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

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.

In this new case study, we report a successful percutaneous transcatheter right atrioventricular (AV) valve closure procedure using a patent foramen ovale occluder (Occlutech International AB, Helsingborg, Sweden) in an 11-year-old boy who had previously undergone a Fontan procedure and surgical right AV valve closure for double-inlet left ventricle, hypoplastic right ventricle, ventricular arterial discordance and coarctation of the aorta and developed severe right AV valve regurgitation during follow-up. We aimed to share our experience regarding the difficulties encountered during the procedure.

Background: Cytomegalovirus (CMV) infection is a significant concern during the post-transplant period in heart transplant recipients. Both preemptive and prophylactic approaches are used to prevent CMV infection. This study evaluates the impact of these CMV-targeted strategies on infection rates and graft outcomes, reflecting real-world clinical experience.

Methods: The prophylactic strategy was defined as initiating antiviral therapy in all at-risk recipients immediately post-transplantation. The preemptive strategy involved administering antiviral treatment only to patients with detected viremia, identified through regular virological monitoring.

Results: CMV infection occurred in 50.0% (30/60) of patients in the preemptive group and 20.8% (5/24) in the prophylactic group, representing a statistically significant reduction with prophylaxis (p=0.014). Graft rejection occurred in 16.7% (10/60) of preemptive patients and 20.8% (5/24) of prophylactic patients, with no significant difference between the groups (p=0.652).

Conclusion: Prophylactic CMV prevention in heart transplant recipients significantly lowers the incidence of CMV infection compared to preemptive strategies. However, graft rejection rates did not differ significantly between the two approaches.

Background: The shortage of donor hearts has led to the increased use of left ventricular assist devices (LVADs) as an alternative treatment for advanced heart failure. As the population of LVAD recipients grows, so does the demand for non-cardiac surgical interventions in this group. This study aims to share our experience with non-cardiac surgeries performed in patients supported by long-term LVADs.

Methods: We retrospectively analyzed 72 patients who underwent LVAD implantation at our clinic between 2017 and 2024. Among them, 53 received the HeartMate 3 (Abbott Inc., Chicago, IL) and 19 received the HeartWare (Medtronic Inc., Minneapolis, MN).

Results: Patients were followed for a mean duration of 48.5 months (range: 1-78 months). During this period, 19 non-cardiac surgical procedures were performed in 13 patients; some patients underwent more than one procedure. A total of 12 procedures were conducted under general anesthesia, while 7 was performed under sedation. No perioperative deaths, thromboembolic events, or device malfunctions occurred. Minor complications included one case of re-intubation and one surgical site infection, associated with repeated amputations in a patient with peripheral arterial disease.

Conclusion: Non-cardiac surgery in patients with long-term LVAD support appears to be safe when carefully planned. Larger studies are warranted to validate these findings.

Background: Anomalous aortic origin of coronary arteries (AAOCA) is the second leading cause of sudden cardiac death in young athletes and poses significant diagnostic and management challenges due to its variable anatomy and unpredictable clinical course.

Methods: We retrospectively analyzed 17 pediatric patients (10 male, 7 female; median age 12 years) diagnosed with AAOCA between 2016 and 2025. All patients underwent echocardiography and electrocardiogram-gated computed tomography angiography. Risk stratification considered interarterial course, intramural segment, and ostial morphology.

Results: Anomalous right coronary artery was most common (n=11, 64.7%), followed by anomalous left coronary artery (ALCA) (n=4, 23.5%) and anomalous circumflex arteries (n=3, 17.6%). Interarterial course was present in 12 patients (70.6%), and intramural course in 9 patients (52.9%). The main presenting symptoms were exercise-induced chest pain (n=10, 58.8%), syncope (n=8, 47.1%), dizziness (n=7, 41.2%), and palpitations (n=6, 35.3%). Syncope was predominantly observed in ALCA patients with interarterial course. Among 15 patients aged ≥8 years who underwent exercise stress testing, 6 (40%) showed inducible ischemia. Nine patients (52.9%) underwent surgical intervention, including unroofing (n=7), ostial reimplantation (n=1), and pulmonary artery translocation (n=1). The remaining eight patients (47.1%) were managed conservatively, six of whom received beta-blocker therapy.

Conclusion: Transthoracic echocardiography reliably identified AAOCA, showing excellent concordance with computed tomography and surgical findings. Standardized echocardiographic protocols are crucial, especially for children presenting with unexplained syncope or exertional symptoms, and can guide optimal management strategies.

