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Background/aim Extracorporeal cardiopulmonary resuscitation (ECPR) is defined as the veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support in a patient who experienced a sudden pulseless condition attributable to cessation of cardiac mechanical activity and circulation. We aimed to evaluate the clinical outcomes of our ECPR experience in a pediatric patient population. Materials and methods Between September 2014 and November 2017, fifteen children were supported with ECPR following in-hospital cardiac arrest (IHCA) in our hospitals. VA-ECMO setting was established for all patients. Pediatric cerebral performance category (PCPC) scales and long-term neurological prognosis of the survivors were assessed. Results The median age of the study population was 60 (4-156) months. The median weight was 18 (4.8-145) kg, height was 115 (63-172) cm, and body surface area was 0.73 (0.27-2.49) m2. The cause of cardiac arrest was a cardiac and circulatory failure in 12 patients (80%) and non-cardiac in 20%. Dysrhythmia was present in 46%, septic shock in 13%, bleeding in 6%, low cardiac output syndrome in 13%, and airway disease in 6% of the study population. Median low-flow time was 95 (range 20-320) minutes. Central VA-ECMO cannulation was placed in only 2 (13.3%) cases. However, the return of spontaneous circulation (ROSC) was obtained in 10 (66.6%) patients, and 5 (50%) of them survived. Overall, five patients discharged from the hospital. Finally, survival following ECPR was 33.3%, and all survivors were neurologically intact at hospital-discharge. Conclusion ECPR can be a life-saving therapeutic strategy using a promising technology in the pediatric IHCA population. For better survival rates, early initiation, well-coordinated, skilled, and dedicated ECMO team is the mainstay.

Objectives:Acute mesenteric ischemia and other end organ emboli are serious life-threatening complications after open-heart surgery. In this study, we evaluated the outcome of patients with mesenteric ischemia and splenic infarction after cardiac surgery.Materials and Methods:From January 2010 to November 2017, all patients (5607) who underwent open-heart surgery were analysed, and patients with registered acute mesenteric ischemia and splenic infarct (32) were retrospectively reviewed.Results:Five thousand six hundred and seven patients were included in this study, of which 32 (0.57%) patients suffered from acute mesenteric ischemia and splenic infarct. Intraoperatively, splenic infarction was detected in six patients who were pre-diagnosed as mesenteric ischemia. In these patients, the symptoms completely improved after the splenectomy and all the patients survived. Only two of 26 patients were survived after segmentary bowel resection. Overall mortality was 24 (%75). Age (p=0.03), need for dialysis (p=0.01), emergency cardiac operation (p=0.05), peripheral arterial disease (p=0.001), and high risk Euroscore (p=0.0001) were significantly different compared to the control group. Mesenteric ischemia was significantly higher in off- pump coronary artery bypass patients (p=0.0001). The time of cardiopulmonary bypass in mesenteric ischemia group was significantly higher than the control group (p=0.0001).Conclusion:Acute mesenteric ischemia is still highly mortal, after cardiac surgery. Splenic infarct symptoms may mimic mesenteric ischemia. Mesenteric ischemia is more common in high-risk cardiac operations. Prompt diagnosis and treatment can be life-saving.

Objective: We investigated the long-term results of autologous bone marrow mononuclear cells (ABMMNCs) implantation in patients with Buerger’s disease (BD). Methods: Twenty-eight patients (25 males and 3 females) who had BD and critical unilateral limb ischemia were investigated between April 2003 and August 2005. The patients were administered multiple injections of CD34+ and CD45+ positive ABMMNCs into the gastrocnemius muscle, the intermetatarsal region, and the dorsum of the foot (n=26) or forearm (n=2) and saline injection into the contralateral limb. Results: The mean follow-up time was 139.6±10.5 months. No complication related to stem cell therapy was observed during the follow-up. The ankle–brachial pressure index evaluated at 6 months and 120 months was compared to the baseline scores (p

