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Coronary artery vasospasm (CAVS) is a clinical entity that can cause angina, but also unstable angina pectoris, acute myocardial infarction, fatal arrhythmias, and sudden death. Although it is a condition that is usually controlled with medical treatment, more aggressive treatments may rarely be required. In this case, the patient with a known diagnosis of CAVS had multiple arrests despite optimal medical treatment. We observed that fatal arrhythmias persisted in the Implantable Cardioverter Defibrillator (ICD) records, even though we implanted a stent and gave the patient maximal medical treatment. We performed sympathectomy as a last resort and we did not detect any recurrence in the 6-month follow-up of the patient. ICD implantation and sympathectomy should always be considered in resistant CAVS cases.

BACKGROUND Powered transvenous lead extraction (TLE) tools are commonly required to remove the leads with long implant duration due to fibrotic adhesions. However, comparative data are lacking among different types of TLE tools. AIM To compare the efficacy and safety of two different rotational mechanical dilator sheaths in retrospectively analyzed patients who underwent TLE. METHODS AND RESULTS A total of 566 lead extractions from 302 patients using TightRail™ (333 lead extractions from 169 patients) and Evolution® (233 lead extractions from 133 patients) mechanical dilator sheaths were performed between July 2009 and June 2018. Acute and long-term outcomes of study groups were compared. There is no statistically significant difference between Evolution® and TightRail™ groups in procedural success (93.9% vs. 94%), clinical success (99.2% vs. 98%), and major complications (3.8% vs. 1.2%), respectively (p > .05). In multivariate regression analysis, lead dwell time, the number of extracted leads, and baseline leukocyte count were found as independent predictors of procedural success (p .05). Chronic renal disease, heart failure, and coagulopathy were shown as independent predictors of all-cause mortality in multivariate regression analysis (p

Aims There is an increasing trend evaluating the role of non-pulmonary vein (PV) triggers to improve ablation outcomes in persistent atrial fibrillation (AF) as pulmonary vein isolation (PVI) strategy alone has modest outcomes. We investigated the long-term safety and efficacy of left atrial appendage isolation (LAAi) in addition to PVI using cryoballoon (CB) in persistent AF. Methods and results In this multicentre retrospective analysis, we included a total of 193 persistent AF patients (mean age: 60 ± 11 years, 50.3% females) who underwent PVI and LAAi using CB. Baseline and follow-up data including electrocardiography (ECG), 24 h Holter ECGs, and echocardiography were recorded for all patients. Atrial tachyarrhythmia (ATa) recurrence was defined as the detection of AF, atrial flutter, or atrial tachycardia (≥30 s) after a 3-month blanking period. At a median follow-up of 55 (36.5–60.0) months, 85 (67.9%) patients with PVI + LAAi were in sinus rhythm after the index procedure. Ischaemic stroke/transient ischemic attack occurred in 14 (7.2%) patients at a median of 24 (2–53) months following catheter ablation. Multivariate regression analysis revealed heart failure with preserved ejection fraction [hazard ratio (HR) 2.29, 95% confidence interval (CI) 1.04–5.02; P = 0.038], male gender (HR 0.53, 95% CI 0.29–0.96; P = 0.037), and LA area (HR 1.04, 95% CI 0.53–1.32; P = 0.023) as independent predictors of ATa recurrence. Conclusion Our findings demonstrated that the LAAi + PVI strategy using CB had acceptable long-term outcomes in patients with persistent AF. Systemic thrombo-embolic events are an important concern throughout the follow-up, which were mostly observed in case of non-adherence to anticoagulants.

We aimed to present the long-term prognostic role of coronary computed tomography angiography (CTA) in a cohort of patients with coronary artery disease (CAD) and noncritical stenosis. A total of 1138 patients who underwent coronary CTA for suspected CAD were included in the study. For the categorization of the coronary atherosclerotic plaque (CAP), the coronary system was divided into 16 segments. For each segment, CAPs were categorized as calcified, noncalcified, and mixed. All-cause and cardiovascular (CV) mortality data were collected for prognostic evaluation. Coronary CTA analyses showed that 34.5% of patients had noncalcified CAP, 14.5% of patients had calcified CAP, and 11% of patients had mixed CAP. During a median of 141.5 months follow-up, CV and all-cause mortality was observed in 57 (5%) and 149 (13.1%) patients, respectively. In multivariable Cox regression analysis, calcified CAP morphology and the extent of involved segments were significant predictors of both CV and all-cause mortality. The presence of calcified CAP morphology and the higher number of diseased coronary segments via coronary CTA might help stratify patients at risk for adverse CV outcomes during long-term follow-up. Patients with these features at index coronary CTA may be evaluated more closely with aggressive preventive measures.

Septal reduction therapy is recommended in patients with obstructive hypertrophic cardiomyopathy (HCM) who remain symptomatic under maximally tolerated optimal medical treatment. Alcohol septal ablation is a favorable option, especially in patients with high surgical risk or who refuse surgery. Alcohol; causes scar-related ventricular arrhythmias and advanced heart blocks more frequently than surgical myectomy. Therefore, novel, safer agents are required for percutaneous septal ablation therapy. All the patients who underwent percutaneous septal ablation between January 2017 and June 2021 with polidocanol because of ongoing symptoms related to HCM despite maximally tolerated medical treatment were enrolled. Data were obtained retrospectively from the hospital electronic database. A total of 28 patients were included. Median age was 61 years (43.5-67), and 19 (67.8%) patients were male. Most of the patients underwent index procedures; however, only 2 cases had history of previous septal ablation. Median follow-up was 3.5 months (0.25 to 12.25). Median left ventricular outflow tract (LVOT) gradient at rest was 68.5 (37-80) mm Hg, and after Valsalva maneuver median LVOT gradient was 95.5 (75-125) mm Hg. Median volume of polidocanol used in procedures was 2 (2-3.37) ml, and mean procedure time was 28.1 ± 2.5 minutes. LVOT gradient invasively measured was significantly reduced (mean 76.5 mm Hg vs mean 30 mm Hg; p 0.001) immediately after the septal ablation. Conduction defects developed in 18 patients (64.2%); however, de novo permanent cardiac implantable electronic device implantation was required in only 4 (14.3%) cases. Leakage of polidocanol and mortality did not occur in any cases. Pericardial effusion developed in only 1 case, and it resolved with medical treatment. After mean 3.5 months follow-up, both LVOT gradient and New York Heart Association functional class parameters were better than baseline values. In conclusion, polidocanol is a safe and effective agent for septal ablation in patients with HCM. Outcomes and complication rates are similar with alcohol septal ablation.

