Aortic Valve Neocuspidization Procedure Provides Better Postoperative Outcomes When Compared to Rapid Deployement Aortic Valves.

BACKGROUND: The aim of this study was to compare the early results of rapid deployment aortic valves (RD-AVR) and aortic valve neocuspidization (AVNeo) techniques. METHODS: Between December 2019 to May 2022, 104 patients were operated on with aortic stenosis by RD-AVR (N = 52) and AVNeo (N = 52) techniques. Patients with isolated aortic valve stenosis and aortic stenosis concomittant with planned other cardiac surgeries were included. RESULTS: The mean age of patients in the RD-AVR and AVNeo groups were 67.4 ± 7.8 vs. 62.9 ± 8.7, respectively. Aortic cross-clamp time in the RD-AVR group was 56.7 ± 23.3 minutes, while it was 104.1 ± 27.9 minutes in the AVNeo group (P < 0.001). Cardiopulmonary bypass time in the RD-AVR group and in the AVNeo group was 89.8 ± 27.6 minutes and 141.8 ± 36.7 minutes, respectively (P < 0.001). Permanent pacemaker become necessary in four patients in the RD-AVR group secondary to type 2 AV block. Paravalvular leak was observed in six patients, who underwent RD-AVR, while grade 2 central aortic regurgitation was observed in one patient in the AVNeo group. Hospital mortality was 8% in the RD-AVR group and 6% in the AVNeo group (P = 0.696). CONCLUSIONS: AVNeo procedure is a feasible technique in all age groups of patients with successful hemodynamic results in the early postoperative period and with the advantage of not requiring anticoagulants. It also can be applied with other cardiac surgical interventions.

Robotic-assisted beating heart mitral valve surgery: Preliminary report.

INTRODUCTION: Robotic mitral valve surgery is a challenging issue, particularly in patients who are not suitable for aortic cross-clamping. In this study, we aimed to determine the feasibility and benefits of robotic, beating heart mitral valve surgery. METHODS: From February 2019 to February 2022, 17 patients underwent robotic beating heart mitral valve surgery. Fourteen of the patients had previous cardiac surgery. The mean age was 58.1 ± 10.3. Dense periaortic adhesions, heavily calcified aorta, and low ejection fraction were retained as indications for beating heart surgery. RESULTS: Mitral valve replacement was performed in 14 patients. Mitral ring annuloplasty was performed in two patients with low ejection fraction (EF). A severe paravalvular leak was repaired in one patient. Additional tricuspid annuloplasties were performed in three patients. Cardiopulmonary bypass time were 185.6 ± 55 min. There were no cases of conversion to sternotomy or thoracotomy. No cerebrovascular event occurred in the follow-up. One patient died as a result of secondary hepatorenal syndrome and multiorgan failure. CONCLUSIONS: Robotic beating heart mitral valve surgery is a feasible and effective technique with favorable early and mid-term results, especially in patients who are not suitable for aortic cross-clamping, secondary to periaortic adhesions, severe aortic calcifications, and low ejection fraction.

Long-term results of endovascular intervention with unibody bifurcation endograft for elective abdominal aortic aneurysm management.

Unibody bifurcated endografts have the advantage of reducing the operative time, avoiding migration and iliac limb dislocation in patient with abdominal aortic aneurysm (AAA). We report our long-term experience in patients who underwent endovascular aortic repair (EVAR) due to infrarenal AAA with Endologix AFX® endograft system. Between January 2013-December 2018, 68 patients with infrarenal AAA had EVAR procedure with Endologix AFX® endograft system. Mean follow-up was 40.4 ± 19.5 months, and all patients had computed tomography periodically, with colored Doppler ultrasonography (CDUS) every six months. Mean age was 68.5 ± 7.1 years and, 63 (92.6%) patients were male. Early mortality, renal complications, stent-graft migration and cardiac complications were not seen in early post-operative period. There was no early mortality in the group and no conversion to open repair. In long-term follow-up 12 patients (17.6%) had endoleak (5 with type II, 7 with type III). Overall survival estimated by Kaplan-Meier analysis was 94.1% at 1 year, 85.2% at 2 years, 74.1% at 3 years and 54.0% at 5 years. Freedom from second intervention and conversion was 98.4% at 1 year, 95.3% at 2 years, 93.3% at 3 years and 87.4% at 5 years. Endologix AFX® endograft provides a fast, safe and effective endograft for the early period, therefore it seems more suitable for elderly and comorbid patients. This endograft has low reintervention rates however according to our results, aneurysms larger than 6 cm may have more sideway displacement possibility and by this way type III endoleak. Proper patient selection and sufficient overlap are the key issues. Close monitoring is mandatory at the follow-up period.

