• Article: Hybrid myocardial revascularization—the cardiologist's view

          Jan Horák, Stanislav Šimek, Tomáš Kovárník, Michal Semrád, Jaroslav Lindner, Aleš Linhart         

• ABSTRACT: This article summarizes current knowledge on the mutual position of surgical and interventional treatment of patients with multivessel coronary artery disease. It focuses on the possibilities of their combined use – so called hybrid myocardial revascularization. The use of minimally invasive surgery combined with current technologies of coronary interventions offers new opportunities, taking advantages of both procedures and eliminating some of their disadvantages. This previously rarely used technique could improve the clinical outcomes and treatment comfort in selected groups of patients.                                                                                                                                                       Cor et vasa 01/2012; 54(3):e188–e201.

• Article: A review of a newly established ECMO program in a university affiliated cardiac center. J Belohlávek, V Rohn, J Tosovsky, J Kunstyr, M Semrád, J Horák, M Lips, F Mlejnsky, I Vykydal, M Balík, M Strítesky, V Mrázek, A Klein, A Linhart, J Lindner 
• ABSTRACT: Extracorporeal membrane oxygenation (ECMO) is an established rescue treatment option for severe respiratory and cardiac failure in infants and neonates and has recently become widely utilised in adults. ECMO support can be initiated rapidly in an emergency setting both by percutanous implantation and surgically; it allows transportation of patients in cardio-pulmonary collapse and bridging of critically ill patients to be recovered, other support measures or transplantation. The aim of this study was to report authors' initial experience after starting an ECMO program in a university-based cardiac center. The institutionally approved ECMO team bears responsibility for adjudication regarding indication and implementation of ECMO in all patients. Since the establishment of the ECMO team in October 2007, one elective and nine urgent patients in deep cardiogenic and/or ventilatory collapse were treated by ECMO support up to December 2008. Three patients suffered severe acute right heart dysfunction, two patients suffered postcardiotomy refractory cardiogenic shock, two patients had a cardiogenic shock due to postinfarction interventricular septal rupture, two patients experienced severe respiratory failure and one had elective ECMO implantation as a back-up support during high-risk percutaneous coronary intervention. Veno-arterial ECMO was used in eight cases and veno-venous in two cases of isolated respiratory failure. In nine patients, ECMO circuit was instituted by peripheral cannulation, in eight out of nine cases by percutaneous puncture. On one occasion central surgical cannulation was used. In urgent patients, immediate hemodynamic and oxygenation improvement was observed. Average support duration was 6.8 days (range 1-16 days). Five (50 %) patients were successfully weaned from ECMO and survived to hospital discharge. The illness severity in urgent patients defined by SOFA score ranged from 10 to 17, patients dying while on ECMO had higher SOFA scores (14.8±1.6 vs. 10.8±1.5; P=0.0065). Complications included mainly bleeding. ECMO support allows treatment of severely ill patients in imminent cardiovascular and/or ventilatory collapse. Therefore, establishment of an ECMO program in university affiliated cardiac center is fully justified. A multidisciplinary approach is essential. Despite adequate training and education of ECMO team members, this highly invasive therapeutic modality bears an inherent risk of complications. The Journal of cardiovascular surgery 06/2011; 52(3):445-51. · 1.51 Impact Factor 
• Article: Postoperative outcome in awake, on-pump, cardiac surgery patients. Michal Porizka, Martin Stritesky, Michal Semrad, Milos Dobias, Alena Dohnalova 
• ABSTRACT: Thoracic epidural anesthesia (TEA) alone or combined with general anesthesia (TEA-GA) has been assumed to improve early postoperative outcome in cardiac surgery. The aim of our study was to investigate data of early and late postoperative outcome results of awake TEA patients undergoing cardiac surgery with comparison to patients under combined and general anesthesia (GA). Forty-seven patients undergoing elective on-pump cardiac surgery were assigned to receive either epidural (group TEA, n = 17), combined (group TEA-GA, n = 15), or general (group GA, n = 15) anesthesia. Early and late postoperative outcome data, including hospital and 3-year mortality rates, were recorded and compared among the study groups. There was no major difference in early or late postoperative outcome data across all study groups, except for lower incidence of atrial fibrillation in the TEA group compared with the GA group (23.5% vs. 66.7%, respectively, P < 0.05). Also, TEA and TEA-GA groups compared with the GA group had lower pain visual analogue scale scores at 24 h postoperatively (4 ± 7, 6 ± 7, 14.7 ± 11, respectively, P < 0.05) and morphine requirements during the first 24 h after surgery (30 ± 6, 30 ± 6, 250 ± 140 μg/kg, respectively, P < 0.05). Based on our data, all three anesthetic methods were equivalent in terms of major determinants of postoperative outcome, except for lower incidence of atrial fibrillation in awake patients compared with patients under general anesthesia. Methods using postoperative epidural analgesia provided superior pain relief. Journal of Anesthesia 05/2011; 25(4):500-8. · 0.87 Impact Factor 
• Article: Standard blood flow rates of cardiopulmonary bypass are adequate in awake on-pump cardiac surgery. Michal Porizka, Martin Stritesky, Michal Semrad, Milos Dobias, Alena Dohnalova, Josef Korinek 
• ABSTRACT: Standard blood flow rates for cardiopulmonary bypass have been assumed to be the same for awake cardiac surgery with thoracic epidural anesthesia (TEA) as for general anesthesia. However, compared with general anesthesia, awake cardiac surgery with epidural anesthesia may be associated with higher oxygen consumption and may result in lactic acidosis when standard blood flow rates were used. The aim of our study was to investigate if standard blood flow rates are adequate in awake cardiac surgery. Forty-five patients undergoing elective on-pump cardiac surgery were assigned to receive either epidural (Group TEA, n=15), combined (Group TEA-GA, n=15) or general (Group GA, n=15) anesthesia. To monitor the adequacy of standard blood flow rates, arterial lactate, acid base parameters, and central venous and jugular bulb saturation were measured at six time points (before, during, and after the surgery) in all groups. Blood flow rates were adjusted when needed. No lactic acidosis has developed in any group (p=NS). TEA as compared with TEA-GA and GA groups had lower central venous (67±4%, 75±11%, and 72±13%, respectively, p<0.05) and jugular bulb oxygen saturations during cardiopulmonary bypass (60±7%, 68±9%, and 75±12%, respectively, p<0.05) during the post-cardiopulmonary bypass period. The TEA group as compared with the TEA-GA and GA groups also had mild hypercapnic respiratory acidosis (56±10, 42±8, and 37±4 mmHg, respectively, p<0.05) and mild decrease of arterial oxygen saturation (93±4%, 97±2%, and 96±1%, respectively, p<0.05) at the end of surgery without any clinical consequences. Thus, no additional blood flow rates adjustments in any study group and no ventilatory support in TEA group were required. Under careful monitoring, the use of standard blood flow rates is adequate for patients undergoing awake on-pump normothermic cardiac surgery. European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 01/2011; 39(4):442-50. · 2.40 Impact Factor 
