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

Thoracic aortic transection is a high mortality event which usually occurs after motor vehicle accidents and is caused by separation of the aortic layers. In this article, we present a 33-year-old, 8 weeks and 5 days pregnant by in vitro fertilization, multi-trauma patient with thoracic aortic transection after a motor vehicle accident. The patient with a complete transection distal to the subclavian artery was successfully treated with thoracic endovascular aortic repair method under general anesthesia, taking all necessary precautions. The patient had a healthy delivery with no problems in follow-up visits. Not one, but two lives were saved with thoracic endovascular aortic repair. In conclusion, this report emphasizes that thoracic endovascular aortic repair is a fast and safe critical treatment method in the treatment of life-threatening aortic transections.

Background: This study aims to assess differences in cardiorespiratory fitness improvement after phase II cardiac rehabilitation in coronary artery bypass grafting patients with various risk factor profiles and to investigate their correlation.

Methods: Between October 2023 and March 2024, a total of 45 patients (35 males, 10 females; mean age: 59.5±8.5 years; range, 55 to 64 years) who underwent phase II cardiac rehabilitation following coronary artery bypass grafting were retrospectively analyzed. Obesity, hypertension, diabetes mellitus, and dyslipidemia were assessed. The patients were classified according to the specific risk factors and risk factor count. Cardiorespiratory fitness parameters including 6-minute walk distance, maximal oxygen consumption, and metabolic equivalents before and after cardiac rehabilitation were recorded.

Results: The average risk factor count was 2.3 per patient, with dyslipidemia most prevalent (73.3%). The highest improvement in cardiorespiratory fitness was shown in patients with four risk factors and those who had obesity. A significant improvement in the cardiorespiratory fitness was observed in all patients, groups with one to four risk factors, and all specific risk factor groups (p<0.05). Patients with obesity showed significantly greater cardiorespiratory fitness improvement, compared to non-obese patients (p=0.009). There was no significant correlation between risk factor count and cardiorespiratory fitness improvement (p>0.05).

Conclusion: Cardiac rehabilitation significantly improved cardiorespiratory fitness in all post-coronary artery bypass grafting patients, regardless of risk factor profiles, with notably greater improvements observed in patients with obesity. Clinically, these findings underscore the importance of universally recommending phase II cardiac rehabilitation in this patient group, particularly emphasizing tailored interventions in individuals with obesity to maximize rehabilitation outcomes and potentially reduce cardiovascular morbidity and mortality.

Background: This study aims to evaluate the outcomes of surgical treatment of post-intubation tracheal stenosis cases and to identify factors associated with recurrence and treatment success.

Methods: Between January 2010 and December 2024, a total of 56 patients (38 males, 18 females; mean age: 49.1±14.8 years; range, 24 to 61 years) who were treated for postintubation tracheal stenosis were retrospectively analyzed. Data were collected using a standardized data extraction form. Demographic data, clinical characteristics, comorbidities, surgical procedures, and postoperative outcomes of the patients were recorded.

Results: Comorbidities, particularly diabetes, were common in the majority of patients. Recurrence occurred in 14 (25%) of the cohort. Early mortality was observed in one (1.7%) patient. Middle tracheal stenosis as the site of stenosis and the use of 3/0 Vicryl separating sutures had higher recurrence rates. The mean length of the removed segment was 3.7±0.7 cm in patients without recurrence, while it was 3.2±0.5 cm in patients with recurrence (p=0.361). While the recurrence rate was 71.4% among patients with comorbidities such as diabetes, hypertension, epilepsy, and Crohn's disease, this rate was 28.6% in those without comorbidities (p<0.001), and the presence of comorbidities significantly increased the likelihood of recurrence (odds ratio [OR]=9.167, 95% confidence interval [CI]: 3.482-24.134, p<0.001).

Conclusion: Surgical treatment of post-intubation tracheal stenosis presents challenges due to the high recurrence rate, particularly in patients with comorbidities. Individualized treatment approaches, meticulous surgical techniques, and comprehensive postoperative care are essential to improve patient outcomes.

