, Florina Pinte, Francisca Blanca Calinescu, St. Deaconu, Nita A., Dumitrascu M., Popovici A. 

Army’s Center for Cardiovascular Diseases Bucharest 

Critical ischemia of the lower limbs represent the most severe form in the evolution of the 

lower limb atherosclerotic disease. The viability of the limb is threatened by the high risk of major 

amputation, around 25% per year. The general prognosis of the patient is also compromised. 

The preoperative evaluation resides in Echo Doppler, Angio MRI scanner and more less in 

arteriography. 

Surgical treatment remains the classical gold standard, but endoluminal treatment gains 

terrain, becoming the first choice in certain localizations (for ex. iliac). There are also situations 

when neither procedure can be applied, or they have both failed. Medical therapies, such as 

prostanoids, gene and cell therapy should not be forgotten. 

In our institution between January 2007 and May 2009, we operated on 164 patients 

(femuro-popliteo-tibial revascularization) of which 71% (130 patients) underwent classic open 

surgical intervention and 21% (34 patients) endovascular intervention. 

Regarding the distal anasthomosis we used preformed PTFE prostheses (Distaflo- 

IMPRA/Bard) in 5 cases and the Miller cuff in 2 cases. 

The follow-up was between 1 and 24 months with an average of 12 months. 

Primary permeability in patients with “cuff” or distaflo was 96% in the first month and 92% at 

6 months. 

In conclusion, endovascular treatment, when it is feasible can be regarded as first-choice 

treatment for patients with multiple lesions, or for those who present high risk for surgery. 

S. Rădulescu, A. Zanfir, C Gherman 



Complicaţii postoperatorii în chirurgia convenţională a 

bolii varicoase. 

Postoperative complications in the conventional 

surgery of varicose vein disease 

Cardiovascular Underlying Pathology And Early Results In Surgical Arterial 

Thromboembolectomy For Upper Limb Acute Ischemia – 10 Years Experience 

Patologia cardiovasculară asociată şi rezultatele imediate în trombembolectomia arterială 

chirugicală pentru ischemia acută a membrului superior – 10 ani de experienţă. 

NJ Tesoiu, Marina Pacescu, SL Baila, DF Barzoi, I Diaconescu, F Cosa, R Halpern, Isabella Oprea, 

Mirela Marcu, Adina Stoica, M Croitoru, Daniela Mitcov 

Institute for Emergencies in Cardiovascular Diseases “Prof. Dr. CC Iliescu”, Bucharest, Romania 

Background: Fogarty balloon catheter surgical treatment is the most common used in 

upper limb arterial thromboembolic acute ischemia. The presence of cardiovascular underlying 

pathology is the major cause of postoperative complications and deaths. Re-operations as well as 

local complications are relatively important events in these patients. Upper limb thromboembolism 

should be considered as one manifestation of a systemic embolism and as imposing severe 

anticoagulant therapy. 

50

Objectives: To present the cardiovascular underlying pathology and the early results in 

patients with surgical upper limb arterial thromboembolectomy performed in emergency in the 

same location within a 10 years period of time. 

Material and Methods: Retrospective study of the operative files of 250 consecutive 

patients operated between January the 1-st 1998 and December the 31-st 2007 regarding 

cardiovascular pathologic circumstances in which acute upper limb ischemia caused by arterial 

thromboembolism appeared and the early postoperative results. 

Results: There were 142 women (median age 71 years, limits 23-90 years) and 108 men (median 

age 70 years, limits 42-92 years). Cardiovascular pathologic circumstances were represented by 

atrial fibrillation – 132 cases, coronary artery disease – 52 cases, cardiac valvulopathy – 28 cases, 

conduction disturbances – 13 cases, stroke sequels – 28 cases, systemic hypertension – 75 cases, 

cor pulmonale – 8 cases, diabetes mellitus – 16 cases, aortic dissecting aneurysm – 1 case. Very 

good results were obtained in 222 cases. Re-operation for re-embolisation in the same or different 

territory (26 cases) and for local complications (2 cases) resulted in limb preservation in 22 cases; 

five major amputations (arm and forearm) were imposed and one patient died. 

Conclusions: Upper limb acute ischemia caused by arterial thromboembolism arrived 

more often in women than in men, in elderly and with serious cardiovascular underlying pathology 

requiring adequate therapy patients. Very good early results were obtained in 89% of the cases. 

Re-operations resulted in limb salvation in 78% of the cases. Survival rate was 97%. 

Keywords: Cardiovascular pathology, Surgical thromboembolectomy, Upper limb acute ischemia 

Patologia cardiovasculară asociată şi rezultatele imediate în trombembolectomia arterială 

chirugicală pentru ischemia acută a membrului superior – 10 ani de experienţă. 

Premize: Tratamentul chirurgical cu sonda cu balon descrisa de Fogarty este cel mai 

utilizat in ischemia acuta tromboembolica arteriala a membrului superior. Prezenta patologiei 

asociate cardiovasculare constituie cauza majora a complicatiilor postoperatorii si deceselor. 

Reinterventiile si complicatiile locale sunt evenimente relative importante la acesti pacienti. 

Tromboembolismul membrului superior ar trebui considerat ca o manifestare a embolismului 

sistemic si ca impunand tratament anticoagulant sever. 

Obiective: Prezentarea patologiei cardiovasculare asociate si rezultatelor imediate la 

pacientii cu tromboembolectomie arteriala la membrul superior efectuata in urgenta in acelasi 

serviciu intr-o perioada de timp de 10 ani. 

Material si metoda: Studiu retrospective asupra fiselor operatorii pentru 250 pacienti 

consecutivi operati intre 1 ianuarie 1998 si 31 decembrie 2007 in ceea ce priveste circumstantele 

patologice cardiovasculare in care apare ischemia acuta a membrului superior prin 

tromboembolism arterial si rezultatele postoperatorii imediate. 

Rezultate: Au fost operati 142 femei (varsta medie 71 ani, limite 23-90 ani) si 108 barbati 

(varsta medie 70 ani, limite 42-92 ani). Circumstantele patologice cardiovasculare au fost 

reprezentate de fibrilatia atriala – 132 cazuri, boala arteriala coronariana – 52 cazuri, valvulopatia 

cardiaca – 28 cazuri, tulburarile de conducere – 13 cazuri, sechelele atacului cerebral – 28 cazuri, 

hipertensiunea arteriala – 75 cazuri, cordul pulmonar – 8 cazuri, diabetul zaharat – 16 cazuri si 

anevrismul disecant de aorta – 1 caz. Rezultate foarte bune au fost obtinute in 222 cazuri. 

Reinterventia pentru reembolizare in acelasi teritoriu sau un altul (26 cazuri) si pentru complicatii 

locale (2 cazuri) a condus la salvarea membrului in 22 cazuri; s-au impus 5 amputatii majore (brat 

si antebrat) si un pacient a decedat. 

Concluzii: Ischemia acuta a membrului superior provocata de tromboembolism arterial a aparut 

mai ales la femei fata de barbati si la pacienti varstnici si cu patologie cardiovasculara grava 

asociata. Rezultate foarte bune au fost obtinute in 89% dintre cazuri. Reinterventia a dus la 

salvarea membrului in 78% dintre cazuri. Rata de supravietuire a fost 97%. 

Cuvinte cheie: Patologie cardiovasculara, Tromboembolectomie chirurgicala, Ischemie acuta a 

membrului superior. 

51

Surgery Summer School Might Raise Medical Students Interest In Cardiovascular Surgery 

Educarea interesului pentru chirurgia cardiovasculară la studenţii medicinişti la şcoala de vară 

Grigore Tinica 1, Andrei Dumbrava 2, Diana Ciurescu 2, 

Mihail Enache 1, Vasile Cepoi 3, Vasile Astarastoae 1 

1Univesity of Medicine and Pharmacy "Gr. T. Popa" Iasi, Romania 

2Cardiovascular Institute, Iasi, Romania 

3Clinical and Experimental Cardiovascular Research Foundation 

Objectives. A decline in applicants to Cardiovascular Surgery Training Programs has been 

observed in the late years, in European countries (e. g., Gott et al., 2006). Consequently, increased 

efforts in recruiting trainees toward the field are required. In the present study, we tested the 

hypothesis that organizing international student groups in the summer break for mentored 

instructions in cardiovascular department and operating room will enhance the interest of junior 

medical students for cardiovascular surgery. 

Materials-methods. The participants, medical students interested in surgery from different 

countries (USA, Canada, UK, Portugal, France, Netherlands, Germany, Italy, Malta, Slovenia, 

Serbia, Macedonia, Kosovo, Egypt) received mentored training for two weeks, in a department of 

cardiovascular surgery with state of the art technology. It consisted from an initial lecture 

presented by an experienced cardiovascular surgeon, followed by practical simulations in the 

“vet lab” (consisting of mentored dissections and practicing surgical suture using hearts and great 

vessels from pigs and cows) and by participation, as direct observers, in the operating room. Their 

perception and interest regarding the cardiovascular surgery have been assessed by 

questionnaire, before and after the summer school. 

Results. Sixtythree medical students participated in summer schools in the last years. 

Initially, most of them (77. 3%) were interested in pursuing a career in surgery, majority (72. 7%) 

being neutral regarding a preference for a career in cardiovascular surgery (only 3 students [4, 

75%] were determined to choose cardiovascular surgery as their specialization). At the end of the 

summer school, more than a half (57%) of them agreed or strongly agreed to a career in 

cardiovascular surgery (p < 0. 001). When asked to select an eventual optional course for the 

following year, less than a third (31, 3%) of the students selected cardiovascular surgery before 

summer school versus almost two thirds (61, 4%) at the end of it (p < 0. 001). 

Discussion. It is critical to expose medical students to cardiovascular surgery early, in their 

preclinical years, if we want them to choose a career in this field. Our program, similar (despite 

being shorter) to that of the Johns Hopkins Medical School from Baltimore, Maryland (Allen et al., 

2009) offered them a broad spectrum of what cardiac surgery is all about. In our opinion, this kind 

of program, aimed to attracting medical students through operative skills training proved to be 

successful in encouraging students to pursue a cardiovascular residency. 

Conclusions. The surgery summer school and the introduction of students to the reality of 

an operating theatre and the procedures used during cardiovascular surgery have proved to be 

an effective way of attracting medical students to cardiovascular specialty. Participating in the 

international surgery summer school improves attitudes towards cardiovascular surgery as a 

career choice and correlates with a greater interest in selecting an optional cardiovascular 

surgery course for the following year of study in the university. 

The Romanian Society of Cardiovascular Surgery should organize, with the help of its 

members, student groups for summer courses in different centers to promote the cardiovascular 

surgery specialty among the students. 

References 

1. J. G. Allen, E. S. Weiss, N. D. Patel, D. E. Alejo, T. P. Fitton, J. A. Williams, C. J. Barreiro, L. U. Nwakanma, S. C. 

Yang, D. E. Cameron. Inspiring Medical Students to Pursue Surgical Careers: Outcomes From Our Cardiothoracic 

Surgery Research Program, Ann Thorac Surg, 2009; 87 (6): 1816 - 1819. 

2. Gott VL, Patel ND, Yang SC, Baumgartner WA. Attracting outstanding students (premedical and medical) to a 

career in cardiothoracic surgery, Ann Thorac Surg 2006: 82: 1-3 

Obiective: În ultimii ani, s-a observat o scădere a numărului de aplicanţi pentru 

programele de instruire în chirurgia cardiovasculară, în ţările europene (e.g., Gott et al., 2006), 

astfel că sunt necesare eforturi sporite în atragerea stagiarilor către acest domeniu. În studiul de 

faţă, am verificat ipoteza că organizarea de grupuri studenţeşti internaţionale, în cursul 

vacanţelor de vară, pentru training în laboratorul de chirurgie (“vet lab”) şi în sala de operaţie 

cardiovasculară, ar putea spori interesul studenţilor medicinişti pentru chirurgia cardiovasculară. 

52

Materiale şi metode. Participanţii, studenţi la medicină interesaţi de domeniul chirurgical, 

din diferite ţări (SUA, Canada, Marea Britanie, Portugalia, Franţa, Olanda, Germania, Italia, Malta, 

Slovenia, Serbia, Macedonia, Kosovo, Egipt), au primit training supravegheat, cu o durată de 

două săptămâni, într-un departament de chirurgie cardiovasculară cu tehnologie de ultimă oră. 

Acesta a constat dintr-un curs iniţial introductiv, ţinut de către un chirurg cardiovascular cu 

experienţă, urmat de simulări practice în “vet lab” (disecţii îndrumate şi exersarea suturii 

chirurgicale, utilizând inimi şi vase mari de porc şi vacă) şi de participarea, în calitate de 

observatori direcţi, la intervenţiile chirurgicale cardiovasculare curente. Percepţia şi interesul 

privitoare la chirurgia cardiovasculară au fost evaluate prin metoda chestionarului, înaintea şi la 

finalul şcolii de vară. 

Rezultate. Şaizeci şi trei de studenţi la medicină au participat la şcolile de vară în ultimii ani. 

Iniţial, cei mai mulţi (77,3%) erau interesaţi în a continua o carieră în chirurgie, majoritatea (72,7%) 

declarându-se neutri în ceea ce priveşte alegerea preferenţială a chirurgiei cardiovasculare 

(doar 3 studenţi [4,75%] se declarau hotărâţi în a o alege drept specializare). La sfârşitul şcolii de 

vară, mai mult de jumătate (57%) dintre studenţi se declarau de acord sau puternic de acord cu 

alegerea unei cariere în chirurgie cardiovasculară (p < 0,001). Rugaţi să-şi selecteze un curs 

opţional pentru anul următor, mai puţin de o treime (31,3%) dintre studenţi au ales chirurgia 

cardiovasculară înaintea începerii şcolii de vară, comparativ cu aproape două treimi (61,4%) 

după terminarea acesteia (p < 0,001). 

Discuţii. Este esenţial a atrage studenţii la medicină către chirurgia cardiovasculară, în anii 

lor preclinici, dacă se urmăreşte îndrumarea opţiunii lor către o carieră în acest domeniu. 

Programul nostru, similar (deşi mai scurt) celui de la Şcoala de Medicină Johns Hopkins din 

Baltimore Maryland (Allen et al., 2009), le-a oferit un spectru larg despre ce înseamnă chirurgia 

cardiacă. În opinia noastră, acest tip de program, care are drept scop atragerea studenţilor la 

medicină, prin formarea competenţelor chirurgicale s-a dovedit a fi de succes în încurajarea 

studenţilor de a urma un rezidenţiat în chirurgia cardiovasculară 

Concluzii. Şcoala de Vară de chirurgie cardiovasculară şi introducerea studenţilor în 

realitatea unei săli de operaţie cardiovasculară şi a procedurilor folosite în timpul intervenţiei 

chirurgicale cardiovasculare pare a se dovedi o modalitate eficientă de atragere a studenţilor 

medicinişti către această specialitate. Participarea la şcoala de vară internaţională de chirurgie 

îmbunătăţeşte atitudinea faţă de chirurgia cardiovasculară în alegerea unei cariere şi se 

corelează cu un interes crescut în optarea pentru un curs facultativ de chirurgie cardiovasculară 

în cadrului anului următor de studiu în universitate. Societatea Romană de Chirurgie 

Cardiovasculară ar putea să organizeze, cu ajutorul membrilor săi, grupuri de studenţi pentru 

cursuri de vară în diferite ţări pentru a promova specialitatea chirurgiei cardiovasculare în rândul 

acestora 

BIBLIOGRAFIE 

1. J. G. Allen, E. S. Weiss, N. D. Patel, D. E. Alejo, T. P. Fitton, J. A. Williams, C. J. Barreiro, L. U. Nwakanma, S. C. 

Yang, D. E. Cameron, et al. Inspiring Medical Students to Pursue Surgical Careers: Outcomes From Our 

Cardiothoracic Surgery Research Program. Ann Thorac Surg, 2009; 87(6): 1816 - 1819. 

2. Gott VL, Patel ND, Yang SC, Baumgartner WA. Attracting outstanding students (premedical and medical) to a 

career in cardiothoracic surgery. Ann Thorac Surg, 2006;82:1-3 

The use of aortic iliac endovascular prosthesis for infrarenal abdominal aortic aneurysm 

D. Trandafir, Silvia Condu, R. Nechifor*, B. Dorobat*, Cristina Tudor**, Ana Filimon 

Department of Cardiovascular Surgery, *Department of Radiology, 

**Department of Anesthesiology University Hospital of Bucharest 

The abdominal aortic aneurysm usually present frequent in elderly patients with serious 

cardiovascular comorbidities that pose a great challenge to the attending surgeon. Surgical 

repair involve major risks for this patients. 

We report a case of a 63 years old patient where we choose elective endovascular repair. 

The patient associate comorbidities such as major surgical abdominal interventions, smoking, 

obesity, hypertension, hiperlipemy 

It was performed the implantation of the aortic iliac Gore Excluder endovascular prosthesis 

with iliac extension with both femoral arteries surgical abort, under peridural anesthesia. 

The patient received 2 units of blood transfused and 2 units of fresh frozen plasma. 

The average hospitalization time was 7 days. 

53

The intervention was a success, the abdominal aortic aneurysm was repaired without 

endoleak, surgical incidents with well vascularisated legs with peripheral pulses in all the elations 

points. 

Simpozion Vasaprostan 

Sesiunea VII 


Open Surgery versus endovascular treatment for abdominal aortic aneurysms 

Chirurgie clasică versus endovasculară în tratamentul anevrismului de aortă abdominală. 

I. Droc, Pinte Fl, Cristian G, Dumitrascu M., Deaconu St., Calinescu F, Murgu V. 

Army, s Center for cardiovascular diseases, Bucharest, Romania 

Endovascular abdominal aortic aneurysm repair (EVAR) was introduced by Parodi in 1991, 

and since then, the technique has gained popularity due to the significant advantages over open 

repair. Several large randomized, controlled, multicentre trials (EVAR1, DREAM) have reported a 

reduction in morbidity and mortality associated with EVAR. Two recent studies have specifically 

examined the results of AAA repair in high risk cohorts. Sicard et al. (2006) reported a mortality rate 

of 2,9% for EVAR and 5,1% for open repair. Bush et al. (2007) found the EVAR mortality rate to be 

3,4% compared to 5,2% in the open group. 

Our study examined the outcomes of patients with AAA undergoing EVAR in terms of AAA 

related mortality, complication rate and reintervention rate, in order to inform the ongoing 

management debate. 

In our department, between july 2008 and dec. 2009, 11 patients undervent EVAR for AAA, 

under epidural anaesthesia. We used different types of endografts (Anaconda-1p, Medtronic 

Talent -3p, Powerlink-7p). The mean hospitalisation time was 3 days. The follow up was done by CTscan 

in paralel with dopler ultrasound at 1, 3, 6 months and at 1year postop. No endoleaks or 

infection on postop. 

Trusting the inevitable progress of newer technology we believe that, in the future, the 

great majority of AAAs will be treated via EVAR. The devices will continue to improve, as it will 

deployment techniques. For now until greater device durability is established EVAR remains an 

imperfect long-term treatment and requires regular life-long graft surveillance, and it should be 

limited to those with large AAAs and „suitable anatomy”, specifically those who prezent high risk 

for open repair. 

