Cannulation of Innominate Artery during Proximal Aortic Aneurysm Repair

Objective: There are many debates for cannulation sites during aortic surgeries. The cannulation technique which is providing antegrade flow is associated with better survival and neurological outcomes than retrograde flow. For this purpose, innominate and axillary artery cannulation have been increasingly used for cardiopulmonary bypass recently. We aimed to present our experience with innominate artery cannulation for cardiopulmonary bypass and antegrade selective cerebral perfusion during proximal aortic aneurysm repair. Methods: A total of eighteen patients with proximal aortic aneurysm underwent surgical repair were included into the study. Pre-operative patient’s charecteristis, surgical details and postoperative outcomes were investigated. Results: The mean age was 58.8±10.2 and majority of the patients were male (72%). Bicuspit leafletes was found in 9 patients (50%). Two patients died in postoperative period. No stroke or new neurological deficit was seen after procedures. Conclusions: This study is emphasize that cannulation of innominate artery can be used in safe and effective during aortic surgery

Great saphenous vein aneurysm presenting as an inguinal hernia

A primary aneurysm in the saphenous vein is very rare. This case study is based on a 55-year-old male patient who applied for general surgery with a complaint of swelling in his left inguinal area, after examinations led to a provisional diagnosis of inguinal hernia. It was decided that surgery was the best option due to the risk of thromboembolism, and pain caused by the condition itself. Confusion with inguinal hernia can affect prognosis. It increases the risk of thromboembolism as well as preventing the chance of early response

Great saphenous vein aneurysm presenting as an inguinal hernia

A primary aneurysm in the saphenous vein is very rare. This case study is based on a 55-year-old male patient who applied for general surgery with a complaint of swelling in his left inguinal area, after examinations led to a provisional diagnosis of inguinal hernia. It was decided that surgery was the best option due to the risk of thromboembolism, and pain caused by the condition itself. Confusion with inguinal hernia can affect prognosis. It increases the risk of thromboembolism as well as preventing the chance of early response

Effects of albumin and synthetic polypeptide-coated oxygenators on IL-1, IL-2, IL-6, and IL-10 in open heart surgery

In this study, we have tried to demonstrate the effects of coating style used in oxygenators on various hematologic and clinical parameters. Twenty-seven patients were included in the study, who had undergone operations because of elective coronary artery disease. Albumin-coated oxygenator was used in Group I. In Group II, a synthetic polypeptide-coated oxygenator was used. C1-inhib (complement), C3c, C4, interleukins (IL-1β, IL2, IL-6, IL-10), and tumor necrosis factor alpha (TNF-α) levels were examined at four different time intervals. Hemoglobin, hematocrit, leukocyte and platelet counts, drainage, and transfused blood volumes were analyzed. Albumin levels were significantly lower in Group I than those in Group II 5 minutes after the removal of the cross-clamp. Twenty-four hours after the surgery, Group I patients also had a significantly higher white blood cell count compared to Group II patients. TNF-α levels in Group I were always expressed in considerably higher amounts than those in Group II. IL-6 levels were significantly higher in Group I, but IL-10 levels were observed to be higher in Group II (p < 0.05). Synthetic polypeptide-coated advanced technology, which employed oxygenators, had an important attenuator effect on acute phase reactants and also on the inflammatory response

The predictive value of the prognostic nutritional index for postoperative acute kidney injury in patients undergoing on-pump coronary bypass surgery

Abstract Background We aimed to investigate the predictive value of the prognostic nutritional index (PNI) regarding the development of acute kidney injury (AKI) after elective coronary artery bypass grafting (CABG). Methods A total of 336 consecutive patients with normal serum creatinine levels undergoing CABG were enrolled in this retrospective study. AKI was defined as meeting Acute Kidney Injury Network (AKIN) criteria based on the occurrence of creatinine changes within the first 48 h after CABG surgery. The patients were grouped according to whether they developed AKI or not into an AKI (−) and an AKI (+) group. Results AKI developed in 88 (26.2%) of all patients. The PNI was independently predictive of AKI (OR: 0.829, 95% CI: 0.783–0.877, p <  0.001). Moreover, C-reactive protein (CRP), a history of diabetes mellitus, and positive inotropric usage were independent risk factors for AKI in the multivariate logistic regression analysis. The area under the curve (AUC) of the multivariable model, including positive inotrope support, a history of diabetes mellitus, and CRP, was 0.693 (95% CI: 0.626–0.760, p <  0.001) in predicting AKIN. When the PNI was added to the multivariable model, the AUC was 0.819 (95% CI, 0.762–0.865, z = 3.777, difference p = 0.0002). Also, the addition of the PNI to the multivariable model was associated with a significant net reclassification improvement estimated at 88.2% (p <  0.001) and an integrated discrimination improvement of 0.22 (p <  0.001). Conclusions Our study demonstrated that decreasing the PNI could be associated with the development of AKI after coronary artery bypass surgery

