Infective endocarditis after transcatheter approach versus surgical pulmonary valve replacement: A meta-analysis Cerrahi pulmoner kapak replasmanına karşı transkateter yaklaşım sonrası enfektif endokardit: Meta-analiz

© 2022. All right reserved by the Turkish Society of Cardiovascular Surgery. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes (http://creativecommons.org/licenses/by-nc/4.0/).Background: In this meta-analysis, we aimed to assess the risk of infective endocarditis in transcatheter versus surgical pulmonary valve replacement patients. Methods: We systematically searched PubMed, Cochrane, EMBASE, Scopus, and Web of Science for the studies that reported the event rate of infective endocarditis in both transcatheter and surgical pulmonary valve replacement between December 2012 and December 2021. Random-effects model was used in the meta-analysis. Results: Fifteen comparison groups with 4,706 patients were included. The mean follow-up was 38.5±3.7 months. Patients with transcatheter pulmonary valve replacement had a higher risk of infective endocarditis than patients receiving surgically replaced valves (OR 2.68, 95% CI: 1.83-3.93, p<0.00001). The calculated absolute risk difference was 0.03 (95% CI: 0.01-0.05), indicating that if 1,000 patients received a surgical valve replacement, 30 cases of infective endocarditis would be prevented. A meta-regression of follow-up time on the incidence of infective endocarditis was not statistically significant (p=0.753). Conclusion: Although transcatheter pulmonary valve replacement is a feasible alternative to surgical replacement in severe right ventricular outflow tract dysfunction, the higher incidence of infective endocarditis in transcatheter replacement remains a significant concern. Regarding this analysis, surgical treatment of right ventricular outflow tract dysfunction is still a viable option in patients with prohibitive risk

Who should perform the duplex ultrasound of arteriovenous fistula patients: Cardiovascular surgeon, radiologist or both?

Introduction: Arteriovenous fistula (AVF) is the gold standard vascular access in hemodialysis patients. The most distal vesselspossible should be chosen for vascular access per the venous preservation principle. Preoperative duplex ultrasound (DUS) helpsdecide the operation level and strategy for AVF surgery. We investigated the importance of intraoperative DUS performed bycardiovascular surgeon.Methods: A total of 16 AVF patients between June and July 2020 were included; 13 patients had autogenous AVFs and 3 patientshad AVF grafts. The vessels were mapped preoperatively by radiologists. Intraoperative examinations for target vessels wereperformed by cardiovascular surgeons under a warm environment and tourniquet.Results: In 4 of the 13 patients; a successful AVF was created more distally than the level suggested by preoperative DUS. In 2patients, a more proximal AVF than decided with the preoperative DUS was necessary because of venous fibrosis in continuityof the vessel. 3 patients with history of unsuccessful AVF attempts received AVF grafts. In 2 of these 3 patients, a graft wasinterposed between the brachial artery and the axillary vein and between the brachial artery and the cephalic vein in the third.Venous valves were evaluated with intraoperative DUS to avoid venous hypertension. Maturation rate was %100.Conclusion: Although the preoperative DUS by radiologists guides the surgeon during AVF surgery, surgeons should performtheir intraoperative ultrasound to the target vessels. It would be favorable to perform both evaluations by a cardiovascularsurgeon to prevent the spread of the disease in the Covid-19 era.Keywords: Arteriovenous fistula, duplex ultrasound, cardiovascular surgeon.</p

82 year old patient with achalasia and pulmonary hydatidosis

Pnömatik dilatasyona cevap vermeyen akalazyalı 82 yaşında erkek hasta yatırıldı. Preoperatif CT’de dilate özofagusla birlikte multipl hidatik kist saptandı. Hastaya aynı seansta sol torakotomi ile akalazya için myotomi, kistler için kistotomi-kapitonaj uygulandı. Postoperatif herhangi bir sorunu olmayan hastanın 6 aylık takibinde nüks görülmedi. Çalışmada 82 yaşında, akalazya ve multipl kist hidatik tanısı ile operasyona alınan olguyu literatür eşliğinde inceledik.A 82-year-old man was hospitalized for achalasia unresponsive to pneumatic dilations. Preoperative CT imaging revealed the multiple hydatid cysts in addition to dilated esophagus. The patient was underwent left thoracotomy and myotomy for achalasia and the cystotomy-capitonnage for cysts were carried out at the same session. Postoperative period was uneventful and no recurrence was seen in a period of 6 months. We evaluated a 82-year-old case operated by achalasia and multiple cyst hidatitosis diagnosis with the aid of literature data

