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Background Today, repair techniques almost completely take place of the mitral valve replacement, especially in patients with degenerative disease. Majority of the surgeons hesitate to prefer repair in patients with bileaflet prolapse. In this study we aimed to investigate postoperative results of our patients with mitral valve insufficiency due to bileaflet prolapse and treated with repair techniques Methods 89 patients who underwent mitral valve repair by the same surgical team due to bileaflet prolapse, between January 2006 and January 2016 in Turkiye Yuksek Ihtisas Hospital were included to this study. Preoperative, operative and postoperative data such as mortality, recurrent mitral insufficiency, echocardiographic parameters and reoperation rates were investigated. Results Mean follow up duration was 25.3±17.7 months. Mean age was 46.6±17.4 years. According to the transthoracic echocardiographic evaluations, 8 (9%) patients had moderate and 81 (91%) patients had severe mitral insufficiency. When preoperative and postoperative values were compared statistically significant improvement in functional capacity of patients according to NYHA classification has been noted. (2.1±0.5 ; 1, , p=0.001) Improvements in left ventricular end diastolic diameter (5.5±0.7 cm ; 5±0.6 cm, p=0.001), left ventricular end sistolic diameter (3.8±0.6 cm ; 3.6±0.6 cm, p=0.004 ), left atrium diameter (4.8±0.9 cm ; 4.3±0.6 cm, p=0.001) and pulmonary artery pressure (44.3±13.4 mmHg; 32.1±5.4 mmHg, p=0.001) were statistically significant. Conclusions In the lights of findings about good postoperative results and durability rates, mitral valve repair can be safely used in patients with mitral valve insufficiency due to bileaflet prolapse especially with chordae replacement technique which can be feasible after improvements in suture technologies.

Backgrounds Postoperative atrial fibrillation (POAF) is one of the most common complication of cardiac surgery. Epicardial fat tissue may play a role in the development of atrial fibrillation (AF). The aim of this study was to evaluate relationship between epicardial fat volume (EFV) and the appearance of new-onset AF in patients undergoing isolated coronary artery bypass graft (CABG) with normal echocardiographic functions. Methods Between January 2017 and June 2020, 281 coronary artery disease patients undergone isolated CABG surgery with normal echocardiographic functions were included in the study. Patient characteristics, medical history, and perioperative variables were retrospectively collected. Patients with AF predisposition factors were excluded. Results Sixty-seven patients (23.8%) developed postoperatively AF during hospital stay. In univariate analysis, patients with postoperative AF were older compared with sinus rhythm patients (60.78 ± 9.03 vs. 65.46 ± 9.22, p = 0.001). There are no statistically significant differences between groups and EFV compared (107.78 ± 41.04 vs. 106.66 ± 34.98 p = 0.84). Large left atrial diameter, female patient, cardiopulmonary bypass and longer cross-clamp time showed correlation between POAF without statistical significance. Conclusion Aging is the only associated factor with AF in this study. There was no EFV difference between POAF and non-AF groups in patients undergoing isolated CABG with normal echocardiographic functions.

BACKGROUND Carotid artery stenosis (CAS) is one of the major causes of stroke in coronary artery bypass grafting (CABG). AIMS The aim of this study was to determine which age groups require screening for CAS using carotid duplex ultrasound in asymptomatic patients undergoing CABG. METHODS We included 644 neurologically asymptomatic consecutive patients (mean [SD] age, 63.9 [8.8] years; men, 453 [70.3%]) who underwent elective isolated CABG between June 2015 and June 2020. Clinical, demographic, and radiological data as well as coronary angiography results were retrospectively reviewed. Patients were classified into 4 age groups: 40 to 50, 51 to 60, 61 to 70, and >70 years, as well as 3 groups depending on the CAS degree: 50% or less, 50% to 70%, and 70% or greater. Regression analysis was applied across the selected parameters to identify risk factors for significant CAS, and receiver operating characteristic analysis, to determine cutoff age and SYNTAX score of patients who had to be screened before CABG. RESULTS Overall, 8 (1.1%) patients included in the present study had stroke following CABG. Cutoff values of the SYNTAX score and CAS of 70% or greater were found to be 27 and 64 years, respectively. The sensitivity and specificity of the cutoff value were 98.4% to 98.3% and 74.3% to 55.1%, respectively. The area under the curve was 0.98 and 0.73, respectively. CONCLUSIONS Based on the receiver operating characteristic analysis, we recommended to perform screening for CAS in patients older than 64 years and with a SYNTAX score of 27 or higher, even if they are asymptomatic. WOS:000613427100005 2-s2.0-85100445536 PubMed: 33078919

Objective This study evaluated the effect of low-energy radiofrequency thermocoagulation added to standard liquid sclerotherapy on clinical outcomes of patients with venous insufficiency. Patients and method We included 111 patients with spider veins CEAP/C1 stage. The patients were randomized into sclerotherapy (Group 1) and sclerotherapy + sclerotherapy immediately followed by low energy percutaneous RF thermocoagulation (Group 2) groups and followed up with same protocols prospectively. Results The study groups did not differ in terms of the mean age, body mass index, the number of spider veins and pre-interventional venous clinical severity scores (VCSS). Patients' self-assessed satisfaction ratings of cosmetic outcomes were found to be higher compared to the baseline (p = 0.001). While both techniques caused a significant decline in VCSS at postprocedural third month, it was observed that the type of applied intervention did not affect the VCSS (p = 0.43 and p = 0.93, respectively). There was a significant difference in hyperpigmentation and trapped blood between the two groups after the procedure (p = 0.009 and p = 0.02, respectively), there was no statistically significant difference in terms of skin necrosis (p = 0.52). A significant difference in the self-assessed cosmetic outcomes was observed in patients treated with sclerotherapy followed by low energy percutaneous RF thermocoagulation compared with patients whom sclerotherapy performed alone (p = 0.001). Discussion This study suggests that radiofrequency thermocoagulation added to the sclerotherapy provides better cosmetic outcomes with less treatment sessions and no additional complication rates.

