[show abstract][hide abstract] ABSTRACT: Cardiopulmonary bypass (CPB) contributes to the secretion of anti-inflammatory cytokines that mediate the inflammatory response observed during open heart surgery. In addition to many factors, type of anesthesia management affects immune response and central nervous system in cardiac surgery. The aim of this study was to assess the effect of propofol versus desflurane anesthesia on systemic immune modulation and central nervous system on patients undergoing coronary artery bypass grafting. Forty patients undergoing elective coronary artery bypass graft surgery with CPB were included in this prospective randomized study. Patients were allocated to receive propofol (n = 20) or desflurane (n = 20) for maintenance of anesthesia. The blood samples for IL-6, IL-8, TNF-α, and S100β were drawn just prior to the operation before the induction of anesthesia, second before cardiopulmonary bypass, third after CPB, fourth 4 h postoperatively at the ICU. Major finding in our study is that S100β levels were lower in propofol group when compared to desflurane anesthesia. And also immune reaction was less in patients exposed to desflurane anesthesia when compared to propofol anesthesia as indicated by lower plasma concentrations of IL-8 and IL-6. Propofol is more preferable in terms of S100β for anesthetic management for CABG.
[show abstract][hide abstract] ABSTRACT: In this randomized controlled study, we investigated the effects of autologous Hemobag blood transfusion (AHBT) and allogenic blood transfusion (ABT) in off-pump coronary artery bypass (OPCAB) surgery.
Sixty patients who underwent surgery between February 2008 and August 2008 were randomized into 2 groups. The AHBT group (n = 30) consisted of patients who received autologous Hemobag blood transfusion, and the ABT group (n = 30) consisted of patients who received allogenic blood transfusion. All patients underwent OPCAB via sternotomy. The time to extubation, chest tube drainage volume, postoperative white blood cell counts, amount of blood transfusion, sedimentation rate, C-reactive protein concentration, postoperative temperature, and the presence of atelectasis were recorded in the intensive care unit.
Intraoperative bleeding and fluid resuscitation were similar in the 2 groups (P > .05); however, there were significant decreases in postoperative blood loss, extubation period, postoperative white cell counts, sedimentation rate, incidence of atelectasis, C-reactive protein, and fever in the AHBT group compared with the ABT group (P < .05). The rate of atrial fibrillation in the AHBT group tended to be lower than in the ABT group.
Autologous blood transfusion in OPCAB may be beneficial in certain cardiac surgery patients; however, these beneficial effects require further study to be proved.
Heart Surgery Forum 10/2009; 12(5):E261-5. · 0.63 Impact Factor
[show abstract][hide abstract] ABSTRACT: We compared the effectiveness of continuous transcutaneous electrical nerve stimulation (TENS) and intermittent TENS in the management of pain after coronary artery bypass grafting (CABG).
We randomized 100 patients who had undergone median sternotomy for CABG into 4 groups with 25 patients each: (1) continuous TENS (CTENS) and pharmacologic analgesia, (2) intermittent TENS (ITENS) and pharmacologic analgesia, (3) placebo TENS (PTENS) and pharmacologic analgesia, and (4) pharmacologic analgesia alone (control). We studied these groups with regard to the relief of postoperative pain during the first 24 hours. For each patient we recorded the following: demographic characteristics; vital signs; intensity of pain with a visual analogue scale (VAS) before treatment (VAS(0)), at the 12th hour (VAS(12)), and at the 24th hour (VAS(24)); and analgesic intake.
The groups were comparable with respect to age, sex, and body mass index at baseline. Mean VAS scores decreased within each group; however, the mean VAS(12) and VAS(24) scores decreased significantly in the CTENS and ITENS groups, compared with PTENS and control groups (P < .05). We found no significant difference between the CTENS and ITENS groups with respect to decreasing VAS(12) and VAS(24) scores (P > .05). Narcotic intake was significantly less in the CTENS and ITENS groups than in the control and PTENS groups (P < .01). Furthermore, narcotic requirements were significantly lower in the CTENS group than in the ITENS group (P < .01).
CTENS and ITENS after median sternotomy for CABG decreased pain and reduced narcotic requirements more than in the PTENS and control treatments during first postoperative 24 hours. Neither CTENS nor ITENS is superior to the other in decreasing pain; however, CTENS leads to a greater reduction in the narcotic requirement than ITENS.