Background Transcatheter aortic valve implantation (TAVI) has become the standard of care treatment in patients with severe aortic stenosis who carry intermediate or high risk for surgical aortic valve replacement. Mitral annular calcification (MAC) is frequently seen in patients with aortic stenosis and it is associated with increased cardiovascular morbidity and mortality. It is reported that MAC is an independent predictor of all cause mortality after TAVI. Aim The aim of this study is to both evaluate the relationship between mitral annular calcification and TAVI related complications and mortality; and to define the predictors of both all cause mortality and permanent pacemaker implantation after TAVI. Methods All of the patients who underwent TAVI procedure due to severe aortic stenosis between 01.01.2020 and 01.06.2020 in our University Hospital were screened and patients fullfilling including criterias were enrolled. Patients' baseline demographic datas, laboratory, echocardiography and TAVI procedure related parameters were recorded. Outcomes are identified as follows; association between mitral annular calcification and TAVI related complications, establishment of the predictors of all cause mortality and permanent pacemaker implantation, definition of the in-hospital and all cause mortality rates. Results A total of 245 patients including 98 males (40%) and 147 females (60%) were enrolled in the study. The mean age of the population was 76,3±8,3 years. The mean left ventricular ejection fraction was % 54,8±11,4; aortic valve area was 0,74±0,14 cm2 and mean aortic transvalvular gradient was 47,0±14,3 mmHg. MAC was detected in 148 (% 60,4) patients (Table 1). In-hospital mortality was occurred in 14 (5,7%) cases. Permanent pacemaker implantation was performed in %17,8 (n=42) patients and all cause mortality was developed in 89 (36,3%) cases during the median 23,1 (11,6–44,3) months follow-up. Pericardial effusion (26,4% vs 12,4%; p=0,013) and contrast induced nephropathy (21,6% vs 7,2%; p=0,005) were developed more frequently in patients with MAC than without MAC (Table-2). Only the presence of MAC extending to left ventricular outflow tract was detected to be independent predictor of permanent pacemaker implantation requirement (HR: 3,32; p=0,002). All cause mortality predictors were established as; use of renin-angiotensin-aldosterone system blockers (HR: p=0,012), level of hemoglobin (HR: 0,79; p=0,006), severe mitral annular calcification (HR: 1,94; p=0,024) and atrial fibrillation development after TAVI (HR: 2,39; p=0,002). There was not any correlation between aortic valve area and MAC vloume (r=0,03; p=0,689), MAC Hounsfield Unit (r=−0,007; p=0,934) and MAC Agatston score (r=−0,08; p=0,290). Discussion MAC is associated with all cause mortality after TAVI and MAC extending to left ventricular outflow tract is an independent predictor of permanent pacemaker implantation requirement. Funding Acknowledgement Type of funding sources: None.

Background/Introduction Covid-19 disease, which affects more than 128 million people worldwide, has caused changes in lifestyle and physical activity habits in patients with cardiovascular disease due to lockdown restrictions. During the pandemic period, patients with chronic diseases (also patients with comorbidities) cannot participate in physical activity and exercise programs due to social isolation. Purpose The aim of our study is to investigate the relationship between the comorbidities of heart rhythm disorder patients and their physical activity levels and kinesophobia in the Covid-19 pandemic. Methods 105 individuals (54 healthy adults, 51 patients with heart rhythm disorders) were included in this study. Physical Activity Level: Physical activity level was evaluated using the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Fear of Movement: Fear of movement was evaluated using the Tampa Scale of Kinesiophobia for Heart. The Comorbid Conditions: The comorbid conditions of the patients were evaluated by the Charlson comorbidity index. Results Table 1. In patients with heart rhythm disorders, there was a negative, moderate correlation between the Charlson comorbidity index and the number of daily steps (r=−402, p=0.03), while a positive, moderate relationship with the Charlson comorbidity index and Tampa score (r=391, p=0.05) has been found. Conclusion While the Charlson comorbidity index value and Tampa Score were higher in patients with heart rhythm disorders than in the control group, the number of inactive patients among the subgroups of the IPAQ-SF scale was higher than the control group. While heart rhythm disorders patients with more comorbidities are more prone to develop kinesiophobia, the number of daily steps decreases in the same direction. Management of comorbidities of patients with heart rhythm disorders can be provided by physical activity counseling to these people. Funding Acknowledgement Type of funding sources: None.

