Kristina Brkić

University Hospital Dubrava

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ŽS

Željko Sutlić

University Hospital Dubrava

Davor Barić

University Hospital Dubrava

Daniel Unić

University Hospital Dubrava

Igor Rudež

University Hospital Dubrava

Bojan Biočina

University Hospital Centre Zagreb

Nada Nikić

University Hospital Dubrava

Ines Lazibat

University Hospital Dubrava

ŽR

Željko Romić

University Hospital Dubrava

BŠ

Bojan Štambuk

Klinički Bolnički Centar Split

Dubravka Jonjić

University Hospital Dubrava

Cooperative Institutions

University Hospital Dubrava

University of Zagreb

University Hospital Centre Zagreb

University of Split

Croatian Science Foundation

University of Rijeka

Catholic University of Croatia

University of Osijek

Klinička bolnica Merkur

IFC Research (United Kingdom)

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Miocardial revascularization without the use of extracorporeal circulation in coronary patients with diabetes mellitus

Bojan Štambuk Željko Sutlić Bojan Biočina Igor Rudež Davor Barić

Cilj: dokazati da je kardiokirurska operacija koja ne koristi izvantjelesnu cirkulaciju (OPCAB) dobra i preporucena operacija kod koronarnih bolesnika sa secernom bolesti, u usporedbi s onim dijabetickim bolesnicima podvrgnutim kardiokirurskoj operaciji koja koristi izvantjelesnu cirkulaciju (CABG), analizirajuci tridesetodnevno poslijeoperacijsko razdoblje Metode: prospektivna studija 273 dijabetickih bolesnika podvrgutih kardiokirurskoj operaciji u petogodisnjem razdoblju (prosinac 1997-prosinac 2002) dijabeticki bolesnici: 84 podvrgnutih OPCAB, 189 podvrgnutih CABG ; demografski podaci: dob i spol ; klinicki podaci: arterijska hipertenzija (sist. tlak>140 mmHg), hiperlipoproteinemija (kolesterol>5.5 mmol/L, LDL>3 mmol/L , LDL/HDL>2) preoperativni cimbenici rizika: prosirenost koronarne bolesti, stenoza debla lijeve koronarne arterije, nestabilna angina pektoris, prethodni infarkt miokarda, prethodni kardiokirurski zahvat ; uporaba arterijskih graftova: a. radialis, a. thoracica interna i v. saphena magma ; komplikacije: poslijeoperacijsko krvarenje, perioperativni infarkt miokarda, povrsinska i duboka infekcija rane, poslijeoperacijski cerebrovaskularni incident ; određivanje p vrijednosti pomocu c2 testa Rezultati: dijabeticki bolesnici podvrgnuti ACBP imaju statisticki znacajno ucestalije arterijsku hipertenziju (66% 52% p=0.047), trožilnu koronarnu bolest (76% 49% p<0.001) totalna arterijska revaskularizacija provedena je statisticki znacajno cesce kod bolesnika podvrgnutih OPCAB (55% 18% p<0.001) jedina statisticki znacajna razlika u postoperativnom morbiditetu nađena je kod pojave perioperativnog infarkta miokarda (ACBP 0% OPCAB 6% p=0.004) nije nađena statisticki znacajna razlika analizirajuci tridesetodnevni poslijeoperacijski mortalitet Zakljucak: OPCAB je zadovoljavajuca i sigurna operacija izbora kod koronarnih bolesnika sa secernom bolesti ; jedino je perioperativni infarkt miokarda cesce prisutan kod ove skupine bolesnika. Međutim, konacne zakljucke moguce je donijeti tek po analizi kasnih (petogodisnjih ili desetogodisnjih) poslijeoperacijskih rezultata

Extracorporeal circulation

Myocardial Revascularization

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Off-pump myocardial revascularization attenuates endothelin-1 expression in systemic, pulmonary, and coronary circulation

Wiener klinische Wochenschrift (2014)

Daniel Unić Davor Barić Kristina Brkić Mislav Planinc Dubravka Jonjić

Coronary circulation

Systemic circulation

Circulation (fluid dynamics)

Myocardial Revascularization

10.1007/s00508-014-0664-8

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Matematika u mlađoj dobi

Kristina Brkić

Djeca jako rano stjecu neformalno znanje matematike, koje je iznenadujce siroko, složeno i raznoliko. Djecu zanimaju razmisljanja u razlicitim

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IMPLEMENTACIJA I DALJNI RAZVOJ UPRAVLJANJA SUSTAVOM KVALITETE PREMA NORMI ISO 9001:2000 NA ODJELU ZA KARDIJALNU KIRURGIJU SVEUČILIŠNE BOLNICE DUBRAVA

Davor Barić Kristina Brkić Željko Sutlić Nada Nikić Milka Grubišić

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Lacidipine in prevention of ischemia after arterial myocardial revascularization

Aleksandar Knežević Željko Sutlić Kristina Brkić Dubravka Jonjić Vesna Bačić Vrca

Lacidipine

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Monitoring of fibrinolysis parameters during myocardial revascularization according to type of procedure

Clinical Chemistry and Laboratory Medicine (CCLM) (2005)

Marcela Živković Kristina Brkić Nada Nikić Dragica Hašperger Jasna Juriček

Abstract The aim of the study was to assess the effect of cardiothoracic surgery on the dynamics of plasminogen, D-dimers and plasminogen activator inhibitor (PAI-I) during the first 24h after surgery. The study included 14 patients operated with (on-pump) and 14 without (off-pump) the use of extracorporeal circulation (ECC). Blood sampling was carried out on induction of anesthesia (timepoint 1), on introduction of heparin (point 2) and protamine (point 3), at the end of surgery (point 4), and the next morning (point 5). Relative to point 1, the utilization of plasminogen at point 2 was 24% and 17% in the on-pump and off-pump groups, respectively (p=0.001 both). Increased D-dimer concentration from the baseline was more pronounced in the on-pump group (p=0.001). At point 5, D-dimer concentrations were comparable in both groups and different from baseline levels. PAI-I activity showed within-group differences from baseline at point 5 in the off-pump group (p=0.001), and at points 3 and 5 in the on-pump group (p=0.002 and 0.001, respectively). At point 5, the activity of PAI-I was comparable in both groups, yielding p=0.001 vs. baseline. Fibrinolysis was more pronounced and more dynamic in the on-pump group due to activation of the systemic inflammatory response induced by the use of ECC. In the off-pump group, fibrinolysis was a normal physiological response to the surgical procedure.

