[Show abstract][Hide abstract] ABSTRACT: Objective:
The aim of this study was to investigate the midterm results of Remedy(®) biodegradable stents, which have recently come into use for lower-extremity arterial occlusive disease.
Sixty-five patients, who underwent surgical intervention in various cardiovascular surgery clinics throughout Turkey, were included in the study. The total number of stents used was 92. The mean age of the patients was 64.11 ± 24.13 years (20-82), and 16 (24.6%) were female. The mean number of stents per patient was 1.42, and 70.7% of the lesions were TASC type A. Patients were followed for a mean of 32 months. Sixty-five patients underwent a control examination using either digital subtraction angiography or colour Doppler ultrasonography. In-stent restenosis was defined as ≥ 50% stenosis in the stent area in asymptomatic patients. The procedure was repeated if the degree of stenosis was ≥ 70%.
During the follow-up period, restenosis (≥50% stenosis) was observed in seven patients (10.7%). The patency rate after secondary intervention was 100%, and there was no loss of limbs in any patient. Restenosis was observed in six patients with superficial femoral artery stents, and in one patient with a popliteal arterial stent.
Our experience shows that Remedy(®) biodegradable peripheral stents were safe and effective in our cohort of patients, with acceptable patency rates.
[Show abstract][Hide abstract] ABSTRACT: Aim: The mortality rate in coronary artery bypass surgery increases with advancing patient age. This study was conducted to analyse and compare older (above 65 years of age) with younger patients (below 65 years of age) who had undergone coronary artery bypass surgery and had an intra-aortic balloon pump (IABP) inserted, comparing hospital stay, clinical features, intensive care unit stay, postoperative complications, and morbidity and mortality rates.
Methods: One hundred and ninety patients who had undergone coronary artery bypass surgery and required IABP support were enrolled in this study. Patients younger than 65 years of age were considered young, and the others were considered old. Ninety-two patients were young and 98 were old. The mortality rates, pre-operative clinical characteristics, postoperative complications, and duration of intensive care unit and hospital stays of the groups were compared. The risk factors for mortality and complications were analysed.
Results: One hundred and thirty-eight of the patients were male, and the mean patient age was 62.7 ± 9.9 years. The mortality rate was higher in the older patient group than the younger group [34 (37.7%) and 23 (23.4 %), respectively (p = 0.043)]. The cross-clamp time, mean ejection fraction, cardiopulmonary bypass time, and length of stay in the intensive care unit were similar among the groups (p > 0.05). Cardiopulmonary bypass time was the single independent risk factor for mortality in both groups.
Conclusion: In this study, high mortality rates in the postoperative period were similar to prior studies regarding IABP support. The complication rates were higher in the older patient group. Prolonged cardiopulmonary bypass and advanced age were determined to be significant risk factors for mortality.
Full-text · Article · Jul 2015 · Cardiovascular journal of Africa
[Show abstract][Hide abstract] ABSTRACT: Objective:
Acute massive pulmonary embolism (PE) is associated with significant mortality rate despite diagnostic and therapeutic advances. The aim of this study was to analyze our clinical outcomes of patients with acute massive PE who underwent emergency surgical pulmonary embolectomy.
This retrospective study included 13 consecutive patients undergoing emergency surgical pulmonary embolectomy for acute massive PE at our institution from March 2000 to November 2013. The medical records of all patients were reviewed for demograhic and preoperative data and postoperative outcomes. All patients presented with cardiogenic shock with severe right ventricular dysfunction confirmed by echocardiography, where 4 (30.8%) of the patients experienced cardiac arrest requiring cardiopulmonary resuscitation before surgery.
The mean age of patients was 61.8 ± 14 years (range, 38 to 82 years) with 8 (61.5%) males. The most common risk factors for PE was the history of prior deep venous thrombosis (n = 9, 69.2%). There were 3 (23.1%) in-hospital deaths including operative mortality of 7.7% (n = 1). Ten (76.9%) patients survived and were discharged from the hospital. The mean follow-up was 25 months; follow-up was 100% complete in surviving patients. There was one case (7.7%) of late death 12 months after surgery due to renal carcinoma. Postoperative echocardiographic pressure measurements demonstrated a significant reduction (P < 0.001). At final follow-up, all patients were in New York Heart Association class I and no readmission for a recurrent of PE was observed.
