Artificial Chordae Implantation vs Posterior Leaflet Preservation: A Comparison of Midterm Results After Mitral Valve Replacement.

BACKGROUND: Various techniques have been proposed for the preservation of the subvalvular apparatus (SVA) in mitral valve replacement. This study aimed to compare the midterm results of posterior leaflet preservation with the results of selective preservation of the SVA involving artificial chordae implantation in terms of left ventricular performance in patients undergoing mitral valve replacement. METHODS: In total, 127 patients were included in this study. Patients were allocated to 1 of 2 groups according to the techniques used to preserve the SVA. Patients in group 1 underwent posterior leaflet preservation: The anterior leaflet was completely resected, and the posterior leaflet was preserved. In group 2, which comprised patients with severe leaflet extension and subvalvular fusion, the mitral valve was excised completely and substituted with artificial chordae. All relevant preoperative, intraoperative, and postoperative data were recorded. RESULTS: Mean (SD) ages in groups 1 and 2 were 63.1 (9.65) and 57.1 (12.3) years, respectively (P = .003). Mean (SD) follow-up time was 59.97 (23.63) months (range, 6-99 months). Left ventricular end-diastolic diameter decreased significantly after artificial chordae implantation (P < .001), while the decrease after posterior leaflet preservation was not statistically significant (P = .20). In both groups, there were statistically significant reductions (P < .001) in left ventricular end-systolic diameter and left atrium diameter in the postoperative period compared with respective preoperative levels. During follow-up, left ventricular ejection fraction was found to have increased beyond the preoperative levels in both groups, but the differences were not statistically significant (P > .05). CONCLUSION: Results of echocardiographic observations regarding the preservation of the SVA via artificial chordae implantation for mitral valve disease in this sample were satisfactory. Findings suggest that artificial chordae implantation should be considered when posterior leaflet preservation is not suitable.

Evaluation of the Patients with Recurrent Angina After Coronary Artery Bypass Grafting.

INTRODUCTION: In this study, we aimed to evaluate the most common causes of recurrent angina after coronary artery bypass grafting (CABG) and our treatment approaches applied in these patients. METHODS: We included all patients who underwent CABG, with or without percutaneous coronary intervention after CABG, at our hospital from September 2013 to December 2019. Patients were divided into two groups according to the time of onset of anginal pain after CABG. Forty-five patients (58.16 ± 8.78 years) had recurrent angina in the first postoperative year after CABG and were specified as group I (early recurrence). Group II (late recurrence) comprised 82 patients (58.05 ± 8.95 years) with angina after the first year of CABG. RESULTS: The mean preoperative left ventricular ejection fraction was 53.22 ± 8.87% in group I, and 54.7 ± 8.58% in group II (P=0.38). No significant difference was registered between groups I and II regarding preoperative angiographic findings (P>0.05). Failed grafts were found in 27.7% (n=28/101) of the grafts in group I as compared to 26.8% (n=51/190) in group II (P>0.05). Twenty-four (53.3%) patients were treated medically in group I, compared with 54 (65.8%) patients in group II (P=0.098). There was a need for intervention in 46.6% (n=21) of group I patients, and in 34.1% (n=28) of group II patients. CONCLUSION: Recurrent angina is a complaint that should not be neglected because most of the patients with recurrent angina are diagnosed with either native coronary or graft pathology in coronary angiography performed.

Evaluation of the Patients with Recurrent Angina After Coronary Artery Bypass Grafting

ABSTRACT Introduction: In this study, we aimed to evaluate the most common causes of recurrent angina after coronary artery bypass grafting (CABG) and our treatment approaches applied in these patients. Methods: We included all patients who underwent CABG, with or without percutaneous coronary intervention after CABG, at our hospital from September 2013 to December 2019. Patients were divided into two groups according to the time of onset of anginal pain after CABG. Forty-five patients (58.16 ± 8.78 years) had recurrent angina in the first postoperative year after CABG and were specified as group I (early recurrence). Group II (late recurrence) comprised 82 patients (58.05 ± 8.95 years) with angina after the first year of CABG. Results: The mean preoperative left ventricular ejection fraction was 53.22 ± 8.87% in group I, and 54.7 ± 8.58% in group II (P=0.38). No significant difference was registered between groups I and II regarding preoperative angiographic findings (P>0.05). Failed grafts were found in 27.7% (n=28/101) of the grafts in group I as compared to 26.8% (n=51/190) in group II (P>0.05). Twenty-four (53.3%) patients were treated medically in group I, compared with 54 (65.8%) patients in group II (P=0.098). There was a need for intervention in 46.6% (n=21) of group I patients, and in 34.1% (n=28) of group II patients. Conclusion: Recurrent angina is a complaint that should not be neglected because most of the patients with recurrent angina are diagnosed with either native coronary or graft pathology in coronary angiography performed.

