Turk Gogus Kalp Damar Cerrahisi Dergisi-Turkish Journal of Thoracic and Cardiovascular Surgery最新文献

Background: Left ventricular assist device inflow cannula malposition can contribute to numerous negative outcomes after device implantation. We analyzed the impact of position changes in the inflow cannula angle in HeartMate II (HM II) and HeartMate 3 (HM 3) patients.

Methods: Between January 2012 and December 2023, patients who underwent HM II and HM 3 implantation were reviewed. Among them, patients with suitable chest X-rays for angle calculation at both 1-2 months and 6-12 months post-implantation were identified.

Results: The study cohort consisted of 66 (82.5%) HM 3 and 14 (17.5%) HM II patients. The median age of the cohort was 57.6 years (Interquartile range [IQR], 47.4-63.2), and the majority were males (n=73, 91.2%). Operative data and demographics were similar between the groups except for the body surface area (p<0.01), body mass index (p=0.01) and hypertension (p=0.02). A significant increase in the inflow cannula coronal angle was observed in the HM 3 group (p=0.03), while the pump depth distance remained similar (p=0.37). In contrast, the HM II group showed no significant changes in the inflow cannula angle (p=0.39) or the pump body angle (p=0.32). The HM 3 group exhibited a significant increase in pump power and pulstility index over time (p<0.01 and p=0.02, respectively).

Conclusion: A significant increase in the coronal angle of the inflow cannula over time was observed in HM 3 patients. Proper assessment of pump positioning at implantation is important, especially in hypertensive and overweight patients, as changes in pump angle over time may influence pump parameters.

Background: This study aims to evaluate preoperative, perioperative, and postoperative parameters in patients with primary spontaneous pneumothorax (PSP) to minimize recurrence and improve predictability.

Methods: This single-center retrospective cohort study included 207 patients who underwent surgery for PSP between 2016 and 2020. Recurrence data were obtained from the national electronic health record system and the institutional hospital information system. Pneumothorax size was calculated preoperatively on posteroanterior chest radiographs using the Collins method.

Results: The mean age of the patients was 24.54±6.98 years and 87% of the patients were male. The overall recurrence rate was 9.7%. A higher Collins percentage (p<0.001), age ≤20 years (p=0.015), and continued smoking postoperatively (p=0.036) were found to be significantly associated with increased recurrence.

Conclusion: The findings suggest that a high Collins percentage on posteroanterior chest radiography, young age at the time of surgery, and continued smoking postoperatively are significant risk factors for recurrence.

Background: Sericin is a natural, macromolecular, adhesive protein that is derived from the cocoons of silkworm. There has been no study to date in literature evaluating the potential for neurotoxicity associated with sericin pleurodesis.

Methods: Adult, male, Wistar-Albino rats aged 12-week-old, weighing 211-256 gr (n=22) were divided randomly into two groups, each comprising 11 rats. A left thoracotomy was performed following intramuscular anesthesia. The A group was administrated sericin 30 mg and B group constituted by sham thoracotomy group. The rats were fed ad-libitum, all were sacrificed on day 13. The brain and cerebellum were excised en-bloc; T9-L3 segment was excised, and a sampling was made from sciatic nerve.

Results: A subarachnoid hemorrhage was observed in the brain specimens of four rats (36.4%) in the control group and six rats (54.5%) in the sericin group (p=0.416). A capillary hemorrhage in the cerebellum was observed in six rats (54.5%) in the control group and in one rat (9.1%) in the sericin group (p<0,.05; p=0.024). A hemorrhage was observed in the central canal in three rats (27.3%) in the control group, whereas no hemorrhage was observed in the sericin group (p=0.082). Congestion in the fibers of the sciatic nerve was observed in five rats (45.5%) in the control group and in seven rats (63.6%) in the sericin group (p=0.416). The observation of capillary hemorrhage in the cerebellar specimens was significantly more common in the control group.

Conclusion: The administration of intrapleural sericin does not cause neurotoxicity in rats and can be safely used in pleurodesis procedures.

Percutaneous pulmonary valve implantation has emerged as a non-surgical intervention for patients with right ventricular outflow tract dysfunction. Congenitally corrected transposition of the great arteries is a rare congenital heart disease characterized by atrioventricular and ventriculoarterial discordance. The long-term follow-up and management of patients with this condition can be challenging. In this case report, we present a successful percutaneous pulmonary valve implantation in a 19-year-old male patient with physiologically repaired congenitally corrected transposition of the great arteries.

