Are inflammatory parameters predictors of amputation in acute arterial occlusions?

Background The aim of the present study was to investigate the role of inflammatory markers to predict amputation following embolectomy in acute arterial occlusion. Methods A total of 123 patients operated for arterial thromboembolectomy due to acute embolism were included in the study. The patients without an extremity amputation following thromboembolectomy were classified as Group 1 ( n = 91) and the rest were classified as Group 2 ( n = 32). These groups were compared in terms of clinical and demographic characteristics, C-reactive protein, complete blood count parameters, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio and red cell distribution width. Results The average age was 68.0 ± 11.7 years. The most common thromboembolism localization was femoral artery. When preoperative mean C-reactive protein ( p = 0.0001), mean platelet volume ( p = 0.0001), platelet-lymphocyte ratio ( p = 0.0001), neutrophil-lymphocyte ratio ( p = 0.0001) and red cell distribution width ( p = 0.0001) were compared, a statistically significant difference was observed between groups. In univariate and multivariate regression analysis, higher levels of preoperative C-reactive protein ( p = 0.009) and mean platelet volume ( p = 0.04) were detected as independent risk factors of early extremity amputation. Conclusion We observed that preoperative mean platelet volume and C-reactive protein were predictors of amputation after thromboembolectomy in acute arterial occlusion.

Mitral valve replacement in an adult with left pulmonary agenesis.

Pulmonary agenesis is associated with the absence of pulmonary vessels, bronchi, or parenchyma. This condition usually occurs between the 4th and 5th week of gestation during the embryonic phase. Etiopathogenic factors associated with pulmonary agenesis are not fully understood. In the literature, genetic and teratogenic factors, viral infections, and vitamin-A deficiency are shown to be associated with pulmonary agenesis [Malcon 2012]. This condition may be seen unilaterally or bilaterally. Although the precise rate of incidence is unknown, it is estimated to occur in one of every 10,000 to 12,000 live births [Yetim 2011]. There is a 1.3:1 female predominance with unilateral agenesis [Halilbasic 2013].

Is Carotid Artery Stenting an Alternative to Simultaneous Carotid Endarterectomy Performed for Carotid Artery Stenosis in Patients Undergoing Isolated Coronary Bypass Surgery?

BACKGROUND: Treatment method in patients with coronary artery disease undergoing coronary bypass surgery with accompanying carotid artery disease is still a hot topic among clinicians. This study is designed to investigate if there is an effect on myocardial infarction, cerebrovascular events and mortality during postoperative period of simultaneous carotid endarterectomy with coronary bypass surgery compared to staged carotid artery stenting before coronary bypass surgery. METHODS: 102 patients (79 male, 23 female) who underwent simultaneous carotid endarterectomy with coronary bypass surgery or staged carotid artery stenting with coronary bypass surgery in the same center with the same surgical team were divided into 2 groups and retrospectively reviewed. Group 1 (n = 71) had coronary artery bypass surgery under general anesthesia with carotid endarterectomy followed by cardiopulmonary bypass with heart team decision. Again with heart team decision, Group 2 (n=31), patients at high-risk for carotid endarterectomy (serious cardiac disease, severe chronic obstructive pulmonary disease, superiorly located lesions), received carotid artery stents in the interventional radiology department and a month later, coronary bypass surgery was performed with cardiopulmonary bypass under elective conditions. RESULTS: Median of patient age was 67.5 (45-83) years. Twenty-two patients (31%) in Group 1 and 19 patients (56.3%) in Group 2 had neurological symptoms, which was statistically significant (P = .004). During the early postoperative term, three patients (4.2%) in Group 1 and two patients (6.5%) in Group 2 died (P = .64). Five patients (7.0%) in Group 1 and two patients (6.5%) in Group 2 developed neurological symptoms during the early postoperative term (P > .05). Likewise, two patients (2.8%) in Group 1 and five patients (16.1%) in Group 2 developed myocardial infarction following carotid intervention (P = .03). CONCLUSIONS: In patients with significant carotid artery stenosis undergoing coronary bypass surgery with cardiopulmonary bypass, in comparison to simultaneous carotid endarterectomy with coronary bypass technique and carotid artery stenting followed with coronary bypass technique showed no difference in combined endpoint (postoperative myocardial infarction, neurological events, and mortality). With proper tools and according to the decisions made by heart teams, both management strategies can be safely performed.

