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1.
Clin Appl Thromb Hemost ; 29: 10760296231173409, 2023.
Article in English | MEDLINE | ID: mdl-37165510

ABSTRACT

Effects of warfarin and new-generation direct oral anticoagulants (DOACs) on thrombus resolution after the treatment of deep vein thrombosis (DVT) are still unknown. The study aimed to investigate the effects of warfarin and DOACs on thrombus resolution after DVT treatment. Methods: The study included 666 patients who were diagnosed with femoropopliteal DVT between January 2016 and January 2022 and had complete medical records without missing data. Patients with and without recanalization were added to groups 1 (n = 396) and 2 (n = 270), respectively. Ultrasonography/venous Doppler examinations of the patients during follow-up were performed by 3 radiologists. Recanalization was defined as the presence of complete flow in the femoral and popliteal veins and the absence of residual venous thrombus. Results: Among the included patients, recanalization was observed in 59.5% patients. The mean follow-up period was 23.6 ± 17.8 (range 1-72; median 17) months. There was no difference between the 2 groups in terms of the types of drugs used in the treatment (P = .208). Cox regression models were used to investigate the factors affecting recanalization. Analysis of the variables having significant differences between both groups revealed the low rate of recanalization in patients with coronary artery disease (odds ratio [OR], 2.3%; 95% confidence intervals [CI]: 1.6-3.4; P < .001) and diabetes mellitus (OR, 1.5; 95% CI: 1.1-1.9; P = .009). Conclusion: Thrombus resolution after femoropopliteal DVT is not affected by the drugs used in the treatment.


Subject(s)
Thrombosis , Venous Thrombosis , Humans , Venous Thrombosis/diagnostic imaging , Venous Thrombosis/drug therapy , Warfarin/therapeutic use , Popliteal Vein/diagnostic imaging , Thrombosis/drug therapy , Ultrasonography , Anticoagulants/therapeutic use , Treatment Outcome
2.
Medicine (Baltimore) ; 102(7): e33008, 2023 Feb 17.
Article in English | MEDLINE | ID: mdl-36800586

ABSTRACT

This study aimed to investigate the effects of pharmacomechanical thrombectomy on novel complete blood count parameters in deep venous thrombosis. This retrospective study included 242 patients aged >18 years who were treated for deep venous thrombosis. Patients were grouped as follows: group 1 was accepted as having interventional operations (n = 123) and group 2 was accepted as having only medical advice (n = 119). Routine complete blood count parameters, the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR) were compared. There was no difference between the groups in terms of admission hemoglobin, hematocrit, mean platelet volume, NLR and PLR (P = .11, P = .24, P = .55, P = .93, and P = .96, respectively). In the pharmacomechanic thrombectomy group, NLR and PLR were significantly reduced after intervention when compared to the admission values (P < .001 and P < .001, respectively). However, the NLR and PLR values of medically treated patients did not differ significantly from their baseline values (P = .16 and P = .08, respectively). In this study, we effectively removed the thrombus load in blocked proximal veins using pharmacomechanical thrombectomy and observed a significant decrease in NLR and PLR, which are current, inexpensive, and accessible parameters.


Subject(s)
Blood Platelets , Venous Thrombosis , Humans , Retrospective Studies , Platelet Count , Blood Cell Count , Lymphocytes , Neutrophils , Thrombectomy , Venous Thrombosis/therapy , Lymphocyte Count
3.
Thorac Cardiovasc Surg ; 71(4): 291-296, 2023 06.
Article in English | MEDLINE | ID: mdl-35896440

ABSTRACT

BACKGROUNDS: Postoperative atrial fibrillation (POAF) is one of the most common complication of cardiac surgery. Epicardial fat tissue may play a role in the development of atrial fibrillation (AF). The aim of this study was to evaluate relationship between epicardial fat volume (EFV) and the appearance of new-onset AF in patients undergoing isolated coronary artery bypass graft (CABG) with normal echocardiographic functions. METHODS: Between January 2017 and June 2020, 281 coronary artery disease patients undergone isolated CABG surgery with normal echocardiographic functions were included in the study. Patient characteristics, medical history, and perioperative variables were retrospectively collected. Patients with AF predisposition factors were excluded. RESULTS: Sixty-seven patients (23.8%) developed postoperatively AF during hospital stay. In univariate analysis, patients with postoperative AF were older compared with sinus rhythm patients (60.78 ± 9.03 vs. 65.46 ± 9.22, p = 0.001). There are no statistically significant differences between groups and EFV compared (107.78 ± 41.04 vs. 106.66 ± 34.98 p = 0.84). Large left atrial diameter, female patient, cardiopulmonary bypass and longer cross-clamp time showed correlation between POAF without statistical significance. CONCLUSION: Aging is the only associated factor with AF in this study. There was no EFV difference between POAF and non-AF groups in patients undergoing isolated CABG with normal echocardiographic functions.


