Evaluation of systemic immune-inflammation index for predicting severity of lower extremity arterial disease.

OBJECTIVE: Predictive value of systemic immune-inflammation index (SII) has been shown in clinical outcomes and complexity of coronary artery disease, acute coronary syndrome, and heart failure. We sight to evaluate value of SII in patients with lower extremity arterial disease (LEAD). METHODS: A total of 271 patients diagnosed with LEAD were included to our study. Blood samples of the patients were collected and analyzed for biochemical variables and complete blood count parameters. SII value of each patient was calculated. The complexity of atherosclerotic disease was classified according to Trans-Atlantic Inter-Society Consensus (TASC II) classification. RESULTS: Patients with TASC C-D were older than patients in TASC A-B group (63.06 ± 9.24 years and 60.85 ± 8.75 years, respectively). Other co-morbidities were comparable in both groups. Hemoglobin level and lymphocyte count were significantly lower, neutrophil, platelet counts, and SII values were significantly higher in patients with TASC C-D disease compared to that of patients with TASC A-B disease. SII showed significant correlation with the severity of LEAD (r = 0.363, p < .001). SII value of 664.24 predicted TASC C-D disease with a sensitivity and specificity of 60.8% and 73.3%, respectively. Results of multivariate logistic regression analysis showed that SII had higher odds ratio compared to platelet, neutrophil, and lymphocyte counts. CONCLUSION: Higher SII may indicate probability of more complex LEAD. This relationship seems plausible in terms of similar pathophysiology of coronary artery disease and peripheral artery disease.

Comparison of Radiofrequency Ablation and Cyanoacrylate Closure for Large-Diameter Great Saphenous Vein Insufficiency.

BACKGROUND: To compare radiofrequency ablation (RFA) and cyanoacrylate closure (CAC) for large-diameter great saphenous vein (GSV) insufficiency between diameters of 12 and 16 mm. METHODS: This study is a single-center retrospective study. Subjects who underwent endovenous treatment with RFA (Group A) or CAC (Group B) for GSV insufficiency between June 2015 and June 2021 who were followed up for at least 2 years were included in the study. Subjects who had a 12-mm to 16-mm target vessel diameter and subjects with grade 3 and grade 4 reflux were included. Subjects' demographic data (age, sex), body mass indices, clinical, etiological, anatomic, pathophysiologic classification, GSV diameter, reflux grade, target vessel length, preoperative venous clinical severity score (VCSS), procedural time, postoperative first-day pain scores, postoperative 14th-day patient satisfaction scale, and postoperative complications were noted. In follow-up, subjects were evaluated with duplex ultrasonography and VCSS at 1, 6, 12, and 24 months. RESULTS: In total, 142 subjects were included (n = 71 for both groups). The mean GSV diameter was 13.21 ± 1.00 for Group A and 13.51 ± 0.97 for Group B. The groups did not differ in terms of age, sex, body mass index, clinical, etiological, anatomic, pathophysiologic classification, GSV diameter, reflux grade, target GSV length, preoperative VCSS, complications, postoperative 24-hr pain status or postoperative 14-day patient satisfaction scale (P > 0.05 for all comparisons). The procedure time was significantly shorter in Group B (34.68 ± 4.22 min for Group A vs. 22.59 ± 4.5 min for Group B, P = 0.001). In the 1-month and 6-month Duplex ultrasonography of the subjects, partial closure and patency rates in Group B were significantly higher than those in Group A (P = 0.003 and P = 0.025, respectively). At the 12-month and 24-month evaluation, closure rates did not show a statistically significant difference between the groups (P = 0.056 and P = 0.090, respectively). Preoperative and 1-month VCSS measurements did not show a statistically significant difference between groups (P > 0.05 for all comparisons). The 6-month, 12-month, and 24-month VCSS measurements of Group A were significantly higher than those in Group B. (P = 0.043, P = 0.009 and P = 0.002, respectively). CONCLUSIONS: Both RFA and CAC were found to be effective in the treatment of large-diameter GSV incompetency. The complication rates were similar between the 2 techniques. CAC had a shorter procedure time. Although the closure rates in the early postoperative period were better in the RFA group, long-term follow-up demonstrated similar patency rates. The functional results in the long-term follow-up were better in the RFA group.

