Central vs. Peripheral Cannulation During Reoperations: A Propensity Score Matching Analysis.

INTRODUCTION: The aim of this study is to compare the postoperative outcomes and early mortality of peripheral and central cannulation techniques in cardiac reoperations using propensity score matching analysis. METHODS: In this retrospective cohort, patients who underwent cardiac reoperations with median resternotomy were analyzed in terms of propensity score matching. Between November 2010 and September 2020, 257 patients underwent cardiac reoperations via central (Group 1) or peripheral (Group 2) cannulation. A 1:1 propensity score matching was performed to balance the influence of potential confounding factors to compare postoperative data and mortality rate. RESULTS: There were no significant differences when comparing the matched groups regarding early mortality (P=0.51), major cardiac injury (P=0.99), prolonged ventilation (P=0.16), and postoperative stroke (P=0.99). The development of acute renal failure (P=0.02) was statistically less frequent in Group 1. CONCLUSIONS: Performing cardiopulmonary bypass via peripheral cannulation increases acute renal failure in cardiac reoperations. In contrast, peripheral or central cannulation have similar early mortality rate in cardiac reoperations.

Fate of the Patent False Lumen of the Descending Aorta After Surgical Treatment for Acute Type 1 Aortic Dissection.

INTRODUCTION: This study aimed to investigate the factors affecting false lumen patency in the descending thoracic aorta among patients who underwent surgery for acute type 1 aortic dissection. METHODS: A total of 112 patients with acute type 1 aortic dissection, with the flap below the diaphragm level, underwent surgery between January 2010 and September 2019. Of these, 60 patients who were followed up for ≥ 12 months and whose computed tomography scans were available were included in this study. The patients were divided into two groups: group I, consists of patent false lumen (n=36), and group II, consists of thrombosed false lumen (n=24). Demographic data, operative techniques, postoperative descending aortic diameters, reintervention, and late mortality were compared between the two groups. RESULTS: The mean follow-up period of all patients was 37.6±26.1 months (range: 12-104). The diameter increase in the proximal and distal descending aorta was significantly higher in the patent false lumen group (5.3±3.7 mm vs. 3.25±2.34 mm; P=0.015; 3.1±2.52 mm vs. 1.9±1.55 mm; P=0.038, respectively). No significant difference in terms of hypertension was found between the two groups during the follow-up period (21 patients, 58.3% vs. 8 patients, 33.3%; P=0.058). A total of 29 patients (48.3%) were found to be hypertensive in the postoperative period. CONCLUSION: After surgical treatment for acute type 1 aortic dissection, patients should be monitored closely, regardless of whether the false lumen is patent or thrombosed. Mortality and reintervention can be seen in patients with patent false lumen during follow-up.

Predictors and outcomes of gastrointestinal complications after cardiac surgery: A systematic review and meta-analysis.

Background: In this systematic review, we aimed to examine the risk factors and surgical outcomes of gastrointestinal complications using the meta-analysis techniques. Methods: Studies involving patients with and without gastrointestinal complications after cardiac surgery were electronically searched using the PubMed database, Cochrane Library and Scopus database, between January 2000 and May 2022. Some studies on gastrointestinal complications examined only single gastrointestinal complication (only intestinal ischemia, only gastrointestinal bleeding or only liver failure). Studies evaluating at least three different gastrointestinal complications were included in the meta-analysis to reduce the heterogeneity. Cohort series that did not compare outcomes of patients with and without gastrointestinal complications, studies conducted in a country"s health system databases, review articles, small case series (<10 patients) were excluded from the meta-analysis. Results: Twenty-five studies (8 prospective and 17 retrospective) with 116,105 patients were included in the meta-analysis. The pooled incidence of gastrointestinal complications was 2.51%. Patients with gastrointestinal complications were older (mean difference [MD]=4.88 [95% confidence interval [CI]: 2.85-6.92]; p<0.001) and had longer cardiopulmonary bypass times (MD=17.7 [95% CI: 4.81-30.5]; p=0.007). In-hospital mortality occurred in 423 of 1,640 (25.8%) patients with gastrointestinal complications. In-hospital mortality was 11.8 times higher in patients with gastrointestinal complications (odds ratio [OR]=11.8 [95% CI: 9.5-14.8]; p<0.001). Conclusion: The development of gastrointestinal complications after cardiac surgery is more commonly seen in patients with comorbidities. In-hospital mortality after cardiac surgery is 11.8 times higher in patients with gastrointestinal complications than in patients without.

Predictive value of age, creatinine, and ejection fraction (ACEF) scoring system for operative mortality in patients with Stanford type A aortic dissection.

