Comparison of the one-year patency rates of radiocephalic arteriovenous fistulas created using no-touch versus conventional technique.

BACKGROUND: This study aims to compare the patency rates of radiocephalic arteriovenous fistulas prepared preserving the perivenous vascular tissues versus those prepared using the conventional technique. METHODS: A total of 169 patients (107 males, 62 females; mean age 59.5 years; range, 39 to 87 years) who underwent a radiocephalic arteriovenous fistula construction were included in this study. In 95 patients, the tissues surrounding the cephalic vein were stripped off as per the conventional method, while the no-touch technique preserving the perivenous vascular tissues was utilized for vein harvesting in 74 patients. Patients were followed-up to compare primary and secondary patency rates of the arteriovenous fistulas at one year. RESULTS: Fistula failure developed in 22 patients within the first year resulting in primary patency rates of 90.5% versus 84.2% for the no-touch and the conventional groups, respectively (p=0.225). Likewise, secondary patency rates were 94.6% versus 93.7% for the no-touch and the conventional groups, respectively (p=0.803). The two groups did not differ with regards to primary or secondary patency rates. CONCLUSION: Findings of this study were not in favor of the no-touch technique compared to the conventional methods in terms of arteriovenous fistula patency at one year.

Proximal Aortic Surgery: Upper "J" or Conventional Sternotomy?

BACKGROUND: While minimally invasive procedures are being used in cardiac surgery, experience with minimally invasive proximal aortic surgery has been limited to certain centers. METHODS: Between January 2010 and March 2015, 54 patients with an upper "J" hemi-sternotomy and 75 patients with a conventional sternotomy due to proximal aortic pathology were included in this study. Forty-five patients from the "J" hemi-sternotomy group were matched with 45 patients from the conventional sternotomy group with respect to age, sex, ejection fraction, diabetes, hypertension, smoking history and operative type. Perioperative variables were in-hospital mortality, surgery for revision, amount of blood loss, requirement for blood transfusion, cardiopulmonary bypass (CPB), aortic cross-clamp and unilateral cerebral protection times, duration of ventilation, and length of intensive care unit (ICU) and total hospital stay. RESULTS: Patients were between 21-76 years with a mean age of 58.14 ± 11.06 years; 73.3% (n = 66) were male and 26.7% (n = 24) were female. Of all the cases included, 36.7% (n = 33) had isolated ascending aortic replacement, 41.1% (n = 37) had concomitant aortic valve replacement and ascending aortic replacement, and 22.2% (n = 20) had a Bentall procedure. Statistically, the amount of bleeding (P = .026), length of ventilation (P = .001), ICU (P = .001) and total hospital stay (P = .004) in the "J" hemi-sternotomy group were all found to be significantly lower than those in the conventional group. CONCLUSIONS: Minimally invasive techniques like an upper "J" hemi-sternotomy can be safely performed without prolonging the aortic clamp time, and with less blood loss, less ventilatory support, and shorter ICU and total hospital stays when compared to conventional methods.

Preoperative risk factors for in-hospital mortality and validity of the Glasgow aneurysm score and Hardman index in patients with ruptured abdominal aortic aneurysm.

The aim of this study is to evaluate the validity of the Glasgow aneurysm score (GAS) and Hardman index in patients operated on because of ruptured abdominal aortic aneurysm (rAAA), and determining preoperative risk factors that affect in-hospital mortality. One hundred one patients operated on to repair a rAAA within the last 10 years were included. The GAS and Hardman index were calculated for each patient separately. The relation between in-hospital mortality and the Hardman index and GAS was analyzed by means of the receiver-operator characteristic (ROC) curve. Univariate and multivariate methods of analyses were used to determine preoperative risk factors. Average age was 69 ± 8, and in-hospital mortality rate was 51.5%. Analysis of the ROC curve showed that the Hardman index had an area under the curve (AUC) = 0.71 (95% confidence interval [CI], 0.593-0.800, P = 0.0002) for predicting in-hospital mortality. The GAS had an AUC = 0.77 (95% CI, 0.680-0.851, P < 0.0001). The results of multivariate analysis revealed the presence of the following preoperative risk factors: age more than 63 years (odds ratio [OR], 4.4; 95% CI, 1.17-16.49, P = 0.028); loss of consciousness (OR, 9.33; 95% CI, 1.94-44.86, P = 0.005); creatinine higher than 1.7 mg/dL (OR, 5.52; 95% CI, 1.92-15.85, P = 0.001); and pH lower than 7.31 (OR, 3.77; 95% CI, 1.18-11.99, P = 0.024). In conclusion, the Hardman index and GAS have a significant correlation with in-hospital mortality rates. Nevertheless, a high score does not necessarily correspond with a definite mortality. This is why scoring systems could not be considered as the sole criterion for choosing patients for this study. Clinical experience was still the leading factor in deciding against or in favor of surgery.