Daniel Nica, M. Gaşpar, P. Deutsch, D. Cioata, 

C. Juşca, G. Dumitraşciuc, H. Feier, A. Merce, A. 

Ionescu 

Institutul de Boli Cardiovasculare Timişoara, Clinica de 

Chirurgie Cardiovasculară II 

Surgical approach of abdominal aortic aneurysms: 

clinical experience ian 2003- dec 2009 

Surgical Approach of Abdominal Aortic Aneurysms Clinical Experience, 

Jan 2003 – dec 2009 

D. Nica, M. Gaspar, P. Deutsch, D. Cioata, C. Jusca, 

G. Dumitrasciuc, H. Feier, A. Merce, A Ionescu. 

Timisoara Cardiovascular Medicine Institute, cardiovascular Surgery Department II 

Objectives: to analyse the results of surgical approach in abdominal aortic aneurysms 

showing the importance of different therapeutic strategies dependig on elective or emergency 

caracter of the cases. 

Methods: retrospective study including patients from Cardiovascular Surgery Department II 

of Timisoara Cardiovascular Diseases Institute operated between january 2003 – december 2009, 

based upon the analysis of epidemiological, clinical and surgical data from the medical files. We 

analized 60 cases (5,08%) of abdominal aortic aneurysm, from which 57 with infrarenal aneurysm 

and 3 with toraco-abdominal aneurysm. There were 20 emergency cases (33,3%) and 40 elective 

cases (66,6%), diagnosed using abdominal ecography 41,6%, abdominal-CT, 28,3%, 

54

angiocoronarography, 66,6%, multislice 64-CT, 33,3%, angio-MRI, 3,33%. Demografic data revealed 

gender male predominance (90%), and in ptients over 60 years old (81,6%). Associated morbidity 

was chronic ischemic heart disease (50%), peripheral arterial disease (25%), arterial hypertension 

(66,6%), dyslipidemia (50%). 

Results: Complex medical and surgical therapy, reprezented by emergency operation 

(30%) and elective operation 70%, surgical tehnique used was aneurysm rezection and restoring 

the arterial flow by interposition of tubular prosthesis (43,3%), or by-pass aorto-bbifemural (56,6%). 

The evolution was favorable in most cases (85%), but in emergency operations evolution was 

unfavorable (15%), with complications such as lower limb ischemia (1,66%), retroperitoneal 

bleading (3,33%), upper gastrointestinal bleading (3,33%), cerebral stroke (1,66%), multiple sitems 

and organs failure (1,66%), leading to an overall mortality of (10%). 

Conclusions: Aortic abdominal aneurysms predominantly affects male patients over 60 

years of age, reprezenting a redoubtable cardiovascular pathology. While elective operated 

cases, even with asociated pathology, have good results with favorable postoperative evolution, 

emergency operated cases for ruptured aneurysms presents severe evolution with still high 

mortality rate. 

Abordarea chirurgicală a anevrismelor de aortă abdominală: experienţa clinică ian. 2003- dec. 2009. 

Obiective: Analiza rezultatelor tratamentului chirurgical al anevrismelor de aorta 

abdominala cu importanta diferentierii strategiei terapeutice in functie de caracterul electiv sau 

de urgenta al cazului. 

Material şi metodă: Studiu retrospectiv cuprinzând pacienţi operaţi in Clinica de Chirurgie 

Cardio-Vasculară II a IBCV Timişoara în perioada ianuarie 2003 – decembrie 2009 şi realizat prin 

analiza aspectelor epidemiologice, clinice, chirurgicale din baza de date. Din 4889 de interventii 

chirurgicale, au fost 1181 (24%) de operatii vasculare din care am analizat 60 de cazuri cu 

anevrism de aorta abdominala (5,08%), din care 57 (95%) cu anevrism de aorta abdominala 

infrarenala şi 3 (5%) cazuri cu anevrism de aorta toraco-abdominala, evidentiate prin ecografie 

abdominala – 25 cazuri (41,6%), CT abdominal – 17 cazuri (28,3%), angiocoronarografie – 40 cazuri 

(66,6%), angio-CT- „64-slice” – 20 cazuri (33,3%), angio-RMN – 2 cazuri (3,33%). Au fost 20 de cazuri 

(33,3%) prezentate in urgenta, iar 40 cazuri (66,6%) reglate. Datele demografice indica 

predominenta clara la bărbaţi 54 (90%) şi la pacienţi cu vârsta peste 60 de ani 49 (81,6%). 

Diagnosticul imagistic: Morbiditatea asociata a fost: cardiopatie ischemica cronica – 30 cazuri 

(50%), arteriopatie cronica obliteranta periferica – 15 cazuri (25%), HTA – 40 cazuri (66,6%), 

dislipidemie – 30 cazuri (50%). 

Rezultate: Tatamentul complex, medical si chirurgical: interventia chirurgicala efectuata 

de urgenta - 18 cazuri (30%), si reglata 42 cazuri (70%), reprezentata de rezectia anevrismului cu 

refacerea fluxului arterial prin interpozitie de proteza tubulara – 26 cazuri (43,3%), sau prin by-pass 

aorto-bifemural – 34 cazuri (56,6%). Evolutia favorabila in 51 cazuri (85%), nefavorabila 9 cazuri 

(15%) – din care 8 cazuri la operatiile de urgenta, complicatiile severe fiind hemoragie 

retroperitoneala, HDS, AVC, IRA, MSOF, ischemie periferica, determinand o mortalitate de 10% (6 

cazuri). 

Concluzii: Anevrismele aortei abdominale afecteaza predominant barbatii peste 60 ani, 

reprezintand o patologie cardiovasculara redutabila. Cazurile operate electiv, chiar cu patologie 

asociata, au rezultate bune cu evolutie favorabila, insa cazurile de anevrism rupt operate in 

urgenta, au evolutie nefavorabila, cu o mortalitate inca mare. 

Sesiunea VIII 

Endovascular procedures for abdominal aorta false aneurysms 

Tratamentul endovascular în pseudoanevrismele aortei abdominale 

Silaghi H 1, Magnan PE 2, Branchereau A 2, Gherman C 1, Mironiuc A 1 

1 2 nd Surgical Clinic, U. M. Ph. “Iuliu Haţieganu”, Cluj-Napoca 

2 Service de Chirurgie Vasculaire, Hôpital Timone, Marseille, France 

Introduction: Anastomotic false aneurysms are rare but severe complications after 

reconstructive surgery of the abdominal aorta, leading mainly to ruptures and aorto-enteric fistula. 

FAAA represent a formal surgery indication, being associated to high mortality risk. Endovascular 

55

false aneurysm repair (EVFAR) avoids recurrent approach and aortic clamping, representing a 

low-risk alternative for open surgery that records eloquent mortality, ranging 8-28%. 

Method: 15 patients (15 men) were submitted to EVFAR between March 2001-October 

2005. A former Dacron graft was used for aortic reconstruction in all cases. Mean age was 72 

years (ranging 54-85) and mean delay between former surgery and FAAA detection was 15 years 

(ranging 9-20). 11 patients out of 15 were asymptomatic. Mean FAAA diameter was 59 mm (43-70 

mm). In 11 patients, we used aorto-uniiliac degressive stent-grafts associated to a cross-over 

bypass, while in 4 patients tubular aortic stent-grafts were used. 6 patients required preoperative 

embolisation procedure. 

Results: All stent-grafts were successfully deployed. Mean procedure delay was 135 

minutes (60-220 minutes). Mean X-ray exposure was 14 minutes (10-25 minutes). EVFAR procedures 

required an average quantity of 150ml contrast product (100-230ml). Mean in-hospital stay was 10. 

6 days (5-24 days), no perioperative death was recorded. During the 5-years postoperative 

surveillance, 5 deaths were recorded (2 cardiac complications, 1 stroke, 1 pulmonary cancer, 1 

highway accident); 1 stent-graft occlusion required an axillo-femoral bypass; 2 distal stent-graft 

stenosis required PTA. 

Conclusions: EVFAR must be considered especially for high risk patients offering similar 

results to open surgery. Preoperative embolisation and other associated surgical procedures are 

frequently required. Long-term surveillance is necessary for the assessment of final results. 

Expresia citokinelor inflamatorii la nivelul ţesutului adipos epicardic şi relaţia cu boala 

aterosclerotică coronariană 

1 Alina Silaghi, 2 Horaţiu Silaghi, 3 Traian Scridon, 

2 Aurel Mironiuc, 2 Şerban Rădulescu 4 Michel Grino 

1 Clinica Endocrinologică Spitalul Clinic Judeţean Cluj, 

2 Clinica Chirurgie II UMF "Iuliu Haţieganu" Cluj, 3 Institutul Inimii UMF "Iuliu Haţieganu"Cluj 

4 INSERM U626, Faculté de Médecine, Aix-Marseille Université, Marseille, France 

Introducere: Ţesutul adipos epicardic (TAE) este un depozit ectopic de ţesut adipos situat 

în contact direct cu miocardul de care nu este despărţit printr-o fascie. TAE înconjură vasele inimii 

şi poate influenţa homeostazia coronariană prin sinteza citokinelor inflamatorii. 

Scop: Evaluarea expresiei principalelor citokine inflamatorii şi stabilirea unei legături cu 

statusul coronarian 

Material şi metodă: S-au realizat biopsii de TAE şi ţesut adipos subcutanat (TAS) de la 32 

pacienţi, 11 femei si 21 bărbaţi, cu vârsta între 36 şi 72 ani, cu IMC-ul mediu de 27,2±1,2; 18 fiind 

coronarieni şi 14 non-coronarieni. Am studiat prin qRT-PCR expresia principalelor adipokine 

inflamatorii: IL-1, IL-6, TNF-α, MCP-1 

Rezultate: Intre cele două grupuri, coronarieni şi non coronarieni, există o diferenţă de 

expresie a MCP-1, dar ea este nu semnificativă statistic nici pentru TAS (p = 0,28) şi nici pentru TAE 

(p = 0,9). Utilizând un test de tip Wilcoxon, am comparat expresia ARNm al TNF-α între TAE si TAS în 

grupul de pacienţi fără coronaropatie, diferenţa găsită fiind nesemnificativă statistic (p = 0,17). In 

grupul de pacienţi coronarieni am găsit o diferenţă semnificativă a expresiei TNF-α între TAE si TAS 

utilizând acelasi tip de test (p = 0, 037). La pacienţii coronarieni am găsit o crestere semnificativă a 

expresiei IL-6 si IL-1ß în TAE fata de TAS utilizând acelasi tip de test (p = 0,031). 

Concluzii: TAE se caracterizează printr-un nivel crescut al expresiei adipokinelor inflamatorii 

şi ar putea contribui printr-un efect local la agravarea bolii aterosclerotice coronariene. 

Cuvinte cheie: ţesut adipos epicardic, citokine inflamatorii, boala aterosclerotică 

coronariană 

Cerebral response after carotid artery revascularisation 

Cerebral hiperperfusion syndrome 

Răsunetul revascularizaţiei carotidiene asupra parenchimului cerebral – sindromul de hiperperfuzie cerebrală 

Dr. Jerzicska E., dr. Balos S., conf. dr. H. Suciu, prof. dr. R. Deac, 

IUBCVT, Târgu Mureş 

The syndrome of cerebral hiperperfusion (SCH) is a relatively new clinical entity, a new 

concept with different symptoms and signs integrated along the years in other categories of 

pathology. It is specific for carotid revascularisation and has a unique patho-physiology 

56

mechanism. The authors studied the current literature with the intention to clarify this chapter of 

revascularisation complications. Our experience in this domain is presented and compared in a 

study during 4 years from 2005-2008, based on clinical evaluation of 247 patients after the 

operation for internal carotid artery revascularisation. As a result of this evaluation we found SCH 

with patogenic mechanism, with clinical manifestations and we suggested procedures for 

prevention. Risk factors for SCH are presented with added personal observations suggesting 

means for imagistic recognition. The incidence of this complication is smaller in our group of 

pactients in comparison with the data from literature suggesting the th efficiency of treatment 

protocol. The main objective of the study is an earlier rehabilitation after internal carotid artery 

revascularisation. 

Răsunetul revascularizaţiei carotidiene asupra parenchimului cerebral – sindromul de hiperperfuzie cerebrală 

Sindromul de hiperperfuzie cerebrala (SHC) este o entitate clinică relativ nouă conceptual, 

diferitele manifestări fiind integrate de-a lungul timpului în alte categorii de patologie. Este specific 

pentru revascularizarea carotidiană şi are mecanism fiziopatologic unic. Am studiat literatura 

curentă, cu intenţia de a clarifica acest capitol al complicaţiilor revascularizarii carotidiene. 

Experienţa noastră în acest domeniu este prezentată şi comparată într-un studiu cuprinzând o 

perioada de 4 ani, din 2005-2008, bazat pe evaluarea clinică postoperatorie a 247 pacienţi cu 

revascularizare carotidiană. Ca rezultat al acestei evaluări, am regăsit SHC, subliniind mecanismul 

patogen, cu manifestările clinice, respectiv am propus proceduri preventive şi curative. Sunt 

prezentaţi factorii de risc în SHC, adăugând observaţiile noastre, respectiv am descris posibilităţile 

de diagnostic imagistic. In lotul nostru incidenţa acestei complicaţii este mai mică faţă de datele 

din literatura de specialitate, subliniind eficienţa protocolului de tratament care ne-a permis 

atingerea acestei incidenţe a SHC. Asigurarea unei recuperări cât mai rapide postrevascularizaţie 

carotidiană este obiectivul primordial. 

125 Years from the Birth of Nicolae Hortolomei – Vascular Surgery Heritage 

NJ Tesoiu 

Institute for Emergencies in Cardiovascular Diseases “Prof. Dr. CC Iliescu”, Bucharest, Romania 

The basis for today‘s vascular surgery rests on achievements from the past; many 

nationalities have been involved as well as numerous individuals. History is the essence of 

innumerable biographies. 

It is a great honor for Romanian surgeons to rend homage in 2010 to Nicolae Hortolomei 

(1885-1961), preeminent representing of the Romanian school of surgery and considered founder 

of the physiologic surgery in Romania, on the occasion of the anniversary of 125 years from his 

birth. 

Born in Husi, he graduates in 1909 the Faculty of Medicine in Iasi and becomes professor of 

surgical pathology in Iasi and then in Bucharest and full member of the Romanian Academy 

(1945). Complex personality, equally preoccupied by organizing, practice, research, education 

and science, he has valuable nationally and internationally recognized contributions in all surgical 

fields including transplantology. He is co-editor with I Turai to the first Romanian surgical treatise. 

He reaches the climax of the professional activity in the middle of the XX-th century in 

conducting a group of young enthusiasts in founding cardiac and vascular surgery in Romania, 

from experimental stage to clinical practice and from complex evaluation to surgical, anesthetic 

and intensive care aspects at Coltea Hospital in Bucharest. He approaches congenital and 

acquired heart disorders and vascular diseases: arterial stenoses and aneurysms, arteriovenous 

fistulas, arterial and portal hypertension, superior vena caval obstruction, cervical rib, carotid body 

tumors, as well as the surgery of sympathetic nervous system. His disciples continue and develop 

these specialties at Fundeni Hospital in Bucharest. 

Impressive personality marking the evolution of the Romanian surgery he remains an 

example of professional devotement for newer generations. 

125 Ani de la nasterea lui Nicolae Hortolomei – Mostenirea în domeniul chirurgiei vasculare 

Bazele chirurgiei vasculare actuale sunt constituite de rezultatele obtinute in trecut; multe 

nationalitati si numeroase personalitati sunt implicate. Istoria este suma mulor biografii. 

Este o mare onoare pentru chirurgii romani sa omagieze in 2010 pe Nicolae Hortolomei 

(1885-1961), reprezentant proeminent al scolii chirurgicale romanesti si considerat fondatorul 

chirurgiei fiziologice in Romania, cu ocazia aniversarii a 125 ani de la nasterea sa. 

57

Nascut la Husi, absolvent in 1909 al Facultatii de Medicina din Iasi, devine profesor de 

patologie chirurgicala la Iasi si apoi la Bucuresti si membru al Academiei Romane (1945). 

Personalitate complexa, preocupat in mod egal de organizare, practica, cercetare, educatie si 

stiinta, are contributii valoroase recunoscute pe plan national si international in toate domeniile 

chirurgiei, inclusiv transplantologie. Este co-redactor cu I Turai la primul tratat de chirurgie 

romanesc. 

Atinge maximul carierei profesionale la mijlocul secolului al XX-lea conducand un grup de 

tineri entuziasti in fundamentarea chirurgiei cardiace si vasculare in Romania: de la nivel 

experimental la aplicatia clinica si de la evaluare complexa la aspectele chirurgicale, anestezice 

si de terapie intensiva in cadrul Spitalului Coltea din Bucuresti. Abordeaza bolile cardiace 

congenitale si dobandite si bolile vasculare: stenozele si anevrismele arteriale, fistulele 

arteriovenoase, hipertensiunea arteriala si hipertensiunea portala, obstructia de vena cava 

superioara, coasta cervicala, tumorile corpusculului carotidian, precum si chirurgia sistemului 

nervos simpatic. Discipolii sai continua si dezvolta aceste specialitati la Spitalul Fundeni din 

Bucuresti. 

Personalitate impresionanta marcand evolutia chirurgiei in Romania, ramane un exemplu 

de devotament profesional pentru noile generatii. 

Popliteal Artery Entrapment Syndrome 

Silvia Condu, D Trandafir*, S. Rurac*, Cristina Tudor**, Florentina Mihaescu** 

Department of Vascular Surgery, University Hospital Bucharest, Romania 

*) Department of Cardio-Vascular Surgery, University Hospital Bucharest, Romania 

**) Department of Anaesthesia and Intensive Care University Hospital Bucharest, Romania 

Popliteal Artery Entrapment Syndrome is a rare condition which may cause severe 

ischemic disability among young adults. It is caused by the anomalous anatomic relationships of 

the musculotendinous structures surrounding the popliteal artery creating extrinsic compression of 

the artery. 

We report a case where duplex ultrasonography, arteriography and magnetic resonance 

imaging were used to diagnose and to establish the level of vascular damage and the anatomic 

type of the syndrome. 

We used a median surgical approach, resection of the occluded segment and operative 

reconstruction with autologous safen vein graft, in addition to decompression of the vessel and 

resection of aberrant muscle. 

The result was favourable with complete recovery and absence of ischemic symptoms 

and with patient verified by angiografic examination 6 moths post surgery. 

Giant External Carotid Aneurysm: Case report 

Anevrism gigant de arteră carotidă externă 

A. Oprea, A. Eni, O. Andercou, A. Buleandra, Diana Turcu, S. Radulescu 

IInd Vascular Surgical Clinic, Cluj-Napoca 

Aneurysms of the extracranial carotid artery are extremely rare. The most frequently are 

the aneurysms of the common carotid artery, followed by the internal carotid, then the aneurysms 

of the external carotid artery. 

We report a case of a 72- year-old female patient with an external carotid aneurysm. The 

patient presented with a lateral cervical mass, dyspnoea and dysphagia. The diagnosis was 

made on investigation with carotid Doppler ultrasound and confirmed with computerized 

tomography. Ligation of the origin of the external carotid artery was followed by the 

disappearance of the compressive syndrome and the remission of the symptoms. 

Anevrismele arterei carotide extracraniene sunt extrem de rare. Dintre acestea cele mai 

frecvente sunt cele ale carotidei comune, urmata de cele ale carotidei interne, pe ultimul loc 

fiind cele ale carotidei externe. Prezentam cazul unei paciente de 72 ani care prezinta un 

anevrism de artera carotida externa. Pacienta se interneaza pentru aparitia unei formatiuni 

tumorale laterocervicale, insotita de disfagie si disfonie.Diagnosticul a fost pus utilizind echografia 

Doppler si a fost confirmat prin angioCT spiral. Ligatura arterei carotide externe si a colateralelor 

transanevrismal a dus la rezolvarea sindromului compresiv cu disparitia simptomatologiei. 

