External Validation and Evaluation of Reliability of the FARP2 Score to Predict Early Graft Failure after Infrainguinal Bypass.

BACKGROUND: To evaluate the accuracy of the FARP2 (female gender [F], bypass after a previous angioplasty [A], Redo bypass [R], and Pedal bypass [P2]) scoring system in predicting early graft failure (EGF) after infrainguinal bypass surgery (IBS). METHODS: Charts of patients who underwent IBS between January 2014 and January 2017 in 2 tertiary academic centers were evaluated retrospectively. In follow-ups, 1 week after operation, detailed physical examination was done, Doppler ultrasonography was performed 1 month after operation, and integrity of the graft was evaluated. Calculation of FARP2 score was performed by a single surgeon (M.S.) who was well informed regarding FARP2 scoring system. The FARP2 scoring system was evaluated as following: female gender 1 point, bypass after a previous angioplasty 1 point, redo bypass 1 point, and pedal bypass 2 points. RESULTS: Totally, 231 patients (180 men and 51 women) were enrolled in the study. The mean FARP2 score was 0.52 ± 0.73. The graft occlusion occurred in 23 patients (10%). Presence of critical leg ischemia was lower in patients who faced early graft occlusion (P = 0.002). On the other hand, Rutherford classification score was significantly higher in patients who did not face graft occlusion (4.1 vs. 3.4, P = 0.007). Moreover, unsuccessful angioplasty history and history of previous surgery were more common in that group (P < 0.001 and P < 0.001, respectively). None of the patients faced acute pulse loss, numbness loss, or ulcerative lesion after unsuccessful angioplasty. The mean interval between unsuccessful angioplasty and bypass was 1 ± 1.2 days in our study, which may have a role to prevent undesirable clinical consequences. The FARP2 score was 1.5 ± 1.2 and 0.4 ± 0.6 in patients who faced graft occlusion and in patients without occlusion (P < 0.001). Multivariate regression analysis identified that critical leg scheme, presence of unsuccessful angioplasty history, and history of previous bypass operation were found as a predictive factor for EGF (P = 0.044, P < 0.001, and P = 0.003, respectively). Finally, our study demonstrated that patients with FARP2 score 3-4 have 2.88-fold increased graft occlusion risk when compared with patients with FARP2 score 1-2. CONCLUSIONS: Our study externally validates that the FARP2 scoring system is related with EGF after IBS. The FARP2 score may be an effective practice in prediction of EGF in patients with peripheral arterial bypass surgery.

Post-transfusion purpura following cardiac surgery.

Post-transfusion purpura (PTP) is a rare disorder characterized by severe thrombocytopenia developing after a blood component transfusion. Ninety percent of the reported cases are women. In this article, we present a case of PTP in a male patient who underwent coronary artery bypass grafting and discuss its management.

Effects of Ginkgo biloba extract on spinal cord ischemia-reperfusion injury in rats.

BACKGROUND: We aimed to assess the biochemical and histopathologic effects of Ginkgo biloba extract (EGb) in an ischemia-reperfusion (IR) model of spinal cord ischemia induced by cross-clamping of the infrarenal abdominal aorta. METHODS: A total of 24 Sprague-Dawley rats were divided into 3 groups as group 1: control (sham laparotomy), group 2: IR, and group 3: IR+EGb treatment (IR+T) group. All subjects were euthanized 2 days postsurgery and their spinal cords were removed. Tissue malondialdehyde, superoxide dismutase, glutathione (GSH), and glutathione peroxidase levels were measured, and the spinal cord tissue samples were examined histopathologically. RESULTS: No significant difference was detected in ischemia markers between control, IR, and IR+T groups, with the exception of GSH, which was significantly lower in the IR group. GSH levels in group 1 and group 3 were similar. The group 2 displayed significant ischemic damage to the medulla spinalis. This damage was less pronounced in group 3 compared with group 2 only, but in extent and intensity comparable with the controls. CONCLUSIONS: Although we were not able to demonstrate a uniform effect of EGb on biochemical markers of IR injury, the histopathologic data appear to show a protective effect conferred on the spinal cord tissue by EGb.

