Comparison of Beating-Heart Technique Versus Aortic Cross-Clamping in Tricuspid Valve Surgery.

OBJECTIVE: Tricuspid valve surgery can be performed on a beating heart or on an arrested heart. We aimed to compare the outcomes of tricuspid valve surgery using these two different approaches. METHODS: Between January 2015 and February 2020, 204 patients who underwent tricuspid valve surgery along with concomitant cardiac surgical procedures were included in the study. Techniques of cross-clamping and beating-heart tricuspid surgery were applied to 103 and 101 patients, respectively. Concomitant valvular and/or coronary interventions were performed under cross clamping in both groups. Results from the preoperative period, immediate postoperative period, and six-month postoperative interval were compared between the groups. RESULTS: There were no differences in demographic characteristics or preoperative grades of tricuspid valve regurgitation between the groups. Duration of mechanical ventilation, and stays in the intensive care unit and hospital were significantly shorter in patients operated on using the beating-heart technique. Additionally, re-exploration surgery and mortality rates were significantly lower in the beating-heart group. Postoperative six-month echocardiography findings related to tricuspid valve regurgitation, maximum and minimum gradients of the tricuspid valve, and pulmonary arterial pressure were also lower in the beating-heart group. CONCLUSION: Beating-heart tricuspid valve surgery may be preferable to the cross-clamping technique to avoid clamp-induced ischemia, which can lead to worsened postoperative outcomes.

Comparison of Clinical Outcomes between del Nido Cardioplegia and Microplegia among Patients Undergoing Elective Mitral Valve Replacement.

BACKGROUND: Cardioplegia solutions are used to protect the myocardium from ischemic injury caused by cardiopulmonary bypass and various types of cardioplegia solutions have been introduced for cardiac surgery. In this study, we aimed to compare the effects of del Nido cardioplegia and microplegia, which were mostly used in our clinic for intraoperative and postoperative processes among patients who underwent elective mitral valve replacement. As a result, the comparison could be performed in a specific patient group without additional valvular or coronary disease, and cardioplegia distribution could be achieved more efficiently. METHODS: Between 2018 and 2023, a total of 120 patients who underwent elective mitral valve replacement via sternotomy with del Nido cardioplegia or microplegia were included in the study. Patients were divided into two groups; group 1 (del Nido, n = 64) and group 2 (microplegia, n = 56). Preoperative characteristics, intraoperative and postoperative early clinical data as primary outcomes, and postoperative mortality rates and intensive care costs as secondary outcomes were compared statistically. RESULTS: There were no statistically significant differences in terms of preoperative characteristics between the two groups. Duration of cross clamp differences between group 1 versus group 2 (45 ± 16 vs. 57 ± 19 min), cardiopulmonary bypass (56 ± 17 vs. 65 ± 21 min), intensive care length of stay (18.04 ± 7.41 vs. 22.37 ± 6.86 h), requirement of intraoperative defibrillation (n = 5 vs. n = 13), and intensive care costs were found to be statistically significantly lower in del Nido group. CONCLUSION: Either del Nido or microplegia solutions can be used safely in mitral valve replacement operations, however, del Nido cardioplegia has some advantages over intraoperative processes, such as lowering the cross clamp and cardiopulmonary bypass time. Furthermore, patients who received del Nido cardioplegia had shorter intensive care stay and required less intraoperative defibrillation compared with the microplegia group. Therefore, less exposure to anesthesia, the prevention of infection due to shortened operation duration, and greater cost-effectiveness can be achieved by using del Nido cardioplegia instead of microplegia.

Effects of antiviral drug therapy on dynamic thiol/disulphide homeostasis and nitric oxide levels in COVID-19 patients.

The novel coronavirus disease 2019 (COVID-19) has led to a serious global pandemic. Although an oxidative stress imbalance occurs in COVID-19 patients, the contributions of thiol/disulphide homeostasis and nitric oxide (NO) generation to the pathogenesis of COVID-19 have been poorly identified. Therefore, the aim of this study was to evaluate the effects of antiviral drug therapy on the serum dynamics of thiol/disulphide homeostasis and NO levels in COVID-19 patients. A total of 50 adult patients with COVID-19 and 43 sex-matched healthy control subjects were enrolled in this prospective study. Venous blood samples were collected immediately on admission to the hospital within 24 h after the diagnosis (pre-treatment) and at the 15th day of drug therapy (post-treatment). Serum native thiol and total thiol levels were measured, and the amounts of dynamic disulphide bonds and related ratios were calculated. The average pre-treatment total and native thiol levels were significantly lower than the post-treatment values (P < 0.001 for all). We observed no significant changes in disulphide levels or disulphide/total thiol, disulphide/native thiol, or native thiol/total thiol ratios between pre- and post-treatments. There was also a significant increase in serum NO levels in the pre-treatment values when compared to control (P < 0.001) and post-treatment measurements (P < 0.01). Our results strongly suggest that thiol/disulphide homeostasis and nitrosative stress can contribute to the pathogenesis of COVID-19. This study was the first to show that antiviral drug therapy can prevent the depletion in serum thiol levels and decrease serum NO levels in COVID-19 patients.

