Are the early postoperative outcomes of coronary artery bypass grafting surgery in elderly women worse compared to men’s?

Abstract Objective: To investigate the impact of gender difference in early postoperative outcomes in elderly patients (aged 70 or older) undergoing coronary artery bypass grafting surgery. Methods: Between October 2009 and December 2013, a total of 223 elderly patients (aged 70 or older) undergoing isolated primary coronary artery bypass grafting surgery were included in this retrospective observational cohort study. Patients were divided into two groups according to their gender. The patients' medical records were collected, their baseline preoperative characteristics, operative data, and postoperative outcomes were retrospectively reviewed, and the effect of gender difference in the early postoperative outcomes was analyzed. Results: Group 1 (female patients) and Group 2 (male patients) consisted of 71 and 152 patients, respectively. Mean age of patients was 74.4±3.6 years (range: 70-84 years). The level of EuroSCORE I, the incidence of hypertension and hyperlipidemia were significantly higher in Group 1, while the rate of smoking was significantly higher in Group 2. Mean postoperative intubation time, length of intensive care unit and hospital stay were longer in female patients than in male patients, but these differences were not statistically significant. No statistically significant difference between two groups in terms of the transfusion of blood products was observed. The rates of in-hospital mortality and major postoperative complications were statistically similar between the two groups. Conclusion: In conclusion, the female gender was not associated with worse early postoperative outcomes in elderly patients undergoing coronary artery bypass grafting surgery

Evaluation of bioabsorbable polylactide film for prevention of postoperative pericardial adhesion in a rabbit model

Postoperatif retrosternal ve intraperikardiyal adezyonlar resternotomiyi, cerrahi ekip için, tehlikeli ve zaman alıcı hale getirir. Bu problemi çözmek için, farklı perikardiyal materyaller kullanılarak, birçok çalışma yapılmıştır. Ancak, bu materyallerin klinik faydalarını gösteren kesin kanıt olmadığından, hiçbirisi rutin kullanıma geçmemiştir. Bu çalışmanın amacı biyoemilebilir polilaktid tabakanın postoperatif perikardial adezyonları önlemedeki etkinliğini araştırmaktır.Yeni Zelanda beyazı kırk tavşan onarlı dört gruba ayrıldı. Sol anterior torakotomiyi takiben perikardiyotomi yapıldı ve kalbin anterolateral yüzeyine karegaz ile epikardiyal abrazyon uygulandı. Kontrol gruplarında, grup 1 ve 2, perikard retrosternal adezyonlara imkan sağlamak için açık bırakıldı. Tedavi gruplarında, grup 3 ve 4, 0,02 mm'lik transparan biyoemilebilir polilaktid tabaka perikarda yerleştirildi ve 6/0 prolen ile fiske edildi. Postoperatif makroskopik ve mikroskopik değerlendirmeler, grup 1 ve 3'te 3 hafta sonra, grup 2 ve 4'te 6 hafta sonra yapıldı.Emilebilir perikardiyal materyal 3 hafta sonra tamamen emilmişti. Adezyon, inflamatuar reaksiyon ve fibröz reaksiyon skorları, kontrol ve tedavi grupları karşılaştırıldığında anlamlı farklı değildi. Ancak, mikroskopide tüm tedavi gruplarında görüldüğü üzere, polilaktid tabaka yeni mezotel benzeri hücre tabakası gelişimine yardımcı oldu.Polilaktid tabaka perikardiyal adezyonların gelişimini önlemedi ancak kabuk görevi görerek perikardiyal rejenerasyona ve mezotel benzeri hücre tabakası gelişimine yardımcı oldu.Postoperative retrosternal and intrapericardial adhesions make a repeat sternotomy time consuming and dangerous for the surgical team. Several studies have been made to resolve this problem by using different types of pericardial substitutes. However, none of them have yet been routinely applicable in the clinical setting, as solid clinical evidence on their benefical effects is absent. The purpose of this study was to evaluate the efficacy of a bioabsorbable polylactide film for preventing postoperative pericardial adhesions.Forty New Zealand white rabbits were divided into for groups of ten. After performing a left anterior thoracotomy, a pericardiotomy was made and epicardial abrasions were done on the anterolateral surface of the heart with gauze. İn control groups, group1 and 2, the pericardium was left open to allow retrosternal adhesions. İn treatment groups, group 3 and 4, 0,02 mm transparent bioabsorbable polylactid film was placed inside the pericardium and 6/0 prolen sutures were used to fix it. Postoperative macroscopic and microscopic evaluations were made at 3 weeks in group1 and 3, at 6 weeks in group2 and 4, after implantation.The absorbable pericardial subtitude was completely absorbed by 3 weeks after implantation. There were no significant differences in adhesion, inflamatuar reaction and fibrous reaction scores, between control and treatment groups. However, polylactid film supported the growth of new mesothelium like layer, as microscopy showed in all treatment groups.Polylactid film did not prevent development of pericardial adhesions but may has served as a scaffold for the regeneration of pericardium and the growth of mesothelium like layer

