Outcomes of conservative management in patients with nutcracker syndrome.

OBJECTIVE: This study aims to evaluate outcomes in nutcracker syndrome patients with tolerable symptoms and treated conservatively without invasive interventions. METHODS: This prospective study included patients treated conservatively. Promoting weight gain, the endpoint of the study was spontaneous resolution of symptoms. RESULTS: Sixteen patients (75% female and mean age 24.4 ± 3.5 years) underwent conservative management. Over a mean follow-up of 27.3 months [13-42, interquartile range (IQR)], the diameter ratio (5.5 [5-6.5, IQR] vs 4.3 [4.1-6], p = NS), the peak velocity ratio (6 [5-7, IQR] vs 4.8 [4.8-5.8], p = NS), beak angle (27° [24-30, IQR] vs 29° [24-32]; p = NS), and aortomesenteric angle (26° [23-29, IQR] vs 28° [24-30]; p = NS) exhibited no statistically significant changes. Complete resolution and improvement of symptoms were 28.5% and 31.4%, respectively, while 68.5% remained unchanged. CONCLUSIONS: This study shows that a conservative approach contributes to the spontaneous improvement or complete resolution in young adult patients with mild symptoms.

Tocilizumab Reduces Lung Injury in a Rat Lung Ischemia and Reperfusion Model.

OBJECTIVE: In this study, the effect of tocilizumab (TCZ) on lung tissue in lung ischemia-reperfusion (I/R) injury in rats was investigated. MATERIAL AND METHODS: A total of 24 Wistar rats were divided into 4 equal groups, with 6 rats in each group: Left lung I/R was applied to I/R groups. In the I/R groups, the left lung hilum was clamped for 45 minutes, and then the clamp was removed and reperfused for 120 minutes. In the TCZ groups, 4 mg/kg and 8 mg/kg of TCZ were administered intraperitoneally to the rats 30 minutes before surgery. RESULTS: The tumor necrosis factor-alpha mean value was not statistically significant between the groups (P = .091). Statistically significant results were observed between group I/R-TCZ (8 mg/kg) and group I/R for catalase. (P = .005). Statistically significant results were observed between group I/R-TCZ (8 mg/kg) and group I/R for malondialdehyde. (P = .009). The difference in total ischemia score between group I/R-TCZ (4 mg/kg) and group I/R-TCZ (8 mg/kg) and group I/R was statistically significant (P < .001). In terms of alveolar hemorrhage, there was a statistically significant difference between group I/R-TCZ (4 mg/kg) and group I/R-TCZ (8 mg/kg) and group I/R (P = .01 and P = .002, respectively). There was a statistically significant difference between group I/R-TCZ (8 mg/kg) and group I/R in terms of neutrophil accumulation (P = .01). In terms of interstitial edema, there was a statistically significant difference between group I/R-TCZ (4 mg/kg) and group I/R-TCZ (8 mg/kg) and group I/R (P = .006 and P = .001, respectively). In terms of pulmonary edema, there was a statistically significant difference between group I/R-TCZ (4 mg/kg) and group I/R-TCZ (8 mg/kg) and group I/R (P = .01 and P = .009, respectively). CONCLUSION: Lung tissue may be affected by I/R injury and this damage can be reversed with the use of TCZ.

Reverse-U Aortotomy (Kirali Incision) for Aortic Valvular Interventions.

BACKGROUND: Surgical incisional approach to the ascending aorta is the main strategic step during valvular and/or subvalvular aortic interventions. Classic aortotomy incisions (transverse or oblique) can be challenging and can cause suboptimal exposure of the aortic root especially for the patients with small aortic annulus or for redo coronary artery bypass patients with patent proximal grafts interposed to the ascending aorta. METHODS: The Kirali incision was used in 91 patients (including 13 reoperations) who underwent an aortic intervention for valvular and subvalvular pathologies. Aortic root was exposed by forming inverted "U" shape incision starting from approximately 3 cm above the right coronary ostium toward the center of the noncoronary annulus and the top of the left-right commissure like a tongue. RESULTS: The aortic valve was replaced with a mechanical prosthesis in 45 patients and with a bioprosthesis in 39 patients including 14 sutureless and 16 stentless prostheses. A total of 29 patients received a concomitant procedure per the following: coronary artery bypass grafting on 8 patients and left ventricular assist device on 7 patients. There was no any problem related to aortotomy incision technique such as bleeding, rupture, dehiscence, or laceration perioperatively. There was no complication related to the procedure during 5-year follow-up. CONCLUSION: This new aortotomy incision technique is a safe procedure that provides good exposure for all kinds of aortic valve interventions and protects grafts and can facilitate aortic root enlargement or aortoplasty easily. This incision has the potential to be an alternative to traditional techniques.

