RESUMEN
BACKGROUND: The management of a small aortic root at the time of aortic valve replacement is controversial. In cases in which the aortic root is very small the choice of aortic valve type and of root-enlargement method is difficult. The technical challenge of the small aortic root has instigated the creation of methods for annular enlargement. Severe mismatch as a predictor of overall 30-day mortality or midterm mortality reports about long-term results of aortic valve replacement using autologous pericardial patch are scarce. Moreover, no reports about patient series are present in the English medical literature. This retrospective study was designed to address this gap in evidence. METHODS: Twenty consecutive patients undergoing aortic valve replacement (with or without mitral valve replacement and/or coronary artery bypass grafting) at Baskent University Adana Medical Center between June 30, 1999 and April 10, 2006 were retrospectively evaluated. All clinical and echocardiographical data belonging to this population were specified. Their perioperational data were assessed. RESULTS: Twenty patients operated using the Manouguian technique for narrow aortic root from June 1999 to April 2006 were followed for 8.54 ± 3.35 years. Fourteen patients were alive at the end of the follow-up. Six patients had died. Early mortality rate was 5% and late mortality after 8.54 ± 3.35 years was 30%. Late mortality related to cardiac reasons was 5%. Only one death could be attributed to a cardiac cause which occured in a 36-year-old male patient 3 years and 6 months after the operation. 70% of the patients were alive after a mean follow-up period of 8.54 ± 3.35 years. CONCLUSION: The main finding of the present study is that aortic root enlargement using untreated fresh autologous pericardium in Manouguian type operations is a durable option, especially in conditions when homograft or stentless valve use is difficult or economically not feasible. We found that no patient had aneurysmal dilatation or mitral regurgitation after a mean follow-up of 8.54 ± 3.35 years with autologous untreated pericardium as the enlargement patch.
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Estenosis de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Prótesis Valvulares Cardíacas , Pericardio/trasplante , Complicaciones Posoperatorias/epidemiología , Adolescente , Adulto , Anciano , Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/diagnóstico , Niño , Ecocardiografía , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de Supervivencia/tendencias , Factores de Tiempo , Trasplante Autólogo , Turquía/epidemiología , Adulto JovenRESUMEN
PURPOSE: Popliteal artery aneurysms (PAAs) can be treated successfully by surgical and endovascular methods; however, the best treatment strategy for a ruptured PAA has yet to be established. We assessed the clinical results of using saphenous vein interposition to treat ruptured PAAs in our hospital. METHODS: The subjects of this study were seven men (average age 59 years, range 43-71 years), who underwent emergency surgery for a ruptured PAA at our hospital between January 2007 and November 2012. The patients were assessed after 1, 6, and 12 months, postoperatively. RESULTS: All included patients underwent saphenous vein graft interposition via a medial approach. No complications or graft thromboses were encountered in the immediate postoperative period. The patients were discharged after an average of 4 days postoperatively (range 3-5 days). The patients were followed up for an average of 32 months (range 2-60 months). The medium-term graft patency was 100%. No patients suffered early or medium-term limb loss and there was no mortality. CONCLUSION: Based on our positive results, saphenous vein graft interposition should be considered as the first choice of surgical treatment for a ruptured PAA.
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Aneurisma Roto/cirugía , Procedimientos Endovasculares/métodos , Arteria Poplítea/cirugía , Vena Safena/trasplante , Adulto , Anciano , Aneurisma Roto/diagnóstico , Diagnóstico por Imagen , Urgencias Médicas , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
Background: This study aimed to provide nuanced insights in managing patients with a history of coronavirus disease 2019 (COVID-19) pneumonia undergoing coronary artery bypass grafting. Methods: This retrospective cohort study involved 168 patients (131 males, 37 females; mean age: 61.2±9.7 years; range, 51 to 72 years) undergoing isolated coronary artery bypass grafting surgery between December 2021 and December 2023. The study examined factors such as age, sex, comorbidities, blood test results, vaccination status, operative parameters, and postoperative complications. Patients' health records were reviewed to confirm the presence of previous COVID-19 pneumonia and vaccination status. Patients were divided into two groups based on their history of COVID-19 pneumonia: Group 1 included 140 who had not been diagnosed with COVID-19 pneumonia, and Group 2 included 28 patients who had a documented history of COVID-19 pneumonia. Postoperative pulmonary complications, including atelectasis, pleural effusion, acute respiratory distress syndrome, and pneumonia, were noted. Results: Patients with a history of COVID-19 pneumonia (Group 2, n=28) demonstrated significantly higher seropositivity for COVID-19 (89.3% vs. 29.3%, p=0.001) compared to those without a history (Group 1, n=140). Although pulmonary complications were higher in Group 2 (17.9% vs. 3.6%, p=0.013), postoperative mortality rates did not differ significantly between the groups. Pleural effusion was markedly higher in Group 2 (14.3% vs. 2.1%, p=0.015). Vaccination did not significantly affect perioperative and postoperative outcomes, except for a minor difference in postoperative drainage volume. Conclusion: This study highlights the impact of prior COVID-19 pneumonia on postoperative outcomes in coronary artery bypass grafting patients. Although there was a rise in pulmonary complications, the mortality rates stayed similar among individuals with and without a prior history of COVID-19 pneumonia. Vaccination did not significantly influence outcomes, emphasizing the need for further research with larger cohorts to validate and expand upon these findings.