Does COVID-19 infection increase the risk of pulmonary embolism in ambulatory patients with deep vein thrombosis.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) can lead to systemic coagulation activation and thrombotic complications including venous thromboembolism. This study compares the development of pulmonary embolism, post-thrombotic syndrome, and clinical outcomes of COVID-19 and non-COVID-19 patients with deep vein thrombosis (DVT). METHODS: One hundred and eight patients diagnosed with acute deep vein thrombosis (DVT) between June 2020 and February 2021 in our institution were included in this retrospective study. Thirty-nine patients had been previously diagnosed with COVID-19 and specified as the COVID-19 group. Sixty-nine patients did not have COVID-19 and specified as the non-COVID-19 group. Mean ages of both groups were 64.3 ± 15.8 and 60.1 ± 19.7 years, respectively (p = .37). RESULTS: The median duration from the onset of the COVID-19 to diagnosis of DVT was 22 (2-120) days in the COVID-19 group. The patients of two groups were mostly treated outpatient at rates of 94.9% vs 94.2%, respectively (p = .88). Pulmonary embolism was seen in six patients (15.4%) in the COVID-19 group and in three patients (4.3%) in the non-COVID-19 group (p = .04). Kaplan-Meir curves showed that patients with COVID-19 had significantly higher pulmonary embolism than those without COVID-19 (p = .015). The recurrence rate of DVT was 2.6% in the COVID-19 group (n = 1), and 4.3% in the non-COVID-19 group (n = 3), indicating no statistically significant difference (p = .63). Mortality was seen in six patients (15.4%) in the COVID-19 group, and in seven patients (10.1%) in the non-COVID-19 group. According to the Kaplan-Meir method, 10 months survival rates were 73.9 ± 10% in the COVID-19 group, and 66.3 ± 12.8% in the non-COVID-19 group with no statistical significance (p = .218). CONCLUSIONS: Our data draw attention to the fact that deep vein thrombosis should not be considered a safe and self-limited condition. Efficient preventive measures such as mobilization and prophylactic drug use should be considered to prevent DVT during the management of COVID-19.

Is trans-apical off-pump neochord implantation a safe and effective procedure for mitral valve repair?

OBJECTIVE: Trans-apical off-pump mitral valve repair is a new minimally invasive surgical technique for the correction of mitral regurgitation caused by mitral leaflet prolapse. The purpose of this study is to evaluate, using clinical and echocardiographic follow-up data, the mid-term results of patients undergoing this procedure. METHODS: A total of 26 patients diagnosed with severe mitral regurgitation underwent mitral valve repair with trans-apical off-pump neochord implantation using the NeoChord device at our hospital from July 2015 to July 2017. All patients were examined by transthoracic and transesophageal echocardiography. Eighteen (69.2%) patients had type A anatomy, 4 (15.4%) had type B anatomy, and 4 (15.4%) had type C anatomy. Preoperative, intraoperative, and postoperative demographic, echocardiographic, and clinical data were collected. RESULTS: The patients' age ranged from 33 to 76 years (mean: 56±10.1 years). The average preoperative EuroSCORE II was 1.04%±0.7%. Acute procedural success was achieved in 25 (96.15%) patients. There was only 1 early death (30-day mortality rate: 3.8%) due to postoperative low cardiac output syndrome. Transthoracic echocardiography examinations revealed trivial/mild mitral regurgitation in 87.5% of the patients and moderate regurgitation in 12.5% of the patients. During the follow-up period, transthoracic echocardiography examinations revealed trivial/mild mitral regurgitation (MR) in 14 (58.3%) patients. Six (25%) patients presented with moderate MR and 4 (16.7%) patients had severe MR. At the 30-month follow-up, freedom from residual severe MR was 78.8%±10.3% and freedom from reoperation was 87.5%±6.8%. CONCLUSION: Trans-apical off-pump mitral valve repair with neochord implantation may be a suitable treatment option in patients with isolated posterior mitral valve leaflet prolapse.

