Acute kidney injury after surgical treatment of failed endovascular aneurysm repair.

Background: This study aims to report the incidence of acute kidney injury following surgical reconstruction after a failed endovascular aneurysm repair (EVAR) in patients with abdominal aortic aneurysms. Methods: This retrospective study included 44 patients (39 males, 5 females; mean age: 70±11.3 years; range, 35 to 84 years) who underwent emergency or elective surgical reconstruction after failed EVAR between February 2015 and January 2019. Patients were divided into two groups: acute kidney injury group and no acute kidney injury group. The primary end-point of the study was to evaluate the development of acute kidney injury following surgery. The secondary end-points included the 30-day and one-year mortality rates. Results: Surgical reconstruction of the abdominal aorta was performed electively in 29 (65.9%) patients and urgently in 15 (34.1%) patients. Acute kidney injury occurred in 12 (27.3%) patients. The interval from endovascular aneurysm repair to surgical reconstruction was statistically significantly higher in the no acute kidney injury group than in the acute kidney injury group (24.6±11.5 and 18.1±13.3 months, respectively; p=0.145). The mean abdominal aortic aneurysm diameter, neck angulation, and neck diameter were statistically significantly higher in the acute kidney injury group than in the no acute kidney injury group (p=0.001, p=0.009, and p<0.001, respectively). No statistically significant difference was observed between the acute kidney injury and no acute kidney injury groups for the overall 30-day mortality (p=0.185) and oneyear mortality (p=0.999). Conclusion: Acute kidney injury is not uncommon after the surgical reconstruction of a failed EVAR. Aneurysm-related anatomical factors may have an impact on the development of postoperative acute kidney injury. Comprehensive surgical planning should be performed for open abdominal aortic surgery after a failed EVAR.

Minimally invasive versus conventional mitral valve surgery: A propensity score matching analysis.

Background: This study aimed to compare the outcomes of minimally invasive mitral valve surgery and conventional surgery in terms of mortality and postoperative complications. Methods: A retrospective analysis was conducted on consecutive minimally invasive and conventional mitral valve surgeries performed between January 2019 and December 2022. Patients undergoing concomitant procedures were excluded from the study, and 293 patients (149 females, 144 males; mean age: 53.8±12.9 years; range, 18 to 82 years) were included in the study. Of these patients, 96 underwent minimally invasive surgery (MI group), and 197 underwent mitral valve surgery via conventional sternotomy (CS group). Propensity score matching was utilized to minimize the biases and confounding factors. After propensity score matching, 55 patients were included in each group. Results: There was no statistically significant difference in terms of mortality between the propensity score-matched groups (p=0.315), and no statistically significant difference in postoperative complications was observed between the groups. However, it was found that postoperative new-onset atrial fibrillation was lower in the minimally invasive group (p=0.022). Conclusion: This study demonstrates that minimally invasive mitral valve surgery is a safe alternative with similar mortality and postoperative complication rates compared to conventional surgery. Additionally, the study suggests an association between minimally invasive surgery and postoperative new onset atrial fibrillation.

Obesity Does Not Affect Major Outcomes in Robotic Coronary Surgery.

BACKGROUND: Robotic-assisted coronary surgery is gaining attraction as an alternative to traditional open-heart procedures, offering potential benefits such as decreased mortality rates, shorter hospital stays, and reduced complications. This study aimed to investigate the outcomes of robotic-assisted coronary surgery, focusing particularly on the impact of obesity. METHODS: A total of 210 consecutive patients underwent robotic-assisted coronary surgery over an eight-year period at a single institution. Patients were categorized based on body mass index (BMI), distinguishing between obese (BMI ≥30 kg/m2) and non-obese (BMI <30 kg/m2) groups. The analysis encompassed preoperative characteristics, operative factors, and postoperative outcomes. RESULTS: Comparisons between obese and non-obese patients revealed similar preoperative comorbidities. However, the operation time was prolonged in the obese group (p = 0.03). Major cardiac and cerebrovascular events, along with overall complications, displayed no significant disparities between the groups. Notably, superficial wound infections were more prevalent among obese patients (p = 0.03). Importantly, intensive care unit and hospital stay times were comparable between the two groups. CONCLUSION: Robotic-assisted coronary surgery demonstrates its potential as a viable alternative to conventional open-heart procedures, offering benefits such as reduced mortality rates, shorter hospital stays, and minimized perioperative complications. This study's findings underscore the feasibility and safety of this approach, with outcomes comparable between obese and non-obese patients.

