The predictive value of internal carotid artery wall thickness in computed tomography angiography to avoid complications of plaque removal failure in modified eversion carotid endarterectomy.

AIM: The benefits of computed tomography carotid angiography (CTA) in terms of evaluating the anatomical structure of the carotid arteries, surgical planning, and evaluating possible risks were reported in previous studies. This study aimed to calculate the predictive value of internal carotid wall thickness in CTA that can predict whether a modified carotid eversion endarterectomy (MCEE) will result in a successful or not. METHOD: This study was designed in a retrospective cross-sectional format. Consecutive 83 symptomatic carotid surgery patients who were operated in our hospital and had CTA were included in this study. The wall thickness of the internal carotid artery (ICA) 20 mm distal from the carotid bifurcation was calculated in axial sections using a three-dimensional imaging technique. In addition, all patients' characteristics and laboratory findings were recorded. Patients who failed MCEE and required classical carotid endarterectomy were compared with patients who had successful MCEE. RESULTS: MCEE technique was applied to 62 patients. In 21 patients, the MCEE technique failed and the classical endarterectomy technique was required. Preoperative clinical and laboratory characteristics were similar in both groups. The mean ICA wall thickness was 0.65 mm 20 mm distal to from the carotid bifurcation and it was lower in the group with successful MCEE (1.03 ± 0.21 mm vs. 0.56 ± 0.08 mm) (p < 0.001). The critical ICA wall thickness was calculated as 0.76 mm in the group that MCEE failed and classical carotid endarterectomy was required. Cut-off analysis of ICA wall thickness was calculated as 0.755 mm in ROC analysis (p < 0.001), (95% confidence interval, curve area; 0.985). CONCLUSION: Successful carotid endarterectomy with the MCEE method is associated with distal ICA wall thickness and distal extension of the atheroma plate. The use of ICA wall thickness 20 mm distal to from the bifurcation as a predictive value for the success of the MCEE technique is beneficial to avoid serious complications.

Detection of residual varicose veins with near infrared light in the early period after varicose surgery and near infrared light assisted sclerotherapy.

OBJECTIVES: Varicose veins that cannot be seen with the naked eye can be easily detected with Near Infrared (NIR) light. With a minimally invasive procedure performed with NIR light guided, the need for reoperation is reduced, while optimal treatment of venous insufficiency and symptoms is provided. In this study, the detection of residual varicose veins after varicose vein surgery using NIR light and the results of treatment of sclerotherapy were investigated. METHODS: In this retrospective study, treatment and clinical outcomes of patients' who underwent NIR light-guided foam sclerotherapy for Clinical-Etiology-Anatomy-Pathophysiology (CEAP) (C1, C2) stage residual varicose veins after surgical varicose treatment between 2014 and 2017 were examined. Data of patients who underwent foam sclerotherapy with NIR light were collected and analyzed. RESULTS: A total of 151 patients and 171 lower extremity varicose veins were treated with surgery. 55 (35.7%) of the patients were male, and 96 (62.3%) were female. Their age ranges from 20 to 64, with an average age of 45.38. 4 (2.6%) of the patients had phlebectomy. 137 of patients (90.7%) had ligation of perforated veins, phlebectomy, and great saphenous vein (GSV) stripping, 10 of patients (6.6%) had GSV stripping, perforating vein ligation, phlebectomy, and small saphenous vein (SSV) surgery. No residual leakage was observed in the controls of GSV, SSV, and perforating veins by duplex ultrasonography (DUS). In the first month after varicose surgery, an average of 1.64 ± 1.05 sessions of sclerotherapy was applied to patients with CEAP C1, C2 stage residual varicose veins. 70 patients had one session of sclerotherapy, 37 patients had two sessions of sclerotherapy, 20 patients had three sessions of sclerotherapy, and 11 patients had four sessions of sclerotherapy administrated. The need for complementary therapy was required for all female patients; 13 of the male patients did not require complementary sclerotherapy. While single-session sclerotherapy was applied to most male patients (32 (58.18%), 10 (18.18%) patients received two sclerotherapy sessions. After completing sclerotherapy, 7 (4.63%) patients had superficial venous thrombosis, and 13 (8.60%) patients had hyperpigmentation. CONCLUSION: Surgical treatment is a safe and effective technique in venous insufficiency. Nevertheless, residual varicose veins may remain, and these can be detected noninvasively with NIR light. Foam sclerotherapy with NIR light is a minimally invasive and safe treatment method for small residual varicose veins after the operation. We think that sclerotherapy with NIR light as a complementary treatment is a practical, reliable, and demanding treatment for clinical improvement, especially in female patients.