Background: This study aims to investigate the effects of deep parasternal intercostal plane block on left internal thoracic artery vasospasm in coronary artery bypass grafting patients.

Methods: Between March 2024 and August 2024, a total of 29 patients (24 males, 5 females; mean age: 60.1±8.3 years; range, 56 to 66 years) who were scheduled for elective coronary artery bypass grafting were included in this prospective study. An ultrasound-guided bilateral deep parasternal intercostal plane block was performed with 15 mL of 0.25% bupivacaine per side after anesthesia induction. Left internal thoracic artery peak systolic velocity, end-diastolic velocity, and resistive index, along with heart rate and mean arterial pressure, were recorded immediately before the block (T0) and 30 min after (T1). Demographics, body mass index, and comorbidities of the patients were noted.

Results: After deep parasternal intercostal plane block administration, the left internal thoracic artery resistivity index decreased significantly (p=0.041), and the left internal thoracic artery diameter increased significantly (p=0.004). Although the peak systolic velocity increased and the end-diastolic velocity decreased following the block, these changes were not statistically significant (p=0.145 and p=0.135, respectively).

Conclusion: Our study findings suggest that deep parasternal intercostal plane block administration may prevent left internal thoracic artery vasospasm by increasing arterial conduit diameter and reducing the resistivity index. Based on these findings, we believe that this method can be safely applied under ultrasound guidance without complications.

Background: This study aims to compare the mid-term clinical and echocardiographic outcomes of quadrangular resection (QR) and butterfly resection (BR) techniques in patients with isolated posterior leaflet prolapse and/or chordal rupture due to Barlow's disease.

Methods: Between May 2009 and January 2023, a total of 142 patients (89 males, 53 females; mean age: 56.6±11.9 years; range, 20 to 84 years) who underwent mitral valve repair with either QR (n=69) or BR (n=73) were retrospectively analyzed. Patients were evaluated using transthoracic and transesophageal echocardiography preoperatively, intraoperatively, and during mid-term follow-up. Clinical variables, echocardiographic parameters, and surgical data were compared between groups.

Results: Baseline characteristics and preoperative echocardiographic findings were similar between the two groups. Both techniques resulted in significant improvements in the New York Heart Association functional class, mitral regurgitation severity, and left ventricular dimensions. However, the BR group demonstrated significantly improved posterior leaflet mobility (Wilkins score 1.97±0.74 vs. 3.23±0.79; p<0.001) and lower mean mitral valve gradient (3 [range, 2 to 4] vs. 6 [range, 5 to 7] mmHg; p<0.001). Coaptation depth was also significantly reduced in the BR group, indicating a more annular-level coaptation.

Conclusion: Butterfly resection is a technically feasible, effective, and anatomically favorable technique for mitral valve repair in Barlow's disease. Its ability to preserve leaflet mobility and minimize mitral gradients makes it a valuable addition to the surgical armamentarium, particularly in anatomically complex cases.

Background: This study aims to investigate the infection patterns and antibiotic utilization in critically ill patients receiving extracorporeal membrane oxygenation treatment.

Methods: Between January 2019 and January 2024, a total of 165 patients (109 males, 56 females; median age: 58 years; range, 48 to 67 years) who were hospitalized for at least 24 h and underwent extracorporeal membrane oxygenation, and received ≥1 antibiotic treatment in the cardiovascular intensive care unit were retrospectively analyzed. Microbiological culture results, pathogen resistance patterns, antibiotics used, and their doses during extracorporeal membrane oxygenation were evaluated based on the literature and the Sanford Antimicrobial Guide database.

