The comparative effects of esmolol and amiodarone on isolated coronary artery bypass grafts

Background/aim: Esmolol and amiodarone are two most commonly used antiarrhythmic drugs in coronary artery bypass grafting (CABG) surgery. Nevertheless, blockade of beta-2 receptors by increasing doses raise concerns about possible vasospasms. We studied the vasoactive effects of amiodarone and esmolol on left internal mammary artery (LIMA), radial artery (RA), and saphenous vein (SV) grafts. Materials and methods: After determining the presence of functional smooth muscle and endothelial layers, the responses of submaximally preconstricted graft samples were recorded in a tissue bath system. A total of 96 graft samples from 40 patients were used: 16 LIMA, 16 RA, and 16 SV grafts for each drug. Esmolol and amiodarone were added to reservoirs separately, starting from a concentration of 10-8 M until a concentration of 10-4 M. Results: Although both drugs caused vasodilatation, amiodarone exhibited a more potent vasodilatory effect than esmolol (P < 0.0001 for LIMA, P = 0.0128 for RA, and P < 0.0001 for SV). The vasodilatation rates with esmolol were 48.99 +/- 1. 2.28% in LIMA, 49.77 +/- 3.03% in RA, and 41.90 +/- 4.05% in SV grafts and with amiodarone they were 71.65 +/- 5.18% in LIMA, 58.61 +/- 5.87% in RA, and 65.07 +/- 4.09% in SV grafts. Conclusion: This in vitro study revealed that even increasing doses of both drugs induce vasodilatation of CABG grafts, with amiodarone having a more potent vasodilatory effect than esmolol

Is using metaproterenol sulfate reliable in hypertension management during the coronary artery bypass graft surgery in terms of graft patency?

Introduction: Coronary artery bypass graft (CABG) surgery that is a basic revascularization method is used commonly and hypertension appears frequently during and after CABG operations. In the treatment of hypertension, metaproterenol sulfate (MS) is one of the main agents; however, the effects of this agent on grafts are not known at an adequate level. The aim of the present study was to determine whether MS could be used safely in CABG operations by examining its effects on coronary grafts. Material and Methods: This cross-sectional, prospective, experimental study was conducted at a university hospital. In this study, internal thoracic artery (ITA), radial artery (RA) and saphenous vein (SV) graft materials were studied in organ bath in patients who underwent CABG surgery between 2013 and 2016. In the organ bath, 10-6 phenylephrine was added to the grafts to ensure that the ITA, RA and SV grafts contracted submaximally. Then, by adding MS with the cumulative method, the resulting relaxation results were recorded and dose-response curves were created. The p < 0.05 was considered as significant. Results: A total of 30 patients were included in the study. The average age of the participants was 59.3 (45-81) years. Minimum 1 and maximum 6 grafts (2.96 in average) were taken from all patients. Relaxation response was formed in the ITA at a rate of 40.49% ± 13.52, in the RA at a rate of 28.41% ± 9.08 and in the SV at a rate of 23.87% ± 8.36 by adding MS with the cumulative method. In the statistical work that was done by comparing the relaxation values among the SV grafts, ITA and RA grafts, it was determined that the efficacy of MS in the SV grafts was significantly lower when compared with the ITA and RA grafts. Conclusions: In the present study, it was concluded that the risk of developing vasospasm was low in all three grafts when MS was used in intraoperative and postoperative periods. However, in the long-term, this made us consider that better graft patency rates might be obtained. Multicenter in-vivo studies with larger patient groups are needed to support our findings. © 2021 Via Medica

The effect of distension pressure on endothelial injury and vasodilatation response in saphenous vein grafts: conversion of a bypass graft to a dead pipe

