Autologous pericardium may be an alternative carotid patch material in patient with undergoing simultaneous carotid endarterectomy and coronary artery bypass grafting

Backround: Dacron, polytetrafluoroethylene, great saphenous vein, and bovine pericardium are the commonly used as patch materials. However, there is no study about autologous pericardial as a patch material in carotid endarterectomy surgery. We aimed to assess the results of the use of autologous pericardial patch in patients undergoing concomitant carotid endarterectomy and coronary artery by-pass graft surgery. Materials and Methods:: The study involved 30 patients who underwent concomitant carotid endarterectomy with patch angioplasty and coronary artery bypass grafting surgery from January 2016 to February 2020. Patchplasty is performed with autologous pericardium for 13 patients and dacron patch for 17 patients during carotid endarterectomy. Results: No statistical difference was found between the groups in terms of reoperation, arterial occlusion, restenosis, operation time, and neurological events. In the postoperative follow-up, it was determined that the amount of drainage from the area on which the carotid surgery was applied was less in the those in whom autologous pericardium was used compared to those in whom Dacron patch was used. (p=0.001) Conclusion: We concluded that the use of autologous pericardium as a carotid artery patch is a safe, feasible, and effective method in patients undergoing combined carotid artery and coronary bypass surgery

DOES BEATING HEART SURGERY TECHNIQUE REDUCE THE MORTALITY AND MORBIDITY AFTER REDO VALVE OPERATIONS?

Aim: The aim of this study was to determine the effect of beating heart technique on mortality and morbidity after redo valve operations. Material and Method: Fifty-two patients who had redo open-heart surgery between May 2005 and November 2006 in Türkiye Yüksek İhtisas Hospital included in this prospective study. All patients had a history of open-heart surgery with median sternotomy. Thirty-two patients who had redo open-heart surgery with beating heart technique were included in Group 1 and 20 patients who had redo open-heart surgery with conventional cardioplegic myocardial arrest technique were included in Group 2. Patients who had any cardiac surgery without median sternotomy were excluded. Results: Functional capacity according to New York Heart Association classification was significantly lower and number of patients with chronic obstructive lung disease was significantly higher in Group 1 (p=0.011 and p=0.003 respectively). There was no significant difference in other preoperative variables. Operation, cardiopulmonary bypass and aortic cross-clamping times were significantly higher in Group 2 (p=0.001, p=0.003, p=0.04 respectively). Mechanical ventilation, inotropic agent support and hospitalization times were significantly higher in Group 2 (p<0.05). Intensive care unit time was significantly longer in Group 1 (p<0.05). Drainage volumes, blood product transfusion volumes, intra-aortic balloon pump support times were not significantly different between the groups. Conclusion: Beating heart technique in redo heart valve operations has better outcomes than the conventional technique

Surgical approach to giant pseudoaneurysm of the left ventricle

Left ventricular pseudoaneurysm is a rare, but life-threatening complication occurring after acute myocardial infarction. Early diagnosis and surgery are critical for the patients' recovery. An 80-year-old man was admitted to hospital with severe dyspnea. Coronary angiography and ventriculography showed a giant left ventricular pseudoaneurysm. Surgical approach to pseudoaneurysm was made through the mitral valve and directly from the aneurysmal sac. Defect was closed by Dacron patch. Postoperative period was uneventful and patient was discharged from hospital seven days after surgery

Successful coronary artery bypass grafting in a patient with bilateral internal carotid artery occlusion: a case report

The best management regimen for patients with coronary artery disease requiring surgery and bilateral total internal carotid artery occlusion remains controversial. A 61-year-old male patient presented with unstable angina pectoris. His medical history revealed that he had a cerebrovascular accident 11 years ago. On physical examination, he had dysarthria and monoparesis on the right upper extremity. Coronary and carotid angiography revealed critical coronary artery stenosis and total occlusion of bilateral internal carotid arteries, total occlusion of the right vertebral artery and 40% stenosis of the left proximal vertebral artery. After general intravenous fentanyl anesthesia, low dose heparin was administered, and coronary artery bypass grafting (CABG) was performed under off-pump beating heart condition. Systolic blood pressure was maintained above 120 mmHg to preserve cerebral blood flow during the operation. The postoperative course was uneventful and the patient was discharged in the 7(th) day postoperatively. If CABG is mandatory in patients having high cerebrovascular risk, off-pump CABG could be performed to reduce the stroke risk

