The comparison between minimally invasive coronary bypass grafting surgery and conventional bypass grafting surgery in proximal LAD lesion

28.07.2016 tarihine kadar kullanımı yazar tarafından kısıtlanmıştır.İstanbul Bilim Üniversitesi, Tıp Fakültesi, Kalp ve Damar Cerrahisi Anabilim DalıAmaç: Minimal invaziv baypas cerrahisi son 10 yılda artan bir popülarite ile dünyada birçok merkezde klinik rutine girmiştir. Günümüzde, teknik olarak gelinen noktadaki başarı ile operasyonların atan kalpte yapılabilirliği önem kazanmış ve son zamanlarda minimal invazif tekniklerin gelişmesiyle giderek yaygınlaşmıştır. Çalışmamızda izole proksimal LAD lezyonlarında, Minimal İnvaziv Direkt Koroner Arter Baypas (MIDKAB) ile konvansiyonel baypas yöntemini klinik ve anjiografik olarak karşılaştırmayı amaçladık. Çalışma Planı: Ocak 2004- Aralık 2011 tarihleri arasında merkezimizde, proksimal LAD lezyonunda, Robot Yardımlı Minimal İnvaziv Koroner Baypas Cerrahisi ile Konvansiyonel Baypas Cerrahisi uygulanmış hastalar dahil edildi. Grup I’ de 35 hastaya tam sternotomiyle KPB ile koroner baypas, Grup II’ deki 35 hastaya ise robot yardımlı minimal invaziv koroner baypas cerrahisi uygulandı. Hastaların demografik özellikleri, preoperatif, peroperatif ve postoperatif verileri retrospektif olarak toplandı. Bulgular: Konvansiyonel baypas grubunun ortalama takip süresi 5.7 yıl (±1.7) iken; robotik grubun ortalama takip süresi ise 7.3 yıl (±1.3) olarak bulundu. Hiçbir olguda İABP, postoperatif TİA, yara enfeksiyonu veya mortalite görülmedi. Konvansiyonel baypas grubundaki olguların transfüzyon ortalaması ve ventilasyon süresi anlamlı olarak yüksekti(p0,05). Sonuç: İzole proksimal LAD darlığında robotik yardımlı MIDKAB cerrahisi konvansiyonel yöntemlere göre daha az kan ve kan ürünü transfüzyonu gerektirmekte, yoğun bakım ve hastane kalış süresi daha kısa olup; erken postoperatif dönemde daha az ağrıya neden olmaktadır. Literatürdeki benzer çalışmalarla uyumlu gelen sonuçlarımız minimal invaziv girişimlerin gelecekte daha da önem kazanıp yaygınlaşacağını düşündürmektedir.Purpose: Minimally invasive bypass grafting surgery has entered the clincal routine in several centers of the world, with an increasing popularity in the last decade. Nowadays, applications of the operations on beating heart has gained importance due to the advances in technical level and recently it is commonly used with the developed minimally invasive techniques. In our study, we aimed to make a comparison between minimally invasive coronary artery bypass grafting surgery and conventional bypass grafting surgery in isolated proximal LAD lesions. Study Plan: In our center between January 2004 and December 2011, patients with proximal LAD lesion, which are treated with robot assisted minimally invasive coronary artery bypass surgery or conventional bypass surgery, were included in the study. In group 1, coronary bypass with cardiopulmonary bypass and complete sternotomy was applied to 35 patients and in group 2, robot assisted minimally invasive bypass surgery was applied to 35 patients. The demographic, preoperative, perioperative and postoperative data are gathered retrospectively. Results: The mean follow up time of conventional bypass group was 5,7±1,7 years, this value was 7,3 ±1,3 in robotic group. There were not complications like postoperative TIA, wound infection, mortality, or need for IABP in any of the patients. In conventional bypass group the transfusion average and ventilation time were significantly higher (p0,05). Conclusion: In isolated proximal LAD stenosis, robotic assisted minimally invasive coronary artery bypass grafting surgery requires less blood products, is associated with shorter ICU and hospital stay and lesser pain in the early postoperative period in contrast to conventional surgery. Our results which showed similarities with contemporary literature lead us to the idea of future importance and common usage of minimally invasive interventions

Minimal invaziv mitral kapak tamirinde neokorda boyu ölçümü için kolay bir teknik

In this article, we present our experience with an easy and practical technique for measuring the length of neo-chordae during minimally invasive mitral valve repair. This technique is based on tying the knots at the level of the plane of the ring using a prolene suture passing through the transverse diameter of the ring as a guideline.Bu yazıda minimal invaziv mitral kapak tamiri sırasında neokorda uzunluğunu ölçmek için deneyimlerimiz kolay ve pratik bir teknik ile sunuldu. Bu teknik, bir kılavuz olarak, halkanın enine çapından geçen bir prolen sütür kullanılarak düğümleri, halka düzleminin seviyesine bağlanmasına dayanmaktadır

Does Transfusion of Blood and Blood Products Increase the Length of Stay in Hospital?

