Day 3 :
- Track 7: Current Research in Cardiology
Robert M. Mentzer, Jr.
Wayne State University School of Medicine, USA
University of Nebraska Medical Center, USA
University of Nebraska Medical Center, USA
Time : 09:00-09:20
Artang graduated from the University of Copenhagen, School of Medicine in 1994 after which he continued his clinical work and Ph.D. research studies on cardiovascular disease and pathophysiology of blood clot formation. He completed his training in Cardiology in United States in 2007. Artang is the director of Non Invasive Cardiac and Vascular Imaging at Mercy Medical Center. He also serves as assistant professor of Medicine at the Division of Cardiology at the University of Nebraska Medical Center in Omaha where he is involved in training and education of cardiology fellows and has ongoing research activities. He has published several papers in basic and clinical science and has presented his work in International meetings including the Annual Scientifi c Session of the American College of Cardiology, European Society of Cardiology and International Society of Thrombosis and Haemostasis on several occasions. The results of his research has been cited more than 50 times by other investigators in International medical journals including the Lancet, Circulation, Heart and Thrombosis and Haemostasis.
Atrial fi brillation is the most common clinically signifi cant cardiac arrhythmia. It is also a potent risk factor for ischemic stroke, increasing the risk of stroke 5-fold and accounting for approximately 15% of all strokes nationally. Th e projected number of patients with atrial fi brillation in united states is more 5 million by year 2050. While warfarin has been recommended for stroke prevention since mid 1990s only half of patients with atrial fi brillation are on appropriate treatment due to various challenges with this agent. Within the past 2-3 years 3 new oral anticoagulant have entered the market for primary stroke prevention and several more are in the pipeline. Th is presentation will review historical perspective of the anticoagulant agents and challenges facing the clinicians with the new agents. Highlights of the 3 major trials with the 3 novel anticoagulants dabigatran, rivaroxaban and apixaban as well as subgroup meta-analysis of the 3 novel agents as compared to the warfarin in regard to the primary and safety outcomes will be presented.
University Malaya Medical Centre, Malaysia
Time : 09:20-09:40
Ramesh Singh Veriah is Consultant Cardiologist and Senior Lecturer in Cardiology and Internal Medicine, Interventional Cardiology Unit, University Malaya Medical Center (UMMC), Kuala Lumpur, Malaysia. Obtained Bachelor of Medicine and Bachelor of Surgery (MBBS) from University of Malaya in 1997. Membership from the Royal College of Physicians, Ireland (MRCP) in February 2002. Involved in many local and international multicenter trials, with main interest in erectile dysfunction (ED) and heart diseases. Won fi rst prize for best research at national level in 2006 at the Malaysian Society of Hypertension (MSH) conference. Main cardiology interest is coronary artery based diseases and preventive and rehabilitative cardiology. Research work on ED was presented at the TCT 2008 in Washington DC. Presented two abstracts in Heart Failure, Nice, France 2009. Presented another abstract in World Congress of Cardiology in Beijing 2010. Invited to give talks in India, Brunei, Seoul and Hanoi (ASEAN Congress of Cardiology). Invited Faculty to many Cardiology Conferences.
Coronary stenting or Percutaneous Coronary Intervention (PCI) is the mainstay of treatment for stenosed coronary arteries. Signifi cant changes have been added to the coronary stent with drug-eluting stents (DES) favoured over bare metal stents. However, the initial DES was still not free of problems. Newer generations stents are more trackable and conformable to the vessel wall. Th ese stents are also less thrombogenic hence reducing the stent thrombosis rates signifi cantly. However, these stents have certain limitations among which include stent shortening. Th is can be overcome with proper and careful stent deployment emphasizing on good operator technique. Future stents will also see involvement of bifurcating stents and absorbable stents with certain stents already using a biodegradable polymer coating.
Mayo Clinic College of Medicine, USA
Time : 09:40-10:00
Sohail completed his medical school at The Aga Khan University, Pakistan in 1998 followed by internship and residency at University of Illinois, College of Medicine at Chicago and fellowship training in Infection Diseases at Mayo Clinic, College of Medicine. He is currently an Assistant Professor of Medicine in the Division of Infectious Diseases at Mayo Clinic. Sohail has published over 40 papers in peer-reviewed medical journals and has served as Faculty at Heart Rhythm Society meeting in May 2012. He is a reviewer for several leading medical journals including The New England Journal of Medicine, The Journal of American Collge of Cardiology and Circulaiton. He is currenlty an active member of Council on Quality of Care and Outcomes Research and Council on Clinical Cardiology of the American Heart Association.