Unusual metastasis of the papillary thyroid adenocarcinoma.

Floating thrombus in the ascending aorta is rare and its association with papillary thyroid adenocarcinoma has not been documented. We report a case of a 64-year-old man who was referred to our emergency unit because of suspected type A aortic dissection. Computerized tomographic and transthoracic echocardiographic scans revealed a floating thrombus in the aneurysmatic ascending aorta. The thrombus was removed with the dilated aorta. Although the aortic wall was macroscopically normal, histologic examination revealed metastatic papillary adenocarcinoma.

Safety of unilateral antegrade cerebral perfusion at 22 degrees C systemic hypothermia.

BACKGROUND: The superiority of antegrade cerebral perfusion (ACP) in aortic surgery is widely accepted, but the sufficiency of unilateral cerebral perfusion and the optimal systemic temperature during the operation are still controversial. METHODS: Thirty patients who underwent operation with unilateral ACP at a systemic temperature of 22 degrees C between January 2005 and September 2007 were included in this study. The mean age (+/-SD) of the patients was 58 +/- 11 years, and 21 (70%) of the patients were male. The indication for surgery was acute type A aortic dissection in 14 patients (47%), degenerative aortic aneurysm in 9 patients (30%), dissecting aortic aneurysm in 6 patients (20%), and intramural hematoma in 1 patient (3%). Supracoronary ascending aorta replacement was performed in 13 patients (43%). Eight patients (27%) underwent ascending aorta and hemiarch replacement. The Bentall procedure was performed with hemiarch replacement in 3 patients (10%). Three patients (10%) underwent total aortic arch replacement, and 2 patients (7%) underwent the Bentall procedure. The ascending aorta, aortic arch, and descending aorta were replaced in 1 patient (3%). RESULTS: Hospital mortality was limited to 1 patient (3.3%). A permanent or transient neurologic deficit was not detected in any of the survivors. The mean cardiopulmonary bypass, aortic cross-clamp, and ACP times were 144 +/- 40 minutes, 82 +/- 28 minutes, and 30 +/- 11 minutes, respectively. The mean mechanical ventilation time was 18 +/- 9 hours. The mean stay in the intensive care unit was 2.3 +/- 1.1 days, and the mean hospital stay was 12 +/- 6 days. CONCLUSION: Unilateral ACP with systemic hypothermia at 22 degrees C is safe and has satisfactory clinical results. Establishing ACP via cannulation of the right axillary artery is fast and simple. The presence of fewer cannulas in the operation field provides an operative condition as convenient as the deep hypothermic circulatory arrest technique.

Primary cardiac rhabdomyosarcoma of the right atrium: case report.

Rhabdomyosarcoma is a rare malignant tumor of the heart that accounts for 20% of all primary malignant neoplasms of the heart. Symptoms vary in accordance with the location of the mass; unfortunately, by the time the patient becomes symptomatic, the tumor has already metastasized to other organs. Diagnosis is frequently obtained via transthoracic or transesophageal echocardiography and nuclear magnetic resonance imaging. Surgery is indicated for malignant cardiac neoplasms to relieve cardiac symptoms and to prolong patient survival. Subsequent postoperative chemotherapy or radiotherapy is necessary, and the long-term prognosis is poor. We present a case of a primary cardiac rhabdomyosarcoma that arose from the lateral wall of the right atrium and required implantation of a permanent cardiac pacemaker after surgery.