Preoperative Platelet to Lymphocyte Ratio Is Associated with Early Morbidity and Mortality after Coronary Artery Bypass Grafting.

OBJECTIVE: To investigate the association of platelet to lymphocyte ratio to mortality and morbidity after coronary artery bypass grafting operation. METHODS: We evaluated records of 916 patients who underwent coronary artery bypass grafting operation between January 2009 and May 2014 retrospectively. Patients were grouped as Group 1 (n = 604) if the platelet to lymphocyte ratio was above 142 and Group 2 (n = 312) if platelet to lymphocyte ratio was below 142. RESULTS: The number of patients who developed a neurologic event during the hospital stay and in the first postoperative month was 7 (1.2%) in Group 1 and 12 (3.8%) in Group 2 for which the difference was statistically significant (P = .007). Early term mortality occurred in 3 patients (0.5%) in Group 1 and in 10 patients (3.2%) in Group 2 for which the difference was statistically highly significant (P = .001). In univariate and multivariate regression analysis, the preoperative platelet to lymphocyte ratio was determined as an independent risk factor for occurrence of atrial fibrillation in the early postoperative period, reoperation for sternum dehiscence, occurrence of a neurologic event, prolonged stay in the hospital and mortality. CONCLUSION: In this study, elevated levels of platelet to lymphocyte ratio were associated with mortality and morbidity after coronary artery bypass grafting operation.

Association between carotid intima-media thickness and acute kidney injury following isolated coronary artery bypass surgery.

OBJECTIVE: The association between pre-operative carotid intima-media thickness (CIMT) and early postoperative acute kidney injury (AKI) following isolated coronary artery bypass grafting (CABG) was investigated. METHODS: Data were sought retrospectively of 237 patients (166 male, 71 female; mean age 61.4 ± 8.1 years; range: 32-74), operated on for isolated CABG with cardiopulmonary bypass (CPB) in a single centre between June 2014 and December 2020, with a serum creatinine level < 1.5 mg/dl and normal carotid arteries on Doppler ultrasonography. AKI diagnosis was made according to the Kidney Disease Improving Global Outcomes 2012 Acute Kidney Injury Guideline. Patients were grouped as group 1 with AKI in the early postoperative period (n = 63) and group 2 without AKI ( n = 174). Univariate analyses were done to determine significant clinical factors, and subsequent multiple logistic regression analysis was done to determine independent predictors of AKI. RESULTS: AKI occurred in 63 (26.6%) patients. Pre-operative CIMT was significantly higher in the AKI group (p = 0.0001). Multivariate logistic regression analysis revealed that elevated pre-operative CIMT ( p = 0.005), C-reactive protein ( p = 0.001), erythrocyte sedimentation rate ( p = 0.005), neutrophil-lymphocyte ratio ( p = 0.0001) and platelet-lymphocyte ratio ( p = 0.0001) increased on the postoperative seventh day. C-reactive protein ( p = 0.04), postoperative first day platelet- lymphocyte ratio ( p = 0.0001), postoperative seventh day erythrocyte sedimentation rate ( p = 0.02) and intubation time ( p = 0.02) were independent predictors of early postoperative AKI following isolated CABG. CONCLUSIONS: Pre-operative CIMT was found to be an independent predictor of AKI in the early postoperative period of isolated CABG.

Clinical characteristics, diagnostic methods and results of surgically treated histologically benign cardiac myxomas.