Surgical treatment of constrictive pericarditis at a single center: 10 years of experience.

BACKGROUND: Constrictive pericarditis (CP) is a pericardial disease characterized by the pericardium becoming calcified or fibrotic as a result of chronic inflammation, which impairs diastolic filling by compressing the cardiac chambers. Pericardiectomy is a promising surgical option for treating CP. In this study, we reviewed over 10 years of preoperative, perioperative, and short-term postoperative follow-ups of patients who underwent pericardiectomy for constrictive pericarditis at our clinic. METHODS: Between January 2012 and May 2022, 44 patients were diagnosed with constrictive pericarditis. Twenty-six patients underwent pericardiectomy for CP. Median sternotomy is the surgical approach of choice because it provides easy access for complete pericardiectomy. RESULTS: The patient median age was 56 (min: 32, max: 71), and 22 out of 26 patients (84.6%) were male. Twenty-one patients (80.8%) complained of dyspnea, which was the most common reason for admission. Twenty-four patients (92.3%) were scheduled for elective surgery. Cardiopulmonary bypass (CPB) was used during the procedure in six patients (23%). The duration of intensive care stay was two days (min: 1, max: 11), and the total hospitalization was six days (min: 4, max: 21). No in-hospital mortality was observed. CONCLUSION: The median sternotomy approach provides a critical advantage in terms of performing a complete pericardiectomy. Although CP is a chronic condition, early diagnosis and planning of pericardiectomy before irreversible deterioration of cardiac function leads to a notable reduction in mortality and morbidity.

Effect of specialized pro-resolving lipid mediators in the regulation of vascular tone and inflammation in human saphenous vein.

Specialized pro-resolving lipid mediators (SPMs), derived from polyunsaturated fatty acids are important mediators in the resolution of inflammation. Recent studies have focused on the effects of SPMs in cardiovascular health and diseases. However, little is known about the effect SPMs on human vascular tone. Therefore, in this study it is aimed to investigate the effect of various SPMs including resolvin D- and E-series, maresin-1 (MaR1) and lipoxin-A4 (LxA4) on the vascular tone of human isolated saphenous vein (SV) preparations under inflammatory conditions. In addition, we aimed to evaluate the effects of SPMs on the release of pro-inflammatory mediators, monocyte chemoattractant protein-1 (MCP-1) and tumor necrosis factor-alpha (TNF- α) from human SV. Pretreatment of isolated of human SV with resolvin E1 (RvE1), resolvin D1 (RvD1) and MaR1 (100 nM, 18 h) significantly reduced the contractile responses to thromboxane A2 mimetic, U46619 whereas pretreatment with LxA4 and RvD2 (100 nM, 18 h) had no significant effect on the vascular tone of SV. Moreover, RvE1, RvD1 and MaR1 but not LxA4 and RvD2 (100 nM, 18 h) pretreatment diminished the release of MCP-1 and TNF-α from SV. In conclusion, our findings suggest that pre-treatment with RvE1, RvD1, and MaR1 could have potential benefits in decreasing graft vasospasm and vascular inflammation in SV.

Comparison of Drug-Coated Balloon Angioplasty Alone and Directional Atherectomy Combined with Drug-Coated Balloon Angioplasty in Patients with Lower Extremity Peripheral Arterial Disease with Claudication.

BACKGROUND: The objective of the study was to compare drug-coated balloon (DCB) angioplasty alone and directional atherectomy (DA) combined with DCB angioplasty in patients with lower extremity peripheral arterial disease (LE-PAD). METHODS: Subjects treated with DCB angioplasty alone (group A) and DA combined with DCB angioplasty (group B) were enrolled in the study. A retrospective chart review was performed between the 4 years. Subjects with severe and occluded LE-PAD were included. Demographic data, atherosclerotic vessel properties, and procedural data were recorded. For both groups, success rates (technical, procedural, and clinical) were presented. RESULTS: In total, 226 patients were evaluated. For baseline characteristics, only tobacco use and hyperlipidemia were higher in group B (P = 0.001 and P = 0.010, respectively). For the ankle-brachial index, no significant difference existed at the first, third, sixth, 12th or 24th month follow-ups. No significant difference existed for the Rutherford class at the first, third, sixth, or 12th months according to the groups. A significant difference was found at 24-month Rutherford levels. The incidence of severe claudication in group A was significantly higher than that in group B (13 [12.4%] for group A and 3 [2.8%] for group B, P = 0.035). The stenosis rate after predilatation in group B was significantly higher than that in group A (54.56 ± 5.36 for group A and 59.20 ± 6.21 for group B, P = 0.012). The distribution of full patency in the 12th month in group B was significantly higher than that in group A. The rate of 70-100% stenosis in the 12th month was significantly higher in group A than in group B. According to the groups, the distribution of the patients who were lost to follow-up and died during the follow-up and secondary results, primary patency rates, and 2-year disease-free survival rates were also similar. CONCLUSIONS: Atherectomy combined with DCB is superior for the long-term treatment of LE-PAD.