Central vs. Peripheral Cannulation During Reoperations: A Propensity Score Matching Analysis.

INTRODUCTION: The aim of this study is to compare the postoperative outcomes and early mortality of peripheral and central cannulation techniques in cardiac reoperations using propensity score matching analysis. METHODS: In this retrospective cohort, patients who underwent cardiac reoperations with median resternotomy were analyzed in terms of propensity score matching. Between November 2010 and September 2020, 257 patients underwent cardiac reoperations via central (Group 1) or peripheral (Group 2) cannulation. A 1:1 propensity score matching was performed to balance the influence of potential confounding factors to compare postoperative data and mortality rate. RESULTS: There were no significant differences when comparing the matched groups regarding early mortality (P=0.51), major cardiac injury (P=0.99), prolonged ventilation (P=0.16), and postoperative stroke (P=0.99). The development of acute renal failure (P=0.02) was statistically less frequent in Group 1. CONCLUSIONS: Performing cardiopulmonary bypass via peripheral cannulation increases acute renal failure in cardiac reoperations. In contrast, peripheral or central cannulation have similar early mortality rate in cardiac reoperations.

Fate of the Patent False Lumen of the Descending Aorta After Surgical Treatment for Acute Type 1 Aortic Dissection.

INTRODUCTION: This study aimed to investigate the factors affecting false lumen patency in the descending thoracic aorta among patients who underwent surgery for acute type 1 aortic dissection. METHODS: A total of 112 patients with acute type 1 aortic dissection, with the flap below the diaphragm level, underwent surgery between January 2010 and September 2019. Of these, 60 patients who were followed up for ≥ 12 months and whose computed tomography scans were available were included in this study. The patients were divided into two groups: group I, consists of patent false lumen (n=36), and group II, consists of thrombosed false lumen (n=24). Demographic data, operative techniques, postoperative descending aortic diameters, reintervention, and late mortality were compared between the two groups. RESULTS: The mean follow-up period of all patients was 37.6±26.1 months (range: 12-104). The diameter increase in the proximal and distal descending aorta was significantly higher in the patent false lumen group (5.3±3.7 mm vs. 3.25±2.34 mm; P=0.015; 3.1±2.52 mm vs. 1.9±1.55 mm; P=0.038, respectively). No significant difference in terms of hypertension was found between the two groups during the follow-up period (21 patients, 58.3% vs. 8 patients, 33.3%; P=0.058). A total of 29 patients (48.3%) were found to be hypertensive in the postoperative period. CONCLUSION: After surgical treatment for acute type 1 aortic dissection, patients should be monitored closely, regardless of whether the false lumen is patent or thrombosed. Mortality and reintervention can be seen in patients with patent false lumen during follow-up.

Impact of Bileaflet Mechanical Mitral Valve Orientation on Pannus Overgrowth.

OBJECTIVE: Pannus overgrowth is a chronic inflammatory process that can cause valve dysfunction and threaten the durability of prosthetic valves. Bileaflet mechanical mitral valve can be implanted in either an anatomical (parallel to the anatomical axis) or nonanatomical (perpendicular or oblique to the anatomical axis) orientation. The effect of the rotational orientation of the bileaflet mechanical mitral valve on excessive pannus enlargement is unknown. The present study compared the effect of bileaflet mechanical mitral valve orientation on pannus overgrowth. METHODS: The study included patients who underwent bileaflet mechanical mitral valve replacement for rheumatic mitral valve stenosis. The pannus formation was confirmed by reexamining all transesophageal echocardiography images in the picture archiving and communication systems between May 2017 and April 2021. The primary aim of this study was the development of pannus overgrowth. Patients were divided into 2 groups based on their implantation orientation of the bileaflet mechanical mitral valve. RESULTS: Pannus overgrowth was found in 26 patients (56.5%) in the anatomical orientation group and 71 patients (74.7%) in the nonanatomical orientation group (P = 0.03). Anatomical orientation reduced the development of pannus overgrowth (odds ratio [OR] = 0.39, P = 0.04), and double left heart valve replacement increased the development of pannus overgrowth (OR = 2.73, P = 0.04). CONCLUSIONS: Pannus overgrowth was less common in bileaflet mechanical mitral valves implanted in the anatomical orientation.