58


Radu Mădălina, dr. Lazar Ovidiu, Dr. Cârjaliu 






Radu Mădălina, dr. Lazăr Ovidiu, Dr. Carjaliu 





Tratamentul stenozelor, fistulelor arterio-venoase 

pentru hemodializa 

Sindromul de furt sangvin post FAV - abord chirurgical 

Arterial Reconstructions In Infrainguinal Occlusive Disease 

- Our Department’s Experience Over 13 Years 

Reconstrucţii arteriale în boala ocluzivă infrainghinală- experienţa secţiei în 13 ani 

D.F. Bărzoi, M. Păcescu, I. Diaconescu, N.J. Teşoiu, R. Halpern, I. Oprea, 

E. Mărginean, O. Moraru, O. Udrică, A.D. Iancu, A. Stoica, S.L. Băilă 

Secţia Chirurgie Vasculară, Institutul de Boli Ccardiovasculare 

de Urgenţă “C.C. Iliescu”, Bucureşti, România 

Vascular Surgery Department, “C.C. Iliescu” Cardiovascular Diseases Institute, Bucharest, Romania 

Aim. The aim of this retrospective study is to present our experience with direct 

reconstructive surgery in infrainguinal arterial occlusive disease over a period of 13 years. 

Materials and methods. During the last thirteen years, we performed arterial 

reconstructions for infrainguinal occlusive disease in 1996 patients. There were 1710 men and 286 

women; their median age was 62.5 years (range 20-95). There were 425 (21.3%) diabetics and 

1687 (84.5%) smokers. 1474 (73.8%) had critical ischaemia (stage III Fontaine- 697; stage IV 

Fontaine- 777), 447 had disabling claudication. The angiography was performed in 97.4% of cases. 

408 operations were redo interventions. There were 1166 conduits to the proximal popliteal artery, 

555 to the distal popliteal artery and 168 to the crural arteries. We used autologous material in 

1198 patients and prostheses in 798 patients (vein- cuffs in 82, composite grafts in 60). 

Results. During the first 30 days, there were 19 deaths (mortality- 1.1%) and 107 major 

amputations (amputation rate- 5.3%). 1870 patients were dismitted with functional grafts. 

Conclusions. Over this period we performed an increasing number of operations. We 

registered an increasing number of elderly patients (450 patients over 70 years ) and a high level 

of associated cardiovascular pathology (hypertension 46.9%, cardiac ischaemia 23.6%). The 

hospital stay was too long (mean=19.6 days) and we used too many prostheses (39.9%). Overall, 

there were good results (amputation rate 5.3% and mortality 1.1%) 

Scopul. Scopul acestei lucrări retrospective este prezentarea experienţei noastre cu reconstrucţiile 

arteriale directe în boala ocluzivă infrainghinală, pe o perioadă de 13 ani. 

Material şi metodă. În ultimii 13 ani, colectivul nostru a efectuat reconstrucţii arteriale directe în boala 

ocluzivă infrainghinală la 1996 pacienţi, 1710 bărbaţi şi 286 femei, cu vârstă medie de 62,5 ani (extreme = 20- 

95 ani). Dintre aceşti pacienţi, 425 (21,3 %) aveau diabet zaharat, iar 1687 (84,5%) erau fumători. Indicaţia 

chirurgicală a fost ischemia critică la 1474 bolnavi (73,8%), dintre care 697 erau în stadiul III Fontaine, iar 777 în 

stadiul IV Fontaine; 447 dintre pacienţi aveau claudicaţie intermitentă. S-a efectuat arteriografie la 97,4 % 

dintre cazuri. 408 operaţii au fost reintervenţii. Anastomozele distale s-au efectuat la nivelul popliteei 

proximale (1166 cazuri), popliteei distale (555 cazuri) şi 168 la arterele crurale. S-a folosit material autolog la 

1198 pacienţi şi proteze la 798 (cu vein- cuff la 82, grafturi compozite la 60). 

Rezultate. La 30 zile, s-au înregistrat 19 decese (mortalitate= 1,1%) şi 107 amputaţii majore (5,3%). 1870 

pacienţi au fost externaţi cu grefoane funcţionale. 

Concluzii. De-a lungul perioadei analizate, colectivul nostru a efectuat un număr din ce în ce mai 

mare de operaţii, la pacienţi din ce în ce mai vârstnici (450 peste 70 ani) şi cu numeroase asocieri 

patologice, mai ales cardiovasculare (hipertensiune 46,9%, ischemie cardiacă 23,6%). Durata de spitalizare a 

fost lungă ( în medie 19,6 zile). S-au utilizat prea multe proteze (39,9%). Pe ansamblu, rezultatele obţinute au 

fost bune: 5,3% amputaţii majore şi 1,1% mortalitate. 

59


Sala Diamond 


Sesiunea IX 


Myocardial revascularization – ESC and EACTS guidelines 2010 

Revascularizarea miocardică – Ghidul ESC şi EACTS 2010 

Prof. dr. Deac Radu, 

IUBCVT Târgu Mureş, Clinica Chirurgie Cardiovasculară I. 

European Society of Cardiology and European Association of Cardiothoracic Surgery 

revised recently the Guidelines for Myocardial Revascularisation (MR) based on the comparison 

between procedures of myocardial revascularisation in coronary heart diseases. The Guidelines 

are based on the detailed analysis of the available evidence at the moment of writing. It is 

recommended to be taken into account at the moment of clinical judgement which does not 

exclude the individual responsibility of the health professionals to take adecquate individual 

decisions in patients with their consultation. It is also the responsibility of health professionals to 

verify the rules and regulations amenable to drugs and devices at their prescriptions to the 

patients. The 2 main prodeures of MR are PCI and CABG. The guidelines begin with the chapter of 

risk stratification of the patients followed up by the process for decision making and patient 

informa-tion. The decision making is multidisciplinary (Heart Team). Strategies for pre-intervention 

diagnosis and imaging include: detection of coronary artery disease, detection of ischaemia, 

hybrid / combined imaging, invasive tests and their prognostic value and detection of myocardial 

viability. Revascularization for stable CAD detailed evidence basis for revascularisation, impact of 

ischaemia burden on prognosis, optimal medical therapy vs PCI and PCI with drug-eluting stents 

vs bare metal stents, also CABg vs. medical therapy, PCI vs CABG. 

Concerning MR in non-ST segmaent elevation in ACS intended early invasive or 

conservative strategies, risk stratification, timing of angiography & intervention, PCI and CABG. For 

revasculari-sation in ST-segment elevation myocardial infraction the guidelines reviews the 

strategies and cardiogenic shock and mechanical complications. Procedural aspects of CABG 

and PCI are detailed. Antithrombotic pharmacotherapy, secondary prevention and strategies for 

follow up are the last chapters of the Guidelines 

Revascularizarea miocardică – Ghidul ESC şi EACTS 2010 

Societatea Europeană de Cardiologie (ESC) şi Asociaţia Europeană de Chirurgie 

Cardiotoracică (EACTS) au revizuit recent recomandările pentru revascularizarea miocardică 

bazat pe comparaţia între procedurile de revascularizare miocardică (RM) în cardiopatia 

coronariană. Acestea au la bază analiza minuţioasă a dovezilor existente la momentul redactării. 

Se recomandă luarea lor în considerare în momentul judecăţii clinice, ceea ce nu exclude 

responsabilitatea individuală a profesioniştilor din sănătate de a lua decizii adecvate individual la 

pacienţi cu consultarea acestora. De asemenea, este responsabilitatea profesioniştilor din 

sănătate să verifice regulile şi reglementările aplicabile medicamentelor şi dispozitivelor medicale 

în momentul indicării/prescrierii acestora. Cele 2 procedee majore de RM sunt bypass-ul aortocoronarian 

chirurgical (BAC) şi intervenţia coronară percutanată (PCI). Recomandările au la 

început un capitol despre stratificarea de risc a pacienţilor, urmat de procesul de luare a deciziei 

şi informarea pacientului. In cadrul strategiilor înainte de intervenţie sunt descrise: detectarea bolii 

coronare, detectarea ischemiei, imagistica combinată hibridă, testele invazive cu valoarea 

prognostică şi detectarea viabilităţii miocardice. In capitolul despre RM pentru angina stabilă sunt 

trecute în revistă dovezile existente pentru revascularizare, terapia medicală optimă, RM cu PCI şi 

aplicare de stenturi DES sau BMS, apoi RM prin BAC cu comparaţie între proceduri. Un alt capitol 

este dedicat RM în ACS fără supradenivelare ST cu referire la stratificarea de risc, intenţia de 

rezolvare invazivă sau conservativă, momentul angiografiei coronare şi al intervenţiei de PCI sau 

BAC. RM în AMI cu elevare ST tratează strategiile de reperfuzie, şocul cardiogen şi complicaţiile 

mecanice. Sunt descrise procedurile de PCI şi BAC. Farmaco-terapia antitrombotică, prevenţia 

secundară şi procedurile de follow up încheie recomandările. 

60

Gerard Bloch 

Spitalul American din Paris 

Horaţiu Moldovan 

Institutul de Boli Cardiovasculare “ Prof. Dr. C.C. Iliescu” 

Bucureşti 

Grigore Tinică 



Actual indications for CABG (coronary artery bypass 

grafting 

Ruptura de sept interventricular post infarct miocardic 

acut 

Revascularizarea chirurgicală coronariană total 

arterială. Argumente şi fapte. 

Totally arterial coronary revascularization. Argument 

and facts. 

Making of The Cardiovascular Hybrid Operating Room 

Organizarea sălii de operaţie hibride cardiovasculare 

Prof dr. Grigore Tinica, Diana Ciurescu, Igor Nedelciuc, Mihail Enache, Vasile Astarastoae 

Universiy of Medicine and Pharmacy „Gr. T. Popa” Iaşi 

Cardiovascular Surgery Clinic, 

Cardiovascular Institute „Prof. Dr. George G. M. Georgescu” IASI 

Background. The recent improvements in the treatment of cardiovascular diseases has 

established the hybrid strategies as an alternative treatment for a variety of cardiovascular 

conditions. These developments have led to the installation of hybrid operating suites that are 

optimal for both open surgery and endovascular procedures. These units require special training, 

planning and design. Important issues include: quality of the imaging equipment, radiation 

burden, ease of use of the equipment, need for specially trained personnel, ergonomics, ability to 

perform both open and percutaneous procedures, sterile environments, as well as quality and 

efficiency of patient care. 

Methods. Before planning a room with an interdisciplinary usage by cardiovascular 

surgeons, interventionalists, anaesthesiologists, a clear vision for the utilization should be 

established. A literature search identified articles pertinent to the key issues during the decisionmaking 

process of creating the optimal endovascular suite. Workflow was analyzed and an 

observational study of the operating room was performed. 

Results and conclusion. The most important feature of working in a hybrid operating room 

should be the ability to attain best treatment of cardiovascular patients. Establishment of an 

endovascular operating room suite has the benefit of a sterile environment, the possibility of 

performing hybrid procedures and conversions when necessary. With the growing trend toward 

endovascular procedures during surgery, the hybrid operating room will become an integral part 

of every cardiovascular center. This new concept will play an important role for minimally invasive 

surgery. As a consequence, better quality and service can be provided to the individual patient. 

The trend towards hybrid techniques is more a revolution than a evolution. 

Keywords: hybrid room, integrated or, angiography-or, high-tech or, minimally invasive, 

cardiovascular surgery. 

Ţintoiu Ion 

Spitalul Militar Bucureşti 

Adrian Molnar 


I. Droc, Tintoiu I. 


“Dr. Constantin Zamfir”, Spitalul Militar Bucureşti 

Clara Alexandrescu 

Centre Cardio-Thoracique du Monaco, Monte 

Carlo 

Rezistenţa la tratamentul antiplachetar şi restenoza în 

stent sau graft 

Chirurgia off pump versus on pump în revascularizarea 

miocardică 

Sesiunea X 

CABG after instent restenosys 

Care este cea mai bună modalitate imagistică înainte de 

chirurgia aortei? 

What is the best imagistic modality before surgery for aortic 

valve and aortic root? 

61

Case Study: Cardiac Rupture After Myocardial Infarction 

Ruptura cardiacă postinfarct miocardic acut - prezentare de caz 

L. Stoica, E. Bitere, E. Ciobanu, G. Tinica 


Cardiovascular Institute “Prof. Dr. George I. M. Georgescu”, Iasi 

Despite the progresses acheved in early miocardic revascularisation, cardiac rupture 

remains an important factor of hight mortality post acute miocardial infarction, frequentely by 

electromechanical dissociation with sudden death, on patients without history of angina. 

The presentation discusses the case of a 73 years old patient, smoker, chronic ethanol 

consumer, without any angina symptoms, known with obliterating arteriopathy of lower limbs, with 

chronic ischemia of his left lower limb stage III, admitted for surgical treatment of this pathology. 

During his admittance he suffers an acute miocardic infarction, followed by cardiac rupture, with 

cardiac tamponade. The patient is tachicardic, SR 120 b/min, BP 110/70 under inotrop support, QS 

in C1, rS in C2 on EKG; on echocardiography - apex with diskinezia, wraped in trombus, lateral wall 

akinezia, with apparently solution of discontinuity on the LV apex, without Doppler flux (wraped in 

thrombus), organized thrombus in the pericardial sac, pericardial fluid of max. 4 cm below RV with 

diastolic collapse of RV; EF 64%, EFvol. 30% (visualy); on coronarography - right dominance, first 

marginale of circumflex artery ocllusion. 

A promt surgycal intervention by closing the rupture with autologus patch of pericardium 

and dacron patch, stabilised with bioglue is performed. On postoperative echocardiography we 

note the absence of pericardial fluid, LV with moderately diminishet, hipokinezia of lateral wall 

and the apex, EF 60%, EFvol 40 – 45%. On EKG SR75b/min with small progression of R wave in C1 – 

C2. Patients developement is favorable, without angina or dyspnoea. 

Within a month after cardiac surgery the patient comes back in order to undergo surgical 

treatment for chronic ischemia of his left lower limb. On echocardiography at 4 months after 

surgery he has EF 60%, preserved LV global systolic function, LV inferior wall hipokinesia, absence 

of pericardic fluid. 

Conclusions: Immediate surgical treatment allowed a positive vital outcome in a patient 

with subacute cardiac rupture post AMI 

R. Vasile, B. Rădulescu, A. Mărginean, S. 

Marin, O. Ghenu, H. Moldovan, V. Iliescu 



Infarct miocardic acut postoperator, prin spasm de artera 

coronara dreaptă indemnă 

Acquired ventricular septal defect: 

mechanical complication of acute myocardial infarction 

Dr. Raicea V., Dr. Moraru L., Dr. Serban V., Dr Bica L., 

Dr Raicea C., prof. dr. Deac R. – IUBCVT Târgu-Mureş 

Ventricular septal defect (VSD) represents a rare and severe complication of acute 

myocardial infarction (AMI) – having absolute surgical indication. Four clinical cases operated 

upon in the Clinic of Cardiovascular Surgery of the IUBCVT Târgu-Mureş in between 2009-2010 are 

presented. There were 3 females and 1 male with the age in between 50-72 years. VSD appeared 

at 1 day post AMI (2 cases) respectively at 1 week post IMA (2 cases), the operation being 

performed at around 1 month from the date of infarction. VSD was situated in the antero-septal 

region (3 cases) – oclusion of left anterior descending artery, respectively 1 case in the posteroinferior 

region – oclusion of right coronary artery. All the cases presented moderat-severe 

secondary pulmonary hypertension (PA>60 mmHg), LVEF was between 35-40%. Preoperatively, 

none of the patients received IABP support (one case needed moderate inotropic support). The 

operations were performed by closure of the VSD with armed isolated sutures (3 cases), 

respectively one case required reconstruction of the left ventricle and closure of the VSD with the 

same patch. Surgical myocardial revascularisation was performed concomitently. The 

postoperative evolution was good in 3 cases. One patient died 30 days postoperatively. 

62

Complicaţia mecanică a infarctului miocardic acut: defectul septal ventricular dobândit. 

Defectul septal ventricular (DSV) reprezintă o complicaţie rară, severă a infarctului 

miocardic acut (IMA) având indicaţie chirurgicală absolută. In lucrare sunt prezentaţi 4 pacienţi 

(3 femei şi 1 bărbat) cu vârsta cuprinsă între 50-72 ani, operaţi în Clinica de Chirurgie 

Cardiovasculară a IUBCVT Tîrgu Mureş în intervalul 2009 - 2010. DSV s-a dezvoltat la 1 zi post IMA (2 

cazuri), respectiv la 1 săptămână post IMA (2 cazuri), operaţia efectuându-se la aproximativ 1 

lună de la data infarctului miocardic. DSV a fost situat antero-septal (3 cazuri) – ocluzie artera 

descendentă anterioară, respectiv 1 caz cu localizare postero-inferioară – ocluzie artera coronară 

dreaptă. Toate cazurile au prezentat hipertensiune pulmonară secundară (PAP peste 60 mmHg). 

FEVS determinată echocardiografic a fost situată între 35-40%. Nici unui pacient nu a fost asistat 

IABP. Un pacient a necesitat suport inotropic moderat. Operaţiile au constat în închiderea DSV cu 

fire izolate armate (3 cazuri), respectiv un caz a necesitat reconstraucţie de VS şi excludere DSV 

cu acelaşi petec, concomitent efectuându-se revascularizarea chirurgicală a miocardului. 

Evoluţia postoperatorie a fost favorabilă la 3 cazuri. A fost înregistrat un deces la 30 zile 

postoperator prin insufcien ă multiplă de organe. 

Miocardial revascularization combined with surgical treatment of other cardiac 

pathologies. Comparison with eacts adult cardiac surgical database report 

Revascularizarea miocardică concomitentă tratamentului chirurgical al altor patologii cardiace. 

Comparaţie cu EACTS adult cardiac Surgical Database report 

Grigore Tinică, Mihail Enache, Diana Ciurescu, 

Oana Bartos, Alexandru Ciucu, Flavia Antoniu, Victor Prisacari 


Cardiovascular Institute “Prof. Dr. George I. M. Georgescu”, Iasi 

Aim: The current work is oriented towards the statistical processing and interpretation of 

the coronary artery by-pass grafting procedures integrated with concurrent surgical procedures 

for other intracardiac pathologies. 

Materials and method: This retrospective study includes all the patients undergoing a 

CABG procedure at IBCV “Prof. Dr. George I. M. Georgescu” Iasi during 2000-august 2010. Out of 

a total of 963 patients, 759 underwent only CABG, 195 underwent CABG+other intracardiac 

procedures and 9 underwent CABG+other extracardiac procedures. The intracardiac surgical 

procedures concurrent with CABG revealed in our study group were as followed: CABG+Ao valve 

(100 patients), CABG+Mi valve (30 patients), CABG+Ao valve+Mi valve (8 patients), CABG+Ao 

valve+other (14 patients), CABG+Mi valve+other (7 patients), CABG+Ao valve+Mi valve+other (5 

patient), CABG+aneurism of the left ventricle (18 patients), CABG+ascendant Ao (7 patients), 

CABG+other (7 patients). We compared the group of patients undergoing CABG+aortic valve 

replacement and CABG+mitral valve procedures with the similar groups from the 4-th EACTS adult 

cardiac surgical database report. 

Results: The overall postoperative mortality was 1% in the group of patients with 

CABG+aortic valve replacement versus 5,5% in EACTS database and 3,33% vs. 8,6% in the group of 

patients with CABG+mitral valve procedures. In both groups of patients, the female mortality was 

0% (EACTS values for CABG+Ao valve was 7,50% and for CABG+Mi valve was 10,40%). 

