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

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.

Background: This study aims to compare the effectiveness of negative-pressure wound therapy (NPWT) compared to conventional methods for the treatment of mediastinitis following coronary artery bypass grafting.

Methods: Between January 2010 and January 2023, a total of 87 patients (47 males, 40 females; mean age: 62.0±10.2 years; range, 35 to 80 years) who developed mediastinitis following sternotomy were retrospectively analyzed. The patients were divided into two groups: those treated with conventional methods (n=39) from January 2010 to February 2015 and those treated with NPWT (n=48) from March 2015 to January 2023. Clinical outcomes, including treatment duration, infection resolution time, hospital stay, and mortality rate, were recorded.

Results: The NPWT group had significantly shorter treatment durations (20.1±4.0 days) than the conventional group (58.6±17.1 days, p<0.001). The time to achieve negative cultures was also significantly reduced in the NPWT group (15.3±3.6 days) compared to the conventional group (36.7±8.1 days, p<0.001). The length of hospital stay was shorter in the NPWT group (34.3±12.8 days) compared to the conventional group (88.0±21.1 days, p<0.001). The NPWT group had a lower hospital mortality rate (4.2%) than the conventional group (17.9%, p=0.049).

Conclusion: The NPWT demonstrated superior efficacy in managing postoperative mediastinitis compared to conventional methods, highlighting its potential as a preferred treatment option for this serious complication.