Comparison of high saphenous ligation and stripping, radiofrequency ablation, and subfascial endoscopic perforator surgery for the treatment of active venous ulcers: Retrospective cohort with five-year follow-up.

OBJECTIVE: To compare the use of high saphenous ligation and stripping, radiofrequency ablation, and subfascial endoscopic perforator surgery for the treatment of active venous ulcers. METHODS: One hundred ninety-five (n = 195) subjects who were treated for venous leg ulcers were enrolled between 2009 and 2014. Three groups were formed (Group A: high saphenous ligation and total stripping, Group B: radiofrequency ablation of the great saphenous vein + perforators, and Group C: radiofrequency ablation of the great saphenous vein + subfascial endoscopic perforator surgery) (n = 65 for each group). The venous clinical severity score for baseline, 1st, 6th, and 12th months, great saphenous vein occlusion at the 1st, 6th, and 12th months, and ulcer rates for the 1st, 2nd, 3rd, 4th, and 5th years were recorded. RESULTS: For venous clinical severity score, only the first month decrease was significant for the subfascial endoscopic perforator surgery group (p = 0.001). Great saphenous vein occlusion was higher at the 6th and 12th months for the high saphenous ligation and stripping and subfascial endoscopic perforator surgery groups than for the radiofrequency ablation group (p = 0.036 and p = 0.037). The rate of ulcers for the subfascial endoscopic perforator surgery group was lower at the second, third, fourth, and fifth years (p = 0.011). No significant difference was found between groups for the five-year recovery rates (p > 0.05). CONCLUSION: Subfascial endoscopic perforator surgery technique in conjunction with radiofrequency ablation of axial vein was superior to both high saphenous ligation and stripping and radiofrequency ablation of axial and perforators for ulcer healing.

Comparative study of coronary artery bypass graft materials: reduced contraction and ADMA levels in internal mammary artery versus saphenous vein.

BACKGROUND: Vasospasm and atherosclerosis due to low endothelial capacity are the most important causes of coronary artery bypass graft failure observed in internal mammary artery (IMA) and saphenous vein (SV). Vasospasm can be mimicked in in-vitro studies by inducing vasoconstriction of graft materials. In the present study, we aimed to compare the vascular contraction induced by several spasmogens including prostaglandin E2 (PGE2), prostaglandin F2 alpha (PGF2α), phenylephrine (PE), leukotriene C4 (LTC4), LTD4, potassium chloride (KCl), and arachidonic acid between IMA and SV preparations. Furthermore, endothelial capacity, nitrite and asymmetric dimethylarginine (ADMA) levels were compared between two grafts. METHODS: By using organ bath, contractile responses induced by different spasmogens were compared between IMA and SV preparations derived from patients underwent coronary artery bypass surgery (N.=35). The endothelial capacity was determined by acetylcholine-induced (ACh) relaxation in PE-precontracted vessels. Nitrite and ADMA levels were measured in organ culture supernatant of IMA and SV preparations. RESULTS: Contractile responses induced by PGE2, PGF2α, PE, LTC4, LTD4, KCl and arachidonic acid were significantly lower in IMA preparations versus SV preparations. ACh-induced relaxation was significantly more prominent in IMA than SV preparations. Nitrite levels were greater and ADMA levels were lower in IMA versus SV preparations. CONCLUSIONS: IMA has reduced capacity to constrict to several vasoconstrictor agents. Furthermore, IMA has greater endothelial capacity associated with higher nitrite levels and lower ADMA levels. Our results support the greater patency rate observed in IMA versus SV preparations.