Cardiovascular implantable electronic device (CIED) implantation rate has substantially risen in the foregoing decades. Unfortunately, this upsurge in CIED implantation rate has been accompanied by a disproportionate rise in the rate of CIED infections. Device infection is a major complication of CIED implantation, necessitating removal of an infected device followed by systemic antimicrobial therapy and reimplantation of a new system. In this presentation, I will review the current epidemiology, risk factors, diagnostic strategy and contemporary management of CIED infection. Moreover, I will address the vexing question of how to best manage patients with Staphylococcus aureus bacteremia, in the setting of an implanted device, but no overt clinical signs of CIED infection. Lastly, I will discuss the preventive strategies to minimize risk of CIED infection.
University of Szeged, Hungary
Time : 10:00-10:20
Norbert Jost has completed his Ph.D. in theoretical medical sciences at the age of 29 years from Faculty of Medicine, University of Szeged, Hungary, and postdoctoral studies from Carl Gustav Carus Faculty of Medicine, Unicersity of Technology Dresden, Germany. He supervises the In Vitro Cardiac Electrophysiology Laboratory, Division of Cardiovasculary Pharmacology, Hungarian Academy of Sciences, a team that in the last one and half decades has published more than 40 papers in the fi eld of cardiac, cellular, electrophysiology and pharmacology. In these publications, they described the properties of various transmembrane currents focusing particularly on the modulating effect of several newly developed antiarrhythmic drugs or investigational compounds.
Atrial fi brillation (AF) is the most common arrhythmia in clinical practice. It can occur at any age, however, it becomes extremely common in the elderly, with a prevalence approaching more than 20% in patients older than 85 years. AF is associated with a wide range of cardiac and extra-cardiac complications and thereby contributes signifi cantly to morbidity and mortality. Present therapeutic approaches to AF have major limitations, which have inspired substantial eff orts to improve our understanding of the mechanisms underlying AF, with the premise that improved knowledge will lead to innovative and improved therapeutic approaches. Our understanding of AF pathophysiology has advanced signifi cantly over the past 10 to 15 years through an increased awareness of the role of “atrial remodeling”. Any persistent change in atrial structure or function constitutes atrial remodeling. Both rapid ectopic fi ring and reentry can maintain AF. Atrial remodeling has the potential to increase the likelihood of ectopic or reentrant activity through a multitude of potential mechanisms. Th e present lecture reviews the main novel results on atrial tachycardia-induced electrical, structural and contractile remodeling focusing on the underlying pathophysiological and molecular basis of their occurrence. Special attention is paid to novel strategies and targets with therapeutic signifi cance for atrial fi brillation.
Istituto Superiore di Sanita, Italy
Title: Transcatheter aortic valve implantation versus surgical aortic valve replacement for severe aortic stenosis: Results from an intermediate risk propensity-matched population of the Italian OBSERVANT Study
Time : 10:20-10:40
Fulvia Seccareccia graduated in Biological Sciences, at the University of Rome “La Sapienza”, in 1979. She works as Senior Researcher at the Department of Cardio and Cerebrovascular Diseases, National Center of Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy. She has been project leader of several projects concerning “Outcome Research”. From 1980 to 2001, her professional experience concerned mainly the epidemiology and prevention of cardiovascular disease. Since 2001, she has been involved in studies concerning comparative effectiveness analyses in cardiology and cardiac surgery. She has published more than 100 papers in reputed International Journals.
