Comparison of the Effect of Pump Flow Type (Pulsatile or Non-Pulsatile) on Postoperative Neurocognitive Functions in Coronary Artery Surgery

ABSTRACT Introduction: The effect of pump flow type on perfusion in coronary surgery using cardiopulmonary bypass (CPB) is discussed. We aimed to evaluate the effect of pump flow type on cognitive functions with neurocognitive function tests. Methods: One hundred patients who underwent isolated coronary artery bypass surgery between November 2020 and July 2021 were divided into two equa groups. Groups were formed according to pump flow type pulsatile (Group 1) and non-pulsatile (Group 2). Clock drawing test (CDT) and standardized mini mental test (SMMT) were performed on the patients in both groups in the preoperative period, on the 1st preoperative day, and on the day before discharge. Neurocognitive effects were compared with all follow-up parameters. Results: There was no difference between the groups in terms of demographic data and in terms of neurocognitive tests performed before the operation. SMMT on postoperative day 1 (Group I: 27.64 ± 1.05; Group II: 24.44 ± 1.64; P=0.001) and CDT (Group I: 5.4 ± 0.54; Group II: 4 .66 ± 0.52; P=0.001), and SMMT on the day before discharge (Group I: 27.92 ± 1.16; Group II: 24.66 ± 1.22; P=0.001) and CDT (Group I: 5 It was calculated as .66 ± 0.48; Group II: 5.44 ± 0.5; P=0.001). The duration of intensive care and hospitalization were higher in the non-pulsatile group. Conclusion: We think that the type of pump flow used in coronary artery bypass surgery using CPB is effective in terms of neurocognitive functions and that pulsatile flow makes positive contributions to this issue.

Effect of Aortic Cross-Clamping Time on Development of Postoperative Atrial Fibrillation in Isolated CABG: A Single-Center Prospective Clinical Study

ABSTRACT Introduction: Many etiological factors affect the occurrence of atrial fibrillation after coronary artery bypass grafting. In this study, the relationship between cardiopulmonary bypass and cross-clamping times and the development of postoperative atrial fibrillation was examined. Methods: All patients who underwent isolated coronary artery bypass grafting with the same surgical team in our clinic between September 2018 and December 2019 were prospectively included in the study, and their perioperative data were recorded. Results: One hundred and three patients who met the specified criteria were included in the study. The median age was 62 (interquartile range: 54-71) years, and 82 (79.6%) were male. The patients were divided into two groups: those who developed atrial fibrillation and those who did not. Atrial fibrillation developed in 25 of 103 patients (24.3%). All patients underwent isolated coronary artery bypass grafting under standard cardiopulmonary bypass. The median duration of cardiopulmonary bypass was 72 (interquartile range: 63-97) minutes in those with atrial fibrillation and 82 (61-98) minutes in those without it, and there was no statistical difference (P=0.717). The median cross-clamping time was 40 (32.5-48) minutes in those with atrial fibrillation and 39.5 (30-46) minutes in those without it. Statistically, the relationship between cross-clamping time and atrial fibrillation was not significant (P=0.625). Conclusion: Our study found no significant relationship between cardiopulmonary bypass and cross-clamping times and the incidence of postoperative atrial fibrillation. However, we believe that there is a need for large-scale and multicenter clinical studies on the subject.

Successful Surgical Treatment of Coronary Aneurysm, Ascending Aortic Aneurysm, and Bicuspid Aorta for a Kawasaki Disease Patient

Abstract Kawasaki disease was first reported in 1967, and it was classified as an autoimmune vasculitis of the small and medium arteries. It is a self-limiting condition that occurs mostly in childhood, but it may involve complications — such as coronary artery aneurysms, myocardial ischemia, and arrhythmias — with significant morbidity and mortality that occur later in life. In this article, we present the association of an ascending aortic aneurysm with bicuspid aortic disease in addition to coronary aneurysm in a 55-year-old patient diagnosed with Kawasaki disease.

Implantación endovascular urgente de stent en disección aórtica aguda tipo III de DeBakey / Emergency endovascular stent graft implantation for acute traumatic DeBakey type III aortic dissection

RESUMEN El tratamiento de las enfermedades de la aorta torácica con la implantación percutánea de stent se viene realizando desde su aplicación, por primera vez, a principios del siglo XX. Se presenta un paciente de 79 años de edad que fue llevado a urgencias con intenso dolor de espalda posterior a un accidente automovilístico, a quien se le realizó tomografía computarizada y se le diagnosticó una disección aórtica tipo III de DeBakey. Se le implantó un stent endovascular autoexpandible de nitinol (Talent Stent Graft, Medtronic) en la aorta descendente, donde comenzaba el segmento disecado. Este procedimiento es un método eficaz para prevenir la isquemia de órganos y la ruptura vascular en las enfermedades traumáticas de la aorta. Es menos invasivo, tiene menos complicaciones que el tratamiento quirúrgico, y es efectivo para restituir el flujo sanguíneo de forma rápida y segura.

