Single-center Study Comparing Short and Mid-Term Results of EVAR in Old and Young Populations.

OBJECTIVE: The purpose of this study was to compare the operative mortality rate and outcomes of endovascular aneurysm repair (EVAR) between young and geriatric people in a single center. METHODS: Eighty-five patients with abdominal aortic aneurysms who underwent EVAR between January 2012 and September 2016 were included. Outcomes were compared between two groups: the young (aged < 65 years) and the geriatric (aged ≥ 65 years). The primary study outcome was technical success; the secondary endpoints were mortality and secondary interventions. The mean follow-up time was 36 months (3-60 months). RESULTS: The study included 72 males and 13 females with a mean age of 71.08±8.6 years (range 49-85 years). Of the 85 patients analyzed, 18 (21.2%) were under 65 years old and 67 patients (78.8%) were over 65 years old. There was no statistically significant correlation between chronic disease and age. We found no statistically significant difference between aneurysm diameter, neck angle, neck length, or right and left iliac angles. The secondary intervention rate was 7% (six patients). The conversion to open surgery was necessary for only one patient and only three deaths were reported (3.5%). There was no statistically significant difference in the mortality and reintervention rates between the age groups. The three deaths occurred only in the geriatric group and two died secondary to rupture. Kidney failure was observed in three patients in the geriatric group (4.5%). CONCLUSION: Our single-center experience shows that EVAR can be used safely in both young and geriatric patients.

Single-center study comparing short and mid-term results of evar in old and young populations

Abstract Objective: The purpose of this study was to compare the operative mortality rate and outcomes of endovascular aneurysm repair (EVAR) between young and geriatric people in a single center. Methods: Eighty-five patients with abdominal aortic aneurysms who underwent EVAR between January 2012 and September 2016 were included. Outcomes were compared between two groups: the young (aged < 65 years) and the geriatric (aged ≥ 65 years). The primary study outcome was technical success; the secondary endpoints were mortality and secondary interventions. The mean follow-up time was 36 months (3-60 months). Results: The study included 72 males and 13 females with a mean age of 71.08±8.6 years (range 49-85 years). Of the 85 patients analyzed, 18 (21.2%) were under 65 years old and 67 patients (78.8%) were over 65 years old. There was no statistically significant correlation between chronic disease and age. We found no statistically significant difference between aneurysm diameter, neck angle, neck length, or right and left iliac angles. The secondary intervention rate was 7% (six patients). The conversion to open surgery was necessary for only one patient and only three deaths were reported (3.5%). There was no statistically significant difference in the mortality and reintervention rates between the age groups. The three deaths occurred only in the geriatric group and two died secondary to rupture. Kidney failure was observed in three patients in the geriatric group (4.5%). Conclusion: Our single-center experience shows that EVAR can be used safely in both young and geriatric patients.

Left Main Coronary Artery Hypoplasia in Elderly.

Congenital anomalies of the coronary artery causing coronary occlusive disease may be of many different types. A 67-year-old woman with no coronary risk factors was referred for coronary angiography with few months' history of angina. The patient underwent coronary angiography due to ischemic cardiac symptoms with nondiagnostic exercising test. In coronary angiography, the left main coronary artery was arising from normal anatomical position; however, left anterior descending artery and circumflex artery were hypoplastic. The treatment of patient was discussed in cardiology-cardiovascular surgery council and coronary surgery was found inappropriate due to the hypoplasia of the left coronary system entirely.

Clinical features and patency rates of Remedy® biodegradable peripheral stents.

OBJECTIVE: The aim of this study was to investigate the midterm results of Remedy® biodegradable stents, which have recently come into use for lower-extremity arterial occlusive disease. METHODS: Sixty-five patients, who underwent surgical intervention in various cardiovascular surgery clinics throughout Turkey, were included in the study. The total number of stents used was 92. The mean age of the patients was 64.11 ± 24.13 years (20-82), and 16 (24.6%) were female. The mean number of stents per patient was 1.42, and 70.7% of the lesions were TASC type A. Patients were followed for a mean of 32 months. Sixty-five patients underwent a control examination using either digital subtraction angiography or colour Doppler ultrasonography. In-stent restenosis was defined as ≥ 50% stenosis in the stent area in asymptomatic patients. The procedure was repeated if the degree of stenosis was ≥ 70%. RESULTS: During the follow-up period, restenosis (≥50% stenosis) was observed in seven patients (10.7%). The patency rate after secondary intervention was 100%, and there was no loss of limbs in any patient. Restenosis was observed in six patients with superficial femoral artery stents, and in one patient with a popliteal arterial stent. CONCLUSION: Our experience shows that Remedy® biodegradable peripheral stents were safe and effective in our cohort of patients, with acceptable patency rates.

