Comparison of the Effect of Pump Flow Type (Pulsatile or Non-Pulsatile) on Postoperative Neurocognitive Functions in Coronary Artery Surgery.

INTRODUCTION: The effect of pump flow type on perfusion in coronary surgery using cardiopulmonary bypass (CPB) is discussed. We aimed to evaluate the effect of pump flow type on cognitive functions with neurocognitive function tests. METHODS: One hundred patients who underwent isolated coronary artery bypass surgery between November 2020 and July 2021 were divided into two equa groups. Groups were formed according to pump flow type pulsatile (Group 1) and non-pulsatile (Group 2). Clock drawing test (CDT) and standardized mini mental test (SMMT) were performed on the patients in both groups in the preoperative period, on the 1st preoperative day, and on the day before discharge. Neurocognitive effects were compared with all follow-up parameters. RESULTS: There was no difference between the groups in terms of demographic data and in terms of neurocognitive tests performed before the operation. SMMT on postoperative day 1 (Group I: 27.64 ± 1.05; Group II: 24.44 ± 1.64; P=0.001) and CDT (Group I: 5.4 ± 0.54; Group II: 4 .66 ± 0.52; P=0.001), and SMMT on the day before discharge (Group I: 27.92 ± 1.16; Group II: 24.66 ± 1.22; P=0.001) and CDT (Group I: 5 It was calculated as .66 ± 0.48; Group II: 5.44 ± 0.5; P=0.001). The duration of intensive care and hospitalization were higher in the non-pulsatile group. CONCLUSION: We think that the type of pump flow used in coronary artery bypass surgery using CPB is effective in terms of neurocognitive functions and that pulsatile flow makes positive contributions to this issue.

Comparison of Del Nido (a different application) and crystalloid blood cardioplegia on arrhythmia and early results.

BACKGROUND: The results of the use of del-Nido(DN) solution using a different method or crystalloid blood cardioplegia in coronary bypass patients were compared. We aimed to investigate the effects on intraoperative and postoperative arrhythmias, arrhythmia durations and early results. METHODS: The study included 175 patients using crystalloid blood cardioplegia (Group 1) and 150 patients using DN solution(Group 2). In the DN group, 75% of the calculated plegia dose was given first. the remaining part was applied by giving from grafts. Intraoperative/postoperative data were compared. RESULTS: There was no significant difference between the groups in terms of demographic characteristics. Preop troponin level was similar.(p = 0.190) However, there was a statistical difference between the postoperative 6th hour.(p = 0.001) There was no difference in troponin values at the postoperative 24th hour. (p = 0.631) Spontaneous rhythm occurred at the cardiopulmonary by pass (CPB) weaning stage in most of the patients in Group 2 (95.3%). Although the need for temporary pacing was less in Group 2, it was not significant.(p = 0.282) No patient required permanent pacing. CPB duration, cross clamp times and intraoperative glucose levels, intensive care follow-up times and hospitalization times were found to be shorter in Group 2. Although the postoperative atrial fibrillation frequency was similar (p = 0.261), the time to return to sinus was lower in Group 2.(p = 0.001). CONCLUSION: The use of DN cardioplegia solution provides significant positive contributions to avoid arrhythmias compared to crystalloid blood cardioplegia. DN solution applied with this method may contribute to reducing the anxieties associated with its use in isolated coronary artery bypass surgery.

Multiple Arterial Thrombosis after COVID-19: A Case Report.

Since the beginning of severe acute respiratory syndrome Coronavirus 2 pandemic, many reports have pointed to states of incrieased hypercoagulability during the acute phase of the disease. We report a 63-year-old female who developed acute mesenteric ischemia due to celiac trunk and superior mesenteric artery thrombi together with acute lower extremity ischemia caused by saddle embolism of the iliac bifurcation and thrombosis of the left external iliac artery. These thrombi developed 20 days after discharge from an intensive care unit due to severe pneumonia and pulmonary embolism associated with COVID-19. The patient had consecutive interventions. Surgical thrombectomy for aortoiliac thrombosis was performed and the mesenteric thrombosis was treated by percutaneous endovascular intervention. We emphasize that the prothrombotic state after COVID-19 infection may persist long after the acute symptomatic phase.

Comparison of flowmeter (transit time flow measurement) values for graft flow in three different surgical methods for isolated coronary artery bypass surgery.

