Non-heparin-induced thrombocytopenia in patients after open-heart surgery

Background Thrombocytopenia (platelet count below 150 x 10(3)/mu L) is a common finding after open-heart surgery and can lead to various complications, including patient death. This study aimed to determine the extent of non-heparin-induced thrombocytopenia in open-heart surgery and to highlight the associated factors. Materials and Methods In this cohort study, 842 patients who underwent valve and/or coronary bypass surgery over a 5-year period were retrospectively analyzed. After open-heart surgery, patients whose platelet count was less than 150 x 10(3)/mu L on a complete blood count 12 and 24 h after surgery were classified as thrombocytopenic. Three hundred twenty patients without thrombocytopenia and 21 patients with a high probability of heparin-induced thrombocytopenia were excluded from the study. Logistic regression analysis was used to assess the association of independent variables in moderate-severe thrombocytopenia: Age groups, sex, underlying disease, symptoms, type of surgery, pump time, pulsatile or non-pulsatile duration, degree of hypothermia, hemodilution, oxygenator type, use of an intra-aortic balloon, and erythrocyte transfusion counts were included in the analysis. Results A total of 501 patients were diagnosed as having non-heparin-induced thrombocytopenia, and 64.3% were male. Three hundred seventy-seven (75.2%) patients had mild thrombocytopenia and 124 (24.7%) had moderate-severe thrombocytopenia. The postoperative platelet count was significantly lower than the preoperative platelet count (213 x 10(3) vs.117 x 10(3)/mu L; p = 80 years odds (OR = 9.026, 95% CI: [1.757-46.363]; p = 0.008), isolated valve surgery (OR = 3.090, 95% CI: [1.867-5.114]; p < 0.001), and valve surgery with coronary bypass (OR = 4.938, 95% CI: [1.638-14.889]; p = 0.005) compared to isolated coronary bypass, type of oxygenator (Nipro vital compared with Affinity OR = 11.097, 95% CI: [1.923-64.023]; p = 0.007), erythrocyte transfusion count (OR = 1.219, 95%CI: [1.046-1.420]; p = 0.011). Conclusion Age 80 years or older, surgical procedures including heart-valve surgery, and the number of red blood cell transfusions are associated with the risk of moderate-to-severe thrombocytopenia. This study provides a guide in terms of risk factors that may lead to moderate-to-severe thrombocytopenia after open-heart surgery. However, future multicentre prospective randomized studies may provide more detailed information on this subject

An Assessment of the 100 Most Frequently Cited Articles Related to Bicuspid Aortic Valve in the Literature

BACKGROUND/AIMS Bicuspid aortic valve disease may cause both aortic stenosis and regurgitation; therefore, it manifests as different symptoms. Aortic stenosis in patients with bicuspid aortic valve exhibits ambiguous hemodynamic effects; moreover, it may remain asymptomatically until the effective orifice area is narrowed below 1.5-2 cm(2). In this study, we aimed to evaluate 100 articles related to bicuspid aortic valve that have been most frequently cited in the literature. MATERIAL and METHODS The study was performed using advanced mode of the search engine server Institute for Scientific Information Web of Science. For this purpose, the words TS=bicuspid or TI=bicuspid were reviewed. The search was carried out, and the 100 most cited articles were determined. The total and annual cite count for each article and information about the authors and the journals were determined via WOS and PubMed. RESULTS The mean cite count of the 100 most cited articles was found to be 238.10 +/- 227.48. The annual cite counts of the studies varied from 4 to 185, and the mean value was calculated as 20.93 +/- 25.25. The first 3 subjects were clinical BAV (41%), pathology of BAV (15%), and genetics of BAV (15%). There was no statistically significant difference between the continent of the corresponding author and overall and annual cite counts. In addition, no statistically significant difference was observed between the journal's continent and overall and annual cite counts (p>.05). CONCLUSION This study is the first in the literature to identify the 100 most cited articles related to BAV. The majority of these studies were based on clinical evaluation of BAV. We found an increase in the number of studies on percutaneous transcatheter interventions over the last 5 years

Effects of carbon dioxide insufflation on anastomosis remodeling at a carotid artery site in rabbits

WOS: 000445425700005PubMed ID: 30310395Introduction: Use of carbon dioxide (CO2) insufflation (CDI) on the surgical field during heart surgery has become widespread, and in some units routine. Aim: To assess the effects of CDI on endothelial dysfunction in a carotid artery model in rabbits. Material and methods: Twelve randomly selected rabbits were divided into two groups. Right carotid arteries of the animals were transected and sutured with running suture technique. Then, 1 l/min CO2 insufflation was initiated with a 45 degrees angle. In the control group, the anastomotic field was irrigated with 0.1 ml/s flow of 0.9% saline. At day 28, the carotid artery segments were removed and prepared for histological specimens. Results: In the cross-sections of the control group vessel samples, thickening of the tunica intima was observed. Scoring the quantity of endothelial nitric oxide synthase (e-NOS) and a-smooth muscle actin (alpha-SMA) positive staining revealed a nonsignificant difference between the experimental groups (p = 0.07). In the CO2 group, the intimal hyperplasia (p = 0.2) and the thickness of the tunica media (p = 0.2) were indistinguishable when compared to the control group. The mean luminal diameters and luminal areas of the experimental groups were all evaluated by histomorphometry and a significant differences was found between luminal areas (p = 0.016). On the other hand, no significant difference was found between mean luminal diameters (p = 0.055). Conclusions: Our study indicated that CDI can affect endothelial cell damage and the mean luminal diameters

Consensus Report on Patient Blood Management in Cardiac Surgery by Turkish Society of Cardiovascular Surgery (TSCVS), Turkish Society of Cardiology (TSC), and Society of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care (SCTAIC)

Anemia, transfusion and bleeding independently increase the risk of complications and mortality in cardiac surgery. The main goals of patient blood management are to treat anemia, prevent bleeding, and optimize the use of blood products during the perioperative period. The benefit of this program has been confirmed in many studies and its utilization is strongly recommended by professional organizations. This consensus report has been prepared by the authors who are the task members appointed by the Turkish Society of Cardiovascular Surgery, Turkish Society of Cardiology (TSC), and Society of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care to raise the awareness of patient blood management. This report aims to summarize recommendations for all perioperative blood-conserving strategies in cardiac surgery