The effect of iloprost and N-acetylcysteine on skeletal muscle injury in an acute aortic ischemia-reperfusion model: an experimental study.

OBJECTIVE: The objective of this study was to examine the effects of iloprost and N-acetylcysteine (NAC) on ischemia-reperfusion (IR) injuries to the gastrocnemius muscle, following the occlusion-reperfusion period in the abdominal aorta of rats. MATERIALS AND METHODS: Forty male Sprague-Dawley rats were randomly divided into four equal groups. Group 1: control group. Group 2 (IR): aorta was occluded. The clamp was removed after 1 hour of ischemia. Blood samples and muscle tissue specimens were collected following a 2-hour reperfusion period. Group 3 (IR + iloprost): during a 1-hour ischemia period, iloprost infusion was initiated from the jugular catheter. During a 2-hour reperfusion period, the iloprost infusion continued. Group 4 (IR + NAC): similar to the iloprost group. FINDINGS: The mean total oxidant status, CK, and LDH levels were highest in Group 2 and lowest in Group 1. The levels of these parameters in Group 3 and Group 4 were lower compared to Group 2 and higher compared to Group 1 (P < 0.05). The histopathological examination showed that Group 3 and Group 4, compared to Group 2, had preserved appearance with respect to hemorrhage, necrosis, loss of nuclei, infiltration, and similar parameters. CONCLUSION: Iloprost and NAC are effective against ischemia-reperfusion injury and decrease ischemia-related tissue injury.

Agenesis of the mitral posterior leaflet in elderly.

Congenital mitral valve regurgitation is a rare disease that is found in infancy and childhood, and sometimes in elderly people. In the case presented, mitral regurgitation that was tolerated well until the sixth decade of life is reported. A 62-year-old male suffering from dyspnea was referred to our hospital. Transthoracic echocardiographic examination demonstrated severe mitral regurgitation with suspicion of agenesis of the posterior leaflet with a long, mobile anterior leaflet. A transesophageal echocardiogram and surgical evaluation verified agenesis of the posterior mitral valve. The patient was successfully treated using mitral valve replacement, and no complications occurred.

Comparing the effectiveness of neutrophil-lymphocyte ratio as a mortality predictor on middle and advanced age coronary artery bypass graft patients.

OBJECTIVE: In this study, the effect of neutrophil-lymphocyte ratio (NLR), which is a recently developed inflammatory parameter, as an early stage mortality predictive marker on coronary artery bypass (CABG) patients of various age groups was examined. METHODS: Seventy eight patients under the age of 45 (Group 1) and 80 patients who were older than 45 (Group 2) randomly chosen from the patients who underwent isolated CABG surgery, were examined. The preoperative characteristics and NLRs were noted. The primary end point of the study was determined as all-cause in- hospital mortality. RESULTS: Mortality was observed in 2 patients in Group 1 and 11 patients in Group 2. The threshold value of NLR was 2,47 in the Receiver Operating Characteristic (ROC) curve in Group 1 and there wasn't any significant correlation between preoperative NLR and mortality rates in the patients whose NLRs were above this curve. The threshold value was determined as 4.07 in Group 2 and there was a significant relation between preoperative NLR and mortality (p<0,01). No relation was found between NLR and mortality when all the examined patients were considered (p>0.05). CONCLUSION: NLR that can be easily calculated, can be used as a mortality predictor in the patients of advanced age who will undergo isolated CABG procedure.

The place of carotico-subclavian bypass surgery in angina treatment.

Coronary-subclavian steal syndrome results from atherosclerotic disease of the proximal subclavian artery, causing reversal of flow in an internal mammary artery used as conduit for coronary artery bypass. In the present case, we discussed the diagnosis and the treatment of coronary steal syndrome in a patient hospitalized due to decompensated cardiac insufficiency.

Neutrophil gelatinase-associated lipocalin as a biomarker for acute kidney injury in patients undergoing coronary artery bypass grafting.

BACKGROUND/OBJECTIVE: The development of acute renal injury (ARI) is an important indicator of clinical outcomes after cardiac surgery. Neutrophil gelatinase-associated lipocalin (NGAL) has been certified as a predictive biomarker of hypoxic ARI. The present study aimed to determine the predictive role of NGAL in coronary bypass graft (CABG) surgery. METHOD: A total of 72 consecutive patients undergoing elective CABG were enrolled in the study. NGAL levels were determined preoperatively and postoperatively after 6 h, 24 h and 72 h for all participants. The participants were then divided into two groups according to their preoperative creatinine levels (group I, creatinine 111.38 µmol/L to 361.55 µmol/L; group II, creatinine <111.38 µmol/L). RESULTS: There was no statistically significant difference between the groups according to their NGAL values (P>0.05), except at 6 h (P=0.045). Three patients required continuous hemodialysis. Comparison of the NGAL levels of these three patients with those of the other participants did not reveal any correlation with serum creatinine levels. In contrast, the NGAL levels were significantly lower in the continuous hemodialysis patients (1.9±1 ng/mL) compared with those of the other participants (22.6±12.8 ng/mL; P=0.001). CONCLUSION: NGAL is one of the most frequently used biomarkers for ARI after cardiac operations, especially in younger patients. The participants in the present study were coronary artery disease patients and were, therefore, older than patients in previous reports. These results support the view that NGAL is not a relevant predictive factor for ARI in patients with CABG, including older patients.