• Article: Veno-arterial ECMO in severe acute right ventricular failure with pulmonary obstructive hemodynamic pattern. Jan Belohlavek, Vilem Rohn, Pavel Jansa, Jan Tosovsky, Jan Kunstyr, Michal Semrad, Jan Horak, Michal Lips, Frantisek Mlejnsky, Martin Balik, Andrew Klein, Ales Linhart, Jaroslav Lindner 
• ABSTRACT: Extracorporeal membrane oxygenation (ECMO) is an effective rescue method for severe respiratory and cardiac failure. Right ventricular (RV) failure with cardiogenic shock is a critical condition with generally poor prognosis unless aggressive therapeutical measures are undertaken. Authors report on their initial experience with ECMO support in severe RV failure with cardiogenic shock caused by an obstructive hemodynamic pattern. Four patients with cardiogenic shock due to severe RV failure related to pulmonary arterial hypertension (2 patients), congenital heart disease with Eisenmenger physiology (1 subject) and massive pulmonary embolism (1 patient) were supported with emergency veno-arterial ECMO. ECMO circuit was instituted using peripheral cannulation in all subjects. Immediate hemodynamic and ventilatory improvement was observed in all patients. The mean support duration was 11 days (range 5-16 days), 2 (50%) patients were successfully weaned off ECMO and survived to hospital discharge. The other 2 patients were considered by mutual consensus to have irreversible organ damage, the ECMO support was withdrawn and the patients died. Bleeding complications were the main complications observed. As per initial experience, veno-arterial ECMO allows bypassing of the pulmonary bed, therefore, relieves the RV pressure overload and does not cause further elevation of the pulmonary pressures in contrary to RV assist devices. This aggressive management approach requires further clinical evaluation in order to establish its definite role in critical RV failure. The Journal of invasive cardiology 08/2010; 22(8):365-9. · 1.57 Impact Factor 
• Article: Late complication of surgical repair of aortic coarctation: ruptured pseudoaneurysm of the aorta treated by thoracic endovascular aortic repair. P Varejka, J C Lubanda, P Prochazka, S Heller, S Beran, O Dostal, F Charvat, J Horejs, M Semrad, A Linhart 
• ABSTRACT: Aortic coarctation is a frequent congenital defect requiring early surgical treatment. Late complications of these surgical procedures can be fatal as in the case of a ruptured anastomotic pseudoaneurysm. We present a case of a 49-year-old man presenting with hemorrhagic shock due to this complication who was successfully treated by endovascular techniques with implantation of two stent grafts. This case illustrates the fact that endovascular aortic repair is feasible, certainly less invasive and very efficient for this type of complication when used in an experienced center. Journal des Maladies Vasculaires 03/2010; 35(3):189-93. · 0.24 Impact Factor 
• Article: Contribution to diagnostics of vascular prosthesis infections. M Spacek, V Jindrák, P Stádler, O Belohlávek, J Balák, P Mitás, M Semrád, J Lindner 
• ABSTRACT: Vascular prosthesis infection is a life-threatening complication in 0.5-5% of cases. Early and reliable diagnosis is a necessity for adequate treatment. Computed tomography (CT) is the gold standard diagnostic method used world-wide with excellent results, but in cases of advanced graft infection. Low grade infections in non-acute patients are a diagnostic challenge requiring a new method with good diagnostic accuracy. The authors describe diagnostic accuracy of currently available methods. Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 01/2010; 89(1):33-8. 
• Article: Outcomes of combined surgical and endovascular treatment of the venous thoracic outlet syndrome during 2000-2007 in the IInd Surgical Clinic of the VFN (General Faculty Hospital) and 1. LF UK (First Medical Faculty, Charles University) in Prague. J Hrubý, M Semrád, T Vidim, P Mitás, O Dostál, L Skalická, J Lindner 
• ABSTRACT: Between 2000-2007 we performed 31 surgical procedures for thoracic outlet syndrome, two patients underwent bilateral procedure. 26 patients had venous TOS, 4 neurovascular and 1 arterial TOS. Rib resection and scalenotomy were performed at 23 patients, rib resection, scalenotomy and deliberation at 9 patients, in one case re-operation. 76% patients were without difficulties after combined endovascular and surgical procedures. Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 01/2010; 89(1):69-72. 
• Article: Complication tardive d’un traitement chirurgical par interposition prothétique d’une coartation aortique : rupture d’un faux anévrisme anastomotique traitée par implantation endoluminale d’endoprothèse couverte P. Varejka, J. C. Lubanda, P. Prochazka, S. Heller, S. Beran, O. Dostal, F. Charvat, J. Horejs, M. Semrad, A. Linhart 
• ABSTRACT: Aortic coarctation is a frequent congenital defect requiring early surgical treatment. Late complications of these surgical procedures can be fatal as in the case of a ruptured anastomotic pseudoaneurysm. We present a case of a 49-year-old man presenting with hemorrhagic shock due to this complication who was successfully treated by endovascular techniques with implantation of two stentgrafts. This case illustrates the fact that endovascular aortic repair is feasible, certainly less invasive and very efficient for this type of complication when used in an experienced center. Journal Des Maladies Vasculaires - J MAL VASCUL. 01/2010; 35(3):189-193. 
• Article: Multiple sequence revascularization of infrapopliteal arteries in the management of critically ischemic extremity. M Slais, P Mitás, M Semrád, J Hrubý, J Lindner, P Stádler 
• ABSTRACT: Most cases of distal bypasses closures are caused by reduced blood flow within the affected peripheral vasculature, resulting in corresponding reduction in the graft's blood supply. The authors use multiple, sequence, Y grafting and bridge grafting procedures on crural and pedal arteries, in order to improve the above hemodynamic features. Furthermore, the techniques facilitate better circulation within larger extremity regions. From April 2007 to January 2009, the authors completed a total of 38 sequence bypass procedures. The procedures included 30 Y graft procedures with peripheral anastomoses with crural arteries, 4 Y graft procedures with peripheral anastomoses with pedal arteries and 4 bridge graft procedures. Y grafting is a technique, in which a classical distal bypass is formed, to which another bypass is attached end-to-side in an acute angle. The composite bypasses form a reversed letter Y. Its distal branches anastomose with crural or pedal arteries. Bridge grafting is a technique, where a short bypass between crural arteries is formed, using a venous graft with removed valves, allowing for a two-way flow. The distal anastomosis is attached end-to-side. All the above vascular reconstructions were indicated for critical extremity ischemia, some patients had a history of endovascular reinterventions. In the patient group, autologous veins were used in 20 reconstructions, while PTFE prostheses were used in 10 reconstructions. Clinical and sonographic examinations were performed on discharge, followed by check ups at 1,3, 6 and 12 months. The follow up period in patients with Y graft reconstructions was 6-20 months (mean duration of 12 months). Two patients underwent major amputation, required for bypass closures, 3 subjects exited with patent vascular reconstructions, their deaths were not related to the procedure. The authors recorded 4 bypass closures, with the main trunk patency. Primary/secondary 30-day patency rate was 90%/97%, the long-term patency rate was 93%. The vascular reconstructions results are similar to those presented in literature. In order to perform more accurate assessment of individual revascularization variants, long- term follow up studies, including randomized studies, are required. Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 01/2010; 89(1):59-63. 
