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

Background: This study aimed to evaluate the effects of perioperative dexmedetomidine administration on opioid consumption and extubation timing in pediatric patients undergoing congenital heart surgery.

Methods: In this single-center, retrospective cohort study, 112 pediatric patients (aged >1 month to <14 years) undergoing congenital cardiac surgery between January 2021-January 2022 were reviewed. Patients were divided into two groups; dexmedetomidine group (n=55) and a control group (n=57). Primary outcome measures included postoperative opioid consumption and mechanical ventilation duration. Secondary outcomes included high-flow oxygen therapy requirement, non-invasive ventilation, intensive care unit stay length, and reintubation rates.

Results: Demographic characteristics were comparable between groups, although the Dex group had a higher proportion of complex surgical cases (risk adjustment for congenital heart surgery-1 category III: 34.5% vs. 25.9%, p=0.034). Mechanical ventilation duration was significantly longer in the Dex group (1.9±3.4 vs. 0.9±0.8 days, p=0.024), as was the requirement for high-flow oxygen therapy (56.4% vs. 31.0%, p=0.007). No significant differences were observed in non-invasive ventilation use, reintubation rates, or mortality.

Conclusion: Perioperative dexmedetomidine was paradoxically associated with prolonged mechanical ventilation and increased postoperative respiratory support requirements. These findings suggest that dexmedetomidine should be employed as an adjunct rather than a substitute for opioids, particularly in patients undergoing complex procedures. Prospective randomized trials are warranted to refine dexmedetomidine's role in fast-track extubation protocols in this high-risk population.

Background: Aortic root thrombosis (ART) in left ventricular assist device (LVAD) patients has gained attention due to potential clinical consequences. This study aims to assess the clinical outcomes associated with ART in LVAD patients.

Methods: We retrospectively evaluated adult patients who received LVAD implants at our center between January 2020 and March 2022. Pre-operative data, including demographics, laboratory values, and echocardiographic assessments, were similar between the ART and non-ART groups. Composite outcomes such as cerebrovascular events, pump thrombosis, myocardial infarction, embolic events, bleeding, right ventricular (RV) failure, and mortality post-discharge were examined.

Results: The study included 44 outpatients (36 HeartMate 3, 8 HeartWare). ART was identified in 20 patients (45%) post-discharge. The "no ART" group had a mean age of 47±10 years (23 of 24 patients were male, 95.8%), while the "ART" group had a mean age of 48±12 years (15 of 20 patients were male, 75%), with no significant age difference (p>0.05). Thrombosis occurred at a median of 59 days post-implantation, primarily affecting the non-coronary cusp in 50% of the ART group. The median follow-up period was 416 days. No significant differences were found in composite outcomes (p=0.276), mortality (p=0.814), bleeding (p=0.808), or RV failure (p=0.197).

Conclusion: ART may be under-recognized in LVAD patients, potentially leading to cardiac and end-organ damage. While ART does not significantly impact mortality, it emphasizes the need for careful management of LVAD patients.

Left ventricular (LV) aneurysms are rare but serious complications and usually result from ischemic etiologies. Non-ischemic causes such as Takotsubo syndrome (TS) are even rarer. We present the case of a 60-year-old male patient who presented with exertional dyspnea and chest pain lasting for a month. The patient had a history of significant emotional stress following a personal tragedy. His workup revealed a non-ischemic LV aneurysm (9 cm). He was discharged in good health after urgent surgery. Although TS has a good prognosis, sometimes such mortal complications can develop. In these cases, close follow-up and early intervention may be important to improve the outcome.

Cystic echinococcosis is a zoonotic parasitic disease that can cause serious mortality and morbidity in humans. A 45-year-old male patient presented to the emergency department of our center with complaints of nausea, vomiting, and swelling in the left leg. His medical history revealed that he was fine needle aspiration had been performed due to an intra-abdominal abscess and that treatment for cystic echinococcosis had been administered, but that the patient had neglected treatment and follow-up. Radiological imaging and serodiagnostic tests revealed a giant hydatid cyst fistulizing into the aorta, causing secondary obstruction in the abdominal aorta and leading to pseudoaneurysm. The patient was successfully treated with open surgery. In conclusion, cystic echinococcosis can be successfully treated involving the primary repair of the cysto-arterial fistula and removal of the cyst.