Comparative study on the effect of aspirin, TP receptor antagonist and TxA2 synthase inhibitor on the vascular tone of human saphenous vein and internal mammary artery.

AIMS: Thromboxane (TxA2) is synthesized from arachidonic acid (AA) via thromboxane synthase (TxS) enzyme and induces vasoconstriction via TP receptor. Our aim is to compare the effects of aspirin, TxS inhibitor and TP receptor antagonist on vascular reactivity of bypass grafts (saphenous vein and internal mammary artery). MAIN METHODS: Using isolated organ bath, saphenous vein and internal mammary artery preparations were incubated with TP receptor antagonist, TxS inhibitor, aspirin, IP or EP4 receptor antagonist. Then prostaglandin (PG)E2, PGF2α, phenylephrine and AA were administered in concentration-dependent manner. The expression of prostanoid receptor and PGI2 synthase (PGIS) enzyme was determined by Western Blot. KEY FINDINGS: TP receptor antagonist inhibited the contraction induced by PGE2, PGF2α, and AA but not that induced by phenylephrine in both types of vessels. Aspirin increased phenylephrine-induced contraction only in internal mammary artery and decreased AA-induced contraction in saphenous vein. TxS inhibitor decreased both PGE2 and AA-induced contraction in both types of vessels. This decrease was reversed by co-incubation of TxS inhibitor and IP/EP4 receptor antagonists. The expressions of EP3 receptor and PGIS enzyme were greater in internal mammary artery compared to saphenous vein while IP and TP receptors expressed at similar levels. SIGNIFICANCE: TP receptor antagonist and TxS inhibitor are more effective to reduce contraction induced by different spasmogens in comparison to aspirin. Our results suggest that TP receptor antagonist and TxS inhibitor might have an advantage over aspirin due to their preventive effect on increased vascular reactivity observed in post-operative period of coronary artery bypass grafting.

Acute Aortic Dissection Surgery in a Patient With COVID-19.

Acute aortic dissection is one of the most common life-threatening diseases that affects the aortic vessel. We present a case of acute Stanford type A aortic dissection in a patient with coronavirus disease 2019 (COVID-19) under treatment with angiotensin-converting enzyme inhibitors. A 68-year-old woman complaining of acute chest pain and dyspnea was admitted to the emergency clinic of our hospital on May 6, 2020. She had history of diabetes and hypertension. This is one of the first acute aortic surgery cases among patients with COVID-19.

Comparison of paclitaxel-coated balloon angioplasty with femoropopliteal bypass surgery in treating femoropopliteal lesions.

OBJECTIVE: To compare drug (paclitaxel)-coated balloon angioplasty with femoropopliteal bypass surgery in the treatment of femoropopliteal lesions. METHODS: A retrospective study was performed between January 2015 and January 2019, covering a four-year period. All subjects who underwent femoropopliteal bypass surgery and drug-coated balloon angioplasty over a four-year period were evaluated. The subjects' demographic characteristics, lesion characteristics, treatment outcomes and disease-free survival were collected. Subjects were divided into the femoropopliteal bypass group (Group A) and the drug-coated balloon angioplasty (Group B) group. RESULTS: In total, 220 subjects were enrolled. Both Group A and Group B consisted of 110 subjects. The proportion of patients with a claudication distance between 0 and 50 m was significantly higher in Group A, and the proportion of patients with a claudication distance between 50 and 100 m was significantly higher in Group B (p = 0.001). In terms of the Rutherford levels, moderate claudication was significantly higher in Group B, and severe claudication was significantly higher in Group A (p = 0.001). The lesion length for the subjects in Group A was significantly longer than that in Group B (24.61 ± 2.79 mm for Group A and 18.59 ± 3.95 mm for Group B, p = 0.001). The stenosis degree in Group A was also significantly higher than that in Group B (96.82 ± 4.32% for Group A and 94.85 ± 4.55% for Group B, p = 0.001). The duration of the procedure, duration of hospitalization and rate of bleeding in Group A were significantly higher than those in Group B. The incidence of overall morbidity and reintervention rates in Group B were significantly higher than that in Group A. The preoperative ankle brachial index values of the subjects in Group B were statistically significantly higher than those in Group A (0.56 ± 0.08 for Group A and 0.61 ± 0.08 for Group B, p = 0.001). The change in the ankle brachial index measurement of the subjects in Group A with respect to the preprocedure value was significantly greater than that in Group B (p = 0.001). For primary patency, there was a significant difference between the groups in the distribution of the duplex ultrasound results at the 3rd, 6th, 9th and 12th month control points (p = 0.001). At all control points, Group A had better primary patency rates, whereas the secondary patency rates did not differ. In total, among the 220 patients, 125 (56.8%) were disease free, and 95 (43.2%) experienced recurrence. The mean disease-free survival times for Group A and Group B were 10.45 ± 0.28 months and 9.11 ± 0.37 months, respectively. The disease-free survival rates were significantly higher in Group A (p = 0.001, p < 0.05). CONCLUSION: Femoropopliteal bypass resulted in better disease-free survival rates than drug-coated balloon angioplasty and serves as an effective modality for the treatment of femoropopliteal lesions.