Heart Surgery Forum 10/2009; 12(5):E266-71. · 0.63 Impact Factor
[show abstract][hide abstract] ABSTRACT: Gastrointestinal ischemia (GII) after heart surgery is a rare but devastating condition. The aim of this study was to compare the occurrence of GII after coronary artery bypass grafting (CABG) performed off-pump (OPCAB) vs on-pump (ONCAB).
We retrospectively evaluated 2625 adult patients who underwent isolated coronary artery surgery during a 6-year period. The OPCAB group included 658 patients and the ONCAB group 1967 patients. Patients were evaluated, and GII, morbidity, and mortality in the 2 groups were compared.
GII developed in 0.4% (7 of 1967) patients in the ONCAB group and in 0.2% (1 of 658) patients in the OPCAB group (P = .28). Mortality rates due to GII were 0.2% (4 of 1967) in the ONCAB group, and no deaths occurred in the OPCAB group (P < .04). Postoperative atrial fibrillation incidence with GII was 100% (7 of 7) in ONCAB group and 0% (0 of 1) in the OPCAB group (P < .01).
Compared to ONCAB, the OPCAB procedure has lower GII related mortality rates, which is an important cause of morbidity and mortality in the postoperative period of CABG surgery.
Heart Surgery Forum 05/2009; 12(2):E79-84. · 0.63 Impact Factor
[show abstract][hide abstract] ABSTRACT: Pseudoaneurysm of the abdominal aorta as a result of blunt trauma is uncommon, due in part to its protected position in the retroperitoneum. This report describes the case of a 58-year-old man with atheromatous aortic plaques with isolated infrarenal abdominal aortic pseudoaneurysm was diagnosed 5 weeks after blunt trauma. ÖZET Künt travmaya bağlı olarak gelişen abdominal aorta pseudoanevrizması retroperitonda aortanın bulunduğu pozisyon nedeniyle çok sık değildir. Bu vakada künt travmadan 5 hafta sonrası aterom palklı aortasında pseudoanevrizma gelişen 58 yaşında erkek hastayı tanımladık.
[show abstract][hide abstract] ABSTRACT: We report on the clinical and molecular findings of a patient who presented alopecia, epicanthus, micrognathia, retrognathia, high arched palate, hypertelorism, Chiari type I malformation, mixed-type hearing loss but with normal heartbeat Q-T interval, malformed earlobes, down-slanted palpebral fissures, downturned corners of the mouth, syndactyly, atopic eczema, and seizures. The patient was a male adult, 23 years old, with short stature (153 cm) and low weight (50.5 kg), due to severe aortic insufficiency and dilatation of the ascending aorta. Conventional cytogenetic screening did not show any chromosomal gains or losses. Molecular genetic screening was conducted for gene mutations involved in various syndromes; the mutations found included [beta-fibrinogen -455 G>A wt/wt (wt/mut), PAI-1 4G/5G (4G/4G), HPA1 a/b (a/a), MTHFR C677T wt/wt (wt/mut), ACE I/D (I/I), and Apo E E3/E4]. Many clinical and molecular genetics findings overlapped with other conditions associated with arterial tortuosity and arterial aneurysms, including the Marfan, Ehler-Danlos, Shprintzen-Goldberg, and Loeys-Dietz syndromes. Although a diagnosis of Shprintzen-Goldberg syndrome was based on clinical findings and radiographic findings indicate other syndromes, aortic root dilatation seems to be a new symptom, similar to phenotypes of connective tissue disorders. The unique grouping of clinical manifestations in this patient and the molecular genetics findings lead us to suggest that this case could be an example of a previously unrecognized syndrome.
[show abstract][hide abstract] ABSTRACT: We aimed to evaluate whether surgical intracoronary shunt protects myocardium in patients with moderate left ventricular dysfunction (MLVD).
Thirty-nine patients consisted the shunt group and 43 patients consisted the shuntless group. Troponin I, CK, and CK-MB were measured preoperatively, and at 6 and 24h postoperatively. Cardiac enzymes, rate of postoperative atrial fibrillation (AF) and third month ejection fraction (EF) were compared between the groups.
