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Braz J Cardiovasc Surg ; 39(2): e20230354, 2024 May 15.
Article in English | MEDLINE | ID: mdl-38748605

ABSTRACT

Postoperative pain after cardiac surgery plays an important role in the patient's recovery process. In particular, pain at the chest tube site can negatively affect the comfort and recovery of these patients. Effective pain control minimizes the risk of many complications. Oral and intravenous analgesics, epidural anesthesia, paravertebral block, and intercostal nerve blockade are used in chest tube pain control. We routinely use the surgical cryoablation method in the presence of atrial fibrillation in the preoperative period of cardiac surgery in our clinic. Here we aimed to describe our method of using the cryoablation catheter for intercostal nerve blockade.


Subject(s)
Atrial Fibrillation , Chest Tubes , Cryosurgery , Pain, Postoperative , Humans , Atrial Fibrillation/surgery , Pain, Postoperative/prevention & control , Pain, Postoperative/etiology , Cryosurgery/methods , Cryosurgery/instrumentation , Nerve Block/methods , Cardiac Surgical Procedures/methods , Intercostal Nerves , Treatment Outcome , Catheters
4.
Rev Assoc Med Bras (1992) ; 70(5): e20240076, 2024.
Article in English | MEDLINE | ID: mdl-38775517

ABSTRACT

OBJECTIVE: Inflammation plays a key role in the pathogenesis of postoperative atrial fibrillation after coronary artery bypass graft surgery. In this study, we aimed to investigate the changes in mean platelet volume and platelet values during the spring and autumn seasons in patients who underwent isolated coronary artery bypass graft surgery and the possible effect of these occurrences on postoperative atrial fibrillation. METHODS: Consecutive patients who underwent elective isolated coronary bypass surgery at our clinic in the spring and autumn months, between August 2020 and July 2022, were retrospectively included in this study. Variables were evaluated according to the spring and autumn seasons. Patients who did not develop in-hospital postoperative atrial fibrillation were identified as Group 1, and those who did constituted Group 2. RESULTS: A total of 622 patients were included in the study. The patients were divided into two groups: those who were operated on in the spring (n=277, median age=62 years, male gender ratio=77.3%) and those who were operated on in the autumn (n=345, median age=61 years, male gender ratio=81.4%). There was no statistically significant difference between the patients operated on in both seasons in terms of age, gender, hypertension rates, and the frequency of chronic obstructive pulmonary disease. In multivariate analysis, being over 70 years old (OR: 1.934, 95% confidence interval (CI) 1.489-2.995, p<0.001), having a left ventricular ejection fraction below 30% (OR: 1.550, 95%CI 1.190-2.236, p=0.012), and having chronic obstructive pulmonary disease (OR: 1.663, 95%CI 1.339-2.191, p<0.001) were found to be independent predictors in predicting the development of postoperative atrial fibrillation. CONCLUSION: In this study, we first demonstrated that mean platelet volume and platelet mass index values were higher in patients in the autumn months. Additionally, for the first time in the literature, we showed that there is a significant relationship between platelet mass index value and the development of postoperative atrial fibrillation in patients who underwent isolated coronary artery bypass graft.


Subject(s)
Atrial Fibrillation , Coronary Artery Bypass , Mean Platelet Volume , Postoperative Complications , Seasons , Humans , Atrial Fibrillation/etiology , Male , Female , Coronary Artery Bypass/adverse effects , Middle Aged , Aged , Retrospective Studies , Postoperative Complications/etiology , Risk Factors , Platelet Count , Blood Platelets
9.
J Clin Ultrasound ; 50(6): 789-794, 2022 Jul.
Article in English | MEDLINE | ID: mdl-35621020