The effects of cardiopulmonary baypas on heart muscle

8. Kardiyoloji ve Kardiyovasküler Cerrahide Yenilikler Kongresi’nde sunulmuştur.Bu çalışma, kalp-akciğer makinası kullanılarak ve kullanılmadan atan kalpte koroner baypası yapılan olgularda, kalp-akciğer makinasının kalp kası üzerine etkilerini değerlendirmek için tasarlandı. Kliniğimize isteğe bağlı koroner baypas yapılmak üzere refere edilmiş 20 olgu, eşit iki gruba ayrılarak prospektif ve randomize olarak çalışmaya alındı. Birinci gruba atan kalpte coroner baypası ve ikinci gruba kalpakciğer makinası kullanılarak atan kalpte coroner baypası operasyonu uygulandı. Olgulardan preoperatif creatinine kinase-myocardial bound (CK-MB), cardiac troponin I (cTnI), N-terminal pro-brain natriüretik peptide (NT-pro-BNP) ve karbonhidrat reaktif protein (CRP) düzeylerine, postoperatif 4, 12, 24, 48. saatlerde CK-MB ile cTnI, 4, 24. saatlerde NT-pro-BNP ve 24. saatte CRP düzeylerine bakılmak üzere venöz kan örnekleri alındı. Grup 1’de hasta damar sayısının daha düşük olmasıyla ilişkili olarak, distal anastomoz sayısı (2.1±0.3) anlamlı olarak Grup 2’den (3.3±0.9) daha düşüktü (p=0.004). Miyokardiyal hasar göstergeleri olarak değerlendirdiğimiz CK-MB ve cTnI düzeylerini karşılaştırdığımızda, gruplar arasında postoperatif CK-MB düzeyleri açısından fark yoktu. Grup 2’de cTnI düzeyleri postoperatif 12, 24 ve 48. saatlerde daha yüksek olarak saptandı. Postoperatif kardiyak fonksiyonları değerlendirmek için baktığımız NT-pro-BNP düzeyleri, Grup 2’de 4. saatte anlamlı olarak daha yüksekti. İnflamasyon göstergesi olarak değerlendirdiğimiz CRP düzeyleri açısından gruplar arasında anlamlı fark saptanmadı.This study was designed to investigate the effect of heart-lung machine on myocardium in beating heart coronary bypass patients operated with or without heart-lung machine support. A total of 20 randomized patients undergoing isolated CABG surgery at our institution were prospectively enrolled in this study and divided into 2 groups. Patients in group 1 underwent off-pump surgery and patient in group 2 underwent beating heart surgery with heart-lung machine support. Blood samples were collected preoperatively to determine creatine kinase (CKMB), troponin I (cTnI), N-terminal pro-brain natriüretik peptide (NT-pro-BNP) and C-reactive protein (CRP) levels and 4, 12, 24, 48 hours after surgery for the levels of cTnI; 4 and 24 hours after for NT-pro-BNP and 24 hours after for CRP levels. In view of the low effected vessel number, in group 1, the number of distal anastomoses (2.1±0.3) were significantly lower than group 2 (3.3±0.9) (p=0.004). Among indicators of myocardial injury; there were no differences in CK-MB levels between two groups. In group 2, cTnI levels 12, 24 and 48 hours after surgery were significantly higher. In group 2, NT-pro-BNP levels for postoperative cardiac function evaluation were significantly higher 4 hours after surgery

A comparison of off-and on-pump beating-heart coronary artery bypass surgery on long-term cardiovascular events