Mechanism of thromboxane receptor-induced vasoconstriction in human saphenous vein.

Saphenous vein (SV) is one of the most widely used graft material in patients undergoing coronary artery bypass graft surgery (CABG). Thromboxane A2 (TXA2) is implicated in graft failure by inducing vasoconstriction and platelet aggregation. The aim of this study is to investigate the mechanism involved in TXA2-induced vasoconstriction in human SV. The role of different inhibitors and blockers on U46619 (TXA2-mimetic)-induced vasoconstriction is investigated by using an isolated organ bath system. Relaxation responses to several mediators are evaluated in SV pre-contracted with U46619 and compared with those pre-contracted with phenylephrine. Our results demonstrate that U46619-induced contraction is completely blocked by myosin light chain kinase inhibitor ML-9 or TP receptor antagonist BAY u3405. Furthermore, U46619-induced contraction is partially inhibited by phospholipase C inhibitor U73122, protein kinase C inhibitor calphostin C, Rho-kinase inhibitor Y-27632, L-type calcium channel blocker nifedipine, store-operated channel inhibitor SKF96365 or removal of extracellular calcium. Relaxation responses to NO donor (sodium nitroprusside), guanylate cyclase (GC) stimulator (riociguat), phosphodiesterase (PDE) inhibitors (sildenafil, IBMX), adenylate cyclase (AC) activator (forskolin) and acetylcholine (ACh) are markedly reduced when U46619 is used as a pre-contraction agent. Our results demonstrate that influx of extracellular Ca2+ (through L-type calcium channels and store-operated calcium channels) and intracellular Ca2+ release together with Ca2+ sensitization (through Rho-kinase activation) are necessary components for TXA2-induced vasoconstriction in SV. Moreover, more pronounced decrease in vasorelaxation induced by several mediators (SNP, riociguat, sildenafil, IBMX, forskolin, and ACh) in the presence of U46619 when compared with phenylephrine suggests that there is a crosstalk between the TP receptor signaling pathway and PDE, AC, GC enzymes. We believe that the investigation of mechanism of the TXA2-induced vasoconstriction in SV will provide additional information for the prevention of SV graft failure.

Comparison of del Nido Cardioplegia and Blood Cardioplegia in Aortic Root Surgery.

AIM: To compare del Nido cardioplegia (DNC) with conventional blood cardioplegia (BC) in aortic root surgery. METHODS: Subjects who underwent aortic root surgery during a 3-year period were included. A DNC group was compared with a matched BC group. RESULTS: A total of 72 subjects were included, 36 who underwent DNC compared with 36 propensity-matched subjects who underwent BC. Fifty-one (70.8%) were male, and 21 (29.2%) were female, with a mean age of 66.19 ± 7.02 years (range 51 to 81). No significant differences in baseline characteristics, preoperative echocardiogram parameters, or intraoperative parameters were found between the groups. For DNC versus BC, cardiopulmonary bypass time, aortic clamp time, cardioplegia volume (all P = .001), and defibrillation (P = .007) were significantly lower. For postoperative biochemical parameters, creatinine levels at hour 24, potassium levels at hours 1 and 24, and glucose levels at hours 6 and 24 did not differ between the groups (P > .05). Creatine kinase-MB and troponin T levels at hours 1 and 24 were significantly lower in DNC versus BC (all P = .001). Hematocrit levels at hours 6 and 24 were significantly higher in DNC (P = .001). The groups did not differ in terms of postoperative inotropic support, postoperative complications, intubation period, or duration of intensive care unit stay (P > .05). Although the need for thrombocyte transfusion did not differ between groups (P > .05), DNC resulted in less use of erythrocyte and fresh frozen plasma transfusions (both P = .001). Postoperative ejection fraction was significantly better in the DNC group than in the BC group (P = .006). CONCLUSION: The results indicate better intraoperative parameters and better ejection fraction rates with DNC than with BC. DNC is an effective and safe alternative to blood cardioplegia for aortic root surgery.