Background: Few studies have yielded information on comparative eff ectiveness of transcatheter aortic valve implantation (TAVI) versus surgical aortic valve replacement (SAVR) procedures in a real-world setting. Aim of this analysis is to describe procedural and post-procedural outcomes in a TAVI/SAVR intermediate risk propensity-matched population. Methods: OBSERVANT is an observational prospective multicenter cohort study, enrolling AS patients undergoing SAVR or TAVI. Propensity score method was applied to analyze procedural and post-procedural outcomes. Pairs of patients with the same probability score were matched (caliper matching). Results: Th e unadjusted enrolled population comprises 1383 SAVR and 725 TAVI patients. Matched population comprised a total of 266 patients (133 patients for each group). A relatively low risk population was selected (mean logistic EuroSCORE 9.4±10.4% vs 8.9±9.5%, SAVR vs TAVI;p=0.650).Th irty-day mortality was 3.8% for both SAVR and TAVI (p=1.000). Th e incidence of stroke (1.5% SAVR and 0.0% TAVI;p=0.156) and myocardial infarction(0.8% SAVR and 0.8% TAVI;p=1.000) was not statistically diff erent between groups, whereas a higher requirement for blood transfusion was reported across the surgical cohort (49.6% vs 36.1%;p=0.026). A higher incidence of major vascular damage (5.3% vs. 0.0%;p=0.007) and pacemaker implantation (0.8% vs 12.0%;p=0.001) were reported in the TAVI group. Conclusions: Patients undergoing transcatheter and surgical treatment of severe aortic stenosis are still extremely distinct populations. In the relatively low-risk propensity-matched population analyzed, despite similar procedural and 30-day mortality, SAVR was associated with a higher risk for blood transfusion, whereas TAVI showed a signifi cantly increased rate of vascular damage, permanent AV block and residual aortic valve regurgitation.
Sri Ramachandra Medical Centre & Research Institute, INDIA
Title: An unusual case of LV myxoma extending through aortic valve presented with antero septal myocardial infarction
Time : 11:15-11:35
Janardhana Rao Babburi is a consultant and interventional cardiologist at Apollo hospital, Apollo heart institutes, Hyderabad. He did his MBBS from NTR University of health sciences and MD from Manipal University. He also worked as Assistant Professor in NRI medical college and PSIMS and RF College. He is presently doing dm cardiology from Sri Ramachandra University Education, Sri Ramachandra Medical College and Research Institute.
History • 37 year young male with no risk factors • ANGINA and BREATHLESSNESS ---- 2 days • Delayed presentation ---- AWMI • Not THROMBOLYSED. Diagnosis: LV Mass (? Myxoma /? Th rombus) with Embolization Treatment: Excision of LV Myxoman + SVG graft s to LAD and PDA Conclusion: Th is case helps to remind that in a young patient with no cardiac risk factors and alterations in ST segment, one must rule out a Th rombo-embolic source like a cardiac tumor.
Grant Medical College & Sir JJ group of Hospitals, India
Title: Assessment of regional and global myocardial systolic function by 2d longitudinal speckle tracking in elderly patients with normal LV function
Time : 11:35-11:55
Bhanu Duggal is faculty at Grant Medical College, India in the Department of Cardiovascular Medicine, but is currently working as a Research Fellow at Cleveland Clinic, USA.
Aging is accompanied by cardiac biological and structural alterations which result in a decrease in diastolic and systolic myocardial functions. Th is study was conducted to assess age-related subclinical changes in left ventricular function using Strain Imaging in healthy elderly individuals with normal left ventricular function by conventional methods (Simpson’s, eyeballing). Th e exclusion criteria were LV myocardial abnormality, valve disease, and atrial fi brillation. Our study included 100 patients divided in 4 groups according to age in years <= 70, 71 to 80, 81 to 90, >= 91; with 25 patients in each group 2D Strain: Comparison of 2D strain values between groups: Global longitudinal strainwas signifi cantly lower in elderly subjects (<= 70-17.95; 71 to 80-17.10; 81 to 90-16.93; >= 91-15.11) P value < 0.05. Th ere was signifi cant diff erence in longitudinal basal, Longitudinal mid, Longitudinal apical region strain rate, showing decreasing trend in all with increase in age (Table). Table:- Comparison of Longitudinal basal, mid and apical measurements and Global stain between age-group.
St. Vincent Hospital, USA
Title: A comparison of T2MR and P2Y12 platelet activity measurements: Assessment of cardiovascular outcomes in patients on anti-platelet therapy
Time : 12:35-12:55
Niroula graduated from Sher-e-Bangla medical college, Bangladesh in 2005 and then joined residency at Saint Vincent Hospital (SVH), University of Massachusetts Medical School (UMMS) in 2009. He received his MD degree in 2012 and is currently working as a Chief Medical Resident at SVH, UMMS. His research interest is in antiplatelet therapy. He will be joining his Hematology-Oncology fellowship training at Roger Williams Medical Center, Boston University, in July, 2013 and will continue his research activities in the fi eld of Hematology-Oncology.
