Prognostic value of CHA2DS2-VASc score for the long-term cardiovascular events after coronary artery bypass grafting.

Background: This study aims to investigate the value of the CHA2DS2-VASc score in predicting long-term major cardiovascular events following coronary artery bypass grafting. Methods: Between January 2008 and January 2010, a total of 559 patients (445 males, 114 females; mean age: 62.7±9.1 years; range, 35 to 84 years) who underwent elective coronary artery bypass grafting were retrospectively analyzed. At a mean of 10.7±3.1-year follow-up, major cardiovascular events were considered as the primary endpoint. Results: The multivariate Cox hazard analysis identified the CHA2DS2-VASc score as an independent predictor of major cardiovascular events (hazard ratio: 1.615; 95% confidence interval: 1.038-2.511; p=0.034). The receiver operating characteristic curve analyses revealed that 3.5 was the most optimal cut-off value of the score predicting major cardiovascular events and the patients were divided into two groups accordingly. The Kaplan-Meier analysis demonstrated a significantly higher incidence of major cardiovascular events in proportion to a higher CHA2DS2-VASc score (p<0.001). Conclusion: CHA2DS2-VASc score ≥4, which includes many risk factors for cardiovascular events, can be used as an independent predictor of long-term major cardiovascular events after coronary artery bypass grafting.

The effect of off-pump coronary bypass graft surgery on subfoveal choroidal thickness, ganglion cell complex, and retinal nerve fiber layer thickness.

Background: Cardiac surgery has been associated with adverse ocular events. Off-pump coronary artery bypass graft surgery evades the systemic inflammatory response seen in extracorporeal circulation and is superior to on-pump surgery with regard to end-organ dysfunction and neurological outcomes. Objectives: To determine the effects of off-pump (without extracorporeal circulation) coronary artery bypass graft surgery on choroidal thickness, ganglion cell complex, and the retinal nerve fiber layer. Design: Prospective, longitudinal study. Methods: Patients who underwent off-pump surgery were examined preoperatively and postoperatively at 1 week and 6 weeks after surgery. Choroidal thickness, ganglion cell complex, and the retinal nerve fiber layer measurements were recorded, and the effects of off-pump coronary artery bypass on these parameters were assessed. Results: A total of 44 eyes of 44 patients were included in the study. There was a statistically significant increase in subfoveal choroidal thickness from 252.84 ± 56.24 µm preoperatively to 273.82 ± 39.76 µm at 1 week and 301.97 ± 44.83 µm at 6 weeks after off-pump coronary artery bypass graft surgery (p = 0.044; p ⩽ 0.001). Ganglion cell complex and retinal nerve fiber measurements showed no significant difference compared to preoperative values. Conclusion: Off-pump coronary artery bypass graft surgery showed no negative effects on ganglion cell complex and retinal nerve fiber measurements. A significant increase in subfoveal choroidal thickness was seen after off-pump surgery, which might be advantageous in patients who are at high risk or have preexisting ocular diseases that are affected by the choroid.

Predictive Value of Neutrophil-Lymphocyte Ratio for Long-Term Cardiovascular Event Following Coronary Artery Bypass Grafting.

OBJECTIVE: To investigate the predictive value of preoperative neutrophil-lymphocyte ratio (NLR) for long-term major adverse cardiac and cerebrovascular events (MACCE), which have not yet been well described, in patients undergoing coronary artery bypass grafting (CABG). METHODS: The records of 751 consecutive patients who underwent elective CABG between January 2008 and January 2010 were retrospectively enrolled and stratified according to quartiles of preoperative NLR. At 7.8-year follow-up, MACCE was considered as an endpoint. RESULTS: Overall MACCE was 11.6% of all cases. Long-term myocardial infarction, percutaneous coronary intervention, stroke and cardiovascular mortality were found associated with the upper NLR quartile (P<0.001, P<0.001, P=0.005, P<0.001, respectively). In multivariate analysis, NLR on admission remained an independent predictor of long-term MACCE (OR 1.087, 95% CI 1.026-1.151; P=0.004), in all EuroSCORE risk groups (P<0.001; P<0.001; P=0.029). The receiver operating characteristic (ROC) curve analyses revealed an NLR cut-off value of 4.32 predicting MACCE. CONCLUSION: NLR is a useful and readily available predictive marker of long-term MACCE following CABG, independent of the EuroSCORE.