Objective: Our aim was to compare short-term outcomes and long-term major adverse cardiovascular event (MACE)-free survival and independent predictors of long-term MACE after off-pump (OPCAB) versus on-pump beating-heart (ONBHCAB) coronary artery bypass grafting (CABG). Methods: We retrospectively reviewed data of all consecutive patients who underwent elective CABG, performed by the same surgeon, from January 2003 to October 2009. A propensity score analysis was carried out to adjust for baseline characteristics and a total of 398 patients were included: ONBHCAB (n = 181), OPCAB (n = 217). Results: OPCAB was associated with significantly shorter ventilation times (p < 0.001), intensive care unit stay (p < 0.001) and hospital stay (p < 0.001). The total blood loss was significantly more in the ONBHCAB group (p < 0.001), and accordingly, the number of transfused blood units was significantly lower in the OPCAB group (p < 0.001). Incidence of peri-operative renal complications were significantly higher in the ONBHCAB group (p = 0.004). The OPCAB group showed significantly lower long-term MACE-free survival (p = 0.029). The mean number of transfused blood units was the only independent predictor of MACE (HR: 1.218, 95% CI: 1.089-1.361; p = 0.001). Conclusion: OPCAB provided better long-term MACE-free survival compared with ONBHCAB. Fewer units of blood transfused following OPCAB surgery may have been the main reason for this result

Are the Early Postoperative Outcomes of Coronary Artery Bypass Grafting Surgery in Elderly Women Worse Compared to Men's?

Abstract Objective: To investigate the impact of gender difference in early postoperative outcomes in elderly patients (aged 70 or older) undergoing coronary artery bypass grafting surgery. Methods: Between October 2009 and December 2013, a total of 223 elderly patients (aged 70 or older) undergoing isolated primary coronary artery bypass grafting surgery were included in this retrospective observational cohort study. Patients were divided into two groups according to their gender. The patients' medical records were collected, their baseline preoperative characteristics, operative data, and postoperative outcomes were retrospectively reviewed, and the effect of gender difference in the early postoperative outcomes was analyzed. Results: Group 1 (female patients) and Group 2 (male patients) consisted of 71 and 152 patients, respectively. Mean age of patients was 74.4±3.6 years (range: 70-84 years). The level of EuroSCORE I, the incidence of hypertension and hyperlipidemia were significantly higher in Group 1, while the rate of smoking was significantly higher in Group 2. Mean postoperative intubation time, length of intensive care unit and hospital stay were longer in female patients than in male patients, but these differences were not statistically significant. No statistically significant difference between two groups in terms of the transfusion of blood products was observed. The rates of in-hospital mortality and major postoperative complications were statistically similar between the two groups. Conclusion: In conclusion, the female gender was not associated with worse early postoperative outcomes in elderly patients undergoing coronary artery bypass grafting surgery

Are the Early Postoperative Outcomes of Coronary Artery Bypass Grafting Surgery in Elderly Women Worse Compared to Men's?

<div><p>Abstract Objective: To investigate the impact of gender difference in early postoperative outcomes in elderly patients (aged 70 or older) undergoing coronary artery bypass grafting surgery. Methods: Between October 2009 and December 2013, a total of 223 elderly patients (aged 70 or older) undergoing isolated primary coronary artery bypass grafting surgery were included in this retrospective observational cohort study. Patients were divided into two groups according to their gender. The patients' medical records were collected, their baseline preoperative characteristics, operative data, and postoperative outcomes were retrospectively reviewed, and the effect of gender difference in the early postoperative outcomes was analyzed. Results: Group 1 (female patients) and Group 2 (male patients) consisted of 71 and 152 patients, respectively. Mean age of patients was 74.4±3.6 years (range: 70-84 years). The level of EuroSCORE I, the incidence of hypertension and hyperlipidemia were significantly higher in Group 1, while the rate of smoking was significantly higher in Group 2. Mean postoperative intubation time, length of intensive care unit and hospital stay were longer in female patients than in male patients, but these differences were not statistically significant. No statistically significant difference between two groups in terms of the transfusion of blood products was observed. The rates of in-hospital mortality and major postoperative complications were statistically similar between the two groups. Conclusion: In conclusion, the female gender was not associated with worse early postoperative outcomes in elderly patients undergoing coronary artery bypass grafting surgery.</p></div