Unilayer Closure of Saphenous Vein Incision Lines is Better than Bilayer Closure.

OBJECTIVE: To examine early results in patients with incision lines closed only along the skin and subcutaneous tissue after removal of the great saphenous vein during coronary artery bypass surgery. MATERIALS AND METHODS: We enrolled 82 patients who underwent elective operations in our clinic between December 2008 and April 2009. The patients had similar demographic characteristics, and the method of incision closure was chosen randomly. Three patients were excluded due to in-hospital mortality. The saphenous incision lines were closed using continuous skin sutures in 41 patients (Group 1) or using continuous subcutaneous sutures followed by continuous skin sutures in 38 patients (Group 2). Patients were followed every day that they were in the hospital, in the first week after being discharged, and at the end of the second month after discharge. The incision lines were evaluated for hematomas, infection, edema, pain and numbness. RESULTS: During the follow-up performed in-hospital and in the first week after discharge, infection, edema and numbness were observed significantly more often in Group 2 than in Group 1. Hematoma was observed more often in Group 1, and pain was observed more often in Group 2, but neither of these findings reached statistical significance. During the follow-up at the end of the second month after discharge, infection, edema, and numbness were observed significantly more frequently in Group 2. CONCLUSION: In patients undergoing saphenous removal using standard procedures, it is sufficient to close the incision line using only skin sutures.

Aortic dissection due to sildenafil abuse.

This report deals with a 28-year-old male patient, admitted with a type A aortic dissection, potentially related to the use of sildenafil. In the literature, we found only two other potentially sildenafil-related cases of aortic dissections, one type A and one type B. In our patient, a bicuspid aortic valve and an ascending aortic aneurysm were other underlying anomalies that could have led to the aortic dissection.

Magnesium sulphate and amiodarone prophylaxis for prevention of postoperative arrhythmia in coronary by-pass operations.

BACKGROUND: The aim of this study was to investigate the use of prophylactic magnesium sulphate and amiodarone in treating arrhythmias that may occur following coronary bypass grafting operations. METHODS: The study population consisted of 192 consecutive patients who were undergoing coronary artery bypass grafting (CABG). Sixty-four patients were given 3 g of magnesium sulphate (MgSO4) [20 ml = 24.32 mEq/L Mg(+2)] in 100 cc of isotonic 0.9% solution over 2 hours intravenously at the following times: 12 hours prior to the operation, immediately following the operation, and on postoperative days 1, 2, and 3 (Group 1). Another group of 64 patients was given a preoperative infusion of amiodarone (1200 mg) on first post-operative day (Group 2). After the operation amiodarone was administered orally at a dose of 600 mg/day. Sixty-four patients in group 3 (control group) had 100 cc. isotonic 0.9% as placebo, during the same time periods. RESULTS: In the postoperative period, the magnesium values were significantly higher in Group 1 than in Group 2 for all measurements. The use of amiodarone for total arrhythmia was significantly more effective than prophylactic treatment with magnesium sulphate (p = 0.015). There was no difference between the two drugs in preventing supraventricular arrhythmia, although amiodarone significantly delayed the revealing time of atrial fibrillation (p = 0.026). Ventricular arrhythmia, in the form of ventricular extra systole, was more common in the magnesium prophylaxis group. The two groups showed no significant differences in other operative or postoperative measurements. No side effects of the drugs were observed. CONCLUSION: Prophylactic use of magnesium sulphate and amiodarone are both effective at preventing arrhythmia that may occur following coronary by-pass operations. Magnesium sulphate should be used in prophylactic treatment since it may decrease arrhythmia at low doses. If arrhythmia should occur despite this treatment, intervention with amiodarone may be preferable.

Delayed Presentation of a Giant Ascending Aortic Aneurysm following Aortic Valve Replacement.

Giant ascending aortic aneurysm formation following aortic valve replacement is rare. A 28-year-old man who underwent aortic valve replacement with a prosthetic valve for aortic regurgitation secondary to congenital bicuspid aortic valve about 10 years ago was diagnosed with a giant ascending aortic aneurysm about 16 cm in diameter in follow-up. The aneurysm was resected leaving the functional old mechanical prosthesis in place and implanted a 34-mm Hemashield woven graft, associated with the left and right coronary artery button implantation. Histological findings of the aortic aneurysm wall showed cystic medial necrosis. The postoperative course was uneventful and postoperative examination demonstrated good surgical results.