ABSTRACT

PURPOSE: Diabetes mellitus (DM) plays a key role in the formation and prognosis of cardiovascular diseases. In this study, we aimed to investigate the effects of DM and glycemic control on left internal thoracic artery (LITA) Doppler flow in patients scheduled to undergo coronary artery bypass graft (CABG) surgery. METHODS: Patients who were hospitalized with a planned isolated CABG operation to our clinic between October 1, 2019 and March 1, 2020 were consecutively included in this prospective study. The patients were divided into three groups as those without DM (Group 1), those with DM and HbA1c values of below 7.5 (Group 2), and those with DM and HbA1c values of 7.5 and above (Group 3). The differences between the LITA Doppler flow patterns of the patients were analyzed. RESULTS: The mean ages of Group 1 (n = 103), Group 2 (n = 42), and Group 3 (n = 47) were 59.8 ± 9.6 years, 60.5 ± 9.3 years, and 61.9 ± 8.1 years, respectively. The groups differed in terms of diameter, volume, Vmax, pulsality index (PI), and resistive index (RI) values, both when the groups were compared among themselves (P < .001, for all), and when they were compared between those with (Groups 2 and 3) and without DM (Group 1) (P < .001, for all). Volume (R = -0.627, P < .001) and Vmax (R = -.450, P < .001) were moderately negatively correlated, while PI (R = .523, P < .001) and RI (R = 0.598, P < 0.001) were moderately positively correlated with HbA1c levels. CONCLUSION: In this study, we showed that increased HbA1c levels may be associated with significant functional and structural changes of LITA.


Subject(s)
Diabetes Mellitus , Mammary Arteries , Coronary Angiography , Coronary Artery Bypass , Glycated Hemoglobin , Humans , Mammary Arteries/diagnostic imaging , Mammary Arteries/transplantation , Prospective Studies
10.
Rev. Assoc. Med. Bras. (1992) ; 67(10): 1421-1426, Oct. 2021. tab, graf
Article in English | LILACS | ID: biblio-1351445

ABSTRACT

SUMMARY OBJECTIVE: Many laboratory parameters allow to follow up the course of the disease and reveal its clinical severity, particularly in patients with coronavirus disease 2019 (COVID-19) pneumonia. In this study, we aimed to investigate the role of the blood urea nitrogen-to-albumin ratio in predicting the mortality in COVID-19 patients with moderate-to-severe disease who are hospitalized in the intensive care unit. METHODS: A total of 358 patients who were hospitalized in intensive care unit at our hospital between November 1, 2020 and May 15, 2021 were included in this study. During their course of intensive care, surviving patients were included in Group 1 and nonsurviving patients in Group 2. RESULTS: There were no statistically significant differences between the two groups in terms of gender, smoking, and chronic obstructive pulmonary disease rates. In multivariate logistic regression analysis, advanced age (OR 1.038, 95%CI 1.014-1.064, p=0.002), neutrophil-to-lymphocyte ratio (OR 1.226, 95%CI 1.020-1.475, p=0.030), blood urea nitrogen-to-albumin ratio (OR 2.693, 95%CI 2.019-3.593, p<0.001), and chest computed tomography severity score (OR 1.163, 95%CI 1.105-1.225, p<0.001) values were determined as independent predictors for in-hospital mortality. CONCLUSION: In this study, we showed that the blood urea nitrogen-to-albumin ratio, which was previously shown as a predictor of mortality in patients with various pneumonia, was an independent predictor of mortality in patients with COVID-19 pneumonia.


Subject(s)
Humans , Blood Urea Nitrogen , Albumins , COVID-19/diagnosis , COVID-19/mortality , Retrospective Studies , Hospital Mortality , Intensive Care Units
11.
Heart Surg Forum ; 24(4): E662-E669, 2021 Jul 28.
Article in English | MEDLINE | ID: mdl-34473028