Effect of N-acetylcysteine on intimal hyperplasia and endothelial proliferation in rabbit carotid artery anastomosis.

INTRODUCTION: Neointimal hyperplasia due to smooth muscle cell migration and proliferation, as well as extracellular matrix accumulation, plays an important role in stenosis and restenosis that develop after reconstructive vascular interventions. Various agents are being tested to reduce neointimal hyperplasia and to prevent lumen stenosis. In the present study, the effect of N-acetylcysteine (NAC) on intimal hyperplasia and endothelial hyperplasia after carotid anastomosis was investigated in a rabbit model. MATERIAL AND METHODS: In the course of the study, rabbits were divided into two groups. The control group (n = 7) underwent right carotid artery anastomosis and received no medication. The NAC group (n = 7) underwent right carotid artery anastomosis and received NAC for 21 days following surgery. NAC was administered at a dose of 150 mg/kg/day just after the surgery. The carotid artery underwent anastomosis, and the histological examination findings of anastomosed and opposite non-anastomosed carotid arteries were compared in two experimental groups that either received NAC or did not. RESULTS: Compared with the control group, the reduction in the lumen area and diameter after anastomosis was significantly recovered in the NAC group (p = 0.018; p = 0.612). Increases in the intima and media areas and the intima/media ratio were smaller in the NAC group after anastomosis than in the control group, but the differences were not significant. CONCLUSIONS: We believe that vascular anastomosis and post-intervention NAC administration will prolong vascular patency by reducing intimal hyperplasia and providing vascular remodeling.

Surgical Treatment of Rare Giant Inferoposterior Left Ventricular Aneurysm: A Case Report.

We present the case of a 63-year-old male with post-myocardial infarction causing a giant left ventricular aneurysm and describe the surgical treatment via Dor Procedure.

Hybrid atherectomy for lower extremity peripheral arterial disease.

OBJECTIVE: To evaluate the effectiveness of directional atherectomy with a Phoenix atherectomy system in lower extremity peripheral arterial disease (LE-PAD). MATERIALS AND METHODS: A retrospective review of subjects who had undergone atherectomy for severe and occluded LE-PAD. Demographic data, procedural properties, and follow-up information were recorded. The technical, procedural and clinical successes were reported. RESULTS: In total, 120 subjects were evaluated. The superficial femoral artery (SFA) group consisted of 64 subjects (53.3%), and the popliteal group consisted of 56 (46.7%) subjects. Groups did not differ in terms of age, gender, comorbid diseases and tobacco use. In both groups, four subjects (6.3% of SFA and 7.1% of the popliteal group) experienced extravasation was encountered in from the vessel during the procedure. During atherectomy, two (3.3%) of the subjects in the SFA group and one (1.9%) subject in the popliteal group experienced vessel dissection. Acute technical success in this study was 96.7% for SFA and 98.1% for the popliteal group. Overall technical success was 97.7%. In the first 72 h, three (5%) of the subjects in the SFA group and four (7.7%) of the subjects in the popliteal group experienced major adverse events. Acute procedural success in this study was 91.7% for SFA and 90.4% for the popliteal group. Overall procedural success was 91.1%. Success was defined as an improvement of at least one grade in the Rutherford classification; two (3.3%) subjects did not demonstrate improvements in the SFA group, and the clinical success rate was 96.7%. All subjects in the popliteal group demonstrated an improvement of at least one grade in the Rutherford classification, and clinical success was 100%. When the groups combined all subjects, the clinical success in this study was 98.2%. CONCLUSION: Directional atherectomy with a Phoenix atherectomy system demonstrated comparable results with the literature.