Conclusions: Our study indicates an upgrade in the incidence of the CABG procedures 

concurrent with additional intracardiac surgical procedures, from 16,49% in the first half of the 

studied period up to 21,57% in the second half. This reflects the fact that the ischemic heart 

disease morbidity markers are increasing and the patient needs to undergo more complex 

cardio-vascular surgical procedures, despite the remarkable scientific progress registered in the 

medical and interventional cardiology field. The results registered in out clinic are superior to those 

quoted in the reference literature, despite the increased complexity of the surgical procedures 

performed. 

Revascularizarea miocardică concomitentă tratamentului chirurgical al altor patologii cardiace. 

Comparatie cu EACTS Adult Cardiac Surgical Database Report 

Obiective: Aceasta lucrare urmareste prelucrarea si interpretarea statistica a interventiilor 

chirurgicale de revascularizare miocardica si a procedeelor chirurgicale concomitente pentru 

alte patologii cardiace. 

63

Materiale si metoda: Acest studiu retrospectiv cuprinde toti pacientii supusi unei interventii 

de revascularizare miocardica chirurgicala la IBCV “Prof. Dr. George. I. M. Georgescu” Iasi intre 

anii 2000- august 2010. Dintr-un total de 963 de pacienti, 759 au fost supusi doar la CABG, 195 

CABG+alte proceduri intracardiace si 9 CABG+proceduri extracardiace. Procedurile chirurgicale 

intracardiace concomitente cu CABG au fost: CABG+valva Ao (100 pacienti), CABG+valva Mi 

(30 pacienti ), CABG+valva Ao+valva Mi (8 pacienti), CABG+valva Ao+alte (14 pacienti), 

CABG+valva Mi+alte (7 pacienti), CABG+valva Ao+valva Mi+alte (5 pacienti), CABG+anevrism VS 

(18 pacienti), CABG+aorta ascendenta (7 pacienti), CABG+alte (7 pacienti). Au fost comparate 

loturile de pacienti operati cu by-pass aortocoronarian asociat cu protezare aortica si proceduri 

mitrale cu loturile similare din 4-th EACTS adult cardiac surgical database report 

Rezultate: Mortalitatea postoperatorie globala a fost de 1% la pacientii cu protezare 

aortica asociata cu by-pass aorto-coronarian fata de 5,5% in baza de date EACTS si de 3,33% fata 

de 8,6% la pacientii cu patologie valvulara mitrala asociata. In ambele grupuri de pacienti, 

mortalitatea feminina a fost 0% (EACTS CABG+valva Ao=7.50% iar EACTS CABG+valva Mi= 

10.40%). 

Concluzii: Studiul efectuat evidentiaza o usoara crestere a incidentei interventiilor 

chirurgicale de revascularizare miocardica ce necesita cura chirurgicala concomitenta a unor 

patologii intracardiace aditionale, de la 16.49% in prima jumatate a deceniului studiat la 21.57% in 

a doua jumatate. Aceasta reflecta faptul ca indicii morbiditatii cardiopatiei ischemice sunt in 

crestere, pacientul avand indicatie pentru interventii chirurgicale cardio-vasculare din ce in ce 

mai complexe, in ciuda progreselor stiintifice inregistrate in ultimul deceniu in domeniul 

cardiologiei medicale si interventionale. Rezultatele obtinute in clinica noastra sunt superioare 

celor citate de literatura de specialitate, in ciuda complexitatii sporite a interventiilor chirurgicale 

efectuate. 

Hybrid Revascularization – A Step Forward In Cardiovascular Procedures 

Revascularizarea hibridă – un pas înainte în medicina cardiovasculară 

Diana Ciurescu, Igor Nedelciuc, Mihail Enache, Dumitrita Gafencu, Grigore Tinica 

Cardiovascular Surgery Clinic, Cardiovascular Institute IASI 

Objective. A hybrid therapy combines the treatments traditionally available only in the 

catheterization laboratory with those traditionally available in the operating room to offer patients 

the best available therapies for any cardiovascular lesion. 

We sought to evaluate clinical and angiographic outcomes of hybrid procedures in patients 

receiving both PCI and other cardiovascular intervention. 

Methods. We retrospectively analyzed 113 patients with CAD who were referred to our 

institution for myocardial ischemia and underwent hybrid procedures. Between January 2002 and 

January 2009, a totally of 113 patients underwent hybrid procedures. In this series, the hybrid 

sequence, in all cases, included a PCI performed in the cardiac catheterization laboratory, 

followed by CABG in 23 patients, by valvular replacement in 6 patients (aortic and mitral), by 

carotid endarterectomy and surgical angioplasty in 12 patients and by peripheral vascular 

reconstructions in 82 patients. 

PCI was performed using femoral or radial artery access using guided catheter techniques and 

the surgical CABG, valvular replacement and the peripheral vascular interventions were 

performed according to our current standard guidelines. 

Results. Clinical follow-up was carried out in 100% of eligible patients. Information about inhospital 

outcomes was obtained from an electronic centralized clinical database. After 

discharge, all clinical follow-up data were prospectively collected by scheduled clinical 

evaluations or direct telephone interviews. Angiographic follow-up was performed at 6-9 months 

after the procedure. It was performed at an earlier time if clinically indicated. 

Discussions. The key requirement in all of these approaches is the need for collaboration 

between cardiac surgeons, vascular surgeons and interventional cardiologists to obtain optimal 

patient outcomes. 

Conclusions. Hybrid revascularization is offered as an alternative strategy for patients with 

complex cardiovascular diseases. Hybrid CABG/PCI may be reserved for higher risk patients who 

are not candidates for conventional surgery. In these patients, assosiation of PTA and surgery may 

help reduce risk. 

64

Revascularizarea hibridă – un pas înainte în procedurile cardiovasculare 

Obiective. Terapia hibridă combină procedurile disponibile, în mod tradiţional, numai în 

laboratorul de cateterism, cu cele disponibile numai în sala de operaţie pentru a oferi pacienţilor 

cele mai bune tratamente pentru orice tip de leziune cardiovasculară. 

În prezenta lucrare, am evaluat rezultatele clinice şi angiografice ale procedurilor hibride la 

pacienţii cu proceduri coronariene intervenţionale (PCI) şi alte intervenţii chirurgicale 

cardiovasculare asociate. 

Metode. Am analizat retrospective cazurile a 113 pacienţi coronarieni internaţi în clinica 

noastră pentru ischemie miocardică şi cărora li s-au practicat proceduri hibride cardiovasculare. 

Între ianuarie 2002 şi ianuarie 2009, s-au efectuat proceduri hibride cardiovasculare la un număr 

de 113 pacienţi. La această serie de pacienţi, secvenţa hibridă, în toate cazurile, a inclus 

proceduri intervenţionale coronariene efectuate în laboratorul de cateterism cardiac, urmate de 

BAC la 23 de pacienţi, înlocuiri valvulare la 6 pacienţi (aortice şi mitrale), endarterectomii 

carotidiene şi plastii de lărgire la 12 pacienţi şi intervenţii chirurgicale vasculare periferice la 82 de 

pacienţi. Procedurile intervenţionale coronariene s-au efectuat prin abord femural sau radial, 

utilizând cateterismul cardiac, în timp ce BAC, înlocuirile valvulare şi intervenţiile de chirurgie 

vasculară au respectat guideline-urile standard actuale. 

Rezultate. Urmărirea clinică a fost realizată la 100% din pacienţii eligibili. Informaţiile despre 

rezultatele intraspitaliceşti au fost obţinute dintr-o bază de date electronică centralizată. După 

externare, toate datele clinice de urmărire au fost colectate prospectiv prin evaluări regulate 

clinice sau interviuri directe prin telefon. Urmărirea angiografică a fost efectuată la 6-9 luni după 

procedură. 

Discuţii. Cerinţa esenţială în toate aceste abordări o reprezintă necesitatea colaborării 

între chirurgii cardiaci, vasculari şi cardiologii intervenţionişti pentru a obţine rezultate optime. 

Concluzii. Revascularizarea hibridă reprezintă o alternativă în managementul pacienţilor 

cu boli complexe cardiovasculare. Ea este rezervată cazurilor cu risc crescut, pacienţilor care nu 

sunt candidaţi acceptaţi pentru revascularizarea chirurgicală convenţională. La aceştia, 

alternative de asociere a procedurilor chirurgicale şi de stentare a celorlalte artere afectate 

poate reduce riscul procedural. 

Surgical harvesting of Radial Artery – 

comparison between skeletonized ans pedicled grafts 

Recoltarea chirurgicală a arterei radiale – comparaţie între tehnica scheletizată şi cea pediculată 

Dr. Moraru L., dr. Raicea V., dr. Serban V., dr. Bica Lucia, Dr. Raicea C., prof. dr. Deac R. 

IUBCVT Târgu Mures 

Radial artery (RA) represents an arterial conduit which may be successfully used in 

coronary surgery. The surgical technique of harvesting RA and utilization in coronary surgery is 

presented. The techniques described were applied in 45 patients operated upon in the Clinic of 

Cardiovascular Surgery at Institute for Cardiovascuar Diseases and Transplantation in Târgu Mures, 

Romania, between 2008-2010. In 31 patients this conduit was harvested “pedicled” (the RA and 

adjacent veins) and in 14 patients “skeletonized” (RA was dissected apart from the adjacent 

veins). In both methods the “no touch” technique with vessel snares for gentle manipulation / 

dissection, was used, also metallic clips for haemostasis at the collateral branches. The conduits 

were flushed with saline without undue pressure. The harvest time was comparable for both 

methods (mean 34 minutes vs 42 minutes). The length of the conduit was also comparable (mean 

13,9 cm vs 14,4 cm). No local complication was noted in utilization of the both techniques. The 

diameter of the graft and its uniformity was greater with the “pedicled” method (mean 2,4 mm vs 

1,3 mm) – which corelated positively with the post-bypass flow measurements. In conclusion the 

“pedicled” surgical harvesting of the radial artery offers a arterial graft with superior and uniform 

diameter associated with a adequate length for the patients with total arterial myocardial 

revascularisation. Morphologic observations will be added to functional data (arterial spasm, flow 

in the RA, patency rate). 

Recoltarea chirurgicală a arterei radiale – comparaţie între tehnica scheletizată şi cea pediculată 

Artera radială (AR) reprezintă un grefon arterial ce poate fi folosit cu succes în chirurgia 

coronariană. In IUBCVT Târgu Mure între anii 2008-2010 au fost operaţi 45 de pacienţi la care AR 

stângă a fost utilizată pentru revascularizarea chirurgicală a miocardului în asociaţie cu alte tipuri 

65

de grefoane. In 31 cazuri acest conduct a fost recoltat”pediculat”, (păstrarea periarterială a 

venelor adiacente), iar în celelalte 14 cazuri AR a fost preparată”scheletizat” (eliberarea AR dintre 

venele aferente). In ambele variante s-a utilizat metoda atraumatică”no touch” cu şnururi de 

hemostază pentru manipulare / disecţie şi utilizare de clipuri metalice pentru hemostaza 

colateralelor. Timpul de recoltare a fost comparabil (medie 34 minute vs 42 minute), lungimea 

grefonului a fost de asemenea comparabilă (medie 13,9 cm vs 14,4 cm), fără a exista complicaţii 

locale post recoltare, în nici una dintre cele două variante utilizate. Diametrul grefonului arterial a 

fost mai mare, respectiv mai uniform în cazul metodei”pediculat” (medie 2,4 mm vs 1,3 mm) – 

fapt corelat pozitiv cu valorile de debit măsurate post-bypass. In concluzie recoltarea 

chirurgicală”pediculată” a AR oferă un conduct arterial cu un diametru superior mai uniform 

asociat cu o lungime corespunzătoare pentru pacienţii cu revascularizare miocardică totală 

arterială. Observaţiile morfologice vor fi completate cu datele funcţionale (spasme arteriale, 

debite prin AR, permeabilitate). 

Use of radial artery in myocardial arterial revascularization 

Utilizarea arterei radiale în revascularizarea arterială miocardică 

Prof. dr. Deac R., dr. Raicea V., dr. Moraru L., dr. Suciu H., 

IUBCVT, Târgu Mureş 

The search for an ideal graft for myocardial revascularisation still continues. The 

advantages of arterial grafts are obvious, but the number of such graft is limited to both mamary 

arteries of the patients. The alterna-tives arterial grafts are one radial artery (RA) and gastroepiploic 

artery. We extended our experience in total arterial revascularisation with the use of 

autologous left radial artery in 45 patients operated upon between 2008-2010. There were 1 

female and 44 males, with the age between 43-71 years, in whom left RA was used for arterial 

myocardial revascularisation. The coronary artery grafted with RA involved: left marginal (16), left 

circomflex (10), RCA (7), LAD (5), D1 (2), Intermediate ves. (1), RCA and intermediate vessel – 2 

segments (1), RCA / ADP (1), LAD + Cx (1), LAD + RCA (1). The majority of RA were associated to 

other arterial grafts (LIMA, RIMA) isolated or with both mamary arteries. There were no death in this 

series. In 2 occasions RA graft were associated with autologus veins, and in 3 cases RA graft were 

implanted proximally in other grafts (LIMA, vein). As a routine RA were implanted proximally in 

ascending aorta. In the interval studied no RA grafts occluded or stenosed. In one case at 8 

months after the operation, the RA received a endocoronary stent for kinking. Rarely (2 cases), a 

RA spasm was noted intraoperatively and was managed by drugs. To note that RA was used only 

in one women. The interval in which the RA grafts were studied is not long enough to evaluate the 

patency rate yet. The quality of the RA arterial grafts deserve further surgical evaluation. 

Utilizarea arterei radiale în revascularizarea arterială miocardică 

Cercetarea pentru un conduct ideal pentru revascularizare miocardică continuă. 

Avantajele conductelor arteriale sunt evidente, dar numărul lor este încă limitat la cele 2 artere 

mamare interne. Alternativele sunt o arteră radială şi artera gastro-epiploică. Am extins 

experienţa noastră în revascu-larizarea totală arterială a miocardului cu utilizarea arterei radiale 

stângi (AR) autologe la 45 de pacienţi operaţi între 2008-2010. Genul pacienţilor a fost cel feminin 

la o pacientă şi masculin la 44 de pacienţi cu vârsta între 43-71 de ani. Arterele coronare 

revascularizate cu AR au fost: artera marginală stâgă (16), circumflexă stângă (10), ACD (7), ADA 

(5), D1(2), Vas intermediar (1), ACD şi vas intermediar – 2 segmente de AR (1), ACD/ADP (1), 

ADA+Cx (1), ADA+ACD (1). Utilizarea AR a fost asociată altor tipuri de conducte (AMIS,AMID) 

izolate sau cu ambele artere mamare interne. Nu au fost înregistrate decese. In 2 cazuri AR a fost 

asociată cu utilizarea de venă autologă, iar în 3 cazuri AR au fost implantate proximal în alte 

artere (AMIS; venă). De rutină, AR a fost implantată proximal în aorta ascendentă la majoritatea 

cazurilor. In intervalul studiat nu s-au înregistrat ocluzii sau stenoze de AR, exceptând un caz în 

care la 8 luni postoperator a necesitat implantare de stent endocoronar pentru o cudură 

determinată de poziţionare. De notat că AR a fost utilizată la o singură pacientă. Intervalul la care 

conductele de AR au fost analizate nu este suficient de lung pentru a evalua încă durabilitatea 

permeabilităţii acestora. Calităţile oferite de grefele de AR justifică evaluarea chirurgicală în 

continuare. 

R. Vasile, B. Rădulescu, A. Vasilescu, 

Luminiţa Iliuţă, H. Moldovan, V. Iliescu 

Institutul de Boli Cardiovasculare “ Prof Dr. 


Revascularizare miocardică folosind arterele mamare 

scheletizate 

66

Sesiunea XI 

The Importance Of Surgery In Controlling The Electrical Storm In A Patient With An Implantable 

Cardioverter And Left Ventricular Anevrysm 

Aportul chirurgical în controlul furtunii electrice la pacient cu defibrilator implantabil şi anevrism gicant de 

ventricul stang. 

Grigore Tinica, Alexandru Ciucu, Mihail Enache, Diana Ciurescu, Flavia Antoniu, 

Mihalea Grecu, Oana Bartos, Victor Prisacari, Daniel Dascalescu 

Cardiovascular surgery clinic IAŞI, Cardiovascular Institute IASI 

Introduction: An implantable cardioverter (ICD) is a first-line therapy for many patients who 

are at risk of sudden death from ventricular arrhythmias. An electrical storm is defined as multiple 

occurrences (two) of ventricular tachycardia/fibrillation within a 24-hours period. Incidence 10- 

20% of implanted ICD patients This is a medical emergency and a poor prognostic marker in 

patients with an ICD. 

Material and methods: We report here on a successful treatment of electrical storm that 

was refractory to amiodarone and β-blockers in a 60-years-old ICD recipient who underwent 

surgery for ischemic cardiomyopathy and huge LV aneurysm. The preoperative ejection fraction 

was very low, 16% and TAPSE was 11mm LV aneurysm resection, Cooley left ventricular 

remodelling and surgical revascularization of the myocardium with the left IMA on LAD 

anastomosed in Y fashion with the left radial artery sequentially on the obtuse marginal artery and 

on the posterolateral artery of ACX was performed under extracorporeal circulation. 

Results: At 15 months the graft patency was verified by arteriography, left ventricular 

function by ultrasound and ventriculography, and also was recorded the ICD history. And the ICD 

did not recorded any therapeutic episodes, the postoperative ejection fraction increasing to 45- 

50%. 

Conclusions: Electrical storms are frequent in patients with IHD and ICD. Management 

requires use of both simple and sophisticated methods. Surgical management could be an 

effective treatment for patients with huge aneurysm and refractory electrical storms to 

antiarrhytmic drugs. 

Aportul chirurgical în controlul furtunii electrice la pacient cu defibrilator implantabil şi 

anevrism gicant de ventricul stang. 

Introducere: Defibrilatorul implantabil (ICD) este o terapie de primă linie pentru pacienţii 

expuşi riscului de moarte subită prin aritmii ventriculare. Furtuna electrică este definită ca prezenţa 

a cel puţin două episoade de tahicardie / fibrilaţie ventriculară într-o perioadă de 24 de ore. 

Aceasta reprezintă o urgenţă medicală şi un marker de prognostic slab la pacienţii cu ICD. 

Material si metode: Prezentăm tratamentul cu succes al unei furtuni electrice, refractară la 

amiodaronă şi β-blocante, la un pacient de 60 de ani, cu defibrilator implantabil, căruia i s-a 

practicat o intervenţie chirurgicală pentru cardiomiopatie ischemică şi anevrism gigant de VS. 

Fractia de ejectie preoperatorie era foarte mica, 16%, TAPSE 11mm. Sub circulatie 

extracorporeala s-a practicat rezectia anevrismului de VS , remodelarea VS prin procedeul 

Cooley modificat si revascularizarea chirurgicala a miocardului cu AMI stanga pe LAD 

anastomozata in Y cu artera radiala stanga secvential pe artera marginala obtuza si artera 

posterolaterala din ACX 

Rezultate: La 15 luni a fost verificata patenta grafturilor prin arteriografie, functia 

ventriculara stanga prin ecografie si ventriculografie si, de asemenea, a fost inregistrat istoricul 

defibrilatorului, iar defibrilatorul nu a mai inregistrat episoade terapeutice, fractia de ejectie 

crescand postoperator la 45-50%. 