Surgical pulmonary embolectomy is a reasonable option and could be performed with acceptable results, if it is performed early in patients with acute massive PE who have not reached the profound cardiogenic shock or cardiac arrest.
Full-text · Article · Dec 2014 · International Journal of Clinical and Experimental Medicine
[Show abstract][Hide abstract] ABSTRACT: Background
Coronary occlusion techniques during OPCAB may lead to an endothelial damage to the target vessel. The adverse effects of these techniques are well-known, and researches have been trying to find out new materials to occlude the coronary artery without an endothelial damage. In the present study, we investigate to the endothelial damage in the rat aorta which is occluded by Poloxamer 407 gel.
Forty-five rats were randomized in three groups: (1) segment of the aorta was occluded with Poloxamer 407 gel in P 407 group; (2) segment of the aorta was occluded with microvascular clamp in MV clamp group; and (3) no onclusion was available in the Control group. The rats were sacrificed of observation, and a 15mm segment of the aorta was obtained as a specimen. Integrity of the endothelial lining was observed with a scanning electron microscopy.
Scanning electron microscopy revealed a statistically significant difference among the 3 groups (p<0,001) using the SPSS 13.0 test. No difference was found between the Control group and the P 407 group (p=0,059). The differences between MV clamp–Control group (p<0,001) and MV clamp–P 407 group were statistically significant (p<0,002).
We suggest that Poloxamer 407 gel occlusion may be a safer and more effective method compared to the microvascular clamp occlusion.
Full-text · Article · Jan 2013 · Journal of Cardiothoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: Leiomyosarcomas rarely arise from primary veins, especially the great saphenous vein. The present report is about a 67 years old female patient who was having a mass medially above her knee, having mild pain and tenderness while walking, for nearly 4 months. The mass was diagnosed as trombosed varicose vein at an outher center and was referred for the operation. After further investigations done at our instution patient was operated successfully. The pathological examination revealed leiomyosarcoma of the great saphenous vein with free margins. The patient did not have any evidence of distal metastasis at the preoperative period and also revealed no evidence of any recurrence during the 24 months of follow up period.
[Show abstract][Hide abstract] ABSTRACT: Background: In this study, we aimed to investigate the preoperative and operative risk factors in patients undergoing valve replacement for the second time, including the types of valves and surgical methods used.
Methods: Between January 1994 and December 2009, a total of 2089 valve replacements were performed in our clinic, and 182 (112 females, 70 males) of these operations (8.7%) were repeat valve surgeries.
Results: The mean age for repeat surgery was 49.2±27.4 years while the mean time elapsed between the first and second surgeries was 11.8±5.7 years. The follow-up period after repeat surgery was 2.6±1.3 years. Bioprosthesis valves were removed from a total of 142 patients (78%), and mechanical valves were removed from 40 patients (22%). In total, 221 valves were replaced. The total number of valves implanted was 219, and valve repair alone was performed on three patients. Of the valves implanted in repeat surgery, 197 (90%) were mechanical valves. The preoperative echocardiography findings revealed that the major problem (84%) observed was valve dysfunction, followed by infection. Fifteen patients (8.2%) who underwent repeat surgery died during the operation or within the first month afterwards.
Conclusion: Repeat heart valve surgery may be performed using the standard surgical procedures with acceptable mortality. Factors increasing the probability of repeat surgery include emergency interventions and infections; however, pulmonary hypertension is not a factor that increases the probability of repeat valve replacement surgery.
Full-text · Article · Jul 2012 · Turkish Journal of Thoracic and Cardiovascular Surgery
[Show abstract][Hide abstract] ABSTRACT: To examine early results in patients with incision lines closed only along the skin and subcutaneous tissue after removal of the great saphenous vein during coronary artery bypass surgery.
