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Background: Currently available risk stratification models for acute pulmonary embolism (PE) include hemodynamic status, cardiac biomarkers, right ventricle (RV) dysfunction on imaging, and clinical scores. Focusing on the length--tension relationship of the ventricle might have a superior predictive capability over RV dysfunction in terms of mortality and classification of patients with acute PE. In this study, our hypothesis suggests that the tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary artery pressure (sPAP) ratio has superior predictive capability for in-hospital mortality in patients with acute PE compared to TAPSE or sPAP as distinct measures. Methods: This single-center study comprised retrospectively evaluated 703 patients referred to our tertiary cardiovascular center with acute PE. We divided patients into quartiles based on the TAPSE/sPAP ratio. Different models were developed to quantify the predictive relationship between in-hospital death and echocardiographic measurements. A base model was created with variables including risk status and RV/LV ratio >1. Then, to evaluate the predictive contribution of each measurement; TAPSE/sPAP, TAPSE, and sPAP were sequentially added to the base model. After that, the performance of each model was evaluated. Results: Predictive and discriminative power was the highest in model containing TAPSE/ sPAP. There was still a significant inverse association between TAPSE/sPAP and the risk of in-hospital death even after adjusting for risk status and RV/LV ratio >1. Receiver operating characteristic curve analysis for TAPSE/sPAP revealed the best cut-off value as 0.34. Conclusion: The outcomes of our study reveal that the ratio of TAPSE/sPAP serves as a more potent predictor of mortality than either of the 2 measurements taken separately. The interpretation and utilization of the TAPSE/sPAP cut-off value in acute PE can assist in identifying patients at risk of deterioration and guide the consideration of more intensive treatment options across all risk groups. [ABSTRACT FROM AUTHOR]

Background: AngioJet rheolytic thrombectomy (ART) system has been widely used as a catheter-directed treatment (CDT) method in acute pulmonary embolism (PE), however, there has been a controversy regarding the safety of its use. In this systematic review and meta-analysis, we evaluated the efficacy and safety outcomes of ART in patients with PE. Methods: Our meta-analysis have been based on search in the MEDLINE, EMBASE, and Cochrane Library for studies published up to August 2022. The primary outcomes were overall pooled rates of major bleeding (MB) and minor bleeding (mB), worsening renal function (WRF), bradycardia/conduction disturbance (BCD), and PE-related and allcause mortality in patients who underwent ART. Results: Among the 233 studies documented at initial search, 24 studies were eligible for meta-analysis, and a total of 427 PE patients who underwent ART were evaluated. Overall pooled rates of MB and mB were 9.6% (95% CI 5.9%-15.2%) and 9.2% (95% CI 6.1%-13.6%), transient BCD and WRF were 18.2% (95% CI 12.4%-26%) and 15% (95% CI 10%-21.8%), and PE-related death and all-cause death were 12.7% (95% CI 9.1%-17.3%) and 15% (95% CI 11%-20%), respectively. However, significant heterogeneity and some evidence of funnel plot asymmetry and publication bias were noted for MB, BCD and WRF, but not for PE-related death and all-cause death. Conclusion: Overall pooled rates of bleeding events, BCD and WRF episodes, PE-related death and all-cause death may be considered as encouraging results for efficacy and safety issues of ART utilization in specific scenarios of acute PE, and a reappraisal for black-box warning on ART seems to be necessary. [ABSTRACT FROM AUTHOR]