Extracorporeal circulation

10.1515/cclm.2005.006

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Individual differences in core inflammatory markers'expression after cardiopulmonary bypass: comparison of IL-6, CRP, neopterin and complement

Kristina Brkić Željko Sutlić Željko Romić Daniel Unić Bojan Biočina

Cardiac surgery with the use of cardiopulmonary bypass (CPB) induces a state of systemic inflammatory response during which different plasma proteins and blood cells are activated. So far, various inflammatory markers were used to monitor that response but neither of them was found to be sensitive and specific enough. The aim of this study was to investigate whether the use of cardiopulmonary bypass emphasizes interindividual differences of core inflammatory markers' expression after cardiac surgery. //Eighty consecutive patients undergoing myocardial revascularization were divided in two groups prospectively: group CABG (n=35) and group OPCAB (n=45). Serum samples were collected one day prior to surgery, 6, 12 and 24 hours after the end of surgery and on 3rd, 5th and 7th day postoperatively. Interleukin-6 and neopterin were measured using ELISA method, C3, C4 and CRP using turbidimetric method. Due to the potential interindividual variations in marker levels, we have analyzed (patients demonstrating the peak values greater or equal to the population median for a given inflammatory marker) for each inflammatory marker between the groups, 12 hours after surgery, with respect to multiple variables. //Interleukin-6 and CRP kinetics did not differ between groups. Interleukin-6 showed peak level 12 hours after the end of surgery, while CRP showed peak level 3rd postoperative day. Complement C4 levels were much lower during the first 24 hours after surgery in CABG hyper-responders compared with OPCAB hyper-responders (p=0.019 ; p=0.027 and p=0.019 for 6, 12 and 24 hours after the end of surgery, respectively). Neopterin levels were higher during first 24 hours postoperatively in CABG hyper-responders (p=0.016, p=0.014 and p=0.014 for 6, 12 and 24 hours after the end of surgery, respectively).

Neopterin

Inflammatory response

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Predictors of short-term neurocognitive outcome following coronary revascularisation (CABG) depending on the use of cardiopulmonary bypass.

PubMed (2012)

Ines Lazibat Željko Sutlić Kristina Brkić Branimir Nevajda Jozica Šikić

The purpose of our study was to investigate the association between perioperative cerebral microembolization, expressed as high-intensity transient signals (HITS) and postoperative dynamics of the neuromarker S100P in patients operated using cardiopulmonary bypass, and to assess their impact upon the neurocognitive function in the early postoperative stage. The study involved 62 consecutive male patients aged 60 or above, alls scheduled for elective aortocoronary bypass. The patients were recruited from two groups with respect to the use of CPB: on-pump group (CPB+, N = 30) and off-pump group (CPB-, N = 32). In all patients we performed intraoperative monitoring of cerebral haemodynamics using transcranial Doppler, with the goal of quantifying perioperative cerebral microembolization. The serum levels of the neuromarker S100l were measured immediately after surgery, and then 12, 24 and 48 hours after the surgery. Neurocognitive status was assessed before and after the surgery and in three cognitive domains. Results of the study have shown that with respect to the short-term postoperative neurocognitive outcome there is no significant difference between the on-pump and off-pump surgical technique of coronary revascularization'. Perioperative cerebral microembolization was significantly more pronounced in the on-pump group yet it did not affect early postoperative neurocognitive function, while the increase in the neuromarker S100beta serum level 48 hours after surgery may have prognostic value as a predictor of postoperative neurocognitive dysfunction.

Neurocognitive

Postoperative cognitive dysfunction

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Neopterin kinetics after cardiac surgery with or without cardiopulmonary bypass

Collegium Antropologicum (2006)

Kristina Brkić Daniel Unić Željko Sutlić Bojan Biočina Igor Rudež

Cardiac surgery (CS) with cardiopulmonary bypass (CPB) induces systemic inflammatory response by activating plasma proteins and blood cells. Activated monocytes/macrophages produce inflammatory marker neopterin (NP). The aim was to explore the NP kinetics in first 24 hours after CS according to the CPB use. Significant difference between groups was found for NP levels 12 and 24 hrs after CS, being higher in on-pump group. Strong association was found between NP levels 12 hrs after CS and the length of ICU stay for on-pump group (r=0.744, p<0.001). Strong association was found between preoperative NP levels and the length of ICU stay for those on-pump patients with elevated preoperative NP (r=0.855, p=0.001; linear regression equation y=0.50x-5.14, p<0.001). Preoperative NP levels higher than 10 nmol/L in on-pump group could predict prolonged ICU stay and outpoint patients at higher risk for developing postoperative complications and, therefore, help to determine the necessary therapeutic interventions.

Neopterin

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ROLE OF QUALITY IN APPLICATION OF SURGICAL LABORATORY FOR BIOMEDICAL RESEARCH FOR INFRASTRUCTURAL PROJECTS OF EUROPEAN REGIONAL DEVELOPMENT FUND

Kristina Brkić Željko Sutlić Ines Lazibat Marijan Kantolić

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