What is the optimal treatment technique for great saphenous vein diameter of ≥10 mm? Comparison of five different approaches.

OBJECTIVE: We aimed to investigate the efficacy and safety of five different treatment approaches in patients with a great saphenous vein (GSV) diameter of ≥10 mm. METHODS: A total of 697 extremities of 671 patients who were diagnosed with a GSV diameter of ≥10 mm underwent conventional surgery or endovenous therapy for symptomatic varicose veins between January 2012 and January 2017 were included in this retrospective study. All extremities included in the study were divided into five groups as follows: high ligation + stripping (HLS), radiofrequency ablation (RFA), cyanoacrylate closure (CAC), endovenous laser ablation (EVLA) procedures at 980 nm and 1,470 nm wavelengths. RESULTS: Among all groups, despite lower recurrence rates in HLS group than the other groups, there was no significant difference at 6 months and 1 year among the HLS, EVLA at 1,470 nm wavelength, and RFA groups. The recurrence rates of EVLA at 980 nm wavelength and CAC groups were found higher than other groups. CONCLUSIONS: In conclusion, our study results show that although HLS seems to be an effective method for the treatment of a GSV diameter of ≥10 mm with a low recurrence rate, it does not statistically significantly differ from EVLA at 1,470 nm wavelength and RFA. Therefore, we believe that EVLA at 1,470 nm wavelength and RFA can be preferred over HLS with low pain scores in this patient population.

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.

The C-reactive protein/albumin ratio as a new predictor for postoperative atrial fibrillation after coronary artery bypass graft surgery.

BACKGROUND: This study aimed to investigate the predictive significance of C-reactive protein/albumin ratio for postoperative atrial fibrillation occurrence in patients who were underwent coronary artery bypass graft surgery. METHODS: Among 830 patients who underwent coronary artery bypass grafting with cardiopulmonary bypass between January 2016 and February 2020, 137 patients with no prior arrhythmia history were included in this cross sectional study. RESULTS: One hundred and thirty-seven (16.5%) patients developed atrial fibrillation in postoperative period. Patients who experienced postoperative atrial fibrillation were more likely to be older but displayed similar rates of diabetes mellitus, hypertension, hypercholesterolemia, cerebrovascular disease, peripheral vascular disease and chronic obstructive pulmonary disease. For prediction of postoperative atrial fibrillation development, diagnostic odds ratio (OR) and positive likelihood ratio of C-reactive protein/albumin ratio value (OR: 1.854; confidence interval [CI]: 1.598-2.142; P < .001) was higher than serum C-reactive protein and albumin levels. (OR: 1.159; CI: 1.115-1.201; P < .001; OR: 0.438; CI: 0.258-0.865; P < .001, respectively). Which means that C-reactive protein/albumin ratio may detect postoperative atrial fibrillation development better C-reactive protein itself. CONCLUSION: Based on our results, patients who developed postoperative atrial fibrillation after coronary artery bypass grafting had significantly higher preoperative C-reactive protein/albumin ratio levels than patients who remained in normal sinus rhythm in the postoperative period. Also, higher C-reactive protein/albumin ratio value was one of the independent predictive factors for postoperative atrial fibrillation. Therefore, we concluded that evaluating preoperative C-reactive protein/albumin ratio value might provide early identification of patients with high risk for postoperative atrial fibrillation.

Surgical treatment of a left ventricular apical thrombus via robotic surgery.

