Evaluation of VEP parameters in patients before and after cardiopulmonary by-pass surgery.

PURPOSE: Coronary bypass surgery is emphasized in aetiology of ischemic optic neuropathy. Our aim in this study was to investigate the pattern visual evoked potentials (PVEP) in patients before and after coronary bypass surgery. METHODS: Thirty-one patients were included in the study. After a full ophthalmological evaluation, PVEP was assesed in the pre and postoperative periods. Operative times, hematological parameters, blood pressures, number of transfusions, body temperatures, anaesthetic drugs and systemic illnesses were recorded for each patient. RESULTS: The mean age of the patients were 59 ± 10.4 years. There was 22 men and 9 women in the study. Only 3 of them needed transfusion during the surgery. The mean duration of the surgery was 3.2 ± 0.7 h. None of the patients had a history of visual disturbance or postoperative ischemic optic neuropathy. The mean VEP P100 amplitude was not statistically significantly different but the mean VEP P100 latency showed statistically significant difference between the preoperative and postoperative periods. (p = 0.014) This significance was more appereant in patients with systemic illnesses. (p = 0.023) There was a positive correlation between the age and VEP P100 latency (r = 0.402, p < 0.05). CONCLUSIONS: Although surgical techniques and equipments are developing each day in the field of cardiopulmonary bypass surgery, the contributing factors such as hypothermia, anemia and diabetes still seem to affect neurophysiological functions even after a noncomplicated surgery.

A Novel Method to Adjust Saphenous Vein Graft Lengths Using 3D Printing Models.

BACKGROUND: The optimal length of saphenous vein grafts can be challenging in surgical coronary revascularization. It is the cornerstone for graft patency. In this study, we tried to demonstrate the value of 3D printing in determining optimal saphenous graft length. METHODS: Sixteen patients who underwent bypass surgery with only vein grafts were examined. Patients' measurements of graft lengths were obtained from postoperative CT images and from both 3D print models manually with plastic tubes and via 3D print digital images of Mimics software during segmentation. Another measurement was done using the Fit Centerline tool in the analysis module of Mimics software after segmentation. These 3 measurements were compared. RESULTS: There was a statistically significant difference between 3 measurement methods for each graft length (P < .001). Measurements of actual grafts were longer than measurements of 3D printed models manually and segmentation images from software were similar (P > .05). CONCLUSION: 3D printing models and their software may be used to determine optimal saphenous graft length and the anastomosis site to decrease operation time. It can be deducted from these results that 3D printing is a promising method for reducing operator dependent variables in adjusting graft size and finding optimal anastomosis sites.

Determination of acute changes in new electrocardiography parameters during veno-venous extracorporeal membrane oxygenation support.

INTRODUCTION: Veno-venous extracorporeal membrane oxygenation (ECMO) support has been used for respiratory insufficiency. Its role in blood oxygenation has been well documented. However, the effects on myocardial electrophysiology have not been studied in detail. AIM: To reveal the acute effects of extracorporeal support on new electrocardiography (ECG) parameters in patients with preserved left ventricular functions. MATERIAL AND METHODS: This retrospective study was conducted in three separate clinics. Sixteen consecutive patients under veno-venous ECMO for respiratory insufficiency who soon could be successfully weaned were analyzed. Immediately before and 2 hours after initiation of ECMO, ECG was performed. P wave, QT, QTc and T wave peak to end were measured and calculated from obtained surface 12-lead ECG. RESULTS: There were statistically significant differences immediately before and 2 hours after initiation of ECMO treatment in the Tp-e interval and Tp-e/QTc ratio, the maximum QTc, minimum QTc, and QTc dispersion values, and P wave dispersion (p < 0.0001 for each). All ECG parameters were significantly decreased with ECMO support. CONCLUSIONS: All atrial and ventricular repolarization parameters were decreased in patients with VV-ECMO support. Despite the limited role of ECMO in intractable arrhythmias, the findings of the study revealed that ECMO therapy for respiratory insufficiency may improve atrial ventricular depolarization and repolarization. Therefore, simple 12-lead surface ECG with new ECG parameters may be evaluated for better outcomes.