BACKGROUND: The time and conditions may not be suitable for performing polysomnography (PSG) before urgent or emergent surgeries, for example, a coronary artery bypass graft. Unavail-ability in many centers, critical clinical situation, and inability to arrange a timely scheduled appointment are other limitations for PSG. In this study, we aimed to investigate if the STOP-BANG Questionnaire may predict obstructive sleep apnea syndrome (OSAS) related postoperative pulmonary alterations during coronary artery surgery. METHODS: Sixty-one subjects who were scheduled to undergo elective isolated coronary artery bypass graft surgery and were consulted for preoperative pulmonary assessment were recruited to the study. The STOP-BANG Questionnaire was used with the subjects; then their relationship with postoperative complications was assessed. RESULTS: Results of the STOP-BANG Questionnaire revealed that 36.1% of subjects were at high risk for OSAS. Three groups were established according to the STOP-BANG Questionnaire (low risk, group 1; moderate risk, group 2; high risk, group 3) and study parameters, including PEEP value in ventilator, detection of apnea at ventilator, CPAP time after extubation, SpO2 1 h after extubation, postoperative hypoxemia, need for CPAP, and ICU length of stay revealed significant relationships among these groups. CONCLUSIONS: The STOP-BANG Questionnaire may predict the OSAS risk and OSAS-related pulmonary complications for patients who are candidates for a coronary artery bypass graft and unable to be evaluated with PSG before surgery due to technical or time-related limitations. © 2018 Daedalus Enterprises.

Background: In procedures involving surgical maneuvers such as cannulation, clamping, or proximal anastomosis where aortic manipulation is inevitable, a preliminary assessment of atherosclerotic plaques bears clinical significance. In the present study, our aim was to evaluate the frequency and distribution of aortic calcifications in patients undergoing coronary artery bypass grafting (CABG) surgery to propose a morphological classification system. Methods: A total of 443 consecutive patients with coronary artery disease were included in this study. Preoperative non-contrast enhanced computed tomography images, in-hospital follow-up data, and patient characteristics were retrospectively evaluated. Results: Whereas 33% of patients had no calcifications at any site in the aorta, 7.9%, 75.4%, and 16.7% had calcifications in the ascending aorta, aortic arch, and descending aorta, respectively. Focal small calcifications were the most common type of lesions in the ascending aorta (3.9%), whereas 9 patients (1.4%) had porcelain ascending aorta. We defined four types of patients with increasing severity and extent of calcifications. Conclusions: Based on the frequency and distribution of calcifications in the thoracic aorta, we propose a classification system from least to most severe for coronary artery disease patients who are candidates for CABG.

Coronaryartery disease with ascending aorta aneurysm surgery may be troublesome forboth the surgeon and the patient. Because so many patients have otherconcomitant diseases such as cancer, severe left ventricular dysfunction,hemodialysis-dependent chronic renal failure, poor nutritional status, obesity,chronic obstructive pulmonary disease (COPD), and cerebrovascular event history.These diseases increase the risk of postoperative mortality and morbiditybecause of the use of extracorporeal circulation and aortic cross-clampingintraoperative. Off-pump reduction aortoplasty may be the right decision forrisky patients with ascending aortic aneurysm and coronary artery disease. Thisreport presents 3 cases of off-pump reduction aortoplasty and concomitantcoronary artery bypass grafting (CABG)., Koronerarter hastalığı ile birlikte yapılan asendan aort cerrahisi hem cerrah hem dehasta için zorlu olabilmektedir. Çünkü bir kısım hastanın kanser, düşük solventrikül fonksiyonu, diyalize bağımlı kronik böbrek yetmezliği, kötü beslenmedüzeyi, obezite, kronik obstrüktif akciğer hastalığı (KOAH) ve serebrovaskülerhastalık öyküsü gibi eşlik eden diğer hastalıkları olabilir. Bu hastalıklarintraoperatif ekstrakoporeal dolaşım kullanımı ve aortun kros-klemplenmesinedeniyle post-operatif mortalite ve morbiditeyi artırırlar. Off-pump küçültücüaortoplasti asendan aort anevrizması ve koroner arter hastalığının olduğuriskli hastalar için uygun karar olabilir. Bu raporda off-pump küçültücüaortoplasti ve eşzamanlı koroner arter bypass cerrahisi yapılan üç olgusunulmuştur.

Background Standard treatment for deep venous thromboembolism involves parenteral anticoagulation overlapping with a vitamin K antagonist, an approach that is effective but associated with limitations including the need for frequent coagulation monitoring. The direct oral anticoagulant rivaroxaban is similarly effective to standard therapy as a single-drug treatment for venous thromboembolism and does not require routine coagulation monitoring. The aim of this analysis was to project the long-term costs and outcomes for rivaroxaban compared to standard of care (tinzaparin/warfarin). Methods A total of 184 patients who were under anticoagulant therapy with warfarin or rivaroxaban for extended deep venous thromboembolism were retrospectively evaluated; 59 received rivaroxaban and 125 received warfarin therapy. Assessments were made on age, gender, place of residence, the duration of anticoagulation, mean international normalized ratio value, the effective rate of international normalized ratio (time in the therapeutic range), bleeding-related complication rate, duration of hospitalization due to complications, the number of annual outpatient department admission, cost for drug, cost for hospitalization, cost for outpatient department admission and international normalized ratio measurements. Results The annual outpatient cost is higher in warfarin group (147.09 ± 78 vs. 62.32 ± 19.79 USD p Conclusion This analysis suggests that rivaroxaban has lower costs than warfarin in terms of outpatient department admission and hospital costs due to complications; however, warfarin was more economic when all cost parameters were considered. Time in the therapeutic range was found as 56% for warfarin that should be taken into account while analyzing costs and benefits.

