Background/Aim. Custodiol is a hyperpolarizing cardioplegic solution which has been used in our national cardiac surgical practice exclusively for the heart transplant surgery. Owing to its numerous advantages over the standard depolarizing solutions, Custodiol became cardioplegia of choice for all other cardiac surgical procedures in many cardiosurgical centers. This study evaluates myocardial protection of Custodiol compared to modified St. Thomas cardioplegia in coronary artery bypass surgery. Methods. In a prospective four-month study 110 consecutive adult patients who underwent primary isolated elective on-pump coronary artery bypass grafting (CABG) were randomized into Custodiol group (n=54) and modified St.Thomas group (n=50), based on the type of administered cardioplegia; six patients were excluded. Cardiac protection was achieved as antegrade cold crystalloid cardioplegia by one of the solutions. Myocardial preservation was assessed through following outcomes: spontaneous rhythm restoration post crossclamp, and postpoperative cardiac specific enzymes level, ejection fraction (EF) change, inotropic support, myocardial infarction (MI), atrial fibrillation (AF), and death. Results. Preoperative and intraoperative characteristics were similar except for a considerably longer cross-clamp time in the Custodiol group (49.1±19.0 vs. 41.0±12.9 minutes; p=0.022). Custodiol group exhibited a higher rate of return to spontaneous rhythm (31.5% vs. 20.0%; p=0.267), lower rates of AF (20.4% vs. 28%; p=0.496), MI (1.8% vs. 10.0%; p=0.075) and inotropic support (9.0% vs. 12.0%; p=0.651), albeit not statistically significant. There was an insignificant difference in peak value of Troponin I (5.0±3.92µg/L vs. 4.5±3.39µg/L; p=0.755) and Creatine Kinase-MB (26.9±15,4µg/L vs. 28.5±24.2µg/L; p=0,646) 6 hours post-surgery. EF reduction was comparable (0,81% vs. 1.26%; p=0.891). There were no deaths. Conclusions. Custodiol and modified St.Thomas cardioplegia have comparable cardioprotective effects in CABG surgery. The trends of less frequent MI, AF and inotropic support, despite the longer cross-clamp time in the Custodiol group may suggest that its benefits could be ascertained in a larger study. ApstraktUvod/Cilj. Custodiol je hiperpolari iraju i kardiolegi ni rastvor koji je kori en, u na oj nacionalnoj kardiohirur koj praksi, isklju ivo u transplantacionoj hirurgiji. Zbog svojih brojnih prednosti u odnosu na standarde, depolari iraju e rastvore, Custodiol je, u mnogim kardiohirur kim centrima, postao kardioplegija i bora a sve kardiohirur ke procedure. Cilj studije je procena miokardne protekcije rastvorom Custodiol-a u poređenju sa modifikovanom St. Thomas kardioplegijom u koronarnoj hirurgiji. Metode. Tokom prospektivne etveromese ne studijie, 110 u astopnih odraslih pacijenata podvrgnutih primarnoj, izolovanoj, elektivnoj operaciji aortokoronarnog bajpas su randomizirani na osnovu primenjene kardioplegije u Custodiol grupu (n=54) i modifikovanu St.Thomas

Background / Aim: To determine the current state of the institutional informed consent policy before elective cardiac surgical procedures in light of actual national legislation. Methods: An anonymous, voluntary survey was conducted among 200 consecutive patients, at the Clinic for Cardiac Surgery, UC Clinical Centre of Serbia, from September to December 2019, after having signed an official institutional consent form. A targeted questionnaire was created to determine the quantity and quality of patient?s information about general and the most important aspects of cardiac surgical care. Results: The mean age of respondents was 66.2 years, with male predominance (68.0%), homogenous ethnicity, and low-to-middle (84.0%) education levels. A significant percentage had no information on the type of surgery (16.0%), extracorporeal circulation (46.0%), anaesthesia (56.0%) and transfusion (51.5%). Of those having some information, 7.0%-20.0% graded them sufficient. The worst situation was recorded concerning risks of disease and surgical treatment, where 88.0% of patients had no information and almost 90.0% having some information, graded them non-sufficient. Surprisingly, 81.5% of patients have signed the consent form without any prior discussion with the operating surgeon. For 56.0% of patients. the information in the actual consent form was clear and sufficient. While 85.5% of patients claimed the importance, the others (14.5%) were not interested to know the most relevant information about their disease and surgery. Conclusion: The results unambiguously indicate an unacceptably low level of our patients? information about the cardiac surgical procedure, extracorporeal circulation, anesthesia, transfusion, and estimated risk. The majority of them (85.5%) comprehend the importance and expect timely and adequate information. An extremely high percentage (81.5%) of patients had no chance to discuss the procedure with the operating surgeon. Both surgical indifference and insufficient knowledge of professional, ethical, and legal importance, are the most important reasons for actual informed consent policy in cardiac surgery.

Objective: The objective of this prospective study was to evaluate the characteristics (positive and negative) of Perceval S valve in patients undergoing aortic valve replacement with a biological prosthesis. The study included 67 patients operated on at our institution and a mean follow-up period of 18 months. Methods: From June 2016 to November 2019, 209 patients underwent aortic valve replacement with a biological prosthesis. Of these, 67 patients were included in the study based on the exclusion and inclusion criteria set before the study began. Their data were recorded during their hospital stay (preoperative, intraoperative, and early and late postoperative time). Results: Fifty-four patients underwent isolated aortic valve replacement (group I) with a Perceval S prosthesis, and 13 patients had combined aortic valve replacement procedures and CABG procedures (group II). Patients were implanted with the following prosthesis sizes: S (N = 12), M (N = 18), L (N = 28), or XL (N = 9). The Perceval S valve successfully was implanted in 67 (91.8%) patients (in 6 patients, the preoperative transthoracic echocardiographic data did not coincide with intraoperative TEE and surgical measurement of the size of the annulus in the suture). Surgical approaches in patients were medial sternotomy (N = 48), mini sternotomy (N = 15), and thoracotomy through the second intercostal space to the right (N = 4). The mean clamping time of the aorta and CPB length for isolated cases was 54 and 82 minutes, respectively, and 96 and 120 minutes for combined procedures. Four (5.9%) patients died within 30 days. Conclusion: Early postoperative results showed that the Perceval S valve was safe. Further follow up is required to evaluate the long-term duration of patients with this bioprosthesis.

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Acute ascending aortic dissection is life-threatening condition that requires emergency surgery. When left untreated, about 33% of patients die within the first 24 hours, and 50% die within 48 hours. The aim of our study was to evaluate the clinical characteristics, management, and outcomes of patients with acute type A aortic dissection during the 5 years period.