Impact of Indexed Effective Orifice Area on the Quality of Life of Patients after Aortic Valve Replacement.

BACKGROUND: Improving health related quality of life is an important goal of aortic valve replacement. Inadequate effective orifice area of prosthesis according to the patient's body surface area may be associated with poor outcomes. In this study, we aimed to analyze impact of indexed effective orifice area (iEOA) on patients' quality of life after aortic valve replacement. METHODS: A total of 138 patients who underwent isolated aortic valve replacement were included to the study. Quality of life assessment was performed with EuroQol Group EQ-5D-5L questionnaire. Patients were divided into three groups based on iEOA (Group 1 had an iEOA of <0.65 cm2/m2 (19 patients), Group 2 had an iEOA between 0.65-0.85 cm2/m2 (71 patients), and Group 3 had an iEOA of >0.85 cm2/m2). Mean EQ-5D-5L scores were compared among the groups statistically. RESULTS: Mean EQ-5D-5L scores were lower in Group 1 than in Groups 2 and 3 (Group 1: 0.72 ± 0.18, Group 2: 0.83 ± 0.20, and Group 3: 0.86 ± 0.9, p = 0.044 and p = 0.014). The EQ-5D-5L score was significantly lower in patients with a ≥20 mmHg transvalvular gradient than those with a <20 mmHg (0.74 ± 0.25 vs. 0.84 ± 0.18, p = 0.014). CONCLUSIONS: Our results show that an iEOA <0.65 cm2/m2 is significantly associated with impaired postoperative health-related quality of life. Newer generation prostheses, transcatheter valve implantation, and root enlargement techniques should be kept in mind in preoperative planning.

Predictors and outcomes of conversion to sternotomy in minimally invasive coronary artery bypass grafting.

Background: This study aims to investigate the risk factors and surgical outcomes of conversion to median sternotomy in minimally invasive direct coronary artery bypass grafting. Methods: Between January 2017 and July 2022, a total of 274 patients (246 males, 28 females; mean age: 57.0±9.6 years; range, 33 to 81 years) who underwent conventional (n=116) or robot-assisted (n=158) minimally invasive direct coronary artery bypass grafting were retrospectively analyzed. The primary outcome measure of the study was conversion to median sternotomy, and the secondary outcome measures were operative mortality, length of intensive care unit and hospital stay. Results: Conversion to median sternotomy was required in 26 (9.5%) patients. The most common cause of conversion was intramyocardial left anterior descending artery (27.0%). Among preoperative and operative characteristics, only age was statistically significant risk factor for conversion to sternotomy (odds ratio=1.06, p=0.01). Operative mortality occurred in one patient (0.36%) patient in the entire cohort. The length of intensive care unit and hospital stay was significantly longer in patients requiring conversion to median sternotomy (p=0.002 and p<0.001, respectively). There was no significant difference in other postoperative outcomes between the two groups (p>0.05). Conclusion: Intramyocardial left anterior descending artery is the most common reason for conversion to sternotomy, and older age increases the risk of conversion. Minimally invasive coronary artery bypass grafting can be performed with satisfactory results, even if it requires conversion to sternotomy.

Predictive value of age, creatinine, and ejection fraction (ACEF) scoring system for operative mortality in patients with Stanford type A aortic dissection.