Effects of albumin and synthetic polypeptide-coated oxygenators on IL-1, IL-2, IL-6, and IL-10 in open heart surgery

Background: In this study, we have tried to demonstrate the effects of coating style used in oxygenators on various hematologic and clinical parameters. Materials and methods: Twenty-seven patients were included in the study, who had undergone operations because of elective coronary artery disease. Albumin-coated oxygenator was used in Group I. In Group II, a synthetic polypeptide-coated oxygenator was used. C1-inhib (complement), C3c, C4, interleukins (IL-1β, IL2, IL-6, IL-10), and tumor necrosis factor alpha (TNF-α) levels were examined at four different time intervals. Hemoglobin, hematocrit, leukocyte and platelet counts, drainage, and transfused blood volumes were analyzed. Results: Albumin levels were significantly lower in Group I than those in Group II 5 minutes after the removal of the cross-clamp. Twenty-four hours after the surgery, Group I patients also had a significantly higher white blood cell count compared to Group II patients. TNF-α levels in Group I were always expressed in considerably higher amounts than those in Group II. IL-6 levels were significantly higher in Group I, but IL-10 levels were observed to be higher in Group II (p < 0.05). Conclusion: Synthetic polypeptide-coated advanced technology, which employed oxygenators, had an important attenuator effect on acute phase reactants and also on the inflammatory response

Neoangiogenesis after direct intramyocardial implantation of bone marrow-derived stem cells in a patient with severe coronary artery disease ineligible for percutaneous or surgical revascularization

Bone marrow-derived stem cells (BMSC) may be an alternative for the treatment of patients with severe coronary artery disease ineligible for either percutaneous or surgical revascularization. This case report presents a 65-year-old male patient with untreatable angina pectoris (Canadian Cardiovascular Society Class III) and severe coronary artery disease. A mixture of BMSC containing approximately 3x106 CD34+ cells was directly injected into preoperatively determined ischemic regions of the myocardium by median sternotomy. At baseline, at 3 months, and at 1 year of follow-up, echocardiography (demonstrating wall motions of 16 segments), single-photon emission computed tomography, and coronary angiography (at baseline and at 1 year) were performed to assess myocardial perfusion, left ventricular (LV) function and coronary anatomy. The patient reached Canadian Cardiovascular Society Class I after 6 months of cell implantation. The ejection fraction increased from 34% to 37% at the third month and 40% at 1 year of follow-up. At 1 year of follow-up, preoperatively akinetic mid-base septum and anteroseptal regions progressed to mild hipokinesia and severe hypokinetic mid-base-apical anterior regions and apical lateral-inferior regions became normokinesia. Single-photon emission computed tomography revealed a visible improvement in anterior and lateral segments at 1 year of follow-up. Coronary angiography showed newly developed collateral arteries at 1 year of follow-up. BMSC transplantation in a patient with severe coronary artery disease resulted in increase of LV ejection fraction, an increase of the perfusion of ischemic myocardial regions, and improvement in wall motion defects without any adverse events

The Relationship Between Contrast Associated Nephropathy and Coronary Collateral Circulation in very Old Patients

Background: The aim of this study was to investigate whether there is a relationship between coronary collateral circulation (CCC) and contrast associated nephropathy (CAN) in very elderly patients. Methods: Patients aged 90 years or older with at least one major occlusion of the coronary artery proximal or mid-section were included in the study. CCC was graded according to the Rentrop classification. CAN was defined as an increase in blood creatinine value of 25% or more on the second day after coronary angiography. Results: Thirty-six patients who met the study criteria were included in the study. In the study group, CAN developed in 12 patients (CAN (+) group), 24 patients did not develop CAN (CAN (&minus;) group). The creatinine levels before coronary angiography were 1.05 &plusmn; 0.12 in the CAN (&minus;) group and 1.22 &plusmn; 0.14 in the CAN (+) group. Baseline creatinine values were significantly higher in the CAN (+) group (p = 0.001). The contrast agent used in the CAN (+) group was significantly higher (p = 0.001). In the CAN (+) group, nine patients (43%) had poor collateral circulation, whereas only three patients (20%) had well-developed collateral circulation. In a logistic regression analysis, the collateral class was not a risk factor for CAN, whereas contrast agent volume and basal creatinine were independent predictors of CAN. Conclusion: We found that CCC grade was not associated with the development of CAN in very old patients, but the amount of contrast agent and pre-procedure creatinine values were independent variables in the development of CAN

