Aortic Valve Neocuspidization Procedure Provides Better Postoperative Outcomes When Compared to Rapid Deployement Aortic Valves.

BACKGROUND: The aim of this study was to compare the early results of rapid deployment aortic valves (RD-AVR) and aortic valve neocuspidization (AVNeo) techniques. METHODS: Between December 2019 to May 2022, 104 patients were operated on with aortic stenosis by RD-AVR (N = 52) and AVNeo (N = 52) techniques. Patients with isolated aortic valve stenosis and aortic stenosis concomittant with planned other cardiac surgeries were included. RESULTS: The mean age of patients in the RD-AVR and AVNeo groups were 67.4 ± 7.8 vs. 62.9 ± 8.7, respectively. Aortic cross-clamp time in the RD-AVR group was 56.7 ± 23.3 minutes, while it was 104.1 ± 27.9 minutes in the AVNeo group (P < 0.001). Cardiopulmonary bypass time in the RD-AVR group and in the AVNeo group was 89.8 ± 27.6 minutes and 141.8 ± 36.7 minutes, respectively (P < 0.001). Permanent pacemaker become necessary in four patients in the RD-AVR group secondary to type 2 AV block. Paravalvular leak was observed in six patients, who underwent RD-AVR, while grade 2 central aortic regurgitation was observed in one patient in the AVNeo group. Hospital mortality was 8% in the RD-AVR group and 6% in the AVNeo group (P = 0.696). CONCLUSIONS: AVNeo procedure is a feasible technique in all age groups of patients with successful hemodynamic results in the early postoperative period and with the advantage of not requiring anticoagulants. It also can be applied with other cardiac surgical interventions.

Sulodexide Develops Contraction in Human Saphenous Vein via Endothelium-Dependent Nitric Oxide Pathway.

Chronic venous disease (CVD) is a proqgressive and underestimated condition related to a vicious circle established by venous reflux and endothelial inflammation, leading to vein dilation and histology distortion, including loss of media tone. Sulodexide (SDX) is a drug restoring the glycocalyx that demonstrated endothelial protection and permeability regulation, together with anti-thrombotic and anti-inflammatory roles. In the lab it also exhibited vein contractility function. The aim of the present study was to show the possible role of endothelium and nitric oxide pathway on SDX's veno-contractile effect on human saphenous veins. The remnants of great saphenous vein (GSV) segments (n = 14) were harvested during coronary artery bypass graft surgery. They were dissected as endothelium-intact (n = 8) and denuded rings (n = 6). First, a viability test was carried out in bath with Krebs-Henseleit solution to investigate a control and basal tension value. After this, cumulative doses of SDX were applied to rings and contraction values were studied in endothelium-intact phenylephrine (PheE, 6 × 10-7 M) pre-contracted vein rings. Finally, endothelium-intact PheE pre-contacted vein rings were treated by nitric oxide synthase inhibitor Nω-nitro-L-arginine methyl ester (L-NAME, 10-4 M) for 10 min. Contraction protocol was applied, and contraction values were measured in cumulative doses of SDX. The same protocol was applied to endothelium-denuded vein rings to investigate the effect of SDX. Saphenous vein rings showed an increase in contraction to cumulative doses of SDX. In endothel-intact rings, KCL-induced contraction from 92.6% ± 0.3 to 112.9% ± 0.4 with cumulative SDX doses. However, SDX did not show any veno-contractile effect on endothel-denuded rings. In denuded rings contraction responses measured from 94.9% ± 0.3 to 85.2% ± 0.3 with increasing doses of SDX, indicating no significant change. Nitric oxide synthase inhibitor (L-NAME) prohibited the contraction response of the sulodexide in all dosages, indicating that the contractile function of SDX was mediated by endothelial derived nitric oxide. Results of endothel-intact and denuded rings with L-NAME showed a similar incline with denuded rings with SDX only. The results confirmed SDX's veno-contractile effect in human samples, by means of nitric oxide synthase pathways involvement.

Effect of perioperative intravenous magnesium sulfate on postoperative pain after iliac venous stenting.