Predictive value of neutrophil-lymphocyte ratio for long-term cardiovascular event following coronary artery bypass grafting

Abstract Objective: To investigate the predictive value of preoperative neutrophil-lymphocyte ratio (NLR) for long-term major adverse cardiac and cerebrovascular events (MACCE), which have not yet been well described, in patients undergoing coronary artery bypass grafting (CABG). Methods: The records of 751 consecutive patients who underwent elective CABG between January 2008 and January 2010 were retrospectively enrolled and stratified according to quartiles of preoperative NLR. At 7.8-year follow-up, MACCE was considered as an endpoint. Results: Overall MACCE was 11.6% of all cases. Long-term myocardial infarction, percutaneous coronary intervention, stroke and cardiovascular mortality were found associated with the upper NLR quartile (P<0.001, P<0.001, P=0.005, P<0.001, respectively). In multivariate analysis, NLR on admission remained an independent predictor of long-term MACCE (OR 1.087, 95% CI 1.026-1.151; P=0.004), in all EuroSCORE risk groups (P<0.001; P<0.001; P=0.029). The receiver operating characteristic (ROC) curve analyses revealed an NLR cut-off value of 4.32 predicting MACCE. Conclusion: NLR is a useful and readily available predictive marker of long-term MACCE following CABG, independent of the EuroSCORE.

A comparison of off- and on-pump beating-heart coronary artery bypass surgery on long-term cardiovascular events.

OBJECTIVE: Our aim was to compare short-term outcomes and long-term major adverse cardiovascular event (MACE) -free survival and independent predictors of long-term MACE after off-pump (OPCAB) versus on-pump beating-heart (ONBHCAB) coronary artery bypass grafting (CABG). METHODS: We retrospectively reviewed data of all consecutive patients who underwent elective CABG, performed by the same surgeon, from January 2003 to October 2009. A propensity score analysis was carried out to adjust for baseline characteristics and a total of 398 patients were included: ONBHCAB (n = 181), OPCAB (n = 217). RESULTS: OPCAB was associated with significantly shorter ventilation times (p < 0.001), intensive care unit stay (p < 0.001) and hospital stay (p < 0.001). The total blood loss was significantly more in the ONBHCAB group (p < 0.001), and accordingly, the number of transfused blood units was significantly lower in the OPCAB group (p < 0.001). Incidence of peri-operative renal complications were significantly higher in the ONBHCAB group (p = 0.004). The OPCAB group showed significantly lower long-term MACE-free survival (p = 0.029). The mean number of transfused blood units was the only independent predictor of MACE (HR: 1.218, 95% CI: 1.089-1.361; p = 0.001). CONCLUSION: OPCAB provided better long-term MACE-free survival compared with ONBHCAB. Fewer units of blood transfused following OPCAB surgery may have been the main reason for this result.

Red blood cell distribution width predicts long term cardiovascular event after on-pump beating coronary artery bypass grafting.

BACKGROUND: Reports investigating the predictive value of red cell distribution width (RDW) on major cardiac and cardiovascular event (MACCE) following coronary artery bypass grafting (CABG) have major limitations, including lack of elimination of common factors affecting RDW levels, such as anemia. The purpose of this study is to identify the real effect of higher RDW level, free from the other factors, on MACCE following CABG. METHODS: Data of 500 consecutive, non-anemic patients (77.2 % male and mean age 63.05 ± 9.24) undergoing ONBHCAB between January 2007 and January 2010, were analyzed retrospectively. RESULTS: Overall MACCE was 7.8 % of all cases. Mean follow-up was 66.5 ± 9.96 months. In multivariate Cox regression analysis, RDW (P = 0.022) remained the only independent predictor of MACCE and the ROC analyze revealed an RDW cut-off value of 13.95 % predicting MACCE. Therefore, patients were grouped on this cut-off value. There were 238 patients in the lower RDW group (Group 1) and 262 patients in the higher RDW group (Group 2). Kaplan-Meier survival analysis of freedom from MACCE revealed significantly lower event free survival in Group 2 (P < 0.001 by the log-rank test). Group 2 showed a higher MACCE incidence in 1 year (P = 0.030), in 3 years (P < 0.001) and in 6 years (P < 0.001). The long-term follow-up was similar regarding noncardiovascular mortality. CONCLUSION: An RDW level greater than 13.95 % in hospital admission is independently associated with an increased incidence of MACCE after CABG. Physicians should be more aggressive in the management of these patients.

Intramyocardial Dissection following Postinfarction Ventricular Wall Rupture Contained by Surrounding Postoperative Adhesions.