Background The tricuspid valve is usually ignored and tricuspid interventions are mostly done in the context of other planned cardiac surgery. Isolated tricuspid reoperative procedure, especially tricuspid valve replacement (TVR) is very rare and carries a very high mortality rate. In this prospective study, clinical results of isolated TVR either through a median re-sternotomy or an antero-lateral thoracotomy with conventional cardiopulmonary bypass (CPB) have been evaluated. Methods Thirty patients with previous open heart surgery through median sternotomy had isolated TVR between 2004 and 2011. Operative approaches were through a median re-sternotomy in 13 patients and a right antero-lateral thoracotomy in 17 patients. Results Follow-up period is complete with a mean duration of 19.77±17.08 months. The hospital mortality rates were 46.2% (six patients) in the Median Re-sternotomy Group and 5.9% (one patient) in the Thoracotomy Group (p= 0.025). The surgical procedures lasted shorter and the postoperative drainage amounts were lower in the Thoracotomy Group (298.08±76.64 min vs 246.76±47.40 min, p= 0.032 and 1787.50±1399.53 mL vs 903.33±692.43 mL, p= 0.03 respectively). Presence of ascites in the preoperative period (p= 0.007), operative technique (median re-sternotomy) (p= 0.025), use of cross-clamp (p= 0.048), and need for inotropic support during the operation (p= 0.002) were statistically significant factors affecting the hospital mortality. The mean estimated life period was better for the Thoracotomy Group (16.7±5.03 versus 35.9±5.01 months, p= 0.044). Presence of ascites in the preoperative period was a significant risk factor for overall mortality according to Cox regression analysis. Conclusion Thoracotomy for TVR in patients with previous median sternotomy is a practical and safe technique with lower mortality rates.

Background Central venous catheterization is an invasive procedure that must be performed during cardiovascular surgery. The addition of ultrasound guidance to the catheterization technique has shown effectiveness in reducing complications because it allows for the visualization of anatomical variations prior to intervention and the continual visualization of the needle during the placement. The purpose of this study was to evaluate the effectiveness of needle-guiding ultrasound for internal jugular venous cannulation. Method Patients undergoing coronary bypass surgery at Hitit University, department of cardiovascular surgery, from January 2014 to June 2018, were included in the study. The patients were divided into two groups: those with catheterization with ultrasound guidance (Group U) and those with catheterization performed with the anatomic landmark technique (Group L). Results A total of 584 cases were investigated. The success of the procedure and complication rates for both methods were compared. Central vein catheterization with ultrasonography produced success and complication rates significantly better than those for catheterization using the landmark technique (p=0.04 and p=0.00001, respectively). Conclusion This study demonstrated that the use of ultrasonography for internal jugular vein catheterization for patients undergoing coronary bypass surgery significantly reduced the complication rates as compared to those of patients where the landmark technique was used for catheterization. WOS:000461529800003 PubMed: 31007984

WOS: 000475389300005, PubMed: 31237550, Background: The aim of our study was to compare the outcome of patients who underwent mitral valve anterior leaflet repair with and without chordal replacement for degenerative mitral valve insufficiency. Methods: This study was conducted at our center between May 2006 and May 2013. The study included 125 patients with degenerative mitral valve insufficiency (64 males, 61 females; mean age 47 years, age range 16-78 years) who underwent mitral valve repair with anterior leaflet procedures. The patients were divided into 2 groups. Group A consisted of 56 patients with chordal replacement, and group B consisted of 69 patients with other repair techniques performed. Results: No significant difference was determined between the 2 groups in mortality, recurrence, and reoperation rates. The mortality rate was 3.6% in group A and 1.4% in group B. During the follow-up period, 3 patients were reoperated on (mitral valve replacement) because of severe mitral valve insufficiency. Two of these patients were from group A (3.6%), and the other was from group B (1.4%). One patient in group A underwent intraoperative mitral valve replacement after unsuccessful chordal replacement. Fifty patients (89.3%) in group A and 65 patients (94.2%) in group B exhibited no or mild recurrence of mitral valve insufficiency. Conclusion: Mitral valve repair in patients with degenerative mitral valve insufficiency resulting from anterior leaflet pathology is a safe procedure because of its durability and good long-term results. Despite the difficulty of the chordal replacement procedure, it may be used as an alternative technique for anterior mitral valve leaflet repair.

WOS: 000474629300005, PubMed: 32082875, Background: This study aims to compare three different tricuspid annuloplasty techniques using suture, ring, and band. Methods: Between January 2010 and December 2015, a total of 231 consecutive patients (78 males, 153 females; mean age 50.3 +/- 15.9 years; range, 34 to 66 years) who underwent tricuspid valve annuloplasty using three different techniques were retrospectively analyzed. Tricuspid valve repair was performed with de Vega a nnuloplasty technique (n=62, 26.8%), flexible ring (n=76, 32.9%) or Teflon strip (n=93, 40.3%). Postoperative data including vital signs, echocardiographic reports, functional status, and the rate of re-do surgeries were recorded. Results: Cardiopulmonary bypass times were statistically significantly shorter in the de Vega annuloplasty group (p< 0.001). There was no significant difference among the groups in terms of the in-hospital mortality. Late postoperative tricuspid regurgitation grades, systolic pulmonary artery pressure, and right atrial diameters showed significant improvements, compared to baseline, in ring and strip annuloplasty groups. Conclusion: Our study results demonstrate that suture-based approaches should be avoided. Instead of performing routine tricuspid ring annuloplasty, Teflon strip annuloplasty may be considered an alternative method in most cases, particularly due to controversy in selection of true ring size and high cost of this surgical material in the real-life setting.

In this case report, we present a patient scheduled for operation due to critical leg ischemia in whom a bilateral great saphenous vein (GSV) had already been used during previous cardiac and peripheral vascular surgeries. The patient underwent femorofemoral crossover bypass from left to right with a small saphenous vein and right femoropopliteal bypass with cephalic vein (CV) during the same session. Distal pulses became palpable, and symptoms regressed dramatically following the operation. A control computed tomographic angiography scan revealed no signs of graft stenosis 32 months after the surgery. Despite the recent advances in synthetic graft materials, small saphenous and CVs should be remembered as alternative long-standing conduits in the absence of the GSV.