Results: The median number of days spent on extracorporeal membrane oxygenation was 4 (range, 2 to 7) days. Klebsiella pneumoniae (28.8%) and Acinetobacter baumannii (21.1%) were frequently detected in culture results. The median number and duration of antibiotics were 2 (range, 1 to 3) and 2 (range, 1 to 4) days, respectively. Cephalosporins (39%) and penicillins (30%) were the most commonly used antibiotics. At least one antibiotic dose inappropriateness was detected in 56 (33.9%) patients. A total of 366 antibiotic administrations included 73 (19.9%) dose inappropriateness. Continuous renal replacement therapy, sepsis/septic shock, and extracorporeal membrane oxygenation duration >4 days were identified as risk factors increasing antibiotic inappropriateness (p<0.05).

Conclusion: Our study results indicate that patients receiving extracorporeal membrane oxygenation frequently experience antibiotic resistance and the proliferation of Gram-negative bacteria. In our study, antibiotic dosing was inappropriate in approximately one-third of patients receiving extracorporeal membrane oxygenation. Based on these findings, adherence to the literature should be increased while selecting antibiotics and doses for patients.

Background: This study aims to emphasize the features that should be considered in the follow-up of patients with solitary fibrous tumors by analyzing the clinical and pathological parameters that are effective in the prognosis.

Methods: In this study, 53 patients (28 males, 25 females; mean age: 56.2±5 years; range, 24 to 76 years) diagnosed with solitary fibrous tumor and operated on between 2009 and 2023 were retrospectively examined. The patients included in the study were followed for at least one year. Patients with complete clinical and pathological data records were included in the study. Survival and recurrence rates were analyzed in relation to clinical and pathological parameters.

Results: The median follow-up was 44.9 months. Eight (15%) patients underwent anatomic resection, 23 (35.8%) patients underwent wedge resection, five (5.6%) patients underwent total pleurectomy, 26 (41.5%) patients underwent mass excision, and three (1.8%) underwent mass excision and chest wall resection. Survival analyses were conducted using the Kaplan-Meier method. Overall survival and disease-free survival were calculated in months from the date of surgery until the date of death or recurrence, respectively. Low mitotic rate was found to be a significant independent predictor of reduced mortality (odds ratio [OR]=0.46, 95% confidence interval [CI]: 0.243-0.877, p=0.018), indicating better survival outcomes in patients with low mitotic activity. In contrast, low Ki-67 expression was not a statistically significant predictor (OR=0.9, 95% CI: 0.880-1.116, p=0.885). Pleomorphism was strongly associated with increased mortality (OR=10.0, 95% CI: 1.316-76.081, p=0.026), highlighting the importance of pleomorphism as an important prognostic marker. Necrosis, although not statistically significant (OR=6.3, 95% CI: 0.497-79,123, p=0.156), showed a trend indicating worse outcomes. Similarly, CD34 negativity showed a trend in favor of mortality (OR=3.5, 95% CI: 0.429-28.990, p=0.241.

Conclusion: Solitary fibrous tumors are generally benign and have low recurrence and high survival rates. However, the recurrence rate is higher in malignant solitary fibrous tumors. According to the results of our study, high mitosis rate and pleomorphism are important independent predictors of increased mortality in solitary fibrous tumors. These findings emphasize the importance of detailed histopathological examination in prognostic evaluation.

Cardiac fibromas are rare primary cardiac tumors. Although they constitute a small portion of cardiac neoplasms, they are the most common primary cardiac neoplasm group in childhood after rhabdomyomas. Cardiac fibromas, composed of connective tissue and fibroblasts, are benign. They may be asymptomatic, cause symptoms such as intracavitary obstruction, coronary artery compression, thromboembolic events, and conduction defects, or result in sudden death. Approximately 180 to 200 cases of cardiac fibromas have been reported in the literature, and most are located in the ventricles. Since fibromas are rare, optimal treatment strategies are unclear. Surgical excision is recommended for tumors that cause arrhythmias, heart failure, or intracavitary obstruction. This video article presented the surgical excision of a 6.2×5×4.3 cm cardiac fibroma originating from the anterior wall of the right ventricle in an 11-month-old infant. Postoperative transesophageal echocardiography showed that the tumor was completely removed and that the right ventricular and tricuspid valve functions were good.