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Background: This study aimed to investigate the intraoperative and early postoperative effects of modified del Nido cardioplegia (DNC) compared to classic blood cardioplegia (BC) in patients with impaired left ventricular ejection fraction (EF) who underwent isolated coronary artery bypass grafting (CABG)., Methods: A total of 123 patients (108 males, 15 females; mean age: 62.2±8.5 years; range, 42 to 78 years) with an EF of 35% or lower who underwent on-pump CABG were included in the retrospective study between December 2022 and December 2023. The patients were divided into two groups according to the type of cardioplegia used: Group 1 (n=74) was designated as the BC group, and Group 2 (n=49) was designated as the DNC group. The groups were compared in terms of aortic cross-clamp duration, cardiopulmonary bypass (CPB) duration, need for defibrillation during weaning from CPB, positive inotrope requirement, intra-aortic balloon pump requirement, postoperative troponin-I levels, postoperative atrial fibrillation occurence, postoperative prolonged ventilation, development of postoperative neurologic complications, need for reintervention due to postoperative bleeding, postoperative transfusion requirement, and EF values at one month after the operation., Results: There was no significant difference between the two groups in the terms of aortic cross-clamp and CPB duration (p=0.955 vs. p=0.816). Additionally, there was no significant difference in the need for intra-aortic balloon pump usage between the two groups (p=0.105). Dopamine and dobutamine usage were significantly lower in Group 2 (p=0.04 and p=0.05, respectively). The intraoperative requirement for defibrillation was significantly lower in Group 2 (p=0.01). In addition, troponin levels at 12 h postoperatively were significantly lower in Group 2 (p=0.03). The incidence of postoperative atrial fibrillation was significantly lower in Group 2 (p=0.02). Moreover, there was no significant difference in EF values at one month after the operation (p=0.08)., Conclusion: In patients who underwent CABG with reduced EF, modified DNC provided myocardial protection comparable to classic BC. Additionally, the need for intraoperative defibrillation and postoperative inotropic agents, as well as the incidence of postoperative atrial fibrillation, were lower in patients operated with DNC., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2024, Turkish Society of Cardiovascular Surgery.)

Background Acute kidney injury (AKI) and acute renal failure contribute significantly to the high mortality and morbidity seen in patients with left ventricular assist devices (LVADs). The role of preoperative right ventricular function in the onset of acute renal failure remains an area of active investigation. This study aims to explore the correlation between preoperative right ventricular function and the development of AKI in patients undergoing LVAD implantation. Methods The demographic characteristics, comorbidities, and preoperative and postoperative data of 61 patients who underwent LVAD implantation between April 2012 and December 2021 were carefully documented. Transthoracic echocardiography was used to assess right ventricular function, with tricuspid annular plane systolic excursion (TAPSE) and right ventricular fractional area change (FAC) serving as key evaluation parameters. TAPSE values of ≥17 mm and FAC of ≥35% were considered indicative of normal right ventricular function. Based on these measurements, the study analyzed the association between preoperative right ventricular function and the incidence of postoperative AKI. Results When patients were grouped based on TAPSE values, significant differences emerged in ICU stay duration, hospital stay length, AKI development, and the need for renal replacement therapy post-AKI. Elevated preoperative serum creatinine levels (p = 0.01), older age (p = 0.02), higher body surface area (p = 0.024), and lower TAPSE values (p = 0.02) were identified as risk factors for postoperative AKI. However, no significant correlation was found between preoperative FAC values and AKI incidence in LVAD-implanted patients. Conclusions Preoperative TAPSE appears to be a more reliable predictor of postoperative renal dysfunction than FAC., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Baskent University Institutional Review Board issued approval KA20/371. This retrospective trial was registered in Baskent University with registration number KA20/371 and dated 06/10/2020. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Beyazpınar et al.)

Objective This study aimed to investigate the causes of amputation and the associated biochemical parameters in patients with acute limb ischemia (ALI). Methods Patients who presented to our clinic with ALI between January 2012 and January 2022 were deemed eligible for participation. Patients who developed ALI owing to atherosclerosis or atrial fibrillation were included in the study. In contrast, patients who developed ALI owing to trauma, iatrogenic causes, or popliteal artery aneurysms were excluded. Patients' demographic data, biochemical parameters, and hemogram values at the time of admission were retrospectively analyzed. Results A total of 374 patients were included in the study. Of them, 57.82% (n = 218) were male and 42.18% (n= 156) were female. Amputation was required in 7.95% (n = 30) of the patients after presenting with ALI and receiving necessary surgical or medical intervention. Multivariate analysis revealed the symptom-to-door time to be the primary factor determining the need for amputation in patients. With each passing hour following the manifestation of symptoms, the risk of amputation increased by 1.3 times [odds ratio (OR): 1.289%, 95% confidence interval (CI): 1.079-1.540 p = 0.05]. The neutrophil-to-lymphocyte ratio (NLR) and other hematological parameters had no effect on amputation in both univariate and multivariate analyses (OR: 1.49%; 95% CI: 0.977-2.287 p = 0.512). Conclusions Based on our findings, the main factor affecting the need for amputation in ALI patients was the symptom-to-door time. Biochemical and hematological parameters had no effect on amputation in ALI., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Erol et al.)