Purpose: Stanford type A aortic dissection (TAAD) is the most common and fatal type of dissection. An easier-to-use risk stratification may help eliminate bias in patients at high risk of dissection. The age, serum creatinine, and ejection fraction (ACEF) score is a simple risk model developed to predict the mortality risk of elective coronary artery bypass graft surgery. This study aimed to evaluate the relationship between preoperative ACEF score and operative mortality in patients with TAAD undergoing emergency surgery. Methods: In this retrospective cohort study, 113 patients diagnosed with TAAD between January 2017 and September 2021 were evaluated. The primary endpoint was operative mortality. Receiver operating characteristic analysis was performed for the ACEF score, ACEF II score, and European System for Cardiac Operative Risk Evaluation II. Univariate and multivariate analyses of operative mortality were performed using the logistic regression model. Results: Operative mortality occurred in 23 (20.4%) patients. The cutoff ACEF score was calculated as 1.1 for predicting operative mortality (area under the curve = 0.712, P value = 0.002, sensitivity = 74.0%, specificity = 67.8%, likelihood ratio = 2.3). Based on the cutoff value, 46 (40.7%) patients had a high ACEF score (ACEF ≥ 1.1) and 67 (59.3%) patients had a low ACEF score (ACEF < 1.1). The high ACEF score was associated with an increased incidence of operative mortality compared with the low ACEF score (37.0% vs. 9.0%; P = 0.001). Conclusions: The ACEF score can be used as a useful and relatively simple tool for risk stratification before TAAD surgery. However, the ACEF score is only indicated for risk assessment and should not affect treatment.

Custodiol versus Blood Cardioplegia: Comparison of Myocardial Immunohistochemical Analysis and Clinical Outcomes

ABSTRACT Introduction: Custodiol (histidine-tryptophan-ketoglutarate) and repetitive blood cardioplegia are the solutions for myocardial protection and cardiac arrest. In this study, we aimed to compare immunohistochemical analysis, clinical outcomes, and cardiac enzyme values of Custodiol and blood cardioplegia groups. Methods: This was a randomized prospective study consisting of 2 groups and 20 patients, 10 patients for each group, who underwent mitral and mitral/tricuspid valve surgery. Group 1 was formed for Custodiol cardioplegia and group 2 for blood cardioplegia. Perioperative and postoperative cardiac events were recorded, cardiac enzymes were analyzed with intervals, and myocardial samples were taken for immunohistochemical analysis. Recorded data were statistically evaluated. Results: There was no significant difference for the Custodiol and blood cardioplegia groups in perioperative and postoperative cardiac performance and adverse events. Cardiac enzyme analysis showed no significant difference between groups. However, two parameters (eNOS, Bcl-2) were in favor of the Custodiol group in immunohistochemical studies. Custodiol performed better in cellular oxidative stress resistance and cellular viability. Conclusion: Clinical outcomes and cardiac enzyme analysis results were similar regarding myocardial protection. However, Custodiol performed better in the immunohistochemical analysis.

Incidentally detected aortitis during coronary bypass surgery: A case report.

Aortitis is the inflammation of the aortic wall. In our case, in which we planned elective coronary bypass surgery, a firm and dilated ascending aorta with a pearlescent color was encountered intraoperatively. Histopathological examination revealed extensive lymphoplasmacytic infiltration and storiform fibrosis. Aortitis may be a component of a multisystemic or autoimmune disease. The time of diagnosis may coincide with the asymptomatic period of the systemic disease. This case was presented as it was incidentally detected during coronary bypass surgery and was histopathologically diagnosed as immunoglobulin G4-related aortitis, although it could not be diagnosed in clinical and laboratory evaluations.

Custodiol versus Blood Cardioplegia: Comparison of Myocardial Immunohistochemical Analysis and Clinical Outcomes.

