<p>UVOD: Vilisov poligon predstavlja najznačajniju rezervu kolateralnog protoka između ekstrakranijalnih arterija koje vaskularizuju mozak i ima sposobnost razvoja kolateranih puteva kod ekstrakranijalne karotidne bolesti. Ova anatomska struktura podložna je varijacijama koje uključuju i prekid kontinuiteta i nekompletnost kolateralizacije. CILJEVI: Cilj je bio da se utvrdi da li nekompletnost Vilisovog poligona utiče na če&scaron;će pojavljivanje neurolo&scaron;ke simptomatologije i ishemijske moždane lezije kod pacijenata sa ekstrakranijalnom karotidnom bolesti. Takođe cilj je bio i da se utvrdi da li cerebrovaskularna reaktivnost kod pacijenata sa asimptomatskom ekstrakranijalnom karotidnom bolesti zavisi od kompletosti Vilisovog poligona i na koji način hirur&scaron;ki tretman utiče na parametre cerebrovaskularne rezerve kod pacijenata sa kompletnim i nekompletnim Vilisovim poligonom. METOD: U retrospektivnoj studiji analiziran je nalaz MRA kod 211 pacijenata sa ekstrakranijalnom karotidnom bolesti i 102 pacijenta iz kontrolne grupe. U prospektivnoj studiji je kod 98 pacijenata sa asimptomatskom karotidnom bolesti pored MRA nalaza određivana cerebrovaskularna reaktivnost putem određivanja &bdquo;breath hold index&ldquo;-a (BHI) pre i nakon operativnog tretmana. REZULTATI: Nekompletan Vilisov poligon nađen je kod 25% asimptomatskih, 47,5% simptomatskih pacijenata sa karotidnom bolesti i kod 59% kontrolne grupe pacijenata, pri čemu su se razlike pokazale kao statistički značajne. Kod asimptomatskih pacijenata sa nekompletnim Vilisovim poligonom BHI preoperativno iznostio je 0,62 a postoperativno 1,01 na strani lezije. U slučaju nekompletnog Vilisovog poligona preoperativna vrednost BHI iznostila je 0,88 a postoperativna 1,09 na strani lezije. Razlike su se pokazale kao statistički značajne između grupa i pre i posle operativnog tretmana. Porast je bio statistički značajno izraženiji u grupi asimptomatskih pacijenata sa nekompletnim Vilisovim poligonom. Nisu zabeležene major operativne komplikacije (perioeprativni moždani udar,smrtni ishod) a na pojavu hiperperfuzionog sindroma najvi&scaron;e su uticali kompletnost Vilisovog poligona, vrednost BHI i preoperativni tretman hipertenzije. ZAKLJUČCI: Nekompletan Vilisov poligon predstavlja faktor rizika za pojavu neurolo&scaron;ke simptomatologije ili ishemijske moždane lezije kod pacijenata sa ekstrakranijalnom karotidnom bolesti. Kod asimptomatskih pacijenata nekompletan Vilisov pologon utiče na smanjenu cerebrovaskularnu reaktivnost i veći rizik od moždanog udara. Parametri cerebrovaskularne reaktivnosti signifikantno se pobolj&scaron;avaju nakon operativnog tretmana.</p> / <p>INTRODUCTION: Circle of Willis is the most important reserve of collateral flow between the extracranial arteries that supply the brain and has the ability to develop collateral pathways in extracranial carotid disease. This anatomical structure is subject to variations which include a disruption in the continuity and incompleteness of collateralisation. OBJECTIVES: was to determine whether the incompleteness of the Circle of Willis is more often associated with neurological symptoms and ishemic cerebral lesions in patients with extracranial carotid artery disease. Also, the objective was to determine whether cerebrovascular reactivity in patients with asymptomatic extracranial carotid artery disease depends on the completeness Circle of Willis and how surgical treatment affects the parameters of cerebrovascular reserve in patients with complete and incomplete Circle of Willis. METHODS: This study analyzed the findings of MRA in 211 patients with extracranial carotid artery disease and 102 patients in the control group. In prospective study in 98 patients with asymptomatic carotid artery disease in addition to the MRA findings cerebrovascular reactivity was determined by determining the &quot;breath hold index&quot; -a (BHI) before and after surgical treatment. RESULTS: Incomplete Circle of Willis was found in 25% of asymptomatic, 47.5% of symptomatic patients with carotid artery disease, and 59% of the control group patients, where the difference proved to be statistically significant. In asymptomatic patients with incomplete Circle of Willis BHI values were 0.62 preoperatively and 1.01 postoperatively on the side of the lesion. In the case of incomplete Circle of Willis preoperative BHI values were 0.88 preopertively and 1.09 postoperatively in asymptomatic patients. The differences are shown to be statistically significant between the groups before and after surgical treatment. The increase was significantly more pronounced in the group of asymptomatic patients with incomplete Circle of Willis. There were not recorded major operative complications (perioeprativni stroke, mortality) and the occurrence hyperperfusion syndrome was most affected by completeness of the Circle of Willis, a value BHI and preoperative treatment of hypertension. CONCLUSIONS: Incomplete Circle of Willis is a risk factor for the occurrence of neurological symptoms or ischemic brain lesions in patients with extracranial carotid artery disease. In asymptomatic patients incomplete Circle of Willis affects the reduced cerebrovascular reactivity and a higher risk of stroke. The parameters of cerebrovascular reactivity significantly improved after surgical treatment.</p>