Association of vaspin rs2236242 gene variants and circulating serum vaspin concentrations with coronary artery disease in a Turkish population.

Coronary artery disease (CAD) is the primary cause of death worldwide. Vaspin was a recently described adipokine, playing a protective role in many metabolic and cardiovascular diseases. This study aimed to assess the relation of serum vaspin levels and vaspin rs2236242 polymorphisms with CAD. The study included 105 healthy subjects and 105 CAD patients. Serum vaspin concentrations and vaspin rs2236242 polymorphisms were determined by enzyme-linked immunosorbent assay and polymerase chain reaction, respectively. There was a statistically significant difference between the genotypes of CAD patients (TT 26.7%, TA 71.4%, and AA 1.9%) and controls (TT 70.5%, TA 28.6%, and AA 1%; χ2 = 40.3; df = 2; p = .000). The TA genotype increased the risk of CAD (odds ratio [OR] = 6.60; 95% confidence interval [CI] = 3.60-12.1; p = .000) as compared to the TT genotype. There was a statistically significant difference between the allelic distribution of CAD patients (T 62.4% and A 37.6%) and controls (T 84.8% and A 15.2%; χ2 = 27.0; df = 1; p = .000). Those carrying the A allele had a higher risk of CAD compared to those with the T allele (OR = 3.35; 95% CI = 2.10-5.36; p = .000). The serum vaspin concentrations of the patients with TT, TA, and AA genotypes were 30.4 ± 1.72, 28.4 ± 2.89, and 36.4 ± 6.38 pg/ml, respectively, and there was no significant difference between the serum vaspin levels and vaspin genotypes (p = .696). All of the above suggested that the vaspin rs2236242 polymorphism was associated with CAD in the Turkish population.

The Comparison of the Effects of Nebivolol and Metoprolol on Erectile Dysfunction in the Cases with Coronary Artery Bypass Surgery.

PURPOSE: Beta-blocker use is common in the cases with coronary artery bypass surgery. According to the literature, beta-blockers have positive effects but may cause erectile dysfunction (ED). The most commonly used beta-blockers in ischemic cardiac disease are nebivolol and metoprolol. In our clinic, we aimed to compare the effects of nebivolol and metoprolol succinate on ED in the sexually active cases with coronary artery bypass surgery. METHODS: In our clinic, a total of 119 patients with coronary artery bypass surgery were included in the study. International Index of Erectile Function (IIEF-5) Test was used to evaluate whether the patients had ED and to grade the cases. RESULTS: No significant difference was found in terms of anti-ischemic efficacy between metoprolol succinate and nebivolol in the postoperative period; however, the incidence of any grade ED was %85.96 in Group 1, %83.87 in Group 2. This difference was considered as statistically significant (p = 0.036). CONCLUSION: Beta-blocker use increases the risk of ED in cases with ischemic cardiac disease. We suggest that the complaints of ED could be less frequent with nebivolol use in sexually active cases with ischemic cardiac disease.

Effects of hyperbaric oxygen therapy combined with platelet-rich plasma on diabetic wounds: an experimental rat model.

