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

Background: This study aims to evaluate the effect of off-pump coronary artery bypass grafting on neurological causes of mortality.

Methods: Between November 1^st, 2014 and December 31^st, 2022, a total of 1,154 off-pump coronary artery bypass grafting patients (963 males, 191 females; mean age: 64±10.9 years; range, 13 to 95 years) were retrospectively analyzed. Demographic characteristics, preexisting comorbidities, perioperative status, and postoperative clinical outcomes of the patients were recorded. Survival analysis was carried out.

Results: No-touch aorta coronary artery bypass grafting was performed 958 (83%) patients and single side-biting clamp was used in 196 (17%) patients. Two-hundred seventy-one (23.5%) patients were in an emergent condition, and 63 (5.5%) patients had a history of stroke and/or transient ischemic attack preoperatively. Concomitant carotid endarterectomy was performed in 50 (4.3%) patients. Postoperatively, 139 (12%) patients had atrial fibrillation and five (0.4%) patients had stroke. Seven patients (0.6%) died in the hospital and one (0.08%) patient died in the postoperative 30-day period. One-year, three-year, and five-year survival rates were 98.7%, 97.4%, and 96.5%, respectively.

Conclusion: Off-pump coronary artery bypass grafting is associated with a low incidence of perioperative stroke. Avoidance of aortic manipulation in off-pump coronary artery bypass grafting may reduce the risk of adverse neurological effects of cardiopulmonary bypass. We attribute the long-term survival to shorter lengths of stay in the intensive care unit and hospital and less need for blood products after surgery.

Background: This study aims to examine factors influencing mortality and reintervention among endovascular aortic aneurysm repair patients treated over nearly two decades in the first hybrid operating room of Türkiye.

Methods: Between December 2006 and December 2020, a total of 372 patients (349 males, 23 females; mean age: 70.4±8.2 years; range, 45 to 89 years) who underwent endovascular aortic aneurysm repair were retrospectively analyzed. Independent predictors of 30-day, one-year, and five-year mortality rate were identified. The Kaplan-Meier analyses compared outcomes across surgical approaches and graft types.

Results: Mortality rates were 6.5% at 30 days, 14.2% at one year, and 21.8% at five years. Multivariate analysis identified postoperative complications (hazard ratio [HR]=3.68, p=0.034), elevated creatinine (HR=1.58, p=0.004), prolonged intubation (HR=1.01, p<0.001), and increased blood transfusion volume (HR=1.17, p=0.003) as independent predictors of 30-day mortality. Advanced age emerged as a significant predictor of five-year mortality (HR=1.09, p<0.001). Elective procedures and bi-iliac grafts demonstrated significantly improved survival across all timeframes (p<0.001).

Conclusion: This real-world analysis identifies several procedural and patient-related factors associated with mortality following endovascular aortic aneurysm repair. Postoperative care indicators consistently demonstrated stronger independent associations with mortality than anatomical or demographic factors, highlighting the importance of comprehensive perioperative care optimization in endovascular aortic aneurysm repair management.

Background: In this meta-analysis, we compare total arterial revascularization versus non-total arterial revascularization coronary artery bypass grafting in diabetic patients and discuss long-term survival rate and early mortality rate, cerebrovascular accident, myocardial infarction, sternal wound infection.

Methods: We searched the Cochrane Library, PubMed, Thieme-Connect and Sage Pub databases for studies which were published from January 2003 to October 2023. Observational studies with propensity-score matched analysis comparing total arterial revascularization versus non-total arterial revascularization coronary artery bypass grafting in diabetic patients were included. The risk of bias was analyzed. Fixed-effects model and random-effects meta-analysis with leave-one-out method as sensitivity analysis were performed.

Results: Six observational studies which were published involving a total of 15,336 patients were included in the meta-analysis. There were significant differences in the long-term survival rates and early myocardial infarction. Total arterial revascularization had higher survival rate (incidence rate ratio [IRR]=0.85, 95% confidence interval [CI]: 0.74-0.98, p=0.02) and lower myocardial infarction event than non-total arterial revascularization (odds ratio [OR]=0.45, 95% CI: 0.22-0.92, p=0.03).