Concluzii: Furtunile electrice sunt frecvente la pacienţii cu defribilator implantabil si 

cardiomiopatie ischemica. Managementul acestora necesită utilizarea unor metode simple şi a 

unora sofisticate. Managementul chirurgical ar putea reprezenta o soluţie eficientă pentru 

pacienţii cu anevrism gigant de VS şi furtuni electrice refractare tratamentului antiaritmic. 

67

Acute ascending aorta dissection asociated 

with bilateral carotid arteries dissection – case report 

Disecţie acută de aortă ascendentă asociată cu disecţie carotidiană bilaterală - prezentare de caz 

Dr. Raicea V., Dr. Moraru L., Dr. Serban V., Dr. Bica Lucia, Dr. Raicea C., prof. dr. Deac R. 

IUBCVT Tg-Mures 

A patient of a 32 years old, was admitted in one clinic of neurology with the diagnostic of 

stroke and left hemiparesis. At 4 days after the admission the echoDoppler examination at the 

carotidian level demonstrated dissection of the right common carotid artery, the CT examination 

and the echocardiography showing acute dissection of the ascending aorta, aortic arch and 

descending aorta (tip A) with dissection on both common carotid arteries, moderate aortic 

regurgitation and hemopericardium. The emergency operation performed in the Clinic of 

Cardiovascular Surgery of IUBCVT Târgu Mures consisted in bilateral aorto-carotidian vascular 

bypass with a Dacron prosthesis, before initiating extracorporeal circulation, then correction of 

ascending aorta dissection at supracoronary level with dacron prosthesis and aortic valvuloplasty. 

The postoperator evolution was satisfactory, the follow up echocardiography showing trivial aortic 

regurgitation and normal flow in the carotid arteries. 

Disecţie acută de aortă ascendentă asociată cu disecţie carotidiană bilaterală - prezentare de caz 

Se prezintă cazul unui pacient de 32 ani, internat într-o clinica de neurologie cu 

diagnosticul de accident vascular cerebral ischemic drept cu hemipareză stângă. La 4 zile după 

debutul simptomatologiei examenul echoDoppler carotidian decelează disecţia arterei carotide 

comune drepte, examenul CT şi echografia cardiacă ulterioară evidenţiind disecţie acută de 

aortă ascendentă, arc aortic şi aorta descendentă (tip A) cu disecţie pe ambele artere carotide 

comune şi insuficienţă aortică moderată cu hemopericard. Se intervine chirurgical de urgenţă 

practicându-se bypass aorto-carotidian bilateral pe arterele carotide comune (pre-bypass 

cardio-pulmonar) cu proteză de dacron, înlocuire de aortă ascendentă supracoronarian cu 

proteză de dacron şi valvuloplastie aortică. Evoluţia pacientului a fost favorabilă, echografia de 

control postoperator demonstrând insuficienţă aortica minoră şi flux carotidian normal. 

Surgical Choices for Aortic Arch Syndrome 



Background. Severe and symptomatic stenotic-occlusive lesions of one or more arch 

vessels ask for an elaborate clinical and imagistic diagnosis and for varied but individually-applied 

surgical techniques, especially in patients having a life expectancy of 15 years or more. 


patients admitted for cerebrovascular insufficiency (including major stroke) and/or upper limb 

ischemia over a 4 year period. The following bypasses were used: ascending aorta-to-bilateral 

carotid artery: 4 cases; ascending aorta-to-carotid and subclavian artery: 4 cases; 

brachiocephalic trunk-to-carotid and subclavian artery: 1 case; subclavian-to-bilateral carotid 

artery: 1 case; subclavian-to-carotid artery: 3 cases; carotid-to-subclavian or axillary artery: 15 

cases. 

Results. Global mortality was 3,57%. One major hemispheric stroke occurred (3,57%). No 

postoperative cranial nerve palsies were encountered. 

Conclusions. Different surgical techniques can be applied for the treatment of the aortic 

arch syndrome. The ascending aorta represents a valuable donor vessel; alternatively, the 

brachiocephalic trunk, the subclavian or the carotid artery – can be used as well, especially in 

severely diseased patients. Doppler ultrasound examination doubled by arch and 4-vessel 

angiogram, represent the major steps in a thorough and efficient diagnostic workup. The 

complete revascularization can be contemplated even in patients with associated diseases but 

otherwise with a longer life expectancy. 

Feier Horea, Gaşpar M, Merce A., Nica D., 

Deutsch P., Milovan Slovenski 


O. Stiru, L.F. Dorobantu, O.Ghenu, Daniela 

Filipescu, V.A.Iliescu 



Opţiuni de tratament ale rupturii posttraumatice de 

aortă. 

Treatment options for traumatic aortic transection 

Pseudonaevrism rupt de aortă ascedentă dupa 

proteazre aortică – rezolvare chirurgicală. 

68

B. Rădulescu, R.Vasile, A.Vasilescu, Luminiţa 

Iliuţă, Y.Hashem, A.Mărginean, Mihaela Crăciun, 

S.Bubenek, H.Moldovan, V.Iliescu 


Medicină şi Farmacie "Iuliu Haţieganu", 

Cluj-Napoca, Chirurgie II 


Bucureşti 

Anevrism gigant de crosă aortică – rezolvare 

chirurgicală. 

New approach for extend Type II TAAA In High risks patients 

P. Bergeron*, A. Petrosyan*, J. Bellos**, F. Markatis**, T. Abdulamit*, A. El shazly, J. -C. Trastour* 

*: Saint-Joseph Hospital, Marseille – France 

**: 1 st surgical clinic Laikon Hospital University of Athens Medical School 

Extend type II thoraco abdominal aortic aneurysms (TAAA) involving Arch Vessels and the 

visceral arteries remains a challenging operation when affecting High Risk Patients (HRP). 

Recently, Hybrid surgery has gained popularity for High Risk Patients (1). The other options 

are branched stent grafting which is still experimental, time consuming with a high radiation 

exposure, and the conventional surgical repair which carries a high risk of morbidity and mortality 

for such patients and which is still indicated for low risk patients. 

Stentgraft technology offer new alternatives when combined to standard surgery. 2 ways 

can be followed to simplify the management of type II TAAA: 

- What we call: the “down staging aneurysms operation” 

- The total antegrade debranching technique 

Technique and personal experience 

In our experience these 2 different techniques have been used for type II TAAA. In a Group 

a, a “down staging operation” was performed using a staged hybrid operation started by a Stent 

Graft from the arch to the distal descending thoracic aorta and was followed by surgical repair 

under partial CPB limited to the celiac aorta (5 patients). In fact, this allow to convert an extend 

type II TAAA to a more limited type IV TAAA (fig 1). In a group b, a staged hybrid operation starting 

by debranching the aorta from sternotomy to supra aortic vessels and visceral arteries was 

followed by an extended stentgrafting (5 patients). We now favour this second attitude which 

avoids cardiopulmonary bypass and aortic clamping. The surgical approach is a median 

sternotomy combined to mid upper laparotomy associated to pericardial and diaphragm 

division. It is well tolerated even in elderly patients and allows easy access to celiac axis (CA), 

superior mesenteric artery (SMA), right renal artery (RAA). Access to the left renal artery is more 

difficult and may benefit from a combined stent grafting and bypass according to the V. O. R. T. 

E. C. technique described by Lachat. M (2) or extra anatomic bypass. 

Rerouting the visceral arteries is done from the ascending Aorta with a partial clamping. 

This implantation site is quite always undiseased offering a good anterograde high flow. 

Combined bypass to the supra aortic vessels is associated when needed. 

Post operative course and follow up. 

During the 30 D period, one patient died in group A, zero in group B. There was no 

paraplegia in these series. Two patients presented a prolonged hospital stay due to a respiratory 

failure and a pancreatic fistula. The other patients were discharged at day 10 after 2 days of ICU. 

Summary 

This preliminary experience seems to be promising. This new approach for rerouting the supra 

aortic and visceral arteries before stent grafting type II TAAA lowers the surgical injury and is 

particularly designed for HRP who cannot benefit from conventional surgery under Cardio 

pulmonary bypass (CPB). 

References 

1. Donas KP, Czerny M, Guber I, Teufelsbauer H, Nanobachvili J. [Hybrid open-endovascular 

repair for thoracoabdominal aortic aneurysms: current status and level of evidence] Eur J Vasc 

Endovasc Surg. 2007 Nov; 34 (5): 528-33. Epub 2007 Aug 1. 

2. Lachat M, Mayer D, Criado FJ, Pfammatter T, Rancic Z, Genoni M, Veith FJ. 

[New Technique to Facilitate Renal Revascularization with Use of Telescoping Self-Expanding Stent 

Grafts: VORTEC.] Vascular. 2008 Mar-Apr; 16 (2): 69-72. 

69

Microsimulation and clinical outcomes analysis support a lower age threshold for use of 

biological valves. Microsimulation bioprostheses 

Serban Stoica, a Kimberley Goldsmith, b Nikolaos Demiris, 

b Prakash Punjabi, c Geoffrey Berg, d Linda Sharples, b Stephen Large e 

aBristol Royal Children's Hospital; bMedical Research Council Biostatistics Unit, 

Cambridge; cHammersmith Hospital, London; dGolden Jubilee National Hospital, 

Glasgow; ePapworth Hospital, Cambridge, UK 

Background: We aimed to characterize contemporary results of aortic valve replacement 

(AVR) in relation to type of prosthesis and subsequent competing hazards. 

Methods: 5470 consecutive AVR ± coronary artery bypass grafting (CABG) patients were 

studied. Microsimulation of survival and valve-related outcomes was performed based on metaanalysis 

and patient data inputs, with separate models for age, gender and CABG. Survival was 

validated against the United Kingdom Heart Valve Registry. 

Results: Patient survival at 1, 5 and 10 years was 90%, 78% and 57% respectively. The 

crossover points at which bio- and mechanical prostheses conferred similar life expectancy (LE) 

was 59 years for males and females (no significant difference between 

prosthesis types between the ages of 56-69 for men, and 58-63 for women). The improvement in 

event-free LE for mechanical valves is greater at younger ages with a crossover point of 66 years 

for males and 67 years for females. Long-term survival was independently influenced by age, male 

gender, and concomitant CABG, but not by type of prosthesis. In bioprostheses the most common 

long-term occurrence is structural deterioration. For men aged 55, 65 and 75 at initial operation it 

has a lifetime incidence of 50%, 30% and 13% respectively. The simulation output showed excellent 

agreement with registry data. 

Conclusion: Bioprostheses can be implanted selectively in patients below 65 without 

significant long-term adverse effects. 

Carotid and Coronary Surgery - actual strategy 

I. Droc, I. Mocanu, Murgu V., Deaconu St., Pinte Fl 

Army’s Center for cardiovascular diseases, Bucharest, Romania 

Lacking randomised trials, a major controversy remains the optimal management of 

patients who presents concomitant carotid and coronary artery disease. 

The main question is whether staged or simultaneous endarterectomy (CEA) will reduce 

peri-operative morbidity and mortality after cardiac surgery. The reported results were 

encouraging using either of the two strategies, but there is no consensus as to which is preferable. 

Recently carotid artery angioplasty with stenting (CAS) represents a potential alternative to CEA 

mostly in 'high-risk for CEA patients. CAS offers a less invasive, safer therapeutic option for cardiac 

patients who underwent or will underwent CABG. In some particular situations CAS+CABG, such a 

strategy might be harmful. In particular, the need for dual antiplatelet therapy after CAS can be 

balanced with avoiding unnecessary bleeding complications after cardiac surgery. 

During 1-year period, between 01.01.2007 – 31.12.2007, at the Army’s Center of 

Cardiovascular Diseases 375 consecutive patients were referred for coronary surgery. 49 patients 

(13,3%) were found to have combined carotid and coronary disease. 37 patients (10%) underwent 

staged carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG), with a mean 

of 30±6 days between the interventions, and 12 patients (3,3%) underwent CABG and CEA 

simultaneously. The mean age was 62,8± 4,7 years and 32 patients (65%) were males. The majority 

of the cases (82%) presented triple vessel disease and 16,7% had left main disease. The carotid 

disease was unilateral in 43 patients (87,7%) and bilateral in 2 (4%), and 36 (74,0%) were 

neurologically asymptomatic. 

The overall morbidity and mortality after the two procedures is 19,2% (Randall, 2006) and 

after simultaneous procedure is 17,4% (Rutherford 2005). 

In conclusion the presence of carotid stenosis is per se a marker of risk. 

There is a need for a randomized controlled trial focusing on combined or staged surgical 

approach or endovascular therapy. 

70

SALA Saphire 

Simpozionul Societăţii Române de Anestezie-Terapie Intensivă 

Cardiacă şi Tehnologie Extracorporeală (SRATICTE) 

Sesiunea XII - Anemia si transfuzia in chirurgia cardiaca 

Daniela Filipescu (Bucureşti) Paradoxul anemie-transfuzie în chirurgia cardiacă 

Ioana Grigoraş (Iaşi) 

Este administrarea perioperatorie de fier o soluţie ? 

Metabolismul fierului la pacientul critic 

How to reduce allogenic blood transfusion in cardiac surgery 

Reducerea necesarului transfuzional în chirurgia cardiacă 

Stanca Aszalos, Muresan A, Negrutiu S, Slabu L, Steiu C, Vlad I 

Anesthesia and Intensive Care Unit, Institutul Inimii “N. Stancioiu” Cluj-Napoca 

Perioperative blood conservation is an important requirement in modern cardiac surgery. 

On one hand allogenic blood transfusion is accompanied by a significant number of serious 

complications (technical, infectious or immune) and is associated with an increase in 

postoperative mortality. On the other hand in our modern society the banked blood availability 

does not match the necessities and allogenic transfusion is associated with significant economic 

costs. There are three conceptual ways to avoid allergenic blood transfusions: tolerating a lower 

hematocrit, reducing the intra and postoperative blood loss and autologous transfusion. Cardiac 

surgery patients do not tolerate well extreme anemia and in order to avoid allogenic transfusion in 

such patients a complex approach following precise protocols is needed. In order to reduce the 

perioperative blood loss a number of pre, intra and postoperative measures and drugs are 

available, and these measures imply a close cooperation between surgeons, anesthetists and 

perfusionists. Autologous transfusion can be planned and performed in advance of a major 

operation, acute, performed immediate before the operation with concomitant hemodilution or 

may be accomplished by intraoperative blood salvage. All these methods have their own 

advantages and disadvantages and their use in a particular case must follow strict guidelines and 

protocols. 

Reducerea necesarului transfuzional in chirurgia cardiaca 

Reducerea necesarului transfuzional reprezinta o cerinta importanta a chirurgiei cardiace 

moderne. Pe de o parte transfuzia este asociata cu un numar de complicatii redutabile (tehnice, 

infectioase si imunologice) si este insotita de cresterea mortalitatii postoperatorii. Pe de alta parte 

in societatea moderna necesarul de sange a depasit demult resursele disponibile iar costurile 

economice sunt semnificative. Reducerea numarului de transfuzii poate fi realizata pe trei cai: 

tolerarea unui hematocrit scazut, reducerea pierderilor de sange si transfuzia autologa. Pacientii 

supusi interventiilor chirurgicale pe cord tolereaza mai greu anemia severa si in cazul lor evitarea 

transfuziei alogene necesita o abordare complexa urmarind protocoale stricte. Reducerea 

pierderilor de sange perioperatorii presupune un complex de masuri pre, intra si postoperatorii in 

aplicarea carora sunt implicati atat chirurgul cat si anestezistul si perfuzionistul si care includ 

tehnici si substante medicamentoase diferite. Transfuzia autologa poate fi si programata, 

preoperatorie, acuta intraoperatorie cu hemodilutie sau poate face apel la tehnicile de 

recuperare a sangelui din campul operator. Toate aceste metode au avantajele si dezavantajele 

lor iar utilizarea la un pacient anume trebuie strict individualizata si efectuata dupa ghiduri si 

protocoale precise. 

Carmen Movileanu, Roxana Toma, Mihaela 

Melinte, Horatiu Suciu (Tg. Mureş) 

Gabriela Olaru, Pavel Morar, Irina Modrigan, 


Sesiunea XIII 

Probleme 

pediatrică 

curente în practica transfuzională 

Particularităţi hematologice în patologia cianogenă 

postoperatorie 

71

Risk factors of renal dysfunction after cardiac surgery 

Factorii de risc ai disfuncţiei renale după intervenţii chirurgicale cardiace 

Dr. Balos S., dr. Kovacs Judit, dr. Mitre R., Jerzicska E., dr. Suciu H., prof. dr. Deac R., 

IUBCVT Targu-Mureş, UMF Targu-Mureş 

Renal dysfunction is a relatively common complication of cardiac surgery, its development 

significantly increasing postoperative morbidity and mortality. 

Material and methods. We conducted a retrospective study at IUBCVT Târgu-Mureş, from 

01/01/2009 to 01/07/2010, to determine risk factors for renal dysfunction and the efficiency of 

diuretics and continuous veno-venous hemodialysis therapy in the prevention and therapy of this 

syndrome. 

Results and discussion. During this period 1067 patients had underwent cardiac surgery, of 

which 74 (6,9%) developed renal dysfunction / failure. Renal dysfunction developed in patients 

with complex surgery with prolonged cardiopulmonary bypass, those with postoperative 

hemodynamic instability requiring treatment with high doses of inotropics and vasoconstrictors to 

maintain blood pressure and cardiac output. 34 patients required renal replacement therapy, the 

rest of the patients responding favorably to diuretics. 

Conclusions. Cardiac surgery is associated with a relatively high incidence of renal 

dysfunction. Pathogenesis of this syndrome after open heart surgery is complex and involves 

hemodynamic and inflammatory changes as well. Therefore the treatment to prevent the 

development of acute tubular necrosis should include rapid hemodynamic stabilisation and 

euvolemia. 

Factorii de risc ai disfuncţiei renale după intervenţii chirurgicale cardiace 

Disfuncţia renală este o complicaţie relativ frecventă a chirurgiei cardiace, dezvoltarea 

acesteia creşte semnificativ morbiditatea şi mortalitatea postoperatorie. 

Material şi metode. Am efectuat un studiu clinic retrospectiv în IUBCVT Tg-Mureş, în 

perioada 1.01.2009 – 1.07.2010. pentru a determina factorii de risc ai disfuncţiei renale 

şi eficienţa terapiei cu diuretice şi prin hemodializă veno-venoasă continuă în prevenirea şi terapia 

acestui sindrom. 

Rezultate şi discuţii. În această perioadă s-a intervenit chirurgical pe cord deschis la 1067 

pacienţi, dintre care la 74 (6,9%) a aparut o disfuncţie/ insuficienţă renală. Disfuncţia renală s-a 

dezvoltat la pacienţii cu intervenţii chirurgicale complexe, cu bypass cardiopulmonar prelungit, 

cu instabilitate hemodinamică postoperatorie, care au necesitat tratament cu doze mari de 

inotropice şi vasoconstrictoare pentru menţinerea tensiunii arteriale şi a debitului cardiac. 

Epurarea extrarenală a fost necesară la 4 pacienţi. Ceilalţi pacienţi au răspuns favorabil la terapia 

cu diuretice. 

Concluzii. Chirurgia cardiacă este asociată cu o incidenţă relativ crescută a disfuncţiei 

renale. Patogeneza acestui sindrom după intervenţii pe cord deschis este complexă, şi implică 

modificări hemodinamice şi inflamatorii deopotrivă. De aceea terapia pentru prevenirea necrozei 

tubulare acute trebuie să cuprindă stabilizarea hemodinamică rapidă şi asigurarea euvolemiei. 