Treatment of Nutcracker Syndrome with Left Renal Vein Transposition and Endovascular Stenting.

BACKGROUND: Nutcracker syndrome is a rare condition that occurs as a result of the entrapment of the left renal vein (LRV) between the aorta and the superior mesenteric artery. It is typically associated with symptoms such as left flank pain, hematuria, proteinuria, and pelvic congestion. The current treatment approach may be conservative in the presence of tolerable symptoms, and surgical or hybrid and stenting procedures in the order of priority in the presence of intolerable symptoms. The aim of this study is to review our experiences to evaluate the results of both methods in this series in which we have a greater tendency toward surgery instead of stenting. METHODS: The clinical data of consecutive patients with nutcracker syndrome who underwent LRV transposition and LRV stenting between July 2019 and October 2023 were retrospectively reviewed. The patients were divided into 2 groups based on the methods of treatment: surgical and stenting. For procedure selection, LRV transposition was primarily recommended, with stenting offered to those who declined. Primary end points were morbidity and mortality. Secondary end points included late complications, patency, freedom from reintervention, and resolution of symptoms. Standard basic statistics and survival analysis methods were employed. RESULTS: Nineteen patients with nutcracker syndrome (female: 100%) were treated with LRV stentings (n = 5) and LRV transposition (n = 14). The mean age was 24 (20-27, interquartile range [IQR]) years. The mean follow-up was 23 (9-32, IQR) months. There were no major complications and mortality after both procedures. The most frequent sign and symptom associated with LRV entrapment were left flank pain 100% (n = 19), proteinuria 88% (n = 15), and hematuria 47% (n = 9). The mean peak velocity ratio on Doppler ultrasound was 6.13 (6-6.44, IQR). Aortomesenteric angle, beak angle (beak sign), and mean diameter ratio on computed tomography were 26° (22.6-28.5, IQR), 25° (23.9-28, IQR), and 5.3 (5-6, IQR), respectively. Venous pressure measurements were only used to confirm the diagnosis in 5 patients in the stenting group. The measured renocaval gradient was 4 (3.9-4.4, IQR) mm Hg. After both procedures, the classical symptoms, including left flank pain, proteinuria, and hematuria, resolved in 89.5% (n = 17), 57.8% (n = 11), and 82.3% (n = 15) of the cases, respectively. A total of 4 patients required reintervention, 3 patients after LRV transposition (occlusion, n = 2; stenosis, n = 1), and 1 patient after stenting (occlusion, n = 1). The 1-year and 3-year primary patency for the 19 patients was 87% and 80%, respectively. Three-year primary-assisted patency was 100%. Similarly, the 1-year and 3-year freedom from reintervention rate was 83% and 72%, respectively. Additionally, the 1-year and 3-year primary patency for the surgical group was 91% and 81%, respectively, and the 1-year and 3-year primary patency for the stenting group was 75%. CONCLUSIONS: Nutcracker syndrome should be kept in mind in cases where flank pain and hematuria cannot be associated with kidney diseases. Radiographic evidence must be accompanied by serious symptoms to initiate the treatment of nutcracker syndrome with LRV transposition and endovascular stenting procedures. Both procedures, along with their respective advantages and disadvantages, can be preferred as primary treatments for nutcracker syndrome. Our study demonstrates that both procedures can be safely and effectively performed, yielding good outcomes.

Long-Term Results of Thoracofemoral Bypass in the Initial Treatment of Juxtarenal Total Aortic Occlusion.

