Emergent endovascular repair of ruptured abdominal and thoracic aortic aneurysms in a single center: midterm outcomes.

OBJECTIVE: Endovascular therapies may offer distinct advantages in acute aortic syndromes. In this paper, we present our experience with emergent endovascular repair of both abdominal and thoracic aortic ruptures and report early and midterm out comes. METHODS: Data from all patients (n=96) who were treated by endovascular procedures between 2004 to 2012 were prospectively collected and early-midterm outcomes of the emergency (e) interventions for both abdominal (EVAR) and thoracic (TEVAR) aortic ruptures (n=20) were retrospectively analysed. RESULTS: The mean age was 65 +- 11 years (range: 27-77 years)and 18 patients (90%) were male. Mean follow-up duration was 28 ± 21.2 months (range=1-57). Thirteen patients were treated by eEVAR (65%) and 7 by eTEVAR (35%). One patient who had a rupture of the aneurysm at arcus aorta level was treated by hybrid procedure (eTEVAR+ debranching).The hospital mortality rate was 20% (n=4) for all cases, 23.0% (n=3) for eEVAR and 14.2% (n=1) for eTEVAR. In the follow-up period, 3 patients (15.0%) had reinterventions. DISCUSSION: Reinterventions and the necessity of close follow-up are the disadvantages of endovascular procedures.Even if that is the case, we believe that eEVAR eTEVAR in the acute setting of ruptured aorta in patients with suitable anatomy is a lifesaving option.

Neuraxial anesthesia in a parturient with common variable immunodeficiency: a case report.

Choosing whether or not to initiate neuraxial anesthesia in pregnant women with immune system defects may be challenging. Anesthesiologists have the responsibility of making the best decision in terms of anesthesia management for both mother and baby during the labor and delivery process. Whether neuraxial anesthesia is associated with an increased risk of central nervous system infection in immunocompromised compared with healthy patients is unknown. It is also unclear if maternal immune modulation required for fetal tolerance makes pregnant women susceptible to pathogens and causes an altered immune response. Infection-related complications of neuraxial anesthesia are rare but may be severe, especially in immunocompromised parturients. There are no guidelines regarding the indications and limitations of regional anesthesia procedures in these patients. Immunocompromised patients are now seen more commonly, and it is essential to adopt a multidisciplinary approach to their care while tailoring anesthetic plans to the individual. We present the case of a 37-year-old parturient who had a congenital immune deficiency and who developed aseptic meningitis after receiving spinal anesthesia for cesarean delivery.

Frailty prevalence and related factors in the older adult-FrailTURK Project.

Frailty is one of the geriatric syndromes and has an important relationship with mortality and morbidity. The aim of this study is to present the characteristics, prevalence, and related factors of frailty in older adults in our country. The study included 1126 individuals over 65 years of age from 13 centers. Frailty was evaluated using the Fried Frailty criteria, and patients were grouped as "frail," "pre-frail," and "non-frail." Nutritional status was assessed with "Mini Nutritional Test," psychological status with the "Center for Epidemiological Studies Depression Scale-CES-D," and additional diseases with the "Charlson Comorbidity index." Approximately 66.5 % of the participants were between 65 and 74 years of age and 65.7 % were women. Some 39.2 and 43.3 % of the participants were rated as frail and pre-frail, respectively. The multinomial logistic regression analysis was used to determine the factors associated with frailty. It was observed that age, female gender, low education level, being a housewife, living with the family, being sedentary, presence of an additional disease, using 4 or more drugs/day, avoiding to go outside, at least one visit to any emergency department within the past year, hospitalization within the past year, non-functional ambulation, and malnutrition increased the risk of frailty (p < 0.05). Establishing the factors associated with frailty is highly important for both clinical practice and national economy. This is the first study on this subject in our country and will provide guidance in determining treatment strategies.

Critical-illness polyneuropathy complicating cardiac operation.

Critical-illness polyneuropathy is a complication of septic syndrome. However, this complication has been largely unrecognized in cardiac surgery units. Difficulty in weaning from the ventilator is an important early manifestation. Electromyography should be routinely performed to establish the diagnosis. Here we report a case of polyneuropathy complicating surgical repair of acute aortic dissection.

Magnesium infusion dramatically decreases the incidence of atrial fibrillation after coronary artery bypass grafting.

