Penetrating cardiac injuries

BACKGROUN

A new technique for the old arterial graft: Internal thoracic artery

The internal thoracic artery (ITA) is the gold-standard conduit for coronary artery bypass surgery. It stays patent well in the long-term period, and this evidence is directly related to the superior later outcome in terms of longevity. Coronary artery bypass grafting with multiarterial grafts can be performed safely, and better long-term result can be expected with the use of arterial conduits, especially ITA. We describe a simple and practical technique for the left ITA grafting by dividing the ITA graft and using its proximal and distal parts in situ for the distal left anterior descending (LAD) artery and the obtuse marginal artery grafting

Mitral valve replacement with the beating heart technique in a patient with previous bypass graft from ascending to descending aorta due to aortic coarctation

Background and Aim: Conventional mitral valve replacement (MVR) is carried out under cardioplegic arrest with cross-clamping of the ascending aorta during cardiopulmonary bypass. In this case, MVR was performed with on-pump beating heart technique without cross-clamping the aorta because of the diffuse adhesion around the ascending aorta, and tube graft presence between ascending and descending aortas. Methods: A 47-year-old female patient had aorto-aortic bypass graft from ascending aorta to descending aorta with median sternotomy and left thoracotomy in single stage because of aortic coarctation 2 years ago in our cardiac center. She was admitted to the hospital with palpitation and dyspnea on mild exertion. Transthoracic echocardiography revealed 4th degree mitral insufficiency. Results: MVR was carried out through remedian sternotomy with on-pump beating heart technique without cross-clamping the aorta. Conclusions: MVR with on-pump beating heart technique offers a safe approach when excessive dissection is required to place cross-clamp on the ascending aorta

Beating heart mitral valve replacement with retrograde coronary sinus perfusion technique

Aim. The aim of this study was to assess the efficacy and applicability of on-pump beating heart mitral valve replacement with Sorin Bicarbon prosthesis using retrograde coronary sinus perfusion

Coronary atherosclerosis distribution and the effect of blood glucose level on operative mortality/morbidity in diabetic patients undergoing coronary artery bypass grafting surgery: a single center experience

Objective: The study aim was to investigate the effect of blood glucose level on atherosclertotic lesion distribution and the contribution to the operative mortality/morbidity in diabetic patients who underwent coronary artery bypass grafting (CABG)

Levosimendan for ischemic preconditioning in thoracic aortic aneurysm repair

Background and Aim: Postoperative neurologic deficit is the most devastating complication after surgical thoracic aorta repair. Cerebrospinal fluid drainage and some medications are used for spinal cord protection during and after the operation. Methods: A 25-year-old patient applied to our clinic with a traumatic descending aortic aneurysm. We performed a surgical repair for the aneurysm but could not achieve to place a lumbar catheter to provide cerebrospinal fluid drainage. Levosimendan was chosen for spinal cord ischemic preconditioning because of its vasodilatory effects. Results: Postoperative course was uneventful. Hemodynamic and neurologic complication was not observed, and the patient was discharged from the hospital in the postoperative 5th day. Conclusions: Levosimendan can be used for preconditioning and spinal cord protection from ischemic injury during descending aorta repair. We clearly benefit from the vasodilator peculiarity of the drug for improving spinal cord perfusion

On-pump beating heart versus hypothermic arrested heart valve replacement surgery

Background: Comparison of neurological parameters in patients undergoing prosthetic heart valve replacement with two operating techniques-either cardioplegic arrest of the heart under hypothermic cardiopulmonary bypass (CPB) or the heart beating on normothermic bypass, with or without cross-clamping the aorta, without cardioplegic arrest. Methods: Fifty valvular surgery patients were randomly assigned into three groups. Sixteen patients underwent beating heart valve replacement with normothermic bypass without cross-clamping the aorta, 17 patients underwent the same procedure with cross-clamping the aorta and retrograde coronary sinus perfusion, and the remaining 17 patients had conventional surgery with hypothermic bypass and cardioplegic arrest. Results: Two-channel electroencephalography (EEG) was recorded to assess changes in cerebral cortical synaptic activity and 95% spectral edge frequency values were recorded continuously. Bispectral monitoring was used to measure the depth of anesthesia. Blood flow rates in middle cerebral artery (MCA) were measured by transcranial Doppler (TCD). Reduction in spectral edge frequency (> 50%) or bispectral index (BIS) ( 50%) was detected in four patients in Group 1, five patients in Group 2, and three patients in Group 3. BIS or EEG values never reached zero, which indicates isoelectric silence during surgery. Gross neurological examinations were normal in all patients postoperatively. Conclusion: There is no difference regarding neurological monitoring results between on-pump beating heart and hypothermic arrested heart valve replacement surgery. Also no significant difference was encountered among the groups regarding the clinical outcomes