Subject(s)
Atrial Fibrillation , Humans , Female , Retrospective Studies , Postoperative Complications/etiology , Treatment Outcome , Coronary Artery Bypass/adverse effects , Risk Factors
4.
Phlebology ; 36(8): 620-626, 2021 Sep.
Article in English | MEDLINE | ID: mdl-33813962

ABSTRACT

OBJECTIVE: This study evaluated the effect of low-energy radiofrequency thermocoagulation added to standard liquid sclerotherapy on clinical outcomes of patients with venous insufficiency. PATIENTS AND METHOD: We included 111 patients with spider veins CEAP/C1 stage. The patients were randomized into sclerotherapy (Group 1) and sclerotherapy + sclerotherapy immediately followed by low energy percutaneous RF thermocoagulation (Group 2) groups and followed up with same protocols prospectively. RESULTS: The study groups did not differ in terms of the mean age, body mass index, the number of spider veins and pre-interventional venous clinical severity scores (VCSS). Patients' self-assessed satisfaction ratings of cosmetic outcomes were found to be higher compared to the baseline (p = 0.001). While both techniques caused a significant decline in VCSS at postprocedural third month, it was observed that the type of applied intervention did not affect the VCSS (p = 0.43 and p = 0.93, respectively). There was a significant difference in hyperpigmentation and trapped blood between the two groups after the procedure (p = 0.009 and p = 0.02, respectively), there was no statistically significant difference in terms of skin necrosis (p = 0.52). A significant difference in the self-assessed cosmetic outcomes was observed in patients treated with sclerotherapy followed by low energy percutaneous RF thermocoagulation compared with patients whom sclerotherapy performed alone (p = 0.001). DISCUSSION: This study suggests that radiofrequency thermocoagulation added to the sclerotherapy provides better cosmetic outcomes with less treatment sessions and no additional complication rates.


Subject(s)
Telangiectasis , Varicose Veins , Electrocoagulation , Humans , Leg , Pilot Projects , Saphenous Vein , Sclerotherapy , Treatment Outcome , Varicose Veins/therapy
5.
Kardiol Pol ; 79(1): 25-30, 2021 01 25.
Article in English | MEDLINE | ID: mdl-33078919

ABSTRACT

BACKGROUND: Carotid artery stenosis (CAS) is one of the major causes of stroke in coronary artery bypass grafting (CABG). AIMS: The aim of this study was to determine which age groups require screening for CAS using carotid duplex ultrasound in asymptomatic patients undergoing CABG. METHODS: We included 644 neurologically asymptomatic consecutive patients (mean [SD] age, 63.9 [8.8] years; men, 453 [70.3%]) who underwent elective isolated CABG between June 2015 and June 2020. Clinical, demographic, and radiological data as well as coronary angiography results were retrospectively reviewed. Patients were classified into 4 age groups: 40 to 50, 51 to 60, 61 to 70, and >70 years, as well as 3 groups depending on the CAS degree: 50% or less, 50% to 70%, and 70% or greater. Regression analysis was applied across the selected parameters to identify risk factors for significant CAS, and receiver operating characteristic analysis, to determine cutoff age and SYNTAX score of patients who had to be screened before CABG. RESULTS: Overall, 8 (1.1%) patients included in the present study had stroke following CABG. Cutoff values of the SYNTAX score and CAS of 70% or greater were found to be 27 and 64 years, respectively. The sensitivity and specificity of the cutoff value were 98.4% to 98.3% and 74.3% to 55.1%, respectively. The area under the curve was 0.98 and 0.73, respectively. CONCLUSION: Based on the receiver operating characteristic analysis, we recommended to perform screening for CAS in patients older than 64 years and with a SYNTAX score of 27 or higher, even if they are asymptomatic.