BACKGROUND: Graft patency is the most important factor in coronary artery bypass surgery. This study aimed to compare the relationship between three different surgical methods and transit time flow measurement (TTFM), which is used to detect technical problems in anastomoses performed during coronary artery bypass graft operations and to correct them if necessary. METHODS: A total of 110 patients undergoing isolated coronary artery bypass surgery were analysed. Of these patients, 48 were operated on by inducing cardiopulmonary arrest (group 1), 33 were operated on without inducing cardiac arrest (group 2) during cardiopulmonary bypass surgery, and 29 underwent surgery on the off-pump beating heart (group 3). TTFMs were performed on all the patients' grafts. Additional surgical intervention requirements, the need for intra-operative and postoperative inotropic support, and all postoperative follow-up data were compared. RESULTS: In total, 110 patients were measured for 301 grafts. Due to insufficient measurements performed on these patients, additional surgical intervention was performed on five grafts in group 1, five grafts in group 2, and seven grafts in group 3. These interventions enabled a normal flow rate to be achieved. The number of grafts that required revision was highest in group 3. There was no difference between the groups in terms of demographic data, EuroSCORE II, preoperative ejection fraction, postoperative complications and mortality rate. CONCLUSION: TTFM is important for detecting technical problems in grafts. We believe that all surgical methods can be applied more safely by controlling graft flow.

SARS-CoV-2 infection-associated thoraco-abdomino-iliac thrombosis in a patient without cardiac and systemic co-morbidity.

Acute pulmonary damage and vascular coagulopathy occur frequently in patients with severe acute respiratory syndrome coronavirus 2 infection in relation to coronavirus disease (COVID-19). The inflammatory process accompanying the infection and excessive coagulation state is one of the most important causes of patient death. The COVID-19 pandemic remains a major challenge for healthcare systems and millions of patients worldwide. In this report, we present a complicated case of COVID-19 associated with lung disease and aortic thrombosis.

Effect of Aortic Cross-Clamping Time on Development of Postoperative Atrial Fibrillation in Isolated CABG: A Single-Center Prospective Clinical Study

ABSTRACT Introduction: Many etiological factors affect the occurrence of atrial fibrillation after coronary artery bypass grafting. In this study, the relationship between cardiopulmonary bypass and cross-clamping times and the development of postoperative atrial fibrillation was examined. Methods: All patients who underwent isolated coronary artery bypass grafting with the same surgical team in our clinic between September 2018 and December 2019 were prospectively included in the study, and their perioperative data were recorded. Results: One hundred and three patients who met the specified criteria were included in the study. The median age was 62 (interquartile range: 54-71) years, and 82 (79.6%) were male. The patients were divided into two groups: those who developed atrial fibrillation and those who did not. Atrial fibrillation developed in 25 of 103 patients (24.3%). All patients underwent isolated coronary artery bypass grafting under standard cardiopulmonary bypass. The median duration of cardiopulmonary bypass was 72 (interquartile range: 63-97) minutes in those with atrial fibrillation and 82 (61-98) minutes in those without it, and there was no statistical difference (P=0.717). The median cross-clamping time was 40 (32.5-48) minutes in those with atrial fibrillation and 39.5 (30-46) minutes in those without it. Statistically, the relationship between cross-clamping time and atrial fibrillation was not significant (P=0.625). Conclusion: Our study found no significant relationship between cardiopulmonary bypass and cross-clamping times and the incidence of postoperative atrial fibrillation. However, we believe that there is a need for large-scale and multicenter clinical studies on the subject.

Successful Surgical Treatment of Coronary Aneurysm, Ascending Aortic Aneurysm, and Bicuspid Aorta for a Kawasaki Disease Patient

Abstract Kawasaki disease was first reported in 1967, and it was classified as an autoimmune vasculitis of the small and medium arteries. It is a self-limiting condition that occurs mostly in childhood, but it may involve complications — such as coronary artery aneurysms, myocardial ischemia, and arrhythmias — with significant morbidity and mortality that occur later in life. In this article, we present the association of an ascending aortic aneurysm with bicuspid aortic disease in addition to coronary aneurysm in a 55-year-old patient diagnosed with Kawasaki disease.