BACKGROUND: The aim of this study was to evaluate the clinical outcomes of tricuspid valve repair using aortic cross-clamping versus using beating heart surgery. METHODS: A total of 208 patients (67 males, 141 females; mean age 61.5±9.2 years; range, 29 to 81 years) who underwent concomitant cardiac surgery and tricuspid valve repair between January 2007 and January 2016 at a single center were included. Two surgical strategies for tricuspid valve repair with aortic cross-clamping (n=102) or on beating heart (n=106) were compared. Primary endpoints were in-hospital mortality and the rate of permanent pacemaker placement after surgery. Secondary endpoints were cross-clamp and cardiopulmonary bypass times, postoperative inotropic support, temporary pacemaker requirement, and residual tricuspid regurgitation at discharge and at one year. RESULTS: Overall hospital mortality was 7% (n=14) (cross-clamping 7% vs. beating heart 7%; p>0.05). The mean cross-clamp and cardiopulmonary bypass times were significantly longer in the aortic cross-clamping group (p=0.0001). Also, a higher number of patients in this group needed inotropic support (78/102) than the beating heart group (57/106) (p2 tricuspid regurgitation was more commonly seen in the cross-clamping group (16% vs. 3%, respectively; p=0.0023). At one year of follow-up, residual >2 tricuspid regurgitation was present in 22 patients (23%) in the aortic crossclamping group and in eight patients (8%) in the beating heart group (p=0.0048). CONCLUSION: Tricuspid valve repair on beating heart offers less inotropic support and a lower rate of postoperative permanent pacemaker placement requirement and residual tricuspid regurgitation, although both techniques yield similar postoperative clinical outcomes. These results support the use of tricuspid valve repair on a beating heart in concomitant left-sided valvular heart surgery.

Objectives Sutureless aortic valve replacement (SU-AVR) is an alternative technique to standard aortic valve replacement. We evaluated our experience with the Perceval SU-AVR with concomitant mitral valve surgery, with or without tricuspid valve surgery, and aimed to discuss the technical considerations. Methods From January 2013 through June 2016, 30 patients with concomitant severe mitral valve disease, with or without tricuspid valve disease, underwent SU-AVR with the Perceval prosthesis in a single center. Results The mean age was 73.0 ± 6.6 years, ranging from 63 to 86 years, and 60% (n = 18) were male. Mean logistic EuroScore of the study cohort was 9.8 ± 4.6. Concomitant procedures consisted of mitral valve repair (n = 8, 26.6%), mitral valve replacement (n = 22, 73.3%), tricuspid valve repair (n = 18, 60%), tricuspid valve replacement (n = 2, 6.6%), and cryoablation for atrial fibrillation (n = 21, 70%). Median prosthesis size was 25 mm (large size). At 1 year, there were 2 deaths from noncardiac causes. One patient (3.3%) had third-degree atrioventricular block requiring permanent pacemaker implantation. Three patients (10%) had intraoperative supra-annular malpositioning of the aortic prosthesis, which was safely removed and reimplanted in all cases. Mean follow-up was 18 ± 4.5 for months (maximum 3 years). During the postoperative period, sinus rhythm restoration rate in patients who underwent the cryo-maze procedure was 76.1% (n = 16) at discharge. There was no structural valve deterioration or migration of the prosthesis at follow-up. Conclusions Perceval SU-AVR is a technically feasible and safe procedure in patients with severe aortic stenosis with good results even in the presence of multivalvular disease and atrial fibrillation surgery.

Background This study aims to evaluate the results of late-onset type A aortic dissection following primary cardiac surgery and to compare the outcomes of patients with or without prior coronary artery bypass grafting. Methods Between January 2005 and December 2015, data of 32 patients (16 males, 16 females; mean age 58.1±10.9 years; range, 45 to 73 years) who were diagnosed with acute type A aortic dissection and underwent repair with a history of previous cardiac surgery at our institution were retrospectively analyzed. The patients were divided into two groups as those with a history of prior coronary artery bypass grafting (n=16) and the patients with a previous cardiac surgery without prior coronary artery bypass grafting (n=16). Results Dissection of the ascending aorta occurred in 32 patients (late acute in 22 and late chronic in 10) who underwent previous cardiac surgery (aortic valve replacement in 12, mitral valve replacement in two, aortic valve replacement + coronary artery bypass grafting in two, coronary artery bypass grafting in 10, mitral valve replacement + coronary artery bypass grafting in four, and dual valve replacement in two patients). The mean time between the first operation and dissection was 4.0±1.5 years. Dissections were treated with the Bentall procedures (n=8), ascending aorta replacement (n=14), ascending aorta replacement + hemiarch replacement (n=4), ascending aorta + aortic valve replacement (n=4) and Bentall + arch replacement (n=2). In-hospital mortality (30-day mortality) was seen in five patients, and oneyear mortality rate was 21.85% (n=7). The survival rates of the all patients for primary cardiac surgery vs primary cardiac surgery + coronary artery bypass grafting were 81.25% vs 75% at one year, 75% vs 68.75% at three years,75% vs 56.25% at five years, 68.75% vs 56.25% at seven years, and 68.75% vs 56.25% at 10 years, respectively (p=0.71, CI: 95%). Conclusion Type-A aortic dissections may develop after cardiac operations with or without coronary artery bypass grafting at any time, and irrespective of associated histologies, they may result in high overall in-hospital mortality. With careful planning by prompt intervention, the outcomes in redo sternotomy operations with or without coronary artery bypass grafting for aortic dissections would be consistent the results of spontaneous aortic dissections.