Subject(s)
Carotid Stenosis , Coronary Artery Disease , Stroke , Adult , Carotid Stenosis/complications , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/surgery , Child , Coronary Artery Bypass , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Treatment Outcome
6.
Int J Crit Illn Inj Sci ; 10(3): 140-142, 2020.
Article in English | MEDLINE | ID: mdl-33409129

ABSTRACT

In this case report, we present a patient scheduled for operation due to critical leg ischemia in whom a bilateral great saphenous vein (GSV) had already been used during previous cardiac and peripheral vascular surgeries. The patient underwent femorofemoral crossover bypass from left to right with a small saphenous vein and right femoropopliteal bypass with cephalic vein (CV) during the same session. Distal pulses became palpable, and symptoms regressed dramatically following the operation. A control computed tomographic angiography scan revealed no signs of graft stenosis 32 months after the surgery. Despite the recent advances in synthetic graft materials, small saphenous and CVs should be remembered as alternative long-standing conduits in the absence of the GSV.

7.
Heart Surg Forum ; 22(3): E234-E240, 2019 05 24.
Article in English | MEDLINE | ID: mdl-31237550

ABSTRACT

BACKGROUND: The aim of our study was to compare the outcome of patients who underwent mitral valve anterior leaflet repair with and without chordal replacement for degenerative mitral valve insufficiency. METHODS: This study was conducted at our center between May 2006 and May 2013. The study included 125 patients with degenerative mitral valve insufficiency (64 males, 61 females; mean age 47 years, age range 16-78 years) who underwent mitral valve repair with anterior leaflet procedures. The patients were divided into 2 groups. Group A consisted of 56 patients with chordal replacement, and group B consisted of 69 patients with other repair techniques performed. RESULTS: No significant difference was determined between the 2 groups in mortality, recurrence, and reoperation rates. The mortality rate was 3.6% in group A and 1.4% in group B. During the follow-up period, 3 patients were reoperated on (mitral valve replacement) because of severe mitral valve insufficiency. Two of these patients were from group A (3.6%), and the other was from group B (1.4%). One patient in group A underwent intraoperative mitral valve replacement after unsuccessful chordal replacement. Fifty patients (89.3%) in group A and 65 patients (94.2%) in group B exhibited no or mild recurrence of mitral valve insufficiency. CONCLUSION: Mitral valve repair in patients with degenerative mitral valve insufficiency resulting from anterior leaflet pathology is a safe procedure because of its durability and good long-term results. Despite the difficulty of the chordal replacement procedure, it may be used as an alternative technique for anterior mitral valve leaflet repair.


Subject(s)
Heart Valve Prosthesis Implantation/adverse effects , Mitral Valve Annuloplasty/adverse effects , Mitral Valve Insufficiency/surgery , Postoperative Complications/epidemiology , Adolescent , Adult , Aged , Cohort Studies , Female , Humans , Male , Middle Aged , Recurrence , Reoperation , Survival Rate , Treatment Outcome , Young Adult
9.
Respir Care ; 63(10): 1264-1270, 2018 Oct.
Article in English | MEDLINE | ID: mdl-29945906

ABSTRACT

BACKGROUND: The time and conditions may not be suitable for performing polysomnography (PSG) before urgent or emergent surgeries, for example, a coronary artery bypass graft. Unavailability in many centers, critical clinical situation, and inability to arrange a timely scheduled appointment are other limitations for PSG. In this study, we aimed to investigate if the STOP-BANG Questionnaire may predict obstructive sleep apnea syndrome (OSAS) related postoperative pulmonary alterations during coronary artery surgery. METHODS: Sixty-one subjects who were scheduled to undergo elective isolated coronary artery bypass graft surgery and were consulted for preoperative pulmonary assessment were recruited to the study. The STOP-BANG Questionnaire was used with the subjects; then their relationship with postoperative complications was assessed. RESULTS: Results of the STOP-BANG Questionnaire revealed that 36.1% of subjects were at high risk for OSAS. Three groups were established according to the STOP-BANG Questionnaire (low risk, group 1; moderate risk, group 2; high risk, group 3) and study parameters, including PEEP value in ventilator, detection of apnea at ventilator, CPAP time after extubation, SpO2 1 h after extubation, postoperative hypoxemia, need for CPAP, and ICU length of stay revealed significant relationships among these groups. CONCLUSIONS: The STOP-BANG Questionnaire may predict the OSAS risk and OSAS-related pulmonary complications for patients who are candidates for a coronary artery bypass graft and unable to be evaluated with PSG before surgery due to technical or time-related limitations.