Introduction. Dissection of the myocardium is a rare form of cardiac rupture, caused by a hemorrhagic dissection among the spiral myocardial fibers, its diagnosis is rarely established before the operation or death, and extremely few cases have been reported in the literature and none of these cases seem to have a history of previous cardiac surgery which makes our report unique. Case Presentation. A 61-year-old female patient was admitted into the emergency room with complaints of progressive chest pain for 2 days. She had a history of second time prosthetic aortic valve replacement and was under anticoagulation therapy. She was diagnosed with an acute inferoposterior myocardial infarction and underwent emergency coronary angiography revealing spontaneous recanalization of the right coronary artery. During the follow-up, she developed cardiogenic shock and a new occurring systolic ejection murmur. Transthoracic echocardiography showed a left ventricular free wall rupture; then, she was taken in for emergency surgery. During the operation, a rupture zone and a wide intramyocardial dissecting area were detected. Intraventricular patch repair technic with autologous pericardial patch was used to exclude the ruptured area. Following the warming period, despite adequate hemostasis, hemorrhage around suture lines progressively increased, leading to the patient's death. Conclusion. Pericardial adhesions might contain left ventricular rupture leading to intramyocardial dissection.

Case report: paravalvular leak as a complication of percutaneous catheter ablation for atrial fibrillation.

An increasing number of reports reveal the safety and efficacy of catheter ablation for atrial fibrillation therapy even in patients with a history of prosthetic heart valve. This case report presents a 60 year old female patient who had a prosthetic mitral paravalvular leak as a complication of radiofrequency ablation. Surgery revealed a 15 mm hole and three broken knots in the posterolateral mitral annulus. This report demonstrates radiofrequency ablation for atrial fibrillation in patients with prosthetic mitral valve may cause a paravalvular leak likely as a result of thermal injury. Moreover, patient can be asymptomatic at first. The clinician should keep in mind such complication and the patient should be evaluated in terms of paravalvular leakage.

Femoral Nerve Palsy due to Anticoagulant Induced Retroperitoneal Hematoma.

A forty-one-year-old man who, sought evaluation for a sudden hip flexion contracture and groin pain with a history of mechanical mitral valve replacement, had been misdiagnosed and treated as having lumbar discopathy for two days. This patient finally was diagnosed with compressive femoral neuropathy due to warfarin-induced retroperitoneal hematoma and successfully managed nonoperatively. This case is reported in order to draw attention to this rare presentation.

A comparison of off-pump and on-pump coronary bypass surgery in patients with low EuroSCORE.

BACKGROUND: The aim of the present study was to evaluate and compare postoperative short-term, mid-term and long-term outcomes of coronary artery bypass surgery performed with or without cardiopulmonary bypass in patients with a low European System for Cardiac Operative Risk Evaluation score. METHODS: A retrospective analysis of 478 consecutive low risk patients undergoing coronary bypass surgery between January 2002 and December 2007 was performed. Of these patients, 83 cases had undergone on-pump and 395 cases had undergone off-pump coronary bypass surgery. The patients were assessed in terms peri-operative complications, survival, mortality due to cardiac events, need for rehospitalization and repeated coronary revascularization. RESULTS: There was no significant difference between the two groups in terms of preoperative characteristics, except for chronic obstructive pulmonary disease. The number of distal anastomosis per patient was significantly lower in the off-pump group than in the on-pump group (2.66 ± 0.74 vs. 3.21 ± 0.85, p < 0.001). Early mortality rates were similar in both groups (1.01% for the off-pump group and 1.2% for the on-pump group, p = 0.687). Neurological complications were significantly lower in the off-pump group than in the on-pump group (1.1% vs. 6%, p = 0.01). The mean follow-up period was 80 ± 19.1 months (range, 3-112 months). The need for revascularization during long-term follow-up was 10.1% in the off-pump group and 7.2% in the on-pump group (p = 0.416). The 5-year survival was 95.2 ± 1.1% and 95.5 ± 2.7% in the off-pump and on-pump groups, respectively (p = 0.8), whereas the 7-year survival was 91.9 ± 1.6% and 84.7 ± 6.8% in the off-pump and on-pump groups, respectively (p = 0.274). The 5-year revascularization-free period was 89.5 ± 1.6% and 89.7 ± 3.5% in the off-pump and on-pump groups, respectively (p = 0.785). The 7-year revascularization-free period was 71.1 ± 3.1% and 73.5 ± 7.3% in the off-pump and on-pump groups, respectively (p = 0.075). The 7-year event-free survival was 80.1 ± 2.2% and 73.4 ± 7.3% in the off-pump and on-pump groups, respectively (p = 0.377). CONCLUSIONS: The present study demonstrated that off-pump cardiac surgery had advantages over on-pump cardiac surgery in the short term; however, both interventions had similar mid-term and long-term outcomes, when performed in low-risk patient.