Objectives Superficial femoral artery (SFA) is the most commonly effected vessel in peripheral arterial disease (PAD) and SFA total occlusions constitute the 50% of PAD patients presenting with symptoms. In this study, we investigated our patients with SFA total occlusions who were treated with percutaneous treatment strategy. Methods In this study, we included ambulatory patients who were admitted to our clinics due to symptomatic severe SFA total occlusion and underwent PTA or PTA + stenting procedure.The demographic findings of the patients, procedure details, complications and follow-up results were noted. Results Out of 67 patients, 62 (92.5%) underwent PTA or PTA + stenting procedure successfully for SFA total occlusions. Only one serious complication, acute renal failure resulting in death developed during hospitalization. The mean follow-up time after the procedure was 11.1±7.2 months. During this follow-up time 36 (58.1%) were asymptomatic. Out of 26 patients who were symptomatic, only 6 of them underwent reintervention and 3 were recommended surgical intervention. Conclusion Peripheral interventions for SFA total occlusions are being performed successfully in experienced centers with low complication rates as the first treatment strategy in PAD. Herein,we have presented our patients who underwent successful PTA and/or stenting procedure with high success and low complication rates. Peripheral interventions should be the first choice for SFA total occlusions in experienced centers.

Objectives The effectiveness of carotid artery stenting (CAS) for primary and secondary prevention of ischemic stroke has been demonstrated in many studies. In this study, we aimed to present the characteristics and post-procedural clinical outcomes of the patients admitted to our clinic with severe carotid artery disease and revascularized by carotid artery stenting (CAS) with distal embolic protection system. Methods This study was a single- center retrospective study. Between Jan 2015 and May 2017 patients undergoing CAS procedure were included in the study. Symptomatic cases with more than 50% stenosis and asymptomatic patients with more than 70% stenosis were included in the study. Results Twenty-five patients were included in the study. 68% of patients were male with a mean age of 69.3 ± 15.7 years. 92% of patients were symptomatic. In all patients, distal embolic protection devices and self-expandable carotid stents were used. All procedures were performed successfully. No mortality or myocardial infarction was observed in any of the patients in whom CAS was applied successfully. Five complications were seen related to the procedure. One patient had air embolism, one patient had transient ischemic attack, one patient had stroke, one patient had symptomatic nodal rhythm and the last patient had hyper-perfusion syndrome. Conclusion CAS is being successfully applied with acceptable complication rates in experienced centers.

AimsPulmonary vein isolation (PVI) alone in persistent atrial fibrillation (AF) is not as successful as in paroxysmal AF, and recent data indicate the key role of non-PV triggers. We aimed to assess the long-term safety and efficacy of left atrial appendage isolation (LAAi) as an adjunct to PVI using cryoballoon (CB) in persistent AF.Methods and resultsWe compared 144 persistent AF patients (59 ± 10 years, 51% females) who underwent PVI combined with LAAi with a propensity-score matched cohort of 138 persistent AF patients (59 ± 6 years, 52% female) in whom PVI-only was performed. Baseline and follow-up data including electrocardiography (ECG), 24-h Holter ECG’s, and echocardiography were recorded for all patients. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (≥30 s) after a 3-month blanking period. At a mean of 30.5 ± 5.6 months follow-up, 85 (61.6%) patients in the PVI-only group and 109 (75.7%) patients in the PVI+LAAi group were free of ATa after the index procedure (P = 0.008). Ischaemic stroke/transient ischaemic attack was detected in 4 (2.9%) patients in PVI-only group and in 5 (3.5%) patients in the PVI+LAAi group (P = 0.784). Cox regression analysis revealed that the PVI-only strategy was found as a significant predictor for recurrence (hazard ratio 3.01, 95% confidence interval 1.81–5.03; P ConclusionsOur findings indicated that CB-based LAAi+PVI was associated with a favourable efficacy compared to PVI-only strategy in patients with persistent AF. Although ischaemic event rates were similar between the groups, rigorous adherence to anticoagulation regime is paramount in order to prevent thrombo-embolic complications.

Objective: Cryoballoon (CB) ablation is a safe alternative to radiofrequency ablation in the treatment of atrial fibrillation (AF). However, phrenic nerve damage (PND) is a bothersome complication of the procedure. In this study, we aimed to establish the incidence of PND during CB and define the characteristics of affected patients. Material & Methods: In this retrospective analysis, all patients with AF that underwent CB ablation between 2013 and 2018 were included into the study. Characteristics and outcomes of patients complicated with PND were evaluated. PNP was detected by palpation of diaphragma contractions or observation of reduced diaphragma motility by fluoroscopy during the procedure. Results: Totally 653 patients were included in the study. PND was detected in 3.5% (23/653) of the patients. Median age of the patients with PNP was 56 (25-78) years and 10 patients (43.4 %) were male. The most common ablation site related with PND was RSPV (18 patients, 78%). Transient PND was observed in 16 patients (69%) of the patients which resolved within 24 hours after the procedure. In the remaining 5 patients (21%) diaphragmatic contraction was recovered at the 6th month control visit. In 2 patients (10%), phrenic nerve paralysis was still present >1 year visit Conclusion: PND is not a rare complication of CB ablation despite all the preventive maneuvers during the procedure and technological developments. However, most of the PND recovered during the follow-up.

Background We aimed to determine the ideal surgical timing in the first 24 hours after admission to the hospital of pediatric supracondylar humerus fractures (SHF) that do not require emergent intervention. Materials and Methods Patients who underwent surgery in our institution between January 2011 and January 2019 due to pediatric Gartland type 3 SHFs were evaluated retrospectively. Open fractures, fractures associated with vascular injury and compartment syndrome, flexion type fractures were excluded. A total of 150 Gartland type 3 were included. The effect of early (12 hours) surgical interventions, daytime or night-time surgeries, working or non-working hour surgeries on operative parameters (operative duration and open reduction rate, reduction quality on postoperative early radiographs) were evaluated in pediatric SHFs. Results Early (12 hours), daytime or nighttime, working or non-working hour surgeries were found to be similar in Gartland type 3 patients regarding early postoperative reduction quality, duration of surgery, open reduction rate (p>0.05). Mean times passed from first admission to hospital until surgery were longer in working hour, late (>12 hours) and daytime surgery groups than non-working hour, early ( Conclusion Although delaying the operation to the working hours seems to prolong the time until surgery in pediatric Gartland type 3 SHF patients who do not require emergent intervention such as open fractures, neurovascular impairment and compartment syndrome, there may not be a time interval that makes a difference for the patients if surgery is performed within the first 24 hours, thus the surgery could be scheduled according to the surgeons’ preference. Level of Evidence: Level 3, Retrospective cohort study