Background: The aim of our study is to assess the neuroprotective effects of the tumor necrosis factor alpha (TNF-α) inhibitor etanercept (ETA) on histopathological and biochemical changes following spinal cord injury (SCI). Patients and Methods: Fifty-four male Wistar albino rats were randomly assigned into three main groups: The sham, trauma, and ETA group (n = 18 per group). Each of these groups was further divided into three subgroups (n = 6 per subgroup) based on the different tissue sampling times postinjury: 1 h, 6 h, and 24 h. Clip compression model was used for SCI. Rats in the ETA group were treated with 5 mg/kg of ETA immediately after the clip was removed. After 1, 6, and 24 h, the spinal cord was totally removed between the levels T8–T10. Sample tissue was immediately harvested and fixed for histopathological and electron microscopic examination and were analyzed for TNF-α, interleukin-1β (IL-1β), superoxide dismutase (SOD), adenosine deaminase, catalase (CAT), and malondialdehyde levels in both the tissue and serum. Results: The serum and tissue levels of cytokines and enzymes were seen to change after SCI between hyperacute, acute, and subacute stages. Treatment with ETA selectively inhibited TNF-α, and IL-1β expression together with increased levels of antioxidative enzymes (SOD, CAT). Conclusion: Early administration of ETA after SCI may remarkably attenuate neuronal injury by decreasing tissue and serum TNF-α and IL-1β levels, while increasing antioxidative enzymes such as SOD and CAT in subacute and acute stages, respectively.

Ischemia in TAO involves the upper and lower extremities, caused by infrapopliteal or infrabrachial vaso-occlusive disease. Features of advanced TAO include ischemic ulcerations and digital gangrene. Tobacco is strongly associated with the pathogenesis and progression of TAO, and results in a high degree of social, and financial costs, in addition to chronic morbidity. Smoking cessation is the only fully effective therapy for TAO. Counseling, analgesia, and local wound care are essential components to the management of patients with ischemic ulcers. Reported evidence indicates that intravenous iloprost is an effective pharmacological treatment option for patients with critical limb ischemia (CLI), and may also help heal ulcers and relieve rest pain in patients with TAO. Distal surgical revascularization may obviate amputations and improve quality of life. Emerging research supports a role for endothelin receptor antagonists, immunoadsorption, growth factors, gene and stem cell-based therapies for the treatment of patients with TAO and CLI.

Background The aim of this study was to investigate lead endocarditis-related tricuspid valve regurgitation, to identify underlying causes, and to report our surgical approaches to tricuspid valve endocarditis. Methods Between March 2010 and August 2016, medical records of a total of 43 patients (23 males, 20 females; mean age: 63.2±13.6 years; range 48 to 72 years) who underwent tricuspid valve surgery for severe tricuspid regurgitation caused by lead endocarditis, which was previously placed as an implantable cardiac electronic device were reviewed. We removed all systems including infected leads and generators, revised infected wounds and tissues, performed tricuspid valve surgery for lead endocarditis, and applied long-term intravenous antibiotic regimen for the culprit agent, as confirmed by the culture. Results Of 43 patients, 18 underwent tricuspid valve repair and 25 underwent tricuspid valve replacement for lead endocarditisrelated severe tricuspid valve regurgitation. During followup (range, 2 to 62 months), two patients required temporary mechanical support due to postoperative acute right heart failure, while eight patients died due to sepsis (n=6; 14%) and stroke (n=2; 4.6%) in the early postoperative period. The remaining patients showed significant improvement in signs and symptoms of heart failure. Conclusion Our study results suggest that incompetent experience and inaccurate decision for valve repair may result in delayed valve replacement and prolonged operation time.