BACKGROUND: Myxomas are primary cardiac tumours that may be detected incidentally due to embolic events, intracardiac obstructive features or non-specific structural symptoms. The aim of this study was to share our experience of clinical features, diagnostic methods, surgical procedures and postoperative follow up of surgically treated cardiac myxomas. METHODS: Data of 34 patients who underwent surgery for a cardiac myxoma between January 2006 and June 2022 were retrospectively analysed. Group 1 (n = 19) consisted of patients who were symptomatic and group 2 ( n = 15) patients were asymptomatic. The medical records of the patients, their clinical status, diagnostic methods, operation information and postoperative course data were collected and recorded. RESULTS: A total of 34 patients (16 female; mean age 54.5 ± 8.8 years) underwent cardiac myxoma resection with cardiopulmonary bypass. Fifteen (44.1%) patients were diagnosed incidentally with asymptomatic myxoma. An additional cardiac surgical procedure was performed in six patients (17.7%). The 34 cardiac myxomas that were surgically resected were localised in the left atrium in 25 patients (73.5%) and in the right atrium in nine patients (26.5%). Patients' most common symptoms were dyspnoea (42.1%), palpitations (21.1%), ischaemic stroke (15.8%) and syncope (10.5%). There was no incident of 30-day mortality and no recurrence was observed in any patient during the follow-up period. The duration of surgical intervention in symptomatic patients was significantly shorter than in asymptomatic patients (p = 0.0001), but there was no statistical difference in terms of characteristics. CONCLUSIONS: Myxomas are benign tumours, but they are serious pathologies that require early treatment because of signs of obstruction, embolic complications and confusion, with left atrial thrombus in the differential diagnosis.

A new biomarker to predict atrial fibrillation and its adverse events after coronary artery bypass surgery: red blood cell distribution volume.

OBJECTIVE: Recent studies suggest that increased red blood cell distribution width may be associated with increased risk of atrial fibrillation. This study aimed to evaluate the relationship between pre-operative and postoperative erythrocyte distribution volume, postoperative atrial fibrillation and related adverse events in patients undergoing isolated coronary artery bypass surgery. METHODS: A total of 790 patients (611 males, mean age 58.3 ± 6.2 years) in pre-operative sinus rhythm, who underwent isolated coronary artery bypass grafting with cardiopulmonary bypass at the same centre and by the same surgical team between January 2015 and December 2021, were enrolled retrospectively. Two groups were created, group 1 (n = 183) and group 2 (n = 607), with regard to the occurrence of atrial fibrillation in the early postoperative period or not, respectively. Clinical and demographic data, biochemical and complete blood count parameters, and intra-operative and postoperative data of the patients were recorded. Univariate and subsequent multivariate logistic regression analysis was done to determine significant clinical factors and independent predictors of postoperative atrial fibrillation. RESULTS: Among the patients, 182 (23.2%) developed atrial fibrillation during the 72 hours postoperatively. Pre-operative and postoperative first-, third- and seventh-day red blood cell distribution volume (p = 0.0001), C-reactive protein (p = 0.0001) and erythrocyte sedimentation rate (p = 0.0001) were significantly increased in group 1. Multivariate logistic regression analysis showed elevated pre-operative and postoperative first-, thirdand seventh-day red blood cell distribution volume, erythrocyte sedimentation rate and C-reactive protein as independent predictors of early postoperative atrial fibrillation. CONCLUSIONS: Pre-operative and postoperative red blood cell distribution volume was found to be an independent predictor of atrial fibrillation and associated adverse events in the early postoperative period of isolated coronary artery bypass grafting.

Popliteal access for endovascular procedures in femoropopliteal artery occlusive disease.

Introduction: Even though it has been reported that femoropopliteal artery endovascular revascularization is often performed with antegrade femoral artery interventions, which are technically relatively challenging, having the advantage of better control, it has also been reported that recanalization failure may occur in approximately 20% of patients and some materials have been developed for this reason. Aim: To evaluate the safety of retrograde popliteal artery intervention and our procedural success rate for symptomatic femoropopliteal artery occlusive disease. Material and methods: A total of 95 endovascular revascularization procedures were performed for treating symptomatic occlusive peripheral artery disease in the study period. Inclusion criteria were defined as patients who underwent endovascular revascularization procedures for symptomatic femoropopliteal artery occlusive disease. Patients who underwent a percutaneous endovascular procedure for iliac artery or below-knee arterial occlusive disease in the same session and patients who had previously undergone peripheral arterial bypass grafting or endovascular treatment for existing femoropopliteal artery disease were excluded. Results: We evaluated 45 peripheral endovascular procedures performed on 39 patients with a mean age of 62.49 ±11.38 years in our hospital for chronic femoropopliteal artery occlusive disease. Twelve (26.7%) of the endovascular treatment procedures were performed with retrograde access through the popliteal artery (Group 2). In neither group were any complications of arterial rupture, distal embolism, early thrombosis, or pseudoaneurysms observed. Conclusions: We are of the opinion that the retrograde popliteal artery technique is an effective and safe intervention option in endovascular revascularization, particularly in the revascularization of the long segment and complex femoropopliteal artery occlusions.