<p>TCD apnea test kao neinvazivna i bezbedna neuroultrasonografska metoda pruža korisne informacije o vazomotornoj reaktivnosti (VMR) u procesu indirektnog sagledavanja funkcionisanja moždane autoregulacije. Vazomotorna reaktivnosti podrazumeva sposobnost dilatacije ili konstrikcije moždanih arteriola nastale kao odgovor na određeni vazoaktivni stimulus, najče&scaron;će ugljen dioksid. Cilj ove doktorske disertacije bio je ispitivanje i analiziranje promene karotidne hemodinamike kod bolesnika sa ishemijskim moždanim udarom (IMU) ili tranzitornim ishemijskim atakom (TIA) i simptomatskom karotidnom stenozom u preoperativnom i tromesečnom postoperativnom periodu, kao i procena revaskularizacionog efekta karotidne endarterektomije (KEA).U istraživanje je uključeno 60 hospitalizovanih bolesnika koji su doživeli prvi IMU i TIA u zoni vaskularizacije arterije cerebri anterior (ACA) i arterije cerebri medije (ACM), svi sa karotidnom stenozom, ACI &ge;70%. Bolesnici su bili hospitalizovani na Klinici za neurologiju, Kliničkog Centra Vojvodine, Klinici za kardiovaskularnu hirurgiju, Instituta za kardiovaskularne bolesti Vojvodine i Klinici za vaskularnu hirurgiju, u Novom Sadu. U odnosu na kliničke manifestacije bolesni i su podeljeni u tri grupe: bolesnici sa TIA i amaurosis fugax, sa parcijalnim infarktom u zoni ACA ili ACM i sa lakunarnim infarktom. Istraživanje je analiziralo uticaj promenljivih i nepromenljivih vaskularnih faktora rizika na pojavu IMU i TIA, ali i na VMR, procenjivanu kroz indeks zadržavanja daha (Breath Holding Index, BHI) ipsilateralno i kontralateralno u odnosu na karotidnu stenozu. Analizirana je povezanost stepena karotidne stenoze sa vrednostima BHI preoperativno, povezanost BHI sa težinom kliničke slike, uticaj kolateralnog krvotoka na VMR, distribucija BHI u pojedinim tipovima IMU i TIA kao i komparacija BHI u pre i u postoperativnom periodu od 30 i 90 dana. Na osnovu sprovedenog istraživanja, do&scaron;lo se do zaključaka da je redukovana VMR preoperativna karakteristika karotidne stenoze ipsilateralno kao i karakteristika različitih tipova IMU i TIA ipsilateralno; postoji negativna korela ija izmeĐu stepena karotidne stenoze i BHI vrednosti. Nije potvrđena hipoteza da veći roj razvijenih kolateralnih puteva uslovljava očuvanu VMR; utvrđena je pozitivna korelacija između BHI vrednosti u preoperativnom i postoperativnom periodu; redukovana VMR ima negativan uticaj na težinu kliničke slike. Prepoznavanje vrednosti TCD apnea testa, koji se može koristiti kao komplementarna metoda drugim vazoaktivnim testovima u praćenju karotidne hemodinamike, od posebne je važnosti neurologu i vaskularnom hirurgu. Time bi se doprinelo daljoj evaluaciji mehanizma nastanka IMU, planiranju terapijskog pristupa i determinisanju prognoze operisanih bolesnika. Činjenica da većina neurolo&scaron;kih odeljenja poseduje TCD aparat, apnea test postaje dostupan svakom neurologu u kliničkom radu, posebno u na&scaron;im uslovima, kada se do drugih drugih, skupljih metoda, te&scaron;ko stiže ili nam ostaju nedostižne.</p> / <p>TCD apnea test, as a noninvasive and safe neuroultrasonographic method, provides useful information about vasomotor reactivity (VMR) in the indirect evaluation of cerebral autoregulation. Vasomotor reactivity is the ability of cerebral arterioles to constrict or to dilate in response to a vasoactive stimulus, mainly carbon dioxide. The aim of this doctoral thesis was to investigate and analyze changes in carotid hemodynamics in patients with ischemic stroke (IS) or transient ischemic attack (TIA) and symptomatic carotid stenosis in the preoperative and three-month postoperative period as well as the assessment of revascularisation effect of carotid endarterectomy (CEA). The study included 60 hospitalized patients who experienced a first ischemic stroke or TIA in the vasularisation area of anterior cerebral artery (ACA) and middle cerebral artery (MCA), all with carotid stenosis &ge;70% ACI. Patients were hospitalized at the Clinic of Neurology, Clinical Center of Vojvodina, Department of Cardiovascular Surgery, Institute of Cardiovascular Diseases and the Department of Vascular Surgery in