A b s t r a c tBackground: Erythropoietin (EPO) deficiency or inadequate EPO secretion in response to bleeding may result in profound or prolonged anaemia after cardiac surgery. Aim:The aim of the study was to evaluate the changes in EPO secretion in patients undergoing off-pump coronary artery bypass grafting (OPCAB).Methods: Blood samples from 43 patients (mean age 65.1 ± 7.6 years) were obtained before surgery and on the 1 st , 2 nd , and 6 th day post isolated OPCAB. EPO levels ≥ 4.3 mIU/mL were considered normal.Results: Thirteen (30%) patients had the preoperative EPO level below normal range even though their preoperative haemoglobin was ≥ 13 g/dL. In patients with basal EPO deficiency lower peak EPO levels were observed compared to the group with normal basal EPO levels, even though reduction in haemoglobin concentrations was comparable in both groups. Moreover, lower reticulocytosis was noted on day 1 (8.5 ± 4.0‰ vs. 11.7 ± 4.4‰; p = 0.04) and a tendency toward lower values was seen on day 2 (9.6 ± 4.3‰ vs. 13.0 ± 5.8‰; p = 0.07) among patients with preoperative EPO deficiency.Conclusions: Erythropoietin deficiency is common in patients scheduled for OPCAB, and it results in diminished increase in EPO secretion in response to bleeding. Consequently, in patients with EPO deficiency, reticulocytosis is lower than it could be predicted based on the observation of patients with normal EPO levels and similar blood loss.

Although coexistence of ASA and BAV has not been reported in paediatric population, it has been diagnosed in very few adults as well as in our series. Additional presence of COCA in this group seems to be very rare. From practical point of view, heart cannulation via the radial artery and subsequent ASA may be challenging. Similarly, COCA presence may have surgical implications during corrective procedures.

A 23-year-old man diagnosed with tetralogy of Fallot with absent pulmonary valve underwent primary repair at the age of two years. Surgical allograft repair was performed at the age of 10 due to allograft stenosis. Seven years later, due to recurrence of pulmonary allograft stenosis, transcatheter pulmonary valve implantation (TPVI) was applied. After prestenting with a bare metal

We present a case of a 65-year-old male admitted to our clinic due to acute aortic dissection Stanford type A. On admission, the patient was in good general condition, blood pressure 85/60 mm Hg, sinus rhythm 67 bpm, with no electrocardiographic changes, and no chest pain. Transthoracic echocardiography revealed aortic dissection, an intimal tear just above the tricuspid aortic valve with no organic changes of the valve and severe regurgitation. The patient was operated with use of cardiopulmonary bypass, in moderate hypothermia. A supracoronary aortic graft was implanted. On the seventh postoperative day, the patient was discharged. One year later the patient was admitted again due to a false aneurysm at the region of proximal anastomosis of supracoronary graft and persistent dissection of aortic arch and descending aorta, with increasing diameter of aortic arch (Fig. 1). The patient was stable, but the lumen of false aneurysm increased in last six months and the risk of right coronary artery occlusion was present. Surgery was planned. The patient was reoperated with cardiopulmonary bypass, in moderate hypothermia at 26 degrees centigrade. The supracoronary aortic graft was cannulated directly, and a two-stage atrial cannula was used. The aorta was cross-clamped at the graft level, and the graft was opened and cold blood cardioplegic solution was administered directly to the coronary ostia. The proximal part of aortic graft was excised with the native aortic root with careful preparation of coronary ostia. An artificial ring was made from a Teflon strip using 29-mm sizer, then the ring was sutured to the annulus from outside with six 4-0 polypropylene sutures, three of them beneath commissures of the valve and three beneath nadirs of aortic cusps. The sinuses were excised leaving approximately 5 mm of aortic wall. A 28-mm Dacron vascular graft was tailored to create three symmetric sinuses and sutured to the aortic wall with three 4-0 polypropylene continuous sutures beginning in the nadir of sinus. Then the Dacron graft was tailored about 2 cm above the commissures, and the aortic valve was carefully assessed and repaired with use of the concept of effective height of aortic cusps using dedicated callipers. Next, the cardiopulmonary bypass was stopped, the aortic arch and branches were dissected, selective brain perfusion was instituted, and the aortic arch was replaced with the branched 28-mm Dacron graft. Extracorporeal circulation was then reinstituted, two Dacron grafts were sutured, and the procedure was finished. Intraoperative transoesophageal echocardiography showed a trivial central aortic regurgitation jet, like the transthoracic echocardiography on the fifth postoperative day (Fig. 2). Postoperative angio-computed tomography scan showed excellent postoperative effect (Fig. 3). On the tenth postoperative day the patient was discharged.