There were no significant differences between the groups for preoperative troponin I, CK, CK-MB, and postoperative CK levels (at 6 and 24h). Postoperative troponin I and CK-MB levels were significantly lower in the shunt group (p<0.001). Although preoperative EF of the patients were not significantly different between groups, the third month EF were significantly increased in both groups, and this increment was significantly higher in the shunt group than the shuntless group. One patient (2.3%) died in the shuntless group whereas there was no death in the shunt group.
Intracoronary shunt has protective effects on myocardium in patients with moderate left ventricular dysfunction.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 10/2008; 34(5):1000-4. · 2.40 Impact Factor
[show abstract][hide abstract] ABSTRACT: The aim of this experimental study was to investigate the possible protective effect of dantrolene on neuronal injury induced by aortic ischemia/reperfusion (I/R).
Nineteen rabbits were divided into three groups: sham (group 1, n = 5, no I/R), control (group 2, n = 7, only I/R) and dantrolene (group 3, n = 7, dantrolene + I/R). Abdominal aortic occlusion between the renal arteries and iliac bifurcations was carried out for 30 min. The spinal cord functions of the subjects were assessed using the Tarlov Scale. Blood and cord tissue samples were taken for biochemical and histopathological evaluation.
Tarlov scores in group 3 were significantly higher than in group 2 ( P < 0.05). In group 3, the MDA levels of the spinal cord decreased significantly compared to those of group 2 ( P < 0.05). In rabbits with I/R (group 2), the GSH levels of the spinal cord decreased significantly compared to those of group 1 ( P < 0.01), but dantrolene pretreatment significantly prevented a decrease in GSH levels. Histopathological examination showed that group 3 had less vascular proliferation, hemorrhage, edema and neuron loss than group 2.
It was concluded that dantrolene applied after ischemia might help protect the spinal cord against ischemia/reperfusion injury.
The Thoracic and Cardiovascular Surgeon 10/2008; 56(7):406-11. · 0.93 Impact Factor
[show abstract][hide abstract] ABSTRACT: Re-mediastinoscopy can be a difficult procedure due to fibrosis in the mediastinum. We have investigated the effect of an anti-adhesive barrier agent "hylan B gel" on the formation of adhesions after dissection in the superior mediastinum in a rat model.
The study was conducted in 70 male Sprague-Dawley rats weighing 300 g. The strap muscles were divided by a midline cervical incision. The anterior and lateral aspects of the trachea were dissected to the level of the carina. Hylan B gel (Sepragel Sinus, Genzyme Company, Redgefield, NJ, USA) was used to create an anti-adhesive barrier. The rats who were subjected to surgery were sacrificed on postoperative days 14 and 28. All rats were previously divided into 5 groups: Sham group (n = 10); Group 1 (n = 15) surgery alone, sacrificed on day 14; Group 2 (n = 15) surgery and Sepragel, sacrificed on day 14; Group 3 (n = 15) surgery alone, sacrificed on day 28; Group 4 (n = 15) surgery and Sepragel, sacrificed on day 28. Histopathological analysis was performed to study the effect of the anti-adhesive agent. Scores were calculated based on collagen fibrosis, fibroblasts, granulation tissue, muscle alterations/inflammation, histiocytes, mononuclear giant cells, inflammation and vascular proliferation.
Collagen fibrosis and fibroblast scores, which represent adhesions, were significantly higher in Groups 1, 2, 3, 4 than in the Sham group ( P < 0.01). The degree of adhesions on day 14 was found to be higher in Group 1 compared to Group 2 ( P < 0.01). Adhesions on day 28 were higher in Group 3 compared to Group 4 ( P < 0.01). There were no differences between groups with regard to foreign body reactions ( P > 0.05).
Adhesions causing technical difficulty during re-mediastinoscopy can be reduced by the application of anti-adhesive agents during the primary procedure.
The Thoracic and Cardiovascular Surgeon 04/2008; 56(3):158-61. · 0.93 Impact Factor
[show abstract][hide abstract] ABSTRACT: An intra-aortic balloon pump (IABP) is frequently used as a mechanical support during the treatment of low cardiac output syndrome. The use of a sheath during IABP treatment can be associated with ischaemic complications in the extremities. The aim of our study was to determine the isolated role of sheaths in the development of vascular complications following IABP catheterisation.