Purpose: Stanford type A aortic dissection (TAAD) is the most common and fatal type of dissection. An easier-to-use risk stratification may help eliminate bias in patients at high risk of dissection. The age, serum creatinine, and ejection fraction (ACEF) score is a simple risk model developed to predict the mortality risk of elective coronary artery bypass graft surgery. This study aimed to evaluate the relationship between preoperative ACEF score and operative mortality in patients with TAAD undergoing emergency surgery. Methods: In this retrospective cohort study, 113 patients diagnosed with TAAD between January 2017 and September 2021 were evaluated. The primary endpoint was operative mortality. Receiver operating characteristic analysis was performed for the ACEF score, ACEF II score, and European System for Cardiac Operative Risk Evaluation II. Univariate and multivariate analyses of operative mortality were performed using the logistic regression model. Results: Operative mortality occurred in 23 (20.4%) patients. The cutoff ACEF score was calculated as 1.1 for predicting operative mortality (area under the curve = 0.712, P value = 0.002, sensitivity = 74.0%, specificity = 67.8%, likelihood ratio = 2.3). Based on the cutoff value, 46 (40.7%) patients had a high ACEF score (ACEF ≥ 1.1) and 67 (59.3%) patients had a low ACEF score (ACEF < 1.1). The high ACEF score was associated with an increased incidence of operative mortality compared with the low ACEF score (37.0% vs. 9.0%; P = 0.001). Conclusions: The ACEF score can be used as a useful and relatively simple tool for risk stratification before TAAD surgery. However, the ACEF score is only indicated for risk assessment and should not affect treatment.

A Rare Catastrophe: Three Cases of Aortic Root Dehiscence after Surgery.

Ascending aortic pathologies may be life-threatening. Postoperative aortic root dehiscence is a very rare but extremely dangerous complication with a high mortality rate, and redo surgery is mandatory due to high risk of spontaneous rupture. We present three cases that had undergone Bentall procedure and had postoperative aortic root dehiscence. One of the patients presented with hemiplegia caused by septic embolus while the others had mild symptoms. Dr. Yakut's modified Bentall procedure, the flanged technique, was performed for each patient in redo surgery. Two patients were successfully discharged from the hospital, but one died due to intracranial hemorrhage and multiple organ failure.

Albumin-Bilirubin Score: A Novel Mortality Predictor in Valvular Surgery.

INTRODUCTION: The heart and liver are two organs that are closely related. The Albumin-Bilirubin (ALBI) score is a developed scoring system for assessing liver function. The aims of this study were to examine the correlation between preoperative ALBI score and pulmonary artery pressure and to investigate its ability to predict heart valve surgery mortality outcomes. METHODS: The data of 872 patients who underwent isolated and combined heart valve surgery from 2014 to 2021 were retrospectively screened. In the preoperative period, 152 patients with laboratory tests including albumin and total bilirubin were found and analyzed retrospectively. Thirteen of these patients were excluded from the study. The remaining 139 patients were included in the analysis. Baseline demographic data, echocardiography data, performance status, laboratory data, operative data, and postoperative status were collected. The optimal cutoff value of preoperative ALBI score was calculated. RESULTS: The cutoff for ALBI scores was calculated as -2.44 to predict in-hospital mortality (sensitivity = 75.0%, specificity = 70%). Based on the cutoff value, 90 patients had a low ALBI score (≤ -2.44, 64.7%) and 49 patients had a high ALBI score (> -2.44, 35.3%). High ALBI score was associated with an increased incidence of acute kidney injury and in-hospital mortality, and a positive correlation was found between ALBI score and pulmonary artery pressure. CONCLUSION: In patients with valvular surgery, high ALBI score was an independent prognostic factor of in-hospital mortality and acute kidney injury. It is easily measurable and a cost-effective way to predict mortality.

Early Mortality Predictors in Infective Endocarditis Patients: A Single-Center Surgical Experience.

INTRODUCTION: Infective endocarditis is a disease that progresses with morbidity and mortality, afecting 3-10 out of 100,000 people per year. We conducted this study to review the early outcomes of surgical treatment of infective endocarditis. METHODS: In this retrospective study, 122 patients who underwent cardiac surgery for infective endocarditis in our clinic between November 2009 and December 2020 were evaluated. Patients were divided into two groups according to in-hospital mortality. Demographic, echocardiographic, laboratory, operative, and postoperative data of the groups were compared. RESULTS: Between November 3, 2009, and December 7, 2020, 122 patients were operated for infective endocarditis in our hospital. Emergency surgery was performed in nine (7.3%) patients. In-hospital mortality occurred in 23 (18.9%) patients, and 99 (81.1%) patients were discharged. In-hospital mortality was related with older age, presence of periannular abscess, New York Heart Association class 3 or 4 symptoms, low albumin level, high alanine aminotransferase level, and longer cross-clamping time (P<0.05 for all). CONCLUSION: The presence of paravalvular abscess was the most important prognostic factor in patients operated for infective endocarditis.

