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AMAÇ: Atriyal fibrilasyon (AF), klinik pratikte yaygın olarak karşılaşılan bir aritmi çeşidi olup açık kalp cerrahisi sonrası da sıklıkla ortaya çıkan iyi tanımlanmış bir komplikasyondur. Postoperatif AF (POAF), koroner arter baypas greftleme (KABG) sonrası ikinci günde en yüksek insidansa sahip olmak üzere 2-4 gün içinde hastaların % 5-40’ında rapor edilmiştir. POAF’ın patofizyolojisi tam olarak anlaşılamamıştır. Bunun en önemli nedeni, patolojiye katılan çok sayıda faktörün gösterilmiş olmasıdır. Bu faktörler, kardiyopulmoner baypas (KPB)’ın non-fizyolojik doğası, enflamatuvar cevap, kardiyoplejik arrest, kardiyak manipülasyonlar, miyokardiyal iskemi-reperfüzyon hasarı ve kullanılan farmakolojik ajanlar olabilir. Albumin ve globulinler, sistemik enflamatuvar sürece katılan iki major serum protein kompanentidir. Serum albumin düzeyi kronik enflamasyonla yakından ilişkili iken, globulinlerin artmış seviyeleri de kronik enflamatuvar cevabın bir belirteci olarak işlev görür ve çeşitli proenflamatuvar sitokinlerin kümülatif maruziyeti yansıtması açısından önemlidir. Bu çalışmada Albumin globulin oranı (AGO)’nın, hem bağımsız olarak hem de POAF gelişimi için öne sürülen diğer risk faktörleri ile birlikte değerlendirilerek, POAF gelişimindeki prediktif öneminin araştırılmasını amaçladık.GEREÇ VE YÖNTEM: Erciyes Üniversitesi Tıp Fakültesi Kardiyovasküler Cerrahi Ana Bilim Dalında 01.01.2018 - 31.12.2020 tarihleri arasında izole KABG cerrahisi geçiren 288 hastanın (62 kadın ve 226 erkek) verileri retrospektif olarak incelendi. Hastaların preoperatif ve postoperatif kan değerleri, bazal karakteristik özellikleri ve intraoperatif parametreleri değerlendirildi. Çoklu regresyon analizi, Backward: Wald metoduna göre yapıldı.BULGULAR: 288 hasta içerisinde . ortanca yaş 63 (56-69) yıl olup AF gelişen grupta ise ortanca yaş, 66,0 (61,2-72,0) yıl (P: 0.003)’dır. POAF gelişme durumlarına göre hastalar gruplandırıldıklarında, iki grup arasında yaş (P: 0.003), total anastomoz sayısı (P:0.004) ve safen ven grefti (SVG) distal anastomoz sayısı (P: 0.006), preoperatif platelet sayısı (P:0.027), kan üre azotu (BUN) (P:0.004), kreatinin (P:0.001) ve postoperatif BUN (P:0.005) değerleri açısından istatistiksel olarak anlamlı fark olduğu saptanırken, preoperatif ve postoperatif AGO değerleri (P: 0,140, P: 0.313) bakımından gruplar arasında istatistiksel açıdan fark olmadığı saptandı. Çoklu regresyon analizindeki Backward: Wald metoduna göre son basamakta, POAF gelişen hastalarda; yaş, preoperatif platelet sayısı, kreatinin seviyeleri, periferik arte hastalığı (PAH) varlığı ve total anastomoz sayısı bağımsız risk faktörleri olarak bulundular.SONUÇ: Bu çalışmada, AGO değerleri ve POAF gelişimi arasında istatistiksel olarak anlamlı bir ilişki tespit edilmedi. KABG uygulanan hastalarda POAF’ın ortaya çıkışında hem genel popülasyonda, hem de ayrı bir alt grup olarak Diabetes Mellitus hastalarında preoperatif kreatinin seviyesi ve platelet sayılarının değerlendirilmesinin önemli olduğu bulunmuştur. Ayrıca, preoperatif kreatinin, yaş, total anastomoz sayısı ve preoperatif platelet sayısı bağımsız risk faktörleridir.