AKI or RIFLE classification in evaluating the prognosis 

of cardiac surgery associated acute renal failure 

Clasificarea AKI sau RIFLE în evaluarea prognosticului insuficienţei renale acute asociate chirurgiei cardiace 

Dr. Balos S., dr. Kovacs Judit, dr. Mitre R., conf. dr. Suciu H., prof. dr. Deac R., IUBCVT Târgu-Mureş, 

Renal dysfunction is a complex syndrome, with clinical and laboratory manifestations 

ranging from minor changes in serum creatinine to anuria and even metabolic coma. In recent 

years two scores were developed to diagnose renal dysfunction. Our study aim to compare them 

in terms of prognostic assessment of acute renal failure associated with cardiac surgery. 

Materials and methods. We conducted a study on 44 patients with open heart surgery in 

IUBCVT Targu-Mureş, between 09/01/2009 to 06/30/2010, who developed various degrees of renal 

dysfunction in the postoperative period. In these patients we calculated and compared the AKI 

score and RIFLE score and studied the progression of the renal syndrome in terms of these scores. 

Results and discussion. AKI criteria allowed to identify more patients having acute renal 

dysfunction (100% vs. 75%) and more patients were classified at stage I (risk group in RIFLE 

classification) (12 vs. 4), but we observed no differences for stage II (renal dysfunction in RIFLE 

72

classification) and stage III (renal failure in RIFLE classification). Mortality was higher in renal failure 

according to RIFLE criteria and in stage III in AKI criteria. 

Conclusions. AKI criteria are more sensitive in identifying patients at risk for renal 

dysfunction / failure after open heart surgery, but there were no differences in the estimation of 

postoperative mortality between the two scales. 

Clasificarea AKI sau RIFLE în evaluarea prognosticului insuficienţei renale acute asociate chirurgiei cardiace 

Disfuncţia renală este un sindrom complex, cu manifestări clinice şi paraclinice variate, 

pornind de la modificări minore ale creatininei serice până la anurie şi chiar comă metabolică. În 

ultimii ani au apărut mai multe scoruri pentru diagnosticarea şi stadializarea disfuncţiei renale. 

Scopul lucrării a fost compararea acestor date în ceea ce priveşte evaluarea prognosticului 

insuficienţei renale acute asociate chirurgiei cardiace. 

Materiale şi metode. Am efectuat un studiu clinic pe 44 pacienţi operaţi pe cord deschis la 

IUBCVT Târgu-Mureş în perioada 1.09.2009-30.06.2010, la care s-au dezvoltat diferite grade de 

disfuncţie renală în perioada postoperatorie. La aceşti pacienţi s-a calculat şi comparat scorul 

RIFLE, scorul AKI şi s-a studiat evoluţia bolii în funcţie de aceste scoruri. 

Rezultate şi discuţii. Criteriile AKI au permis identificarea mai multor pacienţi ca având 

disfuncţie renală acută (100% faţă de 75%) şi au clasificat mai mulţi pacienţi în stadiul I (grupa de 

risc în clasificarea RIFLE) (12 vs. 4), dar nu am observat diferenţe pentru stadiul II (disfuncţe în 

clasificarea RIFLE) şi pentru stadiul III (insuficienţă renală în clasificarea RIFLE). Mortalitatea a fost 

mai mare în caz de insuficienţă renală acută conform criteriilor RIFLE respectiv stadiul III conform 

criteriilor AKI. 

Concluzii. Criteriile AKI sunt mai sensibile în identificarea pacienţilor cu risc crescut pentru a 

dezvolta disfuncţie / insuficienţă renală după intervenţii pe cord deschis, dar nu există diferenţe în 

ceea ce priveşte estimarea mortalităţii postoperatorii între cele două scale. 

N-GAL - early marker for acute renal injury in cardiac surgery? 

Anca Prodea, Mihail Luchian, Alina Paunescu, Ioana Marinica, Oana Ghenu, Simona Marin, Oana 

Mihailescu, Laura Dima, Ovidiu Chioncel, Luminita Iliuta, Daniela Filipescu, Cezar Macarie 

Department of Cardiac Anesthesia & Intensive Care 

Emergency Institute for Cardiovascular Disease, Bucharest, Romania 

Background: Postoperative acute kidney injury (AKI) is a frequent complication after 

cardiac surgery and is related to different mechanisms. AKI is typically diagnosed by measuring 

serum creatinine concentrations but unfortunately creatinine is very insensitive to even substantial 

decline in glomerular filtration rate. The purpose of our study is to analyze the utility of plasmatic 

neutrophil gelatinase-associated lipocalin (N-GAL) determination for detection of early kidney 

injury in unselected patients admitted in intensive cardiac care unit post cardiac surgery with 

cardiopulmonary bypass (CPB). 

Method: Plasma N-GAL level was determined preoperatively (baseline value), 2 hours 

postoperatively and in the first postoperative day in consecutive cardiac on pump surgery 

patients. Patients with abnormal preoperative creatinine value were excluded. AKI was defined as 

an increase in serum creatinine >50% from baseline within the first 72 hours post operatively. N-GAL 

was determined with ELISA test kitt with maximal normal value of 106 ng/ml. Maximal values of N- 

GAL in patients with and without AKI were assessed using logistic regression. The analysis of ROC 

curve was utilized for determination of sensitivity, specificity and cutoff value of postoperative N- 

GAL predicting postoperative AKI. 

Results: 22 patients (17 men and 5 women) were included. 6 patients (27,3%) had AKI and 

5 patients (83,3%) from the group of AKI had a N-GAL value of more than 106 ng⁄ml. In the group 

without AKI, 11 (68,7%) patients had an abnormal N-GAL value. Plasma N-GAL levels after CPB 

were higher in patients who subsequently developed AKI than in those who did not (180,5 (103- 

218) ng/ml vs. 133 (42-232) ng/ml, p

Sesiunea XIV - Siguranţa pacientului în timpul circulaţiei extracorporeale 

Monitoring and Safety Issues in Cardiopulmonary 

Dan Longrois (Paris) 

Bypass 

Oana Ghenu, Mihai Luchian, Victor Pavel, Gabi 

Olteanu, Horaţiu Moldovan, Vlad Iliescu, Daniela Locul ECMO în chirurgia cardiacă 

Filipescu (Bucureşti) 

Dan Longrois (Paris) Experienţa clinica cu ECMO 

Cardio Pulmonary By-Pass Between Neurocognitive Deficits 

in the Past to Postconditioning in the Future? 

Circulaţia extracorporeală de la disfuncţia neurocognitivă în trecut, la postcondiţionare în viitor? 

Diaconescu Victor Mihail 

IBCV “Prof. Dr. Ge. I. M. Georgescu” Iaşi 

Neurocognitiv deficits in cardiac surgery was linked to CPBP. In the last period of time this 

issue is denied. Recently enough, there were published laboratory data on cardiac and neuronal 

postconditioning that could be induced by perfusion changed technique. We include some data 

on preconditioning. The new policy in CPBP may include the possibility of postconditioning in the 

management of elderly patient. 

Bibliografie. Jakob Vinten-Johansen Postconditioning and Controlled Reperfusion, The 

Nerve of It All Anesthesiology 2009; 111: 1177–9 

Lidocaine intravenous is it better? 

Victor Mihail Diaconescu 

Secţia ATI Institutul de Boli Cardiovasculare „Prof.Dr. Ge IM Georgescu” Iaşi 

Postoperative pain remains an incomplete solved issue. There are studies that demonstrate 

the utility of associated intravenous and continuously lidocaine to opioids in anesthesia and in 

postoperative anlgesia. The administered lidocaine reduces the amount of necessary opioids for 

anesthesia and postoperative analgesia and facilitates the gastrointestinal function recovery. The 

link between pain, proinflamatory cytokins and the modulatory action of lidocain on cytokins is 

the main mechanism in the recent studies. 

Method: we random separated two groups of patients – the Saline group and the 

Lidocaine group; the last one received lidocaine intravenous continouslly 2mg/kg/h and 

morphine per cardiac anesthesia, then 1,3mg/kg/h in the postoperative analgesia along with 

tramadol and acetaminophen. 

Conclusion: the opioid consumption was reduced and the intestinal recovery was 12 hours 

faster. We assume that lidocaine administered as part of the analgesia protocol is a good option 

to reduce the opioid consumption and side effects. 

Blood Cardioplegia Leukocyte Filtration – a Myocardial Protection Strategy. 

Filtrarea leucocitara a cardioplegiei cu sange - strategie de protectie miocardică în timpul CEC. 

V. Murgu, I. Mocanu, G. Cristian, I. Droc, G. Sandu, I. Tintoiu, Andreea Teodorescu, Laura Vamanu, 

Andreea Tifrea, Anca Filip, Florina Pinte, I. Tintoiu. 

SIRS (Systemic Inflammatory Response Syndrome) and especially SIRAB (Systemic 

Inflammatory Response Syndrome After cardiopulmonary Bypass) may be life threatening in 

extreme cases. 

Ischemia reperfusion injury is a manifestation of SIRS involving both humoral and cellular 

systemic response, particularly polymorfonuclear leukocytes activation. 

Neutrophyl activation involves two major mechanisms: 1) contact of circulating leukocytes 

with artificial surfaces and (2) ischemia reperfusion injury after the release of the aortic clamp. 

SLF (Strategic Leukocyte Filtration) implies the use of the leukocyte filters only during the 

early postischemic reperfusion phase. 

74

Mechanisms of the leukocyte depleting filters involve al least four kinds of leukocyte 

entrapment: blocking, bridging, interception and adhesion. 

On the other hand SLF (Selective Leukocyte Filtration) of blood cardioplegia adresses to a highly 

pathogenic situation with repetitive 20 min. periods of ischemia followed by a short reperfusion 

phase during cardioplegic reinfusion. 

Our study using systemic leukocyte filtration in the due respect of what means today SLF 

(Strategic Leukocyte Filtration) and TLC (Total Leukocyte Control) reveals better results using 

arterial vs venous line leukocyte filters during CPB in terms of acute phase response markers 

(Reactive CP, IL- 6), leukocyte activation markers (elastase, MPO- Myloperoxidase), injury 

myocardial reperfusion markers (T Troponin, CKMB, lactic acid- from blood coronary sinus), 

inotropic suport, ejection fraction, ICU stay, etc. 

Leukocyte Filtration of blood cardioplegia reduces myocardial ischemia and improves 

cardiac function as determined by stroke work index, limits necrosis, reduces CKMB concentration, 

limits the oxidative damage (MDA in coronary sinus blood) and reduces the inotropic support. 

Keywords: SIRS, SIRAB, Ischemia/reperfusion injury TLC (Total Leukocyte Control), SLF 

(Strategic Leukocyte Filtration) 

Jozsef Budai (Tg. Mures) 

Rezistenţa la heparină - importanţa problemei pentru 

circulaţia extracorporeală 

The advantages of intermittent warm blood cardioplegia supplemented with Mg++ 

Guzgan Iu., Vîrlan E., Matcovschi I., Moscalu V., Manolache S., Batrinac A. 


Combined crystalloid blood cardioplegic solution (2 parts crystalloid, one part venous 

blood), elaborated and implemented by our specialists, assured a good protection of 

myocardium, during the operations also with a long Ao cross-clamping time. This is proved through 

results of more then 3000 of interventions with CPB since 1995 and by clinical, morphological and 

biochemical studies. The revising of temperature protocol and the necessity of extending the time 

between reperfusions according to techniques performed by surgeons determined the need in 

other tactics related to myocardial protection. 

Purpose of study: Evaluation of the efficacy of intermittent warm blood cardioplegia 

supplemented with Mg++ for more lasting protection of myocardium during cardiac arrest. 

Material and methods: The study was performed throughout two groups of patients with no 

significant difference in preoperative clinical conditions, who underwent operations with CPB 

during the February-March 2010 period. In Ist group (control) intermittent cold crystalloid-blood 

cardioplegia (8-10 oC) was delivered every 20 minutes, rectal temperature decreased to 30±1,5 oC. 

In the 2nd group of patients temperature was maintained at 35,5±1,1 oC with applying the warm 

blood cardioplegia according to Calafiore protocol subsequently modified by Casalino et al. by 

adding the magnesia sulfate and extending the period of ischemia up to 25 minutes. The efficacy 

of myocardial protection was done using clinical and functional parameters: the frequency of 

spontaneous cardiac rhythm restoration; emergence of electrocardiographic changes; the 

frequency of applying of cardio version after the reperfusion; the requirement in inotropes during 

the first two days after the intervention; length of staying in ICU. 

Rezults: Besides the convenience of cardioplegic process management, in group II of 

patients were noted several moments of obvious superiority of warm blood cardioplegy 

performed at intervals of 25 minutes of ischemia. Spontaneous restoration of rhythm was 48% in 

group I and in II - 72%. As the absolute number of cardioversion remained practically equal in both 

groups, the II group had fewer patients whom were applied cardioversions after reperfusion. AV 

blocks occurred at equal. Number of patients requiring inotropic support in the early days was 

more representative of the control group. Average length of stay in ICU was 2.5 ± 0.3 for study 

group to 2.9 ± 0.4 for control group. 

Conclusions: Intermittent warm blood cardioplegia with Mg + + allows safe extension of the 

period of ischemia between reperfusions to 25 minutes and has a positive impact on some clinical 

and functional parameters of patients in the immediate postoperative period. 

75

Sesiunea XV 

Percutaneous tracheostomy in ICU patients under videolaryngoscopy 

Traheostomia percutană în terapia intensivă sub control videolaringoscopic 

Ion Miclea, Violeta Bercan, Şerban Bubenek 

Institutul de Urgenţă pentru Boli Cardiovasculare “Prof. Dr. C.C. Iliescu”, Bucharest, Romania 

Modern intensive care involves a series of maneuvers that were formerly the exclusive 

preserve of surgery. Current technology provides special medical kits for percutaneous 

tracheostomy, pleural punctures, intra-aortic balloon pump, etc., facilitating these maneuvers, 

which have become common in intensive care units. Percutaneous tracheostomy occupies an 

important place in airway management of critical ill patient. 

Nowadays, percutaneous tracheostomy became very important in comparision to 

conventional surgical traheostomy. Dilatation technique is considered the gold standard. There 

are more than 600 publications related to percutaneous tracheostomy that were mentioned after 

1985. 

Indications of tracheostomy: - Need for prolonged mechanical ventilation, Airway 

obstruction, Need for improved pulmonary toilet, Inadequate caugh due to chronic pain or 

weakness, Aspiration and the inability to handle secretions, Prophylaxis (preparation for extensive 

head and neck procedures and the convalescent period), Severe sleep apnea not amendable 

to continuous positive airway pressure devices. 

Videolaryngoscopy during percutaneous tracheostomy 

During percutaneous tracheostomy it is possible to puncture the endotracheal tube, or its 

cuff, with the needle, which can lead to airway depressurization, with the risk of difficult ventilation 

or gastric aspiration. To minimize this risk, there is the possibility of withdrawing the intubation tube 

under videolaryngoscopic control. The endotracheal tube is withdrawn until its cuff is seen 

between the vocal cords. The balloon is than inflated, and the percutaneous tracheostomy 

continues in the classical technique. Any reposition of the endotracheal tube, or patient’s 

intubation can be more easily controlled under videolaryngoscopy than with direct laryngoscopy. 

The anaesthetist position during videolaryngoscopy is more convenient than that of direct 

laryngoscopy. With the Glidescope the image of the trachea and the vocal cords is transmitted 

on the screen. 

Role Of The Highly Specific C-Reactive Protein In Perioperatory Risk Evaluation Of Surgical 

Myocardial Revascularization 

Proteina C reactivă înalt specifică în optimizarea predicţiei morbidităţii şi mortalităţii în 

chirurgia de revascularizare miocardică faţă de scorurile clasice 

Lazăr Ovidiu, Goleanu Viorel, Tică Talida, Stanciu Crina, 

Mitulescu Adina, Cârjaliu Ionuţ, Butuşină Marian 

The experience of C.B.C.V. “Agrippa Ionescu” 

The highly specific C-reactive protein – hsCRP, reprezents an independent factor with a 

highly predictive value for postoperative complications, that can occur after surgical myocardial 

revascularization (CABG). 

The aim of our retrospective study consists in the evaluation of suplimentary informations 

and in the optimization, in terms of predictive value, of the currently used clasical scores for 

preoperatory risc asessment (mortality and morbidity) and ICU admision of CABG. 

The study includes 70 pacients with indication for CABG. Preoperatory we calculated 

several mortality and morbidity risk asessment scores as follows: EUROSCORE, PARSONNET, 

ACC/AHA, BIAGIOLI, ICU ADMISION HIGGINS. 

The patinets were followed for 30 days after CABG. 

Results: The hsCRP level, considered “cut-off” is 3, 3 mg/l. The patients presenting high 

levels of hsCRP were also included in the group with an increased incident of mortality and 

morbidity. 

76

Levosimendan in pediatric cardiac surgery 

– preliminary conclusions based on two case reports 

Vlad Ioan H. 

Anesthesia and Intensive Care Unit, Institutul Inimii “N. Stancioiu” Cluj-Napoca 

The objective of this paper is to describe our preliminary experience with levosimendan in 

pediatric cardiac surgery patients. 

The two patients have been operated and treated in the cardiovascular surgery 

department of the Heart Institute “N. Stancioiu” in Cluj-Napoca. The first patient was a one year 

old infant who was admitted for the surgical correction of a severe mitral regurgitation and a 

persistent ductus arteriosus with severe pulmonary hypertension and heart failure. The second 

patient was a newborn with coarctation of the aorta, persistent ductus arteriosus, atrial and 

ventricular septal communications, grade III tricuspid regurgitation, pulmonary hypertension 

cardiogenic shock and respiratory failure. The first patient received a single dose of levosimendan 

while the second patient received two doses. The efficiency and safety of the treatment with 

levosimendan were appreciated by the monitoring of hemodynamic parameters (heart rate, 

arterial pressure, central venous pressure) and by echocardiography. Additionally, the need for 

concomitant therapy with “classical” inotropes was also taken into account. The hemodynamic 

parameters remained stable during and after the levosimendan infusion and echocardiography 

showed an increase in myocardial contractility. Both patients have received long term inotropic 

support reflecting the fact thatnumerous factors are involved in the etiology of the low cardiac 

output syndrome. 

Levosimendan is a safe and efficient therapeutic alternative in pediatric cardiac surgery. 

The inotropic effect is good, rapid and long lasting, the side effects are minimal and it can be 

combined with other inotropes. Additional studies in this setting and a treatment protocol are still 

necessary before routinely use levosimendan in pediatric cardiac surgery. 

Key words: levosimendan, pediatric cardiac surgery, low cardiac output 

Levosimendan in chirurgia cardiaca pediatrica - consideratii pe marginea a doua 

prezentari de caz. 

Obiectivul acestei lucrari il constituie descrierea si interpretarea constatarilor facute in 

urma utilizarii levosimendanului la doi copii operati pe cord si care au prezentat disfunctie 

miocardica severa. 

Cei doi pacienti au fost operati si urmariti in Clinica de chirurgie cardiovasculara a 

Institutului Inimii din Cluj-Napoca. Este vorba despre o fetita de un an care s-a prezentat pentru 

corectia chirurgicala a unei insuficiente mitrale congenitale severe si a unui canal arterial 

permeabil cu hipertensiune pulmonara si insuficienta cardiaca NYHA III si despre un nou nascut 

care a fost internat cu diagnosticul de coarctatie de aorta, persistenta canalului arterial, defect 

septal interatrial, defect septal interventricular, insuficienta tricuspidiana gradul III, hipertensiune 

pulmonara, soc cardiogen, insuficienta respiratorie acuta. 

