Comparison of Surgical Techniques Used in Ventricular Septal Defect Closure

ABSTRACT Introduction: We compared transatrial closure, tricuspid valve septal detachment, and tricuspid valve chordal detachment techniques for ventricular septal defect (VSD) closure. Methods: Patients who had VSD closure with three different techniques in our clinic between September 2016 and December 2020 were retrospectively reviewed. A total of 117 patients were included in the study. The patients were divided into three groups: group 1, classical transatrial closure; group 2, closure with tricuspid valve septal detachment; and group 3, closure with tricuspid valve chordal detachment. The groups were evaluated by serial transthoracic echocardiography (preoperative, postoperative 1st day, postoperative 1st month). Cardiac rhythm checks and recordings were performed. Results: No residual VSD was observed in early or late periods in any of the groups whose VSD closure was performed with the three different techniques. No severe tricuspid regurgitation (TR) was detected during the early and late postoperative periods of all operating procedures. When the groups were compared in terms of early/late TR after the operation (without TR+trace amount of TR and mild TR+moderate TR were compared), no statistically significant difference was found (P>0,05; P=0,969 and P>0,05; P=0,502). Conclusion: In this study, we found no statistically significant difference between three VSD closure techniques in terms of early TR, late TR, residual VSD, and permanent atrioventricular complete block during postoperative period. We hope that our results will be supported by the results of researches that are being made about this subject in large series.

Effect of lima harvesting technique on postoperative drainage in off-pump CABG

Abstract Objective: We investigated the effects of pedicled and semiskeletonized left internal mammary artery (LIMA) harvesting techniques on postoperative drainage in patients subjected to off-pump CABG, ignoring other advantages or disadvantages of those techniques. Methods: The present study comprises a total of 160 subjects that underwent coronary artery bypass surgery in our clinic. Data were collected consecutively and retrospectively. An attempt was made to have similar groups in terms of demographic characteristics. Patients that underwent off-pump coronary artery bypass surgery by two surgical teams which differed only in LIMA harvesting technique were dichotomized and compared according to these techniques. The first group (Group 1) consisted of patients in whom LIMA was harvested with surrounding tissues using the pedicled technique. The second group (Group 2) consisted of patients in whom LIMA was harvested using the semiskeletonized technique, with the veins separated from surrounding connective tissues. Results: The mean amount of drainage in the first 24 hours was 706.1±234.2 ml vs. 591±258.8 ml (Group 1 vs. Group 2; P=0.005), the mean amount of drainage in the second 24 hours was 270±133.6 ml vs. 189.4±140.4 ml (Group 1 vs. Group 2; P<0.001), and the mean amount of total drainage was determined to be 976.1±306.9 ml vs. 781.2±335.5 ml (Group 1 vs. Group 2; P<0.001). Conclusion: It was observed that semiskeletonized LIMA presents reduced amount of postoperative drainage in the first and second 24-hour periods and total amount of drainage than pedicled LIMA, independent of pleural integrity.

Effects of Cardiopulmonary Bypass on Mediastinal Drainage and the Use of Blood Products in the Intensive Care Unit in 60- to 80-Year-Old Patients Who Have Undergone Coronary Artery Bypass Grafting

ABSTRACT OBJECTIVE: The present study consisted of patients who underwent on-pump coronary artery bypass grafting (CABG) and off-pump CABG and investigated effect of using cardiopulmonary bypass (CPB) on the amount of postoperative drainage and blood products, red blood cell (RBC), free frozen plasma (FFP) given in the intensive care unit in 60-80-year-old patients who underwent CABG. METHODS: The present study comprises a total of 174 patients who have undergone coronary artery bypass graft (off-pump or on-pump CABG) surgery in our clinic in between 2012-2015 year. RESULTS: It was observed that the amount of drainage in the first 24 postoperative hours was lower in the on-pump CABG group (Group 1) when compared to off-pump group (Group 2) (Group 1 vs . Group 2; 703.5±253.8 ml vs . 719.6±209.4 ml;P =0.716). However, the amount of drainage in the second 24 hours was statistically significantly lower in the off-pump CABG group (Group 1 vs . Group 2; 259.8±170.6 mlvs . 190.1±129.1 ml; P =0.016). With regard to the amount of overall drainage, no statistically significant difference was observed between the two groups. Group 1 needed RBC transfusion higher than Group 2 (Group 1 vs . Group 2; 2.2±1.3 bag vs . 1.2±0.9 bag;P <0.001). CONCLUSION: We can say that CPB influences the amount of second 24-hour drainage which indexed body surface area. In addition, CPB decreases hct, hb, thrombocyte count in ICU arrived, after 24 hours in postoperative period. Reduced thrombocyte counting effect can be appeared after 48 hours in the postoperative period of CPB.