Vascular complications of intra-aortic balloon pump usage in coronary bypass surgery: 18 years of experience.

OBJECTIVE: To evaluate the vascular complication incidence related to intra-aortic balloon pump usage during coronary bypass surgery and possible risk factors. METHODS: The retrospective study was conducted at Uludog University Hospital, Turkey, and comprised 147 cases in which intra-aortic balloon pump was used during coronary artery bypass surgery between January 1994 and December 2011. Data was examined in terms of age, gender, diabetes mellitus, hypertension, smoking, peripheral vascular disease, pre-operative serum creatinine, history of congestive heart failure, left ventricular ejection fraction, previous infarction and cardiac functional capacity. Time, indication, treatment duration, technique of insertion and complications were recorded about the balloon insertion. Patients in whom peripheral vascular complication developed were evaluated with pulse examination, Doppler ultrasound and angiography. Logistic regression analyses were carried out with the purpose of determining the relation between pre-operative clinical variables and vascular complications and mortality. RESULTS: Of the total, 105 (71%) were males and 42 (28%) were females. The overall mean age was 62.4 +/- 10.1 years. Besides, 16 (41%) cases had diabetes mellitus and 30 (20%) had peripheral artery disease. The mean Euroscore was 7.6 +/- 4.8. Intra-aortic balloon pump was inserted in 16 (10.8%) due to pre-operative high risk and in 75 (51%) cases due to hypotension being non-responsive to inotropes. Balloon catheter was placed with percutaneous technique in 141 (96%) cases and sheath wasn't used in 44 (29%). The balloon stayed for 2.9 +/- 2.1 days on average. Balloon rupture developed in 1 (0.6%) case. Mortality resulted in 58 (39%) cases. Euroscore (p=0.012), staying in hospital (p=0.005), low ejection fraction (p=0.018), hypertension existence (p=0.003) in multivariate logistic regression analyses were found significant in terms of affecting mortality. Duration of therapy (p<0.001), existence of sheath (p=0.002), and existence of peripheral vascular disease (p<0.001) were found significant as factors affecting the development of vascular complication. CONCLUSION: Intra-aortic balloon pump provides mechanical circulation assistance during coronary artery surgery, but peripheral vascular system should be well evaluated in order to avoid vascular complications and the balloon catheter should be placed without the sheath if necessary. The duration of the therapy is a risk factor for the development of vascular complication.

[Therapeutic approach in hemodynamically stable transmediastinal gunshot wounds]. / Hemodinamisi stabil transmediastinal atesli silah yaralanmalarinda tedavi yaklasimi.

Transmediastinal gunshot wounds may result in damage to the heart, large blood vessels, esophagus or lung. In hemodynamically stable patients, diagnostic examinations have critical importance and the preferred therapies still have unresolved points. In this paper, we present our experience with five patients, three of whom were operated for transmediastinal gunshot wounds after diagnostic tests; all were hemodynamically stable. Before deciding on operation, diagnostic tests should be performed in hemodynamically stable patients with transmediastinal gunshot wounds.

[Coronary-to-pulmonary artery fistulas: a report of three cases]. / Koroner arter ile pulmoner arter arasinda fistül: uç olgu sunumu.

Congenital coronary-to-pulmonary artery fistulas are rare anomalies and they generally have an asymptomatic course. We presented three symptomatic patients (2 men, 1 woman; age range 46 to 53 years) who underwent surgical repair via the epicardial approach for coronary-to-pulmonary artery fistulas. Treatment was successful in two patients. Reoperation in extracorporeal circulation was required in one patient having a plexus-like fistula. The distal orifice of the fistula was closed under direct vision from within the pulmonary artery. No complications or symptoms were seen during the follow-up of patients ranging from six months to four years. During repair of coronary-to-pulmonary artery fistulas, the presence of a plexus-like variant must be kept in mind and the treatment should be planned accordingly.

[Endovascular approach in the treatment of traumatic peripheral arterial lesions: report of two cases]. / Travmatik periferik arter lezyonlarinin tedavisinde endovasküler yaklasim: iki olgu sunumu.

Arterial injuries associated with pseudoaneurysms or arteriovenous fistulas are usually due to penetrating trauma. Endovascular treatment modalities are emerging as an alternative and less invasive method compared to the conventional surgical repair methods. Herein we report our recent experience on with two cases of traumatic arterial injury who were successfully managed by using stent-grafts with endovascular approach. Endovascular treatment options should be remembered as an alternative to the surgical repair for management of penetrating arterial injuries.