• vailable from: Michal LipsArticle: Comparison of three protocols for tight glycemic control in cardiac surgery patients. Jan Blaha, Petr Kopecky, Michal Matias, Roman Hovorka, Jan Kunstyr, Tomas Kotulak, Michal Lips, David Rubes, Martin Stritesky, Jaroslav Lindner, Michal Semrad, Martin Haluzik 
• ABSTRACT: We performed a randomized trial to compare three insulin-titration protocols for tight glycemic control (TGC) in a surgical intensive care unit: an absolute glucose (Matias) protocol, a relative glucose change (Bath) protocol, and an enhanced model predictive control (eMPC) algorithm. A total of 120 consecutive patients after cardiac surgery were randomly assigned to the three protocols with a target glycemia range from 4.4 to 6.1 mmol/l. Intravenous insulin was administered continuously or in combination with insulin boluses (Matias protocol). Blood glucose was measured in 1- to 4-h intervals as requested by the protocols. The eMPC algorithm gave the best performance as assessed by time to target (8.8 +/- 2.2 vs. 10.9 +/- 1.0 vs. 12.3 +/- 1.9 h; eMPC vs. Matias vs. Bath, respectively; P < 0.05), average blood glucose after reaching the target (5.2 +/- 0.1 vs. 6.2 +/- 0.1 vs. 5.8 +/- 0.1 mmol/l; P < 0.01), time in target (62.8 +/- 4.4 vs. 48.4 +/- 3.28 vs. 55.5 +/- 3.2%; P < 0.05), time in hyperglycemia >8.3 mmol/l (1.3 +/- 1.2 vs. 12.8 +/- 2.2 vs. 6.5 +/- 2.0%; P < 0.05), and sampling interval (2.3 +/- 0.1 vs. 2.1 +/- 0.1 vs. 1.8 +/- 0.1 h; P < 0.05). However, time in hypoglycemia risk range (2.9-4.3 mmol/l) in the eMPC group was the longest (22.2 +/- 1.9 vs. 10.9 +/- 1.5 vs. 13.1 +/- 1.6; P < 0.05). No severe hypoglycemic episode (<2.3 mmol/l) occurred in the eMPC group compared with one in the Matias group and two in the Bath group. The eMPC algorithm provided the best TGC without increasing the risk of severe hypoglycemia while requiring the fewest glucose measurements. Overall, all protocols were safe and effective in the maintenance of TGC in cardiac surgery patients. Diabetes care 02/2009; 32(5):757-61. · 7.74 Impact Factor 
• Article: Bilateral leg compartment syndrome due to severe myonecrosis caused by inappropriate use of simvastatin. M Chochola, J-C Lubanda, L Skalicka, P Varejka, J Horejs, T Prskavec, M Balík, M Semrád, A Linhart 
• ABSTRACT: Bilateral leg compartment syndrome due to myonecrosis caused by inappropriate use of statins is a rare but potentially fatal complication of this lipid lowering medication. We report a case of a 39-year-old woman who presented with suspicious critical lower limb ischemia. Subsequently, bilateral leg compartment syndrome and myonecrosis developed. The primary cause of myonecrosis was due to misuse of simvastatin mistaken by the patient for a weight-reducing drug. Urgent fasciotomies were performed and the patient underwent urgent renal replacement therapy with continuous hemodialysis for acute renal failure due to myoglobinuria. After this complex treatment, the patient was discharged. She almost fully recovered with only a residual paresis of the left fibular nerve. According to literature, this is a unique case of bilateral compartment syndrome and myonecrosis with acute renal failure due to statin overdose leading to acute renal failure and bilateral fasciotomy. Journal des Maladies Vasculaires 10/2008; 33(4-5):229-33. · 0.24 Impact Factor 
• Article: A suprasternal false aneurysm caused by posttraumatic innominate artery rupture after dissection type A repair. Michal Semrad, Tomas Urban, Jan Tosovsky, Jan Kunstyr 
• ABSTRACT: Figure 1: A 61-year-old patient presented with a 14-day-old upper sternum trauma and a suprasternal aneurysm. The ascending aorta and arch had been replaced 1 year ago as a result of acute aortic type A dissection repair. Figure 2A: A transverse CT scan showing a pseudoaneurysmal formation arising from the ascending aorta and passing through the broken sternum subcutaneously. Figure 2B: A lateral CT scan showing the neck of the pseudoaneurysm below the origin of the innominate artery. The patient underwent cardiopulmonary bypass, femoral vein and axillary artery cannulation, and cooling to 18C. Circulation was arrested and unilateral cerebral perfusion via the right carotid artery under transcranial Doppler monitoring was performed. The aneurysm (Fig 1) was entered and the suture tear between the innominate artery and graft (Fig 2) was patch closed. European Journal of Cardio-Thoracic Surgery 01/2007; 30(6):937. · 2.67 Impact Factor 
• Article: Endoscopic thoracic sympathectomy--its effect in the treatment of refractory angina pectoris. Martin Stritesky, Milos Dobias, Rudolf Demes, Michal Semrad, Eva Poliachova, Tomas Cermak, Jiri Charvat, Ivan Malek 
• ABSTRACT: To document an improvement in the quality of life in a group of patients with refractory angina and videothoracoscopic sympathectomy (VTSY) during the early postoperative period and a six-month follow-up. Ten patients with angina CCS IV refractory to a conventional therapy underwent VTSY between the years 1998 and 2002 at our institution. All patients underwent a complex preoperative evaluation, including pain assessment using a visual analog scale (VAS). Proximal thoracic sympathetic blockage was performed in all patients as a diagnostic test. The resection of bilateral Th2-Th4 ganglions was performed under general anesthesia and selective lung ventilation. All patients were monitored 6 months after the VTSY. No deaths occurred in our group of patients, with an average hospital stay of 4.1 days. Nine of the ten operated patients referred an important subjective relief of pain. There was a drop from 10 to 4 according to VAS (P<0.05), and from 4 to 2.4 according to CCS (P<0.05). Decreases in basal heart rate, norepinephrine level, and an occurrence of ventricular premature beats reached the level of statistical significance. The increasing number of patients with refractory angina prompted a search for an effective and safe therapy to improve the quality of their life. New evidence in the pathophysiology of an ischemic myocardium and investigation of the impact of thoracic sympathectomy suggests sympathetic denervation seems to be a possible alternative method for the treatment of refractory angina pectoris. Interactive Cardiovascular and Thoracic Surgery 08/2006; 5(4):464-8. · 1.11 Impact Factor 
• Article: On-pump cardiac surgery in conscious patients - 5 years experiences in 200 cases. M. Stritesky, M. Semrad, M. Porizka, D. Rubes, M. LipsEuropean Journal of Anaesthesiology - EUR J ANAESTH. 01/2006; 23.  
• Article: Postcatheterization pseudoaneurysm of the radial artery. 
• R Spunda, T Urban, J Tosovský, J Táborský, M Semrád
•  
• ABSTRACT: A postcatheterization pseudoaneurysm of the radial artery remains a rare complication, considering frequencies of its punction. The radial artery is easily accessible for the punction site management after the catheter removal. We present pathogenesis of their origin, their prevention and options for surgical management of the radial artery pseudoaneurysms.                                                                                                                                                                                                                                                               Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 06/2005; 84(5):244-5.