In primul caz s-a administrat o doza unica de levosimendan in timp ce la cel de al doilea 

pacient s-au administrat doua doze. 

Eficienta si siguranta tratamentului au fost apreciate prin urmarirea parametrilor 

hemodinamici (frecventa cardiaca, presiune arteriala, presiune venoasa), a aspectului 

ecocardiografic si a necesarului de inotrope “clasice”. Parametrii hemodinamici au ramas stabili 

in timpul si dupa administrarea levosimendanului in timp ce ecocardiografia a aratat o crestere a 

contractilitatii miocardice. Tratamentul inotrop asociat a fost de durata, reflectand etiologia 

plurifactoriala a sindromului de debit cardiac scazut. 

In concluzie levosimendanul constituie o alternativa terapeutica viabila in chirurgia 

cardiaca pediatrica, atuurile sale fiind efectul inotrop bun, rapid si de durata, lipsa efectelor 

secundare majore si posibilitatea de asociere cu alte antiaritmice. Ar fi insa utile studii care sa 

plaseze exact levosimendanul in lista inotropelor utilizate perioperator, eventual chiar un algoritm 

de administrare similar cu ce de la adulti. 

Cuvinte cheie: levosimendan, chirurgie cardiaca pediatrica, sindrom de debit cardiac 

scazut. 

77

Levosimendan in patients with postoperative haemofiltration 

Levosimendan la pacienti hemofiltrati postoperator 

Mihail Luchian, Ioana Marinica, Alina Paunescu, Oana Ghenu, Simona Marin, Anca Prodea, Ovidiu 

Chioncel, Luminita Iliuta, Oana Mihailescu, Horatiu Moldovan, Vlad Iliescu, Daniela Filipescu 



Background: Levosimendan is a new ino-dilator drug with a special pharmacokinetics. The 

half-life is approximately 1 hour. However, its metabolites have a long half-life explaining the 

hemodynamic effects after the administration of the drug. In contrast to levosimendan, the 

metabolites are dialyzable. Data on the use of levosimendan in patients requiring continuous renal 

replacement therapy (CRRT) are scarce. 

Method: We present our experience with levosimendan (0,1 μg/kg/hour over 24 hours 

without bolus) in twelve consecutive patients with refractory cardiogenic shock after ST-elevation 

myocardial infarction (3 patients) or after cardiac surgery (9 patients), who developed multiorgan 

dysfunction syndrome and also required CRRT. Hemodynamic effects were registered 

invasively and monitored over 72 hours post infusion. Measured parameters were: cardiac 

output/index (CO/CI), pulmonary artery occlusion pressure (PaOP), left ventricular ejection 

fraction (LVEF), mixed venous oxygen saturation (SvO2) and cardiac power (CPO). Length of stay 

(LOS) in cardiac intensive care (CICU) and in-CICU mortality was also registered. Data were 

expressed as mean ± standard deviation (SD). Fisher’s exact test and non-paired t-test were used 

when appropriate. P-value

Scopul lucrarii: Sindromul de raspuns inflamator sistemic (SIRS) si sindromul vasodilatator 

afecteaza pacientii dupa chirurgia cardiaca cu circulatie extracorporeala. Studii anterioare au 

demonstrat beneficiile utilizarii cortizonului in doze mici perioperator. Scopul lucrarii este 

demonstrarea efectelor benefice ale administarii de hemisuccinat de hidrocortizon doar in ziua 

operatiei la pacientii cu risc crescut. 

Material si metoda: Studiu prospectiv pe o serie de 52 de pacienti consecutivi cu risc 

crescut in chirurgia cardiaca. Jumatate din pacienti (26) au primit 100 mg HHC iv bolus la inductia 

anesteziei si 100 mg HHC in perfuzie lenta pe tot parcursul operatiei. 

Concluzii: Am masurat parametri paraclinici (lactat), clinici (durata ventilatiei mecanice, 

durata de sedere in terapie intensiva, utilizarea de vasopresor) incidenta complicatiilor (fibrilatie 

atriala, infectii), mortalitate. Utilizarea dozei stress de HHC doar in timpul operatiei are efecte 

benefice la pacientii cu risc crescut in chirurgia cardiaca. 

Victor Diaconescu (Iaşi) Efecte antiinflamatorii ale combinaţiei xilină-morfină 

Anestezia loco-regionala (blocul cervical) in chirurgia carotidiana – evaluare retrospectiva a 

experientiei din Clinica de Chirurgie Vasculara a SUUB 

Dr. Dumitrescu Radu Mihai medic specialist ATI, 

Dr. Tutor Cristina Anca medic specialist ATI, Sef Lucrari Dr. Copaciu Elena medic primar 

ATI-Clinica ATI Spitalul Universitar de Urgenta Bucuresti 

Introducere: Endarterectomia carotidiana (CEA) reprezinta o preocupare constanta a 

clinicii noastre; in intervalul de timp studiat (martie 2009-iunie 2010) au fost realizate 142 de 

proceduri sub anestezie loco-regionala, unilaterale sau bilaterale simultane reprezentand 42,90% 

din totalul interventiilor. Alegerea tehnicilor de anestezie loco-regionala (ALR) a avut drept 

premise raportarile din literatura de specialitate privind stabilitatea hemodinamica superioara si 

rata mai redusa a complicatiilor cardio-respiratorii perioperatorii (Magnadottir), incidenta mai 

redusa a accidentelor vasculare cerebrale si a atacurilor ischemice tranzitorii (Zvara) precum si 

datele privind monitorizarea neurologica si decizia aplicarii shuntului intraoperator 

(Stoughton).Tehnica anestezica a constat din injectarea unei dilutii de anestezic local 

(ropivacaina), dupa o tehnica modificata, realizandu-se un bloc cervical superficial si profund. 

Monitorizarea intraanestezica a fost una standard (inclusiv TA invaziv cu abord radial, EKG in 5 

derivatii cu monitorizarea de segment ST). 

Obiective: evaluarea incidentelor legate de ALR precum si a evenimentelor neurologice 

majore in cazul interventiilor de CEA precum si raportarea lor la cifrele din literatura; aprecierea 

nivelului de siguranta a tehnicii anestezice. 

Loturile de pacienti studiati au cuprins: 50 de pacienti supusi CEA bilaterala simultana si 87 

de pacienti supusi CEA unilaterala (58,62% stanga si 41,37% dreapta). Au mai fost realizate 12 

interventii complexe sub ALR combinata (bloc cervical si interscalenic) pentru by-pass subclaviocarotidian 

(ipsi sau contralateral) si reimplantare de artera vertebrala simultan cu CEA unilaterala. 

Indicatorii demografici: 73,23% barbati si 26,76% femei cu o repartitie a varstelor medii 65,31 ani 

respectiv 70 ani (CEA unilaterala) si 66 ani respectiv 64,53 ani (CEA bilaterala). Timpul mediu pana 

la externare a fost de 6,04 zile in cazul CEA unilaterala si 5,93 zile in cazul CEA bilaterala fiind 

influentat de tehnica anestezica in cazul unor pacienti cu patologie asociata complexa si 

incadrati in clasa de risc anestezic ASA III-IV. 

Rezultate si concluzii: Superioritatea ALR folosite s-a dovedit in monitorizarea adecvata a 

statusului neurologic (pastrarea contactului verbal si monitorizarea functiei motrice a membrului 

superior contralateral); decizia montarii shuntului temporar intraoperator a fost luata in 5 cazuri de 

CEA unilaterala (5,87%) si 11 cazuri de CEA bilaterala (22%). Din punct de vedere al incidentelor 

legate de tehnica anestezica s-au inregistrat: 3 cazuri de mioclonii faciala si 2 cazuri de convulsii 

cupate rapid la benzodiazepine (3,52%). In 2 cazuri s-a realizat convertirea la anestezie generala 

prin lipsa de cooperare a pacientilor. A existat un sindrom coronarian acut intraoperator si un 

accident vascular cerebral major prin tromboza ACC urmat de decesul pacientului la 10 zile 

postoperator; in 4 cazuri s-a observat si documentat AVC ischemic cu evolutie in curs de 

recuperare la momentul externarii (3,52%). Pentru 2 cazuri care au prezentat hematom 

laterocervical s-a reintervenit precoce pentru controlul hemostazei. Tehnica anestezica s-a 

dovedit avand un profil de siguranta superior, cu cifre referitoare la incidente similare celor din 

literatura. 

79

Oana Mihăilescu, Alina Păunescu, Mihai 

Luchian, Anca Prodea, Oana Ghenu, Ioana 

Marinică, Simona Marin, Laura Dima, Ovidiu 

Chioncel, Luminiţa Iliuţă, Sorin Maximeasa, 

Horaţiu Moldovan, Vlad Iliescu, Daniela Filipescu 

(Bucureşti) 

Este troponina predictivă post chirurgie cardiacă? 

Is Troponin a predictive biomarker in cardiac surgery? 

Oana Mihailescu, Alina Paunescu, Oana Ghenu, Mihai Luchian, Anca Prodea, Simona Marin, 

Ovidiu Chioncel, Luminita Iliuta, Sorin Maximeasa, Horatiu Molovan, Vlad Iliescu, Daniela Filipescu 

Introduction: Cardiac biomarker sensitivity is crucial for detecting postoperative 

myocardial infarction (POMI) and consequently, for prediction of outcome after cardiac surgery. 

The aim of our study was to evaluate the perioperative dynamics of troponin I and its value in risk 

stratification after coronary artery bypass grafting (CABG) surgery. 

Methods: This study is a prospective observational one. Troponin I levels were measured 

preoperatively, in the first 24 hours and on the 7th day after CABG surgery. At the same time 

periods, the following were also assessed: ECG, total creatinine kinase and MB fraction, and transthoracic 

echocardiography images. Demographic and surgical data, medications, duration of 

extracorporeal circulation (ECC) and of aortic cross clamping, postoperative complications, ICU 

and hospitalization length of stay (LOS), and mortality were recorded. Statistical analyses using 

area under the curve (AUC) examined in receiver operating characteristic (ROC) curves in a 

multivariable model and compared analysis of variance (Oneway ANOVA) were performed. 

Results: 158 patients were included, 122 men and 36 women, with a mean age of 60 years. 

Mean troponin I levels increased in the first day after surgery as compared to baseline values 

(mean value 5.078± 9.38 ng/ml) and fall until the 7 th day (mean value 0.38± 0.825 ng/ml). 

Preoperatively all the values of troponin I were normal. POMI was diagnosed in 5 (3.16 %) patients. 

In these patients the mean value of troponin I was 36.3 ng/ml. A significant correlation between 

the value of troponin I in first postoperative day and the duration of ECC (r=0.231, p=0.004) was 

detected. We found two independent predictors for relative decrease of troponin I in the 

postoperative period: the need of positive inotropic therapy (p=0.005) and the left ventricular 

mass (r= 0.206; p=0.023). No relevant correlations between the values of troponin I and 

postoperative complications, mortality, ICU LOS or hospital LOS were found. 

Conclusion: Troponin I level increased in all patients after CABG surgery in the first 

postoperative day as compared to baseline and fall until the 7 th day. However, the relative 

decrease on the 7 th postoperative day was smaller in patients on positive inotropic therapy and in 

patients with higher left ventricular mass. In our study the values of troponin I were not correlated 

with postoperative complications and had no value for risk stratification after CABG surgery. 

Role of ROTEM in post cardiac surgery bleeding 

Daniela Manea, Mihail Luchian, Alina Paunescu, Ioana Marinica, 

Anca Prodea, Oana Ghenu, Simona Marin, Daniela Filipescu 



Background: Cardiac surgery still associates a high postoperative bleeding risk. This risk is 

accompanied by increased morbidity and mortality and it is also closely connected to increased 

transfusion demand. We analyzed the utility of thromboelastometry (ROTEM) in the management 

of significant postoperative bleeding after cardiac surgery in patients with cardiopulmonary 

bypass (CPB). 

Method: We analyzed ROTEM parameters (EXTEM, INTEM, HEPTEM and FIBTEM) in patients 

aged over 18 years, operated on CPB during a 4 month period and having a chest drainage over 

400 ml in the first 6 postoperative hours. Demographic data, type of intervention, CPB and aortic 

cross-clamp duration and minimal temperature on CPB were registered. Haematocrit, 

haemoglobin, platelet count, APTT, INR and the level of fibrinogen were measured preoperatively, 

at the end of the intervention, in the first 6 postoperative hours, and during the 6-12 postoperative 

80

hours. The blood transfusion products (packed red blood cells –PRBC, fresh frozen plasma-FFP and 

platelet concentrate-PC) as well as the hemostatic reintervention and complications were also 

registered. 

Results: There were 7 patients (5 males, 2 females with a mean age of 59±12, 4 years) that 

met the proposed criteria. The mean drainage in the first 6 postoperative hours was 907±567 ml 

(400-2100) and 1164±505ml (800-2250) during the first 12 postoperative hours. 5 patients were on 

aspirin preoperatively and all 7 patients received tranexamic acid (3-6 g) during the intervention. 

At least one ROTEM parameter was affected in all 7 patients. The incidence of hemostatic 

reintervention was 42, 8% (3 patients). Following the ROTEM algorithm for coagulation factors and 

protamin supplementation we succeeded to avoid haemostatic reintervention in 4 patients. The 

blood product usage (mean values) during the first 6/12 hours was: PRBC 2, 4±1, 13/4, 14±2, 03 

units, FFP 2, 86±2, 73/3, 57±3, 36 units, and PC 0, 57±1, 51/1±2, 6 units. There was an increased 

incidence (28. 6%) of prolonged mechanical ventilation, atrial fibrillation, acute renal failure and 

neurologic dysfunction in our study group. 

Conclusions: Evaluation of bleeding cause post cardiac surgery is difficult. The presence of 

coagulation abnormalities do not rule out a surgical source. The use of ROTEM parameters may 

differentiate the cause and optimize the management of bleeding reducing the number of 

reinterventions to control haemostasis after cardiac surgery. 

Cristina Ciochină, Mihai Luchian, Oana Ghenu, 


Anca Prodea, Ovidiu Chioncel, Luminiţa Iliuţă, 

Oana Mihăilescu, Daniela Filipescu (Bucureşti) 

Suciu Horaţiu 


Andrei Iosifescu, Lucian Dorobantu, Sorin 

Maximeasa, Traian Anca, Cristian Boroş, Vlad 

Iliescu 


Bucureşti 

Andrei Iosifescu, Alexandru Cornea, Traian Anca, 

Ioana Ghiorghiu, Platon Pavel, Ioana Marinică, 

Vlad Iliescu 


Bucureşti 

Ce aduce nou ghidul de resuscitare în chirurgia 

cardiacă? 

SALA Ruby 

Grupul de lucrări « CONGENITALI » 

Sesiunea XVI 

Actualităţi în chirurgia pediatrică 

Update in pediatric cardiac surgery 

Tratamentul chirurgical al afecţiunilor congenitale ale 

căii de ieşire din ventriculul stâng 

Stenoza infundibulară pulmonară extrinsecă 

secundară pericarditei constrictive la copil– 

prezentarea unui caz tratat chirurgical 

Baloon angioplasty of pulmonary artery valve 

Ilona Cucu, Vasile Sirbu, Liviu Maniuc, Oleg Repin 


The aim of the study: Evaluation of immediate and long-term results after the valve balloon 

angioplasty in isolated pulmonary artery stenosis. 

Material and methods: During the period 1998-2009 years were made 187 balloon 

angioplasties of pulmonary artery valve. Average age of patients was 5,8 +/- 2,6 years (0-18), 

children up to one year -22 patients (11,7%), above 18 years - 59 patients (31,5%). Out of them 25 

patients had systolic gradient between pulmonary artery and right ventricle 50 mmHg; in 139 

patients (74,6%) gradient VD / AP between 50-100mmHg; in 23 patients the gradient RV/PA> 

100mmHg. 

81

Results: Analysis of pulmonary artery valve balloon angioplasty revealed that satisfactory 

results with a low restenosis rate which were seen in group of patients from 1 to 5 years; in group of 

patients with PG VD/PA 

100mmHg prior to procedure 112 + / -7,7, after – 48,3 + / -8,6. 

The patients group from 5-18 years < 50mmHg before the procedure had 51,5 + / -2,8, after 

– 6,7 +/-3,5; in the group with GP VD/PA from 50-100mmHg before the intervention was 89,2 +/-7,3, 

after – 23,3 +/-3,4; in group GP VD/AP > 100mmHg prior the procedure 125,8 +/-5,7, after – 52,3 +/- 

8,6. 

Complications were determined in 31 patients: papillary muscle rupture – 1 pacient, 2 

patients – ileofemoral thrombosis, 19 patients - transient heart rhythm disorders, in 8 patients - 

allergic reaction. There was a fatal case of acute heart failure in the period immediately after 

surgery in patient 3 months diagnosed with severe mitral valve stenosis with PA 154mmHg 

gradient. 

Long-term results were studied in 112 patients (59,9%) from 6 months to 9 years. Repeated 

angioplasty was performed in 20 patients; 3 patients were operated due to RV outflow tract 

stenosis and 3 patients - due to valve ring hypoplazy. 

Conclusion: Analysis of data received demonstrated that balloon angioplasty of PA valve 

is a less traumatic and effective method to treat PA valve isolated stenosis. Improving the material 

engineering, the intervention technique allows reducing to a minimum of complications during 

intervention and obtaining acceptable results. 

Outcomes of the complex arterial switch operation 

Serban Stoica 1, Esther Carpenter 2, Eduardo da Cruz 2, James Todd 2, Thomas Fagan 2, Max Mitchell 2, 

David Campbell 2, Dunbar Ivy 2, Francois Lacour-Gayet 3 

1 - Bristol Royal Children's Hospital, UK 

2 - Denver Children's Hospital, USA 

3 - Montefiore Hospital, New York, USA 

Purpose: Morbidity and mortality comparison of simple (sASO) and complex arterial switch 

operations (cASO). 

Methods: 93 consecutive patients undergoing arterial switches between 2003-2009 were 

analyzed. Of these 45 had sASO (48%) and 48 (52%) cASO, defined as one or several of the 

following: weight

Surgical correction of Transposition of Great Arteries – experience of 80 cases 

Conf.dr. Suciu H., dr. Paşcanu S., dr. Matei M., dr. Roxana Toma, 

dr. Anca Sglimbea, dr. Opriş C., prof. dr. Deac R., 

IUBCVT Targu Mures 

Introduction: Surgery for transposition of great vessels (TGA) has developed spectacularly 

in recent decades, the”arterial switch” representing along with the”Fontan circulation” two of the 

great therapeutic achievements in congenital surgery. Recent years have contributed to 

overcoming the last obstacles in arterial switch procedure. Today's”arterial switch” solution should 

represent the standard for patients with transposition of great vessels worldwide. 

Purpose: presentation of personal experience (one center, one surgeon) and 

periprocedural surgical management of TGA in a total of 80 cases operated on between 2004- 

2010 in the Clinic of Cardiovascular Surgery Adults and Children II, IUBCVT, Targu - Mures. 

Material / Method: The study group included 80 newborns and infants, aged 7 days – 3 

months, with TGA, operated upon in the past five years in our unit. The present study concerned: 

the geographic origin, gender, age, time of diagnosis, associated perinatal pathology, type of 

TGA, associated pathology, coronary anatomy, clinical and biological status at time of admission 

in our clinic, the need for other medical / interventional procedures, preoperative complications, 

age at the time of surgery, surgical technique, bypass time and ischemia time, number of days of 

intubation, inotropic requirements, number of days in intensive care, postoperative complications. 