Subject(s)
Coronary Artery Bypass/adverse effects , Postoperative Complications/etiology , Sleep Apnea, Obstructive/complications , Surveys and Questionnaires , Aged , Continuous Positive Airway Pressure , Female , Humans , Hypoxia/etiology , Male , Middle Aged , Postoperative Complications/physiopathology , Preoperative Period , Risk Assessment/methods , Sleep Apnea, Obstructive/physiopathology
10.
Phlebology ; 33(1): 53-59, 2018 Feb.
Article in English | MEDLINE | ID: mdl-28056701

ABSTRACT

Background Standard treatment for deep venous thromboembolism involves parenteral anticoagulation overlapping with a vitamin K antagonist, an approach that is effective but associated with limitations including the need for frequent coagulation monitoring. The direct oral anticoagulant rivaroxaban is similarly effective to standard therapy as a single-drug treatment for venous thromboembolism and does not require routine coagulation monitoring. The aim of this analysis was to project the long-term costs and outcomes for rivaroxaban compared to standard of care (tinzaparin/warfarin). Methods A total of 184 patients who were under anticoagulant therapy with warfarin or rivaroxaban for extended deep venous thromboembolism were retrospectively evaluated; 59 received rivaroxaban and 125 received warfarin therapy. Assessments were made on age, gender, place of residence, the duration of anticoagulation, mean international normalized ratio value, the effective rate of international normalized ratio (time in the therapeutic range), bleeding-related complication rate, duration of hospitalization due to complications, the number of annual outpatient department admission, cost for drug, cost for hospitalization, cost for outpatient department admission and international normalized ratio measurements. Results The annual outpatient cost is higher in warfarin group (147.09 ± 78 vs. 62.32 ± 19.79 USD p < 0.001). But annual drug cost is higher in rivaroxaban group (362.6 vs. 71.55 ± 31.01 USD p < 0.001). Overall cost of rivaroxaban group is higher than warfarin group (476.25 ± 36.78 vs. 364.82 ± 174.44 USD). Warfarin is not cost-effective when non-drug costs (342.5 ± 174.44 vs. 113.65 ± 36.77) and hospital costs (173.85 ± 122.73 vs. 64.9 ± 23.55 USD) were analyzed. Conclusion This analysis suggests that rivaroxaban has lower costs than warfarin in terms of outpatient department admission and hospital costs due to complications; however, warfarin was more economic when all cost parameters were considered. Time in the therapeutic range was found as 56% for warfarin that should be taken into account while analyzing costs and benefits.


Subject(s)
Anticoagulants/economics , Anticoagulants/therapeutic use , Factor Xa Inhibitors/economics , Factor Xa Inhibitors/therapeutic use , Health Care Costs , Rivaroxaban/economics , Rivaroxaban/therapeutic use , Thromboembolism/drug therapy , Thromboembolism/economics , Venous Thrombosis/drug therapy , Venous Thrombosis/economics , Warfarin/economics , Warfarin/therapeutic use , Adult , Aged , Ambulatory Care/economics , Anticoagulants/adverse effects , Blood Coagulation/drug effects , Cost Savings , Cost-Benefit Analysis , Drug Costs , Drug Monitoring/economics , Drug Monitoring/methods , Factor Xa Inhibitors/adverse effects , Female , Hemorrhage/chemically induced , Hemorrhage/economics , Hospital Costs , Humans , International Normalized Ratio/economics , Male , Middle Aged , Models, Economic , Retrospective Studies , Risk Factors , Rivaroxaban/adverse effects , Thromboembolism/blood , Thromboembolism/diagnosis , Time Factors , Treatment Outcome , Venous Thrombosis/blood , Venous Thrombosis/diagnosis , Warfarin/adverse effects
11.
Turk Gogus Kalp Damar Cerrahisi Derg ; 26(1): 45-51, 2018 Jan.
Article in English | MEDLINE | ID: mdl-32082710