Left ventriculotomy for thrombus removal is usually associated with a high incidence of cardiac arrhythmias and decreased ejection fraction. A 51-year-old male patient was admitted to the emergency department with loss of consciousness. Transthoracic echocardiography revealed a 20 × 24-mm left ventricular apical nonpedunculated thrombus with normal ejection fraction. A persistent thrombus was shown on magnetic resonance imaging despite anticoagulation therapy. Robotic surgery was planned to avoid possible ventriculotomy-related complications, considering the preoperative neurological condition of the patient. The thrombus was completely removed surgically through left atriotomy using the DaVinci robotic system. In conclusion, robotic surgery can be used in the surgical treatment of left ventriculotomy thrombus in selected patients.

Visceral oxidative stress during antegrade cerebral perfusion and lower body circulatory arrest.

Background: Antegrade cerebral perfusion (ACP) is the standard neuroprotection method in aortic surgery. Visceral ischemia during this modality brings out some controversies. We aimed to investigate the level of oxidative stress at the lower part of body during ACP. Methods: Thirty consecutive patients underwent elective ascending aorta and hemiarch repair with ACP (without distal perfusion) were enrolled to study. The patients were enrolled into two groups which were based on 50th percentile of ACP duration (15 patients in each group). Blood samples from inferior vena cava at the end of ACP were collected to assess oxidative stress with biochemical parameters such as lactate, advanced oxidative protein products (AOPP) and thiol levels. Clinical follow-up parameters regarding to visceral and spinal cord ischemia were recorded. There were no clinical complications at both groups. Results: Mean ACP duration for the study group was found to be 15 min (10-28 min). Lactate, AOPP, and thiol levels were found to be similar between two groups. Furthermore, correlation analysis revealed only low level of correlation between ACP duration and lactate levels. Renal and liver function tests were found to be similar between groups. Conclusions: Immediate parameters (such as lactate, AOPP, and thiol) that show alterations in response to oxidative stress were not affected by the duration of ACP. Therefore, ACP without distal perfusion may not be harmful when conducted for short duration.

Assessment of Radial Artery Graft Patency in Symptomatic Patients.

BACKGROUND: The purpose of this study is to evaluate the patency of radial artery (RA) grafts consistent with the target vessel characteristics. METHODS: Between October 2001 and January 2012, 83 symptomatic patients or patients with positive ischemic test results underwent coronary angiography following coronary artery bypass grafting. Of these, 68 patients with 81 RA grafts at a mean 49.2 ± 31.9 months (range, 1-137 months) were evaluated. According to the location and degree of proximal stenosis, 5-year graft patency was determined by Kaplan-Meier analysis. The relationships between RA graft patency and degree of proximal stenosis, target vessel location, and inflow characteristics of grafts were assessed by means of Cox proportional hazard models. RESULTS: Mean age of the patients was 56.4 ± 10.2 years. The period between the operation and postoperative coronary angiography was 49.2 ± 31.9 months (range, 1-137 months; median, 48.8 months). There was no impact on RA patency with regard to preoperative characteristics of the patients. RA patency was higher for left coronary system compared with right system (p = 0.038; 85.5 vs. 65.4%). In addition, patency rate was statistically higher for the proximal stenosis ≥ 90% (odds ratio, 3.65; 95% confidence interval, 1.20-11.07; p = 0.018). Kaplan-Meier patency analysis showed a patency of RA as 79.2% at 5 years. CONCLUSION: RA graft patency differs with degree of preoperative native coronary artery stenosis and location of target vessel. RA grafts to not severely stenosed (< 90%) coronary system and to the right coronary territory carry a remarkably high risk of graft failure.

Glasgow aneurysm scores in patients undergoing open surgical procedure for aortic aneurysm.

