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

Background: This study aims to classify wound complications after median sternotomy and provide an up-to-date reconstructive algorithm for multidisciplinary use.

Methods: A total of 15 patients (9 males, 6 females; mean age: 68±5 years; range, 60 to 75 years) who underwent sternal reconstruction for wound complications following median sternotomy between August 2020 and October 2023 were retrospectively analyzed. Wound complications requiring reconstruction were classified into three categories based on the extent of the dead space caused by sternal debridement. Type 1, 2, and 3 wounds presented with only skin defects and an intact sternum, with partial and total sternectomy, respectively. The time to consultation for plastic surgery and the duration of hospitalization were compared.

Results: Among the wounds, type 2 wounds were the most common type seen in 11 patients. Two patients each had type 1 and type 3 wounds. A superior epigastric artery perforator skin flap was used for type 1 wounds. Bilateral pectoral and split pectoral turnover muscle flaps from the side where the internal mammary artery was intact were used for type 2 wounds. A rectus abdominis muscle flap was used for type 3 wounds. Early consultation from plastic surgery reduced the length of hospital stay.

Conclusion: For type 1 wounds, skin flaps ensured sufficient coverage as they involved skin and subcutaneous fat, matching the defect. However, sternal excision required muscle flaps to fill the dead space, in which the vital organs were exposed.

Background: This study aimed to review our institutional experience with the Fontan operation, the adverse severe events we encountered during mid-term follow-up, and the associated risk factors.

Methods: In the study, the medical records of 40 patients (22 males, 18 females) who underwent Fontan operation between August 1993 and August 2020 were retrospectively reviewed. The patients were followed up for at least six months.

Results: The Fontan operation was performed at a median age of 6.5 years (range, 3 to 22 years), and the mean follow-up time was 4.1±3.8 years (range, 0.5 to 17 years). The most frequently occurring defect was tricuspid atresia (45.0%). Fifteen (37.5%) patients experienced 24 late adverse events. Late complications and severe side effects, in order of frequency, were arrhythmia in eight (53.3%) patients, hypoxia in five (33.3%) patients, and ventricular dysfunction in three (20%) patients. While protein-losing enteropathy and mortality were each observed in two (13.3%) patients, Fontan failure, thromboembolic event, pulmonary arteriovenous fistulae, and ascites were each observed in one (6.6%) patient. When possible risk factors for late complications were examined, a statistical significance was not found.

Conclusion: Life expectancy and quality of life of patients with Fontan circulation have increased with advances in surgical technique and increased management success. However, complications are not uncommon after the Fontan operation, and late events remain a significant problem. The results of our study indicate that in mid-term follow-up of patients who underwent Fontan surgery at our institution, although not statistically significant, those who underwent fenestration and those operated at a later age tended to experience more severe events and late complications.

Background: This prospective study aimed to validate the prognostic value of Prevent III (PIII) risk score in patients undergoing aortoiliac revascularization, both in limb-related outcomes and cardiovascular risk.

Methods: The prospective cohort study included 130 consecutive patients (122 males, 8 females; mean age: 62.1±9.2 years; range, 53 to 71 years) undergoing elective aortoiliac revascularization between January 2013 and September 2022. Patients' demographic and clinical characteristics were retrieved and PIII scores were calculated. A risk category was assigned according to the total points: low-risk (score ≤3), medium-risk (score 4-7), or high-risk (score ≥8).

Results: The median follow-up period was 55 months (interquartile range, 39 to 70 months). Twenty-four (18.5%) patients had a PIII score ≥4. Regarding short-term outcomes, patients with PIII scores ≥4 exhibited lower ankle-brachial index changes at 30 days and more extended hospital stays. There were no significant associations between PIII scores and major adverse events at 30 days. However, during follow-up, a PIII score ≥4 was associated with increased major adverse limb events (p=0.036) and all-cause mortality (p=0.007).

Conclusion: The PIII score is a reliable predictor of long-term limb and mortality risk in patients undergoing aortoiliac revascularization procedures, leveraging five user-friendly clinical parameters. More research with larger cohorts and studies comparing PIII with other validated scores should be performed in the future.

Background: In this meta-analysis, we aimed to determine the effect of non-pharmacological methods on pain in patients undergoing open heart surgery.

Methods: Scientific articles published between January 2002 and April 2022 were scanned in ScienceDirect, Scopus, PubMed, Web of Science, Google Scholar, Mendeley, Wiley Online Library databases. The keywords "open heart surgery," "cardiovascular surgery," "non-pharmacological," "complementary medicine," and "pain" were used in Turkish and English language. As a result of the search, 7,952 studies were identified and analyzed. Research data were obtained from 49 scientific articles.

Results: The total sample size of the studies included in the analysis was 3,097. The total effect size was found to be 3.070, with a 95% confidence interval of 2.522 at the lower limit and 3.736 at the upper limit. Non-pharmacological pain methods in open heart surgery included positive environmental experience, distraction, massage therapy, hand massage, foot massage, acupuncture therapy, lavender essential oil inhalation, cold application, music therapy, breathing and relaxation exercises, neurolinguistic programming, guided visualization, imagery, therapeutic touch, osteopathic treatment, and transcutaneous electrical nerve stimulation.

Conclusion: The pain of patients who underwent open heart surgery with non-pharmacological methods combined with pharmacological methods was three times less than those without non-pharmacological methods. Based on these findings, non-pharmacological methods are recommended for use due to their ease of application, and low side effects.

Background: This study aims to investigate the incidence, prognosis, and etiology of diaphragmatic elevation following cardiac surgery.