ABSTRACT

BACKGROUND: Coronary endarterectomy (CE) combined with coronary artery bypass grafting (CABG) is an effective but still controversial surgical strategy for the treatment of diffuse coronary artery disease. In this study, we aimed to investigate the impact of gender differences on operative and early postoperative results of patients who underwent CABG with CE. METHODS: This retrospective study included 141 patients who had undergone CE combined with CABG from January 2015 to December 2020, as well as 141 patients without CE as the control group. First, patients with and without CE were compared. Next, patients undergoing CE were divided into 2 groups according to gender (group 1, male patients; group 2, female patients). RESULTS: Of the 141 patients who underwent CE combined with on-pump CABG, 95 (67.3%) were male, and median age was 66 years (range 58 to 71.2). Of the 141 patients who underwent isolated on-pump CABG, 99 (70.2%) were males, and median age was 63 years (range 41 to 80.4). The data for these 2 groups (with and without CE) were compared. Previous percutaneous coronary intervention (PCI), presence of diabetes mellitus, and perfusion time were significantly more common in the CE group. There were 95 patients in group 1, with a median age of 65 years (range 58 to 69), and 46 patients in group 2, with a median age of 66 (64 to 71.2). There were no difference between the groups in terms of age, body mass index, hyperlipidemia, chronic obstructive pulmonary disease, peripheral artery disease, or previous coronary intervention. The need for positive inotropic support and postoperative atrial fibrillation were found to be significantly more common in group 2 (P = .022 and .039, respectively). Defibrillation after releasing the aortic cross clamp was also significantly more common in group 2 (P = .025). CONCLUSION: In our study, the need for defibrillation after aortic cross-clamp releasing in the perioperative period, the need for inotropic support and the incidence of atrial fibrillation in the post-operative period, increased significantly in the female gender. CE can be performed safely in both genders with acceptable mortality and morbidity rates.


Subject(s)
Coronary Artery Bypass/adverse effects , Coronary Artery Disease/surgery , Endarterectomy/adverse effects , Aged , Atrial Fibrillation/etiology , Atrial Fibrillation/therapy , Cardiotonic Agents/therapeutic use , Humans , Middle Aged , Postoperative Care , Postoperative Complications , Retrospective Studies , Risk Factors , Sex Factors
12.
J Thromb Thrombolysis ; 52(3): 759-765, 2021 Oct.
Article in English | MEDLINE | ID: mdl-33710508

ABSTRACT

Severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which has been considered a pandemic by the World Health Organization (WHO). Clinical manifestations of COVID-19 disease may differ, most cases are mild, but a significant minority of patients may develop moderate to severe respiratory symptoms, with the most severe cases requiring intensive care and/or mechanical ventilatory support. In this study, we aimed to identify validity of our modified scoring system for foreseeing the approach to the COVID-19 patient and the disease, the treatment plan, the severity of morbidity and even the risk of mortality from the clinician's point of view. In this single center study, we examined the patients hospitalized with the diagnosis of COVID-19 between 01/04/2020 and 01/06/2020, of the 228 patients who were between 20 and 90 years of age, and whose polymerase chain reaction (PCR) tests of nasal and pharyngeal swab samples were positive. We evaulated 228 (92 male and 136 female) PCR (+) patients. Univariate analysis showed that advanced age (p < 0.001), hemoglobin (p < 0.001), troponin-I (p < 0.001), C-reactive protein (CRP) (p < 0.001), fibrinogen (p < 0.001), HT (p = 0.01), CAD (p = 0.001), DM (p < 0.001), history of malignancy (p = 0.008), along with m-sPESI scores (p < 0.001) were significantly higher in patients that needed intensive care due to COVID-19 infection. In the multivariable logistic regression analysis, only the m-sPESI score higher than ≥ 2 was found to be highly significant in terms of indicating the need for ICU admission (AUC 0.948; 84.6% sensitivity and 94.6% specificity) (p < 0.001). With an increasing number of hospitalized patients, healthcare providers are confronting a deluge of lab results in the process of caring for COVID-19 patients. It is imperative to identify risk factors for mortality and morbidity development. The modified sPESI scoring system, which we put forward, is successful in predicting the course of the disease at the presentation of the patient with COVID-19 disease and predicting the need for intensive care with high specificity and sensitivity, can detect the need for intensive care with high specificity and sensitivity.