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BACKGROUND: Crush Syndrome is a major cause of morbidity and mortality following large-scale catastrophic earthquakes. Since there are no randomized controlled studies on Crush Syndrome, knowledge on this subject is limited to expert experience. The primary objective is to analyze the epidemiological and demographic characteristics, clinical outcomes, and mortality factors of earthquake victims after the Pazarcik and Elbistan earthquakes on February 6, 2023. METHODS: This cross-sectional and observational retrospective study evaluated 610 earthquake victims who presented to our center between February 6 and April 30, 2023. Among these patients, 128 with Crush Syndrome were included in the study. Patient information was gathered from hospital records during their stay and from national registries upon referral. The primary outcome was to identify risk factors for mortality. Demographic and laboratory data were analyzed by acute kidney injury (AKI) stages; mortality-affecting factors were identified through regression analysis. RESULTS: Of the 128 Crush Syndrome patients (100 adults, 28 children), 64 were female. The AKI rate was 32.8%. Among patients with AKI, the frequency of hemodialysis requirement was 69%, and the mortality rate was 14.2%. The overall mortality rate for patients with Crush Syndrome was 4.6%, compared to 3.9% (19/482) in earthquake victims without Crush Syndrome (p=0.705). Notably, low systolic blood pressure at admission was the only factor significantly affecting mortality in Crush Syndrome patients (Hazard Ratio [HR]: 1.088, p=0.021, 95% Confidence Interval [CI]). CONCLUSION: Our study highlights low systolic blood pressure upon admission as a significant risk factor for increased mortality in Crush Syndrome patients. This finding may contribute to the literature by emphasizing the importance of monitoring blood pressure under rubble and administering more aggressive fluid therapy to patients with low systolic blood pressure.
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Lesión Renal Aguda , Síndrome de Aplastamiento , Terremotos , Adulto , Niño , Humanos , Femenino , Masculino , Síndrome de Aplastamiento/epidemiología , Síndrome de Aplastamiento/etiología , Estudios Retrospectivos , Estudios Transversales , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Lesión Renal Aguda/terapiaRESUMEN
Patients who undergo prosthetic aortic valve replacement for infective endocarditis and have no recurrent infection after surgery, rarely develop pseudoaneurysm of either the aortic root or the sinus of Valsalva (SV). Pseudoaneurysm of the SV can have fatal complications, including rupture. The case is reported of a large pseudoaneurysm of the SV that developed after surgical intervention for aortic valve endocarditis, and which was successfully treated.
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Aneurisma Falso , Endocarditis Bacteriana/cirugía , Cardiopatías Congénitas/cirugía , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Complicaciones Posoperatorias , Seno Aórtico , Adulto , Aneurisma Falso/cirugía , Aneurisma de la Aorta , Válvula Aórtica/cirugía , Enfermedad de la Válvula Aórtica Bicúspide , Endocarditis Bacteriana/etiología , Cardiopatías Congénitas/etiología , Enfermedades de las Válvulas Cardíacas/etiología , Humanos , Masculino , Complicaciones Posoperatorias/cirugía , Reoperación , Seno Aórtico/cirugíaRESUMEN
BACKGROUND: A neurologic event (NE) after coronary artery bypass graft (CABG) surgery is a principal complication affecting morbidity and mortality. We investigated the risk factors predicting postoperative NEs and survival in patients with pre-existing NE undergoing CABG. METHODS: Between 2001 and 2012, 3137 patients underwent isolated primary CABG. The data were stored in a computerized database and retrospectively evaluated. Patients were divided into 2 groups based on the existence of preoperative NE (study group; n=126) and without NE (n=3011). Uni- and multivariate logistic regression analyses were performed to evaluate the possible predictors of postoperative NEs. Survival was determined using Kaplan-Meier survival analyses of the study group and propensity score-matched control group. RESULTS: The mean age of the 3137 patients was 60±9 years, and 28% (n=885) were female. Postoperative NE was seen in 4 (3.2%) patients with pre-existing NE and in 16 (0.5%) without pre-existing NE. Preoperative NE (odds ratio 4.47; 95% confidence interval 1.32-15.18; P=.01) and age (≥70 years; odds ratio 2.98; 95% confidence interval 1.21-7.33; P=.01) showed strong multivariate associations with postoperative NE. Median CHA2DS2-VASc scores were 4.5 (interquartile range 3-5) and 3 (range 0-4) in patients in the pre-existing and without NE groups, respectively (P=.01). The overall mean follow-up was 4.6±3 years. Overall survival rates (88.1% and 94%, respectively) were different between the 2 groups (P=.02). CONCLUSIONS: Preoperative neurologic events and advanced age are significant risk factors predicting postoperative neurologic events. Meticulous management of the ascending aorta and carotid artery are important in diminishing postoperative neurologic events. A pre-existing neurologic event is also predictive for decreased overall survival.