Evaluation of 3D printed carotid anatomical models in planning carotid artery stenting.

BACKGROUND: We aimed to investigate the potential role of threedimensional printed anatomical models in pre-procedural planning, practice, and selection of carotid artery stent and embolic protection device size and location. METHODS: A total of 16 patients (10 males, 6 females; mean age 75.6±4.7 years; range, 68 to 81 years) who underwent carotid artery stenting with an embolic protection device between January 2017 and February 2019 were retrospectively analyzed. The sizing was based on intraprocedural angiography findings with the same brand stent using distal protection device. Pre-procedural computed tomography angiography images used for diagnosis were obtained and modeled with three-dimensional printing method. Pre-procedural and threedimensional data regarding the size of stents and protection devices and implantation sites were compared. RESULTS: Measurements obtained from three-dimensional models manually and segmentation images from software were found to be similar and both were smaller than actually used for stent and embolic protection device sizes. The rates of carotid artery stenosis were similar with manual and software methods, but were lower than the quantitative angiographic measurements. Device implantation sites detected by the manual and software methods were different than the actual setting. CONCLUSION: The planning and practicing of procedure with threedimensional models may reduce the operator-dependent variables, shorten the operation time, decrease X-ray exposure, and increase the procedural success.

One-stage combined thoracic ancient schwannomas total removal and coronary artery bypass.

Ancient schwannoma is a rare variant of neural tumors though rarely seen in the thorax. The combination with coronary artery diseases is also rare. Here we describe a 66 year-old male who had undergone one-stage combined surgery for thoracic ancient schwannomas removal and coronary artery disease. The masses were, respectively, 13 cm in the middle mediastinum and 5 cm in diameter originating from the intercostal nerve. The tumors were successfully removed using sternotomy, and then a coronary artery bypass grafting was performed. Here we discuss this rare tumor in relation to the relevant literature.

Omeprazole, lansoprazole and pantoprazole had no effect on blood pressure and electrocardiogram of anesthetized rat.

Expression of H(+)/K(+)-ATPase was recently shown in cardiac and vascular muscle cells and significant inotropic, chronotropic and vasorelaxant effects of proton pump inhibitors were also previously shown on isolated cardiac and vascular muscles. We aimed to study possible reflections of these in vitro effects on a living animal and thus we investigated the effects of intravenously administered omeprazole (7.2 mg/kg), lansoprazole (7.7 mg/kg) and pantoprazole (9 mg/kg) on blood pressure and electrocardiogram in anesthetized rat. None of the three tested inhibitors altered heart rate, blood pressure or electrocardiogram recording in anesthetized rat even at 100-fold greater plasma concentrations than in clinical settings. Inotropic effects of omeprazole and lansoprazole were also tested on electrically induced contractions of human atrial strips and they induced a concentration-dependent, completely reversible and reproducible negative inotropic effect on isolated human myocardium. Both inhibitors further increased the tension of human atrial strips when they applied after the development of ouabain-induced "contracture". This study demonstrates cardiovascular safety of three most commonly used proton pump inhibitors in anesthetized rat. In contrast to in vitro studies, proton pump inhibitors were found to be ineffective in cardiovascular system in vivo and this may be due to high plasma protein binding and rapid elimination rates. Contrary to previous findings on isolated rat atrium, omeprazole and lansoprazole induced negative inotropic effect on isolated human atrial strips.

Comparison of the effects of on-pump versus off-pump coronary artery bypass surgery on serum prostate-specific antigen levels.

