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

Background: The neutrophil-lymphocyte ratio (NLR) has been suggested as a valuable indicator of poor outcomes in patients undergoing cardiac surgery. However, its prognostic role in pediatric patients undergoing open-heart surgery is unclear. This study aimed to evaluate the correlation between the perioperative NLR and clinical outcomes after pediatric open-heart surgery under cardiopulmonary bypass (CPB).

Methods: A literature search was conducted from their inception to July 19, 2024 in PubMed Central, ProQuest, Sage, ScienceDirect and Ovid. We included studies that investigated the perioperative value of NLR as a predictor of outcomes after pediatric cardiac surgery under CPB. A meta-analysis was performed according to preferred reporting items for systematic reviews and meta-analyses guidelines. The Newcastle-Ottawa scale was used to assess the study quality, while JAMOVI statistical software was used to perform the meta-analysis.

Results: A total of six studies were included based on our eligibility criteria; however, only four were included for meta-analysis. The results showed a significant correlation between postoperative NLR with hospital (r=0.34 [95% confidence interval [CI] 0.10-0.58]) and intensive care unit (r=0.25 [95% CI 0.04-0.46]) length of stay.

Conclusion: NLR has shown potential as a simple and affordable inflammatory marker in pediatric cardiac surgery under CPB. However, its moderate to weak correlation with clinical outcomes necessitates cautious interpretation. Further research in the form of impact studies is warranted to strengthen these findings.

A 61-year-old woman with chronic lymphocytic leukaemia was admitted with peripheral embolism in the left arm. Computed tomography angiography showed dense thrombus in the descending aorta, left subclavian artery ostium and radial artery. The patient was successfully treated with thoracic endovascular aortic replacement + chimney graft technique and discharged on postoperative day 5.

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.