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Puente Cardiopulmonar , Enfermedades del Sistema Nervioso/complicaciones , Enfermedades del Sistema Nervioso/psicología , Anciano , Puente Cardiopulmonar/mortalidad , Circulación Cerebrovascular/fisiología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/mortalidad , Periodo Perioperatorio , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/psicología , Periodo Preoperatorio , Estudios Retrospectivos , Factores de Riesgo , Análisis de Supervivencia , Resultado del TratamientoRESUMEN
Minithoracotomy for extrapleural closure of the patent ductus arteriosus (PDA) in seriously ill patients offers a fast and less invasive alternative to conventional transpleural ductal closure. This study reports the immediate postoperative clinical outcomes for 24 extrapleurally clipped premature infants presenting with congestive heart failure in high-risk comorbidity status between March 2007 and November 2010. The demographics, preoperative clinical characteristics, and postoperative outcomes of the patients, including echocardiographic assessments, were evaluated. No surgery-related mortalities occurred. Four mortalities occurred after surgery due to sepsis and bleeding diathesis. All 20 surviving patients exhibited normal left ventricular dimensions and systolic function in the immediate follow-up period. The study shows that extrapleural clip closure in seriously ill premature infants has an acceptable overall short-term mortality and complication rate with a high rate of ductal closure.
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Conducto Arterioso Permeable/cirugía , Enfermedades del Prematuro/cirugía , Toracotomía/métodos , Enfermedades en Gemelos/cirugía , Conducto Arterioso Permeable/epidemiología , Femenino , Insuficiencia Cardíaca/epidemiología , Humanos , Recién Nacido , Recien Nacido Prematuro , Enfermedades del Prematuro/epidemiología , MasculinoRESUMEN
Cardiac papillary fibroelastoma (CPF) is a pathologically benign cardiac tumor. This tumor usually arises from cardiac valves, and it is the most common cardiac valvular tumor. This usually single and pedunculated tumor should be surgically treated when the mass is mobile and the patient has experienced a prior stroke, even if the stroke has manifested as a transient ischemic attack. Surgical treatment is definitive, and no recurrences have been reported in the literature. We describe a patient who had a diagnosis of CPF while undergoing investigation for a cryptogenic stroke.
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Válvula Aórtica , Fibroma/diagnóstico , Neoplasias Cardíacas/diagnóstico , Músculos Papilares , Anciano , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/patología , Válvula Aórtica/cirugía , Diagnóstico Diferencial , Ecocardiografía , Ecocardiografía Transesofágica , Femenino , Fibroma/cirugía , Neoplasias Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Imagen por Resonancia Magnética , Músculos Papilares/diagnóstico por imagen , Músculos Papilares/patología , Músculos Papilares/cirugíaRESUMEN
We retrospectively compared the results of conventional coronary artery bypass grafting (CABG) performed on patients who showed no preoperative evidence of serious atherosclerosis of the ascending aorta with the results of the aortic no-touch technique (using coronary artery-saphenous vein composite grafts) on CABG patients who did show such evidence. From 2003 through 2012, 3,152 consecutive patients underwent isolated primary CABG at our hospital. We chose 360 for the current study. The study group (n=120) comprised patients who had undergone operation via the aortic no-touch technique. Propensity-score-matching (1:2) was used to select the control group of 240 patients who had undergone conventional CABG. Early and late survival rates, reintervention-free survival rates, and freedom from cardiac death were compared. Early and late mortality rates were similar in the study and control groups (P=0.19 vs P=0.29, respectively), as were cardiac-related death (2.5% vs 2.1%, respectively; P=0.53) and overall death (8.3% vs 7.9%, respectively; P=0.51). Overall survival rates were 91.7% vs 92.1% and freedom-from-cardiac-death rates were 97.4% vs 97.5% (P=0.71 vs P=0.78, respectively; mean follow-up period, 5.27 ± 2.51 yr). Reintervention-free survival rates were also similar (96.7% vs 98.8%, respectively; P=0.2). As a result of the similar rates of early and late survival, reintervention-free survival, and freedom from cardiac death, we conclude that the aortic no-touch technique with composite grafts might be a reasonable option in patients who have atherosclerotic ascending aorta that cannot be clamped.