INTRODUCTION: Hyperbaric oxygen and platelet-rich plasma are used in the treatment of diabetic wounds. The aim of this study is to evaluate the effects of hyperbaric oxygen therapy and autologous platelet concentrates in healing diabetic wounds. MATERIAL AND METHODS: Thirty-six female Wistar albino rats were used in this study. Diabetes mellitus was induced chemically with an intraperitoneal injection of streptozotocin. The rats were divided into a control group, a hyperbaric oxygen group, a platelet-rich plasma group, and a combined therapy group. Platelet-rich plasma was applied just after the creation of the wound; hyperbaric oxygen treatment was carried out daily over 7 days. Wound healing was evaluated according to four parameters: ulcerations, epidermal thickness, density of dermal collagen fibers, and proliferation of dermal blood vessels. RESULTS: The number of active ulcers in the combined therapy group was fewer than in the control group (p = 0.039), and the wound area was greatest in controls (p < 0.001). The epidermal thickness in platelet-rich plasma and combined therapy groups was non-significantly greater than in the control group (p = 0.097 and p = 0.074, respectively). The amount of fibrous collagen in these two groups was greater than in the control group (p = 0.002). CONCLUSIONS: Combined hyperbaric oxygen and platelet-rich plasma therapy was found to be successful in diabetic wound healing. The combination therapy had no additive effect in terms of angiogenesis and the development of new collagen fibers.

Administration of perivascular cyanoacrylate for the prevention of cellular damage in saphenous vein grafts: an experimental model.

OBJECTIVE: The saphenous vein is the most commonly used graft in coronary artery bypass surgery, since no suitable arterial graft is available. However, the frequency of late graft failure is a cause for research into graft protection. The objective of this study was to investigate the effect of synthetic adhesive cyanoacrylate administration on the saphenous vein graft for preventing vascular damage due to internal pressure on the graft. METHODS: In this study we enrolled 20 volunteer subjects who had undergone coronary artery bypass surgery and who had excess saphenous vein grafts. Perivascular cyanoacrylate was administered to one of two saphenous vein grafts explanted from each patient. The other saphenous vein graft from each patient was not treated and was used as the control. A model of the arterial system was created using a saphenous vein cardiopulmonary bypass system. Circulation was maintained at 120 mmHg for 45 minutes. Afterwards, the grafts were subjected to histopathological examination. RESULTS: The cyanoacrylate group of grafts did not develop severe vascular damage compared with many instances of moderate and severe damage due to compression in the control group of grafts (p = 0.003). CONCLUSION: Perivascular administration of cyanoacrylate appeared to be successful in the prevention of early saphenous vein graft injury. No in vivo study has been performed to date to assess endothelial damage in the saphenous vein, in order to demonstrate the long-term effect of cyanoacrylate. Further investigations are needed in this regard.

Analysis of clinical outcomes of intra-aortic balloon pump use during coronary artery bypass surgery.

AIM: The mortality rate of coronary artery bypass surgery increases with advanced patient age. This intra-aortic balloon pump (IABP) study was conducted to compare older patients (above 65 years of age) with younger patients (below 65 years of age) who had undergone coronary artery bypass surgery and had had an IABP inserted, with regard to hospital stay, clinical features, intensive care unit stay, postoperative complications, and mortality and morbidity rates. METHODS: One hundred and ninety patients who had undergone coronary artery bypass surgery and had required IABP support were enrolled in this study. Patients younger than 65 years of age were considered younger, and the others were considered older. Ninety-two patients were in younger group and 98 patients were older group. The mortality rates, pre-operative clinical characteristics, postoperative complications, and duration of intensive care unit and hospital stay of the groups were compared. The risk factors for mortality and complications were analysed. RESULTS: One hundred and thirty-eight of the patients were male, and the mean age was 62.7 ± 9.9 years. The mortality rate was higher in the older patient group than the younger group [34 (37.7%) and 23 (23.4 %), respectively (p = 0.043) ]. The crossclamp time, mean ejection fraction, cardiopulmonary bypass time, and length of stay in the intensive care unit were similar between the two groups (p > 0.05). Cardiopulmonary bypass time was the unique independent risk factor for mortality in both groups. CONCLUSION: In this study, high mortality rates in the postoperative period were similar to those in prior studies regarding IABP support. The complication rates were higher in the older patient group. Prolonged cardiopulmonary bypass time and advanced age were determined to be significant risk factors for mortality.