Background: We evaluated the predictive value of electrocardiographic (ECG) findings for pulmonary hemodynamics assessed by right heart catheterization (RHC). Methods: Our study population comprised 562 retrospectively evaluated patients who underwent RHC between 2006 and 2022. Correlations between ECG measures and pulmonary arterial systolic and mean pressures (PASP and PAMP) and pulmonary vascular resistance (PVR) were investigated. Moreover, receiver operating characteristic (ROC) curve analysis assessed the predictive value of ECG for pulmonary hypertension (PH) and precapillary PH. Results: The P-wave amplitude (Pwa) and R/S ratio (r) in V1 and V2, Ra in augmented voltage right (aVR), right or indeterminate axis, but not P wave duration (Pwd) or right bundle branch block (RBBB) significantly correlated with PASP, PAMP, and PVR (P < .001 for all). The partial R2 analysis revealed that amplitude of R wave (Ra) in aVR, R/Sr in V1 and V2, QRS axis, and Pwa added to the base model provided significant contributions to variance for PASP, PAMP, and PVR, respectively. The Pwa > 0.16 mV, Ra in aVR > 0.05 mV, QRS axis > 100° and R/Sr in V1 > 0.9 showed the highest area under curve (AUC) values for PAMP > 20 mm Hg. Using the same cutoff value, Ra in aVR, Pwa, QRS axis, and R/Sr in V1 showed highest predictions for PVR > 2 Wood Units (WU). Conclusion: In this study, Pwa, Ra in aVR, right or indeterminate axis deviations, and R/Sr in V1 and V2 showed statistically significant correlations with pulmonary hemodynamics, and Ra in aVR, R/Sr in V2 and V1, QRS axis, and Pwa contributed to variance for PASP, PAMP, and PVR, respectively. Moreover, Pwa, Ra in aVR, QRS axis, and R/Sr in V1 seem to provide relevant predictions for PH and precapillary PH. [ABSTRACT FROM AUTHOR]

Copyright of Archives of the Turkish Society of Cardiology / Türk Kardiyoloji Derneği Arşivi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Pulmonary embolism severity index and simplified pulmonary embolism severity index have been utilized in initial risk evaluation in patients with acute pulmonary embolism. However, these models do not include any imaging measure of right ventricle function. In this study, we proposed a novel index and aimed to evaluate the clinical impact. Methods: Our study population comprised retrospectively evaluated 502 patients with acute pulmonary embolism managed with different treatment modalities. Echocardiographic and computed tomographic pulmonary angiography evaluations were performed at admission to the emergency room within maximally 30 minutes. The formula of our index was as follows: (right ventricle diameter × systolic pulmonary arterial pressure-echo)/(right ventricle free-wall diameter × tricuspid annular plane systolic excursion). Results: This index value showed significant correlations to clinical and hemodynamic severity measures. Only pulmonary embolism severity index, but not our index value, independently predicted in-hospital mortality. However, an index value higher than 17.8 predicted the long-term mortality with a sensitivity of 70% and specificity of 40% (areas under the curve = 0.652, 95% CI, 0.557-0.747, P = .001). According to the adjusted variable plot, the risk of long-term mortality increased until an index level of 30 but remained unchanged thereafter. The cumulative hazard curve also showed a higher mortality with high-index value versus low-index value. Conclusions: Our index composed from measures of computed tomographic pulmonary angiography and transthoracic echocardiography may provide important insights regarding the adaptation status of right ventricle against pressure/wall stress in acute pulmonary embolism, and a higher value seems to be associated with severity of the clinical and hemodynamic status and long-term mortality but not with in-hospital mortality. However, the pulmonary embolism severity index remained as the only independent predictor for in-hospital mortality. [ABSTRACT FROM AUTHOR]