INTRODUCTION: Custodiol (histidine-tryptophan-ketoglutarate) and repetitive blood cardioplegia are the solutions for myocardial protection and cardiac arrest. In this study, we aimed to compare immunohistochemical analysis, clinical outcomes, and cardiac enzyme values of Custodiol and blood cardioplegia groups. METHODS: This was a randomized prospective study consisting of 2 groups and 20 patients, 10 patients for each group, who underwent mitral and mitral/tricuspid valve surgery. Group 1 was formed for Custodiol cardioplegia and group 2 for blood cardioplegia. Perioperative and postoperative cardiac events were recorded, cardiac enzymes were analyzed with intervals, and myocardial samples were taken for immunohistochemical analysis. Recorded data were statistically evaluated. RESULTS: There was no significant difference for the Custodiol and blood cardioplegia groups in perioperative and postoperative cardiac performance and adverse events. Cardiac enzyme analysis showed no significant difference between groups. However, two parameters (eNOS, Bcl-2) were in favor of the Custodiol group in immunohistochemical studies. Custodiol performed better in cellular oxidative stress resistance and cellular viability. CONCLUSION: Clinical outcomes and cardiac enzyme analysis results were similar regarding myocardial protection. However, Custodiol performed better in the immunohistochemical analysis.

Reduction plasty for giant left atrium causing dysphagia: a case report.

The giant left atrium is described as an atrium with a diameter of 6.5 cm or larger and which can rarely cause dysphagia by compressing on the esophagus. Left atrial enlargement is usually seen due to mitral valve disease. The most common indication of left atrial volume reduction plasty during mitral valve surgery is the compression symptoms. We performed mitral valve replacement in our case and transformed the giant left atrium into an anatomical chamber with the technique we applied. In this way, we successfully eliminated cardiac and compression symptoms. Cardiac causes of dysphagia are rarely seen, usually, cardiac complaints are more prominent than dysphagia. However, it should be kept in mind in the differential diagnosis. We think that cardiac mortality and morbidity may be prevented with early diagnosis and treatment.

A comparison of robotically-assisted endoscopic versus sternotomy approach for myxoma excision: A single-center experience.

BACKGROUND: In this study, we present our single-center experience in robotically-assisted endoscopic surgery versus conventional median sternotomy approach in patients undergoing cardiac myxoma excision. METHODS: Between January 2011 and September 2019, a total of 46 patients (24 males, 22 females; mean age 54.1±12.5 years; range, 25 to 79 years) who had a confirmed diagnosis of isolated cardiac myxoma were included in the study. The patients were divided into two groups as those undergoing robotic-assisted surgery (n=16) and those undergoing conventional median sternotomy (n=30). Clinical characteristics, operative, and postoperative outcomes were compared. Robotic approach to right or left-sided tumors and postoperative pain scores were also analyzed. RESULTS: There was no mortality or major complication. No conversion to sternotomy was needed in robotic procedures. The mean cardiopulmonary bypass and aortic cross-clamp times were significantly shorter in the median sternotomy group (p=0.001 for both). The mean ventilation time and the length of hospital stay were significantly shorter in robotic surgery than sternotomy group (p=0.043 and p=0.048, respectively). The mean amount of postoperative blood loss and transfusion rate were significantly lower in robotic surgery patients (p=0.001 and p=0.022, respectively). The mean postoperative pain scores were significantly lower in patients undergoing robotic surgery (p=0.022). CONCLUSION: Robotic-assisted endoscopic surgery can be performed safely and effectively for cardiac myxoma excision with shorter hospital stay, less pain, and less amount of blood product use, as well as more favorable cosmetic results compared to conventional median sternotomy.

Impact of additional annuloplasty on tricuspid valve and cardiac functions after atrial septal defect closure in adults.