We evaluated a total of 81 patients who had received an IABP for haemodynamic stability, between January 2003 and October 2007, following cardiovascular surgery. To eliminate surgical-related variables, only patients with IABPs and size 8.5 or 9 French catheters (inserted by experienced cardiovascular surgeons using the percutaneous Seldinger technique) were included in the study. To eliminate patient-related variables, patients with a known risk factor for either thrombosis, embolus or peripheral arterial disease were excluded from the study.
The patients were divided into two groups: Group 1 (sheathed catheter group; n=42), Group 2 (sheathless catheter group; n=39). Ischaemic complications were observed in a total of five patients. Four of these patients were from Group 1 and one was from Group 2.
Sheathed catheterisation was found to increase the risk of vascular complications in patients who underwent IABP application. Therefore sheathless catheterisation is recommended for IABP application.
Advances in Therapy 04/2008; 25(3):225-30. · 2.13 Impact Factor
[show abstract][hide abstract] ABSTRACT: We evaluated the surgical results of off-pump coronary artery bypass grafting (OPCAB) performed within the first 12 h of infarction in patients with acute myocardial infarction. From January 2005 to January 2007, emergency coronary artery bypass grafting without cardiopulmonary bypass was performed in 56 patients with acute coronary syndromes. The mean age was 62.9 (range, 51-86) years. All patients underwent OPCAB via sternotomy. An average of 2.5 +/- 1.1 grafts per patient were performed. The mortality rate was 7.1% (4 of 56 patients). One patient suffered from postoperative stroke (1.7%), and 3 (5.3%) needed hemofiltration for acute renal failure. Postsurgery elective coronary angiography (n = 21) showed no significant stenosis. These results indicate that emergency OPCAB can be applied to patients with acute myocardial infarction with low morbidity and mortality and excellent early results.
Heart Surgery Forum 02/2008; 11(1):E13-6. · 0.63 Impact Factor
[show abstract][hide abstract] ABSTRACT: Coronary arteriovenous fistula is an uncommon anomaly, representing an incidental finding in 0.1% to 0.2% of coronary angiograms. A 46-year-old man presented with a five-month history of palpitation and atypical stabbing chest pain on exertion and/or at rest. The electrocardiogram showed normal sinus rhythm, incomplete right bundle branch block with normal axis, and borderline left atrial abnormality. Echocardiography showed normal left ventricular function, mild left ventricular hypertrophy, moderate left atrial enlargement with mild mitral insufficiency, and moderate right atrial enlargement with mild-moderate tricuspid valve regurgitation. During exercise test, frequent ventricular ectopic beats were noted and the patient complained of atypical chest pain. Scintigraphy showed an ischemic defect in the inferior wall of the left ventricle. On coronary angiography, the right coronary artery and left anterior descending artery were normal, but the circumflex coronary artery was connected to the pulmonary artery through a congenital fistula. The patient refused any further intervention for fistula closure.
Turk Kardiyoloji Dernegi arsivi: Turk Kardiyoloji Derneginin yayin organidir 02/2008; 36(8):552-4.
[show abstract][hide abstract] ABSTRACT: We present a case with median and radial nerve injuries together with brachial artery occlusion after a dog bite that is seen rarely in the literature. A 26 year-old man was admitted to our emergency department with a complaint of dog bite and weakness of fingers at the left upper extremity. There were bite impressions at the left arm. The physical examination of the patient revealed no brachial and radial artery pulse. The neurological examination revealed radial and median nerve deficits. The patient underwent a thromboembolectomy operation following laboratory and radiological evaluations. The nerve injuries were evaluated as partial and medical treatment was administered.
[show abstract][hide abstract] ABSTRACT: Abdominal vascular injuries are among the most challenging and lethal injuries in traumatized patients. Inferior vena cava is the most frequently injured vein during the blunt or penetrating trauma. The primary repair, end to end anastomosis, endovascular stenting, or graft interposition with autogenous or synthetic materials should be considered in selected cases. However, in cases the synthetic graft was preferred, intestinal contaminations due to small or large bowel perforation accompanying the trauma have been cited as a limiting factor for the use of such grafts as in the current case. However, a previous history of lower leg variceal surgery prevents the use of great saphenous vein as a graft. So in the present case, the authors report a patient with inferior vena cava injury repaired with autogenous peritoneo-fascial graft. The authors have used APF graft in traumatic inferior vena cava injury for the first time.
