Single center two years' experience of Ozaki procedure: Early follow-up.

The Ozaki Procedure is an innovative surgical technique aiming of aortic valve neocuspidization using glutaraldehyde-treated autologous pericardium was first developed by Ozaki et al in 2007. With this newly developed technique, valve replacement was achieved without using prosthetic material due to both aortic stenosis and aortic insufficiency. Between December 2020 and December 2022, a total of 59 patients were operated on with the Ozaki Procedure due to aortic valve pathologies in our center. We evaluated the pre- and postoperative as well as the first-month data of a total of 44 patients with isolated the Ozaki Procedure and compared their echocardiographic changes. Patients with isolated aortic valve pathology were included in the study. Fifteen patients who underwent simultaneous coronary artery bypass surgery and Ozaki Procedure were excluded from the analysis. In the first month after the operation, n:2 (%4.5) patients died. When the preoperative and postoperative 1st month echocardiographic data of the remaining patients were compared, it was found that the decrease in mean gradient, max gradient and peak velocity values in the aortic valve was statistically significant. This is due to the fact that reaching neo-valves has very similar hemodynamics to the native aortic valve. Aortic valve neocuspidization by Ozaki Procedure may be a viable alternative to both surgical aortic valve replacement (AVR) and transcatheter aortic valve implantation. Its popularity and application is increasing all over the world. Short and mid-term results are available in the literature. The short and mid-term results are good, and the long-term results are hopeful.

Tradition or Innovation in Sternal Dehiscence Repair: Robicsek Versus Titanium Plate.

Objectives: Sternotomy is still the most commonly used incision in cardiac surgery. Sternal complications are seen at a rate of 0.5% to 6.1%. Sternal dehiscence increases morbidity and mortality after cardiac surgery. To prevent dehiscence, the search for alternative sternum closure methods continues today. Titanium plates produced for this purpose can also be used in patients who are re-operated due to sternal dehiscence. In our study, we investigated the effects of titanium plate repair and robicsek repair on the results in patients who were reoperated due to sternal dehiscence. Methods: Thirty-four patients who underwent reoperation due to sternal detachment in our hospital between September 2013 and December 2020 and had no signs of infection in the pre-operative period were analyzed retrospectively. The patients were divided into three groups according to the surgical method applied. These groups are as follows: Group 1: The cases in which the robicsek method was used, Group 2: the cases in which the titanium plate method was used, and Group 3: The cases where the robicsek + titanium plate methods were used together. Results: There was no significant difference between the groups in terms of basic demographic characteristics and risk factors, leading to sternal dehiscence. There was no significant difference between the groups in terms of mortality and length of hospital stay. Considering the infection rates in the post-operative period, 20% and 21.4% post-operative infections were detected in Group 1 and Group 3, respectively, while 70% post-operative infection was observed in Group 2, which was repaired only with the Robicsek technique (p<0.05). Conclusion: As supported by most studies in the literature, titanium plate application provides a superior sternum stabilization compared to the classical wire cerclage method. When evaluated in terms of cost-effectiveness, titanium plate method can be applied in high-risk patients in terms of sternal dehiscence.

Is there a Predictive Value of Hemoglobin A1C for Complications of Cardiac Surgery?

OBJECTIVE: To investigate the effect of preoperative hemoglobin A1c levels for the complications of cardiac surgery. STUDY DESIGN:   Meta-analysis. Place of Study: Siyami Ersek Chest and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey. METHODOLOGY: PubMed, Scopus, Web of Science and Ovid electronic databases were used. The studies were included the recorded preoperative levels of hemoglobin A1C and postoperative complications developed after cardiac surgery. Results of the studies were evaluated, based on either random or fixed effect model, according to presence of heterogeneity (I2>25%). RESULTS: In total, 2,312 articles were obtained. After reviewing the articles, 33 articles covering 3500 patients meeting the inclusion criteria were included. The results pointed out that there was a relationship between preoperative hemoglobin A1c levels and mediastinitis, stroke, pneumonia, sepsis, renal failure and mortality. Heterogeneity was observed for myocardial infarction, atrial fibrillation and multiorgan failure (I2 >25%). CONCLUSION: Preoperative hemoglobin A1C levels were associated with development of mediastinitis, stroke, pneumonia, sepsis, renal failure and mortality after cardiac surgery. Key Words: Hemoglobin A1C, Cardiac surgery, Complication, Meta-analysis.