Introduction: Endothelial damage caused by high pressure applied for spasm relaxation during graft preparation is one of the most plausible theories explaining early graft failure. Aim of the study: We aimed to demonstrate the extent of endothelial damage in saphenous vein grafts distended to different pressure levels by using immunohistochemical methods and in vitro tissue baths. Material and methods: Saphenous vein grafts (SVGs) of 25 patients who underwent isolated elective CABG surgery were used in this study. By using a specific mechanism, SVGs were distended to five different pressure levels for two minutes: 0 mmHg, 50 mmHg, 100 mmHg, 200 mmHg, 300 mmHg. In vitro tissue baths and immunohistochemical examinations were performed. Results: None of the grafts distended to 300 mmHg pressure were functional in the tissue bath system. The relaxation response to carbachol of SVGs distended to 0, 50, 100 and 200 mmHg was 97.87 +/- 4.47%, 98.52 +/- 3.95%, 93.78 +/- 3.64%, and 30.87 +/- 4.11%, respectively. There were no statistically significant differences in terms of relaxation responses between samples distended to 0, 50, and 100 mmHg (p = 0.490). The relaxation response of samples distended to 200 mmHg was significantly decreased (p = 0.021). The endothelia of samples distended to 0 mmHg were almost intact in CD31 staining. Endothelial cell loss occurred at all tested distension pressures at different degrees. Conclusion: In vitro and immunohistochemical studies revealed that distending an SVG used for coronary artery bypass grafting with pressures of 100 mmHg or less results in less endothelial damage and increases graft patency

Symptomatic huge pericardial cyst: a case report

Mediastinal kistler nadir gözlenen, konjenital, neoplastik ve inflamatuar kaynaklı patolojilerdir. Basit perikardiyal kistler tüm yaş gruplarında görülmekle beraber sıklıkla yetişkin yaş grubunda gözlenmektedir. Perikardiyal kistler tüm mediastinal kistler arasında %7 gibi bir oranda gözlenmektedir. Hastaların kliniği sıklıkla asemptomatik seyretmektedir. Semptomlar nadir gözlenmekle beraber %20-30 olguda semptomatik olup ağrı, nefes darlığı, taşipne ve öksürük en sık gözlenen semptomlardır. Kistin kardiyak basısına bağlı olarak hipotansiyon, aritmi, atrial fibrilasyon ya da ani kardiyak ölüm semptomlarda gözlenebilmektedir. X-ray, bilgisayarlı tomografi, ekokardiografi gibi tetkikler ile saptanmaktadır. Yazımızda 35 yaşında, medikal tedaviye dirençli hipotansiyon, aritmi ve nefes darlığı olan, sağ atriuma bası yapan perikardiyal kist olgusunu sunduk.Mediastinal cysts are uncommon and results from congenital, neoblastic or inflamatuar abnormalities. Pericardial cyst may occur in patients of all ages, but commonly present in adults. The overall incidence of pericardial cyst is 7% in mediastinal cysts. The clinical presentation is commonly asymtomatic. Pain, tachpnea, dsypne and cough is the most common symptoms. Tachycardie, hypotansion, arytmi and sudden death are usually because of cardiac compression by the cystic mass.They are commonly found incidentally upon chest radiography, computed tomography or echocardiograph. We present, herein, the case of a 35-year-old female with a symptoms of dsypne, hypotansion and atrial arrhythmia resistant to medical therapies with finding of a pericardial cyst compression to the lateral wall of the right atrium

Systemic Immune-Inflammatory Index as a Determinant of Atherosclerotic Burden and High-Risk Patients with Acute Coronary Syndromes