Subject(s)
COVID-19/diagnosis , Critical Care , Decision Support Techniques , Hospitalization , Pulmonary Embolism/diagnosis , Adult , Age Factors , Aged , Aged, 80 and over , Biomarkers/blood , COVID-19/complications , COVID-19/therapy , Comorbidity , Female , Humans , Intensive Care Units , Male , Middle Aged , Predictive Value of Tests , Prognosis , Pulmonary Embolism/etiology , Pulmonary Embolism/therapy , Retrospective Studies , Risk Assessment , Risk Factors , Severity of Illness Index , Young Adult
13.
Rev Assoc Med Bras (1992) ; 67(10): 1421-1426, 2021 Oct.
Article in English | MEDLINE | ID: mdl-35018969

ABSTRACT

OBJECTIVE: Many laboratory parameters allow to follow up the course of the disease and reveal its clinical severity, particularly in patients with coronavirus disease 2019 (COVID-19) pneumonia. In this study, we aimed to investigate the role of the blood urea nitrogen-to-albumin ratio in predicting the mortality in COVID-19 patients with moderate-to-severe disease who are hospitalized in the intensive care unit. METHODS: A total of 358 patients who were hospitalized in intensive care unit at our hospital between November 1, 2020 and May 15, 2021 were included in this study. During their course of intensive care, surviving patients were included in Group 1 and nonsurviving patients in Group 2. RESULTS: There were no statistically significant differences between the two groups in terms of gender, smoking, and chronic obstructive pulmonary disease rates. In multivariate logistic regression analysis, advanced age (OR 1.038, 95%CI 1.014-1.064, p=0.002), neutrophil-to-lymphocyte ratio (OR 1.226, 95%CI 1.020-1.475, p=0.030), blood urea nitrogen-to-albumin ratio (OR 2.693, 95%CI 2.019-3.593, p<0.001), and chest computed tomography severity score (OR 1.163, 95%CI 1.105-1.225, p<0.001) values were determined as independent predictors for in-hospital mortality. CONCLUSION: In this study, we showed that the blood urea nitrogen-to-albumin ratio, which was previously shown as a predictor of mortality in patients with various pneumonia, was an independent predictor of mortality in patients with COVID-19 pneumonia.


Subject(s)
Albumins , Blood Urea Nitrogen , COVID-19 , COVID-19/diagnosis , COVID-19/mortality , Hospital Mortality , Humans , Intensive Care Units , Retrospective Studies
14.
Heart Surg Forum ; 23(4): E488-E492, 2020 Jul 08.
Article in English | MEDLINE | ID: mdl-32726205

ABSTRACT

BACKGROUND: Aortic dissection is a cardiovascular disease with high mortality and morbidity rates. The aim of this study is to investigate the role of C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) in predicting in-hospital mortality in patients undergoing emergent surgery for Stanford type A aortic dissection. METHODS: Patients operated for acute Stanford type A aortic dissection between January 2010 and December 2018 were included in the study. Patients without in-hospital mortality were classified as Group 1, and patients with mortality were classified as Group 2. RESULTS: One-hundred-eighteen patients were involved in the study. Patient mean age was 57 ± 11.7 years, and 89 patients (75.4%) were male. Neutrophil-to-lymphocyte ratio (NLR), white blood cell (WBC), neutrophil counts, and C-reactive protein (CRP) values at the time of admission also were found to be high in Group 2 (P = .001, .021, < .001, < .001 respectively). Total perfusion times (TPt), antegrade cerebral perfusion time (ACPt), cross-clamp time (CCt), and intensive care unit (ICU) stay periods significantly were higher in the mortality group (P < .001, < .001, = .01, and < .001, respectively). In receiver-operating characteristic (ROC) curve analysis, a cut-off level of 23 mg/L was determined for CRP levels that predict progression to mortality (area under the curve (AUC): 0.879, P < .001, 75.0% sensitivity and 58.0% specificity). Similarly, a cut-off level of 8.8 was found for NLR that predicts progression to mortality (AUC: 0.835, P < .001, 76.0% sensitivity and 61.0% specificity). CONCLUSION: As a result, we can use CRP and NLR values, which easily can be measured or calculated from blood tests to predict mortality in patients with aortic dissections, which may have serious mortal consequences.