© 2022 Elsevier B.V.This study aims to investigate the protective effects of thymoquinone (THQ) in isoproterenol (ISO)-induced myocardial infarction (MI) in rats. Thirty-two rats were divided into four equal groups. Control, THQ; Intragastric(ig) by dissolved 20 mg/kg in 500 μl olive oil at 24-h intervals for 7 days, ISO; On the 6th and 7th days of the experiment, it was dissolved in 1 ml distilled water, 100 mg/kg, subcutaneously(sb), THQ + ISO; THQ was given 20 mg/kg at 24-h intervals for 7 days, 100 mg/kg was given on days 6 and 7 of the ISO experiment. At the end of the experiment, blood and heart tissues were taken and histological, Western blot and biochemical analyzes were performed. In the ISO group, cardiomyocyte damage and large necrotic areas were observed. While neuronal nitric oxide synthase (nNOS) decreased, inducible NOS (iNOS) and endothelial NOS (eNOS) expression increased. Receptor-interacting serine-threonine kinase (RIP/RIPK) RIP1 and RIP3 protein levels were increased. Lactate dehydrogenase (LDH), creatin-kinase (CK-MB) and cardiac troponin I (cTn-I) levels were increased. Atrial natriuretic peptide (ANP) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels were decreased. THQ caused the reduction of necrotic areas caused by ISO. NOS regulated enzyme levels. Increased ISO-induced decreased RIP1 and RIP3 expressions. THQ regulated the biochemical parameter levels. ISO triggers MI-induced necrosis through NOS enzymes by causing severe histological changes in heart tissue. THQ, on the other hand, reveals that it can be an important antinecrotic agent in the prevention of MI-induced damage by regulating both NOS enzyme levels and necrosis markers.

Aim: Fistula occlusion is one of the most common causes of hospitalization and mortality in hemodialysis patients. While there are many factors that affect the preoperative success of the fistula, we examined the effect of calcium and phosphorus values from electrolytes. Materials and methods: A total of 100 patients were included in the study. The effectiveness of the preoperative calcium x phosphorus (Ca x P) value of these patients to fistula success in the first 4 weeks was examined. Results: Calcium and phosphorus values of the blood values taken before the fistula was opened, there was a significant difference between the two groups (8.7 +/- 0.7 vs. 9.3 +/- 0.9, p = 0.001, and 3.4 +/- 0.9 vs. 5.2 +/- 1.4, p = 0.001). The difference in the Ca x P value, which is the hypothesis of our study, was found to be quite significant between the two groups (34.1 +/- 8.9 vs. 48.5 +/- 13.7, p < 0.001). Conclusion: Ca x P value was found to be significantly higher in preoperative fistula success and can be a simple and reliable parameter in the evaluation of fistula success.

Objective: Vascular injuries are observed in 0.2–4% of all traumas and can be life-threatening or difficult when not properly treated. In this study, we aimed to present our experience in the treated vascular injury cases. Materials and Methods: This retrospective and descriptive study covered the period between May 2014 and December 2018. Medical records of patients with vascular injuries were evaluated concerning demographic and trauma-related parameters. Results: In this study, 73.1% of 93 patients were male, and the average age was 27.44+-6.70 years. In the majority of the patients, it was observed that vascular injuries occurred as a result of penetrating traumas, and mainly radial and superficial femoral arteries were affected. Nerve injuries were found to be accompanied in 16.1% of the patients. The concomitant nerve injuries were also present in 16.1% of the patients. End-to-end anastomosis was used in 73.3% of the injuries. Mortality and amputation rates were 1.1% and 3.2%, respectively. Conclusion: Demographic and clinical parameters in vascular injury cases were found to be compatible with the previous studies. By collecting the correct data obtained from this study and the other studies, the medical needs of patients with vascular injuries could be better evaluated and clinical services could be planned in advance by conducting a medical approach accordingly.

Background: In this study, patients undergoing carotid endarterectomy with primary closure or patch angioplasty for carotid artery disease were evaluated retrospectively and our early results were presented. Methods: In our clinic, fifty-five patients who performed carotid endarterectomy for carotid artery disease between November 2013 and May 2017 were enrolled in the study. The files of patients were reviewed retrospectively. These patients were divided into two groups as Group 1 (primer closure group, n =32) and Group 2 (patch angioplasty group, n = 23). Both groups were compared in terms of demographic data, surgical technique, complications and early results. Results: There were no statistically significant differences in terms of intensive care unit stay and hospitalization, postoperative neck hematoma/exploration, postoperative renal failure and the other demographic data, symptomatology, surgical technique, ≥30-day stroke, ≥30-day restenosis, ≥30-day death between both groups. Conclusion: Our study results have shown that the closure of arteriotomy with primary or patch angioplasty after carotid endarterectomy is a safe method in terms of early results.

