Innominate Artery Cannulation for Proximal Aortic Surgery

ABSTRACT Introduction: The aim of this study was to evaluate the efficacy and safety of innominate artery cannulation strategy with side-graft technique in proximal aortic pathologies. Methods: A total of 70 patients underwent innominate artery cannulation with a side graft for surgery on the proximal aorta from 2012 to 2020. There were 46 men and 24 women with an average age of 56±13 years. The indications for surgery were type A aortic dissection in 17 patients (24.3%), aortic aneurysm in 52 patients (74.3%), and ascending aorta pseudoaneurysm in one patient (1.4%). The innominate artery was free of disease in all patients. Hypothermic circulatory arrest with antegrade cerebral perfusion was utilized in 60 patients (85.7%). Three patients had previous sternotomy (4.2%). The most common surgical procedure was ascending aorta with hemiarch replacement in 34 patients (48.5%). Results: The mean cardiac ischemia and cardiopulmonary bypass times were 116+46 minutes and 164+56 minutes, respectively. Mean antegrade cerebral perfusion time was 27+14 minutes. The patients were cooled between 22°C and 30°C during surgery. Thirty-day mortality rate was 7.1% (five patients). One patient (1.4%) had stroke, one patient (1.4%) had temporary neurologic deficit, and eight patients (11.4%) had confusion and agitation that resolved completely in all cases. There was no local complication or arterial injury. Conclusion: Cannulation of the innominate artery with side graft is safe and effective for both cardiopulmonary bypass and antegrade cerebral perfusion. This technique provides satisfactory neurologic outcomes for proximal aortic surgery.

Are standard follow-up parameters sufficient to protect neurocognitive functions in patients with diabetes mellitus who underwent coronary artery bypass grafting?

Abstract Objective: We aimed to compare the effectiveness of cognitive function protection between the standard follow-up parameters and advanced neuromonitoring methods in diabetic patients who underwent coronary artery bypass grafting during cardiopulmonary bypass. Methods: Study design was prospective and observational. Patients were separated into two groups, treated only with standard follow-up parameters (Group 1) and followed up with the change of regional cerebral tissue oxygenation (rSO2) by near-infrared spectroscopy (Group 2). Neurocognitive functions were evaluated preoperatively and postoperatively before discharge in all patients using the Montreal Cognitive Assessment (MoCA) test. Results: Cognitive functions of Group 2 patients in the postoperative period were significantly higher than Group 1 patients (P=0.001). The mean postoperative MoCA score of patients was significantly lower than the mean preoperative MoCA score in Group 1 (24.8±2.2 vs. 23.6±2.6, P=0.02). However, mild cognitive dysfunction was significantly lower in Group 2, compared to Group 1 (P=0.02). Conclusion: In patients followed up with standard parameters, a significant decrease in cognitive function was observed in the early period. However, the use of advanced neuromonitoring methods can significantly prevent this decrease in cognitive functions.

Quality of life after open surgical versus endovascular repair of abdominal aortic aneurysms

Abstract Objective: This study aims to compare open surgical and endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms in terms of their effects on quality of life, using Short Form-36 (SF-36). Methods: A total of 133 consecutive patients who underwent EVAR or open surgical repair for infra-renal abdominal aorta aneurysm between January 2009 and June 2014 were included in the study. Twenty-six (19.5%) patients died during follow-up and were excluded from the analysis. Overall, 107 patients, 39 (36.4%) in the open repair group, and 68 (63.6%) in the EVAR group, completed all follow-up visits and study assessments. Quality of life assessments using SF-36 were performed before surgery and at post-operative months 1, 6, and 12. Results: The mean duration of follow-up was 29.55±19.95 months. At one month, both physical and mental domains of the quality of life assessments favored EVAR, while the two surgical approaches did not differ significantly at or after six months postoperatively. Conclusion: Despite anatomical advantages and acceptable mid-phase mortality in patients with high- or medium-risk for open surgery, EVAR did not exhibit a quality of life superiority over open surgery in terms of physical function and patient comfort at or after postoperative six months.