Background Revision knee arthroplasty (RKA) is associated with low hemoglobin (Hb) levels after surgery, which results mostly from perioperative blood loss. Periprosthetic joint infection (PJI) is one of the common reasons for RKA. This study aimed to determine whether low Hb levels affect the healing process of PJI. Methodology This retrospective study included 69 patients who underwent two-stage revision for PJI between 2013 and 2016. Patients were divided into two groups according to the latest Hb levels (Hb < 10 and Hb > 10 g/dL) during hospitalization for the first-stage revision surgery. Laboratory parameters of infection were measured during the cement spacer retention period: C-reactive protein (CRP), sedimentation rate (SEDIM), and white blood cell (WBC) count. Treatment was evaluated in two periods: cement spacer retention period (between the first surgery and second surgery) and the first normal CRP period (between the first surgery with the first normal CRP level during the cement spacer retention period). Infection parameters in the two time periods and reoperation with cement spacer were compared between the groups. Results The mean patient age was 67.3 ± 7.94 (50-87) years, and the female-to-male ratio was 4:1. No difference was found in the postoperative first control CRP, SEDIM, and WBC between the groups (p = 0.953, p = 0.3341, and p = 0.444, respectively). CRP-SEDIM control curves were observed in parallel, and no significant difference was found. The cement spacer retention period was 60.3 ± 24.8 (17-123) days, and the first normal CRP period was 87.3 ± 28.4 (14-161) days; no statistical difference was found between the groups (p = 0.727, p = 0.754). Conclusions In RKA, as low Hb level was not a negative factor of infection, blood transfusion should be avoided as it has many complications.

Purpose Cryoballoon (CB) and radiofrequency (RF) ablation techniques have similar outcomes for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). However, there is limited data about the impact of different ablation strategies in patients with left common pulmonary vein (LCPV). Our aim was to compare the safety and efficacy of RF and CB ablation in AF patients with LCPV. Methods One hundred and twenty-seven (n = 80 CB and n = 47 RF) AF patients with LCPV detected by preprocedural computerized tomography (CT) were included in the study. Ostial dimensions and trunk distance were measured in all patients. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (>= 30 s) after a 3-month blanking period. Results There was no significant difference in acute procedural success rates for PVI (97.5% in CB and 97.9% in RF, respectively, P = 0.953) and complication rates were similar between the groups (6 (7.5%) in CB and 4 (8.5%) in RF, respectively, P = 1.000). During a median follow-up of 20.7 (4.8-50.2) months for CB and 20.5 (6.2-36.0) months for RF, ATa recurrence was 35.0% and 38.2%, respectively (P = 0.777). Multivariate analysis did not reveal any of the morphologic parameters of LCPV as a significant predictor of ATa recurrence. Conclusions Our findings demonstrated that both CB and RF ablation techniques have similar efficacy and safety in AF patients with LCPV during the mid-term follow-up.

Background The presence of atrial fibrosis has already been known as a risk factor for atrial fibrillation (AF) development. Objective We aimed to evaluate atrial fibrosis with previously defined three different methods, which were cardiac magnetic resonance imaging (C-MRI), echocardiographic strain imaging, and biomarkers, and show the relationship between these methods, in patients with AF scheduled for cryoballoon ablation. Method 30 patients were enrolled. Atrial T1 relaxation durations were measured using C-MRI before the procedure of atrial fibrillation catheter ablation. Fibroblast growth factor-21 (FGF-21) and fibroblast growth factor-23 (FGF-23) levels were measured at serum derived from the femoral artery (Peripheral FGF 21 and 23) and left atrium blood samples (Central FGF 21 and 23) before catheter ablation. Preprocedural transthoracic echocardiography was performed. The Median follow-up duration for atrial tachyarrhythmia (ATa) recurrence was 13 (12-18 months) months. Results The mean ages of the study group were 55.23 ± 12.37 years and there were 17 (56.7%) female patients in study population. There were negative correlations between post contrast T1 relaxation durations of both posterior and posterosuperior atrium, and central FGF-23 (r:-0.561; p=0.003; r:-0.624; p=0.001; Posterior T1 vs central FGF-23 levels and Posterosuperior T1 vs central FGF-23 levels respectively). The positive correlations were observed between postcontrast posterior T1 relaxation durations and left ventricle ejection fraction (r:0.671; p=0.001); left atrial emptying fraction (r:0.482; p=0.013); peak atrial longitudinal strain (r:0.605; p=0.001), and peak atrial contraction strain (r:0.604; p=0.001). Also negative correlation was observed between postcontrast posterior T1 relaxation durations, and left atrial volume index (r:-0.467; p=0.016). Conclusion Our studies showed that there are correlations between T1 mapping of atrial tissue, biomarkers, and atrial mechanics evaluated with transthoracic echocardiography. Our findings are significant as they demonstrate the compatibility of these techniques for the atrial fibrosis evaluation.