Background: This study aims to investigate the effects of various anticoagulant regimens on prosthetic valve-related complications and pregnancy outcomes including feto-maternal mortality and morbidity, and to identify the most optimal anticoagulation therapy regimen. Methods: Anticoagulant therapy regimens for pregnant women who underwent mechanical heart valve replacement between January 1990 and December 2015 was analyzed retrospectively. Seventy-two pregnancies among 57 patients after mechanical heart valve replacement were reviewed, and four different regimens were identified and evaluated during different trimesters of pregnancy. Results: Forty of 72 pregnancies resulted in healthy newborns; 35 (48.6%) healthy neonates, four (5.6%) premature births, and one (1.4%) low birth weight. Eighteen (25%) therapeutic and 12 (16.7%) spontaneous abortions, as well as two (2.8%) stillbirths occurred. Seven valve thromboses developed during pregnancy or the postpartum period. Bleeding occurred in six patients (10.5%) and peripheral embolism also occurred in six patients (10.5%). No maternal mortalities were recorded. Conclusion: Although there is no consensus on the most optimal anticoagulant regimen during pregnancy, substituting warfarin with dose-adjusted unfractionated heparin or low-molecularweight heparin seems suitable to prevent teratogenicity and a high abortion rate in the first trimester. Low-molecular-weight heparin is practical to use and can be monitored reliably, resulting in successful pregnancy outcomes. However, warfarin throughout pregnancy ?5 mg per day may be an alternative choice, if the risk of embryopathy is accepted by the pregnant woman. © 2018 All right reserved by the Turkish Society of Cardiovascular Surgery. Amaç: Bu çalışmada, farklı antikolagülan rejimlerinin protez kapak ile ilişkili komplikasyonlar ve feto-maternal mortalite ve morbidite üzerindeki etkileri araştırıldı ve en ideal antikolagülan tedavi rejimi belirlendi. Çalış­ma­ planı:­ Ocak 1990 - Aralık 2015 tarihleri arasında mekanik kalp kapak replasmanı yapılan gebe kadınlarda antikoagülan tedavi rejimleri, retrospektif olarak incelendi. Mekanik kalp kapak replasmanı sonrası 57 hastada 72 gebelik gözden geçirildi ve dört farklı rejim belirlendi ve gebeliğin farklı trimesterlerinde değerlendirildi. Bulgu­lar:­ Yetmiş iki gebeliğin, 40'ı sağlıklı yeni doğanla, 35’i (%48.6) sağlıklı yenidoğan, dördü (%5.6) prematüre doğum ve biri (%1.4) düşük doğum ağırlığı ile sonuçlandı. On sekiz (%25) terapötik ve 12 (%16.7) spontan düşüğün yanı sıra, iki (%2.8) ölü doğum izlendi. Gebelik süresince veya post-partum dönemde, yedi gebede kapak trombozu gelişti. Altı hastada (%10.5) kanama ve yine altı (%10.5) hastada periferik emboli meydana geldi. Maternal mortalite görülmedi. Sonuç:­ Gebelik sırasında en ideal antikoagülasyon rejimine ilişkin tam bir fikir birliği olmamasına rağmen, birinci trimesterde varfarinin teratojenisite ve artmış düşük riskini önlemek için doz ayarlamalı fraksiyone olmayan heparin veya düşük molekül ağırlıklı heparin ile değiştirilmesi uygundur. Düşük molekül ağırlıklı heparinin uygulaması kolaydır ve güvenilir bir şekilde izlenebilir ve başarılı gebelik sonuçlarına da vesile olabilir. Ancak, gebeliğin tüm trimesterleri süresince, günde ?5 mg varfarini geçmemek kaydıyla kullanılacak varfarin, embriyopati riskinin gebe tarafından kabul edildiği durumlarda, alternatif bir seçenek olabilir.

Background: This study aims to investigate the effects of the use of the Rapid Shallow Breathing Index on extubation success and time to extubation in patients undergoing elective isolated coronary artery bypass grafting. Methods: This prospective, randomized-controlled study included a total of 72 patients (55 males, 19 females; mean age 60.3±9.3 years; range 45 to 76 years) who underwent isolated coronary artery bypass grafting between February 2016 and November 2016. The patients were divided into two groups as the RSBI group (n=36) and the control group (n=36). The control group was extubated by conventional criteria that were routinely applied in our clinic, while the RSBI group was extubated, when the index scores became below 77 breaths per min/L, following ensuring hemodynamic stability and weaning procedure from mechanical ventilation. Results: The mean time to wean from mechanical ventilation was 5.8±1.0 hours in the RSBI group and 8.1±2.0 hours in the control group (p=0.03). Extubation protocol performed through the use of the index was found to provide 26% earlier extubation compared to the conventional extubation criteria. There was no significant difference in the postoperative follow-up parameters or clinical conditions. Conclusion: Our study results show that a practical tool such as the Rapid Shallow Breathing Index can be reliably used for making a decision in favor of extubation in patients undergoing coronary artery bypass grafting. A shortened time to extubation by the use of this index may provide substantial benefits in terms of prevention of infections, mechanical ventilation-induced lung injuries, and potential pulmonary complications. © 2018 All right reserved by the Turkish Society of Cardiovascular Surgery. Amaç: Bu çalışmada elektif izole koroner arter baypas greftleme yapılan hastalarda Hızlı Yüzeyel Solunum İndeks kullanımının ekstübasyon başarısı ve ekstübasyon süresi üzerindeki etkileri araştırıldı. Ça¬lış¬ma pla¬nı: Bu prospektif, randomize kontrollü çalışmaya Şubat 2016 - Kasım 2016 tarihleri arasında izole koroner arter baypas greftleme yapılan toplam 72 hasta (55 erkek, 19 kadın; ort. yaş 60.3±9.3 yıl; dağılım 45-76 yıl) alındı. Hastalar HYSİ grubu (n=36) ve kontrol grubu (n=36) olmak üzere iki gruba ayrıldı. Kontrol grubu kliniğimizde rutin olarak uygulanan konvansiyonel kriterlere göre ekstübe edilirken, HYSİ grubu, hemodinamik stabilizasyon sağlandıktan ve mekanik ventilasyondan ayrılma işleminden sonra indeks skorun 77 solunum L/dk. altına düştüğünde ekstübe edildi. Bulgular: Ortalama mekanik ventilasyondan ayrılma süresi HYSİ grubunda 5.8±1.0 saat ve kontrol grubunda 8.1±2.0 saat idi (p=0.03). Konvansiyonel ekstübasyon kriterlerine kıyasla, indeksin kullanıldığı ekstübasyon protokolü ile %26 daha erken ekstübasyon sağlandı. Ameliyat sonrası takip parametrelerinde veya klinik durumlarda anlamlı bir fark yoktu. So¬nuç: Çalışma sonuçlarımız, Hızlı Yüzeyel Solunum İndeksi gibi pratik bir aracın, koroner arter baypas greftleme yapılan hastalarda ekstübasyon lehine karar vermede güvenle kullanılabileceğini göstermektedir. Bu indeksin kullanımı ile ekstübasyon süresinin kısalması; enfeksiyonların, mekanik ventilasyona bağlı akciğer hasarının ve muhtemel pulmoner komplikasyonların önlenmesi açısından ciddi yarar sağlayabilir.