Vascular and Endovascular Surgery 01/2008; 42(3):272-5. · 0.88 Impact Factor
[show abstract][hide abstract] ABSTRACT: We investigated the effects of preoperative administration of beta-blockers on the incidence of atrial fibrillation (AF) after cardiothoracic surgery and the resulting morbidity and mortality.
We retrospectively evaluated 181 patients who underwent operations between May 2004 and December 2007. We divided the patients into 2 groups according to their preoperative use beta-blockers. Group A (n = 89) consisted of patients who did not receive beta-blockers, and group B (n = 92) consisted of patients who received 50 mg metoprolol succinate daily. All patients underwent on-pump coronary artery bypass grafting (CABG) via sternotomy.
Atrial sizes and the baseline clinical and laboratory data were similar for the 2 groups. The 2 groups were also similar with respect to the numbers of grafts per patient, preoperative ejection fractions, cross-clamp times, cardiopulmonary bypass times, and postoperative inotrope use (P > .05). AF occurred in 39 (21.5%) of the 181 patients after the operation. Postoperative AF occurred in 30 (33.7%) of the group A patients and in 9 patients (9.7%) in group B (P < .05).
Postoperative AF increases the rates of morbidity and mortality and the length of hospital stay after CABG. The prophylactic use of beta-blockers decreases the rate of postoperative AF and thus AF-related complications.
Heart Surgery Forum 01/2008; 11(3):E159-63. · 0.63 Impact Factor
[show abstract][hide abstract] ABSTRACT: We investigated the effectiveness of transcutaneous electrical nerve stimulation (TENS) therapy on pain during the first 24 hours after a cardiac surgical procedure.
A total of 60 patients who had undergone median sternotomy (MS) for coronary artery bypass graft (n = 55) or valve repair surgery (n = 5) were randomized to receive TENS and pharmacologic analgesia, placebo TENS and pharmacologic analgesia, or pharmacologic analgesia alone (control group). For each group we recorded severity of pain, analgesic intake, and pulmonary complications. Pethidine HCL and metamizol sodium were administered for postsurgical analgesia.
Pain after MS was measured on a 10-point visual analogue scale (VAS). Mean scores in the TENS, placebo TENS, and control groups, respectively, were 5.70 +/- 1.78, 5.75 +/- 1.83, and 5.95 +/- 1.63 before treatment (P >.05); 2.40 +/- 1.18, 3.90 +/- 1.48, and 3.55 +/- 1.60 on the 12th hour of the intervention (P < .05); and 1.25 +/- 0.91, 2.30 +/- 1.34, and 2.15 +/- 1.13 on the 24th hour of the intervention (P < .05). The mean VAS scores decreased within each group (P < .05). However, the mean VAS scores decreased much more significantly in the TENS group (P < .05). Metamizol sodium intake was 1.05 +/- 0.39 g, 2.30 +/- 1.08 g, and 2.90 +/- 1.20 g and pethidine HCL intake was 17 +/- 16.25 mg, 57 +/- 21.54 mg, and 51.50 +/- 18.99 mg, respectively, in the TENS, placebo TENS, and control groups. Metamizol sodium and pethidine HCL intake was least in the TENS group (P < .05). Postoperative complications were observed in 6 (10%) of patients. The most frequent complication was atelectasia.
TENS was more effective than placebo TENS or control treatments in decreasing pain and limiting opioid and nonopioid medication intake during the first 24-hour period following MS.
Heart Surgery Forum 01/2008; 11(5):E300-3. · 0.63 Impact Factor
[show abstract][hide abstract] ABSTRACT: We describe the case of a 37-year-old patient with mycotic aneurysm of the right peroneal artery associated with episodes of endocarditis. There are only 7 cases of mycotic aneurysms of the crural arteries reported in the literature. To the best of our knowledge, this is the first reported case of a mycotic aneurysm of the peroneal artery in an adult.
Journal of Clinical Ultrasound 06/2007; 35(6):344-6. · 0.70 Impact Factor