This case report describes a 44-year-old man with midaortic syndrome and resistant hypertension, presenting a diagnostic challenge due to overlapping features of Behçet's disease and Takayasu arteritis. Imaging studies revealed severe aortic stenosis accompanied by aortic wall thickening, findings typically associated with Takayasu arteritis; however, the patient's clinical history and a positive pathergy test supported a diagnosis of Behçet's disease. Immunosuppressive therapy led to symptomatic improvement, and surgical management with thoracic endovascular aortic repair was successfully performed to address the aortic stenosis. This report discusses the possibility of Behçet's disease presenting with aortic stenosis-a rare vascular complication-or the coexistence of Behçet's disease and Takayasu arteritis.

Coronary artery aneurysms are increasingly identified through coronary angiography. To date, no consensus exists regarding the optimal management strategy. Treatment options include surgical intervention, stent placement, or medical therapy. We present a case demonstrating the successful use of a balloon-assisted technique to precisely locate the aneurysm origin and achieve effective exclusion with a covered stent, highlighting its potential as a novel therapeutic approach.

Carotid blowout syndrome is a rare but fatal complication of head and neck cancer. A 62-year-old female patient underwent carotid artery stent implantation for a carotid pseudoaneurysm following multiple surgeries. However, she subsequently presented to the emergency department with bleeding secondary to carotid artery stent extrusion. She underwent emergency surgery, and the carotid artery stent was removed. This case highlights the importance of long-term surveillance of carotid stents in cancer patients who are at risk for tissue necrosis and recurrence.

Endovascular repair has become a standardized approach for aortic diseases, but visceral branch involvement presents major technical challenges. Fenestrated repair allows aneurysm exclusion while maintaining organ perfusion, though custom-made devices are costly and often unavailable in urgent settings. We report the first physician-modified four-fenestration endograft (PMEG) procedure performed in Türkiye for a contained rupture of the visceral aorta. All four visceral branches were successfully revascularized with full exclusion of the aneurysm. The patient had an uneventful recovery, and one-month control computed tomography angiography confirmed complete graft integrity and patency of all visceral branches.

Background: This study aimed to investigate the effects of patient-prosthesis mismatch (PPM) on left ventricular structure and functional capacity in patients undergoing isolated surgical aortic valve replacement (sAVR) for severe aortic stenosis.

Methods: This retrospective analysis included preoperative and postoperative data of 157 consecutive patients who underwent isolated sAVR between January 2016 and January 2023. Body mass index and indexed effective orifice area were calculated. The severity of PPM was assessed using the valve academic research consortium-3 criteria, and patients were categorized into (1) Insignificant PPM and (2) Significant PPM. Left ventricular geometries were classified based on the left ventricular mass index (LVMi) and relative wall thickness. Functional capacity was evaluated according to the New York Heart Association classification.

Results: The mean age of the 91 patients who met the selection criteria was 64.2±8.9 years, and 44% were female and 56% were male. Sixteen patients (17.6%) were assigned to the significant PPM group. The median change in LVMi was -33 g/m² in the insignificant PPM group and -14.5 g/m² in the significant PPM group (p=0.037). Multivariate logistic regression demonstrated a significant association between LVMi change and significant PPM (odds ratio: 1.021, p=0.043). Although no significant change was observed in left ventricular geometry in either the groups, a significant difference was noted in the functional capacity changes (p=0.01).

Conclusion: Avoiding significant PPM provides better regression in LVMi and greater improvement in functional capacity; however, it is not sufficient for a significant change in left ventricular geometr y.

Background: Infective endocarditis continues to pose a significant challenge in cardiovascular surgery, with high morbidity and mortality rates despite advancements in diagnosis and treatment. This study aimed to identify predictors of in-hospital mortality among patients undergoing surgical intervention for active infective endocarditis, with a particular focus on frailty.

Methods: A retrospective analysis was conducted on fifty-five consecutive patients who underwent surgery for active infective endocarditis between October 2022 and April 2025. Clinical variables, operative data, and outcomes were also collected. Frailty was assessed using the clinical frailty scale. Univariate and multivariate logistic regression analyses were performed.

Results: The in-hospital mortality rate was 25.5%. Patients who did not survive were significantly older (median age 65.7 vs. 56.2 years) and had higher clinical frailty scale scores (mean 7.1 vs. 5.4) than those who survived. Frailty emerged as the sole independent predictor of mortality (odds ratio =3.41; 95% confidence interval: 1.20-9.65; p=0.021).

Conclusion: Frailty is a key predictor of early mortality in patients with surgical infective endocarditis. Preoperative frailty assessment and targeted interventions may enhance outcomes in this high-risk population.