Novi Sad. Considering clinical manifestations of stroke, the patients were divided into three groups: patients with TIA and amaurosis fugax, with partial infarction in area ACA or ACM and with lacunar infarct. The study analyzed the impact of variabile and unvariable vascular risk factors on the incidence of ischemic stroke and TIA, but also on VMR, evaluated through Breath Holding Index (Breath Holding Index, BHI) on the ipsilateral and contralateral side from carotid stenosis. We analysed the correlation between the degree of carotid stenosis with preoperative values of BHI, BHI correlation to the severity of clinical findings, the impact of collateral circulation to the VMR, distribution of BHI in certain types of ischemic stroke and TIA as well as comparison of BHI in the pre and postoperative period of 30 and 90 days. On the basis of this research came the conclusion that reduced VMR is characteristic of ipsilateral carotid stenosis in preoperative period as well as number of developed collateral characteristics of different types of ipsilateral ischemic stroke and TIA; there is a negative correlation between the degree of carotid stenosis and BHI values. The hypothesis that the greater pathways causes preservation of VMR was not confirmed, while the positive correlation between BHI values in the preoperative and postoperative period was established. Reduced VMR has a negative impact on the degree of clinical picture severity. Recognizing the importance of TCD apnea test method, that can be used as a complementary method to other vasoactive tests in monitoring of carotid hemodynamics, is of special importance to the neurologists and vascular surgeons. This would contribute to the further evaluation of mechanism of ischemic stroke, planning of therapeutic approach and determining the prognosis of treated patients. The fact that most of neurological department has TCD device, apnea test becomes available to every neurologist in clinical work, specially in our conditions, when other methods remain unattainable.</p>

Introdução: A hipertensão pulmonar tromboembólica crônica (HPTEC) está incluída no grupo 4 da Classificação Internacional de Hipertensão Pulmonar (HP). É caracterizada pela persistência de obstrução por trombos sanguíneos na circulação pulmonar, associada à presença de HP, após três meses de anticoagulação efetiva. O tratamento de escolha é a cirurgia de tromboendarterectomia pulmonar (TEAP), mas alguns dos mecanismos fisiopatológicos envolvidos nesta forma de hipertensão ainda permanecem incertos. O redirecionamento dos fluxos sanguíneos pulmonares e a hipóxia exercem papel importante na HPTEC, como também em casos de hipertensão pulmonar residual, após a cirurgia de TEAP. Entretanto, existem poucos dados sobre as respostas das células endoteliais pulmonares a essas mudanças de fluxo e de oxigenação, surgindo a necessidade do estudo da proteostase celular nesta doença. Objetivo: (A) Caracterização morfológica das células em culturas provenientes de artéria pulmonar de pacientes com HPTEC submetidos à TEAP. (B) Avaliação da resposta das células endoteliais, a partir da análise de proteínas envolvidas na proteostase celular, quando submetidas a diferentes níveis de stress mecânico e à hipóxia. Método: Trombos extraídos por TEAP foram processados, as células retiradas foram cultivadas, marcadas com CD31 e submetidas a stress mecânico por vinte e quatro horas, constituindo o grupo HPTEC. A proteostase celular foi avaliada pela medida de proteínas expressas por essas células, tanto em culturas quanto pela análise imuno-histoquímica do tecido vascular pulmonar. Como grupo controle foram utilizadas células endoteliais pulmonares humanas de linhagem (CE) e tecido de artérias pulmonares de doadores de transplante de pulmão. As culturas de ambos os grupos também foram colocadas em hipóxia e analisada a expressão indireta de óxido nítrico (NO) por meio da medida de nitrato. Resultado: as células do grupo HPTEC com morfologia endotelial foram marcadas positivamente com CD31 e apresentaram características semelhantes às do grupo CE. Em relação ao stress mecânico, na condição estática as células HPTEC expressaram menor quantidade de óxido nítrico sintase endotelial (eNOS). Quando submetidas a stress de alta intensidade (shear stress >= 15 dynes/cm2), as reduções ficaram ainda mais evidentes, sinalizando uma disfunção endotelial. Na análise de outras proteínas, como GRP94, GRP78, HSP70, as respostas também foram menores no alto fluxo. Na avaliação imunohistoquímica da camada íntima do vaso pulmonar, a HSP70 apresentava-se diminuída, corroborando os achados das culturas. Os valores de NO foram inferiores no grupo HPTEC quando se comparam hipóxia e normóxia. Conclusão: (A) A avaliação