Subject(s)
Aortic Aneurysm, Thoracic/blood , Aortic Dissection/blood , C-Reactive Protein/metabolism , Intensive Care Units/statistics & numerical data , Lymphocytes/pathology , Neutrophils/pathology , Aortic Dissection/mortality , Aortic Aneurysm, Thoracic/mortality , Biomarkers/blood , Female , Hospital Mortality/trends , Humans , Leukocyte Count , Lymphocyte Count , Male , Middle Aged , Prognosis , ROC Curve , Retrospective Studies , Risk Factors , Survival Rate/trends , Turkey/epidemiology
15.
Heart Surg Forum ; 23(1): E088-E092, 2020 02 27.
Article in English | MEDLINE | ID: mdl-32118550

ABSTRACT

Backround: Postoperative atrial fibrillation (PoAF), the most common arrythmia observed in 18-40% of patients following coronary artery bypass surgery, may cause hemodynamic disturbances and increase embolism risk. The aim of this study was to investigate the relationship of HATCH score with PoAF in patients who underwent off-pump coronary artery bypass grafting (OPCABG) and evaluate the effect of preoperatively calculated neutrophil-to-lymphocyte ratio (NLR) on PoAF. METHODS: Patients who underwent OPCABG between January 2014 and January 2019 were included in the study. Preoperative and postoperative data retrospectively were obtained. Patients who did not develop PoAF during the postoperative hospitalization period constituted Group 1; those who did were classified as Group 2. RESULTS: Ninety-seven patients (69 males and 28 females) with a mean age of 54.4 ± 11.1 years constituted Group 1, and 26 patients (17 males and 9 females) with a mean age of 61±12.6 years constituted Group 2. Significant differences were observed between the 2 groups, in terms of age and HATCH scores (P = .025 and P < .001, respectively). NLR, number of distal anastomoses, intensive care unit (ICU) stay times, and total hospitalization times were significantly higher in Group 2 (P = .021, P = .021, P < .001, P < .001, respectively). HATCH score was identified as an independent predictor of AF development following OPCABG surgery (OR: 2.125, 95 % CI: 1.296-3.482, P = .003). CONCLUSION: In light of our study, HATCH scores of all patients preoperatively may be calculated so that preventive precautions are taken for high-risk patients.


Subject(s)
Atrial Fibrillation/diagnosis , Coronary Artery Bypass, Off-Pump/adverse effects , Lymphocytes/cytology , Neutrophils/cytology , Severity of Illness Index , Adult , Atrial Fibrillation/etiology , Atrial Fibrillation/pathology , Humans , Leukocyte Count , Lymphocyte Count , Male , Middle Aged , Preoperative Period , Retrospective Studies
17.
Heart Surg Forum ; 17(4): E212-6, 2014 Aug.
Article in English | MEDLINE | ID: mdl-25179975

ABSTRACT

BACKGROUND: Deep sternal wound infection is a life-threatening complication after cardiac surgery. The aim of this study was to investigate the factors leading to mortality, and to explore wound management techniques on deep sternal wound infection after coronary artery bypass surgery. METHODS: Between 2008 and 2013, 58 patients with deep sternal wound infection were analyzed. Risk factors for mortality and morbidity including age, gender, body mass index, smoking status, chronic renal failure, hypertension, diabetes, and treatment choice were investigated. RESULTS: In this study, 19 patients (32.7%) were treated by primary surgical closure (PSC), and 39 patients (67.3%) were treated by delayed surgical closure following a vacuum-assisted closure system (VAC). Preoperative patient characteristics were similar between the groups. Fourteen patients (24.1%) died in the postoperative first month. The mortality rate and mean duration of hospitalization in the PSC group was higher than in the VAC group (P = .026, P = .034). Significant risk factors for mortality were additional operation, diabetes mellitus, and a high level of EuroSCORE. CONCLUSIONS: Delayed surgical closure following VAC therapy may be associated with shorter hospitalization and lower mortality in patients with deep sternal wound infection. Additional operation, diabetes mellitus, and a high level of EuroSCORE were associated with mortality.


Subject(s)
Coronary Artery Bypass/mortality , Coronary Artery Disease/mortality , Coronary Artery Disease/surgery , Hospital Mortality , Negative-Pressure Wound Therapy/mortality , Sternum/surgery , Surgical Wound Infection/mortality , Causality , Comorbidity , Coronary Artery Bypass/statistics & numerical data , Female , Humans , Incidence , Male , Middle Aged , Risk Factors , Survival Rate , Treatment Outcome , Turkey/epidemiology
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