We enrolled 82 patients who underwent elective operations in our clinic between December 2008 and April 2009. The patients had similar demographic characteristics, and the method of incision closure was chosen randomly. Three patients were excluded due to in-hospital mortality. The saphenous incision lines were closed using continuous skin sutures in 41 patients (Group 1) or using continuous subcutaneous sutures followed by continuous skin sutures in 38 patients (Group 2). Patients were followed every day that they were in the hospital, in the first week after being discharged, and at the end of the second month after discharge. The incision lines were evaluated for hematomas, infection, edema, pain and numbness.
During the follow-up performed in-hospital and in the first week after discharge, infection, edema and numbness were observed significantly more often in Group 2 than in Group 1. Hematoma was observed more often in Group 1, and pain was observed more often in Group 2, but neither of these findings reached statistical significance. During the follow-up at the end of the second month after discharge, infection, edema, and numbness were observed significantly more frequently in Group 2.
In patients undergoing saphenous removal using standard procedures, it is sufficient to close the incision line using only skin sutures.
Full-text · Article · Dec 2010 · The Open Cardiovascular Medicine Journal
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to compare the effects of ticlopidine and clopidogrel on the development of neointimal hyperplasia after experimental arterial injury.
This experimental, prospective, randomized controlled study was performed on twenty-seven rabbits, which were divided into three groups, each of which contained nine subjects. Following the development of a balloon catheter injury in the iliac artery, no drugs were administered to Group 1 (control). Group 2 was given ticlopidine, while Group 3 was given clopidogrel. At the end of the 21-day experimental period, arterial sections were evaluated histomorphologically and immunohistochemically with staining using antibodies against platelet derived growth factor beta and basic fibroblast growth factor. Statistical analyses were performed using Chi-Square, Mann Whitney U and one-way ANOVA tests.
At the end of study period, ticlopidine and clopidogrel strongly reduced the development of intimal hyperplasia after arterial injury (54.1%, p<0.001, 53.2%, p<0.001, respectively). No significant difference was observed in terms of intimal and medial areas between the drug-treated groups. Expressions of the basic fibroblast growth factor and platelet derived growth factor beta were significantly lower in the intima of drug treated groups with respect to the control group (p<0.05).
The results of our study suggest that ticlopidine and clopidogrel, which are widely used in antiplatelet treatment in clinics, can similarly prevent the development of intimal hyperplasia after experimental arterial injury.
Full-text · Article · Feb 2010 · Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology
[Show abstract][Hide abstract] ABSTRACT: Metabolic syndrome is a well-known cardiovascular risk factor closely related to increased insulin resistance. This study assessed the effects of metabolic syndrome on early post-operative mortality and morbidity in 100 coronary artery bypass graft (CABG) patients: 50 patients with and 50 without metabolic syndrome. A total of 17 patients were excluded from the analysis as they did not attend follow-up, leaving 51 males (61.4%) and 32 (38.6%) females of mean +/- SD age 60.02 +/- 9.76 years for analysis. Diabetes, hypertension and a high body mass index were significantly more common in patients with metabolic syndrome. A statistically significant relationship was found between metabolic syndrome and surgical wound infection. Non-significant positive correlations were found between metabolic syndrome and post-operative atrial fibrillation, surgical revision due to haemorrhage, ventricular tachycardia and ventricular fibrillation, and prolonged intubation. In conclusion, metabolic syndrome did not affect mortality, but did increase the risk of post-operative surgical wound infection.
Full-text · Article · Feb 2010 · The Journal of international medical research
[Show abstract][Hide abstract] ABSTRACT: Atrial fibrillation (AF) is still the most frequent rhythm disturbance after coronary artery surgery. Our aim was to evaluate the predictive value of preoperative brain natriuretic peptide (BNP) levels for determining postoperative new-onset AF in patients undergoing isolated first-time coronary artery bypass grafting (CABG) using cardiopulmonary bypass (CPB).
We recruited 144 consecutive patients (51 women and 93 men) who underwent isolated CABG. Preoperative and postoperative data were collected. Preoperative BNP levels were measured the day before surgery.