Introduction: Pericardial window (PW) is a surgical procedure in which a part of the pericardium is removed so that the effusion can flow into the chest cavity. Our study aims to analyze a series of patients with chronic recurrent and/or large pericardial effusions who underwent single-port video-assisted thoracoscopic surgery (VATS)-PW opening. The uniportal method seems to be a better option because it is performed with small cosmetic incisions and is less painful. Materials and Methods: Thirty-six patients were referred to our clinic with recurrent, chronic, and/or large PE between March 2019 and May 2022. All patients were analyzed for gender, age, body mass index (BMI), symptom, operation side, discharge time, complications, and pathologic specimens. Results: Of the 35 patients, 25 (71.4%) were male, 10 (28.6%) were female, and the mean age was 60.1±15.4 years. The left side was preferred for 28 patients (80%) and the right for 7 (20%). The median BMI was 25.5 kg/m² (24.0-28.1). The median day of stay in our clinic and/or referred clinic where they are followed up due to comorbidities was 1 (1-2). Four patients (11.4%) who were previously diagnosed with malignancy and whose pericardial biopsy was compatible with the primary disease died within the 1st month postoperatively. The mortalities were not attributed to the pericardial procedure. Conclusion: PW opening using uniportal VATS seems to be a safe method for patients with PE without needing one-lung ventilation. In addition, uniportal VATS can be considered the first surgical option in obese patients. [ABSTRACT FROM AUTHOR]

Background: Although pregnancy in women with pulmonary arterial hypertension has been considered a high-risk condition, current data regarding pregnancy with pulmonary arterial hypertension are scarce. In this study, we aimed to evaluate our single-center data on maternal and fetal outcomes in pregnant women with PAH and review currently available risk-based management strategies. Methods: Our single-center study group comprised 35 women who became pregnant after the diagnosis of pulmonary arterial hypertension or in whom pulmonary arterial hypertension was diagnosed within early post-partum period. Clinical, laboratory, echocardiographic, and hemodynamic characteristics of pregnant and non-pregnant productive women with pulmonary arterial hypertension were compared, and similar comparison was also repeated for survivors and non-survivors in pregnant patient group. Results: Pregnancy was noted in 15% of the 228 females with pulmonary arterial hypertension who were of hormonally productive ages, generally well-tolerated until delivery. Elective abortion and pre-term delivery were documented in 1 (2.8%) and 12 (35.3%) pregnant women, respectively. Switching to sildenafil was the standard medication during pregnancy. Cesarian section was the preferred method of delivery in all pregnant women with pulmonary arterial hypertension and was performed without any complication. Clinic deteoriation within the first week of delivery was observed in 5 (41.6%) patients. Maternal mortality was noted in 13 (37.1%) patients and was documented to cumulate within the first month of delivery. However, any sign predicting post-partum clinical deterioration was not found. No fetal mortality was observed. Conclusion: Despite the development of advanced therapies, pregnancy in pulmonary arterial hypertension still carries a high mortality risk and requires multi-disciplinary expert center care with more proactive management strategies. [ABSTRACT FROM AUTHOR]

Background: In this single-center study, we evaluated efficacy and safety issues and predictors of survival in patients with idiopathic and congenital heart disease-associated pulmonary arterial hypertension who were under macitentan therapies. Method: Our study retrospectively evaluated 221 patients with pulmonary arterial hypertension enrolled in our single-center study, and mono, dual, and triple macitentan therapies were noted in 30, 115, and 76 patients, respectively. The longitudinal changes in clinical, neurohumoral, and echocardiographic measures of pulmonary arterial hypertension were evaluated. The Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management, Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management 2.0, and Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management Lite 2 scores at baseline, Swedish PAH Registry, Comparative Prospective Registry of Newly Initiated Therapies for Pulmonary Hypertension registry, and French Pulmonary Hypertension Network registry risk status both at baseline and first control were assessed. Result: The median follow-up period was 1068 [415-2245] days. Macitentan was associated with significant improvements in functional class, 6-minute walk distance, N-terminal pro-brain natriuretic peptide (NT-proBNP), and echocardiographic measures without any deterioration of hemoglobin or hepatic enzymes. The low-risk scores with each model at baseline and/or first control are related to significantly better survival. Age, gender, and log-NT-proBNP in time-fixed and idiopathic pulmonary arterial hypertension, and log-NT-proBNP in time-dependent Cox proportional hazard regression analyses were independent predictors of mortality. Conclusion: Mono- or sequential combination macitentan therapies were associated with sustained benefits in functional class, 6-minute walk distance, NT-proBNP, and echocardiographic measures in patients with idiopathic pulmonary arterial hypertension and congenital heart disease-associated pulmonary arterial hypertension, and low-risk scores at baseline and/or first controls can be translated to better survival. [ABSTRACT FROM AUTHOR]