© 2022, Sociedade Brasileira de Cirurgia Cardiovascular. All rights reserved.Introduction: Cardiopulmonary bypass (CPB) is associated with hyperlactatemia, which leads to adverse clinical outcomes. No study has examined the effect of different clamping techniques on postoperative hyperlactatemia (PHL). Thus, we aimed to evaluate the impact of two different techniques on PHL and the clinical outcomes in patients undergoing isolated coronary artery bypass surgery. Methods: This retrospective study included 100 patients who underwent isolated CPB either with single clamp technique (SCT, n=47) or double clamp technique (DCT, n=53). Demographic and preoperative laboratory data, as well as operative features and arterial blood lactate levels at the onset and at the end of CPB, were collected from patient charts. Results: Blood lactate levels collected at the end of CPB did not differ significantly between groups whereas intraoperative lactate increased significantly in both groups (P

© 2022, Sociedade Brasileira de Cirurgia Cardiovascular. All rights reserved.Introduction: In this study, we aimed to investigate the relationship between postoperative mortality, morbidity, hospital stay and development of postoperative complications with the glycosylated hemoglobin (HbA1c) level and low left ventricular ejection fraction (LVEF) in diabetic and non-diabetic patients who underwent elective coronary artery bypass (CABG) surgery. Methods: The medical records of patients who underwent CABG at our clinic between January 2015 and December 2019 were retrospectively analyzed. All patients were divided into two groups according to their diabetes mellitus (DM) diagnosis. Diabetic patients were also divided into two groups according to their HbA1c levels. The HbA1c threshold value was 7%. All patients were divided into two groups in terms of LVEF. The LVEF threshold value was 40%. Results: We analyzed 393 patients, of which 304 (77.4%) were male and 177 (45.04%) patients were diabetic. For lower LVEF and HbA1c values, we found no relationship between postoperative mortality, prolonged intensive care unit (ICU) stay and development of postoperative complications. Deep surgical site infection (DSSI) was found to be more common in diabetic patients who had a higher HbA1c value. Length of hospital stay was longer in diabetic patients with HbA1c levels

Introduction: This study aimed to review the surgical excision results and pathological diagnostic features of rarely observed intracardiac masses in the light of the literature. Diagnosis and treatment approaches and complications were evaluated. Methods: Forty patients (26 females, mean age 52.1±18.1 years, and 14 males, mean age 48.1±20.5 years), who had undergone surgery for intracardiac mass between January 2008 and December 2018, were included in this study. The patients’ data were analyzed retrospectively from the medical records of both centers. Results: When the pathological diagnoses were examined, 85.8% of the masses (n=35) were observed to be benign (benign tumor + hydatid cyst) and 14.2% (n=5) were malignant tumors. The masses were most commonly located in the left atrium (75%, n=30), and this was followed by the right ventricle (12.5%, n=5), right atrium (7.5%, n=3), and left ventricle (5%, n=2). Of the patients, 7.5% (n=3) died during the early postoperative period, while the remaining 92.5% (n=37) were discharged with healing. In the histopathological diagnosis of the patients, in whom in-hospital major adverse cardiovascular events were observed, there was malignancy in two cases. Conclusion: Intracardiac masses, which have pathological features, are severe life-threatening problems. In-hospital mortality is frequent, especially in malignant tumors.

Objectives: We aimed to evaluate the potential effects of heart positioning during off-pump CABG (OPCAB) without cardiac stabilizer device on serum levels of IMA and cardiac output. Materials and Methods: This was a prospective study, in which consecutive patients who underwent isolated OPCAB were included. Data including electrocardiography and intraarterial hemodynamic monitoring parameters were recorded. Arterial pressure waveform (APW) was analyzed. Cardiac output was measured for circumflex coronary artery (Cx), diagonal coronary artery (D1), left anterior descending coronary artery (LAD), and right coronary artery (RCA) positions. Preoperative and postoperative 1, 2, 4, and 12-hour blood samples were taken for serum ischemia modified albumin measurements. Results: Forty patients who underwent OPCAB were included in the study. The mean age was 60.3 ± 10.2 years. Hospital mortality, stroke, postoperative myocardial infarction, acute kidney injury, sternal infection and re-operation for bleeding/tamponade were not observed postoperatively. Six patients (15%) who developed postoperative AF had a significantly higher mean serum IMA level compared with patients who did not.There was no statistically significant difference in preoperative and postoperative mean serum IMA levels (p = 0.925). Mean CO values measured at four different positions of the heart were not significantly different from each other except a difference between LAD and Cx(p=0.002). Conclusion: Our results showed that when the heart was in Cx anastomosis position, the cardiac output was significantly lower than LAD position; however, there was no significant serum IMA raise despite cardiac output decrease. IMA levels did not change significantly from baseline values. Patients who developed postoperative AF had higher IMA levels than patients who did not develop AF.