Results: Mortality was reduced alongside with the learning curve. Unlike other centers 

abroad, the number of patients in critical condition (due to late diagnosis and inappropriate 

management before admission to our center) is substantially larger, requiring a bigger number of 

days spent in the ICU facilities. Coronary anatomy is a risk factor only in the case of single coronary 

artery. The techniques for correction of the the mismatch at the level of great arteries were 

needed in 7 cases. Other surgical technical difficulties or palliative techniques (left ventricular 

reconditioning) were needed in 2 cases. Time of CPB and the time of ischemia compared with 

other centers abroad was with 15-20% longer in our group. The number of days of mechanical 

ventilation and intensive care was bigger, especially in connection with postoperative infectious 

complications. 

Conclusions: ”Arterial switch” for TGA correction represent the optimal therapy, carried out 

with good results, after reaching the plateau of learning curve, regardless of anatomical features 

of the lesion. Short-term results are determined by the child's condition before surgery and 

postoperative complications, requiring a more effective collaboration with cardiologists and 

paediatricians in the neonatal centers of the teritory. 

Corectia chirurgicală a Transpoziţiei marilor vase - experienţa a 80 de cazuri 

Introducere: Chirurgia în transpoziţia de mari vase (TVM) a evoluat spectaculos în ultimele 

decenii, switch-ul arterial reprezentând, alături de circulaţia Fontan una din marile realizări 

terapeutice în chirurgia congenitalilor. Ultimii ani au contribuit la depăşirea ultimelor dificultăţi în 

efectuarea switch-ului arterial cum sunt anomaliile de artere coronare. etc. Actualmente ”switchul 

arterial” ar trebui să reprezinte soluţia de elecţie pentru pacientul cu transpoziţie de mari vase 

oriunde în lume. 

Obiectiv: prezentarea experienţei personale (un centru, un operator) în managementul 

periprocedural şi chirugical al transpoziţiei de mari vase la un număr de 80 de cazuri, operate în 

perioada 2004-2010 la nivelul Clinicii Chirurgie Cardiovasculara II Adulti şi Copii, IUBCVT, Târgu 

Mureş. 

Material / Metoda: Lotul de studiu include 80 de nou născuţi şi sugari, cu vârste cuprinse 

între 7 zile şi 3 luni, operaţi pentru TVM in ultimii 5 ani în clinica noastră. La aceştia s-a urmărit: zona 

de provenienţă, sexul, vârsta, momentul diagnosticului, patologia perinatală asociată, tipul de 

TVM, leziunile asociate, anatomia coronarelor, statusul clinic şi biologic la preluarea pacientului în 

unitatea noastră, necesitatea efectuării altor manevre medicale / interventionale, complicaţii 

preoperatorii, vârsta la momentul operaţiei, tehnica operatorie, timpul de by-pass cardiopulmonar, 

timpul de ischemie, numărul de zile de intubaţie oro-traheală, necesarul de inotropice, 

numărul de zile de terapie intensiva, complicaţii postoperatorii. 

Rezultate: Mortalitatea operatorie s-a redus paralel cu curba de învăţare, încadrându-se în 

prezent în media europeană. Spre deosebire de alte centre din străinătate, numărul de pacienţi 

83

decompensaţi la preluare (datorită diagnosticării tardive sau a managementului impropriu 

anterior internării în centrul nostru) este substanţial mai mare, necesitând într-un număr mai mare 

de cazuri îngrijiri de terapie intensivă. Anatomia coronarelor reprezintă un risc doar în cazul unei 

coronarei unice. Tehnici de compensare a mismatch-ului vaselor mari au fost necesare în 7 cazuri. 

Tehnici paleative sau de recondiţionare ventriculară au fost necesare în 2 cazuri. Timpul de 

circulatie extracoropreală şi timpul de ischemie comparativ cu alte centre din străinătate a fost 

cu 15-20% mai prelungit. Numărul de zile de ventilaţie mecanică şi necesarul de zile de terapie 

intensivă este mai lung în cazul prezenţei complicaţiilor postoperatorii infecţioase şi a 

chilotoracelui. 

Concluzii: ”Swich-ul arterial” in TVM este terapia optimă, realizabilă cu rezultate bune, 

după atingerea platoului curbei de învăţare, indiferent de particularităţile anatomice ale leziunii. 

Rezultatele pe termen scurt sunt condiţionate de starea copilului anterior intervenţiei şi de 

complicaţiile postoperatorii, necesitând o colaborare mult mai eficientă cu centrele de 

neonatologie şi cardiologii pediatrii din teritoriu. 

Anomalous origin of left coronary artery from the pulmonary artery 

in association with mitral regurgitation 

Lucian Stoica, Eugen Bitere, Dumitrita-Alina Gafencu, Laurentiu Gafencu, Grigore Tinică 

Cardiovascular Surgery Clinic, Cardiovascular Diseases Institute “Prof. Dr. George I. M. 


Anomalous origin of left coronary artery from the pulmonary artery is a rare malformation, 

first described by Brooks in 1885, with an incidence rate of 1 in 300 000 newborns. The 

consequences are myocardial ischemia, myocardial infarction, congestive heart failure, mitral 

insufficiency (ischemic and/or ventricular dilatation) and death in early ages if not treated. 

Although there is consensus regarding the surgical techniques of left coronary artery 

reimplantation, there are different opinions about the surgical correction of the mitral 

regurgitation at the time of the initial operation. We present you two clinical cases diagnosticated 

and treated at IBCV “Prof. Dr. George I. M. Georgescu” from Iasi. These patients had grade II 

mitral insufficiency, which was not surgically corrected (on purpose). The later echocardiographic 

studies showed mitral regurgitation regression, improved contractility and decreased left 

ventricular volume. 

Case 1: 21 year old female, with low effort tolerance, was diagnose initially with 

myocardial fibroelastosis. The further echocardiographic study revealed the presence of dilatative 

cardiomyopathy and grade II mitral insufficiency (ischaemic mechanism). The imagistic exams 

performed at IBCV “Prof. Dr. George I. M. Georgescu” Iasi showed the anomalous origin of left 

coronary artery from the pulmonary artery. The operative technique was the direct reimplantation 

of the anomalous coronary artery onto aorta and the closure of the pulmonary artery with an 

autologous pericardium patch. The postoperative evolution was free of complications and the 

patient went home after 8 days. After one year the clinical and echocardiographic control shows 

very good evolution, with mitral insufficiency grade regression and significant increase of effort 

tolerance. 

Case 2: 2 year old male with dyspnea and frequent respiratory infections was evaluated 

(echocardiography and coronarography) at IBCV “Prof. Dr. George I. M. Georgescu” from Iasi 

and the diagnoses was anomalous origin of left coronary artery from the pulmonary artery. The 

surgical technique was the translocation of the left main from the pulmonary artery to the aorta. 

The postoperative evolution was very good and the patient went home after 12 days. In a time 

period of three years the clinical controls showed a good evolution, with increase effort tolerance 

and normal statural and ponderal development. 

Conclusion: After successful revascularization, the late results are good, left ventricular 

function recovers and the mitral regurgitation decreases even if the disease is diagnose in the 

adult period. 

Keywords: anomalous origin of left coronary artery from the pulmonary artery, coronary 

anomaly, mitral insufficiency 

Originea anormală a arterei coronare stângi din artera pulmonară asociată cu regurgitare mitrală 

Originea anormală a arterei coronare stângi din artera pulmonară este o malformaţie 

rară, descrisă prima dată de Brooks în 1885, cu o incidenţă de 1 la 300000 de naşteri vii. Poate 

84

cauza ischemie miocardică, infarct, insuficienţă cardiacă congestivă, insuficienţă mitrală 

ischemică şi/sau prin dilatare de inel mitral şi deces la vârste mici. 

Dacă pentru tehnicile de reimplantare a arterei coronare stângi în aortă există un 

consens, în ceea ce priveşte corecţia regurgitării mitrale opiniile sunt diferite. Prezentăm două 

cazuri diagnosticate şi operate la IBCV "Prof. Dr. George I.M. Georgescu" Iaşi care aveau 

regurgitare mitrală gradul II şi la care deliberat nu s-a realizat un gest chirurgical pe valva mitrală. 

Controalele ecocardiografice ulterioare au arătat regresia semnificativă a insuficienţei mitrale, 

ameliorarea contractilităţii şi reducerea volumului ventricular stâng. 

Caz 1: Pacientă în varsta de 21 ani, simptomatică prin toleranţă scăzută la efort, a fost 

diagnosticată iniţial cu fibroelastoză miocardică, ulterior conturându-se ecografic aspectul de 

cardiomiopatie dilatativa şi insuficienţă mitrală gradul II (prin mecanism ischemic). Este explorată 

imagistic la IBCV "Prof. Dr. George I.M. Georgescu" Iaşi, evidenţiindu-se originea trunchiului 

principal coronar stâng în artera pulmonară. S-a practicat reimplantarea arterei coronare stângi 

la nivelul aortei si reconstrucţia arterei pulmonare cu petec de pericard autolog. Evoluţia 

postoperatorie a fost favorabilă, iar pacienta a fost externată la 8 zile postoperator. Controlul 

clinic şi ecografic la un an evidenţiază o evoluţie favorabilă cu regresia insuficienţei mitrale şi 

creşterea semnificativă a capacităţii de efort. 

Caz 2: Pacient în vârstă de 2 ani, cu dispnee la eforturi mici şi infecţii respiratorii repetate, 

este investigat imagistic (ecocardiografic şi coronarografic) la IBCV "Prof. Dr. George I.M. 

Georgescu" Iaşi şi se stabileşte diagnosticul de origine anormală a arterei coronare stângi din 

artera pulmonară. Se practică translocarea trunchiului arterei coronare stângi din artera 

pulmonară în aortă iar pacientul este externat la 12 zile postoperator cu stare generală bună. 

Controalele clinice periodice efectuate timp de 3 ani arată o evoluţie favorabilă cu toleranţă 

bună la efort şi dezvoltare staturo-ponderală normală. 

Concluzii: Reimplantarea arterei coronare stângi în aortă conduce la normalizarea 

perfuziei miocardice şi, pe termen lung, la ameliorarea contractilităţii ventricolului stâng şi regresia 

insuficienţei mitrale, chiar la pacienţi diagnosticaţi la vârsta adultă. 

Cuvinte cheie: origine anormală a arterei coronare stângi în artera pulmonară, anomalie 

coronariană, insuficienţă mitrală 

Chira Manuel, Simona Opriţa 

Institutul Inimii “ Niculae Stăncioiu” Cluj 

Cecilia Lazea*, Rodica Manasia,* Simona 

Opriţa**, Mircea Bârsan**, Svetlana Encica** 

* Clinica Pediatrie I “Axente Iancu” Cluj 

**Institutul Inimii “ Niculae Stăncioiu” Cluj 

Angela Butnariu, Daniela Iacob 

Clinica Pediatrie III, Universitatea de Medicină şi 

Farmacie “Iuliu Haţieganu” Cluj-Napoca 

Mariana Andreica*, Simona Cainap*, Andreea 

Răchişan*, Simona Opriţa**, Cecilia Lazea**, 

Manuel Chira**, Nicolae Miu* 

* Clinica Pediatrie II Cluj-Napoca 

** Institutul Inimii “Niculae Stăcioiu” Cluj-Napoca 

*** Clinica Pediatrie I Cluj-Napoca 

Popa Cherecheanu Matei, Goleanu Viorel, 

Butusina Marian, Lazar Ovidiu, Lazar Mihaela, 

Mihalcescu Daniel, Creţu Magdalena, Radu 

Mădălina, Tănăsescu Dragoş. 

Spitalul Clinic de Urgenţă Militar, Bucureşti 

Rodica Manasia, Cecilia Lazea 

Clinica Pediatrie I “Axente Iancu” Cluj 

Sesiunea XVII 

Intervenţii chirurgicale vs cardiologie intervenţională în 

tratamentul malformaţiilor chirurgicale" 

Tumori cardiace în practica cardiacă 

Aspecte pediatrice ale îngrijirii perioperatorii la copilul 

mic cu malformaţie cardiacă congenitală 

Abordarea clinică şi terapeutică a malformaţiilor 

cardiace congenitale – cazuistica Clinicii Pediatrie II 

Cluj-Napoca 

Chilotorax post cură chirurgicală a defectului septal 

interatrial 

Aspecte din viaţa copilului cardiac 

85

As. Aurica Farcane, Prof Dr. Petru Deutsch. 


As Daniela Demea, Prof. Dr. Marian Gaspar 


SALA Ruby 

Grupul de lucrări « NURSING » 

Concentratul trombocitar obţinut prin afereza, 

tehnologie 

transfuzională 

de interes pentru hematologia 

Rolul bancii de celule si tesuturi in cresterea 

eficientizarii transplantului 

Transpoziţia de vase mari - indicaţii şi risc operator 

Georgeta Teuca 

- Anestezie şi Terapie Intensivă, Institutul Inimii “ N.Stăncioiu”, Cluj- Napoca 

Prezentarea de faţă intitulată ”Transpoziţia de vase mari - indicaţii şi risc operator” 

cuprinde în ansamblu totalitatea intervenţiilor/ manoperelor medicale care se efectuează în 

clinica de chirurgie cardiovasculară la pacienţii internaţi cu această patologie. 

Chirurgia cardiacă a bolilor congenitale are o dinamică de dezvoltare şi perfec ionare 

ieşită din comun. Dacă înainte operaţiile în bolile congenitale se efectuau la vârstă înaintată, 10- 

15 ani, acestea se efectuează la copilul mic, preşcolar, la nou născuţi, perinatal şi chiar prenatal 

intrauterin. 

Aproximativ 3% dintre copii se nasc cu diferite malformaţii congenitale, anomaliile 

cardiace congenitale situându-se pe primul loc cu o pondere de 8: 1000 de nou născuţi vii. 

Până în ultimele decade se considera că 8% dintre defectele cardiace congenitale se 

datorează aberaţiilor cromozomiale, 2% sunt consecutive teratogenilor de mediu ce acţionează 

în perioada cardiogenezei produsului de concepţie, iar restul de 90% sunt multifactoriale. 

Transpozi ia de vase mari este un defect congenital cianogen, în care ambele vase mari 

pornesc din ventriculul opus. Dată fiind amploarea malforma iei cardiace i complicaţiile pe 

care le poate produce în cazul nerezolvării în primele zile de viaţă, se impune intervenţia de 

urgenţă încă din primele zile după naştere. 

În cadrul prezentei lucrări sunt descrise aspectele fiziologice ale cordului normal la nou 

născut, malformaţiile asociate ce pot însoţi transpozi ia de vase mari, precum şi intervenţiile pre, 

intra operatorii. 

Aspectele supuse cercetării - studiul pe care l-am realizat este unul retrospectiv, 

(1.01.2005- 1.01.2009), vizând cazurile operate în decursul a 4 ani - prezintă date statistice 

referitoare atât la vârsta mamei, patologii asociate în decursul sarcinii, Rh-ul mamei, patologii 

asociate ale copilului, precum i date referitoare la durata spitalizării şi manopere efectuate 

acestuia. 

Un rol important în acordarea îngrijirilor medicale acestor micu i pacienţi revine 

asistentelor medicale de pe Terapie Intensivă. Cunoaşterea patologiei, evoluţiei postoperatorii, a 

posibilelor complicaţii, decelarea lor, anunţarea din timp a medicului terapist, contribuie la 

asigurarea calităţii îngrijirilor acordate acestei categorii de pacienţi. 

As. Alina Ganea 

Bloc operator 

Rezultate imediate în protezarea valvei aortice pentru 

stenoză. 

Protocol de reducere necesarului de transfuzii alogene in chirurgie cardiaca 

Protocol of reductions required allogenic transfusion in Surgery Cardiac 

as. Cătinean Mihaela Carmen, dr. Vlad Horea Ioan 

Institutul Inimii de urgen ă pentru boli cardiovasculare” Nicolae Stăncioiu” Cluj-Napoca, Clinca 

de anestezie i terapie intensivă 

Heart Institute emergency cardiovascular disease "Nicholas Stancioiu" 

Cluj-Napoca, Clinca of anesthesia and intensive care 

Obiective: Scopul acestui protocol este de a îmbunătăţi gestionarea perioperatorie a 

transfuziei de sânge şi de a reduce riscul apariţiei efectelor adverse asociate cu transfuzia, 

hemoragia sau cu anemia. 

86

Metoda: S-a efectuat un studiu experimental i comparativ între două loturi de pacien i 

opera i pe cord: Lotul I –lotul experimental si Lotul II – lotul de control 

Rezultate: Rezultatele au evidentiat reducerea necesarului transfuzional in Lotul I. 

Concluzii: Interven iile chirurgicale cardiace cu bypass cardio-pulmonar se pot face fără 

administrare de sânge alogen, ca urmare a elaborarii acestui protocol. 

Objectives: The purpose of this protocol is to improve the management of perioperative 

blood transfusion and reduce the risk of adverse effects associated with transfusions, bleeding or 

anemia. 

Method: An experimental study was performed and compared between two groups of 

patients operated on heart: Lot I-control group and Lot II-experimental group. 

Results: The results have shown to reduce transfusion requirements in group I. 

Conclusions: cardiac surgery with cardio-pulmonary bypass can be done without 

allogeneic blood administration, following the elaboration of this Protocol. 

As. Szabo Noemi, dr. A. Molnar 




Chirurgia coronariană off pump, avantaje şi 

dezavantaje. 

Management of Global Cardiovascular Risk 

- role of sanitary education and active monitoring- 

Dana Marginean 

“Niculae Stancioiu” Heart Institute, Cluj-Napoca 

The modern concept of therapy for a patient with heart disorders implies, besides the 

specific treatment of the disease, non-pharmacological and pharmacological measures applied 

in the purpose of minimizing the global cardiovascular risk. 

In this paper we monitored: 1. The evaluation of the role of the general nurse in changing lifestyle 

and the modification of some risk factors, 2. The assessment of the impact of correcting the 

modifiable risk factors and 3. The possibility of improving the compliance to treatment of patients. 

The material of study was performed on 870 hospitalized patients in the first trimester of 

2009 at the Heart Institute, patients who presented three or more traditional risk factors of which at 

least one factor belonging to the category of modifiable factors. There were two groups, of 50 

patients each, delimited: Group A designed to the educative active intervention and Group B, 

the witness group. Each patient signed a written consent and was monitored on the basis of some 

dedicated questionnaires. Active medical education was made by using specific information 

materials for each risk factor. 

The results obtained after one year of active education and monitoring revealed the 

following: A group – quit smoking in 66% cases, more than 1/3 patients lost weight, 25% reaching a 

normal BMI, the dislipidemy got normal values for 16 patients out of 28, glicolized hemoglobin 

reached normal values in 75% of cases, sport became a regular habit for 56% of patients and salt 

consumption decreased in a controlled manner at 64% of patients. Global compilation to 

treatment maintained in 84% of cases and after one year there was registered a reduction of 

specific medication intake with 30% or at least a reduction of the intake dose with 20%. In the B 

group (the witness group) none of the patients quit smoking, weight loss was registered in 10% of 

cases, the dislipidemy and glicated hemoglobin got normal values for 20% of the patients, 

respectively for 27% of patients, while only 6% made sport and salt consumption relative reduction 

was registered in 30% of the patients. The compliance to treatment was significantly reduced in 

32% of cases and the reduction of medication or of the dose was insignificant (4% and 8%). 

The survey attests the importance and effectiveness of active medical education taught 

by the medical nurse where the amendment of the risk factors is concerned, with indubitable 

impact on cardiovascular morbid-mortality on medium and long term. 

87

RJCS Nr 1 - 2 / 2010 - Academia Oamenilor de Stiinta din Romania

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