Survival of patients with well-developed collaterals undergoing CABG or medical treatment: an observational case-controlled study.

OBJECTIVE: The effects of coronary artery bypass grafting (CABG) on mortality have not been evaluated in patients with well-developed coronary collaterals. We investigated functional capacity, presence of angina, the occurrence of acute myocardial infarction, survival and mortality in patients with well-developed coronary collaterals both undergoing and refusing CABG. METHODS: The study was designed as a retrospective observational case-controlled study. Seventy-eight patients undergoing coronary angiography were included in this study. They had critical occlusion in the proximal left anterior descending artery (LAD) with Rentrop-3 collateral circulation towards LAD, and to proceed with CABG has been suggested. The patients were divided in two groups; first group proceeding with CABG (n=40) and the second, rejecting the surgery (medical treatment group; n=38). The rates of survival, the incidence of angina pectoris and acute myocardial infarction as well as the functional capacities were evaluated in all patients. Survival rates were evaluated using Kaplan-Meier survival analysis. RESULTS: No statistically significant difference was observed between the two groups regarding the baseline characteristics of patients, the presence of angina pectoris, the severity of angina pectoris according to CCS, the occurrence of acute myocardial infarction or stroke, and the functional capacity according to NYHA (p>0.05). Death due to cardiovascular reasons was observed in eight patients of CABG group and in five patients of medical treatment group (p=0.710). The 5-year survival rate was observed to be 80% in CABG group while it was observed to be 84% in the medical treatment group (p=0.730). CONCLUSION: There was no significant difference regarding the survival rates in patients with well-developed coronary collaterals proceeding with CABG or medical treatment.

Percutaneous coronary intervention of a single coronary artery arising from the right sinus of Valsalva.

Anomalous origin of the left main coronary artery from the right sinus of Valsalva is extremely rare when not associated with other congenital cardiac anomalies. In this report we present a patient with a single coronary ostium, with both the left and right coronary artery systems arising from it. The right coronary artery was found to contain a significant flow-limiting lesion that was successfully treated with percutaneous coronary intervention.

The importance of intrapericardial drain selection in cardiac surgery.

INTRODUCTION: To explore the impact of intrapericardial and infracardiac drains on pericardial effusions in cardiac surgery. MATERIALS AND METHODS: Patients undergoing coronary artery bypass grafting were randomized into two groups. At the end of the intervention, an intrapericardial and infracardiac Blake drain was placed in patients in group 1 (n = 97), and an intrapericardial and infracardiac semirigid drain was placed in patients in group 2 (n = 105). In addition, a semirigid drain was placed into mediastinum in all cases. The amount of drainage was calculated at six different time points postoperatively: postoperative 0 to 2 h, postoperative 2 to 4 h, postoperative 4 to 6 h, postoperative 6 to 12 h, postoperative 12 to 24 h, and postoperative 24 to 48 h. The amount of pericardial effusion was estimated by transthoracic echocardiography after the drains were removed. RESULTS: In all measurements, the amount of drainage from intrapericardial Blake drains was higher, the total amount of drainage being equal to 330.7 +/- 29.4 mL and 193.2 +/- 19.6 mL in the Blake drain and semirigid drain groups, respectively (p = 0.000) [mean +/- SD]. When the drains were removed, the volume of pericardial effusion was 3.86 +/- 0.76 mm in Blake drain group and 7.59 +/- 1.16 mm in semirigid drain group (p = 0.000). The incidence of postoperative atrial fibrillation was 11.3% in the group with Blake drains, and 23.8% in the group with semirigid drains (p = 0.016). CONCLUSION: The more effective drainage obtained with infracardiac Blake drains compared to semirigid drains helps to reduce the amount of postoperative pericardial effusion and the risk of atrial fibrillation.