Successful Surgical Treatment of Coronary Aneurysm, Ascending Aortic Aneurysm, and Bicuspid Aorta for a Kawasaki Disease Patient.

Kawasaki disease was first reported in 1967, and it was classified as an autoimmune vasculitis of the small and medium arteries. It is a self-limiting condition that occurs mostly in childhood, but it may involve complications - such as coronary artery aneurysms, myocardial ischemia, and arrhythmias - with significant morbidity and mortality that occur later in life. In this article, we present the association of an ascending aortic aneurysm with bicuspid aortic disease in addition to coronary aneurysm in a 55-year-old patient diagnosed with Kawasaki disease.

Chronic intracardiac thrombus, a long-term complication of COVID-19: Case reports.

Inflammation and thrombogenic effects of coronavirus disease 2019 (COVID-19) can lead to cardiovascular complications in patients even after recovery from COVID-19. Intracardiac thrombus is life-threatening and can cause sudden death. Our study describes two patients who recovered from COVID-19 and presented with chronic intracardiac thrombus.

Successful Combined Treatment of Giant Carotid Body Tumor with Embolization Applied before Surgery.

Carotid body tumors are defined as unusual tumors of neuroectodermal origin that occur in the carotid bifurcation. These generally benign masses grow slowly; then, they become symptomatic with enlargement. In this study, we present a case of a 66-year-old female patient diagnosed with a carotid body tumor with a diameter of 8×9×10 cm. The patient was surgically treated 2 days after embolization due to the wideness of the mass and surgical comorbidity. Furthermore, this article puts emphasis on the importance of embolization before curative surgery in carotid body tumors with large and high blood supply.

Implantación endovascular urgente de stent en disección aórtica aguda tipo III de DeBakey / Emergency endovascular stent graft implantation for acute traumatic DeBakey type III aortic dissection

RESUMEN El tratamiento de las enfermedades de la aorta torácica con la implantación percutánea de stent se viene realizando desde su aplicación, por primera vez, a principios del siglo XX. Se presenta un paciente de 79 años de edad que fue llevado a urgencias con intenso dolor de espalda posterior a un accidente automovilístico, a quien se le realizó tomografía computarizada y se le diagnosticó una disección aórtica tipo III de DeBakey. Se le implantó un stent endovascular autoexpandible de nitinol (Talent Stent Graft, Medtronic) en la aorta descendente, donde comenzaba el segmento disecado. Este procedimiento es un método eficaz para prevenir la isquemia de órganos y la ruptura vascular en las enfermedades traumáticas de la aorta. Es menos invasivo, tiene menos complicaciones que el tratamiento quirúrgico, y es efectivo para restituir el flujo sanguíneo de forma rápida y segura.

ABSTRACT The applications of thoracic aorta pathologies with a stent graft percutaneously have been performed for the first time since the beginning of the 20th century. Computed tomography was performed on a 79-year-old patient who was brought to the emergency room due to an in-vehicle traffic accident with severe back pain, and DeBakey type III aortic dissection was determined. An endovascular self-expanding nitinol stent (Talent Stent Graft, Medtronic) was implanted in the descending aorta where the dissected segment begins. Stent graft implantation is an effective method in preventing organ ischemia and rupture in traumatic aortic pathologies. This procedure is less invasive and has less complication than surgical approach. It is effective in providing blood flow quickly and safely.

Severe Aortic Thrombosis in the Early Period after COVID-19: Two Cases.

A total occlusion of the aorta is a rare condition; however, while rare, it has a very high mortality rate. Coronavirus disease 2019 (COVID-19) poses serious health problems, including vascular problems. Inflammatory changes produced by viral infections can cause serious disturbances in the coagulation system. Although cases showing a marked increase in thrombotic activity in the venous system have been presented, thrombosis in the arterial system, especially in the aorta, has rarely been reported. Here, we present 2 patients admitted to our hospital with an acute aortic thrombosis.

Dynamic thiol/disulphide homeostasis metrics as a risk factor for peripheral arterial disease.