Self-limiting left ventricular wall rupture following myocardial infarction.

A left ventricular posterior-inferior free wall rupture without pseudo aneurysm following inferior myocardial infarction was identified in a 40-year-old male patient. Coronary angiography of the patient demonstrated a total occlusion of the circumflex artery. Repair of the rupture was performed during an elective surgery carried out 15 days after the infarction. We approved to discuss this rarely encountered clinical case with the cases in the literature.

A rare clinical entity: ventricular septal rupture with right ventricular wall dissection after inferior myocardial infarction.

Right ventricular wall dissection following ventricular septal rupture related to inferior myocardial infarction has been reported in a few cases. In most of the cases, right ventricular wall dissection was diagnosed in postmortem studies. Herein, we present a 68-year-old man who had a ventricular septal rupture with right ventricular wall dissection after inferior myocardial infarction. Early recognition of this complication with bedside transthoracic echocardiography and prompt surgical repair are key to achieving survival in these patients.

The curative excision of left ventricular hydatic cyst.

This cystic mass located in apical region near inferior wall was also demonstrated with transoesophageal echocardiography and multislice computerised tomography (MCT). The cystic tissue was removed from the myocardium by peeling. The cyst was extracted entirely. Ventricular space was washed with hypertonic saline serum. Ventriculotomy was closed from inside with dacron patch and ventricular geometry was protected successfully. Sewing line was strengthened by using teflon stripes externally.

Hydroxyethyl starch versus Ringer solution in cardiopulmonary bypass prime solutions (a randomized controlled trial).

BACKGROUND: In our study we compared the Ringer solution, which is the standard prime solution of our department, with the HES (Hydroxyethyl starch) 130-0.4 solution, which can be a potential alternative prime solution with an indispensable material for the cardio-pulmonary bypass applications. METHODS: 140 patients undergoing to CABG (Coronary Artery Bypass Graft surgery) were electively enrolled to the study. 1500 ml Ringer solution + 200 ml mannitol + 60 ml sodium bicarbonate + 150 U/kg heparin was used as a prime solution to start cardiopulmonary by-pass in 70 patients which was defined as group 1. On the other hand, 1500 ml HES 130 - 0.4 + 200 ml mannitol + 60 ml sodium bicarbonate + 150 U/kg heparin was used as a prime solution in 70 patients in group 2. RESULTS: INR (International Normalized Ratio), urea levels and blood platelet counts were significantly different between the groups. INR level was higher in group 1, while blood urea and creatinine levels and platelet count were higher in group 2 at the end of the 12th and 24nd hours postoperatively (p = 0.001).In this study, it was shown that the usage of HES 130-0.4 as a prime solution did not have negative effect on postoperative INR level, platelet count, the need for transfusion and the amount of drainage, despite the negative opinions that similar solutions caused coagulation disorders. Another interesting result of the study was that blood platelet count at 24th hour was statistically significantly higher in group 2 (p = 0.001). CONCLUSION: HES 130-0.4 solution is an alternative colloidal solution which can be used as the prime solution or as a mixture with the crystalloids in cardio-pulmonary bypass applications.

Treatment modalities in hypertrophic obstructive cardiomyopathy: surgical myectomy versus percutaneous septal ablation.

BACKGROUND: The aim of this study was to compare the results of percutaneous septal myocardial ablation (PSMA) and surgical myectomy (SM) for decreasing the left ventricular outflow tract (LVOT) gradient, septal thickness, ventricular dimensions, and mitral regurgitation (MR) in patients with symptomatic hypertrophic obstructive cardiomyopathy. METHODS: We treated 40 patients (mean age, 24.4 +/- 6.8 years; 34 male and 6 female patients) between June 2002 and April 2006. Twenty-four patients underwent SM, and 16 patients underwent PSMA. All patients were symptomatic despite maximal medical treatment and had an LVOT gradient higher than 65 mm Hg. Their echocardiographic data were recorded before and after the procedure and then compared. The patients were followed up postoperatively for a mean of 13 months. RESULTS: There was no mortality in either group. One year after the procedure, the LVOT gradients for the 2 groups were not statistically different. During the follow-up, moderate MR was found in 4 patients (25%) in the ablation group and in 2 patients (8.3%) in the myectomy group. Exercise capacity and New York Heart Association class improved after PSMA, whereas postoperative MR severity and effort capacity were better in the surgical group. CONCLUSION: The 2 approaches yielded similar results with regard to reducing the LVOT gradient. We conclude that SM is preferable to PSMA in cases with MR.