In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection - Does cyanoacrylate increase the severity of infection?

Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery

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

Does coronary bypass surgery effect the heart muscle in which beating on-pump or off-pump?

Bu çalışma, pompa destekli ve desteksiz çalışan kalpte koroner baypas (ÇKKB) yapılan olgularda, pompanın kalp kası üzerine etkilerini değerlendirmek için tasarlandı.Kliniğimize elektif koroner baypas yapılmak üzere refere edilmiş 20 olgu, eşit iki gruba ayrılarak prospektif ve randomize olarak çalışmaya alındı. Birinci gruba ÇKKB ve ikinci gruba pompa destekli ÇKKB operasyonu uygulandı. Olgulardan preoperatif creatinine kinase-myocardial bound (CK-MB), cardiac troponin I (cTnI), brain natriüretik peptid (BNP) ve karbonhidrat reaktif protein (CRP) düzeylerine, postoperatif 4, 12, 24, 48. saatlerde CK-MB ile cTnI, 4, 24. saatlerde 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. Grup 2'deki cTnI yüksekliği, distal anastomoz sayısının fazlalığına bağlı olarak daha fazla iskemi-reperfüzyon süresi ile ilişkili olabilir. Postoperatif kardiyak fonksiyonları değerlendirmek için baktığımız pro-BNP düzeyleri, Grup 2'de 4. saatte anlamlı olarak daha yüksekti. Bu da yine distal anastomoz sayısının fazlalığına bağlı olarak, artmış cerrahi manipülasyon ve ventiküler gerilim süreleri ile ilişkili olabilir. İnflamasyon göstergesi olarak değerlendirdiğimiz CRP düzeyleri açısından gruplar arasında anlamlı fark saptanmadı.Postoperatif miyokardiyal hasar göstergeleri pompa destekli grupta daha yüksek bulundu. Ancak, grupların distal anastomoz sayılarınınhomojenizasyonu sağlanamadığı için, pompa destekli grupta miyokardiyal hasarın daha fazla olduğunu söyleyemeyiz.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 instutition 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 (CK-MB), troponin I (cTnI), brain natriuretic peptid (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 pro-BNP and 24 hours after for CRP levels.In view of the low effected vessel number, in group 1, number of distal anastomosis (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 difference in CK-MB levels between two groups. In group 2 cTnI levels 12, 24 and 48 hours after surgery were significantly higher. Higher cTnI levels in group 2 may be related to higher ischemia-reperfusion injury due to higher number of distal anastomosis. In group 2, Pro-BNP levels for postoperative cardiac function evaluation, were significantly higher 4 hours after surgery. That may be related to more surgical manipulation and longer duration of ventricular wall tension duration due to higher number of distal anastomosis. There was no difference between groups in CRP levels as an inflammatory marker.Heart-lung machine supported group showed higher concentration of postoperative myocardial injury indicators. But, as the number of distal anastomosis was not homogenius between groups, we may not report that myocardial injury occured much more in heart-lung machine supported group

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-pump and on-pump coronary bypass surgery in patients with low EuroSCORE

BACKGROUND: The aim of the present study was to evaluate and compare postoperative short-term, mid-term and long-term outcomes of coronary artery bypass surgery performed with or without cardiopulmonary bypass in patients with a low European System for Cardiac Operative Risk Evaluation score. METHODS: A retrospective analysis of 478 consecutive low risk patients undergoing coronary bypass surgery between January 2002 and December 2007 was performed. Of these patients, 83 cases had undergone on-pump and 395 cases had undergone off-pump coronary bypass surgery. The patients were assessed in terms peri-operative complications, survival, mortality due to cardiac events, need for rehospitalization and repeated coronary revascularization. RESULTS: There was no significant difference between the two groups in terms of preoperative characteristics, except for chronic obstructive pulmonary disease. The number of distal anastomosis per patient was significantly lower in the off-pump group than in the on-pump group (2.66 ± 0.74 vs. 3.21 ± 0.85, p < 0.001). Early mortality rates were similar in both groups (1.01% for the off-pump group and 1.2% for the on-pump group, p = 0.687). Neurological complications were significantly lower in the off-pump group than in the on-pump group (1.1% vs. 6%, p = 0.01). The mean follow-up period was 80 ± 19.1 months (range, 3–112 months). The need for revascularization during long-term follow-up was 10.1% in the off-pump group and 7.2% in the on-pump group (p = 0.416). The 5-year survival was 95.2 ± 1.1% and 95.5 ± 2.7% in the off-pump and on-pump groups, respectively (p = 0.8), whereas the 7-year survival was 91.9 ± 1.6% and 84.7 ± 6.8% in the off-pump and on-pump groups, respectively (p = 0.274). The 5-year revascularization-free period was 89.5 ± 1.6% and 89.7 ± 3.5% in the off-pump and on-pump groups, respectively (p = 0.785). The 7-year revascularization-free period was 71.1 ± 3.1% and 73.5 ± 7.3% in the off-pump and on-pump groups, respectively (p = 0.075). The 7-year event-free survival was 80.1 ± 2.2% and 73.4 ± 7.3% in the off-pump and on-pump groups, respectively (p = 0.377). CONCLUSIONS: The present study demonstrated that off-pump cardiac surgery had advantages over on-pump cardiac surgery in the short term; however, both interventions had similar mid-term and long-term outcomes, when performed in low-risk patient

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

Intramyocardial Dissection following Postinfarction Ventricular Wall Rupture Contained by Surrounding Postoperative Adhesions

Introduction. Dissection of the myocardium is a rare form of cardiac rupture, caused by a hemorrhagic dissection among the spiral myocardial fibers, its diagnosis is rarely established before the operation or death, and extremely few cases have been reported in the literature and none of these cases seem to have a history of previous cardiac surgery which makes our report unique. Case Presentation. A 61-year-old female patient was admitted into the emergency room with complaints of progressive chest pain for 2 days. She had a history of second time prosthetic aortic valve replacement and was under anticoagulation therapy. She was diagnosed with an acute inferoposterior myocardial infarction and underwent emergency coronary angiography revealing spontaneous recanalization of the right coronary artery. During the follow-up, she developed cardiogenic shock and a new occurring systolic ejection murmur. Transthoracic echocardiography showed a left ventricular free wall rupture; then, she was taken in for emergency surgery. During the operation, a rupture zone and a wide intramyocardial dissecting area were detected. Intraventricular patch repair technic with autologous pericardial patch was used to exclude the ruptured area. Following the warming period, despite adequate hemostasis, hemorrhage around suture lines progressively increased, leading to the patient’s death. Conclusion. Pericardial adhesions might contain left ventricular rupture leading to intramyocardial dissection