Background: Bicuspid aortic valve (BAV) increases the risk of thoracic-aortic dilatation/aneurysm and aortic dissection. In the pathogenesis of aortic aneurysm, matrix metalloproteinases have been found to play a role in the degradation of aortic wall proteins. Thus, this study aimed to investigate MMP2 and MMP9 gene polymorphisms in patients with BAV and ascending aortic aneurysm.

Methods: Overall, 83 patients (36 patients admitted to the outpatient clinic and 47 controls) participated in this study. Genomic DNA was extracted from peripheral leukocytes using the MagNA Pure LC DNA Isolation Kit I on the MagNA Pure LC Instrument (Roche Applied Science). MMP2 (C1306T) and MMP9 (C1562T) gene polymorphisms were analyzed using the LightCycler^® 480 High-Resolution Melting Master Kit (Roche Applied Science) with specific primers.

Results: Both groups had similar sex distribution (p=0.601). Hypertension and smoking were more common in patients with MMP9 polymorphism (p<0.001; p=0.011). A statistically significant relationship was found between smoking, hypertension, and MMP9 gene expression. However, no significant relationship was noted between MMP2 and aneur ysm diameter, hypertension, smoking, and antihypertensive drug use.

Conclusion: Our findings indicate that increased aneurysm diameters and MMP9 gene polymorphism are potential predictors of aneurysm development in patients with BAV.

The 7-year outcomes of the Placement of Aortic Transcatheter Valves 3 (PARTNER 3) trial comparing transcatheter aortic valve implantation (TAVI) with surgical aortic valve replacement (SAVR) in low-risk patients indicate that the narrowing difference between the two strategies reflects study design convergence rather than true clinical equivalence. Although the composite endpoint of death, stroke, and rehospitalization appeared comparable, important asymmetries persisted. Notably, approximately one quarter of patients in the SAVR group underwent concomitant coronary artery bypass grafting, whereas no patients underwent percutaneous coronary intervention, and surgical valve types were not standardized. In contrast, the incidences of valve thrombosis and paravalvular leak remained substantially higher after TAVI. Emerging trends in late mortality and crossing hazard curves further suggest potential divergence in long-term survival. Thus, the perceived equivalence of TAVI and SAVR largely reflects trial design and endpoint framing rather than durable clinical parity. Among younger patients, lifetime risk profiles differ fundamentally. As clinical enthusiasm for transcatheter therapy expands, careful interpretation grounded in valve durability, proportional hazards, and transparent analysis remains essential. Ultimately, long-term treatment standards should prioritize biological integrity over procedural convenience.

Background: This study aimed to compare the effects of cryoablation (CrA) and radiofrequency ablation (RFA) in achieving conversion from atrial fibrillation (AF) to sinus rhythm (SR) and to evaluate factors associated with postoperative AF recurrence in patients undergoing mitral valve surgery.

Methods: A total of 88 patients diagnosed with AF who underwent mitral valve replacement combined with the Cox-Maze IV procedure between 2014 and 2020 were included in the study. CrA was performed in 48 patients (54.5%), while RFA was applied in 40 patients (45.5%). Patients were grouped according to the ablation modality used and the presence or absence of postoperative AF recurrence. All patients had AF for at least six months preoperatively, as confirmed by Holter monitoring.Associations between AF recurrence and clinical parameters, including left ventricular ejection fraction (LVEF), left atrial diameter (LAD), and body mass index (BMI), and comorbidities, were evaluated.

Results: The mean follow-up duration was 6 months, with no mortality observed during this period. At six months postoperatively, SR was maintained in 70% (n=28) of patients in the RFA group and 79% (n=38) in the CrA group, with no statistically significant difference between the two groups (p>0.05). AF recurrence was significantly associated with increased LAD (p=0.01), presence of chronic obstructive pulmonary disease (p=0.007), obesity (BMI ≥30 kg/m²; p<0.001), and reduced LVEF (p<0.001).

Conclusion: Both CrA and RFA-as alternative energy sources-were found to be effective in converting AF to SR. Additionally, our study revealed that the demographic and clinical characteristics had an influence on AF recurrence.