Aim: Atrial fibrillation is a common complication after coronary bypass surgery. There are various studies aimed at predicting the development of postoperative atrial fibrillation (POAF). Low vitamin D status has been associated with an increased risk of cardiovascular disease. Atrial fibrillation (AF) is the most common cardiac arrhythmia. We purpose to evaluate the effect of serum 25(OH) vitamin D level on the development of POAF after cardiac bypass surgery (CABG). Material and Methods: Our study is a retrospective chart review which all patients who underwent isolated, elective, on-pump CABG operation between January 2017 and January 2018. POAF was defined as the development of atrial fibrillation after the completion of cardiac surgery, which required intervention.The whole study population divided into two groups: group I, patients who developed POAF and group II, patients who did not.Ejection fraction and left atrium diameter of participants were recorded. 25(OH)D and parathormone values, as well as other demographic and clinical characteristics, were collected. Results: A total of 78 patients were available for analyses. While 61 patients did not develop POAF, 17 patients developed. The rate of POAF was 22%. The median ages of the patients with and without POAF were significantly different (61(54-72) vs. 69(65-77) years, p=0.012). The left atrial diameter was larger in patients with POAF (p=0.025). Preoperative ejection fractions were not different between the groups. Total bypass time and cross-clamp time were not significantly different. Although the mean value of preoperative 25(OH)D level was slightly higher in patients who did not develop POAF compared to that of patients with POAF, the difference was not statistically different between the groups. Conclusion: Preoperative 25(OH)D levels were not different between the patients with and without POAF.

Objective: Median sternotomy is the most commonly used method for open heart surgery. Poor sternal healing after median sternotomy can cause a significant increase in morbidity and mortality and prolong hospital stay. Although several techniques are available for sternal closure, it is practically limited, and the most common technique is the simple wire technique. There is insufficient scientific study on the comparison of alternative techniques. The aim of the present study was to compare the follow-up results of the sternotomy closure techniques: sternal cable and simple wire.

Background Endothermal treatment of the great saphenous vein has become the first line of treatment for superficial venous reflux. A new technique for venous insufficiency is non-thermal ablation with vein sealing system which comprises the endovenous delivery of cyanoacrylate tissue adhesive to the vein causing fibrosis. Methods This is a single-center prospective study of treatment of great saphenous vein incompetence in 62 patients with vein sealing system (Biolas VariClose ® FG Group, Turkey). All cases were implemented under local anesthesia. Tumescent anesthesia was not required. Patients were not given any nonsteroidal anti-inflammatory drug postoperatively; advised to wear elastic bandages for 1 day; and compression stockings were not offered. Results Treatment success was defined as complete occlusion of treated vein or recanalized segment shorter than 5 cm. Subtotal recanalization was defined as great saphenous vein flow containing 5–10 cm segment of treated vein. A recanalized great saphenous vein or treatment failure was defined as an open part of the treated vein segment more than 10 cm in length. At 1 week and 1 month control, duplex scans showed total occlusion for all patients (100%), total occlusion for 58 patients (93.5%), and subtotal occlusion for 4 patients (6.5%) at third month. At the end of 6 months, total occlusion 56 patients (90.3%) and subtotal occlusion for 2 patients (3.2%). For 4 (6.5%) patients, no occlusion was observed, and the diameter was >11 mm. Embolization of great saphenous vein with cyanoacrylate has been performed since the beginning of this decade. Combined chemical and physical mechanism of action results in permanent vein closure. In a recently published study, a 24-month occlusion rate of 92% was demonstrated. The most commonly reported complications of cyanoacrylate use for the treatment of varicose vein disease, so far, include ecchymosis and phlebitis. Almeida et al. reported that phlebitis is the most frequent side effect at a rate of 16%. In our study, phlebitis rate was not as high as reported. It may be caused due to shorter time of follow-up in the hospital. Conclusion Endovenous ablation of incompetent great saphenous vein with cyanoacrylate-based glue is feasible. Operation time is short, and tumescent anesthesia is unnecessary as postprocedure compression stockings. Lack of significant side effects and an yearly success rate of 100% are benefits of the system.