The relationship between plaque cap morphology and access technique in lower extremity chronic total occlusion.

OBJECTIVES: To evaluate access success according to plaque cap morphology in subjects with lower limb chronic total occlusion. METHODS: A retrospective study was performed for a three-year period. Subjects with lower extremity chronic total occlusion (Rutherford category 3-6, ischaemia) were included in the study. Cap morphology was classified according to The chronic total occlusion crossing approach based on plaque cap morphology (CTOP) classification system. When describing the classification by a traditional antegrade approach, Types I, II, III and IV were defined as follows: Type I: concave proximal and distal caps; Type II: concave proximal and convex distal caps; Type III: convex proximal and concave distal caps; Type IV: convex proximal and distal caps. For the study, the data on demographics, access type, and direction crossed, access conversion, crossing success, crossing location, extravascular ultrasound guidance, catheter used, subjects, and localization of were recorded. The effect of cap morphology on crossing strategy and success was evaluated. RESULTS: A total of 110 subjects were enrolled in this study. The type of chronic total occlusion was determined by angiography in 100% of the subjects. The number of the subjects according to CTOP morphology for Types I, II, III and IV were 22 (20%), 39 (35.5%), 23 (20.9%) and 26 (23.6%), respectively. Superficial femoral artery, popliteal, anterior tibial, posterior tibial localizations did not differ among the CTOP types ( p = 0.649, p = 0.831, p = 0.923 and p = 0.903, respectively). Among the pre-operation parameters, lesion length was the only one that is significantly shorter in Type I (14.23 ± 1.93 cm) subjects when compared with Types II (21.77 ± 3.78 cm), III (21.17 ± 2.31 cm) and IV (19.85 ± 3.29 cm) subjects ( p < 0.001, for all comparisons). Antegrade access was significantly higher in group I than in group III. Planned dual access was also significantly lower in CTOP Type I than in CTOP Types II, III and IV. Antegrade crossed direction was significantly higher in CTOP Type I than in CTOP Types II, III and IV ( p = 0.001, for all comparisons). True lumen crossing was significantly higher in CTOP Type I than in CTOP Type II ( p = 0.002). In univariate analysis, chronic total occlusion Type IV was the only significant factor for antegrade crossing ( p = 0.001). Multivariate analysis demonstrated that chronic total occlusion Type IV (OR = 0.09, p = 0.001) was an independent risk factor for antegrade crossing. The odds of antegrade crossing for chronic total occlusion Type IV was 0.190 times that of chronic total occlusion Types I-II-III combined (OR (95% CI): 0.190 (0.070, 0.519), p = 0.001). CONCLUSIONS: CTOP Type I accesses with an antegrade access, and Type IV accesses with a retrograde strategy. Type II and Type III CTOP will need planned dual access in order to prevent device bending and subintimal access.

Comparison of del Nido Cardioplegia with Blood Cardioplegia in Coronary Artery Bypass Grafting Combined with Mitral Valve Replacement.

OBJECTIVE: To compare del Nido cardioplegia (DNC) with blood cardioplegia (BC) in coronary artery bypass grafting (CABG) combined with mitral valve replacement. METHODS: A 3-year single-center retrospective cohort study was carried out. Subjects who underwent CABG (up to triple bypass) combined with mitral valve replacement were divided into DNC and BC groups. Each group had thirty subjects. RESULTS: Both groups demonstrated similar baseline characteristics, including age, gender, cardiac/non-cardiac comorbidity, and preoperative echocardiographic parameters. Compared with the BC group, the DNC group demonstrated significantly lower cardioplegia volume (BC = 1130.00±194.1 mL, DNC = 884.33±156.8 mL, P=0.001), cardiopulmonary bypass time (DNC = 110.90±12.52 min, BC = 121.70±13.57 min, P=0.002), aortic clamp time (DNC = 91.37±11.58 min, BC = 101.37±13.87 min, P=0.004), and need for intraoperative defibrillation (DNC = 6 events, BC = 21 events, P=0.001). Postoperative creatine kinase-MB levels and troponin levels were significantly lower in the DNC group than in the BC group. Postoperative haemoglobin and haematocrit levels were significantly higher in the DNC group than in the BC group. The intubation period (hours) in intensive care unit (ICU) was significantly small in the BC group (DNC = 8.13±12.21, BC = 6.82±1.57, P=0.037); however, ICU stay, total hospital stay, and postoperative complication rates were not significantly different between them. At pre-discharge echocardiography, the DNC group demonstrated significantly higher ejection fraction rates than the BC group (47.79±5.50 and 45.72±5.86, respectively, P=0.005). CONCLUSION: DNC presented better intraoperative and postoperative parameters and it is an effective and safe alternative to BC for CABG combined with mitral valve replacement.