BACKGROUND: Thoracofemoral bypass has been applied mostly secondary to previous procedures in the treatment of aortoiliac occlusive disease. However, its application as an initial treatment is less common, and long-term outcomes remain uncertain. The aim of this analysis was to review the 16-year experience and long-term outcomes of 31 consecutive patients who underwent thoracofemoral bypass as the primary procedure. METHODS: All patients who underwent thoracofemoral bypass for severe aortoiliac occlusive disease between 2005 and 2021 were retrospectively analyzed. The occlusion and calcified plaques of the abdominal aorta at the renal level were common characteristics of all patients. The patients were divided into 2 groups: severe claudication group (Rutherford III group) and chronic limb-threatening ischemia group (Rutherford IV-V). Chi-square test or Fisher's exact test was used to compare categorical variables between the groups, and t-test or Mann-Whitney U-tests were used to compare continuous variables according to their distributions. The Kaplan-Meier curve was used to depict the time-to-event data. RESULTS: Thirty-one patients [age: 62 (56-67.5); male: 87%] underwent thoracofemoral bypass. Among the 31 patients, 21 (67.7%) belonged to the severe claudication group (Rutherford III), while 10 (32.3%) were in the chronic limb-threatening ischemia (Rutherford IV-V). Twenty-two patients (83.8%) remained asymptomatic after thoracofemoral bypass. The mean follow-up duration was 79 ± 32 months. The 30-day mortality rate was 3.2% (n = 1). Major complications were observed in 9.6% of patients (n = 3; respiratory: 6.4%, retroperitoneal hematoma: 3.2%). No significant difference was found between the claudication and chronic limb-threatening ischemia groups regarding major complications (3.2% vs. 6.4%, P = NS). Minor complications occurred in 41.9% of patients, including pleural effusion 9.6% (n = 3), acute kidney injury 9.6% (n = 3), gastrointestinal bleeding 3.2% (n = 1), paralytic ileus 6.4% (n = 2), and superficial skin infection 12.9% (n = 4). The rate of postoperative superficial skin infection was higher in the chronic limb-threatening ischemia group compared to the claudication group (4 [40%] vs. 0 [0%], P: 0.007). The univariable Cox regression analysis revealed that hypertension and diabetes mellitus were not related to primary patency of the thoracofemoral bypass graft. The 5-year Kaplan-Meier estimated primary patency for the entire study was 96% ± 7% (95% confidence interval [CI]: 88.6-100), and the secondary patency was 96.3% ± 6% (95% CI: 89.4-100). The 5-year Kaplan-Meier estimated survival rate after thoracofemoral bypass was 93.4% ± 3 (95% CI: 91-100). CONCLUSIONS: We demonstrated in this study that thoracofemoral bypass can yield good outcomes when preferred as the initial treatment in selected patients with juxtarenal total aortic occlusion. Despite being a complex surgical technique, thoracofemoral bypass has shown to have safe, acceptable mortality and morbidity rates, as well as excellent long-term follow-up results in selected patients.

In-Hospital and Long-Term outcomes after Open-Heart Surgery in Turkish Octogenarians: a Single-Center Study.

OBJECTIVE: We aimed to analyze the early and long-term results of open-heart surgery in Turkish patients aged 80 years or older who were operated on at our center. METHODS: All patients aged 80 years or older who underwent surgery between January 2000 and December 2013 at a high-level heart center were included in the study. The in-hospital data of study patients were obtained from the electronic database and from the hospital files. Survival data were analyzed as a long-term outcome. RESULTS: A total of 245 patients aged 80-93 years were evaluated in the study. The patients were followed up 5.4±3.7 years after open-heart surgery. In-hospital mortality rates were 10% in elective cases and 15.1% overall. Age ≥85 years, chronic kidney disease, chronic obstructive pulmonary disease, and emergency surgery were independent predictors of in-hospital mortality. The median survival time was found to be 4.4±0.3 years for all participants. The long-term survival of patients who underwent emergency cardiac surgery was significantly lower than that of elective patients (log-rank <0.001). CONCLUSION: Octogenarians have satisfactory long-term outcomes after open-heart surgery when operated electively. On the other hand, patients operated under emergency conditions have worse inhospital outcomes and long-term follow-up results.

Can Moderate Patient Prosthesis Mismatch Be Tolerated in a Selected Group of Patients with Aortic Valve Replacement?