Background This study aims to investigate the relationship between the development of aortic dissections and aneurysms with the polymorphisms of angiotensin converting enzyme gene, methylenetetrahydrofolate reductase gene, plasminogen activator inhibitor-1 gene, and nitric oxide synthase gene. Methods Between April 2009 and July 2014, 38 patients with aortic dissections (28 males, 10 females; mean age 55.1±10.7 years; range, 30 to 78 years) and 67 patients with aortic aneurysms (57 males, 10 females; mean age 63.0±11.4 years; range, 31 to 82 years) were included in this cross-sectional study. The control group consisted of 60 healthy volunteers (41 males, 19 females; mean age 56.3±11.2 years; range, 30 to 82 years) without an aortic aneurysm or dissection, as assessed by thoracoabdominal computed tomography. The prespecified four genes were genotyped with competitive allelespecific polymerase chain reaction. Results The aortic dissection group had higher nitric oxide synthase-3 (4b/4b) expression levels, compared to the control group. The aortic aneurysm group had also higher nitric oxide synthase-3 (4b/4a) expression levels, compared to the control group. Compared to the control group, a higher rate of angiotensin converting enzyme I/D gene polymorphism was detected in the aneurysm group, while higher D/D polymorphism rates were found in the dissection group; although not statistically significant. Conclusion Our study results suggest that the nitric oxide synthase-3 intron 4b/4b and nitric oxide synthase-3 intron 4b/4a gene polymorphisms can be used as a predictor of aortic dissection and aneurysm development.

Anterior spinal artery infarction is extremely rare in children; it is caused by the hypoperfusion of the anterior spinal artery, leading to ischemia. Patients typically present with acute paraparesis or quadriparesis, depending on the level of spinal cord involvement. In general, it is clinically diagnosed, and neuroimaging is used to confirm the diagnosis and exclude other conditions. There are only a few reports in the pediatric literature characterizing the etiology, diagnosis, treatment, and prognosis of spinal cord infarction. It is associated with moderate-to-severe disabilities and a high mortality rate. Here we report an unusual case wherein a 12-month-old male developed spinal cord infarction following surgery to repair the coarctation of the aorta. Spinal magnetic resonance imaging showed bilateral hyperintensity corresponding to the anterior horns of grey matter in the conus.

Two patients were given a pericardial-peritoneal window (PPW) using a subxiphoid approach for chylous pericardial effusion. Complete drainage without recurrence was achieved with PPW in a 22-year-old female patient who had recurrent chylopericardium associated with Klippel-Trenaunay syndrome and in an 11-year-old girl with tricuspid atresia who had undergone the Fontan procedure. PPW is a simple, easy-to-learn, safe, and effective procedure. It creates a communication between the pericardial and peritoneal cavities and is applicable in most patients with noninfectious benign pericardial effusion without serious complications and where adequate drainage can be obtained without the need for external draining systems. We describe the technique, its clinical characteristics, and the results of patients undergoing this treatment.

Objective: Impaired sternal wound healing remains problematic after median sternotomy and can cause to significant morbidity after cardiac surgical procedures. Although some reconstruction systems exist for sternal closure, their use is limited by expense and practicality, and simple wire closure remains the most common technique to close the sternum. In this study, we aim to discuss the results of 6 cases that underwent surgery for sternal dehiscence(SD). Methods: We reviewed six patients with sternal dehiscence who underwent surgery in our department between April 2013 and May 2014. We have used a novel closure technique in six patients with sternal dehiscence and evaluated early-term results of sternal clips plus rewiring following failed sternal closure. Results: The mean age was 63 (range, 55 to 79 years). All patients were male. We have used a novel closure technique with sternal clips plus rewiring in all patients. We evaluated six patients with non-infectious SD. Sternal reconstruction using rigid fixation with clips improve bone healing and reduce early postoperative pain. All cases were discharged with successful treatment. Conclusions: We believe that this method of sternal closure guarantees better clinical outcomes rather than sternal wire closure. Additionally, SCD(sternal closure device) clips proved to be cost effective in cardiac surgery. J Clin Exp Invest 2014; 5 (4): 534-538