Objective: Open heart surgery (OHS) is frequently performed on elderly patients. We aimed to investigate the risk factors associated with prolonged intensive care unit (ICU) stay in elderly patients undergoing open heart surgery., Materials and Methods: Medical records of all patients ≥ 75 years who underwent OHS (coronary artery bypass grafting (CABG) and/or heart valve surgery) between June 1, 2013, and December 31, 2020, were retrospectively analyzed. Those staying in the ICU longer than five days were determined as prolonged ICU stay. Patients were divided into two groups, according to ICU stay <5 days and ≥5 days., Results: Out of the 198 patients included in the study, 130 (65.7%) were male. Seventy patients (35.4%) had prolonged ICU stay. The mean age was higher in patients within the prolonged ICU stay group when compared to the other group (79.9±3.5 years vs.78.1±2.7 years, p<0.001). The patients who used statins and angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARBs) in the preoperative period had a shorter ICU stay compared to those who did not (45% vs 31.4%, p=0.04; 57% vs 42.9%, p=0.03). The history of previous thoracic surgery (2.3% vs 10% p=0.03), emergency surgery (12.5% vs 24.5% p=0.04), and preoperative pacemaker usage (0.8% vs 7%, 1 p=0.01) were higher in the group of patients with prolonged ICU stay compared to the other group. Preoperative ejection fraction (EF)% (47.7±11.3 vs 51.1±8.8, p<0.001) and hemoglobin level (11.8±1.9 mg/dL vs 12.9±1.6, p<0.001) were lower in the group with prolonged ICU stay compared to the other group. Incidence of cardiac arrest (3.9% vs 15.7% p=0.006), presence of arrhythmia (16.4% vs 41.6%,p<0.001), frequency of pacemaker and intra-aortic balloon pump (IABP) usage (0 vs 10% p=0.002; 1.6% vs 8.6% p=0.02), and need for renal replacement therapy (3.1% vs 12.9%,p=0.02) were higher in the group with prolonged ICU stay compared to the other group. According to the logistic regression analysis; higher age (OR: 1.225, 95%CI 1.104-1.360, p<0.001), preoperative pacemaker usage (OR: 0.100, 95%CI 0.01-0.969, p<0.04), preoperative statin non-use (OR: 2.056, 95%CI 1.040-4.066, p<0.03) and preoperative low EF (OR: 0.947, 95%CI 0.915-0.981, p=0.002) were determined as independent risk factors for prolonged ICU stay., Conclusion: The incidence of prolonged ICU stay after OHS among patients ≥75 years was 35.4% in our cohort. Higher age, preoperative pacemaker usage, preoperative statin non-use, and low preoperative EF were associated with prolonged ICU stay., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Yeşiler et al.)

Background: Pericardial effusion occurs frequently after surgical atrial septal defect closure. This complication carries the risk of development of cardiac tamponade and death. It is also the responsibility of the hospital for readmissions. Any measure in preventing the development of pericardial effusion is of paramount importance. In this report, our objective was to demonstrate the protective effect of creating a pleuropericardial window against the development of postsurgical pericardial effusion., Methods: Hospital records of all patients who underwent surgical atrial septal defect closure between January 2015 and December 2020 were reviewed. Patients were divided into 2 groups according to the creation of right/left pleuropericardial window during surgical ASD closure. There were 45 patients in group I in which a right pleuropericardial window was done, and 85 patients constituted group II in which pericardium was left intact., Results: None of the 45 patients in group I developed pericardial effusion, while 15 of 85 patients in group II developed pericardial effusion (P=.001). Ten patients developed more than mild pericardial effusion which required medical treatment, while 5 patients had to be re-hospitalized because of massive pericardial effusion and effusions were managed by percutaneous drainage., Conclusions: The creation of a right pleuropericardial window resulted in a safe postoperative recovery after surgical atrial septal defect closure in all patients with the development of no pericardial effusion. No adverse effect of the creation of a pleural communication was noted.

Transcatheter aortic valve implantation (TAVI) is a safe and effective alternative to surgical valve replacement in intermediate and even in low-risk patient cohorts. Direct aortic (DAo) route may be used in patients with severe peripheral vascular disease. Here, we present an 88-year old patient hospitalized with cardiogenic shock. Echocardiography revealed severe aortic valve stenosis with aortic valve area 0.5 cm², mean gradient of 55 mmHg, and peak gradient 92 mmHg. TAVI was considered by the Institutional Heart Team. Multislice computed tomography (MSCT) revealed severe peripheral vascular disease, decreased calibration of abdominal aorta, and multiple large vulnerable atherosclerotic plaques. The patient was scheduled for a DAo TAVI. A 26-mm Medtronic CoreValve Evolut R valve was implanted after predilatation with median sternotomy. The patient was discharged after 96 hours. Although transfemoral (TF) access is used as the default approach for TAVI, it was contraindicated in our patient owing to severe peripheral vascular disease and decreased calibration of the abdominal aorta at its narrowest point (4.5 mm) with multiple large vulnerable atherosclerotic plaques. Careful preprocedural MSCT evaluation is essential and directly affects the success of the procedure. MSCT is also mandatory to confirm the best cannulation zone that must be met for a successful DAo TAVI.