Methods: Between February 2019 and December 2019, a total of 888 patients (631 males, 257 females; mean age: 58.4±12.1 years; range, 19 to 84 years) who underwent cardiac surgery were retrospectively analyzed. A series of chest X-rays taken before and after surgery were analyzed to detect diaphragmatic elevation. The patients were divided into two groups: those without diaphragmatic elevation (Group 1, n=789) and those with diaphragmatic elevation (Group 2, n=99).

Results: Diaphragmatic elevation occurred in 11.14% of patients. Of these patients, 85% recovered within a year. Patients with concomitant chronic obstructive pulmonary disease and diaphragmatic elevation exhibited prolonged mechanical ventilation compared to chronic obstructive pulmonary disease patients without elevation. The incidence of diaphragmatic elevation was higher in coronary artery bypass grafting patients compared to others (p<0.001). A secondary analysis utilizing propensity score matching revealed topical cold slush as an independent risk factor for diaphragmatic elevation. Incidence and hospitalization duration were higher among patients exposed to topical cold slush (p=0.011 and p=0.002, respectively). Left internal mammary artery harvesting and diabetes mellitus were associated with increased incidence of diaphragmatic elevation.

Conclusion: Diaphragmatic elevation is frequent following cardiac surgery, particularly in coronary artery bypass grafting patients with diabetes mellitus. Among chronic obstructive pulmonary disease patients, diaphragmatic elevation can lead to unfavorable clinical outcomes. Minimizing the use of topical cold slush and considering beating heart surgery may be prudent in high-risk groups to reduce diaphragmatic elevation incidence.

Background: This study aimed to explore the evolution and impact of smart cannulas in enhancing outcomes and expanding the scope of minimally invasive cardiac surgery.

Methods: In this study, a comprehensive review of the relevant literature was conducted, focusing on articles detailing the development, implementation, and outcomes associated with smart cannulas in cardiac surgery. PubMed, MEDLINE, and Google Scholar databases were searched until January 2024 using specific search terms related to smart cannulas and cardiac surgery. The review identified six studies, of which five met the inclusion criteria after screening titles and abstracts.

Results: Key findings included improved venous drainage, reduced complications, and enhanced surgical precision. From early prototypes to contemporary designs, smart cannulas demonstrated improved access, enhanced perfusion, and reduced complications compared to traditional cannulation methods. Additionally, advancements in technology-enabled remote access perfusion and facilitated complex procedures in pediatric and adult populations.

Conclusion: Smart cannulas represent a significant advancement in cardiac surgery, offering safer and more efficient alternatives to conventional cannulation techniques. The versatility and effectiveness of smart cannulas have paved the way for expanding the applications of minimally invasive cardiac surgery, ultimately benefiting patients through better improved outcomes and reduced morbidity. Continued research and innovation in smart cannula technology promise further enhancements in the field of cardiac surgery.

Background: This study aimed to analyze our video-assisted thoracic surgery (VATS) experience in the surgical treatment of bronchiectasis and the reasons limiting VATS application.

Methods: Two hundred one patients (106 males, 95 females; mean age: 39.7±14.1 years; range, 12 to 68 years) who underwent surgical treatment for bronchiectasis between January 2012 and October 2021 were included in the retrospective study. Three groups were created based on the surgical technique used: VATS, thoracotomy, and patients who were converted from VATS to thoracotomy.

Results: The most significant presenting symptoms were cough (43%) and excessive sputum expectoration (40%). Surgical intervention was applied to the left side of 60% of the patients, and the most common resection performed in all three groups was left lower lobectomy. The rate of conversion from VATS to thoracotomy was 28.8%, and it was found that dense pleural adhesions were the most common reason. Revision surgery was performed on a total of 11 (5.47%) patients. The frequency of revision surgery did not differ significantly among the three groups (p=0.943). The most common postoperative complication was prolonged air leakage. There was no statistically significant difference in postoperative complication rates among the groups (p=0.417). The rate of surgical treatment of bronchiectasis with VATS was observed to have increased from 11.1% to 77.7% in our clinic.

Conclusion: In experienced hands, VATS can be safely applied in the surgical treatment of bronchiectasis.

Background: This study aimed to assess intraoperative cerebral hemodynamic responses and embolic events during transcarotid artery revascularization via transcranial Doppler, near-infrared spectroscopy, and bispectral index monitoring.

Methods: Twelve patients (7 males, 5 females; mean age: 72.8±9.0 years; range, 63 to 91 years) undergoing transcarotid artery revascularization with simultaneous transcranial Doppler, near-infrared spectroscopy, and bispectral index monitoring were analyzed in this retrospective study between September 2017 and December 2019. The mean flow velocity and pulsatility index of the middle cerebral artery, alongside near-infrared spectroscopy and bispectral index values, before flow reversal, during flow reversal, and after flow reversal phases were investigated. The presence and frequency of high-intensity transient signals were recorded to evaluate embolic incidents.

Results: Significant reductions in middle cerebral artery mean flow velocity were noted during flow reversal (40.58±10.57 cm/sec to 20.58±14.34 cm/sec, p=0.0004), which subsequently returned to and exceeded baseline values after flow reversal cessation (53.33±17.69 cm/sec, p=0.0005). Near-infrared spectroscopy (71±4.4% to 66±6.2%) and bispectral index (45.71±8.5 to 40.14±8.1) values mirrored these hemodynamic changes, with notable decreases during flow reversal, and recoveries after flow reversal. The highest concentration of high-intensity transient signals was observed during stent deployment, signifying a critical embolic phase. No perioperative neurological complications or other significant adverse events were documented.

Conclusion: Transcranial Doppler, near-infrared spectroscopy, and bispectral index effectively monitor cerebral hemodynamics and embolic potential during transcarotid artery revascularization, providing real-time data crucial for optimizing perioperative management. These findings underscore the clinical value of multimodal monitoring in improving patient outcomes in transcarotid artery revascularization procedures.