OBJECTIVE: To examine dynamic thiol/disulphide homeostasis metrics as a novel risk factor of oxidative stress in patients with peripheral arterial disease. METHODS: One hundred patients with lower extremity peripheral arterial disease (a study group) and 100 control subjects were included in this prospective case-control study. Participants' baseline clinical characteristics and laboratory data including some oxidant/antioxidant status parameters such as albumin, ferroxidase and myeloperoxidase, and thiol/disulphide homeostasis parameters such as native thiol, total thiol and disulphide, as well as native thiol/total thiol, disulphide/native thiol and disulphide/total thiol ratios were all recorded and then compared between the groups. RESULTS: Mean albumin and ferroxidase, and median myeloperoxidase levels were found to be significantly higher in patients with the peripheral arterial disease than in control group (p = 0.045, p = 0.000 and p = 0.000, respectively). Mean native thiol and total thiol, and median disulphide levels were found to be significantly lower in the study group as compared with the control group (p = 0.000, p = 0.000 and p = 0.037, respectively). According to the results of logistic regression analysis, systolic blood pressure, ferroxidase and myeloperoxidase levels were detected to be the independent predictors of peripheral arterial disease. CONCLUSION: Our report is the first one in the literature investigating dynamic thiol/disulphide homeostasis metrics as a novel risk factor of oxidative stress in peripheral arterial disease. Dynamic thiol/disulphide homeostasis metrics may be used as a valuable risk factor of oxidative stress in patients with the peripheral arterial disease since it is readily available, easily calculated and relatively cheap.

Investigation of the Relationship between Cerebral Near-Infrared Spectroscopy Measurements and Cerebrovascular Event in Coronary Artery Bypass Grafting Operation in Patients without Carotid Stenosis and Patients with Carotid Stenosis below Surgical Margins.

OBJECTIVES: Stroke is an important cause of mortality and morbidity in surgery. In the present study, we examined the cerebral oximetry values of patients with carotid artery stenosis who did not present surgical indications and those who did not present carotid artery stenosis in coronary artery bypass grafting (CABG) surgery by comparing their cerebral oximetry values with cerebrovascular disease (CVD). METHODS: Between January and May 2014, 40 patients who underwent isolated CABG were included in the study. Cerebral oximetry probes were placed prior to induction of anesthesia. Cerebral oximetry values were recorded before induction, in the pump (cardiopulmonary bypass) inlet period, in the post-clamp period, in the pump outlet period, and in the intensive care unit and neurological complications. RESULTS: There was no difference between the groups in terms of demographic data and routine follow-up parameters. Intraoperative surgical data and early postoperative results were similar in both groups. When comparing the groups, there were no statistically significant results in cerebral oximetry values and CVD development. Only one patient in group 2 had postoperative CVD and this patient was discharged from the hospital with right hemiplegia. Mean arterial pressure (MAP)levels were significantly higher in Group 2 (P<0.05). CONCLUSION: The follow-up of cerebral perfusion with a method like near-infrared spectroscopy (NIRS) will ensure that MAP is adjusted with interventions that will be made according to changes in NIRS. Thus, it will be possible to avoid unnecessary medication and flow-rate increase with cerebral oxygen saturation (rSO2) follow-up.

Investigation of the relationship between cerebral near-infrared spectroscopy measurements and cerebrovascular event in coronary artery bypass grafting operation in patients without carotid stenosis and patients with carotid stenosis below surgical margins

Abstract Objectives: Stroke is an important cause of mortality and morbidity in surgery. In the present study, we examined the cerebral oximetry values of patients with carotid artery stenosis who did not present surgical indications and those who did not present carotid artery stenosis in coronary artery bypass grafting (CABG) surgery by comparing their cerebral oximetry values with cerebrovascular disease (CVD). Methods: Between January and May 2014, 40 patients who underwent isolated CABG were included in the study. Cerebral oximetry probes were placed prior to induction of anesthesia. Cerebral oximetry values were recorded before induction, in the pump (cardiopulmonary bypass) inlet period, in the post-clamp period, in the pump outlet period, and in the intensive care unit and neurological complications. Results: There was no difference between the groups in terms of demographic data and routine follow-up parameters. Intraoperative surgical data and early postoperative results were similar in both groups. When comparing the groups, there were no statistically significant results in cerebral oximetry values and CVD development. Only one patient in group 2 had postoperative CVD and this patient was discharged from the hospital with right hemiplegia. Mean arterial pressure (MAP)levels were significantly higher in Group 2 (P<0.05). Conclusion: The follow-up of cerebral perfusion with a method like near-infrared spectroscopy (NIRS) will ensure that MAP is adjusted with interventions that will be made according to changes in NIRS. Thus, it will be possible to avoid unnecessary medication and flow-rate increase with cerebral oxygen saturation (rSO2) follow-up.