Is pre-operative monocyte count-high-density lipoprotein ratio associated with postoperative acute kidney injury in isolated coronary artery bypass grafting?

OBJECTIVE: Monocyte-to-high-density lipoprotein cholesterol ratio has emerged as an indicator of inflammation and oxidative stress in recent years. The aim of this study was to evaluate the association of monocyte-to-high-density lipoprotein ratio with postoperative acute kidney injury in isolated coronary artery bypass grafting. METHODS: A total of 954 patients (672 males, mean age 60.8 ± 8.2 years), operated on between June 2014 and June 2022, at the same centre by the same team, for isolated coronary artery bypass grafting with cardiopulmonary bypass, whose preoperative serum creatinine level was < 1.5 mg/dl, were enrolled in the study. Patients were placed in group 1 if they had acute kidney injury in the early postoperative period (n = 161) and group 2 comprised those without (n = 793). Univariate and subsequent multivariate logistic regression analysis were done to determine significant clinical factors, and independent predictors of acute kidney injury. RESULTS: Pre-operative monocyte count (p = 0.0001), monocyte count-high-density lipoprotein cholesterol ratio (p = 0.0001), C-reactive protein (p = 0.0001), erythrocyte sedimentation rate (p = 0.0001), mean platelet volume (p = 0.0001) and postoperative first- and third-day C-reactive protein levels (p = 0.0001) were significantly increased in group 1. Multivariate logistic regression analysis revealed that pre-operative elevated monocyte count (p = 0.0001), monocyte-high-density lipoprotein ratio (p = 0.0001), erythrocyte sedimentation rate (p = 0.0001), postoperative first-day C-reactive protein level (p = 0.0001), postoperative first-third day erythrocyte sedimentation rate (p = 0.002, p = 0.004, respectively) and mean platelet volume (p = 0.02, p = 0.0001, respectively) were independent predictors of early postoperative acute kidney injury in patients who had undergone isolated coronary artery bypass grafting. CONCLUSIONS: Pre-operative monocyte-high-density lipoprotein cholesterol ratio was found to be an independent predictor of acute kidney injury in the early postoperative period of isolated coronary artery bypass grafting.

The role of inflammatory parameters in the prediction of postoperative delirium in patients undergoing coronary artery bypass grafting.

OBJECTIVE: In this study, we aimed to evaluate the association of pre-operative and early postoperative inflammatory parameters with postoperative delirium in patients operated on for coronary artery bypass grafting. METHODS: The data of 1 279 cardiac surgery patients operated on between June 2014 and March 2020 were analysed retrospectively. Among these, 777 (61.2%) patients operated on for isolated coronary artery bypass grafting surgery with cardiopulmonary bypass were enrolled. Two groups were formed. The patients who developed postoperative delirium were placed in group 1 (n = 187) and the patients with uneventful postoperative follow up (n = 590) were enrolled in group 2. RESULTS: Pre- and early postoperative mean platelet volume, C-reactive protein level, erythrocyte sedimentation rate, platelet- to-lymphocyte ratio and neutrophil-to-lymphocyte ratio were elevated in group 1 (p = 0.0001). The APACHE II score and duration of hospital and intensive care unit stay were significantly elevated in group 1 (p < 0.05). An early-stage neurological event was observed in eight patients (4.3%) in group 1 and 12 patients (2%) in group 2, which was not statistically significantly different between the groups (p = 0.09). In-hospital mortality was observed in three patients (1.6%) in group 1 and five patients (0.8%) in group 2, which did not show a statistically significant difference (p > 0.05). In univariate and multivariate regression analysis, the pre-operative platelet-to-lymphocyte ratio (p = 0.013), mean platelet volume (p = 0.0001) and erythrocyte sedimentation rate (p = 0.002) were determined as independent risk factors for the occurrence of delirium in the early postoperative period. Also, the postoperative platelet-to-lymphocyte ratio (p = 0.0001), neutrophil-to-lymphocyte ratio (p = 0.0001) and erythrocyte sedimentation rate (p = 0.0001) were determined as independent risk factors for the occurrence of delirium in the early postoperative period. CONCLUSIONS: Pre- and early postoperative inflammatory parameters were observed to be predictors of postoperative delirium in patients operated on for coronary artery bypass grafting.