BACKGROUND: To assess the applicability of the Glasgow aneurysm score (GAS) in patients with aortic aneurysm undergoing an elective open surgical procedure in our hospital. MATERIALS AND METHODS: A total of 105 patients undergoing elective open surgical procedure between January 2006 and June 2012 were evaluated retrospectively. Glasgow aneurysm score (GAS) was calculated as age+7 points for myocardial disease, +10 points for cerebrovascular disease, and +14 points for renal disease. The best cut-off value for GAS was determined using the ROC curve analysis. RESULTS: The hospital mortality rate was 3.8% (4 patients). GAS was significantly lower in patients who survived the operation (76.05 ± 14.71 vs. 92.0 ± 10.8 respectively, p = 0.031). The ICU stay was also significantly lower in patients who survived the operation (2.37 ± 5.23) compared to the nonsurvivors (25.67 ± 13.80, p = 0.001). No significant difference was observed regarding age, duration of hospital stay, and aortic diameter. The area under the ROC curve was 0.818 and for a 100% sensitivity rate, the cut-off value for GAS was 77.5 with a 58.4% specificity rate (p = 0.031). All patients with a GAS < 77.5 were alive after surgery. CONCLUSION: The GAS appears to be a reliable clinical predictor for in hospital mortality following elective repair of abdominal aortic aneurysm following open surgical procedure.

A Unique Emotional Surgery: Removal of Unexploded Ordnance in a Patient With Vascular Injury.

Cases of embedded unexploded ordnance are extremely rare and pose a risk to bystanders and health providers. A patient arrived at the Role 2 medical facility in the Turkish army, whose left arm was amputated due to a terrorist attack and major hemorrhages had been halted by clamping of the left subclavian artery and vein. A piece of metal wire running from the lateral chest wall was detected as an unexploded ordnance piece and it was removed surgically. In these challenging cases, safety principles should be acknowledged. Highlighting the basic precautions is important for similar scenarios and increases awareness of the utmost importance.

Diagnostic criteria for Buerger's disease: International Consensus of VAS - European Independent Foundation in Angiology/Vascular Medicine.

Buerger's disease (BD) remains a debilitating condition and early diagnosis is paramount for its effective management. Despite many published diagnostic criteria for BD, selective criteria have been utilized in different vascular centers to manage patients with BD worldwide. A recent international Delphi Consensus Study on the diagnostic criteria of BD showed that none of these published diagnostic criteria have been universally accepted as a gold standard. Apart from the presence of smoking, these published diagnostic criteria have distinct differences between them, rendering the direct comparison of patient outcomes difficult. Hence, the expert committees from the Working Group of the VAS-European Independent Foundation in Angiology/Vascular Medicine critically reviewed the findings from the Delphi study and provided practical recommendations on the diagnostic criteria for BD, facilitating its universal use. We recommend that the 'definitive' diagnosis of BD must require the presence of three features (history of smoking, typical angiographic features and typical histopathological features) and the use of a combination of major and minor criteria for the 'suspected' diagnosis of BD. The major criterion is the history of active tobacco smoking. The five minor criteria are disease onset at age less than 45 years, ischemic involvement of the lower limbs, ischemic involvement of one or both of the upper limbs, thrombophlebitis migrans and red-blue shade of purple discoloration on edematous toes or fingers. We recommend that a 'suspected' diagnosis of BD is confirmed in the presence of a major criterion plus four or more minor criteria. In the absence of the major criterion or in cases of fewer than four minor criteria, imaging and laboratory data could facilitate the diagnosis. Validation studies on the use of these major and minor criteria are underway.

Surgical Correction of a Complex Aorto-Mitral Pathology.

Pseudoaneurysm of mitral-aortic intervalvular fibrosa is a rare entity related to mostly infective endocarditis and surgical trauma of aortic valve. Its diagnosis may be missed following trans-thoracic echocardiographic assessment. Therefore, further imaging investigation such as transesophageal echocardiography and computed tomographic angiography may play a key diagnostic role. Here we present the successful surgical treatment of a 30- year-old male patient referred for surgical treatment of mixed severe calcific aortic valve disease and apparently without additional anatomical abnormalities.

Cardiovascular Surgeons' Medical Perspectives Regarding Social Media Usage: a Survey Analysis.