Background This pilot study aimed to evaluate the effectiveness of posterior left atrial wall plication (T-plasty) in patients with persistent atrial fibrillation (AF) (> 7 days) undergoing mitral valve surgery. Materials and Methods A total of 60 patients who were scheduled for mitral valve replacement were randomly allocated into two groups: one would receive (Group 1; n = 32, mean age; 49.37 ± 9.00) and one would not receive (Group 2; n = 28; mean age 48.64 ± 8.6) left atrial size reduction using T-plasty technique. Patients with a clear indication for combined procedures other than tricuspid valve disease, aortic valve disease, and coronary artery stenosis were not included. Follow-up was performed at 6th, 12th, and 18th months after the operation. Results After the operation, 21 patients (65.6%) in Group 1 and 13 patients (46.4%) in Group 2 regained sinus rhythm (p = 0.13). Mortality did not occur. AF recurrence rates were not significantly different between the groups in three follow-ups. Restoration of sinus rhythm was significantly more common in Group 1 patients than in Group 2 patients during follow-up. Patients in Group 1 had lower left atrial volume indexes than those in Group 2 at the 6th and 12th months, whereas the difference at the 18th month was at the limit of significance. Conclusion We achieved satisfactory results using the T-plasty technique for left atrial size reduction in terms of mid-term restoration and preservation of normal sinus rhythm in patients undergoing mitral valve surgery. Further study may be justified to reveal the prognostic importance of the technique described herein. © Georg Thieme Verlag Stuttgart. New York.

Study We report our results on a case series of 19 patients receiving platelet-rich plasma application in treatment of patients with chronic unhealing venous leg ulcers. Material and methods There were 16 males and three females with a mean age of 38.55 ± 16.46 years. Planimetric size measurements were performed and pain was tested throughout the treatment period. Follow-up was made in seven-day periods. Patients received 5 ml of platelet-rich plasma for each 5 cm2 of the wound surface with half of the amount being injected 1–2 mm deep into the wound and the wound surface was covered with the remaining half. Results Complete wound healing occurred in 18 of 19 patients (94.7%) within a mean of 4.82 ± 2.16 week. There were significant reductions in wound area among all consecutive measurements except for first week. A significant reduction in wound volume was apparent even in first week and sustained among consecutive measurements. Conclusion Platelet-rich plasma seems effective in terms of promoting healing of venous leg ulcers. Improvement in wound depth was slightly more prominent than that in wound area, indicating a potential role of platelet-rich plasma especially in deep venous ulcers.

WOS: 000424153600005 PubMed ID: 28832097 Background and aim: The morphology and extensity of the stenotic lesion is crucial as well as the obstruction ratio. It is well known that the complexity of lesion has direct impact on endovascular treatment (PTCA/stent), however; different arrangement of the lesions is underestimated and not well studied. We sought to evaluate the hemodynamic effects of different stenotic lesion models and arrangements in vitro Methods: Vascular circulation was simulated in vitro. Oxygenator, tubing set, polytetrahidroflouroethylene synthetic graft, pressure and flow rate sensors were used to build the simulation model. Measurements of isolated short, isolated long, identical stenotic tandem short, identical stenotic tandem long, sub-critical long and critical short lesion combination were performed and hemodynamic parameters were recorded. Results: Tandem lesions were more likely to result critical stenosis comparing single lesions with same obstruction ratio. This difference became more significant as the obstruction ratio was raised. Tandem long lesions were also resulted more critical stenosis than tandem short lesions. It can be claimed that tandem lesions can result more flow restriction with reference to single lesions with same stenotic ratio. Contrary to expectations, tandem short lesions were found more stenotic compared with the same degree long individual lesions. Conclusions: It is effortless to give decision for simple, discrete and individual lesions while ideal decision for long and complicated lesions may remain unclear. Even if these "gray zone" lesions considered non-critical while investigating them one by one, it must be kept in mind overall stenotic effect of these lesions may lead to a more hemodynamic impairment. Hitit University Faculty of Medicine Scientific Research Projects [TIP19002.14.002] The study was funded with the project number of TIP19002.14.002 under the coverage of Hitit University Faculty of Medicine Scientific Research Projects.

Patients with severely calcified aorta have high risk of atheroemboli and bleeding during cardiac surgery. Clamping the ascending aorta to initiate cardiac arrest or to perform proximal anastomosis is a challenging problem. Beating heart coronary artery bypass grafting without aortic clamping is usually accepted as the best solution. Herein, we present a feasible and inexpensive proximal anastomosis technique without using aortic clamps for patients with severely atherosclerotic aorta. © 2016, The Japanese Association for Thoracic Surgery.

