ABSTRACT
OBJECTIVE: We compared electron microscopic histologic changes of the radial artery grafts in non-diabetic and diabetic patients. METHODS: Thirty-six patients were divided into three groups according to their diabetic status (Group I had no diabetes mellitus [DM], Group II had type two DM and HbA1c levels were <7.5%, and Group III had type 2 DM but HbA1c levels were >7.5%). Distal parts of radial artery grafts were evaluated with scanning electron microscopy in a blind fashion by two histologists. Electron microscopic scores were compared among the groups. RESULTS: Radial artery electron microscopic scores were significantly different between group 1, 2 and 1, 3 and 2, 3 (p = 0.028, p < 0.001, and p < 0.001). In linear regression analysis, duration of DM (p = 0.027) and fasting plasma glucose (p = 0.001) were found as independent risk factors for histologic changes of radial artery grafts. CONCLUSION: Duration of DM and poor glycemic control were found to be associated with radial artery electron microscopic changes. doi: 10.1111/jocs.12761 (J Card Surg 2016;31:410-415).
Subject(s)
Coronary Artery Bypass , Coronary Disease/complications , Coronary Disease/surgery , Diabetes Mellitus, Type 2/complications , Radial Artery/transplantation , Radial Artery/ultrastructure , Aged , Diabetes Mellitus, Type 2/metabolism , Glycated Hemoglobin/metabolism , Humans , Linear Models , Microscopy, Electrochemical, Scanning , Middle AgedABSTRACT
Ascending aortic dissection and aneurysm are rare but life-threatening complications after aortic valve replacement. Preoperative evaluation of risk factors such as aortic diameter, structural features of aortic wall, and associated diseases may decrease complication rate. We herein present analysis of risk factors of proximal aortic events following aortic valve replacement based on patient with giant dissecting aneurysm who underwent modified Bentall procedure.
ABSTRACT
INTRODUCTION: The selection of the ideal cannulation site is still one of the major concerns in ascending aortic surgery. In the last decade, many surgeons have chosen to utilize antegrade cerebral perfusion in hypothermic circulatory arrest. In this study, we aimed to evaluate arterial cannulation techniques in patients who underwent root replacement for annuloaortic ectasia. MATERIALS AND METHODS: Between 2005 and 2012, a total of 69 patients with a diagnosis of annuloaortic ectasia underwent aortic root replacement with femoral artery, axillary artery, and direct innominate artery cannulation (IAC). Patients demographic, operative, and postoperative data were collected prospectively and analyzed. RESULTS: A total of 69 patients were investigated. Their ages varied from 13 to 78 (mean age was 54.25 ± 15.69) and 48 patients were male (69.5%). Mean aortic diameter was 5.65 ± 1.58 cm (min: 4.5 cm to max: 7.8 cm) by computerized tomography. The procedures included modified Bentall operation in 61 patients, and Cabrol operation in eight patients. In hospital, the mortality rate was 1.85%, and a 30-day mortality rate was 3.7% in the IAC group and 6.6% in patients who underwent femoral and axillary artery cannulation. Temporary cognitive dysfunction and stroke rate were similar between groups. CONCLUSION: Innominate cannulation is associated with low morbidity and mortality in patients who underwent ascending aorta surgery.
Subject(s)
Aorta/surgery , Aortic Aneurysm, Thoracic/surgery , Axillary Artery , Blood Vessel Prosthesis Implantation/methods , Catheterization/methods , Femoral Artery , Adult , Aged , Aortic Aneurysm, Thoracic/mortality , Blood Vessel Prosthesis Implantation/mortality , Cardiopulmonary Bypass/methods , Catheterization/mortality , Cerebrovascular Circulation/physiology , Female , Heart Arrest, Induced , Hospital Mortality , Humans , Hypothermia, Induced , Male , Middle Aged , Perfusion/methods , Prospective StudiesABSTRACT
A severely calcified aorta carries a high risk of atheroemboli and bleeding for cardiac surgery with an incidence range of 14% to 29%. Various techniques were described avoiding cannulation and clamping of the aorta. Nowadays, the no-touch beating heart technique seems to be the best alternative in patients with calcific aorta. Herein, we present a closed proximal anastomosis technique in this high-risk patient group.