Effect of using pump on postoperative pleural effusion in the patients that underwent CABG / Efeito da circulação extracorpórea no derrame pleural pós-operatório em pacientes submetidos à revascularização do miocárdio

AbstractObjective:The present study investigated effect of using pump on postoperative pleural effusion in patients who underwent coronary artery bypass grafting.Methods:A total of 256 patients who underwent isolated coronary artery bypass grafting surgery in the Cardiovascular Surgery clinic were enrolled in the study. Jostra-Cobe (Model 043213 105, VLC 865, Sweden) heart-lung machine was used in on-pump coronary artery bypass grafting. Off-pump coronary artery bypass grafting was performed using Octopus and Starfish. Proximal anastomoses to the aorta in both on-pump and off-pump techniques were performed by side clamps. The patients were discharged from the hospital between postoperative day 6 and day 11.Results:The incidence of postoperative right pleural effusion and bilateral pleural effusion was found to be higher as a count in Group 1 (on-pump) as compared to Group 2 (off-pump). But the difference was not statistically significant [P>0.05 for right pleural effusion (P=0.893), P>0.05 for bilateral pleural effusion (P=0.780)]. Left pleural effusion was encountered to be lower in Group 2 (off-pump). The difference was found to be statistically significant (P<0.05, P=0.006).Conclusion:Under the light of these results, it can be said that left pleural effusion is less prevalent in the patients that underwent off-pump coronary artery bypass grafting when compared to the patients that underwent on-pump coronary artery bypass grafting.

ResumoIntrodução:O presente estudo investigou efeito da utilização de bomba em derrame pleural pós-operatório nos casos de pacientes que se submeteram à cirurgia de revascularização miocárdica.Métodos:Um total de 256 pacientes que foram submetidos à cirurgia de revascularização isolada no ambulatório de Cirurgia Cardiovascular foram incluídos no estudo. Máquina coração-pulmão Jostra-Cobe (Modelo 043213 105, VLC 865, Suécia) foi utilizada em cirurgia de revascularização miocárdica com circulação extracorpórea. Cirurgia de revascularização miocárdica sem circulação extracorpórea foi realizada utilizando Octopus e Starfish. Anastomose proximal na aorta, em ambas as técnicas, foi realizada por grampos laterais. Os pacientes receberam alta do hospital entre os dias 6 e 11 de pós-operatório.Resultados:A incidência de derrame pleural à direita pós-operatória e derrame pleural bilateral encontrada foi mais elevada em contagem do Grupo 1 (com circulação extracorpórea) em relação ao Grupo 2 (sem circulação extracorpórea). Mas a diferença não foi estatisticamente significativa [P>0,05 para derrame pleural à direita (P=0,893), P>0,05 para derrame pleural bilateral (P=0,780)]. O derrame pleural esquerdo encontrado foi menor no Grupo 2 (CEC). A diferença foi estatisticamente significativa (P<0,05, P=0,006).Conclusão:Sob a luz destes resultados, pode-se dizer que derrame pleural esquerdo é menos prevalente nos pacientes que foram submetidos à revascularização do miocárdio sem circulação extracorpórea em comparação com os pacientes que foram submetidos à revascularização do miocárdio com circulação extracorpórea.

Avaliacao da Relacao entre a Doenca Hepatica Nao Gordurosa e CAD utilizando TCMF / Assessment of the Relationship between Non-Alcoholic Fatty Liver Disease and CAD using MSCT