Background: Systemic immune-inflammatory index (SII), which is derived from neutrophil, platelet and lymphocyte counts, represents the homeostatic balance among inflammatory, immune and thrombotic status. The systemic immune-inflammatory index is superior to indices such as neutrophil-lymphocyte ratio in predicting prognosis in various malignancies, while it is shown to predict future cardiac events better than traditional risk factors after coronary intervention. Objectives: Herein, we aimed to evaluate the relationship of the systemic immune-inflammatory index with atherosclerotic burden and in-hospital complications in acute coronary syndrome patients. Methods: The clinical outcomes, such as extent of myocardial damage, atherosclerotic burden, bleeding, acute kidney injury, duration of hospital stay and in-hospital mortality, were evaluated in a retrospective cohort of 309 consecutive acute coronary syndrome patients. The systemic immune-inflammatory index was calculated as (Platelet X Neutrophil)/Lymphocyte count on admission. Study population was categorized into tertiles with regard to systemic immune-inflammatory index. A p value of <0.05 was considered statistically significant. Results: The highest systemic immune-inflammatory index values were within ST elevation myocardial infarction patients (641.4 in unstable angina pectoris, 843.0 in non-ST elevation myocardial infarction patients and 996.0 in ST elevation myocardial infarction patients; p=0.004). Maximal troponin concentration (0.94 vs. 1.26 vs. 3; p<0.001), number of diseased vessels (1 vs. 2 vs. 2; p<0.001), the SYNTAX (synergy between percutaneous coronary intervention with taxus and coronary artery bypass grafting) score (9 vs. 14 vs. 17.5; p<0.001) and duration of hospital stay (2 vs. 2 vs. 3; p<0.001) also increased with increasing SIItertile (tertile1 vs. tertile 2 vs. tertile 3). Systemic immune-inflammatory index was an independent predictor of SYNTAX score (B: 0.232 [0.001 to 0.003]; p<0.001), extent of myocardial damage (B: 0.152 [0 to 0.001]; p=0.005) and duration of hospital stay (B: 0.168 [0.0 to 0.001]; p=0.003). Conclusions: This study has demonstrated that the systemic immune-inflammatory index, a simple hematological index, is a marker of atherosclerotic burden and longer hospital stay on well-known risk factors in high risk acute coronary syndrome patients

Eşzamanlı Koroner Arter Baypas ve Plonjan Guatr Cerrahisi

[No Abstract Available

Patient satisfaction with hemodialysis catheter in patients with chronic renal failure

Amaç: Kronik böbrek yetmezliği bulunan, renal transplant yapılamayan hastalar hemodiyaliz bağımlı olarak yaşamaktadır. Hemodiyalize giriş yolu olarak arteriovenöz şant (AV) altın standart yöntemlerdir. AV şant açılamayan ya da AV şant mevcut olup henüz olgunlaşmamış hastalarda hemodiyaliz'e girebilmek için hemodiyaliz kateterleri kullanılmaktadır. Hemodiyaliz kateterleri sıklıkla femoral, subklaviyan ve juguler venlere uygulanmakla beraber nadir olarak torakolomber yaklaşımla inferior vena kavaya da takılmaktadır. Çalışmamızda hemodiyaliz amacıyla kullanılan kateterlerin hasta memnuniyeti ve yaşam kalitesine etkilerini incelemeyi amaçladık. Yöntem: Kliniğimizde ocak 2011- mayıs 2012 yılları arasında hemodiyaliz amacıyla arteriyovenöz şant açılan ve katater takılan topla 139 hasta çalışmaya alındı. Hastalardan 91 erkek 48 kadın, yaş ortalaması 60,85 ±14,6 (min: 54, max:83) idi. Hastalar arasında demografik olarak anlamlı fark yoktu. Bu hastalar ile tek tek görülerek takılan kateter ve bölgelere göre menuniyet durumları araştırıldı. Bulgular: Takılan kataterlere bağlı olarak olguların %69.06'da herhangi bir şikayet gözlenmedi. En sık gözlenen şikayet ağrı olup olguların %17.9'da bu şikayet mevcut idi. Diğer şikayetler sırası ile %9.3 olguda görünümünden rahatsız olma ve %3.5 olguda yaşam kalitesinin olumsuz etkilenme olarak belirlendi. Komplikasyon olarak %10.7 oranında katater yeri enfeksiyonu ve %9.3 oranında katater oklüzyonu tespit edildi. Femoral bölgeye takılan kataterlerin enfeksiyon oranı %85 oranında tespit edildi. Sonuç: Kronik böbrek yetmezliği bulunan olgularda hemodiyaliz amacıyla katater takılacağı durumlarda öncelikli olarak juguler bölgenin tercih edilmesi gerektiği, juguler bölgenin uygun olmadığı durumlarda yüksek enfeksiyon oranları sebebiyle subklaviyan bölgenin ve en son seçenek olarak femoral bölgenin tercih edilmesi gerektiğini düşünüyoruz. Katater takılacak bölge ve oluşabilecek şikayetler hakkında hastaların bilgilendirilmesinin hasta memnuniyetini arttıracağı kanaatindeyizPurpose: Patients with chronic renal failure, for whom renal transplantation is not an option, depend on hemodialysis for life. An Arteriovenous shunt is the gold standart access site for hemodialysis. In patients without an AV shunt or with an immature shunt, a hemodialysis catheter is used. Subclavian, femoral and juguler veins are common sites for hemodiaylsis catheter. Patients may have different complaints with the catheter according to the insertion site. In our study, we aimed to investigate the impact of the site of the catheter on patients' comfort and social lives. Method: Between January 2011 and May 2012, 48 women and 91 men (139 patients) who underwent AV shunt operation in our clinic. The mean age of the patients was 60.85&plusmn;14.6(min:54, max:83) years. Every patient was interviewed individually about his comfort and satisfaction with the catheter.There were no statistically significant demographic differences among patients. Results: When insertion of a hemodialysis catheter is planned in patients with chronic renal failure, internal juguler vein is the optimum site and should be preferred in the first line. In cases which juguler vein is not available, subclavian vein is the next preferred site and he femoral vein, due to its high rates of infection, is the last place to choose for the insertion of a hemodialysis catheter. Conclusion: We believe that informing patients about the site of the catheter and the possible disadvantages will improve the patient satisfaction