The median preoperative BNP level was 68 pg/mL. Postoperative AF occurred in 36 (25%) of the patients. Univariate analyses showed that both advanced age and median preoperative BNP levels were associated with postoperative AF (63.9 +/- 8 years versus 57.3 +/- 9.8 years, P < .001; 226 pg/mL versus 65.2 pg/mL, P <.001). Both variables remained independent predictors of postoperative AF after multivariate logistic regression analyses. For advanced age, the odds ratio was 1.074 (95% confidence interval [CI], 1.019-1.131; P = .008); for preoperative BNP level, the odds ratio was 1.004 (95% CI, 1.001-1.006; P = .002). A receiver operating characteristic (ROC) curve demonstrated that preoperative BNP level was a predictor of postoperative AF, with an area under the ROC curve of 0.750. A cutoff value of 135 pg/mL for AF demonstrated a 72.2% sensitivity, a 71.2% specificity, a 45.6% positive predictive value, a 88.5% negative predictive value, and a 71.5% accuracy for predicting postoperative AF.
Elevated preoperative BNP levels and advanced age together are significant predictors for the development of postoperative AF in patients undergoing isolated CABG with CPB.
No preview · Article · Sep 2009 · The Heart Surgery Forum
[Show abstract][Hide abstract] ABSTRACT: Compared to the other isolated peripheral aneurysms, multiple peripheral aneurysms are less commonly encountered. We present a rare case of multiple aneurysms involving subclavian, bilateral popliteal and iliofemoral arteries which developed sequentially over a 4-year period. Histopathological studies of the specimens obtained from aneurysmal sacs demonstrated a correlation with atherosclerotic aneurysm. The aneurysms of the patient were successfully operated on sequentially at different times by using various surgical procedures. This case demonstrated that these patients should be monitored closely during their lifetime for development of new arterial aneurysms at different sites.
Full-text · Article · Jun 2009 · Archives of Medical Science
[Show abstract][Hide abstract] ABSTRACT: The effects of double (n = 60, group 1) versus single (n = 60, group 2) aortic clamping on myocardial function and protection were investigated during coronary artery bypass grafting using a heart-lung pump. In group 1, after opening the cross clamp, proximal anastomosis was completed using side clamps and, in group 2, distal and proximal anastomosis was completed with a single clamp. Cross clamping time in the single-clamp patients (group 2; 77.1 min) was significantly higher than in the double-clamp patients (group 1; 62.9 min). Troponin T was significantly higher in group 2 than in group 1 h and 24 h after surgery. Post-operative left ventricular ejection fraction decreased in both groups, but this was not statistically significant. Post-operative wall motion score index and myocardial performance index increased significantly in both groups compared with the pre-operative level. Overall, the double-clamp technique provided better myocardial protection than the single-clamp technique and neither technique seemed to have a negative impact on the early post-operative global functioning of the left ventricle, however the effect of these techniques on the global functioning of the left ventricle in the late postoperative period needs to be evaluated.
Full-text · Article · Mar 2009 · The Journal of international medical research
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to investigate the use of prophylactic magnesium sulphate and amiodarone in treating arrhythmias that may occur following coronary bypass grafting operations.
The study population consisted of 192 consecutive patients who were undergoing coronary artery bypass grafting (CABG). Sixty-four patients were given 3 g of magnesium sulphate (MgSO4) [20 ml = 24.32 mEq/L Mg(+2)] in 100 cc of isotonic 0.9% solution over 2 hours intravenously at the following times: 12 hours prior to the operation, immediately following the operation, and on postoperative days 1, 2, and 3 (Group 1). Another group of 64 patients was given a preoperative infusion of amiodarone (1200 mg) on first post-operative day (Group 2). After the operation amiodarone was administered orally at a dose of 600 mg/day. Sixty-four patients in group 3 (control group) had 100 cc. isotonic 0.9% as placebo, during the same time periods.