ABSTRACT The applications of thoracic aorta pathologies with a stent graft percutaneously have been performed for the first time since the beginning of the 20th century. Computed tomography was performed on a 79-year-old patient who was brought to the emergency room due to an in-vehicle traffic accident with severe back pain, and DeBakey type III aortic dissection was determined. An endovascular self-expanding nitinol stent (Talent Stent Graft, Medtronic) was implanted in the descending aorta where the dissected segment begins. Stent graft implantation is an effective method in preventing organ ischemia and rupture in traumatic aortic pathologies. This procedure is less invasive and has less complication than surgical approach. It is effective in providing blood flow quickly and safely.

Acumulación quilosa en el espacio mediastínico después de una revascularización miocárdica quirúrgica / Chylous accumulation in the mediastinal space following coronary artery bypass graft surgery

RESUMEN El quilomediastino como complicación de la cirugía cardiovascular tiene una incidencia de menos del 0,5% y es extremadamente raro después de los procedimientos intrapericárdicos. El origen de esta complicación es una lesión directa en los vasos linfáticos del mediastino anterior, en el área del timo o el conducto torácico, en la unión de las venas yugular izquierda y subclavia, que obstruye el drenaje del conducto torácico. En principio se prefiere el tratamiento conservador con suspensión de la vía oral y la administración parenteral de una dieta baja en grasas y triglicéridos de cadena media. Si el drenaje persiste después de 2 semanas de tratamiento conservador, debe considerarse la ligadura quirúrgica del ductus torácico como tratamiento de esta complicación. Se presenta un caso de un hombre que presentó acumulación mediastínica de líquido quiloso, tras una reintervención por sangrado en el segundo día del postoperatorio de una revascularización miocárdica quirúrgica.

ABSTRACT Chylomediastinum as a complication of cardiovascular surgery has a reported incidence of lower than 0,5% and is extremely rare following intrapericardial procedures. The origin of this complication is a direct injury to the anterior mediastinum lymphatics in the thymus area or the thoracic duct, at the junction of the left jugular and subclavian veins, obstructing thoracic duct drainage. Firstly, conservative treatment with low fat and medium chain triglyceride diet is prefered by cutting oral feding. If the drainage persists despite 2 weeks of conservative treatment, the surgical ligation of the ductus thoracicus may be considered for the management of this complication. We present the mediastinal chylous fluid accumulation in a male patient who underwent revision due to bleeding on postoperative second day after coronary artery bypass surgery.

Tratamiento y resultados quirúrgicos en pacientes operados de aneurismas de aorta ascendente / Surgical procedure and outcomes in patients undergoing surgical treatment for ascending aortic aneurysms

RESUMEN Introducción: Los aneurismas de aorta ascendente son lesiones que deben tratarse quirúrgicamente debido a sus complicaciones potencialmente mortales, como la ruptura y la disección. Objetivos: Revisar los resultados a corto y mediano plazo del tratamiento quirúrgico en pacientes con aneurisma de aorta ascendente. Método: Se revisaron retrospectivamente las historias clínicas de 78 pacientes que recibieron tratamiento quirúrgico debido a un aneurisma de aorta ascendente, entre agosto de 2006 y julio de 2018, en el hospital Erzurum Regional Training and Research Hospital. Resultados: La edad promedio de los pacientes fue de 51,7 ± 9,8 (rango 24-77 años). Hubo 54 (69,2%) hombres y 24 (30,8%) mujeres. Cincuenta y ocho pacientes (74,3%) tenían síndrome de Marfan. También se encontraron enfermedad coronaria (15,4%), estenosis mitral (3,8%), insuficiencia (11,5%), estenosis (8,9%) y coartación aórticas (2,6%). Se realizó tratamiento quirúrgico de emergencia en 41 pacientes (52,5%). Se reemplazó la aorta ascendente en 55 pacientes (70,5%). Se empleó la técnica de Bentall (17,9%) y sustitución valvular aórtica más reemplazo de aorta ascendente con injerto (11,5%). En 14 pacientes se utilizó paro anóxico (parada circulatoria total). La mortalidad operatoria fue de 3,8% (3 pacientes) con la técnica de Bentall y la mortalidad postoperatoria temprana fue de 1,3% (1 paciente con coartación aórtica). Conclusiones: Los pacientes con aneurisma de aorta ascendente deben tener un estrecho seguimiento para definir su momento quirúrgico, debido al riesgo de disección y rotura. Aunque se pueden aplicar varias técnicas quirúrgicas de acuerdo con el estado de la válvula aórtica, especialmente en pacientes con síndrome de Marfan, el procedimiento quirúrgico preferido debería ser el reemplazo de la raíz aórtica con injerto compuesto, con el uso de la técnica de Bentall modificada, con reimplantación de los ostium de las arterias coronarias en el injerto.