BACKGROUND: Surgical indications for moderate to severe tricuspid regurgitation (TR) during atrial septal defect (ASD) closure are still unclear. Additional tricuspid valve annuloplasty (TVP) can be beneficial to avoid postoperative persistent TR. Therefore, we compared the results of surgical ASD closure with or without additional TVP in patients who presented with moderate-to-severe TR. METHODS: Between November 2009 and June 2016, 103 patients with ASD and moderate-to-severe TR underwent surgical ASD closure without (n = 76, group 1) and with additional TVP (n = 27, group 2). Clinical outcomes and echocardiographic data were analyzed. RESULTS: There was no mortality. Postoperative outcomes were similar despite significantly longer aortic clamping time in group 2 (P = .003). Mean TR grade, right atrial diameter, right ventricular end-diastolic diameter, pulmonary artery pressure, and Qp/Qs ratio decreased significantly in both groups (P < .05). Mean follow-up time was 5.3 months (range: 1 month-6.2 years) in group 1 and 6.1 months (range: 1 month-4.1 years) in group 2 (P = .66). Echocardiography results showed significant decrease in TR grade in both groups (P = .93). The incidence of persistent moderate to severe TR was higher in isolated ASD closure group (14.4% vs 3.7%, P = .086). Additional TVP provided greater regression in TR grade (-1.49 ± 0.9 vs -1.89 ± 0.8, P = .041). CONCLUSION: Despite TVP being associated with longer ischemic time, postoperative outcomes were comparable to ASD closure alone. Both approach demonstrated an effective decrease in TR, but TVP provided greater regression and lower incidence of persistent TR. Therefore, additional TVP should be considered in patients undergoing ASD closure with moderate-to-severe TR.

Effect of Pulsatile Cardiopulmonary Bypass in Adult Heart Surgery.

BACKGROUND: This study aimed to examine the effect of pulsatile flow pattern on tissue perfusion, particularly cerebral tissue perfusion, at pre-determined intervals during CPB, as well as its effects on postoperative morbidity and mortality. METHODS: This retrospective study included 134 adult patients, who underwent cardiac surgery with cardiopulmonary bypass (CPB). Patients were grouped based on the flow pattern used during CPB: non-pulsatile CPB group (N = 82) and pulsatile CPB group (N = 52). Cerebral oxygen saturation, arterial pH and arterial lactate levels were measured at four time points, during the operation and the 2 groups were compared with regard to changes over time as well as differences in postoperative outcomes. RESULTS: The 2 groups were similar, in terms of mean values and intraoperative changes in cerebral oxygen saturation and arterial pH. Non-pulsatile CABG group had significantly higher arterial lactate levels over the measurement period, which was not affected by the timing of the measurements. Postoperative drainage, duration of ventilation and duration of hospital stay significantly were higher and postoperative blood urea nitrogen significantly was lower in the non-pulsatile CPB group. Other postoperative outcomes were similar across the groups. CONCLUSION: Findings of this study do not support the superiority of pulsatile flow pattern during CPB, in terms of cerebral oxygen saturation or postoperative mortality/morbidity. Further and larger comparative studies are warranted before pulsatile blood flow pattern can be established as a routine clinical method.

Robotic-assisted cardiac surgery without lung isolation utilizing single-lumen endotracheal tube intubation.

OBJECTIVES: This study assessed the feasibility and outcomes of performing robotic cardiac surgery without lung isolation using single-lumen (SL) endotracheal tube intubation. METHODS: Between 2013 and 2017, 132 patients underwent robotically-assisted atrial septal defect closure. A retrospective analysis was performed of 23 patients (11 males, mean age 30.9 ± 5 years) who underwent robotic surgery with double-lumen (DL) endotracheal tube intubation (group 1) compared with 109 patients (57 males, mean age 32.4 ± 7.5 years) undergoing the same procedure with SL endotracheal intubation (group 2). The patient groups were compared in terms of demographic characteristics, operative data, and complications. The technical feasibility of the robotic procedure without lung isolation was evaluated. RESULTS: There were no mortality, intraoperative complication, and conversion. Mean total anesthesia time was significantly decreased in the SL intubation group (238.3 ± 22.4 vs 227.2 ± 21.2 minutes; P = .025). First-pass intubation success was significantly higher in the SL intubation group (17 [73.9%] vs 98 [89.9%] patients; P = .032). Mean ventilation time (10.9 ± 5.3 hours), intensive care unit stay (16.8 ± 10.1 hours), and the length of hospital stay (3.8 ± 1.2 days) was significantly decreased in patients with SL tube (P < .05). Unilateral reexpansion pulmonary edema was observed in five (21.7%) patients with DL tube, whereas no patient with SL tube had this complication. CONCLUSIONS: SL endotracheal tube intubation without lung isolation is a feasible and safe airway alternative in robotic cardiac procedures. This approach resulted in shorter anesthesia time, ventilation time and the length of hospital stay. Port placement and robotic set-up can be uneventfully performed without lung isolation.