What is the optimal time interval between heart catheterization and surgery to prevent acute kidney injury in patients with isolated coronary artery bypass?

Aim: The aim of the article was to study the role of the time between cardiac catheterization and cardiac surgery in the development of early postoperative acute kidney injury in patients who underwent isolated coronary artery bypass grafting was investigated. Material and methods: A total of 1196 patients (832 males, 364 females; mean age 60.8 ±8.2 years; range: 32-74 years) operated between November 2006 and June 2014 at the same centre and by the same team for isolated coronary artery bypass grafting with cardiopulmonary bypass, whose preoperative serum creatinine level was < 1.5 mg/dl, were enrolled in the study. Patients were divided into group 1 - with acute kidney injury in the early postoperative period (n = 207) and group 2 - without (n = 989). Univariate analyses were done to determine significant clinical factors, and subsequent multiple logistic regression analysis was performed to determine independent predictors of acute kidney injury. Results: A total of 207 (17.3%) patients developed acute kidney injury during 72 h postoperatively. Regarding the time interval between coronary angiography and coronary artery bypass grafting, there was a statistically highly significant difference between the patients with and without acute kidney injury (7.8 and 11.9 days, respectively; p = 0.0001). Postoperative C-reactive protein (p = 0.0001) and erythrocyte sedimentation rate (p = 0.0001) were significantly increased in group 1. Multivariate logistic regression analysis revealed the time between cardiac catheterization and surgery (p = 0.0001), increased postoperative C-reactive protein (p = 0.007 and p = 0.0001, respectively), and erythrocyte sedimentation rate (p = 0.0001) as independent predictors of early postoperative acute kidney injury in patients undergone isolated coronary artery bypass grafting. Conclusions: If patients to be operated on are stable from a cardiac aspect, limitation of surgery in the early period following catheterization results in reduction of the incidence of postoperative acute kidney injury.

The role of clopidogrel and acetylsalicylic acid in the prevention of early-phase graft occlusion due to reactive thrombocytosis after coronary artery bypass operation.

BACKGROUND: Reactive thrombocytosis has been reported in 20% of patients after coronary artery bypass grafting (CABG), a frequency that might be related to the high incidence of thrombotic complications. The present study was planned to investigate the effect of combined treatment with clopidogrel and acetylsalicylic acid (ASA) on post-CABG reactive thrombocytosis. METHODS: Included in this prospective, randomized study were 60 patients who underwent CABG operation with a 6-month follow-up. Three study groups were defined: group 1 (n = 20), a control group of patients who have not developed reactive thrombocytosis after CABG surgery; group 2 (n = 20), patients who have developed reactive thrombocytosis and continue taking ASA (300 mg/day); and group 3 (n = 20), patients who have developed reactive thrombocytosis and continue taking ASA (300 mg/day) with the addition of clopidogrel (75 mg/day). RESULTS: The mean ages and sex distributions of the patient groups were similar. There were no significant differences between the groups regarding cardiovascular risk factors, baseline laboratory findings, or intraoperative characteristics. Thrombocytosis disappeared within the first month after the operation in both treatment groups. An evaluation of graft patency in the sixth postoperative month revealed that group 2 had significantly more patients with a "positive" result in the exercise test than group 3 and that group 3 had a lower incidence of graft occlusion than group 2 (P < .01). CONCLUSIONS: Combination antiplatelet therapy with ASA and clopidogrel seems to be more effective than ASA alone for maintaining graft patency in patients with reactive thrombocytosis.

Are Pre and Postoperative Platelet to Lymphocyte Ratio and Neutrophil to Lymphocyte Ratio Associated with Early Postoperative AKI Following CABG?