In the postoperative period, the magnesium values were significantly higher in Group 1 than in Group 2 for all measurements. The use of amiodarone for total arrhythmia was significantly more effective than prophylactic treatment with magnesium sulphate (p = 0.015). There was no difference between the two drugs in preventing supraventricular arrhythmia, although amiodarone significantly delayed the revealing time of atrial fibrillation (p = 0.026). Ventricular arrhythmia, in the form of ventricular extra systole, was more common in the magnesium prophylaxis group. The two groups showed no significant differences in other operative or postoperative measurements. No side effects of the drugs were observed.
Prophylactic use of magnesium sulphate and amiodarone are both effective at preventing arrhythmia that may occur following coronary by-pass operations. Magnesium sulphate should be used in prophylactic treatment since it may decrease arrhythmia at low doses. If arrhythmia should occur despite this treatment, intervention with amiodarone may be preferable.
Full-text · Article · Mar 2009 · Journal of Cardiothoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: Aim. The aim of this study is to retrospectively evaluate 52 patients with pseudoaneurysm who underwent surgical reconstruction in our clinic. Methods. A total of 52 patients (24 women and 28 men) who underwent surgical operation were included in the study. The mean age was 45.1±20.6. There were pseudoaneurysms of the femoral artery 34 (65.3%), popliteal artery 9 (17.3%), brachial artery 4 (7.7%), axillary artery 2 (3.9%), radial artery 2 (3.9%) and iliac artery 1 (1.9%) patients. Diagnosis was made in 51 (98%) of the patients through clinical evaluation together with Doppler ultrasonography, and in 16 (30,7%) of these DSA and in 12 of them (23%) MRA was performed. Results. Primary reconstruction was performed in 40 (77%) of all pseudoaneurysms, while interposition with saphenous venous graft was performed in 9 (17%) patients and Polytetrafluoroethylene (PTFE) graft was performed in 3 (6%) patients. These patients applied our clinic in a mean of 8 (6-15) days following invasive procedure and within 28 (16-44) days after trauma (p<0.05). Popliteal artery pseudoaneurysms there were mostly penetrating injuries by sharp objects 7 (77%) subjects (P<0.05). Infection developed in 6 subjects; no mortality or amputation was reported. Conclusion. Surgical reconstruction remains the most effective treatment method in pseudoaneurysms, especially in cases with large aneurysms.
[Show abstract][Hide abstract] ABSTRACT: The Starr-Edwards caged ball valve is one of the oldest cardiac valve prosthesis and was widely used all around the world in the past decades. Despite the long-term results that have been reported there are only a few cases reported that exceed 30 years of durability. Here in, we report a 53-year-old patient with a well-functioning 35-year-old aortic Starr-Edwards caged ball prosthesis.
Full-text · Article · Jan 2009 · Case Reports in Medicine
[Show abstract][Hide abstract] ABSTRACT: During off-pump coronary bypass grafting, local vascular control of the target vessel and a bloodless field are crucial. The aim of this study is to asses the histopathological outcomes of intracoronary shunts and bulldog clamping on the beating heart in a canine model.
Twelve healthy adult mongrel dogs weighing between 15 to 25 kg were included in the study. Following left thoracotomy, proximal left anterior descending artery segment 1 cm to distal of diagonal branch was marked. Arteriotomy at this site was performed and a shunt was inserted for 10 min in the shunt group. The bulldog clamp was applied 3 cm distal to the mark for 10 min after heparinization in the bulldog group. Thirty days after the procedure, the specimens of left anterior descending artery from both regions were collected and were examined. Vascular damage, presence of intimal hyperplasia, and denudation were noted.
Only intimal denudation was found significantly higher in the shunt group (P < 0.05). In this group, only one case had grade 0 endothelial damage. In the bulldog group, all cases had endothelial damage of various grades.
The proven advantages of temporary intracoronary shunts are well-known, e.g., preserving the ventricular functions. Despite these advantages, our study revealed an ultimate bad result for an off-pump coronary by pass patient: intimal denudation. We conclude that further studies with a larger number of subjects are needed to decide whether routine shunt insertion into coronary arteries during off-pump coronary bypass surgery is appropriate or not.
No preview · Article · Dec 2008 · Journal of Surgical Research