BACKGROUND: The aim of the present study was to evaluate the effect of perioperative intravenous (IV) magnesium sulfate (MS) on low back pain (LBP) severity after iliac venous stent implantation. METHODS: The present study was a single-center retrospective study. A total of 97 patients who had undergone iliac venous stenting for post-thrombotic syndrome between January 1, 2019 and January 11, 2021 were considered for inclusion in the present study. The patients were divided into two groups: those who had received perioperative MS infusions (group M) and those who had not (control group; group C). Group M was given an IV bolus of 20 mg/kg before anesthesia induction and an IV MS infusion of 20 mg/kg/h during the procedure. Postoperative LBP severity was evaluated using the numerical rating scale at 1, 6, 12, and 24 hours after the procedure. The total tramadol consumption within 24 hours was measured with the help of a patient-controlled analgesia device. Moreover, additional analgesic needs and complaints of nausea and vomiting were evaluated. RESULTS: A total of 97 patients were considered for inclusion in the present study. Of the 97 patients, 29 were excluded because of a lack of follow-up data, leaving 68 patients for the final analysis (group M, n = 36; group C, n = 32). The demographic data, body mass index, sedation time, procedure time, and stented side data were similar between the two groups (P > .05). The rates of atropine and ephedrine use during the procedure were similar between the two groups (P > .05). The numerical rating scale scores were significantly lower for group M at all follow-up periods (P < .001). The total tramadol consumption at 24 hours postoperatively was 191.94 ± 68.194 mg for group M and 378.75 ± 31.367 mg for group C (P < .001). Additional analgesics were used by 8 patients (22.2%) in group M and 17 patients (53.1%) in group C. Additional analgesic needs were significantly lower for group M (P = .008). Nausea and vomiting were observed in six (19.4%) and four (11.1%) patients in group M and eight (32%) and five (15.6%) patients in group C, respectively (P > .05). CONCLUSIONS: For patients undergoing iliac venous stenting, perioperative MS infusion was an effective and safe treatment option that reduced LBP severity, opioid consumption, and the need for additional analgesics in the acute postoperative period.

Validation of the Turkish version of the Obstetric Quality-of-Recovery score 11 (ObsQoR-11T) after cesarean delivery.

BACKGROUND: To translate and validate the psychometric characteristics of a Turkish version of the Obstetric Quality-of-Recovery score 11 tool used to measure post-cesarean delivery recovery in Turkish-speaking patients. METHODS: After the original English version of the Obstetric Quality-of-Recovery score 11 tool was translated into Turkish; it was psychometrically validated to assess the post-cesarean delivery quality of recovery. Validity, reliability, and feasibility were investigated. The Obstetric Quality-of-Recovery score 11 tool was administered to Turkish-speaking patients on postoperative day 1. On postoperative day 1, a global health visual analog scale was used to assess the patient's perceived global recovery. RESULTS: One hundred and eighty-six patients completed their questionnaires, providing a completion rate of 97.38%. The Spearman rho (ρ) correlation coefficient between the Obstetric Quality-of-Recovery score and global health visual analog scale (0-100 points) was 0.850 at postoperative day 1 following surgery (P < 0.001). Internal consistency, measured using Cronbach's alpha, was 0.822. The split-half coefficient was 0.708. The Obstetric Quality-of-Recovery score differed significantly between the emergency and elective cesarean delivery groups (80 (41-104) vs. 83.3 (51-102); P < 0.05). The test-retest reliability of the Obstetric Quality-of-Recovery score items was more than 0.6 in 82% of cases, indicating good repeatability and reliability. CONCLUSION: The Obstetric Quality-of-Recovery score 11 is a valid and reliable tool to measure the post-cesarean quality of recovery in Turkish-speaking patients. The psychometric properties of the Turkish version of the scale to measure the post-cesarean quality of recovery were similar to those of the seminal English version.

Linguistic validation of a widely used recovery score: quality of recovery-15 (QoR-15).