WOS: 000356221100004, PubMed ID: 25733550, Aims Statin pretreatment in patients undergoing cardiac surgery is understood to prevent postoperative atrial fibrillation (AF). However, this is based on observational and limited randomized trial evidence, resulting in uncertainty about any genuine anti-arrhythmic benefits of these agents in this setting. We therefore aimed to quantify precisely the association between statin pretreatment and postoperative AF among patients undergoing cardiac surgery. Methods and results A detailed search of MEDLINE and PubMed databases (1st January 1996 to 31st July 2012) was conducted, followed by a review of the reference lists of published studies and correspondence with trial investigators to obtain individual-participant data for meta-analysis. Evidence was combined across prospective, randomized clinical trials that compared the risk of postoperative AF among individuals randomized to statin pretreatment or placebo/control medication before elective cardiac surgery. Postoperative AF was defined as episodes of AF lasting >= 5 min. Overall, 1105 participants from 11 trials were included; of them, 552 received statin therapy preoperatively. Postoperative AF occurred in 19% of these participants when compared with 36% of those not treated with statins (odds ratio 0.41, 95% confidence interval 0.31-0.54, P< 0.00001, using a random-effects model). Atrial fibrillation prevention by statin pretreatment was consistent across different subgroups. Conclusion Short-term statin pretreatment may reduce the risk of postoperative AF among patients undergoing cardiac surgery., Kowa; Accumetrics; Astra Zeneca; Takeda; Essentials; GSK; Regeneron; Sanofi; Merck, K.K.R. reports to receiving honoraria for advisory boards, consultancy, steering committees, and lectures from Pfizer, Astra Zeneca, Abbott, Roche, MSD, Sanofi, Amgen, Regeneron, Aegerion, Kowa, Novartis, Novo Nordisk, Boehringer Ingelheim, Daiichi Sankyo, and Lilly. S.R.K.S. reports to receiving honoraria from Amgen for consultancy, and an unrestricted educational grant (to research group) from Kowa. C.P.C. reports to receiving honoraria for advisory boards, consultancy, travel, and/or meeting expenses from Merck, BMS, Alnylam, Pfizer, CSL, Astra Zeneca, GSK, Regeneron, Sanofi, and Takeda; grants from Accumetrics, Astra Zeneca, Takeda, Essentials, GSK, Regeneron, Sanofi, and Merck; and reports to holding stocks in Audiometrics.

Background The goal of this retrospective study was to clarify the effect of using temporary vascular shunt (TVS) as a previous intervention. Methods A total of 96 cases with war-related lower extremity arterial injury and surgically treated between October 2013 and March 2016 were included in the study. The patients were divided into two groups: those in which TVS was performed as a previous intervention on admission (TVS group, n=24) and those in which compression, tourniquet, and ligation/clampage were performed as a previous intervention on admission (non-TVS group, n=72). Results In comparing injury pattern, there was no difference between the two groups. In addition, mean hematocrit level, mean systolic blood pressure, the incidence of concomitant vein injury, nerve injury, soft tissue damage, and bone injury were similar in both groups. The overall amputation rate was 19%. There were a total of 18 amputations, with 1 (4%) in the TVS group and 17 (24%) in the non-TVS group. The difference on amputation rate was statistically significant. The mean values of the mangled extremity severity score (MESS) were 6.45 in the TVS group and 7.44 in the non-TVS group. The overall mean MESS was 7.1. The duration of ischemia (DoI) was 4.84+-1.84 h in the TVS group and 5.95+-1.92 h in the non-TVS group. These differences in MESS and DoI were statistically significant. Conclusion We think that it may be beneficial for patients to consider a TVS to reduce DoI and gain time for surgical revascularization. As a result, the present study demonstrates that the use of TVS may successfully serve as a bridge between initial injury and definitive repair with a reduction in amputation rates.