Comparison of Drug Eluting Balloon versus Standard Balloon Results in Patients with Below Knee Peripheral Artery Disease

Amaç: Dizaltı aterosklerotik periferik arter hastalığı ile sıklıkla kritik bacak iskemisi tablosuyla karşılaşılmaktadır. Lezyonlarındafarmakolojik ajanların yararlarına rağmen günümüzde en etkili tedavi yöntemi revaskülarizasyondur. Bu çalışmada dizaltıendovasküler tedavi yöntemlerinden ilaç salınımlı balonlar ile çıplak balon sonuçlarının karşılaştırılması amaçlanmıştır.Gereç ve Yöntemler: Namık Kemal Üniversitesi Hastanesi Kalp Damar Cerrahisi kliniğinde, Ocak 2015 ve Haziran 2017 tarihleriarasında infrapopliteal revaskülerizasyon yapılan 196 hasta çalışmaya dahil edildi. Çalışma sırasında 100 hasta ilaç salınımlı balon ile(Lutonix, Bard, USA) ile tedavi edilirken, 96 hasta standart balon (Nanocross, Medtronic, USA) ile tedavi edildi. İki grup arasında biryıllık açık kalma oranları karşılaştırıldı. Hastalar işlem sonrası birinci, üçüncü, altıncı ve on ikinci aylarda kontrole çağrılarak Ayakbileği-Kol indeksi (ABI) ölçümleri ve Rutherford sınıflaması ile takip edildi.Bulgular: Çalışmaya 83 kadın, 113 erkek hasta alındı. Hastaların ortalama yaşı 63,56±11,21 idi. Rutherford sınıflamasına göre ilaçsalınımlı balon grubunda başlangıç Rutherford evrelemesi ortancası 4 (3-5) iken çıplak balon grubunda da 4 (3-5) olarak tespit edildi.Her iki grup arasında işlem sonrası 12 aylık takiplerde ekstremite kurtarma oranı ilaç salınımlı balonlarda %82,0 (n=82) olarak tespitedilirken çıplak balonlarda bu oran %65,6 (n=63) olarak tespit edildi. Ampütasyon oranları açısından ilaç salınımlı balon grubuistatistiksel olarak üstün bulunmuştur (p=0,009).Sonuç: Çalışma sonucunda 12 aylık açık kalma oranları ve klinik takiplerde ilaç salınımlı balonlar çıplak balonlara göre daha üstünolarak bulunmuştur.Aim: Atherosclerotic peripheral arterial disease is frequently seen with critical leg ischemia. Despite the benefits of pharmacological agents in the lesions, the most effective treatment method is revascularization. In this study, we aimed to compare the results of drugeluting balloon and standard balloon endovascular treatment methods. Material and Methods: One hundred and ninety-six patients who underwent infrapopliteal revascularization in Cardiovascular Surgery clinic in Namık Kemal University Hospital between January 2015 and June 2017 were included in the study. During the study, 100 patients were treated with drug-eluting balloon (DEB) (Lutonix, Bard, USA), while 96 patients were treated with standard balloon (PTA) (Nanocross, Medtronic, USA). The one-year patency rates were compared between the two groups. The patients were followed up at 1st, 3rd, 6th and 12th months after the procedure and followed by Ankle-Brachial Index (ABI) measurements and Rutherford classification. Results: Eighty three female and 113 male patients were included in the study. The mean age of the patients was 63.56±11.21. The median Rutherford classification was 4 (3-5) in the drug-eluting group according to the Rutherford classification and 4 (3-5) in the naked balloon group. During the 12-month follow-up period, limb salvage rate was 82.0% (n=82) in drug-eluting balloons and this rate was found to be 65.6% (n=63) in naked balloon group. In terms of amputation rates, the drug-eluting balloon group was found to be statistically superior (p=0.009). Conclusion: In this study, 12-month patency rates were found to be superior to naked balloons at 12-month patency rates and clinical follow-up

