In vitro effects of L-carnitine on coronary artery bypass grafts.

BACKGROUND: The gold standard treatment for multivessel coronary revascularization is coronary artery bypass grafting. The internal mammary artery and saphenous vein grafts are the conduits most frequently used for these operations. Spasm of arterial and venous grafts is a significant problem during the operation. OBJECTIVES: To evaluate the acute in vitro effects of L-carnitine on internal mammary artery and saphenous vein grafts using a tissue bath. METHODS: Ten consecutive patients who underwent elective coronary artery bypass grafting were enrolled in the present study (nine men, one woman; mean [± SD] age 62±9.1 years). Samples from left internal mammary artery and saphenous vein grafts were collected from each patient. Submaximal smooth muscle contraction was achieved by adding 1 µM phenylephrine, and L-carnitine was then added to the solution. The concentration-response curves of the vasodilation response were obtained. RESULTS: In the internal mammary graft samples, the vasodilation response to L-carnitine was 64.3±11.1% at a concentration of 5 mM. In the saphenous vein graft samples, the vasodilation response to L-carnitine was 41.5±11.4% at a concentration of 5 mM. There was a statistically significant difference (P<0.001) between the response of the internal mammary artery and saphenous vein grafts in the in vitro tissue bath system. CONCLUSIONS: These results indicate that L-carnitine is a potential vasodilatory drug for internal mammary artery and saphenous vein grafts.

Harvesting of the radial artery: subfasciotomy or full skeletonization: a comparative study.

BACKGROUND: Long fasciotomy of the posterior aspect of the radial artery (RA) for the purpose of sympathectomy is one of the surgical techniques for the preparation of this graft. We compared the early results of this technique with those of the RA graft harvested as a pedicle in the conventional fashion. METHODS: The study patients have been selected from the patients who underwent coronary artery bypass grafting (CABG) using the RA graft harvested either with a long posterior fasciotomy (group 1) or as a whole with a pedicle in the classical manner (group 2). Only the patients with a flow study have been included. The flow index was described as the bleeding amount of the RA in a minute per body surface area (mL/m2 min). The flow index has been performed before and after fasciotomy in group 1, and after full skeletonization in group 2. The clinical and demographic parameters and flow indices were measured and compared between the groups, and in group 1, before and after fasciotomy. RESULTS: From 218 patients with CABG using the RA between January 1998 and August 2005, a total of 57 patients were recruited into the study. Group 1 consisted of 25 patients. Thirty-two patients constituted group 2. Subfascial dissection of the RA increased the blood flow index from 48 +/- 20 mL/m2 min to 51 +/- 19 mL/m2 min (p < 0.001). The comparison of the clinical, perioperative characteristics of the patients was not different between the groups. CONCLUSIONS: The necessity of total skeletonization of the RA should not be the only option when the aim is to reduce the spasm. While subfascial dissection (sympathectomy) of the pediculed RA alone provides a satisfactory increase in the blood flow index, it also reduces the manipulation time as well as the risk of injury to the graft.

[Missed aortic transection following blunt trauma: a case report]. / Künt travmaya bagli farkedilmeyen aort transeksiyonu: olgu sunumu.

Missed vascular injuries following blunt traumas can lead to fatal clinical conditions that require an emergency intervention. Aortic transection (AT) is the most fatal complication of these missed vascular injuries. In this case report an AT that developed following a blunt trauma is presented. The patient was admitted with effort dyspnea and tachycardia. He had a history of blunt trauma three years ago. There was an enlargement of the upper mediastinum on X-ray studies. Thoracal magnetic resonance imaging and computed tomography revealed aneurysm of the descending aorta. Dacron graft interposition was performed as surgical treatment. The symptom and signs disappeared dramatically after the operation.

The effects of lipid-lowering therapy on graft patency in coronary bypass surgery patients.

BACKGROUND: Our aim was to investigate the effects of lipid-lowering treatment (LLT) on graft patency in coronary artery bypass grafting (CABG) patients. METHODS: A total of 209 CABG patients (95 men, 45%) with a total cholesterol level above 200 mg/dL and a low-density lipoprotein level above 100 mg/dL were included. Patients were divided into 2 groups on the basis of administration of LLT after CABG: group 1 received LLT after the operation (those patients undergoing operations after 1998, n = 102, 49% male) and group 2 did not receive LLT after the operation (those patients undergoing operations between 1992 and 1998, n = 107, 42% male). Median duration of follow-up was 5.2 years. Follow-up angiography could be obtained in 108 (52%) patients (56 in group 1, 52 in group 2). RESULTS: There was a 42% reduction in ischemic events and deaths in group 1, and 60% of these patients had a symptom-free or event-free period for 6 years. The 5-year graft patency for left internal mammary artery-to-left anterior descending artery grafts in group 1 was 95%, and the corresponding figure was 90% in group 2. Right coronary artery-to-saphenous vein graft patency was 66% for group 1 and 30% for group 2. Circumflex artery-to-saphenous vein patency rate was 59% for group 1 and 53% for group 2. A higher graft patency was found in group 1 as a whole. CONCLUSION: Results of this retrospective study support the fact that LLT provides a higher graft patency for CABG patients.

Transcutaneous axillary artery cannulation.

The axillary artery may be an alternative cannulation site for patients with diffused atherosclerosis, aortic dissection, and aneurysm. There are different techniques for axillary artery cannulation that can be performed easily with a transcutaneous approach. Small incision necessity, less dissection, and good wound healing are other advantages of this technique.

[Single clamp technique in elderly patients undergoing coronary artery surgery]. / Koroner Arter Cerrahisi Uygulanan Yasli Hastalarda Tek Klemp Teknigi.

OBJECTIVE: The results of single clamp and partial clamp techniques were retrospectively compared in elderly patients (>70 years) undergoing coronary artery bypass grafting operation (CABG). METHODS: A total of 244 elderly patients undergoing CABG between January 1995 and March 2002 in our center were studied. Single-clamp technique was used in 32 cases (Group 1) and partial-clamp technique was used in 212 cases (Group 2). All patients had isolated coronary artery lesions and a primary elective coronary bypass grafting surgery was planned for every case. Preoperative, operative and postoperative variables; age, gender, pre- and post-operative neurological status (stroke, amaurosis fugax, aphasia, hemiplegia, hemiparesis), cerebrovascular diseases, diabetes mellitus, hypertension, number of distal grafts, left ventricular score, durations of aortic cross-clamping and cardiopulmonary bypass (CPB) times, perfusion pressure during CPB, and postoperative cardiac status were recorded. Patients with a history of neurological complications were excluded from the study. RESULTS: Overall, mean age was 71.9+/-2.18 years. Patients in Group 1 were significantly older as compared to patients in Group 2 (p< 0.01). Average duration of cross-clamping in Group 1 was significantly longer (p<0.001) compared to Group 2, but there were no differences with regard to the total duration of cardiopulmonary bypass (p=0.535). No patients had neurological complications in Group 1, however 22 patients in Group 2 had neurological complications (p<0.05). CONCLUSION: Although single-clamp technique was associated with a longer cross-clamp time, the duration of CPB was not increased and the incidence of neurological complications was low.