Wpływ przedoperacyjnej wartości frakcji wyrzutowej lewej komory na wczesne i średnioterminowe wyniki operacji naprawczej u pacjentów z niedokrwienną niedomykalnością mitralną

Background: It has been well established that reduced left ventriclular ejection fraction (LVEF) has adverse impact on the outcome of patients undergoing ischaemic mitral valve repair. However, the exact value of LVEF which should be used for risk stratification, has not been well established. Aim: To asses which preoperative LVEF (pLVEF) value has the best predictive value in patients undergoing ischaemic mitral valve repair. Methods: A retrospective analysis of 105 patients with ischaemic mitral regurgitation (IMR) treated between January 2003 and June 2009 was conducted. Patients were divided into two groups according to their pLVEF value. The primary endpoints were early in-hospital and late follow-up deaths. Results: The pLVEF cut-off value was determined based on univariate analysis of parameters for primary end-points. The investigated parameters were: age, pLVEF, postoperative NYHA, postoperative mitral regurgitation and postoperative LVEF. The Cox proportional hazard regression analysis identified pLVEF (HR 1.5; 95% CI 1.4-5.0; p < 0.008) as the only independent predictor of the primary end-point. The pLVEF cut-off value of 40% was found to have the highest sensitivity of 76% and specificity of 70% in predicting death. Patients were divided into two groups using the cut-off value of pLVEF of 40%. The compromised group (pLVEF 40%) of 71 patients had inhospital death rates of three (9%) vs two (3%) (NS) and five year mortality of 18 (54%), eight (11%) (p < 0.001), respectively. Conclusions: In IMR surgery, a pLVEF value of 40% is an important prognostic marker for mid-term survival. Kardiol Pol 2010; 68, 11: 1226-1232Wstęp i cel: Celem niniejszego badania była ocena, czy przedoperacyjna wartość frakcji wyrzutowej lewej komory (LVEF) wpływa na rokowanie i wyniki leczenia chorych z niedokrwienną niedomykalnością zastawki mitralnej poddawanych operacji naprawczej. Metody: Przeprowadzono retrospektywną analizę danych 105 pacjentów z niedokrwienną niedomykalnością mitralną z okresu od stycznia 2003 do czerwca 2009 roku. Pacjentów podzielono na dwie grupy zależnie od przedoperacyjnej funkcji lewej komory (pLVEF): z zachowaną (UC) oraz upośledzoną (C) funkcją lewej komory, z uwzględnieniem wartości granicznej pLVEF. Głównymi punktami końcowymi były wczesna śmiertelność wewnątrzszpitalna i odległa śmiertelność w okresie obserwacji. Wyniki: Wartość graniczna pLVEF została określona na podstawie jednoczynnikowej analizy zmiennych dla głównych punktów końcowych. Do ocenianych parametrów należały: wiek, pLVEF, klasa NYHA po zabiegu, pooperacyjna niedomykalność mitralna i pooperacyjna LVEF. Analiza regresji na podstawie modelu proporcjonalnego hazardu Coxa wykazała, że jedynym niezależnym czynnikiem predykcyjnym głównego punktu końcowego była pLVEF (współczynnik narażenia - hazard ratio: 1,5; 95% przedział ufności 1,4-5,0; p < 0,008). Wartość odcięcia pLVEF równa 40% charakteryzowała się najwyższą czułością (76%) oraz specyficznością (70%). Podziału na grupy dokonano zależnie od pLVEF, za graniczną przyjmując wartość 40%. W grupie C (pLVEF 40%) liczącej 71 pacjentów zanotowano odpowiednio 3 (9%) i 2 (3%) przypadki zgonów wewnątrzszpitalnych, natomiast po 5 latach liczba zgonów w tych grupach wynosiła odpowiednio 18 (54%) i 8 (11%). Wnioski: U chorych operowanych z powodu niedokrwiennej niedomykalności mitralnej wartość pLVEF równa 40% stanowi ważny czynnik prognostyczny śmiertelności wewnątrzszpitalnej i średnioterminowej. Kardiol Pol 2010; 68, 11: 1226-123