Background: The role of eosinophils in thrombotic processes is well known, and the prognostic value of eosinophil to monocyte ratio had been determined in patients with ST elevated myocardial infarction and acute ischemic stroke in recent studies. We aimed to evaluate the impact of the eosin ophil -to-m onocy te ratio on short- and long-term allcause mortality in patients with pulmonary embolism, which is another clinical condition closely related to the thrombotic pathway. Methods: In this study, a total of 212 retrospectively evaluated patients with intermediate-high risk and high-risk pulmonary embolism who underwent catheter-directed therapies with ultrasound-assisted thrombolysis or rheolytic thrombectomy (Angiojet©) and intravenous thrombolytic treatment were included. Results: The median Pulmonary Embolism Severity Index score was 105 (86-128; interquartile range: 25-75, min-max: 35-250). The intermediate-high status and high-risk status were noted in 83.5% and 16.5% of the patients, respectively. All of the reperfusion strategies resulted in significant improvements in the measures of pulmonary arterial pressure and right ventricular strain. Death was recorded in 42 (18.6%) patients during the follow-up period (median 1029 days, interquartile range: 651-1358). Multiple Cox regression analysis revealed that a higher pulmonary embolism severity index score (from 85 to 128; hazard ratio = 3.00; 95% CI: 2.11-4.29; P < .001) and a lower eosin ophil -to-m onocy te ratio (from 0.02 to 0.24; hazard ratio = 0.56; 95% CI: 0.34-0.98; P = .032) were 2 independent predictors for long-term all-cause mortality. The eosin ophil -to-m onocy te ratio at the admission of less than 0.03 was documented to be associated with higher mortality (P < .001). Conclusion: Our results revealed that a lower eosin ophil -to-m onocy te ratio and a higher pulmonary embolism severity index score independently predict the long-term mortality in patients with intermediate-high- and high-risk pulmonary embolism. [ABSTRACT FROM AUTHOR]

Copyright of Archives of the Turkish Society of Cardiology / Türk Kardiyoloji Derneği Arşivi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: AngioJet rheolytic thrombectomy (ART) has been used as a catheter-based treatment for acute pulmonary embolism (PE). In this study, based on our 7-year experience with ART in patients with PE, we evaluated the efficacy and safety outcomes of ART. Methods: Our study is based on retrospective evaluation of 56 patients with high- and intermediate-high-risk PE, with an average age of 62 years [interquartile range (IQR) 50-73 years] who underwent ART. Results: High and intermediate-high risks were noted in 21.4% and 78.6% of the patients, respectively. The ART duration was 304 (IQR: 246-468) seconds. Measures of obstruction, right to left ventricle diameter ratio, right to left atrial diameter ratio, and pulmonary arterial pressures were improved (p<0.001 for all). During the hospital stay, acute renal failure, major and minor bleeding, and mortality rates were 37.5%, 7.1%, 12.5%, and 8.9%, respectively. Aging related to post-procedural nephropathy while high-risk status was associated with in-hospital mortality (p=0.006) and long-term mortality. Conclusion: ART resulted in significant and clinically relevant improvements in the pulmonary arterial thrombotic burden, right ventricle strain, and hemodynamics in patients with PE at high and intermediate-high risk. Aging increased the risk of post-procedural nephropathy, whereas baseline high-risk status predicted in-hospital and long-term mortality. [ABSTRACT FROM AUTHOR]