ABSTRACT

BACKGROUND: This study aims to investigate the effects of the use of the Rapid Shallow Breathing Index on extubation success and time to extubation in patients undergoing elective isolated coronary artery bypass grafting. METHODS: This prospective, randomized-controlled study included a total of 72 patients (55 males, 19 females; mean age 60.3±9.3 years; range 45 to 76 years) who underwent isolated coronary artery bypass grafting between February 2016 and November 2016. The patients were divided into two groups as the RSBI group (n=36) and the control group (n=36). The control group was extubated by conventional criteria that were routinely applied in our clinic, while the RSBI group was extubated, when the index scores became below 77 breaths per min/L, following ensuring hemodynamic stability and weaning procedure from mechanical ventilation. RESULTS: The mean time to wean from mechanical ventilation was 5.8±1.0 hours in the RSBI group and 8.1±2.0 hours in the control group (p=0.03). Extubation protocol performed through the use of the index was found to provide 26% earlier extubation compared to the conventional extubation criteria. There was no significant difference in the postoperative follow-up parameters or clinical conditions. CONCLUSION: Our study results show that a practical tool such as the Rapid Shallow Breathing Index can be reliably used for making a decision in favor of extubation in patients undergoing coronary artery bypass grafting. A shortened time to extubation by the use of this index may provide substantial benefits in terms of prevention of infections, mechanical ventilation-induced lung injuries, and potential pulmonary complications.

12.
Kardiol Pol ; 75(12): 1315-1323, 2017.
Article in English | MEDLINE | ID: mdl-28832097

ABSTRACT

BACKGROUND: The morphology and extensity of the stenotic lesion is crucial as well as the obstruction ratio. It is well known that the complexity of lesions has a direct impact on endovascular treatment (PTCA/stent); however, the arrangement of the lesions is underestimated and not well studied. AIM: We sought to evaluate the haemodynamic effects of different stenotic lesion models and arrangements in vitro. METHODS: Vascular circulation was simulated in vitro. Oxygenator, tubing set, polytetrahidroflouroethylene synthetic graft, pressure and flow rate, sensors were used to build the simulation model. Measurements of isolated short, isolated long, identical stenotic tandem short, identical stenotic tandem long, sub-critical long, and critical short lesion combinations were performed and haemodynamic parameters were recorded. RESULTS: Tandem lesions were more likely to result in critical stenosis comparing single lesions with the same obstruction ratio. This difference became more significant as the obstruction ratio was raised. Tandem long lesions also resulted in more critical stenosis than tandem short lesions. It can be claimed that tandem lesions can result in more flow restriction with reference to single lesions with the same stenotic ratio. Contrary to expectations, tandem short lesions were found to be more stenotic compared with the same degree long individual lesions. CONCLUSIONS: It is effortless to give the decision for simple, discrete and individual lesions, while the ideal decision for long and complicated lesions may remain unclear. Even if these "grey zone" lesions are considered non-critical while investigating them one by one, it must be kept in mind that the overall stenotic effect of these lesions may lead to more haemodynamic impairment.


Subject(s)
Cerebrovascular Circulation/physiology , Coronary Stenosis/physiopathology , Models, Anatomic , Coronary Vessels/physiopathology , Hemodynamics , Humans , Regional Blood Flow/physiology
13.
Gen Thorac Cardiovasc Surg ; 65(1): 63-66, 2017 Jan.
Article in English | MEDLINE | ID: mdl-27294378

ABSTRACT

Patients with severely calcified aorta have high risk of atheroemboli and bleeding during cardiac surgery. Clamping the ascending aorta to initiate cardiac arrest or to perform proximal anastomosis is a challenging problem. Beating heart coronary artery bypass grafting without aortic clamping is usually accepted as the best solution. Herein, we present a feasible and inexpensive proximal anastomosis technique without using aortic clamps for patients with severely atherosclerotic aorta.


Subject(s)
Aortic Diseases/surgery , Coronary Artery Bypass, Off-Pump/methods , Vascular Calcification/surgery , Aged , Anastomosis, Surgical/methods , Aorta/surgery , Aortic Diseases/diagnostic imaging , Atherosclerosis/diagnostic imaging , Atherosclerosis/surgery , Constriction , Coronary Artery Disease/surgery , Feasibility Studies , Humans , Male , Middle Aged , Tomography, X-Ray Computed , Vascular Calcification/diagnostic imaging
14.
Aorta (Stamford) ; 5(5): 132-138, 2017 Oct.
Article in English | MEDLINE | ID: mdl-29657951