Relationship between in-hospital mortality and creatinine/albumin in patients with ST-elevation myocardial infarction without standard modifiable risk factors.

Background: Diabetes, hypertension, hyperlipidemia and smoking are associated with coronary artery disease and ST-elevation myocardial infarction (STEMI). However, patients without any classic risk factors have a higher mortality rate in the post-STEMI period. The aim of this study was to investigate the relationship between in-hospital mortality and creatinine/albumin ratio in patients with STEMI without modifiable risk factors. Materials & methods: All patients included in this study with a diagnosis of STEMI and who underwent primary percutaneous intervention between 2016 and 2020 were retrospectively analyzed. Patients were included in the standard modifiable cardiovascular risk factor (SMuRF) group if at least diabetes, hypertension, smoking or hyperlipidemia was present according to risk factors. Patients without these risk factors were considered the non-SMuRF group. Results: Creatinine/albumin ratio was found to be higher in non-SMuRF patients with mortality (p < 0.001). In multivariate logistic regression analysis, ejection fraction, hemoglobin and SMuRF were found to be inversely associated with in-hospital mortality (odds ratio [OR]: 0.48, 95% CI: 0.35-0.66, p < 0.001; OR: 0.70, 95% CI: 0.56-0.88, p = 0.002; OR: 0.57, 95% CI: 0.34-0.95, p = 0.03, respectively). Conclusion: The creatinine/albumin ratio can be used as a predictor of mortality in these patients; it can help identify high-risk patients beforehand.

Custodiol versus Blood Cardioplegia: Comparison of Myocardial Immunohistochemical Analysis and Clinical Outcomes.

INTRODUCTION: Custodiol (histidine-tryptophan-ketoglutarate) and repetitive blood cardioplegia are the solutions for myocardial protection and cardiac arrest. In this study, we aimed to compare immunohistochemical analysis, clinical outcomes, and cardiac enzyme values of Custodiol and blood cardioplegia groups. METHODS: This was a randomized prospective study consisting of 2 groups and 20 patients, 10 patients for each group, who underwent mitral and mitral/tricuspid valve surgery. Group 1 was formed for Custodiol cardioplegia and group 2 for blood cardioplegia. Perioperative and postoperative cardiac events were recorded, cardiac enzymes were analyzed with intervals, and myocardial samples were taken for immunohistochemical analysis. Recorded data were statistically evaluated. RESULTS: There was no significant difference for the Custodiol and blood cardioplegia groups in perioperative and postoperative cardiac performance and adverse events. Cardiac enzyme analysis showed no significant difference between groups. However, two parameters (eNOS, Bcl-2) were in favor of the Custodiol group in immunohistochemical studies. Custodiol performed better in cellular oxidative stress resistance and cellular viability. CONCLUSION: Clinical outcomes and cardiac enzyme analysis results were similar regarding myocardial protection. However, Custodiol performed better in the immunohistochemical analysis.

Outcomes of COVID-19 infection occurring in the recovery period of the open-heart surgery.

Background: In this study, we aimed to examine the effect of novel coronavirus 2019 disease (COVID-19) on the healing process of patients undergoing open-heart surgery. Methods: Between October 2020 and May 2021, a total of in 22 patients (14 males, 8 females; mean age: 60±15 years; range, 18 to 82 years) who developed COVID-19 within the first 30 days after open-heart surgery were retrospectively analyzed. Since the study was conducted in the pre-vaccination period, all of the patients were unvaccinated. Demographic, operative, and laboratory data of the patients were analyzed, and morbidity and mortality rates were evaluated. Results: Postoperative COVID-19 infection occurred in 22 of 1,171 patients who underwent open-heart surgery. Pneumonia developed in 14 (64%) patients and mechanical ventilation support was required in 50% (n=7) of them. Mortality was seen in eight (36%) patients. Only procalcitonin level (p=0.003) and age (p=0.005) had significant effects on survival. Conclusion: Postoperative COVID-19 infection is associated with high pneumonia and mortality rates in unvaccinated patients. Protocols that can prevent false polymerase chain reaction negativity and early contamination can be life-saving.

Effect of Pulsatile Cardiopulmonary Bypass in Adult Heart Surgery.

