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INTRODUCTION: This study aimed to investigate the relationship between acquired antithrombin deficiency in patients undergoing postcardiotomy extracorporeal membrane oxygenation (PC-ECMO) and thromboembolic or haemorrhagic events such as bleeding, peripheral arterial thromboembolism, and ischemic cerebrovascular events. METHODS: The study was designed as a single-center, prospective study and conducted at our hospital between November 2019 and June 2021. 50 patients who underwent ECMO due to postcardiotomy cardiogenic shock were included in the study. Antithrombin (AT) activity testing was performed immediately after ECMO placement and continued for 5 days. The total of haemorrhagic or thromboembolic events was defined as morbidity. The entire patient population was assessed daily for AT measurements according to morbidity status, and ROC analysis was applied to determine the cut-off point. The correlation between clinical outcomes and morbidities with antithrombin levels was analysed. RESULTS: In our study, we identified a cut-off for AT levels on the first postoperative day. The risk of both bleeding (p = .006) and thromboembolism (p = .012) was significantly higher in patients below the 48.9% cut-off value. AT levels were compared with data on separation from PC-ECMO. The rate of separation from ECMO was 7.969 times higher in cases with AT levels above 51.8 on the third postoperative day and 5.6 times higher in cases with AT levels above 47.5 on the fourth postoperative day. CONCLUSION: Acquired antithrombin deficiency may develop in adults undergoing PC-ECMO. In our study, we demonstrated that in patients with low antithrombin levels, the risk of bleeding and thromboembolism increased. Additionally, since AT levels were higher in survivors, this can be considered an indicator of severity. This study is the first prospective study related to determining target antithrombin levels in adult patients undergoing PC-ECMO.
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Steal syndrome causing limb ischemia is a rare but important complication of arteriovenous fistulas. When surgical or endovascular means to resolve ischemia are inconclusive, closure of the fistula becomes required. Our case presented with lower extremity ischemia resulting from an arteriovenous fistula graft. We present the successful endovascular closure of the lower extremity graft using the Amplatzer Vascular Plug.
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BACKGROUND: We aimed to investigate the predictive value of Society of Thoracic Surgeons (STS) and European System for Cardiac Operative Risk Evaluation (EuroSCORE II) scores for mortality in octogenarian cardiac surgery patients. METHODS: Between January 2016 and December 2019, cardiac operations performed in 116 octogenarian patients (73 males, 43 females; mean age: 82.9±3.1 years; range, 80 to 97 years) were retrospectively analyzed. The patients with and without mortality were compared for their demographic and operative factors. The STS and EuroSCORE II scores, and observed mortality rates were assessed. RESULTS: Mean STS score was 3.7±11.1 and mean EuroSCORE II was 5.2±5.4. For any operation type, the mean EuroSCORE II was significantly higher (8.1±7.4 vs. 4.1±4.0, respectively; p=0.006) in the patients with mortality. For elective operations, the mean EuroSCORE II was higher in cases with mortality (7.2±7.3 vs. 3.7±3.9, respectively; p=0.006); however, for urgent cases, there was no significant difference between the scores. Using the receiver operating characteristic curve, the EuroSCORE II had a higher area under the curve for all cases and elective cases than the STS scores. CONCLUSION: The EuroSCORE II performed better than the STS score for mortality prediction in octogenarians, whereas the predictions of either scoring system was unsatisfactory for urgent surgery and combined procedures. Population-based validation studies are needed for a better risk scoring system in this age group.