BACKGROUND: The quality of recovery-15 (QoR-15) is a patient reported outcome questionnaire that measures the quality of recovery after surgery and anesthesia. The QoR-15 has been validated in many languages; Turkish version of the QoR-15 has not yet been established. The aims of this study were to translate the QoR-15 questionnaire into Turkish and to perform a full psychometric evaluation of the Turkish version. METHODS: After translating the original English version of the QoR-15 scale into Turkish, the QoR-15T scale was psychometrically validated. This process included validity, reliability, responsiveness, feasibility. The QoR-15T was evaluated before the surgery and 24 h after surgery. RESULTS: A total of 210 patients completed the pre- and postoperative questionnaires, providing a completion rate of 93.75%. The correlation coefficient between QoR-15T score and VAS score was 0.644 on postoperative day 1 (p < 0.001). Inter item Cronbach's alpha was 0.863. Global test-retest concordance coefficient was 0.98 (95% CI: 0.94-1.00). DISCUSSION: The QoR-15T scale is a reliable and valid instrument for evaluating postoperative quality of recovery in Turkish speaking patients. The psychometric characteristics used to assess postoperative quality of recovery were similar to those in the English version.

Unrecognized indication for aortic valve neocuspidization: Patient with warfarin-induced Stevens-Johnson syndrome and toxic epidermal necrolysis.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe disorders, characterized by necrosis and epidermal detachment. Most important known acquired etiological factor is medications. Warfarin is one of the most common medications of cardiac valve surgery, which may rarely cause SJS or TEN. From this perspective, Aortic Valve Neocuspidization (AVNeo) procedure may be a good treatment option for such kind of patients, with a unique advantage of anticoagulation free postoperative course. In this report we aimed to share a patient with warfarin-induced STS/TEN, who was successfully treated with AVNeo procedure and mitral valve replacement.

Robotic repair of atrial septal defect with partial pulmonary venous return anomaly: Our 5 year experience.

INTRODUCTION: Partial pulmonary venous return anomalies (PPVRA) were not considered as a good candidate for robotic surgery in early time of robotic cardiac surgery. In this study, we present our experience in patients undergoing robotic atrial septal defect (ASD) and PPVRA surgery. METHODS: Between November 2014 and January 2020, data of 21 patients underwent robotic ASD with PPVRA was collected. Inclusion criterion was presence of right-sided PPVRA with ASD. All operations were performed robotically. RESULTS: The mean age of patients was 26.7 ± 10.3 years. Seventeen patients (81%) had superior-caval ASD with supracardiac PPVRA and double-patch technique was used. Four patients had inferior-caval ASD with intracardiac PPVRA and single-patch technique was preferred. Cross-clamp time and cardiopulmonary bypass time were 92.8 ± 29.6 and 127.8 ± 38.1, respectively. There was no mortality. One patient had atrioventricular-block and required pacemaker. CONCLUSION: Robotic repair of ASD with PPVRA is feasible and effective method as an alternative to conventional surgery.

Post-chemotherapy modified template retroperitoneal lymph node dissection in patients with nonseminomatous germ cell tumours.

INTRODUCTION/BACKGROUND: Although a full bilateral template RPLND is thought to be the standard of care for the management of postchemotherapy retroperitoneal residual masses for nonseminomatous germ cell tumors (NSGCT), in the past decade modified templates have become increasingly popular. In this study, we aimed to present our oncological and perioperative outcomes of consecutive seventeen NSGCT patients who underwent a modified template unilateral PC-RPLND for retroperitoneal residual disease. MATERIALS AND METHODS: We retrospectively evaluated the medical records of 17 consecutive NSGCT patients who underwent modified template unilateral PC-RPLND in our university hospital between 2017 and 2020. All patients had normal serum tumour markers with residual disease in the retroperitoneum. Surgical characteristics including the size of the retroperitoneal residual mass, residual tumor pathology, removed lymph nodes, positive percentage of removed lymph nodes, accompanying operations, complications, mean operation time and hospital stay, and long-term results including survival and antegrade ejaculation were evaluated. RESULTS: Eleven patients underwent left and six right-sided surgery. Median residual lymph node diameter was 41mm. Median hospitalisation time was 3.5 days. Median follow-up time was 10.5 months. Necrosis/fibrosis was seen in 6 patients, and teratoma in 11 patients. No viable tumour was seen. No patients died in the follow-up period. None of the patients relapsed during follow-up. Ten/seventeen patients had antegrade ejaculation. CONCLUSIONS: Modified template unilateral PC-RPLND leads to very good oncological outcomes with decreased perioperative morbidity as well as better antegrade ejaculation rates. Low volume retroperitoneal disease seems to fit this procedure best.