INTRODUCTION: In this study, we aimed to determine the incidence of patient prosthesis mismatch (PPM) and its effects on ejection fraction (EF), gradients, and late survival. METHODS: 200 patients who underwent isolated mechanical AVR between March 2013 and May 2016 were retrospectively evaluated based on patient records. RESULTS: 200 patients were included in the study. No PPM was detected in 42 (21%) patients, moderate PPM in 122 (61%), and severe PPM in 36 (18%) patients. A significant decrease was found in all groups in terms of mean valve gradients and LVMI (preoperative LVMI compared with postoperative LVMI at the 12th month) (P < .001). A 30% decrease in mean LVMI in the no PPM and moderate PPM groups and a 20% decrease in the severe PPM group were detected at the 6th month. CONCLUSION: In our postoperative data, we found that EF was preserved, the transvalvular gradient reduced, and LVMI decreased. There was no difference in mortality rates between the control (no PPM) group and the moderate PPM group. Taking into account our patient groups, we can say that no-to-moderate PPM has no major effect on left ventricular remodeling in patients with preserved left ventricular functions.

In-hospital and long-term outcomes after open-heart surgery in turkish octogenarians: a single-center study

Abstract Objective: We aimed to analyze the early and long-term results of open-heart surgery in Turkish patients aged 80 years or older who were operated on at our center. Methods: All patients aged 80 years or older who underwent surgery between January 2000 and December 2013 at a high-level heart center were included in the study. The in-hospital data of study patients were obtained from the electronic database and from the hospital files. Survival data were analyzed as a long-term outcome. Results: A total of 245 patients aged 80-93 years were evaluated in the study. The patients were followed up 5.4±3.7 years after open-heart surgery. In-hospital mortality rates were 10% in elective cases and 15.1% overall. Age ≥85 years, chronic kidney disease, chronic obstructive pulmonary disease, and emergency surgery were independent predictors of in-hospital mortality. The median survival time was found to be 4.4±0.3 years for all participants. The long-term survival of patients who underwent emergency cardiac surgery was significantly lower than that of elective patients (log-rank <0.001). Conclusion: Octogenarians have satisfactory long-term outcomes after open-heart surgery when operated electively. On the other hand, patients operated under emergency conditions have worse in-hospital outcomes and long-term follow-up results.

Prognostic value of main pulmonary artery diameter to ascending aorta diameter ratio in patients with advanced heart failure.

OBJECTIVES AND BACKGROUND: In this study we assessed the prognostic value of main pulmonary artery diameter and its ratio to ascending aorta diameter (P/Ao ratio) in advanced heart failure patients. METHODS: Patients with advanced heart failure who were candidates for heart transplantation were retrospectively evaluated. The clinical information, cardiac catheterisation results, and computed tomography images were gathered from institutional database system. The observed and predicted probabilities for survival were analysed in a nomogram. RESULTS: The P/Ao ratio was found to be a strong predictor for MACE both in traditional multivariable Cox proportional hazard regression modelling (increase in P/Ao ratio per 2 SD, HR:2.72, 95% CI 1.14-6.48, p = 0.024) and ridge regression analysis (increase in P/Ao ratio per 2SD, HR:3.45, 95% CI 1.53-7.74, p = 0.003). Prediction model showed statistically significant correlation between the observed and predicted probabilities for 1-year survival. CONCLUSION: In patients with advanced heart failure, computed tomography derived P/Ao ratio might be a prognostic predictor during follow up.

MitraClip Removal During Left Ventricular Assist Device Implantation.

Mitral regurgitation (MR) is an important consequence of heart failure (HF) patients, which increases hospitalization and mortality rates. The MitraClip procedure is increasingly preferred for HF patients with obvious MR to improve MR and related symptoms. In some cases, patients may need further intervention such as left ventricular assist device implantation with the aim of improving progressive clinical deterioration caused by the progression of HF or mitral clip associated complications (i.e., detachment or mitral stenosis). This case study summarizes our two patients who received concomitant mitral clip removal and left ventricular assist device implantation with clinically successful results.

Transition from Conventional Technique to Less Invasive Approach in Left Ventricular Assist Device Implantations.