Objective: All innovations in cardiac surgery provide us with new techniques to perform surgery through smaller incisions with less invasive and best cosmetic results. After promising results in minimally invasive cardiac surgery (MICS), pain and cosmetic appearance became important end points, especially for female patients. In the current study, we intended to evaluate the surgical results and cosmetic satisfaction with the periareolar and submammary incision types in cardiac surgery. Methods: Ninety-four female patients underwent MICS between July 2013 and March 2018. MICS was performed in 62 patients via periareolar incision and in 32 patients via submammarian incision. We investigated the incision size, wound infection, pain levels by using a postoperative standard pain-level questionnaire, the postoperative scar size, and patient satisfaction using a postoperative patient questionnaire. Results: Periareolar incision size was smaller than the submammary incision (Group A: 5.6±0.6 vs. Group B: 6.7±0.8, p=0.001). Four patients from Group B had superficial wound infection (p=0.01). Patients who underwent MICS via periareolar incision and submammary incision had similar pain level (p=0.2). The scar tissue was smaller in size and postoperatively healed better in the following days for the patients with periareolar incision due to the elastic structure of breast tissue. (Group A: 4.3±0.4 vs. Group B: 5.3±0.2, p=0.001). Conclusion: Our study suggests that the periareolar approach would be more aesthetic, show better healing, and have a smaller scar size in female patients.

Objectives Patients on venoarterial or venovenous extracorporeal membrane oxygenation (ECMO) support may require venoarterial-venous (VAV-ECMO) configuration during follow-up. We report 12 cases of VAV-ECMO with significant outflow steal. Methods Between October 2014 and November 2016, a total of 97 patients (56.6 ± 12.0 years; 59 men/38 women; body surface area 1.84 ± 0.36 m2) were supported with venoarterial ECMO (n = 85) or venovenous ECMO (n = 12). Among the 97 patients, 12 patients (age 61.5 ± 3.5 years; 8 men/4 women; body surface area 1.8 ± 0.8 m2) required hybrid use of VAV-ECMO. Control and monitoring of flow ratios in supplying cannulae using flow sensors were performed, and occluder devices were used according to patient requirements to achieve optimum haemodynamics and oxygenation. Results Among the 85 venoarterial ECMO-supported patients, Harlequin syndrome was detected in 9 cases (10.6%) who required switching to VAV-ECMO. Among the 12 patients, 3 (25%) patients required VAV-ECMO while on venovenous ECMO support as a result of initial respiratory failure subsequently developed cardiac decompensation. Mean duration of VAV-ECMO support was 6.4 ± 1.8 days. Overall, on VAV-ECMO support, 70.0 ± 4.6% of blood flow was detected within the supplying right internal jugular vein cannula as a result of lower afterload in venous system. We partially occluded the internal jugular vein cannula and directed flow to the common femoral artery. After adjustment, 34.3 ± 7.4% flow was directed to internal jugular vein and 65.6 ± 7.4% to common femoral artery. Conclusions Non-invasive monitoring of flow rates within the supplying cannulae of VAV-ECMO and the use of partial occlusion for venous-supplying cannula enable individualized patient management and effective weaning from VAV-ECMO.

We report here on a 43-year-old female patient presenting with non-ST elevation myocardial infarction, severe mitral regurgitation, and mild mitral stenosis secondary to encroachment of the related structures by a primary cardiac angiosarcoma. A coronary angiography revealed significant stenosis in the left main and left circumflex arteries and at exploration, the tumour was arising from posterior left atrial free wall, invading the posterior mitral leaflet, and extending into all of the pulmonary veins and pericardium. Therefore, no further intervention was performed, except for left internal mammarian artery to left anterior descending artery anastomosis and biopsy. As far as we know, this case is unique with respect to its presentation.

Purpose: The purpose of this study was to determine whether the plasma levels of soluble extracellular matrix metalloproteinase inducer (EMMPRIN) differed among the patients with ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and stable coronary artery disease (CAD) and the healthy controls, and to identify the factors associated with the differences in plasma levels of this this protein among patients in these groups. Methods: Plasma EMMPRIN levels were compared among four age- and sex-matched groups of patients with STEMI, NSTEMI and stable CAD and healthy controls (n=44 per group), then logistic regression and correlation analyses were conducted for the whole acute myocardial infarction (AMI) patients group. Results: EMMPRIN levels were significantly higher in the STEMI (39.4±9.2ng/mL) and NSTEMI (37.1±10.5ng/mL) groups than in either the stable CAD (27.5±4.7ng/mL) or control (24.5±5.8ng/mL) groups (p