Penetrating cardiac injuries are one of the most lethal types of trauma. Early diagnosis, appropriate approach in the emergency department (ED), early resuscitation and immediate surgical intervention are essential in the management of penetrating cardiac injuries. In this study we retrospectively evaluated five patients with penetrating cardiac injuries in a 1-year period before an open heart surgery center was set up in our hospital; and we aimed to underline the importance of an appropriate and early surgical intervention without cardiopulmonary by-pass on survival. Median age of our patients was 26 years (range, 17-42 years) and all of the patients were males. Two patients were presented as cardiac arrest and they could not be survived. Three of our patients presented to our ED with cardiogenic shock and all of them recovered after the operation. Right ventricle injury was determined in two patients and both of them survived after the operation. In 3 patients, left ventricle injury was observed and 2 of them died. While 3 patients presented with gunshot injury, 2 of them presented with sharp object injury. One patient in each group was died. Three patients recovered without any complications, however 2 patients- one before operation and 1 during operation- died (survival rate: 3/5). Those 3 patients did not develop any major stationary sequela with normal LVEF in the follow-up at first and third., Penetran kalp yaralanmaları, travma çeşitleri arasında en öldürücü olanlardır. Penetran kalp yaralanmalarına uygun yaklaşımda erken tanı, acil serviste (AS) doğru müdahale, erken resüsitasyon ve acil cerrahi müdahale önemlidir. Biz bu çalışmamızda hastanemizde açık kalp cerrahisi yapılmaya başlanmasından önceki 1 yıl içerisinde, penetran kardiyak yaralanma ile AS'ye getirilen beş hastayı retrospektif olarak inceledik ve kardiyopulmoner by-pass yapılamadığı durumlarda bile, erken ve doğru cerrahi müdahalenin sağkalım üzerine olan önemini vurgulamayı amaçladık. Çalışmaya alınan hastaların ortalama yaşı 26 (17-42) yıl idi ve tümü erkekti. İki hasta AS'ye kardiyak arrest olarak getirilmişti ve bu hastalar kurtarılamadı. Üç hasta ise AS'ye kardiyojenik şok ile getirildi ve bu hastaların tümü ameliyat sonrası iyileşti. İki hastada sağ ventrikül yaralanması tespit edildi ve bu hastaların her ikisi de operasyon sonrası hayatta kaldı. Üç hastada sol ventrikül yaralanması saptandı ve bu hastaların 2'si öldü. Üç hasta ateşli silah ile yaralanırken, 2 hasta kesici alet ile yaralanmıştı. Her iki grupta birer hasta öldü. Üç hasta herhangi bir komplikasyon olmadan taburcu edildi. İki hasta, biri operasyon öncesi ve biri operasyon sırasında olmak üzere öldü (sağkalım oranı: 3/5). Bu 3 hastanın yapılan birinci ve üçüncü ay kontrollerinde sol ventrikül ejeksiyon fraksiyonları normal olarak hesaplandı ve herhangi bir major sekel oluşturan komplikasyon gelişmedi.

Subvalvular apparatus preservation is an important concept in mitral valve replacement (MVR) surgery that is performed to remedy mitral regurgitation. In this study, we sought to determine the effects of papillary muscle repositioning (PMR) on clinical outcomes and echocardiographic left ventricular function in rheumatic mitral stenosis patients who had normal left ventricular systolic function. We prospectively assigned 115 patients who were scheduled for MVR surgery with mechanical prosthesis to either PMR or MVR-only groups. Functional class and echocardiographic variables were evaluated at baseline and at early and late postoperative follow-up examinations. All values were compared between the 2 groups. The PMR group consisted of 48 patients and the MVR-only group of 67 patients. The 2 groups’ baseline characteristics and surgery-related factors (including perioperative mortality) were similar. During the 18-month follow-up, all echocardiographic variables showed a consistent improvement in the PMR group; the mean left ventricular ejection fraction deteriorated significantly in the MVR-only group. Comparison during follow-up of the magnitude of longitudinal changes revealed that decreases in left ventricular end-diastolic and end-systolic diameters and in left ventricular sphericity indices, and increases in left ventricular ejection fractions, were significantly higher in the PMR group than in the MVR-only group. This study suggests that, in patients with rheumatic mitral stenosis and preserved left ventricular systolic function, the addition of papillary muscle repositioning to valve replacement with a mechanical prosthesis improves left ventricular dimensions, ejection fraction, and sphericity index at the 18-month follow-up with no substantial undesirable effect on the surgery-related factors.

Amac: Bu calismada acik kalp cerrahisi sonrasi semptomatik perikardiyal efuzyonlu hastalarda en sik kullanilan iki cerrahi teknigin sonuclari karsilastirildi. Ca­lis­ma­ pla­ni:­ Eylul 2004 Eylul 2012 tarihleri arasinda, klinigimizde acik kalp cerrahisi yapilan 14.390 hastanin verileri retrospektif olarak analiz edildi. Toplam 152 hasta bu calismaya dahil edildi ve uygulanan tedavi yontemine gore iki gruba ayrildi. Subksifoid perikardial drenaj 86 hastaya (%56.6) (grup 1), yan torakotomi ile perikardiyal pencere acilmasi 66 hastaya (%43.4) uygulandi (grup 2). Bu hastalar icerisinde semptomatik perikardiyal efuzyon gelismis olan ve subksifoid perikardiyal drenaj veya yan torakotomi yontemi ile yeniden eksplore edilen hastalar analiz edildi. Ameliyat sirasi veriler, ameliyata bagli ve 30 gunluk hastane mortaliteleri acisindan karsilastirildi. Bul gu lar: Grup 2’de ameliyat teknigi tam bir basariya ulasmisken (%100), grup 1’de basari orani %87.2 idi (p

Background : We evaluated the vasodilatory effects of two antioxidants, vitamins C (ascorbic acid) and E (α-tocopherol), on radial artery and endothelium-dependent responses in patients awaiting coronary artery bypass surgery. Methods : The study was performed in three groups. The first group took 2 g of vitamin C orally (n = 31, vitamin C group), the second group took 2 g of vitamin C with 600 mg of vitamin E orally (n = 31, vitamins C + E group), and the third group took no medication (n = 31, control group). After baseline measurements were taken of the radial artery lumen diameter, flow volume and lumen area in the non-dominant radial artery, occlusion was maintained for five minutes with a pressure cuff placed around the arm. The measurements were taken again at the time of deflating the cuff, and 60 seconds later. The measurements were repeated after medication in two of the groups and after placebo in the third group. Results : We compared values of the vitamin C group with those of the vitamins C + E group, and found that the latter were higher than those of the vitamin C group but not statistically significant. In the control group, there was no statistical difference. Conclusion : Vitamin C or its combination with vitamin E significantly enhanced endothelium-dependent vasodilatation in the radial circulation of patients with coronary artery disease. Its combination with vitamin E was superior to vitamin C administration alone for endothelial enhancement but this difference was not statistically significant. We hypothesised that vitamin C or its combination with vitamin E may be used as antioxidants for arterial graft patency in patients undergoing coronary artery surgery.