morfológica mostrou que as culturas de células HPTEC eram endoteliais. (B) A análise funcional revelou que estas células apresentaram redução de resposta, o que caracteriza alteração da proteostase, que se tornou mais evidente quando foram submetidas a shear stress de alta magnitude. A hipóxia reduziu a produção de NO, entretanto sem diferenciar os grupos celulares estudados / Introduction: Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is included in group 4 of the International Classification of Pulmonary Hypertension (PH). It is characterized by persistent obstruction by blood clots in the pulmonary circulation, associated with the presence of PH, after 3 months of effective anticoagulation. The treatment of choice is pulmonary endarterectomy (PEA). However, some of the pathophysiological mechanisms involved in this form of hypertension still remain uncertain. The redirection of pulmonary blood flow and hypoxia play an important role in CTEPH, and also, in cases of residual pulmonary hypertension after PEA surgery. Nevertheless, there is insufficient data from the pulmonary endothelial cell responses to this flow and oxygenation changes, reflecting the need to further study of cellular proteostasis in this disease. Objective: (A) Morphological characterization of cells in cultures from the pulmonary artery of CTEPH patients submitted to PEA. (B) Evaluation of the response of endothelial cells, through the analysis of proteins involved in cellular proteostasis, when submitted to different levels of mechanical stress and hypoxia. Method: Thrombus extracted by PEA were processed and the cells removed were cultured, marked with CD31 and submitted to mechanical stress for 24 hours and constituted the group CTEPH. Cellular proteostasis was measured by the quantification of the proteins expressed in cultures and in pulmonary vascular tissue by immunohistochemistry analysis. As a control group, the human pulmonary endothelial cells (EC) and pulmonary artery tissue from lung transplant donors were used. Cultures of both groups were also placed in hypoxia and the indirect expression of nitric oxide (NO) was analyzed by nitrate measurement. Results: The cells with endothelial morphology from the CTEPH group were positively marked with CD31 and presented similar characteristics as the EC group. Regarding mechanical stress, in the static condition, the CTEPH cells expressed a lesser amount of endothelial nitric oxide synthase (eNOS). When submitted to high flow (shear stress > 15 dynes / cm2) the reductions became even more evident, signaling an endothelial dysfunction. In the analysis of other proteins, such as GRP94, GRP78, HSP70, responses were also lower in high shear stress. In the immunohistochemistry analysis of the intimal layer of the pulmonary vessel HSP70 was diminished, corroborating with the findings of the cultures. The NO values were lower in the CTEPH group when compared hypoxia and normoxia. Conclusion: (A) Morphological evaluation showed that cultures of CTEPH cells were endothelial. (B) Functional analysis revealed that these cells had reduced response, which characterizes proteostasis alterations, which became more evident when they underwent shear stress of high magnitude. Hypoxia reduced NO production, however without differentiating the cell groups studied

Le traitement de référence des lésions sténosantes carotidiennes de haut grade est la chirurgie associée à un traitement médical. Nous avons mis en place depuis 2003 une base de données prospective colligeant l’ensemble des patients hospitalisés dans notre service pour prise en charge d’une lésion sténosante carotidienne d’indication chirurgicale. Depuis 2012, cette base de données cliniques s’est vue complétée par la mise en place d’une tissuthèque et d’une plasmathèque. Nous présentons ici la méthode de mise en place d’une telle base, puis les résultats de quatre études originales sur la thématique du « patient à risque » en chirurgie carotidienne, portant sur l’influence de la fonction rénale, du délai entre les symptômes et la chirurgie et du statut de l’artère carotide controlatérale sur les résultats de cette chirurgie, ainsi que la proposition d’un score pronostic d’intolérance au clampage carotidien. Nous avons montré que l’insuffisance rénale influait sur les résultats de la chirurgie carotidienne de manière différente en fonction de la méthode d’appréciation de la fonction rénale (créatinine plasmatique, clearance de la créatinine calculée selon Cockcroft-Gault ou selon la formule MDRD) ; que le statut hémodynamique de la carotide controlatérale influait sur le taux de shunt sans modifier la morbidité ; que la chirurgie précoce des sténoses carotidiennes symptomatiques n’était pas grevée d’une surmortalité ; et qu’il était possible dans une certaine mesure de prédire la nécessité de mise en place d’un shunt carotidien. Nous abordons enfin les projets à venir utilisant la collection biologique pour tenter d’identifier les plaques athéromateuses à risque / The treatment of high-grade carotid stenosis is surgery combined with best medical treatment. We established since 2003, a prospective database including all patients hospitalized in our vascular surgery department for management of carotid stenosis. Since 2012, the clinical database was completed for the establishment of a biological database. We present here the method of setting up such a database, and the results of four original studies on the theme of "high-risk patient" for carotid surgery: the influence of renal function, of the delay between symptoms and surgery and of the contralateral carotid artery on outcome and the proposal of a prognostic score of intolerance to carotid clamping. We have shown that renal failure influenced outcome of carotid surgery in different ways depending on the method of assessment of renal function (serum creatinine, creatinine clearance calculated by Cockcroft-Gault or MDRD formula) ; the hemodynamic status of the contralateral carotid affected the rate of shunt without changing morbidity; that early surgery for symptomatic carotid stenosis was not burdened with excess mortality; and that it is possible to predict the need for establishment of a carotid shunt. Finally, we discuss future projects using biological collection to try to identify atherosclerotic plaques at risk

Economic evaluations provide a tool to estimate costs and health consequences of competing medical technologies, ultimately to aid decision makers when deciding which medical technologies should be funded from available resources. Such decisions inevitably need to be taken under uncertainty and it is not clear how to approach them in health care decision-making. Recent work in economic evaluation has proposed an analytic framework where two related, but conceptually different decisions need to be considered: (1) should a medical technology be adopted given existing evidence; and (2) whether more evidence should be acquired to support the adoption decision in the future. The proposed analytic framework requires a decision-analytic model appropriately representing the clinical decision problem under consideration, a probabilistic analysis of this model in order to determine cost-effectiveness and characterise current decision uncertainty, and estimating the value of additional information from research to reduce decision uncertainty. The main aim of this thesis is to apply the analytic framework on three case studies concerning treatment strategies for cardiovascular disease in order to establish whether the treatment strategies should be adopted given current available information and if more information should be acquired to support the adoption decisions in the future. The implications for policy and methodology of utilising the analytic framework employed in the case studies are also discussed in this thesis. The results of the case studies show that a screening programme for abdominal aortic aneurysm in 65-year-old men is likely to be cost-effective in a Swedish setting and there appears to be little value in performing further research regarding this decision problem; an early interventional strategy in non-ST-elevation acute coronary syndrome is cost-effective for patients at intermediate to high risk of further cardiac events in a UK setting; endarterectomy in patients with an asymptomatic carotid artery stenosis is cost-effective for men around 73 years of age or younger in a Swedish setting and conducting further research regarding this decision problem is potentially worthwhile. Comparing the results of the present analyses with current clinical practice shows a need for changing clinical practice in Sweden regarding screening for abdominal aortic aneurysm and endarterectomy in patients with asymptomatic carotid artery stenosis. Furthermore, employing the analytic framework applied in the case studies can improve treatment guidelines and recommendations for further research. In particular, treatment guidelines ought to consider in which particular subgroups of patients an intervention is cost-effective. The case studies indicate that it is feasible to apply the analytic framework for economic evaluation of health care. Methodological development can improve the accuracy with which cost-effectiveness and value of information is estimated, but may also lead to comprehensive and complex evaluations. The nature of the decision problem should determine the level of comprehensiveness required for a particular evaluation.