Repair of rheumatic tricuspid valve stenosis with autologous pericardium.

The aim of the present study was to describe a successful method for treating rheumatic tricuspid valve stenosis with autologous pericardium, commissurotomy, and a Kalangos ring without replacing the tricuspid valve.

Primary myxoma of the pulmonary artery.

Cardiac myxomas are most commonly found within the left atrium. We now report a patient presenting with dyspnea, palpitation, and chest pain who was found to have myxoma arising from the pulmonary valve commissure. Urgent surgical treatment is curative and warranted for these lesions, in order to prevent outflow obstruction and thromboembolic phenomena.

Combined aortic and mitral valve replacement in a child with mucopolysaccharidosis type I: a case report.

Mucopolysaccaridosis syndromes are metabolic disorders that are inherited in an autosomal recessive pattern, and demonstrate cardiovascular involvement that, on rare occasions, results in surgery. The case is presented of a 12-year-old boy with symptoms and signs of congestive heart failure who was referred to the authors' department for severe mitral and aortic valvular stenosis. The patient was shown to have the somatic characteristics of mucopolysaccharidosis, while urinalysis indicated the presence of chondroitin sulfate B. Mitral and aortic valve replacements were carried out, using bileaflet mechanical valves with a standard median sternotomy and cardiopulmonary bypass. A bileaflet preservation technique was adopted during mitral valve replacement to provide better hemodynamics. Severe cardiac involvement in mucopolysaccharidosis requiring cardiac surgery in pediatrics has been rarely documented. A low-profile bileaflet mechanical valve, enabling a larger-sized valve insertion, is preferred in order to avoid patient-prosthesis mismatch during somatic growth of the patient.

Isolated partial anomalous pulmonary venous connection of the left lung.

Isolated partial anomalous pulmonary venous connection (PAPVC) of the entire left lung is a rare congenital anomaly with incidental diagnosis and vague symptoms, if any, until late adulthood. If left untreated, PAPVC may result in severe right ventricular failure and pulmonary vascular disease. We present the case of a 34-year-old woman with isolated PAPVC of the entire left lung. The patient underwent operation with a side-to-side left atrio-vertical vein anastomosis while on cardiopulmonary bypass and under cardioplegic arrest. She was discharged without complications and with a gradient of 2 mm Hg across the anastomosis. Left-sided PAPVC can be repaired with minimal morbidity and mortality. Surgical correction is warranted when patients are symptomatic or show evidence of right-sided overload due to unpredictability of the natural course. Recent data demonstrate that both on-pump and off-pump surgical procedures produce excellent long-term outcomes when performed without persisting gradients.

Comparison of Mask Oxygen Therapy and High-Flow Oxygen Therapy after Cardiopulmonary Bypass in Obese Patients.

Background: To clarify the efficiency of mask O2 and high-flow O2 (HFO) treatments following cardiopulmonary bypass (CPB) in obese patients. Methods: During follow-up, oxygenization parameters including arterial pressure of oxygen (PaO2), peripheral oxygen saturation (SpO2), and arterial partial pressure of carbon dioxide (PaCO2) and physical examination parameters including respiratory rate, heart rate, and arterial pressure were recorded respectively. Presence of atelectasia and dyspnea was noted. Also, comfort scores of patients were evaluated. Results: Mean duration of hospital stay was 6.9 ± 1.1 days in the mask O2 group, whereas the duration was significantly shorter (6.5 ± 0.7 days) in the HFO group (p=0.034). The PaO2 values and SpO2 values were significantly higher, and PaCO2 values were significantly lower in patients who received HFO after 4th, 12th, 24th, 36th, and 48th hours. In postoperative course, HFO leads patients to achieve better postoperative FVC (p < 0.001). Also, dyspnea scores and comfort scores were significantly better in patients who received HFO in both postoperative day 1 and day 2 (p < 0.001, p < 0.001 and p=0.002, p=0.001, resp.). Conclusion: Our study demonstrated that HFO following CPB in obese patients improved postoperative PaO2, SpO2, and PaCO2 values and decreased the atelectasis score, reintubation, and mortality rates when compared with mask O2.