Heart failure is the one of the biggest health problem in the world. Because of limited donors for heart transplant procedures, the ventricular assist device has become a solution for heart failure therapy. With the increase in number of ventricular assist devices, the incidence of complications has also increased. One of the most important life-threatening complications is ventricular assist device thrombosis. Medical therapy and changes in the ventricular assist device are the main therapy methods for ventricular assist device thrombosis. In this study, we showed our clinical experience with treatment of ventricular assist device thrombosis.

Objectives: Acute kidney injury is a frequent complication after orthotopic cardiac transplant. We aimed to describe the risk factors for acute kidney injury after cardiac transplant according to Kidney Disease: Improving Global Outcomes criteria., Materials and Methods: We retrospectively studied a population-based cohort of cardiac transplant recipients (aged > 12 y) at Başkent University between February 2003 and January 2015. Of 94 patients, 64 were evaluated and included in the study. The main outcome was acute kidney injury, defined and classified according to Kidney Disease: Improving Global Outcomes criteria, during 7 postoperative days. Other outcomes included risk factors, use of renal replacement therapy, postoperative complications, mortality, and kidney recovery., Results: Mean age at transplant was 34.14 ± 16.30 years, and 45 patients (70.32%) were men. Acute kidney injury developed in 34 (53.12%) of 64 cardiac transplant recipients, with severity classified as stage 1 in 10 (15.62%), stage 2 in 14 (21.87%), and stage 3 in 10 (15.62%). Renal replacement therapy was given to 25 patients (39.06%). Patients with acute kidney injury were significantly older (40.41 ± 15.85 y vs 27.03 ± 13.91 y; P = .001), had larger body surface area (1.78 ± 0.28 m2 vs 1.61 ± 0.31 m2; P = .033), and more frequently had a history of hypertension (P = .011) and smoking (P = .007) than did patients without acute kidney injury. They also had lower intraoperative urine output (453.380 ± 266.85 mL) than did patients who did not develop acute kidney injury (632.33 ± 430.94 mL (P = .01)., Conclusions: According to the Kidney Disease: Improving Global Outcomes criteria, acute kidney injury occurs in more than 50% of heart transplant patients postoperatively. Older age, larger body surface area, and history of hypertension and smoking are associated with acute kidney dysfunction following orthotopic heart transplant.

Background: Congenital cardiovascular abnormality is an important cause of morbidity and mortality in childhood. Both the type of congenital cardiovascular abnormality and cardiopulmonary bypass are responsible for gastrointestinal system problems., Aims: Intra-abdominal problems, such as paralytic ileus, necrotizing enterocolitis, and intestinal perforation, are common in patients who have been operated or who are being followed for congenital cardiovascular abnormalities. Besides the primary congenital cardiovascular abnormalities, ischemia secondary to cardiac catheterization or surgery contributes to the incidence of these problems., Study Design: Cross-sectional study., Methods: In this study, we aimed to screen the intra-abdominal problems seen in patients with congenital cardiovascular abnormalities who had undergone surgical or angiographical intervention(s). Patients with congenital cardiovascular abnormalities who had been treated medically or surgically between 2000 and 2014 were analyzed retrospectively in terms of intra-abdominal problems. The patients' demographic data, type of congenital cardiovascular abnormalities, the intervention applied (surgical, angiographic), the incidence of intra-abdominal problem(s), the interventions applied for the intra-abdominal problems, and the results were evaluated., Results: Fourteen (Group I) of the 76 patients with congenital cardiovascular abnormalities diagnosis were operated due to intra-abdominal problems, and 62 (Group II) were followed-up clinically for intra-abdominal problems. In Group I (10 boys and 4 girls), 11 patients were aged between 0 and 12 months, and three patients were older than 12 months. Group II included 52 patients aged between 0 and 12 months and 10 patients older than 12 months. Cardiovascular surgical interventions had been applied to six patients in Group I and 40 patients in Group II. The most frequent intra-abdominal problems were necrotizing enterocolitis and intestinal perforation in Group I, and paralytic ileus in Group II. Seven of the Group I patients and 22 of the Group II patients died. The patients who died in both groups had more than three congenital cardiovascular abnormalities in the same patient, and 80% of these patients had been operated for congenital cardiovascular abnormalities., Conclusion: The gastrointestinal system is involved in important complications experienced by patients with congenital cardiovascular abnormalities. The mortality rate was higher in operated patients due to gastrointestinal complications. Gastrointestinal complications are more frequent in patients with cyanotic anomalies. The presence of more than one congenital cardiovascular abnormality in a patient increased the mortality rate.