Surgical treatments for heart failure patients are being increasingly performed every year. While experiences in this field are increasing, transition to alternative surgical approaches to minimize incisions is gaining popularity. However, there are clinics that still avoid performing these techniques. In the current study, we aim to present our experiences in transitioning to a minimally invasive technique by comparing two groups. One group was operated with a minimally invasive technique that has been performed in the learning curve period, while the second was operated with a familiar and standard technique. One hundred twenty patients who were implanted with left ventricular assist devices (LVADs) from April 2015 to January 2019 were retrospectively analyzed. The first 30 LVAD-implanted patients via less invasive approach (since April 2017) were included in group 1, and the last 30 isolated LVAD implanted patients via standard full sternotomy were included in group 2. Early clinical outcomes were compared between these two groups. There were no significant differences between two groups in terms of demographic features and preoperative statuses. Group 1 had significantly lesser mortality rates, cardiopulmonary bypass times, drainages, and blood products. Hospital stays had no significant difference between the groups, while extubation times and ICU stays were significantly lesser in group 1. Left ventricular assist device implantation through thoracotomy and ministernotomy is as feasible as that done through the conventional full sternotomy technique. In this group of patients with a high risk of bleeding, besides providing less hemorrhage, we believe that the surgical procedure was not more difficult than the conventional method.

Regenerating a ventricular cavity during left ventricular assist device implantation.

Ten months after an ineffective percutaneous coronary stent placement, a 53-year-old patient was rehospitalized with NYHA functional class IV congestive heart failure, ischemic heart disease and left ventricular aneurysm. Echocardiography revealed thrombus formation in the left ventricle with apical aneurysm. Even though left ventricular assist device (LVAD) implantation improves quality of patients' lives with an increase of its overall use, it becomes more complicated in the presence of ventricular thrombus. We decided to perform ventricular reconstruction with thrombus extraction concomitant to HeartMate 3™ LVAD implantation. The patient was recovered uneventfully, and discharged on postoperative day 14. This report shares the patient's case and the surgical procedure.

The effect of time between angiography and coronary artery bypass grafting on postoperative acute kidney injury in patients with diabetes mellitus.

BACKGROUND: This study aims to investigate the effect of time interval between coronary angiography and coronary artery bypass grafting surgery on postoperative acute kidney injury in patients with diabetes mellitus. METHODS: Between December 2013 and November 2016, a total of 421 diabetic patients (274 males, 147 females; mean age 60±9.2 years; range, 31 to 84 years) who underwent coronary artery bypass grafting were included in the study. Data including demographic characteristics of the patients, comorbidities, medical, and surgical histories, previous coronary angiographies, and operative and laboratory results were retrospectively analyzed. The patients were divided into two groups as those with acute kidney injury (n=108) and those without acute kidney injury (n=313). The Risk, Injury, Failure, Loss, End-Stage Kidney Disease (RIFLE) criteria were used to define acute kidney injury. The patients were further classified into three subgroups according to the time interval: 0-3 days, 4-7 days, and >7 days. RESULTS: There was no statistically significant difference in the median time between coronary angiography and coronary artery bypass grafting between the patients with and without acute kidney injury (11.5 and 12.0 days; respectively p=0.871). There was no significant difference in the risk factors for acute kidney injury among the subgroups. Multivariate analysis revealed that previous myocardial infarction (odds ratio [OR]: 5.192, 95% confidence interval [CI]: 2.176-12.38; p<0.001) and the increase in the creatinine levels in the first postoperative day (OR: 4.102 and 95% CI: 1.278- 13.17; p=0.018) were independent predictors of acute kidney injury. CONCLUSION: Coronary artery bypass grafting can be performed without any delay after coronary angiography without an increase in the postoperative risk of acute kidney injury in patients with diabetes mellitus.

Fluid inside driveline after left ventricular assist device implantation: A rare case.

In this article, we present our diagnostic and therapeutic approach in a rare case in whom fluid inside the driveline developed following left ventricular assist device implantation.

The mid-term effect of left ventricular assist devices on renal functions.

BACKGROUND: In this study, we aimed to investigate the mid-term effects of left ventricular assist devices on kidney functions. METHODS: Between January 2015 and December 2017, a total of 61 patients (53 males, 8 females; mean age 46.4±11.2 years; range, 20 to 67 years) who underwent left ventricular assist device implantation were retrospectively analyzed. Glomerular filtration rate was evaluated preoperatively and at 24 and 48 h, at one week, and at one, three, and six months postoperatively. According to the preoperative glomerular filtration rates, the patients were divided into three groups: glomerular filtration rates ?60 mL/min/1.73 m2 ( Group 1 ), g lomerular f iltration rates 61-90 mL/min/1.73 m2 (Group 2), and glomerular filtration rates >90 mL/min/1.73 m2 (Group 3). RESULTS: In all groups, the glomerular filtration rate significantly increased at one week and one month postoperatively, compared to preoperative values (p<0.001 and p<0.01, respectively). However, the glomerular filtration values at six months significantly decreased, compared to the values at one week and one month postoperatively (p<0.001 and p<0.001, respectively). The most significant drop to preoperative values was observed in Group 3 (p=0.02) at three months and it dropped below the preoperative level at six months (p<0.001). CONCLUSION: Our study results suggest that left ventricular assist devices can significantly increase the glomerular filtration rate in short-term, irrespective of baseline values. However, this improvement may recede later, particularly in patients with normal renal functions, and it may even disappear following the third postoperative month.