Background. Carotid stenosis is an important cause of stroke. Carotid endarterectomy is a means of reducing the burden of stroke but is of marginal benefit in individuals with asymptomatic carotid stenosis. The identification of factors associated with increased risk of cerebral ischemic events would help select individuals who may obtain a greater benefit. / Methods. A comprehensive search was performed to identify studies examining risk factors for cerebral ischemic events in patients with asymptomatic carotid stenosis. Inclusion criteria were defined a priori. Relevant studies were reviewed, assessed for quality, and data were extracted. / Results. Thirty-four studies met the inclusion criteria. There was a suggestion of increasing neurological events with increasing severity and progression of carotid stenosis. There was some evidence for an association with carotid plaque morphology. No consistent association was found with clinical factors, impaired cerebral vasoreactivity, or cerebral embolic signals. / Conclusions. The evidence is insufficient to reliably identify individuals with asymptomatic carotid stenosis who are at a higher risk of cerebral ischemic events.

Background: Sonolysis is an important factor in therapeutic use of ultrasound in patients with cerebrovascular diseases, it is ultrasound induced lysis of thrombus or embolus. The aim of this work was to asses safety and efficacy of therapeutic ultrasound effect (sonolysis) in acute stroke patients and in patients undergoing carotid artery intervention. First partial aim of this work was to confirm the safety and efficacy of endovascular sonolysis by using the EkoSonic Endovascular System in subjects with acute ischemic stroke. Second partial aim of this work was to test the clinical efficacy of sonolysis for reducing the risk of incidence of new brain ischaemic lesions detected on brain magnetic resonance imaging in patients undergoing elective CEA or CAS for severe internal carotid stenosis. In addition, we assessed the effects of sonolysis on cognitive function, morbidity, and mortality at 30 days post-surgery. Methods: Patients with acute ischemic stroke and occlusion of the middle cerebral artery or basilar artery were enrolled consecutively to the prospective study tested safety and efficacy of endovascular sonolysis using the EkoSonic Endovascular System (EKOS) in patients with acute stroke. The control group (44 MCA and 12 BA occlusions) was selected from historical controls. EkoSonic...

Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery Abstract Currently, the most commonly used technical solution for pumping blood during extracorporeal circulation during cardiac surgery, as well as for some types of ECMO (extracorporeal membrane oxygenation) are either a roller pump or centrifugal pump. Due to its advantages the centrifugal pump is mainly used for prolonged extracorporeal circulation in cardiac surgery and as a heart and / or lung support system. In current literature there is a lack of compelling scientific evidence that would clearly support its use in a routine cardiac surgery. The aim of our study was to compare both types of currently used blood pumps in longer cardiac procedures with deep hypothermic circulation arrest. In a randomized clinical study we had selected a group of patients that underwent a pulmonary endarterectomy (PEA) in order to demonstrate the positive effects of the centrifugal pump on the postoperative inflammatory reactions. There were no statistically significant differences between these two pumps when other clinical and laboratory parameters were observed. Based on the hypothesis that significant temperature changes during cardiac procedure with a deep hypothermia can affect sealing pressure of the endotracheal tube cuff, we performed a...

Current Possibilities in Use of a Centrifugal Pump in the Cardiac Sugery Abstract Currently, the most commonly used technical solution for pumping blood during extracorporeal circulation during cardiac surgery, as well as for some types of ECMO (extracorporeal membrane oxygenation) are either a roller pump or centrifugal pump. Due to its advantages the centrifugal pump is mainly used for prolonged extracorporeal circulation in cardiac surgery and as a heart and / or lung support system. In current literature there is a lack of compelling scientific evidence that would clearly support its use in a routine cardiac surgery. The aim of our study was to compare both types of currently used blood pumps in longer cardiac procedures with deep hypothermic circulation arrest. In a randomized clinical study we had selected a group of patients that underwent a pulmonary endarterectomy (PEA) in order to demonstrate the positive effects of the centrifugal pump on the postoperative inflammatory reactions. There were no statistically significant differences between these two pumps when other clinical and laboratory parameters were observed. Based on the hypothesis that significant temperature changes during cardiac procedure with a deep hypothermia can affect sealing pressure of the endotracheal tube cuff, we performed a...

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