AIM: To compare the effects of coronary artery bypass operation with or without extracorporeal circulation on serum total prostate-specific antigen levels. METHODS: Seventy-six men with a mean age of 57.04+/-9.27 years (range 44-77 years), who underwent coronary artery bypass surgery were enrolled to the study. In 50 patients (Group I), coronary revascularization was performed using extracorporeal circulation, and in 26 patients (Group II) coronary bypass grafting was performed on the beating heart without using extracorporeal circulation. All the patients had serum total prostate-specific antigen levels measured preoperatively and twice postoperatively in the first and fifth postoperative days. Differences in mean total prostate-specific antigen levels between the two groups in the postoperative period were analysed. RESULTS: The mean preoperative total prostate-specific antigen levels in Group I and Group II were 1.28+/-1.13 ng/mL and 1.11+/-0.93 ng/mL, respectively, and there was no significant difference in the preoperative total prostate-specific antigen values between the two groups (P=0.519). In Group I, postoperative means were 4.96+/-6.29 ng/mL and 5.86+/-9.09 ng/mL in the first and fifth days, respectively (P=0.0001, P=0.0001). Total prostate-specific antigen means in the same postoperative period for Group II were 2.13+/-2.72 ng/mL and 2.00+/-2.20 ng/mL, respectively (P=0.014, P=0.024). The comparison of total postoperative prostate-specific antigen levels between the groups showed significantly higher elevation in Group I (postoperative day 1: P=0.013; day 5: P=0.05). CONCLUSIONS: Coronary revascularization can cause a statistically significant rise in serum total prostate-specific antigen levels. This rise is more marked in patients undergoing conventional coronary revascularization.

Proton pump inhibitors omeprazole and lansoprazole induce relaxation of isolated human arteries.

Vasorelaxant effects of H+/K+-ATPase were previously demonstrated in artery rings isolated from experimental animals. We examined the effects of clinically used H+/K+-ATPase inhibitors on isolated human internal mammary (n=19) and radial (n=5) arteries. Omeprazole and lansoprazole (30-300 microM) both induced concentration-dependent, reversible and reproducible relaxations of arteries which were precontracted with phenylephrine (5 microM), histamine (15 microM), high K+ (80 mM), ouabain (1 microM) and K+ free solution. Relaxant responses were similar in both arteries. Presence of Nomega-Nitro-L-arginine methyl ester (30 microM) had no effect on lansoprazole-induced responses, thus relaxations are independent from nitric oxide. Relaxation in the K+ free medium implies that this action could not be due to the inhibition of H+/K+-ATPase. Lansoprazole (300 microM) inhibited Ca2+-induced contractions in high K+-Ca2+ free medium. Omeprazole and lansoprazole may act on a common mechanism which plays a crucial role in regulating human vascular tone and that mechanism appeared to be involved in the regulation of intracellular Ca2+.

Emergency management of severe right ventricular inflow obstruction secondary to a metastatic cardiac tumor.

We report the case of a 21-year-old female with previous history of primitive neuroectodermal tumor of the anterior abdominal wall who developed severe manifestations of right heart failure due to a mass obliterating the right ventricular cavity. She underwent emergent resection of the mass with histopathologic confirmation of metastatic neuroectodermal tumor. To the best of our knowledge, this is the first case of emergent surgical excision of a metastatic cardiac tumor of primitive neuroectodermal origin.

Comparison of off-pump and conventional coronary endarterectomy.

OBJECTIVE: This study was designed to compare the early and midterm results of off-pump coronary endarterectomy (OPCE) with those of conventional coronary endarterectomy (CCE) performed with cardiopulmonary bypass. METHODS: From April 1, 1999, until March 1, 2001, 332 patients underwent off-pump coronary artery bypass grafting at our institution. From this total, 44 (13%) of the patients underwent supplementary OPCE (group 1). The results were compared with those for a group of age-, sex-, and risk factor-matched patients undergoing CCE (group 2) at the same institution. The mean follow-up period was 16 months. The indications for operation in group 1 were angina in 16 (36%) of the cases, cardiac failure in 20 (45%), and prognosis in 8 (19%). In group 2 angina was the indication for operation in 11 (25%) of the cases, cardiac failure in 5 (11%), and prognosis in 30 (64%) of the cases. RESULTS: In group 1, 35 patients underwent single and 9 underwent double endarterectomy. The procedures included 32 right coronary artery, 12 left anterior descending artery, 2 lateral circumflex artery, and 7 diagonal branch operations. Three (6.8%) of the patients in group 1 and 2 (4.4%) of the patients in group 2 developed postoperative myocardial infarction (P <.05). One (2.2%) of the patients in group 1 and 2 (4.4%) of the patients in group 2 died in the postoperative period (P <.05). The numbers of patients with perioperative neurologic deficit in groups 1 and 2 were 0 and 7, respectively (P <.001). Although the rate of perioperative myocardial infarction was higher in group 1, mortality, occurrence of other morbid events, intubation time, intensive care stay, and hospital length of stay were less in group 1 than group 2. CONCLUSION: OPCE can be performed safely with morbidity and mortality comparable with those of CCE.