The publication rate of oral presentations presented in national congresses of Turkish Society of Cardiovascular Surgery.

BACKGROUND: This study aims to investigate the literature contribution of oral presentations presented in the largest national congresses of the Turkish Society of Cardiovascular Surgery. METHODS: A total of 675 orally presented abstracts during biannually organized 12th, 13th, and 14th congresses were reviewed using the PubMed and Google Scholar databases in May 2018. Abstracts were searched for institutions where they were submitted, publication status in scientific journals, type of peer-reviewed journal, and publication year. RESULTS: Of a total of 675 oral presentations, 69.1% were clinical studies, 18.8% were case reports, and 12.1% were experimental researches. Of all accepted abstracts, 47.3% were from university hospitals, 36.1% were from training and research hospitals, and 16.6% were from other multi-center institutions. A total of 279 (41.3%) abstracts were published in a scientific journal. There was a significant difference among the institutions in terms of the rate of publication (p=0.04), and the university hospitals had the highest rate. The mean time from presentation to publication in a scientific journal was 16.7±9.1 (range, 4 to 60) months. CONCLUSION: The rate of published abstracts from the last three congresses of the Turkish Society of Cardiovascular Surgery is higher compared to the literature results reporting national congresses of other specialties, but is lower than the international congresses. We believe that this ratio should be increased to reach the same level as international reports and the methods to encourage researchers to publish should be developed.

The role of genetics in coronary artery bypass surgery patients under 30 years of age.

AIM: We undertook genetic assessment of coronary artery disease (CAD) in 20 patients aged 30 years or less undergoing coronary artery bypass grafting (CABG) surgery, to investigate the prognostic value of pre-defined genes. METHODS: Twenty patients, who underwent CABG surgery between December 2001 and May 2013, were retrospectively analysed to find out the role their genetic make-up played in their disease. We used three genetic diagnostic tests, the plasminogen activator inhibitor (PAI) -1 gene, the A1/A2 polymorphism of glycoprotein IIIa (GpIIIa) gene, and common polymorphisms of the methylenetetrahydrofolate reductase (MTHFR) gene. RESULTS: The mean age of patients was 26.35 ± 3.51 (19-30) years, and 90% were male (n = 18). One patient had diabetes, three had hypertension, 11 (55%) had dyslipidaemia and 16 (80%) were smokers. Eight of the patients (40%) had left ventricular ejection fraction (LVEF) < 50%, and functional capacity was poor in only two (10%) patients (NYHA III-IV). Follow up was completed in all patients (100%). We found five homozygous and 11 heterozygous mutations in the MTHFR gene, which predisposes individuals to coronary artery disease or deep-vein thrombosis. Eight patients were found to have a GpIIIa gene polymorphism, which is associated with increased risk of myocardial infarction (MI). Fifteen patients had a polymorphism in the promoter region of the PAI-1 gene, which is a major inhibitor of the fibrinolytic system. CONCLUSION: MTHFR C677T polymorphism, and GpIIIa and PAI-1 genes are risk factors for CAD. In young patients, genetic studies promise to revolutionise early diagnosis, treatment and prevention of CAD and MI.

Immediate Outcomes of Aortic Valve Replacement with Sutureless versus Stentless Bioprosthesis.

