Search

Objective: In cardiac surgery, low serum albumin level is an important risk factor that increases mortality and morbidity in the postoperative period. Diabetes mellitus may affect this clinical condition by causing albumin loss with proetinuria. In this study, the effects of preoperative albumin values and the presence of diabetes mellitus (DM) on postoperative renal failure were investigated. Method: Patients who underwent coronary artery bypass grafting between 01.01.2015-31.12.2019 in our clinic were retrospectively analyzed. Patients who received dialysis treatment in the preoperative period, whose ejection fraction was below 50%, and who underwent emergency surgery were excluded from the study. The patients were divided into 3 groups according to the serum albumin levels before surgery. Patients with serum albumin level ≥3.5 mgr/dL Group 1; those between 2.5-3.5 mg/dL Group 2; patients with ≤ 2.5 were named as Group 3. Later, these 3 groups were divided into 2 subgroups according to the presence of DM. Results: 308 patients who underwent coronary artery bypass surgery were included in the study. The demographic characteristics, peroperative data and operative data of the patients were similar. The need for renal replacement therapy was higher in Group 2 and Group 3 than in Group 1 in the postoperative period. Conclusion: Preoperative low serum albumin is a risk factor for the development of acute renal failure in the postoperative period, and the presence of DM adversely affects this condition. Close follow-up of these patients positively contributes to reducing mortality and morbidity. [ABSTRACT FROM AUTHOR]

Objective: Although crystalloid solutions are recommended as first choice for fluid replacement after cardiac surgery, abumin and synthetic colloids are used in special condition. In this study, the effects of preoperative albumin level on postoperative period and the effects of albumin on outcomes were investigated. Method: Patients who underwent cardaic surgery between 01.01.2014 and 12.31.2018 were evaluated retrospectively. Patients were divided into two groups according to preoperative albumin levels. Patients with preoperative albumin levels < 4 g/dL and ≥4 g/dL constituted Groups 1, and 2 respectively. Effects of preoperative albumin levels on early postoperative morbidity and mortality and its relationship with fluid replacement were evaluated. Results: Hypoalbuminemia persisted also during the postoperative period in patients with low preoperative albumin levels. During follow-up, 13 patients developed minor complications, of which 12 were in Group 1, and 10 had albumin replacement. Although 7 patients underwent albumin replacement 9 patients in Group 1, and 1 patient in Group 2 exited during postoperative period It was seen that preoperative albumin value under 4 g/dL increased the risk of postoperative complications 14 times and the application of albumin replacement in these patients did not provide the expected contribution to the outcome. Conclusion: Although low preoperative albumin value is associated with increased morbidity and mortality during the postoperative period, albumin replacement does not contribute positively to the outcome. In accordance with the recommendations of current guidelines, it would be appropriate to consider crystalloid solution as the first choice in cases where blood replacement is not required after cardiac surgery. [ABSTRACT FROM AUTHOR]

Objective: Stress caused by cardioplegic ischemic arrest was shown to alter the expression levels of heat shock proteins (Hsp), but little is known about their efects, particularly on pediatric hearts. This study aimed to investigate whether myocardial cellular stress and apoptotic response changes due to diferent cardioplegia (CP) solutions during cardiopulmonary bypass (CPB) in infants and to determine their infuence on surgical/clinical outcomes. Methods: Therefore, twenty-seven infants for surgical closure of ventricular septal defect were randomly assigned to a CP solution: normothermic blood (BCP), delNido (dNCP), and Custodiol (CCP). Hsp levels and apoptosis were determined by immunoblotting in cardiac tissue from the right atrium before and after CP, and their correlations with cardiac parameters were evaluated. Results: No signifcant change was observed in Hsp27 levels. Hsp60, Hsp70, and Hsp90 levels decreased signifcantly in the BCP-group but increased markedly in the CCP-group. Decreased Hsp60 and increased Hsp70 expression were detected in dNCP-group. Importantly, apoptosis was not observed in dNCPand CCP-groups, whereas marked increases in cleaved caspase-3 and -8 were determined after BCP. Serum cardiac troponin-I (cTn-I), myocardial injury marker, was markedly lower in the BCP- and dNCPgroups than CCP. Additionally, Hsp60, Hsp70, and Hsp90 levels were positively correlated with aortic cross-clamp time, total perfusion time, and cTn-I release. Conclusion: Our fndings show that dNCP provides the most efective myocardial preservation in pediatric open-heart surgery and indicate that an increase in Hsp70 expression may be associated with a cardioprotective efect, while an increase in Hsp60 and Hsp90 levels may be an indicator of myocardial damage during CPB. [ABSTRACT FROM AUTHOR]

Copyright of Polish Journal of Thoracic & Cardiovascular Surgery / Kardiochirurgia i Torakochirurgia Polska is the property of Termedia Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The thymus slowly involutes with age after puberty. Various stress conditions accelerate the involution of the thymus and cause changes in the histologic structure of the gland., Objective: The present study performed histomorphological and immunohistochemical (IHC) evaluations of the thymus glands removed during surgical repair in patients with cyanotic or acyanotic congenital heart disease (CHD). The thymus glands in the hypoxic group were compared to those in the non-hypoxic group. This study suggested that the activation of HIF-1 alpha promotes tumor progression and impair prognosis due to the inhibition of apoptosis, increased population of stem cells, and induction of angiogenesis also suggested that inactivation of HIF-1 alpha in tumor-infiltrated tissues could halt tumor progression and improve prognosis., Materials and Methods: The study included 76 thymus glands removed from patients who underwent an operation due to CHD. Of these cases, 38 had cyanotic CHD, and constituted the hypoxic group. The remaining 38 patients had acyanotic CHD, and constituted the non-hypoxic group. IHC procedures were performed for HIF-1 alpha, FoxP3, CD44, Bcl-2, and CD34., Results: There were statistically significant differences between the hypoxic and non-hypoxic groups only in terms of medullary enlargement toward the cortex and effacement of the corticomedullary junction. In the immunohistochemical examination for five markers, staining intensity and staining rates increased with decreasing oxygen saturation., Conclusion: It can be concluded that the activation of HIF-1 alpha promotes tumor progression and impair prognosis due to the inhibition of apoptosis, increased population of stem cells, and induction of angiogenesis.

Introduction: In recent decades, new high-performance prostheses have been invented for use with small aortic annuli, and they have helped avoid patient prosthesis mismatch (PPM) without the need for aortic annular enlargement. The purpose of this study is to examine the trends in mechanical aortic valve replacement surgery in a large, multi-surgeon, single hospital practice., Material and Methods: Between January 1999 and January 2008, 1337 consecutive patients underwent aortic valve replacement (AVR) with or without concomitant aortic annulus enlargement. Patients with aortic dissections and patients undergoing Bentall and Ross procedures were excluded from the analysis. Patients were grouped according to the used aortic valve size. The data were collected and analyzed retrospectively., Results: The mean age of the subjects was 54.37 ± 17.35 (range: 10-84), and 881 of them were men (65.8%). The number of aortic root enlargement procedures decreased over the years (p < 0.05); particularly, the decline of the Nicks procedures was statistically significant (p < 0.05). In 2008, the most frequently used valve size was 23, which stands in contrast with the smaller size preferred in 1999 (p < 0.05). The primary pathophysiology leading to aortic valve replacement, i.e. aortic stenosis, did not change over the years (p > 0.05). Although the use of combined surgery increased in time, there was no statistical relationship with any increase in mortality rates (p > 0.05)., Conclusions: This study showed that avoiding the procedure of aortic root enlargement and implanting high-performance prostheses with larger valves is safe.