Aim: Other techniques are required due to the negative influence of poor superficial venous system calibration (

research Objective: Arteriovenous fistulas (AVF) created for hemodialysis may be complicated by aneurysm formation. The aim of this article is to describe our experience with segmental saphenous graft interposition to treat AVF aneurysms. Material and Methods: Between June 2007 and June 2011, 23 patients who admitted to our clinic with symptoms related to single or multiple AVF aneurysms were included in the study. Under general anesthesia, the aneurysms were resected and a reverse saphenous vein graft was implanted in an end-to-end manner, after inflow and outflow of aneurysmatic fistula tract was clamped. Results: Aneurysms were secondary to brachial-cephalic fistula in 16 (69.5%) patients and radial-cephalic fistula in 7 (30.5%) patients. The mean follow-up period was 40.2±9.4 months, with a range 13 to 61 months. The saphenous vein thrombosed in 3 patients in brachial-cephalic fistula and in 3 patients in radial-cephalic fistula groups. There were no vascular complications in the remaining. Conclusion: Our results show that this method preserves AVF functions and prevents the complications of the aneurysms. Preservation techniques such as segmental saphenous graft interposition may be performed for treating functioning AVF aneurysms. Amaç: Hemodiyaliz amacıyla oluşturulan arteriovenöz fistüllerin önemli bir komplikasyonu, anevrizma gelişmesidir. Bu çalışmanın amacı anevrizma gelişmiş arteriovenöz fistüllerin safen ven grefti kullanılarak onarılmasıyla ilgili tecrübemizi aktarmaktır. Gereç ve Yöntemler: Haziran 2007 ve Haziran 2011 tarihleri arasında tek veya çoklu arteriovenöz fistül anevrizması nedeniyle kliniğimize başvuran 23 hasta çalışmaya dahil edildi. Genel anestezi altında, anevrizmatik fistül segmenti proximal ve distalden klemplenerek rezeke edildi ve yerine safen ven greft interpoze edildi. Bulgular: Anevrizmalar 16 (%69,5) hastada brakiyal-sefalik fistül, 7 (%30,5) hastada radiyal-sefalik fistüle sekonderdi. Hastalar ortalama 40,2±9,4 (13-61) ay takip edildi. Safen greft brakiyal-sefalik fistül ve radiyal-sefalik fistül gruplarında 3’er hastada tromboze oldu. Diğer hastalarda vasküler komplikasyon izlenmedi. Sonuç: Sonuçlar arteriovenöz fistül anevrizmalarının güvenle tamir edilerek fonksiyonlarının korunabileceğini ortaya koymuştur. Segmental safen greft interpozisyonu gibi koruyucu teknikler fonksiyonel arteriyovenöz fistül anevrizmalarını tedavi etmek için kullanılabilir.

Introduction: It is well known that risk for postoperative complications and need for CPAP is increased in patients undergoing coronary artery bypass surgery. Preoperative polysommography may not be performed for these patients prior to surgery due unsuitable conditions or urgency. Aim: We sought to evaluate the predictive role of Epworth and STOP BANG questionnaires on postoperative pulmonary complications. Method: Candidates for coronary artery bypass surgery consultated to chest diseases department preoperatively were enrolled to the study. Patients with higher Epworth and STOP-BANG scores were investigated for whether postoperative pulmonary complications were increased or not. Results: 61 cases were inculded to the study. Ventilatory PEEP value was higher (P Patients in STOP-BANG group 3 (score 5-8) recevied more postoperative CPAP (p=0,007) and in longer periods (P Conclusion: Sleep apnea related complications in postoperative period can be predicted in preoperative period with simple questionaires. STOP-BANG and Epworth questionnaires can be used for coronary artery bypass surgery candidates whom polysommography cannot be performed.

Despite advances in transplantation techniques and the quality of post-transplantation care, opportunistic infections remain an important cause of complications. Pneumocystis jirovecii (P. jirovecii) is an opportunistic organism, represents an important cause of infections in heart transplantation patients. Almost 2% to 10% of patients undergoing cardiac transplantation have Pneumocystis pneumonia. Prophylaxis is essential after surgery. Various prophylaxis regimes had been defined in past and have different advantages. Trimethoprim/sulfamethoxazole (TMP/SMX) has a key role in prophylaxis against P. jirovecii. Generally, although TMP/SMX is well tolerated, serious side effects have also been reported during its use. Pentamidine is an alternative prophylaxis agent when TMP/SMX cannot be tolerated by the patient. Structurally, pentamidine is an aromatic diamidine compound with antiprotozoal activity. Since it is not effectively absorbed from the gastrointestinal tract, it is frequently administered via the intravenous route. Pentamidine can alternatively be administered through inhalation at a monthly dose in heart transplant recipients. Although, the efficiency and safety of this drug is well studied in other types of solid organ transplantations, there are only few data about pentamidine usage in heart transplantation. We sought to evaluate evidence-based assessment of the use of pentamidine against P. jirovecii after heart transplantation.

compilation Manyetik rezonans görüntüleme klinik uygulamada giderek daha sık kullanılan değerli bir tanı aracıdır. Ancak, bu görüntüleme tekniğinin kullanımı, komplikasyon oranını artırdığı için, daha önceki kardiyolojik veya kardiyovasküler cerrahi girişimler sırasında metalik implant takılan hastalarda sınırlı olabilir. Teknolojik gelişmeler sayesinde bu tür cihazlar ve manyetik rezonans görüntüleme arasındaki geçimlilik oranı artmakla birlikte, beklenmedik sonuçlar ile birlikte etkileşim riski halen birçok olguda yüksektir. Bu yazıda, kanıta dayalı veriler eşliğinde, bu hasta popülasyonunda klinik uygulamada manyetik rezonans görüntülemenin güvenirliğine ilişkin pratik bir bilgi kaynağı ve rehber sunuldu. Magnetic resonance imaging is an invaluable diagnostic tool which is increasingly more frequently used in clinical practice. However, the utility of this imaging technique may be limited in patients with metallic implants placed during previous cardiologic or cardiovascular surgical interventions due to increased complication rates. Despite increased rates of compatibility between such devices and magnetic resonance imaging thanks to technological advances, the risk of interaction with untoward consequences is still high in many cases. Herein, we describe a practical source of information and guidance on the reliability of magnetic resonance imaging in this patient population in the clinical practice in the light of evidence-based data.