Anesthesia management for robotic assisted radical prostatectomy. Single center experince.

AIM: The aim of this study was to present our experiences for anesthesia management in patients undergoing robot-assisted radical prostatectomy (RARP) in light of current literature data. MATERIAL AND METHODS: This clinical retrospective study included 103 patients who underwent robot-assisted radical prostatectomy. All patient data were obtained from the patient files and anesthesia follow-up forms. Demographic datas, intraoperative fluids, blood products requirement and blood gas parameters were recorded. RESULTS: A total 15 of 103 patients data were lack, the remaining 88 patients were evaluated. Combination of crystalloid and colloid was used for intravenous fluid management. About 11% of patients required transfusion during surgery. The mean pH and pO2 values of the patients were observed to decrease whereas pCO2 and lactate values increased. DISCUSSION: Radical Prostatectomy can be performed either using open technique as a traditional approach or laparoscopic or robot-assisted technique as a minimally invasive approach. Today, minimally invasive approaches have replaced traditional open prostatectomy. Anaesthesia management of these minimally invasive techniques is very different and challenging from open technique in many aspects. CONCLUSION: Although minimally invasive techniques have good surgical outcomes such as less blood loss, smaller surgical incision, and shorter hospitalization, these techniques bring new problems that anesthesiologists have to deal with. Increased RARP operations has led to the anesthesiologists more likely to encounter perioperative problems. KEY WORDS: Anesthesia, Minimally invasive techniques, Radical prostatectomy.

Analgesic Effectiveness of Ultrasound-Guided Pecs II Block in Central Venous Port Catheter Implantation.

BACKGROUND AND AIM: In oncology patients, central venous port catheter (CVPC) implantation is generally preferred for venous route. However, in this procedure, postoperative pain is often observed. This study aimed to investigate the effectiveness of ultrasound-guided Pecs II block in the management of pain after CVPC placement. METHODS: One hundred and eighty-seven patients who underwent CVPC implantation between January 2017 and August 2018 were included in the study. Patients who underwent Pecs II block under ultrasound guidance were called as the Pecs group, and those who underwent local anesthesia (LA) were referred as the LA group. All procedural parameters were analyzed, including demographic characteristics of patients, visual analogue scores (VAS) at 2nd and 24th hours, and postoperative opioid, and non-steroidal anti-inflammatory drug (NSAID) consumption. RESULTS: The postoperative 2nd hour VAS scores were similar in both groups and were lower than the 24th hour VAS scores. VAS scores at the 24th hour in the Pecs group were significantly lower than the LA group (P = 0.001). While the number of fentanyl rescue doses administered in PACU was similar, the total NSAID consumption in the first 24 hours was higher in the LA group than in the Pecs group. CONCLUSION: In CVPC placement, ultrasound-guided Pecs II block is a more reliable, easily applicable and longer-acting approach than LA infiltration for postoperative analgesia.

Perioperative anesthetic management in a patient with factor XI deficiency undergoing coronary artery bypass graft surgery.