ABSTRACT

BACKGROUND: In procedures involving surgical maneuvers such as cannulation, clamping, or proximal anastomosis where aortic manipulation is inevitable, a preliminary assessment of atherosclerotic plaques bears clinical significance. In the present study, our aim was to evaluate the frequency and distribution of aortic calcifications in patients undergoing coronary artery bypass grafting (CABG) surgery to propose a morphological classification system. METHODS: A total of 443 consecutive patients with coronary artery disease were included in this study. Preoperative non-contrast enhanced computed tomography images, in-hospital follow-up data, and patient characteristics were retrospectively evaluated. RESULTS: Whereas 33% of patients had no calcifications at any site in the aorta, 7.9%, 75.4%, and 16.7% had calcifications in the ascending aorta, aortic arch, and descending aorta, respectively. Focal small calcifications were the most common type of lesions in the ascending aorta (3.9%), whereas 9 patients (1.4%) had porcelain ascending aorta. We defined four types of patients with increasing severity and extent of calcifications. CONCLUSIONS: Based on the frequency and distribution of calcifications in the thoracic aorta, we propose a classification system from least to most severe for coronary artery disease patients who are candidates for CABG.

16.
World J Transplant ; 6(1): 193-8, 2016 Mar 24.
Article in English | MEDLINE | ID: mdl-27011917

ABSTRACT

Despite advances in transplantation techniques and the quality of post-transplantation care, opportunistic infections remain an important cause of complications. Pneumocystis jirovecii (P. jirovecii) is an opportunistic organism, represents an important cause of infections in heart transplantation patients. Almost 2% to 10% of patients undergoing cardiac transplantation have Pneumocystis pneumonia. Prophylaxis is essential after surgery. Various prophylaxis regimes had been defined in past and have different advantages. Trimethoprim/sulfamethoxazole (TMP/SMX) has a key role in prophylaxis against P. jirovecii. Generally, although TMP/SMX is well tolerated, serious side effects have also been reported during its use. Pentamidine is an alternative prophylaxis agent when TMP/SMX cannot be tolerated by the patient. Structurally, pentamidine is an aromatic diamidine compound with antiprotozoal activity. Since it is not effectively absorbed from the gastrointestinal tract, it is frequently administered via the intravenous route. Pentamidine can alternatively be administered through inhalation at a monthly dose in heart transplant recipients. Although, the efficiency and safety of this drug is well studied in other types of solid organ transplantations, there are only few data about pentamidine usage in heart transplantation. We sought to evaluate evidence-based assessment of the use of pentamidine against P. jirovecii after heart transplantation.

18.
Perfusion ; 31(6): 471-6, 2016 Sep.
Article in English | MEDLINE | ID: mdl-26811429

ABSTRACT

OBJECTIVE: We sought to reveal whether the severity of angina pectoris affects sleep quality after elective coronary artery bypass grafting. MATERIAL AND METHODS: Patients scheduled to undergo isolated coronary artery bypass grafting were divided into two groups, having a recent myocardial infarction (Group 1, n=22, mean age 59.40±7.79 years) or not having a recent myocardial infarction (Group 2, n=30, mean age 59.73±7.72 years). The assessment included the Canadian Cardiovascular Society Angina Score, the visual analogue scale for postoperative pain and the Pittsburgh Sleep Quality Index (PSQI). RESULTS: The two groups were similar in regard to baseline characteristics. Cross-clamp time was significantly higher (p=0.007) and the use of inotropes was significantly more common (p=0.01) in those patients with recent myocardial infarction compared to those without. Mean Canadian Cardiovascular Society scores were also higher in patients with recent myocardial infarction (p=0.02). Total Pittsburgh Sleep Quality Index score was significantly higher in patients with recent myocardial infarction (8.45±3.50 vs. 5.03±2.32, respectively, p<0.001). In multivariate analysis, higher angina score (OR: 3.27, 95% CI, 1.20-8.90, p=0.02) and longer time of intensive care unit stay (OR: 6.15, 95% CI, 1.49-25.35, p=0.01) were found to be independent predictors of poor sleep quality. The Canadian Cardiovascular Society angina score showed a significant positive correlation with poor sleep duration score (<0.001), sleep disturbance score (p=0.02), day dysfunction due to sleepiness score (p=0.001), sleep efficiency score (p=0.003), overall sleep quality score (0.03) and total PSQI score (p=0.004). CONCLUSION: The severity of angina pectoris in the preoperative period is independently associated with worse sleep quality after elective isolated coronary artery bypass surgery.