İzole Organ Banyosu Düzeneğinde Esmololün Koroner Arter Bypass Operasyonu Sırasında Kullanılan Radyal Arter, Safen Ven Ve Mammariyan Arter Üzerine Etkilerinin Incelenmesi

GİRİŞ: Koroner arter hastalığı bulunan olgularda beta bloker kullanımı tüm klavuzlar tarafından önerilmektedir. Çalışmamızda selektif beta bloker olan esmolol’ün koroner bypass operasypnu sırasında kullanılan greftler üzerine olan in vitro etkilerinin izole organ banyosu düzeneğinde etkilerinin incelenmesi planlanmıştır. MATERYEL VE METOD Çalışmamızda ocak 2013-2015 arasında kliniğimizde opere olan 15’i kadın 15’si erkek toplam 30 hasta çalışmaya alındı. Yapılan bu çalışmada, esmolol 10-8 M -10-4 M konsantrasyon aralığında izole organ banyosu düzeneğinde radyal arter,safen ven ve mammariyan arter greftleri üzerinde fenilefrin 10-6 ile elde edilen submaksimal kasılma yanıtlarına verdiği gevşeme yanıtları açısından karşılaştırılarak değerlendirildi. SONUÇ: Safen ven grefti esmolol 10-4 maksimum konsantrasyonunda fenilefrin ile elde edilen submaksimal kasılmanın %39.37’si kadar gevşerken bu oran radyal arterde 47.75, mammariyan arterde ise 47.27 olarak saptanmıştır. Arteyel greftler arasında esmolol ile elde edilen gevşeme yanıtları arasında anlamlı fark saptanmaz iken safen ven greftleri ile arteryel greftler arasında anlamlı fark saptanmıştır (P < 0.05). TARTIŞMA: Bu araştırma sonucunda intraoperatif, perioperatif yada postoperatif esmolol perfüzyonu ile internal torasik arter, radyal arter ve safen ven greftlerinde vazospazm gelişiminin önlenebileceğini ve perioperatif morbidite ile mortalitede azalma, uzun dönemde ise daha iyi greft açık kalma oranları elde edilebileceğini düşünmekteyiz.Aim: Beta blocker usage recommending for patient with coranary artery disease patients. The aim of the study is to evaluate the in vitro effects of beta-1 selective blocker ‘’esmolol’’ on internal thoracic artery, radial artery and saphenous vein grafts using the tissue bath. Material and methods: In our study, Thirty (30) consecutive patients (15 women and 15 men) were enrolled in the study between january 2013 and 2015. We investigate esmolol vasorelaxation effect between 10-8 -10-4 M dosage at coronary artery bypass grafts. Results: When the three grafts are compared on the basis of vasorelaxation response, the sahpenous vein group had significantly lower relaxation response compared to the radial artery and internal thoracic artery groups (%39.37, 47.75, 47.27). Conclusion Based on the results of the study, we conclude that, esmolol infusion in the perioperative period is mandatory to diminish the vasospasm of internal thoracic artery, radial artery and saphaneus vein grafts, and hence improve perioperative and long term mortality and morbidity