Predictive Value of Neutrophil-to-Lymphocyte, Aspartate-to-Alanine Aminotransferase, Lymphocyte-to-Monocyte and Platelet-to-Lymphocyte Ratios in Severity and Side of Carotid Artery Stenosis: Are Those Significant?

BACKGROUND: Atherosclerosis is a chronic disease that leads to mortality and morbidity by affecting arterial vascular structures. Carotid artery is one of these arterial structures and occlusive disease of carotid artery may cause stroke or cranial ischemic infarction. Inflammation plays a role in the atherosclerotic process. In this study, we aimed to discuss the relationship between the severity and side of carotid artery occlusion and novel inflammatory parameters include platelet-to-lymphocyte, neutrophil-to- lymphocyte, lymphocyte-to-monocyte, and aspartate-to-alanine aminotransferase ratios. METHODS: One-hundred-fifteen patients who had carotid artery stenosis between 50%-99% and 115 healthy subjects with no carotid artery stenosis or additional disease were included in the study. The relationship between the side and degree of the lesion and platelet-to-lymphocyte, neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and aspartate-to-alanine aminotransferase ratios were studied in the patient group. The patients with carotid artery stenosis and the healthy subjects were compared, in the terms of same parameters. Data were evaluated statistically. RESULTS: There were no statistically significant differences between the groups, in the terms of platelet-to-lymphocyte, neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and aspartate-to-alanine aminotransferase ratios and the degree of stenosis. There was no statistically significant difference between the sides of the lesions and the parameters above except lymphocyte-to-monocyte ratio. It was statistically significantly higher in left-sided lesions. Aspartate-to- alanine aminotransferase and neutrophil-to-lymphocyte ratios were markedly higher in the patient group, when compared to controls. CONCLUSION: Platelet-to-lymphocyte, neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and aspartate-to- alanine aminotransferase ratios are inexpensive, easy, fast, and reproducible parameters that can be used in determining the prediction of carotid artery stenosis.

Usefulness of Radial Artery as a Carotid Artery Patch in Simultaneous Carotid Endarterectomy and Coronary Artery Bypass Graft Operation with Complete Arterial Revascularization.

BACKGROUND: Serious coronary artery diseases including left main coronary artery disease, proximal left anterior descending artery disease, and three-vessel coronary artery disease with carotid artery stenosis are required simultaneous operations. By using complete arterial revascularization technique for coronary artery bypass graft operation, radial artery can be used safely as a patch material for carotid endarterectomy in combined surgery. METHODS: Between 2016 and 2018, 14 patients who had serious coronary artery disease with the stenosis of unilateral carotid artery equal/over 70% were included in the study. Complete arterial revascularization was performed in all patients and radial artery was used as a patch material in carotid endarterectomy. RESULTS: All patients were discharged without any complication and carotid artery colored Doppler ultrasound was performed to the patients in the 3rd months, 6th months, and first year of the operation. There was no restenosis detected. CONCLUSION: In conclusion, radial artery is useable for carotid patch angioplasty in patients who underwent simultaneous carotid endarterectomy and coronary artery bypass graft operation with complete arterial revascularization. Further studies including a large number of patients are needed to examine the long-term patency of this graft.

Gradual treatment of arteriovenous fistula in femoral vessels as a complication of coronary angiography

Abstract Arteriovenous fistula due to coronary angiography intervention is rarely seen. Arteriovenous fistulas may be asymptomatic according to the size of the shunt, as well as to the heart failure. In this case report, we aimed to share gradual transition from endovascular methods to surgery and why surgical treatment is required for a patient who developed arteriovenous fistula after coronary angiography.

Gradual Treatment of Arteriovenous Fistula in Femoral Vessels as a Complication of Coronary Angiography.

Arteriovenous fistula due to coronary angiography intervention is rarely seen. Arteriovenous fistulas may be asymptomatic according to the size of the shunt, as well as to the heart failure. In this case report, we aimed to share gradual transition from endovascular methods to surgery and why surgical treatment is required for a patient who developed arteriovenous fistula after coronary angiography.