• Article: High thoracic epidural anaesthesia and analgesia in cardiac surgery - a retrospective studyD. Rubeš, M. Lipš, T. Eermák, J. Kunstýø, T Kotulák, J. Bláha, M. Matias, M. Semrád, M. Støíteský 
• ABSTRACT: An abstract is unavailable. This article is available as HTML full text and PDF.
• European Journal of Anaesthesiology 05/2005; 22:35-36. · 2.79 Impact Factor  
• Article: Awake patient and pulmonary dysfunction: the new way?
• M. Stritesky, M. Semrad, M. Dobias, D. RubesEuropean Journal of Anaesthesiology - EUR J ANAESTH. 01/2005; 22:4-5.  
• Article: Main clinical and surgical determinants of in-hospital mortality after surgical revascularization of left main coronary artery stenosis: 2 year retrospective study (1998-1999).
• F Holm, J C Lubanda, M Semrad, J Rohac, V Vondracek, I Miler, I Vanek, L Golan, M Aschermann 
• ABSTRACT: Stenosis of left main coronary artery (LMCA) is a common finding on coronary angiographies (7 to 10%). Mortality is very high for conservative therapy in comparison with surgery, which provides very good long-term outcome and is accepted as the standard therapy of this condition. Over the last few years, percutaneous coronary intervention (PCI) has become a new alternative in selected patients. To assess in hospital mortality in subjects referred to our surgical unit for coronary artery bypass grafting (CABG) and to identify the main clinical and surgical determinants of in-hospital mortality. Two year retrospective analysis (1998-1999) of in-hospital mortality and morbidity of patients having left main stenosis referred for CABG. Among a group of 1443 patients operated for coronary heart disease, LMCA stenosis was found in 330 patients (22.9%). The mean age was 63 +/- 8.6 years. Elective surgery was done in 173 patients (52.4%), and acute operation (i.e. urgent, emergent or desperate) in 157 patients (47.6%). The total in-hospital mortality was 4.2% (14/330). Elective surgery in-hospital mortality was 1.7% (3/173) and urgent surgery in-hospital mortality was 7% (11/157). The main risk factors of in-hospital mortality were age > 68 years, low ejection fraction (LVEF<0.4), history of myocardial infarction, gender (female) and urgency of the operation. The proportion of patients undergoing CABG for left main stenosis is relatively high in our center and their mortality is quite low especially for elective operations. As the mortality of patients treated by PCI for LMCA stenosis is similar to surgery in high-risk patients, we postulate that this approach can be a real alternative treatment for such patients. Because of its potential benefit, combined revascularisation is also an alternative that should be considered in some cases. Furthermore, as a new generation of coated stents has emerged in the treatment of restenosis after PCI, we hypothesize that this method can in the near future be accepted as equivalent to surgery. However several randomized clinical trials must first be conduced prove this point. Journal des Maladies Vasculaires 05/2004; 29(2):89-93. · 0.24 Impact Factor 
• vailable from: Michal Semrad