Objective: Endothelium-dependent (ED) and endothelium-independent (EI) flow-mediated vasodilatation (FMD) have been used as measures of systemic arterial vasodilatory reserve. In this study, we aimed to assess both ED-FMD and EI-FMD in different groups with pulmonary hypertension (PH), and to investigate the relationship of these measures with clinical, echocardiographic, and invasive parameters of diseases severity and targeted treatment status. Methods: Our study population comprised 41 patients with PH [28 (68.2%) women, age 46.3±19.6 years] including idiopathic pulmonary arterial hypertension, Eisenmenger syndrome, and chronic thromboembolic PH in whom diagnosis were confirmed in accordance with current guidelines and 17 age and sex-matched healthy controls. The brachial artery (BA) was used for assessment of FMD with Duplex ultrasound, and serial changes in diameter were recorded at baseline, 1, and 3 minutes after termination of 2-minute external occlusive compression for ED-FMD, and after sublingual intake of glycerol trinitrate for EI-FMD, respectively. Results: Compared with controls, overall the PH group showed significantly lower ED-FMD (0.65±0.21 vs. 0.30±0.23 and 0.65±0.18 vs. 0.24±0.21) and EI-FMD (0.67±0.15 vs. 0.37±0.25 and 0.75±0.20 vs. 0.32±0.24) responses at 1st and 3rd min (p<0.001 for all). All these changes in the values of ED-FMD and EI-FMD were comparable among the PH subgroups. Neither ED-FMD nor EI-FMD were correlated with measures of PH severity and targeted therapy (TT) status (p>0.05). Conclusion: Our results suggest an impaired BA vasodilatory reserve in patients with PH regardless of the clinical subgroup. Although these findings seem to be consistent with systemic dysfunction, acute FMD may not reflect the severity of PH and cannot be used as a potential surrogate for outcome in this setting. [ABSTRACT FROM AUTHOR]

Objective: Endovascular therapy (EVT) has increasingly been used even after the development of new techniques and technologies. EVT has displayed durable early and mid-term outcomes for infrarenal aorta occlusions (IAO). Nonetheless, little is known regarding their long-term outcomes and predictors of restenosis. Methods: A total of 55 consecutive patients (age, 58.8±6.97 years; 67.2% male; 42% critical limb ischemia) from a single-center database, undergoing EVT for IAO disease between January 2011 and March 2019 were retrospectively analyzed. The outcome measures were primary patency rate and amputation free survival calculated by the Kaplan-Meier method. Independent predictors of restenosis were assessed by Cox proportional hazard regression model. Results: In 49 patients (89.1%), technical success was achieved. In total, 190 stents (65 self-expandable stents, 60 balloon-expandable stents) were implanted. During the follow up of 34.5±28 months, 7 patients experienced loss of patency. Primary patency rates were 96%, 82%, and 75% at 1, 3, and 5 years, respectively, and amputation free survival rates were 100%, 90%, and 82% at 1, 3, and 5 years, respectively. Conclusion: In this study, five-year outcomes of primary patency and amputation free survival for EVT of infrarenal aorta total occlusive lesions were favorable. None of the demographic, lesion, and device factors were independently associated with loss of primary patency. [ABSTRACT FROM AUTHOR]