Subject(s)
Angina Pectoris/surgery , Coronary Artery Bypass , Sleep , Adult , Aged , Angina Pectoris/physiopathology , Elective Surgical Procedures , Female , Humans , Male , Middle Aged , Myocardial Infarction/physiopathology
19.
Thorac Cardiovasc Surg ; 64(5): 441-6, 2016 Aug.
Article in English | MEDLINE | ID: mdl-26291745

ABSTRACT

Background This pilot study aimed to evaluate the effectiveness of posterior left atrial wall plication (T-plasty) in patients with persistent atrial fibrillation (AF) (> 7 days) undergoing mitral valve surgery. Materials and Methods A total of 60 patients who were scheduled for mitral valve replacement were randomly allocated into two groups: one would receive (Group 1; n = 32, mean age; 49.37 ± 9.00) and one would not receive (Group 2; n = 28; mean age 48.64 ± 8.6) left atrial size reduction using T-plasty technique. Patients with a clear indication for combined procedures other than tricuspid valve disease, aortic valve disease, and coronary artery stenosis were not included. Follow-up was performed at 6th, 12th, and 18th months after the operation. Results After the operation, 21 patients (65.6%) in Group 1 and 13 patients (46.4%) in Group 2 regained sinus rhythm (p = 0.13). Mortality did not occur. AF recurrence rates were not significantly different between the groups in three follow-ups. Restoration of sinus rhythm was significantly more common in Group 1 patients than in Group 2 patients during follow-up. Patients in Group 1 had lower left atrial volume indexes than those in Group 2 at the 6th and 12th months, whereas the difference at the 18th month was at the limit of significance. Conclusion We achieved satisfactory results using the T-plasty technique for left atrial size reduction in terms of mid-term restoration and preservation of normal sinus rhythm in patients undergoing mitral valve surgery. Further study may be justified to reveal the prognostic importance of the technique described herein.


Subject(s)
Atrial Fibrillation/surgery , Atrial Function, Left , Heart Atria/surgery , Heart Rate , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation/methods , Mitral Valve/surgery , Adult , Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/physiopathology , Female , Heart Atria/diagnostic imaging , Heart Atria/physiopathology , Heart Valve Diseases/diagnostic imaging , Heart Valve Diseases/physiopathology , Heart Valve Prosthesis Implantation/adverse effects , Heart Valve Prosthesis Implantation/instrumentation , Humans , Male , Middle Aged , Mitral Valve/diagnostic imaging , Mitral Valve/physiopathology , Pilot Projects , Prospective Studies , Recovery of Function , Recurrence , Time Factors , Treatment Outcome , Turkey
20.
Heart Lung Circ ; 25(5): 493-8, 2016 May.
Article in English | MEDLINE | ID: mdl-26546094

ABSTRACT

BACKGROUND: Delirium is an important morbidity following heart surgery. We sought to determine whether dopamine infusion is associated with increased risk of delirium in patients undergoing coronary artery bypass grafting. METHODS: A total of 137 patients (mean age; 61.02±7.83, 105 males) were included in the study. Patients undergoing isolated coronary artery bypass grafting were considered eligible and those with preoperative neurological deficit or significant neurocognitive disorders, dementia or psychiatric disorders were excluded. Primary outcome measure was occurrence of delirium within 72 hours after operation. The diagnosis of delirium was made using confusion assessment method for the intensive care unit questionnaire. Both administration of dopamine as a dichotomised variable and the total amount of dopamine per kg body-weight were included in two different logistic regression models. RESULTS: Delirium occurred in 18 (13.1%) patients. Age adjusted Mantel-Haenszel relative risk for delirium with receiving dopamine was 4.62. Relative risk was 2.37 (0.18 to 31.28, 95% CI, p=0.51) in total doses over 10mg whereas it was 3.55 (1.16 to 10.89 95% CI, p=0.02) in total doses over 30 mg per kg body-weight. Older age (p=0.03), dopamine administration (OR: 9.227 95% CI, 2.688-32.022, p<0.001) and the amount of dopamine administered (OR: 1.072, 95% CI, 1.032-1.115, p<0.001) were independent predictors for delirium 72 hours after surgery. CONCLUSION: Along with older age, dopamine infusion--even in low doses but more probably in higher doses--emerged as an independent risk factor for delirium in patients undergoing CABG. Further study is needed to confirm the validity of results presented.


Subject(s)
Coronary Artery Bypass/adverse effects , Delirium/drug therapy , Dopamine/administration & dosage , Postoperative Complications , Aged , Delirium/diagnosis , Delirium/etiology , Female , Humans , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/drug therapy , Risk Factors
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