Conclusion: Total arterial revascularization is significantly associated with higher survival rate and lower early myocardial infarction than non-total arterial revascularization in diabetic patients undergoing coronary artery bypass grafting.

Background: This study aims to evaluate our experience with magnetic resonance lymphangiography in single-ventricle congenital heart disease patients and to examine the association between imaging findings and clinical outcomes and postoperative outcomes.

Methods: Between November 2022 and May 2025, a total of 33 patients (22 males, 11 females; median age: 44 months; range, 37 to 57.5 months) with single-ventricle congenital heart disease who underwent T2-weighted magnetic resonance lymphangiography at our center were retrospectively analyzed. The T2-weighted sequences were chosen for their high-resolution depiction of lymphatic structures without the need for contrast agents. The imaging findings were analyzed for preoperative risk evaluation or suspected postoperative lymphatic complications.

Results: Lymphatic abnormalities were categorized into types 1 to 3 based on the extent and distribution of T2-hyperintense signals. No patients in this cohort exhibited type 4 abnormalities. Among 33 patients, 11 (33%) were classified as type 1, 18 (55%) as type 2, and four (12%) as type 3. Although not statistically significant, patients with type 3 patterns had the longest median pleural effusion duration (27.5 days) and length of hospital stay (61 days). One patient showed early postoperative progression from type 2 to type 3, which resolved clinically and radiologically after fenestration ballooning. In the late period, two patients developed protein-losing enteropathy, and one had Fontan failure.

Conclusion: Magnetic resonance lymphangiography provides critical information about structural lymphatic abnormalities. It also aids risk stratification prior to the Fontan procedure and guides individualized management of postoperative complications, ultimately guiding treatment and improving outcomes.

Background: This study aims to compare the effects of measurements taken with indocyanine green fluorescence imaging (IFI) and transittime flowmeter measurement (TTFM) methods on the surgical outcomes of coronary artery bypass grafting.

Methods: Between December 2023 and May 2024, a total of 70 patients (53 males, 17 females; mean age: 64.2±9.1 years; range, 43 to 82 years) who underwent on-pump coronary artery bypass grafting via median sternotomy by the same surgical team were included in this prospective study. The control group (TTFM group, n=35) consisted of patients who had intraoperative TTFM, while the remaining patients received both TTFM and IFI measurements during surgery (TTFM+IFI group, n=35). The groups were compared in terms of first-month survival, ejection fraction preservation, intra-aortic balloon pump use, need for extracorporeal membrane oxygenation, postoperative myocardial infarction, and length of intensive care unit and hospital stay.

Results: In our clinic, distal anastomoses were performed in a mean of 3.3±0.7 vessels in the TTFM group and in a mean of 3.7±0.8 vessels in the TTFM+IFI group. The total number of distal anastomoses in the TTFM group and TTFM+IFI group was 115 and 130, respectively. According to the TTFM and IFI measurements taken during the surgery, no revision was required in any of the grafts. There was no statistically significant difference between the two compared groups in terms of early survival, postoperative myocardial infarction, need for intra-aortic balloon pump, need for extracorporeal membrane oxygenation, preservation of ejection fraction, length of stay in the intensive care unit, and time to discharge (p>0.05).

Conclusion: The use of IFI yields no significant effect on early-term outcomes and TTFM is solely adequate for assessing graft functionalities in coronary artery bypass grafting.

Lymphatic complications are associated with increased morbidity and mortality in single-ventricle patients. T2-weighted magnetic resonance lymphangiography is an imaging modality of increasing importance both to identify the risk status before Fontan palliation and to reveal lymphatic complications that may occur in the postoperative period. In this article, we present the management of a pediatric case who was followed and treated for prolonged chylothorax after Fontan palliation and discuss the use of magnetic resonance lymphangiography in this process.