Michal Semrad, Assoc. Prof, M.D., PhD.

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