Analysis of clinical outcomes of intra-aortic balloon pump during coronary artery bypass surgery.

AIM: The mortality rate in coronary artery bypass surgery increases with advancing patient age. This study was conducted to analyse and compare older (above 65 years of age) with younger patients (below 65 years of age) who had undergone coronary artery bypass surgery and had an intra-aortic balloon pump (IABP) inserted, comparing hospital stay, clinical features, intensive care unit stay, postoperative complications, and morbidity and mortality rates. METHODS: One hundred and ninety patients who had undergone coronary artery bypass surgery and required IABP support were enrolled in this study. Patients younger than 65 years of age were considered young, and the others were considered old. Ninety-two patients were young and 98 were old. The mortality rates, pre-operative clinical characteristics, postoperative complications, and duration of intensive care unit and hospital stays of the groups were compared. The risk factors for mortality and complications were analysed. RESULTS: One hundred and thirty-eight of the patients were male, and the mean patient age was 62.7 ± 9.9 years. The mortality rate was higher in the older patient group than the younger group [34 (37.7%) and 23 (23.4 %), respectively (p = 0.043)]. The cross-clamp time, mean ejection fraction, cardiopulmonary bypass time, and length of stay in the intensive care unit were similar among the groups (p > 0.05). Cardiopulmonary bypass time was the single independent risk factor for mortality in both groups. CONCLUSION: In this study, high mortality rates in the postoperative period were similar to prior studies regarding IABP support. The complication rates were higher in the older patient group. Prolonged cardiopulmonary bypass and advanced age were determined to be significant risk factors for mortality.

Hyperbaric oxygen treatment ameliorates lung injury in paraquat intoxicated rats.

Paraquat (PQ) is an agrochemical agent commonly used worldwide, which can cause acute lung injury (ALI) and death. Hyperbaric oxygen treatment (HBOT) is a therapeutic method, but the mechanisms of the protective effect of HBOT on ALI remain elusive. The purpose of this study was to evaluate the effect of HBOT on acute lung injury induced by PQ in rats. Wistar Albino rats (n=21) were separated into three groups of seven animals each: control (C), PQ, and PQ + HBOT groups. 20 mg/kg PQ was administered intraperitoneally in PQ and PQ + HBOT groups to induce experimental lung injury. Three days after PQ treatment, PQ + HBOT group was administered 100% O2 at 2.0 ATA for 1 hour per day, for five consecutive days. At the end of the study, lung tissue was obtained for determining total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI) and histopathological determination. Tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6), basic fibroblast growth factor (bFGF), transforming growth factor (TGF)-ß1 mRNA levels were assessed by quantitative reverse transcription-polymerase chain reaction. In addition, the inducible nitric oxide synthase (iNOS) level in the plasma was determined. Plasma iNOS, OSI, tissue TNF-α, TGF-ß1 and bFGF mRNA levels, and histological injury scores in PQ + HBOT group were significantly lower than PQ group. TAS level in PQ + HBOT group was significantly higher than PQ group. The findings suggest that HBOT could effectively ameliorate PQ-induced lung injury in rats.

APJ receptor A445C gene polymorphism in Turkish patients with coronary artery disease.