  Article: On-pump cardiac surgery in a conscious patient using a thoracic epidural anesthesia--an ultra fast track method.

  M Stritesky, M Semrad, J Kunstyr, T Hajek, R Demes, J Tosovsky 

• ABSTRACT: To demonstrate the applicability and efficacy of spontaneous ventilation during cardiac surgery. From March 1999 through December 2002, 129 awake patients were operated on; 90 on-pump and 39 off-pump. A thoracic epidural space blockage was performed one hour prior to an incision being made at the Th 2-Th 4 level. Medial approach was used and the hanging drop method was routinely employed for epidural space detection. There were 82 male and 47 female patients with a mean age of 64.5 years. Forty two cases were aortic valve replacement, 32 patients underwent on-pump coronary artery bypass grafting (CABG), 12 underwent mitral valve replacement, 27 patients were indicated for sternal wound reexploration, 12 for off-pump CABG, one for aortic valve replacement with aortic arch reconstruction and aortic valve replacement together with CABG was performed three times. There were ten conversions to general anesthesia and there was no death. Mean duration of the stay in the intensive care unit was 7.2 hours and in the hospital 5.1 days. We did not observe low cardiac output syndrome, stroke, renal insufficiency or pulmonary dysfunction in patients who sufficiently underwent thoracic epidural anesthesia. Less pain at assessments was demonstrated (Visual Analgetic Score=3.3). The recent interest in rapid recovery and early out-patient care of patients after cardiac surgery has prompted investigations into the use of neuraxial analgesia for these procedures. The above mentioned technique would be beneficial for patients with preoperative pulmonary dysfunction and may be particularly useful in endoscopic cardiac surgery. (Tab. 1, Fig. 2, Ref. 18.) Bratislavske lekarske listy 02/2004; 105(2):51-5. · 0.47 Impact Factor

• Article: Les facteurs cliniques et opératoires associés à la mortalité hospitalière après chirurgie d’une sténose du tronc commun de l’artère coronaire gauche

           F. Holm, J. C. Lubanda, M. Semrad, J. Rohac, V. Vondracek, I. Miler, I. Vanek, L. Golan, M. Aschermann

• ABSTRACT: Stenosis of left main coronary artery (LMCA) is a common finding on coronary angiographies (7 to 10%). Mortality is very high for conservative therapy   in comparison with surgery, which provides very good long-term outcome and is accepted as the standard therapy of this condition. Over the last few years, percutaneous coronary  intervention (PCI) has become a new alternative in selected patients.                                                                                                                                                                          Journal Des Maladies Vasculaires - J MAL VASCUL. 01/2004; 29(2):89-93.

• Article: Port access video-assisted proximal anastomosis with the symmetry aortic connector in MIDCABG procedure. Michal Semrad, Martin Stritesky, Vladimir Vondracek, Jaroslav Lindner, Ivan Vanek, Jan Kristof, Michael Aschermann 
• ABSTRACT: We present an alternative way to create a video-assisted port access proximal anastomosis in the ascending aorta with the Symmetry Bypass System Aortic Connector (St. Jude Medical ATG, St. Paul, MN). This technique was successfully used in a patient undergoing urgent minimally invasive direct coronary artery bypass grafting (MIDCABG), in whom the left internal mammary artery was not harvested owing to subtotal occlusion of the left subclavian artery. Port access use of mechanical anastomotic devices may increase the indications for minimally invasive coronary artery surgery.

          The Annals of Thoracic Surgery 10/2003; 76(3):919-21. · 3.45 Impact Factor 

• Article: Video-assisted multivessel revascularization through a left anterior small thoracotomy approach with the Symmetry Aortic Connector System.

          Michal Semrád, Petr Bodlák, Martin Stríteský, Vladimír Vondrácek, Tomás Urban, Petra Vyhnalová, Frantisek Holm, Ivan Vanek 

