Impact of Indexed Effective Orifice Area on the Quality of Life of Patients after Aortic Valve Replacement.

BACKGROUND: Improving health related quality of life is an important goal of aortic valve replacement. Inadequate effective orifice area of prosthesis according to the patient's body surface area may be associated with poor outcomes. In this study, we aimed to analyze impact of indexed effective orifice area (iEOA) on patients' quality of life after aortic valve replacement. METHODS: A total of 138 patients who underwent isolated aortic valve replacement were included to the study. Quality of life assessment was performed with EuroQol Group EQ-5D-5L questionnaire. Patients were divided into three groups based on iEOA (Group 1 had an iEOA of <0.65 cm2/m2 (19 patients), Group 2 had an iEOA between 0.65-0.85 cm2/m2 (71 patients), and Group 3 had an iEOA of >0.85 cm2/m2). Mean EQ-5D-5L scores were compared among the groups statistically. RESULTS: Mean EQ-5D-5L scores were lower in Group 1 than in Groups 2 and 3 (Group 1: 0.72 ± 0.18, Group 2: 0.83 ± 0.20, and Group 3: 0.86 ± 0.9, p = 0.044 and p = 0.014). The EQ-5D-5L score was significantly lower in patients with a ≥20 mmHg transvalvular gradient than those with a <20 mmHg (0.74 ± 0.25 vs. 0.84 ± 0.18, p = 0.014). CONCLUSIONS: Our results show that an iEOA <0.65 cm2/m2 is significantly associated with impaired postoperative health-related quality of life. Newer generation prostheses, transcatheter valve implantation, and root enlargement techniques should be kept in mind in preoperative planning.

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.

Mid-Term Results of Peripheral Cannulation After Robotic Cardiac Surgery.

INTRODUCTION: Various surgical procedures for minimally invasive cardiac surgery have been described in recent decades as alternatives to median sternotomy. Cardiopulmonary bypass via femoral arterial and venous cannulation is the foundation of these procedures. In this study, we evaluated the mid-term outcomes of femoral cannulation performed with U-suture technique in patients undergoing robotic heart surgery. METHODS: A total of 216 patients underwent robotic-assisted cardiac surgery between January 2013 and April 2017. Cardiopulmonary bypass was performed via femoral artery, jugular, and femoral vein cannulation, and a Chitwood clamp was used for aortic occlusion. A total of 192 patients attended the outpatient follow-up, and femoral arterial and venous flow pattern was examined using Doppler ultrasound (DUS) in 145 patients. RESULTS: Hospital mortality occured in 4 of the 216 (1.85%) cases, but there was no late mortality in this patient group. Postoperatively, seroma (n=9, 4.69%) and cannulation site infection (n=3, 1.56%) were managed with outpatient treatment. DUS in 145 patients revealed triphasic flow pattern in the common femoral arteries in all patients except for 2 (1.38%). These patients were determined to have asymptomatic arterial stenosis. Chronic recanalized thrombus in the common femoral vein was also detected in 2 (1.38%) patients. CONCLUSION: Femoral artery cannulation with the U-suture technique can be successfully performed in robotic-assisted cardiac surgery, with good mid-term results.

Mid-term results of peripheral cannulation after robotic cardiac surgery

Abstract Introduction: Various surgical procedures for minimally invasive cardiac surgery have been described in recent decades as alternatives to median sternotomy. Cardiopulmonary bypass via femoral arterial and venous cannulation is the foundation of these procedures. In this study, we evaluated the mid-term outcomes of femoral cannulation performed with U-suture technique in patients undergoing robotic heart surgery. Methods: A total of 216 patients underwent robotic-assisted cardiac surgery between January 2013 and April 2017. Cardiopulmonary bypass was performed via femoral artery, jugular, and femoral vein cannulation, and a Chitwood clamp was used for aortic occlusion. A total of 192 patients attended the outpatient follow-up, and femoral arterial and venous flow pattern was examined using Doppler ultrasound (DUS) in 145 patients. Results: Hospital mortality occured in 4 of the 216 (1.85%) cases, but there was no late mortality in this patient group. Postoperatively, seroma (n=9, 4.69%) and cannulation site infection (n=3, 1.56%) were managed with outpatient treatment. DUS in 145 patients revealed triphasic flow pattern in the common femoral arteries in all patients except for 2 (1.38%). These patients were determined to have asymptomatic arterial stenosis. Chronic recanalized thrombus in the common femoral vein was also detected in 2 (1.38%) patients. Conclusion: Femoral artery cannulation with the U-suture technique can be successfully performed in robotic-assisted cardiac surgery, with good mid-term results.