During anesthesia induction for urgent coronary artery bypass grafting in a 63-year-old man, endotracheal intubation was unsuccessful. Computed tomography of the neck revealed multiple calcified nodules along the tracheal wall. Bronchoscopy demonstrated whitish submucosal nodules narrowing the airway lumen. Tracheobronchopathia osteochondroplastica (TBPO) was suspected and confirmed by biopsy obtained during the same operative session. Since tracheotomy was deemed unfeasible, a 16×60 mm self-expandable Nitinol tracheal stent covered with polyurethane was inserted by the thoracic surgery team, allowing surgery to proceed uneventfully. This case highlights TBPO as a rare but important cause of unexpected difficult intubation in the perioperative setting. The stent was removed uneventfully on postoperative day 9. Following stent removal, the patient's respiratory function remained stable, with no dyspnea or obstructive symptoms during follow-up.

Background: Intraoperative transit time flow (TTF) measurement provides quantitative information regarding graft patency and anastomotic quality. However, limited data exist on the relationship between SYNTAX scores and intraoperative graft flow dynamics during coronary artery bypass grafting (CABG). This study aimed to evaluate the predictive value of SYNTAX scores for intraoperative graft flow parameters, as assessed by TTF measurements of the left internal mammary artery (LIMA) grafted to the left anterior descending (LAD) artery.

Methods: Patients with critical LAD disease who underwent CABG at a single tertiary referral center between February and October 2019 were prospectively evaluated. For each patient, the SYNTAX score, SYNTAX II score, and the LAD-specific contribution to the SYNTAX score (LAD-SYNTAX) were calculated. Correlations between these scores and TTF parameters-including mean graft flow (MGF), diastolic flow (DF), and pulsatility index (PI)-were analyzed.

Results: The SYNTAX score demonstrated a negative correlation with MGF (r =-0.118, p=0.313) and DF (r =-0.026, p=0.828), and a positive correlation with PI (r =0.131, p=0.264). Similarly, the SYNTAX II score showed negative correlations with MGF (r=-0.040, p=0.735) and DF (r=-0.246, p=0.037), and a positive correlation with PI (r=0.168, p=0.149). Consistent trends were observed with LAD-SYNTAX, with MGF and DF showing negative correlations and PI showing a positive correlation; notably, the correlation between LAD-SYNTAX and MGF was statistically significant (r=-0.288, p=0.012).

Conclusion: SYNTAX scores are associated with intraoperative TTF measurements of the LIMA-LAD graft. These findings suggest that both the atherosclerotic burden of the target vessel and patient-specific factors may influence LIMA graft flow dynamics during CABG.

Background: Extracorporeal membrane oxygenation (ECMO) provides life-saving support but carries considerable risks, particularly in neonates and postcardiotomy patients. The vasoactive inotropic score (VIS), which measures cardiovascular support, shows potential as a prognostic marker; however, its role in ECMO remains underexplored. This study aims to assess the impact of vasoactive inotropic score values on mortality and ECMO-related complications in patients undergoing ECMO due to cardiopulmonary failure.

Methods: We analyzed 106 pediatric patients who underwent ECMO between January 2011 and January 2021. The demographics, ECMO indications, cannulation strategies, VIS at initiation, complications, and outcomes were reviewed. The primary endpoint was in-hospital mortality. ROC curve analysis and multivariate logistic regression evaluated the prognostic utility of VIS and ECMO-related complications.

Results: The in-hospital mortality rate was 57.5%, which was higher among neonates (78.6%), infants (62.0%), and patients who underwent central VA ECMO. VIS at cannulation was independently associated with mortality in multivariate analysis (median VIS: 28 in non-survivors vs. 20 in survivors; p<0.001). A VIS value ≥28 demonstrated strong predictive ability for mortality (area under the curve: 0.815; sensitivity: 82%, specificity: 78%). ECMO-related complications occurred in 62.3% of patients, with renal complications requiring dialysis emerging as the strongest mortality predictor (odds ratio [OR]: 3.40; p<0.001), followed by neurological complications (OR: 2.01; p=0.027).

Conclusion: A VIS score ≥28 at ECMO initiation strongly predicted in-hospital mortality. Renal complications substantially worsen clinical outcomes. Incorporating VIS into risk stratification protocols and implementing strategies to prevent major complications may improve prognosis of pediatric patients on ECMO.