Does Homeostasis Model Assessment of Insulin Resistance have a predictive value for post-coronary artery bypass grafting surgery outcomes?

Objective: This study aims to investigate whether pre-operative Homeostasis Model Assessment Insulin Resistance (HOMA-IR) value is a predictor in non-diabetic coronary artery bypass grafting patients in combination with hemoglobin A1c, fasting blood glucose and insulin levels. Methods: Eighty one patients who were admitted to Cardiovascular Surgery Clinic at our hospital between August 2012 and January 2013 with a coronary artery bypass grafting indication were included. Patients were non-diabetic with 2.5, Group B; n=40), respectively. Pre-operative fasting blood glucose and insulin were measured and serum chemistry tests were performed. The Homeostasis Model Assessment Insulin Resistance values were calculated. Statistical analysis was performed. Results: There was a statistically significant difference in fasting blood glucose and HOMA-IR values between the groups. Cross-clamping time, and cardiopulmonary bypass time were longer in Group B, compared to Group A (P=0.043 and P=0.031, respectively). Logistic regression analysis revealed that hemoglobin A1c was not a reliable determinant factor alone for pre-operative glucometabolic evaluation of non-diabetic patients. The risk factors of fasting blood glucose and cardiopulmonary bypass time were more associated with high Homeostasis Model Assessment Insulin Resistance levels. Conclusion: Our study results suggest that preoperative screening of non-diabetic patients with Homeostasis Model Assessment Insulin Resistance may improve both follow-up visit schedule and short-term outcomes, and may be useful in risk stratification of the high-risk population for impending health problems

Comparison of superior septal approach with left atriotomy in mitral valve surgery

Objective: In this study, we aimed to compare clinical outcomes of superior transseptal approach with the conventional left atriotomy in patients undergoing mitral valve surgery. Methods: Between January 2010 and November 2012, a total of 91 consecutive adult patients (39 males, 52 females; mean age: 54.0&#177;15.4 years; range, 16 to 82 years) who underwent mitral valve surgery in the Division of Cardiovascular Surgery at Ko&#351;uyolu Training Hospital were included. The patients were randomized to either superior transseptal approach (n=47) or conventional left atriotomy (n=44). Demographic characteristics of the patients, comorbidities, additional interventions, intraoperational data, pre- and postoperative electrophysiological study findings, and postoperative complications were recorded. Results: Of all patients, 86.7% (n=79) were in New York Heart Association Class III, while 12 were in New York Heart Association Class IV. All patients underwent annuloplasty (42.9%) or valve replacement surgery (57.1%). There was no significant difference in pre- and postoperative electrocardiogram findings between the groups. Change from baseline in the cardiac rhythm was statistically significant in superior transseptal approach group alone (P<0.001). There was no statistically significant difference in mortality rate between the groups. Permanent pacemaker implantation was performed in 10.6% of the patients in superior transseptal approach group and 4.5% in the conventional left atriotomy group. No statistically significant difference in bleeding, total length of hospital and intensive care unit stay, the presence of low cardiac output syndrome was observed between the groups. Conclusion: Our study results suggest that superior transseptal approach does not lead to serious or fatal adverse effects on sinus node function or atrial vulnerability, compared to conventional approach

Stent thrombosis - mythy and facts

© 2014 Bentham Science Publishers.Stent thrombosis is a serious complication in stent era. It can be presented as death, cardiogenic shock or a large non-fatal myocardial infarction, usually with ST elevation. Risks of stent thrombosis, stent thrombosis incidence and predictors are controversial issues due to sparse and controversial data. But all attending physicians should have knowledge of the risk of stent thrombosis, predisposing and protective factors before and after the intervention. This issue is discussed in detail in this review

Triple antiplatelet therapy after PCI - should or could it be done?

© 2014 Bentham Science Publishers.In case of coronary stenting in patients taking long-term oral anticoagulants (OAC), addition of both aspirin and clopidogrel in the drug regimen (so-called triple antiplatelet therapy) is recommended. However such triple therapy increases the risk of serious bleeding events. Comparative data on the efficacy and safety of the triple therapy versus therapy with a single antiplatelet agent and oral anticoagulants in case of coronary stenting are very rare. Most studies show a decreased stroke and myocardial infarction risk, but an increased risk of bleeding events in case of triple therapy. There is general agreement that, when possible, the duration of triple therapy should be shortened followed by clopidogrel and an oral anticoagulant to minimize bleeding risk without increasing other adverse events. In patients with a high risk of bleeding, BMS should be used and triple therapy should be applied for only 1month, followed by one antiplatelet agent and oral anticoagulant. The WOEST study was the first study showing that therapy with clopidogrel and OAC is safe and reduces bleeding and mortality more effectively than triple therapy including aspirin in patients undergoing coronary stenting. Although the risk of bleeding increases with triple therapy as compared to OAC plus a single antiplatelet agent, the second treatment regimen cannot be recommended to all patients. However for those at the highest risk of bleeding it is not unreasonable to consider. Additional randomized studies are needed for the implementation of future treatment guidelines in patients with high risk for bleeding and thrombotic complications

Surgery for Aortic Root Abscess: A 15-Year Experience

Aortic root abscess is the most severe sequela of infective endocarditis, and its surgical management is a complicated procedure because of the high risk of morbidity and death. Twenty-seven patients were included in this 15-year retrospective study: 21 (77.8%) with native- and 6 (22.2%) with prosthetic-valve endocarditis. The surgical reconstruction of the aortic root consisted of aortic valve replacement in 19 patients (70.4%) with (11) or without (8) a pericardial patch, or total aortic root replacement in 7 patients (25.9%); 5 of the 27 (18.5%) underwent the modified Bentall procedure with the flanged conduit. Only one patient (3.7%) underwent subaortic pericardial patch reconstruction without valve replacement. A total of 7 patients (25.9%) underwent reoperation: 6 with prior valve surgery, and 1 with prior isolated sinus of Valsalva repair. The mean follow-up period was 6.8 ± 3.7 years. There were 6 (22.2%) in-hospital deaths, 3 (11.1%) of which were perioperative, among patients who underwent emergent surgery. Five patients (23.8%) died during follow-up, and the overall survival rates at 1, 5, and 10 years were 70.3% ± 5.8%, 62.9% ± 6.4%, and 59.2% ± 7.2%, respectively. Two of 21 patients (9.5%) underwent reoperation because of paravalvular leakage and early recurrence of infection during follow-up. After complete resection of the perianular abscess, replacement of the aortic root can be implemented for reconstruction of the aortic root, with or without left ventricular outflow tract injuries. Replacing the aortic root with a flanged composite graft might provide the best anatomic fit

Association between galectin-3 levels and isolated coronary artery ectasia

Background: Coronary artery ectasia (CAE) is a well-recognised disorder characterised by abnormal dilation of the coronary arteries. Underlying mechanisms associated with abnormal luminal dilation in CAE remain to be elucidated. However, histopathological features resemble those of coronary atherosclerosis. Galectin-3 (Gal-3) is a valuable biomarker for both progression and destabilisation of atherosclerotic lesions. To the best of our knowledge, there is no study in the literature examining serum Gal-3 levels in patients with isolated CAE. In the present study, therefore, we aimed to investigate the possible relationship between serum Gal-3 levels and isolated CAE