Coronary artery disease (CAD) is a disease in which a waxy substance called plaque builds up inside the coronary arteries. Apelin is a novel endogenous peptide with inotropic and vasodilatory properties and is the ligand for the angiotensin receptor-like 1 (APJ) receptor. We aimed to determine genotype and allele frequencies of APJ receptor A445C gene polymorphism in Turkish patients with CAD and healthy controls by RFLP-PCR. This study was performed on 159 unrelated CAD patients and 62 healthy controls. We obtained AA, AC and CC genotype frequencies in CAD patients as 41.5%, 49.1% and 9.4%, respectively. In the control group, frequencies of genotypes were found as 35.5% for AA, 48.4% for AC and 16.1% for CC. We did not observe difference in APJ receptor A445C polymorphism between CAD patients and healthy controls (χ(2) = 2.178; df = 2; P = 0.336). The A allele was encountered in 66% (210) of the CAD and 59.7% (74) of the controls. The C allele was seen in 34% (108) of the CAD and 40.3% (50) of the controls. Allele frequencies of interested genes were not significantly different between groups (χ(2) = 1.57; df = 1; p = 0.225). The frequencies of APJ receptor A445C genotype were not significantly different between control and patients. None of the three APJ receptor A445C genotypes, AA, AC and CC displayed significant difference in CAD patients. We did not find any difference in the clinical parameters except for weight and diastolic blood pressure levels in the AA, AC and CC genotypes of patients. Individuals with CC genotypes had significantly higher weight, systolic and diastolic blood pressure levels and systolic blood pressure than other genotypes, P ≤ 0.05. In addition, HDL-C level was found decreased, but this reduction was not statistically significant. Contrarily, the low levels of weight, SBP, DBP and TC were statistically significant in the subjects with AA genotype in CAD. In conclusion, CC genotype carriers may have more risk than other genotypes in the development of hypertension in CAD, but not AAgenotype carriers. We suggest that this polymorphism may not be a marker of CAD, but it may cause useful in function of the apelin/APJ system and may be a genetic predisposing factor for diagnostic processes and can be helpfull in finding new treatment strategies. We think that it is required to further comprehensive studies in order to make clear this situation in CAD.

Characterization of the apelin -1860T>C polymorphism in Turkish coronary artery disease patients and healthy individuals.

To evaluate the association between the apelin -1860T>C polymorphism and plasma apelin levels in Turkish patients with coronary artery disease (CAD). A total of 276 individuals were enrolled in the present study, including 158 patients with CAD and 118 individuals without CAD as controls. The presence of the apelin -1860T>C gene polymorphism and plasma apelin levels were determined using polymerase chain reaction/restriction fragment length polymorphism and enzyme-linked immunosorbent assay, respectively. Significance was set at p≤0.05 for all statistical analyses. The genotype and allele frequencies of interested genes were significantly different between groups (χ(2)=10.2; df=2; p=0.006 and χ(2)=13.4; df=1; p=0.000, respectively). Frequency of CC genotype and the C allele of -1860T>C site was significantly higher in CAD patients compared to healthy controls. We found that individuals with the TC and CC genotypes were associated with an increased risk of CAD when compared with the TT genotype in CAD patients, and the adjusted ORs (95% CI) were 6.50 (1.27-33.0) and 6.39 (1.77-23.0), respectively. Plasma apelin levels were significantly lower in CAD patients compared to control group. Apelin level of CAD patient group having CC genotype of -1860T>C site was significantly lower compared to those having TT genotypes, but it was not statistically significant (p > 0.05). The homozygous CC genotype of apelin gene is associated with high risk of CAD. Apelin gene polymorphism -1860T>C is a significant predictor of predisposition to CAD in in Turkish population.

Deep sternal wound infection after coronary artery bypass surgery: management and risk factor analysis for mortality.