Background: Adenocarcinoma is the most common subtype of lung cancer. Histopathologically, lung adenocarcinoma is classified into five distinct patterns: lepidic, acinar, papillary, solid, and micropapillary. In 80-90% of cases, heterogeneous histopathological patterns are observed. This study aimed to evaluate the impact of predominant histological patterns on survival in surgically treated patients, as well as to identify other clinical, demographic, and histopathological factors affecting prognosis.

Methods: In this retrospective cohort study, 499 patients who underwent surgery for primary lung adenocarcinoma were evaluated. Survival data were obtained from electronic medical records. Demographic, clinical, and histopathological parameters were analyzed for both surviving and deceased patient groups. Univariate and multivariate Cox regression analyses were conducted to determine independent predictors of mortality.

Results: A total of 499 patients who underwent anatomical resection for primary lung adenocarcinoma and had complete medical data were retrospectively analyzed. The mean age was 61±8.1 years, and 77.6% of patients were male. The median tumor size was 3.5 cm (range: 2.30-5.20 cm), and the median Charlson comorbidity index was 3 (range: 2-4). The 5-year overall survival (OS) rate was found to be 64.5%. The 5-year OS was 59.8% in males and 77.7% in females (p=0.001). Regarding the side of surgery, the 5-year OS was 57.8% for left-sided resections and 67.9% for right-sided resections (p=0.024). The presence of a micropapillary pattern and acinar predominance were both identified as negative prognostic factors for survival (p=0.017, p=0.024, respectively). Additionally, lymphatic invasion and postoperative complications were found to be independent prognostic factors adversely affecting survival in multivariate analysis (p=0.014, p=0.011).

Conclusion: This study demonstrates that predominant histological patterns significantly influence survival in lung adenocarcinoma. The presence of a micropapillary component and acinar predominance were identified as negative predictive factors in multivariate analysis. We believe that relying solely on the TNM staging system may be insufficient for survival prediction; factors such as predominant histological pattern, lymphatic invasion, gender, Charlson comorbidity index, and postoperative complications should also be taken into account. These criteria may also be considered in planning oncological treatment strategies.

Pulmonary valve dysfunction following transannular patch repair of Tetralogy of Fallot can result in right ventricular (RV) dilation, potentially leading to lifelong complications. This study describes three surgical RV remodeling techniques aimed at addressing RV dilation during pulmonary valve replacement (PVR). Early postoperative evaluations demonstrated significant reductions in RV outflow tract diameters and improvement in QRS duration. These findings indicate that incorporating RV remodeling techniques during PVR may help mitigate the progression of RV dysfunction. Long-term follow-up is necessary to confirm these preliminary results.

Background: Corrosive esophagitis caused by ingestion of acidic or alkaline substances remains a serious public health issue, especially in developing countries. Despite numerous studies, there is currently no universally accepted treatment algorithm for corrosive esophagitis. This study aims to present a diagnostic and treatment algorithm developed from 26 years of clinical experience and to evaluate current management approaches.

Methods: In this retrospective study, patients diagnosed with corrosive esophagitis and admitted to a tertiary thoracic surgery clinic between January 1998 and December 2024 were analyzed. Demographic data, ingested substance type and intent (accidental or suicidal), clinical presentation, diagnostic methods, treatment strategies, and outcomes were evaluated. Endoscopic injury severity was classified using the Zargar system. As this was a descriptive study, no statistical testing was performed.

Results: A total of 501 patients were included. Commonly ingested substances were bleach, limescale removers, and detergents. Rigid esophagoscopy was performed in 248 patients (49.5%) and classified using Zargar grades. Oral intake was initiated based on symptoms and injury severity, with a mean of 4.5±5.23 days. All patients received intravenous proton pump inhibitors and antibiotics; corticosteroids were selectively used. Surgery was required in 3 patients due to complications such as perforation and fibrosis, and 8 underwent dilatation for strictures. Four patients (0.8%) died due to airway injury, suicide, or cardiopulmonary arrest.

Conclusion: Corrosive esophagitis remains a diagnostic and therapeutic challenge. A symptom- and imaging-based triage approach may guide safe management. Routine corticosteroid use appears unnecessary. The proposed algorithm, based on 26 years of clinical experience, may serve as a practical tool to streamline management and improve patient outcomes.