Choroba pnia lewej tętnicy wieńcowej: poprawa wczesnych wyników leczenia po pomostowaniu tętnic wieńcowych bez użycia krążenia pozaustrojowego u pacjentów z grupy wysokiego ryzyka

Background: Left main coronary artery (LMCA) stenosis is a risk factor in coronary artery bypass grafting (CABG). Although improved outcomes of off-pump CABG have been well documented, LMCA stenosis is often perceived as a contraindicationfor off-pump CABG. In this study, we compared on-pump and off-pump techniques in high-risk patients with LMCA disease.Aim: Documentation of safety and feasibility of off-pump CABG in patients with LMCA disease.Methods: One hundred ninty nine patients with LMCA disease and a EuroScore ≥ 5 were operated upon between 2007 and 2010. One hundred patients (Group I) were operated upon using off-pump techniques, while 99 (Group II) were operated upon using conventional on-pump techniques. Perioperative variables and outcomes at first six months were compared.Results: Despite higher mean age and EuroScore (70.9 ± 4.8 vs. 65.6 ± 7.9, p < 0.001, and 6.09 ± 0.8 vs. 5.31 ± 0.68,p < 0.001, respectively), and lower ejection fraction (41.4 ± 7.3 vs. 49.0 ± 6.2, p < 0.001), hospital mortality (1% vs. 6.1%,p = 0.065), postoperative inotropic support (9% vs. 48.4%, p < 0.001), blood loss (680.6 ± 265.0 vs. 847.2 ± 382, p < 0.001) and transfusions of blood (0.57 ± 0.79 U vs. 1.49 ± 0.82 U, p < 0.001), and hospital stay (6.57 ± 2.04 vs. 7.68 ± 3.44,p = 0.006) were lower in Group I. In both groups, mean number of distal anastomoses and completeness of revascularisation were similar.Conclusions: Using the off-pump technique is safe and improves postoperative early outcomes in high-risk patients with LMCA disease.Wstęp: Zwężenie pnia lewej tętnicy wieńcowej (LMCA) jest czynnikiem ryzyka w przypadku pomostowania tętnic wieńcowych (CABG). Mimo że istnieje wiele danych potwierdzających, iż zabiegi CABG bez użycia krążenia pozaustrojowego (off-pomp CABG) wiążą się z lepszymi wynikami leczenia, zwężenie LMCA jest często uważane za przeciwwskazanie do wykonaniatego zabiegu. W niniejszym badaniu porównano CABG z zastosowaniem krążenia pozaustrojowego i bez użycia krążenia pozaustrojowego u pacjentów z chorobą LMCA.Cel: Celem badania było udowodnienie, że zabieg CABG bez krążenia pozaustrojowego jest bezpieczny i możliwy do wykonaniau pacjentów z chorobą LMCA.Metody: Do badania włączono 199 osób z chorobą LMCA z punktacją EuroScore ≥ 5, operowanych w latach 2007–2010. U 100 pacjentów (grupa I) przeprowadzono zabieg bez użycia krążenia pozaustrojowego, natomiast u 99 (grupa II) zastosowano konwencjonalną metodę z krążeniem pozaustrojowym. Porównano zmienne okołooperacyjne i wyniki leczenia w ciągu 6 miesięcy po zabiegu.Wyniki: Mimo wyższych średnich wieku i punktacji EuroScore (odpowiednio 70,9 ± 4,8 vs. 65,6 ± 7,9;p < 0,001 i 6,09 ± 0,8 vs. 5,31 ± 0,68; p < 0,001) oraz mniejszej frakcji wyrzutowej (41,4 ± 7,3 vs. 49,0 ± 6,2; p < 0,001) w grupie I śmiertelność wewnątrzszpitalna (1% vs. 6,1%; p = 0,065), odsetek pacjentów wymagających podawania leków inotropowych (9% vs. 48,4%; p < 0,001), utrata krwi (680,6 ± 265,0 vs. 847,2 ± 382; p < 0,001) i ilość przetoczonej krwi (0,57 ± 0,79 j. vs. 1,49 ± 0,82 j.; p < 0,001) były mniejsze, a czas pobytu w szpitalu krótszy (6,57 ± 2,04 vs. 7,68 ± 3,44;p = 0,006). W obu grupach średnia liczba zespoleń dystalnych i odsetek całkowitych rewaskularyzacji były podobne.Wnioski: Stosowanie metody off-pump (bez użycia krążenia pozaustrojowego) jest bezpieczne i wiąże się z poprawą wyników leczenia we wczesnym okresie pooperacyjnym u pacjentów z grupy wysokiego ryzyka z chorobą LMCA

Treatment outcomes of postoperative mediastinitis in cardiac surgery; negative pressure wound therapy versus conventional treatment

Abstract Background The aim of the present study is to compare negative pressure wound therapy versus conventional treatment outcomes at postoperative mediastinitis after cardiac surgery. Methods Between January 2000 and December 2011, after 9972 sternotomies, postoperative mediastinitis was diagnosed in 90 patients. The treatment modalities divided the patients into two groups: group 1 patients (n = 47) were initially treated with the negative pressure wound therapy and group 2 patients (n = 43) were underwent conventional treatment protocols. The outcomes were investigated with Kaplan-Meier method, log-rank test, Student’s test and Fisher’s exact test. Results The 90-days mortality was found significantly lower in the negative pressure wound group than in the conventionally treated group. Overall survival was significantly better in the negative pressure wound group than in the conventionally treated group. Conclusion Negative pressure wound therapy is safe and reliable option in mediastinitis after cardiac surgery, with excellent survival and low failure rate when compared with conventional treatments.</p

Treatment Strategies and Outcomes of Coronary Artery Fistulas in a Turkish Adult Population

Objective: Congenital coronary artery fistulas (CAF) are uncommon abnormalities that are known as abnormal communications between a coronary artery and a cardiac chamber or a major vessel. Incidence of CAF ranges between 0.1% and 0.2% 2 in literature,howeyer, there is no detailed data on the incidence of CAF in a Turkish population. In this article, we evaluated the clinical manifestations, symptoms, chosen treatment strategies, and long term follow-up results of GAF in Turkish adult population. Material and Methods: In this multicenter study carried out between 2001 and 2009, a total of 25 400 angiograms which were taken for various reasons were evaluated retrospectively. Sex, age, clinical manifestations, symptoms, number of the fistulas, chosen treatment strategies, and long term follow up results of the study population were recorded and analyzed. Results: CAF were found in 32 of these cases (0.13%). Eighteen of the cases were males, and 14 were females with a median age of 57.6 years. Fifteen cases had surgery, graft-stent was applied to two cases and coil embolization was preferred in two cases. Thirteen cases were followed up under medical treatment. Graft stents were occluded after 4 and 6 months following implantation in left anterior descending artery in both cases, and hence, these patients required surgery. Mean follow-up period was 48 +/- 27 months. All cases were asymptomatic (at the end of the follow-up period) and were doing well. Conclusion: In conclusion, incidence of CAF was found as 0.13% in the study population, and surgical treatment and coil embolization were considerably successful compared to stent graft application in CAF patients