Transcatheter closure vs totally endoscopic robotic surgery for atrial septal defect closure: A single-center experience.

BACKGROUND: Transcatheter closure is the preferred method for atrial septal defect (ASD) closure. Robotic surgery has become the least invasive technique for ASD closure. Therefore, we sought to evaluate the outcomes in patients who underwent ASD closure with transcatheter or robotic surgery techniques. METHODS: A total of 462 patients underwent totally endoscopic robotic (n = 217) or transcatheter ASD closure (n = 245). Demographic data, perioperative data, and outcomes were compared. RESULTS: The mean age was lower in the robotic surgery group than the transcatheter group (31.4 ± 11.8 vs 39.4 ± 13.2 years; P = .001). Ventilation time, intensive care unit (ICU) stay, and hospital stay was significantly lower in the transcatheter group. The postoperative new-onset neurological event was seen in one (0.5%) patient in robotic surgery, and four (1.6%) patients in the transcatheter closure group. New-onset atrial fibrillation was found to be higher in transcatheter closure (two vs seven patients; P = .133) group. Surgical conversion to a larger incision occurred in two patients (1%) in robotic surgery, while two patients (0.5%) underwent emergency median sternotomy due to device embolization to the main pulmonary artery. There was no mortality in both groups. During follow-up, one patient (0.5%) who underwent robotic surgery was reoperated, and two patients (0.8%) who underwent transcatheter procedure required surgical intervention due to device migration and severe residual shunting (P = .635). CONCLUSION: Both transcatheter and robotic surgery approaches had excellent outcomes but transcatheter closure had shorter hospital and ICU stays. Robotic surgery provides a similar complication risk that can be comparable to the transcatheter approach as well as patient comfort and cosmetic advantage over the other surgical techniques.

Successful long-term limb salvage using cephalic and small saphenous vein grafts: A case report.

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.

Right pericardial window opening: a method of preventing pericardial effusion.

AIM: In this study, we aimed to investigate the superiority of right pericardial window (RPW) versus posterior pericardial drain placing for the parameters of pericardial effusion and the postoperative complications at the patients who has undergone cardiac surgery. MATERIALS AND METHODS: Between July and September 2018, 120 adult patients (mean age 50.30 ± 14.61) who underwent cardiac surgery without the necessity of opening the pleura were included in the study. In Group 1, the RPW was opened (n = 60), and Group 2 posterior pericardial drainage tube was placed without RPW (n = 60). Risk factors and postoperative complication were evaluated and compared between the Groups. RESULTS: Cardiac tamponade occurrence was not significantly different between the Groups (Group 1, n = 0 and Group 2, n = 3, p = 0.079). Postoperative transthoracic echocardiographic controls revealed significant pericardial effusion in Group 2 (6.90 mm ± 13.02 mm) compared to Group 1 (2.30 mm ± 5.60 mm) (p = 0.013). Postoperative creatinine levels were 0.75 ± 0.26 in Group 1 and 0.88 ± 0.36 in Group 2 (p = 0.022). A significant decrease in glomerular filtration rate was observed in Group 2 (102.7 ± 24.5 and 91.2 ± 28, p = 0.019). Postoperative acute renal failure was significantly higher in Group 2 compared to Group 1 (p < 0.001). Postoperative new onset atrial fibrillation occurred in 4 patients in Group 1 and 8 in Group 2 (p = 0.224). The duration of intensive care unit stay was 36.00 ± 22.31 h in Group 1 and 53.60 ± 59.50 h in Group 2 (p = 0.034). Development of pneumothorax, pneumonia and pleural effusion were not statistically different between the Groups (p = 0.079, 0.171, 0.509). CONCLUSION: RPW application is more effective on preventing postoperative complications in cardiac surgery instead of placing drains in posterior pericardium.