Efficacy of Ultrasound-Guided Transversus Thoracic Muscle Plane Block on Postoperative Opioid Consumption After Cardiac Surgery: A Prospective, Randomized, Double-Blind Study.

OBJECTIVES: The postoperative analgesic efficacy of transversus thoracic muscle plane block (TTMPB) has not yet been evaluated sufficiently. This randomized controlled study evaluated the effect of TTMPB on postoperative opioid consumption in patients undergoing cardiac surgery. DESIGN: Prospective, randomized, double-blind study. SETTINGS: Single institution, academic university hospital. PARTICIPANTS: Forty-eight adult patients having cardiac surgery with median sternotomy. INTERVENTIONS: Patients were randomly assigned to receive preoperative ultrasound-guided TTMPB with either 20 mL of 0.25% bupivacaine or saline bilaterally. Postoperative analgesia was administered intravenously in the 2 groups 4 times a day with 1000 mg of paracetamol and patient-controlled analgesia with fentanyl. MEASUREMENTS AND MAIN RESULTS: The primary outcome was opioid consumption in the first 24 hours. Secondary outcomes included postoperative pain scores, first analgesic requirement time, rescue analgesia, intensive care discharge time, and side effects. Compared with the control group (median 465 µg, interquartile range 415-585), the transversus thoracic muscle plane (TTMP) group (median 255 µg, interquartile range 235-305) had reduced postoperative 24-hour opioid consumption (p < 0.001). Pain scores were significantly lower in the TTMP group compared with the control group up to 12 hours after surgery both at rest and active movement (p < 0.001). Compared with the TTMP group, the proportion of postoperative nausea and pruritus was statistically higher in the control group (p < 0.001). CONCLUSIONS: A single preoperative TTMPB provided effective analgesia and decreased opioid requirements in patients undergoing cardiac surgery.

Investigation of the Effect of Pulsatile and Nonpulsatile Flow on Kidney in Coronary Surgery With NIRS.

BACKGROUND: Acute renal insufficiency is a significant cause of morbidity and mortality after coronary artery bypass grafting performed with cardiopulmonary bypass. Functional near-infrared spectroscopy (fNIRS) is an emerging brain-imaging technique that can be used to detect organ perfusions in adults. This study aims to determine the effects of pulsatile and nonpulsatile flow on renal circulation by using functional near-infrared spectroscopy and biochemical markers. METHODS: Forty patients, who had undergone isolated CABG between March 2014 and July 2014 in the authors' clinic, were included in the study. Patients were divided in the pulsatile and nonpulsatile groups by simple randomization. RESULTS: Urine outputs statistically were higher in the pulsatile group, during CPB (P = .045). Renal perfusion measurements via fNIRS intra-operatively statistically were parallel between the groups. When we compared biochemical markers within the groups, in the nonpulsatile group, creatinin statistically is higher on the postoperative first day (P = .003), and BUN statistically is higher on the postoperative first (P = .015), second (P = .001), and fifth (P = .020) days, according to preoperative value. In the pulsatile group, only the postoperative second day BUN is higher (P = .007). CONCLUSION: fNIRS is being used to track cerebral functions. During operation, it also provides a correct observation for blood feeding of somatic organs, such as the kidneys, but it requires more clinical study to be accepted as routine.

Successful Conservative Treatment of Chylopericardium after Open-Heart Surgery: A Case Report.

Chylopericardium is a rare complication following cardiac surgery. The incidence of this pathological condition is very low and mainly attributed to lymphatic injuries to the thymus or anterior mediastinum, thoracic duct injuries, or extensive posterior pericardial dissection with the possible interruption of major cardiac lymph channels. A 62-year-old man was admitted to the cardiovascular surgery department for coronary bypass surgery, and the surgical procedure was performed 3 days later. Revision surgery was performed, because of the drainage associated with bleeding. In the post-revision days, the amount of serous drainage increased, and then chylous drainage occurred. After conservative treatment, the drainage of the chylous features decreased and eventually disappeared. The patient was discharged without any problem. At 6 months' follow-up, the patient was doing well with a normal left ventricular function and without effusion.