OBJECTIVE: In this study, we investigated the role of two of the recent biomarkers of inflammation on the development of acute kidney injury in the early postoperative period of isolated coronary artery bypass grafting. METHODS: Three hundred and eleven patients, who underwent isolated coronary artery bypass grafting with cardiopulmonary bypass by the same surgery team in our clinic between May 2010 and October 2014, who had a preoperative serum creatinine level lower than 1.5 mg/dl were included in the study. These patients' records were reviewed retrospectively. The diagnosis of acute kidney injury was performed according to the Kidney Disease Improving Global Outcomes 2012 Acute Kidney Injury Guideline criteria. Patients who developed acute kidney injury in the early postoperative period were classified as Group-1 (n=62) and the patients with normal postoperative renal functions were classified as Group-2 (n=249). The demographic data, body mass index, comorbidities, hematologic/biochemical profiles, preoperative ejection fraction, blood transfusion history, and operative data of the groups were compared. Univariate analyses were performed to determine significant clinical factors, and multiple logistic regression analyses were subsequently done to determine independent predictors of acute kidney injury. RESULTS: Sixty-two (19.9%) patients developed acute kidney injury during the first 72 hours postoperatively. Multivariate logistic regression analyses revealed preoperative increased creatinine (P=0.0001), C-reactive protein (P=0.02), neutrophil-lymphocyte ratio (P=0.04) and platelet-lymphocyte ratio (P=0.002); increased postoperative first day leukocyte count (P=0.03), C-reactive protein levels (P=0.02), neutrophil-lymphocyte ratio (P=0.002), platelet-lymphocyte ratio (P=0.01) and increased intubation time (P=0.006) as independent predictors of early postoperative acute kidney injury in patients who underwent isolated coronary artery bypass grafting. CONCLUSION: The preoperative and postoperative increased levels of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio which can be calculated by simple methods from routine blood analysis showed us that these parameters are independent biomarkers directly related to development of acute kidney injury in the early postoperative period.

The effect of the keyhole technique on diabetic patients undergoing autologous brachiobasilic transposition of an arteriovenous fistula.

PURPOSE: Our aim was to investigate the efficiency of the keyhole transposed brachiobasilic technique in patients with diabetes mellitus and compare the effect of different arteriovenous fistula techniques on the development of complications. MATERIALS AND METHODS: Thirty-eight diabetic, chronic renal failure patients (group 1) had transposed brachiobasilic arteriovenous fistula creations, and 49 diabetic patients (group 2) had other types of fistula creations and histories of multiple fistula attempts. The 2 groups were compared for age, sex, weight, the presence of hypertension and/or diabetes mellitus, other risk factors, arteriovenous fistula patency, and possible complications. RESULTS: The 2 groups were not different statistically regarding the demographic data including age, sex, weight, the presence of hypertension and/or diabetes mellitus, other risk factors, and mean operation time. The median follow-up after surgery in both groups was 8 months. The primary patency in group 1 was 97.4% in the early period (6 weeks after surgery) and 94.7% in the late period (mean duration of 8 months after surgery). In the second group, these rates were 73% and 62%, respectively (P < .05). The secondary patency rates were 84.2% in group 1 and 53% in group 2 (P < .05). In group 2, the primary and secondary patencies of brachiocephalic and radiocephalic fistulas were significantly lower than the patencies of group 1. The incidence of complications was significantly less in group 1 than in group 2 (P < .05). CONCLUSION: Although the groups were small in size, the success rate with the keyhole transposed brachiobasilic technique in patients with diabetes was extremely gratifying, and this report can be considered to document the first attempt of a hemodialysis-access procedure.

High preoperative monocyte count/high-density lipoprotein ratio is associated with postoperative atrial fibrillation and mortality in coronary artery bypass grafting.

Objectives: The monocyte to high-density lipoprotein ratio has recently emerged as an indicator of inflammation and oxidative stress. The aim of this study was to evaluate the association of the monocyte to high-density lipoprotein ratio with postoperative atrial fibrillation and mortality in coronary artery bypass grafting. Methods: Six hundred and sixty-two patients who were in sinus rhythm preoperatively and who had isolated coronary artery bypass grafting were retrospectively included in the study. Patients who had atrial fibrillation in the early postoperative period were enrolled in group 1 ( n = 153); patients who remained in sinus rhythm in the early postoperative period were included in group 2 ( n = 509). The clinical and demographic data of the patients, biochemical and complete blood count parameters, preoperative monocyte count/high-density lipoprotein cholesterol ratio, and operative and postoperative data were recorded. Results: Preoperative monocyte counts ( P = 0.0001), monocyte count/high-density lipoprotein cholesterol ratio ( P = 0.0001) and C-reactive protein levels ( P = 0.0001) were significantly increased in group 1. In the first month, 8 patients in group 1 (5.2%) and 5 patients in group 2 (1.0%) died, which was statistically significant ( P = 0.003). In univariate and multivariate logistic regression analyses, an elevated preoperative monocyte count/high-density lipoprotein cholesterol ratio ( P = 0.03) and C-reactive protein levels ( P = 0.0001) were predictors of postoperative atrial fibrillation. Preoperative monocyte counts ( P = 0.001), monocyte count/high-density lipoprotein cholesterol ratio ( P = 0.0001) and the use of inotropic support ( P = 0.0001) were also predictors of mortality in the early postoperative period. Conclusions: We have observed that high preoperative monocyte count/ high-density lipoprotein ratio was associated with postoperative atrial fibrillation and mortality after coronary artery bypass grafting operation.