BACKGROUND: Deep sternal wound infection is a life-threatening complication after cardiac surgery. The aim of this study was to investigate the factors leading to mortality, and to explore wound management techniques on deep sternal wound infection after coronary artery bypass surgery. METHODS: Between 2008 and 2013, 58 patients with deep sternal wound infection were analyzed. Risk factors for mortality and morbidity including age, gender, body mass index, smoking status, chronic renal failure, hypertension, diabetes, and treatment choice were investigated. RESULTS: In this study, 19 patients (32.7%) were treated by primary surgical closure (PSC), and 39 patients (67.3%) were treated by delayed surgical closure following a vacuum-assisted closure system (VAC). Preoperative patient characteristics were similar between the groups. Fourteen patients (24.1%) died in the postoperative first month. The mortality rate and mean duration of hospitalization in the PSC group was higher than in the VAC group (P = .026, P = .034). Significant risk factors for mortality were additional operation, diabetes mellitus, and a high level of EuroSCORE. CONCLUSIONS: Delayed surgical closure following VAC therapy may be associated with shorter hospitalization and lower mortality in patients with deep sternal wound infection. Additional operation, diabetes mellitus, and a high level of EuroSCORE were associated with mortality.

Comparing the effectiveness of neutrophil-lymphocyte ratio as a mortality predictor on middle and advanced age coronary artery bypass graft patients.

OBJECTIVE: In this study, the effect of neutrophil-lymphocyte ratio (NLR), which is a recently developed inflammatory parameter, as an early stage mortality predictive marker on coronary artery bypass (CABG) patients of various age groups was examined. METHODS: Seventy eight patients under the age of 45 (Group 1) and 80 patients who were older than 45 (Group 2) randomly chosen from the patients who underwent isolated CABG surgery, were examined. The preoperative characteristics and NLRs were noted. The primary end point of the study was determined as all-cause in- hospital mortality. RESULTS: Mortality was observed in 2 patients in Group 1 and 11 patients in Group 2. The threshold value of NLR was 2,47 in the Receiver Operating Characteristic (ROC) curve in Group 1 and there wasn't any significant correlation between preoperative NLR and mortality rates in the patients whose NLRs were above this curve. The threshold value was determined as 4.07 in Group 2 and there was a significant relation between preoperative NLR and mortality (p<0,01). No relation was found between NLR and mortality when all the examined patients were considered (p>0.05). CONCLUSION: NLR that can be easily calculated, can be used as a mortality predictor in the patients of advanced age who will undergo isolated CABG procedure.

Acute mesenteric ischemia after cardiac surgery: an analysis of 52 patients.

OBJECTIVE: Acute mesenteric ischemia (AMI) is a rare but serious complication after cardiac surgery. The aim of this retrospective study was to evaluate the incidence, outcome, and perioperative risk factors of AMI in the patients undergoing elective cardiac surgery. METHODS: From January 2005 to May 2013, all patients who underwent cardiac surgery were screened for participation, and patients with registered gastrointestinal complications were retrospectively reviewed. Univariate analyses were performed. RESULTS: The study included 6013 patients, of which 52 (0.86%) patients suffered from AMI, 35 (67%) of whom died. The control group (150 patients) was randomly chosen from among cases undergoing cardiopulmonary bypass (CPB). Preoperative parameters including age (P = 0.03), renal insufficiency (P = 0.004), peripheral vascular disease (P = 0.04), preoperative inotropic support (P < 0.001), poor left ventricular ejection fraction (P = 0.002), cardiogenic shock (P = 0.003), and preoperative intra-aortic balloon pump (IABP) support (P = 0.05) revealed significantly higher levels in the AMI group. Among intra- and postoperative parameters, CPB time (P < 0.001), dialysis (P = 0.04), inotropic support (P = 0.007), prolonged ventilator time (P < 0.001), and IABP support (P = 0.007) appeared significantly higher in the AMI group than the control group. CONCLUSIONS: Prompt diagnosis and early treatment should be initiated as early as possible in any patient suspected of AMI, leading to dramatic reduction in the mortality rate.

Posttraumatic true aneurysm of the axillary artery following blunt trauma.