Late open conversion after thoracic and abdominal endovascular aortic repair: challenging cases

Aims:A series of patients who required late open conversion&nbsp; for rare complications which are observedafter thoracic and abdominal endovascular aortic repair (EVAR) are presented inthis study. Methods:Case1 is a 78-year old male patient who presented with acute aortic thrombosisafter EVAR for infrarenal abdominal aortic aneurysm. He was diagnosed with acute ischemia at lower limbs. We first performedan axillobifemoral bypass surgery for limb salvage. Due to recurrent thrombosesof the left limb of the graft during longterm follow-up, we appliedaortobifemoral bypass procedure to provide adequate lower limb flow. Case 2 is &nbsp;a56 year-old male patient who had undergone thoracic endovascular aortic repair(TEVAR) for Stanford type B aortic dissection 6-months before and was admittedto our clinic with uncontrolled hypertension for the last twelve hours andhistory of a syncopal attack three days before. Retrograde ascending aorticdissection (rAAD) was detected in computed tomography angiography. Ascendingaorta and hemiarch replacement with a Dacron graft was safely performed&nbsp;via&nbsp;hypothermiccirculatory arrest and antegrade cerebral perfusion for the treatment of rAADafter TEVAR. Case 3 was a 67- year old male patient who was admittedwith a syncopal attack. He had a history of endovascular aneurysm repair fiveyears before. He was diagnosed as&nbsp; type 3endoleak with rupture. An urgent aorto-bifemoral bypass was performed byremoving the endograft completely.Results: At 24 months of follow-up after the aortobifemoralbypass, the physical examination of Case 1 revealed palpable pulses of thelower limb arteries and no graft failure was observed Thethird month and subsequent CTA images of Case 2 revealed that the graft wasintact with no dissection, haematoma or pseudo-aneurysm in aortic root, arcusaorta or the branches. He is in a good condition at 18th month. Case 3 wasdischarged at twentieth day and had ordinary findings at one year follow-up.Conclusions:Unfavourable aortic anatomy is animportant limitation for EVAR treatment.&nbsp;Extra-anatomic bypass proceduresshould be kept in mind in urgent conditions for limb salvage as for our Case 1.However the long-term patency rates of extra-anatomic bypass procedures are notexcellent, whereas aortobifemoral bypass surgery is a conventionalgold-standard treatment modality which yields excellent long-term patencyrates. Time to intervention is an important issue foracute Type B aortic dissection. Ascending aorta and hemiarch replacement wassafely performed via hypothermic circulatory arrest and antegrade cerebralperfusion for the treatment of rAAD after TEVAR in our Case 2. The extension ofthe retrograde dissection and the involvement of the branches may vary amongthe different patients and the surgery should be modified according to thepathology. The ruptured aneurysm due to type 3 endoleak as in our Case 3 is arare and catastrophic complication. &nbsp;Itis evident that a close surveillence for life time both after EVAR and TEVAR iscrucial. Also it should be noted here that open surgery and endovasculartreatment for aortic pathologies are not substitutional but complementarytherapies currently. &nbsp;&nbsp;</p

82 year old patient with achalasia and pulmonary hydatidosis

Pnömatik dilatasyona cevap vermeyen akalazyalı 82 yaşında erkek hasta yatırıldı. Preoperatif CT’de dilate özofagusla birlikte multipl hidatik kist saptandı. Hastaya aynı seansta sol torakotomi ile akalazya için myotomi, kistler için kistotomi-kapitonaj uygulandı. Postoperatif herhangi bir sorunu olmayan hastanın 6 aylık takibinde nüks görülmedi. Çalışmada 82 yaşında, akalazya ve multipl kist hidatik tanısı ile operasyona alınan olguyu literatür eşliğinde inceledik.A 82-year-old man was hospitalized for achalasia unresponsive to pneumatic dilations. Preoperative CT imaging revealed the multiple hydatid cysts in addition to dilated esophagus. The patient was underwent left thoracotomy and myotomy for achalasia and the cystotomy-capitonnage for cysts were carried out at the same session. Postoperative period was uneventful and no recurrence was seen in a period of 6 months. We evaluated a 82-year-old case operated by achalasia and multiple cyst hidatitosis diagnosis with the aid of literature data