BACKGROUND: Atrial fibrillation (AF) is one of the most common complications of cardiac surgery. Magnesium, like several other pharmacologic agents, has been used in the prophylaxis of postoperative AF with varying degrees of success. However, the dose and the timing of magnesium prophylaxis need to be clarified. The purpose of this study was to assess the effect of intermittent magnesium infusion on postoperative AF. METHODS: A total of 200 consecutive patients who had elective, isolated, first-time coronary artery bypass grafting were prospectively randomized to two groups. Patients in the magnesium group (n = 100) received 6 mmol MgSO4 infusion in 100 mL 0.9% NaCl solution (25 mL/h) the day before surgery, just after cardiopulmonary bypass, and once daily for 4 days after surgery. Patients in the control group (n = 100) received only 100 mL 0.9% NaCl solution (25 mL/h) at the same time points. RESULTS: Postoperative AF occurred in 2 (2%) patients in the magnesium group and in 21 (21%) patients in the control group (p < 0.001). Atrial fibrillation started, on average, 49.4 +/- 16.8 hours postoperatively. The postoperative length of hospital stay was not significantly different in patients with AF (7.4 +/- 8.0 days) compared with patients without AF (5.4 +/- 1.1 days; p = 0.236). CONCLUSIONS: The use of magnesium in the preoperative and early postoperative periods is highly effective in reducing the incidence of AF after coronary artery bypass grafting.

Comparative assessment of chordal preservation versus chordal resection in mitral valve replacement for mitral stenosis.

Mitral valve replacement with preserving all chordae tendineae in patients with mitral regurgitation has been proved to be beneficial for left ventricular performance in the postoperative period. To evaluate the effectiveness of this technique in patients with mitral stenosis a comparison of the hemodynamic and echocardiographic data between patients having operation with this technique (Group P, n = 15, mean age = 37.5 +/- 12 years), and those having operation with the conventional method of mitral valve replacement (Group C, n = 15, mean age = 39 +/- 10.4 years) was made. The study population was limited to patients who had no clinical evidence of coronary artery disease and if over 40 years of age had normal coronary artery anatomy on coronary arteriography; patients with no evidence of aortic stenosis and/or regurgitation; and patients who had pure mitral stenosis or mitral stenosis with slight regurgitation (Grade 2 or less) with a mean gradient across the mitral valve greater than 10 mmHg. Hemodynamic parameters improved in both groups after the operation. However, echocardiographic measurements obtained six months postoperatively revealed a significant decrease in left ventricular ejection fraction in Group C (61.33 +/- 9.29% preoperatively versus 53.2 +/- 10.3% postoperatively; p < 0.05). The difference between left ventricular ejection fraction diminution of the two groups was statistically significant (-0.71 +/- 6.28% in Group P versus -8.07 +/- 13.35% in Group C; p < 0.01). Left ventricular end systolic and end diastolic dimensions decreased in patients with preserved valves and increased in patients operated on with conventional method without reaching a statistical significance. Sizes of prosthetic valves inserted were in the same range and no significant differences were found in preoperative and postoperative comparison of the two groups in respect to effective mitral orifice area and transvalvular gradient. There were no evidence of prosthetic valve dysfunction and paravalvular leakage and no operative or late deaths. It is concluded that if it is suitable, mitral valve replacement with preservation of chordae tendineae is expected to have a beneficial effect on postoperative left ventricular performance in patients with mitral stenosis.

Effect of vitamin E supplementation with exercise on cognitive functions and total antioxidant capacity in older people.

OBJECTIVE: We investigated the effects of six months vitamin E administration on cognition evaluated by event-related potentials in exercising older subjects. DESIGN: Randomised controlled trial. SETTING: Retirement home in Antalya, Turkey. PARTICIPANTS: Fifty-seven adults aged 60-85 years were randomly assigned to one of four groups: sedentary control (C), vitamin E (V), exercise training (E) and vitamin E under training (EV). INTERVENTION: V and EV groups were received vitamin E at a dose of 900 IU/day P.O. for 6 months. Trained groups were subjected to walking exercise involved 3 sessions per week for 6 months. Walking duration was gradually increased during 8 weeks, and stayed constant until the end of training period. Participants were begun walking at % 70 heart rate reserve for 20 min/day at the first two weeks, and walking duration was increased by 5 minutes/day of each week until subjects were reached a level of 50 min/day by week 8. MEASUREMENTS: Plasma vitamin E concentration, total antioxidant capacity and two parameters of event-related potentials namely P3 latency and amplitude were performed on all study groups both before and after training. RESULTS: Significant improvement in P3 latency was found in exercising groups. However, no significant differences were found between vitamin and other groups for P3 latency. Amplitude measurements were found unaltered among all groups. CONCLUSION: We concluded that although six months training results improvement in P3 latency, vitamin E supplementation does not affect cognitive function evaluated by event-related potentials in older subjects.