Comparison of del nido cardioplegia with blood cardioplegia in coronary artery bypass grafting combined with mitral valve replacement

Abstract Objective: To compare del Nido cardioplegia (DNC) with blood cardioplegia (BC) in coronary artery bypass grafting (CABG) combined with mitral valve replacement. Methods: A 3-year single-center retrospective cohort study was carried out. Subjects who underwent CABG (up to triple bypass) combined with mitral valve replacement were divided into DNC and BC groups. Each group had thirty subjects. Results: Both groups demonstrated similar baseline characteristics, including age, gender, cardiac/non-cardiac comorbidity, and preoperative echocardiographic parameters. Compared with the BC group, the DNC group demonstrated significantly lower cardioplegia volume (BC = 1130.00±194.1 mL, DNC = 884.33±156.8 mL, P=0.001), cardiopulmonary bypass time (DNC = 110.90±12.52 min, BC = 121.70±13.57 min, P=0.002), aortic clamp time (DNC = 91.37±11.58 min, BC = 101.37±13.87 min, P=0.004), and need for intraoperative defibrillation (DNC = 6 events, BC = 21 events, P=0.001). Postoperative creatine kinase-MB levels and troponin levels were significantly lower in the DNC group than in the BC group. Postoperative haemoglobin and haematocrit levels were significantly higher in the DNC group than in the BC group. The intubation period (hours) in intensive care unit (ICU) was significantly small in the BC group (DNC = 8.13±12.21, BC = 6.82±1.57, P=0.037); however, ICU stay, total hospital stay, and postoperative complication rates were not significantly different between them. At pre-discharge echocardiography, the DNC group demonstrated significantly higher ejection fraction rates than the BC group (47.79±5.50 and 45.72±5.86, respectively, P=0.005). Conclusion: DNC presented better intraoperative and postoperative parameters and it is an effective and safe alternative to BC for CABG combined with mitral valve replacement.

Comparison of Left Atriotomy and Superior Transseptal Approaches in Mitral Valve Surgery.

PURPOSE: To compare the operative and post-operative outcomes of mitral valve surgery (MVS) with a superior transseptal (STS) approach and a left atriotomy (LA) approach. METHODS: In a tertiary academic center, the charts of patients who underwent MVS between 2012 and 2016 were analyzed retrospectively. A total of 135 patients underwent MVS. Forty patients who underwent MVS with the STS approach were enrolled in the study as the STS group. In the same period, we selected 40 patients who underwent MVS with the LA approach to serve as the control group (LA group). Two groups were operated by the same surgeon. To minimize the bias related to the lack of randomization in this observational study, LA group patients were selected using propensity score matching. RESULTS: According to the study design, the preoperative characteristics of gender, age, mitral valve stenosis, and mitral valve insufficiency were matched (P = .368, P = .920, P = .250 and P = .057, respectively). The cardiopulmonary bypass time was 91.2 ± 12.1 minutes in the superior transseptal group and 72.8 ± 6.4 minutes in the left atriotomy group (P < .001). Additionally, duration of clamp time was significantly shorter in the left atriotomy group (P < .001). Estimated blood loss was significantly less in patients with a left atriotomy (535.8 ml versus 658.0 mL, P < .001). Duration of intensive care unit stay and hospitalization time were significantly longer in patients who underwent the superior transseptal approach compared with patients who underwent left atriotomy (P < .001 versus P < .001, respectively). Post-operative dysrhythmia rate and mortality rate were similar between the groups. CONCLUSION: Our study demonstrated that MVS with LA decreased cardiopulmonary bypass time, duration of clamp time, amount of hemorrhage, duration of intensive care unit stay, and hospitalization time compared with MVS with STS.