Comparision of Surgical Pericardiopulmonary Window and Anterior Pericardiostomy Techniques That İs Done in Patients for Pericardial Effusion Surgery

Amaç Perikardiyum, kalbi çift tabaka halinde saran bir zar tabakasıdır. Perikardiyal kavitede anormal sıvı birikimi perikardiyal efüzyon olarak tanımlanır. Efüzyon kalbin fonksiyonlarını sınırlar ise kardiak tamponad ortaya çıkar ve drene edilmesi gerekir. Çalışmamızda perikardiyoplevral pencere açılması yöntemi ile subksifoidal perikardiostomi tekniklerinin karşılaştırılması amaçlandı. Materyal ve Metod Çalışmamız retrospektif bir çalışma olup perikardiyopulmoner pencere açılması ile subksifoidal perikardiostomi teknikleri karşılaştırılmıştır. Perikardiyoplevral pencere grubunda perikard sol mini anterolateral torakotomi ile 4. interkostal aralıktan mini sternal ekartör kullanılarak açıldı. Subksifoidal perikardiostomi grubunda ise perikard mini anteriyor insizyon ile açılarak rezeke edildi. Her iki grupta 28 F silikon dren kullanıldı. Drenler günlük 150 ml altında sıvı gelmesi durumunda çekildi Bulgular Perikardiyal efüzyon sebebiyle toplam 18 hastaya drenaj işlemi uygulandı. Olguların ortalama yaş 56,25±9,27 yıl olup (min: 45, max: 83), 6’sı (% 33,3) kadın, 12’si (% 66,6) erkek idi. Perikardiyopulmoner pencere açılan grupta postoperatif 10. günde 1 hasta serebrovasküler olaya bağlı olarak eks oldu (%11,1). Rekürren perikardiyal efüzyon sebebiyle subksifoidal perikardiostomi grubunda ise 2 hasta postoperatif 1. ayda reopere edildi (%22,2). Sonuç Perikardiyal efüzyon sebebiyle uygulanacak olan cerrahi tekniğin seçimi çok önemli olup, rekürren perikardiyal efüzyon beklenen olgularda perikardiyopulmoner tekniğin kullanılması, diğer durumlarda ise subksifoidal perikardiostomi tekniğinin kullanımının uygun olacağı kanaatindeyiz.Aim Pericardium is a tough double layered membrane which covers the heart. Pericardial effusion is an abnormal accumulation of fluid in the pericardial cavity. If the effusion is compromising heart function and causing cardiac tamponade, it needs to be drained. In our study we aimed to compare pericardiopulmonary window and anterior subxiphoidal pericardiostomy techniques. Materials and Methods In this retrospective study pericardiopulmonary window and anterior pericardiostomy techniques were compared. In pericardiopulmonary window group, pericardium was opened via a left mini anterothoracotomy through the fourth intercostal area using a mini sternal retractor and pericardium was resected (approximately 4x6 cm), In pericardiostomy group pericardium was exposed via subxiphoidal approach and chest drainage tube was inserted by mini anterior incision. 28 F drainage tubes were used for drainage in all patients. The drainage tube was removed when amount of daily drainage was below 150 ml. Results A total of 18 patients underwent an initial drainage procedure for a pericardial effusion. The mean age of the patients were 56.25±9.27 years (range, 45–83 years). 6 (33.3%) were female and 12 (66.6%) were male. On 10th postoperative day one patient died due to cerebrovascular accident (%11.1) in pericardiopulmonary window group. Reoperation was required in two patients in subxiphoidal pericardiostomy group for reccurence of pericardial effusion one month later (%22.2). Conclusion The choice of surgical technique for pericardial effusion is very important. We think that, while pericardiopulmonary window technique is suitable for patients with recurrent pericardial effusion, subxiphoidal pericardiostomy technique is suitable for other situations