ABSTRACT Introduction: Ascending aortic aneurysms are lesions that should be surgically handled because of their life-threatening complications like rupture and dissection. Objectives: To examine the early and midterm outcomes of surgical treatment in patients with ascending aortic aneurysm. Method: We retrospectively examined the records of 78 patients who underwent surgical treatment due to ascending aortic aneurysm between August 2006 and July 2018 at Erzurum Regional Training and Research Hospital. Results: The patients' average age was 51.7 ± 9.8 (ranged 24-77 years). There were 54 (69.2%) men and 24 (30.8%) women. Fifty-eight (74.3%) patients had Marfan's Syndrome. They also presented coronary artery disease (15.4%), mitral stenosis (3.8%), aortic regurgitation (11.5%), aortic stenosis (8.9%), and aortic coarctation (2.6%). The emergency surgical treatment was required in 41 (52.5 %) patients. Only 55 (70.5 %) patients had performed ascending aortic replacement. Bentall procedure (17.9%) and aortic valve replacement + ascending aortic graft replacement (11.5%) were performed. In 14 patients totally circulatory arrest was used. The operative mortality occurred in 3 (3.8%) patients with Bentall procedure and the early postoperative mortality occurred in 1 (1.3%) patient with aortic coarctation. Conclusions: Patients with ascending aortic aneurysms should be closely monitored for the timing of surgery due to the risk of dissection and rupture. Although various surgical techniques can be applied according to the aortic valve status, especially in patients with Marfan's Syndrome, root replacement with composite graft, and Bentall modifications and button anastomosis of coronary arteries in composite graft applications should be the preferred surgical procedure.

Cierre quirúrgico de comunicación interauricular en pacientes mayores de 40 años de edad: Efecto sobre la función cardíaca y resultados clínicos generales / Surgical closure of atrial septal defect in patients aged 40 years and older: Effect on cardiac function and general clinical outcomes

RESUMEN Introducción: La comunicación interauricular (CIA) es una de las cardiopatías congénitas más frecuentes en los pacientes adultos. Objetivos: Se evaluaron los resultados iniciales y a medio plazo del tratamiento quirúrgico de la CIA tipo ostium secundum en pacientes mayores de 40 años de edad en relación con la función cardíaca y los resultados clínicos. Método: Se estudiaron 32 pacientes, mayores de 40 años de edad, a quienes se les realizó corrección quirúrgica de una CIA tipo ostium secundum. Se compararon los parámetros ecocardiográficos, de función cardíaca y el estado clínico de todos los pacientes antes y después de la operación para evaluar la eficacia del tratamiento quirúrgico. Resultados: Los pacientes fueron seguidos durante un promedio de 2,2 años (rango 3 meses - 3,1 años). No hubo mortalidad en el postoperatorio. En el seguimiento temprano, no hubo ningún evento tromboembólico cerebrovascular y mejoraron las capacidades funcionales de los pacientes. No ocurrieron nuevas fibrilaciones auriculares. Los diámetros de la aurícula y el ventrículo derechos, y las presiones de la arteria pulmonar se redujeron significativamente, mientras que no se encontró variación en la fracción de eyección. La necesidad de tratamiento diurético se redujo después del tratamiento quirúrgico. No se detectó ningún cortocircuito intracardíaco residual durante el seguimiento. Conclusiones: El cierre quirúrgico de la CIA en pacientes adultos mayores de 40 años puede mejorar la función cardíaca medida por ecocardiografía y reducir los síntomas clínicos. Si no se utiliza ningún tratamiento en estos pacientes, los síntomas son escasos y rara vez se encuentran alteraciones en los parámetros hemodinámicos con peligro para la vida. Sin embargo, la reparación quirúrgica debe realizarse lo antes posible, especialmente cuando se detecta en pacientes adultos.

ABSTRACT Introduction: Atrial septal defect (ASD) is one of the most common congenital heart diseases in adult patients. Objectives: We evaluated the early and mid-term results of surgical treatment of secundum atrial septal defects in patients with ≥ 40 years in terms of cardiac functions and clinical outcomes. Method: Thirty-two patients who had undergone surgical correction for secundum atrial septal defect at the age of 40 years an older were examined. Echocardiographic parameters, cardiac functions and clinical status of all patients were compared before and after the operation to evaluate the efficacy of surgical treatment. Results: The patients were followed for an average of 2,2 years (range 3 months - 3,1 years). There was no mortality in the postoperative period. In the early follow-up, there was no cerebrovascular thromboembolic event, functional capacities of the patients improved. No new atrial fibrillation occurred. Right atrial and ventricle diameters, and pulmonary artery pressures were significantly reduced, while ejection fractions did not change. The need for diuretic therapy was reduced after surgical treatment. No residual intracardiac shunt was detected during follow-up. Conclusions: Surgical closure of atrial septal defects in adult patients over the age of 40 can improve cardiac function by echocardiography and reduce clinical complaints. Even if no intervention is made in such patients, the current complaints are scarce and life-threatening problems are rarely seen in hemodynamic parameters. However, surgical repair should be performed as soon as possible, especially when detected in adult patients.