BACKGROUND: This study aimed to examine the effect of pulsatile flow pattern on tissue perfusion, particularly cerebral tissue perfusion, at pre-determined intervals during CPB, as well as its effects on postoperative morbidity and mortality. METHODS: This retrospective study included 134 adult patients, who underwent cardiac surgery with cardiopulmonary bypass (CPB). Patients were grouped based on the flow pattern used during CPB: non-pulsatile CPB group (N = 82) and pulsatile CPB group (N = 52). Cerebral oxygen saturation, arterial pH and arterial lactate levels were measured at four time points, during the operation and the 2 groups were compared with regard to changes over time as well as differences in postoperative outcomes. RESULTS: The 2 groups were similar, in terms of mean values and intraoperative changes in cerebral oxygen saturation and arterial pH. Non-pulsatile CABG group had significantly higher arterial lactate levels over the measurement period, which was not affected by the timing of the measurements. Postoperative drainage, duration of ventilation and duration of hospital stay significantly were higher and postoperative blood urea nitrogen significantly was lower in the non-pulsatile CPB group. Other postoperative outcomes were similar across the groups. CONCLUSION: Findings of this study do not support the superiority of pulsatile flow pattern during CPB, in terms of cerebral oxygen saturation or postoperative mortality/morbidity. Further and larger comparative studies are warranted before pulsatile blood flow pattern can be established as a routine clinical method.

Transcatheter closure vs totally endoscopic robotic surgery for atrial septal defect closure: A single-center experience.

BACKGROUND: Transcatheter closure is the preferred method for atrial septal defect (ASD) closure. Robotic surgery has become the least invasive technique for ASD closure. Therefore, we sought to evaluate the outcomes in patients who underwent ASD closure with transcatheter or robotic surgery techniques. METHODS: A total of 462 patients underwent totally endoscopic robotic (n = 217) or transcatheter ASD closure (n = 245). Demographic data, perioperative data, and outcomes were compared. RESULTS: The mean age was lower in the robotic surgery group than the transcatheter group (31.4 ± 11.8 vs 39.4 ± 13.2 years; P = .001). Ventilation time, intensive care unit (ICU) stay, and hospital stay was significantly lower in the transcatheter group. The postoperative new-onset neurological event was seen in one (0.5%) patient in robotic surgery, and four (1.6%) patients in the transcatheter closure group. New-onset atrial fibrillation was found to be higher in transcatheter closure (two vs seven patients; P = .133) group. Surgical conversion to a larger incision occurred in two patients (1%) in robotic surgery, while two patients (0.5%) underwent emergency median sternotomy due to device embolization to the main pulmonary artery. There was no mortality in both groups. During follow-up, one patient (0.5%) who underwent robotic surgery was reoperated, and two patients (0.8%) who underwent transcatheter procedure required surgical intervention due to device migration and severe residual shunting (P = .635). CONCLUSION: Both transcatheter and robotic surgery approaches had excellent outcomes but transcatheter closure had shorter hospital and ICU stays. Robotic surgery provides a similar complication risk that can be comparable to the transcatheter approach as well as patient comfort and cosmetic advantage over the other surgical techniques.

Right pericardial window opening: a method of preventing pericardial effusion.

AIM: In this study, we aimed to investigate the superiority of right pericardial window (RPW) versus posterior pericardial drain placing for the parameters of pericardial effusion and the postoperative complications at the patients who has undergone cardiac surgery. MATERIALS AND METHODS: Between July and September 2018, 120 adult patients (mean age 50.30 ± 14.61) who underwent cardiac surgery without the necessity of opening the pleura were included in the study. In Group 1, the RPW was opened (n = 60), and Group 2 posterior pericardial drainage tube was placed without RPW (n = 60). Risk factors and postoperative complication were evaluated and compared between the Groups. RESULTS: Cardiac tamponade occurrence was not significantly different between the Groups (Group 1, n = 0 and Group 2, n = 3, p = 0.079). Postoperative transthoracic echocardiographic controls revealed significant pericardial effusion in Group 2 (6.90 mm ± 13.02 mm) compared to Group 1 (2.30 mm ± 5.60 mm) (p = 0.013). Postoperative creatinine levels were 0.75 ± 0.26 in Group 1 and 0.88 ± 0.36 in Group 2 (p = 0.022). A significant decrease in glomerular filtration rate was observed in Group 2 (102.7 ± 24.5 and 91.2 ± 28, p = 0.019). Postoperative acute renal failure was significantly higher in Group 2 compared to Group 1 (p < 0.001). Postoperative new onset atrial fibrillation occurred in 4 patients in Group 1 and 8 in Group 2 (p = 0.224). The duration of intensive care unit stay was 36.00 ± 22.31 h in Group 1 and 53.60 ± 59.50 h in Group 2 (p = 0.034). Development of pneumothorax, pneumonia and pleural effusion were not statistically different between the Groups (p = 0.079, 0.171, 0.509). CONCLUSION: RPW application is more effective on preventing postoperative complications in cardiac surgery instead of placing drains in posterior pericardium.

