Comparison of flowmeter (transit time flow measurement) values for graft flow in three different surgical methods for isolated coronary artery bypass surgery.

BACKGROUND: Graft patency is the most important factor in coronary artery bypass surgery. This study aimed to compare the relationship between three different surgical methods and transit time flow measurement (TTFM), which is used to detect technical problems in anastomoses performed during coronary artery bypass graft operations and to correct them if necessary. METHODS: A total of 110 patients undergoing isolated coronary artery bypass surgery were analysed. Of these patients, 48 were operated on by inducing cardiopulmonary arrest (group 1), 33 were operated on without inducing cardiac arrest (group 2) during cardiopulmonary bypass surgery, and 29 underwent surgery on the off-pump beating heart (group 3). TTFMs were performed on all the patients' grafts. Additional surgical intervention requirements, the need for intra-operative and postoperative inotropic support, and all postoperative follow-up data were compared. RESULTS: In total, 110 patients were measured for 301 grafts. Due to insufficient measurements performed on these patients, additional surgical intervention was performed on five grafts in group 1, five grafts in group 2, and seven grafts in group 3. These interventions enabled a normal flow rate to be achieved. The number of grafts that required revision was highest in group 3. There was no difference between the groups in terms of demographic data, EuroSCORE II, preoperative ejection fraction, postoperative complications and mortality rate. CONCLUSION: TTFM is important for detecting technical problems in grafts. We believe that all surgical methods can be applied more safely by controlling graft flow.

Successful Combined Treatment of Giant Carotid Body Tumor with Embolization Applied before Surgery.

Carotid body tumors are defined as unusual tumors of neuroectodermal origin that occur in the carotid bifurcation. These generally benign masses grow slowly; then, they become symptomatic with enlargement. In this study, we present a case of a 66-year-old female patient diagnosed with a carotid body tumor with a diameter of 8×9×10 cm. The patient was surgically treated 2 days after embolization due to the wideness of the mass and surgical comorbidity. Furthermore, this article puts emphasis on the importance of embolization before curative surgery in carotid body tumors with large and high blood supply.

Endovascular repair of a Stanford Type A dissection with the Cardiatis multilayer flow modulator.

Type A aortic dissection is a condition that can lead to death, and within minutes, it requires an immediate surgical intervention. Despite surgical protection techniques, graft materials and technological advances, there is still a 30% mortality rate associated with surgical treatment. Endovascular repair of aortic dissections can be performed with promising results in high-risk patients.

Off-pump versus on-pump complete coronary artery bypass grafting: Comparison of the effects on the renal damage in patients with renal dysfunction.

BACKGROUND: We aimed to compare off-pump technique with on-pump technique on renal function in patients with nondialysis-dependent renal dysfunction who underwent coronary artery bypass grafting. METHODS: The 94 patients with renal dysfunction undergoing isolated coronary artery bypass grafting were retrospectively analyzed. No patient was receiving dialysis. Patients were randomly assigned to conventional revascularization with cardiopulmonary bypass and beating heart. Both groups were compared in terms of renal dysfunction parameters and dialysis requirement. The logistic regression models were constructed to identify risk factors associated with dialysis requirement. RESULTS: Renal dysfunction requiring dialysis developed in 9 patients in the on-pump group. The measures analysis of variance was performed on the data that showed worsening of renal function in the on-pump group compared with the off-pump group. Cardiopulmonary bypass is significant as independent predictor for the development of postoperative dialysis. CONCLUSION: These results suggest that off-pump coronary revascularization offers a superior renal protection and has a significantly lower risk for renal complications in patients with nondialysis-dependent renal dysfunction when compared with conventional coronary revascularization with cardiopulmonary bypass.

More Successful Results with Less Energy in Endovenous Laser Ablation Treatment: Long-term Comparison of Bare-tip Fiber 980 nm Laser and Radial-tip Fiber 1470 nm Laser Application.

BACKGROUND: Varices and venous insufficiency are common and serious health problems in the general population which affect the quality of life. Endothermal treatment of the great saphenous vein has become the first line of treatment for superficial venous reflux, and the endovenous laser ablation (EVLA) method has been widely accepted all over the world. In this method, ablation is provided by a laser fiber inserted into the lumen of the vein. Initially, the fibers were 810 nm, but today the fibers are usually 940, 980, or 1470 nm. METHODS: The study included 400 patients (419 procedures) who were diagnosed with venous insufficiency and underwent 980 and 1470 nm EVLA. Patients were followed up for 48 months. A 980-nm bare-tip laser catheter in Group A and a 1470-nm radial-tip laser catheter in Group B were inserted until they were 2 cm below the saphenofemoral junction. An EVLA catheter was drawn slowly at the rate of 1-3 cm/sec (2.08 ± 0.6). The energy applied to the saphenous vein was 60-120 J/cm (84.65 ± 13.03) and 45-120 J/cm (76.95 ± 15.06) in Group A and Group B, respectively (P < 0.001), with 15 W in the continuous mode. Follow-up visits included a physical examination and Doppler ultrasonography performed at the following time points: day 1, week 1, and months 1, 6, 12, 24, 36, and 48. Saphenous vein occlusion rates and postprocedure saphenous vein diameters were evaluated at each follow-up visit. Pain levels were evaluated using the Wong-Baker FACES® pain scale (0-10). Postoperative complications were recorded. RESULTS: Group A (980 nm laser) consisted of 200 patients with a mean age of 37.84 ± 12.2 years. Group B (1470 nm laser) consisted of 200 patients with a mean age of 38.38 ± 12.1 years. The mean duration of the procedure was 32.2 ± 9.7 min in Group A and 31.7 ± 8.8 min in Group B, respectively (P = 0.47). Induration, ecchymosis, and paresthesia rates were significantly higher in the bare-tip laser group. The most important complication, deep vein thrombosis, was observed in 4 patients in Group A. Recanalization rates were found to be increased by prolonged follow-up periods. At the 48-month follow-up, this rate was 15.9% in Group A and 8.3% in Group B (P = 0.017). This rate showed that the 1470-nm wavelength laser treatment was more successful in Group B than in Group A over the long term. CONCLUSIONS: Both the 980 and 1470 nm wavelength laser-assisted EVLA procedures appear to be effective in treating saphenous vein insufficiency. The 1470-nm radial-tip fiber is preferred due to lower energy levels, lower complication rates, early return to daily life, and the successful long-term occlusion rate.