Off-Pump Coronary Bypass through Very Limited Sternotomy.

OBJECTIVE: This study was designed to evaluate the feasibility of beating heart coronary bypass operations on the anterior vessels of the heart through very limited sternotomy (VLS). METHODS: Between February 1, 2000, and October 1, 2001, 76 patients with stenosis of the left anterior descending artery (LAD) and right coronary artery (RCA) underwent coronary bypass grafting through 6- to 7-cm T-shaped VLS. Mean age of the patients was 56 +/- 4.7 years. Fourteen patients were women. Nine (12%) of the patients had a left ventricular ejection fraction of less than 35%. Forty-three patients had single-vessel disease, and the others had 2-vessel disease. Patients who needed emergency operations were excluded from the study. RESULTS: In 7 patients the operation was converted to full sternotomy with or without cardiopulmonary bypass. This outcome accounted for an over all failure rate of 9%. The internal mammary artery/arteries were the inflow vessels in all cases. Various types of composite grafts were created with the saphenous vein and radial artery. Thirty-five (46%) of the patients received a single graft to the LAD, 12 (16%) received 2 grafts to the LAD and RCA, 8 (11%) received 2 grafts to the LAD and a diagonal artery, and 21 (27%) received 3 grafts to the LAD, RCA, and a diagonal artery. Average graft number was 1.8 per patient. Mean operation time was 97 +/- 26 minutes (range, 41-177 minutes). Mean anastomosis time for each graft was 16.0 +/- 2.6 minutes in the first 26 patients and 9.0 +/- 1.7 minutes in the rest. Mean intubation time, intensive care unit, and in-hospital stays were 4.1 +/- 1.6 hours, 17.6 +/- 3.4 hours, and 4.1 +/- 0.8 days, respectively. One (1%) of the patients had perioperative myocardial infarction, and 1 (1%) had right lung laceration and prolonged air leakage. There were no cases of cerebrovascular accident, pulmonary insufficiency, deep wound infection, or renal failure. There was no hospital mortality. The mean followup period was 26. 8 +/- 3.5 months. Thirty-nine (51%) of the patients underwent coronary angiography 1 year after the operation. Fifty-eight grafts were examined. There were 6 occluded grafts, with an overall patency rate of 90%. Three patients died in the follow-up period, 1 (1%) of these patients died of a cardiac cause. CONCLUSION: Coronary bypass grafting on the LAD, the RCA, and their tributaries can be safely performed through VLS. Early and midterm results are comparable with those of classic methods of myocardial revascularization. Conversion to full sternotomy is quite easy and safe, should the necessity arise.

Comparison of off-pump versus conventional coronary revascularization.

Between May 1999 and August 2001, 231 patients underwent off-pump coronary bypass, of whom 171 required revascularization of the anterior vessels of the heart. They were compared with a group matched for age, sex, and risk factors undergoing revascularization of the same group of vessels under cardiopulmonary bypass. Mortality was comparable in both groups but the incidence of cerebrovascular accident, respiratory insufficiency, and renal failure was less in the off-pump group. Postoperative drainage and blood transfusion requirements were significantly less in the off-pump group. Intensive care and hospital stay were shorter in the off-pump patients. A considerable number of patients are potential candidates for off-pump coronary bypass, the only contraindication being technical limitations. Follow-up at 6 to 24 months indicates that off-pump coronary bypass can be performed safely with a decrease in morbidity and more rapid return to normal lifestyle.