A massive left-to-right shunt due to delayed spontaneous perforation of polyvinyl alcohol membrane of atrial septal occluder.

Percutaneous closure of an atrial septal defect (ASD) has emerged as an alternative to surgery. A 54-yearold woman with a history of percutaneous ASD closure with a 30-mm Cardia Ultrasept septal occluder (Cardia Inc., Eagan, MN, USA) comprising 2 discs made of Nitinol wire mesh covered with polyvinyl alcohol (PVA) membrane, was admitted to the hospital with unstable angina pectoris. In a routine examination, transthoracic echocardiography revealed a left-to-right shunt through the device. Transesophageal echocardiography (TEE) also demonstrated significant left-to-right shunt through the central portion of the prosthesis. Coronary angiography was performed, which disclosed severe stenosis in the right and left anterior descending coronary arteries. Threedimensional TEE showed multiple perforations of the PVA membrane with intact nitinol frame. Surgical removal of failing device and closure of the ASD with a pericardial patch was performed together with coronary artery bypass graft surgery. On perioperative view, the device appeared to have been correctly implanted, and the device frame was completely intact; however, the PVA membrane of both the right and left discs had almost completely disappeared and there was incomplete endothelialization around the frame. Surgeons must be aware of this rarely seen complication and they should re-examine all patients implanted with Cardia devices in regular follow-up examinations for a long period of time.

Hemoglobin A1c Levels Predicts Acute Kidney Injury after Coronary Artery Bypass Surgery in Non-Diabetic Patients.

INTRODUCTION:: Elevated hemoglobin A1c levels in patients with diabetes mellitus have been known as a risk factor for acute kidney injury after coronary artery bypass grafting. However, the relationship between hemoglobin A1c levels in non-diabetics and acute kidney injury is under debate. We aimed to investigate the association of preoperative hemoglobin A1c levels with acute kidney injury in non-diabetic patients undergoing isolated coronary artery bypass grafting. METHODS:: 202 non-diabetic patients with normal renal function (serum creatinine <1.4 mg/dl) who underwent isolated coronary bypass were analyzed. Hemoglobin A1c level was measured at the baseline examination. Patients were separated into two groups according to preoperative Hemoglobin A1c level. Group 1 consisted of patients with preoperative HbA1c levels of < 5.6% and Group 2 consisted of patients with preoperative HbA1c levels of ≥ 5.6%. Acute kidney injury diagnosis was made by comparing baseline and postoperative serum creatinine to determine the presence of predefined significant change based on the Kidney Disease Improving Global Outcomes (KDIGO) definition. RESULTS:: Acute kidney injury occurred in 19 (10.5%) patients after surgery. The incidence of acute kidney injury was 3.6% in Group 1 and 16.7% in Group 2. Elevated baseline hemoglobin A1c level was found to be associated with acute kidney injury (P=0.0001). None of the patients became hemodialysis dependent. The cut off value for acute kidney injury in our group of patients was 5.75%. CONCLUSION:: Our findings suggest that, in non-diabetics, elevated preoperative hemoglobin A1c level may be associated with acute kidney injury in patients undergoing coronary artery bypass grafting. Prospective randomized studies in larger groups are needed to confirm these results.

The effect of proximal anastomosis on the expansion rate of a dilated ascending aorta in coronary artery bypass surgery: a prospective study.