Background: As subtrochanteric femoral osteotomy extends the operating time and increases bleeding, it is a complex surgical procedure, which exposes the patient to complications. The aim of this study was to describe the controlled femoral cracking method as a safely reduction method and to present the results of this method used in hip arthroplasty without femoral osteotomy in high dislocated hip.Methods: A retrospective examination included 40 Crowe III/IV patients for whom shortening was not planned preoperatively. Femoral osteotomy was planned for Crowe III/IV patients who were expected to have >4cm lengthening according to the preoperative templating. Patients were evaluated in respect of functional results, limb length discrepancy (LLD) and complications. Of the 40 patients applied with surgery without shortening, controlled femoral cracking was required in 20 cases, and no additional procedure was required during reduction in 20 cases. The patients applied with controlled femoral cracking were evaluated in respect of functional results, operating time, actual LLD and complications.Results: The patients comprised 3 males and 37 females with a mean age of 53.7±9.54 years. The mean follow-up period was 38±6.54 months (range, 24-66 months). The Harris Hip Score (HHS) was mean 45.96 preoperatively and 89.44±6.4 (range, 84-99) postoperatively. LLD was determined as 3.4±0.7cm preoperatively and 0.7±0.5 cm (range, 0-2 cm) postoperatively (pConclusion: In patients where more than 4 cm of lengthening is not expected preoperatively, arthroplasty can be successfully managed without a shortening femoral osteotomy. The controlled femoral cracking technique is safe, does not increase LLD or nerve palsy rate, and shortens operating time with less blood loss.

Background: Developmental hip dysplasia (DDH) is shown to have osseous and neural abnormalities but literature is sparse with investigation of vascular structures. Therefore, we aimed to evaluate periacetabular vascular structures. Methods: By computerised tomography angiography (CTA), 13 highly dislocated hips of 11 patients’ iliac bone to external iliac and obturatory artery and vein proximities were measured and compared with the same measurements of 20 healthy hips of 12 patients. Numbering from superior to inferior, a total of 7 axial images were created on the 2D CTA coronal images with 1 cm apart, the 4th being at the level of acetabular dome. Results: The mean age of the patients was 53 (18–72) years. Dysplastic hips tended to have curved (53%) and healthy hips tended to have straight iliac arteries ( p = 0.037). As compared to healthy hips, external iliac veins were significantly closer to the bone at all levels, but the external iliac arteries were closest at 1st to 4th levels ( p Conclusions: The external iliac artery and vein is in close proximity to the iliac bone which dangers acetabular screw, acetabular reaming or retractor placement in highly dislocated hips. The surgeon should be aware of this proximity in operations of these hips to avoid vascular complications.

BACKGROUND: We aimed to evaluate the cost and consequences of failed osteosynthesis of intertrochanteric femur fracture (ITFF) patients and compare with primary ITFF patients. METHODS: We retrospectively evaluated 689 patients who underwent surgery due to ITFF via cephalomedullary nail. 31 patients (5.8%) had revision surgery because of osteosynthesis failure of ITFF. Each revision case included in the study was matched with four primary ITFF cases as control group based on age, gender, year of operation, type of fracture and American Society of Anesthesiologists (ASA) grade. Total cost for the admission that patients underwent surgery, mortality rate at first year, infection rate, length of stay at hospital, length of stay at intensive care unit, and erythrocyte transfusion amounts were recorded from hospital registry records. Tip apex distances (TAD) were noted. RESULTS: The mean total cost of the revision cases and primary cases was 10,027 ± 6387 and 5261 ± 1773 Turkish Liras, respectively (p

Background/Aim: Among all orthopedic injuries, hip fractures continue to have high morbidity and mortality. While the epidemiological features of proximal femoral fractures (PFF) have often been defined, there are studies which examine the relationship between the complications of the types of PFF and mortality. The aim of this study was to determine the frequency of PFF types and investigate the relationship between complications of subtypes and mortality. Methods: This study included 380 patients aged >40 years who underwent surgery for a PFF. The fractures were classified according to localization as intertrochanteric femur fracture (ITFF), femoral neck fracture (FNF) and subtrochanteric fracture (STF). Patient demographic data (age, gender, comorbidities) were recorded, and modified Charlson comorbidity scores were calculated. Major surgical complications (infection, dislocation, implant failure) were defined as those requiring additional surgery, and minor surgical complications (cellulitis, wound site problems, pressure sores, deep vein thrombosis) as those not requiring surgery. Mortality rates were examined at 1, 3 and 12 months postoperatively. The fracture subtypes were compared with respect to surgical complications (major and minor), non-surgical complications and mortality rates. Mortality risk factors were determined according to final mortality status. Results: The patients included 235 females and 136 males (F/M=2/1) with a mean age of 78.5 (12.1) years. Three hundred and thirty (86.5%) patients were aged >65 years and 50 (13.5%) were aged

Background Diabetes is related with both AF occurence and increased thromboembolic risk. There is scarce data about the outcomes of AF catheter ablation in patients with diabetes. Purpose We aimed to evaluate outcomes of AF catheter ablation in patients with diabetes. Methods All patients underwent AF cryoablation between January 2013 and January 2018 were included . Results A total of 493 patients were enrolled. Mean age was 59.6 ± 11.8 years and 253 (51.3 %) patients were female. Median follow up time was 28 (6-59) months. Recurrence occured in 61 (12.4%) patients. Diabetes was present in 78 (16%) cases. Mean HbA1c value of the diabetic patients was 6.79 ± 1.02 %. 50 (64.1 %) patients was under treatment with only oral antidiabetics while others were using insulin. Diabetic group was older (p Conclusion Recurrence and complication rates were similar between diabetic and non-diabetic patients. Despite neuropathy is a well known manifestation of diabetes; phrenic nerve damage rate is similar in diabetic patients with non-diabetic counterparts. Table-1 Diabetic group (n = 78) Non-diabetic group (n = 415) p value Age, (years) 64.38 ±10.12 58.91 ±11.84