INTRODUCTION: We aimed to evaluate the use of social media among cardiovascular surgery specialists and their respective perspectives. METHODS: In total, 173 cardiovascular surgeons were reached through an online survey. The surgeons surveyed were cardiovascular surgery specialists. The questionnaire consisted of 33 questions, including closed-ended and open-ended questions about social media. RESULTS: We found that 73.4% of the participants think that social media facilitates the communication of the patient with the doctor, and 87.9% think that social media increases the publicity of the physician. Furthermore, 80.9% of the participants believe that informing through social media creates information pollution. We found that personal use of Instagram was more common in state hospital cardiac surgeons. The number of patients who contacted surgeons in private hospital for surgery via social media were found to be statistically significant, and it was found that this group benefitted more economically. CONCLUSION: Social media usage rates of cardiovascular surgeons were found to be high. On the other hand, it was observed that the rate of surgeons who share medical content is low. However, half the cardiovascular surgeons who participated in the study believe that their colleagues do not fully comply with the ethical rules in medical sharing.

Robotic repair of atrial septal defect with partial pulmonary venous return anomaly: Our 5 year experience.

INTRODUCTION: Partial pulmonary venous return anomalies (PPVRA) were not considered as a good candidate for robotic surgery in early time of robotic cardiac surgery. In this study, we present our experience in patients undergoing robotic atrial septal defect (ASD) and PPVRA surgery. METHODS: Between November 2014 and January 2020, data of 21 patients underwent robotic ASD with PPVRA was collected. Inclusion criterion was presence of right-sided PPVRA with ASD. All operations were performed robotically. RESULTS: The mean age of patients was 26.7 ± 10.3 years. Seventeen patients (81%) had superior-caval ASD with supracardiac PPVRA and double-patch technique was used. Four patients had inferior-caval ASD with intracardiac PPVRA and single-patch technique was preferred. Cross-clamp time and cardiopulmonary bypass time were 92.8 ± 29.6 and 127.8 ± 38.1, respectively. There was no mortality. One patient had atrioventricular-block and required pacemaker. CONCLUSION: Robotic repair of ASD with PPVRA is feasible and effective method as an alternative to conventional surgery.

Robotic redo mitral valve replacement combined with dysfunctional amplatzer plug resection on a beating heart.

Redo-cardiac surgery is associated with high morbidity and mortality rates. Although redo surgery are relative contraindications for robotic surgery, robotic redo mitral valve surgery has been performed with endo-aortic occlusion techniques and on fibrillated heart successfully. Beating heart mitral valve surgery is another well-known option for redo cardiac surgery practice. Robotic beating heart surgery is not well-studied before. As a new point of view to robotic reoperation surgery, herein, we aimed to present a case who underwent redo robotic mitral valve replacement combined with dysfunctioned amplatzer plug resection on a beating heart.

The protective effect of betanin and copper on spinal cord ischemia-reperfusion injury.

Context: Both copper and betanin have been implicated as having significant bioactivity against ischemic damage in a variety of experimental and clinical settings. The aim of this study is to investigate whether betanin and copper have any protective effect on spinal cord in an ischemia-reperfusion (I/R) model in rats.Design: Spraque-Dawley rats were used in four groups: Sham group (n = 7), control group (laparotomy and cross-clamping of aorta, n = 7), betanin treatment group (dosage of 100 mg/kg of betanin administered intraperitoneally (i.p.) 60 min before laparotomy, n = 7), copper sulfate treatment group (administered copper sulfate i.p. at a dose of 0.1 mg/kg/day for 7 days before laparotomy, n = 7). Malondialdehyde (MDA), glutathione (GSH) levels, myeloperoxidase (MPO) and superoxide dismutase (SOD) activity were measured. Terminal deoxynucleotidyl transferase (TdT) dUTP Nick-End Labeling (TUNEL) assay was also performed to evaluate apoptosis.Setting: Kafkas University, Faculty of Medicine, Kars, Turkey.Results: I/R injury was successfully demonstrated with the surgical model. Betanin and copper treatment significantly decreased MDA levels, MPO activity and the number of apoptotic cells in the spinal cord. Betanin and copper treatment significantly increased GSH levels. Copper treatment significantly increased SOD activity, whereas betanin was not as effective. Apoptotic cells were significantly decreased in both treatment groups.Conclusion: I/R injury of the spinal cord can be successfully demonstrated by aortic clamping in this surgical model. Betanin/Copper sulphate has ameliorative effects against operative I/R injury. Low toxicity of those agents makes them ideal targets for clinical research for this purpose.