WOS: 000474767900017PubMed ID: 30988569We aimed to analyze the use of blood products in cardiac surgery and to investigate its effect on clinical outcomes. Perioperative transfusion requirement, survival and complication rates and the duration of hospitalization were noted. Patients were divided into two groups considering the duration of hospital and intensive care unit (ICU) stay. The cardiopulmonary bypass time and the cross clamp time, and the amount of used cryoprecipitate, fresh frozen plasma, platelet, red blood cell and the bleeding amount were significantly higher in groups that stayed at the hospital for >7days and at the ICU for >2days (p>0.05). In the univariate model, to predict the patients who might stay at the hospital for more than 1week and who might stay at the ICU for more than 3days, we considered the significant efficacy of postoperative blood transfusion, bleeding amount, and the cardiopulmonary bypass time (p<0.05). In the reduced multivariate model, however, we analyzed the significant-independent efficacy of the postoperative fresh frozen plasma use to determine the patients who would stay at the hospital for more than 1week and who would stay at the ICU for more than 3days (p<0.05). We have concluded that increased use of blood products was associated with the cross clamp and cardiopulmonary bypass time and prolonged duration of hospital and ICU stays. In open cardiac surgeries, the use of blood products due to bleeding was identified as a predictor for staying longer than 3days at the ICU and longer than 7days at the hospital

Second recurrence of familial atrial myxomas: mother and daughter simultaneously

EZELSOY, MEHMET/0000-0002-8423-5071WOS: 000482773800002PubMed: 30729976Sporadic cardiac myxomas rarely recur, however recurrence rates are higher in patients with a familial aggregation or Carney complex. Carney complex is characterised by multiple mucocutaneous lesions and accounts for up to two-thirds of familial cardiac myxomas. A second recurrence is very rare, even in the case of Carney complex. We report on two cases of recurrent cardiac myxoma, a mother and daughter, who concurrently presented with a second recurrence of atrial myxomas. the time interval between the first and second recurrence following surgery was four years in both. the possibility of repeat recurrence of cardiac myxomas demonstrates the importance of regular echocardiography to detect recurrence and to prevent the potential complications associated with cardiac myxomas. Family screening should be recommended for familial myxomas

Multidisipliner Ekip Yaklaşımının Kan Transfüzyonu Üzerine Etkileri

Objective: The Joint Commission and the American Medical Association-Convened Physician Consortium for Performance Improvement reported that the blood transfusions are among the top five overused treatments in modern medicine. Optimal management of blood transfusion is one of the most important factors that increase patient safety, and special education is increasing all over the world in this regard. In this retrospective cohort study, our goal was to investigate the effects of periodic consensus meetings and training on perioperative blood transfusion by a team of different branches of medicine. Methods: Patients over the age of 18 undergoing cardiac surgery and required blood transfusion were included in this study. The transfusions were calculated cumulatively; the change concerning years was determined, as well as side effects and complications associated with transfusion. Patients’ cardiac reserves, laboratory values, anticoagulant drug use frequency, transfused blood volume, complications and mortality rates were recorded. The types of surgery, reexploration rate, length of intensive care and hospital stay were recorded. Results: Patients’ age, BMI, comorbidity ratio and antimicrobial drug use did not differ between years (p>0.05). The length of intensive care and hospital stay, amount of bleeding, mortality rate did not differ (p> 0.05). Cardiopulmonary Bypass time and Cross Clamp time in 2016, were significantly higher (p0.05). Besides, after 2014, an increase was observed in platelet transfusion. The change in Hb, Htc, platelet and INR did not differ significantly in the pre-postoperative period. Conclusion: Training on the restrictive use of blood products did not have a positive influence on blood transfusion in our study. It has been demonstrated that there are challenges in sufficiently transferring the knowledge to the clinical environment.Amaç: Birleşik Komisyon ve Amerikan Tabipler Birliği tarafından toplanan Performans İyileştirme Konsorsiyumu, kan transfüzyonlarının modern tıbbın ilk beş aşırı kullanımı arasında olduğunu bildirmiştir. Kan transfüzyonunun optimal yönetimi, hasta güvenliğini artıran en önemli faktörlerden biridir ve bu anlamda tüm dünyada özel eğitimler artmaktadır. Bu geriye dönük kohort çalışmasında amacımız, periyodik konsensus toplantılarının ve perioperatif kan transfüzyonu üzerine yapılan eğitimin, farklı tıp dallarından oluşan bir ekip tarafından araştırılmasıdır. Gereç ve Yöntem: Kan transfüzyonu gereksinimi bulunan, kalp cerrahisi geçiren 18 yaş üstü hastalar çalışmaya dahil edildi. Transfüzyonlar kümülatif olarak hesaplandı, yıllara göre değişim, yan etkiler ve transfüzyon ile ilişkili komplikasyonlar belirlendi. Hastaların kardiyak rezervleri, laboratuvar değerleri, antikoagülan ilaç kullanım sıklığı, transfüzyon miktarı, komplikasyonlar ve mortalite oranları kaydedildi. Ameliyat tipleri, revizyon oranı, yoğun bakım süresi ve hastanede kalış süresi kaydedildi. Bulgular: Hastaların yaş, VKİ, komorbidite oranı, antimikrobiyal ilaç kullanımı yıllara göre farklılık göstermemiştir (p>0.05). Yoğun bakım ve hastanede kalış süresi, kanama miktarı ve mortalite oranı istatistiksel olarak farklı değildi (p>0.05). 2016 yılında CBP ve CX zamanı, 2014 ve 2015’e göre anlamlı olarak daha yüksekti (p0.05). Ayrıca 2014 sonrası trombosit transfüzyonunda artış gözlendi. Ameliyat öncesi dönemde Hb, Htc, trombosit ve INR’deki değişiklik anlamlı olarak farklılık göstermedi. Sonuç: Çalışmamızda restriktif kan ürünü kullanımı ile ilgili eğitimin kan transfüzyonu üzerinde pozitif bir etkiye sahip olmadığı gösterilmiştir. Bilginin klinik ortama yeterince aktarılması konusunda zorluklar olduğu ortaya konulmuştur