Mitral valve replacement with the beating heart technique in a patient with previous bypass graft from ascending to descending aorta due to aortic coarctation

Background and Aim: Conventional mitral valve replacement (MVR) is carried out under cardioplegic arrest with cross-clamping of the ascending aorta during cardiopulmonary bypass. In this case, MVR was performed with on-pump beating heart technique without cross-clamping the aorta because of the diffuse adhesion around the ascending aorta, and tube graft presence between ascending and descending aortas. Methods: A 47-year-old female patient had aorto-aortic bypass graft from ascending aorta to descending aorta with median sternotomy and left thoracotomy in single stage because of aortic coarctation 2 years ago in our cardiac center. She was admitted to the hospital with palpitation and dyspnea on mild exertion. Transthoracic echocardiography revealed 4th degree mitral insufficiency. Results: MVR was carried out through remedian sternotomy with on-pump beating heart technique without cross-clamping the aorta. Conclusions: MVR with on-pump beating heart technique offers a safe approach when excessive dissection is required to place cross-clamp on the ascending aorta

Residual postmyocardial infarction ventricular septal defect repair through right atrium with right thoracotomy on beating heart technique

Background and Aim: The incidence of residual opening after repair of postmyocardial infarction ventricular septal defect (VSD) was reported to be 10% to 25%. Redo surgery with remedian sternotomy is more complex than primary surgery and is consequently associated with higher mortality and morbidity due to the myocardial and patent coronary grafts injury during pericardial dissection. Methods: A 59-year-old female patient had coronary artery bypass grafting and closure of post myocardial infarction ventricular septal defect with patch 10 months earlier in a different cardiac center. She was admitted to the hospital for severe congestive heart failure. Results: She was operated because of the residual opening after repair of post myocardial infarction ventricular septal defect. Post myocardial infarction ventricular septal defect closure was performed through the right atrium by on-pump beating heart technique via the right thoracotomy. Conclusions: Closure of post myocardial infarction ventricular septal defect with this technique offers an alternative and safe approach to repair of the residual VSD when the coronary bypass grafts are patent

On-pump beating heart mitral valve surgery without cross-clamping the aorta

Background and Aim: Cardiac reperfusion injury is a well-described complication occurring after ischemia or following cardioplegic arrest. Various strategies have been developed to prevent ischemic reperfusion injury. The aim of this study was to assess the efficacy and applicability of the on-pump beating heart mitral valve surgery without cross-clamping the aorta in order to prevent reperfusion injury. Methods: The prospective study (between April 2005 and December 2006) included 88 consecutive patients who underwent mitral valve surgery. The operations were carried out on a beating heart using normothermic cardiopulmonary bypass without cross-clamping the aorta, therefore perfusing the heart antegradely through the aortic root. Venting the heart from the aorta and the pulmonary vein provided adequate visualization of the operative field. Results: Seventy-eight patients (88.6%) underwent mitral valve replacement and 10 patients (11.3%) underwent mitral valve repair with this technique. Concomitant surgery was required in 29 patients (32.9%). Twenty-five patients (28.4%) had also undergone previous open heart surgery. Mean cardiopulmonary bypass time was 57.4 +/- 18.4 minutes. Mean duration of ventilation was 12.2 +/- 3.5 hours, mean intensive care unit stay was 1.3 +/- 1.6 days, and mean hospital stay was 6.9 +/- 4.5 days. One-year survival was 96.6% for all causes of mortality. Conclusions: In this study, we showed that on-pump beating heart operations without cross-clamping is an acceptable surgical choice for mitral valve disease. Complication rates are low and perioperative mortality is lower than that generally reported with conventional technique

A new technique for the old arterial graft: Internal thoracic artery

The internal thoracic artery (ITA) is the gold-standard conduit for coronary artery bypass surgery. It stays patent well in the long-term period, and this evidence is directly related to the superior later outcome in terms of longevity. Coronary artery bypass grafting with multiarterial grafts can be performed safely, and better long-term result can be expected with the use of arterial conduits, especially ITA. We describe a simple and practical technique for the left ITA grafting by dividing the ITA graft and using its proximal and distal parts in situ for the distal left anterior descending (LAD) artery and the obtuse marginal artery grafting