Introduction: Regular monitoring of platelet function in patients on antiplatelet therapy with a history of ischemic heart disease remains a clinical dilemma. Commonly used platelet function assays such as the VerifyNow P2Y12 ADP test primarily rely on a highly-specifi c reagent formulation using ADP, PGE1 and fi brinogen coated beads. Th is approach can monitor the pharmacodynamics of P2Y12 platelet receptor inhibitors, but these measurements do not accurately predict the adverse clinical outcomes related to platelet dysfunction, mainly recurrent thrombosis. In our current single-center, prospective study, we used a novel technology to monitor platelet function using a portable T2 Magnetic Resonance (T2MR) device, T2Stat, utilizing small volume blood samples and a reagent cocktail that measures ADP induced platelet mediated clot contraction. Materials and Methods: In our current investigation, we measured prospectively P2Y12 activity (using VerifyNow assay) and T2MR activity on a set of 30 samples of patients who underwent Plavix response testing. Th e T2MR reagent formulation was designed to activate platelets by ADP without PGE1 and simultaneously induce fi brin polymerization. Platelet activity was measured by T2MR via platelet-mediated clot contraction. We used this preliminary data fi rst to build a correlation between these two methodologies. We then compared short-term clinical outcomes with the P2Y12 and T2MR data obtained on an additional 22 patient samples, focusing on the 12 patient samples in which the two diagnostic tests diff ered. Results: Of 12 patients with discrepant results between two methods, 8 had available meaningful data on short-term clinical outcomes. In all of these 8 patients, we observed that the T2MR activity correlated best with the observed clinical outcomes. Conclusion: Th ese initial clinical results suggest that the T2MR ADP test has excellent potential to predict the hemostatic state of ADP-induced platelet activity in patients with history of ischemic heart disease. Additional studies will provide further evidence of the potential role of this new technology for the accurate prediction of clinical outcomes.
- Track 8: Cardiac Surgery
Louis E Samuels
Lankenau Medical Center, USA
Advocate Christ Medical Center, USA
Wayne State University School of Medicine, USA
Time : 13:55-14:15
Mentzer is a cardiothoracic transplant surgeon known for his expertise in the areas of ischemia-reperfusion injury, myocardial protection, and organ preservation. He has held numerous administrative positions including Chairman of the Department of Surgery at the University of Kentucky and Dean and Senior Advisor to the President at the Wayne State University School of Medicine. He is currently Professor of Cardiothoracic Surgery and Physiology at Wayne State University School of Medicine and is a member of the WSU Cardiovascular Research Institute in Detroit, MI. He also holds an adjunct appointment in the Donald P. Shiley BioScience Center at San Diego State University where he is a Research Professor in the Department of Biology and the Director of Translational Research. His current research investigates endogenous mechanisms and novel compounds that protect the heart from ischemia/reperfusion injury, even when given after ischemia or at the time of reperfusion.He has 28 years of continuous peer-reviewed research NIH funding, served on numerous NIH and American Heart Association study sections, and conducted multiinstitutional and multi-national industry-sponsored clinical research trials.
We recently reported that the homeostatic intracellular repair response (HIR2) is activated in the human heart during cardiac surgery [Jahania SM, Sengstock D, Vaitkevicius P, Andres A, Ito BR, Gottlieb RA, Mentzer RM Jr.Activation of the Homeostatic Intracellular Repair Response During Cardiac Surgery.J Am Coll Surg. 2013 Feb 12.]. HIR2 is a benefi cial stress response to ischemia, hypoxia, and nutritional depletion. Th e underlying mechanism is adaptive autophagy, a process that eliminates damaged mitochondria and dysfunctional proteins. To confi rm our recent fi ndings, we measured the cardiac autophagy proteins Beclin-1, Atg5-12, and p62 in a second cohort of 19 patients undergoing heart surgery with cardiopulmonary bypass (CPB). Right atrial tissuewas obtained prior to initiating CPB and cardioplegia and aft er weaning the patient from CPB. Autophagy proteins were analyzed by immunoblotting. In this second cohort of patients, we again observed rapid depletion of autophagy proteins in the heart from beginning to end of CPB. Th ese changes in Beclin-1, Atg5-12, and p62 are consistent with accelerated autophagic fl ux in response to ischemic stress and confi rm our original observation. Strategies designed to amplify this salutary response could lead to new therapeutic approaches designed to prevent ischemia/reperfusion injury in patients undergoing cardiac surgeryor PCI for acute myocardial infarction.