Background: To determine predictors of mortality after surgical management of post-infarction ventricular septal rupture repair. Methods: A total of 63 patients (73.2%, mean age 67.22±7.71 years, male:female ratio; 35:28) underwent open heart surgery for post-infarction ventricular septal rupture repair. Patient demographics, operative data and postoperative parameters were analysed to reveal predictors of early mortality and long-term survival. Results: In-hospital mortality was 54.0% (34/63). Time from myocardial infarction to operation ? 14 days (OR: 4.10, 95% CI 1.16-14.46, p=0.02), systolic pulmonary artery pressure > 45 mmHg (OR: 4.14, 95% CI 1.110-15.496, p=0.03) and age (years) (OR: 1.09, 95% CI 1.002-1.194, p=0.04) were found to be independent predictors of in-hospital mortality. In multivariate Cox regression analysis, presence of pulmonary oedema on admission (HR: 4.95, 95% CI 1.58-15.54, p=0.006), age (years) (HR: 1.09, 95% CI 1.009-1.180, p= 0.02) and cross-clamp time

Objective In this study involving a group of nurses employed in a number of different medical services with relatively well-defined working conditions, the presence and symptoms of chronic venous insufficiency were screened and their association with work burden and physical working conditions was explored. Methods Of the 294 actively employed nurses during the study period, 232 (79%) were recruited on the basis of their willingness for participation and fulfilment of the inclusion criteria. Results Among the study subjects, 62.9% had at least one symptom of chronic venous insufficiency, and 50.4% were found to have chronic venous insufficiency according to Clinical–Etiology–Anatomy–Pathophysiology classification criteria. A significant association was found between the diurnal ankle circumference difference in the left–right ankles and the mean duration of hospital stay. Conclusions Our results have shown that the average duration of hospital stay, which is among the variables used to estimate the work burden of nurses, is associated with an increased frequency of the signs and symptoms of chronic venous insufficiency.

Background: Delirium is an important morbidity following heart surgery. We sought to determine whether dopamine infusion is associated with increased risk of delirium in patients undergoing coronary artery bypass grafting. Methods: A total of 137 patients (mean age; 61.02±7.83, 105 males) were included in the study. Patients undergoing isolated coronary artery bypass grafting were considered eligible and those with preoperative neurological deficit or significant neurocognitive disorders, dementia or psychiatric disorders were excluded. Primary outcome measure was occurrence of delirium within 72 hours after operation. The diagnosis of delirium was made using confusion assessment method for the intensive care unit questionnaire. Both administration of dopamine as a dichotomised variable and the total amount of dopamine per kg body-weight were included in two different logistic regression models. Results: Delirium occurred in 18 (13.1%) patients. Age adjusted Mantel-Haenszel relative risk for delirium with receiving dopamine was 4.62. Relative risk was 2.37 (0.18 to 31.28, 95% CI, p=0.51) in total doses over 10 mg whereas it was 3.55 (1.16 to 10.89 95% CI, p=0.02) in total doses over 30 mg per kg body-weight. Older age (p=0.03), dopamine administration (OR: 9.227 95% CI, 2.688-32.022, p

Objective: We sought to reveal whether the severity of angina pectoris affects sleep quality after elective coronary artery bypass grafting. Material and methods: Patients scheduled to undergo isolated coronary artery bypass grafting were divided into two groups, having a recent myocardial infarction (Group 1, n=22, mean age 59.40±7.79 years) or not having a recent myocardial infarction (Group 2, n=30, mean age 59.73±7.72 years). The assessment included the Canadian Cardiovascular Society Angina Score, the visual analogue scale for postoperative pain and the Pittsburgh Sleep Quality Index (PSQI). Results: The two groups were similar in regard to baseline characteristics. Cross-clamp time was significantly higher (p=0.007) and the use of inotropes was significantly more common (p=0.01) in those patients with recent myocardial infarction compared to those without. Mean Canadian Cardiovascular Society scores were also higher in patients with recent myocardial infarction (p=0.02). Total Pittsburgh Sleep Quality Index score was significantly higher in patients with recent myocardial infarction (8.45±3.50 vs. 5.03±2.32, respectively, pConclusion: The severity of angina pectoris in the preoperative period is independently associated with worse sleep quality after elective isolated coronary artery bypass surgery.

Depression and mood disorders occur commonly following emergent cardiac surgery. Selective serotonin reuptake inhibitors are commonly used antidepressants. We report the development of severe hyponatremia leading to adverse clinical effects due to escitalopram and thiazide diuretic use concomitantly in a patient with depression after emergency coronary artery bypass grafting.

Cardiac valve tumors are rare, accounting for less than 10% of all primary cardiac tumors. Hemangiomas of the tricuspid valve are rarely documented in the literature. A 7 x 5 mm lesionwas determined and resected during the operation of a 17-year-old male who underwent surgery for perimembranous ventricular septal defect and documented as benign vascular proliferation; hemangioma in the pathology report. We report this case because of it’s rarity and to demostrate the importance of inspection for the lesions which can especially accompany to congenital cardiac diseases., Oldukça nadir görülen lezyonlar olan kalp kapak tümörleri kalbin primer neoplastik oluşumlarının %10 kadarını oluşturmaktadırlar. Literatürde triküspid kapakta yer alan hemanjioma oldukça nadir rastlanmaktadır. Olgumuz olan 17 yaşında erkek hasta perimembranöz ventriküler septal defekt nedeniyle opere edilirken triküspid kapağın anterior leafletinde 7 x 5 mm boyutlarında bir lezyon saptanarak eksize edilmiş ve patolojisi benign vasküler proliferasyon; hemanjiom olarak rapor edilmiştir. Bu olguyu literatürde nadir rastlanması ve özellikle konjenital operasyonlarda eşlik edebilecek patolojiler açısından inspeksiyonun önemini vurgulamak amacıyla sunmaktayız.

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