Copyright of Archives of the Turkish Society of Cardiology / Türk Kardiyoloji Derneği Arşivi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: In patients with chest pain; especially described as pressure or burning and radiating to the neck, and/or left arm; acute coronary syndrome (ACS) should be ruled out.Based on electrocardiogram (ECG) and cardiac biomarkers; ACS can be classified as unstable angina (UA), Non ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI). Despite fast and successful reperfusion; patients with STEMI may need mechanical support devices like intra-aortic balloon pump (IABP) or extracorporeal membran oxygenation (ECMO) due to cardiogenic shock or mechanical complications. Systemic immune inflammation index (SII); is a parameter calculated as (neutrophil/ lymphocyte)* platelet and its predictive value has been demonstrated in acute MI in elderly patients. We aimed to investigate the relationship between systemic inflammatory index and mechanical support need in patients with STEMI. Materials and Methods: The patients with ACS between 2021 May and 2021 September were retrospectively evaluated and 155 STEMI patients were enrolled (mean age 58±12, 58.2% male). Results: Relationship between SII and IABP or ECMO need was evaluated by logistic regression. Age, gender, and EF were included in addition to SII, as there were 29 patients requiring IABP and/or ECMO.While the median SII was 1335 (798-2317) in those who needed IABP or ECMO, it was 1274 (696-1703) in those who did not.In the unadjusted analysis,no significant correlation was observed between SII and IABP/ECMO requirement (OR: 1.00, 95% CI 0.99-1.00, p=0.219). No significant correlation was observed between SII and IABP or ECMO need when adjusting for age and gender (OR: 0.99, 95% CI 0.99-1.00, p=0.948). In the model consisting of age, gender, SII and EF, there was a statistically significant correlation between IABP and ECMO need and only EF (OR: 0.79, 95% CI 0.72-0.86, p<0.001) Conclusion: There was no significant correlation between SII and mechanical support need in STEMI,we determined significant correlation between IABP and ECMO need and EF; so echocardiography and physical examination in intensive care unit to detect newly developed murmur (mechanical complication) or lung congestion are important to detect need for mechanical support. [ABSTRACT FROM AUTHOR]

Objective: Pulmonary artery (PA) enlargement is a common finding in patients with severe pulmonary hypertension (PH) and may be associated with extrinsic compression of the left main coronary artery (LMCA-Co) and/or compression of the left recurrent laryngeal nerve resulting in hoarseness named as Ortner syndrome (OS). In this study, we evaluated the diagnostic impact of OS in predicting the PA aneurysm and significant LMCA-Co in patients with PH., Methods: Our study population comprised retrospectively evaluated 865 with PH confirmed with the right heart catheterization between 2006 and 2022. Patients underwent coronary angiography due to several indications, including the presence of a PA aneurysm on echocardiography, angina symptoms, or the incidental discovery of LMCA-Co on multidetector computed tomography. The LMCA-Co is defined as diameter stenosis ³ 50% in reference distal LMCA segment on two consecutive angiographic planes., Results: The LMCA-Co and hoarseness were documented in 3.8% and 4.3% of patients with PH, respectively. Increasing PA diameter was significantly associated with worse clinical, hemodynamic, laboratory, and echocardiographic parameters. The receiver operating curves revealed that the PA diameter >41 mm was cutoff for hoarseness (AUC: 0.834; sensitivity 69%, specificity 84%, and negative predictive value 98%), and PA diameter >35 mm was cutoff for LMCA-Co >50% (AUC: 0.794; sensitivity 89%, specificity 58 %, and negative predictive value 99%). An odds ratio of hoarseness for LMCA-Co was 83.3 (95% confidence interval; 36.5-190, P < 0.001) with 3.2% sensitivity, 98.7% specificity, and 59% positive and 98% negative predictive values., Conclusion: In this study, a close relationship was found between the presence of hoarseness and the probability of extrinsic LMCA-Co by enlarged PA in patients with severe PH. Therefore, the risk of LMCA-Co should be taken into account in patients with PH suffering from hoarseness.