• ABSTRACT: We sought to demonstrate the applicability of video-assisted multivessel revascularization through a left anterior small thoracotomy approach with the use of the Symmetry Aortic Connector System (St Jude Medical Anastomotic Technology Group, Inc, St Paul, Minn) as an alternative to the standard median sternotomy approach and to evaluate predischarge angiographically documented graft patency. From October 2001 through February 2002, a total of 15 patients with triple-vessel disease were operated on through a left anterior small thoracotomy approach with video-assisted port-access construction of proximal aorta-to-saphenous vein anastomoses with the Symmetry Aortic Connector System and cardiopulmonary bypass with femoral cannulation and without cardioplegic arrest. There were 9 male and 6 female subjects with a mean age of 68.3 +/- 3.6 years and an average ejection fraction of 55.8% +/- 19.6%. Subject inclusion criteria consisted of female sex (initially but not throughout the study), coronary artery reoperations, and sternal bone disease. Subject exclusion criteria consisted of an age younger than 65 years, extensive atheromatous plaques in the ascending aorta, and aortoiliac occlusive disease. All but 1 patient underwent angiographic patency evaluation before discharge. Fifteen operations were performed successfully without any deaths. Twenty-nine sutureless proximal anastomoses were performed, with an average of 3.13 +/- 0.62 distal anastomoses per patient. Eleven (73%) patients underwent a fast track protocol with extubation in the operating room. We did not observe any instances of low cardiac output syndrome, stroke, renal insufficiency, wound complication, or perioperative myocardial infarction. A single episode of atrial fibrillation occurred in this group. Angiographic assessment of 44 bypass grafts and target arteries was performed, and 86% of those examined were widely patent (FitzGibbon score A). We have demonstrated a potential advantage of the sutureless Symmetry Aortic Connector System as a suitable approach that affords minimal access. Video-assisted multivessel revascularization through a left anterior small thoracotomy approach with an automated mechanical anastomosis device is particularly useful in patients undergoing coronary artery bypass reoperations or those at risk of poor sternal healing or infection. This approach seems to be a safe alternative to standard median sternotomy. Journal of Thoracic and Cardiovascular Surgery 02/2003; 125(1):129-34. · 3.53 Impact Factor  
• Article: Early results of mitral valve surgery.
• J Lindner, V Vondrácek, M Semrád, J Rohác, I Vanĕk 
• ABSTRACT: The authors submit a retrospective group of 245 patients operated in the course of 6 years at the Second Surgical Clinic of Cardiovascular Surgery of the General Faculty Hospital and First Medical Faculty Charles University on account of mitral valve disease. The early results of mitral valve prostheses are comparable or in some combined operations better than reported in world statistics. In the etiology the authors found a relative decrease of rheumatic defects and higher incidence of ischaemic affections. The general mortality in mitral valve prostheses was 7.1%, combined operations incl. acute ones being predominant. In mitral plastic operations the authors lost 4 patients, i.e. 19%. In all instances acute combined operations were involved and the result is consistent with the predicted mortality according to the Merged Cardiac Registry. The mean hospitalization period was 7.52 days. A postoperative QIM was recorded in one patient, i.e. in 0.46%, revision after mediastinitis also in one patient (0.41%) and revision after haemorrhage in 14 patients, i.e. in 5.7%. Neurological complications were recorded in 10 patients i.e. 4%. The work emphasizes the trend of improving results in this important area of cardiosurgery and indicates further possibilities and ways of development in the treatment of mitral valve diseases. Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 11/2002; 81(10):499-504.