Background Electrical storm (ES) is defined as 3 or more episodes of sustained ventricular tachycardia (VT) within 24 hours and related with high mortality rates. Catheter ablation is an effective treatment option in patiens with ES. Purpose We aimed to evaluate outcomes of VT catheter ablation in patients with ES. Methods All patients who underwent catheter ablation due to VT ablation between June 2014 and November 2018 were screened and outcomes of patients who admitted with ES were evaluated. Results A total of 128 patients were included. 52 (40.6%) patients were admitted with ES. Mean age of the patients with ES was 68 ± 10,5 years and 48(92,3) patients were male. Median follow up was 22.5 (8-46) months. Baseline characteristics were listed in Table- 1.Multivariate regression analysis revealed that hemoglobin level (HR:0.76, CI:0,61-0,94, p = 0.011 ) and antiarrhythmic drug use (HR:0.25, CI:0,10-0.62, p = 0.003) were predictors of ES development. Recurrence rates and number of re-do ablation procedures were significantly higher in patients with ES (Table-1). Cardiovascular and all cause mortality rates were also significantly higher in patients with ES (Table-1). Conclusion Despite catheter ablation is an effective treatment in patients with ES; presence of ES is related with increased mortality and recurrence rates after ablation. Table-1 Patients with ES Patients without ES p value Age, years 68 ± 10,5 63,8 ± 8,8 0,017* Gender, male, n (%) 48(92,3) 72(94,7) 0,853 Hypetension, n (%) 34(65,4) 59(77,6) 0,158 Diabetes, n (%) 17(32,7) 18(23,7) 0,314 Previous PCI 32(61,5) 51(67,1) 0,574 NYHA >II 17(32,7) 13(17,1) 0,044* LV EF, (%) 27,8 ± 8 29,1 ± 8,3 0,369 LV EDD, mm 64,6 ± 9,1 63,3 ± 8,2 0,431 Hemoglobin, g/dL 13,0 ± 2,1 14,1 ± 1,6 0,002* BNP level (pg/mL) 461(35-3161) 244(10-4517) 0,008* Recurrence 23(44,2) 21(27,6) 0,050* Re-do ablation 0,050* 8(10,5) 0,010* Cardiovascular mortality 16(34,8) 12(16,9) 0,045* All cause mortality 22(42,3) 17(22,4) 0,020* Baseline characteristics and outcomes of catheter ablation in patients with and without ES

Background Ablation of ventricular tachycardia (VT) is an effective and safe treatment option in symptomatic patients under antiarrhythmic drugs or patients with frequent ICD therapies. Purpose We aimed to evaluate outcomes of VT catheter ablation in patients with ischemic VT. Methods All of the patients who underwent VT catheter ablation between June 2014 and November 2018 were included. Results 128 patients (120 male, 8 female) were included and mean age was 65 ± 10 years. Mean ejection fraction was 28.6 ± 8.2 %. Baseline characteristics were listed in Table-1. Mean follow-up was 22.3 ± 6.4 months. 52 (46.6 %) patients were admitted with electrical storm. Acute success rate was 96.6%. Complications including transient ischemic attack, deep venous thrombosis, pericardial effusion and inguinal hematoma were developed in 6 patients. Recurrence of VT was occured in 44 (34.4 %) patients and the presence of PCI history and admission with electrical storm were predictors of recurrence. All cause mortality was occured in 39 patients and predictors of all cause mortality was detected as follows; diabetes, NYHA stage >2, lower levels of EF and higher BNP levels. Cardiovascular mortality was developed in 28 patients and predictors were defined as, lower levels of EF, higher BNP levels and number of shock after index ablation. VT recurrence was not found to be related with both cardiovascular and all cause mortality. Conclusion VT ablation is a safe and effective option in patients with ischemic VT who are symptomatic despite optimal medical treatment. Admission with electrical storm and history of PCI were predictors of VT recurrence after ablation. Higher levels of BNP, lower EF values are related with both all cause and cardiovascular mortality. Table-1 Gender, male, (%) 120(93,8) Age(year) 65,5 ± 9,7 HT 93(72,7) DM 35(27,3) AF 41(32,0) NYHA class(pre-ablation) IIIIII IV 71(55,5)27(21,1)25(19,5) 5(3,9) Previous PCI 83(64,8) Previous Cardiac surgery CABG AVR MVR 72(56,3) 70(54,7 1(0,8) 4(3,1) LV EF (%)≤3031-40 ≥41 28,6 ± 8,290(70,3)28(21,9) 10(7,8) Electrical storm 52(40,6) LV EDD (mm) 63,8 ± 8,5 Baseline characteristics

Purpose:Total hip arthroplasty (THA) for high-riding hips is a complex procedure and the requirement for subtrochanteric osteotomy (STO) is an important decision that needs to be taken preoperatively. STO renders this complex surgery even more complicated and there are no guidelines to determine the STO requirement. In this study, the outcomes of THA for patients with high-riding hips were evaluated and a practical classification system is proposed to predict any osteotomy requirement.Methods:A retrospective evaluation was made of 79 hips of 76 patients who underwent THA for high-riding hip dysplasia. The amount of shortening in patients with STO and in patients without STO was compared. All patients were evaluated in respect of Harris hip score, operating time, erythrocyte suspension need, and actual limb length discrepancy. Preoperative radiographs were classified into four types according to the ratio of the distance between the lesser trochanter and the ischial tuberosity with pelvic height (LT-IT/P) to grade the degree of dislocation.Results:The mean follow-up was 30 ± 6.54 months. STO was applied to 47 (60%) hips and not to 32 (40%). There was no statistically significant difference between the groups in respect of the functional scores. STO prolonged the operating time and increased the need for blood transfusion ( p = 0.026, p < 0.001, respectively). When the LT-IT/P index was 0.3 (type 3), a shortening osteotomy will most likely be required. The rate of complications is increased if LT-IT/P is >0.4 (type 4).Conclusion:STO adjunct to THA increases the rate of complications. This practical classification system may guide the surgeon in the decision of whether an STO should be added to the procedure or not.Level of evidence:Level III, clinical trial