Objective: Parallel to the aging of the world population, the complexity of patients with cardiac problems has increased, especially in intensive cardiology care units, and the importance of multidisciplinary care has become more evident. The aim of this study was to analyze the clinical characteristics and gender-related differences of patients hospitalized in a large intensive cardiology care unit., Methods: This single-center, retrospective, cross-sectional study includes all hospitalizations in a large intensive cardiology care unit between January 2016 and March 2021. All data were obtained using data collection software and transferred to MEDULLA, Turkey's general database system., Results: Of the 55 737 consecutive patients included in the analysis, 16342 (29%) were women. The mean age of males was 59.71 ± 12 years, and the mean age of females was 63.3 ± 14 years (P <.001). Over a period of 5 years, the most common reason for hospitalization in the intensive cardiac care unit was acute coronary syndrome. The number of acute coronary syndrome patients who underwent coronary angiography was found to be 17 478 (31%), of which 12 878 were males and 26.3% were female. The number of patients who underwent at least 1 stent implantation was 13 952 (80% of coronary angiography procedures), and 2960 (21%) were women. The second cause of hospitalization in the intensive cardiology care unit was arrhythmias (5654 patients [10%]) followed by advanced heart failure (932 patients [1.7%]). During follow-up in the intensive cardiology care unit, the percentage of development of multiorgan failure was found to be approximately 18%. The mortality rate was 7% in women, which was higher than in men (4%). While the most common cause of death was acute coronary syndrome, the highest rate of death was found in patients with advanced heart failure. Among the patients who died, the mean age of females was higher than that of males, and the length of hospital stay was longer., Conclusion: Although numerically the highest death rate was observed in male acute coronary syndrome patients, the highest mortality rate was found in patients with advanced heart failure. Due to the elderly population and the increase in the number of patients requiring multidisciplinary treatment, the development of multiorgan failure in intensive cardiology care units seems to be one of the most important causes of death. Although the number of females hospitalized in the intensive cardiology care unit is lower than that of males, the mean age and mortality rate were found to be higher than males.

Background: The aim of this study was to analyze the effect of extracorporeal cardiopulmonary resuscitation on survival and neurological outcomes in in-hospital cardiac arrest patients., Methods: Between January 2018 and December 2020, a total of 22 patients (17 males, 5 females; mean age: 52.8±9.0 years; range, 32 to 70 years) treated with extracorporeal cardiopulmonary resuscitation using veno-arterial extracorporeal membrane oxygenation support for in-hospital cardiac arrest after acute coronary syndrome were retrospectively analyzed. The patients were divided into two groups as those weaned (n=13) and non-weaned (n=9) from the veno-arterial extracorporeal membrane oxygenation. Demographic data of the patients, heart rhythms at the beginning of conventional cardiopulmonary resuscitation, the angiographic and interventional results, survival and neurological outcomes of the patients before and after extracorporeal cardiopulmonary resuscitation were recorded., Results: There was no significant difference between the groups in terms of comorbidity and baseline laboratory test values. The underlying rhythm was ventricular fibrillation in 92% of the patients in the weaned group and there was no cardiac rhythm in 67% of the patients in the non-weaned group (p=0.125). The recovery in the mean left ventricular ejection fraction was significantly evident in the weaned group (36.5±12.7% vs. 21.1±7.4%, respectively; p=0.004). The overall wean rate from veno-arterial extracorporeal membrane oxygenation was 59.1%; however, the discharge rate from hospital of survivors without any neurological sequelae was 36.4%., Conclusion: In-hospital cardiac arrest is a critical emergency situation requiring instantly life-saving interventions through conventional cardiopulmonary resuscitation. If it fails, extracorporeal cardiopulmonary resuscitation should be initiated, regardless the underlying etiology or rhythm disturbances. An effective conventional cardiopulmonary resuscitation is mandatory to prevent brain and body hypoperfusion., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2021, Turkish Society of Cardiovascular Surgery.)

Carotid artery stenting has been a widely used interventional treatment method for the last 3 decades in the treatment of carotid artery stenosis. In the current literature, unlike major cardiovascular complications, less emphasis has been placed on carotid pseudoaneurysm (PA). A carotid artery PA can be caused by trauma, spontaneous infection, vasculitis, or it may be iatrogenic. However, the incidence of PA secondary to carotid stenting is extremely rare. Although it may be completely asymptomatic in rare instances, it usually progresses symptomatically (neck swelling, nerve compression, respiratory distress, hoarseness, dysphagia, and ischemic cerebrovascular events). Doppler ultrasound, contrast-enhanced computed tomography, and conventional angiography are the main diagnostic tools. Primary closure, including graft interposition, has been described as a surgical therapeutic option. An endovascular approach with placement of a covered or bare metal stent is an alternative treatment method to surgery.