Angiographic evaluation of graft patency in robotic-assisted coronary artery bypass surgery: 8 year follow-up

WOS: 000333298800015PubMed ID: 24293289BackgroundRobotic telemanipulation systems have emerged as facilitating tools that enhance minimally invasive cardiac surgery.The purpose of this study was to evaluate graft patency by a combination of invasive and non-invasive coronary angiography methods in robotic-assisted coronary artery surgery(CABG) for optimal quality control. MethodsBetween April 2004 and February 2012, patients who had robotic-assisted CABG were called to have cardiac catheterization or multislice computed tomographic angiography to evaluate graft patency. ResultsOne hundred patients out of a total 250 cases were followed for graft patency for a mean period of 60.3 23.8 (range 12-94) months. Mean operative time and left internal mammary artery harvest time was 165.96 +/- 19.5 and 41.74 +/- 5.9 (range 30-55) min. Postoperative graft patency rate was 94% and freedom from target vessel re-interventions was 98%. ConclusionRobotic-assisted CABG can be accomplished with low morbidity, mortality and re-intervention rates. It is a safe procedure in selected patients and produces excellent mid-term graft patency. Copyright (c) 2013 John Wiley & Sons, Ltd

Pain and the Quality of Life Following Robotic Assisted Minimally Invasive Surgery

WOS: 000384793700004PubMed ID: 27585193Objective: Minimally invasive bypass grafting is a promising surgical treatment in proximal LAD stenosis procedures. The main goal of this study was to make comparisons between robotically assisted minimally invasive coronary bypass surgery and conventional surgery in isolated proximal LAD lesions in terms of pain and quality of life improvement. Methods: The study contains patients with proximal LAD lesions who were treated with robotically assisted minimally invasive coronary artery bypass surgery and conventional bypass surgery between June 2005 and November 2012. Fifty patients treated with coronary bypass with cardiopulmonary bypass and complete sternotomy were categorized as Group 1. Fifty patients who applied for robotically assisted minimally invasive bypass surgery were categorized as Group 2. The evaluations of pain and quality of life were done according to the Verbal Rating Scale (VRS) and SF-36 health survey questionnaire, respectively. Results: The conventional bypass group and robotic group had 4.8 +/- 1.9 years and 4.3 +/- 1.6 years mean followup time, respectively. The robotic bypass group had a significantly shorter ICU stay and hospital stay than the conventional bypass group (P < .05). The pain score was higher in the robotic bypass group on the 1st postoperative day (P < .05), but the score on the 4th postoperative day was higher in the conventional bypass group (P < .05). In terms of domains of the SF-36 questionnaire, patient scores were significantly higher in patients who were operated with robotically assisted minimally invasive direct coronary artery bypass (MIDCAB) procedure than in patients who were operated with conventional bypass technique. Conclusion: Patients operated with robotically assisted MIDCAB procedure had results with lesser pain, shorter ICU stay, and shorter hospital stay than the other group in isolated proximal LAD stenosis. The same group also had better quality of life results according to the SF-36 questionnaire results