Fundamento: Alguns fatores de risco para a aterosclerose são acompanhados pela doença hepática gordurosa não alcoólica (DHGNA). Desejamos usar a tomografia computadorizada multi-fatias (TCMF) como a técnica para encontrar relação entre a DHGNA e a doença arterial coronariana (DAC). Objetivo: A relação entre a DHGNA e a DAC foi investigada através de TCMF. Métodos: Um total de 372 indivíduos com ou sem sintomas cardíacos, que foram submetidos à angiografia por TCMF, foram incluídos no estudo. Os pacientes foram divididos em dois grupos, de acordo com a presença da DHGNA. Os segmentos arteriais coronarianos foram avaliados visualmente via angiografia por TCMF. Com base no grau de estenose arterial coronariana, aqueles com placas ausentes ou mínimas foram considerados como normais, enquanto aqueles que apresentavam estenose de menos do que 50% e no mínimo uma placa foram considerados como portadores da doença arterial coronariana não obstrutiva (não-obsDAC). Os pacientes que apresentaram no mínimo uma placa e estenose arterial coronariana de 50% ou mais foram considerados como portadores de doença arterial coronariana obstrutiva (obsDAC). A DHGNA foi determinada de acordo com o protocolo de TCMF, utilizando a densidade hepática. Resultados: De acordo com a densidade hepática, o número de pacientes com doença hepática gordurosa não alcoólica (grupo 1) foi de 204 (149 homens, 54,8%) e com fígado normal (grupos 2) foi de 168 (95 homens, 45.2%). Houve 50 (24,5%) não-obsDAC e 57 (27,9%) casos de obsDAC no Grupo 1, e 39 (23,2%) não-obsDAC e 23 (13,7%) casos de obsDAC no Grupo 2. Conclusões: O presente estudo utilizando TCMF demonstrou que a frequência da doença arterial coronariana em pacientes com NAFDL foi significativamente superior do ...

Background: Some risk factors for atherosclerosis are followed by non-alcoholic fatty liver disease (NAFLD). We wanted to use Multislice computed tomography (MSCT) as technique for searching relationship between NAFLD and coronary artery disease (CAD). Objective: The relationship between NAFLD and CAD was investigated using MSCT. Methods: A total of 372 individuals with or without cardiac symptoms who had undergone MSCT angiography were included in the study. The patients were divided into two groups according to the presence of NAFLD. Coronary artery segments were visually evaluated via MSCT angiography. Based on the coronary artery stenosis degree, those with no or minimal plaques were considered normal, whereas those who had stenosis of less than 50% and at least one plaque were considered to have non-obstructive coronary artery disease (non-obsCAD). The patients who had at least one plaque and coronary artery stenosis of 50% or more were considered to have obstructive coronary artery disease (obsCAD). NAFLD was determined according to the MSCT protocol, using the liver density. Results: According to the liver density, the number of patients with non-alcoholic fatty liver disease (group 1) was 204 (149 males, 54.8%) and with normal liver (group 2) was 168 (95 males, 45.2%). There were 50 (24.5%) non-obsCAD and 57 (27.9%) obsCAD cases in Group 1, and 39 (23.2%) non-obsCAD and 23 (13.7%) obsCAD cases in Group 2. Conclusions: The present study using MSCT demonstrated that the frequency of coronary artery disease in patients with NAFDL was significantly higher than that of patients without NAFDL. .

The Protective Effect of Topical Rifamycin Treatment against Sternal Wound Infection in Diabetic Patients Undergoing on-Pump Coronary Artery Bypass Graft Surgery : Cardiovascular Topic

Objectives: The aim of this study was to investigate the protective effect of topical rifamycin SV treatment against sternal wound infection (SWI) in diabetic patients undergoing on-pump coronary artery bypass graft (CABG) surgery. Methods: One hundred and fifty-nine diabetic patients who were scheduled to undergo isolated on-pump CABG surgery were included. Eight were excluded for various reasons. Of the 151 patients; 51 were on insulin therapy and 100 were on oral anti-diabetics. The risk of mediastinitis was assessed using the American College of Cardiology/American Heart Association 2004 guideline update for CABG surgery. According to the risk scores; patients were divided into two comparable groups: the rifamycin group (n = 78) received topical rifamycin treatment after on-pump CABG surgery; and the control group (n = 73) received no topical treatment. Results: Deep sternal wound infection (mediastinitis) was not observed in either group (0/78 vs 0/73; p = 1.0). No superficial sternal wound infection was observed in the rifamycin group; however; it did occur in one patient in the control group (0/78 vs 1/73; p = 0.303). Wound culture was performed and coagulase-negative staphylococci were observed. The infection regressed on initiation of antibiotic therapy against isolated bacteria and the patient was discharged after a full recovery. Conclusion: Although the difference in rate of superficial sternal wound infection (SSWI) in the rifamycin and control groups was not statistically significant; locally applied rifamycin SV during closure of the sternum in the CABG operation may have had a protective affect against SWI