The majority of the axillary artery aneurysm cases arise as pseudoaneurysms secondary to blunt or iatrogenic trauma. Isolated traumatic true axillary artery aneurysm is a relatively unusual disorder and generally occurs with repetitive blunt trauma. A 22-year-old female patient with distal axillary artery true aneurysm due to simple blunt axillothoracic trauma is presented. The aneurysm was excised with subpectoral-axillary approach and saphenous vein graft interposition was applied. Long-term follow-up with the patient was uneventful.

Unilayer Closure of Saphenous Vein Incision Lines is Better than Bilayer Closure.

OBJECTIVE: To examine early results in patients with incision lines closed only along the skin and subcutaneous tissue after removal of the great saphenous vein during coronary artery bypass surgery. MATERIALS AND METHODS: We enrolled 82 patients who underwent elective operations in our clinic between December 2008 and April 2009. The patients had similar demographic characteristics, and the method of incision closure was chosen randomly. Three patients were excluded due to in-hospital mortality. The saphenous incision lines were closed using continuous skin sutures in 41 patients (Group 1) or using continuous subcutaneous sutures followed by continuous skin sutures in 38 patients (Group 2). Patients were followed every day that they were in the hospital, in the first week after being discharged, and at the end of the second month after discharge. The incision lines were evaluated for hematomas, infection, edema, pain and numbness. RESULTS: During the follow-up performed in-hospital and in the first week after discharge, infection, edema and numbness were observed significantly more often in Group 2 than in Group 1. Hematoma was observed more often in Group 1, and pain was observed more often in Group 2, but neither of these findings reached statistical significance. During the follow-up at the end of the second month after discharge, infection, edema, and numbness were observed significantly more frequently in Group 2. CONCLUSION: In patients undergoing saphenous removal using standard procedures, it is sufficient to close the incision line using only skin sutures.

Delayed Presentation of a Giant Ascending Aortic Aneurysm following Aortic Valve Replacement.

Giant ascending aortic aneurysm formation following aortic valve replacement is rare. A 28-year-old man who underwent aortic valve replacement with a prosthetic valve for aortic regurgitation secondary to congenital bicuspid aortic valve about 10 years ago was diagnosed with a giant ascending aortic aneurysm about 16 cm in diameter in follow-up. The aneurysm was resected leaving the functional old mechanical prosthesis in place and implanted a 34-mm Hemashield woven graft, associated with the left and right coronary artery button implantation. Histological findings of the aortic aneurysm wall showed cystic medial necrosis. The postoperative course was uneventful and postoperative examination demonstrated good surgical results.

Intracoronary shunt versus bulldog clamp in off-pump bypass surgery. Endothelial trauma: shunt versus clamp.

BACKGROUND: During off-pump coronary bypass grafting, local vascular control of the target vessel and a bloodless field are crucial. The aim of this study is to asses the histopathological outcomes of intracoronary shunts and bulldog clamping on the beating heart in a canine model. METHODS: Twelve healthy adult mongrel dogs weighing between 15 to 25 kg were included in the study. Following left thoracotomy, proximal left anterior descending artery segment 1 cm to distal of diagonal branch was marked. Arteriotomy at this site was performed and a shunt was inserted for 10 min in the shunt group. The bulldog clamp was applied 3 cm distal to the mark for 10 min after heparinization in the bulldog group. Thirty days after the procedure, the specimens of left anterior descending artery from both regions were collected and were examined. Vascular damage, presence of intimal hyperplasia, and denudation were noted. RESULTS: Only intimal denudation was found significantly higher in the shunt group (P < 0.05). In this group, only one case had grade 0 endothelial damage. In the bulldog group, all cases had endothelial damage of various grades. CONCLUSION: The proven advantages of temporary intracoronary shunts are well-known, e.g., preserving the ventricular functions. Despite these advantages, our study revealed an ultimate bad result for an off-pump coronary by pass patient: intimal denudation. We conclude that further studies with a larger number of subjects are needed to decide whether routine shunt insertion into coronary arteries during off-pump coronary bypass surgery is appropriate or not.