Objectives This study aims to describe a retrospective study using prospectively gathered data to compare mini-open and extended open release techniques for moderate to severe carpal tunnel syndrome (CTS). Patients and methods The data of 198 consecutive patients (139 males, 59 females; mean age 57.0±4.5 years; range, 44 to 75 years) treated for CPS were used. For matching, age, gender and severity of the compression, the Greathouse Ernst Halle Schaffer neurophysiological classification system was used. After matching, 63 observations in each group (group 1: mini-open and group 2: extended open) were used for analysis. A Jamar hydraulic hand dynamometer was used to measure pre- and postoperative third month grip strengths. The key pinch test was performed also at third month. Patients completed the Boston Carpal Tunnel Questionnaire at the last follow-up. Results Symptom severity and functional status were improved up to half fold in both groups at final follow-up; however, there was no statistically significant clinical difference between the groups (p>0.05). There were totally six patients with paresthesia symptoms (three in each group; 4.7%), which improved in three months. Eight patients (6.3%, one in group 1 and seven in group 2, p=0.032) had dysesthesia and pillar pain. Conclusion Mini-open and extended open carpal tunnel release have similar clinical outcomes without any major complications.

Background In the existing classifications, no importance is given to dislocations accompanying ankle fractures. The present study aims to investigate differences in injury mechanisms of ankle fractures with concomitant dislocation injury in respect of functional outcomes and complications. Methods A retrospective evaluation was carried out of 285 patients who underwent surgery in our clinic for an ankle fracture between January 2012 and December 2018. A comparison was made of functional scores and complications between the patients with ankle fracture with dislocation (AF-D group) and patients with ankle fracture without dislocation (AF-WD). The correlation of dislocation with current classifications (Lauge-Hansen and Danis-Weber) and the effects on functional outcomes were also evaluated. In addition to functional scores, a record was also made for each patient of infection during follow-up, soft-tissue defect, malalignment, non-union, arthrosis and Reflex Sympathetic Dystrophy Syndrome (RSD). Results The mean age of the patients was 44.7±12.04 years (range, 18-72 years) and the mean follow-up period was 3.2 years. Ankle fracture with dislocation was observed in 88 (30.8%). Similar functional results were determined in the AF-WD and AF-D groups with mean AOFAS 84.05±10.5, and 80.33±9.47, respectively (p=0.379), and mean VAS scores of 1±0.5 and 1.23±0.48, respectively (p=0.117). When the AOFAS values of the dislocation function results were evaluated according to the Lauge-Hansen and Danis-Weber subgroups, no significant difference was observed (p=0.562, 0.723). Arthrosis was seen in two of the AF-WD group and seven of the AF-D group (p=0.004). RSD was determined in two of the AF-WD group and in 10 of the AF-D group (p=0.000). From a medico-legal perspective, patients should be informed about arthrosis, and RSD is another significant problem encountered in this patient group. Conclusion Although dislocation accompanying ankle fracture was not seen to worsen functional results, arthrosis and RSD were determined more often in these patients.

BACKGROUND: The success of platelet rich plasma (PRP) applications in conservative treatment of moderate gonarthrosis has increased over time. Two different PRP formulations that buffy coat (Leukocyte rich PRP: LR-PRP) and plasma-based (Leukocyte poor PRP: LP-PRP) are obtained by different centrifugation methods. This prospective randomized trial was whether LP-PRP will be more effective combination for moderate gonarthrosis when compared to LR-PRP or HA. METHODS: A total 90 patients suffering from moderate knee osteoarthritis were enrolled. Patients were divided equally into three groups and treated with 3 times LR-PRP, LP-PRP and HA injections. A prospective evaluation was done at baseline, and then at 2, 6 and 12 months of follow-up using VAS, WOMAC and Likert scoring systems. RESULTS: The 2nd, 6th and 12th month VAS and WOMAC scores of LR-PRP demonstrated the most obvious improvement. Recurrence of symptoms was statistically lower (3; 10%) in LR-PRP group (p

Background Cryoballoon (CB) ablation is a safe alternative to radiofrequency ablation in the treatment of atrial fibrillation (AF). However, phrenic nerve damage (PND) is a bothersome complication of the procedure. Purpose In this study, we aimed to establish the incidence of PND during CB and define the characteristics of affected patients. Methods In this retrospective analysis, all patients with AF that underwent CB ablation between 2013 and 2018 were included into the study. Characteristics and outcomes of patients complicated with PND were evaluated. PND was detected by palpation of diaphragma contractions or observation of reduced diaphragma motility by fluoroscopy during the procedure. Results Totally 653 patients were included in the study. PND was detected in 3.5% (23/653) of the patients. Median age of the patients with PNP was 56 (25–78) years and 10 patients (43.4%) were male. The most common ablation site related with PND was right superior pulmonary vein (RSPV) (18 patients, 78%). Transient PND was observed in 16 patients (69%) of the patients which resolved within 24 hours after the procedure. In the remaining 5 patients (21%) diaphragmatic contraction was recovered at the 6th month control visit. In 2 patients (10%), phrenic nerve paralysis was still present >1 year visit. Table 1. Baseline characteristics of patients with PND Age (years), median (min–max) 56 (25–78) Gender, n (male %) 10 (43.4%) Hypertension, n (%) 9 (39.1%) LA (mm), (mean ± sd) 38.5±5.8 EF (%), (mean ± sd) 60.8±6.5 Structrual heart disease, n (%) 3 (0.13%) – HCMP 2 (0.087%) – DCMP 1 (0.043%) DCMP: Dilated cardiomyopathy; HCMP: Hypertrophic cardiomyopathy; EF: Ejection fraction; LA: Left atrium; PND: Phrenic nerve damage. Conclusion PND is not a rare complication of CB ablation despite all the preventive maneuvers during the procedure and technological developments. However, most of the PND recovered during the follow-up.