BACKGROUND: This study was designed to determine the short- and long-term effects of proximal aortic anastomosis, performed during isolated coronary artery bypass grafting (CABG) in patients with dilatation of the ascending aorta who did not require surgical intervention. METHODS: The study was performed on 192 (38 female and 160 male patients; mean age, 62.1 ± 9.2 years; range, 42-80 years) patients with dilatation of the ascending aorta who underwent CABG surgery between 1 June 2006 and 31 May 2014. In group 1 (n = 114), the saphenous vein and left internal mammarian artery grafts were used, and proximal anastomosis was performed on the ascending aorta. In group 2 (n = 78), left and right internal mammarian artery grafts were used, and proximal aortic anastomosis was not performed. Pre-operatively and in the first and third years postoperatively, the ascending aortic diameter was measured and recorded using transthoracic echocardiography at four different regions (annulus, sinus of Valsalva, sinotubular junction and tubular aorta). RESULTS: A statistically significant difference was found between the groups for the number of grafts used and the duration of aortic cross-clamping and cardiopulmonary bypass. No significant intergroup difference was seen for the mean diameter of the ascending aorta (p > 0.05). Annual changes in the aortic diameter were found to be extremely significantly different in both groups (p = 0.0001). Mean values of the aortic diameter at the level of the sinotubular junction and tubular ascending aorta, mean aortic diameters (p = 0.002 and p = 0.0001, respectively), annual increase in diameter (p = 0.0001 and p = 0.0001, respectively), and mean annual difference in diameter (p = 0.0001 and p = 0.0001, respectively) at one and three years postoperatively were statistically significantly different between the groups. CONCLUSION: In patients with ascending aortic dilatation who did not require surgical intervention and who had proximal anastomosis of the ascending aorta and underwent only CABG, we detected statistically significant increases in the diameter of the sinotubular junction and tubular aorta up to three years postoperatively.

Do preoperative C-reactive protein and mean platelet volume levels predict development of postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting?

INTRODUCTION: Atrial fibrillation (AF) after coronary artery bypass grafting (CABG) operation is associated with increased risk of prolonged hospitalisation, health expenses and adverse clinical outcomes. AIM: To investigate the relationship of atrial fibrillation after an isolated coronary artery bypass operation with levels of mean platelet volume and C-reactive protein. MATERIAL AND METHODS: Among 1240 patients who underwent operations for isolated coronary artery bypass grafting with cardiopulmonary bypass between January 2007 and May 2014, 1138 (91.8%) patients with preoperative normal sinusal rhythm were enrolled in the study. Patients were assigned to group 1 (n = 294) comprising patients who developed atrial fibrillation in the first 72 postoperative hours or group 2 (n = 844) comprising patients who remained in normal sinusal rhythm in the postoperative period. RESULTS: The incidence of postoperative atrial fibrillation was 25.8%. The preoperative mean platelet volume (fl) and C-reactive protein (mg/dl) values in group 1 were 9.1 ±0.5 and 1.1 ±0.9 respectively, while these values were 8.3 ±0.6 and 0.5 ±0.3 respectively in group 2, which was statistically significant (p = 0.0001). Length of stay in the hospital (p = 0.0001) was higher in group 1. The values of mean platelet volume (fl) and mean C-reactive protein (mg/dl) were 9.9 ±0.9 and 30.9 ±3.4 respectively in group 1, while the values of mean platelet volume (fl) and mean C-reactive protein (mg/dl) were 8.8 ±0.6 and 24.9 ±4.8 respectively in group 2 (p = 0.0001 for mean platelet volume, p = 0.0001 for C-reactive protein). The difference between the groups was statistically significant in terms of postoperative neurologic events (p = 0.0001) and hospital mortality (p = 0.001). Increased C-reactive protein and mean platelet volume levels were found to be independent predictors of postoperative atrial fibrillation. CONCLUSIONS: In our study, elevated preoperative mean platelet volume and C-reactive protein levels were associated with development of postoperative atrial fibrillation.

Right atrial myxoma mimicking tricuspid stenosis.

A 62-year-old man presented to the cardiology clinic with symptoms of fatigue, shortness of breath and swelling in the abdomen and legs. A pedunculated mobile mass with a short stalk in the right atrium was found to originate from the inferior vena caval opening and prolapse into the right ventricle through a tricuspid valve during diastole in echocardiography. The patient was referred to our department and surgery was planned for right atrial myxomas diagnosis. The mass with surrounding tissue was surgically removed using the cardiopulmonary bypass method. No postoperative complications were seen in the currently asymptomatic patient who is still under our follow-up schedule.