• Article: Video-assisted myocardial revascularization and left-sided minithoracotomy using the Symmetry automatic connector.
• M Semrád, P Bodlák, M Stríteský, V Vondrácek, T Urban, P Vyhnalová, F Holm, I Vanĕk 
• ABSTRACT: Introduction of the new method of videoassisted multiple direct revascularization of the heart muscle from left-sided minithoracotomy (LAST--Left Anterior Small Thoracotomy) using an automatic connector of central anastomoses Symmetry (St. Jude Medical ATG, Inc., St. Paul, MN) in patients indicated for re-operation of bypasses of the coronary arteries or with pathological conditions of the sternum and for the cosmetic effect of submammary incisions in women. From September 2001 to the end of February 2002 15 patients with affections of three arteries had an operation from a LAST approach with videoscopic construction of central anastomoses by means of a Symmetry connector with portal entries and the use of extracorporeal circulation introduced from the groin without cardioplegic arrest. Nine men and six women were operated with a mean age of 68.7 years and a mean ejection fraction (EF) of 58.2%. In seven instances reoperation of aortocoronary bypasses was involved; two patients with multiple myelomas (morbus Kahler) had a brittle and cavernously altered sternum, all six women wanted a small skin incision below the breast. The criterion for ruling out the mentioned procedure was marked atherosclerotic affection of the ascendent aorta, affection of the arteries in the aortoiliac area and affection of one or two coronary arteries suitable for miniinvasive revascularization without extracorporeal circulation. Fourteen patients had an angiographic check up examination of the patency of grafts before they were discharged. The total number of distal anastomoses per patient was 3.13 +/- 0.6, the median period of extracorporeal circulation was 112 +/- 34 minutes and the mean time of operation 186 +/- 52 minutes. Blood losses were on average 425 ml/24 h without necessity of revision on account of haemorrhage. Eleven (73%) patients were subjected to an ultra fast track protocol with extubation on the operating table. The mean time spent in the postoperative department was 8.6 hours and the total hospitalization period 5.5 days. None of the operated patients died. Peroperative ischaemia of the heart muscle was not observed, in one instance the authors observed a newly developed atrial fibrillation. During an angiographic check-up the authors detected 6 (13.6%) stenoses and occlusions in 44 checked bridged vessels. The alternative approach reduces the risk of cardiac injury during reoperation and the danger of impaired healing of the sternotomical wound in patients with pathological conditions of the sternum, with contamination of the surrounding tissue (e.g. in tracheostomy) or malignant disease. The cosmetic effect of the submammary incision, the small inguinal incision and endoscopic saphenous vein harvesting should be considered in elective direct revascularization of the heart muscle in women. Bridging of the coronary arteries with optical assistance from minithoracotomy and with an automatic connector of central anastomoses seems to be a safe alternative of standard sternotomy only with methodological but not anatomical or functional restriction. Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 09/2002; 81(8):392-7.  
• Article: The in situ saphenous vein--more possibilities for vascular reconstruction?.
• J Lindner, M Semrád, K Novotný, M Slais, I Vanĕk 
• ABSTRACT: A clinical study of 47 patients with reconstruction of the large saphenous vein by the in situ technique indicates a statistically insignificant difference in the patency for venous grafts from 3 to 4 mm as compared with those above 4 mm. This confirms that the in situ technique extends the possibilities of venous reconstructions. In the author's group it extended the possibility to use a venous graft by 12.8%. The study confirms also the fundamental importance of patency of the pedal arch for long-term patency. Secondary patency of reconstructions in situ and reverse reconstructions in our department is comparable during the five-year period: 82 and 84%. Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 05/2002; 81(4):178-82. 
• Article: [Comparison of short-term and long-term results after aortocoronary bypass in ischemic heart disease in diabetics and non-diabetics]. J Charvát, M Stríteský, M Semrád, I Vanĕk, M Kvapil, T Vanĕcek 
• ABSTRACT: In the presented study we have evaluated short-term and long-term results of the multiple aortocoronary bypass surgery in the patients with ischemic heart disease. We have compared the incidence of the preoperative and postoperative complications, short-term and long-term mortality in the group of diabetics in comparison to nondiabetics as well as the entry characteristics of both groups. Among 2518 patients who were treated with aortocoronary bypass surgery there were 773 (30.6%) diabetics. The diabetic patients were significantly elder, we have found more women among them, more frequent presence of hypertension, chronic heart failure and peripheral vascular disease. Contrary in the incidence of the previous myocardial infarction we have not found any significant difference between both groups. The patients with diabetes mellitus had lower ejection fraction of the left ventricle and significantly more extensive coronary artery disease which explains that in this group of patients the number of coronary bypasses was significantly higher. Comparing the incidence of preoperative complications we have not seen any significant difference between the patients with and without diabetes mellitus. Out of the postoperative complications we have noticed significantly more renal failure, infectious complications, low cardiac output syndrome and bleeding disorders in the diabetic patients. The duration of hospitalisation in the intensive care unit was significantly longer in diabetics (55.11 +/- 89.09 hours to 47.84 +/- 65.18 hours in nondiabetics, p < 0.05). 30 days mortality in diabetics was 3.75% and 2.4% in nondiabetics (p < 0.05). This difference was mainly due to the significantly higher incidence of multiorgans failure as a cause of death among diabetics (1.3% in diabetics, 0.5% in nondiabetics, p < 0.05). 89.1% of nondiabetics and 86.9% of diabetics lived 2-6 years after aortocoronary bypass surgery (n.s.). We have found the significantly higher long-term cardiovascular mortality (2-6 years) in diabetics (10.3%) then in nondiabetics (7.6%, p < 0.05). Vnitr̆ní lékar̆ství 04/2002; 48(4):279-84.  Article: Myocardial revascularization via a median sternotomy without cardiopulmonary bypass in 250 patients--midterm results and study of graft patency.
• M Semrád, J Lindner, M Stríteský, V Vondrácek, J Kristof, J Rohác, P Bodlák, K Novotný, I Miler, I Vanĕk 
• ABSTRACT: To evaluate mid-term results and one-year graft patency of less invasive coronary artery bypass grafting through a median sternotomy. From January 1, 1998, to December 31, 1999, 250 patients had coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) through a median sternotomy. The patient base of 188 men and 62 women averaged 61.7 years, mean ejection fraction (EF) was 55.1%. An average of 2.7 (range 1 to 5) distal anastomoses per patient was achieved. Results are compared with a CPB subgroup of patients operated on through a median sternotomy in the same time (N = 1126). In a random subgroup of 100 patients (50 per group) an angiographic control of graft patency was done. A non-CPB group showed lesser occurrence of postoperative acute myocardial infarction (p = 0.038), atrial fibrillation (p = 0.029) and lower incidence of renal (p = 0.033) complications. We observed lower operative mortality (p = 0.019), as well as the occurrence of low cardiac output syndrome (p < 0.001) in the off pump group. The follow-up is 36 +/- 12 months and the number of patients with recurrent angina (5.4%), late AMI (0%) and late death (0.4%) is acceptable. We did not find an inordinate number of vein grafts occlusions (2.2%) and stenoses (7.8%) at anastomotic sites. None of the arterial grafts in both groups were occluded. We detected lower incidence of postoperative complications and decreased operative mortality in a non-CPB group. Angiographic assessment displayed an excellent run-off in both groups of patients. Off-pump coronary bypass grafting is associated with sufficient short-term graft patency and mid-term clinical outcomes. Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 04/2002; 81(4):172-7. 