The efficacy of cryoballoon (CB) for atrial fibrillation (AF) ablation is still debatable in case of anatomical variations like left common pulmonary vein (LCPV). We aimed to assess the impact of LCPV trunk on the acute and long-term clinical outcomes in patients with CB based AF ablation. We compared a total of 82 AF patients (62.5% paroxysmal and 37.5% persistent) who underwent pulmonary vein isolation using CB (LCPV+ group) with a propensity score–matched cohort of 76 AF patients (LCPV− group) (61.8% paroxysmal and 38.2% persistent). Preprocedural computed tomography was performed in all patients and ostial dimensions and trunk distance were measured. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (≥ 30 s) after a 3-month blanking period. Acute procedural success was similar between the groups (100% and 98.7% for LCPV− and LCPV+, respectively, P = 0.991). Overall, 22/76 (28.9%) patients in LCPV− and 21/82 (25.6%) patients in LCPV+ had ATa recurrence at a mean follow-up of 31 ± 15 months (P = 0.770). A multivariate analysis identified only the left atrial (LA) diameter as a predictor of recurrent ATs (HR, 3.28; 95% CI, 1.67–6.41; P = 0.001). In the LCPV+ group, patients with single application had higher ATa recurrence (8/18 patients) compared with sequential freeze group (13/64 patients) (P = 0.042). Our findings indicated that CB was an effective tool in patients with LCPV and freedom from ATa was similar between LCPV− and LCPV+ groups. Only LA diameter predicted the ATa recurrence during long-term follow-up.

To present our experience regarding acute and long-term outcomes of left-sided atrioventricular node (AVN) ablation in patients with atrial fibrillation (AF). A total of 47 patients with AF in whom left-sided AVN ablation via retroaortic approach as a first-line approach were enrolled in this retrospective study. Indications for AVN ablation were high ventricular rate refractory to medical therapy, inappropriate implantable cardioverter defibrillator (ICD) shocks, or loss of cardiac resynchronization therapy (CRT) pacing. Both acute and long-term outcomes were assessed for all participants. Left-sided AVN ablation was successfully performed in 46/47 (98%) patients without any procedural complication. In the remaining 1 patient (2%), right-sided AVN ablation was performed. No mortality was observed within 30 days of the procedure. Upgrade to CRT was performed in 9 (19%) of the patients. During the median 22.5 months of follow-up, all-cause mortality was 25%. Device interrogations on the last clinical visit revealed complete AV block and intrinsic ventricular rate of

Immediate hemostasis following removal of sheaths is essential to prevent access site complications after atrial fibrillation (AF) ablation. Despite various precautions to achieve complete hemostasis in a safe and effective manner, no standard approach is present yet.We aimed to compare the efficacy and safety of standard vs modified figure-of-eight (sFoE vs mFoE) suture for immediate venous hemostasis after cryoballoon (CB) AF ablation.A total of 150 patients who underwent CB catheter ablation were sequentially allocated to either sFoE (n = 75) or mFoE (n = 75) suture to achieve immediate venous hemostasis at right femoral access site after 15 Fr sheath removal. A "three-way stopcock" was used in the mFoE group rather than tying the knot as in a sFoE group. Demographics, clinical and procedural data, and access site complications were recorded.Immediate haemostasis was achieved in all patients (n = 75) with mFoE suture as compared to 90.7% (n = 68) of sFoE suture group (P.001). Light manual pressure of ≤1 min was required in five patients (6.7%) due to looseness and conventional manual compression because of the snapped silk suture during knotting was required in two patients (2.6%) in the sFoE group. Time to hemostasis was shorter in the mFoE group (P.001), but time to ambulation and time to discharge were similar in both groups (P.05). Although no minor or major access site complication has occurred in the mFoE group, in-hospital rebleeding (n = 2, 2.7%) and early local access site infection (n = 2, 2.7%) were observed in the sFoE group.The mFoE suture using three-way stopcock is an available, effective, maybe safe, and time- and cost-saving alternative technique to achieve immediate hemostasis after removal of 15 Fr right femoral venous sheath in patients undergoing cryoablation.

BACKGROUND: We aimed to investigate whether non-alcoholic fatty pancreas disease (NAFPD) is associated with epicardial adipose tissue (EAT), which is a kind of ectopic fat accumulation, and aortic intima-media thickness (aIMT), which is associated with subclinical atherosclerosis. METHODS: Fifty-four patients with NAFPD (22 men; mean age: 52 ± 10 years) and 49 without NAFPD (16 men; mean age: 49 ± 8 years) were included in this study. NAFPD and aIMT were evaluated using transabdominal ultrasonography (TUS). EAT was evaluated with transthoracic echocardiography. RESULTS: EAT (6.09 ± 1.52 mm and 3.87 ± 1.31 mm, p < 0.001) and aIMT [1.12 (0.60-1.90) mm vs. 0.93 (0.50-1.44) mm, p < 0.001] were significantly higher in the NAFPD positive subjects, compared to the NAFPD negative subjects. Multivariate analysis showed that age (p = 0.016), body mass index (p = 0.004), and presence of NAFPD (p = 0.024) were associated with increased aIMT. In addition, multivariate analysis demonstrated that the presence of NAFPD (p < 0.001) was associated with increased EAT. CONCLUSIONS: The presence of NAFPD on TUS is associated with increased aIMT and EAT. Our study results may suggest that NAFPD may reflect subclinical atherosclerosis and may be a simple warning sign for physicians.