Stanford Tip B Aort Diseksiyonu Nedeniyle Yapılan Torasik Endovasküler Aort Tamiri Sonrası İleri Dönemde Retrograd Asendan Aort Diseksiyonu

Deneyim ve Hedefler: Son on yılda torasik endovasküler aort tamiri (TEVAR) aort patolojilerinde giderek artan sıklıkta uygulanan bir tedavi yöntemihaline gelmiştir. Stanford Tip B aort diseksiyonunda (TBAD) malperfüzyon, anevrizmal dilatasyon, dirençli hipertansiyon ve dirençli ağrı görülenkomplike olgularda TEVAR uygulanabilmektedir. Biz burada TEVAR sonrası ileri dönemde retrograd asendan aort diseksiyonu (rAAD) gelişmişolgumuzu sunmayı amaçladık.Metotlar: Elli altı yaşında erkek hasta hipertansiyon nedeniyle başvurdu. Anamnezi ve önceki tetkikleri değerlendirildiğinde altı ay önce TBADnedeniyle akut dönemde (14 gün) TEVAR uygulanmış olduğu anlaşıldı. Yapılan bilgisayarlı tomografik anjiyografide (BTA) rAAD, zone 2’ye implante edilmiş stent greft ve greftin distalinde devam eden diseksiyon flebi görüldü. Ekstravazasyon saptanmadı. RAAD nedeniyle operasyon planlandı.Aksiller arter kanülasyonu ve two stage venöz kanülasyon ile pompaya girildi. 18°C’de sirkulatuvar arrest ve antegrad serebral perfüzyon uygulandı.Endovasküler stent greftin strutlarının trunkus brakiosefalikus ile sol ana karotis arter arasından aortu diseke ettiği görüldü. Stent greftin strutlarınınserbest uçları kesilerek kalan kısmı teflon felt ile arcus aortaya tespitlendi. 28 mm dakron greft (Maquet®, Germany) kullanılarak stent greftin proksimaline oturacak şekilde asendan aorta ve hemiarkus replasmanı yapıldı.Sonuçlar: Hasta 14. günde komplikasyonsuz olarak taburcu edildi. Taburculuk sonrası 3. ayda hastanın muayene bulguları olağandı, BTA’da aort kökü,arkus ve dallarında diseksiyon, hematom veya psödoanevrizma bulgusu saptanmadı.Kararlar: TEVAR sonrası rAAD nadir gelişen bir komplikasyondur ve meydana gelmesinde, işlemin zamanlaması, oturma zonu, asendan aort çapı,aort patolojisinin çeşidi, hipertansiyonun kontrolü gibi çeşitli faktörlerin etkisi olduğu düşünülmektedir. Bizim olgumuzda aort patolojisinin TBADolması, akut dönemde TEVAR uygulanmış olması ve kontrolsüz hipertansiyon, rAAD gelişimi için önemli risk faktörleri olarak değerlendirilebilir.TEVAR endikasyonlarının yalnızca komplike olgularla sınırlı tutulmasının ve hastaların düzenli aralıklarla kontrol görüntülemelerinin ve takiplerininyapılmasının hayati risk oluşturacak komplikasyonları en aza indireceğini düşünmekteyiz</p

A Probable Covid-19 Case Presented with Acute Upper Limb İschemia

The arterial revascularization procedure is still a challenging issue in Covid-19 associated limb ischemia. Herein we aimed to present a case of a 64 year-old woman with acute ischemic signs in upper extremity who was diagnosed as a probable Covid-19 case incidentally after admission. Although late admission and failed recurrent embolectomies lead to an eventful course, intra-arterial thrombolysis seemed to present a benefitable treatment option for our patient.</p