The Predictive Effects of Clinical Hematological Changes on Saphenous Graft Patency after Coronary Artery Surgery.

OBJECTIVES: To investigate the association between clinical hematologic parameters and saphenous vein graft failure after on-pump coronary artery bypass surgery. METHODS: A total of 1950 consecutive patients underwent isolated on-pump coronary artery surgery between November 2010 and February 2013. Of these, 284 patients met our inclusion criteria; their preoperative clinical hematological parameters were retrospectively obtained for this cohort study. And of them, 109 patients underwent conventional coronary angiography after graft failure was revealed by coronary computed tomography angiography. The primary endpoint was to catch at least one saphenous vein graft stenosis or occlusion following the coronary angiogram. We then analyzed risk factors for graft failure. In sequential or T grafts, each segment was analyzed as a separate graft. RESULTS: In logistic regression analysis, older age, platelet distribution width, and diabetes mellitus were identified as independent predictors of saphenous vein graft failure (P<0.). In contrast, preserved ejection fraction value favored graft patency (P<0.001). CONCLUSION: Increased platelet distribution width is easily measurable and can be used as a simple and valuable marker in the prediction of saphenous vein graft failure.

The predictive effects of clinical hematological changes on saphenous graft patency after coronary artery surgery

Abstract Objectives: To investigate the association between clinical hematologic parameters and saphenous vein graft failure after on-pump coronary artery bypass surgery. Methods: A total of 1950 consecutive patients underwent isolated on-pump coronary artery surgery between November 2010 and February 2013. Of these, 284 patients met our inclusion criteria; their preoperative clinical hematological parameters were retrospectively obtained for this cohort study. And of them, 109 patients underwent conventional coronary angiography after graft failure was revealed by coronary computed tomography angiography. The primary endpoint was to catch at least one saphenous vein graft stenosis or occlusion following the coronary angiogram. We then analyzed risk factors for graft failure. In sequential or T grafts, each segment was analyzed as a separate graft. Results: In logistic regression analysis, older age, platelet distribution width, and diabetes mellitus were identified as independent predictors of saphenous vein graft failure (P<0.). In contrast, preserved ejection fraction value favored graft patency (P<0.001). Conclusion: Increased platelet distribution width is easily measurable and can be used as a simple and valuable marker in the prediction of saphenous vein graft failure.

Vacuum-Assisted Closure for Mediastinitis in Pediatric Cardiac Surgery: A Single-Center Experience.

Vacuum-assisted closure (VAC) has been widely used to treat mediastinitis after congenital cardiac surgery, which is associated with a high risk of morbidity and mortality. The aim in this study is to review our 14 cases of mediastinitis treated with VAC therapy after congenital cardiac surgery. We retrospectively reviewed the medical records of 14 congenital heart patients with mediastinitis from January 2012 to March 2017. Patients with fever, wound discharge, sternal dehiscence, a positive wound culture or abscess diagnosed with computed tomography are accepted as mediastinitis. A VAC was applied to all our patients without irrigation or dressing the wound because of sterility concerns. The vacuuming of the wound was either 50 mm Hg or 75 mm Hg according to the sternal intactness. We gradually decreased the pressures and changed the VAC systems once every three days, after wound healing was seen and a negative culture was obtained and VAC was terminated. There were 14 patients (8 male and 6 female) with mediastinitis and all of them were treated using VAC. The mean age of the patients was 6.96 months (ranging from 0.5-26 months). The mean weight was 5.16 kg (2.8-12 kg). Three patients needed extracorporeal membrane oxygenation after the surgery. Mean onset of mediastinitis was 25.3 days. The wound cultures showed methicillin resistant coagulase negative streptococcus and methicillin-sensitive staphylococcus aureus in most cases. Acinetobacter, serratia, pseudomonas, and klebsiella were the other bacterial species seen in cultures. Two patients had mediastinitis symptoms, but their cultures were negative. VAC systems were changed 3.85 times on average. Mean duration of hospital stay was 49.9 days (21-104 days). One patient needed a muscle flap to close the thoracic cavity after mediastinitis. Two patients did not survive. Mediastinitis is a serious postoperative condition in pediatric cardiac surgery patients. Classical wound dressing and irrigation methods are not suitable in mediastinitis for the pediatric age group. Therefore, VAC therapy can be an effective way to successfully treat the situation.