Spontaneous bleeding is rare in patients with factor XI deficiency and significant bleeding usually occurs after a trauma or a surgical procedure. It is difficult to maintain hemostatic balance in these patients. In the present case report, a 68-year-old male patient with no chronic disease was scheduled for elective cardiopulmonary bypass surgery. Eight units of fresh-frozen plasma (FFP) were slowly infused and the operation was initiated with the activated partial thromboplastin time (aPTT) of 34.5, which was 108.7 in the preoperative period. Tranexamic acid bolus was administered before the skin incision and continued throughout the operation. Intraoperative aPTT was measured intermittently and a total of six units of FFP were administered. After 76 minutes of cross-clamp time, the patient was separated from cardiopulmonary bypass without any problem. There is no consensus regarding the management of bleeding during cardiac surgery in patients with factor XI deficiency. The common approach includes normalizing the factor levels via FFP infusion or factor concentrates in the preoperative period, proceeding with surgery following the replacement, and close monitoring of perioperative factor levels and aPTT values.

Complications and pitfalls of central venous port catheters: experience with 782 patients with cancer.

BACKGROUND: The clinical use of port catheters has become widespread because they provide a safe and easy vascular route. Such widespread use of vascular port catheters has revealed early and late complications. AIM: This study was evaluated the early and late noninfectious complications and present precautions and pitfalls to handle these complications. METHODS: The retrospective observational study comprised 801 vascular port catheters inserted into 782 adult patients for various reasons between 2010 and 2018. Patient demographic, indications for port catheter implantation, port catheter types, and insertion sides were noted. Port catheter implantation related early and late complications were recorded. RESULTS: The subclavian vein was selected as a target vein in almost all of the interventions (98.9%). Similarly, right-sided veins were used in about 90% of patients. The most common problem was technical issues related to the interventions. If venous cannulation was challenging, ultrasonography and fluoroscopy guidance roadmap technique were used. Most serious complication was pneumothorax in 7 patients. In the late period, the most common problem was thrombotic occlusion of the catheter. In two-thirds of these patients, thrombolytic therapy for thrombosed port catheters may rescue some catheters and avoid secondary port catheter insertions. CONCLUSIONS: Despite these benefits, port catheters are associated with various complications. However, most of these complications can be effectively prevented by proper techniques and easily applied precautions.

3D-Printed Splitter for Use of a Single Ventilator on Multiple Patients During COVID-19.

During epidemics or pandemics affecting the respiratory systems, hospital equipment such as ventilators may become insufficient and different solutions can be considered. In fast spreading respiratory illnesses such as COVID-19 due to the rapidly increasing number of patients, ventilatory machine insufficiencies may appear. It may be considered to use one hospital ventilator for more than one patient by dividing the airway of the machine with a specially designed splitter. The aim of this study was to determine whether a ventilator can be modified to provide ventilation of two or more patients simultaneously by using 3D designed and manufactured splitters. A two-port and four-port splitter were designed in Autodesk Fusion 360 computer program and manufactured by 3D printer using PolyJet technology (Stratasys J750). Two sets of splitters were used to adapt to the ventilator during trial process: one for inspiratory and one for expiratory outputs. Two intensive care specialists voluntarily tried this study on themselves. It was concluded from the study that 3D designed and manufactured two-port splitter can be used to separate the airway of a single ventilator to multiple patients within a very limited indication and time interval.

Sodium nitrite provides angiogenic and proliferative effects in vivo and in vitro.

BACKGROUND Angiogenesis is the formation of new blood vessels from pre-existing vasculature. Many factors and substances may stimulate angiogenesis and exhibit proliferative effect. In this study, we aimed to investigate the angiogenic and proliferative effects of sodium nitrite. MATERIAL AND METHODS The angiogenic activity of sodium nitrite was examined in vivo in the chick chorioallantoic membrane (CAM) model and in vitro in tube formation assay of human umbilical vein endothelial cells (HUVECs). The proliferative activity of sodium nitrite was also determined through MTT assay on HUVECs. RESULTS In CAM assay, sodium nitrite had an angiogenic effect especially at high concentrations compared with the control group and this was statistically significant. There was a proliferative effect on HUVECs in the presence of sodium nitrite for 24 and 48 h, and this was statistically significant (p<0.05). Comparing the tube length/area ratio values, there was statistically significant increase in the sodium nitrite group compared to the control group (p<0.05). CONCLUSIONS The results provide evidence that sodium nitrite induces angiogenesis in vitro and in vivo.