Advocate Christ Medical Center, USA
Time : 14:15-14:35
Geetha Bhat, Ph.D., M.D., F.A.C.C., Medical Director of The Center for Heart Transplant and Assist Devices at Advocate Christ Medical Center and Professor of Medicine at UIC, is a renowned heart failure, assist device and transplant cardiologist with vast experience in research, education, and management of end-stage cardiac disease. Bhat has given multiple presentations at major medical meetings of the American Heart Association and American College of Cardiology. She has been the principal investigator of landmark clinical trials in heart failure, device and transplantation and is the recipient of many honors and research grants including prestigiuous NIH grants.
Continuous fl ow left ventricular assist devices (LVADs) have become an integral part of advanced heart failure care. Gastrointestinal bleeding (GIB) is one of the major sources of morbidity aft er LVAD implantation. Th e incidence of GIB ranges from 15% to 50% in various studies. Th e mechanisms of GIB include acquired von Willebrand’s disease impaired platelet aggregation, GI tract angiodysplasia, anticoagulation therapy, low pulsatility continuous fl ow devices, previous history of GIB and age. Other contributing factors to GIB are under active investigation. Management of GIB in these patients involves transfusions, GI evaluation with upper and lower GI tract endoscopy, cauterization of AV malformations, decreasing speed of device to increase pulsatility and octreotide therapy. Future studies will focus on understanding of the hematologic abnormalities associated with continuous fl ow LVADs, use of novel anticoagulation and other therapies, and risk stratifi cation of LVAD patients prone to GIB and balancing antithrombotic regimens.
Herlev University Hospital, Denmark
Title: Can we protect the brain against thrombo-embolism, by closing the left atrial appendix during open heart surgery regardless of atrial fibrillation diagnosis?
Time : 14:35-14:55
Helena Domínguez is graduated in the Facultat de Medicina, Univesitat Autònoma de Barcelona, Spain in 1988. She moved since to Denmark. Helena Domínguez is the Director of Research at the Cardiology department of Herlev University Hospital since 2009 and is the Principal supervisor for several Ph.D. students. During her research, she has received several awards. She has published over 25 papers and has been executive editor of a special issue in Hormone and Metabolic Research in 2008. Helena Domínguez is serving as review editor in several journals and has been graded as top-quality reviewer by Annals of Internal Medicine.
Atrial fi brillation is associated to an increased risk of stroke, mostly due to thrombus formation in the left atrial appendix (LAA). Th erefore, many eff orts are targeted to closing the LAA, which has optimized clinical outcomes. Th e incidence of perioperative atrial fi brillation during open heart surgery is high (35-65% depending on the type of heart surgery), which is considered as a temporary condition if the patients have not received the diagnosis of atrial fi brillation before the operation. We hypothesize that most of the patients who undergo coronary artery bypass, valve repair/replacement or both already have a substrate for atrial fi brillation. Th erefore, closure of the LAA on occasion of open heart surgery will result on a life-long protection from thromboemboli. To test this hypothesis, we randomize subjects who are scheduled to undergo non-emergency CABG, valve repair or both, to surgical closure of LAA in a prospective open blinded-endpoint (PROBE) study. Th e subjects are examined with brain magnetic resonance scans (BMRI) before the operation, at discharge and at least six months aft er discharge. Results are presented as number of white-substance lesions and of cerebral infarcts. Th e primary endpoint is a combination of change in number of lacunar infarctions at the last BMRI compared with BMRI at discharge and of clinical stroke. We perform longterm rhythm monitoring and identify markers for atrial fi brillation by proteomics from biopsies from the right auricle. Th e fi rst 35 patients have completed follow-up. We expect to present preliminary results of the study.
University of Sao Paulo, Brazil
Time : 14:55-15:15
Edmo Atique Gabriel, Ph.D., is a Brazilian cardiovascular surgeon, University Professor, cardiovascular surgery Consulting and editor of two textbooks by Springer-Principles of Pulmonary Protection in Heart Surgery (2010-2011) and Infl ammatory Response in Cardiovascular Surgery.