Hybrid treatment of ascending aortic pseudoaneurysm: endovascular stent-graft placement and extraanatomic reconstruction without sternotomy.

Conventional surgical repair of ascending aortic pseudoaneurysms following prior cardiac operations is performed with a high operative mortality. We report a 67 year old female patient with an ascending aortic pseudoaneurysm detected 3 years after coronary bypass surgery. The patient was treated with ascending aortic endovascular stent graft placement and extraanatomic reconstruction of supraaortic branches without using sternotomy.

Endovascular stent-graft treatment of type A dissection: case report and review of literature.

We report a successful endovascular stent-graft treatment of a patient with type A dissection with primary entry tear at the ascending aorta. Simultaneous coronary stenting was performed. A literature review was performed and the possible use of endovascular treatment for ascending aortic dissections is discussed.

EuroSCORE overestimates the cardiac operative risk.

INTRODUCTION: It was the purpose of our study to assess the validity of EuroSCORE (European system for cardiac operative risk evaluation) in our patient population. MATERIALS AND METHODS: Between March 1999 and August 2001, information on risk factors and mortality was collected for 1123 consecutive adult patients undergoing heart surgery with cardiopulmonary bypass. EuroSCORE was used for risk stratification. Mean age +/- standard deviation was 58.6 +/- 10.9 and 29.1% of the patients were female. The area under the receiver operating characteristic (ROC) curve was calculated as an index for the predictive value of the scoring system. RESULTS: The area under the ROC curve was 0.824 for all patients and 0.828 for the isolated CABG subgroup which shows an excellent predictive ability. When the scoring system was applied in low, medium, and high risk groups, there was no overlap between 95% confidence intervals of observed and expected mortality in all three groups both for the isolated CABG cases and for all patients. Decreased left ventricular ejection fraction, emergent operation, and preoperative unstable angina requiring i.v. nitrate treatment were significant predictive variables for early mortality. CONCLUSION: EuroSCORE is a simple and objective system for predicting the risk of heart surgery. The predictive power of the EuroSCORE is excellent, however it seems that mortality is considerably overestimated by this score.

Aortoventriculoplasty in a patient with complex left ventricular outflow tract obstruction, mitral valve stenosis and aneurysm of the ascending aorta.

We describe a new method of aortoventriculoplasty in a patient with calcified mitral stenosis, aortic valvular stenosis, severe left ventricular outflow tract obstruction, and aneurysm of the ascending aorta. This complex pathology was successfully treated with replacement of both the valves and a tubular dacron graft. The proximal end of the dacron tube was tailored as a patch for the repair of the ventricular septum and the aortic root, and the distal end was anastomosed to the distal ascending aorta. The patient had an uneventful recovery and postoperative echocardiography showed no significant residual gradient on the left ventricular outflow tract.

Nitroglycerin-induced hypoxemia does not produce myocardial ischemia.

OBJECTIVE: Nitroglycerin has been the drug of choice for relieving myocardial ischemia for more than a hundred years. Several studies have indicated that a significant reduction in arterial oxygen tension (PaO2) occurs after the administration of sublingual nitroglycerin to patients with coronary artery disease breathing room air. Because available oxygen in arterial blood is reduced, it would be reasonable to assume that oxygen delivery to the myocardium would also be impaired. The purpose of this study was to investigate whether nitroglycerin-induced arterial desaturation results in compromised oxidative metabolism of myocardium assessed by coronary sinus lactate concentration and oxygen content in patients with coronary artery disease undergoing coronary artery bypass surgery. PARTICIPANTS: Ten randomly selected patients undergoing coronary bypass surgery. SETTING: All studies were performed at Siyami Ersek Cardiovascular and Thoracic Surgery Center. METHODS: A catheter was inserted into the radial artery to measure blood gases and arterial lactate concentration. After sternotomy, and aortic and venous cannula placement, a coronary sinus catheter was introduced into the coronary sinus to measure oxygen content and lactate concentration. Control coronary sinus and arterial blood samples were obtained before nitroglycerin infusion. Nitroglycerin was then given in a dose of 2 micrograms/kg/min for a period of 5 minutes. At the end of 5 minutes, second samples were obtained from the coronary sinus and arterial catheters. MAIN RESULTS: It was found that arterial and coronary sinus oxygen tension decreased significantly. Arterial lactate concentration did not change, coronary sinus lactate concentration decreased. Despite a substantial fall in arterial oxygen tension after administration of nitroglycerin, a significant reduction in coronary sinus lactate concentration occurred. CONCLUSION: Nitroglycerin-induced hypoxia does not compromise oxidative metabolism of myocardium as can be assessed by a concomitant decrease in coronary sinus lactate concentration.