BACKGROUND: Aortic valve replacement (AVR) with a sutureless valve is an innovative therapy in high-risk elderly patients. The study aim was to compare the early results of AVR using sutureless aortic valves or stentless aortic bioprostheses. METHODS: A retrospective analysis was conducted of 55 patients who underwent AVR with either a sutureless valve (Perceval S; n = 24 or Edwards Intuity; n = 9) or a stentless valve (Sorin Freedom SOLO™; n = 22). RESULTS: Baseline patient characteristics were similar in both groups, except for NYHA class. Concomitant procedures were performed in 17 patients (51.5%) of the sutureless group and in nine patients (40.9%) of the stentless group (p = 0.44). The aortic cross-clamp time was 55 ± 23 min in the sutureless group and 102 ± 36 min in the stentless group (p <0.0001), while the postoperative peak aortic gradient was 19.5 ± 5.0 mmHg and 29.3 ± 15.4 mmHg for the sutureless group and stentless group, respectively (p = 0.037). The postoperative mean gradient was 9.3 ± 3.4 mmHg for the sutureless group and 15.1 ± 10.5 mmHg for the stentless group (p = 0.06). Blood product transfusion was required less frequently by the sutureless group, but drainage and bleeding was similar in both groups. The intensive care unit and hospital stays were significantly shorter in favor of the sutureless group. One sutureless patient (3.0%) and two stentless patients (9.1%) died in hospital (p = 0.557). CONCLUSIONS: Early results of the present study suggested that surgical AVR with a sutureless valve is associated with a good hemodynamic performance and an improved early outcome.

Early Outcomes of Sutureless Aortic Valves.

BACKGROUND: In elderly high-risk surgical patients, sutureless aortic valve replacement (AVR) should be an alternative to standard AVR. The potential advantages of sutureless aortic prostheses include reducing cross-clamping and cardiopulmonary bypass (CPB) time and facilitating minimally invasive surgery and complex cardiac interventions, while maintaining satisfactory hemodynamic outcomes and low rates of paravalvular leakage. The current study reports our single-center experience regarding the early outcomes of sutureless aortic valve implantation. METHODS: Between October 2012 and June 2015, 65 patients scheduled for surgical valve replacement with symptomatic aortic valve disease and New York Heart Association function of class II or higher were included to this study. Perceval S (Sorin Biomedica Cardio Srl, Sallugia, Italy) and Edwards Intuity (Edwards Lifesciences, Irvine, CA, USA) valves were used. RESULTS: The mean age of the patients was 71.15±8.60 years. Forty-four patients (67.7%) were female. The average preoperative left ventricular ejection fraction was 56.9±9.93. The CPB time was 96.51±41.27 minutes and the cross-clamping time was 60.85±27.08 minutes. The intubation time was 8.95±4.19 hours, and the intensive care unit and hospital stays were 2.89±1.42 days and 7.86±1.42 days, respectively. The mean quantity of drainage from chest tubes was 407.69±149.28 mL. The hospital mortality rate was 3.1%. A total of five patients (7.69%) died during follow-up. The mean follow-up time was 687.24±24.76 days. The one-year survival rate was over 90%. CONCLUSION: In the last few years, several models of valvular sutureless bioprostheses have been developed. The present study evaluating the single-center early outcomes of sutureless aortic valve implantation presents the results of an innovative surgical technique, finding that it resulted in appropriate hemodynamic conditions with acceptable ischemic time.

Oxidant-antioxidant balance during on-pump coronary artery bypass grafting.

BACKGROUND: The aim of this study was to evaluate the changes in perioperative oxidant-antioxidant balance in ONCABG. METHODS: Twenty-three patients were included in this study. Serum total oxidant status (TOS), total antioxidant status (TAS), and oxidative stress index (OSI) values were assessed preoperatively, at 20 minutes after aortic clamping and at 30 minutes, 6 hours, and 48 hours after declamping (reperfusion). The patients were divided into 2 groups according to the median aortic cross clamping (XC) time: group 1 (XC time < 42 minutes) and group 2 (XC time ≥ 42 minutes). RESULTS: TOS and OSI values of whole patients at 30 minutes after reperfusion were higher than preoperative values (P = 0.045, P = 0.015), while perioperative TAS levels of the patients were similar to the preoperative levels (P = 0.173). XC time was correlated with TOS levels at 30 minutes after reperfusion (r = 0.43, P = 0.041). In group 2, TOS and OSI values at 30 minutes after reperfusion were higher than preoperative values (P = 0.023, P = 0.048), whereas a significant difference was not found in group 1 (P = 0.601, P = 0.327). CONCLUSIONS: Oxidative imbalance and increase in TOS at reperfusion in ONCABG may be associated with XC time.