• Article: Off-pump coronary artery bypass grafting. The 1st Medical Faculty of Charles University study. M Semrád, P Bodlák, M Stríteský, J Kristof, J Lindner, T Urban, V Vondrácek, I Vanĕk 
• ABSTRACT: To explore the surgical technique, anaesthesiological management, immediate and mid-term results, graft patency and effectiveness of less invasive coronary artery bypass grafting through a median sternotomy. From January 1998 through December 1999, 144 patients had coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB) done by one surgeon through a median sternotomy. The cohort of 107 men and 37 women averaged 60.8 years, mean ejection fraction (EF) was 51.8%. An average of 2.7 (range 1 to 5) grafts/patients was achieved. Results are compared with a CPB subgroup of patients operated on through a median sternotomy in the same time (N = 234). In a random subgroup of 100 patients (50 per group) an angiographic control of graft patency was done. A non-CPB group showed less postoperative acute myocardial infarction (0.7% vs. 3.8%, p < 0.05) and atrial fibrillation (14.6% vs. 26%, p < 0.05), lower incidence of renal (2.8% vs. 5.1%, p < 0.05) and respiratory complications (2.0% vs. 3.8%, NS). We observed lower operative mortality (0.7% vs. 3.4%, p < 0.05), as well as the occurrence of low cardiac output syndrome (0.7% vs. 5.6%, p < 0.05) in the off-pump group. The follow-up is 36 +/- 12 months and the number of patients with recurrent angina, late AMI and late death is acceptable. We did not find an inordinate number of vein grafts occlusions (0.7% vs. 1.8%, NS) and stenoses (6.6% vs. 6.7%, NS) at anastomotic sites. None of the arterial grafts in both groups were occluded. There was little known about the efficacy of the less invasive coronary artery bypass grafting at the beginning of our study. Starting with pioneering the operative technique, we have discovered and proposed three types of a heart verticalization and a reusable stabilizing device. We detected lower incidence of postoperative complications and decreased operative mortality in a non-CPB group. Angiographic assessment displayed an excellent run-off in both groups of patients. Off-pump coronary bypass grafting is associated with sufficient short-term graft patency and mid-term clinical outcomes. Sbornik lekarsky 01/2002; 103(3):297-304. 
• Article: [Contribution to the theory of venous grafting using the great saphenous vein. An experimental study]. J Lindner, M Krajicek, M Semrád, I Vanĕk 
• ABSTRACT: The experimental study took interest in measurement of the flow through great saphenous vein graft. This study compared the flow through reversed vein graft and nonreversed vein graft with cutting vein valvules in the similar conditions. The flow in nonreversed graft lenght of 65 cm was Q = 697 +/- 26 ml/min, in reversed graft lenght of 65 cm Q = 836 +/- 8.61 ml/min. The flow in nonreversed graft lenght of 55 cm was Q = 1002.5 +/- 12.9 ml/min in reversed graft 55 cm Q = 1059 +/- 7.36 ml/min. The results of measurements show higher flow the shorter the graft as well as higher flow through the reversed graft. The statistically significant difference in values of the flow was also confirmed by Wilcoxon-Mann-Whitney test. The conclusion of our study can be applied on usage of allogenous vein grafts and autogenous vein grafts that could be transferred on the other leg. In these indications we can recommend the usage of reversed technique, because the measured flow through the reversed graft is statistically higher than through the nonreversed graft. Sbornik lekarsky 02/2001; 102(4):501-9. 
• Article: Thrombectomy and embolectomy using the adherent clot catheter.
• K Novotný, J Táborský, M Semrád 
• ABSTRACT: The efficacy of the Adherent Cloth Catheter is demonstrated on the three above described cases. The different mechanism of function on contrary to the classic Fogarty Catheter enables us to remove the older, strongly adherent thrombus from prothesis, artery or vein. The catheter is a functional instrument not only for vascular surgery, but also for invasive angiology. Sbornik lekarsky 02/2001; 102(3):405-10. 
• Article: Comparison of the effectiveness of crystalloid and warm blood cardioplegia in patients with significant left ventricular dysfunction. T Urban, J Táborský, I Vanĕk, M Semrád, I Miler 
• ABSTRACT: In a group of 84 patients undergoing elective coronary artery bypass surgery and with the ejection fraction lower than 40% two types of myocardial protection were studied. Group I (41 cases) was given intermittent cold crystalloid cardioplegia and group II (43 patients) was given intermittent warm blood cardioplegia followed by normothermic reperfusion. Preoperative, intraoperative and postoperative data were retrospectively collected. There were no differences between the two groups except more rhythm disturbances in group I and higher incidence of neurological complications in group II. CONCLUSIONS: Warm blood cardioplegia is an effective, cheap and practical myocardial protection technique. Sbornik lekarsky 02/2000; 101(3):261-6. 
• Article: A nontraditional method of surgical treatment of an aortocaval fistula. Case report. T Urban, J Táborský, I Vanĕk, M Semrád, I Miler 
• ABSTRACT: Unusual method of aortocaval fistula and venous aneurysm repair is discussed and possible advantages of this type of surgery are cleared up. The aortoiliac prosthetic substitution and exclusion of the region, where aorta and inferior vena cava communicate without direct suture of the fistula makes the operation safer and lowers the risk of postoperative bleeding. In authors' opinion, this method is effective even in acutely rising aortocaval fistulas. Sbornik lekarsky 02/2000; 101(3):267-71. 
• Article: Aneurysm of the descending aorta causing destruction of vertebral bodies. Case report. M Semrád, I Vanĕk, J Táborský, T Urban 
• ABSTRACT: A case report of 59-year-old woman with combined lesion of the aneurysm of the descending thoracic aorta and the destruction of vertebral bodies is presented. Considering the infectious aetiology of the whole lesion and the possibility of the future orthopaedic intervention we use the less usual operative approach and technique in this case. Only indirect method to prevent the spinal cord injury was used and the aneurysm was repaired with bypass and exclusion. The only postoperative complication requiring future surgery was the dissection and thrombosis of the right superficial femoral artery used for blood pressure monitoring. We perform, in local heparinization, the proximal femoropopliteal prosthetic bypass. The latter postoperative course was uneventful. Follow-up digital angiography of the aorta 12 month later showed good filling of the prostheses and normal anastomosis, X-ray film and CT scans one, three and five years after operation showed almost complete reconstruction of the vertebral bodies. This article also discusses the technical and tactical aspects of the thoracic aortic aneurysm repair and also analyses the diagnostic and therapeutic chance to influence the spinal cord ischaemia. Sbornik lekarsky 02/2000; 101(3):273-9. 
• Article: Surgery of infectious complications in prostheses in the abdominal aorta. I Miler, J Táborský, M Semrád, I Vanĕk 
• ABSTRACT: The authors describe the successful solution of a serious and feared complication, i.e. infection of a vascular prosthesis. A hitherto not used procedure was adopted-concurrent removal of the infected prosthesis and restoration of the blood flow into both extremities by an extra-anatomical axillobiiliac bypass. The authors draw attention to the advantages of this method in context with possible future solutions; and with regard to the hitherto not complicated postoperative course they assume that this type of treatment could be final. At the same time they draw attention to the complexity of the problem from the diagnostic and therapeutic aspect. Rozhledy v chirurgii: měsíčník Československé chirurgické společnosti 09/1995; 74(5):203-5.