Acquired or congenital structural heart diseases have interaction with complex immunological defense systems. Th is interaction consists of a real battle in which the protagonists are cell receptors, adhesion molecules, cytokines, chemokines, interleukins, monoclonal antibodies, enzymes, hormones and growth factors. It is very oft en to observe concomitance between structural heart disease and some comorbidities such as hypertension, stroke, diabetes, dyslipidemia, hyperuricemia, metabolic syndrome, cardio-renal syndrome and pulmonary diseases arising from excessive smoking. Th us, one can postulate that there is some infl ammatory burden in patients will undergo cardiovascular surgery. Th is infl ammatory pattern is consistently higher, especially if one focuses on procedures associated with cardiopulmonary bypass. Cardiovascular surgery has been understood not only as restricted set of technical principles, but also as surgical science of holistic character, comprising technical knowledge in association with immunological, molecular and infl ammatory aspects. Cardiovascular surgeon has become fully capable to refl ect on surgical strategy to be performed, aiming to minimize ischemiareperfusion in addition to prevent and modulate infl ammatory response intrinsically associated with surgical procedure, particularly when cardiopulmonary bypass support is employed. Th erefore, knowledge of underlying infl ammatory universe related to maneuvers and actions of cardiovascular surgeon is crucial to procedural outcome as well as cardiovascular patients´ prognosis.
University Hospital Saint-Luc Brussels, Belgium
Title: Resection of the native aortic valve prior to percutaneous aortic valve implantation: A mandatory step?
Time : 15:15-15:35
Parla Astarci is a consultant cardiac and vascular surgeon. His main interest in all percutaneous endovascular and endocardiac procedures. He has done his Doctor of Medicine (MD) in 1995 and Cardiovascular Surgeon in the year 2001 at UCL Brussels Belguim.
The remaining native valve is the cause of transcatheter aortic valve implantation (TAVI) complications that I will describe below. For this reason we decided to focus our research on the native aortic valve resection prior to transcatheter valve implantation. Th e complications due to the compression and the squeezing of the diseased native aortic leafl ets between the endovalve and the aortic wall are well known: paravalvular leak, atrio-ventricular bloc, coronary ostia occlusion, continuous calcium embolization, patient/prosthesis mismatch. We analysed carefully all the TAVI complications related papers in the literature. Based on this analyse, we demonstrated the need of native valve resection prior to endovalve deployment. Further clinical work should be done in the nearest future to prove the concept.
Dedinje Cardiovascular Institute, Serbia
Title: Blood loss and intraoperative salvage procedure in patients underwent re-operation coronary artery bypass
Time : 15:45-16:05
Vera Maravic-Stojkovic has completed his Ph.D. at the age of 41 years from Belgrade University and postdoctoral studies from Medizinicshe Hochcshule Hannover, Germany. She is the Head of Laboratory Services in Dedinje Cardiovascular Institute, Belgrade Serbia. She has published more than 25 papers in reputed journals and has been serving as a member of the Heart and Liver Transplant Team in Serbia.
Preoperative patients` characteristics can predict the need for perioperative blood component transfusion in cardiac operations. Currently, a large number of patients are on antiplatelet therapy. A group of these patients required re-operation (redo) aft er coronary artery bypass (CABG). We aimed to compare blood loss in patients having CABG with patients undergoing redo CABG. Fift y-four patients (16% female, 84% male; ages 60.5 ± 6 vs. 66.2 ± 7 years) were divided in: Group 1-CABG, and Group 2-redo CABG. Blood samples were collected: 24h prior, 6h and 24h aft er operation. We measured hematological parameters and total amount of blood products substituted. Preoperative hemoglobin (p = 0.44) and aspirin therapy were not statistically signifi cant (p = 0.116), while preoperative platelet count (0.0004) was signifi cantly lower in Group 2. Although we found some diff erence in blood drainage (868.5 ± 587.5 vs. 1040 ± 823.44) it was not statistically relevant (p = 0.422). Allogeneic erythrocytes substituted intraoperatively was not statistically diff erent (p = 0.611), while autologous blood salvage procedure was important (p = 0.005) in Group 2. Platelets transfused (p = 0.886), fresh frozen plasma (p = 0.681), and packed red blood cells transfused postoperatively (p = 0.324) have not reach statistical diff erence. Length of stay in intensive care unit (ICU) was not infl uenced by used blood components transfusion, either allogeneic or autologous. We have found positive correlation between blood loss and ICU stay (r = 0.49, p = 0.021). Monitoring of these markers off ers an important addition to the preoperative risk assessment.